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Kılıç A, Clarke AL, Moon Z, Hamada Y, Chan AHY, Rahman A, Layton C, Griffiths CJ, Zenner D, Powell E, Kunst H, Lipman M, Mandelbaum M, Papineni P, Tattersall T, Duong T, Abubakar I, Rangaka MX, Horne R. Health and illness beliefs in adults with tuberculosis infection during the COVID-19 pandemic in the UK. Dialogues Health 2024; 4:100162. [PMID: 38516222 PMCID: PMC10953974 DOI: 10.1016/j.dialog.2023.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 03/23/2024]
Abstract
Background COVID-19 disrupted the TB prevention programme in the UK, especially for TB infection (TBI) care. We explore whether experience of the COVID-19 pandemic impacted on patients' perceptions of TBI and its treatment. Methods Semi-structured interviews were conducted as part of the Research to Improve Detection and Treatment of TBI (RID-TB) programme, exploring perceptual and practical barriers to TBI treatment. Nineteen people diagnosed with TBI were interviewed between August 2020 and April 2021. Recordings were transcribed and analysed using a constant comparative approach, allowing for a dynamic and iterative exploration of themes. Themes are organised using the Perceptions and Practicalities Approach. Findings Some participants perceived TBI as a risk factor for increased susceptibility to COVID-19, while some thought that treatment for TBI might protect against COVID-19 or mitigate its effects. Adaptations to TB services (e.g., remote follow-up) and integrated practices during the COVID-19 restrictions (e.g., medication being posted) addressed some practical barriers to TBI treatment. However, we identified beliefs about TBI and COVID-19 that are likely to act as barriers to engagement with TBI treatment, including: interpreting service delays as an indication of TBI not being serious enough for treatment and concerns about contracting COVID-19 in TB clinics. Interpretation COVID-19 and TBI service delays influence people's perceptions and practical barriers to TBI treatment adherence. Failure to address these beliefs may lead to people's concerns about their treatment not being fully addressed. Utilised service adaptations like remote consultations to address practical barriers may be relevant beyond COVID-19. Funding NIHR RID-TB Program (RP-PG-0217-20009).
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Affiliation(s)
- Ayşenur Kılıç
- School of Pharmacy, University College London, London, UK
| | - Amy L. Clarke
- School of Pharmacy, University College London, London, UK
| | - Zoe Moon
- School of Pharmacy, University College London, London, UK
| | - Yohhei Hamada
- Institute for Global Health, University College London, London, UK
| | - Amy Hai Yan Chan
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Ananna Rahman
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | | | - Chris J. Griffiths
- Centre for Primary Care, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dominik Zenner
- Centre for Primary Care, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ellen Powell
- MRC Clinical Trials Unit, University College London, UK
| | - Heinke Kunst
- Respiratory Medicine, Queen Mary University of London, London, UK
| | - Marc Lipman
- Royal Free London NHS Foundation Trust, London, UK
- UCL-TB and UCL Respiratory, University College London, London, UK
| | | | | | | | - Trinh Duong
- MRC Clinical Trials Unit, University College London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Molebogeng X. Rangaka
- Institute for Global Health, University College London, London, UK
- Division of Epidemiology and Biostatistics & CIDRI-AFRICA, University of Cape Town, Cape Town, South Africa
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
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Treacy J, Morrato EH, Horne R, Wolf MS, Bakhai A, Wilson MC, Lightowler M, Guerler S, Jokinen J. Behavioral Science: Enhancing Our Approach to the Development of Effective Additional Risk Minimization Strategies. Drug Saf 2024:10.1007/s40264-024-01420-w. [PMID: 38594553 DOI: 10.1007/s40264-024-01420-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/11/2024]
Abstract
Additional risk minimization strategies may be required to assure a positive benefit-risk balance for some therapeutic products associated with serious adverse drug reactions/risks of use, without which these products may be otherwise unavailable to patients. The goals of risk minimization strategies are often fundamentally to influence the behavior of healthcare professionals (HCPs) and/or patients and can include appropriate patient selection, provision of education and counselling, appropriate medication use, adverse drug reaction monitoring, and adoption of other elements to assure safe use, such as pregnancy prevention. Current approaches to additional risk minimization strategy development rely heavily on information provision, without full consideration of the contextual factors and multi-level influences on patient and HCP behaviors that impact adoption and long-term adherence to these interventions. Application of evidence-based behavioral science methods are urgently needed to improve the quality and effectiveness of these strategies. Evidence from the fields of adherence, health promotion, and drug utilization research underscores the value and necessity for using established behavioral science frameworks and methods if we are to achieve clinical safety goals for patients. The current paper aims to enhance additional risk minimization strategy development and effectiveness by considering how a behavioral science approach can be applied, drawing from evidence in understanding of engagement with pharmaceutical medicines as well as wider public health interventions for patients and HCPs.
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Affiliation(s)
| | - Elaine H Morrato
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL, USA
| | - Robert Horne
- Spoonful of Sugar Ltd, University College London Business Company, Brighton and Hove, UK
| | - Michael S Wolf
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ameet Bakhai
- The Royal Free and University College Medical School, London, UK
| | | | - Mark Lightowler
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King's College London, London, UK
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Farmer AJ, Allen J, Bartlett YK, Bower P, Chi Y, French DP, Gudgin B, Holmes E, Horne R, Hughes DA, Jones L, Kenning C, Locock L, McSharry J, Miles L, Newhouse N, Rea R, Robinson S, Tarassenko L, Velardo C, Williams N, Yu LM. Supporting people with type 2 diabetes in effective use of their medicine through mobile health technology integrated with clinical care (SuMMiT-D pilot): results of a feasibility randomised trial. Pilot Feasibility Stud 2024; 10:15. [PMID: 38273420 PMCID: PMC10809651 DOI: 10.1186/s40814-023-01429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The purpose of this 6-month intervention pilot feasibility randomised trial was to test sending brief messages using mobile phones to promote self-management through taking medication as prescribed to people with type 2 diabetes. This was to inform the design and conduct of a future large-scale United Kingdom-based clinical trial and establish the feasibility of recruitment, the technology used, follow-up, and data collection. METHODS A multicentre individually randomised, controlled parallel group trial in primary care, recruiting adults (≥ 35 years) with type 2 diabetes in England. Consenting participants were randomly allocated to receive short message system text messages up to four times a week, or usual care, for a period of 6 months; messages contained behavioural change techniques targeting medication use. The primary outcome was the rate of recruitment to randomisation of participants to the trial with a planned rate of 22 participants randomised per month. The study also aimed to establish the feasibility of follow-up at 6 months, with an aim of retaining more than 80% of participants. Data, including patient-reported measures, were collected at baseline and the end of the 6-month follow-up period, and a notes review was completed at 24 months. RESULTS The trial took place between 26 November 2018 and 30 September 2019. In total 209 participants were randomly allocated to intervention (n = 103) or usual care (n = 106). The maximum rate of monthly recruitment to the trial was 60-80 participants per month. In total, 12,734 messages were sent to participants. Of these messages, 47 were identified as having failed to be sent by the service provider. Participants sent 2,864 messages to the automated messaging system. Baseline data from medical records were available for > 90% of participants with the exception of cholesterol (78.9%). At 6 months, a further HbA1c measurement was reported for 67% of participants. In total medical record data were available at 6 months for 207 (99.0%) of participants and completed self-report data were available for 177 (84.7%) of participants. CONCLUSION The feasibility of a large-scale randomised evaluation of brief message intervention for people with type 2 diabetes appears to be high using this efficient design. Failure rate of sending messages is low, rapid recruitment was achieved among people with type 2 diabetes, clinical data is available on participants from routine medical records and self-report of economic measures was acceptable. TRIAL REGISTRATION ISCTRN ISRCTN13404264. Registered on 10 October 2018.
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Affiliation(s)
- Andrew J Farmer
- University of Oxford, Oxford, UK.
- Nuffield Department of Primary Care Health Sciences, Woodstock Road, Oxford, OX2 6GG, UK.
| | | | | | | | - Yuan Chi
- University of Oxford, Oxford, UK
| | | | | | | | | | | | | | | | | | | | - Lisa Miles
- University of Manchester, Manchester, UK
| | | | - Rustam Rea
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Stewart SJF, Pandolfo AM, Moon Z, Jani Y, Brett SJ, Brealey D, Singh S, Enne VI, Livermore DM, Gant V, Horne R. UK clinicians' attitudes towards the application of molecular diagnostics to guide antibiotic use in ICU patients with pneumonias: a quantitative study. J Antimicrob Chemother 2024; 79:123-127. [PMID: 37970680 PMCID: PMC10761255 DOI: 10.1093/jac/dkad355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/13/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Molecular diagnostic tests may improve antibiotic prescribing by enabling earlier tailoring of antimicrobial therapy. However, clinicians' trust and acceptance of these tests will determine their application in practice. OBJECTIVES To examine ICU prescribers' views on the application of molecular diagnostics in patients with suspected hospital-acquired and ventilator-associated pneumonia (HAP/VAP). METHODS Sixty-three ICU clinicians from five UK hospitals completed a cross-sectional questionnaire between May 2020 and July 2020 assessing attitudes towards using molecular diagnostics to inform initial agent choice and to help stop broad-spectrum antibiotics early. RESULTS Attitudes towards using molecular diagnostics to inform initial treatment choices and to stop broad-spectrum antibiotics early were nuanced. Most (83%) were positive about molecular diagnostics, agreeing that using results to inform broad-spectrum antibiotic prescribing is good practice. However, many (58%) believed sick patients are often too unstable to risk stopping broad-spectrum antibiotics based on a negative result. CONCLUSIONS Positive attitudes towards the application of molecular diagnostics to improve antibiotic stewardship were juxtapositioned against the perceived need to initiate and maintain broad-spectrum antibiotics to protect unstable patients.
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Affiliation(s)
| | - Alyssa M Pandolfo
- Centre for Behavioural Medicine, University College London, London, UK
| | - Zoe Moon
- Centre for Behavioural Medicine, University College London, London, UK
| | - Yogini Jani
- Centre for Behavioural Medicine, University College London, London, UK
- UCLH-UCL Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephen J Brett
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - David Brealey
- Division of Critical Care, University College London Hospitals NHS Foundation Trust, London, UK
| | - Suveer Singh
- Department of Respiratory and Critical Care Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Virve I Enne
- Division of Infection and Immunity, University College London, London, UK
| | - David M Livermore
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Vanya Gant
- Department of Medical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Robert Horne
- Centre for Behavioural Medicine, University College London, London, UK
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Moncrieff J, Crellin N, Stansfeld J, Cooper R, Marston L, Freemantle N, Lewis G, Hunter R, Johnson S, Barnes T, Morant N, Pinfold V, Smith R, Kent L, Darton K, Long M, Horowitz M, Horne R, Vickerstaff V, Jha M, Priebe S. Antipsychotic dose reduction and discontinuation versus maintenance treatment in people with schizophrenia and other recurrent psychotic disorders in England (the RADAR trial): an open, parallel-group, randomised controlled trial. Lancet Psychiatry 2023; 10:848-859. [PMID: 37778356 DOI: 10.1016/s2215-0366(23)00258-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/07/2023] [Accepted: 07/17/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Maintenance antipsychotic medication is recommended for people with schizophrenia or recurrent psychosis, but the adverse effects are burdensome, and evidence on long-term outcomes is sparse. We aimed to assess the benefits and harms of a gradual process of antipsychotic reduction compared with maintenance treatment. Our hypothesis was that antipsychotic reduction would improve social functioning with a short-term increase in relapse. METHODS RADAR was an open, parallel-group, randomised trial done in 19 National Health Service Trusts in England. Participants were aged 18 years and older, had a diagnosis of recurrent, non-affective psychotic disorder, and were prescribed an antipsychotic. Exclusion criteria included people who had a mental health crisis or hospital admission in the past month, were considered to pose a serious risk to themselves or others by a treating clinician, or were mandated to take antipsychotic medication under the Mental Health Act. Through an independent, internet-based system, participants were randomly assigned (1:1) to gradual, flexible antipsychotic reduction, overseen by treating clinicians, or to maintenance. Participants and clinicians were aware of treatment allocations, but assessors were masked to them. Follow-up was for 2 years. Social functioning, assessed by the Social Functioning Scale, was the primary outcome. The principal secondary outcome was severe relapse, defined as requiring admission to hospital. Analysis was done blind to group identity using intention-to-treat data. The trial is completed and has been registered with ISRCTN registry (ISRCTN90298520) and with ClinicalTrials.gov (NCT03559426). FINDINGS 4157 people were screened, of whom 253 were randomly allocated, including 168 (66%) men, 82 (32%) women, and 3 (1%) transgender people, with a mean age of 46 years (SD 12, range 22-79). 171 (67%) participants were White, 52 (21%) were Black, 16 (6%) were Asian, and 12 (5%) were of other ethnicity. The median dose reduction at any point during the trial was 67% in the reduction group and zero in the maintenance group; at 24 months it was 33% versus zero. At the 24-month follow-up, we assessed 90 of 126 people assigned to the antipsychotic dose reduction group and 94 of 127 assigned to the maintenance group, finding no difference in the Social Functioning Scale (β 0·19, 95% CI -1·94 to 2·33; p=0·86). There were 93 serious adverse events in the reduction group affecting 49 individuals, mainly comprising admission for a mental health relapse, and 64 in the maintenance group, relating to 29 individuals. INTERPRETATION At 2-year follow-up, a gradual, supported process of antipsychotic dose reduction had no effect on social functioning. Our data can help to inform decisions about the use of long-term antipsychotic medication. FUNDING National Institute for Health Research.
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Affiliation(s)
- Joanna Moncrieff
- Division of Psychiatry, University College London, London, UK; North East London Foundation NHS Trust, London, UK.
| | | | - Jacki Stansfeld
- Division of Psychiatry, University College London, London, UK; North East London Foundation NHS Trust, London, UK
| | - Ruth Cooper
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; East London NHS Foundation Trust, Newham Centre for Mental Health, London, UK
| | - Louise Marston
- Research Department of Primary Care and Population Health, University College London, London, UK; PRIMENT Clinical trials unit, University College London, London, UK
| | - Nick Freemantle
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK; PRIMENT Clinical trials unit, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Thomas Barnes
- Division of Psychiatry, Imperial College, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | | | | | | | | | - Maria Long
- Division of Psychiatry, University College London, London, UK; Department of Health Services Research and Management, City University, London, UK
| | - Mark Horowitz
- Division of Psychiatry, University College London, London, UK; North East London Foundation NHS Trust, London, UK
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | - Victoria Vickerstaff
- Research Department of Primary Care and Population Health, University College London, London, UK; PRIMENT Clinical trials unit, University College London, London, UK
| | - Mithilesh Jha
- Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
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Stewart SJF, Slodkowska-Barabasz J, McGeagh L, Moon Z, Brett J, Wells M, Brown MC, Turner M, Horne R, Fenlon D, Rehman F, Cain H, Donnelly P, Harmer V, Turner L, Rose J, Sharp L, Watson E. Development of the HT&Me intervention to support women with breast cancer to adhere to adjuvant endocrine therapy and improve quality of life. Breast 2023; 70:32-40. [PMID: 37300986 PMCID: PMC10382955 DOI: 10.1016/j.breast.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Breast cancer is the most common cancer in women worldwide. Approximately 80% of breast cancers are oestrogen receptor positive (ER+). Patients treated surgically are usually recommended adjuvant endocrine therapy (AET) for 5-10 years. AET significantly reduces recurrence, but up to 50% of women do not take it as prescribed. OBJECTIVE To co-design and develop an intervention to support AET adherence and improve health-related quality-of-life (QoL) in women with breast cancer. METHODS Design and development of the HT&Me intervention took a person-based approach and was guided by the Medical Research Council framework for complex interventions, based on evidence and underpinned by theory. Literature reviews, behavioural analysis, and extensive key stakeholder involvement informed 'guiding principles' and the intervention logic model. Using co-design principles, a prototype intervention was developed and refined. RESULTS The blended tailored HT&Me intervention supports women to self-manage their AET. It comprises initial and follow-up consultations with a trained nurse, supported with an animation video, a web-app and ongoing motivational 'nudge' messages. It addresses perceptual (e.g. doubts about necessity, treatment concerns) and practical (e.g. forgetting) barriers to adherence and provides information, support and behaviour change techniques to improve QoL. Iterative patient feedback maximised feasibility, acceptability, and likelihood of maintaining adherence; health professional feedback maximised likelihood of scalability. CONCLUSIONS HT&Me has been systematically and rigorously developed to promote AET adherence and improve QoL, and is complemented with a logic model documenting hypothesized mechanisms of action. An ongoing feasibility trial will inform a future randomised control trial of effectiveness and cost-effectiveness.
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Affiliation(s)
- Sarah-Jane F Stewart
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, UK
| | | | - Lucy McGeagh
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, UK
| | - Zoe Moon
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, UK
| | - Jo Brett
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, UK
| | - Mary Wells
- Imperial College Healthcare NHS Trust, UK
| | - Morven C Brown
- Population Health Sciences Institute, Newcastle University, UK; Newcastle University Centre for Cancer, Newcastle University, UK
| | - Mark Turner
- Research Software Engineering, Newcastle University, UK
| | - Robert Horne
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, UK
| | - Deborah Fenlon
- Faculty of Medicine and Life Science, Swansea University, UK
| | | | - Henry Cain
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | | | | | | | - Jan Rose
- Patient and Public Involvement Representatives, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, UK; Newcastle University Centre for Cancer, Newcastle University, UK
| | - Eila Watson
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, UK.
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Stringer D, Gardner L, Shaw O, Clarke B, Briggs D, Worthington J, Buckland M, Danzi G, Hilton R, Picton M, Thuraisingham R, Borrows R, Baker R, McCullough K, Stoves J, Phanish M, Shah S, Shiu KY, Walsh SB, Ahmed A, Ayub W, Hegarty J, Tinch-Taylor R, Georgiou E, Bidad N, Kılıç A, Moon Z, Horne R, McCrone P, Kelly J, Murphy C, Peacock J, Dorling A. Optimized immunosuppression to prevent graft failure in renal transplant recipients with HLA antibodies (OuTSMART): a randomised controlled trial. EClinicalMedicine 2023; 56:101819. [PMID: 36684392 PMCID: PMC9852275 DOI: 10.1016/j.eclinm.2022.101819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND 3% of kidney transplant recipients return to dialysis annually upon allograft failure. Development of antibodies (Ab) against human leukocyte antigens (HLA) is a validated prognostic biomarker of allograft failure. We tested whether screening for HLA Ab, combined with an intervention to improve adherence and optimization of immunosuppression could prevent allograft failure. METHODS Prospective, open-labelled randomised biomarker-based strategy (hybrid) trial in 13 UK transplant centres [EudraCT (2012-004308-36) and ISRCTN (46157828)]. Patients were randomly allocated (1:1) to unblinded or double-blinded arms and screened every 8 months. Unblinded HLA Ab+ patients were interviewed to encourage medication adherence and had tailored optimisation of Tacrolimus, Mycophenolate mofetil and Prednisolone. The primary outcome was time to graft failure in an intention to treat analysis. The trial had 80% power to detect a hazard ratio of 0.49 in donor specific antibody (DSA)+ patients. FINDINGS From 11/9/13 to 27/10/16, 5519 were screened for eligibility and 2037 randomised (1028 to unblinded care and 1009 to double blinded care). We identified 198 with DSA and 818 with non-DSA. Development of DSA, but not non-DSA was predictive of graft failure. HRs for graft failure in unblinded DSA+ and non-DSA+ groups were 1.54 (95% CI: 0.72 to 3.30) and 0.97 (0.54-1.74) respectively, providing no evidence of an intervention effect. Non-inferiority for the overall unblinded versus blinded comparison was not demonstrated as the upper confidence limit of the HR for graft failure exceeded 1.4 (1.02, 95% CI: 0.72 to 1.44). The only secondary endpoint reduced in the unblinded arm was biopsy-proven rejection. INTERPRETATION Intervention to improve adherence and optimize immunosuppression does not delay failure of renal transplants after development of DSA. Whilst DSA predicts increased risk of allograft failure, novel interventions are needed before screening can be used to direct therapy. FUNDING The National Institute for Health Research Efficacy and Mechanism Evaluation programme grant (ref 11/100/34).
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Affiliation(s)
- Dominic Stringer
- Biostatistics and Health Informatics, The Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- King's Clinical Trials Unit, King's College London, London, UK
| | - Leanne Gardner
- King's Clinical Trials Unit, King's College London, London, UK
- Centre for Nephrology, Urology and Transplantation, Department of Inflammation Biology, King's College London, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
| | - Olivia Shaw
- Clinical Transplantation Laboratory, Viapath Analytics LLP, London, UK
| | - Brendan Clarke
- Transplant Immunology, Level 09 Gledhow Wing, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - David Briggs
- NHSBT Birmingham, Vincent Drive, Edgbaston, Birmingham, B15 2SG, UK
| | - Judith Worthington
- Transplantation Laboratory, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Matthew Buckland
- Clinical Transplantation Laboratory, The Royal London Hospital, 2nd Floor, Pathology and Pharmacy Building, 80 Newark Street, London, E1 1BB, UK
| | - Guilherme Danzi
- Renal Unit, Hospital das Clínicas da Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife - PE, 50670-901, Brazil
| | - Rachel Hilton
- Department of Nephrology and Transplantation, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
| | - Michael Picton
- Department of Renal Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Raj Thuraisingham
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, E1 1BB, UK
| | - Richard Borrows
- Renal Unit, University Hospital Birmingham, Edgbaston, Birmingham, B15 2LN, UK
| | - Richard Baker
- Renal Unit, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Keith McCullough
- Renal Unit, York Teaching Hospital NHS Foundation Trust, York, YO31 8HE, UK
| | - John Stoves
- Renal Unit, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD5 0NA, UK
| | - Mysore Phanish
- Renal Unit, Epsom and St Helier University Hospitals NHS Trust, Surrey, UK
| | - Sapna Shah
- Renal Unit, King's College Hospital, London, SE5 9RJ, UK
| | - Kin Yee Shiu
- UCL Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, NW3 2QG, UK
| | - Stephen B. Walsh
- UCL Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, NW3 2QG, UK
| | - Aimun Ahmed
- Renal Unit, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, PR2 9HT, UK
| | - Waqar Ayub
- Renal Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - Janet Hegarty
- Renal Unit, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK
| | - Rose Tinch-Taylor
- Biostatistics and Health Informatics, The Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- King's Clinical Trials Unit, King's College London, London, UK
| | | | - Natalie Bidad
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, WC1H 9JP, UK
| | - Ayşenur Kılıç
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, WC1H 9JP, UK
| | - Zoe Moon
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, WC1H 9JP, UK
| | - Robert Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, WC1H 9JP, UK
| | - Paul McCrone
- King's Clinical Trials Unit, King's College London, London, UK
- Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK
| | - Joanna Kelly
- King's Clinical Trials Unit, King's College London, London, UK
| | - Caroline Murphy
- King's Clinical Trials Unit, King's College London, London, UK
| | - Janet Peacock
- School of Life Course and Population Sciences, King's College London, London, UK
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College, USA
| | - Anthony Dorling
- Centre for Nephrology, Urology and Transplantation, Department of Inflammation Biology, King's College London, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
- Corresponding author.
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Khalifeh AH, Alhalaiqa FN, Hamaideh SH, Horne R, Hamdan-Mansour AM. The effect of adherence therapy on medication adherence, health beliefs, self-efficacy, and depressive symptoms among patients diagnosed with major depressive disorder. Int J Ment Health Nurs 2023; 32:778-790. [PMID: 36628477 DOI: 10.1111/inm.13113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 01/12/2023]
Abstract
Medication adherence is a crucial health issue in major depressive disorder (MDD) that requires regular monitoring and attention. Hence, there are multiple reasons for medication non-adherence among them. This study aimed to examine the effect of adherence therapy (AT) on medication adherence, health beliefs, self-efficacy, and depressive symptoms among patients diagnosed with MDD. One group pretest-posttest, repeated measures time-series design was conducted. A sample of 32 patients was recruited conveniently; they received eight weekly sessions of AT. A self-reported questionnaire was used to measure variables. The analysis showed that the mean scores of the baseline indicated non-adherence, moderate general benefits beliefs about the medication, high beliefs that medication is harmful, high beliefs that doctors overuse medication, high beliefs about potential adverse effects from medication, low perception of MDD severity, and high threatening perception regarding MDD, a moderate degree of confidence in the ability to taking medications, and patients had moderately severe depressive symptoms (M = 16, 3.2, 3.1, 4.1, 3.8, 50, 3, 16 respectively). Over four measurement points, adherence therapy enhanced positive beliefs towards taking medication and illness, increased medication adherence self-efficacy, improved medication adherence, and decreased depressive symptoms (F = 68.57-379.2, P < 0.001). These improvements were clinically significant in all variables immediately post-AT but declined minimally over time. The study indicated that integrating AT as part of the pre-discharge protocol is one core component to sustaining positive healthcare outcomes. Continuous efforts should be paid in terms of the long-term sustainability of an intervention to enhance adherence and clinical outcomes.
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Affiliation(s)
| | | | - Shaher Hamad Hamaideh
- Community and Mental Health Nursing Department, Faculty of Nursing-The Hashemite University, Zarqa, Jordan
| | - Robert Horne
- Department of Practice and Policy, Centre for Behavioural Medicine, School of Pharmacy, University College London, London, UK
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9
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Paskins Z, Babatunde O, Sturrock A, Toh LS, Horne R, Maidment I. Supporting patients to get the best from their osteoporosis treatment: a rapid realist review of what works, for whom, and in what circumstance. Osteoporos Int 2022; 33:2245-2257. [PMID: 35688897 PMCID: PMC9568441 DOI: 10.1007/s00198-022-06453-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/28/2022] [Indexed: 11/23/2022]
Abstract
Systematic reviews that examine effectiveness of interventions to improve medicines optimisation do not explain how or why they work. This realist review identified that interventions which effectively optimise medicines use in osteoporosis include opportunities to address patients' perceptions of illness and treatment and/or support primary care clinician decision making. INTRODUCTION In people with osteoporosis, adherence to medicines is poorer than other diseases and patients report follow-up is lacking, and multiple unmet information needs. We conducted a rapid realist review to understand what contextual conditions and mechanisms enable interventions to support osteoporosis medication optimisation. METHODS A primary search identified observational or interventional studies which aimed to improve medicines adherence or optimisation; a supplementary second search identified research of any design to gain additional insights on emerging findings. Extracted data was interrogated for patterns of context-mechanism-outcome configurations, further discussed in team meetings, informed by background literature and the Practicalities and Perception Approach as an underpinning conceptual framework. RESULTS We identified 5 contextual timepoints for the person with osteoporosis (identifying a problem; starting medicine; continuing medicine) and the practitioner and healthcare system (making a diagnosis and giving a treatment recommendation; reviewing medicine). Interventions which support patient-informed decision making appear to influence long-term commitment to treatment. Supporting patients' practical ability to adhere (e.g. by lowering treatment burden and issuing reminders) only appears to be helpful, when combined with other approaches to address patient beliefs and concerns. However, few studies explicitly addressed patients' perceptions of illness and treatment. Supporting primary care clinician decision making and integration of primary and secondary care services also appears to be important, in improving rates of treatment initiation and adherence. CONCLUSIONS We identified a need for further research to identify a sustainable, integrated, patient-centred, and cost- and clinically effective model of long-term care for people with osteoporosis.
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Affiliation(s)
- Z Paskins
- School of Medicine, Keele University, Keele, UK.
- Haywood Academic Rheumatology Centre, Stoke-on-Trent, Staffordshire, UK.
| | - O Babatunde
- School of Medicine, Keele University, Keele, UK
| | - A Sturrock
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - L S Toh
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - R Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK
| | - I Maidment
- Clinical Pharmacy, Aston University, Birmingham, UK
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10
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Rangaka MX, Hamada Y, Duong T, Bern H, Calvert J, Francis M, Clarke AL, Ghanouni A, Layton C, Hack V, Owen-Powell E, Surey J, Sanders K, Booth HL, Crook A, Griffiths C, Horne R, Kunst H, Lipman M, Mandelbaum M, White PJ, Zenner D, Abubakar I. Evaluating the effect of short-course rifapentine-based regimens with or without enhanced behaviour-targeted treatment support on adherence and completion of treatment for latent tuberculosis infection among adults in the UK (RID-TB: Treat): protocol for an open-label, multicentre, randomised controlled trial. BMJ Open 2022; 12:e057717. [PMID: 36691120 PMCID: PMC9454004 DOI: 10.1136/bmjopen-2021-057717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/24/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The successful scale-up of a latent tuberculosis (TB) infection testing and treatment programme is essential to achieve TB elimination. However, poor adherence compromises its therapeutic effectiveness. Novel rifapentine-based regimens and treatment support based on behavioural science theory may improve treatment adherence and completion. METHODS AND ANALYSIS A pragmatic multicentre, open-label, randomised controlled trial assessing the effect of novel short-course rifapentine-based regimens for TB prevention and additional theory-based treatment support on treatment adherence against standard-of-care. Participants aged between 16 and 65 who are eligible to start TB preventive therapy will be recruited in England. 920 participants will be randomised to one of six arms with allocation ratio of 5:5:6:6:6:6: daily isoniazid +rifampicin for 3 months (3HR), routine treatment support (control); 3HR, additional treatment support; weekly isoniazid +rifapentine for 3 months (3HP), routine treatment support; weekly 3HP, additional treatment support ; daily isoniazid +rifapentine for 1 month (1HP), routine treatment support; daily 1HP, additional treatment support. Additional treatment support comprises reminders using an electronic pillbox, a short animation, and leaflets based on the perceptions and practicalities approach. The primary outcome is adequate treatment adherence, defined as taking ≥90% of allocated doses within the pre-specified treatment period, measured by electronic pillboxes. Secondary outcomes include safety and TB incidence within 12 months. We will conduct process evaluation of the trial interventions and assess intervention acceptability and fidelity and mechanisms for effect and estimate the cost-effectiveness of novel regimens. The protocol was developed with patient and public involvement, which will continue throughout the trial. ETHICS AND DISSEMINATION Ethics approval has been obtained from The National Health Service Health Research Authority (20/LO/1097). All participants will be required to provide written informed consent. We will share the results in peer-reviewed journals. TRIAL REGISTRATION NUMBER EudraCT 2020-004444-29.
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Affiliation(s)
- Molebogeng X Rangaka
- Institute for Global Health, University College London, London, UK
- School of Public Health, and Clinical Infectious Disease Research Institute-AFRICA, University of Cape Town, Cape Town, South Africa
| | - Yohhei Hamada
- Institute for Global Health, University College London, London, UK
| | - Trinh Duong
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Henry Bern
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Joanna Calvert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Marie Francis
- Institute for Global Health, University College London, London, UK
| | | | - Alex Ghanouni
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, UK
| | - Charlotte Layton
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Vanessa Hack
- Institute for Global Health, University College London, London, UK
| | - Ellen Owen-Powell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Julian Surey
- Institute for Global Health, University College London, London, UK
| | - Karen Sanders
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Helen L Booth
- North Central London Tuberculosis Service, Whittington Health NHS Trust and University College London Hospitals NHS Foundation Trust, London, UK
| | - Angela Crook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Chris Griffiths
- Wolfson Institute for Population Health Barts and the London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Robert Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, UK
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Marc Lipman
- UCL Respiratory, Division of Medicine, University College, London, UK
- Royal Free London Hospital NHS Foundation Trust, London, UK
| | | | - Peter J White
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
- MRC Centre for Global Infectious Disease Analysis, Imperial College, London, UK
| | - Dominik Zenner
- Institute for Global Health, University College London, London, UK
- Wolfson Institute for Population Health Barts and the London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
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11
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Clarke A, Bodini S, Douglas L, Catapano A, De Luca L, Hollstein T, Payne J, Pirro M, Viljoen A, Vogt A, Horne R. A behavioural science research programme to understand the barriers to achieving recommended LDL cholesterol goals. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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12
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Paskins Z, Babatunde O, Sturrock A, Toh LS, Horne R, Maidment I. P137 Supporting patients to get the best from their osteoporosis treatment; what works for whom, why and in what circumstance: a rapid realist review. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Aims
For two decades, clinicians and academics have been writing about the problem of poor adherence in osteoporosis, while people with osteoporosis have identified a need for more follow up and information about medicines. We aimed to understand what works in supporting people with osteoporosis to get the best from their medicines, and specifically, to understand what mechanisms enable components of interventions to support osteoporosis medication optimisation and the underlying contextual conditions that enabled these mechanisms.
Methods
We conducted a Rapid Realist Review. The scope was informed by a workshop of the Effectiveness Working Group of the Royal Osteoporosis Society Osteoporosis and Bone Research Academy and the approach informed by background syntheses of qualitative literature and the Perceptions and Practicalities Approach as an underpinning conceptual framework. A primary search identified observational or interventional studies which aimed to improve medicines adherence or optimisation. Included studies were assessed for quality and data extracted relating to context, mechanism and outcomes. A supplementary second search was conducted to gain additional insight on included key papers and emerging mechanisms. Extracted data were interrogated by authors independently for patterns of context-mechanism-outcome configurations and further discussed in weekly team meetings. Recommendations for research and clinical practice were co-developed with clinical and lay stakeholders.
Results
41 papers were included. We identified five contextual timepoints for the person with osteoporosis (identifying a problem; starting medicine; continuing medicine) and the practitioner and healthcare system (making a diagnosis and giving a treatment recommendation; reviewing medicine) and mechanisms relating to patient informed decision making, treatment burden, supporting routinisation and memory, supporting clinical decision making, targeting support, and approaches which were integrated and sustainable. Interventions which support patient informed decision making, improve patient knowledge and understanding, have potential to influence long-term commitment to treatment, although few studies explicitly addressed patients’ perceptions of illness and treatment as recommended in NICE guidelines. During treatment, targeting additional consultations to those most in need may be a cost and clinically effective approach to enable this. Supporting primary care clinician decision making and integration of primary and secondary care services also appears to be important, in improving rates of treatment initiation and adherence. Supporting patients’ ability to adhere (eg by lowering treatment burden and issuing reminders) may be helpful to address practical difficulties but there is little evidence to support the use of reminders alone.
Conclusion
For medicines optimisation for people with osteoporosis, we suggest a need for more patient-centred interventions to address patients’ perceptions of illness and treatment, and reduce treatment burden. Specialist services should consider the extent to which they integrate with, and support primary care clinical decision-making, in order to impact long-term clinical outcomes. Specific research recommendations have been co-developed, to address these knowledge gaps.
Disclosure
Z. Paskins: Grants/research support; NIHR, Versus Arthritis, Royal Osteoporosis Society. O. Babatunde: None. A. Sturrock: None. L. Toh: None. R. Horne: None. I. Maidment: None.
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Affiliation(s)
- Zoe Paskins
- School of Medicine, Keele University, Keele, UNITED KINGDOM
| | | | - Andrew Sturrock
- School of Pharmacy and Pharmaceutical Sciences, University of Sunderland, Sunderland, UNITED KINGDOM
| | - Li Shean Toh
- School of Pharmacy, Nottingham University, Nottingham, UNITED KINGDOM
| | - Robert Horne
- School of Pharmacy, University College London, London, UNITED KINGDOM
| | - Ian Maidment
- Clinical Pharmacy, Aston University, Birmingham, UNITED KINGDOM
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13
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Al-Qerem W, Al Bawab AQ, Abusara O, Alkhatib N, Horne R. Validation of the Arabic version of medication adherence report scale questionnaire and beliefs about medication -specific questionnaire: A factor analysis study. PLoS One 2022; 17:e0266606. [PMID: 35413086 PMCID: PMC9004743 DOI: 10.1371/journal.pone.0266606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/23/2022] [Indexed: 11/19/2022] Open
Abstract
Medication Adherence Report Scale questionnaire (MARS-5) and the Beliefs about Medication Questionnaire-specific (BMQ-specific) are well known tools to assess adherence to medication and beliefs of chronic patients. However, validated Arabic versions of such questionnaires are lacking. We aim to validate the Arabic versions of BMQ-specific and MARS-5. In this study, a cross-sectional study was performed between November 2019 and March 2020. Participants were reached from secondary and tertiary care clinics in Jordan. Exploratory factor analysis (EFA) and Confirmatory Factor analysis (CFA) were conducted to validate the employed questionnaires on the tested sample. The internal consistency of the questionnaires was assessed by calculating Cronbach’s alpha, and Cronbach’s alpha if item is deleted. A total of 485 patients who met the inclusion criteria were recruited. The mean age of the participants was 57.14 years (22–82 years); and 39% of the participants were older than 65 years. The most common chronic diseases reported by participants were hypertension and diabetes mellitus, 35.7 and 32.2% respectively. EFA suggested two-factor model for BMQ-specific and one-factor model for MARS-5 which was confirmed by CFA analyses. The resulted Cronbach’s alphas of the questionnaires ranged from 0.89–0.93. Both analyses showed that the Arabic versions of both MARS-5 and BMQ-specific are valid and can be used for the suggested study population. Further validation-based research may enhance the transcultural adaptation of such questionnaires.
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Affiliation(s)
- Walid Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Abdel Qader Al Bawab
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
- * E-mail:
| | - Osama Abusara
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Nimer Alkhatib
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
- Al-Zaytoonah Health Technology and Innovation Office, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Robert Horne
- Centre for Behavioral Medicine, UCL School of Pharmacy, University College London, London, United Kingdom
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14
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Arnold-Forster D, Horne R, Nutland W, Wayal S, Rayment M, Rae C, Desai M, Clarke A, Sullivan A, McCormack S, Gafos M. Perceptions and Practicalities Influencing Pre-exposure Prophylaxis Adherence Among Men Who Have Sex with Men in England. AIDS Behav 2022; 26:2768-2782. [PMID: 35182281 PMCID: PMC9252952 DOI: 10.1007/s10461-022-03624-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 12/27/2022]
Abstract
PrEP is highly effective for HIV prevention but requires adequate adherence. In this paper we use the perceptions and practicalities approach (PAPA) to identify factors that influenced PrEP adherence using qualitative data from the PROUD study. From February 2014 to January 2016, we interviewed 41 gay, bisexual and other men-who-have-sex-with-men and one trans woman who were enrolled in the study. We purposively recruited participants for interview based on trial arm allocation, adherence and sexual risk behaviours. The interviews were conducted in English, audio-recorded, transcribed, coded and analysed using framework analysis. Participants in general were highly motivated to use and adhere to PrEP, and this was linked to strong perceptions of personal necessity for PrEP as they felt at risk of HIV and viewed PrEP as highly effective. On the other hand, concerns about side effects and HIV resistance did inhibit PrEP initiation and adherence although this was uncommon. Practical factors such as daily routine, existing habitual pill-taking and pill storage impacted adherence. Drug and alcohol use rarely caused participants to miss doses. These findings indicate that using the principals of PAPA to unpick influencers of PrEP use, could help tailor adherence support in PrEP programmes.
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Affiliation(s)
- Dora Arnold-Forster
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT, UK
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | | | - Sonali Wayal
- Institute for Global Health, University College London, London, UK
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Caroline Rae
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Monica Desai
- National Institute for Health and Care Excellence, London, UK
| | - Amanda Clarke
- Claude Nicol Centre, Royal Sussex County Hospital, Brighton, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sheena McCormack
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT, UK.
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
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15
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Talat U, Schmidtke KA, Khanal S, Chan A, Turner A, Horne R, Chadborn T, Gold N, Sallis A, Vlaev I. A Systematic Review of Nudge Interventions to Optimize Medication Prescribing. Front Pharmacol 2022; 13:798916. [PMID: 35145411 PMCID: PMC8822212 DOI: 10.3389/fphar.2022.798916] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The benefits of medication optimization are largely uncontroversial but difficult to achieve. Behavior change interventions aiming to optimize prescriber medication-related decisions, which do not forbid any option and that do not significantly change financial incentives, offer a promising way forward. These interventions are often referred to as nudges. Objective: The current systematic literature review characterizes published studies describing nudge interventions to optimize medication prescribing by the behavioral determinants they intend to influence and the techniques they apply. Methods: Four databases were searched (MEDLINE, Embase, PsychINFO, and CINAHL) to identify studies with nudge-type interventions aiming to optimize prescribing decisions. To describe the behavioral determinants that interventionists aimed to influence, data were extracted according to the Theoretical Domains Framework (TDF). To describe intervention techniques applied, data were extracted according to the Behavior Change Techniques (BCT) Taxonomy version 1 and MINDSPACE. Next, the recommended TDF-BCT mappings were used to appraise whether each intervention applied a sufficient array of techniques to influence all identified behavioral determinants. Results: The current review located 15 studies comprised of 20 interventions. Of the 20 interventions, 16 interventions (80%) were effective. The behavior change techniques most often applied involved prompts (n = 13). The MINDSPACE contextual influencer most often applied involved defaults (n = 10). According to the recommended TDF-BCT mappings, only two interventions applied a sufficient array of behavior change techniques to address the behavioral determinants the interventionists aimed to influence. Conclusion: The fact that so many interventions successfully changed prescriber behavior encourages the development of future behavior change interventions to optimize prescribing without mandates or financial incentives. The current review encourages interventionists to understand the behavioral determinants they are trying to affect, before the selection and application of techniques to change prescribing behaviors. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42020168006].
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Affiliation(s)
- Usman Talat
- Alliance Manchester Business School, The University of Manchester, Manchester, United Kingdom
| | - Kelly Ann Schmidtke
- Warwick Medical School, Coventry, United Kingdom
- *Correspondence: Kelly Ann Schmidtke, ; Ivo Vlaev,
| | - Saval Khanal
- Warwick Business School, Coventry, United Kingdom
| | - Amy Chan
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Alice Turner
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Robert Horne
- UCL School of Pharmacy, University College London, London, United Kingdom
| | | | - Natalie Gold
- London School of Economics and Political Science, Public Health England, London, United Kingdom
- Kantar Public, London, United Kingdom
| | - Anna Sallis
- Public Health England, London, United Kingdom
| | - Ivo Vlaev
- Warwick Business School, Coventry, United Kingdom
- *Correspondence: Kelly Ann Schmidtke, ; Ivo Vlaev,
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16
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De Simoni A, Fleming L, Holliday L, Horne R, Priebe S, Bush A, Sheikh A, Griffiths C. Electronic reminders and rewards to improve adherence to inhaled asthma treatment in adolescents: a non-randomised feasibility study in tertiary care. BMJ Open 2021; 11:e053268. [PMID: 34716166 PMCID: PMC8559117 DOI: 10.1136/bmjopen-2021-053268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To test the feasibility and acceptability of a short-term reminder and incentives intervention in adolescents with low adherence to asthma medications. METHODS Mixed-methods feasibility study in a tertiary care clinic. Adolescents recruited to a 24-week programme with three 8-weekly visits, receiving electronic reminders to prompt inhaled corticosteroid (ICS) inhalation through a mobile app coupled with electronic monitoring devices (EMD). From the second visit, monetary incentives based on adherence of ICS inhalation: £1 per dose, maximum £2 /day, up to £112/study, collected as gift cards at the third visit. End of study interviews and questionnaires assessing perceptions of asthma and ICS, analysed using the Perceptions and Practicalities Framework. PARTICIPANTS Adolescents (11-18 years) with documented low ICS adherence (<80% by EMD), and poor asthma control at the first clinic visit. RESULTS 10 out of 12 adolescents approached were recruited (7 males, 3 females, 12-16 years). Eight participants provided adherence measures up to the fourth visits and received rewards. Mean study duration was 281 days, with 7/10 participants unable to attend their fourth visit due to COVID-19 lockdown. Only 3/10 participants managed to pair the app/EMD up to the fourth visit, which was associated with improved ICS adherence (from 0.51, SD 0.07 to 0.86, SD 0.05). Adherence did not change in adolescents unable to pair the app/EMD. The intervention was acceptable to participants and parents/guardians. Exit interviews showed that participants welcomed reminders and incentives, though expressed frustration with app/EMD technological difficulties. Participants stated the intervention helped through reminding ICS doses, promoting self-monitoring and increasing motivation to take inhalers. CONCLUSIONS An intervention using electronic reminders and incentives through an app coupled with an EMD was feasible and acceptable to adolescents with asthma. A pilot randomised controlled trial is warranted to better estimate the effect size on adherence, with improved technical support for the EMD.
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Affiliation(s)
- Anna De Simoni
- Wolfson Institute of Population Health, Queen Mary University of London, Asthma UK Centre for Applied Research, London, UK
| | - Louise Fleming
- Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, Asthma UK Centre for Applied Research, London, UK
| | - Lois Holliday
- Wolfson Institute of Population Health, Queen Mary University of London, Asthma UK Centre for Applied Research, London, UK
| | - Robert Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy - UCL, Asthma UK Centre for Applied Research, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Andrew Bush
- Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, Asthma UK Centre for Applied Research, London, UK
| | - Aziz Sheikh
- Usher Institute - University of Edinburgh, Asthma UK Centre for Applied Research, Edinburgh, UK
| | - Chris Griffiths
- Wolfson Institute of Population Health, Queen Mary University of London, Asthma UK Centre for Applied Research, London, UK
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17
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High J, Enne VI, Barber JA, Brealey D, Turner DA, Horne R, Peters M, Dhesi Z, Wagner AP, Pandolfo AM, Stirling S, Russell C, O'Grady J, Swart AM, Gant V, Livermore DM. INHALE: the impact of using FilmArray Pneumonia Panel molecular diagnostics for hospital-acquired and ventilator-associated pneumonia on antimicrobial stewardship and patient outcomes in UK Critical Care-study protocol for a multicentre randomised controlled trial. Trials 2021; 22:680. [PMID: 34620213 PMCID: PMC8496625 DOI: 10.1186/s13063-021-05618-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hospital-acquired and ventilator-associated pneumonias (HAP and VAP) are common in critical care and can be life-threatening. Rapid microbiological diagnostics, linked to an algorithm to translate their results into antibiotic choices, could simultaneously improve patient outcomes and antimicrobial stewardship. METHODS The INHALE Randomised Controlled Trial is a multi-centre, parallel study exploring the potential of the BioFire FilmArray molecular diagnostic to guide antibiotic treatment of HAP/VAP in intensive care units (ICU); it identifies pathogens and key antibiotic resistance in around 90 min. The comparator is standard care whereby the patient receives empirical antibiotics until microbiological culture results become available, typically after 48-72 h. Adult and paediatric ICU patients are eligible if they are about to receive antibiotics for a suspected lower respiratory infection (including HAP/VAP) for the first time or a change in antibiotic because of a deteriorating clinical condition. Breathing spontaneously or intubated, they must have been hospitalised for 48 h or more. Patients are randomised 1:1 to receive either antibiotics guided by the FilmArray molecular diagnostic and its trial-based prescribing algorithm or standard care, meaning empirical antibiotics based on local policy, adapted subsequently based upon local microbiology culture results. Co-primary outcomes are (i) non-inferiority in clinical cure of pneumonia at 14 days post-randomisation and (ii) superiority in antimicrobial stewardship at 24 h post-randomisation (defined as % of patients on active and proportionate antibiotics). Secondary outcomes include further stewardship reviews; length of ICU stay; co-morbidity indicators, including septic shock, change in sequential organ failure assessment scores, and secondary pneumonias; ventilator-free days; adverse events over 21 days; all-cause mortality; and total antibiotic usage. Both cost-effectiveness of the molecular diagnostic-guided therapy and behavioural aspects determining antibiotic prescribing are being explored. A sample size of 552 will be required to detect clinically significant results with 90% power and 5% significance for the co-primary outcomes. DISCUSSION This trial will test whether the potential merits of rapid molecular diagnostics for pathogen and resistance detection in HAP/VAP are realised in patient outcomes and/or improved antibiotic stewardship. TRIAL REGISTRATION ISRCTN Registry ISRCTN16483855 . Retrospectively registered on 15 July 2019.
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Affiliation(s)
- Juliet High
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, NR4 7TJ, UK.
| | - Virve I Enne
- University College London, Gower Street, London, WC1E 6BT, UK
| | - Julie A Barber
- University College London, Gower Street, London, WC1E 6BT, UK
| | - David Brealey
- NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - David A Turner
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Robert Horne
- University College London, Gower Street, London, WC1E 6BT, UK
| | - Mark Peters
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NIHR Biomedical Research Centre, WC1N 3JH, London, WC1N 3JH, UK
| | - Zaneeta Dhesi
- University College London, Gower Street, London, WC1E 6BT, UK
| | - Adam P Wagner
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, NR4 7TJ, UK
| | | | - Sue Stirling
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Charlotte Russell
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Justin O'Grady
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
- Quadram Institute Bioscience, Norwich Research Park, Norwich, NR4 7UA, UK
| | - Ann Marie Swart
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Vanya Gant
- University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - David M Livermore
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
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18
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Al Bawab AQ, Al-Qerem W, Abusara O, Alkhatib N, Mansour M, Horne R. What Are the Factors Associated with Nonadherence to Medications in Patients with Chronic Diseases? Healthcare (Basel) 2021; 9:1237. [PMID: 34575011 PMCID: PMC8469667 DOI: 10.3390/healthcare9091237] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/29/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Adherence to medications is very crucial for an optimized clinical outcome in the management of chronic diseases. Beliefs about medications and other factors can significantly affect adherence to chronic medications. The objective of the present research was to identify the associated factors of adherence to medication in Jordanian patients with chronic diseases utilizing a stepwise binary logistical regression model. Methods: A cross-sectional study was carried out between November 2018 and March 2020. The participants were reached from secondary and tertiary care setting clinics in Jordan. The recruited patients were asked to report their attitudes of adherence to medications and beliefs about medications via filling out the MARS-5 and BMQ-specific tools. Sociodemographic data were also collected from the recruited patients and included in the regression model. A stepwise binary logistical regression model was applied to identify the associated factors of adherence to chronic medications in the tested sample. Results: A total of 485 patients who met the inclusion criteria were recruited. The mean age of the participants was 57.14 (age ranged from 22 to 82 years). Around 39% of the participants were older than 65 years. Most of the patients were either hypertensive or diabetic (35.7% and 32.2%, respectively). The logistic regression model indicated that necessity beliefs are strongly associated with adherence (OR 4.22), while concerns beliefs, dosage frequency and having medical insurance were negatively associated with adherence (OR 0.73, 0.74 and 0.26, respectively), with a p-value ≤ 0.05. Conclusions: Both the MARS-5 and BMQ-specific questionnaires were applied successfully on the tested sample. Better attention should be paid to the logistic regression model variables that were associated with adherence in order to guarantee optimal treatment outcomes in the treatment of chronic diseases.
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Affiliation(s)
- Abdel Qader Al Bawab
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan; (W.A.-Q.); (O.A.); (N.A.); (M.M.)
| | - Walid Al-Qerem
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan; (W.A.-Q.); (O.A.); (N.A.); (M.M.)
| | - Osama Abusara
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan; (W.A.-Q.); (O.A.); (N.A.); (M.M.)
| | - Nimer Alkhatib
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan; (W.A.-Q.); (O.A.); (N.A.); (M.M.)
| | - Maha Mansour
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan; (W.A.-Q.); (O.A.); (N.A.); (M.M.)
| | - Robert Horne
- Centre for Behavioral Medicine, UCL School of Pharmacy, University College London, London WC1H 9JP, UK;
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19
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Paskins Z, Bullock L, Crawford-Manning F, Cottrell E, Fleming J, Leyland S, Edwards JJ, Clark E, Thomas S, Chapman SR, Ryan S, Lefroy JE, Gidlow CJ, Iglesias C, Protheroe J, Horne R, O'Neill TW, Mallen C, Jinks C. Improving uptake of Fracture Prevention drug treatments: a protocol for Development of a consultation intervention (iFraP-D). BMJ Open 2021; 11:e048811. [PMID: 34408051 PMCID: PMC8375717 DOI: 10.1136/bmjopen-2021-048811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Prevention of fragility fractures, a source of significant economic and personal burden, is hindered by poor uptake of fracture prevention medicines. Enhancing communication of scientific evidence and elicitation of patient medication-related beliefs has the potential to increase patient commitment to treatment. The Improving uptake of Fracture Prevention drug treatments (iFraP) programme aims to develop and evaluate a theoretically informed, complex intervention consisting of a computerised web-based decision support tool, training package and information resources, to facilitate informed decision-making about fracture prevention treatment, with a long-term aim of improving informed treatment adherence. This protocol focuses on the iFraP Development (iFraP-D) work. METHODS AND ANALYSIS The approach to iFraP-D is informed by the Medical Research Council complex intervention development and evaluation framework and the three-step implementation of change model. The context for the study is UK fracture liaison services (FLS), which enact secondary fracture prevention. An evidence synthesis of clinical guidelines and Delphi exercise will be conducted to identify content for the intervention. Focus groups with patients, FLS clinicians and general practitioners and a usual care survey will facilitate understanding of current practice, and investigate barriers and facilitators to change. Design of the iFraP intervention will be informed by decision aid development standards and theories of implementation, behaviour change, acceptability and medicines adherence. The principles of co-design will underpin all elements of the study through a dedicated iFraP community of practice including key stakeholders and patient advisory groups. In-practice testing of the prototype intervention will inform revisions ready for further testing in a subsequent pilot and feasibility randomised trial. ETHICS AND DISSEMINATION Ethical approval was obtained from North West-Greater Manchester West Research Ethics Committee (19/NW/0559). Dissemination and knowledge mobilisation will be facilitated through national bodies and networks, publications and presentations. TRIAL REGISTRATION NUMBER researchregistry5041.
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Affiliation(s)
- Zoe Paskins
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | | | - Fay Crawford-Manning
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | | | - Jane Fleming
- Cambridge Public Health, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, UK
| | | | | | - Emma Clark
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Simon Thomas
- School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, UK
| | | | - Sarah Ryan
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
- School of Medicine & School of Nursing and Midwifery, Keele University, Stoke-on-Trent, UK
| | - J E Lefroy
- School of Medicine, Keele University, Keele, UK
| | | | - C Iglesias
- Department of Health Sciences, University of York, York, UK
- Danish Centre for Healthcare Improvements, Aalborg Universitet, Aalborg, Denmark
| | | | - Robert Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Clare Jinks
- School of Medicine, Keele University, Keele, UK
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20
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Bermon A, Uribe AF, Pérez-Rivero PF, Prieto-Merino D, Saaibi JF, Silva FA, Canon DI, Castillo-Gonzalez KM, Cáceres-Rivera DI, Guio E, Meneses-Castillo KJ, Castillo-Meza A, Atkins L, Horne R, Murray E, Serrano NC, Free C, Casas JP, Perel P. Efficacy and Safety of Text Messages Targeting Adherence to Cardiovascular Medications in Secondary Prevention: TXT2HEART Colombia Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e25548. [PMID: 34319247 PMCID: PMC8367158 DOI: 10.2196/25548] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/22/2021] [Accepted: 05/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality worldwide, with a prevalence of approximately 100 million patients. There is evidence that antiplatelet agents and antihypertensive medications could reduce the risk of new vascular events in this population; however, treatment adherence is very low. An SMS text messaging intervention was recently developed based on behavior change techniques to increase adherence to pharmacological treatment among patients with a history of ASCVD. Objective This study aims to evaluate the efficacy and safety of an SMS text messaging intervention to improve adherence to cardiovascular medications in patients with ASCVD. Methods A randomized controlled clinical trial for patients with a prior diagnosis of cardiovascular events, such as acute myocardial infarction, unstable angina, cerebrovascular disease, or peripheral artery disease, in one center in Colombia was conducted. Patients randomized to the intervention arm were assigned to receive SMS text messages daily for the first 4 weeks, 5 SMS text messages on week 5, 3 SMS text messages each in weeks 6 and 7, and 1 SMS text message weekly from week 8 until week 52. In contrast, patients in the control arm received a monthly SMS text message reminding them of the next study appointment and the importance of the study, requesting information about changes in their phone number, and thanking them for participating in the study. The primary endpoint was the change in low-density lipoprotein cholesterol (LDL-C) levels, whereas the secondary endpoints were the changes in thromboxane B2 levels, heart rate, systolic and diastolic blood pressure, medication adherence, cardiac and noncardiac mortality, and hospitalization. Linear regression analyses and bivariate tests were performed. Results Of the 930 randomized patients, 805 (86.5%) completed follow-up and were analyzed for the primary endpoint. There was no evidence that the intervention changed the primary outcome (LDL-C levels; P=.41) or any of the secondary outcomes evaluated (all P>.05). There was also no evidence that the intervention was associated with adverse events. Conclusions In this study, there was no evidence that a behavior modification intervention delivered by SMS text messaging improved LDL-C levels, blood pressure levels, or adherence at 12 months. More research is needed to evaluate whether different SMS text messaging strategies, including personalized messages and different timings, are effective; future studies should include mixed methods to better understand why, for whom, and in which context (eg, health system or social environment) SMS text messaging interventions work (or not) to improve adherence in patients with ASCVD. Trial Registration ClinicalTrials.gov NCT03098186; https://clinicaltrials.gov/ct2/show/NCT03098186 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2018-028017
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Affiliation(s)
- Anderson Bermon
- Research Center, Fundación Cardiovascular de Colombia, Floridablanca, Colombia.,Epidemiology an Biostatistics, Escuela de Graduados, Universidad CES, Medellín, Colombia
| | - Ana Fernanda Uribe
- Faculty of Psychology, Universidad Pontificia Bolivariana - Seccional Bucaramanga, Floridablanca, Colombia
| | | | - David Prieto-Merino
- Epidemiology and Population Health Faculty, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Applied Statistical Methods in Medical Research Group, Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Jose Federico Saaibi
- Departament of Cardiovascular Surgery, Division of Vascular and Endovascular Surgery, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
| | - Federico Arturo Silva
- Neurovascular Science Group, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
| | - Diana Ivonne Canon
- Departament of Cardiology, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
| | | | | | - Elizabeth Guio
- Metabolism and Genoma Laboratory, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
| | | | | | - Louise Atkins
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Robert Horne
- University College London School of Pharmacy, London, Colombia
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Norma Cecilia Serrano
- Direction of Research, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
| | - Caroline Free
- Epidemiology and Population Health Faculty, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Juan Pablo Casas
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA, United States.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Pablo Perel
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, United Kingdom
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21
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Pandolfo AM, Horne R, Jani Y, Reader TW, Bidad N, Brealey D, Enne VI, Livermore DM, Gant V, Brett SJ. Intensivists' beliefs about rapid multiplex molecular diagnostic testing and its potential role in improving prescribing decisions and antimicrobial stewardship: a qualitative study. Antimicrob Resist Infect Control 2021; 10:95. [PMID: 34187563 PMCID: PMC8243627 DOI: 10.1186/s13756-021-00961-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/09/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Rapid molecular diagnostic tests to investigate the microbial aetiology of pneumonias may improve treatment and antimicrobial stewardship in intensive care units (ICUs). Clinicians' endorsement and uptake of these tests is crucial to maximise engagement; however, adoption may be impeded if users harbour unaddressed concerns or if device usage is incompatible with local practice. Accordingly, we strove to identify ICU clinicians' beliefs about molecular diagnostic tests for pneumonias before implementation at the point-of-care. METHODS We conducted semi-structured interviews with 35 critical care doctors working in four ICUs in the United Kingdom. A clinical vignette depicting a fictitious patient with signs of pneumonia was used to explore clinicians' beliefs about the importance of molecular diagnostics and their concerns. Data were analysed thematically. RESULTS Clinicians' beliefs about molecular tests could be grouped into two categories: perceived potential of molecular diagnostics to improve antibiotic prescribing (Molecular Diagnostic Necessity) and concerns about how the test results could be implemented into practice (Molecular Diagnostic Concerns). Molecular Diagnostic Necessity stemmed from beliefs that positive results would facilitate targeted antimicrobial therapy; that negative results would signal the absence of a pathogen, and consequently that having the molecular diagnostic results would bolster clinicians' prescribing confidence. Molecular Diagnostic Concerns included unfamiliarity with the device's capabilities, worry that it would detect non-pathogenic bacteria, uncertainty whether it would fail to detect pathogens, and discomfort with withholding antibiotics until receiving molecular test results. CONCLUSIONS Clinicians believed rapid molecular diagnostics for pneumonias were potentially important and were open to using them; however, they harboured concerns about the tests' capabilities and integration into clinical practice. Implementation strategies should bolster users' necessity beliefs while reducing their concerns; this can be accomplished by publicising the tests' purpose and benefits, identifying and addressing clinicians' misconceptions, establishing a trial period for first-hand familiarisation, and emphasising that, with a swift (e.g., 60-90 min) test, antibiotics can be started and refined after molecular diagnostic results become available.
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Affiliation(s)
- Alyssa M Pandolfo
- Centre for Behavioural Medicine, University College London, British Medical Association House, Tavistock Square, London, WC1H 9JP, UK
| | - Robert Horne
- Centre for Behavioural Medicine, University College London, British Medical Association House, Tavistock Square, London, WC1H 9JP, UK.
| | - Yogini Jani
- UCLH-UCL Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tom W Reader
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, UK
| | - Natalie Bidad
- Centre for Behavioural Medicine, University College London, British Medical Association House, Tavistock Square, London, WC1H 9JP, UK
| | - David Brealey
- Division of Critical Care, University College London Hospitals NHS Foundation Trust, London, UK
| | - Virve I Enne
- Division of Infection and Immunity, University College London Faculty of Medical Sciences, London, UK
| | - David M Livermore
- University of East Anglia Norwich Medical School, Norwich, Norfolk, UK
| | - Vanya Gant
- Department of Medical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephen J Brett
- Department of Surgery and Cancer, Imperial College London, London, UK
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22
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Pandolfo AM, Horne R, Jani Y, Reader TW, Bidad N, Brealey D, Enne VI, Livermore DM, Gant V, Brett SJ. Understanding decisions about antibiotic prescribing in ICU: an application of the Necessity Concerns Framework. BMJ Qual Saf 2021; 31:199-210. [PMID: 34099497 PMCID: PMC8899486 DOI: 10.1136/bmjqs-2020-012479] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/25/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Antibiotics are extensively prescribed in intensive care units (ICUs), yet little is known about how antibiotic-related decisions are made in this setting. We explored how beliefs, perceptions and contextual factors influenced ICU clinicians' antibiotic prescribing. METHODS We conducted 4 focus groups and 34 semistructured interviews with clinicians involved in antibiotic prescribing in four English ICUs. Focus groups explored factors influencing prescribing, whereas interviews examined decision-making processes using two clinical vignettes. Data were analysed using thematic analysis, applying the Necessity Concerns Framework. RESULTS Clinicians' antibiotic decisions were influenced by their judgement of the necessity for prescribing/not prescribing, relative to their concerns about potential adverse consequences. Antibiotic necessity perceptions were strongly influenced by beliefs that antibiotics would protect patients from deterioration and themselves from the ethical and legal consequences of undertreatment. Clinicians also reported concerns about prescribing antibiotics. These generally centred on antimicrobial resistance; however, protecting the individual patient was prioritised over these societal concerns. Few participants identified antibiotic toxicity concerns as a key influencer. Clinical uncertainty often complicated balancing antibiotic necessity against concerns. Decisions to start or continue antibiotics often represented 'erring on the side of caution' as a protective response in uncertainty. This approach was reinforced by previous experiences of negative consequences ('being burnt') which motivated prescribing 'just in case' of an infection. Prescribing decisions were also context-dependent, exemplified by a lower perceived threshold to prescribe antibiotics out-of-hours, input from external team members and local prescribing norms. CONCLUSION Efforts to improve antibiotic stewardship should consider clinicians' desire to protect with a prescription. Rapid molecular microbiology, with appropriate communication, may diminish clinicians' fears of not prescribing or of using narrower-spectrum antibiotics.
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Affiliation(s)
- Alyssa M Pandolfo
- Centre for Behavioural Medicine, University College London, London, UK
| | - Robert Horne
- Centre for Behavioural Medicine, University College London, London, UK
| | - Yogini Jani
- UCLH-UCL Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tom W Reader
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, UK
| | - Natalie Bidad
- Centre for Behavioural Medicine, University College London, London, UK
| | - David Brealey
- Division of Critical Care, University College London Hospitals NHS Foundation Trust, London, UK
| | - Virve I Enne
- Division of Infection and Immunity, University College London, London, UK
| | | | - Vanya Gant
- Department of Medical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephen J Brett
- Department of Surgery and Cancer, Imperial College London, London, UK
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23
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Jones ASK, Bidad N, Horne R, Stagg HR, Wurie FB, Kielmann K, Karat AS, Kunst H, Campbell CNJ, Darvell M, Clarke AL, Lipman MCI. Determinants of non-adherence to anti-TB treatment in high income, low TB incidence settings: a scoping review. Int J Tuberc Lung Dis 2021; 25:483-490. [PMID: 34049611 DOI: 10.5588/ijtld.21.0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Improving adherence to anti-TB treatment is a public health priority in high-income, low incidence (HILI) regions. We conducted a scoping review to identify reported determinants of non-adherence in HILI settings.METHODS: Key terms related to TB, treatment and adherence were used to search MEDLINE, EMBASE, Web of Science, PsycINFO and CINAHL in June 2019. Quantitative studies examining determinants (demographic, clinical, health systems or psychosocial) of non-adherence to anti-TB treatment in HILI settings were included.RESULTS: From 10,801 results, we identified 24 relevant studies from 10 countries. Definitions and methods of assessing adherence were highly variable, as were documented levels of non-adherence (0.9-89%). Demographic factors were assessed in all studies and clinical factors were frequently assessed (23/24). Determinants commonly associated with non-adherence were homelessness, incarceration, and alcohol or drug misuse. Health system (8/24) and psychosocial factors (6/24) were less commonly evaluated.CONCLUSION: Our review identified some key factors associated with non-adherence to anti-TB treatment in HILI settings. Modifiable determinants such as psychosocial factors are under-evidenced and should be further explored, as these may be better targeted by adherence support. There is an urgent need to standardise definitions and measurement of adherence to more accurately identify the strongest determinants.
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Affiliation(s)
- A S K Jones
- Centre for Behavioural Medicine, Research Department of Practice and Policy, University College London (UCL) School of Pharmacy, London, UK
| | - N Bidad
- Centre for Behavioural Medicine, Research Department of Practice and Policy, University College London (UCL) School of Pharmacy, London, UK
| | - R Horne
- Centre for Behavioural Medicine, Research Department of Practice and Policy, University College London (UCL) School of Pharmacy, London, UK
| | - H R Stagg
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - F B Wurie
- Research Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, UCL, London, UK, Migrant Health, Public Health England, London, UK
| | - K Kielmann
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland
| | - A S Karat
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland, TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - H Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - M Darvell
- UCL Respiratory, Division of Medicine, UCL, London, UK
| | - A L Clarke
- Centre for Behavioural Medicine, Research Department of Practice and Policy, University College London (UCL) School of Pharmacy, London, UK
| | - M C I Lipman
- UCL Respiratory, Division of Medicine, UCL, London, UK, Royal Free London NHS Foundation Trust, London, UK
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Louie K, Nduka C, Taylor J, Hall M, Aucella F, Artero J, Ureña P, Labriola L, Andersson PO, Evenepoel P, Gonzalez Oliva JC, Pisoni R, Fouqueray B, Horne R. MO524CALCIMIMETIC ADHERENCE AND PREFERENCE IN THE MANAGEMENT OF SECONDARY HYPERPARATHYROIDISM IN EUROPE: A PILOT STUDY. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab087.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Oral cinacalcet (CIN) and IV-administered etelcalcetide (ETEL) are calcimimetics available for the management of secondary hyperparathyroidism (SHPT) in hemodialysis (HD) patients. This pilot study assessed patient adherence to calcimimetic therapy and calcimimetic preference of nephrologists and nurses based on adapted questionnaires.
Method
A cross-sectional survey was conducted with HD patients currently using a calcimimetic, and nephrologists and dialysis nurses who prescribed/administered calcimimetic in 7 European countries (Belgium, France, Germany, Italy, Spain, Sweden and the United Kingdom). Patient questionnaires were adapted from the Medication Adherence Report Scale (MARS), the Beliefs about Medicines Questionnaire (BMQ-specific Necessity and Concern), and Treatment Intrusiveness Scale (TIS) to understand patterns of adherence and perceptions of medications; questions about gastrointestinal (GI) symptoms were included. Questionnaires for nephrologists and nurses were adapted from the Treatment Rating Scale (TRS), Health Professional Preference Scale (HPPS), and Prescribing Comparator Scale (PCS) to understand calcimimetic preference. Questionnaires were translated and administered in the local language.
Results
Sixty HD patients (33 CIN and 27 ETEL), 16 nephrologists and 18 dialysis nurses participated in the survey. ETEL patients were younger than CIN patients (mean age: 57 vs. 59 yrs). ETEL patients also had a lower pill burden (mean no. of pills: 6 vs. 11) and had numerically fewer hospitalizations in the last 6 months (mean no. of days: 1.5 vs 3.9) than CIN patients. Self-reported adherence to CIN was high (mean MARS: 4.7±0.7). ETEL and CIN patients did not perceive medications (excluding dialysis, diet and dietary restrictions) as interfering with their life (mean TIS: 1.5±0.5 vs. 1.6±1.6) and neither calcimimetic group had a specific belief in medicines in terms of necessity (mean BMQ CIN: 2.4±0.6 and ETEL: 2.3±0.4) or concerns about potential side-effects (mean BMQ CIN: 3.1±0.6 and ETEL: 3.5±0.7). ETEL patients were less likely than CIN patients to experience GI symptoms in the prior month: nausea (11% vs. 49%), vomiting (11% vs. 24%), and diarrhea (15% vs. 33%). Overall, the adapted patient questionnaires showed good internal consistency for MARS (Cronbach’s α=0.99) and BMQ-Necessity and BMQ-Concerns scales (CIN: α=0.74 and ETEL: α=0.81) but lower consistency for TIS (α=0.3 for both CIN and ETEL).
Nephrologists and nurses had been practicing for a mean of 17 yrs. Nephrologists and nurses viewed ETEL to have more efficacy, lower risk of side effects, lower risk of non-adherence, lower burden for patients compared to CIN according to the TRS. According to HPPS, the top 3 treatment attributes for ETEL preference vs. CIN among nephrologists were encouraging patient adherence (93%; n=14/15), minimizing patient burden (87%; n=13/15) and having fewer side effects (80%; 12/15). Similar for nurses, encouraging patient adherence (88%; n=15/17) and minimizing patient burden (94%; n=16/17) were top attributes for ETEL preference as well as improving patient quality of life (82%; 14/17). Based on PCS, the majority of nephrologists agreed that compared to CIN, ETEL will ensure high adherence (100%), achieve better PTH control (93%; 14/15), reduce treatment burden for patients (87%; 13/15), improve patient’s quality of life (80%; 12/15), and improve effectiveness without increasing side-effects (80%; 12/15); they also agreed that ETEL created more work for nursing staff (80%; 12/15). Two thirds of nephrologists (n=10/15) agreed that ETEL would be more efficacious than CIN.
Conclusion
In this pilot study, CIN patients self-reported high adherence and both calcimimetic groups did not perceive medications to be concerning or intrusive. Nephrologists and nurses showed preference for ETEL than CIN. The questionnaires were validated and will be administered in a large study.
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Affiliation(s)
- Karly Louie
- AMGEN Ltd, Centre for Observational Research, Uxbridge, United Kingdom
| | - Chidozie Nduka
- AMGEN Ltd, Centre for Observational Research, Uxbridge, United Kingdom
| | - Jo Taylor
- Dorset County Hospital, Dorchester, United Kingdom
| | | | - Filippo Aucella
- Fondazione IRCCS - Casa Sollievo della Sofferenza, Nephrology and Dialysis Unit, San Giovanni Rotondo, Italy
| | - Josep Artero
- Hospital Universitari de Girona, Servicio de Nefrología, Girona, Spain
| | - Pablo Ureña
- Necker-Enfant Malades Hospital, Service de Néphrologie-Dialyse, Paris, France
| | - Laura Labriola
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Department of Nephrology, Brussels, Belgium
| | | | - Pieter Evenepoel
- University Hospitals Leuven, Division of Nephrology, Leuven, Belgium
| | | | - Ronald Pisoni
- Arbor Research Collaborative for Health, Michigan, United States of America
| | | | - Robert Horne
- University College London, School of Pharmacy, London, United Kingdom
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Cai Q, Ye L, Horne R, Ye X, Xu Q, Jin M, Li X, Lyu Q. Medication adherence in adult Chinese patients with asthma: role of illness perceptions and medication beliefs. J Asthma 2021; 59:1445-1451. [PMID: 33941026 DOI: 10.1080/02770903.2021.1924773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aimed to investigate the relationship between illness perceptions, medication beliefs, and self-reported adherence to inhaled corticosteroid (ICS) therapy in adult Chinese patients with asthma. METHODS A cross-sectional survey was conducted in the asthma outpatient clinic of Zhongshan Hospital, Fudan University (Shanghai, China) between October 2018 and September 2019. Illness perceptions, medication beliefs, and medication adherence were assessed using validated scales, specifically the Medication Adherence Report Scale for Asthma, Beliefs about Medicines Questionnaire -Specific, and the Brief Illness Perception Questionnaire. Spearman correlation and multiple logistic regression were used to determine the relationship among these factors. Results: A total of 234 patients were included in this study. Of this group, 99 (42.3%) participants were non-adherent to their ICS medication. Medication adherence correlated negatively with 'illness identity' (perceived symptom), 'emotional response' (perceived emotional effect) and concerns about medication (r=-0.16, -0.16 and -0.15, respectively, p < 0.05). After adjusting for illness perceptions, medication beliefs and demographics, beliefs about the necessity of medication (odds ratio [OR]: 1.14, 95% confidence interval [CI]: 1.01-1.30), and emotional response to the disease (OR: 0.89, 95% CI: 0.80-0.99) were significantly associated with medication adherence in patients with asthma. CONCLUSION Beliefs about the necessity of medication and emotional response to the illness have a strong influence on self-reported medication adherence in adult patients with asthma in China. Interventions targeted adherence improvement among patients with asthma may be tailored to the individual's baseline perceptions and medication beliefs, and focus on modifying inaccurate illness perceptions and medication beliefs as the main targets.
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Affiliation(s)
- Qingqing Cai
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Ling Ye
- Department of Respiratory, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | - Xiaofen Ye
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Qing Xu
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Meiling Jin
- Department of Respiratory, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Xiaoyu Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Qianzhou Lyu
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, PR China
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Boruzs K, Fekete Z, Dombrádi V, Bányai G, Nagy A, Horne R, Bíró K. Differences in Beliefs About Cholesterol-Lowering Medications Among the Visegrad Group Countries: A Cross-Sectional Study. Front Public Health 2021; 9:645043. [PMID: 33996721 PMCID: PMC8119757 DOI: 10.3389/fpubh.2021.645043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: New cholesterol guidelines highlight more personalized risk assessments and new cholesterol-lowering drugs for people at the highest risk for cardiovascular disease. Adherence due to fear of and lack of trust in medications prevents treatment to provide better health outcomes. Objectives: The aim of our study was to investigate the possible differences in the beliefs about the necessity and concerns regarding lipid-lowering drugs among the Visegrad Group countries. Methods: The Beliefs About Medicines Questionnaire (BMQ-Specific) was used in our research. The responses of 205 Hungarian, 200 Slovak, 235 Czech, and 200 Polish participants, all taking cholesterol-lowering medications, were compared to each other. Results: Hungarian participants' belief in the necessity of cholesterol-lowering drugs was significantly lower compared to the Slovak (P = 0.001), Czech (P = 0.037), and Polish (P < 0.001) participants. While no difference was observed between the Czech and Slovak responses (P = 0.154), both the Czech (P < 0.001) and Slovak (P = 0.006) respondents' belief regarding necessity was lower than that of the Polish. Regarding concerns, the only significant difference was observed between the Czech and the Polish respondents (P = 0.011). Conclusions: While the beliefs about benefits (necessity) are most prominent among the Polish participants, except in comparison to Czech responses, the Visegrad Group countries do not differ considerably regarding their beliefs about the fear (concerns) of the treatment.
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Affiliation(s)
- Klára Boruzs
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Zita Fekete
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Viktor Dombrádi
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Gábor Bányai
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Attila Nagy
- Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Robert Horne
- School of Pharmacy, University College London, London, United Kingdom
| | - Klára Bíró
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
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Karbownik MS, Horne R, Paul E, Kowalczyk E, Szemraj J. Determinants of Knowledge About Dietary Supplements Among Polish Internet Users: Nationwide Cross-sectional Study. J Med Internet Res 2021; 23:e25228. [PMID: 33658173 PMCID: PMC8100877 DOI: 10.2196/25228] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/10/2020] [Accepted: 02/04/2021] [Indexed: 12/14/2022] Open
Abstract
Background An accurate understanding of dietary supplements (DS) is a prerequisite for informed decisions regarding their intake. However, there is a need for studies on this understanding among the public based on validated research tools. Objective This study aims to assess the knowledge about DS among Polish internet users with no medical education and to identify its determinants and design an appropriate predictive model. Methods The study protocol was prospectively registered with a statistical analysis plan. Polish users of a web-based health service and a social networking service were administered a survey consisting of the recently developed questionnaire on knowledge about DS, the questionnaire on trust in advertising DS, the beliefs about medicines questionnaire, and several other health-related single-item measures and sociodemographic questions. The results were subjected to general linear modeling. Results A total of 6273 participants were included. Of the 17 yes or no questions in the questionnaire of knowledge about DS, the mean number of correct responses was 9.0 (95% CI 8.9-9.1). Health service users performed worse than social networking users by 2.3 points (95% CI 2.1-2.5) in an analysis adjusted for potential confounders. Internet users had fewer true beliefs about DS if they presented higher trust in their advertising (adjusted β=−.37; 95% CI −.39 to −.34), used DS (adjusted β=−.14; 95% CI −.17 to −.12), experienced their positive effect (adjusted β=−.16; 95% CI −.18 to −.13), were older or younger than 35 years (adjusted β=−.14; 95% CI −.17 to −.12), expressed interest in the topic of DS (adjusted β=−.10; 95% CI −.13 to −.08), reported getting information about the products from friends (adjusted β=−.13; 95% CI −.15 to −.11), and believed that medicines are harmful (adjusted β=−.12; 95% CI −.15 to −.10). The proposed 5-predictor model could explain 31.2% of the variance in knowledge about DS. The model appeared resistant to overfitting and was able to forecast most of the observed associations. Conclusions Polish internet users with no medical education exhibit some false beliefs regarding DS. Trusting the advertising of DS appears to conflict with knowledge about them. There is an urgent need for effective web-based educational campaigns on DS and the promotion of advertising literacy. After the proposed predictive model is externally validated, it may help identify the least informed target audience.
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Affiliation(s)
| | - Robert Horne
- Centre for Behavioural Medicine, The School of Pharmacy, University College London, London, United Kingdom
| | | | - Edward Kowalczyk
- Department of Pharmacology and Toxicology, Medical University of Lodz, Lodz, Poland
| | - Janusz Szemraj
- Department of Medical Biochemistry, Medical University of Lodz, Lodz, Poland
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28
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Thapar A, Lawton R, Burgess L, Shalhoub J, Bradbury A, Cullum N, Epstein D, Gohel M, Horne R, Hunt BJ, Norrie J, Davies AH. Compression hosiery to avoid post-thrombotic syndrome (CHAPS) protocol for a randomised controlled trial (ISRCTN73041168). BMJ Open 2021; 11:e044285. [PMID: 33846151 PMCID: PMC8048019 DOI: 10.1136/bmjopen-2020-044285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Up to 50% of patients develop post-thrombotic syndrome (PTS) after an above knee deep vein thrombosis (DVT). The aim of the study was to determine the effect of graduated compression stockings in preventing PTS after DVT. METHODS AND ANALYSIS Pragmatic, UK multicentre randomised trial in adults with first above knee DVT. The standard of care arm is anticoagulation. The intervention arm will receive anticoagulation plus stockings (European class II, 23-32 mm Hg compression) worn for a median of 18 months. The primary endpoint is PTS using the Villalta score. Analysis of this will be through a time to event approach and cumulative incidence at median 6, 12 and 18 months. An ongoing process evaluation will examine factors contributing to adherence to stockings to understand if and how the behavioural interventions were effective. ETHICS AND DISSEMINATION UK research ethics committee approval (reference 19/LO/1585). Dissemination though the charity Thrombosis UK, the Imperial College London website, peer-reviewed publications and international conferences. TRIAL REGISTRATION NUMBER ISRCTN registration number 73041168.
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Affiliation(s)
- Ankur Thapar
- Academic Section of Vascular Surgery, Imperial College London, London, UK
- Faculty of Health Education, Medicine & Social Care, Anglia Ruskin University, Chelmsford, Essex, UK
- Vascular and Endovascular Surgery, Mid and South Essex Hospitals NHS Foundation Trust, Basildon, Essex, UK
| | - Rebecca Lawton
- Academic Section of Vascular Surgery, Imperial College London, London, UK
| | - Laura Burgess
- Academic Section of Vascular Surgery, Imperial College London, London, UK
| | - Joseph Shalhoub
- Academic Section of Vascular Surgery, Imperial College London, London, UK
| | - Andrew Bradbury
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Nicky Cullum
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - David Epstein
- Faculty of Economic and Business Sciences, University of Granada, Granada, Andalucía, Spain
| | - Manjit Gohel
- Department of Vascular Surgery, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Robert Horne
- School of Pharmacy, University College London, London, London, UK
| | - Beverley J Hunt
- Department of Haematology, Guy's & St Thomas' Foundation Trust, London, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - A H Davies
- Academic Section of Vascular Surgery, Imperial College London, London, UK
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Karat AS, Jones AS, Abubakar I, Campbell CN, Clarke AL, Clarke CS, Darvell M, Hill AT, Horne R, Kunst H, Mandelbaum M, Marshall BG, McSparron C, Rahman A, Stagg HR, White J, Lipman MC, Kielmann K. " You have to change your whole life": A qualitative study of the dynamics of treatment adherence among adults with tuberculosis in the United Kingdom. J Clin Tuberc Other Mycobact Dis 2021; 23:100233. [PMID: 33898764 PMCID: PMC8059079 DOI: 10.1016/j.jctube.2021.100233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Maintaining adherence to treatment for tuberculosis (TB) is essential if the disease is to be eliminated. As part of formative research to develop an intervention to improve adherence, we documented the lived experiences of adults receiving anti-TB treatment (ATT) in three UK cities and examined how personal, social, and structural circumstances interacted to impact on individuals’ adherence to treatment. Using a topic guide that explored social circumstances and experiences of TB care, we conducted in-depth interviews with 18 adults (six women) who were being or had been treated for TB (patients) and four adults (all women) who were caring for a friend, relative, or partner being treated for TB (caregivers). We analysed transcripts using an adapted framework method that classified factors affecting adherence as personal, social, structural, health systems, or treatment-related. Eleven of 18 patients were born outside the UK (in South, Central, and East Asia, and Eastern and Southern Africa); among the seven who were UK-born, four were Black, Asian, or Minority Ethnic and three were White British. TB and its treatment were often disruptive: in addition to debilitating symptoms and side effects of ATT, participants faced job insecurity, unstable housing, stigma, social isolation, worsening mental health, and damaged relationships. Those who had a strong support network, stable employment, a routine that could easily be adapted, a trusting relationship with their TB team, and clear understanding of the need for treatment reported finding it easier to adhere to ATT. Changes in circumstances sometimes had dramatic effects on an individual’s ability to take ATT; participants described how the impact of certain acute events (e.g., the onset of side effects or fatigue, episodes of stigmatisation, loss of income) were amplified by their timing or through their interaction with other elements of the individual’s life. We suggest that the dynamic and fluctuating nature of these factors necessitates comprehensive and regular review of needs and potential problems, conducted before and during ATT; this, coupled with supportive measures that consider (and seek to mitigate) the influence of social and structural factors, may help improve adherence.
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Affiliation(s)
- Aaron S. Karat
- Institute for Global Health and Development, Queen Margaret University, Queen Margaret University Way, Musselburgh, Edinburgh EH21 6UU, United Kingdom
- TB Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
- Corresponding authors at: Institute for Global Health and Development, Queen Margaret University, Queen Margaret University Way, Musselburgh, Edinburgh EH21 6UU, United Kingdom (A.S. Karat).
| | - Annie S.K. Jones
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, BMA House, Tavistock Square, London WC1H 9JP, United Kingdom
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - Colin N.J. Campbell
- Institute for Global Health, University College London, Gower Street, London WC1E 6BT, United Kingdom
- Respiratory Diseases Department, National Infection Service, Public Health England, Wellington House, 133–155 Waterloo Road, London SE1 8UG, United Kingdom
| | - Amy L. Clarke
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, BMA House, Tavistock Square, London WC1H 9JP, United Kingdom
| | - Caroline S. Clarke
- Research Department of Primary Care and Population Health, University College London, UCL Medical School, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom
- Priment Clinical Trials Unit, University College London, UCL Medical School, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom
| | - Marcia Darvell
- UCL Respiratory, Division of Medicine, University College London, UCL Medical School, Level 1, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom
| | - Adam T. Hill
- Queen’s Medical Research Institute, University of Edinburgh Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| | - Robert Horne
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, BMA House, Tavistock Square, London WC1H 9JP, United Kingdom
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, 4 Newark Street, London E1 2AT, United Kingdom
| | | | - Ben G. Marshall
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom
- National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Ceri McSparron
- NHS Lothian, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, United Kingdom
| | - Ananna Rahman
- Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1FR, United Kingdom
| | - Helen R. Stagg
- Usher Institute, University of Edinburgh, MacKenzie House, 30 West Richmond Street, Edinburgh EH8 9DX, United Kingdom
| | - Jacqui White
- Whittington Health NHS Trust, The Whittington Hospital, Magdala Avenue, London N19 5NF, United Kingdom
| | - Marc C.I. Lipman
- UCL Respiratory, Division of Medicine, University College London, UCL Medical School, Level 1, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom
- Royal Free London NHS Foundation Trust, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom
| | - Karina Kielmann
- Institute for Global Health and Development, Queen Margaret University, Queen Margaret University Way, Musselburgh, Edinburgh EH21 6UU, United Kingdom
- Corresponding authors at: Institute for Global Health and Development, Queen Margaret University, Queen Margaret University Way, Musselburgh, Edinburgh EH21 6UU, United Kingdom (A.S. Karat).
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Bullock L, Crawford-Manning F, Cottrell E, Fleming J, Leyland S, Edwards J, Clark EM, Thomas S, Chapman S, Gidlow C, Iglesias CP, Protheroe J, Horne R, O'Neill TW, Mallen C, Jinks C, Paskins Z. Developing a model Fracture Liaison Service consultation with patients, carers and clinicians: a Delphi survey to inform content of the iFraP complex consultation intervention. Arch Osteoporos 2021; 16:58. [PMID: 33761007 PMCID: PMC7989712 DOI: 10.1007/s11657-021-00913-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/02/2021] [Indexed: 02/03/2023]
Abstract
Fracture Liaison Services are recommended to deliver best practice in secondary fracture prevention. This modified Delphi survey, as part of the iFraP (Improving uptake of Fracture Prevention drug Treatments) study, provides consensus regarding tasks for clinicians in a model Fracture Liaison Service consultation. PURPOSE The clinical consultation is of pivotal importance in addressing barriers to treatment adherence. The aim of this study was to agree to the content of the 'model Fracture Liaison Service (FLS) consultation' within the iFraP (Improving uptake of Fracture Prevention drug Treatments) study. METHODS A Delphi survey was co-designed with patients and clinical stakeholders using an evidence synthesis of current guidelines and content from frameworks and theories of shared decision-making, communication and medicine adherence. Patients with osteoporosis and/or fragility fractures, their carers, FLS clinicians and osteoporosis specialists were sent three rounds of the Delphi survey. Participants were presented with potential consultation content and asked to rate their perception of the importance of each statement on a 5-point Likert scale and to suggest new statements (Round 1). Lowest rated statements were removed or amended after Rounds 1 and 2. In Round 3, participants were asked whether each statement was 'essential' and percentage agreement calculated; the study team subsequently determined the threshold for essential content. RESULTS Seventy-two, 49 and 52 patients, carers and clinicians responded to Rounds 1, 2 and 3 respectively. One hundred twenty-two statements were considered. By Round 3, consensus was reached, with 81 statements deemed essential within FLS consultations, relating to greeting/introductions; gathering information; considering therapeutic options; eliciting patient perceptions; establishing shared decision-making preferences; sharing information about osteoporosis and treatments; checking understanding/summarising; and signposting next steps. CONCLUSIONS This Delphi consensus exercise has summarised for the first time patient/carer and clinician consensus regarding clearly defined tasks for clinicians in a model FLS consultation.
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Affiliation(s)
- Laurna Bullock
- School of Medicine, Keele University, Newcastle, Staffordshire, UK.
| | - Fay Crawford-Manning
- School of Medicine, Keele University, Newcastle, Staffordshire, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, Staffordshire, UK
| | | | - Jane Fleming
- Cambridge Public Health, University of Cambridge & Addenbrooke's Hospital Fracture Liaison Service, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | | | - John Edwards
- School of Medicine, Keele University, Newcastle, Staffordshire, UK
| | - Emma M Clark
- Bristol Medical School, Faculty of Health Sciences,, University of Bristol, Bristol, UK
| | - Simon Thomas
- School of Pharmacy and Bioengineering, Keele University, Newcastle, Staffordshire, UK
| | - Stephen Chapman
- School of Pharmacy and Bioengineering, Keele University, Newcastle, Staffordshire, UK
| | - Christopher Gidlow
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, Staffordshire, UK
| | - Cynthia P Iglesias
- Department of Health Sciences, University of York, York, UK
- Danish Centre for Healthcare Improvement (CHI), Aalborg University, Aalborg, Denmark
| | - Joanne Protheroe
- School of Medicine, Keele University, Newcastle, Staffordshire, UK
| | - Robert Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, University of Manchester & NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Christian Mallen
- School of Medicine, Keele University, Newcastle, Staffordshire, UK
| | - Clare Jinks
- School of Medicine, Keele University, Newcastle, Staffordshire, UK
| | - Zoe Paskins
- School of Medicine, Keele University, Newcastle, Staffordshire, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, Staffordshire, UK
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31
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Wu RY, Li B, Horne R, Ghamel A, Robinson S, Cadette M, Miyake H, Johnson-Henry K, Pierro A, Sherman PM. A47 SYNTHETIC HUMAN MILK OLIGOSACCHARIDES PREVENT EXPERIMENTAL NECROTIZING ENTEROCOLITIS VIA DIVERGENT TRANSCRIPTOMIC RESPONSES. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Breastmilk reduces the risk of necrotizing enterocolitis (NEC) in preterm infants, but the bioactive components mediating this effect are not well understood. Human milk oligosaccharides (HMOs) reduce NEC both in humans and in relevant animal models. However, it is unclear if there are functional differences between individual oligosaccharides.
Aims
The objective of this study was to compare the intestinal transcriptome responses of individual HMOs using complementary in vitro and in vivo models of NEC.
Methods
RNA sequencing was performed on Caco-2Bbe1 gut epithelial cells after exposure to commercially-purified 2’-fucosyllactose (2’FL), 3-fucosyllactose, 6’-siallyllactose, lacto-N-tetraose (LNT) or lacto-N-neotetraose for 24hr at 37°C for 24 h (n=3). Signaling pathways were analyzed in murine- and human-derived NEC enteroids by qPCR. To validate these findings, five-day-old mouse pups were orally gavaged formula with or without individual HMOs, followed by NEC induction with hypoxia (5% O2, 95% N2) and lipopolysaccharide (4 mg/kg/day). Coded ileal sections (n=6–7/group) were analyzed for mucosal injury by histology, immune fluorescence, immunohistochemistry, and gene expression via qPCR.
Results
The HMO transcriptome clustered into divergent functional categories including metabolic process, protein processing and responses to external stimuli. Each synthetic HMO induced a unique transcriptome and exhibited varying effects on the intestinal epithelial functions and biological pathways. This was confirmed in the murine model of NEC, as both LNT and 2FL mitigated NEC injury with comparable recovery of intestinal cell proliferation (Ki67) and expression of stem cells (Lgr5+). Both qPCR and immunofluorescence staining showed differences between 2FL- and LNT-fed pups in host inflammatory and immune responses.
Conclusions
This study demonstrates that synthetic HMOs ameliorate intestinal injury in experimental NEC. However, the mechanisms by which individual oligosaccharides act on the intestine differ, suggesting that single synthetic HMOs may not fully recapitulate the benefits of pooled HMOs. Future studies will further delineate structure-function relationships of synthetic HMOs on host intestinal innate and adaptive immune responses.
Funding Agencies
CIHRFerring Canada Medical Student Research grant
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Affiliation(s)
- R Y Wu
- SickKids Research Institute, Toronto, ON, Canada
| | - B Li
- SickKids Research Institute, Toronto, ON, Canada
| | - R Horne
- SickKids Research Institute, Toronto, ON, Canada
| | - A Ghamel
- SickKids Research Institute, Toronto, ON, Canada
| | - S Robinson
- SickKids Research Institute, Toronto, ON, Canada
| | - M Cadette
- SickKids Research Institute, Toronto, ON, Canada
| | - H Miyake
- SickKids Research Institute, Toronto, ON, Canada
| | | | - A Pierro
- SickKids Research Institute, Toronto, ON, Canada
| | - P M Sherman
- SickKids Research Institute, Toronto, ON, Canada
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Syafhan NF, Al Azzam S, Williams SD, Wilson W, Brady J, Lawrence P, McCrudden M, Ahmed M, Scott MG, Fleming G, Hogg A, Scullin C, Horne R, Ahir H, McElnay JC. General practitioner practice-based pharmacist input to medicines optimisation in the UK: pragmatic, multicenter, randomised, controlled trial. J Pharm Policy Pract 2021; 14:4. [PMID: 33397509 PMCID: PMC7784025 DOI: 10.1186/s40545-020-00279-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/24/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Changing demographics across the UK has led to general practitioners (GPs) managing increasing numbers of older patients with multi-morbidity and resultant polypharmacy. Through government led initiatives within the National Health Service, an increasing number of GP practices employ pharmacist support. The purpose of this study is to evaluate the impact of a medicines optimisation intervention, delivered by GP practice-based pharmacists, to patients at risk of medication-related problems (MRPs), on patient outcomes and healthcare costs. METHODS A multi-centre, randomised (normal care or pharmacist supplemented care) study in four regions of the UK, involving patients (n = 356) from eight GP practices, with a 6-month follow-up period. Participants were adult patients who were at risk of MRPs. RESULTS Median number of MRPs per intervention patient were reduced at the third assessment, i.e. 3 to 0.5 (p < 0.001) in patients who received the full intervention schedule. Medication Appropriateness Index (MAI) scores were reduced (medications more appropriate) for the intervention group, but not for control group patients (8 [4-13] to 5 [0-11] vs 8 [3-13] to 7 [3-12], respectively; p = 0.001). Using the intention-to-treat (ITT) approach, the number of telephone consultations in intervention group patients was reduced and different from the control group (1 [0-3] to 1 [0-2] vs 1 [0-2] to 1 [0-3], p = 0.020). No significant differences between groups were, however, found in unplanned hospital admissions, length of hospital stay, number of A&E attendances or outpatient visits. The mean overall healthcare cost per intervention patient fell from £1041.7 ± 1446.7 to £859.1 ± 1235.2 (p = 0.032). Cost utility analysis showed an incremental cost per patient of - £229.0 (95% CI - 594.6, 128.2) and a mean QALY gained of 0.024 (95% CI - 0.021 to 0.065), i.e. indicative of a health status gain at a reduced cost (2016/2017). CONCLUSION The pharmacist service was effective in reducing MRPs, inappropriateness of medications and telephone consultations in general practice in a cost-effective manner. TRIAL REGISTRATION ClinicalTrials.Gov, NCT03241498. Registered 7 August 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03241498.
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Affiliation(s)
- Nadia Farhanah Syafhan
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, Indonesia
| | - Sayer Al Azzam
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | | | | | | | - Mustafa Ahmed
- Fern House Surgery, Essex, UK
- Douglas Grove Surgery, Essex, UK
| | | | - Glenda Fleming
- Medicines Optimisation Innovation Centre (MOIC), Antrim, UK
| | - Anita Hogg
- Medicines Optimisation Innovation Centre (MOIC), Antrim, UK
| | - Claire Scullin
- Medicines Optimisation Innovation Centre (MOIC), Antrim, UK
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | | | - James C McElnay
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK.
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Arakelyan S, Karat AS, Jones ASK, Vidal N, Stagg HR, Darvell M, Horne R, Lipman MCI, Kielmann K. Relational Dynamics of Treatment Behavior Among Individuals with Tuberculosis in High-Income Countries: A Scoping Review. Patient Prefer Adherence 2021; 15:2137-2154. [PMID: 34584407 PMCID: PMC8464367 DOI: 10.2147/ppa.s313633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/18/2021] [Indexed: 12/28/2022] Open
Abstract
Although tuberculosis (TB) incidence has significantly declined in high-income, low-incidence (HILI) countries, challenges remain in managing TB in vulnerable populations who may struggle to stay on anti-TB treatment (ATT). Factors associated with non-adherence to ATT are well documented; however, adherence is often narrowly conceived as a fixed binary variable that places emphasis on individual agency and the act of taking medicines, rather than on the demands of being on treatment more broadly. Further, the mechanisms through which documented factors act upon the experience of being on treatment are poorly understood. Adopting a relational approach that emphasizes the embeddedness of individuals within dynamic social, structural, and health systems contexts, this scoping review aims to synthesize qualitative evidence on experiences of being on ATT and mechanisms through which socio-ecological factors influence adherence in HILI countries. Six electronic databases were searched for peer-reviewed literature published in English between January 1990 and May 2020. Additional studies were obtained by searching references of included studies. Narrative synthesis was used to analyze qualitative data extracted from included studies. Of 28 included studies, the majority (86%) reported on health systems factors, followed by personal characteristics (82%), structural influences (61%), social factors (57%), and treatment-related factors (50%). Included studies highlighted three points that underpin a relational approach to ATT behavior: 1) individual motivation and capacity to take ATT is dynamic and intertwined with, rather than separate from, social, health systems, and structural factors; 2) individuals' pre-existing experiences of health-seeking influence their views on treatment and their ability to commit to long-term regular medicine-taking; and 3) social, cultural, and political contexts play an important role in mediating how specific factors work to support or hinder ATT adherence behavior in different settings. Based on our analysis, we suggest that person-centered clinical management of tuberculosis should 1) acknowledge the ways in which ATT both disrupts and is managed within the everyday lives of individuals with TB; 2) appreciate that individuals' circumstances and the support and resources they can access may change over the course of treatment; and 3) display sensitivity towards context-specific social and cultural norms affecting individual and collective experiences of being on ATT.
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Affiliation(s)
- Stella Arakelyan
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Aaron S Karat
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Annie S K Jones
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Nicole Vidal
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Helen R Stagg
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Marcia Darvell
- UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Robert Horne
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Marc C I Lipman
- UCL Respiratory, Division of Medicine, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Karina Kielmann
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
- Correspondence: Karina Kielmann Queen Margaret University, Queen Margaret University Way, Edinburgh, EH216UU, UKTel +44 131 474 0000 Email
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Paskins Z, Crawford-Manning F, Cottrell E, Corp N, Wright J, Jinks C, Bishop S, Doyle A, Ong T, Gittoes N, Leonardi-Bee J, Langley T, Horne R, Sahota O. Acceptability of bisphosphonates among patients, clinicians and managers: a systematic review and framework synthesis. BMJ Open 2020; 10:e040634. [PMID: 33148763 PMCID: PMC7640526 DOI: 10.1136/bmjopen-2020-040634] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To explore the acceptability of different bisphosphonate regimens for the treatment of osteoporosis among patients, clinicians and managers, payers and academics. DESIGN A systematic review of primary qualitative studies. Seven databases were searched from inception to July 2019. Screening, data extraction and quality assessment of full-articles selected for inclusion were performed independently by two authors. A framework synthesis was applied to extracted data based on the theoretical framework of acceptability (TFA). The TFA includes seven domains relating to sense-making, emotions, opportunity costs, burden, perceived effectiveness, ethicality and self-efficacy. Confidence in synthesis findings was assessed. SETTING Any developed country healthcare setting. PARTICIPANTS Patients, healthcare professionals, managers, payers and academics. INTERVENTION Experiences and views of oral and intravenous bisphosphonates. RESULTS Twenty-five studies were included, mostly describing perceptions of oral bisphosphonates. We identified, with high confidence, how patients and healthcare professionals make sense (coherence) of bisphosphonates by balancing perceptions of need against concerns, how uncertainty prevails about bisphosphonate perceived effectiveness and a number of individual and service factors that have potential to increase self-efficacy in recommending and adhering to bisphosphonates. We identified, with moderate confidence, that bisphosphonate taking induces concern, but has the potential to engender reassurance, and that both side effects and special instructions for taking oral bisphosphonates can result in treatment burden. Finally, we identified with low confidence that multimorbidity plays a role in people's perception of bisphosphonate acceptability. CONCLUSION By using the lens of acceptability, our findings demonstrate with high confidence that a theoretically informed, whole-system approach is necessary to both understand and improve adherence. Clinicians and patients need supporting to understand the need for bisphosphonates, and clinicians need to clarify to patients what constitutes bisphosphonate treatment success. Further research is needed to explore perspectives of male patients and those with multimorbidity receiving bisphosphonates, and patients receiving intravenous treatment. PROSPERO REGISTRATION NUMBER CRD42019143526.
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Affiliation(s)
- Zoe Paskins
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | - Fay Crawford-Manning
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | | | - Nadia Corp
- School of Medicine, Keele University, Keele, UK
| | | | - Clare Jinks
- School of Medicine, Keele University, Keele, UK
| | - Simon Bishop
- Centre for Health Innovation, Leadership and Learning, University of Nottingham, Nottingham, UK
| | - Alison Doyle
- Operations and Clinical Practice, Royal Osteoporosis Society, Bath, UK
| | - Terence Ong
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Neil Gittoes
- Centre for Endocrinology Diabetes and Metabolism, University of Birmingham, Birmingham, UK
| | - Jo Leonardi-Bee
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Tessa Langley
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | - Opinder Sahota
- Department of Geriatric Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Buffart LM, Schreurs MAC, Abrahams HJG, Kalter J, Aaronson NK, Jacobsen PB, Newton RU, Courneya KS, Armes J, Arving C, Braamse AM, Brandberg Y, Dekker J, Ferguson RJ, Gielissen MF, Glimelius B, Goedendorp MM, Graves KD, Heiney SP, Horne R, Hunter MS, Johansson B, Northouse LL, Oldenburg HS, Prins JB, Savard J, van Beurden M, van den Berg SW, Brug J, Knoop H, Verdonck-de Leeuw IM. Effects and moderators of coping skills training on symptoms of depression and anxiety in patients with cancer: Aggregate data and individual patient data meta-analyses. Clin Psychol Rev 2020; 80:101882. [PMID: 32640368 DOI: 10.1016/j.cpr.2020.101882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/21/2020] [Accepted: 06/11/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE This study evaluated the effects of coping skills training (CST) on symptoms of depression and anxiety in cancer patients, and investigated moderators of the effects. METHODS Overall effects and intervention-related moderators were studied in meta-analyses of pooled aggregate data from 38 randomized controlled trials (RCTs). Patient-related moderators were examined using linear mixed-effect models with interaction tests on pooled individual patient data (n = 1953) from 15 of the RCTs. RESULTS CST had a statistically significant but small effect on depression (g = -0.31,95% confidence interval (CI) = -0.40;-0.22) and anxiety (g = -0.32,95%CI = -0.41;-0.24) symptoms. Effects on depression symptoms were significantly larger for interventions delivered face-to-face (p = .003), led by a psychologist (p = .02) and targeted to patients with psychological distress (p = .002). Significantly larger reductions in anxiety symptoms were found in younger patients (pinteraction < 0.025), with the largest reductions in patients <50 years (β = -0.31,95%CI = -0.44;-0.18) and no significant effects in patients ≥70 years. Effects of CST on depression (β = -0.16,95%CI = -0.25;-0.07) and anxiety (β = -0.24,95%CI = -0.33;-0.14) symptoms were significant in patients who received chemotherapy but not in patients who did not (pinteraction < 0.05). CONCLUSIONS CST significantly reduced symptoms of depression and anxiety in cancer patients, and particularly when delivered face-to-face, provided by a psychologist, targeted to patients with psychological distress, and given to patients who were younger and received chemotherapy.
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Affiliation(s)
- L M Buffart
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
| | - M A C Schreurs
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - H J G Abrahams
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - J Kalter
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands.
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - P B Jacobsen
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD, Florida, USA.
| | - R U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
| | - K S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.
| | - J Armes
- School of Health Science, University of Surrey, Surrey, UK.
| | - C Arving
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - A M Braamse
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Y Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
| | - J Dekker
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - R J Ferguson
- Division of Hematology-Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
| | | | - B Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
| | - M M Goedendorp
- Department of Health Science, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - K D Graves
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
| | - S P Heiney
- College of Nursing, University of South Carolina, Columbia, SC, USA.
| | - R Horne
- UCL School of Pharmacy, University College London, London, UK.
| | - M S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - B Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
| | - L L Northouse
- University of Michigan School of Nursing, Ann Arbor, MI, USA.
| | - H S Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
| | - J B Prins
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, the Netherlands.
| | - J Savard
- School of Psychology, Université Laval and Laval University Cancer Research Center, Québec, QC, Canada.
| | - M van Beurden
- Department of Gynecology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
| | - S W van den Berg
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, the Netherlands.
| | - J Brug
- National Institute of Public Health and the Environment, Bilthoven, the Netherlands.
| | - H Knoop
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - I M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery and Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, the Netherlands.
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Karbownik MS, Jankowska-Polańska B, Horne R, Górski KM, Kowalczyk E, Szemraj J. Adaptation and validation of the Polish version of the Beliefs about Medicines Questionnaire among cardiovascular patients and medical students. PLoS One 2020; 15:e0230131. [PMID: 32282826 PMCID: PMC7153860 DOI: 10.1371/journal.pone.0230131] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/21/2020] [Indexed: 01/02/2023] Open
Abstract
Background The Beliefs about Medicines Questionnaire (BMQ) is the leading tool intended to assess the cognitive representation of medication, however, the validated Polish version of the questionnaire is lacking. Aims To adapt the original BMQ tool to the Polish language (BMQ-PL) and to validate it. Materials and methods The BMQ was adapted to Polish according to widely accepted guidelines. A total of 311 cardiovascular in- and outpatients as well as medical students taking chronic medication were surveyed to assess data-to-model fit and internal consistency of the measure. The criterion-related validity was determined with the use of Polish version of the Adherence to Refills and Medications Scale. Confirmatory and exploratory factor analyses were used, as well as general linear modeling. Results The BMQ-PL exhibited the same factorial structure as the original questionnaire and all the items loaded on their expected factors. Internal consistency of the questionnaire was satisfactory in the group of cardiovascular patients (Cronbach’s alpha ranging from 0.64 to 0.82 and McDonald’s omega from 0.90 to 0.91). There were significant correlations in the predicted directions between all BMQ-PL subscales and the measure of drug adherence in cardiovascular outpatients, but not in inpatients. Medical students may conceptualize the beliefs about medicines in a different way; as a result, a modified version of the BMQ-PL-General, suitable for medically-educated people, was proposed. Conclusion The BMQ-PL exhibits satisfactory proof of validity to be used among cardiovascular patients.
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Affiliation(s)
| | | | - Robert Horne
- Centre for Behavioural Medicine, The School of Pharmacy, University College London, London, United Kingdom
| | | | - Edward Kowalczyk
- Department of Pharmacology and Toxicology, Medical University of Lodz, Łódź, Poland
| | - Janusz Szemraj
- Department of Medical Biochemistry, Medical University of Lodz, Łódź, Poland
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Emilsson M, Berndtsson I, Gustafsson PA, Horne R, Marteinsdottir I. Reliability and validation of Swedish translation of Beliefs about Medication Specific (BMQ-Specific) and Brief Illness Perception Questionnaire (B-IPQ) for use in adolescents with attention-deficit hyperactivity disorder. Nord J Psychiatry 2020; 74:89-95. [PMID: 31596161 DOI: 10.1080/08039488.2019.1674376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: The purpose of this study was to assess the reliability and validity of Swedish translations of the Beliefs about Medicines Questionnaire-Specific (BMQ-Specific) and Brief Illness Perception Questionnaire (B-IPQ) for use in adolescents with ADHD.Methods: Forward and backward translations of the BMQ-Specific and B-IPQ scales to Swedish were conducted and reviewed by adolescents with ADHD and professionals. The validity and reliability of both questionnaires were investigated in a cross-sectional study of 101 adolescents (13-17 years) on a long-term prescription of ADHD medication recruited from two child and adolescent psychiatric outpatient clinics in Sweden.Results: Regarding the BMQ-Specific, principal component analysis (PCA) loadings confirmed the previously defined components of Specific-Necessity and Specific-Concern. The PCA for B-IPQ revealed two components, the first one, B-IPQ Consequences, captured questions regarding perceptions of the implication of having ADHD (items 1, 2, 5, 6 and 8) and the second one, B-IPQ-Control, the perceptions of the capability to manage the ADHD disorder (items 3, 4 and 7). The Cronbach alpha coefficients for BMQ-Specific-Necessity scale was α = 0.80, for BMQ-Specific-Concern scale α = 0.75, B-IPQ Consequences α = 0.74 and for B-IPQ-Control α = 0.44.Conclusions: The present results prove the Swedish translation of BMQ-Specific and B-IPQ to be valid and reliable for utilization in adolescents with ADHD. The PCA confirmed the original components for BMQ-Specific and the recent findings of two main B-IPQ components describing emotional and cognitive implications versus the capability for self-care maintenance of ADHD.
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Affiliation(s)
- Maria Emilsson
- Department of Health Science, Section of Nursing Graduate Level, University West, Trollhättan, Sweden
| | - Ina Berndtsson
- Department of Health Science, Section of Nursing Graduate Level, University West, Trollhättan, Sweden
| | - Per A Gustafsson
- Department of Clinical and Experimental Medicine and Department of Child and Adolescent Psychiatry, Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - Robert Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK
| | - Ina Marteinsdottir
- Department of Medicine and Optometry Faculty of Health and Life Sciences, Linnæus University, Kalmar, Sweden
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Farmer A, Allen J, Bartlett K, Bower P, Chi Y, French D, Gudgin B, Holmes EA, Horne R, Hughes DA, Kenning C, Locock L, McSharry J, Miles L, Newhouse N, Rea R, Riga E, Tarassenko L, Velardo C, Williams N, Williams V, Yu LM. Supporting people with type 2 diabetes in effective use of their medicine through mobile health technology integrated with clinical care (SuMMiT-D Feasibility): a randomised feasibility trial protocol. BMJ Open 2019; 9:e033504. [PMID: 31888938 PMCID: PMC6937131 DOI: 10.1136/bmjopen-2019-033504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/30/2019] [Accepted: 12/04/2019] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Type 2 diabetes is common, affecting over 400 million people worldwide. Risk of serious complications can be reduced through use of effective treatments and active self-management. However, people are often concerned about starting new medicines and face difficulties in taking them regularly. Use of brief messages to provide education and support self-management, delivered through mobile phone-based text messages, can be an effective tool for some long-term conditions. We have developed messages aiming to support patients' self-management of type 2 diabetes in the use of medications and other aspects of self-management, underpinned by theory and evidence. The aim of this trial is to determine the feasibility of a large-scale clinical trial to test the effectiveness and cost-effectiveness of the intervention, compared with usual care. METHODS AND ANALYSIS The feasibility trial will be a multicentre individually randomised, controlled trial in primary care recruiting adults (≥35 years) with type 2 diabetes in England. Consenting participants will be randomised to receive short text messages three times a week with messages designed to produce change in medication adherence or non-health-related messages for 6 months. The aims are to test recruitment methods, retention to the study, the feasibility of data collection and the mobile phone and web-based processes of a proposed definitive trial and to refine the text messaging intervention. The primary outcome is the rate of recruitment to randomisation of participants to the trial. Data, including patient reported measures, will be collected online at baseline and the end of the 6-month follow-up period. With 200 participants (100 in each group), this trial is powered to estimate 80% follow-up within 95% CIs of 73.8% to 85.3%. The analysis will follow a prespecified plan. ETHICS AND DISSEMINATION Ethics approval was obtained from the West of Scotland Research Ethics Committee 05. The results will be disseminated through conference presentations, peer-reviewed journals and will be published on the trial website: www.summit-d.org (SuMMiT-D (SUpport through Mobile Messaging and digital health Technology for Diabetes)). TRIAL REGISTRATION NUMBER ISRCTN13404264.
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Affiliation(s)
- Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julie Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kiera Bartlett
- The Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Peter Bower
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Yuan Chi
- The Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - David French
- The Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | | | - Emily A Holmes
- School of Health Sciences, Bangor University, Bangor, UK
| | - Robert Horne
- UCL School of Pharmacy, University College London, London, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Cassandra Kenning
- Institute of Population Health, The University of Manchester, Manchester, UK
| | - Louise Locock
- Health Service Research, University of Aberdeen, Aberdeen, UK
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Lisa Miles
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | | | - Rustam Rea
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Evgenia Riga
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lionel Tarassenko
- The Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Carmelo Velardo
- The Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Nicola Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Veronika Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Stagg HR, Abubakar I, Campbell CN, Copas A, Darvell M, Horne R, Kielmann K, Kunst H, Mandelbaum M, Pickett E, Story A, Vidal N, Wurie FB, Lipman M. IMPACT study on intervening with a manualised package to achieve treatment adherence in people with tuberculosis: protocol paper for a mixed-methods study, including a pilot randomised controlled trial. BMJ Open 2019; 9:e032760. [PMID: 31852704 PMCID: PMC6937100 DOI: 10.1136/bmjopen-2019-032760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Compared with the rest of the UK and Western Europe, England has high rates of the infectious disease tuberculosis (TB). TB is curable, although treatment is for at least 6 months and longer when disease is drug resistant. If patients miss too many doses (non-adherence), they may transmit infection for longer and the infecting bacteria may develop resistance to the standard drugs used for treatment. Non-adherence may therefore risk both their health and that of others. Within England, certain population groups are thought to be at higher risk of non-adherence, but the factors contributing to this have been insufficiently determined, as have the best interventions to promote adherence. The objective of this study was to develop a manualised package of interventions for use as part of routine care within National Health Services to address the social and cultural factors that lead to poor adherence to treatment for TB disease. METHODS AND ANALYSIS This study uses a mixed-methods approach, with six study components. These are (1) scoping reviews of the literature; (2) qualitative research with patients, carers and healthcare professionals; (3) development of the intervention; (4) a pilot randomised controlled trial of the manualised intervention; (5) a process evaluation to examine clinical utility; and (6) a cost analysis. ETHICS AND DISSEMINATION This study received ethics approval on 24 December 2018 from Camberwell St. Giles Ethics Committee, UK (REC reference 18/LO/1818). Findings will be published and disseminated through peer-reviewed publications and conference presentations, published in an end of study report to our funder (the National Institute for Health Research, UK) and presented to key stakeholders. TRIAL REGISTRATION NUMBER ISRCTN95243114 SECONDARY IDENTIFYING NUMBERS: University College London/University College London Hospitals Joint Research Office 17/0726.National Institute for Health Research, UK 16/88/06.
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Affiliation(s)
- Helen R Stagg
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | | | - Andrew Copas
- Centre for Pragmatic Global Health Trials, Institute of Global Health, University College London, London, UK
| | | | - Robert Horne
- UCL School of Pharmacy, University College London, London, UK
| | - Karina Kielmann
- Institute for Global Health and Development, Queen Margaret University Edinburgh, Edinburgh, UK
| | - Heinke Kunst
- Department of Respiratory Medicine, Queen Mary University of London, London, UK
| | | | - Elisha Pickett
- Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Alistair Story
- Find&Treat, University College Hospitals NHS Foundation Trust, London, UK
| | - Nicole Vidal
- Institute for Global Health and Development, Queen Margaret University Edinburgh, Edinburgh, UK
| | - Fatima B Wurie
- Institute for Global Health, University College London, London, UK
| | - Marc Lipman
- UCL Respiratory, University College London, London, UK
- Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
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Bermon A, Uribe-Rodríguez AF, Pérez-Rivero PF, Prieto-Merino D, Cáceres Rivera DI, Guio E, Atkins L, Horne R, Murray E, Serrano Díaz NC, Free C, Perel P, Casas JP. Evaluation of the efficacy and safety of text messages targeting adherence to cardiovascular medications in secondary prevention: the txt2heart Colombia randomised controlled trial protocol. BMJ Open 2019; 9:e028017. [PMID: 31818831 PMCID: PMC6924706 DOI: 10.1136/bmjopen-2018-028017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Anti-platelet therapy, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, beta-blockers and statins are cost-effective in patients with atherosclerotic cardiovascular diseases (ASCVD) for reducing the risk of ASCVD events. Unfortunately, there is abundant evidence that adherence to these cardiovascular medications is far from ideal. A recent Cochrane review showed a potential beneficial effect of Short Message Service (SMS) interventions on adherence to medication in ASCVD patients. METHODS AND ANALYSIS The txt2heart study is a pragmatic randomised single-blind controlled trial. The objective is to evaluate the efficacy and safety of an intervention with SMS messages delivered by mobile phones to improve adherence to cardiovascular medications in patients with ASCVD. The intervention consists of behavioural techniques delivered via SMS. The primary outcome is change in blood serum low-density lipoprotein cholesterol levels as an indicator of adherence to statins. Secondary outcomes will include systolic blood pressure as an indicator of adherence to blood-lowering therapies and heart rate as an indicator of adherence to beta-blockers, urine levels of 11-dehydrothromboxane B2, self-reported adherence to cardiovascular medications and rates of cardiovascular death or hospitalisation due to cardiovascular disease. ETHICS AND DISSEMINATION The study will be performed in compliance with the protocol, regulatory requirements, Good Clinical Practice and ethical principles of the Declaration of Helsinki. The Ethics Committee of Fundación Cardiovascular de Colombia evaluated and approved the trial. The txt2heart Colombia trial aims to provide robust evidence to evaluate whether SMS messages delivered through mobile telephones change the behaviour of Colombian patients who have suffered a cardiovascular event. Trial results will be presented to the local health authorities, and if the intervention is effective and safe, we hope this strategy will be implemented quickly because of its low cost and wide-reaching impact on the population. TRIAL REGISTRATION NUMBER NCT03098186.
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Affiliation(s)
- Anderson Bermon
- Research, Fundacion Cardiovascular de Colombia, Floridablanca, Santander, Colombia
- Epidemiology and Biostatistics, CES University, Medellín, Colombia
| | - Ana Fernanda Uribe-Rodríguez
- Faculty of Psychology, Universidad Pontificia Bolivariana - Seccional Bucaramanga, Floridablanca, Santander, Colombia
| | - Paula Fernanda Pérez-Rivero
- Faculty of Psychology, Universidad Pontificia Bolivariana - Seccional Bucaramanga, Floridablanca, Santander, Colombia
| | - David Prieto-Merino
- EPH LSHTM, London School of Hygiene and Tropical Medicine, London, UK
- Applied Statistical Methods in Medical Research Group, Universidad Católica San Antonio de Murcia, Murcia, Spain
| | | | - Elizabeth Guio
- Metabolism and Genoma Laboratory, Fundacion Cardiovascular de Colombia, Floridablanca, Santander, Colombia
| | - Louise Atkins
- University College London Research Department of Epidemiology and Public Health, London, UK
| | - Robert Horne
- University College London School of Pharmacy, London, UK
| | - Elizabeth Murray
- University College London Research Department of Primary Care and Population Health, London, UK
| | | | - Caroline Free
- EPH LSHTM, London School of Hygiene and Tropical Medicine, London, UK
| | - Pablo Perel
- EPH LSHTM, London School of Hygiene and Tropical Medicine, London, UK
| | - Juan P Casas
- Research, Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, Massachusetts, USA
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Ong C, Weichard A, Thacker J, Nixon G, Davey M, Horne R. Gender differences in the effects of sleep disordered breathing in children on blood pressure, sleep, quality of life, executive function and behaviour. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moncrieff J, Lewis G, Freemantle N, Johnson S, Barnes TRE, Morant N, Pinfold V, Hunter R, Kent LJ, Smith R, Darton K, Horne R, Crellin NE, Cooper RE, Marston L, Priebe S. Randomised controlled trial of gradual antipsychotic reduction and discontinuation in people with schizophrenia and related disorders: the RADAR trial (Research into Antipsychotic Discontinuation and Reduction). BMJ Open 2019; 9:e030912. [PMID: 31780589 PMCID: PMC6887002 DOI: 10.1136/bmjopen-2019-030912] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Antipsychotic medication is effective in reducing acute symptoms of psychosis, but it has a range of potentially serious and debilitating adverse effects and is often disliked by patients. It is therefore essential it is only used when benefits outweigh harms. Although multiple trials conducted with people with schizophrenia indicate an increased risk of relapse in the short-term following abrupt antipsychotic discontinuation, there is little evidence about the long-term outcome of a gradual process of reduction and discontinuation on social functioning, relapse and other outcomes. METHODS AND ANALYSIS This is a multicentre, randomised controlled trial involving people with schizophrenia and related disorders who have had more than one episode. Participants are randomised to have a clinically-supervised, gradual reduction of antipsychotic medication, leading to discontinuation when possible, or to continue with maintenance treatment. Blinded follow-up assessments are conducted at 6, 12 and 24 months and the primary outcome is social functioning, measured by the Social Functioning Scale at 24 months. A minimum of 134 evaluable participants provides 90% power to detect a five-point difference, and 206 to detect a four-point difference. Secondary outcomes include severe relapse (admission to hospital) and the study is also intended to detect a minimum 10% difference in severe relapse, which requires 402 participants, assuming a 15% loss to follow-up. Other secondary outcomes include all relapses, as identified by an independent and blinded endpoint committee, symptoms measured by the Positive and Negative Syndrome Scale, quality of life, adverse effects, self-rated recovery and neuropsychological measures. Enrolment started in 2016. The trial is scheduled to finish in June 2022. ETHICS AND DISSEMINATION Ethical approval was initially obtained on 27 October 2016 (UK Research Ethics Committee reference 16/LO/1507). Results will be published in peer-reviewed journals and disseminated to the public. TRIAL REGISTRATION NUMBER ISRCTN90298520. EudraCT: 2016-000709-36. Pre-results.
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Affiliation(s)
- Joanna Moncrieff
- Division of Psychiatry, University College London and North East London NHS Foundation Trust, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Nick Freemantle
- Institute for Clinical Trials and Methodology, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | | | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | | | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | | | | | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | - Nadia E Crellin
- Division of Psychiatry, University College London, London, UK
| | - Ruth E Cooper
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | | | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
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Tibble H, Sheikh A, Tsanas A, Horne R, Mizani M, Simpson C, Lay-Flurrie J. Linkage of Primary Care Prescribing Records and Pharmacy Dispensing Records in Asthma Controller Medications. Int J Popul Data Sci 2019. [DOI: 10.23889/ijpds.v4i3.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background In the UK, issued prescriptions are typically taken to pharmacies, where medications are prepared, recorded, and dispensed. Data Linkage between prescribing and pharmacy dispensing records is not routinely conducted at the individual prescription level for clinical care in England and Wales, however it can be particularly useful for the study of pharmacoepidemiology. With no unique prescribing event identifiers between records, an algorithmic approach is required for this linkage.
Aims To create a linkage system for primary care prescribed asthma controller medications and pharmacy dispensing records.
Methods Free text labels were used to populate fields for data linkage, relating to medication strength, medication type (active ingredients; allows matching of generic substitutions to named brands), doses per medication unit, prescribed units, and prescribed doses. Prescribing and dispensing records were merged using an inner (many to many) join; generating a candidate link for every combination of records matching on unique patient identifier and medicine. A recursive algorithm was developed and applied, working backwards chronologically through dispensing records and finding the most appropriate match based on the time since prescribing and agreement between the medication description fields. Unmatched records were assessed for quality assurance, and the distribution of linkage strength for matches was examined.
Results We developed a harmonisation algorithm in a dataset of over 3 million asthma controller medication prescription records, for which almost 3 in 4 were coded according to the number of units (predominantly inhalers). Incorporating the estimated number of doses prescribed/dispensed into our wider matching algorithm, we were able to find unique prescription records for almost 95% of our dispensing records.
Conclusion Early findings demonstrate the accuracy of the developed algorithm linking prescribing and dispensing records. This algorithm can easily be generalised to other conditions.
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Abstract
OBJECTIVES The National Health Service (NHS) in England recently introduced general practice pharmacists (GPPs) to provide medication-focused support to both patients and the general practice team. This healthcare model may benefit people with asthma, who currently receive suboptimal care and demonstrate low medication adherence. This study aimed to explore the perspectives of adults with asthma on the potential for pharmacist-led adherence support delivered in general practice, with a focus on how these perspectives are formed. DESIGN AND SETTING The study was conducted in the United Kingdom (UK) utilising a qualitative interview methodology. Participants were invited to partake in a telephone-based semistructured interview, followed by an online questionnaire for demographic details and asthma history. Qualitative data were analysed using thematic analysis. PARTICIPANTS Participants (n=17) were adults with asthma in the UK with a prescription for an inhaled corticosteroid. Participants did not have previous experience with GPPs and were asked to provide their views on a proposed GPP-led service. RESULTS Participant perspectives of GPPs were determined by trust in pharmacists, perceived gaps in asthma care and the perceived strain on the NHS. Trust was based on pharmacists' perceived clinical competency, established over time, and gauged through a 'benchmarking' process. GPP's fit in current asthma care was assessed based on potential role overlap with other healthcare professionals, continuity of care and medication-related support needs. Participants navigated the NHS based on a perceived hierarchy of healthcare professionals (general practitioners on top, nurses, then pharmacists), and this influenced their perspectives of GPPs. CONCLUSION While the GPP scheme shows promise based on the perspectives of people with asthma, the identified barriers to optimal patient engagement and service implementation will need to be addressed for the service to be effective.
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Affiliation(s)
- Marissa Ayano Mes
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Caroline Brigitte Katzer
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Vari Wileman
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Amy Hai Yan Chan
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Robert Horne
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
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Boruzs K, Fekete Z, Dombrádi V, Bányai G, Nagy A, Horne R, Bíró K. Beliefs About Medicines: Differences in cholesterol treatment adherence among the Visegrad countries. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Raised cholesterol is a risk factor for cerebrovascular and cardiovascular diseases. New cholesterol guidelines highlight more personalized risk assessments and new cholesterol-lowering drugs for people at the highest risk for cardiovascular disease.
Methods
The aim of our study was to investigate the possible differences in the beliefs about the necessity and concerns regarding lipid-lowering drugs among the Visegrad Group countries. For this the Beliefs About Medicines Questionnaire (BMQ-Specific) was used. The statistical analyses included 235 Czech, 205 Hungarian, 200 Polish, and 200 Slovak respondents, all of who were taking cholesterol lowering drugs.
Results
After comparing the answers of the citizens of the Visegrad Group countries, no statistically significant difference could be found regarding the concerns about the lipid-lowering drugs. However, related to the beliefs in necessity, a significant difference was shown between Poland and Hungary for the benefit of Polish participants. These results suggest, that the citizens of Visegrad Group countries do not differ regarding their beliefs about the fear of the treatment, while the beliefs about benefits are the most emphasized among the Polish citizens and less among the Hungarian citizens.
Conclusions
While policy makers in the Visegrad Group countries can use the same strategy to address the concerns regarding cholesterol lowering medication, the reasons behind the difference in the beliefs in necessity should be further investigated in order to implement country specific interventions.
The research was funded by the GINOP-2.3.2-15-2016-00005 project which is co-financed by
the European Union under the European Regional Development Fund.
Key messages
No differences exist regarding the concerns for cholesterol lowering medication among the Visegrad Group countries. Concerning necessity significant differences were observed among the same countries, which prompts further research questions.
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Affiliation(s)
- K Boruzs
- Department of Health Systems Management and Quality Management in Health Care, University of Debrecen, Debrecen, Hungary
| | - Z Fekete
- Institute of Behavioral Sciences, University of Debrecen, Debrecen, Hungary
| | - V Dombrádi
- Department of Health Systems Management and Quality Management in Health Care, University of Debrecen, Debrecen, Hungary
| | - G Bányai
- Department of Health Systems Management and Quality Management in Health Care, University of Debrecen, Debrecen, Hungary
| | - A Nagy
- Department of Preventive Medicine, University of Debrecen, Debrecen, Hungary
| | - R Horne
- UCL School of Pharmacy, University College London, London, UK
| | - K Bíró
- Department of Health Systems Management and Quality Management in Health Care, University of Debrecen, Debrecen, Hungary
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Stringer D, Gardner LM, Peacock JL, Rebollo-Mesa I, Hilton R, Shaw O, Baker R, Clark B, Thuraisingham RC, Buckland M, Picton M, Worthington J, Borrows R, Briggs D, Shah S, Shiu KY, McCullough K, Phanish M, Hegarty J, Stoves J, Ahmed A, Ayub W, Horne R, McCrone P, Kelly J, Murphy C, Dorling A. Update to the study protocol, including statistical analysis plan, for the multicentre, randomised controlled OuTSMART trial: a combined screening/treatment programme to prevent premature failure of renal transplants due to chronic rejection in patients with HLA antibodies. Trials 2019; 20:476. [PMID: 31383029 PMCID: PMC6683506 DOI: 10.1186/s13063-019-3602-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/19/2019] [Indexed: 12/02/2022] Open
Abstract
Background Chronic rejection is the single biggest cause of premature kidney graft failure. HLA antibodies (Ab) are an established prognostic biomarker for premature graft failure so there is a need to test whether treatment decisions based on the presence of the biomarker can alter prognosis. The Optimised TacrolimuS and MMF for HLA Antibodies after Renal Transplantation (OuTSMART) trial combines two elements. Firstly, testing whether a routine screening programme for HLA Ab in all kidney transplant recipients is useful by comparing blinding versus unblinding of HLA Ab status. Secondly, for those found to be HLA Ab+, testing whether the introduction of a standard optimisation treatment protocol can reduce graft failure rates. Methods OuTSMART is a prospective, open-labelled, randomised biomarker-based strategy (hybrid) trial, with two arms stratified by biomarker (HLA Ab) status. The primary outcome was amended from graft failure rates at 3 years to time to graft failure to increase power and require fewer participants to be recruited. Length of follow-up subsequently is variable, with all participants followed up for at least 43 months up to a maximum of 89 months. The primary outcome will be analysed using Cox regression adjusting for stratification factors. Analyses will be according to the intention-to-treat using all participants as randomised. Outcomes will be analysed comparing standard care versus biomarker-led care groups within the HLA Ab+ participants (including those who become HLA Ab+ through re-screening) as well as between HLA-Ab-unblinded and HLA-Ab-blinded groups using all participants. Discussion Changes to the primary outcome permit recruitment of fewer participants to achieve the same statistical power. Pre-stating the statistical analysis plan guards against changes to the analysis methods at the point of analysis that might otherwise introduce bias through knowledge of the data. Any deviations from the analysis plan will be justified in the final report. Trial registration ISRCTN registry, ID: ISRCTN46157828. Registered on 26 March 2013; EudraCT 2012–004308-36. Registered on 10 December 2012.
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Affiliation(s)
- Dominic Stringer
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Leanne M Gardner
- MRC Centre for Transplantation, King's College London, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
| | - Janet L Peacock
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Irene Rebollo-Mesa
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Rachel Hilton
- Department of Nephrology and Transplantation, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
| | - Olivia Shaw
- Clinical Transplantation Laboratory, Viapath, Guys Hospital, Great Maze Pond, London, SE1 9RT, UK
| | - Richard Baker
- Renal Unit, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Brendan Clark
- Transplant Immunology, Level 09 Gledhow Wing, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Raj C Thuraisingham
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, E1 1BB, UK
| | - Matthew Buckland
- Clinical Transplantation Laboratory, The Royal London Hospital, 2nd Floor, Pathology and Pharmacy Building, 80 Newark Street, London, E1 1BB, UK
| | - Michael Picton
- Department of Renal Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Judith Worthington
- Transplantation Laboratory, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Richard Borrows
- Renal Unit, University Hospital Birmingham, Edgbaston, Birmingham, B15 2LN, UK
| | - David Briggs
- NHSBT Birmingham, Vincent Drive, Edgbaston, Birmingham, B15 2SG, UK
| | - Sapna Shah
- King's College London, London, SE5 9RJ, UK
| | - Kin Yee Shiu
- UCL Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, NW3 2QG, UK
| | | | - Mysore Phanish
- Renal Unit, Epsom and St Helier University Hospitals NHS Trust, Surrey, UK
| | - Janet Hegarty
- Renal Unit, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK
| | - John Stoves
- Renal Unit, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD5 0NA, UK
| | - Aimun Ahmed
- Renal Unit, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, PR2 9HT, UK
| | - Waqar Ayub
- Renal Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - Robert Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, WC1H 9JP, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Joanna Kelly
- King's Clinical Trials Unit, King's College London, London, UK
| | - Caroline Murphy
- King's Clinical Trials Unit, King's College London, London, UK
| | - Anthony Dorling
- MRC Centre for Transplantation, King's College London, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
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Tibble H, Tsanas A, Horne E, Horne R, Mizani M, Simpson CR, Sheikh A. Predicting asthma attacks in primary care: protocol for developing a machine learning-based prediction model. BMJ Open 2019; 9:e028375. [PMID: 31292179 PMCID: PMC6624024 DOI: 10.1136/bmjopen-2018-028375] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/02/2019] [Accepted: 06/04/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Asthma is a long-term condition with rapid onset worsening of symptoms ('attacks') which can be unpredictable and may prove fatal. Models predicting asthma attacks require high sensitivity to minimise mortality risk, and high specificity to avoid unnecessary prescribing of preventative medications that carry an associated risk of adverse events. We aim to create a risk score to predict asthma attacks in primary care using a statistical learning approach trained on routinely collected electronic health record data. METHODS AND ANALYSIS We will employ machine-learning classifiers (naïve Bayes, support vector machines, and random forests) to create an asthma attack risk prediction model, using the Asthma Learning Health System (ALHS) study patient registry comprising 500 000 individuals across 75 Scottish general practices, with linked longitudinal primary care prescribing records, primary care Read codes, accident and emergency records, hospital admissions and deaths. Models will be compared on a partition of the dataset reserved for validation, and the final model will be tested in both an unseen partition of the derivation dataset and an external dataset from the Seasonal Influenza Vaccination Effectiveness II (SIVE II) study. ETHICS AND DISSEMINATION Permissions for the ALHS project were obtained from the South East Scotland Research Ethics Committee 02 [16/SS/0130] and the Public Benefit and Privacy Panel for Health and Social Care (1516-0489). Permissions for the SIVE II project were obtained from the Privacy Advisory Committee (National Services NHS Scotland) [68/14] and the National Research Ethics Committee West Midlands-Edgbaston [15/WM/0035]. The subsequent research paper will be submitted for publication to a peer-reviewed journal and code scripts used for all components of the data cleaning, compiling, and analysis will be made available in the open source GitHub website (https://github.com/hollytibble).
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Affiliation(s)
- Holly Tibble
- Usher Institute of Population Health Sciences and Informatics, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Asthma UK Centre for Applied Research, Edinburgh, UK
| | - Athanasios Tsanas
- Usher Institute of Population Health Sciences and Informatics, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Asthma UK Centre for Applied Research, Edinburgh, UK
| | - Elsie Horne
- Usher Institute of Population Health Sciences and Informatics, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Asthma UK Centre for Applied Research, Edinburgh, UK
| | - Robert Horne
- Asthma UK Centre for Applied Research, Edinburgh, UK
- University College London, London, UK
| | - Mehrdad Mizani
- Usher Institute of Population Health Sciences and Informatics, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Asthma UK Centre for Applied Research, Edinburgh, UK
| | - Colin R Simpson
- Asthma UK Centre for Applied Research, Edinburgh, UK
- School of Health, Victoria University of Wellington, Wellington, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Asthma UK Centre for Applied Research, Edinburgh, UK
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Horne R, Glendinning E, King K, Chalder T, Sabin C, Walker AS, Campbell LJ, Mosweu I, Anderson J, Collins S, Jopling R, McCrone P, Leake Date H, Michie S, Nelson M, Perry N, Smith JA, Sseruma W, Cooper V. Protocol of a two arm randomised, multi-centre, 12-month controlled trial: evaluating the impact of a Cognitive Behavioural Therapy (CBT)-based intervention Supporting UPtake and Adherence to antiretrovirals (SUPA) in adults with HIV. BMC Public Health 2019; 19:905. [PMID: 31286908 PMCID: PMC6615195 DOI: 10.1186/s12889-019-6893-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/25/2019] [Indexed: 12/02/2022] Open
Abstract
Background Delay to start antiretroviral therapy (ART) and nonadherence compromise the health and wellbeing of people living with HIV (PLWH), raise the cost of care and increase risk of transmission to sexual partners. To date, interventions to improve adherence to ART have had limited success, perhaps because they have failed to systematically elicit and address both perceptual and practical barriers to adherence. The primary aim of this study is to determine the efficacy of the Supporting UPtake and Adherence (SUPA) intervention. Methods This study comprises 2 phases. Phase 1 is an observational cohort study, in which PLWH who are ART naïve and recommended to take ART by their clinician complete a questionnaire assessing their beliefs about ART over 12 months. Phase 2 is a randomised controlled trial (RCT) nested within the observational cohort study to investigate the effectiveness of the SUPA intervention on adherence to ART. PLWH at risk of nonadherence (based on their beliefs about ART) will be recruited and randomised 1:1 to the intervention (SUPA intervention + usual care) and control (usual care) arms. The SUPA intervention involves 4 tailored treatment support sessions delivered by a Research Nurse utilising a collaborative Cognitive Behavioural Therapy (CBT) and Motivational Interviewing (MI) approach. Sessions are tailored to individual needs and preferences based on the individual patient’s perceptions and practical barriers to ART. An animation series and intervention manual have been developed to communicate a rationale for the personal necessity for ART and illustrate concerns and potential solutions. The primary outcome is adherence to ART measured using Medication Event Monitoring System (MEMS). Three hundred seventy-two patients will be sufficient to detect a 15% difference in adherence with 80% power and an alpha of 0.05. Costs will be compared between intervention and control groups. Costs will be combined with the primary outcome in cost-effectiveness analyses. Quality adjusted life-years (QALYs) will also be estimated over the follow-up period and used in the analyses. Discussion The findings will enable patients, healthcare providers and policy makers to make informed decisions about the value of the SUPA intervention. Trial registration The trial was retrospectively registered 21/02/2014, ISRCTN35514212. Electronic supplementary material The online version of this article (10.1186/s12889-019-6893-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Horne
- Department of Practice and Policy, Centre for Behavioural Medicine, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP, UK.
| | - E Glendinning
- Department of Practice and Policy, Centre for Behavioural Medicine, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP, UK
| | - K King
- Department of Practice and Policy, Centre for Behavioural Medicine, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP, UK
| | - T Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
| | - C Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, UCL, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - A S Walker
- MRC Clinical Trials Unit at UCL, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - L J Campbell
- HIV Research Centre, King's College London, London, SE5 9RJ, UK
| | - I Mosweu
- Institute of Psychiatry at King's College London, Denmark Hill, London, SE5 8AF, UK
| | - J Anderson
- Centre for the Study of Sexual Health and HIV, Homerton University Hospital, E9 6RS, London, UK
| | - S Collins
- HIV i-Base, 107 The Maltings, 169 Tower Bridge Road, London, SE1 3LJ, UK
| | - R Jopling
- Department of Practice and Policy, Centre for Behavioural Medicine, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP, UK
| | - P McCrone
- Institute of Psychiatry at King's College London, Denmark Hill, London, SE5 8AF, UK
| | - H Leake Date
- Departments of of Pharmacy and HIV Medicine, Brighton & Sussex University Hospitals NHS Trust, Brighton, BN2 5B, UK
| | - S Michie
- Department of Clinical, Educational and Health Psychology, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - M Nelson
- Kobler Clinic, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - N Perry
- Brighton and Sussex University Hospitals NHS Trust, Brighton, BN2 5BE, UK
| | - J A Smith
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - W Sseruma
- UK-CAB, 107 The Maltings, 169 Tower Bridge Road, London, SE1 3LJ, UK
| | - V Cooper
- Department of Practice and Policy, Centre for Behavioural Medicine, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP, UK
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Lee L, El-Den S, Horne R, Carter SR. Patient satisfaction with information, concerns, beliefs and adherence to topical corticosteroids. Patient Educ Couns 2019; 102:1203-1209. [PMID: 30928342 DOI: 10.1016/j.pec.2019.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 12/14/2018] [Accepted: 01/24/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Adherence to topical corticosteroids (TCS) for inflammatory skin conditions is sub-optimal. This Australian study aimed to test the hypothesis that patients who are more satisfied with the level of information they receive about TCS, are less concerned about using TCS and more adherent to healthcare professionals' instructions. METHODS Individuals who were prescribed or had used TCS in the past month were invited to complete an online cross-sectional survey. Reliability and validity of multi-item scales were tested using confirmatory factor analysis. Self-reported adherence to TCS was measured with MARS-5. Multivariate regression with mediation analyses was used to explore relationships between variables. RESULTS Mediation analyses of 195 survey (64.4%) responses was performed. Overall satisfaction with information about TCS action and usage (SIMS-AU) (mean = 60.7%) was higher than potential concerns (SIMS-PC) (mean = 48.2%). Analysis revealed that the SIMS subscales were highly correlated (α = 0.57, p < 0.05). Higher overall SIMS scores were predictive of stronger beliefs that TCS was beneficial, fewer concerns about TCS and better adherence. CONCLUSION Being more satisfied with TCS information was associated with having more favourable disposition towards TCS and higher adherence. PRACTICE IMPLICATIONS Healthcare professionals should identity areas of dissatisfaction with medication information and tailor their counselling accordingly.
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Affiliation(s)
- Ling Lee
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Sarira El-Den
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Robert Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College, London, United Kingdom
| | - Stephen R Carter
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia.
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Carey ME, Agarwal S, Horne R, Davies M, Slevin M, Coates V. Exploring organizational support for the provision of structured self-management education for people with Type 2 diabetes: findings from a qualitative study. Diabet Med 2019; 36:761-770. [PMID: 30868654 DOI: 10.1111/dme.13946] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2019] [Indexed: 01/27/2023]
Abstract
AIM To explore the organizational context in which Type 2 diabetes structured group education is provided. METHODS Four Clinical Commissioning Groups in England providing Type 2 diabetes structured self-management education participated in a qualitative study exploring the context for provision of that education. Using UK National Diabetes Audit returns, two Clinical Commissioning Groups were selected that had non-attendance rates of ≤25%, and two that had non-attendance rates of ≥50%. Between May 2016 and August 2017, 20 interviews were conducted with Clinical Commissioning Group staff including: commissioners, healthcare professionals, managers, general practitioners and diabetes educators. Data gathering was prolonged as it proved challenging to engage with healthcare staff as a result of frequent local restructuring and service disruption. RESULTS Local audits revealed discrepancies in basic data such as referral and attendance numbers compared with national audit data. There was a commonality in the themes identified from interviews: diabetes education was rarely embedded in service structure; where education uptake was poor, a lack of central support to delivery teams was noticeable; and where education uptake was positive, delivery teams were actively engaged, sometimes relying on enthusiastic individuals. Both situations put the local sustainability of diabetes education at risk. CONCLUSIONS There appears to be a link between attendance rates and organizational issues, therefore, when considering how to increase attendance rates, the state of the diabetes education infrastructure should be reviewed. Good uptake of diabetes education can be too reliant on the enthusiastic commitment of small teams or individuals delivering the education.
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Affiliation(s)
- M E Carey
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
- College of Life Sciences, University of Leicester, Leicester, UK
| | - S Agarwal
- College of Life Sciences, University of Leicester, Leicester, UK
| | - R Horne
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - M Davies
- Belfast Health and Social Care Trust, Belfast, UK
| | - M Slevin
- School of Nursing, Ulster University, Coleraine, UK
| | - V Coates
- School of Nursing, Ulster University, Coleraine, UK
- Western Health and Social Care Trust, Londonderry, UK
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