Medication apprehension and compliance among dialysis patients--a comprehensive guidance attitude.

PubMed

Katzir, Ze'ev; Boaz, Mona; Backshi, Irena; Cernes, Relu; Barnea, Zvi; Biro, Alexander

2010-01-01

Compliance with treatment regimens is a continuing challenge for chronic dialysis patients and their medical caregivers. Poor patient adherence to prescribed medications can adversely affect treatment outcome. In this pre- versus post-intervention study, 89 chronic dialysis patients [75 hemodialysis (HD), 14 continuous ambulatory peritoneal dialysis (CAPD); mean age 62.7 +/- 12.39 years, 34 females] responded to a written questionnaire designed to assess knowledge about and compliance with 5 groups of prescribed medications: metabolic drugs, antihypertensives, cardiac-supporting agents, peptic disease therapy and hematological replacement therapy. Mode of intake, storage, means of supply and source of information for each class of drug were also assessed. Patients then received both oral and written instructions regarding their prescribed medications (intervention). This information was repeated 3 months later. Six months after the intervention, patients were re-administered the questionnaires. Response to the questionnaires and laboratory data were compared prior to and following the intervention. Overall, compliance with prescribed medications significantly improved following the intervention, from 89 to 95.7%, p = 0.0007. This relative improvement was greater in HD than CAPD patients (27 vs. 2%, p < 0.0001). Improvement in compliance was associated with lower initial scores, fewer years of education, and longer dialysis vintage. Compared to baseline values, post-intervention blood hemoglobin, hematocrit, mean corpuscular volume, ferritin and Ca levels were significantly improved. Dialysis patients appear to benefit from receiving comprehensive guidance about medications, in terms of compliance with medications and blood chemistry and hematology measures. (c) 2009 S. Karger AG, Basel.

Physician Verbal Compliance-Gaining Strategies and Patient Satisfaction

ERIC Educational Resources Information Center

Olynick, Janna; Iliopulos, Alexandra; Li, Han Z.

2017-01-01

Purpose: The patient healthcare experience is a complex phenomenon, as is encouraging patient compliance with medical advice. To address this multifaceted relationship, the purpose of this paper is to explore the ways resident physicians verbally encourage patient compliance and the relationship between these compliance-seeking strategies and…

Compliance, normality, and the patient on peritoneal dialysis.

PubMed

McCarthy, Alexandra; Shaban, Ramon; Boys, Jennifer; Winch, Sarah

2010-01-01

Monitoring and enhancing patient compliance with peritoneal dialysis (PD) is a recurring and problematic theme in the renal literature. A growing body of literature also argues that a failure to understand the patient's perspective of compliance may be contributing to these problems. The aim of this study was to understand the concept of compliance with PD from the patient's perspective. Using the case study approach recommended by Stake (1995), five patients on PD consented to in-depth interviews that explored the meaning of compliance in the context of PD treatment and lifestyle regimens recommended by health professionals. Participants also discussed factors that influenced their choices to follow, disregard, or refine these regimens. Results indicate that health professionals acting in alignment with individual patient needs and wishes, and demonstrating an awareness of the constraints under which patients operate and the strengths they bring to their treatment, may be the most significant issues to consider with respect to definitions of PD compliance and the development of related compliance interventions. Aspects of compliance that promoted relative normality were also important to the participants in this study and tended to result in greater concordance with health professionals' advice.

Determinants of Compliance among Pediatric Amblyopia Patients.

ERIC Educational Resources Information Center

Wolff, Hans; Juhasz, Anne McCreary

Given the recent focus on patient responsibility for health status and improvement, it is important to understand the dynamics involved in patient compliance to treatment regimens. The determinants of patching compliance among 30 pediatric amblyopia patients and their parents were investigated by means of parent, patient, and physician…

A study of reasons of non-compliance of psychiatric treatment and patients' attitudes towards illness and treatment in Qatar.

PubMed

Bener, Abdulbari; Dafeeah, Elnour E; Salem, Mohamad O

2013-04-01

The aim of this study was to examine the extent of psychiatric patients' compliance and non-compliance with treatment and examine the factors that affect compliance. Patients were recruited who were between 16 and 60 years of age and who were hospitalized with a psychiatric disorder and treated in the outpatient clinics of the psychiatry department. A total of 689 patients were approached and 564 patients agreed to participate in the study, a response rate of 81.8%. Participants were asked to complete a questionnaire that asked about socio-demographic characteristics (e.g., age, gender, nationality, level of education, occupation, marital status, and life style habits); medication(s) prescribed and the participant's response; the degree of social supervision (rated subjectively by the patient as "poor," "good," or "very good"); data also were obtained from clinical records. Data analyses explored significant associations between compliance and non-compliance and a group of relevant variables. Of the 564 patients studied, 328 (58.2%) were compliant with treatment and 236 (41.8%) were non-compliant. There was no significant difference between compliance and non-compliance in terms of gender (p = 0.471). Patients between 21-30 years of age were significantly more compliant with drug treatment than not. Non-compliance was more common among patients diagnosed with schizophrenia (28.4%), followed by depression (14.4%), and bipolar affective disorder (12.7%) (p = 0.001). Only 25% of compliant patients and 26.3% of non-compliant patients used non-psychotropic medication. Social supervision (40%) was very poor in non-compliant patients whereas 49.4% of compliant patients had very good family support. Notable reasons for non-compliance were irregular attendance to clinic (55.5%), ignorance about side effects of medication (61%), free medicine (45.8%), and a lack of education about medication (58.1%). This study revealed that non-compliance rates among psychiatry patients

Factors affecting compliance with preventive treatment for tuberculosis at Mistassini Lake, Quebec, Canada.

PubMed

Rideout, M; Menzies, R

1994-02-01

Non-compliance is the most important cause of failure of anti-tuberculous therapy throughout the world. In 1990 and 1991, an outbreak of tuberculosis occurred on the Mistassini Cree territory in Northern Quebec, Canada, and a number of cases of active tuberculosis occurred among known tuberculin-positive contacts who were non-compliant with preventive therapy. To better understand the factors affecting compliance with preventive treatment, a review of patients prescribed preventive treatment over the past 10 y was conducted. A freely-translated, interviewer-administered questionnaire was used to measure personal/lifestyle factors and knowledge/attitudes about tuberculosis. Clinic dossiers were reviewed to assess compliance. One hundred and two (102) subjects prescribed preventive treatment between 1981 and 1991 were interviewed, of whom 33.7% were judged to have been compliant. The most significant factor associated with compliance with preventive therapy was year of therapy. Between 1981 and 1985, 78% completed treatment, compared to less than 20% since 1986 (p < .0001). The major factor identified as associated with this sudden change was a shift in responsibility for tuberculosis treatment follow-up from native community health workers to non-native nurses in 1985/86. We conclude that tuberculosis control programs must be tailored to take into account the importance of cultural factors in promoting compliance with therapy.

Compliance with referrals to medical specialist care: patient and general practice determinants: a cross-sectional study.

PubMed

van Dijk, Christel E; de Jong, Judith D; Verheij, Robert A; Jansen, Tessa; Korevaar, Joke C; de Bakker, Dinny H

2016-02-01

In a gatekeeper system, primary care physicians and patients jointly decide whether or not medical specialist care is needed. However, it is the patient who decides to actually use the referral. Referral non-compliance could delay diagnosis and treatment. The objective of this study was to assess patient compliance with a referral to medical specialist care and identify patient and practice characteristics that are associated with it. Observational study using data on 48,784 referrals to medical specialist care derived from electronic medical records of 58 general practices for the period 2008-2010. Referral compliance was based on claims data of medical specialist care. Logistic multilevel regression analyses were conducted to determine associations between patient and general practice characteristics and referral compliance. In 86.6% of the referrals, patients complied. Patient and not practice characteristics were significantly associated with compliance. Patients from deprived urban areas and patients aged 18-44 years were less likely to comply, whereas patients aged 65 years and older were more likely to comply. About 1 in 8 patients do not use their referral. These patients may not receive adequate care. Demographic and socio-economic factors appear to affect compliance. The results of this study may be used to make general practitioners more aware that some patients are more likely to be noncompliant with referrals.

Patient's Compliance on the Use of Extended Low Molecular Weight Heparin Post Major Pelvic Surgeries in Cancer Patients at King Hussein Cancer Center.

PubMed

Baba, M; Al-Masri, M; Salhab, M; El-Ghanem, M

2015-01-01

Effective Venous Thrombo-Embolism (VTE) prophylaxis is used in less than 50% of oncology patients despite its wide availability. Low molecular weight heparin (LMWH) as a daily injection is an essential tool for effective prophylaxis against deep vein thrombosis (DVT). Daily outpatient self-injection by the patients or their family members is common practice. The effectiveness of this measure depends on patient compliance. The purpose of this study is to determine the degree of compliance and the factors that affect compliance to the extended out-patient use of prophylactic LMWH for 1 month after major abdominal/pelvic surgeries in cancer patients at King Hussein Cancer Center (KHCC). Following major abdominal/pelvic surgeries, data on 160 cancer patients at KHCC from January 2007 until July 2012 were collected concerning knowledge of DVT and compliance with prophylactic self-injections by answering a questionnaire. We have achieved a high compliance rate, this was explained by the medical team's role in educating the patients about the risk of VTE and the importance of thromboprophylaxis. The compliance with self-injections was directly associated with younger age, employment and higher degree of education. The high compliance rate outside clinical trials can be achieved through comprehensive patient education by a well-qualified medical team, clarification of the importance of DVT prophylaxis and patients' support.

Effect of clinician-patient communication on compliance with flupentixol-melitracen in functional dyspepsia patients

PubMed Central

Yan, Xiu-Juan; Li, Wen-Ting; Chen, Xin; Wang, Er-Man; Liu, Qing; Qiu, Hong-Yi; Cao, Zhi-Jun; Chen, Sheng-Liang

2015-01-01

AIM: To explore whether clinician-patient communication affects adherence to psychoactive drugs in functional dyspepsia (FD) patients with psychological symptoms. METHODS: A total of 262 FD patients with psychological symptoms were randomly assigned to four groups. The patients in Groups 1-3 were given flupentixol-melitracen (FM) plus omeprazole treatment. Those in Group 1 received explanations of both the psychological and gastrointestinal (GI) mechanisms of the generation of FD symptoms and the effects of FM. In Group 2, only the psychological mechanisms were emphasized. The patients in Group 3 were not given an explanation for the prescription of FM. Those in Group 4 were given omeprazole alone. The primary endpoints of this study were compliance rate and compliance index to FM in Groups 1-3. Survival analyses were also conducted. The secondary end points were dyspepsia and psychological symptom improvement in Groups 1-4. The correlations between the compliance indices and the reductions in dyspepsia and psychological symptom scores were also evaluated in Groups 1-3. RESULTS: After 8 wk of treatment, the compliance rates were 67.7% in Group 1, 42.4% in Group 2 and 47.7% in Group 3 (Group 1 vs Group 2, P = 0.006; Group 1 vs Group 3, P = 0.033). The compliance index (Group 1 vs Group 2, P = 0.002; Group 1 vs Group 3, P = 0.024) with the FM regimen was significantly higher in Group 1 than in Groups 2 and 3. The survival analysis revealed that the patients in Group 1 exhibited a significantly higher compliance rate than Groups 2 and 3 (Group 1 vs Group 2, P = 0.002; Group 1 vs Group 3, P = 0.018). The improvement in dyspepsia (Group 1 vs Group 2, P < 0.05; Group 1 vs Group 3, P < 0.05; Group 1 vs Group 4, P < 0.01) and psychological symptom scores (anxiety: Group 1 vs Group 2, P < 0.01; Group 1 vs Group 3, P < 0.05; Group 1 vs Group 4, P < 0.01; depression: Group 1 vs Group 2, P < 0.01; Group 1 vs Group 3, P < 0.01; Group 1 vs Group 4, P < 0.01) in Group 1 were

Effect of clinician-patient communication on compliance with flupentixol-melitracen in functional dyspepsia patients.

PubMed

Yan, Xiu-Juan; Li, Wen-Ting; Chen, Xin; Wang, Er-Man; Liu, Qing; Qiu, Hong-Yi; Cao, Zhi-Jun; Chen, Sheng-Liang

2015-04-21

To explore whether clinician-patient communication affects adherence to psychoactive drugs in functional dyspepsia (FD) patients with psychological symptoms. A total of 262 FD patients with psychological symptoms were randomly assigned to four groups. The patients in Groups 1-3 were given flupentixol-melitracen (FM) plus omeprazole treatment. Those in Group 1 received explanations of both the psychological and gastrointestinal (GI) mechanisms of the generation of FD symptoms and the effects of FM. In Group 2, only the psychological mechanisms were emphasized. The patients in Group 3 were not given an explanation for the prescription of FM. Those in Group 4 were given omeprazole alone. The primary endpoints of this study were compliance rate and compliance index to FM in Groups 1-3. Survival analyses were also conducted. The secondary end points were dyspepsia and psychological symptom improvement in Groups 1-4. The correlations between the compliance indices and the reductions in dyspepsia and psychological symptom scores were also evaluated in Groups 1-3. After 8 wk of treatment, the compliance rates were 67.7% in Group 1, 42.4% in Group 2 and 47.7% in Group 3 (Group 1 vs Group 2, P = 0.006; Group 1 vs Group 3, P = 0.033). The compliance index (Group 1 vs Group 2, P = 0.002; Group 1 vs Group 3, P = 0.024) with the FM regimen was significantly higher in Group 1 than in Groups 2 and 3. The survival analysis revealed that the patients in Group 1 exhibited a significantly higher compliance rate than Groups 2 and 3 (Group 1 vs Group 2, P = 0.002; Group 1 vs Group 3, P = 0.018). The improvement in dyspepsia (Group 1 vs Group 2, P < 0.05; Group 1 vs Group 3, P < 0.05; Group 1 vs Group 4, P < 0.01) and psychological symptom scores (anxiety: Group 1 vs Group 2, P < 0.01; Group 1 vs Group 3, P < 0.05; Group 1 vs Group 4, P < 0.01; depression: Group 1 vs Group 2, P < 0.01; Group 1 vs Group 3, P < 0.01; Group 1 vs Group 4, P < 0.01) in Group 1 were greater than those in

[Hypertension therapy and patient compliance].

PubMed

Rapi, Judit

2002-08-25

In the treatment of chronic disease like hypertension it is very important to achieve good patient compliance. One third of the patients however takes his medicament irregularly. The failure of the treatment is usually caused by the patient, who is not aware of his illness, he feels healthy that's why he does not go to see the doctor or he stops taking the medicine. The cause of bad compliance can also be the doctor who does not spend enough time and energy on his patients. Rarely the therapy is broken off because of the side effects of the medication. In the last year 100 patients with hypertension were asked with help of a questionnaire about their drug-taking habits and their knowledge about hypertension. From the answers we found out that one third of the patients takes his drugs irregularly. Less than half of the patients reaches the normotension. Most of the patients who have been treated for many years do not know the goal blood pressure, the possible complications of hypertension, the goal of the treatment. Often they do not even know the name of their medicine. Compliance is a complicated problem. Improvement could be reached by regular teaching of the patients, by teaching the patients how to measure blood pressure at home, by increasing the number of educational publications, by regular training of the doctors, by keeping the rules of the treatment, by using modern and long-term effective drugs. It would be important to start with teaching the healthy way of living already at a young age.

[Patient compliance with inhaled medication approach in community pharmacy].

PubMed

Maesschalck, J; Duquet, N

2012-03-01

Non compliance with chronic administration of inhaled medication is a great pitfall. Pharmacists have an important task in optimizing patient compliance since they hold several advantages for that purpose: they possess an overview of the patient's medication, even prescription free medication such as cough medicines. Moreover, the pharmacist is capable of explaining the role of the medication in therapy and he enjoys the patient's confidence to do so. This article highlights some strategies to measure patient compliance and seeks to understand the underlying reasons for non-compliance. The appropriate pharmacist's action will depend on that reason.

Assessment of nurse attitudes on psychiatric patient compliance with pharmacotherapy.

PubMed

Gajski, Anita; Karlović, Dalibor

2008-09-01

The aim of the study was to assess the opinion of nurses employed at a psychiatry department about compliance with pharmacotherapy in patients they provide care for on a daily basis, i.e. assessment of the nurse's role in patient compliance with prescribed medication and how much the nurse can contribute to better patient compliance with pharmacotherapy. Thirty-nine nurses, i.e. 2/3 of nurses employed at University Department of Psychiatry, Sestre milosrdnice University Hospital, participated in the study Data were collected through a structured survey/questionnaire for nurses, which is used to assess the nurses' opinion of patient compliance with pharmacotherapy. Study results confirmed the belief that nurses recognize the importance of patient compliance in daily work and are aware that this compliance depends on the patient himself, his diagnosis, the medicine he receives, his family and medical professionals involved in his medical care.

Multi-compartment medication devices and patient compliance.

PubMed

McGraw, Caroline

2004-07-01

Multi-compartment medication compliance devices are widely used in primary care. The aim of this review is to reveal whether they are effective in promoting adherence among non-adherent adults living at home. Searches were undertaken using two electronic databases (Medline (1966-2003) and International Pharmaceutical Abstracts (1970-2002)). Only randomized controlled trials (including crossover studies) were included in the review. Participants had to be non-institutionalized adults receiving one or more prescription medicines each day and displaying problems with adherence. Studies had to compare multi-compartment medication compliance devices to standard packaging and outcome measures and to include either pill counts, biological assays and/or clinical response. Articles were selected if they described a follow up period of at least three months and demonstrated that over 80% of participants had completed the trial. Two studies were identified that met the criteria, reporting data on a total of 148 patients. The findings from the first study found diabetic patients receiving medication in a compliance device demonstrated better glucose control than patients receiving medication in standard packaging. The second study found compliance devices had no impact on blood pressure control in hypertensive patients. Further research needs to be conducted to assess the effectiveness of multi-compartment medication compliance devices in promoting adherence among non-adherent adults living at home.

Compliance as a prognostic indicator. II. Impact of patient's compliance to the individual tooth survival.

PubMed

Miyamoto, Takanari; Kumagai, Takashi; Lang, Melissa S; Nunn, Martha E

2010-09-01

Existing evidence concerning the validity of an appropriate regular periodontal maintenance (PM) regimen and the role of patient compliance is controversial and inconsistent. The objectives of this study are to identify the impact of patient compliance (complete versus erratic) on alveolar bone loss and tooth survival. A retrospective study was conducted using data from 295 patients with >or=20 years of observation, which included treatment and >or=15 years of maintenance therapy, in a private practice in Yamagata, Japan. Subject-level variables and tooth-level variables were recorded at the initial visit, the reevaluation visit, and the final visit. In total, 7,502 teeth in 295 subjects met inclusion criteria and were divided into two groups: non-molar teeth (n = 5,585) and molar teeth (n = 1,917). A tooth-level multivariate survival model and multiple logistic regression model using the method of generalized estimating equations were constructed to analyze the effects of compliance and periodontal maintenance intervals on tooth loss and alveolar bone loss, respectively. Of 7,502 teeth, 284 molar teeth and 364 non-molar teeth were lost. Molar teeth had an approximately 30% reduction in risk of tooth loss for complete compliance, with 2-year compliance classification achieving statistical significance (P = 0.033), and 30% compliance classification approaching statistical significance (P = 0.072). Complete compliers under 30% compliance classification showed over 50% reduction in the risk of alveolar bone loss among non-molars (P = 0.015). Complete patient compliance with increased frequency of periodontal maintenance is important for improved dental prognosis through reduction of tooth loss among molars and minimization of alveolar bone loss among non-molars.

Patient compliance with touchdown weight bearing after microfracture treatment of talar osteochondral lesions.

PubMed

Polat, Gökhan; Karademir, Gökhan; Akalan, Ekin; Aşık, Mehmet; Erdil, Mehmet

2017-03-20

The aim of this study was to prospectively evaluate the compliance of our patients with a touchdown weight bearing (without supporting any weight on the affected side by only touching the plantar aspect of the foot to the ground to maintain balance to protect the affected side from mechanical loading) postoperative rehabilitation protocol after treatment of talar osteochondral lesion (TOL). Fourteen patients, who had been treated with arthroscopic debridement and microfracture, were followed prospectively. The patients were evaluated for weight bearing compliance with using a stationary gait analysis and feedback system at the postoperative first day, first week, third week, and sixth week. The mean visual analog scale (VAS) scores of the patients at the preoperative, postoperative first day, first week, third week, and sixth weeks were 5.5, 5.9, 3.6, 0.9, and 0.4, respectively. The decrease in VAS scores were statistically significant (p < 0.0001). First postoperative day revealed a mean value of transmitted weight of 4.08% ±0.8 (one non-compliant patient). The mean value was 4.34% ±0.8 at the first postoperative week (two non-compliant patients), 6.95% ±2.3 at the third postoperative week (eight non-compliant patients), and 10.8% ±4.8 at the sixth postoperative week (11 non-compliant patients). In the analysis of data, we found a negative correlation between VAS scores and transmitted weight (Kendall's tau b = -0.445 and p = 0.0228). Although patients were able to learn and adjust to the touchdown weight bearing gait protocol during the early postoperative period, most patients became non-compliant when their pain was relieved. To prevent this situation of non-compliance, patients should be warned to obey the weight bearing restrictions, and patients should be called for a follow-up at the third postoperative week.

Influence of various factors on patient compliance after periodontal therapy: A pilot study

PubMed Central

Shah, Rucha; Thomas, Raison; Bhandari, Shilpy; Mehta, Dhoom Singh

2017-01-01

Background: Patient compliance is an important predictor of periodontal prognosis, therapy, and maintenance. Limited studies concentrate up on the factors which affect patient compliance. Thus, the aim of the study is to determine the relationship between sociodemographic data, patient's oral health awareness (OHA) and treatment satisfaction (TS) to patient compliance. Materials and Methods: A total of 150 patients were subjected to a prevalidated questionnaire comprising of thirty questions. Questions covered different aspects such as sociodemographic data, OHA, and level of patient TS. Statistical analysis was done using mean, percentages, and Spearman's correlation coefficient. Results: A sample of 150 people was included into the study of which 93 were females and 67 males with a mean age of 38 years. The total OHA scores when divided into three categories such as 5–7, 8–9, and >10 and plotted against number of missed appointments; the difference found was statistically significant (P < 0.001). The mean TS was divided into four subgroups of score >24, 25–27, 28–30, and >31 and then plotted against the average number of missed appointments, and the difference was found to be statistically significant (P < 0.001). The correlation between the OHA score and number of missed appointments was −0.59 (P < 0.001) and TS score and number of missed appointments was −0.40 (P < 0.001). Conclusion: Within the limitations of the study, it can be concluded that patient education, OHA, and TS are the variables that influence the patient compliance. PMID:29386801

HIPAA compliance and patient privacy protection.

PubMed

Grandison, Tyrone; Bhatti, Rafae

2010-01-01

Recent prosecution of violations of the Health Insurance Portability and Accountability Act (HIPAA), and the amendments currently in process to strengthen the Act of 1996, has led many companies to take serious notice of the measures they must take to be a compliance. A company's privacy policy states the business' privacy practices and embodies the firm's commitments to its users and is normally mandatory step in reaching legislative compliance. in the face of this, the patient has to decipher if the company's privacy practices are congruent with their thoughts on the level of privacy protection they should be receiving. This is the core of our investigation. In this paper, we explore the question "Is a healthcare entity's compliance with regulation sufficient to provide the patient with adequate privacy protection?" in the context of the United States of America.

Supporting the patient's role in guideline compliance: a controlled study.

PubMed

Rosenberg, Stephen N; Shnaiden, Tatiana L; Wegh, Arnold A; Juster, Iver A

2008-11-01

Clinical messages alerting physicians to gaps in the care of specific patients have been shown to increase compliance with evidence-based guidelines. This study sought to measure any additional impact on compliance when alerting messages also were sent to patients. For alerts that were generated by computerized clinical rules applied to claims, compliance was determined by subsequent claims evidence (eg, that recommended tests were performed). Compliance was measured in the baseline year and the study year for 4 study group employers (combined membership >100,000) that chose to add patient messaging in the study year, and 28 similar control group employers (combined membership >700,000) that maintained physician messaging but did not add patient messaging. The impact of patient messaging was assessed by comparing changes in compliance from baseline to study year in the 2 groups. Multiple logistic regression was used to control for differences between the groups. Because a given member or physician could receive multiple alerts, generalized estimating equations with clustering by patient and physician were used. Controlling for differences in age, sex, and the severity and types of clinical alerts between the study and control groups, the addition of patient messaging increased compliance by 12.5% (P <.001). This increase was primarily because of improved responses to alerts regarding the need for screening, diagnostic, and monitoring tests. Supplementing clinical alerts to physicians with messages directly to their patients produced a statistically significant increase in compliance with the evidence-based guidelines underlying the alerts.

Compliance with eye care in glaucoma patients with comorbid depression.

PubMed

Weiss, Guy A; Goldich, Yakov; Bartov, Elisha; Burgansky-Eliash, Zvia

2011-12-01

Comorbid depression may play an important role in non-compliance with medical treatment among patients with chronic illnesses. Glaucoma is a potentially blinding chronic disease requiring life-long commitment to medical therapy. Failure to adhere to anti-glaucoma treatment may lead to disease progression and visual loss. To assess the prevalence of depressive symptoms in glaucoma patients and the association between these symptoms and non-compliance with anti-glaucoma therapy. In this cross-sectional observational study, compliance with pharmacotherapy was assessed with the Morisky Medication Adherence questionnaire (eight items). Screening for depression was performed by means of the CES-D (Center for Epidemiologic Studies Depression scale). The association between depression and compliance rates was analyzed. The study group comprised 76 glaucoma patients; 19.7% of the subjects were classified as non-compliant (Morisky cutoff 10) and 21.1% suffered from depression (CES-D cutoff > or = 16). We found a similar level of non-compliance when comparing depressed with non-depressed glaucoma patients. However, a correlation was observed between the level of depression and the level of non-compliance (P = 0.04). Our study revealed a similar rate of depression in glaucoma patients and the general israeli population. The presence of depression was not associated with the presence of non-compliance, yet the level of depression was associated with the level of non-compliance.

Patient compliance with telephone triage recommendations: a meta-analytic review.

PubMed

Purc-Stephenson, Rebecca J; Thrasher, Christine

2012-05-01

To systematically investigate the extent to which patients comply with triage advice from telenurses and to identify factors that potentially influence compliance. Findings from 13 studies identified through interdisciplinary research databases (1990-2010) were meta-analyzed. Separate pooled analyses compared patients' compliance rates for emergency services and office care (13 outcomes), emergency services and self care (13 outcomes), and self care and office care (12 outcomes). Overall patient compliance was 62%, but varied by intensity of care recommended with low compliance rates for advice to see a general practitioner. Reasons for noncompliance include patients reporting to have heard a different disposition, patients' intentions and health beliefs. Patient compliance to triage recommendations was influenced by the interactive role of patient perceptions and the quality of provider communication, both of which were mediated by access to health services. Further research is needed to clarify whether noncompliance is attributable to poor communication by the nurse or patient misinterpretation. We highlight the need for communication-skills training in a telephone-consultation context that is patient centered, and specifically addresses building active listening and active advising skills and advantages to structuring the call. Crown Copyright © 2011. Published by Elsevier Ireland Ltd. All rights reserved.

Compliance and Subjective Patient Responses to Eyelid Hygiene.

PubMed

Alghamdi, Yousef A; Camp, Andrew; Feuer, William; Karp, Carol L; Wellik, Sarah; Galor, Anat

2017-07-01

Lid hygiene is a commonly prescribed first-line therapy in patients with lid margin disease, yet compliance with therapy is not well characterized. The goals of this study were to assess patient compliance with lid hygiene and evaluate which factors predict a favorable symptomatic response to treatment. This was a cross-sectional study of patients seen in the Miami Veterans Affairs eye clinic between August and December 2014. An evaluation was performed to assess dry eye symptoms and lid margin signs. All patients were then instructed to perform warm compresses and lid scrubs. A follow-up phone survey assessed compliance and subjective therapeutic response 6 weeks later. Two hundred seven of 211 (98%) patients (94% male, 60% white) completed the survey. Of the 207 patients, 188 (91%) completed the follow-up survey. Compliance with therapy was reported in 104 patients (55%); 66 reported complete improvement, 30 partial improvement, and 8 no improvement in symptoms. Patients who self-reported dry eye symptoms at first visit (n=86, 74%) were more likely to be compliant with lid hygiene than those who did not report symptoms (n=18, 25%) (P<0.0005). The only factor associated with poorer response to lid hygiene was longer time of self-reported dry eye symptoms. None of the other signs studied, including the presence of skin rosacea and lid margin telangiectasia, were associated with a differential response to lid hygiene. Patients with dry eye symptoms were moderately compliant with lid hygiene, and patients who performed the routine noted improvement in symptoms.

Determinants of compliance behaviours among patients undergoing hemodialysis in Malaysia.

PubMed

Chan, Yoke Mun; Zalilah, Mohd Shariff; Hii, Sing Ziunn

2012-01-01

Patients with end stage renal disease often fail to follow prescribed dietary and fluid regimen, leading to undesirable outcomes. This study aimed to examine and identify factors influencing dietary, fluid, medication and dialysis compliance behaviours in patients undergoing hemodialysis. This was a cross-sectional study which employed purposive sampling design. A total of 188 respondents were recruited from 14 dialysis centres in Malaysia between 2008-2011. Self-reported compliance behaviours and biochemical measurements were used as evaluation tools. Compliance rates of dietary, fluid, medication and dialysis were 27.7%, 24.5%, 66.5% and 91.0%, respectively. Younger, male, working patients and those with longer duration on hemodialysis were found more likely to be non-compliant. Lacks of adequate knowledge, inadequate self-efficacy skills, forgetfulness and financial constraints were the major perceived barriers towards better compliance to fluid, dietary, medication and dialysis, respectively. Healthcare professionals should recognise the factors hindering compliance from the patients' perspective while assisting them with appropriate skills in making necessary changes possible.

The practitioner, the patient and resistance to change: recent ideas on compliance.

PubMed Central

Butler, C; Rollnick, S; Stott, N

1996-01-01

Despite the explosion of research into the effect of medical advice on patient behaviour, only about 50% of patients comply with long-term drug regimens. And when it comes to changes in lifestyle, the percentage of patients who comply with medical advice often falls to single figures. Review articles on compliance have traditionally concentrated on factors that make it easier for patients to adhere to medical advice. However, recent articles urge clinicians to be more understanding of the wider implications of compliance in their patients' lives. This article focuses on how clinicians' consulting methods can affect patients' behaviour. Specifically, the authors consider the patient-centred clinical method as well as insights from and consulting techniques pioneered in the addictions field that can help to bring ambivalent patients closer to decisions about change. Instead of seeing resistance to change as rooted entirely in the patient, the authors view it as stemming partly from the way clinicians talk to patients. An advice-giving approach is usually inadequate to motivate people to embark on major lifestyle changes. Instead, the authors propose a negotiation-based framework that harnesses patients' intrinsic motivation to make their own decisions. This approach also promotes clinicians' acceptance of patients' decisions, even if these decisions run counter to current medical wisdom. PMID:8616739

Relation between response to illness and compliance in haemodialysis patients.

PubMed

Saounatsou, M

1999-01-01

The treatment schedule of the haemodialysis patient has many restrictions and the long-term haemodialysis patient's response to illness is characterised by various emotional reactions. Compliance with their medical regimens remains a significant problem which influences the progress of health and by extension quality of life. The preconceived idea that a patient's response to illness may influence his adherence to medical regimen led to this study. The main variables examined were the relationship between the patient's response to illness and compliance and the relationship between compliance and age, education and the length of time on haemodialysis.

Patient compliance with managed care emergency department referral: an orthopaedic view.

PubMed

Saroff, Don; Dell, Rick; Brown, E Richard

2002-04-01

Patient compliance with emergency department (ED)-generated referral is an important part of the delivery of quality health care. Although many studies from non-managed care health centers have reported on ED patient compliance, no studies have reported on this in a managed care setting. The objective of this study is to examine patient compliance with ED-generated referral and to produce a benchmark of follow-up rates possible in a capitated managed care system. That is to say, in a health care system whose members pay a uniform per capita payment or fee, one that has salaried physicians, owns its own hospitals, and has a mechanism of transition from ED to outpatient clinic that ensures referral accessibility. Retrospective review of consecutive ED patient compliance with ED-generated referral. All consecutive patients who presented to a managed care hospital's ED with an acute fracture and who were given an outpatient referral during the period from 23rd December 1998 to 23rd January, 1999. Of 8000 consecutive ED patients, 234 were included in the study. Compliance with ED-generated referral was determined from outpatient clinic records. Of the 234 patients treated in the ED and referred, 222 (94.9%) complied with follow-up appointments. We have demonstrated that an ED patient follow-up compliance rate of 94.9% can be obtained. It is probable that the high compliance rate is due to the features of the system studied. The high rate may also be related to the specific diagnosis studied, although previous literature reports poor ED patient compliance for the same diagnosis in a different ED setting. Additional research is needed to determine whether the high compliance rate reported in this study can be obtained in ED settings that are not part of a similar managed care system and to determine the role of referral accessibility (or inaccessibility) in current ED settings.

[The role of patient compliance in the management of glaucoma].

PubMed

Popović Suić, Smiljka; Cerovski, Branimir; Jukić, Tomislav

2008-02-01

The aim of the study was to evaluate patient cooperation in glaucoma treatment. We evaluated data collected by an anonymous questionnare from 98 glaucoma patients who answered 6 questions regarding their compliance and persistence in glaucoma treatment. Study results revealed 50% of patients to fail taking their antiglaucoma therapy regularly. Patients on monotherapy showed better compliance and higher level of satisfaction with treatment than those on combination antiglaucoma therapy consisting of 2 or 3 eyedrops. Discontinuation of persistence was recorded in 31% of patients, whereas 51% of patients did not present for control visits every six months as suggested by their ophthalmologist. Patients are more compliant and persistent with antiglaucoma monotherapy than with combined therapy. Greater compliance and persistence with ocular hypotensive therapy may improve the outcomes in glaucoma.

Patient Compliance During Contact Lens Wear: Perceptions, Awareness, and Behavior

PubMed Central

Bui, Thai H.; Cavanagh, H. Dwight; Robertson, Danielle M.

2011-01-01

Objectives Patient noncompliance with recommended hygienic practices in contact lens wear is often considered a significant risk factor for microbial keratitis and adverse contact lens–related events. Despite advancements in lens materials and care solutions, noncompliant behavior continues to hinder efforts to maximize contact lens safety. The objective of this pilot study was to assess the relationship between perceived and actual compliance with awareness of risk and behavior. Methods One hundred sixty-two established contact lens wearers were sequentially evaluated after their routine contact lens examination at the Optometry Clinic at the University of Texas Southwestern Medical Center at Dallas, TX. Each patient was questioned by a single trained interviewer regarding his or her lens care practices and knowledge of risk factors associated with lens wear. Results Eighty-six percent of patients believed they were compliant with lens wear and care practices; 14% identified themselves as noncompliant. Using a scoring model, 32% demonstrated good compliance, 44% exhibited average compliance, and 24% were noncompliant; age was a significant factor (P = 0.020). Only 34% of patients who perceived themselves as compliant exhibited a good level of compliance (P<0.001). Eighty percent of patients reported an awareness of risk factors, but awareness did not influence negative behavior. Replacing the lens case was the only behavior associated with a positive history for having experienced a prior contact lens–related complication (P = 0.002). Conclusions Perceived compliance is not an indicator for appropriate patient behavior. A large proportion of patients remain noncompliant despite awareness of risk. Education alone is not a sufficient strategy to improve behavior; newer approaches aimed at improving compliance with lens care practices are urgently needed. PMID:20935569

Compliance With Protective Lens Wear in Anophthalmic Patients.

PubMed

Neimkin, Michael G; Custer, Philip L

To evaluate the frequency of protective lens wear by anophthalmic patients and identify factors that influence compliance. An IRB approved descriptive retrospective chart review of patients undergoing surgery with the senior author (PLC) with an anophthalmic orbit and one remaining sighted eye. Results were tabulated and analyzed using age, indication for procedure, duration of visual symptoms, safety glasses wear, number of postoperative visits, and evidence of new trauma to the remaining eye. All patients underwent counseling on the importance of protective lens wear preoperatively and each subsequent visit. Etiologies for loss of the eye in the 132 study patients included trauma (33.3%), blind painful eye (33.3%), congenital disorders (14.4%), adult-onset malignancy (14.4%), and retinoblastoma (4.5%). At the final visit, protective lenses were worn in the following patterns: full-time (55.3%), frequently (11.4%), occasional (6%), and never (28.8%). The regular use of protective eyewear at last visit was more common in patients wearing glasses at presentation (79.7%), than in those who did not (32.9%; p ≤ 0.001). Increased number of office encounters correlated with more frequent use of protective eyewear (p ≤ 0.01). Patient age (p = 0.95), indication for surgery (p = 0.97), and duration of visual loss (p = 0.85) were not predictive of safety glasses wear. Three patients had evidence of subsequent ocular trauma to the remaining eye, with 2 having resultant decrease in acuity; none of these 3 patients wore safety glasses full-time. A significant number of anopthalmic patients were not wearing protective lenses at presentation. Overall compliance was poor; but repeated education on the importance of safety glasses appears to improve compliance. Educating referring providers and primary care physicians about the importance of early and repeated counseling is vital to increasing compliance.

Evolving Patient Compliance Trends: Integrating Clinical, Insurance, and Extrapolated Socioeconomic Data

PubMed Central

Klobusicky, Joseph J.; Aryasomayajula, Arun; Marko, Nicholas

2015-01-01

Efforts toward improving patient compliance in medication focus on either identifying trends in patient features or studying changes through an intervention. Our study seeks to provide an important link between these two approaches through defining trends of evolving compliance. In addition to using clinical covariates provided through insurance claims and health records, we also extracted census based data to provide socioeconomic covariates such as income and population density. Through creating quadrants based on periods of medicine intake, we derive several novel definitions of compliance. These definitions revealed additional compliance trends through considering refill histories later in a patient’s length of therapy. These results suggested that the link between patient features and compliance includes a temporal component, and should be considered in policymaking when identifying compliant subgroups. PMID:26958212

[Compliance to treatment in heart failure patients in Lomé].

PubMed

Yayehd, K; Damorou, F; N'cho Mottoh, M P; Tchérou, T; Johnson, A; Pessinaba, S; Tété, Y; Diziwiè, A M

2013-02-01

The incidence and prevalence rates of the heart failure in the world approach epidemic proportions. The evaluation of the follow-up of the treatment of heart failure can allow the setting up of strategies to reduce the frequency of decompensations and improve the quality of life of these patients. To estimate the compliance to treatment and factors liable to influence it in Togolese patients suffering from heart failure. This study was carried out from January 1st, 2008 to June 30th, 2009 in the department of cardiology of the university teaching hospital Campus in Lomé and included prospectively, patients with chronic heart failure hospitalized for acute decompensation and of which the heart failure was diagnosed and treated for at least 3 months. Questionnaires were filled to estimate the compliance to medication, to diet, as well as knowledge of the patients on their disease and their relationship with their doctor and their family. In the 103 patients included, we noticed no good compliance to medication; there were 74.7% of bad compliance to medication, 47.3% of good compliance to diet; 62.1% of patients had enough knowledge on their disease, 29.1% considered that their doctor did not grant them enough time; 57.3% estimated to have no necessary support of their family. Bad compliance to treatment was correlated to the existence or not of a health care insurance (OR=115.5; 95% CI=21.51-620.08; P<0.0001); this difference persisted after adjusting for age, sex and monthly income (OR=99.65; 95% CI=18.87-587.21; P=0.001). Bad compliance was not associated with monthly income (OR=0.93; 95% CI=0.37-2.28; P=0.944); it was neither influenced by traditional therapy (OR=1.58 95% CI=0.64-3.91; P=0.43), nor recovery prayers (OR=1.6; 95% CI=0.62-4.13; P=0.45), nor frequency of tablets intake (≥3 intake day), OR=0.169; 95% CI=0.05-0.49; P=0.43. The compliance to medication in Togolese heart failure patients was very low and essentially correlated to the absence of health

Compliance with Protective Lens Wear in Anophthalmic Patients

PubMed Central

Neimkin, Michael G.; Custer, Philip L.

2016-01-01

Purpose To evaluate the frequency of protective lens wear by anophthalmic patients and identify factors that influence compliance. Methods An IRB approved descriptive retrospective chart review of patients undergoing surgery with the senior author (PLC) with an anophthalmic orbit and one remaining sighted eye. Results were tabulated and analyzed using age, indication for procedure, duration of visual symptoms, safety glasses wear, number of post-operative visits, and evidence of new trauma to the remaining eye. All pateints underwent counseling on the importance of protective lens wear preoperatively and each subsequent visit. Results Etiologies for loss of the eye in the 132 study patients included trauma (33.3%), blind painful eye (33.3%), congenital disorders (14.4%), adult-onset malignancy (14.4%), and retinoblastoma (4.5%). At the final visit, protective lenses were worn in the following patterns: full-time (55.3%), frequently (11.4%), occasional (6%), and never (28.8%). The regular use of protective eyewear at last visit was more common in patients wearing glasses at presentation (79.7%), than in those who did not (32.9%) (p=<0.001). Increased number of office encounters correlated with more frequent use of protective eyewear (p=<0.01. Patient age (p=0.95), indication for surgery (p=0.97), and duration of visual loss (p=0.85) were not predictive of safety glasses wear. 3 patients had evidence of subsequent ocular trauma to the remaining eye, with 2 having resultant decrease in acuity; none of these 3 patients wore safety glasses full-time. Conclusions A significant number of anopthalmic patients were not wearing protective lenses at presentation. Overall compliance was poor; but repeated education on the importance of safety glasses appears to improve compliance. Educating referring providers and primary care physicians about the importance of early and repeated counseling is vital to increasing compliance. PMID:26866334

Factors that interfere the medication compliance in hypertensive patients

PubMed Central

Daniel, Ana Carolina Queiroz Godoy; Veiga, Eugenia Velludo

2013-01-01

ABSTRACT Objective: To characterize the factors that interfere in drug treatment compliance in a group of individuals with arterial hypertension. Methods: A non-experimental descriptive study that analyzed a sample of 80 patients diagnosed with arterial hypertension, who underwent medical treatment and were admitted to a university hospital during the period from March to May 2009. To collect data, the Instrument for Evaluation of Attitudes Regarding Taking Medication was applied. Results: In the studied population, 45.1% had sufficient degree of compliance to drug therapy. Individuals with controlled blood pressure, females, white, single, married or widowed, retired, aged between 40 and 59 years, and those aged above 80 years were the interviewees who answered positively regarding compliance and follow-up of drug therapy. Conclusion: Despite the fact that the number of factors that facilitate the process of compliance to drug treatment is greater than the number of complicating factors, we found that more than half of the patients surveyed had an insufficient degree of compliance with drug treatment for high blood pressure, which demonstrates the need to develop studies aimed to identify these factors and their contribution to the promotion of patient autonomy, acceptance, awareness and adaptation regarding their illness. PMID:24136760

Patient counseling program to improve the compliance to imatinib in chronic myeloid leukemia patients.

PubMed

Moon, Joon Ho; Sohn, Sang Kyun; Kim, Shi Nae; Park, Seon Yang; Yoon, Sung Soo; Kim, In Ho; Kim, Hyeoung Joon; Kim, Yeo Kyeoung; Min, Yoo Hong; Cheong, June Won; Kim, Jin Seok; Jung, Chul Won; Kim, Dong Hwan

2012-06-01

To achieve successful therapeutic outcomes in chronic myeloid leukemia (CML), continuous and adequate imatinib (Gleevec(®), Glivec(®), Novartis Pharmaceuticals, Basel, Switzerland) dosing is essential. Here, we report a patient counseling program ("Care club", "Happy club" in Korea) performed to improve patient compliance with imatinib. From January 2006 to December 2008, patients diagnosed with chronic phase CML and taking imatinb were eligible for this retrospective study. A total of 114 patients from 4 centers in Korea were recruited at a 50:50 ratio for Happy club group versus non-Happy club group at each center. During 36-month follow-up, persistency (the number of days of imatinib prescribed versus 1 year) was higher in the Happy club group (98.2 ± 0.03%) than in the non-Happy club group (79.3 ± 0.16%, P = 0.001), whereas dose compliance (miligrams of imatinib that were actually taken versus miligrams that should have been taken) was not different between two groups; 96.5 ± 0.6% and 96.6 ± 0.7% in the Happy club and non-Happy club (P = 0.958). Overall compliance (the product of persistency and dose compliance) improved in the Happy club group (93.0 ± 2.3%) compared with the non-Happy club group (76.2 ± 7.4%, P = 0.001). The patient counseling program was efficient especially in patients who needed high-dose imatinib (>400 mg/day), and overall compliance was 87.8 ± 6.0% in the Happy club group versus 65.5 ± 16.1% in the non-Happy club group (P = 0.017). In conclusion, the patient counseling program was effective in persisting imatinib medication, resulting in the improvement of overall compliance.

Patient Compliance with Surveillance Following Elective Endovascular Aneurysm Repair

DOE Office of Scientific and Technical Information (OSTI.GOV)

Godfrey, Anthony D., E-mail: deangodfrey@yahoo.co.uk; Morbi, Abigail H. M., E-mail: a.morbi@soton.ac.uk; Nordon, Ian M., E-mail: ian.nordon@uhs.nhs.uk

PurposeIntegral to maintaining good outcomes post-endovascular aneurysm repair (EVAR) is a robust surveillance protocol. A significant proportion of patients fail to comply with surveillance, exposing themselves to complications. We examine EVAR surveillance in Wessex (UK), exploring factors that may predict poor compliance.MethodsRetrospective analysis of 179 consecutive elective EVAR cases [2008–2013] was performed. 167 patients were male, with the age range of 50–95. Surveillance was conducted centrally (tertiary referral trauma centre) and at four spoke units. Surveillance compliance and predictors of non-compliance including age, gender, co-morbid status, residential location and socioeconomic status were analysed for univariate significance.ResultsFifty patients (27.9 %) were non-compliantmore » with surveillance; 14 (8.1 %) had no imaging post-EVAR. At 1 year, 56.1 % (of 123 patients) were compliant. At years 2 and 3, 41.5 and 41.2 % (of 65 and 34 patients, respectively) were compliant. Four years post-EVAR, only one of eight attended surveillance (12.5 %). There were no statistically significant differences in age (p = 0.77), co-morbid status or gender (p = 0.64). Distance to central unit (p = 0.67) and surveillance site (p = 0.56) was non-significant. While there was a trend towards compliance in upper-middle-class socioeconomic groups (ABC1 vs. C1C2D), correlating with >50 % of non-compliant patients living within <10 mile radius of the central unit, overall predictive value was not significant (p = 0.82).ConclusionsCompliance with surveillance post-EVAR is poor. No independent predictor of non-compliance has been confirmed, but socioeconomic status appears to be relevant. There is a worrying drop-off in attendance beyond the first year. This study highlights a problem that needs to be addressed urgently, if we are to maintain good outcomes post-EVAR.« less

Patient compliance and supportive periodontal therapy: Study among young adults of Namakkal district

PubMed Central

Gokulanathan, Subramanium; Balan, Natarajan; Aravind, Ramaraj Jayabalan; Thangavelu, Kavin

2014-01-01

Aims: The aim of this study is to assess the patient compliance to supportive and maintenance periodontal therapy and to determine the reason for noncompliance among young adult patients of Namakkal district, India. Materials and Methods: This was a cross-sectional study conducted on 400 patients who underwent periodontal therapy and subsequently recalled for supportive and maintenance periodontal treatment in the Department of Periodontics, Vivekanandha Dental College for Women, Namakkal. Patients age group 25-35 years and of both gender were equally selected and grouped by occupation and socioeconomic status. According to their compliance with appointments, they are categorized as complete compliance, partially compliance and insufficient or noncompliance. Noncompliance and partially compliance patients were contacted and asked to rate their experience and reason for noncompliance. Results: In this study, 80% of patients showed complete compliance and were regular for supportive periodontal therapy appointments. Women were more regular in maintaining recall appointments than men. Salaried employers showed 84.3% complete compliance, while self-employed personals showed 77% complete compliance and 75% of nonworking personals were regular to the appointment schedule. Noncompliance person has quoted lack of time and forgetting the appointment date as a major reason for missed appointments. Conclusions: This study recommends the need for improvement in communication skills of practitioners and weekend appointment for patient undergoing periodontal maintenance therapy. PMID:25210365

40 CFR 63.5996 - How do I demonstrate initial compliance with the emission limits for tire production affected...

Code of Federal Regulations, 2010 CFR

2010-07-01

... with the emission limits for tire production affected sources? 63.5996 Section 63.5996 Protection of... Pollutants: Rubber Tire Manufacturing Testing and Initial Compliance Requirements for Tire Production Affected Sources § 63.5996 How do I demonstrate initial compliance with the emission limits for tire...

[Psychological factors associated to patient's treatment compliance in Chilean diabetic teenagers].

PubMed

Ortiz, Manuel; Ortiz, Eugenia

2005-03-01

Treatment compliance among patients with type 1 diabetes mellitus, is low in 50% of diabetic teenagers, becoming a social and medical problem. To determine psycho-social factors associated to treatment compliance among Chilean diabetic type 1 teenagers. A non experimental study of 61 diabetic teenagers (age 14.9+/-1.9 years, 37 male). The number of blood glucose determinations, socioeconomic level and practice of sports was measured. Psychological tests were applied to analyze self-efficiency, motivation of achievement, self-esteem and knowledge of the illness and its treatment. As a measure of patient compliance, glycosilated hemoglobin (HB1Ac) was measured. Six patients had a good control of diabetes (HB1Ac <7%), 24 had HB1Ac values between 7 and 8.9, and 31 (51%) had values of 9% or more, considered as a poor diabetes control. The intensified insulin treatment scheme, the knowledge of the illness and its treatment and the sense of self-efficiency, were the factors associated with a better compliance with treatment. Teenagers of higher socio-economical levels had a better compliance with treatment. Fifty percent of Chilean diabetic teenagers in this sample had a poor control of the disease and the variable knowledge about the disease is the better predictor of patient compliance.

The impact of ERI, burnout, and caring for SARS patients on hospital nurses' self-reported compliance with infection control.

PubMed

Pratt, Maria; Kerr, Michael; Wong, Carol

2009-01-01

Siegrist's (1996) Effort-Reward Imbalance (ERI) Model provided the theoretical basis for this secondary data analysis that examines the relationship between nurses' ERI and their self-reported compliance with infection control, between ERI and burnout and nurses' compliance, and between nurses' experience in caring for SARS patients and their compliance with infection control. Data for this study came from a collaborative interdisciplinary study examining the barriers and facilitators to implementing protective measures against SARS and other existing and emerging infections among hospital nurses in Ontario and British Columbia. This is the first study to examine the relationship between ERI and compliance with infection control, as well as the impact of nurses' experience in caring for SARS patients on their compliance behaviour with infection control. Hierarchical multiple linear regression analyses revealed that ERI is a significant predictor of decreased compliance with infection control (beta = -.15, p < .05). While ERI was shown to be associated with burnout (beta = .60, p < .001), the combined effect of these two variables did not significantly improve the prediction of compliance behaviour (beta = -.03, p = .63). Nurses who reported having directly cared for SARS patients were found to have increased compliance with infection control (beta = .15, p < .001) after controlling for demographic and work environment factors. These findings highlight how nurses' adverse workplace environments can affect their work and health and thus, can be used by nursing and hospital administrators to help develop interventions to lower occupational stress and improve health in the workplace.

Compliance to treatment in patients with chronic illness: A concept exploration

PubMed Central

Rafii, Forough; Fatemi, Naima Seyed; Danielson, Ella; Johansson, Christina Melin; Modanloo, Mahnaz

2014-01-01

Background: Patients’ compliance to treatment is an important indicator for evaluating the successful management in chronic illnesses. Despite the fact an applicable definition of compliance is required to suitable intervention and research, this concept is not clear and there is no consensus concerning its meaning, definition, and measurement. The aim of this study was to explore the concept of compliance and to formulate a working definition. Materials and Methods: Theoretical phase of Schwartz-Barcott and Kim's Hybrid Model of concept analysis was used to analyze the concept of compliance. Data were collected by using literature reviews. Medline, CINAHL, Ovid, Elsevier, Pro Quest and Blackwell databases were searched from 1975 to 2010 using the keywords “Compliance,” “Non-compliance,” “Adherence,” and “Concordance.” Articles published in English were selected if they included adult patients with chronic illnesses and reported attributes of compliance; 23 such relevant articles were chosen. Results: The attributes of compliance included patient obedience, ability to implement medical advice, flexibility, responsibility, collaboration, participation, and persistence in implementing the advices. Antecedents are organized into two interacting categories: Internal factors refer to the patient, disease, and treatment characteristics and external factors refer to the healthcare professionals, healthcare system, and socioeconomic factors. Compliance may lead to desirable and undesirable consequences. A working definition of compliance was formulated by comparing and contrasting the existing definitions with regard to its attributes which are useful in clinical practice and research. Conclusions: This finding will be useful in clinical practice and research. But this working definition has to be tested in a clinical context and a broad view of its applicability has to be obtained. PMID:24834085

Compliance with Clostridium difficile treatment guidelines: effect on patient outcomes.

PubMed

Crowell, K T; Julian, K G; Katzman, M; Berg, A S; Tinsley, A; Williams, E D; Koltun, W A; Messaris, E

2017-08-01

Guidelines for the severity classification and treatment of Clostridium difficile infection (CDI) were published by Infectious Diseases Society of America (IDSA)/Society for Healthcare Epidemiology of America (SHEA) in 2010; however, compliance and efficacy of these guidelines has not been widely investigated. This present study assessed compliance with guidelines and its effect on CDI patient outcomes as compared with before these recommendations. A retrospective study included all adult inpatients with an initial episode of CDI treated in a single academic center from January 2009 to August 2014. Patients after guideline publication were compared with patients treated in 2009-2010. Demographic, clinical, and laboratory data were collected to stratify for disease severity. Outcome measures included compliance with guidelines, mortality, length of stay (LOS), and surgical intervention for CDI. A total of 1021 patients with CDI were included. Based upon the 2010 guidelines, 42 (28·8%) of 146 patients treated in 2009 would have been considered undertreated, and treatment progressively improved over time, as inadequate treatment decreased to 10·0% (15/148 patients) in 2014 (P = 0·0005). Overall, patient outcomes with guideline-adherent treatment decreased CDI attributable mortality twofold (P = 0·006) and CDI-related LOS by 1·9 days (P = 0·0009) when compared with undertreated patients. Compliance with IDSA/SHEA guidelines was associated with a decreased risk of mortality and LOS in hospitalized patients with CDI.

Factors affecting compliance with moving and handling policy: Student nurses' views and experiences.

PubMed

Cornish, Jocelyn; Jones, Anne

2010-03-01

The limited literature available suggests that there continues to be poor compliance by nurses with moving and handling regulations [Swain, J., Pufahl, E., Williamson, G., 2003. Do they practise what we teach? A survey of manual handling practice amongst student nurses. Journal of Clinical Nursing 12(2), 297-306; Jootun, D., MacInnes, A., 2005. Examining how well students use correct handling procedures. Nursing Times 101(4), 38-40; Smallwood, J., 2006. Patient handling: student nurses' views. Learning in Health and Social Care 5(4), 208-219; Cornish, J., Jones, A., 2007. Evaluation of moving and handling training for pre-registration nurses and its application to practice. Nurse Education in Practice 7(3), 128-134]. This paper presents the final phase of a study in which student nurses' reports of their experience in practice are drawn upon to identify possible reasons for a lack of compliance with moving and handling policy. Focus groups were conducted using a topic guide comprising themes generated from the previous two phases of this study; a questionnaire survey and unstructured interviews [Cornish, J., Jones, A., 2007. Evaluation of moving and handling training for pre-registration nurses and its application to practice. Nurse Education in Practice 7(3), 128-134]. Seventeen pre-registration students participated, representing adult, child and mental health branches from both Degree and Diploma programmes Examples of poor practice set the context for the students' experiences. Factors affecting both compliance with poor practice or compliance with moving and handling regulations leading to good practice, are identified. Methods for the management of difficult moving and handling situations are also revealed. The study informs future developments in training and support mechanisms for students in practice. Copyright 2009 Elsevier Ltd. All rights reserved.

Methodological rigor and citation frequency in patient compliance literature.

PubMed Central

Bruer, J T

1982-01-01

An exhaustive bibliography which assesses the methodological rigor of the patient compliance literature, and citation data from the Science Citation Index (SCI) are combined to determine if methodologically rigorous papers are used with greater frequency than substandard articles by compliance investigators. There are low, but statistically significant, correlations between methodological rigor and citation indicators for 138 patient compliance papers published in SCI source journals during 1975 and 1976. The correlation is not strong enough to warrant use of citation measures as indicators of rigor on a paper-by-paper basis. The data do suggest that citation measures might be developed as crude indicators of methodological rigor. There is no evidence that randomized trials are cited more frequently than studies that employ other experimental designs. PMID:7114334

[Evaluation of compliance with antiretroviral treatment in a cohort of 200 patients in Djibouti, 2005].

PubMed

Ahmed, A A; Katlama, C; Ghosn, J; Guiguet, M; Costagliola, D

2007-01-01

We determined the rate of compliance with antiretroviral therapy and investigated the factors that influence it among 86 HIV patients. Compliance ratio (number of tablets taken/number prescribed) was assessed by tablet count. The mean ratio of compliance was 92%. By tablet count, 77% of the patients were compliant (compliance ratio > or =90%). Non-compliance was significantly associated with side-effects, degree of confidentiality of the care centre and travelling. Compliance correlated significantly with viral load. In multivariate analysis, community support and level of education protected against non-compliance. Patients having already missed a dose and those dissatisfied with confidentiality had a 4 times greater risk of non-compliance.

40 CFR 63.1318 - PET and polystyrene affected sources-testing and compliance demonstration provisions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 11 2011-07-01 2011-07-01 false PET and polystyrene affected sources...: Group IV Polymers and Resins § 63.1318 PET and polystyrene affected sources—testing and compliance... not apply and owners or operators are not required to comply with § 63.113. (b) PET affected sources...

40 CFR 63.1318 - PET and polystyrene affected sources-testing and compliance demonstration provisions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 12 2012-07-01 2011-07-01 true PET and polystyrene affected sources...: Group IV Polymers and Resins § 63.1318 PET and polystyrene affected sources—testing and compliance... not apply and owners or operators are not required to comply with § 63.113. (b) PET affected sources...

40 CFR 63.1318 - PET and polystyrene affected sources-testing and compliance demonstration provisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 11 2010-07-01 2010-07-01 true PET and polystyrene affected sources...: Group IV Polymers and Resins § 63.1318 PET and polystyrene affected sources—testing and compliance... not apply and owners or operators are not required to comply with § 63.113. (b) PET affected sources...

Design evolution enhances patient compliance for low-intensity pulsed ultrasound device usage

PubMed Central

Pounder, Neill M; Jones, John T; Tanis, Kevin J

2016-01-01

Poor patient compliance or nonadherence with prescribed treatments can have a significant unfavorable impact on medical costs and clinical outcomes. In the current study, voice-of-the-customer research was conducted to aid in the development of a next-generation low-intensity pulsed ultrasound (LIPUS) bone healing product. An opportunity to improve patient compliance reporting was identified, resulting in the incorporation into the next-generation device of a visual calendar that provides direct feedback to the patient, indicating days for which they successfully completed treatment. Further investigation was done on whether inclusion of the visual calendar improved patient adherence to the prescribed therapy (20 minutes of daily treatment) over a 6-month period. Thus, 12,984 data files were analyzed from patients prescribed either the earlier- or the next-generation LIPUS device. Over the 6-month period, overall patient compliance was 83.8% with the next-generation LIPUS device, compared with 74.2% for the previous version (p<0.0001). Incorporation of the calendar feature resulted in compliance never decreasing below 76% over the analysis period, whereas compliance with the earlier-generation product fell to 51%. A literature review on the LIPUS device shows a correlation between clinical effectiveness and compliance rates more than 70%. Incorporation of stakeholder feedback throughout the design and innovation process of a next-generation LIPUS device resulted in a measurable improvement in patient adherence, which may help to optimize clinical outcomes. PMID:27942237

A Multidisciplinary Patient Navigation Program Improves Compliance With Adjuvant Breast Cancer Therapy in a Public Hospital.

PubMed

Castaldi, Maria; Safadjou, Saman; Elrafei, Tarek; McNelis, John

Cancer health disparities affecting low-income and minority patients have been well documented to lead to poor outcomes. This report examines the impact of patient navigation on adherence to prescribed adjuvant breast cancer treatment. A multidisciplinary patient navigation program was initiated at a public safety net hospital to improve compliance with 3 National Quality Forum measures: (1) administration of combination chemotherapy for women with Stage (defined by the American Joint Committee on Cancer [AJCC]) T1c, II, or III hormone receptor-negative breast cancer within 120 days; (2) administration of endocrine therapy for women with AJCC Stage T1c, II, or III hormone receptor-positive breast cancer within 365 days; and (3) radiation therapy for women receiving breast-conserving surgery within one year. Implementation of a multidisciplinary patient navigation program reduced time to treatment and improved compliance with adjuvant therapy for breast cancer in an underserved minority community.

Influence of active reminders on oral hygiene compliance in orthodontic patients.

PubMed

Eppright, Matthew; Shroff, Bhavna; Best, Al M; Barcoma, Elvi; Lindauer, Steven J

2014-03-01

To determine if text message reminders regarding oral hygiene compliance have an influence on the level of compliance within an orthodontic population. In this prospective, randomized, controlled clinical trial, 42 orthodontic patients were assigned to a text message or control group. Parents of patients assigned to the text message group received a reminder text message one weekday each week. Oral hygiene compliance was measured using bleeding index (BI), modified gingival index (MGI), and plaque index (PI), and visual examination of white spot lesion (WSL) development at baseline (T0), two appointments after baseline (T1), and four appointments after baseline (T2). BI, MGI, and PI scores were significantly lower in the text message group than in the control group at T2. A text message reminder system is effective for improving oral hygiene compliance in orthodontic patients.

Patient compliance with screening for fecal occult blood in family practice.

PubMed Central

Hoogewerf, P E; Hislop, T G; Morrison, B J; Burns, S D; Sizto, R

1987-01-01

Thirty-two family physicians in British Columbia collaborated in a study to evaluate their patients' compliance when offered testing for fecal occult blood (FOB) with Hemoccult II as a screening test for asymptomatic colorectal cancer. Of the 5003 eligible patients 71% complied. Thirteen variables were investigated. Compliance was found to be directly related to age in a linear manner (chi-squared value for trend = 180.4, p less than 0.0001), age alone correctly classifying 58.5% of the patients as complying or not complying. The association with other variables was less strong. Restricting the consumption of red meat during the test period had no effect on compliance. PMID:3607662

Movement Path Tortuosity Predicts Compliance With Therapeutic Behavioral Prompts in Patients With Traumatic Brain Injury.

PubMed

Kearns, William D; Fozard, James L; Ray, Roger D; Scott, Steven; Jasiewicz, Jan M; Craighead, Jeffrey D; Pagano, Craig V

2016-01-01

Rehabilitation of patients with traumatic brain injury typically includes therapeutic prompts for keeping appointments and adhering to medication regimens. Level of cognitive impairment may significantly affect a traumatic brain injury victim's ability to benefit from text-based prompting. We tested the hypothesis that spatial disorientation as measured by movement path tortuosity during ambulation would be associated with poorer compliance with automated prompts by veterans actively being treated for traumatic brain injury. Clinical polytrauma center. Ten (1 female) veteran patients mean age = 35.4 (SD = 12.4) years. Small group correlational study without random assignment. Fractal Dimension, a measure of movement path tortuosity derived from a GPS logging device used to record casual outdoor ambulation at the start of the study. Compliance with smart home machine-generated therapeutic prompts received during rehabilitation at the James A. Haley Veterans Administration Hospital Polytrauma Transitional Rehabilitation Program. A patient was compliant with a prompt if they transited from where the prompt was presented to the prescribed destination (both within the Polytrauma Transitional Rehabilitation Program) within 30 minutes. Noncompliance was failure to appear at the destination within the allotted time. Fractal dimension was significantly inversely related to overall prompt compliance (r = -0.603, n = 10, P = .032; 1-tailed). The findings support the hypothesis that increased spatial disorientation adversely impacts compliance with automated prompts throughout therapy. The results are consistent with previous studies linking elevated path tortuosity to cognitive impairment and increased risk for falls in assisted living facility residents.

Hand hygiene compliance in transplant and other special patient groups: an observational study.

PubMed

Graf, Karolin; Ott, Ella; Wolny, Michael; Tramp, Nadine; Vonberg, Ralf-Peter; Haverich, Axel; Chaberny, Iris Freya

2013-06-01

This study evaluates hand hygiene behavior of health care workers in a German university hospital stratified for treatment of special patient groups (eg, transplant patients). From 2008 to 2010, comprehensive education and training of all health care workers was implemented to improve hand hygiene compliance. Consumption rates of alcohol-based hand rub and gloves were collected and evaluated. Of the 5,647 opportunities of hand disinfection evaluated, 1,607 occurred during care for transplant patients. To our knowledge, this is the largest survey of hand hygiene compliance in special patient groups on intensive care units in a university hospital in Germany. Health care workers on surgical intensive care units showed lower hand hygiene compliance compared with health care workers on other types of intensive care units. Compliance toward hand hygiene was significantly higher on hemato-oncologic and pediatric wards. In general, hand disinfection was performed significantly more frequently after an intervention than before (P < .05, 95% confidence interval: 1.24-1.84). Overall, there was no significant difference in hand hygiene compliance when caring for transplant patients or other patients (odds ratio, 1.16; 95% confidence interval: 0.95-1.42). Nurse's and physician's hand hygiene compliance improved because of education. Hand hygiene compliance is not increased in the care for transplant patients (despite their predisposition for nosocomial infections) compared with other patients. Additional studies will be necessary to further investigate these findings. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

A pharmaco-economic analysis of patients with schizophrenia switching to generic risperidone involving a possible compliance loss.

PubMed

Treur, Maarten; Heeg, Bart; Möller, Hans-Jürgen; Schmeding, Annette; van Hout, Ben

2009-02-18

As schizophrenia patients are typically suspicious of, or are hostile to changes they may be reluctant to accept generic substitution, possibly affecting compliance. This may counteract drug costs savings due to less symptom control and increased hospitalization risk. Although compliance losses following generic substitution have not been quantified so far, one can estimate the possible health-economic consequences. The current study aims to do so by considering the case of risperidone in Germany. An existing DES model was adapted to compare staying on branded risperidone with generic substitution. Differences include the probability of non-compliance and medication costs. Incremental probability of non-compliance after generic substitution was varied between 2.5% and 10%, while generic medication costs were assumed to be 40% lower. Effect of medication price was assessed as well as the effect of applying compliance losses to all treatment settings. The probability of staying on branded risperidone being cost-effective was calculated for various outcomes of a hypothetical study that would investigate non-compliance following generic substitution of risperidone. If the incremental probability of non-compliance after generic substitution is 2.5%, 5.0%, 7.5% and 10% respectively, incremental effects of staying on branded risperidone are 0.004, 0.007, 0.011 and 0.015 Quality Adjusted Life Years (QALYs). Incremental costs are euro757, euro343, -euro123 and -euro554 respectively. Benefits of staying on branded risperidone include improved symptom control and fewer hospitalizations. If generic substitution results in a 5.2% higher probability of non-compliance, the model predicts staying on branded risperidone to be cost-effective (NICE threshold of 30,000 per QALY gained). Compliance losses of more than 6.9% makes branded risperidone the dominant alternative. Results are sensitive to the locations at which compliance loss is applied and the price of generic risperidone

Factors affecting compliance with measles vaccination in Lao PDR.

PubMed

Phimmasane, Maniphet; Douangmala, Somthana; Koffi, Paulin; Reinharz, Daniel; Buisson, Yves

2010-09-24

In line with WHO objectives, the Lao Government is committed to eliminate measles by 2012. Yet from 1992 to 2007, the annual incidence of measles remained high while the vaccination coverage showed a wide diversity across provinces. A descriptive study was performed to determine factors affecting compliance with vaccination against measles, which included qualitative and quantitative components. The qualitative study used a convenience sample of 13 persons in charge of the vaccination program, consisting of officials from different levels of the health care structure and members of vaccination teams. The quantitative study performed on the target population consisted of a matched, case-control survey conducted on a stratified random sample of parents of children aged 9-23 months. Overall, 584 individuals (292 cases and 292 controls) were interviewed in the three provinces selected because of low vaccination coverage. On the provision of services side (supply), the main problems identified were a lack of vaccine supply and diluent, a difficulty in maintaining the cold chain, a lack of availability and competence among health workers, a lack of coordination and a limited capacity to assess needs and make coherent decisions. In the side of the consumer (demand), major obstacles identified were poor knowledge about measles immunization and difficulties in accessing vaccination centers because of distance and cost. In multivariate analysis, a low education level of the father was a factor of non-immunization while the factors of good compliance were high incomes, spacing of pregnancies, a feeling that children must be vaccinated, knowledge about immunization age, presenting oneself to the hospital rather than expecting the mobile vaccination teams and last, immunization of other family members or friends' children. The main factors affecting the compliance with vaccination against measles in Laos involve both the supply side and the demand side. Obtaining an effective

[Depression, social support and compliance in patients with chronic heart failure].

PubMed

Reutlinger, Julia; Müller-Tasch, Thomas; Schellberg, Dieter; Frankenstein, Lutz; Zugck, Christian; Herzog, Wolfgang; Lossnitzer, Nicole

2010-01-01

Depressive patients with chronic heart failure (CHF) show less social integration and greater physical impairment as well as poorer compliance than non depressive CHF patients. Using multiple regression analyses, this study (n=84) investigated a potential mediating effect of depression on the relationship between compliance and both social support and physical functioning. Results did not support the hypothesized mediating effect of depression. However, the variables age, depression, left ventricular ejection fraction (LVEF) and social support were associated with self-reported compliance. Therefore, a lack of social support and depression should be considered as possible reasons, if patients are noncompliant during the treatment process. © Georg Thieme Verlag KG Stuttgart · New York.

[Kidney patients: aspects related to compliance with renal treatment].

PubMed

Caraballo Nazario, G L; Lebrón de avilés, C; Dávila Torres, R R; Burgos Calderón, R

2001-12-01

The Objective of this study was identify the aspects related with the adherence of medical treatment recommended to the patients that received hemodialysis in the tertiary public hospital. A non experimental transectional correlation design was utilized in this study. Fifty-three patients constituted the population study. A structure interview was utilized to gathered the data. Descriptive statistics and Chi-square tests were utilized to analysis. The response rate was 91.0%. The 75.0% of patients not compliance with the medical treatment. Significant association between compliance variable and educational level was encountered (p < or = 0.05). This study provides important findings to will develops educative intervention in the Renal Unit, directed to improve the adherence of the patient with medical treatment.

Compliance and coping potential of cancer patients treated in liaison-consultation psychiatry.

PubMed

Grube, Michael

2006-01-01

To investigate the impact of psychiatric illness, aggression, and other covarying variables on the compliance and coping potential of cancer patients treated in liaison-consultation psychiatry. The study involves 270 cancer patients who were admitted to the oncology ward for diagnosis and treatment. Each patient took part in a psychiatric consultation. We used the Transplant Evaluation Rating Scale (TERS), which provides a system for differentially recording the patient's compliance and coping potential (total score for the TERS items 3-10). Following standardization using the basic psychooncological documentation (PO-BADO), the demographic variables were recorded. We also identified the internal processes which each patient used to deal with the disease using criteria established by Kübler-Ross as well as the phases of cancer experience according to Fawzy. Twenty-three variables were checked for their relationship to the coping and compliance potential. For 13 of these, the Mann-Whitney U-test or Spearmann-Rank correlation calculated exceeded the required Bonferroni-adjusted significance level. The calculation of an ordinal regression model containing these significant single variables showed that the following variables are associated with a lower compliance and coping potential according to their estimate (Beta-value): aggression as the dominant form of dealing internally with cancer (Kübler-Ross), pre-existing DSM IV Axis 1 psychiatric disorders, carcinoma-induced psychiatric disorders, necessity of treatment with neuroleptics and male gender. Acceptance as the dominant form of dealing internally with cancer (Kübler-Ross) is strongly associated with a higher compliance and coping potential. The results show that the compliance and coping potential of oncological in-patients can be comprehensively described by the Transplant Evaluation Rating Scale. The instruments of measurement used in the study are also useful for describing risk factors associated with

Suboptimal compliance with evidence-based guidelines in patients with traumatic brain injuries.

PubMed

Shafi, Shahid; Barnes, Sunni A; Millar, D; Sobrino, Justin; Kudyakov, Rustam; Berryman, Candice; Rayan, Nadine; Dubiel, Rosemary; Coimbra, Raul; Magnotti, Louis J; Vercruysse, Gary; Scherer, Lynette A; Jurkovich, Gregory J; Nirula, Raminder

2014-03-01

Evidence-based management (EBM) guidelines for severe traumatic brain injuries (TBIs) were promulgated decades ago. However, the extent of their adoption into bedside clinical practices is not known. The purpose of this study was to measure compliance with EBM guidelines for management of severe TBI and its impact on patient outcome. This was a retrospective study of blunt TBI (11 Level I trauma centers, study period 2008-2009, n = 2056 patients). Inclusion criteria were an admission Glasgow Coma Scale score ≤ 8 and a CT scan showing TBI, excluding patients with nonsurvivable injuries-that is, head Abbreviated Injury Scale score of 6. The authors measured compliance with 6 nonoperative EBM processes (endotracheal intubation, resuscitation, correction of coagulopathy, intracranial pressure monitoring, maintaining cerebral perfusion pressure ≥ 50 cm H2O, and discharge to rehabilitation). Compliance rates were calculated for each center using multivariate regression to adjust for patient demographics, physiology, injury severity, and TBI severity. The overall compliance rate was 73%, and there was wide variation among centers. Only 3 centers achieved a compliance rate exceeding 80%. Risk-adjusted compliance was worse than average at 2 centers, better than average at 1, and the remainder were average. Multivariate analysis showed that increased adoption of EBM was associated with a reduced mortality rate (OR 0.88; 95% CI 0.81-0.96, p < 0.005). Despite widespread dissemination of EBM guidelines, patients with severe TBI continue to receive inconsistent care. Barriers to adoption of EBM need to be identified and mitigated to improve patient outcomes.

Compliance with recommended care at trauma centers: association with patient outcomes.

PubMed

Shafi, Shahid; Barnes, Sunni A; Rayan, Nadine; Kudyakov, Rustam; Foreman, Michael; Cryer, H Gil; Alam, Hasan B; Hoff, William; Holcomb, John

2014-08-01

State health departments and the American College of Surgeons focus on the availability of optimal resources to designate hospitals as trauma centers, with little emphasis on actual delivery of care. There is no systematic information on clinical practices at designated trauma centers. The objective of this study was to measure compliance with 22 commonly recommended clinical practices at trauma centers and its association with in-hospital mortality. This retrospective observational study was conducted at 5 Level I trauma centers across the country. Participants were adult patients with moderate to severe injuries (n = 3,867). The association between compliance with 22 commonly recommended clinical practices and in-hospital mortality was measured after adjusting for patient demographics and injuries and their severity. Compliance with individual clinical practices ranged from as low as 12% to as high as 94%. After adjusting for patient demographics and injury severity, each 10% increase in compliance with recommended care was associated with a 14% reduction in the risk of death. Patients who received all recommended care were 58% less likely to die (odds ratio = 0.42; 95% CI, 0.28-0.62) compared with those who did not. Compliance with commonly recommended clinical practices remains suboptimal at designated trauma centers. Improved adoption of these practices can reduce mortality. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

The body of knowledge on compliance in heart failure patients: we are not there yet.

PubMed

Nieuwenhuis, Maurice M W; van der Wal, Martje H L; Jaarsma, Tiny

2011-01-01

Noncompliance with diet and fluid restriction is a problem in patients with heart failure (HF). In recent studies, a relationship between compliance with sodium and fluid restriction and knowledge and beliefs regarding compliance was found. In these studies, however, compliance was primarily measured by interview or questionnaire. To examine the relationship between compliance with sodium and fluid restriction measured with a nutrition diary and knowledge, beliefs, and other relevant variables in HF patients. Eighty-four HF patients completed a nutrition diary for 3 days. Patients also completed questionnaires on knowledge, beliefs regarding compliance, and depressive symptoms. Differences in relevant variables between compliant and noncompliant patients were assessed. Compliance with sodium and fluid restriction was 79% and 72%. Although not statistically significant, a higher percentage of patients were compliant with the less stringent restrictions compared with the more stringent restrictions, and in addition, more noncompliant patients perceived difficulty following the regimen compared with their compliant counterparts. In contrast with other studies, no significant differences in knowledge, beliefs, and relevant demographic and clinical variables were found between compliant and noncompliant patients. Perceived difficulty and the amount of the prescribed restriction seem to be relevant concepts that play a role in compliance with sodium and fluid restriction in HF and need to be explored in future research.

The role of the psychiatrist in improving patient compliance.

PubMed

Hotujac, Ljubomir

2007-02-01

Compliance, usually referring to how well the patient takes the medication as prescribed, is an important issue in clinical practice. However, many patients, especially those with a psychiatric illness, stop taking their medications despite physician advice to continue. This cessation can lead to a deterioration in the condition, a relapse, or a recurrence of the illness. In the literature, many different factors contributing to poor compliance have been described, but the doctor's role and responsibilities are hardly mentioned. These factors will be discussed here with special emphasis on what a doctor should do and what a doctor should avoid.

Role of Spiritual Sentiments in Improving the Compliance of Water Intake in Patients with Urolithiasis.

PubMed

Ali, Liaqat; Ali, Saima; Hussain, Syed Awlad; Haider, Fayyaz; Ali, Shehla

2018-02-01

The aim of this study was to compare the compliance for water intake and rate of recurrence between spiritually motivated and non-motivated patients of renal tract stone disease. It is a multi centric prospective cohort study, conducted in Department of Urology, Institute of Kidney Diseases and Peshawar Medical College, from January 10, 2009 to December 2012. A total of 180 patients with comparable demographic, IQ, EQ and BMI after achieving complete stone clearance were divided into two equal groups. Both groups were instructed to increase the water intake timetable according to AUA guidelines. Group 'A' comprising of 90 patients who were identified as spiritually motivated patients based on questioner of FICA 12 is also instructed that increasing the water intake is mentioned in contemporary Islamic medicine. No spiritual instruction was given to Group B. The instructed guidelines and practice for amount and timing of water intake were recalled from participants at the end of 6 and 12 months. The data were recorded on structured proforma and was analyzed using SPSS version 17. The mean age of the patient in Group A was 37.5 years (18-70 years), while in Group B it was 34 years (18-65 years). Urolithiasis affected predominantly male gender in both groups. Sixty-five patients (72.2 %) in Group A have significant compliance (p < 0.001) for water intake over Group B (46 %). The spiritually motivated Group A has significantly reduced rate of recurrence of stones in 23 patients versus 37 in Group B. The spiritually motivated patients had significantly better compliance for water intake and reduced rate of recurrence versus non-motivated individuals in urolithiasis.

Patient compliance in hypertension: role of illness perceptions and treatment beliefs.

PubMed

Ross, S; Walker, A; MacLeod, M J

2004-09-01

Despite many years of study, questions remain about why patients do or do not take medicines and what can be done to change their behaviour. Hypertension is poorly controlled in the UK and poor compliance is one possible reason for this. Recent questionnaires based on the self-regulatory model have been successfully used to assess illness perceptions and beliefs about medicines. This study was designed to describe hypertensive patients' beliefs about their illness and medication using the self-regulatory model and investigate whether these beliefs influence compliance with antihypertensive medication. We recruited 514 patients from our secondary care population. These patients were asked to complete a questionnaire that included the Beliefs about Medicines and Illness Perception Questionnaires. A case note review was also undertaken. Analysis shows that patients who believe in the necessity of medication are more likely to be compliant (odds ratio (OR)) 3.06 (95% CI 1.74-5.38), P<0.001). Other important predictive factors in this population are age (OR 4.82 (2.85-8.15), P<0.001), emotional response to illness (OR 0.65 (0.47-0.90), P=0.01) and belief in personal ability to control illness (OR 0.59 (0.40-0.89), P=0.01). Beliefs about illness and about medicines are interconnected; aspects that are not directly related to compliance influence it indirectly. The self-regulatory model is useful in assessing patients health beliefs. Beliefs about specific medications and about hypertension are predictive of compliance. Information about health beliefs is important in achieving concordance and may be a target for intervention to improve compliance.

Patient compliance based on genetic medicine: a literature review.

PubMed

Schneider, Kai Insa; Schmidtke, Jörg

2014-01-01

For this literature review, medical literature data bases were searched for studies on patient compliance after genetic risk assessment. The review focused on conditions where secondary or tertiary preventive options exist, namely cancer syndromes (BRCA-related cancer, HNPCC/colon cancer), hemochromatosis, thrombophilia, smoking cessation, and obesity. As a counterpart, patient compliance was assessed regarding medication adherence and medical advice in some of the most epidemiologically important conditions (including high blood pressure, metabolic syndrome, and coronary heart disease) after receiving medical advice based on nongenetic risk information or a combination of genetic and nongenetic risk information. In the majority of studies based on genetic risk assessments, patients were confronted with predictive rather than diagnostic genetic profiles. Most of the studies started from a knowledge base around 10 years ago when DNA testing was at an early stage, limited in scope and specificity, and costly. The major result is that overall compliance of patients after receiving a high-risk estimate from genetic testing for a given condition is high. However, significant behavior change does not take place just because the analyte is "genetic." Many more factors play a role in the complex process of behavioral tuning. Without adequate counseling and guidance, patients may interpret risk estimates of predictive genetic testing with an increase in fear and anxiety.

Hand hygiene compliance in patients under contact precautions and in the general hospital population.

PubMed

Almaguer-Leyva, Martín; Mendoza-Flores, Lidia; Medina-Torres, Ana Gabriela; Salinas-Caballero, Ana Gabriela; Vidaña-Amaro, Jose Antonio; Garza-Gonzalez, Elvira; Camacho-Ortiz, Adrián

2013-11-01

Hand hygiene (HH) is the single most important intervention for preventing hospital-acquired infections. Contact precautions are a series of actions that infection control units take to reduce the transmission of nosocomial pathogens. We conducted an observational study of HH compliance. Observations were stratified as opportunities in patients under contact precautions and in the general hospital population. Trained infection control personnel performed all direct evaluations. A total of 3,270 opportunities were recorded. HH compliance was statistically higher in patients on contact precautions than in the overall population (70.3% vs 60.4%; P = .0001). Critical care areas had higher HH compliance when patients were isolated by contact precautions. Medical wards were statistically lower in HH when patients were under contact precautions. Respiratory technicians had the highest HH compliance in both overall performance and in patients under contact precautions. Medical students had a lower HH compliance in both evaluations (P < .001). We noted greater compliance with HH practices when patients were under contact precaution in comparison with the overall hospital population. The difference was stronger in intensive care areas and lower among medical students. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Sequential compression devices in postoperative urologic patients: an observational trial and survey study on the influence of patient and hospital factors on compliance

PubMed Central

2013-01-01

Background Sequential compression devices (SCDs) are commonly used for thromboprophylaxis in postoperative patients but compliance is often poor. We investigated causes for noncompliance, examining both hospital and patient related factors. Methods 100 patients undergoing inpatient urologic surgery were enrolled. All patient had SCD sleeves placed preoperatively. Postoperative observations determined SCD compliance and reasons for non-compliance. Patient demographics, length of stay, inpatient unit type, and surgery type were recorded. At discharge, a patient survey gauged knowledge and attitudes regarding SCDs and bother with SCDs. Statistical analysis was performed to correlate SCD compliance with patient demographics; patient knowledge and attitudes regarding SCDs; and patient self-reported bother with SCDs. Results Observed overall compliance was 78.6%. The most commonly observed reasons for non-compliance were SCD machines not being initially available on the ward (71% of non-compliant observations on post-operative day 1) and SCD use not being restarted promptly after return to bed (50% of non-compliant observations for entire hospital stay). Mean self-reported bother scores related to SCDs were low, ranging from 1–3 out of 10 for all 12 categories of bother assessed. Patient demographics, knowledge, attitudes and bother with SCD devices were not significantly associated with non-compliance. Conclusions Patient self-reported bother with SCD devices was low. Hospital factors, including SCD machine availability and timely restarting of devices by nursing staff when a patient returns to bed, played a greater role in SCD non-compliance than patient factors. Identifying and addressing hospital related causes for poor SCD compliance may improve postoperative urologic patient safety. PMID:23578129

Sequential compression devices in postoperative urologic patients: an observational trial and survey study on the influence of patient and hospital factors on compliance.

PubMed

Ritsema, David F; Watson, Jennifer M; Stiteler, Amanda P; Nguyen, Mike M

2013-04-11

Sequential compression devices (SCDs) are commonly used for thromboprophylaxis in postoperative patients but compliance is often poor. We investigated causes for noncompliance, examining both hospital and patient related factors. 100 patients undergoing inpatient urologic surgery were enrolled. All patient had SCD sleeves placed preoperatively. Postoperative observations determined SCD compliance and reasons for non-compliance. Patient demographics, length of stay, inpatient unit type, and surgery type were recorded. At discharge, a patient survey gauged knowledge and attitudes regarding SCDs and bother with SCDs. Statistical analysis was performed to correlate SCD compliance with patient demographics; patient knowledge and attitudes regarding SCDs; and patient self-reported bother with SCDs. Observed overall compliance was 78.6%. The most commonly observed reasons for non-compliance were SCD machines not being initially available on the ward (71% of non-compliant observations on post-operative day 1) and SCD use not being restarted promptly after return to bed (50% of non-compliant observations for entire hospital stay). Mean self-reported bother scores related to SCDs were low, ranging from 1-3 out of 10 for all 12 categories of bother assessed. Patient demographics, knowledge, attitudes and bother with SCD devices were not significantly associated with non-compliance. Patient self-reported bother with SCD devices was low. Hospital factors, including SCD machine availability and timely restarting of devices by nursing staff when a patient returns to bed, played a greater role in SCD non-compliance than patient factors. Identifying and addressing hospital related causes for poor SCD compliance may improve postoperative urologic patient safety.

Stretching Your Energetic Budget: How Tendon Compliance Affects the Metabolic Cost of Running

PubMed Central

Uchida, Thomas K.; Hicks, Jennifer L.; Dembia, Christopher L.; Delp, Scott L.

2016-01-01

Muscles attach to bones via tendons that stretch and recoil, affecting muscle force generation and metabolic energy consumption. In this study, we investigated the effect of tendon compliance on the metabolic cost of running using a full-body musculoskeletal model with a detailed model of muscle energetics. We performed muscle-driven simulations of running at 2–5 m/s with tendon force–strain curves that produced between 1 and 10% strain when the muscles were developing maximum isometric force. We computed the average metabolic power consumed by each muscle when running at each speed and with each tendon compliance. Average whole-body metabolic power consumption increased as running speed increased, regardless of tendon compliance, and was lowest at each speed when tendon strain reached 2–3% as muscles were developing maximum isometric force. When running at 2 m/s, the soleus muscle consumed less metabolic power at high tendon compliance because the strain of the tendon allowed the muscle fibers to operate nearly isometrically during stance. In contrast, the medial and lateral gastrocnemii consumed less metabolic power at low tendon compliance because less compliant tendons allowed the muscle fibers to operate closer to their optimal lengths during stance. The software and simulations used in this study are freely available at simtk.org and enable examination of muscle energetics with unprecedented detail. PMID:26930416

Behavioural treatment of non-compliance in adolescents with newly acquired spinal cord injuries.

PubMed

Gorski, Jo Anne; Slifer, Keith J; Townsend, Vanessa; Kelly-Suttka, Jennifer; Amari, Adrianna

2005-01-01

To demonstrate the efficacy of using differential reinforcement to treat non-compliance in adolescents with spinal cord injury. A case series design was used to examine three adolescents (aged 14-16 years) with tetraplegia who received multi-disciplinary rehabilitation treatment and a behavioural contract programme during an in-patient hospital admission. Assessment included collecting data on each patient's weekly percentage of compliance with all rehabilitation goals, weekly percentage of negative affect observed in therapy sessions and scores on a measure of mobility in physical therapy. Compliance with rehabilitation demands improved from a baseline of 20-65% to 80% or greater after the patients received differential reinforcement for participating in the rehabilitation regimen. Patients exhibited less anger, sadness and frustration during therapy sessions once contracts were started. The adolescents demonstrated greater compliance after the implementation of a behavioural contract. Future studies should identify the specific variables that affect psychological adjustment and predict 'readiness' to participate in rehabilitation.

Compliance with recommendations for tympanostomy tube follow-up: patient characteristics.

PubMed

Kao, Richard; Kirse, Daniel J; Evans, Adele K

2014-09-01

(1) To determine the percentage of otherwise healthy patients achieving "graduation," or postoperative compliance achieving complete problem resolution and discharge from the otolaryngologist's care, after tympanostomy tube placement. (2) To analyze follow-up behaviors and patient characteristics influencing the likelihood of graduation. Retrospective cohort study. Tertiary care hospital. Analysis of details of tympanostomy tube placements performed from 2004 to 2011 by 2 pediatric otolaryngologists for children aged 0 to 18 years. Exclusion criteria were clearly defined craniofacial anomalies, cleft palates, and other ongoing postoperative care. The remaining study subjects were categorized into 3 groups. Graduation (GRAD) subjects achieved discharge from care with "follow-up pro re nata" status. LOST<2Y subjects had not attended scheduled follow-up in <2 years. LOST≥2Y subjects had no follow-up in ≥2 years. A total of 1454 pediatric subjects were included. GRADs constituted only 25.6% of the subject pool; 22.1% were LOST<2Y, and 52.3% were LOST≥2Y. Statistically significant factors in achieving graduation were total number of follow-up visits, total duration of follow-up, compliance with first postoperative visit, patient age, insurance type, and distance between home and practice. Rate of graduation, or postoperative compliance achieving complete problem resolution, of otherwise healthy tympanostomy tube patients is low despite perioperative discussions of the importance of proper follow-up. Higher graduation rates are associated with increasing number of follow-up visits and duration, younger patient age, private insurance, and proximity to the practice. Compliance with attending the first postoperative visit may be an early marker for increased likelihood of graduation. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

Verifying patient identity and site of surgery: improving compliance with protocol by audit and feedback.

PubMed

Garnerin, P; Arès, M; Huchet, A; Clergue, F

2008-12-01

The potential severity of wrong patient/procedure/site of surgery and the view that these events are avoidable, make the prevention of such errors a priority. An intervention was set up to develop a verification protocol for checking patient identity and the site of surgery with periodic audits to measure compliance while providing feedback. A nurse auditor performed the compliance audits in inpatients and outpatients during three consecutive 3-month periods and three 1-month follow-up periods; 11 audit criteria were recorded, as well as reasons for not performing a check. The nurse auditor provided feedback to the health professionals, including discussion of inadequate checks. 1,000 interactions between patients and their anaesthetist or nurse anaesthetist were observed. Between the first and second audit periods compliance with all audit criteria except "surgical site marked" noticeably improved, such as the proportion of patients whose identities were checked (62.6% to 81.4%); full compliance with protocol in patient identity checks (9.7% to 38.1%); proportion of site of surgery checks carried out (77.1% to 92.6%); and full compliance with protocol in site of surgery checks (32.2% to 52.0%). Thereafter, compliance was stable for most criteria. The reason for failure to perform checks of patient identity or site of surgery was mostly that the anaesthetist in charge had seen the patient at the preanaesthetic consultation. By combining the implementation of a verification protocol with periodic audits with feedback, the intervention changed practice and increased compliance with patient identity and site of surgery checks. The impact of the intervention was limited by communication problems between patients and professionals, and lack of collaboration with surgical services.

Norm compliance affects perceptual decisions through modulation of a starting point bias.

PubMed

Toelch, Ulf; Panizza, Folco; Heekeren, Hauke R

2018-03-01

Adaptive decisions in social contexts depend on both perceptual information and social expectations or norms. These are potentially in conflict when certain choices are beneficial for an individual, but societal rules mandate a different course of action. To resolve such a conflict, the reliability of information has to be balanced against potentially deleterious effects of non-compliance such as ostracism. In this study, we systematically investigated how interactions between perceptual and social influences affect decision-relevant cognitive processes. In a direction-of-motion discrimination task, participants received perceptual information alongside information on other players' choices. In addition, we created conflict scenarios where players' choices affected other participants' monetary rewards dependent on whether their choices were in line or against the opinion of the other players. Importantly, we altered the strength of this manipulation in two separate experiments by contrasting motivations of either preventing harm or providing a benefit to others. Behavioural analyses and computational models of perceptual decisions showed that participants successfully integrated perceptual with social information. Participants' reliance on social information was effectively modulated in conflict situations. Critically, these effects were augmented when the strength of social norms was increased, indexing conditions under which social norms effectively influence decisions. These results inform theories of social influence by providing an account of how higher order goals like social norm compliance affect perceptual decisions.

Norm compliance affects perceptual decisions through modulation of a starting point bias

PubMed Central

Panizza, Folco; Heekeren, Hauke R.

2018-01-01

Adaptive decisions in social contexts depend on both perceptual information and social expectations or norms. These are potentially in conflict when certain choices are beneficial for an individual, but societal rules mandate a different course of action. To resolve such a conflict, the reliability of information has to be balanced against potentially deleterious effects of non-compliance such as ostracism. In this study, we systematically investigated how interactions between perceptual and social influences affect decision-relevant cognitive processes. In a direction-of-motion discrimination task, participants received perceptual information alongside information on other players' choices. In addition, we created conflict scenarios where players’ choices affected other participants' monetary rewards dependent on whether their choices were in line or against the opinion of the other players. Importantly, we altered the strength of this manipulation in two separate experiments by contrasting motivations of either preventing harm or providing a benefit to others. Behavioural analyses and computational models of perceptual decisions showed that participants successfully integrated perceptual with social information. Participants' reliance on social information was effectively modulated in conflict situations. Critically, these effects were augmented when the strength of social norms was increased, indexing conditions under which social norms effectively influence decisions. These results inform theories of social influence by providing an account of how higher order goals like social norm compliance affect perceptual decisions. PMID:29657747

Compliance and quality of life in patients on prescribed voice rest.

PubMed

Rousseau, Bernard; Cohen, Seth M; Zeller, Amy S; Scearce, Leda; Tritter, Andrew G; Garrett, C Gaelyn

2011-01-01

To determine patient compliance with voice rest and the impact of voice rest on quality of life (QOL). Prospective. University hospital. Demographics, self-reported compliance, QOL impact on a 100-mm visual analog scale (VAS), and communication methods were collected from 84 participants from 2 academic voice centers. Of 84 participants, 36.9% were men, 63.1% were women, and 64.3% were singers. The mean age of participants was 47.2 years. The mean duration of voice rest was 8.8 days (range, 3-28), and the median was 7 days. Overall compliance was 34.5%. Postoperative voice rest patients were more compliant than non-postoperative patients (42.4% vs 16.0%, P = .04, χ(2)). Voice rest had an impact on QOL (mean ± SD, 68.5 ± 27.7). Voice rest also had a greater impact on singers than nonsingers (mean VAS 77.2 vs 63.6, P = .03, t test) and on those age <60 years than those age ≥ 60 years (mean VAS 74.4 vs 46.7, P < .001, t test). More talkative patients and those with longer periods of voice rest had worse QOL scores (Spearman correlation = 0.35, P = .001 and Spearman correlation = 0.24, P = .03, respectively). Restrictions in personal and social life were noted in 36.9% of patients, 46.4% were unable to work, 44.0% felt frustrated, and 38.1% reported feeling handicapped while on voice rest. Given poor patient compliance and the significant impact of voice rest on QOL, further studies are warranted to examine the efficacy of voice rest and factors that may contribute to patient noncompliance with treatment.

Why don't patients do their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee

PubMed Central

Campbell, R; Evans, M; Tucker, M; Quilty, B; Dieppe, P; Donovan, J

2001-01-01

STUDY OBJECTIVES—To understand reasons for compliance and non-compliance with a home based exercise regimen by patients with osteoarthritis of the knee.
DESIGN—A qualitative study, nested within a randomised controlled trial, examining the effectiveness of physiotherapy in reducing pain and increasing mobility in knee osteoarthritis. In the intervention arm, participants undertook a series of simple exercises and repositioning of the kneecap using tape. In depth interviews were conducted with a subset of participants in the intervention arm using open ended questions, guided by a topic schedule, to encourage patients to describe their experiences and reflect on why they did or did not comply with the physiotherapy. Interviews were audiotaped, fully transcribed and analysed thematically according to the method of constant comparison. A model explaining factors influencing compliance was developed.
SETTING—Patients were interviewed at home. The study was nested within a pragmatic randomised controlled trial.
PARTICIPANTS—Twenty participants in the intervention arm of the randomised trial were interviewed three months after they had completed the physiotherapy programme. Eight were interviewed again one year later.
MAIN RESULTS—Initial compliance was high because of loyalty to the physiotherapist. Reasoning underpinning continued compliance was more complex, involving willingness and ability to accommodate exercises within everyday life, the perceived severity of symptoms, attitudes towards arthritis and comorbidity and previous experiences of osteoarthritis. A necessary precondition for continued compliance was the perception that the physiotherapy was effective in ameliorating unpleasant symptoms.
CONCLUSIONS—Non-compliance with physiotherapy, as with drug therapies, is common. From the patient's perspective, decisions about whether or not to comply are rational but often cannot be predicted by therapists or researchers. Ultimately, this study

Does compliance to patient safety tasks improve and sustain when radiotherapy treatment processes are standardized?

PubMed

Simons, Pascale A M; Houben, Ruud; Benders, Jos; Pijls-Johannesma, Madelon; Vandijck, Dominique; Marneffe, Wim; Backes, Huub; Groothuis, Siebren

2014-10-01

To realize safe radiotherapy treatment, processes must be stabilized. Standard operating procedures (SOP's) were expected to stabilize the treatment process and perceived task importance would increase sustainability in compliance. This paper presents the effects on compliance to safety related tasks of a process redesign based on lean principles. Compliance to patient safety tasks was measured by video recording of actual radiation treatment, before (T0), directly after (T1) and 1.5 years after (T2) a process redesign. Additionally, technologists were surveyed on perceived task importance and reported incidents were collected for three half-year periods between 2007 and 2009. Compliance to four out of eleven tasks increased at T1, of which improvements on three sustained (T2). Perceived importance of tasks strongly correlated (0.82) to compliance rates at T2. The two tasks, perceived as least important, presented low base-line compliance, improved (T1), but relapsed at T2. The reported near misses (patient-level not reached) on accelerators increased (P < 0.001) from 144 (2007) to 535 (2009), while the reported misses (patient-level reached) remained constant. Compliance to specific tasks increased after introducing SOP's and improvements sustained after 1.5 years, indicating increased stability. Perceived importance of tasks correlated positively to compliance and sustainability. Raising the perception of task importance is thus crucial to increase compliance. The redesign resulted in increased willingness to report incidents, creating opportunities for patient safety improvement in radiotherapy treatment. Copyright © 2014 Elsevier Ltd. All rights reserved.

Frequent Evaluation To Improve Compliance In Patients Treated With Occlusion For Amblyopia: A Randomized controlled Trial.

PubMed

Iturriaga, Hernan; Zanolli, Mario; Damm, Constanza; Oporto, Jorge; Acuna, Olga; Valenzuela, Felipe

2012-01-01

The benefits of occlusion treatment for amblyopia are well established.True compliance can be difficult to assess and is usually based on patient history. We hypothesize that more visits to the physician provides more chances to improve compliance. We conducted a prospective, comparative, blind trial in which 30 children with amblyopia were randomly assigned to be followed up more frequently (every 4 to 6 weeks) (study group) or as established on our standard regular basis (month intervals based on age in years) (control group). The primary outcome was to study differences in treatment compliance between these groups. The secondary outcome was to report compliance in a group of Chilean children and to compare survey results with adherence, to assess concordance between them. Baseline clinical characteristics were similar in the two groups. 30 patients were recruited. Mean compliance for all patients was 82%. Study group compliance was 83% versus 76% in control group (p = 0.5). Without epidemiology, intention to treat analysis (ITT), study group compliance was 97% compared to 76% in control group (p = 0.049). Pearson correlation between negative responses to a parental survey after treatment, of the percentage of adherence and compliance, was -0.57 and statistically significant (p = 0.013). There were no differences in patient compliance comparing more frequent evaluation versus a follow up evaluation based in an age according scheme. There is a high compliance to occlusion therapy in this group of Chilean children. If parents reported more negative adherence aspects in the survey, the worse the compliance.

Duloxetine compliance and its association with healthcare costs among patients with diabetic peripheral neuropathic pain.

PubMed

Wu, N; Chen, S; Boulanger, L; Fraser, K; Bledsoe, S L; Zhao, Y

2009-09-01

Duloxetine is approved to treat diabetic peripheral neuropathic pain (DPNP) in the US. The study objective was to examine the predictors of duloxetine compliance, and its association with healthcare costs among DPNP patients. The study used administrative claims databases to identify non-depressed DPNP patients with a duloxetine prescription dispensed between October 1, 2004 and December 31, 2006. Two cohorts of patients were constructed based on compliance to duloxetine therapy over 1-year follow-up with high compliance defined as a medication possession ratio (MPR) > or =0.80. All-cause, diabetes-, and DPNP-related healthcare costs during 1-year follow-up were estimated. Logistic regressions were performed to examine how average daily dose (ADD) of duloxetine and other factors may influence compliance. Multivariate regressions were estimated to examine the association between compliance and healthcare costs. The study included 1,380 commercially insured (mean age 55 years) and 974 patients with employer-sponsored Medicare supplemental insurance (mean age 75 years). In both populations, patients with an ADD >30 mg were more likely to be compliant with the therapy compared with those with an ADD of < or =30 mg (odds ratio ranged 1.79-3.38, all p<0.05). Controlling for differences in demographics, clinical and economic characteristics, commercially insured low duloxetine compliance patients had greater all-cause ($5,334, p<0.05) and diabetes-related healthcare costs ($3,414, p<0.05) than high-compliance patients, with the biggest difference from inpatient costs (all-cause: $7,508; diabetes-related: $3,785, all p<0.05). Similar trends were found in the Medicare supplemental insured population; however, differences in all-cause healthcare costs were not significant. DPNP patients with a higher ADD of duloxetine over a 1-year follow-up period were more compliant with the therapy. Duloxetine patients with high compliance were also associated with lower healthcare costs

System implications of the ambulance arrival-to-patient contact interval on response interval compliance.

PubMed

Campbell, J P; Gratton, M C; Salomone, J A; Lindholm, D J; Watson, W A

1994-01-01

In some emergency medical services (EMS) system designs, response time intervals are mandated with monetary penalties for noncompliance. These times are set with the goal of providing rapid, definitive patient care. The time interval of vehicle at scene-to-patient access (VSPA) has been measured, but its effect on response time interval compliance has not been determined. To determine the effect of the VSPA interval on the mandated code 1 (< 9 min) and code 2 (< 13 min) response time interval compliance in an urban, public-utility model system. A prospective, observational study used independent third-party riders to collect the VSPA interval for emergency life-threatening (code 1) and emergency nonlife-threatening (code 2) calls. The VSPA interval was added to the 9-1-1 call-to-dispatch and vehicle dispatch-to-scene intervals to determine the total time interval from call received until paramedic access to the patient (9-1-1 call-to-patient access). Compliance with the mandated response time intervals was determined using the traditional time intervals (9-1-1 call-to-scene) plus the VSPA time intervals (9-1-1 call-to-patient access). Chi-square was used to determine statistical significance. Of the 216 observed calls, 198 were matched to the traditional time intervals. Sixty-three were code 1, and 135 were code 2. Of the code 1 calls, 90.5% were compliant using 9-1-1 call-to-scene intervals dropping to 63.5% using 9-1-1 call-to-patient access intervals (p < 0.0005). Of the code 2 calls, 94.1% were compliant using 9-1-1 call-to-scene intervals. Compliance decreased to 83.7% using 9-1-1 call-to-patient access intervals (p = 0.012). The addition of the VSPA interval to the traditional time intervals impacts system response time compliance. Using 9-1-1 call-to-scene compliance as a basis for measuring system performance underestimates the time for the delivery of definitive care. This must be considered when response time interval compliances are defined.

Drug Brand Response and Its Impact on Compliance and Efficacy in Depression Patients

PubMed Central

Li, Mingming; Cai, Jian; Zhang, Ping; Fei, Chunhua; Xu, Feng

2017-01-01

Introduction: Patient's response to drug brand is a comprehensive physiological and psychological effect which might impact the compliance and efficacy of drugs. Whether the therapeutic outcome altered on patients with brand response after they experience drug switch is not clear. Methods: 459 outpatients with mild-to-moderate depression were divided into the imported (joint venture) drug group and the domestic drug group according to their current drug application. Two groups of patients were assessed by drug brand preference questionnaire and medication compliance questionnaire. Patients with brand preference in imported (joint venture) drugs group received rational use of limited medical resource and pharmacoeconomics education, and then switched with domestic drug for 8 weeks. Safety and efficacy were evaluated both before and after the drug switch. Results: Overall, there were 27% of patients in imported drug group and 35% of patients in domestic drug group have brand response, respectively. About 2/3 patients in both groups showed low or no brand response. The compliance was similar in both groups with no significant difference (6.04 ± 2.08 vs. 4.74 ± 2.13, respectively, P > 0.05). The efficacy of imported drug group was significantly better than of the domestic drug group. Correlation analysis showed that in imported (joint venture) drugs group, medication compliance was closely related with brand response, but negatively correlated with age and duration. In domestic drugs group, medication compliance was independent of brand response, but closely related with education, age, and duration. After drug switch with domestic drug on patients with brand response, patients continued to maintain good antidepressant effect, and no severe adverse reaction occurred. Conclusion: The results suggested that domestic drugs switch might be feasible for patients using imported drugs with brand response, while providing patients with rational use of drug education and

Drug Brand Response and Its Impact on Compliance and Efficacy in Depression Patients.

PubMed

Li, Mingming; Cai, Jian; Zhang, Ping; Fei, Chunhua; Xu, Feng

2016-01-01

Introduction: Patient's response to drug brand is a comprehensive physiological and psychological effect which might impact the compliance and efficacy of drugs. Whether the therapeutic outcome altered on patients with brand response after they experience drug switch is not clear. Methods: 459 outpatients with mild-to-moderate depression were divided into the imported (joint venture) drug group and the domestic drug group according to their current drug application. Two groups of patients were assessed by drug brand preference questionnaire and medication compliance questionnaire. Patients with brand preference in imported (joint venture) drugs group received rational use of limited medical resource and pharmacoeconomics education, and then switched with domestic drug for 8 weeks. Safety and efficacy were evaluated both before and after the drug switch. Results: Overall, there were 27% of patients in imported drug group and 35% of patients in domestic drug group have brand response, respectively. About 2/3 patients in both groups showed low or no brand response. The compliance was similar in both groups with no significant difference (6.04 ± 2.08 vs. 4.74 ± 2.13, respectively, P > 0.05). The efficacy of imported drug group was significantly better than of the domestic drug group. Correlation analysis showed that in imported (joint venture) drugs group, medication compliance was closely related with brand response, but negatively correlated with age and duration. In domestic drugs group, medication compliance was independent of brand response, but closely related with education, age, and duration. After drug switch with domestic drug on patients with brand response, patients continued to maintain good antidepressant effect, and no severe adverse reaction occurred. Conclusion: The results suggested that domestic drugs switch might be feasible for patients using imported drugs with brand response, while providing patients with rational use of drug education and

[Impulsivity: What are the consequences on compliance to rehabilitation?].

PubMed

Cancel, A; Naudet, F; Rousseau, P F; Millet, B; Drapier, D

2016-08-01

Impulsivity is a transnosographical dimension with major consequences on medical care with which psychiatrists are frequently confronted. Furthermore, compliance is a major variable that can affect the efficiency of therapeutics and hospitalizations in psychiatry. A study was carried out in three drug and alcohol rehabilitation hospitalization units to find out if impulsivity can have consequences on compliance. The studied population was composed of 85 patients aged from 18 to 70, hospitalized for one or more addiction disorders in a psychometric hospital in Vannes (France). Impulsivity was measured for all patients with the BIS-11 at the beginning of the rehabilitation program. Because no tool to evaluate a total rehab program compliance existed, a scale, used at the end of the hospitalization, was created to measure patient compliance. This score was composed of two simple numeric scales (one used by the nurses and one used by the patient's psychiatrist) and a coefficient of hospitalization duration that was the ratio of completed to planned days of hospitalization. Correlations were made between the different dimensions: impulsivity and compliance, impulsivity and hospitalization conditions, compliance and hospitalization conditions (voluntary or involuntary, planned by a psychiatrist or not, etc.). The main statistically significant result of the study was a negative correlation existing between the motor dimension of impulsivity and compliance (r=-0.37 and P=0.001). The other dimensions of impulsivity showed no significant correlation with compliance score. The study revealed that the different hospitalization conditions showed no link with compliance or impulsivity. These original results show that motor impulsive patients need an adaptation of the rehabilitation programs. Shorter programs might be more efficient. Copyright © 2015 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Assessing the 'relative value' of diabetic patients treated through an incentivized, corporate compliance model.

PubMed

Oldani, Michael J

2010-08-01

Primary Care clinics in the United States continue to incentivize doctors to adhere to clinical guidelines regarding record keeping and managing specific patient disorders. This paper offers a case study of a US physician working in a system of total compliance. This narrative will illustrate how a specific system has emerged that pays doctors an end-of-year bonus for achieving compliance in four specific areas: record keeping, service hours, customer satisfaction surveys, and maintaining tight control of diabetic patients. In particular, special attention is paid to the emphasis on 'the numbers' within the corporate compliance model, and specifically, the relative value units (RVUs) used for structuring billing, labeling patients, and organizing the day-to-day activities of doctors. Although incentivized models of compliance have proved effective in managing both doctors and patients, especially in the UK, 'gaming' the system can occur. This paper identifies one example of how patients assume a hidden risk within this model by potentially being labeled noncompliant by having the wrong numbers, even when receiving good clinical care and acting medically compliant.

40 CFR Table 6 to Subpart Xxxx of... - Initial Compliance With the Emission Limits for Tire Production Affected Sources

Code of Federal Regulations, 2011 CFR

2011-07-01

... if . . . 1. Sources complying with the purchase compliance alternative in § 63.5985(a) The HAP... cements and solvents were purchased and used at the affected source containing HAP in amounts above the...) and (b)(1). 2. Sources complying with the monthly average compliance alternative without using a...

40 CFR Table 6 to Subpart Xxxx of... - Initial Compliance With the Emission Limits for Tire Production Affected Sources

Code of Federal Regulations, 2010 CFR

2010-07-01

... if . . . 1. Sources complying with the purchase compliance alternative in § 63.5985(a) The HAP... cements and solvents were purchased and used at the affected source containing HAP in amounts above the...) and (b)(1). 2. Sources complying with the monthly average compliance alternative without using a...

A Study to Determine the Correlation between Continuity of Care and Patient Medication Compliance

DTIC Science & Technology

1984-08-01

U (III FILE ’Y TO DETERMINE THE CORRELATION BETWEEN CONTINUITY OF CARE AND PATIENT MEDICATION COMPLIANCE IA Graduate Research Project Submitted to...43 APPENDIX A. PATIENT MEDICATION COMPLIANCE QUESTIONNAIRE . . . . . 45 B. COMPUTER CODED INPUT FORMAT . . . . . . . ...... 48 C. RESEARCH DATA...and that adhered to by the patient . This failure to comply with medical recommendations results in a waste of health resources, frustration to the

Improving admission medication reconciliation compliance using the electronic tool in admitted medical patients.

PubMed

Taha, Haytham; Abdulhay, Dana; Luqman, Neama; Ellahham, Samer

2016-01-01

Sheikh Khalifa Medical City (SKMC) in Abu Dhabi is the main tertiary care referral hospital in the United Arab Emirates (UAE) with 560 bed capacity that is fully occupied most of the time. SKMC senior management has made a commitment to make quality and patient safety a top priority. Our governing body Abu Dhabi Health Services Company has identified medication reconciliation as a critical patient safety measure and key performance indicator (KPI). The medication reconciliation electronic form a computerized decision support tool was introduced to improve medication reconciliation compliance on transition of care at admission, transfer and discharge of patients both in the inpatient and outpatient settings. In order to improve medication reconciliation compliance a multidisciplinary task force team was formed and led this quality improvement project. The purpose of this publication is to indicate the quality improvement interventions implemented to enhance compliance with admission medication reconciliation and the outcomes of those interventions. We chose to conduct the pilot study in general medicine as it is the busiest department in the hospital, with an average of 390 patients admitted per month during the study period. The study period was from April 2014 till October 2015 and a total of 8576 patients were evaluated. The lessons learned were disseminated throughout the hospital. Our aim was to improve admission medication reconciliation compliance using the electronic form in order to ensure patient safety and reduce preventable harm in terms of medication errors. Admission medication reconciliation compliance improved in general medicine from 40% to above 85%, and this improvement was sustained for the last four months of the study period.

Patient Compliance Is Critical for Equivalent Clinical Outcomes for Breast Cancer Treated by Breast-Conservation Therapy

PubMed Central

Li, Benjamin D. L.; Brown, William A.; Ampil, Frederico L.; Burton, Gary V.; Yu, Herbert; McDonald, John C.

2000-01-01

Objective To determine the compliance with a standard breast-conservation therapy (BCT) program in a predominantly indigent, minority population of patients with early breast cancer (stage I and II) served by a rural state institution in the South; to compare the clinical outcomes of this group with those reported in clinical trials; and to examine the socioeconomic factors that may have contributed to the rate of compliance. Summary Background Data Disease-free survival and overall survival in early breast cancer treated by BCT versus modified radical mastectomy are reported to be equivalent in prospective randomized trials. However, patients enrolled in clinical trials may not be representative of patients living in the various diverse communities that make up the United States. The authors’ hypothesis is that patients enrolled in clinical trials at the national level may not be representative of indigent patients in the rural South and that clinical trial results may not be directly applicable. Methods A retrospective review of 55 women with early-stage breast cancer treated from 1990 to 1995 was performed. Clinical data, compliance with treatment and clinical follow-up, and recurrence rates were examined. Statistical analysis performed include the Fisher exact test, Kaplan-Meier survival analysis, and log-rank test. Results Full compliance (defined as completion of the entire course of radiation therapy and clinical follow-up) with the BCT program was observed in only 36% of patients. Fifteen of the 35 noncompliant patients did not complete radiation therapy. A significantly higher local failure rate was observed: 8 of these 15 patients (53%) have had local failure. In contrast, patients who were either in full compliance with the BCT program or were deficient only in that they missed part of their clinical follow-up had local failure rates of 5% (1/20) and 10% (2/20), respectively. Age, race, stage of cancer, economic status (measured by availability of

Surgical Safety Checklist compliance: a job done poorly!

PubMed

Sparks, Eric A; Wehbe-Janek, Hania; Johnson, Rebecca L; Smythe, W Roy; Papaconstantinou, Harry T

2013-11-01

The Surgical Safety Checklist (SSC) has been introduced as an effective tool for reducing perioperative mortality and complications. Although reported completion rates are high, objective compliance is not well defined. The purpose of this retrospective analysis is to determine SSC compliance as measured by accuracy and completion, and factors that can affect compliance. In September 2010, our institution implemented an adaptation of the World Health Organization's SSC in an effort to improve patient safety and outcomes. A tool was developed for objective evaluation of overall compliance (maximum score 40) that was an aggregate score of completion and accuracy (20 each). Random samples of SSCs were analyzed at specific, predefined, time points throughout the first year after implementation. Procedure start time, operative time, and case complexity were assessed to determine association with compliance. A total of 671 SSCs were analyzed. The participation rate improved from 33% (95 of 285) at week 1 to 94% (249 of 265) at 1 year (p < 0.0001, chi-square test). Mean overall compliance score was 27.7 (± 5.4 SD) of 40 possible points (69.3% ± 13.5% of total possible score; n = 671) and did not change over time. Although completion scores were high (16.9 ± 2.7 out of 20 [84.5% ± 13.6%]), accuracy was poor (10.8 ± 3.4 out of 20 [54.1% ± 16.9%]). Overall compliance score was significantly associated with case start-time (p < 0.05), and operative time and case complexity showed no association. Our data indicate that although implementation of an SSC results in a high level of overall participation and completion, accuracy remained poor. Identification of barriers to effective use is needed, as improper checklist use can adversely affect patient safety. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

[How to optimize lipid-lowering therapy: do not forget patient's non-compliance].

PubMed

Radermecker, R P; Scheen, A J

2010-01-01

The pharmacological treatment of dyslipidaemia, essentially by statins, should take place in a global strategy of prevention of cardiovascular diseases. Treating a risk factor, asymptomatic by definition, which imposes an early constraint for a potential late benefit, exposes to patient's noncompliance. Besides physician's clinical inertia to initiate and adjust the lipid-lowering therapy in at risk patients, such lack of patient's compliance is one of the key elements that may explain the failure to reach or maintain therapeutic targets, and represents a major pharmacoeconomical concern. This article analyses first the main reasons explaining the poor compliance to lipid-lowering therapy and, then, describes some approaches to improve patient's adherence to medications in order to better prevent cardiovascular diseases.

Factors influencing patient compliance with therapeutic regimens in chronic heart failure: A critical incident technique analysis.

PubMed

Strömberg, A; Broström, A; Dahlström, U; Fridlund, B

1999-01-01

The aim of this study was to identify factors influencing compliance with prescribed treatment in patients with chronic heart failure. A qualitative design with a critical incident technique was used. Incidents were collected through interviews with 25 patients with heart failure strategically selected from a primary health care clinic, a medical ward, and a specialist clinic. Two hundred sixty critical incidents were identified in the interviews and 2 main areas emerged in the analysis: inward factors and outward factors. The inward factors described how compliance was influenced by the personality of the patient, the disease, and the treatment. The outward factors described how compliance was influenced by social activities, social relationships, and health care professionals. By identifying the inward and outward factors influencing patients with chronic heart failure, health care professionals can assess whether intervention is needed to increase compliance.

Nursing Intervention on the Compliance of Hemodialysis Patients with End-Stage Renal Disease: A Meta-Analysis.

PubMed

Wang, Jing; Yue, Peng; Huang, Jing; Xie, Xiaodong; Ling, Yunhua; Jia, Li; Xiong, Yunjin; Sun, Fang

2018-01-01

Dialysis is imperative for patients with end-stage renal disease (ESRD); however, compliance ensures its efficacy. Nursing intervention has been considered to improve compliance. This meta-analysis is aimed at exploring the effects of nursing intervention on dialysis compliance. A search was performed in the PubMed, Cochrane, and Embase databases for relevant original research articles. Studies were included or excluded based on the simultaneous consideration of quality as ranked by Jadad score and the compliance with predefined selection criteria. A total of 817 participants were included. The results showed that nursing intervention led to significantly higher compliance with dialysis than in standard care. A pilot analysis evidenced that different intervention strategies, including educational, cognitive, and behavioral approaches, had limited effects on dialysis compliance. Nursing intervention is beneficial for raising dialysis compliance, providing evidence of the need to strengthen nursing care for ESRD patients administered with dialysis in daily clinical practice. © 2017 S. Karger AG, Basel.

Preoperative assessment of lung cancer patients: evaluating guideline compliance (re-audit).

PubMed

Jayia, Parminderjit Kaur; Mishra, Pankaj Kumar; Shah, Raajul R; Panayiotou, Andrew; Yiu, Patrick; Luckraz, Heyman

2015-03-01

Guidelines have been issued for the management of lung cancer patients in the United Kingdom. However, compliance with these national guidelines varies in different thoracic units in the country. We set out to evaluate our thoracic surgery practice and compliance with the national guidelines. An initial audit in 2011 showed deficiencies in practice, thus another audit was conducted to check for improvements in guideline compliance. A retrospective study was carried out over a 12-month period from January 2013 to January 2014 and included all patients who underwent radical surgical resection for lung cancer. Data were collected from computerized records. Sixty-eight patients had radical surgery for lung cancer between January 2013 and January 2014. Four patients were excluded from the analysis due to incomplete records. Our results showed improvements in our practice compared to our initial audit. More patients underwent surgery within 4 weeks of computed tomography and positron-emission tomography scanning. An improvement was noticed in carbon monoxide transfer factor measurements. Areas for improvement include measurement of carbon monoxide transfer factor in all patients, a cardiology referral in patients at risk of cardiac complications, and the use of a global risk stratification model such as Thoracoscore. Guideline-directed service delivery provision for lung cancer patients leads to improved outcomes. Our results show improvement in our practice compared to our initial audit. We aim to liaise with other thoracic surgery units to get feedback about their practice and any audits regarding adherence to the British Thoracic Society and National Institute for Health and Care Excellence guidelines. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

'Consumers are patients!' shared decision-making and treatment non-compliance as business opportunity.

PubMed

Applbaum, Kalman

2009-03-01

This article describes an aspect of the progressive insertion of commercial interests into the relationship between patients and their clinicians, with particular reference to psychiatry. Treatment noncompliance, a long-standing problem for healthcare professionals, has lately drawn the attention of the pharmaceutical and allied industries as a site at which to improve return on investment (ROI). Newly founded corporate ;compliance departments' and specialized consultancies that regard noncompliance as a form of marketing failure are seeking to rectify it with reinvigorated models and strategies. This intervention stands to impact patients' experience of illness as well as the participation of those formally (physicians, case managers, etc.) and informally (family, friends, etc.) involved in treatment. My analysis draws upon observation at compliance conferences to demonstrate the contrasting models of patient empowerment underlying the marketing vs. medical approaches. I propose a research agenda for measuring the effects of industry compliance programs.

Comprehensive Assessment of Compliance with Antimuscarinic Drug Treatment in the Case of Urge Urinary Incontinence of Older Patients.

PubMed

Kosilov, Kirill V; Loparev, Sergey A; Kuzina, Irina G; Shakirova, Olga V; Zhuravskaya, Natalya S; Lobodenko, Alexandra

2017-01-01

To investigate the heterogeneous factors affecting the stability of patients older than 60 years in the UI treatment with Antimuscarinics. The prevalence of Urge Incontinence (UI) in older persons reaches 29.3%. The symptoms of urinary incontinence in older people reduce the health related life quality. In 1257 patients over 60 years (857 (68.2%) women - average age 67.8, 400 (31.8%) men - 71.4), who received AM for one year, demographic, socio-economic and health parameters were studied. OABq-SF questionnaires, MOS SF-36, urination diaries, uroflowmetry, income information from the tax offices and outpatient records were used. The compliance to AM treatment within 6 months was retained in 44.2%, and within the year - 26.8% of older patients. At least 40% of the total number of patients refused to continue the treatment for medical reasons. The persons taking Solifenacin (p≤ 0.01), Trospium (p≤ 0.05), or Darifenacin (p≤ 0.05), suffering from severe UI symptoms (p≤ 0.01), and experiencing minor side effects (p≤ 0.01), well-informed about UI treatment methods (p≤ 0.01) prevailed among the treatment compliant patients. At least 20.4% of the patients discontinued their treatment due to economic reasons. The persons with significantly larger annual income (p≤ 0.05) and annual medical cost (p≤ 0.01) prevailed among the treatment compliant patients. About 12.2% of the patients stopped their treatment for reasons related to the social background and psychological status. In this experiment, we found that AM treatment compliance in older patients, in addition to medical parameters and health conditions, is largely affected by the economic as well as social, demographic and psychological factors. The study results can be claimed by practitioners involved in correcting UI symptoms in older people. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Rapid anti-transglutaminase assay and patient interview for monitoring dietary compliance in celiac disease.

PubMed

Zanchi, Chiara; Ventura, Alessandro; Martelossi, Stefano; Di Leo, Grazia; Di Toro, Nicola; Not, Tarcisio

2013-06-01

The anti-transglutaminase antibodies (anti-tTG) play an important role in monitoring the celiacs' gluten-free diet (GFD). The authors propose to use the rapid IgA anti-tTG assay based on a whole blood drop to evaluate the compliance to GFD at the clinical ambulatory setting. The rapid test results were compared with those of the conventional ELISA assay and with dietary compliance reported by patients' interview. The authors showed that anti-tTG rapid test is reliable and easy to perform in the ambulatory setting to evaluate dietary compliance. Moreover, they proved that celiacs' interview is more sensitive than serology in identifying patients who transgress.

[Influence of WeChat platform on the compliance of continuous treatment of scar in adult burn patients].

PubMed

Wang, F; Zhang, H L

2018-03-20

Objective: To explore influence of the WeChat platform on the compliance of continuous treatment of scar in adult burn patients. Methods: A total of 124 adult burn patients, conforming to the study criteria, admitted in the Department of Burns of our hospital from January 2015 to January 2016 were divided into WeChat group ( n =63) and control group ( n =61) according to the random number table. Patients in control group only received regular discharging rehabilitation guide, while patients in WeChat group received regular discharging rehabilitation guide and joined WeChat platform after being discharged from hospital. Through pushing rehabilitation plan and rehabilitation related knowledge, organizing support discussion of burn patients, answering the patients' questions, members of WeChat platform intervention group conducted continuous treatment for 6 months on patients of WeChat group. The compliance of functional exercise of patients in two groups in one week before discharge and 3 and 6 months after discharge was evaluated by using the self-made functional exercise compliance log sheet. The compliance of using anti-scar drug and appliance of patients in two groups in 3 and 6 months after discharge was evaluated by using self-made anti-scar drug and appliance usage log sheets. Data were processed with chi-square test, independent sample t test, non-parametric rank sum test of independent sample, and Wilcoxon rank sum test. Results: (1) The compliance ratio of functional exercise of patients in WeChat group (95.24%, 60/63) was close to 93.44% (57/61) in control group in one week before discharge ( χ (2)=0.188, P >0.05). The compliance ratios of functional exercise of patients in WeChat group were respectively 93.65% (59/63) and 87.30% (55/63) in 3 and 6 months after discharge, which were higher than 68.85% (42/61) and 65.57% (40/61) in control group ( χ (2)=12.615, 8.166, P <0.01). (2) The compliance of using anti-scar drug of patients in WeChat group was

Non-compliance with pharmacotherapy of depression is associated with a sensation seeking personality.

PubMed

Ekselius, L; Bengtsson, F; von Knorring, L

2000-09-01

Inadequate compliance of drug intake is an important cause of ineffective pharmacotherapy and has been associated with therapeutic failure. We hypothesized that sensation seeking personality traits would affect compliance with long-term antidepressant medication. Three hundred and eight depressed patients participating in a randomized double-blind study of sertraline and citalopram were included. Personality traits were assessed using the Karolinska Scales of Personality. Compliance to medication was determined in two ways, by means of tablet counting and by measurement concentration of drug in serum. Tablet non-compliance was defined as less than 80% or more than 100% intake of the prescribed drug during weeks 20-24. Serum drug non-compliance was defined as undetectable amounts of either drug and main metabolite in the serum samples at week 24. Two virtually not overlapping groups of non-compliant patients were identified, where those regarded as non-compliant due to the interpretation of the serum drug levels were in majority. The group of serum drug non-compliant patients were recognized by significantly higher scores on the Monotony Avoidance scale and the Impulsive Sensation Seeking Psychopathy factor. The need for better methods than tablet counting and patient questioning to ascertain compliance is emphasized.

Correlation of compliance to statin therapy with lipid profile and serum HMGCoA reductase levels in dyslipidemic patients.

PubMed

Grover, Abhinav; Rehan, Harmeet Singh; Gupta, Lalit Kumar; Yadav, Madhur

The efficacy of statin therapy may be lost or vary with reduction in compliance and intensity of statin therapy. To study and correlate the quantitative effect of compliance on lipid profile and 3-hydroxyl-3-methylglutaryl coenzyme A reductase (HMGCoA-R) levels in dyslipidemic patients. Compliance to different intensity of statin therapy assessed by pill count was correlated with serum levels of total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), triglycerides (TG), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB) and HMGCoA-R. Out of 200 patients, 160 received moderate intensity statin therapy whereas 40 were on high intensity statin therapy. The overall mean compliance of patients was 56.7%. The compliance of patients on moderate intensity statin therapy was higher (56.8%) than those on high intensity (56.4%) (p=0.92). There was significant inverse correlation (p<0.05) between compliance and TC, TG, LDL-C and HMGCoA-R levels and positive correlation (p<0.05) with HDL-C levels. The mean serum HMGCoA-R levels did not fall below 9-10ng/mL when compliance to either moderate or high intensity statin therapy was increased above 60%. It is appropriate to improve the compliance to existing statin therapy than switching over to higher intensity statin therapy. Estimation of HMGCoA-R levels may be explored as a surrogate marker to monitor and assess the compliance of patients to statin therapy. Copyright © 2016. Published by Elsevier B.V.

Weight Management Belief is the Leading Influential Factor of Weight Monitoring Compliance in Congestive Heart Failure Patients.

PubMed

Lu, Min-Xia; Zhang, Yan-Yun; Jiang, Jun-Fang; Ju, Yang; Wu, Qing; Zhao, Xin; Wang, Xiao-Hua

2016-11-01

Daily weight monitoring is frequently recommended as a part of heart failure self-management to prevent exacerbations. This study is to identify factors that influence weight monitoring compliance of congestive heart failure patients at baseline and after a 1-year weight management (WM) program. This was a secondary analysis of an investigative study and a randomized controlled study. A general information questionnaire assessed patient demographics and clinical variables such as medicine use and diagnoses, and the weight management scale evaluated their WM abilities. Good and poor compliance based on abnormal weight gain from the European Society of Cardiology (> 2 kg in 3 days) were compared, and hierarchical multiple logistic regression analysis was used to identify factors influencing weight monitoring compliance. A total of 316 patients were enrolled at baseline, and 66 patients were enrolled after the 1-year WM program. Of them, 12.66% and 60.61% had good weight monitoring compliance at baseline and after 1 year of WM, respectively. A high WM-related belief score indicated good weight monitoring compliance at both time points [odds ratio (OR), 1.043, 95% confidence interval (CI), 1.023-1.063, p < 0.001; and OR, 2.054, 95% CI, 1.209-3.487, p < 0.001, respectively). Patients with a high WM-related practice score had good weight monitoring compliance at baseline (OR, 1.046, 95% CI, 1.027-1.065, p < 0.001), and patients who had not monitored abnormal weight had poor weight monitoring compliance after the 1-year WM program (OR, 0.244, 95% CI, 0.006-0.991, p = 0.049). Data from this study suggested that belief related to WM plays an important role in weight monitoring compliance.

40 CFR Table 5 to Subpart III of... - Compliance Requirements for Molded and Rebond Foam Production Affected Sources

Code of Federal Regulations, 2010 CFR

2010-07-01

... Flexible Polyurethane Foam Production Pt. 63, Subpt. III, Table 5 Table 5 to Subpart III of Part 63—Compliance Requirements for Molded and Rebond Foam Production Affected Sources Emission point Emission point... Rebond Foam Production Affected Sources 5 Table 5 to Subpart III of Part 63 Protection of Environment...

40 CFR Table 5 to Subpart III of... - Compliance Requirements for Molded and Rebond Foam Production Affected Sources

Code of Federal Regulations, 2014 CFR

2014-07-01

... Pollutants for Flexible Polyurethane Foam Production Pt. 63, Subpt. III, Table 5 Table 5 to Subpart III of Part 63—Compliance Requirements for Molded and Rebond Foam Production Affected Sources Emission point... Rebond Foam Production Affected Sources 5 Table 5 to Subpart III of Part 63 Protection of Environment...

40 CFR Table 5 to Subpart III of... - Compliance Requirements for Molded and Rebond Foam Production Affected Sources

Code of Federal Regulations, 2013 CFR

2013-07-01

... Pollutants for Flexible Polyurethane Foam Production Pt. 63, Subpt. III, Table 5 Table 5 to Subpart III of Part 63—Compliance Requirements for Molded and Rebond Foam Production Affected Sources Emission point... Rebond Foam Production Affected Sources 5 Table 5 to Subpart III of Part 63 Protection of Environment...

40 CFR Table 5 to Subpart III of... - Compliance Requirements for Molded and Rebond Foam Production Affected Sources

Code of Federal Regulations, 2011 CFR

2011-07-01

... Flexible Polyurethane Foam Production Pt. 63, Subpt. III, Table 5 Table 5 to Subpart III of Part 63—Compliance Requirements for Molded and Rebond Foam Production Affected Sources Emission point Emission point... Rebond Foam Production Affected Sources 5 Table 5 to Subpart III of Part 63 Protection of Environment...

40 CFR Table 5 to Subpart III of... - Compliance Requirements for Molded and Rebond Foam Production Affected Sources

Code of Federal Regulations, 2012 CFR

2012-07-01

... Flexible Polyurethane Foam Production Pt. 63, Subpt. III, Table 5 Table 5 to Subpart III of Part 63—Compliance Requirements for Molded and Rebond Foam Production Affected Sources Emission point Emission point... Rebond Foam Production Affected Sources 5 Table 5 to Subpart III of Part 63 Protection of Environment...

Satisfaction, compliance and communication.

PubMed

Ley, P

1982-11-01

The literature on communication, compliance, and patient satisfaction is selectively reviewed. As in earlier reviews, it is concluded that dissatisfaction with communication remains widespread, as does lack of compliance with medical advice. Related factors include poor transmission of information from patient to doctor, low understandability of communications addressed to the patient, and low levels of recall of information by patients. There does not appear to be any evidence that provision of additional information leads to adverse reactions by patients. Theoretical approaches to communication and compliance are described, and it is concluded that these should be used to direct future research.

[Reflections about non compliance].

PubMed

Consoli, S G

2012-01-01

Throughout the follow up of a patient suffering from a chronic cutaneous disease, non compliance is rarely avoidable. It is provoked by numerous factors, which have to be looked for in the patient and the doctor, as well, and in the external reality, as in the internal, psychic, reality, both of the patient and the doctor. Being aware of these factors is fundamental for resolving the non compliance conflict. Thus, non compliance can become a chance to seize for avoiding patients' wandering and building a more dynamic, authentic and stronger doctor-patient relationship. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Increased medication compliance of liver transplant patients switched from a twice-daily to a once-daily tacrolimus-based immunosuppressive regimen.

PubMed

Eberlin, M; Otto, G; Krämer, I

2013-01-01

Compliance with immunosuppressive therapy plays a major role in the long-term success of liver transplantation. Thus, the development of strategies to promote compliance of liver transplant patients and its evaluation over time are of particular interest. The main objective of this study was to compare medication compliance rates among liver transplant patients over time after transplantation where switched from a twice- to once-daily tacrolimus-based regimen. Sixty-five liver transplant patients being administered tacrolimus-based therapy were classified into three subgroups with regard to time posttransplantation. Medication compliance with tacrolimus-based therapy was measured using an electronic medication event monitoring system over a 12-month period: for 6 months tacrolimus was administered twice-daily and for 6 months, once-daily. Dosing, taking, and timing compliance as well as drug holidays were compared intra-individually between twice- and once-daily intake and among the three subgroups. In addition, patient compliance and quality of life were evaluated using questionnaires. A per protocol analysis of electronically obtained data showed 63 patients to be eligible. The resulting dosing, taking, and timing compliance rates of the patients were higher during the once-daily dosing period. No significant differences in compliance rates with tacrolimus therapy were observed among three subgroups independent of the dosing regimen. More patients failed the correct timing of the evening compared to the morning dose. Missing doses occurred particularly during weekends. Compliance variables measured by questionnaires (Morisky score, self-report, Medication Experience Scale for Immunosuppressants (MESI) score) and the Hospital Anxiety and Depression Scale score were similar in the two dosing periods. The short-form health survey (SF-36) score was higher with once-daily intake. The high measured compliance rates did not vary significantly dependent upon the time

Evaluation of Patients' Compliance with Medical Practitioners' Prescriptions: University Health Center Experience.

ERIC Educational Resources Information Center

Parsons, Robert J.; And Others

1980-01-01

This research report examines the characteristics of patients and their compliance with drug prescriptions and suggests that there is a need for education among patients receiving medication so that they do not prematurely terminate the medication process. (JN)

Applications of Text Messaging, and Bibliotherapy for Treatment of Patients Affected by Depressive Symptoms.

PubMed

Taleban, Roya; Zamani, Ahmadreza; Moafi, Mohammad; Jiryaee, Nasrin; Khadivi, Reza

2016-01-01

Intensity of depressive symptoms could be exacerbated due to the paucity of appropriate treatments. We assessed the effectiveness of bibliotherapy and text messaging, which aimed at amelioration of patient's behavior and consciousness, which could lead to suicide prevention. This was a randomized clinical trial implemented in rural health centers of Isfahan district (Iran). Health centers were assigned in three trials consisting of the booklet, text messaging, and control groups. Each group consisted of 70 patients. Inclusion criteria were being affected by depressive symptom, <18 years, and cell phone accessibility. Mental retardation, drug and alcohol abuse, visual disability, dementia, suicide attempt history, electrotherapy, and receiving psychological interventions were our not met criteria. Our patient outcomes comprised intensity of depressive symptom and treatment compliance. The first two trials were requested to study instructive booklets in 30 days while the second cohort was demanded to study the booklet in accordance with the daily delivered text messaging. Out of 210 individuals, 198 patients finished this study. The intensity of depressive symptom was significantly affected through time and group factors as well as time-group interaction (F = 12.30, P < 0.001). Based on treatment compliance, the interactive effect of group factor and the time factor was statistically significant. It seems that bibliotherapy could efficiently decrease the intensity of depressive symptoms. Nevertheless, in comparison with our booklet trial, the text messaging group achieved neither durable nor significant success; thus, bibliotherapy could be utilized as a complementary methodology aiming depression treatment.

A study at Manchester Dental Hospital, of the compliance of IV sedation patients and their escorts.

PubMed

Lightfoot, Kate

2014-01-01

Oral surgery, under intravenous sedation, is carried out on a daily basis at Manchester Dental Hospital. This essay discusses the background of conscious sedation in the dental setting and looks at the compliance of patients (and escorts) when having intravenous sedation. The patient journey, from pre-operative assessment through to treatment is considered. Hospital instructions indicate an obligation for patients to attend with a responsible adult (eighteen or over) who remains with them throughout their treatment, escorts them home,and arranges their care for the next twenty-four hours. By following these instructions the patient should receive optimal care. Two questionnaires were devised and given to patients/escorts to assess their compliance with Manchester Dental Hospital postoperative protocols. 100% compliance was the set standard, with results presented as pie charts. This work began during the undergraduate summer vacation of 2012 and continued over a five-month period. Initial results suggested that compliance was generally good but certain improvements could be made. Suggestions for future development are presented. These aim to give clarity to all patients/escorts and their specific roles in the anticipated treatment.

Home-based zoledronic acid infusion therapy in patients with solid tumours: compliance and patient-nurse satisfaction.

PubMed

Lebret, Thierry; Mouysset, Jean-Loup; Lortholary, Alain; El Kouri, Claude; Bastit, Laurent; Ktiouet, Meryem; Slimane, Khemaies; Murraciole, Xavier; Guérif, Stéphane

2013-06-01

This study aimed to explore patient and nurse satisfaction, compliance with best practice, technical feasibility and safety of home infusion of the bisphosphonate zoledronic acid (ZOL). This was a prospective 1-year survey of home ZOL therapy (4 mg Zometa, 15-min i.v., every 3-4 weeks) in patients with bone metastases secondary to a solid malignancy. A physician questionnaire, nurse satisfaction/feasibility questionnaire and patient satisfaction questionnaire were administered at several time-points. Physician participation rate was 56.5% (87/154). Physicians enrolled 818 patients visited by 381 predominantly community nurses. Of the 788 case report forms received, 763 met inclusion criteria. Patient characteristics were as follows: median age, 68 years (30-95); M/F, 40/60; ECOG-PS 0 or 1, 78.6%; and primary tumour site, breast (55.2%), prostate (28.4%), lung (7.2%) or other (9.4%). Nurse satisfaction rates were high: organisation of home ZOL therapy, 90.9%; ease of infusion, 96.7%; patient-nurse relationship, 97.5%; and relationship with hospital staff, 73%. Patient satisfaction was also very high (95.3%). The main reasons were quality of the nurse-patient relationship (57.6%), less travel/waiting (68.8%), home environment (52.9%) and less disruption to daily routine (36.6%). ZOL therapy was well tolerated, the discontinuation rate due to adverse events (including deaths whether related to diseases progression or not) was 33.6%. The incidence of osteonecrosis of the jaw was 0.6% and of fractures, 0.2%. Practitioner compliance with best practice was 76.7-83.7% for recommended and/or tolerated dosage, 73% for dental hygiene checks at inclusion and 48-56% thereafter, 66% for pre-infusion hydration, and often undocumented for calcium/vitamin D supplementation. Home ZOL therapy was well tolerated. Both patient and nurse satisfaction were very high. However, better compliance with best practice should be encouraged.

Impact of a pharmaceutical care program on liver transplant patients' compliance with immunosuppressive medication: a prospective, randomized, controlled trial using electronic monitoring.

PubMed

Klein, Anja; Otto, Gerd; Krämer, Irene

2009-03-27

Compliance with immunosuppressive therapy plays a major role in the long-term success of organ transplantation. Thus, strategies to promote compliance in posttransplant care are of particular interest. At the pharmacy department of the University Hospital Mainz, a program for pharmaceutical care of organ transplant patients has been developed for the first time ever. The main objective of the presented study was to examine the influence of this program on liver transplant patients' compliance with immunosuppressive therapy. To measure compliance, medication event monitoring systems were used. Dosing compliance (DC) was calculated for each patient and the mean DC was compared between the two groups. Further direct and indirect methods of measuring compliance served to confirm the electronic compliance data. Pharmaceutical care of liver transplant patients led to a significant increase in compliance with the immunosuppressive therapy. The mean DC of the intervention group was 90%+/-6% compared with 81%+/-12% in the control group (P=0.015). Only two patients (10%) in the intervention group and nine patients (43%) in the control group showed a DC less than 80% (P=0.032). Furthermore, patients in the intervention group were more likely to achieve target blood levels. Patients who received pharmaceutical care with traditional patient care showed significantly better compliance with their immunosuppressive medication than patients who received only traditional patient care. Pharmaceutical care proved to be an effective intervention that should be implemented in posttransplant care.

Risk factors of compliance with self-harm command hallucinations in individuals with affective and non-affective psychosis.

PubMed

Dugré, Jules R; Guay, Jean-Pierre; Dumais, Alexandre

2018-05-01

Clinicians are often left with the difficult task of assessing and managing the risk of violent behaviors in individuals having command hallucinations, which may result in substantial rates of false positive or false negative. Moreover, findings on the association between command hallucinations and suicidal behaviors are limited. In an attempt to better understand compliance to this hallucinatory phenomenon, our objective was to identify the risk factors of compliance with self-harm command hallucinations. Secondary analyses from the MacArthur Study were performed on 82 participants with psychosis reporting such commands. Univariate logistic regression was used to examine the classification value of each characteristic associated with compliance with such commands. Seriousness and frequency of childhood physical abuse, a current comorbid substance use disorder, emotional distress, general symptomatology, history of compliance, and belief about compliance in the future were found to be significant risk factors of compliance with self-harm commands in the week preceding psychiatric inpatient. Multivariate analyses revealed that severity of childhood physical abuse, belief about compliance in the future, and a current comorbid substance use disorder were independent risk factors. The final model showed excellent classification accuracy as suggest by the receiver operating characteristic curve (AUC=0.84, 95% CI: 0.75-0.92, p<0.001). Our results suggest considerable clinical implications in regard to the assessment of risk of compliance to self-harm command hallucinations in individuals with psychosis. Copyright © 2017 Elsevier B.V. All rights reserved.

CHILDHOOD BLOOD LEAD LEVELS NOT AFFECTED BY HOUSING COMPLIANCE STATUS

EPA Science Inventory

In a secondary analysis of data from the Childhood Lead Poisoning Prevention Program of Philadelphia (July 1, 1999 through September 1, 2004), the authors evaluated the effect of housing compliance status and time to achieve compliance on changes in children's blood lead levels. ...

40 CFR Table 3 to Subpart III of... - Compliance Requirements for Slabstock Foam Production Affected Sources Complying With the...

Code of Federal Regulations, 2012 CFR

2012-07-01

... Foam Production Affected Sources Complying With the Emission Point Specific Limitations 3 Table 3 to... Standards for Hazardous Air Pollutants for Flexible Polyurethane Foam Production Pt. 63, Subpt. III, Table 3 Table 3 to Subpart III of Part 63—Compliance Requirements for Slabstock Foam Production Affected Sources...

40 CFR Table 3 to Subpart III of... - Compliance Requirements for Slabstock Foam Production Affected Sources Complying With the...

Code of Federal Regulations, 2011 CFR

2011-07-01

... Foam Production Affected Sources Complying With the Emission Point Specific Limitations 3 Table 3 to... Standards for Hazardous Air Pollutants for Flexible Polyurethane Foam Production Pt. 63, Subpt. III, Table 3 Table 3 to Subpart III of Part 63—Compliance Requirements for Slabstock Foam Production Affected Sources...

40 CFR Table 3 to Subpart III of... - Compliance Requirements for Slabstock Foam Production Affected Sources Complying With the...

Code of Federal Regulations, 2010 CFR

2010-07-01

... Foam Production Affected Sources Complying With the Emission Point Specific Limitations 3 Table 3 to... Standards for Hazardous Air Pollutants for Flexible Polyurethane Foam Production Pt. 63, Subpt. III, Table 3 Table 3 to Subpart III of Part 63—Compliance Requirements for Slabstock Foam Production Affected Sources...

40 CFR 73.35 - Compliance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 16 2010-07-01 2010-07-01 false Compliance. 73.35 Section 73.35... ALLOWANCE SYSTEM Allowance Tracking System § 73.35 Compliance. (a) Allowance transfer deadline. No allowance shall be deducted for purposes of compliance with an affected source's sulfur dioxide Acid Rain...

40 CFR 73.35 - Compliance.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 16 2011-07-01 2011-07-01 false Compliance. 73.35 Section 73.35... ALLOWANCE SYSTEM Allowance Tracking System § 73.35 Compliance. (a) Allowance transfer deadline. No allowance shall be deducted for purposes of compliance with an affected source's sulfur dioxide Acid Rain...

NON-COMPLIANCE TO ANTI-HYPERTENSIVE MEDICATION AND ITS ASSOCIATED FACTORS AMONG HYPERTENSIVES.

PubMed

Bilal, Arshia; Riaz, Mehwish; Shafiq, Noor-ulain; Ahmed, Mariam; Sheikh, Sadaf; Rasheed, Sobia

2015-01-01

Non-compliance to anti-hypertensive drugs can have negative impact on cardiovascular outcome. Various studies have been conducted on the issue but the factors are not yet explored properly, particularly in Pakistan. This study was conducted to determine the frequency and factors associated with non-compliance to anti-hypertensive medications in Karachi. This descriptive cross sectional study was conducted on 113 indoor hypertensive patients included by purposive sampling, aged 30 years and above diagnosed at least 6 months back in public sector tertiary care institutes of Karachi from March to October 2011. Data was collected through a questionnaire in Urdu. Demographic data, hypertension diagnosis, medical co-morbidity, current number of anti-hypertensive medicines, frequency of missing prescribed antihypertensive therapy and other factors affecting compliance pertaining to medicines, patient, physician and health care centre were included in the questionnaire. This study revealed that 68.14% patients were non-compliant. Non-compliance was found to be associated with gender and socioeconomic status. Duration of hypertension, duration between follow up visits to physician, number of drugs, careless attitude, role of physician and limiting access to health care center are found to be important factors in non-compliance. Multiple factors including patients, medicine and health care system related, which can be prevented with simple measures, were found responsible for higher prevalence of non-compliance against anti-hvnertensive medicines.

Setting radon-specific release criteria and demonstrating compliance for land affected by NORM.

PubMed

García-Talavera, M; Martínez, M; Matarranz, J L M; Ramos, L

2008-11-01

Residues from industrial activities involving naturally occurring radioactive materials (NORMs) may cause radiation exposures to members of the public, particularly when NORM-affected land is brought into residential use. To provide an adequate protection against radiation in such situations, the following limiting criteria are currently required in Spain for releasing NORM-affected land: (i) no more than a 300 microSv yr(-1) increase (excluding radon doses) over the natural background; (ii) (222)Rn concentrations in hypothetical future dwellings lower than 200 Bq m(-3); and (iii) reduction of all radiation exposures to as low as reasonable achievable. This paper addresses some of the problems encountered in translating the (222)Rn criterion into site-specific release limits and in demonstrating compliance with them.

The theory of reasoned action and patient compliance during orthodontic treatment.

PubMed

Bos, Annemieke; Hoogstraten, Johan; Prahl-Andersen, Birte

2005-12-01

The aim of the present study was to investigate the potential of the theory of reasoned action (TRA) for the prediction and understanding of patients' intention to comply during orthodontic treatment and to analyze the effect of two additional variables in the model, namely perceived behavioral control and anticipated regret. Moreover, (the determinants of) intentions of orthodontic patients to comply during treatment were compared with (the determinants of) intentions of parents to stimulate this cooperation. A questionnaire was handed out to patients and parents visiting the Department of Orthodontics of the Academic Centre of Dentistry in Amsterdam. In both the patient and parent sample, independent-sample t-tests, correlation analyses and stepwise regression analyses were conducted. Variables in both samples were compared and tested. The extended version of the TRA explained 20% of the variance in the patients' intention to comply. The patients' anticipated regret, attitude and motivation to comply were significant determinants of the patients' intention to comply. In addition, the parents' attitude toward compliance was a significant predictor. The role of parents in enhancing patients' intentions to comply cannot be neglected. Our findings suggest that patients' intentions to comply during orthodontic treatment are influenced by factors outside of the TRA. Therefore, it is recommended to develop a new model, in which factors of the TRA are included, which can be used specifically for the study of compliance in orthodontics.

Post-discharge compliance to venous thromboembolism prophylaxis in high-risk orthopaedic surgery: results from the ETHOS registry.

PubMed

Bergqvist, David; Arcelus, Juan I; Felicissimo, Paulo

2012-02-01

Venous thromboembolism (VTE) risk persists for several weeks following high-risk orthopaedic surgery (HROS). The ETHOS registry evaluated post-operative VTE prophylaxis prescribed, and actual VTE prophylaxis received, compared with the 2004 American College of Chest Physicians (ACCP) guidelines in HROS patients. We performed a subanalysis of ETHOS to assess patient compliance with ACCP-adherent prophylaxis after discharge and the factors predicting poor compliance. Consecutive patients undergoing hip fracture surgery, total hip arthroplasty, or knee arthroplasty were enrolled at discharge from 161 centres in 17 European countries if they had received adequate in-hospital VTE prophylaxis. Data on prescribed and actual prophylaxis received were obtained from hospital charts and patient post-discharge diaries. Good compliance was defined as percentage treatment intake ≥80% with no more than two consecutive days without treatment. A total of 3,484 patients (79.4%) received ACCP-adherent anticoagulant prescription at discharge and 2,999 (86.0%) had an evaluable patient diary. In total, 87.7% of evaluable patients were compliant with prescribed treatment after discharge. The most common reason for non-compliance (33.4%) was "drug was not bought". Injection of treatment was not a barrier to good compliance. Main factors affecting compliance related to purchase of and access to treatment, patient education, the person responsible for administering injections, country, and type of hospital ward at discharge. Within our study population, patient compliance with ACCP-adherent thromboprophylaxis prescribed at discharge was good. Improvements in patient education and prescribing practices at discharge may be important in further raising compliance levels in high-risk orthopaedic surgery patients.

Applications of Text Messaging, and Bibliotherapy for Treatment of Patients Affected by Depressive Symptoms

PubMed Central

Taleban, Roya; Zamani, Ahmadreza; Moafi, Mohammad; Jiryaee, Nasrin; Khadivi, Reza

2016-01-01

Background: Intensity of depressive symptoms could be exacerbated due to the paucity of appropriate treatments. We assessed the effectiveness of bibliotherapy and text messaging, which aimed at amelioration of patient's behavior and consciousness, which could lead to suicide prevention. Methods: This was a randomized clinical trial implemented in rural health centers of Isfahan district (Iran). Health centers were assigned in three trials consisting of the booklet, text messaging, and control groups. Each group consisted of 70 patients. Inclusion criteria were being affected by depressive symptom, <18 years, and cell phone accessibility. Mental retardation, drug and alcohol abuse, visual disability, dementia, suicide attempt history, electrotherapy, and receiving psychological interventions were our not met criteria. Our patient outcomes comprised intensity of depressive symptom and treatment compliance. The first two trials were requested to study instructive booklets in 30 days while the second cohort was demanded to study the booklet in accordance with the daily delivered text messaging. Results: Out of 210 individuals, 198 patients finished this study. The intensity of depressive symptom was significantly affected through time and group factors as well as time-group interaction (F = 12.30, P < 0.001). Based on treatment compliance, the interactive effect of group factor and the time factor was statistically significant. Conclusions: It seems that bibliotherapy could efficiently decrease the intensity of depressive symptoms. Nevertheless, in comparison with our booklet trial, the text messaging group achieved neither durable nor significant success; thus, bibliotherapy could be utilized as a complementary methodology aiming depression treatment. PMID:27076884

Identification of factors involved in medication compliance: incorrect inhaler technique of asthma treatment leads to poor compliance

PubMed Central

Darbà, Josep; Ramírez, Gabriela; Sicras, Antoni; García-Bujalance, Laura; Torvinen, Saku; Sánchez-de la Rosa, Rainel

2016-01-01

Objective To identify the impact of delivery device of inhaled corticosteroids and long-acting β2-agonist (ICS/LABA) on asthma medication compliance, and investigate other factors associated with compliance. Materials and methods We conducted a retrospective and multicenter study based on a review of medical registries of asthmatic patients treated with ICS/LABA combinations (n=2,213) whose medical devices were either dry powder inhalers (DPIs, such as Accuhaler®, Turbuhaler®, and NEXThaler®) or pressurized metered-dose inhalers (pMDI). Medication compliance included persistence outcomes through 18 months and medication possession ratios. Data on potential confounders of treatment compliance such as asthma exacerbations, comorbidities, demographic characteristics, and health care resource utilization were also explored. Results The probability of asthma medication compliance in case of DPIs was lower compared to pMDIs, which suggests that inhaler devices influence inhalation therapies. There were additional confounding factors that were considered as explanatory variables of compliance. A worse measure of airflow obstruction (forced expiration volume in 1 second), comorbidities and general practitioner (GP) consultations more than once per month decreased the probability of compliance. Within comorbidities, alcoholism was positively associated with compliance. Patients of 29–39, 40–50, and 51–61 age groups or suffering from more than two exacerbations during the study period were more likely to comply with their medication regime. The effects of DPIs toward compliance varied with the different DPIs. For instance, Accuhaler® had a greater negative effect on compliance compared to Turbuhaler® and Nexthaler® in cases of patients who suffered exacerbations. We found that GP consultations reduced the probability of medication compliance for patients treated with formoterol/budesonide combination. For retired patients, visiting the GP increased the

Medical management of primary open-angle glaucoma: Best practices associated with enhanced patient compliance and persistency.

PubMed

Kulkarni, Sadhana V; Damji, Karim F; Buys, Yvonne M

2008-02-02

Primary open angle glaucoma is a chronic optic neuropathy often requiring lifelong treatment. Patient compliance, adherence and persistence with therapy play a vital role in improved outcomes by reducing morbidity and the economic consequences that are associated with disease progression. A literature review including searches of The Cochrane Library, MEDLINE, PubMed, conference proceedings, and bibliographies of identified articles reveals the enormous public health burden in various populations due to the impact of glaucoma associated visual impairment on the overall quality of life eg, fear of blindness, inability to work in certain occupations, driving restrictions, motor vehicle accidents, falls, and general health status. Providing specific definitions for the frequently misunderstood terms "compliance, persistence and adherence" with reference to medication use is central not only for monitoring patients' drug dosing histories and clinical outcomes but also for subsequent research. In this review article, a summary of the advantages/disadvantages including cost-effectiveness of various medical approaches to glaucoma treatment, techniques employed for measuring patient compliance and actual patient preferences for therapy are outlined. We conclude by identifying the key barriers to ongoing treatment and suggest some best practices to enhance compliance and persistence.

[Effects of TES program on exercise capacity, self-efficacy and patient compliance in patients with myocardial infarction].

PubMed

Choo, Jina; Kim, Ja-Mae; Hong, Kyung-Pyo

2003-12-01

This study aimed to develop a TES program to improve exercise capacity to promote patient compliance to the prescribed exercise, and to test the feasibility of the program. The 8-week TES program consisted of three components : exercise training, self-efficacy enhancement and social support. Using the matching of gender, age, and the left ventricular ejection fraction, thirty one subjects were consecutively assigned to either TES group (n=15, 52+7 years) or Control group (n=16, 58+11 years) 3 weeks after MI. With the exception of exercise compliance (only after the TES program), the exercise capacity and exercise self-efficacy were both measured both before and after the 8-week TES program. The VO2peak (p=.043), anaerobic threshold (p=.023) and exercise duration (p=.015) improved in TES group compared to Control group after 8 weeks. The cardiac exercise self-efficacy (p=.036) was significantly higher in TES group than Control group. There was a significant increase of exercise compliance(p=.005) in TES group compared to Control group. The 8-week TES program improved the exercise capacity, exercise self-efficacy and exercise compliance. A appropriately implemented TES program in cardiovascular nursing practice may promote healthy behavioral modification and, therefore, contributing to reduce the risk of mortality and morbidity in MI patients.

Treatment compliance under physician-industry relationship: a framework of health-care coordination in the USA.

PubMed

Chen, Jie; Vargas-Bustamante, Arturo

2013-07-01

Factors associated with treatment compliance have been well studied. However, no study has examined treatment compliance under the context of physician-industry relationship. This study developed a conceptual framework of physician-industry relationship and treatment compliance, and empirically tested patients' treatment compliance and affordability under the physician-industry relationship in the USA. We first proposed a conceptual framework to analyze different scenarios, where the physician-industry relationship could impact patients' treatment compliance and affordability, taking into consideration the role of health insurers. We then employed a nationally representative data set to investigate these relationships. Multivariable logistic regressions were employed to examine the physician-industry relationship and the physicians' perception of patients' treatment compliance. 2008 Health Tracking Physician Survey. Our results showed that physicians with closer industry relationships were more likely to report rejection of care by insurers [odds ratios (ORs): 1.24-1.85, P < 0.001], patients' non-compliance with treatment (OR: 1.34, P < 0.01) and patients' inability to pay (OR: 1.42, P < 0.01) as the major problems affecting their ability to provide high quality care, when compared with physicians without industry relationships. Our results shed light on the lack of articulation among industry, physicians and health insurers in the USA. It is important to make sure that different agents in the health-care marketplace, such as physicians, industry, and health insurers, coordinate more efficiently to provide quality and consistent care to patients.

A Summation Analysis of Compliance and Complications of Compression Hosiery for Patients with Chronic Venous Disease or Post-thrombotic Syndrome.

PubMed

Kankam, Hadyn K N; Lim, Chung S; Fiorentino, Francesca; Davies, Alun H; Gohel, Manj S

2018-03-01

Compression stockings are commonly prescribed for patients with a range of venous disorders, but are difficult to don and uncomfortable to wear. This study aimed to investigate compliance and complications of compression stockings in patients with chronic venous disease (CVD) and post-thrombotic syndrome (PTS). A literature search of the following databases was carried out: MEDLINE (via PubMed), EMBASE (via OvidSP, 1974 to present), and CINAHL (via EBSCOhost). Studies evaluating the use of compression stockings in patients with CVD (CEAP C2-C5) or for the prevention or treatment of PTS were included. After scrutinising full text articles, compliance with compression and associated complications were assessed. Compliance rates were compared based on study type and degree of compression. Good compliance was defined as patients wearing compression stockings for >50% of the time. From an initial search result of 4303 articles, 58 clinical studies (37 randomised trials and 21 prospective studies) were selected. A total of 10,245 limbs were included, with compression ranging from 15 to 40 mmHg (not stated in 12 studies) and a median follow-up of 12 months (range 1-60 months). In 19 cohorts, compliance was not assessed and in a further nine, compliance was poorly specified. Overall, good compliance with compression was reported for 5371 out of 8104 (66.2%) patients. The mean compliance, weighted by study size, appeared to be greater for compression ≤25 mmHg (77%) versus > 25 mmHg (65%) and greater in the randomised studies (74%) than in prospective observational studies (64%). Complications of stockings were not mentioned in 43 out of 62 cohorts reviewed. Where complications were considered, skin irritation was a common event. In published trials, good compliance with compression is reported in around two thirds of patients, with inferior compliance in those given higher degrees of compression. Further studies are required to identify predictors of non-compliance

Effect of intervention using a messaging app on compliance and duration of treatment in orthodontic patients.

PubMed

Li, Xue; Xu, Zhen-Rui; Tang, Na; Ye, Cui; Zhu, Xiao-Ling; Zhou, Ting; Zhao, Zhi-He

2016-11-01

This study aims to determine the effectiveness of a messaging app (WeChat) in improving patients' compliance and reducing the duration of orthodontic treatment (DOT). A randomized controlled trial was performed in a dental hospital and a clinic from August 2012 to May 2015. Orthodontic patients were included at the beginning of treatment. Patients with multiphase treatment or braceless technique were excluded. Participants were randomized to WeChat group (received regular reminders and educational messages) or control group (received conventional management) and were followed up until the treatment was completed. Primary outcome measure was DOT. Others were late and failed attendance, bracket bond failure, and oral hygiene condition. One hundred twelve patients in each group participated and completed the trial. DOT in WeChat group were 7.3 weeks shorter (P = 0.007). There were less failed attendance (3.1 vs. 10.9 %, P < 0.001), late attendance (20.1 vs. 29.9 %, P < 0.001), and bracket bond failure (11.8 vs. 16.1 %, P < 0.001) in WeChat group than control. There was no difference in orthodontic plaque index nor modified gingivitis index between the two groups before and after treatment. Number of failed attendances was identified as an independent factor affecting DOT (P = 0.004; HR = 0.89, 95 % CI 0.84 to 0.95). The intervention with WeChat is effective in reducing the treatment duration and bracket bond failure, and improving the attendance in orthodontic patients. DOT can be reduced by improving patient's compliance. The messaging app is useful for outpatient education and management.

Evaluating compliance with institutional preoperative testing guidelines for minimal-risk patients undergoing elective surgery.

PubMed

Siriussawakul, Arunotai; Nimmannit, Akarin; Rattana-arpa, Sirirat; Chatrattanakulchai, Siritda; Saengtawan, Puttachard; Wangdee, Aungsumat

2013-01-01

Few investigations preoperatively are important for low-risk patients. This study was designed to determine the level of compliance with preoperative investigation guidelines for ASA I patients undergoing elective surgery. Secondary objectives included the following: to identify common inappropriate investigations, to evaluate the impact of abnormal testing on patient management, to determine factors affecting noncompliant tests, and to estimate unnecessary expenditure. This retrospective study was conducted on adult patients over a one-year period. The institute's guidelines recommend tests according to the patients' age groups: a complete blood count (CBC) for those patients aged 18-45; CBC, chest radiograph (CXR) and electrocardiography (ECG) for those aged 46-60; and CBC, CXR, ECG, electrolytes, blood glucose, blood urea nitrogen (BUN), and creatinine (Cr) for patients aged 61-65. The medical records of 1,496 patients were reviewed. Compliant testing was found in only 12.1% (95% CI, 10.5-13.9). BUN and Cr testings were the most frequently overprescribed tests. Overinvestigations tended to be performed on major surgery and younger patients. Overall, overinvestigation incurred an estimated cost of US 200,000 dollars during the study period. The need to utilize the institution's preoperative guidelines should be emphasized in order to decrease unnecessary testing and the consequential financial burden.

40 CFR Table 4 to Subpart III of... - Compliance Requirements for Slabstock Foam Production Affected Sources Complying With the Source...

Code of Federal Regulations, 2010 CFR

2010-07-01

... Standards for Hazardous Air Pollutants for Flexible Polyurethane Foam Production Pt. 63, Subpt. III, Table 4 Table 4 to Subpart III of Part 63—Compliance Requirements for Slabstock Foam Production Affected Sources... Foam Production Affected Sources Complying With the Source-Wide Emission Limitation 4 Table 4 to...

40 CFR Table 4 to Subpart III of... - Compliance Requirements for Slabstock Foam Production Affected Sources Complying With the Source...

Code of Federal Regulations, 2011 CFR

2011-07-01

... Standards for Hazardous Air Pollutants for Flexible Polyurethane Foam Production Pt. 63, Subpt. III, Table 4 Table 4 to Subpart III of Part 63—Compliance Requirements for Slabstock Foam Production Affected Sources... Foam Production Affected Sources Complying With the Source-Wide Emission Limitation 4 Table 4 to...

40 CFR Table 4 to Subpart III of... - Compliance Requirements for Slabstock Foam Production Affected Sources Complying With the Source...

Code of Federal Regulations, 2012 CFR

2012-07-01

... Standards for Hazardous Air Pollutants for Flexible Polyurethane Foam Production Pt. 63, Subpt. III, Table 4 Table 4 to Subpart III of Part 63—Compliance Requirements for Slabstock Foam Production Affected Sources... Foam Production Affected Sources Complying With the Source-Wide Emission Limitation 4 Table 4 to...

Comprehension and compliance with the discharge advice and quality of life at home among the postoperative neurosurgery patients discharged from PGIMER, Chandigarh, India

PubMed Central

Kumar, Vishal; Singh, Amarjeet; Tewari, Manoj K.; Kaur, Sukhpal

2016-01-01

Problem Statement: Neurosurgical patients require special care not only in the hospital but also after their discharge from the hospital. Comprehension and compliance to the instructions given by the doctors/nurses at the time of discharge is important in home care of these patients. Many such patients suffer from various co-morbidities. Variable periods of convalescence affect health-related quality of life in these patients. Purpose of the Study: To determine the degree of compliance of neurosurgery patients and their family caregivers with the discharge advice given by the consultantsTo evaluate the quality of life of these patientsTo know the problems faced by these patients at home. Materials and Methods: This cross-sectional interview-based descriptive study was conducted in 2010 in Chandigarh. These patients were visited at their home. A scale was evolved to evaluate comprehension and compliance to the advice given at the time of discharge, according to the criteria developed by Clark et al. Lawton Brody instrumental activity of daily life and Spitzer quality of life index were used to assess patients' quality of life after the operation. Verbatim responses were recorded for the purpose of qualitative research. Results: Overall, 58 patients and their caregivers were interviewed at home. Mean age of the patients was 38.9 years. Out of 37 patients, 35 showed good comprehension and 33 patients had a good compliance with the instructions given for medication. The condition of 74.1% patients improved after the operation. Depression was reported in 31% of the patients. Many (36.2%) patients had to quit their job due to the disease. Almost half (47.4%) of the patients were independent in daily activities of their life while being evaluated on Barthel activity of daily life index. Conclusion and Recommendations: It is in the long term that the true complexity and impact of operations become apparent. After operation, such patients are likely to have a range of

Evidence regarding patient compliance with incentive spirometry interventions after cardiac, thoracic and abdominal surgeries: A systematic literature review.

PubMed

Narayanan, Aqilah Leela T; Hamid, Syed Rasul G Syed; Supriyanto, Eko

2016-01-01

Evidence regarding the effectiveness of incentive spirometry (ISy) on postoperative pulmonary outcomes after thoracic, cardiac and abdominal surgery remains inconclusive. This is attributed to various methodological issues inherent in ISy trials. Patient compliance has also been highlighted as a possible confounding factor; however, the status of evidence regarding patient compliance in these trials is unknown. To explore the status of evidence on patient compliance with ISy interventions in randomized controlled trials (RCTs) in the above contexts. A systematic search using MEDLINE, EMBASE and CINAHL databases was conducted to obtain relevant RCTs from 1972 to 2015 using the inclusion criteria. These were examined for specific ISy parameters, methods used for determining compliance and reporting on compliance. Main outcome measures were comparison of ISy parameters prescribed and assessed, and reporting on compliance. Thirty-six relevant RCTs were obtained. Six ISy parameters were identified in ISy prescriptions from these trials. Almost all (97.2%) of the trials had ISy prescriptions with specific parameters. Wilcoxon signed-rank test revealed that the ISy parameters assessed were significantly lower (Z=-5.433; P<0.001) than those prescribed; 66.7% of the trials indicated use of various methods to assess these parameters. Only six (16.7%) trials included reports on compliance; however, these were also incomprehensive. There is a scarcity and inconsistency of evidence regarding ISy compliance. Compliance data should be obtained using reliable and standardized methods to facilitate comparisons between and among trials. These should be reported comprehensively to facilitate valid inferences regarding ISy intervention effectiveness.

Evidence regarding patient compliance with incentive spirometry interventions after cardiac, thoracic and abdominal surgeries: A systematic literature review

PubMed Central

Narayanan, Aqilah Leela T; Hamid, Syed Rasul G Syed; Supriyanto, Eko

2016-01-01

BACKGROUND: Evidence regarding the effectiveness of incentive spirometry (ISy) on postoperative pulmonary outcomes after thoracic, cardiac and abdominal surgery remains inconclusive. This is attributed to various methodological issues inherent in ISy trials. Patient compliance has also been highlighted as a possible confounding factor; however, the status of evidence regarding patient compliance in these trials is unknown. OBJECTIVE: To explore the status of evidence on patient compliance with ISy interventions in randomized controlled trials (RCTs) in the above contexts. METHOD: A systematic search using MEDLINE, EMBASE and CINAHL databases was conducted to obtain relevant RCTs from 1972 to 2015 using the inclusion criteria. These were examined for specific ISy parameters, methods used for determining compliance and reporting on compliance. Main outcome measures were comparison of ISy parameters prescribed and assessed, and reporting on compliance. RESULTS: Thirty-six relevant RCTs were obtained. Six ISy parameters were identified in ISy prescriptions from these trials. Almost all (97.2%) of the trials had ISy prescriptions with specific parameters. Wilcoxon signed-rank test revealed that the ISy parameters assessed were significantly lower (Z=−5.433; P<0.001) than those prescribed; 66.7% of the trials indicated use of various methods to assess these parameters. Only six (16.7%) trials included reports on compliance; however, these were also incomprehensive. CONCLUSIONS: There is a scarcity and inconsistency of evidence regarding ISy compliance. Compliance data should be obtained using reliable and standardized methods to facilitate comparisons between and among trials. These should be reported comprehensively to facilitate valid inferences regarding ISy intervention effectiveness. PMID:26909010

Objective assessment of compliance and persistence among patients treated for glaucoma and ocular hypertension: a systematic review

PubMed Central

Reardon, Gregory; Kotak, Sameer; Schwartz, Gail F

2011-01-01

Purpose This study summarizes findings from objective assessments of compliance (or adherence) and persistence with ocular hypotensive agents in patients with glaucoma and ocular hypertension. Design Systematic literature review. Methods A PubMed and reference list search was conducted across publication years 1970–2010, using these terms and variants: “compliance,” the equivalent term “adherence,” and “persistence” in patients with these conditions and therapies. Summaries of selected studies were stratified by measurement method (electronic monitor, prescription fills review, medical chart review). Measures of central tendency across studies were calculated for commonly-reported compliance or persistence measures. Results Fifty-eight articles met all inclusion/exclusion criteria: measurement of compliance–electronic monitoring (seven studies reported in 14 articles), measurement of compliance/ persistence–prescription records (36 studies in 38 articles), and measurement of persistence– medical chart review (six studies in six articles). From electronic monitoring, most therapy-experienced patients took medication consistently, but ≥20% met criteria for poor compliance. From prescription records, only 56% (range 37%–92%) of the days in the first therapy year could be dosed with the medication supply dispensed over this period. At 12 months from therapy start, only 31% (range 10%–68%) of new therapy users had not discontinued, and 40% (range 14%–67%) had not discontinued or changed the initial therapy. From medical chart review, only 67% (range 62%–78%) of patients remained persistent 12 months after starting therapy. Conclusions Evidence provided by this review suggests that poor compliance and persistence has been and remains a common problem for many glaucoma patients, and is especially problematic for patients new to therapy. The direction of empirical research should shift toward a greater emphasis on understanding of root causes

Patient experiences of partnering with healthcare professionals for hand hygiene compliance: a systematic review.

PubMed

Butenko, Samantha; Lockwood, Craig; McArthur, Alexa

2017-06-01

Healthcare-associated infections pose a significant risk to patients in acute healthcare settings such as hospitals. Increasingly, patients are encouraged to be active participants and partner with healthcare professionals to positively influence their own safety and overall experience throughout their healthcare journey. Patient-focused safety initiatives include the empowerment of patients to be active partners with healthcare professionals in order to influence the hand hygiene behaviors and compliance of the healthcare professionals providing care to them. Partnering within the context of healthcare, and between the patient and healthcare professional, can be considered as a general concept that involves the empowerment of patients to participate in their care. Terms used to describe patient partnering within healthcare vary and include patient participation, patient-centeredness, patient empowerment and patient engagement. Although patients appear generally to have positive attitudes and intentions about engaging in their safety and partnering in the healthcare setting, their intentions and actual behaviors vary considerably. Patients appear less likely to engage in behaviors that require questioning of the perceived or real authority of healthcare professionals. A patient's intention and subsequent act of partnering with healthcare professionals for hand hygiene compliance by the healthcare professional are influenced by complex internal, external and social factors as well as cultural, behavioral and systematic factors. To determine the best available evidence in relation to the experiences of the patient partnering with healthcare professionals for hand hygiene compliance. The current review considered qualitative (critical or interpretive) papers that included adult in-patients and healthcare professionals (medical and nursing staff), in the acute hospital-care setting. Adult was considered to be any person aged 18 years or over. It should be noted that

Health behavior of patients after heart transplantation as an indicator of patient compliance.

PubMed

Siwińska, J; Lesiak-Kalukin, M; Przybyłowski, P; Sadowski, J

2011-10-01

Life after heart transplantation (HTX) does not only mean adherence to medical recommendations, but also implementation of healthy habits each day. It is necessary to change health-related customs, diet, and lifestyle, as well as to maintain a high standard of hygiene. Some patients make the necessary lifestyle modifications prior to surgery, as a result of pre-heart failure conditions, such as coronary heart disease or hypertension or diabetes. People who suddenly fall ill must make these changes immediately after the operation. The transplantation team working with patients after HTX since 1988 performs a program of secondary prophylaxis. Patients work with a physician, psychologist, physiotherapist, nursing team, and dietitian. The program is based on the processual model of health behavior Health Action Process Approach by Ralf Schwarzer. The goal of the study was to describe and assess compliance to a healthy lifestyle among patients living with a heart transplant. The study was conducted using the Health Behavior Inventory developed and standardized by Z. Juczyński. The scale examined three types of behavior lowering/raising the risk of illness as associated with compliance to medical recommendations, maintaining health, and reducing disease risk. Participants included 100 HTX patients including 23 women and 77 men of overall age range 21-75 years (average=53.5). The results are as follows: General indicator of health behaviors--7.3 sten. Subscales: proper nutrition habits--3.5; prophylactic behavior--4.1; positive psychological attitude--3 health practices--3.8. Heart transplant patients require professional, interdisciplinary assistance to shape healthy behaviors with motivational and volitional phases. Patients who follow medical recommendations experience a much better quality of life, protecting the new heart from negative effects of bad habits. Copyright © 2011 Elsevier Inc. All rights reserved.

The effects of low tidal ventilation on lung strain correlate with respiratory system compliance.

PubMed

Xie, Jianfeng; Jin, Fang; Pan, Chun; Liu, Songqiao; Liu, Ling; Xu, Jingyuan; Yang, Yi; Qiu, Haibo

2017-02-03

The effect of alterations in tidal volume on mortality of acute respiratory distress syndrome (ARDS) is determined by respiratory system compliance. We aimed to investigate the effects of different tidal volumes on lung strain in ARDS patients who had various levels of respiratory system compliance. Nineteen patients were divided into high (C high group) and low (C low group) respiratory system compliance groups based on their respiratory system compliance values. We defined compliance ≥0.6 ml/(cmH 2 O/kg) as C high and compliance <0.6 ml/(cmH 2 O/kg) as C low . End-expiratory lung volumes (EELV) at various tidal volumes were measured by nitrogen wash-in/washout. Lung strain was calculated as the ratio between tidal volume and EELV. The primary outcome was that lung strain is a function of tidal volume in patients with various levels of respiratory system compliance. The mean baseline EELV, strain and respiratory system compliance values were 1873 ml, 0.31 and 0.65 ml/(cmH 2 O/kg), respectively; differences in all of these parameters were statistically significant between the two groups. For all participants, a positive correlation was found between the respiratory system compliance and EELV (R = 0.488, p = 0.034). Driving pressure and strain increased together as the tidal volume increased from 6 ml/kg predicted body weight (PBW) to 12 ml/kg PBW. Compared to the C high ARDS patients, the driving pressure was significantly higher in the C low patients at each tidal volume. Similar effects of lung strain were found for tidal volumes of 6 and 8 ml/kg PBW. The "lung injury" limits for driving pressure and lung strain were much easier to exceed with increases in the tidal volume in C low patients. Respiratory system compliance affected the relationships between tidal volume and driving pressure and lung strain in ARDS patients. These results showed that increasing tidal volume induced lung injury more easily in patients with low respiratory system

Depot-medication compliance for patients with psychotic disorders: the importance of illness insight and treatment motivation.

PubMed

Noordraven, Ernst L; Wierdsma, André I; Blanken, Peter; Bloemendaal, Anthony Ft; Mulder, Cornelis L

2016-01-01

Noncompliance is a major problem for patients with a psychotic disorder. Two important risk factors for noncompliance that have a severe negative impact on treatment outcomes are impaired illness insight and lack of motivation. Our cross-sectional study explored how they are related to each other and their compliance with depot medication. Interviews were conducted in 169 outpatients with a psychotic disorder taking depot medication. Four patient groups were defined based on low or high illness insight and on low or high motivation. The associations between depot-medication compliance, motivation, and insight were illustrated using generalized linear models. Generalized linear model showed a significant interaction effect between motivation and insight. Patients with poor insight and high motivation for treatment were more compliant (94%) (95% confidence interval [CI]: 1.821, 3.489) with their depot medication than patients with poor insight and low motivation (61%) (95% CI: 0.288, 0.615). Patients with both insight and high motivation for treatment were less compliant (73%) (95% CI: 0.719, 1.315) than those with poor insight and high motivation. Motivation for treatment was more strongly associated with depot-medication compliance than with illness insight. Being motivated to take medication, whether to get better or for other reasons, may be a more important factor than having illness insight in terms of improving depot-medication compliance. Possible implications for clinical practice are discussed.

Gender and ethnic differences in arterial compliance in patients with intermittent claudication.

PubMed

Gardner, Andrew W; Montgomery, Polly S; Blevins, Steve M; Parker, Donald E

2010-03-01

To assess the gender and ethnic differences in arterial compliance in patients with intermittent claudication. A total of 114 patients participated, including 38 Caucasian men, 32 Caucasian women, 16 African American men, and 28 African American women. Patients were assessed on large artery elasticity index (LAEI), small artery elasticity index (SAEI), age, weight, body mass index, ankle-brachial index (ABI), smoking status, and metabolic syndrome components. Group differences were found for LAEI (P = .042), SAEI (P = .019), body mass index (P = .020), prevalence of elevated fasting glucose (P = .001), and prevalence of abdominal obesity (P = .025). Significant covariates for LAEI included age (P = .0002) and elevated triglycerides (P = .0719). LAEI (units = 10 mL x mm Hg) adjusted for age and triglycerides was 39% lower (P = .0005) in African Americans (11.4 +/- .90; mean +/- SE) than in Caucasians (15.8 +/- 0.72), whereas no significant difference (P = .7904) existed between men (13.8 +/- 0.81) and women (13.5 +/- 0.79). Significant covariates for SAEI included age (P = .0001), abdominal obesity (P = .0030), and elevated blood pressure (P = .0067). SAEI (units = 100 mL x mm Hg) adjusted for age, abdominal obesity, and elevated blood pressure was 32% lower (P = .0007) in African-Americans (2.8 +/- 0.3) than in Caucasians 4.1 +/- 0.2), and was 18% lower (P = .0442) in women (3.1 +/- 0.2) than in men (3.8 +/- 0.2). African American patients with intermittent claudication have more impaired macrovascular and microvascular function than Caucasian patients, and women have more impaired microvascular function than men. These ethnic and gender differences in arterial compliance are evident even though ABI was similar among groups, suggesting that arterial compliance provides unique information to quantify vascular impairment in patients with intermittent claudication.

Patient compliance with a health care provider referral for an occupational therapy lymphedema consult.

PubMed

Dominick, Sally A; Natarajan, Loki; Pierce, John P; Madanat, Hala; Madlensky, Lisa

2014-07-01

Limited information exists on breast cancer patients' compliance to attend outpatient appointments with an occupational therapy (OT) lymphedema specialist. The objectives of this study were (1) to examine patient compliance with a health care provider referral for an OT lymphedema consult and (2) to identify potential barriers to compliance. A retrospective chart review of female breast cancer patients at the UC San Diego Health System was conducted. Electronic medical records were queried for breast cancer patients, who received a health care provider referral for an OT lymphedema consult between June 1, 2010 and December 31, 2011. Descriptive statistics and Fisher's exact chi-square tests were used to examine how specific participant characteristics were associated with attending an OT appointment. A total of 210 female patients received an OT referral from a health care provider related to their breast cancer diagnosis. Forty-three (20.5%) patients did not attend an OT appointment. Non-attenders were more likely to have had fewer lymph nodes removed (P<0.01) when compared to attenders. The two most common barriers to attendance were the presence of health problems and undergoing chemotherapy and/or radiation at the time of the OT referral. While most breast cancer patients attended recommended OT lymphedema consults, a substantial number of women might benefit from further education about OT for lymphedema prevention following breast cancer treatment. Further research to understand barriers to attendance is recommended, particularly among women with only sentinel nodes removed.

Compliance with treatment and understanding of own disease in patients with severe and moderate haemophilia.

PubMed

Lindvall, K; Colstrup, L; Wollter, I-M; Klemenz, G; Loogna, K; Grönhaug, S; Thykjaer, H

2006-01-01

It is well known that teenagers with chronic diseases have problems complying with their treatment. The aim of this study was to evaluate the patient's knowledge of haemophilia and his compliance to prophylactic treatment, and the age at which the patient took over the responsibility for his disease and to create educational material for teenagers and adolescents. This was a prospective multicentre study performed in Hemophilia Treatment Centres in Scandinavia. A total of 108 of 134 patients, between 13 and 25 years completed the questionnaire, a response rate of 80%. Eighty-three patients had a severe form of haemophilia, 24 patients in moderate form and one patient did not know the severity of his disease. Seventy-eight patients were on prophylactic treatment. The median age for starting prophylactic treatment was 3.0 years and the median age for the patient performing venepuncture was 11.6 years. Sixty-seven of 78 patients knew that the best time to give prophylactic treatment was in the morning. Even though the patients were on prophylactic treatment, 47 of 78 patients took additional treatment before sports activities. At a mean age of 14.1 years the patient himself had the responsibility for his disease and treatment. In the cohort of 108 patients, 73 were aware of their haemophilia heredity. This study shows a rather high degree of knowledge of haemophilia and compliance with treatment among the patients but it is of great importance for the nurse to continuously improve the patient's compliance and keep him aware of the benefit of regular treatment for his future well being.

Electromagnetic compatibility and safety design of a patient compliance-free, inductive implant charger.

PubMed

Theodoridis, Michael P; Mollov, Stefan V

2014-10-01

This article presents the design of a domestic, radiofrequency induction charger for implants toward compliance with the Federal Communications Commission safety and electromagnetic compatibility regulations. The suggested arrangement does not impose any patient compliance requirements other than the use of a designated bed for night sleep, and therefore can find a domestic use. The method can be applied to a number of applications; a rechargeable pacemaker is considered as a case study. The presented work has proven that it is possible to realize a fully compliant inductive charging system with minimal patient interaction, and has generated important information for consideration by the designers of inductive charging systems. Experimental results have verified the validity of the theoretical findings.

Influence of patient training on persistence, compliance, and tolerability of different dosing frequency regimens of bisphosphonate therapy: An observational study in Turkish patients with postmenopausal osteoporosis.

PubMed

Akarırmak, Ülkü; Koçyiğit, Hikmet; Eskiyurt, Nurten; Esmaeilzadeh, Sina; Kuru, Ömer; Yalçinkaya, Ebru Yılmaz; Peker, Özlen; Ekim, Ayşe Aydemir; Özgirgin, Neşe; Çalış, Mustafa; Rezvani, Aylin; Çevikol, Alev; Eyigör, Sibel; Şendur, Ömer Faruk; İrdesel, Jale

2016-08-01

In our study, we aimed to evaluate the influence of training on compliance and persistence with bisphosphonate treatment given on a weekly vs. monthly basis in postmenopausal osteoporosis patients. A total of 979 patients with postmenopausal osteoporosis (mean age: 63.2 ± 7.2 years) were included in this national, multicenter, prospective non-interventional observational cohort registry study. Patients were randomized into training (n = 492, 50.3%, mean age: 63.4 ± 7.2 years) and control (n = 487, 49.7%, mean age: 63.0 ± 7.1 years) groups. Patients in each intervention group were given weekly (44.9% and 44.6% for training and control subjects, respectively) or monthly (55.1% and 55.4%, respectively) bisphosphonate regimens. After the initial visit, patients were followed up at three-month intervals throughout 12 months of treatment for evaluation of persistence, compliance and adverse events. On average, 79.4% of the patients were persistent with the treatment with a mean of 350.4 days of duration during the 12-month follow-up period. The mean compliance in the compliant and fully compliant group remained at an average of 86.6%. No significant difference was detected between the training and control groups in terms of compliance and persistence. Significantly longer persistence (360.0 ± 89.0 vs. 345.0 ± 108.0 days; p = 0.035), higher percentage of persistent patients (83.4% vs. 74.2%; p = 0.012) and higher compliance rates (88.8% vs. 83.3%; p = 0.002) were noted in monthly regimen patients in comparison to those given weekly regimen. Our findings revealed remarkably high rates for persistence and compliance with bisphosphonate treatment in postmenopausal osteoporosis, with no impact of training on compliance and persistence rates. Longer persistence and better compliance rates were achieved with the monthly bisphosphonate regimen when compared to the weekly regimen. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology

40 CFR 63.826 - Compliance dates.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 10 2011-07-01 2011-07-01 false Compliance dates. 63.826 Section 63... Emission Standards for the Printing and Publishing Industry § 63.826 Compliance dates. (a) The compliance date for an owner or operator of an existing affected source subject to the provisions of this subpart...

Quality of life with rivaroxaban in patients with non-valvular atrial fibrilation by therapeutic compliance.

PubMed

Márquez-Contreras, Emilio; Martell-Claros, Nieves; Gil-Guillén, Vicente; De la Figuera-Von Wichmann, Mariano; Sánchez-López, Eugenio; Gil-Gil, Ines; Márquez-Rivero, Sara

2017-03-01

To assess the quality of life (QOL) with rivaroxaban in patients with non-valvular atrial fibrilation (NVAF) related to therapeutic compliance. Prospective, longitudinal, multicenter study was developed in 160 Spanish primary or specialized care centers. We included 412 patients treated with rivaroxaban, prescribed for stroke prevention. Three visits were conducted: baseline, 6 and 12 months. Compliance was measured by electronic monitoring systems. QOL was measured by a specific questionnaire. We calculated the percentage of compliance means, the percentage of daily compliers and the score of QOL. Three hundred and seventy patients finished the study (mean age 75.19 SD: 7.5 years). Daily compliance was 83.5% (CI 78.53-88.57%) (n = 309) and 80% (CI 74.65-85.35%) at 6 and 12 months, respectively. Average QOL rating was 112.85 (SD 29.31) in non-compliant and 111.80 (SD 29.31) in the compliant group (p = Not significant), and after 12 months of 124.67 (SD 30.78) and 83.47 (SD 26.44), respectively (p < 0.0001), with a decrease in the score compliers (p < 0.01) and an increase in non-compliant group (p < 0.05). A higher number of drugs consumed, as well as the number of diseases/conditions suffered, the older age of the patients and having been previously treated with VKA were associated with a higher overall score (worse QOL). QOL in NVAF patients treated with rivaroxaban improved significantly over the study group at the expense of compliers. A worse QOL was associated with pluripathology, polymedication, older patients and previous treatment with VKA.

Progress and Compliance in Alcohol Abuse Treatment*

PubMed Central

Lien, Hsien-Ming; Lu, Mingshan; Ma, Ching-To Albert; McGuire, Thomas G.

2009-01-01

Improving patient compliance with physicians’ treatment or prescription recommendations is an important goal in medical practice. We examine the relationship between treatment progress and patient compliance. We hypothesize that patients balance expected benefits and costs during a treatment episode when deciding on compliance; a patient is more likely to comply if doing so results in an expected gain in health benefit. We use a unique data set of outpatient alcohol abuse treatment to identify a relationship between treatment progress and compliance. Treatment progress is measured by the clinician’s comments after each attended visit. Compliance is measured by a client attending a scheduled appointment, and continuing with treatment. We find that a patient who is making progress is less likely to drop out of treatment. We find no evidence that treatment progress raises the likelihood of a patient attending the next scheduled visit. Our results are robust to unobserved patient heterogeneity. PMID:20031241

40 CFR 63.11154 - What are my compliance dates?

Code of Federal Regulations, 2012 CFR

2012-07-01

... Applicability and Compliance Dates § 63.11154 What are my compliance dates? (a) If you startup a new affected... subpart not later than January 23, 2007. (b) If you startup a new affected source after January 23, 2007, you must achieve compliance with the applicable provisions of this subpart upon startup of your...

40 CFR 63.11154 - What are my compliance dates?

Code of Federal Regulations, 2013 CFR

2013-07-01

... Applicability and Compliance Dates § 63.11154 What are my compliance dates? (a) If you startup a new affected... subpart not later than January 23, 2007. (b) If you startup a new affected source after January 23, 2007, you must achieve compliance with the applicable provisions of this subpart upon startup of your...

40 CFR 63.11154 - What are my compliance dates?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Applicability and Compliance Dates § 63.11154 What are my compliance dates? (a) If you startup a new affected... subpart not later than January 23, 2007. (b) If you startup a new affected source after January 23, 2007, you must achieve compliance with the applicable provisions of this subpart upon startup of your...

40 CFR 63.11154 - What are my compliance dates?

Code of Federal Regulations, 2011 CFR

2011-07-01

... Applicability and Compliance Dates § 63.11154 What are my compliance dates? (a) If you startup a new affected... subpart not later than January 23, 2007. (b) If you startup a new affected source after January 23, 2007, you must achieve compliance with the applicable provisions of this subpart upon startup of your...

40 CFR 63.11154 - What are my compliance dates?

Code of Federal Regulations, 2014 CFR

2014-07-01

... Applicability and Compliance Dates § 63.11154 What are my compliance dates? (a) If you startup a new affected... subpart not later than January 23, 2007. (b) If you startup a new affected source after January 23, 2007, you must achieve compliance with the applicable provisions of this subpart upon startup of your...

Specific insomnia symptoms and self-efficacy explain CPAP compliance in a sample of OSAS patients

PubMed Central

Philip, Pierre; Bioulac, Stéphanie; Altena, Elemarije; Morin, Charles M.; Ghorayeb, Imad; Coste, Olivier; Monteyrol, Pierre-Jean

2018-01-01

This study explores the association between specific insomnia symptoms (sleep onset, sleep maintenance and early morning awakenings symptoms) and self-efficacy (perceived self-confidence in the ability to use CPAP) with CPAP compliance in French patients with obstructive sleep apnea syndrome (OSAS). We performed a retrospective, cross-sectional analysis of CPAP compliance in a cohort of 404 patients diagnosed with OSAS. Patients completed mailed questionnaires on sleepiness (ESS), insomnia (ISI) and self-efficacy in sleep apnea (SEMSA). Linear regression modeling analyses were performed to explore the impact of measured variables on the number of hours of CPAP use. Of the initial pool of 404 patients, 288 returned the questionnaires (71% response rate). Their mean age was 63.16±12.73 yrs, 31% were females, mean BMI was 30.39±6.31 kg/m2, mean daily CPAP use was 6.19±2.03 h, mean number of years of use was 6.58±6.03 yrs, and mean initial AHI before CPAP use was 34.61±20.71 /h. Age (p<0.01), BMI (p<0.01), sleep onset insomnia symptoms (p<0.01), sleep maintenance insomnia symptoms (p<0.01) and self-efficacy (p<0.01) were significantly associated with mean daily CPAP use. We found that specific insomnia symptoms and self-efficacy were associated with CPAP compliance. Our findings underline the need to demonstrate that interventions that reduce insomnia symptoms and improve self-efficacy will increase CPAP compliance. PMID:29617414

Specific insomnia symptoms and self-efficacy explain CPAP compliance in a sample of OSAS patients.

PubMed

Philip, Pierre; Bioulac, Stéphanie; Altena, Elemarije; Morin, Charles M; Ghorayeb, Imad; Coste, Olivier; Monteyrol, Pierre-Jean; Micoulaud-Franchi, Jean-Arthur

2018-01-01

This study explores the association between specific insomnia symptoms (sleep onset, sleep maintenance and early morning awakenings symptoms) and self-efficacy (perceived self-confidence in the ability to use CPAP) with CPAP compliance in French patients with obstructive sleep apnea syndrome (OSAS). We performed a retrospective, cross-sectional analysis of CPAP compliance in a cohort of 404 patients diagnosed with OSAS. Patients completed mailed questionnaires on sleepiness (ESS), insomnia (ISI) and self-efficacy in sleep apnea (SEMSA). Linear regression modeling analyses were performed to explore the impact of measured variables on the number of hours of CPAP use. Of the initial pool of 404 patients, 288 returned the questionnaires (71% response rate). Their mean age was 63.16±12.73 yrs, 31% were females, mean BMI was 30.39±6.31 kg/m2, mean daily CPAP use was 6.19±2.03 h, mean number of years of use was 6.58±6.03 yrs, and mean initial AHI before CPAP use was 34.61±20.71 /h. Age (p<0.01), BMI (p<0.01), sleep onset insomnia symptoms (p<0.01), sleep maintenance insomnia symptoms (p<0.01) and self-efficacy (p<0.01) were significantly associated with mean daily CPAP use. We found that specific insomnia symptoms and self-efficacy were associated with CPAP compliance. Our findings underline the need to demonstrate that interventions that reduce insomnia symptoms and improve self-efficacy will increase CPAP compliance.

Medical management of primary open-angle glaucoma: Best practices associated with enhanced patient compliance and persistency

PubMed Central

Kulkarni, Sadhana V; Damji, Karim F; Buys, Yvonne M

2008-01-01

Primary open angle glaucoma is a chronic optic neuropathy often requiring lifelong treatment. Patient compliance, adherence and persistence with therapy play a vital role in improved outcomes by reducing morbidity and the economic consequences that are associated with disease progression. A literature review including searches of The Cochrane Library, MEDLINE, PubMed, conference proceedings, and bibliographies of identified articles reveals the enormous public health burden in various populations due to the impact of glaucoma associated visual impairment on the overall quality of life eg, fear of blindness, inability to work in certain occupations, driving restrictions, motor vehicle accidents, falls, and general health status. Providing specific definitions for the frequently misunderstood terms “compliance, persistence and adherence” with reference to medication use is central not only for monitoring patients’ drug dosing histories and clinical outcomes but also for subsequent research. In this review article, a summary of the advantages/disadvantages including cost-effectiveness of various medical approaches to glaucoma treatment, techniques employed for measuring patient compliance and actual patient preferences for therapy are outlined. We conclude by identifying the key barriers to ongoing treatment and suggest some best practices to enhance compliance and persistence. PMID:19920977

Evaluation of patient compliance, quality of life impact and cost-effectiveness of a "test in-train out" exercise-based rehabilitation program for patients with intermittent claudication.

PubMed

Malagoni, Anna Maria; Vagnoni, Emidia; Felisatti, Michele; Mandini, Simona; Heidari, Mahdi; Mascoli, Francesco; Basaglia, Nino; Manfredini, Roberto; Zamboni, Paolo; Manfredini, Fabio

2011-01-01

Patients with intermittent claudication (IC) could benefit from low-cost, effective rehabilitative programs. This retrospective study evaluates compliance, impact on Quality of Life (QoL) and cost-effectiveness of a hospital prescribed, at-home performed (Test-in/Train-out) rehabilitative program for patients with IC. Two-hundred and eighty-nine patients with IC (71 ± 10.1 years, M = 210) were enrolled for a 2-year period. Two daily 10-min home walking sessions at maximal asymptomatic speed were prescribed, with serial check-ups at the hospital. Compliance with the program was assessed by assigning a score of 1 (lowest compliance) to 4 (highest compliance). The SF-36 questionnaire and a constant-load treadmill test were used to evaluate QoL and Initial/Absolute Claudication Distance, respectively. Both direct and indirect costs of the program were considered for cost-effectiveness analysis. Two-hundred and fifty patients (70.5 ± 9.2 years, M = 191), at Fontaine's II-B stage (86%), were included in the study. No adverse events were reported. The average compliance score was 3.1. At discharge, both SF-36 domains and walking performance significantly increased (P < 0.0001). A total of 1,839 in-hospital check-ups (7.36 /patient) were performed. Direct and indirect costs represented 93% and 7% of the total costs, respectively. The average costs of a visit and of a therapy cycle were C68.93 and C507.20, respectively. The cost to walk an additional meter before stopping was C9.22. A Test-in/Train-out program provided favourable patient compliance, QoL impact and cost-effectiveness in patients with IC.

Add-on topiramate reduces weight in overweight patients with affective disorders: a clinical case series

PubMed Central

Kirov, George; Tredget, John

2005-01-01

Background The weight-gain caused by many psychotropic drugs is a major cause for poor compliance with such medications and could also increase cardio-vascular morbidity among psychiatric patients. Recent reports have shown that the anticonvulsant topiramate causes weight loss in various patient groups. The drug has also shown effectiveness in open trials as a mood stabilizer in patients with affective disorders, but not in controlled trials in the acute treatment of mania. We used topiramate to treat 12 patients with affective disorders who had a body-mass index >30 kg/m2. Methods Topiramate was prescribed as part of our routine clinical practice, as an add-on medication, or as a replacement of a mood stabilizer. Patients' weight was recorded in 1 to 2 monthly intervals. Patients were followed up for between 6 and 12 months. The final dose of topiramate varied from 200 to 600 mg/day. Results Topiramate was effective in reducing the weight in 10 out of the 12 patients. At six months the 12 patients had lost a mean of 7.75 kg (SD = 6.9 kg, p < 0.001) and at 12 months 9 patients had lost a mean of 9.61 kg (SD = 6.7 kg, p = 0.003). Three patients stopped the treatment: one due to side effects, one due to possible side effects, and one suffered a manic relapse and showed no sustained weight loss. There were no other clear changes in the course of illness of the patients. Conclusion The evidence of a strong weight-reducing potential of topiramate is indisputable and clinically significant. Topiramate could be considered in the treatment of bipolar patients who are overweight, or whose concerns about weight gain compromise their compliance with long-term prophylactic medication. So far there is no evidence that topiramate has anti-manic effect and it should not be used as monotherapy. PMID:15817130

The role of counselling and other factors in compliance of postmenopausal osteoporotic patients to alendronate 70 therapy

PubMed Central

Horst-Sikorska, Hanna; Stępień-Kłos, Wioletta; Antkowiak, Agnieszka; Janik, Małgorzata; Cieślak, Karol; Marcinkowska, Michalina; Cegłowska, Agnieszka; Stuss, Michał

2013-01-01

Introduction The aim of the study was to assess the role of patient counselling, nurse assistance and effects of biochemical examinations in adherence of women with postmenopausal osteoporosis to alendronate 70 administration over 12 months of therapy. Material and methods Compliance and persistence to alendronate 70 therapy were assessed in a prospective study of 123 postmenopausal women, followed up for one year. The patients were divided into 4 groups (controls, counselled group, biochemical group and nurse assisted group) with monitoring every 6 months; in the nurse assisted group, additional phone contacts were made after 3 and 9 months of treatment. After 12 months, compliance and persistence were analysed. The medication possession ratio (MPR) was regarded as optimal when its value exceeded 80%. Results The compliance to alendronate 70 therapy was 54.03% in the control group and the mean persistence with medication was 197 days. The MPR above 80% was observed in 37.5%, and, after 1 year, 43.75% of patients were found persistent with the therapy. In the remaining groups, both compliance and persistence were higher but not statistically significantly, compared to the control group. Neither patient's age, education, diet, nor physical activity influenced the compliance with prescribed therapy. The most common reason to discontinue therapy was either its side effects or smoking. Conclusions The obtained results suggest that better adherence with medical recommendations is observed in patients who receive additional attention, e.g. counselling, biochemical tests or nursing care. The critical elements for therapy discontinuation were side effects and smoking. PMID:23671440

Caregiver Preference and Treatment Compliance in Patients with Mild-to-Moderate Alzheimer's Disease in South Korea: RECAP Study Results.

PubMed

Lee, Kang Joon; Cho, Seong-Jin; Kim, Byeong Chae; Park, Minseok; Lee, Jae-Hong

2017-02-01

The aim of this study was to assess caregiver preference and treatment compliance with oral and transdermal medications in a "real-world" setting in patients with mild-to-moderate Alzheimer's disease (AD) in South Korea. Real-world evaluation of compliance and preference in Alzheimer's disease treatment (RECAP) was a 24-week, multicenter, prospective, non-interventional study in patients with AD treated with oral or transdermal therapy. Here, we report data from patients living in South Korea. Eligible patients were grouped into one of two treatment cohorts: oral (donepezil, galantamine, rivastigmine, or memantine) or transdermal (rivastigmine patch). Caregiver preference, patient compliance, and physician preference were assessed at week 24 (end of the study). Safety was assessed by reported adverse events (AEs). A total of 398 patients were enrolled (oral 51.8%; transdermal 48.2%) and 79.4% completed the study. Caregivers of patients that were exposed to either the oral or transdermal monotherapy showed a preference for the treatment to which the patients were exposed (both p < 0.0001). However, caregivers of patients that were exposed to both forms of treatments reported a higher preference for transdermal monotherapy (65.9%; p < 0.0041). Patients in both treatment cohorts showed good compliance, with an overall mean (SD) score of 8.84 (1.514) (a median of 9). Of the 15 participating physicians, eight indicated their preference for transdermal therapy and seven preferred oral therapy at week 24. A total of 133 (33.4%) patients reported at least one AE during the study period (oral: 60 patients; transdermal: 73 patients). The study showed higher caregiver preference for transdermal monotherapy over oral monotherapy when patients with AD were exposed to both forms of treatment and good patient compliance for both oral and transdermal treatments.

Monitoring of intracranial compliance: correction for a change in body position.

PubMed

Raabe, A; Czosnyka, M; Piper, I; Seifert, V

1999-01-01

The objectives of our study were 1. to investigate whether the intracranial compliance changes with body position; 2. to test if the pressure-volume index (PVI) calculation is affected by different body positions; 3. to define the optimal parameter to correct PVI for changes in body position and 4. to investigate the physiological meaning of the constant term (P0) in the model of the intracranial volume-pressure relationship. Thirteen patients were included in this study. All patients were subjected to 2 to 3 different body positions. In each position, either classic bolus injection was performed for measurement of intracranial compliance and calculation of PVI or the new Spiegelberg compliance monitor was used to calculate PVI continuously. Four different models were used for calculating the constant pressure term P0 and the P0 corrected PVI values. Pressure volume index not corrected for the constant term P0 significantly decreased with elevating the patients head (r = 0.70, p < 0.0001). In contrast, volume-pressure response and ICP pulse amplitude did not change with position. Using the constant term P0 to correct the PVI we found no changes between the different body positions. Our results suggest that during the variation in body position there is no change in intracranial compliance but a change in hydrostatic offset pressure which causes a shifting of the volume-pressure curve along the pressure axis without its shape being affected. PVI measurements should either be performed only with the patient in the 0 degree recumbent position or that the PVI calculation should be corrected for the hydrostatic difference between the level of the ICP transducer and the hydrostatic indifference point of the craniospinal system close to the third thoracic vertebra.

Scoliosis brace design: influence of visual aesthetics on user acceptance and compliance.

PubMed

Law, Derry; Cheung, Mei-Chun; Yip, Joanne; Yick, Kit-Lun; Wong, Christina

2017-06-01

Adolescent idiopathic scoliosis is a common condition found in adolescents. A rigid brace is often prescribed as the treatment for this spinal deformity, which negatively affects user compliance due to the discomfort caused by the brace, and the psychological distress resulting from its appearance. However, the latter, which is the impact of visual aesthetics, has not been thoroughly studied for scoliosis braces. Therefore, a qualitative study with in-depth interviews has been carried out with 10 participants who have a Cobb angle of 20°-30° to determine the impact of visual aesthetics on user acceptance and compliance towards the brace. It is found that co-designing with patients on the aesthetic aspects of the surface design of the brace increases the level of user compliance and induces positive user perception. Therefore, aesthetic preferences need to be taken into consideration in the design process of braces. Practitioner Summary: The impact of visual aesthetics on user acceptance and compliance towards a rigid brace for scoliosis is investigated. The findings indicate that an aesthetically pleasing brace and the involvement of patients in the design process of the brace are important for increasing user compliance and addressing psychological issues during treatment.

Depot-medication compliance for patients with psychotic disorders: the importance of illness insight and treatment motivation

PubMed Central

Noordraven, Ernst L; Wierdsma, André I; Blanken, Peter; Bloemendaal, Anthony FT; Mulder, Cornelis L

2016-01-01

Background Noncompliance is a major problem for patients with a psychotic disorder. Two important risk factors for noncompliance that have a severe negative impact on treatment outcomes are impaired illness insight and lack of motivation. Our cross-sectional study explored how they are related to each other and their compliance with depot medication. Methods Interviews were conducted in 169 outpatients with a psychotic disorder taking depot medication. Four patient groups were defined based on low or high illness insight and on low or high motivation. The associations between depot-medication compliance, motivation, and insight were illustrated using generalized linear models. Results Generalized linear model showed a significant interaction effect between motivation and insight. Patients with poor insight and high motivation for treatment were more compliant (94%) (95% confidence interval [CI]: 1.821, 3.489) with their depot medication than patients with poor insight and low motivation (61%) (95% CI: 0.288, 0.615). Patients with both insight and high motivation for treatment were less compliant (73%) (95% CI: 0.719, 1.315) than those with poor insight and high motivation. Conclusion Motivation for treatment was more strongly associated with depot-medication compliance than with illness insight. Being motivated to take medication, whether to get better or for other reasons, may be a more important factor than having illness insight in terms of improving depot-medication compliance. Possible implications for clinical practice are discussed. PMID:26893565

A care study exploring a patient's non-compliance to haemodialysis.

PubMed

Murphy, Fiona

This care study is based on the nursing assessment of a 26-year-old man (MT) who attends a local haemodialysis unit for treatment using Gordon's (1994) functional health patterns. There will be a discussion of this framework and the methods used to assess this patient including an exploration of one of the problem areas identified--that of non-compliance.

Compliance with dental treatment recommendations by rural paediatric patients after a live-video teledentistry consultation: A preliminary report.

PubMed

McLaren, Sean W; Kopycka-Kedzierawski, Dorota T

2016-04-01

The purpose of this research was to assess the compliance rate with recommended dental treatment by rural paediatric dental patients after a live-video teledentistry consultation. A retrospective dental chart review was completed for 251 rural paediatric patients from the Finger Lakes region of New York State who had an initial teledentistry appointment with a paediatric dentist located remotely at the Eastman Institute for Oral Health in Rochester, NY. The recommended treatment modalities were tabulated and comprehensive dental treatment completion rates were obtained. The recommended treatment modality options of: treatment in the paediatric dental clinic; treatment using nitrous oxide anxiolysis; treatment with oral sedation; treatment in the operating room with general anaesthesia; or teleconsultation were identified for the 251 patients. Compliance rates for completed dental treatment based on initial teleconsultation recommendations were: 100% for treatment in the paediatric dental clinic; 56% for nitrous oxide patients; 87% for oral sedation; 93% for operating room; and 90% for teleconsultations. The differences in the compliance rates for all treatment modalities were not statistically significant (Fisher's exact test, p > 0.05). Compliance rates for completed comprehensive dental treatment for this rural population of paediatric dental patients were quite high, ranging from 56% to 100%, and tended to be higher when treatment was completed in fewer visits. Live-video teledentistry consultations conducted among rural paediatric patients and a paediatric dentist in the specialty clinic were feasible options for increasing dental treatment compliance rates when treating complex paediatric dental cases. © The Author(s) 2015.

Patient compliance with extended low molecular weight heparin injections following hip and knee arthroplasty.

PubMed

Deakin, Dan E; Mishreki, Andrew; Aslam, Nadim; Docker, Charles

2010-01-01

The use of extended duration thromboprophylaxis following hip and knee arthroplasty is becoming widespread. The aim of our study was to determine patient compliance with extended duration thromboprophylaxis using low molecular weight (LMWH) injections following hip and knee arthroplasty. 42 consecutive patients undergoing hip and knee arthroplasty were prospectively contacted during their fifth post operative week. A fully anonymised questionnaire was completed by each patient. All patients responded. One was excluded having been prescribed warfarin for pre existing atrial fibrillation. Twenty nine (71%) patients were discharged with the intention of self administering LMWH injections. Eight (20%) and four (9%) patients were discharged with the intention of administration by a relative or district nurse respectively. No patient required the person administering the injections to be changed after discharge from hospital. 90% (n=37) of patients reported not missing any doses. 10% (n=2) of patients missed one dose and 10% (n=2) missed two doses. Patient compliance with extended duration thromboprophylaxis using LMWH injections is extremely high. Oral thromboprophylaxis may be useful in the minority of patients requiring daily visits by a nurse to administer injections.

Preoperative chemotherapy for operable breast cancer is associated with better compliance with adjuvant therapy in matched stage II and IIIA patients.

PubMed

Komenaka, Ian K; Hsu, Chiu-Hsieh; Martinez, Maria Elena; Bouton, Marcia E; Low, Boo Ghee; Salganick, Jason A; Nodora, Jesse; Hibbard, Michael L; Jha, Chandra

2011-01-01

Preoperative chemotherapy (PC) for operable breast cancer has shown significant benefits in prospective trials. Many patients are treated in the community setting and some may question the applicability of PC outside the university setting. Retrospective review was performed of stage II and IIIA breast cancer patients treated from January 2002 to July 2009. Fifty-three of 57 patients who underwent PC were matched based on age, tumor size, and hormone receptor status with 53 patients who did not undergo PC. Differences in patient compliance with physician recommendations for all types of adjuvant therapy were evaluated. Crude odds ratios and adjusted odds ratios derived from conditional logistic regression models were calculated. There were 106 patients included. Patient compliance with chemotherapy was better in the PC group than in the adjuvant chemotherapy (AC) group (100% versus 70%; p = .0001). Similarly, more patients in the PC group completed radiation therapy (96% versus 65%; p = .0003) and initiated hormonal therapy (100% versus 62%; p = .0001). Conditional logistic regression revealed that higher pathologic stage and current cigarette smoking were associated with poorer compliance with chemotherapy. For radiation therapy, the univariate model revealed that compliance with chemotherapy and being employed were associated with completion of radiation, whereas current cigarette smoking and larger pathologic size were associated with poorer compliance with radiation. For hormonal therapy, current cigarette smokers were more likely to be noncompliant with initiation of hormonal therapy. PC for operable breast cancer can improve patient compliance with chemotherapy. Current cigarette smokers were more likely to be noncompliant with all types of adjuvant therapy.

Factors affecting compliance and resistance to auditory command hallucinations: perceptions of a clinical population.

PubMed

Barrowcliff, Alastair L; Haddock, Gillian

2010-12-01

Elements of voice content and characteristics of a hallucinatory voice are considered to be associated with compliance and resistance to auditory command hallucinations. However, a need for further exploration of such features remains. To explore the associations across different types of commands (benign, self-harm, harm-other) with a range of symptom measures and a trait measure of expressed compliance with compliance to the most recent command and command hallucinations over the previous 28 days. Participants meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for schizophrenia or schizoaffective disorder, with auditory hallucinations in the previous 28 days were screened. Where commands were reported a full-assessment of positive symptoms, social-rank, beliefs about voices and trait compliance was completed. Compliance with the last self-harm command was associated with elevated voice malevolence, heightened symptom presentation and perceived consequences for non-compliance. Compliance with the last harm-other command was associated with elevated symptom severity, higher perceived consequences for non-compliance and higher levels of voice social rank. However, these associations were not maintained for compliance during the previous 28 days. Findings indicate the importance of identifying the content of commands, overall symptom severity and core variables associated with compliance to specific command categories. The temporal stability of established mediating variables needs further examination.

Compliance assessed by the Medication Event Monitoring System.

PubMed Central

Olivieri, N F; Matsui, D; Hermann, C; Koren, G

1991-01-01

The accurate assessment of patient compliance is especially crucial in evaluating the efficacy of a new treatment. Because of the problems associated with parenteral desferrioxamine, the development of a safe, effective, and convenient iron chelator is of high priority. The high morbidity and mortality associated with iron overload requires careful evaluation of the ability of any new agent to promote long term effective iron chelation. Patients' compliance with an orally available chelating agent, 1,2,-dimethyl-3-hydroxypyrid-4-one (L1), that has been demonstrated to induce in vivo iron excretion equivalent to that of desferrioxamine during supervised short term administration, was examined. Compliance was assessed in seven patients by patient interview, by daily diaries reviewed monthly with each patient, and with the use of the Medication Event Monitoring System (MEMS) standard pill bottles with microprocessors in the cap that record the timing and frequency of bottle openings. L1 was dispensed in MEMS containers to the patients, who, unaware of their significance, recorded compliance using a daily diary. Overall compliance rate (% of prescribed doses taken) measured by MEMS was 88.7 +/- 6.8%. When 'doubling of doses' was accounted for, significantly poorer compliance with L1 was noted by MEMS (91.7 +/- 7.4%) than by patients' diaries (95.7 +/- 5.2%). There was no significant difference in patient compliance recorded between the first and last 30 day period of drug administration. MEMS can eliminate the confounding variable of erratic patient compliance in the evaluation of a new drug's efficacy. As MEMS cannot distinguish a missed dose from one doubled at the next bottle opening, the use of patient diaries is a useful adjunct to the accurate assessment of compliance and should be combined with the use of MEMS. PMID:1776885

Disease management and medication compliance.

PubMed

Cohen, Joshua; Christensen, Kathyrn; Feldman, Lanna

2012-02-01

Lack of medication compliance is harmful to health care systems from both a clinical and economic perspective. This study examines the methods that disease management organizations employ to identify nonadherent patients and to measure effectiveness of compliance programs for patients with diabetes, hyperlipidemia, and cystic fibrosis. In addition, this study investigates the degree to which disease managers assume risk in their contracts, and whether compliance strategies are being coordinated with payers' use of value-based insurance design, in which patient cost sharing is a function of the relative value of pharmaceuticals. This study's findings suggest that disease management may be falling short in terms of: (a) comprehensive commitment to expert-recommended at-home devices used to self-diagnose and measure health indicators; (b) early adoption of expert-recommended new technologies to measure and improve compliance; (c) intensity of use of standard tests in outpatient clinics; (d) coordination of compliance strategies with payers' use of value-based insurance design; and (e) the proportion of risk assumed in disease management contracts.

Effect of group counseling on depression, compliance and blood sugar level in diabetic patients.

PubMed

Long, Feiyan; Yan, Jin; Hu, Ping'an; Xia, Miaojuan; Liu, Hua; Gu, Can

2015-08-01

To establish an interference mode of group counseling for diabetic patients with depression and to evaluate the effectiveness of this mode on depression, treatment compliance and blood sugar level in the patients.
 One hundred diabetic patients with depression were randomly divided into a counseling group and a control group (n=50 per group). Self-Rating Depression Scale (SDS) was applied to all the patients. The interference mode of group counseling was established through literature review, expert consultation or interview. The counseling group received counseling for 8 times within 2 months.
 There was a significant difference in the SDS scores at 0, 3, 6 or 12 months after the intervention between the 2 groups (P<0.001). For the counseling group, there was a significant difference in the SDS scores between pre-intervention and 3, 6 or 12 months after intervention (P<0.001). However, there was no significant difference in the SDS scores between any two time points after the intervention (P>0.05). There was a significant difference in the compliance between any two time points after the intervention (P<0.05). Fasting blood glucose (FBG), 2 h postprandial blood glucose (2hPG) or glycosylated hemoglobin (HbA1c) was significantly different at any two time points after the intervention (P<0.05).
 Group counseling can improve depression, compliance and blood sugar control in the diabetic patients.

Teaching Medical Students about Treatment Compliance

ERIC Educational Resources Information Center

Blackwell, Barry; And Others

1978-01-01

To demonstrate poor patient compliance, medical students who preregistered for a conference on patient compliance were asked to adopt the role of "patient" and to take "medication" (Vitamin C) for one week, to observe certain dietary restrictions, and to complete an attitude and health beliefs questionnaire. Student attitudes resembled those of…

Preoperative Chemotherapy for Operable Breast Cancer Is Associated with Better Compliance with Adjuvant Therapy in Matched Stage II and IIIA Patients

PubMed Central

Hsu, Chiu-Hsieh; Martinez, Maria Elena; Bouton, Marcia E.; Low, Boo Ghee; Salganick, Jason A.; Nodora, Jesse; Hibbard, Michael L.; Jha, Chandra

2011-01-01

Introduction. Preoperative chemotherapy (PC) for operable breast cancer has shown significant benefits in prospective trials. Many patients are treated in the community setting and some may question the applicability of PC outside the university setting. Methods. Retrospective review was performed of stage II and IIIA breast cancer patients treated from January 2002 to July 2009. Fifty-three of 57 patients who underwent PC were matched based on age, tumor size, and hormone receptor status with 53 patients who did not undergo PC. Differences in patient compliance with physician recommendations for all types of adjuvant therapy were evaluated. Crude odds ratios and adjusted odds ratios derived from conditional logistic regression models were calculated. Results. There were 106 patients included. Patient compliance with chemotherapy was better in the PC group than in the adjuvant chemotherapy (AC) group (100% versus 70%; p = .0001). Similarly, more patients in the PC group completed radiation therapy (96% versus 65%; p = .0003) and initiated hormonal therapy (100% versus 62%; p = .0001). Conditional logistic regression revealed that higher pathologic stage and current cigarette smoking were associated with poorer compliance with chemotherapy. For radiation therapy, the univariate model revealed that compliance with chemotherapy and being employed were associated with completion of radiation, whereas current cigarette smoking and larger pathologic size were associated with poorer compliance with radiation. For hormonal therapy, current cigarette smokers were more likely to be noncompliant with initiation of hormonal therapy. Conclusions. PC for operable breast cancer can improve patient compliance with chemotherapy. Current cigarette smokers were more likely to be noncompliant with all types of adjuvant therapy. PMID:21558134

40 CFR Table 3 to Subpart III of... - Compliance Requirements for Slabstock Foam Production Affected Sources Complying With the...

Code of Federal Regulations, 2013 CFR

2013-07-01

... Foam Production Affected Sources Complying With the Emission Point Specific Limitations 3 Table 3 to...) National Emission Standards for Hazardous Air Pollutants for Flexible Polyurethane Foam Production Pt. 63, Subpt. III, Table 3 Table 3 to Subpart III of Part 63—Compliance Requirements for Slabstock Foam...

40 CFR Table 3 to Subpart III of... - Compliance Requirements for Slabstock Foam Production Affected Sources Complying With the...

Code of Federal Regulations, 2014 CFR

2014-07-01

... Foam Production Affected Sources Complying With the Emission Point Specific Limitations 3 Table 3 to...) National Emission Standards for Hazardous Air Pollutants for Flexible Polyurethane Foam Production Pt. 63, Subpt. III, Table 3 Table 3 to Subpart III of Part 63—Compliance Requirements for Slabstock Foam...

40 CFR 63.11422 - What are my compliance dates?

Code of Federal Regulations, 2012 CFR

2012-07-01

... later than July 16, 2008. (b) If you startup a new affected source on or before July 16, 2007, you must... startup a new affected source after July 16, 2007, you must achieve compliance with the provisions in this subpart upon startup of your affected source. Standards and Compliance Requirements ...

40 CFR 63.11422 - What are my compliance dates?

Code of Federal Regulations, 2013 CFR

2013-07-01

... later than July 16, 2008. (b) If you startup a new affected source on or before July 16, 2007, you must... startup a new affected source after July 16, 2007, you must achieve compliance with the provisions in this subpart upon startup of your affected source. Standards and Compliance Requirements ...

40 CFR 63.11422 - What are my compliance dates?

Code of Federal Regulations, 2010 CFR

2010-07-01

... later than July 16, 2008. (b) If you startup a new affected source on or before July 16, 2007, you must... startup a new affected source after July 16, 2007, you must achieve compliance with the provisions in this subpart upon startup of your affected source. Standards and Compliance Requirements ...

40 CFR 63.11422 - What are my compliance dates?

Code of Federal Regulations, 2014 CFR

2014-07-01

... later than July 16, 2008. (b) If you startup a new affected source on or before July 16, 2007, you must... startup a new affected source after July 16, 2007, you must achieve compliance with the provisions in this subpart upon startup of your affected source. Standards and Compliance Requirements ...

40 CFR 63.11422 - What are my compliance dates?

Code of Federal Regulations, 2011 CFR

2011-07-01

... later than July 16, 2008. (b) If you startup a new affected source on or before July 16, 2007, you must... startup a new affected source after July 16, 2007, you must achieve compliance with the provisions in this subpart upon startup of your affected source. Standards and Compliance Requirements ...

Objective assessment of compliance with intra- and extraoral removable appliances.

PubMed

Arreghini, Angela; Trigila, Silvia; Lombardo, Luca; Siciliani, Giuseppe

2017-01-01

To conduct an objective assessment of the level of compliance in young patients prescribed various types of removable appliances and to determine the influence of device type, treatment duration, and patient age, gender, psychological maturity, and awareness of monitoring on compliance. A total of 30 patients were fitted with either a class 2 (Frankel or bionator) or a class 3 (face mask) removable appliance, each bearing a compliance indicator chip, and they were instructed to wear them for 13 hours per day. Compliance was monitored by means of the sensor for an average of 8 months. Of the patients, 14 were informed that their appliance was fitted with a monitoring sensor, and 16 were not. The psychological maturity of all patients was assessed on the Nowicki-Strickland Locus of Control Scale, and the effect on compliance of this score as well as the patient- and treatment-related variables considered were determined via statistical analysis Results: The mean compliance recorded by the chips was 8.6 ± 2.9 hours, far lower than the 13 hours prescribed, and younger patients showed significantly greater compliance than adolescents (P < .01). However, no significant differences in compliance were found between intra- and extraoral appliances, and neither gender, psychological scores, treatment duration, nor awareness of being monitored had any significant effect. Compliance is generally very poor in young patients, regardless of their gender and psychological maturity. Although awareness of monitoring does not appear to boost compliance, such systems may be a valuable means of providing a dentist with objective information regarding their patients' compliance.

Impact of prepackaging antimalarial drugs on cost to patients and compliance with treatment.

PubMed Central

Yeboah-Antwi, K.; Gyapong, J. O.; Asare, I. K.; Barnish, G.; Evans, D. B.; Adjei, S.

2001-01-01

OBJECTIVE: To examine the extent to which district health teams could reduce the burden of malaria, a continuing major cause of mortality and morbidity, in a situation where severe resource constraints existed and integrated care was provided. METHODS: Antimalarial drugs were prepackaged into unit doses in an attempt to improve compliance with full courses of chemotherapy. FINDINGS: Compliance improved by approximately 20% in both adults and children. There were 50% reductions in cost to patients, waiting time at dispensaries and drug wastage at facilities. The intervention, which tended to improve both case and drug management at facilities, was well accepted by health staff and did not involve them in additional working time. CONCLUSION: The prepackaging of antimalarials at the district level offers the prospect of improved compliance and a reduction in the spread of resistance. PMID:11417034

Compliance and persistence of antidepressants versus anticonvulsants in patients with neuropathic pain during the first year of therapy.

PubMed

Gharibian, Derenik; Polzin, Jennifer K; Rho, Jay P

2013-05-01

Neuropathic pain (NP) is a chronic condition that has human, social, and economic consequences. A variety of agents can be used for treatment; however, antidepressants and anticonvulsants are the 2 classes most widely studied and represent first-line agents in the management of NP. Little information is known about the adherence patterns of these medications during the first year of therapy in patients with NP. To examine the compliance and persistence of antidepressants versus anticonvulsants in patients with NP during the first year of therapy. Using electronic medical and pharmacy data for the Kaiser Permanente Southern California region, the adherence patterns for patients with a NP diagnosis prescribed an antidepressant or an anticonvulsant were studied. Compliance and persistence were measured using the medication possession ratio and the Refill-Sequence model, respectively. The study included 1817 patients with NP diagnosis taking either an antidepressant or an anticonvulsant. Within the antidepressant group, 42.9% were considered compliant, compared with 43.7% in the anticonvulsant group. Subanalysis of the 2 cohorts revealed that patients on venlafaxine were the most compliant (69.4%) compared with patients taking gabapentin (44.4%) and tricyclic antidepressants (41.8%) (P<0.01). Only 21.2% of patients in the antidepressant group and 21.4% in the anticonvulsant group were considered persistent with their medication refills. Compliance and persistence rates were similar for patients with NP diagnosis taking antidepressants and anticonvulsants. Higher compliance was observed among patients taking venlafaxine; however, this population did have a small sample size.

Influence of social competence of physicians on patient compliance with osteoporosis medications--a study on Polish postmenopausal women.

PubMed

Bryl, Nadia; Horst-Sikorska, Wanda; Ignaszak-Szczepaniak, Magdalena; Marcinkowska, Michalina; Michalak, Michał; Sewerynek, Ewa

2012-07-01

The aim of the study was to examine the impact of social competence of physicians on the effectiveness of patient compliance and persistence with therapy. The study included physicians and their patients, previously diagnosed with osteoporosis, and eligible to receive pharmacological treatment. The physicians were evaluated with the social competence questionnaire involving three dimensions: social exposure, intimacy and assertiveness, as well as in the combined scale. All patients in the study group were prescribed the same medication: alendronate once a week. Compliance and persistence of the patients were juxtaposed with social interaction skills of physicians during 7 scheduled appointments at 2-month intervals. Doctor's effectiveness in situations demanding close interpersonal contact was higher in the group with good compliance--group A (p < 0.001), as well as in the situations of social exposure, (p < 0.001). On the other hand, their assertiveness was higher in the group with poor compliance--group B (p < 0.001). Co-morbid conditions (group A: 76%, group B: 74%), as well as earlier fractures (40.43% vs. 36.78%) were comparable in both groups. Disease acceptance and suggested methods of treatment were more often accepted by patients from group A than group B (56% vs. 33%, respectively). (1) Disease acceptance is essential for effective treatment. (2) Social skills of physicians influence patient adherence to therapy recommendations. (3) Close interpersonal contact between physicians and their patients eliminates the feeling of fear and

40 CFR 63.11394 - What are my compliance dates?

Code of Federal Regulations, 2013 CFR

2013-07-01

... subpart no later than January 16, 2008. (b) If you startup a new affected source on or before July 16..., 2007. (c) If you startup a new affected source after July 16, 2007, you must achieve compliance with the provisions in this subpart upon startup of your affected source. Standards and Compliance...

40 CFR 63.11394 - What are my compliance dates?

Code of Federal Regulations, 2012 CFR

2012-07-01

... subpart no later than January 16, 2008. (b) If you startup a new affected source on or before July 16..., 2007. (c) If you startup a new affected source after July 16, 2007, you must achieve compliance with the provisions in this subpart upon startup of your affected source. Standards and Compliance...

40 CFR 63.11394 - What are my compliance dates?

Code of Federal Regulations, 2014 CFR

2014-07-01

... subpart no later than January 16, 2008. (b) If you startup a new affected source on or before July 16..., 2007. (c) If you startup a new affected source after July 16, 2007, you must achieve compliance with the provisions in this subpart upon startup of your affected source. Standards and Compliance...

40 CFR 63.11394 - What are my compliance dates?

Code of Federal Regulations, 2011 CFR

2011-07-01

... subpart no later than January 16, 2008. (b) If you startup a new affected source on or before July 16..., 2007. (c) If you startup a new affected source after July 16, 2007, you must achieve compliance with the provisions in this subpart upon startup of your affected source. Standards and Compliance...

40 CFR 63.11394 - What are my compliance dates?

Code of Federal Regulations, 2010 CFR

2010-07-01

... subpart no later than January 16, 2008. (b) If you startup a new affected source on or before July 16..., 2007. (c) If you startup a new affected source after July 16, 2007, you must achieve compliance with the provisions in this subpart upon startup of your affected source. Standards and Compliance...

[Compliance with the treatment by patients with the co-infection HIV/tuberculosis: integrative literature review].

PubMed

Neves, Lis Aparecida de Souza; Reis, Renata Karina; Gir, Elucir

2010-12-01

This is an integrative review whose objective was to evaluate the evidences available in the literature about the factors associated to the compliance with the treatment by patients with the co-infection HIV/TB. Articles published in the period from 2002 to 2008, in the databases LILACS and MEDLINE were analyzed. The material was categorized according to the year of publication, periodical, study location and factors related to the compliance. The final sample included eight articles. The factors found, associated to the compliance with the treatment of the co-infection HIV/TB, related to: the individual and his lifestyle (previous TB treatment, fear of stigma and discrimination, use of chemical substances, depression, social support); the disease and the medication (type of medication regime, use of other medication, adverse effects, difficulty to diagnose TB in these patients); and the health services (operational problems to follow up the treatment, training of the professionals, supervision, different locations to treat TB and HIV).

40 CFR 63.6004 - How do I demonstrate continuous compliance with the emission limits for tire production affected...

Code of Federal Regulations, 2014 CFR

2014-07-01

....5985(a): (1) If, after you submit the Notification of Compliance Status, you use a cement or solvent... must verify that each cement and solvent used in the affected source meets the emission limit, using any of the methods in § 63.5994(a). (2) You must update the list of all the cements and solvents used...

40 CFR 63.11161 - What are my compliance dates?

Code of Federal Regulations, 2014 CFR

2014-07-01

... subpart by January 23, 2007. If you startup a new sintering machine at an existing affected source after... than 180 days after startup. (b) If you have a new affected source, you must achieve compliance with...) If you startup a new affected source on or before January 23, 2007, you must achieve compliance with...

40 CFR 63.11161 - What are my compliance dates?

Code of Federal Regulations, 2010 CFR

2010-07-01

... subpart by January 23, 2007. If you startup a new sintering machine at an existing affected source after... than 180 days after startup. (b) If you have a new affected source, you must achieve compliance with...) If you startup a new affected source on or before January 23, 2007, you must achieve compliance with...

40 CFR 63.11161 - What are my compliance dates?

Code of Federal Regulations, 2012 CFR

2012-07-01

... subpart by January 23, 2007. If you startup a new sintering machine at an existing affected source after... than 180 days after startup. (b) If you have a new affected source, you must achieve compliance with...) If you startup a new affected source on or before January 23, 2007, you must achieve compliance with...

40 CFR 63.11161 - What are my compliance dates?

Code of Federal Regulations, 2011 CFR

2011-07-01

... subpart by January 23, 2007. If you startup a new sintering machine at an existing affected source after... than 180 days after startup. (b) If you have a new affected source, you must achieve compliance with...) If you startup a new affected source on or before January 23, 2007, you must achieve compliance with...

40 CFR 63.11161 - What are my compliance dates?

Code of Federal Regulations, 2013 CFR

2013-07-01

... subpart by January 23, 2007. If you startup a new sintering machine at an existing affected source after... than 180 days after startup. (b) If you have a new affected source, you must achieve compliance with...) If you startup a new affected source on or before January 23, 2007, you must achieve compliance with...

Long term telemedicine study of compliance in paranoid schizophrenia.

PubMed

Krzystanek, Marek; Krzeszowski, Dariusz; Jagoda, Karolina; Krysta, Krzysztof

2015-09-01

Low compliance is one of the crucial problems of contemporary psychiatry. Relapses, deterioration of cognitive functioning, negative symptoms, neuroleptic resistance are the examples of many consequences of noncompliance in schizophrenia The study was designed to assess the compliance in the 200 patients diagnosed with paranoid schizophrenia, all in the state of symptomatic remission and on the stable neuroleptic treatment. The compliance was assessed using a telepsychiatric system, sending reminders: 1 hour before the planned dose to remind them that drug intake is approaching, and at the moment of intake to check if they took the drug. The confirmed drug intakes were counted by the telepsychiatric system. 158 patients completed the study period. The compliance in the first month of the treatment was 44.6% and decreased over the rest of the period to the level of 33.4%. 50% of the schizophrenic patients were compliant at a level lower than 37%. This group was considered the low compliance group, and in this group the compliance increased after 6 months from 9.3% to 10.3% (p<0.0001). The compliance in the group of schizophrenic patients in remission is very low. The telemedicine system improves the compliance in the patients with the worst compliance.

Treatment compliance in cystic fibrosis patients with chronic Pseudomonas aeruginosa infection treated with tobramycin inhalation powder: The FREE study.

PubMed

Blasi, Francesco; Carnovale, Vincenzo; Cimino, Giuseppe; Lucidi, Vincenzina; Salvatore, Donatello; Messore, Barbara; Bartezaghi, Marta; Muscianisi, Elisa; Porpiglia, Pasquale Alberto

2018-05-01

A high treatment burden with nebulised therapies in cystic fibrosis (CF) patients is the major limitation for treatment compliance; moreover, studies on treatment compliance with inhaled antibiotics are limited. This study assessed compliance to TOBI ® Podhaler™ (TIP) treatment in CF patients with chronic Pseudomonas aeruginosa (Pa) infections in a real-world setting using the Italian Treatment Adherence CF Questionnaire (ITA-CFq). This longitudinal, multicentre, cohort study included 2 follow-up (FU) visits: FU-1 at 3-months±15-days from the baseline visit and FU-2 at the end of third TIP cycle (or 6-months after enrolment, whichever occurred first). The effect of TIP on quality-of-life (QoL) and treatment satisfaction were evaluated using Cystic Fibrosis Questionnaire-Revised (CFQ-R) and Treatment Satisfaction Questionnaire for Medication (TSQM), respectively. Overall compliance to treatments was assessed using ITA-CFq. Eighty-two patients (mean age, 24.8 ± 7.9 years), including 22 paediatric patients (age, <18 years), were enrolled in the study; 56 (68.3%) patients, including 17 paediatric patients, completed the study. At baseline, the mean compliance score to aerosol antibiotic treatment was 7.8 ± 3.2; upon introducing TIP, the compliance score improved to 9.4 ± 1.2 at the FU-1 and thereafter remained stable at 9.5 ± 1.2. TSQM was higher for the convenience domain (74.2 ± 17.1 at enrolment and slightly improved to 77.8 ± 15.9 at FU-2) following TIP initiation. No substantial effect of TIP was observed on the QoL when measured using the revised CFQ-R. The safety profile was in line with previous findings. TIP was convenient to use and led to improved treatment adherence in CF patients with chronic Pa-infection. Copyright © 2018 Elsevier Ltd. All rights reserved.

Environmental requirements related to patient care and the team working to ensure compliance.

PubMed

Roberts, Diane

2015-01-01

Healthcare providers are often surprised that regulations promulgated by the US Environmental Protection Agency (EPA) apply to patient care settings. Many find it strange that processes meant to heal have the potential to harm human health and the environment, and are, therefore, regulated by federal and state environmental agencies. The importance of compliance is emphasized by the fact that both the EPA and individual state agencies have the authority to impose civil and criminal penalties if they discover violations. The Joint Commission considers compliance important enough to include it as an element of performance in the Environment of Care standard.

Decentralized colonoscopic surveillance with high patient compliance prevents hereditary and familial colorectal cancer.

PubMed

Sjöström, Olle; Lindholm, Lars; Tavelin, Björn; Melin, Beatrice

2016-10-01

Although colonoscopic surveillance is recommended both for individuals with known hereditary colorectal cancer (HCRC) syndromes and those with a more moderate familial colorectal cancer (FCRC) history, the evidence for the benefits of surveillance is limited and surveillance practices vary. This study evaluates the preventive effect for individuals with a family history of CRC of decentralized colonoscopic surveillance with the guidance of a cancer prevention clinic. We performed a population based prospective study of 261 patients with HCRC or FCRC, recorded in the colonoscopic surveillance registry at the Cancer genetics clinic, University Hospital of Umeå, Sweden. Colonoscopic surveillance was conducted every second (HCRC) or fifth (FCRC) year at local hospitals in Northern Sweden. Main outcome measures were findings of high-risk adenomas (HRA) or CRC, and patient compliance to surveillance. Estimations of the expected numbers of CRC without surveillance were made. During a total of 1256 person years of follow-up, one case of CRC was found. The expected numbers of cancers in the absence of surveillance was between 9.5 and 10.5, resulting in a standardized incidence ratio, observed versus expected cases of CRC, between 0.10 (CI 95 % 0.0012-0.5299) and 0.11 (CI 95 % 0.0014-0.5857). No CRC mortality was reported, but three patients needed surgical intervention. HRA were found in 5.9 % (14/237) of the initial and in 3.4 % (12/356) of the follow-up colonoscopies. Patient compliance to the surveillance program was 90 % as 597 of the planned 662 colonoscopies were performed. The study concludes that colonoscopic surveillance with high patient compliance to the program is effective in preventing CRC when using a decentralized method for colonoscopy surveillance with the guidance of a cancer prevention clinic.

Compliance with preoperative oral nutritional supplements in patients at nutritional risk--only a question of will?

PubMed

Grass, F; Bertrand, P C; Schäfer, M; Ballabeni, P; Cerantola, Y; Demartines, N; Hübner, M

2015-04-01

Preoperative nutrition has been shown to reduce morbidity after major gastrointestinal (GI) surgery in selected patients at risk. In a randomized trial performed recently (NCT00512213), almost half of the patients, however, did not consume the recommended dose of nutritional intervention. The present study aimed to identify the risk factors for noncompliance. Demographic (n = 5) and nutritional (n = 21) parameters for this retrospective analysis were obtained from a prospectively maintained database. The outcome of interest was compliance with the allocated intervention (ingestion of ⩾ 11/15 preoperative oral nutritional supplement units). Uni- and multivariate analyses of potential risk factors for noncompliance were performed. The final analysis included 141 patients with complete data sets for the purpose of the study. Fifty-nine patients (42%) were considered noncompliant. Univariate analysis identified low C-reactive protein levels (P = 0.015), decreased recent food intake (P = 0.032) and, as a trend, low hemoglobin (P = 0.065) and low pre-albumin (P = 0.056) levels as risk factors for decreased compliance. However, none of them was retained as an independent risk factor after multivariate analysis. Interestingly, 17 potential explanatory parameters, such as upper GI cancer, weight loss, reduced appetite or co-morbidities, did not show any significant correlation with reduced intake of nutritional supplements. Reduced compliance with preoperative nutritional interventions remains a major issue because the expected benefit depends on the actual intake. Seemingly, obvious reasons could not be retained as valid explanations. Compliance seems thus to be primarily a question of will and information; the importance of nutritional supplementation needs to be emphasized by specific patients' education.

Electronic compliance monitoring of topical treatment after ophthalmic surgery.

PubMed

Hermann, Manuel Marcel; Ustündag, Can; Diestelhorst, Michael

2010-08-01

The success of many medical treatments is built on compliance. Electronic monitoring is the most accurate tool to quantify compliance by measuring adherence. In order to assess the efficiency of a recently introduced miniature monitoring device for eye drop application, we evaluated adherence in ophthalmic patients undergoing post-operative short-term topical treatment. This pilot study enrolled 30 outpatients (mean age 61.8 +/- 18.5 years) after cataract (n = 24) and glaucoma filtration surgery (n = 6) applying fixed-combination eye drops containing prednisolone and gentamicin five times daily for 2 weeks. Patients received eye drops in conventional bottles each equipped with a miniature monitoring device recording events of application. Two patients failed to bring back the monitoring device; therefore data collected from only 28 patients could be examined. Data showed highly variable results with a mean dose compliance of 50.2%. Dose compliance was below 25% in approximately one out of five patients. Four cataract patients, but no glaucoma patient, discontinued therapy prematurely. The observed mean dosage interval was calculated for each patient and ranged 4.6-19.7 h. Thirty percent of analysed dosage intervals exceeded 12.0 h. Different patterns of compliance behaviour-like early non-persistence, drug holiday and low treatment frequency could be identified and illustrated using electronic data. Age or gender did not significantly influence compliance rates. Our pilot study demonstrates successful electronic compliance monitoring using a technology capable of continuous data recording over weeks of treatment. The low compliance rate for a relevant part of the patients demonstrates the necessity to study and improve compliance in ophthalmology. In future, new application methods and electronic application devices may improve treatment response in eye care.

10 CFR 1040.101 - Compliance reviews.

Code of Federal Regulations, 2011 CFR

2011-01-01

... DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS OR ACTIVITIES Program Monitoring § 1040.101 Compliance reviews. (a) The Director shall periodically conduct compliance... of: (1) The practices to be reviewed; (2) The programs or activities affected by the review; (3) The...

10 CFR 1040.101 - Compliance reviews.

Code of Federal Regulations, 2013 CFR

2013-01-01

... DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS OR ACTIVITIES Program Monitoring § 1040.101 Compliance reviews. (a) The Director shall periodically conduct compliance... of: (1) The practices to be reviewed; (2) The programs or activities affected by the review; (3) The...

10 CFR 1040.101 - Compliance reviews.

Code of Federal Regulations, 2012 CFR

2012-01-01

... DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS OR ACTIVITIES Program Monitoring § 1040.101 Compliance reviews. (a) The Director shall periodically conduct compliance... of: (1) The practices to be reviewed; (2) The programs or activities affected by the review; (3) The...

10 CFR 1040.101 - Compliance reviews.

Code of Federal Regulations, 2014 CFR

2014-01-01

... DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS OR ACTIVITIES Program Monitoring § 1040.101 Compliance reviews. (a) The Director shall periodically conduct compliance... of: (1) The practices to be reviewed; (2) The programs or activities affected by the review; (3) The...

10 CFR 1040.101 - Compliance reviews.

Code of Federal Regulations, 2010 CFR

2010-01-01

... DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS OR ACTIVITIES Program Monitoring § 1040.101 Compliance reviews. (a) The Director shall periodically conduct compliance... of: (1) The practices to be reviewed; (2) The programs or activities affected by the review; (3) The...

40 CFR 63.1102 - Compliance schedule.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 10 2010-07-01 2010-07-01 false Compliance schedule. 63.1102 Section 63.1102 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED... Technology Standards § 63.1102 Compliance schedule. (a) General requirements. Affected sources, as defined in...

40 CFR Table 10 to Subpart Xxxx of... - Continuous Compliance With the Emission Limits for Tire Production Affected Sources

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 13 2014-07-01 2014-07-01 false Continuous Compliance With the Emission Limits for Tire Production Affected Sources 10 Table 10 to Subpart XXXX of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE...

40 CFR Table 10 to Subpart Xxxx of... - Continuous Compliance With the Emission Limits for Tire Production Affected Sources

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 13 2013-07-01 2012-07-01 true Continuous Compliance With the Emission Limits for Tire Production Affected Sources 10 Table 10 to Subpart XXXX of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE...

40 CFR Table 10 to Subpart Xxxx of... - Continuous Compliance With the Emission Limits for Tire Production Affected Sources

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 12 2011-07-01 2009-07-01 true Continuous Compliance With the Emission Limits for Tire Production Affected Sources 10 Table 10 to Subpart XXXX of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE...

40 CFR Table 10 to Subpart Xxxx of... - Continuous Compliance With the Emission Limits for Tire Production Affected Sources

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 12 2010-07-01 2010-07-01 true Continuous Compliance With the Emission Limits for Tire Production Affected Sources 10 Table 10 to Subpart XXXX of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE...

40 CFR Table 10 to Subpart Xxxx of... - Continuous Compliance With the Emission Limits for Tire Production Affected Sources

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 13 2012-07-01 2012-07-01 false Continuous Compliance With the Emission Limits for Tire Production Affected Sources 10 Table 10 to Subpart XXXX of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE...

The elderly on dialysis: some considerations in compliance.

PubMed

McKevitt, P M; Jones, J F; Lane, D A; Marion, R R

1990-10-01

Compliance with scheduled treatments, dietary and fluid restrictions, and multiple medications is an important component in the care and well-being of end-stage renal disease (ESRD) patients. Given the rigorus and complex demands of dialysis, it is important to examine the issue of compliance, focusing on a large and ever-increasing segment of our patient population, the elderly. The ESRD literature reflects efforts to define and measure levels of compliance, identify factors that influence and predict compliance, and develop intervention strategies to improve adherence to treatment regimens. While limited attention has been focused specifically on the elderly, there are studies suggesting that age may be a factor associated with improved adherence and that social support may be a significant contributor to compliance in this patient group. In an effort to examine the current status and needs of the dialysis elderly, research is in progress at Chromalloy American Kidney Center, Washington University, which replicates a study of 5 years ago. Eighty-four patients age 60 and over, on dialysis for a minimum of 6 months, were identified. Sociodemographic, treatment, compliance, and functional capacity data were collected; additional mental and psychological testing was completed on patients willing and able to participate. Preliminary data suggest the current elderly population is larger and significantly older than that of 5 years ago. Other sociodemographic data indicate the population is increasingly female, black, and more socioeconomically disadvantaged. In regard to compliance, the vast majority of elderly demonstrate good compliance as measured by serum potassium, fair to good compliance with phosphorus, and fair to poor compliance with fluid restrictions.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of Remote Internet Follow-Up on Postradiotherapy Compliance Among Patients with Esophageal Cancer: A Randomized Controlled Study.

PubMed

Wang, Ping; Yang, Lin; Hua, Zhongsheng

2015-11-01

To explore the effects of using remote Internet follow-up on postradiotherapy compliance with medical advice provided to patients with esophageal cancer. Between January 1 and August 1, 2013, in total, 128 patients with esophageal squamous cell cancer treated with radiotherapy were randomly assigned to either an observation group (n=64) or a control group (n=64). The control group received routine outpatient follow-up, whereas the observation group received additional remote Internet follow-up for 6 months after discharge from the hospital. The treatment effects and compliance were investigated using a questionnaire. At 3 months and 6 months after discharge, patients in the observation group had sought significantly more consultations and undergone more periodic re-examinations than patients in the control group (all p<0.001). Furthermore, both the disease-free survival rate and the symptom reduction rate were significantly higher in the observation group compared with the control group (all p<0.001). Remote Internet follow-up is an easy and fast method for improving postradiotherapy compliance with medical instructions and promoting normalization among patients with esophageal cancer.

Suicide Assessment in Hospital Emergency Departments: Implications for Patient Satisfaction and Compliance

PubMed Central

Mitchell, Ann M.; Garand, Linda; Dean, Diane; Panzak, George; Taylor, Melissa

2010-01-01

Suicide is a complex, multidimensional event with a host of contributing factors. Suicidal emergencies are among other behavioral and psychiatric emergencies that provide the basis for emergency department visits. Therefore, emergency departments are ideal clinical environments for the assessment of suicidal patients. A case example from an emergency department visit is provided as a basis of discussion as we describe subpopulations at high risk for suicide and review critical assessment parameters for the recognition and treatment of suicidal patients. Lastly, factors associated with patient satisfaction and treatment compliance are addressed to promote positive health outcomes among suicidal patients. PMID:20448823

Compliance with removable orthodontic appliances.

PubMed

Shah, Nirmal

2017-12-22

Data sourcesMedline via OVID, PubMed, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, LILACS and BBO databases. Unpublished clinical trials accessed using ClinicalTrials.gov, National Research Register, ProQuest Dissertation and Thesis database.Study selectionTwo authors searched studies from inception until May 2016 without language restrictions. Quantitative and qualitative studies incorporating objective data on compliance with removable appliances, barriers to appliance wear compliance, and interventions to improve compliance were included.Data extraction and synthesisQuality of research was assessed using the Cochrane Collaboration's risk of bias tool, the risk of bias in non-randomised studies of interventions (ROBINS-I), and the mixed methods appraisal tool. Statistical heterogeneity was investigated by examining a graphic display of the estimated compliance levels in conjunction with 95% confidence intervals and quantified using the I-squared statistic. A weighted estimate of objective compliance levels for different appliances in relation to stipulated wear and self-reported levels was also calculated. Risk of publication bias was assessed using funnel plots. Meta-regression was undertaken to assess the relative effects of appliance type on compliance levels.ResultsTwenty-four studies met the inclusion criteria. Of these, 11 were included in the quantitative synthesis. The mean duration of objectively measured wear was considerably lower than stipulated wear time amongst all appliances. Headgear had the greatest discrepancy (5.81 hours, 95% confidence interval, 4.98, 6.64). Self-reported wear time was consistently higher than objectively measured wear time amongst all appliances. Headgear had the greatest discrepancy (5.02 hours, 95% confidence interval, 3.64, 6.40). Two studies found an increase in compliance with headgear and Hawley retainers when patients were aware of monitoring. Five studies found younger age groups to

[Fostering compliance by understanding its mechanisms].

PubMed

Neves, Chantal; Lecointre, Brigitte

2014-01-01

In the context of chronic disease, nurses play an essential role in the long-term support of the patient. The therapeutic alliance which they create with the patient enables them to detect the various factors which influence compliance, or on the contrary, the non-compliance of the patient. They work in a context of interdisciplinarity in a collaborative practice in which the patient is a partner. Their interventions aim to support the patient in adopting the right health strategies.

42 CFR 3.308 - Compliance reviews.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Compliance reviews. 3.308 Section 3.308 Public... ORGANIZATIONS AND PATIENT SAFETY WORK PRODUCT Enforcement Program § 3.308 Compliance reviews. The Secretary may conduct compliance reviews to determine whether a respondent is complying with the applicable...

Patient Compliance with Postoperative Lower-Extremity Non-Weight-Bearing Restrictions.

PubMed

Chiodo, Christopher P; Macaulay, Alec A; Palms, David A; Smith, Jeremy T; Bluman, Eric M

2016-09-21

A period of non-weight-bearing is prescribed following many orthopaedic injuries and procedures. It is believed that a period of non-weight-bearing is important for proper healing and recovery. The degree to which patients are compliant with non-weight-bearing instructions is unknown. The purpose of this study was to measure patient compliance with a period of prescribed non-weight-bearing. In this single-blinded study, pressure-sensitive film was embedded into short leg casts of 51 consecutive adult orthopaedic patients with unilateral lower-extremity abnormality who had been instructed to be strictly non-weight-bearing. Sensors were retrieved at the time of cast removal (mean, 24.3 days [range, 7 to 48 days]) and then were analyzed for force distribution and magnitude. Noncompliance was defined as maximum detectable pressure exerted on ≥50% of the film. Patient characteristics and the time of year that the casts were worn were also examined to determine if they correlated with weight-bearing. Fourteen (27.5%) of 51 patients were noncompliant with the non-weight-bearing restriction. Six (42.9%) of the 14 noncompliant patients compared with 11 (29.7%) of the 37 compliant patients experienced an adverse event (p = 0.51). Sex, age, language spoken, body mass index, time in the cast, and the treating surgeon did not have a significant influence on weight-bearing performance (p > 0.05). Significantly greater weight-bearing was found (p = 0.04) in warmer months (June to October) than in colder months (November to March) in the United States. The noncompliance rate with the postoperative non-weight-bearing restriction was 27.5% (95% confidence interval, 15.2% to 39.8%) in this patient group, despite explicit instructions and education about possible complications associated with weight-bearing. The only factor found to have a significant effect on weight-bearing compliance was the time of year that the cast was worn. No significant difference was found between the

Evaluation of the relationship between compliance with the follow-up and treatment protocol and health literacy in bladder tumor patients.

PubMed

Turkoglu, Ali Riza; Demirci, Hakan; Coban, Soner; Guzelsoy, Muhammet; Toprak, Erdem; Aydos, Mustafa Murat; Ture, Deniz Azkan; Ustundag, Yasemin

2018-03-07

To investigate the relationship between the compliance of bladder cancer patients with cystoscopic follow-up and the treatment protocol, and their health literacy. Patients who underwent transurethral resection surgery for bladder tumor were found to have non-muscular invasive bladder carcinoma on pathology examination and then underwent cystoscopic follow-up for 1 year or more were included in the study. Cystoscopic follow-up was recommended to the low- and high-risk groups in terms of progression and recurrence. The patients were evaluated with the Health Literacy Survey-European Union scale. The mean age of the patients was 67.13 ± 10.77 years. The treatment continuity rate was 80.50% (n = 33) in the adequate health literacy group (n = 41) and significantly higher than the 56.50% (n = 48) rate in the inadequate health literacy group (n = 85) (p = .008). The health literacy results revealed that the health promotion and general index score was higher in the group of patients under the age of 65. Adequate health literacy in bladder cancer patients is associated with better compliance with the treatment protocol. Young patients show better compliance with the follow-up protocol recommended by the physician. Increasing the follow-up protocol compliance of elderly patients with inadequate health literacy is necessary.

40 CFR Table 4 to Subpart III of... - Compliance Requirements for Slabstock Foam Production Affected Sources Complying With the Source...

Code of Federal Regulations, 2013 CFR

2013-07-01

...) National Emission Standards for Hazardous Air Pollutants for Flexible Polyurethane Foam Production Pt. 63, Subpt. III, Table 4 Table 4 to Subpart III of Part 63—Compliance Requirements for Slabstock Foam... Foam Production Affected Sources Complying With the Source-Wide Emission Limitation 4 Table 4 to...

40 CFR Table 4 to Subpart III of... - Compliance Requirements for Slabstock Foam Production Affected Sources Complying With the Source...

Code of Federal Regulations, 2014 CFR

2014-07-01

...) National Emission Standards for Hazardous Air Pollutants for Flexible Polyurethane Foam Production Pt. 63, Subpt. III, Table 4 Table 4 to Subpart III of Part 63—Compliance Requirements for Slabstock Foam... Foam Production Affected Sources Complying With the Source-Wide Emission Limitation 4 Table 4 to...

Comparative analysis of respiratory systems compliance in three different positioning (lateral, dorsal and sitting) in patients in prolonged invasive mechanical ventilation.

PubMed

Porto, Elias Ferreira; Castro, Antonio Adolfo Matos de; Leite, José Renato de Oliveira; Miranda, Saul Vitoriano; Lancauth, Auristela; Kumpel, Claudia

2008-09-01

This study is justified by the fact that in clinical practice, changes occur in patient's positioning in the bed during hospitalization in intensive care unity, it's necessary better understanding about possible adverse effects that such changes might cause mainly on the respiratory system condition. The objective this study was to evaluate if the patients positioning in bed can to alter the pulmonary complacency. All included patients were submitted to mechanical ventilation and were sedated and curarized respiratory system compliance was assessed in three different positioning: lateral, dorsal and sitting. After an alveolar recruitment maneuver, patients were placed to a position throughout two hours, and in the last five minutes the data was collected from the mechanical ventilator display. twenty eight patients were prospectively assessed. Values of respiratory system compliance in the lateral position were 37,07 ± 12,9 in the dorsal were 39,2 ± 10,5 and in the sitting 43,4 ± 9,6 mL/cmH2O. There were a statistical difference when we compared to the sitting and dorsal with lateral positioning for respiratory system compliance (p = 0.0052) and tidal volume (p < 0.001). There was a negative correlation between mean values of positive end expiratory pressure a respiratory system compliance (r = 0.59, p = 0.002). The FIO2 administered was 0.6 for the lateral positioning and 0.5 for the dorsal and sitting positioning (p = 0.049). That body positioning in patients restrained to a bed and submitted to invasive mechanical ventilation leads to pulmonary compliance, tidal volume and SpO2 oscillations. In the sitting position the pulmonary compliance is higher than in others positions.

Evaluation of Therapy Management and Patient Compliance in Postmenopausal Patients with Hormone Receptor-positive Breast Cancer Receiving Letrozole Treatment: The EvaluateTM Study

PubMed Central

Fasching, P. A.; Fehm, T.; Kellner, S.; de Waal, J.; Rezai, M.; Baier, B.; Baake, G.; Kolberg, H.-C.; Guggenberger, M.; Warm, M.; Harbeck, N.; Würstlein, R.; Deuker, J.-U.; Dall, P.; Richter, B.; Wachsmann, G.; Brucker, C.; Siebers, J. W.; Fersis, N.; Kuhn, T.; Wolf, C.; Vollert, H.-W.; Breitbach, G.-P.; Janni, W.; Landthaler, R.; Kohls, A.; Rezek, D.; Noesslet, T.; Fischer, G.; Henschen, S.; Praetz, T.; Heyl, V.; Kühn, T.; Krauß, T.; Thomssen, C.; Kümmel, S.; Hohn, A.; Tesch, H.; Mundhenke, C.; Hein, A.; Rauh, C.; Bayer, C. M.; Jacob, A.; Schmidt, K.; Belleville, E.; Hadji, P.; Wallwiener, D.; Grischke, E.-M.; Beckmann, M. W.; Brucker, S. Y.

2014-01-01

Introduction: The EvaluateTM study (Evaluation of therapy management and patient compliance in postmenopausal hormone receptor-positive breast cancer patients receiving letrozole treatment) is a prospective, non-interventional study for the assessment of therapy management and compliance in the routine care of postmenopausal women with invasive hormone receptor-positive breast cancer receiving letrozole. The parameters for inclusion in the study are presented and discussed here. Material and Methods: Between January 2008 and December 2009 a total of 5045 patients in 310 study centers were recruited to the EvaluateTM study. Inclusion criteria were hormone receptor-positive breast cancer and adjuvant treatment or metastasis. 373 patients were excluded from the analysis for various reasons. Results: A total of 4420 patients receiving adjuvant treatment and 252 patients with metastasis receiving palliative treatment were included in the study. For 4181 patients receiving adjuvant treatment, treatment with the aromatase inhibitor letrozole commenced immediately after surgery (upfront). Two hundred patients had initially received tamoxifen and started aromatase inhibitor treatment with letrozole at 1–5 years after diagnosis (switch), und 39 patients only commenced letrozole treatment 5–10 years after diagnosis (extended endocrine therapy). Patient and tumor characteristics were within expected ranges, as were comorbidities and concurrent medication. Conclusion: The data from the EvaluateTM study will offer a good overview of therapy management in the routine care of postmenopausal women with hormone receptor-positive breast cancer. Planned analyses will look at therapy compliance and patient satisfaction with how information is conveyed and the contents of the conveyed information. PMID:25568468

Depressive affect in incident hemodialysis patients.

PubMed

McDougall, Kathryn A; Larkin, John W; Wingard, Rebecca L; Jiao, Yue; Rosen, Sophia; Ma, Lin; Usvyat, Len A; Maddux, Franklin W

2018-02-01

The prevalence of depressive affect is not well defined in the incident hemodialysis (HD) population. We investigated the prevalence of and associated risk factors and hospitalization rates for depressive affect in incident HD patients. We performed a prospective investigation using the Patient Health Questionnaire 2 (PHQ2) depressive affect assessment. From January to July of 2013 at 108 in-center clinics randomly selected across tertiles of baseline quality measures, we contacted 577 and 543 patients by telephone for depressive affect screening. PHQ2 test scores range from 0 to 6 (scores  ≥3 suggest the presence of depressive affect). The prevalence of depressive affect was measured at 1-30 and 121-150 days after initiating HD; depressive affect risk factors and hospitalization rates by depressive affect status at 1-30 days after starting HD were computed. Of 1120 contacted patients, 340 completed the PHQ2. In patients screened at 1-30 or 121-150 days after starting HD, depressive affect prevalence was 20.2% and 18.5%, respectively (unpaired t -test, P = 0.7). In 35 patients screened at both time points, there were trends for lower prevalence of depressive affect at the end of incident HD, with 20.0% and 5.7% of patients positive for depressive affect at 1-30 and 121-150 days, respectively (paired t -test, P = 0.1). Hospitalization rates were higher in patients with depressive affect during the first 30 days, exhibiting 1.5 more admissions (P < 0.001) and 10.5 additional hospital days (P = 0.008) per patient-year. Females were at higher risk for depressive affect at 1-30 days (P = 0.01). The prevalence of depressive affect in HD patients is high throughout the incident period. Rates of hospital admissions and hospital days are increased in incident HD patients with depressive affect.

Emergency department patient compliance with follow-up for outpatient exercise stress testing: a randomized controlled trial.

PubMed

Richards, Doug; Meshkat, Nazanin; Chu, Jaqueline; Eva, Kevin; Worster, Andrew

2007-11-01

Numerous patients are assessed in the emergency department (ED) for chest pain suggestive of acute coronary syndrome (ACS) and subsequently discharged if found to be at low risk. Exercise stress testing is frequently advised as a follow-up investigation for low-risk patients; however, compliance with such recommendations is poorly understood. We sought to determine if compliance with follow-up for exercise stress testing is higher in patients for whom the investigation is ordered at the time of ED discharge, compared with patients who are advised to arrange testing through their family physician (FP). Low-risk chest pain patients being discharged from the ED for outpatient exercise stress test and FP follow-up were randomized into 2 groups. ED staff ordered an exercise stress test for the intervention group, and the control group was advised to contact their FP to arrange testing. The primary outcome was completion of an exercise stress test at 30 days, confirmed through both patient contact and stress test results. Patients were unaware that our primary interest was their compliance with the exercise stress testing recommendations. Two-hundred and thirty-one patients were enrolled and baseline characteristics were similar between the 2 groups. Completion of an exercise stress test at 30 days occurred in 87 out of 120 (72.5%) patients in the intervention group and 60 out of 107 (56.1%) patients in the control group. The difference in compliance rates (16.4%) between the 2 groups was statistically significant (Chi(2) = 6.69, p < 0.001) with a relative risk of 1.29 (95% confidence interval 1.18-1.40), and the results remained significant after a "worst case" sensitivity analysis involving 4 control group cases lost to follow-up. When subjects were contacted by telephone 30 days after the ED visit, 60% of those who were noncompliant patients felt they did not have a heart problem and that further testing was unnecessary. When ED staff order an outpatient exercise

Auditory training and challenges associated with participation and compliance.

PubMed

Sweetow, Robert W; Sabes, Jennifer Henderson

2010-10-01

When individuals have hearing loss, physiological changes in their brain interact with relearning of sound patterns. Some individuals utilize compensatory strategies that may result in successful hearing aid use. Others, however, are not so fortunate. Modern hearing aids can provide audibility but may not rectify spectral and temporal resolution, susceptibility to noise interference, or degradation of cognitive skills, such as declining auditory memory and slower speed of processing associated with aging. Frequently, these deficits are not identified during a typical "hearing aid evaluation." Aural rehabilitation has long been advocated to enhance communication but has not been considered time or cost-effective. Home-based, interactive adaptive computer therapy programs are available that are designed to engage the adult hearing-impaired listener in the hearing aid fitting process, provide listening strategies, build confidence, and address cognitive changes. Despite the availability of these programs, many patients and professionals are reluctant to engage in and complete therapy. The purposes of this article are to discuss the need for identifying auditory and nonauditory factors that may adversely affect the overall audiological rehabilitation process, to discuss important features that should be incorporated into training, and to examine reasons for the lack of compliance with therapeutic options. Possible solutions to maximizing compliance are explored. Only a small portion of audiologists (fewer than 10%) offer auditory training to patients with hearing impairment, even though auditory training appears to lower the rate of hearing aid returns for credit. Patients to whom auditory training programs are recommended often do not complete the training, however. Compliance for a cohort of home-based auditory therapy trainees was less than 30%. Activities to increase patient compliance to auditory training protocols are proposed. American Academy of Audiology.

Compliance among soft contact lens wearers.

PubMed

Kuzman, Tomislav; Kutija, Marija Barisić; Masnec, Sanja; Jandroković, Sonja; Mrazovac, Danijela; Jurisić, Darija; Skegro, Ivan; Kalauz, Miro; Kordić, Rajko

2014-12-01

Contact lens compliance is proven to be crucial for preventing lens wear-related complications because of the interdependence of the steps in lens care regime and their influence on lens system microbial contamination. Awareness of the patients' lens handling compliance as well as correct recognition of non-compliant behaviours is the basis for creating more targeted strategies for patient education. The aim of this study was to investigate compliance among soft contact lens (SCL) wearers in different aspects of lens care handling and wearing habits. In our research 50 asymptomatic lens wearers filled out a questionnaire containing demographic data, lens type, hygiene and wearing habits, lenses and lens care system replacement schedule and self-evaluation of contact lens handling hygiene. We established criteria of compliance according to available manufacturer's recommendations, prior literature and our clinical experience. Only 2 (4%) of patients were fully compliant SCL wearers. The most common non-compliant behaviours were insufficient lens solution soaking time (62%), followed by failure to daily exchange lens case solution and showering while wearing lenses. 44% of patients reported storing lenses in saline solution. Mean lens storage case replacement was 3.6 months, with up to 78% patients replacing lens case at least once in 3 months. Average grade in self evaluating level of compliance was very good (4 +/- 0.78) (from 1-poor level of hygiene to 5-great level of hygiene). Lens wearers who reported excessive daily lens wear and more than 10 years of lens wearing experience were also found to be less compliant with other lens system care procedures. (t = -2.99, df=47, p < 0.0045 and t = -2.33, df= 48, p < 0.024, respectively). Our study indicates that almost all patients had some degree of non-compliance in lens system maintenance steps. Most common non-compliant behaviours were the ones that are crucial for maintaining lens sterility and preventing infection

Use of an embedded, micro-randomised trial to investigate non-compliance in telehealth interventions.

PubMed

Law, Lisa M; Edirisinghe, Nuwani; Wason, James Ms

2016-08-01

Many types of telehealth interventions rely on activity from the patient in order to have a beneficial effect on their outcome. Remote monitoring systems require the patient to record regular measurements at home, for example, blood pressure, so clinicians can see whether the patient's health changes over time and intervene if necessary. A big problem in this type of intervention is non-compliance. Most telehealth trials report compliance rates, but they rarely compare compliance among various options of telehealth delivery, of which there may be many. Optimising telehealth delivery is vital for improving compliance and, therefore, clinical outcomes. We propose a trial design which investigates ways of improving compliance. For efficiency, this trial is embedded in a larger trial for evaluating clinical effectiveness. It employs a technique called micro-randomisation, where individual patients are randomised multiple times throughout the study. The aims of this article are (1) to verify whether the presence of an embedded secondary trial still allows valid analysis of the primary research and (2) to demonstrate the usefulness of the micro-randomisation technique for comparing compliance interventions. Simulation studies were used to simulate a large number of clinical trials, in which no embedded trial was used, a micro-randomised embedded trial was used, and a factorial embedded trial was used. Each simulation recorded the operating characteristics of the primary and secondary trials. We show that the type I error rate of the primary analysis was not affected by the presence of an embedded secondary trial. Furthermore, we show that micro-randomisation is superior to a factorial design as it reduces the variation caused by within-patient correlation. It therefore requires smaller sample sizes - our simulations showed a requirement of 128 patients for a micro-randomised trial versus 760 patients for a factorial design, in the presence of within-patient correlation

40 CFR 63.784 - Compliance dates.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 10 2011-07-01 2011-07-01 false Compliance dates. 63.784 Section 63... Emission Standards for Shipbuilding and Ship Repair (Surface Coating) § 63.784 Compliance dates. (a) Each owner or operator of an existing affected source shall comply within two years after the effective date...

Treatment compliance of working persons to high-dose antimuscarinic therapies: a randomized trial.

PubMed

Kosilov, Kirill Vladimirovich; Loparev, Sergey; Kuzina, Irina; Shakirova, Olga; Zhuravskaya, Nataliya; Lobodenko, Alexandra

2016-08-01

The aim of this work was to study the factors affecting the stability of working patients in antimuscarinic (AM) drug treatment. The prevalence of urge urinary incontinence (UUI) is an average of between 8.2% and 16.0% of the population. UUI is a condition that adversely affects the health-related quality of life. The first-line therapy in managing UUI is AM treatment. In 1006 patients between 18 and 60 years old (627 women, 379 men, mean age 69.4) who received AM treatment for one year, the possible demographic, socioeconomic and health factors influencing compliance were studied. Also, the functional state of the lower urinary tract (LUT) was studied in this randomized, prospective survey. The study instruments were the documents of employers, tax offices, outpatient records, OABq-SF (overactive bladder - short form) questionnaires, MOS SF-36 (Medical Outcomes Study short form-36), voiding charts, and uroflowmetry data. The compliance to AM treatment within 6 months was retained in 49.5% patients; during the year, in 32.3% of patients. The average time for reaching the 30-day break in taking trospium was 194 days. In the course of the experiment it was revealed that compliance to AM treatment was significantly higher in patients taking solifenacin and trospium in high dosages ( p ⩽ 0.01, p ⩽ 0.05), suffering from severe symptoms of urgency ( p ⩽ 0.01), and having a low level of side effects ( p ⩽ 0.01). A satisfactory level of compliance is characteristic of patients with a high level of monthly and annual income ( p ⩽ 0.01, p ⩽ 0.01), a low percentage of expenses to AM ( p ⩽ 0.05), and rarely changing employers ( p ⩽ 0.05). In addition, the compliance to treatment is higher in older adults ( p ⩽ 0.05), living in the urban district ( p ⩽ 0.01), and working in educational ( p ⩽ 0.05) and health ( p ⩽ 0.01) institutions, having a high level of the indices of Social Functioning ( p ⩽ 0.05), Role-Emotional ( p ⩽ 0.05), and Mental Health

Effect of health education on patients' beliefs about glaucoma and compliance.

PubMed

Rendell, J

2000-01-01

A pretest-posttest control group experimental design (n = 100) was used to determine the effectiveness of an interactive patient education program compared with a didactic approach for persons with primary open angle glaucoma at a major specialist eye hospital in England. This study used a questionnaire with a knowledge test to explore patients' glaucoma knowledge, a series of vignettes to explore understanding of compliance and health motivation, and health locus of control scales to assess the effect of these variables. The improved posttest results (P = .000) suggest that patients benefit from education programs and that the ophthalmic nurse is an effective patient teacher. The interactive program has no statistically significant difference from the didactic presentation. Other types of interactive programs may prove to be more beneficial.

40 CFR 63.11401 - What are my compliance dates?

Code of Federal Regulations, 2011 CFR

2011-07-01

... July 16, 2007. (b) If you startup a new affected source on or before July 16, 2007, you must achieve compliance with the applicable provisions of this subpart not later than July 16, 2007. (c) If you startup a... this subpart upon startup of your affected source. Standards and Compliance Requirements ...

40 CFR 63.11401 - What are my compliance dates?

Code of Federal Regulations, 2014 CFR

2014-07-01

... July 16, 2007. (b) If you startup a new affected source on or before July 16, 2007, you must achieve compliance with the applicable provisions of this subpart not later than July 16, 2007. (c) If you startup a... this subpart upon startup of your affected source. Standards and Compliance Requirements ...

40 CFR 63.11401 - What are my compliance dates?

Code of Federal Regulations, 2012 CFR

2012-07-01

... July 16, 2007. (b) If you startup a new affected source on or before July 16, 2007, you must achieve compliance with the applicable provisions of this subpart not later than July 16, 2007. (c) If you startup a... this subpart upon startup of your affected source. Standards and Compliance Requirements ...

40 CFR 63.11401 - What are my compliance dates?

Code of Federal Regulations, 2013 CFR

2013-07-01

... July 16, 2007. (b) If you startup a new affected source on or before July 16, 2007, you must achieve compliance with the applicable provisions of this subpart not later than July 16, 2007. (c) If you startup a... this subpart upon startup of your affected source. Standards and Compliance Requirements ...

Compliance with the Use of Medical and Cloth Masks Among Healthcare Workers in Vietnam.

PubMed

Chughtai, Abrar Ahmad; Seale, Holly; Dung, Tham Chi; Hayen, Andrew; Rahman, Bayzidur; Raina MacIntyre, C

2016-06-01

Masks are often worn in healthcare settings to prevent the spread of infection from healthcare workers (HCWs) to patients. Masks are also used to protect the employee from patient-generated infectious organisms but poor compliance can reduce efficacy. The aim of this study was to examine the factors influencing compliance with the use of medical and cloth masks amongst hospital HCWs. HCWs compliance with the use of medical and cloth masks was measured over a 4-week period in a randomized controlled trial in Vietnam. HCWs were instructed to record their daily activities in diary cards. Demographic, clinical, and diary card data were used to determine the predictors of compliance and the relationship of compliance with infection outcomes. Compliance rates for both medical and cloth masks decreased during the 4 weeks: medical mask use decreased from 77 to 68% (P < 0.001) and cloth masks from 78 to 69% (P < 0.001). The presence of adverse events (adjusted RR 0.90, 95% CI 0.85-0.95), and performing aerosol-generating procedures (adjusted RR 0.78, 95% CI 0.73-0.82) were negatively associated with compliance, while contact with febrile respiratory illness patients was positively associated (adjusted RR 1.14, 95% CI 1.07-1.20). Being compliant with medical or cloth masks use (average use ≥70% of working time) was not associated with clinical respiratory illness, influenza-like illness, and laboratory-confirmed viral infection. Understanding the factors that affect compliance is important for the occupational health and safety of HCWs. New strategies and tools should be developed to increase compliance of HCWs. The presence of adverse events such as discomfort and breathing problems may be the main reasons for the low compliance with mask use and further studies should be conducted to improve the design/material of masks to improve comfort for the wearer. © The Author 2016. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

The Impact of Internet Health Information on Patient Compliance: A Research Model and an Empirical Study.

PubMed

Laugesen, John; Hassanein, Khaled; Yuan, Yufei

2015-06-11

Patients have been increasingly seeking and using Internet health information to become more active in managing their own health in a partnership with their physicians. This trend has both positive and negative effects on the interactions between patients and their physicians. Therefore, it is important to understand the impact that the increasing use of Internet health information has on the patient-physician relationship and patients' compliance with their treatment regimens. This study examines the impact of patients' use of Internet health information on various elements that characterize the interactions between a patient and her/his physician through a theoretical model based on principal-agent theory and the information asymmetry perspective. A survey-based study consisting of 225 participants was used to validate a model through various statistical techniques. A full assessment of the measurement model and structural model was completed in addition to relevant post hoc analyses. This research revealed that both patient-physician concordance and perceived information asymmetry have significant effects on patient compliance, with patient-physician concordance exhibiting a considerably stronger relationship. Additionally, both physician quality and Internet health information quality have significant effects on patient-physician concordance, with physician quality exhibiting a much stronger relationship. Finally, only physician quality was found to have a significant impact on perceived information asymmetry, whereas Internet health information quality had no impact on perceived information asymmetry. Overall, this study found that physicians can relax regarding their fears concerning patient use of Internet health information because physician quality has the greatest impact on patients and their physician coming to an agreement on their medical situation and recommended treatment regimen as well as patient's compliance with their physician's advice when

Depressive affect in incident hemodialysis patients

PubMed Central

Larkin, John W; Wingard, Rebecca L; Jiao, Yue; Rosen, Sophia; Ma, Lin; Usvyat, Len A; Maddux, Franklin W

2018-01-01

Abstract Background The prevalence of depressive affect is not well defined in the incident hemodialysis (HD) population. We investigated the prevalence of and associated risk factors and hospitalization rates for depressive affect in incident HD patients. Methods We performed a prospective investigation using the Patient Health Questionnaire 2 (PHQ2) depressive affect assessment. From January to July of 2013 at 108 in-center clinics randomly selected across tertiles of baseline quality measures, we contacted 577 and 543 patients by telephone for depressive affect screening. PHQ2 test scores range from 0 to 6 (scores  ≥3 suggest the presence of depressive affect). The prevalence of depressive affect was measured at 1–30 and 121–150 days after initiating HD; depressive affect risk factors and hospitalization rates by depressive affect status at 1–30 days after starting HD were computed. Results Of 1120 contacted patients, 340 completed the PHQ2. In patients screened at 1–30 or 121–150 days after starting HD, depressive affect prevalence was 20.2% and 18.5%, respectively (unpaired t-test, P = 0.7). In 35 patients screened at both time points, there were trends for lower prevalence of depressive affect at the end of incident HD, with 20.0% and 5.7% of patients positive for depressive affect at 1–30 and 121–150 days, respectively (paired t-test, P = 0.1). Hospitalization rates were higher in patients with depressive affect during the first 30 days, exhibiting 1.5 more admissions (P < 0.001) and 10.5 additional hospital days (P = 0.008) per patient-year. Females were at higher risk for depressive affect at 1–30 days (P = 0.01). Conclusions The prevalence of depressive affect in HD patients is high throughout the incident period. Rates of hospital admissions and hospital days are increased in incident HD patients with depressive affect. PMID:29423211

40 CFR 63.11506 - What are my compliance dates?

Code of Federal Regulations, 2013 CFR

2013-07-01

... startup date is on or before July 1, 2008, you must achieve compliance with the provisions of this subpart... startup date is after July 1, 2008, you must achieve compliance with the provisions of this subpart upon initial startup of your affected source. Standards and Compliance Requirements ...

40 CFR 63.11506 - What are my compliance dates?

Code of Federal Regulations, 2011 CFR

2011-07-01

... startup date is on or before July 1, 2008, you must achieve compliance with the provisions of this subpart... startup date is after July 1, 2008, you must achieve compliance with the provisions of this subpart upon initial startup of your affected source. Standards and Compliance Requirements ...

40 CFR 63.11506 - What are my compliance dates?

Code of Federal Regulations, 2012 CFR

2012-07-01

... startup date is on or before July 1, 2008, you must achieve compliance with the provisions of this subpart... startup date is after July 1, 2008, you must achieve compliance with the provisions of this subpart upon initial startup of your affected source. Standards and Compliance Requirements ...

40 CFR 63.11506 - What are my compliance dates?

Code of Federal Regulations, 2010 CFR

2010-07-01

... startup date is on or before July 1, 2008, you must achieve compliance with the provisions of this subpart... startup date is after July 1, 2008, you must achieve compliance with the provisions of this subpart upon initial startup of your affected source. Standards and Compliance Requirements ...

40 CFR 63.11506 - What are my compliance dates?

Code of Federal Regulations, 2014 CFR

2014-07-01

... startup date is on or before July 1, 2008, you must achieve compliance with the provisions of this subpart... startup date is after July 1, 2008, you must achieve compliance with the provisions of this subpart upon initial startup of your affected source. Standards and Compliance Requirements ...

Beneficial Effect of Educational and Nutritional Intervention on the Nutritional Status and Compliance of Gastric Cancer Patients Undergoing Chemotherapy: A Randomized Trial.

PubMed

Xie, Feng-Lan; Wang, Yong-Qian; Peng, Li-Fen; Lin, Fang-Yu; He, Yu-Long; Jiang, Zhuo-Qin

2017-07-01

Surgery combined with chemotherapy is the standard treatment for gastric cancer (GC); however, chemotherapy-relative adverse effects are common and result in malnutrition and a poor prognosis. In addition, compliance to postoperative chemotherapy remains a problem. This study aimed to prospectively investigate the effect of educational and nutritional interventions on the nutritional status and compliance of GC patients undergoing postoperative chemotherapy. A total of 144 GC patients were randomized into an intervention group that received intensive individualized nutritional and educational interventions during the entire course of chemotherapy and control group that received basic nutrition care and health education during hospitalization. The nutritional status and compliance between the two groups were compared. The interventions significantly improved calorie and iron intake within 24 h after the first chemotherapy session, and improved patients' weight, hemoglobin, total serum protein, and albumin levels during the entire course of chemotherapy. The compliance rate with chemotherapy was significantly higher in the intervention group than in the control group (73.61% vs. 55.56%, P = 0.024). A combination of nutritional and educational interventions provided beneficial effect on the nutrition status and compliance of gastric patients undergoing postoperative chemotherapy, which is worthy of clinical application.

Patient-driven education materials: low-literate adults increase understanding of health messages and improve compliance.

PubMed

Townsend, Marilyn S

2011-09-01

Providing educational materials for low-literate patients is an enormous challenge for nursing professionals given that 90 million adults in the health care setting have limited literacy skills. Through the use of a 5-step process, patient educational materials can be created to increase patient understanding of health messages and improve patient compliance. Published by Elsevier Inc.

A systematic review of compliance to oral nutritional supplements.

PubMed

Hubbard, Gary P; Elia, Marinos; Holdoway, Anne; Stratton, Rebecca J

2012-06-01

Oral nutritional supplements (ONS) play a key role in the management of malnutrition. This systematic review examined patients' compliance with ONS across healthcare settings and the influence of patient and ONS-related factors. A systematic review identified 46 studies (n = 4328) of ONS in which data on compliance (% of prescribed quantity of ONS consumed) was available. Pooled mean %compliance was assessed overall and according to study design and healthcare setting. Inter-relationships between compliance and ONS-related and patient-related factors, and total energy intake were assessed. Overall mean compliance with ONS was 78% (37%-100%; 67% hospital, 81% community; overall mean ONS intake 433 kcal/d). Percentage compliance was similar in randomised (79%) and non-randomised (77%) trials, with little variation between diagnostic groups. Compliance across a heterogeneous group of unmatched studies was positively associated with higher energy-density ONS and greater ONS and total energy intakes, negatively associated with age, and unrelated to amount or duration of ONS prescription. This systematic review suggests that compliance to ONS is good, especially with higher energy-density ONS, resulting in improvements in patients' total energy intakes that have been linked with clinical benefits. Further research is required to address the compliance and effectiveness of other common methods of oral nutritional support. Copyright © 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

The impact of dietary regimen compliance on outcomes for HNSCC patients treated with radiation therapy.

PubMed

Kabarriti, Rafi; Bontempo, Amanda; Romano, Maria; McGovern, Kevin P; Asaro, Alyssa; Viswanathan, Shankar; Kalnicki, Shalom; Garg, Madhur K

2018-04-18

To analyze nutritional factors and compliance with dietary recommendations for associations with overall survival (OS) and progression-free survival (PFS) in patients receiving definitive RT for laryngeal and oropharyngeal cancers. We identified 352 patients with non-metastatic laryngeal (146) and oropharyngeal (206) cancer treated with definitive RT between 2004 and 2013. Disease and patient characteristics, treatment information, sarcopenia based on muscle areas at L3 level on CT, compliance with the nutritional program, and clinical outcomes data were tabulated. Descriptive statistics, Kaplan-Meier survival analysis, and log rank tests were performed, and Cox regression models were used to examine predictors of OS and PFS. The median follow-up for the entire cohort was 22.86 months. The actuarial rates for OS were 91, 86, and 73% at years 1, 2, and 5, respectively. Of patients with abdominal CT prior to starting RT, 70.9% (112/158) were sarcopenic with a median muscle mass index of 48.2 (range 30.4-70.9) for males and 35.9 (range 24.6-53.2) for females. The majority (85.8%) of patients met with a dietitian during their course of RT and 62.6% of these patients were compliant with the nutritional program. Compliance with the nutritional program resulted in 27% (HR 0.73, 95% CI 0.43-1.26) protection from death (did not reach significance) and 31% (HR 0.69, 95% CI 0.50-0.94) significant protection from disease progression. Higher pretreatment BMI was associated with a lower risk of death (HR 0.94, 95% CI 0.90-0.99) and disease progression (HR 0.96, 95% CI 0.93-0.99). Laryngeal and oropharyngeal cancer patients treated with definitive RT who are compliant with regular dietetic counseling and contact appear to have improved outcomes. Not applicable.

Factors Predicting Compliance to Ecological Momentary Assessment Among Adolescent Smokers

PubMed Central

2014-01-01

Introduction: Ecological momentary assessments (EMAs) are increasingly used in smoking research to understand contextual and individual differences related to smoking and changes in smoking. To date, there has been little detailed research into the predictors of EMA compliance. However, patterns or predictors of compliance may affect key relationships under investigation and introduce sources of bias in results. The purpose of this study was to investigate predictors of compliance to random prompts among a sample of adolescents who had ever smoked. Methods: Data for this study were drawn from a sample of 461 adolescents (9th and 10th graders at baseline) participating in a longitudinal study of smoking escalation. We examined 2 outcomes: subject-level EMA compliance (overall rate of compliance over a week-long EMA wave), and in-the-moment prompt-level compliance to the most proximal random prompt. We investigated several covariates including gender, race, smoking rate, alcohol use, psychological symptomatology, home composition, mood, social context, time in study, inter-prompt interval, and location. Results: At the overall subject level, higher mean negative affect, smoking rate, alcohol use, and male gender predicted lower compliance with random EMA prompts. At the prompt level, after controlling for significant subject-level predictors of compliance, increased positive affect, being outside of the home, and longer inter-prompt interval predicted lower momentary compliance. Conclusions: This study identifies several factors associated with overall and momentary EMA compliance among a sample of adolescents participating in a longitudinal study of smoking. We also propose a conceptual framework for investigating the contextual and momentary predictors of compliance within EMA studies. PMID:24097816

40 CFR Table 12 to Subpart Xxxx of... - Continuous Compliance With the Emission Limits for Tire Cord Production Affected Sources

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 12 2010-07-01 2010-07-01 true Continuous Compliance With the Emission Limits for Tire Cord Production Affected Sources 12 Table 12 to Subpart XXXX of Part 63 Protection of... Pollutants: Rubber Tire Manufacturing Pt. 63, Subpt. XXXX, Table 12 Table 12 to Subpart XXXX of Part 63...

Knowledge, compliance and serum phenylalanine concentrations in adolescents and adults with phenylketonuria and the effect of a patient-focused educational resource.

PubMed

Durham-Shearer, S J; Judd, P A; Whelan, K; Thomas, J E

2008-10-01

There is a lack of dedicated resources for adolescent and adult patients with phenylketonuria (PKU) and few studies have examined dietary practices within this group. One hundred and seventy-seven PKU patients were sent questionnaires to assess dietary compliance and the preferred format for an educational resource. Seventy-one patients responded; 32 following diet were recruited to assess the resource's impact on test variables. The results were compared for the intervention group (n = 22) and control group (n = 10) at baseline, and 1 and 6 months after resource intervention. Most patients were aware of dietary recommendations, although this did not always result in compliance. The preferred resource format was a filofax-style folder with inserts (P < 0.05). There was a significant difference in the extent of change in knowledge score between baseline and 1 month in favour of the intervention group (P < 0.05). The improvement in knowledge was not accompanied by a significant improvement in measures of compliance. These findings add to the knowledge base about this patient group and support the use of patient involvement in resource development. It is likely that the test parameters used were not sensitive enough to pick up subtle and longer-term effects on compliance.

The Impact of Internet Health Information on Patient Compliance: A Research Model and an Empirical Study

PubMed Central

Hassanein, Khaled; Yuan, Yufei

2015-01-01

Background Patients have been increasingly seeking and using Internet health information to become more active in managing their own health in a partnership with their physicians. This trend has both positive and negative effects on the interactions between patients and their physicians. Therefore, it is important to understand the impact that the increasing use of Internet health information has on the patient-physician relationship and patients’ compliance with their treatment regimens. Objective This study examines the impact of patients’ use of Internet health information on various elements that characterize the interactions between a patient and her/his physician through a theoretical model based on principal-agent theory and the information asymmetry perspective. Methods A survey-based study consisting of 225 participants was used to validate a model through various statistical techniques. A full assessment of the measurement model and structural model was completed in addition to relevant post hoc analyses. Results This research revealed that both patient-physician concordance and perceived information asymmetry have significant effects on patient compliance, with patient-physician concordance exhibiting a considerably stronger relationship. Additionally, both physician quality and Internet health information quality have significant effects on patient-physician concordance, with physician quality exhibiting a much stronger relationship. Finally, only physician quality was found to have a significant impact on perceived information asymmetry, whereas Internet health information quality had no impact on perceived information asymmetry. Conclusions Overall, this study found that physicians can relax regarding their fears concerning patient use of Internet health information because physician quality has the greatest impact on patients and their physician coming to an agreement on their medical situation and recommended treatment regimen as well as

40 CFR Table 7 to Subpart Xxxx of... - Initial Compliance With the Emission Limits for Tire Cord Production Affected Sources

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 12 2010-07-01 2010-07-01 true Initial Compliance With the Emission Limits for Tire Cord Production Affected Sources 7 Table 7 to Subpart XXXX of Part 63 Protection of... Pollutants: Rubber Tire Manufacturing Pt. 63, Subpt. XXXX, Table 7 Table 7 to Subpart XXXX of Part 63—Initial...

Efficacy of telephone and mail intervention in patient compliance with antihypertensive drugs in hypertension. ETECUM-HTA study.

PubMed

Márquez Contreras, Emilio; Vegazo García, Onofre; Martel Claros, Nieves; Gil Guillén, Vicente; de la Figuera von Wichmann, Mariano; Casado Martínez, José Joaquín; Fernández, Raúl

2005-01-01

To study the efficacy of telephone and mail intervention in therapeutic compliance among patients with mild to moderate hypertension. A prospective controlled multicenter clinical trial. Eighty-five primary care centers in Spain, with a duration of 6 months. A total of 636 patients with newly diagnosed or uncontrolled hypertension were included. Interventions. The patients were randomized and distributed between the following groups: (i) control (CG) - under routine clinical management; (ii) mail intervention (MIG) - received a mailed message reinforcing compliance and reminding of the visits (15 days, 2 and 4 months); (iii) telephone intervention (TIG) - received a telephone call at 15 days, then at 7 and 15 weeks. Five visits were scheduled, with the measurement of blood pressure and counting of tablets. Compliers were defined as subjects showing 80-110% drug consumption. Calculations were made of mean percentage compliance (MPC) and compliers, mean blood pressure and percentage controlled subjects. Five hundred and thirty-eight patients completed the study (261 males); 85.5% were compliers (CI = 82.5-88.5; n = 460). The MPC was 95.1+/-19.6% (CI = 93.28-96.92). The CG consisted of 182 individuals, MIG = 172 and TIG = 184. Compliers represented 69.2% of the CG (CI 62.5-75.9%), 91.3% (CI = 87.1-95.5) of the MIG (p = 0.0001) and 96.2% of the TIG (CI 93.5-98.9%); the final MPC was 89.6%+/-15 in CG, 96.6%+/-12 in MIG and 99.1+/-26.8 in TIG (p = 0.0001). The percentage of controlled subjects was 47.2% in CG (CI = 40-54.4), 61.3% in MIG (CI = 54.1-68.5%) and 63.3% in TIG (CI = 56.4-70.2%) (p<0.05). TIG and MIG are effective measures for improving patient compliance in hypertension.

Compliance, satisfaction, and quality of life of patients with colorectal cancer receiving home chemotherapy or outpatient treatment: a randomised controlled trial

PubMed Central

Borras, J M; Sanchez-Hernandez, A; Navarro, M; Martinez, M; Mendez, E; Ponton, J L L; Espinas, J A; Germa, J R

2001-01-01

Objective To compare chemotherapy given at home with outpatient treatment in terms of colorectal cancer patients' safety, compliance, use of health services, quality of life, and satisfaction with treatment. Design Randomised controlled trial. Setting Large teaching hospital. Participants 87 patients receiving adjuvant or palliative chemotherapy for colorectal cancer. Interventions Treatment with fluorouracil (with or without folinic acid or levamisole) at outpatient clinic or at home. Main outcome measures Treatment toxicity; patients' compliance with treatment, quality of life, satisfaction with care, and use of health resources. Results 42 patients were treated at outpatient clinic and 45 at home. The two groups were balanced in terms of age, sex, site of cancer, and disease stage. Treatment related toxicity was similar in the two groups (difference 7% (95% confidence interval −12% to 26%)), but there were more voluntary withdrawals from treatment in the outpatient group than in the home group (14% v 2%, difference 12% (1% to 24%)). There were no differences between groups in terms of quality of life scores during and after treatment. Levels of patient satisfaction were higher in the home treatment group, specifically with regard to information received and nursing care. There were no significant differences in use of health services. Conclusions Home chemotherapy seemed an acceptable and safe alternative to hospital treatment for patients with colorectal cancer that may improve compliance and satisfaction with treatment. What is already known on this topicHome chemotherapy programmes have been proposed as an alternative to hospital treatmentHowever, they are more costly, and there is little evidence on their impact on outcomes such as compliance, quality of life, or use of other health servicesWhat this study addsHome chemotherapy was not associated with an increased use of health services such as primary care or emergency departmentsHome chemotherapy had no

[Compliance with the PECARN and AEP guidelines in diagnostic approach of mild head trauma in patients younger than 24 months old].

PubMed

Velasco, R; Arribas, M; Valencia, C; Zamora, N; Fernández, S M; Lobeiras, A; Urbaneja, E; Garrote, R; González, L; Benito, H

2015-09-01

Mild head trauma is a frequent complaint in Pediatric Emergency Departments. Several guidelines have been published in the last few years. However, significant variability can be appreciated in terms of the demand for image tests. The aim of this study is to determine the level of compliance with PECARN and AEP guidelines in the management of patients younger than 24 months old in four different hospitals. A multicenter retrospective study was conducted on patients presenting with mild head trauma between October 1st, 2011 and March 31st, 2013 in the Emergency Departments of four hospitals. In the analysis of the results obtained, only one of the four hospitals complied with the AEP guidelines in more than 50% of the patients. The other three hospitals had a level of compliance lower than 50%. Management was more suitable according to PECARN guidelines, with 3 of the 4 hospitals having a level of compliance greater than 50%. However, the best compliance achieved by a hospital was only of 70%. The study shows that the level of compliance with guidelines for management of mild head trauma in patients younger than 24 months old is low. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Analysis of patterns of patient compliance after an abnormal Pap smear result: the influence of demographic characteristics on patient compliance.

PubMed

Rojas, Christine; Zhou, Ming K; Khamis, Harry J; Amesse, Lawrence

2013-07-01

This study aimed to determine population characteristics that correlate to suboptimal follow-up after an abnormal cervical cytology result. Nonpregnant women, ages 21 to 65 years, with newly diagnosed abnormal cervical cytology result between January 2009 and January 2012 at an urban clinic were eligible for inclusion in this retrospective chart review. Cervical cytology data and demographic characteristics such as age, ethnicity, employment, marital and smoking status, health insurance and number of pregnancies were abstracted from electronic medical record. A log-linear model was used to determine which factors influenced patient compliance. Of the total of 206 women, 78 (37.9%) had optimal follow-up and 128 (62.1%) had suboptimal follow-up. The 3 variables that were statistically significant in influencing patient follow-up after adjusted analyses included severity of cytology result (p = .0013), ethnicity (p = .02), and employment status (p = .0159). The risk ratio for optimal follow-up for those with severe cytology result was 1.81; for the non-whites, 1.77; and for the employed, 1.53. Ethnicity, severity of cervical cytology result, and employment status play an important role in patient follow-up after an abnormal cervical cytology result. Detecting trends in our patient population that influence adherence to follow-up will help health care providers formulate strategies that target this problem.

Efficacy of and patient compliance with a ketogenic diet in adults with intractable epilepsy: a meta-analysis.

PubMed

Ye, Fang; Li, Xiao-Jia; Jiang, Wan-Lin; Sun, Hong-Bin; Liu, Jie

2015-01-01

Despite the successful use of a ketogenic diet in pediatric epilepsy, its application in adults has been limited. The aim of this meta-analysis was to summarize the findings of relevant published studies in order to identify the efficacy of and compliance with a ketogenic diet and its main subtypes (i.e., classic ketogenic diet and modified Atkins diet) in adults with intractable epilepsy, and to provide useful information for clinical practice. Electronic searches of PubMed, EMBASE, Google Scholar, and the ISI Web of Science were conducted to identify studies of the efficacy of and patient compliance with a ketogenic diet in adults with intractable epilepsy; the included studies were reviewed. Meta-analyses were performed using STATA to determine combined efficacy rates and combined rates of compliance with the ketogenic diet and its main subtypes. In total, 12 studies qualified for inclusion, and data from 270 patients were evaluated.The results of the meta-analysis revealed combined efficacy rates of all types of ketogenic diet, a classical ketogenic diet, and a modified Atkins diet were 42%, 52%, and 34%, respectively; the corresponding combined compliance rates were 45%, 38%, and 56%. The results indicate that a ketogenic diet is a promising complementary therapy in adult intractable epilepsy, and that while a classical ketogenic diet may be more effective, adult patients are likely to be less compliant with it than with a modified Atkins diet.

Effect of Contract Compliance Rate to a Fourth-Generation Telehealth Program on the Risk of Hospitalization in Patients With Chronic Kidney Disease: Retrospective Cohort Study.

PubMed

Hung, Chi-Sheng; Lee, Jenkuang; Chen, Ying-Hsien; Huang, Ching-Chang; Wu, Vin-Cent; Wu, Hui-Wen; Chuang, Pao-Yu; Ho, Yi-Lwun

2018-01-24

Chronic kidney disease (CKD) is prevalent in Taiwan and it is associated with high all-cause mortality. We have shown in a previous paper that a fourth-generation telehealth program is associated with lower all-cause mortality compared to usual care with a hazard ratio of 0.866 (95% CI 0.837-0.896). This study aimed to evaluate the effect of renal function status on hospitalization among patients receiving this program and to evaluate the relationship between contract compliance rate to the program and risk of hospitalization in patients with CKD. We retrospectively analyzed 715 patients receiving the telehealth care program. Contract compliance rate was defined as the percentage of days covered by the telehealth service before hospitalization. Patients were stratified into three groups according to renal function status: (1) normal renal function, (2) CKD, or (3) end-stage renal disease (ESRD) and on maintenance dialysis. The outcome measurements were first cardiovascular and all-cause hospitalizations. The association between contract compliance rate, renal function status, and hospitalization risk was analyzed with a Cox proportional hazards model with time-dependent covariates. The median follow-up duration was 694 days (IQR 338-1163). Contract compliance rate had a triphasic relationship with cardiovascular and all-cause hospitalizations. Patients with low or very high contract compliance rates were associated with a higher risk of hospitalization. Patients with CKD or ESRD were also associated with a higher risk of hospitalization. Moreover, we observed a significant interaction between the effects of renal function status and contract compliance rate on the risk of hospitalization: patients with ESRD, who were on dialysis, had an increased risk of hospitalization at a lower contract compliance rate, compared with patients with normal renal function or CKD. Our study showed that there was a triphasic relationship between contract compliance rate to the

Oral hygiene compliance in orthodontic patients: a randomized controlled study on the effects of a post-treatment communication.

PubMed

Cozzani, Mauro; Ragazzini, Giulia; Delucchi, Alessia; Mutinelli, Sabrina; Barreca, Carlo; Rinchuse, Daniel J; Servetto, Roberto; Piras, Vincenzo

2016-12-01

Several studies have recently demonstrated that a post-treatment communication to explain the importance of an oral hygiene can improve the orthodontic patients' compliance over a period of 66 days. The main goal of this study is to evaluate the effects of a structured follow-up communication after orthodontic appliance application on oral hygiene compliance after 30-40 days. Eighty-four orthodontic participants enrolled from patients who were beginning fixed orthodontic treatment at the Orthodontic Department, Gaslini Hospital, Genova, between July and October 2014 were randomly assigned to one of three trial arms. Before the bonding, all patients underwent a session of oral hygiene aimed at obtaining an plaque index of "zero." At the following orthodontic appointment, the plaque index was calculated for each patient in order to assess oral hygiene compliance. The first group served as control and did not receive any post-procedure communication, the second group received a structured text message giving reassurance, and the third group received a structured telephone call. Participants were blinded to group assignment and were not made aware that the text message or the telephone call was part of the study. (The research protocol was approved by the Italian Comitato Etico Regionale della Liguria-sezione 3^ c/o IRCCS-Istituto G. Gaslini 845/2014, and it is not registered in the trial's register.) RESULTS: Thirty patients were randomly assigned to the control group, 28 participants to the text message group, and 26 to the telephone group. Participants who received a post-treatment communication reported higher level of oral hygiene compliance than participants in the control group. The plaque index was 0.3 (interquartile range (Iqr), 0.60) and 0.75 (Iqr, 1.30), respectively, with a significant difference (P = 0.0205). A follow-up procedure after orthodontic treatment may be an effective tool to increase oral hygiene compliance also over a short period.

Interventions to improve hand hygiene compliance in patient care.

PubMed

Gould, Dinah J; Moralejo, Donna; Drey, Nicholas; Chudleigh, Jane H; Taljaard, Monica

2017-09-01

Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. This is an update of a previously published review. To assess the short- and long-term success of strategies to improve compliance to recommendations for hand hygiene, and to determine whether an increase in hand hygiene compliance can reduce rates of health care-associated infection. We conducted electronic searches of the Cochrane Register of Controlled Trials, PubMed, Embase, and CINAHL. We conducted the searches from November 2009 to October 2016. We included randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series analyses (ITS) that evaluated any intervention to improve compliance with hand hygiene using soap and water or alcohol-based hand rub (ABHR), or both. Two review authors independently screened citations for inclusion, extracted data, and assessed risks of bias for each included study. Meta-analysis was not possible, as there was substantial heterogeneity across studies. We assessed the certainty of evidence using the GRADE approach and present the results narratively in a 'Summary of findings' table. This review includes 26 studies: 14 randomised trials, two non-randomised trials and 10 ITS studies. Most studies were conducted in hospitals or long-term care facilities in different countries, and collected data from a variety of healthcare workers. Fourteen studies assessed the success of different combinations of strategies recommended by the World Health Organization (WHO) to improve hand hygiene compliance. Strategies consisted of the following: increasing the availability of ABHR, different types of education for staff, reminders (written and verbal), different types of performance feedback, administrative support, and staff involvement. Six studies assessed different types of performance feedback, two studies evaluated education, three studies evaluated cues such

Compliance with barrier precautions during paediatric trauma resuscitations.

PubMed

Kelleher, Deirdre C; Carter, Elizabeth A; Waterhouse, Lauren J; Burd, Randall S

2013-03-01

Barrier precautions protect patients and providers from blood-borne pathogens. Although barrier precaution compliance has been shown to be low among adult trauma teams, it has not been evaluated during paediatric resuscitations in which perceived risk of disease transmission may be low. The purpose of this study was to identify factors associated with compliance with barrier precautions during paediatric trauma resuscitations. Video recordings of resuscitations performed on injured children (<18 years old) were reviewed to determine compliance with an established policy requiring gowns and gloves. Depending on activation level, trauma team members included up to six physicians, four nurses, and a respiratory therapist. Multivariate logistic regression was used to determine the effect of team role, resuscitation factors, and injury mechanism on barrier precaution compliance. Over twelve weeks, 1138 trauma team members participated in 128 resuscitations (4.7% penetrating injuries, 9.4% highest level activations). Compliance with barrier precautions was 81.3%, with higher compliance seen among roles primarily at the bedside compared to positions not primarily at the bedside (90.7% vs. 65.1%, p<0.001). Bedside residents (98.4%) and surgical fellows (97.6%) had the highest compliance, while surgical attendings (20.8%) had the lowest (p<0.001). Controlling for role, increased compliance was observed during resuscitations of patients with penetrating injuries (OR=3.97 [95% CI: 1.35-11.70], p=0.01), during resuscitations triaged to the highest activation level (OR=2.61 [95% CI: 1.34-5.10], p=0.005), and among team members present before patient arrival (OR=4.14 [95% CI: 2.29-7.39], p<0.001). Compliance with barrier precautions varies by trauma team role. Team members have higher compliance when treating children with penetrating and high acuity injuries and when arriving before the patient. Interventions integrating barrier precautions into the workflow of team members are

A Survey of Nurses' Compliance with Hand Hygiene Guidelines in Caring for Patients with Cancer in a Selected Center of Isfahan, Iran, in 2016

PubMed Central

Mostafazadeh-Bora, Mostafa; Bahrami, Masoud; Hosseini, Abbas

2018-01-01

Background: Hand hygiene is one of the key ways of preventing healthcare-associated infections (HCAI), especially in patients with cancer. The aim of this study was to determine nurses' compliance with hand hygiene guidelines in caring for patients with cancer in a selected center in Isfahan, Iran, in 2016. Materials and Methods: The present observational study was conducted on nurses in a cancer center in Isfahan in 2016. The participants were selected via convenience sampling method. Nurses serving at bedsides and willing to participate were entered into the study. Data were collected through the direct observation of nurses during delivering routine care, using the standard checklist for direct observation of the “five moments for hand hygiene” approach. Results: In the present study, 94 nurses were studied at 500 clinical moments. The overall hand hygiene compliance rate was 12.80%. The highest hand hygiene compliance rate was observed in the after body fluid exposure moment (72.70%). In addition, hand hygiene compliance rate in preprocedure indications (before patient contact and before aseptic procedure) and postprocedure indications (after patient contact, after body fluid exposure, and after patient surrounding contact) were 3.40 and 21%, respectively, which had a significant correlation (p = 0.001). Conclusions: The findings indicate that the hand hygiene compliance rate among nurses was low. Further research in this regard is recommended in order to find the causes of low compliance with hand hygiene and design interventions for improvement in hand hygiene compliance rate among nurses. PMID:29628959

Effect of asthma management education program on stress and compliance of patients with allergic asthma to house dust mite.

PubMed

Yoo, Yang Sook; Cho, Ok Hee; Kim, Eun Sin; Jeong, Hye Sun

2005-06-01

This study was designed to examine the effect of asthma management education program applied to allergic asthma patients receiving immunotherapy due to house dust mite on their stress and compliance with health care regimens. A quasi experimental design with non-equivalent control group and non-synchronized design was used. The subjects of this study were 61 patients who were receiving immunotherapy at intervals of a week after their symptoms were diagnosed as house dust mite allergic asthma at the pulmonary department of a university hospital in Seoul. They were divided into an experimental group of 29 patients who received asthma management education and a control group of 32 patients. The asthma management education program was composed of group education (once) and reinforcement education (three times) with environmental therapy and immunotherapy to house dust mite. Stress significantly decreased in the experimental group compared to that in the control group. Compliance with health care regimens significantly increased in the experimental group compared to that in the control group. The results suggested that the asthma management education program is effective for the management of stress and the improvement of compliance in patients with allergic asthma to house dust mite.

State and Local Compliance: a National Report.

ERIC Educational Resources Information Center

Beuke, Vernon

1981-01-01

Discusses the Abt Study of State and Local Compliance which sought to describe state and local implementation of the provisions of the Vocational Education Amendments of 1965; to understand ways in which local environment affects compliance; and to provide Congress with recommendations for achieving greater adherence to federal intent. (JOW)

A Study of Medication Compliance in Geriatric Patients with Chronic Illnesses at a Tertiary Care Hospital

PubMed Central

Shruthi, R.; Pundarikaksha, H.P.; Nagesh, G.N.; Tushar, T.J.

2016-01-01

Introduction Geriatric population is more prone for various chronic and recurrent illnesses like diabetes mellitus, hypertension, IHD, arthritic, neurodegenerative, gastrointestinal, ocular, genitourinary, respiratory disorders etc., which may require chronic medication with multiple drugs. Poor compliance in this age group accounts for medication wastage with increased cost of healthcare and substantial worsening of the disease with disability or death. Most of the human and economic costs associated with non adherence can be avoided by improving medication adherence. Aim To assess the level of medication compliance in elderly patients with chronic illnesses and to analyse the factors influencing medication compliance. Materials and Methods The study subjects were assessed by using twenty item structured questionnaires as per modified Morisky Medication Adherence Scale (MMAS). Results A total of 251 subjects of geriatric age group with chronic illnesses were assessed for the level of compliance for long term medications. The average number of medications 2.96±1.42 per subject and most of the subjects were receiving FDCs. The compliance level was assessed by way of interview using a twenty item structured pretested questionnaire as per modified MMAS. The level of compliance was good in 45.41%, moderate in 35.45% and poor in 19.12% of the study subjects. Conclusion The level of compliance positively correlated with the educational status of the study subjects and their awareness about the diseases and prescribed medications. The overall level of compliance was higher in subjects living with spouse or families, subjects without any functional impairment, subjects who were regular for the follow-up visits and also in subjects who did not experience any adverse events. PMID:28208878

Active and passive compliance in an enhanced recovery programme.

PubMed

Thorn, Christopher C; White, Ian; Burch, Jennie; Malietzis, George; Kennedy, Robin; Jenkins, John T

2016-07-01

Enhanced recovery after surgery (ERAS) is a well-established and accepted practice following colorectal surgery and has been demonstrated to reduce hospital length of stay (LOS) and 30-day morbidity. Despite evidence to support the individual elements on which the programme is based, there remains uncertainty as to how many and which of these are required to realise its benefits. Furthermore, elements of an ERAS programme might either precipitate or reflect recovery, in which case compliance could have a role in the improvement or prediction of outcome. A multidimensional prospective database of 799 consecutive patients undergoing colorectal surgery within an established ERAS programme at a single institution was interrogated. After application of exclusion criteria, 614 patients were studied. The novel concept of 'active compliance' is introduced. An ERAS element is classified as 'active' if the participation of the patient is required to achieve its compliance. This contrasts with 'passive' compliance, where an intervention is delivered to the patient without their direct contribution. The short-term surgical outcomes of this cohort are reported with reference to ERAS protocol compliance. Compliance with the passive elements of the programme was higher than with the active elements. Univariate and multivariate analyses demonstrate that poor compliance with active but not passive elements of the programme was significantly associated with major morbidity. Receiver operator characteristic curve analysis demonstrated active compliance to be a stronger predictor of both major morbidity (AUC 0.71 vs. AUC 0.56) and length of stay (AUC 0.83 vs. 0.57) when compared with passive compliance. The results suggest that poor active compliance may be a surrogate marker of morbidity which can be recognised in the early post-operative period. This implies the potential for timely diagnosis and intervention. This aspect of ERAS compliance is clinically relevant yet has achieved

Interventions to improve hand hygiene compliance in patient care.

PubMed

Gould, Dinah J; Moralejo, Donna; Drey, Nicholas; Chudleigh, Jane H

2010-09-08

Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. To update the review done in 2007, to assess the short and longer-term success of strategies to improve hand hygiene compliance and to determine whether a sustained increase in hand hygiene compliance can reduce rates of health care-associated infection. We conducted electronic searches of: the Cochrane Central Register of Controlled Trials; the Cochrane Effective Practice and Organisation of Care Group specialised register of trials; MEDLINE; PubMed; EMBASE; CINAHL; and the BNI. Originally searched to July 2006, for the update databases were searched from August 2006 until November 2009. Randomised controlled trials, controlled clinical trials, controlled before and after studies, and interrupted time series analyses meeting explicit entry and quality criteria used by the Cochrane Effective Practice and Organisation of Care Group were eligible for inclusion. Studies reporting indicators of hand hygiene compliance and proxy indicators such as product use were considered. Self-reported data were not considered a valid measure of compliance. Studies to promote hand hygiene compliance as part of a care bundle approach were included, providing data relating specifically to hand hygiene were presented separately. Studies were excluded if hand hygiene was assessed in simulations, non-clinical settings or the operating theatre setting. Two reviewers independently extracted data and assessed data quality. Four studies met the criteria for the review: two from the original review and two from the update. Two studies evaluated simple education initiatives, one using a randomized clinical trial design and the other a controlled before and after design. Both measured hand hygiene compliance by direct observation. The other two studies were both interrupted times series studies. One study presented three separate interventions within the

Low Left Atrial Compliance Contributes to the Clinical Recurrence of Atrial Fibrillation after Catheter Ablation in Patients with Structurally and Functionally Normal Heart.

PubMed

Park, Junbeom; Yang, Pil-sung; Kim, Tae-Hoon; Uhm, Jae-Sun; Kim, Joung-Youn; Joung, Boyoung; Lee, Moon-Hyoung; Hwang, Chun; Pak, Hui-Nam

2015-01-01

Stiff left atrial (LA) syndrome was initially reported in post-cardiac surgery patients and known to be associated with low LA compliance. We investigated the physiological and clinical implications of LA compliance by estimating LA pulse pressure (LApp) among patients with atrial fibrillation (AF) and structurally and functionally normal heart. Among 1038 consecutive patients with LA pressure measurements before AF ablation, we included 334 patients with structurally and functionally normal heart (81.7% male, 54.1±10.6 years, 77.0% paroxysmal AF) after excluding those with hypertension, diabetes, and previous ablation or cardiac surgery. We measured LApp (peak-nadir LA pressure) at the beginning of the ablation procedure and compared the values with clinical parameters and the AF recurrence rate. AF patients with normal heart were younger and more frequently male and had paroxysmal AF, a lower body mass index, and a lower LApp compared to others (all p<0.05). Based on the median value, the low LA compliance group (LApp≥13 mmHg) had a smaller LA volume index and lower LA voltage (all p<0.05) compared to the high LA compliance group. During a mean follow-up of 16.7±11.8 months, low LA compliance was independently associated with two fold-higher risk of clinical AF recurrence (HR:2.202; 95%CI:1.077-4.503; p = 0.031). Low LA compliance, as determined by an elevated LApp, was associated with a smaller LA volume index and lower LA voltage and independently associated with higher clinical recurrence after catheter ablation in AF patients with structurally and functionally normal heart.

Does self-monitoring of blood glucose levels improve dietary compliance for obese patients with type II diabetes?

PubMed

Wing, R R; Epstein, L H; Nowalk, M P; Scott, N; Koeske, R; Hagg, S

1986-11-01

Self-monitoring of blood glucose levels is currently being recommended for obese patients with type II diabetes to improve weight loss and glycemic control. To determine whether self-monitoring of blood glucose levels improves dietary compliance in these patients, 50 obese patients with type II diabetes were randomly assigned either to a standard behavioral weight control program or to a weight control program that included self-monitoring of blood glucose levels and focused on the weight-blood glucose relationship. Both groups lost significant amounts of weight and maintained their losses for at least one year; reductions in medication could be made for 70 percent of patients. These data suggest that the behavioral weight control used in this study may be of benefit to patients with type II diabetes. However, there was no evidence that the addition of self-monitoring of blood glucose levels to the treatment program improved the outcome in terms of weight loss, reduction in medication, dietary compliance, or mood state.

Long-Term Percutaneous Nephrostomy Management of Malignant Urinary Obstruction: Estimation of Optimal Exchange Frequency and Estimation of the Financial Impact of Patient Compliance.

PubMed

McDevitt, Joseph L; Acosta-Torres, Stefany; Zhang, Ning; Hu, Tianshen; Odu, Ayobami; Wang, Jijia; Xi, Yin; Lamus, Daniel; Miller, David S; Pillai, Anil K

2017-07-01

To estimate the least costly routine exchange frequency for percutaneous nephrostomies (PCNs) placed for malignant urinary obstruction, as measured by annual hospital charges, and to estimate the financial impact of patient compliance. Patients with PCNs placed for malignant urinary obstruction were studied from 2011 to 2013. Exchanges were classified as routine or due to 1 of 3 complication types: mechanical (tube dislodgment), obstruction, or infection. Representative cases were identified, and median representative charges were used as inputs for the model. Accelerated failure time and Markov chain Monte Carlo models were used to estimate distribution of exchange types and annual hospital charges under different routine exchange frequency and compliance scenarios. Long-term PCN management was required in 57 patients, with 87 total exchange encounters. Median representative hospital charges for pyelonephritis and obstruction were 11.8 and 9.3 times greater, respectively, than a routine exchange. The projected proportion of routine exchanges increased and the projected proportion of infection-related exchanges decreased when moving from a 90-day exchange with 50% compliance to a 60-day exchange with 75% compliance, and this was associated with a projected reduction in annual charges. Projected cost reductions resulting from increased compliance were generally greater than reductions resulting from changes in exchange frequency. This simulation model suggests that the optimal routine exchange interval for PCN exchange in patients with malignant urinary obstruction is approximately 60 days and that the degree of reduction in charges likely depends more on patient compliance than exact exchange interval. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

Towards setting credible speed limits: Identifying factors that affect driver compliance on urban roads.

PubMed

Gargoum, Suliman A; El-Basyouny, Karim; Kim, Amy

2016-10-01

Road geometry, vehicle characteristics, and weather conditions are all factors that impact a driver's perception of a safe or credible speed and, consequently, the driver's decision on whether or not to comply with the posted speed limit. In fact, the role a road's environment plays in a driver's perception of a credible speed limit is a topic that has attracted the interest of many researchers in recent years. Despite that, not many studies have considered using empirical data to investigate what features of the road environment influence a driver's compliance choice. This paper aims to address this matter by exploring the relationships between features of the road surroundings (geometric, temporal factors, and weather conditions) and driver compliance with speed limits. The paper uses data from almost 600 different urban roads in the city of Edmonton, at which over 35 million vehicle spot speeds were collected. Compliance was represented using a categorical ordered response variable, and mixed-effects-logistic-regression models were fitted. Two different models were built, one for arterials and another for collector roads. In general, the findings show that the more restricted drivers become, particularly on arterials, the more likely drivers are to comply with speed limits; potential restrictions include on-street parking and the absence of lateral shoulders. Furthermore, higher traffic activity during peak hours, and presumably on shoulder weekdays, both increase the likelihood of compliance on arterials. Similarly, posted speed limits and traffic volume are both positively correlated with compliance on both arterial and collector roads. The findings of this research provide evidence of the existence of an empirical relationship between road features and compliance, highlighting the importance of setting credible speed limits on roads and the possibility of achieving higher compliance rates through modifications to the road environment. Copyright © 2016

Transforming Patient Compliance Research in an Era of Biomedicalization.

PubMed

Spencer, Karen Lutfey

2018-06-01

The term patient noncompliance emerged in the 1970s as a tool for analyzing why people do not follow medical directives. Despite its early popularity, the term has languished in sociology while flourishing in biomedical arenas. It seems flaccid in a contemporary healthcare context as it overestimates physician authority and is tone-deaf to biomedicalization. I draw from sociological and anthropological traditions, as well as qualitative interviews with terminally ill patients ( N = 26) and their caregivers ( N = 16), to consider facets of a biomedicalized health experience and implications for an updated vision of compliance. First, pathways to care have proliferated under biomedicalization. With increased pathways comes increased need for understanding how treatment plans are socially constituted and assessed. Finally, increased complexity demands a more diverse vocabulary for understanding health related decisions. This paper is a call to sociologists to take the lead in transforming and updating this consequential concept.

Direct medical costs and medication compliance among fibromyalgia patients: duloxetine initiators vs. pregabalin initiators.

PubMed

Sun, Peter; Peng, Xiaomei; Sun, Steve; Novick, Diego; Faries, Douglas E; Andrews, Jeffrey S; Wohlreich, Madelaine M; Wu, Andrew

2014-01-01

To assess and compare direct medical costs and medication compliance between patients with fibromyalgia who initiated duloxetine and patients with fibromyalgia who initiated pregabalin in 2008. A retrospective cohort study design was used based on a large US national commercial claims database (2006 to 2009). Patients with fibromyalgia aged 18 to 64 who initiated duloxetine or pregabalin in 2008 and who had continuous health insurance 1 year preceding and 1 year following the initiation were selected into duloxetine cohort or pregabalin cohort based on their initiated agent. Medication compliance was measured by total supply days, medication possession ratio (MPR), and proportion of patients with MPR ≥ 0.8. Direct medical costs were measured by annual costs per patient and compared between the cohorts in the year following the initiation. Propensity score stratification and bootstrapping methods were used to adjust for distribution bias, as well as cross-cohort differences in demographic, clinical and economic characteristics, and medication history prior to the initiation. Both the duloxetine (n = 3,033) and pregabalin (n = 4,838) cohorts had a mean initiation age around 49 years, 89% were women. During the postindex year, compared to the pregabalin cohort, the duloxetine cohort had higher totally annual supply days (273.5 vs. 176.6, P < 0.05), higher MPR (0.7 vs. 0.5, P < 0.05), and more patients with MPR ≥ 0.8 (45.1% vs. 29.4%, P < 0.05). Further, relative to pregabalin cohort, duloxetine cohort had lower inpatient costs ($2,994.9 vs. $4,949.6, P < 0.05), lower outpatient costs ($8,259.6 vs. $10,312.2, P < 0.05), similar medication costs ($5,214.6 vs. $5,290.8, P > 0.05), and lower total medical costs ($16,469.1 vs. $20,552.6, P < 0.05) in the postinitiation year. In a real-world setting, patients with fibromyalgia who initiated duloxetine in 2008 had better medication compliance and consumed less inpatient, outpatient, and total

Compliance of the abdominal wall during laparoscopic insufflation.

PubMed

Becker, Chuck; Plymale, Margaret A; Wennergren, John; Totten, Crystal; Stigall, Kyle; Roth, J Scott

2017-04-01

To provide adequate workspace between the viscera and abdominal wall, insufflation with carbon dioxide is a common practice in laparoscopic surgeries. An insufflation pressure of 15 mmHg is considered to be safe in patients, but all insufflation pressures create perioperative and postoperative physiologic effects. As a composition of viscoelastic materials, the abdominal wall should distend in a predictable manner given the pressure of the pneumoperitoneum. The purpose of this study was to elucidate the relationship between degree of abdominal distention and the insufflation pressure, with the goal of determining factors which impact the compliance of the abdominal wall. A prospective, IRB-approved study was conducted to video record the abdomens of patients undergoing insufflation prior to a laparoscopic surgery. Photo samples were taken every 5 s, and the strain of the patient's abdomen in the sagittal plane was determined, as well as the insufflator pressure (stress) at bedside. Patients were insufflated to 15 mmHg. The relationship between the stress and strain was determined in each sample, and compliance of the patient's abdominal wall was calculated. Subcutaneous fat thickness and rectus abdominus muscle thickness were obtained from computed tomography scans. Correlations between abdominal wall compliances and subcutaneous fat and muscle content were determined. Twenty-five patients were evaluated. An increased fat thickness in the abdominal wall had a direct exponential relationship with abdominal wall compliance (R 2  = 0.59, p < 0.05). There was no correlation between muscle and fat thickness. All insufflation pressures create perioperative and postoperative complications. The compliance of patients' abdominal body walls differs, and subcutaneous fat thickness has a direct exponential relationship with abdominal wall compliance. Thus, insufflation pressures can be better tailored per the patient. Future studies are needed to demonstrate the

Evaluation of compliance with isotretinoin PPP recommendations and exploration of reasons for non-compliance: Survey among French-speaking health care professionals and patients in Belgium.

PubMed

Lelubre, Mélanie; Hamdani, Jamila; Senterre, Christelle; Amighi, Karim; Peres, Marion; Schneider, Marie-Paule; Bugnon, Olivier; De Vriese, Carine

2018-05-03

To evaluate awareness of and compliance in Belgium by French-speaking health care professionals and patients with the isotretinoin safety recommendations regarding its teratogenic risk. Survey using online questionnaires, delivered from December 2014 to March 2015 for patients, pharmacists, dermatologists, and GPs and delivered again from September 2015 to October 2015 for GPs. Questionnaires were completed by 24 dermatologists, 24 GPs, 58 pharmacists, and 33 female patients. The pregnancy prevention programme was poorly known by health care professionals (23.6%) and patients (15.2%). Health care professionals informed women of childbearing age in depth about the teratogenic risk (98.3% of pharmacists and 100.0% of GPs and dermatologists) and the importance of an effective contraceptive method (87.9% and 100.0%, respectively). Patients were less informed about the pregnancy test (25.9% and 14.6%) and the need to use a second contraceptive method (29.3% and 27.1%). The low compliance with the last 2 recommendations was due to a lack of adoption by health care professionals regarding the need for these recommendations if female patients have an effective contraceptive method and the pregnancy risk is discussed in detail with them. The effectiveness of the pregnancy prevention programme recommendations should be reconsidered by an expert committee. Justifications should be added to effective recommendations to increase their adoption by health care professionals and patients. Copyright © 2018 John Wiley & Sons, Ltd.

Narratives of empowerment and compliance: studies of communication in online patient support groups.

PubMed

Wentzer, Helle S; Bygholm, Ann

2013-12-01

New technologies enable new forms of patient participation in health care. The article discusses whether communication in online patient support groups is a source of individual as well as collective empowerment or to be understood within the tradition of compliance. The discussion is based on a qualitative analysis of patient communication in two online groups on the Danish portal sundhed.dk, one for lung patients and one for women with fertility problems. The object of study is the total sum of postings during a specific period of time - a total of 4301 posts are included. The textmaterial was analyzed according to the textual paradigm of Paul Ricoeur, and the three steps of critical interpretation. Thus, the analysis moves from describing communicative characteristics of the site to a thorough semantic analysis of its narrative structure of construing meaning, interaction and collective identity, and finally as a source of collective action. The meta-narratives of the two groups confirm online patient support groups for individual empowerment, for collective group identity, but not for collective empowerment. The collective identities of patienthood on the two sites are created by the users (patients) through specific styles of communication and interaction, referred to as 'multi-logical narratives'. In spite of the potential of online communities of opening up health care to the critical voice of the public, the analysis points to a synthesis of the otherwise opposite positions of empowerment and compliance in patient care. On a collective level, the site is empowering the individual users to comply with 'doctor's recommendations' as a group. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Clean Air Markets - Compliance Query Wizard

EPA Pesticide Factsheets

The Compliance Query Wizard is part of a suite of Clean Air Markets-related tools that are accessible at http://ampd.epa.gov/ampd/. The Compliance module provides final compliance results. Using the Compliance Query Wizard, the user can find compliance information associated with specific programs, facilities, states or time frames. Quick Reports and Prepackaged Datasets are also available for data that are commonly requested. Final compliance results are available for all years since 1995 for the Acid Rain Program and for the various NOx trading programs EPA has operated since 1999.EPA's Clean Air Markets Division (CAMD) includes several market-based regulatory programs designed to improve air quality and ecosystems. The most well-known of these programs are EPA's Acid Rain Program and the NOx Programs, which reduce emissions of sulfur dioxide (SO2) and nitrogen oxides (NOx)-compounds that adversely affect air quality, the environment, and public health. CAMD also plays an integral role in the development and implementation of the Clean Air Interstate Rule (CAIR).

Perceived service quality's effect on patient satisfaction and behavioural compliance.

PubMed

Mohamed, Bahari; Azizan, Noor Azlinna

2015-01-01

The purpose of this paper is to advance healthcare service quality research using hierarchical component models. This study used a quantitative approach with cross-sectional design as a survey method, combining cluster and convenience sampling and partial least square structural equation modelling (PLS-SEM) to validate the research model and test the hypotheses. The study extends health service quality literature by showing that: patient satisfaction (PS) is dominant, significant and indirect determinant of behavioural compliance (BC); perceived service quality has the strongest effect on BC via PS. Only one hospital was evaluated. The study provides managers with a service quality model for conducting integrated service delivery systems analysis and design. Overall, the study makes a significant contribution to healthcare organizations, better health outcomes for patients and better quality of life for the community.

GPs' Perceptions of Cardiovascular Risk and Views on Patient Compliance: A Qualitative Interview Study.

PubMed

Barfoed, Benedicte Lind; Jarbøl, Dorte Ejg; Paulsen, Maja Skov; Christensen, Palle Mark; Halvorsen, Peder Andreas; Nielsen, Jesper Bo; Søndergaard, Jens

2015-01-01

Objective. General practitioners' (GPs') perception of risk is a cornerstone of preventive care. The aims of this interview study were to explore GPs' professional and personal attitudes and experiences regarding treatment with lipid-lowering drugs and their views on patient compliance. Methods. The material was drawn from semistructured qualitative interviews. We sampled GPs purposively from ten selected practices, ensuring diversity of demographic, professional, and personal characteristics. The GPs were encouraged to describe examples from their own practices and reflect on them and were informed that the focus was their personal attitudes and experiences. Systematic text condensation was applied for analysis in order to uncover the concepts and themes. Results. The analysis revealed the following 3 main themes: (1) use of cardiovascular guidelines and risk assessment tools, (2) strategies for managing patient compliance, and (3) GPs' own risk management. There were substantial differences in the attitudes concerning all three themes. Conclusions. The substantial differences in the GPs' personal and professional risk perceptions may be a key to understanding why GPs do not always follow cardiovascular guidelines. The impact on daily clinical practice, personal consultation style, and patient behaviour with regard to prevention is worth studying further.

GPs' Perceptions of Cardiovascular Risk and Views on Patient Compliance: A Qualitative Interview Study

PubMed Central

Barfoed, Benedicte Lind; Jarbøl, Dorte Ejg; Paulsen, Maja Skov; Christensen, Palle Mark; Halvorsen, Peder Andreas; Nielsen, Jesper Bo; Søndergaard, Jens

2015-01-01

Objective. General practitioners' (GPs') perception of risk is a cornerstone of preventive care. The aims of this interview study were to explore GPs' professional and personal attitudes and experiences regarding treatment with lipid-lowering drugs and their views on patient compliance. Methods. The material was drawn from semistructured qualitative interviews. We sampled GPs purposively from ten selected practices, ensuring diversity of demographic, professional, and personal characteristics. The GPs were encouraged to describe examples from their own practices and reflect on them and were informed that the focus was their personal attitudes and experiences. Systematic text condensation was applied for analysis in order to uncover the concepts and themes. Results. The analysis revealed the following 3 main themes: (1) use of cardiovascular guidelines and risk assessment tools, (2) strategies for managing patient compliance, and (3) GPs' own risk management. There were substantial differences in the attitudes concerning all three themes. Conclusions. The substantial differences in the GPs' personal and professional risk perceptions may be a key to understanding why GPs do not always follow cardiovascular guidelines. The impact on daily clinical practice, personal consultation style, and patient behaviour with regard to prevention is worth studying further. PMID:26495143

Determinants of compliance with nasal continuous positive airway pressure treatment applied in a community setting.

PubMed

Ball, E M.; Banks, M B.

2001-05-01

Objectives: To assess determinants of nasal continuous positive airway pressure (CPAP) compliance when applied in a community setting.Background: One-third of obstructive sleep apnea patients eventually refuse CPAP therapy. Treatment outcomes may be improved by identifying predictors of CPAP failure, including whether management by primary care physicians without sleep consultation affects results.Methods: Polysomnogram, chart review, and questionnaire results for regular CPAP users (n=123) were compared with those returning the CPAP machine (n=26).Results: Polysomnographic data and the presence of multiple sleep disorders were only modestly predictive of CPAP compliance. Striking differences in questionnaire responses separated CPAP users from non-users, who reported less satisfaction with all phases of their diagnosis and management. Rates of CPAP use were not significantly different between patients managed solely by their primary care physician or by a sleep consultant.Conclusions: Polysomnographic findings are unlikely to identify eventual CPAP non-compliers in a cost-effective fashion. Improvements in sleep apnea management may result from addressing the role of personality factors and multiple sleep disorders in determining compliance. In this practice setting, management by primary care physicians did not significantly degrade CPAP compliance.

Electronic compliance monitoring in resistant hypertension: the basis for rational therapeutic decisions.

PubMed

Burnier, M; Schneider, M P; Chioléro, A; Stubi, C L; Brunner, H R

2001-02-01

Incomplete compliance is one of several possible causes of uncontrolled hypertension. Yet, non-compliance remains largely unrecognized and is falsely interpreted as treatment resistance, because it is difficult to confirm or exclude objectively. The goal of this study was to evaluate the potential benefits of electronic monitoring of drug compliance in the management of patients with resistant hypertension. Forty-one hypertensive patients resistant to a three-drug regimen (average blood pressure 156/ 106 +/- 23/11 mmHg, mean +/- SD) were studied prospectively. They were informed that for the next 2 months, their presently prescribed drugs would be provided in electronic monitors, without any change in treatment, so as to provide the treating physician with a measure of their compliance. Thereafter, patients were offered the possibility of prolonging the monitoring of compliance for another 2 month period, during which treatment was adapted if necessary. Monitoring of compliance alone was associated with a significant improvement of blood pressure at 2 months (145/97 +/- 20/15 mmHg, P < 0.01). During monitoring, blood pressure was normalized (systolic < 140 mmHg or diastolic < 90 mmHg) in one-third of the patients and insufficient compliance was unmasked in another 20%. When analysed according to tertiles of compliance, patients with the lowest compliance exhibited significantly higher achieved diastolic blood pressures (P = 0.04). In 30 patients, compliance was monitored up to 4 months and drug therapy was adapted whenever necessary. In these patients, a further significant decrease in blood pressure was obtained (from 150/100 +/- 18/15 to 143/94 +/- 22/11 mmHg, P = 0.04/0.02). These results suggest that objective monitoring of compliance using electronic devices may be a useful step in the management of patients with refractory hypertension, as it enables physicians to take rational decisions based on reliable and objective data of drug compliance and hence to

Effects of Messages Delivered by Mobile Phone on Increasing Compliance With Shoulder Exercises Among Patients With a Frozen Shoulder.

PubMed

Chen, Hui-Chun; Chuang, Tai-Yuan; Lin, Pi-Chu; Lin, Yen-Kuang; Chuang, Yeu-Hui

2017-07-01

The aim of this study was to examine the effects of reminders, encouragement, and educational messages delivered by mobile phone on shoulder exercise compliance and improvements in shoulder function among patients with a frozen shoulder. A randomized controlled trial design was used. A convenience sample of patients with a frozen shoulder in an orthopedic outpatient clinic was recruited. All participants were instructed on how to do shoulder exercises and were provided with a printed pamphlet about shoulder exercises. Then, the intervention group received reminders, encouragement, and educational messages by mobile phone daily for the next 2 weeks, while the comparison group did not. The intervention group had higher compliance with shoulder exercises than did the comparison group (t = 2.263, p = .03) and had significant improvements in shoulder forward flexion (F = 12.067, p = .001), external rotation (F = 13.61, p = .001), and internal rotation (F = 5.903, p = .018) compared to those in the comparison group after the 2-week intervention. The text messages significantly increased patient compliance with shoulder exercises and thus improved patients' shoulder range of motion. Hospital or clinics can send appropriate messages to patients via text message platforms in order to remind and encourage them to do shoulder exercises. © 2017 Sigma Theta Tau International.

[Patients living with HIV/AIDS and co-infection by tuberculosis: difficulties associated with treatment compliance or dropout].

PubMed

de Sousa Filho, Manoel Pereira; Luna, Izaildo Tavares; da Silva, Kelanne Lima; Pinheirod, Patrícia Neyva da Costa

2012-06-01

Research carried out in Fortaleza-CE, between March and April 2011, with the objective of describing the difficulties that influence non-compliance to tuberculosis treatment or treatment dropout in patients infected with Human Immunodeficiency Virus. Qualitative study with data collected through a semi-structured interview, applied to patients with acquired immunodeficiency syndrome and with co-infection of tuberculosis. The Collective Subject's Speech was used for result analysis. Patients reported difficulties related to socioeconomic aspects, lifestyle and drug use. The consumption of alcohol and illicit drugs were factors that led to the discontinuance of the therapeutic process of the disease. We conclude that the barriers related to social economical aspects and to lifestyle are more difficult to be faced for a continuous compliance to treatment, making the role played by health professionals necessary, supported by more effective public and social policies.

[Factors associated with compliance to the semi-recumbent position in the patient on mechanical ventilation: CAPCRI-Q questionnaire].

PubMed

Llauradó-Serra, M; Güell-Baró, R; Lobo-Cívico, A; Castanera-Duro, A; Pi-Guerrero, M; Piñol-Tena, A; Paños-Espinosa, C; Calpe-Damians, N; Olona, M; Sandiumenge, A; Jiménez-Herrera, M F

2015-01-01

To create a questionnaire (CAPCRI-Q) to determine the factors associated with the compliance of the semi-recumbent position in patients under mechanical ventilation. A closed questionnaire was created using a literature review and clinical practice. The initial version consisted of 61 items placed into 5 categories: patient factors, team and professionals factors, activity, educational and training factors, and equipment and resources. A Delphi method was used to prepare the questionnaire. Comprehension, relevance and importance of each item were evaluated, as well as the recommendations of experts. A qualitative pilot test with 9 healthcare professionals was performed, followed by a quantitative pilot test with 67 nurses from 6 intensive care units to test the internal consistency of the instrument. Three rounds with 15 experts were required to reach a consensus. The final version of the questionnaire consisted of 36 items enclosed in the same categories as the initial version. The internal consistency analysis showed values greater than 0.800 for each independent item, each category, and for the global questionnaire (0.873; 95%CI: 0.825-0.913). The analysis of the nurses' responses emphasised the importance of the patient factors, as well as organisational and infra-structural factors, for the compliance of the recommendation. The questionnaire created is reliable and appears to have content validity. The most influential factors for compliance are those related to the patient and the internal organisation. The results of the questionnaire can be used to evaluate the factors influencing the compliance and to establish improvement strategies. Copyright © 2015 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

Doctor-patient communication: some quantitative estimates of the role of cognitive factors in non-compliance.

PubMed

Ley, P

1985-04-01

Patients frequently fail to understand what they are told. Further, they frequently forget the information given to them. These factors have effects on patients' satisfaction with the consultation. All three of these factors--understanding, memory and satisfaction--have effects on the probability that a patient will comply with advice. The levels of failure to understand and remember and levels of dissatisfaction are described. Quantitative estimates of the effects of these factors on non-compliance are presented.

Design and methodology of the COACH-2 (Comparative study on guideline adherence and patient compliance in heart failure patients) study: HF clinics versus primary care in stable patients on optimal therapy.

PubMed

Luttik, M L A; Brons, M; Jaarsma, T; Hillege, H L; Hoes, A; de Jong, R; Linssen, G; Lok, D J; Berger, M; van Veldhuisen, D J

2012-08-01

Since the number of heart failure (HF) patients is still growing and long-term treatment of HF patients is necessary, it is important to initiate effective ways for structural involvement of primary care services in HF management programs. However, evidence on whether and when patients can be referred back to be managed in primary care is lacking. To determine whether long-term patient management in primary care, after initial optimisation of pharmacological and non-pharmacological treatment in a specialised HF clinic, is equally effective as long-term management in a specialised HF clinic in terms of guideline adherence and patient compliance. The study is designed as a randomised, controlled, non-inferiority trial. Two-hundred patients will be randomly assigned to be managed and followed in primary care or in a HFclinic. Patients are eligible to participate if they are (1) clinically stable, (2) optimally up-titrated on medication (according to ESC guidelines) and, (3) have received optimal education and counselling on pre-specified issues regarding HF and its treatment. Furthermore, close cooperation between secondary and primary care in terms of back referral to or consultation of the HF clinic will be provided.The primary outcome will be prescriber adherence and patient compliance with medication after 12 months. Secondary outcomes measures will be readmission rate, mortality, quality of life and patient compliance with other lifestyle changes. The results of the study will add to the understanding of the role of primary care and HF clinics in the long-term follow-up of HF patients.

Understanding medication compliance and persistence from an economics perspective.

PubMed

Elliott, Rachel A; Shinogle, Judith A; Peele, Pamela; Bhosle, Monali; Hughes, Dyfrig A

2008-01-01

An increased understanding of the reasons for noncompliance and lack of persistence with prescribed medication is an important step to improve treatment effectiveness, and thus patient health. Explanations have been attempted from epidemiological, sociological, and psychological perspectives. Economic models (utility maximization, time preferences, health capital, bilateral bargaining, stated preference, and prospect theory) may contribute to the understanding of medication-taking behavior. Economic models are applied to medication noncompliance. Traditional consumer choice models under a budget constraint do apply to medication-taking behavior in that increased prices cause decreased utilization. Nevertheless, empiric evidence suggests that budget constraints are not the only factor affecting consumer choice around medicines. Examination of time preference models suggests that the intuitive association between time preference and medication compliance has not been investigated extensively, and has not been proven empirically. The health capital model has theoretical relevance, but has not been applied to compliance. Bilateral bargaining may present an alternative model to concordance of the patient-prescriber relationship, taking account of game-playing by either party. Nevertheless, there is limited empiric evidence to test its usefulness. Stated preference methods have been applied most extensively to medicines use. Evidence suggests that patients' preferences are consistently affected by side effects, and that preferences change over time, with age and experience. Prospect theory attempts to explain how new information changes risk perceptions and associated behavior but has not been applied empirically to medication use. Economic models of behavior may contribute to the understanding of medication use, but more empiric work is needed to assess their applicability.

40 CFR 72.90 - Annual compliance certification report.

Code of Federal Regulations, 2014 CFR

2014-07-01

... is subject to the Acid Rain emissions limitations, the designated representative of the source at... the source and the affected units at the source in compliance with the Acid Rain Program, whether each... covered by the report in compliance with the requirements of the Acid Rain Program applicable to the unit...

40 CFR 72.90 - Annual compliance certification report.

Code of Federal Regulations, 2011 CFR

2011-07-01

... is subject to the Acid Rain emissions limitations, the designated representative of the source at... the source and the affected units at the source in compliance with the Acid Rain Program, whether each... covered by the report in compliance with the requirements of the Acid Rain Program applicable to the unit...

40 CFR 72.90 - Annual compliance certification report.

Code of Federal Regulations, 2012 CFR

2012-07-01

... is subject to the Acid Rain emissions limitations, the designated representative of the source at... the source and the affected units at the source in compliance with the Acid Rain Program, whether each... covered by the report in compliance with the requirements of the Acid Rain Program applicable to the unit...

40 CFR 72.90 - Annual compliance certification report.

Code of Federal Regulations, 2013 CFR

2013-07-01

... is subject to the Acid Rain emissions limitations, the designated representative of the source at... the source and the affected units at the source in compliance with the Acid Rain Program, whether each... covered by the report in compliance with the requirements of the Acid Rain Program applicable to the unit...

Patient compliance with drug therapy in schizophrenia. Economic and clinical issues.

PubMed

Lindström, E; Bingefors, K

2000-08-01

The effectiveness of drug treatment in clinical practice is considerably lower than the efficacy shown in controlled studies. The lower effectiveness in practice presumably leads to lower cost effectiveness of drug treatment in real-life situations compared with that demonstrated by studies based on results from controlled trials. Improved cost effectiveness in routine clinical practice would be a significant advantage in the treatment of schizophrenia, one of the most costly diseases in society. The aetiology of schizophrenia is unknown, and there is no cure. The main aims of therapy with antipsychotic medication include the effective relief of symptoms without the introduction of adverse effects or serious adverse events, improved quality of life, cost effectiveness and a positive long term outcome. The older classical antipsychotic drugs do not always meet these requirements because of their well-known limitations, such as a lack of response in a subgroup of individuals with schizophrenia and intolerable adverse effects. There has long been a need for new antipsychotics that can ameliorate more symptoms and have no or few adverse effects. Some of the recently introduced antipsychotics have been shown to be more effective in certain clinical situations and to have a more favourable adverse effect profile than the classical antipsychotics. A major factor contributing to the lower effectiveness of drug treatment is noncompliance, which may be very high in schizophrenia. There are several factors influencing compliance, including drug type and formulation, patient, disease status, physician, health care system, community care and family. There have been very few studies of compliance improvement strategies in schizophrenia or, indeed, in medicine in general. Current methods are relatively complex and there are differing opinions on their effectiveness. There are several ways to increase compliance in schizophrenia--the evidence is strongest for psychoeducative

Compliance with lifestyle recommendations in kidney allograft recipients.

PubMed

Kobus, G; Małyszko, J; Małyszko, J S; Puza, E; Bachórzewska-Gajewska, H; Myśliwiec, M

2011-10-01

Many factors affect long-term graft and patient survival. Compliance with lifestyle recommendation may be an important factor. Lifestyle modifications may play a therapeutic and protective role against graft failure and possible death. The aim of this work was to assess compliance with lifestyle recommendations among 110 kidney allograft recipients. All patients were asked to complete a questionnaire regarding life style, frequency of outpatient visits, self-control, diet, physical activity and addictions. The mean age of the population was 48.79±13.18 years, and their mean time after transplantation was 69±44.5 years with a mean serum creatinine value of 1.45±0.7 mg/dL. Physicians were the major source of information (40%) for patients while in the hospital; nurses informed patients in only 5.5% of cases. The majority of patients (97.5%) attended regular outpatient clinic visits. A similar percentage of subjects regularly measured their blood pressure at home. One-fifth of the patient wrote a self-control diary. Only 55.5% of patients knew the immunosuppressive regimen, including the doses of the medications. An overweight condition was diagnosed in 39%, with obesity in 22%; 16% of the patients were smokers; one-fourth of the patients drank alcohol at least several times a month; 85.3% of patients did not change their diet after kidney transplantation; and one-half of the patients (64.2%) were not aware of dietary recommendations after kidney transplantation. The majority of patients regularly attended the outpatient clinic and ingested immunosuppressive medications. However, their knowledge regarding diet, cancer prophylaxis, and self-control was insufficient. Therefore, there is a need to introduce more intense organizational and educational activities to improve patient knowledge. Copyright © 2011 Elsevier Inc. All rights reserved.

40 CFR Table 11 to Subpart Xxxx of... - Minimum Data for Continuous Compliance With the Emission Limits for Tire Cord Production Affected...

Code of Federal Regulations, 2010 CFR

2010-07-01

... With the Emission Limits for Tire Cord Production Affected Sources 11 Table 11 to Subpart XXXX of Part... for Hazardous Air Pollutants: Rubber Tire Manufacturing Pt. 63, Subpt. XXXX, Table 11 Table 11 to Subpart XXXX of Part 63—Minimum Data for Continuous Compliance With the Emission Limits for Tire Cord...

Compliance in peritoneal dialysis: a qualitative study of renal nurses.

PubMed

McCarthy, Alexandra; Cook, Peta S; Fairweather, Carrie; Shaban, Ramon; Martin-McDonald, Kristine

2009-06-01

End-stage renal failure is a life-threatening condition, often treated with home-based peritoneal dialysis (PD). PD is a demanding regimen, and the patients who practise it must make numerous lifestyle changes and learn complicated biomedical techniques. In our experience, the renal nurses who provide most PD education frequently express concerns that patient compliance with their teaching is poor. These concerns are mirrored in the renal literature. It has been argued that the perceived failure of health professionals to improve compliance rates with PD regimens is because 'compliance' itself has never been adequately conceptualized or defined; thus, it is difficult to operationalize and quantify. This paper examines how a group of Australian renal nurses construct patient compliance with PD therapy. These empirical data illuminate how PD compliance operates in one practice setting; how it is characterized by multiple and often competing energies; and how ultimately it might be pointless to try to tame 'compliance' through rigid definitions and measurement, or to rigidly enforce it in PD patients. The energies involved are too fractious and might be better spent, as many of the more experienced nurses in this study argue, in augmenting the energies that do work well together to improve patient outcomes.

Compliance to follow up and adherence to medication in hypertensive patients in an urban informal settlement in Kenya: comparison of three models of care.

PubMed

Kuria, Ng'endo; Reid, Anthony; Owiti, Philip; Tweya, Hannock; Kibet, Caleb Kipkurui; Mbau, Lilian; Manzi, Marcel; Murunga, Victor; Namusonge, Tecla; Kibachio, Joseph

2018-05-19

To determine and compare, among three models of care, compliance to scheduled clinic appointments and adherence to anti-hypertensive medication of patients in an informal settlement of Kibera, Kenya. Routinely collected patient data were used from three health facilities, six walkway clinics and one weekend/church clinic. Patients were eligible if they had received hypertension care for more than six months. Compliance with clinic appointments and self-reported adherence to medication were determined from clinic records and compared using the Chi-square test. Univariate and multivariate logistic regression models estimated the odds of overall adherence to medication. 785 patients received hypertension treatment eligible for analysis, of whom two-thirds were women. Between them, there were 5879 clinic visits with an overall compliance to appointments of 63%. Compliance was high in the health facilities and walkway clinics but men were more likely to attend the weekend/church clinics. Self-reported adherence to medication by those complying with scheduled clinic visits was 94%. Patients in the walkway clinics were two times more likely to adhere to anti-hypertensive medication than patients at the health facility (OR 1.97, 95%CI 1.25-3.10). Walkway clinics outperformed health facilities and weekend clinics. Use of multiple sites for the management of hypertensive patients led to good compliance with scheduled clinic visits and very good self-reported adherence to medication in a low-resource setting. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Vitamin D supplementation in inflammatory bowel disease: the role of dosage and patient compliance.

PubMed

Kojecky, V; Adamikova, A; Klimek, P

2016-01-01

Vitamin D substitution is recommended in patients with inflammatory bowel disease. Specific guidelines are lacking. The aim of this study was to assess the effect of vitamin D supplementation with respect to dosage and patient compliance. A prospective cohort study of 167 Crohn disease/ulcerative colitis outpatients. Patients were screened for serum vitamin D (25OHD2+3) at the end of summer and in late winter. Demographic data, history of vitamin D supplementation were recorded and matched with prescription records. A total of 57 subjects used vitamin D supplementation (mean dose 1104 IU/day). 25OHD2+3 levels were lower (p < 0.001) in winter both in substituted and unsubstituted group, without any differences between groups within the same season. 25OHD2+3 levels did not correlate with the substitution dose. 52.1 % of subjects were fully compliant with substitution. 25OHD2+3 and prevalence of vitamin D deficit in this group were comparable with unsubstituted subjects except a higher prevalence of vitamin D insufficiency (p < 0.02). Fixed dosage of 1100 IU/day of vitamin D was insufficient to correct the deficiency. Patient compliance with vitamin D supplementation was low, however this fact did not significantly contribute to the degree of vitamin D deficiency in this dosage (Tab. 3, Fig. 1, Ref. 21).

Hemodynamic Assessment of Compliance of Pre-Stressed Pulmonary Valve-Vasculature in Patient Specific Geometry Using an Inverse Algorithm

NASA Astrophysics Data System (ADS)

Hebbar, Ullhas; Paul, Anup; Banerjee, Rupak

2016-11-01

Image based modeling is finding increasing relevance in assisting diagnosis of Pulmonary Valve-Vasculature Dysfunction (PVD) in congenital heart disease patients. This research presents compliant artery - blood interaction in a patient specific Pulmonary Artery (PA) model. This is an improvement over our previous numerical studies which assumed rigid walled arteries. The impedance of the arteries and the energy transfer from the Right Ventricle (RV) to PA is governed by compliance, which in turn is influenced by the level of pre-stress in the arteries. In order to evaluate the pre-stress, an inverse algorithm was developed using an in-house script written in MATLAB and Python, and implemented using the Finite Element Method (FEM). This analysis used a patient specific material model developed by our group, in conjunction with measured pressure (invasive) and velocity (non-invasive) values. The analysis was performed on an FEM solver, and preliminary results indicated that the Main PA (MPA) exhibited higher compliance as well as increased hysteresis over the cardiac cycle when compared with the Left PA (LPA). The computed compliance values for the MPA and LPA were 14% and 34% lesser than the corresponding measured values. Further, the computed pressure drop and flow waveforms were in close agreement with the measured values. In conclusion, compliant artery - blood interaction models of patient specific geometries can play an important role in hemodynamics based diagnosis of PVD.

Understanding compliance issues for daily self-injectable treatment in ambulatory care settings

PubMed Central

Brod, Meryl; Rousculp, Matthew; Cameron, Ann

2008-01-01

Background The challenge of understanding factors influencing compliance with injectable treatments is critical as injectable biologics/medications become more common. Objective Understanding compliance issues for long term self-injectable treatments, using a chronic condition (osteoporosis) as a model. Research design A qualitative study to generate hypotheses regarding compliance issues for self-injectable treatments. Semi-structured interview guides were developed and data collected from patients and clinical experts. Findings were analyzed for common themes and a conceptual model of the compliance impact of self-injectable treatments generated. Subjects Six physicians (Rheumatology, Internal Medicine, and Endocrinology) and 22 patients (14% never began treatment, 23% had filled at least one prescription but discontinued treatment, and 63% were currently on treatment) were interviewed. Results Physician and patient factors influenced the compliance process at four distinct time-points: pre-treatment, time treatment recommended, short-term, and long-term. Physician factors that influenced patients’ persistence were knowledge about treatment, patient-training resources, and clinical profile/efficacy evaluations. For patients, motivation level, physician message, and clinical profile were key. Logistical issues, minor side effects and injection site issues influenced adherence but not persistence. Conclusions Compliance is a multifactorial, dynamic process. Both physician and patient factors influence compliance at different points in the process. PMID:19920953

Non-surgical and supportive periodontal therapy: predictors of compliance

PubMed Central

Delatola, Chrysoula; Adonogianaki, Evagelia; Ioannidou, Effie

2015-01-01

Aim To identify predictors of compliance during non-surgical and supportive periodontal therapy (SPT). Materials and Methods In this retrospective study, demographic, dental, medical data of 427 new patients in a private practice were collected. Data were analysed in statistical models with non-surgical therapy and SPT compliance used as dependent variables. Results Of the 427 patients, 17.3% never agreed to initial therapy, 10.7% never completed therapy and 20.8% completed treatment, but never entered SPT. Of the 218 SPT patients, 56% became non-attenders after a period of 20 months, 33% were erratic attenders and 10.5% were regular attenders until the end of the observation period (5.5–6.5 years). Patients became erratic attenders after a mean period of regular attendance of 18.1 ± 16.2 months, whereas 49.6% of the patients, who abandoned SPT, were regular attenders until the time they stopped. In a univariate correlation model, periodontal disease severity emerged as a significant predictor of the completion of non-surgical periodontal therapy (p = 0.01). In a multivariate linear regression model, smoking was negatively associated with SPT compliance (p = 0.047). Conclusions A low compliance of the population was observed. Smoking and periodontal disease severity represented significant, but modest modifiers of a patient compliance with SPT and initial therapy respectively. PMID:24813661

Evaluation of a continual compliance monitoring program for dapsone in an outpatient Hansen's disease clinic.

PubMed

Fischer, J H; West, D P; Worobec, S M

1986-12-01

Guidelines for the assessment of patient compliance to dapsone were developed and evaluated. The urinary dapsone-to-creatinine (D/C) ratio following standardization by dose, ideal body weight, and time since last dose was used for assessment of compliance. Compliance standards were established in 12 patients of known compliance and confirmed prospectively in nine inpatients on 14 occasions. Compliance increased significantly among outpatients (N = 30) attending the University of Illinois Hansen's Disease Clinic from 47% at base line to 73% at 6 months and 80% at 18 months after establishing the monitoring program. In a subgroup of 18 patients, a similar increase in compliance was observed from 50% to 80%. A good therapeutic response was seen in the subgroup patients who were compliant. A poor therapeutic response was seen in the consistently noncompliant patients. These results demonstrate that use of a continual compliance monitoring program can improve patient drug compliance in an outpatient Hansen's disease clinic.

Patient compliance to wear orthodontic retainers during postretention may vary by age, gender, and time since braces were removed.

PubMed

Vig, Katherine W L

2012-09-01

During January to July 2008 a questionnaire was mailed to 1085 subjects who had completed comprehensive orthodontic fixed-appliance treatment from 6 months to 6 years following active tooth movement. This yielded 280 responses (25.8% response rate) after 2 mailings, 3 months apart. The respondents ranged in age from 8 to 72 years. Respondents were from various socioeconomic groups and urban or rural environments. Identifiers allowed respondents to be classified into subgroups. Predictors of compliance among patients/subjects who were provided with removable vacuum-formed retainers (VFRs) or Hawley retainers in the postretention phase of orthodontic treatment. The main outcome measure was self-reported compliance with different types of removable orthodontic retainers worn during the postretention phase of treatment. A logistic regression model identified probabilities of retainer wear, including a likelihood ratio to test the model parameters using chi-square statistics to identify significant variables. The model found age, gender, amount of time since braces were removed, type of retainer, and interpretation of compliance in retainer wear to be statistically significant variables. Time on retainer compliance revealed better compliance with VFR than Hawley retainers during the first 2 years after braces were removed, but then compliance increased with Hawley retainers and overall compliance was greater with Hawley retainers. Compliance with wearing removable retainers was initially better with VFRs but over time was greater with Hawley retainers, and esthetics was not a determinant. Several variables determined compliance, including age, gender, and type of retainer. Copyright © 2012. Published by Mosby, Inc. All rights reserved.

Changes in Cerebral Compartmental Compliances during Mild Hypocapnia in Patients with Traumatic Brain Injury

PubMed Central

Steiner, Luzius A.; Castellani, Gianluca; Smielewski, Peter; Zweifel, Christian; Haubrich, Christina; Pickard, John D.; Menon, David K.; Czosnyka, Marek

2011-01-01

Abstract The benefit of induced hyperventilation for intracranial pressure (ICP) control after severe traumatic brain injury (TBI) is controversial. In this study, we investigated the impact of early and sustained hyperventilation on compliances of the cerebral arteries and of the cerebrospinal (CSF) compartment during mild hyperventilation in severe TBI patients. We included 27 severe TBI patients (mean 39.5 ± 3.4 years, 6 women) in whom an increase in ventilation (20% increase in respiratory minute volume) was performed during 50 min as part of a standard clinical CO2 reactivity test. Using a new mathematical model, cerebral arterial compliance (Ca) and CSF compartment compliance (Ci) were calculated based on the analysis of ICP, arterial blood pressure, and cerebral blood flow velocity waveforms. Hyperventilation initially induced a reduction in ICP (17.5 ± 6.6 vs. 13.9 ± 6.2 mmHg; p < 0.001), which correlated with an increase in Ci (r2 = 0.213; p = 0.015). Concomitantly, the reduction in cerebral blood flow velocities (CBFV, 74.6 ± 27.0 vs. 62.9 ± 22.9 cm/sec; p < 0.001) marginally correlated with the reduction in Ca (r2 = 0.209; p = 0.017). During sustained hyperventilation, ICP increased (13.9 ± 6.2 vs. 15.3 ± 6.4 mmHg; p < 0.001), which correlated with a reduction in Ci (r2 = 0.297; p = 0.003), but no significant changes in Ca were found during that period. The early reduction in Ca persisted irrespective of the duration of hyperventilation, which may contribute to the lack of clinical benefit of hyperventilation after TBI. Further studies are needed to determine whether monitoring of arterial and CSF compartment compliances may detect and prevent an adverse ischemic event during hyperventilation. PMID:21204704

Impaired fasting pyloric compliance in gastroparesis and the therapeutic response to pyloric dilatation.

PubMed

Gourcerol, G; Tissier, F; Melchior, C; Touchais, J Y; Huet, E; Prevost, G; Leroi, A M; Ducrotte, P

2015-02-01

Pyloric pressure and compliance have never been investigated in health nor gastroparesis. We hypothesised that pyloric pressure and/or compliance may be altered in gastroparesis. Fasting pyloric pressure and compliance were investigated in 21 healthy volunteers (HV), 27 gastroparetic patients (GP) and 5 patients who had undergone oesophagectomy without pyloroplasty as positive controls. Under videofluoroscopic control, pyloric compliance and pressure were measured by the EndoFLIP technique. Gastric emptying half time (T1/2 ) using (13) C-octanoic acid breath test, as well as symptoms and quality of life (GIQLI score) were also monitored. Mean fasting pyloric compliance was measured at 25.2 ± 2.4 mm²/mmHg in HV, and was lower both in GP (16.9 ± 2.1 mm²/mmHg; P < 0.05) and patients with oesophagectomy (10.9 ± 2.9 mm²/mmHg; P < 0.05). By contrast, fasting pyloric pressure was not different among groups. Fasting pyloric compliance and pressure correlated with T1/2 in GP (R = -0.43; P = 0.04). Fasting pyloric compliance, but not pressure, correlated with symptoms and GIQLI score. Pyloric dilation in 10 GP with low fasting pyloric compliance (<10 mm²/mmHg) increased compliance from 7.4 ± 0.4 to 20.1 ± 4.9 mm²/mmHg (P < 0.01) and improved the GIQLI score from 72.5 ± 5.5 to 89.3 ± 6.1 (P = 0.04). This prospective study assessed pyloric compliance for the first time, and showed that fasting pyloric compliance is decreased in gastroparetic patients and is associated with T1/2 , symptoms and quality of life. This suggests that pyloric compliance may be a new relevant metric in gastroparetic patients, and may be useful to target patients for pyloric dilation or botulinum toxin injection. © 2014 John Wiley & Sons Ltd.

Effect of electronically delivered prescriptions on compliance and pharmacy wait time among emergency department patients.

PubMed

Fernando, Tasha J; Nguyen, Duy D; Baraff, Larry J

2012-01-01

The primary objectives were to assess whether electronically delivered prescriptions lead to reduced pharmacy wait time, improved patient satisfaction, and improved compliance with prescriptions. Secondary objectives included determining other reasons for noncompliance and if there was an association between prescription noncompliance and subsequent physician and emergency department (ED) visits. In this prospective study, patients discharged from the Ronald Reagan UCLA Medical Center ED with prescriptions for nonnarcotic medications were randomized to a control group who were discharged with standard written prescriptions or an intervention group who had their prescriptions electronically delivered to the pharmacy of their choice. All study participants were contacted 7 to 31 days after ED discharge for a structured telephone interview. Of the 454 patients enrolled, follow-up was successful for 224 patients (52.4%). Twenty-eight patients did not fill their prescriptions (12.5% noncompliance rate). The top three reasons patients stated for not picking up their medications were perceiving their prescription as unnecessary (n = 11), medication affordability (n = 5), and lack of time (n = 4). There was no difference in primary prescription noncompliance between the two study groups (p = 0.58). However, electronically delivered prescriptions significantly reduced the median pharmacy wait time, from 15 to 0 minutes (p = 0.001), and improved patient satisfaction at the pharmacy (p = 0.034). Neither subsequent physician nor ED visits were increased by primary prescription noncompliance. Electronically delivered prescriptions significantly minimized pharmacy wait time and improved patient satisfaction at the pharmacy, but did not improve primary compliance with prescriptions. © 2011 by the Society for Academic Emergency Medicine.

Improvement of therapeutic compliance in haemodialysis patients with poor phosphorus control and adherence to treatment with binders: COMQUELFOS study.

PubMed

Dolores Arenas, M; Pérez-García, Rafael; Bennouna, Mazine; Blanco, Ana; Mauricio, Oscar; Prados, M Dolores; Lerma, José L; Luisa Muñiz, M; Belén Martín, M

2013-01-01

The effectiveness of phosphate binders in daily practice is directly related to therapeutic compliance (TC) by the patient. The goal of this study was to analyse the TC of haemodialysis patients with hyperphosphatemia and its influence on serum phosphorus for 6 months follow up. 181 patients were included, who had mean initial phosphate levels (P) >5mg/dl. TC with different phosphate binders was evaluated, considering non-adherent patients those who had <75% of TC, SMAQ scale score of "non-adherent"(Table 1), and P>5mg/dl. Patients who were adherent at baseline visit (BV) left the study, the rest continued to V5 (6 months). TC at baseline and during the follow up (V1-V5) was analysed. Phosphate binders and the evolution of phosphataemia based on treatment were assessed. 103 male and 78 female patients were evaluated, with a mean age of 59.9 (21-86) years. Of these, 39.2% (n=71) were adherent in the BV. Patients older than 60 years of age were more adherent than younger ones (P=.019).Table 6 specifies the causes of non-compliance. The remaining 60.8% of patients (n=110), were non-adherent and continued through to the end of the study. An average of 27.2% of these patients became adherent during the course of the study. Table 7 shows the relative levels of P with TC over successive visits. At the end of the study, mean P levels had decreased by 1.26mg/dl (P<.0001). Among HD patients with poor P level control, there is a low level of adherence with phosphorus binder treatment, at 39.2%. Compliance and phosphataemia are improved with different strategies. The decrease of P is higher in adherent patients than in non-adherent patients.

Impact of Compliance on Dysphagia Rehabilitation in Head and Neck Cancer Patients: Results from a Multi-center Clinical Trial.

PubMed

Krisciunas, Gintas P; Castellano, Kerlly; McCulloch, Timothy M; Lazarus, Cathy L; Pauloski, Barbara R; Meyer, Tanya K; Graner, Darlene; Van Daele, Douglas J; Silbergleit, Alice K; Crujido, Lisa R; Rybin, Denis; Doros, Gheorghe; Kotz, Tamar; Langmore, Susan E

2017-04-01

A 5-year, 16-site, randomized controlled trial enrolled 170 HNC survivors into active (estim + swallow exercise) or control (sham estim + swallowing exercise) arms. Primary analyses showed that estim did not enhance swallowing exercises. This secondary analysis determined if/how patient compliance impacted outcomes. A home program, performed 2 times/day, 6 days/week, for 12 weeks included stretches and 60 swallows paired with real or sham estim. Regular clinic visits ensured proper exercise execution, and detailed therapy checklists tracked patient compliance which was defined by mean number of sessions performed per week (0-12 times) over the 12-week intervention period. "Compliant" was defined as performing 10-12 sessions/week. Outcomes were changes in PAS, HNCI, PSS, OPSE, and hyoid excursion. ANCOVA analyses determined if outcomes differed between real/sham and compliant/noncompliant groups after 12 weeks of therapy. Of the 170 patients enrolled, 153 patients had compliance data. The mean number of sessions performed was 8.57/week (median = 10.25). Fifty-four percent of patients (n = 83) were considered "compliant." After 12 weeks of therapy, compliant patients in the sham estim group realized significantly better PAS scores than compliant patients in the active estim group (p = 0.0074). When pooling all patients together, there were no significant differences in outcomes between compliant and non-compliant patients. The addition of estim to swallowing exercises resulted in worse swallowing outcomes than exercises alone, which was more pronounced in compliant patients. Since neither compliant nor non-compliant patients benefitted from swallowing exercises, the proper dose and/or efficacy of swallowing exercises must also be questioned in this patient population.

On the independence of compliance and reliance: are automation false alarms worse than misses?

PubMed

Dixon, Stephen R; Wickens, Christopher D; McCarley, Jason S

2007-08-01

Participants performed a tracking task and system monitoring task while aided by diagnostic automation. The goal of the study was to examine operator compliance and reliance as affected by automation failures and to clarify claims regarding independence of these two constructs. Background data revealed a trend toward nonindependence of the compliance-reliance constructs. Thirty-two undergraduate students performed the simulation that presented the visual display while dependent measures were collected. False alarm-prone automation hurt overall performance more than miss-prone automation. False alarm-prone automation also clearly affected both operator compliance and reliance, whereas miss-prone automation appeared to affect only operator reliance. Compliance and reliance do not appear to be entirely independent of each other. False alarms appear to be more damaging to overall performance than misses, and designers must take the compliance-reliance constructs into consideration.

Patients' information-seeking activity is associated with treatment compliance in inflammatory bowel disease patients.

PubMed

Pittet, Valérie; Rogler, Gerhard; Mottet, Christian; Froehlich, Florian; Michetti, Pierre; de Saussure, Philippe; Burnand, Bernard; Vader, John-Paul

2014-06-01

Despite the chronic and relapsing nature of inflammatory bowel diseases (IBD), at least 30% to 45% of the patients are noncompliant to treatment. IBD patients often seek information about their disease. To examine the association between information-seeking activity and treatment compliance among IBD patients. To compare information sources and concerns between compliant and noncompliant patients. We used data from the Swiss IBD cohort study, and from a qualitative survey conducted to assess information sources and concerns. Crude and adjusted odds ratios (OR) for noncompliance were calculated. Differences in the proportions of information sources and concerns were compared between compliant and noncompliant patients. A total of 512 patients were included. About 18% (n = 99) of patients were reported to be noncompliant to drug treatment and two-thirds (n = 353) were information seekers. The OR for noncompliance among information seekers was 2.44 (95%CI: 1.34-4.41) after adjustment for confounders and major risk factors. General practitioners were 15.2% more often consulted (p = 0.019) among compliant patients, as were books and television (+13.1%; p = 0.048), whereas no difference in proportions was observed for sources such as internet or gastroenterologists. Information on tips for disease management were 14.2% more often sought among noncompliant patients (p = 0.028). No difference was observed for concerns on research and development on IBD or therapies. In Switzerland, IBD patients noncompliant to treatment were more often seeking disease-related information than compliant patients. Daily management of symptoms and disease seemed to be an important concern of those patients.

Barriers to compliance with evidence-based care in trauma.

PubMed

Rayan, Nadine; Barnes, Sunni; Fleming, Neil; Kudyakov, Rustam; Ballard, David; Gentilello, Larry M; Shafi, Shahid

2012-03-01

We have preciously demonstrated that trauma patients receive less than two-thirds of the care recommended by evidence-based medicine. The purpose of this study was to identify patients least likely to receive optimal care. Records of a random sample of 774 patients admitted to a Level I trauma center (2006-2008) with moderate to severe injuries (Abbreviated Injury Scale score ≥3) were reviewed for compliance with 25 trauma-specific processes of care (T-POC) endorsed by Advanced Trauma Life Support, Eastern Association for the Surgery of Trauma, the Brain Trauma Foundation, Surgical Care Improvement Project, and the Glue Grant Consortium based on evidence or consensus. These encompassed all aspects of trauma care, including initial evaluation, resuscitation, operative care, critical care, rehabilitation, and injury prevention. Multivariate logistic regression was used to identify patients likely to receive recommended care. Study patients were eligible for a total of 2,603 T-POC, of which only 1,515 (58%) were provided to the patient. Compliance was highest for T-POC involving resuscitation (83%) and was lowest for neurosurgical interventions (17%). Increasing severity of head injuries was associated with lower compliance, while intensive care unit stay was associated with higher compliance. There was no relationship between compliance and patient demographics, socioeconomic status, overall injury severity, or daily volume of trauma admissions. Little over half of recommended care was delivered to trauma patients with moderate to severe injuries. Patients with increasing severity of traumatic brain injuries were least likely to receive optimal care. However, differences among patient subgroups are small in relation to the overall gap between observed and recommended care. II.

Physician perspectives and compliance with patient advance directives: the role external factors play on physician decision making.

PubMed

Burkle, Christopher M; Mueller, Paul S; Swetz, Keith M; Hook, C Christopher; Keegan, Mark T

2012-11-21

Following passage of the Patient Self Determination Act in 1990, health care institutions that receive Medicare and Medicaid funding are required to inform patients of their right to make their health care preferences known through execution of a living will and/or to appoint a surrogate-decision maker. We evaluated the impact of external factors and perceived patient preferences on physicians' decisions to honor or forgo previously established advance directives (ADs). In addition, physician views regarding legal risk, patients' ability to comprehend complexities involved with their care, and impact of medical costs related to end-of-life care decisions were explored. Attendees of two Mayo Clinic continuing medical education courses were surveyed. Three scenarios based in part on previously court-litigated matters assessed impact of external factors and perceived patient preferences on physician compliance with patient-articulated wishes regarding resuscitation. General questions measured respondents' perception of legal risk, concerns over patient knowledge of idiosyncrasies involved with their care, and impact medical costs may have on compliance with patient preferences. Responses indicating strength of agreement or disagreement with statements were treated as ordinal data and analyzed using the Cochran Armitage trend test. Three hundred eighty-eight of 951 surveys were completed (41% response rate). Eighty percent reported they were likely to honor a patient's AD despite its 5 year age. Fewer than half (41%) would honor the AD of a patient in ventricular fibrillation who had expressed a desire to "pass away in peace." Few (17%) would forgo an AD following a family's request for continued resuscitative treatment. A majority (52%) considered risk of liability to be lower when maintaining someone alive against their wishes than mistakenly failing to provide resuscitative efforts. A large percentage (74%) disagreed that patients could not appreciate complexities

Satisfactions, Self-Efficacy, and Compliance in Mandatory Technology Settings

ERIC Educational Resources Information Center

Devgan, Vipan

2012-01-01

Many organizations recognize employees as great assets in the efforts to reduce risk related to information security. Employee's compliance with information security rules and regulations of organization is the key to strengthening information security. It is crucial for organizations to understand factors affecting technology compliance to…

Impact of Compliance on Dysphagia Rehabilitation in Head and Neck Cancer Patients – Results from a Multi-center Clinical Trial

PubMed Central

Krisciunas, Gintas P.; McCulloch, Timothy M.; Lazarus, Cathy L.; Pauloski, Barbara R.; Meyer, Tanya K.; Graner, Darlene; Van Daele, Douglas J.; Silbergleit, Alice K.; Crujido, Lisa R.; Rybin, Denis; Doros, Gheorghe; Kotz, Tamar; Langmore, Susan E.

2016-01-01

Purpose A 5yr, 16 site, randomized controlled trial enrolled 170 HNC survivors into active (estim + swallow exercise) or control (sham estim + swallowing exercise) arms. Primary analyses showed that estim did not enhance swallowing exercises. This secondary analysis determined if/how patient compliance impacted outcomes. Methods A home program, performed 2×/day, 6d/wk, for 12wks included stretches and 60 swallows paired with real or sham estim. Regular clinic visits ensured proper exercise execution and detailed therapy checklists tracked patient compliance which was defined by mean number of sessions performed per week (0-12 times) over the 12wk intervention period. “Compliant” was defined as performing 10-12 sessions/wk. Outcomes were change in PAS, HNCI, PSS, OPSE, and hyoid excursion. ANCOVA analyses determined if outcomes differed between real/sham and compliant/noncompliant groups after 12wks of therapy. Results Of the 170 patients enrolled, 153 patients had compliance data. The mean number of sessions performed was 8.57/wk (median=10.25). Fifty four percent of patients (n=83) were considered “compliant”. After 12wks of therapy, compliant patients in the sham estim group realized significantly better PAS scores than compliant patients in the active estim group (p=0.0074). When pooling all patients together, there were no significant differences in outcomes between compliant and non-compliant patients. Conclusions The addition of estim to swallowing exercises resulted in worse swallowing outcomes than exercises alone, which was more pronounced in compliant patients. Since neither compliant nor non-compliant patients benefitted from swallowing exercises, the proper dose and/or efficacy of swallowing exercises must also be questioned in this patient population. PMID:27848021

The role of patient isolation and compliance with isolation practices in the control of nosocomial MRSA in acute care.

PubMed

Halcomb, Elizabeth J; Griffiths, Rhonda; Fernandez, Ritin

Nosocomial infection remains the most common complication of hospitalisation. Despite infection control efforts, nosocomial methicillin resistant Staphylococcus aureus (MRSA) transmission continues to rise. Various isolation practices are used to minimise MRSA transmission in acute care. However, the effectiveness of these practices has seldom been evaluated. This review sought to evaluate the efficacy of isolation practices in minimising MRSA transmission in the acute hospital setting and explore staff, visitor and patient compliance with isolation practices. This review updates a review published in 2002. A systematic search for relevant published or unpublished English language literature was undertaken using electronic databases, the reference lists of retrieved papers and the Internet. This extended the search published in the original review. Databases searched included: Medline, CINAHL, EMBASE, Cochrane Library and Joanna Briggs Institute Evidence Library. All English language research reports published between 1990 and August 2005 that focused on the role of isolation practices on the nosocomial transmission of MRSA in adult, paediatric or neonatal acute care settings were eligible for inclusion in the review. Studies that evaluated multiple infection control strategies or control of MRSA outbreaks were excluded. The main outcome of interest was the incidence of new cases of MRSA. The secondary outcome was staff, visitor and patient compliance with the isolation practices. Two reviewers assessed each paper against the inclusion criteria and a validated quality scale. Data extraction was undertaken using a tool designed specifically for this review. Statistical comparisons of findings were not possible, so findings are presented in a narrative form. Seven studies met the inclusion criteria. Given the small number of included studies and variable methodological quality, care must be taken when interpreting the review findings. There is some evidence that

Year 2000 compliance issues.

PubMed

1999-03-01

This month, we continue our coverage of the year 2000 (Y2K) problem as it affects healthcare facilities and the professionals who work in them. We present the following articles: "Checking PCs for Y2K Compliance"--In this article, we describe the probable sources of Y2K-related errors in PCs and present simple procedures for testing the Y2K compliance of PCs and application software. "Y2K Assessment Equipment Expectations"--In this article, we review the Y2K compliance data from a small sampling of hospitals to help answer the question "What percentage of medical equipment will likely be susceptible to Y2K problems?" "Y2K Labeling of Medical Devices"--In this article, we discuss the pros and cons of instituting a program to label each medical device with its Y2K status. Also in this section, we present an updated list of organizations that support ECRI's Position Statement on the testing of medical devices for Y2K compliance, which we published in the December 1998 issue of Health Devices (27[12]). And we remind readers of the services ECRI can offer to help healthcare institutions cope with the Y2K problem.

[Analysis on long-term compliance of anticoagulation treatment and demands of disease management in patients with atrial fibrillation].

PubMed

Zuo, Hui-juan; Su, Jiang-lian; Lin, Yun; Zeng, Zhe-chun; Wang, Jin-wen

2010-08-24

To analyze the long-term compliance of oral anticoagulant therapy and the demands of disease management in patient with atrial fibrillation (AF). Inpatients with AF taking warfarin were collected from Department of Internal Medicine from January 1 to December 31, 2008. Inpatients from departments of surgery, ophthalmology, otorhinolaryngology, dermatology and pediatrics and those on a previous warfarin therapy were excluded. The data of patient profiles, medical history and anticoagulant treatment were collected from electronic medical record. And the status of anticoagulant treatment one year later and demands of disease management were inquired by telephone. A total of 268 AF patients received a telephone survey. Among them, 145 patients (54.1%) continued taking warfarin. Gender, age, type of AF, duration of AF and history of ischemic stroke was not significantly associated with the compliance of anticoagulant treatment. The odds ratio was 1.74 (95%CI: 0.67-4.47), 0.87 (95%CI: 0.30-2.53), 1.59 (95%CI: 0.35-1.09), 1.09 (95%CI: 0.61-1.93) and 0.44 (95%CI: 0.12-1.60) respectively. Among patients on warfarin, INR was monitored monthly in 88 patients (60.7%) and 70 patients (48.3%) had an INR value of 2.0-3.0. Among 123 withdrawal patients, 88 patients (71.5%) terminated treatment within 6 month. The common reasons included patient ignorance about long-term anticoagulant treatment (35.0%) and switching to aspirin because of a poor effect (24.4%). About 80% of patients wished to obtain instructions about INR monitoring and adjustment of drug dosage. Among them, 196/268 patients (73.1%) wished for a regular follow-up. And 176/196 patients (89.8%) opted for a telephone follow-up and 150/176 patients (85.2%) wanted to receive monthly instructions. The compliance of anticoagulation treatment and the target-meeting proportion of INR value are relative low. And the common reasons of withdrawal are patient ignorance about long-term anticoagulant treatment and switching to

40 CFR 63.11429 - What are my compliance dates?

Code of Federal Regulations, 2014 CFR

2014-07-01

... must achieve compliance with applicable provisions in this subpart by July 16, 2007. (b) If you startup... provisions in this subpart not later than July 16, 2007. (c) If you startup a new affected source after July 16, 2007, you must achieve compliance with applicable provisions in this subpart upon initial startup...

40 CFR 63.11429 - What are my compliance dates?

Code of Federal Regulations, 2013 CFR

2013-07-01

... must achieve compliance with applicable provisions in this subpart by July 16, 2007. (b) If you startup... provisions in this subpart not later than July 16, 2007. (c) If you startup a new affected source after July 16, 2007, you must achieve compliance with applicable provisions in this subpart upon initial startup...

40 CFR 63.11429 - What are my compliance dates?

Code of Federal Regulations, 2011 CFR

2011-07-01

... must achieve compliance with applicable provisions in this subpart by July 16, 2007. (b) If you startup... provisions in this subpart not later than July 16, 2007. (c) If you startup a new affected source after July 16, 2007, you must achieve compliance with applicable provisions in this subpart upon initial startup...

40 CFR 63.11429 - What are my compliance dates?

Code of Federal Regulations, 2010 CFR

2010-07-01

... must achieve compliance with applicable provisions in this subpart by July 16, 2007. (b) If you startup... provisions in this subpart not later than July 16, 2007. (c) If you startup a new affected source after July 16, 2007, you must achieve compliance with applicable provisions in this subpart upon initial startup...

40 CFR 63.11429 - What are my compliance dates?

Code of Federal Regulations, 2012 CFR

2012-07-01

... must achieve compliance with applicable provisions in this subpart by July 16, 2007. (b) If you startup... provisions in this subpart not later than July 16, 2007. (c) If you startup a new affected source after July 16, 2007, you must achieve compliance with applicable provisions in this subpart upon initial startup...

Generic switch after ramipril patent expiry is not associated with decreased pharmacy refill compliance: a retrospective study using the DAPI database.

PubMed

Ude, Miriam; Schuessel, Katrin; Quinzler, Renate; Leuner, Kristina; Müller, Walter E; Schulz, Martin

2011-09-01

For treatment success in chronic diseases such as hypertension, adequate adherence to long-term pharmacotherapy is a prerequisite. The purpose of this study was to evaluate whether switching from brand name ramipril to a generic product after patent expiry may negatively affect patients' refill compliance. Claims data for ambulatory prescriptions within the statutory health insurance system were evaluated. Patients were included if they had filled a ramipril prescription (index) for either brand name or generic ramipril products between September 2003 and June 2004. Patients had to be continuously treated with ramipril for at least 12 months before and after the index date. Patients with a change from brand name to generic product or vice versa during follow-up after the index date were excluded from the analyses, as were patients who could not be unequivocally allocated to characteristics of covariates. Refill compliance was analysed by calculating the medication possession ratio (MPR), assuming that patients were prescribed one unit dose per day (MPR(UD)). In total, 142,690 and 79,191 patients were classified as brand name or generic therapy, respectively. Median MPR(UD) values were 0.95 and 0.96 (P < 0.001). In a logistic regression model adjusting for covariates, the probability for noncompliance (MPR(UD) < 0.8) was marginally lower in the generic compared with the brand name group (odds ratio 0.926, 99% confidence interval 0.901-0.951, P < 0.001). These results suggest that refill compliance is not negatively affected by a physician-induced switch from brand name to generic ramipril products after patent expiry.

Why we should talk about compliance with assisted reproductive technologies (ART): a systematic review and meta-analysis of ART compliance rates

PubMed Central

Gameiro, S.; Verhaak, C.M.; Kremer, J.A.M.; Boivin, J.

2013-01-01

BACKGROUND The goal of this systematic review and meta-analysis was to estimate the rate of compliance with assisted reproductive technologies (ART) and examine its relationship with treatment success rates. METHODS Six databases were systematically searched from 1978 to December 2011. Studies were included if they reported data on patient progression through three consecutive standard ART cycles. Compliance was estimated for the first three ART cycles (typical ART Regimen Compliance, TARC) and after the first and the second failed cycles (CAF1, CAF2). Treatment success rates for all patients who started ART and for those who fully complied with the three ART cycles were estimated. RESULTS Ten studies with data for 14 810 patients were included. TARC was 78.2% [95% confidence interval (CI) 68.8–85.3%], CAF1 was 81.8% (73.3–88.1%) and CAF2 was 75.3% (68.2–81.2%). The overall success rate was 42.7% (32.6–53.6%) for all patients starting ART and 57.9% (49.4–65.9%) for those who complied with three ART cycles. Compliance rates did not vary according to study quality, but TARC was higher for studies that reported data on doctor-censored patients versus those that did not (84.2% 95% CI 75.5–90.2 versus 70.6% 95% CI 58.3–80.5, P = 0.043). Analysis of funnel plots and the Egger test indicated publication bias for CAF1. CONCLUSIONS Findings from this meta-analysis should reassure clinics and patients that most patients are able to comply with three cycles of ART. Compliers could increase their chances of success by as much as 15%. A more detailed assessment of compliance requires monitoring long-term treatment trajectories through the creation of national registries. PMID:23178304

40 CFR 63.6006 - How do I demonstrate continuous compliance with the emission limits for tire cord production...

Code of Federal Regulations, 2010 CFR

2010-07-01

... compliance with the emission limits for tire cord production affected sources? 63.6006 Section 63.6006... Hazardous Air Pollutants: Rubber Tire Manufacturing Continuous Compliance Requirements for Tire Cord... tire cord production affected sources? (a) You must demonstrate continuous compliance with each...

Personal hand gel for improved hand hygiene compliance on the regional anesthesia team.

PubMed

Parks, Colby L; Schroeder, Kristopher M; Galgon, Richard E

2015-12-01

Hand hygiene reduces healthcare-associated infections, and several recent publications have examined hand hygiene in the perioperative period. Our institution's policy is to perform hand hygiene before and after patient contact. However, observation suggests poor compliance. This is a retrospective review of a quality improvement database showing the effect of personal gel dispensers on perioperative hand hygiene compliance on a regional anesthesia team. Healthcare providers assigned to the Acute Pain Service were observed for compliance with hand hygiene policy during a quality improvement initiative. Provider type and compliance were prospectively recorded in a database. Team members were then given a personal gel dispensing device and again observed for compliance. We have retrospectively reviewed this database to determine the effects of this intervention. Of the 307 encounters observed, 146 were prior to implementing personal gel dispensers. Compliance was 34%. Pre- and post-patient contact compliances were 23 and 43%, respectively. For 161 encounters after individual gel dispensers were provided, compliance was 63%. Pre- and post-patient contact compliances were 53 and 72%, respectively. Improvement in overall compliance from 34 to 63% was significant. On the Acute Pain Service, compliance with hand hygiene policy improves when individual sanitation gel dispensing devices are worn on the person.

Hand hygiene compliance by health care workers at a teaching hospital, Kingston, Jamaica.

PubMed

Nicholson, Alison M; Tennant, Ingrid A; Martin, Allie C; Ehikhametalor, Kelvin; Reynolds, Glendee; Thoms-Rodriguez, Camille-Ann; Nagassar, Rajeev; Hoilett, Tena-Kim; Allen, Roxanne; Redwood, Tahira; Crandon, Ivor

2016-10-31

Consistent practice of hand hygiene (HH) has been shown to reduce the incidence and spread of hospital acquired infections. The objectives of this study were to determine the level of compliance and possible factors affecting compliance with HH practices among HCWs at a teaching hospital in Kingston, Jamaica. A prospective observational study was undertaken at the University Hospital of the West Indies (UHWI) over a two weeks period. Trained, validated observers identified opportunities for hand hygiene as defined by the WHO "Five Hand Hygiene Moments" and recorded whether appropriate hand hygiene actions were taken or missed. Observations were covert to prevent the observer's presence influencing the behaviour of the healthcare workers (HCWs) and targeted areas included the intensive care units (ICUs), surgical wards and surgical outpatient departments. A ward infrastructure survey was also done. Data were entered and analysed using SPSS version 16 for Windows. Chi-square analysis using Pearson's formula was used to test associations between 'exposure' factors and the outcome 'compliance'. A total of 270 hand hygiene opportunities were observed and the overall compliance rate was 38.9%. No differences were observed between the various types of HCWs or seniority. HCWs were more likely to perform hand hygiene if the indication was 'after' rather than 'before' patient contact (p = 0.001). This study underscores the need for improvement in HH practices among HCWs in a teaching hospital. Health education with particular attention to the need for HH prior to physical contact with patients is indicated.

Orthostatic hypotension and association of arterial compliance in elderly patients with hypertension: a pilot study.

PubMed

Toba, Ayumi; Ishikawa, Joji; Harada, Kazumasa

2017-10-01

Orthostatic hypotension (OH) is associated with cardiovascular diseases, heart failure, and increased mortality. We evaluated whether OH was affected by cardiac structure and function or autonomic function in elderly hypertensive outpatients. In 64 hypertension patients (mean age 74.2±1.7 years old), we evaluated changes in blood pressure (BP) and heart rate variability before and after standing up using the MemCalc system. In addition, we retrospectively reviewed their medical records and echocardiographic data. Of the total patients, 28% had OH [decrease of systolic blood pressure (SBP) ≥20 mmHg and/or diastolic BP ≥10 mmHg]. Multivariate linear regression analysis showed that stroke volume (SV)/pulse pressure (PP) was associated independently with orthostatic change in SBP (P=0.007). The patients with OH tended to have a lower SV (57.3±13.1 vs. 68.1±16.3 ml, P=0.009) and lower SV/PP (1.02±0.26 vs. 1.33±0.45, P=0.001) than those without OH. The significance in difference in SV/PP remained even after adjustment for age, sex, BMI, estimated glomerular filtration rate, number of antihypertesive drugs, history of diabetes, and SBP at rest (P=0.036). However, there were no significant differences in change in the low frequency/high frequency ratio after standing up (P=0.899) between patients with and without OH. Elderly hypertensive patients with OH may have a reduced arterial compliance, measured as SV/PP, and may not have differences in sympathetic nerve activities, measured as the low frequency/high frequency ratio.

The use of medication compliance devices by district nursing services.

PubMed

McGraw, C; Drennan, V

2000-07-01

This article presents a critical review of the literature relating to medication compliance devices and the findings of a survey that examined the use of such devices by district nursing services. The UKCC (1992) does not regard the loading of compliance devices by nurses as safe practice; however, compliance devices continue to be used by district nurses. The evidence base concerning the value and use of medication compliance devices is examined and significant gaps in the literature relating to the use of such devices are identified. There is an absence of studies that focus on the effect of compliance devices on adherence among older patients and the nature and frequency of drug administration errors involving these devices. The survey findings show that nurse-loaded compliance devices are used in over one-third of the sample. Further research is necessary to assess the clinical effectiveness of, and clinical risk attached to, compliance devices for older patients in the community. It is suggested that this is an issue of serious concern for primary care groups considering the principles of clinical governance.

Compliance with the gluten-free diet: the role of locus of control in celiac disease.

PubMed

Bellini, Anna; Zanchi, Chiara; Martelossi, Stefano; Di Leo, Grazia; Not, Tarcisio; Ventura, Alessandro

2011-03-01

To verify whether subjects with celiac disease (CD) have a different locus of control (LoC) compared with healthy subjects, and to evaluate the relationship between LoC and compliance with a prescribed gluten-free diet (GFD) and quality of life (QoL). We studied 156 subjects on a GFD (mean age, 10 years) and 353 healthy controls (mean age, 12 years). All subjects completed tests on the Nowicki-Strickland Locus of Control Scale; the subjects with CD also completed a questionnaire to measure compliance with dietary treatment and the disease's impact on QoL. There was no difference in LoC values between patients with CD and controls. Subjects with CD with good dietary compliance had a more internal LoC compared with those who were not compliant (P = .01). Patients who reported a satisfactory QoL had a more internal LoC compared with those who reported negative affects on QoL due to CD (P = .01). Our study confirms the usefulness of the LoC concept for identifying those patients who might be at risk for dietary transgression. Given the enhanced, psychological, and social well being that can result from adherence to a GFD, educational and psychological support can help internalize the LoC in those patients at risk for dietary transgression. Copyright © 2011 Mosby, Inc. All rights reserved.

Comparison between continuous or intermittent schedules of sublingual immunotherapy for house dust mites: effects on compliance, patients satisfaction, quality of life and safety.

PubMed

Cadario, G; Ciprandi, G; Di Cara, G; Fadel, R; Incorvaia, C; Marcucci, F; Marengo, F; Puccinelli, P; Sensi, L; Strazzeri, L; Frati, F

2008-01-01

Sublingual immunotherapy (SLIT) is indicated in the treatment of allergic rhinitis and asthma. However, an issue scantly investigated is the patients satisfaction and the consequent compliance. This study is aimed at evaluating the possible differences of SLIT administered continuously or intermittently on several parameters: clinical efficacy, Quality of Life (QoL), satisfaction, compliance and safety. Forty allergic patients were treated for 12 months. The treatment was carried out by sublingual administration of an allergen extract of a 50% mixture of Dermatophagoides pteronyssinus and Dermatophagoides farinae at 10 and 300 IR/ml concentrations. Patients were randomly treated continuously or intermittently (i.e. 2 month treatment alternate to 2 month suspension). Both schedules were significantly effective in reducing allergic symptoms and improving QoL. Compliance and satisfaction were good in both groups. Local and systemic reactions were few, self-resolving, and mild in both schedules. Intergroup analysis did not reveal any difference between the two groups regarding these parameters. In conclusion, this preliminary study provides the evidence that also intermittent SLIT is as effective and safe as traditional continuous treatment. In addition, compliance and satisfaction are super-imposable in the two groups.

Monitoring of gluten-free diet compliance in celiac patients by assessment of gliadin 33-mer equivalent epitopes in feces123

PubMed Central

Comino, Isabel; Real, Ana; Vivas, Santiago; Síglez, Miguel Ángel; Caminero, Alberto; Nistal, Esther; Casqueiro, Javier; Rodríguez-Herrera, Alfonso; Cebolla, Ángel

2012-01-01

Background: Certain immunotoxic peptides from gluten are resistant to gastrointestinal digestion and can interact with celiac-patient factors to trigger an immunologic response. A gluten-free diet (GFD) is the only effective treatment for celiac disease (CD), and its compliance should be monitored to avoid cumulative damage. However, practical methods to monitor diet compliance and to detect the origin of an outbreak of celiac clinical symptoms are not available. Objective: We assessed the capacity to determine the gluten ingestion and monitor GFD compliance in celiac patients by the detection of gluten and gliadin 33-mer equivalent peptidic epitopes (33EPs) in human feces. Design: Fecal samples were obtained from healthy subjects, celiac patients, and subjects with other intestinal pathologies with different diet conditions. Gluten and 33EPs were analyzed by using immunochromatography and competitive ELISA with a highly sensitive antigliadin 33-mer monoclonal antibody. Results: The resistance of a significant part of 33EPs to gastrointestinal digestion was shown in vitro and in vivo. We were able to detect gluten peptides in feces of healthy individuals after consumption of a normal gluten-containing diet, after consumption of a GFD combined with controlled ingestion of a fixed amount of gluten, and after ingestion of <100 mg gluten/d. These methods also allowed us to detect GFD infringement in CD patients. Conclusions: Gluten-derived peptides could be sensitively detected in human feces in positive correlation with the amount of gluten intake. These techniques may serve to show GFD compliance or infringement and be used in clinical research in strategies to eliminate gluten immunotoxic peptides during digestion. This trial was registered at clinicaltrials.gov as NCT01478867. PMID:22258271

Does patient satisfaction affect patient loyalty?

PubMed

Kessler, Daniel P; Mylod, Deirdre

2011-01-01

This paper aims to investigate how patient satisfaction affects propensity to return, i.e. loyalty. Data from 678 hospitals were matched using three sources. Patient satisfaction data were obtained from Press Ganey Associates, a leading survey firm; process-based quality measures and hospital characteristics (such as ownership and teaching status) and geographic areas were obtained from the Centers for Medicare and Medicaid Services. The frequency with which end-of-life patients return to seek treatment at the same hospital was obtained from the Dartmouth Atlas. The study uses regression analysis to estimate satisfaction's effects on patient loyalty, while holding process-based quality measures and hospital and market characteristics constant. There is a statistically significant link between satisfaction and loyalty. Although satisfaction's effect overall is relatively small, contentment with certain hospitalization experience may be important. The link between satisfaction and loyalty is weaker for high-satisfaction hospitals, consistent with other studies in the marketing literature. RESEARCH LIMITATION/IMPLICATIONS: The US hospitals analyzed are not a random sample; the results are most applicable to large, non-profit teaching hospitals in competitive markets. Satisfaction ratings have business implications for healthcare providers and may be useful as a management tool for private and public purchasers. The paper is the first to show that patient satisfaction affects actual hospital choices in a large sample. Because patient satisfaction ratings are also correlated with other quality measures, the findings suggest a pathway through which individuals naturally gravitate toward higher-quality care.

Compliance, satisfaction, and quality of life of patients with colorectal cancer receiving home chemotherapy or outpatient treatment: a randomised controlled trial.

PubMed

Borras, J M; Sanchez-Hernandez, A; Navarro, M; Martinez, M; Mendez, E; Ponton, J L; Espinas, J A; Germa, J R

2001-04-07

To compare chemotherapy given at home with outpatient treatment in terms of colorectal cancer patients' safety, compliance, use of health services, quality of life, and satisfaction with treatment. Randomised controlled trial. Large teaching hospital. 87 patients receiving adjuvant or palliative chemotherapy for colorectal cancer. Treatment with fluorouracil (with or without folinic acid or levamisole) at outpatient clinic or at home. Treatment toxicity; patients' compliance with treatment, quality of life, satisfaction with care, and use of health resources. 42 patients were treated at outpatient clinic and 45 at home. The two groups were balanced in terms of age, sex, site of cancer, and disease stage. Treatment related toxicity was similar in the two groups (difference 7% (95% confidence interval -12% to 26%)), but there were more voluntary withdrawals from treatment in the outpatient group than in the home group (14% v 2%, difference 12% (1% to 24%)). There were no differences between groups in terms of quality of life scores during and after treatment. Levels of patient satisfaction were higher in the home treatment group, specifically with regard to information received and nursing care. There were no significant differences in use of health services. Home chemotherapy seemed an acceptable and safe alternative to hospital treatment for patients with colorectal cancer that may improve compliance and satisfaction with treatment.

[Main causes of non-compliance with pulmonary tuberculosis treatment].