SMS messages increase adherence to rapid diagnostic test results among malaria patients: results from a pilot study in Nigeria.

PubMed

Modrek, Sepideh; Schatzkin, Eric; De La Cruz, Anna; Isiguzo, Chinwoke; Nwokolo, Ernest; Anyanti, Jennifer; Ujuju, Chinazo; Montagu, Dominic; Liu, Jenny

2014-02-25

The World Health Organization now recommends parasitological confirmation for malaria case management. Rapid diagnostic tests (RDTs) for malaria are an accurate and simple diagnostic to confirm parasite presence in blood. However, where they have been deployed, adherence to RDT results has been poor, especially when the test result is negative. Few studies have examined adherence to RDTs distributed or purchased through the private sector. The Rapid Examination of Malaria and Evaluation of Diagnostic Information (REMEDI) study assessed the acceptability of and adherence to RDT results for patients seeking care from private sector drug retailers in two cities in Oyo State in south-west Nigeria. In total, 465 adult participants were enrolled upon exit from a participating drug shop having purchased anti-malaria drugs for themselves. Participants were given a free RDT and the appropriate treatment advice based on their RDT result. Short Message Service (SMS) text messages reiterating the treatment advice were sent to a randomly selected half of the participants one day after being tested. Participants were contacted via phone four days after the RDT was conducted to assess adherence to the RDT information and treatment advice. Adherence to RDT results was 14.3 percentage points (P-val <0.001) higher in the treatment group who were sent the SMS. The higher adherence in the treatment group was robust to several specification tests and the estimated difference in adherence ranged from 9.7 to 16.1 percentage points. Further, the higher adherence to the treatment advice was specific to the treatment advice for anti-malarial drugs and not other drugs purchased to treat malaria symptoms in the RDT-negative participants who bought both anti-malarial and symptom drugs. There was no difference in adherence for the RDT-positive participants who were sent the SMS. SMS text messages substantially increased adherence to RDT results for patients seeking care for malaria from

Adherence barriers and facilitators for cervical screening amongst currently disadvantaged women in the greater Cape Town region of South Africa

PubMed Central

De Abreu, Chantelle; Horsfall, Hannah

2013-01-01

Abstract Background In South Africa cervical cancer is the second most commonly occurring cancer amongst women, and black African women have the highest risk of developing this disease. Unfortunately, the majority of South African women do not adhere to recommended regular cervical screening. Objectives The purpose of this research was to explore the perceptions, experiences and knowledge regarding cervical screening of disadvantaged women in two informal settlements in South African urban areas. Method The Health Belief Model (HBM) provided a theoretical framework for this study. Four focus groups (n = 21) were conducted, using questions derived from the HBM, and thematic analysis was used to analyse the data. The ages of the women who participated ranged from 21 to 53 years. Results The analysis revealed lack of knowledge about screening as a key structural barrier to treatment. Other structural barriers were: time, age at which free screening is available, and health education. The psychosocial barriers that were identified included: fear of the screening procedure and of the stigmatisation in attending screening. The presence of physical symptoms, the perception that screening provides symptom relief, HIV status, and the desire to know one's physical health status were identified as facilitators of cervical screening adherence. Conclusion This knowledge has the potential to inform healthcare policy and services in South Africa. As globalisation persists and individuals continue to immigrate or seek refugee status in foreign countries, increased understanding and knowledge is required for successful acculturation and integration. Developed countries may therefore also benefit from research findings in developing countries.

Does increased adherence to medications change health care financial burdens for adults with diabetes?

PubMed

Miller, G Edward; Sarpong, Eric M; Hill, Steven C

2015-11-01

The aim of the present study was to investigate increased out-of-pocket drug costs and financial burdens of achieving adherence to oral antidiabetic medications and medications for prevalent comorbidities. Concurrent adherence to medications, out-of-pocket drug costs, and financial burdens were measured among non-elderly adults with diabetes in the Medical Expenditure Panel Survey. "Financial burden" was defined as spending on health care exceeding 10% of family income. This study simulated the increased out-of-pocket drug costs and financial burdens that would result if non-adherent adults in our sample had obtained sufficient medications to be adherent. For each adult, for all therapeutic classes in which they were non-adherent, we calculated the additional days supplied required to become adherent, as well as out-of-pocket spending on these additional days supplied. Approximately one-quarter adhered to all required medications. Among non-adherent adults with employer-sponsored insurance and public insurance, the mean annual out-of-pocket drug costs of achieving adherence were US$171 and US$68, respectively, which was generally affordable. However, 35.6% of the uninsured lived in families that spent 10% or more of their income on health care. Mean simulated additional out-of-pocket drug costs of achieving adherence were US$310 for the uninsured. These additional drug costs would increase those spending 10% or more of income to 39.6% of the uninsured. Efforts to reduce the costs faced by the uninsured and insured will make adherence more affordable and, therefore, more attainable for some adults with diabetes. © 2015 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

Theory-based behavioral intervention increases self-reported physical activity in South African men: a cluster-randomized controlled trial.

PubMed

Jemmott, John B; Jemmott, Loretta S; Ngwane, Zolani; Zhang, Jingwen; Heeren, G Anita; Icard, Larry D; O'Leary, Ann; Mtose, Xoliswa; Teitelman, Anne; Carty, Craig

2014-07-01

To determine whether a health-promotion intervention increases South African men's adherence to physical-activity guidelines. We utilized a cluster-randomized controlled trial design. Eligible clusters, residential neighborhoods near East London, South Africa, were matched in pairs. Within randomly selected pairs, neighborhoods were randomized to theory-based, culturally congruent health-promotion intervention encouraging physical activity or attention-matched HIV/STI risk-reduction control intervention. Men residing in the neighborhoods and reporting coitus in the previous 3 months were eligible. Primary outcome was self-reported individual-level adherence to physical-activity guidelines averaged over 6-month and 12-month post-intervention assessments. Data were collected in 2007-2010. Data collectors, but not facilitators or participants, were blind to group assignment. Primary outcome intention-to-treat analysis included 22 of 22 clusters and 537 of 572 men in the health-promotion intervention and 22 of 22 clusters and 569 of 609 men in the attention-control intervention. Model-estimated probability of meeting physical-activity guidelines was 51.0% in the health-promotion intervention and 44.7% in attention-matched control (OR=1.34; 95% CI, 1.09-1.63), adjusting for baseline prevalence and clustering from 44 neighborhoods. A theory-based culturally congruent intervention increased South African men's self-reported physical activity, a key contributor to deaths from non-communicable diseases in South Africa. ClinicalTrials.gov Identifier: NCT01490359. Copyright © 2014 Elsevier Inc. All rights reserved.

Motivational interviewing: a tool for increasing psychotropic medication adherence for youth.

PubMed

Hamrin, Vanya; McGuinness, Teena M

2013-06-01

There are serious outcomes to nonadherence to psychotropic medications in children and adolescents, including poor school performance, prolonged duration of illness, increased psychopathology, poor interpersonal relationships, increased psychiatric episodes, and suicide attempts. Medication treatment has demonstrated improved psychiatric functioning and a 50% reduction in suicidal behavior. more than 50% of youth with mental health problems are nonadherent with psychiatric medications. A review of literature examining motivational interviewing (MI) for the problem of treatment adherence in children and adolescents is discussed. MI has great potential to improve psychiatric medication adherence in adolescents. An example of how to implement MI with youth is provided.

Antiretroviral therapy initiation and adherence in rural South Africa: community health workers' perspectives on barriers and facilitators

PubMed Central

Loeliger, Kelsey B.; Niccolai, Linda M.; Mtungwa, Lillian N.; Moll, Anthony; Shenoi, Sheela V.

2016-01-01

South Africa has the largest global HIV/AIDS epidemic, but barriers along the HIV care continuum prevent patients from initiating and adhering to antiretroviral therapy (ART). To qualitatively explore reasons for poor ART initiation and adherence rates from the unique perspective of community health workers (CHWs), we conducted focus groups during May–August 2014 with 21 CHWs in rural Msinga, KwaZulu-Natal. Interviews were audio-recorded, transcribed, and translated from Zulu into English. Hybrid deductive and inductive analytical methods were applied to identify emergent themes. Multiple psychosocial, socioeconomic, and socio-medical barriers acted at the level of the individual, social network, broader community, and healthcare environment to simultaneously hinder initiation of and adherence to ART. Key themes included insufficient patient education and social support, patient dissatisfaction with healthcare services, socioeconomic factors, and tension between ART and alternative medicine. Fear of lifelong therapy thwarted initiation whereas substance abuse principally impeded adherence. In conclusion, HIV/AIDS management requires patient counselling and support extending beyond initial diagnosis. Treating HIV/AIDS as a chronic rather than acute infectious disease is key to improving ART initiation and long-term adherence. Public health strategies include expanding CHWs' roles to strengthen healthcare services, provide longitudinal patient support, and foster collaboration with alternative medicine providers. PMID:27043077

Masivukeni: Development of a Multimedia Based Antiretroviral Therapy Adherence Intervention for Counselors and Patients in South Africa

PubMed Central

Remien, Robert H; Mellins, Claude A.; Robbins, Reuben N.; Kelsey, Ryan; Rowe, Jessica; Warne, Patricia; Chowdhury, Jenifar; Lalkhen, Nuruneesa; Hoppe, Lara; Abrams, Elaine J.; El-Bassel, Nabila; Witte, Susan; Stein, Dan J.

2013-01-01

Effective medical treatment for HIV/AIDS requires patients’ optimal adherence to antiretroviral therapy (ART). In resource-constrained settings, lack of adequate standardized counseling for patients on ART remains a significant barrier to adherence. Masivukeni (“Lets Wake Up” in Xhosa) is an innovative multimedia-based intervention designed to help people living with HIV in resource-limited settings achieve and maintain high levels of ART adherence. Adapted from a couples-based intervention tested in the United States (US), Masivukeni was developed through community-based participatory research with US and South African partners and informed by Ewart’s Social Action Theory. Innovative computer-based multimedia strategies were used to translate a labor- and training-intensive intervention into one that could be readily and widely used by lay counselors with relatively little training with low-literacy patients. In this paper, we describe the foundations of this new intervention, the process of its development, and the evidence of its high acceptability and feasibility. PMID:23468079

When weight management lasts. Lower perceived rule complexity increases adherence.

PubMed

Mata, Jutta; Todd, Peter M; Lippke, Sonia

2010-02-01

Maintaining behavior change is one of the major challenges in weight management and long-term weight loss. We investigated the impact of the cognitive complexity of eating rules on adherence to weight management programs. We studied whether popular weight management programs can fail if participants find the rules too complicated from a cognitive perspective, meaning that individuals are not able to recall or process all required information for deciding what to eat. The impact on program adherence of participants' perceptions of eating rule complexity and other behavioral factors known to influence adherence (including previous weight management, self-efficacy, and planning) was assessed via a longitudinal online questionnaire given to 390 participants on two different popular weight management regimens. As we show, the regimens, Weight Watchers and a popular German recipe diet (Brigitte), strongly differ in objective rule complexity and thus their cognitive demands on the dieter. Perceived rule complexity was the strongest factor associated with increased risk of quitting the cognitively demanding weight management program (Weight Watchers); it was not related to adherence length for the low cognitive demand program (Brigitte). Higher self-efficacy generally helped in maintaining a program. The results emphasize the importance of considering rule complexity to promote long-term weight management. 2009 Elsevier Ltd. All rights reserved.

Increased Chain Length Promotes Pneumococcal Adherence and Colonization

PubMed Central

Rodriguez, Jesse L.; Dalia, Ankur B.

2012-01-01

Streptococcus pneumoniae is a mucosal pathogen that grows in chains of variable lengths. Short-chain forms are less likely to activate complement, and as a consequence they evade opsonophagocytic clearance more effectively during invasive disease. When grown in human nasal airway surface fluid, pneumococci exhibited both short- and long-chain forms. Here, we determined whether longer chains provide an advantage during colonization when the organism is attached to the epithelial surface. Chain-forming mutants and the parental strain grown under conditions to promote chain formation showed increased adherence to human epithelial cells (A549 cells) in vitro. Additionally, adherence to A549 cells selected for longer chains within the wild-type strain. In vivo in a murine model of colonization, chain-forming mutants outcompeted the parental strain. Together, our results demonstrate that morphological heterogeneity in the pneumococcus may promote colonization of the upper respiratory tract by enhancing the ability of the organism to bind to the epithelial surface. PMID:22825449

Motivational Enhancement for Increasing Adherence to CPAP: A Randomized Controlled Trial.

PubMed

Bakker, Jessie P; Wang, Rui; Weng, Jia; Aloia, Mark S; Toth, Claudia; Morrical, Michael G; Gleason, Kevin J; Rueschman, Michael; Dorsey, Cynthia; Patel, Sanjay R; Ware, James H; Mittleman, Murray A; Redline, Susan

2016-08-01

Motivational enhancement (ME) shows promise as a means of increasing adherence to CPAP for OSA. We performed an open-label, parallel-arm, randomized controlled trial of CPAP only or CPAP + ME, recruiting individuals 45 to 75 years with moderate or severe OSA without marked sleepiness and with either established cardiovascular disease (CVD) or at risk for CVD. All participants received standardized CPAP support from a sleep technologist; those randomly assigned to CPAP + ME also received standardized ME delivered by a psychologist during two appointments and six phone calls over 32 weeks. Mixed-effect models with subject-specific intercepts and slopes were fitted to compare objective CPAP adherence between arms, adjusting for follow-up duration, randomization factors, and device manufacturer. All analyses were intention-to-treat. Overall, 83 participants (n = 42 CPAP only; n = 41 CPAP + ME) contributed 14,273 nights of data for 6 months. Participants were predominantly male (67%) and had a mean ± SD age of 63.9 ± 7.4 years, a BMI of 31.1 ± 5.2 kg/m(2), and an apnea-hypopnea index of 26.2 ± 12.9 events/h. In our fully adjusted model, average nightly adherence for 6 months was 99.0 min/night higher with CPAP + ME compared with CPAP only (P = .003; primary analysis). A subset of 52 participants remained in the study for 12 months; modeling these data yielded a consistent difference in adherence between arms of 97 min/night (P = .006) favoring CPAP + ME. ME delivered during brief appointments and phone calls resulted in a clinically significant increase in CPAP adherence. This strategy may represent a feasible approach for optimizing management of OSA. ClinicalTrials.gov; No.: NCT01261390; URL: www.clinicaltrials.gov. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Evaluation of an integrated adherence program aimed to increase Medicare Part D star rating measures.

PubMed

Leslie, R Scott; Tirado, Breanne; Patel, Bimal V; Rein, Philip J

2014-12-01

The Centers for Medicare Medicaid Services (CMS) Plan Quality and Performance Program, or Star Ratings Program, allows Medicare beneficiaries to compare quality of care among available Medicare Advantage prescription drug (MA-PD) plans and stand-alone prescription drug plans (PDPs). Health plans have increased intervention efforts and applied existing care management infrastructure as an approach to improving member medication adherence and subsequent Part D star rating performance. Independent Care Health Plan (iCare), an MA-PD plan; MedImpact Healthcare Systems, Inc. (MedImpact), a pharmacy benefits manager; and US MED, a mail order pharmacy, partnered to engage and enroll iCare's dual-eligible special needs population in an intervention designed to improve patient medication adherence and health plan performance for 3 Part D patient safety outcome measures: Medication Adherence for Oral Diabetes Medications (ODM), Medication Adherence for Hypertension (HTN), and Medication Adherence for Cholesterol (CHOL). To (a) assess the effectiveness of a coordinated member-directed medication adherence intervention and (b) determine the overall impact of the intervention on adherence rates and CMS Part D star rating adherence measures.  Administrative pharmacy claims and health plan eligibility data from MedImpact's databases were used to identify members using 3 target medication classes. Adherence was estimated by the proportion of days covered (PDC) for all members. Those members considered at high risk for nonadherence were prioritized for care management services. Risk factors were based on members' use of more than 1 target medication class, newly started therapy, and suboptimal adherence (PDC  less than  80%) in the most recent 6-month period. Data files listing member adherence rates and contact information were formatted and loaded monthly into iCare's care management system, which triggered an alert for care coordinators to counsel members on the importance

Educational opportunities in bladder cancer: increasing cystoscopic adherence and the availability of smoking-cessation programs.

PubMed

Kowalkowski, Marc A; Goltz, Heather Honoré; Petersen, Nancy J; Amiel, Gilad E; Lerner, Seth P; Latini, David M

2014-12-01

Cancer survivors who continue to smoke following diagnosis are at increased risk for recurrence. Yet, smoking prevalence among survivors is similar to the general population. Adherence to cystoscopic surveillance is an important disease-management strategy for non-muscle-invasive bladder cancer (NMIBC) survivors, but data from Surveillance, Epidemiology, and End Results program (SEER) suggest current adherence levels are insufficient to identify recurrences at critically early stages. This study was conducted to identify actionable targets for educational intervention to increase adherence to cystoscopic monitoring for disease recurrence or progression. NMIBC survivors (n = 109) completed telephone-based surveys. Adherence was determined by measuring time from diagnosis to interview date; cystoscopies received were then compared to American Urological Association (AUA) guidelines. Data were analyzed using non-parametric tests for univariate and logistic regression for multivariable analyses. Participants averaged 65 years (SD = 9.3) and were primarily white (95 %), male (75 %), married (75 %), and non-smokers (84 %). Eighty-three percent reported either Ta- or T1-stage bladder tumors. Forty-five percent met AUA guidelines for adherence. Compared to non-smokers, current smokers reported increased fear of recurrence and psychological distress (p < 0.05). In regression analyses, non-adherence was associated with smoking (OR = 33.91, p < 0.01), providing a behavioral marker to describe a survivor group with unmet needs that may contribute to low cystoscopic adherence. Research assessing survivorship needs and designing and evaluating educational programs for NMIBC survivors should be a high priority. Identifying unmet needs among NMIBC survivors and developing programs to address these needs may increase compliance with cystoscopic monitoring, improve outcomes, and enhance quality of life.

"It's important to take your medication everyday okay?" An evaluation of counselling by lay counsellors for ARV adherence support in the Western Cape, South Africa.

PubMed

Dewing, S; Mathews, C; Schaay, N; Cloete, A; Louw, J; Simbayi, L

2013-01-01

There is growing interest in standard care programmes for antiretroviral (ARV) adherence support. In South Africa, individual counselling following ARV initiation is a main strategy for supporting adherence in the public sector. Egan's client-centred "Skilled Helper" counselling model is the predominant model used in HIV counselling in this context. This study evaluated counselling delivered by lay ARV adherence counsellors in Cape Town in terms of adherence to Egan's model. Thirty-eight transcripts of counselling sessions with non-adherent patients were analysed based on the methods of content analysis. These sessions were conducted by 30 counsellors. Generally counsellors' practice adhered neither to Egan's model nor a client-centred approach. Inconsistent with evidence-based approaches to counselling for ARV adherence support, counsellors mainly used information-giving and advice as strategies for addressing clients' non-adherence. Recommendations for improving practice are made. The question as to how appropriate strategies from developed countries are for this setting is also raised.

How to Evaluate Health-Related Quality of Life and Its Association with Medication Adherence in Pulmonary Tuberculosis - Designing a Prospective Observational Study in South Africa.

PubMed

Kastien-Hilka, Tanja; Rosenkranz, Bernd; Bennett, Bryan; Sinanovic, Edina; Schwenkglenks, Matthias

2016-01-01

Health-related quality of life (HRQOL) has become an important measure to identify and shape effective and patient-relevant healthcare interventions innovations through outcomes. Adherence to tuberculosis (TB) treatment is a public health concern. The main objective of this research is to develop a study design for evaluation of HRQOL and its association with medication adherence in TB in South Africa. A conceptual framework for HRQOL in TB has been developed to identify Patient-Reported Outcomes and Quality of Life Database (PROQOLID), (n.d.) measures for HRQOL and adherence and to generate an endpoint model. Two generic (SF-12 and EQ-5D-5L), one disease-specific (St. George's Respiratory Questionnaire) and one condition-specific (Hospital Anxiety and Depression Scale) measure for HRQOL and Morisky Medication Adherence Scale for adherence assessment were identified. All measures are applied in a longitudinal multi-center study at five data collection time points during standard TB treatment. Statistical analysis includes multivariable analysis. Change over time in the physical component score of SF-12 is defined as primary endpoint. Sample size estimation based thereupon has led to a recruitment target of 96 patients. This study is on-going. This is the first longitudinal study in South Africa which evaluates HRQOL and its association with medication adherence in TB in a comprehensive manner. Results will help to improve current treatment programs and medication adherence and will support the identification of sustainable health innovations in TB, determining the value of new products, and supporting decision making with regard to health policy and pricing.

Dating Violence Against HIV-Infected Youth in South Africa: Associations With Sexual Risk Behavior, Medication Adherence, and Mental Health.

PubMed

Kidman, Rachel; Violari, Avy

2018-01-01

As perinatal HIV-infected youth become sexually active, the potential for onward transmission becomes an increasing concern. In other populations, intimate partner violence (IPV) is a risk factor for HIV acquisition. We build on this critical work by studying the role of IPV in facilitating onward transmission among HIV-infected youth-an important step toward effective intervention. Soweto, South Africa. Self-report surveys were completed by 129 perinatal HIV-infected female youth (aged 13-24 years). We calculated the IPV prevalence and used logistic models to capture the association between IPV and health outcomes known to facilitate onward HIV transmission (eg, risky sex, poor medication adherence, depression, and substance abuse). A fifth of perinatal HIV-infected participants reported physical and/or sexual IPV in the past year; one-third reported lifetime IPV. Childhood adversity was common and positively associated with IPV. Past-year physical and/or sexual IPV was positively correlated with high-risk sex [odds ratio (OR) = 8.96; 95% confidence interval (CI): 2.78 to 28.90], pregnancy (OR = 6.56; 95% CI: 1.91 to 22.54), poor medication adherence to antiretroviral therapy (OR = 5.37; 95% CI: 1.37 to 21.08), depression (OR = 4.25; 95% CI: 1.64 to 11.00), and substance abuse (OR = 4.11; 95% CI: 1.42 to 11.86). Neither past-year nor lifetime IPV was associated with viral load or HIV status disclosure to a partner. We find that IPV may increase risk for onward HIV transmission in perinatal HIV-infected youth by both increasing engagement in risky sexual behaviors and lowering medication adherence. HIV clinics should consider integrating primary IPV prevention interventions, instituting routine IPV screening, and collocating services for victims of violence.

A peer adherence support intervention to improve the antiretroviral treatment outcomes of HIV patients in South Africa: the moderating role of family dynamics.

PubMed

Wouters, Edwin; Masquillier, Caroline; Ponnet, Koen; le Roux Booysen, Frederik

2014-07-01

Given the severe shortage of human resources in the healthcare sector in many countries with high HIV prevalence, community-based peer adherence support is being increasingly cited as an integral part of a sustainable antiretroviral treatment (ART) strategy. However, the available scientific evidence on this topic reports discrepant findings on the effectiveness of peer adherence support programmes. These conflicting findings to some extent can be attributed to the lack of attention to the social contexts in which peer adherence support programmes are implemented. This study explores the potential moderating role of family dynamics by assessing the differential impact of peer adherence support in different types of families, based on the theoretical underpinnings of the family functioning framework. These relationships were explored with the aid of multivariate statistical analysis of cross-sectional, post-trial data for a sample of 340 patients interviewed as part of the Effectiveness of Aids Treatment and Support in the Free State (FEATS) study conducted in the public-sector ART programme of the Free State Province of South Africa. The analysis reveals no significant overall differences in CD4 cell count between the intervention group accessing additional peer adherence support and the control group receiving standard care. When controlling for the potential moderating role of family dynamics, however, the outcomes clearly reveal a significant interaction effect between the adherence intervention and the level of family functioning with regard to treatment outcomes. Multi-group analysis demonstrates that peer adherence support has a positive effect on immunological restoration in well-functioning families, while having a negative effect in dysfunctional families. The study outcomes stress the need for peer adherence interventions that are sensitive to the suboptimal contexts in which they are often implemented. Generic, broad-based interventions do not

Does telephone scheduling assistance increase mammography screening adherence?

PubMed

Payton, Colleen A; Sarfaty, Mona; Beckett, Shirley; Campos, Carmen; Hilbert, Kathleen

2015-11-01

The 2 objectives were: 1) describe the use of a patient navigation process utilized to promote adherence to mammography screening within a primary care practice, and 2) determine the result of the navigation process and estimate the time required to increase mammography screening with this approach in a commercially insured patient population enrolled in a health maintenance organization. An evaluation of a nonrandomized practice improvement intervention. Women eligible for mammography (n = 298) who did not respond to 2 reminder letters were contacted via telephone by a navigator who offered scheduling assistance for mammography screening. The patient navigator scheduled appointments, documented the number of calls, and confirmed completed mammograms in the electronic health record, as well as estimated the time for calls and chart review. Of the 188 participants reached by phone, 112 (59%) scheduled appointments using the patient navigator, 35 (19%) scheduled their own appointments independently prior to the call, and 41 (22%) declined. As a result of the telephone intervention, 78 of the 188 women reached (41%) received a mammogram; also, all 35 women who had independently scheduled a mammogram received one. Chart documentation confirmed that 113 (38%) of the cohort of 298 women completed a mammogram. The estimated time burden for the entire project was 55 hours and 33 minutes, including calling patients, scheduling appointments, and chart review. A patient navigator can increase mammography adherence in a previously nonadherent population by making the screening appointment while the patient is on the phone.

Impact of a Prescription Copayment Increase on Lipid Lowering Medication Adherence in Veterans

PubMed Central

Doshi, Jalpa A.; Zhu, Jingsan; Lee, Bruce; Kimmel, Stephen; Volpp, Kevin

2009-01-01

Background In February 2002, the VA increased copayments from $2 to $7 per 30-day drug supply of each medication for many veterans. We examined the impact of the copayment increase on lipid lowering medication adherence. Methods and Results Quasi-experimental study using electronic records of 5,604 veterans receiving care at the Philadelphia VA Medical Center from November, 1999 to April, 2004. The “All Copayment” group included veterans subject to copayments for all drugs with no annual cap. Veterans subject to copayments for drugs only if indicated for a non-service connected condition with an annual cap of $840 for out-of-pocket costs comprised the “Some Copayment” group. Veterans who remained copayment exempt formed a natural control group (“No copayment” group). Patients were identified as “adherent” if the proportion of days covered (PDC) with lipid-lowering medications was >= 80%. Patients were identified as having a “continuous gap” if they had at least one continuous episode with no lipid lowering medications for >= 90 days. A difference-indifference approach comparing changes in lipid lowering medication adherence during the 24 months pre- and post- copayment increase among veterans subject to the copayment change versus those who were not. Adherence declined in all three groups after the copayment increase. However, the percent of patients who were adherent (PDC>=80%) declined significantly more in the all copayment (-19.2%) and some copayment (-19.3%) groups relative to the exempt group (-11.9%). The incidence of a continuous gap increased significantly at twice the rate in both copayment groups (+24.6% all copayment group and 24.1% some copayment group) than the exempt group (+11.7%). Compared to the exempt group, the odds of having a continuous gap in the post- relative to the pre-period were significantly higher in both the all copayment group (OR 3.04 95% CI 2.29-4.03) and the some copayment group (OR 1.85 95% CI 1

SadA-Expressing Staphylococci in the Human Gut Show Increased Cell Adherence and Internalization.

PubMed

Luqman, Arif; Nega, Mulugeta; Nguyen, Minh-Thu; Ebner, Patrick; Götz, Friedrich

2018-01-09

A subgroup of biogenic amines, the so-called trace amines (TAs), are produced by mammals and bacteria and can act as neuromodulators. In the genus Staphylococcus, certain species are capable of producing TAs through the activity of staphylococcal aromatic amino acid decarboxylase (SadA). SadA decarboxylates aromatic amino acids to produce TAs, as well as dihydroxy phenylalanine and 5-hydroxytryptophan to thus produce the neurotransmitters dopamine and serotonin. SadA-expressing staphylococci were prevalent in the gut of most probands, where they are part of the human intestinal microflora. Furthermore, sadA-expressing staphylococci showed increased adherence to HT-29 cells and 2- to 3-fold increased internalization. Internalization and adherence was also increased in a sadA mutant in the presence of tryptamine. The α2-adrenergic receptor is required for enhanced adherence and internalization. Thus, staphylococci in the gut might contribute to gut activity and intestinal colonization. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

Increasing daily water intake and fluid adherence in children receiving treatment for retentive encopresis.

PubMed

Kuhl, Elizabeth S; Hoodin, Flora; Rice, Jennifer; Felt, Barbara T; Rausch, Joseph R; Patton, Susana R

2010-11-01

To examine the efficacy of an enhanced intervention (EI) compared to standard care (SC) in increasing daily water intake and fluid goal adherence in children seeking treatment for retentive encopresis. Changes in beverage intake patterns and fluid adherence were examined by comparing 7-week diet diary data collected during participation in the EI to achieved data for families who had previously completed the SC. Compared to children in SC (n = 19), children in the EI (n = 18) demonstrated a significantly greater increase in daily water intake from baseline to the conclusion of treatment ( p ≤ .001), and were four and six times more likely to meet fluid targets in Phases 1 (Weeks 3-4) and 2 (Weeks 5-6) of fluid intervention, respectively (both p ≤ .001). Enhanced education and behavioral strategies were efficacious in increasing children's intake of water and improving fluid adherence. Future research should replicate the findings in a prospective randomized clinical trial to discern their effectiveness.

Increase in single-tablet regimen use and associated improvements in adherence-related outcomes in HIV-infected women.

PubMed

Hanna, David B; Hessol, Nancy A; Golub, Elizabeth T; Cocohoba, Jennifer M; Cohen, Mardge H; Levine, Alexandra M; Wilson, Tracey E; Young, Mary; Anastos, Kathryn; Kaplan, Robert C

2014-04-15

The use of single-tablet antiretroviral therapy (ART) regimens and its implications on adherence among HIV-infected women have not been well described. Participants were enrolled in the Women's Interagency HIV Study, a longitudinal study of HIV infection in US women. We examined semiannual trends in single-tablet regimen use and ART adherence, defined as self-reported 95% adherence in the past 6 months, during 2006-2013. In a nested cohort study, we assessed the comparative effectiveness of a single-tablet versus a multiple-tablet regimen with respect to adherence, virologic suppression, quality of life, and AIDS-defining events, using propensity score matching to account for demographic, behavioral, and clinical confounders. We also examined these outcomes in a subset of women switching from a multiple- to single-tablet regimen using a case-crossover design. We included 15,523 person-visits, representing 1727 women (53% black, 29% Hispanic, 25% IDU, median age 47). Use of single-tablet regimens among ART users increased from 7% in 2006% to 27% in 2013; adherence increased from 78% to 85% during the same period (both P < 0.001). Single-tablet regimen use was significantly associated with increased adherence (adjusted risk ratio: 1.05; 95% confidence interval: 1.03 to 1.08) and virologic suppression (risk ratio: 1.06; 95% confidence interval: 1.01 to 1.11), while associations with improved quality of life and fewer AIDS-defining events did not achieve statistical significance. Similar findings were observed among the subset of switchers. Single-tablet regimen use was associated with increased adherence and virologic suppression. Despite this, 15% of women prescribed ART were still not optimally adherent; additional interventions are needed to maximize therapeutic benefits.

Specialized survivor clinic attendance increases adherence to cardiomyopathy screening guidelines in adult survivors of childhood cancer.

PubMed

Marr, Kristin C; Agha, Mohammad; Sutradhar, Rinku; Pole, Jason D; Hodgson, David; Guttmann, Astrid; Greenberg, Mark; Nathan, Paul C

2017-10-01

To determine if attendance at a specialized clinic for adult survivors of childhood cancer is associated with better rates of adherence to the Children's Oncology Group (COG) Long-term Follow-up (LTFU) guidelines for cardiomyopathy screening. We conducted a retrospective population-based study using administrative data in Ontario, Canada of 5-year survivors diagnosed between 1986 and 2005 at risk of therapy-related late cardiomyopathy. Patients were classified into three groups based on the recommended frequency of screening: annual, every 2 years, and every 5 years. Of 1811 eligible survivors followed for median 7.8 years (range 0-14.0), patients were adherent to screening for only 8.6% of their period of follow-up. Survivor clinic utilization had the strongest association with increased rates of adherence: when compared to no attendance, ≥ 5 clinic visits/10-year period had RR of adherence of 10.6 (95% CI 5.7-19.5) in the annual group, 3.3 (95% CI 2.3-4.8) in the every 2-year group, and 2.3 (95% CI 1.6-3.2) in the every 5-year group. Additional factors associated with increased adherence after adjusting for clinic attendance included annual assessment by a general practioner, female sex, diagnosis prior to 2003, and living in a rural area. In a model of specialized survivor care, increased clinic utilization is associated with improved patient adherence to COG LTFU cardiomyopathy screening guidelines. Specialized survivor clinics may improve health outcomes in survivors through improved adherence to screening. However, rates of adherence remain suboptimal and further multifacetted strategies need to be explored to improve overall rates of screening in adult survivors of childhood cancer.

Evaluation of increasing antecedent specificity in goal statements on adherence to positive behavior-management strategies.

PubMed

Cohrs, Corey M; Shriver, Mark D; Burke, Raymond V; Allen, Keith D

2016-12-01

We evaluated the impact of antecedent specificity in goal statements on adherence to positive behavior-management strategies. Teaching staff were recruited from 2 different school settings where there were routine expectations to use behavior-specific praise in the classroom, but adherence was poor. In a concurrent multiple baseline design, the use of behavior-specific praise by 4 participants was found to be unaffected by goal statements that increasingly specified the behavior to be used and the conditions under which the behavior should occur. However, adherence by 3 of the 4 participants did change when goal statements included teacher-specified frequencies with which the behavior should occur. Results were systematically replicated in a second study in which, in a concurrent multiple baseline design, 3 participants showed marked increases in adherence when goal statements specified the target behavior, the conditions under which it should occur, and the frequency with which it should occur. © 2016 Society for the Experimental Analysis of Behavior.

Gravity increase at the south pole

USGS Publications Warehouse

Behrendt, John C.

1967-01-01

Abstract. Measurements made between December 1957 and January 1966 of the gravity difference between the McMurdo Sound pendulum station, which is on bedrock, and the South Pole station, which is on the Antarctic ice sheet, show a gravity increase at the South Pole of 0.11 milligals per year. The most likely hypothesis for the increase is that it was caused by ice flowing downslope across a gravity gradient and by the sinking of the South Pole station as a result of accumulation of ice. An alternate hypothesis that the gravity increase was caused by a decrease in ice thickness, of about 40 centimeters per year, is theoretically possible but is not supported by direct evidence.

Blister Packaging Medication to Increase Treatment Adherence and Clinical Response: Impact on Suicide-related Morbidity and Mortality

DTIC Science & Technology

2014-12-01

AD _ Award Number: W81XWH-09-1-0723 TITLE: Blister Packaging Medication to Increase Treatment Adherence and Clinical Response: Impact on Suicide ...Medication to Increase Treatment Adherence and Clinical Response: Impact on Suicide -related Morbidity and Mortality 5a. CONTRACT NUMBER 5b

INCREASE IN SINGLE-TABLET REGIMEN USE AND ASSOCIATED IMPROVEMENTS IN ADHERENCE-RELATED OUTCOMES IN HIV-INFECTED WOMEN

PubMed Central

HANNA, DAVID B.; HESSOL, NANCY A.; GOLUB, ELIZABETH T.; COCOHOBA, JENNIFER M.; COHEN, MARDGE H.; LEVINE, ALEXANDRA M.; WILSON, TRACEY E.; YOUNG, MARY; ANASTOS, KATHRYN; KAPLAN, ROBERT C.

2014-01-01

Introduction The use of single-tablet ART regimens and its implications on adherence among HIV-infected women have not been well-described. Methods Participants were enrolled in the Women’s Interagency HIV Study (WIHS), a longitudinal study of HIV infection in U.S. women. We examined semiannual trends in single-tablet regimen use and ART adherence, defined as self-reported 95% adherence in the past 6 months, during 2006–2013. In a nested cohort study, we assessed the comparative effectiveness of a single-tablet versus a multiple-tablet regimen with respect to adherence, virologic suppression, quality of life, and AIDS-defining events, using propensity score matching to account for demographic, behavioral, and clinical confounders. We also examined these outcomes in a subset of women switching from a multiple- to single-tablet regimen, using a case-crossover design. Results 15,523 person-visits, representing 1,727 women (53% black, 29% Hispanic, 25% IDU, median age 47), were included. Use of single-tablet regimens among ART users increased from 7% in 2006 to 27% in 2013; adherence increased from 78% to 85% during the same period (both p<0.001). Single-tablet regimen use was significantly associated with increased adherence (adjusted RR 1.05, 95% CI 1.03–1.08) and virologic suppression (RR 1.06, 95% CI 1.01–1.11), while associations with improved quality of life and fewer AIDS-defining events did not achieve statistical significance. Similar findings were observed among the subset of switchers. Conclusion Single-tablet regimen use was associated with increased adherence and virologic suppression. Despite this, 15% of women prescribed ART were still not optimally adherent; additional interventions are needed to maximize therapeutic benefits. PMID:24326606

A performance improvement plan to increase nurse adherence to use of medication safety software.

PubMed

Gavriloff, Carrie

2012-08-01

Nurses can protect patients receiving intravenous (IV) medication by using medication safety software to program "smart" pumps to administer IV medications. After a patient safety event identified inconsistent use of medication safety software by nurses, a performance improvement team implemented the Deming Cycle performance improvement methodology. The combined use of improved direct care nurse communication, programming strategies, staff education, medication safety champions, adherence monitoring, and technology acquisition resulted in a statistically significant (p < .001) increase in nurse adherence to using medication safety software from 28% to above 85%, exceeding national benchmark adherence rates (Cohen, Cooke, Husch & Woodley, 2007; Carefusion, 2011). Copyright © 2012 Elsevier Inc. All rights reserved.

Increased adherence of sickled and phosphatidylserine-enriched human erythrocytes to cultured human peripheral blood monocytes.

PubMed

Schwartz, R S; Tanaka, Y; Fidler, I J; Chiu, D T; Lubin, B; Schroit, A J

1985-06-01

The precise mechanism by which sickle erythrocytes (RBC) are removed from the circulation is controversial, although it is possible that enhanced recognition of these cells by circulating mononuclear phagocytes could contribute to this process. We investigated this possibility by interacting sickle cells with cultured human peripheral blood monocytes. Our results show that both irreversibly sickled cells (ISC) and deoxygenated reversibly sickled cells (RSC) had a higher avidity for adherence to monocytes than did oxygenated sickle and normal RBC. ISC were the most adherent cell type. Adherence of RSC to monocytes was found to be reversible; reoxygenation of deoxygenated RSC resulted in a significant decrease in RSC--monocyte adherence. Concomitant with alterations in sickle RBC adherence were alterations in the organization and bilayer distribution of membrane phospholipids in these cells. Specifically, enhanced adherence was associated with increased exposure of RBC membrane outer leaflet phosphatidylserine (PS) and phosphatidylethanolamine, whereas lack of adherence was associated with normal patterns of membrane phospholipid distribution. To investigate the possibility of whether the exposure of PS in the outer membrane leaflet of these cells might be responsible for their recognition by monocytes, the membranes of normal RBC were enriched with the fluorescent PS analogue 1-acyl-2[(N-4-nitro-benzo-2-oxa-1,3-diazole)aminocaproyl]-phosphatidy lse rine (NBD-PS) via transfer of the exogenous lipid from a population of donor phospholipid vesicles (liposomes). RBC enriched with NBD-PS exhibited enhanced adherence to monocytes, whereas adherence of RBC enriched with similar amounts of NBD-phosphatidylcholine (NBD-PC) was not increased. Furthermore, preincubation of monocytes with PS liposomes resulted in a approximately 60% inhibition of ISC adherence to monocytes, whereas no inhibition occurred when monocytes were preincubated with PC liposomes. These findings

Increasing Daily Water Intake and Fluid Adherence in Children Receiving Treatment for Retentive Encopresis

PubMed Central

Hoodin, Flora; Rice, Jennifer; Felt, Barbara T.; Rausch, Joseph R.; Patton, Susana R.

2010-01-01

Objective To examine the efficacy of an enhanced intervention (EI) compared to standard care (SC) in increasing daily water intake and fluid goal adherence in children seeking treatment for retentive encopresis. Methods Changes in beverage intake patterns and fluid adherence were examined by comparing 7-week diet diary data collected during participation in the EI to achieved data for families who had previously completed the SC. Results Compared to children in SC (n = 19), children in the EI (n = 18) demonstrated a significantly greater increase in daily water intake from baseline to the conclusion of treatment ( p ≤ .001), and were four and six times more likely to meet fluid targets in Phases 1 (Weeks 3–4) and 2 (Weeks 5–6) of fluid intervention, respectively (both p ≤ .001). Conclusions Enhanced education and behavioral strategies were efficacious in increasing children’s intake of water and improving fluid adherence. Future research should replicate the findings in a prospective randomized clinical trial to discern their effectiveness. PMID:20439348

Patterns of disclosure and antiretroviral treatment adherence in a South African mining workplace programme and implications for HIV prevention.

PubMed

Bhagwanjee, Anil; Govender, Kaymarlin; Akintola, Olagoke; Petersen, Inge; George, Gavin; Johnstone, Leigh; Naidoo, Kerisha

2011-01-01

Social and psychological barriers to the disclosure of one's seropositive HIV status to significant others and poor adherence to taking medications pose significant challenges to the scaling-up of access to antiretroviral treatment (ART) in the workplace. Such barriers are predictive of sub-optimal treatment outcomes and bedevil HIV-prevention interventions at a societal level. Against this background, this article explores the lived experiences of 19 HIV-positive male participants, between the ages of 33 and 57 years, who were enrolled in an ART programme managed at an occupational health clinic at a mining company in South Africa. The majority of these mineworkers had been aware of their HIV status for between 5 and 7 years. The study explored psychological and relational factors, as aspects of these participants lived experiences, which had a bearing on their adherence to their ART regimen and the disclosure choices that they made regarding their HIV status. In our sample, those participants who were adherent demonstrated higher levels of control and acceptance of their HIV infection and were more confident in their ability to manage their treatment, while the group who were non-adherent presented with lower levels of adherence motivation and self-efficacy, difficulties in maintaining a healthy lifestyle and significant challenges in maintaining control over their lives. While most of the men favoured disclosing their HIV status to their partners for the sake of treatment support, they were less sure about disclosing to family members and non-family members, respectively, because of their need to protect these persons and due to their fear of being stigmatised. It was evident that treatment adherence choices and behaviours were impacted by psychological and relational factors, including disclosure decisions. We conclude with a bivariate model for understanding the adherence behaviours that influenced different patterns of ART adherence among the sample, and

Increasing adherence to obstructive sleep apnea treatment with a group social cognitive therapy treatment intervention: a randomized trial.

PubMed

Bartlett, Delwyn; Wong, Keith; Richards, Dianne; Moy, Emma; Espie, Colin A; Cistulli, Peter A; Grunstein, Ronald

2013-11-01

To examine whether a social cognitive therapy (SCT) intervention increases continuous positive airway pressure (CPAP) use compared to equivalent social interaction (SI) time. Individuals with obstructive sleep apnea (OSA) referred for CPAP therapy. Participants received a 30-min group education session regarding OSA and CPAP. Groups of three to four participants were then randomly assigned to an SCT session or social interaction. CPAP usage was assessed at 7 nights, then 1, 3, and 6 months. The two primary outcomes were adherence, usage ≥ 4 h per night at 6 months, and uptake of CPAP. Questionnaires were given pretreatment and posttreatment. Two hundred six individuals were randomized to SI (n = 97) or SCT (n = 109). CPAP uptake was not different between groups (82% in SI, 88% in SCT groups, P = 0.35). There were no differences between groups in adherence: 63-66% at 1 week, and at 6 months 55-47% (P = 0.36). Higher pretreatment apnea-hypopnea index, higher baseline self-efficacy, and use of CPAP (≥ 4 h) at 1 week were independent predictors of CPAP adherence at 6 months. CPAP adherence increased by a factor of 1.8 (odds ratio = 1.8, 95% confidence interval 1.1-3.0) for every one-unit increase in self-efficacy. There was no difference between groups postintervention in self-efficacy scores, sleepiness, mood, or sleep quality. In this randomized trial, a single SCT application did not increase adherence when compared with SI time. Although self-efficacy scores prior to CPAP predicted adherence, self-efficacy was not increased by the interventions. Increasing intensity and understanding of SCT interventions may be needed to improve CPAP adherence. Australian New Zealand Clinical Trials Registry, ACTRN12607000424404.

The challenges of adherence to infant feeding choices in prevention of mother-to-child transmission of HIV infections in South East Nigeria

PubMed Central

Lawani, Lucky O; Onyebuchi, Azubuike K; Iyoke, Chukwuemeka A; Onoh, Robinson C; Nkwo, Peter O

2014-01-01

Background Global and national efforts in the 21st century are directed toward the elimination of new pediatric HIV infections through evidence-based infant feeding interventions for the prevention of mother-to-child-transmission, with patient preference, motivation, and adherence identified as key factors for success. Objectives This study assessed the challenges faced by HIV-infected parturients in adhering to the national infant feeding recommendations and their infant feeding preference for prevention of mother-to-child transmission in South East Nigeria. Methods This is a cross-sectional, descriptive, questionnaire-based study of 556 parturients infected with HIV/AIDS. Results The mean age of the participants was 28.0±5.3 years. The infant feeding choices were made jointly by both partners (61.1%) in the antepartum period. The HIV status disclosure rate was 89.2%. A large proportion (91.7%) practiced exclusive breastfeeding with highly active antiretroviral therapy, and 7.6% practiced mixed feeding because of nonadherence to their choice and national/international recommendations on infant feeding in the context of HIV/AIDS. This was mainly a result of pressure from family members (42.8%) and cultural practices (28.5%). Multivariate logistic regression analysis indicates that adherence was strongly associated with age, marital status, and employment status, but not with residence, educational status, or parity. Conclusion Exclusive breastfeeding is predominately the infant feeding choice among HIV-infected parturients in South East Nigeria, but there is still a gap between infant feeding preference and adherence to standard practice as a result of sociocultural challenges associated with risk for mixed feeding and the risk for mother-to-child-transmission of HIV by nursing mothers. PMID:24707171

Adherence to antiretroviral therapy among children living with HIV in South India

PubMed Central

Mehta, K; Ekstrand, ML; Heylen, E; Sanjeeva, GN; Shet, A

2017-01-01

Adherence to ART, fundamental to treatment success, has been poorly studied in India. Caregivers of children attending HIV clinics in southern India were interviewed using structured questionnaires. Adherence was assessed using a visual analogue scale representing past-month adherence and treatment interruptions >48 hours during the past 3 months. Clinical features, correlates of adherence and HIV-1 viral-load were documented. Based on caregiver reports, 90.9% of the children were optimally adherent. In multivariable analysis, experiencing ART-related adverse effects was significantly associated with suboptimal adherence (p=0.01). The proportion of children who experienced virological failure was 16.5%. Virological failure was not linked to suboptimal adherence. Factors influencing virological failure included running out of medications (p=0.002) and the child refusing to take medications (p=0.01). Inclusion of drugs with better safety profiles and improved access to care could further enhance outcomes. PMID:26443264

Biomaterial adherent macrophage apoptosis is increased by hydrophilic and anionic substrates in vivo

NASA Astrophysics Data System (ADS)

Brodbeck, William G.; Patel, Jasmine; Voskerician, Gabriela; Christenson, Elizabeth; Shive, Matthew S.; Nakayama, Yasuhide; Matsuda, Takehisa; Ziats, Nicholas P.; Anderson, James M.

2002-08-01

An in vivo rat cage implant system was used to identify potential surface chemistries that prevent failure of implanted biomedical devices and prostheses by limiting monocyte adhesion and macrophage fusion into foreign-body giant cells while inducing adherent-macrophage apoptosis. Hydrophobic, hydrophilic, anionic, and cationic surfaces were used for implantation. Analysis of the exudate surrounding the materials revealed no differences between surfaces in the types or levels of cells present. Conversely, the proportion of adherent cells undergoing apoptosis was increased significantly on anionic and hydrophilic surfaces (46 ± 3.7 and 57 ± 5.0%, respectively) when compared with the polyethylene terephthalate base surface. Additionally, hydrophilic and anionic substrates provided decreased rates of monocyte/macrophage adhesion and fusion. These studies demonstrate that biomaterial-adherent cells undergo material-dependent apoptosis in vivo, rendering potentially harmful macrophages nonfunctional while the surrounding environment of the implant remains unaffected.

Realist evaluation of the antiretroviral treatment adherence club programme in selected primary healthcare facilities in the metropolitan area of Western Cape Province, South Africa: a study protocol

PubMed Central

Mukumbang, Ferdinand C; Van Belle, Sara; Marchal, Bruno; Van Wyk, Brian

2016-01-01

Introduction Suboptimal retention in care and poor treatment adherence are key challenges to antiretroviral therapy (ART) in sub-Saharan Africa. Community-based approaches to HIV service delivery are recommended to improve patient retention in care and ART adherence. The implementation of the adherence clubs in the Western Cape province of South Africa was with variable success in terms of implementation and outcomes. The need for operational guidelines for its implementation has been identified. Therefore, understanding the contexts and mechanisms for successful implementation of the adherence clubs is crucial to inform the roll-out to the rest of South Africa. The protocol outlines an evaluation of adherence club intervention in selected primary healthcare facilities in the metropolitan area of the Western Cape Province, using the realist approach. Methods and analysis In the first phase, an exploratory study design will be used. Document review and key informant interviews will be used to elicit the programme theory. In phase two, a multiple case study design will be used to describe the adherence clubs in five contrastive sites. Semistructured interviews will be conducted with purposively selected programme implementers and members of the clubs to assess the context and mechanisms of the adherence clubs. For the programme's primary outcomes, a longitudinal retrospective cohort analysis will be conducted using routine patient data. Data analysis will involve classifying emerging themes using the context-mechanism-outcome (CMO) configuration, and refining the primary CMO configurations to conjectured CMO configurations. Finally, we will compare the conjectured CMO configurations from the cases with the initial programme theory. The final CMOs obtained will be translated into middle range theories. Ethics and dissemination The study will be conducted according to the principles of the declaration of Helsinki (1964). Ethics clearance was obtained from the

Advance notification letters increase adherence in colorectal cancer screening: a population-based randomized trial.

PubMed

van Roon, A H C; Hol, L; Wilschut, J A; Reijerink, J C I Y; van Vuuren, A J; van Ballegooijen, M; Habbema, J D F; van Leerdam, M E; Kuipers, Ernst J

2011-06-01

The population benefit of screening depends not only on the effectiveness of the test, but also on adherence, which, for colorectal cancer (CRC) screening remains low. An advance notification letter may increase adherence, however, no population-based randomized trials have been conducted to provide evidence of this. In 2008, a representative sample of the Dutch population (aged 50-74 years) was randomized. All 2493 invitees in group A were sent an advance notification letter, followed two weeks later by a standard invitation. The 2507 invitees in group B only received the standard invitation. Non-respondents in both groups were sent a reminder 6 weeks after the invitation. The advance notification letters resulted in a significantly higher adherence (64.4% versus 61.1%, p-value 0.019). Multivariate logistic regression analysis showed no significant interactions between group and age, sex, or socio-economic status. Cost analysis showed that the incremental cost per additional detected advanced neoplasia due to sending an advance notification letter was € 957. This population-based randomized trial demonstrates that sending an advance notification letter significantly increases adherence by 3.3%. The incremental cost per additional detected advanced neoplasia is acceptable. We therefore recommend that such letters are incorporated within the standard CRC-screening invitation process. Copyright © 2011 Elsevier Inc. All rights reserved.

What factors increase Dutch child health care professionals' adherence to a national guideline on preventing child abuse and neglect?

PubMed

Konijnendijk, Annemieke A J; Boere-Boonekamp, Magda M; Fleuren, Margot A H; Haasnoot, Maria E; Need, Ariana

2016-03-01

Guidelines to support health care professionals in early detection of, and responses to, suspected Child Abuse and Neglect (CAN) have become increasingly widely available. Yet little is known about professionals' adherence to these guidelines or the determinants that affect their uptake. This study used a cross-sectional design to assess the adherence of Dutch Child Health Care (CHC) professionals to seven key activities described in a national guideline on preventing CAN. This study also examined the presence and strengths of determinants of guideline adherence. Online questionnaires were filled in between May and July 2013 by 164 CHC professionals. Adherence was defined as the extent to which professionals performed each of seven key activities when they suspected CAN. Thirty-three determinants were measured in relation to the guideline, the health professional, the organisational context and the socio-political context. Bivariate and multivariate regression analyses tested associations between determinants and guideline adherence. Most of the responding CHC professionals were aware of the guideline and its content (83.7%). Self-reported rates of full adherence varied between 19.5% and 42.7%. Stronger habit to use the guideline was the only determinant associated with higher adherence rates in the multivariate analysis. Understanding guideline adherence and associated determinants is essential for developing implementation strategies that can stimulate adherence. Although CHC professionals in this sample were aware of the guideline, they did not always adhere to its key recommended activities. To increase adherence, tailored interventions should primarily focus on enhancing habit strength. Copyright © 2015 Elsevier Ltd. All rights reserved.

Text-message reminders plus incentives increase adherence to antidiabetic medication in adults with type 2 diabetes.

PubMed

Raiff, Bethany R; Jarvis, Brantley P; Dallery, Jesse

2016-12-01

Some adults with Type 2 diabetes mellitus have difficulty adhering to their oral medication regimens. The current study used a multiple baseline design with 3 adults with Type 2 diabetes. Medication taking was monitored remotely in real time via an electronic pill bottle. During the intervention, monetary incentives were delivered contingent on evidence of adherence to taking medication at specified times. Text-message reminders were also sent if medication was not taken. Adherence increased for all participants. Future studies should separate the relative contributions of text-message and incentive components of the intervention. © 2016 Society for the Experimental Analysis of Behavior.

Realist evaluation of the antiretroviral treatment adherence club programme in selected primary healthcare facilities in the metropolitan area of Western Cape Province, South Africa: a study protocol.

PubMed

Mukumbang, Ferdinand C; Van Belle, Sara; Marchal, Bruno; Van Wyk, Brian

2016-04-04

Suboptimal retention in care and poor treatment adherence are key challenges to antiretroviral therapy (ART) in sub-Saharan Africa. Community-based approaches to HIV service delivery are recommended to improve patient retention in care and ART adherence. The implementation of the adherence clubs in the Western Cape province of South Africa was with variable success in terms of implementation and outcomes. The need for operational guidelines for its implementation has been identified. Therefore, understanding the contexts and mechanisms for successful implementation of the adherence clubs is crucial to inform the roll-out to the rest of South Africa. The protocol outlines an evaluation of adherence club intervention in selected primary healthcare facilities in the metropolitan area of the Western Cape Province, using the realist approach. In the first phase, an exploratory study design will be used. Document review and key informant interviews will be used to elicit the programme theory. In phase two, a multiple case study design will be used to describe the adherence clubs in five contrastive sites. Semistructured interviews will be conducted with purposively selected programme implementers and members of the clubs to assess the context and mechanisms of the adherence clubs. For the programme's primary outcomes, a longitudinal retrospective cohort analysis will be conducted using routine patient data. Data analysis will involve classifying emerging themes using the context-mechanism-outcome (CMO) configuration, and refining the primary CMO configurations to conjectured CMO configurations. Finally, we will compare the conjectured CMO configurations from the cases with the initial programme theory. The final CMOs obtained will be translated into middle range theories. The study will be conducted according to the principles of the declaration of Helsinki (1964). Ethics clearance was obtained from the University of the Western Cape. Dissemination will be done through

Understanding adherence-related beliefs about medicine amongst patients of South Asian origin with diabetes and cardiovascular disease patients: a qualitative synthesis.

PubMed

Kumar, Kanta; Greenfield, Sheila; Raza, Karim; Gill, Paramjit; Stack, Rebecca

2016-05-26

Prevalence of diabetes and cardiovascular (CVD) disease amongst UK South Asians is higher than in the general population. Non-adherence to medicines may lead to poor clinical outcomes for South Asian patients with diabetes and CVD. To understand the decision making processes associated with taking medicines, a qualitative systematic meta-synthesis exploring medicine taking behaviours, and beliefs was undertaken. Four databases (Medline, Embase, Science Citation Index and CINAHL) were searched to identify qualitative studies of South Asian patients taking diabetic medicines. Data were thematic coded and synthesised. The following themes were identified: [1] beliefs about the need for and efficacy of medicines; [2] toxicity of medicines and polypharmacy; [3] the necessity of traditional remedies versus "western medicines"; [4] stigma and social support; and [5] communication. South Asians described cultural social stigma associated with diabetes and reported fears about drug toxicity as barriers to taking medicines. Cultural beliefs about traditional remedies and interactions with healthcare professionals also appeared to play a role in the way people made decisions about medicines. Advice should be tailored provided to South Asian patients highlighting the long term consequences of diabetes and CVD.

Individualised motivational counselling to enhance adherence to antiretroviral therapy is not superior to didactic counselling in South African patients: findings of the CAPRISA 058 randomised controlled trial.

PubMed

van Loggerenberg, Francois; Grant, Alison D; Naidoo, Kogieleum; Murrman, Marita; Gengiah, Santhanalakshmi; Gengiah, Tanuja N; Fielding, Katherine; Abdool Karim, Salim S

2015-01-01

Concerns that standard didactic adherence counselling may be inadequate to maximise antiretroviral therapy (ART) adherence led us to evaluate more intensive individualised motivational adherence counselling. We randomised 297 HIV-positive ART-naïve patients in Durban, South Africa, to receive either didactic counselling, prior to ART initiation (n = 150), or an intensive motivational adherence intervention after initiating ART (n = 147). Study arms were similar for age (mean 35.8 years), sex (43.1 % male), CD4+ cell count (median 121.5 cells/μl) and viral load (median 119,000 copies/ml). Virologic suppression at 9 months was achieved in 89.8 % of didactic and 87.9 % of motivational counselling participants (risk ratio [RR] 0.98, 95 % confidence interval [CI] 0.90-1.07, p = 0.62). 82.9 % of didactic and 79.5 % of motivational counselling participants achieved >95 % adherence by pill count at 6 months (RR 0.96, 95 % CI 0.85-1.09, p = 0.51). Participants receiving intensive motivational counselling did not achieve higher treatment adherence or virological suppression than those receiving routinely provided didactic adherence counselling. These data are reassuring that less resource intensive didactic counselling was adequate for excellent treatment outcomes in this setting.

Individualised motivational counselling to enhance adherence to antiretroviral therapy is not superior to didactic counselling in South African patients: Findings of the CAPRISA 058 randomised controlled trial

PubMed Central

van Loggerenberg, Francois; Grant, Alison D.; Naidoo, Kogieleum; Murrman, Marita; Gengiah, Santhanalakshmi; Gengiah, Tanuja N.; Fielding, Katherine; Karim, Salim S. Abdool

2014-01-01

Concerns that standard didactic adherence counselling may be inadequate to maximise antiretroviral therapy (ART) adherence led us to evaluate more intensive individualised motivational adherence counselling. We randomised 297 HIV-positive ART-naïve patients in Durban, South Africa, to receive either didactic counselling, prior to ART initiation (n=150), or an intensive motivational adherence intervention after initiating ART (n=147). Study arms were similar for age (mean 35.8 years), sex (43.1% male), CD4+ cell count (median 121.5 cells/μl) and viral load (median 119 000 copies/ml). Virologic suppression at nine months was achieved in 89.8% of didactic and 87.9% of motivational counselling participants (risk ratio [RR] 0.98, 95% confidence interval [CI] 0.90-1.07, p=0.62). 82.9% of didactic and 79.5% of motivational counselling participants achieved >95% adherence by pill count at six months (RR 0.96, 95%CI 0.85-1.09, p=0.51). Participants receiving intensive motivational counselling did not achieve higher treatment adherence or virological suppression than those receiving routinely provided didactic adherence counselling. These data are reassuring that less resource intensive didactic counselling was adequate for excellent treatment outcomes in this setting. PMID:24696226

Motivational Interviewing to Increase Cognitive Rehabilitation Adherence in Schizophrenia.

PubMed

Fiszdon, Joanna M; Kurtz, Matthew M; Choi, Jimmy; Bell, Morris D; Martino, Steve

2016-03-01

Adherence to treatment in psychiatric populations is notoriously low. In this randomized, controlled, proof-of-concept study, we sought to examine whether motivational interviewing (MI) could be used to enhance motivation for, adherence to, and benefit obtained from cognitive rehabilitation. Dual diagnosis MI, developed specifically for individuals with psychotic symptoms and disorganization, was further adapted to focus on cognitive impairments and their impact. Sixty-four outpatients diagnosed with schizophrenia spectrum disorders completed baseline assessments and were randomized to receive either the 2-session MI focused on cognitive functioning or a 2-session sham control interview focused on assessment and feedback about preferred learning styles. Next, all participants were given 4 weeks during which they could attend up to 10 sessions of a computer-based math training program, which served as a brief analog for a full course of cognitive rehabilitation. As hypothesized, MI condition was associated with greater increases in task-specific motivation along with greater training program session attendance. Moreover, postinterview motivation level predicted session attendance. There were no significant differences in improvement on a measure of cognitive training content, which may have been due to the abbreviated nature of the training. While the literature on the efficacy of MI for individuals with psychosis has been mixed, we speculate that our positive findings may have been influenced by the adaptations made to MI as well as the focus on a nonpharmacological intervention. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center 2015.

Towards Developing an Initial Programme Theory: Programme Designers and Managers Assumptions on the Antiretroviral Treatment Adherence Club Programme in Primary Health Care Facilities in the Metropolitan Area of Western Cape Province, South Africa.

PubMed

Mukumbang, Ferdinand C; van Belle, Sara; Marchal, Bruno; van Wyk, Brian

2016-01-01

The antiretroviral adherence club intervention was rolled out in primary health care facilities in the Western Cape province of South Africa to relieve clinic congestion, and improve retention in care, and treatment adherence in the face of growing patient loads. We adopted the realist evaluation approach to evaluate what aspects of antiretroviral club intervention works, for what sections of the patient population, and under which community and health systems contexts, to inform guidelines for scaling up of the intervention. In this article, we report on a step towards the development of a programme theory-the assumptions of programme designers and health service managers with regard to how and why the adherence club intervention is expected to achieve its goals and perceptions on how it has done so (or not). We adopted an exploratory qualitative research design. We conducted a document review of 12 documents on the design and implementation of the adherence club intervention, and key informant interviews with 12 purposively selected programme designers and managers. Thematic content analysis was used to identify themes attributed to the programme actors, context, mechanisms, and outcomes. Using the context-mechanism-outcome configurational tool, we provided an explanatory focus of how the adherence club intervention is roll-out and works guided by the realist perspective. We classified the assumptions of the adherence club designers and managers into the rollout, implementation, and utilisation of the adherence club programme, constructed around the providers, management/operational staff, and patients, respectively. Two rival theories were identified at the patient-perspective level. We used these perspectives to develop an initial programme theory of the adherence club intervention, which will be tested in a later phase. The perspectives of the programme designers and managers provided an important step towards developing an initial programme theory, which will

Motivational Interviewing to Increase Postdischarge Antibiotic Adherence in Older Adults with Pneumonia.

PubMed

Eyler, Rachel; Shvets, Kristina; Blakely, Michelle L

2016-01-01

To evaluate the impact of a pharmacist-led, motivational interviewing on antibiotic adherence following discharge in older adults with pneumonia. Inpatient medical wards in a large tertiary academic medical center. Older adults diagnosed with pneumonia were enrolled from December 1, 2013, to August 1, 2014, at Yale-New Haven Hospital. Motivational interviewing-a patient-centered method of communication-has gained recognition as a tool that can aid pharmacists in addressing negative health behaviors (e.g., medication adherence, health screenings, substance abuse during counseling sessions). However, the potential role of motivational interviewing in older adults to improve medication adherence during transitions of care is not clear. In this study, in addition to standard discharge care, older adults hospitalized with pneumonia who were randomized to the intervention group received enhanced care: pharmacist-led motivational interviewing. Evaluation of adherence to prescribed antibiotic regimens and patient satisfaction with the motivational interviewing, enhanced-care session. Ultimately, 87% of patients in the intervention group (n = 16) compared with 64% of patients in the control group (n = 14) were adherent to their antibiotic regimens. Patient satisfaction with the motivational interviewing intervention was high. Pharmacist-led motivational interviewing sessions have the potential to positively influence antibiotic adherence rates and patient satisfaction.

Increasing diabetic patient engagement and self-reported medication adherence using a web-based multimedia program.

PubMed

Elsabrout, Kerri

2018-05-01

Evidence-based, multimedia applications to supplement clinical care can improve patient engagement and clinical outcomes. Patients with diabetes with potentially devastating complication of foot ulcers present a substantial opportunity to improve engagement. This project examines how providing an online, multimedia self-management program affects patient engagement and self-reported medication adherence scores within 4-6 weeks compared with preprogram scores. Participants included 14 adult, diabetic outpatients receiving care at a Wound Care Center in suburban New York. Participants watched a Type 2 diabetes Emmi educational module on an electronic tablet during a routine wound treatment visit. Self-reported medication adherence was measured immediately before and at 4-6 weeks after the educational intervention. Patient engagement was measured immediately before, immediately after, and at 4-6 weeks postintervention. Self-reported medication adherence results demonstrated a modest increase at the delayed postintervention time. In addition, there was a large increase in engagement scores at the delayed postintervention time. The direction of change for both measures was consistent with the intervention being effective. Incorporating this type of novel, multimedia patient education resource may provide opportunities to enhance diabetes care.

Effect of Medicaid Policy Changes on Medication Adherence: Differences by Baseline Adherence.

PubMed

Amin, Krutika; Farley, Joel F; Maciejewski, Matthew L; Domino, Marisa E

2017-03-01

In 2001, the North Carolina (NC) Medicaid program reduced the number of days prescription supply that enrollees could fill from 100 days to 34 days and increased copayments for brand-name medications. Previous work has shown that a change in these policies led to a decrease in medication adherence from 2.9 to 8.0 percentage points in specific populations with chronic conditions. Studies have also shown that days supply limits and copayment increases have heterogeneous effects based on enrollees' baseline characteristics, including baseline adherence. However, this phenomenon has not been studied in the Medicaid population. We undertook this study to assess the heterogeneous effect of the NC Medicaid policy changes in groups with varying levels of baseline adherence. To examine whether restrictions on days supply had heterogeneous effects in subgroups defined by medication adherence before the policy changes. A partial difference-in-difference-in-differences model with fixed effects was used to compare medication adherence before and after the NC Medicaid policy changes among Medicaid enrollees subject to the policy changes because of their use of long prescriptions (> 40 days) as compared with (a) NC Medicaid enrollees using short prescriptions (< 40 days) before policy adoption, as well as (b) Medicaid enrollees in Georgia restricted to a 31 days supply through the study period. Medicaid enrollees were included if they filled a prescription for 1 of the following medication classes: antihypertensives, lipid-lowering drugs, or antipsychotics. The effect of the policy changes on medication adherence, calculated using the proportion of days covered (PDC) each quarter by baseline adherence level and clinical condition group, was studied. Average adherence levels over the 18-month prechange period were used to stratify individuals into 3 baseline adherence groups: fully adherent (PDC ≥ 80%), partially adherent (50%-79%), and nonadherent (PDC ≤ 50%). Enrollees fully

Study on Incentives for Glaucoma Medication Adherence (SIGMA): study protocol for a randomized controlled trial to increase glaucoma medication adherence using value pricing.

PubMed

Bilger, Marcel; Wong, Tina T; Howard, Kaye L; Lee, Jia Yi; Toh, Ai Nee; John, Geraldine; Lamoureux, Ecosse L; Finkelstein, Eric A

2016-07-15

Many glaucoma patients do not adhere to their medication regimens because they fail to internalize the (health) costs of non-adherence, which may not occur until years or decades later. Behavioural economic theory suggests that adherence rates can be improved by offering patients a near-term benefit. Our proposed strategy is to offer adherence-contingent rebates on medication and check-up costs. This form of value pricing (VP) ensures that rebates are granted only to those most likely to benefit. Moreover, by leveraging loss aversion, rebates are expected to generate a stronger behavioural response than equivalent financial rewards. The main objective of the Study on Incentives for Glaucoma Medication Adherence (SIGMA) is to test the VP approach relative to usual care (UC) in improving medication adherence. SIGMA is a randomized, controlled, open-label, single-centre superiority trial with two parallel arms. A total of 100 non-adherent (Morisky Medication Adherence Scale ≤6) glaucoma patients from the Singapore National Eye Centre are block-randomized (blocking factor: single versus multiple medications users) into the VP and UC arms in a 1:1 ratio. The treatment received by VP patients will be strictly identical to that received by UC patients, with the only exception being that VP patients can earn either a 50 % or 25 % rebate on their glaucoma-related healthcare costs conditional on being adherent on at least 90 % or 75 % of days as measured by a medication event monitoring system. Masking the arm allocation will be precluded by the behavioural nature of the intervention but blocking size will not be disclosed to protect concealment. The primary outcome is the mean change from baseline in percentage of adherent days at month 6. A day will be counted as adherent when the patients take all their medication(s) within the appropriate dosing windows. This trial will provide evidence on whether adherence-contingent rebates can improve medication adherence among

Understanding Specific Contexts of Antiretroviral Therapy Adherence in Rural South Africa: A Thematic Analysis of Digital Stories from a Community with High HIV Prevalence

PubMed Central

Treffry-Goatley, Astrid; Lessells, Richard; Sykes, Pam; Bärnighausen, Till; de Oliveira, Tulio; Moletsane, Relebohile; Seeley, Janet

2016-01-01

Near-perfect adherence to antiretroviral therapy (ART) is required to achieve the best possible prevention and treatment outcomes. Yet, there have been particular concerns about the challenges of adherence among patients living in resource-limited settings in sub-Saharan Africa. The primary objective of this study was to explore adherence in a low-resourced, rural community of high HIV prevalence in South Africa and to identify specific individual and structural factors that can either challenge or support adherence in this context. We applied digital stories as a qualitative research tool to gain insights into personal contexts of HIV and ART adherence. Through an inductive thematic analysis of twenty story texts, soundtracks and drawings, we explored experiences, understandings, and contexts of the participants and identified potential barriers and facilitators for those on lifelong treatment. We found that many of the stories reflected a growing confidence in the effectiveness of ART, which should be viewed as a key facilitator to successful adherence since this attitude can promote disclosure and boost access to social support. Nevertheless, stories also highlighted the complexity of the issues that individuals and households face as they deal with HIV and ART in this setting and it is clear that an overburdened local healthcare system has often struggled to meet the demands of a rapidly expanding epidemic and to provide the necessary medical and emotional support. Our analysis suggests several opportunities for further research and the design of novel health interventions to support optimal adherence. Firstly, future health promotion campaigns should encourage individuals to test together, or at least accompany each other for testing, to encourage social support from the outset. Additionally, home-based testing and ART club interventions might be recommended to make it easier for individuals to adhere to their treatment regimens and to provide a sense of

"That is why I stopped the ART": patients' & providers' perspectives on barriers to and enablers of HIV treatment adherence in a South African workplace programme.

PubMed

Dahab, Mison; Charalambous, Salome; Hamilton, Robin; Fielding, Katherine; Kielmann, Karina; Churchyard, Gavin J; Grant, Alison D

2008-02-18

As ART programmes in African settings expand beyond the pilot stages, adherence to treatment may become an increasing challenge. This qualitative study examines potential barriers to, and facilitators of, adherence to ART in a workplace programme in South Africa. We conducted key informant interviews with 12 participants: six ART patients, five health service providers (HSPs) and one human resources manager. The main reported barriers were denial of existence of HIV or of one's own positive status, use of traditional medicines, speaking a different language from the HSP, alcohol use, being away from home, perceived severity of side-effects, feeling better on treatment and long waiting times at the clinic. The key facilitators were social support, belief in the value of treatment, belief in the importance of one's own life to the survival of one's family, and the ability to fit ART into daily life schedules. Given the reported uncertainty about the existence of HIV disease and the use of traditional medicines while on ART, despite a programme emphasising ART counselling, there is a need to find effective ways to support adherence to ART even if the individual does not accept biomedical concepts of HIV disease or decides to use traditional medicines. Additionally, providers should identify ways to minimize barriers in communication with patients with whom they have no common language. Finally, dissatisfaction with clinical services, due to long waiting times, should be addressed.

Unearthing how, why, for whom and under what health system conditions the antiretroviral treatment adherence club intervention in South Africa works: A realist theory refining approach.

PubMed

Mukumbang, Ferdinand C; Marchal, Bruno; Van Belle, Sara; van Wyk, Brian

2018-05-09

Poor retention in care and suboptimal adherence to antiretroviral treatment (ART) undermine its successful rollout in South Africa. The adherence club intervention was designed as an adherence-enhancing intervention to enhance the retention in care of patients on ART and their adherence to medication. Although empirical evidence suggests the effective superiority of the adherence club intervention to standard clinic ART care schemes, it is poorly understood exactly how and why it works, and under what health system contexts. To this end, we aimed to develop a refined programme theory explicating how, why, for whom and under what health system contexts the adherence club intervention works (or not). We undertook a realist evaluation study to uncover the programme theory of the adherence club intervention. We elicited an initial programme theory of the adherence club intervention and tested the initial programme theory in three contrastive sites. Using a cross-case analysis approach, we delineated the conceptualisation of the intervention, context, actor and mechanism components of the three contrastive cases to explain the outcomes of the adherence club intervention, guided by retroductive inferencing. We found that an intervention that groups clinically stable patients on ART in a convenient space to receive a quick and uninterrupted supply of medication, health talks, counselling, and immediate access to a clinician when required works because patients' self-efficacy improves and they become motivated and nudged to remain in care and adhere to medication. The successful implementation and rollout of the adherence club intervention are contingent on the separation of the adherence club programme from other patients who are HIV-negative. In addition, there should be available convenient space for the adherence club meetings, continuous support of the adherence club facilitators by clinicians and buy-in from the health workers at the health-care facility and the

Towards Developing an Initial Programme Theory: Programme Designers and Managers Assumptions on the Antiretroviral Treatment Adherence Club Programme in Primary Health Care Facilities in the Metropolitan Area of Western Cape Province, South Africa

PubMed Central

Mukumbang, Ferdinand C.; van Belle, Sara; Marchal, Bruno; van Wyk, Brian

2016-01-01

Background The antiretroviral adherence club intervention was rolled out in primary health care facilities in the Western Cape province of South Africa to relieve clinic congestion, and improve retention in care, and treatment adherence in the face of growing patient loads. We adopted the realist evaluation approach to evaluate what aspects of antiretroviral club intervention works, for what sections of the patient population, and under which community and health systems contexts, to inform guidelines for scaling up of the intervention. In this article, we report on a step towards the development of a programme theory—the assumptions of programme designers and health service managers with regard to how and why the adherence club intervention is expected to achieve its goals and perceptions on how it has done so (or not). Methods We adopted an exploratory qualitative research design. We conducted a document review of 12 documents on the design and implementation of the adherence club intervention, and key informant interviews with 12 purposively selected programme designers and managers. Thematic content analysis was used to identify themes attributed to the programme actors, context, mechanisms, and outcomes. Using the context-mechanism-outcome configurational tool, we provided an explanatory focus of how the adherence club intervention is roll-out and works guided by the realist perspective. Results We classified the assumptions of the adherence club designers and managers into the rollout, implementation, and utilisation of the adherence club programme, constructed around the providers, management/operational staff, and patients, respectively. Two rival theories were identified at the patient-perspective level. We used these perspectives to develop an initial programme theory of the adherence club intervention, which will be tested in a later phase. Conclusion The perspectives of the programme designers and managers provided an important step towards developing

Psychosocial influencers and mediators of treatment adherence in haemodialysis patients.

PubMed

Oh, Hyun Soo; Park, Ji Suk; Seo, Wha Sook

2013-09-01

This article is a report of the development and testing of the hypothetical model that illustrates relationships between treatment adherence and its psychosocial influencing factors and to elucidate the direct and indirect (mediating) effects of factors on treatment adherence. Poor adherence has been consistently reported in haemodialysis patients. Much research has showed various influencing factors of adherence, but these studies have failed to identify consistent influencing factors. This study was performed using a non-experimental, cross-sectional design. The study subjects were 150 end-stage renal failure patients on haemodialysis at a university hospital located in Incheon, South Korea. Data were collected over 10 months (June 2010-April 2011). The hypothetical model provided a good fit with data. Haemodialysis-related knowledge, perceived barrier to adherence, self-efficacy on adherence, and healthcare provider support had significant effects on adherence. Self-efficacy was found to mediate barrier-adherence and family support-adherence relationships. Self-efficacy in combination with barrier, family support, and healthcare provider support was found to mediate the depression-adherence relationship. Strategies aimed at the development of successful adherence interventions should focus on reducing perceived barriers and enhancing self-efficacy and knowledge. It can be suggested that efforts to improve the healthcare provider-patient relationship would enhance adherence. In depressive patients, strategies that promote self-efficacy and the support of family or healthcare providers could diminish the negative impact of depression on adherence. © 2013 Blackwell Publishing Ltd.

Patient satisfaction on tuberculosis treatment service and adherence to treatment in public health facilities of Sidama zone, South Ethiopia.

PubMed

Nezenega, Zekariyas Sahile; Gacho, Yohannes H Michael; Tafere, Tadese Ejigu

2013-03-22

Patient compliance is a key factor in treatment success. Satisfied patients are more likely to utilize health services, comply with medical treatment, and continue with the health care providers. Yet, the national tuberculosis control program failed to address some of these aspects in order to achieve the national targets. Hence, this study attempted to investigate patient satisfaction and adherence to tuberculosis treatment in Sidama zone of south Ethiopia. A facility based cross sectional study was conducted using quantitative method of data collection from March to April 2011. A sample of 531 respondents on anti TB treatment from 11 health centers and 1 hospital were included in the study. The sample size to each facility was allocated using probability proportional to size allocation, and study participants for the interview were selected by systematic random sampling. A Pre tested, interviewer administered questionnaire was used to collect the data. Collected data was edited, coded and entered to Epi data version 3.1 and exported to SPSS version 16. Confirmatory factor analysis was done to identify factors that explain most of the variance observed in most of the manifested variables. Bivariate and Multivariate analysis were computed to analyze the data. The study revealed 90% of the study participants were satisfied with TB treatment service. However, 26% of respondents had poor adherence to their TB treatment. Patient perceived on professional care, time spent with health care provider, accessibility, technical competency, convenience (cleanliness) and consultation and relational empathy were independent predictors of overall patient satisfaction (P < 0.05). In addition to this, perceived waiting time was significantly associated with patient satisfaction (Beta = 0.262). In multivariate analysis occupational status, area of residence, perceived time spent with health care provider, perceived accessibility, perceived waiting time, perceived professional care

Offering financial incentives to increase adherence to antipsychotic medication: the clinician experience.

PubMed

Highton-Williamson, Elizabeth; Barnicot, Kirsten; Kareem, Tarrannum; Priebe, Stefan

2015-04-01

Financial incentives for medication adherence in patients with psychotic disorders are controversial. It is not yet known whether fears expressed by clinicians are borne out in reality. We aimed to explore community mental health clinicians' experiences of the consequences of giving patients with psychotic disorders a financial incentive to take their depot medication. We implemented descriptive and thematic analyses of semistructured interviews with the clinicians of patients assigned to receive incentives within a randomized controlled trial. Fifty-nine clinicians were interviewed with regard to the effect of the incentives on 73 of the 78 patients allocated to receive incentives in the trial. Most commonly, the clinicians reported benefits for clinical management including improved adherence, contact, patient monitoring, communication, and trust (n = 52). Positive effects on symptoms, insight, or social functioning were reported for some (n = 33). Less commonly, problems for patient management were reported (n = 19) such as monetarization of the therapeutic relationship or negative consequences for the patient (n = 15) such as increased drug and alcohol use. Where requests for increased money occurred, they were rapidly resolved. It seems that, in most cases, the clinicians found that using incentives led to benefits for patient management and for patient health. However, in 33% of cases, some adverse effects were reported. It remains unclear whether certain clinical characteristics are associated with increased risk for adverse effects of financial incentives. The likelihood of benefit versus the smaller risk for adverse effects should be weighed up when deciding whether to offer incentives to individual patients.

Adherence to a Gluten Free Diet Is Associated with Receiving Gluten Free Foods on Prescription and Understanding Food Labelling.

PubMed

Muhammad, Humayun; Reeves, Sue; Ishaq, Sauid; Mayberry, John; Jeanes, Yvonne M

2017-07-06

Treatment of coeliac disease requires a strict gluten-free (GF) diet, however, a high proportion of patients do not adhere to a GF diet. The study explores the practical challenges of a GF diet and dietary adherence in Caucasian and South Asian adults with coeliac disease. Patients with biopsy- and serology-proven coeliac disease were recruited from a hospital database. Participants completed a postal survey ( n = 375), including a validated questionnaire designed to measure GF dietary adherence. Half of Caucasians (53%) and South Asians (53%) were adhering to a GF diet. The quarter of patients ( n = 97) not receiving GF foods on prescription had a lower GF dietary adherence score compared with those receiving GF foods on prescription (12.5 versus 16.0; p < 0.001). Not understanding food labelling and non-membership of Coeliac UK were also associated with lower GF dietary adherence scores. A higher proportion of South Asian patients, compared with Caucasians, reported difficulties understanding what they can eat (76% versus 5%; p < 0.001) and understanding of food labels (53% versus 4%; p < 0.001). We recommend retaining GF foods on prescription, membership of a coeliac society, and regular consultations with a dietitian to enable better understanding of food labels. Robust studies are urgently needed to evaluate the impact of reducing the amount of GF foods prescribed on adherence to a GF diet in all population groups.

Adherence to Drug-Refill Is a Useful Early Warning Indicator of Virologic and Immunologic Failure among HIV Patients on First-Line ART in South Africa

PubMed Central

El-Khatib, Ziad; Katzenstein, David; Marrone, Gaetano; Laher, Fatima; Mohapi, Lerato; Petzold, Max; Morris, Lynn; Ekström, Anna Mia

2011-01-01

Background Affordable strategies to prevent treatment failure on first-line regimens among HIV patients are essential for the long-term success of antiretroviral therapy (ART) in sub-Saharan Africa. WHO recommends using routinely collected data such as adherence to drug-refill visits as early warning indicators. We examined the association between adherence to drug-refill visits and long-term virologic and immunologic failure among non-nucleoside reverse transcriptase inhibitor (NNRTI) recipients in South Africa. Methods In 2008, 456 patients on NNRTI-based ART for a median of 44 months (range 12–99 months; 1,510 person-years) were enrolled in a retrospective cohort study in Soweto. Charts were reviewed for clinical characteristics before and during ART. Multivariable logistic regression and Kaplan-Meier survival analysis assessed associations with virologic (two repeated VL>50 copies/ml) and immunologic failure (as defined by WHO). Results After a median of 15 months on ART, 19% (n = 88) and 19% (n = 87) had failed virologically and immunologically respectively. A cumulative adherence of <95% to drug-refill visits was significantly associated with both virologic and immunologic failure (p<0.01). In the final multivariable model, risk factors for virologic failure were incomplete adherence (OR 2.8, 95%CI 1.2–6.7), and previous exposure to single-dose nevirapine or any other antiretrovirals (adj. OR 2.1, 95%CI 1.2–3.9), adjusted for age and sex. In Kaplan-Meier analysis, the virologic failure rate by month 48 was 19% vs. 37% among adherent and non-adherent patients respectively (logrank p value = 0.02). Conclusion One in five failed virologically after a median of 15 months on ART. Adherence to drug-refill visits works as an early warning indicator for both virologic and immunologic failure. PMID:21408071

Adherence and the Lie in a HIV Prevention Clinical Trial

PubMed Central

Stadler, Jonathan; Scorgie, Fiona; van der Straten, Ariane; Saethre, Eirik

2016-01-01

The lie has been presented as a performance that protects identities against moral judgment in the context of power imbalances. We explore this assertion from the perspective of a pre-exposure prophylaxis trial to prevent HIV for African women in South Africa, in which context biological evidence of widespread lying about product adherence was produced, resulting in a moral discourse that opposed altruistic and selfish motivations. In this article, we seek to understand the meaning of the lie from the perspective of women trial participants. Seeing the trial as representing a hopeful future, and perfect adherence as sustaining their investment in this, participants recited scripted accounts of adherence and performed the role of the perfect adherer, while identifying other participants as dishonest. Given that clinical trials create moral orders and adherence is key to this, we argue that women embraced the apparatus of the clinical trial to assert their moral subjectivities. PMID:26575611

Adherence as a language game.

PubMed

Kolberg, Espen Skarstein

2017-04-01

Non-adherence, i.e. medication intake behavior not corresponding with agreed recommendations, is associated with increased morbidity and death, and it has been estimated that as many as 50% of patients in developed countries are not taking their medications as prescribed. But even as efforts in improving medication adherence over the years have increased, results are inconsistent, with only a minority of clinical trials showing any improvement in both adherence and clinical outcome. Since patient education is central to promoting good medication adherence, and language is integral to education, perhaps an exploration of the meaning and use of language, using the philosophy of Ludwig Wittgenstein, is in order.

Predictors of Poor Adherence of US Gastroenterologists with Colonoscopy Screening and Surveillance Guidelines.

PubMed

Iskandar, Heba; Yan, Yan; Elwing, Jill; Early, Dayna; Colditz, Graham A; Wang, Jean S

2015-04-01

The US Multi-Society Task Force on Colorectal Cancer published guidelines for colonoscopy screening and surveillance in 2008 and affirmed them in 2012. Characteristics associated with guideline adherence among US gastroenterologists have not been assessed. Assess awareness and adherence of US gastroenterologists with national guidelines for colonoscopy screening and surveillance and predictors of adherence to guidelines. A Web-based survey was administered to gastroenterologists in various practice settings across the USA. A total of 306 gastroenterologists completed the survey; 86 % reported awareness of the guidelines. Low-volume colonoscopists (<20/month) were less likely to be aware of the guidelines (OR 0.26, p = 0.03) compared to high-volume colonoscopists (>100/month). Those completing training before 1990 were less likely to report following guidelines (OR 0.37, p = 0.01). Adherence with guidelines was then assessed via clinical scenarios. Compared to physicians finishing training in 1991-2010, less adherence was seen in those finishing before 1990 (OR 0.75, p < 0.001) or currently in training (OR 0.72, p = 0.004). Compared to the Western USA, less adherence was seen in the Midwest (OR 0.69, p = 0.001), Northeast (OR 0.63, p < 0.001), and South (OR 0.59, p < 0.001). Lower adherence was seen among non-academic physicians (OR 0.72, p = 0.001) and low-volume colonoscopists (OR 0.52, p < 0.001). There is poor adherence with colonoscopy screening and surveillance guidelines among US gastroenterologists. Poor adherence was associated with being in training or finishing training before 1990, practicing in the South, non-academic settings, and low colonoscopy volume. These findings can target interventions for quality improvement in colorectal cancer screening and surveillance.

Impact of increasing adherence to disease-modifying therapies on healthcare resource utilization and direct medical and indirect work loss costs for patients with multiple sclerosis.

PubMed

Yermakov, Sander; Davis, Matthew; Calnan, Michaela; Fay, Monica; Cox-Buckley, Brieana; Sarda, Sujata; Duh, Mei Sheng; Iyer, Ravi

2015-01-01

To estimate the effect of adherence to disease-modifying therapies (DMTs) among patients with multiple sclerosis (MS) on healthcare resource utilization (HRU) and costs, and model the impact of a 10 percentage point increase in adherence on these outcomes. Employed patients, 18-64 years old, with ≥2 MS diagnoses and ≥1 DMT claim during January 1, 2002 to September 30, 2012 were identified from a large commercially-insured US claims database. Adherence was measured as proportion of days covered (PDC) during follow-up. Multivariate regression analyses were conducted to estimate the effect of adherence on HRU related to urgent care (i.e., inpatient or emergency room visit), days of work loss, direct medical cost, and indirect work loss costs. Model coefficients were used to evaluate the impact of a 10 percentage point increase in adherence on the outcomes. A total of 1510 patients were included (mean age = 43.4 years, 64% female). Patients with higher adherence had lower HRU, fewer days of work loss, and lower direct and indirect costs. A 10 percentage point increase in adherence significantly decreased the likelihood of an inpatient or emergency room visit by 9-19%, days of work loss by 3-8%, and direct and indirect costs by 3-5%, depending on the follow-up period (all p < 0.01). Increasing DMT adherence was found to significantly decrease urgent-care HRU, days of work loss, and direct and indirect costs among patients with MS.

Improving treatment adherence for blood pressure lowering via mobile phone SMS-messages in South Africa: a qualitative evaluation of the SMS-text Adherence SuppoRt (StAR) trial.

PubMed

Leon, Natalie; Surender, Rebecca; Bobrow, Kirsty; Muller, Jocelyn; Farmer, Andrew

2015-07-03

Effective use of proven treatments for high blood pressure, a preventable health risk, is challenging for many patients. Prompts via mobile phone SMS-text messaging may improve adherence to clinic visits and treatment, though more research is needed on impact and patient perceptions of such support interventions, especially in low-resource settings. An individually-randomised controlled trial in a primary care clinic in Cape Town (2012-14), tested the effect of an adherence support intervention delivered via SMS-texts, on blood pressure control and adherence to medication, for hypertensive patients. ( ClinicalTrials.gov NCT02019823). We report on a qualitative evaluation that explored the trial participants' experiences and responses to the SMS-text messages, and identified barriers and facilitators to delivering adherence support via patients' own mobile phones. Two focus groups and fifteen individual interviews were conducted. We used comparative and thematic analysis approaches to identify themes and triangulated our analysis amongst three researchers. Most participants were comfortable with the technology of using SMS-text messages. Messages were experienced as acceptable, relevant and useful to a broad range of participants. The SMS-content, the respectful tone and the delivery (timing of reminders and frequency) and the relational aspect of trial participation (feeling cared for) were all highly valued. A subgroup who benefitted the most, were those who had been struggling with adherence due to high levels of personal stress. The intervention appeared to coincide with their readiness for change, and provided practical and emotional support for improving adherence behaviour. Change may have been facilitated through increased acknowledgement of their health status and attitudinal change towards greater self-responsibility. Complex interaction of psycho-social stressors and health service problems were reported as broader challenges to adherence behaviours

Adherence-Specific Social Support Enhances Adherence to Calcium Supplementation Regimens among Pregnant Women.

PubMed

Martin, Stephanie L; Omotayo, Moshood O; Pelto, Gretel H; Chapleau, Gina M; Stoltzfus, Rebecca J; Dickin, Katherine L

2017-04-01

further study. This research demonstrates the importance of adherence support and suggests that interventions to increase household-level support for antenatal micronutrient supplementation may be needed to implement the WHO guidelines. This trial was registered at clinicaltrials.gov as NCT02238704. © 2017 American Society for Nutrition.

Explanatory Models and Medication Adherence in Patients with Depression in South India

PubMed Central

Siddappa, Adarsh Lakkur; Raman, Rajesh; Hattur, Basavana Gowdappa

2017-01-01

Introduction Conceptualization of depression may have bearing on treatment seeking. It may affect adherence behaviour of the patients. Aim To find out the explanatory models and their relationship with socio-demographic variables and medication adherence in patients with depression. Materials and Methods Fifty-eight consecutive patients with depression in remission were recruited as per selection criteria. Socio-demographic details were collected. Patients were assessed using Mental Distress Explanatory Model Questionnaire (MDEMQ) and Morisky Medication Adherence Scale (MMAS). Results Significant scores were observed in all dimensions of explanatory models. In the Mann-Whitney U test the patient’s marital status (MU=113.500, p=0.05, sig≤0.05, 2-tailed), and family history of mental illness (MU=165.5, p=0.03, sig≤0.05, 2-tailed) had a statistically significant group difference in the score of MDEMQ. In linear regression analysis, four predictors (MDEMQ subscales Stress, Western physiology, Non-Western physiology and Supernatural) had significantly predicted the value of MMAS (R2=0.937, f=153.558, p<0.001). Conclusion Findings of this study suggested that patients with depression harbor multidimensional explanatory model. The levels of explanatory models are inversely associated with levels of medication adherence. PMID:28274025

How to Increase Reach and Adherence of Web-Based Interventions: A Design Research Viewpoint.

PubMed

Ludden, Geke D S; van Rompay, Thomas J L; Kelders, Saskia M; van Gemert-Pijnen, Julia E W C

2015-07-10

Nowadays, technology is increasingly used to increase people's well-being. For example, many mobile and Web-based apps have been developed that can support people to become mentally fit or to manage their daily diet. However, analyses of current Web-based interventions show that many systems are only used by a specific group of users (eg, women, highly educated), and that even they often do not persist and drop out as the intervention unfolds. In this paper, we assess the impact of design features of Web-based interventions on reach and adherence and conclude that the power that design can have has not been used to its full potential. We propose looking at design research as a source of inspiration for new (to the field) design approaches. The paper goes on to specify and discuss three of these approaches: personalization, ambient information, and use of metaphors. Central to our viewpoint is the role of positive affect triggered by well-designed persuasive features to boost adherence and well-being. Finally, we discuss the future of persuasive eHealth interventions and suggest avenues for follow-up research.

How to Increase Reach and Adherence of Web-Based Interventions: A Design Research Viewpoint

PubMed Central

2015-01-01

Nowadays, technology is increasingly used to increase people’s well-being. For example, many mobile and Web-based apps have been developed that can support people to become mentally fit or to manage their daily diet. However, analyses of current Web-based interventions show that many systems are only used by a specific group of users (eg, women, highly educated), and that even they often do not persist and drop out as the intervention unfolds. In this paper, we assess the impact of design features of Web-based interventions on reach and adherence and conclude that the power that design can have has not been used to its full potential. We propose looking at design research as a source of inspiration for new (to the field) design approaches. The paper goes on to specify and discuss three of these approaches: personalization, ambient information, and use of metaphors. Central to our viewpoint is the role of positive affect triggered by well-designed persuasive features to boost adherence and well-being. Finally, we discuss the future of persuasive eHealth interventions and suggest avenues for follow-up research. PMID:26163456

“Life-Steps” for PrEP Adherence: Demonstration of a CBT-Based Intervention to Increase Adherence to Preexposure Prophylaxis (PrEP) Medication Among Sexual-Minority Men at High Risk for HIV Acquisition

PubMed Central

Taylor, S. Wade; Psaros, Christina; Pantalone, David W.; Tinsley, Jake; Elsesser, Steven A.; Mayer, Kenneth H.; Safren, Steven A.

2016-01-01

One dramatic advance in human immunodeficiency virus (HIV) prevention efforts has been the prescription of medications typically used for HIV treatment as prophylaxis against acquiring HIV. As a preventative agent, this practice is referred to as “preexposure prophylaxis” (PrEP). The U.S. Federal Drug Administration approved daily PrEP for adults at risk for HIV who do not consistently use condoms during sex with HIV-infected or unknown-status partners. In this paper, we describe a cognitive-behavioral therapy (CBT) PrEP adherence intervention developed for use in high-risk sexual-minority men in the United States, adapted from “Life-Steps,” an evidence-based CBT intervention to promote adherence to HIV treatment. Modules include creating a PrEP dosing schedule, adhering to daily PrEP, problem solving barriers to adherence, and sexual risk-reduction techniques. Supplemented with practical video vignettes, this novel intervention may help to enhance the clinical practice of health care providers in outpatient settings to increase PrEP adherence in sexual-minority men. PMID:28392673

Patient adherence in COPD.

PubMed

Bourbeau, J; Bartlett, S J

2008-09-01

Patient adherence to treatment in chronic obstructive pulmonary disease (COPD) is essential to optimise disease management. As with other chronic diseases, poor adherence is common and results in increased rates of morbidity, healthcare expenditures, hospitalisations and possibly mortality, as well as unnecessary escalation of therapy and reduced quality of life. Examples include overuse, underuse, and alteration of schedule and doses of medication, continued smoking and lack of exercise. Adherence is affected by patients' perception of their disease, type of treatment or medication, the quality of patient provider communication and the social environment. Patients are more likely to adhere to treatment when they believe it will improve disease management or control, or anticipate serious consequences related to non-adherence. Providers play a critical role in helping patients understand the nature of the disease, potential benefits of treatment, addressing concerns regarding potential adverse effects and events, and encouraging patients to develop self-management skills. For clinicians, it is important to explore patients' beliefs and concerns about the safety and benefits of the treatment, as many patients harbour unspoken fears. Complex regimens and polytherapy also contribute to suboptimal adherence. This review addresses adherence related issues in COPD, assesses current efforts to improve adherence and highlights opportunities to improve adherence for both providers and patients.

Low Pretreatment Impulsivity and High Medication Adherence Increase the Odds of Abstinence in a Trial of N-Acetylcysteine in Adolescents with Cannabis Use Disorder

PubMed Central

Bentzley, Jessica P.; Tomko, Rachel L.; Gray, Kevin M.

2016-01-01

Background In light of recent progress toward pharmacologic interventions to treat adolescent cannabis use disorder, it is important to consider which adolescent characteristics may be associated with a favorable response to treatment. This study presents secondary analyses from a parent randomized controlled trial of N-acetylcysteine (NAC) in adolescents with cannabis use disorder. We hypothesized high pretreatment impulsivity and medication non-adherence would be associated with reduced abstinence rates. Methods Participants were treatment-seeking adolescents (N = 115) who met criteria for cannabis use disorder and were assessed for pretreatment impulsivity. They received 1200 mg NAC or placebo orally twice daily for 8 weeks. An intent-to-treat analysis using a repeated-measures logistic regression model was used to relate pretreatment impulsivity (Barratt Impulsiveness Scale) and treatment group to abstinence rates, measured by urine cannabinoid tests. To explore mechanisms by which NAC may reduce cannabis use, relationships between impulsivity, adherence, and abstinence were assessed in a second statistical model using data from participants with recorded adherence and urine cannabinoid test results (n = 54). Results In the intent-to-treat analysis, low pretreatment impulsivity, NAC treatment, and negative baseline urine cannabinoid test results independently increased the odds of having negative urine cannabinoid tests during treatment (OR = 2.1, 2.3, 5.3 respectively). In the sample of participants with adherence data (n = 54), adherence tripled the odds of abstinence. Notably, the effect of adherence on abstinence was only observed in the NAC treatment group. Lastly, although the highly impulsive participants had reduced rates of abstinence, highly impulsive individuals adherent to NAC treatment had increased abstinence rates compared to non-adherent individuals. Conclusion Low impulsivity, NAC treatment, medication adherence, and baseline negative

Medication adherence among adult patients on hemodialysis.

PubMed

Alkatheri, Abdulmalik M; Alyousif, Sarah M; Alshabanah, Najla; Albekairy, Abdulkareem M; Alharbi, Shemylan; Alhejaili, Fayze F; Alsayyari, Abdullah A; Qandil, Abeer Ma; Qandil, Amjad M

2014-07-01

Medication adherence was assessed in 89 patients on hemodialysis (HD) at the King Abdul Aziz Medical City using an Arabic version of the Morisky Medication Adherence Scale (MASS-8). The results of the study revealed that 31.46% and 40.45% of the participants showed low and medium adherence, respectively, while 28.09% showed high medication adherence. Accordingly, 71.91% of the patients visiting the dialysis unit were considered medication non-adherent. While being of older age (P = 0.012), being married (P = 0.012) increased the level of adherence, being of medium level of education (P = 0.024) decreased adherence levels. On the other hand, gender, presence of a care-giver, number of members in the household and employment status seems to have no effect on the level of medication adherence. These results call upon the practitioners in HD units to develop intervention programs that can increase the level of medication adherence.

An adapted education program to increase adherence to the dietary guidelines for Americans: a feasibility study

USDA-ARS?s Scientific Manuscript database

The National Institutes of Health (NIH) We Can! (Ways to Enhance Children's Activity and Nutrition) was culturally tailored in order to increase adherence to the Dietary Guidelines for Americans, as the vehicle for preventing childhood overweight and obesity in Louisiana families. We Can! Louisiana ...

Predictors of poor adherence of U.S. gastroenterologists with colonoscopy screening and surveillance guidelines

PubMed Central

Iskandar, Heba; Yan, Yan; Elwing, Jill; Early, Dayna; Colditz, Graham A.; Wang, Jean S.

2014-01-01

Background The U.S. Multi-Society Task Force on Colorectal Cancer published guidelines for colonoscopy screening and surveillance in 2008 and affirmed them in 2012. Characteristics associated with guideline adherence among U.S. gastroenterologists have not been assessed. Aims Assess awareness and adherence of U.S. gastroenterologists with national guidelines for colonoscopy screening and surveillance and predictors of adherence to guidelines. Methods A web-based survey was administered to gastroenterologists in various practice settings across the United States. Results A total of 306 gastroenterologists completed the survey; 86% reported awareness of the guidelines. Low-volume colonoscopists (<20 /month) were less likely to be aware of the guidelines (OR 0.26, p=0.03) compared to high-volume colonoscopists (>100/month). Those completing training before 1990 were less likely to report following guidelines (OR 0.37, p=0.01). Adherence with guidelines was then assessed via clinical scenarios. Compared to physicians finishing training in 1991-2010, less adherence was seen in those finishing before 1990 (OR 0.75, p<0.001) or currently in training (OR 0.72, p=0.004). Compared to the Western U.S., less adherence was seen in the Midwest (OR 0.69, p=0.001), Northeast (OR 0.63, p<0.001), and South (OR 0.59, p<0.001). Lower adherence was seen among non-academic physicians (OR 0.72, p=0.001) and low-volume colonoscopists (OR 0.52, p<0.001). Conclusions There is poor adherence with colonoscopy screening and surveillance guidelines among U.S. gastroenterologists. Poor adherence was associated with being in training or finishing training before 1990, practicing in the South, non-academic settings, and low colonoscopy volume. These findings can target interventions for quality improvement in colorectal cancer screening and surveillance. PMID:25366146

Effects of Statin Intensity and Adherence on the Long-Term Prognosis After Acute Ischemic Stroke.

PubMed

Kim, Jinkwon; Lee, Hye Sun; Nam, Chung Mo; Heo, Ji Hoe

2017-10-01

Statin is an established treatment for secondary prevention after ischemic stroke. However, the effects of statin intensity and adherence on the long-term prognosis after acute stroke are not well known. This retrospective cohort study using a nationwide health insurance claim data in South Korea included patients admitted with acute ischemic stroke between 2002 and 2012. Statin adherence and intensity were determined from the prescription data for a period of 1 year after the index stroke. The primary outcome was a composite of recurrent stroke, myocardial infarction, and all-cause mortality. We performed multivariate Cox proportional regression analyses. We included 8001 patients with acute ischemic stroke. During the mean follow-up period of 4.69±2.72 years, 2284 patients developed a primary outcome. Compared with patients with no statin, adjusted hazard ratios (95% confidence interval) were 0.74 (0.64-0.84) for good adherence, 0.93 (0.79-1.09) for intermediate adherence, and 1.07 (0.95-1.20) for poor adherence to statin. Among the 1712 patients with good adherence, risk of adverse events was lower in patients with high-intensity statin (adjusted hazard ratio [95% confidence interval], 0.48 [0.24-0.96]) compared with those with low-intensity statin. Neither good adherence nor high intensity of statin was associated with an increased risk of hemorrhagic stroke. After acute ischemic stroke, high-intensity statin therapy with good adherence was significantly associated with a lower risk of adverse events. © 2017 American Heart Association, Inc.

TB tracer teams in South Africa: knowledge, practices and challenges of tracing TB patients to improve adherence.

PubMed

Bristow, Claire C; Podewils, Laura Jean; Bronner, Liza Ellen; Bantubani, Nonkqubela; Walt, Martie van der; Peters, Annatjie; Mametja, David

2013-09-04

In 2008-2009 the South African National Tuberculosis (TB) Program (NTP) implemented a national pilot project, the TB Tracer Project, aiming to decrease default rates and improve patient outcomes. The current study aimed to inform the NTP by describing the knowledge, attitudes, and practices of TB program personnel involved with tracing activities. A self-administered written questionnaire was sent to TB staff, managers and tracer team leaders to assess basic TB knowledge, attitudes and practices. Descriptive statistics were used to summarize results and the chi-squared statistic was used to compare responses of staff at facilities that participated in the TB Tracer Project (tracer) and those that followed standard NTP care (non-tracer). Of 560 total questionnaires distributed, 270 were completed and returned (response rate 48%). Total TB knowledge ranged from 70.8-86.3% correct across all response groups. However, just over half (range 50-59.3%) of each respondent group was able to correctly identify the four components of a DOT encounter. A patient no longer feeling sick was cited by 72.1% of respondents as the reason patients fail to adhere to treatment. Tracer teams were viewed as an effective means to get patients to return to treatment by 96.3% of health facility level respondents. Tracer team leaders reported concerns including lack of logistical support (41.7%), insufficient physical safety precautions (41.7%), and inadequate protection from contracting TB (39.1%). Upon patients returning to treatment at the clinic, facilities included in the TB Tracer Project were significantly more likely to discuss alternate DOTS arrangements than non-tracer facilities (79.2 vs. 66.4%, p = 0.03). This study identified key components of knowledge, attitudes, and practices regarding TB patient tracing activities in South Africa. Educating patients on the essential need to complete treatment irrespective of clinical symptoms may help improve treatment adherence. Future

TB tracer teams in South Africa: knowledge, practices and challenges of tracing TB patients to improve adherence

PubMed Central

2013-01-01

Background In 2008–2009 the South African National Tuberculosis (TB) Program (NTP) implemented a national pilot project, the TB Tracer Project, aiming to decrease default rates and improve patient outcomes. The current study aimed to inform the NTP by describing the knowledge, attitudes, and practices of TB program personnel involved with tracing activities. Methods A self-administered written questionnaire was sent to TB staff, managers and tracer team leaders to assess basic TB knowledge, attitudes and practices. Descriptive statistics were used to summarize results and the chi-squared statistic was used to compare responses of staff at facilities that participated in the TB Tracer Project (tracer) and those that followed standard NTP care (non-tracer). Results Of 560 total questionnaires distributed, 270 were completed and returned (response rate 48%). Total TB knowledge ranged from 70.8-86.3% correct across all response groups. However, just over half (range 50–59.3%) of each respondent group was able to correctly identify the four components of a DOT encounter. A patient no longer feeling sick was cited by 72.1% of respondents as the reason patients fail to adhere to treatment. Tracer teams were viewed as an effective means to get patients to return to treatment by 96.3% of health facility level respondents. Tracer team leaders reported concerns including lack of logistical support (41.7%), insufficient physical safety precautions (41.7%), and inadequate protection from contracting TB (39.1%). Upon patients returning to treatment at the clinic, facilities included in the TB Tracer Project were significantly more likely to discuss alternate DOTS arrangements than non-tracer facilities (79.2 vs. 66.4%, p = 0.03). Conclusions This study identified key components of knowledge, attitudes, and practices regarding TB patient tracing activities in South Africa. Educating patients on the essential need to complete treatment irrespective of clinical symptoms may

Does the presence of placental basal plate myometrial fibres increase the risk of subsequent morbidly adherent placenta: a case-control study.

PubMed

Miller, E S; Linn, R L; Ernst, L M

2016-12-01

Antenatal diagnosis of morbidly adherent placenta has been shown to improve outcomes, but existing predictors lack sensitivity. Our objective was to determine whether the presence of myometrial fibres attached to the placental basal plate (BPMYO) in an antecedent pregnancy is associated with subsequent morbidly adherent placenta. A case-control study. Departments of Obstetrics and Gynecology and Pathology, Northwestern University, Chicago, IL, USA. Women who had at least two pregnancies with placental pathological evaluation. Cases were defined as women with evidence of morbidly adherent placenta (both clinically and pathologically) in their most recent pregnancy whereas women without evidence of morbidly adherent placenta served as controls. Pathological specimens of placentas from previous pregnancies were evaluated for BPMYO. The presence of BPMYO on a previous placenta was evaluated to determine whether it could be used to improve the antenatal diagnosis of morbidly adherent placenta. Of the 25 cases of morbidly adherent placenta, 19 (76%) had BPMYO present on their previous placenta compared with 41 (41%) of controls (odds ratio 4.8, 95% CI 1.8-13.0). Adding BPMYO to a regression including other risk factors for morbidly adherent placenta (i.e. maternal age, number of previous caesarean sections, placenta praevia, previous multiple gestation, any previous curettage, and ultrasonographic suspicion of placenta accreta) significantly improved the sensitivity of antenatal diagnosis of morbidly adherent placenta (61% versus 39%, P < 0.001) without a change in specificity (97% versus 97%, P = 1.00). BPMYO on previous placental pathology is associated with an increased risk of morbidly adherent placenta in a subsequent pregnancy. These findings may shed light on the pathophysiology of accreta and inform future research on predictors of accreta. Previous basal plate myometrium improves the ability to detect subsequent morbidly adherent placenta. © 2015 Royal

Culturally targeted patient navigation for increasing african americans' adherence to screening colonoscopy: a randomized clinical trial.

PubMed

Jandorf, Lina; Braschi, Caitlyn; Ernstoff, Elizabeth; Wong, Carrie R; Thelemaque, Linda; Winkel, Gary; Thompson, Hayley S; Redd, William H; Itzkowitz, Steven H

2013-09-01

Patient navigation has been an effective intervention to increase cancer screening rates. This study focuses on predicting outcomes of screening colonoscopy for colorectal cancer among African Americans using different patient navigation formats. In a randomized clinical trial, patients more than 50 years of age without significant comorbidities were randomized into three navigation groups: peer-patient navigation (n = 181), pro-patient navigation (n = 123), and standard (n = 46). Pro-patient navigations were health care professionals who conducted culturally targeted navigation, whereas peer-patient navigations were community members trained in patient navigation who also discussed their personal experiences with screening colonoscopy. Two assessments gathered sociodemographic, medical, and intrapersonal information. Screening colonoscopy completion rate was 75.7% across all groups with no significant differences in completion between the three study arms. Annual income more than $10,000 was an independent predictor of screening colonoscopy adherence. Unexpectedly, low social influence also predicted screening colonoscopy completion. In an urban African American population, patient navigation was effective in increasing screening colonoscopy rates to 15% above the national average, regardless of patient navigation type or content. Because patient navigation successfully increases colonoscopy adherence, cultural targeting may not be necessary in some populations.

Current Situation of Medication Adherence in Hypertension.

PubMed

Vrijens, Bernard; Antoniou, Sotiris; Burnier, Michel; de la Sierra, Alejandro; Volpe, Massimo

2017-01-01

Despite increased awareness, poor adherence to treatments for chronic diseases remains a global problem. Adherence issues are common in patients taking antihypertensive therapy and associated with increased risks of coronary and cerebrovascular events. Whilst there has been a gradual trend toward improved control of hypertension, the number of patients with blood pressure values above goal has remained constant. This has both personal and economic consequences. Medication adherence is a multifaceted issue and consists of three components: initiation, implementation, and persistence. A combination of methods is recommended to measure adherence, with electronic monitoring and drug measurement being the most accurate. Pill burden, resulting from free combinations of blood pressure lowering treatments, makes the daily routine of medication taking complex, which can be a barrier to optimal adherence. Single-pill fixed-dose combinations simplify the habit of medication taking and improve medication adherence. Re-packing of medication is also being utilized as a method of improving adherence. This paper presents the outcomes of discussions by a European group of experts on the current situation of medication adherence in hypertension.

Antiretroviral drug diversion links social vulnerability to poor medication adherence in substance abusing populations.

PubMed

Tsuyuki, Kiyomi; Surratt, Hilary L

2015-05-01

Antiretroviral (ARV) medication diversion to the illicit market has been documented in South Florida, and linked to sub-optimal adherence in people living with HIV. ARV diversion reflects an unmet need for care in vulnerable populations that have difficulty engaging in consistent HIV care due to competing needs and co-morbidities. This study applies the Gelberg-Andersen behavioral model of health care utilization for vulnerable populations to understand how social vulnerability is linked to ARV diversion and adherence. Cross-sectional data were collected from a targeted sample of vulnerable people living with HIV in South Florida between 2010 and 2012 (n = 503). Structured interviews collected quantitative data on ARV diversion, access and utilization of care, and ARV adherence. Logistic regression was used to estimate the goodness-of-fit of additive models that test domain fit. Linear regression was used to estimate the effects of social vulnerability and ARV diversion on ARV adherence. The best fitting model to predict ARV diversion identifies having a low monthly income and unstable HIV care as salient enabling factors that promote ARV diversion. Importantly, health care need factors did not protect against ARV diversion, evidence that immediate competing needs are prioritized even in the face of poor health for this sample. We also find that ARV diversion provides a link between social vulnerability and sub-optimal ARV adherence, with ARV diversion and domains from the Behavioral Model explaining 25 % of the variation in ARV adherence. Our analyses reveal great need to improve engagement in HIV care for vulnerable populations by strengthening enabling factors (e.g. patient-provider relationship) to improve retention in HIV care and ARV adherence for vulnerable populations.

Connecticut's Value-Based Insurance Plan Increased The Use Of Targeted Services And Medication Adherence.

PubMed

Hirth, Richard A; Cliff, Elizabeth Q; Gibson, Teresa B; McKellar, M Richard; Fendrick, A Mark

2016-04-01

In 2011 Connecticut implemented the Health Enhancement Program for state employees. This voluntary program followed the principles of value-based insurance design (VBID) by lowering patient costs for certain high-value primary and chronic disease preventive services, coupled with requirements that enrollees receive these services. Nonparticipants in the program, including those removed for noncompliance with its requirements, were assessed a premium surcharge. The program was intended to curb cost growth and improve health through adherence to evidence-based preventive care. To evaluate its efficacy in doing so, we compared changes in service use and spending after implementation of the program to trends among employees of six other states. Compared to employees of other states, Connecticut employees were similar in age and sex but had a slightly higher percentage of enrollees with chronic conditions and substantially higher spending at baseline. During the program's first two years, the use of targeted services and adherence to medications for chronic conditions increased, while emergency department use decreased, relative to the situation in the comparison states. The program's impact on costs was inconclusive and requires a longer follow-up period. This novel combination of VBID principles and participation requirements may be a tool that can help plan sponsors increase the use of evidence-based preventive services. Project HOPE—The People-to-People Health Foundation, Inc.

Age, Stigma, Adherence and Clinical Indicators in HIV-Infected Women.

PubMed

McCoy, Katryna; Higgins, Melinda; Zuñiga, Julie Ann; Holstad, Marcia McDonnell

Stigma has become a gendered phenomenon that affects increasing numbers of HIV-infected women worldwide. This study examined the role of age as a possible moderator of the relationship between stigma and antiretroviral therapy adherence, CD4% and viral load among 120 HIV-infected women. A secondary analysis was conducted using data from the Keeping Healthy and Active with Risk Reduction and Medication Adherence (KHARMA) Project, an National Institutes of Health (NIH) funded randomized controlled trial to improve Antiretroviral treatment (ART) adherence and reduce risky behaviors in HIV-infected women at five clinical sites in a South-eastern city from 2005 to 2008. Stigma was measured using the Perceived Personal Stigma of Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) scale. Among participants <50 years old (n=90), age was significantly associated with viral load (rho=-.24, p=.02) and stigma was negatively associated with CD4% (r =-.26, p=.02). For the 30 participants >50 years old, age was not significantly associated with viral load, stigma or CD4%, and there was no significant association between stigma and CD4% (r=.07, p=.70). These findings indicate the need for further study regarding this potential moderating effect and possible interventions to address the susceptibility of younger women to the harmful effects of stigma.

Correlates of Pediatric CPAP Adherence.

PubMed

Hawkins, Stephen M M; Jensen, Emily L; Simon, Stacey L; Friedman, Norman R

2016-06-15

Obstructive sleep apnea (OSA) is a common pediatric condition characterized by recurrent partial or complete cessation of airflow during sleep, typically due to inadequate upper airway patency. Continuous positive airway pressure (CPAP) is a therapeutic option that reduces morbidity. Despite efforts to promote use, CPAP adherence is poor in both pediatric and adult populations. We sought to determine whether demographics, insurance status, OSA severity, therapeutic pressure, or comorbid conditions were associated with pediatric CPAP adherence. A retrospective review of adherence download data was performed on all pediatric patients with initiation or adjustment of CPAP treatment over a one-year period with documented in-laboratory CPAP titration. Patients were grouped as CPAP adherent or non-adherent, where adherence was defined as > 70% nightly use and average usage ≥ 4 hours per night. Differences between the groups were analyzed by χ(2) test. Overall, nearly half of participants were CPAP adherent (49%, 69/140). Of the demographic data collected (age, ethnicity, sex, insurance status), only female sex was associated with better adherence (60.9% vs 39.5% of males adherent; odds ratio [OR] = 2.41, 95%CI = 1.20-4.85; p = 0.01). Severity of OSA (diagnostic apnea-hypopnea index [AHI] and degree of hypoxemia), therapeutic pressure, and residual AHI did not impact CPAP adherence (p > 0.05). Patients with developmental delay (DD) were more likely to be adherent with CPAP than those without a DD diagnosis (OR = 2.55, 95%CI = 1.27-5.13; p = 0.007). Female patients with trisomy 21 tended to be more adherent, but this did not reach significance or account for the overall increased adherence associated with female sex. Our study demonstrates that adherence to CPAP therapy is poor but suggests that female sex and developmental delay are associated with better adherence. These findings support efforts to understand the pathophysiology of and to develop adherence

Distress and Its Effect on Adherence to Antidiabetic Medications Among Type 2 Diabetes Patients in Coastal South India

PubMed Central

Kumar, Nithin; Unnikrishnan, Bhaskaran; Thapar, Rekha; Mithra, Prasanna; Kulkarni, Vaman; Holla, Ramesh; Bhagawan, Darshan; Kumar, Avinash; Aithal, Shodhan

2017-01-01

Background: Distress can bring about an unfavorable attitude among the patients toward tackling their disease which can affect adherence to medications. The purpose of this study was to assess the effect of distress on adherence to medication among patients with diabetes. Methodology: In this cross-sectional study, 124 type 2 diabetes patients above 18 years, attending the hospitals affiliated to Kasturba Medical College, Mangalore, selected using nonprobability sampling were interviewed to assess the presence of diabetes-related distress (DRD) and their level of adherence to medications. Distress was assessed using diabetes distress scale. Morisky Adherence Questionnaire was used to assess the level of adherence. Approval was obtained from the Institutional Ethics Committee. Multivariate logistic regression was conducted to assess the influence of domains of distress on adherence to antidiabetic medication and P < 0.05 was considered statistically significant. Results: In our study, 41.9% (n = 52) of the participants had high diabetes distress. Exactly 43.5% (n = 54) of the participants had low adherence to antidiabetic medications. On univariate analysis, participants with low regimen distress, low physician distress, and low interpersonal distress were found to have good adherence to antidiabetic medication. However, on multivariate analysis, only low regimen distress was found to be significantly associated with good adherence to medication among the study participants. Conclusion: DRD is a problem in our study participants which affects the adherence to medications. Identifying distress at an early stage can help doctors formulate and implement remedial measures, thereby improving adherence to medications. PMID:28781491

Biosurfactant Produced by Salmonella Enteritidis SE86 Can Increase Adherence and Resistance to Sanitizers on Lettuce Leaves (Lactuca sativa L., cichoraceae)

PubMed Central

Rossi, Eliandra M.; Beilke, Luniele; Kochhann, Marília; Sarzi, Diana H.; Tondo, Eduardo C.

2016-01-01

Salmonella Enteritidis SE86 is an important foodborne pathogen in Southern Brazil and it is able to produce a biosurfactant. However, the importance of this compound for the microorganism is still unknown. This study aimed to investigate the influence of the biosurfactant produced by S. Enteritidis SE86 on adherence to slices of lettuce leaves and on resistance to sanitizers. First, lettuce leaves were inoculated with S. Enteritidis SE86 in order to determine the amount of biosurfactant produced. Subsequently, lettuce leaves were inoculated with S. Enteritidis SE86 with and without the biosurfactant, and the adherence and bacterial resistance to different sanitization methods were evaluated. S. Enteritidis SE86 produced biosurfactant after 16 h (emulsification index of 11 to 52.15 percent, P < 0.05) and showed greater adherence capability and resistance to sanitization methods when the compound was present. The scanning electron microscopy demonstrated that S. Enteritidis was able to adhere, form lumps, and invade the lettuce leaves’ stomata in the presence of the biosurfactant. Results indicated that the biosurfactant produced by S. Enteritidis SE86 contributed to adherence and increased resistance to sanitizers when the microorganism was present on lettuce leaves. PMID:26834727

Correlates of Pediatric CPAP Adherence

PubMed Central

Hawkins, Stephen M.M.; Jensen, Emily L.; Simon, Stacey L.; Friedman, Norman R.

2016-01-01

Study Objectives: Obstructive sleep apnea (OSA) is a common pediatric condition characterized by recurrent partial or complete cessation of airflow during sleep, typically due to inadequate upper airway patency. Continuous positive airway pressure (CPAP) is a therapeutic option that reduces morbidity. Despite efforts to promote use, CPAP adherence is poor in both pediatric and adult populations. We sought to determine whether demographics, insurance status, OSA severity, therapeutic pressure, or comorbid conditions were associated with pediatric CPAP adherence. Methods: A retrospective review of adherence download data was performed on all pediatric patients with initiation or adjustment of CPAP treatment over a one-year period with documented in-laboratory CPAP titration. Patients were grouped as CPAP adherent or non-adherent, where adherence was defined as > 70% nightly use and average usage ≥ 4 hours per night. Differences between the groups were analyzed by χ2 test. Results: Overall, nearly half of participants were CPAP adherent (49%, 69/140). Of the demographic data collected (age, ethnicity, sex, insurance status), only female sex was associated with better adherence (60.9% vs 39.5% of males adherent; odds ratio [OR] = 2.41, 95%CI = 1.20–4.85; p = 0.01). Severity of OSA (diagnostic apnea-hypopnea index [AHI] and degree of hypoxemia), therapeutic pressure, and residual AHI did not impact CPAP adherence (p > 0.05). Patients with developmental delay (DD) were more likely to be adherent with CPAP than those without a DD diagnosis (OR = 2.55, 95%CI = 1.27–5.13; p = 0.007). Female patients with trisomy 21 tended to be more adherent, but this did not reach significance or account for the overall increased adherence associated with female sex. Conclusions: Our study demonstrates that adherence to CPAP therapy is poor but suggests that female sex and developmental delay are associated with better adherence. These findings support efforts to understand the

Mobile phone text messaging for promoting adherence to anti-tuberculosis treatment: a systematic review

PubMed Central

2013-01-01

Background Mobile phone text messaging (SMS) has the potential to promote adherence to tuberculosis treatment. This systematic review aims to synthesize current evidence on the effectiveness of SMS interventions in improving patients’ adherence to tuberculosis treatment. Methods We searched electronic databases (PubMed, EMBASE, Science Citation Index), reference lists of relevant articles, conference proceedings, and selected websites for eligible studies available by 15 February 2013; regardless of language or publication status. Two authors independently screened selected eligible studies, and assessed risk of bias in included studies; resolving discrepancies by discussion and consensus. Results We identified four studies that compared the outcomes of the SMS intervention group with controls. Only one of the four studies was a randomized controlled trial. This was conducted in Argentina and the SMS intervention did not significantly improve adherence to tuberculosis treatment compared to self-administration of tuberculosis treatment (risk ratio [RR] 1.49, 95% confidence intervals [CI] 0.90 to 2.42). One of the non-randomized studies, conducted in South Africa, which compared SMS reminders to directly observed therapy short course (DOTS) reported similar rates of tuberculosis cure (62.35% vs. 66.4%) and treatment success (72.94% vs. 69.4%). A second study from South Africa, utilized SMS reminders when patients delayed in opening their pill bottles and reported increased tuberculosis cure (RR 2.32, 95% CI 1.60 to 3.36) and smear conversion (RR 1.62, 95% CI 1.09 to 2.42) rates compared to DOTS. In the third non-randomized study, conducted in Kenya, use of SMS reminders increased rates of clinic attendance on scheduled days compared to standard care (RR 1.56, 95% CI 1.06 to 2.29). Using the GRADE approach, we rate the quality of the evidence as low, mainly because of the high risk of bias and heterogeneity of effects across studies. Conclusions This systematic

Improving medication adherence with a targeted, technology-driven disease management intervention.

PubMed

Lawrence, David B; Allison, Wanda; Chen, Joyce C; Demand, Michael

2008-06-01

Treatment adherence is critical in managing chronic disease, but achieving it remains an elusive goal across many prevalent conditions. As part of its care management strategy, BlueCross BlueShield of South Carolina (BCBSSC) implemented the Longitudinal Adherence Treatment Evaluation program, a behavioral intervention to improve medication adherence among members with cardiovascular disease and/or diabetes. The objectives of this study were to 1) assess the effectiveness of telephonic intervention in influencing reinitiation of medication therapy, and 2) evaluate the rate and timing of medication reinitiation. BCBSSC applied algorithms against pharmacy claims data to identify patients prescribed targeted medications who were 60 or more days overdue for refills. This information was provided to care managers to address during their next patient contact. Care managers received focused training on techniques for medication behavior change, readiness to change, motivational interviewing, and active listening. Training also addressed common barriers to adherence and available resources, including side effect management, mail order benefits, drug assistance programs, medication organizers, and reminder systems. Overdue refills were tracked for 12 months, with medication reinitiation followed for an additional 3 months. In the intervention group, 94 patients were identified with 123 instances of late medication refills. In the age- and gender-matched comparison group, 61 patients were identified with 76 late refills. The intervention group had a significantly higher rate of medication reinitiation (59.3%) than the control group (42.1%; P < 0.05). Time to reinitiation was significantly shorter in the intervention group, 59.5 (+/- 69.0) days vs. 107.4 (+/- 109) days for the control group (P < 0.05). This initiative demonstrated that a targeted disease management intervention promoting patient behavior change increased the number of patients who reinitiated therapy after a

Expansion of the Adherence Club model for stable antiretroviral therapy patients in the Cape Metro, South Africa 2011-2015.

PubMed

Wilkinson, Lynne; Harley, Beth; Sharp, Joseph; Solomon, Suhair; Jacobs, Shahieda; Cragg, Carol; Kriel, Ebrahim; Peton, Neshaan; Jennings, Karen; Grimsrud, Anna

2016-06-01

The ambitious '90-90-90' treatment targets require innovative models of care to support quality antiretroviral therapy (ART) delivery. While evidence for differentiated models of ART delivery is growing, there are few data on the feasibility of scale-up. We describe the implementation of the Adherence Club (AC) model across the Cape Metro health district in Cape Town, South Africa, between January 2011 and March 2015. Using data from monthly aggregate AC monitoring reports and electronic monitoring systems for the district cohort, we report on the number of facilities offering ACs and the number of patients receiving ART care in the AC model. Between January 2011 and March 2015, the AC programme expanded to reach 32 425 patients in 1308 ACs at 55 facilities. The proportion of the total ART cohort retained in an AC increased from 7.3% at the end of 2011 to 25.2% by March 2015. The number of facilities offering ACs also increased and by the end of the study period, 92.3% of patients were receiving ART at a facility that offered ACs. During this time, the overall ART cohort doubled from 66 616 to 128 697 patients. The implementation of the AC programme offset this increase by 51%. ACs now provide ART care to more than 30 000 patients. Further expansion of the model will require additional resources and support. More research is necessary to determine the outcomes and quality of care provided in ACs and other differentiated models of ART delivery, especially when implemented at scale. © 2016 John Wiley & Sons Ltd.

Side effects, adherence self-efficacy, and adherence to antiretroviral treatment: a mediation analysis in a Chinese sample.

PubMed

Zhang, Liying; Li, Xiaoming; Lin, Zhenping; Jacques-Tiura, Angela J; Xu, Jinping; Zhou, Yuejiao; Qiao, Shan; Shen, Zhiyong; Stanton, Bonita

2016-07-01

Antiretroviral therapy (ART) is a lifelong treatment. To date, ART adherence is suboptimal for most patients in resource-poor settings. Previous research indicates that medication side effects are perceived to be a significant barrier of high ART adherence. Data regarding the role of adherence self-efficacy in mediating the relationship between side effects from ART and adherence to ART are limited; thus, this study examines this potential mediational role of self-efficacy. A cross-sectional survey of 2987 people living with HIV aged ≥18 years was conducted in 2012-2013 in Guangxi Autonomous Region (Guangxi) which has one of the fastest-growing HIV rates in China. Of the total sample, 2146 (72.1%) participants had initiated ART. Participants reported the number of days of completing the daily dose of ART in the past month; adherence was defined as completing the daily dose at least 28 days in the last month (≥90%). Side effects were significantly negatively related to adherence to ART. Mediation analyses indicated that adherence self-efficacy significantly mediated the side effects-adherence relationship. Future interventions to increase adherence self-efficacy and effective coping with side effects among HIV patients are needed in order to improve their ART adherence.

Poor adherence to P2Y12 antagonists increased cardiovascular risks in Chinese PCI-treated patients.

PubMed

Sun, Yang; Li, Chenze; Zhang, Lina; Hu, Dong; Zhang, Xudong; Yu, Ting; Tao, Min; Wang, Dao Wen; Shen, Xiaoqing

2017-03-01

Low adherence to secondary prevention medications (ATM) of patients after acute coronary syndrome (ACS) is associated with poor clinical outcomes. However, literature provides limited data on assessment of ATM and risks associated with poor in Chinese patients with ACS. In the current work, ATM was assessed in consecutively recruited patients with ACS in Tongji Hospital from November 5, 2013 to December 31, 2014. A total of 2126 patients were classified under low adherence (proportion of days covered (PDC) C< 50%) and high adherence (PDC>50%) groups based on their performance after discharge. All patients were followed up at the 1st, 6th, and 12th month of discharge while recording ATM and major adverse cardiac events (MACE). Bivariate logistic regression was used to identify the factors associated with ATM. Cox regression was used to analyze the association between ATM and MACE within one year after discharge. Results showed that coronary artery bypass grafting (CABG) alone had significantly lower proportion of high adherence to P2Y12 antagonists (83.0% vs. 90.7%, P < 0.01) than patients treated with percutaneous coronary intervention (PCI) only. Moreover, in patients undergoing PCI, high adherence to P2Y12 antagonists decreased the risk of MACE (hazard ratio = 0.172, 95% confidence interval: 0.039-0.763; P = 0.021). In conclusion, PCI-treated patients are more prone to remaining adherent to medications than CABG-treated patients. High adherence to P2Y12 antagonists was associated with lower risk of MACE.

Fibrin monomer increases platelet adherence to tumor cells in a flowing system: a possible role in metastasis?

PubMed

Biggerstaff, J P; Seth, N B; Meyer, T V; Amirkhosravi, A; Francis, J L

1998-12-15

Considerable evidence exists linking hemostasis and malignancy. Platelet adhesion to tumor cells has been implicated in the metastatic process. Plasma fibrinogen (Fg) and fibrin (Fn) monomer, increased in cancer, may play a role in tumor biology. Binding of Fn monomer to tumor cells and its effect on platelet-tumor cell adhesion in a flowing system were studied. Fn monomer was produced by adding thrombin (1 micro/mL) to FXIII- and plasminogen-free Fg in the presence of Gly-Pro-Arg-Pro (GPRP) amide. Fn monomer binding to live A375 cells was visualized by confocal laser scanning microscopy (CLSM). Adherent cells were perfused for 1h with Fn monomer, washed and stained in situ with anti-human Fn (American Biogenetic Sciences, Inc.) followed by goat anti-mouse IgG(FITC). Platelet adherence to Fn monomer treated A375 cells was performed under flow conditions by passing platelets (5x10(4)/microl 0.25 mL/min; labeled with the carbocyanine dye DiI) over the tumor cells for 30 min. CLSM images were obtained after washing. There was considerable binding of Fn monomer, but not Fg alone. Platelets adhered relatively weakly to untreated A375 cells and this was not significantly affected by pre-treatment of the tumor cells with fibrinogen or thrombin. However, pre-treatment with Fn monomer resulted in extensive platelet binding to tumor cells, suggesting that coagulation activation and the subsequent increase in circulating Fn monomer may enhance platelet adhesion to circulating tumor cells and thereby facilitate metastatic spread.

Patients' experiences of an intervention to support tuberculosis treatment adherence in South Africa.

PubMed

Atkins, Salla; Biles, David; Lewin, Simon; Ringsberg, Karin; Thorson, Anna

2010-07-01

Tuberculosis (TB) infects over 9 million people annually and, in high prevalence settings, is closely related to HIV/AIDS. Despite this, the two diseases are often treated using contrasting approaches: one focused on patient control, the other focused on empowerment. This article reports on patient experiences of a TB treatment programme in South Africa modelled on the empowerment-oriented antiretroviral treatment (ART) programme. Patients' perceptions of the programme and its impacts on their lives were investigated through six focus groups with patients from intervention clinics; two focus groups with patients from a comparison clinic; and interviews with two patients who had failed to adhere to the intervention treatment. The data were analysed using content analysis. The main themes that emerged were: the tension between agency and coercion in treatment taking; treatment as a lifestyle change; and the role of the lay treatment supporter as either constraining or facilitating empowerment. Patients reported having made lifestyle changes and discussed issues of treatment control and responsibility. However, it seemed that treatment supporters maintained a monitoring role regarding patients' treatment, limiting patients' opportunities to exercise control over their illness and their drug regimen. The study suggests that differences remain between the ART approach and the new TB treatment model. While the new programme seems to have succeeded in providing additional information, it is not clear that it substantially changed patient agency over their treatment taking in this setting.

How Patient Cost-Sharing Trends Affect Adherence and Outcomes

PubMed Central

Eaddy, Michael T.; Cook, Christopher L.; O’Day, Ken; Burch, Steven P.; Cantrell, C. Ron

2012-01-01

Objective We sought to assess the relationship between patient cost sharing; medication adherence; and clinical, utilization, and economic outcomes. Methodology: We conducted a literature review of articles and abstracts published from January 1974 to May 2008. Articles were identified using PubMed, Ovid, medline, Web of Science, and Google Scholar databases. The following terms were used in the search: adherence, compliance, copay, cost sharing, costs, noncompliance, outcomes, hospitalization, utilization, economics, income, and persistence. Results: We identified and included 160 articles in the review. Although the types of interventions, measures, and populations studied varied widely, we were able to identify relatively clear relationships between cost sharing, adherence, and outcomes. Of the articles that evaluated the relationship between changes in cost sharing and adherence, 85% showed that an increasing patient share of medication costs was significantly associated with a decrease in adherence. For articles that investigated the relationship between adherence and outcomes, the majority noted that increased adherence was associated with a statistically significant improvement in outcomes. Conclusion: Increasing patient cost sharing was associated with declines in medication adherence, which in turn was associated with poorer health outcomes. PMID:22346336

Self-reported adherence to treatment: a study of socioeconomic factors and psychiatric morbidity among male and female patients with HIV infection in Sokoto, Nigeria. Running title: Treatment adherence, socioeconomic factors and psychiatric morbidity in HIV patients.

PubMed

Yunusa, Mufutau A; Njoku, Chibueze H; Obembe, Ayo

2014-01-01

Adherence to treatment is important and relevant in HIV treatment. Previous studies in sub Sahara Africa and south western Nigeria reported that psychiatric morbidity influence treatment adherence. The present study was to examine treatment adherence among the male and the female patients with HIV infection and the effect of socioeconomic factors and psychiatric morbidity on treatment adherence. A total of 159 patients which comprised of 48 male and 111 female who were eligible for this cross sectional prospective study were included having given their consent to participate. Questionnaire relating to socioeconomic factors and treatment adherence were administered. Psychiatric morbidity was assessed using HADS. Data was analyzed with SPSS for windows version 16.0. Treatment adherence was poor in 5.3% of the patients. The male patients had slightly better adherence than the female patients. Factors associated with poor treatment adherence include poor clinic attendance, presence of anxiety symptoms in males and poor education attainment in females. Treatment adherence is related to socioeconomic factors and psychiatric morbidity. Treatment protocol in which mental health and detailed socioeconomic circumstance of patient is an integral part should be encouraged.

Rethinking adherence.

PubMed

Steiner, John F

2012-10-16

In 2012, the Centers for Medicare & Medicaid Services (CMS) will introduce measures of adherence to oral hypoglycemic, antihypertensive, and cholesterol-lowering drugs into its Medicare Advantage quality program. To meet these quality goals, delivery systems will need to develop and disseminate strategies to improve adherence. The design of adherence interventions has too often been guided by the mistaken assumptions that adherence is a single behavior that can be predicted from readily available patient characteristics and that individual clinicians alone can improve adherence at the population level.Effective interventions require recognition that adherence is a set of interacting behaviors influenced by individual, social, and environmental forces; adherence interventions must be broadly based, rather than targeted to specific population subgroups; and counseling with a trusted clinician needs to be complemented by outreach interventions and removal of structural and organizational barriers. To achieve the adherence goals set by CMS, front-line clinicians, interdisciplinary teams, organizational leaders, and policymakers will need to coordinate efforts in ways that exemplify the underlying principles of health care reform.

Evaluation of Increasing Antecedent Specificity in Goal Statements on Adherence to Positive Behavior-Management Strategies

ERIC Educational Resources Information Center

Cohrs, Corey M.; Shriver, Mark D.; Burke, Raymond V.; Allen, Keith D.

2016-01-01

We evaluated the impact of antecedent specificity in goal statements on adherence to positive behavior-management strategies. Teaching staff were recruited from 2 different school settings where there were routine expectations to use behavior-specific praise in the classroom, but adherence was poor. In a concurrent multiple baseline design, the…

Increasing Number of Scarlet Fever Cases, South Korea, 2011-2016.

PubMed

Kim, Jong-Hun; Cheong, Hae-Kwan

2018-01-01

The increasing number of reported scarlet fever cases during 2011‒2016 in the National Notifiable Infectious Disease database in South Korea occurred because of increased overall reporting and expanded reporting criteria rather than because of increasing scarlet fever incidence. Further increases are anticipated because of other expansions in reporting requirements.

Shortcomings of adherence counselling provided to caregivers of children receiving antiretroviral therapy in rural South Africa.

PubMed

Coetzee, Bronwyne; Kagee, Ashraf; Bland, Ruth

2016-03-01

In order to achieve optimal benefits of antiretroviral therapy (ART), caregivers of children receiving ART are required to attend routine clinic visits monthly and administer medication to the child as prescribed. Yet, the level of adherence to these behaviours varies considerably in many settings. As a way to achieve optimal adherence in rural KwaZulu-Natal, caregivers are required to attend routine counselling sessions at HIV treatment clinics that are centred on imparting information, motivation, and behavioural skills related to medication administration. According to the information-motivation-behavioural skills model, information related to adherence, motivation, and behavioural skills are necessary and fundamental determinants of adherence to ART. The purpose of the study was to observe and document the content of adherence counselling sessions that caregivers attending rural clinics in KwaZulu Natal receive. We observed 25 adherence counselling sessions, which lasted on average 8.1 minutes. Counselling typically consisted of counsellors recording patient attendance, reporting CD4 count and viral load results to caregivers, emphasising dose times, and asking caregivers to name their medications and dosage amounts. Patients were seldom asked to demonstrate how they measure the medication. They were also not probed for problems regarding treatment, even when an unsuppressed VL was reported to a caregiver. This paper calls attention to the sub-optimal level of counselling provided to patients on ART and the urgent need to standardise and improve the training, support, and debriefing provided to counsellors.

Adherence to Biobehavioral Recommendations in Pediatric Migraine as Measured by Electronic Monitoring: The Adherence in Migraine (AIM) Study.

PubMed

Kroon Van Diest, Ashley M; Ramsey, Rachelle; Aylward, Brandon; Kroner, John W; Sullivan, Stephanie M; Nause, Katie; Allen, Janelle R; Chamberlin, Leigh A; Slater, Shalonda; Hommel, Kevin; LeCates, Susan L; Kabbouche, Marielle A; O'Brien, Hope L; Kacperski, Joanne; Hershey, Andrew D; Powers, Scott W

2016-07-01

The purpose of this investigation was to examine treatment adherence to medication and lifestyle recommendations among pediatric migraine patients using electronic monitoring systems. Nonadherence to medical treatment is a significant public health concern, and can result in poorer treatment outcomes, decreased cost-effectiveness of medical care, and increased morbidity. No studies have systematically examined adherence to medication and lifestyle recommendations in adolescents with migraine outside of a clinical trial. Participants included 56 adolescents ages 11-17 who were presenting for clinical care. All were diagnosed with migraine with or without aura or chronic migraine and had at least 4 headache days per month. Medication adherence was objectively measured using electronic monitoring systems (Medication Event Monitoring Systems technology) and daily, prospective self-report via personal electronic devices. Adherence to lifestyle recommendations of regular exercise, eating, and fluid intake were also assessed using daily self-report on personal electronic devices. Electronic monitoring indicates that adolescents adhere to their medication 75% of the time, which was significantly higher than self-reported rates of medication adherence (64%). Use of electronic monitoring of medication detected rates of adherence that were significantly higher for participants taking once daily medication (85%) versus participants taking twice daily medication (59%). Average reported adherence to lifestyle recommendations of consistent noncaffeinated fluid intake (M = 5 cups per day) was below recommended levels of a minimum of 8 cups per day. Participants on average also reported skipping 1 meal per week despite recommendations of consistently eating three meals per day. Results suggest that intervention focused on adherence to preventive treatments (such as medication) and lifestyle recommendations may provide more optimal outcomes for children and adolescents with

Persistence and adherence with urinary antispasmodic medications among employees and the impact of adherence on costs and absenteeism.

PubMed

Kleinman, Nathan L; Odell, Kevin; Chen, Chieh-I; Atkinson, Amy; Zou, Kelly H

2014-10-01

Overactive bladder (OAB) and related conditions, such as urge urinary incontinence (UI), can interfere with work, leisure activities, and healthy sleep patterns. To report (a) employee urinary antispasmodic (UA) medication persistence and adherence; (b) the impact of salary and copay on adherence; and (c) the impact of UA adherence on medical, pharmacy, sick leave (SL), short- and long-term disability (STD, LTD), workers' compensation costs, work absence days, and turnover. This retrospective study used a 2001-2011 database of claims, payroll, and demographic data from 27 large U.S. employers. Employees aged 18-64 years taking UA medications with health plan enrollment from 6 months before the index UA medication prescription to 12 months after were included. Persistence (days until first ≥ 30-day gap in UA medication supply) and adherence (percentage of the annual post-index period with available medication) were assessed using survival analysis and generalized linear regression models that controlled for demographics, job-related factors, copay, and pre-index employee benefit utilization.  2,960 employees met study criteria. Median days of persistence by OAB subtype were 76, 82, 43, 66, and 60 for urge UI, mixed UI, nocturnal UI, other OAB, and no diagnosis, respectively (P  less than  0.05 for urge and mixed vs. no diagnosis). Increased copay and copay as a percentage of salary were associated with lower adherence. Employees with ≥ 80% adherence had lower medical, SL, and STD and higher overall drug costs than employees with less than  80% adherence.  This study suggests potential economic benefits to employers from increased UA adherence. Additionally, economic factors such as ability to pay influence adherence to UA medications.

The prevalence and factors associated for anti-tuberculosis treatment non-adherence among pulmonary tuberculosis patients in public health care facilities in South Ethiopia: a cross-sectional study.

PubMed

Woimo, Tadele Teshome; Yimer, Wondwossen Kassahun; Bati, Temesgen; Gesesew, Hailay Abrha

2017-03-20

Evidence exists pointing out how non-adherence to treatment remains a major hurdle to efficient tuberculosis control in developing countries. Many tuberculosis (Tb) patients do not complete their six-month course of anti-tuberculosis medications and are not aware of the importance of sputum re-examinations, thereby putting themselves at risk of developing multidrug-resistant and extensively drug-resistant forms of tuberculosis and relapse. However, there is a dearth of publications about non-adherence towards anti-Tb medication in these settings. We assessed the prevalence of and associated factors for anti-Tb treatment non-adherence in public health care facilities of South Ethiopia. This was a cross-sectional survey using both quantitative and qualitative methods. The quantitative study was conducted among 261 Tb patients from 17 health centers and one general hospital. The qualitative aspect included an in-depth interview of 14 key informants. For quantitative data, the analysis of descriptive statistics, bivariate and multiple logistic regression was carried out, while thematic framework analysis was applied for the qualitative data. The prevalence of non-adherence towards anti-Tb treatment was 24.5%. Multiple logistic regression analysis demonstrated that poor knowledge towards tuberculosis and its treatment (AOR = 4.6, 95%CI: 1.4-15.6), cost of medication other than Tb (AOR = 4.7, 95%CI: 1.7-13.4), having of health information at every visit (AOR = 3, 95% CI: 1.1-8.4) and distance of DOTS center from individual home (AOR = 5.7, 95%CI: 1.9-16.8) showed statistically significant association with non-adherence towards anti- tuberculosis treatment. Qualitative study also revealed that distance, lack of awareness about importance of treatment completion and cost of transportation were the major barriers for adherence. A quarter of Tb patients interrupted their treatment due to knowledge, availability and accessibility of DOTS service. We recommend

Improving adherence to physical activity.

PubMed

Bélisle, M; Roskies, E; Lévesque, J M

1987-01-01

Two studies tested the efficacy of Marlatt and Gordon's relapse-prevention approach in increasing attendance during an exercise program (short-term adherence) and continuation of exercise activities for 12 weeks following termination of the formal program (longer term adherence). Participants in both studies were registrants in 10-week exercise groups (jogging, aerobic dance, and pre-ski training) sponsored by the Université de Montréal Sports Centre. The intervention, designed to increase awareness of obstacles to exercise and to develop appropriate techniques for coping with them, was delivered by group leaders within the context of the regular program. Results of both studies indicate a small but consistent superiority of adherence in the experimental condition compared to the control condition. The low cost of this intervention, however, makes even small gains cost effective. Possible methods for strengthening the treatment effect are discussed.

Food Insecurity Is Associated with Increased Risk of Non-Adherence to Antiretroviral Therapy among HIV-Infected Adults in the Democratic Republic of Congo: A Cross-Sectional Study

PubMed Central

Musumari, Patou Masika; Wouters, Edwin; Kayembe, Patrick Kalambayi; Kiumbu Nzita, Modeste; Mbikayi, Samclide Mutindu; Suguimoto, S. Pilar; Techasrivichien, Teeranee; Lukhele, Bhekumusa Wellington; El-saaidi, Christina; Piot, Peter; Ono-Kihara, Masako; Kihara, Masahiro

2014-01-01

Background Food insecurity is increasingly reported as an important barrier of patient adherence to antiretroviral therapy (ART) in both resource-poor and rich settings. However, unlike in resource rich-settings, very few quantitative studies to date have investigated the association of food insecurity with patient adherence to ART in Sub-Saharan Africa. The current study examines the association between food insecurity and adherence to ART among HIV-infected adults in the Democratic Republic of Congo (DRC). Methods and Findings This is a cross-sectional quantitative study of patients receiving ART at three private and one public health facilities in Kinshasa, DRC. Participants were consecutively recruited into the study between April and November 2012. Adherence was measured using a combined method coupling pharmacy refill and self-reported adherence. Food insecurity was the primary predictor, and was assessed using the Household Food Insecurity Access Scale (HFIAS). Of the 898 participants recruited into the study, 512 (57%) were food insecure, and 188 (20.9%) were not adherent to ART. Food insecurity was significantly associated with non-adherence to ART (AOR, 2.06; CI, 1.38–3.09). We also found that perceived harmfulness of ART and psychological distress were associated respectively with increased (AOR, 1.95; CI, 1.15–3.32) and decreased (AOR, 0.31; CI, 0.11–0.83) odds of non-adherence to ART. Conclusion Food insecurity is prevalent and a significant risk factor for non-adherence to ART among HIV-infected individuals in the DRC. Our findings highlight the urgent need for strategies to improve food access among HIV-infected on ART in order to ensure patient adherence to ART and ultimately the long-term success of HIV treatment in Sub-Saharan Africa. PMID:24454841

Late 20th Century increase in South Pole snow accumulation

USGS Publications Warehouse

Mosley-Thompson, E.; Paskievitch, J.F.; Gow, A.J.; Thompson, L.G.

1999-01-01

A compilation of the 37-year history of net accumulation at the South Pole [Mosley-Thompson et al., 1995] suggests an increase in net annual accumulation since 1965. This record is sporadic and its quality is compromised by spatially restricted observations and nonsystematic measurement procedures. Results from a new, spatially extensive network of 236 accumulation poles document that the current 5-year (1992-1997) average annual net accumulation at the South Pole is 84.5??8.9 mm water equivalent (w.e.). This accumulation rate reflects a 30% increase since the 1960s when the best, although not optimal, records indicate that it was 65 mm w.e. Identification of two prominent beta radioactivity horizons (1954/1955 and 1964/1965) in six firn cores confirms an increase in accumulation since 1965. Viewed from a longer perspective of accumulation provided by ice cores and a snow mine study, the net accumulation of the 30-year period, 1965-1994, is the highest 30-year average of this millennium. Limited data suggest this recent accumulation increase extends beyond the South Pole region and may be characteristic of the high East Antarctic Plateau. Enhanced accumulation over the polar ice sheets has been identified as a potential early indicator of warmer sea surface temperatures and may offset a portion of the current rise in global sea level. Copyright 1999 by the American Geophysical Union.

Natural Variant of Collagen-Like Protein A in Serotype M3 Group A Streptococcus Increases Adherence and Decreases Invasive Potential

PubMed Central

Jewell, Brittany E.; Versalovic, Erika M.; Olsen, Randall J.; Bachert, Beth A.; Lukomski, Slawomir; Musser, James M.

2015-01-01

Group A Streptococcus (GAS) predominantly exists as a colonizer of the human oropharynx that occasionally breaches epithelial barriers to cause invasive diseases. Despite the frequency of GAS carriage, few investigations into the contributory molecular mechanisms exist. To this end, we identified a naturally occurring polymorphism in the gene encoding the streptococcal collagen-like protein A (SclA) in GAS carrier strains. All previously sequenced invasive serotype M3 GAS possess a premature stop codon in the sclA gene truncating the protein. The carrier polymorphism is predicted to restore SclA function and was infrequently identified by targeted DNA sequencing in invasive strains of the same serotype. We demonstrate that a strain with the carrier sclA allele expressed a full-length SclA protein, while the strain with the invasive sclA allele expressed a truncated variant. An isoallelic mutant invasive strain with the carrier sclA allele exhibited decreased virulence in a mouse model of invasive disease and decreased multiplication in human blood. Further, the isoallelic invasive strain with the carrier sclA allele persisted in the mouse nasopharynx and had increased adherence to cultured epithelial cells. Repair of the premature stop codon in the invasive sclA allele restored the ability to bind the extracellular matrix proteins laminin and cellular fibronectin. These data demonstrate that a mutation in GAS carrier strains increases adherence and decreases virulence and suggest selection against increased adherence in GAS invasive isolates. PMID:25561712

Community nurse-led initiation of antiviral therapy for chronic hepatitis C in people who inject drugs does not increase uptake of or adherence to treatment.

PubMed

Lewis, Heather; Kunkel, Jan; Axten, David; Dalton, Jane; Gardner, Hayley; Tippett, Andrew; Wynne, Stephanie; Wilkinson, Mandie; Foster, Graham R

2016-11-01

Chronic hepatitis C is common in people who inject drugs (PWID) and this population serves as a reservoir for infection. Treatment levels are low among this group, ranging from 1 to 19%. We explored whether a nurse-initiated community treatment model increased uptake of and adherence to interferon-based therapies. This was a cluster randomized trial of nurse-initiated versus physician-initiated antiviral therapy with pegylated interferon and ribavirin for hepatitis C virus in community clinics (trial registration: ISRCTN07774040). The proportion of participants initiating treatment during follow-up was 10% with nurse-initiated (6/62) and 9% with physician-initiated (6/76) therapy. Adherence was similar in both groups, with only one patient in each arm not adhering to therapy. There were no serious adverse events, but interferon-related side effects were common. Drug and alcohol use did not change during therapy. Despite easy access to antiviral therapy, uptake of treatment was poor, with no significant difference between the groups. Nurse-led initiation of interferon-based antiviral therapy in PWID did not lead to increased uptake of, response to or adherence with treatment. Further service improvement is unlikely to increase the proportion of PWID undergoing antiviral therapy for hepatitis C virus and early adoption of interferon-free regimens may increase the proportion initiating and completing treatment.

Medication adherence in glaucoma: approaches for optimizing patient compliance.

PubMed

Tsai, James C

2006-04-01

To summarize recent literature regarding medication adherence with a focus on the complexities inherent in glaucoma management. Adherence to medications can be enhanced by undertaking the following strategies: enhanced patient education; improved dosing schedules; increased accessibility to healthcare (including longer hours, evening hours, and shorter wait times), and improved provider-patient relationships (e.g. increased trust). Patients may be less likely to forgo medication use due to cost pressures if the physician trust level is high. Recent studies suggest a role for baseline screening for adherence predictors and focused interventions in addressing modifiable risk factors for poor adherence (such as depression, stress, and lower education). Many factors are associated with the lack of medication adherence in patients. The solution is likely to be multi-dimensional and employ combination strategy (must be individualized for the patient). Educational interventions involving patients, family members, or both can be effective in improving adherence.

The Cost of Unintended Pregnancies in Canada: Estimating Direct Cost, Role of Imperfect Adherence, and the Potential Impact of Increased Use of Long-Acting Reversible Contraceptives.

PubMed

Black, Amanda Y; Guilbert, Edith; Hassan, Fareen; Chatziheofilou, Ismini; Lowin, Julia; Jeddi, Mark; Filonenko, Anna; Trussell, James

2015-12-01

Unintended pregnancies (UPs) are associated with a significant cost burden, but the full cost burden in Canada is not known. The objectives of this study were to quantify the direct cost of UPs in Canada, the proportion of cost attributable to UPs and imperfect contraceptive adherence and the potential cost savings with increased uptake of long-acting reversible contraceptives (LARCs). A cost model was constructed to estimate the annual number and direct costs of UP in women aged 18 to 44 years. Adherence-associated UP rates were estimated using perfect- and typical-use contraceptive failure rates. Change in annual number of UPs and impact on cost burden were projected in three scenarios of increased LARC usage. One-way sensitivity analyses were conducted to assess the impact of key variables on scenarios of increased LARC use. There are more than 180 700 UPs annually in Canada. The associated direct cost was over $320 million. Fifty-eight percent (58%) of UPs occurred in women aged 20 to 29 years at an annual cost of $175 million; 82% of this cost ($143 million) was attributable to contraceptive non-adherence. Increased LARC uptake produced cost savings of over $34 million in all three switching scenarios; the largest savings ($35 million) occurred when 10% of oral contraceptive users switched to LARCs. The minimum duration of LARC usage required before cost savings was realized was 12 months. The cost of UPs in Canada is significant and much of it can be attributed to imperfect contraceptive adherence. Increased LARC uptake may reduce contraceptive non-adherence, thereby reducing rates of UP and generating significant cost savings, particularly in women aged 20 to 29.

Adherence to physiotherapy clinical guideline acute ankle injury and determinants of adherence: a cohort study

PubMed Central

van der Wees, Philip J; Hendriks, Erik JM; Jansen, Mariette J; van Beers, Hans; de Bie, Rob A; Dekker, Joost

2007-01-01

Background Clinical guidelines are considered important instruments to improve quality in health care. In physiotherapy, insight in adherence to guidelines is limited. Knowledge of adherence is important to identify barriers and to enhance implementation. Purpose of this study is to investigate the ability to adherence to recommendations of the guideline Acute ankle injury, and to identify patient characteristics that determine adherence to the guideline. Methods Twenty-two physiotherapists collected data of 174 patients in a prospective cohort study, in which the course of treatment was systematically registered. Indicators were used to investigate adherence to recommendations. Patient characteristics were used to identify prognostic factors that may determine adherence to the guideline. Correlation between patient characteristics and adherence to outcome-indicators (treatment sessions, functioning of patient, accomplished goals) was calculated using univariate logistic regression. To calculate explained variance of combined patient characteristics, multivariate analysis was performed. Results Adherence to individual recommendations varied from 71% to 100%. In 99 patients (57%) the physiotherapists showed adherence to all indicators. Adherence to preset maximum of six treatment sessions for patients with severe ankle injury was 81% (132 patients). The odds to receive more than six sessions were statistically significant for three patient characteristics: females (OR:3.89; 95%CI: 1.41–10.72), recurrent sprain (OR: 6.90; 95%CI: 2.34 – 20.37), co-morbidity (OR: 25.92; 95% CI: 6.79 – 98.93). All factors together explained 40% of the variance. Inclusion of physiotherapist characteristics in the regression model showed that work-experience reduced the odds to receive more than six sessions (OR: 0.2; 95%CI: 0.06 – 0.77), and increased explained variance to 45%. Conclusion Adherence to the clinical guideline Acute ankle sprain showed that the guideline is

Medication adherence and measures of health plan quality.

PubMed

Seabury, Seth A; Lakdawalla, Darius N; Dougherty, J Samantha; Sullivan, Jeff; Goldman, Dana P

2015-06-01

Medication adherence is increasingly being considered as a measure for performance-based reimbursement contracts in healthcare systems. However, the association between health outcomes and adherence at the plan level is unknown. Retrospective analysis of medical and pharmacy claims from a large private sector claims database from 2000 to 2009. We compared plan-level measures of medication adherence and health outcomes for patients with diabetes and congestive heart failure (CHF). Plan performance was based on average rates of disease complications. Medication adherence was calculated as the percent of patients having 80% of days covered for medications treating diabetes or CHF. Both adherence and outcomes were adjusted for patient differences using multivariate regression. Plans were stratified into low, moderate, and high adherence, based on adherence in the bottom quartile, middle 2 quartiles, and top quartile, respectively. Average adherence varied significantly across plans. Plans with low adherence to diabetes medications had adjusted rates of uncontrolled diabetes admissions of 13.2 per 1000 patients, compared with 11.2 in moderate adherence plans and 8.3 in high adherence plans (P < .001). The adjusted rate of CHF-related hospitalization was 15.3% in low adherence plans, compared with 12.4% in moderate adherence plans and 12.2% in high adherence plans (P < .001). These patterns were consistent across different types of complications for both diabetes and CHF. Private health plans vary considerably in average adherence to medications treating chronic diseases. Plans with higher average adherence had lower rates of disease complications, suggesting that medication adherence measures are potentially useful tools for improving the performance of health plans.

Health Care Resource Utilization and Costs in Patients with Chronic Myeloid Leukemia with Better Adherence to Tyrosine Kinase Inhibitors and Increased Molecular Monitoring Frequency.

PubMed

Latremouille-Viau, Dominick; Guerin, Annie; Gagnon-Sanschagrin, Patrick; Dea, Katherine; Cohen, Benjamin G; Joseph, George J

2017-02-01

Frequent molecular monitoring (qPCR tests), as recommended by evidence-based monitoring guidelines, is associated with higher adherence to tyrosine kinase inhibitors (TKIs) in the management of chronic myeloid leukemia (CML); both factors have been associated with better clinical and economic outcomes. To (a) estimate the effect of more frequent qPCR tests on health care resource utilization (HRU) and associated costs, including direct (effect of qPCR test frequency on HRU) and indirect (through TKI adherence) effects, and (b) develop an economic model applicable to multiple clinical practice scenarios. Adult patients newly diagnosed with CML who started TKI firstline therapy were identified from U.S. administrative claims data (2010-2015). TKI adherence (medication possession ratio [MPR]), number of inpatient days, emergency room (ER) visits, outpatient service days, and mean costs per HRU event were measured during the first year of CML treatment. Direct and indirect effects of qPCR test frequency were estimated using multivariate regression models. Subsequently, an economic model was developed to assess the overall effect of varying qPCR test frequency on HRU and associated costs during the first year of CML treatment under different clinical practice scenarios; the scenario reported is the increase from 1 to 2 qPCR tests. Of the 1,431 patients included, 36% had no qPCR tests, the average qPCR test frequency was 1.6, and the average MPR was 0.86 during the first year of CML treatment. The direct effect of increasing qPCR test frequency by 1 was associated with 13.0% fewer inpatient days (adjusted incidence rate ratio [adjusted IRR] = 0.87; P = 0.010); 8.3% fewer ER visits (adjusted IRR = 0.92; P = 0.043); and 3.0% more outpatient service days (adjusted IRR = 1.03; P = 0.002). Each increase of 1 test was associated with an increase in TKI adherence by 2.2 percentage points (adjusted MPR difference = 0.022; P < 0.001). When considering the indirect effect of q

Multicenter intervention program to increase adherence to hand hygiene recommendations and glove use and to reduce the incidence of antimicrobial resistance.

PubMed

Trick, William E; Vernon, Michael O; Welbel, Sharon F; Demarais, Patricia; Hayden, Mary K; Weinstein, Robert A

2007-01-01

To determine whether a multimodal intervention could improve adherence to hand hygiene and glove use recommendations and decrease the incidence of antimicrobial resistance in different types of healthcare facilities. Prospective, observational study performed from October 1, 1999, through December 31, 2002. We monitored adherence to hand hygiene and glove use recommendations and the incidence of antimicrobial-resistant bacteria among isolates from clinical cultures. We evaluated trends in and predictors for adherence and preferential use of alcohol-based hand rubs, using multivariable analyses. Three intervention hospitals (a 660-bed acute and long-term care hospital, a 120-bed community hospital, and a 600-bed public teaching hospital) and a control hospital (a 700-bed university teaching hospital).Intervention. At the intervention hospitals, we introduced or increased the availability of alcohol-based hand rub, initiated an interactive education program, and developed a poster campaign; at the control hospital, we only increased the availability of alcohol-based hand rub. We observed 6,948 hand hygiene opportunities. The frequency of hand hygiene performance or glove use significantly increased during the study period at the intervention hospitals but not at the control hospital; the maximum quarterly frequency of hand hygiene performance or glove use at intervention hospitals (74%, 80%, and 77%) was higher than that at the control hospital (59%). By multivariable analysis, preferential use of alcohol-based hand rubs rather than soap and water for hand hygiene was more likely among workers at intervention hospitals compared with nonintervention hospitals (adjusted odds ratio, 4.6 [95% confidence interval, 3.3-6.4]) and more likely among physicians (adjusted odds ratio, 1.4 [95% confidence interval, 1.2-1.8]) than among nurses at intervention hospitals. A significantly reduced incidence of antimicrobial-resistant bacteria among isolates from clinical culture was

Pediatric Psychologist Use of Adherence Assessments and Interventions

PubMed Central

Rohan, Jennifer M.; Martin, Staci; Hommel, Kevin; Greenley, Rachel Neff; Loiselle, Kristin; Ambrosino, Jodie; Fredericks, Emily M.

2013-01-01

Objective To document current clinical practices for medical regimen adherence assessment and intervention in the field of pediatric psychology. Methods 113 members of the Society of Pediatric Psychology completed an anonymous online survey that assessed use of adherence assessments and interventions in clinical practice, barriers and facilitators to their use, and preferred resources for obtaining information on adherence assessments and interventions. Results Respondents reported using a range of adherence assessment and intervention strategies, some of which are evidence-based. Barriers to implementing these clinical strategies included time constraints and lack of familiarity with available clinical tools. Respondents reported that education about effective clinical tools would facilitate their use of adherence assessments and interventions. Conclusions Future research and clinical efforts in adherence should consider developing practical tools for clinical practice, making accessible resources to promote dissemination of these tools, and increase understanding of clinician implementation of adherence assessments and interventions. PMID:23658375

Increasing Number of Scarlet Fever Cases, South Korea, 2011–2016

PubMed Central

Kim, Jong-Hun

2018-01-01

The increasing number of reported scarlet fever cases during 2011‒2016 in the National Notifiable Infectious Disease database in South Korea occurred because of increased overall reporting and expanded reporting criteria rather than because of increasing scarlet fever incidence. Further increases are anticipated because of other expansions in reporting requirements. PMID:29260684

Clarifying the Concept of Adherence to eHealth Technology: Systematic Review on When Usage Becomes Adherence

PubMed Central

Kelders, Saskia M; van Gemert-Pijnen, Julia EWC

2017-01-01

Background In electronic health (eHealth) evaluations, there is increasing attention for studying the actual usage of a technology in relation to the outcomes found, often by studying the adherence to the technology. On the basis of the definition of adherence, we suggest that the following three elements are necessary to determine adherence to eHealth technology: (1) the ability to measure the usage behavior of individuals; (2) an operationalization of intended use; and (3) an empirical, theoretical, or rational justification of the intended use. However, to date, little is known on how to operationalize the intended usage of and the adherence to different types of eHealth technology. Objective The study aimed to improve eHealth evaluations by gaining insight into when, how, and by whom the concept of adherence has been used in previous eHealth evaluations and finding a concise way to operationalize adherence to and intended use of different eHealth technologies. Methods A systematic review of eHealth evaluations was conducted to gain insight into how the use of the technology was measured, how adherence to different types of technologies was operationalized, and if and how the intended use of the technology was justified. Differences in variables between the use of the technology and the operationalization of adherence were calculated using a chi-square test of independence. Results In total, 62 studies were included in this review. In 34 studies, adherence was operationalized as “the more use, the better,” whereas 28 studies described a threshold for intended use of the technology as well. Out of these 28, only 6 reported a justification for the intended use. The proportion of evaluations of mental health technologies reporting a justified operationalization of intended use is lagging behind compared with evaluations of lifestyle and chronic care technologies. The results indicated that a justification of intended use does not require extra measurements to

Moving branded statins to lowest copay tier improves patient adherence.

PubMed

Chen, Shih-Yin; Shah, Sonali N; Lee, Yuan-Chi; Boulanger, Luke; Mardekian, Jack; Kuznik, Andreas

2014-01-01

Statins are efficacious in reducing the risk of major cardiovascular events for both primary and secondary prevention, yet long-term adherence is poor. Their effectiveness could be compromised in actual practice when patients are not adherent to the treatments. Higher copayments have been shown to be associated with lower adherence to statins. To assess the effect on patient adherence of moving branded atorvastatin and rosuvastatin from the second to the first tier by a Medicare Part D plan sponsor. Pharmacy claims and eligibility records between July 1, 2009, and July 31, 2011, of Medicare Part D members not receiving the low-income subsidy were analyzed. New atorvastatin and rosuvastatin users in January 2010 (2010 cohort) were compared with those in January 2011 (2011 cohort) after this formulary tier change (tier-reduction group). Adherence was defined by the proportion of days covered (PDC) over 6 months. The impact of tier reduction on adherence was evaluated via logistic regression for binary outcome (PDC≥0.8) and generalized linear regression for continuous PDC by comparing the 2011 cohort with the 2010 cohort, adjusting for demographic and clinical characteristics. Other statin users (97% on generic statins) were also analyzed, serving as a nontier-reduction comparator group. We identified 12,437 members in the tier-reduction group. Between the 2010 and 2011 cohorts, mean PDC increased from 0.77 to 0.83, and the proportion of members with high adherence increased from 62.0% to 72.9% (both P < 0.001). After regression adjustment, members in the 2011 cohort were more likely to be adherent (OR=1.68; 95% CI=1.55-1.82) and had a 5.9% increase in PDC (P < 0.05). There was no significant increase in adherence observed in the comparator nontier-reduction group. Findings from this study suggest that financial incentives may improve medication adherence. Future studies should evaluate whether such formulary strategies improve long-term adherence and patient

Medication adherence among hypertensive patients of primary health clinics in Malaysia

PubMed Central

Ramli, Azuana; Ahmad, Nur Sufiza; Paraidathathu, Thomas

2012-01-01

Purpose Poor adherence to prescribed medications is a major cause for treatment failure, particularly in chronic diseases such as hypertension. This study was conducted to assess adherence to medications in patients undergoing hypertensive treatment in the Primary Health Clinics of the Ministry of Health in Malaysia. Factors affecting adherence to medications were studied, and the effect of nonadherence to blood pressure control was assessed. Patients and methods This was a cross-sectional study to assess adherence to medications by adult patients undergoing hypertensive treatment in primary care. Adherence was measured using a validated survey form for medication adherence consisting of seven questions. A retrospective medication record review was conducted to collect and confirm data on patients’ demographics, diagnosis, treatments, and outcomes. Results Good adherence was observed in 53.4% of the 653 patients sampled. Female patients were found to be more likely to adhere to their medication regime, compared to their male counterparts (odds ratio 1.46 [95% confidence intervals [CI]: 1.05–2.04; P < 0.05]). Patients in the ethnic Chinese were twice as likely (95% CI: 1.14–3.6; P < 0.05) to adhere, compared to those in the Indian ethnic group. An increase in the score for medicine knowledge was also found to increase the odds of adherence. On the other hand, increasing the number of drugs the patient was taking and the daily dose frequencies of the medications prescribed were found to negatively affect adherence. Blood pressure control was also found to be worse in noncompliers. Conclusion The medication adherence rate was found to be low among primary care hypertensive patients. A poor adherence rate was found to negatively affect blood pressure control. Developing multidisciplinary intervention programs to address the factors identified is necessary to improve adherence and, in turn, to improve blood pressure control. PMID:22969292

What do community-dwelling Caucasian and South Asian 60-70 year olds think about exercise for fall prevention?

PubMed

Horne, Maria; Speed, Shaun; Skelton, Dawn; Todd, Chris

2009-01-01

strategies to prevent falls often recommend regular exercise. However, 40% of over 50s in the UK report less physical activity than is recommended. Even higher rates of sedentary behaviour have been reported among South Asian older adults. to identify salient beliefs that influence uptake and adherence to exercise for fall prevention among community-dwelling Caucasian and South Asian 60-70 year olds in the UK. we undertook an ethnographic study using participant observation, 15 focus groups (n = 87; mean age = 65.7 years) and 40 individual semi-structured interviews (mean age = 64.8 years). Data analysis used framework analysis. young older adults do not acknowledge their fall risk and are generally not motivated to exercise to prevent falls. Those who had fallen are more likely to acknowledge risk of future falls. Whilst many of the beliefs about falls and exercise expressed were very similar between Caucasians and South Asians, there was a tendency for South Asians to express fatalistic beliefs more often. fall prevention should not be the focus of strategies to increase uptake and adherence to exercise. The wider benefits of exercise, leading to an active healthy lifestyle should be encouraged.

Association of cinacalcet adherence and costs in patients on dialysis.

PubMed

Lee, Andrew; Song, Xue; Khan, Irfan; Belozeroff, Vasily; Goodman, William; Fulcher, Nicole; Diakun, David

2011-01-01

In addition to negative impacts on clinical effectiveness in treating secondary hyperparathyroidism, low adherence to cinacalcet may have negative impacts on healthcare costs. This study assessed the relationship between medication adherence and healthcare costs among US patients on dialysis given cinacalcet to manage secondary hyperparathyroidism. Retrospective cohort study of patients who were receiving dialysis with an initial cinacalcet prescription between January 2004 and April 2010 and who survived ≥12 months. Longitudinal, integrated medical, and pharmacy claims data from the MarketScan? database were used to calculate medication possession ratios (MPR) over 12 months and to examine the association of adherence with inpatient, outpatient, emergency room, outpatient medication, and total costs while controlling for patient characteristics, co-morbid medical conditions, and concomitant medication MPR in a multivariate regression model. Patients were dichotomized as adherent (<180 days refill gap) or non-adherent (≥180 day refill gap). Adherent patients were further dichotomized as low adherent (<0.8 MPR) and high adherent (≥0.8 MPR). The final study cohort included 4923 patients. After 12 months, 46% were non-adherent, 27% were low adherent, and 28% were high adherent. Greater cinacalcet adherence was associated with significantly lower inpatient costs with cost-savings of a greater magnitude than the increased medication costs. This study demonstrated that low adherence to cinacalcet, which may be associated with undesirable clinical and health-economic outcomes, is common. Despite limitations inherent in retrospective studies of claims databases, such as unobserved confounding, non-discrimination between prescription fill and actual use, and not knowing the reasons for non-adherence, these results suggest that inpatient cost savings of $8899, more than offset higher medication costs of $5858 associated with increased cinacalcet adherence.

Universal test and treat is not associated with sub-optimal antiretroviral therapy adherence in rural South Africa: the ANRS 12249 TasP trial.

PubMed

Iwuji, Collins; McGrath, Nuala; Calmy, Alexandra; Dabis, Francois; Pillay, Deenan; Newell, Marie-Louise; Baisley, Kathy; Porter, Kholoud

2018-06-01

HIV treatment guidelines now recommend antiretroviral therapy (ART) initiation regardless of CD4 count to maximize benefit both for the individual and society. It is unknown whether the initiation of ART at higher CD4 counts would affect adherence levels. We investigated whether initiating ART at higher CD4 counts was associated with sub-optimal adherence (<95%) during the first 12 months of ART. A prospective cohort study nested within a two-arm cluster-randomized trial of universal test and treat was implemented from March 2012 to June 2016 to measure the impact of ART on HIV incidence in rural KwaZulu-Natal. ART was initiated regardless of CD4 count in the intervention arm and according to national guidelines in the control arm. ART adherence was measured monthly using a visual analogue scale (VAS) and pill counts (PC). HIV viral load was measured at ART initiation, three and six months, and six-monthly thereafter. We pooled data from participants in both arms and used random-effects logistic regression models to examine the association between CD4 count at ART initiation and sub-optimal adherence, and assessed if adherence levels were associated with virological suppression. Among 900 individuals who initiated ART ≥12 months before study end, median (IQR) CD4 at ART initiation was 350 cells/mm 3 (234, 503); median age was 34.6 years (IQR 27.4 to 46.4) and 71.7% were female. Adherence was sub-optimal in 14.7% of visits as measured by VAS and 20.7% by PC. In both the crude analyses and after adjusting for potential confounders, adherence was not significantly associated with CD4 count at ART initiation (adjusted OR for linear trend in sub-optimal adherence with every 100 cells/mm 3 increase in CD4 count: 1.00, 95% CI 0.95 to 1.05, for VAS, and 1.03, 95% CI 0.99 to 1.07, for PC). Virological suppression at 12 months was 97%. Optimal adherence by both measures was significantly associated with virological suppression (p < 0.001 for VAS; p = 0.006 for PC

Supporting patient adherence to antiretrovirals using mobile phone reminders: patient responses from South India.

PubMed

Sidney, Kristi; Antony, Jimmy; Rodrigues, Rashmi; Arumugam, Karthika; Krishnamurthy, Shubha; D'souza, George; De Costa, Ayesha; Shet, Anita

2012-01-01

There has been exponential growth in the use of mobile phones in India over the last few years, and their potential benefits as a healthcare tool has raised tremendous interest. We used mobile phone reminders to help support adherence to antiretroviral therapy (ART) among HIV patients at an infectious disease clinic in a tertiary hospital in Bangalore. Between March and June 2010, 139 adult HIV patients taking regular ART for at least a month received weekly reminders to support adherence. These reminders consisted of a weekly interactive call and a non-interactive neutral pictorial short message service (SMS). After four weeks of the intervention, participants were interviewed to study perceptions on preference, usefulness, potential stigma and privacy concerns associated with this intervention. Majority of the participants were urban (89%), and had at least a secondary education (85%). A total of 744 calls were made, 545 (76%) of which were received by the participants. In addition, all participants received the weekly pictorial SMS reminder. A month later, 90% of participants reported the intervention as being helpful as medication reminders, and did not feel their privacy was intruded. Participants (87%) reported that they preferred the call as reminders, just 11% favoured SMS reminders alone. Only 59% of participants viewed all the SMSs that were delivered, while 15% never viewed any at all. Participants also denied any discomfort or stigma despite 20% and 13%, respectively, reporting that another person had inadvertently received their reminder call or SMS. Mobile phone interventions are an acceptable way of supporting adherence in this setting. Voice calls rather than SMSs alone seem to be preferred as reminders. Further research to study the influence of this intervention on adherence and health maintenance is warranted.

Perspectives Regarding Adherence to Prescribed Treatment in Highly Adherent HIV-Infected Gay Men.

PubMed

Brion, John M; Menke, Edna M

2008-01-01

Focus group methodology was used to describe the medication adherence experience of 24 HIV-infected gay men who reported being adherent to their medication regimens. A conceptualization of medication adherence as an evolving process consisted of challenges to adherence (learning the diagnosis, starting the medications, struggling with the medications, dealing with side effects, coping with stigma) as well as those factors supportive of adherence (believing in medications, finding motivating factors, using reminders, depending on others, owning the disease). Themes associated with challenges to adherence focused on diagnosis and the physical and emotional adjustments individuals made to incorporate antiretroviral medications into their daily lives and move toward medication adherence. The factors supportive of adherence were related to the ongoing behaviors identified with establishing and maintaining adherence behaviors. What can be taken from the study is that adherence is a complex and dynamic process rather than a static behavior.

Positive airway pressure adherence and subthreshold adherence in posttraumatic stress disorder patients with comorbid sleep apnea

PubMed Central

Krakow, Barry J; Obando, Jessica J; Ulibarri, Victor A; McIver, Natalia D

2017-01-01

Study objectives Patients with comorbid posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) manifest low adherence to continuous positive airway pressure (CPAP) due to fixed, pressure-induced expiratory pressure intolerance (EPI), a subjective symptom and objective sign aggravated by anxiety sensitivity and somatosensory amplification. As advanced PAP therapy modes (ie, auto-bilevel PAP [ABPAP] or adaptive servo-ventilation [ASV]) may address these side effects, we hypothesized such treatment would be associated with decreased expiratory intolerance and increased adherence in posttraumatic stress patients with co-occurring OSA. Methods We reviewed charts of 147 consecutive adult patients with moderately severe posttraumatic stress symptoms and objectively diagnosed OSA. All patients failed or rejected CPAP and were manually titrated on auto-adjusting, dual-pressure ABPAP or ASV modes in the sleep laboratory, a technique to eliminate flow limitation breathing events while resolving EPI. Patients were then prescribed either mode of therapy. Follow-up encounters assessed patient use, and objective data downloads (ODDs) measured adherence. Results Of 147 charts reviewed, 130 patients were deemed current PAP users, and 102 provided ODDs: 64 used ASV and 38 used ABPAP. ODDs yielded three groups: 59 adherent per insurance conventions, 19 subthreshold compliant partial users, and 24 noncompliant. Compliance based on available downloads was 58%, notably higher than recently reported rates in PTSD patients with OSA. Among the 19 partial users, 17 patients were minutes of PAP use or small percentages of nights removed from meeting insurance compliance criteria for PAP devices. Conclusion Research is warranted on advanced PAP modes in managing CPAP failure in PTSD patients with comorbid OSA. Subthreshold adherence constructs may inform clinical care in a patient-centric model distinct from insurance conventions. Speculatively, clinical application of this

Clarifying the Concept of Adherence to eHealth Technology: Systematic Review on When Usage Becomes Adherence.

PubMed

Sieverink, Floor; Kelders, Saskia M; van Gemert-Pijnen, Julia Ewc

2017-12-06

In electronic health (eHealth) evaluations, there is increasing attention for studying the actual usage of a technology in relation to the outcomes found, often by studying the adherence to the technology. On the basis of the definition of adherence, we suggest that the following three elements are necessary to determine adherence to eHealth technology: (1) the ability to measure the usage behavior of individuals; (2) an operationalization of intended use; and (3) an empirical, theoretical, or rational justification of the intended use. However, to date, little is known on how to operationalize the intended usage of and the adherence to different types of eHealth technology. The study aimed to improve eHealth evaluations by gaining insight into when, how, and by whom the concept of adherence has been used in previous eHealth evaluations and finding a concise way to operationalize adherence to and intended use of different eHealth technologies. A systematic review of eHealth evaluations was conducted to gain insight into how the use of the technology was measured, how adherence to different types of technologies was operationalized, and if and how the intended use of the technology was justified. Differences in variables between the use of the technology and the operationalization of adherence were calculated using a chi-square test of independence. In total, 62 studies were included in this review. In 34 studies, adherence was operationalized as "the more use, the better," whereas 28 studies described a threshold for intended use of the technology as well. Out of these 28, only 6 reported a justification for the intended use. The proportion of evaluations of mental health technologies reporting a justified operationalization of intended use is lagging behind compared with evaluations of lifestyle and chronic care technologies. The results indicated that a justification of intended use does not require extra measurements to determine adherence to the technology. The

Medical adherence to acne therapy: a systematic review.

PubMed

Snyder, Stephanie; Crandell, Ian; Davis, Scott A; Feldman, Steven R

2014-04-01

Poor adherence of acne patients to treatment may equate to poor clinical efficacy, increased healthcare costs, and unnecessary treatments. Authors have investigated risk factors for poor medical adherence and how to improve this difficult problem in the context of acne. This systematic review aims to describe what methods have been used to measure adherence, what is known about acne patients' adherence to treatment, and the factors affecting adherence. A MEDLINE search was performed for randomized controlled trials published between 1978 and June 2013, focusing on patient adherence to prescribed acne medications. A test for equality of proportions was performed on studies of similar design to collectively analyze adherence to oral versus topical medication. The self-reported adherence data collected from these clinical trials were then compared with adherence data from a pharmacy database study. Studies varied in modalities of data collection, but the majority utilized subjective methods. Topical therapies were more often studied than oral. The overall oral adherence rate, as calculated by a test of equality of proportions, was 76.3%, while the overall topical adherence rate was 75.8% (p=0.927). The occurrence of side effects and young age were cited as the top reasons for poor adherence, followed by forgetfulness. The MEDLINE search resulted in a limited sample of adherence studies. In addition, there is currently no standardized or fully validated method of measurement, allowing for variability in what was considered 'adherent'. Lastly, data collected via subjective methods cannot guarantee reliable results. Overall, the values reflected a population adherent to both topical and oral medications, with no significant difference in adherence between the two. However, the methodologies used by many of the studies were weak, and the findings are not consistent with results of more objective measures of adherence. The leading factors that contribute to poor adherence

Communication strategies to improve HIV treatment adherence.

PubMed

Rochon, Donna; Ross, Michael W; Looney, Carol; Nepal, Vishnu P; Price, Andrea J; Giordano, Thomas P

2011-01-01

Although antiretroviral therapy has increased the survival of HIV-positive patients, traditional approaches to improving medication adherence have failed consistently. Acknowledging the role of communication in health behavior, we conducted a qualitative study to learn about patients' HIV treatment adherence experiences and to identify which communication strategies might influence adherence. Findings indicate that five constructs--cultural beliefs/language, stigma, cues to action, self-efficacy, and mood state--are potentially modifiable by improved communication. Results will be used to create a direct marketing campaign targeted to HIV-infected patients. Copyright © Taylor & Francis Group, LLC

[Early drop-outs and retentions in substance abuse outpatient clinics: a cross-sectional comparative study of factors that increase or decrease adherence].

PubMed

Calvo, Fran; Carbonell, Xavier; Valero, Ramón; Costa, Jordi; Turró, Oriol; Giralt, Cristina; Ramírez, Marissa

2017-08-23

The aim of this study is to define the risk factors associated with early discharge in out-patients clinics. Cross-sectional and observational study. Substance abuse clinics in Girona (Catalonia, Spain). A total of 264 individuals were included in the sample, and 34.8% of them abandoned the process within two months of starting the therapy (n=92). Clinical and socio-demographic variables of the clinical history were compared between participants with/without adherence. The Student t test was used to measure the comparison, and the chi-squared test was used for the analysis of qualitative variables. A binary logistic regression model was adjusted, with adherence as the dependent variable. The results indicated that attending the appointments unaccompanied (OR=3.13), being female (OR=2.44), having cocaine related issues (OR=1.14), and being younger (OR=0.89) are the factors which increase the risk early abandonment. Contrarily, being referred to specialists from a Primary Health Centre reduces the risk (OR=0.28). It is concluded that special attention must be devoted to the patients' families, women, and young patients. Moreover, the appropriate coordination between specialist services and basic services increases adherence to treatment among drug users. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Review on Factors Influencing Physician Guideline Adherence in Cardiology.

PubMed

Hoorn, C J G M; Crijns, H J G M; Dierick-van Daele, A T M; Dekker, L R C

2018-04-09

Cardiovascular disease is the most common cause of death in Western countries. Physician adherence to guidelines is often suboptimal, resulting in impaired patient outcome and prognosis. Multiple studies have been conducted to evaluate patterns and the influencing factors of patient adherence, but little is known about factors influencing physician guideline adherence. This review aims to identify factors influencing physician guideline adherence relevant to cardiology and to provide insights and suggestions for future improvement. Physician adherence was measured as adherence to standard local medical practice and applicable guidelines. Female gender and older age had a negative effect on physician guideline adherence. In addition, independent of the type of heart disease, physicians without cardiologic specialization were linked to physician noncompliance. Also, guideline adherence in primary care centers was at a lower level compared to secondary or tertiary care centers. The importance of guideline adherence increases as patients age, and complex diseases and comorbidity arise. Appropriate resources and interventions, taking important factors for nonadherence in account, are necessary to improve guideline adoption and adherence in every level of the chain. This in turn should improve patient outcome.

Factors affecting adherence to a raw vegan diet

PubMed Central

Link, Lilli B.; Jacobson, Judith S.

2008-01-01

The purpose of this study was to evaluate adherence and identify predictors of adherence to a raw vegan diet (i.e., uncooked plant foods) following a stay at a raw vegan institute. In this cohort study of guests at a raw vegan institute, subjects completed written questionnaires upon arrival and 12 weeks later. Of 107 eligible guests, 84 participated. Mean age was 54 years, 23 were male, and 73 white. Fifty-one completed the 12-week follow-up. Eight (16%) reported their diet to be ≥80% raw vegan at baseline and 14 (28%) at follow-up. Based on a raw vegan dietary adherence score (range 0-42) created for this study, mean adherence (SD) increased from 15.1 (5.4) to 17.0 (5.8) over 12 weeks (p=0.03). Baseline predictors of adherence included: education (β=0.95), severity of disease (β=0.98), and self-efficacy to adhere (β=0.72). Future interventions that evaluate this diet should address self-efficacy, an important, potentially remediable predictor of adherence. PMID:18243943

Factors affecting adherence to a raw vegan diet.

PubMed

Link, Lilli B; Jacobson, Judith S

2008-02-01

The purpose of this study was to evaluate adherence and identify predictors of adherence to a raw vegan diet (i.e., uncooked plant foods) following a stay at a raw vegan institute. In this cohort study of guests at a raw vegan institute, subjects completed written questionnaires upon arrival and 12 weeks later. Of 107 eligible guests, 84 participated. Mean age was 54 years, 23 were male, and 73 white. Fifty-one completed the 12-week follow-up. Eight (16%) reported their diet to be 80% raw vegan at baseline and 14 (28%) at follow-up. Based on a raw vegan dietary adherence score (range 0-42) created for this study, mean adherence (SD) increased from 15.1 (5.4) to 17.0 (5.8) over 12 weeks (p=0.03). Baseline predictors of adherence included: education (beta=0.95), severity of disease (beta=0.98), and self-efficacy to adhere (beta=0.72). Future interventions that evaluate this diet should address self-efficacy, an important, potentially remediable predictor of adherence.

A model to increase rehabilitation adherence to home exercise programmes in patients with varying levels of self-efficacy.

PubMed

Picha, Kelsey J; Howell, Dana M

2018-03-01

Patient adherence to rehabilitation programmes is frequently low - particularly adherence to home exercise programmes. Home exercise programmes have been identified as complementary to clinic-based physical therapy in an orthopaedic setting. Barriers to patient adherence have previously been identified within the literature. Low self-efficacy is a barrier to adherence that clinicians have the ability to have an impact on and improve. The theory of self-efficacy is defined as a person's confidence in their ability to perform a task. This theory examines the ability of a person to change through exerting control over inner processes of goal setting, self-monitoring, feedback, problem solving and self-evaluation. If clinicians are able to identify patients with low self-efficacy prior to the prescription of a home exercise programme, adjustments to individualized care can be implemented. Individualized care based on improving self-efficacy for home exercise programmes may improve patient adherence to these programmes. The purpose of this article was to use the theory of self-efficacy to direct clinicians in providing individualized programmes to patients with varying levels of self-efficacy. Copyright © 2017 John Wiley & Sons, Ltd.

Time perspective and medication adherence among individuals with hypertension or diabetes mellitus.

PubMed

Sansbury, Brittany; Dasgupta, Abhijit; Guthrie, Lori; Ward, Michael

2014-04-01

The study determined if time perspective was associated with medication adherence among people with hypertension and diabetes. Using the Health Beliefs Model, we used path analysis to test direct and indirect effects of time perspective and health beliefs on adherence among 178 people who participated in a community-based survey near Washington, D.C. We measured three time perspectives (future, present fatalistic, and present hedonistic) with the Zimbardo Time Perspective Inventory and medication adherence by self-report. The total model demonstrated a good fit (RMSEA=0.17, 90% CI [0.10, 0.28], p=0.003; comparative fit index=0.91). Future time perspective and age showed direct effects on increased medication adherence; an increase by a single unit in future time perspective was associated with a 0.32 standard deviation increase in reported adherence. There were no significant indirect effects of time perspective with reported medication adherence through health beliefs. The findings provide the first evidence that time perspective plays an under-recognized role as a psychological motivator in medication adherence. Patient counseling for medication adherence may be enhanced if clinicians incorporate consideration of the patient's time perspective. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The household economic burden of eating disorders and adherence to treatment in Australia.

PubMed

Gatt, Lauren; Jan, Stephen; Mondraty, Naresh; Horsfield, Sarah; Hart, Susan; Russell, Janice; Laba, Tracey Lea; Essue, Beverley

2014-11-29

This study investigated the household economic burden of eating disorders and cost-related non-adherence to treatment in Australia. Multi-centre prospective observational study using a structured questionnaire. Ninety participants were recruited from two clinic settings in New South Wales, Australia and from the community using social media. The primary outcome measures were household economic burden of illness measured in terms of out-of-pocket expenditure, household economic hardship and cost-related non-adherence. The pattern of out-of-pocket expenditure varied by diagnosis, with Bulimia Nervosa associated with the highest total mean expenditure (per three months). Economic hardship was reported in 96.7% of participants and 17.8% reported cost-related non-adherence. Those most likely to report cost-related non-adherence had a longer time since diagnosis. Cost-related non-adherence and higher out-of-pocket expenditure were associated with poorer quality of life, a more threatening perception of the impact of the illness and poor self-reported health. This study is the first to empirically and quantitatively examine the household economic burden of eating disorders from the patient perspective. Results indicate that households experience a substantial burden associated with the treatment and management of an eating disorder. This burden may contribute to maintaining the illness for those who experience cost-related non-adherence and by negatively influencing health outcomes. Current initiatives to implement sustainable and integrated models of care for eating disorders should strive to minimise the economic impact of treatment on families.

Exploratory Analysis of Exercise Adherence Patterns with Sedentary Pregnant Women

PubMed Central

Yeo, SeonAe; Cisewski, Jessi; Lock, Eric F.; Marron, J. S.

2010-01-01

Background It is not well understood how sedentary women who wish to engage in regular exercise adhere to interventions during pregnancy and what factors may influence adherence over time. Objective To examine longitudinal patterns of pregnant women’s adherence to exercise. Methods Exploratory secondary data analyses were carried out with 124 previously sedentary pregnant women (ages 31 ± 5 years; 85% non-Hispanic White) from a randomized controlled trial. Daily exercise logs (n = 92) from 18 through 35 weeks of gestation were explored using linear regression, functional data, and principal component analyses. Results Adherence decreased as gestation week increased (p < .001); the top adherers maintained levels of adherence, and the bottom adherers decreased levels of adherence; and adherence pattern was influenced by types of exercise throughout the study period. Discussion Exercise behavior patterns were explored in a randomized controlled trial study, using chronometric data on exercise attendance. A new analytic approach revealed that sedentary pregnant women may adopt exercise habits differently from other populations. PMID:20585224

Fledgling survival increases with development time and adult survival across north and south temperate zones

USGS Publications Warehouse

Lloyd, Penn; Martin, Thomas E.

2016-01-01

Slow life histories are characterized by high adult survival and few offspring, which are thought to allow increased investment per offspring to increase juvenile survival. Consistent with this pattern, south temperate zone birds are commonly longer-lived and have fewer young than north temperate zone species. However, comparative analyses of juvenile survival, including during the first few weeks of the post-fledging period when most juvenile mortality occurs, are largely lacking. We combined our measurements of fledgling survival for eight passerines in South Africa with estimates from published studies of 57 north and south temperate zone songbird species to test three predictions: (1) fledgling survival increases with length of development time in the nest; (2) fledgling survival increases with adult survival and reduced brood size controlled for development time; and (3) south temperate zone species, with their higher adult survival and smaller brood sizes, exhibit higher fledgling survival than north temperate zone species controlled for development time. We found that fledgling survival was higher among south temperate zone species and generally increased with development time and adult survival within and between latitudinal regions. Clutch size did not explain additional variation, but was confounded with adult survival. Given the importance of age-specific mortality to life history evolution, understanding the causes of these geographical patterns of mortality is important.

Use of a goal setting intervention to increase adherence to low back pain rehabilitation: a randomized controlled trial.

PubMed

Coppack, Russell J; Kristensen, Jakob; Karageorghis, Costas I

2012-11-01

To examine the effects of a goal setting intervention on self-efficacy, treatment efficacy, adherence and treatment outcome in patients undergoing low back pain rehabilitation. A mixed-model 2 (time) × 3 (group) randomized controlled trial. A residential rehabilitation centre for military personnel. UK military personnel volunteers (N = 48); mean age was 32.9 (SD 7.9) with a diagnosis of non-specific low back pain. Subjects were randomly assigned to either a goal setting experimental group (Exp, n = 16), therapist-led exercise therapy group (C1, n = 16) or non-therapist-led exercise therapy group (C2, n = 16). Treatment duration for all groups was three weeks. Self-efficacy, treatment efficacy and treatment outcome were recorded before and after the treatment period. Adherence was rated during regularly scheduled treatment sessions using the Sports Injury Rehabilitation Adherence Scale (SIRAS). The Biering-Sørensen test was used as the primary measure of treatment outcome. ANCOVA results showed that adherence scores were significantly higher in the experimental group (13.70 ± 1.58) compared with C2 (11.74 ± 1.35), (P < 0.025). There was no significant difference for adherence between the experimental group and C1 (P = 0.13). Self-efficacy was significantly higher in the experimental group compared to both C1 and C2 (P < 0.05), whereas no significant difference was found for treatment efficacy. Treatment outcome did not differ significantly between the experimental and two control groups. The findings provide partial support for the use of goal setting to enhance adherence in clinical rehabilitation.

The effect of excise tax increases on cigarette prices in South Africa

PubMed Central

Linegar, Daniel J; van Walbeek, Corne

2018-01-01

Introduction The effectiveness of excise tax increases as a tool for reducing tobacco consumption depends largely on how the tax increases impact the retail price. We estimate this relationship in South Africa for 2001–2015. Data Statistics South Africa provided disaggregated cigarette price data, used in the calculation of the Consumers’ Price Index. Data on the excise tax per cigarette were obtained from Budget Reviews prepared by the National Treasury of South Africa. Methods Regression equations were estimated for each month. The month-on-month change in cigarette prices in February through April was regressed against March’s excise tax change to estimate the pass-through coefficient. For the other 9 months, the month-on-month change in cigarette price was regressed against monthly dummy variables to determine the size of the non-tax-related price increase in each of these months. The analysis was performed in both nominal and real (inflation-adjusted) terms. Findings Expressed in real terms, the excise tax was undershifted. A R1.00 (one rand) increase in the excise tax is associated with an increase in the retail price of cigarettes of R0.90 in the pre-2010 period, and R0.49 in the post-2010 period. In the pre-2010 period, the tobacco industry increased the retail price of cigarettes in July/August, independent of the excise tax increase. The discretionary July/August price increases largely disappeared after 2010, primarily because the market became more competitive. Conclusion The degree of excise tax pass-through, and the magnitude of discretionary increases in cigarette prices, is significantly determined by the competitive environment in the cigarette market. PMID:28341767

Patients' beliefs: do they affect tuberculosis control? A study in a rural district of South Africa.

PubMed

Edginton, M E; Sekatane, C S; Goldstein, S J

2002-12-01

A rural district of South Africa. To describe the beliefs and experiences about tuberculosis of patients and community members and to suggest how these affect presentation to health services and treatment adherence. A descriptive study using structured interviews with individual patients, and focus group interviews with patients and community groups. There is a strong belief in this community that tuberculosis is the result of breaking cultural rules that demand abstinence from sex after the death of a family member and after a woman has a spontaneous abortion. People believe that the resulting disease can only be treated by traditional healers. This delays presentation to hospitals or clinics. There is also a belief in a 'western' type TB that can spread from sufferers or is due to environmental pollution or to smoking or alcohol excesses. A number of factors were cited that influenced adherence to treatment. These included the stigma of TB, the belief that there should be abstinence from sex while on treatment, difficulties accessing health services, long waits and unacceptable health worker attitudes. With the increasing rates of tuberculosis in South Africa, strenuous measures are needed to implement a good control programme that will increase the cure rate of tuberculosis patients. The results of this study suggest the need for health workers to learn about local beliefs that may influence presentation and adherence, and for traditional and western health workers to collaborate.

Medication Adherence Challenges among HIV Positive Substance Abusers: The Role of Food and Housing Insecurity

PubMed Central

Surratt, Hilary L.; O’Grady, Catherine L.; Levi-Minzi, Maria A.; Kurtz, Steven P.

2014-01-01

This study examines the prevalence of food/housing insecurity and its association with psychological, behavioral and environmental factors impacting ARV medication adherence and diversion among substance using HIV+ patients in South Florida. 503 HIV+ substance abusers were recruited through targeted sampling. Participants completed a standardized instrument assessing demographics, mental health status, sex risk behaviors, HIV diagnosis, treatment history and access, ARV adherence and diversion, and attitudes toward health care providers. Chi-square and t-tests were used to examine differences by food/housing status and a multivariate linear regression model examined food/housing insecurity and its associations to ARV adherence. Food/housing insecurity was reported by 43.3% of the sample and was associated with higher likelihood of severe psychological distress and substance dependence. Nearly 60% reported recent ARV diversion; only 47.2% achieved 95% medication adherence over one week. Food/housing insecure participants had deficits in their HIV care, including less time in consistent care, lower access to medical care, and less favorable attitudes toward care providers. Multivariate linear regression showed food/housing insecurity demonstrated significant main effects on adherence, including lower past week adherence. Medication diversion was also associated with reduced adherence. Our findings suggest that food/housing insecurity operates as a significant driver of ARV non-adherence and diversion in this population. In the pursuit of better long term health outcomes for vulnerable HIV+ individuals, it is essential for providers to understand the role of food and housing insecurity as a stressor that negatively impacts ARV adherence and treatment access, while also significantly contributing to higher levels distress and substance dependence. PMID:25314042

Medication adherence challenges among HIV positive substance abusers: the role of food and housing insecurity.

PubMed

Surratt, Hilary L; O'Grady, Catherine L; Levi-Minzi, Maria A; Kurtz, Steven P

2015-01-01

This study examines the prevalence of food/housing insecurity and its association with psychological, behavioral, and environmental factors impacting antiretroviral (ARV) medication adherence and diversion among substance using HIV+ patients in South Florida. Five hundred and three HIV+ substance abusers were recruited through targeted sampling. Participants completed a standardized instrument assessing demographics, mental health status, sex risk behaviors, HIV diagnosis, treatment history and access, ARV adherence and diversion, and attitudes toward health-care providers. Chi-square and t-tests were used to examine differences by food/housing status and a multivariate linear regression model examined food/housing insecurity and its associations to ARV adherence. Food/housing insecurity was reported by 43.3% of the sample and was associated with higher likelihood of severe psychological distress and substance dependence. Nearly 60% reported recent ARV diversion; only 47.2% achieved 95% medication adherence over one week. Food/housing insecure participants had deficits in their HIV care, including less time in consistent care, lower access to medical care, and less favorable attitudes toward care providers. Multivariate linear regression showed food/housing insecurity demonstrated significant main effects on adherence, including lower past week adherence. Medication diversion was also associated with reduced adherence. Our findings suggest that food/housing insecurity operates as a significant driver of ARV non-adherence and diversion in this population. In the pursuit of better long-term health outcomes for vulnerable HIV+ individuals, it is essential for providers to understand the role of food and housing insecurity as a stressor that negatively impacts ARV adherence and treatment access, while also significantly contributing to higher levels of distress and substance dependence.

The effect of reminder systems on patients’ adherence to treatment

PubMed Central

Fenerty, Sarah D; West, Cameron; Davis, Scott A; Kaplan, Sebastian G; Feldman, Steven R

2012-01-01

Background Patient adherence is an important component of the treatment of chronic disease. An understanding of patient adherence and its modulating factors is necessary to correctly interpret treatment efficacy and barriers to therapeutic success. Purpose This meta-analysis aims to systematically review published randomized controlled trials of reminder interventions to assist patient adherence to prescribed medications. Methods A Medline search was performed for randomized controlled trials published between 1968 and June 2011, which studied the effect of reminder-based interventions on adherence to self-administered daily medications. Results Eleven published randomized controlled trials were found between 1999 and 2009 which measured adherence to a daily medication in a group receiving reminder interventions compared to controls receiving no reminders. Medication adherence was measured as the number of doses taken compared to the number prescribed within a set period of time. Meta- analysis showed a statistically significant increase in adherence in groups receiving a reminder intervention compared to controls (66.61% versus 54.71%, 95% CI for mean: 0.8% to 22.4%). Self-reported and electronically monitored adherence rates did not significantly differ (68.04% versus 63.67%, P = 1.0). Eight of eleven studies showed a statistically significant increase in adherence for at least one of the reminder group arms compared to the control groups receiving no reminder intervention. Limitations The data are limited by imperfect measures of adherence due to variability in data collection methods. It is also likely that concomitant educational efforts in the study populations, such as instructions regarding proper administration and importance of correct dosing schedules, contributed to improved patient adherence, both in reminder and control arms. The search strategy could have missed relevant studies which were categorized by disease rather than adherence. Conclusions

Long-term adherence to daily controller medication in children with asthma: The role of outpatient clinic visits.

PubMed

Keemink, Yvette S; Klok, Ted; Brand, Paul L P

2015-11-01

To investigate changes in inhaled corticosteroids adherence, both before and after a scheduled follow-up visit, in young children in a comprehensive asthma management program. One-year prospective follow-up study in 104 asthmatic children (mean age 4.8 years). Adherence to inhaled corticosteroids was assessed using electronic (Smartinhaler®) devices. We assessed changes in adherence before and after clinic visits. A  > 10% increase in adherence in the 3 days preceding a clinic visit was considered to reflect clinically relevant white coat adherence (WCA) if it exceeded background variation in adherence (median change >0, and increase larger than adherence changes after a clinic visit). Overall adherence was high (median 85%). A pre-visit increase in adherence of >10% was demonstrated in 17 patients (22%), but the median change in adherence around a clinic visit was 0. There were no significant differences in changes in adherence between the days before or after a visit (P > 0.2). The median coefficient of variation in adherence was 9%, and did not significantly differ between children with and without a pre-visit increase in adherence (P = 0.12). Twelve patients (15.4%) showed an increase of adherence in the month following a clinic visit; their overall mean (SE) adherence was slightly lower (73% (4.6%)) than those without such an increase (80% (2.2%), P = 0.054). There was no WCA in children with asthma enrolled in a comprehensive asthma management program with high overall adherence. This suggests that WCA in pediatric chronic conditions primarily occurs against the background of low overall adherence. © 2014 Wiley Periodicals, Inc.

Adherence to Analgesics in Oncology Outpatients: Focus on Taking Analgesics on Time.

PubMed

Oldenmenger, Wendy H; Sillevis Smitt, Peter A E; de Raaf, Pleun J; van der Rijt, Carin C D

2017-06-01

Inadequate adherence to prescribed analgesics may be one of the reasons why patients with cancer experience unrelieved pain. Adherence is directly influenced by patients' barriers about pain management. Patient pain education programs (PEPs) have been developed to reduce patients' barriers and increase patients' adherence to their analgesics. The purpose of this article was to evaluate patients' adherence in patients receiving a pain consult and patient pain education in comparison with patients receiving standard pain treatment (standard care [SC]), to better explore the difficulties in medication adherence in cancer-related pain and the effects of PEP. In 54 adult outpatients with cancer-related pain, patients' adherence to the prescribed around-the-clock analgesics was measured with a Medication Event Monitoring System, in the following time intervals: weeks 1 and 2, weeks 3 and 4, and weeks 7 and 8 after randomization. Adherence was differentiated into taking adherence, taking the correct dose, and taking analgesics at the right time intervals. Taking adherence increased in the intervention group compared to baseline (from 91% to 93%) and decreased in the SC group (from 85% to 78%; P < 0.05). At the end of the study, more patients in the intervention group took their analgesics at the right intervals (78%) than did patients in the SC group (64%, P < 0.05). During the study, patients were more adherent to opioids than to World Health Organization step 1 analgesics. The combined intervention can increase adherence. The true problem in pain management is that patients do not take their prescribed analgesics at the right time intervals. With the detailed adherence information from this study, it is possible to further tailor patient education to the individual patient. © 2016 World Institute of Pain.

Addressing drug adherence using an operations management model.

PubMed

Nunlee, Martin; Bones, Michelle

2014-01-01

OBJECTIVE To provide a model that enables health systems and pharmacy benefit managers to provide medications reliably and test for reliability and validity in the analysis of adherence to drug therapy of chronic disease. SUMMARY The quantifiable model described here can be used in conjunction with behavioral designs of drug adherence assessments. The model identifies variables that can be reproduced and expanded across the management of chronic diseases with drug therapy. By creating a reorder point system for reordering medications, the model uses a methodology commonly seen in operations research. The design includes a safety stock of medication and current supply of medication, which increases the likelihood that patients will have a continuous supply of medications, thereby positively affecting adherence by removing barriers. CONCLUSION This method identifies an adherence model that quantifies variables related to recommendations from health care providers; it can assist health care and service delivery systems in making decisions that influence adherence based on the expected order cycle days and the expected daily quantity of medication administered. This model addresses the possession of medication as a barrier to adherence.

A Self-Reported Adherence Measure to Screen for Elevated HIV Viral Load in Pregnant and Postpartum Women on Antiretroviral Therapy

PubMed Central

Brittain, Kirsty; Mellins, Claude A.; Zerbe, Allison; Remien, Robert H.; Abrams, Elaine J.; Myer, Landon; Wilson, Ira B.

2016-01-01

Maternal adherence to antiretroviral therapy (ART) is a concern and monitoring adherence presents a significant challenge in low-resource settings. We investigated the association between self-reported adherence, measured using a simple three-item scale, and elevated viral load (VL) among HIV-infected pregnant and postpartum women on ART in Cape Town, South Africa. This is the first reported use of this scale in a non-English speaking setting and it achieved good psychometric characteristics (Cronbach α = 0.79). Among 452 women included in the analysis, only 12 % reported perfect adherence on the self-report scale, while 92 % had a VL <1000 copies/mL. Having a raised VL was consistently associated with lower median adherence scores and the area under the curve for the scale was 0.599, 0.656 and 0.642 using a VL cut-off of ≥50, ≥1000 and ≥10000 copies/mL, respectively. This simple self-report adherence scale shows potential as a first-stage adherence screener in this setting. Maternal adherence monitoring in low resource settings requires attention in the era of universal ART, and the value of this simple adherence scale in routine ART care settings warrants further investigation. PMID:27278548

Genetic factors in exercise adoption, adherence and obesity.

PubMed

Herring, M P; Sailors, M H; Bray, M S

2014-01-01

Physical activity and exercise play critical roles in energy balance. While many interventions targeted at increasing physical activity have demonstrated efficacy in promoting weight loss or maintenance in the short term, long term adherence to such programmes is not frequently observed. Numerous factors have been examined for their ability to predict and/or influence physical activity and exercise adherence. Although physical activity has been demonstrated to have a strong genetic component in both animals and humans, few studies have examined the association between genetic variation and exercise adherence. In this review, we provide a detailed overview of the non-genetic and genetic predictors of physical activity and adherence to exercise. In addition, we report the results of analysis of 26 single nucleotide polymorphisms in six candidate genes examined for association to exercise adherence, duration, intensity and total exercise dose in young adults from the Training Interventions and Genetics of Exercise Response (TIGER) Study. Based on both animal and human research, neural signalling and pleasure/reward systems in the brain may drive in large part the propensity to be physically active and to adhere to an exercise programme. Adherence/compliance research in other fields may inform future investigation of the genetics of exercise adherence. © 2013 The Authors. obesity reviews © 2013 International Association for the Study of Obesity.

What do community-dwelling Caucasian and South Asian 60–70 year olds think about exercise for fall prevention?

PubMed Central

Horne, Maria; Speed, Shaun; Skelton, Dawn; Todd, Chris

2009-01-01

Background: strategies to prevent falls often recommend regular exercise. However, 40% of over 50s in the UK report less physical activity than is recommended. Even higher rates of sedentary behaviour have been reported among South Asian older adults. Objective: to identify salient beliefs that influence uptake and adherence to exercise for fall prevention among community-dwelling Caucasian and South Asian 60–70 year olds in the UK. Methods: we undertook an ethnographic study using participant observation, 15 focus groups (n = 87; mean age = 65.7 years) and 40 individual semi-structured interviews (mean age = 64.8 years). Data analysis used framework analysis. Results: young older adults do not acknowledge their fall risk and are generally not motivated to exercise to prevent falls. Those who had fallen are more likely to acknowledge risk of future falls. Whilst many of the beliefs about falls and exercise expressed were very similar between Caucasians and South Asians, there was a tendency for South Asians to express fatalistic beliefs more often. Conclusion: fall prevention should not be the focus of strategies to increase uptake and adherence to exercise. The wider benefits of exercise, leading to an active healthy lifestyle should be encouraged. PMID:19039019

The effect of excise tax increases on cigarette prices in South Africa.

PubMed

Linegar, Daniel J; van Walbeek, Corne

2018-01-01

The effectiveness of excise tax increases as a tool for reducing tobacco consumption depends largely on how the tax increases impact the retail price. We estimate this relationship in South Africa for 2001-2015. Statistics South Africa provided disaggregated cigarette price data, used in the calculation of the Consumers' Price Index. Data on the excise tax per cigarette were obtained from Budget Reviews prepared by the National Treasury of South Africa. Regression equations were estimated for each month. The month-on-month change in cigarette prices in February through April was regressed against March's excise tax change to estimate the pass-through coefficient. For the other 9 months, the month-on-month change in cigarette price was regressed against monthly dummy variables to determine the size of the non-tax-related price increase in each of these months. The analysis was performed in both nominal and real (inflation-adjusted) terms. Expressed in real terms, the excise tax was undershifted. A R1.00 (one rand) increase in the excise tax is associated with an increase in the retail price of cigarettes of R0.90 in the pre-2010 period, and R0.49 in the post-2010 period. In the pre-2010 period, the tobacco industry increased the retail price of cigarettes in July/August, independent of the excise tax increase. The discretionary July/August price increases largely disappeared after 2010, primarily because the market became more competitive. The degree of excise tax pass-through, and the magnitude of discretionary increases in cigarette prices, is significantly determined by the competitive environment in the cigarette market. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Medication adherence beliefs of U.S community pharmacists.

PubMed

Witry, Matthew J

2018-05-01

There is increasing attention on the role of community pharmacists in improving medication adherence. There is a need to better understand pharmacist attitudes and experiences related to this role. To assess community pharmacist perceptions of patient reasons for non-adherence, characterize the adherence beliefs of community pharmacists, and test if there are demographic predictors of pharmacists' self-efficacy, outcome expectations, and role beliefs related to intervening on medication non-adherence. A cross-sectional survey was mailed using a 4-contact approach to 1000 pharmacists practicing in 5 Midwestern U.S. States. The survey included seven domains to address the study objectives. Descriptive statistics were calculated for demographic items, coefficient alphas tested the internal consistency of scales, and multiple regression was used to test the relationship between demographics and scale means. There were 261 usable responses giving a 29% response rate. Pharmacists perceived forgetting and instructions changing without a new prescription to be the most common reasons for late refills. A minority of pharmacists agreed that non-adherence involves a deliberate decision or that negative medication beliefs were common reasons for late refills. Pharmacists were confident, had positive outcome expectations, and positive role beliefs related to interacting with patients who have adherence issues. Barriers to adherence intervention included difficulties with follow-up and documentation. Also, over half of the pharmacists reported that discussing adherence makes patients defensive. Pharmacists had positive attitudes toward intervening on medication non-adherence although barriers to intervention are present. Pharmacists perceived non-intentional reasons for late refills to be more prevalent than intentional reasons. Pharmacists may benefit from additional non-adherence communication training and support targeted at identifying a broader range of non-adherence

Adherence to gout management recommendations of Chinese patients.

PubMed

Sheng, Feng; Fang, Weigang; Zhang, Bingqing; Sha, Yue; Zeng, Xuejun

2017-11-01

Though efficacious and affordable treatments for gout are widely available, gout is still not well controlled in many countries of the world including China.To investigate patient adherence to gout management recommendations and potential barriers in Chinese male gout patients, a survey was carried out by telephone interview in male patients registered in the gout clinic at Peking Union Medical College Hospital. Adherence to dietary and medication recommendations was measured by a food frequency questionnaire and proportion of cumulative time adherent to chemical urate-lowering therapy (ULT), respectively. Dietary adherence was defined as consumption of alcohol, seafood and animal organs less than once per month, and reduced red meat after dietary counseling. Medication adherence was defined as ULT ≥80% of time in the past 12 months for patients with indications. Logistic regression models were used to identify patient characteristics associated with management adherence. Reasons for nonadherence were also sought by open-end questions.Dietary and medication adherence were 44.2% and 21.9%, respectively. Older age (odds ratio [OR] 7.90, 95% confidence interval [CI] 2.49-25.04 for age ≥60), higher serum uric acid (sUA) levels (OR 3.53, 95% CI 1.42-8.75 for the highest quartile), and tophi (OR 2.31, 95% CI 1.12-4.77) were associated with dietary adherence independently, while tophi (OR 14.05, 95% CI 2.67-74.08) and chronic kidney disease (OR 16.66, 95% CI 2.63-105.37) were associated with medication adherence independently. Reasons that patients reported for nonadherence to medication included remission after treatment (35.3%), concerns for potential side effects (22.7%), insufficient patient education (8.7%), and adverse events (8.2%).Patient adherence to gout management recommendations is poor in China. Older age, increased disease burden, and specific comorbidities were associated with management adherence.

Using protection motivation theory and formative research to guide an injury prevention intervention: increasing adherence to the North American Guidelines for Children's Agricultural Tasks.

PubMed

Ashida, Sato; Heaney, Catherine A; Kmet, Jennifer M; Wilkins, J R

2011-05-01

The North American Guidelines for Children's Agricultural Tasks (NAGCAT) were developed to reduce childhood agricultural injuries by assisting adults in assigning appropriate chores and providing needed supervision and training. To develop an effective intervention to increase adherence to NAGCAT among farm parents, formative research (focus groups and pilot-testing) was conducted. Protection motivation theory (PMT) was used to guide this research and inform intervention development. Focus group results suggested how PMT constructs might be addressed to increase adherence. A home visit intervention, using a standardized presentation in POWERPoint™, was developed to (a) introduce NAGCAT, (b) increase motivation to use NAGCAT and enhance safe work behaviors, and (c) ultimately reduce agricultural work-related injuries among youth. Process evaluation data suggests that the intervention was well received by farm parents. Conducting theory-guided formative research identified motivational barriers and strategies for overcoming these barriers that might not have been otherwise apparent.

Ethical considerations in adherence research.

PubMed

Patel, Nupur U; Moore, Blake A; Craver, Rebekah F; Feldman, Steven R

2016-01-01

Poor adherence to treatment is a common cause of medical treatment failure. Studying adherence is complicated by the potential for the study environment to impact adherence behavior. Studies performed without informing patients about adherence monitoring must balance the risks of deception against the potential benefits of the knowledge to be gained. Ethically monitoring a patient's adherence to a treatment plan without full disclosure of the monitoring plan requires protecting the patient's rights and upholding the fiduciary obligations of the investigator. Adherence monitoring can utilize different levels of deception varying from stealth monitoring, debriefing after the study while informing the subject that some information had been withheld in regard to the use of adherence monitoring (withholding), informed consent that discloses some form of adherence monitoring is being used and will be disclosed at the end of the study (authorized deception), and full disclosure. Different approaches offer different benefits and potential pitfalls. The approach used must balance the risk of nondisclosure against the potential for confounding the adherence monitoring data and the potential benefits that adherence monitoring data will have for the research subjects and/or other populations. This commentary aims to define various methods of adherence monitoring and to provide a discussion of the ethical considerations that accompany the use of each method and adherence monitoring in general as it is used in clinical research.

Utility of an Interactive Voice Response System to Assess Antiretroviral Pharmacotherapy Adherence Among Substance Users Living with HIV/AIDS in the Rural South

PubMed Central

Simpson, Cathy A.; Huang, Jin; Roth, David L.; Stewart, Katharine E.

2013-01-01

Abstract Promoting HIV medication adherence is basic to HIV/AIDS clinical care and reducing transmission risk and requires sound assessment of adherence and risk behaviors such as substance use that may interfere with adherence. The present study evaluated the utility of a telephone-based Interactive Voice Response self-monitoring (IVR SM) system to assess prospectively daily HIV medication adherence and its correlates among rural substance users living with HIV/AIDS. Community-dwelling patients (27 men, 17 women) recruited from a non-profit HIV medical clinic in rural Alabama reported daily medication adherence, substance use, and sexual practices for up to 10 weeks. Daily IVR reports of adherence were compared with short-term IVR-based recall reports over 4- and 7-day intervals. Daily IVR reports were positively correlated with both recall measures over matched intervals. However, 7-day recall yielded higher adherence claims compared to the more contemporaneous daily IVR and 4-day recall measures suggestive of a social desirability bias over the longer reporting period. Nearly one-third of participants (32%) reported adherence rates below the optimal rate of 95% (range=0–100%). Higher IVR-reported daily medication adherence was associated with lower baseline substance use, shorter duration of HIV/AIDS medical care, and higher IVR utilization. IVR SM appears to be a useful telehealth tool for monitoring medication adherence and identifying patients with suboptimal adherence between clinic visits and can help address geographic barriers to care among disadvantaged, rural adults living with HIV/AIDS. PMID:23651105

Identifying configurations of behavior change techniques in effective medication adherence interventions: a qualitative comparative analysis.

PubMed

Kahwati, Leila; Viswanathan, Meera; Golin, Carol E; Kane, Heather; Lewis, Megan; Jacobs, Sara

2016-05-04

Interventions to improve medication adherence are diverse and complex. Consequently, synthesizing this evidence is challenging. We aimed to extend the results from an existing systematic review of interventions to improve medication adherence by using qualitative comparative analysis (QCA) to identify necessary or sufficient configurations of behavior change techniques among effective interventions. We used data from 60 studies in a completed systematic review to examine the combinations of nine behavior change techniques (increasing knowledge, increasing awareness, changing attitude, increasing self-efficacy, increasing intention formation, increasing action control, facilitation, increasing maintenance support, and motivational interviewing) among studies demonstrating improvements in adherence. Among the 60 studies, 34 demonstrated improved medication adherence. Among effective studies, increasing patient knowledge was a necessary but not sufficient technique. We identified seven configurations of behavior change techniques sufficient for improving adherence, which together accounted for 26 (76 %) of the effective studies. The intervention configuration that included increasing knowledge and self-efficacy was the most empirically relevant, accounting for 17 studies (50 %) and uniquely accounting for 15 (44 %). This analysis extends the completed review findings by identifying multiple combinations of behavior change techniques that improve adherence. Our findings offer direction for policy makers, practitioners, and future comparative effectiveness research on improving adherence.

The intelligent, painless, "germ-free" colonoscopy: A Columbus' egg for increasing population adherence to colorectal cancer screening?

PubMed

Perri, Francesco; Iacobellis, Angelo; Gentile, Marco; Tumino, Emanuele; Andriulli, Angelo

2010-12-01

Colorectal cancer (CRC) represents a major cause of morbidity and mortality. Although it is widely accepted that CRC screening in average risk populations lowers CRC incidence and mortality, a disappointedly low adherence rate to both faecal occult blood testing and colonoscopy-based screening programs has been observed in Italy and in other European countries. Main reasons for the low acceptance of colonoscopy-based CRC screening has been ascribed to lack of recommendations given by general practitioners, fear of discomfort or complications, embarrassment, and avoidance of unpleasant preparation. New advances in endoscopic technology such as colon capsule and robotic colonoscopy might represent the ideal tool for CRC screening since they reduce or eliminate procedure-related pain and discomfort. Moreover, no disinfection between procedures is required. Motion of the new probes along the gastrointestinal tract is achieved either in passive modality by utilizing the gut peristalsis (colon capsule) or in active "intelligent" modality by means of computer-assisted propulsion (robotic colonoscopy). In this review, the preliminary clinical results obtained with the new devices are summarized. It is expected that the new instruments will be soon available in clinical practice with the hope of increasing adherence to CRC screening programs. Copyright © 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Patient adherence and effective communication.

PubMed

Bukstein, Don A

2016-12-01

Poor adherence to inhaled corticosteroid medication is a critical problem for asthma because it contributes to morbidity and mortality through poor asthma control, frequent asthma exacerbations, acute care visits, and oral corticosteroid use. To discuss evidence-based, time-efficient strategies that can be adopted by most practitioners to try to increase patient adherence. Asthma management guidelines and other key publications are used to enhance discussion. Establishing patient-centered, collaborative care that permits effective patient-practitioner communication can improve adherence, thus leading to improved asthma outcomes. One critical strategy is shared decision making, in which the patient and the practitioner share relevant information, discuss risks vs benefits of various treatment options, express treatment preferences, deliberate the options, and agree on treatment. Asthma self-management education, which emphasizes self-efficacy, is also essential. The education necessary to provide those skills depends in part on consideration of the patient's health literacy. Practitioners also have at their disposal a variety of tips and techniques to improve communication and gather information not only at the patient-practitioner level but also at the practitioner-practitioner level, such as within a group practice or within a health care system. To improve patient adherence, clinicians need to consider a variety of factors and implement strategies that directly target underlying issues. Strategies may include customizing and simplifying learning and intervention regimens, identifying barriers to adherence and addressing them, ensuring patient support structures are in place, and improving self-efficacy and health literacy. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Patient adherence predicts outcome from cognitive behavioral therapy in obsessive-compulsive disorder.

PubMed

Simpson, Helen Blair; Maher, Michael J; Wang, Yuanjia; Bao, Yuanyuan; Foa, Edna B; Franklin, Martin

2011-04-01

To examine the effects of patient adherence on outcome from exposure and response prevention (EX/RP) therapy in adults with obsessive-compulsive disorder (OCD). Thirty adults with OCD were randomized to EX/RP (n = 15) or EX/RP augmented by motivational interviewing strategies (n = 15). Both treatments included 3 introductory sessions and 15 exposure sessions. Because there were no significant group differences in adherence or outcome, the groups were combined to examine the effects of patient adherence on outcome. Independent evaluators assessed OCD severity using the Yale-Brown Obsessive Compulsive Scale. Therapists assessed patient adherence to between-session EX/RP assignments at each session using the Patient EX/RP Adherence Scale (PEAS). Linear regression models were used to examine the effects of PEAS scores on outcome, adjusting for baseline severity. The relationship between patient adherence and other predictors of outcome was explored using structural equation modeling. Higher average PEAS ratings significantly predicted lower posttreatment OCD severity in intent-to-treat and completer samples. PEAS ratings in early sessions (5-9) also significantly predicted posttreatment OCD severity. The effects of other significant predictors of outcome in this sample (baseline OCD severity, hoarding subtype, and working alliance) were fully mediated by patient adherence. Patient adherence to between-session EX/RP assignments significantly predicted treatment outcome, as did early patient adherence and change in early adherence. Patient adherence mediated the effects of other predictors of outcome. Future research should develop interventions that increase adherence and then test whether increasing adherence improves outcome. If effective, these interventions could then be used to personalize care. (c) 2011 APA, all rights reserved.

The Psychosocial Context Impacts Medication Adherence after Acute Coronary Syndrome

PubMed Central

Kronish, Ian M.; Rieckmann, Nina; Burg, Matthew M.; Alcántara, Carmela; Davidson, Karina W.

2013-01-01

Background Depression is associated with poor adherence to medications and worse prognosis in patients with acute coronary syndrome (ACS). Purpose To determine whether cognitive, behavioral, and/or psychosocial vulnerabilities for depression explain the association between depression and medication adherence among ACS patients. Methods 169 ACS patients who agreed to have their aspirin adherence measured using an electronic pill bottle for 3 months were enrolled within 1 week of hospitalization. Linear regression was used to determine whether depression vulnerabilities predicted aspirin adherence after adjustment for depressive symptoms, demographics, and comorbidity. Results Of the depression vulnerabilities, only role transitions (beta = −3.32; p=0.02) and interpersonal conflict (beta −3.78; p=0.03) predicted poor adherence. Depression vulnerabilities did not mediate the association between depressive symptoms and medication adherence. Conclusions Key elements of the psychosocial context preceding the ACS including major role transitions and conflict with close contacts place ACS patients at increased risk for poor medication adherence independent of depressive symptoms. PMID:24163188

Adherence with renal dosing recommendations in outpatients undergoing haemodialysis.

PubMed

Kim, G J; Je, N K; Kim, D-S; Lee, S

2016-02-01

Adjustment of drug dosage in patients with end-stage renal disease prevents serious adverse effects, which occur due to the accumulation of drugs or other toxic metabolites. Nevertheless, dosing errors occur most commonly among patients with end-stage renal disease. The aim of this study was to assess the quality of care for end-stage renal disease outpatients using their renal dosing adjustment status. A cross-sectional study was performed using the data collected from 43 South Korean medical institutions via questionnaires. A total of 2428 patients on haemodialysis, who were at least 18 years of age, were included. Among these patients, the study population was confined to patients who were taking medications and required renal dosing adjustments from three therapeutic classes: antihypertensives, antihyperglycaemics and lipid-modifying agents. The study population (n = 828) was prescribed a total of 1097 drug orders for the target drugs. Determination of appropriate dosage adjustment was based on GFR (glomerular filtration rate) using the Modification of Diet in Renal Disease revised 4-variable equation. The primary outcome was non-adherence to drug dosing requirements for end-stage renal disease patients with consideration to their renal function. Among the study population (n = 828), 469 haemodialysis patients were identified as having drug orders that were adherent to renal dosing recommendations. There were significant differences between the patient groups who received recommendation-adherent and non-adherent drug orders in the characteristics of the medical institutions they visited, causes of chronic renal failure and prevalence of concurrent diabetes mellitus. The primary factor of non-adherence to renal dosing adjustment recommendations was characteristics of medical institutions. Compared to tertiary hospitals, secondary hospitals and primary care clinics were 1·16 and 1·22 times, respectively, more non-adherent in accordance with the multivariate

Meeting patient needs trumps adherence. A cross-sectional study of adherence and adaptations when national guidelines are used in practice.

PubMed

Kakeeto, Mikael; Lundmark, Robert; Hasson, Henna; von Thiele Schwarz, Ulrica

2017-08-01

In the evidence-to-practice pathway, guidelines are developed to provide a practical summary of evidence and stimulate change. However, when guidelines are used in practice, adherence to the recommendations in guidelines is limited, and adaptations are common. Thus, we need more detailed knowledge about adherence and adaptations when guidelines are used in practice to understand the end of the evidence-to-practice pathway. Subsequently, the aim is to examine adherence to and adaptations of recommendations in the Swedish National Guidelines for Methods of Preventing Disease. A questionnaire was sent to healthcare professionals and managers in Stockholm between January and March 2014. Adherence to the recommendations was compared between practice settings, and the frequency of different adaptations and reasons for adaptations was analysed. Partial adherence to the guidelines was found. The adherence was significantly greater within primary care than at the hospitals (P < .001). Modifications formed the most common category of adaptations (55%) and included mainly prioritization of specific patient groups and increased patient customization. The most common reason for adaptations (25%) was to meet the patients' specific needs and capabilities. This study provides insight into adherence and adaptation when guidelines are used in practice. Work with lifestyle habits was partially done in accordance with the guidelines. Lack of time and lack of resources were not the most common reasons for adaptations. Rather, the findings suggest that when patient needs and capabilities contrast with guideline recommendations, patient needs trump adherence to guidelines. © 2017 John Wiley & Sons, Ltd.

A Multichannel Medication Adherence Intervention Influences Patient and Prescriber Behavior.

PubMed

Leslie, R Scott; Gilmer, Todd; Natarajan, Loki; Hovell, Melbourne

2016-05-01

The Centers for Medicare & Medicaid Services (CMS) Medicare Health Plan Quality and Performance Ratings program, or Star Ratings program, includes 3 medication adherence outcome measures (Medication Adherence for Diabetes Medications, Medication Adherence for Hypertension, and Medication Adherence for Cholesterol), which contribute to approximately 31% of a Medicare Advantage prescription drug (MA-PD) plan's Part D summary rating and 12% of its overall star rating (a weighted summary of a plan's Part C and Part D ratings). MA-PD plans have been increasing their adherence intervention efforts as an approach to improving beneficiaries' medication adherence and the plan's quality performance ratings. However, few evaluations have examined the effects of these interventions on medication adherence and performance ratings. To assess the impact of a quasi-experimental multichannel adherence intervention on beneficiaries' medication adherence and health plan quality performance measures for 2 MA-PD plans. The intervention included a daily prescriber-directed 90-day retail refill component and a weekly member-directed refill reminder component. Members filling 1 or more medications assessed by the 3 CMS star ratings adherence measures (oral antidiabetics [DM], antihypertensives [HTN], and statins [CHOL]) were identified for a 2-component intervention starting in April 2013. The retail-based 90-day refill component sent populated 90-day prescription letters via fax to prescribers of members who had filled a 30-day prescription. One fax per member-medication instance was sent and included the option to fax approval of a new 90-day prescription. For prescribers who approved, members were notified that a 90-day refill was available at their retail pharmacies. The refill reminder component used weekly scans of pharmacy claims to identify members' refill patterns. Reminder letters were sent to members 7 days late to refill. An intent-to-treat approach was used to assess

Improving Adherence to Web-Based and Mobile Technologies for People With Psychosis: Systematic Review of New Potential Predictors of Adherence.

PubMed

Killikelly, Clare; He, Zhimin; Reeder, Clare; Wykes, Til

2017-07-20

Despite the boom in new technologically based interventions for people with psychosis, recent studies suggest medium to low rates of adherence to these types of interventions. The benefits will be limited if only a minority of service users adhere and engage; if specific predictors of adherence can be identified then technologies can be adapted to increase the service user benefits. The study aimed to present a systematic review of rates of adherence, dropout, and approaches to analyzing adherence to newly developed mobile and Web-based interventions for people with psychosis. Specific predictors of adherence were also explored. Using keywords (Internet or online or Web-based or website or mobile) AND (bipolar disorder or manic depression or manic depressive illness or manic-depressive psychosis or psychosis or schizophr* or psychotic), the following databases were searched: OVID including MedLine, EMBASE and PsychInfo, Pubmed and Web of Science. The objectives and inclusion criteria for suitable studies were defined following PICOS (population: people with psychosis; intervention: mobile or Internet-based technology; comparison group: no comparison group specified; outcomes: measures of adherence; study design: randomized controlled trials (RCT), feasibility studies, and observational studies) criteria. In addition to measurement and analysis of adherence, two theoretically proposed predictors of adherence were examined: (1) level of support from a clinician or researcher throughout the study, and (2) level of service user involvement in the app or intervention development. We provide a narrative synthesis of the findings and followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for reporting systematic reviews. Of the 20 studies that reported a measure of adherence and a rate of dropout, 5 of these conducted statistical analyses to determine predictors of dropout, 6 analyzed the effects of specific adherence

Adherence to treatment in patients with systemic lupus erythematosus.

PubMed

Prados-Moreno, Sebastián; Sabio, José Mario; Pérez-Mármol, José Manuel; Navarrete-Navarrete, Nuria; Peralta-Ramírez, María Isabel

2018-01-12

Non-adherence to treatment is usually a clinical problem in patients with systemic lupus erythematosus (SLE). Increasing the knowledge of predictors of treatment adherence can be meaningful in the clinical setting. The main objective of the present study was to analyse the influence of sociodemographic, clinical and psychological variables on the degree of treatment adherence in a sample of Spanish women with SLE. This is an observational-transversal study. All participants were evaluated for the degree of treatment adherence, their clinical status, psychopathological manifestations, the level of perceived stress and self-efficacy. The sample was divided into two groups (adherent vs non-adherent). The factors associated with a lack of adherence in this sample were analysed by means of logistic regression. This study comprises 72 women with SLE (average age=36.72±12.2 years). Almost 64% of patients with SLE were non-adherent to treatment. The results showed that a low educational level, being unemployed, living with a partner and alcohol abuse were associated with low treatment adherence. There were significant mean differences between groups in psychopathological subscales of somatisation, obsession-compulsion and general psychopathological indices. There were also mean differences between groups for the level of perceived stress. The use of non-steroidal anti-inflammatory drugs, suffering arthrosis and scoring higher in dimensions of psychopathology were significant predictors of treatment adherence, explaining between 35% and 47% of its variability. Including the clinical and psychopathological manifestations as important aspects in the clinical reasoning of health professionals could improve the adherence to treatment of patients with SLE. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

78 FR 23671 - Onions Grown in South Texas; Increased Assessment Rate

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-22

... FR] Onions Grown in South Texas; Increased Assessment Rate AGENCY: Agricultural Marketing Service... Texas Onion Committee (Committee) for the 2012-13 and subsequent fiscal periods from $0.025 to $0.03 per 50-pound equivalent of onions handled. The Committee locally administers the marketing order that...

Adherence to the dialysis prescription: partnering with patients for improved outcomes.

PubMed

White, Randee Breiterman

2004-01-01

Nonadherence is common in the U.S. dialysis population. No single strategy has been definitely proven to yield universal and/or lasting improvements in adherence. However, using a patient-centered approach, including the removal of barriers to adherence, ongoing education, and cognitive behavioral strategies, may generate increased opportunities for patients and the nephrology staff to improve both adherence and outcomes.

Influence of irrigation regimens on the adherence of Enterococcus faecalis to root canal dentin.

PubMed

Kishen, Anil; Sum, Chee-Peng; Mathew, Shibi; Lim, Chwee-Teck

2008-07-01

Enterococcus faecalis is frequently associated with post-treatment endodontic infections. Because adherence of bacteria to a substrate is the earliest stage in biofilm formation, eliciting the factors that links adherence of this bacterium to dentin would help in understanding its association with treatment-failed root canals. This investigation aimed to study the effects of endodontic irrigants on the adherence of E. faecalis to dentin. The bacteria adherence assay was conducted by using fluorescence microscopy, and the adhesion force was measured by using atomic force microscopy. There were significant increases in adherence and adhesion force after irrigation of dentin with ethylenediaminetetraacetic acid (EDTA), whereas sodium hypochlorite (NaOCl) reduced it. With the use of chlorhexidine (CHX), the force of adhesion increased, but the adherence assay showed a reduction in the number of adhering bacteria. The irrigation regimen of EDTA, NaOCl, and CHX resulted in the least number of adhering E. faecalis cells. This study highlighted that chemicals that alter the physicochemical properties of dentin will influence the nature of adherence, adhesion force, and subsequent biofilm formation of E. faecalis to dentin.

Adherence to cognitive behavioral therapy for insomnia: a systematic review.

PubMed

Matthews, Ellyn E; Arnedt, J Todd; McCarthy, Michaela S; Cuddihy, Leisha J; Aloia, Mark S

2013-12-01

Chronic insomnia is a significant public health problem worldwide, and insomnia has considerable personal and social costs associated with serious health conditions, greater healthcare utilization, work absenteeism, and motor-vehicle accidents. Cognitive behavioral therapy for insomnia (CBTI) is an efficacious treatment, yet attrition and suboptimal adherence may diminish its impact. Despite the increasing use of CBTI, surprisingly little attention has been devoted to understanding the role of adherence. This review describes a comprehensive literature search of adherence to CBTI. The search revealed 15 studies that evaluated adherence to CBTI in adults using valid and reliable measures of sleep, and measure of adherence other than study withdrawals. The primary purposes of this review were to 1) synthesize current study characteristics, methodology, adherence rates, contributing factors, and impact on outcomes, 2) discuss measurement issues, and 3) identify future practice and research directions that may lead to improved outcomes. Strong patterns and inconsistencies were identified among the studies, which complicate an evaluation of the role of adherence as a factor and outcome of CBTI success. The importance of standardized adherence and outcome measures is discussed. In light of the importance of adherence to behavior change, this systematic review may better inform future intervention efforts. Copyright © 2013 Elsevier Ltd. All rights reserved.

Medication adherence monitoring: implications for patients and providers.

PubMed

Gheorghiu, Bobby; Nayani, Seema

2018-05-01

Non-adherence to medication is a key worldwide issue and can lead to adverse patient outcomes and increased health system costs. Would a process facilitating notification of non-adherence infringe upon the autonomy of individuals or breach expectations of privacy? In contrast, patients who are not taking their medication could unknowingly be putting themselves at risk and all the while prescribers are unaware and without the opportunity to intervene. With the advent of electronic methods of medication adherence monitoring, this ethical dilemma now involves a new layer of complexity. We present two scenarios encountered in clinical practice that reflect issues occurring regularly in the Canadian healthcare system.

Brief report: Adherence to fluid recommendations in children receiving treatment for retentive encopresis.

PubMed

Kuhl, Elizabeth S; Felt, Barbara T; Patton, Susana R

2009-01-01

Limited data are available regarding whether children being treated for retentive encopresis are adherent to recommendations to increase their daily fluid intake. The purpose of this study was to examine fluid adherence in children who received treatment for retentive encopresis. A retrospective chart review was performed using diet diary data for 26 children (ages 3-12) who completed a group behavioral intervention for retentive encopresis. Mean daily intake of clear fluid increased significantly during treatment and children relied primarily on water and juice to make this dietary change. However, adherence rates to clear fluid goals were <50%. Children's increased clear fluid intake did not equate to high fluid adherence. Children's high juice consumption is concerning as it could place them at risk for other negative health consequences. Future research should examine whether enhanced fluid education and use of behavior change strategies yield higher fluid adherence.

Food insecurity and Mediterranean diet adherence among Greek university students.

PubMed

Theodoridis, X; Grammatikopoulou, M G; Gkiouras, K; Papadopoulou, S E; Agorastou, T; Gkika, I; Maraki, M I; Dardavessis, T; Chourdakis, M

2018-05-01

To assess Mediterranean diet (MD) adherence and food insecurity (FI) among university students in Greece. A non-probability sample of 236 students was recruited from Athens and Thessaloniki during 2016. FI was assessed with the Household Food Insecurity Access Scale and MD adherence with the MEDAS questionnaire. Mean MEDAS score of the sample was 6.4 ± 1.9, with women demonstrating greater MD adherence compared to men (p = 0.016) and Dietetics students exhibiting increased score compared to the rest (p ≤ 0.001). A low proportion of participants were food-secure (17.8%), 45.3% were severely food-insecure, 22.0% experienced moderate FI and the remaining 14.8% had low FI. Participants studying in the city they grew up exhibited lower FI compared to those studying in other cities (p = 0.009), while, additionally, a trend was noted for increased FI among students with an unemployed family member (p = 0.05). Students working night shifts had lower MD adherence and increased FI compared to the rest (p = 0.004 and p = 0.003, respectively). The same pattern was observed among participants who smoked (p = 0.003 for MD adherence and p = 0.009 for FI, respectively). Multivariate regression analyses did not reveal any connections between FI categories, waist circumference or BMI, but showed an inverse relationship between severe FI and MD adherence. The majority of the surveyed university students from Greece demonstrate some degree of FI, with a great proportion being severely food-insecure. Increased FI is inversely associated with MD adherence. Copyright © 2018 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

78 FR 8047 - Onions Grown in South Texas; Increased Assessment Rate

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-05

... benefits derived by the operation of the marketing order. In addition, the Committee's meeting was widely... DEPARTMENT OF AGRICULTURE Agricultural Marketing Service 7 CFR Part 959 [Doc. No. AMS-FV-12-0039; FV12-959-1 PR] Onions Grown in South Texas; Increased Assessment Rate AGENCY: Agricultural Marketing...

Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review

PubMed Central

Medic, Goran; Littlewood, Kavi J.; Diez, Teresa; Granström, Ola; De Hert, Marc

2013-01-01

Background: Nonadherence to medication is a recognized problem and may be the most challenging aspect of treatment. Methods: We performed a systematic review of factors that influence adherence and the consequences of nonadherence to the patient, healthcare system and society, in patients with schizophrenia. Particular attention was given to the effect of nonadherence on hospitalization rates, as a key driver of increased costs of care. A qualitative systematic literature review was conducted using a broad search strategy using disease and adherence terms. Due to the large number of abstracts identified, article selection was based on studies with larger sample sizes published after 2001. Thirty-seven full papers were included: 15 studies on drivers and 22 on consequences, of which 12 assessed the link between nonadherence and hospitalization. Results: Key drivers of nonadherence included lack of insight, medication beliefs and substance abuse. Key consequences of nonadherence included greater risk of relapse, hospitalization and suicide. Factors positively related to adherence were a good therapeutic relationship with physician and perception of benefits of medication. The most frequently reported driver and consequence were lack of insight and greater risk of hospitalization respectively. Conclusions: Improving adherence in schizophrenia may have a considerable positive impact on patients and society. This can be achieved by focusing on the identified multitude of factors driving nonadherence. PMID:24167693

Threefold Increase in PrEP Uptake Over Time with High Adherence Among Young Men Who Have Sex With Men in Chicago.

PubMed

Morgan, Ethan; Moran, Kevin; Ryan, Daniel T; Mustanski, Brian; Newcomb, Michael E

2018-05-04

The goal of this work is to better understand utilization and uptake of pre-exposure prophylaxis (PrEP) among young men who have sex with men (YMSM) and transgender women (TGW). We assessed trends and correlates of PrEP use and adherence across three time points of longitudinal data collection among 885 YMSM and TGW (aged 16-29) from the RADAR cohort in Chicago, 2015-2017. Past 6-month PrEP use increased across three visits: from 6.6 to 17.5%. In multivariable models, past 6-month PrEP use was significantly associated with participation in condomless sex, having more sexual partners, and older age. At least three-quarters of current PrEP users reported being ≥ 90% adherent to PrEP medication across all visits. Past 6-month PrEP use increased over time with those who participated in high-risk HIV behaviors also those most likely to have taken PrEP. As PrEP uptake continues to rise, more research will be needed to understand predictors of PrEP usage, as well as patterns of sexual behavior change following uptake.

Predictors of medication adherence and smoking cessation among smokers under community corrections supervision.

PubMed

Cropsey, Karen L; Clark, C Brendan; Stevens, Erin N; Schiavon, Samantha; Lahti, Adrienne C; Hendricks, Peter S

2017-02-01

Individuals in the U.S. criminal justice system now represent over 12% of all current U.S. smokers. With smoking banned in most U.S. jails and prisons, the cessation focus for this population has shifted to individuals who are under community correction supervision (e.g., probation, parole). The aim of this study was to examine predictors of successful smoking cessation among criminal justice individuals supervised in the community. Five hundred participants under community corrections supervision were randomized to receive either four sessions of smoking cessation counseling or no counseling in conjunction with 12weeks of bupropion treatment plus brief physician advice to quit. Logistic regression analyses examined associations of smoking variables with medication adherence and successful abstinence. Mediation analysis evaluated the indirect effects of medication adherence on smoking abstinence. The strongest associate of medication adherence was previous use of bupropion, while the strongest associate of smoking abstinence was medication adherence. Mediation analysis indicated that previous use of bupropion indirectly increased cessation rates through the pathway of increased medication adherence. These results highlight the importance of medication adherence for smoking cessation among community corrections smokers. Providing exposure to medication may be a promising intervention to increase medication adherence and subsequent cessation rates in this population. Copyright © 2016 Elsevier Ltd. All rights reserved.

Live-cell calcium imaging of adherent and non-adherent GL261 cells reveals phenotype-dependent differences in drug responses.

PubMed

Strong, Averey D; Daniels, Richard L

2017-08-02

The tumor-derived GL261 cell line is used as a model for studying glioblastoma and other high-grade gliomas, and can be cultured adherently or as free-floating aggregates known as neurospheres. These different culture conditions give rise to distinct phenotypes, with increased tumorigenicity displayed by neurosphere-cultured cells. An important technique for understanding GL261 pathobiology is live cell fluorescent imaging of intracellular calcium. However, live cell imaging of GL261 neurospheres presents a technical challenge, as experimental manipulations where drugs are added to the extracellular media cause the cells to move during analysis. Here we present a method to immobilize GL261 neurospheres with low melting point agarose for calcium imaging using the fluorescent calcium sensor fura-2. GL261 cells were obtained from the NCI-Frederick Cancer Research Tumor Repository and cultured as adherent cells or induced to form neurospheres by placing freshly trypsinized cells into serum-free media containing fibroblast growth factor 2, epidermal growth factor, and B-27 supplement. Prior to experiments, adherent cells were loaded with fura-2 and cultured on 8-well chamber slides. Non-adherent neurospheres were first loaded with fura-2, placed in droplets onto an 8-well chamber slide, and finally covered with a thin layer of low melting point agarose to immobilize the cells. Ratiometric pseudocolored images were obtained during treatment with ATP, capsaicin, or vehicle control. Cells were marked as responsive if fluorescence levels increased more than 30% above baseline. Differences between treatment groups were tested using Student's t-tests and one-way ANOVA. We found that cellular responses to pharmacological treatments differ based on cellular phenotype. Adherent cells and neurospheres both responded to ATP with a rise in intracellular calcium. Notably, capsaicin treatment led to robust responses in GL261 neurospheres but not adherent cells. We demonstrate the use

Pharmacists' perspectives on monitoring adherence to treatment in Cystic Fibrosis.

PubMed

Mooney, Karen; Ryan, Cristín; Downey, Damian G

2016-04-01

improved adherence monitoring. Current adherence knowledge is largely based on self-report. Further work is required to establish the most appropriate method of adherence monitoring in CF centres, to improve the recording of adherence and to understand the impact of increased specialist pharmacist involvement on that adherence.

Enhancing medication adherence: in older adults with bipolar disorder.

PubMed

Depp, Colin A; Lebowitz, Barry D

2007-06-01

The number of older adults with bipolar disorder is increasing, yet little is known about the optimal clinical management of these patients. Medication adherence is a vital to effective long-term treatment of these patients; thus enhancement of adherence is often an important clinical goal. We reviewed available evidence about the characteristics of later-life bipolar disorder along with behavioral and organizational strategies to enhance adherence in this population. Based on available data, cognitive impairment, medical comorbidity, and functional limitations are frequent and are likely to impact treatment adherence in this population. In terms of treatment, there have been no placebo-controlled randomized clinical trials of medications or psychosocial interventions for this population. Based on extrapolation from intervention research on younger adults with bipolar disorder and older adults with other chronic illness, psychosocial interventions that reduce effortful cognitive processing in managing medications and reduce organizational barriers to adherence may be beneficial in enhancing adherence in this population. Much more research needs to be done to understand the impact of aging on bipolar disorder, along with optimization of treatment. Interventions to enhance adherence in this population need to be adapted to fit with the unique needs of older adults with bipolar disorder.

Case management and adherence to an online disease management system.

PubMed

Robertson, Lucy; Smith, Michael; Tannenbaum, Dennis

2005-01-01

Non-adherence to treatment presents a significant obstacle to achieving favourable health outcomes. We have studied consumers' adherence to an online disease management system for depression, called Recovery Road. Recovery Road was implemented on a pilot basis for mental health care in Western Australia. Recovery Road was available for use by consumers and clinicians to augment usual treatment. One hundred and thirty consumers who had been diagnosed with major depression were enrolled. Consumers who used Recovery Road (n = 98) were provided with education, progress monitoring, e-consultation, e-diary and online evidenced-based therapy. Consumers received either standard, automated adherence reminders by email (n = 69), or case management, which included personalized email and telephone follow-up in response to non-adherence (n = 29). After the first eight sessions, the adherence was 84% in the case management group and 55% in the automatic reminders group. The results suggest that case management increases adherence to online disease management systems.

Fathers’ Involvement in Preadolescents’ Diabetes Adherence and Glycemic Control*

PubMed Central

Rohan, Jennifer M.; Carle, Adam C.; Pendley, Jennifer Shroff; Delamater, Alan; Drotar, Dennis

2011-01-01

Objective To examine the relationship of paternal involvement in diabetes care with adherence and glycemic control. Methods One hundred and thirty-six mothers and fathers of preadolescents (aged 9–12 years) with type 1 diabetes reported on paternal involvement. Adherence was measured by interview and blood glucose meter downloads. Mothers’ and fathers’ ratings of paternal involvement in diabetes care were compared. We evaluated three structural equation models linking paternal involvement with adherence and glycemic control. Results Mothers and fathers reported similar amounts of paternal involvement, yet mothers rated paternal involvement as more helpful. The data supported a model indicating links between more paternal involvement and higher HbA1c and between lower adherence and higher HbA1c. Mediation and moderation models were not supported. Discussion Although paternal involvement was not directly associated with treatment adherence, it was associated with poorer glycemic control. Some fathers may increase their involvement in response to suboptimal glycemic outcomes. PMID:21515643

Electronic monitoring of treatment adherence and validation of alternative adherence measures in tuberculosis patients: a pilot study.

PubMed

van den Boogaard, Jossy; Lyimo, Ramsey A; Boeree, Martin J; Kibiki, Gibson S; Aarnoutse, Rob E

2011-09-01

To assess adherence to community-based directly observed treatment (DOT) among Tanzanian tuberculosis patients using the Medication Event Monitoring System (MEMS) and to validate alternative adherence measures for resource-limited settings using MEMS as a gold standard. This was a longitudinal pilot study of 50 patients recruited consecutively from one rural hospital, one urban hospital and two urban health centres. Treatment adherence was monitored with MEMS and the validity of the following adherence measures was assessed: isoniazid urine test, urine colour test, Morisky scale, Brief Medication Questionnaire, adapted AIDS Clinical Trials Group (ACTG) adherence questionnaire, pill counts and medication refill visits. The mean adherence rate in the study population was 96.3% (standard deviation, SD: 7.7). Adherence was less than 100% in 70% of the patients, less than 95% in 21% of them, and less than 80% in 2%. The ACTG adherence questionnaire and urine colour test had the highest sensitivities but lowest specificities. The Morisky scale and refill visits had the highest specificities but lowest sensitivities. Pill counts and refill visits combined, used in routine practice, yielded moderate sensitivity and specificity, but sensitivity improved when the ACTG adherence questionnaire was added. Patients on community-based DOT showed good adherence in this study. The combination of pill counts, refill visits and the ACTG adherence questionnaire could be used to monitor adherence in settings where MEMS is not affordable. The findings with regard to adherence and to the validity of simple adherence measures should be confirmed in larger populations with wider variability in adherence rates.

Medication adherence and Medicare expenditure among beneficiaries with heart failure.

PubMed

Lopert, Ruth; Shoemaker, J Samantha; Davidoff, Amy; Shaffer, Thomas; Abdulhalim, Abdulla M; Lloyd, Jennifer; Stuart, Bruce

2012-09-01

To (1) measure utilization of and adherence to heart failure medications and (2) assess whether better adherence is associated with lower Medicare spending. Pooled cross-sectional design using six 3-year cohorts of Medicare beneficiaries with congestive heart failure (CHF) from 1997 through 2005 (N = 2204). Adherence to treatment was measured using average daily pill counts. Bivariate and multivariate methods were used to examine the relationship between medication adherence and Medicare spending. Multivariate analyses included extensive variables to control for confounding, including healthy adherer bias. Approximately 58% of the cohort were taking an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), 72% a diuretic, 37% a beta-blocker, and 34% a cardiac glycoside. Unadjusted results showed that a 10% increase in average daily pill count for ACE inhibitors or ARBs, beta-blockers, diuretics, or cardiac glycosides was associated with reductions in Medicare spending of $508 (not significant [NS]), $608 (NS), $250 (NS), and $1244 (P <.05), respectively. Estimated adjusted marginal effects of a 10% increase in daily pill counts for beta-blockers and cardiac glycosides were reductions in cumulative 3-year Medicare spending of $510 to $561 and $750 to $923, respectively (P <.05). Higher levels of medication adherence among Medicare beneficiaries with CHF were associated with lower cumulative Medicare spending over 3 years, with savings generally exceeding the costs of the drugs in question.

Positive provider interactions, adherence self-efficacy, and adherence to antiretroviral medications among HIV infected adults: A mediation model

PubMed Central

Johnson, Mallory O.; Chesney, Margaret A.; Goldstein, Rise B.; Remien, Robert H.; Catz, Sheryl; Gore-Felton, Cheryl; Charlebois, Edwin; Morin, Stephen F.

2008-01-01

Adherence to antiretroviral (ARV) therapy for HIV infection is critical for maximum benefit from treatment and for the prevention of HIV-related complications. There is evidence that many factors determine medication adherence, including adherence self-efficacy (confidence in one's ability to adhere) and relations with health care providers. However, there are no studies that examine how these two factors relate to each other and their subsequent influence on HIV medication adherence. The goal of the current analysis was to explore a model of medication adherence in which the relationship between positive provider interactions and adherence is mediated by adherence self-efficacy. Computerized self administered and interviewer administered self reported measures of medication adherence, demographic and treatment variables, provider interactions, and adherence self-efficacy were administered to 2765 HIV infected adults on ARV. Criteria for mediation were met, supporting a model in which adherence self-efficacy is the mechanism for the relationship between positive provider interactions and adherence. The finding was consistent when the sample was stratified by gender, race, injection drug use history, and whether the participant reported receipt of HIV specialty care. Positive provider interactions may foster greater adherence self-efficacy, which is associated with better adherence to medications. Results suggest implications for improving provider interactions in clinical care, and future directions for clarifying inter-relationships among provider interactions, adherence self-efficacy, and medication adherence are supported. PMID:16623624

Attitudes and beliefs to the uptake and maintenance of physical activity among community-dwelling South Asians aged 60-70 years: a qualitative study.

PubMed

Horne, M; Skelton, D A; Speed, S; Todd, C

2012-05-01

To identify the attitudes and beliefs associated with the uptake and adherence of physical activity among community-dwelling South Asians aged 60-70 years. A qualitative research study using an ethnographic approach. Focus groups and in-depth interviews were conducted to explore motivational factors associated with initiating and maintaining physical activity. Data analysis followed the framework approach. Health, maintaining independence and social support were important in terms of initiating physical activity. Social support, psychosocial elements of activity, health and integrating physical activity within everyday activities were important for adherence to physical activity. The need for gendered physical activity sessions was important to initiating exercise among Muslim South Asians aged 60-70 years. Promoting active lifestyles and building physical activity in and around day-to-day activities are important strategies in increasing activity levels. However, the needs for culturally appropriate facilities, peer mentors who could assist those with language barriers, specific tailored advice, advice on integrating physical activity in everyday life and general social support could promote uptake and subsequent adherence among this population group. Copyright © 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Brief Report: Adherence to Fluid Recommendations in Children Receiving Treatment for Retentive Encopresis

PubMed Central

Felt, Barbara T.; Patton, Susana R.

2009-01-01

Objective Limited data are available regarding whether children being treated for retentive encopresis are adherent to recommendations to increase their daily fluid intake. The purpose of this study was to examine fluid adherence in children who received treatment for retentive encopresis. Methods A retrospective chart review was performed using diet diary data for 26 children (ages 3–12) who completed a group behavioral intervention for retentive encopresis. Results Mean daily intake of clear fluid increased significantly during treatment and children relied primarily on water and juice to make this dietary change. However, adherence rates to clear fluid goals were <50%. Conclusions Children's increased clear fluid intake did not equate to high fluid adherence. Children's high juice consumption is concerning as it could place them at risk for other negative health consequences. Future research should examine whether enhanced fluid education and use of behavior change strategies yield higher fluid adherence. PMID:19304779

Adherence to isoniazid prophylaxis among HIV-infected children: a randomized controlled trial comparing two dosing schedules

PubMed Central

le Roux, Stanzi M; Cotton, Mark F; Golub, Jonathan E; le Roux, David M; Workman, Lesley; Zar, Heather J

2009-01-01

Background Tuberculosis contributes significantly to morbidity and mortality among HIV-infected children in sub-Saharan Africa. Isoniazid prophylaxis can reduce tuberculosis incidence in this population. However, for the treatment to be effective, adherence to the medication must be optimized. We investigated adherence to isoniazid prophylaxis administered daily, compared to three times a week, and predictors of adherence amongst HIV-infected children. Methods We investigated adherence to study medication in a two centre, randomized trial comparing daily to three times a week dosing of isoniazid. The study was conducted at two tertiary paediatric care centres in Cape Town, South Africa. Over a 5 year period, we followed 324 HIV-infected children aged ≥ 8 weeks. Adherence information based on pill counts was available for 276 children. Percentage adherence was calculated by counting the number of pills returned. Adherence ≥ 90% was considered to be optimal. Analysis was done using summary and repeated measures, comparing adherence to the two dosing schedules. Mean percentage adherence (per child during follow-up time) was used to compare the mean of each group as well as the proportion of children achieving an adherence of ≥ 90% in each group. For repeated measures, percentage adherence (per child per visit) was dichotomized at 90%. A logistic regression model with generalized estimating equations, to account for within-individual correlation, was used to evaluate the impact of the dosing schedule. Adjustments were made for potential confounders and we assessed potential baseline and time-varying adherence determinants. Results The overall adherence to isoniazid was excellent, with a mean adherence of 94.7% (95% confidence interval [CI] 93.5-95.9); similar mean adherence was achieved by the group taking daily medication (93.8%; 95% CI 92.1-95.6) and by the three times a week group (95.5%; 95% CI 93.8-97.2). Two-hundred and seventeen (78.6%) children achieved a

Personality and medication non-adherence among older adults enrolled in a six-year trial

PubMed Central

Jerant, Anthony; Chapman, Benjamin; Duberstein, Paul; Robbins, John; Franks, Peter

2011-01-01

Objectives Personality factors parsimoniously capture the variation in dispositional characteristics that affect behaviours, but their value in predicting medication non-adherence is unclear. We investigated the relationship between five-factor model personality factors (Conscientiousness, Neuroticism, Agreeableness, Extraversion, and Openness) and medication non-adherence among older participants during a six-year randomized placebo-controlled trial (RCT). Design Observational cohort data from 771 subjects aged ≥72 years enrolled in the Ginkgo Evaluation of Memory study, a RCT of Ginkgo biloba for prevention of dementia. Methods Random effects logistic regression analyses examined effects of NEO Five-Factor Inventory scores on medication non-adherence, determined via pill counts every 6 months (median follow-up 6.1 years) and defined as taking <80% of prescribed pills. Analyses adjusted for covariates linked with non-adherence in prior studies. Results Each 5 year increment in participant age was associated with a 6.7% greater probability of non-adherence (95% confidence interval, CI [2.4, 11.0]). Neuroticism was the only personality factor associated with non-adherence: a 1 SD increase was associated with a 3.8% increase in the probability of non-adherence (95% CI [0.4, 7.2]). Lower cognitive function was also associated with non-adherence: a 1 SD decrease in mental status exam score was associated with a 3.0% increase in the probability of non-adherence (95% CI [0.2, 5.9]). Conclusions Neuroticism was associated with medication non-adherence over 6 years of follow-up in a large sample of older RCT participants. Personality measurement in clinical and research settings might help to identify and guide interventions for older adults at risk for medication non-adherence. PMID:21226789

Adherence and Non-Adherence to Treatments: Focus on Pharmacy Practice in Nepal

PubMed Central

Bastakoti, Suresh; Khanal, Saval; Dahal, Bibek; Pun, Nirmala Tilija

2013-01-01

Nepal is one of the developing countries having many limitations in providing the quality health services to its population. In many countries, improvement in patients’ adherence to the pharmacotherapy had been one of major outcome of quality pharmaceutical services. Till date, very less thing has been done in this area in Nepal; so it seems mandatory to improve the patient adherence to the treatment plans. Adherence to the medical therapy can be explained by the extent of the behavioral coincidence to the medication and non-medication regimen by a patient whereas compliance and concordance are two different models of patient adherence to the therapy. Compliance model suggests that patients have been brought responsible for being unable to follow ‘doctor’s order and concordance tempts to measure the degree of agreement between patient and his or her clinician about the nature of illness and the best possible therapy for the welfare of the patient. Non-adherence to the therapy may lead to different problems as consequences of non-adherence in four different level- individual, institutional, societal and national levels. Although some programs like, “Direct Observation Treatment, Short-course (DOTS) for tuberculosis, implementation of antiretroviral treatment schedules for HIV patients and pediatric vaccination models,” are the examples of attention towards the cases of noncompliance in Nepal. It has long been faced its limitations in the forms of either untrained manpower or lack of good documentation of patients’ adherence to therapy or high illiteracy rate or unaffordibility of patients to their treatment or lack of pharmaceutical care services. PMID:23730670

Impact of decreasing copayments on medication adherence within a disease management environment.

PubMed

Chernew, Michael E; Shah, Mayur R; Wegh, Arnold; Rosenberg, Stephen N; Juster, Iver A; Rosen, Allison B; Sokol, Michael C; Yu-Isenberg, Kristina; Fendrick, A Mark

2008-01-01

This paper estimates the effects of a large employer's value-based insurance initiative designed to improve adherence to recommended treatment regimens. The intervention reduced copayments for five chronic medication classes in the context of a disease management (DM) program. Compared to a control employer that used the same DM program, adherence to medications in the value-based intervention increased for four of five medication classes, reducing nonadherence by 7-14 percent. The results demonstrate the potential for copayment reductions for highly valued services to increase medication adherence above the effects of existing DM programs.

Short-Term Effectiveness of a Mobile Phone App for Increasing Physical Activity and Adherence to the Mediterranean Diet in Primary Care: A Randomized Controlled Trial (EVIDENT II Study).

PubMed

Recio-Rodriguez, Jose I; Agudo-Conde, Cristina; Martin-Cantera, Carlos; González-Viejo, Mª Natividad; Fernandez-Alonso, Mª Del Carmen; Arietaleanizbeaskoa, Maria Soledad; Schmolling-Guinovart, Yolanda; Maderuelo-Fernandez, Jose-Angel; Rodriguez-Sanchez, Emiliano; Gomez-Marcos, Manuel A; Garcia-Ortiz, Luis

2016-12-19

The use of mobile phone apps for improving lifestyles has become generalized in the population, although little is still known about their effectiveness in improving health. We evaluate the effect of adding an app to standard counseling on increased physical activity (PA) and adherence to the Mediterranean diet, 3 months after implementation. A randomized, multicenter clinical trial was carried out. A total of 833 participants were recruited in six primary care centers in Spain through random sampling: 415 in the app+counseling group and 418 in the counseling only group. Counseling on PA and the Mediterranean diet was given to both groups. The app+counseling participants additionally received training in the use of an app designed to promote PA and the Mediterranean diet over a 3-month period. PA was measured with the 7-day Physical Activity Recall (PAR) questionnaire and an accelerometer; adherence to the Mediterranean diet was assessed using the Mediterranean Diet Adherence Screener questionnaire. Participants were predominantly female in both the app+counseling (249/415, 60.0%) and counseling only (268/418, 64.1%) groups, with a mean age of 51.4 (SD 12.1) and 52.3 (SD 12.0) years, respectively. Leisure-time moderate-to-vigorous physical activity (MVPA) by 7-day PAR increased in the app+counseling (mean 29, 95% CI 5-53 min/week; P=.02) but not in the counseling only group (mean 17.4, 95% CI -18 to 53 min/week; P=.38). No differences in increase of activity were found between the two groups. The accelerometer recorded a decrease in PA after 3 months in both groups: MVPA mean -55.3 (95% CI -75.8 to -34.9) min/week in app+counseling group and mean -30.1 (95% CI -51.8 to -8.4) min/week in counseling only group. Adherence to the Mediterranean diet increased in both groups (8.4% in app+counseling and 10.4% in counseling only group), with an increase in score of 0.42 and 0.53 points, respectively (P<.001), but no difference between groups (P=.86). Leisure-time MVPA

From assessment to improvement of elderly care in general practice using decision support to increase adherence to ACOVE quality indicators: study protocol for randomized control trial

PubMed Central

2014-01-01

Background Previous efforts such as Assessing Care of Vulnerable Elders (ACOVE) provide quality indicators for assessing the care of elderly patients, but thus far little has been done to leverage this knowledge to improve care for these patients. We describe a clinical decision support system to improve general practitioner (GP) adherence to ACOVE quality indicators and a protocol for investigating impact on GPs’ adherence to the rules. Design We propose two randomized controlled trials among a group of Dutch GP teams on adherence to ACOVE quality indicators. In both trials a clinical decision support system provides un-intrusive feedback appearing as a color-coded, dynamically updated, list of items needing attention. The first trial pertains to real-time automatically verifiable rules. The second trial concerns non-automatically verifiable rules (adherence cannot be established by the clinical decision support system itself, but the GPs report whether they will adhere to the rules). In both trials we will randomize teams of GPs caring for the same patients into two groups, A and B. For the automatically verifiable rules, group A GPs receive support only for a specific inter-related subset of rules, and group B GPs receive support only for the remainder of the rules. For non-automatically verifiable rules, group A GPs receive feedback framed as actions with positive consequences, and group B GPs receive feedback framed as inaction with negative consequences. GPs indicate whether they adhere to non-automatically verifiable rules. In both trials, the main outcome measure is mean adherence, automatically derived or self-reported, to the rules. Discussion We relied on active end-user involvement in selecting the rules to support, and on a model for providing feedback displayed as color-coded real-time messages concerning the patient visiting the GP at that time, without interrupting the GP’s workflow with pop-ups. While these aspects are believed to increase

Medication Adherence: WHO Cares?

PubMed Central

Brown, Marie T.; Bussell, Jennifer K.

2011-01-01

The treatment of chronic illnesses commonly includes the long-term use of pharmacotherapy. Although these medications are effective in combating disease, their full benefits are often not realized because approximately 50% of patients do not take their medications as prescribed. Factors contributing to poor medication adherence are myriad and include those that are related to patients (eg, suboptimal health literacy and lack of involvement in the treatment decision–making process), those that are related to physicians (eg, prescription of complex drug regimens, communication barriers, ineffective communication of information about adverse effects, and provision of care by multiple physicians), and those that are related to health care systems (eg, office visit time limitations, limited access to care, and lack of health information technology). Because barriers to medication adherence are complex and varied, solutions to improve adherence must be multifactorial. To assess general aspects of medication adherence using cardiovascular disease as an example, a MEDLINE-based literature search (January 1, 1990, through March 31, 2010) was conducted using the following search terms: cardiovascular disease, health literacy, medication adherence, and pharmacotherapy. Manual sorting of the 405 retrieved articles to exclude those that did not address cardiovascular disease, medication adherence, or health literacy in the abstract yielded 127 articles for review. Additional references were obtained from citations within the retrieved articles. This review surveys the findings of the identified articles and presents various strategies and resources for improving medication adherence. PMID:21389250

Increase in the Hydrophilicity and Lewis Acid-Base Properties of Solid Surfaces Achieved by Electric Gliding Discharge in Humid Air: Effects on Bacterial Adherence

NASA Astrophysics Data System (ADS)

Kamgang, J. O.; Naitali, M.; Herry, J.-M.; Bellon-Fontaine, M.-N.; Brisset, J.-L.; Briandet, R.

2009-04-01

This study addressed the effects of treatment with gliding discharge plasma on the surface properties of solid materials, as well as the consequences concerning adherence of a model bacterium. As evaluated by contact angles with selected liquids, plasma treatment caused an increase in surface hydrophilicity and in the Lewis acid-base components of the surface energy of all materials tested. These modifications were more marked for low density polyethylene and stainless steel than for polytetrafluoroethylene. After treatment, the hydrophilicity of the materials remained relatively stable for at least 20 days. Moreover, analysis of the topography of the materials by atomic force microscopy revealed that the roughness of both polymers was reduced by glidarc plasma treatment. As a result of all these modifications, solid substrates were activated towards micro-organisms and the adherence of S. epidermidis, a negatively charged Lewis-base and mildly hydrophilic strain selected as the model, was increased in almost all the cases tested.

Interventions targeting absences increase adherence and reduce abandonment of childhood cancer treatment in El Salvador.

PubMed

Salaverria, Carmen; Rossell, Nuria; Hernandez, Angelica; Fuentes Alabi, Soad; Vasquez, Roberto; Bonilla, Miguel; Lam, Catherine G; Ribeiro, Raul C

2015-09-01

In El Salvador, about 200 new cases of pediatric cancer are diagnosed each year, and survival rates approach 70%. Although treatment is available at no cost, abandonment of therapy has remained at a steady yearly rate of 13% during the past decade. A time sensitive adherence tracking procedure (TS-ATP) was recently implemented to detect missed appointments, identify their causes, and intervene promptly. Procedure The study team was informed daily of patient/family failure to attend medical appointments in the pediatric oncology unit; the families were contacted and interviewed to ascertain and address the reasons. Patients who did not return after this initial contact were contacted again through local health clinics and municipalities. Law enforcement was a last resort for patients undergoing frontline treatment with a good prognosis., The system was adapted to clinical urgency: families of patients undergoing induction therapy were contacted within 24 hr, those in other therapy phases, within 48 hr, and those who had completed treatment, within one week. Reasons for absence were obtained by telephone or in person. The annual rate of abandonment was reduced from 13-3% during the 2 years period. There were 1,111 absences reported and 1,472 contacts with caregivers and institutions. The three main reasons for absences were financial needs (165, 23%), unforeseen barriers (116, 16%), and domestic needs (86, 12%). Use of the treatment adherence tracking system to locate and communicate with patients/families after missed appointments and the allocated aid stemming from these interviews substantially reduced abandonment and non-adherence. © 2015 Wiley Periodicals, Inc.

INTERVENTIONS TARGETING ABSENCES INCREASE ADHERENCE AND REDUCE ABANDONMENT OF CHILDHOOD CANCER TREATMENT IN EL SALVADOR

PubMed Central

Salaverria, Carmen; Rossell, Nuria; Hernandez, Angelica; Alabi, Soad Fuentes; Vasquez, Roberto; Bonilla, Miguel; Lam, Catherine G.; Ribeiro, Raul C.

2015-01-01

Background In El Salvador, about 200 new cases of pediatric cancer are diagnosed each year, and survival rates approach 70%. Although treatment is available at no cost, abandonment of therapy has remained at a steady yearly rate of 13% during the past decade. A time sensitive adherence tracking procedure (TS-ATP) was recently implemented to detect missed appointments, identify their causes, and intervene promptly. Procedure The study team was informed daily of patient/family failure to attend medical appointments in the pediatric oncology unit; the families were contacted and interviewed to ascertain and address the reasons. Patients who did not return after this initial contact were contacted again through local health clinics and municipalities. Law enforcement was a last resort for patients undergoing frontline treatment with a good prognosis., The system was adapted to clinical urgency: families of patients undergoing induction therapy were contacted within 24 hours, those in other therapy phases, within 48 hours, and those who had completed treatment, within one week. Reasons for absence were obtained by telephone or in person. Results The annual rate of abandonment was reduced from 13% to 3% during the 2-year period. There were 1111 absences reported and 1472 contacts with caregivers and institutions. The three main reasons for absences were financial needs (165, 23%), unforeseen barriers (116, 16%), and domestic needs (86, 12%). Conclusions Use of the treatment adherence tracking system to locate and communicate with patients/families after missed appointments and the allocated aid stemming from these interviews substantially reduced abandonment and non-adherence. PMID:25925227

The influence of supervision on manual adherence and therapeutic processes.

PubMed

Anderson, Timothy; Crowley, Mary Ellen J; Patterson, Candace L; Heckman, Bernadette D

2012-09-01

To identify the effectiveness of psychotherapy supervision on therapists' immediate (next session) and long-term (1 year) adherence to time-limited dynamic psychotherapy (TLDP). Sixteen therapists from the Vanderbilt II psychotherapy project were assigned new cases in pretraining, training, and booster/posttraining year-long cohorts. Technical adherence to the manual, as well as general therapeutic relational processes, were rated for clinical supervisory sessions in which the third therapy session was discussed. The therapy sessions immediately before and after the supervisory sessions were also rated for technical adherence and relational processes. Postsupervision adherence increased from the presupervision session during the training cohort. In supervision, therapists' discussion of techniques and strategies from the manual in supervision was significantly related to technical adherence in the session prior to (but not after) supervision. However, supervisors' discussion of specific techniques predicted therapists' total technical adherence in the therapy session after (but not before) supervision. In terms of the type of techniques, supervisors' influenced postsupervision therapy adherence on TLDP's unique approach to formulation, the cyclical maladaptive pattern, but did not influence technical adherence on the therapeutic relationship. In supervision, therapists tend to focus on how they adhered to techniques from the previous session, whereas supervisors' comments about specific techniques predicted how the therapist would adhere to techniques in the next therapy session. The findings provide support for the immediate effects of supervision in shaping therapist techniques as well as highlighting the challenges of altering common relational processes through technical training. © 2012 Wiley Periodicals, Inc.

Reasons for non-adherence to the dapivirine vaginal ring: results of the MTN-032/ AHA study.

PubMed

Montgomery, Elizabeth T; Stadler, Jonathan; Naidoo, Sarita; Katz, Ariana; Laborde, Nicole; Garcia, Morgan; Reddy, Krishnaveni; Mansoor, Leila; Etima, Juliane; Zimba, Chifundo; Chitukuta, Miria; Soto-Torres, Lydia

2018-05-11

METHODS:: Former ASPIRE participants were stratified by age group (18-21; 22-45) and randomly selected at seven sites in Malawi, South Africa, Uganda and Zimbabwe, 12-17 months after trial exit. Using in-depth interviews or focus group discussions, ring use barriers were explored using structured guides and visual tools including individual-level depictions of dapivirine levels detected in plasma and returned rings. 187 were enrolled; 37% were 18-21 when they began ASPIRE. Most (75%) had drug-level results suggesting inconsistent ring use throughout ASPIRE. Participants viewed themselves as adherent, while simultaneously describing regular instances and reasons for ring removal (e.g. for sex or menses). Less adherent women reported fears that partners would oppose the ring or feel it during sex. High adherers expressed altruistic motivations for ring use. Women of all ages attributed young women's non-adherence to their tendency to be less "serious" about the future, HIV prevention and the study; motivated predominantly by benefits; more fearful of fertility-related consequences; and to having less relationship control. When presented with objective adherence data, participants provided reasons for intermittent ring use, while simultaneously portraying themselves as consistent ring users. Further research is needed to understand how women could use the ring in a way that fits into the context of their relationships and their lives while still conferring adequate HIV prophylaxis.

Mobile phone text messaging improves antihypertensive drug adherence in the community.

PubMed

Varleta, Paola; Acevedo, Mónica; Akel, Carlos; Salinas, Claudia; Navarrete, Carlos; García, Ana; Echegoyen, Carolina; Rodriguez, Daniel; Gramusset, Lissette; Leon, Sandra; Cofré, Pedro; Retamal, Raquel; Romero, Katerine

2017-12-01

Antihypertensive drug adherence (ADA) is a mainstay in blood pressure control. Education through mobile phone short message system (SMS) text messaging could improve ADA. The authors conducted a randomized study involving 314 patients with hypertension with <6 months of antihypertensive treatment from the Preventive Health Program of 12 different primary care centers in Santiago, Chile. Patients were randomly assigned to receive or not receive SMS related to ADA and healthy lifestyle. Adherence was assessed by the self-reported four-item scale Morisky-Green-Levine questionnaire at baseline and after 6 months of follow-up, with four of four positive questions classified as good adherence. Group comparison for adherence was performed by means of a logistic regression model, adjusting by baseline adherence, age older than 60 years, and sex. A total of 163 patients were randomized to receive and 151 to not receive SMS. After 6 months of follow-up, ADA in the non-SMS group decreased from 59.3% to 51.4% (P=.1). By contrast, adherence increased from 49% to 62.3% (P=.01) in the SMS group. Text messaging intervention improved ADA (risk ratio, 1.3; 95% confidence interval, 1.0-1.6 [P<.05]). At 6-month follow-up, text messaging resulted in an increase in reporting ADA in this hypertensive Latino population. This approach could become an effective tool to overcome poor medication adherence in the community. ©2017 Wiley Periodicals, Inc.

Non-adherence to antibiotic therapy in patients visiting community pharmacies.

PubMed

Fernandes, Milene; Leite, Andreia; Basto, Maria; Nobre, Miguel Araújo; Vieira, Nuno; Fernandes, Rui; Nogueira, Paulo; Nicola, Paulo Jorge; Jorge, Paulo

2014-02-01

Patient non-adherence to antibiotic therapy may lead to therapeutic failure, re-infection, and bacterial resistance. Assessing the factors associated with this problem is important for promoting rational use of antibiotics. This study aimed to measure prevalence and reasons for non-adherence to antibiotic treatment and to identify associated factors. Patients were recruited for the study in community pharmacies in Lisbon, Portugal, from February to April, 2009. Data from prescriptions for oral antibiotics were collected for adult subjects. Adherence to treatment was assessed with a modified Portuguese version of the Morisky scale. Factors associated with non-adherence were identified through bivariate analysis and logistic regression models. A total of 243 patients were included in the study. They had a mean age 46.5 ± 16.6 years and 74.5 % of the sample was female. The prevalence of non-adherence was 57.7 % and was related to delays and failures in taking the prescribed medicine. Increasing age (OR 0.97), difficulty in buying the antibiotic (OR 2.34), duration of treatment (OR 1.28), difficulty with ingestion (OR 3.08), and satisfaction with the information given by physician (OR 0.33) were identified as independent factors associated with non-adherence. Non-adherence to antibiotics is common in the community setting. Factors related to the antibiotic, the patient, and the patient-physician relationship should be addressed to promote adherence. Pharmacists should provide information to patients about correct use of antibiotics and address barriers to adherence.

Adherence as therapeutic citizenship: impact of the history of access to antiretroviral drugs on adherence to treatment.

PubMed

Nguyen, Vinh-Kim; Ako, Cyriaque Yapo; Niamba, Pascal; Sylla, Aliou; Tiendrébéogo, Issoufou

2007-10-01

A dramatic increase in the use of antiretroviral drugs in Africa has increased focus on adherence to treatment, which has so far been equivalent if not superior to that in northern contexts. The reasons for this exceptional adherence are poorly understood. In this paper, we examine adherence in the historical and ethnographic context of access to treatment in Burkina Faso, Côte d'Ivoire and Mali. Living where there is no social security and minimal, if any, medical care, individuals diagnosed with HIV are faced with the threat of illness, death, ostracism and destitution, and were obliged to negotiate conflicting networks of obligation, reciprocity, and value. HIV and AIDS programmes value efforts to address social, and indeed biological, vulnerability. In contrast, kinship-based social relationships may value individuals in other ways. These conflicting moral economies often intersect in the worlds of people living with HIV. HIV status can be used to claim resources from the public or non-governmental organization programmes. This may interfere with social networks that are the most stable source of material and emotional support. Self-help and empowerment techniques provided effective tools for people living with HIV to fashion themselves into effective advocates. In the early years of the use of antiretroviral therapy (ART), access to treatment was thus mediated by confessional practices and forms of social triage. We introduce the term 'therapeutic citizenship' to describe the way in which people living with HIV appropriate ART as a set of rights and responsibilities to negotiate these at times conflicting moral economies. Exemplary adherence should be viewed through the lens of therapeutic citizenship.

How does patient-provider communication influence adherence to asthma medications?

PubMed

Young, Henry N; Len-Rios, Maria E; Brown, Roger; Moreno, Megan M; Cox, Elizabeth

2017-04-01

To assess hypothesized pathways through which patient-provider communication impacts asthma medication adherence. A national sample of 452 adults with asthma reported assessments of patient-provider communication, proximal outcomes (understanding of asthma self-management, patient-provider agreement, trust in the clinician, involvement in care, motivation), and adherence to asthma medications. Structural equation modeling was used to examine hypothesized pathways. Significantly positive direct pathways were found between patient-provider communication and all proximal outcomes. Only positive indirect pathways, operating through trust and motivation, were found between patient-provider communication and medication adherence. Patient-provider communication influences many desirable proximal outcomes, but only influences adherence through trust and motivation. To promote better adherence to asthma medication regimens and, ultimately positive asthma outcomes, healthcare providers can focus on implementing communication strategies that strengthen patients' trust and increase patient motivation to use asthma medications. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Adherence to the Australian dietary guidelines during pregnancy: evidence from a national study.

PubMed

Malek, Lenka; Umberger, Wendy; Makrides, Maria; Zhou, Shao J

2016-05-01

To assess dietary intake of pregnant women against the Australian Dietary Guidelines with respect to the Five Food Group recommendations and determine predictors of adherence to the recommendations. Cross-sectional web-based survey. Data were analysed using descriptive statistics and logistic regression. Pregnant women living in Australia. A national sample was recruited using an online panel provider and a South Australian sample was recruited through the antenatal clinic of a large public maternity hospital. A total of 857 pregnant women. Fifty-six per cent, 29% and less than 10% of women met the recommendations for the fruit, dairy and other core food groups, respectively. None of the women met the recommendations for all Five Food Groups. Women who were born overseas and who were less physically active pre-pregnancy were less likely to adhere to the fruit and dairy recommendations. Women who smoked during pregnancy, were overweight pre-pregnancy and had lower household incomes were also less likely to meet the fruit recommendations; and women living in metropolitan areas were less likely to meet the vegetable recommendations. Sixty-one per cent believed their diet during this pregnancy was healthy. The majority of pregnant women in Australia perceive their diets to be healthy yet they do not consume the recommended daily servings from the Five Food Groups. Intervention strategies are warranted, particularly those that increase women's ability to evaluate their diet and also encourage positive dietary changes. These strategies may increase adoption of dietary guidelines and optimise pregnancy and other long-term health outcomes.

Reducing Time and Increasing Sensitivity in Sample Preparation for Adherent Mammalian Cell Metabolomics

PubMed Central

Lorenz, Matthew A.; Burant, Charles F.; Kennedy, Robert T.

2011-01-01

A simple, fast, and reproducible sample preparation procedure was developed for relative quantification of metabolites in adherent mammalian cells using the clonal β-cell line INS-1 as a model sample. The method was developed by evaluating the effect of different sample preparation procedures on high performance liquid chromatography- mass spectrometry quantification of 27 metabolites involved in glycolysis and the tricarboxylic acid cycle on a directed basis as well as for all detectable chromatographic features on an undirected basis. We demonstrate that a rapid water rinse step prior to quenching of metabolism reduces components that suppress electrospray ionization thereby increasing signal for 26 of 27 targeted metabolites and increasing total number of detected features from 237 to 452 with no detectable change of metabolite content. A novel quenching technique is employed which involves addition of liquid nitrogen directly to the culture dish and allows for samples to be stored at −80 °C for at least 7 d before extraction. Separation of quenching and extraction steps provides the benefit of increased experimental convenience and sample stability while maintaining metabolite content similar to techniques that employ simultaneous quenching and extraction with cold organic solvent. The extraction solvent 9:1 methanol: chloroform was found to provide superior performance over acetonitrile, ethanol, and methanol with respect to metabolite recovery and extract stability. Maximal recovery was achieved using a single rapid (~1 min) extraction step. The utility of this rapid preparation method (~5 min) was demonstrated through precise metabolite measurements (11% average relative standard deviation without internal standards) associated with step changes in glucose concentration that evoke insulin secretion in the clonal β-cell line INS-1. PMID:21456517

Adherence to national recommendations for safe methotrexate dispensing in community pharmacies.

PubMed

Koster, Ellen S; Walgers, Joelle C D; van Grinsven, Mariska C J; Winters, Nina A; Bouvy, Marcel L

2014-02-01

The number of patients using methotrexate (MTX) has increased during the last decade. Because of the narrow therapeutic range and potential risks of incorrect use, vigilance is required when dispensing MTX. In 2009, the Royal Dutch Pharmacists Society, in accordance with the Dutch Health Care Inspectorate, published safe MTX dispensing recommendations for community pharmacies. To examine adherence to recommendations aimed at safe 
MTX dispensing. This study was conducted within a convenience sample of 78 community pharmacies belonging to the Utrecht Pharmacy Practice Network for Education and Research (UPPER). Data were collected in May 2011. 95 pharmacists and 337 pharmacy technicians were interviewed to assess self-reported adherence with dispensing recommendations. In addition, medication records for patients using MTX were extracted in 52 pharmacies in order to objectively assess adoption of recommendations. More than 75% of the pharmacists and pharmacy technicians reported to be adherent to 6 of the 11 recommendations. There are variations in reported adherence between team members working in 1 pharmacy; higher adherence rates ( greater than 75%) for the pharmacy team as a whole were only shown for 2 recommendations (recording of day of intake on the label and moment of authorization by the pharmacist). The medication records showed that adherence with working procedures significantly increased: The number of dispensed records with notification of the day of intake on the medication label increased from 9.9% of the records per pharmacy in 2008 to 77.1% in 2010 (P  less than  0.001). Dutch community pharmacies seem to be adherent to most safe dispensing recommendations. However, inconsistencies exist between team members that emphasize the importance of addressing this issue and discussing recommendations within the team, as there is still room for improvement to ensure safe dispensing.

Patient communication tools to enhance ART adherence counseling in low and high resource settings.

PubMed

Finocchario-Kessler, Sarah; Catley, Delwyn; Thomson, Domonique; Bradley-Ewing, Andrea; Berkley-Patton, Jannette; Goggin, Kathy

2012-10-01

Few articles have examined specific counseling tools used to increase antiretroviral therapy (ART) adherence. We present communication tools used in the context of Project MOTIV8, a randomized clinical trial. We developed, piloted, and evaluated pictorial images to communicate the importance of consistent dose timing and the concept of drug resistance. Electronic drug monitoring (EDM) review was also used to provide visual feedback and facilitate problem solving discussions. Adherence knowledge of all participants (n=204) was assessed at baseline and 48 weeks. Participant satisfaction with counseling was also assessed. Adherence knowledge did not differ at baseline, however, at 48 weeks, intervention participants demonstrated significantly increased knowledge compared to controls F(1, 172)=10.76, p=0.001 (12.4% increase among intervention participants and 1.8% decrease among controls). Counselors reported that the tools were well-received, and 80% of participants felt the counseling helped them adhere to their medications. Counseling tools were both positively received and effective in increasing ART adherence knowledge among a diverse population. While developed for research, these counseling tools can be implemented into clinical practice to help patients; particularly those with lower levels of education or limited abstract thinking skills to understand medical concepts related to ART adherence. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Morbidly adherent placenta treatments and outcomes.

PubMed

Bailit, Jennifer L; Grobman, William A; Rice, Madeline Murguia; Reddy, Uma M; Wapner, Ronald J; Varner, Michael W; Leveno, Kenneth J; Iams, Jay D; Tita, Alan T N; Saade, George; Rouse, Dwight J; Blackwell, Sean C

2015-03-01

To describe recent maternal and neonatal delivery outcomes among women with a morbidly adherent placenta in major centers across the United States. This study reviewed a cohort of 115,502 women and their neonates born in 25 hospitals in the United States between March 2008 and February 2011 from the Assessment of Perinatal EXcellence data set. All cases of morbidly adherent placenta were identified. Maternal demographics, procedures undertaken, and maternal and neonatal outcomes were analyzed. There were 158 women with a morbidly adherent placenta (1/731 births, 95% confidence interval 1/632-866). Eighteen percent of women with a morbidly adherent placenta were nulliparous and 37% had no prior cesarean delivery. Only 53% (84/158) were suspected to have a morbidly adherent placenta before delivery. Women with a prenatally suspected morbidly adherent placenta experienced large blood loss (33%), hysterectomy (92%), and intensive care unit admission (39%) compared with 19%, 45%, and 22%, respectively, in those not suspected prenatally to have a morbidly adherent placenta (P<.05 for all). Eighteen percent of women with a morbidly adherent placenta were nulliparous. Half of the morbidly adherent placenta cases were suspected before delivery and outcomes were poorer in this group, probably because the more clinically significant morbidly adherent placentas are more likely to be suspected before delivery. : II.

Socioeconomic disadvantage and primary non-adherence with medication in Sweden.

PubMed

Wamala, Sarah; Merlo, Juan; Bostrom, Gunnel; Hogstedt, Christer; Agren, Gunner

2007-06-01

Lack of adherence with pharmacological therapy is a public health concern that compels tremendous costs for the health care system and the community. To analyse the association between socioeconomic disadvantage and primary non-adherence with medication, and to explore possible mediating effects of trust in health care and lifestyle profile. Cross-sectional population-based study based on data from the Swedish national public health surveys 2004-2005. The study comprised 13603 men and 18292 women aged 21-84 years who had any contact with a physician at a hospital or primary care centre. Measures Primary non-adherence with medication based on whether respondents reported that they refrained from purchasing at the pharmacy prescribed medication. Socioeconomic Disadvantage Index was based on four different indicators of economic deprivation. Socioeconomic disadvantage was associated with primary non-adherence with medication independent of long-term illness, risky lifestyle, low education, living alone and low trust for health care. This association increased with older age, particularly among women. Among individuals aged 21-34 years, severe compared with no socioeconomic disadvantage, was associated with two-fold increased odds for non-adherence with medication. The corresponding odds among individuals aged 65-84 years were three-fold increase among elderly men (OR=3.3, 95% CI: 1.4-7.8) and six-fold increase among elderly women (OR=6.2, 95% CI: 2.5-15.3). Yet every seventh elderly woman aged 65-84 years suffered from long-term illness. Results indicate that health policies for 'care on equal terms' in Sweden have been less successful in relation to equitable access to prescribed medication, especially among the elderly.

Effects of incentives for naltrexone adherence on opiate abstinence in heroin-dependent adults

PubMed Central

Jarvis, Brantley P.; Holtyn, August F.; DeFulio, Anthony; Dunn, Kelly E.; Everly, Jeffrey J.; Leoutsakos, Jeannie-Marie S.; Umbricht, Annie; Fingerhood, Michael; Bigelow, George E.; Silverman, Kenneth

2017-01-01

Aim To test whether an incentive-based intervention that increased adherence to naltrexone also increased opiate abstinence. Design Post-hoc combined analysis of three earlier randomized controlled trials that individually showed that incentives for adherence to oral and to extended-release injection naltrexone dosing schedules increased naltrexone adherence but not opiate abstinence. Setting Outpatient therapeutic workplace in Baltimore, MD, USA. Participants 140 unemployed heroin-dependent adults participating from 2006–2010. Interventions Participants were hired in a model workplace for 26 weeks and randomized to a Contingency (n=72) or Prescription (n=68) group. Both groups were offered naltrexone. Contingency participants were required to take scheduled doses of naltrexone in order to work and earn wages. Prescription participants could earn wages independent of naltrexone adherence. Measures Thrice-weekly and monthly urine samples tested for opiates and cocaine and measures of naltrexone adherence (percentage of monthly urine samples positive for naltrexone or percentage of scheduled injections received). All analyses included prerandomization attendance, opiate use, and cocaine use as covariates. Additional analyses controlled for cocaine use and naltrexone adherence during the intervention. Findings Contingency participants had more opiate abstinence than Prescription participants (68.1% vs. 52.9% opiate-negative thrice-weekly urine samples, respectively; and 71.9% vs. 61.7% opiate-negative monthly urine samples, respectively) based on initial analyses (thrice-weekly samples, OR = 3.3, 95% CI = 1.7–6.5, p < .01; monthly samples, OR = 2.6, 95% CI = 1.0–7.1, p = .06) and on analyses that controlled for cocaine use (thrice-weekly samples, OR = 3.9, 95% CI = 3.3–4.5, p < .01; monthly samples, OR = 3.4, 95% CI = 1.1–11.1, p =.04), which was high and associated with opiate use. The difference in opiate abstinence rates between Contingency participants

Optimizing adherence to antiretroviral therapy

PubMed Central

Sahay, Seema; Reddy, K. Srikanth; Dhayarkar, Sampada

2011-01-01

HIV has now become a manageable chronic disease. However, the treatment outcomes may get hampered by suboptimal adherence to ART. Adherence optimization is a concrete reality in the wake of ‘universal access’ and it is imperative to learn lessons from various studies and programmes. This review examines current literature on ART scale up, treatment outcomes of the large scale programmes and the role of adherence therein. Social, behavioural, biological and programme related factors arise in the context of ART adherence optimization. While emphasis is laid on adherence, retention of patients under the care umbrella emerges as a major challenge. An in-depth understanding of patients’ health seeking behaviour and health care delivery system may be useful in improving adherence and retention of patients in care continuum and programme. A theoretical framework to address the barriers and facilitators has been articulated to identify problematic areas in order to intervene with specific strategies. Empirically tested objective adherence measurement tools and approaches to assess adherence in clinical/ programme settings are required. Strengthening of ART programmes would include appropriate policies for manpower and task sharing, integrating traditional health sector, innovations in counselling and community support. Implications for the use of theoretical model to guide research, clinical practice, community involvement and policy as part of a human rights approach to HIV disease is suggested. PMID:22310817

Adherence to Selective Serotonin and Serotonin-Norepinephrine Reuptake Inhibitor Prescriptions Affects Overall Medication Adherence in Older Persons: Evidence From the Italian Nationwide OsMed Health-DB Database.

PubMed

Marengoni, Alessandra; Onder, Graziano; Degli Esposti, Luca; Russo, Pierluigi; Sangiorgi, Diego; Buda, Stefano; Fini, Massimo; Marchionni, Niccolò; Bonassi, Stefano; Mammarella, Federica; Marrocco, Walter; Pozzi, Giuseppe; Palmer, Katie; Monaco, Alessandro; Pecorelli, Sergio; Pani, Luca

2016-12-01

This study aimed to evaluate prevalence of prescription of and adherence to selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) and whether adherence to these classes of drugs affects overall medication adherence in older persons. In a cross-sectional analysis of administrative data comprehensive of all prescribed drugs reimbursed by the Italian national health care system, new prescriptions of SSRIs and SNRIs to persons aged 65 years or older were analyzed (n = 380,400 in 2011; 395,806 in 2012; 409,741 in 2013, from a total sample of 3,762,299 persons aged 65 years or older) as well as prescriptions of antihypertensives, statins, other psychiatric drugs, antidiabetics, antiplatelets, anticoagulants, drugs for chronic obstructive pulmonary disease, and antiosteoporotics. Adherence was estimated by calculating the proportion of days covered by drugs dispensed during a period of 365 days. Adherence was defined as a proportion of days covered of more than 80%. Prevalence of SSRI and SNRI prescriptions varied from 11.4% in 2011 to 12.1% in 2013. Adherence to SSRI and SNRI prescriptions ranged from 31.2% in persons aged ≥ 95 years in 2011 to 41.8% in persons aged 75-84 years in 2013. Persons adherent to SSRI and SNRI prescriptions were more likely to be adherent to the other medications, after adjustment for age, gender, and number of drugs prescribed. The highest association was found for adherence to psychiatric drugs (OR = 1.9; 95% CI, 1.8-2.0). Adherence to SSRI and SNRI prescriptions is poor in older persons. However, people adherent to these classes of antidepressants are more likely to be adherent to the other medications they are prescribed. Studies are needed to evaluate the reasons for and the potential benefits of increasing adherence to antidepressants on overall adherence. © Copyright 2016 Physicians Postgraduate Press, Inc.

'Home from home': risk perceptions, malaria and the use of chemoprophylaxis among UK South Asians.

PubMed

Joshi, Mary Sissons; Lalvani, Ajit

2010-08-01

Malaria is a serious disease hazard facing travellers to tropical countries. On average around 2000 cases of malaria are annually imported into the UK, with an over-representation of ethnic minority members. The current research examined adherence to chemoprophylaxis among UK South Asians travelling to malarial regions in South Asia and East Africa. Four hundred South Asians were interviewed with a questionnaire investigating use of malaria prophylaxis, knowledge of malaria, risk perceptions and reasons for inadequate or zero adherence to chemoprophylaxis. Two hundred interviews were conducted in 1994, and a further 200 interviews in 2004. Participants were recruited from areas of known ethnic density in Leicester, London and Oxford. In 1994, although 49% embarked on taking anti-malaria tablets, only 22% took tablets for 2 or more weeks upon return to the UK (and only 6% for the medically advisory period of 4 weeks). In 2004, 32% embarked on taking tablets but only 9% took tablets for 2 or more weeks upon returning to the UK (and only 2.5% for 4 weeks). Good adherence was associated with greater knowledge about the symptoms and transmission of malaria, and being more likely to define the trip as a 'holiday' rather than as a visit to 'family and friends'. Zero adherence was associated with a failure to recognise the potential severity and critical nature of malaria. Common reasons for partial and zero adherence were the perception that the personal risk of getting malaria was low and an erroneous belief in immunity. The specific cognitions available to ethnic minority members travelling 'home' contribute to a very low use of chemoprophylaxis, thus placing them at a heightened risk of acquiring malaria. Health messages need to stress that malaria is a serious health hazard and that emigres visiting malarial regions cannot rely on personal immunity.

Retrospective cohort study of the South Tyneside Exercise Referral Scheme 2009-14: predictors of dropout and barriers to adherence.

PubMed

Kelly, Michael C; Rae, Glen C; Walker, Diane; Partington, Sarah; Dodd-Reynolds, Caroline J; Caplan, Nick

2017-12-01

Exercise Referral Schemes (ERS) are a prevalent method of increasing physical activity levels. However, they suffer from participant dropout and research predicting dropout or barriers to adherence are limited. This study aimed to focus upon the effect of referral characteristics on dropout, dropout predictors and whether self-reported barriers to exercise predict dropout. ERS data from 2009 to 2014 were retrieved for analysis. Chi-squared and t-tests were used to investigate differences between referral characteristics, and logistic regression used to investigate dropout predictors. Of 6894 participants, 37.8% (n = 2608) dropped out within 6 weeks and 50.03% (n = 3449) by the final 12th week. More males adhered (P < 0.001) with dropouts being significantly younger (P < 0.001). Dropout predictors were smoking (OR = 1.58, 95% CI: 1.29-1.93) or being a Tier 3 referral (OR = 1.47, 95% CI: 1.25-1.73). Increasing age (OR = 0.98, 95% CI: 0.98-0.99), drinking alcohol (OR = 0.82, 95% CI: 0.71-0.95), secondary care referrals (OR = 0.68, 95% CI: 0.52-0.90), having a lack of motivation (OR = 0.81, 95% CI: 0.69-0.95) or a lack of childcare (OR = 0.69, 95% CI: 0.50-0.95) decreased the likelihood of dropout. ERS dropout continues to be problematic. Smoking and having moderate-high comorbidities predicted dropout. Increasing age and patient-reported barriers of a lack of time or childcare decreased dropout risk. The reasons for dropout require further investigation. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Evidence-based Assessment of Adherence to Medical Treatments in Pediatric Psychology

PubMed Central

Modi, Avani C.; Lemanek, Kathleen L.; Ievers-Landis, Carolyn E.; Rapoff, Michael A.

2008-01-01

Objectives Adherence to medical regimens for children and adolescents with chronic conditions is generally below 50% and is considered the single, greatest cause of treatment failure. As the prevalence of chronic illnesses in pediatric populations increases and awareness of the negative consequences of poor adherence become clearer, the need for reliable and valid measures of adherence has grown. Methods This review evaluated empirical evidence for 18 measures utilizing three assessment methods: (a) self-report or structured interviews, (b) daily diary methods, and (c) electronic monitors. Results Ten measures met the “well-established” evidence-based (EBA) criteria. Conclusions Several recommendations for improving adherence assessment were made. In particular, consideration should be given to the use of innovative technologies that provide a window into the “real time” behaviors of patients and families. Providing written treatment plans, identifying barriers to good adherence, and examining racial and ethnic differences in attitudes, beliefs and behaviors affecting adherence were strongly recommended. PMID:17846042

Sticker charts: a method for improving adherence to treatment of chronic diseases in children.

PubMed

Luersen, Kara; Davis, Scott A; Kaplan, Sebastian G; Abel, Troy D; Winchester, Woodrow W; Feldman, Steven R

2012-01-01

Poor adherence is a common problem and may be an underlying cause of poor clinical outcomes. In pediatric populations, positive reinforcement techniques such as sticker charts may increase motivation to adhere to treatment regimens. To review the use of sticker charts to improve adherence in children with chronic disease, Medline and PsycINFO searches were conducted using the key words "positive reinforcement OR behavior therapy" and "adherence OR patient compliance" and "child." Randomized controlled retrospective cohort or single-subject-design studies were selected. Studies reporting adherence to the medical treatment of chronic disease in children using positive reinforcement techniques were included in the analysis. The systematic search was supplemented by identifying additional studies identified through the reference lists and authors of the initial articles found. Positive reinforcement techniques such as sticker charts increase adherence to medical treatment regimens. In several studies, this effect was maintained for months after the initial intervention. Better adherence correlated with better clinical outcomes in some, but not all, studies. Few studies examining the use of sticker charts were identified. Although single-subject-design studies are useful in establishing the effect of a behavioral intervention, larger randomized controlled trials would help determine the precise efficacy of sticker chart interventions. Adherence to medical treatments in children can be increased using sticker charts or other positive reinforcement techniques. This may be an effective means to encourage children with atopic dermatitis to apply their medications and improve clinical outcomes. © 2012 Wiley Periodicals, Inc.

Adherence of oral streptococci to nanostructured titanium surfaces.

PubMed

Narendrakumar, Krunal; Kulkarni, Mukta; Addison, Owen; Mazare, Anca; Junkar, Ita; Schmuki, Patrik; Sammons, Rachel; Iglič, Aleš

2015-12-01

Peri-implantitis and peri-mucositis pose a severe threat to the success of dental implants. Current research focuses on the development of surfaces that inhibit biofilm formation while not inferring with tissue integration. This study compared the adherence of two oral bacterial species, Streptococcus sanguinis and Streptococcus mutans to nanostructured titanium surfaces. The samples included TiO2 nanotubes formed by anodization of titanium foil of 100, 50 and 15nm diameter (NT15, NT50, NT100), a nanoporous (15nm pore diameter) surface and compact TiO2 control. Adherent surviving bacteria were enumerated after 1h in an artificial saliva medium containing bovine mucin. Lowest numbers of adherent bacteria of both species were recovered from the original titanium foil and nanoporous surface and highest numbers from the Ti100 nanotubes. Numbers of attached S. sanguinis increased in the order (NT15increasing percentage of surface fluoride. The lowest adhesion of S. sanguinis and S. mutans on TiO2 nanostructured surfaces was observed for small diameter nanoporous surfaces which coincides with the highest osteoblast adhesion on small diameter nanotubular/nanoporous surfaces shown in previous work. This study indicates that the adherence of oral streptococci can be modified by titanium anodization and nanotube diameter. Copyright © 2015 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Non-adherence in patients on peritoneal dialysis: a systematic review.

PubMed

Griva, Konstadina; Lai, Alden Yuanhong; Lim, Haikel Asyraf; Yu, Zhenli; Foo, Marjorie Wai Yin; Newman, Stanton P

2014-01-01

It has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD) therapy. There is therefore a need to establish the levels of non-adherence to different aspects of the PD regimen (dialysis procedures, medications, and dietary/fluid restrictions). A systematic review of peer-reviewed literature was performed in PubMed, PsycINFO and CINAHL databases using PRISMA guidelines in May 2013. Publications on non-adherence in PD were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Relevant data on patient characteristics, measures, rates and factors associated with non-adherence were extracted. The quality of studies was also evaluated independently by two reviewers according to a revised version of the Effective Public Health Practice Project assessment tool. The search retrieved 204 studies, of which a total of 25 studies met inclusion criteria. Reported rates of non-adherence varied across studies: 2.6-53% for dialysis exchanges, 3.9-85% for medication, and 14.4-67% for diet/fluid restrictions. Methodological differences in measurement and definition of non-adherence underlie the observed variation. Factors associated with non-adherence that showed a degree of consistency were mostly socio-demographical, such as age, employment status, ethnicity, sex, and time period on PD treatment. Non-adherence to different dimensions of the dialysis regimen appears to be prevalent in PD patients. There is a need for further, high-quality research to explore these factors in more detail, with the aim of informing intervention designs to facilitate adherence in this patient population.

Impact of statin adherence on cardiovascular disease and mortality outcomes: a systematic review

PubMed Central

De Vera, Mary A; Bhole, Vidula; Burns, Lindsay C; Lacaille, Diane

2014-01-01

Aims While suboptimal adherence to statin medication has been quantified in real-world patient settings, a better understanding of its impact is needed, particularly with respect to distinct problems of medication taking. Our aim was to synthesize current evidence on the impacts of statin adherence, discontinuation and persistence on cardiovascular disease and mortality outcomes. Methods We conducted a systematic review of peer-reviewed studies using a mapped search of Medline, Embase and International Pharmaceutical Abstracts databases. Observational studies that met the following criteria were included: defined patient population; statin adherence exposure; defined study outcome [i.e. cardiovascular disease (CVD), mortality]; and reporting of statin-specific results. Results Overall, 28 studies were included, with 19 studies evaluating outcomes associated with statin adherence, six with statin discontinuation and three with statin persistence. Among adherence studies, the proportion of days covered was the most widely used measure, with the majority of studies reporting increased risk of CVD (statistically significant risk estimates ranging from 1.22 to 5.26) and mortality (statistically significant risk estimates ranging from 1.25 to 2.54) among non-adherent individuals. There was greater methodological variability in discontinuation and persistence studies. However, findings of increased CVD (statistically significant risk estimates ranging from 1.22 to 1.67) and mortality (statistically significant risk estimates ranging from 1.79 to 5.00) among nonpersistent individuals were also consistently reported. Conclusions Observational studies consistently report an increased risk of adverse outcomes associated with poor statin adherence. These findings have important implications for patients and physicians and emphasize the importance of monitoring and encouraging adherence to statin therapy. PMID:25364801

Increased cardiovascular risk in South African patients with Addison's disease.

PubMed

Ross, I L; Bergthorsdottir, R; Levitt, N S; Schatz, D A; Johannsson, G; Marais, A D

2013-11-01

Patients with Addison's disease (AD) are believed to be at risk for cardiovascular disease (CVD). South Africa, like the rest of the developing world is experiencing an increase in CVD and patients with AD may be at double the risk of their peers. We wished to explore AD patients' CVD risk factors. A cross-sectional nationwide study in South Africa of patients with AD was conducted. A cohort of 147 patients with AD and 147 healthy control subjects were matched by age, gender, ethnicity, and BMI as far as was possible. Lipoproteins and highly-sensitive C-reactive-protein (hs-CRP) were the main outcome measures. AD patients had significantly higher triglycerides; (p=0.001), lower HDLC (p<0.001), higher hs-CRP (p<0.001), and more small dense LDL; (p=0.002) than controls. Nonesterified fatty acids were lower in patients (p<0.001). Approximately 65% [95% confidence interval (CI 55.6-72.4%)] had hypercholesterolaemia, 75% (CI 64.8-81.2%) had low HDLC, and 75% (CI 68.0-84.1%) had a higher LDLC. Thirteen percent of AD patients had diabetes mellitus, but none of the risk factors differed from the nondiabetics. Only HDLC correlated positively with daily hydrocortisone dose (r=0.32; p=0.005). In conclusion dyslipidaemia is common in South African AD patients; CVD risk assessment and intervention are probably warranted in the management of these patients. © Georg Thieme Verlag KG Stuttgart · New York.

Impact of a web-based intervention on the awareness of medication adherence.

PubMed

Gupta, Vasudha; Hincapie, Ana L; Frausto, Sonya; Bhutada, Nilesh S

Medication nonadherence is a widely recognized problem that leads to adverse outcomes and increased health care costs. Reasons for medication nonadherence are multifactorial, and patient awareness of the salience of medication adherence is critical. The purpose of this research was to assess the impact of a pharmacist-led, web-based video presentation in increasing patients' awareness of the importance of medication adherence. Patients aged 35 years and above, taking at least 1 chronic prescription medication were included in the study (n = 166). Patients completed a pre-survey, watched a pharmacist-led web-based video presentation educating them on the importance of medication adherence, then completed a 1-month follow-up survey. The primary outcome was measurement of change in patients' awareness of the importance of medication adherence. Results indicated a statistically significant increase in the primary outcome of increasing awareness of the importance of medication adherence. More patients in the follow-up survey indicated that it was important for their health to take their medications around the same time daily (P = 0.002), and more patients identified that their family will be impacted as a result of their medication nonadherence (P = 0.001) as compared to the pre-survey. More patients in the follow-up survey reported that they expected to experience fewer emergency room visits (P = 0.0001) and anticipated that they would get more time to spend with friends and family (P = 0.0039) as benefits of taking medications as prescribed. A pharmacist-led web-based video presentation may be a low-cost intervention to increase patients' awareness of the importance of medication adherence. Copyright © 2015 Elsevier Inc. All rights reserved.

Electronic medication packaging devices and medication adherence: a systematic review.

PubMed

Checchi, Kyle D; Huybrechts, Krista F; Avorn, Jerry; Kesselheim, Aaron S

2014-09-24

Medication nonadherence, which has been estimated to affect 28% to 31% of US patients with hypertension, hyperlipidemia, and diabetes, may be improved by electronic medication packaging (EMP) devices (adherence-monitoring devices incorporated into the packaging of a prescription medication). To investigate whether EMP devices are associated with improved adherence and to identify and describe common features of EMP devices. Systematic review of peer-reviewed studies testing the effectiveness of EMP systems in the MEDLINE, EMBASE, PsycINFO, CINAHL, International Pharmaceutical Abstracts, and Sociological Abstracts databases from searches conducted to June 13, 2014, with extraction of associations between the interventions and adherence, as well as other key findings. Each study was assessed for bias using the Cochrane Handbook for Systematic Reviews of Interventions; features of EMP devices and interventions were qualitatively assessed. Thirty-seven studies (32 randomized and 5 nonrandomized) including 4326 patients met inclusion criteria (10 patient interface-only "simple" interventions and 29 "complex" interventions integrated into the health care system [2 qualified for both categories]). Overall, the effect estimates for differences in mean adherence ranged from a decrease of 2.9% to an increase of 34.0%, and the those for differences in the proportion of patients defined as adherent ranged from a decrease of 8.0% to an increase of 49.5%. We identified 5 common EMP characteristics: recorded dosing events and stored records of adherence, audiovisual reminders to cue dosing, digital displays, real-time monitoring, and feedback on adherence performance. Many varieties of EMP devices exist. However, data supporting their use are limited, with variability in the quality of studies testing EMP devices. Devices integrated into the care delivery system and designed to record dosing events are most frequently associated with improved adherence, compared with other

Not at All Effective: Differences in Views on the Causes of Prescription Non-adherence Between North Korean Defectors and Medical Providers in South Korea.

PubMed

Hong, Soo Jung

2015-06-01

By focusing on North Korean defectors' medical experiences in South Korea and their medical providers' experiences treating the defectors, this article considers the differences between the views of these two groups in regard to the causes of prescription non-adherence. The results suggest that (a) whereas the defectors tended to see their symptoms as being physical in nature, the medical providers often ascribed symptoms to psychological/socio-cultural influence; (b) whereas the defectors tended to trust in their ability to self-diagnose and in their belief systems established in North Korea, the medical providers tended not to place trust in these aspects; (c) whereas the defectors tended to view the available medical treatment as inappropriate for them, the medical providers often noted the presence of tolerant bacterial strains as causes of treatment failure; and (d) whereas the defectors felt that the treatment they received was slow and ineffective and attributed this to capitalism, the medical providers felt that the defectors failed to understand the concept of staged treatments. Based on the findings, some solutions are suggested to address the complex issue of North Korean defectors' prescription non-adherence in terms of subjective/objective health assessments and patient-centered care. North Korean defectors' established health beliefs/lack of medical knowledge based on their previous medical and cultural experiences gave rise to beliefs and practices associated with medicine that differ significantly from those of the health providers and that have the potential to severely compromise the defectors' health. Therefore, therapy negotiation and appropriate education are suggested as possible solutions, and as an agenda, the notion of civic friendship is addressed. Implications for medical practice, prevention, and intervention are also discussed.

Optimal recall period in assessing the adherence to antihypertensive therapy: a pilot study.

PubMed

Doró, Péter; Benko, Ria; Czakó, Anikó; Matuz, Mária; Thurzó, Ferenc; Soós, Gyöngyvér

2011-08-01

To evaluate the validity of patient self-reported adherence, and to find the optimal length of recall period which best reflects the long-term adherence pattern of the patient. Patients were recruited from a general practitioner's practice in a Hungarian town. In this prospective study 30 patients, who had already been on antihypertensive treatment, were involved. The study was designed to monitor one antihypertensive medication per patient for 3 months. Patients received a 3-month supply of one antihypertensive medication in an electronic Medication Event Monitoring System (MEMS). At the end of the study period patients completed a structured questionnaire regarding their medication taking behavior during the last 7, 14 and 30 days. The results measured with MEMS were considered as the reference value, and other measures were compared using the Bland-Altman method. Self-reported adherence, length of recall period, taking adherence and timing adherence measured by MEMS. Of the 30 patients included, 29 patients (13 males and 16 females) completed the study. The mean age of the patients was 60.6 years, ranging between 36 and 86 years. Patients were monitored for an average of 89 days (ranging between 49 and 106 days). Fifteen patients were on once daily, 9 patients were on twice daily, and 5 patients were on 3 times daily dosing schedule. The total expected number of medication taking events was 4,281. The MEMS caps recorded a total of 4,071 openings, which showed only a 3.56% deviation from the pill counts of the remaining tablets. The overall taking adherence was 95.1%, timing adherence was 75.2%. Patients' adherence report using a visual analog scale and reporting the number of missed doses became more accurate as the length of the recall period increased. Increased number of chronically taken medications was associated with better adherence. Increased dosing frequency of the observed antihypertensive medication resulted in decreased adherence. The results showed

A cluster randomized trial to determine the effectiveness of a novel, digital pendant and voice reminder platform on increasing infant immunization adherence in rural Udaipur, India.

PubMed

Nagar, Ruchit; Venkat, Preethi; Stone, Logan D; Engel, Kyle A; Sadda, Praneeth; Shahnawaz, Mohammed

2017-11-18

Five hundred thousand children under the age of 5 die from vaccine preventable diseases in India every year. More than just improving coverage, increasing timeliness of immunizations is critical to ensuring infant health in the first year of life. Novel, culturally appropriate community engagement strategies are worth exploring to close the immunization gap. In our study, a digital NFC (Near Field Communication) pendant worn on black thread and voice call reminder system was tested for the effectiveness in improving DTP3 adherence within 2 monthly camps from DTP1 administration. A cluster randomized controlled trial was conducted in which 96 village health camps were randomized to 3 arms: NFC sticker, NFC pendant, and NFC pendant with voice call reminder in local dialect. Randomization was done across 5 blocks in the Udaipur District serviced by Seva Mandir from August 2015 to April 2016. In terms of our three primary outcomes related to DTP3 adherence, point estimates show conflicting results. Two outcomes presented adherence in the control. DTP3 completion within two camps after DTP1 showed higher adherence in the Control (Sticker) (74.2%) arm compared to the Pendant (67.2%) and Pendant and Voice arms (69.3%). Likewise, the estimate for DTP3 completion within 180 days of birth in the Control (Sticker) (69.4%) arm was higher than estimates in the Pendant (57.4%) and Pendant and Voice arms (58.7%). However, one outcome displayed higher adherence in the intervention. DTP3 completion within two months from the time of registration was higher in the Pendant (37.7%) and Pendant and Voice arms (38.7%) compared to the Control (Sticker) arm (27.4%). In all primary outcomes, differences in adherence were statistically insignificant both before and after controlling for confounding factors. In terms of secondary outcomes, our results suggest that providing a necklace generated significant community discussion (H = 8.8796, df = 2, p = .0118), had strong

Adherence to Antiretroviral Therapy (ART) in Yaoundé-Cameroon: Association with Opportunistic Infections, Depression, ART Regimen and Side Effects

PubMed Central

Fonsah, Julius Y.; Njamnshi, Alfred K.; Kouanfack, Charles; Qiu, Fang; Njamnshi, Dora M.; Tagny, Claude T.; Nchindap, Emilienne; Kenmogne, Léopoldine; Mbanya, Dora; Heaton, Robert; Kanmogne, Georgette D.

2017-01-01

Following global efforts to increase antiretroviral therapy (ART) access in Sub-Saharan Africa, ART coverage among HIV-infected Cameroonians increased from 0% in 2003 to 22% in 2014. However, the success of current HIV treatment programs depends not only on access to ART, but also on retention in care and good treatment adherence. This is necessary to achieve viral suppression, prevent virologic failure, and reduce viral transmission and HIV/AIDS-related deaths. Previous studies in Cameroon showed poor adherence, treatment interruption, and loss to follow-up among HIV+ subjects on ART, but the factors that influence ART adherence are not well known. In the current cross-sectional study, patient/self-reported questionnaires and pharmacy medication refill data were used to quantify ART adherence and determine the factors associated with increased risk of non-adherence among HIV-infected Cameroonians. We demonstrated that drug side-effects, low CD4 cell counts and higher viral loads are associated with increased risk of non-adherence, and compared to females, males were more likely to forego ART because of side effects (p<0.05). Univariate logistic regression analysis demonstrated that subjects with opportunistic infections (on antibiotics) had 2.42-times higher odds of having been non-adherent (p<0.001). Multivariable analysis controlling for ART regimen, age, gender, and education showed that subjects with opportunistic infections had 3.1-times higher odds of having been non-adherent (p<0.0003), with significantly longer periods of non-adherence, compared to subjects without opportunistic infections (p = 0.02). We further showed that compared to younger subjects (≤40 years), older subjects (>40 years) were less likely to be non-adherent (p<0.01) and had shorter non-adherent periods (p<0.0001). The presence of depression symptoms correlated with non-adherence to ART during antibiotic treatment (r = 0.53, p = 0.04), and was associated with lower CD4 cell counts (p

Increasing Employability by Implementing a Work-Integrated Learning Partnership Model in South Africa--A Student Perspective

ERIC Educational Resources Information Center

Taylor, Susanne; Govender, Cookie M.

2017-01-01

In South Africa, 70 per cent of the population is under 35 years old. South Africa has a vision to increase youth employment by focusing on education, training and skills development that will promote employment opportunities. A work-integrated learning (WIL) partnership model was developed to provide students with work experience and to increase…

Using the theory of planned behavior to improve treatment adherence in Mexican Americans with schizophrenia.

PubMed

Kopelowicz, Alex; Zarate, Roberto; Wallace, Charles J; Liberman, Robert Paul; Lopez, Steven R; Mintz, Jim

2015-10-01

Failure to adhere to treatment with antipsychotic medication is the most common cause of relapse among patients with schizophrenia. A novel multifamily group (MFG) intervention, informed by the Theory of Planned Behavior (TPB), demonstrated efficacy in increasing medication adherence and decreasing rehospitalizations in schizophrenia patients. This report explores the hypothesis that the improved outcomes obtained through the MFG approach were mediated by changes in the patients' attitudes toward medications, subjective norms-social influences, and perceived behavioral control of resources. Data from a recently completed, randomized controlled trial of MFG was used to test the hypothesis that the improvement in adherence was mediated by the 3 TPB factors. Subjects were 174 Mexican American adults with schizophrenia-spectrum disorder who had participated in a study of MFG focused on improving medication adherence. Assessments occurred at baseline and at 4, 8, 12, 18, and 24 months. Path analysis revealed that the increased adherence associated with MFG was mediated by improvements in subjective norms but not attitudes toward medications nor perceived behavioral control. An MFG treatment specifically tailored to increase medication adherence among Mexican Americans with schizophrenia achieved its benefits by leveraging social influences through teaching family members how to support medication adherence in their ill relatives. (c) 2015 APA, all rights reserved).

Using the Theory of Planned Behavior to Improve Treatment Adherence in Mexican Americans with Schizophrenia

PubMed Central

Kopelowicz, Alex; Zarate, Roberto; Wallace, Charles J.; Liberman, Robert Paul; Lopez, Steven R.; Mintz, Jim

2015-01-01

Objective Failure to adhere to treatment with antipsychotic medication is the most common cause of relapse among patients with schizophrenia. A novel multi-family group (MFG) intervention, informed by the Theory of Planned Behavior (TPB), demonstrated efficacy in increasing medication adherence and decreasing re-hospitalizations in schizophrenia patients. This report explores the hypothesis that the improved outcomes obtained through the MFG approach were mediated by changes in the patients’ attitudes towards medications, subjective norms-social influences, and perceived behavioral control of resources. Method Data from a recently completed, randomized controlled trial of MFG was used to test the hypothesis that the improvement in adherence was mediated by the three TPB factors. Subjects were 174 Mexican American adults with schizophrenia-spectrum disorder who had participated in a study of MFG focused on improving medication adherence. Assessments occurred at baseline and at 4, 8, 12, 18 and 24 months. Results Path analysis revealed that the increased adherence associated with MFG was mediated by improvements in subjective norms but not attitudes towards medications nor perceived behavioral control. Conclusion An MFG treatment specifically tailored to increase medication adherence among Mexican Americans with schizophrenia achieved its benefits by leveraging social influences through teaching family members how to support medication adherence in their ill relatives. PMID:26030760

Examining adherence to components of cognitive-behavioral therapy for youth anxiety after training and consultation.

PubMed

Edmunds, Julie M; Brodman, Douglas M; Ringle, Vanesa A; Read, Kendra L; Kendall, Philip C; Beidas, Rinad S

2017-02-01

The present study examined 115 service providers' adherence to components of cognitive-behavioral therapy (CBT) for youth anxiety prior to training, post workshop training, and after three months of weekly consultation. Adherence was measured using a role-play with a trained actor. We examined differences in individual adherence to CBT components across time and the relationship between number of consultation sessions attended and adherence ratings following consultation. Findings indicated that somatic arousal identification and relaxation were the most used treatment components prior to training. Adherence to all components of CBT increased following workshop training, except the usage of problem-solving. Adherence to problem-solving, positive reinforcement, the identification of anxious self-talk, and the creation of coping thoughts increased following consultation but usage of problem-solving remained low compared to other treatment components. Overall adherence remained less than optimal at the final measurement point. Number of consultation sessions attended predicted post-consultation adherence to identification of somatic arousal, identification of anxious self-talk, and positive reinforcement. Implications include tailoring future training based on baseline levels of adherence and spending more time during training and consultation on underutilized CBT components, such as problem-solving. Limitations of the present study, including how adherence was measured, are discussed. This study adds to the implementation science literature by providing more nuanced information on changes in adherence over the course of training and consultation of service providers.

Relations between cognitive status and medication adherence in patients treated for memory disorders

PubMed Central

Ownby, Raymond L.; Hertzog, Christopher; Czaja, Sara J.

2012-01-01

Medication adherence has been increasingly recognized as an important factor in elderly persons' health. Various studies have shown that medication non-adherence is associated with poor health status in this population. As part of a study of the effects of two interventions to promote medication adherence in patients treated for memory problems, information on medication adherence and cognitive status was collected at 3-month intervals. Twenty-seven participants (16 men, 11 women, age 71–92 years) were assigned to control or treatment conditions and adherence was evaluated with an electronic monitoring device. Cognitive status was evaluated at 3-month intervals beginning in April of 2003 and continuing through September of 2006. We have previously reported on the effectiveness of these interventions to promote adherence. In this paper, we examine the relations of cognitive status and adherence over time using a partial least squares path model in order to evaluate the extent to which adherence to cholinesterase medications was related to cognitive status. Adherence predicted cognitive status at later time points while cognition did not, in general, predict adherence. Results thus suggest that interventions to ensure high levels of medication adherence may be important for maintaining cognitive function in affected elderly people. PMID:24575293

Whoonga: potential recreational use of HIV antiretroviral medication in South Africa.

PubMed

Grelotti, David J; Closson, Elizabeth F; Smit, Jennifer A; Mabude, Zonke; Matthews, Lynn T; Safren, Steven A; Bangsberg, David R; Mimiaga, Matthew J

2014-03-01

Whoonga is a drug cocktail in South Africa rumored to contain illicit drugs and HIV antiretroviral (ARV) medication. Although its use may adversely impact adherence to HIV treatment and may have the potential to generate ARV resistance, there is a paucity of research characterizing whoonga. We learned of whoonga during semi-structured interviews about substance abuse and HIV risk at "club-events" known as inkwaris in an urban township of Durban, South Africa. Whoonga was an emerging theme spontaneously identified as a problem for the community by 17 out of 22 informants. Perceptions of whoonga suggest that it is highly addictive, contains ARVs (notably efavirenz), is used by individuals as young as 14, and poses a threat to the health and safety of those who use it, including increasing the risk of HIV infection. Our informants provide preliminary evidence of the dangers of whoonga and reinforce the need for further study.

Adherence and outcomes: a systematic review of palivizumab utilization.

PubMed

Wong, Sophie K; Li, Abby; Lanctôt, Krista L; Paes, Bosco

2018-01-01

Palivizumab is a humanized monoclonal antibody used for respiratory syncytial virus (RSV) prophylaxis. RSV is the primary cause of lower respiratory tract infection in children aged <2 years, and can give rise to high-burden hospitalization and respiratory complications in later life. Adherence to a monthly dosing regimen, both in timing and injection number, is essential to sustain therapeutic levels of palivizumab and maintain protective status. Deviation from the approved dosing schedule may reduce the efficacy of palivizumab and increase the risk of breakthrough RSV infection and hospitalization. Areas covered: There is no standardized definition of adherence to palivizumab treatment. This review addresses the wide variability in defining and reporting adherence to palivizumab prophylaxis across different studies. The review assesses whether a relationship exists in the outcomes reported in studies relative to the monthly adherence protocol as defined in published randomized controlled trials of the efficacy and safety of palivizumab. Expert commentary: Standardized detailed reporting of adherence to palivizumab prophylaxis using consistent definitions will help provide a more robust level of evidence. This information may be important when considering variations in effectiveness, alterations to recommendations and guidelines, and cost-effectiveness of treatment.

Language Shift or Increased Bilingualism in South Africa: Evidence from Census Data

ERIC Educational Resources Information Center

Posel, Dorrit; Zeller, Jochen

2016-01-01

In the post-apartheid era, South Africa has adopted a language policy that gives official status to 11 languages (English, Afrikaans, and nine Bantu languages). However, English has remained the dominant language of business, public office, and education, and some research suggests that English is increasingly being spoken in domestic settings.…

Factors influencing adherence among Irish haemodialysis patients.

PubMed

Mellon, Lisa; Regan, Daniel; Curtis, Ruth

2013-07-01

Adherence to dietary and fluid restrictions among haemodialysis patients with end stage renal failure (ESRD) is a multi-factorial concept. This study seeks to assess the predictive value of demographic and psychological variables in non-adherence. A multi-centre cross sectional design assessed 50 haemodialysis patients on self reported adherence, attitudes towards dietary restrictions, quality of life, depression and anxiety. Adherence to fluid and dietary restrictions was measured objectively using potassium (K), phosphorus (PO4) and inter-dialytic weight gain (IDWG) parameters. 62% of patients were non-adherent with at least one aspect of the treatment regime. Regression analysis revealed age as significantly associated with adherence, in particular IDWG, with younger patients displaying poorer adherence. Younger patients may experience greater difficulty integrating complex treatment demands into their lifestyles, and non-adherence may be a consequence of the severe lifestyle limitations imposed by the haemodialysis treatment regime. Individualised interventions may be more effective than traditional methods of adherence monitoring in reducing the non-adherent behaviour. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Cognitive function and adherence of older adults undergoing hemodialysis.

PubMed

Hain, Debra J

2008-01-01

As the number of older adults undergoing hemodialysis increases, it is important for nurses to consider cognitive impairment as a contributing factor to non-adherence. The purpose of this exploratory study was to identify cognitive markers that nurses can use to alert them to potential problems with adherence among older adults undergoing hemodialysis. Stories of the health challenge of making lifestyle change were analyzed with a linguistic analysis software program. A standardized instrument (3MS) that measures global cognitive function was administered. Determination of adherence level was the last activity of data collection. In this sample (n=63), 39.7% of the participants had evidence of cognitive impairment (3MS score less than 80); 58.2% of the 39.7% had evidence of non-adherence. There was a significant relationship between word use and cognitive function (p < .01). Cognitive impairment is prevalent among older adults undergoing hemodialysis and words might be a proxy for recognizing this.

Beliefs about medicines and self-reported adherence among pharmacy clients.

PubMed

Mårdby, Ann-Charlotte; Akerlind, Ingemar; Jörgensen, Tove

2007-12-01

To analyse any association between general beliefs about medicines and self-reported adherence among pharmacy clients. Further, to examine general beliefs about medicines by background variables. The data were collected by questionnaires including the general section of the Beliefs about Medicines Questionnaire (BMQ), the self-reporting Medication Adherence Report Scale (MARS) and the following background variables: gender, age, education, country of birth and medicine use. The General BMQ measures beliefs about medicines as something harmful (General-Harm), beneficial (General-Benefit) and beliefs about how doctors prescribe medicines (General-Overuse). Of the 324 participating pharmacy clients, 54% were considered non-adherent. An association was found between General-Harm and adherence. Adherent behaviour and higher level of education were associated respectively with more beneficial and less harmful beliefs about medicines. Those born in the Nordic countries regarded medicines as more beneficial. Current users of herbal medicines and non-users of medicines were more likely to believe that doctors overprescribed medicines. General-Harm was associated with adherence to medication among Swedish pharmacy clients. Country of birth, education and medicine use influenced beliefs about medicines. Increased awareness of the patient's beliefs about medicines is needed among healthcare providers. We should encourage patients to express their views about medicines in order to optimize and personalize the information process. This can stimulate concordance and adherence to medication.

Families as catalysts for peer adherence support in enhancing hope for people living with HIV/AIDS in South Africa

PubMed Central

Masquillier, Caroline; Wouters, Edwin; Mortelmans, Dimitri; Booysen, Frederik le Roux

2014-01-01

Introduction Hope is an essential dimension of successful coping in the context of illnesses such as HIV/AIDS, because positive expectations for the future alleviate emotional distress, enhance quality of life and have been linked to the capacity for behavioural change. The social environment (e.g. family, peers) is a regulator of hope for people living with HIV/AIDS (PLWHA). In this regard, the dual aim of this article is (1) to analyze the influence of a peer adherence support (PAS) intervention and the family environment on the state of hope in PLWHA and (2) to investigate the interrelationship between the two determinants. Methods The Effective AIDS Treatment and Support in the Free State study is a prospective randomized controlled trial. Participants were recruited from 12 public antiretroviral treatment (ART) clinics across five districts in the Free State Province of South Africa. Each of these patients was assigned to one of the following groups: a control group receiving standard care, a group receiving additional biweekly PAS or a group receiving PAS and nutritional support. Latent cross-lagged modelling (Mplus) was used to analyse the impact of PAS and the family environment on the level of hope in PLWHA. Results The results of the study indicate that neither PAS nor the family environment has a direct effect on the level of hope in PLWHA. Subsequent analysis reveals a positive significant interaction between family functioning and PAS at the second follow-up, indicating that better family functioning increases the positive effect of PAS on the state of hope in PLWHA. Conclusions The interplay between well-functioning families and external PAS generates higher levels of hope, which is an essential dimension in the success of lifelong treatment. This study provides additional insight into the important role played by family dynamics in HIV/AIDS care, and it underscores the need for PAS interventions that are sensitive to the contexts in which they are

Families as catalysts for peer adherence support in enhancing hope for people living with HIV/AIDS in South Africa.

PubMed

Masquillier, Caroline; Wouters, Edwin; Mortelmans, Dimitri; Booysen, Frederik le Roux

2014-01-01

Hope is an essential dimension of successful coping in the context of illnesses such as HIV/AIDS, because positive expectations for the future alleviate emotional distress, enhance quality of life and have been linked to the capacity for behavioural change. The social environment (e.g. family, peers) is a regulator of hope for people living with HIV/AIDS (PLWHA). In this regard, the dual aim of this article is (1) to analyze the influence of a peer adherence support (PAS) intervention and the family environment on the state of hope in PLWHA and (2) to investigate the interrelationship between the two determinants. The Effective AIDS Treatment and Support in the Free State study is a prospective randomized controlled trial. Participants were recruited from 12 public antiretroviral treatment (ART) clinics across five districts in the Free State Province of South Africa. Each of these patients was assigned to one of the following groups: a control group receiving standard care, a group receiving additional biweekly PAS or a group receiving PAS and nutritional support. Latent cross-lagged modelling (Mplus) was used to analyse the impact of PAS and the family environment on the level of hope in PLWHA. The results of the study indicate that neither PAS nor the family environment has a direct effect on the level of hope in PLWHA. Subsequent analysis reveals a positive significant interaction between family functioning and PAS at the second follow-up, indicating that better family functioning increases the positive effect of PAS on the state of hope in PLWHA. The interplay between well-functioning families and external PAS generates higher levels of hope, which is an essential dimension in the success of lifelong treatment. This study provides additional insight into the important role played by family dynamics in HIV/AIDS care, and it underscores the need for PAS interventions that are sensitive to the contexts in which they are implemented.

Non-Adherence in Patients on Peritoneal Dialysis: A Systematic Review

PubMed Central

Griva, Konstadina; Lai, Alden Yuanhong; Lim, Haikel Asyraf; Yu, Zhenli; Foo, Marjorie Wai Yin; Newman, Stanton P.

2014-01-01

Background It has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD) therapy. There is therefore a need to establish the levels of non-adherence to different aspects of the PD regimen (dialysis procedures, medications, and dietary/fluid restrictions). Methods A systematic review of peer-reviewed literature was performed in PubMed, PsycINFO and CINAHL databases using PRISMA guidelines in May 2013. Publications on non-adherence in PD were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Relevant data on patient characteristics, measures, rates and factors associated with non-adherence were extracted. The quality of studies was also evaluated independently by two reviewers according to a revised version of the Effective Public Health Practice Project assessment tool. Results The search retrieved 204 studies, of which a total of 25 studies met inclusion criteria. Reported rates of non-adherence varied across studies: 2.6–53% for dialysis exchanges, 3.9–85% for medication, and 14.4–67% for diet/fluid restrictions. Methodological differences in measurement and definition of non-adherence underlie the observed variation. Factors associated with non-adherence that showed a degree of consistency were mostly socio-demographical, such as age, employment status, ethnicity, sex, and time period on PD treatment. Conclusion Non-adherence to different dimensions of the dialysis regimen appears to be prevalent in PD patients. There is a need for further, high-quality research to explore these factors in more detail, with the aim of informing intervention designs to facilitate adherence in this patient population. PMID:24586478

Adherence and acceptability in MTN 001: A randomized cross-over trial of daily oral and topical tenofovir for HIV prevention in women

PubMed Central

Minnis, Alexandra M.; Gandham, Sharavi; Richardson, Barbra A.; Guddera, Vijayanand; Chen, Beatrice A.; Salata, Robert; Nakabiito, Clemensia; Hoesley, Craig; Justman, Jessica; Soto-Torres, Lydia; Patterson, Karen; Gomez, Kailazarid; Hendrix, Craig

2012-01-01

We compared adherence to and acceptability of daily topical and oral formulations of tenofovir (TFV) used as pre-exposure prophylaxis (PrEP) for HIV prevention among women in South Africa, Uganda and the United States. 144 sexually active, HIV-uninfected women participated in a cross-over study of three regimens: oral tablet, vaginal gel, or both. We tested for differences in adherence and evaluated product acceptability. Self-reported adherence for all regimens was high (94%), but serum TFV concentrations indicated only 64% of participants used tablets consistently. Most women in the U.S. (72%) favored tablets over gel; while preferences varied at the African sites (42% preferred gel and 40% tablets). Findings indicate a role for oral and vaginal PrEP formulations and highlight the importance of integrating pharmacokinetics-based adherence assessment in future trials. Biomedical HIV prevention interventions should consider geographic and cultural experience with product formulations, partner involvement, and sexual health benefits that ultimately influence use. PMID:23065145

Clustering based on adherence data.

PubMed

Kiwuwa-Muyingo, Sylvia; Oja, Hannu; Walker, Sarah A; Ilmonen, Pauliina; Levin, Jonathan; Todd, Jim

2011-03-08

Adherence to a medical treatment means the extent to which a patient follows the instructions or recommendations by health professionals. There are direct and indirect ways to measure adherence which have been used for clinical management and research. Typically adherence measures are monitored over a long follow-up or treatment period, and some measurements may be missing due to death or other reasons. A natural question then is how to describe adherence behavior over the whole period in a simple way. In the literature, measurements over a period are usually combined just by using averages like percentages of compliant days or percentages of doses taken. In the paper we adapt an approach where patient adherence measures are seen as a stochastic process. Repeated measures are then analyzed as a Markov chain with finite number of states rather than as independent and identically distributed observations, and the transition probabilities between the states are assumed to fully describe the behavior of a patient. The patients can then be clustered or classified using their estimated transition probabilities. These natural clusters can be used to describe the adherence of the patients, to find predictors for adherence, and to predict the future events. The new approach is illustrated and shown to be useful with a simple analysis of a data set from the DART (Development of AntiRetroviral Therapy in Africa) trial in Uganda and Zimbabwe.

Improved Information and Educational Messages on Outer Packaging of Micronutrient Powders Distributed in Indonesia Increase Caregiver Knowledge and Adherence to Recommended Use.

PubMed

Sutrisna, Aang; Vossenaar, Marieke; Poonawala, Alia; Mallipu, Agnes; Izwardy, Doddy; Menon, Ravi; Tumilowicz, Alison

2018-06-08

The objective of this study was to examine the influence of improved information and educational messages on outer packaging of a micronutrient powder (MNP), locally known as “ Taburia ”, on knowledge and adherence to recommended use. A community-based cluster randomized controlled trial was conducted among 1149 caregivers and their children aged 6⁻36 months. Caregiver⁻child dyads were randomized by their villages to receive 30 sachets of Taburia with the: (i) original outer packaging; (ii) improved outer packaging; or (iii) improved outer packaging combined with cooking demonstrations. Adherence to Taburia use was assessed through caregiver interviews and observation of unused sachets during home visits; “high” adherence was defined as consuming 13⁻17 sachets in the previous month. Data collection included surveys and focus groups discussions. The majority of caregivers (>80%) preferred the improved packaging because it was more attractive and contained more comprehensive information. Caregivers who received the improved packaging had better knowledge regarding the recommended use of Taburia ( p < 0.001) and higher adherence with the prescribed use of Taburia (43% with “high” adherence) ( p < 0.001) than those who received the original packaging (29% with “high” adherence). Caregivers who participated in cooking demonstrations generally had better knowledge regarding the benefits of Taburia and recommended use, but this did not lead to higher adherence to recommended use. “Underconsumption” of Taburia (≤7 sachets) was much less prevalent than “overconsumption” (≥23 sachets), and original packaging users were more likely to consume Taburia daily instead of every two days as recommended. We conclude that the design of the outer packaging and comprehensiveness of information provided are important influencers of recommended MNP use by caregivers.

Using communication skills to improve adherence in children with chronic disease: the adherence equation.

PubMed

Brand, Paul L P; Klok, Ted; Kaptein, Adrian A

2013-12-01

Nonadherence to maintenance medication is common in paediatric chronic conditions. Despite the common belief that nonadherence is therapy-resistant, and the apparent lack of evidence for successful interventions to improve adherence, there is, in fact, a considerable body of evidence suggesting that adherence can be improved by applying specific communicative consultation skills. These can be summarized as the adherence equation: adherence=follow-up+dialogue+barriers and beliefs+empathy and education => concordance. Close follow-up of children with a chronic condition is needed to establish a therapeutic partnership with the family. Teaching self management skills is not a unidirectional process of providing information, but requires a constructive and collaborative dialogue between the medical team and the family. Identifying barriers to adherence can be achieved in a non-confrontational manner, by showing a genuine interest what the patient's views and preferences are. In particular, parental illness perceptions and medication beliefs should be identified, because they are strong drivers of nonadherence. Through empathic evidence-based education, such perceptions and beliefs can be modified. By applying these strategies, concordance between the child's family and the medical team can be achieved, resulting in optimal adherence to the jointly created treatment plan. Copyright © 2013 Elsevier Ltd. All rights reserved.

Effect of a clinic-wide social marketing campaign to improve adherence to antiretroviral therapy for HIV infection

PubMed Central

Giordano, Thomas P.; Rodriguez, Sonia; Zhang, Hong; Kallen, Michael A.; Jibaja-Weiss, Maria; Buscher, April L.; Arya, Monisha; Suarez-Almazor, Maria E.; Ross, Michael

2012-01-01

This demonstration study tested the impact of a 5-month clinic-wide social marketing campaign at improving adherence to antiretroviral therapy (ART). The intervention included a video, posters, pens, mugs, and lapel buttons with the campaign slogan “Live the Solution: Take Your Pills Every Day.” Participants self-reported adherence over a 4-week interval, the primary outcome, with a visual analogue scale. Pre- and post-intervention surveys were completed by 141 participants. Adherence did not change over time (absolute mean change −2.02%, paired t-test p=0.39). Among the 39.7% of participants who correctly identified the campaign slogan on the post-intervention survey, adherence increased by 3.3%, while it decreased in the other participants by 5.5% (paired t-test p=0.07). The well-received campaign did not increase short-term adherence to ART, but adherence tended to increase in participants who were more engaged with the intervention. Future interventions should engage patients more completely and have a more potent effect on adherence. PMID:22983536

Effect of a clinic-wide social marketing campaign to improve adherence to antiretroviral therapy for HIV infection.

PubMed

Giordano, Thomas P; Rodriguez, Sonia; Zhang, Hong; Kallen, Michael A; Jibaja-Weiss, Maria; Buscher, April L; Arya, Monisha; Suarez-Almazor, Maria E; Ross, Michael

2013-01-01

This demonstration study tested the impact of a 5-month clinic-wide social marketing campaign at improving adherence to antiretroviral therapy (ART). The intervention included a video, posters, pens, mugs, and lapel buttons with the campaign slogan "Live the Solution: Take Your Pills Every Day." Participants self-reported adherence over a 4-week interval, the primary outcome, with a visual analogue scale. Pre- and post-intervention surveys were completed by 141 participants. Adherence did not change over time (absolute mean change -2.02 %, paired t test P = 0.39). Among the 39.7 % of participants who correctly identified the campaign slogan on the post-intervention survey, adherence increased by 3.3 %, while it decreased in the other participants by 5.5 % (paired t test P = 0.07). The well-received campaign did not increase short-term adherence to ART, but adherence tended to increase in participants who were more engaged with the intervention. Future interventions should engage patients more completely and have a more potent effect on adherence.

The effects of medication adherence and health literacy on health-related quality of life in older people with hypertension.

PubMed

Park, Nam Hee; Song, Mi Sook; Shin, So Young; Jeong, Ji-Hye; Lee, Hyo Young

2018-04-17

This study investigated the effects of medication adherence and health literacy on health-related quality of life in vulnerable older people with hypertension. Health literacy is particularly critical for providing accurate information regarding correct medication intake to improve medication adherence. Additionally, health-related quality of life is directly related to impairment from chronic disease. A descriptive, cross-sectional study design was used. The participants were 160 low-income older people with hypertension registered in 16 public health centres in Busan, South Korea. They had received "visiting nursing services" for at least 6 months until the latest date and had belonged to the priority group of visiting nursing services. The Morisky Medication Adherence Scale, the Newest Vital Signs and EuroQol-5 Dimensions were used to assess medication adherence, health literacy and health-related quality of life, respectively. Medication adherence and health literacy were significantly associated with health-related quality of life in vulnerable older people with hypertension, although exercise and subjective health were more significant factors affecting health-related quality of life than medical adherence and health literacy. Level of education, monthly income and employment status were not associated with health-related quality of life. To effectively promote health-related quality of life in this population, medication adherence and health literacy of patients should be considered when developing health interventions, including subjective health and exercise. To effectively promote health-related quality of life in vulnerable older people, medication adherence and health literacy of patients should be assessed, and patient-centred intervention strategies that consider their individual differences should be developed. © 2018 John Wiley & Sons Ltd.

The Need for Invariant Assessments in South African Education

ERIC Educational Resources Information Center

Dampier, Graham A.

2014-01-01

Presently, a plethora of instruments designed to assess a mathematical skill, disposition, or competence prevail in South Africa. Yet few of them adhere to the basic requirements of the unidimensionality and invariance of measures. The Marko-D is a mathematical instrument designed to test learners between the ages of 4 and 8. The instrument, thus…

Prospective study of vaginal dilator use adherence and efficacy following radiotherapy

PubMed Central

Law, Ethel; Kelvin, Joanne F.; Thom, Bridgette; Riedel, Elyn; Tom, Ashlyn; Carter, Jeanne; Alektiar, Kaled; Goodman, Karyn A.

2016-01-01

Background and purpose Vaginal stenosis (VS) after pelvic radiotherapy can impair long-term quality of life. We prospectively assessed adherence and efficacy of VD use as the primary and secondary objectives, respectively. Material and methods Women with gastrointestinal (n=63) and gynecologic (n=46) cancers self-reported use and VD size in monthly diaries for 12 months after radiotherapy. Adherence was measured as actual VD use out of recommended times over 12 months (3×/week × 52 weeks = 156). Results Among 109 participants, aged 28–81 years (median, 58 years), mean percent adherence over 12 months was 42% (95% confidence interval [CI], 36%–48%). Adherence was highest in the first quarter (56%), but fell to 25% by the fourth. Disease type, treatment sequence, and chemotherapy were predictors of adherence (all P<.05). Eighty-two percent maintained pre-RT VD size at 12 months; of 49% with decrease in VD size at 1 month post-RT, 71% returned to pre-RT VD size at 12 months. Disease type, younger age, and increased adherence at 6 months were associated with maintaining or returning to pre-RT size at 12 months (all P≤.05). Conclusions VD use is effective in minimizing VS, but adherence at 12 months was poor. Studies evaluating methods of improving adherence and determining the optimal frequency and duration of use are needed. PMID:26164775

Adherence to Insulin, Emotional Distress, and Trust in Physician Among Patients with Diabetes: A Cross-Sectional Study.

PubMed

Halepian, Lucine; Saleh, Mary Bou; Hallit, Souheil; Khabbaz, Lydia Rabbaa

2018-04-01

Type 2 diabetes represents a significant public health issue, with increasing prevalence in developing countries while adherence to insulin treatment remains a challenge. No studies have evaluated the relationship between adherence to insulin, diabetes-related distress, and trust in physician among persons with diabetes. Our objectives were to evaluate treatment adherence to insulin, emotional distress (using the Problem Areas in Diabetes Questionnaire, PAID), trust in physician, and to examine associations between them among Lebanese patients with diabetes. This cross-sectional study, conducted in all districts of Lebanon between August 2016 and April 2017, enrolled 135 adult patients. The mean percentage score of adherence to insulin was 79.7 ± 19.94. A significantly higher mean adherence score was found in non-sedentary (81.96) compared to sedentary patients (67.41) (p = 0.017), with no difference between gender, employment, rural vs non-rural residence, or familial history of diabetes. In addition, no significant relationship was seen between adherence score and education level, smoking, or alcohol intake. A significant positive association was found between trust in physician and adherence scores, whereas a significant but negative one was found between PAID and adherence scores. The results of linear regressions showed that a secondary level of education (beta = - 13.48) significantly decreased the trust in physician score, whereas the total number of oral antidiabetics (beta = 0.93) increased it. Having a sedentary lifestyle (beta = - 12.73) and smoking < 3 waterpipes/week compared to no smoking (beta = - 16.82) significantly decreased the adherence score. Female gender (beta = 10.46), smoking < 3 waterpipes (beta = 27.42) and 3 + waterpipes/week (beta = 17.95) significantly increased the PAID score. Trust in physician is associated with an increased adherence and with decreased diabetes-related distress. This distress was also associated with poor

Childhood bullying and healthcare adherence in adulthood.

PubMed

Sansone, Randy A; Bohinc, R Jordan; Wiederman, Michael W

2015-12-01

The relationship between childhood bullying and healthcare adherence in adulthood has been rarely studied, but one published study suggests that being bullied in childhood is related to lower healthcare adherence among adolescents. This previous study examined few adherence variables and was limited to youths. In this study, we assessed five variables for childhood bullying as related to seven measures of healthcare adherence among a cohort of adult primary care outpatients. Using a cross-sectional, self-report survey methodology in a sample of 263 consecutive internal medicine outpatients, we examined five aspects of bullying and seven aspects of adherence with general healthcare. Being a victim of bullying, type of bullying (emotional, physical), number of years bullied and number of bullies each evidenced no statistical relationships with healthcare adherence. However, being a bully demonstrated several statistical relationships with healthcare adherence, indicating less adherence to instructions provided by healthcare professionals. Despite all of the deleterious psychological and physical effects of being bullied in childhood, there was no evidence that non-adherence with healthcare in adulthood is one of them. In contrast, bullies evidenced several areas of reduced healthcare adherence. © The Author(s) 2015.

Psychosocial factors and adherence to drug treatment in patients on chronic haemodialysis.

PubMed

Huertas-Vieco, María P; Pérez-García, Rafael; Albalate, Marta; de Sequera, Patricia; Ortega, Mayra; Puerta, Marta; Corchete, Elena; Alcázar, Roberto

2014-11-17

The daily pill burden in hemodialysis patients is one of the highest reported to date in any chronic disease. The adherence to prescribed treatment has implications on the quality of life, the survival of patients, and the economic cost of their treatment, this being a priority public health issue. To evaluate the adherence to pharmacological treatment examining, among the possible causes of non-adherence, psychosocial factors such as depression, anxiety, cognitive impairment and social support. Transversal-observational study of thirty five patients that suffer from chronic renal disease and who are on manteinance hemodialysis, evaluated by self-reported measures. Non-adherent patients have significant higher depression index than adherent patients. Anxiety, cognitive impairment and social support do not show a significant relation with the degree of adherence or compliance with farmacological treatment. These results suggest that psychological intervention in chronic haemodialysis patients with a severe depression index could increase the degree of fulfillment and general well-being of renal patients.

Additive effect of red blood cell rigidity and adherence to endothelial cells in inducing vascular resistance.

PubMed

Kaul, D K; Koshkaryev, A; Artmann, G; Barshtein, G; Yedgar, S

2008-10-01

To explore the contribution of red blood cell (RBC) deformability and interaction with endothelial cells (ECs) to circulatory disorders, these RBC properties were modified by treatment with hydrogen peroxide (H(2)O(2)), and their effects on vascular resistance were monitored following their infusion into rat mesocecum vasculature. Treatment with 0.5 mM H(2)O(2) increased RBC/EC adherence without significant alteration of RBC deformability. At 5.0 mM H(2)O(2), RBC deformability was considerably reduced, inducing a threefold increase in the number of undeformable cells, whereas RBC/EC adherence was not further affected by the increased H(2)O(2) concentration. This enabled the selective manipulation of RBC adherence and deformability and the testing of their differential effect on vascular resistance. Perfusion of RBCs with enhanced adherence and unchanged deformability (treatment with 0.5 mM H(2)O(2)) increased vascular resistance by about 35% compared with untreated control RBCs. Perfusion of 5.0 mM H(2)O(2)-treated RBCs, with reduced deformability (without additional increase of adherence), further increased vascular resistance by about 60% compared with untreated control RBCs. These results demonstrate the specific effects of elevated adherence and reduced deformability of oxidized RBCs on vascular resistance. These effects can be additive, depending on the oxidation conditions. The oxidation-induced changes applied in this study are moderate compared with those observed in RBCs in pathological states. Yet, they caused a considerable increase in vascular resistance, thus demonstrating the potency of RBC/EC adherence and RBC deformability in determining resistance to blood flow in vivo.

Why don't patients take their drugs? The role of communication, context and culture in patient adherence and the work of the pharmacist in HIV/AIDS.

PubMed

Penn, Claire; Watermeyer, Jennifer; Evans, Melanie

2011-06-01

This study examined facilitators and barriers to adherence in four South African antiretroviral therapy (ART) clinic sites and explored context and communication factors in relation to the role of the pharmacist. Data were collected from interviews and narratives of patients and health professionals around the issues of adherence and qualitatively analysed using principles of Thematic Content Analysis. Findings confirm the complex interplay between illness, communication, sociocultural, economic, context and systemic issues. Analysis suggests adherence is multifaceted and reinforces the critical role of communication factors in achieving concordance between patient and pharmacist. Successful treatment of HIV/AIDS depends on pharmacists and healthcare teams understanding contextual and interactional factors which play a role in adherence. The findings reinforce the importance of embedding a patient-centred approach in the training and everyday practice of pharmacists. The value of qualitative methods in understanding barriers to adherence and the potential value of the cultural broker in intercultural settings is discussed. Some suggestions are made as to how adherence counselling can be made relevant and effective. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Predictors of positive airway pressure therapy adherence in children: a prospective study.

PubMed

DiFeo, Natalie; Meltzer, Lisa J; Beck, Suzanne E; Karamessinis, Laurie R; Cornaglia, Mary Anne; Traylor, Joel; Samuel, John; Gallagher, Paul R; Radcliffe, Jerilynn; Beris, Heidi; Menello, Mary Kate; Marcus, Carole L

2012-06-15

Children with obstructive sleep apnea are increasingly being treated with positive airway pressure (PAP), particularly if they have underlying medical conditions. Although PAP is an effective treatment, its use is challenging due to poor adherence. We hypothesized that demographic, psychosocial, and polysomnographic parameters would be related to PAP adherence. We therefore prospectively collected data potentially pertaining to PAP adherence, and correlated it with PAP use. Fifty-six patients and their parents completed a series of psychosocial questionnaires prior to PAP initiation. Objective adherence data were obtained after 1 and 3 months of PAP use. The population was primarily obese; 23% had neurodevelopmental disabilities. PAP adherence varied widely, with PAP being worn 22 ± 8 nights in month-1, but mean use was only 3 ± 3 h/night. The greatest predictor of use was maternal education (p = 0.002 for nights used; p = 0.033 for mean h used/night). Adherence was lower in African American children vs other races (p = 0.021). In the typically developing subgroup, adherence correlated inversely with age. Adherence did not correlate with severity of apnea, pressure levels, or psychosocial parameters other than a correlation between family social support and nights of PAP use in month-3. PAP adherence in children and adolescents is related primarily to family and demographic factors rather than severity of apnea or measures of psychosocial functioning. Further research is needed to determine the relative contributions of maternal education, socioeconomic status and cultural beliefs to PAP adherence in children, in order to develop better adherence programs.

Treatment Adherence in a Lay Health Adviser Intervention to Treat Tobacco Dependence

ERIC Educational Resources Information Center

Hood, N. E.; Ferketich, A. K.; Paskett, E. D.; Wewers, M. E.

2013-01-01

Lay health advisers (LHAs) are increasingly used to deliver tobacco dependence treatment, especially with low-socioeconomic status (SES) populations. More information is needed about treatment adherence to help interpret mixed evidence of LHA intervention effectiveness. This study examined adherence to behavioral counseling and nicotine patches in…

Food group adherence scores assess food patterns compared to US Department of Agriculture Food Guide.

PubMed

Knol, Linda L; Haughton, Betsy; Fitzhugh, Eugene C

2006-08-01

The purpose of this study was twofold: (a) develop and test the potential usefulness of a new measure of dietary adherence to the US Department of Agriculture (USDA) Food Guide and (b) use this measure to assess the diets of children in the United States. Using 2 days of food intake data from the 1994-1996, 1998 Continuing Survey of Food Intakes by Individuals, food group adherence scores for individual food groups were calculated based on intake and recommendations from the USDA Food Guide. Two samples of children, age 2 to 3 years (n=2,815) and 4 to 8 years (n=3,769), were selected from the 1994-1996, 1998 Continuing Survey of Food Intakes by Individuals. Descriptive statistics were computed by age and sex. Linear regression analysis was used to detect significant differences in adherence scores and number of servings consumed between age groups after adjusting for factors that impact intake. Comparing the two age groups, differences in the food group adherence scores for some food groups did not mimic the differences seen in mean number of servings from the same food group. For these two age groups of children, although the number of servings from the food groups significantly increased with increasing age, the adherence scores significantly decreased, reflecting decreased adherence to the recommended food patterns by age. Results suggest adherence to the USDA Food Guide decreases with increasing age in young children in the United States. Adherence scores may be a useful tool to describe adherence to the new USDA Food Guide. These scores could be used in program evaluation, surveillance, and epidemiological studies of diet and health.

Toward an information-motivation-behavioral skills model of microbicide adherence in clinical trials.

PubMed

Ferrer, Rebecca A; Morrow, Kathleen M; Fisher, William A; Fisher, Jeffrey D

2010-08-01

Unless optimal adherence in microbicide clinical trials is ensured, an efficacious microbicide may be rejected after trial completion, or development of a promising microbicide may be stopped, because low adherence rates create the illusion of poor efficacy. We provide a framework with which to conceptualize and improve microbicide adherence in clinical trials, supported by a critical review of the empirical literature. The information-motivation-behavioral skills (IMB) model of microbicide adherence conceptualizes microbicide adherence in clinical trials and highlights factors that can be addressed in behavioral interventions to increase adherence in such trials. This model asserts that microbicide adherence-related information, motivation, and behavioral skills are fundamental determinants of adherent microbicide utilization. Specifically, information consists of objective facts about microbicide use (e.g., administration and dosage) as well as heuristics that facilitate use (e.g., microbicides must be used with all partners). Motivation to adhere consists of attitudes toward personal use of microbicides (e.g., evaluating the consequences of using microbicides as good or pleasant) as well as social norms that support their use (e.g., beliefs that a sexual partner approves use of microbicides). Behavioral skills consist of objective skills necessary for microbicide adherence (e.g., the ability to apply the microbicide correctly and consistently). Empirical evidence concerning microbicide acceptability and adherence to spermicides, medication, and condom use regimens support the utility of this model for understanding and promoting microbicide adherence in clinical trials.

IMPACT OF PHYSICIAN COMMUNICATION ON DIABETIC EYE EXAMINATION ADHERENCE: Results From a Retrospective Cohort Analysis.

PubMed

Storey, Philip P; Murchison, Ann P; Pizzi, Laura T; Hark, Lisa A; Dai, Yang; Leiby, Benjamin E; Haller, Julia A

2016-01-01

To evaluate the effect of written communication between an ophthalmologist and a primary care physician (PCP) on patient adherence to diabetic eye examination recommendations. In a retrospective cohort study of a multiethnic population at an urban ophthalmology center, records of all patients with diabetes and clinic visits between 2007 and 2010 were reviewed. Data collected included patient demographics, insurance status, hemoglobin A1C, severity of diabetic retinopathy, follow-up examinations, and written communication between a patient's ophthalmologist and PCP. Statistical analyses were performed to examine the relationship between physician communication and adherence to diabetic eye examination based on the American Academy of Ophthalmology-published recommendations. A total of 1,968 people with diabetes were included. Written communication from an ophthalmologist to a PCP was associated with increased adherence to follow-up eye examination recommendations (Odds Ratio: 1.49; 95% Confidence Interval: 1.16-1.92; P = 0.0018). Communication from a PCP to an ophthalmologist was also associated with increased adherence (Odds Ratio: 1.94; 95% Confidence Interval: 1.37-2.77; P = 0.0002). Multivariable analysis controlling for other factors associated with examination adherence confirmed that communication both to and from an ophthalmologist was independently and significantly associated with increased follow-up adherence. Patients with communication between ophthalmologists and PCPs are more likely to adhere to diabetic eye examinations.

Investigating Reasons for CPAP Adherence in Adolescents: A Qualitative Approach

PubMed Central

Prashad, Priya S.; Marcus, Carole L.; Maggs, Jill; Stettler, Nicolas; Cornaglia, Mary A.; Costa, Priscilla; Puzino, Kristina; Xanthopoulos, Melissa; Bradford, Ruth; Barg, Frances K.

2013-01-01

Study Objectives: Adolescents with obstructive sleep apnea syndrome (OSAS) represent an important but understudied subgroup of long-term continuous positive airway pressure (CPAP) users. The purpose of this qualitative study was to identify factors related to adherence from the perspective of adolescents and their caregivers. Methods: Individual open-ended, semi-structured interviews were conducted with adolescents (n = 21) and caregivers (n = 20). Objective adherence data from the adolescents' CPAP machines during the previous month was obtained. Adolescents with different adherence levels and their caregivers were asked their views on CPAP. Using a modified grounded theory approach, we identified themes and developed theories that explained the adolescents' adherence patterns. Results: Adolescent participants (n = 21) were aged 12-18 years, predominantly male (n = 15), African American (n = 16), users of CPAP for at least one month. Caregivers were mainly mothers (n = 17). Seven adolescents had high use (mean use 381 ± 80 min per night), 7 had low use (mean use 30 ± 24 min per night), and 7 had no use during the month prior to being interviewed. Degree of structure in the home, social reactions, mode of communication among family members, and perception of benefits were issues that played a role in CPAP adherence. Conclusions: Understanding the adolescent and family experience of using CPAP may be key to increasing adolescent CPAP adherence. As a result of our findings, we speculate that health education, peer support groups, and developmentally appropriate individualized support strategies may be important in promoting adherence. Future studies should examine these theories of CPAP adherence. Citation: Prashad PS; Marcus CL; Maggs J; Stettler N; Cornaglia MA; Costa P; Puzino K; Xanthopoulos M; Bradford R; Barg FK. Investigating reasons for CPAP adherence in adolescents: a qualitative approach. J Clin Sleep Med 2013;9(12):1303-1313. PMID:24340293

Association between adherence to concomitant proton pump inhibitor therapy in current NSAID users and upper gastrointestinal complications.

PubMed

Jonasson, Christian; Hatlebakk, Jan G; Lundell, Lars; Kouri, Jukka P; Andersen, Morten; Granath, Fredrik

2013-05-01

Proton pump inhibitors (PPIs) play a well-documented role as a gastroprotective agent among NSAID users at an increased risk of peptic ulcer and bleeding. Observational studies have, however, suggested that the clinical efficacy of PPI therapy may be reduced because of poor adherence. To study the association between adherence to concomitant PPI in current NSAID users and the risk of peptic ulcer and bleeding. Case-control study linking nationwide data from the Swedish Patient Registry with the Swedish Drug Prescription Database. The study population included patients admitted for a first-time peptic ulcer or bleeding and who were incident users of NSAID. Each case was matched on age, sex, NSAID duration, and calendar month with five controls. PPI adherence was calculated as the proportion of NSAID days being covered by PPI therapy. Matched and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using conditional logistic regression. A total of 3649 cases were identified. Patients with poor adherence (<20% PPI coverage) had a significantly increased risk of upper gastrointestinal complications (OR=1.88, 95% CI 1.22-2.88) compared with fully adherent patients (≥80% PPI coverage). As a continuous variable, the risk of an event increased with 6% points for every 10% decrease in PPI adherence (OR=1.06, 95% CI 1.03-1.10). The gastroprotective effect of PPI in NSAID users is highly dependent on adherence, with about twice the risk in patients with poor adherence. Efforts to increase adherence should be an integrated part of clinical practice.

Factors that influence adherence to antiretroviral treatment in an urban population, Jakarta, Indonesia.

PubMed

Weaver, Emma Rosamond Nony; Pane, Masdalina; Wandra, Toni; Windiyaningsih, Cicilia; Herlina; Samaan, Gina

2014-01-01

Although the number of people receiving antiretroviral therapy (ART) in Indonesia has increased in recent years, little is known about the specific characteristics affecting adherence in this population. Indonesia is different from most of its neighbors given that it is a geographically and culturally diverse country, with a large Muslim population. We aimed to identify the current rate of adherence and explore factors that influence ART adherence. Data were collected from ART-prescribed outpatients on an HIV registry at a North Jakarta hospital in 2012. Socio-demographic and behavioral characteristics were explored as factors associated with adherence using logistics regression analyses. Chi squared test was used to compare the difference between proportions. Reasons for missing medication were analyzed descriptively. Two hundred and sixty-one patients participated, of whom 77% reported ART adherence in the last 3 months. The level of social support experienced was independently associated with adherence where some social support (p = 0.018) and good social support (p = 0.039) improved adherence compared to poor social support. Frequently cited reasons for not taking ART medication included forgetting to take medication (67%), busy with something else (63%) and asleep at medication time (60%). This study identified that an increase in the level of social support experienced by ART-prescribed patients was positively associated with adherence. Social support may minimize the impact of stigma among ART prescribed patients. Based on these findings, if social support is not available, alternative support through community-based organizations is recommended to maximize treatment success.

Ongoing Initiatives to Improve the Quality and Efficiency of Medicine Use within the Public Healthcare System in South Africa; A Preliminary Study

PubMed Central

Meyer, Johanna C.; Schellack, Natalie; Stokes, Jacobus; Lancaster, Ruth; Zeeman, Helecine; Defty, Douglas; Godman, Brian; Steel, Gavin

2017-01-01

Introduction: South Africa has an appreciable burden of both communicable and non-communicable diseases as well as high maternal, neonatal, and child morbidity. In recent years there have been significant strides with improving the public health system, and addressing current inequalities, with the right to health a constitutional provision in South Africa. Initiatives include the introduction of National Health Insurance, programmes to enhance access to medicines for patients with chronic diseases, as well as activities to improve care in hospitals, including improving pharmacovigilance. Consequently, the objective of this paper is to review ongoing initiatives within the public healthcare sector in South Africa and their influence to provide future direction. Method: Principally a structured review of current and planned activities. Results: There have been a number of major activities and initiatives surrounding the availability and access to medicines in the public system in recent years in South Africa. This includes a National Surveillance Centre and an innovative early warning system for the supply of medicines as well as the development of a National Health Care Pricing Authority and initiatives to improve contracting. There have also been developments to improve the supply chain including instigating Medicine Procurement Units in the provinces and enhancing forecasting capabilities. Access to medicines is improving though the instigation of stable chronic disease management initiatives to increase the number of external pick-up points for medicines. There are also ongoing programmes to enhance adherence to medicines as well as enhance adherence to the Standard Treatment Guidelines and the Essential Medicines List with their increasing availability. In addition, there is a movement to enhance the role of health technology assessment in future decision making. Hospital initiatives include increased focus on reducing antimicrobial resistance through

Ongoing Initiatives to Improve the Quality and Efficiency of Medicine Use within the Public Healthcare System in South Africa; A Preliminary Study.

PubMed

Meyer, Johanna C; Schellack, Natalie; Stokes, Jacobus; Lancaster, Ruth; Zeeman, Helecine; Defty, Douglas; Godman, Brian; Steel, Gavin

2017-01-01

Introduction: South Africa has an appreciable burden of both communicable and non-communicable diseases as well as high maternal, neonatal, and child morbidity. In recent years there have been significant strides with improving the public health system, and addressing current inequalities, with the right to health a constitutional provision in South Africa. Initiatives include the introduction of National Health Insurance, programmes to enhance access to medicines for patients with chronic diseases, as well as activities to improve care in hospitals, including improving pharmacovigilance. Consequently, the objective of this paper is to review ongoing initiatives within the public healthcare sector in South Africa and their influence to provide future direction. Method: Principally a structured review of current and planned activities. Results: There have been a number of major activities and initiatives surrounding the availability and access to medicines in the public system in recent years in South Africa. This includes a National Surveillance Centre and an innovative early warning system for the supply of medicines as well as the development of a National Health Care Pricing Authority and initiatives to improve contracting. There have also been developments to improve the supply chain including instigating Medicine Procurement Units in the provinces and enhancing forecasting capabilities. Access to medicines is improving though the instigation of stable chronic disease management initiatives to increase the number of external pick-up points for medicines. There are also ongoing programmes to enhance adherence to medicines as well as enhance adherence to the Standard Treatment Guidelines and the Essential Medicines List with their increasing availability. In addition, there is a movement to enhance the role of health technology assessment in future decision making. Hospital initiatives include increased focus on reducing antimicrobial resistance through

Level of adherence and predictors of adherence to the Option B+ PMTCT programme in Tigray, northern Ethiopia.

PubMed

Ebuy, Haftamu; Yebyo, Henock; Alemayehu, Mussie

2015-04-01

The aim of this study was to determine the level of adherence to Option B+ PMTCT drugs and factors associated with adherence among HIV-positive pregnant women in public hospitals of Tigray, northern Ethiopia. A cross-sectional study was conducted among 277 HIV-positive pregnant women in 2014. A two-stage cluster sampling technique was used to select the study participants. Individual consent was obtained from each participant. Multivariate logistic regression was used to estimate the net effect sizes of factors associated with adherence to Option B+ PMTCT drugs. The level of adherence of respondents to Option B+ PMTCT drugs was 87.1% (95% confidence interval (CI) 82.6-90.7%). Controlling for the effect of other factors, the odds of adhering to Option B+ PMTCT were 4.7 times higher among women who received counselling on medication as compared to those who did not (adjusted odds ratio (aOR) 4.7, 95% CI 1.98-11.35). Similarly, disclosing HIV status was positively associated with good adherence (aOR 4.2, 95% CI 1.07-16.33). The adherence level was found to be reasonably good. Counselling on medication and HIV status disclosure were positive predictors of adherence to Option B+ PMTCT drugs. Copyright © 2015. Published by Elsevier Ltd.

Exercise Adherence. ERIC Digest.

ERIC Educational Resources Information Center

Sullivan, Pat

This digest discusses exercise adherence, noting its vital role in maximizing the benefits associated with physical activity. Information is presented on the following: (1) factors that influence adherence to self-monitored programs of regular exercise (childhood eating habits, and psychological, physical, social, and situational factors); (2)…

Early warning indicators for first-line virologic failure independent of adherence measures in a South African urban clinic.

PubMed

Marconi, Vincent C; Wu, Baohua; Hampton, Jane; Ordóñez, Claudia E; Johnson, Brent A; Singh, Dinesh; John, Sally; Gordon, Michelle; Hare, Anna; Murphy, Richard; Nachega, Jean; Kuritzkes, Daniel R; del Rio, Carlos; Sunpath, Henry

2013-12-01

We sought to develop individual-level Early Warning Indicators (EWI) of virologic failure (VF) for clinicians to use during routine care complementing WHO population-level EWI. A case-control study was conducted at a Durban clinic. Patients after ≥ 5 months of first-line antiretroviral therapy (ART) were defined as cases if they had VF [HIV-1 viral load (VL)>1000 copies/mL] and controls (2:1) if they had VL ≤ 1000 copies/mL. Pharmacy refills and pill counts were used as adherence measures. Participants responded to a questionnaire including validated psychosocial and symptom scales. Data were also collected from the medical record. Multivariable logistic regression models of VF included factors associated with VF (p<0.05) in univariable analyses. We enrolled 158 cases and 300 controls. In the final multivariable model, male gender, not having an active religious faith, practicing unsafe sex, having a family member with HIV, not being pleased with the clinic experience, symptoms of depression, fatigue, or rash, low CD4 counts, family recommending HIV care, and using a TV/radio as ART reminders (compared to mobile phones) were associated with VF independent of adherence measures. In this setting, we identified several key individual-level EWI associated with VF including novel psychosocial factors independent of adherence measures.

Association between addressing antiseizure drug side effects and patient-reported medication adherence in epilepsy

PubMed Central

Moura, Lidia M V R; Carneiro, Thiago S; Cole, Andrew J; Hsu, John; Vickrey, Barbara G; Hoch, Daniel B

2016-01-01

Background and aim Adherence to treatment is a critical component of epilepsy management. This study examines whether addressing antiepileptic drug (AED) side effects at every visit is associated with increased patient-reported medication adherence. Patients and methods This study identified 243 adults with epilepsy who were seen at two academic outpatient neurology settings and had at least two visits over a 3-year period. Demographic and clinical characteristics were abstracted. Evidence that AED side effects were addressed was measured through 1) phone interview (patient-reported) and 2) medical records abstraction (physician-documented). Medication adherence was assessed using the validated Morisky Medication Adherence Scale-4. Complete adherence was determined as answering “no” to all questions. Results Sixty-two (25%) patients completed the interviews. Participants and nonparticipants were comparable with respect to demographic and clinical characteristics; however, a smaller proportion of participants had a history of drug-resistant epilepsy than nonparticipants (17.7% vs 30.9%, P=0.04). Among the participants, evidence that AED side effects were addressed was present in 48 (77%) medical records and reported by 51 (82%) patients. Twenty-eight (45%) patients reported complete medication adherence. The most common reason for incomplete adherence was missed medication due to forgetfulness (n=31, 91%). There was no association between addressing AED side effects (neither physician-documented nor patient-reported) and complete medication adherence (P=0.22 and 0.20). Discussion and conclusion Among patients with epilepsy, addressing medication side effects at every visit does not appear to increase patient-reported medication adherence. PMID:27826186

Prevalence, predictors, and clinical consequences of medical adherence in IBD: How to improve it?

PubMed Central

Lakatos, Peter Laszlo

2009-01-01

Inflammatory bowel diseases (IBD) are chronic diseases with a relapsing-remitting disease course necessitating lifelong treatment. However, non-adherence has been reported in over 40% of patients, especially those in remission taking maintenance therapies for IBD. The economical impact of non-adherence to medical therapy including absenteeism, hospitalization risk, and the health care costs in chronic conditions, is enormous. The causes of medication non-adherence are complex, where the patient-doctor relationship, treatment regimen, and other disease-related factors play key roles. Moreover, subjective assessment might underestimate adherence. Poor adherence may result in more frequent relapses, a disabling disease course, in ulcerative colitis, and an increased risk for colorectal cancer. Improving medication adherence in patients is an important challenge for physicians. Understanding the different patient types, the reasons given by patients for non-adherence, simpler and more convenient dosage regimens, dynamic communication within the health care team, a self-management package incorporating enhanced patient education and physician-patient interaction, and identifying the predictors of non-adherence will help devise suitable plans to optimize patient adherence. This editorial summarizes the available literature on frequency, predictors, clinical consequences, and strategies for improving medical adherence in patients with IBD. PMID:19750566

Prevalence, predictors, and clinical consequences of medical adherence in IBD: how to improve it?

PubMed

Lakatos, Peter Laszlo

2009-09-14

Inflammatory bowel diseases (IBD) are chronic diseases with a relapsing-remitting disease course necessitating lifelong treatment. However, non-adherence has been reported in over 40% of patients, especially those in remission taking maintenance therapies for IBD. The economical impact of non-adherence to medical therapy including absenteeism, hospitalization risk, and the health care costs in chronic conditions, is enormous. The causes of medication non-adherence are complex, where the patient-doctor relationship, treatment regimen, and other disease-related factors play key roles. Moreover, subjective assessment might underestimate adherence. Poor adherence may result in more frequent relapses, a disabling disease course, in ulcerative colitis, and an increased risk for colorectal cancer. Improving medication adherence in patients is an important challenge for physicians. Understanding the different patient types, the reasons given by patients for non-adherence, simpler and more convenient dosage regimens, dynamic communication within the health care team, a self-management package incorporating enhanced patient education and physician-patient interaction, and identifying the predictors of non-adherence will help devise suitable plans to optimize patient adherence. This editorial summarizes the available literature on frequency, predictors, clinical consequences, and strategies for improving medical adherence in patients with IBD.

Benefits of adherence to psychotropic medications on depressive symptoms and antiretroviral medication adherence among men and women living with HIV/AIDS.

PubMed

Cruess, Dean G; Kalichman, Seth C; Amaral, Christine; Swetzes, Connie; Cherry, Chauncey; Kalichman, Moira O

2012-04-01

Psychotropic medications are commonly used for depressive symptoms among people living with HIV/AIDS. We examined the relationships between adherence to psychotropic medications, depressive symptoms, and antiretroviral adherence. We assessed depressive symptoms among 324 people living with HIV/AIDS across a 3-month period (70% men; mean age 45 years; 90% African-American). Psychotropic and antiretroviral adherence was assessed using monthly, unannounced telephone pill counts. Multiple-regression and mediation analyses were utilized to examine associations under investigation. Greater depressive symptoms were associated with lower antiretroviral and psychotropic medication adherence. Greater adherence to psychotropic medications regardless of medication class was positively related to higher antiretroviral adherence. Greater adherence to psychotropic medications also significantly mediated the association between depressive symptoms and antiretroviral adherence. This study demonstrates the benefits of adherence to psychotropic medications on both depressive symptoms and antiretroviral adherence. Future work examining psychotropic medication adherence on disease outcomes in people living with HIV/AIDS is warranted.

Are patient's simply unaware? A cross-sectional study of website promotion of community pharmacy adherence-related services in Tennessee.

PubMed

Hohmeier, Kenneth C; Borja-Hart, Nancy

Medication adherence rates can impact patient outcomes, quality of life, and health care costs. Community pharmacists who offer adherence-related services are well positioned to bolster medication adherence rates. One means for patients to learn more about these services is through the pharmacy's website. However, the prevalence of pharmacies' promotion of adherence services through the internet is unknown. The present study aimed to quantify the online promotion of pharmacies' adherence-related services. This was a cross-sectional, observational study of websites representing licensed community pharmacies. One-hundred and sixty-nine community pharmacy websites, representing 1161 of community pharmacies in Tennessee (U.S. State), were included in the observational analysis. The most commonly promoted adherence-related service was online refills (81.1%). Auto refill, medication synchronization, and packaging systems were promoted on <20% pharmacy websites. Types of promoted adherence services differed between chain and independent pharmacy websites. Despite 67% of pharmacies offering adherence-related services, only a fraction of them promote these services online. Patient awareness represents a hidden and often unaddressed variable in increasing adherence. Future studies should investigate whether increasing website promotion of these services would increase service use, and potentially improve adherence rates. Copyright © 2015 Elsevier Inc. All rights reserved.

Recommended care adherence: improved by patient reminder letters but with potential attenuation by the healthcare process complexity.

PubMed

Zhang, Zhou; Fish, Jason

2012-01-01

American adults receive the recommended care just over half of the time for all recommended services. Many patient reminder strategies have attempted to increase the adherence rates for preventative and chronic disease management. However, there is a lack of data available in relation to adherence rates for symptom-specific recommended services and a lack of data identifying any contributions from the organisational structures to these adherence rates. To identify the efficacy and differences in patient reminder letter strategies on various categories of recommended services, as well as to analyse the relationship between a novel quantification of a healthcare system's process complexity with adherence rates. Retrospective cohort study analysing pilot data collected from an urban, academic healthcare provider utilising patient reminder letters. Adults attending one academic medical centre's outpatient practice from 2008 to 2009. Two reminder letters sent chronologically if the recommended care was not completed in the appropriate time frame. Adherence rates of each recommended service at baseline, after first and second reminder letters, and non-adherence rates despite the reminder letter intervention. Process flow complexity was calculated as a composite score combining elements of fastest time to complete routine order, number of different steps in routine order, number of departments involved, and number of sites patients visit. Patient adherence rates increased for all the recommended services after the first reminder letter. Preventative and Chronic Disease Management recommendations demonstrated additional moderate increases after the second reminder letter. Referrals and Radiologogy and Diagnostic Testing (acute, symptom specific) and Labs (acute and nonacute) demonstrated additional minimal adherence rate increases after the second reminder letter. Comparison of the process flow complexity demonstrated an inverse relationship between process complexity and

Gamification and Adherence to Web-Based Mental Health Interventions: A Systematic Review.

PubMed

Brown, Menna; O'Neill, Noelle; van Woerden, Hugo; Eslambolchilar, Parisa; Jones, Matt; John, Ann

2016-08-24

Adherence to effective Web-based interventions for common mental disorders (CMDs) and well-being remains a critical issue, with clear potential to increase effectiveness. Continued identification and examination of "active" technological components within Web-based interventions has been called for. Gamification is the use of game design elements and features in nongame contexts. Health and lifestyle interventions have implemented a variety of game features in their design in an effort to encourage engagement and increase program adherence. The potential influence of gamification on program adherence has not been examined in the context of Web-based interventions designed to manage CMDs and well-being. This study seeks to review the literature to examine whether gaming features predict or influence reported rates of program adherence in Web-based interventions designed to manage CMDs and well-being. A systematic review was conducted of peer-reviewed randomized controlled trials (RCTs) designed to manage CMDs or well-being and incorporated gamification features. Seven electronic databases were searched. A total of 61 RCTs met the inclusion criteria and 47 different intervention programs were identified. The majority were designed to manage depression using cognitive behavioral therapy. Eight of 10 popular gamification features reviewed were in use. The majority of studies utilized only one gamification feature (n=58) with a maximum of three features. The most commonly used feature was story/theme. Levels and game leaders were not used in this context. No studies explicitly examined the role of gamification features on program adherence. Usage data were not commonly reported. Interventions intended to be 10 weeks in duration had higher mean adherence than those intended to be 6 or 8 weeks in duration. Gamification features have been incorporated into the design of interventions designed to treat CMD and well-being. Further research is needed to improve understanding

Self-monitoring of blood glucose among patients with diabetes in Jordan: Perception, adherence, and influential factors.

PubMed

Al-Keilani, Maha S; Almomani, Basima A; Al-Sawalha, Nour A; Shhabat, Batool A

2017-04-01

To investigate the self-monitoring of blood glucose (SMBG) adherence among Jordanian patients with diabetes and to identify the predictive factors. A cross-sectional survey was carried out in 18 hospitals and healthcare centers covering south, north, and middle of Jordan. All patients with diabetes attending endocrinology clinics from May to December, 2015 were approached. The questionnaires were distributed by trained pharmacists and were self-administered. A total of 1079 participants completed the survey. Only 59% of participants were SMBG adherent. Predictors of SMBG adherence were treatment regimen; insulin with oral hypoglycemic agents (p=0.044, CI 1.023-5.274, OR=2.323) or insulin only (p=0.005, CI 1.225-3.115, OR=1.953), and health education on how to use the SMBG meter (p<0.001, CI 10.538-32.497, OR=18.506). The frequency of SMBG was significantly associated with the treatment regimen, with patients who were taking oral hypoglycemic agents (p<0.001) or insulin therapy (p=0.004) tested more frequently as compared to others. Additionally, the frequency of testing was significantly associated with the reason of performing SMBG (p<0.001). Frequency of daily testing was the highest among patients who performed SMBG to know if they were hypoglycemic (48.9%) or hyperglycemic (48.0%), or to inform their doctors (28.4%). SMBG adherence was suboptimal. Predictors of SMBG adherence were treatment regimen and health education about the SMBG meter. Copyright © 2017 Elsevier B.V. All rights reserved.

Effect of respiratory syncytial virus (RSV) infection on the adherence of pathogenic bacteria to human epithelial cells

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

Faden, H.; Hong, J.J.; Ogra, P.L.

1986-03-01

The effect of RSV infection on the adherence of Streptococcus pneumoniae (SP), Haemophilus influenzae (HI) and Staphylococcus aureus (SA) to human epithelial cells was determined. RSV-infected Hep-2 cell cultures at different stages of expression of surface viral antigens and bacteria labeled with /sup 3/H-thymidine were employed to examine the kinetics of bacterial adherence to virus-infected cells. RSV infection did not alter the magnitude of adherence of HI or SA to HEp-2 cells. However, adherence of SP to HEp-2 cells was significantly (P < 0.01) enhanced by prior RSV infection. The degree of adherence was directly related to the amount ofmore » viral antigen expressed on the cell surface. The adherence was temperature dependent, with maximal adherence observed at 37/sup 0/C. Heat-inactivation of SP did not alter adherence characteristics. These data suggest that RSV infection increases adherence of SP to the surface of epithelial cells in vitro. Since attachment of bacteria to mucosal surfaces is the first step in many infections, it is suggested that viral infections of epithelial cells render them more susceptible to bacterial adherence. Thus, RSV infection in vivo may predispose children to SP infections, such as in otitis media, by increasing colonization with SP.« less

A Systematic Review of CPAP Adherence Across Age Groups: Clinical and Empiric Insights for Developing CPAP Adherence Interventions

PubMed Central

Sawyer, A.M.; Gooneratne, N.; Marcus, C.L.; Ofer, D.; Richards, K.C.; Weaver, T.E.

2011-01-01

Continuous positive airway pressure (CPAP) is a highly efficacious treatment for obstructive sleep apnea (OSA) but adherence to the treatment limits its overall effectiveness across all age groups of patients. Factors that influence adherence to CPAP include disease and patient characteristics, treatment titration procedures, technological device factors and side effects, and psychological and social factors. These influential factors have guided the development of interventions to promote CPAP adherence. Various intervention strategies have been described and include educational, technological, psychosocial, pharmacological, and multi-dimensional approaches. Though evidence to date has led to innovative strategies that address adherence in CPAP-treated children, adults, and older adults, significant opportunities exist to develop and test interventions that are clinically applicable, specific to subgroups of patients likely to demonstrate poor adherence, and address the multifactorial nature of CPAP adherence. The translation of CPAP adherence promotion interventions to clinical practice is imperative to improve health and functional outcomes in all persons with CPAP-treated OSA. PMID:21652236

Adherence to Preexposure Prophylaxis: Current, Emerging, and Anticipated Bases of Evidence

PubMed Central

Amico, K. Rivet; Stirratt, Michael J.

2014-01-01

Despite considerable discussion and debate about adherence to preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV), scant data are available that characterize patterns of adherence to open-label PrEP. The current evidence base is instead dominated by research on adherence to placebo-controlled investigational drug by way of drug detection in active-arm participants of large randomized controlled trials (RCTs). Important differences between the context of blinded RCTs and open-label use suggest caution when generalizing from study product adherence to real-world PrEP use. Evidence specific to open-label PrEP adherence is presently sparse but will expand rapidly over the next few years as roll-out, demonstration projects, and more rigorous research collect and present findings. The current evidence bases established cannot yet predict uptake, adherence, or persistence with open-label effective PrEP. Emerging evidence suggests that some cohorts could execute better adherence in open-label use vs placebo-controlled research. Uptake of PrEP is presently slow in the United States; whether this changes as grassroots and community efforts increase awareness of PrEP as an effective HIV prevention option remains to be determined. As recommended by multiple guidelines for PrEP use, all current demonstration projects offer PrEP education and/or counseling. PrEP support approaches generally fall into community-based, technology, monitoring, and integrated sexual health promotion approaches. Developing and implementing research that moves beyond simple correlates of either study product use or open-label PrEP adherence toward more comprehensive models of sociobehavioral and socioecological adherence determinants would greatly accelerate progress. Intervention research is needed to identify effective models of support for open-label PrEP adherence. PMID:24926036

Adherence to antidepressant medications: a randomized controlled trial of medication reminding in college students.

PubMed

Hammonds, Tracy; Rickert, Krista; Goldstein, Carly; Gathright, Emily; Gilmore, Sarah; Derflinger, Bethany; Bennett, Brooke; Sterns, Anthony; Drew, Barbara L; Hughes, Joel W

2015-01-01

To determine if medication reminding via smartphone app increases adherence to antidepressant medications in college students. College students (N = 57) enrolled at a state-funded institution who had a current prescription for an antidepressant and regularly used a smartphone device. Participants were randomized to either a reminder group or a control group. Both groups were asked to complete a survey and undergo a manual pill count at the beginning of the study and 30 days later. There was a strong trend suggesting that the use of a medication reminder app was beneficial for adherence to antidepressant medication regimens. Factors influencing medication adherence in college students included health beliefs, use of illicit drugs, and type of professional care received. Use of a medication reminder may increase adherence to antidepressant medications in college students.

The Role of Self-Efficacy in HIV Treatment Adherence: Validation of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES)

PubMed Central

Johnson, Mallory O.; Neilands, Torsten B.; Dilworth, Samantha; Morin, Stephen F.; Remien, Robert H.; Chesney, Margaret A.

2008-01-01

Adherence to HIV treatment, including adherence to antiretroviral (ART) medication regimens, is paramount in the management of HIV. Self-efficacy for treatment adherence has been identified as an important correlate of medication adherence in the treatment of HIV and other medical conditions. This paper describes the validation of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES) with two samples of HIV+ adults on ART. Factor analyses support subscales measuring Adherence Integration (eigenvalue = 6.12) and Adherence Perseverance (eigenvalue = 1.16), accounting for 61% of the variance in scale items. The HIV-ASES demonstrates robust internal consistency (ρs > .90) and 3-month (rs > .70) and 15-month (rs > .40) test-retest reliability. Concurrent validity analyses revealed relationships with psychosocial measures, ART adherence, clinical status, and healthcare utilization. Findings support the use of the HIV-ASES and provide guidance for further investigation of adherence self-efficacy in the context of treatment for HIV and other diseases. PMID:17588200

Adherence to blood pressure and glucose recommendations in chronic kidney disease hospital inpatients: Clinical inertia and patient adherence.

PubMed

Gardiner, Fergus William; Nwose, Ezekiel Uba; Bwititi, Phillip Taderera; Crockett, Judith; Wang, Lexin

2018-05-01

To determine the extent to which targets for blood pressure (BP) (<140.90 mmHg) and random blood glucose level (BGL) (<7.7 mmol/L) control in patients with chronic kidney disease (CKD) are achieved; and the extent clinical inertia affects BP and glucose control in CKD and diabetes mellitus (DM). Data was collected from the 1st January 2015 until 31st December 2015 on key patient pathology, admission reason, final discharge diagnosis, and information concerning clinical guideline adherence. Eighty-seven (n = 87) CKD patients were included. The average hospital BP for all CKD patients was 134.3/73.4 mmHg, adhering to recommendations of <140/90 mmHg. The average CKD patient pre-admission BP was 134.8/72.2 mmHg compared to the discharge BP of 129.8/72.2 mmHg. At admission, 63.3% and 93.1% of patients adhered to systolic and diastolic BP recommendations, which significantly (p = < .05) increased at discharge to a systolic and diastolic BP adherence of 83.9% and 98.8%, respectively. The average random hospital BGL was 7.7 mmol/L, indicating good control, whereas the pre-hospital HbA1c average was 7.58%, indicating poor control (>7.0% >53 mmol/mol). There were 21 cases of clinical inertia, affecting 18 out of 87 patients (20.7%), with significant adverse hospital discharge differences (p = <.05) between clinical inertia and non- clinical inertia patient systolic BP (144.2 vs. 132.8 mmHg), deranged BGL (66.7% vs. 35.3%), and reduction in kidney function (83.3% vs. 30.9%). Adherence appears to be related to inpatient clinical inertia and outpatient patient health literacy and empowerment. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Discordance between surgical care improvement project adherence and postoperative outcomes: implications for new Joint Commission standards.

PubMed

Chang, Victor; Blackwell, Robert H; Markossian, Talar; Yau, Ryan M; Blanco, Barbara A; Zapf, Matthew A C; Abood, Gerard J; Gupta, Gopal N; Kuo, Paul C; Kothari, Anai N

2017-05-15

Infectious (INF) and venous thromboembolism (VTE) complication rates are targeted by surgical care improvement project (SCIP) INF and SCIP VTE measures. We analyzed how adherence to SCIP INF and SCIP VTE affects targeted postoperative outcomes (wound complication [WC], deep vein thrombosis, and pulmonary embolism [PE]) using all-payer data. A retrospective review (2007-2011) was conducted using Healthcare Cost and Utilization Project State Inpatient Database Florida and Medicare's Hospital Compare. The association between SCIP adherence rates and outcomes across 355 included surgical procedures was measured using multilevel mixed-effects linear regression models. One hundred sixty acute care hospitals and 779,922 patients were included. Over 5 y, SCIP INF-1, -2, and -3 adherence improved by 12.5%, 8.0%, and 20.9%, respectively, whereas postoperative WC rate decreased by 14.8%. When controlling for time, SCIP INF-1 adherence was associated with improvement of postoperative WC rates (β = -0.0044, P = 0.005), whereas SCIP INF-2 adherence was associated with increased WCs (β = 0.0031, P = 0.018). SCIP VTE-1, -2 adherence improved by 14.6% and 20.2%, respectively, whereas postoperative deep vein thrombosis rate increased by 7.1% and postoperative PE rate increased by 3.7%. SCIP VTE-1 and -2 adherence were both associated with increased postoperative PE when controlling for time (SCIP VTE-1: β = 0.0019, P < 0.001; SCIP VTE-2: β = 0.0015, P < 0.001). Readmission analysis found SCIP INF-1 adherence to be associated with improved 30-d WC rates when controlling for patient and hospital characteristics (β = -0.0021, P = 0.032), whereas SCIP INF-3 adherence was associated with increased 30-d WC rates when controlling for time (β = 0.0007, P = 0.04). Only SCIP INF-1 adherence was associated with improved outcomes. The Joint Commission has retired SCIP INF-2, -3, and SCIP VTE-2 and made SCIP INF-1 and VTE-1 reporting optional. Our study supports

Diabetes mellitus prevalence is increasing in South Asians but is stable in Chinese living in Singapore and Mauritius.

PubMed

Tan, Kristin H X; Barr, Elizabeth L M; Koshkina, Vira; Ma, Stefan; Kowlessur, Sudhir; Magliano, Dianna J; Söderberg, Stefan; Chia, Kee Seng; Zimmet, Paul; Lim, Wei-Yen

2017-09-01

Asia is experiencing a type 2 diabetes epidemic, but prevalence differs by ethnicity and level of socioeconomic development. Singapore and Mauritius have implemented comprehensive campaigns to address this public health problem. We compared diabetes and obesity prevalence trends among Chinese and South Asians living in Singapore and Mauritius to determine the contribution of ethnicity and economic development to diabetes. Age-specific data from serial national population-based surveys in Singapore and Mauritius between 1987 and 2010 were used to estimate age-standardized diabetes and obesity prevalence. Modified Breslow-Cox proportional hazard models were used to obtain rate ratios for diabetes risk factors. In Singapore, the age-standardized prevalence of diabetes remained stable for Chinese (men: 14% in 1992, 13% in 2010; women: 12% in 1992, 10% in 2010), but increases were observed for South Asians (men: 20% in 1992, 26% in 2010; women: 18% in 1992, 20% in 2010). There were similar patterns in Mauritius. In both countries, obesity prevalence trends were stable for Chinese women, but increased for Chinese men and South Asians. Associations between obesity and diabetes were stronger in Chinese than South Asians regardless of country. Despite different socioeconomic settings in Singapore and Mauritius, we observed rising diabetes prevalence among South Asians but stable prevalence in Chinese in both countries. This provides further evidence that ethnicity contributes to the development of diabetes, and that there should be an increased emphasis on future prevention strategies targeting South Asian populations in these countries. © 2016 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

Trends in adherence to dietary recommendations among Korean type 2 diabetes mellitus patients.

PubMed

Park, Kyong

2015-12-01

The current study examined trends in adherence to dietary recommendations and compared the levels of adherence between diagnosed and undiagnosed subjects with type 2 diabetes mellitus (T2DM) in Korea over the past 14 years. Data were collected from the 1998-2012 Korea National Health and Nutrition Examination Surveys (KNHANES). Diagnosed diabetes was defined as giving a positive response to questions about awareness of the disease, a physician's diagnosis of diabetes, or medical treatment for diabetes, whereas undiagnosed diabetes was defined as having a fasting glucose level ≥ 126 mg/dl. Assessment of adherence level was based on 6 components of dietary guidelines, considering meal patterns and intake levels of calories, carbohydrates, vegetable/seaweed, sodium, and alcohol. The participants received 1 point if they met the criteria for each of the 6 components, and the total possible score ranged from 0 to 6 points. Multivariate generalized linear regression was performed, taking into account the complex survey design. Among all diabetic patients aged 30 years or older, the proportion of diagnosed diabetes increased dramatically, from 40.9% in 1998 to 75.9% in 2012 (P for trend < 0.001). The overall adherence levels to dietary recommendations were low and did not significantly differ between diagnosed and undiagnosed subjects with T2DM for all survey years. Several improvements were observed, including increased adherence to maintaining sufficient vegetable/seaweed consumption (increased from 0.12 to 0.16 points) and limiting sodium intake (increased from 0.12-0.13 points to 0.19-0.24 points; P for trend < 0.001), while adherence to maintaining moderate alcohol consumption decreased. Analysis of data collected by the KNHANES indicates that Korean T2DM patients have poor adherence to dietary recommendations and maintenance of a healthy lifestyle, regardless of disease awareness. This finding suggests that development of practical, evidence-based guidelines is

Patients differ in their ability to self-monitor adherence to a low-sodium diet versus medication.

PubMed

Chung, Misook L; Lennie, Terry A; de Jong, Marla; Wu, Jia-Rong; Riegel, Barbara; Moser, Debra K

2008-03-01

Poor adherence to a low-sodium diet (LSD) and prescribed medications increases rehospitalization risk in patients with heart failure (HF). Clinicians have difficulty assessing adherence objectively, so they depend on patients' self-report. The degree to which self-reported adherence reflects actual adherence is unclear. We examined patients' ability to self-monitor adherence to an LSD and medications by comparing self-reported adherence with objective evidence of adherence. A total of 133 patients with HF (male 71%; ejection fraction 35% +/- 14%) completed the Medical Outcomes Study Specific Adherence Scale. Adherence to the LSD and medication were assessed objectively using 24-hour urinary sodium excretion and dose counting with an electronic monitoring device, respectively. On the basis of self-report, patients were divided into adherent and non-adherent groups and evaluated for differences according to objective adherence. There were no differences in urinary sodium levels between the self-reported LSD adherent and non-adherent groups (4560 mg vs. 4333 mg; P = .59). Self-reported adherent and non-adherent medication groups took 92.4% and 80.4% of prescribed doses, respectively (P < .001). Patients were able to accurately estimate adherence to medication, but they failed to estimate LSD adherence. This finding suggests that we need to improve our means of evaluating adherence to the LSD and of educating patients more thoroughly about following the LSD. We speculated that the inability to estimate LSD adherence may be the result of gaps in patients' knowledge that preclude accurate self-assessment.

Predictors of Vitamin Adherence After Bariatric Surgery.

PubMed

Sunil, Supreet; Santiago, Vincent A; Gougeon, Lorraine; Warwick, Katie; Okrainec, Allan; Hawa, Raed; Sockalingam, Sanjeev

2017-02-01

Vitamin supplementation in bariatric aftercare is essential to prevent nutrient deficiencies; however, rates of vitamin adherence have been as low as 30 % 6 months post-surgery. Preliminary literature suggests non-adherence to prescribed treatments can be linked to demographic and psychological factors. We aimed to determine the relationship between these factors to vitamin adherence in post-bariatric surgery patients. A total of 92 bariatric patients were assessed 6 months post-surgery. Patients were administered a questionnaire collecting demographic information, psychological scores, and self-reported adherence. Nutrient deficiencies were analyzed through serum vitamin levels measured 3 and 6 months after surgery. Wilcoxon rank-sum and chi-square tests were used for analysis. Non-adherence was associated with male sex and full-time employment (p = 0.027, p = 0.015). There were no differences with respect to living situation, education level, or relationship type. Non-adherent patients did not have significantly higher scores for generalized anxiety, depressive symptoms, or avoidant behaviors. However, non-adherent patients displayed greater attachment anxiety than their adherent counterparts (p = 0.0186). Non-adherence was also associated with lower vitamin B12 levels 6 months post-surgery (p = 0.001). Male gender and full-time work have previously been shown to be associated with non-adherence. This is the first study to demonstrate that attachment anxiety is associated with poor multivitamin adherence in the post-surgical bariatric population. This result is concordant with recent literature that has demonstrated attachment anxiety is associated with poor adherence to dietary recommendations in bariatric patients 6 months postoperatively. Presurgical screening for attachment anxiety could facilitate early interventions to promote better bariatric aftercare in this group.

Outcome Measures in Rheumatology - Interventions for medication Adherence (OMERACT-Adherence) Core Domain Set for Trials of Interventions for Medication Adherence in Rheumatology: 5 Phase Study Protocol.

PubMed

Kelly, Ayano; Tong, Allison; Tymms, Kathleen; March, Lyn; Craig, Jonathan C; De Vera, Mary; Evans, Vicki; Hassett, Geraldine; Toupin-April, Karine; van den Bemt, Bart; Teixeira-Pinto, Armando; Alten, Rieke; Bartlett, Susan J; Campbell, Willemina; Dawson, Therese; Gill, Michael; Hebing, Renske; Meara, Alexa; Nieuwlaat, Robby; Shaw, Yomei; Singh, Jasvinder A; Suarez-Almazor, Maria; Sumpton, Daniel; Wong, Peter; Christensen, Robin; Beaton, Dorcas; de Wit, Maarten; Tugwell, Peter

2018-03-27

Over the last 20 years, there have been marked improvements in the availability of effective medications for rheumatic conditions such as gout, osteoporosis and rheumatoid arthritis (RA), which have led to a reduction in disease flares and the risk of re-fracture in osteoporosis, and the slowing of disease progression in RA. However, medication adherence remains suboptimal, as treatment regimens can be complex and difficult to continue long term. Many trials have been conducted to improve adherence to medication. Core domains, which are the outcomes of most relevance to patients and clinicians, are a pivotal component of any trial. These core domains should be measured consistently, so that all relevant trials can be combined in systematic reviews and meta-analyses to reach conclusions that are more valid. Failure to do this severely limits the potential for trial-based evidence to inform decisions on how to support medication adherence. The Outcome Measures in Rheumatology (OMERACT) - Interventions for Medication Adherence study by the OMERACT-Adherence Group aims to develop a core domain set for interventions that aim to support medication adherence in rheumatology. This OMERACT-Adherence study has five phases: (1) a systematic review to identify outcome domains that have been reported in interventions focused on supporting medication adherence in rheumatology; (2) semi-structured stakeholder interviews with patients and caregivers to determine their views on the core domains; (3) focus groups using the nominal group technique with patients and caregivers to identify and rank domains that are relevant to them, including the reasons for their choices; (4) an international three-round modified Delphi survey involving patients with diverse rheumatic conditions, caregivers, health professionals, researchers and other stakeholders to develop a preliminary core domain set; and (5) a stakeholder workshop with OMERACT members to review, vote on and reach a consensus on

Epidemiology of Trichomoniasis in South Korea and Increasing Trend in Incidence, Health Insurance Review and Assessment 2009-2014.

PubMed

Joo, So-Young; Goo, Youn-Kyoung; Ryu, Jae-Sook; Lee, Sang-Eun; Lee, Won Kee; Chung, Dong-Il; Hong, Yeonchul

2016-01-01

Trichomoniasis, which is caused by Trichomonas vaginalis, is one of the most common non-viral sexually transmitted infections; however, limited population-based data are available that describe patterns and trends of the disease. We summarized insurance claims of trichomoniasis cases reported during 2009-2014 to South Korea Health Insurance Review and Assessment Service. The average annual incidence in South Korea was 276.8 persons per 100,000 population, and a substantial sex-associated variation was observed. The incidence rate among female subjects trended upward over 6 years, that is, it increased from 501 in 2009 to 625.8 in 2014 per 100,000 female population, which indicates a 25% overall increase. This trend was sharpest in the ≥60 years group of female population. However, a 66% decrease in incidence rates was observed among male subjects (23.7 in 2009 to 15.7 in 2014 per 100,000 male population). Further, substantial decrease was observed in the ≥40 years groups of male population. The incidence of trichomoniasis varied across regions and was the highest in Jeju province of South Korea. Overall, as the incidence of trichomoniasis appears to have increased in South Korea during 2009-2014, the disease burden is increasing; hence, there is a need to better understand the disease transmission.

Medication adherence following coronary artery bypass graft surgery: assessment of beliefs and attitudes.

PubMed

Khanderia, Ujjaini; Townsend, Kevin A; Erickson, Steven R; Vlasnik, Jon; Prager, Richard L; Eagle, Kim A

2008-02-01

The medication management of patients following coronary artery bypass graft (CABG) surgery may include antiplatelet agents, beta-blockers, angiotensin-converting enzyme inhibitors, and statins. However, poor adherence is common, and patient attitudes and beliefs play a role in adherence. To evaluate the association between self-reported adherence and the beliefs patients have about cardiovascular medicines used after CABG. Adults were surveyed 6-24 months following CABG. The validated Beliefs about Medicines Questionnaire (BMQ) assessed attitudes concerning the Specific Necessity, Specific Concerns, General Harm, and General Overuse of medicines. The validated medication adherence scale assessed self-reported adherence. Analysis included univariate comparison (BMQ scales) and multivariate logistic regression (identification of adherence predictor variables). Of 387 patients surveyed, 132 (34%) completed the questionnaire. Nonparticipants were more likely to be female and have undergone 1- or 2-vessel CABG procedures compared with 3- or 4-vessel procedures. Subjects were primarily English-speaking, white, and male. Adherent behavior was reported in 73 of 132 patients (55%). The average period between CABG and the survey was 16 months. Nonadherent patients were in stronger agreement on the General Overuse (p = 0.01) and General Harm (p = 0.04) scales. The adjusted odds of adherent behavior were significantly lower, with an increasing General Overuse score (OR 0.83; 95% CI 0.72 to 0.95; p = 0.007); an annual income of $50,000 to $100,000 relative to less than $20,000 (OR 0.36; 95% CI 0.14 to 0.91; p = 0.031), and a living status of "alone" compared with "with adults and no children" (OR 0.20; 95% CI 0.06 to 0.65; p = 0.007). The odds ratio of self-reported adherence was higher with increasing age (OR 1.05; 95% CI 1.01 to 1.09; p = 0.023). In summary, patient beliefs and attitudes regarding medications, along with other social, economic, and demographic factors, help

Scaling up ART adherence clubs in the public sector health system in the Western Cape, South Africa: a study of the institutionalisation of a pilot innovation.

PubMed

MacGregor, Hayley; McKenzie, Andrew; Jacobs, Tanya; Ullauri, Angelica

2018-04-25

In 2011, a decision was made to scale up a pilot innovation involving 'adherence clubs' as a form of differentiated care for HIV positive people in the public sector antiretroviral therapy programme in the Western Cape Province of South Africa. In 2016 we were involved in the qualitative aspect of an evaluation of the adherence club model, the overall objective of which was to assess the health outcomes for patients accessing clubs through epidemiological analysis, and to conduct a health systems analysis to evaluate how the model of care performed at scale. In this paper we adopt a complex adaptive systems lens to analyse planned organisational change through intervention in a state health system. We explore the challenges associated with taking to scale a pilot that began as a relatively simple innovation by a non-governmental organisation. Our analysis reveals how a programme initially representing a simple, unitary system in terms of management and clinical governance had evolved into a complex, differentiated care system. An innovation that was assessed as an excellent idea and received political backing, worked well whilst supported on a small scale. However, as scaling up progressed, challenges have emerged at the same time as support has waned. We identified a 'tipping point' at which the system was more likely to fail, as vulnerabilities magnified and the capacity for adaptation was exceeded. Yet the study also revealed the impressive capacity that a health system can have for catalysing novel approaches. We argue that innovation in largescale, complex programmes in health systems is a continuous process that requires ongoing support and attention to new innovation as challenges emerge. Rapid scaling up is also likely to require recourse to further resources, and a culture of iterative learning to address emerging challenges and mitigate complex system errors. These are necessary steps to the future success of adherence clubs as a cornerstone of

Examining adherence among challenging patients in public and private HIV care in Argentina

PubMed Central

Jones, Deborah; Cook, Ryan; Cecchini, Diego; Sued, Omar; Bofill, Lina; Weiss, Stephen; Waldrop-Valverde, Drenna; Lopez, Maria R; Spence, Andrew

2015-01-01

Treatment engagement, retention and adherence to care are required for optimal HIV outcomes. Yet, patients may fall below the treatment recommendations for achieving undetectable viral load or not be retained in care. This study examined the most challenging patients in Buenos Aires, Argentina, those non-adherent to HIV care. Men (n = 61) and women (n = 59) prescribed antiretrovirals (ARVs) and non-adherent to treatment in the prior 3 to 6 months were enrolled and assessed regarding adherence, knowledge, motivation and attitudes regarding treatment. Private clinic patients had lower viral load and higher self-reported adherence than public clinic patients. Motivations to be adherent and positive beliefs regarding ARVs were associated with increased adherence in public clinic participants. Increased self-efficacy was associated with increased adherence among participants from both clinics. Results support patient and provider interventions that strengthen the characteristics supporting adherence, engagement and retention in public and private clinic settings. Resumen El compromiso, la retención en el cuidado y adherencia al tratamiento son esenciales para el manejo óptimo del paciente con VIH. Sin embargo, muchos pacientes con VIH no siguen las el tratamiento para lograr tener una carga viral indetectable, o no permanecen bajo cuidado médico. Este estudio examina los pacientes más difíciles de retener en el cuidado médico en Buenos Aires, Argentina. Hombres (n = 61) y mujeres (n = 59) a los que se les habían recetado antiretrovirales pero seguían el tratamiento en los últimos 3 - 6 meses participaron en el estudio. Adherencia, conocimiento, motivación y actitudes frente al tratamiento fueron evaluados. Los pacientes en la clínica privada tenían menor carga viral y mejor adherencia que los de la clínica pública. Motivación y pensamientos positivos con respecto a antiretrovirales estaban asociados con mejor adherencia en los pacientes de la clínica p

Solar radiation increases suicide rate after adjusting for other climate factors in South Korea.

PubMed

Jee, Hee-Jung; Cho, Chul-Hyun; Lee, Yu Jin; Choi, Nari; An, Hyonggin; Lee, Heon-Jeong

2017-03-01

Previous studies have indicated that suicide rates have significant seasonal variations. There is seasonal discordance between temperature and solar radiation due to the monsoon season in South Korea. We investigated the seasonality of suicide and assessed its association with climate variables in South Korea. Suicide rates were obtained from the National Statistical Office of South Korea, and climatic data were obtained from the Korea Meteorological Administration for the period of 1992-2010. We conducted analyses using a generalized additive model (GAM). First, we explored the seasonality of suicide and climate variables such as mean temperature, daily temperature range, solar radiation, and relative humidity. Next, we identified confounding climate variables associated with suicide rate. To estimate the adjusted effect of solar radiation on the suicide rate, we investigated the confounding variables using a multivariable GAM. Suicide rate showed seasonality with a pattern similar to that of solar radiation. We found that the suicide rate increased 1.008 times when solar radiation increased by 1 MJ/m 2 after adjusting for other confounding climate factors (P < 0.001). Solar radiation has a significant linear relationship with suicide after adjusting for region, other climate variables, and time trends. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Indigenous Gambling Motivations, Behaviour and Consequences in Northern New South Wales, Australia

ERIC Educational Resources Information Center

Breen, Helen M.; Hing, Nerilee; Gordon, Ashley

2011-01-01

Against a background of public health, we sought to examine and explain gambling behaviours, motivations and consequences of Indigenous Australians in northern New South Wales. Adhering to national Aboriginal and ethical guidelines and using qualitative methods, 169 Indigenous Australians were interviewed individually and in small groups using…

Roles of family dynamics on adherence to highly active antiretroviral therapy among people living with HIV/AIDS at a tertiary hospital in Osogbo, south-west Nigeria.

PubMed

Afolabi, B A; Afolabi, M O; Afolabi, A A; Odewale, M A; Olowookere, S A

2013-12-01

Adherence to highly active antiretroviral therapy (HAART) has been proven to be the only effective treatment for HIV/AIDS worldwide. Good adherence to HAART might require good family support. To determine the family dynamics and social support of people living with HIV/AIDS (PLWHA) and its roles on HAART adherence at an ARV treatment clinic in Osogbo, Nigeria. Descriptive cross-sectional study. Consenting PLWHA on HAART were interviewed using pre-tested semistructured questionnaire incorporating Perceived Social Support- Family Scale and Family APGAR. HAART adherence was measured using patient self report. A total of 379 PLWHA were interviewed. Their mean age was 40.8 (SD=9.9) years. Most (60.7%) were females. More than half (55.7%) were currently married and the majority (72.1%) had secondary education and were Yoruba (86.3%). Most respondents (95.5%) were adherent to HAART. Over 90% were satisfied with support received from their family while 82.3% were treated like other family members. Most attributed their HAART adherence to the care and support received from their family. Most PLWHA had good social support and were adherent to HAART.

Mental models of adherence: parallels in perceptions, values, and expectations in adherence to prescribed home exercise programs and other personal regimens.

PubMed

Rizzo, Jon; Bell, Alexandra

2018-05-09

A mental model is the collection of an individual's perceptions, values, and expectations about a particular aspect of their life, which strongly influences behaviors. This study explored orthopedic outpatients mental models of adherence to prescribed home exercise programs and how they related to mental models of adherence to other types of personal regimens. The study followed an interpretive description qualitative design. Data were collected via two semi-structured interviews. Interview One focused on participants prior experiences adhering to personal regimens. Interview Two focused on experiences adhering to their current prescribed home exercise program. Data analysis followed a constant comparative method. Findings revealed similarity in perceptions, values, and expectations that informed individuals mental models of adherence to personal regimens and prescribed home exercise programs. Perceived realized results, expected results, perceived social supports, and value of convenience characterized mental models of adherence. Parallels between mental models of adherence for prescribed home exercise and other personal regimens suggest that patients adherence behavior to prescribed routines may be influenced by adherence experiences in other aspects of their lives. By gaining insight into patients adherence experiences, values, and expectations across life domains, clinicians may tailor supports that enhance home exercise adherence. Implications for Rehabilitation A mental model is the collection of an individual's perceptions, values, and expectations about a particular aspect of their life, which is based on prior experiences and strongly influences behaviors. This study demonstrated similarity in orthopedic outpatients mental models of adherence to prescribed home exercise programs and adherence to personal regimens in other aspects of their lives. Physical therapists should inquire about patients non-medical adherence experiences, as strategies patients

Personality and patient adherence: correlates of the five-factor model in renal dialysis.

PubMed

Christensen, A J; Smith, T W

1995-06-01

The five-factor taxonomy of personality traits has received increasing attention in the literature regarding personality correlates of health outcomes and behaviors. We examined the association of the five NEO Five-Factor Inventory dimensions to medical regimen adherence in a sample of 72 renal dialysis patients. Results indicated that Conscientiousness (Dimension III) is a five-factor trait significantly associated with adherence to the medication regimen. No other NEO-FFI dimension was significantly associated with patient adherence.

A Mobile Gaming Intervention to Increase Adherence to Antiretroviral Treatment for Youth Living With HIV: Development Guided by the Information, Motivation, and Behavioral Skills Model.

PubMed

Whiteley, Laura; Brown, Larry; Lally, Michelle; Heck, Nicholas; van den Berg, Jacob J

2018-04-23

; and increasing personal relevance of HIV care. Behavioral skills themes centered on self-efficacy and strategies for medical adherence and self-care. On the client service questionnaire, 10 out of the 11 participants indicated they were "satisfied with the game activities," and 9 out of 11 "would recommend it to a friend." On the session evaluation form, 9 out of 11 agreed that they "learned a lot from the game." We utilized youth feedback, social learning theory (information-motivation-behavioral skills), and agile software development to create a multilevel, immersive, action-oriented iPhone gaming intervention to measure and improve treatment adherence for adolescents and young adults living with HIV. There is a dearth of gaming interventions for this population, and this study is a significant step in working toward the development and testing of an iPhone gaming app intervention to promote adherence to antiretroviral treatment. ClinicalTrials.gov NCT01887210; http://clinicaltrials.gov/ct2/show/NCT01887210 (Archived by WebCite at http://www.webcitation.org/6xHMW0NI1). ©Laura Whiteley, Larry Brown, Michelle Lally, Nicholas Heck, Jacob J van den Berg. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 23.04.2018.

A Mobile Gaming Intervention to Increase Adherence to Antiretroviral Treatment for Youth Living With HIV: Development Guided by the Information, Motivation, and Behavioral Skills Model

PubMed Central

2018-01-01

health care providers; decreasing stigma; and increasing personal relevance of HIV care. Behavioral skills themes centered on self-efficacy and strategies for medical adherence and self-care. On the client service questionnaire, 10 out of the 11 participants indicated they were “satisfied with the game activities,” and 9 out of 11 “would recommend it to a friend.” On the session evaluation form, 9 out of 11 agreed that they “learned a lot from the game.” Conclusions We utilized youth feedback, social learning theory (information-motivation-behavioral skills), and agile software development to create a multilevel, immersive, action-oriented iPhone gaming intervention to measure and improve treatment adherence for adolescents and young adults living with HIV. There is a dearth of gaming interventions for this population, and this study is a significant step in working toward the development and testing of an iPhone gaming app intervention to promote adherence to antiretroviral treatment. Trial Registration ClinicalTrials.gov NCT01887210; http://clinicaltrials.gov/ct2/show/NCT01887210 (Archived by WebCite at http://www.webcitation.org/6xHMW0NI1) PMID:29685863

Treatment Adherence in Patients With Headache: A Systematic Review

PubMed Central

Ramsey, Rachelle R.; Ryan, Jamie L.; Hershey, Andrew D.; Powers, Scott W.; Aylward, Brandon S.; Hommel, Kevin A.

2017-01-01

Objective To review and critically evaluate the extant research literature pertaining to adherence in youth and adults with headache and to provide recommendations for future research. Background This article provides the first systematic review of pediatric headache adherence and updates a previous review of treatment adherence in adults with headache. Design Systematic review of empirical literature. Methods A literature search with no date restriction was conducted using PubMed and PsycINFO electronic databases and bibliographies of relevant articles. Results Adherence rates in adults with headache range considerably from 25% to 94% across treatment, assessment method, and definition of adherence utilized. Methods to assess adherence included retrospective prescription claims data, paper or electronic diaries, follow-up appointment attendance, written and verbal self-report of general adherence, verbal self-report of adherence over a specific amount of time via in person interview or telephone, validated adherence measures, adherence questionnaires without validation, and counselor ratings of homework. Each methodology and assessment tool demonstrated strengths and weaknesses. No studies have systematically examined medication adherence in children with headache, and the few available studies examining adherence to behavioral treatment have documented adherence rates ranging from 52% to 86%. Conclusions Adherence research in adults with headache is growing, but studies demonstrate a number of methodological shortcomings. Adherence research in children with headache, and adherence intervention research in both adults and children, is scant. Future research should use objective measures of adherence, consider over-the-counter medications and medication overuse, examine demographic, psychological, and behavioral correlates of adherence, assess adherence to botulinum toxin type A, and examine the efficacy of adherence interventions in individuals with headache. PMID

Patient reminder systems and asthma medication adherence: a systematic review.

PubMed

Tran, Nancy; Coffman, Janet M; Sumino, Kaharu; Cabana, Michael D

2014-06-01

One of the most common reasons for medication non-adherence for asthma patients is forgetfulness. Daily medication reminder system interventions in the form of text messages, automated phone calls and audiovisual reminder devices can potentially address this problem. The aim of this review was to assess the effectiveness of reminder systems on patient daily asthma medication adherence. We conducted a systematic review of the literature to identify randomized controlled trials (RCTs) which assessed the effect of reminder systems on daily asthma medication adherence. We searched all English-language articles in Pub Med (MEDLINE), CINAHL, EMBASE, PsychINFO and the Cochrane Library through May 2013. We abstracted data on the year of study publication, location, inclusion and exclusion criteria, patient characteristics, reminder system characteristics, effect on patient adherence rate and other outcomes measured. Descriptive statistics were used to summarize the characteristics and results of the studies. Five RCTs and one pragmatic RCT were included in the analysis. Median follow-up time was 16 weeks. All of the six studies suggested that the reminder system intervention was associated with greater levels of participant asthma medication adherence compared to those participants in the control group. None of the studies documented a change in asthma-related quality of life or clinical asthma outcomes. All studies in our analysis suggest that reminder systems increase patient medication adherence, but none documented improved clinical outcomes. Further studies with longer intervention durations are needed to assess effects on clinical outcomes, as well as the sustainability of effects on patient adherence.

[Transcultural adaptation of scales for treatment adherence in hemodialysis: Renal Adherence Behaviour Questionnaire(RABQ) and Renal Adherence Attitudes Questionnaire(RAAQ)].

PubMed

Machado, Inês Maria de Jesus; Bandeira, Marina Bittencourt; Pinheiro, Hélady Sanders; Dutra, Nathália Dos Santos

2015-10-01

Treatment adherence in hemodialysis is important for guaranteeing better results for patients, but Brazil still lacks validated assessment tools for this purpose. The current study aimed to perform a cross-cultural adaptation of the Renal Adherence Behaviour Questionnaire (RABQ) and the Renal Adherence Attitudes Questionnaire (RAAQ). The two questionnaires were submitted to the following cross-cultural adaptation procedures: translation, back-translation, expert panel review, and pilot study. Changes were made in the items' wording and application, which requires a face-to-face interview. It was not necessary to change the choices of answers. The Brazilian versions of the RABQ and RAAQ showed semantic and cultural equivalence to the original versions and are easy for the target population to understand. The two scales still require validity and reliability studies before use in the field.

Understanding how adherence goals promote adherence behaviours: a repeated measure observational study with HIV seropositive patients

PubMed Central

2012-01-01

Background The extent to which patients follow treatments as prescribed is pivotal to treatment success. An exceptionally high level (> 95%) of HIV medication adherence is required to suppress viral replication and protect the immune system and a similarly high level (> 80%) of adherence has also been suggested in order to benefit from prescribed exercise programmes. However, in clinical practice, adherence to both often falls below the desirable level. This project aims to investigate a wide range of psychological and personality factors that may lead to adherence/non-adherence to medical treatment and exercise programmes. Methods HIV positive patients who are referred to the physiotherapist-led 10-week exercise programme as part of the standard care are continuously recruited. Data on social cognitive variables (attitude, intention, subjective norms, self-efficacy, and outcome beliefs) about the goal and specific behaviours, selected personality factors, perceived quality of life, physical activity, self-reported adherence and physical assessment are collected at baseline, at the end of the exercise programme and again 3 months later. The project incorporates objective measures of both exercise (attendance log and improvement in physical measures such as improved fitness level, weight loss, improved circumferential anthropometric measures) and medication adherence (verified by non-invasive hair analysis). Discussion The novelty of this project comes from two key aspects, complemented with objective information on exercise and medication adherence. The project assesses beliefs about both the underlying goal such as following prescribed treatment; and about the specific behaviours such as undertaking the exercise or taking the medication, using both implicit and explicit assessments of patients’ beliefs and attitudes. We predict that i) the way people think about the underlying goal of their treatments explains medication and exercise behaviours over and above

Clinical and economic impact of non-adherence to antidepressants in major depressive disorder: A systematic review.

PubMed

Ho, Siew Ching; Chong, Huey Yi; Chaiyakunapruk, Nathorn; Tangiisuran, Balamurugan; Jacob, Sabrina Anne

2016-03-15

Medication non-adherence is one of the major challenges in treating patients with depression. This systematic review aims to determine the clinical and economic outcomes of non-adherence in depression. A systematic search was performed across the following databases: PubMed, EMBASE, DARE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews; from database inception to March 31, 2015. Studies must report on the association between adherence and outcomes, and English full texts needed to be available. The quality of each study was assessed using the Newcastle-Ottawa scale. A total of 11 articles were included, with eight reporting on clinical outcomes, two reporting on economic outcomes, and one reporting on both. The majority of studies were retrospective cohort studies. The mean quality of all included studies was 7, with a range from 3 to 9. Results clearly indicate that patients who were non-adherent were more likely to experience increased risks of relapse and/or recurrence, emergency department visits, and hospitalization rates; increased severity of depression, and a decrease in response and remission rates. The worsening of clinical outcomes in patients who were non-adherent subsequently translated to an increase in healthcare utilization and charges. No standardized adherence measurement tools were used, and few studies looked at the economic impact of non-adherence in depression. There is a strong association between non-adherence to antidepressants and a worsening of patients' clinical and economic outcomes. Cost-effective interventions should be directed to this group of patients to improve medication adherence. Copyright © 2015 Elsevier B.V. All rights reserved.

Economic impact of medication non-adherence by disease groups: a systematic review.

PubMed

Cutler, Rachelle Louise; Fernandez-Llimos, Fernando; Frommer, Michael; Benrimoj, Charlie; Garcia-Cardenas, Victoria

2018-01-21

To determine the economic impact of medication non-adherence across multiple disease groups. Systematic review. A comprehensive literature search was conducted in PubMed and Scopus in September 2017. Studies quantifying the cost of medication non-adherence in relation to economic impact were included. Relevant information was extracted and quality assessed using the Drummond checklist. Seventy-nine individual studies assessing the cost of medication non-adherence across 14 disease groups were included. Wide-scoping cost variations were reported, with lower levels of adherence generally associated with higher total costs. The annual adjusted disease-specific economic cost of non-adherence per person ranged from $949 to $44 190 (in 2015 US$). Costs attributed to 'all causes' non-adherence ranged from $5271 to $52 341. Medication possession ratio was the metric most used to calculate patient adherence, with varying cut-off points defining non-adherence. The main indicators used to measure the cost of non-adherence were total cost or total healthcare cost (83% of studies), pharmacy costs (70%), inpatient costs (46%), outpatient costs (50%), emergency department visit costs (27%), medical costs (29%) and hospitalisation costs (18%). Drummond quality assessment yielded 10 studies of high quality with all studies performing partial economic evaluations to varying extents. Medication non-adherence places a significant cost burden on healthcare systems. Current research assessing the economic impact of medication non-adherence is limited and of varying quality, failing to provide adaptable data to influence health policy. The correlation between increased non-adherence and higher disease prevalence should be used to inform policymakers to help circumvent avoidable costs to the healthcare system. Differences in methods make the comparison among studies challenging and an accurate estimation of true magnitude of the cost impossible. Standardisation of the metric measures

Economic impact of medication non-adherence by disease groups: a systematic review

PubMed Central

Fernandez-Llimos, Fernando; Frommer, Michael; Benrimoj, Charlie; Garcia-Cardenas, Victoria

2018-01-01

Objective To determine the economic impact of medication non-adherence across multiple disease groups. Design Systematic review. Evidence review A comprehensive literature search was conducted in PubMed and Scopus in September 2017. Studies quantifying the cost of medication non-adherence in relation to economic impact were included. Relevant information was extracted and quality assessed using the Drummond checklist. Results Seventy-nine individual studies assessing the cost of medication non-adherence across 14 disease groups were included. Wide-scoping cost variations were reported, with lower levels of adherence generally associated with higher total costs. The annual adjusted disease-specific economic cost of non-adherence per person ranged from $949 to $44 190 (in 2015 US$). Costs attributed to ‘all causes’ non-adherence ranged from $5271 to $52 341. Medication possession ratio was the metric most used to calculate patient adherence, with varying cut-off points defining non-adherence. The main indicators used to measure the cost of non-adherence were total cost or total healthcare cost (83% of studies), pharmacy costs (70%), inpatient costs (46%), outpatient costs (50%), emergency department visit costs (27%), medical costs (29%) and hospitalisation costs (18%). Drummond quality assessment yielded 10 studies of high quality with all studies performing partial economic evaluations to varying extents. Conclusion Medication non-adherence places a significant cost burden on healthcare systems. Current research assessing the economic impact of medication non-adherence is limited and of varying quality, failing to provide adaptable data to influence health policy. The correlation between increased non-adherence and higher disease prevalence should be used to inform policymakers to help circumvent avoidable costs to the healthcare system. Differences in methods make the comparison among studies challenging and an accurate estimation of true magnitude of the

Adherence to exercise and affective responses: comparison between outdoor and indoor training.

PubMed

Lacharité-Lemieux, Marianne; Brunelle, Jean-Pierre; Dionne, Isabelle J

2015-07-01

Postmenopausal women, despite their increased cardiovascular risk, do not meet physical activity recommendations. Outdoor exercise bouts induce more positive affective responses than the same indoor exercise. Outdoor training could therefore increase exercise adherence. This study aims to compare the long-term effects of outdoor and indoor training on affective outcomes and adherence to exercise training in postmenopausal women. In a 12-week randomized trial, 23 healthy (body mass index, 22-29 kg/m) postmenopausal women (aged 52-69 y) were assigned to either outdoor training or indoor training and performed three weekly 1-hour sessions of identical aerobic and resistance training. Adherence, affective valence (Feeling Scale), affective states (Exercise-Induced Feeling Inventory), and rating of perceived exertion were measured during exercise sessions, whereas depression symptoms (Beck Depression Inventory) and physical activity level (Physical Activity Scale for the Elderly) were assessed before and after the intervention. After 12 weeks of training, exercise-induced changes in affective valence were higher for the outdoor training group (P ≤ 0.05). A significant group-by-time interaction was found for postexercise tranquility (P ≤ 0.01), with a significant increase outdoors and a significant decrease indoors (both P ≤ 0.05). A time effect was revealed for positive engagement, which decreased across time in the indoor group (P ≤ 0.05). Adherence to training (97% vs 91%) was significantly higher outdoors (P ≤ 0.01). Between baseline and week 12, depression symptoms decreased and physical activity level increased only for the outdoor group (P ≤ 0.01 and P ≤ 0.05, respectively). Outdoor training enhances affective responses to exercise and leads to greater exercise adherence than indoor training in postmenopausal women.

The Influence of Chronic Ego Depletion on Goal Adherence: An Experience Sampling Study.

PubMed

Wang, Ligang; Tao, Ting; Fan, Chunlei; Gao, Wenbin; Wei, Chuguang

2015-01-01

Although ego depletion effects have been widely observed in experiments in which participants perform consecutive self-control tasks, the process of ego depletion remains poorly understood. Using the strength model of self-control, we hypothesized that chronic ego depletion adversely affects goal adherence and that mental effort and motivation are involved in the process of ego depletion. In this study, 203 students reported their daily performance, mental effort, and motivation with respect to goal directed behavior across a 3-week time period. People with high levels of chronic ego depletion were less successful in goal adherence than those with less chronic ego depletion. Although daily effort devoted to goal adherence increased with chronic ego depletion, motivation to adhere to goals was not affected. Participants with high levels of chronic ego depletion showed a stronger positive association between mental effort and performance, but chronic ego depletion did not play a regulatory role in the effect of motivation on performance. Chronic ego depletion increased the likelihood of behavior regulation failure, suggesting that it is difficult for people in an ego-depletion state to adhere to goals. We integrate our results with the findings of previous studies and discuss possible theoretical implications.

Optimizing adherence in HIV prevention product trials: Development and psychometric evaluation of simple tools for screening and adherence counseling.

PubMed

Tolley, Elizabeth E; Guthrie, Kate Morrow; Zissette, Seth; Fava, Joseph L; Gill, Katherine; Louw, Cheryl E; Kotze, Philip; Reddy, Krishnaveni; MacQueen, Kathleen

2018-01-01

Low adherence in recent HIV prevention clinical trials highlights the need to better understand, measure, and support product use within clinical trials. Conventional self-reported adherence instruments within HIV prevention trials, often relying on single-item questions, have proven ineffective. While objective adherence measures are desirable, none currently exist that apply to both active and placebo arms. Scales are composed of multiple items in the form of questions or statements that, when combined, measure a more complex construct that may not be directly observable. When psychometrically validated, such measures may better assess the multiple factors contributing to adherence/non-adherence. This study aimed to develop and psychometrically evaluate tools to screen and monitor trial participants' adherence to HIV prevention products within the context of clinical trial research. Based on an extensive literature review and conceptual framework, we identified and refined 86 items assessing potential predictors of adherence and 48 items assessing adherence experience. A structured survey, including adherence items and other variables, was administered to former ASPIRE and Ring Study participants and similar non-trial participants (n = 709). We conducted exploratory factor analyses (EFA) to identify a reduced set of constructs and items that could be used at screening to predict potential adherence, and at follow-up to monitor and intervene on adherence. We examined associations with other variables to assess content and construct validity. The EFA of screener items resulted in a 6-factor solution with acceptable to very good internal reliability (α: .62-.84). Similar to our conceptual framework, factors represent trial-related commitment (Distrust of Research and Commitment to Research); alignment with trial requirements (Visit Adherence and Trial Incompatibility); Belief in Trial Benefits and Partner Disclosure. The EFA on monitoring items resulted in 4

The ability of multifamily groups to improve treatment adherence in Mexican Americans with schizophrenia.

PubMed

Kopelowicz, Alex; Zarate, Roberto; Wallace, Charles J; Liberman, Robert Paul; Lopez, Steven R; Mintz, Jim

2012-03-01

Evidence-based interventions to improve medication adherence among patients with schizophrenia are lacking. Although family psychoeducation has demonstrated efficacy in improving outcomes in schizophrenia, empirical support for its ability to enhance medication adherence is scarce. To determine whether a culturally adapted, multifamily group (MFG) therapy would increase medication adherence and decrease psychiatric hospitalizations for Spanish-speaking Mexican Americans with schizophrenia. A total of 174 Mexican American adults with schizophrenia-spectrum disorder and their key relatives were studied in a 3-armed, randomized controlled trial of MFG therapy focused on improving medication adherence. Assessments occurred at baseline and at 4, 8, 12, 18, and 24 months. Two community mental health centers in Los Angeles, California. Patients had a diagnosis of schizophrenia or schizoaffective disorder with a recent exacerbation of psychotic symptoms and nonadherence to medication before enrollment. Intervention  Patients participated in 1 of 2 MFGs (MFG-adherence or MFG-standard) or treatment as usual. Groups convened twice monthly in 90-minute sessions for 1 year. The Treatment Compliance Interview uses multiple sources of information to quantify medication adherence. Computerized records were used to collect information on the use of inpatient resources. At the end of the 1-year treatment, MFG-adherence was associated with higher medication adherence than MFG-standard or treatment as usual only (F = 6.41; P = .003). The MFG-adherence participants had a longer time to first hospitalization (χ(2) = 13.3; P = .001) and were less likely to be hospitalized than those in MFG-standard (χ(2) = 8.2; P = .04) and treatment as usual alone (χ(2) = 11.3; P < .001). Increased adherence accounted for one-third of the overall effect of treatment on the reduced risk for psychiatric hospitalization. Multifamily group therapy specifically tailored to improve

Impact on medication use and adherence of Australian pharmacists' diabetes care services.

PubMed

Krass, Ines; Taylor, Susan J; Smith, Carlene; Armour, Carol L

2005-01-01

To assess the effect of a specialized service implemented in community pharmacies for patients with type 2 diabetes on medication use and medication-related problems. Parallel group, multisite, control versus intervention, repeated measures design, with three different regions in New South Wales, Australia, used as intervention regions, then matched with control regions as much as possible. After initial training, pharmacists followed a clinical protocol for more than 9 months, with patient contact approximately monthly. Each patient received an adherence assessment at the beginning and end of the study, adherence support, and a medication review as part of the intervention. Risk of nonadherence using Brief Medication Questionnaire (BMQ) scores and changes to medication regimen. Compared with 82 control patients, 106 intervention patients with similar demographic and clinical characteristics had significantly improved self-reported nonadherence as reflected in total BMQ scores after 9 months. The mean (+/-SD) number of medications prescribed at follow-up in intervention participants decreased significantly, from 8.2+/-3.0 to 7.7+/-2.7. No reduction was observed among the control patients (7.6+/-2.4 and 7.3+/-2.4). The overall prevalence of changes to the regimen was also significantly higher in the intervention group (51%) compared with controls (40%). Community pharmacists trained in medication review and using protocols in collaboration with providers improved adherence in patients with type 2 diabetes, reduced problems patients had in accessing their medications, and recommended medication regimen changes that improved outcomes.

Contemporary issues on the epidemiology and antiretroviral adherence of HIV-infected adolescents in sub-Saharan Africa: a narrative review

PubMed Central

Adejumo, Olurotimi A; Malee, Kathleen M; Ryscavage, Patrick; Hunter, Scott J; Taiwo, Babafemi O

2015-01-01

Introduction Adolescents are a unique and sometimes neglected group in the planning of healthcare services. This is the case in many parts of sub-Saharan Africa, where more than eight out of ten of the world's HIV-infected adolescents live. Although the last decade has seen a reduction in AIDS-related mortality worldwide, largely due to improved access to effective antiretroviral therapy (ART), AIDS remains a significant contributor to adolescent mortality in sub-Saharan Africa. Although inadequate access to ART in parts of the subcontinent may be implicated, research among youth with HIV elsewhere in the world suggests that suboptimal adherence to ART may play a significant role. In this article, we summarize the epidemiology of HIV among sub-Saharan African adolescents and review their adherence to ART, emphasizing the unique challenges and factors associated with adherence behaviour. Methods We conducted a comprehensive search of online databases for articles, relevant abstracts, and conference reports from meetings held between 2010 and 2014. Our search terms included “adherence,” “compliance,” “antiretroviral use” and “antiretroviral adherence,” in combination with “adolescents,” “youth,” “HIV,” “Africa,” “interventions” and the MeSH term “Africa South of the Sahara.” Of 19,537 articles and abstracts identified, 215 met inclusion criteria, and 148 were reviewed. Discussion Adolescents comprise a substantial portion of the population in many sub-Saharan African countries. They are at particular risk of HIV and may experience worse outcomes. Although demonstrated to have unique challenges, there is a dearth of comprehensive health services for adolescents, especially for those with HIV in sub-Saharan Africa. ART adherence is poorer among older adolescents than other age groups, and psychosocial, socio-economic, individual, and treatment-related factors influence adherence behaviour among adolescents in this region. With

Variation in formulary adherence in general practice over time (2003-2007).

PubMed

van Dijk, Liset; de Jong, Judith D; Westert, Gert P; de Bakker, Dinny H

2011-12-01

To study trends and variation in adherence to the main national formulary for the 20 most prevalent health problems in Dutch general practice over a 5-year period (2003-07). Routine electronic medical records from a pool of 115 representative general practices were linked to the main national formulary. Analyses included over 2 million prescriptions for 246 391 patients. The outcome variable was whether or not the prescribed medication was congruent with recommendations in the national formulary. Trends and variation were analysed using three-level multilevel logistic regression analyses (general practice, patient, and prescription). The percentage of formulary adherent prescriptions for the 20 most prevalent health problems was 73-76% between 2003 and 2007. The percentage varied considerably between guidelines. Lowest adherence rates were found for acute bronchitis and acute upper respiratory infection. Interpractice variation was constant over time. General practice information networks are useful for monitoring general patterns of formulary on a year-to-year basis. Formulary adherence is stable over time but varies across diagnoses, patients and general practices. In the past decade, efforts have been made to increase the level of formulary adherent prescribing. These general efforts managed to stabilize (variation in) adherence in a field where many other initiatives (e.g. by pharmaceutical companies) are undertaken to influence prescribing behaviour.

Adherence to Behavioral Interventions for Urge Incontinence When Combined With Drug Therapy: Adherence Rates, Barriers, and Predictors

PubMed Central

Burgio, Kathryn L.; Goode, Patricia S.; Markland, Alayne D.; Kenton, Kimberly; Balasubramanyam, Aarthi; Stoddard, Anne M.

2010-01-01

Background Behavioral intervention outcomes for urinary incontinence (UI) depend on active patient participation. Objective The purpose of this study was to describe adherence to behavioral interventions (pelvic-floor muscle [PFM] exercises, UI prevention strategies, and delayed voiding), patient-perceived exercise barriers, and predictors of exercise adherence in women with urge-predominant UI. Design This was a prospectively planned secondary data analysis from a 2-stage, multicenter, randomized clinical trial. Patients and Intervention Three hundred seven women with urge-predominant UI were randomly assigned to receive either 10 weeks of drug therapy only or 10 weeks of drug therapy combined with a behavioral intervention for UI. One hundred fifty-four participants who received the combined intervention were included in this analysis. Measurements Pelvic-floor muscle exercise adherence and exercise barriers were assessed during the intervention phase and 1 year afterward. Adherence to UI prevention strategies and delayed voiding were assessed during the intervention only. Results During intervention, 81% of women exercised at least 5 to 6 days per week, and 87% performed at least 30 PFM contractions per day. Ninety-two percent of the women used the urge suppression strategy successfully. At the 12-month follow-up, only 32% of the women exercised at least 5 to 6 days per week, and 56% performed 15 or more PFM contractions on the days they exercised. The most persistent PFM exercise barriers were difficulty remembering to exercise and finding time to exercise. Similarly, difficulty finding time to exercise persisted as a predictor of PFM exercise adherence over time. Limitations Co-administration of medication for UI may have influenced adherence. Conclusions Most women adhered to exercise during supervised intervention; however, adherence declined over the long term. Interventions to help women remember to exercise and to integrate PFM exercises and UI prevention

A Step Toward Equal Justice: Programs to Increase Black Lawyers in the South.

ERIC Educational Resources Information Center

Evans, Eli, Ed.

An extensive evaluation of 5 years of grants from private foundations, corporations, and individuals to increase the number of black lawyers in the South is summarized in this pamphlet. The results of the evaluation of the Earl Warren Legal Training Program, Inc., and the Law Students Civil Rights Research Council indicated: (1) Larger numbers of…

Pain predicts non-adherence to pap smear screening among middle-aged African American women.

PubMed

Hoyo, Cathrine; Yarnall, Kimberly S H; Skinner, Celette Sugg; Moorman, Patricia G; Sellers, Denethia; Reid, LaVerne

2005-08-01

Middle-aged African American women have the highest incidence and mortality of invasive cervical cancer in the United States and the lowest adherence to pap smear screening. In 2001, we identified factors associated with non-adherence to screening recommendations using three focus group interviews and subsequently developed a questionnaire administered to 144 African American women aged 45 to 65 years. The perception that the Pap test was painful was associated with non-adherence to screening recommendations (OR = 4.78; 95%CI: 1.67-13.7). Difficulty to pay for the office visit coupled with perceived pain was associated with a nearly sixfold increase in risk of non-adherence (OR = 5.8; 95%CI: 2.8-15.5). Previously identified barriers to screening including lower education and socioeconomic status, poor access to care, knowledge of and exposure to known risk factors of invasive cervical cancer, cancer fatalism, and perceived racism were not independently associated with non-adherence. These data suggest that, among middle-aged African American women, future interventions addressing pain during a Pap test will likely increase acceptability of and adherence to cervical cancer screening. Pain could be addressed either by providing information during the pap test and/or using smaller lubricated speculums.

A population-based analysis of increasing rates of suicide mortality in Japan and South Korea, 1985-2010.

PubMed

Jeon, Sun Y; Reither, Eric N; Masters, Ryan K

2016-04-23

In the past two decades, rates of suicide mortality have declined among most OECD member states. Two notable exceptions are Japan and South Korea, where suicide mortality has increased by 20 % and 280 %, respectively. Population and suicide mortality data were collected through national statistics organizations in Japan and South Korea for the period 1985 to 2010. Age, period of observation, and birth cohort membership were divided into five-year increments. We fitted a series of intrinsic estimator age-period-cohort models to estimate the effects of age-related processes, secular changes, and birth cohort dynamics on the rising rates of suicide mortality in the two neighboring countries. In Japan, elevated suicide rates are primarily driven by period effects, initiated during the Asian financial crisis of the late 1990s. In South Korea, multiple factors appear to be responsible for the stark increase in suicide mortality, including recent secular changes, elevated suicide risks at older ages in the context of an aging society, and strong cohort effects for those born between the Great Depression and the aftermath of the Korean War. In spite of cultural, demographic and geographic similarities in Japan and South Korea, the underlying causes of increased suicide mortality differ across these societies-suggesting that public health responses should be tailored to fit each country's unique situation.

Therapist adherence to a motivational-interviewing intervention improves treatment entry for substance-misusing adolescents with low problem perception.

PubMed

Smith, Douglas C; Hall, James A; Jang, Mijin; Arndt, Stephan

2009-01-01

This study evaluated whether adherence to the Strengths-Oriented Referral for Teens (SORT) model, a motivational interviewing (MI)-consistent intervention addressing ambivalence about attending treatment, positively predicted adolescents' initial-session attendance. Therapist adherence was rated in 54 audiotaped SORT sessions by coders who were blind to treatment-entry status. Higher adherence scores reflected greater use of MI and solution focused language, discussion of client strengths, and dialogue with families on treatment need and options. Therapist adherence during adolescent segments interacted with adolescent problem perception. Predicted probabilities of attending initial sessions increased for low-problem-perception adolescents at increasingly higher therapist adherence. Although replication studies are needed, the SORT model of providing MI-consistent debriefing following initial assessments appears to be a promising approach for increasing treatment entry. Initial support for the treatment-matching hypothesis was found for substance-misusing adolescents contemplating treatment entry.

Psychosocial and demographic predictors of adherence and non-adherence to health advice accompanying air quality warning systems: a systematic review.

PubMed

D'Antoni, Donatella; Smith, Louise; Auyeung, Vivian; Weinman, John

2017-09-22

Although evidence shows that poor air quality can harm human health, we have a limited understanding about the behavioural impact of air quality forecasts. Our aim was to understand to what extent air quality warning systems influence protective behaviours in the general public, and to identify the demographic and psychosocial factors associated with adherence and non-adherence to the health advice accompanying these warnings. In August 2016 literature was systematically reviewed to find studies assessing intended or actual adherence to health advice accompanying air quality warning systems, and encouraging people to reduce exposure to air pollution. Predictors of adherence to the health advice and/or self-reported reasons for adherence or non-adherence were also systematically reviewed. Studies were included only if they involved participants who were using or were aware of these warning systems. Studies investigating only protective behaviours due to subjective perception of bad air quality alone were excluded. The results were narratively synthesised and discussed within the COM-B theoretical framework. Twenty-one studies were included in the review: seventeen investigated actual adherence; three investigated intended adherence; one assessed both. Actual adherence to the advice to reduce or reschedule outdoor activities during poor air quality episodes ranged from 9.7% to 57% (Median = 31%), whereas adherence to a wider range of protective behaviours (e.g. avoiding busy roads, taking preventative medication) ranged from 17.7% to 98.1% (Median = 46%). Demographic factors did not consistently predict adherence. However, several psychosocial facilitators of adherence were identified. These include knowledge on where to check air quality indices, beliefs that one's symptoms were due to air pollution, perceived severity of air pollution, and receiving advice from health care professionals. Barriers to adherence included: lack of understanding of the indices

Mediation effects of medication information processing and adherence on association between health literacy and quality of life.

PubMed

Song, Sunmi; Lee, Seung-Mi; Jang, Sunmee; Lee, Yoon Jin; Kim, Na-Hyun; Sohn, Hye-Ryoung; Suh, Dong-Churl

2017-09-16

To examine whether medication related information processing defined as reading of over-the-counter drug labels, understanding prescription instructions, and information seeking-and medication adherence account for the association between health literacy and quality of life, and whether these associations may be moderated by age and gender. A sample of 305 adults in South Korea was recruited through a proportional quota sampling to take part in a cross-sectional survey on health literacy, medication-related information processing, medication adherence, and quality of life. Descriptive statistics and structural equation modeling (SEM) were performed. Two mediation pathways linking health literacy with quality of life were found. First, health literacy was positively associated with reading drug labels, which was subsequently linked to medication adherence and quality of life. Second, health literacy was positively associated with accurate understanding of prescription instructions, which was associated with quality of life. Age moderation was found, as the mediation by reading drug labels was significant only among young adults whereas the mediation by understanding of medication instruction was only among older adults. Reading drug labels and understanding prescription instructions explained the pathways by which health literacy affects medication adherence and quality of life. The results suggest that training skills for processing medication information can be effective to enhance the health of those with limited health literacy.

Impact of a pharmaceutical care program on clinical evolution and antiretroviral treatment adherence: a 5-year study

PubMed Central

Arroyo, María Jesús Hernández; Figueroa, Salvador Enrique Cabrera; Correa, Rosa Sepúlveda; de la Paz Valverde Merino, María; Gómez, Alicia Iglesias; Hurlé, Alfonso Domínguez-Gil

2013-01-01

Background Antiretroviral treatments (ART) form the basis of adequate clinical control in human immunodeficiency virus-infected patients, and adherence plays a primary role in the grade and duration of the antiviral response. The objectives of this study are: (1) to determine the impact of the implementation of a pharmaceutical care program on improvement of ART adherence and on the immunovirological response of the patients; and (2) to detect possible correlations between different adherence evaluation measurements. Methods A 60-month long retrospective study was conducted. Adherence measures used were: therapeutic drug monitoring, a simplified medication adherence questionnaire, and antiretroviral dispensation records (DR). The number of interviews and interventions related to adherence made for each patient in yearly periods was related to the changes in the adherence variable (measured with DR) in these same yearly periods. The dates when the laboratory tests were drawn were grouped according to proximity with the study assessment periods (February–May, 2005–2010). Results A total of 528 patients were included in the study. A significant relationship was observed between the simplified medication adherence questionnaire and DR over the 60-month study period (P < 0.01). Improvement was observed in the mean adherence level (P < 0.001), and there was a considerable decrease in the percentage of patients with CD4+ lymphocytes less than 200 cells/mm3 (P < 0.001). A relationship was found between the number of patients with optimum adherence levels and the time that plasma viral load remained undetected. The number of interviews and interventions performed in each patient in the first 12 months from the onset of the pharmaceutical care program (month 6), was related to a significant increase in adherence during this same time period. Conclusion The results suggest that the establishment and permanence of a pharmaceutical care program may increase ART adherence

"It Was Not My Aim to Sleep There": The Impact of Timing and Location of Sex on Adherence to Coitally-Dependent HIV Pre-exposure Prophylaxis.

PubMed

Scorgie, Fiona; Stadler, Jonathan; Baron, Deborah; Ju, Susan; Ikaneng, Tshepiso; Mabude, Zonke; Makgopa, Sylvia; Malefo, Matshidiso A; Manenzhe, Kgahlisho N; Mazibuko, Thulani; Ntjana, Hilda; Nkala, Busi; Palanee-Phillips, Thesla; Gray, Glenda; Rees, Helen; Delany-Moretlwe, Sinead

2018-06-16

The FACTS 001 trial found that vaginal pre- and post-coital application of 1% tenofovir gel did not prevent HIV-1 infection amongst young South African women. The trial included a multi-faceted approach to adherence support and collected objective and self-reported adherence measures. Using qualitative data collected from a random sub-set of FACTS 001 participants (135 in-depth interviews at product discontinuation and 13 focus group discussions at dissemination of trial results), we explore the importance of 'place' and 'timing' in shaping acts of sexual intimacy and product adherence. Demographically, this qualitative sub-sample is similar to the trial cohort of predominantly young, unemployed women living with parents or other family members. Sexual intimacy was largely unpredictable and happened across multiple locations in which women had limited privacy, autonomy, or control over the timing of sex. This made adherence to the dosing strategy challenging. Findings may inform the development of future event-driven pre-exposure prophylaxis regimens or products.

Epidemiology of Trichomoniasis in South Korea and Increasing Trend in Incidence, Health Insurance Review and Assessment 2009-2014

PubMed Central

Joo, So-Young; Goo, Youn-Kyoung; Ryu, Jae-Sook; Lee, Sang-Eun; Lee, Won Kee; Chung, Dong-Il; Hong, Yeonchul

2016-01-01

Trichomoniasis, which is caused by Trichomonas vaginalis, is one of the most common non-viral sexually transmitted infections; however, limited population-based data are available that describe patterns and trends of the disease. We summarized insurance claims of trichomoniasis cases reported during 2009–2014 to South Korea Health Insurance Review and Assessment Service. The average annual incidence in South Korea was 276.8 persons per 100,000 population, and a substantial sex-associated variation was observed. The incidence rate among female subjects trended upward over 6 years, that is, it increased from 501 in 2009 to 625.8 in 2014 per 100,000 female population, which indicates a 25% overall increase. This trend was sharpest in the ≥60 years group of female population. However, a 66% decrease in incidence rates was observed among male subjects (23.7 in 2009 to 15.7 in 2014 per 100,000 male population). Further, substantial decrease was observed in the ≥40 years groups of male population. The incidence of trichomoniasis varied across regions and was the highest in Jeju province of South Korea. Overall, as the incidence of trichomoniasis appears to have increased in South Korea during 2009–2014, the disease burden is increasing; hence, there is a need to better understand the disease transmission. PMID:27936227

A mobile application improves therapy-adherence rates in elderly patients undergoing rehabilitation

PubMed Central

Mertens, Alexander; Brandl, Christopher; Miron-Shatz, Talya; Schlick, Christopher; Neumann, Till; Kribben, Andreas; Meister, Sven; Diamantidis, Clarissa Jonas; Albrecht, Urs-Vito; Horn, Peter; Becker, Stefan

2016-01-01

Abstract Medication adherence is crucial for success in the management of patients with chronic conditions. This study analyzes whether a mobile application on a tablet aimed at supporting drug intake and vital sign parameter documentation affects adherence in elderly patients. Patients with coronary heart disease and no prior knowledge of tablet computers were recruited. They received a personal introduction to the mobile application Medication Plan, installed on an Apple iPad. The study was conducted using a crossover design with 3 sequences: initial phase, interventional phase (28 days of using the app system), and comparative phase (28 days of using a paper diary). Users experienced the interventional and comparative phases alternately. A total of 24 patients (12 males; mean age 73.8 years) were enrolled in the study. The mean for subjectively assessed adherence (A14-scale; 5-point Likert scale, from “never” to “very often” which results in a score from 0 to 56) before the study was 50.0 (SD = 3.44). After both interventions there was a significant increase, which was more pronounced after the interventional phase (54.0; SD = 2.01) than after the comparative phase (52.6; SD = 2.49) (for all pairs after both interventions, P <0.001). Neither medical conditions nor the number of drug intake (amount and frequency of drug taking) per day affected subjective adherence. Logging data showed a significantly stronger adherence for the medication app than the paper system for both blood pressure recordings (P <0.001) and medication intake (P = 0.033). The majority of participants (n = 22) stated that they would like to use the medication app in their daily lives and would not need further assistance with the app. A mobile app for medication adherence increased objectively and subjectively measured adherence in elderly users undergoing rehabilitation. The findings have promising clinical implications: digital tools can assist chronic disease patients achieve

Financial incentives to improve adherence to antipsychotic maintenance medication in non-adherent patients: a cluster randomised controlled trial.

PubMed

Priebe, Stefan; Bremner, Stephen A; Lauber, Christoph; Henderson, Catherine; Burns, Tom

2016-09-01

.67; p = 0.003) and subjective quality of life (difference in means 0.71, 95% CI 0.26 to 1.15; p = 0.002). Follow-ups: after incentives stopped, adherence did not differ significantly between groups, neither during the first 6 months (adjusted difference in means -7.4%, 95% CI -17.0% to 2.1%; p = 0.175) nor during the period from month 7 to month 24 (difference in means -5.7%, 95% CI -13.1% to 1.7%; p = 0.130). Cost-effectiveness: the average costs of the financial incentives was £303. Overall costs per patient were somewhat higher in the intervention group, but the difference was not significant. Semistructured interviews: the majority of patients and clinicians reported positive experiences with the incentives beyond their monetary value. These included improvement in the therapeutic relationship. The majority of both patients and clinicians perceived no negative impact after the intervention was stopped after 1 year. Financial incentives are effective in improving adherence to LAI medication. Health-care costs (including costs of the financial incentive) are unlikely to be increased substantially by this intervention. Once the incentives stop, the advantage is not maintained. The experiences of both patients and clinicians are largely, but not exclusively, positive. Whether or not financial incentives are effective for patients with more favourable background, those on oral mediation or for shorter or longer time periods remains unknown. Current Controlled Trials ISRCTN77769281. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 70. See the NIHR Journals Library website for further project information.

Gamification and Adherence to Web-Based Mental Health Interventions: A Systematic Review

PubMed Central

O'Neill, Noelle; van Woerden, Hugo; Eslambolchilar, Parisa; Jones, Matt; John, Ann

2016-01-01

Background Adherence to effective Web-based interventions for common mental disorders (CMDs) and well-being remains a critical issue, with clear potential to increase effectiveness. Continued identification and examination of “active” technological components within Web-based interventions has been called for. Gamification is the use of game design elements and features in nongame contexts. Health and lifestyle interventions have implemented a variety of game features in their design in an effort to encourage engagement and increase program adherence. The potential influence of gamification on program adherence has not been examined in the context of Web-based interventions designed to manage CMDs and well-being. Objective This study seeks to review the literature to examine whether gaming features predict or influence reported rates of program adherence in Web-based interventions designed to manage CMDs and well-being. Methods A systematic review was conducted of peer-reviewed randomized controlled trials (RCTs) designed to manage CMDs or well-being and incorporated gamification features. Seven electronic databases were searched. Results A total of 61 RCTs met the inclusion criteria and 47 different intervention programs were identified. The majority were designed to manage depression using cognitive behavioral therapy. Eight of 10 popular gamification features reviewed were in use. The majority of studies utilized only one gamification feature (n=58) with a maximum of three features. The most commonly used feature was story/theme. Levels and game leaders were not used in this context. No studies explicitly examined the role of gamification features on program adherence. Usage data were not commonly reported. Interventions intended to be 10 weeks in duration had higher mean adherence than those intended to be 6 or 8 weeks in duration. Conclusions Gamification features have been incorporated into the design of interventions designed to treat CMD and well

Effects of written action plan adherence on COPD exacerbation recovery.

PubMed

Bischoff, Erik W M A; Hamd, Dina H; Sedeno, Maria; Benedetti, Andrea; Schermer, Tjard R J; Bernard, Sarah; Maltais, François; Bourbeau, Jean

2011-01-01

The effects of written action plans on recovery from exacerbations of chronic obstructive pulmonary disease (COPD) have not been well studied. The aims of this study were to assess the effects of adherence to a written action plan on exacerbation recovery time and unscheduled healthcare utilisation and to explore factors associated with action plan adherence. This was a 1-year prospective cohort study embedded in a randomised controlled trial. Exacerbation data were recorded for 252 patients with COPD who received a written action plan for prompt treatment of exacerbations with the instructions to initiate standing prescriptions for both antibiotics and prednisone within 3 days of exacerbation onset. Following the instructions was defined as adherence to the action plan. From the 288 exacerbations reported by 143 patients, start dates of antibiotics or prednisone were provided in 217 exacerbations reported by 119 patients (53.8% male, mean age 65.4 years, post-bronchodilator forced expiratory volume in 1 s (FEV(1)) 43.9% predicted). In 40.1% of exacerbations, patients adhered to their written action plan. Adherence reduced exacerbation recovery time with statistical (p=0.0001) and clinical (-5.8 days) significance, but did not affect unscheduled healthcare utilisation (OR 0.94, 95% CI 0.49 to 1.83). Factors associated with an increased likelihood of adherence were influenza vaccination, cardiac comorbidity, younger age and lower FEV(1) as percentage predicted. This study shows that adherence to a written action plan is associated with a reduction in exacerbation recovery time by prompt treatment. Knowing the factors that are associated with proper and prompt utilisation of an action plan permits healthcare professionals to better focus their self-management support on appropriate patients.

The effects of physician communications skills on patient satisfaction; recall, and adherence.

PubMed

Bartlett, E E; Grayson, M; Barker, R; Levine, D M; Golden, A; Libber, S

1984-01-01

An understanding of means to improve patient adherence to the therapeutic regimen is a subject of increasing concern in medical care. This study examined the effects of physician interpersonal skills and teaching on patient satisfaction, recall, and adherence to the regimen. We studied the ambulatory visits of 63 patients to five medical residents at a teaching hospital in Baltimore. It was found that quality of interpersonal skills influenced patient outcomes more than quantity of teaching and instruction. Secondary analyses found that all the effects of physician communication skills on patient adherence are mediated by patient satisfaction and recall. These findings indicate that the physician might pay particular attention to these two variables in trying to improve patient adherence, and that enhancing patient satisfaction may be pivotal to the care of patients with chronic illness.

Differential subjective responsiveness to a future cigarette price increase among South Korean youth smokers.

PubMed

Do, Young Kyung; Farooqui, Muhammad Assad

2012-02-01

While higher sensitivity to tobacco price increases among younger smokers as a group has been well recognized, little information is available on heterogeneity among youth smokers. This study examined differential responsiveness to an unspecified future cigarette price increase by smoking rate. This study used a subsample of 6,187 current youth smokers derived from the 2007 Korea Youth Health Survey, an annually repeated cross-sectional survey designed to monitor adolescent health behaviors in a large nationally representative sample of middle-school and high-school students in South Korea (N = 74,698). A generalized ordered logit model was estimated to examine independent associations of self-reported responses to an unspecified future cigarette price increase with smoking rate and time since smoking initiation, after controlling for other individual and family characteristics. Higher smoking rates and longer time since smoking initiation were associated with a greater likelihood to continue smoking despite a future cigarette price increase. When these two factors were accounted for in the model, other individual characteristics were not statistically significant. Among youth smokers in South Korea, higher smoking rates were associated with lower self-reported responsiveness to a future cigarette price increase. Tobacco tax increases help prevent youth smokers from progressing to advanced stages of smoking, while certain subgroups of youth smokers, especially with nicotine dependence, may still need other effective cessation interventions.

Modeling the economic impact of medication adherence in type 2 diabetes: a theoretical approach.

PubMed

Cobden, David S; Niessen, Louis W; Rutten, Frans Fh; Redekop, W Ken

2010-09-07

While strong correlations exist between medication adherence and health economic outcomes in type 2 diabetes, current economic analyses do not adequately consider them. We propose a new approach to incorporate adherence in cost-effectiveness analysis. We describe a theoretical approach to incorporating the effect of adherence when estimating the long-term costs and effectiveness of an antidiabetic medication. This approach was applied in a Markov model which includes common diabetic health states. We compared two treatments using hypothetical patient cohorts: injectable insulin (IDM) and oral (OAD) medications. Two analyses were performed, one which ignored adherence (analysis 1) and one which incorporated it (analysis 2). Results from the two analyses were then compared to explore the extent to which adherence may impact incremental cost-effectiveness ratios. In both analyses, IDM was more costly and more effective than OAD. When adherence was ignored, IDM generated an incremental cost-effectiveness of $12,097 per quality-adjusted life-year (QALY) gained versus OAD. Incorporation of adherence resulted in a slightly higher ratio ($16,241/QALY). This increase was primarily due to better adherence with OAD than with IDM, and the higher direct medical costs for IDM. Incorporating medication adherence into economic analyses can meaningfully influence the estimated cost-effectiveness of type 2 diabetes treatments, and should therefore be considered in health care decision-making. Future work on the impact of adherence on health economic outcomes, and validation of different approaches to modeling adherence, is warranted.

Microbial adherence to cosmetic contact lenses.

PubMed

Chan, Ka Yin; Cho, Pauline; Boost, Maureen

2014-08-01

To investigate whether cosmetic contact lenses (CCL) with surface pigments affect microbial adherence. Fifteen brands of CCL were purchased from optical, non-optical retail outlets, and via the Internet. A standardized rub-off test was performed on each CCL (five lenses per brand) to confirm the location of the pigments. The rub-off test comprised gentle rubbing on the surfaces of each CCL with wetted cotton buds for a maximum of 20 rubs per surface. A new set of CCL (five lenses per brand) were incubated in Pseudomonas aeruginosa overnight. Viable counts of adhered bacteria were determined by the number of colony-forming units (CFU) on agar media on each lens. The adherence of P. aeruginosa as well as Staphylococcus aureus and Serratia marcescens to three brands of CCL (A-C) (five lenses per brand) were also compared to their adherences on their clear counterparts. Only two of the 15 brands of CCL tested (brands B and C) had pigments that did not detach with the rub-off test. The remaining 13 brands of CCL all failed the rub-off test and these lenses showed higher P. aeruginosa adherence (8.7 × 10(5)-1.9 × 10(6) CFU/lens). Brands B and C lenses showed at least six times less bacterial adhesion than the other 13 brands. Compared to their clear counterparts, bacterial adherence to brands B and C lenses did not differ significantly, whereas brand A lenses showed significantly higher adherence. Surface pigments on CCL resulted in significantly higher bacterial adherence. Copyright © 2013 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Predictors of adherence to treatment in bronchiectasis.

PubMed

McCullough, Amanda R; Tunney, Michael M; Stuart Elborn, J; Bradley, Judy M; Hughes, Carmel M

2015-07-01

We aimed to determine if beliefs about treatment, clinical factors and quality of life predicted adherence to treatment in patients with bronchiectasis. We recruited participants with confirmed bronchiectasis to a one-year study. We calculated adherence to treatment using medication possession ratios and self-report. Baseline Beliefs about Medicines, clinical, demographic and Quality of Life Questionnaire-Bronchiectasis data were collected. We used logistic regression to determine predictors of adherence to treatment during the subsequent year. Seventy-five participants were recruited. Beliefs about harm, age and total number of prescribed medications were predictors of adherence to inhaled antibiotics. Concerns about medication, age and Quality of Life Questionnaire-Bronchiectasis Treatment Burden were predictors of adherence to other respiratory medicines. Beliefs about necessity of airway clearance and age were predictors of adherence to airway clearance. Beliefs about treatment, age, number of prescribed medications and perceived treatment burden predicted subsequent adherence in bronchiectasis, thereby, providing potential targets for future interventions in this population. Clinicians can use these data to identify patients with bronchiectasis who might be at risk of non-adherence i.e. those who are younger, have concerns about medications, who do not think airway clearance is necessary or who are prescribed numerous medications. Copyright © 2015 Elsevier Ltd. All rights reserved.

Menstrual cycle phase and single tablet antiretroviral medication adherence in women with HIV.

PubMed

Hessol, Nancy A; Holman, Susan; Minkoff, Howard; Cohen, Mardge H; Golub, Elizabeth T; Kassaye, Seble; Karim, Roksana; Sosanya, Oluwakemi; Shaheen, Christopher; Merhi, Zaher

2016-01-01

Suboptimal adherence to antiretroviral (ARV) therapy among HIV-infected individuals is associated with increased risk of progression to AIDS and the development of HIV resistance to ARV medications. To examine whether the luteal phase of the menstrual cycle is independently associated with suboptimal adherence to single tablet regimen (STR) ARV medication, data were analyzed from a multicenter cohort study of HIV-infected women who reported regular menstrual cycles and were taking an STR. In a cross-sectional analysis, suboptimal adherence to an STR among women in their follicular phase was compared with suboptimal adherence among women in their luteal phase. In two-way crossover analyses, whereby the same woman was assessed for STR medication adherence in both her follicular and luteal phases, the estimated exact conditional odds of non-adherence to an STR was measured. In adjusted logistic regression analysis of the cross-sectional data (N=327), women with ≤12 years of education were more than three times more likely to have suboptimal adherence (OR=3.6, p=.04) compared to those with >12 years of education. Additionally, women with Center for Epidemiological Studies Depression Scale (CES-D) scores ≥23 were 2.5-times more likely to have suboptimal adherence (OR=2.6, p=.02) compared to those with CES-D scores <23. In conditional logistic regression analyses of the crossover data (N=184), having childcare responsibilities was associated with greater odds of ≤95% adherence. Menstrual cycle phase was not associated with STR adherence in either the cross-sectional or crossover analyses. The lack of association between phase of the menstrual cycle and adherence to an STR in HIV-infected women means attention can be given to other more important risk factors for suboptimal adherence, such as depression, level of education, and childcare responsibilities.

Determinants of medication adherence to topical glaucoma therapy.

PubMed

Dreer, Laura E; Girkin, Christopher; Mansberger, Steven L

2012-01-01

To determine the associations between medical, demographic, socioeconomic, and ocular factors and adherence to topical glaucoma ocular hypotensive therapy. One hundred sixteen patients with ocular hypertension or open-angle glaucoma from 2 tertiary glaucoma services participated in this prospective study. Adherence to ocular hypotensive therapy was measured using an electronic dose monitor (Travatan Dosing Aid, Alcon Laboratories Inc., Fort Worth, TX) and collected data at 3 months after enrollment. We used 3 different definitions of adherence: 1) Definition 1: the proportion of days taking the prescribed number of drops within 3 hours of the prescribed dosing time; 2) Definition 2: the proportion of days taking any drops within 3 hours of the prescribed dosing time; and 3) Definition 3: the proportion of days taking any drops within 6 hours of the prescribed dosing time. Univariate and multivariate models were used to determine the association between the 3 adherence definitions, medical, demographic, socioeconomic, and ocular factors at 3-month follow-up. The main outcome measures for this study were risk factors for poor objective medication adherence. Adherence, using Definition 1, Definition 2, and Definition 3, was 64%, 75%, and 80%, respectively. Age, total number of other eye diseases, and race were significantly associated with full treatment adherence (Definition 1), with race alone significantly predicting 11% of full treatment adherence. For Definition 2, age, income, level of education, and total number of eye diseases were significantly associated with partial adherence (3 h), again race alone significantly predicted 15% of partial adherence (any drops within 3 h). For Definition 3, race, income, level of education, and total number of other eye diseases significantly predicted partial adherence (any drops within 6 h), both race and income predicted 19% of partial treatment adherence. Significant differences for adherence rates between patients of

Relationships among medication adherence, lifestyle modification, and health-related quality of life in patients with acute myocardial infarction: a cross-sectional study.

PubMed

Lee, Yu-Mi; Kim, Rock Bum; Lee, Hey Jean; Kim, Keonyeop; Shin, Min-Ho; Park, Hyeung-Keun; Ahn, Soon-Ki; Kim, So Young; Lee, Young-Hoon; Kim, Byoung-Gwon; Lee, Heeyoung; Lee, Won Kyung; Lee, Kun Sei; Kim, Mi-Ji; Park, Ki-Soo

2018-05-22

The healthy adherer effect is a phenomenon in which patients who adhere to medical therapies tend to pursue health-seeking behaviors. Although the healthy adherer effect is supposed to affect health outcomes in patients with coronary artery disease, evaluation of its presence and extent is not easy. This study aimed to assess the relationship between medication adherence and lifestyle modifications and health-related quality of life among post-acute myocardial infarction (AMI) patients. A cross-sectional study was conducted in 417 post-AMI patients who underwent percutaneous coronary intervention (PCI). Patients were recruited from 11 university hospitals from December 2015 to March 2016 in South Korea. Details regarding socio-demographic factors, six health behaviors (low-salt intake, low-fat diet and/or weight-loss diet, regular exercise, stress reduction in daily life, drinking in moderation, and smoking cessation), medication adherence using the Modified Morisky Scale (MMS), and HRQoL using the Coronary Revascularization Outcome Questionnaire (CROQ) were surveyed in a one-on-one interview. In the univariate logistic analysis, sex (female), age (≥70 years), MMS score (≥5), and CROQ score were associated with adherence to lifestyle modification. In the multiple logistic analysis, a high MMS score (≥5) was associated with adherence to lifestyle modification after adjusting for sex, age, marital status, education, and family income (adjusted odds ratio [OR] = 11.7, 95% confidence interval [CI] = 1.5-91.3). After further adjusting for the CROQ score, the association between high MMS score and adherence to lifestyle modification was significant (adjusted OR = 11.5, 95% CI = 1.4-93.3). Adherence to medication was associated with adherence to lifestyle modification, suggesting the possible presence of the healthy adherer effect in post-AMI patients. After further adjusting for HRQoL, the association remained. To improve health outcome in post

Improving AIDS Care After Trauma (ImpACT): Pilot Outcomes of a Coping intervention Among HIV-Infected Women with Sexual Trauma in South Africa.

PubMed

Sikkema, Kathleen J; Mulawa, Marta I; Robertson, Corne; Watt, Melissa H; Ciya, Nonceba; Stein, Dan J; Cherenack, Emily M; Choi, Karmel W; Kombora, Matapelo; Joska, John A

2018-03-01

Improving AIDS Care after Trauma (ImpACT), a coping intervention for HIV-infected women with sexual abuse histories, was evaluated for feasibility and potential efficacy in a public clinic in Cape Town, South Africa. Sixty-four participants were enrolled prior to starting antiretroviral therapy (ART). After completing baseline assessments, participants were randomly assigned to standard of care (SoC: three adherence counseling sessions) or ImpACT (SoC plus four individual and three group sessions). Participants completed assessments at 3 months (after individual sessions) and 6 months post-baseline. In exploratory analysis of primary outcomes, ImpACT participants, compared to SoC, reported greater reductions in avoidance and arousal symptoms of PTSD and greater increases in ART adherence motivation at 3 months. Clinically significant decreases in overall PTSD symptoms were also demonstrated at 3 months. These effects continued as trends at the 6-month assessment, in addition to increases in social/spiritual coping. In analysis of secondary outcomes, high levels of non-adherence to ART and poor care engagement were evident at 6 months, with no differences between study arms. A trauma-focused, culturally-adapted individual intervention delivered by a non-specialist in the HIV care setting is feasible and acceptable. Preliminary findings suggest ImpACT has potential to reduce PTSD symptoms and increase ART adherence motivation, but a more intensive intervention may be needed to improve and maintain care engagement among this population. ClinicalTrials.gov NCT02223390.

Role of Counseling to Promote Adherence in Healthy Lifestyle Medicine: Strategies to Improve Exercise Adherence and Enhance Physical Activity.

PubMed

Stonerock, Gregory L; Blumenthal, James A

Although healthy lifestyles (HL) offer a number of health benefits, nonadherence to recommended lifestyle changes remains a frequent and difficult obstacle to realizing these benefits. Behavioral counseling can improve adherence to an HL. However, individuals' motivation for change and resistance to altering unhealthy habits must be considered when developing an effective approach to counseling. In the present article, we review psychological, behavioral, and environmental factors that may promote adherence and contribute to nonadherence. We discuss two established models for counseling, motivational interviewing and the transtheoretical model of behavior change, and provide an example of how these approaches can be used to counsel patients to exercise and increase their levels of physical activity. Copyright © 2016 Elsevier Inc. All rights reserved.

Self-Efficacy and Short-Term Adherence to Continuous Positive Airway Pressure Treatment in Children.

PubMed

Xanthopoulos, Melissa S; Kim, Ji Young; Blechner, Michael; Chang, Ming-Yu; Menello, Mary Kate; Brown, Christina; Matthews, Edward; Weaver, Terri E; Shults, Justine; Marcus, Carole L

2017-07-01

Infants, children, and adolescents are increasingly being prescribed continuous positive airway pressure (CPAP) for treatment of obstructive sleep apnea syndrome (OSAS), yet adherence is often poor. The purpose of this study was to examine the relationship between caregiver and patient-reported health cognitions about CPAP prior to starting CPAP and CPAP adherence at 1 month. We hypothesized that greater caregiver-reported self-efficacy would be positively associated with CPAP adherence in children. We also evaluated patient-reported self-efficacy and caregiver- and patient-reported risk perception and outcome expectations as they related to adherence, as well as how demographic factors influenced these relationships. A pediatric modification of the Self-Efficacy Measure for Sleep Apnea Questionnaire was administered to children and adolescents with OSAS-prescribed CPAP and their caregivers during the clinical CPAP-initiation visit. The primary outcome variable for adherence was the average total minutes of CPAP usage across all days from the date that CPAP was initiated to 31 days later. Unadjusted ordinary least-square regression showed a significant association between caregiver-reported self-efficacy and adherence (p = .007), indicating that mean daily CPAP usage increased by 48.4 minutes when caregiver-reported self-efficacy increased by one point (95% confidence interval 13.4-83.4 minutes). No other caregiver- or patient-reported cognitive health variables were related to CPAP use. This study indicates that caregiver CPAP-specific self-efficacy is an important factor to consider when starting youth on CPAP therapy for OSAS. Employing strategies to improve caregiver self-efficacy, beginning at CPAP initiation, may promote CPAP adherence. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Post-traumatic stress disorder and medication adherence: results from the Mind Your Heart study.

PubMed

Kronish, Ian M; Edmondson, Donald; Li, Yongmei; Cohen, Beth E

2012-12-01

Patients with post-traumatic stress disorder (PTSD) are at increased risk for adverse outcomes from comorbid medical conditions. Medication non-adherence is a potential mechanism explaining this increased risk. We examined the association between PTSD and medication adherence in a cross-sectional study of 724 patients recruited from two Department of Veterans Affairs Medical Centers between 2008 and 2010. PTSD was assessed using the Clinician Administered PTSD Scale. Medication adherence was assessed using a standardized questionnaire. Ordinal logistic regression models were used to calculate the odds ratios (ORs) for medication non-adherence in patients with versus without PTSD, adjusting for potential confounders. A total of 252 patients (35%) had PTSD. Twelve percent of patients with PTSD reported not taking their medications as prescribed compared to 9% of patients without PTSD (unadjusted OR 1.85, 95% CI 1.37-2.50, P<0.001). Forty-one percent of patients with PTSD compared to 29% of patients without PTSD reported forgetting medications (unadjusted OR 1.90, 95% CI 1.44-2.52, P<0.001). Patients with PTSD were also more likely to report skipping medications (24% versus 13%; unadjusted OR 2.01, 95% CI 1.44-2.82, P<0.001). The association between PTSD and non-adherence remained significant after adjusting for demographics, depression, alcohol use, social support, and medical comorbidities (adjusted OR 1.47, 95% CI 1.03-2.10, P=0.04 for not taking medications as prescribed and 1.95, 95% CI 1.31-2.91, P=0.001 for skipping medications). PTSD was associated with medication non-adherence independent of psychiatric and medical comorbidities. Medication non-adherence may contribute to the increased morbidity and mortality observed in patients with PTSD. Copyright © 2012 Elsevier Ltd. All rights reserved.

The association between market availability and adherence to antihypertensive medications: an observational study.

PubMed

Evans, Charity D; Eurich, Dean T; Lu, Xinya; Remillard, Alfred J; Shevchuk, Yvonne M; Blackburn, David

2013-02-01

High adherence to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reported in observational studies has frequently been attributed to improved tolerability. However, these agents are also relatively new to the market compared to other antihypertensive medications. We aimed to determine if an association exists between adherence and market availability of a specific antihypertensive agent. This retrospective cohort study used administrative data from Saskatchewan, Canada. Subjects were ≥40 years of age and received a new antihypertensive medication between 1994 and 2002. The primary outcome was the proportion of subjects achieving optimal adherence (≥80%) at 1 year, stratified by antihypertensive medication class and the year of availability. Adherence was measured using the cumulative mean gap ratio. A total of 36,214 subjects met the inclusion criteria. Optimal adherence was observed in 4987 of 8623 (57.8%) subjects receiving ACEIs and 1013 of 1600 (63.3%) subjects receiving ARBs, but adherence appeared inconsistent when examined within each antihypertensive class. A pattern of increasing mean adherence was observed according to availability in the ACEI subgroup (Spearman r = 0.82; P = 0.007) but not the ARB subgroup (Spearman r = 0.41; P = 0.49). However, the association between availability and optimal adherence converged when ARB and ACEI users were combined (Spearman r = 0.85, P < 0.001). Optimal adherence with ACEIs and ARBs compared to other antihypertensive agents may be associated with their relative availability. To what extent optimal adherence is also associated with improved tolerability, as currently believed, remains to be determined.

Non-adherence in children with asthma reviewed: The need for improvement of asthma care and medical education.

PubMed

Klok, Ted; Kaptein, Adrian A; Brand, Paul L P

2015-05-01

Adherence to daily inhaled corticosteroid therapy is a key determinant of asthma control. Therefore, improving adherence to inhaled corticosteroids is the most effective method through which healthcare providers can help children with uncontrolled asthma. However, identifying non-adherent patients is difficult, and electronic monitoring is the only reliable method to assess adherence. (Non-)adherence is a complex behavioural process influenced by many interacting factors. Intentional barriers to adherence are common; driven by illness perceptions and medication beliefs, patients and parents deliberately choose not to follow the doctor's recommendations. Common non-intentional barriers are related to family routines, child-raising issues, and to social issues such as poverty. Effective interventions improving adherence are complex, because they take intentional and non-intentional barriers to adherence into account. There is evidence that comprehensive, guideline-based asthma self-management programmes can be successful, with excellent adherence and good asthma control. Patient-centred care focused on healthcare provider-patient/parent collaboration is the key factor determining the success of guided self-management programmes. Such care should focus on shared decision-making as this has been shown to improve adherence and healthcare outcomes. Current asthma care falls short because many physicians fail to adhere to asthma guidelines in their diagnostic approach and therapeutic prescriptions, and because of the lack of application of patient-centred health care. Increased awareness of the importance of patient-centred communication and increased training in patient-centred communication skills of undergraduates and experienced attending physicians are needed to improve adherence to daily controller therapy and asthma control in children with asthma. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Technology and the healthcare system: implications for patient adherence.

PubMed

Beni, Juliet B

2011-01-01

Patient nonadherence is a growing and costly problem in the healthcare system, especially for patients with chronic illness. Between 25% and 40% of patients are nonadherent to treatment, and estimated costs directly associated with patient nonadherence in the US healthcare system are $290 billion a year. Nonadherence to preventive and treatment regimens is correlated to negative consequences for patients; however, many barriers to the promotion of successful adherence remain. Some such barriers include financial constraints, physical disability, side effects, forgetfulness, age and complex multi-drug regimens. The implementation of technology in healthcare systems is changing the way in which healthcare providers and patients must approach adherence. The following review applies a framework, the Information-Motivation-Strategy Model?, developed by DiMatteo and colleagues, to the field to conceptualise the changing factors affecting patient adherence as global healthcare moves toward increasingly technology-based systems of care.

Deep South Atlantic carbonate chemistry and increased interocean deep water exchange during last deglaciation

NASA Astrophysics Data System (ADS)

Yu, Jimin; Anderson, Robert F.; Jin, Zhangdong; Menviel, Laurie; Zhang, Fei; Ryerson, Fredrick J.; Rohling, Eelco J.

2014-04-01

Carbon release from the deep ocean at glacial terminations is a critical component of past climate change, but the underlying mechanisms remain poorly understood. We present a 28,000-year high-resolution record of carbonate ion concentration, a key parameter of the global carbon cycle, at 5-km water depth in the South Atlantic. We observe similar carbonate ion concentrations between the Last Glacial Maximum and the late Holocene, despite elevated concentrations in the glacial surface ocean. This strongly supports the importance of respiratory carbon accumulation in a stratified deep ocean for atmospheric CO2 reduction during the last ice age. After ˜9 μmol/kg decline during Heinrich Stadial 1, deep South Atlantic carbonate ion concentration rose by ˜24 μmol/kg from the onset of Bølling to Pre-boreal, likely caused by strengthening North Atlantic Deep Water formation (Bølling) or increased ventilation in the Southern Ocean (Younger Drays) or both (Pre-boreal). The ˜15 μmol/kg decline in deep water carbonate ion since ˜10 ka is consistent with extraction of alkalinity from seawater by deep-sea CaCO3 compensation and coral reef growth on continental shelves during the Holocene. Between 16,600 and 15,000 years ago, deep South Atlantic carbonate ion values converged with those at 3.4-km water depth in the western equatorial Pacific, as did carbon isotope and radiocarbon values. These observations suggest a period of enhanced lateral exchange of carbon between the deep South Atlantic and Pacific Oceans, probably due to an increased transfer of momentum from southern westerlies to the Southern Ocean. By spreading carbon-rich deep Pacific waters around Antarctica for upwelling, invigorated interocean deep water exchange would lead to more efficient CO2 degassing from the Southern Ocean, and thus to an atmospheric CO2 rise, during the early deglaciation.

Mobile Applications to Improve Medication Adherence.

PubMed

Haase, Jamie; Farris, Karen B; Dorsch, Michael P

2017-02-01

Background and Introduction: Mobile applications are useful tools to improve medication adherence. As developers continue to improve the features of existing mobile applications, pharmacists should be aware of the current features that are available to patients. There are limited studies available that discuss which applications have the most desirable features. The aim of this study was to compare available mobile applications and identify ideal application features used to improve medication adherence. As of September 5, 2014, the search terms "medication adherence" and "medication reminder" generated a total of 225 hits. Ideal application features were used to create an Application Score Card to identify applications with the highest number of ideal features. We identified 30 applications that were written in English, medication related, last updated in 2014, and did not meet any exclusion criteria. The top five applications RxNetwork, Mango Health, MyMeds, C3HealthLink, and HuCare are discussed in detail. There are numerous studies looking at medication adherence. However, current literature regarding mobile applications to improve medication adherence is lacking. This article will provide pharmacists with a brief overview of the available mobile applications and features that could be used to improve patient adherence to medications. Existing mobile applications to improve medication adherence have ideal features that could help patients take medication as prescribed. Once further research is performed to establish their efficacy, pharmacists could begin to recommend mobile applications to their patients.

Integrative Review of Mobile Phone Contacts and Medication Adherence in Severe Mental Illness.

PubMed

Bright, Cordellia E

Poor medication adherence is a significant problem in individuals with severe mental illness (SMI). About 50% of people with SMI become nonadherent to treatment in the first month following discharge from the hospital. This study examined literature in the past decade (2006-2016) on the use of mobile phone contacts in individuals with SMI to improve medication adherence post hospital discharge. This integrative review used the search terms texting, text messaging, SMS, cell/mobile phone, medication adherence, medication compliance, and mental illness. Databases (CINAHL, PubMed, PsycINFO, and Scopus) and manual searching of reference lists were done. The main inclusion criteria were the use of mobile phone contacts on medication adherence in individuals with SMI. Adults 18 years and older, studies conducted from 2006 to 2016, and studies conducted in English were also criteria for inclusion. Only five studies met criteria for inclusion. Outcomes from the review showed that mobile phone contacts have been used to improve medication adherence in individuals with SMI and able to provide the four types of social support (instrumental, informational, emotional, and, appraisal). When phone contacts especially text messaging was used as an adjunct to other interventions, it yielded better medication adherence than when used alone. However, results on medication adherence rates were mixed in participants on both psychiatric and nonpsychiatric medications. Although mobile phone contacts are a promising tool to enhance medication adherence after hospital discharge, its effectiveness to increase medication adherence in this population remains inconclusive.

Assessment of rheumatoid arthritis patients' adherence to treatment.

PubMed

Gadallah, Mohsen A; Boulos, Dina N K; Gebrel, Asmaa; Dewedar, Sahar; Morisky, Donald E

2015-02-01

Reports on adherence among patients with rheumatoid arthritis (RA) in Egypt and the Middle East region are lacking. This study aimed to measure adherence to treatment among a sample of patients with RA at Ain Shams University Rheumatology outpatient clinic and to assess factors affecting it. A cross-sectional descriptive study was carried out at the rheumatology outpatient clinic on a sample of 140 patients with RA. An interview questionnaire was used to measure adherence using the 8-item Morisky's scale, factors affecting adherence to treatment like patients satisfaction were assessed using the short form patient satisfaction questionnaire, also patients' knowledge, beliefs and rate of prescription refilling were assessed. Disease Activity Score-28 was used as an objective method to assess RA disease activity. According to Morisky's scale, 90.6% and 9.4% were classified as low and moderately adherent, respectively, none was classified as highly adherent to treatment. Important barriers to adherence reported were fear of side effects, nonavailability of free drugs in hospital pharmacy and cost of medications. Younger patients (P=0.002) and those reporting greater general satisfaction (P=0.02) were more likely to be adherent. In addition, on-time refill rates of medication (P=0.001) and disease activity (P=0.02) were associated with higher adherence scores and thus further validated the results of the adherence questionnaire. Higher adherence was associated with more positive beliefs on medication, greater satisfaction with health care and less disease activity.

Psychosocial factors in maternal phenylketonuria: women's adherence to medical recommendations.

PubMed Central

Waisbren, S E; Hamilton, B D; St James, P J; Shiloh, S; Levy, H L

1995-01-01

OBJECTIVES. This study identified factors predicting adherence to medical recommendations in maternal phenylketonuria, which can result in severe fetal damage. METHODS. Sixty-nine women with phenylketonuria, 68 of their acquaintances, and 69 women with diabetes mellitus were interviewed annually for 5 years. A model in which each stage in the maternal phenylketonuria life cycle represented a treatment-related goal provided a means to assess adherence. RESULTS. At the stages of prevention of unplanned pregnancy, treatment initiation, and diet continuation throughout pregnancy, attitudes and social support were associated with adherence to medical recommendations. No specific variables were associated with outcome at reproductive decision making, but women with phenylketonuria were more likely to delay making a decision, resulting in unplanned and, hence, untreated or late-treated pregnancy. CONCLUSIONS. Women with phenylketonuria differed from their acquaintances and diabetic women in many respects, suggesting that special programs are needed. Greater emphasis on reproductive decision making is especially needed. Interventions that focus on improving social support networks and attitudes about treatment may increase adherence to recommendations. PMID:7503337

The Influence of Chronic Ego Depletion on Goal Adherence: An Experience Sampling Study

PubMed Central

Wang, Ligang; Tao, Ting; Fan, Chunlei; Gao, Wenbin; Wei, Chuguang

2015-01-01

Although ego depletion effects have been widely observed in experiments in which participants perform consecutive self-control tasks, the process of ego depletion remains poorly understood. Using the strength model of self-control, we hypothesized that chronic ego depletion adversely affects goal adherence and that mental effort and motivation are involved in the process of ego depletion. In this study, 203 students reported their daily performance, mental effort, and motivation with respect to goal directed behavior across a 3-week time period. People with high levels of chronic ego depletion were less successful in goal adherence than those with less chronic ego depletion. Although daily effort devoted to goal adherence increased with chronic ego depletion, motivation to adhere to goals was not affected. Participants with high levels of chronic ego depletion showed a stronger positive association between mental effort and performance, but chronic ego depletion did not play a regulatory role in the effect of motivation on performance. Chronic ego depletion increased the likelihood of behavior regulation failure, suggesting that it is difficult for people in an ego-depletion state to adhere to goals. We integrate our results with the findings of previous studies and discuss possible theoretical implications. PMID:26562839

Adherence to pharmacotherapy improves school performance in children with rhinitis and asthma.

PubMed

Sánchez, J; Sánchez, A; Cardona, R

2018-03-17

Adherence to pharmacotherapy reduces symptoms of asthma and rhinitis, however, little is known of its impact on school performance. To evaluate the impact of pharmacotherapy in absenteeism and school performance in a child population. A cross-sectional study, carried out in eight schools. All participants and their parents were given a questionnaire assessing parameters related to respiratory diseases and pharmacotherapy. Data on school performance was obtained from the academic history of each child who participated in the study. Adherence to pharmacotherapy was classified as a correct use of therapy for more than five days per week. 1109 children agreed to participate. Students were divided into two groups: symptomatic (36%) and asymptomatic (63%). The symptomatic group had a higher frequency of school absenteeism (1 vs. 3.1days/year/patient p<0.01) and lower academic performance (failed: 20% vs. 33% p<0.01). After dividing the symptomatic group between adherents and non-adherents to the pharmacotherapy, the group of adherents had a similar school performance to the asymptomatic group and it was significantly different from the no-adherent group. Respiratory symptoms are associated with poor school performance and with an increase in school absenteeism, but adherence to pharmacotherapy can reduce these negative impacts in children. Copyright © 2018 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.

Promoting adherence to nebulized therapy in cystic fibrosis: poster development and a qualitative exploration of adherence.

PubMed

Jones, Stephen; Babiker, Nathan; Gardner, Emma; Royle, Jane; Curley, Rachael; Hoo, Zhe Hui; Wildman, Martin J

2015-01-01

Cystic fibrosis (CF) health care professionals recognize the need to motivate people with CF to adhere to nebulizer treatments, yet little is known about how best to achieve this. We aimed to produce motivational posters to support nebulizer adherence by using social marketing involving people with CF in the development of those posters. The Sheffield CF multidisciplinary team produced preliminary ideas that were elaborated upon with semi-structured interviews among people with CF to explore barriers and facilitators to the use of nebulized therapy. Initial themes and poster designs were refined using an online focus group to finalize the poster designs. People with CF preferred aspirational posters describing what could be achieved through adherence in contrast to posters that highlighted the adverse consequences of nonadherence. A total of 14 posters were produced through this process. People with CF can be engaged to develop promotional material to support adherence, providing a unique perspective differing from that of the CF multidisciplinary team. Further research is needed to evaluate the effectiveness of these posters to support nebulizer adherence.

Promoting adherence to nebulized therapy in cystic fibrosis: poster development and a qualitative exploration of adherence

PubMed Central

Jones, Stephen; Babiker, Nathan; Gardner, Emma; Royle, Jane; Curley, Rachael; Hoo, Zhe Hui; Wildman, Martin J

2015-01-01

Background Cystic fibrosis (CF) health care professionals recognize the need to motivate people with CF to adhere to nebulizer treatments, yet little is known about how best to achieve this. We aimed to produce motivational posters to support nebulizer adherence by using social marketing involving people with CF in the development of those posters. Methods The Sheffield CF multidisciplinary team produced preliminary ideas that were elaborated upon with semi-structured interviews among people with CF to explore barriers and facilitators to the use of nebulized therapy. Initial themes and poster designs were refined using an online focus group to finalize the poster designs. Results People with CF preferred aspirational posters describing what could be achieved through adherence in contrast to posters that highlighted the adverse consequences of nonadherence. A total of 14 posters were produced through this process. Conclusion People with CF can be engaged to develop promotional material to support adherence, providing a unique perspective differing from that of the CF multidisciplinary team. Further research is needed to evaluate the effectiveness of these posters to support nebulizer adherence. PMID:26346635

Allopurinol Medication Adherence as a Mediator of Optimal Outcomes in Gout Management.

PubMed

Coburn, Brian W; Bendlin, Kayli A; Sayles, Harlan; Meza, Jane; Russell, Cynthia L; Mikuls, Ted R

2017-09-01

Patient and provider factors, including allopurinol medication adherence, affect gout treatment outcomes. The aim of this study was to examine associations of patient and provider factors with optimal gout management. Linking longitudinal health and pharmacy dispensing records to questionnaire data, we assessed patient and provider factors among 612 patients with gout receiving allopurinol during a recent 1-year period. Associations of patient (medication adherence and patient activation) and provider factors (dose escalation, low-dose initiation, and anti-inflammatory prophylaxis) with serum urate (SU) goal achievement of less than 6.0 mg/dL were examined using multivariable logistic regression. Medication adherence was assessed as a mediator of these factors with goal achievement. A majority of patients (63%) were adherent, whereas a minority received dose escalation (31%). Medication adherence was associated with initiation of daily allopurinol doses of 100 mg/d or less (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.20-2.76). In adjusted models, adherence (OR, 2.35; 95% CI, 1.50-3.68) and dose escalation (OR, 2.48; 95% CI, 2.48-4.25) were strongly associated with SU goal attainment. Low starting allopurinol dose was positively associated with SU goal attainment (OR, 1.11; 95% CI, 1.02-1.20) indirectly through early adherence, but also had a negative direct association with SU goal attainment (OR, 0.21; 95% CI, 0.12-0.37). Medication adherence and low starting dose combined with dose escalation represent promising targets for future gout quality improvement efforts. Low starting dose is associated with better SU goal attainment through increased medication adherence, but may be beneficial only in settings where appropriate dose escalation is implemented.

Psychological determinants of adolescent exercise adherence.

PubMed

Douthitt, V L

1994-01-01

The purpose of this study was to identify some psychological determinants of exercise adherence on which public school physical education programs may have an impact. Data were collected twice, once representing a structured physical education classroom setting (N = 132), and later representing an unstructured summer vacation exercise setting (N = 110). Male and female physical education students at a large suburban high school completed five questionnaires which represented four psychological variables (self-motivation, perceived control, personality/sport congruence, and perceived self-competency), and one physical activity variable (exercise adherence) in both of the two data-collection periods. The results indicated that Perceived Romantic Appeal was predictive of male exercise adherence while Perceived Athletic Competency, Perceived Global Self-Worth, and Perceived Physical Appearance were predictive of female exercise adherence. None of the psychological predictor variables was significant for competitive subjects in either exercise setting, yet Perceived Romantic Appeal and Personality/Sport Congruence were predictive of noncompetitive subjects' exercise adherence in the structured and unstructured settings, respectively.

Improving Medication Adherence in Cardiometabolic Disease

PubMed Central

Ferdinand, Keith C.; Senatore, Fortunato Fred; Clayton-Jeter, Helene; Cryer, Dennis R.; Lewin, John C.; Nasser, Samar A.; Fiuzat, Mona; Califf, Robert M.

2017-01-01

Medication nonadherence, a major problem in cardiovascular disease (CVD), contributes yearly to approximately 125,000 preventable deaths, which is partly attributable to only about one-half of CVD patients consistently taking prescribed life-saving medications. Current interest has focused on how labeling and education influence adherence. This paper summarizes the scope of CVD nonadherence, describes key U.S. Food and Drug Administration initiatives, and identifies potential targets for improvement. We describe key adherence factors, methods, and technological applications for simplifying regimens and enhancing adherence, and 4 areas where additional collaborative research and implementation involving the regulatory system and clinical community could substantially reduce nonadherence: 1) identifying monitoring methods; 2) improving the evidence base to better understand adherence; 3) developing patient/health provider team-based engagement strategies; and 4) alleviating health disparities. Alignment of U.S. Food and Drug Administration approaches to dissemination of information about appropriate use with clinical practice could improve adherence, and thereby reduce CVD death and disability. PMID:28126162

Cost-Effectiveness of Patient Navigation to Increase Adherence with Screening Colonoscopy Among Minority Individuals

PubMed Central

Ladabaum, Uri; Mannalithara, Ajitha; Jandorf, Lina; Itzkowitz, Steven H.

2015-01-01

Background Colorectal cancer (CRC) screening is underutilized by minority populations. Patient navigation increases adherence with screening colonoscopy. We estimated the cost-effectiveness of navigation for screening colonoscopy from the perspective of a payer seeking to improve population health. Methods We informed our validated model of CRC screening with inputs from navigation studies in New York City (population 43% African American, 49% Hispanic, 4% White, 4% Other; base case screening 40% without and 65% with navigation, navigation costs $29/colonoscopy completer, $21/non-completer, $3/non-navigated). We compared: 1) navigation vs. no navigation for one-time screening colonoscopy in unscreened persons age ≥50; 2) programs of colonoscopy with vs. without navigation, vs. fecal occult blood testing (FOBT) or immunochemical testing (FIT) for ages 50-80. Results In the base case: 1) one-time navigation gained quality-adjusted life-years (QALYs) and decreased costs; 2) longitudinal navigation cost $9,800/QALY gained vs. no navigation, and assuming comparable uptake rates, it cost $118,700/QALY gained vs. FOBT, but was less effective and more costly than FIT. Results were most dependent on screening participation rates and navigation costs: 1) assuming a 5% increase in screening uptake with navigation and navigation cost of $150/completer, one-time navigation cost $26,400/QALY gained; 2) longitudinal navigation with 75% colonoscopy uptake cost <$25,000/QALY gained vs. FIT when FIT uptake was <50%. Probabilistic sensitivity analyses did not alter the conclusions. Conclusions Navigation for screening colonoscopy appears to be cost-effective, and one-time navigation may be cost-saving. In emerging healthcare models that reward outcomes, payers should consider covering the costs of navigation for screening colonoscopy. PMID:25492455

Interplay between Oral Hypoglycemic Medication Adherence and Quality of Life among Elderly Type 2 Diabetes Mellitus Patients.

PubMed

Manan, Mohamed Mansor; Husin, Akhma Radzuanna; Alkhoshaiban, Ali Saleh; Al-Worafi, Yaser Mohammed Ali; Ming, Long Chiau

2014-12-01

Adherence to medications is an important factor that contributes to therapeutic success. With the current increase in the elderly population, information relating to adherence to treatment and quality of life (QoL) of diabetic elderly patients will help the healthcare provider to improve their treatment. Thus, this study aims to determine the factors affecting adherence to medications and the consequence of non adherence to QoL. This was a cross-sectional study using validated Morisky Medication Adherence Scale (MMAS) Questionnaire. This study was conducted to assess the level of adherence on oral hypoglycemic medications (OHM) and quality of life of the Type 2 diabetes mellitus (T2DM) elderly patients in an urban health centre in Malaysia. A retrospective medication record review was also conducted to collect and confirm data on patients' demographics, diagnosis, treatments, and outcomes. One hundred and seventy nine patients were recruited in this study. Median adherence score was 7.75 (IQR 6.50- 8.00). Good adherer was observed in 48.00% of the participants. A Chi-square test indicated significant correlation between adherence and HbA1c (p= 0.010). The mean elderly diabetes mellitus Problem Areas in Diabetes (PAID) score was 6.30 ±SD 8.50. A significant inversed association was observed between PAID score and the level of adherence (r = - 0.175, p< 0.05). A highly significant difference in the low adherence group (p = 0.002). PAID score significantly correlated with age (years), female gender and HbA1c (p <0.05). A negative association between HbA1c levels and adherence was identified where a 1% increase in HbA1c was associated with a 30% decrease in the likelihood of being adherent. A medication adherence rate of 48% was obtained among elderly T2DM patients treated in the primary care clinic. This study showed that HbA1c is a relevant tool to assess patient glycemic control and adherence. Sociodemographic characteristics were not statistically significantly

Self-perception of body fat changes and HAART adherence in the Women's Interagency HIV Study.

PubMed

Plankey, Michael; Bacchetti, Peter; Jin, Chengshi; Grimes, Barbara; Hyman, Charles; Cohen, Mardge; Howard, Andrea A; Tien, Phyllis C

2009-02-01

To determine the association of self-perceived fat gain or fat loss in central and peripheral body sites with adherence to highly active antiretroviral therapy (HAART) in HIV-seropositive women. 1,671 women from the Women's Interagency HIV Study who reported HAART use between April 1999 and March 2006 were studied. Adherence was defined as report of taking HAART >/= 95% of the time during the prior 6 months. Participant report of any increase or decrease in the chest, abdomen, or upper back in the prior 6 months defined central fat gain and central fat loss, respectively. Report of any increase or decrease in the face, arms, legs or buttocks in the prior 6 months defined peripheral fat gain or peripheral fat loss. Younger age, being African-American (vs. White non-Hispanic), a history of IDU, higher HIV RNA at the previous visit, and alcohol consumption were significant predictors of HAART non-adherence (P < 0.05). After multivariate adjustment, self-perception of central fat gain was associated with a 1.5-fold increased odds of HAART non-adherence compared to no change. Self-perception of fat gain in the abdomen was the strongest predictor of HAART non-adherence when the individual body sites were studied. Women who perceive central fat gain particularly in the abdomen are at risk for decreased adherence to HAART despite recent evidence to suggest that HIV and specific antiretroviral drugs are more commonly associated with fat loss than fat gain.

Multiple ART Programs Create a Dilemma for Providers to Monitor ARV Adherence in Uganda.

PubMed

Obua, Celestino; Gusdal, Annelie; Waako, Paul; Chalker, John C; Tomson, Goran; Wahlström, Rolf; Team, The Inrud-Iaa

2011-01-01

Increased availability and accessibility of antiretroviral therapy (ART) has improved the length and quality of life amongst people living with HIV/AIDS. This has changed the landscape for care from episodic to long-term care that requires more monitoring of adherence. This has led to increased demand on human resources, a major problem for most ART programs. This paper presents experiences and perspectives of providers in ART facilities, exploring the organizational factors affecting their capacity to monitor adherence to ARVs. From an earlier survey to test adherence indicators and rank facilities as good, medium or poor adherence performances, six facilities were randomly selected, two from each rank. Observations on facility set-up, provider-patient interactions and key informant interviews were carried out. The strengths, weaknesses, opportunities and threats identified by health workers as facilitators or barriers to their capacity to monitor adherence to ARVs were explored during group discussions. Findings show that the performance levels of the facilities were characterized by four different organizational ART programs operating in Uganda, with apparent lack of integration and coordination at the facilities. Of the six facilities studied, the two high adherence performing facilities were Non-Governmental Organization (NGO) programs, while facilities with dual organizational programs (Governmental/NGO) performed poorly. Working conditions, record keeping and the duality of programs underscored the providers' capacity to monitor adherence. Overall 70% of the observed provider-patient interactions were conducted in environments that ensured privacy of the patient. The mean performance for record keeping was 79% and 50% in the high and low performing facilities respectively. Providers often found it difficult to monitor adherence due to the conflicting demands from the different organizational ART programs. Organizational duality at facilities is a major

Medication Adherence: A Call for Action

PubMed Central

Bosworth, Hayden B.; Granger, Bradi B.; Mendys, Phil; Brindis, Ralph; Burkholder, Rebecca; Czajkowski, Susan M.; Daniel, Jodi G.; Ekman, Inger; Ho, Michael; Johnson, Mimi; Kimmel, Stephen E.; Liu, Larry Z; Musaus, John; Shrank, William H.; Buono, Elizabeth Whalley; Weiss, Karen; Granger, Christopher B.

2013-01-01

Poor adherence to efficacious cardiovascular related medications has led to considerable morbidity, mortality, and avoidable health care costs. This paper provides results of a recent think tank meeting in which various stakeholder groups representing key experts from consumers, community health providers, the academic community, decision-making government officials (FDA, NIH, etc), and industry scientists met to evaluate the current status of medication adherence and provide recommendations for improving outcomes. Below, we review the magnitude of the problem of medication adherence, prevalence, impact, and cost. We then summarize proven effective approaches and conclude with a discussion of recommendations to address this growing and significant public health issue of medication non adherence. PMID:21884856

Encouraging CPAP adherence: it is everyone's job.

PubMed

Bollig, Suzanne M

2010-09-01

Obstructive sleep apnea (OSA) is a chronic disease treated effectively with the use of continuous positive airway pressure (CPAP) therapy. Patient adherence to prescribed CPAP is variable, however, leaving the undertreated OSA patient at risk of development or worsening of comorbid medical conditions, including hypertension and cardiovascular disease. The severity of disease and the presence of daytime sleepiness appear to have some predictive quality for subsequent adherence, though a search for consistent predictive factors related to CPAP adherence has proven elusive. Other influences, such as sex, age, socioeconomic status, and personality traits are less robust predictors. The use of sophisticated therapy modalities such as auto-titration or bi-level PAP units has been shown to improve adherence in certain subsets of OSA patients. Adverse effects such as nasal congestion, dry mouth, or skin irritation occur in approximately 50% of CPAP users, and addressing these adverse effects may improve adherence in some patients. More encouraging, studies on the use of intensive patient education and behavioral interventions have shown more positive effects on adherence, leading to the conclusion that improvement in patient adherence to CPAP therapy requires a multi-layered approach, using combined technological, behavioral, and adverse-effect interventions.

Adherence therapy improves medication adherence and quality of life in people with Parkinson's disease: a randomised controlled trial.

PubMed

Daley, D J; Deane, K H O; Gray, R J; Clark, A B; Pfeil, M; Sabanathan, K; Worth, P F; Myint, P K

2014-08-01

Many factors are associated with medication non-adherence in Parkinson's disease (PD), including complex treatment regimens, mood disorders and impaired cognition. However, interventions to improve adherence which acknowledge such factors are lacking. A phase II randomised controlled trial was conducted investigating whether Adherence Therapy (AT) improves medication adherence and quality of life (QoL) compared with routine care (RC) in PD. Eligible PD patients and their spouse/carers were randomised to intervention (RC plus AT) or control (RC alone). Primary outcomes were change in adherence (Morisky Medication Adherence Scale) and QoL (Parkinson's Disease Questionnaire-39) from baseline to week-12 follow up. Secondary outcomes were MDS-UPDRS (part I, II, IV), Beliefs about Medication Questionnaire (BMQ), EuroQol (EQ-5D) and the Caregiving Distress Scale. Blinded data were analysed using logistic and linear regression models based on the intention-to-treat principle. Seventy-six patients and 46 spouse/carers completed the study (intervention: n = 38 patients, n = 24 spouse/carers). At week-12 AT significantly improved adherence compared with RC (OR 8.2; 95% CI: 2.8, 24.3). Numbers needed to treat (NNT) were 2.2 (CI: 1.6, 3.9). Compared with RC, AT significantly improved PDQ-39 (-9.0 CI: -12.2, -5.8), BMQ general harm (-1.0 CI: -1.9, -0.2) and MDS-UPDRS part II (-4.8 CI: -8.1, -1.4). No significant interaction was observed between the presence of a spouse/carer and the effect of AT. Adherence Therapy improved self-reported adherence and QoL in a PD sample. The small NNT suggests AT may be cost-effective. A larger pragmatic trial to test the efficacy and cost-effectiveness of AT by multiple therapists is required. © 2014 John Wiley & Sons Ltd.

Behavioral and Pharmacological Adherence in Pediatric Sickle Cell Disease: Parent-Child Agreement and Family Factors Associated With Adherence.

PubMed

Klitzman, Page H; Carmody, Julia K; Belkin, Mary H; Janicke, David M

2018-01-01

This study aimed to evaluate agreement between children and parents on a measure of behavioral and pharmacological adherence in children with sickle cell disease (SCD), and the associations among family factors (i.e., problem-solving skills, routines, communication) and adherence behaviors. In all, 85 children (aged 8-18 years) with SCD and their parents completed questionnaires assessing individual and family factors. Overall parent-child agreement on an adherence measure was poor, particularly for boys and older children. Greater use of child routines was associated with better overall child-reported adherence. Open family communication was associated with higher overall parent-reported adherence. While further research is needed before definitive conclusions can be drawn, results suggest the need to assess child adherence behaviors via both child and parent reports. Findings also suggest that more daily family routines and open family communication may be protective factors for better disease management. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

High adherence is necessary to realize health gains from water quality interventions.

PubMed

Brown, Joe; Clasen, Thomas

2012-01-01

Safe drinking water is critical for health. Household water treatment (HWT) has been recommended for improving access to potable water where existing sources are unsafe. Reports of low adherence to HWT may limit the usefulness of this approach, however. We constructed a quantitative microbial risk model to predict gains in health attributable to water quality interventions based on a range of assumptions about pre-treatment water quality; treatment effectiveness in reducing bacteria, viruses, and protozoan parasites; adherence to treatment interventions; volume of water consumed per person per day; and other variables. According to mean estimates, greater than 500 DALYs may be averted per 100,000 person-years with increased access to safe water, assuming moderately poor pre-treatment water quality that is a source of risk and high treatment adherence (>90% of water consumed is treated). A decline in adherence from 100% to 90% reduces predicted health gains by up to 96%, with sharpest declines when pre-treatment water quality is of higher risk. Results suggest that high adherence is essential in order to realize potential health gains from HWT.

High self-efficacy predicts adherence to surveillance colonoscopy in inflammatory bowel disease.

PubMed

Friedman, Sonia; Cheifetz, Adam S; Farraye, Francis A; Banks, Peter A; Makrauer, Frederick L; Burakoff, Robert; Farmer, Barbara; Torgersen, Leanne N; Wahl, Kelly E

2014-09-01

Patients with extensive ulcerative colitis or Crohn's disease of the colon have an increased risk of colon cancer and require colonoscopic surveillance. In this study, we assessed individual self-efficacy (SE) to estimate the probability of adherence to surveillance colonoscopies. Three hundred seventy-eight patients with ulcerative colitis or Crohn's disease of the colon for at least 7 years and with at least one third of the colon involved participated in this cross-sectional questionnaire study performed at 3 tertiary referral inflammatory bowel disease clinics. Medical charts were abstracted for demographic and clinical variables. The questionnaire contained a group of items assessing SE for undergoing colonoscopy. We validated our 20-question SE scale and used 8 of the items that highlighted scheduling, preparation, and postprocedure recovery, to develop 2 shorter SE scales. All 3 scales were reliable with Cronbach's α ranging from 0.845 to 0.905 and correlated with chart-documented adherence to surveillance colonoscopy (P < 0.001). We then developed logistic regression models to predict adherence to surveillance colonoscopy using each scale separately along with other key variables (i.e., disease location, knowledge of correct adherence intervals, and information sources of patients consulted regarding Crohn's disease and ulcerative colitis) and demonstrated model accuracy up to 74%. SE, as measured by our validated scales, correlates with chart-adherence to surveillance colonoscopy. Our adherence model, which includes SE, predicts adherence with 74% certainty. An 8-item validated clinical questionnaire can be administered to assess whether patients in this population may require further intervention for adherence.

Medication adherence and stroke/TIA risk in treated hypertensives: results from the REGARDS study.

PubMed

Cummings, Doyle M; Letter, Abraham J; Howard, George; Howard, Virginia J; Safford, Monika M; Prince, Valerie; Muntner, Paul

2013-01-01

The extent to which low medication adherence in hypertensive individuals contributes to disparities in stroke and transient ischemic attack (TIA) risk is poorly understood. Investigators examined the relationship between self-reported medication adherence and blood pressure (BP) control (<140/90 mm Hg), Framingham Stroke Risk Score, and physician-adjudicated stroke/TIA incidence in treated hypertensive subjects (n = 15,071; 51% black; 57% in Stroke Belt) over 4.9 years in the national population-based REGARDS cohort study. Mean systolic BP varied from 130.8 ± 16.2 mm Hg in those reporting high adherence to 137.8 ± 19.5 mm Hg in those reporting low adherence (P for trend < .0001). In logistic regression models, each level of worsening medication adherence was associated with significant and increasing odds of inadequately controlled BP (≥140/90 mm Hg; score = 1, odds ratio [95% confidence interval], 1.20 [1.09-1.30]; score = 2, 1.27 [1.08-1.49]; score = 3 or 4, 2.21 [1.75-2.78]). In hazard models using systolic BP as a mediator, those reporting low medication adherence had 1.08 (1.04-1.14) times greater risk of stroke and 1.08 (1.03-1.12) times greater risk of stroke or TIA. Low medication adherence was associated with inadequate BP control and an increased risk of incident stroke or TIA. Copyright © 2013 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.