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Biomedical subjects

D P Nau

Publications and source records attributed to D P Nau.

7 recordsLinked to original sources
PubMed2000

The relationship of disease severity, health beliefs and medication adherence among HIV patients.

The objective was to investigate the relationship of disease severity, health beliefs and medication adherence among HIV/AIDS patients. A survey was administered to 72 patients in three different stages of HIV/AIDS (CDC clinical categories A, B, C). Multivariate analyses revealed that there were no significant differences in patients' perceptions of the severity of HIV/AIDS or perceptions of the benefits and barriers for the treatment across three disease stages. However, the most severely ill patients (in stage C) perceived a higher risk of complications if they did not take their medicine as prescribed compared to asymptomatic patients (stage A) (p = 0.01). Also, patients in stages B and C were more adherent to their medications compared to patients in stage A (p = 0.007). Finally, perceived susceptibility-inaction was positively related to medication adherence (p = 0.005) and difficulty in following doctors' instructions was negatively related to patients' medication adherence (p = 0.009). In conclusion, patients' illness experiences are associated with their beliefs about the chances of developing complications if they do not adhere to their medications. Patients who have experienced more complications perceive a stronger relationship between medication non-adherence and AIDS-related complications, and are also more adherent to their medication regimen when compared to patients with no prior complications.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Congruence of three self-report measures of medication adherence among HIV patients.

OBJECTIVE: To evaluate the accordance between three measures of self-reported medication adherence. METHODS: A survey was administered to HIV patients. The three adherence measures included a four-item Morisky-type scale (Measure1) and two measures defining adherence as the percentage of doses taken as prescribed during the past two days (Measure2) or past two weeks (Measure3). RESULTS: For Measure1, 29.2% of the patients were categorized as high adherence and 61.5% as medium adherence. For Measure2 and Measure3, the mean scores were 93.6% and 96.5%, respectively. Using 90% as cutoff values, 78.5% and 95.4% of the patients were classified as adherent by Measure2 and Measure3, respectively (kappa = 0.30; p = 0.001). When 80% was used, 90.8% of the patients were classified as adherent for Measure2 and 96.9% for Measure3 (kappa = 0.48; p < 0.001). When using 90% and 80% as cutoff values to categorize Measure2 and Measure3 as three levels, there was no agreement between Measure1 and the other two measures. The accordance of Measure2 and Measure3 was significant albeit not high (kappa = 0.31; p < 0.001). CONCLUSIONS: The accordance between a Morisky-type adherence scale and measures of missed doses is unsatisfactory. However, "missed-dose" measures using two-day or two-week time periods yield fairly similar results. Researchers should be cautious when comparing adherence rates between studies that use different methods for assessing adherence.

Adolescent↗
PubMed1999

Evaluation of patient's Health-Related Quality of Life using a modified and shortened version of the Living With Asthma Questionnaire (ms-LWAQ) and the medical outcomes study, Short-Form 36 (SF-36).

OBJECTIVE: The specific objectives of this study were to: 1) study the effect of moderate-to-severe asthma on patient's Health-Related Quality of Life (HRQoL) as measured by the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) and 2) evaluate the construct validity of a modified and shortened version of the Living With Asthma Questionnaire (ms-LWAQ) using the SF-36 as a concomitant measure of HRQoL. METHODS: Cross-sectional, telephone or mail surveys of asthmatic patients enrolled in two central Florida managed care organizations. RESULTS: All subscales of the SF-36 and four subscales of the ms-LWAQ demonstrated adequate reliability in this population (Cronbach alpha > 0.72). The subscales of the SF-36 most affected by patient's asthma were: general health perceptions, vitality and physical role functioning. These three subscales were correlated with four subscales of the ms-LWAQ: consequences, seriousness, affect and leisure. Six of the eight SF-36 subscales and all of the ms-LWAQ subscales were associated with patient's emergency department and hospital utilization. CONCLUSION: The ms-LWAQ and SF-36 are valid as useful measures of asthma patient's HRQoL in this cross-sectional study. Severity of disease, as measured by health care utilization, was significantly associated with HRQoL.

Adolescent↗
PubMed1998

State pharmacy regulators' opinions on regulating pharmaceutical care outcomes.

OBJECTIVE: To examine the opinions of state pharmacy regulators regarding responsibility for the outcomes of drug therapy, and approaches that might be taken to regulate for pharmaceutical care outcomes. DESIGN: Surveys were sent to the executive secretaries of state pharmacy boards. The executive secretaries were encouraged to seek input from other board staff and board members in formulating a response. Reminder postcards were sent to all subjects 1 week after the initial mailing. MEASURES: The survey instrument was divided into three sections. The first section identified 10 approaches that state boards could use to regulate for outcomes and asked subjects to indicate the utility of each. The second and third sections asked the subjects to determine the extent to which pharmacies and pharmacists, respectively, should be responsible for outcomes potentially related to pharmaceutical care. RESULTS: Forty-one usable surveys were returned. All approaches to regulation were viewed as potentially useful, and scores for three approaches indicated that they would be consistently helpful for effective regulation of pharmaceutical care outcomes. The pharmacy was viewed as solely responsible for poor outcomes related to systems deficiencies, a lack of self-assessment, inadequate references, equipment, and technician support. Pharmacists were assigned greatest responsibility for outcomes related to prescription filling, and less responsibility for outcomes related to patient care. However, there was considerable variation in responses to many of the items, reflecting the diverse opinions of pharmacy regulators on these issues. CONCLUSIONS: While pharmacy regulators appear open to some outcomes-oriented approaches to regulation, there is no clear consensus on responsibility for pharmaceutical care outcomes.

Humans↗
PubMedDate not supplied

Patients' perceptions of the benefits of pharmaceutical care.

OBJECTIVE: To investigate patients' perceptions of the benefits of regular participation in pharmaceutical care services. DESIGN: Written survey of a convenience sample. SETTING: Pharmacist-run anticoagulation clinic in a Veterans Administration Medical Center. PATIENTS: 154 patients who had regularly scheduled appointments in the clinic. INTERVENTIONS: Patients were asked to complete a written survey. The survey was read to those who had trouble reading it. MAIN OUTCOME MEASURES: Patients' perceptions about the benefit of services provided in the clinic and the relationship between those services and reduced risks of medication-related problems. RESULTS: All components of anticoagulant-related pharmaceutical care were rated as at least fairly beneficial. Monitoring of warfarin blood levels and information on the appropriate use of warfarin were rated highest. The perceived benefits of the pharmaceutical care components were associated with patients' perceptions of the extent to which pharmaceutical care reduced their risk of experiencing blood clots or warfarin-related problems. Patients also perceived that their risk of developing blood clots or bleeding problems would be higher if they did not regularly visit the anticoagulation clinic. CONCLUSION: Patients' perceptions of the benefits of pharmaceutical care were associated with the perceived threat reduction capacity of the pharmacist's services. Pharmaceutical care providers may be able to enhance patient participation in their services by educating patients on the risks of medication-related problems and how frequent monitoring of key clinical indicators may help reduce those risks.

Adult↗