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Biomedical subjects

F Garfield

Publications and source records attributed to F Garfield.

11 recordsLinked to original sources
PubMed2000

Stages of change for adherence with medication regimens for chronic disease: development and validation of a measure.

BACKGROUND: The stages-of-change (SOC) model has been used to explain and predict how behavior change occurs, but it is new as an approach to understanding why patients fail to take their medications as prescribed. OBJECTIVE: This study validated a 2-item measure of SOC for adherence with medication regimens in 2 groups of patients prescribed pharmacologic therapy for chronic conditions. METHODS: Two cross-sectional studies of attitudes toward medication adherence included the same measure of SOC for medication adherence. One was a sample of 161 HIV-positive patients in the United States, and the other was an international sample of 731 patients with hypertension. The validity of the measure of SOC for medication adherence was examined in both convenience samples using previously validated self-reported measures of adherence (the Medication Adherence Scale and a measure of adherence from the Medical Outcomes Study), and in the HIV sample using electronic monitoring of adherence behavior in 85 patients. RESULTS: Construct validity was demonstrated in both samples by associations between SOC and the previously validated measures of adherence (P < 0.001), and predictive validity was supported by significant associations between SOC for medication adherence and electronically monitored medication-taking behavior during the next 30 days (P < 0.03). CONCLUSIONS: Behavior-change theory suggests that stage-tailored communication strategies are more effective than uniform health-promotion messages. Our results provide a foundation for the development of interventions for medication adherence that are tailored to patients' readiness for change. Our validated 2-item measure of SOC for medication adherence can be used to match communication strategies to individual motivation and readiness for adherence with chronic disease medication regimens.

Anti-HIV Agents↗
PubMed1997

The effects of planned duration of residential drug abuse treatment on recovery and HIV risk behavior.

OBJECTIVE: This study assessed the effects of planned duration of residential drug abuse treatment on recovery from drug use and on human immunodeficiency virus (HIV) risk behaviors. METHODS: Two concurrent randomized controlled trials of programs differing in planned duration were conducted: 6-month vs 12-month versions of a traditional therapeutic community program, and 3-month vs 6-month versions of a modified therapeutic community incorporating a relapse prevention and health education program. Outcomes, measured at least 16.5 months after admission, included time from admission to first drug use; severity of drug, alcohol, legal, and employment problems; and risky drug injection and sexual behaviors. RESULTS: Among 539 clients (86% of those enrolled), there were no significant effects of planned duration of treatment upon Addiction Severity Index scores or HIV risk behavior. In the relapse prevention program, clients randomized to the 6-month program had a longer time to first drug use than those in the 3-month program (hazard ratio = 0.74; 95% confidence interval = 0.58, 0.93). Employment problems at follow-up were significantly less severe among clients treated in the therapeutic community than among those in the relapse prevention program. CONCLUSIONS: No overall benefit of extending treatment beyond 6 months was found.

Adult↗
PubMed1997

Planned duration of residential drug abuse treatment: efficacy versus effectiveness.

AIMS: Two randomized controlled trials of residential drug abuse treatment programs found the programs to be equally effective, based on outcomes among those assigned to the treatments. This study aimed to compare the relative efficacy of the programs, based on outcomes among those who received the specific treatment program as planned. DESIGN: Secondary analyses of data from two concurrent randomized controlled trials, with stratification by actual length of stay. SETTING: Two residential drug abuse treatment facilities in the United States. PARTICIPANTS: Six hundred and twenty-eight clients were enrolled over a 2-year period, representing 85% of all clients admitted, 91% of all eligible clients, and 95% of those asked to participate. INTERVENTIONS: At one facility, clients were randomized to 3-month or 6-month versions of a traditional therapeutic community program. At the second facility, clients were randomized to 3-month or 6-month versions of a modified therapeutic community program that emphasized relapse prevention and health education. MEASUREMENTS: Time from admission to first drug use (except alcohol); and Addiction Severity Index (ASI) composite scores for severity of drug, alcohol, legal, and employment problems. FINDINGS: Five hundred and thirty-nine clients (86%) completed a follow-up interview at least 16.5 months after admission. In the relapse prevention trial, benefits of the 6-month program were generally limited to those who stayed at least 40 days. In the therapeutic community trial, among those who stayed at least 171 days, the 12-month program had a beneficial effect on employment. Otherwise, there were inconsistent differences between the 6- and 12-month programs. CONCLUSIONS: On average, clients who stayed in treatment at least 80 days benefited from continuing in treatment for up to 6 months, but not beyond. Conversely, those admitted to programs of longer planned duration who dropped out of treatment early had worse outcomes than those who dropped out of shorter programs. Thus, although longer planned duration of treatment may be efficacious, it is not effective.

Adult↗
PubMed1996

Strategies for follow-up of drug users: field research guidelines.

The timely follow-up of clients who exited from two residential treatment programs was achieved by the consistent application of the described strategies. The enrollment and treatment phases of the study provided the environment for the use of standard follow-up and enhanced outreach methods. The applicability of the strategies to a variety of settings makes the prioritization of the follow-up methods presented a meaningful one. The role of the researcher in the reevaluation of follow-up protocols within an ethical context is discussed.

Cost-Benefit Analysis↗
PubMed1995

The effectiveness of alternative planned durations of residential drug abuse treatment.

Randomized controlled trials were conducted at two residential drug abuse treatment facilities to compare programs that differed in planned duration. One trial compared a 6-month and a 12-month therapeutic community program (n = 184), and the second compared a 3-month and a 6-month relapse prevention program (n = 444). Retention rates over comparable time periods differed minimally by planned treatment duration, and the longer programs had lower completion rates. There was no effect in either trial of planned treatment duration on changes in psychosocial variables between admission and exit or on rates or patterns of drug use at follow-up between 2 and 6 months after exit.

Follow-Up Studies↗
PubMed1994

Radioimmunoassay of hair for determination of cocaine, heroin, and marijuana exposure: comparison with self-report.

Radioimmunoassay of hair (RIAH) was compared with self-report for cocaine, heroin, and marijuana in two populations: 109 persons entering residential drug user treatment and 86 at follow-up posttreatment. Among treatment entrants, 89% of 87 RIAH cocaine-positives and 96% of 45 RIAH heroin-positives were confirmed by self-report. However, among those followed-up posttreatment, only 51% of 43 RIAH cocaine-positives and 67% of 18 RIAH heroin-positives were so confirmed. Whereas 95% of 104 self-reports of cocaine use in the combined population were confirmed by RIAH, only 69% of 80 self-reports of heroin use were. Self-report and RIAH for marijuana were weakly associated.

Adolescent↗
PubMed1981

Impact of a cardiology data bank on physicians' prognostic estimates. Evidence that cardiology fellows change their estimates to become as accurate as the faculty.

To determine whether physicians would be influenced by the prognostic information in a large coronary artery disease data bank, cardiology faculty and fellows made initial estimates of the prognoses of their patients and then made revised final estimates after seeing the outcome of matched patients (OMP) from the data bank. The faculty cardiologists' original estimates proved to be as accurate as those of the data bank's OMP, and the faculty revised their estimates minimally in response to the data bank's OMP. Conversely, the cardiology fellows' original estimates were less accurate than the data bank's OMP, and under all observed circumstances the fellows responded more to the data bank's OMP than did the faculty. As a result, the accuracy of the fellows' final estimates was similar to the accuracies of both the faculty cardiologists and the data bank's OMP. Computerized data banks seem more likely to have impact when their information is provided to physicians who are relatively inexperienced with the disease in question.

Cardiology↗
PubMedDate not supplied

The relationship between legal factors and attrition from a residential drug abuse treatment program.

This article examines the legal involvement of 438 clients randomized to three- and six-month versions of a residential drug abuse treatment program with respect to early attrition (before 40 days in treatment) and later attrition (40-79 days in treatment). Concern about legal problems was reported by 21% of subjects in response to an open-ended question about factors that led to admission; 42% had other legal circumstances that were determined either from documented evidence of legal involvement from chart review or from self-report through structured questioning about legal status. For those with "concern about legal problems" the early attrition rate was 16%, compared with 33% for those with no legal factors--odds ratio (OR) .38 with 95% confidence interval (95% CI) (.20,.73) and the later attrition rate was 25%, OR .76, 95% CI (.39,1.48). Those subjects with "legal circumstances" only had an early attrition rate of 29%--OR .86, 95% CI (.54,1.37) and a later attrition rate of 19%, OR .53, 95% CI (.29,.98) compared to those with no legal factors. There was little evidence of confounding in any of these results from adjusted analyses. Findings suggest that only self-reported concern about legal status as a problem mentioned at entry to treatment is significantly associated with lower early attrition and there is no significant relationship of legal factors with later attrition.

Adult↗