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Results for “Adherence Interventions”

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PubMed2006

A randomized trial of exercise and dietary counseling after liver transplantation.

We report results of a randomized clinical trial of a combined intervention of exercise and dietary counseling (ExD) after orthotopic liver transplantation (OLT). Of the 151 patients randomized into ExD or usual care (UC), 119 completed testing 2, 6 and 12 months post-OLT. Testing included assessment of exercise capacity (VO(2peak)), quadricep muscle strength, body composition (DXA), nutritional intake (Block 95) and health-related quality of life (SF-36). The intervention consisted of individualized counseling and follow-up to home-based exercise and dietary modification. Repeated measure ANOVA was performed to determine differences over time between ExD and UC with a secondary analysis to determine differences over time between adherers (Adh), nonadherers (Nadh) to the intervention and UC. The ExD group showed greater increases in VO(2peak) (p = 0.036), and self-reported general health (p = 0.038) compared to UC. Both groups demonstrated increases in muscle strength, body weight, body fat and other SF-36 scale scores. Adherence to the intervention was 37% with positive trends in VO(2peak) and body composition observed in Adh compared to Nadh and UC. These data suggest improvements in exercise capacity and body composition are achieved with nutrition and exercise behavior modifications initiated early after OLT and with regular follow-up.

Adipose Tissue↗

PubMed2004

Better medication adherence results in greater improvement in severity of psoriasis.

BACKGROUND: Patients are commonly nonadherent to medication regimens. In dermatology, there has been little study of the effect of nonadherence on outcomes. OBJECTIVES: To test the association between adherence behaviour and changes in severity of psoriasis. METHODS: Twenty-four subjects with psoriasis were enrolled in an 8-week, left/right, controlled trial of salicylic acid plus topical tacrolimus ointment vs. salicylic acid plus placebo. Subjects were given salicylic acid to apply to all lesions. The salicylic acid was supplied in a bottle with a medication event monitoring system cap in order to assess adherence to the salicylic acid. The primary outcome for this study was the relationship between the change in the disease severity (change in sum score of erythema, scale and thickness scores for a target plaque) and medication adherence. RESULTS: The mean initial disease severity was 5.8 on a nine-point sum score scale. For the topical tacrolimus-treated side, a decrease in adherence rate of 10% was associated with a 1-point increase in severity (P < 0.05). For the placebo-treated side, adherence was not significantly correlated with changes in severity. CONCLUSIONS: Nonadherence may have a significant role in altering clinical trial data, skewing it towards ineffectiveness. Improved outcomes in psoriasis may be achievable through interventions that improve patients' adherence to treatment.

Adolescent↗

PubMed2002

Determinants of adherence in adults with cystic fibrosis.

Cystic fibrosis (CF) is now as much a disease of adults as of children and adolescents. An important focus of recent research has been the impact of the complex, expensive, and time consuming routine of self-care and medical treatment that is required by adults with CF to maintain health. A growing concern for medical and allied health teams is the issue of patient adherence to prescribed health management plans. A summary of the particular medical and treatment context of CF is followed by a review of adherence measurement issues and the determinants of adherence to treatment regimens in people with CF, primarily adults. Evidence for factors which influence adherence decisions of people with CF is examined. The medical and psychological aspects of this complex problem have not been adequately addressed because of difficulties with definition and measurement. Only a small proportion of the variance in adherence has been accounted for in the literature. New measurement technologies and new theoretical directions offer promise for a better understanding of this complex and important issue and may result in more effective intervention strategies to improve adherence.

Adult↗

PubMed1984

Improved medical care for the elderly: intervening in medical education.

It is the premise of this paper that certain instructional interventions in the medical school behavioral science curriculum will eventually improve the health care received by elderly patients. Four content areas for such intervention are reviewed: patient adherence to medication regimens, risk and management of psychosocial stress, responses to chronic illness, and doctor-patient communication patterns. The final section describes research that supports the long-term efficacy of such curricular interventions.

Aged↗

PubMed2006

Reductions in depressed mood and denial coping during cognitive behavioral stress management with HIV-Positive gay men treated with HAART.

BACKGROUND: Stress management interventions for HIV-positive persons have been designed to enhance coping skills and encourage health-promoting behaviors with the hope of decreasing distress and slowing disease progression. PURPOSE: We examined the efficacy of a cognitive behavioral stress management (CBSM) intervention in combination with medication adherence training (MAT) in 130 gay and bisexual men living with HIV infection. METHODS: Participants were randomized to either a 10-week CBSM+MAT intervention (n = 76) or a MAT-only condition (n = 54). Measures of self-reported adherence, active cognitive coping (i.e., acceptance and positive reinterpretation), avoidant coping (i.e., denial and behavioral disengagement), and depressed mood were examined over the 10-week intervention period. RESULTS: Men in CBSM+MAT reported reductions in depressed mood and denial coping during the 10-week intervention period, but no changes in active cognitive coping or self-reported adherence were observed. Using path analysis, greater reliance on denial coping at baseline was associated with decreased depressed mood at 10 weeks. We also determined that CBSM+MAT may decrease depressed mood by reducing reliance on denial coping over the 10-week intervention period. CONCLUSIONS: Although denial may be an effective means of distress reduction in the short term, reliance on this coping strategy may result in a decreased capacity to effectively manage a variety of disease-related stressors in the long term. CBSM+MAT addresses this potentially detrimental pattern by teaching stress reduction skills that may decrease depressed mood via reduced reliance on denial coping.

Adaptation, Physiological↗

PubMed2002

A prospective study of adherence and viral load in a large multi-center cohort of HIV-infected women.

OBJECTIVES: To examine the relationship between antiretroviral adherence and viral load, and to determine the predictors of adherence over time in HIV-infected women. DESIGN: Prospective observational study. METHODS: One-hundred sixty-one HIV-infected women who were taking antiretroviral therapy for a median of 3.0 years were recruited from the HIV Epidemiology Research Study, a multicenter cohort study of HIV infection in women. Antiretroviral adherence (percent of doses taken as prescribed) was measured over a 6-month period using MEMS caps. At baseline and follow-up, CD4 lymphocyte count and viral load were measured, and a standardized interview was administered to elicit medication history and drug use behaviors. To examine changes in adherence over time, the mean adherence to all antiretroviral agents was calculated for each monitored month. RESULTS: Adherence varied significantly over time (P < 0.001), ranging from a mean of 64% in month 1 to 45% in month 6. Nearly one-fourth of the participants had a 10% or greater decrease in adherence between consecutive months. Virologic failure occurred in 17% of women with adherence of > or = 88%, 28% of those with 45-87% adherence, 43% of those with 13-44% adherence, and 71% of those with < or = 12% adherence. In multivariate analysis, factors predicting lower adherence included active drug use, alcohol use, more frequent antiretroviral dosing, shorter duration of antiretroviral use, younger age, and lower initial CD4 lymphocyte count. CONCLUSIONS: Antiretroviral adherence is not stable over time. Interventions aimed at monitoring and improving long-term adherence in women are urgently needed.

Adult↗

PubMedDate not supplied

Structured group interaction: An intervention strategy for the continued development of elderly populations.

Structured group interaction, through an emphasis on pre-group structuring, didactic presentations, experiential learning, and evaluation, provides a flexible approach to achieving a variety of goals while compensating for many of the problem characteristics of an aged institutionalized population. Structured groups are characterized by adherence to a rigorous intervention planning methodology, with a high degree of pre-planned group structure, explicit behaviorally stated performance goals, and a concern for transferring group behavior to everyday settings. After a consideration of literature support and some of the limitations and hazards involved in the approach, it is concluded that structured groups represent a useful tool for the applied gerontologist.

Aged↗

PubMedDate not supplied

HIV treatment adherence in women living with HIV/AIDS: research based on the Information-Motivation-Behavioral Skills model of health behavior.

Close and consistent adherence to anti-HIV medication regimens is necessary to achieve the maximum benefit of these potentially effective treatments. The authors examined cognitive and behavioral factors associated with HIV treatment adherence in a convenience sample of 112 women, 72 of whom were currently taking HIV treatments at the time of the study. Women completed confidential surveys and interviews to assess HIV-related health status, treatment regimens, and cognitive behavioral characteristics derived from the Information-Motivation-Behavioral Skills model of health promotion behaviors. Results showed that women who had missed at least one dose of their HIV medications in the past week reported lower intentions (motivation) to remain adherent and lower adherence self-efficacy (skills). Structural equation modeling showed that motivational and skills-building factors significantly predicted the number of medication doses missed. However, treatment-related information did not predict treatment adherence. In addition, women who had missed a dose of medication in the past week were more likely to have ever used devices and strategies to remind them of doses, but were no more likely to currently use such strategies. Interventions that enhance treatment adherence motivation and build adherence skills may help improve HIV treatment adherence in women receiving anti-HIV therapies.

Adult↗

PubMed2004

Patient-centered instructions for medications prescribed for the treatment of heart failure.

BACKGROUND: Chronic heart failure (CHF) is associated with reduced functional capacity and quality of life, particularly among older adults. Complex medication regimens for CHF challenge older patients' ability to adhere to them, in part because of age-related cognitive decline and poor communication about medications. OBJECTIVE: This article describes patient-centered instructions for taking CHF medications that were developed as part of a multifaceted pharmacy-based intervention to improve medication adherence and health-related outcomes among older adults with CHF. The findings of 3 initial validation studies investigating patients' reactions to the instructions are reported. METHODS: Patients' responses to the instructions were measured using focus group (study 1) and questionnaire (studies 2 and 3) techniques. RESULTS: Overall, older adults with CHF in the 3 studies preferred the patient-centered instructions to the standard pharmacy instructions (93.8% in study 1, 65.0% in study 2). In addition, participants' preferences depended on their medication-related goals. A preference for patient-centered instructions reflected a focus on ease of understanding (as supported by the use of large type size, icons, and patient-centered organization), whereas a preference for the standard pharmacy instructions reflected a focus on the amount of information provided about drug interactions (studies 2 and 3). CONCLUSIONS: In the 3 validation studies, older adults with CHF tended to prefer the patient-centered instructions to the standard pharmacy instructions, although the results were not statistically significant in study 2. This suggests that the use of such instructions may improve patients' medication knowledge and their adherence to treatment regimens.

Aged↗

PubMedDate not supplied

A review of quantitative studies of adherence to mental health clinical practice guidelines.

Mental health clinical practice guidelines have proliferated, but there is little evidence regarding the degree to which they are actually implemented in clinical practice. The goal of this study was to locate and review all peer-reviewed reports published through 2000 that provide quantitative information on rates of adherence to specific mental health guidelines. A literature search yielded 41 pertinent studies. These studies were of three types: 26 were cross-sectional investigations performed after the release of guidelines, six were conducted before and after release of guidelines without any specific intervention (pre/post), and nine involved a controlled trial of a specific intervention. Only 37% were conducted in the mental health specialty sector. Adequate adherence was found in 27% of the cross-sectional and pre/post studies but in 67% of the controlled trials. Successful interventions tended to be complex, involving system redesign or additional resources. Only six of 13 investigations (46%) that also measured patient outcome found that better outcome was associated with greater guideline adherence. Several studies showed that after cessation of interventions, adherence rates returned to preintervention levels. Thus, evidence indicates that guideline adherence is not high without specific intervention, but that certain interventions (typically multifaceted and resource-intensive ones) improve adherence. However, the public health challenge is to design and implement interventions that are sustainable in general clinical practice.

Attitude of Health Personnel↗

PubMed2001

Predictors of intention to adhere to physiotherapy among women with urinary incontinence.

During the last decade, pelvic floor muscle exercise (PFME) therapy has proved its short-term efficacy among women with urinary incontinence. Long-term success with PFME therapy is hampered by non-adherence. So far, specific knowledge on determinants of adherence behavior has been scarce. A cross-sectional study was conducted to elucidate the relative importance of determinants of the intention to adhere to PFME therapy in women with urinary incontinence. Based on behavioral theories, literature research and interviews, a questionnaire measuring determinants of the intention to adhere to PFME therapy was developed. In total, 129 women, aged 17 years or over, with symptoms of urinary incontinence, completed this questionnaire. Multiple regression analysis with backward elimination was carried out to identify determinants that predict intention. Significant predictors of the intention to adhere to PFME therapy were the amount to urinary loss per wet episode and women's perception of their ability to do the exercises as recommended under various circumstances. Building self-efficacy might be a good starting point for health education interventions aiming to promote adherence to PFME therapy, which can be used by physiotherapists and general practitioners.

Adult↗

PubMed2004

A conceptual framework to study medication adherence in older adults.

BACKGROUND: Adults aged > or =50 years often have multiple chronic diseases requiring multiple medications. However, even drugs with well-documented benefits are often not taken as prescribed, for a variety of reasons. OBJECTIVE: The objective of this article was to provide background information about medication adherence and its measurement, the development of the conceptual model for use in adherence research, and supportive intervention strategies such as pharmaceutical care by pharmacists to improve chronic medication use in older adults. METHODS: English-language literature published from 1990 to 2000 was searched on MEDLINE, International Pharmaceutical Abstracts, and AARP Ageline using the terms aged, heart failure, CHF, adherence, chronic heart failure, compliance, and related terms. The authors used their personal files and libraries to obtain seminal literature and textbooks published before 1990. RESULTS: Although the cognitive processes needed to manage and take medications decline with aging, the number of prescription and nonprescription medications consumed increases. Other factors such as vision, hearing, health literacy, disability, and social and financial resources may all complicate the ability of older adults to adhere to the pharmacologic prescription. CONCLUSIONS: Many factors are associated with medication adherence and related health outcomes in older adults. Therefore, strategies to improve adherence will need to be multidimensional, including improvements in pharmacy services that consider age-related factors (eg, declining cognitive and physical functions) as well as a variety of environmental and social factors.

Aged↗

PubMed2005

Assessment of adherence measures with different stimulants among children and adolescents.

STUDY OBJECTIVE: To examine adherence measures with different stimulants in children and adolescents. DESIGN: Retrospective analysis. DATA SOURCE: Texas Medicaid prescription claims database. PATIENTS: A total of 9549 patients aged 5-18 years with attention-deficit-hyperactivity disorder. MEASUREMENTS AND MAIN RESULTS: Paid prescription claims for newly started stimulants during the 2001-2002 school year were extracted from a database; 28,344 prescriptions (9549 patients) were available for analysis. Adherence was evaluated based on the drug therapy prescribed (i.e., mixed amphetamine salts, immediate-release methylphenidate, and extended-release methylphenidate-OROS [oral-osmotic formulation]) and the age and sex of the patient. Adherence measures were persistence and medication possession ratio (MPR). Persistence was higher for extended-release methylphenidate-OROS (0.50 +/- 0.33) than for mixed amphetamine salts (0.42 +/- 0.29) or immediate-release methylphenidate (0.37 +/- 0.26; p < 0.001). The MPR was also higher for extended-release methylphenidate-OROS (0.76 +/- 0.37) than for mixed amphetamine salts (0.73 +/- 0.37) or immediate-release methylphenidate (0.69 +/- 0.37; p < 0.001). Patients aged 5-9 years had equal or better persistence and MPR than those aged 10-14 and 15-18 years (p < 0.001). No sex-related differences in adherence were observed. CONCLUSION: Adherence measures in our study were low. Although they were significantly better for extended-release methylphenidate-OROS than the other stimulants, the clinical significance of these differences are unclear. Further research should be conducted regarding pharmaceutical products, administration methods, and clinical interventions that may enhance adherence.

Adolescent↗

PubMedDate not supplied

Reducing disparities in vaccination rates between different racial/ethnic and socioeconomic groups: the potential of community-based multilevel interventions.

There are well-documented disparities in vaccination rates between different socioeconomic and racial/ethnic groups in the United States. These disparities persist in spite of an overall increase in vaccination rates during the last decade and the implementation of several interventions that have aimed to increase vaccination rates in disadvantaged groups. Although many interventions are efficacious at improving vaccination rates under trial conditions, these interventions when extended to the general population frequently do not appreciably improve its health. Explanations for this limited intervention efficiency include poor adherence to protocols in real life versus idealized trial situations, changes in baseline so that the trial conditions are no longer replicable, and the contribution of other community-level factors that make it difficult to extend the trial methods to other communities. Multilevel community intervention trials recognize and address the multiple competing forces that shape the health of the population in cities and have the potential to increase vaccination rates among minorities and marginalized groups.

Community Health Services↗

PubMed2006

Understanding medication adherence in pediatric acute lymphoblastic leukemia: a review.

Significant numbers of children and adolescents with acute lymphoblastic leukemia (ALL) do not adequately adhere to their treatment regimen. Failure to take the appropriate amount of prescribed medication may result in disease relapse. Although a number of research studies have sought to identify the factors associated with medication nonadherence in this group, no systematic study has sought to evaluate the efficacy of intervention packages in improving adherence. The aim of the current paper is to provide an overview of the research investigating treatment adherence in ALL patients and to identify the relevant risk factors associated with reduced adherence with medication. The paper will further discuss the role of psychologic therapy in improving treatment adherence in children and adolescents with ALL, with a particular focus on identifying the need for controlled outcome studies.

Adolescent↗

PubMed2005

Acculturation and mammography screening among Hispanic women living in farmworker communities.

The relationship between acculturation and mammography screening practices among Hispanic women is unclear due to inconsistent study findings. The purpose of this research was to further investigate the effect of acculturation on mammography screening practices among Hispanic women and to explore the effect of biculturalism on mammography screening. Hispanic female farmworkers (N = 716) who were 50 years of age and older living in communities in Texas, New Mexico, and California were interviewed at their homes. Data collection was conducted from November 2001 to February 2002. Logistic regression models showed no significant effect for acculturation for the entire sample. Post hoc stratified analysis found that bicultural study participants in California were 3 times more likely to be adherent to screening compared to those with low acculturation. Study findings suggest that distinct differences might exist for Hispanic women living in farmworker communities in California, and perhaps other communities not on the United States-Mexico border. Women in such communities with low levels of acculturation can be targeted for interventions to increase mammography adherence.

Acculturation↗

PubMed2005

Integration of motivational interviewing and cognitive behavioral therapy to improve HIV medication adherence and reduce substance use among HIV-positive men and women: results of a pilot project.

Directly addressing HIV medication adherence and substance use together is ideal in light of the research on the complex connections between these two behaviors. This paper describes the development of a pilot program in which a combined motivational interviewing and cognitive behavioral therapy intervention was used to increase adherence to highly active antiretroviral therapy (HAART) and reduce substance use in HIV-infected adults. The main goals of the pilot study were (1) to confirm the ability to recruit HIV-positive substance users taking HAART; (2) to demonstrate the ability to retain participants over the course of an eight-session intervention; and (3) to examine changes in substance use and HAART adherence from pretreatment to posttreatment. Twelve HIV-positive adults with a substance use disorder participated in an 8-week intervention, which consisted of weekly individual sessions with a trained therapist. Results showed that despite the small sample size, there was a significant reduction in substance use from pretreatment to posttreatment. No statistically significant differences were found for changes in HIV medication adherence, but the trends suggest the potential for positive results with a larger sample. Retention for all eight sessions of the treatment was 73.3%. Eighty percent completed the 3-month follow-up assessment. Participants reported high therapeutic alliance reflecting comfort with their therapists and in the treatment. Overall, the pilot demonstrated feasibility and acceptability of the treatment. Furthermore, results suggest that this may, in fact, be an effective intervention to reduce substance use and improve HIV medication adherence.

Adult↗

PubMed2001

Trust and the acceptance of and adherence to antiretroviral therapy.

BACKGROUND: Antiretroviral therapy (ART) has resulted in reduced AIDS incidence and mortality. Socially marginalized individuals with HIV infection, particularly injection drug users (IDUs), have received less ART and derived less benefit than others. Little is known about the therapeutic process necessary to promote acceptance of and adherence to ART among marginalized HIV-infected populations. We report on the correlates of both acceptance of and adherence to ART among HIV infected prisoners, most of whom are IDUs. DESIGN: Using a cross-sectional survey design within four ambulatory prison HIV clinics, 205 HIV-infected prisoners eligible for ART were recruited between March and October 1996. MEASUREMENTS: Detailed interviews were conducted that included personal characteristics, health status and beliefs, and validated standardized scales measuring depression, health locus of control, social desirability and trust in physician, medical institutions and society. Acceptance and adherence were documented by self-report and validated for a subset by pharmacy review. Clinical information was obtained from standardized chart review. Adherence was defined as having taken > or = 80% of ART. RESULTS: The acceptance of (80%) and adherence to (84%) ART among this group of prisoners was high. Multiple regression models demonstrated that correlates of acceptance of and adherence to ART differed. Acceptance was associated with trust in physician (8% increase for each unit increase with trust in physician scale) and trust in HIV medications (threefold reduction for those mistrustful of medication). Side effects (OR = 0.09), social isolation (OR = 0.08), and complexity of the antiretroviral regimen (OR = 0.33) were associated with decreased adherence. The prevalence of health beliefs suggesting an adverse relationship between ART and drugs of abuse was high (range 59 to 77%). Adherence did not differ among those receiving directly observed therapy (82%) or self-administration (85%). CONCLUSIONS: ART can be successfully administered within a correctional setting. Trust and the therapeutic relationship between patient and physician remain central in the ART initiation process. Characteristics of the therapeutic agents and the degree of social isolation predict adherence. These results may inform the design of interventions to improve both acceptance of and adherence to ART particularly among marginalized populations who have not derived full benefit from these potent new therapies.

Adult↗