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Results for “Adherence Interventions”

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PubMed2002

[Geriatric drug therapy guide: evaluation of the effect on prescription at old people's homes in Gipuzkoa].

OBJECTIVE: To analyse the impact of the composition, publication and dissemination of the Geriatric Drug-therapy Guide of Gipuzkoa (GDGG) and monitoring of adherence to it, as an intervention in the community to improve medical prescription in old people s homes (OPH) in Gipuzkoa. DESIGN: Descriptive evaluation < > the intervention. SAMPLE: billed prescriptions for pharmaceutical products (PP) from Osakidetza in 1996 (pre-intervention) and 1997-1999 (post-intervention). SOURCE: the prescription data base of the Basque Government. SETTING: 35 OPH in Gipuzkoa (2963 residents). MEASUREMENTS AND RESULTS: Indicators: Adherence percentage=(No. units prescribed of PP with selected active principles)x100/total No. PP prescribed); Mean price per unit (MPU)=(total RSP of units/total No. PP units). Overall adherence rose from 44% in 1996 to 62% in 1999; the groups accounting for 84% of prescription and the sub-groups accounting for 65% of prescription went up in these years from 43% to 64% and from 50% to 67%, respectively. A deceleration of the increase in MPU in OPH was detected, when compared with the figure for primary care. CONCLUSIONS: Overall adherence to the GDGG is high, with an upwards tendency that lasts about three years after the initial intervention. Similarly, the evolution of the MPU for the PP prescribed in OPH is better than the primary care average, with a steady deceleration in the indirect indicator analysed. The community intervention undertaken is an effective tool for improving medical prescription in the old people s homes examined.

Aged↗

PubMedDate not supplied

Medication adherence and persistence: a comprehensive review.

Estimates of adherence to long-term medication regimens range from 17% to 80%, and nonadherence (or nonpersistence) can lead to increased morbidity, mortality, and healthcare costs. Multifaceted interventions that target specific barriers to adherence are most effective, because they address the problems and reinforce positive behaviors. Providers must assess their patients' understanding of the illness and its treatment, communicate the benefits of the treatment, assess their patients' readiness to carry out the treatment plan, and discuss any barriers or obstacles to adherence that patients may have. A positive, supporting, and trusting relationship between patient and provider improves adherence. Individual patient factors also affect adherence. For example, conditions that impair cognition have a negative impact on adherence. Other factors--such as the lack of a support network, limited English proficiency, inability to obtain and pay for medications, or severe adverse effects or the fear of such effects--are all barriers to adherence. There are multiple reasons for nonadherence or nonpersistence; the solution needs to be tailored to the individual patient's needs. To have an impact on adherence, healthcare providers must understand the barriers to adherence and the methods or tools needed to overcome them. This report describes the barriers to medication adherence and persistence and interventions that have been used to address them; it also identifies interventions and compliance aids that practitioners and organizations can implement.

Drug Therapy↗

PubMed2006

A systematic review of the effects of home blood pressure monitoring on medication adherence.

Home blood pressure monitoring (HBPM) improves blood pressure control, but little is known about its effects on medication adherence. The authors conducted a systematic review of the published literature on the effects of HBPM on medication adherence. Of 440 abstracts and citations reviewed, 11 randomized control trials met predefined criteria. Six of the 11 randomized controlled trials reported statistically significant improvement in medication adherence; 84% of these were complex interventions involving the use of HBPM in combination with other adherence-enhancing strategies such as patient counseling by nurses, pharmacists, or a telephone-linked system; patient education; and the use of timed medication reminders. Interventions conducted in primary care settings were not effective compared with those that occurred in hospital-based clinics or nonclinical settings. The data on the effects of HBPM on patients' medication-taking behavior are mixed. Future studies should investigate the independent effects of HBPM in primary care practices where the majority of hypertensive patients receive their care.

Antihypertensive Agents↗

PubMed2000

Barriers pediatricians face when using asthma practice guidelines.

OBJECTIVE: To describe barriers to the successful use of the 1997 National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines. METHODS: We conducted 3 focus groups to understand barriers to the use of 4 recommendations within the NHLBI guidelines (prescription of inhaled corticosteroids, recommendation of daily peak flowmeter use, smoking cessation screening and counseling, and allergen exposure counseling). PARTICIPANTS: Twenty-one pediatricians and 1 nurse practitioner, who each followed an average of 47 patients with asthma, participated. Six participants (27%) had a faculty or adjunct appointment at a medical school. Nineteen (90%) of the 21 pediatricians were board certified. RESULTS: We identified 171 comments about barriers to adherence. Type of recommendation and physician year of graduation from medical school were related to which barrier was prominent. For corticosteroid prescription, senior physicians mentioned lack of agreement, whereas younger physicians described lack of confidence in dosing or recognizing contraindications. For peak flow-meter use, senior physicians emphasized lack of training. Only senior physicians described the inertia of previous practice as a barrier. All groups mentioned time limitations. CONCLUSIONS: Efforts to improve adherence to asthma guidelines should consider the range of barriers that pediatricians face, such as lack of awareness, familiarity, or agreement, and external barriers owing to environmental, guideline, or patient factors. In addition, this study documents barriers not previously considered, such as lack of self-efficacy, lack of outcome expectancy, and inertia of previous practice, that prevent adherence. Because type of recommendation and physician demographics are related to which barriers are prominent, interventions to improve NHLBI guideline adherence should be tailored to these factors.

Adolescent↗

PubMed2003

[Dynamic short-term psychotherapy between support and interpretation].

Interpersonal approaches based on the classic concepts of psychoanalysis draw their significance not only from guiding therapists but also provide instruments for empirical psychotherapy research, particularly focussing on the therapeutic process itself. The Dusseldorf Short Term Psychotherapy Project uses several strategies of the SASB-CMP method to examine the interrelation among certain groups of disorders, different courses of treatment, and outcome in dynamic short term psychotherapy. In addition, this paper uses the concept of CMP-based therapeutic interventions to analyze focus-adherence and offers a system for the classification of other, not focus-related therapeutic interventions. For understanding the effects of dynamic short term psychotherapy, it is essential to consider the distinction between more specific approaches, e. g. interpretation, transference, and insight on the one hand, and more general concepts, e. g. emotional experience, absence of re-traumatization, direct or indirect support on the other hand. The 'principle of interpretation' needs a relatively structured patient's ego, while in other cases the basic (re-)organizing of the patient has to be the crucial goal of therapy. This leads to the assumption that successful outcome is achieved by different ways depending on the patients' differing structural levels. The 2 pilot cases of this study illustrate that based on a higher level of structural functioning, more CMP-specific interpretations in the here and now are used to obtain good results, whereas in a case of lower level the first aim is to strengthen the patient's ego functions and to scrutinize his CMP in the there and then.

Adaptation, Psychological↗

PubMed2002

Reconciling incompatibilities: a grounded theory of HIV medication adherence and symptom management.

The purpose of this grounded theory study was to explain how ethnically diverse men and women living with HIV manage their interacting illness symptoms, medication side effects, and treatment adherence choices. The authors used the constant comparative method to analyze textual data from in-depth interviews with 66 HIV-infected people representing the changing HIV demographic profile in the San Francisco Bay area and generate a theory of Reconciling Incompatibilities. Adherence options of complying, not complying, or self-tailoring occurred in a context of attributional uncertainty as to whether distress was illness- or treatment-related, a sometimes silent virus, and perceived fickle medical markers. Conditions, including self-identity, illness ideology, concurrent treatment regimens, the meaning of time, medication burden and side effects, and lifestyle, coalesced to produce a state of mind that shaped adherence choices on a dose-by-dose basis. This theory offers a basis for interventions designed to promote optimal adherence choices concerning HIV therapies.

Adult↗

PubMed2004

Lipaemia, inflammation and atherosclerosis: novel opportunities in the understanding and treatment of atherosclerosis.

Atherosclerosis is the major cause of death in the world. Fasting and postprandial hyperlipidaemia are important risk factors for coronary heart disease (CHD). Recent developments have undoubtedly indicated that inflammation is pathophysiologically closely linked to atherogenesis and its clinical consequences. Inflammatory markers such as C-reactive protein (CRP), leucocyte count and complement component 3 (C3) have been linked to CHD and to hyperlipidaemia and several other CHD risk factors. Increases in these markers may result from activation of endothelial cells (CRP, leucocytes, C3), disturbances in adipose tissue fatty acid metabolism (CRP, C3), or from direct effects of CHD risk factors (leucocytes). It has been shown that lipoproteins, triglycerides, fatty acids and glucose can activate endothelial cells, most probably as a result of the production of reactive oxygen species. Similar mechanisms may also lead to leucocyte activation. Increases in triglycerides, fatty acids and glucose are common disturbances in the metabolic syndrome and are most prominent in the postprandial phase. People are in a postprandial state most of the day, and this phase is proatherogenic. Inhibition of the activation of leucocytes, endothelial cells, or both, is an interesting target for intervention, as activation is obligatory for adherence of leucocytes to the endothelium, thereby initiating atherogenesis. Potential interventions include the use of unsaturated long-chain fatty acids, polyphenols, antioxidants, angiotensin converting enzyme inhibitors and high-dose aspirin, which have direct anti-inflammatory and antiatherogenic effects. Furthermore, peroxisome proliferator activating receptor gamma (PPARgamma) agonists and statins have similar properties, which are in part independent of their lipid-lowering effects.

Animals↗

PubMed2005

Can hand-held computers improve adherence to guidelines? A (Palm) Pilot study of family doctors in British Columbia.

OBJECTIVE: To examine whether Palm Prevention, a free software tool for Palm OS personal digital assistants (PDAs) that provides quick access to preventive guidelines in a patient-specific manner at the point of care, improved adherence to five preventive measures in primary care. DESIGN: Prospective intervention pilot study. SETTING: Vancouver, BC, and surrounding area. PARTICIPANTS: Eight general practitioners. INTERVENTIONS: Each physician used Palm Prevention for five preventive measures during routine preventive health visits with 10 patients (n = 80). Charts of consenting patients were reviewed for documentation of recommended maneuvers. MAIN OUTCOME MEASURES: Rates of adherence to five evidence-based guidelines selected from the Canadian and American task forces on preventive care and incorporated into Palm Prevention. RESULTS: Intervention and control physicians were similar in their familiarity with and use of PDAs, and they recruited similar patients for the study. Intervention and control groups had similar rates of screening for hypertension. Intervention improved adherence to the remaining four guidelines: cervical cancer screening increased 22% (only absolute increases are reported); hyperlipidemia screening increased 30%; colorectal cancer screening increased 27%; and prophylaxis with acetylsalicylic acid in high-risk patients increased 38%. Participants were surveyed after the study; all reported that they found the software helpful and would continue using Palm Prevention. Usage statistics showed that study participants used the tool outside the trial: users entered between 28 and 68 unique patients into the program during the 2-month intervention. CONCLUSION: This pilot study suggests PDAs are useful in improving preventive care and facilitating translation of knowledge into practice. This was particularly apparent with newer guidelines.

British Columbia↗

PubMed2004

Factors influencing health care workers' adherence to work site tuberculosis screening and treatment policies.

BACKGROUND: Despite the known risk of tuberculosis (TB) to health care workers (HCWs), research suggests that many are not fully adherent with local TB infection control policies. The objective of this exploratory study was to identify factors influencing HCWs' adherence to policies for routine tuberculin skin tests (TSTs) and treatment of latent TB infection (LTBI). METHODS: Sixteen focus groups were conducted with clinical and nonclinical staff at 2 hospitals and 2 health departments. Participants were segmented by adherence to TST or LTBI treatment policies. In-depth, qualitative analysis was conducted to identify facilitators and barriers to adherence. RESULTS: Among all focus groups, common themes included the perception that the TST was mandatory, the belief that conducting TSTs at the work site facilitated adherence, and a general misunderstanding about TB epidemiology and pathogenesis. Adherent groups more commonly mentioned facilitators, such as the perception that periodic tuberculin skin testing was protective and the employee health (EH) provision of support services. Barriers, such as the logistic difficulty in obtaining the TST, the perception that LTBI treatment was harmful, and a distrust of EH, emerged consistently in nonadherent groups. CONCLUSIONS: This information may be used to develop more effective interventions for promoting HCW adherence to TB prevention policies. Informed efforts can be implemented in coordination with reevaluations of infection control and EH programs that may be prompted by the publication of the revised TB infection control guidelines issued by the Centers for Disease Control and Prevention in 2005.

Antitubercular Agents↗

PubMed2004

Medication adherence for HIV positive women caring for children: in their own words.

Few studies have directly focused on adherence to highly active antiretroviral medication (HAART) in HIV positive women caring for children. These women may have unique barriers and facilitators to taking medication, and a deeper understanding of their adherence patterns could enhance intervention strategies. A total of 36 HIV positive women who care for children less than 18 years of age were interviewed regarding their patterns and decision around taking HAART. The study group was comprised of 19 Latinas, 10 Euro-Americans, five African Americans and two Cape Verdeans. The mean length of time the women knew they were HIV positive was 11.15 years. Adherence patterns shifted over the course of the women's HIV history. The participants continually discussed medication adherence within the context of events and relationships that either upset or stabilized their adherence. The following themes emerged: (1) shifting adherence patterns; (2) reasons for adherence; (3) reasons for non-adherence; (4) the relationship between distress level and medication adherence; (5) interpersonal relationship as barrier or facilitator of medication adherence; and (6) children as facilitators in adherence. Providers need to be aware of the shifting nature of adherence and its relationship to psychosocial functioning.

Adult↗

PubMed2004

Enhancement of treatment adherence among patients with bipolar disorder.

OBJECTIVE: Because about one-third of persons with bipolar illness take less than 30 percent of their medication and because nonadherence is associated with rehospitalization and suicide, the literature was searched to identify controlled studies of enhancement of treatment adherence among persons with bipolar disorder. METHODS: Studies published up to October 2003 were evaluated. Those selected for review were controlled trials that used samples of adults with a diagnosis of bipolar disorder and that measured adherence to either mood-stabilizing medication or psychotherapy. Information was extracted on the diagnostic composition and size of the study group, the type and duration of the intervention, the method of measuring adherence, and outcomes. RESULTS: Eleven studies met inclusion criteria. Although the literature on enhancing treatment adherence among persons with bipolar disorder is limited, the existing data are promising and demonstrate development over time in our understanding of how best to manage this illness. Interventions that have been shown to be effective include interpersonal group therapy, cognitive-behavioral therapy, group sessions for partners of persons with bipolar disorder, and patient and family psychoeducation. Effective therapies occur in the context of long-term management of illness that incorporates a good understanding of medications and their risks and benefits as well as education about illness awareness and self-management. The majority of effective therapies feature an interactional component between patients and their care providers or therapists. CONCLUSIONS: Adherence to treatment for bipolar disorder may be enhanced by interventions that address issues of appropriately taking medications to manage illness. For optimum outcomes, promotion of adherence must be integrated into the medication management of bipolar illness.

Bipolar Disorder↗

PubMed2006

Patient navigation and case management following an abnormal mammogram: a randomized clinical trial.

BACKGROUND: A high rate of low-income, ethnic minority women delay or fail to keep appointments following abnormal mammograms. This study was designed to test the effectiveness of a structured counseling and patient navigation intervention for improving follow-up rates at a large public sector medical center. METHODS: This randomized clinical trial, conducted in Los Angeles 2001-2002, included 204 women with abnormal mammograms referred for follow-up who were then assigned to intervention or usual care. The primary outcome was the rate of follow-up through diagnostic resolution within eight months. RESULTS: The intervention resulted in a significant increase in the rate of adherence to follow-up through diagnostic resolution. The intervention group was much more likely to be adherent through diagnostic resolution than the control group (90% vs. 66%, OR=4.48, p<0.001) and were more likely to experience timely adherence than UC patients (77% vs. 57%, OR=2.5, p=0.01). Intervention effectiveness was not significantly different for women assigned to different levels of service intensity. CONCLUSIONS: Patient navigation and counseling driven by a structured clinical algorithm are highly effective strategies to improve diagnostic resolution follow-up among low-income, ethnic minority women with abnormal mammograms. The intervention algorithm and available training materials can be adapted for diverse care systems serving high-risk women to decrease loss to follow-up.

Acculturation↗

PubMed2004

Effectiveness of diabetic therapeutic footwear in preventing reulceration.

OBJECTIVE: To review the evidence for the effectiveness of therapeutic footwear in preventing foot reulceration in individuals with diabetes and foot risk factors. RESEARCH DESIGN AND METHODS: We conducted a structured literature review based on a Medline search for studies of therapeutic footwear that examined prevention of reulceration. Nine published articles were identified. Characteristics of the study population, components of the intervention, and level of adherence were evaluated. U.S. Preventive Services Task Force criteria for evaluating research were applied to rate each study on study design and internal validity. RESULTS: Risk ratios in all studies assessing the association between therapeutic footwear and reulceration were below 1.0, suggesting some protective footwear benefit. However, in the most rigorous experimental study, no statistically significant benefit was observed between control patients wearing their own footwear and intervention patients wearing study footwear. Annual reulceration in these studies' control groups ranged from 8.4 to 59.3%. In patients with severe foot deformity or prior toe or ray amputation, observational studies suggested a significant protective benefit from therapeutic footwear. CONCLUSIONS: Therapeutic footwear has been used for decades as one of many strategies to prevent reulceration in patients with diabetes and foot risk factors. The findings of several studies reporting statistically significant protective effects from therapeutic footwear may have been influenced by several design issues. When considering the appropriateness of therapeutic footwear recommendations for moderate-risk patients, clinicians and patients should jointly explore individual strategies to decrease events that lead to foot ulcers.

Diabetic Foot↗

PubMedDate not supplied

Predictors of recovery following involuntary hospitalization of violent substance abuse patients.

The goal of this study was to evaluate the results and predictors of good recovery following involuntary hospitalization of violent substance abuse patients. Twenty patients (16 male, aged 13 to 53 years [mean+/-s.d.=32.9+/-10.2]) were admitted in 1997 with a median hospital time of 73.5 days (20 to 455) for exhibiting violent behavior following drug abuse and a loss of self-control. They were treated with psychiatric medication, a 12-step program (Minnesota), psychotherapy and family therapy, and, following hospitalization, counselling, psychotherapy, and participation in self-help groups. Follow-up ranged from 3 to 24 months (17.8+/-4.9). We studied the probability of maintenance of complete abstinence and social adaptation (professional-educational, family and legal parameters) using T and Fisher tests (significance level p< or =0.05). Of the twenty, thirteen patients (65%) achieved excellent social reintegration, and twelve maintained total abstinence. Two patients died (AIDS, hepatic cirrhosis). The chances of complete abstinence and social reintegration were increased by lower age at admission (p=0.02), some form of treatment following hospitalization (p=0.007), adherence to the entire period of treatment (p=0.05), and regular attendance at self-help groups (p=0.05). No significant differences were found in terms of other demographic parameters, drugs used (number or class), previous hospital admissions, length of hospitalization, or follow-up. Sixty percent of patients can expect an excellent outcome over a period of 18 months, according to strict clinical and social criteria. Early intervention and factors increasing adherence to prolonged treatment increase abstinence and social reintegration and thus should be further explored.

Adolescent↗

PubMed1998

The role of the behavioral counselor in obesity treatment.

This review summarizes the role of behavioral counselors in obesity treatment. Behavioral counselors, who are often also registered dietitians, provide multidisciplinary treatment teams with expertise in the modification of diet and physical activity behaviors. Behavioral counselors use a variety of behavior-change strategies aimed at modifying obesity-related behaviors. The first step is to establish a collaborative alliance that will facilitate adherence and behavior change. Then, multiple intervention-related strategies can be used to further enhance adherence to treatment and elicit behavior change. These strategies include self-monitoring, stimulus control, cognitive restructuring, stress management, social support, physical activity, and relapse prevention. Interventions that incorporate these strategies are effective in producing gradual and moderate weight loss in persons with obesity.

Behavior Therapy↗

PubMed2005

Integrating physical activity into mental health services for persons with serious mental illness.

This article reviews evidence supporting the need for interventions to promote physical activity among persons with serious mental illness. Principles of designing effective physical activity interventions are discussed along with ways to adapt such interventions for this population. Individuals with serious mental illness are at high risk of chronic diseases associated with sedentary behavior, including diabetes and cardiovascular disease. The effects of lifestyle modification on chronic disease outcomes are large and consistent across multiple studies. Evidence for the psychological benefits for clinical populations comes from two meta-analyses of outcomes of depressed patients that showed that effects of exercise were similar to those of psychotherapeutic interventions. Exercise can also alleviate secondary symptoms such as low self-esteem and social withdrawal. Although structured group programs can be effective for persons with serious mental illness, especially walking programs, lifestyle changes that focus on accumulation of moderate-intensity activity throughout the day may be most appropriate. Research suggests that exercise is well accepted by people with serious mental illness and is often considered one of the most valued components of treatment. Adherence to physical activity interventions appears comparable to that in the general population. Mental health service providers can provide effective, evidence-based physical activity interventions for individuals with serious mental illness.

Cardiovascular Diseases↗

PubMedDate not supplied

Pharmacists' interventions using an electronic medication-event monitoring device's adherence data versus pill counts.

OBJECTIVE: To compare adherence data from an electronic medication-event monitoring device (MEMS, Aprex) with pill counts in assisting pharmacists in making recommendations regarding diabetes therapy. DESIGN: Two-month, double-blind, randomized, controlled trial. SETTING: Veterans Affairs Medical Center ambulatory care clinics. PATIENTS: Forty-seven patients with poor to fair metabolic control of diabetes mellitus were enrolled. Patients were excluded if they were receiving insulin, had a concurrent infection, required child-resistant caps or medication remainder devices, or could not return for followup visits. Twenty patients were randomized to the MEMS and 27 to the control group (pill counts). Fasting plasma glucose concentrations were measured monthly and glycohemoglobin concentrations were measured at baseline and 60 days. Thirty-two patients were evaluable: 15 using MEMS and 17 using pill counts. INTERVENTION: Investigators made pharmacologic or educational recommendations to the patient's healthcare provider based on both laboratory data and MEMS readings in the treatment group or laboratory data and pill counts in the control group. MAIN OUTCOME MEASURE: Quantities and types of recommendations regarding diabetes therapy made by pharmacists using adherence data from the two methods were tabulated. RESULTS: In the MEMS group, 47 percent of the recommendations related to patient education compared with 12 percent in the control group (p = 0.028). MEMS data would have changed four recommendations in the control group to involve patient education. CONCLUSIONS: MEMS data resulted in different numbers and types of recommendations than pill counts. Pharmacists then could make specific recommendations regarding patient education before resorting to pharmacologic manipulations.

Aged↗

PubMed2001

Do community-based support services benefit bereaved children? A review of empirical evidence.

AIMS: To consider the evidence of effect from English language, empirically based quantitative evaluations of community-based interventions for bereaved children; community-based interventions being understood as those taking place outside a clinical setting. METHODS: MedLine, PsychInfo, Applied Social Sciences Index and Sociological Abstracts were searched for documents containing the words 'child', 'bereavement' and 'program', 'group', 'intervention', 'support' or 'evaluation'. The criterion for inclusion was that studies use a control group or pre- and post-test measurements using a standardized instrument. RESULTS: Nine relevant studies were identified. However, empirical evidence of positive outcomes for children was limited and compromised by methodological weaknesses in the design of the studies. Small sample sizes, irregular attendance, high levels of attrition, short time scales between pre- and post-testing and difficulty in developing appropriate instrumentation, including assessment of adherence to the agreed intervention programme, all created problems. CONCLUSIONS: The case for universal inclusion of this group of children in such support programmes remains unproven, and further exploration of the outcomes of a range of different community interventions is required, with a specific focus on long-term and/or unwanted effects and evaluation of the basis for referral.

Bereavement↗