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Results for “Adherence Interventions”

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At least 739 records · Page 41Linked to original sources

PubMed2005

Evidence-based rheumatology practice.

PURPOSE OF REVIEW: This review is intended to update readers on recent developments in the evidence-based practice of rheumatology. RECENT FINDINGS: Several new or updated evidence-based practice guidelines have recently emerged. In addition, a large body of evidence upon which to base practice has been addressed in the many systematic reviews and meta-analyses that have been newly published, including nine new or updated Cochrane reviews. Several studies have also investigated adherence to practice guidelines, interventions to improve clinical practice, and quality of care in the field of rheumatology in the past year. SUMMARY: Evidence-based rheumatology is an ongoing effort, with continuing revision and update of recommendations. It may currently be used to address a wide variety of clinical questions. The initiatives on practice-based research to establish quality indicators and identify areas where rheumatology practice can be enhanced are a welcome addition to health services research in this field.

Evidence-Based Medicine↗

PubMed2006

Hazardous alcohol use: a risk factor for non-adherence and lack of suppression in HIV infection.

OBJECTIVE: We examined the independent effect of alcohol and combined effects of drug and alcohol use on antiretroviral (ART) utilization, adherence, and viral suppression in an urban cohort of HIV-infected individuals. METHODS: In an observational clinical cohort, alcohol use, active drug use, and adherence were prospectively assessed at 6-month intervals. We classified hazardous alcohol use as >7 drinks/week or >3 drinks/occasion in women, and >14 drinks/week or >4 drinks/occasion in men and active drug use as any use in the previous 6 months. Our outcomes included ART utilization, 2-week adherence, and viral suppression. We used generalized estimating equations to analyze the association between independent variables and outcomes. Analyses were adjusted for age, sex, race, years on ART, and clinic enrollment time. RESULTS: Between 1998 and 2003, 1711 individuals participated in 5028 interviews. 1433 of these individuals received ART accounting for 3761 interviews. The prevalence of any alcohol use at the first interview was 45%, with 10% classified as hazardous drinkers. One-third of the sample used illicit drugs. In multivariate analyses adjusting for age, sex, race, active drug use, years on ART, and clinic enrollment time, hazardous alcohol use was independently associated with decreased ART utilization (AOR, 0.65; 95% CI: 0.51 to 0.82), 2-week adherence (AOR, 0.46; 95% CI: 0.34 to 0.63), and viral suppression (AOR, 0.76; 95% CI: 0.57 to 0.99) compared to no alcohol use. Concurrent injection drug use (IDU) exacerbated this negative effect on ART use, adherence, and suppression. CONCLUSIONS: Hazardous alcohol use alone and combined with IDU was associated with decreased ART uptake, adherence, and viral suppression. Interventions targeting alcohol use may improve HIV outcomes in individuals with hazardous alcohol use.

Adult↗

PubMedDate not supplied

Talking circles: Northern Plains tribes American Indian women's views of cancer as a health issue.

OBJECTIVE: The purpose of this research was to understand the cultural meanings of cancer among American Indian women from Northern Plains tribes living in western South Dakota and their experiential view of breast and cervical cancer screening. DESIGN AND SAMPLE: Using an exploratory design, a purposive sample of 28 women, 35-75 years of age, were recruited into three Talking Circles. MEASUREMENT: Talking Circle and focus group methodology, combined with Affonso's Focus Groups Analytic Schema, were used to generate contextual data sets including thematic findings. RESULTS: Ten themes emerged indicating interrelationships between cultural traditions and health structures of care. The themes provided a unique perspective for conceptualizing women's experiences with breast and cervical cancer screening. CONCLUSIONS: Incorporating women's cultural experiences into screening services is necessary to address clinical and policy challenges for reducing breast and cervical cancer mortality among American Indian women. Findings from this research will be used to guide a future study investigating breast-screening patterns related to mammography adherence and development of interventions specific to American Indian women.

Adult↗

PubMed2006

The effect of pharmacy benefit design on patient-physician communication about costs.

BACKGROUND: Incentive-based formularies have been widely instituted to control the rising costs of prescription drugs. To work properly, such formularies depend on patients to be aware of financial incentives and communicate their cost preferences with prescribing physicians. The impact of financial incentives on patient awareness of and communication about those costs is unknown. OBJECTIVE: To evaluate the relationship between enrollment in incentive-based pharmacy benefit plans and awareness of out-of-pocket costs and rates of communication about out-of-pocket costs. DESIGN: A matched telephone survey of patients and their primary care physicians. SETTING: Los Angeles County. PARTICIPANTS: One thousand nine hundred and seventeen patients aged 53 to 82 (73% response rate). MEASUREMENTS: Patient-reported pharmacy benefit design, knowledge of out-of-pocket costs, and discussion of out-of-pocket costs with physicians. RESULTS: Sixty-two percent of patients who had prescription drug coverage and were aware of their pharmacy benefit design reported being enrolled in incentive-based plans. The majority of these (54%) were "never" or only "sometimes" aware of their out-of-pocket cost requirements at the time of the physician visit. After controlling for numerous physician and patient level variables, we found that patients enrolled in pharmacy benefit designs requiring no copayments were more likely to report they "never" discuss out-of-pocket costs with physicians compared with patients enrolled in incentive-based pharmacy benefit designs (81% vs 67%, P=.001) and patients with no prescription drug insurance (57%, P<.001). CONCLUSIONS: Incentive-based pharmacy benefit plans and lack of insurance are associated with increased rates of discussions about out-of-pocket costs. Nonetheless, most incentive-based enrollees are unaware of out-of-pocket costs when prescriptions are written and never discuss out-of-pocket costs with their physicians, likely mitigating the effectiveness of financial incentives to guide decision making. Considering that out-of-pocket costs are associated with adherence to medical therapy, interventions to improve patient access to out-of-pocket cost information and the frequency of patient-physician discussions about costs are needed.

Aged↗

PubMedDate not supplied

Compliance with outpatient lithium therapy.

This study was conducted to identify factors that influence compliance in patients being treated with lithium carbonate and regularly scheduled supportive clinic appointments for major affective disorders. The researcher examined the predictive value of elements of the Health Belief Model relative to patient compliance, the demographic characteristics of patients, and the effects of patient mood and type of treatment on patient compliance. Patient compliance was operationally defined as serum lithium level within a recommended therapeutic range and attendance at 75 percent or more of regularly scheduled clinic appointments for six months prior to the study. Fifty patients (67%) were compliant with both indices specified by the research, and only three patients (4%) were noncompliant with both indices. Lithium compliance was significantly greater among married patients and patients with higher levels of education. Appointment-keeping compliance was positively associated with individual therapy and increased patients' perceptions of continuity, and negatively correlated with patients' perceptions of increased costs of treatment. The study demonstrates the complexity of the issue of patient compliance with the long-term treatment of primary affective disorders and supports the need for additional research. While some findings suggest interventions to improve patient adherence, scrutiny and testing of these strategies to promote compliance is necessary to determine their effectiveness.

Adult↗

PubMed2004

Clinical update on the use of niacin for the treatment of dyslipidemia.

PURPOSE: To provide nurse practitioners (NPs) with clinical and practical information about the use of niacin in the treatment of dyslipidemia. DATA SOURCES: Research-based and review articles in the medical literature and National Cholesterol Education Program guidelines. CONCLUSIONS: Niacin provides beneficial effects on all major lipid fractions, particularly high-density lipoprotein cholesterol and triglycerides. Niacin also reduces low-density lipoprotein (LDL) cholesterol; lipoprotein (a); and the number of highly atherogenic small, dense LDL particles. Niacin promotes angiographic regression when used in combination with other drugs that lower LDL cholesterol and can reduce cardiovascular risk in patients with coronary heart disease. Several niacin formulations are available, but the safety (i.e., from hepatotoxicity) and tolerability (i.e., severity of flushing) of these niacin formulations may differ. IMPLICATIONS FOR PRACTICE: Niacin therapy is appropriate for many types of lipid abnormalities, including complex dyslipidemias. NPs can take several steps to minimize potential side effects of niacin therapy and to ensure that patients adhere to this important intervention.

Humans↗

PubMed2006

Effective interventions for lifestyle change after myocardial infarction or coronary artery revascularization.

PURPOSE: This science clinical paper reviews medical literature and examines interventions that are currently used to assist patients in achieving lifestyle change after myocardial infarction or coronary artery revascularization. Interventions that focused on both provider- and patient-implemented strategies were included. The effectiveness of these interventions to significantly reduce coronary heart disease risk factors was explored. DATA SOURCES: Original longitudinal research studies or reviews indexed in PubMed between 1999 and 2004 were included. Eight studies were identified that met the inclusion criteria and presented successful interventions to increase participants' adherence to recommended lifestyle changes. CONCLUSIONS: Current strategies for achieving recommended risk factor reductions include frequent follow-up, intensive diet changes, individualized and group exercise, coaching, group meetings, education on lifestyle modification and behavior change, and formal cardiac rehabilitation programs. IMPLICATIONS FOR PRACTICE: Nurse Practitioners can help close the gap between evidence-based recommendations and clinical practice by implementing education programs in their practices and in the community. Recommendations include frequent follow-up visits, negotiating personalized treatment plans, and a general emphasis on therapeutic lifestyle change as an essential component of the treatment plan.

Aftercare↗

PubMed2006

Potential population impact of the UK government strategy for reducing the burden of coronary heart disease in England: comparing primary and secondary prevention strategies.

OBJECTIVE: To use population impact measures to help prioritise the National Service Framework (NSF) strategies recommended by the UK government for reducing the population burden of coronary heart disease (CHD). DESIGN: Modelling study. SETTING: Primary care. DATA SOURCES: Published data on incidence, baseline risk and prevalence of risk factors for CHD and the proportion treated, eligible for treatment, and adhering to the different interventions. Data from meta-analyses and systematic reviews for relative risk and relative risk reduction associated with different risk factors and interventions. MAIN OUTCOME MEASURES: Population impact measures for the decline in the prevalence of a risk factor and the increased uptake of interventions expressed as number of CHD events prevented in the population. RESULTS: If lifestyle targets for primary prevention are met, 73 522 (95% CI 54,117 to 95,826) CHD events would be prevented per year, with the greatest gain coming from reduced cholesterol and blood pressure levels. In those at high risk of developing CHD, achieving target levels for lifestyle interventions would prevent 4410 (95% CI 1993 to 8014) CHD events and for pharmacological treatments 2008 (95% CI 790 to 3627) CHD events. For patients with established CHD, achieving NSF targets will result in the prevention of 3067 (95% CI 1572 to 5878) CHD events through improved drug treatment and 1103 (95% CI 179 to 2097) events through lifestyle interventions. CONCLUSION: Current strategies focus largely on secondary prevention, but many more cardiovascular events would be prevented by meeting the government's public health and primary prevention targets than targeting people at high risk or those with established heart disease.

Age Distribution↗

PubMed2006

Smoking hygiene: reducing infant exposure to tobacco.

The American Academy of Pediatrics recently removed nicotine from the list of drugs contraindicated during breastfeeding. The objective of this study was to evaluate the feasibility of determining the effect of a smoking hygiene intervention on infants of breastfeeding mothers who smoke cigarettes. An experimental design with repeated measures was used. A convenience sample of 35 mother-infant dyads from seven sites was recruited and randomly assigned to the intervention or control group. Of the 27 dyads completing the study, 16 were in the experimental group and 11 were in the control group. Smoking hygiene was introduced when infants were 2 weeks old and reinforced when they were 3 and 5 weeks old. At these three data points, infant health and urinary nicotine and cotinine levels were measured, as well as the mothers' breast-milk nicotine and cotinine levels and smoking hygiene behaviors. Recruiting and retaining a sample of breastfeeding mothers who smoke proved difficult. Only 27% of women in the intervention group implemented all aspects of the smoking hygiene intervention behaviors. Repeated-measures ANOVA revealed no difference in a) infant urinary nicotine and cotinine levels or b) breast-milk nicotine and cotinine levels between the two groups. The McNemar test for related samples revealed no difference between frequency of respiratory symptoms in either the control or intervention groups when Week 2 levels were compared with levels at Weeks 3 and 5. Mothers were not successful in adhering to the smoking hygiene intervention. To adequately test interventions, strategies must be developed to help women incorporate health-promoting behaviors into their lives.

Analysis of Variance↗

PubMed2002

Consequences and determinants of adherence to antiretroviral medication: results from Adult AIDS Clinical Trials Group protocol 370.

OBJECTIVES: (1) To document rates and patterns of adherence from enrollment until week 24 of an AIDS clinical trial; (2) to examine the association of adherence to clinical end-points including plasma HIV-1 RNA level and CD4 cell count; and (3) to identify predictors of adherence from clinical, behavioural, psychosocial and demographic factors. DESIGN: Sub-study of a multicentre, randomised, open-label, comparison-controlled trial; 21 collaborating units of the Adult AIDS Clinical Trials Group. Observational, prospective analysis. METHODS: Ninety-three subjects with baseline plasma HIV-1 RNA levels >500 copies/ml, who completed clinical assessment, plasma HIV-1 RNA titres and CD4 cell counts at study entry, weeks 2, 4 and every 4 weeks thereafter until week 24. All patients were antiretroviral-experienced but were naive to non-nucleoside reverse transcriptase inhibitors and protease inhibitors. Self-reported adherence to antiretroviral therapies prescribed as part of the trial was assessed every 4 weeks from trial, week 4 until week 24. RESULTS: Average adherence was high, with 63% of subjects reporting >95% adherence across the trial. However, there was a significant decline in adherence over time on trial. After controlling for potential confounding variables, patients who were less than 95% adherent to medications were 3.5-times more likely to have treatment failure (HIV-1 RNA >50 copies/ml) than subjects with adherence rates of 95-100%. The strongest predictor of adherence was adverse clinical events (for example, dermatological, gastrointestinal symptoms): patients with adverse events were 12.8-times less likely to have 95-100% adherence. Other clinical, demographic, psychosocial and behavioural factors were also significant predictors of adherence. CONCLUSIONS: Adherence influences virological outcome even in AIDS clinical trials where overall adherence rates are high and should therefore be monitored in future trials. Intervention may be warranted to enhance adherence for subjects who have early toxicities, express concern about taking medications as directed, and for women and minorities.

Adult↗

PubMed2005

Biobehavioral treatment, disability, and psychological effects of pediatric headache.

Headache is a common condition among children and adolescents, and it can result in considerable pain, distress, and functional disability. Lacking proper care, many children will continue to experience headaches into adulthood. These considerations point to the importance of prompt, effective, and early intervention for pediatric headache. Biobehavioral treatments are central to such intervention. From promotion of adherence to optimal use of abortive and prophylactic medications to health behaviors that reduce headache activity to biofeedback-assisted relaxation training, the addition of biobehavioral treatment components to a comprehensive pediatric headache care plan can lead to better initial clinical outcomes, may lessen the need for medication, and may help maintain effects over the long term. Attention to the effects of headache and the accompanying psychological distress is an equally important part of treatment. Indeed, outcomes should be measured in terms of pain parameters (headache frequency, duration, severity) and effect on functional disability and quality of life (school absences, mood, satisfaction with pain relief). Optimal care for children and adolescents with headache can be realized with collaboration among primary care practitioners and headache specialists such as child neurologists and pediatric behavioral medicine experts. Biobehavioral treatment is a foundation for provision of such care.

Biofeedback, Psychology↗

PubMed1993

Medication: reasons and interventions for noncompliance.

1. There is a strong correlation between medication noncompliance and higher rates of illness relapse. The causes of noncompliance include side effects, knowledge deficits, and patient/therapist relationships. 2. The nurse's ongoing assessment and understanding of the patients' reasons for treatment resistance is the key to promoting medication compliance. 3. Because compliance requires patients' complete understanding of their illness and their need for medication treatment, patient education is the initial intervention in promoting medication adherence. 4. The patient must no longer be viewed as the guilty party. The promotion of medication compliance must be the responsibility of both the health care professional and the patient.

Defense Mechanisms↗

PubMed1998

Perceived causes of relapse among a sample of recovering psychiatric patients at a Mafikeng hospital.

The aim of the present study was to identify factors that are perceived by recovering psychiatric patients as contributing to their relapse. The participants were a convenient sample of out-patients at a psychiatric hospital in Mafikeng, north west South Africa. The sample consisted of 15 males and 15 females, aged 18 to 60 years (mean age = 38.7 years). The research data was collected using a questionnaire and non-structured interview. The results showed that 43 percent of the patients attributed their relapse to inability to adhere to prescribed medical intervention. Patients also attributed relapse to lack of social support (20 percent), grief following the loss of a close family member (20 percent), and lack of employment (17 percent). It is recommended that a more integrated approach aimed at providing effective social support be considered in relapse prevention.

Adolescent↗

PubMed1999

[A case of neuroaxis endodermal cyst].

The patient was a 69-year-old male. During examination of possible deafness, a cystic mass was found in the left frontal lobe, which required surgical intervention. Though the mass adhered strongly to the dura mater macroscopically, the boundary between the mass and arachnoid was clear, having a meningioma-like appearance. The pathological diagnosis was epithelial cyst consisting of layered cubic to cylindrical epithelium. It is essential to perform an electronmicroscopic or immunohistological examination for knowing the origin of an epithelial cyst in the neuroaxis, that is, of ectodermal, endodermal, or mesenchymal origin. However, the diagnosis of heterotopic endodermal cyst was established in this patient because the continuity with ependyma cells or choroid plexus was absent without the so-called ectodermogenic tissue such as glia and nerve cells.

Aged↗

PubMedDate not supplied

The laparoscopic retrieval of an orthopedic fixation pin from the liver with repair of an associated diaphragmatic laceration.

We report the successful removal of a shoulder fixation pin from the right lobe of the liver with intracorporeal repair of a diaphragmatic laceration. An expeditious workup and urgent operative intervention were required. We adhered to the principles of room setup, optical correctness, establishment of the triangle of success, appropriate instrument entry and convergence angles, two-handed surgical skills, and competence in intracorporeal suturing techniques that were all required for successful completion of the case. We also present a review of the significant literature.

Aged↗

PubMed2002

Application of the Transtheoretical Model to physically active adults.

BACKGROUND: A physically activity lifestyle has established health benefits, but interventions to increase exercise adherence have had mixed success. Examining physically active individuals could provide insight into strategies that are effective for exercise maintenance. The purpose of this study was to compare active adults based on exercise stage classification [action (ACT) and maintenance (MT)] according to the Transtheoretical Model (TTM). Physiological and psychosocial differences between stages were hypothesized to be consistent with theory and previous research. METHODS: A cross-sectional design was used to examine components of the TTM, exercise behavior, resting cardiovascular variables, and VO(peak). Data from 57 physically active college students (age= 21.2 +/- 3.7 yrs, 67% female, 71.9% Caucasian) were included in the analysis. TTM variables and self-report of behavior were measured with established questionnaires. VO(peak) was determined from expired gases during a maximal exercise test. RESULTS: Volume of weekly exercise and number of months consistently active were significantly greater for MT (n=35) than for ACT (n=22). When controlling for gender effects, VO(peak) and systolic blood pressure were also greater in MT than ACT. MT also scored higher than ACT on decisional balance (pros-cons of exercise) and 4 processes of change. CONCLUSIONS: Membership in MT and ACT stages was corroborated by aerobic capacity. Predicted differences in TTM components were only partially supported, but behavioral strategies were used more by participants who were consistently active longer. Physically active individuals should be studied over time to determine if targeting behavioral processes of change will enhance long-term exercise adherence.

Adolescent↗

PubMed2005

Racial differences in analgesic/anti-inflammatory medication adherence among patients with osteoarthritis.

OBJECTIVES: This study examined the prevalence of self-reported adherence to medications for osteoarthritis (OA) and racial differences in adherence. METHODS: This was a cross-sectional survey of 156 Black and White veterans who were taking medications for OA. RESULTS: One quarter of participants reported sometimes forgetting to take their OA medications, 16% were sometimes careless about taking medications, and 27% sometimes stopped taking their medications when they felt better. Overall, 44% of participants reported at least one of these three behaviors. In a multivariable logistic regression model adjusting for demographic factors, OA severity, participatory decision making (PDM), and side effects, Black patients were more likely to report at least one nonadherent behavior (odds ratio [OR] = 2.25, 95% CI = 1.03-4.91). Patients with greater PDM scores were slightly less likely to report nonadherent behavior (OR = 0.95, 95% CI = 0.91-0.99). DISCUSSION: Additional research is needed to examine factors underlying racial differences in adherence, to guide effective interventions.

Analgesics↗

PubMed1995

Evolution of the understanding of the role of exercise in obesity and its complications.

Exercise is often added to energy intake restriction in treatment programs for obesity. The effects of exercise alone on body fat mass is highly variable, and less efficient than diminishing energy intake. However, exercise has additional, beneficial effects on most of the metabolic risk factors for cardiovascular disease and non-insulin dependent diabetes mellitus. A problem is the feasibility of training programs. Conventional, aerobic type of interventions are difficult to adhere to because of their strenuous character and because of boredom. Recent findings of essentially similar effects of low intensity programs, creating Metabolic Fitness appear more attractive and useful. The final proof of a potential protective effects of exercise against cardiovascular disease and diabetes needs very difficult, time-consuming and expensive studies, if at all feasible to perform. The current evidence for protective effects is highly suggestive, and the beneficial effects on the risk factors for these diseases have been demonstrated. Provided that feasible methods and motivation are available we can therefore now probably recommend increased physical activity.

Body Composition↗