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Results for “Adherence Interventions”

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PubMed1992

Medication adherence behaviors in older adults: effects of external cognitive supports.

Medication adherence behaviors of 61 elderly adults were examined using a sensitive microelectronic monitoring device. To assess the effects of external cognitive supports on adherence, different subjects received (a) no intervention, (b) an organizational chart, (c) an over-the-counter medication organizer, or (d) both the chart and organizer. The young-old subjects showed a high rate of adherence (94%) and were not improved by the addition of the interventions. Old-old subjects had a lower rate of adherence (85%) than young-olds. Omission errors were the most frequent mistakes and were lower in the condition in which subjects received both chart and organizer.

Aged↗

PubMed2000

[A review of socio-behavioural studies on adherence to antiretroviral treatments: beyond biomedical models?].

This paper, based on a review of the literature of socio-behavioural research in this field, shows how the AIDS epidemic has renewed traditional approaches to patients behaviour toward medical treatment by substituting the notion of adherence for the traditional one of compliance. It shows how this issue of patients adherence has come to the forefront of HIV care with the recent diffusion of highly active antiretroviral therapeutics (HAART), because inadequate adherence has profound implications for the individual and public heath effectiveness of these therapeutic advances. The paper argues that two alternatives, and indeed conflicting, approaches to adherence to treatment in HIV infection however persist. The aim of the first approach remains to predict and correct non-adherent behaviour in certain patients and sometimes suggests that such predictions may provide justification for denying individuals treatment. This 'predictive' approach focuses on identification of individual barriers to 'good' adherence and calls on social science research to help improve the 'acceptability' of prescribed regimens for patients. An alternative 'empathic' approach focuses more on encouraging and supporting all HIV-infected patients medically eligible for HAART to devise appropriate individualised plans that can facilitate management of their treatment in their daily life. This latter approach more willingly learns from social science research which recognises the patient's subjective experience of illness as a central concern. In the future, the respective contributions of these two alternative approaches will have to be judged on the basis of their capacity to analyse both the factors which influence HIV-infected patients' initial adherence to antiretroviral treatment and those, potentially quite different, which interfere with adherence on the long term. They will also be judged for their capacity to inspire effective psychological and socio-behavioural interventions aimed at facilitating patients adherence.

Anti-HIV Agents↗

PubMed1997

Effective group behavioral intervention for older periodontal patients.

A randomized clinical trial assessed the effect of a group-based behavior modification intervention on oral hygiene skills, adherence and clinical outcomes for older periodontal patients. Subjects (n = 107) were aged 50-70 yr with moderate periodontal disease. They were randomly assigned to usual care or intervention. Intervention consisted of 5 weekly, 90-min sessions that included skill training, self-monitoring, weekly feedback about bleeding points and group support focused on long-term habit change. Four-month follow-up indicated significant improvements in the intervention versus the usual periodontal maintenance group for oral hygiene skills and self-reported flossing (p < 0.001), plaque, gingival bleeding, bleeding upon probing throughout the mouth, and pocket depth for sulcus depths that measured between 3 and 6 mm at baseline (p < 0.009). Group oral health intervention provides an effective and relatively inexpensive means of helping patients improve their self-care skills and achieve high levels of adherence to an effective self-care regimen.

Aged↗

PubMedDate not supplied

The effects of standard care counseling or telephone/in-person counseling on beliefs, knowledge, and behavior related to mammography screening.

PURPOSE/OBJECTIVES: To determine the most effective methods of increasing mammography adherence while also considering ease of intervention delivery in evolving healthcare systems. DESIGN: Experimental. SETTING: Women from a health maintenance organization and a large general medicine practice. SAMPLE: Women 50-85 years of age who had not had breast cancer and did not have a mammogram within the last 15 months. METHODS: Once consent and baseline information were obtained, women were randomized to receive in-person, telephone, or no mammography counseling. MAIN RESEARCH VARIABLES: Mammography adherence, perception of susceptibility to breast cancer, and benefits, barriers to, and knowledge of mammography. FINDINGS: Compared to standard care, telephone counseling was more than twice as effective at increasing mammography adherence, whereas in-person counseling resulted in almost three times the mammography adherence postintervention. Both telephone and in-person counseling are successful in changing perceived susceptibility, knowledge, barriers, and benefits. CONCLUSION: Both telephone and in-person counseling interventions were successful in changing beliefs, which, in turn, increased mammography adherence. IMPLICATIONS FOR NURSING PRACTICE: Interventions based on altering beliefs are effective for increasing mammography adherence.

Aged↗

PubMed2001

Measuring adherence to a women's walking program.

The purpose of this study is to demonstrate the use of a self-report exercise log and a heart-rate monitor in the measurement of adherence to the dimensions of an exercise prescription and to propose an alternative way to define adherence to a 24-week home-based women's walking program, which reflects the dynamic process of behavior change. Adherence was measured with exercise logs, Polar Vantage XL Heart-Rate Monitors, and pre- to postintervention change in VO2 max. Of the dimensions of the exercise prescription, frequency of walks documented by both the heart-rate monitor and the exercise log had a higher correlation than duration and intensity of walking, with change in VO2 max suggesting that frequency was potentially the most predictive adherence measure. Examination of the total number of walks and the number and sequence of weeks without walks over the 24-week intervention revealed dynamic patterns of adherence suggesting variation in the degree of behavioral change.

Aged↗

PubMed2003

Standardizing contact investigation protocols.

SETTING: The State of Alabama Department of Public Health Division of Tuberculosis Control. OBJECTIVE: To standardize contact investigation protocols and implement an intervention to increase TB field worker adherence to the protocols with the goal of promoting efficiency and effectiveness in contact investigations. DESIGN: A process evaluation of existing data collection and management systems and protocols was performed. Standardized protocols and an intervention to increase TB field worker adherence to the protocols were created and pilot tested. These were then implemented and formative evaluation data were collected. RESULTS: The process evaluation revealed considerable variance among field workers with regard to protocols and definitions of variables related to contact investigations. Protocols were standardized and an intervention targeted at TB field workers was developed. The intervention consisted of a training workshop and the development of a computer-based contact investigation module. This was successfully implemented throughout the state. CONCLUSIONS: To perform effective contact investigations and conduct studies to improve the effectiveness of these investigations, TB control programs must pay careful attention to precisely defining variables and concepts related to the contact investigation. Furthermore, protocols must be standardized and resources devoted to training of TB field workers to ensure adherence to protocols.

Alabama↗

PubMed2006

Adherence to treatment among economically disadvantaged patients with panic disorder.

OBJECTIVE: The purpose of this study was to examine the feelings of disadvantaged patients about and experiences of treatment for anxiety disorders in primary care settings. METHODS: The patients had participated in the Collaborative Care for Anxiety and Panic study, which tested the effectiveness of an intervention to help primary care providers treat panic disorder. The treatment comprised cognitive behavioral therapy (CBT) combined with pharmacotherapy administered by primary care physicians with the expert advice of a psychiatrist. Post hoc semistructured interviews were conducted with 21 intervention participants who were classified according to adherence or nonadherence to treatment. The interview focused on reactions to CBT; reactions to the different features of the intervention, such as therapy sessions, demonstration videotapes, exercises, and a workbook; and comfort with the therapist. Two members of the research team independently coded, analyzed, and interpreted the data. RESULTS: Three themes emerged: information was empowering and reduced the sense of isolation experienced by participants, participants engaged in a dynamic and iterative personalized assessment of the intervention, and barriers to adherence were predominantly logistical. CONCLUSIONS: Results indicate that the extent to which patients chose to remain in treatment and follow treatment recommendations was rarely an all-or-nothing phenomenon. In a disadvantaged population such decisions seem to be influenced by the beliefs of the patient about what will and will not be effective in his or her individual case, an ongoing self-assessment of well-being, and the logistical barriers that come into play.

Adaptation, Psychological↗

PubMed1989

Adherence and its management in clinical trials: implications for arthritis treatment trials.

Adherence in clinical trials is a consistent problem regardless of the disease process or organ system under investigation. In this paper data and examples from clinical trials examining cardiovascular diseases are used as the basis for a review of various adherence principles. Issues reviewed include: the importance of adherence in clinical trials, an overall program for adherence in clinical trials, and specific issues in adherence from arthritis clinical trials. Special attention is given to a program for the prevention of reduced adherence for participants of a clinical trial as well as acute and chronic intervention plans for those with good adherence and those with reduced adherence in a clinical trial.

Arthritis↗

PubMed2006

Adherence to preventive medications: predictors and outcomes in the Diabetes Prevention Program.

OBJECTIVE: To evaluate barriers to and strategies for medication adherence and predictors of adherence and the primary outcome in the Diabetes Prevention Program (DPP). RESEARCH DESIGN AND METHODS: Within a randomized, controlled primary prevention study for type 2 diabetes, we collected data on study medication adherence, its predictors, and health outcomes in 27 clinical centers across mainland U.S. and Hawaii. Medication arm participants included 2,155 adults with impaired glucose tolerance randomly assigned to either metformin or matched placebo treatment arms. Structured interviews were used to promote medication adherence and to collect data regarding adherence. Adherence was measured by pill count. The primary DPP outcome of type 2 diabetes was assessed by fasting plasma glucose and oral glucose tolerance test. RESULTS: Older age-groups were more adherent than the youngest group (P = 0.01) in the metformin group. The most frequently reported barrier to adherence was "forgetting" (22%). Women reported more adverse effects of metformin (15 vs. 10%, P = 0.002) in the metformin group. Odds of nonadherence increased as participants reported more than one barrier (odds ratio 19.1, P < 0.001). Odds of adherence increased as participants reported multiple strategies to take medication (2.69, P < 0.0001). There was a 38.2% risk reduction for developing diabetes for those adherent to metformin compared with those adherent to placebo (P < 0.0003). CONCLUSIONS: DPP medication adherence results are unique in primary prevention for a chronic disease in a large multiethnic sample. Our finding that adherence was associated with risk reduction for diabetes supports the development of brief interventions in clinical settings where medication adherence is a challenge.

Adult↗

PubMed2004

Adherence to HAART among HIV-infected persons in rural Louisiana.

The purpose of this study was to examine factors associated with nonadherence to highly active antiretroviral therapy (HAART) in patients seen in HIV clinics throughout nonurban Louisiana. A convenience sample of 273 patients from 8 areas in nonurban Louisiana were interviewed to obtain demographic, clinical and adherence information. Associations between demographic, clinical, and behavioral factors and nonadherence were examined. Ideally, non-adherence should not exceed 5% in patients for whom HAART was prescribed. Mean age was 38.6 years (range, 19-66), 29.3% were female, 60.1% were African American, 34.4% reported nonadherence to their HAART medication (defined as the subject's self-report of missing any doses of HAART medication in the prior week). In the prior month, participants reported the following behaviors: binge drinking (12.8%), problem drinking (12.8%), and illicit drug use (16.5%). Depression was found in 49.8% of the respondents. In logistic regression analysis, problem drinking odds ratio [OR] (95% confidence interval [CI]): 3.92 (1.69,9.09) was found to be associated with nonadherence. Demographic and behavioral factors such as illicit drug use and depression were not associated with nonadherence on multivariable analysis. Problem drinking was associated with lack of adherence to HAART over the past week. Interventions to treat problem drinking are needed and may improve adherence to medication for HIV-infected persons living in rural, town, and small-city areas.

Adult↗

PubMedDate not supplied

Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial.

BACKGROUND: Endovascular aneurysm repair (EVAR) to exclude abdominal aortic aneurysm (AAA) was introduced for patients of poor health status considered unfit for major surgery. We instigated EVAR trial 2 to identify whether EVAR improves survival compared with no intervention in patients unfit for open repair of aortic aneurysm. METHODS: We did a randomised controlled trial of 338 patients aged 60 years or older who had aneurysms of at least 5.5 cm in diameter and who had been referred to one of 31 hospitals in the UK. We assigned patients to receive either EVAR (n=166) or no intervention (n=172). Our primary endpoint was all-cause mortality, with secondary endpoints of aneurysm-related mortality, health-related quality of life (HRQL), postoperative complications, and hospital costs. Analyses were by intention to treat. FINDINGS: 197 patients underwent aneurysm repair (47 assigned no intervention) and 80% of patients adhered to protocol. The 30-day operative mortality in the EVAR group was 9% (13 of 150, 95% CI 5-15) and the no intervention group had a rupture rate of 9.0 per 100 person years (95% CI 6.0-13.5). By end of follow up 142 patients had died, 42 of aneurysm-related factors; overall mortality after 4 years was 64%. There was no significant difference between the EVAR group and the no intervention group for all-cause mortality (hazard ratio 1.21, 95% CI 0.87-1.69, p=0.25). There was no difference in aneurysm-related mortality. The mean hospital costs per patient over 4 years were UK pound sterling 13,632 in the EVAR group and pound sterling 4983 in the no intervention group (mean difference pound sterling 8649, SE 1248), with no difference in HRQL scores. INTERPRETATION: EVAR had a considerable 30-day operative mortality in patients already unfit for open repair of their aneurysm. EVAR did not improve survival over no intervention and was associated with a need for continued surveillance and reinterventions, at substantially increased cost. Ongoing follow-up and improved fitness of these patients is a priority.

Aged↗

PubMed2006

Reframing HIV adherence as part of the experience of illness.

Understanding and enhancing adherence to HIV medications has been identified as a major challenge. The purpose of this study was to explore patterns and determinants of non-adherence among individuals receiving HIV care in a medical clinic. Seven focus groups were conducted with 42 HIV+ patients, and verbatim transcripts of focus group sessions were analyzed through a combination of ethnographic and content analysis. Of the participants currently on combination therapy, 68% reported at least one recent instance of non-adherence. The most commonly cited reasons for non-adherent behavior were grouped into four categories: (1) problems with side effects; (2) conflicts with daily life activities; (3) feelings of aversion toward the medications themselves; and (4) deliberate alterations to the prescribed regimen. Findings based on structured analysis of patient responses in each category differ from past research which defines adherence as a treatment problem and emphasizes logistical characteristics of the treatment regimen itself and patients' ability or willingness to follow specific instructions. In contrast, our focus group data suggest an alternative frame for understanding barriers to adherence which focuses on: (1) the meaning that adherence/pill-taking behavior has for individuals experiencing chronic illness; and (2) the impact that this behavior has on their identity. Because adherence behavior is integral to patients' experience of their disease, non-adherence is no longer a treatment problem, but is an illness problem. Framing adherence as an illness problem rather than a treatment problem is a critical shift that can be applied to the creation of assessments and interventions designed to support patient adherence; this article ends with a series of specific recommendations for programs, policy, and research.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Strategies to improve hand hygiene practices in two university hospitals.

OBJECTIVE: To evaluate the strategies to improve hand hygiene practices among participants in two university hospitals. MATERIAL AND METHOD: A quasi-experimental study was performed from January 1, 2001 to December 31, 2004 at Siriraj Hospital and from January 1, 2004 to July 31, 2004 at the neonatal intensive care unit (NICU), Maharaj Nakorn Chiang Mai Hospital. The study was divided into three phases; 1) pre-intervention phase to identify factors associated with non-adherence in hand hygiene practices among participants, 2) intervention phase, 3) post-intervention phase to include observations to evaluate the effectiveness of interventions on hand hygiene practices among participants. Interventions at Siriraj Hospital included distribution of posters, leaflets, rewarding healthcare workers (HCWs) who suggest the most attractive name for alcohol gel and a handwashing slogan, and a parade to boost hand hygiene practice. Interventions at Maharaj Nakorn Chiang Mai Hospital included training, a reminder poster display, provision of alcohol-based handrubs and performance feedback. RESULTS: Six hundred and forty-six HCWs were observed before and after the non-invasive procedures and 404 HCWs were observed before and after an invasive procedure at Siriraj Hospital. At Maharaj Nakorn Chiang Mai Hospital, participants included 26 nursing personnel in the NICU. After intervention, significant improvement on handwashing was observed in both the invasive procedure (p<0.001) and non-invasive procedures (p<0.001) at Siriraj Hosptial. Significant improvement on handhygiene practice was also observed among participants at Maharaj Nakorn Chiang Mai Hosptial (p=0.001). CONCLUSION: Different strategies worked well in different institutions. The present study suggested the role of multi-faceted approaches to help improve handhygiene practices among HCWs.

Adult↗

PubMed2005

Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: double-blind, randomised, controlled clinical trial.

BACKGROUND: Chronic heart failure (CHF) is an important cause of hospital admission and death. Poor adherence to medication is common in some chronic illnesses and might reduce the population effectiveness of proven treatments. Because little is known about adherence in patients with CHF and about the consequences of non-adherence, we assessed the association between adherence and clinical outcome in the CHARM (Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity) programme. METHODS: CHARM was a double-blind, randomised, controlled clinical trial, comparing the effects of the angiotensin receptor blocker candesartan with placebo in 7599 patients with CHF. Median follow-up was 38 months. The proportion of time patients took more than 80% of their study medication was defined as good adherence and 80% or less as poor adherence. We used a Cox proportional hazards regression model, with adherence as a time-dependent covariate in the model, to examine the association between adherence and mortality in the candesartan and placebo groups. FINDINGS: We excluded 187 patients because of missing information on adherence. In the time-dependent Cox regression model, after adjustment for predictive factors (demographics, physiological and severity-of-illness variables, smoking history, and number of concomitant medications), good adherence was associated with lower all-cause mortality in all patients (hazard ratio [HR] 0.65, 95% CI 0.57-0.75, p<0.0001). The adjusted HR for good adherence was similar in the candesartan (0.66, 0.55-0.81, p<0.0001) and placebo (0.64, 0.53-0.78, p<0.0001) groups. INTERPRETATION: Good adherence to medication is associated with a lower risk of death than poor adherence in patients with CHF, irrespective of assigned treatment. This finding suggests that adherence is a marker for adherence to effective treatments other than study medications, or to other adherence behaviours that affect outcome. Understanding these factors could provide an opportunity for new interventions, including those aimed at improving adherence.

Aged↗

PubMed1993

Process variables as predictors of risk factor changes in a family health behavior change program.

The purpose of the present study was to determine the extent to which intervention process measures are useful in predicting changes in cardiovascular disease (CVD) risk factors among subjects exposed to interventions. Subjects were 99 adult and 105 children who participated in an 18 session, family-based diet and exercise change program. During the intervention, each participant self-monitored diet and exercise for 12 weeks. Additionally, attendance, session evaluation, confidence to achieve goals and goal achievement data were collected each week. The intervention was successful in changing diet, blood pressure and cholesterol levels, but did not produce significant changes in exercise or body mass index. Stepwise multiple regression analyses were conducted for each outcome variable at the 1 and 2 year follow-ups. Ethnicity and sex were first forced into each regression. None of the process measures consistently predicted multiple outcomes in adults and children. The pattern of results provides limited support for the hypothesis that intervention process variables such as attendance, adherence to self-monitoring, achievement of goals and attitude toward sessions partially mediate intervention effects. It is concluded that process measures should be collected in health behavior change programs so that process-outcome relationships can be further explored.

Adolescent↗

PubMed2006

Adherence to cardioprotective medications and mortality among patients with diabetes and ischemic heart disease.

BACKGROUND: Patients with diabetes and ischemic heart disease (IHD) are at high risk for adverse cardiac outcomes. Clinical practice guidelines recommend multiple cardioprotective medications to reduce recurrent events. We evaluated the association between cardioprotective medication adherence and mortality among patients with diabetes and IHD. METHODS: In a retrospective cohort study of 3,998 patients with diabetes and IHD, we evaluated use of ACE inhibitors or angiotensin receptor blockers, beta-blockers, and statin medications. Receipt of cardioprotective medications was based on filled prescriptions. Medication adherence was calculated as the proportion of days covered (PDC) for filled prescriptions. The primary outcome of interest was all-cause mortality. RESULTS: The majority of patients (92.8%) received at least 1 cardioprotective medication. Patients receiving any medications had lower unadjusted mortality rates compared to patients not receiving any medications (7.9% vs. 11.5%; p = 0.03). In multivariable analysis, receipt of any cardioprotective medication remained associated with lower all-cause mortality (OR 0.65; 95% CI 0.43-0.99). Among patients receiving cardioprotective medications, the majority (80.3%) were adherent (PDC > or = 0.80). Adherent patients had lower unadjusted mortality rates (6.7% vs. 12.1%; p < 0.01). In multivariable analysis, medication adherence remained associated with lower all-cause mortality (OR 0.52; 95% CI 0.39-0.69) compared to non-adherence. In contrast, there was no mortality difference between patients receiving cardioprotective medications who were non-adherent compared to patients not receiving any medications (OR 1.01; 95% CI 0.64-1.61). CONCLUSION: In conclusion, medication adherence is associated with improved outcomes among patients with diabetes and IHD. Quality improvement interventions are needed to increase medication adherence in order for patients to maximize the benefit of cardioprotective medications.

Adrenergic beta-Antagonists↗

PubMed1997

Patient participation and compliance in cancer chemoprevention trials: issues and concerns.

Cancer chemoprevention trials have unique characteristics that make the tasks of participant recruitment, enrollment, and long-term adherence to the study protocol and intervention regimen especially difficult. Barriers to patient accrual, long-term participation, and optimal adherence are inherent in clinical trial design and organization, and are frequently associated with the attitudes and behavioral dynamics of physicians and the participants themselves. Attracting racially and ethnically diverse populations to trial participation adds additional problems and considerations. Careful planning early in the design phase of a chemoprevention clinical trial must take into account these numerous issues. Clinical investigators should seek expert advice from a number of health care disciplines to better design chemoprevention protocols that minimize logistic complexity, maximize participant eligibility, simplify data collection, and take into account the complex behavioral dynamics of the clinical trial process.

Anticarcinogenic Agents↗

PubMed2004

A cost-effectiveness comparison of three tailored interventions to increase mammography screening.

BACKGROUND: Mammography is the primary method used for breast cancer screening. However, adherence to recommended screening practices is still below acceptable levels. This study examined the cost-effectiveness of three combinations of tailored telephone and mailed intervention strategies for increasing adherence to mammography. METHODS: There were 1044 participants who were randomly assigned to one of four groups. A logistic regression model with adherence as the dependent variable and group as the independent variable was used to test for significant differences, and a ratio of cost/improvement in mammogram adherence evaluated the cost-effectiveness. RESULTS: All three of the interventions (tailored telephone, tailored mail, and tailored telephone and mail) had significantly better adherence rates compared with the control group (usual care). However, when also considering costs, one emerged as the superior strategy. The cost-effectiveness ratios for the three interventions show that the tailored mail (letter) was the most cost-effective strategy, achieving 43.3% mammography adherence at a marginal cost of dollar 0.39 per 1% increase in women screened. The tailored mail plus telephone achieved greater adherence (49.4%), but at a higher cost (dollar 0.56 per 1% increase in women screened). CONCLUSIONS: A tailored mail reminder is an effective and economical intervention to increase mammography adherence. Future research should confirm this finding and address its applicability to practice in other settings.

Adult↗