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Results for “Medication Adherence”

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PubMed2006

Specialised care for early psychosis: symptoms, social functioning and patient satisfaction: randomised controlled trial.

BACKGROUND: The provision of early intervention services for people with psychosis is UK government policy, although evidence for benefit of such services is sparse. AIMS: To evaluate the effects of a service providing specialised care for early psychosis (the Lambeth Early Onset Team) on clinical and social outcomes, and on service user satisfaction. METHOD: One hundred and forty-four people with psychosis, presenting to mental health services for the first or second time (if previously failed to engage in treatment), were randomly allocated to care by the early onset team or to standard care. Information was obtained on symptoms, treatment adherence, social and vocational functioning, satisfaction and quality of life. Relapse and rehospitalisation data have been reported separately. RESULTS: Outcomes for the participants treated by the early onset team were significantly better at 18 months for aspects of social and vocational functioning, satisfaction, quality of life and medication adherence. Symptom improvement did not significantly differ between the groups. CONCLUSIONS: The provision of specialised care for early psychosis can achieve better outcomes. The study therefore provides support for current policy.

Adolescent↗

PubMedDate not supplied

Cynical hostility, powerful others control expectancies, and patient adherence in hemodialysis.

OBJECTIVE: The present study examined the joint role of cynical hostility and powerful others health locus of control expectancies in predicting regimen adherence in a sample of center hemodialysis patients. METHOD: Forty-eight hemodialysis patients completed the Cook-Medley Hostility (Ho) Scale and the Powerful Others Health Locus of Control (PHLC) scale. Adherence to the fluid-restriction and phosphorus reduction components of the treatment regimen was assessed by examining patients' interdialysis session weight gains and serum phosphorus (P) levels. RESULTS: In a hierarchical regression analysis, higher hostility was associated with significantly higher serum P levels indicating poorer dietary and medication adherence. The main effect for hostility was qualified by the interaction of hostility and PHLC. This pattern indicated that the deleterious effect of hostility on adherence was most pronounced among patients possessing the expectancy that positive health outcomes are not strongly contingent on the actions or advice of powerful others (eg. health care providers). Similar analyses failed to show significant effects for hostility or PHLC in the prediction of interdialytic weight gain. CONCLUSIONS: The present findings suggest that jointly assessing hostility and health-related expectancies may be useful in identifying chronically ill patients who are potentially at risk for difficulties in performing a prescribed regimen.

Adult↗

PubMed1999

Quality of public sector care for schizophrenia in Arkansas.

OBJECTIVE: Using process-of-care indicators, we examined the quality of care provided to 139 individuals receiving treatment for schizophrenia in public sector systems. METHODS: Longitudinal data on services use and medication management were abstracted from medical records. Medication adherence data were obtained by self- and informant reports. RESULTS: Overall, 39% of participants had less than monthly contact with community-based service (CBS) providers. When participants in day treatment or partial hospitalization programs were excluded, less than monthly CBS contact increased to 70%. Of participants, 40%-60% were prescribed medications outside guideline-recommended dose ranges. Up to half of participants reported taking half or less of prescribed antipsychotics. The adverse impact on patient outcomes of these practice patterns is well established. CONCLUSIONS: Public sector organizations face powerful challenges to the behavioral changes needed to sustain best practice care. Overcoming these challenges to assure high-quality care for schizophrenia will require tremendous creativity and commitment.

Adolescent↗

PubMed2005

Modern strategies in the prevention of implant-associated infections.

The application of medical devices either for temporary or permanent use has become an indispensible part of almost all fields of medicine. However, foreign bodies are associated with a substantial risk of bacterial and fungal infections. Implant-associated infections significantly contribute to the still increasing problem of nosocomial infections. To reduce the incidence of such infections, specific guidelines providing evidence-based recommendations and comprising both technological and nontechnological strategies for prevention have been established. Strict adherence to hygienic rules during insertion or implantation of the device are aspects of particular importance. Besides such basic and indispensable aspects, the development of new materials which could withstand microbial adherence and colonization has become a major topic in recent years. Modification of surface by primarily physico-chemical methods may lead to a change in specific and unspecific interactions with microorganisms and, thus, to a reduction in microbial adherence. Medical devices made out of a material that would be ideally antiadhesive or at least colonization-resistant would be the most suitable candidates to avoid colonization and subsequent infection. However, it appears impossible to create a surface with an absolute 'zero'-adherence due to thermodynamical reasons and due to the fact that a modified material surface is in vivo rapidly covered by plasma and connective tissue proteins. Therefore, another concept for the prevention of implant-associated infections involves the impregnation of devices with various antimicrobial substances such as antibiotics, antiseptics, and/or metals. In fact, already commercially available materials for clinical use such as antimicrobial catheters have been introduced, in part with considerable impact on subsequent infections. However, future studies are warranted to translate the knowledge on the pathogenesis of device-associated infections into applicable prevention strategies.

Anti-Bacterial Agents↗

PubMed2004

Non-adherence to antipsychotic medication regimens: associations with resource use and costs.

BACKGROUND: Several factors are thought to influence resource use and costs in treating schizophrenia. AIMS: To assess the relative impact of non-adherence and other factors associated with resource use and costs incurred by people with schizophrenia. METHOD: Secondary analyses were made of data from a 1994 national survey of psychiatric morbidity among adults living in institutions in the UK. Factors potentially relating to resource use and costs were examined using two-part models. RESULTS: Patients who failed to adhere to their medication regimen were over one-and-a-half times as likely as patients who did adhere to it to report use of in-patient services. Non-adherence is one of the most significant factors in increasing external service costs, by a factor of almost 3. Non-adherence predicted an excess annual cost per patient of approximately 2500 British pounds for in-patient services and over 5000 British pounds for total service use. CONCLUSIONS: Resource use and costs are influenced by various factors. Medication non-adherence consistently exhibits an association with higher costs. Further important factors are patient needs and the ability of the system to address them.

Adult↗

PubMed2001

Developing a community-specific health-related quality of life (HRQOL) questionnaire for asthma: the Asthma-Specific Quality of Life Questionnaire for Native American Adults (AQLQ-NAA).

The Asthma Quality of Life Questionnaire for Native American Adults (AQLQ-NAA) was developed by modifying the Asthma Quality of Life Questionnaire-Marks (AQLQ-M) using the focus group technique. The 19-item AQLQ-NAA has emphasis on restrictions in social, community, and cultural activities. Higher scores indicate a better quality of life. The modified questionnaire was administered to a sample of 51 Native American adults with asthma at the Albuquerque USPHS Indian Hospital and its affiliated field clinics. Principal components analysis identified three domains with eigenvalues greater than 1.00: Community and Social Restrictions (CSR), Psychological Impact (PIM), and Symptoms (SYM). Cronbach's coefficient alpha for the AQLQ-NAA was 0.95 and ranged from 0.82 to 0.93 for the individual domains, indicating good internal consistency. The AQLQ-NAA score correlated negatively and significantly to urgent care visits, physician visits, and total number of medications taken for asthma in the past 6 and 12 months (p < 0.05). Additionally, the AQLQ-NAA score was correlated positively and significantly to medication adherence in the past 6 and 12 months (p < 0.05). Similar patterns of correlations were found with all three domain scores. These results indicated that there is evidence for the construct validity of the AQLQ-NAA and its domains. The AQLQ-NAA should provide a useful measure of HRQOL in asthma-specific medical interventions for the population in which it was developed.

Adult↗

PubMed1982

Factors associated with children's adherence to stimulant medication.

Hyperactive children and their families were studied to assess adherence to a regimen of stimulant medication. Of those agreeing to participate for one year, 20% had discontinued medication by the fourth month and 44% by the tenth month. Findings are discussed in relation to child and parent characteristics, and unique nature of using medication to treat behavior problems in children, and the difficulty of carrying out such long-term investigations with children.

Attention Deficit Disorder with Hyperactivity↗

PubMed1996

Effect of a multidisciplinary intervention on medication compliance in elderly patients with congestive heart failure.

PURPOSE: The objectives of this investigation were to prospectively assess medication compliance rates in elderly patients with congestive heart failure, to identify factors associated with reduced compliance, and to evaluate the effect of a multidisciplinary treatment approach on medication adherence. PATIENTS AND METHODS: A total of 156 patients > or = 70 years of age (mean, 79.4 +/- 6.0; 67% female, 65% nonwhite) hospitalized with congestive heart failure were evaluated prospectively. Prior to discharge, patients were randomized to the study intervention (n = 80) or conventional care (n = 76). The intervention consisted of comprehensive patient education, dietary and social service consultations, medication review, and intensive postdischarge follow-up. Detailed data were collected on all prescribed medications at the time of discharge, and compliance was assessed by pill counts 30 +/- 2 days later. RESULTS: The overall compliance rate during the first 30 days after discharge was 84.6 +/- 15.1% (range, 23.1-100%). Compliance was 87.9 +/- 12.0% in patients randomized to the study intervention, compared with 81.1 +/- 17.2% in the control group (P = 0.003). A compliance rate of > or = 80% was achieved by 85.0% of the treatment group versus 69.7% of the control group (P = 0.036). By multivariate analysis, assignment to the treatment group was the strongest independent predictor of compliance (P = 0.008). Other variables included in the model were Caucasian race (P = 0.044) and not living alone (P = 0.09). CONCLUSIONS: A multidisciplinary treatment strategy is associated with improved medication compliance during the first 30 days following hospital discharge in elderly patients with congestive heart failure. Improved compliance may contribute to improved outcomes in these patients.

Aged↗

PubMed2005

Adherence to combined Lamivudine + Zidovudine versus individual components: a community-based retrospective medicaid claims analysis.

Adherence to a fixed dose combination of dual nucleoside antiretroviral therapy was compared between human immunodeficiency virus (HIV)-infected patients newly started on a fixed dosed combination of lamivudine (3TC) 150 mg/zidovudine (ZDV) 300 mg versus its components taken as separate pills. Medicaid pharmacy claims data were used for analyses. To examine the association between treatment group and medication adherence, three types of multivariate regressions were employed. In addition, all regressions were conducted for the whole population using data from 1995 to 2001 as well as a subpopulation, which excluded data prior to September 1997. Model covariates included patient characteristics, healthcare utilization, and non-study antiretroviral therapy use. The likelihood of > or =95% adherence among patients on combination therapy was three times greater than patients taking 3TC and ZDV in separate pills. Also, combination therapy patients had on average 1.4 fewer adherence failures per year of follow-up and nearly double the time to adherence failure compared to the separate pills group. Consistency among study results suggests that fixed dose combination therapies such as lamivudine (3TC) 150 mg/ zidovudine (ZDV) 300 mg should be considered when prescribing HIV treatment that includes an appropriate dual nucleoside.

Adult↗

PubMed2005

Antidepressant drug-drug interaction profile update.

Drug-drug interactions continue to be underappreciated and misunderstood by most clinicians. Although life-threatening drug interactions are rare, serious clinical consequences, including altered drug response, poor tolerability with reduced medication adherence, and increased costs for care tied to the increased complexity of therapy, are fairly commonplace. Drug interactions may be further complicated by genetic differences in metabolic capacity. Patients who routinely require long-term treatment for depression have an increased likelihood of experiencing a drug-drug interaction since they will take over-the-counter and prescription medications for intercurrent and/or co-morbid illness. Antidepressants can be the object of drug interactions when their metabolic pathways are affected by other substances, or they can precipitate interactions by inhibiting enzyme pathways. Clinicians can improve the short- and long-term outcomes of patients with a depressive disorder by considering the possibility of drug-drug interactions both before prescribing a specific antidepressant and while monitoring for response, adverse effects and patient compliance.

Antidepressive Agents↗

PubMed2003

The future of pharmacotherapy for schizophrenia.

Although enormous progress has been made in the treatment of schizophrenia, and the use of existing pharmacologic agents can have a dramatic effect on the short- and long-term management of the disorder, enormous challenges and unmet needs continue to exist. Despite the introduction of a second generation of antipsychotic medications, many patients continue to derive inadequate benefits from available agents. Negative symptoms and cognitive dysfunction, and decrements in psychosocial and vocational functioning, often continue to persist despite our best available treatments. Medication adherence remains a constant challenge and has not been dramatically improved by the new-generation antipsychotic drugs. Since all currently marketed antipsychotic agents possess some degree of dopamine antagonist effects, the role of other neurotransmitters in the primary antipsychotic activity remains largely unclear. It is possible that different domains of disease effects might benefit from different specific classes of medications, yet research in this area is not highly developed. The promise of further discoveries in genetics leading to new treatment targets and better predictors of treatment response (both therapeutic and adverse) is enormously exciting, but these developments will require years of additional research. The field must balance the need to make the most informed and thorough use of available agents with a sense of both excitement and patience as we work toward other approaches.

Journal Article↗

PubMed2000

Telephoning the patient's pharmacy to assess adherence with asthma medications by measuring refill rate for prescriptions.

OBJECTIVE: To determine whether a prescription refill history obtained by telephoning patients' pharmacies identifies poor adherence with asthma medications more frequently than physician assessment. METHODS: The study population consisted of 116 children with persistent asthma who were Medicaid recipients; patients who received medication samples were excluded. During a clinic visit pulmonologists interviewed patients, caretakers, or both and estimated adherence on a checklist. A nurse asked the caretakers where they obtained medications and telephoned 66 identified pharmacies for refill histories. The maximum possible adherence was calculated as the number of doses refilled/number of doses prescribed x 100 for a mean duration of 163 days (range, 63 to 365 days). The accuracy of the refill information was determined from Medicaid reimbursement records. RESULTS: Information provided by pharmacies was 92% accurate. The mean (95% CI) of maximum potential adherence was 72% (65%,77%) for theophylline, 61% (55%,68%) for inhaled corticosteroids, and 38% (23%,53%) for cromolyn; only cromolyn and theophylline were significantly different. Physicians were able to identify 21 (49%) of 43 patients who refilled </=50% of prescribed doses of long-term symptom controllers and only 3 (27%) of 11 patients who used albuterol excessively. CONCLUSIONS: Physicians often were unable to identify patients with very poor adherence. Checking prescription refills is an accurate and practical method of identifying such patients.

Anti-Asthmatic Agents↗

PubMed2006

Predictors of relapse in bipolar disorder: A review.

INTRODUCTION: Bipolar disorder is the sixth leading cause of disability in the United States. Moreover, repeated episodes and non-responsiveness to treatment continue to present a significant problem, and little is known about the factors that may precipitate relapse. This article reviews the available literature on predictors of bipolar relapse. METHODS: We conducted a literature search on Medline from 1996 to March 2006, using the keywords "relapse," "recurrence," "compliance," "adherence," "life events," "kindling," and "predictors" combined with the term "bipolar disorder(s)." References from the resulting articles also supplemented the initial search. Thirty-eight articles were included in the analysis. RESULTS: Predictors of episodes include stressful life events, increased number of previous episodes, decreased interval between episodes, and persistence of affective symptoms and episodes. Factors associated with longer survival times include psychotherapy, social support, and medication adherence. CONCLUSIONS: Our review suggests several reliable predictors of bipolar episodes. Knowledge of these factors has significant clinical implications and could aid in treatment and prevention strategies. However, further research is clearly needed to address the limitations of the existing research and to increase our understanding of predictors of relapse, with the intent of improving quality of life and preventing episodes in patients with bipolar disorder.

Antipsychotic Agents↗

PubMedDate not supplied

The other side of the pill bottle: the lived experience of HIV-positive nurses on HIV combination drug therapy.

A qualitative study of nine HIV-positive nurses was conducted to explore the experience of daily life for HIV-positive nurses taking HIV combination drug therapy. The purpose of the study was to gain a better understanding of factors relating to HIV medication adherence and nonadherence. The study also provided new knowledge on what it is like to be a nurse who is HIV-positive. Implementation of the study and analysis of the data were done using an integrated method for conducting phenomenological research. Face-to-face in-depth interviews were conducted around the United States with three women and six men who were HIV-positive nurses. Participants had acquired HIV via three modes: occupational exposure, sexual transmission, and contaminated blood products. The nurses were taking HIV antiretroviral medications in various combinations. Analysis of the nurses' interviews revealed six major themes that described the experience of day-to-day life for HIV-positive nurses on HIV combination drug therapy. The metaphor that emerged across the narratives was the Double-Edged Sword of Being a Nurse on the Other Side, in the role of patient. The metaphor described the life-changing experience of being an HIV-positive nurse attempting to adhere to the prescribed HIV combination drug regiment. While many of the study findings were congruent with the literature, new components of the experience emerged. The study gave voice to a group of nurses who previously have been described only in terms of HIV/AIDS statistics.

Adaptation, Psychological↗

PubMedDate not supplied

Achieving patient centeredness in pharmacy practice: openness and the pharmacist's natural attitude.

OBJECTIVE: To present the benefits of openness for achieving patient centeredness by pharmacists, provide patient narratives from two qualitative research studies that demonstrated how patients have experienced pharmacists' traditional approach, and describe a tool with six component strategies for pharmacists to use in direct patient care. DESIGN: (1) Ethnographic study and (2) hermeneutic phenomenological study. SETTING: (1) Pharmaceutical care practices and (2) university. PARTICIPANTS: (1) Patients, practitioners, and student pharmacists, and (2) university faculty and staff taking long-term medications for chronic diseases. INTERVENTIONS: (1) Participant observation, in-depth interviews, focus groups, and analysis of documents, and (2) unstructured, in-depth interviews. MAIN OUTCOME MEASURES: (1) Observations and participant comments and (2) patient comments. RESULTS: Pharmacists' primary reliance on pharmacology and pharmacotherapy--without consideration of the patient as an individual--can devalue patients' personal understanding of their own situation and negatively affect care. This "natural attitude" of pharmacists, created through their preparation and education, involves their understanding of medications, focus on the product, use of counseling as the major approach with patients, and emphasis on medication adherence as a goal. Pharmacists as professionals must recognize how their natural attitude negatively affects care and work to become more patient-centered practitioners by the development of skills such as openness. Pharmacists can achieve openness by applying six strategies with patients (listen, acknowledge, wonder) and themselves and professional colleagues (recognize, question, reflect). CONCLUSION: Patients want to be heard and seen as individuals with unique experiences and responses to medications. If pharmacists are intent on working with patients to ensure that their medication-related needs are met, they should grasp what it means to be patient-centered, and the six strategies for achieving openness should be applied in the daily practice of pharmacy.

Adult↗

PubMed2001

The definition and meaning of treatment-resistant depression.

Most patients treated for an episode of unipolar or bipolar major depression are treatment resistant in the sense that the majority do not achieve full remission with the first somatic or psychosocial treatment they receive. Little attention has been given to formalizing criteria for evaluating the nature and extent of treatment resistance, even though determining the adequacy and outcome of prior treatment trials is key in clinical decision making about subsequent treatment. Furthermore, determining the adequacy of prior treatment is essential since substantial evidence indicates that large numbers of depressed patients are undertreated, resulting in prolonged episodes and the appearance of "pseudoresistance." Adequacy of antidepressant treatment trials should be defined in terms of thresholds for the dosage and duration of medication, adherence, and clinical outcome. The Antidepressant Treatment History Form is presented as one method to formalize the evaluation of treatment adequacy and treatment resistance.

Affective Disorders, Psychotic↗

PubMed2005

Psychosocial treatments for bipolar disorders.

Psychosocial problems may be causes or consequences of BP relapses,and adding psychologic therapies to usual-treatment approaches may improve the prognosis of those at risk of persistent symptoms or frequent episodes. The three core individual manualized therapies (IPSRT, cognitive therapy, and FFT) have all developed specific models for use in BP. Colom et al's group psychoeducation model also has a clearly developed rationale and format, and it allows individuals to share their views of BP with others, to learn adaptive coping strategies from the other 8 to 12 members of the group, and to have regular contact with an expert therapist. Careful review of the four more extended and comprehensive approaches and the brief technique-driven interventions demonstrates that the effective therapies incorporate one or more of the modules show in Box 1. At present,the choice between the four extended models is more likely to be dictated by patient choice or the availability of a trained therapist. The technique-driven interventions are briefer than the specific therapies (about 6-9 sessions compared with about 20-22 sessions) and usually offer a generic, fixed treatment package targeted at a circumscribed issue such as medication adherence or managing early symptoms of relapse. These brief interventions can be delivered by a less-skilled or less-experienced professional than the specific model. They potentially seem to be useful in day-to-day clinical practice in general adult psychiatry settings; additional larger-scale, randomized trials should be encouraged. Given the reduction in relapse rates and hospitalizations associated with the use of psychologic therapy as an adjunct to medication, it is likely that these approaches will prove to be clinically and cost effective. They may provide a significant improvement in the quality of life of individuals with BP (and indirectly to that of their partners and family members). Brief,evidence-based therapies represent an important component of good clinical practice in the management of BP. Studies of a comprehensive, whole-system approach to the collaborative psychobiosocial management of BP are being undertaken in the United States. If these approaches improve the quality and continuity of care for individuals with BP, they will have further implications for the delivery and organization of mental health services. The number and variety of trials of psychosocial interventions is exciting for researchers and clinicians interested in BP. Enthusiasm for advocating these approaches should be tempered by an acknowledgment that the trials undertaken so far largely demonstrate efficacy in selected samples of patients treated at specialist BP clinics or psychologic treatment research centers. Translating efficacy into effectiveness requires evidence that the approaches used in the treatment trials are equally beneficial when used by the wider therapist community treating patients seen routinely in non-specialist or nonresearch centers. These patients often have multiple problems or complex presentations that preclude their involvement in pharmacologic or psychologic treatment studies, but monitoring the outcomes of these representative samples will be important in determining the true place of psychologic approaches in the management of BP. Large-scale studies are now underway on both sides of the Atlantic (the Medical Research Council study in the United Kingdom and the STEP-BD project in the United States). These trials are likely to answer basic questions about the benefits and limitations of psychologic therapies in the acute and maintenance treatment of BP in the clinical realm and will increase understanding of the effectiveness-versus-efficacy question.

Antimanic Agents↗

PubMed2005

Curriculum design and program to train older adults to use personal digital assistants.

PURPOSE: The aim of this study was to demonstrate that many older adults can share in the potential benefits of using a personal digital assistant (PDA), including using the device as a memory aid for addresses and appointments, to improve medication adherence, and as a useful organizational tool and communication device. DESIGN AND METHODS: A curriculum, designed specifically for older adults, was developed that provided the necessary information and practice to use the technology. The degree to which the curriculum improved user skills was measured by testing participants on basic and advanced features of each of the standard PDA programs. RESULTS: Participants were successful in using the technology and indicated satisfaction with the medication-reminder program specifically designed to accommodate the needs of older adults. IMPLICATIONS: The PDA, supported with well-designed software and well-executed training, can provide unique benefits to older adults.

Aged↗