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Results for “Medication Adherence”

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PubMed2004

Written individualised management plans for asthma in children and adults.

BACKGROUND: Non-adherence to treatment advice is a common phenomenon in asthma and may account for a significant proportion of the morbidity. Comprehensive care that includes asthma education, a written self-management plan and regular review has been shown to improve asthma outcomes, but the contribution of these components has not been established. OBJECTIVES: To determine whether the provision of a written asthma self-management plan increases adherence and improves outcome. SEARCH STRATEGY: We carried out a search on the Cochrane Airways Group trials register. There was no language restriction. The search of the databases used the following terms: action plan OR self OR self-care OR self-manag* OR educ* AND adher* OR comply OR compli*. We contacted authors of included studies for any unpublished or on-going studies and bibliographies of all included studies and reviews were searched for further studies. The most recent search was carried out in May 2003. SELECTION CRITERIA: We only considered randomised controlled trials (RCTs) in patients with asthma. Participants must have been assigned to receive an individualised written asthma management plan (symptom or peak flow based) about the actions required for regular asthma management and/or the actions to take in the event of an asthma exacerbation. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed study quality and abstracted data. MAIN RESULTS: Seven trials met the inclusion criteria. The written management plans were either peak flow or symptom based, which were compared against each other or compared to no written management plan. Reported outcomes included: medication adherence, hospitalisation, emergency department visits, oral corticosteroid use, lung function, days lost from school/work, unscheduled doctor visits and respiratory tract infections. There was no consistent evidence that written plans produced better patient outcomes than no written plan. For some outcomes, there appeared to be an advantage of one type of plan over the other, but there was no consistency - one type of plan was not consistently more effective than another. REVIEWERS' CONCLUSIONS: The available trials are too small and the results too few and inconsistent to form any firm conclusions as to the contribution of written self management plans in the known beneficial effects of a comprehensive asthma care programme.

Adult↗

PubMed2005

Barriers to uptake and adherence with malaria prophylaxis by the African community in London, England: focus group study.

BACKGROUND: Rates of imported malaria in the UK and other European countries are increasing, and particularly the more serious Plasmodium falciparum malaria. This study investigated beliefs about malaria and barriers to the uptake and adherence to malaria prophylaxis experienced by African descent individuals in inner London who have low rates of use of malaria prophylaxis and high risks of P. falciparum malaria. DESIGN: Five focus groups conducted with 44 volunteers of African origin living in south London. Transcripts were analysed qualitatively. RESULTS: Failure to access the drugs prior to travel was influenced by perceptions of malaria as a low threat, non-serious and easily treatable, and a belief that they were vaccinated or somehow not at personal risk, together with concerns about side effects of the drugs, dislike of the taste and disbelief by some participants of the drugs effectiveness. Health service barriers included the cost of drugs, waiting times for appointments and uncertainty regarding appropriate medication. Adherence to the prophylaxis was hindered by difficulties in remembering complex regimes, a lack of understanding of the rationale for continuing the drugs after return to the UK and the practice of leaving drugs for relatives in Africa. However, there was some variability in beliefs and practices that appeared to be associated with socio-economic status, prior experience of malaria and the local organisation and delivery of primary care travel services. CONCLUSIONS: Much non-adherence is 'intentional' and reflects both beliefs common to all travellers and the particular circumstances and experiences of migrants of African descent. However, there was considerable variability in beliefs and practices among participants that reflects the heterogeneity within the West African community in their socio-economic position and circumstances. Changing behaviours requires a multi-dimensional approach involving community-based health promotion that targets the beliefs of this ethnic group and health service measures.

Adolescent↗

PubMedDate not supplied

Insurance coverage and health care use among near-elderly women.

OBJECTIVES: Data on near-elderly (ages 55-64) women's access to and use of health care have been limited. In this study, we sought to examine the status of near-elderly women's health insurance coverage in the United States and how it may influence their use of health care services. METHODS: A nationwide random sample of women aged 55-64 was drawn from the 2002 wave of the Health and Retirement Study. Descriptive statistics were calculated and multivariable regression analyses were performed to quantify the impact of insurance coverage on near-elderly women's use of outpatient services, inpatient services, and prescription medication over a 2-year period. RESULTS: In 2002, 9.4% of near-elderly women in the United States were uninsured and 15.4% had public coverage. Those who had coverage for a particular service were significantly more likely to use that service compared to women without coverage, with odds ratios ranging from 2.0-6.7 for services such as a physician visit, hospital stay, dental visit, and use of prescription medication. Among those who had at least one physician visit, near-elderly women who had some of the cost covered by insurance reported significantly more visits than women without coverage. Likewise, for near-elderly women regularly taking prescription medications, having more extensive coverage significantly increased their likelihood of medication adherence. The frequency of hospitalization was also higher for women who had complete coverage for the cost. CONCLUSIONS: The nature of a near-elderly woman's insurance coverage significantly affects her use of health care services. More attention is needed to improve the health care of near-elderly women with inadequate insurance coverage.

Attitude to Health↗

PubMed1998

Meeting the needs of primary care physicians: a guide to content for programs on depression.

OBJECTIVE: The purpose of this article is to identify literature-based content for the design of educational programs on depression for practicing primary care physicians. METHODS: A MEDLINE search was conducted of English-language medical literature published from 1982 through July 1997 for studies describing primary care physicians' knowledge, skills, practice patterns, and perceived barriers related to care of depressed patients. Studies focusing exclusively on residency training and those describing physician practices outside North America were excluded. Of 377 articles identified, forty met inclusion and exclusion criteria. RESULTS: Recommendations for educational content were identified from the literature review. For recognition, educators should prioritize communication skills and strategies for the use of depression questionnaires. For diagnosis, practice interpreting symptoms in the medically ill, strategies for efficient diagnosis, and systematic approaches to assessing suicide risk should be emphasized. For treatment, greater attention to the therapeutic alliance, staged therapy, and strategies for improving medication adherence are indicated. CONCLUSIONS: There is a moderately well developed literature describing self-perceived and observed gaps in the current care for depression in primary care. Addressing the entire list of needs would take more time than practicing physicians are likely to have. An important challenge for educators is to design flexible programs based on individualized needs assessment or, when not possible, to prioritize the most generalizable needs.

Antidepressive Agents↗

PubMed2003

Adherence to antiretroviral medications in HIV/AIDS care: a narrative exploration of one woman's foray into intentional nonadherence.

Intentional nonadherence occurs when patients deliberately do not take their medications. This phenomenon has not been studied within HIV/AIDS care, a significant omission due to the difficulty of adherence to antiretroviral medications for HIV/AIDS patients and the severe risks associated with nonadherence. The purpose of this study was to explore, using HIV-positive women's own recollections collected in diary format, how and why women living with HIV/AIDS intentionally fail to adhere to their antiretroviral medications. We examined the journal entries of 20 HIV-positive women written during a 1-month period. Although three participants wrote about their intentional nonadherence, the journal entries of only one woman are presented in detail. This woman's story highlights the complex reasons for intentional nonadherence and the social/emotional ramifications of such nonadherence. Results suggest that intentional nonadherence is emotionally trying for patients and that patients' adherence decisions are continually renegotiated, underscoring the need for routine provider-patient adherence communication.

Adaptation, Psychological↗

PubMed2004

Ethnicity and prescription patterns for haloperidol, risperidone, and olanzapine.

OBJECTIVE: Patients with schizophrenia may respond better to second-generation antipsychotics than to older antipsychotics because of their superior efficacy and safety profiles. However, the reduced likelihood among ethnic minority groups of receiving newer antipsychotics may be associated with reduced medication adherence and health service use, potentially contributing to poor response rates. This study examined whether ethnicity helped predict whether patients with schizophrenia were given a first- or a second-generation antipsychotic, haloperidol versus risperidone or olanzapine, and what type of second-generation antipsychotic was prescribed, risperidone or olanzapine, when other factors were controlled for. METHODS: Texas Medicaid claims were analyzed for persons aged 21 to 65 years with a diagnosis of schizophrenia or schizoaffective disorder who started treatment with olanzapine (N=1875), risperidone (N=982), or haloperidol (N= 726) between January 1, 1997 and August 31, 1998. The association between antipsychotic prescribing patterns among African Americans, Mexican Americans, and whites was assessed by using logistic regression analysis. Covariates included other patient demographic characteristics, region, comorbid mental health conditions, and medication and health care resource use in the 12 months before antipsychotic initiation. RESULTS: The results of the first- versus second-generation antipsychotic analysis indicated that African Americans were significantly less likely than whites to receive risperidone or olanzapine. Although not statistically significant, the odds ratio indicated that Mexican Americans were also less likely to receive risperidone or olanzapine. Ethnicity was not associated with significant differences in the prescribing patterns of risperidone versus olanzapine. CONCLUSIONS: When other factors were controlled for, African Americans were significantly less likely to receive the newer antipsychotics. Among those who received the newer antipsychotics, ethnicity did not affect medication choice.

Adult↗

PubMedDate not supplied

Physicians, nonphysician healthcare providers, and patients communicating in hepatitis C: an in-office sociolinguistic study.

In-office conversations about hepatitis C can impact patients' perceptions of outcomes, as well as medication adherence. This study analyzed interactions between physicians, nonphysician healthcare providers (including nurses), and patients with hepatitis C virus infection in order to examine differences based on number and type of providers participating. Gastroenterologists, nonphysician healthcare providers, and patients with hepatitis C virus infection were video- and audio-recorded during regularly scheduled visits. Recordings were transcribed and analyzed using validated sociolinguistic techniques. Thirty-four visits took place with a physician only, 4 with a nonphysician healthcare provider only, and 25 with both providers (9 concurrent and 16 consecutive). Differences among the participant schema included visit length, patient "talk-time," and motivation provided. When providers saw patients consecutively, differing information was sometimes provided. In visits where providers saw the patient concurrently, competing authority between providers and exclusion of the patient through use of medical jargon were obstacles to ideal communication. Differences in hepatitis C-related interactions based on the number and type of participants suggest opportunities for improved communication. In visits with multiple providers, physicians and nurses should attempt to ensure that they (a) avoid supplying differing information, (b) present a "unified front" to avoid competing authority, and (c) minimize the use of medical jargon, which excludes patients from participating in their own healthcare.

Adult↗

PubMedDate not supplied

Adherence to antihypertensive therapy with fixed-dose amlodipine besylate/benazepril HCl versus comparable component-based therapy.

Adhering to medication regimens has the potential to significantly improve clinical outcomes for persons with high blood pressure. A patient-related factor likely to affect adherence to treatment is the convenience of the prescribed drug regimen. The authors hypothesized that medication adherence would be superior and cost benefits would accrue in subjects who receive a once-daily, single-capsule, fixed-dose combination product for blood pressure control, compared with subjects who receive a similar regimen of separate components. A managed care organization that provides benefits for members enrolled in various health plans provided the data for this retrospective analysis. The database was used to assess medication adherence patterns for two groups of hypertensive subjects. Group 1 included subjects who had been prescribed the single-capsule, fixed-dose combination of amlodipine besylate/benazepril HCl. Group 2 comprised subjects who had been prescribed a regimen including an angiotensin-converting enzyme inhibitor and a dihydropyridine calcium channel blocker as separate drugs. Adherence was measured by the medication possession ratio, and medical resource utilization by the two groups was assessed during the study period. Group 1 (n=2754) and Group 2 (n=2978) were balanced with regard to age (mean, 53 years; range, 18-64 years) and sex (men, 50%; women, 50%). The overall medication possession ratio for Group 1 was significantly higher than that for Group 2 (80.8% vs. 73.8%; p<0.001). The average annual cost of cardiovascular-related care per subject was significantly lower in Group 1 compared with Group 2 (p<0.001). Subjects receiving the once-daily, single-capsule, fixed-dose combination of amlodipine/benazepril HCl demonstrated significantly better medication adherence and required fewer medical resources than did subjects receiving an angiotensin-converting enzyme inhibitor and a dihydropyridine calcium channel blocker as separate components.

Adolescent↗

PubMed2003

Searching for moderators and mediators of pharmacological treatment effects in children and adolescents with anxiety disorders.

OBJECTIVE: To examine whether age, gender, ethnicity, type of anxiety disorder, severity of illness, comorbidity, intellectual level, family income, or parental education may function as moderators and whether treatment adherence, medication dose, adverse events, or blinded rater's guess of treatment assignment may function as mediators of pharmacological treatment effect in children and adolescents with anxiety disorders. METHOD: The database of a recently reported double-blind placebo-controlled trial of fluvoxamine in 128 youths was analyzed. With a mixed-model random-effects regression analysis of the Pediatric Anxiety Rating Scale total score, moderators and mediators were searched by testing for a three-way interaction (strata by treatment by time). A two-way interaction (strata by time) identified predictors of treatment outcome. RESULTS: No significant moderators of efficacy were identified, except for lower baseline depression scores, based on parent's (but not child's) report, being associated with greater improvement (p < .001). Patients with social phobia (p < .05) and greater severity of illness (p < .001) were less likely to improve, independently of treatment assignment. Blinded rater's guess of treatment assignment acted as a possible mediator (p < .001), but improvement was attributed to fluvoxamine, regardless of actual treatment assignment. Treatment adherence tended to be associated (p = .05) with improvement. CONCLUSIONS: In this exploratory study, patient demographics, illness characteristics, family income, and parental education did not function as moderators of treatment effect. Social phobia and severity of illness predicted less favorable outcome. Attribution analyses indicated that study blindness remained intact. The presence of concomitant depressive symptoms deserves attention in future treatment studies of anxious children.

Adolescent↗

PubMedDate not supplied

What does the Medicare prescription drug legislation mean for the American cardiologist?

The Medicare Modernization Act of 2003 authorized the most sweeping changes to the Medicare and Medicaid programs since their inception in 1965. One key feature, a prescription drug benefit, will begin enrolling seniors in November 2005, and the benefit will begin in January 2006. This benefit will have complex and largely unknown effects on medication adherence in the elderly. It has a complex system of copayments and deductibles and subsidy eligibility requirements, as well as a "donut hole." Drug coverage for people dually eligible for Medicare and Medicaid will change greatly. Medicare beneficiaries will have to choose from a large, bewildering choice of prescription plans and many will turn to their physicians for advice. This article details the background, benefits, and expected impact of all of these aspects of the new Medicare Part D prescription drug benefit.

Aged↗

PubMed2002

Characteristics and treatment of patients with heart failure in the emergency department.

INTRODUCTION: This study was conducted to develop a detailed profile of patients who come to the emergency department for heart failure treatment. METHODS: Patient interviews were supplemented by medical record reviews in a convenience sample of 57 participants. A structured interview guide included data concerning patient characteristics and ED treatment. RESULTS: Participants used a variety of self-care strategies before coming to the emergency department. Many of the patients studied (25%) reported barriers to medication adherence, such as memory problems and lack of knowledge regarding self-administration. The most frequently reported symptoms were breathing difficulties (88%), chest discomfort (35%), and fatigue (16%). Seventy-four percent of the participants were classified as specific activity scale class III or IV, indicating moderate to severe functional limitation. Mean quality of life at the time of interview was 5.1 (on a 1 to 10 scale). Length of stay was < or = 2 days for 33%. DISCUSSION: A number of the findings of this study have implications for ED nurses. For example, almost one third of the patients studied had not received directions for a low-sodium diet during hospitalization, when fluid volume overload with sodium retention was the most common cause of hospitalization in a study of patients with decompensated heart failure. Hospital lengths of stay of no more than 2 days suggest that early detection and treatment of acute heart failure may reduce the need for ED visits for some patients. Patients need education and support with self-help strategies and need to better understand the administration of their medication.

Adult↗

PubMed2003

Nonstigmatizing ways to engage HIV-positive African-American teens in mental health and support services: a commentary.

This commentary illustrates a hospital/adolescent-clinic based model for providing support services and for increasing medical adherence among HIV positive inner city African-American adolescents. This commentary reviews the racial/ethnic disparities in HIV disease among adolescents and describes a successful program model for overcoming stigma. Traditional support groups were rejected by youth with HIV/AIDS. Seven elements common to successful programs were identified. Successful programs built on designs described in the research literature. Focus groups composed of HIV-positive adolescents identified what they wanted and needed. Stigmatizing labels were avoided in naming programs. Practical barriers to access, such as transportation and childcare, were eliminated. Programs were skills oriented, culturally sensitive, and life affirming, focusing on healthy living. HIV-positive inner city African-American youth can be successfully recruited and engaged in hospital based programs. Although these programs were qualitatively evaluated by youth as successful and attrition was low and attendance averaged 50%, rigorous quantitative research is needed to evaluate the effectiveness of such programs. We need quantitative research to successfully advocate for government funding. Stigma needs to be addressed openly in public health. Future research is needed to evaluate interventions to overcome the health consequences of stigma on utilization of available medical and mental health services.

Adolescent↗

PubMed2006

Self-reported medication and lifestyle adherence in Hungarian patients with Type 2 diabetes.

BACKGROUND: Type 2 diabetes is a complex disorder that requires the patient to pay constant attention to diet, physical activity, glucose monitoring and medication. OBJECTIVE: To evaluate the medication, lifestyle adherence and factors associated to these in Type 2 diabetes in Hungarian patients. SETTING: Fourteen community pharmacies in Hungary between March and May 2004. METHOD: A questionnaire was given to every tenth Type 2 diabetic patient who presented to one of the 14 pharmacies included in this study with a prescription for oral antidiabetics, oral antidiabetics and insulin or exclusively insulin. For the latter two groups, the prerequisite for inclusion in the study was also that their diabetes had developed after the age of 35 and that at some in their treatment regimen they had taken only oral antidiabetics. These latter two criteria were controlled in the patient's general practitioners' (GP) database. General and diabetes-related data were collected in the questionnaire, and the adherence and lifestyle of the participant were assessed. An adapted and validated Hungarian version of the EQ-5D (EuroQol Group, 1993) quality-of-life questionnaire was also included. Descriptive and chi(2) test statistical methods and two sample t-test were used. A significance level of P<0.05 was considered to be significant. MAIN OUTCOME MEASURE: Patient self-reported adherence to diet, physical activity, self monitoring of blood glucose, purchasing of drug(s), drug regimen, association of demographic factors, treatment, lifestyle and quality of life on adherence. RESULTS: Of the 220 questionnaires distributed to diabetic patients, 151 were returned, of which 142 were evaluated (nine did not satisfy the above-mentioned inclusion criteria). With respect to the factors assessed, sub-optimal adherence was assessed for: diet (76.8%), physical activity (33.8%), self-monitoring of blood glucose (81%), drug purchasing (20.4%) and drug taking (52.1%). Smokers comprised 14.8% of the respondents, while 8.5% were heavy drinkers. Fewer than five meals a day were eaten by 46.5% of the patients, and about 43.6% of the patients did not self-monitor blood glucose. The results indicate few significant associations between at least one of the four main areas of adherence (diet, physical activity, purchasing of drug(s), drug regimen) and body mass index, GP consultation frequency, quality-of-life parameters and EQ-5D index. CONCLUSION: The adherence of Hungarian Type 2 diabetics in some areas does not reach optimal levels, especially for diet, self-monitoring, drug purchasing and adherence to drug taking.

Aged↗

PubMed2006

Long-term effectiveness and cost of a systematic care program for bipolar disorder.

CONTEXT: Despite the availability of efficacious treatments, the long-term course of bipolar disorder is often unfavorable. OBJECTIVE: To test the effectiveness of a multicomponent intervention program to improve the quality of care and long-term outcomes for persons with bipolar disorder. DESIGN: Randomized controlled trial with allocation concealment and blinded outcome assessment. SETTING: Mental health clinics of a group-model prepaid health plan. PATIENTS: Of 785 patients in treatment for bipolar disorder who were invited to participate, 509 attended an evaluation appointment, 450 were found eligible to participate, and 441 enrolled in the trial. INTERVENTIONS: Participants were randomly assigned to a multicomponent intervention program or to continued care as usual. Three nurse care managers provided a 2-year systematic intervention program, including the following: a structured group psychoeducational program, monthly telephone monitoring of mood symptoms and medication adherence, feedback to treating mental health providers, facilitation of appropriate follow-up care, and as-needed outreach and crisis intervention. MAIN OUTCOME MEASURES: In-person blinded research interviews every 3 months assessed mood symptoms using the Longitudinal Interval Follow-up Examination. Health plan administrative records were used to assess the use and cost of mental health services. RESULTS: Intent-to-treat analyses demonstrated that the intervention significantly reduced the mean level of mania symptoms (z = 2.09, P = .04) and the time with significant mania symptoms (19.2 vs 24.7 weeks; F(1) = 6.0, P = .01). There was no significant intervention effect on mean level of depressive symptoms (z = 0.19, P = .85) or time with significant depressive symptoms (47.6 vs 50.7 weeks; F(1) = 0.56, P = .45). Benefits of the intervention were found only in a subgroup of 343 persons with clinically significant mood symptoms at the baseline assessment. The incremental cost (adjusted) of the intervention was 1251 dollars (95% confidence interval, 55-2446 dollars), including approximately 800 dollars for the intervention program services and an approximate 500 dollars increase in the costs of other mental health services. CONCLUSIONS: Population-based systematic care programs can significantly reduce the frequency and severity of mania in bipolar disorder, and cost increases are modest considering the clinical gains. The incorporation of more specific cognitive and behavioral content or more effective medication regimens may be necessary to significantly reduce the symptoms of depression.

Adult↗

PubMedDate not supplied

Correlates of health-related quality of life among lower-income, urban adults with congestive heart failure.

BACKGROUND: Improving health-related quality of life (HRQL) is a primary goal in the treatment of patients with congestive heart failure (CHF), yet few studies have explored correlates of HRQL among CHF patients. OBJECTIVES: We report on the association of demographic and pathophysiologic measures, social-cognitive measures, and environmental variables with HRQL as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ), Chronic Heart Failure (CHQ), and a single question of perceived overall health (PH). METHODS: Cross-sectional data were obtained from the baseline interview and electronic medical records of 212 patients 50 years of age and older who were enrolled during the first 7 months of a medication adherence study. RESULTS: Mean age was 63; 32% were male; 53% were black; the mean Charlson comorbidity score was 3.7; and the mean New York Heart Association class was 2.1. Correlations between KCCQ and CHQ subscale scores and PH ranged from 0.16 to 0.37. Multivariate regression analyses showed that the pathophysiologic measures ejection fraction and comorbidity were not associated with any of the HRQL measures. Overall PH was associated with greater age and more positive health beliefs. Persons of greater age, males, and black respondents had higher CHF-specific HRQL scores, as did persons reporting more positive health beliefs, greater income, social support, and communication with their physician. Variance explained ranged from 14 to 33%. CONCLUSION: These cross-sectional data highlight the potential significance of social and behavioral factors in CHF-specific HRQL.

Age Factors↗

PubMed2006

Adherence to antiretroviral medications in HIV: differences in data collected via self-report and electronic monitoring.

Controversy remains regarding the reliability of methods used to determine adherence to antiretroviral medication in HIV. In this study the authors compared adherence rates of 119 HIV-positive participants during a 6-month study, as estimated via electronic monitoring (EM) and self-report (SR). Adherence for both short (4-day) and long (4-week, or intervisit) periods was examined, as well as factors that underlie discrepancies between EM and SR. Results showed that intervisit EM estimates were consistently lower than those of SR. SR estimates based on shorter periods (4 days) were closer to those of EM. Higher discrepancies between EM and SR estimates were associated with lower cognitive functioning and externalized locus of control. These findings lend support for using both EM and SR methods; however, study design (e.g., length) and other factors (e.g., cognitive status, cost) should be considered.

Adult↗

PubMedDate not supplied

Effects of illicit drug use on adherence to prescribed antiretroviral medication.

This exploratory analysis compared adherence to antiretroviral medication on days that illicit drugs were used and on matched abstinence days in twelve subjects who used MEMS caps during participation in a clinical trial. Adherence on drug use days was lower in seven subjects, higher in one, and the same in four. Three subjects maintained 100% adherence despite illicit substance use on studied days. Thus, in a subset of patients, the actions involved in procuring drugs and the acute effects of using them contribute to non-adherence on those specific drug use days, associated with substance abuse. (Am J Addict 2003;12:455-458)

Adult↗

PubMed1997

A 'second life' agenda. Psychiatric research issues raised by protease inhibitor treatments for people with the human immunodeficiency virus or the acquired immunodeficiency syndrome.

Seldom in the history of medicine has an entire generation of patients with an incurable, progressive, and ultimately fatal disease suddenly been offered the prospect of extended survival and even, perhaps, a "second life." The relatively simultaneous appearance of 2 major treatment developments has created profound changes in therapeutic options and outlook. The first development is an assay of serum levels of human immunodeficiency virus viral copies, providing a critical tool for clinical decision making. The second is the marketing between December 1995 and April 1997 of 4 human immunodeficiency virus protease inhibitors that, combined with previously available antiviral medications, achieve a new level of efficacy. With the advent of these changes come multiple psychiatric research and policy issues. These include the development of strategies to establish and maintain medication adherence. This is a critical task, given the complexity of combination therapy regimens and the rapid onset of viral resistance to protease inhibitors within days to weeks of missed or suboptimal dosing. The psychological issues to be studied include the process of restructuring lives and expectations in the event of clinical benefit or managing the distress associated with clinical failure. Other research questions include the effects of restored health on the appraisal of human immunodeficiency virus risk behaviors, assessment of effect of neurocognitive functioning, and unanswered questions about psychotropic or protease inhibitor drug interactions due to their shared metabolic pathways. Behavioral scientists can inform provision of care to patients who may be considered difficult to treat, such as those with severe and persistent mental illness or active substance abuse or the homeless. This includes the provision of empirical data regarding individual and situational characteristics that are likely to promote or impede adherence, as well as innovative provision systems. Psychiatry can make notable contributions during this turning point in human immunodeficiency virus therapeutics and research.

Acquired Immunodeficiency Syndrome↗