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Results for “Adherence Interventions”

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PubMedDate not supplied

Techniques, complications, and pitfalls of endoscopic saphenectomy for coronary artery bypass grafting surgery.

OBJECTIVES: The purpose of the present paper is to discuss technical features of endoscopic saphenectomy with CO2 insufflation for CABG surgery and to highlight special situations in which to avoid potential pitfalls that may be encountered. METHODS: The initial section describes the approaches used with endoscopic saphenectomy with insufflation of CO2 at the Montreal Heart Institute and the Wausau Heart Institute, which can be used by operators with different levels of experience. The following sections expose numerous intraoperative tricks and maneuvers to facilitate the procedure. Specific situations associated with increased difficulty are reviewed such as the obese patient, venous insufficiency, vein tethered to the dermis, and double venous systems. Complications specific to the technique such as gas embolism, tunnelitis, and hematomas are discussed and preventive measures are proposed to avoid the rare morbidity associated with endoscopic harvesting. Preparation of the patient as well as monitoring during the intervention are also reviewed. RESULTS: Adherence to the comprehensive approach presented in this text should to ensure retrieval of high-quality grafts with a low complication rate providing patients with the full benefits, both cardiac and functional, of this minimally invasive technique of saphenous vein harvesting for CABG.

Age Factors↗

PubMed2001

Perceived stigma as a predictor of treatment discontinuation in young and older outpatients with depression.

OBJECTIVE: The authors' goal was to examine the extent to which perceived stigma affected treatment discontinuation in young and older adults with major depression. METHOD: A two-stage sampling design identified 92 new admissions of outpatients with major depression. Perceived stigma was assessed at admission. Discontinuation of treatment was recorded at 3-month follow-up. RESULTS: Although younger patients reported perceiving more stigma than older patients, stigma predicted treatment discontinuation only among the older patients. CONCLUSIONS: Patients' perceptions of stigma at the start of treatment influence their subsequent treatment behavior. Stigma is an appropriate target for intervention aimed at improving treatment adherence and outcomes.

Adolescent↗

PubMed2005

[Theories of behavior change through preventive and health promotion interventions in occupational therapy].

BACKGROUND: Community occupational therapy practice challenges therapists in their health educator role and incites them to implement preventive strategies with their clients. Working in the community also provides an interesting context for the implementation of strategies targeting health promotion at the community level. PURPOSE: This article describes some of the theories that are used in the public health and health promotion fields to explain health-related behaviour change. It also highlights their potential for community practice in occupational therapy. The theories presented in this paper are the health belief model, social cognitive theory, theory of reasoned action and theory of planned behavior. They are among the most widely used for health-related behaviour analysis and intervention. PRACTICE IMPLICATIONS: Since these theories emphasize a set of factors that influence health behaviours, reviewing these theories could contribute to enhance the effectiveness of educational interventions with regards to clients'adherence to their prevention and health promotion recommendations.

Behavior Therapy↗

PubMedDate not supplied

Situational obstacles to adherence for adolescents with diabetes.

Twenty adolescents with insulin-dependent diabetes mellitus were interviewed to obtain samples of problem situations that create obstacles to dietary adherence. The resulting 57 situations were analyzed using a reliable coding system to determine the presence or absence of 28 stimulus features. A hierarchical cluster analysis was used to identify 10 relatively homogeneous categories of obstacles to dietary adherence: being tempted to stop trying; negative emotional eating; facing forbidden foods; peer interpersonal conflict; competing priorities; eating at school; social events and holidays; food cravings; snacking when home, alone, or bored; and social pressure to eat. Diabetes educators should consider an individual's ability to cope with this array of obstacles to adherence when individualizing treatment. Dietary intervention then can be personalized to address specific situational obstacles.

Adolescent↗

PubMed2004

Involuntary outpatient commitment, community treatment orders, and assisted outpatient treatment: what's in the data?

OBJECTIVE: Involuntary outpatient commitment (OPC), also referred to as community treatment orders or assisted outpatient treatment, is a legal intervention intended to improve treatment adherence among persons with serious mental illness. This paper reviews the empirical literature on the procedure's effectiveness. METHODS: We identified and reviewed all English-language studies of OPC and related procedures available in Medline and other bibliographic search services. RESULTS: Existing naturalistic and quasi-experimental studies, taken as a whole, moderately support the view that the procedure is effective, although all do have methodological limitations. Two randomized controlled studies of OPC have conflicting findings and are reviewed in detail. CONCLUSIONS: On balance, empirical studies support the view that OPC is effective under certain conditions, although some of the evidence has been contested and the policy remains controversial.

Ambulatory Care↗

PubMed2004

Patient beliefs and tamoxifen discontinuance in older women with estrogen receptor--positive breast cancer.

PURPOSE: To investigate the patterns and predictors of tamoxifen discontinuance throughout a 2-year period in a cohort of women 65 years or older with newly diagnosed, estrogen receptor (ER)-positive breast cancer, focusing on the role of patients' beliefs about the risks and benefits of tamoxifen therapy. SUBJECTS AND METHODS: We enrolled a convenience sample of women cared for in four geographic regions of the United States with stage 1 (>/= 1 cm), stage II, or stage IIIA disease; no prior history of breast cancer; and no simultaneously diagnosed second primary breast cancer. Data sources included medical records and telephone interviews with patients at 3, 6, 15, and 27 months following definitive surgery. RESULTS: Of the 597 women with ER-positive tumors, 516 women (86%) were prescribed tamoxifen, and of these, 88 (17%) stopped taking tamoxifen during the 2-year follow-up period. Of the women who stopped taking tamoxifen, the majority (68%) took it for less than 1 year. Women with neutral or negative beliefs about the value of tamoxifen (3.0; 95% CI, 1.6 to 5.6) and those with positive nodes (odds ratio = 2.5; 95% CI, 1.0 to 6.3) were more likely to discontinue tamoxifen therapy. CONCLUSION: How women with early-stage breast cancer perceive the risks and benefits of tamoxifen therapy seems critical for sustaining adherence to adjuvant tamoxifen therapy. Interventions designed to educate women about the benefits and risks of tamoxifen therapy may help to reduce discontinuance.

Age Factors↗

PubMed2001

Medicaid's beta 2-agonist recipients and their treatment by national standards.

OBJECTIVE: To determine whether Connecticut's Medicaid high-dose beta 2-agonists (HDB) users (> 1 canister/mo) are receiving medications according to National Institutes of Health (NIH) asthma guidelines, and to compare healthcare utilization between HDB users and patients receiving no more than one canister of a short-acting beta 2-agonist per month. METHODS: All Connecticut Medicaid pharmacy claims from April to December 1998 were examined. Subjects were included if they had an asthma diagnosis and were excluded if they had chronic obstructive pulmonary disease. The percentage of HDB users not receiving long-term-control medication; receiving low doses of a long-term-control medication; and receiving oral, nebulized, or long-acting beta 2-agonists was determined. Healthcare utilization between HDB users and patients receiving no more than one canister of a short-acting beta 2-agonist per month was also compared. RESULTS: Of 1599 profiles included, 14% (n = 223) were HDB users. Twenty-five percent of these patients did not receive a long-term-control medication, and 35% received low doses of a long-term-control medication. Claims for oral, nebulized, and long-acting beta 2-agonists were submitted for 4%, 29%, and 22% of HDB users, respectively. More claims for short courses of oral corticosteroids were submitted for HDB users than for patients receiving no more than one canister of a short-acting beta 2-agonist per month (n = 1376) (1.99 +/- 3.60 vs. 0.39 +/- 1.07 mean +/- SD; p < 0.001). HDB users visited their physicians' offices an average of 4.72 +/- 24.08 times per month compared with an average of 2.40 +/- 14.4 office visits per month for patients receiving no more than one canister of a short-acting beta 2-agonist (p = 0.04). CONCLUSIONS: A high proportion of Connecticut's Medicaid HDB users are not receiving medications according to NIH guidelines. HDB users were significantly more likely to receive short courses of oral corticosteroids and required significantly more office visits than patients receiving no more than one canister of a short-acting beta 2-agonist per month. Intervention programs designed to improve adherence to the guidelines will be developed.

Adolescent↗

PubMed2005

Treatment of type 2 diabetes in primary health care: a drug utilization study.

BACKGROUND: Metabolic control in type 2 diabetes depends on patient adherence to therapy. Quantitative consumption data do not supply information regarding the appropriate use of medicine. Drug utilization studies are useful to identify treatment adherence problems and, thus, design interventions to improve drug use. OBJECTIVE: To describe the treatment and outcome in terms of degree of metabolic control in these patients, assess the agreement between the doses of antidiabetic drugs reported by the patient and those written in the medical record, and describe the drug utilization characteristics in relation to the standards of care. METHODS: This drug utilization study was conducted in primary care centers in Barcelona, Spain. Consecutive patients with type 2 diabetes attending a follow-up visit were interviewed regarding lifestyle, diet, glycosylated hemoglobin level, and treatment. Concordance between the information obtained through medical records and patient interviews was analyzed. RESULTS: Metabolic control was deficient in 73 (40%), acceptable in 50 (28%), and good in 58 (32%) of the 181 patients with available information. For 38 (19%) patients, there was disagreement between the dose of the antidiabetic drug reported by the patient and that written in the medical record. For 83 (41%) patients, the treatment in the medical history was in agreement with published standards. CONCLUSIONS: Identification of disagreement between standards of care and clinical practice in type 2 diabetes management is the basis to improve drug utilization and achieve better metabolic control in these patients.

Aged↗

PubMed1999

Nosocomial infections in the ICU: the growing importance of antibiotic-resistant pathogens.

Patients hospitalized in ICUs are 5 to 10 times more likely to acquire nosocomial infections than other hospital patients. The frequency of infections at different anatomic sites and the risk of infection vary by the type of ICU, and the frequency of specific pathogens varies by infection site. Contributing to the seriousness of nosocomial infections, especially in ICUs, is the increasing incidence of infections caused by antibiotic-resistant pathogens. Prevention and control strategies have focused on methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and extended-spectrum beta-lactamase-producing Gram-negative bacilli, among others. An effective infection control program includes a surveillance system, proper handwashing, appropriate patient isolation, prompt evaluation and intervention when an outbreak occurs, adherence to standard guidelines on disinfection and sterilization, and an occupational health program for health-care providers. Studies have shown that patients infected with resistant strains of bacteria are more likely than control patients to have received prior antimicrobials, and hospital areas that have the highest prevalence of resistance also have the highest rates of antibiotic use. For these reasons, programs to prevent or control the development of resistant organisms often focus on the overuse or inappropriate use of antibiotics, for example, by restriction of widely used broad-spectrum antibiotics (e.g., third-generation cephalosporins) and vancomycin. Other approaches are to rotate antibiotics used for empiric therapy and use combinations of drugs from different classes.

Anti-Bacterial Agents↗

PubMed2005

Attention-deficit/hyperactivity disorder among adolescents: a review of the diagnosis, treatment, and clinical implications.

Attention-deficit/hyperactivity disorder (ADHD) is the most common mental disorder in childhood, and primary care clinicians provide a major component of the care for children with ADHD. However, because of limited available evidence, the American Academy of Pediatrics guidelines did not include adolescents and young adults. Contrary to previous beliefs, it has become clear that, in most cases, ADHD does not resolve once children enter puberty. This article reviews the current evidence about the diagnosis and treatment of adolescents and young adults with ADHD and describes how the information informs practice. It describes some of the unique characteristics observed among adolescents, as well as how the core symptoms change with maturity. The diagnostic process is discussed, as well as approaches to the care of adolescents to improve adherences. Both psychosocial and pharmacologic interventions are reviewed, and there is a discussion of these patients' transition into young adulthood. The article also indicates that research is needed to identify the unique adolescent characteristics of ADHD and effective psychosocial and pharmacologic treatments.

Adolescent↗

PubMed1995

Bronchiolitis. Origins and optimal management.

There is currently no prospect of an end to the annual epidemics of acute bronchiolitis, which cause considerable morbidity in previously healthy infants and are a major threat to the well-being of infants with underlying cardiac, respiratory or immunological disease. The respiratory syncytial virus remains the major cause of this condition, and prospects of developing a vaccine remain bleak while our understanding of the viral-host interaction remain incomplete. Treatment of patients with this condition has remained essentially unchanged for more than 30 years. Correction of hypoxia with oxygen, minimal handling to reduce the risk of exhaustion and careful noninvasive monitoring for complications such as apnoea and respiratory failure are the mainstays of management. Mortality in at-risk groups has fallen substantially during the past 10 years. This appears to be due to improved supportive and intensive care. The role of the antiviral agent ribavirin in the improved outcome, if any, is unclear. Other novel therapies have been tried, but none have been shown to significantly alter the natural history of the condition. The only effective preventive intervention currently available is strict adherence to measures designed to prevent nosocomial infection. This condition is likely to remain a continuing challenge to paediatricians for the foreseeable future.

Anti-Bacterial Agents↗

PubMedDate not supplied

Controlling antimicrobial resistance in hospitals: infection control and use of antibiotics.

Antimicrobial-drug resistance in hospitals is driven by failures of hospital hygiene, selective pressures created by overuse of antibiotics, and mobile genetic elements that can encode bacterial resistance mechanisms. Attention to hand hygiene is constrained by the time it takes to wash hands and by the adverse effects of repeated handwashing on the skin. Alcohol-based hand rubs can overcome the time problem and actually improve skin condition. Universal glove use could close gaps left by incomplete adherence to hand hygiene. Various interventions have been described to improve antibiotic use. The most effective have been programs restricting use of antibiotics and computer-based order forms for health providers.

Alcohols↗

PubMedDate not supplied

Using social marketing to develop and test tailored health messages.

OBJECTIVE: To advance and promote procedures to evaluate tailored health messages based on the 4 Ps of social marketing (SM). METHOD: Three studies are presented for heuristic purposes to show the evolution and application of a "research plan" to 3 phases of SM research that address the 4 Ps. RESULTS: Qualitative and quantitative methods provide useful information to develop messages and to evaluate message efficacy for public health campaigns, to recruit participants to interventions, and/or to influence program adherence and participant retention. CONCLUSIONS: Formal, systematic research methods offer a viable means to evaluate the potential of SM constructs.

Feedback↗

PubMedDate not supplied

[The expert assessment of the damages to the teeth resulting from an operation for their removal].

Evaluates the causes and mechanisms of tooth fractures occurring during tooth removal, using mathematical simulation methods. Most common sites of tooth destruction during tooth removal are noted. The authors emphasize obligatory thorough examination of a patient before the operation, a detailed description of the status of oral tissues and teeth in the case history, rational choice of instruments, and strict adherence to the protocol of intervention.

Forensic Dentistry↗

PubMed2001

The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial.

OBJECTIVE: To test the effects of a high intensity home-based progressive strength training program on the clinical signs and symptoms of osteoarthritis (OA) of the knee. METHODS: Forty-six community dwelling patients, aged 55 years or older with knee pain and radiographic evidence of knee OA, were randomized to a 4 month home based progressive strength training program or a nutrition education program (attention control). Thirty-eight patients completed the trial with an adherence of 84% to the intervention and 65% to the attention control. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index pain and physical function subscales. Secondary outcomes included clinical knee examination, muscle strength, physical performance measures, and questionnaires to measure quality of life variables. RESULTS: Patients in the strength training group who completed the trial had a 71% improvement in knee extension strength in the leg reported as most painful versus a 3% improvement in the control group (p < 0.01). In a modified intent to treat analysis, self-reported pain improved by 36% and physical function by 38% in the strength training group versus 11 and 21%, respectively, in the control group (p = 0.01 for between group comparison). In addition, those patients in the strength training group who completed the trial had a 43% mean reduction in pain (p = 0.01 vs controls), a 44% mean improvement in self-reported physical function (p < 0.01 vs controls), and improvements in physical performance, quality of life, and self-efficacy when compared to the control group. CONCLUSION: High intensity, home based strength training can produce substantial improvements in strength, pain, physical function and quality of life in patients with knee OA.

Aged↗

PubMed1992

[Psychosocial characteristics of phenylketonuric women: birth defect prevention].

Women with phenylketonuria (PKU) are at high risk for having offspring with mental retardation, microcephaly, heart defects and low birth weight. These adverse outcomes can be prevented by a low-phenylalanine diet started before conception and continued throughout pregnancy. In view of the frequency of poor dietary compliance in women with PKU, a psychosocial model was developed that delineates developmental stages with specific behavioral goals for them to follow. In the present study 15 women with PKU over the age of 16 were followed for 3 years and compared to groups of their healthy acquaintances and of diabetic women. Structured interviews and standard questionnaires were used to study factors hypothesized as being related to the subjects' adjustment and to achievement of their PKU-related behavioral goals. After 1 year most of the PKU subjects were not planning a pregnancy, making their main behavioral goal the prevention of an unplanned pregnancy. Their knowledge of the risks of maternal PKU and family planning was unsatisfactory. PKU subjects had more conservative attitudes about sex and contraception than the controls. The psychosocial profile of PKU subjects pinpointed their special needs and indicated the kinds of specific intervention that might help them adhere to the recommended treatment and prevent birth defects in their offspring.

Adolescent↗

PubMed2006

Epidemiology, clinical consequences, and psychosocial treatment of nonadherence in schizophrenia.

Partial adherence and nonadherence to medication continue to be problems in the treatment of patients with schizophrenia. Nonadherence to medication has a negative impact on the course of illness for these patients as is shown by data on relapse, rehospitalization, time to remission, and attempted suicide. Several factors that contribute to poor adherence have been identified and need to be taken into account when attempting to address the problem of nonadherence. These risk factors relate to the patient, his or her illness and social situation, and the physician. Among the measures that have the potential to improve adherence to medication are psychosocial interventions, psychoeducation in the form of professional, peer-to-peer or family-to-family interventions, and shared decision making.

Antipsychotic Agents↗

PubMedDate not supplied

Midlife women's adherence to home-based walking during maintenance.

BACKGROUND: Despite the many known benefits of physical activity, some women (27%) report no leisure-time physical activity in the prior month. Of those women who began an exercise program, the dropout rate was as high as 50% in the first 3-6 months. The challenge for researchers and clinicians is to identify those factors that influence not only adoption, but also maintenance, of physical activity. OBJECTIVE: The purpose of this study was (a) to describe midlife women's maintenance of walking following the intervention phase of a 24-week, home-based walking program, and (b) to identify the effects of background characteristics, self-efficacy for overcoming barriers to exercise, and adherence to walking during the intervention phase on retention and adherence to walking. METHODS: There were Black and White women participants (N = 90) aged 40-65 years who completed a 24-week, home-based walking program. Self-efficacy for overcoming barriers to exercise, maximal aerobic fitness, and percentage of body fat were measured at baseline, 24 weeks, and 48 weeks. Adherence was measured with heart-rate monitors and an exercise log. RESULTS: Retention was 80% during maintenance. On average, the women who reported walking during maintenance adhered to 64% of the expected walks during that phase. Examination of the total number of walks and the number and sequence of weeks without a walk revealed dynamic patterns. The multiple regression model explained 40% of the variance in adherence during the maintenance phase. DISCUSSION: These results suggest that both self-efficacy for overcoming barriers and adherence during the intervention phase play a role in women's walking adherence. The findings reflect dynamic patterns of adopting and maintaining new behavior.

Adult↗