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Results for “Medication Adherence”

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PubMed2006

A randomized controlled trial of cognitive therapy for bipolar disorder: focus on long-term change.

BACKGROUND: This study reports the outcome of a randomized controlled trial of cognitive therapy (CT) for bipolar disorder. The treatment protocol differed from other published forms of CT for bipolar disorder through the addition of emotive techniques. METHOD: Fifty-two patients with DSM-IV bipolar I or II disorder were randomly allocated to a 6-month trial of either CT or treatment as usual, with both treatment groups also receiving mood stabilizers. Outcome measures included relapse rates, dysfunctional attitudes, psychosocial functioning, hopelessness, self-control, and medication adherence. Patients were assessed during treatment by independent raters blind to the patients' group status. RESULTS: At posttreatment, patients allocated to CT had experienced less severe depression scores (Beck Depression Inventory and Montgomery-Asberg Depression Rating Scale) and less dysfunctional attitudes. After controlling for the presence of major depressive episode at baseline, there was a statistical trend toward a greater time to depressive relapse (p=.06) for the CT group. At 12-month follow-up, the CT group showed a trend toward lower Young Mania Rating Scale scores and improved behavioral self-control. The Clinical Global Impressions-Improvement scale, comparing the 18 months prior to treatment to the severity of illness status at follow-up, showed a substantial difference between groups in favor of CT. CONCLUSION: Our findings corroborate previous bipolar disorder research in demonstrating the value of CT, particularly immediately post-treatment, and indicate some continuation (albeit diminishing) of benefits in the succeeding 12 months. These findings suggest that psychological booster sessions may be crucial for maintaining the beneficial effects of cognitive therapy.

Adult↗

PubMed2003

Computerised reminders and feedback in medication management: a systematic review of randomised controlled trials.

OBJECTIVE: To systematically review randomised controlled trials (RCTs) of computer-generated medication reminders or feedback directed to healthcare providers or patients. DATA SOURCES: Extensive computerised and manual literature searches identified 76 English-language reports of RCTs reported before 1 January 2002. Searches were conducted between June 1998 and April 2002. STUDY SELECTION: 26 papers making 29 comparisons (two papers reported on multiple interventions) of computer-supported medication management to a control group. DATA EXTRACTION: The quality of the RCTs was systematically assessed and scored independently by two reviewers. Rates of compliance with (potential) reminders for the control and intervention groups were extracted. DATA SYNTHESIS: Heterogeneity of studies prevented a meta-analysis. Where possible, rates were calculated using the intention-to-treat principle. The comparisons were grouped into five areas. Reminders to providers in outpatient settings: six of 12 comparisons demonstrated positive effects (relative rates [RRs: intervention rates/control rates], 1.0 to 42.0). Provider feedback in outpatient settings: five of seven comparisons showed improved clinician behaviour (RRs, 1.0 to 2.5). Combined reminders and feedback in outpatient settings: the single comparison found no improvement. Reminders to providers in inpatient settings: three of five comparisons showed improvements (RRs, 1.0 to 2.1). Patient-directed reminders: two of four comparisons showed improvements in patient compliance. CONCLUSION: Reminders are more effective than feedback in modifying physician behaviour related to medication management. Patient-directed reminders can improve medication adherence.

Drug Therapy↗

PubMed2005

Cost-effectiveness of full medicare coverage of angiotensin-converting enzyme inhibitors for beneficiaries with diabetes.

BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors slow renal disease progression and reduce cardiac morbidity and mortality in patients with diabetes. Patients' out-of-pocket costs pose a barrier to using this effective therapy. OBJECTIVE: To estimate the cost-effectiveness to Medicare of first-dollar coverage (no cost sharing) of ACE inhibitors for beneficiaries with diabetes. DESIGN: Markov model with costs and benefits discounted at 3%. DATA SOURCES: Published literature and Medicare claims data. TARGET POPULATION: 65-year-old Medicare beneficiary with diabetes. TIME HORIZON: Lifetime. PERSPECTIVE: Medicare and societal. INTERVENTIONS: We evaluated Medicare first-dollar coverage of ACE inhibitors compared with current practice (no coverage) and the new Medicare drug benefit. OUTCOME MEASURES: Costs (2003 U.S. dollars), quality-adjusted life-years (QALYs), life-years, and incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: Compared with current practice, first-dollar coverage of ACE inhibitors saved both lives and money (0.23 QALYs gained and 1606 USD saved per Medicare beneficiary). Compared with the new Medicare drug benefit, first-dollar coverage remained a dominant strategy (0.15 QALYs gained, 922 USD saved). RESULTS OF SENSITIVITY ANALYSIS: Results were most sensitive to our estimate of increase in ACE inhibitor use; however, if ACE inhibitor use increased by only 7.2% (from 40% to 47.2%), first-dollar coverage would remain life-saving at no net cost to Medicare. In analyses conducted from the societal perspective, benefits were similar and cost savings were larger. LIMITATIONS: Results depend on accuracy of the underlying data and assumptions. The effect of more generous drug coverage on medication adherence is uncertain. CONCLUSIONS: Medicare first-dollar coverage of ACE inhibitors for beneficiaries with diabetes appears to extend life and reduce Medicare program costs. A reduction in program costs may result in more money to spend on other health care needs of the elderly.

Aged↗

PubMed1998

Major Depressive Disorder and HIV-1 Infection: A Review of Treatment Trials.

Major depression is a common psychiatric presentation during the course of many chronic illnesses. Although estimates of its prevalence in people with human immunodeficiency virus (HIV) infection and acquired immunedeficiency syndrome have varied widely in the literature, it has become increasingly clear that people with HIV infection experience depression or depressive symptoms frequently, and that major depression may be the most common psychiatric disorder. This report reviewed the currently reported data and clinical trials for treatment of depression or depressive symptoms in the course of HIV infection. We have reviewed both psychopharmacologic and psychotherapy trials and although blinded efficacy studies are the gold standard, because there is often a lack of data, we have included noncontrolled (open) trials for comparison. Pharmacologic medication trials show that selective serotonin reuptake inhibitors (SSRIs), although not more efficacious, may be more tolerable and have greater overall effectiveness. Furthermore, when medications are used to treat depression, it may be essential to evaluate for tolerability and potential drug interactions to increase efficacy. Psychotherapy trials have investigated a variety of treatment modalities including group, individual, and stress reduction techniques. In treatment trials, all of these modalities have been associated with a reduction in distress and depressive symptoms. With the advances in therapy for HIV infection, treatment of a major depressive episode or depressive symptoms has become increasing important because untreated depression could both compromise medication adherence and potentiate the disabling effects of the illness.

Journal Article↗

PubMed2001

Predictors of self-care behavior in adults with type 2 diabetes: an RRNeST study.

BACKGROUND AND OBJECTIVES: Fourfactors have been linked with self-care behaviors in patients with type 2 diabetes: (1) patient demographics, (2) doctor-patient relationship, (3) stress, and (4) social context. This study determined the relationship of each of these factors on self-care behavior in diabetic family practice patients. METHODS: We conducted a cross-sectional survey of patients seeking care in the outpatient clinics of the Residency Research Network of South Texas (RRNeST), a network of six family practice residency programs affiliated with the University of Texas Health Science Center at San Antonio. A total of 397 consecutive adults with type 2 diabetes presenting for appointments with family medicine faculty and family practice residents over a 6-month time period were surveyed about various factors and their relationship to self-care behavior pertinent to diabetes. RESULTS: Self-care was related to age, patient satisfaction with his/her doctor-patient relationship, personal stress, and family context. Social context, as reflected by the statement "My family understands my diabetes," was strongly associated with diet, exercise, and medication adherence. Multivariate analysis demonstrated that, after controlling for patient demographic characteristics andpatient satisfaction, personal stress and social context were strongly associated with self-care, especially diet. CONCLUSIONS: Social context, specifically the family, is significantly associated with self-care behaviors. Attempts to improve self-care behavior should include thefamily members of the diabetic patient. Since family physicians often provide care to multiple members of the family, they are ideally positioned to implement these interventions.

Age Factors↗

PubMed2002

Improving the quality of home care for patients with heart failure.

Home care nurses play a very important role in caring for patients with heart failure. The home care nurse's ability to follow patients one-on-one over a period of time, assess and observe patient self-care behaviors such as medication adherence and dietary intake, and intervene with patient education is unique.

Aged↗

PubMed2003

Predictive factors and selection of thymidine analogue mutations by nucleoside reverse transcriptase inhibitors according to initial regimen received.

Thymidine analogue mutations were determined and compared in patients who received zidovudine monotherapy and added didanosine or zalcitabine, and in patients who started with one of these dual nucleoside combinations. Although patients who started in the era of zidovudine monotherapy had a longer duration of therapy compared with the other group, there was no statistical difference in the number of mutations between the two groups. However, thymidine analogue mutations were more frequent in patients who added didanosine to zidovudine monotherapy compared with those who added zalcitabine. Patients who started with a dual nucleoside combination developed 215Y/F first, followed by 215Y/F+41L, then 215Y/F+41L+210W, then 215Y/F+67N+70R+41L or 219Q/E, and then 215Y/F+41L+67N+70R+219Q/E. Patients who started with zidovudine monotherapy had a different pathway with the mutation at codon 70 appearing first, followed by 215Y/F+70R or 210W, then 215Y/F+41L+210W, then 215Y/F+67N+70R+219Q/E, and then 215Y/F+41L+67N+70R+210W. Medication adherence was associated with the number of mutations in both groups of patients. Two distinct mutational patterns were noted. The first pattern involved mutations at codons 41, 210 and 215, while the second involved mutations at codons 67, 70 and 219.

Anti-HIV Agents↗

PubMed2003

Treatment of difficult-to-control blood pressure in a multidisciplinary clinic at a public hospital.

Cardiovascular morbidity and mortality in disadvantaged populations remains high. Few innovative strategies or services to treat chronic diseases have been critically analyzed in these patients. We evaluated our initial experiences with a newly established multidisciplinary clinic For the treatment of difficult-to-control hypertension and describe reasons for poor blood pressure control as well as treatment strategies. Patients with blood pressures greater than 140/90 despite concurrent treatment with three or more medications for at least three months were referred to our clinic. Data regarding sociodemographic characteristics, health beliefs and behaviors were collected. Two physicians jointly proposed an explanation for lack of blood pressure control. A multidisciplinary team of physicians, nurses, pharmacists, and nutritionists aggressively assessed and reinforced educational objectives tailored to individual needs. 58% of patients achieved target blood pressure at six months, but 22% were lost to follow-up. The most common reasons for previous treatment failure were volume overload and poor medication adherence. We conclude that a multidisciplinary clinic for difficult-to-control blood pressure can be successful in a large, urban hospital serving a disadvantaged minority population. However, more study is needed to delineate the specific reasons for success and further refine treatment strategies.

Adult↗

PubMed2003

Pharmacists successfully tackle management of depression in primary care.

It's an entirely logical move, when you consider that medication adherence is a major problem in the treatment of mood disorders, but it is only recently that health systems have begun to take advantage of the pharmacist's expertise in this area. And at least one model is proving popular with physicians as well as patients--and it is getting results. Get the details on implementation and outcomes.

Depressive Disorder↗

PubMed2004

Older age and plasma viral load in HIV-1 infection.

BACKGROUND: The purpose of the study was to examine the relationship between age and plasma viral load in HIV-1-infected individuals. DESIGN: The experimental method was to recruit older (> 50 years of age) and younger (18-39 years of age) HIV-1-infected individuals. The plasma viral load was measured using the Roche Molecular Systems UltraSensitive Roche HIV-1 Monitor test reflexively with the standard Amplicor HIV Monitor test to quantify viral load in the range of 50-750,000 copies of HIV-1 RNA/ml plasma. SUBJECTS: A total of 135 HIV-1-seropositive individuals (at Centers for Disease Control and Prevention early symptomatic stage B or late symptomatic stage/AIDS C) were enrolled as part of a larger cohort also consisting of HIV-1-seronegative individuals. RESULTS: A generalized linear models statistical analysis was conducted in order to evaluate age category as a predictor of plasma viral load. The result was a significant effect of age category, with older age associated with a lower plasma viral load. The association held controlling for antiretroviral therapy usage, disease stage, antiretroviral medication adherence, HIV-1 serostatus duration, alcohol and substance use, recent sexually transmitted disease, and sociodemographics (except income). CONCLUSION: Older age was associated with lower levels of HIV-1 replication in this sample, independent of antiretroviral therapy usage, regimen adherence, and disease stage. It is suggested that the effect may be caused by changes in viral evolution or immunological monitoring specific to older individuals with HIV-1 infection.

Adult↗

PubMed2004

The psychosocial aspects of diabetes care. Using collaborative care to manage older adults with diabetes.

Diabetes is a chronic disease that requires managing medications, adhering to dietary requirements, and engaging in age- and abilities appropriate physical activity. This article addresses the need for a collaborative care management approach that emphasizes a partnership between older adults and health care professionals. Such an approach recognizes that patients are the experts about their lives and primary care providers are experts about diabetes. A collaborative care management approach can help primary care providers assist older adults to address psychosocial concerns, cognitive functioning, and depression. We conclude this article with a brief discussion regarding a transdisciplinary approach that takes the collaborative care management approach one step further.

Aged↗

PubMed2004

Enhancing primary care for complex patients. Demonstration project using multidisciplinary teams.

PROBLEM BEING ADDRESSED: Communication between community-based providers is often sporadic and problem-focused. OBJECTIVE OF PROGRAM: To implement collaborative community-based care among providers distant from one another and to improve or maintain the health of high-risk community-dwelling patients, with a focus on medication use. PROGRAM DESCRIPTION: Six primary health care teams were formed of a family physician, a pharmacist, and a home care case manager (nurse). Three of these teams also had a family physician's office nurse. Teams received training and decided on processes of care that included a home visit, medication history, and weekly 1.5-hour face-to-face team meetings. In 151 team conferences, 705 medication or health issues were identified for 182 patients over 6 months. Medication adherence was improved at 3 and 6 months. After 6 months, all providers had a greater understanding of the roles of the other providers. CONCLUSION: Primary health care teams developed in this study require few structural changes to existing health care systems, but will require more reimbursement options.

Aged↗

PubMed2005

Interruption and discontinuation of highly active antiretroviral therapy in the multicenter AIDS cohort study.

OBJECTIVE: Identify the determinants and consequences of interrupting and discontinuing highly active antiretroviral therapy (HAART) among a population-based cohort of HIV-infected men. METHODS: Longitudinal analyses were applied to 2916 person-visit pairs (589 men) of continuous HAART use, 243 person-visit pairs (154 men) during which HAART was interrupted, and 151 person-visit pairs (130 men) in which HAART was discontinued by the second visit. HIV RNA increase was defined as > or =1 log10 copies/mL across the visit pairs. RESULT: : Younger age, black race, geographic location, higher HIV RNA level, depression, shorter time on HAART, lower medication adherence, and not taking a lamivudine-containing regimen predicted interrupting HAART use. Younger age, higher HIV RNA level, depression, and taking an abacavir- or lopinavir-containing regimen predicted discontinuing HAART. Among men with < or =1000 HIV RNA copies/mL, approximately 5% of those who interrupted HAART for < or =7 days and those who continued HAART had an HIV RNA increase. Men with longer interruptions and HAART discontinuers had significantly higher rates of HIV RNA increases (35.7% and 70.5%, respectively). Discontinuation and long interruptions resulted in lower CD4 cell counts. CONCLUSIONS: Host characteristics play a role in short interruptions, whereas longer interruptions may be clinically indicated. These longer stoppages had further virologic and immunologic consequences, however.

Adult↗

PubMed2005

Women and HIV. Symptoms and quality of life in women.

Symptoms occur across the trajectory of HIV disease and can diminish the quality of life of women living with the virus. Untreated symptoms may also influence medication adherence and lead to complications of HIV and coexisting illnesses. Symptom management can address these concerns. A variety of self-care approaches should be incorporated into any plan of treatment, which ideally should be based on a partnership between the woman with HIV and her health-care providers. This article will address a range of issues concerning symptoms in women with HIV both in the U.S. and worldwide.

Female↗

PubMed2005

An improvement in virologic response to highly active antiretroviral therapy in clinical practice from 1996 through 2002.

Early studies of highly active antiretroviral therapy (HAART) use in clinical practice suggested suboptimal rates of viral suppression. HAART regimens and expertise in the use of HAART have since evolved, and we sought to determine how virologic response to HAART has changed in clinical practice. We compared all patients who started a first HAART regimen from 1996 through 2002 in a longitudinal cohort of HIV-infected patients in care in Baltimore. There were significant improvements in suppressing HIV RNA to < 400 copies/mL, ranging from 43.8% (1996) to 72.4% (2001-2002) by 6 months and from 60.1% (1996) to 79.9% (2001-2002) by 12 months (both P < 0.01 for trend). There were also significant improvements in CD4 cell response. Over time, there was a significant increase in the use of a nonnucleoside reverse transcriptase inhibitor (NNRTI) or boosted protease inhibitor (PI) regimen compared with a single PI as well as an increase in the number of patients who were antiretroviral (ARV) naive. There was also a significant temporal trend from 1996 through 2002 in achieving a suppressed HIV RNA level, adjusting for being ARV naive, specific HAART regimen, CD4 cell count, HIV-1 RNA level, and demographic factors. This suggests that improved virologic response may also be attributable to other factors such as a greater focus on medication adherence, improved ARV tolerability, and ease of dosing.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Three-year follow-up of a factorial randomised controlled trial of two decision aids for newly diagnosed hypertensive patients.

This study is a 3-year follow-up of a factorial randomised controlled trial of two decision aids - decision analysis and information video plus leaflet - for newly diagnosed hypertensive patients. We found no evidence of differences for either of the two decision aids compared with controls for the primary outcome of blood pressure control at follow-up. There were also no differences in any of the secondary outcomes measured - the proportion taking blood pressure lowering drugs, self-reported medication adherence, or consulting behaviour. The randomised controlled trial cohort as a whole, irrespective of randomised group, demonstrated substantial reductions in blood pressure and 10-year cardiovascular risk over the follow-up period.

Antihypertensive Agents↗

PubMedDate not supplied

Predictors of influenza immunization among home care clients in Ontario.

BACKGROUND: This study examined factors associated with the receipt of influenza vaccination among Ontario home care clients. METHODS: Home care clients were assessed, as part of a routine home visit, during a pilot study of the Resident Assessment Instrument - Home Care (RAI-HC) in 12 Ontario Community Care Access Centres (CCACs). The RAI-HC is a multidimensional assessment that identifies clients' needs and level of functional ability. Multiple logistic regression was used to identify factors associated with influenza immunization in the two years prior to assessment. RESULTS: The overall rate of immunization reached about 80% by 2002. Factors such as age, respiratory problems, diabetes and congestive heart failure were associated with greater uptake, but overall rates of influenza immunization were lower than expected. Low education, smoking and poor medication adherence were negatively associated with influenza immunization. In addition, there was considerable variation in uptake among CCACs after adjusting for other significant individual-level independent variables. INTERPRETATION: Comprehensive assessments like the RAI-HC can be used to help identify and respond to health promotion and disease prevention issues in this population, and to compare rates across Canada.

Adult↗

PubMed2006

Low-density lipoprotein cholesterol goal attainment among high-risk patients: Does a combined intervention targeting patients and providers work?

BACKGROUND: Physicians are aware of the National Cholesterol Education Program guidelines; however, most patients fail to attain cholesterol goals. OBJECTIVE: To determine whether a combined program of patient education and provider awareness could improve the National Cholesterol Education Program goal attainment among patients at high risk for cardiovascular events. METHODS: One hundred seven high-risk patients with cardiovascular disease were educated in a single 15-minute session regarding their cholesterol levels, risk factors, and medication adherence. Those with scores of 2 or lower on the Morisky questionnaire were classified as low-adherence patients, and those with scores of 3 or higher were classified as high-adherence patients. Seven physicians were provided this information and were requested to evaluate the dyslipidemia management of these patients. Lipid levels were reevaluated 8 to 12 weeks after the intervention. RESULTS: At the start of the study, 38 (35.5%) of the 107 patients were at target low-density lipoprotein cholesterol (LDL-C) levels, and 64 of the 107 patients (59.8%) were at target levels after the intervention. High-adherence patients decreased their LDL-C levels from a mean of 118.6 mg/dL (3.07 mmol/L) to 98.6 mg/dL (2.55 mmol/L); low-adherence patients increased their LDL-C levels after the intervention from 134.5 mg/dL (3.48 mmol/L) to 142.1 mg/dL (3.68 mmol/L). A comparison between the LDL-C goal achievers vs nonachievers revealed a significant difference in adherence (P = .001). Among the goal achievers, significant decreases in preintervention vs postintervention total cholesterol levels (P = .001) and LDL-C levels (P = .001) were also noted. CONCLUSION: This study demonstrates that an intervention simultaneously targeting patients and providers is successful in improving goal attainment among high-risk patients.

Adult↗