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Results for “Adherence Interventions”

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PubMed2003

Optimizing medication adherence in older persons with hypertension.

Suboptimal control of hypertension in large communities can be attributed, in part, to about 50% of patients who stop taking their antihypertensive drugs after 1 year. Older patients with many illnesses (including chronic kidney disease) are at especially high risk for discontinuing prescribed medications, but age is a weaker predictor than the number of consumed pills. Determining if medications are being taken as prescribed is difficult, but asking the patient and significant other the simple question, "Have you missed any pills in the last week?" is a good place to start. Despite all their other virtues, clinical trials seldom provide the same answers regarding medication adherence that are found in clinical practice. Observational and a few interventional trials have established that short, simple regimens that improve patients' symptoms and are well tolerated are more likely to be taken correctly. Patient (and family) education is the cornerstone of improving adherence to medication, but several other interventions have also proven useful. There appears to be no "magic bullet" that will improve medication adherence in all patients, but providing written instructions, simplifying the medication regimen to as few as necessary, once daily, well tolerated and inexpensive pills, involving family members, and prompting pill taking by certain activities of daily living all seem to help. Improving medication adherence would be a simple way to make antihypertensive therapies much more cost effective, since a medication that is not taken incurs all of cost, and provides no benefit to the patient.

Aged↗

PubMedDate not supplied

Self-reported symptoms after initiation of a protease inhibitor in HIV-infected patients and their impact on adherence to HAART.

PURPOSE: The purpose of our study was to assess short-term self-reported symptoms in patients who were started on two nucleoside reverse transcriptase inhibitors and one protease inhibitor (PI) in the multicenter APROCO cohort (N = 336) and to assess the influence of these symptoms on adherence. METHOD: Adherence and patient's reported symptoms were measured at 1 and 4 months (M) after initiation of highly active antiretroviral therapy (HAART) through self-administered questionnaires. RESULTS: Most patients reported at least one symptom (94.0% at M1; 88.0% at M4); fatigue and diarrhea were the most often reported symptoms. Respectively, 81.3% and 75.0% of patients were strictly adherent to HAART during the 4 days prior to M1 and M4 visits. After adjustment for younger age, history of antiretroviral treatment, unstable housing, poor social support, and alcohol consumption, patients who reported a high number of symptoms at M1 were more likely to be nonadherent at M4 (odds ratio per symptom = 1.13; 95% CI = 1.03-1.24). CONCLUSION: Patients reporting a high number of symptoms soon after HAART initiation are at higher risk of future nonadherence and could be targeted for interventions to achieve good levels of adherence and to improve treatment outcome.

Adult↗

PubMed1993

Adherence to continuous screening for colorectal neoplasia.

Continuous screening is defined as the periodic provision of an opportunity for diagnostic testing to a population of individuals who are asymptomatic and at increased risk for disease. If screening is offered periodically irrespective of response to an earlier screening invitation, this situation may be referred to as serial screening. When continuous screening is made available only to individuals who had tested previously, population member response is referred to as repeat screening. This study assessed adherence to serial- and repeat-colorectal cancer screening among older adult members of an independent practice association-type health maintenance organization (HMO) in two consecutive rounds of screening. In the first screening round, fecal occult blood tests (FOBTs) were sent to 1,565 subjects who were randomly assigned to receive usual care or behavioral interventions intended to encourage testing. Overall, 647 (41%) subjects completed and returned their tests. In the second screening round, FOBTs were mailed again to all subjects; however, the interventions were discontinued. Logistic regression analysis results shows that first-round testing was a significant independent predictor of serial adherence for subjects older than 65 years of age (odds ratio[OR] = 10.8) and those younger than 65 years of age (OR = 10.9); and a significant negative association between exposure to first-round intervention and serial adherence (OR = 0.5) was found among younger subjects. Among first-round adherers, age was significantly and positively related to repeat adherence (OR = 1.6). However, exposure to first-round intervention and having an abnormal FOBT result were significantly and negatively associated with repeat adherence (OR = 0.5 and OR = 0.4, respectively). The results of this study reported here indicate that previous screening is a strong predictor of serial adherence, and special efforts may be required to achieve high levels of serial and repeat adherence among younger adults. Additional research is needed to understand why persons with abnormal screening test results are unlikely to engage in repeat screening.

Age Factors↗

PubMedDate not supplied

Improving quality of life in patients with heart failure: an innovative behavioral intervention.

Nurses play a major role in assisting patients with chronic diseases manage their symptoms, adhere to treatment, and change behavior. This article describes an innovative behavioral intervention for patients with heart failure. The rationale and theoretical basis for the intervention, implementation, and evaluation of the intervention and its implications for use in clinical practice and further research are presented.

Activities of Daily Living↗

PubMed1999

Parental knowledge of attention-deficit hyperactivity disorder and opinions of treatment options: impact on enrollment and adherence to a 12-month treatment trial.

OBJECTIVE: This study examines the relationship between parents' knowledge of attention-deficit hyperactivity disorder (ADHD) and opinions of treatment and their impact on enrolment in and adherence to both pharmacological and nonpharmacological interventions for children with ADHD. METHOD: Participants in the study were the parents of 81 children who reached diagnostic criteria for ADHD and who were referred to a treatment study of ADHD involving stimulant medication and parent groups. The mothers completed a modified version of the ADHD Knowledge and Opinion Scale (AKOS) prior to receiving diagnostic feedback and prior to the families' decisions to participate in a 12-month randomized trial (medication [methylphenidate or placebo] and parent groups [training or support]). Treatment enrolment and adherence were monitored over the 12-month trial, and families who remained in the study at 12 months completed another modified AKOS. RESULTS: A higher level of knowledge of ADHD was found to be related to more favourable opinions of parent groups but not of medication. Moreover, parents who were more knowledgeable about ADHD were more likely to enroll in both pharmacological and nonpharmacological treatments. Adherence to pharmacological and nonpharmacological treatments was not predicted by parental knowledge of ADHD or opinions of the treatment. CONCLUSION: Parents' knowledge of ADHD and opinions of treatments play a significant role in enrollment in treatments for their children with ADHD. Providing information to parents regarding ADHD prior to offering treatment modalities could have a favourable impact on treatment enrollment and hence treatment adherence.

Adult↗

PubMedDate not supplied

Increasing activity to reduce obesity in adolescent girls: a research review.

OBJECTIVE: To provide a systematic review of physical activity intervention research conducted with adolescent girls (12-19 years of age and/or in middle or high school) in the United States and Canada during the past two decades. DATA SOURCES: Published articles in English were identified in searches using MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycLIT, EMBASE, Science Citation Index, and the Cochrane Controlled Trials Register, with the keywords adolescent health, obesity, physical activity, and exercise, between the dates of May 1980 and November 2003. STUDY SELECTION: Research studies with interventions that started within the adolescent time period. Only 7 studies met the inclusion criteria. DATA EXTRACTION: The publication year, sample description, study design, interventions used, and outcomes were extracted from each study. DATA SYNTHESIS: The 7 studies were published between 1989 and 2003, included girls and boys in the overall sample (no studies with girl-only samples), used randomized controlled trial or quasi-experimental designs, and included multicomponent interventions. Body mass index, fitness levels, exercise, and weight were measured as outcomes. CONCLUSIONS: Although the results were not consistent across studies, they suggest that school-based, multicomponent interventions that were also designed to decrease sedentary behavior were effective in increasing physical activity in adolescent girls. Future research should focus on determinants of long-term adherence and the duration and intensity of interventions necessary to prevent obesity in adolescent girls.

Adolescent↗

PubMed2004

A psycho-educational intervention for depressed women: a qualitative analysis of the process.

Yalom (1995) has stated that psycho-educational interventions could be made more effective by incorporating a focus on the interpersonal process. A qualitative analysis is proposed to investigate the degree of fidelity with which a psycho-educational intervention for women with depressive symptoms was delivered and to identify Yalom's significant therapeutic mechanisms operating in group therapy. The intervention consisted of six 2 two-hour weekly sessions organized around educational material. Eight groups were conducted with 5-19 participants each. A qualitative analysis was undertaken based on Kvale's (1996) technique of 'categorization of meanings' for the transcribed registers of audiotaped recordings. The analysis led to the definition of five major group process categories: establishment of rules, educational exchange, experiential exchange, reflexive work designed to achieve cognitive and behavioural change, and limitations on the exchange process. It showed that the facilitators largely adhered to the goals of the intervention, its strategies and model, and that the main limitations concerned facilitators' and participants'speaking for over-long periods of time and facilitators' failure to cover all the material due to lack of time. The subsequent analysis identified four of Yalom's categories: installation of hope, didactic instruction, catharsis, and universality. In support of Yalom's assertion, we concluded that this exercise was useful in that it highlighted important therapeutic factors that could be more purposefully manipulated in the future.

Adult↗

PubMed2005

Pharmaceutical care of patients with heart failure.

AIM: The aim of this study was to investigate the impact of a pharmacist-led pharmaceutical care programme, involving optimization of drug treatment and intensive education and self-monitoring of patients with heart failure (HF) within the United Arab Emirates (UAE), on a range of clinical and humanistic outcome measures. METHODS: The study was a randomized, controlled, longitudinal, prospective clinical trial at Al-Ain Hospital, Al-Ain, UAE. Patients were recruited from the general medical wards and from cardiology and medical outpatient clinics. HF patients who fulfilled the entrance criteria, and had no exclusion criteria present, were identified for inclusion in the study. After recruitment, patients were randomly assigned to one of two groups: intervention group or control group. Intervention patients received a structured pharmaceutical care service while control patients received traditional services. Patient follow-up took place when patients attended scheduled outpatient clinics (every 3 months). A total of 104 patients in each group completed the trial (12 months). The patients were generally suffering from mild to moderate HF (NYHA Class 1, 29.5%; Class 2, 50.5%; Class 3, 16%; and Class 4, 4%). RESULTS: Over the study period, intervention patients showed significant (P < 0.05) improvements in a range of summary outcome measures [AUC (95% confidence limits)] including exercise tolerance [2-min walk test: 1607.2 (1474.9, 1739.5) m.month in intervention patients vs. 1403.3 (1256.5, 1549.8) in control patients], forced vital capacity [31.6 (30.8, 32.4) l.month in the intervention patients vs. 27.8 (26.8, 28.9) in control patients], health-related quality of life, as measured by the Minnesota living with heart failure questionnaire [463.5 (433.2, 493.9) unit.month in intervention patients vs. 637.5 (597.2, 677.7) in control patients; a lower score in this measure indicates better health-related quality of life]. The number of individual patients who reported adherence to prescribed medications was higher (P < 0.05) in the intervention group (85 vs. 35), as was adherence to lifestyle advice (75 vs. 29) at the final assessment (12 months). There was a tendency to have a higher incidence of casualty department visits by intervention patients, but a lower rate of hospitalization. CONCLUSIONS: The research provides clear evidence that the delivery of pharmaceutical care to patients with HF can lead to significant clinical and humanistic benefits.

Aged↗

PubMed2026

Teach-Back in Clinical Communication: A Systematic Review and Meta-analysis.

BACKGROUND: Teach-back has been identified as a high-quality clinical communication strategy. Our aim was to synthesize current literature on teach-back effectiveness. METHODS: We searched MEDLINE, Embase, and CINAHL Complete databases to identify relevant studies published between 2018 and 2026. We also included pre-2018 studies identified in prior systematic reviews. Studies were eligible for inclusion if they involved adult patients and/or care partners, delivered teach-back in a single encounter, had a comparator group, and reported proximal/intermediate patient outcomes (as defined in our conceptual model). Two independent investigators screened each citation at the title/abstract and full-text levels and assessed risk of bias. Study characteristics and results were extracted. When meta-analysis was performed, we used standardized mean differences (SMD) to estimate summary effects. We assessed certainty of evidence (COE) using Grading of Recommendations Assessment, Development and Evaluation (GRADE) domains. RESULTS: Our systematic review included 18 randomized controlled trials (RCTs) involving 1985 participants. Across 9 RCTs assessing knowledge acquisition, conceptual inconsistencies precluded meta-analysis. Overall, there was no clear pattern of the effect of teach-back on knowledge (very low COE). In a meta-analysis of 5 RCTs assessing self-efficacy (416 participants), we found that teach-back interventions led to a large increase in self-efficacy relative to usual care (SMD = 2.40; 95%CI 0.37-4.44) (very low COE). In a meta-analysis of 7 RCTs assessing adherence to health behaviors (571 participants), teach-back interventions led to a large increase in adherence (SMD = 1.04; 95%CI 0.45-1.64) (low COE). Meta-analyses for both self-efficacy and adherence had large confidence intervals that ranged from small to large effect sizes and had substantial heterogeneity. DISCUSSION: In this systematic review and meta-analysis, we did not identify a clear benefit of teach-back on knowledge acquisition but did find evidence that teach-back improves self-efficacy and self-reported, short-term adherence to health behaviors.

clinical communication↗

PubMed2006

Antiretroviral therapy in resource-poor settings. Decreasing barriers to access and promoting adherence.

Since 2002, the HIV Equity Initiative of the nongovernmental organization Partners in Health has been expanded in conjunction with the Haitian MOH to cover 7 public clinics. More than 8000 HIV-positive persons, 2300 of whom are on antiretroviral therapy (ART) are now followed. This article describes the interventions to promote access to care and adherence to ART developed in reference to the specific context of poverty in rural Haiti. User fees for clinic attendance have been waived for all patients with HIV and tuberculosis and for women presenting for prenatal services. Additionally, HIV testing has been integrated into the provision of primary care services to increase HIV case finding among those presenting to clinic because of illness, rather than solely focusing on those who present for voluntary counseling and testing (VCT). Once a patient is diagnosed with HIV, medications and monitoring tests are provided free of charge and transportation costs for follow-up appointments are covered to defray patients' out-of-pocket expenses. Patients are given home-based adherence support from a network of health workers who provide psychosocial support and directly observed therapy. In addition, the neediest patients receive nutritional support. Following the description of the program is an approximation of the costs of these interventions and a discussion of their impact.

Anti-HIV Agents↗

PubMed2006

Measures of fidelity in motivational enhancement: a systematic review.

The movement to use empirically supported treatments has increased the need for researchers and clinical supervisors to evaluate therapists' adherence to and competence in particular empirically supported interventions. Motivational interviewing (MI) is an empirically supported intervention for substance abuse and other behavioral problems. However, for this intervention to work, it must be provided with fidelity and skill. This article provides a systematic review of MI adherence and competence measures that have been developed and described independently elsewhere. Recommendations for refinement of the measures and future research are also discussed.

Evidence-Based Medicine↗

PubMed2006

Attributions of adolescents with type 1 diabetes in social situations: relationship with expected adherence, diabetes stress, and metabolic control.

OBJECTIVE: To examine the relationships among negative attributions of friend reactions (NAFRs) within a social context, anticipated adherence difficulties, diabetes stress, and metabolic control. RESEARCH DESIGN AND METHODS: A sample of 104 adolescents with type 1 diabetes completed instruments measuring demographics, attribution of friend reactions, anticipated adherence, and diabetes stress. Metabolic control was measured by HbA(1c) obtained during the clinic visit. RESULTS: Path analysis demonstrated an excellent fit of a model depicting an indirect relationship between NAFRs and metabolic control through the mechanisms of expected adherence difficulties and diabetes stress. CONCLUSIONS: Adolescents who make NAFRs are likely to find adherence difficult in social situations and have increased feelings of stress, with the latter associated with poorer metabolic control. Intervention efforts to address negative attributions may impact adherence behavior and feelings of stress, especially if specific contexts of self-care behavior are taken into account.

Adolescent↗

PubMed2002

Adherence to asthma self-management plans with inhaled corticosteroid and oral prednisone: A descriptive analysis.

BACKGROUND: Asthma self-management plans (SMP) are widely recommended for use, but there is little information regarding the degree of patient adherence to their instructions. The aim of the present study was to perform a descriptive analysis of patient responses to worsening asthma with regard to using individualized SMP. METHODS: Diary data were obtained from an earlier 2 year study in which patients used regularly revised SMP in combination with daily recordings of peak expiratory flow (PEF) and symptoms to manage intercurrent asthma episodes. Based on PEF and symptom changes, the SMP contained instructions about increasing the dose of inhaled corticosteroid (ICS) or commencing oral prednisone during worsening asthma, depending on severity. Data from 165 patient diaries were analysed. First, documented responses to episodes of worsening asthma were matched against SMP instructions and adherence was determined using a priori criteria. Second, each occasion when the ICS dose was increased or prednisone was commenced was identified and changes in PEF and/or symptoms that may have led to these actions were sought. RESULTS: Adherence for increasing the ICS dose was dependent on asthma severity, ranging from 78% during severe episodes to 31% during mild short-lived events. When oral prednisone was indicated, patients were adherent on 56% of occasions. Symptoms prompted intervention more frequently than changes in PEF. Significant changes in PEF were absent on 41 and 48% of occasions for ICS dose increase and oral prednisone use, respectively. CONCLUSIONS: Adherence to asthma SMP is variable and often poor. It tends to increase in proportion to the severity and duration of an asthma episode. This underscores the importance of SMP in more severe asthma. Symptoms are more important then PEF in prompting patients to alter treatment. This ought to modify our approach in constructing individual asthma SMP.

Adult↗

PubMed2006

Health literacy and adherence to glaucoma therapy.

PURPOSE: To describe the health literacy of subjects with open angle glaucoma and to investigate the hypothesis that low health literacy is associated with poor glaucoma medication adherence. DESIGN: Cross-sectional patient survey and concomitant chart review. METHODS: One hundred and ninety-seven subjects with open angle glaucoma participated in a survey which included basic demographic information such as age, gender, ethnicity, and level of education completed, and a test of heath literacy, the Rapid Assessment of Adult Literacy in Medicine. Information was collected regarding visual field tests and prescribed medication. The subjects' pharmacies were contacted to ascertain the number of refills requested over the previous six months. RESULTS: Although 146 subjects (74%) reported completing high school, only 94 subjects (48.0%) read at or above a ninth grade level; 23 (11.7%) read at a level of third grade or below. The mean number of refills requested by a subject in the preceding six months was not predicted by race (P = .27,) gender (P = .31), age (P = .92), mean deviation of the visual field (P = .36), or level of education (P = .58). There was a positive relationship between health literacy and the number of refills obtained (P = .003). CONCLUSIONS: Many patients with open angle glaucoma may have poor health literacy. The subjects in our study with low literacy were less adherent with their glaucoma medications than those with a higher level of literacy. Interventions specifically targeting patients with low literacy may improve medication adherence.

Aged↗

PubMed2004

Facilitating treatment adherence with lifestyle changes in diabetes.

Healthy eating and increased physical activity can prevent or delay diabetes and its complications. Techniques that facilitate adherence to these lifestyle changes can be adapted to primary care. Often, the patient's readiness to work toward change must be developed gradually. To prepare patients who are reluctant to change, it is effective to assess and address their conviction and confidence. Patients facing the long-term task of making lifestyle changes benefit from assistance in setting highly specific behavior-outcome goals and short-term behavior targets. Individualization is achieved by tailoring these goals and targets to the patient's preferences and progress, building the patient's confidence in small steps, and implementing more intensive interventions according to a stepped-care model. At each office visit, physician follow-up of the patient's self-monitored goals and targets enhances motivation and allows further customization of the plan. A coaching approach can be used to encourage positive choices, develop self-sufficiency, and assist the patient in identifying and overcoming barriers. More intensive intervention using a team approach maximizes adherence.

Diabetes Mellitus↗

PubMed1989

Enhancing the effectiveness of abortive therapy: a controlled evaluation of self-management training.

Research suggests that approximately one half of recurrent headache sufferers fail to adhere properly to drug treatment regimens with as many as two thirds of patients failing to make optimal use of abortive medications such as ergotamine. In spite of these findings there are no controlled studies that have attempted to evaluate methods for improving adherence to drug regimens for the treatment of chronic headache disorders. In an initial effort to address this adherence problem thirty-four recurrent migraine sufferers were randomized to abortive therapy with ergotamine tartrate plus caffeine (standard abortive therapy) or to standard abortive therapy accompanied by a brief educational intervention designed to facilitate the migraine sufferer's effective use of ergotamine. Patients who received the adjunctive educational intervention attempted to abort a greater percentage of their migraine attacks (70% vs 40%) and showed larger reduction in headache activity (e.g., 40% vs 26% reduction in month two of treatment). However, patients in both treatment groups used similar amounts of abortive medication when attempting to abort a migraine attack and showed similar reductions in analgesic medication use with abortive therapy. There results suggest that brief educational interventions designed to address the problem of patient adherence may yield significant improvements in standard therapies. We argue that such educational interventions deserve more attention in the headache treatment literature than they have received to date.

Adult↗

PubMed1997

Compliance with cardiovascular disease prevention strategies: a review of the research.

The efficacy of cardiovascular risk-reduction programs has been established. However, the extent to which risk-reduction interventions are effective may depend on adherence. Non-compliance, or non-adherence, may occur with any of the recommended or prescribed regimens and may vary across the treatment course. Compliance problems, whether occurring early or late in the treatment course, are clinically significant, as adherence is one mediator of the clinical outcome. This article, which is based on a review of the empirical literature of the past 20 years, addresses compliance across four regimens of cardiovascular risk reduction: pharmacological therapy, exercise, nutrition, and smoking cessation. The criteria for inclusion of a study in this review were: (a) focus on cardiovascular disease risk reduction; (b) report of a quantitative measure of compliance behavior; and (c) use of a randomized controlled design. Forty-six studies meeting these criteria were identified. A variety of self-report, objective, and electronic measurement methods were used across these studies. The interventions employed diverse combinations of cognitive, educational, and behavioral strategies to improve compliance in an array of settings. The strategies demonstrated to be successful in improving compliance included behavioral skill training, self-monitoring, telephone/mail contact, self-efficacy enhancement, and external cognitive aids. A series of tables summarize the intervention strategies, compliance measures, and findings, as well as the interventions demonstrated to be successful. This review reflects the progress made over two decades in compliance measurement and research and, further, advances made in the application of behavioral strategies to the promotion of cardiovascular risk reduction.

Behavior Therapy↗

PubMed2006

A programme of symptom management for improving quality of life and drug adherence in AIDS/HIV patients.

AIM: This paper reports an evaluation of the effect of symptom management programmed on drug adherence, CD4 count and virus load and the quality of life of patients with HIV/AIDS. BACKGROUND: Patients with HIV/AIDS have to face the long-term side effects caused by highly active antiretroviral therapy regimens. There has been little research to evaluate the influence of drug intervention side effects on self-care. METHODS: Sixty-seven patients with HIV/AIDS were randomly assigned to one-on-one teaching, group teaching, or control groups. All those in the one-on-one and group teaching groups attended a symptom management programme once a week, followed by 3 weeks of continuity and telephone counselling. Those in the control group were offered experimental intervention at the conclusion of data collection. The Customized Adherence Self-Report Questionnaire, CD4 count and virus load, and Quality of Life Index were used to evaluate the effectiveness of the symptom management programme before and at 3 months after the intervention. RESULTS: Median differences on the Customized Adherence Self-Report Questionnaire, CD4 count and virus load, and quality of life in both experimental groups were statistically significantly better than in the control group. CONCLUSIONS: The symptom management programme can increase self-care ability in managing medication side effects in patients with HIV/AIDS.

Acquired Immunodeficiency Syndrome↗