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Results for “Adherence Interventions”

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At least 973 records · Page 54Linked to original sources

PubMed2001

Fat adherence syndrome after retinal surgery treated with amniotic membrane transplantation.

PURPOSE: We present favorable results with amniotic membrane transplantation in a patient who developed fat adherence syndrome after retinal surgery. DESIGN: Interventional case report. METHODS: A 37-year-old man had diplopia resulting from hypotropia of the left eye after retinal detachment surgery. Removal of a previously implanted silicon sponge had little effect because of fibrous adhesion between the inferior rectus muscle and adjacent periorbital fat. We performed amniotic membrane transplantation combined with conventional extraocular muscle surgery. RESULTS: Postoperatively, supraduction of the left eye became almost full. The field of binocular vision was extended markedly by treatment, both in the primary position and with downward gaze. These improvements remained stable over 1 year of follow-up. CONCLUSION: Amniotic membrane transplantation appears to be effective for preventing regrowth of restrictive scar tissue in the fat adherence syndrome.

Adipose Tissue↗

PubMedDate not supplied

Pain assessment in patients with fibromyalgia syndrome: a consideration of methods for clinical trials.

OBJECTIVE: This study was designed to compare 3 commonly used methodologies for assessing clinical pain during trials involving patients diagnosed with fibromyalgia syndrome. Baseline characteristics, characteristics over time, and compliance were evaluated for each of the methods. METHODS: Fourteen patients diagnosed with fibromyalgia syndrome were asked to monitor their symptoms of pain using 3 different strategies over a 12-week period: 1) real-time pain reports were collected on an electronic diary using randomly-scheduled audible prompts; 2) end-of-week reports asked patients to rate their mean pain over the past week on the electronic diary; and 3) monthly in-clinic reports asked patients to rate their mean pain for the week using a traditional paper and pencil diary. RESULTS: Significantly different baseline values were obtained for the 3 methods. Paper and pencil produced the highest values, and real-time pain reports produced the lowest baseline values. Pain ratings were more likely to reflect decreases in the 2 methods relying on recall than the real-time strategy. The average adherence with pain monitoring using the electronic diary was 85%, which was superior to the adherence for the recall measures completed during the clinic visits. CONCLUSION: Pain assessment methods relying on recall might contribute to an apparent improvement in clinical trials in the absence of an intervention; such an effect has been considered a "placebo response." Future clinical trials might consider using a real-time approach to pain assessment, which in this study appeared to mitigate against seeing improvement in the absence of an intervention and demonstrated higher levels of patient adherence.

Adult↗

PubMed2006

Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus.

BACKGROUND: Medication nonadherence may reduce the effectiveness of therapies. To our knowledge, the association between medication nonadherence and mortality remains unexplored outside the context of clinical trials. METHODS: A retrospective cohort study of 11 532 patients with diabetes mellitus in a managed care organization. Medication adherence was calculated as the proportion of days covered for filled prescriptions of oral hypoglycemics, antihypertensives, and statin medications. The primary outcomes of interest were all-cause hospitalization and all-cause mortality. Multivariable regression analyses were performed to assess the independent association between medication adherence and outcomes. RESULTS: Nonadherent patients (proportion of days covered, <80%; prevalence, 21.3%) were younger and had fewer comorbidities compared with adherent patients. During follow-up, nonadherent patients had higher glycosylated hemoglobin, systolic and diastolic blood pressure, and low-density lipoprotein cholesterol levels. In unadjusted analyses, nonadherent patients had higher all-cause hospitalization (23.2% vs 19.2%, P<.001) and higher all-cause mortality (5.9% vs 4.0%, P<.001). In multivariable analyses, medication nonadherence remained significantly associated with increased risks for all-cause hospitalization (odds ratio, 1.58; 95% confidence interval, 1.38-1.81; P<.001) and for all-cause mortality (odds ratio, 1.81; 95% confidence interval, 1.46-2.23; P<.001). The findings were consistent across patient subgroups and using different cutoffs for the proportion of days covered. CONCLUSIONS: Medication nonadherence is prevalent among patients with diabetes mellitus and is associated with adverse outcomes. Interventions are needed to increase medication adherence so that patients can realize the full benefit of prescribed therapies.

Administration, Oral↗

PubMed2003

HIV-related knowledge and adherence to HAART.

Near perfect adherence is considered essential for patients on HAART, yet adherence to medical recommendations is rarely so high. Supportive services and reminder tools may help individuals to become adherent, yet it is difficult to determine who may need such interventions. In this study, based on data from the NYSDOH/AIDS Institute Treatment Adherence Demonstration Program, we look at the association between HIV-related knowledge and adherence, hypothesizing that a better understanding of HIV and its treatment is associated with better adherence. In analyses based on 997 participants, knowledge, as measured by five true/false questions, was significantly associated with self-reported adherence. In multivariate analysis, compared to persons with four or five items answered correctly, persons with fewer correct answers were more likely to report missed doses (OR = 1.72 for 2-3 correct, p < 0.01; OR = 2.92 for 0-1 correct, p < 0.05). Our data suggest that providers should include questions focused on knowledge of HIV in their assessments of medication readiness and need for adherence support. Similarly, providers should be diligent with respect to patient education, ensuring that each patient has the information needed to support reasoned decision making and adequate adherence.

Adolescent↗

PubMed2004

Non-adherence to medications following pediatric liver transplantation.

Non-adherence to medications is a leading cause of organ loss and morbidity in children and adolescents who had a liver transplant. Yet there are very few published studies about ways to detect whether patients are taking their medications or not, and about treatment options to improve adherence. The Pediatric Liver/Liver Transplant Program at Mount Sinai developed clinical and research programs that evaluate adherence. We review initial results from these programs. Clinic patients participate in an adherence-monitoring program that involves standardized assessments by patients, parents, clinicians, and routine examinations of medication blood levels. A research program adds an electronic monitoring device (MEMS-caps, AARDEX/APREX, Switzerland) and examines the use of azathioprine metabolites as predictors for non-adherence. Patients receive a thorough psychosocial evaluation to identify potential risk factors for non-adherence. Preliminary results indicate that an objective adherence detection method has to be incorporated into practice if non-adherence is to be reliably detected (clinicians' impressions and patients' reports are not sufficient). A risk factor for non-adherence, post-traumatic stress disorder, emerges as a potential target for intervention. It is possible to integrate a formal mechanism to assess adherence into the work of a liver/liver transplant clinic. We hope that the presented program will inspire clinicians in the community and other programs to regard the assessment and improvement of adherence to medications as an important goal in the management of children who had a transplant.

Azathioprine↗

PubMed2006

Knowing how to help tobacco users. Dentists' familiarity and compliance with the clinical practice guideline.

BACKGROUND: A U.S. Public Health Service-sponsored clinical practice guideline urges all health care providers to make tobacco-use cessation counseling a routine part of clinical practice. This study assessed practices of dentists in east Texas, their adherence to the guideline and barriers to adherence. METHODS: A cross-sectional survey mailed September 2003 through January 2004 assessed demographic characteristics and knowledge, attitudes and activities of 783 dentists. The survey focused on familiarity with the guideline, adherence to the recommended steps (including the "5 A's" for tobacco users willing to quit and the "5 R's" for tobacco users unwilling to quit), perceived barriers and time spent counseling. RESULTS: Most dentists were unfamiliar with the guideline and usually did not follow its recommended steps. Less than 20 percent of dentists spent three or more minutes per patient on counseling. Knowledge of and training in using the guideline were significantly associated with adherence and time spent counseling. Lack of training was cited as the greatest barrier. CONCLUSIONS: Most dentists in east Texas are unaware of the clinical practice guideline. Lack of training is a major barrier to adherence. Practice Implications. Opportunities for improving patients' health through brief counseling interventions are missed. Measures are needed to increase dentists' familiarity with and adherence to the guideline.

Adult↗

PubMed1998

Adherence-related behavior in adolescents with asthma: results from focus group interviews.

Focus group interviews were conducted with 14 adolescents with asthma to explore self-management behavior, in particular with regard to adherence behavior. In addition, the adolescents discussed their feelings about having asthma, gave insight into how they evaluate the provided health care, and made recommendations for healthcare providers and for the development of patient education materials. The majority of participants did not take their prophylactic asthma medication regularly, and were rather late in starting to use their bronchodilator. They were sometimes fed up with having asthma. Moreover, the majority of participants were not always frank in telling their pediatrician how they managed their asthma. Finally, they found it essential that information about asthma should be given personally and not by means of leaflets, and recommended that healthcare providers should use audio-visual aids to illustrate what they are explaining. The results of the focus group interviews have been used for the development of an intervention program which aims at enhancing adherence in adolescents with asthma.

Adolescent↗

PubMed2000

A clinic and community-based approach to hypertension control for an underserved minority population: design and methods.

This paper describes the design and methodology of the Community Hypertension Intervention Project (CHIP). CHIP is investigating the environmental and psychosocial factors related to treatment adherence and examining the effects of combining usual hypertension care with the effects of three interventions designed to improve patient compliance with treatment for high blood pressure in a high-risk, underserved minority population. Thirteen hundred and sixty-seven inner-city hypertension patients (75% black and 25% Hispanic) have agreed to participate in the 4-year longitudinal study. These participants were randomized to usual care or one of three intervention groups: individualized counseling sessions; home visits/discussion groups; or computerized appointment-tracking system. Participants are representative of the surrounding, predominantly low-income minority community and are treated in a hospital-based clinic and in a private clinic in the community. About 65% have blood pressure levels considered to be out of control. It was concluded that structural changes at the clinic site, along with the targeted interventions, would improve patient satisfaction, increase treatment adherence, and improve blood pressure control.

Adolescent↗

PubMed2004

Resource utilisation for neuropsychiatric disorders in developing countries: a multinational Delphi consensus study.

BACKGROUND: Substantial information is now available at a global and regional level relating to the burden of mental disorders, yet hardly any international data are available on the resources that are needed to respond to this global burden. AIMS: The aim of this study was to develop consensus-driven estimates of resource utilisation, coverage and adherence for key mental health care interventions capable of reducing leading neuropsychiatric causes of disease burden. METHODS: A resource utilisation questionnaire was developed for a series of mental health care interventions for schizophrenia, affective and anxiety disorders, alcohol misuse, epilepsy and Alzheimer's disease. Expert opinion surveys using a Delphi approach were conducted in seven countries (Brazil, China, Egypt, Ghana, India, Mexico and Thailand). Initial results were fed back to participants in order to elicit a second, final set of consensus estimates. Mean and median values were calculated, together with measures of dispersion and agreement. RESULTS: Sixty-seven psychiatrists took part in the first Delphi round and 60 completed the seven consensus panels in the second Delphi round. Expected resource use was highest for acute psychosis, mania, severe depression and severe dementia (at least monthly outpatient visits, and over 25% of cases admitted to hospital with an average length of stay one month). Aggregated estimates for current treatment coverage ranged from below 20% for Alzheimer's disease to 60% for epilepsy. Coverage and adherence levels for affective disorders were both below 50%. CONCLUSION: The Delphi technique proved to be a feasible and efficient method for data collection and consensus generation concerning mental health care resource utilisation. Results provide a set of range estimates for mental health resource planning and evaluation in a variety of developing regions.

Delphi Technique↗

PubMed2003

Acceptability of a urinary continence promotion programme to women in postpartum.

OBJECTIVE: To assess the acceptability to postpartum women of a physiotherapist-delivered urinary continence promotion programme. DESIGN: A survey of women participating in a randomised controlled trial where women received the intervention (which involved training in pelvic floor exercises and incorporated adherence-enhancing strategies) or usual postpartum care. SETTING: Postpartum wards of three tertiary teaching hospitals in the Hunter Region, NSW, Australia. SAMPLE: Women were eligible to participate in the trial if they had a forceps/ventouse assisted delivery and/or delivered a higher birthweight baby (> or =4000 g). This study is based primarily on data obtained for 348 women in the intervention group. METHODS: Baseline hospital-based interview; eight-week follow up appointment with physiotherapist; three-month follow up telephone interview. MAIN OUTCOME MEASURES: Comparative dropout rates for intervention and control groups; reasons for non-participation; attendance at hospital follow up; self-reported acceptability of and embarrassment about per vaginum examination; utilisation and perceived usefulness of intervention components; self-reported adherence with recommended pelvic floor exercise regime. RESULTS: There was no significant difference in dropouts between intervention (5.9%) and control groups (6.3%). Only 14% of women gave not wanting the per vaginum assessments as their main reason for not participating in the study. Eighty-eight percent of women participated in the eight-week postpartum follow up visit with the physiotherapist, with two-thirds of these women attending the hospital for this; 72.2% of women reported no embarrassment, and 22.5% just a little embarrassment about per vaginum assessment. The information components of the intervention were well received. At the eight-week follow up visit, 83.9% reported performing pelvic floor exercises at adequate frequency. CONCLUSIONS: The postpartum period provides an ideal opportunity for pelvic floor muscle testing and the delivery of continence promotion advice.

Adolescent↗

PubMed2006

Effectiveness of Centers for Disease Control and Prevention recommendations for outcomes of acute otitis media.

OBJECTIVES: To determine whether we could increase adherence to the Centers for Disease Control and Prevention (CDC) recommendations with well-accepted approaches to improving quality of care and adherence to the CDC recommendations resulted in improved outcomes for acute otitis media (AOM). METHODS: A cluster randomization study was conducted in 12 pediatric practices (6 intervention and 6 control sites). The main outcome measures were adherence to the CDC recommendations (modified to include 2 additional antimicrobial agents) and a subsequent antibiotic prescription for AOM within 30 days after diagnosis. RESULTS: Of 3152 patients referred to research assistants, 2584 (82%) were eligible. Of those eligible, 1368 (99%) of 1382 at the intervention sites and 1138 (99%) of 1146 at the control sites consented to participate. Rates of adherence to the CDC recommendations were not significantly higher at the intervention sites than at the control sites, for initial enrollment episodes (78.2% vs 70.6%) or second episodes (62.6% vs 59.9%). After controlling for clustering according to site and covariates, children who were not treated in adherence to the CDC recommendations for both episodes had 1.60 times the odds of a subsequent prescription within 12 days, compared with those treated in adherence at both episodes. CONCLUSIONS: Despite using evidence-based approaches that are known to influence physician behavior, we were unable to increase adherence to the CDC recommendations for treatment of AOM. However, we did establish that prescription of antimicrobial therapy consistent with the CDC recommendations for a second episode of AOM was associated with improved outcomes, measured as the need for subsequent antibiotic prescription. Because of the selection of resistant otopathogens, adherence to the CDC recommendations is likely more important in subsequent episodes of AOM than in the initial episode.

Acute Disease↗

PubMed2002

[Effects of a regional intervention to promote asthma guidelines implementation].

AIM: Despite of asthma guidelines existing for years, secondary data analysis shows insufficient medical care of asthmatics in Germany. The aim of the present study was to improve asthma guideline adherence by promoting guidelines implementation. METHOD: We analyzed prospectively pre- and post-interventional medical care of a sample of 127 asthmatics who were recruited by physicians working in ambulatory care and in hospitals of the Region Neckar-Alb, Germany. Data came primarily from patient interviews by phone. Our intervention to promote guidelines implementation consisted of following methods: 1. analyzing regional asthma care followed by a feedback performance report to physicians; 2. delivering asthma patient diaries and peak flow meters to study patients; 3. developing and adapting regionally asthma guidelines for adult asthmatics in the Region of Neckar-Alb; 4. promoting guidelines utilization by publishing the adapted guidelines in a scientific journal, direct mailing of a short version to the practitioners, and boosting the guidelines at regional CE meetings; 5. reanalyzing asthma care of the study cohort and the implementation of the guidelines 13 months after the beginning of the intervention. We studied the effect of the intervention using a qualitative model comprising 18 quality indicators measuring the proportion of patients who were treated in accordance to the guidelines. To compare pre- and post-interventional proportions we used the McNemar test for statistical analysis. RESULTS: The proportion of asthmatics treated in accordance to the guidelines improved significantly from 48 % to 57 %. The increase was mainly due to an improvement of guidelines adherence within the field of promoting asthma self-management and continuous monitoring of patients (42 % pre- and 57 % post-intervention), whereas guidelines adherence in pharmacotherapy improved only from 53 % to 56 %. CONCLUSION: The proportion of asthmatics treated in accordance to guidelines can be improved by using a multifaceted regional approach to promote guidelines implementation.

Adult↗

PubMed2000

[The recommendations of GESIDA/SEFH/PNS for improving adherence to antiretroviral treatment. AIDS Study Group of the Spanish Society of Hospital Pharmacy and the National Plan on AIDS of the Minister of Health and Consumers].

The main objective of HAART is to achieve a complete suppression of the viral replication for long time. However, when the therapeutic drug levels are low, HIV can replicate and it can develop resistances. This fact can be the reason of treatment failure, HIV transmission of resistant strains and therefore an inappropriate use of the economical resources. In order to get the adequate therapeutic drug levels it is necessary to have a good adherence to the treatment. We review the factors that influence the adherence, the evaluation methods and we recommend the possible intervention strategies which should be given by a multidisciplinary team, integrated by physicians, pharmacists, nurses, psychologists and other personal support. To start HAART is not an emergency. For this reason is very important to prepare to the patient and to identify the non-adherence factors in order to correct it. Once the HAART is indicated it is very important to offer information during the medical prescription and when the drugs are dispensed. During the therapy is necessary to follow actively all patients on HAART. In order to make therapeutical decisions we need to know the patient drug adherence rate. We recommend to use several methods to calculate the drug adherence rate, being the most commonly used the patient interview, the patient questionnaire, the refill count, the pharmacy visits rate together with the viral load evolution of the patient. In order to get all this information it is necessary to have a very good communication between all the people involved in HIV infected patients care. If non-adherence is detected it is necessary to start the intervention strategies to correct it and if they fail it might be necessary in some cases to stop HAART. The potential benefits of the adherence programs can justify the economical spend in human and hospital facilities resources.

Anti-HIV Agents↗

PubMed1990

Issues in adherence with pediatric regimens.

Adherence to recommendations for health care is an area of serious concern for pediatric psychologists. The present article highlights several key issues affecting research and clinical work in this area. They include: difficulties defining and measuring adherence; developmental aspects of adherence; special concerns with low income populations; and limitations of intervention research. In addition, several directions for future investigation in the area of pediatric adherence are addressed.

Child↗

PubMed2006

Attenuation of antipsychotic-induced weight gain with early behavioral intervention in drug-naive first-episode psychosis patients: A randomized controlled trial.

BACKGROUND: The purpose of this study was to compare an early behavioral intervention (EBI) with nonstructured standard physical care (routine care intervention [RCI]) in preventing antipsychotic-induced weight gain in drug-naive first-episode psychosis patients. METHOD: Sixty-one patients with a DSM-IV-diagnosed psychotic disorder were first randomly assigned to 3 different antipsychotic treatments (risperidone [N = 23], olanzapine [N = 18], and haloperidol [N = 21]) and subsequently randomly assigned to the intervention condition (EBI, N = 35) or RCI (N = 27). EBI was specifically designed to teach strategies to enhance control over factors associated with antipsychotic-induced weight gain and consisted of 8 flexible intervention modules that incorporated behavioral interventions, nutrition, and exercise. In the RCI group, patients were informed about potential weight gain and advised to increase their exercise and limit food intake. Body weight and body mass index were measured at baseline and then weekly for 3 months. In addition to change in weight and body mass index, a third outcome measure was the proportion of patients who had gained more than 7% of their body weight at 3 months. Participating patients were referred between August 2002 and September 2004. RESULTS: All 61 participants completed the study. Patients in the EBI group gained significantly less weight (mean = 4.1 kg, SD = 4.0) than those allocated to the RCI group (mean = 6.9 kg, SD = 4.5) (p < .01) during the 3-month follow-up period. Similar findings were obtained when both groups were compared on treatment-induced change in body mass index, which was significantly less in the EBI group than in the RCI group (1.40 vs. 2.39 kg/m2) (p < .01). Accordingly, significantly fewer patients in the EBI group (N = 11; 39.3%) than in the RCI group (N = 26; 78.8%) (p < .002) increased their baseline weight by more than 7%, the cutoff for clinically meaningful weight gain. CONCLUSIONS: EBI was effective in attenuating antipsychotic-induced weight gain in a drug-naive first-episode psychosis cohort. Patients displayed good adherence to this type of preventive intervention.

Adolescent↗

PubMed1989

The effects of self-monitoring and reinforcement on exercise adherence.

Two behavioral techniques were assessed to determine their effects on subjects' adherence to unsupervised exercise. The subjects were 35 moderately fit persons who had just completed an adult fitness program (AF group) and 42 sedentary individuals who were recruited through the campus newspaper (NEWS group). Participants were randomly assigned to one of three conditions: (a) self-monitoring, (b) reinforcement supplied by another person, or (c) control. All subjects were given instructions on how to exercise and asked to exercise on their own for 18 weeks. Self-monitoring subjects kept written records of their exercise behavior, while reinforcement subjects verbally reported their exercise behavior to another person who periodically administered rewards. Pre- and posttreatment tests on the NEWS group revealed no significant treatment or interaction effects. However, the reinforcement group had an 11% improvement in predicted max VO2 and a 9 bpm improvement in exercise heart rate compared to 7.8%, 5 bpm for the self-monitoring (SM) group and 5.3%, 6 bpm for the control group. T-tests indicated that reward and SM groups improved significantly on these variables, whereas the control group did not. SM (M = 2.07) and reinforcement (M = 2.29) groups reported a significantly higher frequency of exercise per week than the control (M = 1.36) group. The AF subjects were able to maintain their fitness level (with the exception of a small increase in body fat) over the 18-week period. The behavioral interventions had little differential effect on adherence by AF subjects who were already regular exercisers.

Adult↗

PubMed1998

[Therapeutic strategies for patients with tuberculosis].

OBJECTIVES: To determine the effectiveness of strategies used to promote adherence to anti-tuberculosis treatment. SEARCH STRATEGY: MEDLINE 1966-1996 (August), Cochrane Collaboration Trials Registers (October 1996), LILACS 1982-1996 (September); reference lists in articles on adherence, contact with experts in the fields of TB and adherence research. SELECTION CRITERIA: Randomised or pseudo-randomised controlled trials of interventions to promote compliance with curative or preventive chemotherapy for TB, with at least one measure of adherence. DATA COLLECTION AND ANALYSIS: Data on study methods, participants, interventions and outcomes were collected for each study and methodological quality was assessed. Estimates of effect were assessed for categorical outcomes using the Peto odds ratio, with 95% confidence intervals. MAIN RESULTS: Strategies found to be of benefit were reminder cards sent to defaulters, assistance of patients by lay health workers, monetary incentives offered to patients, and increased supervision of TB clinic staff. It is not possible to determine from current trials whether health education by itself leads to better adherence to treatment. Even though directly-observed therapy (DOT) is widely advocated as the most cost-effective means of ensuring completion of TB treatment, no completed trials could be found which confirm or refute this view. CONCLUSIONS: RCT evidence exists that certain strategies improve adherence to anti-tuberculous therapy, and these should be adopted into clinical practice depending on their appropriateness to practice circumstances. Further innovations should be tested to find solutions that will be useful in low income countries. Randomised trials evaluating the independent effects of directly-observed therapy (DOT) are awaited.

Antitubercular Agents↗

PubMed2003

A randomised trial of hip protector use by frail older women living in their own homes.

OBJECTIVES: To investigate the efficacy and effectiveness of hip protectors in frail community living older women. DESIGN: Randomised controlled trial. SETTING: Aged care health services in New South Wales, Australia. PATIENTS: 600 women 74 years of age or more (mean age 83 years), who had two or more falls or one fall requiring hospital admission in the previous year, and who lived in their own homes. INTERVENTION: Use of hip protectors. MAIN OUTCOME MEASURES: Adherence with use of hip protectors, falls, incidence of hip fracture, and adverse effects of use of hip protectors. RESULTS: Adherence was approximately 53% over the duration of the study and hip protectors were worn at the time of 51% of falls in the intervention group. The risk of hip fracture when falling while wearing hip protectors, compared with a fall with no hip protectors in place, was significantly reduced (relative risk (RR) 0.23, 95% confidence interval (CI) 0.08 to 0.67). On an intention to treat analysis, 21 and 22 hip fractures occurred in the intervention and control groups respectively (adjusted RR 0.92, 95% CI 0.51 to 1.68). Three users of hip protectors sustained a hip fracture while wearing properly applied protectors, while 16 hip protector users (5%) developed minor local complications. CONCLUSIONS: Hip protectors prevent hip fractures in community dwelling older women if worn at the time of a fall. The overall effectiveness of hip protectors was not established in this study, because of incomplete adherence with use of the protectors, and limited statistical power.

Accidental Falls↗