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At least 991 records · Page 55Linked to original sources
PubMed2003

Validation of a self-reported questionnaire assessing adherence to antiretroviral medication.

The aim of this study was to verify the validity of a new self-reported questionnaire designed to assess nonadherence to antiretroviral medication among patients with HIV. Two hundred fifty-six patients from four clinics participated in a prospective longitudinal study. The questionnaire was designed to measure if patients with HIV were taking less than the total number of antiretroviral pills prescribed by their physician. Change in viral load was used as the criterion for validity analyses. Self-reported adherence, viral load and CD4 cell count were assessed at T0 (baseline), T3 (3-month), and T6 (6-month). The findings indicated that the questionnaire had adequate validity (sensitivity, 71%; specificity, 72%; correct classification, 72%; odd ratio, 6.15). These best values were obtained when the analyses excluded individuals with an unstable viral load and a CD4 cell count of less than 200 copies per milliliter over the 6-month follow-up period. This study has shown that this questionnaire has satisfactory psychometric qualities to assess nonadherence to antiretroviral medication among patients with HIV. The questionnaire is brief, simple, and can be used in both clinical or research settings regardless of the patients' antiretroviral regimens.

Adult↗
PubMed2000

Approaches to the enhancement of patient adherence to antidepressant medication treatment.

The number of safe and effective medication treatments for depression has increased significantly over the past 10 years. Relative to the older tricyclic antidepressants and monoamine oxidase inhibitors, the newer medications offer comparable efficacy with fewer side effects and a markedly reduced risk for serious adverse effects. In spite of these benefits, and in spite of the extensive and successful efforts that have been made to inform the general population about the diagnosis and treatment of depression, many patients do not comply with treatment recommendations. Although specific factors such as side effects lead to high rates of noncompliance with medication treatment, noncompliance is a multifactorial phenomenon. The reasons for noncompliance can include rational and intentional decisions based on beliefs about the illness, concerns over side effects, ineffectiveness of treatment. costs of the medication, decisions influenced by the symptoms of the disorder, and many other cultural and attitudinal factors. Some of the important concepts that should be addressed with depressed patients are reviewed. Strategies aimed at informing patients about depression and its treatment and providing a collaborative treatment environment have the potential to significantly improve treatment outcome and treatment adherence.

Antidepressive Agents↗
PubMed2004

Interventions to improve adherence to lipid lowering medication.

BACKGROUND: Lipid lowering drugs are still widely underused, despite compelling evidence about their effectiveness in the treatment and prevention of cardiovascular disease. Poor patient adherence to medication regimen is a major factor in the lack of success in treating hyperlipidaemia. In this review we focus on interventions, which encourage patients at risk of heart disease or stroke to take lipid lowering medication regularly. OBJECTIVES: To assess the effect of interventions aiming at improved adherence to lipid lowering drugs, focusing on measures of adherence and clinical outcomes. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycInfo and CINAHL. Date of most recent search was in February 2003. No language restrictions were applied. SELECTION CRITERIA: Randomised controlled trials of adherence-enhancing interventions to lipid lowering medication in adults for both primary and secondary prevention of cardiovascular disease in an ambulatory setting. DATA COLLECTION AND ANALYSIS: Two reviewers extracted data independently and assessed studies according to criteria outlined by the Cochrane Reviewers' Handbook. MAIN RESULTS: The eight studies found contained data on 5943 patients. Interventions could be stratified into four categories : 1. simplification of drug regimen, 2. patient information/education, 3. intensified patient care such as reminding and 4. complex behavioural interventions such as group sessions. Change in adherence ranged from -3% to 25% (decrease in adherence by 3% to increase in adherence by 25%). Three studies reported significantly improved adherence through simplification of drug regimen (category 1), improved patient information/education (category 2) and reminding (category 3). The fact that the successful interventions were evenly spread across the categories, does not suggest any advantage of one particular type of intervention. The methodological and analytical quality was generally low and results have to be considered with caution. Combining data was not appropriate due to the substantial heterogeneity between included randomised controlled trials (RCTs). REVIEWERS' CONCLUSIONS: At this stage, no specific intervention aimed at improving adherence to lipid lowering drugs can be recommended. The lack of a gold standard method of measuring adherence is one major barrier in adherence research. More reliable data might be achieved by newer methods of measurement, more consistency in adherence assessment and longer duration of follow-up. Increased patient-centredness with emphasis on the patient's perspective and shared-decision-making might lead to more conclusive answers when searching for tools to encourage patients to take lipid lowering medication.

Cardiovascular Diseases↗
PubMed1993

Measuring adherence with therapy for chronic diseases: implications for the treatment of heterozygous familial hypercholesterolemia.

The failure of patients to adhere adequately to prescribed medication and behavioral regimens is an important medical problem. Poor adherence is most common when the treatment regimen is preventive rather than curative, when patients are asymptomatic, and when the duration of treatment is long. For these reasons, adherence with dietary therapy for hypercholesterolemia is well recognized to be a significant clinical and research challenge. Medication adherence has been acknowledged to be a problem for those treatments with significant side effects, such as flushing and pruritus or the low palatability of bile acid sequestering agents. The availability of drugs that lack these effects has long been viewed as an important contribution to improving overall patient compliance. However, the literature on patient adherence with life-long treatment regimens that are simple and palatable (e.g., antihypertensives) suggests that while these improved treatments can enhance adherence, the overall rates of patient compliance still average only 50%. The fact that patients with heterozygous familial hypercholesterolemia are at high risk for early coronary artery disease and death if they fail to adhere to therapy is not sufficient to assure high rates of appropriate therapy over long periods of time, as demonstrated by the poor or erratic adherence commonly reported to treatments for other life-threatening diseases, such as advanced renal disease, hemophilia, and type I diabetes. The measurement of patient adherence to hypercholesterolemia therapy is often neglected in clinical practice and inadequate in hypercholesterolemia research.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic Disease↗
PubMed1997

Health beliefs, personality, and adherence in hemodialysis patients: an interactional perspective.

Research examining the main effects of health beliefs and personality on medical regimen adherence has yielded inconsistent results. This study tested the hypothesis that health beliefs and personality predict adherence in an interactive manner. Components of the Health Beliefs Model, Conscientiousness (C) from the NEO-Five Factor Inventory, and regimen adherence were assessed in a sample of 70 in-center hemodialysis patients. In a hierarchical regression analysis, the interaction of health beliefs and C failed to explain a significant portion of the variance in interdialysis weight gain, a measure of adherence to fluid restrictions, after controlling for demographic characteristics. The interaction did significantly predict individual differences in serum phosphorus levels, a measure of diet and medication adherence. The effect was primarily attributable to the interaction of C and perceived severity. However, the combination of high C and high perceived severity was associated with poorer patient adherence. Such a pattern may be the result of defective coping patterns associated with high levels of anxious arousal and has implications for therapeutic interventions targeted at modifying health beliefs among chronically ill patients following prescribed medical regimens.

Adult↗
PubMed2006

Patient self-medication--a change in hospital practice.

AIMS AND OBJECTIVES: The purpose of this study was to evaluate the effectiveness of a self-medication programme (SMP) for inpatients of the Nursing Convalescent Unit, a 26-bed unit with medical and surgical patients. BACKGROUND: Self-medication is an important part of self-management of chronic illness. Self-medication is a way of allowing patients to give themselves their medications in hospital after receiving education instead of the usual practice of medications administered by a Registered Nurse (RN). DESIGN: The pilot study was undertaken over a six-month period to examine the relationship between a programme of self-medication and patient knowledge and adherence to medication regimens, number of medication errors, efficiency in relation to the number of nursing hours associated with the SMP, patient and nursing satisfaction. METHODS: A total of 220 patients participated in the study. The SMP included three levels of patient self-administration of medications: level one, medications administered by a RN; level two, self-medication directly supervised by a RN and level three, self-medication indirectly supervised by a RN. Outcome measures included staff and patient satisfaction, number of medication errors, time taken by nurses to undertake activities related to the SMP and the number of patients who achieved levels two and three. RESULTS: Study findings showed that 45% of patients remained on level one, 26% achieved level two and 29% achieved level three. There were no patient initiated medication errors during the study period. Efficiencies were identified in staff workload associated with patient discharge procedures. Overall, nurses perceived that the SMP increased their knowledge of medications and contributed to effective patient education. CONCLUSIONS: In selected patients, the SMP was an effective aid for improving adherence to medication regimens. Collaboration between nurses, medical staff, pharmacists, patients and carers is integral to the success of in hospital SMP.

Aged↗
PubMed2006

Sustained benefit from a long-term antiretroviral adherence intervention. Results of a large randomized clinical trial.

OBJECTIVE: To assess the efficacy of 2 adherence interventions, medication managers (MM) and medication alarms (ALR), among antiretroviral (ARV)-naive persons with HIV initiating ARV therapy. METHODS: A multicenter, randomized, adherence intervention clinical trial was conducted among participants coenrolled in an HIV ARV strategy study for ARV-naive individuals. Sites were assigned by cluster randomization using a 2 x 2 factorial design to administer MM, ALR, MM + ALR, or neither (control). MM participants received individualized, structured, long-term adherence support from trained MMs. ALR participants received individually programmed ALR alarms for use throughout the study. RESULTS: The 928 participants, followed a median of 30 months, included 22% women and 75% nonwhites; the median baseline CD4 count was 155 cells/mm. First virologic failure was 13% lower in all MM versus no-MM groups (P = 0.13) and 28% lower in MM versus no-MM subgroups randomized to 2-class ARV arms in the parent ARV study (P = 0.01). MM (vs. no-MM) participants had significantly better CD4 cells count (P = 0.01) and adherence (P < 0.001) outcomes. ALR (vs. no-ALR) participants had worse virologic outcomes. CONCLUSION: This large randomized clinical trial demonstrated that interpersonal structured adherence support was associated with improved long-term medication adherence and virologic and immunologic HIV outcomes.

Adult↗
PubMedDate not supplied

Impaired awareness of deficits and treatment adherence among people with traumatic brain injury or spinal cord injury.

OBJECTIVE: To examine the relation between impaired awareness of deficits (IAD) and treatment adherence and to verify previous findings regarding the types of disabilities that people with traumatic brain injury (TBI) tend to underestimate. DESIGN: Cross-sectional study. PARTICIPANTS: Twenty-four persons with moderate to severe TBI and 16 persons with traumatic spinal cord injury (SCI) admitted to an inpatient neurorehabilitation program. MAIN OUTCOME MEASURES: IAD assessed using the short version of the Problem Checklist of the Head Injury Family Interview and treatment adherence using the Medical Regimen Adherence Scale. RESULTS: Presence of IAD is linked with poor adherence. Patients with TBI significantly underestimate their emotional/behavioural and cognitive disabilities, but accurately assess their physical disabilities, whereas patients with SCI accurately assess all spheres. Patients with TBI are significantly less aware of their disabilities compared with the patients with SCI as expected. CONCLUSIONS: These results confirm IAD's link to treatment adherence, and support the observation that IAD is a common clinical feature of brain injury that should be carefully considered when making prognoses and developing and applying interventions with this population.

Adult↗
PubMed2002

Chronic disease self-management and adherence to HIV medications.

Although it is widely recognized that potent antiretroviral therapies have transformed HIV from an acute to a chronic illness, it is less often recognized that with this change, a different model of care is appropriate. People living with chronic HIV must function independently, taking personal long-term, day-to-day responsibility for care. The role of doctors and the healthcare system is to help them do this. The authors present a conceptual framework for the self-management of chronic HIV disease and discuss the components of an HIV self-management program. The ability to take antiretroviral medications well and consistently is a key part of self-management but should be nested within an array of important skills, including symptom-management skills, goal setting and planning, communication, and accessing information and resources.

Chronic Disease↗
PubMed2004

Non-compliance in children post-liver transplant. Who are the culprits?

Although non-compliance in pediatric liver transplants is known to be a major cause of late graft loss and patient mortality, follow-up seems inconsistent. As liver transplant becomes a luxury because of the shortage of organs, the need to maximize graft and patient survival by intense monitoring becomes a necessity. When evaluating children with elevated liver enzymes post-transplant, early or late non-compliance should always be suspected. The risk of non-compliance in children with chronic illness varies from 10 to 89%. In a study by Sudan et al. non-compliance was one of the leading causes of late mortality in children age 10-17 yr. Although it is well documented that teenagers have a high rate of non-compliance, the rate in the younger children has not been documented. In our series, we found that parental non-compliance comprises the majority of our problems with liver dysfunction, hospitalization, and graft loss. The purpose of this study was to evaluate the incidence of non-compliance in children post-liver transplant. A retrospective chart review of patient records from admissions and outpatient records was performed for documentation of elevated enzymes and low immunosuppressive levels. From July 1987 to December 2002, our program performed 266 liver transplants in 234 children, with 1-yr graft survival of 84% and 1-yr patient survival of 90%. Our overall patient survival was 85% with 77% graft survival. There were 40 children with documented non-compliance with mild to severe liver dysfunction in this study. Twenty-eight of these children were younger than 10 yr [28 of 40 (46%) <5 yr], and 12 (30%) were older than 10 yr at the time of rejection. In 10 of 40 children, there was one documented incident of non-compliance, while 26 of 40 had two to four incidents, and four had five or more documented events. Our children (50%) came from two-parent households. The remaining 50% were from single households. In 27 of 40 (68%) children, rejection was confirmed by liver biopsy. In children on cyclosporine (Neoral; Novartis, East Hanover, NJ, USA) with a known history of non-compliance and low immunosuppressive levels, C2 monitoring was performed to verify absorption. Admission for drug monitoring and verification of non-compliance was accomplished in 32 of 40 (80%). Four of the 40 children (10%) were retransplanted, and one child had died. In conclusion, non-adherence to medications remains a major source of graft loss and morbidity post-transplant. We found that non-compliance crosses all socio-economic and cultural groups and that flexibility of clinic hours, shortened time between visits, and decreased numbers and times of medication will increase adherence.

Adolescent↗
PubMed1983

Adherence by medical-surgical inpatients to recommendations for outpatient psychiatric treatment.

A records review of medical-surgical inpatients at a university hospital reveals that only 20% of patients seen in psychiatric consultation followed recommendations to seek psychiatric outpatient treatment. The study is unique in that immediate appointments with the consulting psychiatrists were offered prior to patients' discharge. The low rate is similar to the findings by others. Diagnosis of depression was associated with patients' keeping appointments, although social class may have been an indirect factor. Transformation of the medical-surgical inpatient to psychiatric outpatient remains a poorly understood process.

Adolescent↗