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Results for “Adherence Interventions”

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PubMed1997

Determinants of medication compliance in schizophrenia: empirical and clinical findings.

Advances in psychopharmacology have produced medications with substantial efficacy in the treatment of positive and negative symptoms of schizophrenia and the prevention of relapse or symptom exacerbation after an acute episode. In the clinical setting, the individual patient's acceptance or rejection of prescribed pharmacological regimens is often the single greatest determinant of these treatments' effectiveness. For this reason, an understanding of factors that impede and promote patient collaboration with prescribed acute and maintenance treatment should inform both pharmacological and psychosocial treatment planning. We review the substantive literature on medication adherence in schizophrenia and describe a modified health belief model within which empirical findings can be understood. In addition to factors intrinsic to schizophrenia psychopathology, medication-related factors, available social support, substance abuse comorbidity, and the quality of the therapeutic alliance each affect adherence and offer potential points of intervention to improve the likelihood of collaboration. Because noncompliance as a clinical problem is multidetermined, an individualized approach to assessment and treatment, which is often best developed in the context of an ongoing physician-patient relationship, is optimal. The differential diagnosis of noncompliance should lead to interventions that target specific causal factors thought to be operative in the individual patient.

Antipsychotic Agents↗

PubMed2004

Family functioning in young children with cystic fibrosis: observations of interactions at mealtime.

This study examined family functioning at mealtime, a context relevant to the management of cystic fibrosis (CF). Thirty-three families of children with CF and a control sample of 33 families of children without a chronic illness were assessed. Family functioning was rated during a videotaped dinner using the McMaster Mealtime Interaction Coding System (MICS), and mealtime behavioral problems were assessed using the Behavioral Pediatrics Feeding Assessment Scale (BPFAS). Ratings for families of children with CF were lower than for control families on overall functioning and five of six MICS dimensions (Communication, Interpersonal Involvement, Behavior Control, Affect Management, Roles). In families of children with CF, better family functioning was related to less frequently occurring mealtime behavioral problems (BPFAS); however, family functioning was not related to the child's weight status or the child's caloric intake. Data support that nutritional intervention may be maximized if dietary adherence is promoted in the context of positive parent-child and family interactions.

Body Weight↗

PubMed1992

Seatbelt injuries in children.

Twelve cases of Chance-type flexion-distraction injuries in children less than 16 years old were reviewed. Patients were evaluated in terms of initial treatment regimen, subsequent modifications, and ultimate outcome. Follow-up ranged from 6 months to 9 years. Seven patients with a significant ligamentous component to their injury were initially treated, for various reasons, in a brace. All patients responding to brace treatment had an initial kyphotic deformity of less than 20 degrees and a maximum measured deformity of less than 25 degrees. In patients in whom brace treatment failed, initial deformity was greater than 20 degrees in all cases. Kyphotic deformity progressed to greater than 30 degrees before surgical intervention in these four cases. Improved adherence to lap seatbelt precautions, while of great benefit in reducing motor vehicle-related morbidity and mortality, has simultaneously increased the likelihood of flexion-distraction lumbar spine injuries. Our results suggest that an approach to treatment designed specifically for children is appropriate.

Adolescent↗

PubMed1985

Health beliefs, compliance, and control of diabetes mellitus.

The problem of compliance and control in the treatment of diabetic patients is widely recognized. However, compliance research is contradictory and impractical as a basis for intervention to improve the patient's adherence to his medical regimen. Health beliefs may provide an opportunity to intervene to improve compliance and control of the disease. In this study we examined the health beliefs of 93 male diabetic patients and correlated their beliefs with behavioral and physiologic measures of compliance gathered at a follow-up interview. The belief in severity of illness related to compliance. Health beliefs were better predictors of metabolic control than compliance itself. The study suggests that improving attitudes about care may be a means of directly influencing control of the disease.

Attitude to Health↗

PubMed2005

Hepatitis C virus treatment decision-making in the context of HIV co-infection: the role of medical, behavioral and mental health factors in assessing treatment readiness.

Hepatitis C virus (HCV)-related liver disease is among the leading causes of mortality among HIV patients, yet very few co-infected patients receive pegylated-interferon and ribavirin combination therapy, the standard of care for chronic HCV. Whereas factors related to the provider, patient and clinic setting all contribute to HCV treatment decision-making, the decision of the provider to recommend or defer treatment is perhaps the most critical determinant of whether a patient receives treatment. This paper reviews the literature related to the medical, behavioral and mental health variables that contribute to providers' assessment of treatment readiness, and associations with treatment response, adherence and retention. A greater understanding of the multilevel factors contributing to HCV treatment decision-making, as well as patient characteristics that predict treatment outcome and adherence, can inform the development of interventions aimed at improving HCV care for HIV patients.

Antiviral Agents↗

PubMed1993

Hyponatremia after aneurysmal subarachnoid hemorrhage.

Hyponatremia frequently complicates the clinical course for patients with aneurysmal subarachnoid hemorrhage (SAH). Although commonly attributed to the syndrome of inappropriate antidiuretic hormone (SIADH), emerging evidence suggests a range of pathological conditions may produce the abnormality. Effective management requires an approach to data collection which avoids suppositions about etiology, as incorrect assumptions may result in selection of interventions leading to further clinical deterioration. Adherence to comprehensive monitoring and management protocols ensures rapid detection and efficient management of this common problem after SAH.

Humans↗

PubMed2007

Directly observed therapy and tuberculosis: how can a systematic review of qualitative research contribute to improving services? A qualitative meta-synthesis.

AIM: This paper reports the findings from a qualitative meta-synthesis concerning people with, or at risk of, tuberculosis, service providers and policymakers and their experiences and perceptions of tuberculosis and treatment. BACKGROUND: Directly observed therapy is part of a package of interventions to improve tuberculosis treatment and adherence. A Cochrane systematic review of trials showed an absence of evidence for or against directly observed therapy compared with people treating themselves. METHOD: Qualitative systematic review methods were used to search, screen, appraise and extract data thematic analysis was used to synthesize data from 1990 to 2002, and an update of literature to December 2005. Two questions were addressed: 'What does qualitative research tell us about the facilitators and barriers to accessing and complying with tuberculosis treatment?' and 'What does qualitative research tell us about the diverse results and effect sizes of the randomized controlled trials included in the Cochrane review?' Findings help explain the diverse trial results in a Cochrane systematic review of directly observed therapy and tuberculosis and consider implications for research, policy and practice. FINDINGS: Five themes emerged from the 1990 to 2002 synthesis: socio-economic circumstances, material resources and individual agency; explanatory models and knowledge systems in relation to tuberculosis and its treatment; the experience of stigma and public discourses around tuberculosis; sanctions, incentives and support, and the social organization and social relationships of care. Two additional themes emerged from the 2005 update. CONCLUSION: The qualitative meta-synthesis improved the relevance and scope of the Cochrane review of trials. The findings make a major contribution to the development of theory concerning global WHO-branded disease control and the practicality of local delivery to people.

Directly Observed Therapy↗

PubMed1999

Exorcisms used for treatment of urinary tract diseases in Greece during the Middle Ages and Renaissance.

Using an unpublished 16th century manuscript as a pilot case, we examined the role of the formal Christian rituals and of hybrid semi-Christian semi-pagan exorcistic writings in curing renal ailments. It was found that in spite of the changing religious and cultural orthodoxy in the lands around the Eastern Mediterranean Basin, people did adhere to their belief in divine intervention when they were suffering from renal and/or other afflictions. We traced the origin of these beliefs at least to the preclassical period, and its continuation well beyond the Renaissance. The same practice applied both to nephrological diseases of humans (clergy and laymen alike) and of animals. We also present several interesting works of art from the palaeo-Christian to the post-Byzantine era supporting our theses.

Animals↗

PubMedDate not supplied

Stigma: a health barrier for women with HIV/AIDS.

The stigma experienced by women with HIV/AIDS is much like that of Hester Prynne in The Scarlet Letter. At the time of diagnosis with HIV/AIDS, women already are aware of the stigma associated with the disease. They immediately see themselves differently and believe others do also. The purpose of this article is to explore the multidimensional effect of stigma on women's efforts to promote, maintain, and enhance their health. The experiences of the women in this study tell of rejection by family members, friends, health care providers, employers, and church members. This rejection caused by stigma affects access to health care, medication adherence, social interaction, and social support. Interventions are needed to decrease the impact of stigma on women with HIV/AIDS so they can achieve a higher level of wellness, increase their life span, continue in the workforce, and improve their quality of life.

Adult↗

PubMed2006

Explaining variation in GP referral rates for x-rays for back pain.

BACKGROUND: Despite the availability of clinical guidelines for the management of low back pain (LBP), there continues to be wide variation in general practitioners' (GPs') referral rates for lumbar spine x-ray (LSX). This study aims to explain variation in GPs' referral rates for LSX from their accounts of the management of patients with low back pain. METHODS: Qualitative, semi-structured interviews with 29 GPs with high and low referral rates for LSX in North East England. Thematic analysis used constant comparative techniques. RESULTS: Common and divergent themes were identified among high- and low-users of LSX. Themes that were similar in both groups included an awareness of current guidelines for the use of LSX for patients with LBP and the pressure from patients and institutional factors to order a LSX. Differentiating themes for the high-user group included: a belief that LSX provides reassurance to patients that can outweigh risks, pessimism about the management options for LBP, and a belief that denying LSX would adversely affect doctor-patient relationships. Two specific differentiating themes are considered in more depth: GPs' awareness of their use of lumbar spine radiology relative to others, and the perceived risks associated with LSX radiation. CONCLUSION: Several key factors differentiate the accounts of GPs who have high and low rates of referral for LSX, even though they are aware of clinical guideline recommendations. Intervention studies that aim to increase adherence to guideline recommendations on the use of LSX by changing the ordering behaviour of practitioners in primary care should focus on these factors.

Journal Article↗

PubMed2002

Factors associated with antiretroviral adherence among HIV-infected women with children.

HIV symptomatic or AIDS diagnosed women who had a young well child were recruited for a study investigating their adherence to antiretrovirals (N = 46). Very poor rates of adherence were found, ranging from 43% (pill count assessment) to 56% (self-report of 3-day adherence to dose). Several factors were associated with nonadherence, including alcohol use, perceived stress, having a partner and age of youngest child, poor self-efficacy to stay with treatment, and poor outcome expectancies regarding the benefits of following the treatment regimen. Interventions to assist these women in improving adherence are urgently needed.

Adult↗

PubMed2004

Overcoming obstacles: collaboration for change.

Effective diabetes care requires a partnership between prepared, proactive practice teams and informed, activated patients. Diabetes education helps to overcome many of the barriers to effective self-management by enabling people with diabetes to make informed decisions about their day-to-day self-care. Both psychosocial and health outcomes have been improved through a variety of training programmes; however, education must be coupled with ongoing self-management support if these benefits are to be sustained. The principal goal of diabetes education has undergone a major shift over the past few years--evolving from primarily didactic interventions, focused on encouraging patients to adhere to the prescribed therapy, towards more interactive learning that supports people in making informed, self-directed decisions.

Cooperative Behavior↗

PubMed2001

[Developing the care proposed by Leininger with a person in dialysis treatment].

Study of a ethnographic approach, type case study. Describing a person's bearer of chronic renal inadequacy accompaniment, with adhesion deficit to the treatment. The theoretical presupposition had the model SUNRISE proposed by Leininger. It's presented the Mr. Light and the involved sceneries. Described. Influences economical, social, cultural, technological and educational in the process of taking care. After the identification of the systems of health, were decided the actions of taking care through the maintenance, accommodation and restoration. The study possibilited effective interventions for the behaviors of non adherence. The referencial in continuous and lingering processes of care, favoured by the proximity between nurse and attended person.

Cultural Characteristics↗

PubMed2006

Use of pictorial aids in medication instructions: a review of the literature.

PURPOSE: The effects of pictorial aids in medication instructions on medication recall, comprehension, and adherence are reviewed. SUMMARY: Many patients depend on medication labels and patient information leaflets for pertinent drug information, but these materials are often difficult for patients to understand. Research in psychology and marketing indicates that humans have a cognitive preference for picture-based, rather than text-based, information. Studies have shown that pictorial aids improve recall, comprehension, and adherence and are particularly useful for conveying timing of doses, instructions on when to take medicine, and the importance of completing a course of therapy. Other research has compared various techniques for using picture-based information and supports the use of integrative instructions, a combination of textual, oral, and pictorial communication, to promote comprehension and adherence. While pictures have generally proven useful for improving patient comprehension and adherence, not all picture-based interventions have produced successful results. Some icons, particularly clock icons, have been found to be too complex to enhance understanding and could not overcome the advantage provided by the familiarity of the textbased format, suggesting that patients be trained to use pictorial medication information before they are expected to use icons as an aid for medication administration. In addition to enhancing understanding, pictorial aids have been found to improve patients' satisfaction with medication instructions. CONCLUSION: The use of pictorial aids enhances patients' understanding of how they should take their medications, particularly when pictures are used in combination with written or oral instructions.

Audiovisual Aids↗

PubMed1993

What do we miss with the traditional efficacy/safety evaluation?

The traditional efficacy/safety evaluation has mainly been based on objective clinical features, findings and tests. Subjective symptoms have often been taken into account and much efforts have been put into the methods of their measurement. The emotional, social and functional consequences of disease, however, seldom have received much attention. Little attention has also been paid to patients expectation and the true causes of why the patient has sought medical help. Important aspects of disease and consequences of intervention are therefore often missed when adhering only to the traditional methods of evaluation.

Attitude to Health↗

PubMed2002

[Interventions to improve the management of diabetes mellitus in primary health care and outpatient community settings].

UNLABELLED: This review should be cited as: Renders CM, Valk GD, Griffin S. Wagner EH, Eijk JThM van, Assendelft WJJ. Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings (Cochrane Review). In: The Cochrane Library, Issue 2, 2001. Oxford: Update Software. A substantive amendment to this systematic review was last made on 29 June 2000. Cochrane reviews are regularly checked and updated if necessary. BACKGROUND: Diabetes is a common chronic disease that is increasingly managed in primary care. Different systems have been proposed to manage diabetes care. OBJECTIVES: To assess the effects of different interventions, targeted at health professionals or the structure in which they deliver care, on the management of patients with diabetes in primary care, outpatient and community settings. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, the Cochrane Controlled Trials Register (Issue 4 1999), MEDLINE (1966-1999), EMBASE (1980-1999), Cinahl (1982-1999), and reference lists of articles. SELECTION CRITERIA: Randomised trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series (ITS) analyses of professional, financial and organisational strategies aimed at improving care for people with Type 1 or Type 2 diabetes. The participants were health care professionals, including physicians, nurses and pharmacists. The outcomes included objectively measured health professional performance or patient outcomes, and self-report measures with known validity and reliability. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Forty-one studies were included involving more than 200 practices and 48,000 patients. Twenty-seven studies were RCTs, 12 were CBAs, and two were ITS. The studies were heterogeneous in terms of interventions, participants, settings and outcomes. The methodological quality of the studies was often poor. In all studies the intervention strategy was multifaceted. In 12 studies the interventions were targeted at health professionals, in nine they were targeted at the organization of care, and 20 studies targeted both. In 15 studies patient education was added to the professional and organisational interventions. A combination of professional interventions improved process outcomes. The effect on patient outcomes remained less clear as these were rarely assessed. Arrangements for follow-up (organisational intervention) also showed a favourable effect on process outcomes. Multiple interventions in which patient education was added or in which the role of the nurse was enhanced also reported favourable effects on patients' health outcomes. REVIEWERS' CONCLUSION: Multifaceted professional interventions can enhance the performance of health professionals in managing patients with diabetes. Organisational interventions that improve regular prompted recall and review of patients (central computerised tracking systems or nurses who regularly contact the patient) can also improve diabetes management. The addition of patient-oriented interventions can lead to improved patient health outcomes. Nurses can play an important role in patient-oriented interventions, through patient education or facilitating adherence to treatment.

Community Health Centers↗

PubMed1989

Moving clients toward wellness: behavioral change.

Assisting clients to incorporate behavior change into their life-style presents a challenge to the clinical nurse specialist. Lack of adherence to prescribed regimens and educational interventions constitutes a primary reason for the occurrence and complications of illness, leading to inadequate control of the disease process and increased health care costs. This paper describes behavior modification techniques that can be used in conjunction with an educational program to initiate and maintain healthier behaviors among clients who demonstrate physical and emotional readiness for learning. The author also discusses how social support as a maintenance technique helps clients embarking on behavior change programs. Maintenance of a behavior change through utilizing a family systems focus not only facilitates an individual's coping with illness but also promotes family coping and adaptation.

Behavior Therapy↗

PubMedDate not supplied

The Carotene and Retinol Efficacy Trial (CARET) to prevent lung cancer in high-risk populations: pilot study with asbestos-exposed workers.

Pilot studies are an essential component for major chemoprevention trials. Prior to initiating the multicenter Carotene and Retinol Efficacy Trial to assess the effectiveness of beta-carotene and retinol for preventing lung cancer, we conducted pilot studies in Seattle between 1985 and 1988 in two high risk populations: current and former heavy smokers and asbestos-exposed workers. The Asbestos Workers Pilot Study for the Carotene and Retinol Efficacy Trial demonstrated that recruitment of asbestos-exposed participants with relevant risk factors was feasible from identified sources. We documented negligible toxicity and high adherence with the protocol, schedule, and intervention. Results from the pilot led to extension of the placebo run-in period, changes in the eligibility criteria, improvements in recruitment strategies and scheduling, elimination of stratification by risk factors in randomization, modifications of study vitamin dosage and of side effects monitoring, and refinement of trial design parameters for Carotene and Retinol Efficacy Trial. The Smokers Pilot is reported in the accompanying article (G. E. Goodman et al., Cancer Epidemiol., Biomarkers & Prev., 2: 389-396, 1993).

Aged↗