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Journal of Managed Care Pharmacy : JMCP Jan 2008Non-adherence to therapy is a widespread problem, with typical adherence rates for prescribed medications being approximately 50%. An estimated 20% to 50% of patients... (Review)
Review
BACKGROUND
Non-adherence to therapy is a widespread problem, with typical adherence rates for prescribed medications being approximately 50%. An estimated 20% to 50% of patients with ulcerative colitis (UC) do not take their medications as prescribed, resulting in higher disease-recurrence rates and potentially higher health care costs.
OBJECTIVE
To characterize the problem of non-adherence in UC, to review the many factors affecting compliance and persistence in this population, and to discuss practical strategies to improve adherence in these patients.
SUMMARY
Adherence to and persistence with medication are complex and multifactorial behaviors. Factors shown to affect adherence in UC patients include disease extent and duration, cost of medications, fear of adverse effects, individual psychosocial variables, and the patient-physician relationship. In contrast, recent data do not support an important role for treatment-related factors such as daily dose, regimen, and formulation in influencing adherence in this population, particularly with longer duration of use. Strategies to improve adherence should involve the patient, the provider, and the health care delivery system. For UC patients, knowledge and discussion of the rationale for supporting persistence, such as recent data regarding agents that have a potential chemoprotective benefit, may encourage persistence, even during periods of quiescence. The patient-physician relationship is critical in encouraging adherence, particularly with respect to education, open communication, and agreement regarding the value of the assigned treatment. Health care delivery systems can improve adherence by encouraging the participation of multidisciplinary teams, providing reporting and tracking systems, and eliminating financial barriers where possible.
Topics: Colitis, Ulcerative; Humans; Interprofessional Relations; Patient Compliance; Patient Education as Topic; Physician-Patient Relations; Practice Guidelines as Topic; Treatment Refusal
PubMed: 18240888
DOI: 10.18553/jmcp.2008.14.s1-a.1a -
Dialogues in Clinical Neuroscience 2008Recent research has indicated that psychosocial interventions can have a valuable role in reducing the substantial psychosocial disability associated with bipolar... (Review)
Review
Recent research has indicated that psychosocial interventions can have a valuable role in reducing the substantial psychosocial disability associated with bipolar disorder. Randomized controlled trials of these interventions indicate that improvements are seen in symptoms, psychosocial functioning, and treatment adherence. These interventions, systematically presented in the form of standardized treatment manuals, vary in format, duration, and theoretical basis. All are meant to augment pharmacotherapy, which represents the standard of treatment in the field. Modalities that have gathered the most empirical support include cognitive-behavioral therapy, family-focused therapy, interpersonal and social rhythms therapy, and psychoeducation. The enhancement of adherence to pharmacotherapy is a common therapeutic target, due to the association of nonadherence with higher relapse rates, hospitalization, and health care costs among people with bipolar disorder. Given the complexity of nonadherence behavior, multicomponent interventions are often required. In this review, we provide an overview of the rationale, evidence base, and major psychotherapeutic approaches in bipolar disorder, focusing on the assessment and enhancement of medication adherence.
Topics: Antimanic Agents; Bipolar Disorder; Cognitive Behavioral Therapy; Humans; Patient Compliance; Psychotherapy; Social Support
PubMed: 18689293
DOI: 10.31887/DCNS.2008.10.2/cadepp -
Journal of Internal Medicine Nov 2015
Topics: Alcohol Drinking; Cardiovascular Diseases; Diet Therapy; Female; Humans; Life Style; Patient Compliance; Smoking
PubMed: 26250841
DOI: 10.1111/joim.12408 -
American Journal of Infection Control Apr 2018Antimicrobial therapy is among the mainstream treatment modalities employed in clinical settings. Antimicrobial sensitivity of the pathogen and patient compliance are...
BACKGROUND
Antimicrobial therapy is among the mainstream treatment modalities employed in clinical settings. Antimicrobial sensitivity of the pathogen and patient compliance are key determinants of the efficacy of antimicrobial therapy.
OBJECTIVE
In this study, we sought to investigate the factors that affect patient compliance to antimicrobial therapy in a Chinese teaching hospital to enhance patient compliance and to prevent abuse and misuse of antibiotics by patients.
METHODS
A questionnaire survey was conducted among patients willing to answer all the questions who were prescribed antimicrobial drugs orally, and for whom at least half of the duration of therapy was not under the supervision of a doctor or nurse. Data analyses were performed using Kruskal-Wallis test and multivariate logistic regression.
RESULTS
A total of 720 patients participated in the survey; of these, 714 patients provided complete data and were included in the analysis. Up to 86.97% of patients showed noncompliance to antimicrobial therapy (total compliance score < 8), whereas 13.03% of patients showed good compliance (total compliance score = 8). On multivariate analyses, understanding of the treatment was an important factor associated with compliance.
CONCLUSIONS
A range of factors were associated with compliance to antimicrobial therapy, including understanding of the treatment, gender, age, home address, education level, and family income.
Topics: Anti-Infective Agents; China; Data Collection; Female; Humans; Male; Multivariate Analysis; Patient Compliance; Socioeconomic Factors; Surveys and Questionnaires
PubMed: 29592834
DOI: 10.1016/j.ajic.2018.01.008 -
Eye & Contact Lens Jul 2017Lid hygiene is a commonly prescribed first-line therapy in patients with lid margin disease, yet compliance with therapy is not well characterized. The goals of this...
OBJECTIVES
Lid hygiene is a commonly prescribed first-line therapy in patients with lid margin disease, yet compliance with therapy is not well characterized. The goals of this study were to assess patient compliance with lid hygiene and evaluate which factors predict a favorable symptomatic response to treatment.
METHODS
This was a cross-sectional study of patients seen in the Miami Veterans Affairs eye clinic between August and December 2014. An evaluation was performed to assess dry eye symptoms and lid margin signs. All patients were then instructed to perform warm compresses and lid scrubs. A follow-up phone survey assessed compliance and subjective therapeutic response 6 weeks later.
RESULTS
Two hundred seven of 211 (98%) patients (94% male, 60% white) completed the survey. Of the 207 patients, 188 (91%) completed the follow-up survey. Compliance with therapy was reported in 104 patients (55%); 66 reported complete improvement, 30 partial improvement, and 8 no improvement in symptoms. Patients who self-reported dry eye symptoms at first visit (n=86, 74%) were more likely to be compliant with lid hygiene than those who did not report symptoms (n=18, 25%) (P<0.0005). The only factor associated with poorer response to lid hygiene was longer time of self-reported dry eye symptoms. None of the other signs studied, including the presence of skin rosacea and lid margin telangiectasia, were associated with a differential response to lid hygiene.
CONCLUSIONS
Patients with dry eye symptoms were moderately compliant with lid hygiene, and patients who performed the routine noted improvement in symptoms.
Topics: Aged; Aged, 80 and over; Cross-Sectional Studies; Dry Eye Syndromes; Eyelid Diseases; Female; Health Surveys; Humans; Hygiene; Hyperthermia, Induced; Male; Middle Aged; Patient Compliance; Surveys and Questionnaires
PubMed: 27243349
DOI: 10.1097/ICL.0000000000000258 -
The Angle Orthodontist Jan 2017To conduct an objective assessment of the level of compliance in young patients prescribed various types of removable appliances and to determine the influence of device...
OBJECTIVE
To conduct an objective assessment of the level of compliance in young patients prescribed various types of removable appliances and to determine the influence of device type, treatment duration, and patient age, gender, psychological maturity, and awareness of monitoring on compliance.
MATERIALS AND METHODS
A total of 30 patients were fitted with either a class 2 (Frankel or bionator) or a class 3 (face mask) removable appliance, each bearing a compliance indicator chip, and they were instructed to wear them for 13 hours per day. Compliance was monitored by means of the sensor for an average of 8 months. Of the patients, 14 were informed that their appliance was fitted with a monitoring sensor, and 16 were not. The psychological maturity of all patients was assessed on the Nowicki-Strickland Locus of Control Scale, and the effect on compliance of this score as well as the patient- and treatment-related variables considered were determined via statistical analysis Results: The mean compliance recorded by the chips was 8.6 ± 2.9 hours, far lower than the 13 hours prescribed, and younger patients showed significantly greater compliance than adolescents (P < .01). However, no significant differences in compliance were found between intra- and extraoral appliances, and neither gender, psychological scores, treatment duration, nor awareness of being monitored had any significant effect.
CONCLUSIONS
Compliance is generally very poor in young patients, regardless of their gender and psychological maturity. Although awareness of monitoring does not appear to boost compliance, such systems may be a valuable means of providing a dentist with objective information regarding their patients' compliance.
Topics: Adolescent; Age Factors; Attitude to Health; Child; Extraoral Traction Appliances; Female; Humans; Male; Malocclusion, Angle Class II; Malocclusion, Angle Class III; Orthodontic Appliance Design; Orthodontic Appliances; Orthodontic Appliances, Functional; Orthodontic Appliances, Removable; Orthodontic Retainers; Patient Compliance; Sex Factors; Time Factors
PubMed: 27508935
DOI: 10.2319/020616-104.1 -
Archives of Osteoporosis 2015Compliance and persistence with daily, weekly, and monthly bisphosphonates (BPs) for osteoporosis were assessed using data from the Platform for Clinical Information...
UNLABELLED
Compliance and persistence with daily, weekly, and monthly bisphosphonates (BPs) for osteoporosis were assessed using data from the Platform for Clinical Information Statistical Analysis (CISA) database that contains data of prescriptions in 13 university hospitals in Japan. The analysis revealed compliance and persistence improved as the dosing interval increases.
PURPOSE
BPs are an effective first-line therapy for osteoporosis, but adherence is low. Compliance (medication possession ratio, MPR) and persistence (time to discontinuation) with daily, weekly, and monthly BPs were compared to ensure better adherence.
METHODS
Using data from the CISA database containing prescription data in 13 university hospitals in Japan, adherence to oral BPs of osteoporotic patients was investigated. Daily and weekly BPs were compared for compliance and persistence over 5 and 8 years, and daily, weekly, and monthly BPs for those over 1 and 2 years.
RESULTS
MPR over 5 years was 20.8 and 60.9 % for daily and weekly BPs (p < 0.001), respectively. MPR over 1 year was 38.6, 70.6, and 77.7 % for daily, weekly, and monthly BPs (P < 0.001), respectively. Persistence over 8 years was significantly higher in weekly than daily BPs (p < 0.001), and that over 5 years was highest in patients receiving BPs monthly (p < 0.01).
CONCLUSION
The present analysis indicates that a monthly regimen has better adherence to treatment as compared with weekly and daily regimens.
Topics: Aged; Databases, Factual; Diphosphonates; Drug Administration Schedule; Female; Humans; Japan; Male; Middle Aged; Osteoporosis; Patient Compliance
PubMed: 26297076
DOI: 10.1007/s11657-015-0231-6 -
Acta Reumatologica Portuguesa 2010Despite its relative high prevalence,potential devastating clinical consequences and socio-economic impact, the existence of effective drugs to treat it, and the well...
INTRODUCTION
Despite its relative high prevalence,potential devastating clinical consequences and socio-economic impact, the existence of effective drugs to treat it, and the well recognised direct relation between acute flares and treatment interruptions and its resumption, gout is still often considered the chronic disease with the worst rate of adherence to therapy. The reason for this is unknown. We proposed to thoroughly evaluate a subgroup of patients, aiming at identifying the clinical features predictive of non-compliance, and 5 different ways to assess those.
METHODS
We analysed a number of clinical, analytical and ultrasound data relating to 34 gout patients (according to the Wallace-ARA diagnostic criteria for gout 1977 and the EULAR recommendations for gout diagnosis 2006), which were followed in a specialized rheumatology consultation as part of an ongoing study for ultrasound validation in gout. To assess non-compliance, we compared the prevalence of each one of these clinical features with 5 outcomes (2 of which related to "non-compliance": self-report of non-adherence to therapy and missing consultation, and 3 other outcomes related to "non-response": gout flare(s), final serum uric acid (sUA) ≥ 6 mg/dL, and no sonographic improvement) registered during a 1 year of follow-up assessment.
RESULTS
We have found an association between younger age, higher body mass index, previous treatment with urate lowering drugs, self-report of previous non-compliance, nephrolithiasis and hyperuricosuria and the "outcomes of non-compliance". These patients tended to be less often treated with NSAID and allopurinol, and more often treated with corticosteroid and benzbromarone during the 1 year follow-up. They have also presented higher rate of gout flares and final sUA. Evaluating the 3 "outcomes of non-response", we have noticed a tendency for association with long disease duration, self-report of previous non-compliance (frequently attributed to gout flare), higher initial sUA and kidney failure. These patients tended to be less often treated with NSAID, and more often treated with allopurinol. Gout flare correlated to self-report of non-compliance and no sonographic improvement. Sonographic non response also correlated to higher final sUA.
CONCLUSIONS
This study shows an association between some clinical features and non-compliance, but above all, and unlike the majority of other studies, it has found a correlation between non-compliance with possible causes of worst response or lower rate of treatment, such as hyperuricosuria, nephrolithiasis, kidney failure, and contraindication for NSAID treatment. The data which is based on a comprehensive and detailed clinical assessment, might point out hidden elements, which might go beyond the visible non-compliance, contributing to the frequent lack of control of the disease.
Topics: Female; Gout; Humans; Male; Middle Aged; Patient Compliance; Prospective Studies; Risk Factors
PubMed: 21245815
DOI: No ID Found -
BMC Neurology Mar 2014Data sources for MS research are numerous but rarely provide an objective measure of drug therapy compliance coupled with patient-reported health outcomes. The objective... (Clinical Trial)
Clinical Trial Observational Study
BACKGROUND
Data sources for MS research are numerous but rarely provide an objective measure of drug therapy compliance coupled with patient-reported health outcomes. The objective of this paper is to describe the methods and baseline characteristics of the Therapy Optimization in MS (TOP MS) study designed to investigate the relationship between disease-modifying therapy compliance and health outcomes.
METHODS
TOP MS was designed as a prospective, observational, nationwide patient-focused study using an internet portal for data entry. The protocol was reviewed and approved by Sterling IRB. The study was registered with ClinicalTrials.gov. It captured structured survey data monthly from MS patients recruited by specialty pharmacies. Data collection included the clinical characteristics of MS such as MS relapses. Disability, quality of life and work productivity and activity impairment were assessed quarterly with well-validated scales. When events like severe fatigue or new or worsening depression were reported, feedback was provided to treating physicians. The therapy compliance measure was derived from pharmacy drug shipment records uploaded to the study database. The data presented in this paper use descriptive statistics.
RESULTS
The TOP MS Study enrolled 2966 participants receiving their disease-modifying therapy (DMT) from specialty pharmacies. The mean age of the sample was 49 years, 80.4% were female, 89.9% were Caucasian and 55.7% were employed full or part time. Mean time since first symptoms was 11.5 years; mean duration since diagnosis was 9.5 years. Patient-reported EDSS was 3.5; 72.2% had a relapsing-remitting disease course. The most commonly reported symptoms at the time of enrollment were fatigue (74.7%), impaired coordination or balance (61.8%) and numbness and tingling (61.2%). Half of the sample was using glatiramer acetate and half was using beta-interferons.
CONCLUSION
Demographic and clinical characteristics of the TOP MS sample at enrollment are consistent with other community-based MS samples, and the sample appears to be representative of DMT users in the US. TOP MS data can be used to explore the associations between disease-modifying therapy compliance and health outcomes.
TRIAL REGISTRATION
ClinicalTrials.gov (NCT00819000).
Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Patient Compliance; Prospective Studies; Treatment Outcome; Young Adult
PubMed: 24624979
DOI: 10.1186/1471-2377-14-49 -
BMJ Open Respiratory Research Jun 2023The influence of body position in obstructive sleep apnoea patients is well known. A positional therapy device placed at the forehead has proven to be effective in... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The influence of body position in obstructive sleep apnoea patients is well known. A positional therapy device placed at the forehead has proven to be effective in reducing the severity of positional obstructive sleep apnoea (POSA) symptoms. The aim of the study was to evaluate patients' therapy compliance and satisfaction in the short term and mid-term.
METHODS
A post hoc analysis of a randomised controlled trial was conducted using an inactive device (ID) or an active device (AD) for 3 months. The primary outcomes were device usage and the percentage of patients with good compliance (defined as device use for more than 4 hours per night and more than 70% of nights per week). Secondary outcomes included time spent with head in the supine position, patient satisfaction and side effects.
RESULTS
The median duration of using the device was 6.9 hours in the ID group and 6.7 hours in the AD group (p=0.309), and the durations were similar throughout the follow-up period and from the first day of use. The percentage of patients with good compliance was similar and greater than 60% in both groups. The median time spent with head in the supine position was significantly lower in the AD group (2.9%) than in the ID group (12.4%) since the first day of treatment. Both groups showed satisfaction scores values above 8.5 (out of 10) in all items, while side effects were scarcely reported.
CONCLUSION
High device compliance was achieved in POSA patients, both in terms of device usage time and percentage of days used. Patients were highly satisfied, and the device effectively reduced the time spent with the head in the supine position from the first day of use.
Topics: Humans; Forehead; Polysomnography; Patient Satisfaction; Sleep Apnea, Obstructive; Patient Compliance; Personal Satisfaction
PubMed: 37349132
DOI: 10.1136/bmjresp-2022-001503