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Primary Care Respiratory Journal :... Mar 2011
Topics: Asthma; Attitude to Health; Female; Guideline Adherence; Humans; Male; Patient Compliance; Patient Education as Topic; Practice Guidelines as Topic; United Kingdom
PubMed: 21336461
DOI: 10.4104/pcrj.2011.00016 -
BMC Public Health May 2012Non-compliance with antidepressant treatment continues to be a complex problem in mental health care. In immigrant populations non-compliance is one of several barriers...
BACKGROUND
Non-compliance with antidepressant treatment continues to be a complex problem in mental health care. In immigrant populations non-compliance is one of several barriers to adequate management of mental illness; some data suggest greater difficulties in adhering to pharmacological treatment in these groups and an increased risk of therapeutic failure. The aim of this study is to assess differences in the duration and compliance with antidepressant treatment among immigrants and natives in a Spanish health region.
METHODS
Population-based (n = 206,603), retrospective cohort study including all subjects prescribed ADT between 2007 and 2009 and recorded in the national pharmacy claims database. Compliance was considered adequate when the duration was longer than 4 months and when patients withdrew more than 80% of the packs required.
RESULTS
5334 subjects (8.5% of them being immigrants) initiated ADT. Half of the immigrants abandoned treatment during the second month (median for natives = 3 months). Of the immigrants who continued, only 29.5% presented good compliance (compared with 38.8% in natives). The estimated risk of abandoning/ending treatment in the immigrant group compared with the native group, adjusted for age and sex, was 1.28 (95%CI 1.16-1.42).
CONCLUSIONS
In the region under study, immigrants of all origins present higher percentages of early discontinuation of ADT and lower median treatment durations than the native population. Although this is a complex, multifactor situation, the finding of differences between natives and immigrants in the same region suggests the need to investigate the causes in greater depth and to introduce new strategies and interventions in this population group.
Topics: Adolescent; Adult; Africa South of the Sahara; Age Distribution; Antidepressive Agents; Attitude to Health; Catchment Area, Health; Depression; Emigrants and Immigrants; Europe, Eastern; Female; Follow-Up Studies; Humans; Latin America; Male; Middle Aged; Patient Compliance; Patient Dropouts; Proportional Hazards Models; Retrospective Studies; Socioeconomic Factors; Spain
PubMed: 22469197
DOI: 10.1186/1471-2458-12-256 -
American Heart Journal Sep 1995Ambulatory treatment of hypertension depends largely on long-term oral medications to lower blood pressure and delay or prevent cardiovascular morbidity and mortality.... (Review)
Review
Ambulatory treatment of hypertension depends largely on long-term oral medications to lower blood pressure and delay or prevent cardiovascular morbidity and mortality. Failure to achieve the therapeutic goal may reflect biologic, pharmacologic, or behavioral factors. Ignoring behavioral factors may result in unnecessary or even dangerous regimen escalation. More than half of patients with insufficient reductions in blood pressure display suboptimal medication compliance as assessed by pill count or bioassay. Once-daily dosing may be an important part of enhancing compliance, patient convenience, and regimen simplification; however, drug concentrations may be subtherapeutic when dosing delays or omissions occur. Electronic monitoring data in hypertension, glaucoma, seizure disorders, and other diseases indicate that 50% to 60% of patients adhere well to prescribed regiments, that 5% to 10% adhere poorly, and that the 30% to 45% adhere to an intermediate but markedly variable degree. A growing body of literature offers empirical support for focused and personalized interventions.
Topics: Ambulatory Care; Antihypertensive Agents; Female; Humans; Hypertension; Male; Patient Compliance; Treatment Outcome
PubMed: 7661077
DOI: 10.1016/0002-8703(95)90368-2 -
PloS One 2022Though antiretroviral therapy (ART) is widely available, HIV positive pregnant women in Zambia are less likely to start and remain on therapy throughout pregnancy and...
BACKGROUND
Though antiretroviral therapy (ART) is widely available, HIV positive pregnant women in Zambia are less likely to start and remain on therapy throughout pregnancy and after delivery. This study sought to understand readiness to start ART among HIV pregnant women from the perspectives of both women and men in order to suggest more holistic programs to support women to continue life-long ART after delivery.
METHODS
We conducted a qualitative study with HIV positive pregnant women before and after ART initiation, and men with female partners, to understand readiness to start lifelong ART. We conducted 28 in-depth interviews among women and 2 focus group discussions among male partners. Data were transcribed verbatim and analyzed in NVivo 12 using thematic analysis. Emerging themes from the data were organized using the social ecological framework.
RESULTS
Men thought of their female partners as young and needing their supervision to initiate and stay on ART. Women agreed that disclosure and partner support were necessary preconditions to ART initiation and adherence and, expressed fear of divorce as a prominent barrier to disclosure. Maternal love and desire to look after one's children instilled a sense of responsibility among women which motivated them to overcome individual, interpersonal and health system level barriers to initiation and adherence. Women preferred adherence strategies that were discrete, the effectiveness of which, depended on women's intrinsic motivation.
CONCLUSION
The results support current policies in Zambia to encourage male engagement in ART care. To appeal to male partners, messaging on ART should be centered on emphasizing the importance of male involvement to ensure women remain engaged in ART care. Programs aimed at supporting postpartum ART adherence should design messages that appeal to both men's role in couples' joint decision-making and women's maternal love as motivators for adherence.
Topics: Adult; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Female; Focus Groups; HIV Infections; Humans; Infectious Disease Transmission, Vertical; Male; Medication Adherence; Patient Compliance; Pregnancy; Pregnancy Complications, Infectious; Pregnant Women; Qualitative Research; Sexual Partners; Zambia
PubMed: 35025923
DOI: 10.1371/journal.pone.0262392 -
Psychiatria Danubina Sep 2013The treatment of psychiatric disorders often consists of a combined approach that integrates both pharmacotherapy and psychotherapy. Unfortunately, psychiatric texts and... (Review)
Review
The treatment of psychiatric disorders often consists of a combined approach that integrates both pharmacotherapy and psychotherapy. Unfortunately, psychiatric texts and the educational process in psychiatry training do not adequately address the combined approach. There is a lack of information concerned with the psychological aspect of prescribing medications. This is striking since many patients require both treatments. There is an inevitable psychological aspect of the administration of medication in psychiatry, and the meaning ascribed to the prescription of drugs has an impact on doctor-patient relationship. Understanding the psychodynamic issues is crucial for the success of psychopharmacology. Psychodynamic psychopharmacotherapy represents an integration of biological psychiatry and psychodynamic insights and techniques. This approach recognizes that many of the core discoveries of psychoanalysis are powerful factors in the complex relationship between the patient, the illness, the doctor, and the medications. Scientific pharmacotherapy is, as it should be, based upon patients' responses to treatments of specific target conditions. Enduring personality traits are being increasingly incorporated as targets for pharmacotherapy. However, in the real world of psychiatric practice we see that transference issues and a patient's character or set of personality traits have a greater impact on the selection, dosage, tolerability, and treatment outcome than is generally recognized or admitted. In contemporary psychiatry, a psychodynamic perspective must be preserved. Without it, meaning will be lost, and both diagnostic understanding and informed treatment planning will suffer.
Topics: Humans; Mental Disorders; Patient Compliance; Psychiatry; Psychopharmacology; Psychotherapy, Psychodynamic
PubMed: 24048404
DOI: No ID Found -
The Cochrane Database of Systematic... May 2020Nicotine replacement therapy (NRT) delivers nicotine without the toxic chemicals present in tobacco smoke. It is an effective smoking cessation aid in non-pregnant...
BACKGROUND
Nicotine replacement therapy (NRT) delivers nicotine without the toxic chemicals present in tobacco smoke. It is an effective smoking cessation aid in non-pregnant smokers, but there is less evidence of effectiveness in pregnancy. Systematic review evidence suggests that pregnant women do not adhere to NRT as prescribed, which might undermine effectiveness. Electronic cigarettes (e-cigarettes) have grown in popularity, but effectiveness and safety in pregnancy are not yet established. The determinants of uptake and use of NRT and e-cigarettes in pregnancy are unknown.
OBJECTIVES
To explore factors affecting uptake and use of NRT and e-cigarettes in pregnancy.
SEARCH METHODS
We searched MEDLINE(R), CINAHL and PsycINFO on 1 February 2019. We manually searched OpenGrey database and screened references of included studies and relevant reviews. We also conducted forward citation searches of included studies.
SELECTION CRITERIA
We selected studies that used qualitative methods of data collection and analysis, included women who had smoked in pregnancy, and elicited participants' views about using NRT/e-cigarettes for smoking cessation or harm reduction (i.e. to smoke fewer cigarettes) during pregnancy.
DATA COLLECTION AND ANALYSIS
We identified determinants of uptake and use of NRT/e-cigarettes in pregnancy using a thematic synthesis approach. Two review authors assessed the quality of included studies with the Wallace tool. Two review authors used the CERQual approach to assess confidence in review findings. The contexts of studies from this review and the relevant Cochrane effectiveness review were not similar enough to fully integrate findings; however, we created a matrix to juxtapose findings from this review with the descriptions of behavioural support from trials in the effectiveness review.
MAIN RESULTS
We included 21 studies: 15 focused on NRT, 3 on e-cigarettes, and 3 on both. Studies took place in five high-income countries. Most studies contributed few relevant data; substantially fewer data were available on determinants of e-cigarettes. Many studies focused predominantly on issues relating to smoking cessation, and determinants of NRT/e-cigarette use was often presented as one of the themes. We identified six descriptive themes and 18 findings within those themes; from these we developed three overarching analytical themes representing key determinants of uptake and adherence to NRT and/or e-cigarettes in pregnancy. The analytical themes show that women's desire to protect their unborn babies from harm is one of the main reasons they use these products. Furthermore, women consider advice from health professionals when deciding whether to use NRT or e-cigarettes; when health professionals tell women that NRT or e-cigarettes are safer than smoking and that it is okay for them to use these in pregnancy, women report feeling more confident about using them. Conversely, women who are told that NRT or e-cigarettes are as dangerous or more dangerous than smoking and that they should not use them during pregnancy feel less confident about using them. Women's past experiences with NRT can also affect their willingness to use NRT in pregnancy; women who feel that NRT had worked for them (or someone they know) in the past were more confident about using it again. However, women who had negative experiences were more reluctant to use NRT. No trials on e-cigarette use in pregnancy were included in the Cochrane effectiveness review, so we considered only NRT findings when integrating results from this review and the effectiveness review. No qualitative studies were conducted alongside trials, making full integration of the findings challenging. Women enrolled in trials would have agreed to being allocated to NRT or control group and would have received standardised information on NRT at the start of the trial. Overall, the findings of this synthesis are less relevant to women's decisions about starting NRT in trials and more likely to help explain trial participants' adherence to NRT after starting it. We considered most findings to be of moderate certainty; we assessed findings on NRT use as being of higher certainty than those on e-cigarette use. This was mainly due to the limited data from fewer studies (only in the UK and USA) that contributed to e-cigarette findings. Overall, we judged studies to be of acceptable quality with only minor methodological issues.
AUTHORS' CONCLUSIONS
Consistent messages from health professionals, based on high-quality evidence and clearly explaining the safety of NRT and e-cigarettes compared to smoking in pregnancy, could help women use NRT and e-cigarettes more consistently/as recommended. This may improve their attitudes towards NRT or e-cigarettes, increase their willingness to use these in their attempt to quit, and subsequently encourage them to stay smoke-free.
Topics: Adolescent; Adult; Electronic Nicotine Delivery Systems; Female; Humans; Middle Aged; Patient Compliance; Pregnancy; Pregnant Women; Qualitative Research; Safety; Smoking; Smoking Cessation; Tobacco Use Cessation Devices; Young Adult
PubMed: 32441810
DOI: 10.1002/14651858.CD013629 -
Obesity Reviews : An Official Journal... Oct 2014This review extends findings from four previous reviews of physical activity (PA) interventions among African Americans (AA) and includes papers published between... (Review)
Review
This review extends findings from four previous reviews of physical activity (PA) interventions among African Americans (AA) and includes papers published between January 2009 and August 2013. Eligible papers were retrieved using strategies employed in previous reviews. Overall, 16 relevant papers were identified, including four pilot studies and 12 full trials. Interventions were based on a variety of behavioural sciences theories. The most common setting for interventions was churches. Most interventions lasted >6 months; few interventions included >6 months of post-intervention follow-up. Overall, studies identified within-group differences showing positive improvements in PA, and most studies showed statistically significant between-group differences in at least one measure of PA. A quality score was used to rate various elements of the studies and provide a numerical assessment of each paper; scores ranged from 3 to 10 out of 13 possible points. The current review indicates a continued need for studies that use objective PA measures, assess long-term intervention impact, provide specific PA goals for interventions, include more attention to strategies that can increase retention and adherence among AA study participants, include AA men and determine the independent and synergistic effects of individual and environmental (socio-cultural and built) change strategies.
Topics: Adult; Black or African American; Evidence-Based Medicine; Exercise; Health Behavior; Health Promotion; Humans; Motor Activity; Obesity; Patient Compliance; United States
PubMed: 25196410
DOI: 10.1111/obr.12205 -
Alimentary Pharmacology & Therapeutics Oct 2006Any chronic disease is a risk situation for non-adherence to treatment. This results in suboptimal medication, and poor disease control. Adherence and compliance are... (Review)
Review
Any chronic disease is a risk situation for non-adherence to treatment. This results in suboptimal medication, and poor disease control. Adherence and compliance are directly related to therapeutic success, which is further complicated in inflammatory bowel disease patients. There is a wide array of circumstances that increase the likelihood of non-compliance in a given patient: difficult-to-follow treatment schedules (multiple doses and multiple drugs), insufficient patient information, longer evolution of the disease and inactive disease. Depression, male gender, active employment and living alone are also associated with poorer adherence to therapy. Monitoring drug intake is possible in many circumstances, directly or indirectly (urinary salicylate levels; erythrocyte metabolites and increased mean corpuscular volume and bilirubin in patients under azathioprine; blood levels of ciclosporin or tacrolimus). However, such measures are probably better utilized for dose adjustment and not for the identification of non-compliant patients. High-risk patients are a target group in which pre-emptive intervention could ensure better compliance. If the question of non-adherence arises, for instance, as a possible cause of therapy failure, the patient should be carefully approached. This should take into consideration factors that may be corrected and, most importantly, should aim at building a better patient-doctor relationship.
Topics: Humans; Inflammatory Bowel Diseases; Patient Compliance; Treatment Failure
PubMed: 16961745
DOI: 10.1111/j.1365-2036.2006.03060.x -
Nephrology, Dialysis, Transplantation :... Oct 2015Significant progress has been made in the management of hypertension (HTN) in the last 60 years. A large number of antihypertensive drugs (AHD) is available for... (Review)
Review
Significant progress has been made in the management of hypertension (HTN) in the last 60 years. A large number of antihypertensive drugs (AHD) is available for effective control of elevated blood pressure (BP) that were also shown to be beneficial in improving all-cause mortality and cardiovascular morbidity in hypertensive individuals. Despite these successes, rates of BP control and outcomes in hypertensive patients remain suboptimal. Therefore, the availability of effective drug therapy itself appears to be insufficient to guarantee desirable results. Adherence to antihypertensive medications is a crucial mediator of favorable outcomes in treating HTN, and non-adherence, in turn, halts BP control. In this review, we will summarize the available evidence on health-related impacts of adherence to AHD, methods for the evaluation of adherence and potential interventions aimed to improve adherence in hypertensive individuals.
Topics: Antihypertensive Agents; Drug Prescriptions; Humans; Hypertension; Medication Adherence; Patient Compliance; Quality of Life
PubMed: 25335506
DOI: 10.1093/ndt/gfu330 -
The American Journal of Managed Care Feb 2003For many chronic conditions, poor patient compliance with prescribed medications and other aspects of medical treatment can adversely affect the treatment outcome.... (Review)
Review
For many chronic conditions, poor patient compliance with prescribed medications and other aspects of medical treatment can adversely affect the treatment outcome. Compliance with long-term treatment for chronic asymptomatic conditions such as hypertension is on the order of 50%. Although drugs with a longer therapeutic half-life may ease the burden of repeated daily dosing, the efficacy of any self-administered medication depends to a large extent on patient compliance. This article addresses the compliance issues in patients undergoing renal replacement therapy and in those with a successful renal transplant. A focused discussion of compliance in dialysis and renal transplant patients is followed by a general review of the literature on patient compliance. Many factors associated with poor compliance in this patient population are identified via a review of the recent literature. The difficulties in monitoring medication compliance and the methods used are discussed. Among factors associated with poor compliance, the following have been identified in several studies: frequent dosing, patient's perception of treatment benefits, poor patient-physician communication, lack of motivation, poor socioeconomic background, lack of family and social support, and younger age. Many strategies have been suggested to improve medication compliance, most without scientific validation. Strategies to improve compliance in dialysis and transplant patients are similar to those described for other chronic conditions and include simplifying the treatment regimen, establishing a partnership with the patient, and increasing awareness through education and feedback.
Topics: Drug Costs; Drug Monitoring; Health Behavior; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Patient Compliance; Patient Education as Topic; Physician-Patient Relations; Renal Dialysis; Self Administration; Social Support; Surveys and Questionnaires; Treatment Refusal
PubMed: 12597603
DOI: No ID Found