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PLoS Medicine Jul 2007Tuberculosis (TB) is a major contributor to the global burden of disease and has received considerable attention in recent years, particularly in low- and middle-income... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Tuberculosis (TB) is a major contributor to the global burden of disease and has received considerable attention in recent years, particularly in low- and middle-income countries where it is closely associated with HIV/AIDS. Poor adherence to treatment is common despite various interventions aimed at improving treatment completion. Lack of a comprehensive and holistic understanding of barriers to and facilitators of, treatment adherence is currently a major obstacle to finding effective solutions. The aim of this systematic review of qualitative studies was to understand the factors considered important by patients, caregivers and health care providers in contributing to TB medication adherence.
METHODS AND FINDINGS
We searched 19 electronic databases (1966-February 2005) for qualitative studies on patients', caregivers', or health care providers' perceptions of adherence to preventive or curative TB treatment with the free text terms "Tuberculosis AND (adherence OR compliance OR concordance)". We supplemented our search with citation searches and by consulting experts. For included studies, study quality was assessed using a predetermined checklist and data were extracted independently onto a standard form. We then followed Noblit and Hare's method of meta-ethnography to synthesize the findings, using both reciprocal translation and line-of-argument synthesis. We screened 7,814 citations and selected 44 articles that met the prespecified inclusion criteria. The synthesis offers an overview of qualitative evidence derived from these multiple international studies. We identified eight major themes across the studies: organisation of treatment and care; interpretations of illness and wellness; the financial burden of treatment; knowledge, attitudes, and beliefs about treatment; law and immigration; personal characteristics and adherence behaviour; side effects; and family, community, and household support. Our interpretation of the themes across all studies produced a line-of-argument synthesis describing how four major factors interact to affect adherence to TB treatment: structural factors, including poverty and gender discrimination; the social context; health service factors; and personal factors. The findings of this study are limited by the quality and foci of the included studies.
CONCLUSIONS
Adherence to the long course of TB treatment is a complex, dynamic phenomenon with a wide range of factors impacting on treatment-taking behaviour. Patients' adherence to their medication regimens was influenced by the interaction of a number of these factors. The findings of our review could help inform the development of patient-centred interventions and of interventions to address structural barriers to treatment adherence.
Topics: Humans; Outcome Assessment, Health Care; Patient Compliance; Qualitative Research; Tuberculosis
PubMed: 17676945
DOI: 10.1371/journal.pmed.0040238 -
Clinical Medicine & Research Jun 2013Despite evidence indicating therapeutic benefit for adhering to a prescribed regimen, many patients do not take their medications as prescribed. Non-adherence often... (Comparative Study)
Comparative Study
OBJECTIVE
Despite evidence indicating therapeutic benefit for adhering to a prescribed regimen, many patients do not take their medications as prescribed. Non-adherence often leads to morbidity and to higher health care costs. The objective of the study was to assess patient characteristics associated with medication adherence across eight diseases.
DESIGN
Retrospective data from a repository within an integrated health system was used to identify patients ≥18 years of age with ICD-9-CM codes for primary or secondary diagnoses for any of eight conditions (depression, hypertension, hyperlipidemia, diabetes, asthma or chronic obstructive pulmonary disease, multiple sclerosis, cancer, or osteoporosis). Electronic pharmacy data was then obtained for 128 medications used for treatment.
METHODS
Medication possession ratios (MPR) were calculated for those with one condition and one drug (n=15,334) and then for the total population having any of the eight diseases (n=31,636). The proportion of patients adherent (MPR ≥80%) was summarized by patient and living-area (census) characteristics. Bivariate associations between drug adherence and patient characteristics (age, sex, race, education, and comorbidity) were tested using contingency tables and chi-square tests. Logistic regression analysis examined predictors of adherence from patient and living area characteristics.
RESULTS
Medication adherence for those with one condition was higher in males, Caucasians, older patients, and those living in areas with higher education rates and higher income. In the total population, adherence increased with lower comorbidity and increased number of medications. Substantial variation in adherence was found by condition with the lowest adherence for diabetes (51%) and asthma (33%).
CONCLUSIONS
The expectation of high adherence due to a covered pharmacy benefit, and to enhanced medication access did not hold. Differences in medication adherence were found across condition and by patient characteristics. Great room for improvement remains, specifically for diabetes and asthma.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Asthma; Comorbidity; Depression; Diabetes Mellitus; Educational Status; Female; Humans; Hyperlipidemias; Hypertension; Male; Medication Adherence; Middle Aged; Patient Compliance; Racial Groups; Retrospective Studies; Sex Factors; Young Adult
PubMed: 23580788
DOI: 10.3121/cmr.2013.1113 -
Journal of Medical Internet Research Jul 2020Telemonitoring enables care providers to remotely support outpatients in self-managing chronic heart failure (CHF), but the objective assessment of patient compliance... (Randomized Controlled Trial)
Randomized Controlled Trial
The Effects of Telemonitoring on Patient Compliance With Self-Management Recommendations and Outcomes of the Innovative Telemonitoring Enhanced Care Program for Chronic Heart Failure: Randomized Controlled Trial.
BACKGROUND
Telemonitoring enables care providers to remotely support outpatients in self-managing chronic heart failure (CHF), but the objective assessment of patient compliance with self-management recommendations has seldom been studied.
OBJECTIVE
This study aimed to evaluate patient compliance with self-management recommendations of an innovative telemonitoring enhanced care program for CHF (ITEC-CHF).
METHODS
We conducted a multicenter randomized controlled trial with a 6-month follow-up. The ITEC-CHF program comprised the provision of Bluetooth-enabled scales linked to a call center and nurse care services to assist participants with weight monitoring compliance. Compliance was defined a priori as weighing at least 4 days per week, analyzed objectively from weight recordings on the scales. The intention-to-treat principle was used to perform the analysis.
RESULTS
A total of 184 participants (141/184, 76.6% male), with a mean age of 70.1 (SD 12.3) years, were randomized to receive either ITEC-CHF (n=91) or usual care (control; n=93), of which 67 ITEC-CHF and 81 control participants completed the intervention. For the compliance criterion of weighing at least 4 days per week, the proportion of compliant participants in the ITEC-CHF group was not significantly higher than that in the control group (ITEC-CHF: 67/91, 74% vs control: 56/91, 60%; P=.06). However, the proportion of ITEC-CHF participants achieving the stricter compliance standard of at least 6 days a week was significantly higher than that in the control group (ITEC-CHF: 41/91, 45% vs control: 23/93, 25%; P=.005).
CONCLUSIONS
ITEC-CHF improved participant compliance with weight monitoring, although the withdrawal rate was high. Telemonitoring is a promising method for supporting both patients and clinicians in the management of CHF. However, further refinements are required to optimize this model of care.
TRIAL REGISTRATION
Australian New Zealand Clinical Trial Registry ACTRN12614000916640; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366691.
Topics: Aged; Chronic Disease; Female; Heart Failure; Humans; Male; Patient Compliance; Remote Consultation; Self-Management; Telemedicine; Treatment Outcome
PubMed: 32673222
DOI: 10.2196/17559 -
Investigacion Y Educacion En Enfermeria Sep 2019To determine the factors associated with adherence to the therapeutic regime in patients with hypertension and type 2 diabetes mellitus cared for in primary care centers.
OBJECTIVES
To determine the factors associated with adherence to the therapeutic regime in patients with hypertension and type 2 diabetes mellitus cared for in primary care centers.
METHODS
This was an analytical cross-sectional study, conducted with 500 patients from two institutions in Bucaramanga (Colombia). Adherence to the therapeutic regime was measured with the label of Nursing outcomes "Treatment Behavior: Illness or Injury" and the instrument "Factors that influence on adherence to pharmacological and non-pharmacological treatments" by Ortiz Suárez was used.
RESULTS
Factors affecting negatively adherence to the therapeutic regime were: belonging to the subsidized regime, never being able to read written information about the management of their disease, and never receiving information about benefits of the medications ordered by the physician. On the contrary, positive influence was noted by referring "never" to the following statements, which impacted positively on adherence: the diverse occupations you have in and out of the house hinder your following the treatment; when your symptoms improve, do you interrupt the treatment? previously, have you had difficulties in complying with your treatment and believe there are difficult-to-change customs about foods and exercises?
CONCLUSIONS
Two socioeconomic factors and one related with the health system and staff affected negatively on adherence to the therapeutic regime, while four factors related with the therapy favored it. The factors identified could be used in the design of nursing interventions to improve adherence in this population.
Topics: Aged; Colombia; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Female; Humans; Hypertension; Male; Middle Aged; Patient Compliance; Primary Health Care; Socioeconomic Factors
PubMed: 31830400
DOI: 10.17533/udea.iee.v37n3e02 -
Heart (British Cardiac Society) May 2003Partial medication compliance, where patients do not take enough of their prescribed medicine to achieve adequate outcomes, is common. Research using electronic... (Review)
Review
Partial medication compliance, where patients do not take enough of their prescribed medicine to achieve adequate outcomes, is common. Research using electronic monitoring to assess compliance has shown that people take approximately 75% of doses as prescribed, irrespective of the condition being treated or its severity. Erratic compliance often leads to discontinuation of therapy, as treatment is perceived to be ineffective. Compliance decreases as frequency of dosing increases. Inadequate compliance and treatment persistence results in poor outcomes, despite the best efforts of the medical team. It is important to develop and implement a strategy to improve compliance. Simple steps that can be taken include helping patients to select "cues" to remind them to take their tablets, use of dose reminder boxes, and visual feedback of compliance data from electronic monitors.
Topics: Drug Administration Schedule; Drug Therapy; Humans; Patient Compliance; Pharmaceutical Preparations; Therapy, Computer-Assisted; Treatment Outcome
PubMed: 12695430
DOI: 10.1136/heart.89.suppl_2.ii19 -
Canadian Respiratory Journal 2004
Topics: Administration, Inhalation; Humans; Patient Compliance; Pulmonary Disease, Chronic Obstructive; Steroids; Treatment Outcome
PubMed: 15010726
DOI: 10.1155/2004/763071 -
Respiratory Care Jun 2015Nonadherence to prescribed medications results in disease instability and poor clinical control, with increases in hospital admissions, emergency room visits,... (Review)
Review
Nonadherence to prescribed medications results in disease instability and poor clinical control, with increases in hospital admissions, emergency room visits, school/work absenteeism, morbidity, and mortality. Poor patient adherence to therapy can be due to lack of cognition, competence, or contrivance. Patients who have not been trained or fail to understand use of drug and device combinations (cognition) often do not have the ability to use an aerosol device correctly (competence). Many patients have the competence to use the device correctly and know why they should use the device in the way they were taught; however, they still contrive to use it in an ineffective and suboptimal manner that reduces its efficiency and effectiveness. Ensuring effective aerosol therapy and optimizing its role in disease management involve not only delivery of aerosolized medications to the lungs, but also understanding why, when, and how to use the medications, competence to use the device, motivation to adhere to therapy, and not contriving to use the device in a way that will prevent effective drug delivery. This paper explains some of the problems with patient education and adherence to aerosol therapy and suggests strategies to evaluate, monitor, and improve patient adherence effectively in primary care. Factors affecting patient adherence to prescribed medications, effective educational interventions, and strategies to promote patient adherence to aerosol therapy are also discussed.
Topics: Administration, Inhalation; Aerosols; Cognition; Health Knowledge, Attitudes, Practice; Humans; Mental Competency; Nebulizers and Vaporizers; Patient Compliance; Patient Education as Topic
PubMed: 26070585
DOI: 10.4187/respcare.03854 -
Adicciones Apr 2019This study investigates the predictive value of impulsivity traits (as measured by the UPPS-P impulsive behaviour scale) and relevant covariates (sociodemographics,...
This study investigates the predictive value of impulsivity traits (as measured by the UPPS-P impulsive behaviour scale) and relevant covariates (sociodemographics, gambling severity, dysphoric mood, other potentially addictive behaviours, and non-verbal intelligence) with regard to treatment dropout and level of adherence to therapy guidelines and instructions in patients with gambling disorder. Sixty-six patients seeking treatment for gambling disorder, and recruited to participate in a larger protocol (G-Brain), were initially assessed in impulsivity traits and relevant covariates in the first six months after admission. Of these, 24 patients dropped out (DO) and 42 patients remained in therapy (NDO) during the subsequent 6-month follow-up period. A multivariate analysis of impulsivity subscales suggested prospective differences between DO and NDO, with affect-driven dimensions (positive and negative urgency) seemingly driving these differences. Among these, only positive urgency independently predicted a slight increase in the drop-out probability. In the NDO group, a higher degree of adherence to therapy was independently predicted by lower sensation-seeking scores and stronger awareness of gambling-related problems. Results suggest the presence of affect-driven impulsivity traits as dropout predictors in patients with gambling disorder. Awareness of gambling-related problems and lower sensation-seeking enhanced compliance with therapeutic guidelines and instructions.
Topics: Adult; Awareness; Female; Gambling; Harm Reduction; Humans; Impulsive Behavior; Logistic Models; Male; Middle Aged; Multivariate Analysis; Patient Compliance; Patient Dropouts; Prospective Studies; Surveys and Questionnaires
PubMed: 30059585
DOI: 10.20882/adicciones.1041 -
Atencion Primaria Feb 2015To test the effectiveness of a program to improve treatment adherence in new onset hypertensive patients.
OBJECTIVE
To test the effectiveness of a program to improve treatment adherence in new onset hypertensive patients.
DESIGN
This is a quasi-experimental study.
LOCATION
Four health centers in Almeria.
PARTICIPANTS
A total of 120 subjects between 18 and 65 years, diagnosed with hypertension within the previous 12 months.
MAIN MEASUREMENTS
The participants were divided into three groups: intervention group A, which received educational instruction, intervention group B, educational instruction and feedback process, and the control group C, received usual care. Adherence was determined by lifestyle (diet, physical activity, smoking, alcohol) and drug treatment.
RESULTS
As regards diet and physical activity, there were significant differences between performance groups after intervention (p<0,05), with better adherence levels being found in group B subjects for these variables. Better adherence to pharmacological treatment was also observed in these patients. No significant results were found regarding alcohol and smoking.
CONCLUSIONS
In the study population, patients undergoing educational instruction and feedback had better adherence levels than those who received only instruction or usual treatment.
Topics: Adult; Aged; Female; Humans; Hypertension; Male; Middle Aged; Patient Compliance; Program Evaluation; Young Adult
PubMed: 24889381
DOI: 10.1016/j.aprim.2014.03.009 -
Early Intervention in Psychiatry Apr 2020The stigma of mental disorders and poor treatment compliance can deprive patients with major depressive disorder (MDD) of receiving standard treatment. This study aimed... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
The stigma of mental disorders and poor treatment compliance can deprive patients with major depressive disorder (MDD) of receiving standard treatment. This study aimed to clarify whether MDD patients' stigma and treatment non-compliance issues can be mitigated using group cognitive behavioural therapy (GCBT).
METHODS
Eighty-eight participants with first-episode MDD were randomly divided into GCBT groups (GCBTs) and control groups (Cs). The Hamilton Rating Scale for Depression (HRSD-24), Morisky Medication Adherence Scale (MMAS-8™) and Stigma Scale (SS) were used to evaluate the therapeutic effect on all participants before and after receiving GCBT. Data were assessed at baseline and post-treatment.
RESULTS
At the baseline, there were no significant differences (in terms of the demographic data of the participants and the scores on HRSD-24, MMAS-8™ and SS) between the two groups. After 8 weeks of GCBT, there were significant differences in HRSD-24 (P < .01), MMAS-8™ (P < .01), SS (P < .01), treatment compliance (P < .01) and therapeutic effect evaluation based on rate of deduction (P < .05) between the two groups.
CONCLUSION
GCBT can reduce patients' sense of stigma, improve treatment compliance, effectively alleviate depressive symptoms and promote the recovery of MDD patients.
Topics: Adolescent; Adult; Cognitive Behavioral Therapy; Depressive Disorder, Major; Female; Humans; Male; Middle Aged; Patient Compliance; Psychotherapy, Group; Social Stigma; Treatment Outcome; Young Adult
PubMed: 31264787
DOI: 10.1111/eip.12841