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Journal of Parkinson's Disease 2020Exercise is increasingly being recognized as a key element in the overall management of persons living with Parkinson's disease (PD) but various (disease-specific)... (Review)
Review
Exercise is increasingly being recognized as a key element in the overall management of persons living with Parkinson's disease (PD) but various (disease-specific) barriers may impede even motivated patients to participate in regular exercise. We aimed to provide a comprehensive review of the various barriers and motivators for exercise in persons with PD. We scrutinized data on compliance-related factors published in cross-sectional studies, randomized controlled trials and reviews. We classified the barriers and motivators to exercise from a patient perspective according to the International Classification of Functioning, Disability and Health. We present an overview of the large range of potential motivators and barriers for exercise in persons with PD. Healthcare professionals should consider a wide and comprehensive range of factors, in order to identify which specific determinants matter most for each individual. Only when persons with PD are adequately motivated in a way that appeals to them and after all person-specific barriers have been tackled, we can begin to expect their long-term adherence to exercise. Such long-term compliance will be essential if exercise is to live up to its expectations, including the hope that prolonged engagement in regular exercise might help to modify the otherwise relentlessly progressive course of PD.
Topics: Attitude to Health; Exercise; Exercise Therapy; Humans; Motivation; Parkinson Disease; Patient Compliance; Self Efficacy
PubMed: 32925106
DOI: 10.3233/JPD-202247 -
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 -
American Journal of Hematology Sep 2018Declining a treatment modality should not be considered the same as refusal of medical care as illustrated by the management of Jehovah's Witness patients who do not...
Declining a treatment modality should not be considered the same as refusal of medical care as illustrated by the management of Jehovah's Witness patients who do not accept transfusions. Over the years, a comprehensive set of strategies have been developed to meet the specific needs of these patients and these strategies are collectively called "Bloodless Medicine and Surgery" (BMS). The focus in BMS is to optimize the patients' hematopoietic capacity to increase hemoglobin (Hgb) level, minimize blood loss, improve hemostasis, and provide supportive strategies to minimize oxygen consumption and maximize oxygen utilization. We present 3 case reports that illustrate some of the challenges faced and measures available to effectively treat these patients. Under BMS programs, patients with extremely low hemoglobin levels, not conducive to survival under ordinary conditions, have survived and recovered without receiving allogeneic transfusions. Additionally, the valuable experience gained from caring for these patients has paved the way to develop the concept of Patient Blood Management as a standard care to benefit all patients, and not only those for whom blood is not an option.
Topics: Adolescent; Adult; Anemia; Blood Transfusion; Disease Management; Female; Hemoglobins; Humans; Jehovah's Witnesses; Male; Middle Aged; Oxygen Consumption; Patient Compliance; Treatment Refusal
PubMed: 30033541
DOI: 10.1002/ajh.25167 -
Revista de Saude Publica Dec 2016To verify the effects of antihypertensive treatment (pharmacological and non-pharmacological) on the health-related quality of life of individuals with hypertension. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To verify the effects of antihypertensive treatment (pharmacological and non-pharmacological) on the health-related quality of life of individuals with hypertension.
METHODS
We conducted a systematic review with meta-analysis using the following databases: IBECS, LILACS, SciELO, Medline, Cochrane, Science Direct, Scopus and the Brazilian Capes Theses and Dissertations Database. The statistical analysis was performed using Review Manager, version 5.2. The average difference was used for the summarization of meta-analytic effect by the fixed-effect model. Twenty studies were included.
RESULTS
The summarization of the effect showed an average increase of 2.45 points (95%CI 1.02-3.87; p < 0.0008) in the quality of life of individuals adhering to non-pharmacological treatment for arterial hypertension. Adherence to pharmacological treatment indicated an average increase of 9.24 points (95%CI 8.16-10.33; p < 0.00001) in the quality of life of individuals with arterial hypertension.
CONCLUSIONS
Non-pharmacological treatment improves the overall quality of life and physical domain of people with arterial hypertension. Adherence to pharmacological treatment has a positive impact on the mental and physical domains of patients, as it did on the overall quality of life score.
OBJETIVO
Verificar os efeitos do tratamento anti-hipertensivo (farmacológico e não-farmacológico) na qualidade de vida relacionada à saúde de pessoas com hipertensão arterial.
MÉTODOS
Foi conduzida revisão sistemática com metanálise utilizando as bases de dados IBECS, Lilacs, SciELO, Medline, Cochrane, Science Direct, Scopus e o banco de teses da Capes. A análise estatística foi realizada pelo Review Manager versão 5.2. Foi utilizada a diferença da média na sumarização do efeito metanalítico pelo modelo de efeito fixo. Vinte estudos foram incluídos.
RESULTADOS
A sumarização do efeito mostrou incremento de 2,45 pontos na média (IC95% 1,02-3,87; p < 0,0008) da qualidade de vida em pessoas com adesão ao tratamento não farmacológico para hipertensão arterial. A adesão ao tratamento farmacológico indicou aumento de 9,24 pontos na média (IC95% 8,16-10,33; p < 0,00001) da qualidade de vida em pessoas com hipertensão arterial.
CONCLUSÕES
O tratamento não-farmacológico melhora a qualidade de vida global e o domínio físico de pessoas com hipertensão arterial. A adesão ao tratamento farmacológico impacta positivamente nos domínios mental, físico e escore total da qualidade de vida.
Topics: Antihypertensive Agents; Brazil; Humans; Hypertension; Medication Adherence; Patient Compliance; Quality of Life
PubMed: 28099657
DOI: 10.1590/S1518-8787.2016050006415 -
Journal of Medical Internet Research Feb 2015Adherence to chronic disease management is critical to achieving improved health outcomes, quality of life, and cost-effective health care. As the burden of chronic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Adherence to chronic disease management is critical to achieving improved health outcomes, quality of life, and cost-effective health care. As the burden of chronic diseases continues to grow globally, so does the impact of non-adherence. Mobile technologies are increasingly being used in health care and public health practice (mHealth) for patient communication, monitoring, and education, and to facilitate adherence to chronic diseases management.
OBJECTIVE
We conducted a systematic review of the literature to evaluate the effectiveness of mHealth in supporting the adherence of patients to chronic diseases management ("mAdherence"), and the usability, feasibility, and acceptability of mAdherence tools and platforms in chronic disease management among patients and health care providers.
METHODS
We searched PubMed, Embase, and EBSCO databases for studies that assessed the role of mAdherence in chronic disease management of diabetes mellitus, cardiovascular disease, and chronic lung diseases from 1980 through May 2014. Outcomes of interest included effect of mHealth on patient adherence to chronic diseases management, disease-specific clinical outcomes after intervention, and the usability, feasibility, and acceptability of mAdherence tools and platforms in chronic disease management among target end-users.
RESULTS
In all, 107 articles met all inclusion criteria. Short message service was the most commonly used mAdherence tool in 40.2% (43/107) of studies. Usability, feasibility, and acceptability or patient preferences for mAdherence interventions were assessed in 57.9% (62/107) of studies and found to be generally high. A total of 27 studies employed randomized controlled trial (RCT) methods to assess impact on adherence behaviors, and significant improvements were observed in 15 of those studies (56%). Of the 41 RCTs that measured effects on disease-specific clinical outcomes, significant improvements between groups were reported in 16 studies (39%).
CONCLUSIONS
There is potential for mHealth tools to better facilitate adherence to chronic disease management, but the evidence supporting its current effectiveness is mixed. Further research should focus on understanding and improving how mHealth tools can overcome specific barriers to adherence.
Topics: Cardiovascular Diseases; Chronic Disease; Diabetes Mellitus; Disease Management; Humans; Lung Diseases; Patient Compliance; Randomized Controlled Trials as Topic; Telemedicine; Text Messaging; Treatment Outcome
PubMed: 25803266
DOI: 10.2196/jmir.3951 -
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 -
Vision Research Sep 2015In the past 20 years, there has been a great advancement in knowledge pertaining to compliance with amblyopia treatments. The occlusion dose monitor introduced... (Review)
Review
In the past 20 years, there has been a great advancement in knowledge pertaining to compliance with amblyopia treatments. The occlusion dose monitor introduced quantitative monitoring methods in patching, which sparked our initial understanding of the dose-response relationship for patching amblyopia treatment. This review focuses on current compliance knowledge and the impact it has on patching and atropine amblyopia treatment.
Topics: Amblyopia; Atropine; Child; Humans; Mydriatics; Patient Compliance; Sensory Deprivation; Visual Acuity
PubMed: 25743080
DOI: 10.1016/j.visres.2015.02.012 -
Medicine Aug 2022Disease management programs (DMPs) have shown great potential for optimizing care of chronically ill patients, thereby improving health outcomes and patient... (Review)
Review
Disease management programs (DMPs) have shown great potential for optimizing care of chronically ill patients, thereby improving health outcomes and patient satisfaction. This had led to an overall reduction in healthcare costs. Longer life expectancy has led to increased utilization of healthcare facilities, which may lead to a rise in costs. DMPs are an effective means of improving care and compliance and ultimately curbing inappropriate resource utilization. The present study reviews different definitions proposed for disease management, its components, the evidence behind it, and the conditions for success. It also examines heart failure management as an example of a DMP, exploring the complexity surrounding implementation of guideline-based approaches in patient care. A literature search on DMPs was conducted using PubMed, MEDLINE, and Google Scholar, including heart failure management programs from articles published from 2000 to 2020. This reviewed emphasized on the management of important biomarkers and cardiovascular indicators such as glycemic levels, urine output to improve efficacy of disease management programme during patient treatment. The review concluded that diseases like heart failure can be combat by improving the quality of care for patients and reducing the burden on the public healthcare system. Moreover, DMPs have proved to be an effective way of improving care and compliance with treatment.
Topics: Chronic Disease; Disease Management; Health Care Costs; Heart Failure; Humans; Patient Compliance
PubMed: 35945723
DOI: 10.1097/MD.0000000000029805 -
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 -
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