43,904 research outputs found
Strategies Towards Chronic Disease Management via Medication Compliance
In the wake of the 21st century, healthcare systems around the globe are faced with an exponential rise in expenses, heavy utilization of services associated with a steep rise in aging population, and limited financial as well as human resources to manage the growing healthcare needs. A large percentage of chronic diseases deteriorate to the point where a crisis is reached resulting in unnecessary long-term hospitalization at massive cost to the healthcare sector. A critical inference drawn from epidemiological data and past studies is that preventing occurrences of acute episodes holds the key to providing quality healthcare, reducing incidences of prolonged hospitalizations and resultant healthcare expenses. This research is a work-in-progress that seeks to explore innovative strategies towards promoting medication compliance among chronic patients. This paper discusses the need for medication compliance and the cost of non-compliance to the healthcare sector. Salient behavioral, organizational, and technical research issues, opportunities, and challenges associated with promoting medication compliance via communication, computing, and sensing technologies are discussed. Potential benefits and costs of deploying innovative IT based medication compliance are also presented
Inhalation therapy in the next decade : Determinants of adherence to treatment in asthma and COPD
Peer reviewedPublisher PD
Recommended from our members
A pilot study of a text messaging intervention to modify illness and medication beliefs amongst patients diagnosed with inflammatory bowel disease
Intentional and unintentional medication non-adherence is a particular challenge for patients with inflammatory bowel disease (IBD). Non-adherence can affect patients’ quality of life, which can result in unfavorable treatment outcomes, more hospitalizations, and higher healthcare-related costs. The purpose of this study was to assess whether a tailored text message intervention designed to modify illness and medication adherence beliefs in patients with IBD would increase treatment compliance and change patients’ illness perceptions and medication concerns. This pilot study utilized a pre-test-post-test non-randomized design. A sample of 32 IBD patients was recruited within the UK. Participants’ medication beliefs and illness perception scores determined the set of tailored daily text messages, which were sent to patients over duration of 12 weeks. Medication adherence increased post-intervention, as “forgetting to take medication” decreased while “never” forgetting to take medication increased over time. A significant increase in treatment control and coherence and a decreased level of concern surrounding their condition was evident. Participants’ level of concern towards their medications changed during the 12 weeks, with a baseline mean concern score of 3.08 (.57) in comparison to the 12 weeks mean concern score of 2.89 (.59), which is statistically different, t (31) = 2.16, p < .038, r = .36 (medium effect). Sixty-six percent of participants from the baseline were aware of the necessity of their medication: “without my medication I would become ill.” The results have direct implications for improving medication adherence and changing illness and medication beliefs. This study validated the benefits of text messages and highlighted the importance of addressing these beliefs in order to understand the reasons for non-adherence fully
Psychological Factors and Treatment Adherence Behavior in Patients With Chronic Heart Failure
Background: Chronic heart failure adversely affects 300,000 Australians. Symptom stabilization and prognosis are partially determined by patients following medical and lifestyle recommendations. Methods: To test the hypothesis that depression, anxiety, and self-efficacy are independent predictors of such adherence, 115 predominately male (70.6%) volunteers with a mean age of 63 years were recruited from a major teaching hospital in Australia. Results: Depression (Beck Depression Inventory score >10, 33.3%) failed to predict adherence. Trait anxiety (State-Trait Anxiety Inventory score >40, 31%) explained minimal variability regarding smoking and alcohol adherence. Self-efficacy strongly predicted adherence behavior. Conclusions: Findings will assist cardiac nurses to prepare strategies to optimize adherence and quality of life while minimizing public health costs
Recent Saccadic Eye Movement Research Uncovers Patterns of Cognitive Dysfunction in Schizophrenia.
The frontal cortex and the subcortical areas of the brain play a major role in the control of thought and action. Eye movements are increasingly used in neuropsychological research to explore the executive and sensorimotor functions of such neural networks. This interface links the control of action, at the fundamental levels of neurophysiological and neurochemical processes, with the high-level cognitive operations that underlie visual orienting. Patients with schizophrenia have neurocognitive impairments that can be readily investigated with novel saccadic eye movement paradigms. Animal, human lesion, and neuroimaging studies have identified the cerebral centers that underlie saccadic eye movements. The areas of the prefrontal cortex include the dorsolateral prefrontal cortex, the frontal eye fields, the supplementary eye fields, and the anterior cingulate gyrus. Pathology of saccadic eye movements therefore provides information on the functional status of the underlying neural circuitry in brain disorders such as schizophrenia
The clinical effectiveness and cost-effectiveness of inhaler devices used in the routine management of chronic asthma in older children: a systematic review and economic evaluation
Background:
This review examines the clinical effectiveness and
cost-effectiveness of hand-held inhalers to deliver
medication for the routine management of chronic
asthma in children aged between 5 and 15 years.
Asthma is a common disease of the airways, with a
prevalence of treated asthma in 5–15-year-olds of
around 12% and an actual prevalence in the community
as high as 23%. Treatment for the condition
is predominantly by inhalation of medication. There
are three main types of inhaler device, pressurised
metered dose, breath actuated, and dry powder, with
the option of the attachment of a spacer to the first
two devices under some prescribed circumstances.
Two recent reviews have examined the clinical and
cost-effectiveness evidence on inhaler devices, but
one was for children aged under 5 years and the
comparison in the second was made between pressurised
metered dose inhalers and other types only.
Objectives:
This review examines the clinical effectiveness and
cost-effectiveness of manual pressurised metered
dose inhalers, breath-actuated metered dose
inhalers, and breath-actuated dry powder inhalers,
with and without spacers as appropriate, to deliver
medication for the routine management of chronic
asthma in children aged between 5 and 15 years.
Methods:
Two previous HTA reviews have compared the
effectiveness of inhaler devices, one focusing on
asthma in children aged under 5 years and the
other on asthma and chronic obstructive airways
disease in all age groups. For the current review, a
literature search was carried out to identify all
evidence relating to the use of inhalers in older
children with chronic asthma. A search of in-vitro
studies undertaken for one of the previous reviews
was also updated.
The data sources used were: 15 electronic bibliographic
databases; the reference lists of one of the
previous HTA reports and other relevant articles;
health services research-related internet resources;
and all sponsor submissions.
Studies were selected according to strict inclusion
and exclusion criteria, and relevant information
concerning effectiveness and patient compliance
and preference was extracted directly on to an
extraction/evidence table. Quality assurance
was monitored.
Economic evaluation was undertaken by reviewing
existing cost-effective evidence. Further economic
modelling was carried out, and tables constructed
to determine device cost-minimisation and
incremental quality-adjusted life-year (QALY)
thresholds between devices.
Results:
Number and quality of studies, and
direction of evidence:
Fourteen randomised controlled studies were
identified relating to the clinical effectiveness of
inhaler devices for delivering β2-agonists. A further
five were on devices delivering corticosteroids and
one concerned the delivery of cromoglicate.
Overall, there were no differences in clinical
efficacy between inhaler devices, but a pressurised
metered dose inhaler with a spacer would appear
to be more effective than one without. These
findings endorse those of a previous HTA review
but extend them to other inhaler devices.
Seven randomised controlled trials examined the
impact on clinical effectiveness of using a nonchlorofluorocarbon
(CFC) propellant in place of
a CFC propellant in metered dose inhalers, both
pressurised and breath activated, although only one
study considered the latter type. No differences were
found between inhalers containing either propellant.
A further 30 studies of varying quality, from 12 randomised
controlled trials to non-controlled studies,
were identified that concerned the impact of use
by, and preference for, inhaler type, and treatment
adherence in children. Differences between the
studies, and limitations in comparative data between
various inhaler device types, make it difficult to draw
any firm conclusions from this evidence.
Summary of benefits:
No obvious benefits for one inhaler device type
over another for use in children aged 5–15 years
were identified.
Costs and cost per quality-adjusted
life-year:
Two approaches have been taken: cost-minimisation
and QALY threshold. In the QALY threshold
approach, additional QALYs that each device must
produce compared with a cheaper device to achieve
an acceptable cost per QALY were calculated. Using
the cheapest and most expensive devices for delivering
200 ÎĽg of beclometasone per day, assuming no
cost offset for any device, and a threshold of ÂŁ5000,
the largest QALY needed was 0.00807. With such
a small QALY increase, no intervention can be
categorically rejected as not cost-effective.
Conclusions:
Generalisability of findings:
On the available evidence there are no obvious
benefits for one inhaler device over another
when used by children aged 5–15 years with
chronic asthma. However, the evidence, in the
majority of cases, was compiled on children
with mild to moderate asthma and restricted
to a limited number of drugs. Therefore the
findings may not be generalisable to those at
the more severe end of the spectrum of the
disease or to inhaler devices delivering some
of the drugs used in the management of asthma.
Need for further research:
Many of the previous studies are likely to
have been underpowered. Further clinical
trials with a robust methodology, sufficient
power and qualitative components are needed
to demonstrate any differences in clinical
resource use and patients’ asthma symptoms.
Further studies should also include the
behavioural aspects of patients towards their
medication and its delivery mechanisms.
It is acknowledged that sufficient power may
prove impractical owing to the large numbers
of patients required
The Value Driven Pharmacist: Basics of Access, Cost, and Quality 2nd Edition
https://digitalcommons.butler.edu/butlerbooks/1017/thumbnail.jp
Attitudes towards clinical services among people who self-harm: systematic review.
BACKGROUND: Self-harm is increasingly common in many countries, is often repeated and may have other negative outcomes. AIMS: To systematically review people's attitudes towards clinical services following self-harm in order to inform service design and improvement. METHOD: A search of electronic databases was conducted and experts in the field were contacted in order to identify relevant worldwide qualitative or quantitative studies. Data were extracted independently by two reviewers with more weight given to studies of greater quality and relevance. RESULTS: Thirty-one studies met the inclusion criteria. Despite variations in healthcare systems and setting, participants' experiences were remarkably similar. Poor communication between patients and staff and a perceived lack of staff knowledge with regard to self-harm were common themes. Many participants suggested that psychosocial assessments and access to after-care needed to be improved. CONCLUSIONS: Specific aspects of care that might increase service user satisfaction and treatment adherence include staff knowledge, communication and better after-care arrangements. A standard protocol could aid regular audits of users' experiences of services
Psychometric properties of the Mental Health Recovery Star.
BACKGROUND: The Mental Health Recovery Star (MHRS) is a popular outcome measure rated collaboratively by staff and service users, but its psychometric properties are unknown. AIMS: To assess the MHRS's acceptability, reliability and convergent validity. METHOD: A total of 172 services users and 120 staff from in-patient and community services participated. Interrater reliability of staff-only ratings and test-retest reliability of staff-only and collaborative ratings were assessed using intraclass correlation coefficients (ICCs). Convergent validity between MHRS ratings and standardised measures of social functioning and recovery was assessed using Pearson correlation. The influence of collaboration on ratings was assessed using descriptive statistics and ICCs. RESULTS: The MHRS was relatively quick and easy to use and had good test-retest reliability, but interrater reliability was inadequate. Collaborative ratings were slightly higher than staff-only ratings. Convergent validity suggests it assesses social function more than recovery. CONCLUSIONS: The MHRS cannot be recommended as a routine clinical outcome tool but may facilitate collaborative care planning
- …