A systematic review of measures of self-reported adherence to unsupervised home-based rehabilitation exercise programmes, and their psychometric properties

BACKGROUND: Adherence is an important factor contributing to the effectiveness of exercise-based rehabilitation. However, there appears to be a lack of reliable, validated measures to assess self-reported adherence to prescribed but unsupervised home-based rehabilitation exercises. OBJECTIVES: A systematic review was conducted to establish what measures were available and to evaluate their psychometric properties. DATA SOURCES: MEDLINE, EMBASE, PsycINFO CINAHL (June 2013) and the Cochrane library were searched (September 2013). Reference lists from articles meeting the inclusion criteria were checked to ensure all relevant papers were included. STUDY SELECTION: To be included articles had to be available in English; use a self-report measure of adherence in relation to a prescribed but unsupervised home-based exercise or physical rehabilitation programme; involve participants over the age of 18. All health conditions and clinical populations were included. DATA EXTRACTION: Descriptive data reported were collated on a data extraction sheet. The measures were evaluated in terms of eight psychometric quality criteria. RESULTS: 58 studies were included, reporting 61 different measures including 29 questionnaires, 29 logs, two visual analogue scales and one tally counter. Only two measures scored positively for one psychometric property (content validity). The majority of measures had no reported validity or reliability testing. CONCLUSIONS: The results expose a gap in the literature for well-developed measures that capture self-reported adherence to prescribed but unsupervised home-based rehabilitation exercises

Complementary and alternative medicines (CAMs) and adherence to mental health medications

BACKGROUND: Medication regimes are often poorly adhered to, and the negative consequences of this are well recognised. The dynamics underlying non-adherence are less understood. This paper examines adherence to prescription medications for mental health difficulties in relation to the use of complementary and alternative medicines (CAMs). This was based on suggestions that within medical pluralism, CAMs may reduce adherence to conventional prescription medications for reasons such as their further complicating the medication regime or their being perceived as a substitute with less adverse side effects than conventional prescription medications. METHODS: Data used was from the National Comorbidity Study Replication (NCS-R), specifically those 1396 individuals who reported taking a prescription drug for mental health difficulties within the last 12 months and under the supervision of a health professional. This subsample was selected due to their being the only subgroup questioned regarding their medication adherence. Other demographic and health factors were also considered. RESULTS: The use of complementary medicines alongside the conventional medicines bore no significant relation to odds of reporting adherence versus non adherence. Ethnicity and medication count were significant predictors of adherence versus non-adherence. CONCLUSIONS: The above findings are discussed from the point of both promoting the use of CAMs and increasing health professionals’ understanding of the dynamics underlying adherence, or the lack thereof, and subsequently informing interventions to reduce the problems associated with this issue in terms of increased health care needs and reduced quality of life

What elements of the patient–pharmacist relationship are associated with patient satisfaction?

Suliman A AlGhurair, Scot H Simpson, Lisa M GuirguisDepartment of Pharmacy Practice, University of Alberta, Edmonton, CanadaBackground: Optimal medication management requires an effective relationship between the patient and health care professional. As pharmacists move from the traditional dispensing role to become more actively involved in patient care, factors influencing their relationship with patients need to be identified. A better understanding of these factors will facilitate more effective relationships.Objective: To explore the effect of patient-perceived pharmacist expertise on relationship quality, self-efficacy, patient satisfaction, and relationship commitment.Methods: This was a cross-sectional study conducted in five community pharmacies within the province of Alberta, Canada. A total of 500 patients were asked to complete a set of validated, self-administered questionnaires that measured perceived pharmacist expertise, relationship quality, self-efficacy, patient satisfaction, and relationship commitment. Hierarchical multiple regression was used to examine the associations between variables.Results: A total of 112 surveys were returned. Internal consistency ranged from 0.86–0.92, suggesting good reliability, except for the relationship commitment scale. There was a significant, positive correlation between patient-perceived pharmacist expertise and quality of the relationship (0.78; P < 0.001). There were also significant, positive correlations between perceived expertise and patient satisfaction (0.52; P < 0.001) and relationship commitment (0.47; P < 0.001). These associations remained significant but the magnitude of correlation decreased when relationship quality was taken into account (0.55; P < 0.001 and 0.56; P < 0.001, respectively). On the other hand, there was no significant association between either patient-perceived pharmacist expertise or relationship quality and medication self-efficacy (0.06; P = 0.517 and 0.10; P = 0.292, respectively).Conclusion: Patient-perceived pharmacist expertise is an independent determinant of relationship quality, patient satisfaction, and relationship commitment. Relationship quality also appears to mediate the effect of perceived expertise on patient satisfaction and relationship commitment.Keywords: relationship quality, pharmacist expertise, self-efficacy, relationship commitment, satisfactio

Investigation of Insertion Phenomena with Needles Treated by Plasma Etching

AbstractPain during injection of a medical needle is greatly influenced by the surface roughness and geometry of its cutting edges. An ion- plasma sputtering treatment is a promising candidate as a clean and precise polishing method for the painless needles. In this paper, the mechanism of the reduction of inserting force of the plasma-treated needles is investigated by microscopically observing artificial skins and needles during insertion. It was found that the time distribution of insertion force was influenced by the roughness at the cutting edges. Plasma-treated needles resulted in force reduction by approximate half in comparison of untreated ones. Furthermore, the microscopic observation found that the sharp dropping of force was occurring at the corners between cutting faces. Using the plasma-treated needle, the sharp dropping was significantly decreased. The plasma-etching treatment will lead to a clean finishing process for painless medical needles