Preventing a Post-Pandemic Double Burden of Disease in the COVID-19 Pandemic

As the world focuses on containing the spread of the coronavirus disease 2019 (COVID-19) and limiting the effects of the pandemic on the global population, care must be taken not to lose sight of existing individual health issues. There is a real risk of creating a 'post-pandemic double burden of disease'- where the pressures of having to manage acute COVID-19-related impacts on the health system are added to the existing burden of chronic non-communicable diseases or long-term conditions in developed countries. This could create a post-pandemic health crisis by devoting less attention to existing health conditions. A growing evidence base from other epidemics and health emergencies highlight the potential negative impact of short-term health crises on long-term public health. The significant disruptions to the usual healthcare systems and society can lead to increased morbidity and mortality in the long-term if not managed appropriately. This viewpoint provides an overview of the evidence to support the management of long-term conditions during, and after, health emergencies, to limit the impact of COVID-19 on public health in the short- and long-term

Filial Piety and Dignity in End-of-Life Caregiving: Lived experience of Chinese families facing terminal cancer and receiving LTC care services in Hong Kong

Conference Theme: Clinical, Legal and Administrative ChallengesFree Paper Presentation 2published_or_final_versio

What’s your PLAN? A pilot study of a brief intervention to improve patient self-reported understanding of their health condition and medication in an inpatient hospital setting

OBJECTIVE: Health literacy is poor in many health service users. Although interventions exist, none have been implemented during an inpatient setting. This pilot study investigated the effect of a brief intervention, delivered by hospital pharmacists during an inpatient admission, on patient self-reported understanding of their health condition and medication—one aspect of health literacy. METHODS: Patients admitted to a tertiary hospital in New Zealand on one or more high-risk medication were included. Patients received a brief intervention discussing four steps (PLAN) to help patients: Prepare for their next health visit, Listen and share concerns, Ask questions and Note what to do next. The primary outcome was patient self-reported understanding of their health condition and medication. Secondary outcomes were number and types of pharmacist interventions, patient satisfaction and pharmacist intervention acceptability. RESULTS: Thirty-eight patients received the intervention. Scores improved for how well patients felt they understood their health conditions (increase from 3.65±1.16 to 4.28±0.74, P=0.027), their medication (3.50±1.11 to 4.44±0.77, P=0.001) and how to take their medication (4.12±0.95 to 4.60±0.76, P=0.051). Additional pharmacy interventions were made for 47% of patients. Mean patient satisfaction scores were high (4.64±0.57); however, pharmacist acceptability was only moderately positive with many finding the intervention only somewhat rewarding. CONCLUSION: This pilot study shows that a pharmacist-delivered intervention can have an effect on an aspect of health literacy in an inpatient setting. It suggests the potential for further inpatient interventions, which target health literacy issues

The Medication Adherence Report Scale (MARS-5): a measurement tool for eliciting patients’ reports of non-adherence

Aims: This study aimed to develop a questionnaire measure of patients' adherence to medications to elicit patients' report of medication use. The reliability and validity were assessed in patients with hypertension. Additional analyses were performed on other patient groups. Methods: Using a cross‐sectional study design, a 10‐item version of the Medication Adherence Report Scale (MARS)© Professor Rob Horne was piloted in two samples of patients receiving treatment for hypertension (n=50 + 178), asthma (n=100) or diabetes (n=100) at hospital outpatient or community clinics in London and the South‐East of England. Following principal components analysis, five items were retained to form the ‘MARS‐5'©Professor Rob Horne. Evaluation comprised internal reliability, test‐retest reliability, criterion‐related validity (relationship with blood pressure control) and construct validity (relationship with patients' beliefs about medicines). Results: The MARS‐5 demonstrated acceptable reliability (internal and test‐retest) and validity (criterion‐related and construct validity). Internal reliability (Cronbach's α) ranged from 0.67 to 0.89 across all patient groups; test‐retest reliability (Pearson's r) was 0.97 in Hypertension. Criterion‐related validity was established with more adherent hypertension patients showing better blood‐pressure control (χ2=4.24, df=1, p<0.05). Construct validity with beliefs about medicines was demonstrated with higher adherence associated with stronger beliefs in treatment necessity, and lower concerns. Conclusions: The MARS‐5 performed well on several psychometric indicators. It shows promise as an effective self‐report tool for measuring patients' reports of their medication use across a range of health conditions

Liberating dying persons & bereaved families from the oppression of death and loss in Chinese societies

postprintThe 20th IUHPE World Conference on Health Promotion, Geneva, Switzerland, 11-15 July 2010

Art Therapy Approach to Burnout Reduction for Hospice and Palliative Care Workers

Poster Presentation: no. SPP-P8.29Conference Theme: Enhancing Health - 協作同心‧醫澤社群published_or_final_versio

Medication beliefs, adherence, and outcomes in people with asthma: The importance of treatment beliefs in understanding inhaled corticosteroid nonadherence—a retrospective analysis of a real-world data set

BACKGROUND: Poor adherence to inhaled corticosteroids (ICSs) increases asthma morbidity and mortality and is influenced by patients’ treatment beliefs. This study maps patients’ beliefs about ICSs across 6 countries examining variations in beliefs, and their relationship with adherence and outcomes. OBJECTIVE: We sought to explore the relationship between patient treatment beliefs, and adherence and outcomes in asthma across 6 countries. METHODS: Patients 18 years or older with asthma, receiving ICS alone or in combination with a long-acting β2-agonist, were included from a point-in-time paper survey of patients with asthma in Europe and the United States. Clinical characteristics, such as adherence and asthma control, were collected by self- and physician-report. Patients completed the Beliefs about Medicines Questionnaire, adapted for ICSs. Relationships between patient treatment beliefs, adherence, and outcomes were examined using regression analyses. RESULTS: Data from 1312 patients were analyzed. Patients were from Germany (24%), the United States (21%), France (21%), Spain (16%), Italy (10%), and the United Kingdom (9%). Most had physician-reported mild-intermittent asthma (87%), and mean age was 40 ± 15.5 years. There was considerable variation in necessity beliefs between countries, with respondents in Italy having more doubts about treatment necessity and respondents in Spain showing higher concerns. Patients with doubts about ICS necessity and high concerns had lower self-reported (necessity: χ2(2) = 34.31, P < .001; concerns: χ2(2) = 20.98, P < .001) and physician-reported adherence (necessity: χ2(2) = 11.70, P = .003; concerns: χ2(2) = 34.45, P < .001). Patients with high necessity beliefs (F(2, 483) = 3.33; P = .037) and high concerns (F(2,483) = 23.46; P < .001) reported poorer control. Physician estimates of adherence did not correlate well with patient self-report (ρ = 0.178, P < .001). CONCLUSIONS: ICS necessity beliefs and concerns were associated with adherence and asthma control. This has implications for the design of adherence interventions

Effect of electronic adherence monitoring on adherence and outcomes in chronic conditions: A systematic review and metaanalysis

Introduction Electronic adherence monitoring (EAM) is increasingly used to improve adherence. However, there is limited evidence on the effect of EAM in across chronic conditions and on patient acceptability. We aimed to assess the effect of EAM on adherence and clinical outcomes, across all ages and all chronic conditions, and examine acceptability in this systematic review and meta-analysis. Methods A systematic search of Ovid MEDLINE, EMBASE, Social Work Abstracts, PsycINFO, International Pharmaceutical Abstracts and CINAHL databases was performed from database inception to December 31, 2020. Randomised controlled trials (RCTs) that evaluated the effect of EAM on medication adherence as part of an adherence intervention in chronic conditions were included. Study characteristics, differences in adherence and clinical outcomes between intervention and control were extracted from each study. Estimates were pooled using random-effects meta-analysis, and presented as mean differences, standardised mean differences (SMD) or risk ratios depending on the data. Differences by study-level characteristics were estimated using subgroup meta-analysis to identify intervention characteristics associated with improved adherence. Effects on adherence and clinical outcomes which could not be meta-analysed, and patient acceptability, were synthesised narratively. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed, and Risk of bias (RoB) assessed using the Cochrane Collaboration's RoB tool for RCTs. The review is registered with PROSPERO CRD42017084231. Findings Our search identified 365 studies, of which 47 studies involving 6194 patients were included. Data from 27 studies (n = 2584) were extracted for the adherence outcome. The intervention group (n = 1267) had significantly better adherence compared to control (n = 1317), (SMD = 0.93, CI:0.69 to 1.17, p<0.0001) with high heterogeneity across studies (I2 = 86%). There was a significant difference in effect according to intervention complexity (p = 0.01); EAM only improved adherence when used with a reminder and/or health provider support. Clinical outcomes were measured in 38/47 (81%) of studies; of these data from 14 studies were included in a meta-analysis of clinical outcomes for HIV, hypertension and asthma. In total, 13/47 (28%) studies assessed acceptability; patient perceptions were mixed. Interpretation Patients receiving an EAM intervention had significantly better adherence than those who did not, but improved adherence did not consistently translate into clinical benefits. Acceptability data were mixed. Further research measuring effects on clinical outcomes and patient acceptability are needed

Comparative Risks of Nonsteroidal Anti-Inflammatory Drugs on CKD

BACKGROUND AND OBJECTIVES: There have been doubts about the association between nonsteroidal anti-inflammatory drug use and worsening kidney function, and whether there is a difference between risks of individual nonsteroidal anti-inflammatory drugs is presently unclear. Therefore, this study aimed to evaluate the association between nonsteroidal anti-inflammatory drug exposure and the risk of incident eGFR <60 ml/min per 1.73 m2 and compare the risks between nonsteroidal anti-inflammatory drug subtypes in the Chinese population. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: From 2008 to 2017, a total of 1,982,488 subjects aged 18 years or older with baseline eGFR ≥60 ml/min per 1.73 m2 were enrolled in this retrospective cohort study. Multivariable Cox proportional hazards regression adjusted for each patient's baseline characteristics was adopted to examine the association between nonsteroidal anti-inflammatory drug and incident eGFR <60 ml/min per 1.73 m2 or eGFR decline ≥30% with reference to baseline. RESULTS: After a median follow-up duration of 6.3 (interquartile range, 3.3-9.4) years, 271,848 cases (14%) of incident eGFR <60 ml/min per 1.73 m2 and 388,386 (21%) events of eGFR decline ≥30% were recorded. After adjusting for each patient's baseline characteristics, nonsteroidal anti-inflammatory drug treatment was shown to be associated with a significantly higher risk of incident eGFR <60 ml/min per 1.73 m2 (hazard ratio, 1.71; 95% confidence interval, 1.67 to 1.75) and eGFR decline ≥30% (hazard ratio, 1.93; 95% confidence interval, 1.89 to 1.96) when compared with no nonsteroidal anti-inflammatory drug, with etoricoxib exhibiting the highest risk of eGFR<60 ml/min per 1.73 m2 (hazard ratio, 3.12; 95% confidence interval, 2.69 to 3.62) and eGFR decline ≥30% (hazard ratio, 3.11; 95% confidence interval, 2.78 to 3.48) and ibuprofen displaying the lowest risk of eGFR<60 ml/min per 1.73 m2 (hazard ratio, 1.12; 95% confidence interval, 1.02 to 1.23) and eGFR decline ≥30% (hazard ratio, 1.32; 95% confidence interval, 1.23 to 1.41). CONCLUSIONS: Nonsteroidal anti-inflammatory drug exposure was associated with higher risks of incident eGFR <60 ml/min per 1.73 m2 and eGFR decline ≥30%. Highest risk was observed in etoricoxib users, and lowest risk was with ibuprofen. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_04_28_CJN18501120.mp3

Factors associated with medication adherence in school-aged children with asthma

Adherence to preventive asthma treatment is poor, particularly in children, yet the factors associated with adherence in this age group are not well understood. Adherence was monitored electronically over 6 months in school-aged children who attended a regional emergency department in New Zealand for an asthma exacerbation and were prescribed twice-daily inhaled corticosteroids. Participants completed questionnaires including assessment of family demographics, asthma responsibility and learning style. Multivariable analysis of factors associated with adherence was conducted. 101 children (mean (range) age 8.9 (6-15) years, 51% male) participated. Median (interquartile range) preventer adherence was 30% (17-48%) of prescribed. Four explanatory factors were identified: female sex (+12% adherence), Asian ethnicity (+19% adherence), living in a smaller household (-3.0% adherence per person in the household), and younger age at diagnosis (+2.7% for every younger year of diagnosis) (all p<0.02). In school-aged children attending the emergency department for asthma, males and non-Asian ethnic groups were at high risk for poor inhaled corticosteroid adherence and may benefit most from intervention. Four factors explained a small proportion of adherence behaviour indicating the difficulty in identifying adherence barriers. Further research is recommended in other similar populations