Efficacy and safety of a multifactor intervention to improve therapeutic adherence in patients with chronic obstructive pulmonary disease (COPD): protocol for the ICEPOC study

<p>Abstract</p> <p>Background</p> <p>Low therapeutic adherence to medication is very common. Clinical effectiveness is related to dose rate and route of administration and so poor therapeutic adherence can reduce the clinical benefit of treatment. The therapeutic adherence of patients with chronic obstructive pulmonary disease (COPD) is extremely poor according to most studies. The research about COPD adherence has mainly focussed on quantifying its effect, and few studies have researched factors that affect non-adherence. Our study will evaluate the effectiveness of a multifactor intervention to improve the therapeutic adherence of COPD patients.</p> <p>Methods/Design</p> <p>A randomized controlled clinical trial with 140 COPD diagnosed patients selected by a non-probabilistic method of sampling. Subjects will be randomly allocated into two groups, using the block randomization technique. Every patient in each group will be visited four times during the year of the study. Intervention: Motivational aspects related to adherence (beliefs and behaviour): group and individual interviews; cognitive aspects: information about illness; skills: inhaled technique training. Reinforcement of the cognitive-emotional aspects and inhaled technique training will be carried out in all visits of the intervention group.</p> <p>Discussion</p> <p>Adherence to a prescribed treatment involves a behavioural change. Cognitive, emotional and motivational aspects influence this change and so we consider the best intervention procedure to improve adherence would be a cognitive and emotional strategy which could be applied in daily clinical practice. Our hypothesis is that the application of a multifactor intervention (COPD information, dose reminders and reinforcing audiovisual material, motivational aspects and inhalation technique training) to COPD patients taking inhaled treatment will give a 25% increase in the number of patients showing therapeutic adherence in this group compared to the control group.</p> <p>We will evaluate the effectiveness of this multifactor intervention on patient adherence to inhaled drugs considering that it will be right and feasible to the clinical practice context.</p> <p>Trial registration</p> <p>Current Controlled Trials <a href="http://www.controlled-trials.com/ISCTN18841601">ISCTN18841601</a></p

Is it possible to diagnose the therapeutic adherence of patients with COPD in clinical practice? A cohort study

<p>Abstract</p> <p>Background</p> <p>Therapeutic adherence of patients with chronic obstructive pulmonary disease (COPD) is poor. It is therefore necessary to determine the magnitude of non-adherence to develop strategies to correct this behaviour. The purpose of this study was to analyse the diagnostic validity of indirect adherence methods.</p> <p>Methods</p> <p>Sample: 195 COPD patients undergoing scheduled inhaled treatment attending 5 Primary Care Centres of Malaga, Spain. Variables: Sociodemographic profile, illness data, spirometry, quality of life (St. George Respiratory Questionnaire: SGRQ), and inhaled medication counting (count of dose/pill or electronic monitoring) were collected. The patient's knowledge of COPD (Batalla test:BT),their attitude towards treatment (Morisky-Green test: MGT) and their self-reported therapeutic adherence (Haynes-Sackett test: HST) were used as methods of evaluating adherence. The follow-up consisted four visits over one year (the recruitment visit: V0; and after 1 month:V1; 6 months:V2; and 1 year:V3).</p> <p>Results</p> <p>The mean age was 69.59 (95% CI, 68.29-70.89) years old and 93.8% were male. Other findings included: 85.4% had a low educational level, 23.6% were smokers, 71.5% mild-moderate COPD stage with a FEV1 = 56.86 (SD = 18.85); exacerbations per year = 1.41(95% CI, 1-1.8). The total SGRQ score was 44.96 (95% CI, 42.46-47.46), showing a mild self-perceived impairment in health. The prevalence of adherence (dose/pill count) was 68.1% (95% CI, 60.9-75.3) at V1, 80% (95% CI, 73-87) at V2 and 84% (95% CI, 77.9) at V3. The MGT showed a specificity of 67.34% at V1, 76.19% at V2 and 69.62% at V3. The sensitivity was 53.33% at V1, 66.66% at V2 and 33.33% at V3.The BT showed a specificity of 55.1% at V1, 70.23% at V2 and 67.09% at V3. The sensitivity was 68.88% at V1, 71.43% at V2 and 46.66% at V3. Considering both tests together, the specificity was 86.73% at V1, 94.04% at V2 and 92.49% at V3 and the sensitivity was 37.77% at V1, 47.62% at V2 and 13.3% at V3.</p> <p>Conclusions</p> <p>The prevalence of treatment adherence changes over time. Indirect methods (dose/pill count and self-reported) can be useful to detect non-adherence in COPD patients. The combination of MGT and BT is the best approach to test self-reported adherence.</p

IDC-PAL : instrumento diagnóstico de la complejidad en cuidados paliativos : documento de apoyo al PAI cuidados paliativos

Publicado en la página web de la Consejería de Igualdad, Salud y Políticas Sociales: www.juntadeandalucia.es/salud (Consejería de Igualdad, Salud y Políticas Sociales/ Profesionales / Nuestro Compromiso por la Calidad / Procesos Asistenciales Integrados)IDC-Pal ha sido elaborado a iniciativa del Plan Andaluz de Cuidados Paliativos, con la participación de la Fundación CUDECA y el Plan Andaluz de Cuidados Paliativos con financiación de la Consejería de Salud y Bienestar Social, de la Junta de Andalucía, en el periodo 2009-2012.YesLa complejidad en cuidados paliativos (CP), es un concepto multifactorial que depende de un conjunto de elementos relacionados entre sí y que no tiene una definición unánime en la literatura por lo que en el Proceso Asistencial Integrado Cuidados Paliativos, tras la revisión de la bibliografía, se realizó un grupo nominal que elaboró una lista de elementos de complejidad y consensuó agruparlos en 5 categorías, según dependieran del paciente, la familia, los profesionales, las intervenciones terapéuticas, u otras no clasificables en los anteriores y posteriormente, se establecieron cuatro niveles de complejidad: ausente, mínima, media y alta a los que se les asignaron elementos de complejidad de cada una de las 5 categorías. En el año 2010, a instancias del Plan Andaluz de Cuidados Paliativos se configuró un proyecto de investigación con el objetivo de establecer, a partir de esta clasificación teórica, una herramienta diagnóstica y clasificatoria de la complejidad que pudiera ser de utilidad en la práctica clínica en la atención a los pacientes en situación terminal. Todo ello, ha permitido construir IDC-Pal, herramienta diagnóstica y clasificatoria de las situaciones o elementos de complejidad susceptibles de aparecer en pacientes en situación terminal

The Liverpool Care Pathway implementation in Spanish in Argentina and Spain: a study of health professional perceptions on end of life

Las percepciones de los profesionales de la salud ante el final de la vida pueden influir en la comunicación con pacientes y familias. Si bien en cuidados paliativos (CP) la muerte es algo esperable y natural, genera emociones de distinta intensidad y pone en evidencia la propia finitud y/o la de seres amados y pérdidas previas no elaboradas. El Liverpool Care Pathway (LCP) propone un programa de calidad de atención para personas en situación de últimos días (SUD). En Argentina y España se está implementando el LCP (en español) desde las ONG Pallium (programa PAMPA) y Cudeca respectivamente. Nuestro objetivo es explorar las condiciones subjetivas (percepciones) que enfrentan los profesionales de la salud en relación con la atención en el final de la vida, en el contexto previo y posterior a la implementación de una secuencia de cuidado integral LCP/PAMPA en un contexto binacional latino (Argentina-España). Proponemos identificar y describir los significados que los profesionales le asignan a: los cuidados del muriente, la comunicación, el trabajo en equipo, la documentación y las actitudes en SUD.Health professionals’ perceptions on the end of life (EoL) can influence communication with patients and families. Although death is expected in palliative care (PC), emotions of varying intensity are generated. The fears and difficulties encountered in facing this subject will be different according to previous personal experiences. The Liverpool Care Pathway (LCP) proposes a quality programme of care for people at the EoL. Both in Argentina, Pallium and in Spain, Cudeca, are implementing a Spanish version of LCP. Our goal is to explore the subjective conditions (perceptions) faced by health professionals concerning EoL, and the influence before and after the implementation of the LCPin a Latin-American cultural context (Argentina-Spain). We propose to: identify and describe the meanings that professionals assigned to the care of the dying, communication, teamwork, documentation, and attitudes to EoL.Fil: Tripodoro, Vilma. Instituto Pallium Latinoamérica; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Luxardo, Natalia. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Veloso, Verónica. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Pérez, Marisa. Instituto Pallium Latinoamérica; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología ; ArgentinaFil: Martín Roselló, Marisa. Fundación Cudeca; EspañaFil: de la Ossa Sendra, María J.. Fundación Cudeca; EspañaFil: Vidal España, Francisca. Fundación Cudeca; EspañaFil: Hannam, Susan. Fundación Cudeca; EspañaFil: Cazorla González, Rosa. Fundación Cudeca; EspañaFil: Rosúa Rodríguez, María. Fundación Cudeca; EspañaFil: Arranz de la Torre, Alicia. Fundación Cudeca; EspañaFil: de Simone, Gustavo. Instituto Pallium Latinoamérica; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología ; Argentin