Medication adherence: the critical step towards better patient outcome

Medication adherence is defined as patient’s adherence to take their medications as prescribed and continue to take the prescribed medication for stipulated time frame. Medication non-adherence is a growing concern to physicians, healthcare systems, and other stakeholders (e.g., payers) and there is an increasing evidence of its prevalence and is associated with adverse clinical outcomes eventually resulting into higher costs of care. The cost of non-adherence has been estimated at $100 billion to$300 billion annually, including costs from avoidable hospitalizations, nursing home admissions, and premature deaths. Improving adherence to medication is critical to improve the quality of health care, to encourage better chronic care management, and promote better health outcomes. Reasons for non-adherence are multiple and complex. Studies have reported that poor adherence to drug dosage is due to patient perception that the disease is non-significant, adverse drug effects, lack of treatment effectiveness, and the patient’s poor or incomplete knowledge of the disease and (cost). A multifactorial approach is required to tackle this complex problem as a single approach will be ineffective for all patients. The most effective intervention is to use a combination of approaches and address literacy, behavior, and organizational issues. There are challenges as well as opportunities in addressing the public health issue of medication adherence. Changing healthcare reforms, advances in digital health media, social media and modern technologies can now provide alternatives to tackle this issue

Knowledge, attitudes and practice among healthcare workers towards COVID-19 in a tertiary care centre in north India

Background: Coronavirus disease pandemic has affected the entire world and till date, there is no definitive cure for it with prevention of infection and knowledge about the disease being the only proven effective methods to contain it. Healthcare workers (HCWs) are highly susceptible to getting infected and their knowledge about COVID-19 infection has been known to be inversely proportional to the rates of COVID-19 infection. Methods: Cross-sectional questionnaire-based study assessing knowledge, attitude and practices towards COVID-19 preventive measures was carried out amongst HCWs at a tertiary care hospital in North India. Results: Around 95% of HCWs had received training regarding COVID-19 infection and more than 95% HCWs had adequate knowledge about COVID-19 infection. More than 95% HCWs experienced anxiety and fear while monitoring and treating COVID-19 patients. 85% HCWs felt that there is sufficient awareness in the society regarding COVID-19 infection. Most of the respondents followed correct practices for avoidance of COVID-19 infection with around 90% respondents using face masks and practicing frequent hand washing. Social distancing and avoidance of large gatherings was practiced by around 95% respondents. More than 95% respondents had either taken COVID-19 vaccine or wish to take it. Conclusions: The study suggested that the majority of HCWs had good knowledge and positive attitude toward COVID-19 but there are still some lacunae present in the knowledge regarding prevention of COVID 19 infection. Further education and training are required for HCWs so as to fight COVID and prevent its spread in a better way

Medical devices in India: a perspective of guidelines and the way forward

In recent times, emerging countries including India have become favored destination for medical device companies to leverage the growth opportunities. However, the Indian regulatory system is not ready to meet the challenges that may come up with growing medical device business. It needs major amendments to current Drugs and Cosmetic Act 1940, to include medical device as a separate entity. Like in developed world, the challenges could be addressed by defining medical devices, risk based classification of devices, guidelines for device safety surveillance, and clinical trials for medical devices. Drugs and Cosmetic (Amendment) Bill 2013, which is yet to be released has addressed the concerns to some extent. However, it needs a major revamp to establish effective regulatory framework for medical devices

Su salud a la mano (your health at hand): patient perceptions about a bilingual patient portal in the Los Angeles safety net.

ObjectivesDriven by beneficial patient-centered outcomes associated with patient portal use and the Affordable Care Act, portal implementation has expanded into safety nets-health systems that offer access to care to a large share of uninsured, Medicaid, and other vulnerable populations. However, little attention has been paid to the factors that affect portal accessibility by the vulnerable patients served by these health systems-including those who are limited English proficient (LEP).Materials and methodsThe Los Angeles County Department of Health Services (LAC DHS), the second-largest safety net system in the nation, launched its first patient portal, and one of the few bilingual English-Spanish interfaces in existence, in March of 2015. To explore portal awareness and perceptions, we conducted focus groups with LAC DHS patients, in English and Spanish (LEP). The Technology Acceptance Model was used to guide thematic analysis of focus group data.ResultsOf the 46 participants, 37 were patients and 9 were caretakers; 23 were English-speaking and 23 Spanish-speaking LEP. All patients had diabetes or hypertension. Over half had an annual household income <$10 000, yet 78% of English-speaking and 65% of Spanish-speaking LEP participants reported at-home Internet access. Participants' discussion centered around 3 major thematic narratives: (1) participants' awareness or attitudes about the LAC DHS portal; (2) role of culture, language, or community with regard to portal accessibility and utility; and (3) perceived needs for successful portal implementation.ConclusionsSafety net participants identified concrete benefits to the portal and emphasized the need for portal engagement that offered accessible education, support, and resources in clinical and community settings. The portal offers an additional opportunity to engage the patient and family with trusted and validated health information, and should be further developed in this capacity. This study provides a better understanding of preferred improvements of patient portal engagement that guide broader health technology efforts to address electronic health disparities

Clinical Uncertainties, Health Service Challenges, and Ethical Complexities of HIV “Test-and-Treat”: A Systematic Review

Despite the HIV “test-and-treat” strategy’s promise, questions about its clinical rationale, operational feasibility, and ethical appropriateness have led to vigorous debate in the global HIV community. We performed a systematic review of the literature published between January 2009 and May 2012 using PubMed, SCOPUS, Global Health, Web of Science, BIOSIS, Cochrane CENTRAL, EBSCO Africa-Wide Information, and EBSCO CINAHL Plus databases to summarize clinical uncertainties, health service challenges, and ethical complexities that may affect the test-and-treat strategy’s success. A thoughtful approach to research and implementation to address clinical and health service questions and meaningful community engagement regarding ethical complexities may bring us closer to safe, feasible, and effective test-and-treat implementation

Consistency of state statutes with the Centers for Disease Control and Prevention HIV testing recommendations for health care settings.

In September 2006, the Centers for Disease Control and Prevention (CDC) released the "Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-care Settings" to improve screening and diagnosis. The CDC now recommends that all patients in all health care settings be offered opt-out HIV screening without separate written consent and prevention counseling. State law on HIV testing is widely assumed to be a barrier to implementing the recommendations. To help policymakers and providers better understand their own legal context and to correct possible misunderstandings about statutory compatibility, a state-by-state review (including Washington, DC) of all statutes pertaining to HIV testing was performed and the consistency of these laws with the new recommendations was systematically assessed. Criteria were developed for classifying state statutory frameworks as consistent, neutral, or inconsistent with the new recommendations, and the implications for implementation of the CDC recommendations in these various legal contexts were examined. The statutory frameworks of 34 states and Washington, DC, were found to be either consistent with or neutral to the new CDC recommendations, which would enable full implementation. Statutory frameworks of 16 states were inconsistent with the new CDC recommendations, which would preclude implementation of 1 or more of the novel provisions without legislative change. In the 2 years since release of the recommendations, 9 states have passed new legislation to move from being inconsistent to consistent with the guidelines. State statutory laws are evolving toward greater compliance with the CDC recommendations. Policymakers, provider groups, consumer advocates, and other stakeholders should ensure that HIV screening practices comply with existing state law and work to amend inconsistent laws if they are interested in implementing the CDC recommendations

Portals of Change: How Patient Portals Will Ultimately Work for Safety Net Populations

Despite the implementation of internet patient portals into the safety net after the introduction of the Affordable Care Act in the United States, little attention has been paid to the process of engaging vulnerable patients into these portals. The portal is a health technology tool that was developed with a mainstream, English-speaking audience in mind. Thus, there are valid concerns that such technologies will actually exacerbate health care disparities, conferring further advantages to the already advantaged. In this paper, we describe a framework for portal engagement (awareness, registration, and use) among safety net patients. We incorporate the experiences in the Los Angeles County Department of Health Services to illustrate important contextual factors for portal outreach in our safety net. Finally, we discuss considerations for moving forward with health technology in the safety net as the next version of patient portals are being developed

Reliability of left ventricular ejection fraction calculated with gated myocardial perfusion single photon emission computed tomography in patients with extensive perfusion defect

INTRODUCTION: Gated myocardial perfusion scintigraphy (g-MPS) provides functional information on the left ventricle (LV) apart from the perfusion status. Computer algorithm-based LV ejection fraction (EF) calculated from resting g-MPS has been found to be reliable in patients with normal perfusion. However, its role in patients with extensive perfusion defects is not clear. AIM: To find the reliability of LVEF calculated from resting g-MPS in patients with extensive perfusion defects (>25% of LV myocardium) and to correlate this with echocardiography and multigated radionuclide ventriculography (RNV). MATERIALS AND METHODS: Thirty patients with fixed perfusion defect of size greater than or equal to 25% of LV myocardium on rest g-MPS study were included. EF was calculated using three software packages: Emory Cardiac Toolbox, Myometrix, and quantitative gated single photon emission computed tomography (SPECT)/quantitative perfusion SPECT. The patients underwent RNV (gold standard) and echocardiography within a week of the g-MPS. Agreement among the EF values obtained by different methods was determined using Bland–Altman analysis. Correlation among the EF values was measured using Spearman's rank correlation. RESULTS: Thirty patients (23 male; seven female; mean age 51 years, range 32–70 years) were included prospectively. The average size of perfusion defect was 38% of the LV myocardium (range 25–56% of LV). The average ejection fraction values were 33% for Emory Cardiac Toolbox (range 11–50%), 31% for Myometrix (range 18–46%), and 33% for quantitative gated SPECT/quantitative perfusion SPECT (range 17–49%). The mean EF on echocardiography was 37% (range 22–60%), whereas that of RNV was 33% (range 10–50%). The data were normally distributed. There was statistically significant positive agreement between algorithm-based EF measurements to the gold standard RNV. CONCLUSION: This study suggests that EF calculations, from g-MPS SPECT data using different software, have high agreement with the gold standard RNV even in patients with extensive perfusion defects.Chidambaram Natrajan Balasubramanian Harisankar, Bhagwant Rai Mittal, Koramadai Karuppuswamy Kamaleshwaran, Madan Parmar, Anish Bhattacharya, Baljinder Singh and Rajiv Mahajanhttp://journals.lww.com/nuclearmedicinecomm/Abstract/2011/06000/Reliability_of_left_ventricular_ejection_fraction.8.asp