11 research outputs found
Quantitative assessment of adherence to treatment in clinical medicine: protocol, procedure, interpretation
We developed and embedded in research and clinical practice of the method of quantitative evaluation of adherence to treatment in clinical medicine. Assessment of adherence is investigated by completion of the questionnaire. Analysis of the answers allows us to quantitatively calculate the indicators of adherence to drug therapy, medical support, modification of lifestyle and integral adherence to treatment. In accordance with the obtained results, an adherence can be «high,» «satisfactory» or «unsatisfactory», serving as a basis for making research or treatment decisions. Dynamic quantitative assessment of adherence allows to assess the current efficacy of interventions and to forecast their trends. The questionnaire is recommended for use in clinical practice when treating patients with chronic diseases, as well as at the stages of organization and execution of clinical studies and clinical trials
Modern Anticoagulant Therapy for Atrial Fibrillation: Patient Adherence in Clinical Practice
Aim. To assess the adherence of doctors and patients to anticoagulant therapy for atrial fibrillation (AF).Materials and methods. An observational prospective study included 99 patients with AF at high risk of thromboembolic complications in Ryazan and Omsk. To study adherence, a questionnaire for quantitative assessment of treatment adherence ("QAA-25") was used. The questionnaire allows you to assess adherence by three main parameters separately: adherence to drug therapy, lifestyle modification and medical support. For the purposes of the study, adherence rates of less than 75% were regarded as insufficient, 75%. % or more as sufficient. To assess food preferences and determine the risk of changes in the activity of warfarin, a questionnaire of food preferences was used. The questionnaire allows you to assess the risk of alimentary increase (≥30 points) and decrease (≥60 points) of warfarin activity, as well as the overall risk of alimentary change (≥90 points) of warfarin activity in each patient, taking into account the volume and frequency of consumption of products that affect the activity of warfarin.Results. After the first visit, 99% of respondents received anticoagulant treatment. Rivaroxaban was the leader in prescribability among anticoagulants (36.7%). About a third of respondents were prescribed apixaban by a doctor (30.6%) and dabigatran (17.3%) and warfarin (19.4%) were prescribed almost twice as rarely as rivaroxaban. Respondents with the highest rates of adherence to drug therapy, lifestyle modification and medical support are AF patients taking apixaban. The respondents who were prescribed rivaroxaban had the lowest level of adherence to drug therapy and lifestyle modification. And the lowest level of commitment to medical support is among respondents who have been prescribed warfarin. The number of people with a sufficient level of commitment did not reach half. Only 43.9% were ready to take prescribed medications and slightly more than a third (34.7%) agreed to come to appointments for a long time. But, despite the importance of lifestyle modification in patients with AF, only 16.3% of respondents said they were ready to give up bad habits, lose weight and lead a more active lifestyle. The proportion of people with sufficient adherence to drug therapy was the smallest in the group taking rivaroxaban (25.7%). The least number of respondents with sufficient commitment to medical support in the group taking dabigatran (25%). Only one in ten patients (11.1%) taking warfarin had a sufficient level of commitment to lifestyle modification. 15% of the study participants had an increased risk of alimentary changes in the activity of warfarin.Conclusion. Assessment of adherence to anticoagulant therapy by doctors in two regional centers (Omsk and Ryazan) showed high prescribability of preventive antithrombotic therapy, which corresponds to modern therapeutic approaches. At the same time, patients demonstrated rather low levels of adherence to drug therapy, lifestyle modification, and medical support
Приверженность лечению больных воспалительными заболеваниями кишечника
Inflammatory bowel disease (IBD) is a common pathology that reduces the quality and duration of a patient’s life. The cornerstone of treatment of IBD patients is polypharmacotherapy based on the use of salicylates, antibiotics, immunomodulatory and biological drugs, and topical dosage forms. Multicomponent treatment has shown to reduce the quality of life and negatively affect adherence to drug therapy in IBD patients.One of the leading causes of treatment failure is low treatment adherence, which leads to disease progression, disability, and increased financial costs. Currently, there are many factors that affect adherence to therapy, some of them are modifiable, which creates opportunities to improve the effectiveness of existing medical interventions. However, the available data on the level of adherence in IBD patients are not numerous and homogeneous, so a low level of adherence to drug therapy in IBD patients is registered in 7–72% of cases.An important issue in understanding adherence in IBD patients is a lack of research on the level of adherence to counselling and lifestyle modification. However, the course of IBD, treatment features related to the duration of therapy and necessary lifestyle modifications (nutrition), as well as regular monitoring of laboratory and instrumental parameters determine the need to assess adherence to lifestyle modification and counselling along with adherence to drug therapy.Воспалительные заболевания кишечника (ВЗК) – это распространенная патология, снижающая качество и продолжительность жизни пациента. Краеугольным камнем лечения больных ВЗК является полифармакотерапия, основанная на применении салицилатов, антибиотиков, иммуномодулирующих и биологических препаратов, использовании местных лекарственных форм. Показано, что сложные схемы лечения снижают качество жизни и отрицательно сказываются на приверженности лекарственной терапии больных ВЗК.Одной из ведущих причин неэффективности лечения является низкий уровень приверженности, что приводит к прогрессированию заболевания, инвалидизации и увеличению финансовых затрат. В настоящий момент известно много факторов, влияющих на приверженность терапии, часть из них модифицируема, что создает возможности для повышения эффективности существующих медицинских вмешательств. Однако имеющиеся данные об уровне приверженности больных ВЗК не отличаются многочисленностью и однородностью. Так, низкий уровень приверженности лекарственной терапии больных ВЗК регистрируется в 7–72% случаев.Важной проблемой понимания приверженности больных ВЗК является отсутствие исследований об уровне приверженности медицинскому сопровождению и модификации образа жизни. Тогда как течение ВЗК и особенности лечения, связанные с длительностью терапии, необходимой модификацией образа жизни (питания), а также регулярный контроль лабораторных и инструментальных параметров диктуют необходимость оценки приверженности модификации образа жизни и медицинскому сопровождению наряду с приверженностью лекарственной терапии
The Scale of Quantitative Assessment Adherence to Treatment «QAA-25»: Updating of Formulations, Constructive and Factor Validity and a Measure of Consent
Aim: To update the definitions of selected questions of the "QAA-25" (quantitative adherence assessment) scale and evaluate it according to the criteria of validity and measure of agreement.Materials and Methods. In a descriptive cross-sectional study including 200 patients with coronary heart disease, adherence was determined using traditional and alternative versions of selected questions of the QAA-25 scale, followed by assessment of construct validity, factor validity, and measure of agreement.Results. Alternative question versions did not significantly affect test results, with 81% of respondents in the outpatient sample and 69% in the inpatient sample rating them as "more acceptable." The QAA-25 scale has good construct and internal validity (α – 0.818, αst – 0.832), with moderate agreement (κ – 0.562) and demonstrates high reliability of internal validity – when scale items are consistently excluded, α values remain in the 0.801-0.839 range.Conclusion. The QAA-25 scale with modified question definitions should be used instead of the previous version of the scale. Good construct validity and factor validity, sufficient measure of agreement and specificity, high sensitivity and reliability of the QAA-25 scale allow to recommend it as a tool for assessing adherence to drug therapy, medical support, lifestyle modification and integral adherence to treatment in scientific and clinical practice
Вторичная занятость и ее роль в получении высшего медицинского образования
The study objective is to examine the structure and characteristics of secondary employment of medical university students. The authors carry out a survey of students of Omsk State Medical University of the Ministry of Health of Russia by continuous questionnaire survey technique. The questions of the questionnaire were aimed at socio-demographic identification of students. 2 330 (59,6 %) respondents participated in the survey of 3 906 students studying in the organization. According to the survey results 24,7 % (576) of students of OSMU work in their free time, while 12,6 % (294) work in medical sphere. Employed students are more common among married respondents compared to unmarried ones (55,9 and 29,1 % respectively, χ2 = 55.53, p < 0.001, Pearson). There is a growing trend in the proportion of employed students from the 1st year to 5th year (11,9 and 41,8 %, respectively). The same dynamics is revealed in the proportion of employed respondents in medicine (4,4 and 28,8 %, respectively). Respondents studying at the Preventive Medicine Department are employed in the medical field significantly less likely than other departments (χ2 = 30,04, p < 0.001, Pearson). The share of employed OSMU students increases while moving up the educational ladder. At the same time, employed students are 2 times more common among married students. The proportion of employed students of the Faculty of Dentistry of the 3rd and 5th yersis much higher compared to other faculties. Medical and Preventive Faculty students show the lowest rates with respect to employment in the medical field in their free time.Цель исследования – изучить структуру и особенности вторичной занятости студентов медицинского университета. Проведен опрос методом сплошного анкетирования студентов специалитета ФГБОУ ВО «Омский государственный медицинский университет» Минздрава России. Вопросы анкеты направлены на социально-демографическую идентификацию студентов. Из 3 906 студентов, обучающихся в организации, в опросе приняли участие 2 330 (59,6 %) респондентов. По результатам опроса 24,7 % (576) студентов ОмГМУ в свободное от учебы время работают, при этом 12,6 % (294) работают в медицинской сфере. Среди респондентов, состоящих в браке, значимо чаще встречаются трудоустроенные студенты, чем среди лиц, не состоящих в браке (55,9 и 29,1 % соответственно, χ2 = 55,53, р < 0,001, Pearson). Наблюдается тенденция увеличения доли работающих студентов от 1 к 5 курсу включительно (11,9 и 41,8 % соответственно). Та же динамика выявлена в отношении доли трудоустроенных респондентов в медицине (4,4 и 28,8 % соответственно). Респонденты, обучающиеся на медико-профилактическом факультете, достоверно реже остальных работают в медицинской сфере (χ2 = 30,04, р < 0,001, Pearson). По мере продвижения обучающихся ОмГМУ по образовательным ступеням увеличивается доля трудоустроенных студентов. При этом среди тех студентов, кто состоит в браке, трудоустроенные студенты встречаются в два раза чаще. Доля трудоустроенных респондентов на стоматологическом факультете ощутимо выше, чем на других факультетах среди студентов 3 и 5 курсов. Студенты медико-профилактического факультета демонстрируют самые низкие показатели в отношении трудоустройства в медицинской сфере в свободное от учебы время
Contribution of anticoagulant therapy adherence to the risk of complications of atrial fibrillation
Aim. To study compliance and its role in the development of the fatal complications of anticoagulant therapy in patients with atrial fibrillation (AF).Material and methods. Antithrombotic therapy and compliance were studied in an open observational controlled prospective study with 109 AF patients. The dynamics and presence of thromboembolic and hemorrhagic complications were recorded.Results. For the first time in patients with AF, we detected a significantly high relative risk of development of life-threatening and lethal complications of anticoagulant therapy with warfarin with insufficient compliance (RR=8,0; [1,728;37,027]; p<0,05) and drug therapy (RR=70; [1,493;32,819]; p<0,05). At the same time, patients with AF could not detect any links between the level compliance and the risk of treatment with directly acting oral anticoagulants (DAOC) — patients who achieved a common primary endpoint had no association between the relative risk and the level of compliance (RR=1,0; [0,106;9,445]; p<0,05).Conclusion. The study showed for the first time that in patients with AF, the most unfavorable prognostic factor in the development of life-threatening and lethal complications with warfarin taking is low adherence to lifestyle modification and drug therapy. At the same time, in patients with AF, who receive DAOK as anticoagulants, there was no connection between compliance and the development of hemorrhagic or thromboembolic complications
Algorithm for the Choice of Anticoagulant for Patients with Atrial Fibrillation
Aim. To evaluate the effectiveness of the anticoagulant choice algorithm in the prevention of complications of atrial fibrillation (AF). Material and methods. Patients with AF (n=98) were included into observational prospective study. The level of adherence to treatment, risk of food interactions and presence of CYP2C9 and VKORC1 genes mutations were determined at the initial examination. These indicators were necessary to specify an eligible anticoagulant according to the evaluated algorithm. Therapy was prescribed by the attending physician. Hemorrhagic and thromboembolic complications were assessed at the next examination after 24 weeks. Results. Hemorrhagic complications were observed in 31.6% of patients during the follow-up. Their number was comparable in individuals taking antiplatelet agents and direct oral anticoagulants (DOACs) (χ2=1.44; p<0.49, Pearson) and significantly more in individuals taking warfarin (as compared to DOACs: χ2=25.08; p<0.000, Pearson; and antiplatelet agents: χ2=34.32; p<0.000, Pearson). Thromboembolic complications were reported in 8.16% of patients. Their number was more in patients taking DOACs than warfarin (χ2=7.03; p<0.03, Pearson). Patients who had to take DOACs according to the algorithm, but in the study took warfarin, demonstrated significantly greater number of thromboembolic complications, with a comparable number of hemorrhagic complications. Patients who could take warfarin according to the algorithm, but in the study took DOACs, had significantly greater number of thromboembolic complications, with a comparable number of hemorrhagic complications. Conclusion. The results of the study demonstrated the potential for reduction in complications, especially thromboembolic, in the choice of anticoagulant using the algorithm; and reduction in complications of therapy, primarily with warfarin, due to the initial prescription of DOACs. The proposed approach, which consists in using the quantitative assessment of adherence to treatment, and only if necessary supplemented by the assessment of food preferences and/or pharmacogenetic studies, contributes to the treatment optimization
Treatment Adherence as a New Choice Factor for Optimization of Oral Anticoagulation Therapy in Patients with Atrial Fibrillation and Hemostatic Gene Polymorphisms
Aim. To evaluate treatment adherence and prevalence of CYP2C9 and VKORC1 gene mutations in patients with atrial fibrillation (AF) and provide rationale of choice for oral anticoagulation therapy.Material and methods. Treatment adherence was evaluated in 137 AF patients (aged 35-85 years) with quantitative estimation of drug therapy adherence along with compliance to medical support and lifestyle modifications. Among them 82 patients underwent polymerase chain reaction (PCR) analysis of CYP2C9 and VKORC1 gene polymorphisms.Results. Patients receiving anticoagulation therapy are characterized by lower level of adherence compared to patients without anticoagulants (65.2±19.3% vs 68.5±19.1%; Wald-Wolfowitz; p<0.05). Considering all studied parameters men are less adherent than women (54.7±18.6% vs 60.6±16.7%; Kolmogorov-Smirnov; p<0.05). Patients receiving new oral anticoagulants (NOAC) have better compliance compared with patients of warfarin group. Mutations in CYP2C9 gene were detected in 32.9%, VKORC1 – in 68.3%, and their combination – in 21.9% of study participants. Warfarin therapy may be potentially dangerous in such patients due to low adherence.Conclusion. Considering high prevalence of CYP2C9 and VKORC1 gene mutations treatment adherence should be estimated to optimize choice of anticoagulation therapy. NOAC treatment should be considered in patients with low adherence for prevention of thromboembolic complications
RATIONAL PHARMACOTHERAPY IN CARDIOLOGY: FROM MINIMIZATION OF EXPENSES TO EFFECTIVE MANAGEMENT
Aim. To study the clinical and economic advantages of patient-oriented treatment in comparison with the traditional treatment of polymorbid patients with hypertension according to the secondary combined end point (benefit) and the primary end point (total mortality).Material and methods. A change in the "advantage" index and total mortality in patient-oriented treatment (n=500) and traditional treatment (n=500) were studied in a cohort study in 1,000 polymorbid patients with hypertension.Results. The change in advantage was related to the intensity of the response of the starting therapy and the effectiveness of its subsequent modification based on an assessment of the respondents' initial adherence to treatment, rather than the class or cost of medicines, the original or generic nature of the drugs, or their dosage frequency. The patient-centered approach, based on active feedback, demonstrated advantages over traditional treatment. The principle of estimating the "cost of living in effective rubles" has shown that in patient-oriented treatment, even with an increase in the direct costs of pharmacotherapy, clinical improvement with a reduction in overall mortality ensures greater treatment benefits than traditional therapy. The initial advantage of treatment was 4.22 and 4.28 effective rubles, by the 100th week of the study – 3.08 and 4.09, and by the 200th week – 2.75 and 3.75 rubles, respectively. The mortality rate for 200 weeks was 3.8% in the first, and 5.4% in the second subsample (p=0.017).Conclusion. The analysis of advantage can be a step towards resolving the "conflict of interests" of the subjects of medical care. The introduction of clinical advantage assessment in medical practice allows a practical doctor to substantiate the clinical and economic feasibility of a specific therapeutic regimen, including the selection of a commercial nomenclature of medicines