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Aljabaa, Aljazi Hussain. "Adherence among orthodontic patients." Thesis, King's College London (University of London), 2016. https://kclpure.kcl.ac.uk/portal/en/theses/adherence-among-orthodontic-patients(3184705a-7a98-4381-a0fa-9f5d61734f54).html.
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Objectives: A patient’s adherence is an important factor for successful orthodontic treatment. This adherence can take the form of maintaining good oral hygiene, appliance maintenance, observing dietary recommendations, and appointment keeping. This thesis consisted of three studies. A systematic review was conducted to investigate the effectiveness of interventions to enhance adherence among orthodontic patients aged 12 to 18. Specific adherence outcomes included: recall of information given by the orthodontic team; attendance at orthodontic appointments; self-reported oral hygiene behaviour; and clinical indices of oral hygiene. A survey was undertaken to explore predictors of adherence amongst patients 12–18 years of age receiving orthodontic treatment with fixed appliances at the initial follow-up appointment 6 weeks post bracket placement. Finally, a randomised controlled trial compared three methods designed to enhance adherence to oral hygiene instructions in orthodontic patients aged 12–18 years: mind map, if-then plan, and leaflet. Materials and Methods: Systematic review: Electronic searches of Medline via OVID (1966– March 2012), EMBASE, and the Cochrane central register of control trials from its inception to March 2012, as well as a hand search were undertaken to identify relevant studies. The longitudinal study: Measured adherence to orthodontic treatment in terms of self-reported oral hygiene-related behaviour, oral hygiene maintenance, knowledge of oral health-related behaviour, appliance breakages, and appointment attendance among 200 individuals undergoing maxillary and mandibular fixed orthodontic appliances with an age range of 12 to 18 years. Oral health-related behaviour and clinical indicators of oral healthwere assessed at bond-up appointment (T1) and at 6 weeks follow up appointment (T2) to determine their relationship to adherence. Randomised controlled trial: Orthodontic patients from Guy’s and St Thomas’ NHS Trust were drawn as potential participants; patients were randomly allocated to one of the three interventions used. Eligibility criteria: patients aged 12–18 years undergoing maxillary and mandibular fixed orthodontic treatment. Individuals with systemic disease, craniofacial development disorders including cleft lip and palate, individuals with previous history of orthodontic treatment, patients attending the specialist hypodontia clinic and individuals who declined to participate were excluded. Outcomes: Primary outcomes: plaque levels. Secondary outcomes: bleeding on probing, patient’s knowledge about adherence in orthodontic treatment, and self-reported behaviours. Randomisation: patients were randomly allocated to one of three conditions. The three groups were: mind mapping, if-then planning group, and patient information tools (leaflet). Allocation was concealed using sealed envelopes. Blinding: the participant and their parents as well as the researcher undertaking the intervention and assessing the outcomes were not blinded. The statistician undertaking the statistical analysis was blinded. Participants were assessed at four time points: at the fitting of the fixed appliance (T1); at initial follow-up 6 weeks later, at which time after the assessment of their oral hygiene and completion of the questionnaire (T2), they were randomly allocated to the three groups of intervention; 6 weeks after the intervention (T3); and 18 weeks after the intervention (T4).Results: Systematic Review: A total of 381 articles were identified through the electronic searches. Initial screening of the abstracts and titles by all review authors identified 7 articles that met the inclusion criteria for this review. The full articles were then retrieved. Four randomised controlled trials were found; all used different methods of intervention, including: a system of rewards or awards; the Hawthorne effect; written information; and demonstration of the microbiology of plaque. The longitudinal study: Significant changes in lingual plaque (P= 0.026), bleeding on probing (P= 0.006), and knowledge (P < 0.001) were found between bond-up and at initial follow-up. There were no relationships between age and gender of the patients and adherence. Clinical status at bond-up was the only significant predictor of clinical status at initial follow-up. Randomised Controlled Trial: Total sample of 90 participants were randomised in a 1:1:1 ratio. No statistical differences were found in adherence among the three methods used. Conclusion: The literature advocates the use of several methods to improve compliance/adherence among orthodontic patients. While there is insufficient evidence to allow clinicians to choose a single method, the results demonstrate the value of spending time with patients to illustrate the importance of adherence. Future studies should develop multiple methods of assessing patient adherence including self-report, behavioural observation and recording, as well as change in clinical indices, with different types of interventions to be included and tested for effectiveness. The survey demonstrated that the oral hygiene of patients worsens following the start of orthodontic treatment. Age, gender, and knowledge are not good predictors of adherence. However, initial clinical status predicts subsequent adherence. The randomised controlled trial revealed no differences in adherence among the three methods used.
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Joice, Sara A. "Adherence in behavioural interventions for stroke patients : measurement and prediction." Thesis, University of St Andrews, 2005. http://hdl.handle.net/10023/7262.
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Background: With the increasing incidence in stroke and the resultant high prevalence of residual disability resources are not adequately meeting the needs of the patients. Furthermore patients continue to express dissatisfaction with their care. New interventions are being developed and evaluated. However, when offered these new interventions, patients may refuse or not participate fully. A stroke workbook intervention was developed through a line of research examining the role of perceived control in recovery. During the randomised controlled trial (RCT) evaluating its efficacy patients failed to fully participate in the activities proposed in the workbook. Why, when there is such a dearth of treatment available, do stroke patients not fully participate in or adhere to the interventions offered? Methods: Three studies were conducted, a predictive study using the intervention group of the RCT exploring the demographic, clinical and psychological factors predicting adherence; a predictive study using one of the intervention groups from a larger 2x2 RCT to examine the predictors of adherence to an easier intervention (video); and a third longitudinal study examining the efficacy of an even simpler intervention (letter) on increasing adherence to the video. The theoretical framework of Leventhal's Self Regulation Model was used to develop the letter intervention and to explain the findings. Results: Five types of adherence behaviours emerged from the three studies, all with their own difficulties of definition, measurement and their individual predictor variables. Gender, impairment and illness representations were all predictive of adherence. An easier intervention promoted adherence especially for men and the more impaired. Women appeared to adhere more readily to the complex intervention. These gender differences may be associated with illness representations. A theoretical-based letter does not increase adherence per se but may increase the amount of adherence to an easier intervention. Conclusion: Adherence behaviour is not one type of behaviour and is associated with measurement difficulties. The Self-Regulation model appeared to offer some logical explanations to the findings. The findings have clinical implications and could possibly be associated with patients' satisfaction with care.
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Gamble, Jacqueline Margaret. "Medication adherence in patients with difficult asthma." Thesis, Queen's University Belfast, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.527931.
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Thomas, Valarie Finley. "Increasing Patients' Understanding of Prescribed Medication Adherence." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5422.
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The cost of healthcare in the United States has increased due to growing numbers of patients who live with chronic health problems, such as heart disease. The cost of healthcare is compounded by the cost in terms of complications of cardiovascular disease secondary to medication non-adherence. Education about medication use and adherence, safety, and side effects was needed for patients in a cardiovascular unit to improve adherence to medications as prescribed. Results of a health care provider (HCP) and nursing staff needs assessment provided by the site showed the need for improved cardiovascular medication education. The project focused question asked if cardiovascular patient medication education provided to HCPs and nursing staff would be incorporated into practice by the HCPs and nursing staff. The purpose of the project was to improve the education provided to patients by the HCPs and nursing staff. A literature review provided content for the educational program. Strategies to promote adherence and medication safety and a patient education worksheet were presented with guidance on implementation. Post education qualitative results from HCPs and nursing staff showed that the sheet was implemented and helpful with educating cardiovascular patients. This project promotes positive social change by the implementation of a patient education program that may improve patient education and adherence to cardiovascular medications. As a result, improved adherence to medications may reduce patient and healthcare related costs long term.
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Khatib, R. "Adherence to secondary prevention medicines by coronary heart disease patients : first reported adherence." Thesis, University of Bradford, 2012. http://hdl.handle.net/10454/5484.
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Background Non-adherence to evidence based secondary prevention medicines (SPM) by coronary heart disease (CHD) patients limits their expected benefits and may result in a lack of improvement or significant deterioration in health. This study explored self-reported non-adherence to SPM, barriers to adherence, and the perception that patients in West Yorkshire have about their medicines in order to inform practice and improve adherence. Methods In this cross-sectional study a specially designed postal survey (The Heart Medicines Survey) assessed medicines-taking behaviour using the Morisky Medicines Adherence 8 items Scale (MMAS-8), a modified version of the Single Question Scale (SQ), the Adherence Estimator (AE), Beliefs about Medicines Questionnaire(BMQ) and additional questions to explore practical barriers to adherence. Patients were also asked to make any additional comments about their medicines-taking experience. A purposive sample of 696 patients with long established CHD and who were on SPM for at least 3 months was surveyed. Ethical approval was granted by the local ethics committee. Results 503 (72%) patients participated in the survey. 52%, 34% and 11% of patients were prescribed at least four, three and two SPMs respectively. The level of non-adherence to collective SPM was 44%. The AE predicted that 39% of those had an element of intentional non-adherence. The contribution of aspirin, statins, clopidogrel, beta blockers, angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) to overall non-adherence as identified by the SQ scale was 62%, 67%, 7%, 30%, 22% and 5%, respectively. A logistic regression model for overall non-adherence revealed that older age and female gender were associated with less non-adherence (OR = 0.96, 95% CI: 0.94, 0.98; OR = 0.56, 95% CI: 0.34, 0.93; respectively). Specific concern about SPM, having issues with repeat prescriptions and aspirin were associated with more non-adherence (OR = 1.12, 95% CI: 1.07, 1.18; OR = 2.48, 95% CI: 1.26, 4.90, OR = 2.22, 95% CI: 1.18, 4.17). Other variables were associated with intentional and non-intentional non-adherence. 221 (44%) patients elaborated on their medicines-taking behaviour by providing additional comments about the need for patient tailored information and better structured medicines reviews. Conclusions The Medicines Heart Survey was successful in revealing the prevalence of self-reported non-adherence and barriers to adherence in our population. Healthcare professionals should examine specific modifiable barriers to adherence in their population before developing interventions to improve adherence. Conducting frequent structured medicines-reviews, which explore and address patients' concerns about their medicines and healthcare services, and enable them to make suggestions, will better inform practice and may improve adherence.
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Williams, Amanda L. "Physician adherence to communication tasks with adult vs. older adult female patients." CardinalScholar 1.0, 2010. http://liblink.bsu.edu/uhtbin/catkey/1560844.
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The study investigated whether physician communication adherence was similar between
adult and older adult female patients in a family medicine setting. Additionally, the study
investigated whether or not the level of communication adherence was related to patient
perceptions of working alliance. Previous research has failed to adequately examine age
as a variable in physician-patient communication and has neglected to examine the
working alliance within the physician-patient relationship. The sample included 41 adult
female, family medicine patients, who agreed to have their appointment with their
physician videotaped. The videotaped encounters were coded by trained observers using
the Behavioral Science Tape Review Checklist (BSTRC). Participants also completed the
Working Alliance Inventory-Short Form (WAI-SF). Results from the study suggested
that physician adherence to communication tasks did not vary significantly between adult
patients and older adult patients. Further, results demonstrated that the combination of
responses to the bond and tasks subscales of the WAI-SF significantly accounted for 16%
of the variance in communication adherence.Department of Counseling Psychology and Guidance Services
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Cerimagic, Zlata. "Self-reported medication adherence among patients with diabetes /." View online ; access limited to URI, 2004. http://0-wwwlib.umi.com.helin.uri.edu/dissertations/dlnow/3145414.
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Dos, Reis Juliao. "Factors associated with medication adherence among tuberculosis patients in Timor-Leste." Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/94662/1/Juliao_Dos%20Reis_Thesis.pdf.
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This thesis investigated medication adherence among people living with tuberculosis in Timor Leste. Suboptimal adherence was commonly reported, and was influenced by service inaccessibility, family poverty, patients' absence of disease symptoms and misperception of recovery, untreated depression and a popular cultural belief that luck or chance determines health outcomes. The study has implications for improving health literacy and counselling programs to achieve effective adherence to medication and good health outcomes.
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Michel, Marielena. "Health literacy and treatment adherence among Latinos with end stage renal disease." CSUSB ScholarWorks, 2008. https://scholarworks.lib.csusb.edu/etd-project/3359.
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The purpose of this study was to examine health literacy and treatment adherence among Latinos with end stage renal disease. Health literacy has been overlooked as one of the factors that affects one's ability to comply with the physician's prescribed medical treatment.
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Krolop, Linda [Verfasser]. "Adherence Management for Cancer Patients on Capecitabine / Linda Krolop." Bonn : Universitäts- und Landesbibliothek Bonn, 2013. http://d-nb.info/1046622641/34.
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Mathivha, Tshifularo Maud. "The role of family support and HIV/AIDS stigma on adherence and non-adherence to antiretrovirals at Nzhelele in Limpopo Province, South Africa." Thesis, University of Limpopo (Turfloop Campus), 2012. http://hdl.handle.net/10386/767.
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Thesis (M.PH.) --University of Limpopo, 2012Objectives: To determine the level of adherence of people who are on ARVs and to determine the influence of HIV and AIDS stigma and family support on adherence and non-adherence to antiretrovirals. Methods: A descriptive cross sectional study involving 175 HIV/AIDS adult patients attending Siloam hospital was conducted. These patients were on ARV drugs. They were investigated for the level of adherence and the influence of HIV and AIDS stigma and family support on adherence and non-adherence to antiretrovirals. Data were collected from respondents through self-administered questionnaires which were distributed to 175 randomly selected participants. The key variables were demographic information and social support and disclosure, current use of ARVs and personal experience of living with HIV/AIDS. Data were analyzed using descriptive statistics, numerical summaries, tables, graphs, ANOVA, Pearson chi-square test and statistical package for social sciences (SPSS). Results: Forty comma eight percent (40,8%) of the respondents on ARVs were males and 28, 8 % females aged between 23-35 years; 23, 9% males and 40, 4% females ranged between 36-45 years; 35, 2% males and 30, 8% were 46 years old and above. The most commonly cited reasons for missing doses were: Social grant, forgetting, side effects and stigma. The most cited reasons for taking medication were: respondents wanted to feel better; to increase the CD4 count; and they feared death. The majority of the adhering participants, 68, 9% and 55, 8% of the non- adhering group never experienced negative reactions from their families after disclosure. There was no significant difference between the adhering and the non adhering group (P =0.250). A substantial number of ARV users of the adhering group 92, 2% participants disclosed that they were receiving support which included emotional/psychological support, financial support, physical care support as well as reminders to ensure that they took their medications on time. There was no significant difference between the adhering and the non adhering group on the general satisfaction with the overall support they received from their family (p= 0.976). Conclusion: Patients have a range of reasons for failing to adhere to their antiretroviral therapy and reasons for adhering. Support can improve adherence to therapy and patients can only receive support if they revealed their HIV positive status. It was recommended that the community should be sensitised about the availability of treatment and the importance of adherence Keywords: Adherence, antiretrovirals, HIV/AIDS, stigma and family support
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Mansoor, Sarab M. "Adherence support strategies: inter-professional collaboration and role of community pharmacists in improving patients' adherence to medications." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/12686.
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Background Adherence to therapy is a growing concern for all healthcare professionals. Improving adherence requires a range of strategies that primarily focus on fostering behavioural change. Community pharmacists are well placed to deliver a range of strategies to support patients` adherence. Aims to investigate the extent to which Australian community pharmacists are providing adherence support strategies to patients and to explore the attitudes and opinions of pharmacists and general practitioners (GPs) on the provision of multiprofessional and collaborative adherence support interventions. Methods The research project consisted of two phases: Phase 1 (Quantitative study), encompassed the development and implementation of a mail survey instrument where a sample of 2020 pharmacies was randomly selected from the lists of Australian community pharmacies, and mailed a survey and Phase 2 (Qualitative study), consisted of qualitative focus group discussions with separate groups of pharmacists (N=23) and GPs (N=22), who were recruited from different geographic areas of Sydney. Results Both studies showed that reviewing dispensing and medical records of patients was found to be the most common method of identifying non-adherent patients. While simplifying medication regimen and providing dose administration aids were commonly used as strategies to support adherence. Factors found to potentially influence the provision of strategies to support adherence included “stakeholders/skills” and the number of equivalent staff. Conclusion Through a combination of qualitative and quantitative methods, this research identified the perceived reasons for non-adherence, strategies used by GPs and pharmacists to address and monitor adherence, and facilitators and barriers to the provision of adherence support services in community.
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Glover, Mary. "Shame and non-adherence to treatment in adolescent renal patients." Thesis, University of Nottingham, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.442263.
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Reed, Caroline. "Increasing Hydroxyurea Adherence for Pediatric Patients With Sickle Cell Anemia." Thesis, Walden University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10141603.
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Sickle cell disease is a disabling chronic autosomal recessive blood disease characterized by abnormal hemoglobin, pain crises, and frequent emergency department visits. Adherence to hydroxyurea therapy has been shown to improve these patient outcomes. Guided by the theory of comfort, the purpose of this project was to determine if an educational intervention would increase adherence to hydroxyurea therapy in pediatric patients between 2 and 17 years of age recruited from an urban university hospital hematology clinic. The RE-AIM model was used to support the translation of evidence and the change process. An educational video produced by AFLAC was viewed by patients’ parents 4 weeks after enrollment into this pretest/posttest design project. A total of 22 African-American parent participants completed the 8-item Morisky Medication Adherence Scale at baseline and again at 8 weeks to assess hydroxyurea adherence. The Short Test of Functional Health Literacy in Adults tool was used to assess parents’ health learning needs; all parents met the adequate literacy level at baseline. Using t test statistics, no statistically significant differences were found pretest to posttest on the Morisky Medication Adherence Scale scores, mean corpuscular hemoglobin, and fetal hemoglobin percentages. Wilcoxon Signed Rank tests showed no significant differences in emergency room visits nor number of pain crisis. Although no significant changes emerged in short-term hematologic findings, emergency room visits, and pain crises, social change in the health care setting was promoted by confirming parents were able to understand education and a high level of hydroxyurea adherence was maintained; literature indicated that long-term adherence to hydroxyurea limits severe attacks.
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Nsamenang, Sheri A., and Jameson K. Hirsch. "Positive Psychological Determinants of Treatment Adherence Among Primary Care Patients." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/700.
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Patient adherence to medical treatment recommendations can affect disease prognosis, and may be beneficially or deleteriously influenced by psychological factors.AimWe examined the relationships between both adaptive and maladaptive psychological factors and treatment adherence among a sample of primary care patients.MethodsOne hundred and one rural, primary care patients completed the Life Orientation Test-Revised, Trait Hope Scale, Future Orientation Scale, NEO-FFI Personality Inventory (measuring positive and negative affect), and Medical Outcomes Study General Adherence Scale.FindingsIn independent models, positive affect, optimism, hope, and future orientation were beneficially associated with treatment adherence, whereas pessimism and negative affect were negatively related to adherence. In multivariate models, only negative affect, optimism and hope remained significant and, in a comparative model, trait hope was most robustly associated with treatment adherence.ImplicationsTherapeutically, addressing negative emotions and expectancies, while simultaneously bolstering motivational and goal-directed attributes, may improve adherence to treatment regimens.
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Phillips, C., and Nicholas E. Hagemeier. "Pharmacists' and Patients' Perceptions of Medication Adherence in Rural Appalachia." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/1462.
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McQueen, Chandrika. "Educating psychiatric nurses to improve medication adherence among schizophrenic patients." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6067.
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The purpose of this project was to implement an educational program that provided psychiatric nurses with the knowledge and skills to engage patients with a diagnosis of schizophrenia in self-care management regarding medication and treatment adherence. The theory employed in the project was the educational theory. Evidence of effectiveness came from a pre- and postintervention assessment of nurses' knowledge and confidence in teaching about medication, along with a pre- and postassessment of knowledge gained as a result of the educational intervention. Pre- and posteducational rates of patient rehospitalization for medication nonadherence were compared. The results indicated a 15% rate of readmission of schizophrenia patients prior to the educational sessions. The 30-day readmission rate decreased to approximately 5% after the educational sessions. Based on these results, it was concluded that the educational project intervention had a positive impact on improving knowledge and insight of the nurses about nonadherence to medication among patients with schizophrenia. The positive social impact of improving nurses' knowledge of educating schizophrenic patients are increased patient well-being and reduced social costs associated with relapse and readmission. Recommendations from this project include that nurses should educate patients with schizophrenia on how to adhere to medication directives and the importance of doing so.
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Al, Solami Fatmah. "Factors affecting antihypertensive medications adherence among hypertensive patients attending a general hospital in Jeddah City, Saudi Arabia." Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/100185/1/Fatmah%20Jabr%20A_Al%20Solami_Thesis.pdf.
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This research assessed factors affecting antihypertensive medication adherence among hypertensive patients in Saudi Arabia. It was a cross-sectional study that used a self-reporting method to identify the level of antihypertensive medication adherence and the contributing factors. The results of analysing the Hill-Bone Compliance scale revealed that 28% of the patients were optimal adherents and that 72% of the patients were suboptimal adherents to antihypertensive medications. The study has identified the following significant factors to be associated with antihypertensive medication adherence were patient’s concern about taking antihypertensive medication, their belief of the necessity of taking antihypertensive medications, and the patient-physician relationship. To our knowledge, this is the first study to identify the factors affecting antihypertensive treatment adherence in Saudi Arabia.
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Fadele, Florence. "Increasing Providers’ Adherence to Ordering Urine Microalbumin Tests." NSUWorks, 2017. https://nsuworks.nova.edu/hpd_con_stuetd/47.
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Currently, a microalbumin urine test is an annual test for diabetic patients recommended by the American Diabetes Association, but primary care providers are not ordering the tests. This may be, in part, attributable to the fact that there are no guidelines for ordering microalbumin urine tests. The purpose of this capstone project was to assess providers' compliance in identifying the need for the microalbumin urine test for patients with diabetes, to develop evidence-based guidelines for monitoring and ordering microalbumin urine tests, and to evaluate providers' compliance. Rogers's theory of the diffusion of innovation provided the framework for this capstone project. A quantitative, descriptive design using a non-parametric paired t-test was used. Data was collected pre- and post-evidence based practice guidelines implementation in electronic health records. The mean monthly percentage of diabetic patients given microalbumin urine tests pre-implementation was 66.86 (SD = 4.25; 95% CI = (64.17, 69.56). The mean monthly percentage of diabetic patients given microalbumin urine tests post-implementation was 73.53 (SD = 2.58; 95% CI = (70.32, 76.73). SPSS version 23 (IBM Corp., Armonk, NY). The two sample t-test was statistically significant, t (15) = -3.232, p = 0.006). The introduction of evidence-based practice guidelines for ordering microalbumin urine tests improved provider compliance.
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McConnell, Angela H. "Influence of Patient Engagement Protocol on Health Outcomes and Medication Adherence of Patients with Metabolic Syndrome." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2741.
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August 2016
Management of metabolic syndrome (MetS) may be enhanced by promoting patient engagement. Training health care providers in the conceptual and practical application of integrative patient centered care tools may promote patient lifestyle behaviors for better management of MetS. The purpose of this quantitative quasi-experimental study was to assess the impact of training providers in integrative patient centered care for patients with MetS. The biopsychosocial construct provided the conceptual framework for the study. Two groups of physicians were included; one received training in an integrative model (IM) while the second received no training and provided usual care (UC). Following training, patient disease biometrics and medication adherence were monitored for approximately four months. Due to a diminished sample size in the completer data set, an intention to treat (ITT) data set was created with baseline values brought forward. In the ITT set, BMI decreased significantly (p=0.005, d=0.18) with each group over time: (IM: 32.9 -± 7.3 Kg/m2 to 31.6 -± 6.8 Kg/m2) and (UC: 32.1 -± 6.7 to 31.5 -± 6.3 Kg/m2). However, there were no statistically significant differences between these two groups' measures. In the completer set, BMI decreased significantly (p < 0.05, d=0.18) over time with the IM group, but not the UC group: (IM: 35.14 -± 7.9 Kg/m2 to 33.65* -± 7.62 Kg/m2) and (UC: 32.4 -± 6.62 Kg/m2 and (32.4 -± 6.5 Kg/m2); indicating a possible relationship between the intervention training (IM) and improved health outcomes. Thus, providers are assisting patients with important lifestyle choices to better manage MetS, potentially leading to social change around improved patient health care behaviors and advancement in providers' patient centered practices.
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Fisher, Jacinda. "A comparison of predictive models of adherence behaviour in hypertensive patients /." Title page, abstract and contents only, 1998. http://web4.library.adelaide.edu.au/theses/09SPS/09spsf534.pdf.
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Yi, Yuxiang, and 易宇翔. "Factors affecting adherence to new specialist outpatient appointments among elderly patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B2662798X.
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Hunot, Vivien Mary. "Factors associated with adherence in patients prescribed antidepressants in primary care." Thesis, King's College London (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.422206.
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Chen, Yike, and Xinxin Wang. "The experience of medication adherence in hypertensive patients : A descriptive review." Thesis, Högskolan i Gävle, Avdelningen för vårdvetenskap, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-36819.
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Makondo, Rulani. "Adherence to lifestyle modification recommendations in hypertensive patients at Parirenyatwa Hospital." University of the Western Cape, 2018. http://hdl.handle.net/11394/6899.
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Magister Public Health - MPHBackground: Hypertension (HTN) complications are one of the leading causes of disability and mortality worldwide, with increasing trends noted in Africa. The most neglected causes of uncontrolled HTN and its complications are unhealthy diets, excess alcohol consumption and physical inactivity. Adherence to recommended lifestyle modifications remains low in Zimbabwe. This study seeks to explore the factors influencing adherence to World Health Organisation (WHO) lifestyle modification recommendations in patients with hypertension at Parirenyatwa Hospital, Harare. Methodology: An analytic cross-sectional study design was utilized. 328 hypertensive patients aged at least 18, receiving care at Parirenyatwa Hospital were recruited into the study. A self-administered questionnaire was used to collect information on demographics, knowledge and adherence to WHO recommended lifestyle modifications from participants. Statistical Package for Social Scientists (SPSS) version 20 was used for data analysis. The Spearman test was used to test for linear correlation among variables and the 5-point Likert Scale was utilized to categorize the extent of practice of dietary and physical activity recommendations by WHO.
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Fahlén, Elin, and Julia Davidsson. "Factors that affect adherence to recommended treatment among diabetes patients in Kampala." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-294957.
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Background: Diabetes is an increasing global health problem and this puts high demands on the health care system. Patients with diabetes demand continuous treatment and monitoring in order to control the disease and avoid complications. Adherence to recommended treatment was important in order for the treatment to give positive effect. In this context adherence was defined as the extent to which the patients follow medical instructions.Aim: The aim of this study was to identify factors that can affect the adherence to recommended treatment among patients with type 1 and type 2 diabetes. Method: The study was a cross-sectional study with a quantitative method. A questionnaire was administered to 150 respondents at the diabetes clinic of Mulago hospital in Kampala, Uganda. Patients diagnosed with both type 1 and type 2 diabetes were included in the study. Result: Out of 150 participants 48 (32%) did not take their drugs as prescribed and 80 (53.3%) did not follow any recommended diet. Main reason for non-adherence to the treatment was reported as financial problems. 118 (78.7%) of the respondents had participated in some kind of diabetes education, still 67 patients (44.7%) reported that they did not have enough knowledge about their diabetes diagnosis. The results show that those with knowledge about their diabetes diagnosis also take their medication to a higher extent (46%) than those who reported lack of knowledge (22%). Conclusion: Factors that affect the adherence was identified as poverty, lack of knowledge, non-access to medications, the use of alternative medicines and non-access to health care. Further studies about adherence to treatment among diabetes patients are of importance in order to improve the diabetes care and come up with solutions to a growing global health problem.
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Wanunda, Wendy Ashley. "Barriers and facilitators regarding patient adherence towards physiotherapy rehabilitation programs in the management of osteoarthritis in Nairobi, Kenya." University of Western Cape, 2020. http://hdl.handle.net/11394/7696.
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Magister Scientiae (Physiotherapy) - MSc(Physio)Reduced adherence levels have been demonstrated by some patients affected with Osteoarthritis. Therefore, this study aimed at exploring the barriers and facilitators regarding patient adherence towards physiotherapy rehabilitation programs in the management of osteoarthritis in Nairobi, Kenya. The objectives of the study were to determine the clinical profile of patients with osteoarthritis on physiotherapy rehabilitation programs, to explore the patient-reported barriers and facilitators towards physiotherapy rehabilitation programs and exploring physiotherapists’ perceptions of patient adherence towards physiotherapy rehabilitation programs. The study setting was at the Kenyatta National Hospital physiotherapy clinic in Nairobi, Kenya.
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Jankie, Thenjiwe Rose. "Exploration of factors that influence poor adherence to antiretroviral therapy amongst patients at Pule Sefatsa primary health care clinic in Mangaung district, South Africa." University of Western Cape, 2019. http://hdl.handle.net/11394/6703.
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Magister Public Health - MPHBackground: Over the past decade, South Africa has scaled-up its antiretroviral treatment (ART) programme in an effort to control the HIV epidemic. Interventions to support the rollout of ART include task shifting ART initiation to nurses at primary health care level and ensuring HIV adherence counselling at every visit by lay counsellors. Furthermore, community-based outreach teams work at the community level to follow up on patients and ensure that patients remain in care and are adhering to ART. Despite all these efforts, poor adherence to ART remains a pertinent problem. In 2016, the national adherence to ART rate among adult patients was estimated at 35% compared to 39% in Pule Sefatsa clinic in Mangaung district, Free-state Province. Aim: The aim of the study was to explore the factors that influence poor adherence to ART among patients receiving ART at Pule Sefatsa primary health care clinic in Mangaung district, South Africa. Methodology: A descriptive qualitative research approach was used. Two focus group discussions were conducted with health workers and community caregivers and 16 in-depth interviews were conducted with ART patients who are in care and those who had defaulted on their treatment. Audio recorded data obtained from these sources were transcribed verbatim and prepared for analysis. Thematic analysis was used for data analysis and the results were classified under various categories. Findings: Adherence to ART in Pule Sefatsa clinic was found to be influenced by medical related factors, socio-economic factors, health system factors and individual factors. The medical-related factor was the side effects of the medication. The socio-economic factors were stigma and discrimination, lack of family support, poverty and food insecurity. Health system factors that hindered adherence to ART were medication stock-outs, long waiting times and poor service delivery. The final group of barriers to ART adherence was related to the individuals using ART and these include patients forgetting to take treatment and feeling depressed.
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Arnold, Tava L. "Predicting fluid adherence in hemodialysis patients via the illness perception questionaire - revised." unrestricted, 2007. http://etd.gsu.edu/theses/available/etd-11122007-020016/.
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Thesis (Ph. D.)--Georgia State University, 2007.Title from file title page. Roger O. Weed, committee chair; Gregory Brack, Phillip Gagne, Kenneth B. Matheny, committee members. Electronic text (67 p.) : digital, PDF file. Description based on contents viewed on July 11, 2008. Includes bibliographical references (p. 61-67).
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Carpenter, Delesha Miller DeVellis Robert F. "Understanding the effect of conflicting information on medication adherence for vasculitis patients." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2009. http://dc.lib.unc.edu/u?/etd,2834.
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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2009.Title from electronic title page (viewed Jun. 4, 2010). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Health Behavior and Health Education." Discipline: Health Behavior and Health Education; Department/School: Public Health.
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Arnold, Tava L. "Predicting Fluid Adherence in Hemodialysis Patients via the Illness Perception Questionaire - Revided." Digital Archive @ GSU, 2008. http://digitalarchive.gsu.edu/cps_diss/27.
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The Illness Perception Questionnaire - Revised (IPQ - R; Moss-Morris, Weinman, Petrie, Horne, Cameron, & Buick, 2002) was utilized in the current research to better understand and predict fluid adherance in hemodialysis patients. A sample of patients was recruited from three hemodialysis centers in the Los Angeles area and 116 participants completed the Illness Perception Questionnaire - Revised.
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Moshkovska, Tetyana. "Medication adherence to 5-aminosalicylic acid therapy in patients with ulcerative colitis." Thesis, University of Leicester, 2011. http://hdl.handle.net/2381/9417.
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5-aminosalycilic acid (5-ASA) therapy is effective for maintaining remission in patients with ulcerative colitis (UC) and may also reduce colorectal cancer risk. However, medication non-adherence is a known barrier to the effectiveness of prescribed regimes and there is a lack of evidence about methods of improving adherence to 5-ASA treatment. This research programme addressed the hypothesis that adherence can be improved by a multi-faceted intervention tailored to individual patient needs. A qualitative study identified that important determinants of adherence to 5-ASA medication are: information provided, patient beliefs and the patient-clinician relationship. Adherence can change over time; the study highlighted the need for reinforcement and the fact that health care professionals have a crucial role to play in this dynamic. A cross-sectional study confirmed the difficulty of accurately assessing medication adherence. The two measures used (self-report and urine analysis) were not correlated, phi correlation 0.029 (p = 0.725). Logistic regression identified a significant association between self-reported non-adherence and: younger age [OR for increased age 0.954, 95% CI 0.932–0.976] and also doubts about personal need for medication (OR for BMQ – Specific Necessity scores 0.578, 95%CI 0.366–0.913). For non-adherence based on urine analysis, only South Asian ethnicity was independently associated with non-adherence (OR 2.940, 95%CI 1.303–6.638). A randomised controlled trial showed that a multi-faceted, tailored intervention (including an opportunity for patients to select reminder devices from a range offered) had a significant positive impact on maintaining adherence levels in the intervention group (p=0.001), with a 44% difference between adherence levels in the two groups at follow-up. Changes in questionnaire scores suggested a positive effect of the intervention on satisfaction with information (p<0.001). The intervention was feasible, and was acceptable to patients. The multi-faceted approach studied has potential for implementation in routine care for enhancing persistence with 5-ASA and thus improving patient outcomes.
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Ruz, S. Abu. "Factors influencing adherence and disease control in patients with asthma and diabetes." Thesis, Queen's University Belfast, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273144.
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Elander, Astrid. "Adherence to inhalation technique and drugsin general in asthma- and COPD-patients." Thesis, Umeå universitet, Farmakologi, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-157698.
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Macdonald, L. A. "Medication adherence in bipolar disorder : understanding patients' perspectives to inform intervention development." Thesis, University College London (University of London), 2017. http://discovery.ucl.ac.uk/1543201/.
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Bipolar Disorder is primarily treated with medication which can be effective in reducing relapse risk, however, treatment is complex and adherence is sub-optimal. People can face significant challenges in self-managing the condition. The aim of this thesis was to better understand patients’ perspectives of BD and its treatment. Then, to use both this knowledge and self-regulation and behaviour change theory to develop and test a novel intervention entitled Improving information for people with Bipolar Disorder (IBiD). Intervention mapping, a stepwise process was followed to develop intervention content, delivery and evaluation. A systematic review with meta-analysis (k=18) was conducted and revealed that interventions are effective in improving adherence, effects are durable and brief interventions may be more effective than longer programmes (Chapter 3). A qualitative study (Chapter 4) (n=12) revealed patients insights into the burden of illness, unmet information needs and also how to live well with BD. These findings informed the IBiD intervention, which was tested in a feasibility RCT in a sample of patients in an acute mental health setting (Chapters 5-7). The intervention can feasibly be delivered in this setting and was acceptable to patients. Aspects of the intervention and the study itself had self-reported positive outcomes, however a more targeted, longer intervention may be required to actually modify specific medication beliefs and adherence. In order to explore additional factors raised during these studies a cross-sectional study (n=57) into the associations between perceptions, adherence and involvement in treatment decisions was conducted. Experiences of involvement and preferences for this were high. Involvement was significantly associated with satisfaction with information and illness perceptions. Associations between involvement and adherence were inconsistent. The results of this research programme have important implications for both mental health services and the application of health and illness theory to mental health.
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Yoon, Jean. "Adherence to prescription drugs and adverse health events for patients with hypertension." Diss., Restricted to subscribing institutions, 2008. http://proquest.umi.com/pqdweb?did=1679722851&sid=1&Fmt=2&clientId=1564&RQT=309&VName=PQD.
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Oser, Megan L. "Evaluation of a bibliotherapy intervention for improving patients' adherence to antihypertensive medications." abstract and full text PDF (UNR users only), 2008. http://0-gateway.proquest.com.innopac.library.unr.edu/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3339133.
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Beaver, Melissa A. "A Secondary Analysis of Imatinib Adherence Among Patients with Chronic Myeloid Leukemia." Thesis, The University of Arizona, 2010. http://hdl.handle.net/10150/156890.
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Background: Two recent studies have identified a strong association between treatment adherence and treatment response in patients with chronic myeloid leukemia (CML) treated with imatinib; and suggested a possible 7-10% tolerance margin for nonadherence before impaired treatment response is likely to occur. Objective: To determine at what percentage of dosing adherence of imatinib impaired treatment response (suboptimal response of incomplete cytogenetic response is likely to occur; and, conversely, at what percent of dosing adherence positive treatment response is likely to ensue CML patients.
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Mathevula, Hlayiseka Mokesh. "Factors affecting adherence to treatment in patients on chronic medication at Mokopane Hospital." Thesis, University of Limpopo (Turfloop Campus), 2013. http://hdl.handle.net/10386/1047.
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Thesis (M.Pharm) -- University of Limpopo, 2013Introduction: Many patients with chronic illnesses including asthma, hypertension, diabetes mellitus and HIV/AIDS, have difficulties adhering to their recommended regimens. This may result in sub-optimal management and control of the illness. What a patient understands about a specific regimen, including the reason for taking each medication and the intricacies of dosing schedules and administration requirements, can have a profound influence on adherence. Monitoring the effectiveness and safety of the treatment administered helps to decide whether this should be continued, changed or stopped. Any drug may produce unwanted or unexpected adverse reactions. The choice of drugs depends on many factors, such as the pattern of diseases, the treatment facilities, the training and experience of the available personnel, the financial resources available and demographic or environmental factors. The level of adherence to medication among with hypertension and diabetes mellitus or anti-retroviral therapy has not been studied in Limpopo province Aim: The aim of the study was to determine the adherence patterns and the factors contributing to the adherence to treatment by diabetic, hypertensive and HIV/AIDS patients at Mokopane Hospital. Methodology: This was a cross-sectional, descriptive study conducted through use of a questionnaire administered as an exit interview at the pharmacy after the patients had consulted the doctor and received their medication from the pharmacy. Results: The data was collected over a period of two months, where every patient was seen only once using their hospital numbers to avoid repetition. The study included a total of 307 participants, 201 (60%) were patients on ARVs, 48 (16%) were on anti-hypertensive, 35 (11%) on anti-diabetic, and 23 (8%) on both anti-hypertensive and anti-diabetics. The respondents were predominantly female (n = 234; 76%) while 73 (24%) male. Similarly of the 201 participants on ARVs treatment, 153 (76%) were females and 48 (24%) were males; among those on anti-hypertensives only 11 (22%) were males. For the diabetics 6 (17%) were males and 29 (83%) were females. Of participants with both hypertension and diabetes 9 (39.1%) were males and 14 (60.9%) were females. Seventy-nine percent (79%) of respondents on ART, 69% of those on anti-hypertensive, 72% of those on anti-diabetics, and 66% of those on both anti-diabetics and anti-hypertensives were adherent to their treatment. The younger patients (21 to 40 years) were less likely to have forgotten to take their treatment in the last one month (21% of respondents) than the older patients (41 to 87 years), 34% of whom forgot to take medication in the month prior to the study. Most respondents 250 (81%) reportedly used an alarm system/timer as reminder to take their medication. Most of them reported that they received information regarding their condition and medication, though some were not sure of the side effects or indications for the medications. Adherence was attributed to faith in the healthcare worker, fear of complications of the condition, and a desire to control the condition. Non-adherence was seen as an active decision, partly based on misunderstandings of the condition and general disapproval of medication which was only taken in order to facilitate daily life or minimize adverse effects. Conclusion: The levels of non-adherence (21% to 34%) among the patients on chronic medication are not acceptable. Elderly patients were more likely to be non-adherent to their treatment compared to the younger patients. Some information gaps were identified regarding their conditions and indications for medications. It is therefore important for the health professional to provide patients with full information about the indications, efficacy, and side effects of the medication given to them. Ways should be found to support elderly patients who are on chronic medications; for instance through directly observed therapy and/or using treatment supporters.
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Smith, Harriet K. "Adherence to ethical standards: Pharmacists as experts." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/127834/1/Harriet_Smith_Thesis.pdf.
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Credence goods are characterised by qualities of products that cannot be detected by consumers before their use, preventing them from assessing beforehand the true experienced utility. This study aims to apply the credence goods framework to the joint diagnosis-treatment in the sale of over-the-counter medicines in a real world setting. The presence of inefficiencies was studied through a unique sample (394 observations) of OTC pharmaceutical purchases in a controlled Australian field setting. This study provides first evidence from a simulated patient experiment on the provision of advice and pharmaceuticals using the credence goods framework in Australia. The results indicate there are significant inefficiencies present through over- and under-treatment, overselling and diagnostic failure. The analysis found that pharmacies were engaging in strategic overselling as a substitute for overcharging strategies which were not attainable due to institutional conditions.
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Feivik, Erica, and Andreas Backman. "Namibian nurses experience of patients adherence to the treatment plan : an empirical study of nurses work related to patients diagnosed with multi drug resistant Tuberculosis." Thesis, Högskolan Väst, Avdelningen för omvårdnad - grundnivå, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-9111.
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Background: A low adherence is one of the reasons for the development of drug resistant Tuberculosis. One of the identified factors connected to adherence is the relations between health care personal and patient. Nurses all over the world daily work close to the patient supporting them to achieve a high adherence to their treatment plan. Still there is an underrepresentation in a scientific view of exploring and evaluating this preformed work. Aim: The aim of this study wad to explore how the Namibian nurses experienced adherence to treatment in patients diagnosed with multidrug-resistant tuberculosis. Method: A qualitative research technic was used to collect data. The interview questions were constructed in a semi-structure with partly opened questions. The data was analysed with Graneheim and Lundman (2004) analysis model. Result: Strategies that was used by the nurses to enable a high adherence was providing information, counselling and education to the patient together with a practical support of delegating DOTS and providing the patient with medicine. There was a divided opinion on how to communicate with the patient depending on the nurse fundamental view of adherence. A doctor centred view resulted in a one way communication by informing the patient. A patient centred view of adherence resulted in a two way communication when the nurse aimed to learn about the patient own point of views. Conclusion: To enable a high adherence there has to be a two way communication which demands high communicational skills from the nurse.
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Moore, Suzanne P. "Adherence to randomised drug regimens of patients enrolled in the Second Australian National Blood Pressure Study : a description of the patterns of adherence and of factors influencing non-adherence /." [St. Lucia, Qld.], 2001. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16251.pdf.
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Thobias, Anna. "Exploration of Factors Associated with Poor Adherence amongst Patients Receiving Antiretroviral Therapy at Katutura State Hospital Communicable Disease Clinic in Khomas Region in Namibia." Thesis, University of the Western Cape, 2008. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_7058_1273775927.
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Background: HIV/AIDS affects the health of millions of people world wide. According to the Joint United Nations Program on HIV/AIDS [UNAIDS], the number of people living with HIV globally has risen from 26 million in 2001 to 33.2 million in 2007. It is estimated that 2.5 million people were newly infected with HIV in 2007. The introduction of anti-retroviral therapy [ART] has brought hope to millions of people living with HIV and AIDS. More recently, the increased availability of treatment in many countries including Namibia has dramatically improved survival rates and lowered the incidence of opportunistic infections among HIV patients. Adherence to antiretroviral therapy (ART) is a fundamental attribute of excellent clinical HIV care and a key aspect in determining the effectiveness of treatment. Strict adherence to ART is vital to maintain low viral load and to prevent the development of drug resistant virus. Poor adherence is one of the key obstacles to successful ART for HIV positive patients. Literature has shown that there are various factors that hinder adherence to ART such as patient, service, community, family, socio-economic and work-related factors. Aim: This study aimed to describe the experiences of patients in the ART programme at Katutura State Hospital, Communicable Disease Clinic (CDC), in the Khomas region of Namibia and to explore factors that contribute to poor adherence.
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Hernández, Pombo María Gimena. "Treatment safety, adherence and health-related quality of life in patients with asthma." Doctoral thesis, Universitat Autònoma de Barcelona, 2018. http://hdl.handle.net/10803/666784.
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L'objectiu general d'aquesta tesi doctoral va ser avaluar la qualitat de vida relacionada amb la salut (QVRS) en pacients amb asma i els factors sociodemogràfics i clínics que contribueïxen al seu deteriorament. També, avaluar la seguretat dels broncodilatadors d'acció llarga (BAL) combinats amb corticosteroides inhalats (CI) i els determinants de l'adherència al tractament.
L’evidència obtinguda en estudis observacionals (recerca sistemàtica en MEDLINE i EMBASE, període 1990-2013, incloent 19 estudis amb graandàries mostrals entre 50 i 514.216), mostren que el tractament combinat de LABA i CI no està associat a un major risc d'esdeveniments adversos greus, en comparació amb només CI. Els principals dèficits identificats van ser la mancança de disseny prospectiu, de població pediàtrica i de inclusió de la mortalitat com a resultat primari. Una revisió sistemàtica dels estudis observacionals sobre els determinants de l'adherència als inhaladors per a l‘asma va identificar 51 estudis (cerca realitzada a EMBASE, Medline, PsychInfo i PsychArticles de 1990 a 2014) que van examinar principalment els factors relacionats amb el pacient, i van trobar associacions consistents entre l’adherència i creences més arralades en la necessitat dels inhaladors, i possiblement amb una edat més avançada. Es va detectar la necessitat d'una amplia adopció d'estàndards conceptuals i metodològics comuns.
El projecte titulat “Assessment of the Safety of LABAs in asthma in routine care by combining health care data bases and direct patient-follow-up” (ASTRO-LAB) va ser un estudi prospectiu longitudinal (n = 908 pacients). Els pacients es van reclutar en els centres d’atenció primària a França i el Regne Unit. Els criteris d'inclusió eren: individus de 6 a 40 anys d'edat amb asma persistent, definit com més de 6 mesos de prescripció de CI i/o BAL durant els 12 mesos previs al seu reclutament. L'anàlisi dels 290 pacients que van completar l'EQ-5D-5L en l'enquesta basal per internet va demostrar un efecte sostre acceptable, una bona validesa de constructe i una alta fiabilitat, donant suport a la idoneitat d'aquesta nova versió del EQ-5D per avaluar la QVRS en pacients amb asma.
Finalment, vam comparar els pacients francesos (n = 222) amb les normes de referència EQ-5D procedents de França per estimar l'impacte de l'asma en la QVRS del pacient. L'asma persistent té un impacte moderadament negatiu en els pacients d'ambdós sexes, i les dones més joves van ser identificades com un grup d'alt risc que mereix més recerca. Hem identificat el control de l'asma com a principal factor associat de la reducció de la QVRS en els pacients, independentment del seu gènere, el que suggereix que l'impacte de l‘asma en la QVRS es podria mitigar aconseguint un bon control dels símptomes.El objetivo general de esta tesis doctoral fue evaluar la calidad de vida relacionada con la salud (CVRS) en pacientes con asma y los factores sociodemográficos y clínicos que contribuyen a su deterioro. Asimismo, evaluar la seguridad de los broncodilatadores de acción larga (BAL) combinados con corticosteroides inhalados (CI) y los determinantes de la adherencia al tratamiento. La evidencia obtenida en los estudios observacionales (búsqueda sistemática en MEDLINE y EMBASE, período 1990-2013, incluyó 19 estudios de tamaños muestrales entre 50 y 514.216) demuestra que el tratamiento combinado de BAL y CI no se asocia con un mayor riesgo de eventos adversos graves, en comparación con el tratamiento sólo con CI. Los principales déficits identificados fueron la falta de diseño prospectivo, de población pediátrica y de mortalidad como resultado primario. La revisión sistemática de estudios observacionales sobre determinantes de la adherencia a los inhaladores para el asma identificó 51 estudios (búsqueda realizada en EMBASE, Medline, PsychInfo y PsychArticles entre 1990 y 2014) que examinaron principalmente los factores relacionados con el paciente y encontraron una relación consistente entre la adherencia y las creencias más arraigadas en la necesidad de inhaladores, y posiblemente con una edad más avanzada. Se detectó la necesidad de una adopción más amplia de estándares conceptuales y metodológicos comunes. El proyecto titulado “Assessment of the Safety of LABAs in asthma in routine care by combining health care data bases and direct patient-follow-up” (ASTRO-LAB) fue un estudio longitudinal prospectivo (n = 908 pacientes). Los pacientes fueron reclutados en centros de atención primaria en Francia y Reino Unido. Los criterios de inclusión fueron: individuos cuyas edades estaban comprendidas entre los 6 y 40 años con asma persistente, definido como más de 6 meses de prescripción de CI y/o BAL durante los 12 meses anteriores al reclutamiento. El análisis de los 290 pacientes que completaron el EQ-5D-5L en la encuesta basal por internet demostró un efecto techo aceptable, una buena validez de constructo y una alta fiabilidad, lo cual apoya la idoneidad de esta nueva versión del EQ-5D para evaluar la CVRS en pacientes con asma. Finalmente, comparamos los pacientes franceses (n = 222) con las normas de referencia del EQ-5D en Francia para estimar el impacto del asma en la CVRS de los pacientes. El asma persistente tiene un impacto en la CVRS moderadamente negativo en pacientes de ambos sexos, y las mujeres más jóvenes fueron identificadas como un grupo de alto riesgo que merece más investigación. Identificamos el control del asma como el principal factor asociado al deterioro de la CVRS en los pacientes, independientemente de su sexo, lo que sugiere que el impacto del asma en la CVRS se podría mitigar logrando un buen control de los síntomas.
The general aim of this doctoral thesis was to evaluate the health-related quality of life (HRQoL) in patients with asthma, and the socio-demographic and clinical factors which contributed to its impairment. Also, to assess the safety of long-acting beta-agonists (LABAs) combined with inhaled corticosteroids (ICs), and the determinants of treatment adherence. Evidence from observational studies (systematic search in MEDLINE and EMBASE, period 1990-2013, including 19 studies with sample sizes from 50 to 514,216) shows that the combined treatment of LABAs and ICs is not associated with a higher risk of serious adverse events, compared to ICs alone. Major gaps identified were: prospective design, paediatric population and inclusion of mortality as a primary outcome. The systematic review of observational studies on determinants of asthma inhaler adherence identified 51 studies (search performed in EMBASE, Medline, PsychInfo and PsychArticles from 1990 to 2014) which mainly examined patient-related factors and found consistent links between adherence and stronger beliefs in inhaler necessity, and possibly with older age. The need of a broader adoption of common conceptual and methodological standards was detected. The project entitled “Assessment of the Safety of LABAs in asthma in routine care by combining health care data bases and direct patient-follow-up” (ASTRO-LAB) was a prospective longitudinal study (n= 908 patients). Patients were enrolled in primary care in France and United Kingdom by their general practitioner. Inclusion criteria were: subjects aged 6-40 years old, with persistent asthma, defined as more than 6 months of prescribed ICs and/or LABAs during 12 months before inclusion. Analysis of the 290 patients who completed the EQ-5D-5L in the baseline online survey demonstrated acceptable ceiling effect, good construct validity, and high reliability, supporting the adequacy of this new EQ-5D version for assessing HRQoL in asthma patients. Finally, French patients (n= 222) were compared with the EQ-5D reference norms from France to estimate the impact of asthma on patients' HRQoL. Persistent asthma has a moderately negative HRQoL impact on patients of both genders, and the youngest women have been identified as a high risk group which merits further research. We identified asthma control as the major factor associated to impaired HRQoL in patients, regardless of their gender, suggesting that asthma HRQoL impact could be alleviated by achieving a good symptom control.
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Russell, Megan Nezu Arthur M. "Treatment adherence, health status, and problem orientation in patients with chronic heart failure /." Philadelphia, Pa. : Drexel University, 2006. http://dspace.library.drexel.edu/handle/1860/749.
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Pollard, Samantha. "Medication adherence among adult asthma patients : investigating the role for shared decision-making." Thesis, University of British Columbia, 2017. http://hdl.handle.net/2429/62993.
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Background: Shared decision-making (SDM) has been suggested as a means to improve communication between patients and their healthcare providers, with the purposes of improving multiple asthma-related health outcomes. Despite mounting evidence that suggests potential benefits attributable to SDM, clinical uptake has been slow.
Objectives: The purpose of this dissertation is to ascertain the role of SDM in asthma management, to determine the extent to which SDM is currently being implemented into regular asthma care, and to suggest clinical implementation strategies that may facilitate SDM implementation in BC.
Methods: This project consists of a) a systematic review of physician attitudes toward SDM, b) a comprehensive narrative literature review to describe the proposed role of SDM in asthma, c) a population level analysis to explore variation in adherence to controller medication, as well as d) an online survey of 117 adult asthma patients living in BC.
Results: Results of this work show that in general a) physicians support the use of SDM in various clinical practice scenarios, b) there is a clear role for SDM in treating asthma patients with the goal of reducing the burden of controller medication non-adherence, and c) adherence to controller medications is sub-optimal, with little variation being explained at the population level. The patient survey (d) provided additional insight into this research agenda by showing that while patients prefer to be actively involved in treatment decision-making, there is substantial variation in the extent to which asthma patients are being engaged in their care. Furthermore, multiple predictors of adherence that can be addressed during the clinical encounter (e.g. medication-related concerns) were shown to impact self-reported treatment adherence.
Conclusions: The results of this project provide further support for the use of SDM in regular care of asthma patients. I conclude by highlighting the importance of addressing issues related to adherence in an individual and ongoing basis, the value of increasing awareness about the use of SDM, and the potentially valuable role of engaging non-physician caregivers in future SDM implementation efforts. These findings may guide future research investigations regarding SDM uptake and efforts to reduce the disease burden of asthma.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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Thrasher, Angela D. Earp Jo Anne L. "Discrimination, distrust, and racial/ethnic disparities in antiretroviral therapy adherence by HIV+ patients." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2006. http://dc.lib.unc.edu/u?/etd,668.
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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2006.Title from electronic title page (viewed Oct. 10, 2007). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Health Behavior and Health Education, School of Public Health." Discipline: Health Behavior and Health Education; Department/School: Public Health.
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McFadden, Linsey. "An evaluation of medication adherence and self-management techniques in patients with epilepsy." Connect to resource, 2007. http://hdl.handle.net/1811/30118.
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Siao, Sih-Yin, and 蕭偲吟. "Forecasting Medication Adherence for Diabetic Patients." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/d5mejk.
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碩士國立中興大學
企業管理學系所
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Diabetes mellitus is one of ten main mortalities in Taiwan every year, and medication adherence is the biggest challenge in the process of treatment for diabetic patients. According to research, improper blood sugar control caused by poor medication adherence may cause the occurrence of many complications. The first stage of the research aims to verify the influence of medication adherence on health status of patients. The second stage is the construction of the prediction model of medication adherence, and find out the feature of high-level and low-level adherence. In the end, the model of evaluation will be construct. Data was drawn from national health insurance research database in the year 2000 to 2004. Generalized estimating equation is analyzed to evaluate the association between medication adherence and Charlson comorbidity index. And using three data mining technologies including logistic regression, decision tree, and neural network to build prediction model of medication adherence. Eventually, prediction models will be evaluated by three indicators including the rate of accuracy, sensitivity, and specificity and misclassification cost. The research findings of the study show that medication adherence has a significant impact on the health status of diabetic patients, and the higher age the patients are, the lower level of hospitals patients visit, and the higher expense the patients pay, the higher medication adherence patients show. The empirical result, in addition to theoretically confirming the effect of takeing medications on-time on the health status of diabetic patients, also reflects that how to improve the compliance of diabetic patients in clinical practice is an important issue. In the section of model evaluation, neural network shows the highest accuracy of 80.26%, decision tree shows the highest sensitivity rate of 64.43%, and logistic regression shows the best specificity rate of 97.56%. Considering the results of misclassification costs, the finding is that the actual costs of type 1 and type 2 errors will affect the optimal threshold of the predict values of the dependent variable in the model.
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Ghimire, S. "Understanding determinants of medication adherence and current adherence assessment practices in Australian haemodialysis patients." Thesis, 2018. https://eprints.utas.edu.au/28470/1/Ghimire_whole_thesis.pdf.
Full textAbstract:
Medication nonadherence is a well-recognised problem in chronic diseases with a global prevalence rate estimated to be 50%. Determinants of nonadherence are multifactorial, although increasing complexity of disease and medication regimen contribute to nonadherence. End-stage kidney disease (ESKD) patients undergoing haemodialysis are prescribed complex regimens and are at high risk of medication nonadherence. Current clinical practice places significant emphasis on selecting medications that have been shown to improve patient outcomes, however little attention is paid to measuring and ensuring patient adherence to their prescribed treatments. Our understanding of factors contributing to medication nonadherence in patients undergoing haemodialysis is limited. This research sought to determine potential predictors of medication nonadherence, explore current practices and barriers to assessing adherence, and identify strategies to improve adherence assessment practices in clinical settings. The specific research objectives were to:
• summarise existing literature on medication nonadherence and identify factors associated with medication nonadherence in patients undergoing haemodialysis;
• investigate the prevalence pattern, and socio-demographic, clinical and psychosocial factors contributing to medication nonadherence in Australian haemodialysis patients, and
• identify current practices of assessing medication adherence in renal patients by health professionals, barriers to assessment, and strategies to improve adherence assessment practices in Australian dialysis centres.
These research aims were investigated in four distinct studies. The first study summarised the existing literature on medication nonadherence using a systematic review. From the 44 relevant publications identified through the systematic review, the prevalence of medication nonadherence in patients undergoing haemodialysis varied between 12.5% and 98.6%. This wide variation occurred due to the heterogeneity in measures and definitions employed by the included studies. This inconsistency in the reporting of results did not allow us to conduct a more effective synthesis of results, such as meta-analysis, as part of the systematic review. However, through a narrative synthesis approach we identified a number of patient-, disease-, and medicationrelated factors contributing to nonadherence in patients undergoing haemodialysis.
The second study was a prospective study of 53 adult (≥ 18 years) patients undergoing haemodialysis, recruited from an outpatient dialysis centre in Hobart, Australia. More than half (56.6%, n = 30) of these patients were found to be nonadherent based on self-reports. Comparatively, nonadherence was much higher among the subset of patients (n = 33) analysed using pre-dialysis serum phosphate levels, as an objective measure (72.7%, n = 24). Increasing age was the only significant predictor of self-reported adherence (odds ratio (OR) 1.05; 95% CI 1.00–1.11), whereas older age (OR 1.10; 95% CI 1.00–1.21), higher level of comorbidity (OR 1.58; 95% CI 1.03–2.42), and higher medication regimen complexity index (OR 1.14; 95% CI 1.02–1.27) were independent predictors of objective adherence.
The third study was a qualitative study aimed at exploring haemodialysis patients’ perspectives on their medication-taking behaviour. Thirty patients undergoing haemodialysis from the aforementioned prospective study, completed one-on-one semi-structured interviews. The qualitative themes identified were mapped against WHO (World Health Organisation) determinants of adherence and comprised of patient-related (knowledge, awareness, attitude, self-efficacy, action control, and facilitation); health system/healthcare team-related (quality of interaction, and mistrust and collateral arrangements); therapy-related (physical characteristics of medicines, packaging, and side effects); condition-related (symptom severity); and social/economic factors (access to medicines, and relative affordability).
Findings from the second and third study, led to the inception of the fourth study on healthcare professionals’ perspectives on the issue of medication nonadherence in patients undergoing haemodialysis. As such, the fourth study consisted of crosssectional surveys and follow-up interviews with renal healthcare professionals, aimed at measuring their perceptions and practices of assessing adherence in clinical practice. A total of 113 renal nurses and 41 specialist renal pharmacists participated in this study. Attempts to engage renal doctors were unsuccessful despite trying various recruitment strategies. Renal nurses (83.2%, n = 89), relied heavily upon objective blood results to determine adherence, compared to pharmacists (57.1%, n = 16). Patient engagement via self-reported measures were rarely used by the pharmacists (27.6%, n = 8) compared to the nurses (55.1%, n = 59); this was mainly due to absence of a dedicated pharmacist to conduct such activities. Perceived barriers to assessing adherence by the renal professionals included: lack of time, administrative support, and patients’ disinterest in discussing medication related issues.
Survey participants were followed-up for a qualitative interview to expand on the survey findings and identify strategies to improve adherence assessment practices. Eighteen participants, comprising 12 nurses and six pharmacists, were interviewed. Three categories of barriers with seven underlying themes were identified: organisation-level (prioritisation of resources), professional-level (interplay between workload and available time, awareness and training deficits, and concerns around practicality/suitability of adherence tools), and patient-level (communication and assessment services, patient participation, and trust). Similarly, strategies that were identified to improve adherence assessment practices, included: formalisation of assessment process, integration of assessment process and tools into routine, and using multidisciplinary support.
Despite the widespread prevalence of medication nonadherence among Australian haemodialysis patients, little attention has been given to ensuring patients adhere to their prescribed medicines. Communication and dialogue between patients and healthcare providers concerning medication-related issues are lacking within the dialysis settings. In order to improve this status quo, measuring nonadherence is vital. However, renal professionals placed too much emphasis on objective measures while assessing adherence; using such measures is subject to overlooking actual understanding of patient’s medication-taking behaviour. As patient self-reported measures are important tools to supplement the objective measures, they should be promoted to healthcare providers so an open dialogue on medication nonadherence can be initiated. This may be a first step in a right direction in improving medication adherence in patients undergoing dialysis. In addition, current adherence assessment practices could be improved by formalising and integrating these practices into hospital policies and procedures. For example, by integrating adherence checklists into treatment sheets for routine assessments. Although easier said than done, having a dedicated and trained healthcare professional to measure adherence, is another key initiative that may improve medication adherence among dialysis patients. Finally, the importance of frequent discussion with patients to identify concerns they may have related to their medications cannot be overestimated.