CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 12 2006
Chad C Carroll
SUMMARY 1Maintaining patient adherence to a drug regimen has proven to be difficult. Missed doses can impact drug efficacy and disease control, leading to increased health-care costs. 2During clinical drug trials, poor adherence could lead to false conclusions regarding drug efficacy. Therefore, the purpose of the present study was to determine the feasibility of using personal digital video cameras to monitor adherence to a medication regimen during a clinical investigation. 3Older men and women (60,78 years) participated in a double-blind, placebo-controlled trial to determine the effect of ibuprofen or paracetamol on skeletal muscle adaptations to chronic resistance exercise training. Patients took three daily doses of either a placebo or the maximal daily over-the-counter dose of ibuprofen (1.2 g/day) or paracetamol (4.0 g/day) for 12 weeks. Prior to beginning the study, subjects were trained to use a personal digital video camera to record their drug consumption. 4Subjects correctly recorded 4956 of 5375 doses, resulting in an average camera compliance rate of 92% (71,100%). 5We describe a method of monitoring adherence to a prescribed drug regimen during a clinical investigation. Camera compliance rates, which directly confirm drug consumption, were higher than what is typically obtained with other methods of monitoring adherence. This camera compliance method provides the investigator with a simple and convenient means to generate direct evidence of drug consumption. [source]

Impact of Provider Self-Management Education, Patient Self-Efficacy, and Health Status on Patient Adherence in Heart Failure in a Veterans Administration Population

CONGESTIVE HEART FAILURE, Issue 1 2008
Usha Subramanian MD
To address the need for more information on predictors of adherence to heart failure (HF) self-management regimens, this study analyzed surveys completed by 259 HF patients receiving care at 2 Veterans Affairs hospitals in 2003. Linear multivariable regression models were used to examine general health status, HF-specific health status (Kansas City Cardiomyopathy Questionnaire) self-management education, and self-efficacy as predictors of self-reported adherence to salt intake and exercise regimens. Self-management education was provided most often for salt restriction (87%) followed by exercise (78%). In multivariable regression analyses, education about salt restriction (P=.01), weight reduction (P=.0004), self-efficacy (P=.03), and health status (P=.003) were significantly associated with patient-reported adherence to salt restriction. In a similar model, self-efficacy (P=.006) and health status (P,.0001), but not exercise education, were significantly associated with patient-reported exercise adherence. Findings suggest that provider interventions may lead to improved adherence with HF self-management and thus improvements in patients' health. [source]

A randomized study of massed three-week cognitive behavioural therapy schedule for panic disorder

ACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2009
M. K. Bohni
Objective:, To compare the efficacy of massed vs. spaced group cognitive behavioural therapy (CBT) for patients with panic disorder with or without agoraphobia (PD). Method:, Thirty-nine PD patients were randomly assigned to massed group CBT (daily 4-h sessions in week 1, two 2-h sessions in week 2 and one 2-h session in week 3) or traditional spaced weekly group CBT (13 consecutive, weekly 2-h sessions). The content and number of hours in the two treatment schedules were identical. Outcome was assessed after treatment, and at 3, 6 and 18 months of follow-up. Results:, Both treatment groups achieved significant improvement on all measures with large pre- to post-treatment and pre-treatment to follow-up effect sizes. No between-group differences were registered. Adherence and patient satisfaction did not differ between groups. Conclusion:, The massed, 3-week group CBT schedule proved to be effective and feasible for PD patients with outcomes comparable with that of standard, spaced group CBT. [source]

Multidisciplinary antenatal care for opiate-using women: Child-care issues

DRUG AND ALCOHOL REVIEW, Issue 2 2010
ADERONKE A. ADENIJI
Abstract Introduction and Aims. The fact that particular parents suffer afflictions limiting their ability to care does not mean that they should automatically be deemed unsuitable parents. Prompted by neonatal team concerns about child-care issues, a local multidisciplinary group was set up to care for substance-abusing pregnant women in our region. Design and Methods. This project was conducted in order to review the records of all the women who had been discussed at our management planning meetings over the past 5 years. Our assessment tool records were reviewed and analysed using spss. Results. A total of 233 women were assessed. The majority of patients booked before 20 weeks (62%) and 96 women (41%) attended over 80% of their antenatal appointments. There was little change in substance use during the course of pregnancy. Overall, at delivery, 196 of the 233 women (84%) used methadone and 89(38%) used heroin. There was no correlation between usage and foster care of the baby (methadone: ,2 = 0.5, P = 0.8 NS) (heroin: ,2 = 3.1, P = 0.08 NS). There was an absolute correlation between social services involvement and foster care (,2 = 2.33, P < 0.0001). Adherence with planned antenatal appointments significantly increased the likelihood of a child being discharged with his mother (,2 = 6.7, P = 0.009). Discussion and Conclusions. The majority of newborns were discharged home with their mothers directly with the most significant factor in placing a child in foster care being prior involvement of social services. However, many of these families will continue to need support during the children's early years.[Adeniji AA, Purcell A, Pearson L, Antcliffe JM, Tutty S, Sinha C, Pairaudeau PW, Lindow SW. Multidisciplinary antenatal care for opiate-using women: Child-care issues. Drug Alcohol Rev 2009] [source]

Profiles in Patient Safety: Medication Errors in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 3 2004
Pat Croskerry MD
Abstract Medication errors are frequent in the emergency department (ED). The unique operating characteristics of the ED may exacerbate their rate and severity. They are associated with variable clinical outcomes that range from inconsequential to death. Fifteen adult and pediatric cases are described here to illustrate a variety of errors. They may occur at any of the previously described five stages, from ordering a medication to its delivery. A sixth stage has been added to emphasize the final part of the medication administration process in the ED, drawing attention to considerations that should be made for patients being discharged home. The capability for dispensing medication, without surveillance by a pharmacist, provides an error-producing condition to which physicians and nurses should be especially vigilant. Except in very limited and defined situations, physicians should not administer medications. Adherence to defined roles would reduce the team communication errors that are a common theme in the cases described here. [source]

Prevalence and cost of nonadherence with antiepileptic drugs in an adult managed care population

EPILEPSIA, Issue 3 2008
Keith L. Davis
Summary Purpose: This study assessed the extent of refill nonadherence with antiepileptic drugs (AEDs) and the potential association between AED nonadherence and health care costs in an adult-managed care population. Methods: Retrospective claims from the PharMetrics database were analyzed. Inclusion criteria were: age ,21, epilepsy diagnosis between January 01, 2000 and March 12, 2005, ,2 AED prescriptions, and continuous health plan enrollment for ,6 months prior to and ,12 months following AED initiation. Adherence was evaluated using the medication possession ratio (MPR). Patients with an MPR <0.8 were classified as nonadherent. Multivariate regression was used to assess the effect of AED nonadherence on annualized cost outcomes. Regression covariates included patient demographics, Charlson Comorbidity Index (CCI), and follow-up duration. Results: Among patients meeting all inclusion criteria (N = 10,892), 58% were female, mean age was 44 years, mean CCI was 0.94, and mean follow-up was 27 months. Mean MPR was 0.78 and 39% of patients were nonadherent. AED nonadherence was associated with an increased likelihood of hospitalization (odds ratio [OR]= 1.110, p = 0.013) and emergency room (ER) admission (OR = 1.479, p < 0.0001), as well as increased inpatient and ER costs of $1,799 and $260 (both p = 0.001), respectively, per patient per year. Outpatient and other ancillary costs were not significantly affected by nonadherence. A large net positive effect of nonadherence on total annual health care costs remained (+$1,466, p = 0.034) despite an offset from reduced prescription drug intake. Discussion: Adherence with AEDs among adult epilepsy patients is suboptimal and nonadherence appears to be associated with increased health care costs. Efforts to promote AED adherence may lead to cost savings for managed care systems. [source]

Adherence to pharmacotherapy in patients with alcohol and opioid dependence

ADDICTION, Issue 11 2004
Roger D. Weiss
ABSTRACT Aims An important factor that has thus far limited the effectiveness of pharmacotherapies for patients with alcohol and opioid dependence is poor adherence to medication regimens. This paper presents a review of issues related to medication adherence in patients with these substance use disorders. Design and methods A literature review was conducted of English language publications relating to medication adherence among patients with alcohol or opioid dependence. Findings The paper places the topic in the context of adherence difficulties among patients with a variety of chronic medical and psychiatric illnesses. Difficulties measuring adherence are discussed, and strategies to improve medication adherence are reviewed. These include specific interventions that prescribing clinicians can implement in their individual meetings with patients; the use of external reinforcers, such as positive and negative contingencies, and involvement of family members or significant others; and specific prescribing and dosing practices that may improve adherence. Conclusions As the use of pharmacotherapy for substance-dependent patients increases, rigorous and innovative approaches to encourage medication adherence should be sought. [source]

Feasibility of an exercise rehabilitation programme for cancer patients

EUROPEAN JOURNAL OF CANCER CARE, Issue 4 2006
C. STEVINSON bsc, research fellow
A growing body of evidence indicates the benefits of exercise as a rehabilitation intervention for cancer patients. However, few hospitals offer exercise-based rehabilitation programmes to patients. This study evaluated the feasibility and acceptability of a group-based exercise programme for cancer patients attending a local oncology centre. The intervention consisted of a weekly instructor-led circuit training class supplemented by home-based activity 4 days/week for 10 weeks. From 28 eligible patients, 12 were recruited (43%), of whom nine completed the intervention (75%). The three withdrawals were due to worsening of disease. Adherence (mean of 7.5 classes attended and 4 days/week of home activity performed) and tolerability (no adverse events) were good. Positive features of the programme identified in interviews with participants included the variety and scope of the exercises, and the empathetic but positive approach of the instructors. The small group format was highly valued with participants receiving social support and inspiration from each other. Perceived outcomes included improved fitness, reduced fatigue, enjoyment, enhanced mood and a sense of achievement. Several participants felt that the intervention represented a stepping stone to becoming habitual exercisers. Results suggested that the programme was feasible and acceptable to patients, but uptake was low, indicating a need for more effective recruitment strategies in order for a cost-effective service to be implemented. [source]

Client-level Predictors of Adherence to MST in Community Service Settings

FAMILY PROCESS, Issue 3 2003
SONJA K. SCHOENWALD Ph.D.
This study examined the association of youth and family characteristics with therapist fidelity to an evidence-based treatment provided in real world practice settings. Participants were 233 families that reported on the 66 therapists organized into 16 teams in nine organizations providing multisystemic therapy (MST). Therapist adherence ratings were lower for youths referred for both criminal offenses and substance abuse than for youths referred either for substance abuse or status offenses, and was negatively associated with pretreatment arrests and school suspensions. Adherence ratings were positively associated with educational disadvantage and caregiver-therapist ethnic match and marginally positively associated with economic disadvantage. The findings suggest directions for future research on the implementation of evidence-based treatments in community settings. [source]

Behavioral Facilitation of Medical Treatment for Headache,Part II: Theoretical Models and Behavioral Strategies for Improving Adherence

HEADACHE, Issue 9 2006
Jeanetta C. Rains PhD
This is the second of 2 articles addressing the problem of noncompliance in medical practice and, more specifically, compliance with headache treatment. The companion paper describes the problem of noncompliance in medical practice and reviews literature addressing compliance in headache care (Behavioral Facilitation of Medical Treatment for Headache,Part I: Review of Headache Treatment Compliance). The present paper first summarizes relevant health behavior theory to help account for the myriad biopsychosocial determinants of adherence, as well as patient's shifting responsiveness or "readiness for change" over time. Appreciation of health behavior models may assist in optimally tailoring interventions to patient needs through instructional, motivational, and behavioral treatment strategies. A wide range of specific cognitive and behavioral compliance-enhancing interventions are described, which may facilitate treatment adherence among headache patients. Strategies address patient education, patient/provider interaction, dosing regimens, psychiatric comorbidities, self-efficacy enhancement, and other behavioral interventions. [source]

Behavioral Facilitation of Medical Treatment of Headache: Implications of Noncompliance and Strategies for Improving Adherence

HEADACHE, Issue 2006
Jeanetta C. Rains PhD
Clinical recommendations were gleaned from a review of treatment adherence published in the regular issue of Headache (released in tandem with this supplement). The recommendations include: (1) Nonadherence is prevalent among headache patients, undermines treatment efficacy, and should be considered as a treatment variable; (2) Calling patients to remind them of appointments and recalling those who miss a scheduled appointment are fundamentally the most cost-effective adherence-enhancing strategies, insofar as failed appointment-keeping acts as a ceiling on all future treatment and adherence efforts; (3) Simplified and tailored medication regimens improve adherence (eg, minimized number of medications and dosings, fixed-dose combinations, cue-dose training, stimulus control); (4) Screening and management of psychiatric comorbidities, especially depression and anxiety, is encouraged; (5) The concept of self-efficacy as a modifiable psychological process often can be employed to predict and improve adherence. [source]

Long-term utility of measuring adherence by self-report compared with pharmacy record in a routine clinic setting

HIV MEDICINE, Issue 5 2005
CK Fairley
Objectives To compare long-term adherence to antiretroviral therapy in an HIV service, as measured by self-report and by pharmacy records. To determine the level of adherence by each measure required to suppress viral load in a majority of patients. Methods The percentage of prescribed doses taken was calculated from (a) the number of missed doses in the previous 28 days reported by patients in a questionnaire at each clinic visit, and (b) pharmacy dispensing records. These were compared with each other and with HIV viral load data. Results Mean adherence was 96.2% by pharmacy record over 44 months and 98.6% by self-report over 25 months. The two methods correlated with each other (P<0.001) and the proportion of patients with viral load <400 HIV-1 RNA copies/mL increased with adherence as measured by self-report (P=0.001) and pharmacy record (P=0.004). Fewer than 60% of patients always had viral loads <400 copies/mL if adherence fell below 95% (pharmacy record) or 97% (self-report). Adherence was higher for once-daily than for twice-daily therapy (by pharmacy record: 97.2% vs. 96.0%; P<0.001). Adherence by both measures increased over time. Conclusions Self-reported antiretroviral adherence correlates with pharmacy dispensing records and predicts suppression of viral load at levels ,97%. It is practical to adopt this into routine HIV clinical care. [source]

Determinants of adherence to highly active antiretroviral therapy (HAART) in Chinese HIV/AIDS patients

HIV MEDICINE, Issue 2 2003
OW Fong
Objective Drug adherence is crucial to the success of highly active antiretroviral therapy (HAART) in the treatment of HIV disease. Adherence to HAART and its determinants may, however, differ across HIV/AIDS populations. Methods We retrospectively studied drug adherence by self-report in HIV-1 infected Chinese patients who have been on HAART for at least 1 year as at the end of year 2000. HAART is defined as three or more antiretrovirals with at least one protease inhibitor or non-nucleoside analogue reverse transcriptase inhibitor. Results The last drug adherence level assessed by self-report in 161 Chinese patients were: grade A (100%) , 130, 80.7%; grade B (95,99%) , 25, 15.5%; grade C (90,94%) , three, 1.9% and grade D (< 90%) , three, 1.9%. Patients with full adherence were more likely to have undetectable (< 500 copies/mL) plasma virus level (adjusted OR, 4.22; 95% CI, 1.75,12.33). Patients' demographics, HIV disease status and antiretroviral regimen did not affect adherence. Partial drug adherence was, however, independently associated with the psychosocial factors of missing clinic appointments (adjusted OR, 3.13; 95% CI, 1.23,8.33), forgetfulness (adjusted OR, 4.55; 95% CI, 1.64,12.5) and a busy work life (adjusted OR, 6.67; 95% CI, 1.75,25). Conclusion There were similarities and differences in determinants affecting HAART adherence in Chinese compared with other patients. Psychosocial factors rather than HIV disease or treatment were more important factors in our Chinese patients. The relevance of patient populations and care setting for adherence to HAART shall be further studied. [source]

Adherence to HIV treatment: results from a 1-year follow-up study

HIV MEDICINE, Issue 1 2002
M Martini
Summary We evaluated adherence to HIV treatments every 4 months during one year in 63 HIV-infected subjects using combination therapies including a protease inhibitor. A total of 18 subjects reported a high level of adherence, 14 in two evaluations, and eight a low level of adherence in all the three evaluations. The remaining 23 subjects (36.5%) reported different levels of adherence to treatment in the three evaluations. These findings suggest that the level of adherence to treatment changes markedly for each patient over time. [source]

How adherent to treatment with azathioprine are patients with Crohn's disease in long-term remission?

INFLAMMATORY BOWEL DISEASES, Issue 4 2007
Gerassimos J. Mantzaris MD
Abstract Background: Patients with longstanding quiescent Crohn's disease on azathioprine usually maintain an excellent quality of life but are also concerned about long-term safety. This may affect adherence to treatment. The aim of the present study was to assess the adherence to azathioprine in a cohort of patients with Crohn's disease in long-term remission. Methods: Thirty patients with Crohn's disease in remission on azathioprine for ,48 months were enrolled in the study. All were asked to record the number of azathioprine tablets they consumed daily. Notes were kept every other month for 6 months. Adherence was defined as consumption of ,80% of medication. Results: Most patients (18/28, 74.3%) were not adherent to treatment. The mean (±SD) daily dose of azathioprine in adherent and nonadherent patients was 145 ± 45 mg and 102 ± 20 mg, respectively. However, there were no significant differences between the 2 groups in the mean IBDQ score and mean Crohn's Disease Activity Index (CDAI) score, both throughout the entire study and at each time point of the study. Male gender, single status, and consumption of >5 concomitant medications were associated with nonadherence. Conclusions: Most patients with Crohn's disease in longstanding remission had low self-reported adherence to azathioprine. Both male gender and single status were associated with nonadherence to azathioprine, whereas disease factors were not related to self-reported adherence. Patients considered nonadherent to treatment maintained disease remission and a quality of life similar to patients who were adherent to treatment. (Inflamm Bowel Dis 2006) [source]

Adherence to antiretroviral therapy: are we doing enough?

INTERNAL MEDICINE JOURNAL, Issue 5-6 2003
T. Read
Abstract Adherence to antiretroviral therapy is a powerful predictor of response to therapy. For optimal antiretroviral therapy response, individuals need to take more than 95% of their prescribed medication. The most widely used method for measuring adherence is self-report of the number of missed doses and this should be done at every clinic visit. There are several well-recognized predictors of poor adherence, such as illicit drug use, depression, limited knowledge or ambivalence about starting treatment. Adherence can be improved by addressing these issues or through other means such as pill boxes or electronic reminders. (Intern Med J 2003; 33: 254,256) [source]

Effect of conditioning films and a novel anti-adherent agent on bacterial adherence to dentine

INTERNATIONAL ENDODONTIC JOURNAL, Issue 4 2001
A. Maglad
Aim,Adherence of bacteria to dentine is a prerequisite to infection of the root canal system, yet adherence of root canal bacteria to dentine is poorly understood. The aim of this study was to evaluate the effect of conditioning films and anti-adherent compounds on bacterial adherence to dentine. Methodology,Freshly extracted molar teeth were prepared and sectioned to give 225 discs of predetermined dimensions. The discs were allocated to two groups. Group 1 (n = 189) was divided into three subgroups (n = 63) and coated with one of three conditioning agents (artificial saliva, serum, or distilled water) prior to bacterial inoculation. Group 2 discs (n = 36) were treated with either a novel anti-adherent agent (PC1036, Biocompatibles) (n = 18) or distilled water (n = 18) prior to conditioning with artificial saliva. Monospecies bacterial biofilms were generated on the dentine discs by incubating them in brain heart infusion broth (37 gL,1) containing Streptococcus intermedius (Si), Enterococcus faecalis (Ef) or Lactobacillus fermentum (Lf) (originally isolated from infected root canals). The number of bacteria adhering to the discs in each of the groups was determined using standard serial dilution protocols. Additional discs were prepared under all conditions for scanning electron microscopy. Where appropriate, statistical analysis by one way anova, post hoc Bonferroni, and independent t -test were used. Results,Si adhered significantly better to dentine when conditioned with serum compared with artificial saliva (P = 0.005) or distilled water (P = 0.009). Conversely, Ef adhered significantly better to the control discs (distilled water) compared with serum conditioned discs (P = 0.016). The conditioning films had no effect on the adherence of Lf, which adhered to the dentine discs significantly less (P = 0.001) than either Si or Ef. The anti-adherent coating significantly reduced the number of Si adhering to the dentine compared with the control (P = 0.012). Conclusion,Given the importance of adherence in root canal infection it is conceivable that an anti-adherent compound, could be used to prevent bacterial recontamination of cavities or the root canal system. [source]

Achieving long-term compliance with colonoscopic surveillance guidelines for patients at increased risk of colorectal cancer in Australia

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2007
P. A. Bampton
Summary We have previously demonstrated that we could improve colonoscopic surveillance practice for patients at increased risk of colorectal cancer by the adoption of guidelines, facilitated by a nurse co-ordinator. This study was to determine whether we could sustain this improvement over a longer period (4 years). All colonoscopic surveillance decisions made by the co-ordinated colorectal screening programme of our hospital between 2000 and April 2004 were reviewed. Reasons for variance were recorded, and surveillance decisions made in the last 4 months of the study time were compared with decisions made 4 years previously, both before and after the introduction of the co-ordinated programme. Between 2000 and 2004, 1794 surveillance decisions were made with variance occurring in 100. In the last 4 months of the period of study, 98% of decisions matched guidelines, suggesting that the improvement made following the adoption of the guidelines (45,96% p < 0.05) could be maintained. Reasons for variance from guidelines included a belief that the particular clinical scenario was not covered in the guidelines, disagreement with the guidelines or patient anxiety. Adherence to evidence based medicine guidelines for colonoscopy surveillance can be maintained over time at a high level. A number of clinical scenarios are not covered adequately by the existing guidelines and continue to generate disagreement amongst clinicians. [source]

Factors associated with adherence to antiretroviral therapy for the treatment of HIV-infected women attending an urban care facility

INTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 1 2008
Heila E Aspeling RN MSN
Adherence to antiretroviral therapy (ART) is often jeopardized by factors misapprehended by health-care providers. As South Africa is severely affected by HIV and AIDS, identifying factors that influence adherence in this specific context becomes essential. An exploratory and descriptive case study design was used to further explore this subject and to identify factors that could influence adherence to ART. A significant correlation with international data was found. Most participants indicated that their traditional beliefs and customs did not interfere with their adherence to ART, although the lack of HIV education might facilitate reversion to traditional customs. Adequate treatment preparation, comprehensive HIV education and a supportive patient,provider relationship seemed to impact adherence significantly. [source]

Non-adherence to antihypertensive medication and impaired cognition: which comes first?

INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 5 2010
Paul R. Gard
Abstract Objective, Antihypertensive medications are important in the prevention of serious consequences of hypertension, such as stroke and heart failure. Up to one-third of elderly hypertensive patients, however, do not adhere to their medication. Adherence to medication decreases with increasing age, and with decreasing cognitive ability, thus elderly, cognitively-impaired patients have poorer control of blood pressure. Good control of blood pressure is associated with decreased prevalence of dementia and Alzheimer's disease. This study assessed the evidence that antihypertensive medications have effects on the prevalence or severity of mild cognitive impairment, dementia or Alzheimer's disease. Methods, The ISI Web of Knowledge database was searched; including replicates, the nine searches identified 14 400 publications since 1952, of which 9.9% had been published in 2009. This review considers the 18 studies meeting the set criteria published in 2009 or later. Key findings, Not all antihypertensive medications are equivalent in their positive cognitive effects, with brain-penetrating angiotensin-converting-enzyme inhibitors and possibly angiotensin receptor antagonists being the most effective. Conclusions, Based on evidence of blood-pressure control and cost, UK National Institute for Health and Clinical Excellence guidelines recommend calcium-channel blockers or thiazide-type diuretics for the treatment of hypertension in patients over 55 years. These guidelines take no account of the potential cognitive effects of the antihypertensive therapies, consideration of which might lead to a review. There may be benefit in stressing that adherence to antihypertensive medication not only decreases the risk of cardiovascular disease and death, but may also decrease the risk or severity of mild cognitive impairment, dementia and Alzheimer's disease. [source]

A decision theory perspective on why women do or do not decide to have cancer screening: systematic review

JOURNAL OF ADVANCED NURSING, Issue 6 2009
Kelly Ackerson
Abstract Title.,A decision theory perspective on why women do or do not decide to have cancer screening: systematic review. Aim., This paper is a report of a review in which decision theory from economics and psychology was applied to understand why some women with access to care do not seek cancer screening. Background., Mammography and cervical smear testing are effective modes of cancer screening, yet many women choose not to be screened. Nurses need to understand the reasons behind women's choices to improve adherence. Data sources., Research papers published between January 1994 and November 2008 were identified using the Cumulative Index to Nursing and Allied Health Literature, MEDLINE and PsycINFO data bases. The search was performed using the following terms: cervical cancer screening, breast cancer screening, decision, choice, adherence and framing. Forty-seven papers were identified and reviewed for relevance to the search criteria. Methods., Nineteen papers met the search criteria. For each paper, reasons for obtaining or not obtaining cancer screening were recorded, and organized into four relevant decision theory principles: emotions, Prospect Theory, optimism bias and framing. Findings., All women have fears and uncertainty, but the sources of their fears differ, producing two main decision scenarios. Non-adherence results when women fear medical examinations, providers, tests and procedures, do not have/seek knowledge about risk and frame their current health as the status quo. Adherence is achieved when women fear cancer, but trust care providers, seek knowledge, understand risk and frame routine care as the status quo. Conclusion., Nurses need to address proactively women's perceptions and knowledge about screening by openly and uniformly discussing the importance and benefits. [source]

Maximum Daily 6 Minutes of Activity: An Index of Functional Capacity Derived from Actigraphy and Its Application to Older Adults with Heart Failure

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2010
Jason Howell BA
OBJECTIVES: To compare the correlation between the maximum 6 minutes of daily activity (M6min) and standard measures of functional capacity in older adults with heart failure (HF) with that in younger subjects and its prognostic utility. DESIGN: Prospective, cohort study. SETTING: Tertiary care, academic HF center. PARTICIPANTS: Sixty, ambulatory, adults, New York Heart Association (NYHA) Class I to III, stratified into young (50.9 ± 9.4) and older cohorts (76.8 ± 8.0). MEASUREMENTS: Correlation between M6min and measures of functional capacity (6-minute walk test; 6MWT) and peak oxygen consumption (VO2) according to cardiopulmonary exercise testing in a subset of subjects. Survival analysis was employed to evaluate the association between M6min and adverse events. RESULTS: Adherence to actigraphy was high (90%) and did not differ according to age. The correlation between M6min and 6MWT was higher in subjects aged 65 and older than in those younger than 65 (correlation coefficient (r=0.702, P<.001 vs r=0.490, P=.002). M6min was also significantly associated with peak VO2 (r=0.612, P=.006). During the study, 26 events occurred (2 deaths, 10 hospitalizations, 8 emergency department visits, and 6 intercurrent illnesses). The M6min was significantly associated with subsequent events (hazard ratio=2.728, 95% confidence interval=1.10,6.77, P=.03), independent of age, sex, ejection fraction, NYHA class, brain natriuretic peptide, and 6MWT. CONCLUSION: The high adherence to actigraphy and association with standard measures of functional capacity and independent association with subsequent morbid events suggest that it may be useful for monitoring older adults with HF. [source]

Effectiveness of Falls Clinics: An Evaluation of Outcomes and Client Adherence to Recommended Interventions

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2008
Keith D. Hill PhD
OBJECTIVES: To evaluate outcomes associated with falls clinic programs. DESIGN: Longitudinal. SETTING: Thirteen outpatient falls clinics in Victoria, Australia. PARTICIPANTS: Four hundred fifty-four people referred for clinic assessment (mean age±standard deviation 77.9±8.8; 73% female). INTERVENTION: After assessment, multifactorial interventions were organized to address identified risk factors. MEASUREMENTS: A Minimum Data Set was developed and used across all clinics to derive common data on falls, falls injuries, and secondary measures associated with falls risk, including balance, falls efficacy, gait, leg strength, function, and activity. All measures were repeated 6 months later. RESULTS: Clients had a high risk of falls, with 78% having had falls in the preceding 6 months (63% multiple fallers, 10% experiencing fractures from the falls). An average of 7.6±2.8 falls risk factors were identified per client. The clinic team organized an average of 5.7±2.3 new or additional interventions per client. Sixty-one percent of eligible clients returned for the 6-month assessment. At this time, there was more than a 50% reduction in falls, multiple falls, and fall injuries (P,.004) and small but significant improvements evident on secondary measures of balance, leg strength, gait speed, and confidence outcomes (P<.006). Average adherence to recommendations was 74.3%. Factors associated with higher adherence included being male, younger than 65, living with others, and having a caregiver (P<.05). CONCLUSION: This large multicenter study identified high falls risk of older people referred to falls clinics, the multifactorial nature of their presenting problems and provides preliminary evidence of positive outcomes after falls clinic management. [source]

Using Assessing Care of Vulnerable Elders Quality Indicators to Measure Quality of Hospital Care for Vulnerable Elders

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2007
Vineet M. Arora MD
OBJECTIVES: To assess the quality of care for hospitalized vulnerable elders using measures based on Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QIs). DESIGN: Prospective cohort study. SETTING: Single academic medical center. PARTICIPANTS: Subjects aged 65 and older hospitalized on the University of Chicago general medicine inpatient service who were defined as vulnerable using the Vulnerable Elder Survey-13 (VES-13), a validated tool based on age, self-reported health, and functional status. MEASUREMENTS: Inpatient interview and chart review using ACOVE-based process-of-care measures referring to 16 QIs in general hospital care and geriatric-prevalent conditions (e.g., pressure ulcers, dementia, and delirium); adherence rates calculated for type of care process (screening, diagnosis, and treatment) and type of provider (doctor, nurse). RESULTS: Six hundred of 845 (71%) older patients participated. Of these, 349 (58%) were deemed vulnerable based on VES-13 score. Three hundred twenty-eight (94%) charts were available for review. QIs for general medical care were met at a significantly higher rate than for pressure ulcer care (81.5%, 95% confidence interval (CI)=79.3,83.7% vs 75.8%, 95% CI=70.5,81.1%, P=.04) and for delirium and dementia care (81.5%, 95% CI=79.3,83.7 vs 31.4% 95% CI=27.5,35.2%, P<.01). According to standard nursing assessment forms, nurses were responsible for high rates of adherence to certain screening indicators (pain, nutrition, functional status, pressure ulcer risk; P<.001 when compared with physicians), although in patients with functional limitations, nurse admission assessments of functional limitations often did not agree with reports of limitations by patients on admission. CONCLUSION: Adherence to geriatric-specific QIs is lower than adherence to general hospital care QIs. Hospital care QIs that focus on screening may overestimate performance by detecting standard nursing or protocol-driven care. [source]

Predictors of Adherence to the Use of Hip Protectors in Nursing Home Residents

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2004
Andrea Warnke PhD
Objectives: To assess predictors of hip-protector use in nursing home residents under usual-care conditions and after intervention consisting of structured education of nurses and nursing home residents and provision of free hip protectors. Design: Nested cohort analyses within a cluster randomized, controlled trial with 18 months follow-up. Setting: Forty-nine nursing home clusters in Hamburg, Germany. Participants: Residents with at least one fall during the study period (intervention group, n=237; usual-care group, n=274). Measurements: Use of hip protector while falling. Regression analyses were performed for each of the two cohorts of fallers using the time to the first fall without hip protector as the dependent variable. Predefined nursing home cluster-related parameters (center, staffing ratio, proportion of registered nurses in nursing staff, hip-protector use before study period) and resident-related parameters (sex, history of falls and fractures, fear of falling, urinary incontinence, use of walking aid, degree of disablement) were considered as explanatory variables. Results: Under usual care, 97% of fallers (n=266), compared with 62% (n=148) in the intervention group, experienced at least one fall without hip protection. Using Cox proportional hazards models with and without frailty parameter (random cluster effect), the following predictors were identified: intervention group: use of walking aid, hazard ratio (HR)=1.53 (95% confidence interval (CI):0.98,2.39) and no urinary incontinence, HR=1.47 (95% CI:1.03,2.09); usual care: nursing staff per 10 residents, HR=0.78 (95% CI=0.63,0.96); high degree of disablement, HR=1.38 (95% CI=1.06,1.80); strong fear of falling, HR=0.78 (95% CI=0.60,1.02). The nursing home cluster was a significant predictor in the control group (P=.029), but not in the intervention group (P=.100). Conclusion:, Only a few and weak predictors of hip-protector use of questionable relevance could be identified in both groups. Future research should concentrate on the implementation of interventions of proven efficacy, such as provision of hip protectors combined with structured education of staff and residents. [source]

Adherence to Pressure Ulcer Prevention Guidelines: Implications for Nursing Home Quality

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2003
Debra Saliba MD
OBJECTIVES: This study aims to assess overall nursing home (NH) implementation of pressure ulcer (PU) prevention guidelines and variation in implementation rates among a geographically diverse sample of NHs. DESIGN: Review of NH medical records. SETTING: A geographically diverse sample of 35 Veterans Health Administration NHs. PARTICIPANTS: A nested random sample of 834 residents free of PU on admission. MEASUREMENTS: Adherence to explicit quality review criteria based on the Agency for Healthcare Research and Quality Practice Guidelines for PU prevention was measured. Medical record review was used to determine overall and facility-specific adherence rates for 15 PU guideline recommendations and for a subset of six key recommendations judged as most critical. RESULTS: Six thousand two hundred eighty-three instances were identified in which one of the 15 guideline recommendations was applicable to a study patient based on a specific indication or resident characteristic in the medical record. NH clinicians adhered to the appropriate recommendation in 41% of these instances. For the six key recommendations, clinicians adhered in 50% of instances. NHs varied significantly in adherence to indicated guideline recommendations, ranging from 29% to 51% overall adherence across all 15 recommendations (P < .001) and from 24% to 75% across the six key recommendations (P < .001). Adherence rates for specific indications also varied, ranging from 94% (skin inspection) to 1% (education of residents or families). Standardized assessment of PU risk was identified as one of the most important and measurable recommendations. Clinicians performed this assessment in only 61% of patients for whom it was indicated. CONCLUSIONS: NHs' overall adherence to PU prevention guidelines is relatively low and is characterized by large variations between homes in adherence to many recommendations. The low level of adherence and high level of variation to many best-care practices for PU prevention indicate a continued need for quality improvement, particularly for some guidelines. [source]

A Group-Mediated Cognitive-Behavioral intervention for Increasing Adherence to Physical Activity in Older Adults,

JOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 1 2000
Lawrence R. Brawley
This study examined the efficacy of a group-mediated cognitive behavioral intervention (GMCB) on adherence rates to physically active lifestyles in older adults. Sixty older adults were randomized to I of 3 groups: waiting list control (WLC), a standard physical activity program (SPA), or GMCB. The SPA and GMCB involved 6 months of combined center- and home-based activity. Contact with participants was then terminated with a follow-up assessment at 9 months. Results revealed that, at the 9-month follow-up the GMCB group had a higher frequency of weekly physical activity than the SPA group. At 6 months, both groups were more active, had higher aerobic power, and improved HRQL when compared with the control group. [source]

Examining Implementation Intentions in an Exercise Intervention: The Effects on Adherence and Self-Efficacy in a Naturalistic Setting,

JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 10 2009
Terra C. Murray
Some studies have found positive associations between implementation intentions and exercise, independent of motivational factors. However, most research has not been conducted in actual exercise contexts. In a naturalistic setting, implementation intentions may be associated with self-efficacy (SE) beliefs. This study examined the effect of implementation intentions on adherence and SE over an 11-week exercise program. Women (N = 72) were randomly assigned to an experimental (i.e., implementation intention) or a control group, with 52 participants completing the study. Results showed that while adherence decreased over time in both groups, the experimental group had better adherence than did the control group. Scheduling SE was also higher in the experimental group. Implementation intentions may help to maintain adherence and scheduling SE. [source]

ASH Position Paper: Adherence and Persistence With Taking Medication to Control High Blood Pressure

JOURNAL OF CLINICAL HYPERTENSION, Issue 10 2010
Martha N. Hill RN
J Clin Hypertens (Greenwich). 2010;12:757-764. © 2010 Wiley Periodicals, Inc. Nonadherence and poor or no persistence in taking antihypertensive medications results in uncontrolled high blood pressure, poor clinical outcomes, and preventable health care costs. Factors associated with nonadherence are multilevel and relate not only to the patient, but also to the provider, health care system, health care organization, and community. National guideline committees have called for more aggressive approaches to implement strategies known to improve adherence and technologies known to enable changes at the systems level, including improved communication among providers and patients. Improvements in adherence and persistence are likely to be achieved by supporting patient self-management, a team approach to patient care, technology-supported office practice systems, better methods to measure adherence, and less clinical inertia. Integrating high blood pressure control into health care policies that emphasize and improve prevention and management of chronic illness remains a challenge. Four strategies are proposed: focusing on clinical outcomes; empowering informed, activated patients; developing prepared proactive practice teams; and advocating for health care policy reform. With hypertension remaining the most common reason for office visits, the time is now. [source]