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Adherence Scores (adherence + score)
Selected AbstractsAn examination of the intentional and unintentional aspects of medication non-adherence in patients diagnosed with hypertensionJOURNAL OF CLINICAL NURSING, Issue 4 2007Elaine Lehane MSc Aims., The primary aim of this study was to describe the unintentional and intentional aspects of non-adherence in patients diagnosed with hypertension. A secondary aim was to examine the relationships between medication adherence and purposeful actions (intentional non-adherence), patterned behaviours (unintentional non-adherence) and demographic questionnaire variables. Background., Non-adherence to medications continues to be a significant health-care issue, the extent and consequences of which have been well documented. Despite considerable research over the past five decades, little progress has been made in solving this healthcare problem. Recent literature indicates that this lack of progress can be attributed to the fact that past research has concentrated solely upon either the unintentional or the intentional aspects of non-adherence, instead of addressing both facets simultaneously. Methods., A quantitative, descriptive, correlation research design was employed using Johnson's (2002) Medication Adherence Model as a theoretical framework. A convenience sample of 73 participants with hypertension, attending the outpatients' clinics of two university hospitals was recruited. Data were collected by means of a researcher administered questionnaire and analysed using the Statistical Package for Social Sciences. Results., High levels of medication adherence with a mean adherence score of 4·75 (maximum 5) were reported. Low and medium levels of purposeful actions and medium and high levels of patterned behaviours towards medication taking were found. Correlational analyses did not demonstrate statistically significant associations. Conclusions., Both the intentional and unintentional dimensions of medication-taking are simultaneously considered by patients to varying levels when adhering to therapeutic regimens. This is an important research area for nurses as it facilitates an increased understanding of non-adherence and, in so doing, aids the uncovering of more effective interventions aimed at sustaining lifelong pharmacotherapy. Relevance to clinical practice., By acknowledging a broader approach to patient medication-taking, nurses will be able more effectively to assess and intervene in non-adherent behaviours and actions. [source] Clinical Practice Guideline Implementation Strategy Patterns in Veterans Affairs Primary Care ClinicsHEALTH SERVICES RESEARCH, Issue 1p1 2007Sylvia J. Hysong Background. The Department of Veterans Affairs (VA) mandated the system-wide implementation of clinical practice guidelines (CPGs) in the mid-1990s, arming all facilities with basic resources to facilitate implementation; despite this resource allocation, significant variability still exists across VA facilities in implementation success. Objective. This study compares CPG implementation strategy patterns used by high and low performing primary care clinics in the VA. Research Design. Descriptive, cross-sectional study of a purposeful sample of six Veterans Affairs Medical Centers (VAMCs) with high and low performance on six CPGs. Subjects. One hundred and two employees (management, quality improvement, clinic personnel) involved with guideline implementation at each VAMC primary care clinic. Measures. Participants reported specific strategies used by their facility to implement guidelines in 1-hour semi-structured interviews. Facilities were classified as high or low performers based on their guideline adherence scores calculated through independently conducted chart reviews. Findings. High performing facilities (HPFs) (a) invested significantly in the implementation of the electronic medical record and locally adapting it to provider needs, (b) invested dedicated resources to guideline-related initiatives, and (c) exhibited a clear direction in their strategy choices. Low performing facilities exhibited (a) earlier stages of development for their electronic medical record, (b) reliance on preexisting resources for guideline implementation, with little local adaptation, and (c) no clear direction in their strategy choices. Conclusion. A multifaceted, yet targeted, strategic approach to guideline implementation emphasizing dedicated resources and local adaptation may result in more successful implementation and higher guideline adherence than relying on standardized resources and taxing preexisting channels. [source] Two studies of proximal outcomes and implementation quality of universal preventive interventions in a community,university collaboration contextJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 5 2002Richard Spoth Here we present the results from two longitudinal studies of competency-training interventions that entailed community,university collaboration intended to enhance implementation quality. In Study 1, 22 rural schools were randomly assigned to a family-focused intervention or a minimal contact control group. In Study 2, 36 rural schools were randomly assigned to a family-focused preventive intervention combined with a school-based intervention, the school-based intervention alone, or a minimal contact control group. In both studies, observers rated adherence to intervention protocols. Results showed that, on average, high levels of observer-rated adherence were attained in both studies. Analyses of the relationship between observer-rated adherence scores and proximal outcomes showed limited evidence of poorer outcomes associated with lower-adherence groups. Overall, findings highlight the benefits of community,university collaboration intended to facilitate high levels of intervention adherence. The need for a framework guiding a collaborative implementation research agenda is discussed. © 2002 Wiley Periodicals, Inc. [source] Measuring physiotherapists' guideline adherence by means of clinical vignettes: a validation studyJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2006Geert M.J. Rutten MPH Abstract Rationale, aims and objectives, To assess the criterion validity of paper-and-pencil vignettes to assess guideline adherence by physiotherapists in the Netherlands. The evidence-based physiotherapy practice guideline for low back pain was used as an example. Methods, Four vignettes were constructed and pre-tested. Three vignettes were found to represent an adequate case-mix. They described one patient with specific low back pain, one with non-specific low back pain and a normal recovery process and one with non-specific low back pain and a delay in the recovery process. Invited to participate were 113 primary care physiotherapists who had joined an randomized controlled trial study 8 months before, in which guideline adherence had been measured by means of semi-structured treatment recording forms. The criterion validity was determined with Spearman's rs, using Cohen's classification for the behavioural sciences to categorize its effect size. Results, Of the 72 physiotherapists who agreed to participate, 39 completed the questions on the vignettes. In the end, both adherence measures were available for 34 participants, providing 102 vignettes and 268 recording forms. Mean guideline adherence scores were 57% (SD = 17) when measured by vignettes and 74% (SD = 15) when measured by recording forms. Spearman's rs was 0.31 (P = 0.036), which, according to Cohen's classification, is a medium effect size. Conclusion, Vignettes are of acceptable validity, and are an inexpensive and manageable instrument to measure guideline adherence among large groups of physiotherapists. Further validation studies could benefit from the use of standardized patients as a gold standard, a more diverse case mix to better reflect real physiotherapy practice, and the inclusion of longitudinal vignettes that cover the patients' course of treatment. [source] Photocoagulation for diabetic retinopathy: determinants of patient satisfaction and the patient,provider relationshipACTA OPHTHALMOLOGICA, Issue 3 2005Maneli Mozaffarieh Abstract. Purpose:,To assess satisfaction with photocoagulation treatment in diabetes patients and to investigate how it relates to patient-related characteristics and patients' visual ability. Further, to observe the interaction between physician and patient and suggest ways to improve the patient,provider relationship and, thereby, treatment satisfaction. Methods:,This open longitudinal study included 123 diabetes patients undergoing first photocoagulation treatment for diabetic maculopathy or proliferative retinopathy. The Diabetes Treatment Satisfaction Questionnaire (DTSQ) was completed by all patients. Communication, scheduling and adherence scores were defined for each physician,patient pair. Outcome measures were: the patient's overall satisfaction with laser treatment; the patient's degree of satisfaction in relation to visual results; communication, scheduling and adherence scores, and visual acuity results. Results:,The level of satisfaction after initial photocoagulation treatment was high; 46.4% of patients with proliferative retinopathy and 53.1% with maculopathy scored 31 or higher. Although 69.5% of all patients reported that their expectations of treatment corresponded to their final 9-month visual results, only 8.7% of these patients reported an improvement in visual acuity after 9 months. The number of unwanted actions performed by the patients during treatment were significantly related to the number of unclear instructions given by the physician (Fisher's exact test P < 0.01). Conclusions:,A high level of satisfaction was observed, despite the minimal improvements in visual acuity. Attempts to further improve patient satisfaction might focus on improved education of patients on the possible benefits of laser treatment, greater care in communicating information during treatment, additional nursing support, and additional clerical time to communicate with patients before each appointment. [source] | ||||||||||