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Poor Treatment Adherence (poor + treatment_adherence)
Selected Abstracts,Difficult Asthma': Can Symptoms be Controlled in a Structured Environment?PEDIATRIC PULMONOLOGY, Issue 8 2009K. De Boeck MD Abstract Objective Difficult asthma implies persistent asthma symptoms despite therapy with high doses of inhaled corticosteroids. The objective was to evaluate children with difficult asthma in a setting that excludes aggravating factors such as poor treatment adherence and adverse environmental influences. Patients and Methods Sixty children (,6 years) had been referred because of difficult asthma to the rehabilitation centre over a period of 10 years. The diagnosis of poor asthma symptom control was confirmed if exacerbations continued during stay in the centre or if symptoms interfered with daily activities at least 3 times a week. Results The median stay at the centre was 5 months. In four patients a diagnosis other than asthma was made. In five patients symptom control remained difficult. In the remaining 51 children, asthma symptoms became well controlled. Many factors contributed to poor asthma control in the home setting: poor treatment adherence (n,=,32), parental smoking (n,=,22), allergen exposure (n,=,10). Psychosocial problems occurred in 36 children. Contributing factors often co-existed. During stay at the centre, lung function improved in the group with well controlled asthma symptoms (P,<,0.001) but not in the group with continued poor symptom control. In the majority of children who obtained good symptom control, this persisted in the years following discharge. Conclusion Of 60 children referred with a diagnosis of difficult asthma, optimal medical management in a structured environment resulted in good symptom control in 51 patients; symptom control remained poor in 5 patients, a diagnosis other than asthma was made in 4 patients. Pediatr Pulmonol. 2009; 44:743,748. © 2009 Wiley-Liss, Inc. [source] Prevention of relapse and interventions for enhancing medication adherence in schizophrenia: An East Asian perspectiveASIA-PACIFIC PSYCHIATRY, Issue 2 2010Salleh Mohd Razali MPM FAMM Abstract Introduction: Studies investigating the efficacy of interventions for improving treatment non-adherence in schizophrenia have generated contrasting findings. The present review examined psychosocial interventions for improving medication adherence and prevention of relapse among patients with schizophrenia in developing countries in the Asia-Pacific. Methods: The relevant literature and systematic review were identified by computerized searches using keywords, and hand-searched for other selected articles. Results: The reasons for poor medication adherence were complex and heterogenous. Psychoeducation programs alone are ineffective in achieving good medication adherence because they do not lead to attitudinal and behavioral changes. The greatest improvement in adherence was seen with interventions employing a combination of educational, behavioral and cognitive strategies. Unfortunately, few relevant studies from this region were found. There were some interventions related to psychoeducation and compliance therapy (CT) that were successfully conducted by nurses. Patients in developing countries generally had better family support, but strong stigma towards mental illness and interference by traditional healers led to poor treatment adherence. Lack of facilities and shortage of medical professionals aggravated the situation. Discussion: Intervention to improve treatment adherence and prevention of relapse among patients with schizophrenia should be incorporated into existing psychiatric services. Adherence to treatment in patients with schizophrenia could be improved if continuously supported and monitored by caregivers and treating doctors, to facilitate a change in the patient's attitude. Paramedical personnel, such as psychiatric nurses, could be actively involved in intervention programs because of the shortage of medical professionals in this region. [source] Suicidal risk in bipolar I disorder patients and adherence to long-term lithium treatmentBIPOLAR DISORDERS, Issue 5p2 2006Ana Gonzalez-Pinto Objectives:, Among the well-established treatments for bipolar disorder (BPD), lithium continues to offer an unusually broad spectrum of benefits that may include reduction of suicidal risk. Methods:, We examined the association of suicidal acts with adherence to long-term lithium maintenance treatment and other potential risk factors in 72 BP I patients followed prospectively for up to 10 years at a Mood Disorders Research Center in Spain. Results:, The observed rates of suicide were 0.143, and of attempts, 2.01%/year, with a 5.2-fold (95% CI: 1.5,18.6) greater risk among patients consistently rated poorly versus highly adherent to lithium prophylaxis (11.4/2.2 acts/100 person-years). Treatment non-adherence was associated with substance abuse, being unmarried, being male, and having more hypomanic,manic illness and hospitalizations. Suicidal risk was higher with prior attempts, more depression and hospitalization, familial mood disorders, and being single and younger, as well as treatment non-adherence, but with neither sex nor substance abuse. In multivariate analysis, suicidal risk was associated with previous suicidality > poor treatment adherence > more depressive episodes > younger age. Conclusions:, The findings support growing evidence of lower risk of suicidal acts during closely monitored and highly adherent, long-term treatment with lithium and indicate that treatment adherence is a potentially modifiable factor contributing to antisuicidal benefits. [source] Statin treatment after a recent TIA or stroke: is effectiveness shown in randomized clinical trials also observed in everyday clinical practice?ACTA NEUROLOGICA SCANDINAVICA, Issue 1 2010H. F. Lingsma Lingsma HF, Steyerberg EW, Scholte op Reimer WJM, van Domburg R, Dippel DWJ, the Netherlands Stroke Survey Investigators. Statin treatment after a recent TIA or stroke: is effectiveness shown in randomized clinical trials also observed in everyday clinical practice? Acta Neurol Scand: 2010: 122: 15,20. © 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Aim and background,,, The benefit of statin treatment in patients with a previous ischemic stroke or transient ischemic attack (TIA) has been demonstrated in randomized clinical trials (RCT). However, the effectiveness in everyday clinical practice may be decreased because of a different patient population and less controlled setting. We aim to describe statin use in an unselected cohort of patients, identify factors related to statin use and test whether the effect of statins on recurrent vascular events and mortality observed in RCTs is also observed in everyday clinical practice. Methods,,, In 10 centers in the Netherlands, patients admitted to the hospital or visiting the outpatient clinic with a recent TIA or ischemic stroke were prospectively and consecutively enrolled between October 2002 and May 2003. Statin use was determined at discharge and during follow-up. We used logistic regression models to estimate the effect of statins on the occurrence of vascular events (stroke or myocardial infarction) and mortality within 3 years. We adjusted for confounders with a propensity score that relates patient characteristics to the probability of using statins. Results,,, Of the 751 patients in the study, 252 (34%) experienced a vascular event within 3 years. Age, elevated cholesterol levels and other cardiovascular risk factors were associated with statin use at discharge. After 3 years, 109 of 280 (39%) of the users at discharge had stopped using statins. Propensity score adjusted analyses showed a beneficial effect of statins on the occurrence of the primary outcome (odds ratio 0.8, 95% CI: 0.6,1.2). Conclusion,,, In our study, we found poor treatment adherence to statins. Nevertheless, after adjustment for the differences between statin users and non-statin users, the observed beneficial effect of statins on the occurrence of vascular events within 3 years, although not statistically significant, is compatible with the effect observed in clinical trials. [source] | ||||||||||