Level Of Adherence Research Articles

A randomized controlled trial of an acceptance-based, insight-inducing medication adherence therapy (AIM-AT) for adults with early-stage psychosis

This study aimed to test the effectiveness of an acceptance-based medication adherence intervention for people with early-stage psychosis. An assessor-blind, three-arm randomized controlled trial design was used. One hundred and twenty-six participants who were adults with ≤3 years of psychosis were recruited from four district Integrated Community Centers for Mental Wellness in Hong Kong. They were randomly assigned to receive a 10-session acceptance-based, insight-inducing medication adherence therapy (AIM-AT) intervention, a conventional psychoeducation group program, or usual treatment (n = 42 per group). Primary outcomes were medication adherence and insight into the illness/treatment. All study outcomes were measured at recruitment and immediately, 6 months, and 12 months post-intervention. Participants in the AIM-AT experienced statistically significant improvements in the primary outcomes (levels of medication adherence and insight into illness/treatment), when compared to those in the other two groups over the 12-month follow-ups. The AIM-AT group also had significantly greater improvements in psychotic symptoms, psychosocial functioning, service satisfaction, length of rehospitalization, and total number of patients hospitalized over the follow-up period. These findings support the effectiveness of the AIM-AT to improve medication adherence, psychosocial health, and service satisfaction in people with early-stage psychosis.

Facilitators, barriers and support needs to GLA:D exercise adherence – a mixed method study

BackgroundKnee and hip osteoarthritis (OA) are among the most common musculoskeletal joint diseases worldwide. International guidelines recommend exercise and education as first-line interventions for their management. The Good Life with osteoArthritis Denmark (GLA:D) programme aims to achieve self-management using group exercise and education sessions. It also encourages participants to stay physically active and perform GLA:D exercises (GE) twice weekly after programme end. This study investigated the participants’ self-reported level of physical activity (PA) and self-reported adherence to the GE between five and 17 months after completion of the GLA:D programme and also explored the barriers, facilitators and support needs to achieve long-term adherence to GE.MethodsA mixed method study using an exploratory sequential design was performed. A qualitative phase, involving semi-structured interviews and a focus group, led to the development of a questionnaire on participants’ level of PA, as well as ratings of the barriers, facilitators and support needs for the achievement of long-term adherence to GE. In a second quantitative phase, the survey was conducted online with former GLA:D participants from Switzerland. Descriptive statistical analysis and a group comparison between adherent and non-adherent participants to the GE were performed using Fisher’s exact test, odds ratio, and confidence interval.ResultsEleven former GLA:D participants attended the interviews and focus group, and former GLA:D participants (30% response rate) participated in the survey. Of these, 84% (n = 285) reported to reach the recommended level of PA and 53% (n = 178) GE adherence. The top barrier to GE adherence was no/little self-discipline to perform GE (40%, n = 112) and the top facilitator was GE are easy to perform (93%, n = 300). The top 3 items regarding support needs to enhance GE adherence were a shortened version (max. 30 min) of the GE home programme (75%, n = 255), monthly continuation of small GE groups under GLA:D physiotherapists’ supervision (65%, n = 221), and monitoring with regular testing of individual progress (65%, n = 221).ConclusionsThe top barriers and facilitators should be considered by those responsible for the GLA:D programme and may need to be specifically addressed during and after the programme. The development of a shortened version of the GLA:D programme, a post-GLA:D group, and monitoring with regular testing seem crucial for enhancing GE adherence.Clinical Trial Registrationnot applicable.

Improving quality and patient safety in surgical care through standardisation and harmonisation of perioperative care (SAFEST project): A research protocol for a mixed methods study.

Adverse events in health care affect 8% to 12% of patients admitted to hospitals in the European Union (EU), with surgical adverse events being the most common types reported. SAFEST project aims to enhance perioperative care quality and patient safety by establishing and implementing widely supported evidence-based perioperative patient safety practices to reduce surgical adverse events. We will conduct a mixed-methods hybrid type III implementation study supporting the development and adoption of evidence-based practices through a Quality Improvement Learning Collaborative (QILC) in co-creation with stakeholders. The project will be conducted in 10 hospitals and related healthcare facilities of 5 European countries. We will assess the level of adherence to the standardised practices, as well as surgical complications incidence, patient-reported outcomes, contextual factors influencing the implementation of the patient safety practices, and sustainability. The project will consist of six components: 1) Development of patient safety standardised practices in perioperative care; 2) Guided self-evaluation of the standardised practices; 3) Identification of priorities and actions plans; 4) Implementation of a QILC strategy; 5) Evaluation of the strategy effectiveness; 6) Patient empowerment for patient safety. Sustainability of the project will be ensured by systematic assessment of sustainability factors and business plans. Towards the end of the project, a call for participation will be launched to allow other hospitals to conduct the self-evaluation of the standardized practices. The SAFEST project will promote patient safety standardized practices in the continuum of care for adult patients undergoing surgery. This project will result in a broad implementation of evidence-based practices for perioperative care, spanning from the care provided before hospital admission to post-operative recovery at home or outpatient facilities. Different implementation challenges will be faced in the application of the evidence-based practices, which will be mitigated by developing context-specific implementation strategies. Results will be disseminated in peer-reviewed publications and will be available in an online platform.

Antihypertensive use insights and experiences among hypertensive patients at Korle-Bu teaching hospital.

Across the globe, a vast number of people, amounting to 1.28 billion adults aged 30-79 years, suffer from hypertension. Two-thirds of them reside in low- and middle-income countries, and a significant 46% of these adults with hypertension are unaware of their condition. Hence the study aims to determine the Antihypertensive use insights and experiences among hypertensive patients at Korle-Bu Teaching Hospital. A qualitative exploratory design was employed to recruit thirty 30 hypertensive patients from both male and female medical wards as well as the hypertensive clinic at the OPD of Korle Bu Teaching Hospital. The patients were selected using a purposive sampling technique, following which they were involved in face-face in-depth interviews which were audiotaped. Recorded data was then transcribed and analyzed with content analysis. The analysis of the data resulted in three (3) main themes and 10 sub-themes. The study uncovered a general lack of knowledge about antihypertensive medications. This limited understanding resulted in a negative attitude among most patients toward the use of prescribed antihypertensive drugs. When it came to their experiences with antihypertensive medications, patients shared a wide range of experiences. It was concluded that there is a need to improve the knowledge and attitude of patients as these play pivotal roles in determining adherence levels. Thus, interventions such as the organization of educational programs and awareness creation is recommended to improve adherence level and in turn, decrease the prevalence of hypertensive complications associated with poor management.

Innovative Approaches to Enhance and Measure Medication Adherence in Chronic Disease Management: A Review.

Medication non-adherence is a problem that affects up to 50% of patients with chronic diseases. The result is a failure to achieve therapeutic goals and an increased burden on the healthcare system. It is, therefore, highly appropriate to develop models to assess patient adherence to prescribed therapy. To date, there are many methods for doing this. However, several tools have been developed that subjectively or objectively, directly or indirectly, assess the level of patient adherence. Electronic medication packaging devices are among the most rapidly evolving methods of measuring adherence. Other emerging technologies include the use of artificial intelligence algorithms and ingestible biosensors. The former is being used to create applications for mobile phones and laptops. The latter appears to be the least susceptible to the risk of overestimating adherence but remains very expensive. Here, we present recent developments in measuring patient adherence, and provide details of achievements in objective methods for assessing adherence, such as electronic monitoring devices, video-observed therapy, and ingestible biosensors. A dedicated section on using artificial intelligence and machine learning in adherence measurement and reviewing questionnaires and scales used in specific diseases is also included. Methods are discussed along with their advantages and potential limitations. This article aimed to review current measures and future initiatives to improve patient medication adherence.

Adherence to Fluid Restrictions among Haemodialysis Patients In Private Haemodialysis Centres in Kuala Lumpur Malaysia

End stage kidney disease (ESKD) is an irreversible progressive kidney function that requires kidney replacement therapy. Over two million people have currently received dialysis treatment worldwide. Haemodialysis treatment has been developed as a practical, safe and efficient method for the care of patients with ESRD. However, HD treatments generally have a more negative impact on patients' quality of life (QoL), high morbidity and mortality rate, as well as major adverse cardiovascular events. Compliance to dietary, fluid restrictions, medications and treatment regimens is one of the contributors to the quality of life observed in patients ESKD undergoing haemodialysis treatment. This study is aimed on the measurement of the fluid restriction adherence of 132 haemodialysis patient in MAIWP-PICOMS haemodialysis centres. An interdialytic weight gain (IDWG) was used as an indicator to describe the level of adherence level. Method: An observational study was conducted among consenting patients on HD for ≥3 months with criteria of age from 18 to 65 years old using end-stage renal disease-adherence questionnaire (ESRD-AQ). Result: Of 132 participated patients were observed, 53% were female and 47% were male with a mean age of 49.05 ±11.52 years and HD duration mean length of 1.33 ranging from 1-5 years. Statistically, a significant association between level of fluid adherence behaviour and treatment duration (p < .01) was found in this study. Meanwhile, the level of adherence to fluid restrictions was range between 45.5% - 50%, which was considered good. Conclusion: Significantly, adhered to fluid restriction among haemodialysis patients may prevent patients from many adverse consequences and improve the quality of life. Therefore, nurses and healthcare providers has been suggested to play a pivotal role in delivering education on fluid restriction for haemodialysis patient.

Using machine learning to unveil relevant predictors of adherence to recommended health-protective behaviors during the COVID-19 pandemic in Denmark.

What were relevant predictors of individuals' proclivity to adhere to recommended health-protective behaviors during the COVID-19 pandemic in Denmark? Applying machine learning (namely, lasso regression) to a repeated cross-sectional survey spanning 10 months comprising 25 variables (Study 1; N = 15,062), we found empathy toward those most vulnerable to COVID-19, knowledge about how to protect oneself from getting infected, and perceived moral costs of nonadherence to be strong predictors of individuals' self-reported adherence to recommended health-protective behaviors. We further explored the relations between these three factors and individuals' self-reported proclivity for adherence to recommended health-protective behaviors as they unfold between and within individuals over time in a second study, a Danish panel study comprising eight measurement occasions spanning eight months (N =441). Results of this study suggest that the relations largely occurred at the trait-like interindividual level, as opposed to at the state-like intraindividual level. Together, the findings provide insights into what were relevant predictors for individuals' overall level of adherence to recommended health-protective behaviors (in Denmark) as well as how these predictors might (not) be leveraged to promote public adherence in future epidemics or pandemics.

Exploring the Role of Self-Efficacy in Maintaining Healthy Lifestyle Habits among Patients with Cardiometabolic Diseases; Findings from the Multi-Center IACT Cross-Sectional Study.

(1) Background: Cardiometabolic disease progression can be delayed if patients engage in healthy lifestyle behaviors, adherence to which is highly influenced by psychosocial factors. The present study aimed at investigating the association of self-efficacy with the adherence level to healthy lifestyle behaviors among patients with cardiometabolic diseases in Greece. (2) Methods: 1988 patients (1180 females) with cardiometabolic diseases participated. Anthropometric, demographic, socioeconomic, clinical, and lifestyle characteristics were recorded. Patients were also asked to evaluate their efficacy to comply with healthy lifestyle behaviors. (3) Results: The majority exhibited unhealthy lifestyle behaviors. A subgroup demonstrated elevated self-efficacy in maintaining healthy habits despite facing diverse psychosocial challenges. Individuals with higher educational attainment, socioeconomic status, and rural/semi-urban residency had significantly elevated self-efficacy. Those with heightened self-efficacy exhibited significantly lower BMI and reduced prevalence of certain health conditions. Self-efficacy significantly influenced adherence to the Mediterranean diet, physical activity engagement, and smoking cessation, even in challenging circumstances. (4) Conclusions: This study represented an innovative approach in examining the role of self-efficacy in shaping health behaviors and outcomes within a Greek population. By integrating specific psychosocial circumstances into the analysis, valuable insights were provided into the contextual factors influencing self-efficacy and adherence to healthy lifestyle behaviors.

Adaptive designs were primarily used but inadequately reported in early phase drug trials

BackgroundFaced with the high cost and limited efficiency of classical randomized controlled trials, researchers are increasingly applying adaptive designs to speed up the development of new drugs. However, the application of adaptive design to drug randomized controlled trials (RCTs) and whether the reporting is adequate are unclear. Thus, this study aimed to summarize the epidemiological characteristics of the relevant trials and assess their reporting quality by the Adaptive designs CONSORT Extension (ACE) checklist.MethodsWe searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov from inception to January 2020. We included drug RCTs that explicitly claimed to be adaptive trials or used any type of adaptative design. We extracted the epidemiological characteristics of included studies to summarize their adaptive design application. We assessed the reporting quality of the trials by Adaptive designs CONSORT Extension (ACE) checklist. Univariable and multivariable linear regression models were used to the association of four prespecified factors with the quality of reporting.ResultsOur survey included 108 adaptive trials. We found that adaptive design has been increasingly applied over the years, and was commonly used in phase II trials (n = 45, 41.7%). The primary reasons for using adaptive design were to speed the trial and facilitate decision-making (n = 24, 22.2%), maximize the benefit of participants (n = 21, 19.4%), and reduce the total sample size (n = 15, 13.9%). Group sequential design (n = 63, 58.3%) was the most frequently applied method, followed by adaptive randomization design (n = 26, 24.1%), and adaptive dose-finding design (n = 24, 22.2%). The proportion of adherence to the ACE checklist of 26 topics ranged from 7.4 to 99.1%, with eight topics being adequately reported (i.e., level of adherence ≥ 80%), and eight others being poorly reported (i.e., level of adherence ≤ 30%). In addition, among the seven items specific for adaptive trials, three were poorly reported: accessibility to statistical analysis plan (n = 8, 7.4%), measures for confidentiality (n = 14, 13.0%), and assessments of similarity between interim stages (n = 25, 23.1%). The mean score of the ACE checklist was 13.9 (standard deviation [SD], 3.5) out of 26. According to our multivariable regression analysis, later published trials (estimated β = 0.14, p < 0.01) and the multicenter trials (estimated β = 2.22, p < 0.01) were associated with better reporting.ConclusionAdaptive design has shown an increasing use over the years, and was primarily applied to early phase drug trials. However, the reporting quality of adaptive trials is suboptimal, and substantial efforts are needed to improve the reporting.

Physiotherapists’ adherence to Clinical Practice Guidelines in fibromyalgia: a cross-sectional online survey

To evaluate the level of knowledge and adherence to Clinical Practice Guidelines on fibromyalgia of physiotherapists in Spain. A cross-sectional study using an ad-hoc online survey was implemented to assess aspects on the assessment, treatment, and decision of the length of the therapeutic approach on fibromyalgia. Based on the results, professionals were classified as adherent, partially adherent, or non-adherent. The level of agreement with several statements on the condition was also evaluated across the professionals surveyed to evaluate the potential consensus. A total of 240 physiotherapists met inclusion criteria, amongst which 68 (28.33%) were adherent. The academic level of studies (Chi-square = 48.601, p-value = 0.001) and having had previous training in fibromyalgia (Chi-square = 151.011, p-value = 0.001) displayed statistically significant differences across adherence-based groups. Consensus was reached for 15 out of 24 statements. Our findings highlight the presence of an acceptable level of knowledge and adherence to clinical practice guidelines in the field of fibromyalgia among physiotherapists in Spain.Practice implicationsOur results also reveal the existence of an evidence-to-practice gap in the field, with potential room for improvement: further efforts on promoting and reinforcing the importance of evidence-based therapies are needed, from university teaching plans to clinical updates for daily practice.

Joystick-Operated Ride-On Toy Navigation Training for Children With Hemiplegic Cerebral Palsy: A Pilot Study.

Children with hemiplegic cerebral palsy (HCP) require intensive task-oriented training to make meaningful gains in affected upper extremity (UE) motor function. To evaluate the acceptability and utility of single joystick-operated ride-on toy (ROT) navigation training incorporated into a modified constraint-induced movement therapy (CIMT) camp for children with HCP. Single group pretest-posttest design. Three-wk structured CIMT camp. Eleven children with HCP between ages 3 and 14 yr. Children received group-based CIMT for 6 hr/day, 5 days/wk, for 3 wk. As part of camp activities, children also received ROT navigation training for 20 to 30 min/day, 5 days/wk, for 3 wk. We assessed children's acceptance of ROT training by monitoring adherence and evaluating child engagement (affect and attention) during training sessions. The effects of ROT training combined with other camp activities on children's affected UE motor function were also assessed with the standardized Quality of Upper Extremity Skills Test (QUEST) and training-specific measures of ROT maneuvering accuracy. Children demonstrated high levels of training adherence, positive affect, and task-appropriate attention across weeks. Positive engagement during ROT sessions was correlated with independent navigation. We also found medium- to large-sized improvements in QUEST scores and toy-maneuvering capabilities after the combined program. Our pilot data support the use of joystick-operated ROTs as child-friendly therapy adjuncts that can be incorporated into intensive UE training programs to improve adherence and motivation in therapy programs, boost treatment dosing, and promote affected UE motor function in children with HCP. Plain-Language Summary: This pilot study offers promising evidence that supports the use of modified single joystick-operated ride-on toys (ROTs) for children with hemiplegic cerebral palsy (HCP). The study used ROTs as one of several interventions that were part of a constraint-induced movement therapy (CIMT) camp program for children with HCP. The ROTs boosted children's motivation, their engagement with and adherence to training, and their practice in using their affected upper extremity (UE) for goal-directed activities in their natural settings. ROTs are accessible, age-appropriate, and easy-to-use devices for both occupational therapy clinicians and families to encourage children to use their affected UEs by challenging their perceptual, motor-planning, problem-solving, and movement-control skills in an enjoyable and engaging way. ROTs can be used within and outside conventional rehabilitation settings.

Immunomodulator adherence in multiple myeloma patients with lower socioeconomic status: a retrospective study.

Poor adherence to oral chemotherapy adversely impacts clinical outcomes and escalates overall healthcare costs. Despite barriers to medication adherence, a significant gap remains in assessing adherence to oral chemotherapy among multiple myeloma (MM) patients with lower socioeconomic status. Hence, our study aims to evaluate immunomodulator adherence in MM patients at a county hospital, primarily serving underrepresented and indigent individuals with low socioeconomic status across the greater Houston area. Inclusion criteria composed of patients diagnosed with MM, aged at least 18years, and treated with lenalidomide or pomalidomide-two widely used immunomodulators-for a minimum of 2months or having two or more records of dispensation between May 2019 and May 2021. Adherence was gauged using an adjusted version of the medication possession ratio (MPR). Sixty-two patients were enrolled, yielding a mean MPR value of 88% (SD, ± 18.9). Of these, 43 patients (69.3%) demonstrated adherence with an MPR of ≥ 0.90. A significant difference was found in treatment duration between the adherent (mean 8.8months; SD, ± 7.2) and non-adherent (mean 13.4months; SD, ± 7.9) groups (p = 0.027). Notably, race/ethnicity demonstrated a significant difference (p = 0.048), driven by disparities in African American and Hispanic representation across adherence levels. In summary, our findings highlight race and treatment duration to be predictors of immunomodulator adherence among MM patients with lower socioeconomic status. Further research is imperative to devise and test innovative interventions aimed at enhancing medication adherence, thereby contributing to improved survival and healthcare quality in this population.

Association of a Healthy Lifestyle With Ambulatory 24-Hour Blood Pressure Among Chinese Youths: A Cross-Sectional Study.

This study aims to explore the association between a healthy lifestyle and abnormal ambulatory blood pressure (ABP) in Chinese youths. A school-based sample of 1,296 college students was investigated. A lifestyle score was calculated by synthesizing 5 lifestyle factors, including smoking, alcohol consumption, diet, physical activity, and sleeping. The total score ranged from 0 to 5, with a higher score indicating a healthier lifestyle. This score was then divided into 3 categories representing low adherence to a healthy lifestyle (0-2), medium adherence (3), and high adherence (4-5). Abnormal 24-hour blood pressure (BP) was defined as systolic BP (SBP) ≥ 130 mm Hg and/or diastolic BP (DBP) ≥ 80 mm Hg. Abnormal daytime BP was determined as daytime SBP ≥ 135 mm Hg and/or DBP ≥ 85 mm Hg, while abnormal nighttime BP was characterized as nighttime SBP ≥ 120 mm Hg and/or DBP ≥ 70 mm Hg. We assessed the associations using the binomial regression model. Mean age was 18.81 years, and 74.5% were women. The prevalence of abnormal 24-hour BP, daytime BP, and nighttime BP are 4.2%, 3.7%, and 9.0%, respectively. We found that participants with a high level of adherence to a healthy lifestyle had a significantly lower prevalence of abnormal 24-hour BP [prevalence ratios (PR) = 0.15, 95% CI: 0.05, 0.48] and abnormal daytime BP (PR = 0.16, 95%CI: 0.05, 0.52), when compared to those with a low level of adherence and after adjusting for the potential covariates. A healthier lifestyle is associated with a better ambulatory BP profile among youths.

HealthCall: Smartphone Enhancement of Brief Interventions to Improve HIV Medication Adherence Among Patients in HIV Care.

Heavy drinking among people living with HIV (PLWH) reduces ART adherence and worsens health outcomes. Lengthy interventions are not feasible in most HIV care settings, and patients infrequently follow referrals to outside treatment. Utilizingvisual and video features ofsmartphone technology, we developed HealthCall as an electronic means of increasing patient involvement in a brief intervention to reduce drinking and improve ART adherence. The objective of the current study is to evaluate the efficacy of HealthCall to improve ART adherence among PLWH who drink heavily when paired with two brief interventions: the National Institute on Alcoholism and Alcohol Abuse (NIAAA) Clinician's Guide (CG) or Motivational Interviewing (MI). Therefore, we conducted a 1:1:1 randomized trial among 114 participants with alcohol dependence at alargeurban HIV clinic. Participants were randomized to one of three groups: (1) CG only (n = 37), (2) CG and HealthCall (n = 38), or (3) MI and HealthCall (n = 39). Baseline interventions targeting drinking reduction and ART adherence were ~ 25min, with brief (10-15min) booster sessions at 30 and 60days.Theoutcomewas ART adherence assessed using unannounced phone pill-count method(possible adherence scores: 0-100%)at 30-day, 60-day, 3, 6, and 12months. Analyses were conducted using generalized linear mixed models with pre-planned contrasts. Of the 114 enrolled patients, 58% were male, 75% identified as Black/African American, 28% were Hispanic, and 62% had less than a high school education. The mean age was 47.5years (standard deviation [SD] 10years) and the mean number of years since they were diagnosed with HIV was 18.6 (SD 7.6). Participants assigned to HealthCall to extend the CG had increased levels of ART adherence at 60-day and 6-month follow-up (compared to CG only), although there was no statistically significant difference by 12-month follow-up. Participants who were assigned to HealthCall to extend the MI never had statistically significant higher levels of ART adherence. These results suggest that the use of a smartphone app can be used to initially extend the reach of a brief drinking intervention to improve ART adherence over a short period of time;however, sustained long-term improvements in ART adherence after intervention activity ends remains a challenge.

Medication non-adherence and its associated factors among kidney transplant patients in a large teaching hospital in Ethiopia

BackgroundThis study examines medication adherence among kidney transplant patients at St. Paul’s Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia, focusing on the level of adherence and associated factors to immunosuppressant medicines.Methods and materialsA cross-sectional study was conducted on 270 patients from October 2021 to January 2022 using a structured questionnaire analyzed with SPSS version 26. The prevalence of medication adherence was computed, and a binary logistic regression was fitted to estimate the association. Medication adherence level measurement in post-kidney transplant patients was assessed using the Simplified Medication Adherence Questionnaire (SMAQ) and Basel Adherence Assessment Scale in Immunosuppressants (BAASIS). A 95% confidence interval and p-value < 0.05 were used for statistical significance.ResultsThe study found that 71.5% of kidney transplant patients were male, with a median age of 37 and a mean duration of 3.55 years. Medication adherence in post-kidney transplant patients was 81.9%. Post-transplant duration above 5 years and missing follow-up visits more than two times was associated with a 92.6% and 91.2% in medication non-adherence rate respectively. Additionally, forgetfulness was associated with a 90.6%, non-adherence level compared to drug unavailability and financial reasons.Conclusion and recommendationThe study indicates that our patients exhibit higher medication adherence than WHO-measured levels, suggesting the need for healthcare providers to strengthen their intervention, especially for those above 5 years post-kidney transplant. The reason for increased adherence could be explained by the health education program about the medication name, dosing, frequency of ingestion and adverse effects of the drug, and effects of non-adherence.

Level of Adherence to Glaucoma Medication and Its Associated Factors Among Adult Jordanian Patients.

Glaucoma is considered the second most common cause of blindness in patients above the age of 50. Lack of adherence to glaucoma medications frequently results in undesirable complications, specifically blindness and disability. The study's objectives are to evaluate the level of adherence to glaucoma topical medicationsand factors associated with adherence to glaucoma medications. In total, 348 patients, of whom 48.6% were above the age of 65, were recruited. A cross-sectional study from August 2018 to March 2020 was conducted on glaucoma patients who were referred to the Department of Ophthalmology in Royal Medical Services in Amman, Jordan. A questionnaire was employed to collect patients' demographic data, level of adherence, and factors associated with medication adherence.The inclusion criteria include the following: age above 20 years, diagnosis of glaucoma, currently under medical treatment, and willingness to participate in the study. Exclusion criteria include the following:patients who were hospitalized for glaucoma treatment,patients who had unstable medical conditions, and any patients for whom ophthalmologists had determined that they should be excluded for any other reasons. Almost half (47.1%) of the patients adhered to their personal glaucoma medications, and the most frequent cause of nonadherence was forgetfulness (39.9%), whereas the least common was stopping the drug after feeling better (7.0%). Proper patient education and explanation of the seriousness of medication adherence and its association with treatment outcomes, along with assisting old and disabled patients when applying ophthalmic medications, may positively improve the adherence of patients to glaucoma and otherrelated visual impairment medications.

Predictive Role of Resilience and Hope on Adherence to Treatment in Hemodialysis Patients.

To determine the predictive role of resilience and hope on adherence to treatment in hemodialysis patients hospitalized in two hospitals affiliated to Shiraz University of Medical Sciences (Shiraz, Iran). This is a descriptive-analytical study that was conducted in 2021-2022 on 120 patients treated in hemodialysis sections in Namazi and Shahid Faqihi teaching hospitals. Sampling was conducted using a stratified random method. Demographic information questionnaires, Connor and Davidson's resilience, Snyder's hope and adherence to kidney patients' treatment questionnaires were used to collect the data. The finds showed that the levels of resilience, hope, and adherence to treatment had hight level. More specifically, it was indicated that the mean and standard deviation for the total resilience score, the hope variable, and adherence to total treatment was 75.45±14.34, 40.43±3.66, and 80.12±18.20, respectively; which have maximum possible scores of 100, 48 and 100. Thus, it can be said that no correlation was observed between resilience and adherence to treatment variables (p>0.05); hope variable and adherence to treatment (p>0.05), and adherence to treatment with hope and resilience variables (p>0.05). However, hope and resilience variables showed a direct and weak correlation with each other (r=0.36, p<0.05); that is, patients who had more hope indicated better resilience as well. Although in this study we found that the resilience and hope variables were not able to predict the treatment adherence, hope and resilience indicated a direct and weak correlation. It is recommended that nurses should pay more attention to hope and resilience of hemodialysis patients in order to promote their health.

Adherence and persistence of encorafenib in combination with cetuximab among patients with BRAF metastatic CRC in the United States (US) based on two claims databases.

e23146 Background: The BRAF V600E mutation (BRAF-m) occurs in approximately 7% of patients with metastatic CRC (mCRC). Encorafenib (enco) in combination with cetuximab (cetux) was approved in April 2020 as the first targeted regimen for the treatment of adult patients with mCRC with BRAF-m. The purpose of this study is to analyze the post-approval real-world persistence and adherence to treatment with enco in combination with cetux or with panitumumab (pani), an alternative EGFR, in mCRC, based on two claims databases in the US. Methods: This was a retrospective cohort study in the IQVIA PharMetrics Plus database and the Merative MarketScan Commercial Database (2013-2022). Adults ≥18 years old with ≥1 claim for enco (first claim for enco on/after its date of approval in April 2020) with concurrent EGFR (cetux or pani), ≥2 ICD-9/10 codes for malignancy of the colon or rectum ≥30 days apart in the 1 year before index date, and ≥1 day of pharmacy and medical continuous enrollment during the index date were included. Patients were excluded if they had a record of melanoma or non-small cell lung cancer during the year before index date, were enrolled in a clinical trial any time after the CRC diagnosis date or did not have a treatment regimen starting on or after CRC diagnosis date (-14 days). Index date was the date of first treatment of enco + EGFR during the identification period (4/1/2020-3/31/2022). Patient demographics and disease characteristics were assessed at baseline, adherence (measured as at least 80% of days covered) and persistence (measured as time to discontinuation by Kaplan-Meier method) were estimated during the follow-up period. Results: 205 patients were included. Median (Q1 [1st quartile], Q3 [3rd quartile]) age at index was 59 (50, 64) years and 51.7% were female. Metastases were present in 3 or more sites in 62.9% of the patients, in 1 or 2 sites in 35.6%. The 2011 Modified Quan Charlson Comorbidity Index was 0 for 44.9% of the patients, 1-2 for 38.5%, and 3 or more for 16.6%. Most patients received cetux as their EGFR combined with enco (76.1%). Adherence to enco + EGFR was high (87.8%); enco + cetux vs. enco + pani: 89.7% vs. 82.6%. Median (Q1, Q3) proportion of time on cetux while on enco was 87% (78%, 95%) and median (Q1, Q3) proportion of time on pani while on enco was 85% (71%, 91%). Median (95% confidence interval) time to enco regimen discontinuation during follow-up was 6.1 (5.3–7.7) months. Conclusions: This up-to-date study provides current real-world evidence on the use of enco + EGFR in mCRC BRAF-m patients in the US. The results show high levels of adherence to the treatment, suggesting high tolerability to encorafenib, and persistence consistent with clinical trial evidence.

Effectiveness of telerehabilitation on pain and function in musculoskeletal disorders: A systematic review of randomized controlled trials

AbstractIntroductionMusculoskeletal disorders are common, causing high hospital and healthcare utilisation. Telerehabilitation (TR) is a new strategy to deliver treatment remotely to patients in their own homes, with lower costs and easier accessibility. This study investigated the effectiveness of TR on pain and function in musculoskeletal disorders.MethodsA literature search of randomised controlled trials (RCTs) in the Medline/PubMed, Cochrane Library, and PEDro databases was conducted by two reviewers on 10 Jan 2023. We included studies that investigated pain and function with TR compared with a control group in any musculoskeletal disorders. The data synthesis included the TR platforms and measured outcomes. Effectiveness was measured based on the pain and function results. The study methodological quality was assessed by the PEDro scale for RCTs.ResultsAfter removing duplicated and irrelevant studies, 200 were initially identified. This review includes seven RCTs of a total of 183 participants with musculoskeletal conditions such as low back pain, fibromyalgia, total knee arthroplasty, shoulder subacromial decompression, knee osteoarthritis, and rotator cuff syndrome. The TR platforms used were smartphone and web apps, video, phone calls, and teleconference sessions. The findings showed no significant differences between the TR and control groups in pain and function. TR showed better improvement with a significant short‐term difference in some variables, but this was not sustained in the long term.ConclusionTR was comparably effective to clinic‐based rehabilitation for treating musculoskeletal disorders. However, it was not superior to conventional rehabilitation. TR showed lower costs and a high level of adherence. We recommend implementing new TR tools to remotely treat patients.Systematic Review RegistrationPROSPERO Registration Number CRD42022375048.

Perception, acceptability and challenges of digital adherence technology among TB healthcare workers

&lt;sec&gt;&lt;title&gt;INTRODUCTION&lt;/title&gt;Successful treatment of TB requires high levels of adherence to treatment. This has been found to be below optimal with directly observed therapy (DOT), and digital adherence technologies (DATs) offer a promising approach to non-adherence to medication and improving treatment outcomes. This study explores the perception, acceptability, and challenges of DATs among healthcare workers (HCWs).&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;METHODS&lt;/title&gt;The study was conducted in eight states in Nigeria among Health Care workers involved in treating patients with TB. This was a descriptive cross-sectional study using an open questionnaire and analysed using IBM SPSS v25.&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;RESULTS&lt;/title&gt;Twenty-three HCWs (95.8%) agreed that DATs helped them provide better support and counselling to their patients. All of them would recommend DATs to their patients and found it easy to explain them. Eleven (45.8%) of them were not able to use DATs on a few occasions; their reasons were poor network (n = 9, 37.5%) and (n = 1, 4.2%) power failure.&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;CONCLUSION&lt;/title&gt;DATs help HCWs provide better support and care regarding real-time tracking of their patients’ adherence to treatment and possibly reduction of attrition. This implies that DATs are a suitable alternative to DOT to help HCWs provide the best care and support to their patients towards achieving the End TB targets.&lt;/sec&gt;