Adherence Measures Research Articles

A scoping review of interventions to optimize medication adherence in hypertension comorbidity.

Patients with hypertension and other comorbidities have difficulties adhering to their medications which have negative impacts on clinical outcomes. Although some studies have identified strategies to improve medication adherence, a thorough analysis of these interventions will provide synthesized evidence for clinical decision-making and improved health outcomes for patients with hypertension comorbidities. To conduct a scoping review on interventions that have been utilised to improve medication adherence in patients with hypertension and other co-morbid conditions. A systematic literature search was conducted in the following databases: CINAHL, COCHRANE TRIALS, MEDLINE, and SCOPUS. One (1) search engine, GOOGLE SCHOLAR was included. This was done between September 2023 to February 2024. The PRISMA-SCR guidelines were followed for this review. A total of 456 unique studies were identified after duplicates were removed. Following screening and eligibility assessments, 26 papers were selected for review with a focus on the study aim and purpose, study population, interventions used and adherence measures. Most of the interventions were delivered by pharmacists, with 25 studies utilising the multimodal intervention approach. A total of 22 studies (80% of the total) found that the interventions significantly improved medication adherence. Results from 16 studies showed a significant improvement in blood pressure. Improvements in medication adherence were a common outcome of interventions that focused on patient education. Interventions such as patient education, simplified treatment regimens, and multidisciplinary care can improve medication adherence and clinical outcomes in patients with hypertension and comorbidities, but further research is needed to understand long-term effects.

Digital Health Technologies for Optimising Treatment and Rehabilitation Following Surgery: Device-Based Measurement of Sling Posture and Adherence

Background: Following shoulder surgery, controlled and protected mobilisation for an appropriate duration is crucial for appropriate recovery. However, methods for objective assessment of sling wear and use in everyday living are currently lacking. In this pilot study, we aim to determine if a sling-embedded triaxial accelerometer and/or wrist-worn sensor can be used to quantify arm posture during sling wear and adherence to sling wear. Methods: Four participants were asked to wear a GENEActiv triaxial accelerometer on their non-dominant wrist for four hours in an office environment, and, for two of those hours, they also wore a sling in which an additional GENEActiv accelerometer was secured. During sling wear, they were asked to move their arm in the sling through a series of pre-specified arm postures. Results: We found that upper arm angle and posture type during sling wear can be predicted from a sling sensor alone (R2 = 0.79, p < 0.001 and Cohen’s kappa = 0.886, respectively). The addition of a wrist-worn sensor did not improve performance. The optimisation of an existing non-wear algorithm accurately detected adherence (99.3%). Conclusions: the remote monitoring of sling adherence and the quantification of immobilisation is practical and effective with digital health technology.

Acceptability and feasibility of a urine-based tenofovir adherence assay for monitoring and providing feedback on PrEP adherence in Kenya

ABSTRACT Objective measures of oral PrEP adherence – especially point-of-care (POC) measures that enable real-time assessment, intervention, and feedback – have the potential to improve adherence. Our team previously developed and validated a novel urine-based POC metric of PrEP adherence. In this study, we sought to determine whether this assay is acceptable and feasible among women taking PrEP and PrEP providers in Kenya. We conducted a trial comparing PrEP adherence counseling using the assay (intervention) versus standard-of-care counseling. We conducted in-depth interviews (IDIs) with intervention-arm participants (n = 20), and focus group discussions (n = 18) after the final (12-month) follow-up visit. We also conducted IDIs with purposively-sampled healthcare providers (HCPs) (n = 8) who administered the assay. The assay was highly acceptable among participants and HCPs as it was perceived to be accurate, could provide evidence of adherence, provides real-time results, and improves participant and provider relationship. HCPs reported that the assay facilitated counseling, seemed to increase adherence, and would be feasible to implement in routine care settings. Both participants and HCPs reported concerns about the assay related to the fear of being stigmatized for negative results, and test accessibility. Future studies should evaluate the impact of this novel test on adherence patterns over time in diverse populations. Trial registration: ClinicalTrials.gov identifier: NCT03935464.

Adherence Monitor for Measurement of Removable Cast Walker Wear-Time: Multiple Sensors and Predictive Analytics Improve Accuracy.

Treatment of diabetes and its complications is a primary health care expense. Up to 25% of people with diabetes will develop diabetic foot ulcers (DFUs). Removable cast walker (RCW) boots commonly prescribed for DFU treatment, promote healing, and provide offloading and wound protection. Patient RCW removal for hygiene and wound care can lead to decreased adherence and treatment effectiveness. This study evaluated a new system for wear-time adherence measurement using multiple sensor types. An electronic wear-time monitor was developed, which included internal and external temperature sensors, an accelerometer, and capacitive proximity foot and ankle sensors. Time-stamped and date-stamped data were saved once per minute for up to 22 days. Ten healthy volunteer subjects were recruited to wear an RCW for two weeks while keeping a diary of don/doff times. Sensor data were then compared with volunteers' wear diaries using confusion matrix predictive analytics. Algorithms were developed for data processing. Correlation coefficients between algorithms and diaries were calculated for individual and multiple sensor combinations. Differential temperature and accelerometer algorithms were significantly better at predicting subject wear-time than individual temperature sensor algorithms (P = .009, P = .001, respectively). Foot proximity had significantly better correlation with subject diaries than temperature (P = .024), and acceleration algorithms (P = .005). Multi-sensor analysis showed high correlation (.96) with wear-time from subject diaries. Removable cast walker wear-time can be accurately determined using an electronic data recorder and multiple sensors. Wear-time measurement accuracy can be improved using algorithms that operate on data from multiple sensors that use a variety of sensor technologies.

Impact of anxiety symptoms on dialysis adherence and complication rates: A longitudinal observational study.

Anxiety is a common psychological comorbidity in patients undergoing dialysis, yet its impact on treatment adherence and complication rates remains understudied. We designed a longitudinal observational study to investigate these relationships, based on the hypothesis that higher anxiety symptoms would be associated with increased complication rates and negatively associated with adherence to the dialysis regimen. To investigate the relationship between anxiety symptoms, dialysis adherence, and complication rates in patients undergoing dialysis over a 24-month period. This observational study analyzed data from 250 adult patients who underwent hemodialysis or peritoneal dialysis at three Affiliated Hospitals of Youjiang Medical University for Nationalities over a period of 24 months. Anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale-Anxiety subscale at baseline and every 6 months. Dialysis adherence was evaluated through attendance records, interdialytic weight gain, and patient-reported medication adherence. We recorded complications (infections, cardiovascular events, and hospitalizations) and used mixed-effects models and survival analyses to infer associations between anxiety symptoms, adherence measures, and complication rates. Higher anxiety symptoms were significantly associated with poorer dialysis adherence, including increased missed sessions [incidence rate ratio = 1.32, 95% confidence interval (CI): 1.18-1.47, P < 0.001], greater interdialytic weight gain (β = 0.24, 95%CI: 0.15-0.33, P < 0.001), and lower medication adherence (odds ratio = 0.85, 95%CI: 0.78-0.93, P < 0.001). Patients with clinically significant anxiety (Hospital Anxiety and Depression Scale-Anxiety subscale ≥ 8) had a higher risk of complications [hazard ratio (HR) = 1.68, 95%CI: 1.32-2.14, P < 0.001], particularly infections (HR = 1.89, 95%CI: 1.41-2.53, P < 0.001) and cardiovascular events (HR = 1.57, 95%CI: 1.18-2.09, P = 0.002). The relationship between anxiety and complications was partially mediated by adherence measures. Anxiety symptoms in patients undergoing dialysis are associated with poorer treatment adherence and increased complication rates. Regular screening and targeted interventions to address symptoms may improve adherence and clinical outcomes.

Association between lifelines diet score with odds of nonalcoholic fatty liver disease and some novel anthropometric indices among adults: a case-control study.

Nonalcoholic Fatty Liver Disease (NAFLD) is a prevalent condition strongly associated with poor dietary habits and obesity. The Lifelines Diet Score (LLDS), a measure of adherence to a health-promoting diet, may reduce the risk of NAFLD. This study investigates the association between LLDS and NAFLD risk, as well as its relationship with novel anthropometric indices in adults. This case-control study included 180 NAFLD patients and 250 controls aged 20-65 years from Valiasr Hospital, Zanjan, Iran. Dietary intake was assessed using a validated 147-item food frequency questionnaire, and LLDS was calculated by scoring food groups according to dietary guidelines. Anthropometric measurements included Body Mass Index (BMI), Waist Circumference (WC), A Body Shape Index (ABSI), Body Roundness Index (BRI), and Visceral Adiposity Index (VAI). Logistic regression models estimated the odds ratios (ORs) for NAFLD across LLDS quartiles. Participants in the highest LLDS quartile had significantly reduced odds of NAFLD compared to those in the lowest quartile (OR = 0.49; 95% CI: 0.30-0.65; p < 0.001). Gender-specific analysis revealed that LLDS had a stronger inverse association with NAFLD in females (OR = 0.45; 95% CI: 0.29-0.64) than in males (OR = 0.63; 95% CI: 0.40-0.79). LLDS was inversely associated with VAI (β = -1.14; 95% CI: -2.89, -0.3; p = 0.036), but no significant associations were observed with ABSI or BRI. Higher LLDS scores are associated with a lower risk of NAFLD and reduced visceral adiposity, particularly in females. These findings highlight the importance of improving dietary quality as a preventive strategy for NAFLD.

Remote Monitoring of Tai Chi Balance Training Interventions in Older Adults Using Wearable Sensors and Machine Learning.

Tai Chi, an Asian martial art, is renowned for its health benefits, particularly in promoting healthy aging among older adults, improving balance, and reducing fall risk. However, methodological challenges hinder the objective measurement of adherence to and proficiency in performing a training protocol, critical for health outcomes. This study introduces a framework using wearable sensors and machine learning to monitor Tai Chi training adherence and proficiency. Data were collected from 32 participants with inertial measurement units (IMUs) while performing six Tai Chi movements evaluated and scored for adherence and proficiency by experts. Our framework comprises a model for identifying the specific Tai Chi movement being performed and a model to assess performance proficiency, both employing Random Forest algorithms and features from IMU signals. The movement identification model achieved high accuracy (micro F1: 90.05%). Proficiency assessment models also achieved high accuracy (mean micro F1: 78.64%). This study shows the feasibility of using IMUs and machine learning for detailed Tai Chi movement analysis, offering a scalable method for monitoring practice. This approach has the potential to objectively enhance the evaluation of Tai Chi training protocol adherence, learnability, progression in proficiency, and safety in Tai Chi programs, and thus inform training program parameters that are key to achieving optimal clinical outcomes.

Diverging paths: Modeling the relation between adverse effects, attitudes, perceived adherence, and treatment effect in an internet-based cognitive-behavioral intervention for obsessive-compulsive disorder.

The efficacy of internet-based interventions (IBI) for various psychiatric disorders is widely established, but little is known about the mechanisms or possible influencing factors. One of the most prominent problems in IBI is low adherence, but the relationship between adherence and level of improvement is still unclear. Patients' attitudes and beliefs about IBI as well as the experience of adverse effects-another widely neglected topic-may also influence the effectiveness of these interventions. This secondary analysis is aimed at investigating the relationship between adverse effects, attitudes, perceived adherence (i.e., patient's impression of their compliance), and treatment effect in an IBI for obsessive-compulsive disorder (OCD). Participants were 151 individuals with symptoms of OCD, of which 59.96% (n=90) took part in the post-assessment. Attitudes toward IBI were assessed before they used an IBI for OCD; subjective adherence perception and experience of negative effects were assessed afterward. OCD symptom severity was evaluated at two time points, the difference score defining the treatment effect. A path analysis was conducted to test the hypothesized model. Objective and subjective adherence measures were correlated exploratively. The path analysis revealed that attitude toward IBI and adverse effects were negatively associated with adherence perception but adherence perception was not associated with the treatment effect. Objective and subjective adherence measures did not correlate. The results did not support the hypothesized model. Since both attitudes toward IBI and adverse effects were negatively associated with adherence perception, managing users' expectations clearly before using IBI might improve adherence. The role of adherence perception on the treatment effect is yet to be clarified.

Estimating the economic impact of blister-packaging on medication adherence and health care costs for a Medicare Advantage health plan.

Medication nonadherence is a persistent challenge in the United States, leading to increased health care resource utilization (HCRU) and health care costs and worsened health outcomes. Medicare Star Ratings is a program developed by the Centers for Medicare and Medicaid Services (CMS) to evaluate Medicare health plan quality and performance. Three of the Medicare Part D Star Ratings quality measures assess medication adherence, showing the importance CMS places on improving medication adherence in older adults. Although a variety of medication adherence-enhancing interventions are available to help promote adherence among patients, one intervention that has shown success historically is blister-packaging. To model the potential impact of blister-packaging chronic medications on HCRU and health care costs in the Medicare population. An economic model was developed to assess the potential impact of blister-packaging the 3 Medicare Star Ratings adherence measure medication classes: renin-angiotensin system antagonists (RASAs), statins, and noninsulin antidiabetics. The model perspective was that of a hypothetical Medicare Advantage health plan with a plan size of 100,000 members. A 12-month time horizon was used in the model. The dichotomous adherence threshold in the model was set at 80% or greater of the proportion of days covered (PDC). Literature-based references were used to inform both the impact of blister-packaging on the number of patients who become adherent as well as the impact of medication adherence on HCRU and health care costs for each of the medication classes. One-way sensitivity analyses and several scenario analyses were conducted to assess model uncertainty. Owing to increased adherence from the blister-packaging intervention, the hypothetical health plan in the analysis saw 776 additional members adherent to RASAs, 1,651 additional members adherent to statins, and 414 additional members adherent to oral antidiabetics. Although medication expenditure increased for all 3 medication classes (RASAs: $274,963; statins: $730,083; oral antidiabetics: $100,529), medical costs decreased across all classes (RASAs: -$4,098,848; statins: -$5,549,699; oral antidiabetics: -$917,968). Total net health care costs decreased by $3,823,885 for RASAs (-$3.19 per member per month [PMPM]), $4,819,616 for statins (-$4.02 PMPM), and $817,438 for oral antidiabetics (-$0.68 PMPM). The entire Medicare Advantage population scenario analysis saw reductions in total health care costs of $1,081,394,737 for RASAs, $1,362,987,376 for statins, and $231,171,496 for oral antidiabetics. Dispensing chronic medications with blister-packaging for Medicare Advantage health plan patients was modeled to reduce HCRU and health care costs. Future studies are needed to assess whether the impact of blister-packaging medications is tied to reductions in HCRU and health care costs in real-world settings.

Adherence measurement considerations for oral antiretroviral medications.

Adherence measurement considerations for oral antiretroviral medications.

Predictors of Nosocomial Infections among Geriatric Patients in the Internal Medicine Department of the University Teaching Hospital of Butare (CHUB), South, Huye, Rwanda

Purpose: Nosocomial infections pose a significant burden worldwide, particularly in resource-limited settings. This study aimed to determine predictors of nosocomial infections among geriatric patients at the University Teaching Hospital of Butare (CHUB) in Rwanda. Methodology: A quantitative cross-sectional cohort study over seven months included participants admitted to CHUB's Internal Medicine department from July 2023 to January 2024 with the aim to determine the Nosocomial infections predictors among elderly aged 61 years and above. The target sample size was 313, but a census approach with 400+ participants was used. Data collection involved physician examinations, laboratory testing, interviews, facility observations, specimen culture, antimicrobial susceptibility testing, and logistic regression analyses. Findings: The study included 206 participants who were screened infection-free at admission, predominantly from Southern Province (85%) and female (56%), with a median hospital stay of 3 days. Most were admitted from Kabutare District Hospital (22%) to Internal Medicine (90%). Age distribution peaked at 61 years and above (38.8%) and 60 years and below (61.2%). Unemployment was high (83%), especially among females (60%) and those with low education. Prior 30-day hospitalization occurred in 34%, mainly for non-communicable diseases (41%) and infections (20%). Chronic conditions were reported by 41%, commonly hypertension (37%), other non-communicable diseases (14%), and diabetes (10%). Recent antibiotic use was 23%, primarily ceftriaxone (54%). Urine samples dominated (55%), with prevalent pathogens like Escherichia coli and Staphylococcus species. But more importantly this study demonstrated a strong association between nosocomial infection level and some predictors with significant P values as follows: time of stay (P=0.002), Health Care providers following WHO 5 Moments of hand hygiene (P=0.005), disinfection of medical devices by Health Care providers (P=0.036) and hands washing before taking medicines (P=0.047). Unique Contribution to Theory, Practice and Policy: The environmental decontamination and antibiotic rotation policies should be implemented to manage Acinetobacter spp. infections. As well hand hygiene adherence and preventive measures for urinary tract infections will address Escherichia Coli infections. Efforts to mitigate the burden of nosocomial infections should prioritize the enhanced surveillance, establishing robust infection tracking systems across healthcare facilities, invest in antimicrobial stewardship and targeted interventions tailoring infection control practices to high-risk groups like geriatric patients.

O029 The Impact of Adherence to Specific Components of CBT for Insomnia on Treatment Outcomes

Abstract Introduction CBT-I requires significant behavioural change. A recent systematic review found there are surprisingly few associations between adherence to that behaviour change and outcomes. Prior studies examined adherence over the entire course of treatment, however, the role of adherence may change throughout therapy. We examined the effect of adherence to Sleep Restriction (SR) and Stimulus Control (SC) using the recently proposed two-stage Build-Maintain Model of CBT-I. Methods 83 participants underwent 7 weeks of therapist-led CBT-I. 78 initiated SR (age: 48.0±14.3, 57.7%F). Treatment was divided into “Build” (initial phase of SR, building sleep debt) and “Maintain” (starting the first week sleep opportunity increased) stages of therapy. Analyses examined the impact of adherence to SR (deviation from bed/wake times, naps) and SC (wake time-in-bed during daytime, overnight, and after final awakening) and stage of treatment on diary-based sleep efficiency (SE) and Insomnia Severity Index (ISI). Results Adherence to morning SC predicted both greater SE (regardless of the stage) and lower ISI (specifically during Maintain stage). Fewer average minutes napping predicted lower ISI scores, regardless of stage. Discussion Adherence to morning SC (i.e., getting out of bed right away after final awakening) and adherence to the no-nap rule of SR were associated with better CBT-I treatment outcomes. Surprisingly, adherence to neither the prescribed bed time nor wake time in SR were associated with treatment outcomes. While adherence to some aspects of CBT-I appear related to outcomes, more work needs to be conducted to determine the measure(s) of adherence most predictive of treatment outcomes.

Real-World Outcomes of Selective RET Inhibitor Selpercatinib in the United States: Descriptive, Retrospective Findings from Two Databases.

This study described real-world patient characteristics and outcomes among selpercatinib-treated patients in the United States, using the Flatiron Health electronic health record-derived deidentified database (FHD) for advanced/metastatic non-small cell lung cancer (a/mNSCLC) and Optum's de-identified Clinformatics® Data Mart Database (CDM). Patients initiating selpercatinib treatment between 08MAY2020 and 30JUN2023 were included. We evaluated real-world time to selpercatinib treatment discontinuation or death (rwTTDd) and time to next treatment or death (rwTTNTd) using Kaplan-Meier analyses. Medication possession ratio (MPR) was estimated as a measure of medication adherence in CDM patients. In a/mNSCLC patients from the FHD (N = 68), the median rwTTDd and rwTTNTd were 22.4 [95%CI: 13.3-NR] and 21.0 [95%CI: 11.6-NR] months, respectively. In CDM, these durations were 12.1 [95%CI: 9.6-NR] and 16.2 [95%CI: 9.6-NR] months for lung cancer (n = 43), while these were not reached for thyroid cancer (n = 24) patients. The median MPR was 0.98 [IQR: 0.84-1.00] among all patients in the CDM (N = 75), with 77.3% of patients adhering (MPR ≥ 0.80) to selpercatinib. Real-world outcomes in this older and frailer patient cohort align with phase 3 trial results, further supporting selpercatinib as the standard of care for patients with RET-altered cancers. Early testing for the detection of RET alterations remains essential.

Exploring whether home-based neuromodulation can boost the analgesic effects of exercise in people with knee osteoarthritis: protocol for a double-blinded, pilot randomised controlled trial

IntroductionKnee osteoarthritis (OA) represents a leading cause of disability globally. Exercise has been demonstrated to improve pain and function in people with knee OA. However, when in pain, commencement of...

Variation in adherence measures as a function of calculation methods.

We aim to compare different operational definitions of medication adherence as well as examine the within-patient variability among these measures among patients treated for multiple comorbid conditions. Electronically monitored adherence data from a study on comorbid conditions were examined using three different calculation methods. DAILY adherence calculated the number of administrations divided by the number prescribed, without considering inter-dose interval. TIMING used predefined inter-dose intervals. Measures were aggregated to six 30-day periods. A PILLCOUNT approach counted the total administrations divided by the expected number in each 30-day period. Within-patient variability was computed based on DAILY and TIMING results for each 30-day period. Results varied by adherence calculation method. PILLCOUNT demonstrated the largest adherence rates (89%-92%); DAILY rates were lower (79%-85%); and TIMING was the lowest (62%-68%) over the 6-month period. TIMING within-patient variability (29%-35%) was larger than DAILY (20%-25%). Differences among the three methods confirm the importance of the adherence definition. TIMING may underestimate medicinal effects because patients may take medication as instructed (e.g., with meals) rather than at fixed intervals. PILLCOUNT may overestimate adherence by not accounting for inconsistent use. DAILY may best provide daily estimates of correct administration. Higher variability for TIMING may indicate patients are more likely to vary time between doses. Adherence calculation methods are important in interpreting results. Variability measures provide a more complete picture of adherence and may raise the likelihood of effects on biological outcomes. We propose studies of adherence include calculation method in the definition of adherence.

Abstract 4128919: A Study Using Team Based Hypertension Care Focused on Black Patients to Inform a Future Randomized Trial

Background: Current telemedicine programs to manage hypertension are less effective in Black patients perhaps due to insufficient support for self-care skills and social needs. We describe a tailored program for Black patients emphasizing self-management support and social needs to inform future studies. Method: We piloted a 12-week telemedicine intervention comprising home blood pressure (BP) guided pharmacotherapy, frequent self-management support and social support using pharmacist, nurses, community health workers (CHW) and social workers (SW) among 20 patients in 2 clinics. At enrollment, we trained patients to use a BP monitor and a telemonitoring app that transmits BP real-time via a smartphone and provided a pill box to facilitate medication adherence. We asked patients to measure BP at least once daily and used 6 weeks average to guide pharmacotherapy. Trained nurses helped patients achieve self-care goals and provided 8-12 self-management support calls discussing hypertension, medication adherence, diet, physical activity, weight management, sleep, and BP measurement techniques. SWs and CHWs provided social support to address social needs such as food, transportation, and housing, and also offered home visits. Result: Eighteen patients completed the study of which 15 were Black, 2 White, and 1 Korean (9 were women). Mean age was 61.7 ± 11.8 years. Patients measured BP 10 ± 8.6 times/week and completed 8.3 ± 2.5 self-management calls. Over 12 weeks, SBP/DBP decreased by 16.5 ± 26.2/10.2 ± 18.5 mmHg without safety events (Table). There were 1.1 ± 0.8 (range 0-3) medication adjustments (dose or medication changes) per patient. Patients had 8 minor technical difficulties that were promptly resolved. 17 patients used pill boxes to improve medication adherence. Conclusion: Our tailored telemedicine program to manage hypertension is feasible among Black patients and offer valuable insights for future research.

Recommendations for monitoring adherence and fidelity in pragmatic trials based on experience in the Pain Management Collaboratory.

Most pragmatic trials follow the PRagmatic Explanatory Continuum Indicator Summary (PRECIS-2) criteria. The criteria specify unobtrusive measurement of participants' protocol adherence and practitioners' intervention fidelity but suggest no special monitoring strategies to assure trial integrity. We present experience with adherence/fidelity monitoring in the Pain Management Collaboratory (PMC) and provide recommendations for their monitoring in pragmatic trials to preserve inferences of treatment comparisons. In November 2021, we surveyed 10 of 11 originally funded PMC pragmatic trials to determine the extent to which adherence and fidelity data were being monitored. Of the 10 PMC trials, 8 track adherence/fidelity. The electronic health record is the most frequent source for monitoring adherence (7/10) and fidelity (5/10). Most adherence data are used to monitor participant engagement with the trial intervention (4/10) and are reviewed by study teams (8/10) and often with a data and safety monitoring board (DSMB) (5/10). Half of the trials (5/10) reported using fidelity data for feedback/training; such data are not shared with a DSMB (0/10). Only 2 of 10 trials reported having prespecified guidance or rules around adherence/fidelity (eg, stopping rules or thresholds for corrective action, such as retraining). As a best practice for pragmatic trials, we recommend early and regular adherence/fidelity monitoring to determine whether intervention delivery is as intended. We propose a 2-stage process with thresholds for intervening and triggers for conducting a formal futility analysis if adherence and fidelity are not maintained. The level of monitoring should be unobtrusive for both participants and those delivering the intervention; resulting data should be reviewed by an independent DSMB.

Sodelovanje in vztrajanje bolnikov z multiplo sklerozo pri zdravljenju z zdravili

Multiple sclerosis (MS) is a chronic, inflammatory, and demyelinating disease of the central nervous system that presents the second highest cause of disability among young adults in their thirties. Medication treatments are based on parenteral and novel oral disease-modifying therapies (DMTs) for their simple dosage form, increased efficacy, and safety. Medication adherence (MA) assesses the extent to which patients’ medication administration corresponds with the agreed-upon treatment recommendations from health-care providers. Medication persistence (MP) is part of the MA continuum and defined as the interval between the initiation and last dose of the applied medication immediately preceding discontinuation. Adherence measures are based on medication availability and gaps over the period it is dispensed. Medication adherence in persons with MS is complex due to disease chronicity and more demanding routes of administration. Adherence is higher in patients on oral compared to older injectable parenteral treatment. Younger age, female gender, and longer disease course are key risk factors leading to lower adherence, which declines substantially after six months of treatment. The association of disability with adherence remains unknown. The major adherence barriers in the course of treatment are adverse effects, injectophobia, and dosage frequency. Common non-adherence reasons among patients are forgetfulness, depression, and fatigue. Medication non-adherence is associated with lower health and economic outcomes. Interventions for increasing MA in persons with MS are complex and individualized. Overcoming adherence barriers in MS should be aimed at injectophobia, coping with adverse effects, and increasing beliefs towards treatment necessity.

Homework adherence in mindfulness-based cognitive interventions for female sexual dysfunction: a scoping review.

Mindfulness-based cognitive therapy (MBCT) includes regular home practice of mindfulness exercises as a key means of cultivating mindfulness. Although there are instruments available for measuring homework adherence following cognitive behavioral therapy (CBT), little is known about measuring homework practice in MBCT studies for sexual dysfunction. In this review we sought to investigate which items and instruments are the most used for the assessment of homework adherence in studies evaluating MBCT for the treatment of female sexual dysfunction (FSD). We also investigated the types of homework used in these interventions. Five databases (PubMed, Scopus, PsycINFO, Embase, and Web of Science) were searched and a total of 30 articles were included in this review. Our main findings revealed that there was no gold standard instrument used to assess homework adherence in patients using MBCT interventions for FSD, and that most of the reported studies did not provide information on how they assess homework adherence. Six of the 9 studies for which the articles reported how homework was assessed used only ad hoc measures. Only 3 studies used psychometrically validated instruments. We also found that mindfulness, psychoeducation, and CBT exercises were the most prescribed homework. This review uniquely integrates homework adherence measures with studies on FSD that evaluate mindfulness, finding no gold standard for assessing adherence. However, limitations including both MBCT and CBT interventions, limiting generalization to MBCT alone, the predominance of Western-based studies, and the lack of reporting on instruments used to assess adherence, indicating a gap in the field. Further studies should consider adapting existing instruments that assess homework adherence in studies of CBT for other psychopathologies or seek to develop new psychometrically validated instruments for MBCT interventions that assess homework adherence.

Food insecurity impacts diet quality and adherence to the gluten-free diet in youth with celiac disease.

Celiac disease (CD) is an autoimmune gastrointestinal disorder that requires a strict lifelong gluten-free diet (GFD). Gluten-free (GF) foods are more expensive and less readily accessible than gluten-containing foods, contributing to an increased risk for food insecurity (FI). The study aimed to determine associations between GF-FI, sociodemographic risk factors and child dietary adherence and diet quality (DQ). A 26-item, cross-country online survey was administered through social media to parents of children with CD on the GFD. The survey elicited household and CD child sociodemographic and clinical characteristics (e.g., duration of CD), measures of household FI, child DQ and GFD adherence, and parents' concerns related to GF food. Household GF-FI was evaluated using the validated Hunger Vital Sign™ and the US Department of Agriculture Six-Item Short Form Household Food Security Survey Module. GF-FI occurred in 47% of households with children with CD with >30% reporting low to very low food security. Sociodemographic risk factors identified included lower income, renters, rural residency, single-parental households, and having children with additional dietary restrictions (p < 0.001). Regardless of FI status, a majority of households reported experiencing significantly higher GF food expenditure. GF-FI was associated with reduced adherence to the GFD, increased consumption of processed GF food, and lower intakes of fresh fruits and vegetables and GF grains among children with CD (p < 0.05). GF-FI is prevalent in this multiethnic cohort of households with CD children and is associated with worsening DQ and GFD adherence. Policy interventions are urgently needed to address GF-FI.