Degree Of Treatment Adherence Research Articles

A217 TREATMENT ADHERENCE OF CHRONIC HEPATITIS B PATIENTS WITH HEPATOCELLULAR CARCINOMA FROM THE CANHEPB NETWORK

BackgroundChronic hepatitis B (CHB) is the most common cause of hepatocellular carcinoma (HCC) worldwide.AimsThe primary aim of this study is to explore the degree of treatment adherence to the American Association For The Study of Liver Disease (AASLD) HCC treatment guidelines for patients with CHB-HCC.MethodsThis is a retrospective, cross-sectional study of available data (2005–2020) in patients mono-infected with CHB collected from the Canadian HBV Network; a national consortium across 8 Canadian provinces. We analyzed data using descriptive statistics along with parametric and nonparametric statistical methods with a significance level of p < 0.05.ResultsOf the 6500 patients, 132 (2.0%) patients met inclusion criteria. The median age was 64 (IQR: 53.5- 71.5) with 101 (76%) being male. The median ALT was 40 (IQR: 26–59.5) and the median tumor number was 1(IQR: 1- 2) with a median tumor size of 2.6 cm (IQR: 1.9- 4.5). 98 (74.5%) patients were HBeAg negative with a median viral load of 3.8 logs (IQR 1.9 – 5.8). 58 (43%) patients had cirrhosis at diagnosis. 36% of patients were diagnosed with HCC on their first screening imaging whereas 39% were found to have HCC on repeated surveillance imaging. 116 (87.9%) were on treatment at the time of diagnosis or after (70 (60.3%) NA and 46 (39%) Combination therapy with double NA or NA plus interferon). Out of the 132 patients, BCLC stage 0, A, B, and C represented 30 (23%), 42 (32%), 17 (13%), and 5 (4%) patients, respectively, with 38 (28%) patients with unknown BCLC stage. The overall adherence to AASLD guidelines was 61%. The HCC treatment adherence rate for patients with BCLC stage 0, A, B were 63%, 97.5%, and 23.5%, respectively. BCLC stages C and D did not have a sufficient sample size for analysis. The adherence rate ranged from 53% (Eastern Canada) to 71% (Western Canada) across Canada.ConclusionsIn this retrospective nationwide cohort study of patients with CHB-related HCC, the overall treatment adherence rate to AASLD guidelines was low with notable regional differences. Further analysis will determine the cause of regional differences.Funding AgenciesNone

ERESEARCH IN THE DEGREE OF ADHERENCE BY ASTHMA PATIENTS – A PILOT STUDY

Introduction: Non-adherence to treatment is a global issue which in recent years has reached epidemic proportions. The WHO has reported that treatment adherence in chronic patients is 50% in developed countries on average. According to data from the Association of Bulgarians with Bronchial Asthma (ABBA) the percentage of asthma patients who are not regularly treated is the highest compared with other chronic diseases. Non-adherence to treatment not just influences the patient’s quality of life but increases the health care costs in society.&#x0D; Objectives: The aim of this study is to analyse the degree of adherence to prescribed treatment in asthma patients.&#x0D; Methods: An anonymous survey was made among 50 outpatients with asthma using an adapted survey card consisting of two parts: a questionnaire that collects information about the demographic profile of the patient (gender, age, educational background, etc) and a validated tool, the Morisky test, which is a questionnaire that defines the degree of treatment adherence.&#x0D; Results: The results from the Morisky test (Morisky coefficient 2.22) showed a mean degree of adherence both for the whole sample and for men and women separately, with a minimal difference of 0.01 in favour of men (Morisky coefficient 2.24 in men and 2.23 in women).&#x0D; Conclusions: The studied asthma patients show unsatisfactory adherence to the prescribed treatment. The mean degree of adherence reported in the study indicates the need for educating patients, monitoring and collaboration among doctors, patients, pharmacists and other healthcare professionals.

Glycemic benefits with adherence to testosterone therapy in men with hypogonadism and type 2 diabetes mellitus.

While previous studies have demonstrated testosterone's beneficial effects on glycemic control in men with hypogonadism and Type 2 Diabetes, the extent to which these improvements are observed based on the degree of treatment adherence has been unclear. To evaluate the effects of long-term testosterone therapy in A1C levels in men with Type 2 Diabetes Mellitus and hypogonadism, controlling for BMI, pre-treatment A1C, and age among different testosterone therapy adherence groups. We performed a retrospective analysis of 1737 men with diabetes and hypogonadism on testosterone therapy for 5years of data from 2008-2018, isolating A1C, lipid panels, and BMI results for analysis. Subjects were categorized into adherence groups based on quartiles of the proportion of days covered (> 75% of days, 51-75% of days, 26-50% of days and 0-25% of days), with >75% of days covered considered adherent to therapy. Pre-treatment median A1C was 6.8%. Post-treatment median A1C was 7.1%. The adherent group, >75%, was the only group notable for a decrease in A1C, with a median decrease of -0.2 (p=0.0022). BMI improvement was associated with improved post-treatment A1C (p=0.007). When controlling for BMI, age, and pre-treatment A1C, the >75% adherence group was associated with improved post-treatment A1C (p<0.001). When controlling for all studied variables, testosterone adherence was associated with improved post-treatment A1C. The higher the initial A1C at the initiation of therapy, the higher the potential for lowering the patient's A1C with >75% adherence. Further, all groups showed some reduction in BMI, which may indicate that testosterone therapy may affect A1C independent of weight loss. Even when controlling for improved BMI, pre-treatment A1C, and age, testosterone positively impacted glycemic control in diabetes patients with hypogonadism, with the most benefit noted in those most adherent to therapy (>75%).

ADHERENCE TO TREATMENT AND QUALITY OF LIFE OF PATIENTS WITH CARDIOVASCULAR DISEASES AT THE OUTPATIENT TREATMENT STAGE OF MEDICAL CARE

Aim: to analyze an adherence to treatment, factors affecting it, and the quality of life of patients with cardiovascular diseases at the outpatient stage of medical care.Material and methods. The population of the study was 225 people. The Moriski-green compliance scale was used to analyze patients’ adherence to treatment, and the EuroQol EQ-5D-5L international questionnaire was used to assess the quality of life of patients. Statistical data processing was performed using the program STATISTICA 10.0.Results. The percentage of committed to treating patients who sought outpatient care was 59%. The main reason for poor adherence was forgetfulness – 25,27 %. It is patient’s opinion, in 73.8% of cases, communication with a doctor plays an important role in improving their compliance. The total index of quality of life (QOL) of patients with cardiovascular diseases (CVD) was 0.712 ± 0.165. In estimating the relationship between quality of life and adherence to treatment, a positive correlation was found: the more compliant the patient, the higher their quality of life, and vice versa (r=0.2, p=0.013). The relationship between high adherence to treatment and quality of life was confirmed in the group of men (p=0.01), while the statistical significance of differences was not achieved in women (p=0.2). In examining the aspect of a disease of chronic heart failure (CHF), the worsening of NYHA functional class (from I to II) was accompanied by a sharp decrease in self-esteem of health for both sexes (p=0.01).Conclusion. Almost every second patient is against of the rules of the medication regimen. Better adherence to treatment can be facilitated by more careful attention from the attending physician with a detailed explanation of the causes and the aspect of the disease, treatment methods, as well as ways to self-control the symptoms of the disease. The degree of treatment adherence is correlated with the level of quality of life on the EQ-5D-5L scale, mainly in the male population.

Obstructive Sleep Apnea and Arterial Hypertension: Implications of Treatment Adherence.

This review seeks to present an overview of the recent literature on the importance of CPAP and antihypertensive treatment adherence in blood pressure control of hypertensive patients, especially those with obstructive sleep apnea. Although it is unquestionable that a good adherence to CPAP and antihypertensive drugs is crucial to improvements in sleep-related symptoms, blood pressure levels (even the modest reductions of 2-2.5mmHg achieved by CPAP treatment) and future cardiovascular risk, this adherence decreases over time, despite efforts made toward behavioral intervention and monitoring. Curiously, although taking a drug would seem to be easier than the use of CPAP treatment, based on current information, it seems that the compliance with drug treatment in hypertensive subjects is not better than that achieved with CPAP treatment in OSA patients with hypertension. However, some studies have shown some phenotypes of hypertensive and OSA patients with good adherence and better hypertensive effect, such as those with uncontrolled blood pressure (resistant and refractory hypertension), severe forms of sleep apnea, and more sleep-related symptoms, especially a higher degree of diurnal hypersomnia. The positive effect of antihypertensive drugs and CPAP treatment on blood pressure levels depends on the degree of treatment adherence, especially in forms of uncontrolled hypertension, but this adherence decreases over time. Educational programs and new devices are needed to improve adherence to treatment in these patients, along with fuller understanding of the different patterns and phenotypes of non-adherence.

Meaning of Adherence in Hepatitis C-Infected Military Veterans.

Among United States (U.S.) veterans, the prevalence of chronic hepatitis C infection is three times that of the general U.S. population. Treatment success is proportionate to the degree of treatment adherence. There has been little research dedicated to the systematic exploration of issues related to treatment adherence. The purpose of this study was to describe factors that influenced adherence in infected military veterans. Phenomenological research emphasizes a rich description. A convenience sample of 21 veterans was recruited from a clinic in north Texas. One-time in-depth interviews explored reasons for remaining in treatment despite difficult side effects. Analysis included immersion, data transformation, thematic analysis, and summary. Cognitive strategies to stay on medication include making a commitment to treatment, "not ready to leave this world," conserving energy and staying busy, looking forward, and starting over. Veterans utilize previously learned military discipline to stay on medications and follow providers' orders. They are not ready to die and have plans for life after treatment. Patient education should focus on side effect management, rather than on genotypes or viral load. Treatment teams should include substance abuse specialists and gastroenterology providers. Future studies need to develop a measurement tool for adherence during antiviral treatment.

Emerging integrase inhibitor resistance mutations in raltegravir-treated HIV-1-infected patients with low-level viremia

The emergence of integrase strand-transfer inhibitor (INSTI) resistance-associated mutations was examined in patients with low-level viremia after switching from enfuvirtide to raltegravir in the ANRS 138-Easier trial. Integrase genes of plasma virus from raltegravir-treated patients in the Easier trial with low-level viremia (50-500 copies/ml) were sequenced to determine INSTI resistance-associated mutations. Baseline viral load, baseline and nadir CD4 cell count, antiretroviral treatment, genotypic susceptibility score, level of viremia and degree of treatment adherence during the study period were also analyzed. Forty-nine patients experienced at least one episode of low-level viremia while receiving raltegravir; integrase genotyping was successful in samples from 39 individuals (80%). Among them, three [7.7%, 95% confidence interval (CI) 1.6-20.9%] had significant INSTI resistance mutations consisting of N155H in two and P145S in one. Absence of these mutations from proviral DNA at baseline suggested selection of INSTI resistance during episodes of low-level viremia. No specific factors significantly associated with emergence of INSTI resistance mutations during low-level viremia were identified. Emergence of INSTI resistance mutations can occur during episodes of low-level viremia in patients receiving raltegravir-containing regimens.

Psychological Factors and Medical Compliance Among Patients With Breast Pain

Background/Purpose This study was designed to examine how psychological factors related to premenstrual syndrome (PMS) influence adherence to medical regimens for patients with breast pain. Methods Three hundred and seventy-six female subjects from a breast clinic completed a structured questionnaire during their visits. All subjects were followed-up by telephone interview to determine their degree of treatment adherence. The presence of PMS symptoms was used to indicate psychological disturbances of the subjects in relation to their adherence to a mastalgia regimen. The PMS status of subjects was measured by modifying the Diagnostic and Statistical Manual of Mental Disorders, 4 th edition, research criteria for premenstrual dysphoric disorder. The severity of each subject's PMS was summarized by confirmatory factor analysis. Logistic regression was used to establish associations between the aggregated PMS score and compliance behavior. Results PMS scores were statistically significant in predicting adherence to medical regimens for breast pain. Conclusion The psychological aspects of PMS have considerable influence on noncompliance with medical regimens for breast pain, and patients should be counseled accordingly.

Asociación entre los niveles de estrés y depresión y la adhesión al tratamiento en personas seropositivas al VIH en Hermosillo, México

To evaluate the association between variables related to stress, reasons, and depression, and adherence to treatment in HIV-positive individuals, and to analyze the robustness according to a theoretical psychology model. This was a cross-sectional study of 25 female and 39 male HIV-positive participants receiving services at the Outpatient Center for Prevention and Treatment of HIV/AIDS and Sexually-transmitted Diseases (Centro Ambulatorio para la Prevención y Atención del VIH/Sida e Infecciones de Transmisión Sexual) in Hermosillo, Sonora, Mexico. The psychological variables, the degree of treatment adherence, stress-related circumstances, and the severity of depression were examined. Rates were calculated for the key variables associated with stress, reasons, and depression. The associations among variables were determined by multiple regression. During the month preceding the study, 65.6% of the 64 participants reported having faithfully followed the prescribed treatment, while 34.4% had failed, in some way, to follow the treatment (chi(2) = 6.250; P = 0.012). Regression analysis found that there was only one combination, an intermediate level of stress linked to tolerance of uncertainty and low levels of depression, that was significantly associated (F [3.58] = 3.298; P = 0.027) with adherence to treatment; the combination of these two variables explained 38.2% of the total variance found. The combination of stress levels with tolerance of uncertainty and depression could be used as a predictor for true compliance with prescribed treatment plans. These results should be taken into account when designing intervention and treatment-adherence campaigns in HIV-positive individuals.

Project STOP: Cognitive Behavioral Assessment and Treatment for Sex Offenders with Intellectual Disability

ABSTRACT In this brief article, we provide relevant background concerning the prevalence, characteristics and vulnerabilities of intellectually disabled (ID) sex offenders, as well as scientifically-informed guidelines for assessment and treatment. Specifically, we suggest assessment methods concerning the various areas of vulnerability associated with sex offending risk, with emphasis on dynamic or changeable areas of vulnerability. Treatment guidelines are consistent with an individualized case formulation approach aimed at changing each individual's unique area of vulnerability. We provide a description of Project STOP, as a case example of these principles. A program evaluation of this project revealed a low rate of recidivism and a high degree of treatment adherence. Finally, we propose which elements of the case formulation approach appear to be associated with successful outcome.