Differences In Treatment Adherence Research Articles

Place of telemedicine in the organization of emergency care: feasibility and benefits

IntroductionTelemedicine encompasses all medical practices that allow patients to be remotely cared for through new information and communication technologies. This study aims to assess the remote management of patients consulting emergency services and not requiring in-hospital care during both pre-pandemic and pandemic periods of COVID-19.MethodsThis was a prospective, randomized, controlled study. The telemedicine group received follow-up at home after emergency room discharge according to a predefined protocol, with telephone calls on days 2, 7, 15, and 30. The control group received standard care without regular telephone follow-up (only a call on day 30). The study was conducted with patients consulting the emergency department of FarhatHached Hospital in Sousse. Patient inclusion occurred between November 1, 2019, and April 30, 2020. The primary outcome measures were the re-consultation rate and treatment adherence. The secondary outcome measure was patient satisfaction.SPSS version 23.0 for Windows was used for data analysis. Descriptive statistics calculated frequencies, percentages, means, standard deviations, medians, and range. Analytical study involved Student’s t-test and Pearson chi-square test for mean and frequency comparisons, respectively. Significance threshold (p) for all tests was set at 0.05.ResultsA total of 400 patients were included. The average age of patients was 40 years. Both groups were comparable in terms of demographics and clinical characteristics. Diagnoses included mainly benign infectious diseases, trauma, mild decompensations of chronic conditions (asthma, COPD, heart failure), and suspected COVID cases. Patients in the telemedicine group tended to reconsult less in the month following their initial emergency room visit (14% versus 26.5%) (p = 0.004). There was a significant difference in treatment adherence between the telemedicine group and the control group (97.5% versus 92%; p = 0.014). The satisfaction with telemedicine was higher than satisfaction with regard to an in-person consultation at the emergency department (90% versus 37.5%).ConclusionIt is necessary to implement telemedicine in Tunisia, especially in emergency services. It ensures better remote patient care by reducing re-consultation rates, increasing treatment adherence, and improving patient satisfaction.

Racial differences in treatment adherence and response to acupuncture and cognitive behavioral therapy for insomnia among Black and White cancer survivors.

Racial disparities in sleep are well-documented. However, evidence-based options for addressing these disparities are lacking in cancer populations. To inform future research on sleep interventions, this study aims to understand racial differences in treatment responses to acupuncture and cognitive behavioral therapy for insomnia (CBT-I) among Black and White cancer survivors. We conducted a secondary analysis of a comparative effectiveness trial evaluating acupuncture versus CBT-I for insomnia in cancer survivors. We compared insomnia severity, sleep characteristics, and co-morbid symptoms, as well as treatment attitudes, adherence, and responses among Black and White participants. Among 156 cancer survivors (28% Black), Black survivors reported poorer sleep quality, longer sleep onset latency, and higher pain at baseline, compared to White survivors (all p < 0.05). Black survivors demonstrated lower adherence to CBT-I than White survivors (61.5% vs. 88.5%, p = 0.006), but their treatment response to CBT-I was similar to white survivors. Black survivors had similar adherence to acupuncture as white survivors (82.3% vs. 93.4%, p = 0.16), but they had greater reduction in insomnia severity with acupuncture (-3.0 points, 95% CI -5.4 to 0.4, p = 0.02). This study identified racial differences in sleep characteristics, as well as treatment adherence and responses to CBT-I and acupuncture. To address racial disparities in sleep health, future research should focus on improving CBT-I adherence and confirming the effectiveness of acupuncture in Black cancer survivors.

User-Centered Design to Develop Automated Short Message Service Messaging for Patient Support of Rheumatic Heart Disease Secondary Antibiotic Prophylaxis.

The Active Community Case Management Platform is a cloud-based technology developed to facilitate rheumatic heart disease case management by health care providers. This study aimed to design and pilot an automated short message service (SMS) intervention to support secondary prophylaxis adherence. We developed a concise library of messages to support secondary antibiotic prophylaxis. The SMS intervention used TextIT, an interface that enables users to send out interactive SMS messages at scale. The message bank was piloted in a cohort of 50 patients with rheumatic heart disease randomized into 2 groups. Group 1 received standard support (nurse-led/Active Community Case Management Platform). Group 2 received standard support plus SMS intervention for 2 months in the Lira and Gulu districts of Northern Uganda. We collected qualitative data on participants' experiences and assessed treatment adherence. Using a sequential user-centered process consisting of 4 phases (phases 1-4), we developed a message bank (n=43) deployed during our pilot study. There were no between-group differences in treatment adherence or acceptance. Interviews of participants indicated that the intervention was viewed positively. A total of 75% of SMS recipients responded to the messages, and 25% called the study staff to acknowledge receipt of text messages. This study has successfully developed a bank of SMS messages to support secondary antibiotic prophylaxis adherence. We have demonstrated the feasibility and acceptability of SMS technology in rheumatic heart disease care management. Future work will include integrating automated SMS into the Active Community Case Management Platform and a larger study of integrated SMS to reduce health care worker burden for patient support and improve adherence to secondary antibiotic prophylaxis.

Physical activity influences adherence to pharmacological treatments in patients with severe mental disorders: results from the multicentric, randomized controlled LIFESTYLE trial.

Introduction: Poor adherence to pharmacological treatment is frequent in people with severe mental disorders and it often causes lack of effectiveness of many psychotropic drugs. Thus, efforts should be made to improve adherence to pharmacological treatments in patients with these disorders. Methods: In this paper, based on the LIFESTYLE randomized, controlled multicentric trial, we aim to: 1) assess the level of adherence in a real-world sample of patients with severe mental disorders; 2) evaluate differences in treatment adherence according to patients' socio-demographic and clinical characteristics; 3) evaluate the impact of an innovative psychosocial intervention, on patients' adherence to treatments. The Lifestyle Psychosocial Group Intervention consists of group sessions, focused on different lifestyle behaviours, including healthy diet; physical activity; smoking habits; medication adherence; risky behaviours; and regular circadian rhythms. At end of each session a 20-min moderate physical activity is performed by the whole group. Results: The sample consists of 402 patients, mainly female (57.1%, N = 229), with a mean age of 45.6years (±11.8). Less than 40% of patients reported a good adherence to pharmacological treatments. Adherence to treatments was not influenced by gender, age, diagnosis and duration of illness. At the end of the intervention, patients receiving the experimental intervention reported a significant improvement in the levels of adherence to treatments (T0: 35.8% vs. T3: 47.6%, p < 0.005). Patients practicing moderate physical activity reported a two-point improvement in the levels of adherence [odds ratio (OR): 1,542; 95% confidence intervals (CI): 1,157-2,055; p < 0.001], even after controlling for several confounding factors. Discussion: The experimental lifestyle intervention, which can be easily implemented in the routine clinical practice of mental health centres, was effective in improving adherence to pharmacological treatments.

Harnessing technology and gamification to increase adult physical activity: a cluster randomized controlled trial of the Columbia Moves pilot

BackgroundThe use of health technologies and gamification to promote physical activity has increasingly been examined, representing an opportunistic method for harnessing social support inherent within existing social ties. However, these prior studies have yielded mixed findings and lacked long-term follow-up periods. Thus, a pilot cluster randomized controlled trial was conducted to gauge the feasibility and preliminary efficacy of a digital gamification-based physical activity promotion approach among teams of insufficiently active adults with existing social ties.MethodsTeams (N = 24; 116 total participants) were randomized to either a 12-week intervention (Fitbit, step goals, app, feedback; TECH) or the same program plus gamification (TECH + Gamification). Mixed effects models were used to compare group differences in treatment adherence, and changes in social support, steps, and moderate-to-vigorous physical activity at 12 weeks and 52 weeks from baseline, adjusted for sociodemographic characteristics and team size.ResultsTECH had a lower mean number of days of Fitbit self-monitoring versus TECH + Gamification during the intervention (adjusted difference: -.30; 95% CI, -.54 to -.07; P = .01). Post-intervention, TECH had 47% lower odds of self-monitoring 7 days per week versus TECH + Gamification (.53; 95% CI, .31 to .89; P = .02). No differences were observed between TECH + Gamification and TECH in increases in social support (0.04; 95% CI, -.21 to .29; P = .76), ActiGraph-measured daily steps (-425; 95% CI, -1065 to 215; P = .19), or moderate-to-vigorous physical activity minutes (-3.36; 95% CI, -8.62 to 1.91; P = .21) from baseline to 12 weeks or in the regression of these improvements by 1 year (Ps > .05). Although not significant in the adjusted models (Ps > .05), clinically meaningful differences in Fitbit-measured daily steps (TECH, 7041 ± 2520; TECH + Gamification, 7988 ± 2707) and active minutes (TECH, 29.90 ± 29.76; TECH + Gamification, 36.38 ± 29.83) were found during the intervention.ConclusionsA gamified physical activity intervention targeting teams of adults with existing social ties was feasible and facilitated favorable, clinically meaningful additive physical activity effects while in place but did not drive enhanced, long-term physical activity participation. Future investigations should explore optimal team dynamics and more direct ways of leveraging social support (training teams; gamifying social support).Trial registrationClinicaltrials.gov (NCT03509129, April 26, 2018).

Effect of a computerized decision support system on the treatment approach of stage III or IV pressure injury in patients with spinal cord injury: a feasibility study

BackgroundStage III and IV pressure injuries (PIs) in patients with spinal cord injury (SCI) require complex interdisciplinary and interprofessional treatment approaches that are difficult to implement. Practical aspects, such as information exchange and coordination, remain challenging. We investigated whether a computerized decision support system (CDSS) could increase treatment adherence and improve clinical outcomes and interprofessional collaboration.MethodIn this feasibility study, a core team developed the initial treatment process and adapted it based on several discussions with clinical experts and information technologists. The CDSS followed the Basel Decubitus Approach and was used in a clinic specializing in SCI. Thirty patients with SCI admitted for stage III/IV PI between July 2016 and May 2017 were randomly allocated to standard or CDSS-supported care. Between-group differences in treatment adherence, complication rates, length of stay, and costs were analyzed using descriptive statistics. The use of the CDSS and potential barriers and facilitators were evaluated through interprofessional focus groups, transcribed verbatim, and thematically analyzed (30 participants).ResultsNo differences in SCI characteristics, comorbidities, or PI characteristics (localization: ischium [number (n) = 19 PI, 63%], sacrum [n = 10 PI, 33%], recurrent PI [n = 21, 70%]) were found between the two groups. Furthermore, no statistically significant differences were observed in treatment adherence, frequency of major (20% vs. 13% between CDSS and control group) and minor (33% vs 27%) complications, and length of stay (98 [±28] vs 81 [±23] days). Healthcare professionals found the CDSS to be helpful for visualizing the treatment process. However, the high workload and difficulties in the information technology processes, such as missing reminders, slow computer performance and data processing, and poor accessibility, hindered the effective implementation of the CDSS.ConclusionThe implementation of the CDSS to support the treatment of stage III/IV PI in patients with SCI was feasible and included definitions of milestones, interventions, and outcomes. However, to assess the impact of the CDSS, a longer observation period is required. Further, the technical difficulties must be addressed, and solid integration of the CDSS into the clinical information system is necessary.Trial RegistrationThis quality improvement project received a declaration of no objection from the Ethics Committee of Northwest and Central Switzerland (EKNZ UBE-16/003), and ethical approval was received for the focus groups (EKNZ Req-2017-00860).

EE478 Do Triple Single-Pill Combinations Make a Difference in Treatment Adherence, Outcomes and Healthcare Resource Utilization in Hypertension? A Real-World Analysis of Patients on Perindopril/Amlodipine/Indapamide in Italy

EE478 Do Triple Single-Pill Combinations Make a Difference in Treatment Adherence, Outcomes and Healthcare Resource Utilization in Hypertension? A Real-World Analysis of Patients on Perindopril/Amlodipine/Indapamide in Italy

The impact of substance use on health care utilization, treatment, and outcomes in patients with non-small cell lung cancer.

Mortality from non-small cell lung cancer (NSCLC) has improved with screening and novel treatments. The substance use epidemic has threatened health outcomes in a variety of diseases, but little is known about how it is associated with NSCLC outcomes. We performed a retrospective cohort study of 211 patients with NSCLC treated at a safety-net hospital. Sociodemographic data and clinical outcomes were extracted via review of electronic medical records. Patients were stratified based on substance use status. Comparative and multivariable analyses were performed to evaluate baseline characteristics and lung cancer outcomes including survival. Among 193 patients (91.5%) with information available on substance use, 24.9% reported substance use; specifically, alcohol, marijuana, and illicit substances. Patients with substance use were more likely to have increased health care utilization and poor social determinants of health, including safe housing, stable employment, and social support. There were no significant differences in treatment adherence. Only 6.3% of patients with substance use did not receive guideline concordant care (GCC) compared to 24.8% of patients without substance use; due to poor performance status, increased comorbidities, or loss to follow up. On univariable analysis, patients with substance use experienced inferior median overall survival (OS) if they had metastatic disease (0.40 vs. 1.03 years, P=0.01). However, in the multivariable analysis, substance use did not predict for survival. Independent predictors of mortality were sex (male HR, 1.67; 95% CI: 1.04-2.68; P=0.04), smoking status (current smoking HR, 2.63; 95% CI: 1.14-6.08; P=0.02), and stage (stage IV HR, 14.96; 95% CI: 6.28-35.63; P=0.008). Substance use is associated with poor social determinants of health and increased health care utilization. On multivariable analysis, substance use was not independently associated with OS once guideline-concordant care was used. Future studies should focus on improving our understanding of these associations, delineating potential mechanisms, and developing evidence-based strategies to reduce health care utilization and overcome challenges related to poor social determinants of health.

Urban-Rural Difference in Treatment Adherence of Chinese Hypertensive Patients.

ObjectiveThe aims of this study were to evaluate the treatment adherence and the main factors associated with adherence for Chinese hypertensive patients between urban and rural areas.Participants and MethodsA total of 529 hypertensive patients with 328 from urban areas and 201 from rural areas hospitalized in a tertiary hospital in Xi’an, China during the period from May 1 to December 31, 2021 were invited to participate in the cross-sectional study. The adherence to treatment was assessed by “modified Chinese Hill-Bone compliance to high blood pressure therapy scale”. Binary logistic regression analysis was used to analyze independent risk factor for treatment adherence of hypertensive patients. General linear model was used to analyze the association of the independent risk factors to treatment adherence in each subgroup of the scale.ResultsThe treatment adherence of Chinese hypertensive patients in rural areas was 23.88% and it was significantly lower than that in urban areas (36.59%). Age and gender were the factors that independently associated with treatment adherence of hypertensive patients regardless of urban or rural status. The duration of antihypertensive drugs used was identified to be the factor that independently associated with treatment adherence only in urban patients. The subgroups including reduced sodium intake and medication taking had significant effects on treatment adherence in certain factors.ConclusionThe treatment adherence of Chinese hypertensive patients was low, especially in rural areas. More emphasis should be placed on patients in rural areas. Furthermore, more attention and effective strategies should be designed to address factors affecting treatment adherence in both urban and rural areas. Health programs should focus on education including the importance of taking continuous antihypertensive drugs and low sodium diet.

Ferritin-guided iron supplementation in whole blood donors: optimal dosage, donor response, return and efficacy (FORTE)—a randomised controlled trial protocol

BackgroundFrequent whole blood donors have an increased risk of developing iron deficiency. Iron deficiency can have detrimental health effects when left untreated. Donation intervals are commonly too short to replenish...

Transcranial Direct Current Stimulation Provides no Additional Benefit to Improvements in Self-Reported Craving Following Mindfulness-Based Relapse Prevention.

Mindfulness-Based Relapse Prevention (MBRP) and transcranial direct current stimulation (tDCS) have each demonstrated efficacy in improving outcomes in those with alcohol use disorder (AUD), however a recent study that combined MBRP with tDCS found tDCS provided no additional benefit to MBRP for AUD. Differences in treatment adherence between active versus sham tDCS groups may have contributed to this result. The current study examined whether treatment adherence interacted with tDCS condition in predicting post-treatment mindfulness and craving. This study was a secondary data analysis from a randomized sham-controlled trial comparing MBRP paired with tDCS. Linear regression analyses were conducted examining the interaction between tDCS condition and two measures of treatment adherence (i.e., number of groups attended, number of tDCS administrations) on post-treatment mindfulness and craving. There was no effect of treatment adherence by tDCS condition in predicting mindfulness, however the interaction between treatment adherence and tDCS condition significantly predicted post-treatment craving. There was a significant negative association between treatment adherence and post-treatment craving in the sham group, but there was no association in the active tDCS group. MBRP coupled with sham stimulation led to significant reductions in self-reported craving when patients attended more sessions and received a greater number of sham tDCS administrations, while no relationship was observed between treatment adherence and craving among those who received active tDCS. This result provides tentative evidence that, rather than improve the effects of MBRP on craving, this active tDCS protocol provides no additional benefit to MBRP in reducing craving. This study was registered with clinicaltrials.gov (NCT02861807).

Differences by race in patient-reported symptoms during chemotherapy among women with early-stage, hormone receptor-positive breast cancer.

6528 Background: Symptom burden may contribute to racial differences in cancer treatment adherence and survival. Evidence on changes in symptom burden during chemotherapy and whether these differ by race is scarce. We used patient reported outcomes data collected before and after breast cancer chemotherapy initiation to compare symptom burden by race. Methods: Using electronic medical records of a large cancer center in the southern region of the US, we identified Black and White women diagnosed with stage I-III, hormone-receptor positive breast cancer from January 2007 to December 2015. A tablet-based platform [ConcertAI] was used to collect patient reported symptoms at the point of care. We included patients with at least one completed symptom report before and during chemotherapy. We focused on two standardized composite scores – physical symptoms and treatment side-effect (mean of 50 and standard deviation of 10), and calculated changes in symptoms using the closest report before chemotherapy and the most severe score reported during chemotherapy. Patients with a 10-point increase were classified as having a clinically meaningful increase in symptom burden. We used Oaxaca-Blinder decomposition to quantify racial differences in symptom burden change explained by baseline characteristics. These included baseline symptom scores, sociodemographic characteristics (age, regional level household income and education, state) and clinical characteristics (cancer stage and primary chemo regimen). Results: Among 1,167 included patients, Black women (30%) were younger (52 vs. 55 years old, p&lt;.001), more likely to live in areas with lower median household income and less education, and reported most severe scores about 2 weeks later than White women ( p&lt;.05). They were also more likely to report a 10-point increase in symptom burden for physical (68.5% vs. 61.2%, p=.017) and side-effects symptoms score (49.0% vs. 41.4%, p=.015). This was driven by larger increases in selected individual symptoms among Black women, such as sweating, itching, and numbness (under physical symptom score), and hair loss and taste change (under side-effect score). Decomposition analyses showed that baseline characteristics (especially primary chemo regimen) explained 79.2% ( p=.002) and 35.2% ( p=.131) of the increased probability of Black women reporting a 10-point increase in physical symptom and side-effects scores respectively. Conclusions: Black women with early-stage breast cancer were more likely to report a clinically meaningful increase in treatment side-effects and physical symptoms during chemotherapy compared to White women. Differences by race in physical symptoms scores were mostly explained by baseline characteristics. Future studies should examine whether racial differences in symptom burden translate into differences in treatment adherence and mortality.

A Comparative Study of Treatment Adherence Among In-Center Hemodialysis Patients Based on Years on Dialysis and Demographic Factors

Shortened or missed dialysis treatments are directly associated with increased hospitalization and mortality rates among end-stage renal disease (ESRD) patients. The purpose of this study was to investigate the differences in treatment adherence according to the number of years on dialysis and demographic factors such as age, annual income, living status, and sex, with respect to the numbers of dialysis treatments shortened by ≥10 min and missed dialysis treatments among patients undergoing in-center hemodialysis. This study used a quantitative and nonexperimental research design to investigate the differences in adherence. Data were collected from 412 in-center hemodialysis patients through patient surveys and from the participants’ medical records. Dialysis patients aged ≥60 years were found to be more adherent than those aged 18–59 years, with a statistically significant difference between the groups (p = .01, each for shortened and missed treatments). Patients whose annual income was >200% of the federal poverty level were also more adherent than those who reported less income, with a statistically significant difference between the groups (p = .01, each for shortened and missed treatments). Future studies should focus on addressing adherence by incorporating more adherence factors and different treatment modalities for ESRD.

Multiple Sclerosis in a Multi-Ethnic Population in Houston, Texas: A Retrospective Analysis.

Multiple Sclerosis (MS) is a progressive neurodegenerative disease that affects more than 2 million people worldwide. Increasing knowledge about MS in different populations has advanced our understanding of disease epidemiology and variation in the natural history of MS among White and minority populations. In addition to differences in incidence, African American (AA) and Hispanic patients have greater disease burden and disability in earlier stages of disease compared to White patients. To further characterize MS in AA and Hispanic populations, we conducted a retrospective chart analysis of 112 patients treated at an MS center in Houston, Texas. Here, we describe similarities and differences in clinical presentation, MRI findings, treatment regimens, disability progression, and relapse rate. While we found several similarities between the groups regarding mean age, disability severity, and degree of brain atrophy at diagnosis, we also describe a few divergences. Interestingly, we found that patients who were evaluated by a neurologist at symptom onset had significantly decreased odds of greater disability [defined as Expanded Disability Status Scale (EDSS) > 4.5] at last presentation compared to patients who were not evaluated by a neurologist (OR: 0.04, 95% CI: 0.16–0.9). We also found that active smokers had significantly increased odds of greater disability both at diagnosis and at last clinical encounter compared to nonsmokers (OR: 2.44, 95% CI: 1.10–7.10, OR= 2.44, 95% CI: 1.35–6.12, p = 0.01, respectively). Additionally, we observed significant differences in treatment adherence between groups. Assessment of the degree of brain atrophy and progression over time, along with an enumeration of T1, T2, and gadolinium-enhancing brain lesions, did not reveal differences across groups.

996-P: A Randomized Study to Evaluate the Efficacy of Insulclock Pen Device in Insulin-Treated Patients with Uncontrolled Type 2 Diabetes

Insulin pen devices have been reported to improve patient satisfaction and treatment adherence compared to the traditional vial/syringe. Insulclock® is a small electronic device plugged onto insulin pen to track information via Bluetooth to smart-phone technology on date, time and dosage of injections and with an alarm system to reduce insulin omissions. We performed a randomized, cross-over design study in patients with type 2 diabetes (T2D) on basal insulin to assess the efficacy and satisfaction of Insulclock device. Eighty T2D patients on basal insulin ± oral agents with HbA1c between 7.0% and 12.0% were randomized to a 12-week ’intervention’ phase receiving reminders or to a 12-week ’control’ phase with device without feedback. Basal insulin was titrated every 2 weeks to a target fasting and premeal glucose between 70-130 mg/dl. Study outcomes included differences between groups on glycemic control, treatment adherence and satisfaction (DTSQc survey). Baseline characteristics were similar between groups (56±11 years, HbA1c 9.2%±1.5). HbA1c improved significantly from baseline, with reduction of 0.9 % in the intervention and 0.7% in the control group. Insulclock improved glycemic control with an estimated reduction in average mean daily blood glucose (BG), fasting BG, and pre-meal BG of 6.03 (95% CI: [-3.21, 15.3]), 6.66 (95% CI: [-1.72, 15.04]), and 5.57 (95% CI: [-6.15, 17.31]) mg/dl, respectively. Repeated measures analyses based on linear mixed models suggest significant effects of insulclock on the trajectory of mean daily BG, fasting BG, pre-meal BG (p&amp;lt;0.01, p=0.03, p=0.01). There were no differences in treatment adherence or on the rate of hypoglycemia, and patients were equally satisfied with the device during intervention and control phase (DTSQc 15.5±3.7 and 15.2±3.1, respectively). In conclusion, the use of Insulclock resulted in improved glycemic control and treatment satisfaction in insulin treated patients with T2D. Disclosure C. Ramos: None. R.J. Galindo: Advisory Panel; Self; Lilly Diabetes. Consultant; Self; Valeritas, Inc. Research Support; Self; Novo Nordisk Inc. Other Relationship; Self; UpToDate. M.M. Alam: None. S. Cardona: None. B.S. Albury: None. O. Oladejo: None. F.J. Pasquel: Advisory Panel; Self; AstraZeneca, Eli Lilly and Company. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp &amp; Dohme Corp. Research Support; Self; Dexcom, Inc., Merck Sharp &amp; Dohme Corp., National Institutes of Health. P. Vellanki: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. M. Fayfman: None. A. Migdal: None. G. Davis: None. J. Haw: None. G.E. Umpierrez: None.

Intervention Design and Trial Protocol: Mindfulness-based Exposure for PAP-associated Claustrophobia

Positive airway pressure (PAP) associated claustrophobia is common among obstructive sleep apnea patients and plays a prominent role in low adherence and treatment failure. As there are no evidence-based interventions for PAP-associated claustrophobia, the objective of the present research is to pilot test Mindfulness-based Exposure for PAP-associated Claustrophobia, in sleep apnea adults that present with treatment non-adherence and claustrophobia. This approach combines Mindfulness-based Stress Reduction with exposure-based treatment components to target this treatment-associated claustrophobia. The present article outlines the mindfulness exposure intervention design and methods and reports the pilot trial study protocol. Trial findings are intended to: (a) develop a preliminary effect size of the intervention on PAP-associated claustrophobia; (b) explore differences in treatment adherence by group (intervention vs control); and (c) establish feasibility for expanded protocol implementation, delivery, and participant acceptability of the intervention to support subsequent design of a fully powered randomized controlled trial.

Evaluation of recorded video-observed therapy for anti-tuberculosis treatment.

BACKGROUND: Asynchronous video directly observed therapy (VDOT) may reduce tuberculosis (TB) program costs and the burden on patients. We compared VDOT performance across three cities in the United States, each of which have TB incidence rates above the national average.METHODS: Patients aged ≥18 years who are currently receiving directly observed anti-TB treatment were invited to use VDOT for monitoring treatment. Pre- and post-treatment interviews and medical records were used to assess site differences in treatment adherence and patient characteristics and perceptions.RESULTS: Participants were enrolled in New York City, NY (n = 48), San Diego, CA (n = 52) and San Francisco, CA, USA (n = 49). Overall, the mean age was 41 years (range 18-87); 59% were male; most were Asian (45%) or Hispanic/Latino (30%); and 77% were foreign-born. The median fraction of expected doses observed (FEDO) was 88% (IQR 76-96). At follow-up, 97% thought VDOT was "very or somewhat easy to use" and 95% would recommend VDOT to other TB patients. Age, race/ethnicity, annual income, and country of birth differed by city (P < 0.05), but FEDO and VDOT perceptions did not.CONCLUSIONS: TB programs in three large US cities observed a high FEDO using VDOT while minimizing staff time and travel. Similar findings across sites support VDOT adoption by other large, urban TB programs.

Lifestyle changes for treating psoriasis.

Lifestyle changes for treating psoriasis.

Morbidity pattern, social safety net, and drug adherence level among geriatric patients attending in a health-care facility: A cross-sectional study.

INTRODUCTION:Financial support system available to geriatric populations affects their adherence level to the prescribed treatment leading to a rise in chronic disease burden.OBJECTIVE:The aim of this study was to ascertain the disease pattern, health expenditure, and adherence to the prescriptions among geriatric patients reporting to a hospital in North India.METHODOLOGY:This descriptive, cross-sectional study was conducted from July 2017 to June 2018. Patients who were 60 or above years in age, already diagnosed and were on treatment for more than 3 months were included in the study. A total of 310 patients were selected using convenient sampling method. Data were collected by a pretested and validated questionnaire.RESULTS:The mean age of the patients was 66.16 years ± 5.37 years (54.8% males). Monthly average family income was Rs. 15202.97 ± 1134.63. Overall, 25% of the treatment cost was met through various social schemes (52% = pension scheme, 32% of patients had no such schemes and only 2% through health insurance schemes). Rest was out-of-pocket expenditure. Common diseases were hypertension (60.64%), diabetes mellitus (35.8%), cancer (28.38%), and coronary artery disease (22.58%). More than half (52.9%) of the patients had two or more illnesses; about 35.8% of them were taking treatment for 1–5 years. Moderate adherence was observed among the majority of the patients. Statistically significant (P < 0.05) difference in treatment adherence to the prescriptions was observed.CONCLUSION:Geriatric patients had many chronic morbidities. They had high out-of-pocket expenditure and suboptimal financial support affecting their level of adherence to the prescriptions.

Outcomes from a large 10 year hepatitis C treatment programme in people who inject drugs: No effect of recent or former injecting drug use on treatment adherence or therapeutic response.

Background and aimsPeople who inject drugs (PWID) are historically viewed as having “difficult to treat” hepatitis C disease, with perceived inferior treatment adherence and outcomes, and concerns regarding reinfection risk. We evaluated for differences in treatment adherence and response to Peginterferon-alfa-2a/Ribavirin (Peg-IFNα/RBV) in a large urban cohort with and without a history of remote or recent injection drug use.MethodsPatient data was retrospectively reviewed for 1000 consecutive patients—608 former (no injecting drug use for 6 months of therapy), 85 recent (injecting drug use within 6 months) PWID, and 307 non-drug users who were treated for chronic hepatitis C with Peg-IFNα/RBV. The groups were compared for baseline characteristics, treatment adherence, and outcome.ResultsThere was no significant difference in treatment non-adherence between the groups (8.4% in PWID vs 6.8% in non-PWIDs; RR = 1.23, CI 0.76–1.99). The overall SVR rate in PWID (64.2%) was not different from non-PWIDs (60.9%) [RR = 1.05, 95% CI 0.95–1.17]. There was no significant difference in SVR rates between the groups controlling for genotype (48.4% vs 48.4% for genotype 1; 74.9 vs 73.3% for genotype 3). Former and recent PWID had similar adherence rates.ConclusionsPWID have comparable treatment adherence and SVR rates when compared to non-drug users treated with Peg-IFNα/RBV. These data support a public health strategy of HCV treatment and eradication in PWID in the DAA era.