High Adherence Rates Research Articles

Feasibility and acceptability of a mindfulness app-based intervention among patients with metastatic renal cell carcinoma: a multinational study.

Patients with metastatic renal cell carcinoma (mRCC) experience emotional distress and limited supportive care access. This study assesses a mindfulness app's feasibility, acceptability, and preliminary efficacy in improving emotional symptoms, trait mindfulness, and overall quality of life for patients with mRCC on immunotherapy. This multinational study recruited patients with mRCC undergoing immunotherapy from Brazil and the United States. Participants were required to engage in mindfulness app-based activities for 20-30min daily, at least 4 days per week, over a 4-week period. Assessments were conducted at weeks 0, 2, 4, and 12 to evaluate emotional symptoms (PROMIS-Anxiety and Depression, Fear of Cancer Recurrence-7), fatigue (Brief Fatigue Inventory), trait mindfulness (Mindfulness Attention Awareness Scale), and quality of life (Functional Assessment of Chronic Illness Therapy-General). Self-reported data were used to assess adherence. Linear mixed-effects models were used to evaluate changes over time for the measured outcomes. Among 50 patients with mRCC, the feasibility of this intervention was demonstrated; 96% of patients were assessed at week 4, with high adherence rates reported by 75% of patients. Participants expressed positive feedback on the smartphone-based approach. Significant improvements were observed in emotional symptoms, fatigue, and quality of life scores from baseline to post-intervention (P = .001 for each), suggesting the positive impact of this intervention. Our findings provide encouraging evidence for the feasibility and acceptability of a mindfulness app-based intervention among patients with mRCC. This intervention may offer a viable and accessible means of providing psychosocial support to patients with mRCC.

Preterm preeclampsia screening and prevention: a comprehensive approach to implementation in a real-world setting

BackgroundPreeclampsia significantly impacts maternal and perinatal health. Early screening using advanced models and primary prevention with low-dose acetylsalicylic acid for high-risk populations is crucial to reduce the disease’s incidence. This study assesses the feasibility of implementing preterm preeclampsia screening and prevention by leveraging information from our current aneuploidy screening program in a real-world setting with geographic separation clinical site and laboratory analysis site.MethodsA prospective cohort study involved pregnant individuals undergoing nuchal translucency scans between 11 and 14 weeks. Risk for preterm preeclampsia was assessed using the Fetal Medicine Foundation algorithm, which includes maternal risk factors, uterine artery Doppler, mean arterial pressure and serum markers (Placental growth factor, PlGF and Pregnancy-associated plasma protein-A, PAPP-A). High-risk patients were offered low-dose acetylsalicylic acid prophylaxis. Feasibility outcomes, such as recruitment rates, protocol adherence, operational impact, integration with existing workflows, screening performance and pregnancy outcomes, were evaluated.ResultsOut of 974 participants, 15.6% were deemed high-risk for preterm preeclampsia. The study achieved high recruitment (82.1%) and adherence rates, with 95.4% of high-risk patients prescribed low-dose acetylsalicylic acid. Screening performance, adjusted for low-dose acetylsalicylic acid use, showed a detection rate of 88.9–90% (FPR 13.0% and 12.7%) for preterm preeclampsia. High-risk group for preeclampsia had higher incidences of adverse outcomes, including preterm preeclampsia (7.5 vs 0.4%; p < 0.001), preterm delivery (21.2 vs 6.2%; p < 0.001), low birth weight (23.3 vs 5.6%; p < 0.001) and birthweight < 10th percentile (11% vs 5.6%; p = 0.015) compared to low-risk group. The integration of preeclampsia screening had a minimal effect on the time required for aneuploidy screening, with results obtained within a rapid turnaround time.ConclusionsThe study confirms the feasibility of integrating comprehensive preeclampsia screening into clinical practice, notwithstanding geographic separation between laboratory and clinical settings. It underscores the need for broader adoption and enhanced infrastructure to optimize patient care and outcomes across diverse healthcare settings.Trial registrationClinical trial: NCT04412681 (2020–06-02).

Narrative mobile video game-based cognitive training to enhance frontal function in patients with mild cognitive impairment

Although cognitive training has been proposed as a possible therapeutic modality for mild cognitive impairment (MCI), most serious games focus on specific tasks. This study aimed to investigate the feasibility and efficacy of narrative video game-based cognitive intervention for MCI. A four-week (± 1-week) mobile game intervention was given to 17 MCI participants (mean age (SD) = 72.8(4.75)). At baseline and post-intervention, the participants received neuropsychological tests and a depression scale. Frontal function was assessed using the Corsi block-tapping test, Color Word Stroop Test, Controlled Oral Word Association Test, Digit Symbol Coding, and Trail Making Test-Elderly’s Version; depression was assessed using the Geriatric Depression Scale. User’s compliance and gaming experience were also evaluated. MCI patients showed significant improvements in frontal function, particularly in Digit Symbol Coding (mean ± SD, 0.47 ± 0.49, p = 0.007) and phonemic fluency (mean ± SD, 0.39 ± 0.55, p = 0.024). Each frontal subtest’s mean z-score was increased (mean ± SD, 0.44 ± 0.38, p = 0.008). Block span and depression scale remained unchanged. High adherence rates (122.35%) and favorable feedback on the gaming experience indicated that the game intervention’s usability boosted patients’ motivation and engagement. Our findings demonstrate that narrative game-based cognitive intervention was not only beneficial but also enjoyable for elderly MCI.

Feasibility and psychometric quality of smartphone administered cognitive ecological momentary assessments in women with metastatic breast cancer.

Metastatic breast cancer (MBC) is associated with burdensome side effects, including cognitive changes that require ongoing monitoring. Cognitive ecological momentary assessments (EMAs) allow for assessment of individual cognitive functioning in natural environments and can be administered via smartphones. Accordingly, we sought to establish the feasibility, reliability, and validity of a commercially available cognitive EMA platform. Using a prospective design, clinical cognitive and psychosocial assessments (cognitive batteries; patient reported outcomes) were collected at baseline, followed by a 28-day daily EMA protocol that included self-ratings for symptoms and mobile cognitive tests (memory, executive functioning, working memory, processing speed). Satisfaction and feedback questions were included in follow-up data collection. Feasibility data were analyzed using mixed descriptive methods. Test-retest reliability was examined using intraclass correlation coefficients (ICCs) for each EMA, and Pearson's correlation were used to evaluate convergent validity between cognitive EMAs and baseline clinical cognitive and psychosocial variables. Fifty-one women with MBC (n = 51) completed this EMA study. High satisfaction (median 90%), low burden (median 19%), high adherence rates (mean 94%), and 100% retention rate were observed. ICCs for cognitive tests of working memory, executive function, and processing speed were robust (>0.90) and ICC for memory tests acceptable (>0.66). Other correlational findings indicated strong convergent validity for all cognitive and psychosocial EMAs. Cognitive EMA monitoring for 28 days is feasible and acceptable in women with MBC, with specific cognitive EMAs (mobile cognitive tests; cognitive function self-ratings) demonstrating strong reliability and validity.

Improving health outcomes through a strength training and yoga program for young women with PCOS: A quality improvement project

Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder associated with physical, mental, and reproductive health challenges. Lifestyle interventions, including exercise and yoga, have shown promise in managing PCOS symptoms. This quality improvement project aimed to assess the impact of a combined strength training and yoga program on the health outcomes of young women with PCOS. Methods: The 13-month program (December 2021 to January 2023) was conducted in a community setting. Participants were young women diagnosed with PCOS, selected based on predefined inclusion criteria. The intervention included bi-weekly strength training and yoga sessions, supplemented by group discussions and motivational coaching. Primary outcomes included weight loss, BMI reduction, mental health improvement (measured by PHQ-9 and GAD-7 scores), and menstrual regularity. Adherence and participation rates were tracked to evaluate engagement. Results: The average weight loss among participants was 5.2 ± 2.4 kg, with BMI reduced from 29.1 ± 3.2 kg/m² to 26.8 ± 2.9 kg/m². PHQ-9 depression scores decreased from 12.3 ± 4.5 to 6.4 ± 3.2, and GAD-7 anxiety scores improved from 10.6 ± 3.7 to 5.8 ± 2.9. Menstrual regularity improved, with 75% of participants reporting regular cycles by the end of the program. 82% of participants completed at least 70% of the sessions, indicating strong adherence. Conclusion: The combined strength training and yoga program effectively improved physical, mental, and reproductive health outcomes among young women with PCOS. High adherence rates demonstrated the feasibility of this approach, emphasizing the importance of lifestyle interventions in managing PCOS. Future efforts should focus on scaling the program and integrating nutrition-based strategies for even better outcomes.

Adherence to the Swedish paediatric guidelines for urinary tract infections.

To audit adherence to the Swedish paediatric guidelines for urinary tract infections (UTIs) in infants. Secondary objectives were to compare findings on imaging performed according to the guidelines with imaging without guideline support and to identify predictors of non-adherence. A prospective multicentre study of infants <1 year treated at paediatric hospitals for their first UTI. Adherence to recommendations was assessed for diagnosis, treatment, and imaging of the urinary tract with a follow-up period of 1 year. Vesicoureteral reflux on voiding cystourethrography and findings on renal scintigraphy according to recommendations were compared to imaging without recommendation. A total of 1357 infants were included. Adherence to recommended diagnostic procedures, antibiotic treatment, and imaging was 86.1%, 91.0% and 64.2%, respectively. Non-adherence to imaging recommendations was associated with inpatient management and smaller hospitals but was also more often due to excessive rather than refrained imaging. High adherence rates to diagnostic and treatment recommendations indicate careful attention to infant UTI among paediatricians. Lower adherence to imaging recommendations raises concerns regarding the guideline algorithm; particularly, early DMSA scans seem to be challenging for smaller hospitals.

Scoping Review of Digitally Delivered Physical Activity and Exercise Programs for Older Adults

Physical inactivity among older adults is a major public health concern linked to various chronic conditions. Digitally delivered physical activity (PA) programs offer a promising solution to overcome traditional barriers. This scoping review aimed to explore the feasibility, acceptability, and engagement factors of these programs for older adults. A comprehensive search was conducted on PubMed, Embase (OVID), and Scopus on 22 May 2024, adhering to PRISMA guidelines. Inclusion criteria targeted older adults (≥60 years) engaged in healthy digital PA interventions. Data analysis was guided by the FAME Framework, TSQ, and the COM-B model. A total of 16 studies met the inclusion criteria, involving 901 older adults. Most studies reported moderate to high adherence rates with programs being well-received. However, several implementation challenges were found, such as inadequate digital literacy, concerns regarding program quality, participant safety, and lack of perceived relevance. Despite these implementation challenges, they may be overcome using the TAM and UTAUT frameworks for technology acceptance and usage to address digital literacy, ensuring high-quality interactions and participant safety, and incorporating social support. Future interventions should leverage similar theoretical frameworks to enhance design and implementation.

Effects of Adjuvant Endocrine Therapy-Specific Perceptions on Response to a Behavioral Intervention for Adjuvant Endocrine Therapy Adherence in Patients With Breast Cancer.

Adjuvant endocrine therapy (AET) is a life-saving medication for patients with hormone-sensitive breast cancer, yet many struggle with adherence, warranting behavioral intervention. In our recent trial, participation in a group cognitive behavioral intervention (STRIDE) for symptom management and adherence was associated with improvements in symptom distress, coping, quality of life, and mood. We now explore whether baseline patient- and medication-specific factors-which may be modifiable by clinician-led discussions-moderated the effect of STRIDE on adherence rates. From October 2019 to June 2021, 100 patients with early-stage breast cancer reporting AET-related distress were enrolled and randomly assigned to STRIDE or a medication monitoring (MM) control group. All patients stored their AET in electronic pill bottles to track objective adherence. Patients also self-reported their adherence on the Medication Adherence Report Scale-5 and their perceptions of AET on the Cancer Therapy Satisfaction Questionnaire at baseline. We conducted hierarchical linear modeling to test moderators of intervention effects on objective adherence rates. We report the time × group × moderator effects. Among patients reporting greater perceived difficulties with AET adherence at baseline, STRIDE participants had higher adherence rates over time compared with MM (b = -13.80; SE = 4.56; P < .01). Patients with greater expectations of therapeutic benefit from AET also had improved adherence rates if they were assigned to STRIDE, versus MM (b = 0.25; SE = 0.10; P = .01). Patients who perceived taking AET as convenient and had been taking their AET for less time had higher adherence rates in STRIDE, versus MM. The current study identified patient- and medication-specific factors that may augment AET adherence interventions and may be modifiable through clinician-led discussions, such as perceptions of adherence problems, therapeutic efficacy, and convenience of AET.

Impact of alcohol use disorder on antiretroviral therapy adherence in adults with HIV/AIDS at University of Gondar, Northwest Ethiopia

Background Alcohol use disorder in people living with the human immunodeficiency virus is an important public health problem associated with high rates of HIV infection and lower antiretroviral treatment adherence. However, little is known about the prevalence of alcohol use disorders and its impact on ART adherence among people living with HIV/AIDS (PLWHA). Thus, this study aimed to evaluate the magnitude of alcohol use disorder and its impact on medication adherence among PLWHA attending the ART clinic. Methods A hospital based cross sectional study design was conducted at University of Gondar Comprehensive Specialized Hospital (UOGCSH) ART clinic from September 30, 2023 to February 30, 2024. The World Health Organization’s Alcohol Use Disorders Identification Tool (AUDIT) was utilized to assess alcohol use disorder. Bivariate and multivariate logistic regression analyses were employed to investigate the relationship between AUDs and other variables. Statistical analysis was conducted using SPSS version 26, with a significance level set at P < 0.05. Results The overall prevalence of AUDs was 38.8%, with hazardous use, harmful use, and alcohol dependence accounting for 24.6%, 6.1%, and 8.1% of the total, respectively. In addition, 67.8% of the participants had medication adherence above 95%. Factors associated with alcohol use disorder were male AOR = 1.52; 95% CI (1.01, 2.30), cigarette smoking AOR = 2.384, 95% CI (1.183, 4.80), educational status AOR = 1.96, 95% CI (1.016, 3.764), and age 45–57 years AOR = 3.05, CI (1.587, 5.871). In present study, compared with social drinkers, harmful drinkers and alcohol dependents showed low medication adherence under 95% (AOR = 4.08 and AOR = 8.89, respectively). Conclusion The study reveals a high prevalence of alcohol use and dependence in PLWHA, underscoring the need for effective detection and intervention strategies particularly for males, cigarette smoker, and age between 54 and 75 years in healthcare and community settings. Alcohol use is strongly associated with poor adherence to antiretroviral therapy (ART). Individuals with hazardous alcohol use are four times more likely to have low adherence, while alcohol-dependent individuals are nearly nine times more likely to have low adherence compared to social drinkers.

Effectiveness of treat-to-target cholesterol-lowering interventions on cardiovascular disease and all-cause mortality risk in the community-dwelling population: a target trial emulation

Little is known about the long-term effectiveness of risk-based treat-to-target cholesterol-lowering interventions on cardiovascular risk. Here, we show the emulated effectiveness of guideline-recommended low-density and non-high-density lipoprotein cholesterol-lowering interventions using the absolute risk reduction (ARR) and the restricted mean event-free time-based number needed to treat (NNT). With 5,375 participants, the 29-year risks for cardiovascular disease (CVD), all-cause mortality, and atherosclerotic CVD were 18.6%, 25.6%, and 17.7%, respectively. Long-term treat-to-target interventions showed significant reductions in CVD (ARR −2.3%, 95%CI −3.4% to −0.8%; NNT 115), all-cause mortality (−3.0%, −4.3% to −1.8%; 95), and atherosclerotic CVD (−2.6%, −3.5% to −1.2%; 104). Such effects appear more pronounced in women, smokers, and those with body mass index < 24 kg/m² or higher adherence rates.

Performance Measures in the Management of ST-Segment Elevation Myocardial Infarction Patients at Manila Doctors Hospital

INTRODUCTION: ST-segment elevation myocardial infarction (STEMI) is a common and potentially fatal presentation of cardiovascular disease. Once a diagnosis is made, prompt intervention is crucial, with substantial effect on morbidity and even mortality. OBJECTIVE: The aim of this study was to assess the adherence of physicians of a tertiary care hospital to American College of Cardiology/American Heart Association and European Society of Cardiology performance measures for the management of acute STEMI patients. METHODOLOGY: This was a descriptive retrospective chart review of acute STEMI patients seen in a tertiary care hospital over a 2-year period. RESULTS: A total of 118 STEMI patients were included in the study. Mean age was 57.8 years with male predominance. High adherence rates (100% achievement score) to recommended discharge medications and counseling for smoking cessation were observed. However, performance measures for time to reperfusion therapy via percutaneous coronary intervention (average, 16.7% over 2 years) and referral to cardiac rehabilitation (average, 38.0%) were consistently low, although time to percutaneous coronary intervention improved from an average of 170 minutes to 142 minutes in the second year of this study. CONCLUSION: For 2 consecutive years, all STEMI patients seen in our institution were adequately managed with regard to recommended medications. All patients have been advised lifestyle change, particularly smoking cessation for current smokers. There is room for improvement with regards to time to reperfusion therapy and referral to cardiac rehabilitation. Some measures have been suggested, including shortening the time to secure patient consent. KEYWORDS: myocardial infarction, performance measures, STEMI

Real-life data of hepatitis C treatment with direct acting antiviral therapy in persons injecting drugs or on opioid substitution therapy.

HCV treatment has been revolutionized by introduction of direct-acting antiviral therapy (DAA). Short treatment duration of eight to twelve weeks combined with significantly improved tolerability opened the opportunity to reach out to difficult-to-treat populations. Here, we retrospectively analyzed real life data on HCV treatment adherence and outcome in people who inject drugs (PWID) or on opioid substitution therapy (OST). All PWID or on OST receiving DAA therapy between 3/2021-11/2022 at an infectious disease clinic in Bonn were retrospectively analyzed. Patients received either 8weeks glecaprevir/pibrentasvir or 12weeks sofosbuvir/velpatasvir (+ ribavirin in genotype 3 cirrhotic patients). Sustained virological response (SVR) was measured 4 and 12weeks after HCV therapy. In our cohort 47 patients (68%) received treatment with glecaprevir/pibrentasvir and 22 patients (32%) sofosbuvir/velpatasvir. All 47 (100%) patients started on glecaprevir/pibrentasvir received prescriptions for the full length of therapy, while patients on sofosbuvir/velpatasvir completed 12weeks therapy in 86% and 8weeks in 14% (p = 0.029). Of 69 patients 74% were found to achieve SVR. In 20% no information is available as they were lost to follow-up. Re-infection was documented in 3 patients and one relapse in a gt3 patient with cirrhosis. High adherence and response rates to HCV treatment were found following DAA based therapy in PWID supporting the call to include difficult-to-treat populations into HCV treatment efforts on the way to HCV elimination. Treatment of OST and HCV at one institution supporting patients by a multidisciplinary team may further facilitate adherence to follow up visits enabling documentation of treatment outcomes more easily.

COMPLIANCE OF EXERCISE IN PATIENTS WITH ANKYLOSING SPONDYLITIS IN LOWER MIDDLE-INCOME COUNTRY

Exercise adherence is crucial for the management of patients with ankylosing spondylitis (AS), particularly in reducing symptoms and improving quality of life. However, barriers to exercise adherence in this patient population remain poorly studied, especially in resource-poor settings. This study focused on assessing exercise adherence among AS patients in Quetta, Pakistan, identifying both challenges and facilitators of adherence. Objective: The objective of this study was to assess exercise adherence among AS patients in Quetta, Pakistan, and explore key factors influencing their adherence to prescribed exercise programs, including barriers such as physical limitations, financial constraints, and social and support systems. Methods: This descriptive cross-sectional study was conducted in several rheumatology outpatient clinics in Quetta from January to July 2024. A purposive sample of 20 AS patients was recruited and a self-administered questionnaire was used to collect clinical and demographic data. Thematic analysis was performed to identify key themes related to exercise adherence, including facilitators and barriers. Results: Of the 20 participants, 60% were male and 40% were female, with a mean age of 45 years. Thematic analysis revealed four key themes: physical barriers (including chronic pain and fatigue), financial challenges (such as not being able to afford a gym membership or transportation), social factors (including stigma and lack of support), and motivational influences. Despite these barriers, social support and personalized exercise prescriptions emerged as key facilitators of adherence. Participants who received personalized exercise programs and education on the benefits of physical activity had higher adherence rates. Conclusion: Exercise adherence among AS patients in Quetta is influenced by a complex interaction of physical, social, and financial factors. Eliminating these barriers through patient-centred strategies, including personalized exercise programs and increased social support, can significantly improve adherence. These findings highlight the need for personalized approaches to promote physical activity among patients with AS, especially in resource-poor settings such as Quetta.

Home Sotalol Initiation for the Management of Atrial and Ventricular Arrhythmias Using Remote Electrocardiographic Monitoring.

Sotalol is a class III antiarrhythmic drug used for the management of patients with atrial fibrillation to maintain sinus rhythm. Sotalol-induced QT interval prolongation can be proarrhythmic and is conventionally initiated in an inpatient setting where routine electrocardiographic (ECG) monitoring is available while sotalol reaches the steady state. The emergence of cellular-compatible home ECG devices, such as AliveCor's Kardia Mobile 6L, which offers 6-lead ECG, has made it possible to accurately measure QT intervals outside the hospital. This study aimed to evaluate the safety, feasibility, and patient adherence to protocol-driven, pharmacist-led outpatient sotalol initiation using the Kardia Mobile 6L for remote ECG monitoring and to compare these outcomes with patients completing inpatient sotalol protocol for initiation. Patients who underwent outpatient sotalol initiation through an antiarrhythmic clinic for the treatment of both atrial and ventricular arrhythmias over a period of approximately 3 years, from September 1, 2020, to June 16, 2023, were retrospectively reviewed and compared with a cohort of inpatients initiated on sotalol. The outpatient cohort had a minimum longitudinal follow-up of 90days. A total of 263 patients using the outpatient sotalol initiation protocol were compared with 28 age- and sex-matched inpatients who underwent inpatient sotalol initiation. The outpatient cohort included 179 men (68%), with an age of 68.8 ± 10.1 years, CHA2DS2-VASc score of 3.48 ± 1.43, baseline 12-lead QTc interval of 440.77 ± 33.42ms, and a left ventricular ejection fraction of 57.4% ± 9.23%. Outpatients were started on a median (minimum-maximum) dose of 120 (80-160) mg of sotalol twice a day (120-mg dose; n=227; 86.3%) and ended at a median (minimum-maximum) dose of 120 (60-160) mg twice a day (120-mg dose; n=217; 82.5%). The proportions of patients prescribed low-, moderate-, or high-dose sotalol twice a day (60mg, 80mg, 120mg, and 160mg) at the end of initiation were similar between the inpatient and outpatient groups (P=0.5). The majority (98.9%; 260 of 263) of patients completed the 3-day outpatient initiation. Outpatient adherence was high during the 3-day initiation period among patients with varied age and socioeconomic background; 258 patients (98.1%) completed the ECG on day 1, and 240 (91.3%) completed the ECG on day 3. No significant QTc interval prolongation was observed during the outpatient postinitiation study period. There were similar sotalol discontinuation rates within 30days of initiation in the inpatient vs outpatient cohorts (7% vs 8%; P > 0.90). A total of 17 (6.5%) patients stopped sotalol because of symptomatic bradycardia, and 1 death was observed over a 90-day follow-up period in the outpatient cohort. Outpatient initiation of sotalol through a protocol-driven, pharmacist-led antiarrhythmic clinic is feasible and safe, with high adherence rates in a diverse range of patients using personal remote ECG.

Intake Patterns and Experiences of Patients Using Direct Oral Anticoagulants Measured by Electronic Monitoring in Community Pharmacies.

Several international organizations advocate for monitoring of adherence to direct oral anticoagulants (DOACs), given the prevalent issue of suboptimal adherence to DOACs. The aim was to investigate intake patterns in patients on DOAC therapy by electronic monitoring of medication adherence in community pharmacies (using a Medication Event Monitoring System® (MEMS®)-device), and to assess patients' experiences with this device. Patients using apixaban, rivaroxaban or edoxaban and visiting a community pharmacy, were included. Adherence was electronically monitored over a twelve-week period. Pharmacists conducted data readings from the electronic device at six and twelve weeks, and discussed these data with the patients. At the beginning and end of the study, patients completed a questionnaire about their expectations and experiences respectively. Eighty-nine patients were included and high taking adherence rates were observed (median adherence of 100% for once-daily dosed patients and 96.7% for twice-daily dosed patients), but more than half of the patients took at least one dose too late or skipped at least one dose, possibly resulting in temporarily reduced protection against thromboembolic events. Most patients who felt that their adherence had improved, believed this was due to the combination of the electronic device and the personal follow-up by the pharmacist. Although most patients stated that medication adherence is their own responsibility, they were grateful for the support they received from their community pharmacist. High adherence rates were observed, but there was still room for improvement regarding intake moments. Positive experiences with an electronic device for medication adherence monitoring were reported.

Adherence to infliximab treatment in patients with immune-mediated inflammatory diseases from a referral center in Brazil: a cohort study

BackgroundInfliximab therapy is effective in controlling symptoms and attaining clinical remission of immune-mediated inflammatory diseases. However, treatment adherence is essential to achieve the therapeutic objective. This study aimed to determine the rate of adherence to infliximab treatment in patients treated at a referral center at a university hospital.MethodThis ambispective cohort study included patients treated at the Professor Edgard Santos University Hospital (HUPES) referral center of our university hospital between March 2022 and February 2023. Sociodemographic, clinical, and pharmacotherapeutic data were collected from 101 patients through interviews and medical record reviews using a structured form. The adherence rate was defined as the proportion of days covered in a year. Patients who achieved an adherence rate > 80% were considered adherent.ResultsThe treatment adherence rate was 91.04%. Individuals with inflammatory bowel diseases had a 39.1% higher risk of non-adherence to treatment compared with other patients in our sample (p < 0,05). Most patients achieved remission or control of the underlying disease activity and had good functional capacities. The main reason for absence on the scheduled date was difficulty traveling to the referral center.ConclusionsDespite the reported difficulties, treatment adherence was observed to be high. As the study was conducted in a reference unit with multidisciplinary care and continuous monitoring for treatment effectiveness, safety, and adherence, welcoming and good communication between professionals and patients may have contributed to the high adherence rate.

Impact of Phase III cardiac telerehabilitation on cardiorrespiratory fitness, safety and adherence in patients with ischemic heart disease

Abstract Background and Purpose Cardiac rehabilitation program (CRP) is an interdisciplinary intervention aimed to improve exercise tolerance, promote the reintegration of patients with heart disease into their normal lives, and reduce the rate of long-term complications and mortality. Of the three phases, Phase II is responsible for achieving sufficient and safe gains to guarantee adaptation, but it is in Phase III where the long-term beneficial effects and self-management will be achieved. Nevertheless, only 30% - 60% of patients report continuing regular exercise during this stage, adherence rates are heterogeneous, and the diversity of results sustained over time is wide. Therefore, cardiac telerehabilitation (CTR) emerged as an affordable tool to achieve closer and safer surveillance at Phase III. The aim of the study is to evaluate the impact of CTR on exercise tolerance, safety and phase III adherence in patients with ischemic heart disease (IHD) Methods Quasi-experimental study that follows Phase II, in which patients with IHD were assigned to virtual sessions at 1st, 3rd, 6th and 12th months, In each session, they were questioned about adherence to training, exercise tolerance, symptoms, outcomes and control of cardiovascular risk factors (CVRF). The percentage of moderate in relation to vigorous physical activity was also evaluated. After one year they underwent a cardiopulmonary exercise test to analyze comparisons in cardiorespiratory fitness (CRFit) and control of CRF between the end of Phase II and the annual follow-up of Phase III. Results At one year of Phase III follow-up, a significant gain in VO2p and maintenance of the other variables associated with fitness such as oxygen pulse (OP2) and VE/VCO2 slope were evident, with a reduction in weight and diastolic blood pressure. There was a significant gain in CRF measured by VO2p and METs-load in those patients who maintained adherence to CTR Phase III (p=0.0001, see figure), with more improvement in those with attendance&amp;gt;50% (2 or more virtual sessions; p=0.008 and p=0.004 , respectively). A directly proportional correlation was observed between the percentage of attendance and the percentage of vigorous physical activity (p&amp;lt;0.01, Pearson r=0.46, CI 0.16-0.68). A positive and significant correlation was observed between the percentage of attendance at CTR Phase III and the number of METs-load (p&amp;lt;0.05, Pearson r=0.36, CI 0.05-0.61), as well as positive and significant correlation with the amount of VO2p (p&amp;lt;0.01, Pearson r=0.50, CI 0.21-0.70) at the end of Phase III. No cardiovascular adverse events were reported. Conclusion CTR strategy in Phase III is safe, effective and has high adherence rates among patients in our population, achieving control of CVRF, maintaining levels of METs-load and obtaining even greater increases in VO2p at one year of follow-up compared to those obtained at the end of Phase II.

Medication adherence in geriatric patients attending medical outpatient department.

Adherence to medication represents a challenge in managing chronic conditions in the geriatric population. This study assessed adherence rates and factors affecting adherence of geriatric patients attending the Helen Joseph Hospital outpatient department. This was a prospective cross-sectional study of 130 patients aged 65 years and older, with at least two chronic conditions. Participants were administered a survey incorporating the Medication Adherence Rating Scale and the Adherence Barrier Questionnaire to identify medication adherence and patient-specific barriers to adherence, respectively. These instruments are reliable and valid. Descriptive statistics and logistic regression were used for analysis. Most patients were female (63%) with a mean age of 72 (67-78) years. Common comorbidities included type 2 diabetes mellitus (63%), hypertension (98%), dyslipidaemia (92%) and congestive cardiac failure (38%). Polypharmacy was prevalent, affecting 53% of the participants. Despite 96% of participants being adherent, all had at least one barrier to adherence, with the majority (65%) having more than one barrier. The main barriers were forgetfulness (59%), fear of side effects (39%), problems with taking the medications (26%) and believing medications are poisonous (22%). Although most participants accessed the pharmacy easily, only 83% reported consistent medication availability and 11% could not afford to collect their medication. Polypharmacy is common in the population. Despite high adherence rates, barriers such as believing medications are poisonous remain significant. A good patient-doctor relationship improves adherence.Contribution:Understanding the barriers to adherence in older adults with polypharmacy and multimorbidity can assist practitioners improve patient care.

Safety and adherence of early oral immunotherapy for peanut allergy in a primary care setting: a retrospective cross-sectional study

BackgroundPeanut allergy is a common food allergy with potentially life-threatening implications. Early oral immunotherapy for peanut allergy (P-EOIT) has been shown to be effective and safe in research and specialty clinic settings. Provision of P-EOIT in primary care would make it available to more patients. We sought to assess the safety of P-EOIT in a primary care setting by documenting the rates of peanut-related allergic reactions leading to emergency department (ED) visits and use of epinephrine. We also examined adherence by assessing the percentage of patients reaching maintenance phase and continuing ingestion after one year of P-EOIT.MethodsThis retrospective study included all patients aged less than 36 months who started P-EOIT at a primary care allergy clinic in New Brunswick, Canada, from 2016 to 2020. The population included patients who (1) had a history of an allergic reaction to peanuts with a positive skin prick test or positive peanut specific IgE level (ps-IgE) or (2) no history of ingestion and a baseline ps-IgE ≥5 kU/L. Patients had biweekly clinic visits with graded increases in peanut protein up to a maintenance dose of 300 mg of peanut protein daily. A blinded retrospective review of paper charts and electronic medical records was conducted along with phone interviews regarding ED visits and epinephrine use.ResultsAll 69 consented patients reached maintenance dose over a median of 29 weeks, and 66 patients (95.7%) were still regularly consuming peanut protein after 1 year of maintenance. One patient had a peanut ingestion-related ED visit requiring epinephrine during the escalation phase of peanut protein dosing (1.4%). During the first year of maintenance phase, no patients had peanut ingestion-related ED visits nor required epinephrine.ConclusionEarly oral immunotherapy for peanut allergy in a primary care setting appears to be safe and our findings suggest that it does not lead to an increased burden of emergency department visits. Our population had high adherence rates, with the majority achieving maintenance dose and staying on this dose for one year.

Exploring the Effectiveness of Technology-Assisted Interventions for Promoting Independence in Elderly Patients: A Systematic Review.

The aging global population presents significant challenges for healthcare systems. Technology-assisted interventions have emerged as promising tools to enhance independence and well-being among elderly individuals. The aim of this study was to evaluate the effectiveness of technology-assisted interventions in promoting independence among elderly patients and identify key barriers and facilitators to their implementation. A systematic review was conducted following PRISMA guidelines. Searches were performed in PubMed, IEEE Xplore, ACM Digital Library, Cochrane Library, and Scopus. Studies evaluating technology-assisted interventions for promoting independence in elderly patients were included. Data were synthesized through narrative and thematic analysis. Fourteen studies met inclusion criteria. Technology-assisted interventions demonstrated positive impacts on physical and cognitive functioning, health management, quality of life, and technological engagement among elderly patients. Improvements were observed in areas such as mobility, chronic disease management, mental health, and daily living activities. High usability and adherence rates were reported for well-designed interventions. However, challenges in user-centered design, personalization, and integration with existing healthcare systems were identified. Technology-assisted interventions show promise in promoting independence among elderly patients. Future research should focus on addressing identified challenges and conducting larger, long-term studies to confirm effectiveness and sustainability.