Increase Treatment Adherence Research Articles

Well-Being and Mental Health: Where Do We Stand After COVID-19 Pandemic?

Mental health encompasses the ability to cope with important stresses of life and to realize one's abilities in the community, and the COVID-19 pandemic represented a very stressful event for people with mental illnesses. Our aim was to assess mental well-being in people living with different mental disorders, comparing results obtained in 2016 with those observed after the COVID-19 pandemic. Ninety-six participants were assessed using the Mental Health Continuum Short Form and classified as "flourishing," "moderately mentally healthy," and "languishing." Overall, a significant increase in the prevalence of "flourishing" and "moderately mentally healthy" subjects and a reduction of "languishing" subjects ( p = 0.003) were observed. However, a significant improvement in well-being ( p = 0.005) was observed only in the schizophrenia spectrum disorder group. Moreover, only subjects that never contracted SARS-CoV-2 showed a significant ( p = 0.019) increase in positive well-being states. Lockdowns may have led caregivers to spend more time with the participants, also increasing treatment adherence, resulting in an improvement of overall well-being in several participants.

Trauma-informed practice for genetic counselors: Insights from a workshop evaluation.

Trauma-informed practice (TIP) is an emerging model of care that acknowledges the widespread impact of trauma and emphasizes both physical and psychological safety for consumer and provider. It is being increasingly integrated into models of healthcare delivery, organizational policies, and practices, and has been shown to improve clinical interactions, increase treatment adherence, and improve healthcare outcomes. However, to date, TIP has not yet been systematically integrated into genetic counseling training and practice. In this study, using the RISE2 Genomics reporting standard, we present the outcomes of developing and evaluating a TIP workshop designed and delivered for genetic counselors in New South Wales, Australia. This workshop was the first of its kind and addressed the unique clinical and psychosocial challenges that genetic counselors face, including the risk of vicarious trauma and the high rates of burnout in the profession. The workshop aimed to enhance genetic counselors' understanding of trauma and its effects, provide practical strategies for communication and engagement with trauma-affected individuals, and offer guidance on incorporating TIP into clinical practice. Genetic counselors who participated in the TIP training expressed strong appreciation for the workshop and reported increased awareness of the ubiquity of trauma and the presentation of traumatic responses, and increased self-perceived knowledge and confidence in providing trauma-informed care. Additionally, participants were interested in ongoing TIP professional development and the integration of TIP into models of genetic counseling and professional practice. As the field of genetic counseling continues to evolve, we suggest that integrating TIP into training, professional development, and practice will not only improve client outcomes but also reduce rates of vicarious trauma and burnout among genetic counselors. This study is the first to consider the educational needs and the incorporation of TIP into genetic counseling practice, and in doing so, it paves the way for future research and policy development that integrates TIP into models of genetic counseling.

A meta-analysis of technology-based interventions on treatment adherence and treatment success among TBC patients.

Various technology-based interventions have been designed to improve medication adherence and treatment success. However, research on the most effective mode to address this issue is still limited. Our study evaluated the effectiveness of technology-based interventions in improving treatment adherence, completion, and treatment success among tuberculosis (TBC) patients. We conducted a meta-analysis of randomized controlled trials by searching articles from six databases including PubMed, Science Direct, Cochrane, Jstor, Embase, and Scopus from 2018 to April 2023. Two independent reviewers assessed the study quality using the Cochrane Risk of Bias 2.0 tool. We analysed the data using a random-effects model. We also conducted publication bias and sensitivity analysis. In total, 13 studies were identified and 4,794 participants were included in the meta-analysis. The results indicated that technology-based interventions were effective in improving treatment adherence, completion, and success (Odds Ratio (OR): 2.57, 95% Confident Interval (CI): 1.01-6.50, I2 = 86.6%; OR: 1.77, 95% CI: 0.95-3.28, I2: 82.3%; OR: 1.61, 95% CI: 0.85-3.06, I2: 84%, respectively). We examined the possibility of publication bias in the published studies included in this systematic review. However, no evidence of publication bias was found. From the sensitivity analysis by removing one study randomly, we found that our results are robust. Based on the results, we can conclude that technology-based interventions like MERM, text-based messages, video conferencing, and VOT are effective in increasing treatment adherence and completion in tuberculosis management. Therefore, technology shows immense potential in enhancing patient outcomes.

CTNI-40. PSYCHOLOGICAL DOMAINS CORRELATE WITH ADHERENCE IN TTFIELDS TREATMENT OF GLIOBLASTOMA

Abstract INTRODUCTION Adherence is critical to the success of the treatment with Tumor Treating Fields (TTFields) for Glioblastoma Multiforme (GBM). Previously found factors influencing treatment adherence in general are social support, belief in the efficacy of treatment, communication with physicians, anxiety, and depression. We propose those five factors predict adherence to TTFields treatment since, to our knowledge, no systematic data exists for this treatment. METHODS We conducted a longitudinal study and included 25 patients with newly diagnosed GBM who received treatment with TTFields. Participants were invited to take part in six structured interviews, each four weeks apart, during their treatment with TTFields, assessing the five factors expected to influence treatment adherence over time. RESULTS We found a significant impact of communication, anxiety, and depression on treatment adherence with TTFields. Furthermore, also the time point during treatment (days of treatment) was significantly related to adherence. Better physician communication and a higher level of anxiety were associated with higher adherence and higher depression with less adherence. A higher belief in efficacy showed a trend toward significantly improving treatment adherence. When results were separately compared for early, middle, and later 90-day treatment phases, factors seemed to be differentially influential, with belief in efficacy being significantly relevant in the first, efficacy, communication, and anxiety in the second, and depression in the third phase of treatment with TTFields. CONCLUSIONS Our findings not only confirm the predictive role of psychosocial factors in treatment adherence but also provide specific targets for psychological interventions. This suggests that by addressing these factors, healthcare providers can potentially increase treatment adherence among GBM patients. Moreover, our results indicate that these interventions may be most effective when tailored to the specific phase of treatment, offering a practical approach for healthcare providers.

Pharmacist interventions in the control of hypertension and adherence to anti-hypertensive treatment: A systematic review and meta-analysis of randomised controlled trials

Abstract Introduction Non-adherence to antihypertensive therapy is one of the major barriers for the achievement of blood pressure (BP) control and has a significant cost burden1. Non-adherence is also thought to be one of the leading factors leading to ethnic disparities in hypertension control in the UK2. Pharmacists have an important role in the management of hypertension and non-adherence due to their ideal position to promote optimal use of medication3. Many have advocated for pharmacist involvement in team-based hypertension management, however which pharmaceutical care interventions are most effective remains unclear. There have been many new studies in recent years exploring the effect of pharmacist interventions in hypertension and this meta-analysis provides an update of the current literature and quantification of the results. Aim This study aimed to systematically evaluate the efficacy of pharmacist-delivered interventions for adults with hypertension and examine the intervention characteristics associated with greater BP-lowering efficacy. The primary outcome was the change in BP and secondary outcomes were % achieving BP control. Methods Systematic review and meta-analysis of randomized controlled trials (RCTs). This review was registered on PROSPERO. Embase, CENTRAL, MedLine, Psychinfo and CINAHL were searched until February 2024. Eligible studies included adult patients with a diagnosis of essential hypertension where a pharmacist intervention (alone or collaborative care) targeting BP control was compared with control (usual care). Exclusion criteria included secondary hypertension, pregnancy, children and review articles/case studies. The risk of bias was assessed by the Cochrane risk-of-bias tool for RCTs. The primary outcome was change in BP. We extracted data on sample and intervention characteristics. Meta-analysis was performed using Comprehensive Meta-Analysis Software v4. Moderator analyses examined the association between intervention effects and intervention features. This study was a systematic review and meta-analysis of already completed trials and so ethical approval was not required. Results 2402 articles were retrieved. After removal of duplicates, 1538 were screened by title and abstract against the inclusion criteria. 88 studies with 25,516 participants were included. Mean intervention duration was 7.2 months (range 1-14 months). The overall pooled mean differences in systolic BP (SBP) and diastolic BP (DBP) between pharmacist intervention and control were -7.39 (-8.56, -6.23) mmHg and -3.99 (-4.61, -3.37) mmHg respectively, both P<0.001. With BP control, pharmacist interventions caused a significant increase in those achieving BP control compared to usual care (+21 (16.88, 25.27) %, P<0.001). Duration of intervention had no influence on change in SBP or DBP (both P>0.05). Discussion Pharmacists can make a significant impact in the management of hypertension in respect to increasing treatment adherence and improving BP control and this study highlights the importance of including them as part of the multidisciplinary team responsible for patient care. Limitations of the present study include the inability to extract individual patient data and stratification by ethnicity, socioeconomic status and gender. However, pharmacist interventions in hypertension significantly reduced SBP and DBP and improved BP control. Identifying the characteristics of the most effective interventions can lead to better treatment adherence and BP-lowering in patients with hypertension.

A Qualitative Study on Illness Perception and Coping Behaviors Among Patients with Chronic Obstructive Pulmonary Disease: Implications for Intervention.

Understanding patients' perceptions of their illness may be more beneficial for healthcare providers in maintaining vigilance than merely focusing on the clinical status of patients. As patients' perceptions can significantly influence their behavior, it is possible that health care providers who are aware of patients' thoughts in advance may help improve their intervention programs, such as increased treatment adherence. However, current research offers limited insight into the subjective perceptions of disease among patients with Chronic Obstructive Pulmonary Disease (COPD). This study aims to deeply explore COPD patients' illness perception and coping behaviors. A descriptive qualitative approach was used, conducting semi-structured in-depth interviews with 32 COPD patients, and verbatim data recording. Data analysis was based on thematic analysis methods proposed by Braun and Clarke. Through data analysis, we identified three themes to describe participants' perceptions and coping behaviors related to COPD: inadequate knowledge regarding the disease, improper self-management of the disease, and diverse impacts resulting from the disease. Illness perception is crucial for COPD patients. Participants' descriptions underscored their perceptions of the disease as well as the various challenges and consequences they face when dealing with it. To enhance care for individuals with COPD, researchers and healthcare professionals should increase awareness about the disease among patients, understanding their coping strategies, beliefs, and recognizing its significant impacts.

The Effect of Cognitive Behavioural Therapy-Based Psychoeducation on Medication Adherence and Aggression in Individuals Diagnosed With Schizophrenia: An Experimental Study.

It is known that treatment compliance is low and aggression is higher in individuals diagnosed with schizophrenia compared to the normal population. Cognitive behavioural therapy (CBT) is known to reduce relapse and hospitalisation and increase well-being in individuals diagnosed with schizophrenia. However, there are almost no studies on increasing treatment compliance and decreasing aggression. This study was conducted to determine how CBT-based psychoeducation affects medication adherence and aggression in individuals diagnosed with schizophrenia. The study was conducted as a quasi-experimental model with the pre-test-post-test control group with 73 schizophrenic patients (33 experimental, 40 control) between June 2022 and July 2023. Data were collected using the Descriptive Characteristics Form, Morisky Medication Adherence Scale (MMAS) and Buss-Perry Aggression Questionnaire (BPSQ). The schizophrenic patients in the experimental group were given eight sessions of CBT-based psychoeducation, while the schizophrenic patients in the control group were not given any training. The data were analysed using mean, standard deviation, chi-squared test, dependent samples t-test and independent samples t-test. It was determined that the aggression level of the experimental group before the training was 80.51 ± 19.38, and after the CBT-based psychoeducation, it was 73.12 ± 15.28. It was determined that the aggression level of the control group before the training was 84.22 ± 12.13, and after the post-test, it was 85.60 ± 11.72. It was determined that the medication adherence level of the experimental group before the training was 2.75 ± 1.25, and after the CBT-based psychoeducation, it was 3.57 ± 0.67. It was determined that the medication adherence level of the control group before the training was 2.05 ± 1.33, and after the post-test, it was 2.17 ± 1.36. The psychoeducation based on CBT caused a statistically significant difference (p = 0.001) in medication adherence and aggression levels in the experimental group. It was determined that CBT applied to individuals diagnosed with schizophrenia was effective on increasing their medication adherence and reducing their aggression. It is recommended for psychiatric nurses to include CBT-based psychoeducation in their nursing practices in order to increase medication adherence and reduce aggression in individuals with schizophrenia. The findings emphasise that CBT-based psychoeducation increases treatment adherence and significantly decreases the level of aggression in individuals diagnosed with schizophrenia. Psychiatric nurses should include CBT-based psychoeducation in their treatments.

Beyond Treatment: A Narrative Review of Humanization Practices, Empathetic Communication, and Comprehensive Support in Oncology Patient Care in Brazil Over the Last Two Decades (2003-2023).

Humanization in oncology patient care represents a significant innovation in health care practice, shifting the traditional focus solely on treating physical conditions to encompass the emotional and psychosocial dimensions of patient experience. This study aimed to explore the importance of humanization in oncology and the application of practices that promote a patient-centered approach. Through a narrative review of the past 2 decades, the objective was to analyze the practices, benefits, and challenges of humanization in the oncology context. The methodology involved reviewing the relevant literature on empathetic communication, psychological support, and the integration of these aspects into oncology care. The results indicated that humanization significantly contributes to improving patients' quality of life, increasing treatment adherence, and fostering a more satisfying work environment for health care teams. However, effective implementation faces challenges, such as the need for ongoing training, resource limitations, and resistance to change. Despite these obstacles, humanization is essential to provide more comprehensive and patient-centered care. The adoption of humanized practices transforms the oncology care experience, making it more empathetic and holistic.

Treatment Adherence and Health-Related Quality of Life Among Patients with Hypertension at Tertiary Healthcare Facility in Lalitpur, Nepal: A Cross-Sectional Study.

Measurement of medication adherence and health-related quality of life is extremely important when planning different health policies. Drug therapy and adherence to medication are critical to prevent complications of hypertension, especially in countries like Nepal, where hypertension is one of the most prevalent diseases. However, this has not been studied in Nepal. This study, hence, aimed to explore medication adherence, factors affecting medication adherence, health-related quality of life, and the correlation between medication adherence and health-related quality of life in hypertensive patients visiting tertiary care health facilities in Lalitpur district of Nepal. This quantitative cross-sectional study was conducted among 380hypertensive patients at KIST Medical College and Teaching Hospital, Lalitpur, Nepal. The Nepali version of the European Quality of Life tool EQ-5D-5L and the Hill-Bone Compliance to High Blood Pressure Therapy Scale (HBCTS) were used. Intergroup differences in medication adherence, the EQ-5D index and EQ-VAS scores were assessed for statistical significance using either the Mann-Whitney or Kruskal-Wallis tests for numerical data. Spearman correlation coefficient was used to identify the relationship among medication adherence, EQ-5D-5L index values, and EQ-VAS scores. The mean treatment score was 22.43 ± 4.12. Age, sex, and occupation were significant factors that affected treatment adherence. The EQ-5D score was 0.72 with age, sex, income, and educational status as significant factors and marital status as an insignificant factor. A slightly negative correlation was found between the total treatment adherence score and the EQ-5D index. The treatment adherence of patients to antihypertensive therapy was suboptimal, which could affect the outcome of therapy. Better treatment adherence was correlated with a better health-related quality of life. Hence, both health-care providers and patients should make efforts to increase treatment adherence to attain better HRQOL.

Изучение психосоциальных факторов, влияющих на приверженность пациентов к лечению хронических заболеваний.

This research article scrutinises the psychosocial underpinnings that influence adherence to treatment among patients with chronic diseases, assuming that adherence is a multifaceted phenomenon shaped by a complex set of psychosocial factors. Purpose: the aim of the study is to uncover the complex relationship between these factors and adherence to treatment, using linear sampling to capture the dynamics and temporal evolution of adherence behaviour in the context of chronic illness. Materials and methods. Using a rigorous methodological framework, participants with many chronic conditions were included in the study, with inclusion and exclusion criteria carefully developed to ensure a representative and diverse group. The study utilised a range of validated psychometric tools to quantify psychosocial variables such as social support, stress levels and health beliefs, as well as a multifaceted approach to assess adherence combining self-report, pharmacy records and biometric measures. Advanced statistical analyses, including mixed-effects models and structural equation modelling, were used to identify relationships between psychosocial factors and adherence to treatment, taking into account the complexity and longitudinal nature of the data. Results. The findings highlight the critical role of social support in increasing treatment adherence as well as the detrimental effects of elevated stress levels, emphasising the critical interplay between individual psychological resilience and external support systems. The study also clarifies the influence of health beliefs and illness perceptions on adherence behaviour, advocating a better understanding of the cognitive and affective dimensions that determine patients’ engagement in treatment. Findings. The article concludes by arguing that a paradigm shift towards integrating psychosocial support mechanisms into holistic models of care is needed to increase adherence in chronic disease management. It calls for the implementation of health care policies and practices that not only address the biomedical aspects of chronic disease, but also the psychosocial complexities inherent in long-term disease management. Findings from the study encourage further research into specialised psychosocial interventions aimed at improving adherence and consequently quality of life for people coping with the challenges of chronic illness.

Reducing Viral Load Impact: Blood Transfusions as a Complementary Approach in HIV Treatment

Blood transfusions have traditionally been associated with the management of anemia in individuals living with HIV; however, their potential role as a complementary approach in reducing viral load impact is gaining attention. This review explores how blood transfusions can enhance immune function, improve oxygen delivery, and support the efficacy of antiretroviral therapy (ART), thereby contributing to better health outcomes for patients. By addressing complications associated with HIV, such as anemia and immune dysfunction, blood transfusions may play a crucial role in optimizing treatment strategies and enhancing the overall quality of life for individuals living with the virus. The relationship between viral load and immune function is critical in HIV management, as high viral loads are associated with increased morbidity and mortality. Blood transfusions can mitigate the negative effects of viral load by improving the physiological conditions necessary for an effective immune response. Enhanced oxygenation from transfusions supports immune cell proliferation and activity, potentially leading to better control of viral replication and lower viral load levels. Moreover, improving hemoglobin levels through transfusions can reduce fatigue, increase treatment adherence, and promote active participation in ART. Keywords: anemia, blood transfusions, HIV, immune response, viral load

Digital Mental Health Interventions for Alleviating Depression and Anxiety During Psychotherapy Waiting Lists: Systematic Review.

Depression and anxiety have become increasingly prevalent across the globe. The rising need for treatment and the lack of clinicians has resulted in prolonged waiting times for patients to receive their first session. Responding to this gap, digital mental health interventions (DMHIs) have been found effective in treating depression and anxiety and are potentially promising pretreatments for patients who are awaiting face-to-face psychotherapy. Nevertheless, whether digital interventions effectively alleviate symptoms for patients on waiting lists for face-to-face psychotherapy remains unclear. This review aimed to synthesize the effectiveness of DMHIs for relieving depression and anxiety symptoms of patients on waiting lists for face-to-face therapy. This review also investigated the features, perceived credibility, and usability of DMHIs during waiting times. In this systematic review, we searched PubMed, PsycINFO, Cochrane, and Web of Science for research studies investigating the effectiveness of DMHIs in reducing either depression or anxiety symptoms among individuals waiting for face-to-face psychotherapy. The search was conducted in June 2024, and we have included the studies that met the inclusion criteria and were published before June 6, 2024. Of the 9267 unique records identified, 8 studies met the eligibility criteria and were included in the systematic review. Five studies were randomized controlled trials (RCTs), and 3 studies were not. Among the RCTs, we found that digital interventions reduced depression and anxiety symptoms, but the majority of interventions were not more effective compared to the control groups where participants simply waited or received a self-help book. For the non-RCTs, the interventions also reduced symptoms, but without control groups, the interpretation of the findings is limited. Finally, participants in the included studies perceived the digital interventions to be credible and useful, but high dropout rates raised concerns about treatment adherence. Due to the lack of effective interventions among the reviewed studies, especially among the RCTs, our results suggest that waiting list DMHIs are not more effective compared to simply waiting or using a self-help book. However, more high-quality RCTs with larger sample sizes are warranted in order to draw a more robust conclusion. Additionally, as this review revealed concerns regarding the high dropout rate in digital interventions, future studies could perhaps adopt more personalized and human-centered functions in interventions to increase user engagement, with the potential to increase treatment adherence and effectiveness.

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.

P145 EFFICACY AND SAFETY OF PERINDOPRIL/INDAPAMIDE/AMLODIPINE/BISOPROLOL SINGLE PILL COMBINATION IN PATIENTS WITH ESSENTIAL HYPERTENSION UNCONTROLLED ON TRIPLE THERAPY: AN INTERNATIONAL, RANDOMIZED, DOUBLE-BLIND, PHASE III TRIAL

Background and objectives: In hypertensive patients uncontrolled on triple therapy, guidelines recommend the addition of a fourth drug such as mineral corticoid receptor antagonists, or alternatively, a betablocker. They also support the use of SPCs at any step of the treatment to increase treatment adherence and BP control. Currently, no SPC of 4 drugs is available. This 4-month phase III trial aimed to demonstrate the superiority in BP reduction, ofperindopril/indapamide/amlodipine/bisoprolol (Per/Ind/Aml/Biso) SPC versus a free combination of Per/Ind/Aml in hypertensive patients uncontrolled on triple therapy at optimal doses. Methods: After a 2-month run-in period on the combination of Per/Ind/Aml at optimal doses (10/2.5/5 or 10/2.5/10 mg), patients with sustained uncontrolled essential hypertension with office SBP≥140mmHg and SBP at 24h-ambulatory blood pressure monitoring (ABPM)≥130mmHg received the quadruple SPC of Per/Ind/Aml/Biso (10/2.5/5/5 or 10/2.5/10/5 mg) or continued the same triple therapy for two additional months. Efficacy was assessed on office-SBP (primary endpoint), DBP, BP control, 24h-ABPM and home-BPM (HBPM). Results: 183 patients were randomized: 53.0% were men, mean age was 57.4±10.6 years, mean BMI was 28.2±2.6 kg/m2, and mean office SBP/DBP was 150.35±8.49/90.09±8.23mmHg. After two months, significantly greater decrease in office-SBP (-8.0mmHg, 95%CI [-11.9; -4.0]; p<0.0001) was observed in the quadruple SPC group (n=80) versus the triple therapy group (n=83). Greater decrease in the 24h-systolic ABPM was achieved with the quadruple SPC therapy (-7.5mmHg, 95%CI [-10.9;-4.1]; p<0.0001). Higher percentage of patients achieved 24h-ABPM and HBPM control in the SPC group 51.2% vs 20.7% (p<0.0001) and 60.7% vs 25.4%, (p<0.0001) respectively. After intentional 1-day SPC omission in patient volunteers (n=28), mean 24h-ABPM remained below the 130/80mmHg target, supporting the sustained efficacy of the SPC. Both treatments were well tolerated. Conclusion: The first quadruple SPC of Per/Ind/Aml/Biso demonstrated its superiority to the free combination of Per/Ind/Aml, offering a new alternative to treat effectively and safely patients with hypertension uncontrolled with a combination of Per/Ind/Aml at optimal doses.

If patients had a choice - Treatment satisfaction and patients' preference in therapy of actinic keratoses.

Actinic keratoses (AK) are increasing in incidence and represent the most common (pre-)cancerous lesion in the fair-skinned population, with a high unmet medical need. In order to increase treatment adherence, it is very important to assess patients' therapy-related evaluations of different treatment options. 100 patients with AK who were treated with at least two different treatment options were included. They rated their therapies using the Treatment Satisfaction Questionnaire for Medication (TSQM, maximum 100 points per category) and a Likert scale (LS, 1 = very satisfied; 6 = not satisfied). Patients were also asked about their needs in terms of treatment goal, cost, type, duration, and location of treatment. 81% of the study participants were male and on average 74 years old. 95% had field cancerization. Eight frequently used therapy procedures were evaluated by the patients (surgery, cryotherapy, various topical agents, photodynamic therapy). The TSQM satisfaction scores ranged from 78.47 ±16.07 (surgical procedures) to 53.03 ±22.13 (diclofenac-HA). Statistically significant differences between the procedures were only found in the area of efficacy. Side effects were classified as low. Low recurrence rate and safe removal were the most important treatment goals (LS: 1.18 ±0.44 and 1.27 ±0.53, respectively). Understanding patient preferences is essential for adherence and is therefore of great importance for the success of AK therapy. Personalized approaches should be considered in the choice of therapy.

Impact of Group Reality Therapy on Treatment Adherence and Health Indicators in Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Trial

Background: The use of non-pharmacological therapies is important in reducing the complications and consequences of diabetes. Objectives: This study aimed to determine the effect of group reality therapy on adherence to treatment regimens and health indicators in patients with type 2 diabetes. Methods: This randomized controlled trial was performed on 60 patients with diabetes who were referred to Amir Al-Momenin Hospital in Ahvaz. Patients were randomly assigned to either the intervention group (N = 30) or the control group (N = 30). Both groups completed health indicator tests, questionnaires on demographic and clinical information, perceived adherence to the treatment regimen, and the Perceived Stress Scale. The intervention group received reality therapy training, which consisted of 10 sessions of 45 minutes each (one session per week) over 2 months, delivered through lectures and face-to-face training sessions. The control group received only routine hospital interventions. The collected data were then analyzed using a one-way t-test and one-way analysis of variance (ANOVA). Results: Twenty-seven patients in the intervention group and 27 in the control group completed the study. After analyzing the data, it was revealed that the mean age of the patients in the control group was 55.30 ± 7.95, while it was 51.96 ± 10.55 in the intervention group. Findings showed that scores for the dimensions of adherence to the treatment regimen in the intervention group significantly increased compared to the control group (P < 0.001). Additionally, the mean health indicators in the intervention group showed a significant decrease compared to the control group (P < 0.001). Moreover, the mean blood sugar level of patients in the intervention group decreased from 229.63 ± 98.76 to 123.59 ± 42.03. Likewise, the level of glycosylated hemoglobin and blood cholesterol significantly decreased from 8.19 ± 2.09 to 6.11 ± 1.86 and from 176.52 ± 51.53 to 146.22 ± 34.68, respectively. Conclusions: A reality therapy training program can be effectively used to increase treatment adherence and improve health indicators in patients with type 2 diabetes.

Clinical Considerations for HealthcareProvider-Administered Lipid-Lowering Medications.

Atherosclerotic cardiovascular disease (ASCVD), a leading cause of mortality and morbidity, is associated with a substantial healthcare and economic burden. Reduction of low-density lipoprotein cholesterol (LDL-C) to guideline-recommended goals is crucial in the prevention or management of ASCVD, particularly in those at high risk. Despite the availability of several effective lipid-lowering therapies (LLTs), up to 80% of patients with ASCVD do not reach evidence-based LDL-C goals. This nonattainment may be due to poor adherence to, and lack oftimely utilization of, LLTs driven by a range of variables, including polypharmacy, side effects, clinical inertia, costs, and access issues. Inclisiran was approved by the US Food and Drug Administration in 2021 as a novel, twice-yearly, healthcare provider (HCP)-administered LLT. In-office administration allows HCPs more control of drug acquisition, administration, and reimbursement, and may allow for more timely care and increased patient monitoring. In the USA, in-office administered drugs are considered a Medical Benefit and can be acquired and reimbursed using the "buy-and-bill" process. Buy-and-bill is a standard system for medication administration already established in multiple therapeutic areas, including oncology, vaccines, and allergy/immunology. Initiating in-office administration will involve new considerations for clinicians in the cardiovascular specialty, such as the implementation of new infrastructure and processes; however, it could ultimately increase treatment adherence and improve cardiovascular outcomes for patients with ASCVD. This article discusses the potential implications of buy-and-bill for the cardiology specialty and provides a practical guide to implementing HCP-administered specialty drugs in US clinical practice.

(Invited) Battery-Free Wearable and Implantable Electronics for Chronic Disease Management

60% of Americans live with at least one chronic disease. These diseases and their associated comorbidities are now the leading causes of death in the United States. The effective management of complex chronic diseases requires body-wide, long-term, accurate, and continuous monitoring of multiple physiological signals from wearable and implantable devices to precisely determine the pathological state. Wearable physiological signal monitoring can dramatically reduce the demand for physician visits and increase patients' engagement and treatment adherence rates. Specifically, battery-free wearables and implantable electronics reduce device volume and mechanical stiffness, significantly improving wear comfort, which is highly desirable for next-generation wearable and implantable electronics. However, battery-free wearables and implantable electronics still face many challenges, mainly wireless energy and data transfer. To address these challenges, my research has been involved in the exploration of rational system design concepts, material and device fabrication innovation, and tailored algorithms to enable smart battery-free wearables and implantable electronics targeting next-generation chronic disease management.Here, I would like to discuss two of my developed technology platforms to elaborate on the concept of battery-free wearable and implantable systems. First, I will describe an RFID-based body area sensor network technology platform. This technology uses electromagnetic waves and RF antennas as energy and data transmission media and has broad applications in sleep tracking, workout monitoring, chronic wound healing, and inflammation management. Second, I will describe a triboelectric transducer-based implantable battery-free device. This technology platform uses ultrasound waves and triboelectric transducers as energy and data transmission media and has broad applications in implantable sensing. Overall, the developed technology platforms can assess multiple health outcomes and treatment responses to various chronic diseases. Ultimately, this technology will help reduce the burden of chronic diseases, lower medical costs, and provide a better quality of life for patients. (1,2,3,4)

Effectiveness of a Health Belief Model-based Educational Intervention on Treatment Adherence Among Type 2 Diabetic Patients: Insights from a Randomized Controlled Trial in Iran

Background: Diabetes is a significant and costly health problem worldwide, requiring effective interventions to improve adherence. The aim of this study was to increase treatment adherence in patients with type 2 diabetes using constructs from the Health Belief Model (HBM). Methods: An educational intervention consisting of four sessions was conducted on 100 patients with type 2 diabetes referred to the Diabetes Clinic affiliated with the Social Security Organization in Mobarakeh, Isfahan province, Iran. The mean difference before and after the intervention in HBM constructs and self-efficacy activities was compared using independent t-tests. The association between self-care behaviors before and after the educational intervention in both groups and the expected value of a part of the HBM was examined using linear regression. The threshold for statistical significance was P<0.05. Results: After the intervention, the mean difference scores for all components of the HBM and self-efficacy increased significantly in the intervention group. In linear regression analysis, perceived vulnerability was the only variable that showed a direct and significant relationship with self-care in the intervention group. Conclusion: The results of the study suggest that patient education improved all HBM constructs related to treatment adherence. This underscores the importance and effectiveness of self-care education in controlling blood glucose levels in diabetic patients.

Treatment Adherence and Health Status of Patients With COPD Under Treatment With Salmeterol/Fluticasone via the Elpenhaler® Device: The AHEAD Study.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous progressive lung condition characterized by long-term respiratory symptoms and airflow limitation. Appropriate bronchodilation is the cornerstone of COPD treatment, leading to better health status as well as benefits in prognosis and mortality. In the current open, noninterventional, observational study, 716 patients diagnosed with COPD of variable severity were administered a fixed-dose combination (FDC) of fluticasone propionate and salmeterol (500 + 50 mcg) through the Elpenhaler® device. The patients' adherence to treatment (based on the MMAS-8 [8-item Morisky Medication Adherence Scale]) and health status (based on the CCQ [Clinical COPD Questionnaire]) were assessed at the beginning of the study and at the end of the 3-month follow-up period. The mean ± SD MMAS-8 score at 1 and 3 months was 6.12 ± 1.89 and 6.45 ± 1.80, respectively, indicating medium adherence overall; however, there was a statistically significant increase of 0.33 units in the MMAS-8 score at the end of the follow-up (paired t-test p < 0.0001), suggestive of an improvement in adherence throughout the study. Higher adherence was associated with better health status at baseline, which further improved by the end of the follow-up. Moreover, we observed a statistically significant decrease of 1.07 points (p < 0.0001) in the mean CCQ total score from the baseline (CCQ score = 2.2 ± 1.00) until the end of the study follow-up (CCQ score = 1.13 ± 0.67). Similar conclusions were also drawn in the mean domain scores regarding symptoms (score equal to 1.36 ± 0.72, decrease by 1.18) as well as functional and mental state (scores equal to 0.86 ± 0.73 and 1.20 ± 0.88, decrease by 1.04 and 1.00, respectively, p < 0.0001). Similarly, when patients were stratified into subgroups with and without comorbidities, the former group showed an increase of 7% in the patients with medium to high adherence during the course of the study. In the same patient subgroup, there was a notable decrease in CCQ score by 1.18 points (p < 0.0001) during the study. The administration of FDC of fluticasone propionate and salmeterol, (500 + 50 mcg) via the Elpenhaler® device for COPD, resulted in a well-maintained or slight increase in treatment adherence and a subsequent benefit in health status, which further persisted after 3 months of treatment.