Physician Adherence Research Articles

Patient selection, peri-procedural management, and ablation techniques for catheter ablation of atrial fibrillation: an EHRA survey.

Catheter ablation (CA) of atrial fibrillation (AF) is the therapy of choice for the maintenance of sinus rhythm in patients with symptomatic AF. Time towards interventional treatment and peri-procedural management of patients undergoing AF ablation may vary in daily practice. The scope of this European Heart Rhythm Association (EHRA) survey was to report the current clinical practice regarding the management of patients undergoing AF ablation and physician's adherence to the European Society of Cardiology Guidelines and the EHRA/HRS/ECAS expert consensus statement on the CA for AF. This physician-based survey was conducted among EHRA members, using an internet-based questionnaire developed by the EHRA Scientific Initiatives Committee. A total of 258 physicians participated in the survey. In patients with paroxysmal or persistent AF, 42 and 9% of the physicians would routinely perform AF ablation as first-line therapy respectively, whereas 71% of physicians would consider ablation as first-line therapy in patients with symptomatic AF and left ventricular ejection fraction <35%. Only 14% of the respondents manage cardiovascular risk factors in patients referred for CA using a dedicated AF risk factor management programme. Radiofrequency CA is the preferred technology for first-time AF (56%), followed by cryo-balloon CA (40%). This EHRA survey demonstrated a considerable variation in the management of patients undergoing AF ablation in routine practice and deviations between guideline recommendations and clinical practice.

Abstract #1313472: Adherence of Physicians to Evidence-Based Management Guidelines for Treating Type 2 Diabetes and Atherosclerotic Cardiovascular Disease in Ajman, United Arab Emirates

Good adherence by physicians to treatment guidelines for T2DM could improve therapy outcome for patients. In this retrospective, cross-sectional study, we assessed physicians’ adherence to evidence-based guidelines for T2DM management in adult patients (aged ≥18 years) with either confirmed atherosclerotic cardiovascular disease (ASCVD) or those at high risk of developing ASCVD at the Thumbay Hospital Ajman an Academic Health Center affiliated with Gulf Medical University - United Arab Emirates

Evaluation of drug use pattern in adults’ outpatient clinics in a tertiary teaching hospital using WHO core prescribing indicators

Abstract Objectives This study has evaluated the drug use pattern among adults attending the outpatient clinics of the Jordan University Hospital (JUH), by assessing the adherence of prescriptions to the World Health Organization (WHO) core prescribing indicators. Methods This is a cross-sectional study that was conducted during the period from October 2011 to January 2022 at JUH. Several prescriptions from 10 different adult outpatient clinics were reviewed to evaluate hospital adherence to the five WHO core prescribing indicators. Key findings To assess the WHO core prescribing indicators, data for 2451 prescriptions were reviewed. Around one-third of the patients (33.4%) were receiving polypharmacy (five medications or more). Results revealed that two core prescribing indicators were not following the standard values specified by the WHO; the average number of drugs prescribed per encounter (3.8 medications/prescription), and the percentage of drugs from the essential drug list (EDL) (54.1%). Endocrine clinics showed the highest average of drugs (6.3) per prescription and the highest percentage of prescriptions with injectable medicines (51.7%). On the other hand, ophthalmology clinics showed the highest percentage of prescriptions with antibiotics (29.9%) and the lowest percentage of drugs prescribed from the EDL at JUH (14.1%). Evaluating factors affecting the number of prescribed medications per encounter revealed that elderly patients (&amp;gt; 60 years), being female, referring to the endocrine clinic, and having insurance have a higher average number of medications per encounter compared with others (P &amp;lt; 0.05). Conclusion The proper prescribing practices in a sizable tertiary hospital in Amman, Jordan, are clarified by this study. The percentage of medications from EDL and the typical number of drugs/encounters did not comply with WHO requirements. The study findings should guide the Jordanian health policymakers in designing and implementing strategies to limit irrational prescribing practices and raise awareness of and ensure physician adherence to the national EDL.

Patient-Versus Physician-Perceptions of Symptoms, Treatment and Management in Chronic Myeloid Leukemia

BackgroundChronic myeloid leukemia (CML) is a chronic disease with treatment-free remission (TFR) increasingly regarded as a feasible goal of treatment. The optimal outcome achieved in CML requires both prolonged adherence to oral tyrosine kinase inhibitor (TKI) therapy by patients and careful monitoring of treatment responses by their physicians. Various factors would impact doctors following international guidelines for CML management in real-word, however, very few studies has investigated possible discrepancies between patient- and physician-reporting in the CML setting. Objective To compare the reporting of care between CML patients and their treating doctors, and to explore the underlying causes for both physicians and patients non-adherence. MethodsParallel patient and physician online surveys were conducted between September 22, 2021 and March 15, 2022, using the WeChat-based survey program Wenjuanxing. Descriptive analysis of the results mainly focused on CML adults patients and physicians treating CML regarding TKI treatment options, monitoring and toxicities, TFR, and facing challenges. ResultsA total of 1882 patients and 305 physicians completed the survey. Among the enrolled patients, 69.9% received imatinib as first-line therapy, of them 47.0% switched to other TKIs due to imatinib resistance/intolerance (58.5%), exploration on more potent TKI to achieve TFR (13.1%), and treating physicians’ recommendation (15.8%). 91.8% of the physicians believed BCR-ABL1 level should be assessed every 3 months, however, only 42.7% patient respondents committed to 3-monthly testing and 17.8% strictly followed their treating physicians’ recommendation. Half of the patients (49.9%) aimed at TFR, however, just 45.2% physicians considered TFR as one of the three major treatment objectives, obstacles to achieve TFR mainly attributed to their patients. Fatigue and anemia were the key negative impactors for patients who were significantly associated with higher incidence of mental disorders, whilst physicians paid more attention to platelet and neutrophil count. Incidence of moderate to severe anxiety or depression is 12.0% and 20.8%, respectively; but only 41.3% of patients needed support from their doctors, and 53.7% physicians provided their patients with additional support. 13.7% patients had delayed follow-up visit and molecular monitoring, 7.4% patients discontinued TKI or reduced TKI dose due to economic difficulties (69.2%), which resulted in 10.2% patients suffering from disease progression amid the COVID-19 pandemic. 42.3% patients were vaccinated for SARS-CoV-2, another 57.7% patients against vaccine because of safety concern. Cost is the major impactor for treatment choices, molecular monitoring, treatment objective, mental health, and even the treatment under the pandemic, which were fully recognized by both the patients and physicians. ConclusionsPhysicians who joined our survey had low awareness on patients’ fatigue and anemia. Mental disorders existed in a significant proportion of patients, whereas less concerned by both patients and physicians. Cost is the major impactor for physician and patient adherence to current clinical practice guidelines, especially under current COVID-19 pandemic in China.

Knowledge, Attitude, and Practice Among Physicians Regarding Pain Management in Patients with SCD

Introduction Pain from vaso-occlusive crises (VOC) is the most common symptom experienced by patients with sickle cell disease (SCD). It is also the most common cause for emergency department (ED) visits and hospital admissions. Nevertheless, clinical studies of appropriateness of treatment provided during these episodes are sparse, and there are concerns that care for these patients is both inadequate and doesn't meet guidelines. Therefore, studies assessing the healthcare practitioners' knowledge and practice in pain management in SCD patients are an integral component in the process of improving the care provided to this vulnerable population. The goal of our study is to assess adherence of physicians caring for SCD patients to the published guidelines in pain management (published by National Heart, Lung, and Blood Institute, and American Pain Society), and to identify risk factors for self-reported non-adherence. Thus this study should provide an opportunity for focused strategies to improve patients' care. Moreover, this study is particularly important for The State of Qatar, as the burden of SCD in it is among the highest in the entire world. Materials and Methods This is a cross-sectional convenience sample survey study of physicians in Internal Medicine, Hematology and Emergency departments in two hospitals under Hamad Medical Corporation, the main health care provider in The State of Qatar. It is conducted using a validated written survey consisting of 34 items to assess provider attitudes and practices with SCD patients. Excel program and SPSS version 29 were used for data analysis. Continuous data was analyzed descriptively using median (IQR). Mann Whitney test and Kruskal-Wallis test were used to compare average between groups at alpha level = 0.05). Results: We have 130 eligible participants with an 85% complete response rate (111 completed surveys). Most physicians self-report adherence to using parenteral opioids (81%) and acetaminophen (77.5%). Self-reported adherence is lower for other recommendations including redosing opioids within 30 minutes if analgesia is inadequate (21%), use of patient-controlled analgesia (18%), sparing non-steroidal anti-inflammatory drugs (66%) and using hypotonic fluids for euvolemic patients (5%). Factors that are associated with significant differences in analgesic practices in our study include age and race. For example, male physicians are more likely to use acetaminophen, and physicians who identified as "Others" under the category of race versus Whites, Blacks and Asians are more likely to administer morphine (P value = 0.015) during VOC. Other factors such as age, level of practice, and department are not associated with significant differences in analgesic practices. Furthermore, analgesic practices are affected by physicians' attitudes. Interestingly, high scores on both the positive and negative attitudes scales (thought to reflect opposing perceptions of individuals with SCD) are both associated with more frequent use of acetaminophen. Unexpectedly, and as shown in the table below, high scores on negative attitudes scale are associated with more frequent use of morphine, while high scores on positive attitudes scale are associated with less frequent use of it. Discussion and conclusion A large number of SCD patients will have at least one VOC annually. There's an association between the number and severity of these crises and mortality rate. Also, these crises affect patients' quality of life, economic contribution, and overall satisfaction. The cornerstones of managing VOC are parenteral opioids and frequent reassessments. Our data show that the majority of surveyed physicians report that they adhere to guidelines about the use of opioids and acetaminophen for the treatment of VOC, while other recommendations have less penetration. Positive and negative attitudes toward SCD patients are not associated with lower adherence to guidelines. Our data indicate that penetration of many of these recommendations into practice is poor. A policy statement from respective professional societies may help expert recommendations to penetrate the providers' practice. Furthermore, interventions to improve attitudes towards SCD patients should be undertaken, since these attitudes can exert some effects on patients' care. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Antiretroviral therapy non-adherence among children living with HIV in Dire Dawa, Eastern Ethiopia: a case-control study

Background:In 2018, nearly 90% of the global children living with human immunodeficiency virus (HIV) were in sub-Saharan Africa (SSA). Compared to the adult population, antiretroviral therapy (ART) coverage among children was limited. However, adherence remained a problem among children though they had limited access to ART. This study was conducted to identify the risk factors of non-adherence to ART among children aged 6 to 17 years.Methods:This case-control study was conducted in 2020 using data obtained from clinical record reviews and self-reported data from 272 caregivers of HIV-infected children aged 6–17 years. Cases and controls represented children with poor versus children with good adherence to ART, respectively. Good adherence was defined based on a past 30-day physician adherence evaluation of taking ≥ 95% of the prescribed doses. Binary logistic regression was used to identify factors associated with non-adherence to ART. All statistical tests are defined as statistically significant at P-values < 0.05.Results:Of the 272 children, for whom data were obtained, 78 were cases and 194 were controls; females accounted for 56.3%, 32% attended secondary school, and for 83.1%, the reporting caregivers were biological parents. Non-adherent children had higher odds of association with the following risk factors: a caregiver who is a current substance user (aOR = 2.87, 95% CI: 1.44, 5.71), using AZT-and ABC-based regimen compared to the TDF-regimen (AZT-based, aOR = 4.12, 95% CI: 1.43, 11.86; ABC-based, aOR = 5.58, 95% CI: 1.70, 18.30), and had an increase in viral load from baseline compared to those remained undetectable (remained at or decreased to < 1000, aOR = 4.87, 95% CI: 1.65, 14.33; remained at ≥ 1000, aOR = 9.30, 95% CI: 3.69, 23.46). In contrast, non-adherent children had 66% lower odds of being at early adolescent age compared to 6–9 years old (10–14 years, aOR = 0.34, 95% CI: 0.12, 0.99) and had 70% lower odds of being aware of their HIV status (aOR = 0.30, 95% CI: 0.13, 0.73).Conclusion:Technical support to caregivers to build disclosure self-efficacy, identifying the appropriate regimen for children, counseling on viral load suppression on subsequent visits, and helping caregivers avoid or reduce substance use may help improve the problem of children’s non-adherence to ART.

Guideline-based audit of the hospital management of heart failure with reduced ejection fraction.

Heart failure is a major burden in Australia in terms of morbidity, mortality and healthcare expenditure. Multiple evidence-based therapies are recommended for heart failure with reduced ejection fraction (HFrEF), but data on physician adherence to therapy guidelines are limited. To compare use of HFrEF therapies against current evidence-based guidelines in an Australian hospital inpatient population. A retrospective review of patients admitted with a principal diagnosis of HFrEF across six metropolitan hospitals in Sydney, Australia, between January 2015 and June 2016. Use of medical and device therapies was compared with guideline recommendations using individual patient indications/contraindications. Readmission and mortality data were collected for a 1-year period following the admission. Of the 1028 HFrEF patients identified, 39 were being managed with palliative intent, leaving 989 patients for the primary analysis. Use of beta-blockers (87.7% actual use/93.6% recommended use) and diuretics (88.4%/99.3%) was high among eligible patients. There were large evidence-practice gaps for angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB; 66.4%/89.0%) and aldosterone antagonists (41.0%/77.1%). In absolute terms, use of these therapies each increased by over 11% from admission. Ivabradine (11.5%/21.2%), automated internal cardiac defibrillators (29.5%/66.1%) and cardiac resynchronisation therapy (13.1%/28.7%) were used in a minority of eligible patients. Over the 1-year follow-up period, the mortality rate was 14.8%, and 44.2% of patients were readmitted to hospital at least once. Hospitalisation is a key mechanism for initiation of HFrEF therapies. The large evidence-practice gaps for ACEI/ARB and aldosterone antagonists represent potential avenues for improved HFrEF management.

SURGICAL OR PERCUTANEOUS LEFT ATRIAL APPENDAGE OCCLUSION IN PATIENTS WITH ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED TRIALS

Guidelines recommend most patients with atrial fibrillation (AF) receive oral anticoagulation (OAC) to reduce their risk of stroke. However, OAC is limited by physician adherence to guidelines, patient compliance, and temporary interruptions. Therefore, occluding the left atrial appendage – the most common area of thrombus formation in AF – is an attractive alternative or adjunct to OAC in patients with AF. Aiming to summarize the evidence for the efficacy and safety of left atrial appendage occlusion (LAAO), we performed a systematic review and meta-analysis of randomized controlled trials evaluating LAAO.

Adherence to guideline in hydrating traumatic patients with crystalloid fluids: A single center experience from Southern Iran

Objective: The adherence of the physicians to guidelines in resuscitation of the patients is of great importance since it can predict the outcome. To evaluate the adherence of the physicians of our center in hydration of traumatic patients with crystalloids regarding the Advanced Trauma Life Support (ATLS) guidelines. Methods: We designed an algorithm obtained from ATLS guidelines using vital signs and status of bleeding of the traumatic patients to classify them. After categorizing the patients according to the algorithm, we evaluated the adherence of the physicians to the guideline in hydration of traumatic patients with crystalloids. Results: This is a cross-sectional study in which 998 traumatic patients who were admitted to the emergency ward of Rajaee trauma hospital were enrolled. Most of the patients were men (89.6%) and the most common causes of traumatic injuries were traffic accidents. Proper hydration was seen in only 14.7% of the patients. Most of the patients were overhydrated (85%) regarding both our algorithm and the patients’ base excess. Conclusion: The present study showed that the adherence of physicians in our center in resuscitation with crystalloid was low. Also, most of the traumatic patients were overhydrated with crystalloids. It is suggested that physicians retrain concerning the side effects of over hydration. In addition, we need a user friendly and more applicable guideline for hydration with crystalloids.

The whole experience of public hospital physicians from several specialties with biopharmaceutical effectiveness, safety, adverse drug reactions and interchangeability: A qualitative study

BackgroundAlthough there is increasing support for biosimilar medicines by the Iraqi Ministry of Health (MOH), there is scarce information about whether physicians accept these medicines and support movement toward replacing reference medicines with their biosimilar counterparts. ObjectivesThe study objectives were to 1) explore in-depth the perceptions of Iraqi physicians working in public hospitals about the difference in effectiveness and safety between biosimilar medicines and their reference biological counterparts, 2) evaluate physicians' barriers to prescribing biosimilar medicines, 3) assess the adherence of physicians to the new pharmacovigilance regulations on reporting biopharmaceutical adverse drug reactions (ADRs) and 4) identify any barriers facing physicians to reporting biopharmaceutical- ADRs. MethodsThis qualitative study included face-to-face and virtual semi-structured interviews involving physicians from different disciplines who had experience with biological or biosimilar medicines. The interviews were conducted between November 6, 2020, and February 7, 2021. Thematic analyses were used to analyze qualitative data generated from the interviews. ResultsThe study sample included 36 physicians (6 women and 30 men) from seven different specialties at ten governmental hospitals mainly in Baghdad, and one physician was from Mosul, Iraq. Because most physicians had insufficient experience with biosimilar medications and were not sure about their effectiveness, the majority were hesitant to prescribe them. Most physicians preferred to prescribe reference biological medicines initially. However, the initial prescribing and switching between a reference and counterpart biosimilar relies on its availability. They chose biosimilar medications that have been approved by the U.S. FDA or EMA. Most physicians were unaware about the new pharmacovigilance regulations to report adverse biopharmaceutical reactions. The physicians tended to underreport biopharmaceutical ADRs and believed that inadequate physician-pharmacist collaboration negatively impacts preventing and reporting ADRs. ConclusionsMedicine procurement in healthcare settings should focus on sustainably securing high-quality biopharmaceuticals rather than looking only at costs to enhance physician experience and patient clinical outcomes. Promoting documentation, monitoring, and physician-pharmacist collaboration is pivotal to prevent, monitor, and treat biopharmaceutical ADRs.

Improve physician adherence to high-intensity statin in the secondary prevention of acute coronary syndrome

Statin therapy is critical in reducing morbidity and mortality associated with cardiovascular disease. However, prescribed statins are only effective if patients take them regularly, a process known as medication adherence. Patient factors, physician factors, and health system factors all influence patient adherence to statin therapy, with interactions between the categories common. Physician factors include the doctor's adherence to guideline recommendations, office visits, and interactions with patients. A prospective interventional study was conducted in Iraq, Al-Muthanna Governorate, Al-Hussein Teaching Hospital during the period from October 2021 to March 2022. A convenient sampling method was adapted to enrol the participants in the current study which included two groups including the intervention and control group. In the intervention group, the researcher sought to use an educational program, mediated by clinical pharmacists, to improve physician adherence to secondary prevention of acute coronary syndrome in hospitalized patients at discharge. Regarding the prescription of statin to patients with age of &lt;75 years, there was no significant difference between the study groups at the first visit after discharge in group A and after intervention in group B.

Empathy, psychological characteristics, and compliance in patients with chronic gastritis

Aim . To study the associations between empathy, anxiety, and compliance in patients with chronic gastritis. Materials and Methods . Here we recruited 302 patients with chronic gastritis, further stratifed into 4 groups: 1) 96 patients with H. pylori-associated gastritis and high compliance; 2) 110 patients negative for Helicobacter pylori and also having high compliance; 3) 36 patients with H. pylori-associated gastritis and low compliance; 4) 60 patients with Helicobacter pylori-associated gastritis and partial compliance. Empathy was evaluated using Consultation and Relational Empathy Measure (CARE Measure) questionnaire, whilst anxiety was determined using the Spielberger-Khanin questionnaire. Results . The highest Helicobacter pylori eradication rate was observed in patients with high empathy and adherence and vice versa. Correlation analysis showed that physician interpersonal skills, therapeutic success, and adherence to treatment were positively associated with patient empathy and negatively associated with patient anxiety. Conclusion . Doctor-patient relationship defnes the patient compliance, while patient empathy is a key factor determining adherence to treatment in patients with chronic gastritis.

Assessment of Saudi Physicians and Physical Therapists' Adherence to the Updated Clinical Practice Guideline for Benign Paroxysmal Positional Vertigo: A Cross-Sectional Study.

Introduction Variations in clinical practice regarding the management of benign paroxysmal positional vertigo (BPPV) among clinicians have been noted in previous studies. Such variations might be related to the different adherence to clinical practice guidelines. Objective To evaluate clinicians' adherence to BPPV guidelines and investigate the variations in the adherence between different specialties and qualifications. Methods This is a cross-sectional study with a vignettes-based survey conducted between June and August, 2020. We included clinicians engaged in managing BPPV that had at least one year of clinical experience. We excluded students, and clinicians who were not involved in the management of individuals with BPPV. Participants were asked to make their management choices based on four hypothetical patient vignettes. The sample ranged from 77 participants for the first vignette to 45 participants for the last vignette. Results We included 77 clinicians in the study, with the majority being Otolaryngologists (31.2%). The respondents' mean adherence to the guideline was of 63.3%. Result showed that Otolaryngologists' adherence was higher than that of clinicians from different specialties ( p = 0.006, d = 0.72). Furthermore, clinicians with a postgraduate degree were more likely to adhere than those with a bachelor's degree only ( p = 0.014, d = 0.58) and participants who were aware of the guideline were more likely to adhere to it ( p < 0.001, d = 1.05). Lastly, regression analysis exhibited that adherence was affected by postgraduate degree and guideline awareness. Conclusion Otolaryngologists were more likely to adhere to the guideline than other specialties. Among all specialties, higher adherence was associated with guideline awareness and postgraduate degrees.

Discriminating Low to High Adherent Type 2 Patients with Diabetes by Glycosylated Hemoglobin A1c, Eating Self-Efficacy and Other Psychosocial Determinants: Difference Between Patient and Physician Adherence Models.

ObjectiveDevelop individual discriminant models using clinical and psychosocial variables for physicians and patients with diabetes based on their perceptions of patient adherence.MethodsThis was a cross-sectional research design utilizing a discriminant analysis approach. Type 2 patients on treatment for diabetes for at least 2 years prior to research were selected. Clinical data were obtained from patient records, and psychosocial variables were collected by survey instruments filled out by patients. A final sample of 200 patients was recruited.ResultsWe found a positive correlation between patient and physician assessment of patient adherence behaviors. Greater adherence efforts were associated with lower HbA1c. Better quality of the patient-physician relationship was linked to better patient adherence. Increased HbA1c, longer therapy duration and higher BMI described low patient adherence for physicians. Lower HbA1c, female gender and fewer difficulties in marital adjustment characterized high adherence for patients. Dietary self-efficacy as well as emotional and social isolation discriminated mid-level adherers in both models.ConclusionThis research confirmed that patients and physicians perceived and judged patients’ adherence behaviors differently. Physicians and patients associated different clinical and psychological factors with low and high adherence. Further research is recommended to clarify how the quality of the physician-patient as well as the patient-spouse relationship affect dietary efficacy and patient adherence. A randomized, controlled clinical trial approach is recommended to establish the effectiveness of interventions aiming to improve dietary self-efficacy on adherence outcomes.

Improvement of secondary prevention of acute coronary syndrome

Regular usage and correct administration of secondary prevention drugs for acute coronary syndrome increase the quality of life and survival by up to 80%. This study was conducted to assess the effect of pharmacist educational intervention in improving the adherence of the physicians to guideline-recommended secondary intervention therapy for secondary prevention of acute coronary syndrome and evaluate the clinical benefit of this intervention. A prospective interventional study was conducted in Iraq, Al-Muthanna Governorate, Al-Hussein Teaching Hospital during the period from October 2021 to March 2022. A convenient sampling method was adapted to enrol the participants in the current study which included two groups including the intervention and control group. In the intervention group, the researcher sought to use an educational program, mediated by clinical pharmacists, to improve physician adherence to secondary prevention of acute coronary syndrome in hospitalized patients at discharge. There was no significant difference between the study groups at the first visit after discharge regarding the prescription of aspirin, ACEI, B blocker, or clopidogrel/ticagrelor while there was a significant difference at the end of follow up.

Physician adherence and patient-reported outcomes in heart failure with reduced ejection fraction in the era of angiotensin receptor-neprilysin inhibitor therapy

This Korean nationwide, multicenter, noninterventional, prospective cohort study aimed to analyze physician adherence to guideline-recommended therapy for heart failure (HF) with reduced ejection fraction (HFrEF) and its effect on patient-reported outcomes (PROs). Patients diagnosed with or hospitalized for HFrEF within the previous year were enrolled. Treatment adherence was considered optimal when all 3 categories of guideline-recommended medications (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor-neprilysin inhibitors; beta-blockers; and mineralocorticoid receptor antagonists) were prescribed and suboptimal when ≤ 2 categories were prescribed. The 36-Item Short Form Survey (SF-36) scores were compared at baseline and 6 months between the 2 groups. Overall, 854 patients from 30 hospitals were included. At baseline, the optimal adherence group comprised 527 patients (61.7%), whereas during follow-up, the optimal and suboptimal adherence groups comprised 462 (54.1%) and 281 (32.9%) patients, respectively. Patients in the suboptimal adherence group were older, with a lower body mass index, and increased comorbidities, including renal dysfunction. SF-36 scores were significantly higher in the optimal adherence group for most domains (P < 0.05). This study showed satisfactory physician adherence to contemporary treatment for HFrEF. Optimal adherence to HF medication significantly correlated with better PROs.

Self-Reported Practices and Emotions in Prescribing Opioids for Chronic Noncancer Pain: A Cross-Sectional Study of German Physicians.

Background: The pressure on physicians when a patient seeks pain relief and their own desire to be self-effective may lead to the prescription of strong opioids for chronic noncancer pain (CNCP). This study, via physician self-reporting, aims to identify and measure (i) physician adherence to national opioid prescribing guidelines and (ii) physician emotions when a patient seeks a dosage increase of the opioid. Methods: Within a cross-sectional survey—conducted as part of a randomized controlled online intervention trial (ERONA)—600 German physicians were queried on their opioid prescribing behavior (choice and formulation of opioid, indications) for CNCP patients and their emotions to a case vignette describing a patient seeking an opioid dosage increase without signs of objective deterioration. Results: The prescription of strong opioids in this study was not always in accordance with current guidelines. When presented with a scenario in which a patient sought to have their opioid dose increased, some physicians reported negative feelings, such as either pressure (25%), helplessness (25%), anger (23%) or a combination. The risk of non-guideline-compliant prescribing behavior using the example of ultrafast-acting fentanyl for CNCP was increased when negative emotions were present (OR: 1.7; 95%-CI: 1.2–2.6; p = 0.007) or when sublingual buprenorphine was prescribed (OR: 15.4; 95%-CI: 10.1–23.3; p < 0.001). Conclusions: Physicians’ emotional self-awareness represents the first step to identify such direct reactions to patient requests and to ensure a responsible, guideline-based opioid prescription approach for the long-term well-being of the patient.

Adequacy of physician clinical rounds and nursing care elements for non-COVID-19 infected patients admitted during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic created many challenges for healthcare systems. Frontline workers and especially healthcare professionals were the most severely affected through increased working hours, burnout and major psychological distress. ObjectivesTo evaluate the changes in standard care elements which occurred during the COVID-19 pandemic, specifically the physician clinical rounds and nursing care provided to non-COVID-19 infected patients. DesignObservational retrospective study. SettingsThe study was conducted at King Abdulaziz Medical City, Riyadh Saudi Arabia. KAMC is a 1200 bed tertiary care referral academic medical center. Patients (materials) and methodsWe compared the physician clinical rounds and nursing care elements in all admissions due to non-COVID-19 pneumonia and ST elevation myocardial infarction during the lockdown period with similar admissions in a baseline period in the same weeks in the previous pre-lockdown. Main outcome measuresTo evaluates the changes occurring during the COVID-19 pandemic in terms of the standard care elements, such as the physician rounds and nursing care. Sample sizeTotal of 113 patients records were analyzed. ResultsDuring the lock down period, a total of 113 patients were admitted to the medical and cardiology wards, (95 patients with pneumonia and 18 patients with ST segment elevation myocardial infarction (STEMI)) compared to 89 patients in the pre lockdown period (74 patients with pneumonia and 15 patients with STEMI). Both groups were similar in age, gender, disposition, length of stay, goal of care planning and outcome. Chronic respiratory disease and Diabetes were more present in patients admitted on the pre lockdown time. Azithromycin was more frequently used as part of the initial antibiotic regimen for pneumonia during the pre-lockdown while doxycycline was significantly more during the lockdown.For the 95 patients admitted in the medical wards during the lockdown, there were a total of 820 physicians’ clinical rounds opportunities for senior and junior physicians each. The residents missed 133 (16.2%) and consultant missed 252 (30.7%) of those clinical rounds opportunities. Missed clinical rounds opportunities during the pre-lock down period was higher for residents and consultants at 19.3% (P = 0.429 ) and 36.3% respectively (P = 0.027 ). Similarly, missed clinical rounds opportunities was less during the lockdown period from 35.2% to 25% (p 0.022) and from 38.8% to 30.6% (p = 1 ) for junior staff and consultant cardiology respectively compared to pre lockdown period. For nursing care elements, there was a decrease in missed opportunities in vital signs measurement (p 0.47 and p 0.226), pain assessment (p 0.088 and p 0,366) and skin care (p 0.249 and p 0.576) for patients admitted during the lockdown period in medical and cardiology wards. ConclusionsCaring for patients admitted for non COVID 19 infection reasons, physicians’ clinical rounds did marginally increase compared to pre lockdown period while nurses monitoring for those patients was significantly higher. No difference in mortality was observed for patients admitted pre and during lockdown. The number of missed opportunities to do clinical rounds by physicians remains high during both periods and measures to improve adherence of physicians to performed clinical rounds are needed.

Knowledge, attitudes, and behaviors regarding the use of clinical practice guidelines among spine surgeons in Latin America.

Background: Clinical Practice Guidelines (CPGs) are invaluable tools to assure evidence-based spine surgery care. In this study, we aimed to identify perceptions, barriers, and potential determinants for the use of CPG among Latin American spine surgeons.Methods: A 28-item questionnaire regarding the use of CPGs was sent to the members of AO Spine Latin America. The questionnaire was subdivided into three sections: (1) demographic data; (2) perceptions and awareness of CPGs; (3) and potential barriers to CPG use. Multivariate logistic regression was performed to assess potential associations with CPG use.Results: A total of 304 spine surgeons answered the questionnaire. Most of the participants were male (91.8%) and orthopedic spine surgeons (52.3%) who averaged 45–65 years of age. Most respondents were aware of some CPGs for spine care (68.8%) and reported using them (70.4%); lack of awareness about CPGs was the most frequent barrier to their use (65.1%).Conclusion: Awareness of CPGs in spine surgery is of paramount importance for their use. Educational programs explaining the importance and benefits of spine care CPG surgical and clinical practice would increase the adherence of physicians to the guidelines.

Adherence of physicians to evidence-based management guidelines for treating type 2 diabetes and atherosclerotic cardiovascular disease in Ajman, United Arab Emirates

BackgroundGood adherence by physicians to treatment guidelines for type II diabetes mellitus (T2DM) could improve therapy outcome for patients. In this retrospective, cross-sectional study, we assessed physicians’ adherence to evidence-based guidelines for T2DM management in adult patients (aged ≥18 years) with either confirmed atherosclerotic cardiovascular disease (ASCVD) or those at high risk of developing ASCVD at the Thumbay Academic Health Center, United Arab Emirates (UAE).MethodsRelevant data was obtained from patients’ medical records, assessed, and compared based on the 2018 diabetes guidelines of the American Diabetes Association and European Association for the Study of Diabetes.ResultsA total of 218 patients (186 males and 32 females) were included in the analysis. Of these, 122 were prescribed either sodium-glucose co-transporter-2(SGLT2) inhibitors or glucagon-like peptide 1 (GLP-1) receptor agonists and 34 were prescribed both. The overall adherence to the guidelines was 56%, which was significantly influenced by body mass index (BMI), hemoglobin A1c (HbA1c) levels, and estimated average glucose (eAG).ConclusionsAdherence to guidelines was significantly high when treating patients with elevated levels of HbA1c and eAG, suggesting that physicians are more likely to prescribe SGLT2 inhibitors or/and GLP-1 receptor agonists to such patients. Physicians’ adherence to guidelines was significantly correlated with patients’ BMI and the levels of HbA1c and eAG. To the best of our knowledge, this is the first study conducted on diabetes and its risk factors in UAE.