Program Adherence Research Articles

Supporting adherence to a home practice reading program using self-monitoring in persons with aphasia: a single case experimental design study

ABSTRACT Background Impairments in reading comprehension impact participation in daily activities for persons with aphasia. Home practice programs can be used by speech-language pathologists to extend treatment by providing additional practice to support recovery. However, adherence to home programs is often low and factors that enhance adherence to home programs are poorly understood. Aims We sought to examine if using self-monitoring practice with an aphasia-friendly logbook and a timer is an effective mechanism to support home program adherence and to explore the perception of this technique by individuals with aphasia. Methods & procedures This non-concurrent multiple baseline single case experimental design was completed during the COVID-19 Pandemic. Procedures were completed virtually or in person. If in person, assessments were done in the clinic or in the participant’s home. The participants (n = 6) were at least six months post-stroke, diagnosed with aphasia, and reported interest in practicing reading. There were five males and one female. During the baseline phase, participants received training on a mobile reading comprehension application on an iPad. They were instructed to practice reading 80 minutes seven days a week, and were not provided with self-monitoring supports, but were given a single cue card that indicated the practice expectation. The number of data points in the baseline phase was at least five and increased across participants. At the end of baseline, participants received training on the use of a timer and an aphasia-friendly logbook for self-monitoring minutes of practice. They were instructed to continue practicing for 80 minutes every day. In both phases, participants received weekly check-ins to ensure the technology was working. Outcomes & results The primary outcome measures were minutes of practice and percent adherence. Three out of the six participants demonstrated an effect with the self-monitoring intervention with more minutes of practice or greater percent adherence during the intervention phase. Responders typically had higher self-efficacy for exercise scores and a shorter baseline phase. Three participants did not demonstrate an effect of the self-monitoring intervention. The logbook was reported as one of the two most helpful features of the intervention by all the participants with weekly technology check-ins and iPad training as the least helpful elements. Conclusions Self-monitoring with an aphasia-friendly logbook and timer can support some individuals with aphasia in achieving a greater amount of home program practice. Additional research with a larger more diverse sample that incorporates timing and self-efficacy for exercise is warranted.

Daily high-frequency transcranial random noise stimulation (hf-tRNS) for sleep disturbances and cognitive dysfunction in patients with mild vascular cognitive impairments: A study protocol for a pilot randomized controlled trial.

Poor sleep quality is increasingly considered to be an underlying cause of cerebrovascular diseases. This is a slowly progressing condition that gradually leads to vascular cognitive impairment and stroke during ageing. At present, randomized clinical trials examining the non-pharmacological therapies in the management of this comorbidity are very limited. Transcranial current stimulation (tCS) is a non-invasive technology for promoting cognitive function and treating brain disorders. As advanced modalities of tCS, transcranial random noise stimulation (tRNS) and transcranial alternating current stimulation (tACS), could deliver frequency-specific waveforms of currents that can modulate brain activities in a more specific manner. Chinese individuals between the ages of 60 and 90 years, who are right-handed and have mild vascular cognitive impairment (VCI) with sleep disturbances, will participate in a randomized study. They will undergo a 2-week intervention period where they will be randomly assigned to one of three groups: high-frequency (hf)-tRNS, 40 Hz tACS, or sham tCS. Each group will consist of 15 participants. Before the intervention, high-resolution magnetic resonance imaging (MRI) data will be used to create a computational head model for each participant. This will help identify the treatment target of left inferior parietal lobe (IPL). Throughout the study, comprehensive assessments will be conducted at multiple time points, including baseline, 2nd week, 6th week, and 12th week. These assessments will evaluate various factors such as sleep quality, domain-specific cognitive performance, and actigraphic records. In addition, the participants' adherence to the program and any potential adverse effects will be closely monitored throughout the duration of the intervention. The primary objective of this study is to examine the safety, feasibility, and effectiveness of hf-tRNS and 40 Hz tACS interventions targeting left IPL in individuals with mild vascular cognitive impairment (VCI) who experience sleep disturbances and cognitive dysfunction. Additionally, the study seeks to evaluate the program's adherence, tolerability, and any potential adverse effects associated with frequency-specific transcranial current stimulation (tCS). The findings from this research will contribute to a deeper understanding of the intricate relationship between oscillation, sleep, and cognition. Furthermore, the results will provide valuable insights to guide future investigations in the field of sleep medicine and neurodegenerative diseases. ClinicalTrials.gov Identifier: NCT06169254.

The Western Australian medical schools mindfulness project: a randomised controlled trial

BackgroundEvidence for the longer-term benefits of online mindfulness training for medical students, including in the reduction of stress and improved wellbeing, is limited. This study aimed to evaluate the impact of a novel online mindfulness training program on trait mindfulness, wellbeing and study engagement of medical students at program completion and 6-month follow-up.MethodsThis was a randomised waitlist control study of an 8-week, online, mindfulness-based intervention versus normal curriculum alone for medical students (N = 114). The primary outcome measures were the changes from baseline to program completion at Week 8 for self-reported trait mindfulness (Freiburg Mindfulness Inventory), perceived stress (Perceived Stress Scale), self-compassion (Self-Compassion Scale) and study engagement scores (Utrecht Work Engagement Scale for Students). The secondary outcome measures were these score changes from baseline to 6-month follow up. Intervention and control students completed surveys at all three time points. Program adherence (Mindfulness Adherence Questionnaire) was also measured in the intervention group.ResultsThe intervention group experienced modest but statistically significant improvements in mindfulness (9%, p = 0.0002), self-compassion (5%, p = 0.026), and study engagement (4%, p = 0.035) from baseline to Week 8. They also reported a sustained improvement of 5% (p = 0.017) in mindfulness scores at 6 months. The control group reported no significant changes at Week 8 or 6 Months. Between-group comparisons showed that compared to the control group, the intervention group improved significantly more in mindfulness (p = 0.0076), and statistically marginally more in study engagement (p = 0.0534) at Week 8. No statistically significant between-group differences were observed at 6 months.ConclusionsThese results add to the small but growing body of evidence suggesting that online mindfulness-based interventions with minimal contact can improve, albeit in modest magnitude, mindfulness and possibly study engagement in medical students for the duration of a mindfulness program. Further refinements to the program may be important to maintain improvements in the longer-term.Trial registrationRegistration number ACTRN12624000783527.

Effects of an Exercise and Lifestyle Education Program in Brazilians living with prediabetes or diabetes: study protocol for a multicenter randomized controlled trial.

Patient education is a crucial strategy for promoting prevention and diabetes self-management since glycemic control achievement involves taking medications, medical nutrition therapy, physical exercise, and behavior changes. However, patient education programs are still barely implemented in low- and middle-income countries. This trial aims to investigate whether a lifestyle education intervention added to physical exercising is superior to sole physical exercising regarding functional capacity, disease-related knowledge, health behaviors, cardiometabolic health parameters, quality of life, depression, and diet quality in individuals with prediabetes or diabetes. Multicenter double-blinded randomized controlled trial with two parallel arms involving 12-week intervention and 6-month follow-up. The eligible individuals (≥ 18years, living with prediabetes or diabetes, literate, no clinical decompensation and/or physical and/or mental limitations that contraindicate physical exercising, written physician permission for exercise, no cognitive impairment, no vision limitations for reading, no confirmed diagnosis of unstable coronary disease or heart failure, no pacemaker and/or implantable cardioverter-defibrillator, no complex ventricular arrhythmias, no intermittent claudication, no recent cardiovascular event or cardiac surgery, and no currently enrolled in a structured exercise program) were recruited from two Brazilian cities and randomized to either (1) an Exercise and Lifestyle Education Program (ExLE) or (2) an Exercise Program (Ex), which can be delivered on-site or remotely based on the participants' internet access and technology literacy. The primary outcomes will be changes in functional capacity and disease-related knowledge. The secondary outcomes will involve changes in health behaviors (health literacy, physical activity level, exercise self-efficacy, and medication adherence) and cardiometabolic health parameters (glycemic control, anthropometric measures, and cardiac autonomic control). Program adherence, satisfaction with the program, diabetes-related morbidity, and changes in quality of life, depression, and diet quality will be the tertiary outcomes. Assessments will occur at baseline, post-intervention, and after 6-month follow-up. If superior effectiveness of ExLE compared to Ex program to improve the outcomes measures is found, this program could be delivered broadly in the Brazilian health system, especially in the primary care facilities where most individuals living with prediabetes and diabetes in our country are assisted. ClinicalTrials.gov, NCT03914924 . Registered on April 16, 2019.

Impact of family engagement on client participation in coordinated specialty care for first episodes of psychosis

BackgroundCoordinated specialty care (CSC) programs for first episodes of psychosis are increasingly offered in the United States. A component of CSC programs is active family engagement in treatment, though research on the impact of this engagement is limited. This study examined the characteristics of families engaged compared to families not engaged in treatment, and the impact of family engagement on client participation and medication adherence over the first 6 months of treatment.MethodsUsing data from the Early Psychosis Intervention Network (EPINET) research hub in Minnesota (EPI-MINN), we compared two groups of individuals: clients who had a family member(s) engaged in their treatment vs. clients who did not. Family engagement was defined as any treatment services provided to a family member(s) by CSC clinical staff. The groups were compared on intake demographic variables, duration of untreated psychosis (DUP), hospitalizations, symptom severity, and functioning. A comparison of the total number of treatment visits during the first 6 months of treatment was tested using both nonparametric (Mann Whitney U) and parametric (ANCOVA) tests. Group comparisons on self ratings of “intent to attend visits,” “intent to complete the program,” and medication adherence were tested with ANCOVA and Chi-Square.ResultsFamily-engaged clients were younger, with less years of education, and more often White; clients without family engagement were more often Black. Family engagement was positively associated with increased total number of visits for all interventions with the exceptions of client peer support and case management visits. Family engagement increased clients’ self-reported intent to attend visits, though not intention to complete the program, which was moderately to markedly high in both groups. No differences were noted with medication adherence, with high rates of adherence across the entire study sample.ConclusionsOverall, results of the study support the benefits of family engagement in CSC on client participation, though future research is needed to understand why Black families are less engaged and what treatment adaptations are needed to reduce these racial differences. The results also support the value of CSC programs for medication adherence, a critical factor in symptom reduction and mental health recovery.

Welcoming pregnant women as a strategy for adherence to dental prenatal care and health promotion in early childhood

This research deals with implementing Dental Prenatal Care as a public policy in the Brazilian Unified Health System (SUS) to care for pregnant women and their future babies. The legal framework that assures pregnant women's rights of priority in accessing services is usually not enough to guarantee the health promotion coverage goals for this population group, who frequently have low adherence to dental care. Brazilian Unified Healthcare System (SUS) recommends monitoring pregnant women through eight mensal consultations during healthy pregnancy. Oral health is usually not monitored to the same extent, and many pregnant women still go through pregnancy without any dental consultation. This study was proposed to improve dental prenatal care and program adherence by mothers and children in the Basic Healthcare Unit Amaro José de Souza, in the municipality of Barueri, through the increased participation of the dental surgeon in the pregnant women welcoming team. A cross-sectional cohort study was designed to identify and meet the demands of low-risk pregnant women. For six months, all the women attending prenatal care at BHU Amaro José de Souza in Barueri were invited to participate and receive personal guidance from the multi-professional team. Information on dental health was investigated through questions targeting previous knowledge about the recommended moments for the first dental appointment of a child, the importance of exclusive nasal respiration, the identification of craniofacial asymmetries at birth, and general baby care. Attitudes and self-care were also investigated, including prenatal program adherence. Answers were collected in a Google Form platform and analyzed to characterize the group's literacy about prenatal care and breastfeeding and identify information needs about dental health care during pregnancy. At the same time, a welcoming expanded listening, educational, and preventive health action was developed: conversation and sharing experience groups were promoted monthly for pregnant women, breastfeeding mothers, and their families. 90 pregnant women out of the 104 attending the BHU in the six months of the research were invited, and 83 agreed to participate. All the participants declared at least one previous appointment with the healthcare team, 92.8 % of them, with a gynecologist. The nursing team was involved in 53.0 % of the appointments, but only 6.0 % were reported to have been conducted exclusively by a nurse. A dental surgeon appointment was mentioned by 30.1 % of the research participants. The dental health literacy investigation revealed that 57.8 % believed they should only take their babies to a dental appointment after teething, and 27.7 % were aware of the child's craniofacial asymmetries at birth. Only 28.9 % had previous knowledge about the importance of exclusive nasal respiration. Despite only 34.9 % having their first pregnancy, 78.3 % declared they would appreciate receiving information about pregnancy. After the guidance, 72.0 % of the pregnant women had undergone dental prenatal care. Workshops for pregnant women and breastfeeding mothers provided a convenient welcoming space, to listen and provide guidance to pregnant women and their families, in addition to demystifying the fear of dental care during pregnancy and breastfeeding. The intervention to guide pregnant women to perceive the BHU as an educational and health promotion space, not just a curative intervention, effectively increased adherence to dental prenatal care. The contact with the Specialist in Functional Jaw Orthopedics in this first phase of life facilitated dental health education and access to more complex cases. The prenatal program adherence, the pregnant woman’s self-care, and the care of the baby were favored by the welcoming, expanded listening, and personalized service.

Design and development of a gamified cognitive training program targeting executive functions for older adults

With increased population aging, cognitive training has emerged as a popular intervention for combating age-related cognitive decline. Considering the purpose of cognitive interventions, the development of cognitive training programs typically focuses on properties that may enhance cognition, often neglecting the key element of user engagement. Consequently, many cognitive training studies have reported poor adherence and high participant attrition. To increase the likelihood of long-term cognitive benefits, there must be sustained use of the intervention (i.e., good training program adherence). Utilizing a research-through-design approach, this paper presents the design and development of a cognitive training program for older adults. Specifically, the primary focus was on outlining a conceptual framework for developing this program, which draws from gamification principles to foster motivation and enjoyment, as well as cognitive plasticity and transfer principles to foster cognitive engagement. Overall, the program encompasses gamified, adaptive, multidomain training of core executive functions (working memory, inhibitory control, and cognitive flexibility). This program will be the basis for future works exploring older adults’ experiences and preferences of cognitive training, and evaluating the efficacy of multidomain executive functions training in enhancing cognition and well-being in older age.

Assessing factors of adherence and efficacy: A randomized controlled trial of a fully automated self-help A-EBT website.

Treatment for trichotillomania is notably limited, preventing suffering individuals from having access to treatment. To address this need, researchers have developed and tested asynchronous online interventions for adults with trichotillomania. A factor that may impact the efficacy of these programs is the use of phone check-ins (or similar coaching support) to improve treatment adherence in website treatment delivery. In the current study we evaluated the role of check-ins on treatment adherence and efficacy of a website delivering acceptance and commitment therapy-enhanced behavior therapy (A-EBT). A sample of 101 adults with trichotillomania were randomly assigned to an A-EBT web-based intervention with or without phone check-in support. Adherence to the web-based program was not significantly improved by check-ins and treatment outcomes did not vary by condition (with or without check-ins). However, adherence to the program across conditions, did predict treatment outcomes. The program was found to be effective at decreasing trichotillomania symptom severity and improving trichotillomania specific psychological inflexibility over time across check-in conditions. Our findings suggest that check-ins did not improve adherence to or efficacy of the program, thus supporting recent literature suggesting that check-ins do not necessarily improve program adherence.

Impact of a Clinical Pharmacist-Led, Artificial Intelligence-Supported Medication Adherence Program on Medication Adherence Performance, Chronic Disease Control Measures, and Cost Savings

Chronic diseases are the leading cause of disability and death in the United States. Clinical pharmacists have been shown to optimize health outcomes and reduce healthcare expenditures in patients with chronic diseases through improving medication adherence. The primary objective of this study was to evaluate a pharmacist-led, artificial intelligence-supported medication adherence program on medication adherence, select disease control measures, and healthcare expenditures. This was a multicenter, retrospective, quasi-experimental evaluation from January 2019 to December 2019 (pre-implementation) and January 2021 to December 2021 (post-implementation). This pharmacy-driven service focuses on improving medication adherence and patient outcomes through artificial intelligence-supported analytics, individual patient case review, and pharmacist-led individual patient outreach. The primary endpoint was to determine if implementation improved medication adherence in three medication-related measures: medication adherence for hypertension (MAH), medication adherence for cholesterol (MAC), and medication adherence for diabetes (MAD). Secondary outcomes were to evaluate reductions in select chronic diseases control measures and cost savings of this service following implementation of this service. This medication adherence service was deployed across 10,477 patients: 60.6% of patients were in at least one medication-related measure, generating 2,762 actionable medication adherence gaps. Following the implementation of this pharmacist-led program, medication adherence improved in all three disease state measures (MAH: 5.9% improvement; MAC: 7.9% improvement; MAD: 6.4% improvement), and Medicare Star ratings also improved. The percentage of patients with diabetes who reached their A1c goal also increased (75.5% to 81.7%). Furthermore, reductions in overall healthcare expenditures were seen per member per month in patients that were adherent in comparison to those who were non-adherent (hypertension: 31% cost savings; hyperlipidemia 25% cost savings; diabetes: 32% cost savings). This clinical pharmacist driven service leveraged technology and patient connection to increase medication adherence in patients with chronic disease states and led to improvement in select disease control measures and substantial healthcare cost savings.

Adesão ao uso da estratégia NutriSUS para fortificação alimentar infantil em municípios de Goiás

Introduction: The high demand for nutrients in children under five years of age, added to low nutritious diets, makes them vulnerable to micronutrient deficiencies. The NutriSUS Strategy, launched as part of the School Health Program (PSE) in 2014, aims to combat these deficiencies through the distribution of micronutrient sachets. The effectiveness of this strategy in Goiás, considering the weaknesses in the municipalities, needs to be evaluated. The objective of this study was to verify adherence to the NutriSUS Strategy in municipalities in the state of Goiás and the list of sachets used by agreed and added day care centers. Methods: A retrospective observational study analyzed data on micronutrient supplementation provided by the NutriSUS Strategy in the state of Goiás, between 2017 and 2019. The database available on the Ministry of Health website was used to identify adherence and coverage of the program in 10 regional health departments. The inclusion criteria were municipalities that implemented the strategy during the period studied, while those that did not adhere or did not show interest were excluded. The analysis was performed using absolute and relative frequencies in the EPI Info 7.2.6.0 program. Results: The NutriSUS Strategy was implemented in 35 (14.23%) of the total municipalities (n=246). Micronutrient supplementation targets were constant throughout the period from 2017 to 2019, with some cities, such as Araguapaz, Britânia, and Santa Helena de Goiás, exceeding their supplementation targets in some of the periods, while others, such as Aragarças, Hidrolândia, Piracanjuba, São Luís de Montes Belos, and Buriti Alegre, did not reach the expected targets. The analysis, by semester of supplementation coverage in daycare centers, showed significant fluctuations: a drop in 2017 from 45.44% to 32.60% from the first to the second semester. In 2018, the percentage was 34.43% in the first half of the year, but there was a significant increase to 52.37% in the second half of the year. In 2019, coverage rose to an average of 61.63% in the first half, followed by a drop to 35.74% in the second half. The data also revealed variations in standard deviation, reflecting fluctuations in program adherence. Conclusion: The NutriSUS Strategy showed a variable implementation in the municipalities of Goiás in the period studied, with fluctuations in supplementation coverage over time. The analysis highlighted both success in some locations and difficulties in others, highlighting the importance of continuously monitoring and adjusting supplementation strategies to ensure that all counties adequately benefit children from micronutrient supplementation.

Systematic review of adherence to technology-based falls prevention programs for community-dwelling older adults: Reimagining future interventions.

Prevention programs, and specifically exercise, can reduce falls among community-dwelling older adults, but low adherence limits the benefits of effective interventions. Technology may overcome some barriers to improve uptake and engagement in prevention programs, although less is known on adherence for providing them via this delivery mode. We aimed to synthesize evidence for adherence to technology-based falls prevention programs in community-dwelling older adults 60 years and older. We conducted a systematic review following standard guidelines to identify randomized controlled trials for remote delivered (i.e., no or limited in-person sessions) technology-based falls prevention programs for community-dwelling older adults. We searched nine sources using Medical Subject Headings (MeSH) terms and keywords (2007-present). The initial search was conducted in June 2023 and updated in December 2023. We also conducted a forward and backward citation search of included studies. Two reviewers independently conducted screening and study assessment; one author extracted data and a second author confirmed findings. We conducted a random effects meta-analysis for adherence, operationalized as participants' completion of program components, and aimed to conduct meta-regressions to examine factors related to program adherence and the association between adherence and functional mobility. We included 11 studies with 569 intervention participants (average mean age 74.5 years). Studies used a variety of technology, such as apps, exergames, or virtual synchronous classes. Risk of bias was low for eight studies. Five interventions automatically collected data for monitoring and completion of exercise sessions, two studies collected participants' online attendance, and four studies used self-reported diaries or attendance sheets. Studies included some behavior change techniques or strategies alongside the technology. There was substantial variability in the way adherence data were reported. The mean (range) percent of participants who did not complete planned sessions (i.e., dropped out or lost to follow-up) was 14% (0-32%). The pooled estimate of the proportion of participants who were adherent to a technology-based falls prevention program was 0.82 (95% CI 0.68, 0.93) for studies that reported the mean number of completed exercise sessions. Many studies needed to provide access to the internet, training, and/or resources (e.g., tablets) to support participants to take part in the intervention. We were unable to conduct the meta-regression for adherence and functional mobility due to an insufficient number of studies. There were no serious adverse events for studies reporting this information (n = 8). The use of technology may confer some benefits for program delivery and data collection. But better reporting of adherence data is needed, as well as routine integration and measurement of training and skill development to use technology, and behavior change strategies within interventions. There may be an opportunity to rethink or reimagine how technology can be used to support people's adoption and integration of physical activity into daily life routines.

Patient-Centric Outcomes: A Longitudinal Study on the Impact of Multifaceted Interventions in Diabetes and Cardiovascular Health

This longitudinal study investigates the effectiveness of multifaceted interventions in improving patient outcomes in diabetes and cardiovascular health. With an increasing prevalence of these conditions worldwide, there is a pressing need for holistic approaches that address multiple facets of patient care. Our study follows a cohort of individuals diagnosed with diabetes and cardiovascular diseases over five years, examining the impact of comprehensive interventions on various patient-centric outcomes. These interventions encompassed a combination of lifestyle modifications, medication adherence programs, dietary counseling, physical activity promotion, and psychological support. Through rigorous data collection and analysis, we assessed changes in key clinical indicators such as HbA1c levels, lipid profiles, blood pressure, and body mass index, alongside patient-reported outcomes including quality of life, self-efficacy, and satisfaction with care. Additionally, we explored healthcare utilization patterns and economic implications associated with the interventions. Our findings reveal significant improvements in both clinical and patient-reported outcomes among participants engaged in multifaceted interventions compared to those receiving standard care. The interventions demonstrated sustained benefits over the follow-up period, suggesting their long-term efficacy in managing chronic conditions and enhancing overall well-being. Furthermore, our study highlights the importance of personalized, patient-centered approaches in chronic disease management, emphasizing the need for integrated care models that prioritize individual needs and preferences. These insights have profound implications for healthcare policymakers, providers, and stakeholders seeking to optimize outcomes and reduce the burden of diabetes and cardiovascular diseases on patients and healthcare systems.

Empowerment of Augmented Reality (AR) for Patient Education and Engagement: Medication Adherence Programs' Impact on Public Health Outcomes

The entire effectiveness of pharmacological treatment depends on patients taking their medications as prescribed. Patient education is a vital component of the endeavours to enhance adherence to medications. However, many people still fail to take their prescription pills as prescribed. In addition to having access to healthcare, those who follow their doctors' orders greatly improve their chances of a positive outcome. The unfortunate reality is that many people do not take their medications as prescribed, which has led to deteriorating health, higher healthcare costs, and more overall costs. Hence, this paper presents the Smart Augmented Reality-based Patient Medication Adherence Program (SAR-PMAP) model for effective patient education and engaging medication. The augmented reality spectacles help those with trouble keeping track of their medication, and the model encourages patients to take their prescriptions as prescribed. Users may easily go to their homes with the aid of the navigation functions, and patients with impaired eyesight can benefit from the audio option that gives out the date and time. Given all this data, the Medication Coach Intelligent Agent (MCIA) takes the lead in making comprehensive decisions so patients can get autonomous, individualized, and unobtrusive treatments.

Individual placement and support in mental health services: evaluation of routine clinical data using aretrospective chart review

People with severe mental illnesses are often excluded from working life and would like support to (re)enter the general labor market as part of the psychiatric treatment. Individual placement and support (IPS) is an effective method of finding and retaining work in the general labor market. The aim of the study was to determine the integration rates of IPS into the general labor market in acute and postacute psychiatric settings, identifying patient, setting and program characteristics associated with (re)entering work. A retrospective chart review (RCR) of routine clinical data between 2016 and 2021 was carried out. The IPS program adherence was rated using the IPS fidelity scale. A total of 375 patients participated in the IPS with at least 4 appointments. The (re)integration rate into the general labor market was 51.7%. A shorter time period to the last working day, diagnosis of F1, F2, F3 (vs. F4), change of treatment setting and IPS in the psychiatric institute outpatient department (PIA), IPS fidelity and the number of IPS coaching sessions were positively correlated with (re)integration into work. The implementation of IPS in clinical mental healthcare is possible and leads to high integration rates in the open labor market. An early start of IPS during the clinical treatment can promote social inclusion.

Psychosocial factors affecting the adherence of chronic kidney disease patients to undergo a hemodialysis program: a cross-sectional study

Introduction: This study aims to analyze the effect of psychosocial factors on hemodialysis program adherence. Methods: The study was cross-sectional, with a sample size of 90 respondents, obtained through simple random sampling. The study’s dependent variable was hemodialysis program adherence and the independent variables were knowledge, motivation, coping, depression, perceived family support and health worker support. Data were collected using a questionnaire and analyzed using multiple linear regression. Results: Most respondents adhered to the hemodialysis program (90%). The level of knowledge, motivation, coping, family support, and health worker support was in the good category (93.3%; 100%; 91.1%; 90%; 88.9%, respectively), and did not experience depression (90%). The independent variables (knowledge, motivation, coping, family support, health worker support) simultaneously significantly affected the dependent variable, namely adherence to the hemodialysis program by 94.5% (R2 = 0.945; F = 236.613; p = 0.001). Partially, the factors of knowledge, motivation, coping, family support, health workers support, and depression also had a significant effect on hemodialysis program adherence (t = 2.234, t = 5.344, t = 3.473, t = -4.190, t = 6.457, t = 4.887, t = 4.190, respectively; p = 0.001). Conclusions: The study results showed that psychosocial factors (knowledge, motivation, coping, family support, health worker support, and depression) simultaneously or partially influenced the adherence of CKD patients to undergo a hemodialysis program, with the most dominant factor affecting adherence to hemodialysis as perceived family support. Keywords: Adherence, Hemodialysis, Psychosocial

Movement pattern definitions for resistance training behavior measurement in diabetes.

Type 2 diabetes can result in debilitating vascular complications, and resistance training (RT) is an effective therapy for improving cardiovascular outcomes. However, only 10-30% of adults meet the public health guidance for RT. While current RT guidelines focus on targeting major muscle groups, guidance specific to simplified movement categorization may augment understanding of RT programming and improve uptake and outcomes. Current movement pattern definitions and descriptions lack clarity, accuracy, and consistency. This paper proposes movement definitions and descriptions to be used for RT intervention design and prescription, and includes the following categories: hip, knee, ankle, vertebral column, vertical push, horizontal push, vertical pull, and horizontal pull. These categories are intended to aid clinicians, researchers, and trainers in RT surveillance and RT intervention design for improving vascular complications in type 2 diabetes. Simplified RT program design using these categories may also facilitate greater RT program understanding and adherence for patients.

Digital Exclusion, Social Deprivation, and Clinical Outcomes of Patients Undergoing Hyperacuity Home Monitoring.

Digital exclusion is a growing challenge when deploying digital patient care pathways and a potential barrier to widespread implementation, especially in the field of smartphone-based self-monitoring of vision. This retrospective case series seeks to examine the characteristics of individuals who adhere to a smartphone homemonitoring programme using the Alleye app for retinal disease, with a focus on digital exclusion, social deprivation and clinical outcomes. We conducted a retrospective analysis of 89 patients with retinal pathologies including diabetic retinopathy and retinal vein occlusions at Moorfields Eye Hospital participating in an Alleye homemonitoring programme between April 2020 and November 2022. Postcodes were used to determine the Digital Exclusion Risk Index (DERI) and the Index of Multiple Deprivation (IMD) rebased for London. Clinical information from the electronic patient record and Alleye app usage data were extracted for each patient. Associations between the DERI/IMD, clinical parameters and app use were examined using multivariable regression models. Mean DERI was 2.56 (standard deviation [SD] = 0.36), IMD was 6.25 (SD = 2.79), visual acuity (VA) in the better eye at study entry was 83.28 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (SD = 7.92), and mean follow-up was 344.46days (SD = 260.13). During the observation period, 36% received an intravitreal injection (IVI) and VA fell by at least ten letters in approximately one in four patients. In 87.5% of patients requiring IVI, the use of the app increased. We found no association between clinical parameters and programme adherence for DERI or IMD. We found no association between high digital exclusion risk and high social deprivation with monitoring adherence to smartphone-based self-monitoring of vision, contrary to the currently available evidence. This suggests that smartphone-based self-monitoring of vision is accessible to population groups of varying digital exclusion and social deprivation risk, and can be safely employed to monitor clinical progression.

The Management of Depression and Anxiety in Primary Care: Examining Predictors of Adherence to a Psychopharmacological Collaborative Care Management Program for Veterans.

Collaborative care management (CoCM) is an evidenced based approach to psychiatric treatment in primary care, yet literature examining factors associated with program adherence is lacking. This study analyzed predictors of adherence to a CoCM model of psychopharmacological treatment of depression and anxiety in primary care by conducting a retrospective cohort analysis on Veterans referred to a large VA Medical Center's CoCM program over an 18-month period. Baseline characteristics, symptomatic assessments, and covariates of interest were collected. For the primary outcome, the association between covariates and programmatic completion were analyzed. Secondary analyses assessed improvements in psychiatric symptoms. A total of 757 Veterans with depressive or anxiety disorders were included, and 256 completed the CoCM program. Baseline covariates associated with differences in completion rates included the following: age, contact with psychology prior to referral, baseline PHQ-9, baseline GAD-7, and a number of comorbid psychiatric/substance abuse covariates. After controlling for baseline differences, age remained a significant positive predictor of completion (OR 1.019, 95% CI 1.008‒1.030) and cannabis use a significant negative predictor (OR 0.507, 95% CI 0.275‒0.934). Both early improvement in PHQ-9 (OR 1.864, 95% CI 1.210‒2.872) and GAD-7 (OR 1.762, 95% CI 1.154‒2.691) scores were positive predictors. Secondary analyses showed that programmatic completion was associated with greater reductions in psychiatric symptoms. Results identified a number of modifiable parameters associated with differences in completion rates and greater symptomatic reduction for those who complete the program. Additional studies should be conducted examining interventions to optimize CoCM programs by supporting positive predictors while minimizing negative predictors.

A case study on the implementation of quality and comprehensive indicators set in routine diabetes care

IntroductionType 2 diabetes is a major public health issue in Mexico due to its high prevalence and its projection for the coming years for this disease. Findings on multidisciplinary care related to chronic diseases have proven effective, based on measurement of patient-centered outcomes, The Center of Comprehensive Care for Patients with Diabetes (CAIPaDi) is a multidisciplinary program focused on reducing diabetes complications. This case study aims to illustrate the results of implementing health outcomes measurements and demonstrate the beneficial effects of establishing a comprehensive model of care through a patient-centered approach.MethodsA descriptive analysis of the comprehensive care indicators of patients with type 2 diabetes treated in the CAIPaDi program between 2013 and 2023 was conducted. The results were structured according to the standard set of outcomes for diabetes proposed by the International Consortium for Health Outcomes Measurements (ICHOM).ResultsThe baseline and prospective registration of consultations was completed for five years, complying with 25 of the 26 indicators of the ICHOM set. In diabetes control, 56.5% of patients had A1c ≤ 7%, 87.9% had BP ≤ 130/80 mmHg, 60.9% had LDL-cholesterol < 100 mg/dl, and obesity rates decreased from 42.19% to 30.6% during annual consultations. Fewer years of diagnosis before the first visit is key to overall improvement in program adherence (P = 0.02).In acute events, a hyperglycemic crisis occurred in only two cases and severe hypoglycemia episodes in 8 patients. For chronic complications, no lower limb amputations occurred. Cardiovascular outcomes occurred in < 1%. Periodontal disease was analyzed, and periodontitis decreased from 82.9% to 78.7%. Mortality reports were low, with COVID-19 being the main cause of death. Patient-reported outcomes demonstrated reductions in anxiety, depression, and diabetes distress during follow-up.ConclusionRegistering quality-of-care indicators is feasible in a comprehensive care program. It allows improving the medical, mental health, and lifestyle outcomes of patients with type 2 diabetes and provides relevant data for planning health programs. A quick diagnosis before program adherence is crucial for overall improvement in patients.

Co-designing an information map guiding patients on their journey to cardiac rehabilitation in Austria

Abstract Background Cardiac rehabilitation (CR) is underutilised worldwide. Cardiac patients lack sufficient information about CR, for example, regarding the health benefits of CR and how to obtain a referral. This gap presents a significant barrier to CR uptake. Purpose The purpose of this study was (1) to define patients’ needs during their transition from the acute hospital setting to CR and (2) to design a need-based information map. Methods We conducted three sequential co-design workshops with 17 participants: ten cardiac patients, most of whom had completed a CR programme, six healthcare professionals who worked within the CR pathway, and one who was a healthcare professional with a cardiac condition who had completed a CR programme. Patients’ needs and design suggestions were elicited through generative co-design methods [1], such as paper prototyping, persona scenarios, group discussions and presentations, and card sorting. Data were analysed with thematic analysis. Results Workshop participants identified three "steps" at which orientation is required to guide patients along their journey: (1) during the hospital stay, (2) while at home, and (3) throughout the CR programme. Patients’ needs changed accordingly, prompting us to tailor information and tips to these steps (s. Figure). In the hospital, patients needed orientation about follow-up care. The patients sought facts about CR, enabling them to make an informed decision for or against participation. Particularly, info about programme duration, content and health benefits were appreciated. Information about common symptoms related to the treatment and explanations of the hospital environment were also perceived as helpful. After discharge, the time at home was characterised by a need for calm after the stressful time in the hospital. Patients reflected on their cardiac events. Information on adopting a heart-healthy lifestyle and guidance on preparing for CR were perceived as helpful. Contact details for medical support were appreciated. During the CR programme, patients sought motivational support for programme adherence. They appreciated tips such as making use of the time for bonding and seeking out friendships with other patients. Testimonials sharing experiences and tips presented by fellow patients were considered helpful at any point along the patient journey. Conclusion When transitioning from the acute hospital to CR, cardiac patients’ needs change in distinctive steps, which the settings hospital, home and CR represent. Information and tips should be tailored accordingly. Our information map may support patients’ CR uptake and facilitate cardiac patient pathways in Austria, for example, by developing patient-facing technology.Patients' needs and required information