Reasons For Non-compliance Research Articles

23. Implementation and effects of risk-dependent obstetric care in the Netherlands: A clinical impact study (Expect study II)

Introduction This study evaluates former obstetric care as usual (Expect I) with risk-dependent care using a prediction tool (Expect II). The Expect I study externally validated 39 prediction models using data of 2,614 women prospectively included from 2013 to 2015. Clinically useful models were embedded in a web-based prediction tool. Additionally, risk-dependent care paths were developed, resulting in antenatal care tailored to the outcomes of individual risk assessments. Risk-dependent care was embraced by a consortium of obstetric healthcare professionals in the Dutch province of Limburg. Objective This part focuses on adherence of healthcare professionals and compliance of women to key recommendations; e.g. adequate calcium intake in all women and low-dose aspirin treatment in women at increased risk of preeclampsia. Methods Women receiving risk-dependent care are being enrolled in a prospective multicenter cohort (Expect II) and receive four questionnaires at intervals. Preliminary results Ten months after introduction our prediction tool is being used in an estimated 24–40% of pregnant women in our region. Currently, 435 women have been enrolled. Recommendations regarding calcium intake were discussed with 351 women (81%), of which 285 (81%) reported the intention to comply (Expect I, adequate calcium intake in 34% of women). In case of an elevated preeclampsia risk (n = 223) aspirin treatment was discussed with 180 women (76%), of which 52 (29%) intended to comply (Expect I, actual use in the high-risk group: 1.5%). Discussion The preliminary results indicate risk-dependent care has been implemented by a reasonable proportion of healthcare professionals. Furthermore, usage of the prediction tool increases recommendation of preventive interventions. Implementing new guidelines asks an additional effort of healthcare professionals, especially if it includes novel strategies such as a prediction tool. Future research should focus on barriers that hamper the adherence of healthcare professionals to risk-dependent care and on reasons for non-compliance of women.

Compliance to antihypertensive therapy.

To determine compliance, factors affecting compliance to antihypertensive therapy and to compare compliant and non-compliant groups, in a tertiary care setting. Analytical (cross-sectional) study. The outpatient clinics at the Aga Khan University from May 2004 to February 2005. Two hundred patients presenting to the outpatients clinic were included. All patients 18 years and above, who had stage 1 and 2 hypertension, had one clinic visit to a medicine clinic, 6 months prior to presentation and started on antihypertensive medicines, were included. Sixty six percent were males and 33.5 % were females. Mean age was 58.1(+/-12) years and mean duration of hypertension was 7.2 (+/- 6.7) years. Fifty-seven percent were compliant and 43 % were noncompliant. In the noncompliant group, 53.4 % had mild noncompliance, 24.4 % had severe non-compliance, while 22% had moderate noncompliance. Factors of noncompliance were 56.8% missed doses due to forgetfulness, 12.7% deliberately missed their doses, 11.6% could not take the medicine due to side effects, 10.4% did not take the dose due to increased number of tablets, 4.6% were not properly counseled by the physician and 3.48% did not take medicines due to cost issues. The mean systolic blood pressure was 126 +/- 19.2 mmHg in the compliant group while it was 133 +/-16.5 mmHg in the noncompliant group p-value 0.004). The mean diastolic blood pressure in the compliant group was 76 +/- 11.9 mmHg, while in the noncompliant group it was 81.9 +/-10.9 mmHg (p-value 0.001). Compliance to antihypertensive therapy in a tertiary care center is significantly good. Forgetfulness was the major reason for noncompliance. The mean blood pressure control was better in the compliant group.

Reasons for Non-Compliance to Inhaled Medications among Adult Asthma Patients Attending Referral Chest Hospital in North India

Introduction: Asthma is a major public health problem affecting a large number of individuals of all ages, characterized bychronic airway inflammation and inhaled medications are main stay of treatment but compliance to these medications is poor.Aim: This study was conducted to look for common reasons for non-compliance to inhaled medications (MDI and DPI) in asthmapatients attending out-patient department of a referral chest hospital. Material and methods: The study was conducted on 150diagnosed asthma patients on follow based on an open labeled questionnaire in a hospital from North India. Results: Overallcompliance of the patients to inhaled medications (MDI and DPI) was only 34.6% (52 /150 patients) and 65.4 % (98 out of 150) were found to be noncompliant. Among reason for non-compliance, belief that medications were not needed during symptom freeperiod was found in 43.8% (43/98), followed by feeling that they may become dependent/ develop addiction if used for long timein 32.6% (32/98) and social embarrassment in using inhalers found in 14.2%(14/98). All other reasons accounted for onlyaround 9% of non-compliance. Conclusion: The data indicates that despite strict instructions for adherence to medicationcompliance rate was poor, although majority of the patients believed that compliance was extremely important. This studysuggests that besides continued health education new health care initiatives are needed to be designed to improve the complianceof asthma patient for inhaled medications.

Computed tomography of the head for adult patients with minor head injury: are clinical decision rules a necessary evil?

This study aimed to evaluate compliance with and performance of the Canadian Computed Tomography Head Rule (CCHR), and its applicability to the Singapore adult population with minor head injury. We conducted a retrospective study over six months of consecutive patients who presented to the adult emergency department (ED) with minor head injury. Data on predictor variables indicated in the CCHR was collected and compliance with the CCHR was assessed by comparing the recommendations for head computed tomography (CT) to its actual usage. In total, 349 patients satisfied the inclusion criteria. Common mechanisms of injury were falls (59.3%), motor vehicle crashes (16.9%) and assault (12.0%). 249 (71.3%) patients underwent head CT, yielding 42 (12.0%) clinically significant findings. 1 (0.3%) patient required neurosurgical intervention. According to the CCHR, head CT was recommended for 209 (59.9%) patients. Compliance with the CCHR was 71.3%. Among the noncompliant group, head CT was overperformed for 20.1% and underperformed for 8.6% of patients. Multivariate logistic regression analysis revealed that absence of retrograde amnesia (odds ratio [OR] 4.1, 95% confidence interval [CI] 1.8-9.7) was associated with noncompliance to the CCHR. Factors associated with underperformance were absence of motor vehicle crashes as a mechanism of injury (OR 6.6, 95% CI 1.2-36.3) and absence of headache (OR 10.8, 95% CI 1.3-87.4). Compliance with the CCHR for adult patients with minor head injury remains low in the ED. A qualitative review of physicians' practices and patients' preferences may be carried out to evaluate reasons for noncompliance.

Adherence to aromatase inhibitors (AIs) in Hispanic patients with early stage breast cancer.

70 Background: Adherence to Aromatase Inhibitors (AIs) is essential for the effective prevention of breast cancer recurrence. We sought to evaluate adherence to AIs as well as possible factors behind non-adherence in a large American-Mexican border city with predominantly Hispanic population. Methods: After IRB approval, women with Stages I-III breast cancer treated at the Texas Tech breast care center in El Paso, TX were included if they were receiving adjuvant AI therapy. We utilized the validated Morisky Medication Adherence Scale (MMAS-8) to determine AI compliance. In addition, a question to indicate reasons for noncompliance was added. Results: 87 patients were enrolled, median age was 61 years; 78 (90%) were identified as Hispanic. The majority of participants were women of low socioeconomic status 53 (61%) with an annual income of < $15,000. MMAS-8 results showed 35 (40%) patients admitted to forgetting to take their AI pill. Additionally, 71 (82%) of the patients denied forgetting to take the AI pill within the past two weeks. 11 (13%) patients admitted to sometimes having difficulty remembering to take their AI medication, and 74 (85%) stated never or rarely having difficulty remembering to take their AI medication. 50 (57.5%) patients provided a reason why they did not take their AI pill, 35 (40%) cited forgetfulness, 14 (17%) cited other reasons including cost, limited insurance coverage, lack of transportation involved in obtaining the medication and timely prescription refills, and only 1(1%) due to side effects. Conclusions: Non-adherence to AI appears to be prevalent among Hispanic patients with breast cancer. Main causes of noncompliance are forgetfulness and financial reasons. Healthcare providers could reinforce educating patients about the importance of compliance. Financial assistance may also be helpful in improving AI compliance. Clinical trial information: NCT03144037.

Smartphone App Using Mindfulness Meditation for Women With Chronic Pelvic Pain (MEMPHIS): Protocol for a Randomized Feasibility Trial

BackgroundFemale chronic pelvic pain (CPP) is defined as intermittent or constant pelvic or lower abdominal pain occurring in a woman for at least 6 months. Up to a quarter of women are estimated to be affected by CPP worldwide and it is responsible for one fifth of specialist gynecological referrals in the United Kingdom. Psychological interventions are commonly utilized. As waiting times and funding capacity impede access to face-to-face consultations, supported self-management (SSM) has emerged as a viable alternative. Mindfulness meditation is a potentially valuable SSM tool, and in the era of mobile technology, this can be delivered to the individual user via a smartphone app.ObjectiveTo assess the feasibility of conducting a trial of a mindfulness meditation intervention delivered by a mobile phone app for patients with CPP. The main feasibility objectives were to assess patient recruitment and app adherence, to obtain information to be used in the sample size estimate of a future trial, and to receive feedback on usability of the app.MethodsMindfulness Meditation for Women With Chronic Pelvic Pain (MEMPHIS) is a three-arm feasibility trial, that took place in two hospitals in the United Kingdom. Eligible participants were randomized in a 1:1:1 ratio to one of three treatment arms: (1) the intervention arm, consisting of a guided, spoken mindfulness meditation app; (2) an active control arm, consisting of a progressive muscle relaxation app; and (3) usual care (no app). Participants were followed-up for 6 months. Key feasibility outcomes included the time taken to recruit all patients for the study, adherence, and estimates to be used in the sample size calculation for a subsequent full-scale trial. Upon completion of the feasibility trial we will conduct focus groups to explore app usability and reasons for noncompliance.ResultsRecruitment for MEMPHIS took place between May 2016 and September 2016. The study was closed March 2017 and the report was submitted to the NIHR on October 26, 2017.ConclusionsThis feasibility trial will inform the design of a large multicentered trial to assess the clinical effectiveness of mindfulness meditation delivered via a smartphone app for the treatment of CPP.Trial RegistrationClinicalTrials.gov: NCT02721108; https://clinicaltrials.gov/ct2/show/NCT02721108 (Archived by WebCite at http://www.webcitation.org/6wLMAkuaU); BioMed Central: ISRCTN10925965; https://www.isrctn.com/ISRCTN10925965 (Archived by WebCite at http://www.webcitation.org/6wLMVLuys)

A survey study to assess the patients’ knowledge about anticoagulation therapy

Warfarin is the most commonly used oral anticoagulants for the patients with DVT, atrial fibrillation, atrial flutter, valvular heart diseases and artificial heart valve. The aim of the study was to assess the knowledge among elderly patients about warfarin therapy. A survey based study was done on 200 elderly patients. Post operative cardiac surgery patients with prosthetic valve replacement, patients with atrial fibrillation and age more than 60 years (elderly) were enrolled for this study. Demographic related data was collected and Standardized Anticoagulant knowledge assessment (AKA) questionnaire was used for the survey. Data analysis was done using STATA 11.1, with the level of significance at p < 0.05. A total of 200 elderly patients, 65% men and 35% women participated in this survey-based study. The mean age of the patients was 69 years. About 58% of elderly patients reported forgetfulness, 14% reported non availability of medicine, and 18% reported financial problems as a reason for non compliance. In this study, only 42% of the patients were aware of any adverse effects of medicine and 66% of elderly patients were not knew of any drug interactions. 75% of patients reported that they are monitoring their PT/INR regularly. It was found that patients’ knowledge of warfarin therapy was low. It is of high importance that medical and nursing professionals must educate elderly patients about warfarin therapy to avoid life threatening drug complications.

Factors affecting compliance to antihypertensive treatment among adults in a tertiary care hospital in Mumbai

Background:Compliance to antihypertensive therapy reduces the risk of complications. It is important to understand the factors affecting compliance in patients so that the goal of successful treatment is not jeopardized.Objectives:To determine the proportion of participants' compliant to treatment and various factors associated with compliance of antihypertensive treatment.Settings and Design:A cross-sectional study of 330 hypertensive patients on treatment attending the outpatient department of a tertiary care hospital in Mumbai.Subjects and Methods:It was conducted over 8 weeks using a validated, pretested questionnaire including information on the individual's sociodemographic profile, compliance to antihypertensive therapy and lifestyle advice assessed using a 4-point Likert scale.Statistical Analysis:Data were entered into MS Excel 2007 and analyzed using SPSS 20.Results:Participants' mean age was 55.2 ± 12.6 years. 39.4% were compliant to their treatment. Common reasons for frequently skipping the dose – forgetfulness (41.2%) and discontinued the medication when feeling well (30.3%). Factors positively associated with compliance were gender and illiteracy. The proportion of noncompliance among smokers and alcoholics was statistically significant.Conclusion:Forgetfulness and subjective feeling of wellness were the prevalent reasons for noncompliance. Controlling habits such as smoking and alcohol may prove as key factors for compliance.

Adherence to a Nurse-Driven Feeding Protocol in a Pediatric Intensive Care Unit.

Patients admitted to pediatric intensive care units (PICUs) often experience prolonged periods without nutrition support, which may result in hospital-induced malnutrition and longer length of stay. Nurse-driven feeding protocols have been developed to prevent unnecessary interruptions or delays to nutrition support. The primary objective of this study was to identify compliance and reasons for noncompliance to a feeding protocol at a tertiary care hospital PICU in Canada. The secondary aim was to determine the mean time (hours) spent without any form of nutrition and to identify reasons for time spent without nutrition. This was a prospective cohort audit, consisting of 150 consecutive PICU admissions (January-February 2016). Exclusion criteria consisted of patient mortality within 48 hours (n = 1) and patients who were still admitted at the end of the data collection timeframe (n = 7). The remaining cohort consisted of 142 consecutive admissions. Data collection took place in real time and included patient demographics, diagnostic categories, time spent without nutrition, reasons for interruptions to nutrition support, and reasons for noncompliance to the protocol. Observations were obtained through paper and computer charts and conversing with clinicians. There was a 95% compliance rate to the protocol and an average of 25.6 hours spent without nutrition per patient. The most prevalent reason for noncompliance was an avoidable delay to restart feeds before/after procedures or after surgery. A nurse-driven feeding protocol may reduce time spent without nutrition. Future research is required to examine the relationship between adherence to feeding protocols and clinical outcomes.

Impact of a clinical pathway tool on appropriate palliative radiation therapy for bone metastases

PurposeClinical pathways increase compliance with treatment guidelines, improve outcomes, and reduce costs. Guidelines recommend single fraction radiation therapy (SFRT) for palliation of uncomplicated bone metastases, but implementation is variable. We examined the effects of a pathway tool on SFRT rates in an academic radiation oncology practice. Methods and materialsUsing published literature, clinical guidelines, and expert input, we designed a clinical pathway for bone metastases radiation therapy displayed on a Web-based electronic interface. In March 2016, the pathway launched on a palliative radiation service at the Dana Farber/Brigham and Women's Cancer Center main campus and at affiliated community sites. Providers were surveyed pre- and postimplementation to assess expectations and elicit feedback. Rates of pathway utilization, compliance with SFRT recommendations, and reasons for noncompliance were assessed. ResultsThe final pathway includes 20 endpoints and several validated prognostic scoring systems. It was used in 38% of 723 bone metastases radiation prescriptions, with appropriate SFRT rates rising from 18% before implementation to 48% after launch (P < .01). Major reasons for rejecting recommendations included disagreement with life expectancy prognostication and patient convenience. The pathway increased physicians’ confidence regarding compliance with treatment guidelines and made it easier to find well-supported treatment recommendations. Workflow disruptions and the inability to handle nuanced situations emerged as limitations. ConclusionsOur experience demonstrates the utility of clinical pathway decision support for bone metastases radiation in complex academic settings. Next steps include increasing the pathway’s ease of use, refining the pathway’s prognostic abilities, and measuring cost savings related to the pathway.

Percutaneous Tibial Nerve Stimulation in the Office Setting: Real-world Experience of Over 100 Patients

To examine the outcomes and compliance with percutaneous tibial nerve stimulation (PTNS) for overactive bladder (OAB) symptoms. Adults who had PTNS from June 30, 2011, to October 8, 2015, were retrospectively reviewed for demographics, copay, travel distance, employment status, history, symptoms, and treatments used before, during, and after PTNS. Pearson chi-square test, Fisher exact test, Wilcoxon rank and paired t test were performed. Of 113 patients (mean age 75 ± 12 years), most were women (65.5%), married (78.1%), and retired or unemployed (80.2%). The median distance to the clinic was 8.1 mi, and the median copay was $0. The most common indication for PTNS was nocturia (92.9%) followed by OAB with urgency urinary incontinence (75.2%) and urinary urgency and/or frequency (24.8%). Prior treatments included anticholinergics (75.2%), mirabegron (36.6%), behavioral modification (29.2%), pelvic floor physical therapy (18.6%), and others (19.5%). Patients completed a mean of 10.5 ± 3 of 12 planned weekly PTNS treatments. Of 105 patients, 40 (38.1%) used concomitant treatments (most commonly anticholinergics). Of 87 patients, 62 (71.3%) had decreased symptoms at 6 weeks, and of 85 patients, 60 (70.6%) had decreased symptoms at 12 weeks. The majority (82; 75.6%) completed all 12 weekly treatments and 45 (54.9%) completed 3 (median) monthly maintenance treatments. The most common reason for noncompliance was lack of efficacy. Visit copay, employment status, and distance to the clinic were not associated with failure to complete weekly treatments or progression to monthly maintenance. Although most patients' symptoms decreased after weekly PTNS, nonadherence to maintenance and lack of efficacy may limit long-term feasibility. Copay and distance traveled were not associated with noncompliance.

Benchmarking the American Society of Breast Surgeon Member Performance for More Than a Million Quality Measure-Patient Encounters

BackgroundNine breast cancer quality measures (QM) were selected by the American Society of Breast Surgeons (ASBrS) for the Centers for Medicare and Medicaid Services (CMS) Quality Payment Programs (QPP) and other performance improvement programs. We report member performance.Study DesignSurgeons entered QM data into an electronic registry. For each QM, aggregate “performance met” (PM) was reported (median, range and percentiles) and benchmarks (target goals) were calculated by CMS methodology, specifically, the Achievable Benchmark of Care™ (ABC) method.ResultsA total of 1,286,011 QM encounters were captured from 2011–2015. For 7 QM, first and last PM rates were as follows: (1) needle biopsy (95.8, 98.5%), (2) specimen imaging (97.9, 98.8%), (3) specimen orientation (98.5, 98.3%), (4) sentinel node use (95.1, 93.4%), (5) antibiotic selection (98.0, 99.4%), (6) antibiotic duration (99.0, 99.8%), and (7) no surgical site infection (98.8, 98.9%); all p values < 0.001 for trends. Variability and reasons for noncompliance by surgeon for each QM were identified. The CMS-calculated target goals (ABC™ benchmarks) for PM for 6 QM were 100%, suggesting that not meeting performance is a “never should occur” event.ConclusionsSurgeons self-reported a large number of specialty-specific patient-measure encounters into a registry for self-assessment and participation in QPP. Despite high levels of performance demonstrated initially in 2011 with minimal subsequent change, the ASBrS concluded “perfect” performance was not a realistic goal for QPP. Thus, after review of our normative performance data, the ASBrS recommended different benchmarks than CMS for each QM.

Analysis of reasons for noncompliance with laser treatment in patients of diabetic retinopathy

To identify the underlying reasons for noncompliance among Chinese patients undergoing laser photocoagulation treatment for diabetic retinopathy (DR). Prospective cohort study. A total of 262 patients with DR with indications for panretinal photocoagulation and focal laser treatment were recruited. Those who did not complete the prescribed laser treatment were categorized into 2 types of defaulters: Type 1 defaulters were those who did not initiate laser treatment as scheduled; type 2 defaulters were those who did not complete the entire laser sessions, including terminating midterm or defaulting prompt supplement of laser treatment. A standardized questionnaire was given to the 2 types of defaulters to collect information about the reasons for noncompliance. Data were analyzed and subjected to χ2 test or Fisher exact statistical tests. The noncompliance rate was 45.5%, which is significantly greater than some developed countries. Unawareness of the necessity for treatment and unawareness of the importance to complete treatment were 2 main reasons leading to noncompliance, representing 28.8% and 36.0%, respectively. Unawareness of the necessity for treatment and fear of laser treatment were more important for type 1 defaulters (29 vs 6 and 11 vs 0, respectively), whereas unawareness of completeness of laser treatment was overweighed in type 2 defaulters (27 vs 13 patients; all P<0.01). These results were likely related to the lack of knowledge about the potential consequences of DR, the underlying principle of laser treatment, and panretinal photocoagulation procedures. Developing appropriate education programs targeting specific reasons will help to improve the compliance in patients with DR.

Hand hygiene compliance in a universal gloving setting

The use of gloves for every patient contact (ie, universal gloving) has been suggested as an infection prevention adjunct and alternative to contact precautions. However, gloves may carry organisms unless they are changed properly. In addition, hand hygiene is required before donning and after removing gloves, and there are scarce data regarding glove changing and hand hygiene in a universal gloving setting. This nonrandomized observational before-after study evaluated the effect of education and feedback regarding hand hygiene. Compliance with hand hygiene and glove use was directly observed in a universal gloving setting at a 10-bed intensive care unit in a Japanese tertiary care university teaching hospital. A total of 6,050 hand hygiene opportunities were identified. Overall, hand hygiene compliance steadily increased from study period 1 (16.1%) to period 5 (56.8%), although there were indication-specific differences in the baseline compliance, the degree of improvement, and the reasons for noncompliance. There were decreases in the compliance with universal gloving and the incidence of methicillin-resistant Staphylococcus aureus. It is difficult to properly perform glove use and hand hygiene in a universal gloving setting, given its complexity. Direct observation with specific feedback and education may be effective in improving compliance.

Preliminary survey on knowledge, attitudes and practices regarding rabies

Introduction The Public Health Veterinary Services’ goal is to reduce the number of deaths from rabies to zero by 2020. Community awareness and responsible behaviour of pet owners are key to achieving this goal. Knowledge, attitude and practices (KAP) regarding rabies has been reported only from Kandy district. We describe a preliminary survey among outpatients in Colombo, to supplement existing knowledge. Methods A convenience sample (n = 200) was selected during April to May 2016, from outpatients of the National Hospital of Sri Lanka. Data was collected using a self-administered questionnaire. Results Majority were female (66.5%), Buddhist (80.5%) and from Colombo (58.5%). More than 75% of the sample knew dogs were the main reservoir, that transmission was by biting, that washing the wound was important and that rabies could be prevented by vaccinating dogs and humans. However, only 22.5% were aware that rabies was fatal after development of disease. Knowledge was lacking regarding other animal reservoirs, other modes of transmission and clinical features of rabid animals. Pet owners were more likely to have been bitten by a dog than others (p<0.05). However, only half of the respondents admitted that their pets had been vaccinated during the last year. Conclusion Future health education programs should highlight other animals, other methods of transmission and clinical features to identify rabid animals. Message needs to be clear that vaccination after developing the disease does not change the outcome. Reasons for non compliance regarding dog vaccination needs to be investigated.

Feasibility of Patient Reporting of Symptomatic Adverse Events via the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) in a Chemoradiotherapy Cooperative Group Multicenter Clinical Trial

To assess the feasibility of measuring symptomatic adverse events (AEs) in a multicenter clinical trial using the National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Patients enrolled in NRG Oncology's RTOG 1012 (Prophylactic Manuka Honey for Reduction of Chemoradiation Induced Esophagitis-Related Pain during Treatment of Lung Cancer) were asked to self-report 53 PRO-CTCAE items representing 30 symptomatic AEs at 6 time points (baseline; weekly ×4 during treatment; 12weeks after treatment). Reporting was conducted via wireless tablet computers in clinic waiting areas. Compliance was defined as the proportion of visits when an expected PRO-CTCAE assessment was completed. Among 226 study sites participating in RTOG 1012, 100% completed 35-minute PRO-CTCAE training for clinical research associates (CRAs); 80 sites enrolled patients, of which 34 (43%) required tablet computers to be provided. All 152 patients in RTOG 1012 agreed to self-report using the PRO-CTCAE (median age 66years; 47% female; 84% white). Median time for CRAs to learn the system was 60minutes (range, 30-240minutes), and median time for CRAs to teach a patient to self-report was 10minutes (range, 2-60minutes). Compliance was high, particularly during active treatment, when patients self-reported at 86% of expected time points, although compliance was lower after treatment (72%). Common reasons for noncompliance were institutional errors, such as forgetting to provide computers to participants; patients missing clinic visits; Internet connectivity; and patients feeling "too sick." Most patients enrolled in a multicenter chemoradiotherapy trial were willing and able to self-report symptomatic AEs at visits using tablet computers. Minimal effort was required by local site staff to support this system. The observed causes of missing data may be obviated by allowing patients to self-report electronically between visits, and by using central compliance monitoring. These approaches are being incorporated into ongoing studies.

Perceived compliance and barriers to care in sublingual immunotherapy.

For allergy immunotherapy to be effective, patient compliance is critical. However, aqueous sublingual immunotherapy (SLIT) may be considered demanding for patients, requiring strict daily dosing and refilling of medication at regular intervals. In this study we sought to determine how patients perceive their own compliance with SLIT and identify barriers that may hinder compliance. Using a retrospective review, 46 patients currently undergoing aqueous SLIT were identified to have less-than-excellent compliance based on frequency of clinic visits for SLIT refills. Twenty-eight of these patients completed a phone survey regarding symptom improvement, compliance, and barriers to care. In addition, 56 patients who withdrew from therapy before completion were polled about barriers to adherence. Of the 28 patients participating in the initial phone survey, 24 (86%) reported subjective improvement in symptoms on SLIT, despite less-than-excellent compliance. Nineteen (68%) of these patients perceived their own compliance to be excellent. Eighteen patients (65%) reported the inconvenience of scheduling and attending clinic appointments to be the main reason for noncompliance. The most common reasons for withdrawal from therapy were cost (27%), lack of effectiveness (25%), and difficulty with compliance (14%). The majority of aqueous SLIT patients perceived their compliance to be excellent, although, based on a previous study, these patients did not reach excellent compliance benchmarks. Inconvenience of clinic visits and cost of therapy were found to be the most common barriers to care. Despite what providers perceived as less-than-excellent compliance, 82% of patients reported symptom improvement with SLIT.

Views on Antipsychotic Medication in Jordan: From the People Diagnosed with Schizophrenia Perspectives

Background: Antipsychotic medications are commonly used to ameliorate symptoms associated with psychotic disorders such as schizophrenia. The aim of this study was to investigate of the People Diagnosed with Schizophrenia (PDwS) experiences towards antipsychotic medication. Methods: A qualitative semi-structured interview was conducted with PDwS (n=22) to elicit their perspectives about antipsychotic medication. Results: Interviewees perceived antipsychotic medication is a source of threat to their wellbeing and identified several reasons for non-compliance, including lack of insight, dissatisfaction with mental health services and the illness nature and treatment. The participants attributed lack of family support as a reason for noncompliance. Moreover, many of these factors in Jordan are similar to noncompliance reasons in high income countries Conclusion: PDwS reported wide range of experiences and attitudes towards antipsychotic medication and this study identified the major factors for noncompliance with medication in low-income country. Therefore, the current mental health policy should be revised to address these factors in order to enhance adherence rate.

Compliance and patterns of iron-folic acid intake among adolescent girls and antenatal women in rural Tamil Nadu

Background: Anemia continues to be a major public health problem in India despite its long-recognized negative impact on health, especially of women. In a scenario where there is little increase in Hb levels even with implementation of various iron supplementation program apart from compliance, their dietary pattern also may play a role. Moreover, majority of the current literature assessed compliance to Iron Folic Acid (IFA) supplements in facility based settings. Objectives: This study aims to identify the compliance to Iron Folic Acid intake and dietary pattern which could influence the absorption of iron among anaemic pregnant women and adolescent girls in a rural area of Tamil Nadu. Methods: This community based cross sectional study was carried out in one of the primary health centres (PHC) in Tamil Nadu during the period of Feb-Mar 2013 among pregnant women and adolescent girls. From the eligible pregnant women and adolescent girls, information regarding socio economic characteristics, practices related to personal hygiene, dietary patterns, consumption of Iron Folic Acid tablets, and reason for non compliance were collected using structured questionnaires during house-to-house visit. Following this, Haemoglobin was estimated among all study participants. Results: Totally 147 (99.3%), 99 (56.6%) pregnant women, adolescent girls were found to be anemic respectively. Out of these, Iron folic acid tablets were consumed by 136 (91.9%), 60 (60.6%) of pregnant women and adolescent girls respectively. Around 90% of the anemic participants consumed IFA tablets during the night time, immediately after food in rice based diet. Pregnant women who were in their third trimester (OR 0.27, 95% CI: 0.10 to 0.69) and high socio economic status (OR 0.10, 95% CI: 0.02 to 0.55) had significant poor compliance compared to women in second trimester and low socio economic status respectively. Among the adolescent girls, increasing age and current school going status had facilitated the consumption of more number of IFA tablets. Conclusion: In this backward district, prevalence of anemia among pregnant women and adolescent girls were extremely high. Compliance to IFA tablets among pregnant women is favourable whereas among adolescent girls is extremely poor. Some of the dietary practices followed in this region could impair the iron absorption level and treatment effect.

Assessment of chronic myeloid leukemia patients' adherence with “tyrosine kinase inhibitors” in King Abdulaziz Medical City

CONTEXT: Worldwide, chronic myeloid leukemia (CML) accounts for 15% of all leukemia types. CML treatment and outcome has improved dramatically from the average survival of 3–5 years in the past to almost normal life expectancy with the new targeted therapy with tyrosine kinase inhibitors (TKI). Compliance of CML patients with oral TKIs is a medically challenging issue preventing achieving a favorable outcome. AIMS: The aim of this study is to assess CML patients' adherence to treatment in King Abdulaziz Medical City (KAMC). SUBJECTS AND METHODS: This is a prospective, observational study that includes all patients diagnosed with CML in KAMC-Riyadh (KAMC-R) where patients were interviewed before receiving TKI prescription and during a subsequent visit. Consent, demographics, and medication data were obtained in the first encounter. Compliance and reasons for noncompliance were assessed using pill count methods during the second visit. STATISTICAL ANALYSIS USED: Statistical analysis was performed using SPSS. RESULTS: A total of 63 CML patients are followed and treated in KAMC-R at the time of conducting this study. Sixteen patients were excluded from the study due to either loss of follow-up or using a non-TKI treatment option. The study was conducted on 47 patients; male:female ratio was 20 (40%):28 (60%). The mean age was 51 years (range 23–76 years). Twenty-four patients (51%) were fully compliant to the TKIs while 23 patients (49%) were not compliant. The study reported three main reasons for noncompliance, drug toxicity in 7 patients (30%), forgetfulness in 7 patients (30%), and ignorance in 2 patients (9%). CONCLUSIONS: To the best of our knowledge, this is the first study assessing compliance of CML patients with TKIs among Saudi population. Noncompliance with TKIs is a major health-care problem affecting the outcome of treatment. Stressing on patient education before and during TKIs treatment might improve the compliance.