Risk Factors For Noncompliance Research Articles

Actual compliance rate of Enhanced Recovery After Surgery protocol in laparoscopic distal gastrectomy.

PurposeThe Enhanced Recovery After Surgery (ERAS) protocol enhances recovery rate after laparoscopic distal gastrectomy (LDG). An ERAS protocol has been applied to most patients who underwent LDG at our center. In this study, we determined the actual compliance rate of the ERAS protocol and analyzed the risk factors for noncompliance.MethodsMedical records of 1,013 patients who underwent LDG from March 2016 to December 2017 were reviewed retrospectively. The compliance group (A) included 327 patients who were discharged within four days postoperatively. The noncompliance group (B) comprised 686 patients who were not discharged within four days postoperatively.ResultsThe compliance rate of the ERAS protocol was 32.3%. Potential compliance rate was 53.2%. Most common reasons for noncompliance were fever (n = 115) and ileus (n = 111). The 30-day emergency room visit rate was significantly lower in group A than that in group B (p = 0.006). Median age, American Society of Anesthesiologists (ASA) physical status classification, operation time, and pathologic stage were significantly higher in group B than those in group A (p < 0.001, p < 0.001, p = 0.005, and p < 0.001, respectively). Risk factors for noncompliance were ASA classification of ≥III (odds ratio [OR], 2.251; p = 0.007), age of ≥70 years (OR, 1.572; p = 0.004), operation time of ≥180 minutes (OR, 1.475; p = 0.003), and pathologic stage of ≥III (OR, 2.224; p < 0.001).ConclusionThe current ERAS protocols should be applied to patients without risk factors.

Follow-Up Appointment Delay in Diabetic Macular Edema Patients

To evaluate a novel measure of compliance, follow-up appointment delay, and assess its relationship with clinical and sociodemographic factors in patients undergoing treatment for diabetic macular edema (DME). This is a comparative case series of patients treated for DME. The novel measure of compliance - the time in days from the intended day of return and actual day of return, or follow-up appointment delay - was studied and compared to a traditional measure: the percentage of visits missed. These were correlated with clinical and sociodemographic characteristics: best-corrected visual acuity, hemoglobin A1C percent (HbA1c), median household income, smoking status, type of insurance held, marital status, gender, and age. Univariate and multivariable analyses were conducted. One hundred fifty-five patients (212 eyes) were included in the study. The median times between recommended and actual appointments was 5.0 days (range: 2.0-14.0 days). The mean percentage of visits missed was 31.7% (± 13.3%). The two measures of compliance were positively associated, but the correlation was moderate (r = 0.44). Non-white race, lack of bilateral injections, and higher baseline HBA1c were significant predictors of a median time greater than 7 days between the intended and actual follow-up dates. The current study identified a novel method of measuring compliance of DME patients seen by retina specialists and has identified non-white race, lack for bilateral treatment, and poorer glycemic control as risk factors for noncompliance. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:200-206.].

Efficacy and safety of direct oral anticoagulants in patients with pulmonary thromboembolism

Anticoagulant therapy is the treatment of any variant of pulmonary thromboembolism and patients in 100% of cases. In actual clinical practice, for the treatment and prevention, it is necessary to carry out regular control laboratory indicators, a constant dose adjustment, which can always be feasible for patients and it is not surprising to doctors when they independently discontinue treatment. The last decade was marked by the emergence of direct oral anticoagulants (DOAC) – factors determining Xa and direct thrombin inhibitor, which provide a predictable mechanism of action, the dosage regimen in standard dosages, no need for laboratory control and a minimum of food and drug interactions. In clinical practice, it is very important to try to balance the risks and benefits when choosing a new anticoagulant, which leads to a comparative analysis of the effectiveness and safety of all currently registered DOAC. This article is devoted to the analysis of the problems of safety and efficacy of anticoagulants, as well as their use over a long period of time. It should be understood that the large-scale studies convincingly prove that the effectiveness and safety of flights, however, should be recognized that patients with indications for thrombectomy reduce the rate of renal reaction with a glomerular rate of less than 30 ml/min. In this regard, the assessment of the actual efficacy and safety of the PAK also reveals risk factors for noncompliance in actual clinical practice, which are important not only with frequent dosing, but also with motivation, understanding, and socio-economic status of the pat ient.

Abstract 173: Predictors of Medication Noncompliance in Patients with an Acute Myocardial Infarction

Background: Aspirin, P2Y12 inhibitors, Statins, Angiotensin-Converting-Enzyme Inhibitor/Angiotensin II Receptor Blockers and Beta Blockers improve outcomes for patients with an Acute Myocardial Infarction (AMI). Despite this, some patients remain noncompliant with medications. We investigated potential predictors of medication noncompliance in patients with an AMI. Method: We examined adult patients with an AMI enrolled in a quality improvement program (QIP). Patients discharged prior to enrollment or those discharged to skilled nursing facilities were excluded. The primary outcome was medication noncompliance at the first follow up visit - defined as not taking at least 1 of the medications listed above. Multivariate logistic regression was used to identify risk factors for noncompliance. Results: Among 173 patients enrolled in the QIP, 119 patients (Mean age 64 +/- 1 year; 32% Females) had data regarding their follow-up office visit, of which 32% of patients were noncompliant. Table 1 lists the univariate and multivariate predictors of noncompliance. Among 25 clinical and socio-demographic variables examined, we found that needing help with medical care, or being a primary care giver to others were each associated with a roughly 5 fold higher risk of medication noncompliance. Conclusion: A significant number of patients with an AMI are noncompliant with their medications. Social support programs should focus efforts on providing patients with the help needed at home to ensure compliance with care.

Medication Noncompliance among Patients with Chronic Diseases Attending a Primary Health Facility in a Periurban District in Ghana.

Background Despite the growing interest in understanding the aetiology of chronic diseases, limited studies exist on medication noncompliance, especially, among periurban and rural dwellers in Ghana. In this study, we determined the prevalence of medication noncompliance and explored the medication intake behaviour of patients with chronic diseases. The relative influence of cost on medication noncompliance and the risk factors for noncompliance were also assessed. Methods The design was a cross-sectional study of 200 patients from ages below 40 years to ages above 60 years sampled from the Offinso South Municipality, a periurban district of the Ashanti region of Ghana. Data collected through the administration of structured questionnaires was coded, cleaned, and analysed using the SPSS (v20) software programme. Descriptive and multivariate analyses using binary logistic regression were performed. Results Medication noncompliance was high (55.5%), with patients living with HIV/AIDS and those with psychological disorders being the most noncompliant. Majority of patients took at least 2 medications (81.5%), did so twice daily (79.0%), did not experience side effects with intake (67.0%), considered their medication to be effective (88.5%), and were aware of the complications that could arise from noncompliance. The dominant route of medication intake was oral (86.8%) and a lesser proportion of patients (22.5%) took herbal preparation alongside their prescribed medications. The cost of medication did not prevent patients from adhering to their medication regimen as most of these drugs were covered by the National Health Insurance Scheme (NHIS). Age, duration of diagnosis and difficulty in remembering medication instructions were identified as significant predictors of noncompliance. Conclusion Educating patients on the need to be compliant with their medication regimen, the complications that could arise from noncompliance and avoidance of intake of herbal medications during their treatment should form part of the clinical sessions organized for patients with chronic conditions.

Factors predicting brace noncompliance among idiopathic clubfoot patients treated with the Ponseti method

Abstract Objectives The purpose of this study was to determine the compliance of parents of children with clubfeet treated with the Ponseti method and to identify factors that may predict brace non-compliance. Methods A myriad of factors affecting families' compliance were assessed by administering questionnaires to 108 patients with clubfoot from December 2009 to January 2012. The family's demographic data, including monthly income, educational level of the parents, number of children in the family, and other factors, were studied and statistically analysed. Results All 108 patients had severe clubfoot. The parents of 72 (66.7%) patients complied with the use of the brace compared to 36 (33.3%) parents who did not comply. Unilateral clubfoot was a significant risk factor for non-compliant parents compared to bilateral clubfeet (p = 0.05). Parents with 3 or more children had more non-compliance (66.7%) compared to those with less than 3 children (38.9%). All non-compliant parents reported that their babies cried during the application of the brace in contrast to 25% of the complaint parents (p Conclusion More children per family, unilateral clubfoot, and the inability of a single parent alone to apply the brace were found to be major risk factors for brace non-compliance. Families' awareness about the importance of the brace and encouragement might improve brace compliance.

Compliance with oral antiestrogens utilizing a bubble pack.

132 Background: Adherence to endocrine therapy in breast cancer has been a long recognized problem despite efficacy to these drugs. Most of our knowledge of noncompliance has been largely observational and retrospective. Although multifactorial, extremes of age and race are risk factors for noncompliance. This report is an interim analysis of a well-designed study prospectively measuring compliance rates of “bubble” packaging of oral anti-estrogens Methods: A total of 88 patients were enrolled between August 2012 and April 2014. Out of 88 patients, 1 declined participation and 1 was deemed ineligible based on metastatic disease. Of the remaining 86, 53 continued participation and were included in this analysis. Demographic and clinical data were collected prospectively including age, race, insurance, duration of therapy, stage, and comorbidities. Duration of therapy was divided into 3 cohorts: early (less than 12 months), middle ( 12-36 months,) or late (37-60 months.) Comorbidities were defined as none, moderate (1-3) or significant (&gt;3.) All patients received anti-estrogens in a “bubble”pack. All used bubble packs and missed dose diaries were returned at follow up appointments for review. Results: The majority of patients were white (77%)) and stage I/II (74%.) The overall compliance rate was 97%; however only 61% of enrolled patients were continued in the analysis. None of the variables examined race, age, insurance status and/ or stage had an impact on compliance. Only duration of therapy had a marginal effect on compliance (p value = 0.06.) The late cohort was least likely to be compliant at 89.53%, although only represented 9% of the included patients. Conclusions: The compliance rate of bubble packaging is higher than expected however should be interpreted with caution given the 39% withdrawal. Interestingly there was no difference in compliance rate among race, insurance status or age which contradicts our current knowledge on high risk groups. However duration of therapy did have a negative impact on compliance and may become increasingly important as duration of anti-estrogen therapy extends. However given the small number of patient in this cohort this will need to be confirmed at final analysis with larger involvement within this group. Clinical trial information: NCT01694225.

Compliance with Surgical Antibiotic Prophylaxis Guidelines in Pediatric Surgery

Surgical antibiotic prophylaxis (AP) guidelines balance the need to prevent infection with the risks of adverse drug effects. Our aim was to assess compliance with AP guidelines. A retrospective study was performed in a pediatric medical center. Included were patients aged 0 to 18 years that underwent clean-contaminated surgery during a 1-year period (2008-2009) and required AP. Compliance with four AP bundle guidelines was evaluated. Risk factors for noncompliance were identified using univariate and multivariate analyses. AP was given to 239 of 247 (96.8%) of patients. Complete compliance with AP guidelines was achieved in 16 of 247 (6.5%) patients. Compliance with guidelines for appropriate antibiotic, drug dose, correct timing, and treatment duration were found in 97.1, 52.2, 31.9, and 35.9% of patients, respectively. Multivariable analysis showed that inappropriate timing was associated with age ≥ 4 years (p = 0.002), urgent surgery (p = 0.0018), surgical department AP administration (p = 0.0001), and night-time surgery (p = 0.015). Incorrect AP dose was associated with presence of comorbidities (p = 0.006). No risk factor was related to incorrect AP duration. We have found a low rate of full compliance with AP guidelines. AP should only be given in the operating room. Increased awareness to AP guidelines is needed.

Unplanned Interruptions during Radiation Therapy for Head and Neck Cancer: Analysis of Potential Pretreatment Risk Factors for Non-compliance

Unplanned Interruptions during Radiation Therapy for Head and Neck Cancer: Analysis of Potential Pretreatment Risk Factors for Non-compliance

POSTVASECTOMY SA: RISK FACTORS FOR NONCOMPLIANCE

You have accessJournal of Urology1 Apr 2008POSTVASECTOMY SA: RISK FACTORS FOR NONCOMPLIANCE Alek Mishail, Jacqueline Lee, David Schulsinger, and Yefim R Sheynkin Alek MishailAlek Mishail More articles by this author , Jacqueline LeeJacqueline Lee More articles by this author , David SchulsingerDavid Schulsinger More articles by this author , and Yefim R SheynkinYefim R Sheynkin More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)61745-0AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "POSTVASECTOMY SA: RISK FACTORS FOR NONCOMPLIANCE." The Journal of Urology, 179(4S), p. 595 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 595 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Alek Mishail More articles by this author Jacqueline Lee More articles by this author David Schulsinger More articles by this author Yefim R Sheynkin More articles by this author Expand All Advertisement PDF downloadLoading ...

Abandono do tratamento de tuberculose utilizando-se as estratégias tratamento auto-administrado ou tratamento supervisionado no Programa Municipal de Carapicuíba, São Paulo, Brasil

To determine treatment noncompliance rates among patients participating in a municipal tuberculosis control program and to identify the variables related to noncompliance depending on the type of treatment strategy used. A longitudinal non-concurrent cohort study was carried out involving two cohorts of patients participating in the Tuberculosis Control Program of the city of Carapicuíba, Brazil. The first cohort comprised 173 patients with tuberculosis treated from January 1, 2003 to December 31, 2003 using self administration of treatment, and the second comprised 187 patients with tuberculosis treated from July 1, 2004 to June 30, 2005 using the directly observed therapy, short-course strategy. Noncompliance rates decreased from 13.3% (self administration of treatment) to 5.9% (directly observed therapy, short-course), a significant difference (p < 0.05). For the self administration of treatment strategy, the variables significantly associated with treatment noncompliance were as follows: being an unregistered worker (relative risk [RR] = 3.06); retreatment (RR = 2.73); alcoholism (RR = 3.10); and no investigation of contacts (RR = 8.94). For the directly observed therapy, short-course strategy, no variables were significantly associated with noncompliance. The directly observed therapy, short-course strategy decreased noncompliance rates and produced better treatment outcomes, even when the risk factors for noncompliance were the same.

Risk Factors for Noncompliance With Follow-up Among Normal-tension Glaucoma Suspects

To evaluate noncompliance with follow-up in normal-tension glaucoma (NTG) suspects. Retrospective cohort study. We reviewed 203 patient charts at a university eye clinic, identified as NTG suspects from a database of optic disk photographs. Noncompliance was defined as less than one year of follow-up and/or fewer than two completed visual field (VF) tests. Twenty-two patients (11%) were excluded because at least two VF tests were not ordered. The 181 patients analyzed included 45 (25%) non-Whites and 16 (9%) non-English speakers. Eighty-three patients (46%) were noncompliant. These patients were significantly younger (50.5 +/- 15.0 years vs 55.1 +/- 12.8 years; P = .028), were more likely to speak English (P = .023), and were more likely to have no or unknown health insurance (P < .001). Almost half of NTG suspects lacked appropriate follow-up. Lack of health insurance may be a significant barrier to compliance with follow-up in this population.

Factores pronósticos del abandono del tratamiento antituberculoso en una región endémica del Perú

To identify factors that predict noncompliance with tuberculosis treatment in the province of Ica, Peru. Between 1998 and 2000 a case-control study (1:1 ratio) was conducted in the province of Ica, with 55 cases (persons who dropped out of treatment) being identified. The factors evaluated were chosen from Lalonde's model of the field of health. The respective odds ratios were calculated by means of univariate analysis and multivariate analysis. The following factors were identified as being predictive of noncompliance with tuberculosis treatment: thinking that the information that health workers provided on treatment was insufficient (odds ratio (OR) = 4.20; 95% confidence interval (95% CI), 1.77-10.02), thinking that the office hours for receiving treatment were inadequate (OR = 9.95; 95% CI, 1.97-50.21), and consuming illegal drugs (OR = 7.15; 95% CI, 1.69-30.23). To improve compliance with tuberculosis treatment, it is necessary to provide patients with personalized information on the disease and its treatment, and to offer them flexible, appropriate times to receive treatment. Drug consumption is the most serious risk factor for noncompliance, and identifying and following up with drug users is crucial.

Noncompliance With Directly Observed Therapy for Tuberculosis: Epidemiology and Effect on the Outcome of Treatment

To describe the epidemiology and clinical consequences of noncompliance with directly observed therapy (DOT) for treatment of tuberculosis. Retrospective review. An urban tuberculosis control program that emphasizes DOT. All patients treated with outpatient DOT from 1984 to 1994. We defined noncompliance as follows: (1) missing > or = 2 consecutive weeks of DOT; (2) prolongation of treatment > 30 days due to sporadic missed doses; or (3) incarceration for presenting a threat to public health. Poor outcomes of therapy were defined as a microbiologic or clinical failure of initial therapy, relapse, or death due to tuberculosis. Fifty-two of 294 patients (18%) who received outpatient DOT fulfilled one or more criteria for noncompliance. Using multivariate logistic regression, risk factors for noncompliance were alcohol abuse (odds ratio, 3.0; 95% confidence interval, 1.2 to 7.5; p = 0.02) and homelessness (odds ratio, 3.2; 95% confidence interval, 1.5 to 7.2; p = 0.004). Noncompliant patients had poor outcomes from the initial course of therapy more often than compliant patients: 17 of 52 (32.7%) vs 8 of 242 (3.3%); relative risk was 9.9; 95% confidence interval was 4.5 to 21.7 (p < 0.001). In an urban tuberculosis control program, noncompliance with DOT was common and was closely associated with alcoholism and homelessness. Noncompliance was associated with a 10-fold increase in the occurrence of poor outcomes from treatment and accounted for most treatment failures. Innovative programs are needed to deal with alcoholism and homelessness in patients with tuberculosis.