Self-reported Adherence Scores Research Articles

Antimicrobial Stewardship for Outpatients with Chronic Bone and Joint Infections in the Orthopaedic Clinic of an Academic Tertiary Hospital, South Africa.

Bone and joint infections are associated with prolonged hospitalizations, high morbidity and complexity of care. They are difficult to treat, and successful therapy requires organism-specific antimicrobial therapy at high doses for a prolonged duration as recommended in standard treatment guidelines (STGs). Adherence to the treatment plan is equally important, which is enhanced with knowledge of the condition as well as appropriate antibiotics. Consequently, the aim of this study was to provide antimicrobial stewardship (AMS) services to outpatients with chronic bone and joint infections presenting to the orthopaedic clinic at a public South African tertiary hospital. A total of 44 patients participated in this study. Chronic osteomyelitis was diagnosed in 39 (89%) patients and septic arthritis in 5 (11%). The majority (43%) of infections were caused by Staphylococcus aureus followed by Pseudomonas aeruginosa (14%). Seventy-one antibiotics were prescribed at baseline with rifampicin prescribed the most (39%), followed by ciprofloxacin (23%). The majority (96%) of the antibiotics were not prescribed according to the South African STG; however, interventions were only needed in 31% of prescribed antibiotics (n = 71) since the STG only recommends empiric therapy directed against Staphylococcus aureus. Seventy-seven percent of the patients obtained a high self-reported adherence score at baseline. Consequently, there is a need to improve AMS in bone and joint infections to improve future care.

Effect of pelvic floor muscle training using mobile health applications for stress urinary incontinence in women: a systematic review

BackgroundPelvic floor muscle training (PFMT) is the first-line treatment for urinary incontinence, but adherence to PFMT is generally poor. Currently, a number of novel strategies exist to facilitate adherence of PFMT. We sought to determine effectiveness of mHealth app-based PFMT for treating stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (MUI) in women. The primary objective was to assess the effects of mHealth app-based PFMT and usual treatment on severity of the symptom, the quality of life (QoL) of users and the patient’s global impression of improvement. The secondary objective was to assess how mHealth app use affects adherence of PFMT.MethodsAll randomized controlled trials and quasi-randomized controlled trials aimed at evaluating the effects of mHealth app-based PFMT in women with SUI or stress-predominant MUI were included. Twelve electronic databases, namely the Cochrane Library, PubMed, CINAHL, Embase, Web of science, OVID, SciELO, REHABDATA, PEDro database, Chinese CNKI and Wanfang and the Open Grey databases were used as search sources. The protocol was registered in PROSPERO (CRD 42020183515). This systematic review was developed following the PRISMA 2020 Checklist. The Cochrane Handbook for Systematic Reviews of Interventions for Randomized Controlled Trials was used to assess risk of bias in included studies. Two authors extracted the data into a standardized spreadsheet.ResultsSix studies that met the eligibility criteria were included. The full sample included 439 patients with treatment via mHealth app and 442 controls of usual treatment. ICIQ-UI SF, ICIQ-VS, and QUID scores decreased after follow-up in the mHealth app and control groups in six studies. ICIQ-LUTS QoL scores decreased after follow-up in the mHealth app and control groups in three studies. In only one study, ICIQ-VS QoL scores decreased after 1 month and 2 months of follow-up in the mHealth app group, but increased abruptly after 3 months of follow-up. EQ5D-VAS scores increased in both groups in one study. The percentage of PGI-I increased in the mHealth app group in three studies after follow-up. After follow-up in three studies, BPMSES scores and self-reported adherence scores increased in the mHealth app group relative to the initial time point, but in one study, at 6 months compared with 3 months of follow-up, adherence scores decreased slightly in the mHealth app group.ConclusionsThis systematic review determined that mHealth app-based PFMT showed promise from the perspective of improving both outcomes and exercise adherence.

Community-based medication delivery program for antihypertensive medications improves adherence and reduces blood pressure.

Non-adherence to antihypertensive medications is a major cause of uncontrolled hypertension, leading to cardiovascular morbidity and mortality. Ensuring consistent medication possession is crucial in addressing non-adherence. Community-based medication delivery is a strategy that may improve medication possession, adherence, and blood pressure (BP) reduction. Our program in Kenya piloted a community medication delivery program, coupled with blood pressure monitoring and adherence evaluation. Between September 2019 and March 2020, patients who received hypertension care from our chronic disease management program also received community-based delivery of antihypertensive medications. We calculated number of days during which each patient had possession of medications and analyzed the relationship between successful medication delivery and self-reported medication adherence and BP. A total of 128 patient records (80.5% female) were reviewed. At baseline, mean systolic blood pressure (SBP) was 155.7 mmHg and mean self-reported adherence score was 2.7. Sixty-eight (53.1%) patients received at least 1 successful medication delivery. Our pharmacy dispensing records demonstrated that medication possession was greater among patients receiving medication deliveries. Change in self-reported medication adherence from baseline worsened in patients who did not receive any medication delivery (+0.5), but improved in patients receiving 1 delivery (-0.3) and 2 or more deliveries (-0.8). There was an SBP reduction of 1.9, 6.1, and 15.5 mmHg among patients who did not receive any deliveries, those who received 1 delivery, and those who received 2 or more medication deliveries, respectively. Adjusted mixed-effect model estimates revealed that mean SBP reduction and self-reported medication adherence were improved among individuals who successfully received medication deliveries, compared to those who did not. A community medication delivery program in western Kenya was shown to be implementable and enhanced medication possession, reduced SBP, and significantly improved self-reported adherence. This is a promising strategy to improve health outcomes for patients with uncontrolled hypertension that warrants further investigation.

Determining Persistence with an Inhaled Corticosteroid in Asthma: Assessment Using an Objective Measurement vs the Self-Reported Foster Score.

IntroductionAdherence with controller medication is a major challenge in asthma management. Thus, a reliable method of measurement is mandatory to assess adherence.AimTo examine the test-retest reliability on adherence with inhaled corticosteroids in adults with asthma using, a self-reported adherence score (Foster score).MethodsPatients with asthma and >1 routine follow-up appointment at a university hospital outpatient clinic reported Foster scores. The objective Medication Possession Ratio (MPR) was calculated based on pharmacy redemption data and physician-prescribed doses of inhaled corticosteroids. The difference between Foster score and MPR at the first and second visit was assessed using a Bland–Altman plot, outcomes reported as limits of agreements and bias. Foster scores from both visits were used to calculate an intraclass correlation coefficient (ICC).ResultsSelf-reported adherence with asthma controller medication measured by Foster score was significantly higher than the objective MPR (p < 0.0001). The Bland–Altman plot for MPR and Foster score at the first and second visit showed upper and lower limits of agreement of 83.5 – (−1.6) and 80.9 – (−6.9) and bias was 41.0 and 37.0, respectively. Of the included patients, 93.1% reported identical Foster scores between visits, resulting in an excellent ICC of 0.92. Absolute median difference between Foster scores and MPR at first and second visit was 8.7 percentage points (p = 0.049).ConclusionFoster score shows an excellent ICC; however, its poor agreement with objective measures of adherence suggests that clinicians should not rely on Foster scores alone to assess adherence with inhaled corticosteroids in patients with asthma.

Differential manifestation of COVID-19 anxiety and adherence to precautionary measures as a function of socioeconomic status: A longitudinal study in coastal Andhra Pradesh

Introduction: There is a possibility that the coronavirus disease (COVID-19)-related anxiety may differ between people from varied socioeconomic status for a variety of reasons. Furthermore, the adherence to COVID-19 precautionary measures could be different between socioeconomic strata in light of the differences in opportunities to more effectively follow these measures for people from different socioeconomic status. Aim and Objectives: The aim of this study was to check the differences in COVID-19 anxiety and precautionary measure adherence between subjects from different socioeconomic strata and to conduct a stratified analysis of the association between anxiety and adherence based on socioeconomic status of the participants. Materials and Methods: This longitudinal study was conducted in the months of July and November 2020 among 648 subjects belonging to the coastal districts of Andhra Pradesh. The COVID-19 Anxiety Scale (CAS) was used to assess the disease-related anxiety among the study participants, and self-reported adherence (SRA) scores were collected to document the adherence of the study subjects to COVID-19 precautionary measures. Statistical analysis was performed using SPSS version 20 software. Results: Significant differences were found in the CAS scores between subjects from different socioeconomic strata in the month of July, while no such observations were made in November. For the outcome of SRA scores, there were significant differences between socioeconomic strata at both the study time points. Overall, the mean CAS and SRA scores decreased from July (20.35 ± 5.54 and 14.48 ± 3.45, respectively) to November (15.96 ± 5.67 and 12.57 ± 4.17, respectively). Conclusion: The study results highlight the need to reinforce the necessity and importance of adhering to COVID-19 precautionary measures in light of the potential danger of the second wave of COVID-19 in the country.

Evaluation of Motivational Interviewing to Improve Psychotropic Medication Adherence in Adolescents.

Medication adherence rates in adolescents are poor. The World Health Organization identified that those at greatest risk were nonwhite adolescents with depression. Medication nonadherence results in poorer mental health outcomes. The first aim of the study was to investigate if two motivational interviewing (MI) sessions would improve medication adherence in adolescents taking antidepressants and mood stabilizers. The second aim was to evaluate if attitudes toward medication correlated with adherence. The third aim was to determine if self-reported adherence scores were similar to electronic adherence data collected. The quasi-experimental study contained an MI intervention, including a baseline and postintervention assessment of adherence over 30 days. A total of 48 adolescents, ranging in age from 12 to 18 years, were recruited from a university mental health center to participate in the study; 41 completed the study. Four nurse practitioners and two child psychiatrists mastered the MI techniques evaluated with standardized measures. The Medication Electronic Monitoring System (MEMS) was the primary measure of medication adherence. The Drug Attitude Inventory (DAI) was used as a secondary measure. Finally, participants completed the client evaluation of MI and a satisfaction survey of MI. At endpoint, 70.7% of the participants were taking their medications between 80% and 100% of the time, as measured over 30 days, compared with 43.9% of participants at baseline. Mean adherence scores significantly improved by 17% after two MI sessions. Mean baseline adherence scores were 63.7%, whereas mean endpoint adherence scores were 80.6% (p < 0.0001). The effect size was 0.65, demonstrating moderate effect. Participants (n = 29) who demonstrated 80% or greater adherence had DAI mean scores of 16.48, whereas those below 80% had a DAI mean of 15.5 (p = 0.73), demonstrating no significant difference on drug attitudes between the two groups at endpoint. DAI baseline mean scores were 14.2, whereas endpoint mean scores were 16.2. There was a significant difference between self-rated adherence and objective data collected from the MEMS caps as participants over-reported medication adherence by an average of 18.4% at baseline (t = 6.84, df = 40, p < 0.001). Participants reported a high degree of satisfaction with MI. MI is a promising intervention for adolescents to improve psychotropic medication adherence.

212 Rate of decline appears to be decreased in patients with higher self-reported adherence scores

212 Rate of decline appears to be decreased in patients with higher self-reported adherence scores

Effect of Self‐Efficacy and Social Support on Adherence to Antihypertensive Drugs

To determine the relationship between poor adherence and self-efficacy or social support after a pharmacist intervention. Post-hoc analysis of data from two randomized controlled trials of physician-pharmacist collaborative interventions (6 and 9 mo, respectively) to improve blood pressure control. Eleven university-affiliated primary care clinics. Five hundred eighty-four patients (aged 21-85 yrs) with uncontrolled primary hypertension; 296 were in the intervention group and 288 were in the control group. Pharmacists provided intensified hypertension management and drug adherence counseling to patients in the intervention group. Social support and self-efficacy questionnaires were administered at baseline and end-of-study visits. Patient adherence was monitored by using the Morisky self-reported adherence questionnaire. Self-reported adherence scores improved significantly in the control group (p=0.0053) but not in the intervention group; however, adherence at baseline in both groups was high. There were small, but significant, improvements in self-efficacy (p<0.04) and social support (p<0.05) scores in the intervention group but not the control group at the end of the study. Social support and, to a lesser extent, self-efficacy improved as a function of duration of study participation (9-mo vs 6-mo intervention), regardless of whether the patient received the intervention. Blood pressure control in both groups improved significantly at the end of the study; however, mean blood pressure was significantly lower in the intervention group (129.7/76.6 mm Hg) compared with the control group (140.8/78.9 mm Hg; p<0.0001 for systolic, p=0.032 for diastolic). Social support and self-efficacy improved significantly in the intervention group at the end of the pharmacist intervention. Drug adherence was correlated with self-efficacy even though drug adherence did not improve significantly in the intervention group. The fact that social support and self-efficacy improved as a function of duration of study participation suggests that participation in a research study may have had a positive influence on these measures. Even though the changes in social support, self-efficacy, and drug adherence were modest, there was significantly better blood pressure control in the intervention group compared with the control group. These findings indicate that changes in drug adherence, self-efficacy, or social support probably played a minor role in the blood pressure outcomes in these studies.

Antecedents of adherence to antituberculosis therapy.

This correlational study identified antecedents of adherence to antituberculosis (anti-TB) therapy in a convenience sample of 62 English-speaking adults. From a demographic perspective, the study sample was similar to the referent population of TB patients in Georgia. A variety of parametric analyses revealed the following: The mean self-reported adherence score was 92.6% (SD = 3.3). Higher levels of self-reported adherence were associated with an annual income of $11,000 or more, education beyond high school, no current alcohol use, perceived support and absence of barriers to medication taking, strong intentions to adhere, and a high capacity for self-care. Those six variables accounted for 28% of adherence variance, F(6, 44) of 4.3, p = 0.0017. Additionally, belief in the usefulness and benefit of the medications was strongly correlated with intentions to adhere (r = 0.83, p < 0.001), and interpersonal aspects of care was significantly correlated with perceptions of medication utility (r = 0.65, p < 0.001), supports/barriers (r = 0.44, p < 0.001), intentions (r = 0.69, p < 0.001), and self-care (r = -0.42, p < 0.01). Persons who were diagnosed with both TB and human immunodeficiency virus (HIV) reported significantly lower adherence.

Factors influencing adherence in chronic dialysis patients with hyperphosphatemia

Objective: To determine if patients with moderate hyperphosphatemia are more knowledgeable about hyperphosphatemia and its treatment than patients with severe hyperphosphatemia. Design: Observational study. Setting: University-affiliated outpatient dialysis center. Patients: Twenty-one stable, chronic hemodialysis or continuous ambulatory peritoneal dialysis patients with serum phosphorus concentrations greater than 4.5 mg/dL were divided into two groups based on moderate and severe hyperphosphatemia. Intervention: Participants were evaluated by questionnaire on their knowledge of hyperphosphatermia and its treatment. Patients' self-reported adherence to prescribed phosphate binder medication regimens was determined. Main Outcome Measure: Knowledge test scores, self-reported adherence scores, and social and medical variables were compared between the two groups. Results: Knowledge test scores in the moderately hyperphosphatemic group were statistically higher than in the severely hyperphosphatemic group. The occupation of the patient correlated with knowledge test score. Multiple regression analysis showed that, except for age, no other social or medical variables, including serum phosphorus levels, had a significant effect on self-reported adherence. Self-reported adherence was found to be an increasing function of the age of the patient. Overall, patient knowledge of hyperphosphatemia and its treatment was poor. Conclusion: Increasing patient knowledge of hyperphosphatemia and its treatment may enhance adherence to dietary phosphorus restriction and phosphate binder medications.