BACKGROUND Nonadherence is a major problem in the treatment of psychotic disorders.It has been hypothesized that nonadherent patients with schizophrenia are not a homogeneous population and subtypes of nonadherence mi...BACKGROUND Nonadherence is a major problem in the treatment of psychotic disorders.It has been hypothesized that nonadherent patients with schizophrenia are not a homogeneous population and subtypes of nonadherence might exist,but this hypothesis has not been specifically tested.AIM To test the hypothesis of subtypes of nonadherence in schizophrenia and schizoaffective disorder.METHODS This prospective study included 110 consecutively admitted patients diagnosed with schizophrenia or schizoaffective disorder.Assessments were performed at baseline and at 6 mo follow-up after discharge.Sociodemographic,clinical,psychopathological and treatment-related variables were evaluated.Adherence was defined as the concurrence of adherence to antipsychotic treatment and outpatient follow-up during the six-month period.Adherence to antipsychotic treatment was defined as the concurrence of objective and subjective adherence.Sixty-four patients(58%)fulfilled nonadherence criteria at the end of the followup period and were categorized according to their subtype of nonadherence.RESULTS In nonadherent patients(n=64),32(50%)fulfilled criteria of intentional nonadherence,and 32(50%)of unintentional nonadherence(UNA).Unintentional nonadherent patients,as compared to intentional nonadherent patients,are characterized by older age,lower educational level,worse cognitive and negative symptoms,greater severity,worse knowledge of their treatment regimen,greater prevalence of supervision of the treatment,lower number of prior hospitalizations and greater use of nonpsychiatric treatment,anticholinergics and hypnotics.Low educational level(OR=26.1;95%CI:2.819-241),worse treatment knowledge at six months(OR per unit=0.904;95%CI:0.853-0.957)and nonpsychiatric treatment at six months(OR=15.8;95%CI:1.790-139)were independently associated to UNA.CONCLUSION Differentiated subtypes of nonadherence according to intentionality seem to exist in patients with schizophrenia and schizoaffective disorder.Our findings suggest the need for differentiated approach,both in future research and in clinical practice.展开更多
The introduction of novel immunosuppressive agents over the last two decades and the improvement of our diagnostic tools for early detection of antibodymediated injury offer us an opportunity, if not a mandate, to bet...The introduction of novel immunosuppressive agents over the last two decades and the improvement of our diagnostic tools for early detection of antibodymediated injury offer us an opportunity, if not a mandate, to better match the immunosuppression needs of the individual patients with side effects of the therapy. However, immunosuppressive regimens in the majority of programs remain mostly protocol-driven, with relatively little inter-program heterogeneity in certain areas of the world. Emerging data showing different outcomes with a particular immunosuppressive strategy in populations with varying immunological risks underscore a real potential for "personalized medicine" in renal transplantation. Studies demonstrating marked differences in the adverse-effect profiles of individual drugs including the risk for viral infections, malignancy and renal toxicity call for a paradigm shift away from a "one size fits all" approach to an individually tailored immunosuppressive therapy for renal transplant recipients, assisted by both screening for predictors of graft loss and paying close attention to dose or class-related adverse effects. Our paper explores some of the opportunities during the care of these patients. Potential areas of improvements may include:(1) a thorough assessment of immunological and metabolic risk profile of each renal transplant recipient;(2) screening for predictors of graft loss and early signs of antibody-mediated rejection with donor-specific antibodies, protocol biopsies and proteinuria(including close follow up of adverse effects with dose adjustments or conversions as necessary); and(3) increased awareness of the possible link between poor tolerance of a given drug at a given dose and non-adherence with the prescribed regimen. Altogether, these considerations may enable the most effective use of the drugs we already have.展开更多
Antihypertensive medication is one way to manage hypertension but many hypertensive patients do not optimize drug therapy to achieve blood pressure control. Hypertensive medication non-adherence continues to become a ...Antihypertensive medication is one way to manage hypertension but many hypertensive patients do not optimize drug therapy to achieve blood pressure control. Hypertensive medication non-adherence continues to become a contributing factor to hypertensive complications like heart attacks, heart failure, stroke, kidney disease. Prevalence of non-adherence to antihypertensive treatment is not known but it’s thought to be increasing. Associated factors of non-adherence are complex, are both internal and external to the patient but are difficult to extrapolate. This can partly be because the determinants of non-adherence to hypertensive may have a locality effect due to many factors such as culture and health system in a given locality. Hence, studies from one region may not have a cross-application. Therefore, there is the need to study the factors associated with non-adherence at a local scale. Descriptive study design was adopted to guide the implementation of the study. The population comprised of 575 people among doctors, pharmacists, nurses, record officers and hypertension patients. The respondents were identified through simple random sampling and a sample size of 81 patients was achieved and 10 health care providers including doctors, pharmacists, record officers and nurses were also interviewed through census method. Data was collected between the month of April and May 2019. Questionnaires were used as data collection tools for the patients while the interview schedule was conducted to health care providers through an interview guide. Descriptive and inferential statistics were used for data analysis, aided by SPSS. The study revealed a significant negative correlation (rpb = −0.227, p 0.05) between age and non-adherent, insignificant relationship with marital status (rpb = −0.129), insignificant (rpb = −0.064) correlation with patients’ level of education and a positive correlation with monthly income (rpb = 0.24). A majority of patients stated that (64%) of the hypertensive patients had missed medication. Patient-related factors: cost of medication, religious beliefs, age of the patient, their education level, preference to traditional medicine, and sociocultural factors together were found to be significant predictors of non-adherence to hypertension medication, χ2= 17.14, df = 1, N = 81, p 0.05. However, it’s only age (p = 0.01), religious beliefs (p = 0.04), and cost of medication (p 0.05) that were individually, significant predictors to non-adherence. Non-adherence to hypertension medication is a major problem at Chuka Level Five Hospital. This was due to lack of funds, time, forgetfulness and patient thinking that they had healed thus continuous follow-ups to improve adherence, positive reinforcement to increase motivation in order to address forgetfulness, and supply of constant and subsidized hypertensive drugs to the hospital are necessary to prevent patients from missing the drugs. There is need to reduce out of pocket payment through establishment and strengthening of the community health insurance scheme. The study recommends that the hospital should set aside some resources for making patients’ follow-ups especially those were treated and left to go home;discussions be made with patients on severity of non-adherence and importance of adherence;use of positive reinforcement to increase motivation and mechanism to be put in place to subsidize the cost of medication.展开更多
Background:An increasing number of valid and well-designed trials have demonstrated a positive correlation between visit-to-visit variability(VVV)in systolic blood pressure(SBP)and increased risk of stroke and coronar...Background:An increasing number of valid and well-designed trials have demonstrated a positive correlation between visit-to-visit variability(VVV)in systolic blood pressure(SBP)and increased risk of stroke and coronary heart disease among hypertensive patients.Methods:A cross-sectional study was conducted that involved 74 patients who visited the outpatient clinic at the Tabanan III Primary Health Care Service during April to May 2017.Blood pressure was retrospectively obtained from medical records.VVV was classified as low or high on the basis of the standard deviation of SBP.Antihypertensive medication adherence was expressed as the percentage of days covered,and sodium intake was measured with 24-hour food recall.Bi-variate analysis was performed,followed by multivariate analysis for significant variables.Results:Among the participants,67.6%were female,with a mean(standard deviation[SD])age of 62.70(10.00)years.Blood pressure was measured 4.82±0.78 times during the period,and the mean(SD)SBP was 139.65(10.57)mm Hg.Nonadherence and sodium intake were signifi-cantly higher in the high-VVV group than in the low-VVV group(nonadherence 13.5%vs.37.8%,P=0.033;sodium intake 1278.44±43.02 mg vs.1495.85±45.26 mg,P=0.038).After adjustment for other covariates,the differences remained significant only for nonadherence(model I exp β=3.89[95.0%confidence interval 1.23-12.34,P<0.05],model II expβ=3.9[95.0%confidence interval 1.12-14.15,P<0.05]).The area under the curve was 0.636(P<0.05),with sensitivity of 67.6%and specificity of 51.4%.Conclusion:Nonadherence to antihypertensive medication was significantly associated with higher VVV of SBP.Further study is needed to assess whether improving adherence could reduce VVV and improve cardiovascular outcomes.展开更多
Poor adherence to prescribed medication regimens can undermine the effectiveness of medications.This study was conducted to determine the demographic profile of forensic psychiatric inpatients refusing medications and...Poor adherence to prescribed medication regimens can undermine the effectiveness of medications.This study was conducted to determine the demographic profile of forensic psychiatric inpatients refusing medications and to identify the reasons for refusal.Data were collected through interviews using a questionnaire including Drug Attitude Inventory‑10.Medication refusal was more common among Aboriginals(68%,n=34)than Caucasians(32%,n=16)and was highest among the patients 21–30 years of age(44%,n=22).Antisocial personality disorder and substance use disorder featured prominently among patients refusing medications.The main reasons for medication refusal were inconvenience(34%,n=17)followed by side effects(22%,n=11),ineffective medication(20%,n=10),illness‑related(16%,n=8),and no reasons(8%,n=6).Antipsychotic medications topped the list of the major classes of medications refused followed by Antidepressants and Mood Stabilizers.展开更多
基金Supported by College of Physicians of Las Palmas,No.I03/19.
文摘BACKGROUND Nonadherence is a major problem in the treatment of psychotic disorders.It has been hypothesized that nonadherent patients with schizophrenia are not a homogeneous population and subtypes of nonadherence might exist,but this hypothesis has not been specifically tested.AIM To test the hypothesis of subtypes of nonadherence in schizophrenia and schizoaffective disorder.METHODS This prospective study included 110 consecutively admitted patients diagnosed with schizophrenia or schizoaffective disorder.Assessments were performed at baseline and at 6 mo follow-up after discharge.Sociodemographic,clinical,psychopathological and treatment-related variables were evaluated.Adherence was defined as the concurrence of adherence to antipsychotic treatment and outpatient follow-up during the six-month period.Adherence to antipsychotic treatment was defined as the concurrence of objective and subjective adherence.Sixty-four patients(58%)fulfilled nonadherence criteria at the end of the followup period and were categorized according to their subtype of nonadherence.RESULTS In nonadherent patients(n=64),32(50%)fulfilled criteria of intentional nonadherence,and 32(50%)of unintentional nonadherence(UNA).Unintentional nonadherent patients,as compared to intentional nonadherent patients,are characterized by older age,lower educational level,worse cognitive and negative symptoms,greater severity,worse knowledge of their treatment regimen,greater prevalence of supervision of the treatment,lower number of prior hospitalizations and greater use of nonpsychiatric treatment,anticholinergics and hypnotics.Low educational level(OR=26.1;95%CI:2.819-241),worse treatment knowledge at six months(OR per unit=0.904;95%CI:0.853-0.957)and nonpsychiatric treatment at six months(OR=15.8;95%CI:1.790-139)were independently associated to UNA.CONCLUSION Differentiated subtypes of nonadherence according to intentionality seem to exist in patients with schizophrenia and schizoaffective disorder.Our findings suggest the need for differentiated approach,both in future research and in clinical practice.
文摘The introduction of novel immunosuppressive agents over the last two decades and the improvement of our diagnostic tools for early detection of antibodymediated injury offer us an opportunity, if not a mandate, to better match the immunosuppression needs of the individual patients with side effects of the therapy. However, immunosuppressive regimens in the majority of programs remain mostly protocol-driven, with relatively little inter-program heterogeneity in certain areas of the world. Emerging data showing different outcomes with a particular immunosuppressive strategy in populations with varying immunological risks underscore a real potential for "personalized medicine" in renal transplantation. Studies demonstrating marked differences in the adverse-effect profiles of individual drugs including the risk for viral infections, malignancy and renal toxicity call for a paradigm shift away from a "one size fits all" approach to an individually tailored immunosuppressive therapy for renal transplant recipients, assisted by both screening for predictors of graft loss and paying close attention to dose or class-related adverse effects. Our paper explores some of the opportunities during the care of these patients. Potential areas of improvements may include:(1) a thorough assessment of immunological and metabolic risk profile of each renal transplant recipient;(2) screening for predictors of graft loss and early signs of antibody-mediated rejection with donor-specific antibodies, protocol biopsies and proteinuria(including close follow up of adverse effects with dose adjustments or conversions as necessary); and(3) increased awareness of the possible link between poor tolerance of a given drug at a given dose and non-adherence with the prescribed regimen. Altogether, these considerations may enable the most effective use of the drugs we already have.
文摘Antihypertensive medication is one way to manage hypertension but many hypertensive patients do not optimize drug therapy to achieve blood pressure control. Hypertensive medication non-adherence continues to become a contributing factor to hypertensive complications like heart attacks, heart failure, stroke, kidney disease. Prevalence of non-adherence to antihypertensive treatment is not known but it’s thought to be increasing. Associated factors of non-adherence are complex, are both internal and external to the patient but are difficult to extrapolate. This can partly be because the determinants of non-adherence to hypertensive may have a locality effect due to many factors such as culture and health system in a given locality. Hence, studies from one region may not have a cross-application. Therefore, there is the need to study the factors associated with non-adherence at a local scale. Descriptive study design was adopted to guide the implementation of the study. The population comprised of 575 people among doctors, pharmacists, nurses, record officers and hypertension patients. The respondents were identified through simple random sampling and a sample size of 81 patients was achieved and 10 health care providers including doctors, pharmacists, record officers and nurses were also interviewed through census method. Data was collected between the month of April and May 2019. Questionnaires were used as data collection tools for the patients while the interview schedule was conducted to health care providers through an interview guide. Descriptive and inferential statistics were used for data analysis, aided by SPSS. The study revealed a significant negative correlation (rpb = −0.227, p 0.05) between age and non-adherent, insignificant relationship with marital status (rpb = −0.129), insignificant (rpb = −0.064) correlation with patients’ level of education and a positive correlation with monthly income (rpb = 0.24). A majority of patients stated that (64%) of the hypertensive patients had missed medication. Patient-related factors: cost of medication, religious beliefs, age of the patient, their education level, preference to traditional medicine, and sociocultural factors together were found to be significant predictors of non-adherence to hypertension medication, χ2= 17.14, df = 1, N = 81, p 0.05. However, it’s only age (p = 0.01), religious beliefs (p = 0.04), and cost of medication (p 0.05) that were individually, significant predictors to non-adherence. Non-adherence to hypertension medication is a major problem at Chuka Level Five Hospital. This was due to lack of funds, time, forgetfulness and patient thinking that they had healed thus continuous follow-ups to improve adherence, positive reinforcement to increase motivation in order to address forgetfulness, and supply of constant and subsidized hypertensive drugs to the hospital are necessary to prevent patients from missing the drugs. There is need to reduce out of pocket payment through establishment and strengthening of the community health insurance scheme. The study recommends that the hospital should set aside some resources for making patients’ follow-ups especially those were treated and left to go home;discussions be made with patients on severity of non-adherence and importance of adherence;use of positive reinforcement to increase motivation and mechanism to be put in place to subsidize the cost of medication.
文摘Background:An increasing number of valid and well-designed trials have demonstrated a positive correlation between visit-to-visit variability(VVV)in systolic blood pressure(SBP)and increased risk of stroke and coronary heart disease among hypertensive patients.Methods:A cross-sectional study was conducted that involved 74 patients who visited the outpatient clinic at the Tabanan III Primary Health Care Service during April to May 2017.Blood pressure was retrospectively obtained from medical records.VVV was classified as low or high on the basis of the standard deviation of SBP.Antihypertensive medication adherence was expressed as the percentage of days covered,and sodium intake was measured with 24-hour food recall.Bi-variate analysis was performed,followed by multivariate analysis for significant variables.Results:Among the participants,67.6%were female,with a mean(standard deviation[SD])age of 62.70(10.00)years.Blood pressure was measured 4.82±0.78 times during the period,and the mean(SD)SBP was 139.65(10.57)mm Hg.Nonadherence and sodium intake were signifi-cantly higher in the high-VVV group than in the low-VVV group(nonadherence 13.5%vs.37.8%,P=0.033;sodium intake 1278.44±43.02 mg vs.1495.85±45.26 mg,P=0.038).After adjustment for other covariates,the differences remained significant only for nonadherence(model I exp β=3.89[95.0%confidence interval 1.23-12.34,P<0.05],model II expβ=3.9[95.0%confidence interval 1.12-14.15,P<0.05]).The area under the curve was 0.636(P<0.05),with sensitivity of 67.6%and specificity of 51.4%.Conclusion:Nonadherence to antihypertensive medication was significantly associated with higher VVV of SBP.Further study is needed to assess whether improving adherence could reduce VVV and improve cardiovascular outcomes.
文摘Poor adherence to prescribed medication regimens can undermine the effectiveness of medications.This study was conducted to determine the demographic profile of forensic psychiatric inpatients refusing medications and to identify the reasons for refusal.Data were collected through interviews using a questionnaire including Drug Attitude Inventory‑10.Medication refusal was more common among Aboriginals(68%,n=34)than Caucasians(32%,n=16)and was highest among the patients 21–30 years of age(44%,n=22).Antisocial personality disorder and substance use disorder featured prominently among patients refusing medications.The main reasons for medication refusal were inconvenience(34%,n=17)followed by side effects(22%,n=11),ineffective medication(20%,n=10),illness‑related(16%,n=8),and no reasons(8%,n=6).Antipsychotic medications topped the list of the major classes of medications refused followed by Antidepressants and Mood Stabilizers.
