Patients' Perspective of Medication Adherence in Chronic Conditions: A Qualitative Study.

INTRODUCTION: About 50% of patients do not take their long-term therapy for chronic conditions as prescribed. Many studies have centered on patients' adherence to a specific treatment or single conditions, but few have taken all chronic conditions into consideration from a patient's perspective. This study aims to explore factors that impact on drug compliance and to identify strategies to improve this from the perspective of patients with at least one chronic condition. METHODS: Patients were recruited by healthcare professionals from a hospital pharmacy, four community pharmacies, patient associations, and a primary care center in Barcelona. Five focus groups were conducted (N = 36). Conversations were audiotaped and transcribed verbatim to allow qualitative analysis. RESULTS: Study subjects were aged 39-90 years (mean 65 years) and the mean number of comorbidities per patient was 2.3 (range 1-7). The main modifiers of therapeutic conduct were: patients' health beliefs, patient-prescriber relationships, and patients' motivation and perception of illness control. Study participants wanted greater participation in decision-making concerning their health and increased education about their illness and medication. They also wanted individualized healthcare that took their preferences and personal and emotional issues into account. CONCLUSION: Our results highlight how the patient-prescriber's relationship and factors such as health beliefs, motivation and perception of illness control impact on medication adherence in chronic patients. Future interventions to optimize adherence to treatment should focus on shared decision-making and more extensive health education. FUNDING: Celgene Corporation.

Cost of temporary work disability due to musculoskeletal diseases in Spain.

OBJECTIVE: To estimate the annual cost of temporary work disability (TWD) caused by musculoskeletal diseases (MSDs) in Spain and its variations between regions (autonomous communities: ACs) and paying institutions. METHOD: Descriptive study of the costs of MSD-related TWD in ACs in 2007. The Spanish National Institute of Social Security (NISS) provided aggregate data. Extrapolations to the rest of the TWD payers (mutual societies and employers) were used. RESULTS: MSDs were the leading cause of TWD in Spain in 2007, causing 908,781 episodes of TWD (18% of the total), 39,342,857 lost working days (23%), and a cost of 1,702 million euros (23%). The annual incidence of TWD episodes per 1,000 employed was 45. The cost per TWD process was 1,873 €, ranging from 1,391 € (La Rioja) to 2,429 € (Basque Country). CONCLUSION: MSDs produce annually in Spain over 39 million days lost by TWD with a cost of over 1,700 million euros. Regions observed wide variations of the TWD cost.

Knowledge on musculoskeletal diseases by the Spanish population.

OBJECTIVE: To explore knowledge on musculoskeletal-diseases (MSDs) by the Spanish population. METHODS: This was a cross-sectional study of the general population (> 18 years) using a telephone survey of 1,009 subjects stratified by habitat size, age, sex, and geographic area. A structured questionnaire was used to collect information on the subjects, their general knowledge of MSDs (GK), their specific knowledge of particular MSDs (SK), and their knowledge of their social impact (KSI). Synthetic indicators of the level of knowledge were used to analyze, using univariate and multivariate models, variables associated to the level of knowledge. RESULTS: The KSI level ranges from medium-high (mean: 0.62 ± 0.16 out of 1), suggesting that most subjects recognize MSDs as disabling conditions which affect the ability to work and have a high personal and social cost. The GK level is intermediate (mean: 0.50 ± 0.17); 60% of subjects know something about MSDs, but 54% state that their information is poor/very poor. The SK level is low (mean: 0.18 ± 0.10), and there are some MSDs that are little known (lupus, spondylitis). Being male or retired or having a MSD is associated to a greater knowledge of MSDs. CONCLUSION: The Spanish population has a medium level of knowledge of the frequency and extent to which MSDs affect performance of activities by those who suffer them. They identify them adequately and have a GK of their symptoms, but have little information about them. The level of knowledge varies depending on social and demographic factors and on whether or not the subject has direct or indirect experience of what a MSD means.

Perceptions, attitudes and experiences of family caregivers of patients with musculoskeletal diseases: a qualitative approach.

OBJECTIVE: To determine the perceptions, attitudes and experiences among family caregivers of patients with musculoskeletal diseases (MSD). METHODS: Descriptive, exploratory, qualitative study. Two discussion groups were organized with family caregivers of MSD patients, representing the caregiver profile: gender (men/women) and age (31-45 years/46-65 years); and patient profiles: MSD type (rheumatoid arthritis/ankylosing spondylitis), work status (yes or no for the variables housewife, at least 3 episodes of sick leave, patients who abandoned their work, and patients with permanent work disability). A content analysis based on the Grounded Theory was done to detect and explore emerging categories. RESULTS: The emerging dimensions were: alterations in daily life activities, need for caregiver support, physical and psychological impact on the caregiver, characteristics of the patient, and several aspects of care. Relevant experiences mentioned were: the diagnosis of a MSD changes the patient and their family members' life affecting work, financial, social, psychological and physical spheres, making it necessary help for basic activities of daily living. Early age at onset or severe MSDs require dedication and effort on the part of caregivers which increases with time. This leads to a great emotional overload on the caregivers, which may be modulated by the support they receive when providing care. CONCLUSION: The primary consequences for caregivers are loss of purchasing power, work problems, social isolation and emotional stress. Programs for effective at-home support need to be developed with streamlined administrative processes to quickly classify the level of disability and provide official assistance.

Conceitos fundamentais da cirurgia plástica reparadora / Fundamental concepts of reconstructive plastic surgery

A ferida constitui uma solução e continuidade e resulta na perda da integridade física do organismo. Este, por sua vez, com o objetivo de preservar e manter o meio interno, inicia uma série de eventos fisiologicamente integrados na tentativa de reparar a lesão. O processo é conhecido como cicatrização, cujo resultado culmina na formação de um tecido fibroso, com características de espessura, cor e elasticidade diferentes do tecido sadio: a cicatriz. Este trabalho tem por objetivo orientar as diversas especialidades cirúrgicas quanto aos conceitos fundamentais no atendimento primário de feridas, e elaborar um protocolo para sutura no pronto-socorro. Para isso foi realizada revisão de literatura sobre cicatrização de feridas e tipos de reconstrução existentes e praticadas atualmente. (AU)

Conceitos fundamentais da cirurgia plástica reparadora

A ferida constitui uma solução e continuidade e resulta na perda da integridade física do organismo. Este, por sua vez, com o objetivo de preservar e manter o meio interno, inicia uma série de eventos fisiologicamente integrados na tentativa de reparar a lesão. O processo é conhecido como cicatrização, cujo resultado culmina na formação de um tecido fibroso, com características de espessura, cor e elasticidade diferentes do tecido sadio: a cicatriz. Este trabalho tem por objetivo orientar as diversas especialidades cirúrgicas quanto aos conceitos fundamentais no atendimento primário de feridas, e elaborar um protocolo para sutura no pronto-socorro. Para isso foi realizada revisão de literatura sobre cicatrização de feridas e tipos de reconstrução existentes e praticadas atualmente.