RESUMEN
OBJECTIVE: To assess patient perceptions of gout management goals. METHODS: We conducted a cross-sectional Internet survey of people who visited the Gout and Uric Acid Education Society's website to assess patient/respondent perception of gout management goals. We used chi-square test for categorical or t-test for continuous variables. RESULTS: Among the 320 survey respondents with physician-diagnosed gout, mean age was 57 (SD, 13.4) years, 72% were male, 77% White; mean gout duration was 7.6 years (SD, 11), gout flares in the last year were 5.2 (SD, 6.1), and medical comorbidities were common, 2.7 (SD, 2.6). Two-thirds respondents each reported very severe or severe symptoms from gout and that gout ranked among the top two health conditions with a negative impact on quality of life. During a clinic visit, only one-third of respondents' physicians spent 50% of more of the time discussing gout treatment. Only 54% respondents were prescribed ULT by their healthcare provider. By patient preference, the best life-long gout treatment strategies were the lowering of the serum urate level and the control of gout symptoms (62%) followed by serum urate lowering (32%). Respondents considered the following as the most important things for making gout treatment satisfactory: (1) patient education; (2) effective physician-patient communication; (3) diet and lifestyle modification; (4) serum urate monitoring and target achievement; (5) pain management and flare prevention; and (6) medication management. CONCLUSIONS: Patient identification of gout symptom control and serum urate level monitoring as the most important treatment goals is informative for clinicians and guideline developers.
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Manejo de la Enfermedad , Monitoreo de Drogas , Supresores de la Gota/uso terapéutico , Gota , Relaciones Médico-Paciente , Calidad de Vida , Percepción Social , Ácido Úrico/sangre , Actitud Frente a la Salud , Estudios Transversales , Monitoreo de Drogas/métodos , Monitoreo de Drogas/psicología , Femenino , Gota/sangre , Gota/psicología , Gota/terapia , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto/métodos , Educación del Paciente como Asunto/normas , Conducta de Reducción del Riesgo , Evaluación de SíntomasRESUMEN
Poor medication adherence remains frequent in schizophrenia. The present study examined the efficacy of two month-long pilot interventions using the Medication Event Monitoring System (MEMS®). Thirty-three outpatients at high risk for relapse were randomized to receive a smartphone-based intervention, a nurse-based intervention, or treatment as usual. All patients then used the MEMS® to objectively measure medication adherence over six months. No differences were observed in adherence measures or relapse rates across the three groups. When using electronic medication monitoring as an objective measure of adherence, easily-implemented interventions may not significantly improve adherence in patients at high risk for relapse.
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Atención Ambulatoria/psicología , Monitoreo de Drogas/psicología , Cumplimiento de la Medicación/psicología , Esquizofrenia/tratamiento farmacológico , Psicología del Esquizofrénico , Teléfono Inteligente , Adulto , Atención Ambulatoria/métodos , Enfermedad Crónica , Monitoreo de Drogas/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios/psicología , Proyectos PilotoAsunto(s)
Aprobación de Drogas , Pediatría , Rol del Médico , Pautas de la Práctica en Medicina , Terapias en Investigación/psicología , Niño , Comercio , Aprobación de Drogas/organización & administración , Etiquetado de Medicamentos/normas , Monitoreo de Drogas/métodos , Monitoreo de Drogas/psicología , Monitoreo de Drogas/normas , Drogas en Investigación/uso terapéutico , Humanos , Pediatría/métodos , Pediatría/normas , Rol del Médico/psicología , Pautas de la Práctica en Medicina/normas , Vigilancia de Productos Comercializados/métodos , Vigilancia de Productos Comercializados/normas , Terapias en Investigación/métodosRESUMEN
Background The direct oral anticoagulants (DOACs) offer several advantages over warfarin in the management atrial fibrillation, including the provision of fixed dosing without a requirement for regular monitoring. Recently however the subject of DOAC monitoring has been probed after several post-hoc analyses demonstrated an association between plasma levels and efficacy and safety events. Objective The aim of this pilot study was to explore the acceptability of DOAC plasma monitoring amongst patients with atrial fibrillation and the factors that may influence these attitudes. Method A simple DOAC monitoring schedule based on the dabigatran pharmacokinetic profile was developed. A cross-sectional survey was distributed to patients with atrial fibrillation asking them to indicate their likelihood of taking a particular DOAC subjected to plasma monitoring. Results Thirty patients participated in the study. Most patients (63.3%) favoured taking a DOAC subjected to monitoring under the proposed schedule, citing increased efficacy and reduced toxicity as the reasons for their response. Conclusion There is some suggestion that atrial fibrillation patients may in fact favour taking a DOAC subjected to infrequent monitoring if this enhanced safety and efficacy.
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Anticoagulantes/administración & dosificación , Anticoagulantes/sangre , Fibrilación Atrial/sangre , Fibrilación Atrial/tratamiento farmacológico , Monitoreo de Drogas/métodos , Administración Oral , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/psicología , Estudios Transversales , Dabigatrán/administración & dosificación , Dabigatrán/sangre , Monitoreo de Drogas/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos PilotoRESUMEN
INTRODUCTION: Community pharmacy is an ideal setting to monitor medication adherence, however, barriers to pharmacist-led interventions exist. Preparing future pharmacists for enhanced roles may overcome such barriers. Our objective was to identify medication monitoring attitudes and contextual factors that influence adherence monitoring by pharmacy interns to inform educational activities on medication adherence. METHODS: An online factorial survey of all pharmacy interns (N = 123) in the Republic of Ireland, completing advanced community pharmacy experiential learning in May 2016 was undertaken to evaluate attitudes to medication monitoring and to identify respondent characteristics and contextual factors which influence adherence monitoring of older hypertensive adults during repeat dispensing. The medication monitoring attitude measure (MMAM) was used to evaluate interns' attitudes, and factorial vignette analysis was performed to identify factors influencing behavioural intention to offer adherence advice. RESULTS: There were 121 completed online surveys. Half of interns reported they felt uncomfortable and confrontational discussing adherence with patients. In factorial vignette analysis, higher medication monitoring attitudes resulted in higher likelihood to offer adherence advice; experiential-learning characteristics such as pharmacy ownership-type (nonchain store) and contextual factors including patients being treated for longer and time-pressures had a significant negative influence on pharmacy interns' likelihood to offer adherence advice. DISCUSSION: Medication monitoring attitudes and contextual factors influenced responses to offer adherence advice in hypothetical scenarios. Ensuring pharmacy students are educated on patterns of adherence and appropriate skills to address nonadherence, and engage in structured programmes to facilitate patient interactions during experiential learning, may improve medication monitoring attitudes and adherence monitoring.
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Antihipertensivos/uso terapéutico , Actitud del Personal de Salud , Hipertensión/tratamiento farmacológico , Cumplimiento de la Medicación/psicología , Residencias en Farmacia/organización & administración , Factores de Edad , Anciano , Servicios Comunitarios de Farmacia/organización & administración , Monitoreo de Drogas/psicología , Femenino , Humanos , Irlanda , Masculino , Farmacéuticos/psicología , Rol Profesional/psicología , Encuestas y Cuestionarios/estadística & datos numéricosRESUMEN
BACKGROUND: Clinical research coordinators (CRCs) are persons who collect, record, and maintain clinical trial data in accordance with the principles of Good Clinical Practice at investigators' sites. This study was conducted to examine attitudes of clinical research coordinators (CRCs) toward risk-based monitoring (RBM) prior to full-scale implementation of RBM in Korea. METHODS: The study subjects were 607 CRCs, and data were collected using a self-reported questionnaire. Collected data were analyzed by frequency, percentage, χ2 test and Fisher exact test. RESULTS: Among CRCs, 42.3% had heard of RBM and 44.6% were found to oppose its implementation. Those opposed believed that implementation of RBM would increase the workload of CRCs and CRAs' work support for CRCs. In addition, they showed many negative opinions such as poor accuracy of test data input and failure to increase the overall quality of clinical tests. In particular, such attitudes were more noticeable in CRCs with 5 or more years of experience. CONCLUSION: Before the implementation of RBM, it is necessary to come up with administrative measures such as education for practitioners and recruitment of human resources to help CRCs properly understand RBM.
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Actitud , Monitoreo de Drogas/psicología , Investigadores/psicología , Adulto , Sesgo , Ensayos Clínicos como Asunto , Femenino , Humanos , Masculino , Guías de Práctica Clínica como Asunto , República de Corea , Autoinforme , Carga de TrabajoAsunto(s)
Actitud Frente a la Salud , Enfermedad Crónica/tratamiento farmacológico , Monitoreo de Drogas , Cumplimiento de la Medicación , Calidad de Vida , Tecnología Biomédica/métodos , Tecnología Biomédica/tendencias , Enfermedad Crónica/psicología , Monitoreo de Drogas/ética , Monitoreo de Drogas/métodos , Monitoreo de Drogas/psicología , Monitoreo de Drogas/tendencias , Conductas Relacionadas con la Salud , Humanos , Cumplimiento de la Medicación/psicología , Cumplimiento de la Medicación/estadística & datos numéricos , Administración del Tratamiento Farmacológico , Relaciones Médico-Paciente , Sistemas Recordatorios , Autoadministración/psicologíaRESUMEN
BACKGROUND: While clozapine (CLZ) is the most effective antipsychotic drug for schizophrenia treatment, it remains underused. In order to understand the barriers of frequent blood draws for white blood cell counts (WBCs) and clozapine levels, we developed a psychiatrist survey and began an integrative approach of designing a point-of-care device that could eventually have real-time monitoring with immediate results. METHODS: We ascertained barriers related to CLZ management and the acceptance of possible solutions by sending an anonymous survey to physicians in psychiatric practice (n=860). In parallel, we tested CLZ sensing using a prototype point-of-care monitoring device. RESULTS: 255 responses were included in the survey results. The two barriers receiving mean scores with the highest agreement as being a significant barrier were patient nonadherence to blood work and blood work's burden on the patient (out of 28). Among nine solutions, the ability to obtain lab results in the physician's office or pharmacy was top ranked (mean±sd Likert scale [4.0±1.0]). Physicians responded that a point-of-care device to measure blood levels and WBCs would improve care and increase CLZ use. Residents ranked point-of-care devices higher than older physicians (4.07±0.87 vs. 3.47±1.08, p<0.0001). Also, the prototype device was able to detect CLZ reliably in 1.6, 8.2, and 16.3 µg/mL buffered solutions. DISCUSSION: Survey results demonstrate physicians' desire for point-of-care monitoring technology, particularly among younger prescribers. Prototype sensor results identify that CLZ can be detected and integrated for future device development. Future development will also include integration of WBCs for a complete detection device.
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Clozapina , Monitoreo de Drogas , Cooperación del Paciente/psicología , Esquizofrenia/tratamiento farmacológico , Adulto , Anciano , Antipsicóticos/administración & dosificación , Antipsicóticos/efectos adversos , Antipsicóticos/sangre , Actitud del Personal de Salud , Clozapina/administración & dosificación , Clozapina/efectos adversos , Clozapina/sangre , Monitoreo de Drogas/instrumentación , Monitoreo de Drogas/métodos , Monitoreo de Drogas/psicología , Femenino , Pruebas Hematológicas/psicología , Humanos , Masculino , Persona de Mediana Edad , Pruebas en el Punto de Atención , Pautas de la Práctica en Medicina/estadística & datos numéricos , Psicología del Esquizofrénico , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Background: Therapeutic drug monitoring (TDM) may improve the efficacy and cost-effectiveness of anti-TNF therapy. A standardized approach of utilizing TDM has not been established. The objective of this study was to determine gastroenterologists' attitudes and barriers toward TDM of anti-TNF therapy in clinical practice. Methods: An 18-question survey was distributed to members of the American College of Gastroenterology and Crohn's and Colitis Foundation via email. We collected physician characteristics, practice demographics, and data regarding TDM use and perceived barriers to TDM. Factors associated with the use of TDM were determined by logistic regression analysis. Results: A total of 403 gastroenterologists from 42 US states (76.4% male) met inclusion criteria: 90.1% use TDM, mostly reactively for secondary loss of response (87.1%) and primary nonresponse (66%); 36.6% use TDM proactively. The greatest barriers to TDM implementation were uncertainty about insurance coverage (77.9%), high out-of-pocket patient costs (76.4%), and time lag from serum sample to result (38.5%). Factors independently associated with the use of TDM and proactive TDM were practice in an academic setting (P = 0.019), and more IBD patients seen per month (P = 0.015), and Crohn's and Colitis Foundation membership (P < 0.001), and more IBD patients on anti-TNF therapy per month (P = 0.006), respectively. If all barriers were removed, an additional one-third of physicians would apply proactive TDM. Conclusions: Lack of insurance coverage, high out-of-pocket costs, and the time lag from test to result limit use of TDM in the United States. Validation of low-cost assays, point of care testing, and studies that standardize the use of TDM are needed to make TDM more commonplace.
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Actitud del Personal de Salud , Monitoreo de Drogas/psicología , Gastroenterólogos/psicología , Adhesión a Directriz/estadística & datos numéricos , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Infliximab/uso terapéutico , Guías de Práctica Clínica como Asunto , Femenino , Fármacos Gastrointestinales/uso terapéutico , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresRESUMEN
BACKGROUND: Therapeutic drug monitoring (TDM) is increasingly performed to optimize biologic therapy in inflammatory bowel disease (IBD). However, patients and physicians may be reluctant to perform TDM due to concerns related to potential out-of-pocket costs. AIMS: The aim of this study was to evaluate patient understanding and attitudes toward TDM in different clinical scenarios with and without potential out-of-pocket costs. METHODS: Adult IBD patients at a tertiary gastroenterology clinic were anonymously surveyed from March to September 2016 to assess their understanding of and willingness to undergo TDM in a variety of clinical scenarios, both with and without a potential out-of-pocket cost. Responses were analyzed for associations with changes in attitudes if out-of-pocket costs were involved. RESULTS: Of 118 completed surveys, 68.2% of patients were aware of or had previously undergone TDM. Patient willingness to undergo TDM was high both with and without potential out-of-pocket costs (70 and 98%, respectively); however, patients were significantly less willing with out-of-pocket cost (p < 0.01). Higher disease-related quality of life scores, as measured by the short inflammatory bowel disease questionnaire (SIBDQ), was significantly associated with an increased willingness to assume a potential out-of-pocket cost (p = 0.007). CONCLUSIONS: Overall, patients understand and are willing to undergo TDM in certain potentially beneficial clinical scenarios, however, are significantly less willing if paying out-of-pocket. A higher SIBDQ score was associated with an increase in willingness to undergo TDM when out-of-pocket cost was involved. Physicians should discuss TDM with their patients in order to make an informed and personalized treatment decision.
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Monitoreo de Drogas/economía , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Adolescente , Adulto , Anciano , Terapia Biológica , Monitoreo de Drogas/psicología , Femenino , Gastos en Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adulto JovenRESUMEN
OBJECTIVE: To explore the barriers and facilitators to inhaled asthma treatment in adolescents with asthma. DESIGN: Qualitative analysis of posts about inhaler treatment in adolescents from an online forum for people with asthma. Analysis informed by the Perceptions and Practicalities Approach. PARTICIPANTS: Fifty-four forum participants (39 adolescents ≥16 years, 5 parents of adolescents, 10 adults with asthma) identified using search terms 'teenager inhaler' and 'adolescent inhaler'. SETTING: Posts from adolescents, parents and adults with asthma taking part in the Asthma UK online forum between 2006 and 2016, UK. RESULTS: Practical barriers reducing the ability to adhere included forgetfulness and poor routines, inadequate inhaler technique, organisational difficulties (such as repeat prescriptions), and families not understanding or accepting their child had asthma. Prompting and monitoring inhaler treatment by parents were described as helpful, with adolescents benefiting from self-monitoring, for example, by using charts logging adherence. Perceptions reducing the motivation to adhere included asthma representation as episodic rather than chronic condition with intermittent need of inhaler treatment. Adolescents and adults with asthma (but not parents) described concerns related to attributed side effects (eg, weight gain) and social stigma, resulting in 'embarrassment of taking inhalers'. Facilitators to adherence included actively seeking general practitioners'/consultants' adjustments if problems arose and learning to deal with the side effects and stigma. Parents were instrumental in creating a sense of responsibility for adherence. CONCLUSIONS: This online forum reveals a rich and novel insight into adherence to asthma inhalers by adolescents. Interventions that prompt and monitor preventer inhaler use would be welcomed and hold potential. In clinical consultations, exploring parents' beliefs about asthma diagnosis and their role in dealing with barriers to treatment might be beneficial. The social stigma of asthma and its role in adherence were prominent and continue to be underestimated, warranting further research and action to improve public awareness of asthma.
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Antiasmáticos/uso terapéutico , Asma , Barreras de Comunicación , Cumplimiento de la Medicación/psicología , Nebulizadores y Vaporizadores , Estigma Social , Administración por Inhalación , Adolescente , Adulto , Asma/psicología , Asma/terapia , Monitoreo de Drogas/métodos , Monitoreo de Drogas/psicología , Femenino , Humanos , Londres , Masculino , Motivación , Pautas de la Práctica en Medicina , Percepción Social , Encuestas y CuestionariosRESUMEN
BACKGROUND: Direct oral anticoagulants (DOACs) are an alternative for vitamin K antagonists (VKA) in the treatment and prevention of venous thromboembolism (VTE). Patient preferences for treatment options have not been extensively explored. METHODS: A random sample of 200 patients was obtained from those treated with VKA for deep vein thrombosis, pulmonary embolism or both at the Thrombosis Service Amsterdam. Preference for DOACs relative to VKA was assessed using a treatment trade-off technique administered as a questionnaire sent to all patients. The trade-off consisted of four consecutive scenarios: 1 (no need for laboratory control), 2 (decreased bleeding risk), 3 (less interactions with food and other drugs), 4 (higher efficacy). RESULTS: The response rate was 68%. In scenario 1, 36% of patients would switch to a DOAC. This proportion rises to 57% (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.6-3.3) for scenario 2. Scenario 3 resulted in 64% of patients preferring a DOAC (OR 3.2; 95%CI 2.2-4.6). The advantage of greater efficacy did not result in a noteworthy change in the preference. Patients who were less satisfied with their current treatment, who were younger and those with higher education were more likely to prefer a DOAC over a VKA. The variables gender, treatment duration, and type of VKA were not significantly associated with DOAC preference. CONCLUSION: Almost two-thirds of patients preferred DOACs over VKA. Patients considered the lack of regular laboratory monitoring, the lower risk of serious bleeding and less interactions with food and other drugs the most important arguments to switch to a DOAC.
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Anticoagulantes/administración & dosificación , Antifibrinolíticos/administración & dosificación , Prioridad del Paciente/psicología , Tromboembolia Venosa/psicología , Vitamina K/antagonistas & inhibidores , Administración Oral , Factores de Edad , Anciano , Anciano de 80 o más Años , Monitoreo de Drogas/psicología , Sustitución de Medicamentos/psicología , Escolaridad , Femenino , Hemorragia/inducido químicamente , Hemorragia/psicología , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Encuestas y Cuestionarios , Tromboembolia Venosa/tratamiento farmacológicoRESUMEN
BACKGROUND: Poor drug adherence is a major cause of apparent treatment-resistant hypertension. As a consequence, several methods have been developed and attempted implemented in clinical practice to reveal non-adherence and to monitor drug adherence. There are, however, several hitherto unresolved ethical aspects regarding potential methods for drug monitoring in these patients. RESULTS: The most striking challenge is the balance between patient autonomy and the physician's desire for the patient to adhere to the prescribed therapy. Also, methods for monitoring must only be implemented in the treatment of well-informed and consenting patients. Major resources are used on non-adherent patients; how long the physician should encourage continuation of treatment is an important question. CONCLUSIONS: We believe that physicians should reflect and discuss these potential challenges, and that patient education, information and a solid patient-physician relationship are essential for achieving drug adherence. Methods for monitoring adherence represent, however, a useful and often necessary supplement.
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Antihipertensivos/uso terapéutico , Resistencia a Medicamentos , Hipertensión/tratamiento farmacológico , Hipertensión/psicología , Cooperación del Paciente/psicología , Relaciones Médico-Paciente/ética , Presión Sanguínea , Monitoreo de Drogas/psicología , Humanos , Hipertensión/fisiopatología , Consentimiento Informado , Conocimiento de la Medicación por el Paciente , Participación del Paciente/psicología , Pacientes/psicología , Médicos/psicologíaAsunto(s)
Analgésicos Opioides/uso terapéutico , Monitoreo de Drogas/psicología , Administración del Tratamiento Farmacológico/organización & administración , Dolor/tratamiento farmacológico , Analgésicos Opioides/orina , Humanos , Cumplimiento de la Medicación/psicología , Manejo del Dolor/métodos , Manejo del Dolor/psicología , Relaciones Profesional-PacienteRESUMEN
BACKGROUND: Medication nonadherence contributes to hospitalizations in recently discharged patients with heart failure (HF). We aimed to test the feasibility of telemonitoring medication adherence in patients with HF. METHODS AND RESULTS: We randomized 40 patients (1:1) hospitalized for HF to 30 days of loop diuretic adherence monitoring with telephonic support or to passive adherence monitoring alone. Eighty-three percent of eligible patients agreed to participate. The median age of patients was 64 years, 25% were female, and 45% were Hispanic. Overall, 67% of patients were nonadherent (percentage of days that the correct number of doses were taken <88%). There were no differences between intervention and passive monitoring group patients, respectively, in adherence (median correct dosing adherence 82% vs 73%; P = .41) or in the proportion readmitted within 30 days (30% vs 20%; P = .72). Eighty-eight percent of patients rated the wireless electronic adherence device as somewhat or very easy to use, and 88% agreed to use it again. CONCLUSIONS: Adherence telemonitoring was acceptable to most patients with HF. Diuretic nonadherence was common even when patients knew they were being monitored. Future studies should assess whether adherence telemonitoring can improve adherence and reduce readmissions among patients with HF.
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Monitoreo de Drogas , Insuficiencia Cardíaca/tratamiento farmacológico , Cumplimiento de la Medicación , Inhibidores del Simportador de Cloruro Sódico y Cloruro Potásico/uso terapéutico , Telemedicina/métodos , Monitoreo de Drogas/instrumentación , Monitoreo de Drogas/métodos , Monitoreo de Drogas/psicología , Femenino , Humanos , Masculino , Cumplimiento de la Medicación/psicología , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Proyectos Piloto , Autocuidado/métodos , Autocuidado/psicologíaRESUMEN
Cancer is a top concern globally. Cancer care suffers from lack of coordination, silos of information, and high cost. Interest is emerging in person-centered technology to assist with coordination to address these challenges. This study evaluates the usability of the "personal health network" (PHN), a novel solution leveraging social networking and mobile technologies, among individuals undergoing chemotherapy and receiving care coordination. Early results from interviews of 12 participants in a randomized pragmatic trial suggest that they feel more connected to the healthcare team using the PHN, find value in access to the patient education library, and are better equipped to organize the many activities that occur during chemotherapy. Improvements are needed in navigation, connectivity, and integration with electronic health records. Findings contribute to improvements in the PHN and informs a roadmap for potentially greater impact in technology-enabled cancer care coordination.
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Neoplasias/tratamiento farmacológico , Satisfacción del Paciente/estadística & datos numéricos , Atención Dirigida al Paciente/estadística & datos numéricos , Atención Individual de Salud/estadística & datos numéricos , Apoyo Social , Anciano , Anciano de 80 o más Años , Continuidad de la Atención al Paciente/estadística & datos numéricos , Monitoreo de Drogas/psicología , Monitoreo de Drogas/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Evaluación de Necesidades , Neoplasias/psicología , Estados UnidosRESUMEN
This position statement is based on the current evidence available on the safety and benefits of continuous subcutaneous insulin pump therapy (CSII) in diabetes with an emphasis on the effects of CSII on glycemic control, hypoglycaemia rates, occurrence of ketoacidosis, quality of life and the use of insulin pump therapy in pregnancy. The current article represents the recommendations of the Austrian Diabetes Association for the clinical praxis of insulin pump treatment in children, adolescents and adults.
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Diabetes Mellitus/diagnóstico , Diabetes Mellitus/tratamiento farmacológico , Monitoreo de Drogas/normas , Sistemas de Infusión de Insulina/normas , Insulina/administración & dosificación , Guías de Práctica Clínica como Asunto , Adolescente , Adulto , Austria , Niño , Preescolar , Diabetes Mellitus/psicología , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Monitoreo de Drogas/psicología , Medicina Basada en la Evidencia , Femenino , Humanos , Hipoglucemiantes/administración & dosificación , Sistemas de Infusión de Insulina/psicología , Masculino , Calidad de Vida/psicología , Resultado del Tratamiento , Adulto JovenRESUMEN
In order to treat glaucoma with medication successfully, the patient needs to participate actively in the process. "Adherence", formerly "compliance", describes the willingness and capacity to follow the prescribed regimen every day. It is not trivial to measure adherence and persistence, as this quite often relies on self reports by the patient or speculations by the physician. Hence, the overall reported adherence may vary from 5 to 95â%. In general, the following categories have been defined for reduced adherence: medication-related factors, patient-related factors, environmental factors and social factors. Age has been found to intensify or modify many of these factors. Older adults often face various challenges, due to motor disabilities, reduced visual acuity or impaired cognitive capabilities. In patients with movement disorders or tactile limitations, the target area can be reached more successfully with standard eye drop bottles than with single-use dose units. This should be considered if antiglaucoma eye drops are prescribed in the elderly. Frequency of application is a main factor influencing adherence. Monotherapy--as provided with prostaglandins--or drops with a fixed combination have proven to support adherence significantly. A significant boost for self-monitoring activities is initiated by the growing market of electronic devices, like smartphones. For instance, they can provide acoustic alarms as reminders to apply the eye drops. It is evident that any external support or disease-related information by family members, the medical practitioners, support groups or even electronic devices may improve adherence and persistence, even in patients with severe impairments.
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Antihipertensivos/administración & dosificación , Monitoreo de Drogas/métodos , Glaucoma/tratamiento farmacológico , Cumplimiento de la Medicación/psicología , Sistemas Recordatorios , Autocuidado/métodos , Anciano , Anciano de 80 o más Años , Monitoreo de Drogas/psicología , Femenino , Glaucoma/diagnóstico , Glaucoma/psicología , Servicios de Salud para Ancianos/organización & administración , Humanos , Masculino , Autocuidado/psicologíaRESUMEN
BACKGROUND: Little is known about the role, extent, or effects of family member involvement in monitoring and managing opioid analgesics. Knowing when or how family members monitor prescribed opioid medication taking, whether it is acceptable to patients, or how family relationships may be affected by monitoring, are not well documented. METHODS: The study was conducted at Kaiser Permanente Northwest, an integrated health plan in Oregon and Washington. Semistructured in-depth interviews (N = 87) assessed circumstances surrounding overdose events among individuals who either experienced an opioid-related overdose or were family members of patients who died as a result of such an overdose. A subset of participants (n = 20) described family members' roles in monitoring opioid medications before or after overdoses. Interviews were transcribed verbatim and coded using Atlas.ti. We used a modified grounded theory approach to categorize emergent data and to identify common themes. RESULTS: When family members played roles in monitoring and managing opioid medications, clinicians were often unaware of their involvement. Patients and family members reported better outcomes when the patient, caregiver, and clinician developed a shared treatment plan. Negative outcomes included relationship stress, particularly when patients and caregivers had differing perspectives about what constituted effective pain management versus misuse and abuse. CONCLUSIONS: When families are concerned about opioid medications, coordination between clinicians, patients, and family carers appears to clarify roles and foster better outcomes. Increased stress and worse outcomes were reported when clinicians were not actively involved and when they did not attend to carers' concerns.
Asunto(s)
Analgésicos Opioides/efectos adversos , Cuidadores/psicología , Monitoreo de Drogas/psicología , Sobredosis de Droga/prevención & control , Relaciones Familiares/psicología , Adulto , Femenino , Humanos , Masculino , Investigación Cualitativa , Adulto JovenRESUMEN
To improve the quality of treatment of patients with spondyloarthrities based on analysis of adherence to therapy and its timely correction by regular remote monitoring the activity of the disease. MATERIALS AND METHODS: 46 patents with axial spondylitis (ankylosing spondylitis, non-radiographic spondylitis) were interviewed by phone once in 4 weeks for 18 months with a 3 month interval after 12 months. 96 patients underwent routine outpatient examination for the evaluation of the main parameters of the disease. RESULTS AND DISCUSSION: Arbitrarily examined patients with spondyloarthritis reported poor compliance with therapy and its low efficiency. During 18 months, 79% of the patients were recommended treatment with TNF-a inhibitors. Only 18.5% of them in the remote monitoring group failed to reach the BASDAI index S 4 whereas 73.9% of the patients examined remotely for 1 year had low activity of the disease or its partial remission. An increased period between two phone interviews from 1 to 3 months in 58.6% patients with low activity of the disease was associated with impaired adherence to therapy (decreased intake of the anti-inflammatory drug or its withdrawal) that did not lead to enhancement of activity during 3 months after the change in the treatment. CONCLUSION: Remote monitoring of activity of the disease (one phone interview every 4 weeks) allows to decrease it or reach remission in 73.9% of the patients with axial spondyloarthritis. The decrease in the frequency of telephone calls to one every 3 months results in the impairment of compliance with therapy but does not lead to increase of disease activity in the short run.