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1.
MMWR Morb Mortal Wkly Rep ; 69(40): 1437-1442, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33031362

RESUMEN

During 2018, estimated incidence of human immunodeficiency virus (HIV) infection among Hispanic and Latino (Hispanic/Latino) persons in the United States was four times that of non-Hispanic White persons (1). Hispanic/Latino men who have sex with men (MSM) accounted for 24% (138,023) of U.S. MSM living with diagnosed HIV infection at the end of 2018 (1). Antiretroviral therapy (ART) adherence is crucial for viral suppression, which improves health outcomes and prevents HIV transmission (2). Barriers to ART adherence among Hispanic/Latino MSM have been explored in limited contexts (3); however, nationally representative analyses are lacking. The Medical Monitoring Project reports nationally representative estimates of behavioral and clinical experiences of U.S. adults with diagnosed HIV infection. This analysis used Medical Monitoring Project data collected during 2015-2019 to examine ART adherence and reasons for missing ART doses among HIV-positive Hispanic/Latino MSM (1,673). On a three-item ART adherence scale with 100 being perfect adherence, 77.3% had a score of ≥85. Younger age, poverty, recent drug use, depression, and unmet needs for ancillary services were predictors of lower ART adherence. The most common reason for missing an ART dose was forgetting; 63.9% of persons who missed ≥1 dose reported more than one reason. Interventions that support ART adherence and access to ancillary services among Hispanic/Latino MSM might help improve clinical outcomes and reduce transmission.


Asunto(s)
Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/etnología , Accesibilidad a los Servicios de Salud , Hispanoamericanos/psicología , Homosexualidad Masculina/etnología , Cumplimiento de la Medicación/etnología , Adolescente , Adulto , Hispanoamericanos/estadística & datos numéricos , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Factores Socioeconómicos , Estados Unidos , Adulto Joven
2.
Eur J Contracept Reprod Health Care ; 25(6): 445-448, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33044107

RESUMEN

OBJECTIVES: The aims of the study were to investigate the effects of social distancing during the COVID-19 pandemic on the use of hormonal contraceptives, their discontinuation and the risk of unplanned pregnancy. METHODS: The study enrolled 317 women listed in the database of the Department of General Surgery and Medical-Surgical Specialties, University of Catania, Italy, family planning clinic who were known to be using hormonal contraceptives. The women were contacted by telephone and asked whether they would like to participate in the study. If they agreed, they were then emailed a questionnaire about their social behaviour and sexual activity during the pandemic, according to their cohabiting status, i.e., whether they were continuing to use their hormonal contraception and whether they had had an unplanned pregnancy. RESULTS: The questionnaire was completed by 175 (81.8%) women who were using short-acting reversible contraception (SARC) and by 90 (87.4%) women who were using long-acting reversible contraception (LARC). All married and cohabiting women were continuing to use their contraceptive method. None had had an unplanned pregnancy. On the other hand, 51 (50.5%) non-cohabiting or single women had discontinued their SARC method while social distancing, for non-method-related reasons; however, 47 (46.5%) non-cohabiting or single women had continued their sexual activity, infringing social distancing rules, and 14.9% had had an unplanned pregnancy, for which they had sought a termination. CONCLUSION: Several non-cohabiting women using SARC had discontinued their contraceptive method during the pandemic but had continued to engage in sexual activity and had had an unplanned pregnancy. Clinicians should counsel women about what they should do in regard to contraception in the event of new, future social distancing measures.


Asunto(s)
Conducta Anticonceptiva , Agentes Anticonceptivos Hormonales/uso terapéutico , Infecciones por Coronavirus , Cumplimiento de la Medicación/estadística & datos numéricos , Pandemias , Neumonía Viral , Conducta Sexual , Aislamiento Social/psicología , Adulto , Betacoronavirus , Control de Enfermedades Transmisibles/métodos , Conducta Anticonceptiva/psicología , Conducta Anticonceptiva/tendencias , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/psicología , Femenino , Humanos , Italia/epidemiología , Evaluación de Necesidades , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/psicología , Embarazo , Embarazo no Planeado , Salud Reproductiva/estadística & datos numéricos
3.
Medicine (Baltimore) ; 99(35): e21606, 2020 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-32871876

RESUMEN

The increasing availability of antiretroviral therapy (ART) worldwide is yet to result in decreasing HIV-related mortality among adolescents (10-19 years old) living with HIV (ALHIV) in part because of poor adherence. the poor adherence might itself be due to high level of depression. We assess the prevalence of depressive symptomatology and it's associated with adherence among ALHIV receiving ART care in Brazzaville and Pointe Noire, Republic of Congo (RoC).Adolescents aged 10 to 19 years, on antiretroviral therapy (ART), followed in the two Ambulatory Treatment Centers (ATC) in Brazzaville and Pointe Noire, RoC were included in this cross-sectional study. From April 19 to July 9, 2018, participants were administered face to face interviews using a standardized questionnaire that included the nine-item Patient Health Questionnaire (PHQ-9). Participants who reported failing to take their ART more than twice in the 7 days preceding the interview were classified as non-adherent. Bivariate and multivariable log-binomial models were used to estimate the prevalence ratio (PR) and 95% confidence interval (95%CI) assessing the strength of association between predictors and presence of depressive symptoms (PHQ-9 score ≥9).Overall, 135 adolescents represented 50% of ALHIV in active care at the 2 clinics were interviewed. Of those, 67 (50%) were male, 81 (60%) were 15 to 19 years old, 124 (95%) had been perinatally infected, and 71 (53%) knew their HIV status. Depressive symptoms were present in 52 (39%) participants and 78 (58%) were adherent. In univariate analyses, the prevalence of depressive symptoms was relative higher among participants who were not adherent compared to those who were (73% vs 33%; PR: 2.20 [95%CI: 1.42-3.41]). In multivariate analysis, after adjustment for report of been sexually active, alcohol drinking, age category (10-14 and 15-19), not in school, loss of both parents, the association between depression and adherence was strengthened (PR: 2.06 [95%CI: 1.23-3.45]).The prevalence of depressive symptoms in adolescents living with HIV is high and was strongly associated with poor adherence even after adjustment of potential confounders. Efforts to scale-up access to screening and management of depression among ALHIV in sub-Saharan is needed for them to realize the full of ART.


Asunto(s)
Antirretrovirales/uso terapéutico , Depresión/epidemiología , Infecciones por VIH/psicología , Cumplimiento de la Medicación/psicología , Adolescente , Instituciones de Atención Ambulatoria , Estudios de Casos y Controles , Niño , Congo/epidemiología , Estudios Transversales , Depresión/psicología , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Tamizaje Masivo/métodos , Tamizaje Masivo/psicología , Cumplimiento de la Medicación/estadística & datos numéricos , Atención Perinatal/estadística & datos numéricos , Atención Perinatal/tendencias , Prevalencia , Encuestas y Cuestionarios , Adulto Joven
4.
Value Health ; 23(9): 1210-1217, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32940239

RESUMEN

OBJECTIVES: Significant literature exists on the effects of medication adherence on reducing healthcare costs, but less is known about the effect of medication adherence among Medicare low-income subsidy (LIS) recipients. This study examined the effects of medication adherence on healthcare costs among LIS recipients with diabetes, hypertension, and/or heart failure. METHODS: This retrospective study analyzed Medicare claims data (2012-2013) linked to the Area Health Resources Files. Using measures developed by the Pharmacy Quality Alliance, adherence to 11 medication classes was studied among patients with 7 possible combinations of the diseases mentioned. Adherence was measured in 8 categories of proportion of days covered (PDC): ≥95%, 90% to <95%, 85% to <90%, 80% to <85%, 75% to <80%, 50% to <75%, 25% to <50%, and <25%. Annual Medicare costs were compared across adherence categories. A generalized linear model was used to control for patient/community characteristics. RESULTS: Among patients with only one disease, such as diabetes, patients with the lowest adherence (PDC < 25%) had $3152/year higher Medicare costs than patients with the highest adherence (PDC ≥ 95%; $11 101 vs $7949; P < .05). The adjusted costs among patients with PDC < 25% was $1893 higher than patients with PDC ≥ 95% ($9919 vs $8026; P < .05). Among patients with multiple chronic conditions, patients' adherence to medications for fewer diseases had higher costs. CONCLUSIONS: Greater medication adherence is associated with lower Medicare costs in the Medicare LIS population. Future policy affecting the LIS program should encourage better medication adherence among patients with chronic diseases.


Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Costos de la Atención en Salud/estadística & datos numéricos , Insuficiencia Cardíaca/epidemiología , Hipertensión/epidemiología , Medicare/estadística & datos numéricos , Cumplimiento de la Medicación/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Comorbilidad , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Hipertensión/tratamiento farmacológico , Medicare/economía , Estudios Retrospectivos , Estados Unidos
5.
Diabetes Metab Syndr ; 14(5): 1583-1587, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32947759

RESUMEN

AIMS: To explore the impact of the coronavirus disease lockdown on diabetes patients living in Jeddah, Saudi Arabia, in terms of their compliance with medication intake and lifestyle habits, and quality of life. METHODS: In this cross-sectional, qualitative prospective study, a questionnaire was administered over the telephone to diabetes patients who had attended National Guard primary care centers in Jeddah, Saudi Arabia. The survey included questions on demographic data, type of diabetes, medications used, comorbidities, medication compliance, and daily habits before and after the lockdown, and those assessing patients' psychological parameters during the past month by using the Kessler Psychological Distress Scale (K10). Data analysis was performed using SPSS program version 26. RESULTS: Totally, 394 patients participated. All of them had type 2 diabetes, and 37.6% had only one comorbidity. Antidiabetic monotherapy was used in 76.4% of the patients, while combination therapy was used in 23.6%. The compliance score before the lockdown was significantly higher (18.49 ± 3.05) than that after it (17.40 ± 3.25) (p-value <0.001). The average psychological assessment score was 9.78 ± 4.14 (range 8-35). Male participants and smokers had a significantly better psychological status than female participants (p-value = 0.002) and non-smokers (p value < 0.001), respectively. CONCLUSIONS: The patients' levels of compliance with medications and healthy lifestyle habits were significantly reduced after the lockdown. These findings highlight the need for healthcare professionals to encourage diabetes patients to adhere to healthy lifestyle habits and use telemedicine during lockdowns to ensure optimal blood glucose control and reduce the incidence of complications.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Cumplimiento de la Medicación/estadística & datos numéricos , Cuarentena/psicología , Adulto , Infecciones por Coronavirus , Estudios Transversales , Diabetes Mellitus Tipo 2/psicología , Femenino , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral , Estudios Prospectivos , Investigación Cualitativa , Calidad de Vida , Arabia Saudita , Adulto Joven
6.
Ann Epidemiol ; 49: 1-7, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32951802

RESUMEN

PURPOSE: Oral emtricitabine/tenofovir disoproxil fumarate was approved for use as pre-exposure prophylaxis (PrEP) by the U.S. Food and Drug Administration in 2012. We used national pharmacy data to examine trends of PrEP use in U.S. counties from 2012 to 2018. METHODS: Using multi-level small-area spatio-temporal modeling, we calculated the estimated annual percentage change (EAPC) in prevalence of PrEP use in the general population from 2012 to 2018. We also used a proxy measure for prevalence of PrEP use among men who have sex with men (MSM) to evaluate trends of use among MSM, the PrEP use-to-MSM ratio (PmR) or number of male PrEP users per 1000 MSM population. RESULTS: The prevalence of PrEP use and PmR increased (EAPC range: (+26.9%, +71.0%) and (+28.4%, +158.7%), respectively) in all counties with varying magnitude of increase. Counties of the Midwest and the upper South and upper West had the slowest increase in prevalence of PrEP use (EAPC range: (+26.9%; +52.9%)). Counties of the northern part of the South had the lowest PmR (EAPC range: (+28.4%; +76.0%)). Counties of the most populous core-based statistical areas had a relatively faster increase in population prevalence of PrEP use but slower increase in PmR. CONCLUSIONS: All counties in the U.S. have witnessed an increase in PrEP use with important geographic variabilities. Identifying areas with slow improvement in PrEP use, as well as "model counties" with the fastest pace of progress in PrEP coverage, is critical to inform local and state-level policies and program evaluation for PrEP scale up, particularly among MSM at higher risk for HIV.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Emtricitabina/administración & dosificación , Infecciones por VIH/prevención & control , Homosexualidad Masculina/estadística & datos numéricos , Cumplimiento de la Medicación/estadística & datos numéricos , Profilaxis Pre-Exposición/estadística & datos numéricos , Tenofovir/administración & dosificación , Adulto , Femenino , Humanos , Masculino , Profilaxis Pre-Exposición/tendencias , Prevalencia , Análisis de Área Pequeña , Análisis Espacio-Temporal , Estados Unidos/epidemiología
7.
BMC Public Health ; 20(1): 1443, 2020 Sep 23.
Artículo en Inglés | MEDLINE | ID: mdl-32967646

RESUMEN

BACKGROUND: Client-Centered Representative Payee (CCRP) is an intervention modifying implementation of a current policy of the US Social Security Administration, which appoints organizations to serve as financial payees on behalf of vulnerable individuals receiving Social Security benefits. By ensuring beneficiaries' bills are paid while supporting their self-determination, this structural intervention may mitigate the effects of economic disadvantage to improve housing and financial stability, enabling self-efficacy for health outcomes and improved antiretroviral therapy adherence. This randomized controlled trial will test the impact of CCRP on marginalized people living with HIV (PLWH). We hypothesize that helping participants to pay their rent and other bills on time will improve housing stability and decrease financial stress. METHODS: PLWH (n = 160) receiving services at community-based organizations will be randomly assigned to the CCRP intervention or the standard of care for 12 months. Fifty additional participants will be enrolled into a non-randomized ("choice") study allowing participant selection of the CCRP intervention or control. The primary outcome is HIV medication adherence, assessed via the CASE adherence index, viral load, and CD4 counts. Self-assessment data for ART adherence, housing instability, self-efficacy for health behaviors, financial stress, and retention in care will be collected at baseline, 3, 6, and 12 months. Viral load, CD4, and appointment adherence data will be collected at baseline, 6, 12, 18, and 24 months from medical records. Outcomes will be compared by treatment group in the randomized trial, in the non-randomized cohort, and in the combined cohort. Qualitative data will be collected from study participants, eligible non-participants, and providers to explore underlying mechanisms of adherence, subjective responses to the intervention, and implementation barriers and facilitators. DISCUSSION: The aim of this study is to determine if CCRP improves health outcomes for vulnerable PLWH. Study outcomes may provide information about supports needed to help economically fragile PLWH improve health outcomes and ultimately improve HIV health disparities. In addition, findings may help to refine service delivery including the provision of representative payee to this often-marginalized population. This protocol was prospectively registered on May 22, 2018 with ClinicalTrials.gov (NCT03561103) .


Asunto(s)
Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación/estadística & datos numéricos , Marginación Social , Seguridad Social/economía , Humanos , Proyectos de Investigación , Estados Unidos , United States Social Security Administration
8.
AIDS Educ Prev ; 32(3): 181-195, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32749876

RESUMEN

The twin epidemics of HIV and incarceration impact Puerto Rico, which has limited resources to address the social and structural determinants of health in incarcerated populations. A Special Programs of National Significance grant supported a Puerto Rican community-based organization to implement the evidence-informed Transitional Care Coordination intervention among incarcerated persons living with HIV, targeting changes at the individual, organization, and systems levels. After implementation (November 2015-July 2018; n = 69), 93.1% of eligible clients were linked to community-based HIV care, 86.3% remained in care for 6 months, and 78.6% remained for 12 months. A greater proportion reported consistent HIV care, ART adherence, food security, and transportation to access care. Integrating HIV case management with housing and employment services, and developing buy-in and collaboration from partners across systems of care, including after a natural disaster, led to positive client outcomes. This intervention shows promise for adaptation to other HIV care and service delivery systems.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Servicios de Salud Comunitaria/organización & administración , Continuidad de la Atención al Paciente , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación/estadística & datos numéricos , Prisioneros/estadística & datos numéricos , Cuidado de Transición , Adulto , Femenino , Abastecimiento de Alimentos , Infecciones por VIH/psicología , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Puerto Rico , Determinantes Sociales de la Salud
9.
Niger J Clin Pract ; 23(8): 1033-1038, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32788477

RESUMEN

Background: Inhaler corticosteroids (ICS) are the most commonly used antiinflammatory drugs in the treatment of asthma. Although systemic adverse effects are minimal, patients hesitate to use ICS for a long time because of corticophobia. There is no study evaluating corticophobia via Likert-type appendix among the asthmatic patients. Aim: In this study, it was aimed to evaluate the fears and beliefs about ICS in asthmatic patients. Subjects and Methods: Between December 2017 and January 2018, 150 stable asthmatic patients were included in the study. Demographic data (age, education, smoking history, etc.) and asthma-related data (pulmonary function test, drug use) were recorded. The appendix of TOPICOP study applied to the patients with asthma which was composed of 10 questions (five questions about fear of ICS and five questions about beliefs of ICS). Results: The rate of ICS maintain in stable asthmatic patients was found to be 66.6%. According to the survey results, 68% of the patients believed that ICS may lead to weight gain, 52% believed that ICS may lead to infection, 73% believed that ICS may pass into bloodstream, and 67.3% believed that ICS may damage the lungs. It was also found that 90.7% needed to be informed about ICS and 67.3% wanted to cut the ICS drug as soon as possible. Conclusion: We found that treatment adherence may increase, if physicians allocate more time to asthma patients to inform about ICS beneficial effects at the initiating of ICS treatment and control visits.


Asunto(s)
Corticoesteroides/uso terapéutico , Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Miedo , Conocimientos, Actitudes y Práctica en Salud , Cumplimiento de la Medicación/psicología , Trastornos Fóbicos/psicología , Administración por Inhalación , Corticoesteroides/efectos adversos , Adulto , Antiasmáticos/efectos adversos , Asma/psicología , Femenino , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Trastornos Fóbicos/epidemiología , Trastornos Fóbicos/etiología , Encuestas y Cuestionarios
10.
Value Health ; 23(8): 1063-1071, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32828219

RESUMEN

OBJECTIVES: To classify older people with multimorbidity according to their adherence patterns and to examine the association between medication adherence and health outcomes. METHODS: This is a secondary analysis of a cohort study. Community-dwelling adults aged ≥70 years were recruited from 15 general practices in Ireland in 2010 (wave 1) and followed up 2 years later (wave 2). Participants had ≥2 RxRisk-V multimorbidity conditions at wave 1 and had ≥2 dispensations of RxRisk-V medications (wave 1-wave 2). Average adherence across RxRisk-V conditions was estimated based on continuous multiple-interval measure of medication availability (CMA7 function in AdhereR). Group-based trajectory models were used to group participants' adherence patterns for RxRisk-V medications. Multilevel regression was used to examine the association between adherence and (1) EuroQol 5-dimension (EQ-5D) utility (linear) and (2) vulnerability, using the Vulnerable Elders Survey (≥3 defined as vulnerable; logistic) at wave 2, controlling for potential confounders. RESULTS: Average adherence (CMA7) was 77% across 501 participants. Group-based trajectory models identified 5 adherence groups: (1) initial low adherers, gradual increase; (2) high adherers, sharp decline; (3) steady adherers, gradual decline; (4) consistent high adherers; and (5) consistent nonadherers. Higher average adherence was associated with a significant increase in EQ-5D utility (adjusted ß = 0.11, robust standard error 0.04). Group 5 was associated with significantly increased vulnerability compared to group 4 (adjusted odds ratio = 1.88; 95% confidence interval 1.01-3.50). CONCLUSION: Increased average adherence was associated with higher EQ-5D utility. Adherence grouping did not significantly impact utility. Suboptimal adherence to multiple medications in older adults with multimorbidity was associated with vulnerability.


Asunto(s)
Evaluación Geriátrica/métodos , Cumplimiento de la Medicación/estadística & datos numéricos , Multimorbilidad , Calidad de Vida , Anciano , Anciano de 80 o más Años , Femenino , Estado de Salud , Humanos , Irlanda/epidemiología , Masculino , Polifarmacia
11.
Transplantation ; 104(8): e224-e235, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32732828

RESUMEN

BACKGROUND: Lack of support for self-management may contribute to adverse health outcomes. eHealth has the potential to support self-management, but evidence in solid organ transplantation remains unclear. This review aims to evaluate the benefits and harms of eHealth interventions to support self-management in solid organ transplant recipients. METHODS: We searched Cochrane Central Register of Controlled Trials, MEDLINE, and Embase databases for randomized trials of eHealth interventions in solid organ transplant recipients. We calculated the risk ratios or standardized mean difference of outcomes, and summary estimates were determined using random-effects models. The Cochrane risk of bias tool and Grading of Recommendations, Assessment, Development, and Evaluations were used to assess trial quality. RESULTS: Twenty-one trials from 6 countries involving 2114 participants were included. Compared with standard care, eHealth interventions improved medication adherence (risk ratio, 1.34; CI, 1.12-2.56; I = 75%) and self-monitoring behavior (risk ratio, 2.58; CI, 1.56-4.27; I = 0%) up to 12 mo posttransplant. The treatment effects were largely consistent across different subgroups except for intervention functionality and mode of delivery. The effects on other outcomes were uncertain. Nine trials reported harms. The overall risk of bias was considered high or unclear, and the quality of evidence was low to very low for all outcomes. CONCLUSIONS: eHealth interventions may improve medication adherence and self-monitoring behavior in the short term, but high-quality intervention studies are needed to determine whether eHealth will improve long-term patient-relevant outcomes.


Asunto(s)
Rechazo de Injerto/prevención & control , Trasplante de Órganos/efectos adversos , Automanejo/métodos , Telemedicina/métodos , Receptores de Trasplantes , Rechazo de Injerto/inmunología , Humanos , Inmunosupresores/uso terapéutico , Cumplimiento de la Medicación/estadística & datos numéricos , Educación del Paciente como Asunto/métodos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Sistemas Recordatorios , Resultado del Tratamiento
12.
Cochrane Database Syst Rev ; 8: CD000544, 2020 08 28.
Artículo en Inglés | MEDLINE | ID: mdl-32856298

RESUMEN

BACKGROUND: Oral 5-aminosalicylic acid (5-ASA; also known as mesalazine or mesalamine) preparations were intended to avoid the adverse effects of sulfasalazine (SASP) while maintaining its therapeutic benefits. In an earlier version of this review, we found that 5-ASA drugs were more effective than placebo for maintenance of remission of ulcerative colitis (UC), but had a significant therapeutic inferiority relative to SASP. In this version, we have rerun the search to bring the review up to date. OBJECTIVES: To assess the efficacy, dose-responsiveness, and safety of oral 5-ASA compared to placebo, SASP, or 5-ASA comparators for maintenance of remission in quiescent UC and to compare the efficacy and safety of once-daily dosing of oral 5-ASA with conventional (two or three times daily) dosing regimens. SEARCH METHODS: We performed a literature search for studies on 11 June 2019 using MEDLINE, Embase, and the Cochrane Library. In addition, we searched review articles and conference proceedings. SELECTION CRITERIA: We included randomized controlled trials with a minimum treatment duration of six months. We considered studies of oral 5-ASA therapy for treatment of participants with quiescent UC compared with placebo, SASP, or other 5-ASA formulations. We also included studies that compared once-daily 5-ASA treatment with conventional dosing of 5-ASA and 5-ASA dose-ranging studies. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. The primary outcome was the failure to maintain clinical or endoscopic remission. Secondary outcomes were adherence, adverse events (AE), serious adverse events (SAE), withdrawals due to AEs, and withdrawals or exclusions after entry. Trials were separated into five comparison groups: 5-ASA versus placebo, 5-ASA versus SASP, once-daily dosing versus conventional dosing, 5-ASA (balsalazide, Pentasa, and olsalazine) versus comparator 5-ASA formulation (Asacol and Salofalk), and 5-ASA dose-ranging. We calculated the risk ratio (RR) and 95% confidence interval (CI) for each outcome. We analyzed data on an intention-to-treat basis, and used GRADE to assess the overall certainty of the evidence. MAIN RESULTS: The search identified 44 studies (9967 participants). Most studies were at low risk of bias. Ten studies were at high risk of bias. Seven of these studies were single-blind and three were open-label. 5-ASA is more effective than placebo for maintenance of clinical or endoscopic remission. About 37% (335/907) of 5-ASA participants relapsed at six to 12 months compared to 55% (355/648) of placebo participants (RR 0.68, 95% CI 0.61 to 0.76; 8 studies, 1555 participants; high-certainty evidence). Adherence to study medication was not reported for this comparison. SAEs were reported in 1% (6/550) of participants in the 5-ASA group compared to 2% (5/276) of participants in the placebo group at six to 12 months (RR 0.60, 95% CI 0.19 to 1.84; 3 studies, 826 participants; low-certainty evidence). There is probably little or no difference in AEs at six to 12 months' follow-up (RR 0.93, 95% CI 0.73 to 1.18; 5 studies, 1132 participants; moderate-certainty evidence). SASP is more effective than 5-ASA for maintenance of remission. About 48% (416/871) of 5-ASA participants relapsed at six to 18 months compared to 43% (336/784) of SASP participants (RR 1.14, 95% CI 1.03 to 1.27; 12 studies, 1655 participants; high-certainty evidence). Adherence to study medication and SAEs were not reported for this comparison. There is probably little or no difference in AEs at six to 12 months' follow-up (RR 1.07, 95% CI 0.82 to 1.40; 7 studies, 1138 participants; moderate-certainty evidence). There is little or no difference in clinical or endoscopic remission rates between once-daily and conventionally dosed 5-ASA. About 37% (717/1939) of once-daily participants relapsed over 12 months compared to 39% (770/1971) of conventional-dosing participants (RR 0.94, 95% CI 0.88 to 1.01; 10 studies, 3910 participants; high-certainty evidence). There is probably little or no difference in medication adherence rates. About 10% (106/1152) of participants in the once-daily group failed to adhere to their medication regimen compared to 8% (84/1154) of participants in the conventional-dosing group (RR 1.18, 95% CI 0.72 to 1.93; 9 studies, 2306 participants; moderate-certainty evidence). About 3% (41/1587) of participants in the once-daily group experienced a SAE compared to 2% (35/1609) of participants in the conventional-dose group at six to 12 months (RR 1.20, 95% CI 0.77 to 1.87; moderate-certainty evidence). There is little or no difference in the incidence of AEs at six to 13 months' follow-up (RR 0.98, 95% CI 0.92 to 1.04; 8 studies, 3497 participants; high-certainty evidence). There may be little or no difference in the efficacy of different 5-ASA formulations. About 44% (158/358) of participants in the 5-ASA group relapsed at six to 18 months compared to 41% (142/349) of participants in the 5-ASA comparator group (RR 1.08, 95% CI 0.91 to 1.28; 6 studies, 707 participants; low-certainty evidence). AUTHORS' CONCLUSIONS: There is high-certainty evidence that 5-ASA is superior to placebo for maintenance therapy in UC. There is high-certainty evidence that 5-ASA is inferior compared to SASP. There is probably little or no difference between 5-ASA and placebo, and 5-ASA and SASP in commonly reported AEs such as flatulence, abdominal pain, nausea, diarrhea, headache, and dyspepsia. Oral 5-ASA administered once daily has a similar benefit and harm profile as conventional dosing for maintenance of remission in quiescent UC.


Asunto(s)
Ácidos Aminosalicílicos/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Colitis Ulcerosa/tratamiento farmacológico , Quimioterapia de Mantención/métodos , Mesalamina/administración & dosificación , Administración Oral , Antiinflamatorios no Esteroideos/efectos adversos , Sesgo , Colitis Ulcerosa/prevención & control , Esquema de Medicación , Humanos , Cumplimiento de la Medicación/estadística & datos numéricos , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Placebos/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Inducción de Remisión/métodos , Sulfasalazina/administración & dosificación , Sulfasalazina/efectos adversos
13.
PLoS One ; 15(8): e0237781, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32857798

RESUMEN

BACKGROUND: Drug therapy problems (DTPs) are major concerns of healthcare and have been identified to contribute to negative clinical outcomes. The occurrence of DTPs in heart failure patients is associated with worsening of outcomes. The aim of this study was to assess DTPs, associated factors and patient satisfaction among ambulatory heart failure patients at Tikur Anbessa Specialized Hospital (TASH). METHODS: A hospital based prospective cross-sectional study was conducted on 423 heart failure patients on follow up at TASH. Data was collected through patient interview and chart review. Descriptive statistics, binary and multiple logistic regressions were used for analyses and P < 0.05 was used to declare association. RESULTS: Majority of the patients were in NYHA class III (55.6%) and 66% of them had preserved systolic function. DTPs were identified in 291(68.8%) patients, with an average number of 2.51±1.07.per patient. The most common DTPs were drug interaction (27.3%) followed by noncompliance (26.2%), and ineffective drug use (13.7%). ß blockers were the most frequent drug class involved in DTPs followed by angiotensin converting enzyme inhibitors. The global satisfaction was 78% and the overall mean score of treatment satisfaction was 60.5% (SD, 10.5). CONCLUSION: Prevalence of DTPs as well as non-adherence among heart failure patients on follow up is relatively high. Detection and prevention of DTPs along with identifying patients at risk can save lives, help to adopt efficient strategies to closely monitor patients at risk, enhance patient's quality of life and optimize healthcare costs.


Asunto(s)
Antagonistas Adrenérgicos beta/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Insuficiencia Cardíaca/tratamiento farmacológico , Cumplimiento de la Medicación/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Adolescente , Antagonistas Adrenérgicos beta/farmacocinética , Adulto , Anciano , Anciano de 80 o más Años , Inhibidores de la Enzima Convertidora de Angiotensina/farmacocinética , Estudios Transversales , Interacciones Farmacológicas , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/etiología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/psicología , Etiopía/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Cumplimiento de la Medicación/psicología , Persona de Mediana Edad , Servicio Ambulatorio en Hospital/estadística & datos numéricos , Prevalencia , Estudios Prospectivos , Calidad de Vida , Encuestas y Cuestionarios/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricos , Adulto Joven
14.
Cochrane Database Syst Rev ; 8: CD013679, 2020 07 14.
Artículo en Inglés | MEDLINE | ID: mdl-32813276

RESUMEN

BACKGROUND: The global burden of poor maternal, neonatal, and child health (MNCH) accounts for more than a quarter of healthy years of life lost worldwide. Targeted client communication (TCC) via mobile devices (MD) (TCCMD) may be a useful strategy to improve MNCH. OBJECTIVES: To assess the effects of TCC via MD on health behaviour, service use, health, and well-being for MNCH. SEARCH METHODS: In July/August 2017, we searched five databases including The Cochrane Central Register of Controlled Trials, MEDLINE and Embase. We also searched two trial registries. A search update was carried out in July 2019 and potentially relevant studies are awaiting classification. SELECTION CRITERIA: We included randomised controlled trials that assessed TCC via MD to improve MNCH behaviour, service use, health, and well-being. Eligible comparators were usual care/no intervention, non-digital TCC, and digital non-targeted client communication. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane, although data extraction and risk of bias assessments were carried out by one person only and cross-checked by a second. MAIN RESULTS: We included 27 trials (17,463 participants). Trial populations were: pregnant and postpartum women (11 trials conducted in low-, middle- or high-income countries (LMHIC); pregnant and postpartum women living with HIV (three trials carried out in one lower middle-income country); and parents of children under the age of five years (13 trials conducted in LMHIC). Most interventions (18) were delivered via text messages alone, one was delivered through voice calls only, and the rest were delivered through combinations of different communication channels, such as multimedia messages and voice calls. Pregnant and postpartum women TCCMD versus standard care For behaviours, TCCMD may increase exclusive breastfeeding in settings where rates of exclusive breastfeeding are less common (risk ratio (RR) 1.30, 95% confidence intervals (CI) 1.06 to 1.59; low-certainty evidence), but have little or no effect in settings where almost all women breastfeed (low-certainty evidence). For use of health services, TCCMD may increase antenatal appointment attendance (odds ratio (OR) 1.54, 95% CI 0.80 to 2.96; low-certainty evidence); however, the CI encompasses both benefit and harm. The intervention may increase skilled attendants at birth in settings where a lack of skilled attendants at birth is common (though this differed by urban/rural residence), but may make no difference in settings where almost all women already have a skilled attendant at birth (OR 1.00, 95% CI 0.34 to 2.94; low-certainty evidence). There were uncertain effects on maternal and neonatal mortality and morbidity because the certainty of the evidence was assessed as very low. TCCMD versus non-digital TCC (e.g. pamphlets) TCCMD may have little or no effect on exclusive breastfeeding (RR 0.92, 95% CI 0.79 to 1.07; low-certainty evidence). TCCMD may reduce 'any maternal health problem' (RR 0.19, 95% CI 0.04 to 0.79) and 'any newborn health problem' (RR 0.52, 95% CI 0.25 to 1.06) reported up to 10 days postpartum (low-certainty evidence), though the CI for the latter includes benefit and harm. The effect on health service use is unknown due to a lack of studies. TCCMD versus digital non-targeted communication No studies reported behavioural, health, or well-being outcomes for this comparison. For use of health services, there are uncertain effects for the presence of a skilled attendant at birth due to very low-certainty evidence, and the intervention may make little or no difference to attendance for antenatal influenza vaccination (RR 1.05, 95% CI 0.71 to 1.58), though the CI encompasses both benefit and harm (low-certainty evidence). Pregnant and postpartum women living with HIV TCCMD versus standard care For behaviours, TCCMD may make little or no difference to maternal and infant adherence to antiretroviral (ARV) therapy (low-certainty evidence). For health service use, TCC mobile telephone reminders may increase use of antenatal care slightly (mean difference (MD) 1.5, 95% CI -0.36 to 3.36; low-certainty evidence). The effect on the proportion of births occurring in a health facility is uncertain due to very low-certainty evidence. For health and well-being outcomes, there was an uncertain intervention effect on neonatal death or stillbirth, and infant HIV due to very low-certainty evidence. No studies reported on maternal mortality or morbidity. TCCMD versus non-digital TCC The effect is unknown due to lack of studies reporting this comparison. TCCMD versus digital non-targeted communication TCCMD may increase infant ARV/prevention of mother-to-child transmission treatment adherence (RR 1.26, 95% CI 1.07 to 1.48; low-certainty evidence). The effect on other outcomes is unknown due to lack of studies. Parents of children aged less than five years No studies reported on correct treatment, nutritional, or health outcomes. TCCMD versus standard care Based on 10 trials, TCCMD may modestly increase health service use (vaccinations and HIV care) (RR 1.21, 95% CI 1.08 to 1.34; low-certainty evidence); however, the effect estimates varied widely between studies. TCCMD versus non-digital TCC TCCMD may increase attendance for vaccinations (RR 1.13, 95% CI 1.00 to 1.28; low-certainty evidence), and may make little or no difference to oral hygiene practices (low-certainty evidence). TCCMD versus digital non-targeted communication TCCMD may reduce attendance for vaccinations, but the CI encompasses both benefit and harm (RR 0.63, 95% CI 0.33 to 1.20; low-certainty evidence). No trials in any population reported data on unintended consequences. AUTHORS' CONCLUSIONS: The effect of TCCMD for most outcomes is uncertain. There may be improvements for some outcomes using targeted communication but these findings were of low certainty. High-quality, adequately powered trials and cost-effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCCMD. Future studies should measure potential unintended consequences, such as partner violence or breaches of confidentiality.


Asunto(s)
Teléfono Celular , Salud del Niño/normas , Comunicación , Necesidades y Demandas de Servicios de Salud , Salud del Lactante/normas , Salud Materna/normas , Lactancia Materna/estadística & datos numéricos , Salud del Niño/estadística & datos numéricos , Preescolar , Parto Obstétrico/normas , Femenino , Infecciones por VIH/tratamiento farmacológico , Conductas Relacionadas con la Salud , Estado de Salud , Humanos , Lactante , Salud del Lactante/estadística & datos numéricos , Recién Nacido , Salud Materna/estadística & datos numéricos , Cumplimiento de la Medicación/estadística & datos numéricos , Periodo Posparto , Embarazo , Atención Prenatal/estadística & datos numéricos , Mejoramiento de la Calidad , Ensayos Clínicos Controlados Aleatorios como Asunto , Envío de Mensajes de Texto
15.
AIDS Patient Care STDS ; 34(8): 344-355, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32757979

RESUMEN

Antiretroviral therapy (ART) adherence is vital for optimal HIV treatment. However, there is limited ART adherence research on the US Latinx population, who are at increased risk for HIV infection and worse HIV health outcomes. This study examined electronically measured ART adherence (Medication Event Monitoring System) and its association with demographic, clinical, neurocognitive, and sociocultural variables in Latinx and non-Latinx white (NLW) persons living with HIV [PLWH (N = 128)]. Latinx participants demonstrated worse adherence than NLW participants (p = 0.04). Linear regressions revealed different predictors of adherence. Among Latinx participants, recent cocaine use, stress, and, unexpectedly, higher US acculturation predicted worse adherence (ps < 0.05). Among NLW participants, recent cocaine use predicted worse adherence (p < 0.05). Intergroup comparisons within the Latinx group were not conducted due to subsample size. Thus, ethnicity, sociocultural variables, and cocaine use are important considerations for ART adherence, and poor ART adherence may be one pathway explaining worse outcomes in Latinx PLWH. Culturally tailored adherence interventions incorporating substance use treatment, acculturation, and stress management are warranted to improve health outcomes.


Asunto(s)
Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Disparidades en Atención de Salud/etnología , Hispanoamericanos/psicología , Cumplimiento de la Medicación/etnología , Trastornos Relacionados con Sustancias/complicaciones , Aculturación , Adulto , Grupo de Ascendencia Continental Europea/psicología , Femenino , Infecciones por VIH/psicología , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Factores Socioeconómicos , Estrés Psicológico , Trastornos Relacionados con Sustancias/epidemiología
16.
PLoS One ; 15(7): e0236801, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32735566

RESUMEN

INTRODUCTION: Adherence to antiretroviral therapy (ART) and retention in treatment programs are required for successful virologic suppression and treatment outcomes. As the number of adolescents living with HIV continues to increase globally, more information about adherence and retention patterns during and through transition from child- to adult-centered care is needed to ensure provision of a high level of care and inform development of targeted interventions to improve patient outcomes in this vulnerable population. In this analysis, we sought to describe long-term trends in adherence, retention, and virologic suppression in adolescents receiving ART at a pediatric HIV clinic in Nigeria through transition to the adult clinic. SETTING: The Jos University Teaching Hospital, United States President's Emergency Plan for AIDS Relief (PEPFAR)-funded HIV clinic in Jos, Plateau State, Nigeria. METHODS: We conducted a retrospective observational longitudinal evaluation of data that had been collected during the course of care in a large pediatric ART program in Nigeria. We used descriptive statistics to define our patient population and quantify retention from ART initiation through adolescence and transition to adult-centered care. Logistic regression was used to evaluate predictors of loss to follow-up. We used medication possession ratio (MPR) to quantify adherence for each year a patient was on ART. To evaluate adherence and virologic suppression, we measured the proportion of patients with ≥95% MPR and the proportion with virologic suppression (viral load ≤400 copies/mL) within each age cohort, and used bivariate analyses to examine any association between MPR and VL suppression for all person-years observed. RESULTS: A total of 476 patients received at least one dose of ART as an adolescent (ages 10-19 years). The proportions of patients lost to follow-up were: 11.9% (71/597) prior to adolescence, 19.1% (31/162) during adolescence, and 13.7% (10/73) during transition to adult-centered care. While over 80% of patients had ≥95% medication adherence in all age groups, their viral load suppression rates through adolescence and post-transition were only 55.6%-64.0%. For patients that successfully transitioned to adult-centered care, we observed 87.7% (50/57) retention at month 12 post-transition, but only 34.6% (9/26) viral load suppression. CONCLUSIONS: Our evaluation found considerable proportions of adolescents lost to follow-up throughout the ART program cascade. We also found discrepancies between the proportions of patients with ≥95% MPR and the proportions with VL suppression, suggesting that true medication adherence in this population may be poor. Significant attention and targeted interventions to improve retention and adherence focused on adolescents are needed in order for global programs to achieve 90-90-90 goals.


Asunto(s)
Salud del Adolescente , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación/estadística & datos numéricos , Adolescente , Adulto , Niño , Femenino , Humanos , Estudios Longitudinales , Masculino , Nigeria , Estudios Retrospectivos , Resultado del Tratamiento , Carga Viral , Adulto Joven
17.
Health Psychol ; 39(9): 767-775, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32833478

RESUMEN

OBJECTIVE: To describe development of the Positive Affect, Promoting Positive Engagement, and Adherence for Life (APPEAL) program. METHOD: APPEAL is intended to increase HIV medication adherence through promotion of positive affect, and was developed through an iterative process involving 6 focus groups (N = 34) that elicited feedback on intervention content, followed by an individually administered prepilot of the entire intervention (N = 7). RESULTS: Participants provided feedback on important potential moderator variables, including depression, on mode of intervention administration, and on anticipated barriers and benefits to participation. Insights gained were used to finalize study procedures in preparation for a feasibility trial. For the feasibility trial, a total of 80 participants who, in the past 6 months have had at least one plasma HIV RNA >200 copies/mL, will be randomized to receive APPEAL or standard of care (N = 40 per group). Intervention group participants will receive 3 monthly, individually administered sessions, and all participants will have their medication adherence monitored and complete structured interviews at baseline and at 3 and 6 months. CONCLUSION: The APPEAL program is innovative in that it focuses on promoting self-regulation of positive emotions, an understudied approach to promoting chronic disease self-management behaviors such as HIV medication adherence. Findings from the feasibility trial will gauge suitability of the APPEAL intervention and evaluation methods for subsequent testing in a confirmatory trial and will examine changes in positive affect, the primary mechanism of change targeted in the intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Asunto(s)
Cumplimiento de la Medicación/estadística & datos numéricos , Adulto , Estudios de Factibilidad , Femenino , Grupos Focales , Humanos , Masculino , Adulto Joven
18.
Med Care ; 58(9): 763-769, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32732784

RESUMEN

BACKGROUND: Increases in prescription drug cost-sharing may decrease adherence to treatment among persons with schizophrenia and lead to discontinuation of use and an increased risk of hospitalization. OBJECTIVE: The objective of this study was to investigate the impact of new deductible and increased drug copayments implemented on antipsychotic and other drug purchases and on rates of hospitalizations and primary care contacts among persons with schizophrenia in Finland. RESEARCH DESIGN: Interrupted time series analysis. SUBJECTS: All persons with schizophrenia in Finland who were alive at the beginning of 2015 (N=41,017). MEASURES: We measured the rates of antipsychotic, other psychotropic and cardiometabolic drug purchasers, hospitalizations, and primary care contacts during 2015 and 2016 with data collected from several nationwide health care registers. RESULTS: During 2016, the proportion of antipsychotic purchasers decreased by -0.26 percentage points per month [95% confidence interval (CI): -0.47 to -0.05] compared with 2015. The trend of other psychotropic purchasers decreased to -0.13 percentage points per month in 2016 (95% CI: -0.22 to -0.04) compared with 2015 and cardiometabolic drug purchases to -0.17 percentage points per month (95% CI: -0.29 to -0.05) compared with 2015. The decreasing trend of psychiatric hospitalizations in 2015 halted in 2016. There were no other significant differences in health care utilization. CONCLUSIONS: In our nationwide time-series analysis, we observed decreases in the slopes of antipsychotic and other drug purchases of persons with schizophrenia after prescription drug cost-sharing increase implementation on January 1, 2016. Policymakers need to be aware of the unintended consequences of increasing cost-sharing among people with severe mental disorders.


Asunto(s)
Antipsicóticos/administración & dosificación , Antipsicóticos/economía , Seguro de Costos Compartidos/estadística & datos numéricos , Cumplimiento de la Medicación/estadística & datos numéricos , Esquizofrenia/tratamiento farmacológico , Adulto , Anciano , Antipsicóticos/uso terapéutico , Femenino , Finlandia , Hospitalización/estadística & datos numéricos , Humanos , Análisis de Series de Tiempo Interrumpido , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Psicotrópicos/administración & dosificación , Psicotrópicos/economía
19.
Am Heart J ; 228: 17-26, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32745732

RESUMEN

BACKGROUND: Secondary preventive therapies play a key role in the prevention of adverse events after coronary artery bypass grafting (CABG). However, adherence to secondary preventive drugs after CABG is often poor. With the increasing penetration of smartphones, health-related smartphone applications might provide an opportunity to improve medication adherence. We aimed to evaluate the effectiveness and feasibility of using a smartphone-based application to improve medication adherence in patients after CABG. METHODS: The Measurement and Improvement Studies of Surgical coronary revascularizatION: medication adherence (MISSION-2) study is a multicenter randomized controlled trial that planned to enroll over 1000 patients who underwent isolated CABG at one of four large teaching hospitals in China; all enrolled participants had access to a smartphone and were able to operate at least three smartphone applications. The investigators randomly assigned the participants to one of two groups: (1) the intervention group with an advanced smartphone application for 6 months which was designed specifically for this trial and did not exist before. Participants could receive medication reminders and cardiac health education by the smartphone application or (2) the control group with usual care. The primary outcome was CABG secondary preventive medication adherence as measured by the translated Chinese version of the 8-item Morisky Medication Adherence Scale (MMAS-8) at 6 months after randomization. The secondary outcomes were mortality, major adverse cardiovascular and cerebrovascular events (MACCE), cardiovascular rehospitalization, self-reported secondary preventive medication use after 6 months of follow-up, blood pressure (BP), body mass index (BMI), and self-reported smoking status. All analyses were conducted using the intention-to-treat principle. RESULTS: A total of 1000 patients (mean age, 57.28 [SD, 9.09] years; 85.5% male) with coronary heart disease after CABG were enrolled between September 2015 and September 2016 and were randomly assigned to the intervention (n = 501) or control group (n = 499). At 6 months, the proportion of low-adherence participants, categorized by MMAS-8 scores, was 11.8% in the intervention group and 11.7% in the control group (RR = 1.005, 95% CI 0.682 to 1.480, P = 1.000). Similar results were found in sensitivity analyses that considered participants who withdrew from the study, or were lost to follow-up as nonadherent. There were no significant differences in the secondary clinical outcome measures, and there were no significant differences in the primary outcome across the subgroups tested. In the intervention group, the proportion of participants who used and operated the application during the first month after CABG was 88.1%; however, the use rate decreased sharply from 42.5% in the second month to 9.2% by the end of the study (6 months). CONCLUSIONS: A smartphone-based application supporting secondary prevention among patients after CABG did not lead to a greater adherence to secondary preventive medications. The limited room for improvement in medication adherence and the low participants' engagement with the smartphone applications might account for these non-significant outcomes.


Asunto(s)
Fármacos Cardiovasculares/uso terapéutico , Puente de Arteria Coronaria/efectos adversos , Enfermedad Coronaria , Educación en Salud/métodos , Cumplimiento de la Medicación/estadística & datos numéricos , Complicaciones Posoperatorias , Teléfono Inteligente , Programas Informáticos , Puente de Arteria Coronaria/métodos , Enfermedad Coronaria/tratamiento farmacológico , Enfermedad Coronaria/psicología , Enfermedad Coronaria/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Sistemas Recordatorios/instrumentación , Prevención Secundaria/métodos
20.
Am Heart J ; 228: 36-43, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32768690

RESUMEN

BACKGROUND: Less than half of patients with cardiometabolic disease consistently take prescribed medications. While health insurers and some delivery organizations use claims to measure adherence, most clinicians do not have access during routine interactions. Self-reported scales exist, but their practical utility is often limited by length or cost. By contrast, the accuracy of a new 3-item self-reported measure has been demonstrated in individuals with HIV. We evaluated its concordance with claims-based adherence measures in cardiometabolic disease. METHODS: We used data from a recently-completed pragmatic trial of patients with cardiometabolic conditions. After 12 months of follow-up, intervention subjects were mailed a survey with the 3-item measure that queries about medication use in the prior 30 days. Responses were linearly transformed and averaged. Adherence was also measured in claims in month 12 and months 1-12 of the trial using proportion of days covered (PDC) metrics. We compared validation metrics for non-adherence for self-report (average <0.80) compared with claims (PDC <0.80). RESULTS: Of 459 patients returning the survey (response rate: 43.5%), 50.1% were non-adherent in claims in month 12 while 20.9% were non-adherent based on the survey. Specificity of the 3-item metric for non-adherence was high (month 12: 0.83). Sensitivity was relatively poor (month 12: 0.25). Month 12 positive and negative predictive values were 0.59 and 0.52, respectively. CONCLUSIONS: A 3-item self-reported measure has high specificity but poor sensitivity for non-adherence versus claims in cardiometabolic disease. Despite this, the tool could help target those needing adherence support, particularly in the absence of claims data.


Asunto(s)
Cumplimiento de la Medicación/estadística & datos numéricos , Síndrome Metabólico/tratamiento farmacológico , Medición de Resultados Informados por el Paciente , Encuestas y Cuestionarios/normas , Femenino , Humanos , Revisión de Utilización de Seguros/estadística & datos numéricos , Masculino , Síndrome Metabólico/epidemiología , Síndrome Metabólico/psicología , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Disponibilidad de Medicamentos Vía Internet , Consulta Remota/métodos , Consulta Remota/estadística & datos numéricos , Autoinforme/normas , Sensibilidad y Especificidad , Estados Unidos/epidemiología
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