RESUMO
INTRODUCTION: It is estimated that up to 50% of medications for long-term conditions are not taken as prescribed. In mental health conditions, poor adherence leads to increased relapse, suicide rates, and hospitalizations. It is recommended that health care professionals aim to elicit and address beliefs and attitudes about medication, and to understand the patient's experience of taking them, as these, among other factors, affect adherence rates. This study evaluated a pilot trial of a medicines group for adult inpatients on an acute mental health ward. METHODS: This study comprises a pilot service evaluation of a medicines education group through the descriptive analysis of data obtained using a tailored outcome measure using validated experience and attitude measures. The medicines education group was designed by a multidisciplinary team and focused on eliciting perceptual and practical barriers to adherence, lived experience, psychoeducation, and shared problem solving. The group was run during a period of 3 months and was compared to a baseline data set. RESULTS: In total there were 35 medicine group attendees, there were 3 dropouts, and the outcome measure was fully completed in 68% of cases, with only 4 refusing, indicating this pilot evaluation was feasible and acceptable. Descriptive analysis found that on average, group attendees reported a better understanding of the purpose and side effects of their medication, and felt more involved in decisions about their medicines compared with the baseline data set. DISCUSSION: This pilot evaluation found that running a novel medicines education group, targeting perceptual and practical barriers to adherence, was acceptable to attendees and feasible to deliver on an adult psychiatric inpatient unit.
RESUMO
To reduce greenhouse gas emissions from deforestation, Indonesia instituted a nationwide moratorium on new license areas ("concessions") for oil palm plantations, timber plantations, and logging activity on primary forests and peat lands after May 2011. Here we indirectly evaluate the effectiveness of this policy using annual nationwide data on deforestation, concession licenses, and potential agricultural revenue from the decade preceding the moratorium. We estimate that on average granting a concession for oil palm, timber, or logging in Indonesia increased site-level deforestation rates by 17-127%, 44-129%, or 3.1-11.1%, respectively, above what would have occurred otherwise. We further estimate that if Indonesia's moratorium had been in place from 2000 to 2010, then nationwide emissions from deforestation over that decade would have been 241-615 MtCO2e (2.8-7.2%) lower without leakage, or 213-545 MtCO2e (2.5-6.4%) lower with leakage. As a benchmark, an equivalent reduction in emissions could have been achieved using a carbon price-based instrument at a carbon price of $3.30-7.50/tCO2e (mandatory) or $12.95-19.45/tCO2e (voluntary). For Indonesia to have achieved its target of reducing emissions by 26%, the geographic scope of the moratorium would have had to expand beyond new concessions (15.0% of emissions from deforestation and peat degradation) to also include existing concessions (21.1% of emissions) and address deforestation outside of concessions and protected areas (58.7% of emissions). Place-based policies, such as moratoria, may be best thought of as bridge strategies that can be implemented rapidly while the institutions necessary to enable carbon price-based instruments are developed.
