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3.
Int J Rheum Dis ; 23(12): 1611-1612, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33342064
4.
Pulm Circ ; 10(4): 2045894020968023, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33240490

RESUMO

Patients with pulmonary hypertension are more sedentary than the general population, but attitudes and experiences that may influence their exercise behaviour remain poorly understood. This study identified patterns of behaviour, attitudes towards exercise, barriers and enablers of exercise for people living with pulmonary hypertension. Accessibility of rehabilitation services from a patient perspective was also explored. A voluntary, international survey of people living with pulmonary hypertension was conducted, with mixed quantitative and qualitative data collection. Data from 187 participants in 19 countries were included in the analyses. In total, 52% (95/183) of people with pulmonary hypertension reported that they attempted to engage in regular physical activity. This was less than the proportion who did so prior to diagnosis (61%, 112/184, p = 0.006) and was accompanied by uncertainty and anxiety about exercise. In total, 63% (113/180) of the cohort reported experiencing previous adverse events while exercising, which was associated with a greater likelihood of ongoing exercise concerns and anxiety. Fear, frustration and uncertainty about exercise were noted as common barriers to engaging in exercise with pulmonary hypertension. Other barriers to exercise included intrinsic factors such as debilitating breathlessness and fatigue, and external factors such as cost and access to appropriate services. Most respondents (76%, 128/169) did not have access to a multi-disciplinary rehabilitation service, although an overwhelming majority (92%, 159/172) reported that this would be helpful. Respondents rated education; a supervised, structured exercise programme; and psychology input as the most important components of a multi-disciplinary rehabilitation service for pulmonary hypertension. Health professionals must work together with consumers to co-design rehabilitation services that will facilitate exercise and increased activity for people living with pulmonary hypertension.

5.
Arch Osteoporos ; 15(1): 118, 2020 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-32728971

RESUMO

Fracture liaison services (FLSs) were established to address the well-recognised gap in bone health management after a fragility fracture. However, it is unclear what happens to patients after discharge from an FLS. Our study suggests FLSs should include a patient bone health education session and a follow-up telephone call 12-18 months post-discharge to optimise management, in particular, to assess therapy adherence and to reinforce bone health advice. PURPOSE: While fracture liaison services (FLSs) have improved bone health management following fragility fracture, it is unclear what happens to patients following discharge from these services. We sought to determine patient self-reported medication adherence and the need for bone-specific health advice ≥ 12 months following discharge from one of the first FLSs in Australia. METHODS: Patients were contacted by telephone ≥ 12 months following discharge from the Coffs Fracture Prevention Clinic (CFPC)/FLS to determine if the patient was still taking prescribed bone protective therapy (BPT). Bone health advice was provided, if appropriate, during the telephone interview. RESULTS: Of the 516 consecutive patients seen in CFPC from July 2012-December 2018, 326 (63.2%) were assessed and discharged from the clinic. One hundred and two patients (19.8%) were lost to follow-up/uncontactable. Of 190 patients commenced on BPT at CFPC and who were discharged ≥ 12 months prior, 141 (74.2%) self-reported adherence with BPT. Bone health advice was required during the telephone call in 60/190 (31.6%) of these patients. Of the 141 adherent patients, 40 (28.4%) had attended a bone health education session, compared to 4/49 (8.2%) patients in the non-adherent group (p = 0.004). CONCLUSION: At 19 months following discharge from our FLS, self-reported adherence with treatment was 74%. One bone health education session at baseline was associated with increased treatment adherence. At time of telephone contact, one third of patients required further advice to optimise bone health.


Assuntos
Alta do Paciente , Assistência ao Convalescente , Densidade Óssea , Conservadores da Densidade Óssea , Seguimentos , Humanos , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Prevenção Secundária
6.
Pulm Circ ; 10(2): 2045894020922806, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32489642

RESUMO

Exercise training was not traditionally recommended for patients with pulmonary hypertension. However, recent work has demonstrated that exercise improves endurance and quality-of-life in patients with pulmonary hypertension. Unfortunately, patients with pulmonary hypertension are often sedentary. While some studies have examined patient attitudes to exercise, none have investigated physician perspectives on exercise in patients with pulmonary hypertension. This multinational survey of physicians involved in treating patients with pulmonary hypertension sought to ascertain physician attitudes to exercise and physician-identified barriers and enablers of exercise in this patient population. We collected cross-sectional survey data from a cohort of 280 physicians, including rehabilitation physicians, cardiologists, respiratory physicians and rheumatologists. We found that overall, 86% physicians recommended exercise, in line with current guidelines, although there were differences in the rationale for prescribing exercise and in the type of exercise prescription. Barriers to exercise included patient-related factors, such as patient ill health preventing exercise; poor patient motivation and lack of understanding regarding the benefits of exercise. Systemic barriers included cost/funding issues and limited availability of appropriate services. Perceived enablers of exercise included access to appropriate programmes, provision of education and supportive treating clinicians. Further research is required to identify and implement interventions to promote physical activity in patients with pulmonary hypertension.

7.
BMC Rheumatol ; 4: 22, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32411925

RESUMO

Background: Severe spinal pain is an unusual presentation of gout. Due to its rarity and the difficulty of obtaining joint fluid or tissue for crystal analysis, dual energy computed tomography (DECT) may be a useful imaging modality in the management of axial gout. Case presentation: Two patients independently presented to a major teaching hospital with severe spinal pain subsequently shown to be due to gout. The first patient presented with back pain and fevers and was initially thought to have lumbar facet joint septic arthritis. The second case presented with severe back pain. In both cases, DECT suggested monosodium urate deposition in spinal tissues as the cause of their presentation. Conclusions: Axial gout should be considered in the differential diagnosis of severe spinal pain. A DECT study may be a useful diagnostic tool in the management of spinal gout.

8.
BMJ Open ; 9(2): e024582, 2019 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-30813117

RESUMO

OBJECTIVES: Patients are often provided with medicine information sheets (MIS). However, up to 60% of patients have low health literacy. The recommended readability level for health-related information is ≤grade 8. We sought to assess the readability of MIS given to patients by rheumatologists in Australia, the UK and Canada and to examine Australian patient comprehension of these documents. DESIGN: Cross-sectional study. SETTING: Community-based regional rheumatology practice. PARTICIPANTS: Random sample of patients attending the rheumatology practice. OUTCOME MEASURES: Readability of MIS was assessed using readability formulae (Flesch Reading Ease formula, Simple Measure of Gobbledygook scale, FORCAST (named after the authors FORd, CAylor, STicht) and the Gunning Fog scale). Literal comprehension was assessed by asking patients to read various Australian MIS and immediately answer five simple multiple choice questions about the MIS. RESULTS: The mean (±SD) grade level for the MIS from Australia, the UK and Canada was 11.6±0.1, 11.8±0.1 and 9.7±0.1 respectively. The Flesch Reading Ease score for the Australian (50.8±0.6) and UK (48.5±1.5) MIS classified the documents as 'fairly difficult' to 'difficult'. The Canadian MIS (66.1±1.0) were classified as 'standard'. The five questions assessing comprehension were correctly answered by 9/21 patients for the adalimumab MIS, 7/11 for the methotrexate MIS, 6/28 for the non-steroidal anti-inflammatory MIS, 10/11 for the prednisone MIS and 13/24 for the abatacept MIS. CONCLUSIONS: The readability of MIS used by rheumatologists in Australia, the UK and Canada exceeds grade 8 level. This may explain why patient literal comprehension of these documents may be poor. Simpler, shorter MIS with pictures and infographics may improve patient comprehension. This may lead to improved medication adherence and better health outcomes.


Assuntos
Letramento em Saúde , Educação de Pacientes como Assunto , Doenças Reumáticas/psicologia , Antirreumáticos/uso terapêutico , Compreensão , Estudos Transversais , Escolaridade , Feminino , Letramento em Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/normas , Educação de Pacientes como Assunto/estatística & dados numéricos , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/terapia
9.
Intern Med J ; 48(10): 1280-1281, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30288905
10.
Curr Rheumatol Rep ; 20(10): 64, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30173305

RESUMO

PURPOSE OF REVIEW: Conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) have been used in the treatment of inflammatory arthritis (IA) for many years. More recently, biologic (bDMARDs) and targeted synthetic (tsDMARDs) DMARDs have further improved treatment. Due to increased patient longevity and effective oncology treatment, rheumatologists often encounter patients with IA and previous malignancy. The immunosuppressive effect of DMARDs causes concern regarding impaired tumour surveillance with a potential increased risk of malignancy. We reviewed the literature regarding the risk of malignancy in patients on cs-/b-/tsDMARDS and sought to provide practical advice regarding use of these drugs in patients with previous malignancy. RECENT FINDINGS: Data from randomised controlled trials is limited as patients with pre-existing malignancy are often excluded. Reassuringly, an increasing range of "real world" data from various national b/tsDMARD registries has not provided a convincing signal that these drugs increase tumour recurrence. Nevertheless, awareness of, and adherence to, national screening guidelines for malignancy is important. Given the improvement in quality of life achieved with these novel and well-tolerated therapeutic agents, the benefit/risk profile remains overwhelmingly favourable in most patients.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Neoplasias/complicações , Padrões de Prática Médica , Artrite Reumatoide/complicações , Humanos , Qualidade de Vida
11.
Best Pract Res Clin Rheumatol ; 32(6): 720-734, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-31427051

RESUMO

Autoimmune inflammatory rheumatic diseases (AIIRD) such as rheumatoid arthritis and spondyloarthritis, including psoriatic arthritis and ankylosing spondylitis are associated with an increased risk of infection due to a combination of the immunosuppressive effect of the AIIRD, comorbidities, and use of corticosteroids and the immunosuppressive effect of conventional synthetic disease-modifying antirheumatic drugs (DMARDs), targeted synthetic (ts-) DMARDs, and biologic (b-) DMARDs. Many infections are preventable with vaccination. However, as the protective immune responses induced by vaccination may be impaired by immunosuppression, vaccination should be considered before the commencement of immunosuppression. Another opportune time to review vaccination status is when planning overseas travel, as destination-specific vaccines are often required. Although limited published data regarding vaccine efficacy in patients with AIIRD make prescriptive guidelines difficult, a vaccination history should be part of the initial workup in all patients with AIIRD. Unfortunately, this is often not done by rheumatologists. This paper encourages those caring for patients with AIIRD to regularly review vaccination status.


Assuntos
Antirreumáticos/uso terapêutico , Doenças Reumáticas/tratamento farmacológico , Vacinação/métodos , Antirreumáticos/farmacologia , Estudos de Coortes , Humanos , Estudos Retrospectivos
12.
BMJ Open ; 7(2): e014037, 2017 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-28167746

RESUMO

INTRODUCTION: Pulmonary hypertension (PH) is a potentially life-threatening condition characterised by elevated pulmonary artery pressure. Early stage PH patients are often asymptomatic. Disease progression is associated with impairment of right ventricular function and progressive dyspnoea. Current guidelines recommend exercise training (grade IIa, level B). However, many questions remain regarding the mechanisms of improvement, intensity of supervision and optimal frequency, duration and intensity of exercise. This study will assess the effect of an outpatient rehabilitation programme on haemodynamics and cardiac right ventricular function in patients with pulmonary arterial hypertension (PAH), a subgroup of PH. METHODS AND ANALYSIS: This randomised controlled trial involves both a major urban tertiary and smaller regional hospital in New South Wales, Australia. The intervention will compare an outpatient rehabilitation programme with a control group (home exercise programme). Participants will be stable on oral PAH-specific therapy. The primary outcome measure will be right ventricular ejection fraction measured by cardiac MRI. Secondary outcomes will include haemodynamics measured by right heart catheterisation, endurance, functional capacity, health-related quality of life questionnaires and biomarkers of cardiac function and inflammation. ETHICS APPROVAL AND DISSEMINATION: Ethical approval has been granted by St Vincent's Hospital, Sydney (HREC/14/SVH/341). Results of this study will be disseminated through presentation at scientific conferences and in scientific journals. TRIAL REGISTRATION NUMBER: ACTRN12615001041549; pre-results.


Assuntos
Terapia por Exercício/métodos , Coração/diagnóstico por imagem , Hipertensão Pulmonar/reabilitação , Função Ventricular Direita , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Teste de Esforço , Tolerância ao Exercício , Feminino , Coração/fisiopatologia , Hemodinâmica , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , New South Wales , Pacientes Ambulatoriais , Qualidade de Vida , Análise de Regressão , Projetos de Pesquisa , Capacidade Vital , Adulto Jovem
13.
Intern Med J ; 47(5): 491-500, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28101910

RESUMO

Autoimmune inflammatory rheumatic diseases (AIIRD), such as rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis are often complicated by infection, which results in significant morbidity and mortality. The increased risk of infection is probably due to a combination of immunosuppressive effects of the AIIRD, comorbidities and the use of immunosuppressive conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs) and more recently, targeted synthetic DMARDs and biologic DMARDs that block specific pro-inflammatory enzymes, cytokines or cell types. The use of these various DMARDs has revolutionised the treatment of AIIRD. This has led to a marked improvement in quality of life for AIIRD patients, who often now travel for prolonged periods. Many infections are preventable with vaccination. However, as protective immune responses induced by vaccination may be impaired by immunosuppression, where possible, vaccination may need to be performed prior to initiation of immunosuppression. Vaccination status should also be reviewed when planning overseas travel. Limited data regarding vaccine efficacy in patients with AIIRD make prescriptive guidelines difficult. However, a vaccination history should be part of the initial work-up in all AIIRD patients. Those caring for AIIRD patients should regularly consider vaccination to prevent infection within the practicalities of routine clinical practice.


Assuntos
Antirreumáticos/administração & dosagem , Doenças Autoimunes/tratamento farmacológico , Imunossupressores/administração & dosagem , Doenças Reumáticas/tratamento farmacológico , Vacinação/métodos , Austrália/epidemiologia , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/imunologia , Humanos , Doenças Reumáticas/epidemiologia , Doenças Reumáticas/imunologia
14.
Intern Med J ; 47(4): 361-369, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27338855

RESUMO

Pulmonary hypertension (PH) is a clinical condition characterised by raised pulmonary artery pressure, which results in increased right ventricular afterload and dyspnoea. This is accompanied by reduced exercise capacity, quality of life and, eventually, death. An increasing range of targeted medications has transformed the treatment of pulmonary arterial hypertension, a specific type of PH. Supervised exercise training is recommended as part of a multifaceted management plan for PH. However, many questions remain regarding how exercise training improves exercise capacity and quality of life. The optimal exercise regimen (frequency, timing, duration and intensity) also remains unclear. This review provides an update on the pathophysiology of exercise impairment in PH, suggests mechanisms by which exercise may improve symptoms and function and offers evidence-based recommendations regarding the frequency and intensity of an exercise programme for patients with PH.


Assuntos
Terapia por Exercício , Hipertensão Pulmonar/terapia , Prática Clínica Baseada em Evidências , Tolerância ao Exercício/fisiologia , Humanos , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/reabilitação , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida , Resultado do Tratamento
15.
Aust J Rural Health ; 25(1): 28-33, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27087403

RESUMO

OBJECTIVE: To report the initial two and a half years' experience of one of the first Fracture Liaison Services in regional Australia. DESIGN: Case study. SETTING: Hospital Clinic, mid-north coast NSW. PARTICIPANTS: Patients aged ≥50 years with a fragility fracture identified at Coffs Harbour Health Campus July 2012 to December 2014. INTERVENTION: Patients were identified by a Fracture Liaison Coordinator (FLC) and seen in Fracture Prevention Clinic (FPC) by a rheumatologist. Patients discharged from FPC were contacted via telephone on one occasion 12 months later. MAIN OUTCOME MEASURES: Number/characteristics of patients seen in or declining an appointment in FPC, type of bone protective therapy commenced and patient adherence with this. RESULTS: An appointment in FPC was offered to 222 patients but declined by 56 patients. One hundred and sixty-six patients were seen in FPC, of whom 40% (n = 66/166) had a prevalent fragility fracture but only 12% (n = 8/66) were on bone protective therapy. Eighty-two percent (n = 136/166) commenced bone protective therapy. Of the 55 patients discharged from FPC with long enough follow-up to allow contact at 12 months, 60% (n = 33/55) required bone health advice during the follow-up telephone call at 12 months. Of the 31 patients who commenced bone protective therapy, 65% (n = 20/31) said they were adherent with medication. CONCLUSIONS: A FLC, committed clinician and supportive hospital environment were all that was required for an effective Fracture Liaison Service in a regional hospital. The number of patients who declined an appointment suggested the implications of a fragility fracture were often not appreciated.


Assuntos
Fraturas por Osteoporose/prevenção & controle , Educação de Pacientes como Assunto/métodos , Prevenção Secundária/métodos , Continuidade da Assistência ao Paciente , Feminino , Fraturas Ósseas/prevenção & controle , Humanos , Masculino , New South Wales , Avaliação de Resultados em Cuidados de Saúde
16.
BMJ Open ; 6(12): e011028, 2016 12 08.
Artigo em Inglês | MEDLINE | ID: mdl-27932335

RESUMO

INTRODUCTION: Systemic sclerosis (SSc) is a severe and costly multiorgan autoimmune connective tissue disease characterised by vasculopathy and fibrosis. One of the major causes of SSc-related death is pulmonary arterial hypertension (PAH), which develops in 12-15% of patients with SSc and accounts for 30-40% of deaths. In situ thrombosis in the small calibre peripheral pulmonary vessels resulting from endothelial dysfunction and an imbalance of anticoagulant and prothrombotic mediators has been implicated in the complex pathophysiology of SSc-related PAH (SSc-PAH), with international clinical guidelines recommending the use of anticoagulants for some types of PAH, such as idiopathic PAH. However, anticoagulation has not become part of standard clinical care for patients with SSc-PAH as only observational evidence exists to support its use. Therefore, we present the rationale and methodology of a phase III randomised controlled trial (RCT) to evaluate the efficacy, safety and cost-effectiveness of anticoagulation in SSc-PAH. METHODS AND ANALYSIS: This Australian multicentre RCT will compare 2.5 mg apixaban with placebo, in parallel treatment groups randomised in a 1:1 ratio, both administered twice daily for 3 years as adjunct therapy to stable oral PAH therapy. The composite primary outcome measure will be the time to death or clinical worsening of PAH. Secondary outcomes will include functional capacity, health-related quality of life measures and adverse events. A cost-effectiveness analysis of anticoagulation versus placebo will also be undertaken. ETHICS AND DISSEMINATION: Ethical approval for this RCT has been granted by the Human Research Ethics Committees of all participating centres. An independent data safety monitoring board will review safety and tolerability data for the duration of the trial. The findings of this RCT are to be published in open access journals. TRIAL REGISTRATION NUMBER: ACTRN12614000418673, Pre-results.


Assuntos
Anticoagulantes/uso terapêutico , Hipertensão Pulmonar/tratamento farmacológico , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Escleroderma Sistêmico/complicações , Administração Oral , Adulto , Coagulação Sanguínea , Protocolos Clínicos , Análise Custo-Benefício , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Masculino , Fibrose Pulmonar/etiologia , Projetos de Pesquisa
17.
Rheumatol Int ; 36(11): 1535-1542, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27665289

RESUMO

Rheumatoid arthritis (RA) is an autoimmune inflammatory disease which results in extensive articular and extra-articular morbidity and increased mortality from cardiovascular disease. Despite an increasing range of non-biological and biological disease-modifying agents, poor patient adherence with medication is a significant barrier to effective control of the inflammation associated with RA. This review seeks to identify factors that affect patient adherence with medication, examine the effectiveness of interventions to address this issue and offer practical suggestions to improve medication adherence. The impact of health literacy on medication adherence and the novel role of musculoskeletal ultrasound as an educational intervention will also be discussed.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Adesão à Medicação/psicologia , Artrite Reumatoide/psicologia , Letramento em Saúde , Humanos
18.
Int J Rheum Dis ; 19(7): 658-64, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24839920

RESUMO

OBJECTIVE: To determine if showing patients with rheumatoid arthritis (RA) ultrasound (US) images of their inflamed joints: (i) increased belief in the necessity of medication; (ii) encouraged patient activation, that is, confidence and understanding in managing their health; and (iii) facilitated medication adherence. METHOD: Eighteen patients aged ≥ 18 years old with active RA (DAS28 [Disease Activity Score of 28 joints] > 2.6) requiring increased immunosuppression were included. The following questionnaires were administered at baseline (T1), 3 days post-US (T2) and 10 days post-US (T3): (i) Beliefs about Medicines Questionnaire (BMQ) to measure the cost-benefit analysis made by patients regarding the necessity versus concern of medication; (ii) Patient Activation Measure (PAM-13) to assess patient activation; (iii) Compliance Questionnaire-Rheumatology (CQR) to measure medication adherence; and (iv) Routine Assessment of Patient Index-3 (RAPID3) to assess physical function, pain and global status. US of ≥ 1 clinically affected joints was performed on one occasion with an explanation of findings. RESULTS: Patient cost-benefit decisions shifted positively following US, that is, favored belief in the necessity of medication with a mean ± SD cost-benefit ratio (possible range - 20 to + 20) at T1 of 1.17 ± 6.10 which increased to 2.54 ± 5.38 at T2 and 4.06 ± 5.76 at T3, P = 0.043 by analysis of variance (anova). PAM-13, CQR and RAPID3 scores remained stable (all P > 0.05 by anova). CONCLUSION: Showing patients with RA 'real-time' US images of clinically inflamed joints resulted in a more favorable cost-benefit analysis, that is, increased patient belief in the necessity of medication versus concern about taking medication. There was no change in patient activation, medication adherence or disease severity.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Imunossupressores/uso terapêutico , Articulações/diagnóstico por imagem , Adesão à Medicação , Educação de Pacientes como Assunto , Ultrassonografia Doppler , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Antirreumáticos/efeitos adversos , Antirreumáticos/economia , Artrite Reumatoide/economia , Artrite Reumatoide/psicologia , Recursos Audiovisuais , Análise Custo-Benefício , Custos de Medicamentos , Feminino , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/economia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Projetos Piloto , Valor Preditivo dos Testes , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Percepção Visual
19.
Biomed Res Int ; 2015: 150658, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26060812

RESUMO

BACKGROUND: Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease affecting <1% of the population. Incompletely controlled RA results in fatigue, joint and soft tissue pain, progressive joint damage, reduced quality of life, and increased cardiovascular mortality. Despite an increasing range of disease modifying agents which halt disease progression, poor patient adherence with medication is a significant barrier to management. OBJECTIVE: The goal of this review was to examine the effectiveness of measures to improve patient medication adherence. METHODS: Studies addressing treatment adherence in patients with RA were identified by trawling PsycINFO, Medline, Cochrane, Pubmed, and ProQuest for studies published between January 2000 and October 2014. Articles were independently reviewed to identify relevant studies. RESULTS: Current strategies were of limited efficacy in improving patient adherence with medications used to treat RA. CONCLUSION: Poor medication adherence is a complex issue. Low educational levels and limited health literacy are contributory factors. Psychological models may assist in explaining medication nonadherence. Increasing patient knowledge of their disease seems sensible. Existing educational interventions appear ineffective at improving medication adherence, probably due to an overemphasis on provision of biomedical information. A novel approach to patient education using musculoskeletal ultrasound is proposed.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Adesão à Medicação , Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/psicologia , Letramento em Saúde , Humanos , Adesão à Medicação/psicologia , Adesão à Medicação/estatística & dados numéricos , Modelos Psicológicos , Sistema Musculoesquelético/diagnóstico por imagem , Educação de Pacientes como Assunto/métodos , Ultrassonografia
20.
Medicine (Baltimore) ; 93(25): e129, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25437024

RESUMO

The aim of this study was to assess health literacy (word recognition and comprehension) in patients at a rural rheumatology practice and to compare this to health literacy levels in patients from an urban rheumatology practice.Inclusion criteria for this cross-sectional study were as follows: ≥18-year-old patients at a rural rheumatology practice (Mid-North Coast Arthritis Clinic, Coffs Harbour, Australia) and an urban Sydney rheumatology practice (Combined Rheumatology Practice, Kogarah, Australia). Exclusion criteria were as follows: ill-health precluding participation; poor vision/hearing, non-English primary language. Word recognition was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). Comprehension was assessed using the Test of Functional Health Literacy in Adults (TOFHLA). Practical comprehension and numeracy were assessed by asking patients to follow prescribing instructions for 5 common rheumatology medications.At the rural practice (Mid-North Coast Arthritis Clinic), 124/160 patients agreed to participate (F:M 83:41, mean age 60.3 ±â€Š12.2) whereas the corresponding number at the urban practice (Combined Rheumatology Practice) was 99/119 (F:M 69:30, mean age 60.7 ±â€Š17.5). Urban patients were more likely to be born overseas, speak another language at home, and be employed. There was no difference in REALM or TOFHLA scores between the 2 sites, and so data were pooled. REALM scores indicated 15% (33/223) of patients had a reading level ≤Grade 8 whereas 8% (18/223) had marginal or inadequate functional health literacy as assessed by the TOFHLA. Dosing instructions for ibuprofen and methotrexate were incorrectly understood by 32% (72/223) and 21% (46/223) of patients, respectively.Up to 15% of rural and urban patients had low health literacy and <1/3 of patients incorrectly followed dosing instructions for common rheumatology drugs.There was no significant difference in word recognition, functional health literacy, and numeracy between rural and urban rheumatology patients.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Letramento em Saúde , Pacientes Ambulatoriais , Idoso , Antirreumáticos/administração & dosagem , Austrália , Compreensão , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reumatologia , População Rural , Fatores Socioeconômicos , População Urbana
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