Cross-Cutting mHealth Behavior Change Techniques to Support Treatment Adherence and Self-Management of Complex Medical Conditions: Systematic Review.

Background: Mobile health (mHealth) interventions have immense potential to support disease self-management for people with complex medical conditions following treatment regimens that involve taking medicine and other self-management activities. However, there is no consensus on what discrete behavior change techniques (BCTs) should be used in an effective adherence and self-management-promoting mHealth solution for any chronic illness. Reviewing the extant literature to identify effective, cross-cutting BCTs in mHealth interventions for adherence and self-management promotion could help accelerate the development, evaluation, and dissemination of behavior change interventions with potential generalizability across complex medical conditions. Objective: This study aimed to identify cross-cutting, mHealth-based BCTs to incorporate into effective mHealth adherence and self-management interventions for people with complex medical conditions, by systematically reviewing the literature across chronic medical conditions with similar adherence and self-management demands. Methods: A registered systematic review was conducted to identify published evaluations of mHealth adherence and self-management interventions for chronic medical conditions with complex adherence and self-management demands. The methodological characteristics and BCTs in each study were extracted using a standard data collection form. Results: A total of 122 studies were reviewed; the majority involved people with type 2 diabetes (28/122, 23%), asthma (27/122, 22%), and type 1 diabetes (19/122, 16%). mHealth interventions rated as having a positive outcome on adherence and self-management used more BCTs (mean 4.95, SD 2.56) than interventions with no impact on outcomes (mean 3.57, SD 1.95) or those that used >1 outcome measure or analytic approach (mean 3.90, SD 1.93; P=.02). The following BCTs were associated with positive outcomes: self-monitoring outcomes of behavior (39/59, 66%), feedback on outcomes of behavior (34/59, 58%), self-monitoring of behavior (34/59, 58%), feedback on behavior (29/59, 49%), credible source (24/59, 41%), and goal setting (behavior; 14/59, 24%). In adult-only samples, prompts and cues were associated with positive outcomes (34/45, 76%). In adolescent and young adult samples, information about health consequences (1/4, 25%), problem-solving (1/4, 25%), and material reward (behavior; 2/4, 50%) were associated with positive outcomes. In interventions explicitly targeting medicine taking, prompts and cues (25/33, 76%) and credible source (13/33, 39%) were associated with positive outcomes. In interventions focused on self-management and other adherence targets, instruction on how to perform the behavior (8/26, 31%), goal setting (behavior; 8/26, 31%), and action planning (5/26, 19%) were associated with positive outcomes. Conclusions: To support adherence and self-management in people with complex medical conditions, mHealth tools should purposefully incorporate effective and developmentally appropriate BCTs. A cross-cutting approach to BCT selection could accelerate the development of much-needed mHealth interventions for target populations, although mHealth intervention developers should continue to consider the unique needs of the target population when designing these tools.

The Effects of Patient Preference on Clinical Outcome, Satisfaction and Adherence Within the Treatment of Anxiety and Depression: A Meta-Analysis.

BACKGROUND: Taking patient preference into consideration has received increased attention in the last decades. We conducted a meta-analysis to estimate the effects of patient preference on clinical outcome, satisfaction and adherence regarding treatment of depression and anxiety. METHODS: Pubmed, Embase, PsycINFO and Scopus were searched for (cluster) randomized controlled trials. Twenty-six randomized controlled clinical trials were included, comprising 3670 participants, examining the effect of patient preference regarding treatment of anxiety and depression on clinical outcome, satisfaction and/or adherence. RESULTS: No effect of patient preference was found on clinical outcome [d = 0.06, 95% CI = (-0.03, 0.15), p = 0.16, n = 23 studies]. A small effect of patient preference was found on treatment satisfaction [d = 0.33, 95% CI = (0.08, 0.59), p = 0.01, n = 6 studies] and on treatment adherence [OR = 1.55, 95% CI = (1.28, 1.87), p < 0.001, n = 22 studies]. LIMITATIONS: Patient preference is a heterogeneous concept, future studies should strive to equalize operationalization of preference. Subgroup analyses within this study should be interpreted with caution because the amount of studies per analysed subgroup was generally low. Most studies included in this meta-analysis focused on patients with depression. The small number of studies (n = 6) on satisfaction, prevents us from drawing firm conclusions. CONCLUSIONS: While this meta-analysis did not find a positive effect of considering patient preference on clinical outcome, it was associated with slightly better treatment satisfaction and adherence. Accommodating preference of patients with anxiety and depression can improve treatment. TRIAL REGISTRATION: PROSPERO: CRD42020172556.

Treatment Nonadherence among Multimorbid Chronic Disease Patients: Evidence from 3515 Subjects in Indonesia.

Background and Objectives: Multimorbid patients require intensive treatment for their diseases. However, little research has been given to their treatment adherence as part of its management. This study aims to determine the prevalence and characteristics of chronic disease multimorbidity in Indonesia, alongside its treatment nonadherence. Materials and Methods: We conducted a cross-sectional study using the fifth Indonesian Family Life Survey database among adult subjects aged ≥ 15 years with multimorbidity. Our descriptive and multivariate analyses include sex, age, formal education, ethnicity, geographic residence, demographic residence, household size, insurance ownership, annual income, current self-perceived health status, missing active days, smoking behavior, and body mass index. Results: We identified 3515 multimorbid patients, constituting 30.8% prevalence across chronic disease patients. Hypertension was found to be a prevalent component of multimorbidity (61.2%), followed by digestive diseases (44.5%) and arthritis (30.3%). We identified that 36.4% of the subjects were nonadherent to their chronic disease treatment. Characteristics associated with nonadherence were found to be a good self-perception of health (aOR 1.79, 95% CI 1.54-2.08), active smoking behavior (aOR 1.51, 95% CI 1.14-1.99), no smoking behavior (aOR 1.44, 95% CI 1.08-1.90), missing seven active/productive days or less in the past month due to poor health (aOR 1.36, 95% CI 1.10-1.68), no insurance ownership (aOR 1.20, 95% CI 1.04-1.39), age of 15-65 years (aOR 1.25, 95% CI 1.01-1.55), income below IDR 40 million (aOR 1.23, 95% CI 1.04-1.46), and household size of 2-6 people (aOR 1.17, 95% CI 1.01-1.36). Conclusions: While the prevalence of multimorbidity in Indonesia is generally similar to that observed in previous studies, we have identified patient characteristics related to nonadherence. We suggest that patient's nonadherence was primarily dictated by their self-perception of health and treatment complexity. With the longstanding issue of nonadherence, this study indicated the need to consider creating patient-tailored treatment programs in clinical practice to improve adherence by considering individual patients' characteristics.

Exploring Lifestyle Factors and Treatment Adherence among Older Adults with Hypertension Attending a Mobile Health Unit (MHU) in a Rural Area of Central Portugal.

This cross-sectional and analytical study aimed to characterize a sample of hypertensive older adults attending a Mobile Health Unit (MHU) in a rural area of central Portugal according to their lifestyle and to analyze the impact of lifestyles on treatment adherence. The sample comprised 235 Portuguese hypertense patients, mainly females (63.8%) with a mean age of 75 years (±8.14 years) and low level of education. The data collection was carried out through a questionnaire consisting of sociodemographic questions, dietary variables, an Alcohol Dependence Questionnaire, an International Physical Activity Questionnaire (Short Version), a Nutrition Health Determination Questionnaire, a Self-Care with Hypertension Scale, and an Adherence to Treatments Measurement Scale. Only 34.5% of the hypertensive patients have controlled blood pressure values (28.2% men and 38% women). However, more than half (56.2%) of the hypertensive patients are classified as adherent to therapeutic measures. The hypertensive individuals, who present higher levels of adherence to the treatment, do not present alcohol dependence, are frequent consumers of aromatic herbs, sporadically consume salt, present good nutritional health, and practice moderate physical activity. The predictor variables for treatment adherence are the self-care dimensions general dietary (p = 0.001), specific dietary (p = 0.034), physical activity (p = 0.031), and antihypertensive medication intake (p < 0.001). Hypertensive patients with healthier lifestyles present better levels of treatment adherence. Therefore, promoting physical activity and healthy dietary practices is necessary to improve treatment adherence and increase antihypertensive treatment's effectiveness.

Adherencia a la rehabilitación pulmonar en pacientes con enfermedad pulmonar instersticial difusa (EPID) / Adherence to pulmonary rehabilitation in patients with diffuse interstitial pulmonary disease (DILD)

Introducción La enfermedad pulmonar intersticial difusa (EPID), a pesar de su baja prevalencia, presenta un curso progresivo y letal. Como estrategia secundaria al tratamiento farmacológico, los pacientes son remitidos a programas de rehabilitación pulmonar; no obstante, existe escasa evidencia con relación a la adherencia a dichos programas. Objetivo Analizar la adherencia de los pacientes diagnosticados con EPID a los programas de rehabilitación pulmonar en una clínica de Colombia en el año 2021. Materiales y métodos Estudio descriptivo observacional y prospectivo donde se vincularon 74 pacientes con EPID, que se dividieron en 2 grupos, adherencia baja/moderada y adherencia alta, tomando como referente el modelo de cumplimiento de Oates et al. Para la comparación de los dos grupos se realizó la prueba chi2 y la prueba T student para muestras independientes. Se tuvo en cuenta una significación del 95%, y se consideraron significativos valores p<0,05. Resultados Se obtuvo una adherencia alta en el 67,6% de los pacientes vinculados en el estudio. En las variables clínicas, diagnósticos, hospitalizaciones, días hospitalizados, y en el dominio síntomas del cuestionario de calidad de vida se presentaron diferencias significativas con un valor p≤0,05 entre los grupos de adherencia. La razón de motivo de abandono del programa de rehabilitación pulmonar en la mayoría de pacientes fue por exacerbación y no tener dinero para el transporte. Conclusiones Se presentó una alta adherencia en el 67,6% de los participantes. Pacientes con alta adherencia tenían mayor prevalencia de EPID clasificadas, hospitalizaciones, distancia recorrida y mejor calidad de vida (AU)

Introduction Diffuse interstitial lung disease (DILD), despite its low prevalence, has a progressive and lethal course. As a secondary strategy to pharmacological treatment, patients are referred to pulmonary rehabilitation programs; however, there is little evidence regarding adherence to these programs. Objective To analyze the adherence of patients diagnosed with ILD to pulmonary rehabilitation programs in a clinic in Colombia in the year 2021. Materials and methods Observational and prospective descriptive study where 74 patients with ILD were linked, who were divided into two groups, low/moderate adherence and high adherence, taking as reference the compliance model of Oates et al. For the comparison of the two groups, the chi2 test and the T student test for independent samples were performed. A significance of 95% was taken into account, and significant p-values<0.05 were considered. Results High adherence was obtained in 67.6% of the patients included in the study. In the clinical variables, diagnoses, hospitalizations, days hospitalized, and in the symptoms domain of the quality of life questionnaire, there were significant differences with a p-value≤0.05 between the adherence groups. The reason for abandonment of the pulmonary rehabilitation program in the majority of patients was due to exacerbation and not having money for transportation. Conclusions High adherence was present in 67.6% of the participants. Patients with high adherence had a higher prevalence of classified ILD, hospitalizations, distance traveled and better quality of life (AU)

Atencion Farmaceutica al paciente VIH en tratamiento con Dolutegravir y Lamivudina / Pharmaceutical Care for HIV patients on treatment with Dolutegravir and Lamivudine

Introducción: De acuerdo con la Organización Mundial de la Salud el Virus de la Inmunodeficiencia Humana (VIH) continúa siendo uno de los mayores problemas para la salud pública mundial. A día de hoy, la importancia de la adherencia al tratamiento continúa siendo el centro de atención de todos los profesionales sanitarios. La falta de adherencia supone un gran problema económico y sanitario. Método: Este estudio se centra en el servicio de atención farmacéutica (AF) realizado a los pacien-tes VIH en tratamiento con el comprimido coformulado dolutegravir/lamivudina (DTG/3TC) desde su comercialización en julio de 2019 hasta mayo 2021.Variables estudiadas: sexo, edad, adherencia, carga viral, recuento de linfocitos CD4, terapia anti-rretroviral (TAR) previa en paciente no naive, tratamientos concomitantes, interacciones, en pacientes no naive el motivo que ha conducido al cambio de TAR y los efectos adversos (EA) desarrollados. Fuente de datos: programa informático dispensación pacientes externos e historia clínica electrónica. Resultados: En el servicio de AF en la primera entrevista con el farmacéutico se tratan cinco aspectos: adherencia, EA, tratamientos y/o productos de herboristería concomitantes, interacciones y motivo de cambio de TAR. 62 pacientes iniciaron tratamiento con DTG/3TC: 24,1% (15/62) naive y 75,8% (47/62) no naive. El 100% de los pacientes naive presentaron una alta adherencia, solamente el 6,4% de los pacientes pretratados fueron identificados como no adherentes. Se encontró una contraindicación: hipérico. Conclusiones: Los pacientes presentan una alta adherencia, el tratamiento es efectivo y seguro. Se realiza el servicio de AF de forma eficaz. Conocemos la adherencia de nuestros pacientes y realizamos un estrecho seguimiento farmacoterapéutico. (AU)

Introduction: According to the World Health Organization, Human Immunodeficiency Virus (HIV) continues being one of the world's major public health problems. Currently, the importance of adherence to treatment continues being the focus of attention of health professionals. Lack of adherence is a major economic and health problem. Method: This study focuses on the pharmaceutical care service performed on all HIV patients (naive and non-naive) on treatment with the coformulated tablet dolutegravir/lamivudine (DTG/3TC) from its commercialization in July 2019 until May 2021. Variables studied: sex, age, adherence, viral load, CD4 lymphocyte count, previous antiretroviral therapy (ART) in non-naïve patients, concomitant treatments, interactions, the reason that led to the change of ART in non-naïve patient and the adverse effects developed. Results: In the first interview with the pharmacist in the pharmaceutical care service, five fundamental aspects are discussed: adherence, adverse effects, concomitant treatments and/or herbal products, interactions and reason for changing antiretroviral drugs in non-naive patients. 62 patients started treatment with DTG/3TC: 24.1% (15/62) naive and 75.8% (47/62) no naive. 100% of naive patients were highly adherent, only 6.4% of pre-treated patients were identified as non-adherent. Only one contraindication was found: hypericum. Conclusions: Patients are highly adherent, the treatment is effective and safe. The pharmaceutical care service is carried out efficiently. We are aware of our patients' adherence and carry out close phar-macotherapeutic monitoring. (AU)

Análisis de la adherencia farmacológica utilizando la receta electrónica en una farmacia comunitaria: estudio ‘REACT’ / Analysis of medication adherence using electronic prescriptions in a community pharmacy: ‘REACT’ study

Antecedentes: la falta de adherencia de los pacientes a sus tratamientos tiene un gran impacto tanto clínico como económico. Aunque existen diferentes métodos para medir la adherencia, los estudios retrospectivos son cada vez más utilizados por ser objetivos y menos sensibles a la percepción del paciente, interfiriendo menos en su vida. El sistema de receta electrónica proporciona a la farmacia comunitaria una herramienta útil para llevar a cabo esta investigación.Objetivos: utilizar el sistema de receta electrónica para medir la adherencia de los pacientes a su medicación crónica, analizando diferentes grupos terapéuticos y la salud mental de los pacientes.Métodos: se desarrolló un estudio observacional, ambispectivo y longitudinal. La adherencia se evaluó mediante la Proportion of Days Covered (PDC) por paciente y por tratamiento y con el test de Morisky Green Levine. A través del sistema de receta electrónica se obtuvieron datos sobre los medicamentos dispensados a los pacientes durante los últimos 12 meses. Los datos sobre la salud mental de los pacientes se recogieron mediante el cuestionario PHQ-2.Resultados: se reclutaron un total de 300 pacientes, pero sólo 290 se incluyeron en el análisis. El 25,5 % (IC: 20,6-30,9) se clasificó como polimedicado. El PDC por paciente tuvo una mediana de 0,90 (AI: 0,73-1). Según el cuestionario de Morisky Green Levine, el 57,9 % de los pacientes (IC: 52,0-63,6) eran adherentes a sus tratamientos. La concordancia entre el test de Morisky Green Levine y el PDC fue de kappa=0,086.Conclusiones: la receta electrónica resultó ser una herramienta útil para conocer la adherencia de la población a sus tratamientos crónicos medida con el PDC. (AU)

Uso de antiepilépticos en niños hospitalizados en el Hospital Pediátrico, Centro Hospitalario Pereira Rossell / Use of antiepileptic drugs in children hospitalized at the Pereira Rossell Pediatric Hospital / Uso de drogas antiepilépticas em crianças internadas no Hospital Pediátrico Pereira Rossell

Introducción: indicaciones off label, estrecho margen terapéutico, variabilidad farmacocinética, interacciones farmacológicas constituyen algunos de los problemas a abordar en el uso crónico de antiepilépticos (AE). Caracterizar su perfil de uso es necesario para promover su prescripción racional. Objetivo: Describir el perfil de uso de AE en menores de 15 años hospitalizados en el Centro Hospitalario Pereira Rossell entre 1/07/2020 y 31/12/2020. Material y método: estudio descriptivo, de menores de 15 años hospitalizados en cuidados moderados en tratamiento con AE. Variables: tipo y número de AE, motivo de la indicación, vía de administración, dosis, uso asociado con psicofármacos, adherencia. Resultados: recibían AE 113 pacientes, mediana edad 7 años, 50,4% sexo femenino. Motivo de la indicación: epilepsia (grupo A) 50,4% y otras patologías (grupo B) 49,6%. Mediana de edad: 2,7 años grupo A vs. 11,5 años grupo B. El AE más indicado fue levetiracetam en el grupo A (35%) y ácido valproico en el grupo B (35,7%). La asociación con psicofármacos se registró en 8,7% grupo A vs. 44,6% en el grupo B. Conclusiones: predominó el uso de levetiracetam en pacientes epilépticos. La mitad de los pacientes recibieron AE para patologías diferentes a la epilepsia, mayoritariamente psiquiátricas. En este grupo predominó el uso de ácido valproico. El análisis de esta serie permite una aproximación al conocimiento del perfil de uso de AE en los niños asistidos en este centro, y por tanto de los principales problemas a abordar. Futuros estudios multicéntricos con población ambulatoria son necesarios para mejorar el conocimiento y contribuir al uso racional de los mismos.

Introduction: off-label prescription, narrow therapeutic margin, pharmacokinetic variability, drug interaction, are some of the problems to consider in the chronic use of antiepileptic drugs (AEDs). It is necessary to characterize their utilization profile in order to promote rational prescription. Objective: to describe the utilization profile of AEDs in children under 15 years of age hospitalized at the Pereira Rossell Pediatric Hospital from 7/01/2020 to 12/31/2020. Material and Methods: descriptive study of children under 15 years of age hospitalized in moderate care units receiving treatment with AEDs. Variables: type and number of AEDs, reason for the prescription, dose, associated use of psychotropic drugs, compliance. Results: 113 patients received AEDs, median age 7 years, 50.4% females. Reason for prescription; epi- lepsy (group A) 50.4%, other pathologies (group B) 49.6%. Median age in group A 2.7 years, versus 1.1.5 years in group B. Most frequently prescribed AEDs was levetiracetam in group A (35%) and valproic acid in group B (37,7%). Association with psychotropic drugs was present in 8.7% of group A versus 44.6% of group B. Conclusions: levetiracem use was predominant in epileptic patients. Half of the patients received AEDs for pathologies other than epilepsy, mostly psychiatric. In this group the use of valproic acid was predominant. Analysis of this series enables an approximation to the understanding of the profile of AEDs use in children assisted at this Hospital, and there- fore an approximation to the problems to be considered. Future multicenter studies with an outpatient population are necessary to expand our knowledge and to contribute to a rational use of these drugs.

Introdução: indicações off-label, margem terapêutica estreita, variabilidade farmacocinética, interações farmacológicas são alguns dos problemas a serem abordados no uso crônico de drogas antiepilépticas (EA). Caracterizar seu perfil de uso é necessário para promover sua prescrição racional. Objetivo: descrever o perfil de utilização da AE em crianças menores de 15 anos internadas no Centro Hospitalar Pereira Rossell entre 01/07/2020 e 31/12/2020. Material e Métodos: estudo descritivo de crianças menores de 15 anos internadas em cuidados moderados em tratamento de EA. Variáveis: tipo e número de EAs, motivo da indicação, via de administração, dose, uso associado a psicotrópicos, adesão. Resultados: 113 pacientes receberam EA, com meia idade de 7 anos, 50,4% do sexo feminino. Motivo da indicação: epilepsia (grupo A) 50,4% e outras patologias (grupo B) 49,6%. Mediana de idade: 2,7 anos grupo A vs. 11,5 anos grupo B. O EA mais indicado foi Levetiracetam no grupo A (35%) e ácido valpróico no grupo B (35,7%). A associação com psicotrópicos foi registrada em 8,7% do grupo A vs. 44,6% no grupo B. Conclusões: o uso de Levetiracetam em pacientes epilépticos predominou. A metade dos pacientes recebeu AE por outras patologias que não foram a epilepsia, principalmente psiquiátricas. Nesse grupo, predominou o uso do ácido valpróico. A análise desta série permite aproximar o conhecimento do perfil de uso da AE nas crianças atendidas nesse centro e, portanto, a aproximação aos principais problemas a serem abordados. Futuros estudos multicêntricos com população ambulatorial são necessários para aprimorar o conhecimento e contribuir para sua utilização racional.

Associação entre a adesão terapêutica e o controle glicêmico de pacientes com Diabetes Mellitus tipo 2 / Association between therapeutic adherence and glycemic control in patients with type 2 diabetes mellitus

Introdução: A adesão ao tratamento no diabetes mellitus é fundamental para o controle metabólico, prevenção de complicações, melhoria e manutenção da qualidade de vida. Objetivo: Avaliar a associação entre a adesão ao tratamento farmacológico e o controle glicêmico de pacientes diabéticos tipo 2 e investigar fatores associados a essas condições. Método: Estudo transversal com pacientes ≥ 18 anos com diabetes mellitus tipo 2, atendidos em um serviço privado de endocrinologia, em uso de antidiabéticos orais há pelo menos 6 meses e com dosagem de hemoglobina glicada (HbA1c) de no máximo 12 meses. Foram utilizados a MMAS-8 (Morisky Medication Adherence Scale) e um questionário com dados sociodemográficos e clínicos. Resultados apresentados em razão de prevalência (RP) e intervalo de confiança (IC) 95%, ajustados por regressão logística pelo método enter. O nível de significância estatística adotado foi de 5%. Resultados: Participaram do estudo 134 pacientes, com média de 56,7 ± 12,9 anos, sendo 58,2% mulheres. A adesão terapêutica foi demonstrada por 78,4% dos pacientes, havendo associação positiva com a escolaridade e negativa em relação à idade e ao tempo de diagnóstico. O controle glicêmico foi verificado por 68,7%, não havendo diferença estatisticamente significativa em relação a sexo, idade, raça, escolaridade e tempo de diagnóstico. Entre os pacientes considerados aderentes, 77,1% apresentaram controle adequado da glicemia, enquanto entre pacientes considerados não aderentes, 37,9% foram considerados controlados (p<0,001). Conclusão: A adesão ao tratamento farmacológico esteve associada ao controle glicêmico em pacientes com diabetes tipo 2, acompanhados em consultório privado de endocrinologia.

Introduction: Treatment adherence in diabetes mellitus is essential for metabolic control, complication prevention, quality of life improvement and maintenance. Objective: To assess the association between adherence with pharmacological treatment and glycemic control in patients with type 2 diabetes and investigate factors associated with these conditions. Method: This is a cross-sectional study with patients ≥ 18 years old with type 2 diabetes mellitus, treated at a private endocrinology service, using oral antidiabetics for at least 6 months and with a glycated hemoglobin (HbA1c) measurement for a maximum of 12 months. The MMAS-8 (Morisky Medication Adherence Scale) and a questionnaire with sociodemographic and clinical data were used. Results presented as prevalence ratio (PR) and 95% confidence interval (CI), adjusted by logistic regression using the enter method. The level of statistical significance adopted was 5%. Results: A total of 134 patients participated in the study, with a mean age of 56.7 ± 12.9 years, 58.2% of whom were women. Therapeutic adherence was demonstrated by 78.4% of patients, with a positive association with education and a negative association with age and time since diagnosis. Glycemic control was verified by 68.7%, with no statistically significant difference in relation to sex, age, race, education and time since diagnosis. Among patients considered adherent, 77.1% had adequate glycemic control, while among patients considered non-adherent, 37.9% were considered controlled (p<0.001). Conclusion: Pharmacological treatment adherence was associated with glycemic control in patients with type 2 diabetes followed up in a private endocrinology office.

Adherence to Sars-CoV2 vaccination in hematological patients.

Background: SARS-CoV2 vaccination efficiently prevents severe COVID-19, although hematological patients, particularly under therapy, respond less well. Besides vaccine efficacy, adherence to vaccination is essential for ensuring adequate protection of this vulnerable population. Methods: We evaluated the impact of a program aimed at maximizing patient adherence by comparing the rate of SARS-CoV2 vaccination of our hematological patients and a matched sample of the general population. Results: Vaccination rates were 88.9% among 2,156 patients, aged 65.2 ± 15.8 years (M ± SD, range 19-86 years). Rates differed considerably with age, i.e. 84.2% between 18-64 years and 92.4% above 65 years (p<0.0001), but not with sex. In the general population, rates were 76.3% overall, 73.0% between 18-64 and 86.7% above 65 years, all significantly lower than among patients, overall (Standardized Incidence ratio (SIR) 1.17; 95%CI 1.12-1.22, p<0.0001) as well as among younger (SIR 1.15; 1.07-1.24, p<0.0001) or older (SIR 1.06; 1.00-1.13, p=0.046) people. Vaccination rates increased to 92.2% overall (SIR 1.21; 1.16-1.27, p<0.0001), 88.5% in younger (SIR 1.21; 1.13-1.30, p<0.0001) and 94.8% in older (SIR 1.09; 1.03-1.12, p=0.0043) patients, after excluding those with medical contraindications, and further to 95.6% overall (SIR 1.26; 1.20-1.32, p<0.0001), 93.8% in younger (SIR 1.29; 1.20-1.38, p<0.0001) and 96.9% in older (SIR 1.11; 1.05-1.18, p=0.0004) patients, after excluding those not seen in hematology in 2021. Conclusions: Vaccination rates were significantly higher in hematological patients compared to the general population regardless of age, sex and municipality. Acceptance of Covid vaccines by hematological patients may be improved by targeted information campaigns carried out by trusted health care professionals.

An Intelligent Cardiopulmonary Training System and Adherence to Training Intensity: A Feasibility Study.

Objective: Our aim was to evaluate the feasibility of our developed intelligent cardiopulmonary training system (ICTS) and of the percentage of time spent within the target HR range (%time) as an indicator of adherence to training intensity. Methods: In this noncontrolled trial, nine participants with sedentary lifestyles were recruited from the outpatient rehabilitation department of a teaching hospital. All participants received twelve 30 min sessions of cycling ergometer exercises (5 min warm up, 20 min training phase, and 5 min cool down) with the ICTS three times per week. Training intensity was determined at 60−80% heart rate reserve using cardiopulmonary exercise (CPET) pretests. During training, pedaling resistance was automatically adjusted by the ICTS to keep the user's heart rate at the predetermined intensity range. Workload-peak and peak oxygen uptake (VO2-peak) were measured during the pretests and post-tests. We recorded the percentage of time spent within the target heart rate range (%time) during the 20 min training phase for each training session as an indicator of adherence. The correlation between %time and gains in VO2-peak was assessed. Results: After 4 weeks of training on the ICTS, workload-peak and VO2-peak significantly improved by 13.6 ± 7.2 w (mean ± SD, p = 0.008) and 1.5 ± 1.1 mL/kg/min (p = 0.011), respectively. The 12-session average %time ranged from 10.6% to 93.1% among the participants, and five participants achieved an average %time >80%. A positive correlation between average %time and training efficacy was found (rs = 0.85, p = 0.004). Conclusions: Cardiopulmonary training with an ICTS is feasible, and the percentage of time spent within the target heart rate range seems to be a reasonable indicator for monitoring training-intensity adherence.

Evaluating the efficacy of the HITSystem 2.1 to improve PMTCT retention and maternal viral suppression in Kenya: Study protocol of a cluster-randomized trial.

BACKGROUND: Gaps in the provision of guideline-adherent prevention of mother-to-child transmission of HIV (PMTCT) services and maternal retention in care contribute to nearly 8000 Kenyan infants becoming infected with HIV annually. Interventions that routinize evidence-based PMTCT service delivery and foster consistent patient engagement are essential to eliminating mother-to-child transmission of HIV. The HITSystem 2.1 is an eHealth intervention that aims to improve retention in PMTCT services and viral load monitoring, using electronic alerts to providers and SMS to patients. This study will evaluate the impact, implementation, and cost-effectiveness of HITSystem 2.1. METHOD: This cluster randomized trial will be conducted at 12 study hospital (6 intervention, 6 control). Pregnant women living with HIV who have initiated PMTCT care ≤36 weeks gestation are eligible. Women enrolled at control hospitals will receive standard-of-care PMTCT services. Women enrolled at intervention hospitals will receive standard-of-care PMTCT services plus enhanced HITSystem 2.1 tracking. Mixed logistic regression models will compare the arms on two primary outcomes: (1) completed guideline-adherence PMTCT services and (2) viral suppression at both delivery and 6 months postpartum. We will assess associations between provider and patient characteristics (disclosure status, partner status, depression, partner support), PMTCT knowledge, and motivation with retention outcomes. Using the RE-AIM model, we will also assess implementation factors to guide sustainable scale-up. Finally, a cost-effectiveness analysis will be conducted. DISCUSSION: This study will provide insights regarding the development and adaptation of eHealth strategies to meet the global goal of eliminating new HIV infections in children and optimizing maternal health through PMTCT services. If efficacious, implementation and cost-effectiveness data gathered in this study will guide scale-up across Kenyan health facilities. TRIAL REGISTRATION: This study was registered at clinicaltrials.gov (NCT04571684) on October 1, 2020.

Escala de Adherencia Terapéutica para tratamiento de Cáncer de Mama (EAT-CaMa): Una evaluación multidimensional / Therapeutic Adherence Scale for the treatment of Breast Cancer (EAT-CaMa): A multidimensional assessment

Introducción: La adherencia terapéutica es un aspecto clave en el éxito del tratamiento en oncología, sin embargo, su medición es un reto dentro del sistema de salud. Asimismo, no se tienen escalas especificas validas o construidas para evaluar la adherencia en pacientes con cáncer de mama. Objetivo:Determinar las propiedades psicométricas de la Escala de Adherencia Terapéutica al Cáncer de Mama (EAT-CaMa). Método:Se empleó un diseño no experimental, instrumental con un muestreo no probabilístico. Se incluyeron 189 participantes con diagnóstico de CaMa entre 21 y 84 años. Análisis estadísticos: Se realizó un análisis factorial exploratorio y consistencia interna. Resultados: La EAT-CaMa de 27 reactivos, obtuvo una consistencia interna global α= 0,81 y una varianza explicada del 64%. Se identificaron factores de autoeficacia y comunicación médico paciente, así como varios indicadores. Conclusión:El EAT-CaMa es un instrumento breve, válido y confiable para la evaluación multidimensional de la adherencia al tratamiento en población con CaMa. La estructura factorial identificada corrobora componentes reportados en la literatura y clínicamente relevantes. Se recomienda su usoen la atención clínica (inicio y seguimiento del tratamiento) y en investigación (AU)

Introduction: The therapeutic adherence is a key aspect in the success of the oncology treatment, however its measurement is a challenge within the health system. Likewise, there are no valid or constructed scales to assess adherence in patients with breast cancer. Objective: To determine the psychometric properties of the Breast Cancer Therapeutic Adherence Scale (EAT-CaMa). Method: A non-experimental, instrumental design with a non-probabilistic sampling was used, for convenience. One hundred eighty nine participants with a diagnosis of breast cancer, between 21 and 84 years old, were included. Statistical analysis: An exploratory factor analysis was performed. Results: An exploratory factor analysis and internal consistency were carried out. Results: The EAT-CaMa of 27 questions obtained a global internal consistency α = 0.81 and an explained variance of 64%. Self-efficacy and physician-patient communication factors were identified, as well as several indicators. Conclusion: The EAT-CaMa is a short, valid and reliable instrument for the multidimensional evaluation of adherence to treatment in the Mexican breast cancer population. The identified factorial structure corroborates components reported in the literature and clinically relevant. It is recommended for use in clinical care (initiation and follow-up of treatment) and in future research (AU)

In-Person vs Electronic Directly Observed Therapy for Tuberculosis Treatment Adherence: A Randomized Noninferiority Trial.

Importance: Electronic directly observed therapy (DOT) is used increasingly as an alternative to in-person DOT for monitoring tuberculosis treatment. Evidence supporting its efficacy is limited. Objective: To determine whether electronic DOT can attain a level of treatment observation as favorable as in-person DOT. Design, Setting, and Participants: This was a 2-period crossover, noninferiority trial with initial randomization to electronic or in-person DOT at the time outpatient tuberculosis treatment began. The trial enrolled 216 participants with physician-suspected or bacteriologically confirmed tuberculosis from July 2017 to October 2019 in 4 clinics operated by the New York City Health Department. Data analysis was conducted between March 2020 and April 2021. Interventions: Participants were asked to complete 20 medication doses using 1 DOT method, then switched methods for another 20 doses. With in-person therapy, participants chose clinic or community-based DOT; with electronic DOT, participants chose live video-conferencing or recorded videos. Main Outcomes and Measures: Difference between the percentage of medication doses participants were observed to completely ingest with in-person DOT and with electronic DOT. Noninferiority was demonstrated if the upper 95% confidence limit of the difference was 10% or less. We estimated the percentage of completed doses using a logistic mixed effects model, run in 4 modes: modified intention-to-treat, per-protocol, per-protocol with 85% or more of doses conforming to the randomization assignment, and empirical. Confidence intervals were estimated by bootstrapping (with 1000 replicates). Results: There were 173 participants in each crossover period (median age, 40 years [range, 16-86 years]; 140 [66%] men; 80 [37%] Asian and Pacific Islander, 43 [20%] Black, and 71 [33%] Hispanic individuals) evaluated with the model in the modified intention-to-treat analytic mode. The percentage of completed doses with in-person DOT was 87.2% (95% CI, 84.6%-89.9%) vs 89.8% (95% CI, 87.5%-92.1%) with electronic DOT. The percentage difference was -2.6% (95% CI, -4.8% to -0.3%), consistent with a conclusion of noninferiority. The 3 other analytic modes yielded equivalent conclusions, with percentage differences ranging from -4.9% to -1.9%. Conclusions and Relevance: In this trial, the percentage of completed doses under electronic DOT was noninferior to that under in-person DOT. This trial provides evidence supporting the efficacy of this digital adherence technology, and for the inclusion of electronic DOT in the standard of care. Trial Registration: ClinicalTrials.gov Identifier: NCT03266003.

Strengthening therapeutic adherence and pharmacovigilance to antimalarial treatment in Manaus, Brazil: a multicomponent strategy using mHealth.

BACKGROUND: Public health initiatives for improving adherence to primaquine based regimens and enhancing effective pharmacovigilance are needed to support the efforts for malaria elimination in real world conditions. METHODS: A multicomponent patient-oriented strategy using a Smart Safety Surveillance (3S) approach including: (1) educational materials for treatment counselling and identification of warning symptoms of haemolytic anaemia; (2) an mHealth component using Short Message Service (SMS) treatment reminders and (3) development and implementation of follow-up phone surveys three days after treatment completion, using a web-based platform linked to the local information system of malaria. Adherence was measured using the Morisky Medication Adherence Scale. Self-reported events were registered using a structured questionnaire and communicated to the Brazilian Health Regulatory Agency. RESULTS: Educational materials were disseminated to 5594 patients, of whom 1512 voluntarily entered the mHealth component through the local information system; 7323 SMS were sent, and 1062 participants completed a follow-up survey after treatment. The mean age of patients was 37.36 years (SD 13.65), 61.24% were male, 98.54% were infected with. Plasmodium vivax and 95.90% received a short regimen of chloroquine plus primaquine (CQ + PQ 7 days), as per malaria case management guidelines in Brazil. From the 1062 surveyed participants 93.31% were considered adherent to the treatment. Most of the patients (95.20%) reported at least one adverse event. Headache, lack of appetite and nausea/vomiting were the most frequently reported adverse events by 77.31%, 70.90% and 56.78% of the patients respectively. A quarter of the patients reported anxiety or depression symptoms; 57 (5.37%) patients reported 5 to 6 warning symptoms of haemolytic anaemia including jaundice and dark urine in 44 (4.14%). Overall, three patients presenting symptoms of haemolytic anaemia attended a hospital and were diagnosed with G6PD deficiency, and one had haemolysis. All of them recovered. CONCLUSIONS: Under real world conditions, a multicomponent patient-oriented strategy using information and communication technologies allowed health care providers to reinforce treatment adherence and enhance safety surveillance of adverse events associated with regimens using primaquine. Active monitoring through phone surveys also reduced under-reporting of ADRs. This approach is low-cost, scalable and able to support prioritized activities of the national malaria programme.

Korean Clinical Practice Guidelines: Current Status of Adherence to the RIGHT Checklist.

BACKGROUND: The Korean Academy of Medical Sciences (KAMS) has been utilizing AGREE II to audit the quality of clinical practice guidelines (CPGs) developed in Korea. Monitoring the RIGHT Checklist adherence could help monitor the quality status and discover areas for improvement of CPG development. METHODS: We included 129 CPGs from the past 5 years and assessed each item of the RIGHT Checklist. STATA version 15.0 was used for statistical analysis. RESULTS: Among the seven sections of the RIGHT checklist, sections with a full compliance rate over 60% were 'basic information' (65%) and 'background' (66%). The other sections' mean full compliance rates were 'Evidence' 52%, 'Recommendation' 35%, 'Review and quality assurance' 25% and 'Funding, declaration and management of interest' 17%. Sections with a partial compliance rate over 60% were 'Recommendation' (60%) and 'Funding, declaration and management of interest' (70%). Non-compliance was highest in the 'Review and quality assurance' (17%) domain. In comparison between groups 1 (under median group) and 2 (over median group), group 2 showed a tendency to have multi-stakeholder involvement and present sufficient information on financial resources and conflict of interest declarations. For the CPGs developmental methodology aspect, group 2 provided more pertinent information than group 1 about supporting evidence-making and the process from evidence to recommendation. CONCLUSION: This study evaluated adherence to the RIGHT Checklist of CPGs developed in Korea. It can provide helpful information to develop strategic plans for enhancing the capabilities of developing CPGs in Korea.

Risk Factors and Diet Components Determining Adherence to the Mediterranean Diet in Acute Ischemic Stroke Patients: A Cross-Sectional Analysis of a Prospective Hospital Register Study.

OBJECTIVES: Low adherence to a Mediterranean diet (MeDi) is associated with increased incidence, mortality, and severity of acute ischemic strokes (AIS). Nevertheless, the explanatory factors associated with such results are unclear. Our aim was to investigate stroke risk factors associated with adherence to a MeDi in a prospective cohort of AIS patients. MATERIALS AND METHODS: Patients admitted from February 2017 to February 2020 were included in this study. Adherence was measured using the 14-point Mediterranean Diet Adherence Screener (MEDAS). Demographic and clinical characteristics were compared with adherence with a univariate analysis. A binomial regression was used to investigate the independent association of premorbid factors and MeDi components with adherence. RESULTS: There were 413 patients. Mean age was 68.6 (17.4), 176 (42.6%) women. Median MEDAS score was 6 (IQR 4-7) points. 253 patients (61.2%) had a low adherence (MEDAS ≤ 6). In the univariate analysis, a low MEDAS was associated with lower education, diabetes, sedentary lifestyle, greater body mass index (BMI), lower alcohol consumption, and higher LDLc. In the regression analysis, younger age, lower education, functional disability, hypertension, sedentary lifestyle, and higher BMI were associated with lower MEDAS scores. Six MeDi components had particularly low patient adherence: seafood, legumes, olive oil, nuts, wine, and fruit. DISCUSSION: These data indicate low adherence to MeDi in younger patients who are less educated and have existing cardiovascular risk factors, in particular hypertension, sedentary lifestyle, and higher BMI. Some components of the diet had a particularly low adherence. CONCLUSIONS: Tailoring diet prevention interventions to these specific populations, focusing on components with known less adherence, could improve adherence to a MeDi and the opportunity for secondary stroke prevention.

Prevalence of non-adherence and non-compliance during maintenance therapy in adults with acute lymphoblastic leukemia and their associations with survival.

OBJECTIVES: Explore patient adherence and physician compliance to protocol guidelines during maintenance therapy, including the association with survival in adults with acute lymphoblastic leukemia (ALL). METHODS: Blood counts, aminotransferase levels and prescribed 6-mercaptopurine (6MP)/methotrexate (MTX) doses were compared with the protocol guidelines to assess compliance. Non-adherence to the prescribed medication was confirmed in patients with unmeasurable 6MP metabolite levels and suspected in patients with low 6MP metabolites concurrent with aminotransferase and white blood cell count within normal ranges, while potential intermittent non-adherence was defined by >1.9 fold fluctuating 6MP metabolites. RESULTS: Physicians' non-compliance with insufficient dose increments of 6MP/MTX despite white blood cell counts above the target level comprised a median of 20.1% (interquartile range 9.7-39.3%) of the observed time in maintenance therapy, yet no association to relapse was found (P = .17). Non-adherence to 6MP was confirmed in 9.8% (5 of 51 patients), suspected in an additional 9.8% (5 of 51 patients), and intermittent non-adherence was suspected in 52.6% (20 of 38 patients). CONCLUSION: Although no association between non-compliance and leukemic relapse was found, likely due to lack of power, increased attention to this phase of ALL therapy is indicated.