Implementation of Medication Event Reminder Monitors among patients diagnosed with drug susceptible tuberculosis in rural Viet Nam: A qualitative study.

BACKGROUND: Despite the criticality of adherence to tuberculosis treatment, there is paucity of rigorous experimental research exploring the efficacy of interventions to promote adherence and a greater lack of inquiry addressing the integral role of adherence behaviour. The aim of this formative study was to examine the way in which the Wisepill evriMED Medication Event Reminder Monitor (MERM) was used among outpatients with drug susceptible pulmonary tuberculosis. METHODS: In depth interviews were conducted with 20 outpatients receiving treatment from two public healthcare facilities in Thanh Hoa, a rural province in northern Viet Nam. Patients had been enrolled in a randomized controlled trial evaluating the effect of using the MERM device upon adherence for between 1-3 months. The control group used the device without an alert, while the intervention group used the device with a daily alert and scheduled dosing history review. FINDINGS: All 20 patients interviewed were supportive of using the MERM device. Those able to be at home at the time that their treatment was due (50%) used the device as intended. Patients who worked all reported separating the time when the box was opened from the time at which they ingested their medication. Patients expressed fidelity to the prescribed medication taking time and concerns regarding the portability of the device. Limitations of the study surround the inclusion of a small sample population that did not experience factors that further compromise adherence. CONCLUSIONS: Data recorded by the box did not always accurately reflect usage patterns. The alert in the intervention arm was able to support adherence only in patients who did not work while completing their treatment. MERM implementation can be improved by better aligning prescriber instructions with patients' daily routines, and increasing the use of adherence data to guide adherence support practices. Healthcare staff need to be aware of potential barriers to optimal use of MERM devices. A rigorous qualitative approach to formative assessment is essential to inform the scale up of new digital technologies.

The Use of Tablet Technology by Older Adults in Health Care Settings-Is It Effective and Satisfying? A Systematic Review and Meta Analysis.

OBJECTIVES: This systematic review/meta-analysis examines the potential for older people to accept and use tablet technology in clinical settings by assessing satisfaction and effectiveness. METHODS: A comprehensive literature search was conducted of PubMed, SCOPUS, and CINAHL through March 2017. Inclusion criteria included studies with any clinical use of a tablet technology with a median patient age above 65 years. RESULTS: We included a total of 12 studies (4 randomized controlled trials, 4 cross-sectional studies, and 4 pre/post studies). Interventions included the use of tablet technology for medication self-management, post-surgery education, memory retention, cognitive rehabilitation, and exercise promotion. The use of tablet technology by older people in clinical settings was associated with high satisfaction with a pooled prevalence of satisfaction of 78%; 95% CI 27-100. We did not find evidence for effectiveness in improving clinical or behavioral outcomes. CONCLUSIONS: Older people can use and are satisfied with table technology in clinical settings. More studies are needed to evaluate the effectiveness of tablet technology at promoting health outcomes. CLINICAL IMPLICATIONS: Clinicians should be encouraged to utilize tablet technology in the care of older patients.

Subjective patient-reported versus objective adherence to subcutaneous interferon ß-1a in multiple sclerosis using RebiSmart®: the CORE study.

BACKGROUND: Patient adherence to treatment is key to preventing the worsening of neurological disability in multiple sclerosis (MS). The RebiSmart® autoinjector facilitates self-administration of subcutaneous interferon ß-1a (sc IFN ß-1a) and records objective adherence data. The CORE study was undertaken to evaluate the relationship between subjectively reported and objective adherence of MS patients using RebiSmart® in Switzerland and explore variables associated with objective adherence. METHODS: Patients with relapsing-remitting MS who were treated with sc IFN ß-1a 44 or 22 µg three times weekly using RebiSmart® for at least 9 months participated in this phase IV non-interventional study. Neurologist questionnaires were used at month 0 to collect patient demographics, medical history and estimates of patients' adherence. Patient questionnaires were used to record subjective patient-reported adherence at month 0 and estimates of variables influencing adherence. Objective adherence data were obtained from the RebiSmart® log-files at months 0 and 6. RESULTS: Of 56 patients who completed the observation period, 53 had evaluable data. Objective adherence differed significantly between self-reported compliant (n = 33) and non-compliant groups (n = 20) (p = 0.00001). Older age, greater disability, patient's perception of the importance of ease of use and storage, being well informed about RebiSmart® features and neurologists' estimations of adherence were all positively associated with treatment adherence. CONCLUSIONS: We showed for the first time that subjective patient-reported adherence in MS was well in line with objective adherence, suggesting that the frequency of administration is reported accurately by patients to their neurologist. This observation may have implications for future treatment monitoring strategies and strategic medical decisions. Patients, particularly those who are younger and with lower levels of disability, may benefit from being better informed of the importance of being adherent to their treatments and receiving information about their medication and the device they are using.

Uso de plantas medicinales por la comunidad boliviana en el área metropolitana de Barcelona / Uso de plantas medicinais pela comunidade boliviana na área metropolitana de Barcelona / Use of medicinal plants by the Bolivian community in the Metropolitan Region of Barcelona

Las condiciones de vida que los inmigrantes de Sudamérica encuentran en España influye en sus prácticas para el cuidado de la salud. Los objetivos de este estudio fueron documentar la etnofarmacopea de los inmigrantes bolivianos en Barcelona y comprender sus pautas de comportamiento en relación con la necesidad de atención sanitaria. Para recabar información, tanto cualitativa como cuantitativa, se utilizaron cuestionarios y listados libres, asi como entrevistas semi-estructuradas y no estructuradas. Adicionalmente, se recogieron y documentaron todas las plantas medicinales y productos citados disponibles. A partir de entrevistas con 51 informantes, se registró un total de 60 remedios vegetales (115 citas de uso), con un total de 77 usos. Es común el pluralismo medicinal: los informantes utilizaban tanto los remedios vegetales en automedicación como la consultas con médicos de familia del sistema nacional de salud español. Los remedios vegetales culturalmente más relevantes incluyen infusiones de manzanilla (Matricaria recutita L.) y de hoja de coca (Erythroxylum coca Lam.) y Mentisan©, un ungiiento mentolado. A pesar de ser una muestra relativamente pequeña, este primer estudio sobre el uso de plantas medicinales por inmigrantes en España claramente indica que la comunidad boliviana sigue siendo fiel a sus tradiciones médicas (AU)

As condicoes de vida que os imigrantes da América do Sul encontram em Espanha influencia as suas práticas de cuidados de saúdo. Os objetivos deste estudo foram documentar a etnofarmacopeia do imigrantos bolivianos em Barcelona o entender sous padroes do comportamento em rolaçáo a necessidade de cuidados de saúdo. Para rocolhor informacoes, tanto qualitativas como quantitativas, foram utilizados questionários o listas livros, o entrevistas semi-estruturadas e nao estruturadas. Alem disso, recolhoram-se o documentaram-so todas as plantas medicinais o produtos citados disponíveis. A partir de entrevistas com 51 participantes, foram registados um total de 60 romádios vegetais (115 citacoes de uso), com um total de 77 usos. O pluralismo médico e comum: os informantes tanto usam remédios a base de plantas na auto-modicaçáo como consultas com médicos de familia do sistema nacional de saúde espanhol. Osremédios a base de plantas culturalmente mais relevantes incluem infusoes do camomila (Matricaria recutita L.) o de coca (Erythroxylum coca Lam.) o Mentisan©, um unguento mentolado. A pesar de ser uma amostra relativamente pequena, este primeiro estudo sobre o uso de plantas medicinais por imigrantes em Espanha indica claramente que a comunidade boliviana permanece fiel as suas tradicoes médicas (AU)

Living conditions that South American migrant communities encounter in Spain have an influence on their health care practices. The aims of this study are both to determine Bolivian migrants' ethnopharmacopeia in Barcelona and to understand the health-seeking strategies. Questionnaires and free-listings as well as semi-structured and unstructured interviews were used to gather both quantitative and qualitative data during the field work. Moreover, all accessible medicinal plants and herbal products mentioned were both collected and documented. As a result and on the basis of interviews with 51 informants, a total of sixty herbal remedies (115 use reports) were recorded used to treat with a total of 77 uses. Medical pluralism is common: informants used both plant remedies in self—medication and consultations with family doctors of the Spanish health care system. The most culturally salient plant remedies included chamomile (Matricaria recutita L.) infusion, infusion of coca leaf (Erythroxylum coca Lam.) and Mentisan©, a mentholated ointment. Despite of a relatively small sample size, this first study on immigrant medicinal plant use in Spain clearly shows that the Bolivian community in Barcelona remains loyal to their medical traditions (AU)

Determinants of self-medication with NSAIDs in a Portuguese community pharmacy

Background: Non-steroid anti-inflammatory drugs (NSAIDs) are a widely used therapeutic group in the world, and particularly in the Portuguese population. Objective: To compare NSAID’s use by prescription and self-medication acquisition and to determine the pattern of indication of NSAIDs, their usage profile and possible implications for patients’ safety. Methods: A cross-sectional design was used where individuals presenting at a community pharmacy requesting NSAIDs during the study period (one month) were invited to answer a face-to-face interview where socio-demographic characteristics, the indication pattern and previous experience of side effects were assessed. A follow-up interview was performed one week later to assess the incidence of adverse effects. The study was ethically approved. Results: A sample of 130 NSAIDs users was recruited, comprising mostly women (n=87; 66.9%), actively employed (n=77; 59.2%) and presenting a mean age of 49.5 years old (SD=20.49). An equal proportion of individuals acquired NSAIDs by self-medication and with medical prescription (n=65; 50%). Over 4/5 of patients (n=57; 87.7%) acquiring NSAIDs without a prescription were self-medicated by their own initiative, and only 10.8% (n=7) had been advised by the pharmacist. The most commonly acquired active substances were ibuprofen and diclofenac. Self-medicated users more frequently resorted to topical NSAIDs following short term treatments. The major underlying condition motivating NSAIDs sought were musculoskeletal disorders (45.0%), regardless of the regimen. An important proportion of prevalent users of NSAIDs reported previous experience of adverse effects (11.3%). One week after initiating NSAID therapy, a small proportion of patients reported incidence of adverse effects. Conclusion: Self-medication with NSAIDs is sought for numerous medical conditions. Reported adverse effects (prevalent and incident) confirm the need for a more rational use of NSAIDs and ongoing pharmacovigilance (AU)

No disponible

Medication reminder device for the elderly patients with mild cognitive impairment.

Reminder devices reportedly improve medication adherence in the elderly patients with mild dementia; however, the efficacy of such devices remains unexplored. Therefore, a 3-month before and after study with convenience sampling was conducted to determine the efficacy of a medication reminder device used by 18 participants (aged 81.2 ± 6.2 years) with Clinical Dementia Rating scores of 0.5 or 1. At the onset of device use, examiners visited the users' homes to ensure that they and their caregivers understood how to use the device. Caregivers monitored its use during the first week. Values of the self-administration medication rate during 1 week for 13 (72.2%) users showed improvement at 3 months. This result revealed that reminder devices can improve medication adherence in the elderly patients with mild cognitive impairment. Further study is needed to assess the magnitude of this improvement and to enhance its support for users with mild cognitive impairment.

[Investigation on the usage and prescription of adrenaline self-injector against anaphylaxis].

BACKGROUND: In Japan Adrenaline self injector (ASJ) became available for patients with anaphylaxis including children in 2005. Countermeasure against anaphylaxis in Japan is far behind international standards, and understanding of anaphylaxis and its treatment by doctors is thought to be unsatisfactory level. METHODS AND SUBJECTS: This investigation was carried out using questionnaire towards 1,196 doctors who had contributed nationwide survey of food allergy monitoring in 2005. The investigation was done on January in 2006. The questionnaire consisted of possession of registration as ASJ prescription doctor, prescription experience, indication of ASJ prescription, and timing for patients to use ASJ. RESULTS: Seven hundred and seven replies were obtained out of 1,196 doctors, and 443 doctors (62.7%) were reported to be registered as an ASJ prescription doctors. Among 443 registered doctors, 209 doctors had experienced to prescribe ASJ. Only 88 percent of doctors accepted the cases with repeated anaphylaxis as criteria for absolute prescription of ASJ, and 41.6 percent of doctors accepted cases with history of anaphylaxis as the criteria. Timing by doctors to inject adrenaline was reported to be cases with circulatory symptom (93.7%), airway mucosa symptom (79.4%), and with respiratory symptom (56.6%), DISCUSSION: Japanese doctors seem to have unsatisfactory level of knowledge of anaphylaxis . It is important for Japanese doctors to receive appropriate education on anaphylaxis and ASJ.

Development and validation of the self-administration of medication tool.

BACKGROUND: Consumer participation in planning and implementing health care is actively encouraged as a means of improving patient outcomes. In assessing the ability of patients to self-medicate, health professionals can identify areas in which patients need assistance, education, and intervention to optimize their health outcomes after discharge. OBJECTIVE: To develop and validate a tool to quantify the ability of patients to administer their regularly scheduled medications while they are hospitalized. METHODS: Past research enabled us to develop the Self-Administration of Medication (SAM) tool. Using a Delphi technique of 3 rounds, a panel of expert health professionals established the content validity of the tool. For determining level of agreement in using the SAM tool, 56 patients were selected; for each patient, 2 randomly selected nurses completed an assessment. Construct validity and internal consistency were examined by testing the tool in 50 patients and comparing with other validated scales. RESULTS: The 29-item SAM tool had high content validity scores for clarity, representation, and comprehensiveness, with content validity index values ranging from 0.95-1.0. In testing the level of agreement between 2 nurses, out of 43 valid cases, 95.3% of nurses overwhelmingly agreed about the patients' competence to self-administer their drugs. The intraclass correlation coefficient was 0.819 (95% CI 0.666 to 0.902). Internal consistency for the SAM tool was high, with a Cronbach's alpha of 0.899. A moderate to strong correlation was obtained when comparing the SAM tool with other validated measures. CONCLUSIONS: The SAM tool is valid and reliable for quantifying patients' ability to manage their regularly scheduled medications in the hospital setting.