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J Gerontol Nurs ; 47(4): 7-12, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34038247


This process evaluation of the Rural Elder Awareness of Medication Safety (REAMS) program provided identification of successful and unsuccessful elements along with barriers to and facilitators of this home-based pilot program. The REAMS program was developed to assist rural older adults aged >65 years and community health care organizations with strategies to improve health literacy related to medications. Recruitment of older adults, rurality of the program's setting, time constraints, and the onset of the COVID-19 pandemic were the greatest barriers. The collaborative relationship developed with community health care partners was the greatest facilitator. This relationship promoted shared ideas and adjustments in program design to achieve the outcome goals. The lessons learned from process evaluation may benefit future researchers or community health promotion planners with designing community-based programs for older adults in rural areas. Future research should focus on expanding recruitment opportunities in acute care, primary care, and home health with the inclusion of all established health care providers in the community. [Journal of Gerontological Nursing, 47(4), 7-12.].

Idoso Fragilizado , Letramento em Saúde , Serviços de Assistência Domiciliar/organização & administração , Educação de Pacientes como Assunto/métodos , Conhecimento do Paciente sobre a Medicação , Segurança do Paciente , Serviços de Saúde Rural/organização & administração , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Projetos Piloto , População Rural , Estados Unidos
PLoS One ; 15(12): e0243947, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33315926


Infections of diabetic foot ulcers are common, generally recalcitrant and often complicated by antibiotic resistance. Alternative antimicrobial strategies are needed. Phage therapy is a promising alternative that is being rediscovered. Despite phage therapy's 100-year history, there have been no investigations into patient thoughts and concerns. This study aimed to explore patient awareness of and concern about antibiotic resistance and gain insight into the perceptions of phage therapy among a patient group that could potentially benefit from phage therapy. Patients with an active or resolved (healed or amputated) diabetic foot ulcer were eligible to participate. A survey was distributed digitally to eligible patients across Scotland via the NHS Research Scotland Diabetes Network and hard copies were available in diabetic foot clinics at the Royal Infirmary of Edinburgh and Queen Elizabeth University Hospital, Glasgow. A focus group of five survey respondents was held in Glasgow. Fifty-five survey responses were obtained. There was a high level of awareness (76.4%; N = 55) and concern (83.3%; N = 54) about antibiotic resistance. While largely aware of viruses, most patients had not heard of phage or phage therapy. Patients were no more concerned about phage than antibiotic therapy, with most suggesting more information could alleviate any concerns. Patient acceptability of phage therapy was high, a finding confirmed by the focus group. Patients are concerned about antibiotic resistance and supportive of 'new' antimicrobials. We have demonstrated that patients are supportive, enthusiastic and accepting of phage therapy. Although 'Western' phage therapy remains in its infancy, an understanding of patient ideas, concerns and expectations will be important in eventually shaping and successfully reintroducing phage therapy.

Diabetes Mellitus/tratamento farmacológico , Pé Diabético/tratamento farmacológico , Conhecimento do Paciente sobre a Medicação , Terapia por Fagos , Antibacterianos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Diabetes Mellitus/patologia , Diabetes Mellitus/psicologia , Pé Diabético/epidemiologia , Pé Diabético/psicologia , Farmacorresistência Bacteriana/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Terapia por Fagos/psicologia , Escócia/epidemiologia , Cicatrização/genética
Rev Med Suisse ; 16(714): 2165-2168, 2020 Nov 11.
Artigo em Francês | MEDLINE | ID: mdl-33174698


For a patient, the daily preparation and self-administration of medication require a wide range of cognitive and social skills : these skills fall under the concept of medication literacy. Individuals with insufficient skills have difficulties to understand instructions from professionals, to communicate their concerns and are at greater risk of inappropriate use of their medications. In this new area of research, standardised instruments have been developed but their conceptual basis lacks consensus and none have been designed for older patients and their specificities. This article proposes some benchmarks so that physicians, pharmacists and nurses can better understand this concept and identify patients with difficulties.

Conhecimento do Paciente sobre a Medicação , Preparações Farmacêuticas , Autogestão , Idoso , Humanos , Educação de Pacientes como Assunto , Autoadministração
PLoS One ; 15(9): e0238538, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881969


Self-medication and antibiotic utilization without healthcare oversight may lead to delayed appropriate treatment, transmission of communicable infections, untoward adverse events, and contribute to antimicrobial resistance. Previous data suggest people obtain over-the-counter (OTC) animal antibiotics for their personal use. This study examined the availability of OTC fish antibiotics online and the documented intent for self-medication. The authors conducted a web-based cross-sectional study using Google search engine to identify vendor websites selling fish antibiotics in the United States. Vendor websites were included if product information, consumer reviews, and comments were publicly available. Nine fish antibiotics were chosen due to their possibility of having consequences to human misuse. The cost and availability of fish antibiotics was recorded. The proportion of reviews and comments related to human consumption was calculated. Consumer review traffic based on "likes" and "dislikes" received was compared between human- and non-human consumption-related reviews. Selected fish antibiotics were purchased and evaluated for physical appearance and compared to FDA-approved available equivalents. We found 24 website vendors with online ordering available for OTC fish antibiotics. Cost varied significantly by antibiotic and quantity ranging from USD $8.99 to $119.99. There were 2,288 reviews documented for the 9 selected antibiotics being sold. Among consumer reviews, 2.4% were potentially associated with human consumption. Human consumption-related reviews constituted 30.2% of all "likes" received and 37.5% of all "dislikes" received. Human consumption-related reviews received an average of 9.2 likes compared to 0.52 likes for non-human consumption-related reviews. The 8 fish antibiotics purchased were consistent with FDA-approved equivalents in physical appearance. Although infrequent, antibiotics intended for fish use are being purchased online without a prescription for self-medication to circumvent professional medical care. Reviews related to human consumption generate significant online traffic compared to reviews unrelated to human consumption.

Antibacterianos/administração & dosagem , Uso Indevido de Medicamentos/estatística & dados numéricos , Medicamentos sem Prescrição/administração & dosagem , Disponibilidade de Medicamentos Via Internet/estatística & dados numéricos , Automedicação/estatística & dados numéricos , Drogas Veterinárias/administração & dosagem , Estudos Transversais , Humanos , Conhecimento do Paciente sobre a Medicação , Ferramenta de Busca/estatística & dados numéricos , Estados Unidos
Ars pharm ; 61(3): 193-197, jul.-sept. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195123


INTRODUCCIÓN: El conocimiento que tiene el paciente sobre su medicación antidiabética (CPMA) influye en la adherencia al tratamiento. Por eso es necesario cuantificarlo. OBJETIVO: El objetivo de este estudio fue identificar las distintas formas en que se ha medido el CPMA MÉTODO: Se realizó una revisión sistemática en las bases de datos de Medline, Escopus, Cinahl y Psycinfo. Se utilizó como guía las recomendaciones PRISMA para realizar esta revisión. RESULTADOS: Se incluyeron 3 artículo. Dos de ellos utilizaban cuestionarios para medir el CPMA y el otro utilizó una demostración práctica por parte del paciente. CONCLUSIONES: Ninguna de las formas de medición del CPMA aporto datos de validez y fiabilidad. Es necesario definir el CMPA consensuado a nivel internacional y diseñar una herramienta de medida valida y fiable basada en esta definición

INTRODUCTION: The patient's knowledge about the antidiabetic medication (PKAM) influences medication adherence. That is why it is necessary to quantify it. AIM: The aim of the study was to identify the different ways in which PKAM has been measured. METHOD: A systematic review was carried out in the Medline, Scopus, Cinahl and Psycinfo databases. The PRISMA recommendations were used to perform this review. RESULTS: 3 articles were included. Two of them used questionnaires to measure PKAM and the other used a practical demonstration by the patient. CONCLUSIONS: None of the PKAM measurement methods provided validity and reliability data. It is nec-essary to define the PKAM agreed at an international level and design a valid and reliable measurement tool based on this definition

Humanos , Conhecimento do Paciente sobre a Medicação/normas , Hipoglicemiantes/normas , Educação de Pacientes como Assunto/normas , Hipoglicemiantes/administração & dosagem , Cooperação e Adesão ao Tratamento , Conhecimentos, Atitudes e Prática em Saúde
Drugs Aging ; 37(9): 635-655, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32643062


BACKGROUND: Older patients are regularly exposed to multiple medication changes during a hospital stay and are more likely to experience problems understanding these changes. Medication counselling is often proposed as an important component of seamless care to ensure appropriate medication use after hospital discharge. OBJECTIVES: The purpose of this systematic review was to describe the components of medication counselling in older patients (aged ≥ 65 years) prior to hospital discharge and to review the effectiveness of such counselling on reported clinical outcomes. METHODS: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology (PROSPERO CRD42019116036), a systematic search of MEDLINE, EMBASE and CINAHL was conducted. The QualSyst Assessment Tool was used to assess bias. The impact of medication counselling on different outcomes was described and stratified by intervention content. RESULTS: Twenty-nine studies were included. Fifteen different components of medication counselling were identified. Discussing the dose and dosage of patients' medications (19/29; 65.5%), providing a paper-based medication list (19/29; 65.5%) and explaining the indications of the prescribed medications (17/29; 58.6%) were the most frequently encountered components during the counselling session. Twelve different clinical outcomes were investigated in the 29 studies. A positive effect of medication counselling on medication adherence and medication knowledge was found more frequently, compared to its impact on hard outcomes such as hospital readmissions and mortality. Yet, evidence remains inconclusive regarding clinical benefit, owing to study design heterogeneity and different intervention components. Statistically significant results were more frequently observed when counselling was provided as part of a comprehensive intervention before discharge. CONCLUSIONS: Substantial heterogeneity between the included studies was found for the components of medication counselling and the reported outcomes. Study findings suggest that medication counselling should be part of multifaceted interventions, but the evidence concerning clinical outcomes remains inconclusive.

Aconselhamento Diretivo/organização & administração , Adesão à Medicação , Alta do Paciente , Conhecimento do Paciente sobre a Medicação/organização & administração , Idoso , Bases de Dados Factuais , Aconselhamento Diretivo/normas , Aconselhamento Diretivo/estatística & dados numéricos , Humanos , Tempo de Internação , Adesão à Medicação/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Conhecimento do Paciente sobre a Medicação/estatística & dados numéricos
PLoS One ; 15(7): e0235625, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645036


INTRODUCTION: The risk of emergence and spread of antibiotic resistance is high in Southeast Asian countries and various strategies are being used to raise awareness about appropriate antibiotic use and antibiotic resistance within communities. Public engagement in science has not been widely practised in Myanmar. We describe the use of a forum theatre to engage with the community about antibiotic use. METHODS: The engagement activities took place in a peri-urban township in Yangon, Myanmar. Five preliminary story gathering workshops with the community were carried out to develop scripts and songs for the forum theatre. After that, we organised forum theatre plays between September and October 2018. Following each play we provided four simple key messages based on WHO's world antibiotic awareness week advocacy materials; 1) Antibiotics are medicines used to treat bacterial infections 2) Antibiotics are not useful for coughs and colds 3) Never use leftover antibiotics or share antibiotics with others 4) Prevent infections by regularly washing hands, preparing food hygienically, avoiding close contact with sick people, and keeping vaccinations up to date. We evaluated the engagement activities by conducting focus group discussions (FGD) with audience members. RESULTS: Ten forum theatre plays were performed on two topics; "Fever and antibiotics" and "Mixed medicines", reaching 1175 community members. Four themes emerged from our thematic analysis: 1) Knowledge dissemination, 2) Enjoyment and fun, 3) Willingness to support and recommendations for future engagement activities and 4) Preference over traditional methods of health education. We found improvement of antibiotic related knowledge and enjoyment among audience who were also willing to support future engagement activities and preferred forum theatre approach over formal health talks. CONCLUSIONS: We conclude that forum theatre is an effective innovative approach to engage and disseminate knowledge on appropriate use of antibiotics with the community in a participatory way.

Anti-Infecciosos/administração & dosagem , Educação de Pacientes como Assunto/métodos , Conhecimento do Paciente sobre a Medicação/métodos , Participação do Paciente/métodos , Humanos , Adesão à Medicação , Mianmar , Jogos e Brinquedos
Biomédica (Bogotá) ; 40(supl.1): 132-138, mayo 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1124250


Introducción. La satisfacción y el conocimiento del cambio de tenofovir por tenofovir- alafenamida en pacientes con HIV no se han estudiado aún. Estos dos parámetros se relacionan con mejores resultados en salud y, por lo tanto, es importante medirlos durante la práctica clínica habitual. Objetivo. Evaluar el grado de conocimiento y satisfacción de los pacientes positivos para HIV ante el cambio de tratamiento antirretroviral con rilpivirina, emtricitabina y tenofovir (RPV-FTC-TDF) por rilpivirina, emtricitabina y tenofovir-alafenamida (RPV-FTC-TAF). Materiales y métodos. Se llevó a cabo un estudio prospectivo en un hospital de tercer nivel entre los meses de septiembre y noviembre de 2018. Se incluyeron pacientes previamente tratados con RPV-FTC-TDF que acudían por segunda vez a consulta para recibir el tratamiento con RPV-FTC-TAF. La satisfacción y el grado de conocimiento se analizaron mediante nueve preguntas, usando una escala de tipo Likert de 5 puntos para evaluar el grado de acuerdo. Resultados. Se incluyeron 116 pacientes en el estudio. El 75 % de ellos se mostró satisfecho con el cambio y se consideró que el 64 % conocía lo que implicaba. Los pacientes jóvenes se mostraron menos satisfechos con el modo en que se les explicó el cambio (p=0,0487). Los pacientes estaban mejor informados sobre las ventajas renales (85 % de conocimiento) y óseas (82 %) de la nueva medicación, que sobre sus inconvenientes para el perfil lipídico (40 %). Conclusiones. En general, los pacientes se mostraron satisfechos con el cambio de medicación y conocían la posología del medicamento y las ventajas de la tenofovir- alafenamida frente al tenofovir, pero no sus posibles efectos adversos.

Introduction: Satisfaction and knowledge among patients with HIV after switching from tenofovir to tenofovir/alafenamide remain unexplored. Given that both parameters are associated with better health outcomes it is relevant to measure them in patients during routine clinical practice. Objective: To evaluate the degree of knowledge and satisfaction in patients who had their antiretroviral regimen switched from rilpivirine (RPV)/emtricitabine (FTC)/TDF to RPV/FTC/TAF. Materials and methods: We conducted a prospective study in a third-level hospital between September, 2018, and November, 2018. We included patients who had previously been treated with RPV/FTC/TDF and collected their RPV/FTC/TAF treatment in the second visit. A 5-point Likert-type agreement/disagreement scale was used to assess satisfaction and knowledge regarding the medication switch. Results: We included 116 patients in the study of whom 75% were satisfied and 64% had a high-level of knowledge. Young patients were less satisfied with the way in which the change was explained (p=0.0487). Concerning the new medication, the patients were better informed about its renal (85% of them) and bone benefits (82%) than about its adverse effects on the lipid profile (40%). Conclusions: The patients were generally satisfied with the change in medication and well informed about the dosage and advantages of TAF over TDF, but less well informed about the possible adverse effects of TAF.

HIV , Satisfação do Paciente , Conhecimento do Paciente sobre a Medicação , Farmacêuticos , Rilpivirina , Tenofovir
J Clin Nurs ; 29(13-14): 2675-2690, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32301200


AIM AND OBJECTIVES: To describe the (a) prevalence and perceptions of cardiovascular disease and related health conditions in African Americans with osteoarthritis pain, (b) their knowledge of cardiovascular safety of commonly prescribed analgesics for osteoarthritis and (c) frequency of high-risk analgesic use. BACKGROUND: African Americans have more disabling osteoarthritis pain and an excessive burden of cardiovascular disease than any other US racial group. However, minimal research has investigated the relationship between chronic pain and cardiovascular disease and subsequent medication knowledge and use in African Americans. Consolidated Criteria for Reporting Qualitative and Srengthening the Reporting of Observational studies in Epidemiology checklists were followed. DESIGN: A descriptive, secondary mixed-methods analysis. METHODS: A convenience sample of 110 African American adults (50-94 years and older) completed surveys and individual qualitative interviews. Data were analysed using descriptive statistics, chi-square or Fisher's exact test, t test, Mann-Whitney U and a qualitative content analysis. RESULTS: Hypertension was the most common cardiovascular condition reported, and African Americans with hypertension reported greater pain than those without. The survey questions revealed that most participants did not possess accurate knowledge about the appropriateness of analgesics in heart failure and other cardiovascular-related diseases; however, during the interviews, some did acknowledge a general understanding of the negative effects of some medications. Still, many older adults were taking nonsteroidal anti-inflammatory drugs despite having hypertension. CONCLUSIONS: There was evidence of multimorbidity in our sample; based on our data, chronic osteoarthritis pain and hypertension are two highly comorbid conditions, suggesting a possible syndemic. More disparate is the lack of knowledge that African Americans possess as it relates to safe use of analgesic medications when cardiovascular disease is present. RELEVANCE TO CLINICAL PRACTICE: Chronic pain and cardiovascular-related diseases are common and often co-occur and should be evaluated in all older adults, particularly African Americans. Both issues are important to manage, including the safe and appropriate use of medications, to prevent adverse effects.

Dor Crônica/tratamento farmacológico , Hipertensão/tratamento farmacológico , Osteoartrite/tratamento farmacológico , Conhecimento do Paciente sobre a Medicação , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Dor Crônica/complicações , Feminino , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Medição da Dor/métodos , Pesquisa Qualitativa , Inquéritos e Questionários
J Korean Med Sci ; 35(14): e92, 2020 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-32281312


BACKGROUND: Non-adherence to oral maintenance therapy in adolescents with inflammatory bowel disease (IBD) is a significant healthcare problem. Knowledge of the prescribed medication can increase medication adherence. We aimed to investigate the relationship between medication adherence and disease-related knowledge of pediatric and adolescent patients with IBD. METHODS: We conducted a "pop quiz" to investigate the disease-related knowledge of pediatric patients with IBD who were followed-up at our institution and reviewed their medical records, including data on sex, diagnosis, age at diagnosis, and disease duration. Medication adherence was evaluated by the doctor in charge, and ≥ 80% of patients constituted the "good adherence group." RESULTS: Of 93 patients, 59 (63.4%) were males, and 78 (83.9%) had Crohn's disease. The mean age at diagnosis was 13.8 ± 2.8 years; mean follow-up duration, 4.8 ± 3.4 years; and mean patient age, 18.6 ± 3.7 years. Only 65 patients (69.9%) knew the exact name of the medication they were currently taking, and 34 (36.6%) knew the correct dose. Only 15 patients (16.1%) knew the name of the medications they were previously taking. A total of 64 patients (66.8%) showed an adherence rate of 80% for the weekly prescribed oral medication. The patients in the poor adherence group were significantly older than those in the good adherence group (P = 0.035). The number of hospitalizations per year was statistically higher in the good adherence group (P = 0.024). The proportion of patients who knew the names of the medications they were previously taking and were aware of the side effects of the medications was significantly higher in the good adherence group (P = 0.008 and P = 0.020, respectively). CONCLUSION: Adolescent IBD patients have lower oral medication adherence. Knowledge of the prescribed medications taken previously, and the adverse effects of these medications are associated with good adherence. IBD specialists should educate the patients regarding the disease and about their medication.

Doenças Inflamatórias Intestinais , Adesão à Medicação , Conhecimento do Paciente sobre a Medicação , Adolescente , Criança , Feminino , Humanos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Masculino , Adulto Jovem
JAMA Netw Open ; 3(3): e200341, 2020 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-32125427


Importance: The treatment plans of patients with cancer involve multiple modalities that oncologists need to explain to patients. One such modality is chemotherapy, in which information about the goals, duration, and expected complications of therapy are considered fundamental to achieving optimal patient understanding. Therefore, effective communication between patients and their treating physicians is important to ensure patient adherence to treatment and achieve better outcomes. Objective: To investigate the concordance in the understanding of chemotherapy treatment plans between patients and their treating oncologists and to identify the potential factors associated with concordance. Design, Setting, and Participants: A cross-sectional study was conducted among adult patients (aged >18 years) with cancer who consented to receive chemotherapy between October 4, 2017, and November 8, 2018. The study also included the treating oncologists of patients receiving chemotherapy. An interview-based structured questionnaire was administered in both inpatient and outpatient settings at the Princess Noorah Oncology Center in Jeddah, Saudi Arabia. The demographic data of patients and physicians were obtained from the ARIA Oncology Information System, a chemotherapy-prescribing software database used at the center. Patients who had a personal history of cancer or were unwilling to be involved in the decision-making process were excluded. Data were analyzed from November 15 to December 20, 2018. Exposures: Patients' comprehension and concordance with their treating physicians regarding the aspects of the intended treatment plan. Main Outcomes and Measures: The main outcomes measured were the patient-physician concordance level in the understanding of treatment plans and the identification of patient-related and physician-related factors associated with the level of concordance. Results: A total of 151 adult patients (77 men [51.0%] and 74 women [49.0%]) were interviewed. Of those, 144 patients (75.5%) were younger than 60 years, and 52 patients (34.4%) had a college or advanced degree. A total of 20 treating oncologists were interviewed, of whom 14 (70.0%) were men and 6 (30.0%) were women. Arabic was the primary language of 19 oncologists (95.0%), and 19 oncologists (95.0%) had medical practice experience outside of Saudi Arabia. Only 20 patients (13.7%) had full concordance with their physicians regarding the aspects of their treatment plans. The remaining 131 patients (86.2%) had discordance with 1 or more aspect of their treatment plans. The most common aspect of discordance was the planned duration of the chemotherapy regimen, with 104 patients (68.4%) having full discordance. Full patient-physician concordance was more likely among patients with college or advanced degrees (χ21 = 17.73; P < .001) and patients with a family history of cancer (χ21 = 15.88; P < .001). In addition, older physicians (>40 years) compared with younger physicians (aged 30-40 years) were more likely to achieve higher rates of full patient-physician concordance, whereas older patients (>60 years) were associated with only partial concordance compared with patients younger than 60 years (χ21 = 5.84; P = .008), with an AR of 2.7. Conclusions and Relevance: Most patients showed suboptimal understanding of aspects of their chemotherapy treatment plans. More effort and time should be dedicated to enhancing the understanding of chemotherapy plans among patients with lower educational levels. In addition, self-report surveys that evaluate patients' understanding of their chemotherapy treatment plans should be developed and added to the informed consent process to objectively assess how much a patient understands and to develop a stepwise patient education program that targets patients with the lowest levels of understanding.

Antineoplásicos/uso terapêutico , Neoplasias/tratamento farmacológico , Oncologistas , Educação de Pacientes como Assunto , Conhecimento do Paciente sobre a Medicação , Adolescente , Adulto , Estudos Transversais , Duração da Terapia , Escolaridade , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Arábia Saudita , Adulto Jovem
Health Qual Life Outcomes ; 18(1): 73, 2020 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-32178684


BACKGROUND: Literature has paid little attention in describing the specific contribution of each modifiable and non-modifiable characteristics on health-related quality of life (HRQoL) in physician-managed anticoagulated patients using vitamin K antagonists (VKAs). To describe how patients' treatment-specific knowledge, health literacy, treatment beliefs, clinical, and socio-demographic characteristics influence HRQoL in Italian physician-managed anticoagulated patients using VKAs. METHODS: Cross-sectional multicentre study with a consecutive sampling strategy, enrolling 164 long-term anticoagulated patients. Clinical and socio-demographic characteristics were collected from electronic medical records. Valid and reliable questionnaires were used to collect patients' treatment-specific knowledge, health literacy, beliefs about VKAs, physical and health perceptions. RESULTS: Obtaining and understanding health information (i.e., communicative health literacy) positively predicts both adequate mental (ORadjusted = 10.9; 95%CI = 1.99-19.10) and physical (ORadjusted = 11.54; 95%CI = 1.99-34.45) health perceptions. Conversely, the ability to perform proper health decision making (i.e., critical health literacy) was associated with lower rates of adequate mental health perception (ORadjusted = 0.13; 95%CI = 0.03-0.63). Further, age negatively predicted physical health perception (ORadjusted = 0.87; 95%CI = 0.81-0.93). CONCLUSIONS: Health literacy plays an interesting role in predicting HRQoL. The relationship between critical health literacy and mental health perception could be influenced by some psychological variables, such as distress and frustration, which could be present in patients with higher levels of critical health literacy, as they could be more inclined for self-monitoring. For this reason, future research are needed to identify the most suitable patients' profile for each OAC-management model, by longitudinally describing the predictive performance of each modifiable and non-modifiable determinant of HRQoL.

Inibidores do Fator Xa/uso terapêutico , Conhecimento do Paciente sobre a Medicação , Qualidade de Vida , Vitamina K/antagonistas & inibidores , Adulto , Estudos Transversais , Feminino , Humanos , Itália , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
Medicine (Baltimore) ; 99(12): e19490, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195948


INTRODUCTION: Contraceptive use and sexual health behavior remain a prominent public health concern in South Africa (SA). Despite many government interventions, unintended pregnancies and termination of pregnancies remain relatively high. This review aimed to map evidence on factors influencing contraceptive use and sexual behavior in SA. METHODS: We conducted a scoping review guided by Arksey and O'Malley's framework. We searched for articles from the following databases: PubMed/MEDLINE, American Doctoral Dissertations via EBSCO host, Union Catalogue of Theses and Dissertations (UCTD) and SA ePublications via SABINET Online and World Cat Dissertations, Theses via OCLC and Google Scholar. Studies published from January 1990 to March 2018 were included. We used the Population, Concept, and Context (PCC) framework and the PRISMA chart to report the screening of results. The Mixed Method Appraisal Tool (MMAT) version 11 and ACCODS tools were used to determine the quality of the included studies. RESULTS: A total of 2030 articles were identified by our search criteria for title screening. Only 21 studies met our inclusion criteria and were included in quality assessment stage. We found that knowledge of a contraceptive method, length of a relationship, sexual debut, age difference between partners availability of a contraceptive method, long waiting hours, and nurse's attitudes toward human immunodeficiency virus (HIV) positive or younger clients predict whether or not women use a contraceptive method or improve sexual behavior. CONCLUSION: There remains a necessity for improving educational programs aimed at transferring knowledge on contraceptives and sexual behavior to both women and their male counterparts, alongside the public health systems' improvements.

Comportamento Contraceptivo/tendências , Anticoncepção/psicologia , Conhecimento do Paciente sobre a Medicação/estatística & dados numéricos , Comportamento Sexual/psicologia , Aborto Induzido/estatística & dados numéricos , Adolescente , Adulto , Comportamento Contraceptivo/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Gravidez , Gravidez não Planejada/psicologia , Parceiros Sexuais/psicologia , África do Sul/epidemiologia , Adulto Jovem
Pharm Res ; 37(3): 60, 2020 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-32103380


PURPOSE: A patient was denoted to be generic brittle (GB) if they had a negative opinion about generics (e.g. prior history of a switch problem) or took the innovator brand of their most problematic anti-epileptic drug (AED) when generic was available. The aim of this hypothesis-generating study was to assess possible genetic and physiologic differences between GB and not GB patients with epilepsy. METHODS: Patients (n = 148) with epilepsy were previously characterized as being either GB or not GB. Blood was collected from each subject for genotyping and physiologic testing. Genotyping for 24 single nucleotide polymorphisms (SNPs) and two copy number variants (CNVs) was performed across 12 genes in each patient. Forty-four physiologic tests were conducted in each patient. Chi square analysis was performed to assess for associations between genotyping results and GB status, as well as between physiologic test results and GB status. RESULTS: No SNP or CNV discriminated GB status in genetic analysis (genotype or allele frequency). Physiologic test results in this study were not associated with GB status. CONCLUSIONS: Questions from neurologists and patients about generics is frequently based on applicability of generic drug standards to individual subjects. However, findings here in patients with epilepsy did not uncover genetic or physiologic reasons that explained which patients were GB and which were not GB.

Anticonvulsivantes/uso terapêutico , Medicamentos Genéricos/uso terapêutico , Epilepsia/tratamento farmacológico , Epilepsia/genética , Conhecimento do Paciente sobre a Medicação , Anticonvulsivantes/farmacocinética , Comportamento de Escolha , Citocromo P-450 CYP3A/genética , Medicamentos Genéricos/farmacocinética , Frequência do Gene , Genótipo , Humanos , Polimorfismo de Nucleotídeo Único , Receptores Nicotínicos/genética , Equivalência Terapêutica
Am J Nurs ; 120(2): 36-42, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31977416


Polypharmacy, the use by a patient of multiple medications, contributes to adverse drug events, hospitalizations, geriatric syndromes, and increased health care costs. In the United States, polypharmacy is increasingly widespread, particularly among community-dwelling adults over age 62. In 2005-2006, 31% of such adults used five or more prescription drugs and 8.4% used medication combinations associated with potential interactions. By 2010-2011, 36% used five or more prescription drugs and 15% used potentially problematic drug combinations. Reducing the dangers of polypharmacy, however, requires clinicians to broaden their focus, considering not only the number of drugs a patient takes, but also the prescription of potentially inappropriate medications and potential prescribing omissions. This article explores the factors that contribute to polypharmacy and discusses its negative physiological, psychological, and economic effects. It also describes strategies for reducing polypharmacy, including both "explicit" approaches, which are grounded in the findings of literature reviews and expert opinion, and "implicit" approaches, which are based on the provider's interpretation of clinical data and the patient's medication regimen.

Desprescrições , Vida Independente/estatística & dados numéricos , Polimedicação , Padrões de Prática Médica , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Múltiplas Afecções Crônicas/tratamento farmacológico , Conhecimento do Paciente sobre a Medicação/enfermagem , Lista de Medicamentos Potencialmente Inapropriados , Estados Unidos
Patient Educ Couns ; 103(3): 537-543, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31685357


OBJECTIVES: The growing number of cancer patients treated with Oral Chemotherapy (OC) at home, is prompting many healthcare centers to develop Therapeutic Patient Education (TPE) programs. This study aimed to 1) describe the different forms of knowledge shared and learned in these programs, and 2) better understand how self-care and psychosocial skills are promoted in the TPE context. METHOD: This study used qualitative data from the French "ONCORAL" program. Data collection was conducted with non-participant observations. The corpus comprised 42 TPE sessions. RESULTS: Analysis highlighted that TPE specifically helps patients' functional health, revealed the medical expectations and social norms that shape the patient's role, and exposed the difficulties faced by the patient when acquiring self-care skills. Self-care skills and psychosocial skills also appeared to be mutually dependent in the context of TPE. CONCLUSION: TPE programs which focus more on developing medical knowledge inevitably give less importance to psychosocial skills. Yet the recognition and promotion of the latter in TPE may lead to positive coping strategies related to medical outcomes, such as adherence. PRACTICE IMPLICATION: Dedicated TPE program objectives for patients undergoing oral chemotherapy should recognize not only the value of medical knowledge but also of lay knowledge.

Antineoplásicos/uso terapêutico , Comunicação , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias/tratamento farmacológico , Educação de Pacientes como Assunto/métodos , Relações Profissional-Paciente , Administração Oral , Adulto , Tratamento Farmacológico , Feminino , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Conhecimento do Paciente sobre a Medicação , Participação do Paciente , Pesquisa Qualitativa
Rev. enferm. UFSM ; 10: 24, 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1119007


Objetivo: identificar o conhecimento da pessoa com transtorno mental sobre o tratamento medicamentoso. Método: pesquisa observacional transversal desenvolvida com 300 pessoas em tratamento em dois Centros de Atenção Psicossocial de Curitiba, Paraná. Os dados foram coletados por entrevista estruturada e consulta à prescrição de medicamentos em prontuário. Foi realizada análise descritiva e inferencial. Resultados: a maioria dos participantes apresentou conhecimento insuficiente quanto ao nome dos medicamentos (64%), dose (91,9%) e frequência de administração (82,6%). Houve associação entre conhecimento insuficiente sobre a terapêutica medicamentosa e uso de medicamentos para comorbidades, desconhecimento do diagnóstico, depressão, idade avançada, autoadministração dos medicamentos, consumo de álcool e informações fornecidas pela enfermagem ou psicólogos. Conclusões: destaca-se que, principalmente, a autoadministração de medicamentos, transtornos depressivos e uso de medicamentos para outras condições de saúde podem estar relacionadas ao nível de conhecimento insuficiente da terapêutica medicamentosa, representando possíveis obstáculos a adesão e uso seguro dos medicamentos.

Objective: to identify knowledge about drug therapy among those people with mental illness. Method: cross-sectional observational research carried out with 300 people undergoing treatment at Psychosocial Care Centers in Curitiba, Paraná. Data were collected through structured interviews and by consulting prescriptions for medications in medical records. A descriptive and inferential analysis was performed. Results: the majority of participants had insufficient knowledge regarding the name of the drugs (64%), dose (91.9%) and frequency of administration (82.6%). There was an association between insufficient knowledge regarding drug therapy and the use of drugs for comorbidities, ignorance about the diagnosis, depression, advanced age, self-administration of drugs, alcohol consumption and misunderstanding information provided by nurses or psychologists. Conclusions: it is underscored that self-administration of medications, depressive disorders and use of medications for other health conditions may be related to the level of insufficient knowledge regarding their drug therapy; thus representing obstacles to adherence of medications.

Objetivo: identificar el conocimiento de la persona con trastorno mental sobre el tratamiento medicamentoso. Método: investigación observacional transversal desarrollada con 300 personas en tratamiento en Centros de Atención Psicosocial de Curitiba, Paraná. Los datos han sido recolectados por entrevista estructurada y consulta a la prescripción de medicamentos. Ha sido realizado análisis descriptivo e inferencia. Resultados: La mayoría de los participantes ha presentado conocimiento insuficiente cuanto al nombre de los medicamentos (64%), dosis (91,9%) y frecuencia de administración (82,6%). Ha habido asociación entre conocimiento insuficiente sobre la terapéutica y uso de medicamentos para comorbilidad, desconocimiento del diagnóstico, depresión, edad avanzada, auto-administración de medicamentos, consumo de alcohol e información provista por la enfermería o psicólogos. Conclusiones: Se destaca que la auto-administración de medicamentos, trastornos depresivos y uso de medicamentos para otras condiciones de salud pueden estar relacionadas al nivel de conocimiento insuficiente de la terapéutica medicamentosa, representando obstáculos de adhesión.

Humanos , Prescrições de Medicamentos , Conhecimento do Paciente sobre a Medicação , Transtornos Mentais , Serviços de Saúde Mental
Rev. polis psique ; 10(2): 122-142, 2020. graf
Artigo em Português | LILACS, Index Psicologia - Periódicos | ID: biblio-1103204


Neste artigo compartilhamos reverberações de uma experiência formativa na cidade de Santos, em São Paulo, e da articulação de um Observatório Internacional de Práticas de Gestão Autônoma da Medicação (GAM), com vistas à produção de estratégias emancipatórias e libertárias em saúde mental. Nos últimos anos, novas ações de cuidado baseadas no paradigma da Atenção Psicossocial vêm sendo propostas sem, entretanto, serem acompanhadas de forma a evidenciar suas potencialidades e limitações no cotidiano dos serviços. A partir de metodologia participativa e colaborativa, percebemos que a formação para a GAM traz materialidade aos princípios da Reforma Psiquiátrica Brasileira, possibilitando aos trabalhadores um exercício radical de problematização de aspectos sutis e pouco incorporados em suas práticas, convocando a um percurso a ser feito junto dos usuários. Especificamente, junto a pessoas com problemas com drogas, ressaltamos a inseparabilidade do debate sobre as drogas prescritas e não prescritas, presente nas experimentações e buscas pelo prazer, pelo alívio da dor, pela construção de lugar nas relações de consumo, e pela reinvenção de possíveis. Acreditamos que o Observatório GAM viabilizará a difusão da incidência da GAM sobre as diferentes das práticas manicomiais do contemporâneo, necessariamente, medicalizantes.

In this article, we share reverberations of a formative experience in the city of Santos, in São Paulo, and in the articulation of an International Observatory of Medication Management Practices (GAM), with a view to the production of emancipatory and libertarian statistics in mental health . In recent years, the new care actions adopted in the Psychosocial Care paradigm have been applied without, however, being monitored in order to highlight their potential and the unused permissions in daily services. Based on a participatory and collaborative methodology, it is perceived that the training for GAM brings materiality to the principles of the Brazilian Psychiatric Reform, allowing workers a radical exercise of problematizing subtle aspects and little incorporated in their practices, summoning a student to be done together of users. Specifically, with people with drug problems, we highlight the inseparability of the debate about prescription and non-prescription drugs, present in experiences and in the search for pleasure, for the wear of pain, for the construction of a place in consumption relationships and for the reinvention of possible ones. We believe that the GAM Observatory enables the dissemination of GAM on the different imposed, medicalizing manicomic practices of the contemporary.

En este artículo, compartimos las reverberaciones de una experiencia formativa en la ciudad de Santos, en São Paulo, y en la articulación de un Observatorio Internacional de Prácticas de Gestión de Medicamentos (GAM), con miras a la producción de estadísticas emancipadoras y libertarias en salud mental. . En los últimos años, las nuevas acciones de atención adoptadas en el paradigma de la Atención Psicosocial se han aplicado sin, sin embargo, ser monitoreadas para resaltar su potencial y los permisos no utilizados en los servicios diarios. Basado en una metodología participativa y colaborativa, se percibe que la capacitación para GAM aporta materialidad a los principios de la Reforma Psiquiátrica brasileña, permitiendo a los trabajadores un ejercicio radical de problematizar aspectos sutiles y poco incorporados en sus prácticas, convocando a un estudiante para que se hagan juntos de usuarios. Específicamente, con personas con problemas de drogas, destacamos la inseparabilidad del debate sobre los medicamentos recetados y no recetados, presente en las experiencias y en la búsqueda del placer, el desgaste del dolor, la construcción de un lugar en las relaciones de consumo y la reinvención de los posibles. Creemos que el Observatorio GAM permite la difusión de GAM en las diferentes prácticas manicómicas medicalizadas impuestas y contemporáneas.

Humanos , Participação do Paciente , Grupos Focais , Capacitação de Recursos Humanos em Saúde , Conhecimento do Paciente sobre a Medicação , Serviços de Saúde Mental , Brasil , Autonomia Pessoal , Transtornos Mentais/tratamento farmacológico
JACC Clin Electrophysiol ; 5(10): 1101-1114, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31648734


Education has long been recognized as an important component of chronic condition management. Whereas education has been evaluated in atrial fibrillation (AF) populations as part of multifaceted interventions, it has never been tested as a single entity. The aim of this review is to describe the rationale for and role of education as part of comprehensive AF management. The development and use of educational material as part of the intervention of a randomized controlled trial, the HELP-AF (Home-Based Education and Learning Program in AF) study, will be described. This study was designed to determine the impact of a home-based structured educational program on outcomes in individuals with AF. An educational resource was developed to facilitate delivery of 4 key messages targeted at empowering individuals to self-manage their condition. The key messages focused on strategies for managing future AF episodes, the role of pharmacotherapy in the treatment of AF, the appropriate use of medicines to manage stroke risk and the role of cardiovascular risk factor management in AF. To support structured educational visiting, an educational booklet titled Living Well With Atrial Fibrillation (AF) was developed by a multidisciplinary team and was further refined following input from expert clinicians and patient interviews. Using a structured educational visiting approach, education was delivered by trained clinicians within the patient's home.

Fibrilação Atrial/terapia , Folhetos , Educação de Pacientes como Assunto/métodos , Autogestão , Materiais de Ensino , Antiarrítmicos/uso terapêutico , Anticoagulantes/uso terapêutico , Gerenciamento Clínico , Letramento em Saúde , Visita Domiciliar , Humanos , Conhecimento do Paciente sobre a Medicação , Assistência Centrada no Paciente , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle