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1.
Psychol Trauma ; 2024 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-39298218

RESUMO

OBJECTIVE: Driven by research demonstrating the pervasiveness of trauma, forensic mental health (FMH) and intellectual disability services are increasingly adopting a trauma-informed approach to caring for patients. However, there has been limited attention to exploring what trauma-informed care (TIC) means to patients in these settings and what practices enable or restrict them in adapting positively after experiences of trauma. This study aimed to understand how TIC is conceptualized by people admitted to an FMH and intellectual disability service. METHOD: Focus groups were facilitated with 10 people residing in three low-secure units in the South East of the United Kingdom. Focus groups explored participants' perceptions and experiences of TIC with reference to the guiding principles of safety, trustworthiness, choice, collaboration, and empowerment. Audio recordings of the focus groups were transcribed and analyzed using reflexive thematic analysis. RESULTS: Three themes were generated to capture participants' perceptions that a trauma-informed approach in an FMH and intellectual disability service should entail promoting a sense of safety, fostering a sense of belonging, and encouraging the development of an autonomous identity. CONCLUSIONS: The findings indicate that prioritizing social-interpersonal relationships is crucial to providing care that enables people admitted to FMH and intellectual disability services to adapt positively after experiences of trauma. The findings support previous research regarding recovery in secure services, indicating the value of creating sufficiently safe conditions for people to connect with others and develop a positive and independent sense of self. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

2.
J Manag Care Spec Pharm ; 27(9): 1210-1220, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34464214

RESUMO

BACKGROUND: Direct oral anticoagulants (DOACs) are widely used for the prevention of stroke in nonvalvular atrial fibrillation (NVAF); however, real-world primary nonadherence (failing to collect the first prescription) has been measured in very few studies. OBJECTIVE: To report primary nonadherence in NVAF patients who are newly prescribed DOACs and identify associated factors. METHODS: This observational retrospective cohort study used a large primary care database in Catalonia. Patients with NVAF who were newly prescribed a DOAC between January 2009 and December 2015 were identified, and primary nonadherence was measured by comparing prescribing records to pharmacy claims data. Multivariable logistic regression was used to determine associated factors. RESULTS: A total of 12,257 patients met the inclusion and exclusion criteria; of these, 1,276 (10.4%) were primary nonadherent. Primary nonadherence was found to be 12.8% for apixaban, 8.6% for dabigatran, and 10.8% for rivaroxaban. Multivariable logistic regression indicated higher odds of primary nonadherence with apixaban and rivaroxaban compared to dabigatran (apixaban: OR = 1.61, 95% CI = 1.39-1.87; rivaroxaban: OR = 1.28, 95% CI = 1.11-1.47). Patients aged at least 80 years showed lower odds of primary nonadherence compared to those aged less than 65 years (OR = 0.78, 95% CI = 0.66-0.93). A diagnosis of chronic kidney disease was associated with primary nonadherence (OR = 1.27, 95% CI = 1.08-1.50). Whereas, diabetes (OR = 0.85, 95% CI = 0.74-0.97), hypertension (OR = 0.79, 95% CI = 0.70-0.91), and stroke/transient ischemic attack (OR = 0.70, 95% C I =0.59-0.82) were inversely associated with primary nonadherence. CONCLUSIONS: Overall, 10.4% of patients prescribed DOACs were primary nonadherent, failing to collect the first prescription. The percentage could have serious implications for patient outcomes and the real-world cost-effectiveness of prescribing DOACs in NVAF. Rates of primary nonadherence and associated factors may provide useful information for the design and evaluation of adherence interventions. DISCLOSURES: No outside funding was received for this study. The data for this study came from the European Medicines Agency PE-PV project (Grant/Award Number EMA/2015/27/PH). The authors have nothing to disclose. A preliminary version of this work was presented at the European Drug Utilisation Research Group (EuroDURG) Conference, Szeged, Hungary, March 5, 2020.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Adesão à Medicação , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Dabigatrana/uso terapêutico , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Rivaroxabana/uso terapêutico , Acidente Vascular Cerebral/prevenção & controle , Varfarina/uso terapêutico
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