Impact of a nurse short message service intervention for patients with diabetes

The purpose of this study was to investigate the effect of a nurse short message service by cellular phone and the Internet on glycosylated hemoglobin (HbA1c) levels and adherence to diabetes control recommendations. The patients with diabetes were asked to input their blood glucose levels every day by cellular phone or the Internet. Optimal recommendations were sent weekly to each patient by short message service. After 12 weeks, the patients had a mean decrease of 1.1% in HbA1c level and an increase in diabetic medication taking, 30 minutes of physical exercise, and foot care adherence.     

基于"互联网+"app在T2DM患者健康管理中的应用

目的:探析基于"互联网+"的手机app在2型糖尿病(T2DM)患者管理中的应用效果。方法:以2018年11~12月在清远市人民医院内分泌科诊治并建档的T2DM患者120例纳入实践观察中,基于随机数字表法分成试验组和对照组各60例,均行专科对症治疗。对照组采取常规随访管理,试验组同时应用健康管理手机app,持续12个月。比较分析两组干预前后空腹血糖(FBG)、餐后2 h血糖(2 hBG)、糖化血红蛋白(HbA1c)、血压及体重指数(BMI)变化,并通过问卷评测患者健康知识知晓率和健康行为执行情况。结果:干预前两组患者FBG、2 hBG、HbA1c、血压及BMI差异均无统计学意义(均P>0.05),干预后试验组均显著优于对照组,差异有统计学意义(均P<0.05)。通过问卷评测,试验组患者的健康知识知晓率为96.67%,遵医用药率为96%,饮食控制率93.33%,坚持运动率为88.33%,对照组分别为85.00%、85.00%、80.00%、76.67%,差异有统计学意义(P<0.05)。结论:在T2DM患者健康管理中应用"互联网+"app,可有效强化血糖水平和质量控制效果,提高患者的健康认知,强化健康行为执行能力。     

Interventions to improve adherence to medication in people with type 2 diabetes mellitus: a review of the literature on the role of pharmacists

BACKGROUND AND OBJECTIVE: Pharmacists are now adopting a crucial role in the management of chronic illness in primary care, providing diabetes care and advice. This review aims to show whether a range of diabetes care interventions delivered by pharmacists is successful in improving adherence to medication. METHODS: The studies reviewed formed a subgroup of a Cochrane review on interventions to improve adherence to medication in people with type 2 diabetes. Search terms were 'type 2 diabetes mellitus' and 'compliance' or 'adherence'. Studies were included if they assessed adherence to medical treatment specifically, rather than other aspects of self-management. Out of the 21 studies selected for review, five described an intervention delivered by a pharmacist. RESULTS AND DISCUSSION: Two studies reported on attempts to improve adherence focused on the taking of medication. A system of reminders and packaging improved medication adherence, but measuring medicine taking through pill counts or Medication Event Monitoring System was not effective. Three studies evaluated pharmacist-led integrated management and education programmes designed to improve glycaemic control for under-served patient populations. They all succeeded in lowering glycated haemoglobin, but it remains unclear whether this resulted from improved patient adherence. CONCLUSION: This review indicates a potential benefit of pharmacist interventions to improve medication adherence in diabetes, especially in providing patient education.     

健康教育对提高老年糖尿病患者服药依从性的研究

目的:探讨健康教育对老年糖尿病患者服药依从性的影响.方法:将61例就诊的老年糖尿病患者随机分为干预组和对照组,对照组采取常规的定期随访,干预组在常规定期随访基础上开展针对性的全程糖尿病健康教育.通过半年的干预监测,分析两组患者的服药依从性.结果:61例老年糖尿病患者的服药依从率为44.26%.经过半年的健康教育,干预组的服药依从性明显优于对照组.结论:老年糖尿病患者服药依从性较差,健康教育可以提高其服药依从性.     

Using text messaging in the treatment of eating disorders

New technologies for communicating with patients can open up new treatment possibilities. This article describes the use of mobile phone text messaging as a therapeutic intervention in the treatment of eating disorders. In text messaging a person can conceal themselves and--very significantly in the context of eating disorders--the body does not show. The exchange does not have to be instantaneous and is not face to face. This article outlines the use of mobile phone texting, alongside therapy and other nursing interventions, as an effective tool to help clients communicate their thoughts and feelings in a safer and freer way.     

Nurse case management to improve risk reduction outcomes in a stroke prevention clinic

Stroke prevention clinic health care professionals are mandated to provide early access to neurological consultation and treatment, diagnostic testing, and behavioural risk factor management for clients with transient ischemic attack or mild non-disabling stroke. Clinic nurses collaborate with clients and interprofessional teams to support risk factor reduction to prevent recurrent stroke events. Although hypertension is the most important modifiable risk factor for stroke, broader evidence indicates that adherence to prescribed medications may be less than 50%. One clinic identified a need to improve risk factor outcomes through identifying clients with uncontrolled hypertension, cognitive, self-eficacy and/or adherence characteristics predictive of non-achievement of blood pressure targets. To address this need, an expanded nurse case management care delivery model was pilot tested for feasibility in a participant sample of 20 clients. Motivational interviewing and self-management approaches were combined with interventions designed to improve adherence:facilitation of the simplification of medication routines, providing memory cues and home self-monitoring equipment, counselling, and six-month nursing follow-up. Results demonstrated that an expanded nurse case management model of care delivery is feasible with only a modest impact on clinic resources. At six months, there were significant reductions in blood pressure and increases in medication self-efficacy and adherence for selected clients identified with high risk for stroke and non-achievement of treatment outcomes.     

Improving adherence and reducing medication discrepancies in patients with diabetes

OBJECTIVE: To improve medication adherence by reducing self-reported adherence barriers, and to identify medication discrepancies by comparing physician-prescribed and patient-reported medical regimens. DESIGN: Prospective, randomized, controlled trial. SETTING AND PARTICIPANTS: A single academically affiliated community health center. Eligible patients had type 2 diabetes, had undergone laboratory testing in the year preceding the study, and had visited the clinic in the 6 months preceding the study. INTERVENTION: A pharmacist administered detailed questionnaires, provided tailored education regarding medication use and help with appointment referrals, and created a summary of adherence barriers and medication discrepancies that was entered into the medical record and electronically forwarded to the primary care provider. MEASUREMENTS: Changes in self-reported adherence rates and barriers were compared 3 months after the initial interview. Intervention patients with medication discrepancies at baseline were assessed for resolution of discrepancies at 3 months. RESULTS: Rates of self-reported medication adherence were very high and did not improve further at 3 months (6.9 of 7 d, with all medicines taken as prescribed; p = 0.3). Medical regimen discrepancies were identified in 44% of intervention patients, involving 45 doses of medicines. At 3-month follow-up, 60% of discrepancies were resolved by corrections in the medical record, while only 7% reflected corrections by patients. CONCLUSIONS: In this community cohort, patients reported few adherence barriers and very high medication adherence rates. Our patient-tailored intervention did not further reduce these barriers or improve self-reported adherence. The high prevalence of medication discrepancies appeared to mostly reflect inaccuracies in the medical record rather than patient errors.     

Randomized Trial of Telephone Outreach to Improve Medication Adherence and Metabolic Control in Adults With Diabetes

OBJECTIVEMedication nonadherence is a major obstacle to better control of glucose, blood pressure (BP), and LDL cholesterol in adults with diabetes. Inexpensive effective strategies to increase medication adherence are needed.RESULTSOf the 2,378 subjects, 89.3% in the intervention group and 87.4% in the usual-care group had sufficient data to analyze study outcomes. In intent-to-treat analyses, intervention was not associated with significant improvement in primary adherence, medication persistence, or intermediate outcomes of care. Results were similar across subgroups of patients defined by age, sex, race/ethnicity, and study site, and when limiting the analysis to those who completed the intended intervention.CONCLUSIONSThis low-intensity intervention did not significantly improve medication adherence or control of glucose, BP, or LDL cholesterol. Wide use of this strategy does not appear to be warranted; alternative approaches to identify and improve medication adherence and persistence are needed.     

HIV感染者合并慢性非传染性疾病多药依从性管理的研究进展

由于艾滋病抗病毒药物的广泛使用,HIV感染者寿命得以延长,老年HIV感染者的人数不断增多,最终导致HIV合并慢性非传染性疾病（chronic non-communicable diseases,NCDs）的人群逐年递增。NCDs包括心血管疾病、糖尿病、癌症和慢性呼吸道疾病等,需要长期服用多种药物,加之复杂的HIV抗病毒药物方案,会导致HIV感染者服药依从性降低,出现错服、漏服等现象。HIV感染者多药依从性问题逐渐引起重视。该文系统回顾了HIV感染者合并NCDs多药依从性管理的相关研究,对HIV感染者合并NCDs多药依从性的定义和影响因素进行阐述,并提出提高合并NCDs的HIV感染者多药依从性的干预措施,以期为HIV感染者多药依从性管理的研究和护理实践提供参考。     

Relationship of depression and diabetes self-care, medication adherence, and preventive care

OBJECTIVE: We assessed whether diabetes self-care, medication adherence, and use of preventive services were associated with depressive illness. RESEARCH DESIGN AND METHODS: In a large health maintenance organization, 4,463 patients with diabetes completed a questionnaire assessing self-care, diabetes monitoring, and depression. Automated diagnostic, laboratory, and pharmacy data were used to assess glycemic control, medication adherence, and preventive services. RESULTS: This predominantly type 2 diabetic population had a mean HbA(1c) level of 7.8 +/- 1.6%. Three-quarters of the patients received hypoglycemic agents (oral or insulin) and reported at least weekly self-monitoring of glucose and foot checks. The mean number of HbA(1c) tests was 2.2 +/- 1.3 per year and was only slightly higher among patients with poorly controlled diabetes. Almost one-half (48.9%) had a BMI >30 kg/m(2), and 47.8% of patients exercised once a week or less. Pharmacy refill data showed a 19.5% nonadherence rate to oral hypoglycemic medicines (mean 67.4 +/- 74.1 days) in the prior year. Major depression was associated with less physical activity, unhealthy diet, and lower adherence to oral hypoglycemic, antihypertensive, and lipid-lowering medications. In contrast, preventive care of diabetes, including home-glucose tests, foot checks, screening for microalbuminuria, and retinopathy was similar among depressed and nondepressed patients. CONCLUSIONS: In a primary care population, diabetes self-care was suboptimal across a continuum from home-based activities, such as healthy eating, exercise, and medication adherence, to use of preventive care. Major depression was mainly associated with patient-initiated behaviors that are difficult to maintain (e.g., exercise, diet, medication adherence) but not with preventive services for diabetes.     

Polypharmacy and medication adherence in patients with type 2 diabetes

OBJECTIVE: To determine medication adherence and predictors of suboptimal adherence in a community cohort of patients with diabetes and to test the hypothesis that adherence decreases with increased number of medicines prescribed. RESEARCH DESIGN AND METHODS: A total of 128 randomly selected patients with type 2 diabetes from a single community health center responded to a pharmacist-administered questionnaire regarding medication use. Survey data were linked to clinical data available from the electronic medical record. We assessed self-reported adherence rates for each diabetes-related medicine, barriers and attitudes regarding medication use, and HbA(1c), total cholesterol, and blood pressure levels. RESULTS: Patients were taking a mean of 4.1 (+/-1.9) diabetes-related medicines. The average 7-day adherence was 6.7 +/- 1.1 days. Total number of medicines prescribed was not correlated with medication adherence. Adherence was significantly lower for medicines not felt to be improving current or future health (6.1 vs. 6.9 days out of 7, P < 0.001). Among patients on three or more medicines, 71% (15 of 21 patients) with suboptimal adherence were perfectly adherent with all but one medicine. Side effects were the most commonly reported problem with medication use. Of 29 medicines causing side effects that interfered with adherence, 24 (83%) did so for >1 month, and only 7 (24%) were reported to the patient's primary care physician. CONCLUSIONS: In this sample, patients reported very high medication adherence rates regardless of number of medicines prescribed. Among patients on multiple medicines, most patients with suboptimal adherence were perfectly adherent to all but one medicine. Unreported side effects and a lack of confidence in immediate or future benefits were significant predictors of suboptimal adherence. Physicians should not feel deterred from prescribing multiple agents in order to achieve adequate control of hyperglycemia, hypertension, and hyperlipidemia.     

Information technology in the service of diabetes prevention and treatment

In the year since the first ATTD yearbook was published the field of internet and cell phone interventions has made major advances. This chapter contains clinical studies and reviews of the state-of-the-art regarding the ability of technology-enabled self-management education and support to improve outcomes for patients with, or at risk for, diabetes. The reviews and papers in this chapter demonstrate increased understanding of the underlying basis for effective interventions - a prerequisite for improving the effectiveness and efficiency of these approaches. The research studies described demonstrate that internet interventions are effective for a variety of patients and for specific outcomes (e.g. diabetes self-management for teens as well as older patients, medication adherence, empowerment, psychosocial well-being, helping patients become more active, and helping patients lose weight and keep it off). As additional and more sophisticated studies are completed and the evidence base is expanded one can hope that payors will recognise their value and begin to pay for these treatments. That is what ultimately will bring effective treatments to those who need them. The associate editors' mission was to choose articles that would give the non-technology skilled reader a general overview of the field of information technology and the prevention and treatment of obesity and diabetes. Articles were selected because they either provided a significant review of the state-of the art of the field or were the results from studies that could give the reader a better understand of the benefits and challenges associated with information technology use in clinical settings.     

Effect of mental health nurses' beliefs and knowledge of medication on their use of strategies to improve medication adherence

Despite the proven efficiency of medication for mental illness, research indicates low patient adherence to medication. Nonetheless, only few studies have directly examined the relationship between nurse beliefs and knowledge, and their use of strategies to improve patient adherence to psychiatric medication. Therefore, the aim of the present study was to clarify nurses' views, beliefs about, and knowledge of psychiatric medication affect their inclination to implement various strategies to improve patient adherence. One hundred nurses working at an Israeli psychiatric hospital participated in the study. Self‐completed questionnaires were distributed. The research findings showed that nurses' levels of knowledge of psychiatric medication were moderate, but their beliefs of taking psychiatric medication were positive. The findings also showed that the higher the nurses' age and seniority, as well as their positive beliefs about taking medication, the higher their probability of implementing strategies to improve patient adherence to medication. Additionally, there was a positive correlation between positive beliefs about the nursing staff on taking medication and the staff's utilization of strategies to improve patient adherence to medication. The current study shows that nurses' traits and beliefs affect their use of strategies promoting mental health patient adherence to medication and the enhancement of these strategies.     

Qualitative inquiry into motivators for maintaining medication adherence among Taiwanese with schizophrenia

Medication non‐adherence is associated with higher rates of relapse in persons with schizophrenia. Psychiatric nurses play a significant role in facilitating their medication adherence. The motivators which strengthen patients with schizophrenia to maintain their adherence to medication have seldom been explored. This study aims to explore what motivates persons with schizophrenia to consistently maintain their medication adherence. A qualitative approach was used to collect data from a psychiatric day‐care centre at an armed forces hospital in Taiwan. Ten clients agreed to undergo an in‐depth interview. The data was analyzed by a content analysis method. Four themes were identified: (i) the benefits of antipsychotic medication treatment; (ii) firm and ongoing family support; and the Chinese values of (iii) filial piety and (iv) hope for the future. These findings may provide psychiatric nurses with a better understanding of the motivators for medication adherence in persons with schizophrenia from the Chinese perspective. Nurses will then be able to adjust their practice to facilitate patients’ medication adherence.     

HIV感染者/AIDS患者服药依从性管理的系统评价再评价

目的 对接受抗病毒治疗（antiretroviral therapy,ART）的HIV感染者/AIDS患者服药依从性管理的系统评价进行再评价。 方法 2020年8月,计算机检索中国知网、中国生物医学文献数据库以及乔安娜布里格斯研究所、The Cochrane Library等数据库,检索HIV感染者/AIDS患者ART服药依从性管理的系统评价,由2名研究成员独立进行文献筛选、资料提取,分别对纳入的系统评价和结局指标进行质量评价。 结果 共纳入16篇系统评价,评价结果显示,12篇质量等级为极低,4篇质量等级为低。结果显示,移动技术干预方法能提高HIV感染者/AIDS患者的服药依从性,服药依从性的评价方法多元。 结论 移动技术可提高HIV感染者/AIDS患者的服药依从性,但现存的证据不足,HIV感染者/AIDS患者ART服药依从性管理的总体效果需进一步探讨,后续仍需要高质量、大样本的研究来进一步验证。     

Adherence to oral therapy for type 2 diabetes: opportunities for enhancing glycemic control

PURPOSE: Although diet and exercise are important parts of type 2 diabetes treatment, most patients require pharmacological intervention with multiple agents to maintain adequate glycemic control. This article addresses the numerous patient-related, disease-related, and demographic variables affecting medication adherence in this patient population. DATA SOURCES: Extensive review of scientific literature, clinical practice guidelines, and Internet sources. CONCLUSIONS: Studies have demonstrated that treatments including multiple medications or frequent dosing had a negative impact on adherence. Practitioners have used several approaches in an effort to improve adherence to oral antidiabetic medical therapy, including increased communication between health care providers and patients, implementation of multidisciplinary programs, and use of treatment regimens with easier dosing (i.e., reduced number of drugs or doses taken per day). IMPLICATIONS FOR PRACTICE: Options for type 2 diabetes treatments that combine effective medications into a simpler oral-dosage form may motivate and improve patient adherence. Ultimately, simplifying dosing may lead to better glycemic control, thereby reducing the risks associated with long-term consequences of the disease.