The effect of patient-centered education in adherence to the treatment regimen in patients with coronary artery disease

This study aimed to determine the effect of patient-centered education on adherence to the treatment regimen in patients with coronary artery disease. It was a parallel randomized controlled study with a 1:1 allocation ratio. 104 patients who met the inclusion criteria were chosen through non-probability consecutive sampling and divided into intervention and control groups. For the intervention group, along with the usual education, two sessions of 45-60 minute patient-centered education were performed. The control group received only the usual education. The primary outcome was adherence to the treatment regimen which was measured before and after the intervention. The findings indicated that there was a statistically significant difference between the mean scores of adherence to the treatment regimen in three dimensions of diet, physical activity, and medication at the beginning and end of the research in intervention and control groups. Patient-centered education is effective in improving adherence to the treatment regimen in patients with coronary artery disease. Consequently, patient-centered education applied in the current study can be recommended as a simple, low-cost, and efficient technique in increasing adherence to the treatment regimen in patients with coronary artery disease.     

Challenges adhering to a medication regimen following first-time percutaneous coronary intervention: A patient perspective

BackgroundPercutaneous coronary intervention is the most common therapeutic intervention for patients with narrowed coronary arteries due to coronary artery disease. Although it is known that patients with coronary artery disease often do not adhere to their medication regimen, little is known about what patients undergoing percutaneous coronary interventions find challenging in adhering to their medication regimen after hospital discharge.ObjectivesTo explore patients’ experiences in adhering to medications following early post-discharge after first-time percutaneous coronary intervention.DesignAn abductive qualitative approach was used to conduct in-depth interviews of patients undergoing first-time percutaneous coronary intervention.SettingsParticipants were recruited from a single tertiary university hospital, which services a large geographical area in western Norway. Patients fulfilling the inclusion criteria were identified through the Norwegian Registry for Invasive Cardiology.ParticipantsParticipants were patients aged 18 years or older who had their first percutaneous coronary intervention six to nine months earlier, were living at home at the time of study inclusion, and were prescribed dual antiplatelet therapy. Patients who were cognitively impaired, had previously undergone cardiac surgery, and/or were prescribed anticoagulation therapy with warfarin or novel oral anticoagulants were excluded. Purposeful sampling was used to include patients of different gender, age, and geographic settings. Twenty-two patients (12 men) were interviewed between December 2016 and April 2017.MethodsFace-to-face semi-structured interviews were conducted, guided by a set of predetermined open-ended questions to gather patient experiences on factors relating to medication adherence or non-adherence. Transcribed interviews were analysed by qualitative content analysis.FindingsPatients failed to adhere to their medication regimen for several reasons; intentional and unintentional reasons, multifaceted side effects from heart medications, scepticism towards generic drugs, lack of information regarding seriousness of disease after percutaneous coronary intervention, psychological impact of living with coronary artery disease, and these interacted. There were patients who felt that the medication information they received from physicians and nurses was uninformative and inadequate. Side effects from heart medications were common, ranging from minor ones to more disabling side effects, such as severe muscle and joint pain and fatigue. Patients found well established medication taking routines and aids to be necessary, and these improved adherence.ConclusionPatients undergoing first-time percutaneous coronary intervention face multiple, interacting challenges in trying to adhere to prescribed medications following discharge. This study highlights the need for a more structured follow-up care in order to improve medication adherence and to maximise their self-care abilities.     

Efficacy of Guided Imagery with Relaxation for Osteoarthritis Symptoms and Medication Intake

Supporting safe self-management interventions for symptoms of osteoarthritis (OA) may reduce the personal and societal burden of this increasing health concern. Self-management interventions might be even more beneficial if symptom control were accompanied by decreased medication use, reducing cost and potential side effects. Guided imagery with relaxation (GIR) created especially for OA may be a useful self-management intervention, reducing both symptoms and medication use. A longitudinal randomized assignment experimental design was used to study the efficacy of GIR in reducing pain, improving mobility, and reducing medication use. Thirty older adults were randomly assigned to participate in the 4-month trial by using either GIR or a sham intervention, planned relaxation. Repeated-measures analysis of variance revealed that, compared with those who used the sham intervention, participants who used GIR had a significant reduction in pain from baseline to month 4 and significant improvement in mobility from baseline to month 2. Poisson technique indicated that, compared with those who used the sham intervention, participants who used GIR had a significant reduction in over-the-counter (OTC) medication use from baseline to month 4, prescribed analgesic use from baseline to month 4, and total medication (OTC, prescribed analgesic, and prescribed arthritis medication) use from baseline to month 2 and month 4. Results of this study support the efficacy of GIR in reducing symptoms, as well as in reducing medication use. Guided imagery with relaxation may be useful in the regimen of pain management for clinicians.     

Putting cancer pain management regimens into practice at home

The purpose of this study was to describe the difficulties with pain management that patients and family caregivers bring to a nurse's attention during a teaching and coaching intervention. Data were obtained from audiotaped and transcribed interactions between intervention nurses and patients (n = 52) and their family caregivers (n = 33) who were participating in a randomized clinical trial of a nursing intervention called the PRO-SELF Copyright Pain Control Program. Using qualitative content analysis, we found that patients had difficulty in seven areas when they attempted to put a pain management regimen into practice, namely: obtaining the prescribed medication(s), accessing information, tailoring prescribed regimens to meet individual needs, managing side effects, cognitively processing information, managing new or unusual pain, and managing multiple symptoms simultaneously. The findings from this study suggest that the provision of information about cancer pain management to patients and their family caregivers is not sufficient to improve pain control in the home care setting. Patients and their family caregivers require ongoing assistance with problem-solving to optimize their pain management regimen.     

A nursing intervention for the quality use of medicines by elderly community clients

Although considerable research and development work has been undertaken on the role of General Practitioners (GPs) and pharmacists in medication management, monitoring and referral, there is limited research into a role in medication management for community nurses. One hundred and thirteen older people living at home and receiving community nursing care were assessed for their knowledge of, and ability to manage their medication regimen. From these data, a nurse-initiated intervention was developed that included nursing interventions and referral pathways to GPs for people who might benefit from a GP and/or pharmacist medication review. A subgroup of 24 participants with diminished knowledge of medications or ability to manage their regime (considered to be at risk of drug-related problems) who were followed up, demonstrated an increase in knowledge, some alteration in compliance aids and with no statistically significant change in medication regime complexity. This paper details an approach to medication review and intervention suitable for community nurses that includes referral pathways within the medication team.     

Using motivational interviewing to promote adherence to antiretroviral medications: a pilot study.

This report describes a pilot study of a nursing intervention to increase adherence to combination therapy. The intervention was based on motivational interviewing (MI). Participants completed a baseline assessment using the computer-administered self-interview with audio (ACASI) data collection method and then were randomly assigned to the MI intervention or control condition. Nurse counselors met with participants in the MI intervention group for three adherence sessions. Two months following baseline, participants completed a follow-up assessment. Mean scores on ratings of missed medications were lower for participants in the intervention group than those in the control group. Although there were no significant differences in the number of medications missed during the past 4 days, participants in the MI group reported being more likely to follow the medication regimen as prescribed by their health care provider. The pilot study provided useful information about the acceptability of ACASI and the adequacy of intervention procedures. The results of this pilot study show promise for the use of MI as an intervention to promote adherence to antiretroviral medications.     

Venous thromboembolism prophylaxis conversion in nonsurgical inpatients

OBJECTIVE: To provide venous thromboembolism (VTE) prophylaxis according to national consensus guidelines while minimizing associated medication costs. METHODS: Patients admitted to our institution who were receiving VTE prophylaxis with the low-molecular-weight heparin (LMWH) enoxaparin were identified and evaluated for potential conversion to low-dose unfractionated heparin (LDUH). Patients admitted for general medical conditions were targeted for a potential conversion. Factors that excluded patients from conversion were any surgical intervention or evidence of bleeding. For all eligible patients, the treating physician was contacted through written recommendations in an effort to achieve conversion to an LDUH regimen. RESULTS: Throughout a 10-month period, 463 patients were identified as receiving enoxaparin for VTE prophylaxis. Of these, 112 (24%) were candidates for an LDUH regimen. A total of 88 pharmacy recommendations were provided, of which 59 (67%) were accepted. This conversion program resulted in the avoidance of 250 days of enoxaparin prophylaxis and 8495 US dollars of associated medication costs. CONCLUSIONS: Clinical pharmacy programs directed at converting patients from a more costly LMWH regimen for VTE prophylaxis to an LDUH regimen can significantly reduce medication costs while adhering to consensus guidelines.     

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.     

Improving knowledge and skills for use of medication by patients after stroke: evaluation of a nursing intervention

OBJECTIVE: The objective of this study was to determine if a tailored nursing intervention, as opposed to usual rehabilitation care, can improve knowledge and behavioral skills for correct use of medication use in aged stroke patients. DESIGN: Stratified random sampling created two homogenous groups: 73 intervention patients, who were provided with the nursing intervention program along with usual rehabilitation care, and 82 controls, who underwent usual rehabilitation care alone. Participants were assessed within the first week of admission to the rehabilitation ward, 3 mos after stroke (at the end of the intervention), and 6 mos after stroke. An assessment instrument measuring correct knowledge and skills concerning medications was used. RESULTS: After 3 and 6 mos, intervention subjects were significantly better than controls in knowledge of shape and dosage of their medications, in knowledge of side effects and correct response to side effects, and in adherence to their dietary regimen. However, for knowledge of color and daily schedule of medications, there were differences at 3 mos, but differences were diminished after 6 mos. CONCLUSIONS: This nursing intervention, tailored to the specific needs of the aged stroke patient, increased the patients' knowledge and skills concerning medication therapy, but to a limited extent and for a limited time.     

Treatment satisfaction and efficacy of the rapid release formulation of sumatriptan 100 mg tablets utilising an early intervention paradigm in patients previously unsatisfied with sumatriptan

Aims: To evaluate treatment satisfaction, efficacy and functional ability of the rapid release formulation of sumatriptan 100 mg tablets (sumatriptan RT 100 mg) in an early intervention paradigm in patients who were dissatisfied with low‐dose sumatriptan and not completely satisfied with their current migraine regimen. Methods: Experienced migraineurs who reported a mild migraine pain phase, dissatisfaction with the previous sumatriptan treatment and some dissatisfaction with their current treatment regimen had no experience with sumatriptan at the 100 mg dose were enrolled in an open‐label, single group study. Subjects were instructed to treat four migraine attacks within 30 min of the onset of mild pain. Treatment satisfaction was measured with the Patient Perception of Migraine Questionnaire Revised version (PPMQ‐R) questionnaire. Results: More than half of the subjects were either very satisfied or satisfied with the efficacy of early intervention sumatriptan RT 100 mg after each attack and at the follow‐up study visit. The mean total PPMQ‐R score was 75.2 out of 100. Between 63% and 73% of subjects were pain‐free within 4 h of dosing. Between 79% and 90% of subjects reported an ability to function normally within 4 h of taking the study medication. Conclusion: Subjects who were previously unsatisfied with lower doses of sumatriptan and less than very satisfied with their current treatment regimen were more likely to be satisfied or very satisfied with sumatriptan RT 100 mg in an early intervention paradigm. Results were consistent across four migraine attacks and at a follow‐up visit. The treatment satisfaction results corresponded with positive results on efficacy measures and a functional status measure.     

Medication and dietary compliance beliefs in heart failure

Patients with heart failure are required to comply with a medication regimen and dietary sodium restrictions. The objectives of this study were to determine the most frequently perceived benefits of and barriers to compliance with medication and dietary sodium restrictions and evaluate the relevancy of these scale items for testing in tailored intervention studies. Data were collected as part of two studies that evaluated the psychometric properties of two questionnaires. The most frequently identified benefit of medication compliance was decreasing the chance of being hospitalized, and the most commonly reported barrier was disruption of sleep. Patients were knowledgeable about the benefits of compliance with dietary sodium restrictions, and the poor taste of food on the low sodium diet was the most common barrier. Heart failure patients perceive benefits of and barriers to compliance with therapeutic regimens that are likely to be amenable to tailored interventions designed to enhance compliance.     

艾滋病患者抗病毒治疗依从性教育方式探讨

目的探讨艾滋病患者抗病毒治疗依从性教育方式。方法两组患者实施常规抗病毒治疗及健康教育,观察组在此基础上实施个体化干预措施,分析患者治疗依从性差的原因,针对原因,制订干预措施:包括加强护理人员培训、加强健康教育力度、使用服药管理工具、简化用药方案、建立支持系统及心理干预等方法。结果提高了患者抗病毒治疗的依从性及检测CD4+细胞计数,差异均具有统计学意义(P﹤0.01)。结论实施个体化干预措施能提高艾滋病患者抗病毒治疗的依从性,从而提高治疗效果。     

Adding medications in the emergency department: effect on knowledge of medications in older adults.

INTRODUCTION: Older adults constitute 20% of the ED population. Of older patients discharged from the emergency department, 40% receive at least one new medication to add to their already complex medication regimen. The purpose of this study was to determine the effect of increasing medication complexity on knowledge of newly prescribed medications for older adults discharged from the emergency department. METHODS: The complexity of self-administered medications after ED treatment was measured with the Medication Complexity Index to determine its potential influence on the patient's knowledge of medication. The Knowledge of Medication Subtest, a measure of the effectiveness of medication teaching, was administered by telephone interview 48 to 72 hours after ED discharge. RESULTS: Sixty rural ED patients ranging in age from 60 to 98 years completed the study. Higher medication complexity after the addition of medications in the emergency department was associated with less knowledge of their medications (r = 0.37, P =. 004). DISCUSSION: The increase in medication complexity that results from ED therapeutic intervention may decrease knowledge of medications. A heightened emphasis should be placed on effective medication teaching, counseling, and follow-up for older adult ED patients.     

High Risk for Ineffective Management of Therapeutic Regimen: A Protocol Study

In this article, the authors present a protocol study developed to evaluate the usefulness of the nursing diagnosis “high risk for ineffective management of therapeutic regimen” among patients with congestive heart failure (CHF). Nursing interventions for increasing the CHF patient's abilities to perform therapeutic self-care for the promotion and maintenance of a prescribed medication regimen were evaluated based on predicted outcomes. Orem's self-care deficit theory of nursing provided the theoretical framework used in the protocol. Orem's supportive-educative nursing system was the approach used. Knowledge deficit was noted to be a major obstacle to maintaining the prescribed medication regimen among CHF patients. Comprehensive teaching of the patient, supported by a therapeutic nurse-patient relationship, was found to be the most important factor in the promotion and maintenance of a prescribed medication regimen among patients with CHF.     

Impact of telephone medication therapy management on medication and health-related problems, medication adherence, and Medicare Part D drug costs: a 6-month follow up

Background

The Medicare Modernization Act of 2003 mandated the provision of medication therapy management (MTM) to eligible Part D beneficiaries to improve medication-related outcomes. As MTM programs evolve, evaluation is necessary to help inform MTM best practices.

Objective

The objective of this study was to determine the impact of pharmacist-provided telephone MTM on: (1) medication and health-related problems (MHRPs); (2) medication adherence; and (3) Part D drug costs.

Methods

This quasi-experimental study included Part D beneficiaries from a Texas health plan. Andersen's Behavioral Model of Health Services Use served as the study framework. MTM utilization was the health behavior. Age, gender, and race were predisposing factors, and number of medications, chronic diseases, and medication regimen complexity were need factors. Outcomes were pre-to-post changes in: (1) MHRPs; (2) medication adherence, using the medication possession ratio (MPR); and (3) total drug costs. Multiple regression was used to analyze group differences while controlling for predisposing and need factors.

Results

At baseline, the intervention (n = 60) and control (n = 60) groups were not statistically different regarding predisposing and need factors, with the exception of gender. The intervention group had significantly (P = 0.009) more men compared with the control group (51.7% vs 28.3%). There were 4.8 (2.7) and 9.2 (2.9) MHRPs identified at baseline and 2.5 (2.0) and 7.9 (3.0) MHRPs remained at the 6-month follow up in the intervention and control groups, respectively. The intervention group (vs control) had significantly more MHRPs resolved (P = 0.0003). There were no significant predictors of change in MPR or total drug costs from baseline to follow up, although total drug costs decreased by $158 in the intervention group compared with a $118 increase in the control group.

Conclusions

A telephone MTM program resolved significantly more MHRPs compared with a control group, but there were no significant changes in adherence and total drug costs.