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Non-adherence to diabetes treatment at Mulago Hospital in Uganda: prevalence and associated factors
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Background
Non-adherence to diabetes treatment leads to poor glucose control and increases the risk of disease complications. The prevalence and factors associated with non-adherence in resource limited settings should be determined so as to lower the impact of a disease that is on the increase, on the health systems which are already overburdened with communicable diseases.Objectives
To determine the prevalence and factors associated with non-adherence to diabetes treatment.Methods
A cross sectional study was carried out from February to April 2004 in Mulago Hospital, Uganda. The participants were 402 type 1 and 2 diabetic patients selected from the outpatients'' diabetic clinic using systematic sampling. They were aged 18 years and above, had been taking diabetes treatment for at least one month and gave informed consent to participate. Non-adherence was assessed using patients'' self reports.Results
The prevalence of non-adherence was 28.9% (n = 116, 95%CI = 24.5 – 33.3%). Factors that were independently associated with non-adherence were: female gender (OR = 2.9, 95%CI = 1.4 – 6.3), not understanding the drug regimen well (OR = 4.0, 95%CI = 1.0 – 16.3), affording only some or none of prescribed drugs (OR = 3.7, 95%CI = 1.8 – 7.6) and longer time since last since last visit to a health worker (OR = 7.3, 95%CI = 2.7 – 19.9).Conclusions
Adherence to diabetic treatment was suboptimal. There is need to improve it through strategies helping patients understand their drug regimens, always availing drugs in the hospital so that they do not have to buy them and giving shorter time between visits to health worker. Further studies should be done to find out why females were not adhering to treatment so as to improve their adherence. 相似文献3.
Background
Poor adherence to prescribed therapy among patients with chronic diseases is a growing concern which undermines the benefits of current medical care.Objectives
To evaluate the pattern of treatment non-adherence among ambulatory patients with poorly controlled type 2 diabetes in southwestern Nigeria, and to determine the possible factor(s) that accounted for such non-adherence with a view to identifying areas of future intervention to improve outcome.Methods
A prospective cross-sectional interview using the concept of RIM (Recognize, Identify and Manage) model was used to evaluate adherence to treatment recommendations among 176 consented patients recruited from the endocrinology out-patient clinics of two teaching hospitals in southwestern Nigeria between November, 2010 and January, 2011.Results
Overlaps of non-adherence behavior were obtained. More than three-quarter (153; 88.4%) were not aware of indication for each of the prescribed medications, 26 (15.3%) correctly described regimen as prescribed. The factorsidentified as possible barriers to medication adherence include practical (145; 40.1%), knowledge (103; 28.5%), and attitudinal (114; 31.5%) barriers. Dietary non-adherence was mostly due to inappropriate guidance (62; 33.7%).Conclusions
The arrays of non-adherence behavior among the cohort further emphasize the need for patient-centered approach as a reasonable strategy in resolving non-adherence problems in routine clinical practice. 相似文献4.
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Raymond Oppong Mark Jit Richard D Smith Christopher C Butler Hasse Melbye Sigvard M?lstad Joanna Coast 《The British journal of general practice》2013,63(612):e465-e471
Background
Point-of-care C-reactive protein (POCCRP) is a biomarker of inflammation that offers clinicians a rapid POC test to guide antibiotic prescribing decisions for acute cough and lower respiratory tract infections (LRTI). However, evidence that POCCRP is cost-effective is limited, particularly outside experimental settings.Aim
To assess the cost-effectiveness of POCCRP as a diagnostic tool for acute cough and LRTI from the perspective of the health service.Design and setting
Observational study of the presentation, management, and outcomes of patients with acute cough and LRTI in primary care settings in Norway and Sweden.Method
Using hierarchical regression, data were analysed in terms of the effect on antibiotic use, cost, and patient outcomes (symptom severity after 7 and 14 days, time to recovery, and EQ-5D), while controlling for patient characteristics (self-reported symptom severity, comorbidities, and health-related quality of life) at first attendance.Results
POCCRP testing is associated with non-significant positive reductions in antibiotic prescribing (P = 0.078) and increased cost (P = 0.092). Despite the uncertainty, POCCRP testing is also associated with a cost per quality-adjusted life year (QALY) gain of €9391. At a willingness-to-pay threshold of €30 000 per QALY gained, there is a 70% probability of CRP being cost-effective.Conclusion
POCCRP testing is likely to provide a cost-effective diagnostic intervention both in terms of reducing antibiotic prescribing and in terms of QALYs gained. 相似文献7.
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Yafang Huang Rui Chen Tao Wu Xiaoming Wei Aimin Guo 《The British journal of general practice》2013,63(616):e787-e794
Background
Most patients with respiratory tract infections (RTIs) are prescribed antibiotics in general practice. However, there is little evidence that antibiotics bring any value to the treatment of most RTIs. Point-of-care C-reactive protein testing may reduce antibiotic prescribing.Aim
To systematically review studies that have examined the association between point-of-care (POC) C-reactive protein testing and antibiotic prescribing for RTIs in general practice.Design and setting
Systematic review and meta-analysis of randomised controlled trials and observational studies.Method
MEDLINE® and Embase were systematically searched to identify relevant publications. All studies that examined the association between POC C-reactive protein testing and antibiotic prescribing for patients with RTIs were included. Two authors independently screened the search results and extracted data from eligible studies. Dichotomous measures of outcomes were combined using risk ratios (RRs) with 95% confidence intervals (CIs) either by fixed or random-effect models.Results
Thirteen studies containing 10 005 patients met the inclusion criteria. POC C-reactive protein testing was associated with a significant reduction in antibiotic prescribing at the index consultation (RR 0.75, 95% CI = 0.67 to 0.83), but was not associated with antibiotic prescribing at any time during the 28-day follow-up period (RR 0.85, 95% CI = 0.70 to 1.01) or with patient satisfaction (RR 1.07, 95% CI = 0.98 to 1.17).Conclusion
POC C-reactive protein testing significantly reduced antibiotic prescribing at the index consultation for patients with RTIs. Further studies are needed to analyse the confounders that lead to the heterogeneity. 相似文献12.
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Michael Moore Beth Stuart Samuel Coenen Chris C Butler Herman Goossens Theo JM Verheij Paul Little 《The British journal of general practice》2014,64(619):e75-e80
Background
Antibiotics are of limited overall clinical benefit for uncomplicated lower respiratory tract infection (LRTI) but there is uncertainty about their effectiveness for patients with features associated with higher levels of antibiotic prescribing.Aim
To estimate the benefits and harms of antibiotics for acute LRTI among those producing coloured sputum, smokers, those with fever or prior comorbidities, and longer duration of prior illness.Design and setting
Secondary analysis of a randomised controlled trial of antibiotic placebo for acute LRTI in primary care.Method
Two thousand and sixty-one adults with acute LRTI, where pneumonia was not suspected clinically, were given amoxicillin or matching placebo. The duration of symptoms, rated moderately bad or worse (primary outcome), symptom severity on days 2–4 (0–6 scale), and the development of new or worsening symptoms were analysed in pre-specified subgroups of interest. Evidence of differential treatment effectiveness was assessed in prespecified subgroups by interaction terms.Results
No subgroups were identified that were significantly more likely to benefit from antibiotics in terms of symptom duration or the development of new or worsening symptoms. Those with a history of significant comorbidities experienced a significantly greater reduction in symptom severity between days 2 and 4 (interaction term −0.28, P = 0.003; estimated effect of antibiotics among those with a past history −0.28 [95% confidence interval = −0.44 to −0.11], P = 0.001), equivalent to three people in 10 rating symptoms as a slight rather than a moderately bad problem. For subgroups not specified in advance antibiotics provided a modest reduction in symptom severity for non-smokers and for those with short prior illness duration (<7 days), and a modest reduction in symptom duration for those with short prior illness duration.Conclusion
There is no clear evidence of clinically meaningful benefit from antibiotics in the studied high-risk groups of patients presenting in general practice with uncomplicated LRTIs where prescribing is highest. Any possible benefit must be balanced against the side-effects and longer-term effects on antibiotic resistance. 相似文献16.
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Tinne Smets Johan Bilsen Lieve Van den Block Joachim Cohen Viviane Van Casteren Luc Deliens 《The British journal of general practice》2010,60(573):e163-e170
Background
Euthanasia became legal in Belgium in 2002. Physicians must adhere to legal due care requirements when performing euthanasia; for example, consulting a second physician and reporting each euthanasia case to the Federal Review Committee.Aim
To study the adherence and non-adherence of GPs to legal due care requirements for euthanasia among patients dying at home in Belgium and to explore possible reasons for non-adherence.Design of study
Large scale, retrospective study.Setting
General practice in Belgium.Method
A retrospective mortality study was performed in 2005–2006 using the nationwide Belgian Sentinel Network of General Practitioners. Each week GPs reported medical end-of-life decisions taken in all non-sudden deaths of patients in their practice. GP interviews were conducted for each euthanasia case occurring at home.Results
Interviews were conducted for nine of the 11 identified euthanasia cases. Requirements concerning the patient''s medical condition were met in all cases. Procedural requirements such as consultation of a second physician were sometimes ignored. Euthanasia cases were least often reported (n = 4) when the physician did not regard the decision as euthanasia, when only opioids were used to perform euthanasia, or when no second physician was consulted. Factors that may contribute to explaining non-adherence to the euthanasia law included: being unaware of which practices are considered to be euthanasia; insufficient knowledge of the euthanasia law; and the fact that certain procedures are deemed burdensome.Conclusion
Substantive legal due care requirements for euthanasia concerning the patient''s request for euthanasia and medical situation were almost always met by GPs in euthanasia cases. Procedural consultation and reporting requirements were not always met. 相似文献19.
Anthea Dallas Mieke van Driel Thea van de Mortel Parker Magin 《The British journal of general practice》2014,64(626):e561-e567