1 + 1 = 3? The systematic development of a theoretical and evidence-based tailored multimedia intervention to improve medication adherence

Objective

To describe the development of a theoretical and evidence-based tailored multimedia intervention to improve medication intake behavior in patients with inflammatory bowel disease (IBD). The intervention integrates interpersonal and technology-mediated strategies with the expectation that this will work synergistically.

Methods

The development followed the Medical Research Council's framework. Three literature reviews and three pre-tests among 84 IBD patients and eight nurses were conducted to guide the development of the intervention. A feasibility study was carried out among four nurses and 29 patients.

Results

The components include: (1) an online preparatory assessment (OPA); (2) tailored interpersonal communication; and (3) tailored text messaging. To support the development, the feasibility was tested. Results indicated that the OPA was comprehensive and could be a helpful tool for both patients and nurses to prepare for the consultation. The training was evaluated as being instructive and applicable with a mean mark of 8.5. Of the developed messages, 65.6% received positive evaluations and were used in the intervention.

Conclusion

By applying the framework, we were able to describe the logic behind the development of a tailored multimedia intervention to improve medication intake behavior.

Practice implications

This study could serve as a guide for the development of other health interventions.     

High-Dose Spinal Cord Stimulation Reduces Long-Term Pain Medication Use in Patients With Failed Back Surgery Syndrome Who Obtained at Least 50% Pain Intensity and Medication Reduction During a Trial Period: A Registry-Based Cohort Study

ObjectivesHigh-dose spinal cord stimulation (HD-SCS) revealed positive results for obtaining pain relief in patients with failed back surgery syndrome (FBSS). However, it is less clear whether HD-SCS also is able to reduce pain medication use. The aim of this registry-based cohort study is to explore the impact of HD-SCS on pain medication use in FBSS patients.Materials and MethodsData from the Discover registry was used in which the effectiveness of HD-SCS was explored in neurostimulation-naïve FBSS patients as well as in rescue patients. All neurostimulation-naïve FBSS patients positively responded to a four-week SCS trial period in which at least 50% pain relief and 50% medication reduction were obtained. Medication use was measured with the Medication Quantification Scale III (MQS) in 259 patients at baseline and at 1, 3, and 12 months of HD-SCS. Additionally, defined daily doses (DDD) and morphine milligram equivalents (MME) were calculated as well.ResultsOne hundred thirty patients reached the visit at 12 months. In neurostimulation-naïve patients, a statistically significant decrease in MQS (χ² = 62.92, p < 0.001), DDD (χ² = 11.47, p = 0.009), and MME (χ² = 21.55, p < 0.001) was found. In rescue patients, no statistically significant improvements were found. In both patient groups, statistically significant reductions in the proportion of patients on high-risk MME doses ≥90 were found over time. At the intraindividual level, positive correlations were found between MSQ scores and pain intensity for back (r = 0.56, r = 0.31, p < 0.001) and leg pain (r = 0.61, r = 0.22, p < 0.001) in neurostimulation-naïve and rescue patients, respectively.ConclusionsRegistry data on HD-SCS in FBSS patients revealed a statistically significant and sustained decrease in pain medication use, not only on opioids, but also on anti-neuropathic agents in neurostimulation-naïve patients, who positively responded to an SCS trial period with at least 50% pain relief and 50% pain medication decrease, but not in rescue patients.     

不同年龄冠心病慢性心衰患者临床特征和出院医嘱用药分析

目的探讨不同年龄段冠状动脉粥样硬化性心脏病(简称冠心病)慢性心力衰竭患者的临床特征,并分析出院医嘱用药情况。方法选取海南省安宁医院2017年12月至2018年12月出院的冠心病慢性心力衰竭患者200例,回顾性分析其临床资料,比较药物应用与年龄、性别、纽约心脏病协会(NYHA)心功能分级、左室射血分数(LVEF)的关系。结果男性多于女性;60~74岁年龄段发病率较高;排名前3的合并症分别为高血压(64. 50%)、糖尿病(50. 50%)、心肌梗死(39. 00%);他汀类、硝酸酯类、阿司匹林、利尿剂、β受体阻滞剂、醛固酮拮抗剂(MRA)、中成药、地高辛使用率较高,血管紧张素转换酶抑制剂(ACEI)、血管紧张素Ⅱ受体拮抗剂(ARB)使用率较低;利尿剂女性使用率高于男性(P <0. 05);阿司匹林在60~74岁年龄段的使用率较高,氯吡格雷、利尿剂、钙离子拮抗剂(CCB)、ARB在> 74岁年龄段使用率高于60~74岁及<60岁(P <0. 05);Ⅰ/Ⅱ级的阿司匹林、他汀类使用率高于Ⅲ/Ⅳ级,而氯吡格雷、地高辛、利尿剂、MRA使用率低于Ⅲ/Ⅳ级(P <0. 05);地高辛、MRA在LVEF减低组使用率高于正常组,而ARB及CCB在正常组使用率高于减低组(P <0. 05);单用药物在LVEF减低组中占比低于正常组(P <0. 05);3种合用药物在NYHA分级Ⅲ/Ⅳ级中占比高于Ⅰ/Ⅱ级(P <0. 05)。结论 60~74岁的冠心病慢性心力衰竭患者中阿司匹林使用率较高,> 74岁时氯吡格雷、利尿剂、CCB、ARB使用率较高。应规范他汀类、硝酸酯类、阿司匹林、利尿剂在不同年龄段患者的使用,对于使用率较低且与指南有差距的药物应根据患者疾病状况合理选用。