Adherence to Treatment in Patients after Kidney Transplantation Author: Barbora Vaňková Tutor: PharmDr. Josef Malý, Ph.D. Consultant: PharmDr. Kateřina Ládová, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aims: Kidney transplantation (KT) is the best treatment option for patients with end- stage renal disease. However, despite its numerous benefits it requires a lifelong medical regimen of immunosuppressive treatment (IS) with a special emphasis on a strict medication adherence (MA). The objective of our study was to analyse MA in KT outpatients. We also intended to analyse non- adherence as one of the drug-related problems. Furthemore, we focused on analysis of the main self- management tasks. Methods: The prospective cross-sectional study was undertaken in one year period from March 2016 to March 2017 at the Haemodialysis Centre in the Teaching Hospital Hradec Králové. Patients ≥ 18 years old and at least 3 weeks after KT were addressed within their regularly scheduled visit to the nephrologist. Structured interview was performed by pharmacist to determine patients' self-reported MA to IS using validated Czech version of Medication Adherence Report Scale (MARS-CZ). In addition, patients were interviewed about other...

Introduction: In recent year, the role of the pharmacist has evolved from product-focused to patient-focused activities. Following this evolution, new professional pharmacy services were simultaneously developed by researchers and started to be legally implemented and remunerated for community pharmacists around the world. Implementation, essential to ensure a good programme delivery and therefore its effectiveness, was seen as a passive process for which diffusion and dissemination were sufficient to translate research into practice. However, the transition from theory to practice is often difficult as different factors hinder or facilitate the implementation of such services. In consequence of that, implementation research started to be developed in the community pharmacy field to understand and fil the gap between theory and practice.Objectives of the thesis: Three projects were conducted in Belgium and Switzerland; (1) to understand the implementation of an existing programme in Belgium; the isotretinoin pregnancy prevention programme (PPP) (Chapter IV, point 4.1), and (2) to study the implementation of two new developed pharmaceutical services, which include an interview between the pharmacist and the patient and require interprofessional collaboration; the medication adherence program in Switzerland and the medication review in Belgium (Chapter IV, point 4.2). Methods: To understand the implementation of the isotretinoin PPP, two studies were conducted. The first study was a survey sent to health care professionals (pharmacists, general practitioners and dermatologists) and patients. The outcomes of the survey were the PPP awareness and compliance to safety recommendations related to the teratogenic risk of isotretinoin. The second study was cross-sectional and analysed the reimbursed prescription data of the Belgian population taking isotretinoin between January 2012 and August 2015. The outcomes were medication adherence to isotretinoin and to contraception, and the concomitant use of contraception and isotretinoin. Medication adherence was measured using the medication possession ratio (MPR), dividing the total days of medication supplied within the refill interval by the number of days in the refill interval. The concomitant use of isotretinoin and contraception was realised in combining prescription database of both isotretinoin and contraception of women between 12 and 21 years old, who received at least one prescription of isotretinoin during the study period.To study the implementation of the medication adherence program in Switzerland and the medication review service in Belgium, two prospective and observational studies were conducted with a mixed method approach (quantitative and qualitative outcomes). The defined outcomes, based on the RE-AIM model, were; reach of the target patients, adoption of the service by health care professionals providing the service, implementation (facilitators, barriers and fidelity or the extent to which the intervention is delivered as intended), and maintenance (the extent to which the intervention become institutionalized or part of the routine activity). Outcomes were collected through web platforms for quantitative data, and interviews and focus groups for qualitative data.Results and discussion: The study of the isotretinoin PPP implementation showed that two safety recommendations related to the teratogenic risk were particularly poorly applied by interviewed health care professionals. These two recommendations were the use of a second contraceptive method (like condoms) and the monthly pregnancy test. They considered these two recommendations as unnecessary for women taking an effective contraceptive method. Through the prescription refill data analysis, we observed that 46.1% of patients were adherent to isotretinoin (MPR ≥ 0.8) and 74.0% of women taking isotretinoin to their prescribed contraception (oral contraceptive, rings and patches). Lastly, 83.4% of women between 12 and 21 years taking isotretinoin did not receive an effective contraceptive method one month before, during and one month after isotretinoin treatment. However, the proportion of women receiving at least one prescription of contraception during (74.1%) and after (72.1%) isotretinoin treatment was higher than one month before isotretinoin treatment (35.7%). Regarding these results, less adopted recommendations should be reviewed by an expert committee and interventions focused on the improvement of the use of contraception during isotretinoin treatment could be developed.The two studies related to two new developed pharmaceutical services showed that their implementation was feasible in community pharmacy practice. Most of pharmacists participating in both projects had positive attitude regarding the implementation of these services in their daily practice. They considered it as professionally satisfying and important for patients and perceived the benefits of the programs. However, similar barriers were observed; difficulties to include patients and lack of interprofessional collaboration, and lack of time (related to lack of staff, administrative burden and lack of team adoption). According to participating health care professionals, the development of new strategies to overcome these barriers is necessary to anticipate the future implementation and the maintenance of these services at the national level. Following these results, the proposed strategies are for example the development of broad based media campaigns (for health care professionals and patients), or the development of specific trainings focusing on interprofessional collaboration, service-process, practice change management and leadership. Conclusion: The legal evolution of the pharmacists’ role is a positive progress but insufficient to ensure a full implementation in practice. Implementation strategies should be considered at different implementation stages (exploration, preparation, testing, operation and maintenance) and levels (individual, pharmacy, local setting, and system). The use of implementation science would allow a quicker and more effective implementation of these new professional pharmacy services. The anticipation of change and the selection of appropriate strategies would allow a higher fidelity level to the different components of the service by health care professionals and therefore a higher effectiveness, e.g. clinical and economic outcomes. Health care professionals, professional associations, academics and policy makers should be aware of implementation science and integrate it in the development of the new pharmacists’ role. As shown in our results, it should also be considered for existing programmes such as the isotretinoin PPP. / Doctorat en Sciences biomédicales et pharmaceutiques (Pharmacie) / info:eu-repo/semantics/nonPublished

Bakgrund: Bristande följsamhet till läkemedelsbehandling både på lång och kort sikt är ett problem i behandlingen av patienter som genomgått hjärtinfarkt. Den farmakologiska behandlingen utgör dock en central del i den sekundärpreventiva vården efter hjärtinfarkt med påverkan på både livskvalitet och överlevnad. Brister i följsamhet ses vid all läkemedelsbehandling men tenderar att tillta ju längre behandlingen pågår. Den varierar också med olika typer av läkemedelsterapier där minst följsamhet till läkemedel kan ses vid förebyggande behandling. Följaktligen riskerar den farmakologiskt sekundärpreventiva och delvis livslånga behandlingen efter hjärtinfarkt att fallera. Syfte: Syftet var således att belysa barriärer som påverkar följsamhet till läkemedelsbehandling hos patienter efter hjärtinfarkt. Design: En litteraturöversikt med systematisk sökstrategi användes som design för att svara mot syftet. 16 vetenskapliga artiklar, varav 11 kvantitativa och fem av mixad metod erhölls efter systematiska sökningar i databaserna CINAHL och PubMed och vidare kvalitetsgranskade. Dessa sammanställdes genom integrerad analys utifrån Whittemore och Knalf’s modell. Resultat: Patientens attityd och kunskap, hälsoaspekter, sociodemografiska parametrar samt erhållet stöd och behandling är faktorer som kan utgöra barriärer för följsamhet till läkemedelsbehandling efter hjärtinfarkt. Slutsats: Kunskap och medvetenhet hos sjuksköterskan och övrig vårdpersonal kring barriärer till följsamhet till läkemedelsbehandling efter hjärtinfarkt är central. Utifrån denna kunskap kan adekvata omvårdnadsåtgärder och interventioner vidtas för att främja följsamheten till förskrivna läkemedel. Att överleva hjärtinfarkt innebär förändringar och utmaningar för den drabbade som behöver bearbetas och integreras i det fortsatta livet. De drabbade patienterna behöver få möta sjuksköterskor som har gedigna kunskaper om vanligt förekommande reaktioner, utmaningar och problem som patienten ställs inför. Att förstå detta skeende genom att betrakta det som en transition kan hjälpa sjuksköterskan att identifiera hur patientens behov av stöd ser ut vid den unika tidpunkten. / Background: Lack of medication adherence, both long and short term, is a problem in the treatment of patients after a myocardial infarction. Pharmacological treatment is a central part of the secondary preventive care after myocardial infarction affecting both quality of life and survival. Deficiencies in adherence are seen in all types of drug treatment but tend to increase the longer the treatment lasts. It also varies with different types of drug therapies where the least adherence to drugs can be seen in preventive treatment. Consequently, this puts the pharmacological secondary preventive and partly lifelong treatment after myocardial infarction at risk. Aim: The aim was to highlight barriers affecting medication adherence in patients after myocardial infarction. Design: A literature review with a systematic search strategy was used to answer the aim of this study. Sixteen scientific articles, of which eleven were quantitative and five of mixed method were obtained after systematic searches and quality review in CINAHL and PubMed databases. An integrated analysis based on Whittemore and Knalf's model was used to analys the data. Results: The patient's attitude and knowledge, health aspects, sociodemographic parameters and the support and treatment received are factors that can constitute barriers to medical adherence after myocardial infarction. Conclusion: Nurses and other health personnels´ knowledge and awareness regarding barriers to medication adherence after myocardial infarction is central. Based on this knowledge, adequate nursing measures and interventions can be taken to promote adherence to prescribed medication. Surviving a myocardial infarction means changes and challenges for the person that needs to be processed and integrated into their daily life. Patients impacted need to meet nurses who have good knowledge of common reactions, challenges and problems that they may face. Understanding these course of events by considering it as a transition can help the nurse identify the patient's need for support at this unique time.

Medication complexity and nonadherence are significant risk factors for avoidable hospitalizations and health care spending for older adults in the United States. However, limited empirical research has investigated pharmacist-run telephonic medication management programs as a potential solution to the problem of reducing medication complexity while improving medication adherence. This quantitative study employed the behavioral change model to analyze archival data from a sample of 1,148 participants, examining the relationship of a pharmacist-run telephonic consulting program on medication adherence and medication complexity for one pharmacy benefit management firm's Medicare Part D recipients. The primary research questions investigated the relationship of medication therapy management programs to medication adherence and complexity. Data were assessed using correlation and regression analysis to determine the association between receiving pharmacist counseling, medication adherence, and medication complexity, and to assess the strength of any relationships identified. No linear relationship was found between pharmacists' counseling, medication complexity, and medication adherence. However, the study found a weak correlation between medication complexity and comorbidities, and between medication complexity and medication adherence. This study promotes positive social change by identifying information that can be used to reduce pharmaceutical industry liability by improving proper management of medications, by reducing the burden of comorbidities related to poor management of chronic disease, and streamlining health services and improving their outcom

Diabetes is a challenging chronic disease for adult patients to manage effectively. Poor adherence to prescribed medications treatment is one of the main reasons for poor blood sugar control. Despite healthcare providers' efforts to emphasize the importance of taking medications, adult patients with Type II diabetes frequently present with complications related to persistent failure to adhere to prescribed medication regimen. These patients should thoroughly understand why adhering to a strict medication regimen to maintain control of their blood sugar is so important. The purpose of this project, guided by Orem's self-care deficit nursing theory, was to develop an educational module toolkit that identifies best practices for nurses to address issues of medication adherence with adult patients with Type II diabetes. Future implementation of these toolkit resources may enhance nurses' ability to teach adult patients how to adhere to their medication regimen. Five participants, all considered professional diabetes content experts, were invited to evaluate the educational module toolkit subject matter. The completion response rate was 100% (n = 5). The content experts rated survey items using a 5-point Likert scale where 1= strongly disagree, 2= disagree, 3= not applicable, 4 = agree and 5= strongly agree and responded to 2 questions that allowed for narrative feedback. The experts were satisfied with the content of the educational module toolkit; suggesting that the toolkit may serve as a functional guide for nurses assisting adult patients with diabetes. Improved medication regimen compliance may produce cascading effects; helping these patients achieve a better quality of life while producing positive social change within their families and communities.

Indiana University-Purdue University Indianapolis (IUPUI) / Medication nonadherence among middle-aged to older adults with chronic conditions often stems from forgetting to take or fill medications as prescribed. A pilot study indicated the feasibility of technology acceptance model (TAM)-based smartphone medication reminder app (SMRA) training as a way to promote their app use and medication adherence. This dissertation assesses the viability and effect size of the modified TAM-based SMRA training in promoting app use and medication adherence, as well as its delivery design in preparation for a larger efficacy study. A two-group pretest-posttest design was employed. Twenty-nine adults aged over 40 years and taking medications for chronic condition management were recruited from Midwestern university and community sites. The training group (n = 15) received the modified TAM-based SMRA training; whereas the non-training group (n = 14) self-navigated app features. The training group reported significantly higher levels of perceived usefulness, perceived ease of use, positive subjective norm, and intention to use the app. In addition, the training group reported a higher proportion of active app use than the non-training group. Modified TAM-based SMRA training was not viable in increasing the levels of medication adherence variables. Effect sizes suggested at least 52 participants as a sample size for a larger efficacy study. Participants suggested that training could be improved by scheduling separate group training for iPhone and Android phone users, providing a live online training option, providing small group training with peer helper, tailoring training length to participant preference, and working with family members and healthcare providers as co-trainees and co-trainers.

No description available.

No description available.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24188号 / 医博第4882号 / 新制||医||1060(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 古川 壽亮, 教授 中山 健夫, 教授 寺田 智祐 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Background: The lack of adherence to drug therapy is a major problem; it can contribute to significant deterioration of disease and increased health-care costs. Improving medication adherence is a big challenge; there is no simple solution to the problem. It is thus essential to improve our knowledge of non-adherence (NA) and its causes. Aims: The aims of the thesis were to study the influence of gender and psychological distress on self-reported, intentional and unintentional non-adherent behaviour, and to investigate the reasons for NA. Methods: A population-based study that included a postal questionnaire was carried out in a cross-section of the general Swedish population (n=7,985, aged 18-84 years). The response rate was 61.1% (n=4,875) and current prescription drug use was reported by 2,802 participants. The questionnaire covered use of prescription drugs, NA to the drug regimens, reasons for NA, economic status, attitudes to drugs, and the presence of somatic or mental problems, and also included the Hospital Anxiety and Depression Scale questionnaire. Results: The results showed differences in various self-reported non-adherent behaviour patterns and reasons for NA between the genders. In most cases, these remained after controlling for confounders such as socioeconomic factors and attitudes to drugs that are known to differ between women and men. Associations were also found between symptoms of anxiety and/or depression and the presence of intentional or unintentional non-adherent behaviour (with a stronger average association for intentional NA), and between anxiety/depression and some of the reasons given for NA, e.g. adverse drug reactions (ADRs). Conclusions: Although it was not possible to confirm causal relationships, this thesis emphasises the effects of gender and psychological distress on NA. In summary, both gender and anxiety and/or depression influenced non-adherent behaviour and the reasons given for NA. For instance, ADRs seemed to influence the decision not to take the drug as prescribed, especially among women and participants under psychological distress. It is suggested that a deep understanding of the causes of NA and of the impact of gender and psychological distress on the outcomes would help those aiming to improve adherence to prescribed medication.