In 2015, over 427,000 children were in foster care and the largest population were in California's system. Of those children, more than 9,400 were prescribed psychotropic medications. Increases of psychotropic medication use have led to investigations and findings of medication oversights in foster care. Medication oversights included medication nonadherence, which was linked to an increase of problematic behaviors in foster children. The purpose of this phenomenological study was to explore the issues of medication adherence for foster care providers who care for foster children of mild to chronic health concerns who were prescribed medications and experienced multiple placements. By utilizing the health belief model as a guide to formulate the research question and interview questions, an understanding of how the beliefs, attitudes, and behaviors of foster care providers were impacting proper medication adherence behaviors began to manifest. Data gathered through semistructured interviews of foster care providers were analyzed to code and identify themes. The results of this phenomenological study revealed the perceptions, beliefs, and attitudes of foster care providers related to medication adherence behaviors. Multiple barriers to medication adherence for foster children included systemic interferences, limited health information, limited knowledge regarding medications and medication side effects, and child refusal. These findings may be used to create educational trainings, inform policymakers, and develop regulations for medication use in foster care, which could bring about positive change by increasing the potential for better health outcomes for foster children.

Patient nonadherence to physicians' prescribed therapeutic regimen is the greatest challenge in the effective treatment of patients with diabetes worldwide. Scientific evidence has revealed that nonadherence to prescribed medication could result in diabetic complications such as cardiovascular disease, retinopathy, nephropathy, and neuropathic diabetic foot ulcers. The purpose of this study was to explore predictive relationships between levels of adherence to antidiabetic medications, patient HbA1c levels, and diabetic complications among Jamaicans, an understudied population. The research question that guided this study was: Do the patient level of adherence and HbA1c levels have any predictive relationship with the severity of diabetic complications (cardiovascular disease, retinopathy, nephropathy and neuropathic foot ulcer) among Jamaicans after controlling for age and gender? The theory of planned behavior was used to guide the study. Data regarding diabetic complications were collected from 119 records during a cross-sectional review of patient dockets. Level of adherence was determined from an interviewer-administered Morisky 8-item adherence scale. A multiple regression analysis revealed that lower levels of patient adherence to treatment and higher HbA1c levels predicted greater severity of cardiovascular disease (p = .000; p = .000), retinopathy (p = .009; p =.090), nephropathy (p =.007; p =.001) and diabetic neuropathic foot ulcers (p =.027; p =.001). Findings from this study will contribute to the knowledge base on diabetic medication nonadherence and may encourage health care professionals to advocate for better medication adherence strategies among people with diabetes.

Diabetes is the 7th leading cause of death in the United States. Uncontrolled diabetes and lack of self-care knowledge leads to increased emergency department (ED) visits, utilizing limited health care resources. The practice-focused question asked whether a patient-focused diabetic self-care toolkit could decrease the number of diabetes-related ED visits. The purpose of this project was to reduce the number of diabetes-related ED visits and was supported by the social cognitive theory. The sources of evidence included the facility's ED Information System (EDIS) data and a patient survey developed by the project lead. There were 149 participants (135 males and 14 females). Before program implementation there were 3240 total ED visits with 124 diabetes-related disposition diagnoses. Post-project there were 3362 total ED visits, with 126 diabetes-related disposition diagnoses. Data collected revealed no meaningful difference between the pre-project and post-project ED diabetes related visits. However, of the 124 pre-project diabetes-related visits, 59 had a triage complaint or disposition diagnosis of medication refill, and of the 126 post-project diabetes-related visits, 33 were medication refills. Although implementation of the diabetes resource toolkit did not help to decrease diabetes related emergency department visits, it did identify that 47.58% of pre-project visits and 26.19% of post-project visits were related to medication refills, showing a 21.39% post-project decrease in medication refill visits. This identifies one potential positive impact of the toolkit implementation. The implications for positive social change from this project is the recognition that medication refills are an impacting contributor to diabetes-related ED visits and from that, nursing practice can gain new knowledge in the fight against diabetes.

Nonadherence to medications for chronic illnesses is a public health problem that requires education related to its illnesses and medications in order to reduce morbidity, mortality, and health care costs, and to improve quality of life. Scholars have identified that morbidity and mortality are much higher among African Americans due to poor medication adherence when compared to Euro-Americans. This study focused on African Americans to increase their medication adherence with chronic illnesses. The purpose of this study was to analyze the effectiveness of using different educational methods to enhance medication adherence. The social cognitive theory and the theory of planned behavior were used as a foundation to develop this quantitative study. Three validated tools were used to assess the effectiveness of educational methods to see if there would be any increase in knowledge, self-efficacy, and change in health beliefs. A sample size of 144 African Americans in Chicago with chronic illnesses was randomized to an experimental group that received education on medication adherence for a period of 8 weeks through lecture, video presentation, roleplaying, and group discussion. A control group received regular education for the same 8 weeks. ANOVA, ANCOVA, and MANOVA statistical methods were used to analyze the findings that reported no statistical significance in the knowledge difference scores F(1,261) = 0.17, p = 0.678, self-efficacy difference scores F(1,259) = 0.96, p = 0.328, and health beliefs difference scores F(4,258) = 0.46, p = 0.765. This study contributes to social change by identifying a public health problem which can be improved by adding and testing other variables such as fatigue and cognitive and sensory deficits associated with chronic illnesses, which could yield a more valuable in-depth understanding.

No description available.

This thesis investigates the potential of Mobile Augmented Reality (MAR) for improving medication adherence. Empirical research was conducted by interviewing patients, pharmacists, and a homecare worker. Based on insights and findings, an onboarding concept called MedinAR was developed through sketching and prototyping, with the aim of refining the idea and understanding the user experience. MedinAR leverages MAR to offer new ways of accessing and consuming medication information, making it more accessible to users. The concept, explored through four prototypes, focuses on onboarding for new medication regimes, providing an interaction flow for users to scan pill bottles, receive digital information in the physical space, and finally receive guidance on the appropriate placement of medication in the pillbox according to their medication regime. Further research is required to assess the technology's meaningful adoption, but the study's results underscore the importance of further exploring new supportive tools for medication adherence.

Hypertoni är en riskfaktor för allvarliga kardiovaskulära sjukdomar. Olika läkemedelsklasser används vid behandling av hypertoni. Dessa inkluderar angiotensin omvandlade enzymhämmare, angiotensin II-receptorblockerare, kalciumkanalblockerare och tiaziddiuretika. Även om nuvarande läkemedelsterapier kan vara effektiva, är det få som kan uppnå målblodtryck. De flesta patienter med hypertoni kräver minst två antihypertensiva läkemedel för att uppnå sitt målblodtryck. Detta ledde till komplicerade behandlingsmetoder som i sin tur har blivit en stor bidragande faktor till dålig patientföljsamhet. Även om ett stort antal läkemedel finns tillgängliga för behandling, är kontrollen av blodtryck dålig på grund av patienternas dåliga följsamhet till medicinering som vanligtvis är en kombination av flera substanser. Följsamheten minskar med antalet tabletter som en patient behöver ta vilket leder till en komplicerad behandlingsstrategi.  Syftet med detta examensarbete var att undersöka blodtryckssänkande effekt med en enkel tablettform Single-Pill Combination (SPC) som innehåller en kombination av flera antihypertensiva läkemedelsklasser och att undersöka patienternas följsamhet till (SPC) behandling.  Metod det här arbetet är en litteraturstudie utförd i PubMed. Olika sökord användes” single-pill combination in hypertension”, “Fixed dose combination in hypertension “, “Adherence to single-pill combination in hypertension”. Sökningen filtrerades till “Randomized controlled trial”. Nya studier valdes ut som undersökte effekten av SPC och följsamhet till behandling. Resultat Studier 1,2,3 och 4 som undersökte effekten gav positiva resultat som gynnade SPC framför standardmonoterapi och placebo. SPC kunde minska blodtrycket statiskt signifikant i alla studierna. I studie 1 blev den genomsnittliga skillnaden i SBT mellan grupperna (–6,9) mm Hg med (p-värde <0,001). I studie 2 blev skillnaden i genomsnittlig 24-timmars SBT mellan SPC- och placeboperioder (–18,7) mm Hg med p-värde <0,0001. I studie 3 blev SBT-förändringar på klinik -16,5 ± (15,5) mm Hg (p <0,001) med amlodipin/valsartan FDC och -6,9 ± (11,4) mm Hg (p = 0,012) med valsartan monoterapi medan motsvarande förändringar i DBP i Office var -9,8 ± (7,7) mm Hg (p <0,001) respektive -2,5 ± (6,6) mm Hg (p = 0,095). Resultat av studie 4 visade att andelen deltagare som uppnådde målblodtryck efter 6 månader (SBT <140, DBT <90 mm Hg) blev 69% i SPC gruppen och 55,3% i monoterapi gruppen. I studie 5 kunde ingen signifikant skillnad i följsamheten observeras mellan SPC gruppen och FEC gruppen. Följsamhetsgraden var 98% i båda grupperna. Studie 6 rapporterade signifikant resultat där PDT blev 95,1 % i SPC gruppen och 92,1% i kontrollgruppen p-värde <0,05.  Slutsats Alla resultat i studierna 1,2,3 och 4 gynnade signifikant SPC när det gäller effekten. Studie 6 visade att patienternas följsamhet till behandling var bättre i SPC gruppen än kontrollgrupp. Studie 5 kunde inte ge signifikanta resultat avseende följsamheten till SPC jämfört med FEC. Fler RCT studier behövs för att undersöka om SPC kan leda till bättre följsamhet hos hypertonipatienter / Background Hypertension is a risk factor for serious cardiovascular diseases. Different drug classes are used in the treatment of hypertension. These include angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, and thiazide diuretics. Although current drug therapies can be effective, few are able to achieve target blood pressure therefore it has become well-known that most hypertensive patients require at least two antihypertensive drugs to reach their target blood pressure. This led to complicated treatment methods, which in turn has become a significant contributing factor to poor patient compliance. When two or more drug classes are combined, this contributes to improved efficacy, as different mechanisms of action work together to block different pathways to high blood pressure. This leads to lower doses of the individual components being used, which results in a reduced likelihood of side effects. Although a large number of drugs are available for treatment, there is still poor control of blood pressure due to patients' poor adherence to medication, which is usually a combination of several substances. Adherence decreases with the number of tablets a patient needs to take, leading to a complicated treatment strategy. Lower levels of adherence are associated with poorer blood pressure control. Aim The aim of the work is to investigate the blood pressure-lowering effect with a simple tablet form "Single-Pill Combination" (SPC) that contains a combination of several antihypertensive drug classes and to investigate the patients' adherence to this form of treatment (SPC). Method This work is a literature study carried out in Pubmed. Different search terms were used: "single-pill combination for the treatment of hypertension", "Fixed dose combination in hypertension", and "Adherence to single-pill combination for hypertension". The search was filtered to "Randomized controlled trial". New studies were selected that investigated the effect of single-pill combination and blood pressure control and adherence to treatment. Results Studies 1, 2, 3, and 4 investigating the efficacy produced positive results favoring SPC over standard monotherapy and placebo. SPC was able to reduce blood pressure statically significantly in all studies. In Study 1, the primary outcome variable was the mean difference in SBT between groups (–6.9) mm Hg with (p-value <0.001). In Study 2, the difference in mean 24-hour SBT between SPC and placebo periods was (–18.7) mm Hg with a p-value <0.0001. Whereas in Study 3, in-clinic SBT changes were -16.5 ± (15.5) mm Hg (p < 0.001) with amlodipine/valsartan FDC and -6.9 ± (11.4) mm Hg (p = 0.012) with valsartan monotherapy while the corresponding changes in DBP in Office were -9.8 ± (7.7) mm Hg (p <0.001) and -2.5 ± (6.6) mm Hg (p = 0.095), respectively. The results of study 4 were that the percentage of participants who achieved target blood pressure after 6 months (SBT <140, DBT <90 mm Hg) was 69% in the SPC group and 55.3% in the monotherapy group. In study 5, no significant difference in compliance could be observed between the SPC group and the FEC group. The compliance rate was 98% in both groups. While study 6 reported significant results where PDT was 95.1% in the SPC group and 92.1% in the control group p-value <0.05. Conclusion All results in studies 1,2,3and 4 significantly favored SPC in terms of efficacy. Study 6 showed that patients’ adherence to treatment was better in the SPC group than in the control group. While study 5 which was the first RCT study in this area could not provide positive and significant results regarding the adherence to SPC compared to FEC. More RCT studies are needed to investigate whether SPC can lead to better adherence in hypertensive patients.

<p>  </p> <p><strong>OBJECTIVES:</strong> Medication synchronization (med-sync) aligns patients’ chronic medications to a predetermined routine pickup date at a community pharmacy. An appointment-based model (ABM) med-sync service includes a comprehensive medication review at the pharmacy. We had the following objectives: (1) To systematically characterize literature describing healthcare utilization, cost clinical, and humanistic outcomes for patients enrolled in medication synchronization, (2) to determine the characteristics of Medicare Part D beneficiaries’ receipt of medication synchronization program and (3) to compare healthcare utilization outcomes of Medicare beneficiaries enrolled in an ABM med-sync program to beneficiaries not enrolled in such a program.</p> <p><br></p> <p><strong>METHODS:</strong> A systematic literature review was conducted using electronic databases from January 2008 to October 2022. The retrospective cohort study analyzed Medicare claims data from 2014-16 for a sample of 1 million beneficiaries utilizing community pharmacies identified as offering a med-sync program. Medicare inpatient, outpatient, emergency, and pharmacy claims data were used to create med-sync and non-med-sync cohorts. We applied Andersen’s Health Services Utilization model to determine factors associated with med-sync enrollment. We constructed logistic regression models with med-sync enrollment as the dependent variable adding predisposing, enabling, and need variables. Descriptive statistics and bi-variate analysis were performed on the cohorts. All patients were followed longitudinally for 12 months before and after a 2015 index/enrollment month to calculate healthcare utilization. Difference-in-differences (DID) was used to compare mean changes in utilization outcomes between cohorts before and after enrollment.</p> <p><br></p> <p><strong>RESULTS:</strong> Through systematic review, we found limited studies related to costs and healthcare utilization. Med-sync programs have shown to increase drug adherence to medications and improve patient satisfaction. For our study with Medicare beneficiaries, we identified 13,193 beneficiaries in the med-sync cohort and 156,987 beneficiaries in non-med sync (control) cohort. As age of beneficiaries increased, likelihood of med-sync enrollment increased (AOR=1.003, 95% CI:1.001-1.005). There were ​higher odds of enrollment for beneficiaries residing in Northeast (AOR=1.094, 95% CI:1.018-1.175), South (AOR=1.109, 95% CI:1.035-1.188), and West (AOR=1.113, 95% CI:1.020-1.215) than the Midwest. Beneficiaries residing in non-metro areas had lower odds of enrollment​ (AOR: 0.914, 95% CI: 0.863-0.969) than metro areas. Beneficiaries with less previous inpatient hospitalizations (AOR=0.945, 95% CI:0.914-0.977) were less likely to be enrolled whereas those with higher outpatient visits (AOR=1.003, 95% CI:1.001-1.004) were more likely to be enrolled. Beneficiaries taking a higher number of oral chronic medications (AOR=1.005, 95% CI:1.002-1.008) had greater odds of enrollment in med-sync. After propensity matching, 13,193 beneficiaries in each cohort were used for analysis. Mean pharmacy utilizations increased before and after enrollment for both cohorts while mean outpatient utilization decreased before and after enrollment for med-sync cohort only. Healthcare utilization mean DID were significantly less in the med-sync cohort compared to the non-med-sync cohort for outpatient visits (DID: 0.01, p=0.0073) and pharmacy fills (DID: 0.01, p<0.0001). There was no significant DID for inpatient and emergency visits between cohorts.</p> <p><br></p> <p><strong>CONCLUSION:</strong> Disparities in age, geographic region, type of residence and prior health utilization for med-sync enrollment were identified. Outpatient and pharmacy utilization changes were significantly lower in med-sync cohort compared to the non-med-sync cohort in the 12-months after enrollment. Lower pharmacy utilization could be due to optimization of therapy during medication reviews of ABM med-sync. As Medicare is approaching to a value-based system, there needs to be a greater focus on systems such as med-sync that has shown to improve a patient’s adherence. </p>

Introduktion: Tidigare forskning visar att det finns flera olika faktorer som bidrar till följsamhet vid läkemedelsbehandling av psykisk sjukdom, både möjligheter och svårigheter. En viktig uppgift som psykiatrisjuksköterskan har i mötet med patienter som lider av psykisk sjukdom är att psykiatrisjuksköterskan ska motivera patienten till att ta emot rekommenderad läkemedelsbehandling. Det är av värde att göra en översikt gällande aktuell forskning kring omvårdnadsmetoder och åtgärder som kan vidtas av psykiatrisjuksköterskan för att motivera patienter med psykisk sjukdom till följsamhet vid läkemedelsbehandling. Syfte: Syfte med denna studie är att undersöka hur sjuksköterskor inom psykiatrisk vård kan motivera personer med psykisk sjukdom till följsamhet vid läkemedelsbehandling. Metod: Metoden för detta examensarbete var litteraturöversikt bestående av 21 vetenskapliga artiklar, varav 14 kvantitativa, 5 kvalitativa och två med mixad metod. Vid litteratursökningenanvändes databaserna Pubmed och CINAHL. Resultat: Analysen av data resulterade i fyra kategorier (figur 3) vilket beskriver hur en sjuksköterska inom psykiatrisk vård kan motivera patienter med psykisk sjukdom tillföljsamhet vid läkemedelsbehandling. Dom fyra kategorierna blev: Den terapeutiska relationen och stöd från anhöriga vid följsamhet till läkemedelsbehandling, Psykoedukation för följsamhet till läkemedelsbehandling, Följsamhetsterapi för läkemedelsbehandling och Andra interventioner för att motivera till följsamhet vid läkemedelsbehandling. Slutsats: Det finns flera olika omvårdnadsinterventioner som specialistsjuksköterskan i psykiatrisk vård kan använda sig av för att motivera patienten att ta emot läkemedel och följa rekommenderad läkemedelsbehandling. Dessa omvårdnadsinterventioner överensstämmer med Roys anpassningsteori där Roy beskriver sjuksköterskans roll i patientens anpassningsförmåga och hur sjuksköterskan hjälper individer att hitta strategier för att hantera olika situationer samt ger individer möjligheter och stöd om behovet finns / Introduction: Previous research has shown that there are several different factors that contributes to adherence to drug treatment of mental illness, both opportunities and difficulties. An important task that the psychiatric nurse has in the meeting with patients suffering from mental illness is that the psychiatric nurse should motivate the patient to accept recommended drug treatment. It is of value to make an overview of current research on the different methods and measures that can be used by the psychiatric nurse to motivate patients with mental illness to adherence to drug treatment. Aim: The aim of this study is to investigate on how nurses in psychiatric care can motivate people with mental illness to adherence to drug treatment. Method: The method for this thesis was a literature review consisting of 21 scientific articles, of which 14 quantitative, 5 Qualitative and two with mixed method. The databases Pubmed and CINAHL were used in the literature search. Results: The analysis of the data resulted in four categories (figure 3), which describes how a nurse in psychiatric care can motivate patients with mental illness to adherence to drug treatment. The four categories were: The therapeutic relationship and support from relatives to motivate adherence to drugtreatment, Psychoeducation for adherence to drug treatment, Adherence therapy for drug treatment and Other interventions to motivate adherence to drug treatment. Conclusion: There are several different nursing interventions that the specialist nurse in psychiatric care can use to motivate a patient to receive medication and follow recommended drug treatment. These nursing interventions are consistent with Roy's adaptation theory where Roy describes the nurse's role in the patient's adaptation capability and how the nurse helps individuals find strategies to handle different situations and gives individuals opportunities and support if needed.

Kranskärlssjukdom är den vanligaste hjärt- och kärlsjukdomen och orsakas av ateroskleros i hjärtats kranskärl. Riskfaktorer för att utveckla kranskärlssjukdom är till stor del modifierbara med läkemedel eller livsstilsförändringar. Sjukdomen kan yttra sig som angina, hjärtinfarkt och hjärtsvikt. Efter den akuta behandlingen krävs livslång behandling med sekundärpreventiva läkemedel. Målet är ökad livskvalitet, minskad progress av sjukdom och minskad mortalitet. Trots god evidens för läkemedelsbehandlingen visar flertal studier att följsamheten på lång sikt är dålig. Syftet med den litteraturstudien var att beskriva erfarenheter som kan påverka individers följsamhet till sekundärpreventiva läkemedel vid kranskärlssjukdom. Metoden som användes för att besvara syftet var allmän litteraturöversikt med systematisk sökstrategi och 16 orginalartiklar inkluderades. Studierna kvalitetsgranskades enligt Sophiahemmets högskolas mall och den kvalitativa datan analyserades med utgångspunkt i en tematisk analys. Det sammanvägda resultatet presenteras i temat Inre erfarenheter som kan påverka individens följsamhet till läkemedelsbehandling med underteman Tankar och attityder samt Anpassningsförmåga. Samt i temat Yttre erfarenheter som kan påverka individens följsamhet till läkemedelsbehandling med underteman Vårdrelationer och kunskap om sjukdom och läkemedel, Stödsystem samt Läkemedelsrelaterade hinder. En rädsla för att insjukna på nytt och önskan att hålla sig frisk stärkte följsamhet medan nedstämdhet kunde minska följsamhet. En anpassningsförmåga till att skapa rutiner i vardagen var viktig för följsamheten. En bra relationen till vårdgivare och närstående stärkte följsamhet. Upplevda biverkningar var negativt för följsamheten. Kunskap om sjukdom, riskfaktorer och läkemedel hade en inverkan och efterfrågades. Resultatet diskuteras gentemot personcentrad vård. Vår slutsats är att inre eller yttre erfarenheter kan påverka följsamheten positivt eller negativt. Sekundärpreventiv uppföljning med personcentrerat förhållningssätt kan leda till att erfarenheter som påverkar följsamheten till läkemedel uppmärksammas. Därmed ges en möjlighet att arbeta aktivt med dessa för att förbättra följsamhet till läkemedelsbehandling. / Coronary heart disease is the most common form of cardiovascular disease and is caused by atherosclerosis in the coronary arteries of the heart. Risk factors for developing coronary heart disease are in greater part modifiable with medication or lifestyle changes. The disease can manifest itself as angina, myocardial infarction and heart failure. After the acute treatment phase lifelong treatment with secondary preventive medication is required. The goal is increased quality of life, reduced progression of disease and reduced mortality. Despite good evidence for medication treatment, several studies show that long-term adherence is poor. The aim of this literature review was to describe experiences that can influence individuals' adherence to secondary preventive medication for coronary heart disease. The method used to adress the aim was a general literature review with a systematic search strategy. 16 original research articles were included. The studies were critically appraised according to Sophiahemmet University's template and the qualitative data was analyzed based on a thematic analysis. The result is presented through the theme Inner experiences that can affect the individual's adherence to medication treatment with the subthemes Thoughts and attitudes and Adaptability. As well as the theme External experiences that can affect the individual's adherence to drug treatment with the subthemes Relationships with caregivers and knowledge of illness and medication, Support systems and Medication-related obstacles. A fear of recurrent illness and the desire to stay healthy strengthened adherence, while depression could decrease adherence. An ability to adapt to creating routines in everyday life was important for adherence. A good relationship with caregivers and relatives strengthened adherence. Perceived side effects were negative for adherence. Knowledge of disease, risk factors and medication had an impact and was requested. The result is discussed in relation to personcentered care. Our conclusion is that different inner or external experiences can affect adherence positively or negatively. Secondary preventive follow-up with a person-centred approach can lead to experiences that affect adherence to medication being noticed. This favours an opportunity to work actively with them to improve adherence to medication treatment.