AIM:To assess adherence rates to nucleos(t)ide analogues(NUCs) therapy in patients with chronic hepatitis B virus infection and determine factors associated with adherence.METHODS:The questionnaire study was conducte... AIM:To assess adherence rates to nucleos(t)ide analogues(NUCs) therapy in patients with chronic hepatitis B virus infection and determine factors associated with adherence.METHODS:The questionnaire study was conducted in the liver clinics at Concord Repatriation General Hospital.All patients who were currently taking one or more NUCs were asked to complete a structured,selfadministered 32-item questionnaire.Adherence was measured using visual analogue scales.The patient’s treating clinician was also asked to assess their patient’s adherence via a structured questionnaire.RESULTS:A total of 80 patients completed the questionnaire.Sixty six percent of the patients(n = 49) reported optimal adherence whilst 25(33.8%) graded their adherence to NUCs as suboptimal.Thirty four(43%) patients reported to have omitted taking their NUCs sometime in the past.Recent non-adherence was uncommon.Amongst the patients who reported skipping medications,the most common reason cited was 'forgetfulness'(n = 27,56.25%).Other common reasons included:ran out of medications(n = 5,10.42%),being too busy(n = 4,8.33%) and due to a change in daily routine(n = 5,10.42%).Patients who reported low adherence to other prescription pills were also more likely to miss taking NUCs(P = 0.04).Patients who were under the care of a language-discordant clinician were also more likely to report suboptimal adherence to NUCs(P = 0.04).CONCLUSION:Adherence rates were much less than that expected by the physician and has potential adverse affect on long term outcome.Communication and education appear central and strategies need to be implemented to improve ongoing adherence.展开更多
AIM To investigate patient adherence to surveillance endoscopy after index esophageal variceal hemorrhage and the extent to which adherence influences outcomes.METHODS We reviewed the records of patients with cirrhosi...AIM To investigate patient adherence to surveillance endoscopy after index esophageal variceal hemorrhage and the extent to which adherence influences outcomes.METHODS We reviewed the records of patients with cirrhosis admitted to the medical intensive care unit between 2000 and 2014 for first time esophageal variceal hemorrhage treated with endoscopic variceal ligation who were subsequently discharged and scheduled for surveillance endoscopy at our medical center. Demographic and clinical data were obtained through the medical records, including etiology of cirrhosis, completion of variceal obliteration, attendance at surveillance endoscopy, zip code of primary residence, distance from home to hospital, insurance status, rehospitalization for variceal hemorrhage, beta-blocker at discharge, pharmacologically treated psychiatric disorder, and transplant free survival. RESULTS Of 99 consecutive survivors of esophageal variceal bleeding, the minority(33) completed variceal obliteration and fewer(12) adhered to annual surveillance. Completion of variceal obliteration was associated with fewer rehospitalizations for variceal rebleeding(27% vs 56%, P = 0.0099) and when rehospitalizations occurred, they occurred later in those who had completed obliteration(median 259 d vs 207 d, P = 0.0083). Incomplete adherence to endoscopic surveillance was associated with more rehospitalizations for variceal rebleeding compared to those fully adherent to annual endoscopic surveillance(51% vs 17%, P = 0.0328). Those adherent to annual surveillance were more likely to be insured privately or through Medicare compared to those who did not attend post-hospital discharge endoscopy(100% vs 63%, P = 0.0119).CONCLUSION Most patients do not complete variceal obliteration after index esophageal variceal hemorrhage and fewer adhere to endoscopic surveillance, particularly the uninsured and those insured with Medicaid.展开更多
Introduction: Tuberculosis is a global health problem. Improving medication adherence is an important attribute concerning the outcome of tuberculosis treatment. This study investigates illness experience of patients ...Introduction: Tuberculosis is a global health problem. Improving medication adherence is an important attribute concerning the outcome of tuberculosis treatment. This study investigates illness experience of patients belonging to a low-income district within Manguinhos catchment area. Narrative studies are able to unfold features concerning patient adherence and co-occurrence of depressive symptoms. Methods: Twenty-three patients under treatment were interviewed using McGill Illness Narrative Interview (MINI-McGILL), besides depression screening with “Self-Report Questionnaire-20” (SRQ-20) and “Beck Depression Inventory” (BDI). Results: Explanatory models disregarded airborne microorganism contagion, known but not considered relevant while bohemian or deviant lifestyle was rather perceived as a causal model. Patients mentioned contiguous events suggesting pneumonia or influenza misdiagnosis before final tuberculosis diagnosis (testing or suspicion). Therapeutic pathways were erratic, suggesting low literacy level and postponed or inadequate diagnosis accuracy. Emergency units or private services usually stood for primary care units considered first choice by planners. Expressions such as “dreadful/shameful disease” or “very heavy illness” acknowledged stigma. Research data detected the importance of social network role, highlighting the family through financial and affective support. Hopelessness and depression were closely related to illness suffering and adversities. The percentage of patients for positive common mental disorder and depression approaches 30%. Conclusion: Tuberculosis remains a stigmatizing disease. Building effective health services networks, comprising treatment facilities, community and family resources are very important to improve medication adherence. Effective tuberculosis management through health teams training seems necessary. Incorporating simple screening instruments for depression assessment might promote well-being and patient adherence.展开更多
文摘 AIM:To assess adherence rates to nucleos(t)ide analogues(NUCs) therapy in patients with chronic hepatitis B virus infection and determine factors associated with adherence.METHODS:The questionnaire study was conducted in the liver clinics at Concord Repatriation General Hospital.All patients who were currently taking one or more NUCs were asked to complete a structured,selfadministered 32-item questionnaire.Adherence was measured using visual analogue scales.The patient’s treating clinician was also asked to assess their patient’s adherence via a structured questionnaire.RESULTS:A total of 80 patients completed the questionnaire.Sixty six percent of the patients(n = 49) reported optimal adherence whilst 25(33.8%) graded their adherence to NUCs as suboptimal.Thirty four(43%) patients reported to have omitted taking their NUCs sometime in the past.Recent non-adherence was uncommon.Amongst the patients who reported skipping medications,the most common reason cited was 'forgetfulness'(n = 27,56.25%).Other common reasons included:ran out of medications(n = 5,10.42%),being too busy(n = 4,8.33%) and due to a change in daily routine(n = 5,10.42%).Patients who reported low adherence to other prescription pills were also more likely to miss taking NUCs(P = 0.04).Patients who were under the care of a language-discordant clinician were also more likely to report suboptimal adherence to NUCs(P = 0.04).CONCLUSION:Adherence rates were much less than that expected by the physician and has potential adverse affect on long term outcome.Communication and education appear central and strategies need to be implemented to improve ongoing adherence.
文摘AIM To investigate patient adherence to surveillance endoscopy after index esophageal variceal hemorrhage and the extent to which adherence influences outcomes.METHODS We reviewed the records of patients with cirrhosis admitted to the medical intensive care unit between 2000 and 2014 for first time esophageal variceal hemorrhage treated with endoscopic variceal ligation who were subsequently discharged and scheduled for surveillance endoscopy at our medical center. Demographic and clinical data were obtained through the medical records, including etiology of cirrhosis, completion of variceal obliteration, attendance at surveillance endoscopy, zip code of primary residence, distance from home to hospital, insurance status, rehospitalization for variceal hemorrhage, beta-blocker at discharge, pharmacologically treated psychiatric disorder, and transplant free survival. RESULTS Of 99 consecutive survivors of esophageal variceal bleeding, the minority(33) completed variceal obliteration and fewer(12) adhered to annual surveillance. Completion of variceal obliteration was associated with fewer rehospitalizations for variceal rebleeding(27% vs 56%, P = 0.0099) and when rehospitalizations occurred, they occurred later in those who had completed obliteration(median 259 d vs 207 d, P = 0.0083). Incomplete adherence to endoscopic surveillance was associated with more rehospitalizations for variceal rebleeding compared to those fully adherent to annual endoscopic surveillance(51% vs 17%, P = 0.0328). Those adherent to annual surveillance were more likely to be insured privately or through Medicare compared to those who did not attend post-hospital discharge endoscopy(100% vs 63%, P = 0.0119).CONCLUSION Most patients do not complete variceal obliteration after index esophageal variceal hemorrhage and fewer adhere to endoscopic surveillance, particularly the uninsured and those insured with Medicaid.
文摘Introduction: Tuberculosis is a global health problem. Improving medication adherence is an important attribute concerning the outcome of tuberculosis treatment. This study investigates illness experience of patients belonging to a low-income district within Manguinhos catchment area. Narrative studies are able to unfold features concerning patient adherence and co-occurrence of depressive symptoms. Methods: Twenty-three patients under treatment were interviewed using McGill Illness Narrative Interview (MINI-McGILL), besides depression screening with “Self-Report Questionnaire-20” (SRQ-20) and “Beck Depression Inventory” (BDI). Results: Explanatory models disregarded airborne microorganism contagion, known but not considered relevant while bohemian or deviant lifestyle was rather perceived as a causal model. Patients mentioned contiguous events suggesting pneumonia or influenza misdiagnosis before final tuberculosis diagnosis (testing or suspicion). Therapeutic pathways were erratic, suggesting low literacy level and postponed or inadequate diagnosis accuracy. Emergency units or private services usually stood for primary care units considered first choice by planners. Expressions such as “dreadful/shameful disease” or “very heavy illness” acknowledged stigma. Research data detected the importance of social network role, highlighting the family through financial and affective support. Hopelessness and depression were closely related to illness suffering and adversities. The percentage of patients for positive common mental disorder and depression approaches 30%. Conclusion: Tuberculosis remains a stigmatizing disease. Building effective health services networks, comprising treatment facilities, community and family resources are very important to improve medication adherence. Effective tuberculosis management through health teams training seems necessary. Incorporating simple screening instruments for depression assessment might promote well-being and patient adherence.
