Adherence (medicine) - Wikipedia
Primary medication non-adherence is caused by cost and patients' mental There is a clear relationship between rising prices and non-adherence. According to Community Catalyst, both doctors and patients are often in. That negative attitudes to doctors was a stronger predictor of nonadherence than however, these studies often do not assess the patient-doctor relationship. It is clear that physicians understand that medication adherence is company needs to use the doctor-patient relationship to reinforce its.
In fact, it is thought to be at the core of the doctor-patient relationship and a critical component of modern quality care [ 14 ]. This relationship is also thought to be associated with important health-related outcomes. For instance, a collaborative doctor-patient relationship has previously been emphasized as critical to adherence in medical patients [ 5 ]. Thus, the questionnaire examined in the present study first aims at providing an efficient instrument that can be used among patients with a chronic illness, whereby medication adherence is paramount to treatment success and survival.
HIV is one such illness. To date, mounting evidence has established a positive association between different components of the doctor-patient relationship and adherence behaviors among HIV-infected patients receiving antiretroviral therapy [ 6 - 15 ]. Overall, trust has consistently emerged as the most common correlate of adherence [ 671213 ] along with communication with the doctor [ 17 ] and accessibility [ 916 ]. Studies conducted among other medical populations have emphasized this relationship as well [ 1819 ], consequently giving this observation more credence.
Most of the evidence accumulated to date has relied on crosssectional studies, thus leaving a void for prospective studies to elucidate the proposed causal links. In addition, the range of health outcomes examined in relation to the doctor-patient relationship should be expanded beyond adherence, as suggested by a recent meta-analysis that highlighted the impact of the doctor-patient relationship on both subjective and objective health outcomes across diverse medical conditions [ 20 ].
Methods Overview Two studies were conducted as part of this investigation. Lauderdale and Los Angeles areas. Participants were included if they were HIV positive. Exclusion criteria included being under 18, being diagnosed with another life threatening illness, taking medications affecting stress hormones e.
[Full text] Patient–doctor relationship and adherence to capecitabine in out | PPA
All participants provided written informed consent prior to entering the study. Studies procedures were approved by the Institutional Review Board. The first study was a cross sectional study comparing a group of long survivors to normal course controls on psychosocial and biological variables, and medical outcomes for a study on stress and coping with HIV [ 22 ]. When followed longitudinally, normal course controls may become long survivors, this group thus represents a conservative control group.Two Minutes: What’s the Risk? Physicians Under Pressure: Non-Compliant Patients
Participants completed questionnaires including the DPR: Study 2 was a sub-study of Study 1 that prospectively followed the normal course controls mentioned above for a year. For this sub-study, all materials, including psychosocial questionnaires, clinical interview, and blood sample, were collected at the entry of the study and at a 1-year follow up.
We hypothesized that poorer patient—doctor relationship would be related to negative beliefs about cancer medication, lower satisfaction with information about medication, and lower adherence rates. Exploring those associations and identifying possible opportunities for improvement can help health care professionals to enhance services related to prescribing medicines such as capecitabine in order to ameliorate adherence.
Subjects and methods Participants The study design was a cross-sectional single center study. These units started to cooperate just recently and our commitment was to monitor adherence from the outset.
Participants were recruited from September 1, to March 1, They were able to participate in this trial after providing written informed consent. Lower scores are interpreted as indicators of lower levels of adherent behavior.
The Satisfaction with Information about Medicines Scale SIMS is a questionnaire aiming at evaluating the extent to which patients feel satisfied with the information they have received about prescribed drugs.
Participants can assess the amount of information they have received according to the following response categories: There are 3 levels of response analysis: A range from 0 to 17 is covered, with high scores standing for a high degree of overall satisfaction with the amount of information received on the medication. Individual item scores within both scales are summed up. Thus, total scores for the Necessity and Concerns Scales range from 5 to Higher scores indicate stronger beliefs; scores above This differential can be thought of as the cost—benefit analysis for each patient, for whom costs concerns are weighed against their perceived benefits necessity beliefs.
Patients were invited to score their perceived burden of common side effects on a visual analog scale with a range from 0 not at all to maximum.
Statistical analyses The data were mainly at ordinal or categorical level or did not follow a normal distribution. Hence, non-parametric testing was employed. SPSS version 24 was used for data analysis.
For categorical parameters, absolute and relative frequencies were reported.
Multivariate logistic regression models were used to identify the independent factors associated with adherence to capecitabine, with adjustments for age, gender and time since diagnosis.
Results Sociodemographics and clinical data Sixty-four patients completely filled in their questionnaires.
Non-adherence to medication and doctor-patient relationship: Evidence from a European survey.
Table 1 also presents relevant clinical data for the sample population. Participants were mostly in their second year from cancer diagnosis and in their first year of capecitabine treatment. Figure 1 presents the extent to which participants declared to feel troubled by the side effects most frequently reported. N neg, no regional lymph node metastases; T1, tumor invades submucosa; N pos, metastasis to regional lymph nodes; T2, tumor invades muscularis propria; T3, tumor invades through the muscularis propria into the pericolorectal tissues; M neg, no distant metastasis; M pos, metastasis to distant organs; T4, tumor penetrates visceral peritoneum or invades to other organs or structures; TX, primary tumor cannot be assessed; Cap, capecitabine.
Figure 1 Perceived burden of side effects on a visual analog scale VAS, 0— Adherence Thirteen participants reported non-adherence, and 2 of them reported multiple methods of deviation.
Participants reporting non-adherent behavior and those reporting no deviation did not differ significantly in demographic or clinical characteristics. The necessity—concerns differential yielded negative results for 13 participants, indicating that concerns regarding oral anticancer therapy outweighed necessity beliefs. The strongest concerns referred to long term effects of capecitabine intake Figures S2 and S3.
Satisfaction with information about medicines Figure 2 demonstrates the distribution of responses of the SIMS. Eleven participants reported complete satisfaction with the information provided about capecitabine therapy. The median of the subscale on potential problems of medication was 5 IQR 4—7. Potential predictors of outcome measures Sociodemographic variables, clinical variables including side effects and adherence did not correlate significantly Tables 2 and 3.
Furthermore, there were no significant correlations between the PDRQ-9 single item score and adherence.
These results illustrate that patients who were more satisfied with the patient—doctor relationship were generally more satisfied with the information received about their medicine. Those patients also reported greater satisfaction with the received information about action, usage and potential problems of their medication.
Two logistic regression models were investigated, both with adherence as dependent variable. There were no confounding factors adjusted for as we found no significant correlations between sociodemographic and medical variables with adherence in our sample.
The Cause and Effect of Patient Non-Adherence
The requirements of logistic regression no multicollinearity, no outliers, log linearity were checked with appropriate methods and were met in both models. Table 4 Logistic regression model on adherence with sum scores as predictors. Table 5 Logistic regression model on adherence with subscores as predictors.
Discussion We initiated a survey on the associations between the patient—doctor relationship and beliefs or satisfaction with information about capecitabine in a sample of outpatients treated with oral capecitabine in the clinical setting of a German Comprehensive Cancer Center. Sixty-four percent of patients received capecitabine as a monotherapy. The mean time since tumor diagnosis and start of capecitabine therapy was 19 and 7 months, respectively.