scholarly journals Making medications stick: improving medication adherence by highlighting the personal health costs of non-compliance

2019 ◽  
pp. 1-21 ◽  
Author(s):  
JON M. JACHIMOWICZ ◽  
JOE J. GLADSTONE ◽  
DAN BERRY ◽  
CHARLOTTE L. KIRKDALE ◽  
TRACEY THORNLEY ◽  
...  
Keyword(s):  
Public Health ◽  
Medication Adherence ◽  
Controlled Trial ◽  
Prescription Medication ◽  
Cost Effective ◽  
Public Health Care ◽  
Health Costs ◽  
Personal Health ◽  
Health Crisis ◽  
Comparison Groups

AbstractPoor compliance of prescription medication is an ongoing public health crisis. Nearly half of patients do not take their medication as prescribed, harming their own health while also increasing public health care costs. Despite these detrimental consequences, prior research has struggled to establish cost-effective and scalable interventions to improve adherence rates. We suggest that one reason for the limited success of prior interventions is that they make the personal health costs of non-adherence insufficiently prominent, while a higher saliency of these costs may motivate patients to adhere more. In the current research, we test whether an intervention that makes the personal health costs of non-compliance more salient for patients will increase their medication adherence. To do so, we conducted a randomized controlled trial with 16,191 patients across 278 UK pharmacies over a 9-month time period and manipulated the perceived consequences of medication non-adherence. We find that patients who received a treatment highlighting the personal health costs of non-compliance were significantly more likely to adhere to their medication than three comparison groups (odds ratio = 1.84, 95% confidence interval = 1.37–2.47). Shifting patients’ focus to the personal health costs of non-compliance may thus offer a potentially cost-effective and scalable approach to improving medication adherence.

Risking Lives to Save Others During COVID-19: A Focus on Public Health Care Workers in Bangladesh and Egypt

2021 ◽  
pp. 002073142110637
Author(s):  
Shahjahan Bhuiyan
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Workers ◽  
Health Workers ◽  
Public Health Care ◽  
Altruistic Behavior ◽  
Ongoing Research ◽  
Health Crisis ◽  
Street Level ◽  
Care Workers

The coronavirus (COVID-19) pandemic has been spreading around the world, causing a major public health crisis that has already claimed hundreds of thousands of lives. Street-level bureaucrats­—health workers, teachers, street cleaners, police officers­, and so forth—are at the forefront in fighting against the pandemic. Of these, public health care workers, due to the nature of their involvement, should know and understand why they are risking their lives to save others during this pandemic. Based on the preliminary data gleaned from interviews with public health care workers in Bangladesh and Egypt, this ongoing research suggests they are risking their lives for reasons such as altruistic behavior, service to profession, adherence to bureaucratic accountability, and a desire to help mankind. The findings contribute to the existing literature about street-level bureaucratic behavior in atypical times such as these of the pandemic. This study is unique in that it comprehends that public health care workers of two culturally and geographically distinct countries are risking their lives for the same public-spirited cause.

scholarly journals Prevention of developmental delays among children at public healthcare facilities of Pakistan: protocol for a cluster Randomized Controlled Trial

2021 ◽  
Vol 20 (11) ◽  
Author(s):  
Nida Khan ◽  
Muhammad Amir Khan ◽  
Muhammad Ahmar Khan ◽  
Amna Ejaz ◽  
Azza Warraitch ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Randomized Controlled Trial ◽  
Developmental Delays ◽  
Controlled Trial ◽  
Cluster Randomized Controlled Trial ◽  
Public Health Care ◽  
Public Healthcare ◽  
Randomized Controlled ◽  
Cluster Randomized

Objectives: This cluster Randomized Controlled Trial (cRCT) aims to evaluate the effectiveness of an integrated ECD package in preventing developmental delays among children aged two years, in public health care centers, as compared to a control arm. Methods: This is a parallel, two-arm, cluster randomized controlled trial. 768 mother-child pairs (‘dyads’) attending any of the 24-public health centers in two districts of Pakistan will be recruited, with an average of 32 participants per cluster. In the intervention arm, ECD based counselling sessions will be delivered to mother–child dyads by trained staff at public health care centers. Our primary outcome is reduction in prevalence of two or more developmental delays among children, from 38% to 23% in the intervention arm. Unit of randomization will be public health care center. 24 eligible clusters recruited will be randomized into intervention and control arms, using 1:1 allocation. Discussion: The integrated model of child care into primary health care has the potential to provide a feasible and sustainable model for improving child developmental scale. Key words: Early Child Development; Prevention; Developmental Delays; Public healthcare facilities

Gene Drives and Genome Modification in Nonhuman Animals: A Concern for Informed Consent?

2018 ◽  
Vol 28 (1) ◽  
pp. 93-99
Author(s):  
JOANNA SMOLENSKI
Keyword(s):  
Public Health ◽  
Informed Consent ◽  
Scientific Community ◽  
Cost Effective ◽  
Ongoing Research ◽  
Health Crisis ◽  
Genome Modification ◽  
Nonhuman Animals ◽  
Experimental Treatments ◽  
Gene Drives

Abstract:In recent years, CRISPR-Cas9 has become one of the simplest and most cost-effective genetic engineering techniques among scientists and researchers aiming to alter genes in organisms. As Zika came to the fore as a global health crisis, many suggested the use of CRISPR-Cas9 gene drives in mosquitoes as a possible means to prevent the transmission of the virus without the need to subject humans to risky experimental treatments. This paper suggests that using gene drives or other forms of genome editing in nonhumans (like mosquitos) for the purposes of disease prevention raises important issues about informed consent. Additionally, it examines the consequences this line of inquiry could have for the use of gene drives as a tool in public health and suggests that the guidance offered by informed consent protocols could help the scientific community deploy gene drives in a way that ensures that ongoing research is consistent with our ethical priorities.

A trinidadian cardiovascular medication adherence survey: the ADHERE TNT study

2017 ◽  
Vol 4 (10) ◽  
pp. 3601 ◽  
Author(s):  
Naveen Seecheran ◽  
Neval Nandlal ◽  
Sushanta Nankissoon ◽  
Cherisse Nancoo ◽  
Caniecea Nelson ◽  
...  
Keyword(s):  
Public Health ◽  
Medication Adherence ◽  
Trinidad And Tobago ◽  
Health Sector ◽  
Tertiary Hospital ◽  
Public Health Care ◽  
Sample Population ◽  
Cross Sectional ◽  
Level Of Education ◽  
Cardiovascular Medication

Background: This study aims to quantitatively estimate the level of cardiovascular medication adherence in Trinidad’s public health sector and to determine any correlating factors. The study was of a descriptive, cross-sectional design which was performed at a cardiology outpatient clinic located at a northern-central public health care tertiary hospital in Trinidad during the period November 2016 to June 2017. Methods: 595 persons in total were asked to participate, of whom, 535 agreed. Patients that were younger under the age of 18 years and those that declined participation were excluded from the study. Primary endpoints were the percentages of low, medium and high cardiovascular medication adherence. Secondary endpoints were the comorbidity prevalence rates and prevalence of cardiovascular medications prescribed to patients. Results: In total, 595 individuals were asked to participate in the study; of whom, 535 agreed with a resultant 90% response rate. The mean age of the sample population was 63.5 years. Approximately half of the respondents were females and over 75% had only primary and secondary level of education combined as well as a monthly income of <$5,000 Trinidad and Tobago dollars (TTD). Almost 75% of study participants had low and medium adherence levels, and conversely a little more than one-quarter had high adherence levels. There were no significant associations between adherence and any other demographic factor, however there was near-significance with respect to adherence and level of education (p= 0.061). Conclusions: Patients generally displayed a limited level of cardiovascular medication adherence which is likely to translate into a higher rate of cardiovascular events with their potentially devastating sequalae. This study underscores the imperative need of implementing comprehensive interventions to accentuate cardiovascular medication adherence in Trinidad and Tobago. Further comparable studies with reference national data are required to validate these findings. 

PTSD in Active Combat Soldiers: To Treat or Not to Treat

2014 ◽  
Vol 42 (2) ◽  
pp. 161-170 ◽  
Author(s):  
Bethany C. Wangelin ◽  
Peter W. Tuerk
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Health Care ◽  
Health Care Services ◽  
Treatment Strategies ◽  
Cost Effective ◽  
Public Health Care ◽  
Care Utilization ◽  
Care Services ◽  
Cost Effective Treatment

Treatment of military-related posttraumatic stress disorder (PTSD) is a major public health care concern. Since 2001 over 2.5 million troops have been deployed to Iraq or Afghanistan, many of whom have experienced direct combat and sustained threat. Estimates of PTSD rates related to these wars range from 8% to over 20%, or 192,000 to 480,000 individuals. Already, nearly 250,000 service members of Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND) have sought VA health care services for PTSD. This recent increased need for mental health services comes in addition to the ongoing needs of Vietnam-era and other veterans who continue to suffer from PTSD. PTSD is related to high co-morbidities of other mental health difficulties, poorer physical health status, and increased medical care utilization. Such high demand for services is an important contributor to the large cost associated with combat-related PTSD. Accordingly, promoting successful, cost-effective treatment strategies for PTSD is a chief public health care priority.

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