Abstract 146: Medical Home Model in the management of Heart Failure

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Linda Houston-Feenstra ◽  
Kenneth Jutzy ◽  
Reane Larsen
Keyword(s):  
Heart Failure ◽  
Medication Adherence ◽  
Medical Home ◽  
Patient Adherence ◽  
Intervention Group ◽  
Standard Of Care ◽  
Sodium Balance ◽  
Control Group ◽  
Evidence Based ◽  
Ed Visits

Purpose: Heart failure (HF) continues as the most expensive diagnosis to manage in the US. Patient failure to adhere to medication regimens and fluid overload have been identified as causative factors in frequent exacerbations requiring hospitalization. This study was designed to evaluate outcomes over time of a Medical Home interdisciplinary team management and patient education design compared to standard of care in HF. Methods: The study was designed as a prospective case-control study. Enrollment occurred post HF hospitalization. During hospitalization all pts received education in Guideline-driven management of HF, and were discharged on evidence-based medications. Patients provided informed consent allowing review of medical records for 5 years. One group of pts agreed to participate in a Medical Home for the management of HF (MHHF) while another group chose management of HF by their own cardiologists. Data analysis was performed using case controlled pairing of pts based on age, gender and socio-economic status. Data represents results at 48 months. The Intervention group (22 pts: mean age 60.8) was followed in a MHHF which includes a HF specific clinic and a 12 week comprehensive HF management and exercise program (both clinic and HF management program have the same disease management protocols) and the Control group (48 pts: mean age 62.2) returned to standard follow up care for HF. In MHHF medications were optimized per evidence -based recommendations and education included use of medications, diet and effective sodium balance. Results: Functional Capacity Results: Medication adherence/Hospitalizations/ED visits Note: * baseline to 48 months. Hosp. visits = # hospitalizations/yr/ patient, ED Visits = # ED visits/yr/ patient. Medical record review of medication use for Standard of Care pts failed to provide adequate information on dose /patient. **Adherence was often self reported so true adherence may be lower than reported for this group. Conclusions: 1. Patients participating in MHHF demonstrated long-term improvement in medication adherence and smoking cessation. 2. Patients participating in MHHF demonstrated significantly fewer HF related Hospitalizations and ED visits 48 months following their baseline hospitalization.

P578Use of a smartphone application to increase adherence to medical treatment in patients with acute coronary syndrome: a randomized clinical trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C M Garmendia ◽  
P Miranda ◽  
E Verello ◽  
M A Goyeneche ◽  
J F Furmento ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Medical Treatment ◽  
Low Cost ◽  
Intervention Group ◽  
Standard Of Care ◽  
Smartphone Application ◽  
Secondary Outcome ◽  
Control Group ◽  
Post Discharge ◽  
Coronary Syndrome

Abstract Background Adherence to cardiovascular medications following acute coronary syndrome (ACS) hospitalization is generally poor and is associated with increased risk of rehospitalization and mortality. There are still significant opportunities to identify simple and low-cost interventions that improve medication adherence and clinical outcomes. Purpose To evaluate the use of a digital platform for smartphones to improve adherence to medical treatment and outcomes for 90-days post discharge in patients hospitalized for ACS with or without ST-elevation. Methods This was a unicentric, single-blinded, randomized controlled trial enrolling 90 patients with an ACS event requiring hospitalization. The intervention consisted of a smartphone application which allowed for the loading of medication prescription together with reminder of the daily compliance. Patients in the intervention group (n=46) were equipped with the smartphone application. Patients in the control group (n=44) received written and oral instructions as per standard of care. The primary outcome was adherence to medical treatment measured at 90-days post discharge using the 8-item Morisky Medication Adherence Scale (MMAS-8). The secondary outcome was a composite of re-hospitalizations for ACS, consultations to the emergency department (ED), or unplanned visits to the clinic. Results The mean age of the population was 63.2±9.9 and 75.6% were male. At 90 days, 64.7% of patients using the smartphone application were adherent compared with 20.5% of patients in the control group (p<0.001). Patients in the intervention group had higher adherence (mean MMAS-8 score 7.52±1.25) compared with the control group (mean MMAS-8 score 6.47±1.23; p<0.001). The secondary outcome measures showed that there were no significant differences in patients using the smartphone application versus the standard of care (4.3% vs 15.9%, p=0.07, respectively). Table 1 Variables Global (n=90) Control (n=44) Intervention (n=46) p MMAS-8 score 7±1.34 6.47±1.23 7.52±1.25 <0.001 Adherents 40 (44.4%) 9 (20.5%) 31 (67.4%) <0.001 Events 9 (10.1%) 7 (15.9%) 2 (4.3%) 0.071 ED consultations 9 7 2 Score assessment 8.85±1.4 Conclusions In patients with ACS, the use of a smartphone application increased the medication adherence compared with the standard of care. These data suggest that there is potential for a simple, low-cost intervention to help patients adhere to medications. ClinicalTrials.gov unique identifier: NCT03766789.

Abstract 18944: Efficacy of Clinical Notifications to Health Care Providers in Management of Heart Failure Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Reyhaneh M Akhavein ◽  
Jiri Sklenar ◽  
Jessica Minnier ◽  
Stephen Heitner
Keyword(s):  
Heart Failure ◽  
Health Care Providers ◽  
Anticoagulation Therapy ◽  
Intervention Group ◽  
Direct Result ◽  
Control Group ◽  
Evidence Based ◽  
Written Communication ◽  
Care Providers ◽  
Provider Behavior

Introduction: Adherence to guideline recommendations for patients with heart failure improves short and long-term outcomes, and can potentially reduce healthcare costs. Hypothesis: Written communication to care providers of individuals with heart failure with reduced systolic function (HFrEF) will result in better adherence to guidelines. Methods: We prospectively enrolled providers of all outpatients with HFrEF at Oregon Health and Science University in 2012. We reviewed adherence to six evidence-based HF therapies in each patient [ACE-I/ARB, beta blocker, aldosterone antagonist, anticoagulation therapy for atrial fibrillation or flutter, CRT, and ICD]. We excluded patients with destination therapy, resolution of HFrEF, lost to follow-up or death. After implementation of exclusion criteria, of 320 patients evaluated, 114 patients were ultimately included. These patients’ providers were randomized to either receiving a standardized written communication (intervention) or none (control). The letter highlighted 2013 ACCF/AHA heart failure management guidelines, and was sent by US mail to providers in intervention group. Six months later, we re-evaluated all patients according to the same criteria at the outset. Results: Optimal medical therapy (OMT) in intervention group improved in only 9% of patients who were previously sub-optimally treated (p 0.83), but 31% of patients who had already been on OMT experienced deescalated therapies despite no clear documentation (p 0.65). In control group, 11% of patients had increased treatment according to guidelines, and 9% of patients who had already been receiving OMT had deescalated treatment. There were no new ICDs implanted as a result of intervention, while 6.5% of patients in control group did receive ICD (p 0.46). Conclusions: Identification of patients with HFrEF and assessment of adherence to guideline-based therapies is now feasible via electronic medical record enquiry. Written notifications do not result in improved adherence to evidence-based guidelines, nor do these letters seem to alter provider behavior at all. We speculated that the lack of response is a direct result of “notification-fatigue”, and that alternative provider behavior modification techniques need to be evaluated.

scholarly journals Effect of a Virtual Reality-enhanced Exercise and Education Intervention on Patient Engagement and Learning in Cardiac Rehabilitation: Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Victoria Vavala ◽  
Daniel Graves ◽  
Shannon Ames ◽  
Pavitra Krishnamani
Keyword(s):  
Virtual Reality ◽  
Cardiac Rehabilitation ◽  
Patient Adherence ◽  
Controlled Trial ◽  
Intervention Group ◽  
Standard Of Care ◽  
Final Visit ◽  
Control Group ◽  
Satisfaction With Treatment ◽  
And Control

BACKGROUND Cardiac rehabilitation is clinically proven to reduce morbidity and mortality, but many patients do not attend treatment. Those who do attend frequently do not finish their full course of treatment. This is greatly influenced by socioeconomic factors but is also due to patients’ lack of understanding on the importance of their care and a lack of motivation to maintain attendance. OBJECTIVE The goal of this study was to explore the potential benefits of virtual reality (VR) walking trails within cardiac rehabilitation treatment, specifically on patient education retention, satisfaction with treatment, and overall attendance of treatment sessions. METHODS New cardiac rehabilitation patients were enrolled and randomized on a rolling basis to either control or intervention groups. Intervention patients completed time on the treadmill with VR walking trails, including audio recorded education; control patients completed standard of care therapy. Both groups were assisted by nursing staff for all treatment sessions. Primary outcomes were determined by assessing six-minute-walk-test (6MWT) improvement. Additionally, secondary outcomes of patients’ cardiac knowledge and satisfaction were assessed via computer-based questionnaire; patient adherence to recommended number of sessions was also monitored. Cardiac knowledge assessment included a pre-rehabilitation education quiz, the same quiz repeated at their final visit, and again at a 2-month follow up. The satisfaction questionnaire was completed at their final visit. RESULTS Between January 2018 and May 2019, 72 patients were enrolled, 41 to the intervention group and 31 to the control group. Based upon the results of the pre- and post-rehabilitation 6MWT, no differences were seen between intervention and control groups (P = .23). No statistical differences were seen between groups on education (P = .50) or satisfaction (P = .30) at any time point. The control group had statistically more favorable rates of attendance, both by risk group (P = .024) and by completion of minimum sessions (P = .046), but no correlation was seen between study group and reason for ending treatment. CONCLUSIONS While no improvements were seen in the VR intervention group over the control group, it is worth noting that limitations in the study design may have influenced these outcomes, not the medium itself. Furthermore, qualitative information suggests that patients may have indeed enjoyed their experience with VR in a way that the quantitative data in this study may not have captured. Suggested within this paper are further considerations of how and when VR should be applied to cardiac rehabilitation. CLINICALTRIAL ClinicalTrials.gov NCT03945201

Effectiveness of a web-based medication adherence tool with patient centered communication: Results of a clustered randomized controlled trial (Preprint)

2019 ◽  
Author(s):  
Jan van Lieshout ◽  
Joyca Lacroix ◽  
Aart van Halteren ◽  
Martina Teichert
Keyword(s):  
Randomized Controlled Trial ◽  
Medication Adherence ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Community Pharmacies ◽  
Web Based ◽  
Randomized Controlled ◽  
Tailored Interventions ◽  
Increased Risk

BACKGROUND Growing numbers of people use medication for chronic conditions; non-adherence is common, leading to poor disease control. A newly developed web-based tool to identify an increased risk for non-adherence with related potential individual barriers might facilitate tailored interventions and improve adherence. OBJECTIVE To assess the effectiveness of the newly developed tool to improve medication adherence. METHODS A cluster randomized controlled trial assessed the effectiveness of this adherence tool in patients initiating cardiovascular or oral blood glucose lowering medication. Participants were included in community pharmacies. They completed an online questionnaire comprising an assessments of their risk for medication non-adherence and subsequently of barriers to adherence. In pharmacies belonging to the intervention group, individual barriers displayed in a graphical profile on a tablet were discussed by pharmacists and patients at high non-adherence risk in face to face meetings and shared with their general practitioners and practice nurses. Tailored interventions were initiated by the healthcare providers. Barriers of control patients were not presented or discussed and these patients received usual care. The primary outcome was the difference in medication adherence at 8 months follow-up between patients with an increased non-adherence risk from intervention and control group, calculated from dispensing data. RESULTS Data from 492 participants in 15 community pharmacies were available for analyses (intervention 253, 7 pharmacies; control 239, 8 pharmacies). The intervention had no effect on medication adherence (-0.01; 95%CI -0.59 – 0.57; P= .96), neither in the post hoc per protocol analysis (0.19; 95%CI -0.50 – 0.89; P=.58). CONCLUSIONS This study showed no effectiveness of a risk stratification and tailored intervention addressing personal barriers for medication adherence. Various potential explanations for lack of effect were identified. These explanations relate for instance to high medication adherence in the control group, study power and fidelity. Process evaluation should elicit possible improvements and inform the redesign of intervention and implementation. CLINICALTRIAL The Netherlands National Trial Register: NTR5186. Date: May 18, 2015 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5186)

A patient-centered mobile intervention to promote self-management and improve patient outcomes in chronic heart failure: The ManageHF4Life trial (Preprint)

2020 ◽  
Author(s):  
Michael P. Dorsch ◽  
Karen B. Farris ◽  
Brigid E. Rowell ◽  
Scott L. Hummel ◽  
Todd M. Koelling
Keyword(s):  
Heart Failure ◽  
Mobile Application ◽  
Controlled Trial ◽  
Intervention Group ◽  
Self Care ◽  
Self Management ◽  
Control Group ◽  
Patient Centered ◽  
Self Monitoring ◽  
Heart Failure Questionnaire

BACKGROUND Successful management of heart failure (HF) involves guideline based medical therapy as well as self-care behavior. As a result, the management of HF is moving toward a proactive real-time technological model of assisting patients with monitoring and self-management. OBJECTIVE Evaluate the effectiveness of a mobile application intervention that enhances self-monitoring on health-related quality of life, self-management, and reduces HF readmissions. METHODS A single-center randomized controlled trial was performed. Patients greater than 45 years of age and admitted for acute decompensated HF or recently discharged in the past 4 weeks were included. The intervention group used a mobile application (App). The intervention prompted daily self-monitoring and promoted self-management. The control group (No App) received usual care. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) from baseline to 6 and 12 weeks. Secondary outcomes were the Self-Care Heart Failure Index (SCHFI) questionnaire and recurrent HF admissions. RESULTS Eighty-three patients were enrolled and completed all baseline assessments. Baseline characteristics were similar between groups with the exception of HF etiology. The App group had a reduced MLHFQ at 6 weeks (37.5 ± 3.5 vs. 48.2 ± 3.7, P=0.039) but not at 12 weeks (44.2 ± 4 vs. 45.9 ± 4, P=0.778) compared to No App. There was no effect of the App on the SCHFI at 6 or 12 weeks. The time to first HF admission was not statistically different between the App versus No App groups (HR 0.89, 95% CI 0.39-2.02, P=0.781) over 12 weeks. CONCLUSIONS The mobile application intervention improved MLHFQ at 6 weeks, but did not sustain its effects at 12 weeks. No effect was seen on HF self-care. Further research is needed to enhance engagement in the application for a longer period of time and to determine if the application can reduce HF admissions in a larger study. CLINICALTRIAL NCT03149510

scholarly journals Benefit of a pharmacist-led intervention for medication management of renal transplant patients: a controlled before-and-after study

2021 ◽  
Vol 12 ◽  
pp. 204062232110052
Author(s):  
Jeremy Chambord ◽  
Lionel Couzi ◽  
Pierre Merville ◽  
Karine Moreau ◽  
Fabien Xuereb ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Immunosuppressive Therapy ◽  
Medication Management ◽  
Intervention Group ◽  
Knowledge Score ◽  
Control Group ◽  
Patient Knowledge ◽  
Transplant Patients ◽  
Before And After ◽  
High Level

Aims: To assess the effect of a pharmacist-led intervention, using Barrows cards method, during the first year after renal transplantation, on patient knowledge about their treatment, medication adherence and exposure to treatment in a French cohort. Methods: We conducted a before-and-after comparative study between two groups of patients: those who benefited from a complementary pharmacist-led intervention [intervention group (IG), n = 44] versus those who did not [control group (CG), n = 48]. The pharmacist-led intervention consisted of a behavioral and educational interview at the first visit (visit 1). The intervention was assessed 4 months later at the second visit (visit 2), using the following endpoints: treatment knowledge, medication adherence [proportion of days covered (PDC) by immunosuppressive therapy] and tacrolimus exposure. Results: At visit 2, IG patients achieved a significantly higher knowledge score than CG patients (83.3% versus 72.2%, p = 0.001). We did not find any differences in treatment exposure or medication adherence; however, the intervention tended to reduce the proportion of non-adherent patients with low knowledge scores. Using the PDC by immunosuppressive therapy, we identified 10 non-adherent patients (10.9%) at visit 1 and six at visit 2. Conclusions: Our intervention showed a positive effect on patient knowledge about their treatment. However, our results did not show any improvement in overall medication adherence, which was likely to be because of the initially high level of adherence in our study population. Nevertheless, the intervention appears to have improved adherence in non-adherent patients with low knowledge scores.

scholarly journals Assessment of the impact of an opioid-specific education series on rates of medication-assisted treatment for opioid use disorder in veterans

2020 ◽  
Author(s):  
Taylor Kirby ◽  
Robert Connell ◽  
Travis Linneman
Keyword(s):  
Multivariate Analysis ◽  
Hospital Admission ◽  
Intervention Group ◽  
Opioid Use Disorder ◽  
Control Group ◽  
Opioid Use ◽  
Motivation To Change ◽  
Heroin Use ◽  
Ed Visits ◽  
The Impact

Abstract Purpose The impact of a focused inpatient educational intervention on rates of medication-assisted therapy (MAT) for veterans with opioid use disorder (OUD) was evaluated. Methods A retrospective cohort analysis compared rates of MAT, along with rates of OUD-related emergency department (ED) visits and/or hospital admission within 1 year, between veterans with a diagnosis of OUD who completed inpatient rehabilitation prior to implementation of a series of group sessions designed to engage intrinsic motivation to change behavior surrounding opioid abuse and provide education about MAT (the control group) and those who completed rehabilitation after implementation of the education program (the intervention group). A post hoc, multivariate analysis was performed to evaluate possible predictors of MAT use and ED and/or hospital readmission, including completion of the opioid series, gender, age (&gt;45 years), race, and specific prior substance(s) of abuse. Results One hundred fifty-eight patients were included: 95 in the control group and 63 in the intervention group. Rates of MAT were 25% (24 of 95 veterans) and 75% (47 of 63 veterans) in control and intervention groups, respectively (P &lt; 0.01). Gender, completion of the opioid series, prior heroin use, and marijuana use met prespecified significance criteria for inclusion in multivariate regression modeling of association with MAT utilization, with participation in the opioid series (odds ratio [OR], 9.56; 95% confidence interval [CI], 4.36-20.96) and prior heroin use (OR, 3.26; 95% CI, 1.18-9.01) found to be significant predictors of MAT utilization on multivariate analysis. Opioid series participation and MAT use were independently associated with decreased rates of OUD-related ED visits and/or hospital admission (hazard ratios of 0.16 [95% CI, 0.06-0.44] and 0.32 [95% CI, 0.14-0.77], respectively) within 1 year after rehabilitation completion. Conclusion Focused OUD-related education in a substance abuse program for veterans with OUD increased rates of MAT and was associated with a decrease in OUD-related ED visits and/or hospital admission within 1 year.

Motivational Interviewing to Support Oral AntiCoagulation adherence in patients with non-valvular Atrial Fibrillation (MISOAC-AF): a randomised clinical trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Tzikas ◽  
A Samaras ◽  
A Kartas ◽  
D Vasdeki ◽  
G Fotos ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Medication Adherence ◽  
Medical Care ◽  
Oral Anticoagulation ◽  
Intervention Group ◽  
Control Group ◽  
Motivational Intervention ◽  
Clinical Events ◽  
Secondary Outcomes

Abstract Background Oral anticoagulation (OAC) is paramount to effective thromboprophylaxis; yet adherence to OAC remains largely suboptimal in patients with atrial fibrillation (AF). Purpose We aimed to assess the impact of an educational, motivational intervention on the adherence to OAC in patients with non-valvular AF. Methods Hospitalised patients with non-valvular AF who received OAC were randomly assigned to usual medical care or a proactive intervention, comprising motivational interviewing and tailored counseling on medication adherence. The primary study outcome was adherence to OAC at 1-year, evaluated as Proportion of Days Covered (PDC) by OAC regimens and assessed through nationwide prescription registers. Secondary outcomes included the rate of persistence to OAC, gaps in treatment, proportion of VKA-takers with labile INR (defined as time to therapeutic range&lt;70%) and clinical events. Results A total of 1009 patients were randomised, 500 in the intervention group and 509 in the control group. At 1-year follow-up, 77.2% (386/500) of patients in the intervention group had good adherence (PDC&gt;80%), compared with 55% (280/509) in the control group (adjusted odds ratio 2.84, 95% confidence interval 2.14–3.75; p&lt;0.001). Mean PDC±SD was 0.85±0.26 and 0.75±0.31, respectively (p&lt;0.001). Patients that received the intervention were more likely to persist in their OAC therapy at 1 year, while usual medical care was associated with more major (≥3 months) treatment gaps [Figure]. Among 212 VKA-takers, patients in the intervention group were less likely to have labile INR compared with those in the control group [21/120 (17.1%) vs 34/92 (37.1%), OR 0.33 95% CI 1.15–0.72, p=0.005]. Clinical events over a median follow-up period of 2 years occurred at a numerically lower, yet non-significant, rate in the intervention group [Table]. Conclusions In patients receiving OAC therapy for non-valvular AF, a motivational intervention significantly improved patterns of medication adherence, without significantly affecting clinical outcomes. Primary and secondary outcomes Funding Acknowledgement Type of funding source: None

scholarly journals POS0058-PARE INCREASING PREECLAMPSIA KNOWLEDGE IN SLE WITH A SPECIFIC EDUCATIONAL TOOL: PRELIMINARY RESULTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 235.2-235
Author(s):  
J. Y. E. Lee ◽  
A. Mendel ◽  
I. Malhamé ◽  
S. Bernatsky ◽  
E. Vinet
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Pregnant Women ◽  
Lupus Erythematosus ◽  
Intervention Group ◽  
Standard Of Care ◽  
Vulnerable Population ◽  
Control Group ◽  
Educational Tool ◽  
Second Trimester ◽  
Systemic Lupus

Background:Pregnant women with systemic lupus erythematosus (SLE) are at high risk of preeclampsia, leading to substantial maternal and fetal morbidity. Aspirin reduces preeclampsia risk but recent studies suggest aspirin is used only in a minority of SLE pregnancies. There is an urgent need to improve preeclampsia counselling and management in this vulnerable population.Objectives:We are conducting the PREPARE (PREeclamPsia knowledge & Aspirin adheRence in lupus prEgnancies) trial, a randomized controlled trial (RCT) evaluating an educational tool on preeclampsia knowledge and aspirin adherence among pregnant women with SLE. We present preliminary analyses of the effect of this tool on preeclampsia knowledge.Methods:Consecutive pregnant SLE women are recruited until the 16th gestational week at 5Canadian Systemic Lupus International Collaborating Clinics centres (i.e. Montreal, Halifax, Quebec, Winnipeg, and Calgary) since 05/2018. Subjects are randomly assigned to receive either the specifically-designed educational tool (intervention group) or standard of care (control group). At baseline (i.e. first trimester) and second trimester visits, the participants complete self-administered preeclampsia knowledge questionnaires (scored out of 30 by the research team blinded to the intervention). We restricted the current analysis to participants enrolled in Montreal (accounting for nearly half of the total planned sample size). We performed a univariate linear regression analysis to assess the effect of the educational tool on preeclampsia knowledge (i.e. mean score difference between the two groups from baseline to second trimester visit).Results:Thirty-three pregnant SLE women were included in the study, among which 16 were exposed to the intervention and 17 were unexposed. Baseline characteristics were well balanced between the two groups with similar mean maternal age between intervention group (32.2 years, standard deviation, SD, 4.6) and control group (34.1 years, SD 4.2) and identical proportion of subjects with post-secondary education (i.e. 80%). The difference in mean preeclampsia knowledge scores between second trimester and baseline visits in the intervention group was 4.4 points (95% CI -0.1, 9.0) and in the control group was 1.5 points (95% CI -2.7, 5.7). The mean difference in knowledge scores (from baseline to second trimester) for those receiving the educational tool was 2.7 points higher (95% CI -1.5, 6.9) than those receiving standard of care.Conclusion:Approximately midway into the PREPARE trial, we observed a trend for improvement in preeclampsia knowledge from the baseline to the second trimester visit in pregnant women with SLE who received a specifically-designed educational tool compared to the control group, although the CIs included the null. Our RCT is well-poised to provide a new evidence-based approach to improve preeclampsia knowledge in pregnant women with SLE, which could help to optimize aspirin use and outcomes in this vulnerable population.References:[1]Schramm AM, Clowse ME. Aspirin for prevention of preeclampsia in lupus pregnancy. Autoimmune Dis. 2014;2014:920467. doi:10.1155/2014/920467[2]Bujold E, Roberge S, Lacasse Y, et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol. 2010;116(2 Pt 1):402-414. doi:10.1097/AOG.0b013e3181e9322a[3]Andreoli L, Bertsias GK, Agmon-Levin N, et al. EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis. 2017 Mar;76(3):476–85. doi: 10.1136/annrheumdis-2016-209770.[4]Mendel A, Bernatsky SB, Hanly JG, et al. Low aspirin use and high prevalence of preeclampsia risk factors among pregnant women in a multinational SLE inception cohort. Ann Rheum Dis. 2019;78(7):1010-1012. doi:10.1136/annrheumdis-2018-214434Disclosure of Interests:None declared.

scholarly journals 83 A Medication Self-Management Intervention to Improve Medication Adherence For Older People with Multimorbidity: A Pilot Study

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
C Yang ◽  
Z Hui ◽  
S Zhu ◽  
X Wang ◽  
G Tang ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Pilot Study ◽  
Older People ◽  
Intervention Group ◽  
Self Management ◽  
Control Group ◽  
Medication Knowledge ◽  
Management Intervention ◽  
Patient Reported

Abstract Introduction Medication self-management support has been recognised as an essential element in primary health care to promote medication adherence and health outcomes for older people with chronic conditions. A patient-centred intervention empowering patients and supporting medication self-management activities could benefit older people. This pilot study tested a newly developed medication self-management intervention for improving medication adherence among older people with multimorbidity. Method This was a two-arm randomised controlled trial. Older people with multimorbidity were recruited from a community healthcare centre in Changsha, China. Participants were randomly allocated to either a control group receiving usual care (n = 14), or to an intervention group receiving three face-to-face medication self-management sessions and two follow-up phone calls over six weeks, targeting behavioural determinants of adherence from the Information-Motivation-Behavioural skills model (n = 14). Feasibility was assessed through recruitment and retention rates, outcome measures collection, and intervention implementation. Follow-up data were measured at six weeks after baseline using patient-reported outcomes including medication adherence, medication self-management capabilities, treatment experiences, and quality of life. Preliminary effectiveness of the intervention was explored using generalised estimating equations. Results Of the 72 approached participants, 28 (38.89%) were eligible for study participation. In the intervention group, 13 participants (92.86%) completed follow-up and 10 (71.42%) completed all intervention sessions. Ten participants (71.42%) in the control group completed follow-up. The intervention was found to be acceptable by participants and the intervention nurse. Comparing with the control group, participants in the intervention group showed significant improvements in medication adherence (β = 0.26, 95%CI 0.12, 0.40, P &lt; 0.001), medication knowledge (β = 4.43, 95%CI 1.11, 7.75, P = 0.009), and perceived necessity of medications (β = −2.84, 95%CI -5.67, −0.01, P = 0.049) at follow-up. Conclusions The nurse-led medication self-management intervention is feasible and acceptable among older people with multimorbidity. Preliminary results showed that the intervention may improve patients’ medication knowledge and beliefs and thus lead to improved adherence.

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