Improving Tuberculosis Treatment Adherence Support: The Case for Targeted Behavioral Interventions

2021 ◽  
Author(s):  
Justin J. Boutilier ◽  
Jónas Oddur Jónasson ◽  
Erez Yoeli
Keyword(s):  
At Risk ◽  
Treatment Adherence ◽  
Patient Engagement ◽  
Behavioral Interventions ◽  
Controlled Trial ◽  
Problem Definition ◽  
Short Term Treatment ◽  
Adherence Support ◽  
Risk Patients ◽  
The Impact

Problem definition: Lack of patient adherence to treatment protocols is a main barrier to reducing the global disease burden of tuberculosis (TB). We study the operational design of a treatment adherence support (TAS) platform that requires patients to verify their treatment adherence on a daily basis. Academic/practical relevance: Experimental results on the effectiveness of TAS programs have been mixed; and rigorous research is needed on how to structure these motivational programs, particularly in resource-limited settings. Our analysis establishes that patient engagement can be increased by personal sponsor outreach and that patient behavior data can be used to identify at-risk patients for targeted outreach. Methodology: We partner with a TB TAS provider and use data from a completed randomized controlled trial. We use administrative variation in the timing of peer sponsor outreach to evaluate the impact of personal messages on subsequent patient verification behavior. We then develop a rolling-horizon machine learning (ML) framework to generate dynamic risk predictions for patients enrolled on the platform. Results: We find that, on average, sponsor outreach to patients increases the odds ratio of next-day treatment adherence verification by 35%. Furthermore, patients’ prior verification behavior can be used to accurately predict short-term (treatment adherence verification) and long-term (successful treatment completion) outcomes. These results allow the provider to target and implement behavioral interventions to at-risk patients. Managerial implications: Our results indicate that, compared with a benchmark policy, the TAS platform could reach the same number of at-risk patients with 6%–40% less capacity, or reach 2%–20% more at-risk patients with the same capacity, by using various ML-based prioritization policies that leverage patient engagement data. Personal sponsor outreach to all patients is likely to be very costly, so targeted TAS may substantially improve the cost-effectiveness of TAS programs.

scholarly journals Improved adherence with Medicines Use Review service in Slovenia: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Urška Nabergoj Makovec ◽  
Igor Locatelli ◽  
Mitja Kos
Keyword(s):  
Medication Adherence ◽  
Controlled Trial ◽  
Test Group ◽  
Multiple Linear Regression Model ◽  
Relative Difference ◽  
Control Group ◽  
Adherence Support ◽  
Medicines Use ◽  
The Impact ◽  
Medicines Use Review

Abstract Background Based on several existing patient-oriented activities, Medicines Use Review (MUR) service was standardized and officially adopted in Slovenia in 2015. Service aims to provide adherence support and ensure safe and effective medicines use. Therefore, the aim of the study was to evaluate the benefits of MUR in Slovenia, primarily the impact on medication adherence. Methods A randomised controlled trial was performed in community pharmacies to compare MUR with standard care. Patients were randomised into either the test (patients received MUR by a certified MUR provider at visit 1), or control group. The study primary outcome was self-reported adherence to multiple medications, assessed by electronic ©Morisky Widget MMAS-8 Software at the first visit (V1) and after 12 weeks (V2). A sub-analysis of intentional and unintentional non-adherence was performed. MUR impact was defined as the relative difference in ©MMAS-8 score after 12 weeks between the test and control group. A multiple linear regression model was used to predict MUR impact based on baseline adherence (low versus medium and high). Several secondary outcomes (e.g. evaluation of drug-related problems (DRPs)) were also assessed. Results Data from 153 (V1) and 140 (V2) patients were analysed. Baseline adherence was low, moderate and high in 17.6, 48.4 and 34.0% patients, respectively. In the low adherence subpopulation, test group patients showed a 1.20 point (95% CI = 0.16–2.25) increase in total ©MMAS-8 score (p = 0.025) compared to control group patients. A 0.84 point (95% CI = 0.05–1.63) increase was due to intentional non-adherence (p = 0.038), and a 0.36 point (95% CI = − 0.23-0.95) was due to unintentional non-adherence (p = 0.226). Additionally, statistically significant decrease in the proportion of patients with manifested DRPs (p < 0.001) and concerns regarding chronic medicines use (p = 0.029) were revealed. Conclusion MUR service in Slovenia improves low medication adherence and is effective in addressing DRPs and concerns regarding chronic medicines use. Trial registration ClinicalTrials.gov - NCT04417400; 4th June 2020; retrospectively registered.

A Critical Analysis of the Specific Pharmacist Interventions and Risk Assessments During the 12-Month TRANSAFE Rx Randomized Controlled Trial

2021 ◽  
pp. 106002802110447
Author(s):  
Haley M. Gonzales ◽  
James N. Fleming ◽  
Mulugeta Gebregziabher ◽  
Maria Aurora Posadas Salas ◽  
John W. McGillicuddy ◽  
...  
Keyword(s):  
High Risk ◽  
Medication Reconciliation ◽  
Controlled Trial ◽  
Therapy Monitoring ◽  
Pharmacist Intervention ◽  
Risk Levels ◽  
Medication Therapy ◽  
Risk Patients ◽  
The Impact ◽  
Medication Changes

Background Medication safety issues have detrimental implications on long-term outcomes in the high-risk kidney transplant (KTX) population. Medication errors, adverse drug events, and medication nonadherence are important and modifiable mechanisms of graft loss. Objective To describe the frequency and types of interventions made during a pharmacist-led, mobile health–based intervention in KTX recipients and the impact on patient risk levels. Methods This was a secondary analysis of data collected during a 12-month, parallel-arm, 1:1 randomized clinical controlled trial including 136 KTX recipients. Participants were randomized to receive either usual care or supplemental, pharmacist-driven medication therapy monitoring and management using a smartphone-enabled app integrated with telemonitoring of blood pressure and glucose (when applicable) and risk-based televisits. The primary outcome was pharmacist intervention type. Secondary outcomes included frequency of interventions and changes in risk levels. Results A total of 68 patients were randomized to the intervention and included in this analysis. The mean age at baseline was 50.2 years; 51.5% of participants were male, and 58.8% were black. Primary pharmacist intervention types were medication reconciliation and patient education, followed by medication changes. Medication reconciliation remained high throughout the study period, whereas education and medication changes trended downward. From baseline to month 12, we observed an approximately 15% decrease in high-risk patients and a corresponding 15% increase in medium- or low-risk patients. Conclusion and Relevance A pharmacist-led mHealth intervention may enhance opportunities for pharmacological and nonpharmacological interventions and mitigate risk levels in KTX recipients.

The impact of donor cytomegalovirus DNA on transfusion strategies for at-risk patients

Transfusion ◽  
2013 ◽  
pp. n/a-n/a ◽  
Author(s):  
Malte Ziemann ◽  
David Juhl ◽  
Siegfried Görg ◽  
Holger Hennig
Keyword(s):  
At Risk ◽  
Risk Patients ◽  
The Impact

scholarly journals Evaluating a Pharmacist-Led Opioid Stewardship Initiative at an Urban Teaching Hospital

2021 ◽  
Vol 74 (3) ◽  
Author(s):  
Anna Chen ◽  
Michael Legal ◽  
Stephen Shalansky ◽  
Tamara Mihic ◽  
Victoria Su
Keyword(s):  
At Risk ◽  
Risk Factor ◽  
Teaching Hospital ◽  
Illicit Drugs ◽  
Clinical Teaching ◽  
Targeted Interventions ◽  
Stewardship Program ◽  
Tertiary Teaching ◽  
Risk Patients ◽  
The Impact

Background: Deaths due to overdose from illicit drugs have risen in Canada, despite various community-led harm reduction programs. There have been limited pharmacist-led inpatient initiatives aimed at reducing opioid harm. The authors’ group recently developed and implemented the Medication and Risk Factor Review, Optimize, Refer at Risk Patients, Educate and Plan (MORE) tool, a systematic checklist designed to help pharmacists follow and enhance the safety of in-hospital opioid prescribing. Objectives: To evaluate the impact of a pharmacist-led opioid stewardship program utilizing the MORE tool in the care of patients at one tertiary teaching hospital. Methods: This study involved a review of health care records for patients admitted to general surgery and internal medicine clinical teaching units at a tertiary hospital between September 10 and December 31, 2018, for whom opioids were prescribed during the hospital stay. A descriptive data analysis was performed for patients who underwent assessment with the MORE tool. Results: Of the 210 patients who met the initial eligibility criteria, including in-hospital opioid therapy for at least 3 days, 50 were assessed by a pharmacist using the MORE tool. For 40 (80%) of these patients, the pharmacist recommended an intervention, and 35 (87.5%) of these interventions were accepted by the prescriber. Among all 50 patients, the most common pharmacist interventions were adding or optimizing non-opioid pain medications (23 patients [46%]), decreasing opioid dose or frequency (15 patients [30%]), and adding a bowel regimen (9 patients [18%]). Conclusions: Most patients who underwent assessment by a pharmacist had risk factors for adverse events from opioid prescriptions and/or suboptimal orders and drug combinations. The MORE tool provided a guided approach for pharmacists to make targeted interventions aimed at improving opioid safety. A dedicated opioid stewardship pharmacist might be able to provide additional benefit. RÉSUMÉ Contexte : Les décès provoqués par les surdoses de drogues illégales ont augmenté au Canada, malgré les divers programmes communautaires axés sur la réduction des risques. Le nombre d’initiatives menées par les pharmaciens auprès des patients hospitalisés visant à réduire les dommages causés par les opioïdes est limité. Le groupe d’auteurs de cette étude a récemment élaboré et mis en place l’outil Medication and Risk Factor Review, Optimize, Refer at Risk Patients, Educate and Plan (MORE) : une liste de contrôle systématique conçue pour aider les pharmaciens à respecter et à renforcer la sécurité de la prescription d’opioïdes en milieu hospitalier. Objectifs : Évaluer l’impact d’un programme de gestion des opioïdes dirigé par des pharmaciens à l’aide de l’outil MORE pour les soins des patients résidant dans un hôpital d’enseignement tertiaire. Méthodes : Cette étude impliquait l’examen des dossiers de santé des patients admis dans les unités d’enseignement clinique de chirurgie générale et de médecine interne d’un hôpital tertiaire entre le 10 septembre et le 31 décembre 2018. Des opioïdes ont été prescrits à ces patients lors de leur séjour hospitalier. Une analyse descriptive des données a été menée auprès des patients ayant fait l’objet d’une évaluation à l’aide de l’outil MORE. Résultats : Sur les 210 patients qui répondaient aux critères d’admissibilité initiaux, notamment à celui d’un traitement aux opioïdes à l’hôpital pendant au moins trois jours, 50 ont fait l’objet d’une évaluation à l’aide de l’outil MORE. Le pharmacien a recommandé une intervention auprès de 40 de ces patients (80 %), et le prescripteur a accepté 35 de ces interventions (87,5 %). Les interventions des pharmaciens les plus répandues réalisées auprès des 50 patients consistaient en l’ajout ou en l’optimisation des analgésiques sans opioïdes (23 patients [46 %]); en la diminution de la dose d’opioïdes ou de leur fréquence (15 patients [30 %]); et en l’ajout d’un régime d’hygiène intestinale (9 patients [18 %]). Conclusions : La plupart des patients ayant fait l’objet d’une évaluation menée par un pharmacien présentaient des facteurs de risque d’effets indésirables découlant des prescriptions d’opioïdes et/ou d’ordonnances et de combinaisons médicamenteuses sous-optimales. L’outil MORE a permis aux pharmaciens d’adopter une approche guidée pour qu’ils puissent effectuer des interventions ciblées visant à améliorer l’innocuité des opioïdes. Un pharmacien affecté spécifiquement à la gestion des opioïdes pourrait offrir des avantages supplémentaires.  

scholarly journals Neurocognitive Benefits of Maternal Thiamine Supplementation for Breastfed Cambodian Infants

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 931-931
Author(s):  
Kyly Whitfield ◽  
Dare A Baldwin ◽  
Mary Chea ◽  
Tim Green ◽  
Frank Wieringa ◽  
...  
Keyword(s):  
At Risk ◽  
Language Development ◽  
Thiamine Deficiency ◽  
Controlled Trial ◽  
Newborn Infants ◽  
Cognitive Test ◽  
York Academy ◽  
Double Blind ◽  
Significant Drop ◽  
The Impact

Abstract Objectives Women reliant on rice-heavy diets can have inadequate thiamine intakes, placing breastfed infants at risk of thiamine deficiency and, in turn, neurocognitive impairments. We investigated the impact of maternal thiamine supplementation doses on infants’ cognitive, motor, and language development across the first year. Methods In this double-blind, four-parallel arm, randomized controlled trial, healthy mothers of exclusively breastfed newborn infants were recruited in Kampong Thom, Cambodia. At 2-weeks postnatal, women (n = 335) were randomized to one of four treatment groups to consume one capsule/day with varying amounts of thiamine for 22 weeks: 0 mg, 1.2 mg, 2.4 mg, and 10 mg. At 2-, 12-, 24- and 52-weeks of age, infants were assessed with the Mullen Scales of Early Learning (MSEL). Results Mixed effects modeling suggest that by 6 months of age, the highest maternal thiamine dose (10 mg/day) held significant benefits for infants’ language development, F's (3,659) &gt; 33.2, P's &lt; 0.001, but generally not for motor or visual reception development. Despite having achieved standardized scores on the MSEL that approximated US norms by 6 months, infants showed a significant drop in all cognitive domains following trial completion, indicating that nutritional interventions beyond 6 months may be necessary. Conclusions Findings provide the first experimental evidence that thiamine supplementation among lactating mothers at risk of thiamine deficiency protects their infants’ neurocognitive development, with particular benefit to developing language capacities. Results are consistent with studies that report a widening gap in cognitive test scores over time between children from high vs. low-risk contexts. Important questions remain, particularly with respect to the appropriate duration of thiamine supplementation and/or alternate interventions such as mandatory fortification, with potential to build protective stores of thiamine in preconception or pregnancy. Funding Sources Bill & Melinda Gates Foundation and the New York Academy of Sciences (Opportunity ID OPP1176128).

scholarly journals The influence of alcohol abuse on agitation, delirium and sedative requirements of patients admitted to a general intensive care unit

2018 ◽  
Vol 20 (3) ◽  
pp. 208-215
Author(s):  
Donald Stewart ◽  
John Kinsella ◽  
Joanne McPeake ◽  
Tara Quasim ◽  
Alex Puxty
Keyword(s):  
Intensive Care Unit ◽  
At Risk ◽  
Intensive Care ◽  
Alcohol Abuse ◽  
Low Risk ◽  
World Health ◽  
Related Disease ◽  
Risk Patients ◽  
The Impact ◽  
Alcohol Dependent

Purpose Patients with alcohol-related disease constitute an increasing proportion of those admitted to intensive care unit. There is currently limited evidence regarding the impact of alcohol use on levels of agitation, delirium and sedative requirements in intensive care unit. This study aimed to determine whether intensive care unit-admitted alcohol-abuse patients have different sedative requirements, agitation and delirium levels compared to patients with no alcohol issues. Methods This retrospective analysis of a prospectively acquired database (June 2012–May 2013) included 257 patients. Subjects were stratified into three risk categories: alcohol dependency (n = 69), at risk (n = 60) and low risk (n = 128) according to Fast Alcohol Screening Test scores and World Health Organisation criteria for alcohol-related disease. Data on agitation and delirium were collected using validated retrospective chart-screening methods and sedation data were extracted and then log-transformed to fit the regression model. Results Incidence of agitation (p = 0.034) and delirium (p = 0.041) was significantly higher amongst alcohol-dependent patients compared to low-risk patients as was likelihood of adverse events (p = 0.007). In contrast, at-risk patients were at no higher risk of these outcomes compared to the low-risk group. Alcohol-dependent patients experienced suboptimal sedation levels more frequently and received a wider range of sedatives (p = 0.019) but did not receive higher daily doses of any sedatives. Conclusions Our analysis demonstrates that when admitted to intensive care unit, it is those who abuse alcohol most severely, alcohol-dependent patients, rather than at-risk drinkers who have a significantly increased risk of agitation, delirium and suboptimal sedation. These patients may require closer assessment and monitoring for these outcomes whilst admitted.

scholarly journals Developing Public Service Announcements to Help Prevent Suicide among Young People

2021 ◽  
Vol 18 (8) ◽  
pp. 4158
Author(s):  
Maria Ftanou ◽  
Nicola Reavley ◽  
Jo Robinson ◽  
Matthew J. Spittal ◽  
Jane Pirkis
Keyword(s):  
At Risk ◽  
Young People ◽  
Suicide Prevention ◽  
Public Service ◽  
Controlled Trial ◽  
Public Service Announcement ◽  
Message Content ◽  
Media Message ◽  
Suicidal Crisis ◽  
The Impact

Background: Suicide is the leading cause of death among young people in Australia. Media campaigns have the potential to reach a broad audience, change attitudes and behaviours, and, ultimately, help prevent suicide. Little is known about the type of content or format suicide prevention media message should take to help prevent suicide among young people. Objective: the objective of this study was to involve young people aged 18 to 24 years in developing three suicide prevention public service announcement (PSAs) targeting young people at risk of suicide appropriate for testing in a randomised controlled trial (RCT). Method: fifteen young people attended at least one of four workshops in Melbourne, Australia. The workshops focused on exploring the appropriateness of three key suicide prevention media PSAs: “Talk to someone”, “Find what works for you”, and “Life can get better”. Young people also provided input into message content, format, and design. Results: participants perceived that all three suicide prevention PSAs were useful and helpful. Participants were concerned that the PSAs may not be suitable for nonwestern cultural groups, could trivialise psychological suffering, and that the actions they promoted could seem distant or unattainable to young people at risk. The featuring of young people, especially young people with hopeful narratives of how they overcame a suicidal crisis, was considered to be an important characteristic of suicide prevention PSAs targeting young people. Conclusions: Developing suicide prevention PSAs with young people is rare but essential to better understand young people’s needs and improve the quality of suicide prevention media PSAs. Further research is needed to evaluate the impact of suicide prevention PSAs developed by young people, for young people.

Impact of Behavioral Nudges on the Quality of Serious Illness Conversations Among Patients With Cancer: Secondary Analysis of a Randomized Controlled Trial

2021 ◽  
Author(s):  
Eric H. Li ◽  
William Ferrell ◽  
Tamar Klaiman ◽  
Pallavi Kumar ◽  
Nina O'Connor ◽  
...  
Keyword(s):  
Family Involvement ◽  
Behavioral Interventions ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Mortality Prediction ◽  
Serious Illness ◽  
Patients With Cancer ◽  
Baseline Characteristics ◽  
The Impact

PURPOSE: Serious Illness Conversations (SICs) are structured conversations between clinicians and patients about prognosis, treatment goals, and end-of-life preferences. Although behavioral interventions may prompt earlier or more frequent SICs, their impact on the quality of SICs is unclear. METHODS: This was a secondary analysis of a randomized clinical trial ( NCT03984773 ) among 78 clinicians and 14,607 patients with cancer testing the impact of an automated mortality prediction with behavioral nudges to clinicians to prompt more SICs. We analyzed 318 randomly selected SICs matched 1:1 by clinicians (159 control and 159 intervention) to compare the quality of intervention vs. control conversations using a validated codebook. Comprehensiveness of SIC documentation was used as a measure of quality, with higher integer numbers of documented conversation domains corresponding to higher quality conversations. A conversation was classified as high-quality if its score was ≥ 8 of a maximum of 10. Using a noninferiority design, mixed effects regression models with clinician-level random effects were used to assess SIC quality in intervention vs. control groups, concluding noninferiority if the adjusted odds ratio (aOR) was not significantly < 0.9. RESULTS: Baseline characteristics of the control and intervention groups were similar. Intervention SICs were noninferior to control conversations (aOR 0.99; 95% CI, 0.91 to 1.09). The intervention increased the likelihood of addressing patient-clinician relationship (aOR = 1.99; 95% CI, 1.23 to 3.27; P < .01) and decreased the likelihood of addressing family involvement (aOR = 0.56; 95% CI, 0.34 to 0.90; P < .05). CONCLUSION: A behavioral intervention that increased SIC frequency did not decrease their quality. Behavioral prompts may increase SIC frequency without sacrificing quality.

Sign in / Sign up

Export Citation Format

Share Document