Treatment Noncompliance Level Among Patients with Type 2 Diabetes Mellitus: A Hospital Based Cross-Sectional Study in Bangladesh.

Introduction: The consequence of good diabetic treatment depends on the patient's commitment to a large degree. Noncompliance leads to inadequacy of metabolic control, which strengthens the advancement and speeds up diabetic complications. The study's main goal was to assess the treatment noncompliance level among patients with type-2 diabetes mellitus (T2DM) in Bangladesh. Methodology: This descriptive cross-sectional study was conducted at Medical Center Hospital, Chattogram, Bangladesh. The study included two hundred and fifty-nine patients with T2DM. Data regarding sociodemographic factors, patients characteristics, medication factors, physician-related factors, and noncompliance were collected using a pretested and structured questionnaire. Treatment adherence was assessed by Morisky Medication Adherence Scales (MMAS-8). Data analyses were conducted on SPSS v23.0 Software. Results: The majority of the participants (56%) were in the 40-45 years of age group, followed by 32% in the older age group (>/=60 years), and 62.5% of them were male. One hundred and sixty eight (64.86%) patients were considered low adherent as per the response of the MMAS-8 scale (score <6), followed by 57 (22.0%) patients were regarded as high adherent (score 8) and 34 (13.13%) patients were considered medium adherent (score 6-7) to treatment. Observing the frequency distribution for noncompliance, financial concerns (32.3 %), forgetfulness (27.7%), a busy daily schedule (17.7%), and fear of antihyperglycemic drug side effects were all identified as significant explanations. On multivariate analysis, participants aged 60 years or more, monthly family incomes of <30,000BDT or 30,000 to 50,000 BDT, smoking, and uncontrolled glycemic status showed higher chances of noncompliance than their counterparts. Conclusion: Patient counseling and awareness programs may enhance treatment adherence among people with T2DM. Our findings will help physicians and public health workers to develop targeted strategies to increase awareness of the same among their patients.

Factors Associated With Pharmacological and Non-pharmacological Treatments Adherence in Patients With Borderline Personality Disorder in Iran

BackgroundBorderline personality disorder is a major mental illness characterized by a sustained relationship instability, impulsive behavior and intense affects. Adherence is a complex behavior, from minor refusals of treatment to inappropriate use of health services or even abandonment of treatment, which can be affected by various factors. Therefore, the present study aimed to investigate the factors affecting pharmacological and non-pharmacological adherence in patients with borderline personality disorder referred to an outpatient referral clinic in Tehran, Iran.MethodsThe study was a retrospective cohort. The files of patients with borderline personality disorder referred to the outpatient clinic of the Tehran Psychiatric Institute were reviewed as the first step. In the next step, we contacted the patients and asked them to fill out the questionnaires. Data were collected using the Drug Attitude Inventory (DAI) questionnaire and a researcher made questionnaire to determine the attitude of patients toward pharmacological and non-pharmacological treatment and therapeutic adherence. After collecting data, patients’ therapeutic acceptance was divided into three groups: poor, partial, good compliance. The data were analyzed by SPSS software version-22.Results Ninety-four patients were involved in the study and fifty four of them were women. In terms of psychotherapy adherence, patients with higher education and hospital admission history have better compliance. Medication attitudes were negative in 54 patients (57.4%), while 40.4% of them stated that psychotherapy or counselling did not help their condition and showed a negative attitude toward non-pharmacological treatment. Additionally, psychotherapy good adherence of the patients (44.7%) was higher than medication good adherence (31.9%). The most common reasons for discontinuation of treatment were medication side effects (53.1%), dissatisfaction with the therapist (40.3%) and then fear of medication dependence (40%). The results showed no relationship between other demographic factors and treatment adherence.ConclusionsResults of the current study show that attitude toward psychotherapy is more positive than pharmacotherapy. In addition, according to the results, working on changeable factors such as patients’ fear of dependence to medication, dissatisfaction with the therapist, and medication side effects may improve patients' treatment adherence.

The Effect of Family Psychoeducation on Tuberculosis Treatment Adherence of Children in Indonesia

Tuberculosis (TB) is an infectious disease leading cause of death in the world but treatment adherence the most underrated and understudied factor affecting the outcome of TB therapy. The aim of this study was to determine the effect of family psychoeducation on TB treatment adherence of children. The study used a randomized controlled trial (RCT). The sample was 40 pairs of primary caregivers and children who received TB treatment and experienced no side effects of anti-TB drugs in Wonosari Hospital Indonesia in 2019. The treatment group was given psychoeducation by trained health personnel psychoeducators, while the control group was given education by health workers. Psychoeducation was carried out individually, 3 meetings in the first week of the study. Adherence was measured at the sixth month which was the end of treatment period, using a questionnaire. Data were analyzed by using multiple logistic regression. The results showed that family psychoeducation had a significant effect on TB treatment adherence in children after controlling for mother’s knowledge (P-value 0.05 ≤ 0.05). Family psychoeducation is a preventive factor for non-adherence to TB treatment. It is important that psychoeducation is provided to all TB patients to reduce psychological problems that can lead to treatment non-adherence.

Technology And Its Role In Supporting Tuberculosis Treatment Adherence

Compliance with TB treatment has now become a problem that must be handled seriously because the high non-adherence rate will give a bad contribution to the success of TB treatment, including MDR-TB and also morbidity and mortality. Many innovations have been made to improve TB treatment adherence, one of which is using mobile-based technology. This article aims to explore the effectiveness of the technology used to improve treatment adherence in TB patients: types, ways of working, advantages, and limitations of each application. This is a systematic review through searching 3 databases, namely Scopus, WoS, and Science Direct. Some of the advantages in applying technology to improve TB treatment adherence are easy to use if you understand how to operate tools/applications are cost-effective because they reduce transportation costs in reaching remote areas or in conditions of transportation difficulties such as after a disaster, the use of this technology provides patient satisfaction in treatment and facilitates the involvement of the family/support system in the treatment of patients. Several things must be considered (limitations) of the technology to be used, including experts, patient knowledge and skills, economic condition, electricity availability, and whether the technology used will not increase the burden on patients related to the stigma of TB disease. We can conclude that the use of technology is indeed very good in supporting the improvement of TB treatment adherence, but the selection of this application must pay attention to the characteristics of the population as well as the advantages and limitations of each application. Keywords: Technology, Adherence, Tuberculosis

Technology and its role in supporting Tuberculosis treatment adherence

Compliance with TB treatment has now become a problem that must be handled seriously because the high non-adherence rate will give a bad contribution to the success of TB treatment, including MDR-TB and also morbidity and mortality. Many innovations have been made to improve TB treatment adherence, one of which is using mobile-based technology. This article aims to explore the effectiveness of the technology used to improve treatment adherence in TB patients: types, ways of working, advantages, and limitations of each application. This is a systematic review through searching 3 databases, namely Scopus, WoS, and Science Direct. Some of the advantages in applying technology to improve TB treatment adherence are easy to use if you understand how to operate tools/applications are cost-effective because they reduce transportation costs in reaching remote areas or in conditions of transportation difficulties such as after a disaster, the use of this technology provides patient satisfaction in treatment and facilitates the involvement of the family/support system in the treatment of patients. Several things must be considered (limitations) of the technology to be used, including experts, patient knowledge and skills, economic condition, electricity availability, and whether the technology used will not increase the burden on patients related to the stigma of TB disease. We can conclude that the use of technology is indeed very good in supporting the improvement of TB treatment adherence, but the selection of this application must pay attention to the characteristics of the population as well as the advantages and limitations of each application.

Association of the Comprehensive ESRD Care (CEC) Model with Treatment Adherence

Background: Poor adherence to scheduled dialysis treatments is common and can cause adverse clinical and economic outcomes. In 2015, the Center for Medicare and Medicaid Innovation launched the Comprehensive End-Stage Renal Disease Care (CEC) Model, a novel modification of the Accountable Care Organization framework. Many Model participants reported efforts to increase dialysis adherence and promptly reschedule missed treatments. Methods: With Medicare databases covering 2014-2019, we used difference-in-differences models to compare treatment adherence among patients aligned to 1,037 CEC facilities relative to those aligned to matched comparison facilities, while accounting for their differences at baseline. Using dates of service, we identified patients who typically received three weekly treatments and the days when treatments typically occurred. Skipped treatments were defined as days when the patient was not hospitalized but did not receive an expected treatment, and rescheduled treatments as days when a patient who had skipped their previous treatment received an additional treatment before their next expected treatment date. Results: Patients in the CEC Model had higher odds of attending as-scheduled sessions relative to the comparison group, though the effect was only marginally significant (OR=1.018, p=0.076). Effects were stronger among females (OR=1.028, p=0.062) than males (OR=1.010, p=0.485), and among those under 70 years (OR=1.024, p=0.040) than those 70+ (OR=0.999, p=0.963). The CEC was associated with higher odds of rescheduled sessions (OR=1.092, p<0.001). Effects were significant for both sexes, but were larger among males (OR=1.109, p<0.0001) than females (OR=1.070, p=0.012), and effects were significant among those under 70 years (OR=1.121, p<0.0001), but not those 70+ years (OR=0.990, p=0.796). Conclusions: The CEC Model is intended to incentivize strategies to prevent costly interventions. Because poor dialysis adherence may precipitate hospitalizations or other adverse events, many CEC Model participants encouraged adherence and promptly rescheduled missed treatments as strategic priorities. This study suggests the success of these efforts, though the absolute magnitudes of the effects were modest.