The Managerial and Organizational Impact of Therapeutic Adherence in the National Health System: A Regional Social Welfare Comparison in the Perspective of Planning PNRR Funding and Social Welfare Regulation

This article analyses therapeutic adherence to the national health system from a multidimensional perspective, through a comparative analysis of regulation and planning at different levels of European, national, regional and corporate governance. This analytical path is oriented to identify the critical issues and possible strategies aimed not only to overcome them, but also to implement the current management through organizational tools and alternative management models. In this evolution, an important role is played by the funding deriving from the PNRR intended to implement both territorial medicine and digital innovation, as main axes of the path to improving therapeutic adhesion. The conclusions concern the application of organizational models ( one health, change management, value based health) able to channel these resources towards this area of therapeutic adherence. In the current phase of planning and financing from PNRR mission 6, italian institutions such as AGENAS and the Ministry of Health have initiated the reform of the D.M. n. 70/2015 through outline the lines of development of social protection to support social assistance adherence therapeutic. This programming path is accompanied by the regulation of local health care characterized by a greater continuity of care between hospital and home and multidisciplinary coordination for a wider take-up.

Breast cancer patients therapeutic adherence during the COVID-19 pandemic in Indonesia: Knowledge level analytical study.

89 Background: Corona virus diseases 2019 (COVID-19) pandemic is a new challenge for Indonesia's cancer patient’s treatment. Patients face problems in undergoing therapy during the pandemic due to government lockdown regulations. Cancer patients, especially breast cancer, still do not understand how to deal with this problem. This study aims to determine COVID-19 knowledge’s effect on therapeutic adherence in breast cancer patients in Indonesia. Methods: This study was a cross-sectional study conducted from February to April 2021. This study involved breast cancer patients from various regions in Indonesia. The research instrument employed the UNS-CASKQ14 questionnaire (Universitas Sebelas Maret-Cancer Altitude Satisfaction Knowledge Questionnaire) to determine COVID-19 knowledge and therapeutic adherence levels in breast cancer patients. The data were then tested the Spearman Rho correlation utilizing SPSS 25. Results: There were 812 respondents in this study, with the most respondents in the age range of 50-59 years (31.8%). As many as 222 (27.3%) respondents had a low knowledge level about COVID-19, 511 (62.9%) respondents had a sufficient knowledge level, and 79 (9.8%) respondents had a good knowledge level. As many as 369 (45.4%) respondents had a low therapeutic adherence level, and 443 (54.6%) respondents had a good adherence level during the COVID-19 pandemic. Based on the Spearman Rho correlation test between COVID-19 knowledge and therapeutic adherence levels, the results obtained were p = 0.51 (p > 0.05), with the Spearman Rho coefficient value = 0.026. Conclusions: There was no significant effect between COVID-19 knowledge and therapeutic adherence levels in breast cancer patients during the COVID-19 pandemic in Indonesia.

Patients’ perspectives about their treatment in cardiovascular diseases and mental disorders (Preprint)

BACKGROUND Non-communicable diseases (NCDs) account for 71% of deaths worldwide. The World Health Organization has recently developed a global action plan to address the impact of NCDs, with a goal of reducing the number of premature NCD-related deaths to 25% by the year 2025. Appropriate therapeutic adherence is critical for effective disease management; however, approximately 30-50% of patients with an NCD do not comply with disease management activities as prescribed. Online patient communities can represent a platform from which to gather specific information outside of a clinical trial setting on patient perception of treatment adherence. OBJECTIVE This study aimed to better understand patient perspectives regarding therapeutic adherence and iatrogenic risk in two major groups of NCDs for which poor disease management can have fatal consequences: cardiovascular diseases and mental disorders. Therapeutic adherence, motivational factors, patient awareness and perception of iatrogenesis, and treatment tools used by patients were assessed. METHODS An online survey was performed among patients with cardiovascular diseases and/or mental disorders who were registered on the French Carenity platform, an online community in which patients with an NCD can share experiences and receive support and information. The study inclusion criteria were defined as follows: adults with a diagnosis of cardiovascular disease and/or mental disorder, ≥18 years of age, residing in France, registered on the French Carenity platform and undergoing pharmaceutical treatment for their illness. The patients that met the inclusion criteria were then invited to complete a self-administered online questionnaire, which included questions addressing therapeutic adherence and iatrogenic risk. RESULTS A total of 820 patients were enrolled in the study which included patients with cardiovascular diseases (403/820, 49.2%), mental disorders (292/820, 35.6%), and both (125/820, 15.2%). The mean age of the participants was 55.2±12.7 years. It was found that 82.8% (679/820) of patients experienced medication side effects. Patients tended to perceive themselves as more adherent than they actually were, as a significant number of patients disregarded their prescription and stopped or interrupted a medication without consulting with a doctor. Patients with cardiovascular disease were nearly twice as adherent as patients with a mental disorder (P≤.001). Gender, age, and treatment complexity were significantly associated with adherence. Finally, for each disease type, three patient profiles were identified that provide significant insight to improve therapeutic adherence and adapt strategies specifically according to patient behavior. CONCLUSIONS This study provides insight into the perspectives of patients undergoing therapy for cardiovascular disease and/or mental disorder, which could help to improve the management of NCDs and prevent premature death. Our study also shows that online patient platforms provide new opportunities to improve disease management based on patient experiences.

Rationale and Methods of Evaluation for ACHO, a New Virtual Assistant to Improve Therapeutic Adherence in Rural Elderly Populations: A User-Driven Living Lab

Low therapeutic adherence is a concern for health professionals as it decreases therapeutic efficiency while increasing costs, especially in elderly populations. To increase therapeutic adherence in elderly populations, the technology applied in the medical devices that are used must be adapted to improve usability. This paper outlines the rationale behind, and methods applied to assess the usability of, ACHO (Assistant on Care and Health Offline), a voice assistant that provides elderly patients with reminders of medical appointments to attend and when they need to take their medication. This work is a descriptive, cross-sectional, observational study, and will include a three-phase (analysis, testing and refinement) multidimensional usability analysis of an initial prototype, in the setting of a user-driven Living Lab, which enables the needs and characteristics of the end users to be identified and incorporated into the prototype with each iteration, in which a multidisciplinary team of researchers and users will participate as co-creators. This methodology will allow us to develop a better prototype, increasing usability and, thus, increasing therapeutic adherence.