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Objective To explore the effect of WeChat group management on blood pressure control rate and drug compliance of hypertension patients during the epidemic of coronavirus disease 2019 (COVID-19) . Methods A total of 428 consecutive patients with essential hypertension in our outpatient department from Jan. 2020 to Dec. 2020 were enrolled and randomly divided into experimental group and control group with a ratio of 1 : 1. There were 214 patients in the experimental group, 110 males and 104 females, with an average age of (55.48+/-6.11) years. There were 214 cases in the control group, 108 males and 106 females, with an average age of (56.52+/-5.19) years. WeChat groups were established for the 2 groups separately. Information on education, supervised medication and lifestyle of hypertension was provided to the patients in the experimental group through WeChat, while no active intervention was given to the control group. The blood pressure control rate and medication possession ratio (MPR) were calculated at 1, 3, 6 and 12 months of intervention, and the differences between the 2 groups were compared. Results There were no significant differences in the blood pressure control rate (91.12%195/214 vs 90.65% 194/214, 86.67%182/210vs 89.62%190/212or MPR (0.90+/-0.03 vs 0.90+/-0.05, 0.85+/-0.04 vs 0.88+/-0.03) between the 2 groups at 1 or 3 months of intervention (all P>0.05). At 6 and 12 months, the blood pressure control rate (81.73%170/208vs 88.57%186/210,75.12%154/205vs 85.99%178/207) and MPR (0.74+/-0.04 vs 0.87+/-0.05, 0.58+/-0.05 vs 0.85+/-0.03) of patients in the experimental group were significantly higher than those in the control group (all P<0.05). Conclusion During the COVID-19 epidemic, WeChat group management of hypertension patients by doctors could improve patients' blood pressure control rate and drug compliance and strengthen patients' self-management ability.Copyright © 2022, Second Military Medical University Press. All rights reserved.
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Objectives: Investigate the utilization of cycled antineoplastic therapies (where dosages vary per monthly supply) for various cancers among Medicare-eligible patients, and medical costs and outcomes associated with discontinuation gaps in monthly adherence. Method(s): This retrospective study used the MarketScan Supplemental and Coordination of Benefits Design databases from 2019-2020. Discontinuations were calculated for 2020 utilizing cycled medications (8 generic products) from 6 therapeutic categories, where discontinuation was defined as the first gap in medication supply during the last 6 months of the year at intervals of >=1.5*prior supply. Continuous enrollment was required, as were ICD oncology diagnosis codes for those at least 65 years of age. New to therapy/diagnosis was inferred from 2019 metric files. Patients were excluded if hospice care and inpatient transplant services were indicated. Models examined adherence level (discontinued or not) and 10 covariates (including COVID-19 indications), with interaction terms, for significant associations with medical costs (inpatient and outpatient), hospitalizations, and length of hospital stay (LOS). Result(s): Patients who met metric criteria (n=1,357;Mean age 73.9) had a discontinuation rate of 16.7%. A total of 64.0% were new to therapy/diagnosis and 5.2% were identified having COVID-19 in 2020. However, COVID-19 was not significantly correlated with a discontinuation. Hospitalization rate was at 30.3% with mean LOS=9.8. Models found significant discontinuation effects with increased total medical costs ($11,977, p<.03), odds of hospitalization (2.7, p<.0001), and LOS (5.4, p<.03). COVID-19 patients had significantly higher total medical costs ($18,145, p<.007), odds of hospitalization (6.3, p<.0001), and non-oncology LOS (4.6, p<.009). Significant covariate interactions are discussed in the poster. Conclusion(s): Medication adherence (fewer gaps in medication coverage) on cycled oral antineoplastics can lead to lower medical costs and fewer hospitalization events or LOS as compared to lower adherence levels. This was independent of COVID-19 indications that were associated with increased costs, hospitalization, and non-cancer LOS.Copyright © 2023
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Comprehensive medication management (CMM) is increasingly provided by health care teams through telehealth or hybrid modalities. The purpose of this scoping literature review was to assess the published literature and examine the economic, clinical, and humanistic outcomes of CMM services provided by pharmacists via telehealth or hybrid modalities. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Randomized controlled trials (RCTs) and observational studies were included if they: reported on economic, clinical, or humanistic outcomes;were conducted via telehealth or hybrid modalities;included a pharmacist on their interprofessional team;and evaluated CMM services. The search was conducted between January 1, 2000, and September 28, 2021. The search strategy was adapted for use in Medline (PubMed);Embase;Cochrane;Cumulative Index to Nursing and Allied Health Literature;PsychINFO;International Pharmaceutical s;Scopus;and grey literature. Four reviewers extracted data using a screening tool developed for this study and reviewed for risk of bias. Authors screened 3500 articles, from which 11 studies met the inclusion criteria (9 observational studies, 2 RCTs). In seven studies, clinical outcomes improved with telehealth CMM interventions compared to either usual care, face-to-face CMM, or educational controls, as shown by the statistically significant changes in chronic disease clinical outcomes. Two studies evaluated and found increased patient and provider satisfaction. One study described a source of revenue for a telehealth CMM service. Overall, study results indicate that telehealth CMM services, in select cases, may be associated with improved clinical outcomes, but the methods of the included studies were not homogenous enough to conclude that telehealth or hybrid modalities were superior to in-person CMM. To understand the full impact on the Quadruple Aim, additional research is needed to investigate the financial outcomes of CMM conducted using telehealth or hybrid technologies.Copyright © 2022 Pharmacotherapy Publications, Inc.
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Objective To explore the effect of WeChat group management on blood pressure control rate and drug compliance of hypertension patients during the epidemic of coronavirus disease 2019 (COVID-19) . Methods A total of 428 consecutive patients with essential hypertension in our outpatient department from Jan. 2020 to Dec. 2020 were enrolled and randomly divided into experimental group and control group with a ratio of 1 : 1. There were 214 patients in the experimental group, 110 males and 104 females, with an average age of (55.48+/-6.11) years. There were 214 cases in the control group, 108 males and 106 females, with an average age of (56.52+/-5.19) years. WeChat groups were established for the 2 groups separately. Information on education, supervised medication and lifestyle of hypertension was provided to the patients in the experimental group through WeChat, while no active intervention was given to the control group. The blood pressure control rate and medication possession ratio (MPR) were calculated at 1, 3, 6 and 12 months of intervention, and the differences between the 2 groups were compared. Results There were no significant differences in the blood pressure control rate (91.12%[195/214] vs 90.65% [194/214], 86.67%[182/210]vs 89.62%[190/212])or MPR (0.90+/-0.03 vs 0.90+/-0.05, 0.85+/-0.04 vs 0.88+/-0.03) between the 2 groups at 1 or 3 months of intervention (all P>0.05). At 6 and 12 months, the blood pressure control rate (81.73%[170/208]vs 88.57%[186/210],75.12%[154/205]vs 85.99%[178/207]) and MPR (0.74+/-0.04 vs 0.87+/-0.05, 0.58+/-0.05 vs 0.85+/-0.03) of patients in the experimental group were significantly higher than those in the control group (all P<0.05). Conclusion During the COVID-19 epidemic, WeChat group management of hypertension patients by doctors could improve patients' blood pressure control rate and drug compliance and strengthen patients' self-management ability.Copyright © 2022, Second Military Medical University Press. All rights reserved.
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Introduction: Conservative estimates suggest that the cost of poor medication adherence (MA) to healthcare systems in the UK is close to 800Mn annually, however figures may be as high as 920Mn to 224Bn across larger parts of Europe and the US.(1) This may be attributed to the relationship between poor MA and an increased risk of hospital admission.(2) Often, cases are preventable and hence present an opportunity for avoidable costs if appropriately identified and managed, such as in the case of early readmissions (admissions occurring within 30 days of discharge). However, despite the association between MA and admissions, to date no predictive model has been developed that integrates a holistic Patient-Reported Outcome Measure (PROM) of MA. This study evaluated one such PROM, known as SPUR, as a predictor of general admission and early readmission in patients living with Type 2 Diabetes (T2D). Aim(s): This study sought to develop a predictive model of early readmission and general admission risk using the SPUR tool as a PROM of MA in patients living with T2D. Method(s): Using an observational study design, 6-month retrospective and prospective patient monitoring were conducted to assess the number of admissions and early readmissions during the observational period. Outcomes were reported as binary and count variables. Patients were previously recruited from a large London NHS Trust as part of a cross-sectional study to validate SPUR. Covariates of interest included: age, ethnicity, gender, education level, income, the number of medicines and medical conditions, and Covid-19 diagnoses. A Poisson or negative binomial model was employed for count outcomes, with the exponentiated coefficient indicating incident ratios (IR) [95% CI]. For binary outcomes (Coefficient, [95% CI]), a logistic regression model was developed. Result(s): Data were available for 200 patients. The modal age range was 70-79 years (n=74/200, 37.0%). Most participants were GCSE educated (42.5%), white (76.0%), and over a third female (36.0%) identified as female. For general admission risk as a count variable, a higher SPUR score (increased adherence) was significantly associated with a lower number of admissions (IR = 0.98, [0.96, 1.00]). Other factors associated with an increased risk of admission included: age >=80 years (IR = 5.18, [1.01, 26.55]), GCSE education (IR = 2.11, [1.15 - 3.87]), number of medical conditions (IR = 1.07, [1.01, 1.13]), and a positive Covid- 19 diagnosis during follow-up (IR = 1.83, [1.11, 3.02]). SPUR remained significant when modelled as a binary variable (-0.048, [-0.094, -0.003]). For early readmission, only the SPUR score was significantly predictive of the outcome as a binary variable (-0.051, [-0.094, -0.007]), indicating that those with a higher SPUR score were at less risk of an early readmission. Conclusion(s): The study successfully developed a predictive model for both general admission and early readmissions in patients living with T2D using the SPUR tool and several covariates of clinical relevance. However, a small sample size is noted as a limitation. Future work may look to integrate SPUR as a holistic PROM of MA to support the development of tailored interventions to reduce patients' risk of admission.
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Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a respiratory condition characterised by a progressive and irreversible decline in lung function. COPD prevalence increased by 44.2% between 1990 and 2015, resulting in 3.2 million deaths globally in 2015.(1) Inhalers are an essential treatment for people living with COPD. However, poor adherence to inhaled medicines is associated with worsening symptom severity, increased hospitalisation, comorbidity, and mortality.(2) Patient Reported Outcome Measures (PROMs) have been designed to examine the factors that contribute to poor medication adherence (MA). To date, none provide a holistic assessment that could be used to design tailored MA interventions. This study sought to address this by evaluating a novel PROM that holistically assesses four key factors of MA referred to as Social, Psychological, Usage, and Rationale, in short, SPUR. Aim(s): To explore the validity of the SPUR model as a holistic PROM of MA in patients living with COPD Methods: This cross-sectional study surveyed adults living with COPD from a large London NHS Trust between January and December 2021. Participants were eligible if they had >=1 inhaler prescribed for a minimum of 6 months prior to the study and were able to read and write in English. Participants who were too clinically unwell to independently complete the survey were excluded, which often included those with a Covid-19 diagnoses. Convenience sampling was used to recruit participants from in-patient wards and the acute admissions unit prior to administration of face-to-face surveys. Survey questions related to socio-clinical data, the SPUR tool, and a previously validated PROM known as the Inhaler Adherence Scale (IAS) that was included as a comparator. The Medication Possession Ratio (MPR), a measure of a patient's pill count in a given time period, was used as an objective comparator of MA. MPR, IAS, and SPUR scores were compared using Spearman's rank correlation coefficient (p). Symptom severity was examined using the COPD Assessment Test (CAT), with a Chi-square analysis (chi2) conducted to explore the relationship between the CAT and SPUR. Result(s): From 123 patients approached for this study, 100 participated providing a response rate of 81.3%. The modal age range was 70-79 years. Participants were predominantly white (90%), educated to GCSE level (51%), and identified as female (52%). Over two thirds (67%) were ex-smokers. SPUR was significantly (p<0.01) and positively correlated with IAS (p=0.65) and MPR (p=0.30), demonstrating that SPUR is a valid measure of MA. Chi-Square analysis identified a significant (p<0.01) relationship between CAT and SPUR scores (chi2=8.570);hence SPUR could reliably identify patients with poorer adherence, which was associated with worsening symptom severity. Conclusion(s): A study strength includes the implementation of an objective measure (MPR) and PROM (IAS) as part of validating SPUR. However, the results should be treated cautiously given the small sample size, which was limited due to Covid-19. This study provides early evidence of SPUR as a reliable holistic measure of MA with significant associations to COPD symptom severity, which could be applied in clinical practice to prospectively address patient outcomes linked to poor MA.
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The management of patients with cognitive impairment (CI) is one of the urgent problems of modern medicine. Issues of diagnostics and therapy of patients with CI and their high mortality during the period of coronavirus infection are discussed. A wide prevalence of patients with mild CI (MCI), an important role of neuropsychological research in establishing CI, and frequent diagnosis of CI only at the stage of dementia were noted. In our country, CI is poorly diagnosed, the most common cause of CI in the elderly - Alzheimer's disease (AD) - is rarely established, patients are observed for a long time with a diagnosis of cerebrovascular disease (CVD). Some non-drug and drug methods can reduce the manifestations of CI, improve the quality of life of both the patients themselves and those around them. In severe CI, socio-psychological methods, stimulating patients to feasible household and social, physical and mental activity, and avoiding prolonged hospitalization are of primary importance. In addition to lifestyle changes, much attention in CI is given to the prevention of stroke, the treatment of arterial hypertension and diabetes mellitus. At the stage of dementia, cholinomimetic drugs (acetylcholinesterase inhibitors, donepezil, rivastigmine, galantamine) and the glutamate receptor blocker memantine are used. The use of choline alfoscerate in CI and the results of the multicenter, placebo-controlled ASCOMALVA study are discussed, in which, in patients with AD and CVD, the addition of choline alfoscerate to donepezil reduced the severity of CI, manifestations of depression, anxiety, and apathy. A new oral form of choline alfoscerate (Cerpechol) is reported that may improve patient compliance and be used in patients with swallowing disorders.Copyright © 2023 Ima-Press Publishing House. All rights reserved.
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Aims: The purpose of this study is to evaluate the effects of lockdown measures by the Jordanian government to contain the spread of the novel corona virus (COVID-19) on glycemic control of patients with diabetes mellitus. Method(s): This cross-sectional study was conducted in Jordan University Hospital. A total of 264 patients with type 2 or type 1 diabetes mellitus were sampled. The authors evaluated the extent of glycemic control reached by patients with type 2 or type 1 diabetes mellitus by measuring change in glycosylated hemoglobin (A1C) values, in addition to the number of hypoglycemic episodes experienced by patients during lockdown. The authors conducted a questionnaire via telephone interviews to record information about drug adherence and availability, diet, physical activity, and telephone consultations. A paired sample t-test was used to compare values before and after lockdown. Result(s): A significant reduction in HbA1C values was found during lockdown (p=0.038), with only 33.6% of patients experiencing one or more hypoglycemic episodes;both factors suggest controlled blood glucose levels. Medication adherence was found to be the main reason for improvement, with 74.8% of our population being strongly adherent to their medications. Conclusion(s): In Jordanian patients with diabetes mellitus, glycemic control was significantly improved during COVID-19 lockdown and this was found to be associated with strong medication adherence.Copyright © 2023 University of Jordan,Deanship of Scientific Research. All rights reserved.
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Background: Evidence suggests negative monthly medication adherence trends during the COVID-19 era for patients with HIV (PWH) and multiple chronic conditions. However, it is unknown whether observed trends are associated with changes in outcomes of HIV care before and during the COVID-19 era. Method(s): Adult PWH with type 2 diabetes, hypertension, and/or hypercholesterolemia were identified in a US mid-Atlantic integrated health system. Multivariable population-averaged panel general estimating equations were used to assess the relationship between medication adherence [i.e., accepted dichotomous thresholds for optimal proportion of days covered (PDC)] for four medication groups: antiretrovirals [ART], diabetes medications [DMs], renin-angiotensin antagonists [RASMs], and statins [SMs] and their related clinical endpoints [i.e., viral load (VL;copies/mL), HbA1c, systolic and diastolic blood pressure (SBP, DBP;mmHg), and total cholesterol (TC;mg/dl)] during a 37-month longitudinal observation period [9/2018-9/2021]. Covariates included demographics, number of medication groups, COVID-19 era (starting 3/1/2020), and a COVID-19/PDC interaction term. Result(s): The cohort [n=543] was predominantly 51-64y [59.30%], Black [73.11%], male [69.24%], and privately insured [65.38%]. All patients were prescribed ART with 75.32% co-prescribed SMs;followed by RASMs [42.73%];and DMs [25.60%]. ART PDC>=0.9 was associated with decreased odds of VL>=200 copies/mL [aOR=0.77, 95% CI: 0.63-0.94]. For DMs, RASMs and SMS, PDC>=0.8 was not associated with the clinical endpoints of HbA1c>=7.0% [aOR=0.99, 95% CI: 0.94-1.04], SBP>=130 mmHg [aOR=1.03;95% CI: 0.93-1.14], DBP>=80 mmHg [aOR=1.05, 95% CI: 0.94-1.16] or TC>=200 mg/dl [aOR=1.00, 95% CI: 0.96-1.04], respectively. The COVID-19 era [3/2020 to 9/2021] was associated with increased odds of SBP>=130 [aOR=1.22, 95% CI: 1.01-1.48], but not for DBP>=80 mmHg [aOR=1.05, 95% CI: 0.85-1.28], VL>=200 copies/ mL [aOR=1.01, 95% CI: 0.67-1.52], HbA1c>=7.0% [aOR=0.99, 95% CI: 0.88-1.11], and TC>=200 mg/dl [aOR=0.95, 95% CI: 0.86-1.04]. No interactions between COVID-19 era and PDC on clinical endpoints were observed. Conclusion(s): ART adherence was associated with viral suppression in PWH, but there were no observed associations between DM, RASM, and SM adherence and their respective clinical endpoints. With the exception of a direct relationship between the COVID-19 start date and SBP, the COVID-19 era was not associated with variations in VL, HbA1c, DBP, and TC clinical endpoints.
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Case report Chronic rhinosinusitis with nasal polyps (CRSwNP) is a frequent comorbidity in severe asthma in adults. Both diseases share key pathophysiological mechanisms that can involve type-2 inflammatory pathways. However, this is an uncommon presentation in pediatric patients. Dupilumab, a fully human monoclonal antibody against IL-4Ralpha, inhibits IL-4/ IL-13 signaling, which are key drivers of type-2 inflammation and interfere with both eosinophilic and allergic pathways. It is approved for patients >= 12-year- old with moderate to severe uncontrolled asthma, but its approval in CRSwNP is limited to adults. We report a case of a 12-year- old boy with severe uncontrolled asthma and highly symptomatic CRSwNP referred to our center in May 2021. He was sensitized to house dust mite and pollens, and a specific immunotherapy had been tried previously. He was treated with high dose inhaled corticosteroid, long-acting beta agonist, long-acting muscarinic antagonist, montelukast and daily intra-nasal corticosteroids. Furthermore, a bilateral endoscopic sinus surgery with polypectomy was performed in April 2021. Despite adherence to medication and surgical treatment, both diseases were uncontrolled with frequent exacerbations requiring unscheduled visits and multiple systemic corticosteroid courses. This led to failure to thrive and several missed school days. Oral corticosteroid (OCS) tapering was unachieved due to symptoms rebound and so maintenance therapy with prednisolone 10mg daily was attempted, with only a slight improvement. High levels of eosinophils (1010 cells/muL), FeNO (122 ppb) and IgE (2255 kU/L) were present. Treatment with subcutaneous dupilumab was started in July 2021. A clinical and analytical improvement was evident at the 3-month evaluation (Table 1). He was able to stop prednisolone, and no clinically relevant exacerbations occurred. He also was fully vaccinated and had an asymptomatic COVID-19 infection in December 2021. Patients with CRSwNP and comorbid asthma have a higher disease burden than patients with each disease alone. In this adolescent, dupilumab was effective as an add-on treatment, for both severe asthma and CRSwNP. It led to disease control, OCS withdrawal, reduced eosinophilic inflammation, improved lung function, smell recovery and absence of exacerbations during follow-up. Dupilumab, targeting the type 2 inflammatory process, may allow a better management of pediatric patients >=12 years old with severe CRSwNP and comorbid asthma. (Table Presented).
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Background: In March 2020, the state of alarm was declared in Spain due to the health crisis caused by SARS-COV-2. The rapid spread of the virus generated uncertainty and concern about the impact it could have on patients with severe asthma (SA) and boosted for the first time the use of teleconsultation for the management of these patients. For this reason, it was necessary to facilitate the transition to a hybrid model that combines face-to-face and digital consultations. Objective(s): Development of the first document designed for SA patients, aimed to support the preparation of the telematic follow-up consultations with their specialist. Method(s): Nine experts in SA from different specialties: 4 allergists, 3 pulmonologists and 2 asthma unit nurses contributed to the conceptualization and development of the document. In a first phase of conceptualization, the profile of patients to which the material is addressed was defined and the minimum content needed to be useful to both patients and healthcare professionals (HCPs) was established. A first draft was prepared and refined after evaluation by adult patients and parents of pediatric patients through cognitive interviews. Result(s): Onasm@ is the first document intended for SA patients to prepare the telematic follow-up consultation with their specialist. It consists of three blocks: A first one with general considerations to be applied on the telematic consultation, a second one to collect all the information that might be requested by the healthcare professional (HCP) during the off-site visit (asthma medications, dosage, adherence, asthma crisis events, emergency visits and oral corticosteroid use) and the third block with tips for achieving and maintaining asthma control. The asthma control test (ACTTM) for adults and the children's version (cACTTM) is also incorporated. Conclusion(s): The transition to a hybrid healthcare model due to the pandemic situation makes it essential to support SA patients to face the telematic follow-up consultation with their specialist. Onasm@ is the first document designed to help patients to appreciate the information needed to face this type of visit, with the aim to promote a fluid communication with their HCP and more efficient visits. This type of document could be applied to the management of other conditions and as such have broader impact on the future of healthcare, which is currently immersed in far-reaching change and transformation.
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Background: Telemedicine based on wearable intelligent health devices becomes increasingly promissing for the elderly due to the accelerated aging population. Especially during COVID-19 pandemic, more elderly coronary heart disease patients with chronic comorbidities are in less secondary prevention management at home. Objective(s): To explore the prevention effect on main cardiovascular risk factors and repeated hospitalization in elderly comorbidities patients by telemedicine intervention based on multi-parameter wearable monitoring devices. Method(s): Total of 337 patients with comorbidities of coronary heart disease, hypertension and diabetes, with age more than 65 years old were recruited in the study from October 2019 to January 2021. They were randomly divided into control group and telemedcine intervention group. The latter used remote multi-parameter wearable devices to measure blood pressure, glycemic and electrocardiograph at home every day. A real-time monitoring platform would alarm any abnormal data to the doctors. Both doctors and patients can read the measurement results on a real-time mobile phone APP and interact with each other remotely twice a week routinely. A medical team remotely indicated the medications, while offering guidance on lifestyle. In contrast, the control group adopted traditional outpatient medical strategy to manage diseases. Result(s): A total of 306 patients were enrolled in the follow-up experiment finally: 153 in the intervention group and 153 in the control group. Patient characteristics at baseline were balanced between two groups. After 12 months, compared with the control group, the intervention group saw the following metrics significantly reduced: Systolic blood pressure (SBP) (131.66+/-9.43 vs 137.20+/-12.02 mmHg, P=0.000), total cholesterol (TC) (3.65+/-0.79 vs 4.08+/-0.82 mmol/L, P=0.001), low density lipoprotein cholesterol (LDL-C) (2.06+/-0.53 vs 2.38+/-0.61 mmol/L, P=0.002), and fasting blood glucose (FBG) (6.26+/-0.75 vs 6.81+/-0.97 mmol/L, P=0.000), while the following metrics went up significantly: Blood pressure control rate (77.3% vs 59.1%, P=0.039), blood lipid control rate(39.4% vs 21.2%, P=0.037), glycemic control rate (71.2% vs 51.5%, P=0.031), and medication adherence score (7.10+/-0.77 vs 6.80+/-0.73, P=0.020). Linear regression model analysis indicates that when interaction frequency >=1.53, 2.47 and 1.15 times/week, the SBP, LDL-C and FBG levels would be controlled, respectively. Cox survival analysis finds that the hospitalization rate of intervention group is significantly lower than that of the control group (24.18% vs 35.29%, P=0.031). Conclusion(s): The telemedicine interactive intervention based on multiparameter wearable devices provides effectively improvement of cardiovascular risk controlling, medication adherence, while reducing the hospitalization rate of patients. A frequency of doctor-patient interactions more than 2 times/week is beneficial for disease management the elderly at home. (Figure Presented) .
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Many patients with severe mental illness (SMI) relapsed and deteriorated during the COVID-19 pandemic, as they experienced medication interruption. This study aimed to investigate factors affecting medication interruption in patients with SMI during the COVID-19 pandemic. A total of 2,077 patients with SMI participated in an online survey on medication interruption during the COVID-19 outbreak. The questionnaire comprised six parts: basic demographic information, COVID-19 exposure, state of disease, medication compliance before COVID-19, medication interruption during COVID-19, and the specific impact and needs. A total of 2,017 valid questionnaires were collected. Nearly 50% of patients with SMI have been affected to varying degrees of life expectancy and treatment. Among them, 74 patients stopped taking medicines for more than 14 days without a prescription. Logistic regression analysis showed that cohabitant exposure [OR = 26.629; 95% CI (3.293-215.323), p = 0.002], medication partial compliance and non-compliance pre-COVID-19 [OR = 11.109; 95% CI (6.093-20.251), p < 0.001; OR = 20.115; 95% CI (10.490-38.571), p < 0.001], and disease status [OR = 0.326; 95% CI (0.188-0.564), p < 0.001] were related to medication interruption. More than 50% of the patients wanted help in taking medications, follow-up, and receiving more financial support and protective materials. We found that the daily lives of patients with SMI were much more susceptible to impact during the pandemic. Patients with a history of partial or non-medication compliance before COVID-19 and an unstable disease state are more easily affected by pandemics and epidemics and need extra attention should similar large-scale outbreaks occur in the future.
Subject(s)
COVID-19 , Mental Disorders , Humans , Pandemics , Outpatients , Mental Disorders/epidemiology , Medication AdherenceABSTRACT
Background Graft versus host disease (GVHD) most often occurs 100-365 days after hematopoietic stem cell transplant (HSCT). Manifestations most often are dermatologic, hepatic or pulmonic, and are rarely cardiac. We present a unique case of GVHD inducing cardiogenic shock necessitating advanced heart failure therapies. Case This is a 34 year-old male with a history of acute lymphoblastic leukemia who completed chemoradiation and HSCT from an HLA perfect sibling in 1992. In May 2020, he presented with dyspnea for 6 weeks. An echocardiogram at that time showed an EF of 10% and severe biventricular dilatation. He was originally hospitalized at an outside institution for hypoxia where a left heart catheterization showed normal coronaries and goal directed therapy was initiated. After 2 negative COVID tests, he was discharged with a LifeVest. One month later, despite medication compliance, he returned in cardiogenic shock after his LifeVest was activated for ventricular tachycardia (VT). Decision-making He was started on inotropic therapy and an intra-aortic balloon pump (IABP) was placed 1:1 prior to transfer to our tertiary center. After support was started, a right heart catheterization showed a right atrial pressure of 13 mmHg, a wedge of 17, and a cardiac index of 2.6. His course was complicated by VT storm. Differentials for his non-ischemic cardiomyopathy (NICMO) included myocarditis (viral vs. giant cell) with a possible component of chemotherapy/radiation induced NICMO. Immediate AHFT work-up was started. He was unable to be weaned off his IABP or inotropic support. The decision was made to pursue emergent left ventricular assist device placement (LVAD) and achieve a definitive diagnosis with a core biopsy. Pathology resulted with myocyte hypertrophy, chronic inflammation with eosinophils concerning for chronic GVHD. Conclusion There have only been a handful of case reports describing cardiac manifestations of GVHD, and none with NICMO and cardiogenic shock requiring an LVAD. Despite this, suspicion should remain present for GVHD in HSCT patients regardless of time frame from oncologic therapies or specificity of HLA match when presenting in cardiogenic shock.Copyright © 2023 American College of Cardiology Foundation
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Objective: We aimed to evaluate asthma control status, drug compliance and anxiety levels of children and their parents who were followed up with the diagnosis of asthma during the COVID-19 pandemic. Material(s) and Method(s): Sixty-seven children aged between 8-12 years diagnosed with asthma and their parents were prospectively recruited to the study. A questionnaire including demographic features such as age, gender, asthma medications and questions about COVID-19 prepared according to a 5-point Likert scale was conducted to the parents. Children completed the State-Trait Anxiety Inventories for Children (STAI-C) scales, and childhood asthma control test(c-ACT). Parents also fulfilled STAI scales. Result(s): The mean age of the patients was 9.5+/-1.2 years, the median follow-up period for asthma (C-ACT) was 36 (21-66) months, and 45 (67.2%) were male. Most of the children were using their asthma medication regularly. Children's STAI-C state and trait anxiety scores showed a statistically significant positive correlation with parents' STAI state and trait anxiety scores. The anxiety levels of parents who thought that they would get the disease and that there would be no effective treatment and vaccine against COVID-19 were found to be higher. Conclusion(s): During the pandemic period, regular asthma follow-up and drug compliance are very important controlling asthma symptoms in children. Considering the effects of the pandemic in children with asthma, psychosocial evaluations during outpatient controls may have positive effects on children's mental health and disease control.Copyright © 2021 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.
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The proceedings contain 88 papers. The topics discussed include: scalability of effective adherence interventions for patients using cardiovascular disease medication: a realist synthesis-inspired systematic review;the presence of medication adherence management courses in European nurse education;from adherence to treatment to adherence to follow-up: paradigm shift of gene therapy for hemophilia;12-year evolution of immunosuppressant non-adherence in adult kidney transplantation recipients: the Swiss transplant cohort study;acceptance and adherence to covid-19vaccine in a Portuguese population survey: role of cognitive and emotional representations;patients' perspectives and experiences of medication use in osteoporosis: systematic review of qualitative studies;patients' perspectives on inflammatory bowel disease medication adherence in southern New Zealand;and determinants of daily HIV pre-exposure prophylaxis implementation among men who have sex with men.
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Background: The Covid-19 lockdown imposed all across the nation substantially disturbed the lifestyle and dietary habits among Indians, and this can be particular concern among individuals with diabetes. Objective(s): To understand the impact of lockdown on glycemic control in patients with type 2 diabetes, and to evaluate the healthcare practitioner (HCP) treatment preferences. Method(s): This systematic survey was done among 126 HCPs in whom a structured objective questionnaire was administered. The survey collected data related to the proportion of patients with poor glycemic control, its causes, and treatment preferences. Result(s): For the pre lockdown scenario, 37% and 48% of HCPs respectively, opined that 10-20% and 20-40% of their patients had HbA1c >8.5%. Only 10.3% HCPs reported 40-60% patients presented with high HbA1c respectively. However, for the post lockdown scenario, 8.7% and 42% of HCPs respectively, reported that 10-20% and 20-40% of their patients had HbA1c >8.5%. A notable 42% of HCPs admitted that after the lockdown 40-60% of their patients presented with HbA1c >8.5%. While 4% of HCPs reported uncontrolled glycemia in >60% of their patients before lockdown this proportion considerably increased to 7% for post lockdown scenario. HCPs perceived excess carbohydrate consumption and the lack of physical activity as the main causes of uncontrolled glycemia followed by poor medication adherence and stress. Of all the respondents, 53% agreed that they will prefer triple-drug therapy in more than 30% of their patients with HbA1c values above 8.5%. More than half of the HCPs mentioned that they would choose triple-drug therapy (Glimepiride+ metformin+ voglibose fixeddose combination) over other antidiabetics to manage the uncontrolled glycemia in their patients. Conclusion(s): The survey findings indicated an increase in the proportion of patients with HbA1c >8.5% after the lockdown as compared to the pre-lockdown phase. The altered nutritional behavior and reduced physical activity during lockdown are believed to be the major contributors to such an alarming rise in the proportion of patients with uncontrolled diabetes. Clinically, the triple-drug FDC (Glimepiride+ metformin+ voglibose) is perceived as the choice of therapy to achieve optimal glycemic control by a majority of HCPs.
ABSTRACT
Background: The coronavirus disease-19 (COVID-19) pandemic has significantly affected healthcare systems. Down syndrome (DS) is a chronic disease caused by trisomy of chromosome 21 which is associated with a variety of medical problems such as autoimmune thyroid disease (AITD) that necessitate comprehensive routine treatment. During the COVID-19 pandemic, there was an increasing an unavailability, which became an impediment to chronic disease patients' drug consumption. Objective(s): The purpose of this study was to examine the barriers to medication adherence faced by DS patients during the COVID-19 pandemic. Method(s): An observational analytic study was conducted from January to July 2021 among parents of DS patients who registered in the pediatric endocrinology outpatient clinic of Dr. Soetomo General Hospital. Inclusion criteria include: The parents of DS with AITD patients aged 1-18 years who came to the pediatric endocrinology polyclinic, routinely took oral medication before March 2020, can fill out questionnaire forms independently, and signed the informed consent. Exclusion criteria were parents of DS patients who did not take regular medication, or started treatment after March 2020. Data were collected and analyzed using the Wilcoxon comparison test Results: There are 31 DS patients responded and completed the questionnaires. Adherence to hospital visits in DS with AITD patients before and during the COVID-19 pandemic showed significant differences (P = 0.001). The main barriers to follow-up visits during the pandemic were lockdown protocol which made travel difficult (28%). The compliance for taking medication was still high although 13 (41.9%) obtained the medicine without a prescription. Conclusion(s): Changes in terms of medication adherence during the pandemic have highlighted the importance of improving DS patient's access to healthcare. Shifting medication counseling to the nearest primary health care provider with supervision from a tertiary referral specialist appears to be a reasonable and potentially cost-effective strategy in improving treatment adherence especially in a pandemic setting.Copyright © 2023, Author(s).
ABSTRACT
BACKGROUND: Two most important factors determining treatment success in chronic myeloid leukemia (CML) are adequate medication compliance and molecular monitoring albeit still being suboptimal. The CMyLife platform is an eHealth innovation, co-created with and for CML patients, aiming to improve their care, leading to an increased quality of life and the opportunity of hospital-free care. OBJECTIVE: To explore the effectiveness of CMyLife in terms of information provision, patient empowerment, medication compliance, molecular monitoring, and quality of life. METHODS: Effectiveness of CMyLife was explored using a patient-preference trial. Upon completion of the baseline questionnaire, participants actively used (intervention group) or did not actively use (questionnaire group) the CMyLife platform for at least 6 months, after which they completed the post-intervention questionnaire. Scores between the intervention group and the questionnaire group were compared with regard to the within-subject change between baseline and post-measurement using Generalized Estimating Equation models. RESULTS: At baseline, 33 patients were enrolled in the questionnaire group and 75 in the intervention group. Online health information knowledge improved significantly when actively using CMyLife and patients felt more empowered. No significant improvements were found regarding medication compliance and molecular monitoring, which were already outstanding. Self-reported effectiveness showed that patients experienced that using CMyLife improved their medication compliance and helped them to oversee their molecular monitoring. Patients using CMyLife reported more symptoms but were better able to manage these. CONCLUSIONS: Since hospital-free care has shown to be feasible in time of the COVID-19 pandemic, eHealth-based innovations such as CMyLife could be a solution to maintain the quality of care and make current oncological health care services more sustainable. TRIAL REGISTRATION: ClinicalTrials.gov NCT04595955 , 22/10/2020.