Multidimensional factors affecting medication adherence among patients with chronic obstructive pulmonary disease.

AIMS AND OBJECTIVES: This study aimed to investigate the effects of socioeconomic-, patient-, treatment-, condition- and health system-related factors on medication adherence in patients with chronic obstructive pulmonary disease (COPD). BACKGROUND: Medication adherence is essential for the management of chronic diseases. The World Health Organization created a Multidimensional Adherence Model (MAM) and showed that medication adherence is affected by a combination of numerous factors. DESIGN: A descriptive correlational study was conducted. METHODS: A total of 114 patients with COPD were included. Data were collected on five dimensions based on the MAM framework. Medication adherence, self-efficacy and symptoms were evaluated using the Adherence to Refills and Medications Scale-7 (ARMS-7), COPD Self-Efficacy Scale (CSES) and COPD Assessment Test (CAT), respectively. The data were analysed using descriptive statistics, correlational statistics and structural equation modelling. The STROBE checklist was used. RESULTS: The ARMS-7 scores were associated with the body mass index of patients (F = 4.245, p = .017), smoke pack-years (r = .277, p = .004) and the CSES total score (ß = -0.249, p = .002) in patient-related factors. The ARMS-7 score was not associated with socio-economic and health system-related factors. The ARMS-7 score showed a significant correlation between COPD diagnosis duration (r = -.276, p = .003) and the total number of drugs (r = -.215, p = .022) in treatment-related factors. The ARMS-7 scores were associated with the number of comorbid illnesses of patients with COPD in condition-related factors (F = 3.533, p = .033). CONCLUSION: This study showed that medication adherence in COPD was mostly affected by patient-, treatment- and condition-related factors. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals should establish training and counselling programs to increase the medication adherence level of patients, particularly for patients who are newly diagnosed, require multiple drugs and have comorbid diseases or low self-efficacy.

Effects of Aloe vera in adults with mucocutaneous problems: A systematic review and meta-analysis.

AIMS: To analyse the different types of Aloe vera (AV) effects on various mucocutaneous problems among adults. DESIGN: A systematic review and meta-analysis. DATA SOURCES: An exhaustive scanning of PubMed, Medline, ScienceDirect, and Google Scholar databases was conducted from January 2000-December 2019. REVIEW METHODS: Randomized controlled trials (RCTs) publishing reports on the effects of AV in various mucocutaneous problems, psoriasis, burn, wound-healing were included. The standardized mean differences (SMD) with 95% confidence Intervals (CIs) were determined for the main outcomes, heterogeneity was analysed using the I2 test and the risk of bias in the studies was reviewed by the Cochrane risk of bias assessment tool. RESULTS: The study included 23 trials with a total of 4,023 participants. Six trials were included in the meta-analysis. The results indicated no significant differences in pain scores as assessed by the Visual Analog Scale (VAS) (SMD = 0.11, 95% CI: -0.37 to 0.59). The Psoriasis Area Severity Index (PASI) scores were significantly lower following AV gel application in two of the studies (SMD = -1.32 95% CI: -1.86 to -0.78). Considering results in a systematic manner, AV accelerated tissue epithelialization and wound-healing process (N = 3), reduced oral mucositis (N = 3), and improved quality of life (N = 1). CONCLUSION: AV might have beneficial effects in reducing pain scores and the severity of mucocutaneous problems compared with placebo, especially with limited mild to moderate adverse effects. IMPACT: AV may be used as an alternative and integrative approach to reducing symptom severity in mucocutaneous problems and the wound-healing process. High quality and well-designed RCTs are still needed to elucidate the effects of AV in a variety of dosages and forms among adults with mucocutaneous problems.

The effects of nurse-driven self-management programs on chronic obstructive pulmonary disease: A systematic review and meta-analysis.

AIMS: To analyse the effects of nurse-driven self-management (SM) programs on physical and psychosocial health variables in people with chronic obstructive pulmonary disease (COPD). DESIGN: A systematic review and meta-analysis. DATA SOURCES: An exhaustive scanning of PubMed, Cochrane Controlled Register of Trials, CINAHL, ScienceDirect and Medline databases between January 2010-December 2019 was conducted for this meta-analysis. REVIEW METHODS: Randomized controlled trials (RCTs) related to nurse-driven SM programs in COPD population were included. The standardized mean differences with 95% confidence intervals were determined for the main variables and heterogeneity was analysed using the I2 test. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was used. RESULTS: Twelve studies were included. The results indicated that significant difference in physical health scores based on COPD Assessment Tool (CAT) and walking distance according to the 6-min walk distance (6MWD) test in the intervention groups compared with the control groups. About psychosocial health findings, the quality of life increased and the Hospital Anxiety and Depression Scale (HADS) scores decreased following SM programs. All of the studies had good quality (varying from 5-8 points) according to The Modified Jadad Scale. CONCLUSION: Nurse-driven SM programs may contribute to prognosis in patients with COPD. Due to methodological weaknesses in the included trials, high-quality RCTs are needed to better determine the effects of nurse-driven SM programs in the management of COPD. Nurse-driven SM programs may be employed as a useful strategy to improve health status and QOL and psychosocial health in the COPD population, as well. IMPACT: Current evidence shows that nurse-driven SM programs could be safely integrated into the clinical practice for patients with COPD. Future studies are warranted that evaluating the effects of nurse-driven SM programs on other frequently observed COPD symptoms such as dyspnoea, fatigue and sleep disturbance.

Relationship between symptom burden, medication adherence and spiritual well-being in patients with chronic obstructive pulmonary disease.

AIMS AND OBJECTIVES: To investigate the relationship between symptom burden, medication adherence and spiritual well-being in patients with chronic obstructive pulmonary disease (COPD). BACKGROUND: The relationship between spirituality and medication adherence has been investigated in different chronic conditions. However, the relationship between symptom burden, medication adherence and spiritual well-being in patients with COPD has not been explored. DESIGN: A descriptive correlational study design was adopted. METHODS: A total of 112 patients with COPD were included in the study. Data were collected using the COPD Assessment Test (CAT), the Adherence to Refills and Medications Scale-7 (ARMS-7) and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). The data were analysed using descriptive and correlational statistics. The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) Checklist was used. RESULTS: The CAT score was significantly higher in patients on long-term oxygen therapy and those who had more than three comorbid conditions (p < .05). The mean score of ARMS-7 was significantly associated with age (p < .05). Current smokers had higher ARMS-7 and lower FACIT-Sp scores (p < .001). The FACIT-Sp score was negatively and moderately associated with the CAT and ARMS-7 scores (p < .001). CONCLUSION: This study concluded that individuals with higher spiritual well-being had lower symptom burden and higher medication adherence. The need for long-term oxygen therapy and a high number of comorbid conditions were associated with increased symptom burden. Current smokers had lower spiritual well-being and medication adherence. RELEVANCE TO CLINICAL PRACTICE: Spiritual well-being should be evaluated when assessing symptom burden and medication adherence in clinical practice. In addition, further studies examining the causal relationship between symptom burden, spiritual well-being and medication adherence in different populations are warranted.