ABSTRACT
BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is a rare inherited kidney disorder with considerable symptom burden and negative effects even in early-stage disease. Patients' reporting of ADPKD symptom burden may differ from physicians' impressions. In this quantitative, cross-section survey study, we evaluated patient and physician assessments of symptom burden at early- and late-stage ADPKD. METHODS: In the United States, 300 patients with ADPKD and 155 physicians treating patients with ADPKD completed online surveys administered by Kantar. Disease stage was categorized as early (chronic kidney disease [CKD] stages 1-3) or late (stages 4-5). Patients completed the Work Productivity and Activity Impairment Questionnaire and reported current disease symptoms. Patients and physicians assessed impacts of ADPKD on daily life and burden of specific symptoms. Statistical analyses compared patient versus physician responses stratified by early- versus late-stage ADPKD. RESULTS: We found that impairment in work productivity was statistically greater in late- versus early-stage CKD. Compared with physicians' impressions, patients were more likely at early stages and less likely at later stages to report a moderate/strong impact of ADPKD on daily life. Among patients, 74% with early- and 88% with late-stage disease reported that ADPKD caused them to modify their daily lives. In early-stage disease, patients reported a statistically greater burden from feeling exhausted and less burden from dull kidney pain, cardiovascular problems, high blood pressure, and liver cysts than physicians assumed. At later stages, patients reported feeling exhausted and skeletal/joint pain as more burdensome, and frequent urination, high blood pressure, liver cysts, and hematuria as less burdensome, compared with physicians' impressions. CONCLUSION: The results of this survey study demonstrate a disconnect between patients' experiences and physicians' awareness of the burden of ADPKD and highlight the need for more patient/physician discussion of symptoms and disease management.
ABSTRACT
Introduction: This study aimed to understand women's preferences regarding the subdermal contraceptive implant and to assess the proportion of women who would be underserved (with increased unintended pregnancies as the consequence) by not providing implant access equal to that of uterine-based long-acting reversible contraceptive methods (LARCs). Methods: A total of 1,200 women aged 18-44 years old (mean: 30.42 ± 7.67 years) participated in a U.S. cross-sectional online survey. To qualify for the study, women had to be sexually active with a male and not pregnant or trying to get pregnant at the time of the study. Women who had undergone a hysterectomy, a bilateral salpingo-oophorectomy, or a tubal ligation, and women with general infertility or those with a vasectomized partner were excluded. Descriptive analyses were conducted and weighted estimates, projecting to the total U.S. population were also provided. Results: The majority of women (72.6%) reported that they would be willing to switch to a LARC, should it be readily available to them. Considering those women who already use an implant and those who would be willing to switch to it, 58% of women would be underserved by not being provided equal access to the subdermal implant. This reduced availability of this type of LARC may alone elevate the number of unintended pregnancies in the United States by â¼8% of all pregnancies per year. Conclusion: Thus, making all the available contraceptive methods and maintaining access to LARCs would help reduce unintended pregnancies and better serve women and their family planning needs.
ABSTRACT
AIMS: People with diabetes who use mealtime insulin (MTI) were surveyed about insulin wastage and injection habits when insufficient insulin remains in a disposable prefilled pen/cartridge to administer a full dose in a single injection. METHODS: Cross-sectional, online, self-reported survey of MTI usage/wastage behaviour in 400 adults with type 1 (n=120) or type 2 (n=280) diabetes mellitus administering >20units/day of MTI via 100units/ml prefilled pens/cartridges for ⩾1month, conducted in France, Germany, Italy and UK. RESULTS: Participants' mean±standard deviation age was 54.5±12.2years, body mass index was 29.9±7.2kg/m2 and duration of MTI therapy was 8.6±7.8years. They administered 3.7±5.9 injections/day with meals, using 11.3±18.0 prefilled pens/cartridges per month. Overall, 63.5% split the dose across two prefilled pens/cartridges (i.e. administered two injections to obtain a full dose), 15.0% used just what remained in their current pen (i.e. took a lower-than-prescribed dose) and 36.3% discarded prefilled pens/cartridges still containing insulin (i.e. took full dose with new pen). The latter participants discarded a mean 5.5±8.2 prefilled pens/cartridges monthly still containing insulin, each containing 8.6±8.7 units of insulin. Participants who wasted insulin considered it frustrating, time-consuming and painful to inject twice. CONCLUSIONS: Patients taking >20units/day MTI can find transitions between insulin pens challenging. This study highlights the need to identify ways of improving transitions between pens to make transitions easier for insulin users, which could potentially improve adherence to prescribed doses and reduce waste.
