Assessment of owner perceptions of caregiver burden, veterinarian-client relationship and satisfaction with the provider in canine pruritus: An experimental vignette study.

BACKGROUND: Complicated treatments for skin disease are linked to owner-caregiver burden and poorer perception of the veterinarian-client relationship, regardless of disease severity. HYPOTHESES/OBJECTIVES: Using experimental vignettes, we explored the impact on owner perception of the interaction of treatment complexity and skin disease outcomes. We hypothesised that: (i) vignette conditions involving injection therapy would result in lower burden, better veterinary-client relationship and greater satisfaction relative to multimodal therapy conditions; (ii) the vignette condition of injection therapy with a completely effective outcome would be superior to all other conditions; (iii) ineffective vignette conditions would be inferior to all other conditions; and (iv) the vignette condition injection with a mostly effective outcome would be similar or superior to the multimodal therapy with a completely effective outcome condition. PARTICIPANTS: Three hundred and nine owners of pruritic dogs recruited from a general veterinary practice, pet-related podcast, or social media dog allergy group. MATERIALS AND METHODS: Participants were presented with six counterbalanced online vignettes representing three levels of treatment effectiveness (Completely Effective, Mostly Effective, Ineffective) and two treatment regimens (Multimodal, Injection). Measurements of participant perceptions of caregiver burden, veterinarian-client relationship and satisfaction were recorded. RESULTS: Injection with perfect outcome was superior to other conditions (p < 0.001). Conditions with poor effectiveness were inferior (p < 0.001). Comparison of Injection with a mostly effective outcome to Multimodal treatment with perfect outcome yielded small-to-medium effects of preference for the latter in veterinarian-client relationship and satisfaction (p < 0.01); no difference was observed for caregiver burden. When good effectiveness was assured, injection was preferred (p < 0.001). CONCLUSIONS AND CLINICAL RELEVANCE: Owners preferred a Completely Effective outcome and were prepared to select the Injection regimen or Multimodal therapy to achieve this; Injection was preferred when effectiveness was assured.

Effectiveness of cognitive-behavioural therapies of varying complexity in reducing depression in adults: systematic review and network meta-analysis.

BACKGROUND: Cognitive-behavioural therapy (CBT) is frequently used as an umbrella term to include a variety of psychological interventions. It remains unclear whether more complex CBT contributes to greater depression reduction. AIMS: To (a) compare the effectiveness of core, complex and ultra-complex CBT against other psychological intervention, medication, treatment-as-usual and no treatment in reducing depression at post-treatment and in the long term and (b) explore important factors that could moderate the effectiveness of these interventions. METHOD: MEDLINE, PsycInfo, Embase, Web of Science and the Cochrane Register of Controlled Trials were searched to November 2021. Only randomised controlled trials were eligible for the subsequent network meta-analysis. RESULTS: We included 107 studies based on 15 248 participants. Core (s.m.d. = -1.14, 95% credible interval (CrI) -1.72 to -0.55 [m.d. = -8.44]), complex (s.m.d. = -1.24, 95% CrI -1.85 to -0.64 [m.d. = -9.18]) and ultra-complex CBT (s.m.d. = -1.45, 95% CrI -1.88 to -1.02 [m.d. = -10.73]) were all significant in reducing depression up to 6 months from treatment onset. The significant benefits of the ultra-complex (s.m.d. = -1.09, 95% CrI -1.61 to -0.56 [m.d. = -8.07]) and complex CBT (s.m.d. = -0.73, 95% CrI -1.36 to -0.11 [m.d. = -5.40]) extended beyond 6 months. Ultra-complex CBT was most effective in individuals presenting comorbid mental health problems and when delivered by non-mental health specialists. Ultra-complex and complex CBT were more effective for people younger than 59 years. CONCLUSIONS: For people without comorbid conditions healthcare and policy organisations should invest in core CBT. For people <59 years of age with comorbid conditions investments should focus on ultra-complex and complex CBT delivered without the help of mental health professionals.

Prevalence of polypharmacy and associated factors among patients living with HIV infection in Spain: The POINT study.

PURPOSE: Survival in people living with HIV (PLWH) has increased and thus people are aging with HIV, increasing the frequency of multimorbidity and polypharmacy. This cross-sectional study was conducted to evaluate the prevalence of polypharmacy among PLWH who were on antiretroviral treatment and were followed in an outpatient setting by the pharmacy department of several hospitals across Spain. In addition, we aimed to evaluate factors associated with polypharmacy and treatment complexity among this population. MATERIAL AND METHODS: We recorded information on demographic data, data on disease control including viral load and CD4 count at the time of inclusion, comorbidities, pharmacologic treatment and drugs interactions. Polypharmacy was defined as the use of 6 or more different drugs, including antiretroviral medication; major polypharmacy was defined as the use of ≥11 different drugs. RESULTS: Overall, 1225 PLWH were eligible in the study. The median (IQR) age was 49 (40-54). Comorbidities were present in 819 (67%) PLWH and 571 (47%) had two or more comorbidities. Overall, 397 (32.4%, 95% CI 29.8-34.9) PLWH met the criteria for polypharmacy, and 67 (5.5%, 95% CI, 4.2-6.7) had major polypharmacy. Several factors were associated with polypharmacy such as type of antiretroviral treatment, presence of potential interactions, the use of several types of medications and the number of comorbidities. Treatment complexity was also a factor strongly associated with polypharmacy; for each point increase in the medication regimen complexity index (MRCI), the likelihood of polypharmacy increased 2.3-fold. CONCLUSIONS: Polypharmacy is frequent among PLWH in Spain and contributes to a relevant extent to treatment complexity.

Prevalence of polypharmacy and associated factors among patients living with HIV infection in Spain: The POINT study / Prevalencia y factores asociados a la polifarmacia en pacientes VIH+ en España. Estudio POINT

PurposeSurvival in people living with HIV (PLWH) has increased and thus people are aging with HIV, increasing the frequency of multimorbidity and polypharmacy. This cross-sectional study was conducted to evaluate the prevalence of polypharmacy among PLWH who were on antiretroviral treatment and were followed in an outpatient setting by the pharmacy department of several hospitals across Spain. In addition, we aimed to evaluate factors associated with polypharmacy and treatment complexity among this population.Material and methodsWe recorded information on demographic data, data on disease control including viral load and CD4 count at the time of inclusion, comorbidities, pharmacologic treatment and drugs interactions. Polypharmacy was defined as the use of 6 or more different drugs, including antiretroviral medication; major polypharmacy was defined as the use of ≥11 different drugs.ResultsOverall, 1225 PLWH were eligible in the study. The median (IQR) age was 49 (40–54). Comorbidities were present in 819 (67%) PLWH and 571 (47%) had two or more comorbidities. Overall, 397 (32.4%, 95% CI 29.8–34.9) PLWH met the criteria for polypharmacy, and 67 (5.5%, 95% CI, 4.2–6.7) had major polypharmacy. Several factors were associated with polypharmacy such as type of antiretroviral treatment, presence of potential interactions, the use of several types of medications and the number of comorbidities. Treatment complexity was also a factor strongly associated with polypharmacy; for each point increase in the medication regimen complexity index (MRCI), the likelihood of polypharmacy increased 2.3-fold.ConclusionsPolypharmacy is frequent among PLWH in Spain and contributes to a relevant extent to treatment complexity.

ObjetivoLa supervivencia de las personas con infección por el VIH ha aumentado notablemente en los últimos años incrementado la edad de estos sujetos. Ello se asocia con una mayor presencia de multimorbilidad y polifarmacia. El objetivo de este estudio es evaluar la prevalencia de la polifarmacia en pacientes VIH+ con tratamiento antirretroviral activo seguidos en las consultas externas de los servicios de farmacia hospitalaria en toda España. Adicionalmente, analizar los factores asociados a polifarmacia y a la complejidad farmacoterapéutica en esta población.Material y métodosEstudio multicéntrico, transversal. Se recogieron variables demográficas, variables relacionadas con el control de la enfermedad como la carga viral y los linfocitos CD4, las comorbilidades, el tratamiento farmacológico completo del paciente y la presencia de interacciones. La polifarmacia se definió como el uso de al menos 6 fármacos incluyendo el TAR. Se definió polifarmacia mayor como la toma de más de 11 fármacos diferentes. Se midió la complejidad farmacoterapéutica por la escala de valoración Medication Regimen Complexity Index (MRCI).ResultadosSe incluyeron 1.225 pacientes. La mediana (RIQ) de edad fue de 49 años (40-54). En total 819 (67,0%) pacientes presentaban al menos una comorbilidad en el momento del estudio, teniendo 2 o más comorbilidades, el 47,0% de los mismos. Un total de 397 (32,4%; IC 95%: 29,8-34,9) pacientes cumplieron los criterios de polifarmacia y 67 (5,5%; IC 95%: 4,2-6,7) los de polifarmacia mayor. Los factores asociados con la polifarmacia fueron: el tratamiento antirretroviral, la presencia de interacciones potenciales, el uso de diferentes tipos de fármacos y el número de comorbilidades. La complejidad farmacoterapéutica se asoció de forma importante con la presencia de polifarmacia, incrementándose su probabilidad de aparición entre 2 y 3 veces por cada incremento en un punto en su escala de valoración.Conclusión

An objective system for appraising clear aligner treatment difficulty: clear aligner treatment complexity assessment tool (CAT-CAT).

BACKGROUND: Recent years have witnessed a remarkable evolution of clear aligner technology and clear aligners are becoming more and more versatile in treating orthodontic patients. The aim of this study was to develop an objective evaluation system for assessing clear aligner treatment difficulty. METHODS: A total of 120 eligible patients (100 patients for developing and testing the evaluation system and 20 patients for validating this system) were recruited in this retrospective cross-sectional study. Based on clinical data (dental models, radiographs and photographs), complexity levels of cases were evaluated by two experts and regarded as the gold standard. Difficulty scores were determined through an evaluation system encompassing three domains (dental model analysis, radiographic examinations and clinical examinations). The reliability of the evaluation system was examined through analyzing the agreement between complexity levels and difficulty scores. Moreover, multivariable linear regression test was used to examine the independent association of each variable (e.g. overbite and crowding) with the complexity level. RESULTS: The results revealed that the assessment of treatment difficulty by this objective evaluation system substantially matched the gold standard (R2 = 0.80). The multivariable regression test revealed that complexity level was significantly associated with difficulty score (p < 0.001), age (p = 0.015), tooth extraction (p < 0.001), treatment stage (p < 0.01) and the number of difficult tooth movement (p = 0.005). This objective evaluation system elaborated in this study was viable and reliable in appraising clear-aligner treatment difficulty in clinical practice. CONCLUSIONS: We suggest orthodontists and general practitioners use this objective evaluation system (CAT-CAT) to appraise clear aligner treatment difficulty and to select appropriate clear aligner patients.

Prevalence of polypharmacy and associated factors among patients living with HIV infection in Spain: The POINT study.

PURPOSE: Survival in people living with HIV (PLWH) has increased and thus people are aging with HIV, increasing the frequency of multimorbidity and polypharmacy. This cross-sectional study was conducted to evaluate the prevalence of polypharmacy among PLWH who were on antiretroviral treatment and were followed in an outpatient setting by the pharmacy department of several hospitals across Spain. In addition, we aimed to evaluate factors associated with polypharmacy and treatment complexity among this population. MATERIAL AND METHODS: We recorded information on demographic data, data on disease control including viral load and CD4 count at the time of inclusion, comorbidities, pharmacologic treatment and drugs interactions. Polypharmacy was defined as the use of 6 or more different drugs, including antiretroviral medication; major polypharmacy was defined as the use of ≥11 different drugs. RESULTS: Overall, 1225 PLWH were eligible in the study. The median (IQR) age was 49 (40-54). Comorbidities were present in 819 (67%) PLWH and 571 (47%) had two or more comorbidities. Overall, 397 (32.4%, 95% CI 29.8-34.9) PLWH met the criteria for polypharmacy, and 67 (5.5%, 95% CI, 4.2-6.7) had major polypharmacy. Several factors were associated with polypharmacy such as type of antiretroviral treatment, presence of potential interactions, the use of several types of medications and the number of comorbidities. Treatment complexity was also a factor strongly associated with polypharmacy; for each point increase in the medication regimen complexity index (MRCI), the likelihood of polypharmacy increased 2.3-fold. CONCLUSIONS: Polypharmacy is frequent among PLWH in Spain and contributes to a relevant extent to treatment complexity.

Juvenile Huntington's disease: two case reports and a review of the literature.

BACKGROUND: Huntington's disease is a rare, autosomal dominant neurodegenerative disease characterized by motor, cognitive, and psychiatric symptoms. Usually, the disease symptoms first appear around the age of 40, but in 5-10% of cases, they manifest before the age of 21. This is then referred to as juvenile Huntington's disease. According to the small number of cases reported in the literature, the course of juvenile Huntington's disease significantly differs from adult onset and shows significant interpatient variability, making every case unique. CASE PRESENTATION: Our study aims to highlight the complexity and diversity of rare juvenile Huntington's disease. We report cases of two Caucasian patients with chronic tics referred to the Huntington's Disease Competence Center of Vilnius University Hospital Santaros Klinikos with suspicion of juvenile Huntington's disease due to the appearance of chronic motor tics, and behavior problems. The diagnosis of juvenile Huntington's disease was confirmed on both clinical and genetic grounds. In both cases described, the patients developed symptoms in all three main groups: motor, cognitive, and psychiatric. However, the first patient was experiencing more severe psychiatric symptoms; in the second case, motor symptoms (rigidity, tremor) were more prominent. In both cases, apathy was one of the first symptoms and affected patients' motivation to participate in treatment actively. These two case descriptions serve as an important message for clinicians seeing patients with chronic tics and gradually worsening mood and behavior, indicating the need to investigate them for rare genetic disorders. CONCLUSIONS: Description of these two clinical cases of juvenile Huntington's disease provides insight into how differently it manifests and progresses in young patients and the difficulties the patients and their families face. There were different but painful ways for families to accept the diagnosis. Because the disease inevitably affects the patient's closest ones, it is crucial to also provide adequate psychological and social support to all the family members. Establishment of multidisciplinary specialist centers for Huntington's disease, as demonstrated by our experience, not only allows timely diagnosis and treatment plans but also ensures thorough disease management and care for patients and systematic support for their families.

Service evaluation of referrals to secondary care: A question of complexity?

OBJECTIVES: To evaluate referral patterns to secondary care and categorise referrals by complexity level. To assess compliance with commissioning guidelines for cases accepted for treatment in secondary care, comparing complexity to Index of Orthodontic Treatment Need (IOTN) data. DESIGN: Service evaluation of all referrals during study period recorded prospectively. The standard was set that >85% of cases offered treatment in secondary care should be complexity level 3b. SETTING: Seven NHS orthodontic departments within a regional clinical effectiveness group in secondary care in England. PARTICIPANTS: All patients seen as new referrals during the three-month study period. METHODS: Data recorded at clinic appointment on data collection proforma including referral information, complexity, IOTN and outcome of the first appointment. Data were collated on a spreadsheet and simple statistics were applied. RESULTS: A total of 493 patients were included in data analysis. Median waiting time for a new patient appointment was 11.0 weeks. For the whole study group, 53.8% were IOTN 5, 30.8% IOTN 4, 9.7% IOTN 3; complexity levels were 54.2% complexity 3b, 37.1% 3a and 6.7% 2. Of the patients, 30.0% were offered treatment in secondary care at their first attendance; of these, 74.3 % were IOTN 5, 93.2% were complexity level 3b. CONCLUSION: The gold standard has been met in the region as a whole and at each individual unit. There is a large discrepancy between the IOTN score and complexity level in those patients offered orthodontic treatment in secondary care. Routine recording of complexity level is recommended for all patients seen in the secondary care setting.

Impact of Orthodontic Treatment Complexity on Oral Health-Related Quality of Life in Turkish Patients: A Prospective Clinical Study.

OBJECTIVE: The study aimed to evaluate the relationship between orthodontic treatment complexity and oral health-related quality of life (OHRQoL) and to assess the impact of malocclusion and orthodontic treatment on OHRQoL in orthodontic patients with regard to gender and age. METHODS: This prospective clinical study included 102 patients aged 13-35 years who were referred to the orthodontic department. The impact of orthodontic treatment complexity was assessed using the Index of Complexity, Outcome and Need (ICON). The Turkish version of the Oral Health Impact Profile (OHIP-14) was used to examine the subjects for OHRQoL before and after treatment. The before and after treatment data (T1 and T2, respectively) were tested using a paired t-test, and one-way analysis of variance (ANOVA) with the Bonferroni test was used to assess the differences in OHIP-14 across groups, as defined by the ICON. The cross-sectional comparisons between genders and age groups before and after treatment were tested using the Student's t-test. The level of significance was set to a p value of 0.05. RESULTS: Patients with moderate treatment complexity reported a significantly negative impact on the psychological disability domain compared to the difficult treatment complexity. OHRQoL improved after treatment. Females showed statistically significant and highest scores on the physical pain domain compared to males. Adults showed a statistically significant negative impact on the psychological domains before treatment as well as a statistically significant positive impact on the psychological disability domain after treatment compared to adolescents (p<0.05). CONCLUSION: Orthodontic treatment improves OHRQoL, and orthodontic treatment complexity does not seem to have an impact on OHRQoL.

Predoctoral Dental Education in Tooth Prognosis and Treatment Complexity: A Survey of U.S. Dental Schools.

The aim of this study was to determine the educational methods and tools used to teach tooth prognosis and treatment complexity determination in U.S. predoctoral dental programs. In 2018, an online survey was emailed to the academic deans of all 66 accredited U.S. dental schools. Of these, 42 schools responded (63.6%), and 36 schools completed the entire survey (54.5%). The methods reported for teaching tooth prognosis and case complexity determination varied widely among the participating schools. Among the respondents, 25% reported using the American Association of Endodontists' Endodontic Case Difficulty Assessment, while 10% reported having no specific method for teaching prognosis. The most common method for teaching overall treatment complexity was the Prosthodontic Diagnostic Index, which was used by 24% of the respondents. However, another 24% reported that their school did not have a specific method for teaching treatment complexity. Large percentages of the respondents reported that students sometimes or often made wrong tooth prognosis and case complexity determination (90% and 92%, respectively). The most prominent feedback provided by the respondents based on their experience was the importance of faculty standardization, the understanding of students' inexperience, and the need for an interdisciplinary approach. The majority of these respondents reported that their schools had specific methods of teaching prognosis and case complexity determination. However, there was a wide range of teaching practices related to the contents and levels of evidence.

Judging orthodontic treatment complexity

Objective: The aim of the present study was to investigate possible relations between anticipated overall treatment complexity (AOTC) of an orthodontic case and malocclusion characteristics. Methods: Two groups of orthodontists (groups A and B) were asked to define perceived treatment complexity (PTC) of orthodontic cases based on 16 characteristics of malocclusion by means of a questionnaire. Each question was answered on a six-point ordinal scale, with one "not applicable" option (score 0). Group A was also asked to give the AOTC of the specific case on a five-point ordinal scale. The index of orthodontic treatment need (IOTN) score of the specific cases as well as the malocclusion characteristics were assessed by one author. Results: There is a significant relationship between IOTN and AOTC (p< 0.0001), 22% of variability is explained by differences in IOTN. Adding objective characteristics of malocclusion to explain AOTC does not significantly increase the explained variability (p = 0.086). In judging interobserver agreement, a weighted Kappa of 0.60 for group A and 0.56 for group B was found. The weighted Kappa for agreement in AOTC equals 0.06. Conclusion: The relation between IOTN and AOTC was found to be significant. Moderate agreement on PTC among observers and a low level agreement regarding AOTC were found in the present study.

Objetivo: o objetivo do presente estudo foi investigar possíveis relações entre a previsão da complexidade geral do tratamento (AOTC, Anticipated Overall Treatment Complexity) de um caso ortodôntico e as características da má oclusão. Métodos: dois grupos de ortodontistas (Grupo A e Grupo B) foram orientados a definir, por meio de um questionário, sua percepção da complexidade do tratamento (PTC, Perceived Treatment Complexity) de casos ortodônticos, com base em 16 características da má oclusão. Cada questão foi respondida em uma escala ordinal de seis pontos, com a opção "não aplicável" (nota 0) disponível. Pediu-se ao Grupo A que também determinasse, em uma escala ordinal de cinco pontos, a AOTC de cada caso. A nota relativa ao índice de necessidade de tratamento ortodôntico (IOTN,Index of Orthodontic Treatment Need) de casos específicos e as características das más oclusões foram avaliadas por um dos autores. Resultados: existe uma relação significativa (p < 0,0001) entre o IOTN e a AOTC. Diferenças no IOTN são a causa de 22% da variabilidade. Adicionar características objetivas da má oclusão para explicar a AOTC não aumentou significativamente essa variabilidade mencionada (p = 0,086). Ao se avaliar a concordância interexaminadores, foram encontrados valores de Kappa ponderado de 0,60 para o Grupo A e 0,56 para o Grupo B. O valor de Kappa ponderado para a concordância quanto à AOTC foi de 0,06. Conclusão: a relação encontrada entre o IOTN e a AOTC foi considerada significativa. Verificou-se uma moderada concordância interexaminadores com relação à PTC, e um baixo nível de concordância com relação à AOTC.

Treatment complexity: a description of chemotherapy and supportive care treatment visits in patients with advanced-stage cancer diagnoses.

PURPOSE: Modern chemotherapy regimens are growing increasingly complex, involving lengthy outpatient infusions, and additional visits for supportive care. The treatment of advanced-stage patients is uniquely one of unremitting therapy and varying complexity. The study's purpose was to describe and quantify the dimensions of treatment complexity in terms of chemotherapy (CT) and supportive care (SC) visits. METHODS: Electronic medical records for 121 subjects with stages III and IV cancer were reviewed. Visits were classified as SC and CT types, and actual hours and visit numbers were calculated for a 3-month treatment period. Analysis included descriptive and generalized linear modeling statistics. RESULTS: Subjects ≥65 years spent fewer total hours (M = 18.17 h, SD = 10.17 h, p = 0.04), but experienced more total visits (M = 10.96 visits, SD = 4.65 visits, p = 0.02) than younger subjects. More than 71% of younger patients spent two or more hours per chemotherapy visit, compared to 41.7% of older patients (p = 0.001). Older subjects were more likely to have a SC visit (p = 0.03), but did not differ from younger subjects in SC visit numbers (p = 0.3) or hours (p = 0.6). Females averaged 3.81 more total hours (M = 22. 61 h, SD = 11.06 h, p = 0.055) and had more total visits (M = 10.80 visits, SD = 3.71, p = 0.02) than males. By visit type, women spent twice the hours undergoing SC than males (M = 3.3 vs. 1.5 h, p = 0.051), but genders did not differ in CT visit hours or average length. By diagnosis, colon/esophageal subjects spent more hours in CT visits (M = 21.90 h, SD = 8.60 h, p < 0.01), and lung subjects trended toward spending more hours in SC visits (M = 4.80 h, SD = 8.23 h, p < 0.06). CONCLUSIONS: Advanced-stage cancer patients differed in visit types, hours, and treatment length undergoing CT and SC visits. Age, gender, and diagnosis explained the differences, and this study adds new understanding to the phenomenon of treatment complexity.

Tackling the increasing complexity of CF care.

Health outcomes for individuals with cystic fibrosis (CF) have dramatically improved in parallel with better organization of clinical care systems, evolution of novel therapeutics, and improvements in diagnosis and screening for CF and CF-related complications. In parallel with these advances has come an increasing complexity and burden of care, leading to challenges with adherence to treatment regimens. As novel therapeutics continue to be developed and introduced to the CF care regimen, there are clear opportunities to refine and personalize care. This can be done by adding comparative effectiveness research to the CF clinical research paradigm and integrating novel technologies in drug delivery and remote monitoring that can facilitate adherence but also reduce the burden of treatment while maintaining efficacy. This review highlights both the challenges of the increasingly complex treatment regimens in CF and the opportunities to advance care by addressing adherence, implementation science, comparative effectiveness, and integration of novel technologies in CF care.

Medication beliefs, treatment complexity, and non-adherence to different drug classes in patients with type 2 diabetes.

OBJECTIVE: To assess the relationship of patients' medication beliefs and treatment complexity with unintentional and intentional non-adherence for three therapeutic groups commonly used by patients with type 2 diabetes. METHODS: Survey data about adherence (Medication Adherence Report Scale) and beliefs about medicines (Beliefs about Medicines Questionnaire) were combined with prescription data from the Groningen Initiative to ANalyse Type 2 diabetes Treatment (GIANTT) database. Patients were classified as being adherent, mainly unintentional non-adherent, or partly intentional non-adherent per therapeutic group (glucose-, blood pressure-, and lipid-lowering drugs). Treatment complexity was measured using the Medication Regimen Complexity Index, which includes the dosage form, dosing frequency and additional directions of taking the drug. Analyses were performed using Kruskal-Wallis and Mann-Whitney U-tests. RESULTS: Of 257 contacted patients, 133 (52%) returned the questionnaire. The patients had a mean age of 66years and 50% were females. Necessity beliefs were not significantly different between the adherers, mainly unintentional non-adherers, and partly intentional non-adherers (differences smaller than 5 points on a scale from 5 to 25). For blood pressure-lowering drugs, patients reporting intentional non-adherence had higher concern beliefs than adherers (8 point difference, P=0.01). Treatment complexity scores were lower for adherers but similar for mainly unintentional and partly intentional non-adherers to glucose- and blood pressure-lowering drugs. CONCLUSION: Treatment complexity was related to non-adherence in general. Beliefs about necessity were not strongly associated with non-adherence, while patients' concern beliefs may be associated with intentional non-adherence. However, the role of these determinants differs per therapeutic group.