CAN ADHERENCE BE IMPROVED? - PowerPoint PPT Presentation

About This Presentation
Title:

CAN ADHERENCE BE IMPROVED?

Description:

BE IMPROVED? Status of Adherence Intervention Studies To Medication To Exercise To Diet 19 Adherence Intervention Studies Randomized Control Group Assessment of ... – PowerPoint PPT presentation

Number of Views:152
Avg rating:3.0/5.0
Slides: 26
Provided by: Schoolof73
Learn more at: https://sites.pitt.edu
Category:

less

Transcript and Presenter's Notes

Title: CAN ADHERENCE BE IMPROVED?


1
CAN ADHERENCE BE IMPROVED?
2
Status of Adherence Intervention Studies
  • To Medication
  • To Exercise
  • To Diet

3
19 Adherence Intervention Studies
  • Randomized
  • Control Group
  • Assessment of Adherence
  • Assessment of Outcome
  • 6 month Follow Up
  • Haynes, R. B., Montague, P., Oliver, T.,
    McKibbon, K. A., Brouwers, M. C., Kanani, R.
    (2001). Interventions for helping patients to
    follow prescriptions for medications. Systematic
    Review Cochrane Consumers Communication Group
    Cochrane Database of Systematic Reviews.

4
19 Adherence Intervention Studies
  • ? All Use Self - Report
  • ? 1 Study addresses Remediation
  • Education/Counseling/Behavioral Strategies
  • All Address Single Regimen/Disease

5
Characteristics of Successful Interventions
  • Educational/Behavioral
  • Multicomponent
  • Long-Term
  • (from Haynes, 1996)

6
Adherence Monitoring as Intervention
  • Use of Electronically Monitored Data as Feedback
  • Improved Blood Pressure Control1
    Improved Blood Pressure Management
  • Reduction in Seizures2
    Improved Adherence
  • 1 Bertholet et al, 2000
  • 2 Schneider et al, 2000

7
Summary of Interventions
  • Education
  • Social Support
  • Self-Efficacy Enhancement
  • Behavioral Intervention
  • Electronic Monitoring/Feedback
  • Self-Monitoring
  • Counseling
  • Positive Reinforcement
  • Cuing
  • Verbal Persuasion

8
Interventions to Promote Adherence to Exercise
  • Self-Monitoring 1,6,8
  • Counseling 2,6,7
  • Positive Reinforcement 1,5
  • 1 Atkins et al, 1984
  • 2 Belise et al, 1987
  • 3 Daltroy, 1985
  • 4 Jakicic et al, 1995
  • 5 Keefe Blumenthal, 1980
  • Cuing 1,5
  • Verbal Persuasion 3
  • Education 4,9
  • 6 King et al, 1988
  • 7 King Frederikson, 1984
  • 8 Rogers et al, 1987
  • 9 Schneiders et al, 1998

9
Interventions to Promote Adherence to Dietary
Regimen
  • Education 5,7
  • Behavioral Intervention 9
  • 6 McCann et al, 1988
  • 7 Mojonnier et al, 1980
  • 8 Simkin-Silverman et al, 1995
  • 9 Wing Anglen, 1996
  • Counseling 3,4,8
  • Social Support 1,2,6
  • Self-Efficacy Enhancement 6
  • 1 Barnard et al, 1992
  • 2 Borbjerb et al, 1995
  • 3 Dolecek et al, 1986
  • 4 Glueck et al, 1986
  • 5 Karvetti, 1981

10
Summary
  • Interventions are not targeted to patient
    adherence patterns or to patient-reported reasons
    for poor adherence
  • Outcome measures are not reliable or accurate
  • Very few RCTs have been reported

11
3 Randomized Controlled StudiesDesigned to
Examine Strategies to Improve Compliance
  • Study 1. An intervention study designed to
    improve poor adherers - asymptomatic condition
  • Study 2. An intervention study with poor
    compliers - symptomatic condition
  • Study 3. Adherence in clinical trials
  • - an induction study

12
An Intervention Study Designed to Improve Poor
Compliers
  • Purpose To evaluate a multicomponent
    behavioral strategy designed to improve
    compliance among poor compliers
  • Setting Multi-center randomized controlled
    clinical trial designed to test the cholesterol
    hypothesis
  • Coronary Primary Prevention Trial

13
Proportion of Subjects gt 75 Compliance
  • Pre-intervention Post-Intervention
  • Experimental 0 9
  • Attention Control 0 1
  • Usual Care 0 3
  • ?2 10.21, 2dĆ’, p .006

14
Change in Cholesterol Levels
15
Variability in Adherence and Treatment Response
  • Greater response to monitoring/attention
  • overestimated compliance (r .75)
  • greater variability (r .50)
  • Relationship between variability and
    overestimation (r .54)

16
An Intervention Study Designed to Improve Poor
AdherersRAC-1
  • Purpose
  • To evaluate a series of behavioral/problem
    solving interventions to improve poor
    adherence
  • Setting Specialty practice sites

17
RESULTS
  • Group Differences Baseline To End Of Treatment
  • Average Change In Adherence x sd
  • Intervention 4.30 24.7
  • Usual Care -7.99 27.1
  • t -2.02, p .023
  • Proportion Greater Than 80 Adherence
  • Intervention Maintenance 29.7
  • Usual Care 15.6
  • X2 2.25, df 1, p .065

18
Relationship of Change in Adherence and
Functional Status
  • Tx F/U
  • Adherence Pain rs .02 rs -.22
  • (n 96) (n 98)
  • Adherence Difficulty rs .04 rs
    -.11
  • (n 95) (n 97)
  • Adherence Assistance rs .03 rs
    -.12
  • (n 96) (n 97)
  • plt.01 Changes in adherence were associated with
    changes in pain in carrying out activities of
    daily living, but no level of difficulty or
    assistance required

19
Predictors of Change
  • Baseline Correlates With Change Score
  • End of Treatment rs -.20 p .036
  • Follow-up rs -.32 p .001
  • Session Attendance and Change Score
  • Follow-up f 9.07, df 2, p .0007

20
Compliance in Clinical Trials - An Induction
Study
  • Purpose To evaluate a minimal strategy
    designed to promote initial compliance
  • Setting Single center randomized, clinical
    trial designed to study the psychological and
    behavioral effects of cholesterol
    lowering
  • M. Muldoon, the CARE Study

21
Group Differences in AdherenceACTat 6 Months
  • n 180 MEMS MEMS Pill Count
  • ( days compliant) ( pills taken)
  • Usual Care (Mdn) 62.5 85.7 93.5
  • Habit Training (Mdn) 67.9 92.8 96.1
  • Habit Training (Mdn) 61.6 90.2 93.8
  • Problem Solving
  • p NS NS NS

22
Summary
  • Poor Adherence is
  • Wide Spread
  • Costly
  • Hard to Identify
  • Difficult to Predict Who Does Not Adhere
  • Few Studies Point to Interventions

23
Summary
  • Individuals vary in dosing adherence
  • Measures to identify poor adherence need to be
    sensitive to dosing patterns
  • Minimal intervention does not appear to improve
    long-term adherence
  • Adherence can be improved with intensive
    interventions
  • Improving adherence positively impacts clinical
    outcomes

24
Recommendations
  • Address individual adherence patterns in clinical
    and research setting
  • Take careful account of method of assessment in
    interpretation of adherence data
  • Design/evaluate adherence interventions

25
Any Questions? Thank You!
Write a Comment
User Comments (0)
About PowerShow.com