Diabetes Transitional Care from Inpatient to Outpatient Setting

2012 ◽  
Vol 26 (2) ◽  
pp. 120-124 ◽  
Author(s):  
Mansi Shah ◽  
CaTanya A. Norwood ◽  
Sol Farias ◽  
Sonia Ibrahim ◽  
Pang H. Chong ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Transitional Care ◽  
Intervention Group ◽  
Outpatient Setting ◽  
Controlled Study ◽  
Adherence Rate ◽  
Control Group ◽  
Diabetes Medication ◽  
Counseling Intervention

Purpose: Diabetes transitional care from the inpatient to outpatient setting is understudied. This study evaluated the effect of inpatient pharmacist discharge counseling on outpatient diabetes medication adherence. Research methods: Prospective, randomized, controlled study compared pharmacist discharge counseling (intervention) with usual patient care (control) in 127 patients with established diabetes and an A1C ≥8% who had a provider and medications filled within the county health system. The primary outcome was diabetes medication adherence rate measured using the prescription of days covered (PDC) method. Results: Patients in the intervention, compared with control group, had greater diabetes medication adherence rate 150 days after discharge (55.2% vs 34.8%; P = .002), rate of follow-up visits (60.5% vs 43.9%; P = .01) and reduction in A1C (−1.97% vs +0.114%; P = .003). Being in the intervention group and having greater adherence with follow-up visits correlated independently with lower follow-up A1C. Conclusion: Transitional care in the form of inpatient education geared to improve self-management after hospital discharge. This may serve as a paradigm to improve outpatient adherence rate with medications, follow-up visits, and A1C reduction.

Motivational Interviewing to Support Oral AntiCoagulation adherence in patients with non-valvular Atrial Fibrillation (MISOAC-AF): a randomised clinical trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Tzikas ◽  
A Samaras ◽  
A Kartas ◽  
D Vasdeki ◽  
G Fotos ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Medication Adherence ◽  
Medical Care ◽  
Oral Anticoagulation ◽  
Intervention Group ◽  
Control Group ◽  
Motivational Intervention ◽  
Clinical Events ◽  
Secondary Outcomes

Abstract Background Oral anticoagulation (OAC) is paramount to effective thromboprophylaxis; yet adherence to OAC remains largely suboptimal in patients with atrial fibrillation (AF). Purpose We aimed to assess the impact of an educational, motivational intervention on the adherence to OAC in patients with non-valvular AF. Methods Hospitalised patients with non-valvular AF who received OAC were randomly assigned to usual medical care or a proactive intervention, comprising motivational interviewing and tailored counseling on medication adherence. The primary study outcome was adherence to OAC at 1-year, evaluated as Proportion of Days Covered (PDC) by OAC regimens and assessed through nationwide prescription registers. Secondary outcomes included the rate of persistence to OAC, gaps in treatment, proportion of VKA-takers with labile INR (defined as time to therapeutic range<70%) and clinical events. Results A total of 1009 patients were randomised, 500 in the intervention group and 509 in the control group. At 1-year follow-up, 77.2% (386/500) of patients in the intervention group had good adherence (PDC>80%), compared with 55% (280/509) in the control group (adjusted odds ratio 2.84, 95% confidence interval 2.14–3.75; p<0.001). Mean PDC±SD was 0.85±0.26 and 0.75±0.31, respectively (p<0.001). Patients that received the intervention were more likely to persist in their OAC therapy at 1 year, while usual medical care was associated with more major (≥3 months) treatment gaps [Figure]. Among 212 VKA-takers, patients in the intervention group were less likely to have labile INR compared with those in the control group [21/120 (17.1%) vs 34/92 (37.1%), OR 0.33 95% CI 1.15–0.72, p=0.005]. Clinical events over a median follow-up period of 2 years occurred at a numerically lower, yet non-significant, rate in the intervention group [Table]. Conclusions In patients receiving OAC therapy for non-valvular AF, a motivational intervention significantly improved patterns of medication adherence, without significantly affecting clinical outcomes. Primary and secondary outcomes Funding Acknowledgement Type of funding source: None

scholarly journals 83 A Medication Self-Management Intervention to Improve Medication Adherence For Older People with Multimorbidity: A Pilot Study

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
C Yang ◽  
Z Hui ◽  
S Zhu ◽  
X Wang ◽  
G Tang ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Pilot Study ◽  
Older People ◽  
Intervention Group ◽  
Self Management ◽  
Control Group ◽  
Medication Knowledge ◽  
Management Intervention ◽  
Patient Reported

Abstract Introduction Medication self-management support has been recognised as an essential element in primary health care to promote medication adherence and health outcomes for older people with chronic conditions. A patient-centred intervention empowering patients and supporting medication self-management activities could benefit older people. This pilot study tested a newly developed medication self-management intervention for improving medication adherence among older people with multimorbidity. Method This was a two-arm randomised controlled trial. Older people with multimorbidity were recruited from a community healthcare centre in Changsha, China. Participants were randomly allocated to either a control group receiving usual care (n = 14), or to an intervention group receiving three face-to-face medication self-management sessions and two follow-up phone calls over six weeks, targeting behavioural determinants of adherence from the Information-Motivation-Behavioural skills model (n = 14). Feasibility was assessed through recruitment and retention rates, outcome measures collection, and intervention implementation. Follow-up data were measured at six weeks after baseline using patient-reported outcomes including medication adherence, medication self-management capabilities, treatment experiences, and quality of life. Preliminary effectiveness of the intervention was explored using generalised estimating equations. Results Of the 72 approached participants, 28 (38.89%) were eligible for study participation. In the intervention group, 13 participants (92.86%) completed follow-up and 10 (71.42%) completed all intervention sessions. Ten participants (71.42%) in the control group completed follow-up. The intervention was found to be acceptable by participants and the intervention nurse. Comparing with the control group, participants in the intervention group showed significant improvements in medication adherence (β = 0.26, 95%CI 0.12, 0.40, P < 0.001), medication knowledge (β = 4.43, 95%CI 1.11, 7.75, P = 0.009), and perceived necessity of medications (β = −2.84, 95%CI -5.67, −0.01, P = 0.049) at follow-up. Conclusions The nurse-led medication self-management intervention is feasible and acceptable among older people with multimorbidity. Preliminary results showed that the intervention may improve patients’ medication knowledge and beliefs and thus lead to improved adherence.

scholarly journals Efficacy of Text Messaging and Personal Consultation by Pharmacy Students Among Adults With Hypertension: Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Panpan Zhai ◽  
Khezar Hayat ◽  
Wenjing Ji ◽  
Qian Li ◽  
Li Shi ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Text Messaging ◽  
Controlled Trial ◽  
Intervention Group ◽  
Text Messages ◽  
Chinese Patients ◽  
Control Group ◽  
To Receive ◽  
Sms Text Messaging

BACKGROUND Hypertension is one of the leading risk factors for ischemic heart diseases, and high rates of hypertension prevalence have either remained the same or increased in developing countries in recent years. Unfortunately, about 20% to 50% of patients with chronic diseases have been nonadherent to their drug therapy. SMS text messaging and pharmacy student–led consultations have the potential to help patients manage their blood pressure (BP). OBJECTIVE The aim of this study was to assess the effectiveness, feasibility, and acceptability of SMS text messaging and consultation to manage the BP of Chinese patients with hypertension. METHODS We conducted a two-arm cluster randomized controlled trial among patients with hypertension in Xi’an City, Shaanxi Province, China, and recruited 384 patients from 8 community health care centers. Patients were randomized into an intervention group to receive SMS text messages and consultations or into a control group to receive usual care for 3 months. We sent SMS text messages at 3-day intervals and collected data at baseline (including demographics, clinical outcomes, medication complexity, side effects, patient behavior, knowledge about hypertension, BP, and medication adherence) and the 3-month follow-up (including BP, medication adherence, and knowledge about hypertension). RESULTS We assessed 445 patients with hypertension and excluded 61 patients who were not eligible or who had not filled out their questionnaires. The mean age of the patients was 68.5 (SD 7.9) years in the intervention group and 69.4 (SD 9.7) years in the control group, and the sample was primarily female (265/384, 69.0%). Patients in the intervention group showed significant improvements in systolic BP (SBP; mean 134.5 mm Hg, SD 15.5 mm Hg vs mean 140.7 mm Hg, SD 15.2 mm Hg; <i>P</i>=.001), medication adherence (mean 7.4, SD 1.2 vs mean 7.0, SD 1.3; <i>P</i>=.04), and knowledge about hypertension (mean 6.3, SD 0.9 vs mean 5.9, SD 1.2; <i>P</i>=.004) compared with those in the control group. In measures of diastolic BP (DBP), the two arms showed nonsignificant improvements (mean 78.2 mm Hg, SD 9.0 mm Hg vs mean 77.2 mm Hg, SD 10.3 mm Hg; <i>P</i>=.06). In total, 176 patients had controlled BP at the 3-month follow-up (98 patients in the intervention group vs 78 patients in the control group), but it was nonsignificant (<i>P</i>=.08). CONCLUSIONS The use of SMS text messaging and consultation to manage SBP and improve medication adherence is effective, feasible, and acceptable among Chinese patients with hypertension, although a significant difference was not observed with regard to DBP. It is important to maximize the potential of SMS text messaging and consultation by increasing the feasibility and acceptance of mobile interventions and conduct a cost-effectiveness analysis on this method. CLINICALTRIAL Chinese Clinical Trial Registry ChiCTR1900026862; http://www.chictr.org.cn/showproj.aspx?proj=42717.

scholarly journals Telephone-Based Reeducation of Drug Administration for Helicobacterpylori Eradication: A Multicenter Randomized Controlled Study

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Yan Zhao ◽  
Mudan Ren ◽  
Xin Wang ◽  
Guifang Lu ◽  
Xinlan Lu ◽  
...  
Keyword(s):  
Eradication Rate ◽  
Symptom Relief ◽  
Intervention Group ◽  
Eradication Therapy ◽  
Incidence Rates ◽  
Controlled Study ◽  
Control Group ◽  
Intention To Treat ◽  
Event Rates

Poor adherence to treatment instructions may play an important role in the failure of Helicobacter pylori eradication. The aim of this study was to evaluate the effects of telephone-based reeducation on 14-day quadruple H. pylori eradication therapy. In total, 162 patients were randomly assigned (1 : 1) to either the intervention group (patients received telephone-based reeducation on the 4th, 7th, and 10th days of the course) or the control group (patients received instructions only at the time of getting the prescriptions). All patients received a 14-day quadruple H. pylori eradication therapy. The primary outcome was the H. pylori eradication rate. The secondary outcomes included the symptom relief rates and the incidence rates of adverse events. Seventy-five patients in the reeducation group and 74 patients in the control group completed the follow-up. The H. pylori eradication rate in the reeducation group was statistically higher than that in the control group (intention-to-treat: 72.8% vs. 50.6%, P=0.006; per-protocol: 78.7% vs. 55.4%, P=0.003). However, the symptom relief rates and the adverse event rates in these two groups were not significantly different. Overall, the results from this study suggest that telephone-based reeducation can be potentially applied to improve the H. pylori eradication rate in clinical practice, without significantly increasing the adverse effects.

A Multicentre Randomised Controlled Study Evaluating the Effect of a Standardised Education Programme on Quality of Life, Disease Severity, and Disease Knowledge in Patients with Moderate-To-Severe Psoriasis: The EDUPSO Study

Dermatology ◽  
2021 ◽  
pp. 1-10
Author(s):  
Fatma Jendoubi ◽  
Stefana Balica ◽  
Marie Aleth Richard ◽  
Christine Chiaverini ◽  
Claire Bernier ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Intervention Group ◽  
Education Programme ◽  
Controlled Study ◽  
Control Group ◽  
Randomised Controlled Study ◽  
Randomised Controlled ◽  
To Receive

<b><i>Background:</i></b> Psoriasis is a chronic inflammatory skin disease that has a profound effect on health-related quality of life (HRQoL). Patient education programmes may help patients to gain life-long control over their chronic disease. <b><i>Objective:</i></b> This multicentre randomised controlled study evaluated whether a standardised multidisciplinary education programme was beneficial to psoriasis patients. <b><i>Methods:</i></b> Adults with moderate-to-severe psoriasis were randomly assigned (1:1) to an intervention group to receive an educational programme or to a control group to receive usual care. Randomization was stratified by previous treatment history. The primary outcome was HRQoL, assessed by scoring the Skindex-29 domains emotion, symptom, and functioning. Psoriasis severity was assessed using the psoriasis area severity index (PASI). Levels of perceived stress, patient knowledge about psoriasis, and patient satisfaction were also assessed. Follow-up evaluations were performed at 3, 6, and 12 months. <b><i>Results:</i></b> A total 142 patients formed the intention-to-treat population: 70 in the control group and 72 in the intervention group. Skindex component scores and the PASI were significantly lower at 3, 6, and 12 months as compared to baseline in both groups, but no significant differences were found between the groups. Knowledge about psoriasis improved significantly during follow-up amongst patients from the intervention group compared to controls (68% of correct answers vs. 56%; <i>p</i> &#x3c; 0.01). Patient satisfaction with psoriasis management and treatment was also better in the intervention group. <b><i>Conclusions:</i></b> The standardised education programme did not improve HRQoL and disease severity in psoriasis, but led to a significant improvement in patient knowledge about the disease and increased patient satisfaction.

scholarly journals Pharmacist-Led Discharge Medication Counseling and its Corresponding Impact on Medication Adherence and Hospital Readmission Rates

2020 ◽  
Vol 11 (3) ◽  
pp. 6
Author(s):  
Savannah Cunningham ◽  
Joshua D. Kinsey
Keyword(s):  
Medication Adherence ◽  
Hospital Readmission ◽  
Intervention Group ◽  
Control Group ◽  
Readmission Rates ◽  
Discharge Medication ◽  
Hospital Readmission Rates ◽  
Medication Counseling ◽  
Significant Difference

Objectives: Pharmacists have been shown to reduce hospital readmission rates and improve adherence rates by providing discharge medication counseling and offering services such as a bedside delivery program.1 Hospitals are now penalized by Medicare if patients are readmitted within 30 days of discharge, so implementation of these programs have the potential to be financially significant as well.2 The primary endpoint of this study is to evaluate the impact of a pharmacist discharge medication counseling bedside delivery program on medication adherence rates within a six-week period following discharge. The secondary endpoint focuses on hospital readmission rates. The objective of this study is to increase collaboration between community pharmacies and hospitals in order to improve the quality of patient care. Methods: This study was designed as intervention versus control, whereas the intervention patients were those who received counseling from a pharmacist or pharmacist intern and control patients were those who did not within the same time period. Collected patient data (n=81) included patients’ demographic data and all disease states, genders, and insurance coverage were encompassed by the included patients. Medication adherence was measured at follow-up intervals utilizing the proportion of days covered (PDC) equation, where a score of at least 80% is required for optimal therapeutic efficacy. Informed consent was obtained from all participants regarding a follow-up telephone call or retrieval of medication records through the pharmacy electronic medication records system and hospital electronic medical records system. Approximately 10-15-minute counseling sessions were performed at the time of discharge. Follow-up phone calls were conducted for the intervention group at four-weeks and six-weeks post-discharge using an eight-item Morisky medication adherence survey to discuss medication adherence and side effects experienced.  Results: There was a total of 81 patients enrolled in this study. There were 27 patients in the intervention group and 54 patients in the control group. These pharmacist-led discharge counseling sessions made a statistically significant difference in medication adherence rates (P=<0.001) as calculated using PDC, showing adherence rates of 84.4% in the intervention group and 62.8% in the control group. The pharmacist-led discharge counseling sessions did not make a statistically significant difference in hospital readmission rates, though investigators do expect to see an impact on clinical and financial endpoints. Conclusion: Pharmacist involvement in a bedside delivery program helps to improve medication adherence in patients being discharged from a hospital. A PDC of at least 80% is required for optimal therapeutic efficacy in most classes of chronic medications, and only the intervention arm reached this threshold.13 Although this study’s sample size was not sufficient to show a statistically significant difference in reduced hospital readmission rates for patients receiving a pharmacist-led discharge counseling session, the findings show the potential for a clinical impact and improved patient outcomes due to increased adherence rates.   Original Research

scholarly journals Impact of Testing on Sexually Transmitted Infections among Female Brothel Sex Workers in Bangladesh: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Asad Islam ◽  
HongQi Alexis Tan ◽  
Claire C. Bristow ◽  
Md Golam Hasnain ◽  
Russell Smyth ◽  
...  
Keyword(s):  
Sexually Transmitted Infections ◽  
Sex Workers ◽  
Controlled Trial ◽  
Intervention Group ◽  
Controlled Study ◽  
Baseline Survey ◽  
Control Group ◽  
Sexually Transmitted ◽  
Randomized Controlled

Past studies that have designed interventions to reduce the prevalence of sexually transmitted infections (STIs) have typically provided onsite treatment to sex workers who tested positive, which were expensive and difficult to implement. The purpose of this study was to examine the effect of an intervention which tested for STIs and provided information on the closest treatment facility on reducing the prevalence of STIs among female brothel-based sex workers (BSWs) in Bangladesh. The study adopted a pre–post interventional design as well as a randomized controlled study design. A baseline sample and follow-up urine sample were collected to evaluate the prevalence of STIs among participants in the treatment, but not control group. A baseline survey and interviews were also conducted for both the groups. The study found a nonsignificant reduction from baseline to follow-up in STI prevalence among intervention participants (adjusted odds ratio [aOR]: 0.74; 95% CI: 0.38, 1.45). However, the participants in the intervention group were significantly more likely to have a repeat client (aOR: 1.60; 95% CI: 1.12, 2.29) and nonsignificantly less likely to engage with a client suspected of having an STI (aOR: 0.62; 95% CI: 0.39, 1.00) than participants in the control group. The intervention testing of STIs and providing information to the positive cases about nearest treatment facilities were not effective in reducing the prevalence of STIs among BSWs. Further study of the clinical and behavioral impacts of such efforts to reduce STIs among BSWs is warranted.

scholarly journals Mindfulness-Based Intervention for Children with Mental Health Problems: a 2-Year Follow-up Randomized Controlled Study

Mindfulness ◽  
2021 ◽  
Author(s):  
Katarina Laundy ◽  
Peter Friberg ◽  
Walter Osika ◽  
Yun Chen
Keyword(s):  
Mental Health ◽  
Disruptive Behavior ◽  
Mental Health Problems ◽  
Intervention Group ◽  
Health Problems ◽  
Controlled Study ◽  
Control Group ◽  
Registration Number ◽  
Group A

Abstract Objectives Moderate mental health problems are highly prevalent and increasing in Swedish schoolchildren, elevating risk for future mental and somatic disability. The aim of this study was to determine whether an 8-week mindfulness-based intervention, Training for Mindfulness and Resilience (TMR), mitigates mental health symptoms and increases resilience during a 2-year follow-up. Methods Schoolchildren (aged 9–14 years) reporting moderate mental health problems were randomized into either TMR intervention group (N = 22) or control group, receiving best current practice (N = 12). We used validated questionnaires to measure anxiety, depression, anger, disruptive behavior, self-concept, resilience, stress, and mindfulness before treatment with either TMR or control, as well as at 6 months, 1 year, and 2 years follow-up. Results We found a statistically significant effect of TMR intervention vs control, on resilience, anxiety, anger, and disruptive behavior. Compared to baseline, TMR increased the level of resilience at 6 months (p < .001); anxiety at 1 (p <  = .033) and 2 years (p = .04); anger at 6 months (p = .004) and 2 years (p = .039); disruptive behavior at 6 months (p = .006). In the control group, a decrease in resilience between 6 months and 2 years (p = .05) was observed. No other significant effects were found in the control group. Conclusions This study suggested that TMR improved mental health in schoolchildren with effects on anxiety and anger lasting for 2 years, and on resilience and disruptive behavior lasting for 6 months. Trial Registration Number NCT04806542, date of registration 18th of March 2021, retrospectively registered.

scholarly journals A241 PRICE: PREVENTING READMISSIONS IN IBD CENTRES OF EXCELLENCE

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 118-119
Author(s):  
F Dang ◽  
P Habashi ◽  
Z Gallinger ◽  
G C Nguyen
Keyword(s):  
Medication Adherence ◽  
Hospital Discharge ◽  
Hospital Readmission ◽  
Practice Nurse ◽  
Intervention Group ◽  
Small Sample ◽  
Control Group ◽  
Post Discharge ◽  
Readmission Rates

Abstract Background Hospital readmission rates are high in the IBD population, with 20% of patients readmitted within the same calendar year. Hospital discharge processes are not routinely standardized and deficiencies in the transition of care after discharge puts patients at increased risk of illness, hospital utilization and healthcare cost. In addition to increased healthcare expenditure, hospitalizations for IBD patients are associated with nosocomial complications such as venous thromboembolism and infection. Aims We hypothesize that implementing standardized follow-up by an IBD practice nurse and electronic health outcome monitoring through NoviSurvey can reduce the risk of hospital readmission compared to current approaches of hospital discharge alone. Methods This parallel randomized control trial is powered for N=400 and will include patients admitted for an IBD flare without requiring surgical intervention from the gastroenterology service or consulted from general internal medicine. Patients randomized to the control arm are discharged with usual standard of care. Patients in the intervention group will be eligible for usual post-discharge care in addition to organized telephone follow-up by an IBD practice nurse at 1, 7 and 30 days post-discharge. In addition, these patients will receive bi-weekly correspondence from NoviSurvey to complete a short questionnaire on clinical disease severity and medication adherence. Based on telephone interaction and survey scores, the IBD nurse may arrange readmission or expedited ambulatory visit for high-risk patients. Results 15 patients are currently enrolled into our study, with 7 randomized to the intervention and 8 to the control group. In the control group, 25% of patients were readmitted to hospital within 30 days of discharge and 13% failed to follow their steroid taper. There were no patients in the intervention group who were readmitted to hospital within 30 days and none who failed their steroid taper. In both the control or intervention group, there were no occurrences of deep vein thrombosis within 30 days post-discharge. Conclusions The preliminary findings in our small sample study indicate that a nurse led post-discharge intervention may translate to benefits including decreased readmission rates to hospital, better patient satisfaction and better medication adherence. Funding Agencies CCC

scholarly journals One-Year Follow-Up of the Effectiveness of Cognitive Behavioral Group Therapy for Patients’ Depression: A Randomized, Single-Blinded, Controlled Study

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Kai-Jo Chiang ◽  
Tsai-Hui Chen ◽  
Hsiu-Tsu Hsieh ◽  
Jui-Chen Tsai ◽  
Keng-Liang Ou ◽  
...  
Keyword(s):  
Group Therapy ◽  
Rating Scale ◽  
Intervention Group ◽  
Automatic Thoughts ◽  
Controlled Study ◽  
Control Group ◽  
Cognitive Behavioral Group Therapy ◽  
One Year

The aim of the study was to investigate the long-term (one year) effectiveness of a 12-session weekly cognitive behavior group therapy (CBGT) on patients with depression. This was a single-blind randomized controlled study with a 2-arm parallel group design. Eighty-one subjects were randomly assigned to 12 sessions intervention group (CBGT) or control group (usual outpatient psychiatric care group) and 62 completed the study. The primary outcome was depression measured with Beck Depression Inventory (BDI-II) and Hamilton Rating Scale for Depression (HRSD). The secondary outcomes were automatic thoughts measured by automatic thoughts questionnaire (ATQ). Both groups were evaluated at the pretest (before 2 weeks), posttest (after 12 therapy sessions), and short- (3 months), medium- (6 months), and long-term (12 months) follow-up. After receiving CBGT, the experimental group had a statistically significant reduction in the BDI-II from 40.30 at baseline to 17.82 points at session eight and to 10.17 points at postintervention(P<0.001). Similar effects were seen on the HRSD. ATQ significantly decreased at the 12th session, 6 months after sessions, and 1 year after the sessions ended(P<0.001). We concluded that CBGT is effective for reducing depression and continued to be effective at 1 year of follow-up.

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