scholarly journals Length of Initial Prescription at Hospital Discharge and Long-Term Medication Adherence for Elderly, Post-Myocardial Infarction Patients: Protocol for an Interrupted Time Series Study

10.2196/18981 ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. e18981
Author(s):  
J D Schwalm ◽  
Noah M Ivers ◽  
Zachary Bouck ◽  
Monica Taljaard ◽  
Madhu K Natarajan ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Usual Care ◽  
Intervention Group ◽  
Interrupted Time Series ◽  
Interventional Study ◽  
Cardiac Medication ◽  
The Impact ◽  
To Receive ◽  
Discharge Prescription

Background Based on high-quality evidence, guidelines recommend the long-term use of secondary prevention medications post-myocardial infarction (MI) to avoid recurrent cardiovascular events and death. Unfortunately, discontinuation of recommended medications post-MI is common. Observational evidence suggests that prescriptions covering a longer duration at discharge from hospital are associated with greater long-term medication adherence. The following is a proposal for the first interventional study to evaluate the impact of longer prescription duration at discharge post-MI on long-term medication adherence. Objective The overarching goal of this study is to reduce morbidity and mortality among post-MI patients through improved long-term cardiac medication adherence. The specific objectives include the following. First, we will assess whether long-term cardiac medication adherence improves among elderly, post-MI patients following the implementation of (1) standardized discharge prescription forms with 90-day prescriptions and 3 repeats for recommended cardiac medication classes, in combination with education and (2) education alone compared to (3) usual care. Second, we will assess the cost implications of prolonged initial discharge prescriptions compared with usual care. Third, we will compare clinical outcomes between longer (>60 days) versus shorter prescription durations. Fourth, we will collect baseline information to inform a multicenter interventional study. Methods We will conduct a quasiexperimental, interrupted time series design to evaluate the impact of a multifaceted intervention to implement longer duration prescriptions versus usual care on long-term cardiac medication adherence among post-MI patients. Intervention groups and their corresponding settings include: (1) intervention group 1: 1 cardiac center and 1 noncardiac hospital allocated to receive standardized discharge prescription forms supporting the dispensation of 90 days’ worth of cardiac medications with 3 repeats, coupled with education; (2) intervention group 2: 4 sites (including 1 cardiac center) allocated to receive education only; and (3) control group: all remaining hospitals within the province that did not receive an intervention (ie, usual care). Administrative databases will be used to measure all outcomes. Adherence to 4 classes of cardiac medications — statins, beta blockers, angiotensin system inhibitors, and secondary antiplatelets (ie, prasugrel, clopidogrel, or ticagrelor) — will be assessed. Results Enrollment began in September 2017, and results are expected to be analyzed in late 2020. Conclusions The results have the potential to redefine best practices regarding discharge prescribing policies for patients post-MI. A policy of standardized maximum-duration prescriptions at the time of discharge post-MI is a simple intervention that has the potential to significantly improve long-term medication adherence, thus decreasing cardiac morbidity and mortality. If effective, this low-cost intervention to implement longer duration prescriptions post-MI could be easily scaled. Trial Registration ClinicalTrials.gov NCT03257579; https://clinicaltrials.gov/ct2/show/NCT03257579 International Registered Report Identifier (IRRID) DERR1-10.2196/18981

scholarly journals Length of Initial Prescription at Hospital Discharge and Long-Term Medication Adherence for Elderly, Post-Myocardial Infarction Patients: Protocol for an Interrupted Time Series Study (Preprint)

2020 ◽  
Author(s):  
J D Schwalm ◽  
Noah M Ivers ◽  
Zachary Bouck ◽  
Monica Taljaard ◽  
Madhu K Natarajan ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Usual Care ◽  
Intervention Group ◽  
Interrupted Time Series ◽  
Interventional Study ◽  
Cardiac Medication ◽  
The Impact ◽  
To Receive ◽  
Discharge Prescription

BACKGROUND Based on high-quality evidence, guidelines recommend the long-term use of secondary prevention medications post-myocardial infarction (MI) to avoid recurrent cardiovascular events and death. Unfortunately, discontinuation of recommended medications post-MI is common. Observational evidence suggests that prescriptions covering a longer duration at discharge from hospital are associated with greater long-term medication adherence. The following is a proposal for the first interventional study to evaluate the impact of longer prescription duration at discharge post-MI on long-term medication adherence. OBJECTIVE The overarching goal of this study is to reduce morbidity and mortality among post-MI patients through improved long-term cardiac medication adherence. The specific objectives include the following. First, we will assess whether long-term cardiac medication adherence improves among elderly, post-MI patients following the implementation of (1) standardized discharge prescription forms with 90-day prescriptions and 3 repeats for recommended cardiac medication classes, in combination with education and (2) education alone compared to (3) usual care. Second, we will assess the cost implications of prolonged initial discharge prescriptions compared with usual care. Third, we will compare clinical outcomes between longer (>60 days) versus shorter prescription durations. Fourth, we will collect baseline information to inform a multicenter interventional study. METHODS We will conduct a quasiexperimental, interrupted time series design to evaluate the impact of a multifaceted intervention to implement longer duration prescriptions versus usual care on long-term cardiac medication adherence among post-MI patients. Intervention groups and their corresponding settings include: (1) intervention group 1: 1 cardiac center and 1 noncardiac hospital allocated to receive standardized discharge prescription forms supporting the dispensation of 90 days’ worth of cardiac medications with 3 repeats, coupled with education; (2) intervention group 2: 4 sites (including 1 cardiac center) allocated to receive education only; and (3) control group: all remaining hospitals within the province that did not receive an intervention (ie, usual care). Administrative databases will be used to measure all outcomes. Adherence to 4 classes of cardiac medications — statins, beta blockers, angiotensin system inhibitors, and secondary antiplatelets (ie, prasugrel, clopidogrel, or ticagrelor) — will be assessed. RESULTS Enrollment began in September 2017, and results are expected to be analyzed in late 2020. CONCLUSIONS The results have the potential to redefine best practices regarding discharge prescribing policies for patients post-MI. A policy of standardized maximum-duration prescriptions at the time of discharge post-MI is a simple intervention that has the potential to significantly improve long-term medication adherence, thus decreasing cardiac morbidity and mortality. If effective, this low-cost intervention to implement longer duration prescriptions post-MI could be easily scaled. CLINICALTRIAL ClinicalTrials.gov NCT03257579; https://clinicaltrials.gov/ct2/show/NCT03257579 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/18981

Abstract 225: A Depression Quality Program and Cardiovascular Disease: Assessing the Impact on Care

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Linda Gordon ◽  
Amanda Malecky ◽  
Andrew Althouse ◽  
Nicole Ansani
Keyword(s):  
Usual Care ◽  
Goal Attainment ◽  
Intervention Group ◽  
Phone Call ◽  
Categorical Variables ◽  
Care Group ◽  
Control Group ◽  
Surrogate Outcome ◽  
The Impact

Background: Data demonstrate an adverse association between depression and coronary artery disease prognosis. Therefore, a depression screening program was initiated in the catheterization (cath) lab. The goals were to improve HEDIS depression compliance rates and determine the impact on clinical outcomes. Methods: Adult patients in an inpatient cath lab from 3 cardiology practices were screened for enrollment in a randomized controlled trial. All cath lab patients received a PHQ-9 depression screener. Those who screened positive for depression (score ≥ 10) were randomized to intervention or usual care. The usual care group received a follow-up phone call to re-administer the PHQ-9 at 6-8 weeks and within 210 days of discharge. The intervention group was administered the PHQ-9 and received intensive education at baseline, 6-8 weeks, and within 210 days of discharge. Education included targeted depression information with a mental health care provider and comprehensive disease management education with a cardiovascular nurse practitioner. Outcomes included: differences in HEDIS depression goal attainment; depression response/remission rates; and cardiovascular goals. Differences between groups were tested using chi-squared tests (categorical variables) and t-tests (continuous variables). Results: Baseline characteristics were similar between control (N=43) and intervention (N=40) groups, with the exception of significantly fewer African American patients in the control group (N=2, 4.7%) vs intervention (N=9, 22.5%). Changes in HEDIS goal attainment show that patients in the intervention group were slightly more likely to be referred to a provider to address depression (95.0% vs 86.0%, p=0.314), or receive meds for depression (65.0% vs 51.2%, p=0.219), but these differences are not statistically significant. More patients in the intervention group refused meds for depression compared to control (15.0% vs. 2.3%, p=0.041); have received blood work (65.0% vs 41.9%, p=0.030); and have received follow-up within 210 days (82.5% vs 46.5%, p<0.001). Treatment adjustment rate was higher in the intervention group compared to control (85.0% vs. 65.1%, p=0.037). Hospital readmission rate was similar between groups (p=0.896) and there was no difference in depression remission or response rates (p=0.426). Further, no differences were seen in cardiovascular surrogate outcome parameters, including cholesterol, A1c, CRP, or BNP between groups; except SGOT was significantly different between groups (-5.0 intervention vs 2.0 control p=0.045). Conclusions: These data demonstrate improvements in attaining a surrogate outcome measure of quality (HEDIS goals); however, this does not appear to translate to a significant clinical impact. Quality measures may need to be continuously reassessed to ensure efficiency and effectiveness of care.

Medication Adherence and Long-Term Functional Outcomes in the Treatment of Schizophrenia in Usual Care

2006 ◽  
Vol 67 (03) ◽  
pp. 453-460 ◽  
Author(s):  
Haya Ascher-Svanum ◽  
Douglas E. Faries ◽  
Baojin Zhu ◽  
Frank R. Ernst ◽  
Marvin S. Swartz ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Usual Care ◽  
Functional Outcomes

Long-term effects on income and sickness benefits after work-focused cognitive-behavioural therapy and individual job support: a pragmatic, multicentre, randomised controlled trial

2018 ◽  
Vol 75 (10) ◽  
pp. 703-708 ◽  
Author(s):  
Simon Øverland ◽  
Astrid Louise Grasdal ◽  
Silje Endresen Reme
Keyword(s):  
Randomised Controlled Trial ◽  
Usual Care ◽  
Cognitive Behavioural Therapy ◽  
Controlled Trial ◽  
Intervention Group ◽  
Behavioural Therapy ◽  
Work Participation ◽  
Cognitive Behavioural ◽  
Randomised Controlled

BackgroundThere is moderate quality evidence that integrating work-directed interventions and components from psychological therapies reduces sickness absence in the medium term. We aimed to extend this evidence by examining objectively ascertained income and work participation status up to 4 years after an intervention to improve outcomes among people who struggle with work from common mental disorder.MethodsThe intervention combined components from cognitive behavioural therapy with principles from supported employment, and compared its efficacy with usual care. Outcomes were derived from registry data with no attrition, in a pragmatic multisite randomised controlled trial (N=1193).ResultsThe intervention group had higher income, higher work participation and more months without receiving benefits over the 10-month to 46-month long-term follow-up period after end of treatment, but differences were not statistically significant. For the group on long-term benefits at inclusion, effect sizes were larger and statistically significant.ConclusionThere were no statistically significant differences between the two groups in the primary outcome in the total population. In a secondary analysis for the subgroup most at risk of permanent work exclusion, long-term outcomes were favourable in the intervention group compared with usual care. The results support integrated work and health services for people on the severe end of work participation challenges.Trial registration numberNCT01146730.

scholarly journals Effect of Dehydroepiandrosterone Replacement on Lipoprotein Profile in Hypoadrenal Women

2009 ◽  
Vol 94 (3) ◽  
pp. 761-764 ◽  
Author(s):  
Manivannan Srinivasan ◽  
Brian A. Irving ◽  
Ketan Dhatariya ◽  
Katherine A. Klaus ◽  
Stacy J. Hartman ◽  
...  
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Low Density ◽  
Lipoprotein Profile ◽  
Double Blind ◽  
Caucasian Women ◽  
Study Participants ◽  
The Impact ◽  
To Receive

Abstract Context: Levels of dehydroepiandrosterone (DHEA) and its sulfate form (DHEAS) are inversely associated with cardiovascular mortality in men but not women. Very little evidence is available on the impact of DHEA administration on lipoprotein profile in women. DHEAS levels are very low/undetectable in hypoadrenal women. Objective: The objective of the study was to determine the impact of DHEA replacement on lipoprotein profile in hypoadrenal women. Design and Setting: A double-blind, randomized, placebo-controlled, cross-over design study was conducted at the Mayo Clinic. Participants: Thirty-three hypoadrenal Caucasian women (mean ± sd; age 50.3 ± 15.2 yr, body mass index 26.6 ± 4.4 kg/m2) took part in the study. Intervention: Study participants were assigned to receive either a placebo or 50 mg/d of DHEA for 3 months each. Lipid levels and lipoprotein profile were analyzed using the Lipo Science Lipoprotein nuclear magnetic resonance system. Main Outcome Measures: Changes in various lipoprotein sizes and levels were measured. Results: The DHEA period had higher plasma DHEAS levels than during placebo (&lt;0.3 ± 0.0 vs. 3.5 ± 1.3 nmol/liter, P &lt; 0.001). DHEA replacement significantly reduced total cholesterol (20.0 vs. −22, P = 0.02) and high-density lipoprotein (HDL) levels (2.0 vs. −6.0, P = 0.006) and tends to reduce triglyceride and total low-density lipoprotein levels. Although, DHEA replacement had no effect on low-density lipoprotein particle size, it significantly reduced larger HDL particles and to modest extent small HDL particles. Conclusions: Our study findings showed that oral DHEA administration in hypoadrenal women results in an unfavorable lipoprotein profile. The results warrant long-term studies to determine the impact of DHEA replacement on cardiovascular risk.

Early rehabilitation after hospital admission for road trauma using an in-reach multidisciplinary team: a randomised controlled trial

2017 ◽  
Vol 31 (9) ◽  
pp. 1189-1200 ◽  
Author(s):  
Jane Wu ◽  
Steven G Faux ◽  
John Estell ◽  
Stephen Wilson ◽  
Ian Harris ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Usual Care ◽  
Intervention Group ◽  
Psychological Status ◽  
Randomised Control Trial ◽  
Control Group ◽  
Rehabilitation Team ◽  
Secondary Outcomes ◽  
The Impact

Objective: To investigate the impact of an in-reach rehabilitation team for patients admitted after road trauma. Design: Randomised control trial of usual care versus early involvement of in-reach rehabilitation team. Telephone follow-up was conducted by a blind assessor at three months for those with minor/moderate injuries and six months for serious/severe injuries. Setting: Four participating trauma services in New South Wales, Australia. Subjects: A total of 214 patients admitted during 2012-2015 with a length of stay of at least five days. Intervention: Provision of rehabilitation services in parallel with ward based therapy using an in-reach team for the intervention group. The control group could still access the ward based therapy (usual care). Main measures: The primary outcome was acute length of stay. Secondary outcomes included percentage requiring inpatient rehabilitation, function (Functional Independence Measure and Timed Up and Go Test), psychological status (Depression Anxiety and Stress Score 21), pain (Orebro Musculoskeletal Pain Questionnaire) and quality of life (Short Form-12 v2). Results: Median length of stay in acute care was 13 days (IQR 8-21). The intervention group, compared to the control group, received more physiotherapy and occupational therapy sessions (median number of sessions 16.0 versus 11.5, P=0.003). However, acute length of stay did not differ between the intervention and control groups (median 15 vs 12 days, P=0.37). There were no significant differences observed in the secondary outcomes at hospital discharge and follow-up. Conclusion: No additional benefit was found from the routine use of acute rehabilitation teams for trauma patients over and above usual care.

scholarly journals Long-Term Control of Endemic Hospital-Wide Methicillin-ResistantStaphylococcus aureus(MRSA): The Impact of Targeted Active Surveillance for MRSA in Patients and Healthcare Workers

2010 ◽  
Vol 31 (8) ◽  
pp. 786-795 ◽  
Author(s):  
Jesus Jesús Rodríguez-Baño ◽  
Lola García ◽  
Encarnación Ramírez ◽  
Carmen Lupión ◽  
Miguel A. Muniain ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Healthcare Workers ◽  
Clinical Epidemiology ◽  
Tertiary Care ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Epidemiology Data ◽  
The Impact ◽  
Mrsa Colonization

Objective.To evaluate the long-term impact of successive interventions on rates of methicillin-resistantStaphylococcus aureus(MRSA) colonization or infection and MRSA bacteremia in an endemic hospital-wide situation.Design.Quasi-experimental, interrupted time-series analysis. The impact of the interventions was analyzed by use of segmented regression. Representative MRSA isolates were typed by use of pulsed-field gel electrophoresis.Setting.A 950-bed teaching hospital in Seville, Spain.Patients.All patients admitted to the hospital during the period from 1995 through 2008.Methods.Three successive interventions were studied: (1) contact precautions, with no active surveillance for MRSA; (2) targeted active surveillance for MRSA in patients and healthcare workers in specific wards, prioritized according to clinical epidemiology data; and (3) targeted active surveillance for MRSA in patients admitted from other medical centers.Results.Neither the preintervention rate of MRSA colonization or infection (0.56 cases per 1,000 patient-days [95% confidence interval {CI}, 0.49-0.62 cases per 1,000 patient-days]) nor the slope for the rate of MRSA colonization or infection changed significantly after the first intervention. The rate decreased significantly to 0.28 cases per 1,000 patient-days (95% CI, 0.17-0.40 cases per 1,000 patient-days) after the second intervention and to 0.07 cases per 1,000 patient-days (95% CI, 0.06-0.08 cases per 1,000 patient-days) after the third intervention, and the rate remained at a similar level for 8 years. The MRSA bacteremia rate decreased by 80%, whereas the rate of bacteremia due to methicillin-susceptibleS. aureusdid not change. Eighty-three percent of the MRSA isolates identified were clonally related. All MRSA isolates obtained from healthcare workers were clonally related to those recovered from patients who were in their care.Conclusion.Our data indicate that long-term control of endemic MRSA is feasible in tertiary care centers. The use of targeted active surveillance for MRSA in patients and healthcare workers in specific wards (identified by means of analysis of clinical epidemiology data) and the use of decolonization were key to the success of the program.

scholarly journals Improving the nursing informatics competency of critical care nurses: results of an interventional study

2020 ◽  
Author(s):  
Somayeh Jouparinejad ◽  
Golnaz Foroughameri ◽  
Reza Khajouei ◽  
Jamileh Farokhzadian
Keyword(s):  
Critical Care ◽  
Training Program ◽  
Nursing Practice ◽  
Intervention Group ◽  
Educational Programs ◽  
Critical Care Nurses ◽  
Nursing Informatics ◽  
Interventional Study ◽  
Critical Care Units ◽  
The Impact

Abstract Background Along with growth and development of health information technology (HIT), nursing informatics (NI) is becoming a fundamental part of all domains of nursing practice especially in critical care settings. Nurses at different levels of the nursing continuum are expected to equip with NI competency for providing patient-centered evidence-based care. Therefore, improvement of the nurses’ NI competency through educational programs is important and necessary for effective using of HIT. This study aimed to evaluate the impact of a training program on NI competency of critical care nurses. Methods In this interventional study, 60 nurses working in critical care units at hospitals affiliated with a large University of Medical Sciences in the southeast of Iran were randomly and equally assigned to the control and intervention groups. NI competency was trained to the intervention group in a three-day workshop. Data were collected using demographic questionnaire and Nursing Informatics Competency Assessment Tool (NICAT) before and one month after the intervention. Results In the pretest stage, both intervention and control groups were at the “competent” level in terms of the NI competency, and no significant difference was observed between them ( p =0.65). However, in the posttest, the NI competency and its dimensions significantly increased in the intervention group with a large effect size compared with the control group ( p = 0.001). This difference showed that the intervention group achieved the “proficient” level in posttest stage. Conclusions The improved scores of NI competency and its dimensions after using the training program implied the effectiveness of this method in enhancing the NI competency of nurses working in the critical care units. The higher efficiency of the training program can be determined by its application in diverse domains of nursing practice. The project is a fundamental for improving nurses’ NI competency through continuous educational programs in Iran, other cultures and contexts.

scholarly journals Impact of iron fortification on anaemia and iron deficiency among pre-school children living in Rural Ghana

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246362
Author(s):  
Samuel Kofi Tchum ◽  
Fareed Kow Arthur ◽  
Bright Adu ◽  
Samuel Asamoah Sakyi ◽  
Latifatu Alhassan Abubakar ◽  
...  
Keyword(s):  
Placebo Group ◽  
Iron Deficiency ◽  
School Children ◽  
Iron Status ◽  
Intervention Group ◽  
Iron Group ◽  
Double Burden ◽  
Micronutrient Powder ◽  
The Impact

Anaemia in young sub-Saharan African children may be due to the double burden of malaria and iron deficiency. Primary analysis of a double-blind, cluster randomized trial of iron containing micronutrient powder supplementation in Ghanaian children aged 6 to 35 months found no difference in malaria risk between intervention and placebo groups. Here, we performed a secondary analysis of the trial data to assess the impact of long-term prophylactic iron fortificant on the risk of iron deficiency and anaemia in trial subjects. This population-based randomized-cluster trial involved 1958 children aged between 6 to 35 months, identified at home and able to eat semi-solid foods. The intervention group (n = 967) received a daily dose containing 12.5 mg elemental iron (as ferrous fumarate), vitamin A (400 μg), ascorbic acid (30 mg) and zinc (5 mg). The placebo group (n = 991) received a similar micronutrient powder but without iron. Micronutrient powder was provided daily to both groups for 5 months. At baseline and endline, health assessment questionnaires were administered and blood samples collected for analysis. The two groups had similar baseline anthropometry, anaemia, iron status, demographic characteristics, and dietary intakes (p > 0.05). Of the 1904 (97.2%) children who remained at the end of the intervention, the intervention group had significantly higher haemoglobin (p = 0.0001) and serum ferritin (p = 0.0002) levels than the placebo group. Soluble transferrin receptor levels were more saturated among children from the iron group compared to non-iron group (p = 0.012). Anaemia status in the iron group improved compared to the placebo group (p = 0.03). Continued long-term routine use of micronutrient powder containing prophylactic iron reduced anaemia, iron deficiency and iron deficiency anaemia among pre-school children living in rural Ghana’s malaria endemic area.

scholarly journals The impact of using a mobile application to improve asthma patients’ adherence to medication in Jordan

2021 ◽  
Vol 27 (3) ◽  
pp. 146045822110429
Author(s):  
Mohammad K Al-Nawayseh ◽  
Montaha AL-Iede ◽  
Eman Elayeh ◽  
Rima Hijazeen ◽  
Khaled Al Oweidat ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Asthma Control ◽  
Mobile Application ◽  
Intervention Group ◽  
P Value ◽  
Asthma Control Test ◽  
Adherence To Medication ◽  
Asthma Patients ◽  
Act Score ◽  
The Impact

The main aim of this study is to assess the effectiveness of using a developed asthma mobile application to enhance medication adherence in Jordan. Asthma patients visiting outpatient respiratory clinics and using inhalers were recruited. Patients were assigned into two groups: intervention and control. The intervention group was instructed to download and use the application. Asthma control was assessed using Asthma Control Test (ACT) at baseline and at follow-up of 3 months for both groups. A total of 171 patients (control, n = 83, and intervention, n = 88) participated in the study. After 3 months of usage, patients in the intervention group achieved a significant improvement in ACT score compared to control ( p-value <0.05), and reported a significant satisfaction of the application use. Therefore, the asthma mobile application is found as an effective tool to enhance medication adherence in asthma patients.

Sign in / Sign up

Export Citation Format

Share Document