Challenges experienced by community health workers and their motivation to attend a self-management programme

Background: Community health workers (CHWs) are change agents expected to assist in decreasing the global burden of disease in the communities they serve. However, they themselves have health risk behaviours, which predispose them to non-communicable diseases and thus need to be empowered to make better health choices. There is a gap in literature detailing the challenges faced by CHWs in addressing their own health risk behaviours.Aim: This study aimed to explore the challenges experienced by CHWs in carrying out their daily duties and the motivating factors to join a self-management programme.Setting: The study was conducted in a low socio-economic urban area of the Western Cape, South Africa.Methods: This study used a qualitative exploratory design using in-depth interviews to obtain rich data about the personal and professional challenges that CHWs experience on a daily basis.Results: Five themes emerged with regard to professional challenges (social conditions, mental health of patients, work environment, patient adherence and communication). This cadre identified ineffective self-management as a personal challenge and two themes emerged as motivation for participating in a self-management programme: empowerment and widening perspective.Conclusion: The challenges raised by the CHWs have a direct impact on their role in communities. This study therefore highlights an urgent need for policymakers and leaders who plan training programmes to take intentional strategic action to address their health challenges and to consider utilising a self-management intervention model to improve their overall health status.

Impact of 5-Year Endoscopic Surveillance Intervals with Biopsy following Endoscopic Papillectomy for Ampullary Adenoma

Background: Endoscopic snare papillectomy (ESP) has been established as a safe and effective treatment for ampullary adenomas. However, little is known about the optimal post-procedure follow-up period and the role of routine endoscopic surveillance biopsy following ESP. We aimed to evaluate patient adherence to a 5-year endoscopic surveillance and routine biopsy protocol after ESP of ampullary adenoma. Methods: We reviewed our prospectively collected database (n = 98), all members of which underwent ESP for ampullary lesions from January 2011 to December 2016, for the evaluation of long-term outcomes. The primary outcome was the rate of patient adherence to 5-year endoscopic surveillance following ESP. The secondary outcomes were the diagnostic yield of routine endoscopic biopsy, recurrence rate, and adverse events after endoscopic surveillance in the 5-year follow-up (3-month, 6-month, and every 1 year). Results: A total of 19 patients (19.4%) experienced recurrence during follow-up, all of these patients experienced recurrence within 3 years of the procedure (median 217 days, range 69–1083). The adherence rate for patients with sporadic ampullary adenoma were 100%, 93.5%, and 33.6% at 1, 3, and 5 years after ESP, respectively. The diagnostic yield of routine endoscopic biopsy without macroscopic abnormality was 0.54%. Pancreatitis occurred in four patients (4%, 3 mild, 1 moderate) after surveillance endoscopic biopsy without macroscopic abnormality. Conclusions: Given the low 5-year adherence rate and diagnostic yield of routine endoscopic biopsy with risk of pancreatitis, optimal surveillance intervals according to risk stratification (low grade vs. high grade adenoma/intramucosal adenocarcinoma) may be required to improve patient adherence, and routine biopsy without macroscopic abnormality may not be recommended.

Factors related to patient adherence to the use of new oral anticoagulants

ABSTRACT Objective: To characterize the self-reported adherence of patients with cardiovascular diseases to the use of new oral anticoagulants and to identify factors related to adherence to these drugs. Method: This is a descriptive, correlational, and cross-sectional study, carried out with outpatients. The collection of sociodemographic, clinical, and adherence data, through the Measurement of Adherence to Treatments, was made through telephone calls. Descriptive, correlation, and multiple linear regression analyses were used. Results: A total of 120 patients using new anticoagulants for 32.3 months, on average, participated in the study. More than half of the sample consisted of women, who were professionally inactive, with a mean age of 70.1 years and a mean family income of 6.7 minimum wages. The mean adherence score was 5.7, in a possible range between 1 and 6, indicating medication adherence. Inactive employment status, female sex, higher family income, and follow-up at a public outpatient clinic were related to greater adherence to these medications. Conclusion: The patients showed high adherence to new anticoagulants. Employment status, sex, family income, and type of outpatient follow-up were related to medication adherence, and should be considered in the design of interventions for this public.

Medication Nonadherence: Implications for patient health outcomes in pharmacy practice

ABSTRACT Objectives: The primary objective of this review is (1) to better understand the prevalence and impact of medication nonadherence, (2) to identify risk factors for medication nonadherence, (3) to understand the association between nonadherence and its implications on patient health outcomes in pharmacy practice, and (4) to study interventions designed to improve patient adherence to prescribed medications for medical conditions, considering its impact on both medication adherence and patient health outcomes. Methods: Published journal articles were manually sorted. Additional references were obtained from citations within the retrieved articles. This review surveyed the findings of the identified articles with data extracted to presents various strategies and resources on medication nonadherence related to patients and healthcare providers. English languages were considered inclusion criteria in reviewing published articles related to medication nonadherence. This review also surveyed identified articles to determine both subjective and objective medication adherence measures. Key findings: The research in this field needs advances, including improved design of feasible long‐term interventions, objective adherence measures, and sufficient study power to detect improvements in patient health outcomes. Conclusion: Current methods of improving medication adherence for chronic health problems are mostly complex and ineffective so full benefits of treatment cannot be realized. To date, monitoring of patient medication adherence and use of interventions to improve adherence are rare in routine clinical practice.

Strategies to Optimize Adherence in Patients with Mycosis Fungoides

Patient adherence to medications for common skin conditions has been extensively studied over the past two decades, and suboptimal adherence is a primary contributor to treatment failure. The impact of sub-par adherence in cutaneous T-cell lymphoma (CTCL) patients has been largely unexplored, and promoting adherence in this patient population may represent a promising area of consideration for improving treatment outcomes. We apply patient adherence strategies that have been studied in dermatology to CTCL and provide concrete examples of how these strategies can be used to improve adherence in the CTCL setting. Through the implementation of small changes in how we present and counsel about therapeutic options to our patients, we can maximize patient adherence, which has the potential to optimize therapy regimens and reduce treatment failure.

Anticoagulation Practice in Patients with Cancer-Associated Thrombosis: Insights from GeCAT, a German Prospective Registry Study

Introduction: Cancer-associated venous thrombosis (CAT) is a common and serious complication of active malignancies, increasing in frequency during systemic treatment and radiotherapy. Due to a high risk of recurrence and bleeding, the administration of anticoagulants for initial treatment and secondary prevention of CAT is challenging. We conducted a prospective registry study of patients with acute CAT to evaluate the way treatment is given to these patients in routine practice. Methods: From May 2015 to May 2017, all consecutive patients with acute venous thromboembolism (VTE) admitted to specialty or emergency departments of the participating hospitals in Berlin, Germany, were entered in the registry. Patients with cancer underwent extensive baseline evaluation including the type and location of thrombosis and use of anticoagulant therapy. Follow-up assessments were made at discharge and by telephone interviews at 3 and 6 months. Results: A total of 382 patients with acute CAT were enrolled in the study, representing 24.5% of all patients with thrombosis. 70.4% of CAT patients had deep vein thromboses (DVT), 48.2% had pulmonary embolism (PE), and 18.6% had concurrent PE and DVT. A significant proportion of VTE (27%) were asymptomatic and were diagnosed only incidentally. At baseline, 97.9% of the patients received anticoagulant therapy, predominantly with low-molecular-weight heparin (LMWH) (n=334, 87.4%). Direct oral anticoagulants (DOACs) were given to 5.8% of patients, and vitamin K antagonists (VKAs) were rarely used (<2% of patients). Changes in the prescription of antithrombotic agents were seen at discharge from hospital and during follow-up. Overall, the use of LMWH declined during follow-up, while the proportion of patients treated with DOACs increased to 32.4% at 6 months. At baseline, the most frequently used LMWH were enoxaparin and nadroparin, but many patients were switched to once daily tinzaparin prior to discharge. Initially and after discharge the majority of patients were treated by oncologists. Overall, 263 (68.8%) and 222 (58,1%) patients were still alive and could be contacted at 3 and 6 months of follow-up, respectively. Of these, 84.0% and 71.6% were still on anticoagulant therapy (58.6% and 36.5% on LMWH). Conclusion: In accordance with the guidelines, the majority of CAT patients received anticoagulation therapy for the recommended minimum duration of 3-6 months. LMWH remained the preferred option throughout the study, demonstrating good patient adherence. In deviation from guideline recommendations and available study results during the study period, more than a quarter of CAT patients were treated with DOACs. Only recently, DOACs have been established as another option for anticoagulation in CAT patients.

Pengaruh Efisiensi Waktu Tunggu, Biaya Pelayanan, Kebersihan, serta Kenyamanan Ruangan terhadap Kepuasan Pasien (Studi Pada Pelayanan Instalasi Rawat Jalan Rumah Sakit Medika Lestari)

Seeing the importance of patient adherence in a patient's therapeutic journey and several factors related to patient adherence, we tried to assess patient satisfaction with the outpatient unit of Medika Lestari Hospital in 2021. Therefore, we conducted a cross-sectional study of patients aged 18–59 years to assess their satisfaction with the services of the Medika Lestari Hospital outpatient unit on 28 July 2021. We evaluated 4 main dimensions, namely: (1) Efficiency, (2) Convenience; (3) Cleanliness; and (4) Financing. The survey instrument was prepared based on the consensus of the research team and has good validity and reliability based on the Pearson and Cronbach–alpha tests. All statistical analyzes were performed with SmartPLS software version 3.3.3. A total of 206 patients were recruited, with a composition of 102 (49.51%) males and 104 (50.49%) females. There were 43 (20.87%), 103 (50%), 46 (22.33%), and 14 (6.80%) patients, respectively, in the age categories 18-25 years, 26–35 years, 36–45 years, and 46–59 years, respectively. We found that the average patient satisfaction with outpatient services at Medika Lestari Hospital was 4.23 (84.6%). The average patient satisfaction score for the outpatient service at the Medika Lestari Hospital is 4.23±0.363. In addition, we also found that service efficiency, cost, cleanliness of the service room, and comfort of the service room had a positive effect on patient satisfaction in the outpatient unit at Medika Lestari Hospital.

Expert opinion on current trends in hyperpigmentation management: Indian perspective

<p class="abstract">Hyperpigmentation is a common pigmentary disorder characterized by increased production of melanin. It is present in Asian skin phototypes, with a higher prevalence in the Indian population. Skin heterogeneity is seen in more than 80% of individuals of all age groups and genders in several cities across India. In children, the prevalence of hyperpigmentary disorders accounts for 1.54 per 1000 children.Sixty expert dermatologists participated in expert group meetings via teleconference webinar to elaborate on the current trends in the management of hyperpigmentary disorders. The major reasons for hyperpigmentary disorders in India include melanocyte function followed by exposure to ultraviolet radiation, race, ethnicity, use of medications, pregnancy, and use of cosmetic. There are wide varieties of skin-lightening or depigmenting agents and skin resurfacing procedures that aid in the management of hyperpigmentation. However, treatment becomes challenging due to compliance issues related to affordability, complexity of prescriptions, and treatment duration. Compliance increases only if the patient sees any improvement or discontinues treatment due to higher expectations. Hence, the success of the treatment lies in patient adherence. This article summarizes expert opinions on identifying, diagnosing, and managing hyperpigmentation with the help of topical depigmenting agents in the Indian scenario. It also emphasizes treatment adherence issues along with the role of patient counseling and education regarding disease awareness and treatment strategies.</p>

Methodological approach to risk prediction noncompliance in patients with myocardial infarction

Aim. To develop a methodological approach in order to predict the risk of noncompliance in patients with myocardial infarction.Methods. 416 patients were questioned in the single-centered, prospective, non-randomized study using the original author's method. The patients were treated in specialized cardiological departments of the city of Kemerovo with the diagnosed myocardial infarction. The methodological approach to predicting the risk of non-compliance in patients with myocardial infarction covered 29 factors in 6 main blocks: sociodemographic and socio-economic characteristics, health status, medical and pharmaceutical culture of the patient, awareness of medical and pharmaceutical services, patient adherence to medical recommendations.Results. Patients with myocardial infarction were characterized by insufficient adherence to the therapy, low awareness of the disease, which can negatively affect the longterm disease prognosis. The identification of a large number of subjective factors limiting adherence to the therapy is the reason for the widespread use of noncompliance risk measurement among patients with myocardial infarction, which will allow determining the range of the risk group for each individual patient.Conclusion. The adherence to the treatment of patients with myocardial infarction is revealed as 80% which is indicated as low and requires the prophylactic use of educational and psychological programs that increase medical and social awareness and readiness to comply with the doctor's recommendations, and also justifies the need for complex risk measurement of non-compliance patients for personalized identification and addressing risk factors for poor adherence to therapy.

Analysis of the therapeutic benefits of symptomatic slow acting drugs in osteoarthritis: emphasis on structural-modifying action

The review presents an analysis of the therapeutic effect in osteoarthritis (OA) of the original complex injectable drug Alflutop (bioactive concentrate of small marine fish), which is one of the most widely used symptomatic slow acting drugs (SYSADOA) in Russia. It stimulates the proliferation of chondrocytes, activates the synthesis of the extracellular matrix by modulating transforming growth factor β (TGFβ), inhibits hyaluronidase, oxidative stress and the activity of extracellular expression of proinflammatory cytokine genes – interleukin (IL) 1β, IL6 and IL8 in vitro.The results of prospective clinical studies are presented, which demonstrate the ability of Alflutop to slow down the X-ray progression of OA of the knee joints (inhibit the narrowing of the joint space, the growth of osteophytes and increase the intra-articular concentration of hyaluronic acid), as well as restore the mobility of the hip joints when it is locally introduced into the zone of pathological changes in the articular lip of the acetabulum. Combined therapy with Alflutop leads to activation of reparative processes and significant clinical improvement in patients with post-traumatic OA, and also slows down the progression of chondrodegeneration according to magnetic resonance imaging. The new Alflutop administration regimen for knee OA (2 ml every other day, №10) can increase patient adherence to therapy.The results of clinical studies presented in the review prove the structural-modifying effect of Alflutop in OA of various localization and substantiate its widespread use in this disease in rheumatological, traumatological and orthopedic practice.