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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
M Dolores Arenas Jiménez, Eduardo Parra Moncasi, Fernando Álvarez-Ude Cotera
PURPOSE: Phosphate binders (PB) have to be taken with food, their interference with an individual's lifestyle and social habits influences treatment adherence. Several PBs are available, and patient preferences should not be ignored when prescribing. The purpose was to know the extent of intentional and unintentional nonadherence to PB in hemodialysis (HD) patients, and to evaluate the long-term results (adherence, serum phosphate levels, and cost) of a strategy of prescription of PB that takes into account patient preferences...
April 25, 2017: Clinical Nephrology
Emily A Leven, Rachel Annunziato, Jacqueline Helcer, Sarah R Lieber, Christopher S Knight, Catherine Wlodarkiewicz, Rainier P Soriano, Sander S Florman, Thomas D Schiano, Eyal Shemesh
A growing number of older adults are undergoing liver transplantation (LT) in the United States. In some settings, it is thought that adherence declines with age. This retrospective study examined adherence and clinical outcomes in older vs younger adult LT recipients. Medical records of adult LT recipients from 2009 to 2012 from a single urban center were reviewed. The medication level variability index (MLVI) was the predefined primary outcome, with nonadherence defined as MLVI >2.5. The secondary outcome was incidence of rejection...
April 1, 2017: Clinical Transplantation
Jennifer Scheel, Sandra Reber, Lisa Stoessel, Elisabeth Waldmann, Sabine Jank, Kai-Uwe Eckardt, Franziska Grundmann, Frank Vitinius, Martina de Zwaan, Anna Bertram, Yesim Erim
BACKGROUND: Different measures of non-adherence to immunosuppressant (IS) medication have been found to be associated with rejection episodes after successful transplantation. The aim of the current study was to investigate whether graft rejection after renal transplantation is associated with patient-reported IS medication non-adherence and IS trough level variables (IS trough level variability and percentage of sub-therapeutic IS trough levels). METHODS: Patient-reported non-adherence, IS trough level variability, percentage of sub-therapeutic IS trough levels, and acute biopsy-proven late allograft rejections were assessed in 267 adult renal transplant recipients who were ≥12 months post-transplantation...
March 29, 2017: BMC Nephrology
Ruth Webster, Jose M Castellano, Oyere K Onuma
Regulatory approvals for cardiovascular polypills are increasing rapidly across more than 30 countries. The evidence clearly shows polypills improve adherence and cardiovascular disease risk factors for patients with indications for use of polypill components-ie, those with established cardiovascular disease or at high risk. However, the implementation of polypills into clinical practice has many challenges. The clinical trials literature provides insights into the clinical impact of a polypill strategy, including cost-effectiveness, safety of use, substantial improvement in adherence, and better risk factor control than usual care...
March 11, 2017: Lancet
Ian M Kronish, Nathalie Moise
No abstract text is available yet for this article.
May 1, 2017: JAMA Internal Medicine
Niteesh K Choudhry, Alexis A Krumme, Patrick M Ercole, Charmaine Girdish, Angela Y Tong, Nazleen F Khan, Troyen A Brennan, Olga S Matlin, William H Shrank, Jessica M Franklin
Importance: Forgetfulness is a major contributor to nonadherence to chronic disease medications and could be addressed with medication reminder devices. Objective: To compare the effect of 3 low-cost reminder devices on medication adherence. Design, Setting, and Participants: This 4-arm, block-randomized clinical trial involved 53 480 enrollees of CVS Caremark, a pharmacy benefit manager, across the United States. Eligible participants were aged 18 to 64 years and taking 1 to 3 oral medications for long-term use...
May 1, 2017: JAMA Internal Medicine
Karumathil M Murali, Judy Mullan, Jenny H C Chen, Steven Roodenrys, Maureen Lonergan
BACKGROUND: Medication non-adherence is common among renal dialysis patients. High degrees of non-adherence in randomized controlled trials (RCTs) can lead to failure to detect a true treatment effect. Cardio-protective pharmacological interventions have shown no consistent benefit in RCTs involving dialysis patients. Whether non-adherence contributes to this lack of efficacy is unknown. We aimed to investigate how medication adherence and drug discontinuation were assessed, reported and addressed in RCTs, evaluating cardiovascular or mortality outcomes in dialysis patients...
January 31, 2017: BMC Nephrology
Daniel Cukor, Nisha Ver Halen, Melissa Pencille, Fasika Tedla, Moro Salifu
BACKGROUND: Nonadherence to immunosuppressant medication is a prevalent practice among kidney transplant recipients and has been associated with increased risk for graft failure and economic burden. The aim of this pilot study was to test whether a culturally sensitive cognitive-behavioral adherence promotion program could significantly improve medication adherence to tacrolimus prescription as measured by telephone pill counts among kidney transplant recipients. METHODS: Thirty-three adult transplant recipients were less than 98% adherent to tacrolimus prescription based on 3 telephone pill counts and were randomized either to the 2-session cognitive-behavioral adherence promotion program or to standard care...
2017: Nephron
E Leigh Gibson, Ines Held, Dina Khawnekar, Peter Rutherford
Patients with chronic kidney disease (CKD) often require regular hemodialysis (HD) to prolong life. However, between HD sessions, patients have to restrict their diets carefully to avoid excess accumulation of potassium, phosphate, sodium, and fluid, which their diseased kidneys can no longer regulate. Failure to adhere to their renal dietary regimes can be fatal; nevertheless, non-adherence is common, and yet little is known about the psychological variables that might predict this dietary behavior. Thus, this study aimed to assess whether dietary adherence might be affected by a variety of psychological factors including stress, personality, and health locus of control, as well as dietary knowledge, in chronic HD patients...
2016: Frontiers in Psychology
David J Taber, James N Fleming, Cory E Fominaya, Mulugeta Gebregziabher, Kelly J Hunt, Titte R Srinivas, Prabhakar K Baliga, John W McGillicuddy, Leonard E Egede
BACKGROUND: Non-adherence to medication is a well-studied and known cause of late allograft loss, but it is difficult to measure and prospectively monitor. The aim of this study was to assess if appointment non-adherence was correlated with medication non-adherence and a predictor of graft outcomes. METHODS: This was a longitudinal cohort study that used the National United States Renal Data System and veterans affairs health records data with time-to-event analyses conducted to assess the impact on graft and patient survival...
2017: American Journal of Nephrology
Anne Rebafka
BACKGROUND: Whether or not patients follow the advice given by their healthcare professional is commonly referred to as adherence. In the case of kidney transplantation, transplant recipients need to take immunosuppressive drugs on a regular basis to prevent rejection of their transplant. However, medication adherence can be problematic for many patients. OBJECTIVES: This critical appraisal of evidence aimed to gain insights into factors contributing to adherence and non-adherence in recipients of kidney transplants, and to explore patients' perceptions regarding adherence to immunosuppression...
December 2016: Journal of Renal Care
Tai Mooi Ho, Dolors Estrada, Josep Agudo, Piedad Arias, Raúl Capillas, Elvira Gibert, Mª Mar Isnard, Mª José Solé, Anna Salvadó
BACKGROUND: It is accepted that patient education can be beneficial in the treatment of chronic diseases. We conducted an educational intervention (EI) in hypertensive patients seen at Primary Care centres (PCC) and specialised Hypertension Units (SHU). OBJECTIVES: To assess patient's knowledge of hypertension and to verify the impact of this educational initiative. METHODS: A multicentre quasi-experimental study with the participation of 120 patients with hypertension...
December 2016: Journal of Renal Care
B Zawadzka, S Zawadzka, W Sułowicz, E Ignacak
BACKGROUND: Cooperation between patients and physicians in chronic treatment is an important factor in the patients' adaptation to difficult circumstances. The search is ongoing for factors important to the physician-patient relationship, with the goal of identifying deficits and psychological resources of the patients and medical soft skills of the physicians that can affect the quality of cooperation. The aim of this study was to analyze the psychological mechanisms of patient cooperation with physicians in the area of treatment after kidney transplantation...
June 2016: Transplantation Proceedings
B Zawadzka, S Zawadzka, A Będkowska-Prokop, E Ignacak, W Sułowicz
INTRODUCTION: A patient who complies with doctor recommendations is an indicator of proper cooperation in treatment. It is affected by environmental factors, soft competences of the doctors, and properties of the human personality. We investigated the psychological characteristics of patients that may facilitate human contact and promote healthy behaviors. The aim of the study was to analyze the importance of psychological factors for the occurrence of health-related behaviors necessary for cooperation in treatment...
June 2016: Transplantation Proceedings
Gordon D Schiff, Enrique Seoane-Vazquez, Adam Wright
An 1833 article in the Boston Medical and Surgical Journal (forerunner of the New England Journal of Medicine) explained why prescriptions should be written in Latin to protect patients from knowledge of the names of and indications for the prescribed drugs: "The question is often asked, why..
July 28, 2016: New England Journal of Medicine
Bartłomiej Matłosz, Ewa Firląg-Burkacka, Andrzej Horban, Justyna D Kowalska
Although infrequent, kidney disease is a potentially serious co-morbidity among human immunodeficiency virus (HIV)-infected patients. The spectrum of renal impairment is very wide from clinically insignificant to end stage renal disease and often requires nephrologist's consultation. Therefore, we established combined renal and HIV care in the HIV Out-Patient Clinic in Warsaw. Medical records of patients consulted by nephrologist from March 2014 to March 2015 were included in analyses. Patients changing medication without consulting the physician or persistently not coming for follow-up visits were defined as non-compliant...
February 2017: AIDS Care
Rachel E Patzer, Marina Serper, Peter P Reese, Kamila Przytula, Rachel Koval, Daniela P Ladner, Josh M Levitsky, Michael M Abecassis, Michael S Wolf
We sought to evaluate the prevalence of medication understanding and non-adherence of entire drug regimens among kidney transplantation (KT) recipients and to examine associations of these exposures with clinical outcomes. Structured, in-person interviews were conducted with 99 adult KT recipients between 2011 and 2012 at two transplant centers in Chicago, IL; and Atlanta, GA. Nearly, one-quarter (24%) of participants had limited literacy as measured by the Rapid Estimate of Adult Literacy in Medicine test; patients took a mean of 10 (SD=4) medications and 32% had a medication change within the last month...
October 2016: Clinical Transplantation
Timo Kauppila, Merja K Laine, Mikko Honkasalo, Marko Raina, Johan G Eriksson
OBJECTIVE: To characterize dropouts from type-2 diabetes (T2D) care in communal primary health care. DESIGN: An observational study. SETTING: In a Finnish city, patients with T2D who had not contacted the public primary health care system during the past 12 months were identified with a computer based search and contacted by a trained diabetes nurse. SUBJECTS: Dropouts from T2D treatment. MAIN OUTCOME MEASURES: Demographic factors, laboratory parameters, examinations, medications, and comorbidities...
September 2016: Scandinavian Journal of Primary Health Care
Mohammed Awais Hameed, Indranil Dasgupta, Paramjit Gill
No abstract text is available yet for this article.
July 21, 2016: BMJ: British Medical Journal
Yana Vinogradova, Carol Coupland, Peter Brindle, Julia Hippisley-Cox
OBJECTIVES:  To estimate rates of discontinuation and restarting of statins, and to identify patient characteristics associated with either discontinuation or restarting. DESIGN:  Prospective open cohort study. SETTING:  664 general practices contributing to the Clinical Practice Research Datalink in the United Kingdom. Data extracted in October 2014. PARTICIPANTS:  Incident statin users aged 25-84 years identified between January 2002 and September 2013...
June 28, 2016: BMJ: British Medical Journal
2016-07-02 13:02:57
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