November 13th, 2008 · Comments Off
Alignmap In Cites Goes Video
A plethora of compliance-pertinent videos are now available online. I’ve begun posting some of these flicks on this blog’s tumblelog counterpart, AlignMap In Cites.
Videos selected for the AlignMap In Cites Patient Compliance Theater meet one or more of the following inclusion criteria:
- Presentations of patient compliance research that briefly and clearly present highlights of findings
- Tips targeted to patients or clinicians that may improve adherence
- Demonstrations of and infomercials about devices that ostensibly enhance adherence – or at least amuse me.
- Testimonials from patients and pontifications from clinicians that provide useful information, reveal pertinent attitudes that could have a positive or negative impact on patient compliance, or surpass a difficult to articulate but easy to recognize threshold of – oh, let’s call it eccentricity.
- Anything else that strikes my fancy.
The following videos in the list that follows have been posted to AlignMap In Cites in the past 24 hours. The links below go directly and only to the post indicated. These posts can also be accessed en masse by going to the AlignMap In Cites home page and scrolling back through the chronologically listed posts.
The AlignMap In Cites Patient Compliance Theater
Infomercial about the e-Pill Cube Pill Timer and Pillbox My first impression, based on the rather complex explanation of its operation, is that the device might be better positioned as a test of cognition rather than a convenient medication dose reminder.
Tips to enhance adherence to medication regimen Nothing unusual but potentially helpful ideas about remembering to take ones medications. Targeted to patients.
Medication compliance survey: Moderately self-serving presentation and recommendations from The National Community Pharmacists Association.
Infomercial about the e-Pill MD2 dispenser
Psych Medication Non-compliance: A patient’s own story of medication noncompliance.
Adherence to ARVs — Part 1 and Adherence to ARVs — Part 2: Poignant patient educational video from Baragwanath Hospital, Soweto, South Africa promoting adherence to anti-HIV ARV drugs.
How to Improve Patient Compliance in Dyslipidemia Diagnosis: Medscape produced video report on study affirming value of electronic patient reminders.
Importance of Patient Compliance in Healing: Presented by a clinician and targeted to patients. Excerpt: So, do what the doctor tells you. Try to be compliant. Try to get better. And if you need our help, we’re Baker Chiropractic. We put patients first.
Tags: AlignMap In Cites · Enhancements · Patient Education · Patient's Role
July 23rd, 2008 · Comments Off
Source: Effects of Depression and Selective Serotonin Reuptake Inhibitor use on Adherence to Highly Active Antiretroviral Therapy and on Clinical Outcomes in HIV-infected Patients Michael Alan Horberg, MD, MAS, FACP; Michael Jonah Silverberg, PhD, MPH; et al. J Acquir Immune Defic Syndr. 2008;47(3):384-390.
This large (3359 patients) retrospective cohort study was designed to “determine the impact of depression on highly active antiretroviral therapy (HAART) adherence and clinical measures and investigate if selective serotonin reuptake inhibitors (SSRIs) improve these measures.”
Design & Results: (Excerpted)
[Researchers] measured the effects of depression (with and without SSRI use) on adherence and changes in viral and immunologic control among HIV-infected patients starting a new HAART regimen. HAART adherence, HIV RNA levels, and changes in CD4 T-cell counts through 12 months were measured. … [O]f 3359 patients … 42% had a depression diagnosis, and 15% used SSRIs during HAART. Depression without SSRI use was associated with significantly decreased odds of achieving =90% adherence to HAART (odds ratio [OR] = 0.81, 95% confidence interval [CI]: 0.70 to 0.98; P = 0.03). Depression was associated with significantly lower odds of an HIV RNA level <500 copies/mL (OR = 0.77, 95% CI: 0.62 to 0.95; P = 0.02). Depressed patients compliant with SSRI medication (greater than 80% adherence to SSRI) had HAART adherence and viral control statistically similar to nondepressed HIV-infected patients taking HAART. Comparing depressed with nondepressed HIV-infected patients, CD4 T-cell responses were statistically similar; among depressed patients, those compliant with SSRI had statistically greater increases in CD4 cell responses.
Depression significantly worsens HAART adherence and HIV viral control. Compliant SSRI use is associated with improved HIV adherence and laboratory parameters.
The conclusions drawn by the authors are straightforward, immediately useful to clinicians, and heartening, an all too unusual set of qualities for a clinical study dealing with patient compliance.
Moreover, while the researchers are appropriately careful to limit these conclusions to those being treated for HIV, a disorder frequently accompanied by depression (a prevalence of greater than 30% in some studies in HIV-infected patients), it is certainly possible that depression and SSRI treatment have analogous effects on adherence to the treatments of other disorders. There is little evidence that depression associated with HIV is a different pathology than free-standing depression or depression associated with other diseases or that patterns of compliance and noncompliance with HAART are fundamentally different from adherence and nonadherence to other disorders.
Because adherence is a life or death matter for HIV patients and because the HAART regimen has been an especially rigorous and difficult protocol for patients to follow, clinicians and researchers working with this disorder have been long been concerned about compliance issues and their efforts have resulted in advances in clinical practice. My subjective impression is that the results of these labors have sometimes remained isolated to those working in this field. If so, perhaps it’s time for an organized effort to assure that patient compliance research is distributed across diagnostic and professional boundaries.
Tags: Clinical Info