Dissertations / Theses on the topic 'Medication counseling'

Medication complexity and nonadherence are significant risk factors for avoidable hospitalizations and health care spending for older adults in the United States. However, limited empirical research has investigated pharmacist-run telephonic medication management programs as a potential solution to the problem of reducing medication complexity while improving medication adherence. This quantitative study employed the behavioral change model to analyze archival data from a sample of 1,148 participants, examining the relationship of a pharmacist-run telephonic consulting program on medication adherence and medication complexity for one pharmacy benefit management firm's Medicare Part D recipients. The primary research questions investigated the relationship of medication therapy management programs to medication adherence and complexity. Data were assessed using correlation and regression analysis to determine the association between receiving pharmacist counseling, medication adherence, and medication complexity, and to assess the strength of any relationships identified. No linear relationship was found between pharmacists' counseling, medication complexity, and medication adherence. However, the study found a weak correlation between medication complexity and comorbidities, and between medication complexity and medication adherence. This study promotes positive social change by identifying information that can be used to reduce pharmaceutical industry liability by improving proper management of medications, by reducing the burden of comorbidities related to poor management of chronic disease, and streamlining health services and improving their outcom

This study was undertaken to test the satisfaction process as it relates to the consumption of prescription medication. The disconfirmation of expectations model was used as a framework for the study. The study sought to evaluate the impact the provision of drug information has on the satisfaction/dissatisfaction process. To accomplish this, consumers recruited from two community pharmacies were provided with a scenario that described the purchase, and consequences of taking a prescription product intended for the treatment of migraine headache. Each subject received a scenario that contained one of four (4) levels of drug information. The four levels were: (1) no drug information; (2) information about side effects; (3) information about effectiveness; and (4) information about effectiveness and side effects. Each subject also received a scenario that described one of four therapeutic outcomes. They were: (1) no side effects with total elimination of headaches; (2) no side effects with partial elimination of headaches; (3) side effects with total elimination of headaches; and (4) side effects with partial elimination of headaches. The disconfirmation of expectation model was supported by the study. Using an ANOVA model, analyses revealed that the provision of drug information resulted in more positive disconfirmation and higher levels of satisfaction when the outcome of therapy was less than optimal. The measures of future intention were also affected by the provision of drug information. Further analyses revealed satisfaction was a function of expectation and disconfirmation.

Class of 2006 Abstract
Background: Patients with a medication adherence rate of 80-90 % have the highest incidence of developing drug resistance Human Immunodeficiency Virus (HIV). The optimal adherence rate of 95% is believed to be necessary to prevent resistance to medication therapy in HIV infected patients. This level of adherence can be difficult to achieve because of the complications and complexity of medication regimens currently available for HIV treatment. Objectives: To determine if therapeutic goals set by the patient by having interventional meetings with a pharmacist improved their medication compliance rate and laboratory monitoring. Study Design: A retrospective chart review. Setting: One HIV clinic with two sites. Patients: The estimated population of the clinic was 150 patients. Only data from 14 patients met the criteria of the study and was available for collection. Intervention: Patients met initially with a pharmacist and made medication therapy goals. The patients then returned to the pharmacist at least once in a six-month period to evaluate if the goals were achieved. Measurements: CD4+ counts and viral loads from 6 months before the start of the intervention, at the beginning of intervention, and at least 6 months after the intervention were collected for analysis. Self-reports of achieving goals and self reported compliance were also collected. Results: The results showed there was no significant change in the CD+4 count in either the pre vs. baseline (p=0.0.967) or baseline vs. post- (p=0.551). There was also no significant change in the viral load in either the pre vs. baseline (p=0.388) or baseline vs. post (p=0.344). The mean (± SD) number of pharmacist visits was 2.93 (± 1.77). There was no significant improvement in viral loads (p=0.359) and CD4+ counts (p=0.268) between patient who reported missing medications and those who reported not missing doses. The same was true for patients who reported they met self-goals and those who reported they did not meet their goals (viral load p= 0.421 and CD4+ p=0.411). Conclusions: This study found no significant association between patients who set their own therapeutic goals and visited with a pharmacist and those who did not. However, an important limitation is that only 14 patients met the inclusion criteria for the study and had the required data available. Additional research is needed to more fully evaluate this intervention.

Opioid abuse and opioid related deaths continue to affect families and communities across the United States. Medication-assisted treatment shows advantages over other types of interventions for opioid use disorder (OUD) (Bart, 2012). While buprenorphine, an approved medication for the treatment of OUD, has a wide research base to support its efficacy, there is little research or guidance on behavioral interventions to use in conjunction with the medication. Investigating clients' experiences in treatment can provide helpful and necessary information for improving treatment efforts. The following qualitative study used a phenomenological approach to explore the client experience of group therapy with buprenorphine for OUD. Results showed the importance of supportive, genuine relationships in recovery, as well as the need for accountability and a safe space for self-disclosure. This research highlights the importance of the therapeutic alliance, the 11 therapeutic factors of groups, and the necessity of building authentic relationships in treatment.
Doctor of Philosophy
As opioid overdoses continue to rise in the United States, it is essential that we improve addiction treatment. Medication-assisted treatment (MAT) combines the use of medications and counseling to treat the whole person. This type of approach shows advantages over counseling only interventions for opioid use disorder (OUD) (Bart, 2012). While MAT shows promise over counseling only approaches, there is little research or guidance on how to implement counseling with the medication. Investigating clients’ experiences in treatment can provide helpful and necessary information for improving counseling in MAT. The following qualitative study used in-depth interviews with participants who are currently in a MAT program to better understand their experiences in treatment. Results showed the importance of supportive, genuine relationships in recovery, as well as the need for accountability and a safe space for sharing. This research helps further knowledge of treatment for OUD to better serve those affected by addiction, as well as adding to the gaps in group therapy and addiction’s literature.

Integrated primary care has been incorporated into a variety of healthcare settings. The benefits of these services are empirically supported by a plethora of studies, which highlight the integration of behavioral and physical healthcare to be beneficial for both patient and healthcare providers. Integrated care models are typically incorporated in Veterans Affairs hospitals, general primary care facilities, and community clinics. Community-based clinics, such as safety-net clinics, typically serve underrepresented populations, and research has shown several mental and physical health disparities to exist among minority populations. Further, the minority stress model posits that distal and proximal minority-based stress processes can result in a cascade of negative health outcomes, such as increased symptomology or poor health-management behaviors. Although minority stressors can lead to this series of consequences, several community and personal strengths may serve as protective factors for marginalized individuals. These processes may occur within safety-net primary care, considering that the populations of interest are underserved. Black patient populations face numerous barriers to healthcare, such as racism, discrimination, and provider bias. Prior literature has shown that prior experiences of racism result in poorer mental and physical health outcomes for Black patient populations. Further, these outcomes have been shown to negatively impact healthcare attitudes and behaviors. The current study aimed to examine how aspects of the minority stress model may operate within safety-net primary care services for Black patient populations. It was hypothesized that racism would predict poorer mental health, which would negatively impact provider trust, and therefore predict lower medication adherence. Using a strengths-based approach, grit and social support were hypothesized to serve as personal and collective buffers to this series of relationship. A path analysis showed that racism significantly predicted mental health, which predicted poorer provider trust; however, the last path of this model, provider trust to medication adherence, was not found to be statistically significant. Thus, the path analysis was broken up into a series of mediations, which explored the relationship between racism and both provider trust and medication adherence through mental health. Mental health was found to mediate the relationship from racism to provider trust and from racism to medication adherence. The moderated mediation effect of social support was found to be non-significant for all mediations, except that grit was moderated the mediation between racism to medication adherence through mental health. These results showed grit served as a personal strength to dampen the associated effects of racism, which may suggest improving intrinsic attitudes and motivation towards long-term health related goals may increase treatment adherence behaviors. Results from this study also confirm the importance of integrated primary care services, as the data suggested high rates of mental health problems, which typically go underreported among Black patients in healthcare settings.

Older people admitted to hospital are at high risk of rehospitalization and medication errors. We have demonstrated, in a randomized controlled trial, that a clinical pharmacist intervention reduces the incidence of revisits to hospital for patients aged 80 years or older admitted to an acute internal medicine ward. The aims of this thesis were to further study the effects of the intervention and to investigate possibilities of targeting the intervention by identifying predictors of treatment response or adverse health outcomes. The effect of the pharmacist intervention on the appropriateness of prescribing was assessed, by using three validated tools. This study showed that the quality of prescribing was improved for the patients in the intervention group but not for those in the control group. However, no association between the appropriateness of prescribing at discharge and revisits to hospital was observed. Subgroup analyses explored whether the clinical pharmacist intervention was equally effective in preventing emergency department visits in patients with few or many prescribed drugs and in those with different levels of inappropriate prescribing on admission. The intervention appeared to be most effective in patients taking fewer drugs, but the treatment effect was not altered by appropriateness of prescribing. The most relevant risk factors for rehospitalization and mortality were identified for the same study population, and a score for risk-estimation was constructed and internally validated (the 80+ score). Seven variables were selected. Impaired renal function, pulmonary disease, malignant disease, living in a nursing home, being prescribed an opioid and being prescribed a drug for peptic ulcer or gastroesophageal reflux disease were associated with an increased risk, while being prescribed an antidepressant drug (tricyclic antidepressants not included) was linked with a lower risk. These variables made up the components of the 80+ score. Pending external validation, this score has potential to aid identification of high-risk patients. The last study investigated the occurrence of prescription errors when patients with multi-dose dispensed (MDD) drugs were discharged from hospital. Twenty-five percent of the MDD orders contained at least one medication prescription error. Almost half of the errors were of moderate or major severity, with potential to cause increased health-care utilization.

Adults with intellectual disability (ID) experience twice the rate of mental health disorders when compared to the general population. Despite increased prevalence of mental health disorders, caregivers supporting adults with ID rarely seek mental health counseling supports, but instead are referred to psychiatric services. There is limited understanding among researchers about the lack of counseling services for adults with ID. The purpose of this study was to explore the lived experiences of mental health counselors who have worked with adults with ID in a counseling relationship. Hermeneutic phenomenology was used to develop thick and rick experiential detail about counselor experiences providing services for adults with ID. The conceptual framework involved the social constructivist and hermeneutic phenomenological lenses. The 8 participants were recruited using a purposive snowball sampling method and provided data through semi-structured interviews. Data analysis involved coding for themes with the help of NVivo software. Findings indicated counselor perceptions of adults with ID as being stigmatized and marginalized within their communities, which aligned with literature. Adults with ID must be prepared for counseling and there must be appropriate adaptations to support meaningful participation and benefit from counseling interventions. Exposure to adults with ID was a factor in counselors being willing to engage with this population, and questions about counselor education and preparedness were a consistent theme. The social implications of exploring this gap will lead to a better understanding of counselor experiences and can inform the professional body about how to increase access to counseling services for adults with ID.

This study explored the roles and responsibilities of social workers providing services to nonmedical prescription drug users (NMPDU). Researchers have indicated NMPDU disproportionately affects people living in rural communities. The overarching research question sought to explore the concerns of social workers when providing services to patients coping with NMPDU in the rural community of Ulster County, New York. The intention was to examine systemic challenges facing rural social workers when attempting to decrease morbidity risks and increase the health of Ulster County residents. A total of 7 social workers participated in 3 focus groups to explore their ideas for defining, clarifying, and identifying solutions to the problem. The social exchange theory was used to frame the roles and responsibilities of social workers within rural communities at the macro, mezzo, and micro levels. Qualitative content analysis identified 5 themes: roles and responsibilities, barriers, education, treatment interventions, NMPDU and illicit substances of use. The results of the study included advocating for the fair and equitable distribution of resources for all residents coping with NMPDU in Ulster County, their responsibility to collaborate on pressing matters and educate physicians, community service providers, local legislators, individuals, and families of the warning signs and harmful effects of NMPDU. Findings may effect social change by enhancing the role of social workers by reducing overdose and death rates of NMPDUs.

Class of 2017 Abstract
Objectives: Our working hypothesis is that patients who opt in to pharmacist counseling will have a higher medication possession ratio and longer length on therapy than patients who opt out of pharmacist counseling. Methods: Using data extracted from patient’s charts we retrospectively calculated medication possession ratio and length on therapy in relation to the patient receiving or not receiving counseling. Results: The patients analyzed were receiving 8 specific oral oncolytic medications provided by Avella Specialty Pharmacy in 2015. There were no significant differences found in MPR values for any of the 8 oral oncolytic medications included in the study. Iressa (p=0.826), Lonsurf (p=0.392), Stivarga (p=0.838), Zydelig (p=0.633), Zykadia (p=0.077), Tagrisso (p=0.060), Imbruvica (p=0.263) and Tarceva (p=0.326). No statistically significant differences were found in LOT values for any of the 8 oral oncolytic medications included in the study. Iressa (p=0.885), Lonsurf (p=0.868), Stivarga (p=0.326), Zydelig (p=0.502), Zykadia (p=0.212), Tagrisso (p=0.089), Imbruvica (p=0.540), Tarceva (p=0.129). Conclusions: Pharmacist counseling does not appear to affect MPR or LOT for patients taking oral oncolytic medications. Further research is warranted targeting other chronic disease states with complex oral regimens where medication adherence has not already been established from prior therapy options and adequate disease state knowledge.

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Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro
A insuficiência cardíaca (IC) é uma síndrome prevalente que, apesar dos avanços no tratamento, acarreta significativa morbidade e mortalidade. Estudos demonstram que a não adesão ao tratamento é uma importante causa de resultados insatisfatórios na terapia, descompensação no quadro clínico, internação e óbito. Acreditando-se que a efetiva inserção do farmacêutico na assistência, mesmo na dispensação convencional, seria capaz de promover maior adesão, tevese por objetivo avaliar como dois modelos de atuação farmacêutica impactam sobre a adesão à farmacoterapia em pacientes com IC com fração de ejeção reduzida assistidos em dois centros clínicos especializados da rede pública de saúde. O trabalho foi organizado em duas partes. A primeira parte foi um estudo prospectivo com análise transversal de dados de pacientes com ICFER acompanhadas por uma equipe multidisciplinar, no momento da inserção do profissional farmacêutico nessa equipe e após 4 meses, com orientação farmacêutica por demanda do paciente. A segunda parte é a análise transversal de um estudo prospectivo que realizou acompanhamento farmacoterapêutico com pacientes de outro centro clínico especializado, por 4 meses. Foram incluídos respectivamente 38 e 31 pacientes. Nos dois grupos, observou-se maioria de homens, com predomínio de IC leve a moderada, polimedicados e tratando duas ou mais comorbidades, utilizando combinação de betabloqueador, inibidores da enzima conversora da angiotensina e/ou antagonistas dos receptores da angiotensina, antagonista da aldosterona e diurético. Na primeira parte do estudo, observou-se associação de maior número de comorbidades, maior gravidade e polifarmácia com boa adesão. Na segunda parte, verificou-se associação de idade maior, viver sem cônjuge e com menor número de pessoas no mesmo lar, razão de posse de medicamentos e razão para não tomar o medicamento com a adesão. Os resultados sobre adesão melhoraram nos dois grupos, ao final do estudo, embora sem significância estatística. Na segunda parte observou-se melhora estatisticamente significante no nível de conhecimento da prescrição, na razão de posse de medicamentos e na autoavaliação de saúde. Não foi possível observar melhora significativa na adesão, porém verificaram-se melhorias significativas em fatores associados à boa adesão. O limitado número amostral exigirá cautela na extrapolação dos resultados
Heart failure (HF) is a prevalent syndrome that, despite advances in treatment, causes significant morbidity and mortality. Studies show that nonadherence to treatment is an important cause of unsatisfactory results in therapy, decompensation in the clinical condition, hospitalization and death. Believing that the effective insertion of the pharmacist into the patient care would be able to promote greater adherence, even in the conventional dispensation, the objective of this study was to evaluate how two models of pharmaceutical services impact on adherence to pharmacotherapy in patients with HF with reduced ejection fraction, assisted in two specialized clinical centers of the public health network. The study was organized in two parts. The first was a prospective study with cross-sectional of data from patients assisted by a multidisciplinary team, at the time of insertion of the pharmacist in this team and after 4 months, with pharmaceutical orientation by patient demand. The second part is a cross-sectional analysis of a prospective study that carried out pharmacotherapeutic follow-up with patients from another specialized clinical center for 4 months. Thirty-eight and 31 patients were included respectively. In the two groups, was observed majority of men, with a predominance of mild to moderate HF, polymedicated and treating two or more comorbidities, using a combination of beta-blocker, angiotensin converting enzyme inhibitor and/or angiotensin receptor antagonist, aldosterone antagonist and diuretic. In the first part of the study, we observed an association of higher number of comorbidities, greater severity and polypharmacy with good adherence. In the second part, there was an association of older age, living with no spouse and with fewer people in the same household, reason for possession of medications and reason for not taking the drug with high adherence. The adherence level was improved in both groups at the end of the study, although without statistical significance. In the second part, there was a statistically significant improvement in the level of prescription knowledge, in the drug possession ratio and in the health self-assessment. It was not possible to observe a significant improvement in adherence, but there were significant improvements in factors associated with good adhesion. The limited sample size will require caution in extrapolating the results

Relationships among demographic, socioeconomic and person factors and Opioid Use Disorder diagnosis, treatment, and recidivism were explored. Data from a sample of 4,860 adults with substance use difficulties were analyzed. A program evaluation was conducted on Gateway Community Services to explore the use of Medication Assisted Treatments (MATs) and Psychosocial (PS) treatments to address Opioid Use Disorder. Using archival data, a chi-square analysis and independent sample t-test was performed. The results expressed that a relationship among race, type of substance use diagnosis, and treatment type and recidivism rate was found. While White/Non-Hispanics adults were more likely to use heroin than any other racial/ethnic backgrounds, gender differences were also found. Finally, frequency and duration of a combined treatment (PS + MAT) were negatively related to recidivism with no determination of previous prescription opioid use to be examined at this time. Keywords: medication assisted treatment, recidivism, psychosocial, opioid

BACKGROUND: Parent medication errors are exceedingly common, with one child experiencing an outpatient medication error every 8 minutes. In a previous randomized controlled trial where the intervention was carried out under ideal conditions, we examined the efficacy of a pictographic, health literacy-informed medication instruction sheet-based intervention (HELPix) in reducing parent dosing errors. While our intervention was efficacious in reducing errors, reproducing these results in a real world setting, is necessary to examine the true effectiveness of HELPix. OBJECTIVES: 1) To examine the impact of HELPix implementation on parent medication dosing errors. 2) To assess the effect of HELPix implementation on provider use of medication counseling strategies. DESIGN/METHODS: A pre-implementation/post-implementation study design was used in 2 pediatric Emergency Departments (EDs) in New York City, one with planned implementation of the HELPix intervention (HELPix site) and the other a control site within the same hospital network. Subject inclusion criteria included: 1) English or Spanish-speaking parent, 2) child <9 years old, child prescribed a short course (≤14 days) daily liquid medicine, and 3) parent present with the child in the emergency department and received medication counseling. Parents were recruited over the phone; those who enrolled completed a phone interview along with a follow-up in-person assessment (median time to follow-up=15 days). ED providers (residents, fellows, attendings) were also recruited. The HELPix intervention consists of: 1) provider provision of patient- and medicine-specific pictographic instruction sheets, 2) provider use of pictures/drawings as part of counseling to reinforce dosing information, 3) provider demonstration of the dose using an oral syringe, 3) teachback of dose information, 4) parent showback of the dose they plan to give, and 5) provider provision of an oral syringe. At the HELPix site, ED providers were trained in the use of HELPix counseling strategies as well as how to use the electronic medical record (EMR) system to generate the instruction sheets while ordering a prescription. Outcomes assessed were: 1) provider provision of HELPix instruction sheets via web tracking, 2) dosing errors ≥ 20% deviation from prescribed dose, assessed from observation at follow-up visit, 3) provider counseling practices (i.e. use of pictures/drawings, demonstration, teachback, showback, provision of dosing tool) obtained by parent report. RESULTS: A total of 1493 parents were assessed by telephone for eligibility in the pre-/post-implementation phases. 561 parent-child dyads were recruited by phone (284 at HELPix site; 277 at control site). A total of 92% were mothers, 52% were Spanish speakers, 78% were Latino, 16% were Black, and 85% were of low socioeconomic status. Web tracking at the HELPix intervention site indicated that for 58% of the enrolled families in the post-implementation period, providers generated HELPix medication instruction sheets. Compared to the pre-implementation period at the intervention site, parent dosing errors rates were significantly reduced during the post-implementation period (37% versus 16%; AOR=0.3, p<0.001); with an overall Relative Risk Reduction (RRR)=57%, with greatest reductions in errors among those that received HELPix sheets (12% error rate, RRR=68%). Providers at the HELPix implementation site were significantly more likely to use recommended provider counseling strategies post-implementation compared to pre-implementation (pictures/drawings: 37% versus 1%; dosing demonstration: 59% versus 33%; teachback: 24% versus 8%; showback: 33% vs. 13%, and provision of oral syringe 79% versus 25%; p<0.0001 for all strategies). In the non-intervention site, there were no differences in parent dosing error rates, or in provider use of counseling strategies between the pre- and post-implementation periods. CONCLUSION: Implementation of the HELPix intervention resulted in increased provider use of recommended counseling strategies as well as decreased parent medication dosing errors in an urban public hospital setting serving low socioeconomic status families. Use of HELPix supports high quality provider medication counseling and appears to be feasible to incorporate as part of routine Emergency Department discharge practices.

Wu Yan Fei.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2003.
Includes bibliographical references (leaves 161-189).
Abstracts in English and Chinese.
Chapter 1. --- BACKGROUND --- p.1
Chapter 1.1 --- Hong Kong health care system --- p.1
Chapter 1.2 --- Medication compliance and treatment responses --- p.2
Chapter 1.3 --- Definition of compliance --- p.5
Chapter 1.3.1 --- Compliance --- p.5
Chapter 1.3.2 --- Adherence --- p.6
Chapter 1.3.3 --- Concordance --- p.7
Chapter 1.4 --- Definitions of satisfactory compliance --- p.9
Chapter 1.5 --- Importance of compliance --- p.10
Chapter 1.6 --- Non-compliance as a behavioral disease --- p.12
Chapter 1.6.1 --- Disease manifestation (Patterns of non-compliance) --- p.12
Chapter 1.6.2 --- Prevalence/Epidemiology (Rate of non-compliance) --- p.14
Chapter 1.6.3 --- Diagnosis (Detecting non-compliance) --- p.15
Chapter 1.6.3.1 --- Direct methods --- p.16
Chapter 1.6.3.1.1 --- Use of biological fluids --- p.17
Chapter 1.6.3.1.2 --- Biological surrogate (Drug) markers --- p.18
Chapter 1.6.3.1.3 --- Pharmacological indicators --- p.20
Chapter 1.6.3.2 --- Indirect methods --- p.22
Chapter 1.6.3.2.1 --- Self-report / Direct questioning --- p.24
Chapter 1.6.3.2.2 --- Pill counts --- p.25
Chapter 1.6.3.2.3 --- Diaries --- p.27
Chapter 1.6.3.2.4 --- Electronic monitoring --- p.27
Chapter 1.6.3.2.5 --- Physician estimates --- p.31
Chapter 1.6.3.2.6 --- Outcome measurement and clinical judgment --- p.32
Chapter 1.6.3.2.7 --- Presence of side effects --- p.33
Chapter 1.6.3.2.8 --- Keeping of appointments --- p.34
Chapter 1.6.3.2.9 --- Prescription refill rates --- p.34
Chapter 1.6.3.3 --- Direct observation --- p.35
Chapter 1.6.3.4 --- The ideal detection method --- p.36
Chapter 1.6.4 --- Risk factors (Related factors of non-compliance) --- p.37
Chapter 1 .6.4.1 --- Patient related factors --- p.37
Chapter 1.6.4.1.1 --- Understanding and comprehension --- p.37
Chapter 1.6.4.1.2 --- Health beliefs --- p.39
Chapter 1.6.4.1.3 --- Socio-demographic factors --- p.44
Chapter 1.6.4.1.4 --- Forgetfulness --- p.45
Chapter 1.6.4.2 --- Illness --- p.46
Chapter 1.6.4.3 --- Therapeutic regimen --- p.46
Chapter 1 .6.4.4 --- Patient-practitioner relationship --- p.48
Chapter 1.6.5 --- Treatment (Interventions) --- p.50
Chapter 1.6.5.1 --- Education --- p.51
Chapter 1.6.5.2 --- Dosing regimen planning --- p.55
Chapter 1.6.5.3 --- Clinic scheduling --- p.57
Chapter 1.6.5.4 --- Communication --- p.57
Chapter 1.6.6 --- Intelligent non-compliance --- p.60
Chapter 1.6.7 --- Overview of problems with compliance studies --- p.63
Chapter 1.6.7.1 --- Complex and not effective --- p.64
Chapter 1.6.7.2 --- Lack theoretical framework --- p.64
Chapter 1.6.7.3 --- Fragmented studies --- p.65
Chapter 1.6.7.4 --- Lack high quality compliance study --- p.66
Chapter 1.6.7.5 --- Without long term follow up --- p.67
Chapter 1.6.7.6 --- Correlation between compliance and desired therapeutic outcomes --- p.68
Chapter 2 --- HYPOTHESIS AND OBJECTIVES --- p.71
Chapter 3 --- METHODS --- p.75
Chapter 3.1 --- Study design --- p.76
Chapter 3.2 --- Outcome measures --- p.80
Chapter 3.3 --- Statistical analysis --- p.81
Chapter 3.4 --- Power analysis --- p.82
Chapter 4. --- RESULTS --- p.85
Chapter 4.1 --- Patient demographics --- p.85
Chapter 4.2 --- Clinic attended and drug usage --- p.85
Chapter 4.3 --- Non-compliant rates and its patterns --- p.86
Chapter 4.4 --- Reasons for non-compliance --- p.86
Chapter 4.5 --- Relationship between drug class and medication compliance --- p.86
Chapter 4.6 --- Relationship between dosage frequency and medication compliance --- p.87
Chapter 4.7 --- Clinical characteristics of compliant and non-compliant patients --- p.87
Chapter 4.8 --- Comparison of non-compliant patients identified at baseline during the second reassessment --- p.88
Chapter 4.9 --- Effects of pharmacist's telephone intervention on tertiary outcomes --- p.88
Chapter 4.9.1 --- Medication compliance --- p.88
Chapter 4.9.2 --- Blood pressure --- p.89
Chapter 4.10 --- Effects of pharmacist's telephone intervention on secondary outcomes --- p.90
Chapter 4.11 --- Primary end-points of compliant versus non-compliant patients --- p.91
Chapter 4.12 --- Best predictors of mortality rate for the studied population --- p.92
Chapter 4.13 --- Effects of pharmacist's telephone intervention on primary outcomes --- p.92
Chapter 4.14 --- Clinical characteristics of non-compliant patients with / without second follow up --- p.93
Chapter 4.15 --- Clinical outcomes of defaulted patients at the second visit --- p.93
Chapter 5. --- DISCUSSION --- p.126
Chapter 5.1 --- Study design --- p.126
Chapter 5.2 --- Compliance assessment method --- p.126
Chapter 5.3 --- Patient demographics and drug prescribing pattern --- p.128
Chapter 5.4 --- Extent and pattern of non-compliance --- p.128
Chapter 5.5 --- Reasons for non-compliance --- p.129
Chapter 5.5.1 --- Lack of knowledge --- p.129
Chapter 5.5.1.1 --- Dosing instructions --- p.129
Chapter 5.5.1.2 --- Drug identification --- p.130
Chapter 5.5.1.3 --- Storage --- p.131
Chapter 5.5.2 --- Forgetfulness --- p.131
Chapter 5.5.3 --- Problems with health beliefs --- p.132
Chapter 5.5.3.1 --- Common myths or misconceptions --- p.132
Chapter 5.5.4 --- Presence of side effects --- p.133
Chapter 5.6 --- Predictability of non-compliance --- p.134
Chapter 5.6.1 --- Socio-demographics --- p.134
Chapter 5.6.2 --- Polypharmacy --- p.135
Chapter 5.6.3 --- Dosing frequency --- p.137
Chapter 5.6.3.1 --- "Little difference between daily, twice daily and thrice daily dosing." --- p.137
Chapter 5.6.3.2 --- Importance of drug property in determining the impact of usual dosages --- p.138
Chapter 5.6.3.3 --- The impact of missed dosage on clinical condition --- p.139
Chapter 5.6.3.4 --- Practical issues regarding dosing frequency --- p.140
Chapter 5.6.4 --- Drug Profiles --- p.141
Chapter 5.7 --- Outcomes measure --- p.142
Chapter 5.8 --- The role of pharmacist in chronic care --- p.147
Chapter 5.9 --- The role of physician in chronic care --- p.155
Chapter 5.10 --- Possible sources of bias and limitations --- p.156
Chapter 5.11 --- Further studies --- p.156
Chapter 5.12 --- Concluding remarks --- p.159
Chapter 6. --- REFERENCES --- p.161
Chapter 7. --- APPENDICES --- p.190

Yes
Background Interventions to reduce medicines discontinuity at transitions during and reinforced after discharge are effective. However, few studies have linked hospital-based counseling with onward referral for community pharmacy-based follow-up to support patients' medicines use. Objective To determine the effects of targeted hospital pharmacist counseling on discharge or targeted community pharmacy medicines reviews post-discharge on patients' knowledge of newly started medication. Methods The study was a controlled trial of targeted medicines discharge counseling provided by hospital pharmacists or follow-up post-discharge medicines review provided by community pharmacists compared with usual care (nurse counseling). Outcomes measured using a structured telephone survey conducted at two and four weeks after patients were discharged from hospital. Results Patients who received hospital pharmacist counseling were significantly more likely to report being told the purpose of their new medicine and how to take it versus those receiving usual care. Fewer than half of the patients who were allocated to receive a community pharmacy medicines review received one. Conclusions Patient knowledge of medicines newly prescribed in the hospital was increased by targeted counseling of hospital pharmacists. The findings suggest the need to improve the consistency of the information covered when providing counseling, perhaps by the implementation of a counseling checklist for use by all disciplines of staff involved in patient counseling. The potential of community pharmacy follow-up medicines review is currently undermined by several barriers to uptake.
The full-text of this article will be released for public view at the end of the publisher embargo on 14 May 2017.

Background. In average hypertensive patients m China, approximately 3-4 major cardiovascular disease (CVD) events can be prevented in 100 treated with anti-hypertensive drugs for 5 years. Previous cross-sectional studies in healthy individuals showed that their willingness to payout of pocket for anti-hypertensive drugs dropped substantively after they were informed of the quantitative benefits, harms and costs of the treatment. These findings suggest, importantly, that patients should be provided with evidence and engaged in decision making for such conditions as hypertension in order to make decisions that will satisfy patients. This large effect of evidence-informed decision making found in the cross-sectional study has, however, not been confirmed in more rigorous studies and in diagnosed hypertensive patients in the country. We therefore conducted this randomized controlled trial to assess the effect of individualized, evidence-based counseling on medicine-using behaviors of hypertensive patients.
Methods. This is a randomized controlled trial with 210 patients with mild hypertension and free of CVD recruited in two primary care centers in Shenzhen, China. Individualized, evidence-based counseling on antihypertensive treatment and general counseling on lifestyle modifications (103 patients) were compared with general counseling alone (107 patients). The counseling was provided face-to-face and reinforced by a telephone call a week later. The key information provided in the intervention group included the lO-year CVD risk estimated based on an individual's risk factors, individualized benefit expressed in the absolute risk reduction, side effects, and costs of antihypertensive drugs. Medication use and good adherence at 6-month follow up were used as the primary outcomes.
Results. At baseline, the mean age of patients was 54.3 (SD=7.8) years, 49% were men, 62.4% were currently taking antihypertensive medicines which was all covered by health insurance. The overall attrition rate was 8.6%. At six months, the rate of medication use was marginally higher in the intervention group than that in the control group (65.0% vs 57.9%; odds ratio (OR) = l.35, 95% confidence interval (Cl): [0.77, 2.36]; P value= 0.290). The rate of good adherence in the intervention group was also slightly higher than that in the control group (43.7% vs 40.2%; OR= 1.15, 95% Cl: [0.67, 2.00]; P value= 0.607). The difference in medication use and good adherence between the intervention and control groups was however not statistically significant. The results remained unchanged in multivariate and sensitivity analyses.
Conclusions. The individualized, evidence-based counseling made little difference to the use of and adherence to anti-hypertensive medications in insured patients with mild hypertension in China. The lack of effect of informed decision making is likely a result of persistence of entrenched practice in particular for insured clinical conditions. The finding of this study raises important questions as to whether insurance policies and clinical guidelines reflect the true needs and opinions of the patients, and about the usefulness of informing and engaging patients in decision-making under such circumstances.
背景：對100 例一般中國高血壓患者，進行持續5 年的降壓藥物治療，可預防心腦血管事件3-4 例。健康人群中進行的橫斷面調查結果顯示，研究對象在獲得降塵藥物治療量化的收益、副作用和花費的信息後，其支付意願明顯下降。此結果的重要提示是，應向患者提供此類信息，並且患者參與自身的醫療決策，使其能夠做出符合其價值觀等的決定。然而，目前尚未在中國開展相闊的隨機對照試驗。上述知情決策的顯著效果亦尚未在患者中得到證實。在此項隨機對照試驗中，我們蚣評價個體化、循證諮詢對高血壓患者服藥情況的影響。
方法：這是一項雙中心的隨機對照試驗。研究共納入輕度高血壓患者210例，這些患者均無心腦血管病。干預組患者(共103 例)接受關於降壓藥物的個體化、循證諮詢和生活習慣調整的一般諮詢，對照組患者(共107 例)僅接受一般諮詢。我們為每組患者均提供當面諮詢，並於一周後通過電話進行加強。為干預組患者提供的主要信息包括:基於每例患者危險因素評估的10 年心血管病風險，降塵藥物治療的收益、副作用及花費。其中收益以絕對風險降低表示。以諮詢結束後六個月時患者服藥和良好依從性作為主要結局指標。
結果：基線調查中，患者的平均年齡為54. 3 (標準差為7.8) 歲，有49% 的患者為男性， 62. 峭的患者目前正在服用降塵藥物，所有患者的降塵藥物花費均由醫療保險全部或部分支付。研究中總失訪率為8.6% 。諮詢結束後六個月，干預組患者整體服藥率較對照組患者稍高(干預組65.0% 對照組57.9%比值比:1.35，95%可信區問: [0.77 ，2.36];p=0.290) 。干預組患者中，良好依從性的比例亦稍高於對照組(干預組43.7%，對照組40.2%:比值比:1.15 , 95%可信區問: [0.67，2.00]; p= 0.607)。在多因素分析和敏感性分析中，上述結果均無顯著變化。
結論：個體化、循證諮詢並未明顯改變中國醫療保險覆蓋下輕度高血壓患者的服藥情況。知情決策無明顯效果很可能由固定化的醫療實踐導致，這種情況對醫療保險覆蓋的治療尤其突出。此研究的發現還引出了兩個重要問題:現行的醫療保險制度和臨床指南是否反映患者的真實需要和想法，患者知情並參與決策是否必要。
Di, Mengyang.
Thesis Ph.D. Chinese University of Hong Kong 2015.
Includes bibliographical references (leaves 127-139).
Abstracts also in Chinese; some appendixes in Chinese.
Title from PDF title page (viewed on 06, October, 2016).
Di, Mengyang.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.