Patient preference and adherence最新文献

Gestational Diabetes Mellitus (GDM) requires long-term management, frequent visits, and additional financial costs compared to normal pregnancies. Patients often express preferences for services that save time, reduce expenses, and simplify screening. Virtual and telehealth services are valued as they shorten travel and waiting times, lower costs, and improve satisfaction. Screening preferences emphasize accuracy, affordability, and convenience, while recent machine learning (ML) models have enhanced prediction and early detection, supporting more personalized strategies. Patients' preferences have been explored through qualitative, quantitative, and mixed methods, which capture lived experiences, quantify trade-offs, and contextualize results. This review aims to examine GDM patients' experiences with time, costs, and screening, highlight the role of machine learning in screening, and synthesize evidence from preference-elicitation methods to inform patient-centred care. By linking patient preferences with technological advances in ML, this review provides a broader and more integrated perspective than previous reviews, helping to guide future GDM research and service design.

Introduction: Natalizumab (NTZ, Tysabri, Biogen) is an established treatment for highly active relapsing-remitting multiple sclerosis (RRMS), administered either intravenously (IV) in hospital settings or subcutaneously (SC), the latter of which can be administered in primary care. This study investigated self-reported preferences, satisfaction, and time allocation of patients and healthcare professionals (HCPs).

Methods: A total of 83 patients with RRMS and 14 HCPs participated and completed questionnaires across five Swedish hospitals. Participants had experience with both NTZ IV and SC administration, and data collection focused on time efficiency, impact on daily activities, satisfaction, and the ease of transitioning to SC.

Results: SC administration was reported as more time-efficient, with 72% of patients spending ≤30 min at the hospital vs 83% reporting 1-2 h for IV. In primary care, 75% of patients reported that SC treatments required less than 15 minutes. The setting of the SC administration had an effect on work disruption according to patients; 60% of patients in primary care reported no impact on work, compared to 35% for SC treatments in hospitals. Regarding preference, 80% of patients favoured SC over IV. Among patients offered SC in primary care, 75% preferred it over hospital treatment. HCPs reported shorter preparation times and improved workflow efficiency with SC, with 93% completing SC treatments within 30 minutes. Both patients and HCPs found the transition from IV to SC manageable, and 86% of HCPs expressed confidence in their ability to inform patients about SC administration.

Discussion: The results align with previous studies, showing SC NTZ provides time savings, less disruption to daily life, and high satisfaction for patients and HCPs. Its feasibility in primary care supports broader adoption, with implications for improving healthcare resource allocation and patient adherence. Future research should focus on long-term outcomes and global implementation.

Background: Most randomized controlled trials (RCTs) on advance care planning (ACP) focus on advanced cancer, while evidence for dialysis patients with end-stage renal disease (ESRD) remains limited. This study aimed to evaluate the effectiveness of a structured educational intervention in enhancing ACP engagement among dialysis patients.

Methods: The VOICE study, an RCT, was conducted at the Central Hospital of Wuhan. Initially, 117 patients were enrolled; ultimately, data from 50 participants in the intervention group and 52 in the control group were included in the final analysis. Patients in the control group received standard care, while those in the intervention group received a structured ACP intervention specifically tailored to the needs of ESRD patients. The primary outcome assessed in the study was decisional conflict, evaluated through the use of the Decisional Conflict Scale (DCS). Secondary outcomes included ACP engagement (ACPES), attitudes toward death (DAP-R), and quality of life (KDQOL-36™).

Results: After six weeks, the intervention group showed significant but small reductions in the DCS Uncertainty subscale (P = 0.001, Cohen's d=-0.17), and improvements in the Informed (P = 0.049, Cohen's d=-0.12), Values Clarity (P = 0.003, Cohen's d=-0.11), and Effective Decision (P = 0.012, Cohen's d=-0.12) subscales. Regarding secondary outcomes, the intervention group demonstrated significantly higher scores across all ACP engagement domains (P < 0.05), reduced fear of death and death avoidance, and greater natural acceptance of death (all P < 0.05). Moreover, the intervention group reported significantly better quality of life, particularly in the Effects of Kidney Disease and Burden of Kidney Disease subscales (P < 0.05).

Conclusion: The VOICE ACP intervention improved short-term ACP engagement and led to modest improvements in several domains of decisional conflict in dialysis patients. Future multicenter, longitudinal trials are warranted to evaluate the sustainability and cost-effectiveness of such interventions.

Trial registration: Chinese Clinical Trial Registry: ChiCTR2500097890. Registered 27 February 2025.

Background: Reasons for First Dental Visit (RFV) represent patients' subjective motives for seeking dental care and often reflect their most urgent needs. These complaints, frequently related to pain, directly influence diagnosis and treatment planning. Addressing RFV is crucial for patient satisfaction and the delivery of quality oral health care. This systematic review aimed to identify the most commonly reported RFVs at initial dental visits in Saudi Arabia (SA) and to explore the underlying motivations for seeking dental care.

Methods: Following a PRISMA-guided protocol, a systematic online search was conducted through PubMed, EMBASE, OVID and Web of Science databases, supplemented by manual searches in regional journals, to identify studies reporting dental RFVs in SA published between 2002 and June 2025. Eligible cross-sectional studies in English and Arabic were screened independently by two reviewers. Data were extracted on study characteristics, demographics, and RFV prevalence/types. Study quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Analytical Cross-Sectional Studies.

Results: Ten cross-sectional studies met the inclusion criteria. The JBI appraisal revealed that 2(20%) were at low risk of bias, 7(70%) were at moderate risk (of which 3 were classified as low-to-moderate), and 1(10%) was high-to-moderate risk. First-visit attendance was largely symptom-driven-pain/emergency (19.8-71.5%) and caries (17.9-45.2%)-while preventive motives were less frequent (check-up 10.5-27.3%; one outlier 40.3%; fluoride/cleaning 3.2-20.5%). Other indications were infrequent (generally ≤10%; eg, trauma 0-9.2%, extraction 2.4-10.6%, malocclusion ~8.8%, discoloration ~5.1%, referral 0.8-0.9%), indicating predominance of restorative or endodontic demand over preventive care.

Conclusion: Initial dental visits in SA are predominantly symptom-driven, led by pain and caries, while preventive and elective reasons remain limited. Strengthening public health and clinical initiatives that encourage early, routine attendance through education and recalls is vital to shift dental care utilization toward prevention.

Purpose: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) are widely prescribed, yet medication adherence varies. This study evaluated real-world adherence and persistence to semaglutide and empagliflozin among adults with T2D and assessed the associations between adherence and clinical outcomes.

Patients and methods: A retrospective observational study was performed using electronic health records and pharmacy dispensing data from a military hospital in Tabuk, Saudi Arabia, between July 1, 2023 and June 30, 2024. Adults with T2D (≥18 years old) prescribed semaglutide or empagliflozin were included. Medication adherence was quantified using proportion of days covered (PDC). Persistence was defined by absence of treatment gap ≥60 days. Associations between adherence and patient characteristics, and clinical out-comes, were examined.

Results: Among 5087 patients (mean age 57.9 ± 12.3 years, mean T2D duration 10.3 ± 7.6 years), 4020 received empagliflozin and 1067 initiated semaglutide. Adherence (PDC ≥ 80%) was observed in 57.7% of semaglutide and 60% of empagliflozin users. Persistence was lower 40% (semaglutide) and 45% (empagliflozin) met the criteria. Sociodemographic variables were not significant predictors of medication adherence.

Conclusion: Medication adherence and persistence to both semaglutide once-weekly injection and oral empagliflozin were suboptimal among T2D patients. Adherent patients to both medications experienced a significant improvement in glycemic control. Targeted strategies are needed to enhance patient motivation for consistent medication use and timely refills.

Purpose: Effective management of hypertension requires consistent and long-term therapy. In Indonesia, the association between medication information from healthcare providers and adherence to antihypertensive therapy has not been examined. This study aimed to analyze the relationship between receiving antihypertensive medication information and medication adherence among adults with hypertension in Indonesia.

Methods: A cross-sectional analysis was conducted using secondary data from the 2023 Indonesian Health Survey. Baseline characteristics were described using descriptive statistics. Medication non-adherence, receipt of antihypertensive medication information, and potential confounders such as gender, age, education level, marital status, occupation, and island of residence were assessed through self-reported single-item measures. The association between lack of information and medication non-adherence was examined using binary logistic regression adjusted for confounders. Both Crude (COR) and Adjusted Odds ratios (AORs) with corresponding 95% confidence intervals (CIs) were reported.

Results: Among 53,668 patients, most were female (66.3%), married (77.4%), aged over 35 years (95.3%), and unemployed (40.9%). The majority (68.1%) had received information emphasizing the need for regular antihypertensive medication. A lack of information about the necessity of long-term antihypertensive treatment was significantly associated with medication non-adherence (AOR=5.05; 95% CI=4.84-5.26).

Conclusion: This study demonstrates a strong association between a lack of information regarding long-term antihypertensive medication and non-adherence among hypertensive patients in Indonesia. Therefore, there is a need for improved communication strategies between patients and healthcare providers to improve long-term medication adherence.

Background: Pediatric uveitis often results in severe visual impairment, significantly impairing the quality of life for affected children and their families. The Pediatric Eye Questionnaire (PedEyeQ) was originally developed and validated in English to assess vision-related quality of life (VR-QOL) in children. However, the psychometric properties of its Chinese adaptation (PedEyeQ-CN) remain unexplored in pediatric uveitis patients. To fill this gap, we conducted the first study to translate the PedEyeQ into Chinese and evaluate its psychometric properties using Rasch analysis in children with uveitis.

Methods: The PedEyeQ (12-17 years) was translated from English into Chinese, building upon the previously adapted PedEyeQ-CN (5-11 years). Patients with pediatric uveitis were recruited to complete the Child section, while their parents completed the Proxy and Parent sections. Rasch analysis was conducted to assess the psychometric properties of both age-specific versions (5-11 and 12-17 years), including unidimensionality, measurement precision, fit statistics, differential item functioning (DIF), category threshold ordering, and targeting.

Results: The study included 154 children aged 5-11 years and 193 children aged 12-17 years, each accompanied by a parent. Unidimensionality was confirmed for every domain in both age-specific versions of the PedEyeQ-CN. Additionally, Rasch analysis showed evidence of ordered category thresholds, adequate measurement precision, and satisfactory person-item targeting for all questionnaires. Both the Child and Proxy PedEyeQ-CN (12-17 years) each had one item with an outfit value greater than 1.5. A few items displayed minimal differential item functioning (DIF) by gender in each section of the PedEyeQ-CN.

Conclusion: The PedEyeQ-CN demonstrates acceptable psychometric properties and is a valid tool for assessing VR-QOL in Chinese pediatric patients with uveitis and their families. This instrument is available for use in clinical and research settings, providing a standardized method to quantify the impact of uveitis and its treatments on daily life, and facilitating patient-centered care and outcome evaluation.

Purpose: Complications such as tumor lysis syndrome occur during the Chimeric antigen receptor (CAR)-T cell treatment process, which adversely affects the treatment effect. The aim of this study is to study the combination of personalised rational medication monitoring and the Knowledge, Attitude, and Behavior (KABP) model health education to improve the adherence and prognosis of CAR-T cell therapy.

Patients and methods: 91 patients with lymphoma and multiple myeloma who received CAR-T cell therapy in our hospital from January 2021 to December 2024 were included in this single-retrospective study and divided into the control group (n=46, routine care) and the observation group (n=45, routine care + personalised rational medication monitoring combined with KABP model health education) based on the treatment methods. Compliance, clinical treatment efficacy, self-care ability, Functional Assessment of Cancer Therapy-General (FACT-G) scale, State-Trait Anxiety Inventory (STAI), and Knowledge, Attitude, and Behavior (KAB) scale were compared between the two groups.

Results: The observation group demonstrated significantly higher total compliance and clinical efficacy compared to the control group (P < 0.05). Following personalized rational drug monitoring and KABP model health education post-management, the observation group also exhibited higher scores in self-care ability, FACT-G, and KAB, along with lower STAI scores than the control group (P < 0.05).

Conclusion: This approach proves beneficial in enhancing patient adherence, treatment effectiveness, and quality of life in CAR-T cell therapy.

Purpose: Depression is a significant public health concern in Hungary, contributing to disability, reduced productivity, and impaired quality of life.

Patients and methods: A nationwide online survey (14 May-11 June 2025) was followed by multiple linear regression analyses to explore links between patients' socio-demographic factors and their scores on the Beliefs about Medicines Questionnaire and Beck Anxiety Inventory. The main focus of the study was on participants' adherence to prescribed antidepressant treatment assessed using the Medication Adherence Report Scale. Adults over 18 taking GP-prescribed antidepressants were included. This was a cross-sectional observational study based on self-reported survey data.

Results: The sample consisted of 213 participants. The participants who smoked were less adherent to their prescribed antidepressant regimen (coef=-1.445; p=0.038). In contrast, individuals reporting satisfaction with their general practitioner exhibited higher adherence levels (coef=1.609; p=0.033). Monthly collection of antidepressant prescriptions was associated with better adherence than less frequent collection intervals-specifically every two months (coef=5.106; p=0.001), every three months (coef=3.900; p=0.016), or less often (coef=3.887; p=0.013). General beliefs about medicine influence antidepressant adherence: perceiving them as harmful (coef=-2.404; p=0.001) or overused (coef=-1.197; p=0.002) reduces adherence, while viewing antidepressants as necessary enhances it (coef=1.531; p=0.001).

Conclusion: Medication adherence is influenced by patients' beliefs, smoking status, anxiety levels, and satisfaction with care. Enhancing treatment continuity requires addressing these areas.

Introduction: Currently, telehealth, which encompasses digital tools such as video communication, mobile applications, and remote monitoring, enables professional remote education and medical care. This study aimed to assess the acceptance of telehealth care by women with Gestational Diabetes Mellitus (GDM) in routine care based on data from the Istel Care system.

Material and methods: This retrospective, multicenter observational study included 62 patients from three clinical centers: 44 from Krakow, 10 from Rzeszow, and 8 from Zabrze. Patients who consented to participate in the research and conduct home measurements as recommended received a glucometer, a blood pressure monitor, a scale, and a mobile application integrated with the telemedicine Istel Care System. Only the first visit was face-to-face, and the rest were online. After the study, patients completed a satisfaction questionnaire using the Istel Care System.

Results: Of the 62 participants, 58 completed the study, and 50 responded to the follow-up survey. Satisfaction was high across several areas, including convenience (8.7 ± 2.5), accessibility (9.0 ± 2.3), and ease of interpreting results (9.3 ± 1.7). Patients used the system 5-7 times daily, most often seeking information on gestational diabetes and dietary advice. The most valued feature was the ability to easily share measurements with their doctor (89.8%), while 76.9% reported improved communication with their healthcare provider. Reported challenges included technological barriers (45.7%) and concerns about data security (21.6%). Suggested improvements included measurement reminders and real-time feedback from professionals. Overall, the system was positively received, enhancing patient control and motivation for lifestyle changes.

Conclusion: The Istel Care telehealth system was well accepted and feasible for women with GDM in routine care, supporting effective communication and patient self-management.These findings encourage further evaluation of telehealth solutions in diabetes care under routine clinical conditions.