Patient preference and adherence最新文献

Purpose: Treatment adherence is essential for achieving therapeutic goals and improving patient outcomes. In older adults, polypharmacy and potentially inappropriate prescriptions (PIPs) may negatively affect adherence.

Objective: To assess treatment adherence in older adults with polypharmacy and PIPs in a primary care setting.

Patients and methods: A descriptive, observational study was carried out in the primary care setting of Toledo, Spain, involving patients aged over 65 who had been taking six or more medications for at least six months. Demographic, clinical, and pharmacological data were collected. Adherence was the primary outcome. PIPs were assessed using the Beers and STOPP criteria. Data were obtained from electronic medical records, prescription systems, and billing records.

Results: The study included 448 patients (mean age: 79 years; 60.9% female). A total of 4413 medications were prescribed, with a mean of 9.9 drugs per patient. Overall adherence was 64.3%. The prevalence of PIPs was 44.0% (STOPP) and 42.6% (Beers). No significant association was found between adherence and PIPs (p = 0.426 for Beers; p = 0.164 for STOPP).

Conclusion: Among older adults with polypharmacy, treatment adherence was 64.3%. The rate of potentially inappropriate prescribing was high, but no significant relationship with adherence was observed. Further studies are needed to explore the impact of PIPs in this population. Pharmaceutical interventions-such as educational programmes for prescribers and patients, and regular medication reviews-may help improve adherence.

Objective: To address the diverse needs of patients at different levels, VIP (Very Important Person) outpatient services function as a personalized approach and are of significant importance in the healthcare system. Additionally, patient satisfaction serves as a critical tool for understanding and improving the quality of healthcare services. Therefore, this study aimed to classify VIP outpatients based on satisfaction levels and identified its determinants, hypothesizing that distinct satisfaction segmentations exist and are influenced by several factors.

Methods: A total of 4068 patients who attended the VIP outpatient at a tertiary hospital were enrolled between June and July 2025. The SERVQUAL model was used in this study. Descriptive statistical analyses were conducted and quantitative data were gathered using a 5-point Likert scale tailored to assess patient satisfaction. Latent Class Analysis (LCA) was used to delineate heterogeneous satisfaction groups, while a chi-square test and binary logistic regression were employed to investigate satisfaction levels and potential influencing factors.

Results: Two latent classes were identified using Mplus 8.4: the overall high satisfaction group (73.1%) and the high medical care-low support service group (26.9%). All hypotheses are supported. A total of 49.7% waited less than 30 min before consultation, and 76.4% communicated with the doctor for more than 20 min. Binary logistic regression analysis revealed that the patient source, waiting time before consultation, and length of communication with the doctor were associated factors (all p < 0.05).

Conclusion: For non-local patients registered as outpatients with VIP, priority should be given to addressing their core clinical needs and strengthening doctor-patient interactions. Furthermore, measures such as implementing a cap on registrations and assigning doctor assistants can be introduced to reduce waiting times and extend the length of communication.

Purpose: Hospitalisation is usually accompanied by changes in patients' drug regimen followed by increased information need. To identify inpatients most suitable for pharmaceutical care interventions addressing these information needs, different prioritisation strategies exist. Here, we present a novel screening method taking particularly patient-reported needs into account. We aimed to test (i) whether the screening method is able to identify patients who benefit most from an intervention, and (ii) whether the intervention can actually reduce patients' difficulties with managing their drug treatment.

Patients and methods: This study comprised of an admission screening, a pharmaceutical care intervention during the inpatient stay, and a follow-up phone call after discharge. During screening, patients answered questionnaires regarding e. g., their beliefs about medicine, adherence, and complexity of drug treatment. According to predefined criteria, patients were selected for the intervention. During intervention, patients received counselling and information leaflets according to their needs. After the inpatient visit, all screened patients were contacted for a follow-up call. During intervention and follow-up, patients were asked applicable key questions on factors potentially increasing complexity of drug treatment to identify difficulties with managing their drug treatment.

Results: Among 128 screened patients, 105 were deemed suitable for the intervention. Patients receiving the intervention showed less difficulties with managing their drug treatment after discharge (mean difficulties during intervention = 1.3 vs mean difficulties during follow-up = 0.9, p = 0.040). However, at follow-up, the number of patients' difficulties did not differ between patients suitable or unsuitable for the intervention and between suitable patients receiving or not receiving the intervention (p = 0.434).

Conclusion: The novel screening method identified many patients with high information needs, but its effectiveness for prioritisation is limited. While the intervention reduced patients' difficulties with managing drug treatment over time, no significant differences were observed between intervention groups.

Purpose: Major depressive disorder (MDD) is a significant mental health issue among adolescents globally. In Thailand, medication adherence among adolescents with MDD is low. While international studies highlight factors such as family support and beliefs about medication, these may not apply to the Thai context, where cultural norms, stigma, and access to care differ. Guided by the Individual and Family Self-management Theory (IFSMT), this study explored context-specific factors influencing medication adherence among Thai adolescents with MDD.

Methods: A cross-sectional quantitative study was conducted with 146 adolescent-legal guardian dyads recruited via purposive sampling from two psychiatric outpatient clinics in Thailand. Guided by the IFSMT, the study assessed context factors across three domains: condition-specific, physical and social environment, and individual and family factors. To examine associations between IFSMT context factors and medication adherence, multiple linear regression analysis was performed. Written informed assent and consent were obtained.

Results: The adolescents (mean age = 16.16 years, 71.92% female) and legal guardians (mean age = 48.62 years, 77.40% female, 90.41% parents) completed the survey. Approximately 80% of adolescents reported low adherence to the guidelines. Three context factors were significantly associated with adherence: antidepressant side effects, adolescent preference for medication-only treatment, and legal guardian preference for medication-only treatment (p <0.05). Other variables were not significant.

Conclusion: Medication adherence among Thai adolescents with MDD was associated with side effects and treatment preferences of both adolescents and their legal guardians. These findings highlight the importance of addressing individual and family preferences during treatment planning. Culturally informed interventions that consider these contextual influences may improve adherence outcomes. Future research should explore these factors further using longitudinal designs.

Purpose: This study aimed to evaluate the effectiveness of a multidisciplinary collaborative medication literacy intervention, grounded in the Information-Motivation-Behavioral Skills (IMB) model, on the medication self-management capacity, stroke-related knowledge, medication literacy, medication adherence, and health status of stroke patients.

Patients and methods: This single-blind, two-arm RCT in a Wuxi tertiary hospital enrolled 127 participants, randomized into intervention (n = 63) and control groups (n = 64). The intervention group received a medication literacy intervention based on the Information-Motivation-Behavioral Skills (IMB) model through multidisciplinary collaboration, while the patients in the control group received standard care and follow-up after discharge. The primary outcome measure was medication self-management capacity, while secondary outcome measures included stroke-related knowledge, medication literacy, medication adherence, blood pressure, lipid levels, and unplanned readmission rates. The generalized estimating equation (GEE) model was employed to assess the effectiveness of the intervention.

Results: Compared with the control group, the intervention group showed significant improvement in medication self-management capacity (β_{day of discharge} = 1.41, p = 0.045, Cohen's d = 0.31; β₄ weeks = 2.74, p = 0.003, Cohen's d = 0.52; β₁₂ weeks = 3.46, p = 0.003, Cohen's d = 0.74). Significant improvements were also observed in stroke-related knowledge (β₄ weeks = 2.67, p < 0.001; β₁₂ weeks = 3.97, p < 0.001), medication literacy (β₄ weeks = 1.22, p < 0.001; β₁₂ weeks = 1.18, p < 0.001), medication compliance (β₄ weeks = 1.07, p = 0.034; β₁₂ weeks = 1.45, p = 0.013), and blood pressure reduction (p < 0.05). The intervention did not significantly affect blood lipids or unplanned readmission rates (p > 0.05). The sensitivity analysis using the PP method indicated that the obtained results were comparable to the ITT results, suggesting that the preliminary research results and conclusions of the medication literacy intervention based on multidisciplinary collaboration were reliable.

Conclusion: The medication literacy intervention based on the Information-Motivation-Behavioral Skills (IMB) model effectively enhances the medication self-management capacity of stroke patients. It positively influences several outcomes, including stroke-related knowledge, medication literacy, medication adherence, blood pressure.

Background: Guillain-Barré Syndrome (GBS) is an acute autoimmune disorder of the peripheral nervous system that can lead to muscle weakness, respiratory failure, and long-term disability. While clinical aspects have been widely studied, evidence on the biopsychosocial-spiritual impacts among adults remains limited.

Purpose: This scoping review aimed to map existing evidence on the biological/physical, psychological, social, and spiritual impacts of GBS in adult patients and to identify research gaps.

Methods: The review followed the framework by Arksey and O'Malley (2005) and was reported according to PRISMA-ScR guidelines. Literature searches were conducted in PubMed, Scopus, and EBSCOhost for studies published between January 2015 and January 2025. Using the PCC framework, we included peer-reviewed primary research on adult patients with GBS that examined physical, psychological, social outcomes. Selection is done through title/abstract screening and full-text review. Optional quality appraisal was conducted using the Joanna Briggs Institute (JBI) critical appraisal tools to enhance the rigor of included studies. Data were extracted using a structured form and analyzed thematically.

Results: Of 1,067 identified records, 16 studies across 10 countries were analyzed. Common physical impacts were residual motor weakness, neuropathic pain, sleep disturbances, and persistent fatigue. Psychological impacts included anxiety, depression, and posttraumatic stress, particularly among patients with residual disability or intensive care histories. Social impacts involved barriers to returning to work, stigma, and reduced social participation, with family support acting as a protective factor. Notably, no primary studies addressed the spiritual dimension, highlighting a critical research gap.

Conclusion: Adults with GBS experience multidimensional and interrelated impacts across physical, psychological, and social domains. The absence of evidence on spiritual outcomes underscores the need for future research incorporating biopsychosocial-spiritual assessment to inform holistic, patient-centered care.

Background: Improved drug adherence and usability over the long term are urgent issues in Japan. Press-through packaging (PTP) is commonly used for prescription and over-the-counter drugs; however, some patients, particularly those with finger deformities or weak functional pinch strength in their hands, have difficulty opening and removing pills from PTP. The present study aimed to investigate whether alternative ways to distribute drugs could be a practical solution for such individuals.

Methods: We prepared three types of drug packages/containers, including PTP and "Bold" and "Slim" bottle types, and then conducted evaluations of their usability and preferences among 26 outpatients (22 women, 4 men; mean age: 72.6 years). We also measured the functional pinch and grip strength of the participants and investigated the related usability and preferences.

Results: Some patients could not open PTP. On the other hand, every patient, even those with no prior experience, could easily use the Bold and Slim bottle-type containers. The release times (ie, the time it takes to dispense two pills from a container) for PTP and Slim were almost the same. Regarding Bold, the difference between the minimum and maximum release times was the smallest among all three types (Bold mean extraction time = 5.4 ± 2.2 s, p < 0.05). Even among the participants who were able to remove the pills from all three types of packages/containers without any difficulties, Bold required the least amount of time. Regarding the relationship between pinch strength and usability, Bold had a positive correlation with the key pinch position and was preferred by the participants.

Conclusion: In the present study, Bold showed faster extraction times and slightly higher preference scores, although these differences were not statistically significant. Although the sample size was small, the participants preferred the Bold bottle-type container, which they found easy to use. These findings suggest that individuals with impaired hand and finger function prefer Bold bottle-type containers as drug packaging. Thus, the use of such packaging could help improve drug adherence and usability for some users over the long term.

Objective: This study explores how tuberculosis (TB) patients in China perceive AI-assisted remote health services, focusing on the psychological and sociocultural dynamics involved in balancing perceived support and perceived surveillance.

Methods: A qualitative descriptive approach was adopted. 25 TB patients were recruited from urban and rural health facilities in Hubei Province, including both those currently in treatment and those who had recently completed it. In-depth, semi-structured interviews were conducted to examine patients' treatment experiences, digital literacy, and attitudes toward AI-assisted care. The AI system described to participants was a hypothetical prototype based on emerging technologies rather than an implemented service. Thematic analysis was guided by the Health Belief Model and Affordance Theory to identify key patterns and interpret their meanings.

Results: Five key themes emerged. Patients reported treatment fatigue and fluctuating motivation, reflecting complex psychological demands. Trust in AI systems was conditional, shaped by concerns about usability, digital unfamiliarity, and system reliability. Participants experienced a tension between viewing AI tools as supportive and feeling uncomfortable with constant monitoring, especially given the stigmatized and regulated nature of TB. A strong desire to preserve autonomy and dignity shaped patients' preferences for systems that minimize disruption and allow self-regulation. Acceptability was influenced by interface simplicity, preferred modalities such as voice-based prompts, and the assurance that AI would supplement rather than replace human care. These findings were synthesized into a conceptual framework, illustrating how treatment burden, psychological interpretations of AI, and perceived empowerment converge into a process of contextualized acceptance.

Conclusion: This study offers new insight into digital health engagement among an underserved population. It shows that TB patients do not passively receive AI interventions but interpret and evaluate them in light of their experiences and expectations. Designing acceptable AI-assisted systems requires sensitivity to patients' social contexts, emotional needs, and desire for agency in care.

Objective: To evaluate the effect of an internet plus health education model on treatment adherence among patients with pulmonary tuberculosis (PTB).

Methods: A total of 75 patients diagnosed with PTB and meeting the inclusion criteria were recruited from Beijing Chest Hospital between October and November 2024. Participants were randomly assigned to either the control group or the intervention group using a random number table The control group received conventional health education, whereas the intervention group received additional education via a WeChat mini programme. Treatment adherence was measured through outpatient follow-up cognitive assessments. Patients' knowledge of core PTB prevention and control concepts was evaluated using a standardised knowledge assessment questionnaire. Patient satisfaction was assessed using a self-developed satisfaction survey. After a 6-month intervention period, clinical parameters were compared between the two groups.

Results: Compared with the control group, the intervention group demonstrated significantly higher treatment adherence (P < 0.05). The mean disease knowledge scores were 66.05 ± 7.18 in the control group and 83.51 ± 8.15 in the intervention group, indicating a statistically significant difference between the two groups (P < 0.05). The overall knowledge awareness rate in the intervention group (83.51%) was significantly higher than that in the control group (64.61%) (P < 0.05). The satisfaction rate of patients in the intervention group was significantly higher than that in the control group (93% vs 100%) (P < 0.05).

Conclusion: The internet plus health education model delivered via a WeChat mini programme can considerably improve treatment adherence, enhance disease knowledge and increase patient satisfaction among individuals with PTB. This model shows promise for broader application in tuberculosis wards.

Purpose: This study aimed to evaluate self-care activities (SCAs) and self-efficacy, and to determine their correlates and predictors among Jordanian patients with hypertension.

Patients and methods: A descriptive, cross-sectional correlational design study was used among 231 patients. Data was collected using structured interviews guided with a questionnaire that included demographic and clinical data, the Arabic version of the Hypertension Self-care Activity Level Effects (H-SCALE), and the Perceived Self-Efficacy Scale.

Results: The mean age was 49.2 years (SD = 13.4); 55.4% were males and 72.7% were married. Among them, comorbidities were prevalent (68%), with 42% of participants reporting diabetes. More than half were smokers (56.3%). The mean BMI was 28.3 (SD = 4.5), indicating overweight status. The mean H-SCALE score was 40.7 (SD = 9.1, range 17.82-62.8), indicating low adherence to recommended self-care activities to manage hypertension. Female patients and those with chronic hypertension had significantly higher H-SCALE scores (p <0.001). Significant predictors of H-SCALE included gender (B = 2.91, p =0.027), marital status (B = -4.52, p =0.01), time since diagnosis (B = 4.2, p =0.001), and self-efficacy (B =0.18, p =0.001), explaining 28% of the variance (R² =0.277, F(10, 220) = 4.81, p <0.001). The mean self-efficacy score was 16.6 (SD = 12.2, range 0-45), indicating low self-efficacy. Female patients and those with chronic hypertension also had higher self-efficacy (p <0.001). Predictors included age (B = -0.288, p <0.001), time since diagnosis (B = 7.84, p <0.001), and H-SCALE score (B =0.290, p =0.001), accounting for 35% of the variance (R² =0.354, F(10, 220) = 7.55, p <0.001).

Conclusion: Low levels of self-care activities and self-efficacy increase the risk of hypertension-related complications. Targeted interventions, such as patient education, lifestyle modification, routine follow-up, self-monitoring, and integrating digital health tools, are needed to improve patient outcomes.