Patient preference and adherence最新文献

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.

Background and objective: While clozapine is an effective medication for treatment-resistant schizophrenia (TRS), adherence to treatment is often the focus of concern. The subjective experiences of patients with TRS treated with clozapine can be helpful in managing the concern related to its use. Therefore, this study aimed to explore the subjective well-being of patients with TRS treated with clozapine.

Materials and methods: This study was conducted using a mixed-methods approach. In the quantitative part, data was gathered using two questionnaires, completed by 42 patients with TRS treated with clozapine. In the qualitative part, semi-structured interviews were conducted with seven patients to gather their experiences. The quantitative data were analyzed using descriptive statistics, and content analysis was used for analyzing qualitative data.

Results: Half of the participants in the quantitative part were female, and half were male. Their average age was 40.94 ± 10.89 years. The average duration of clozapine use among these patients was 71.66 ± 118.60 months. Study participants reported both positive and negative changes in their symptoms after clozapine use. The most substantial improvements were reported in mood (71.4% "better"), sleep (64.3% "better"), and quality of life (45.2% "much better"). Hypersalivation (21.4% "much worse"), abdominal pain (81% "worse"), and unusual sensations (64.3% "worse") were the most frequent negative experiences. The results of the qualitative analysis also showed that participants had subjective pleasant and unpleasant experiences. Pleasant experiences were related to symptom reduction and personal and family satisfaction with clozapine use, while unpleasant experiences were related to side effects and other issues with clozapine use.

Conclusion: The quantitative and qualitative results are strongly interconnected, revealing that subjective experiences of patients with TRS who used clozapine range from positive experiences, such as improved quality of life, to negative experiences, such as adverse side effects and contextual barriers. The results can be helpful for clinicians in the management of TRS patients treated with clozapine. Highlighting positive changes to patients and their families can increase adherence to treatment, and managing negative changes and adverse side effects can impact treatment outcomes.

Purpose: This study aims to explore the challenges and service needs faced by elderly patients with comorbidities during the transition from hospital discharge, and the study is proposing a way forward for transitioning the elderly patients with multimorbidity.

Patients and methods: A purposive sampling approach was employed to select 12 elderly patients with comorbidities from the geriatric departments of two tertiary hospitals in the Xinjiang region between November 2024 and March 2025. A phenomenological research design was utilized to conduct semi-structured interviews with participants. Data were analyzed using the seven-step Colaizzi method for phenomenological analysis, supported by Nvivo 15.0 software.

Results: Three main themes and twelve subthemes were identified: (1) Support System Dilemma, (2) Guidance Needs for Discharge Information, (3) Demand for Continuous Services and Safeguards in Medical Institutions.

Conclusion: Elderly patients with comorbidities experience multiple challenges and unmet needs during the discharge transition period. Clinically, it is essential to establish a multidisciplinary transitional care team, conduct comprehensive pre-discharge assessments, enhance system support and polypharmacy management, develop tailored discharge guidance plans to improve the quality of life during the post-discharge transition period.

Background: The aim of this study is to present and analyze the results obtained from satisfaction surveys of oncology patients diagnosed with lung cancer. Surveys were part of the pilot project of the National Cancer Network in Poland, conducted between 2019 and 2023, using data collected from the largest oncology center in the Lower Silesian Voivodeship, with population of 2.9 million.

Methods and findings: Anonymous and voluntary surveys from 2019 to 2023 were analyzed. The questions focused on aspects related to patient satisfaction, including hospital stay, medical care, the scope of information provided about the treatment process, and selected elements of the National Cancer Network pilot. The surveys were completed by both hospitalized and outpatient patients. A total of 260 surveys were assessed, with a response rate of 5.80%. The aspect that received the lowest score was the scope and flow of information provided by medical personnel (average 4.44 ± 0.75). The highest score was given to support from the Oncology Care Coordinator, with 86% of respondents giving positive ratings. In the cross-analysis, statistical significance was found for the assessment of hospital meal quality, differentiated by both gender (p=0.041) and age (p=0.041) of the patients. Additionally, the sense of intimacy during medical procedures had the strongest impact on overall patient satisfaction.

Conclusion: Our analysis of satisfaction surveys highlights important elements of healthcare that affect overall satisfaction. Presented results provide valuable insights for further improving the quality of oncology care in Poland, with an emphasis on enhancing staff-patient communication. At our center, future studies need higher survey response rates, as the low participation was this study's main limitation and may have caused response bias.

Objective: This study aims to investigate the mediating role of health literacy-both in hypertensive patients and their spouses -on the relationship between illness perception and medication adherence, based on the Actor-Partner Interdependence Mediation Model (APIMeM).

Methods: Hypertensive patients and their spouses from a selected region were recruited through convenience sampling between August 2024 and March 2025. Data were collected using the General Information Questionnaire, Brief Illness Perception Questionnaire, Health Literacy Scale for Chronic Disease Patients, Morisky Medication Adherence Scale, and the Caregiver Self-care Contribution Scale.

Results: (1) Regarding the actor effects, patients' health literacy partially mediated the relationship between their illness perception and medication adherence (effect size: 0.028, 95% CI: 0.007~0.067, P < 0.05). Similarly, spouses' health literacy partially mediated the effect of their own illness perception on their medication adherence (effect size: 0.240, 95% CI: 0.165~0.324, P < 0.05). (2) For the partner effects, patients' health literacy partially mediated the relationship between their spouse's illness perception and the patient's medication adherence (effect size: 0.042, 95% CI: 0.018~0.084, P < 0.05). Meanwhile, the spouse's health literacy fully mediated the effect of the patient's illness perception on the spouse's medication adherence (effect size: 0.139, 95% CI: 0.020~0.302, P < 0.05).

Conclusion: A bidirectional actor-partner effect exists between illness perception and medication adherence among hypertensive patients and their spouses. Health literacy plays a significant mediating role in these relationships. These findings suggest that clinical interventions should target both patients and their spouses simultaneously, enhancing health literacy, strengthening disease knowledge, improving illness perception, and thereby promoting better medication adherence.

Purpose: Effective management of tuberculosis-multimorbidity is crucial to reducing disease burden and preventing complications. While studies have explored the role of health literacy in improving TB-treatment adherence and self-management, few have addressed how a collective, multi-faceted approach can optimize the management of TB-multimorbidity. This study aims to bridge these gaps by exploring how various stakeholders perceive health literacy and its role in managing TB-multimorbidity, ultimately providing a more holistic understanding that could guide policy interventions and healthcare strategies in India.

Methods: A qualitative study was carried out among multiple stakeholders engaged in the management of TB-multimorbidity in Odisha, India. A total of 27 in-depth interviews and 13 key informant interviews were conducted. The data were digitally recorded, transcribed, and translated into English. A thematic framework analysis of stakeholder perceptions, guided by the Health Literacy Instrument for Adults (HELIA), was performed. HELIA informed our interpretation by structuring coding around its literacy dimensions, including access, understand, appraise, and apply, which allows to map interview insights onto literacy-related barriers and facilitators to ground the interpretation of the theme in a validated health-literacy framework.

Results: The findings explored the significance of health literacy in the management of TB multimorbidity. Information gaps exist in TB materials concerning comorbidities. Furthermore, low-literacy patients often faced cultural and semantic challenges, and they relied on community networks; however, the high-literacy patients trusted digital information. The literacy levels many times shape the care plan and patient navigation pathways. The navigation difficulties indicate the possible use of community health workers as trusted guides. The participants suggested including visual tools, improved provider training, and integrated IEC materials addressing multimorbidity, with clear implications for policy and practical healthcare interventions in India to enhance accessibility, trust, and patient-centred care in India.

Conclusion: The study indicates the need for concrete and actionable steps to improve TB-multimorbidity management in India, including the development of accessible multilingual materials, enhancing provider training in health literacy and communication, and strengthening trust and navigation through community and system-level supports. We recommend piloting and evaluating these targeted interventions to generate practical guidance for policymakers and practitioners.

Aim: To determine the latent profiles of health beliefs for stroke patients and analyze the differences among different clusters of stroke patients.

Methods: 1358 stroke patients were recruited by a stratified cluster random sampling approach in Henan Province, China, from March to April 2023. The instruments used were the general situation questionnaire, Stroke Knowledge Questionnaire, National Institute of Health Stroke Scale, modified Rankin Scale, Health Behavior Scale for Stroke Patients, and Short Form Health Belief Model Scale. Questionnaires were distributed through the Questionnaire Star Platform. The health belief clusters were determined by Mplus8.3. Pearson's chi-square test and one-way ANOVA in SPSS 26.0 were applied to examine the profiles' differences.

Results: A total of 1358 questionnaires were returned, resulting in an effective response rate of 87.33%. Model fitting indicators supported the three-class model of health beliefs. Latent profile analysis identified three distinct clusters, labeled Class 1 (health belief absence cluster totally), Class 2 (self-deficiency deprivation cluster), and Class 3 (higher perception behavior disorder cluster). Total Short Form Health Belief Model Scale scores among Class 1-3 differed significantly. Single-factor analysis showed statistical significance in the modified Rankin Scale, health behavior, health knowledge, education, residence, profession, medical insurance mode, and hypertension.

Conclusion: Individual heterogeneity is evident in health beliefs among stroke patients. The belief can be divided into three potential clusters. The study provides reference for the developing regular health belief and provide methodological guidance for other clinical studies. Clinicians are able to offer tailored guidance according to the different health beliefs of patients.

Background: Patients with multimorbidity tend to have multiple medications or polypharmacy to achieve optimal outcomes, which may result in non-adherence to medication. Medication non-adherence in this population is relatively higher than in patients with a single disease because of more complex medication regimens and greater adverse drug reactions. Providing interventions is an essential solution in changing patients' behavior towards medication adherence among patients with multimorbidity. Pharmacists could help patients achieve optimal outcomes by optimizing medication use, including improving medication adherence. This scoping review aims to identify evidence of the effectiveness and characterize pharmacist-led interventions in improving medication adherence among patients with multimorbidity.

Methods: A systematic search was conducted to identify relevant studies on PubMed, Scopus, CENTRAL, and through hand searching. Randomized controlled trial design studies performing interventions to improve medication adherence led by pharmacists among patients living with multimorbidity were included. We focused on original search with the key concepts of "multimorbidity", "pharmacists", and "medication adherence". Narrative synthesis was used to extract and synthesize the data.

Results: Twelve studies that included participants with multimorbidity were reviewed. Nine of all twelve studies showed improvement of medication adherence in the intervention group with a p-value <0.05, while three other studies indicated no significant difference between the intervention and control groups. All of the studies employed personalized interventions. Interventions used could be divided into counselling sessions, medication management, or using a supporting tool as a reminder of drug administration.

Conclusion: In nine out of twelve studies, interventions led by pharmacists were found to be effective in improving medication adherence in patients with multimorbidity. Effective interventions showed significant improvement in medication adherence in the intervention group compared with the usual care group. These interventions included counselling sessions, medication management, and the use of a supporting tool to remind patients about drug administration.

Background: Schizophrenia is a complex disease that affects many aspects of the lives of people living with the disease. Therefore, many different treatment goals are possible. Treatment goals in schizophrenia may differ between patients and physicians. Here, we set out to explore whether there are subgroups in which differences between patient goals and treating psychiatrist's goals are especially marked, which would highlight the need for better dialogue between psychiatrists and patients belonging to these subgroups.

Methods: In a survey, patients with schizophrenia and their treating psychiatrists were asked about treatment goals. To this end, questionnaires were sent to psychiatrists all over Germany. Psychiatrists were asked to rank and rate a prespecified set of treatment goals for up to 3 specific patients. Furthermore, these same patients were asked to rank and rate the goals for themselves. Responses are analyzed in subgroups of patients stratified by sex, disease duration (≤5 years/>5 years) and treatment by psychiatrists in private practice vs hospital-based psychiatrists.

Results: We obtained answers from 28 physicians, 17 of which worked exclusively in private practice, and 80 patients. Of the patients, 13 had a disease duration ≤5 years, 31 were female, and 52 were treated by psychiatrists in private practice. Concordance between patients and their physicians was fairly high, and none of the subgroups (shorter/longer disease duration, male/female sex, treatment by psychiatrists in private practice vs hospital-based psychiatrists) stood out as markedly different from the total cohort. The most marked differences between patients and physicians regarded avoidance of different possible medication side effects.

Conclusion: We did not find any major differences between the subgroups in this study. Overall, there was a high concordance of rankings and ratings of treatment goals. Patients tended to focus on different side effects than physicians, indicating that these should be discussed thoroughly when making a treatment decision.