Patient preference and adherence最新文献

Introduction: Pulmonary tele-rehabilitation (PTR) is an effective treatment for patients with chronic obstructive pulmonary disease (COPD). However, determinants of sustained motivation and adherence have been sparsely investigated.

Aim: This study examined how motivation and engagement evolved throughout 25 weeks of a maintenance PTR program in patients with moderate to very severe COPD.

Methods: In a qualitative study with a longitudinal recurrent cross-sectional design, 11 individual semi-structured interviews were conducted after 10 week of Homebased Pulmonary Rehabilitation (HPR) or PTR intervention and 10 interviews were conducted after 25 weeks into the maintenance PTR program with 16 patients participating in a randomized controlled trial on pulmonary tele-rehabilitation at Hvidovre Hospital, Denmark. The interview guide and initial coding framework were directed by the Theoretical Domains Framework in a deductive content analysis. An unconstrained matrix, based on inductive principles, was used to capture categories across multiple domains.

Results: Three main categories emerged: (1) Acceptance and Hope, (2) Physical Factors, and (3) External Support. Over time, participants developed greater acceptance of COPD, transitioning from fear-driven motivation to sustained engagement through improved coping strategies. Easy PTR access, continuous therapist, and peer support were key factors in maintaining adherence.

Conclusion: Over the course of 25 weeks, motivation evolved from fear-driven to autonomous, reflective engagement. The results emphasize the importance of external support and tailored environments like remote delivery methods for long-term adherence to maintenance PTR programs.

Aims and objectives: This study aimed to explore barriers to preventing lipohypertrophy for individuals with diabetes.

Design: A qualitative descriptive design was used.

Methods: 17 individuals with diabetes with LH were interviewed face-to-face in individual semi-structured interviews. Qualitative content analysis was used, and data saturation was achieved.

Results: The analysis yielded three primary themes with eight subthemes: lack of knowledge (insufficient health education, forgetfulness, and misconceptions), limited feasibility (several limitations in site rotation, financial pressures in needle replacement, and failure to self-monitor flat LH), and low motivation (low perceived severity and low perceived susceptibility).

Conclusion: Identifying these barriers provides patients with targeted recommendations or measures to improve LH prevention, further improving self-management at home and diabetes outcomes.

Relevance for clinical practice: LH is a common insulin therapy complication that affects insulin absorption and glycemic control. The correct injection technique for preventing LH depends on the effectiveness of insulin therapy in individuals with diabetes.

Patient or public contribution: 17 individuals with type 2 diabetes who participated in the interviews contributed to this study.

Purpose: To evaluate the clinical and implementation impact of "Alert System for New Prescriptions and Therapeutic Adherence Monitoring" (SANPAT), a real-time prescription alert system embedded in a structured pharmaceutical care model, aimed at optimizing antiretroviral therapy (ART) and improving medication adherence in people living with HIV (PLWH).

Patients and methods: A quasi-experimental, before-and-after study was conducted in a hospital outpatient pharmaceutical care unit in Andalusia, Spain. Patients aged ≥50 years receiving ART were included if they had polypharmacy (≥6 concurrent medications) or demonstrated poor adherence. The pre-intervention period (Feb 2023-Jan 2024) relied on standard care without alerts. The post-intervention period (Feb 2024-Jan 2025) incorporated SANPAT, enabling pharmacists to receive real-time alerts for new prescriptions and adherence risks. Pharmaceutical interventions were classified using a validated Capacity-Motivation-Opportunity (CMO)-based taxonomy, and implementation was evaluated using the Reach, Effectiveness, Adoption, Implementation y Maintenance (RE-AIM) framework.

Results: A total of 153 patients were included (84 pre- and 69 post-intervention). The number of pharmacist interventions increased markedly post-intervention (from 84 to 877 events), especially in adherence support (0.0% to 47.2%) (p<0.001) and medication error prevention (0.0% to 34.7%) (p<0.001). The frequency of polypharmacy and major polypharmacy increased, while immunovirological risk markers improved (CD4 cell count<200 cells/μL decreased from 15.0% to 4.3%; detectable viral load from 20.3% to 3.6%) (p<0.001). The RE-AIM evaluation demonstrated broad reach, high adoption, improved implementation metrics, and early signs of long-term sustainability.

Conclusion: SANPAT significantly enhanced the timely identification and resolution of pharmacotherapeutic risks in PLWH, supporting personalized interventions and optimizing ART management. Its integration within existing electronic prescribing populations.platforms and structured care models represents a scalable strategy to improve medication safety in aging and complex patients.

Background: Traditional Chinese Medicine techniques have unique advantages in complementary cancer treatment, and their clinical application largely relies on patient acceptance. Scientific assessment of patients' acceptance of Traditional Chinese Medicine techniques is a key step in promoting their clinical application. However, no scientifically validated tools exist to assess cancer patients' acceptance of Traditional Chinese Medicine techniques.

Purpose: To develop and validate the acceptance scale for Traditional Chinese Medicine techniques in cancer patients.

Patients and methods: The study involved scale development and psychometric testing. Items were generated via conceptual definition, literature review, and qualitative research based on the Technology Acceptance Model. Two rounds of expert review and a pilot study refined the scale and assessed content validity. Psychometric evaluation was conducted on 370 cancer patients, including item analysis, exploratory and confirmatory factor analysis, validity assessments, and reliability testing.

Results: The finalized 25-item scale has four dimensions: perceived usefulness, perceived ease of use, behavioral intention, and apprehensions about usage. Content validity indices ranged from 0.933 to 1.000. Exploratory factor analysis revealed four common factors, accounting for 66.6% of the variance. Confirmatory factor analysis showed good fit (χ²/df=2.304, GFI=0.803, CFI=0.907, NFI=0.847, RMSEA=0.079). Convergent validity indicated Average Variance Extraction values of 0.493-0.679 and Composite Reliability of 0.858-0.913. Correlations between dimensions ranged from 0.624 to 0.730, with satisfactory discriminant validity. Reliability was high (Cronbach's alpha=0.951, split-half=0.871, test-retest=0.876).

Conclusion: This scale is a reliable and effective tool for assessing cancer patients' acceptance of Traditional Chinese Medicine techniques. It provides guidance for clinical practice and research involving these techniques.

Objective: To conduct a scoping review of discrete choice experiment (DCE) studies assessing medication preference patterns in patients with osteoporosis, focusing on quantifying preference intensities, willingness-to-pay for treatment attributes, and heterogeneity in preferences across patient subgroups. This analysis aims to support evidence-based clinical decision-making.

Methods: A scoping review was undertaken, where five electronic databases were searched for key terms to identify eligible DCE studies related to drug treatment preference for osteoporosis patients. We included studies that met criteria, including being published from database establishment until April 20, 2024. Data were systematically extracted, tabulated, and summarised in a narrative review.

Results: Nine studies met the inclusion criteria, six of which were conducted in Europe. The included DCE studies contained between 3 and 6 attributes and 2 to 6 levels per attribute. The number of choice sets per study ranged from 8 to 36. Treatment efficacy emerged as the most critical attribute. Subgroup analyses revealed significant preference heterogeneity associated with age, educational attainment, and fracture history.

Conclusion: Incorporating quantified patient preferences and WTP metrics into treatment planning may optimize adherence rates and osteoporosis management outcomes. This preference-sensitive approach demonstrates potential to reduce both clinical burden and patient financial burden through value-based treatment allocation.

Objective: The primary objective of this study is to evaluate residents' preferences for inclusive commercial health insurance to inform policy optimization, as well as to assess the applicability of the Best-Worst Scaling (BWS) and Discrete Choice Experiments (DCE) methods.

Methods: A face-to-face survey incorporating both DCE and BWS tasks was conducted with residents recruited in Heilongjiang Province, China. The attributes include insurance liability, premium, reimbursement ratio, deductible, government involvement, and payment methods. Data from BWS and DCE tasks were analyzed using mixed logit and conditional logit models to estimate preference weights for each attribute level. The optimal measurement method was evaluated based on internal consistency, validity, and acceptability.

Results: A total of 415 respondents were included in the analysis. Comparative analysis of DCE and the BWS methodologies revealed a pronounced preference among respondents for a 90% reimbursement rate and a streamlined, one-stop claims settlement process. However, notable discrepancies emerged in the ranking of preferences for other attributes. Further analysis indicated a correlation between the preference weights derived from the two methods, although the concordance was only moderate. Additionally, the DCE method demonstrated superior validity and reliability compared to BWS-2.

Conclusion: This study reveals residents' preferences for inclusive commercial health insurance (ICHI), providing valuable insights for optimizing product design and informing policy development. It also provides the first comparative analysis of DCE and BWS methods in the context of ICHI, which validates the superior applicability of DCE for health insurance, offering new perspectives and methodological guidance for future studies.

Purpose: Pain is the most common symptom of Osteoarthritis (OA) making OA one of the most frequent causes of mobility dependence and disability and resulting in a significant negative impact on health-related quality of life (HRQoL). The main objective of this study was to estimate health state utility values (HSUVs) associated with different levels of pain related to Knee OA (KOA).

Patients and methods: Six different health state vignettes were developed using best practices and real-world data from the Osteoarthritis Initiative (OAI) database that included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) instrument. OAI data from individuals with KOA were categorized into 6 different pain profiles using patient responses to the WOMAC pain items (pain while: walking; climbing stairs; sleeping; resting and standing) each having response levels 0 (no)-4 (extreme). The six vignettes identified the most frequently observed response levels of the pain items. A time trade-off study was conducted in the UK among individuals with KOA.

Results: Analysis dataset included 198 interviews. Participants' mean age was 51.6 years and 58.6% were females. Mean HSUVs ranged from 0.983 for the mildest health state, which was described as slight pain while climbing stairs and no pain on the other items, to 0.305 for the most severe health state which was described as extreme pain in all items.

Conclusion: This is the first known set of HSUVs estimated describing levels of pain most commonly reported by individuals with KOA. The results demonstrate considerable HRQoL burden in individuals with KOA.

Background: As the incidence and recurrence rates of chronic obstructive pulmonary disease (COPD) among older people continue to rise globally, it is essential to understand the health literacy needs of these patients at various stages of the disease. Health literacy is closely linked to the risk of COPD onset and recurrence. However, there is a notable deficiency in research that specifically addresses the health literacy requirements of this population across different disease stages.

Objective: This study aimed to investigate the health literacy needs of older patients with COPD across various stages of their disease trajectory.

Methods: Utilizing a timing framework, purposive sampling was conducted from July 2023 to March 2024, selecting participants from Shanghai Chest Hospital. Semi-structured in-depth interviews were conducted, and thematic analysis was employed to interpret the data.

Results: A total of 28 participants completed the interviews, comprising 18 males and 10 females. Based on timing theory, these findings identified four themes: 1) Diagnostic period: Limited ability to acquire disease information, psychological support, and change unhealthy lifestyles, 2) Treatment period: therapeutic information support and efficient care, 3) Discharge preparation period: specific health guidance and a promising life plan, 4) Home recovery period: self-management, continuous healthcare support, and balancing self-discipline with external discipline.

Conclusion: The health literacy needs of older patients with COPD varied across different stages of the disease. Healthcare professionals should develop individualized health literacy interventions that are tailored to the specific needs and characteristics of individuals at different stages of their health journey.

Background: Exercise is an critical component of diabetes health management. Long-term regular exercise can improve blood glucose levels and prevent or control diabetes-related complications. When facing exercise decision-making, patients are often full of confusion and hesitation, and may refuse to participate, thus affecting the effect of blood glucose control.

Purpose: The objective of this review was to systematically evaluate and integrate qualitative research on factors influencing exercise behaviour and exercise experience in diabetes patients to provide references for formulating management strategies to improve patients' exercise compliance.

Patients and methods: PubMed, Web of Science, Embase, PsycINFO, CINAHL, Scopus, CNKI, VIP, Wanfang and SinoMed were searched for qualitative studies or mixed methods studies concerning qualitative research on exercise influencing factors or experience in diabetes patients from the establishment of the database to March 2025. The quality evaluation of the included studies was critically conducted using an established tool after study selection.And then extract and analyse the data, using a systematic review and thematic synthesis approach to analyse the data.

Results: A total of 32 studies were included, using thematic analysis, 11 interrelated themes were identified. Among them, exercise stimulates positive emotions and makes exercise a habit; perceiving the benefits of exercise; external support system; correct understanding of exercise; suitable exercise mode serves as promoting factors, obstacle factors including limitations due to personal conditions or concerns about adverse events caused by exercise; lack of knowledge related to exercises or misconceptions about it; being restricted by external conditions; incomplete support system; personal emotions and psychosocial factors; cultural restrictions and other reasons.

Conclusion: The influencing factors of exercise behavior are complex and have a profound impact on patients' exercise compliance. Medical staff should clarify the four core dimensions that affect patients' exercise behavior, enhance patients' exercise-related knowledge through health education and other methods, encourage patients to choose exercise methods that are suitable for themselves, and encourage family members or peers to participate with patients, and promote patients' active participation in exercise by exerting their autonomy, thereby achieving more ideal health outcomes.