Browsing by Subject "Medication Adherence"
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Item Association Between Posttraumatic Growth, Medication Adherence, and Barriers to Adherence in Pediatric Solid Organ Transplant Patients and Their Caregivers(2020-08-01T05:00:00.000Z) Mbroh, Hayden Mensah; Triplett, Kelli; Stewart, Sunita M.; McClintock, Shawn Michael; Bonsu, Mary L.; Selders, MichaelLiving with a chronic illness can be a traumatic experience, yet there is also evidence that adverse experiences may facilitate positive psychological changes, such as posttraumatic growth (PTG). Little is known about PTG in pediatric solid organ transplant (SOT) patients and their caregivers or PTG's relationship with health behaviors. Study aims were to longitudinally evaluate 1) the role of medication nonadherence and BTA on PTG, and 2) PTG's influence on medication nonadherence and barriers to adherence (BTA). It was hypothesized that 1) Greater baseline medication nonadherence and BTA would predict greater follow-up PTG, and 2) greater baseline PTG would predict lower follow-up medication nonadherence and fewer BTA. Participants included 43 pediatric SOT patient-caregiver dyads at baseline (range: .11-17.09 years post SOT) and follow-up (range: .87-3.37 years post baseline). Baseline measures of PTG, medication nonadherence, BTA, and psychosocial factors were obtained. Follow-up measures of primary outcomes were also collected. Baseline medication nonadherence (β = -.05, SE = .87), patient-rated BTA (β = -.17, SE = .10), and caregiver-rated BTA (β = -.24, SE = .12), did not predict follow-up patient PTG. More baseline caregiver-rated BTA (β = .29, SE = .30), but not medication nonadherence (β = .07, SE = 3.02) or patient-rated BTA (β = .20, SE = .20), predicted greater follow-up caregiver PTG. Baseline patient PTG (β = -.01, SE = .04) and caregiver PTG (β = -.25, SE = .01) did not predict follow-up medication nonadherence. Higher baseline caregiver PTG (β = -.25, SE = .08), but not patient PTG (β = -.07, SE = .26), predicted fewer follow-up patient-rated BTA. Greater baseline patient PTG (β = -.01, SE = .21), but not caregiver PTG (β = -.04, SE = .06), predicted more follow-up caregiver-rated BTA. Exploratory analyses were also conducted to identify psychosocial predictors of primary outcomes. Results suggest that strengthening PTG in caregivers of pediatric SOT patients may be important for reducing BTA. Further research needed to determine whether specific domains of PTG and BTA are associated. Findings have the potential to inform strength-based interventions focused on decreasing BTA for pediatric SOT patients.Item Culturally Informed Motivational Interviewing to Improve Oral Chemotherapy Adherence for Pediatric Acute Lymphoblastic Leukemia Patients and Their Caregivers: A Feasibility, Acceptability, and Preliminary Efficacy Trial(2019-07-24) El Behadli Gonzalez, Ana Fey; Faith, Melissa A.; Stewart, Sunita M.; Winick, Naomi; Germann, Julie; Acosta, DailynBACKGROUND: Curative therapy for childhood acute lymphoblastic leukemia (ALL) mandates a two-to-three-year maintenance chemotherapy phase wherein patients must take daily oral 6-mercaptopurine (6-MP). 6-MP regimen adherence is challenging and failure to take medication has been associated with an increase in relapse risk. Accordingly, interventions that enhance 6-MP adherence during ALL maintenance chemotherapy may result in decreased morbidity and mortality for pediatric ALL patients. This study investigated the feasibility and acceptability of brief, English- and Spanish-delivered, culturally informed MI sessions during routine outpatient ALL maintenance therapy appointments. Additionally, this study preliminarily explored MI efficacy, compared to an education-only control, for improving caregiver-reported 6-MP adherence, patients' TGN blood serum levels, and caregiver-perceived 6-MP adherence barriers. METHOD: Participants included 121 caregivers (Age M(SD) = 36.66(8.02), 80.7% mothers, 47.1% Hispanic, 23.1% Spanish-speaking) of pediatric ALL patients (Age M(SD) = 7.55(4.80), range = .9-24; 66.1% male; Medicaid = 54.2%; B- and T-ALL risk category: Standard = 50.9%, High/Very High = 49.1%) in maintenance ALL treatment. Eighty caregivers (66.12%) were randomized to receive MI and the remaining 42 caregivers (33.8%) were randomized to the education-only control group. For the purpose of analyses, participants were categorized based on their ethnicity and primary language as a proxy for potential cultural similarities. Cultural categories included: (1) Non-Hispanic, English-speaking caregivers (N=63, 52.07%); (2) Hispanic, English-speaking caregivers (N=30, 24.79%); and (3) Hispanic, Spanish-speaking caregivers (N=28, 23.14%). Participants completed self-report measures assessing demographics, 6-MP adherence, 6-MP knowledge, perceived medication adherence barriers, and intervention acceptability. We obtained biological data (i.e., TGN concentrations) via chart review. MI sessions were audio recorded and rated using the MITI 4.2.1. coding manual to ensure intervention fidelity. Primary analyses included Analysis of Covariance (ANCOVA). We also conducted exploratory post-hoc analyses. RESULTS: Findings confirmed primary MI feasibility and acceptability hypotheses, supporting the possibility of delivering adherence-enhancing MI as part of routine oncological care. Additionally, although methodological limitations hindered adequate assessment of MI efficacy for improving caregiver-reported 6-MP adherence and patients' TGN concentration, post-hoc analyses suggested MI was effective for reducing caregiver-perceived 6-MP adherence barriers. CONCLUSIONS: MI may represent a deliverable, cost-effective, "no-risk" approach to improving adherence and represent an easily incorporated, low cost avenue for enhancing cure. Overall, study findings have the potential to inform a larger, future MI efficacy RCT by establishing the feasibility and acceptability of MI delivery during outpatient oncology clinic visits.Item Improving Adherence to Opioid Prescribing CDC Guidelines for Chronic Pain(2021-05-01T05:00:00.000Z) Zamir, Aemen; Reed, W. Gary; Kandil, Enas; Phelps, EleanorBACKGROUND: The Centers for Disease Control and Prevention have released treatment guidelines for chronic pain care as concerns about opioid overuse and abuse increase. Additionally, The Texas Medical Board has outlined their policy for the use of medication for non-malignant chronic pain purposes in Rule 170.3 of the Texas Administrative Code. Some of the requirements include a signed pain management agreement, regular review of the Prescription Monitoring Program, a urine drug screen, and documentation of completion of requirements in patient's medical records. OBJECTIVE: Establish baseline adherence to TMB policy for opioid prescribing and implement electronic medical record tools to facilitate completion of requirements METHODS: A preliminary chart review of patients on the opioid registry, an intervention in early phase of implementation meant to easily identify patients receiving opioids for chronic pain, was conducted to determine baseline adherence to Rule 170.3 amongst physicians. Several CDC guidelines which corresponded with TMB requirements were chosen. Post-intervention data was collected from the chronic opioid registry regarding the percentage of patients who had annual review of Prescription Monitoring Database, a urine drug screen, a pain management agreement, and documentation of completion of requirements in patient's medical records. RESULTS: Of the 206 patients studied through chart review pre-intervention, only 6% had all three TMB mandated elements in their charts. After implementing the EMR tools meant to facilitate completion of TMB laws and CDC guidelines, the percentage of patients with a urine drug screen and review of PDMP increased while the percentage of patients with a pain management agreement in their chart decreased. CONCLUSION: Poor compliance in the UTSW system necessitates tools that will streamline the process for completing and documenting the requirements. The implementation of the EHR tools and the opioid registry best practice alerts, as they were rolled out by the Opioid Task Force, helped facilitate completion of requirements.Item Maternal Intrusive Involvement and Adolescent Functioning in Youth with Type I Diabetes(2007-12-17) Oroza, Maria Gabriela; Wiebe, Deborah J.One factor affecting emotional and physical well being in adolescents with type 1 diabetes is the degree of maternal involvement. Adolescents whose mothers are actively involved in the daily management of their diabetes tend to follow their regimen more consistently and are in better glycemic control. However, intrusive levels of involvement have been correlated with increased depression, decreased adherence, and poor metabolic control. In the past intrusive involvement has been seen as a consequence of innate maternal characteristics such as trait anxiety, and as the cause of poor child functioning in adolescents with intrusively involved caregivers. More current research takes a transactional perspective in which intrusive involvement interacts with child functioning in a reciprocal manner. To investigate the current transactional perspective, the current study explored the temporal relationships between intrusive maternal involvement in adolescent diabetes management and child functioning variables including depression, adherence, and metabolic control across two time points (an average of 16 months apart) using cross-lagged panel correlation analyses and hierarchical linear regression. The current study also investigated the role of maternal trait anxiety in the development of intrusive involvement by proposing one potential transactional process and testing it in the sample. Adolescents (N = 83, 10 to 15 years of age, 53% male) with type 1 diabetes mellitus (duration of at least 1 year) completed measures of adherence, depression, and intrusive involvement, and their mothers provided relevant demographic and illness related information. Metabolic control was collected from participants' medical records. This study found no evidence to support the workings of a transactional process within mother-teen dyads for adolescents with type 1 diabetes. However, consistent with the traditional linear model, results indicated that intrusive involvement was associated with higher levels of depressive symptoms in females at Time 1, and that the effects continued to be seen over time. No association was found between intrusive involvement and depressive symptomatology for males at either time point. These findings point to the need for interventions geared toward improving mother-daughter interactions and reducing depressive symptomatology in teenage girls with type 1 diabetes.Item Medication Adherence in Children and Adolescents with Major Depressive Disorder(2006-08-11) Sternweis, Kathryn VanArsdale; Hughes, Carroll W.Major Depressive Disorder (MDD) is a serious psychiatric disorder in children and adolescents where antidepressant adherence remains an important issue. The present study uses electronic monitoring (Medication Event Monitoring System, APREX, Fremont, California [MEMS® caps]) to compare various methods of measuring adherence. Subjects who met the Diagnostic and Statistical Manual of Mental Disorders' (DSM-IV) criteria for MDD participated in a randomized controlled trial involving fluoxetine. A subset of patients had their medication adherence monitored for up to 12 weeks using MEMS caps, blood levels, self-report, medication diaries, physicians' estimates, and pill counts. Throughout the 12-week process, patients also completed a number of questionnaires assessing treatment expectancy, side effects, family functioning, school functioning, cognitive beliefs, depressive symptoms, and the identity of the individual(s) dispensing medication.Item Predicting Potential Risk Factors of Prescription Pain Medication Misuse in a Chronic Pain Population Through PROMIS Global Health Score(2014-09-01) Altamirano, Gerardo; Gatchel, Robert J.; Noe, Carl; Robinson, Richard C.BACKGROUND: Chronic pain patients who are treated through an interdisciplinary treatment program have shown to report less symptoms of pain by a substantial degree. (Gatchel & Okifuji, 2006) Aspects of the Biopsychosocial Model such as physical and mental health, as well as appropriate medication adherence, must be considered for treatment. This study attempts to reinforce the clinical utility of the Biopsychosocial model by illustrating differences in self-perceived physical and mental health status. Subsequently, we hope to identify the influence of mental vs. physical health on pain-behaviors. Overall we hope to find a correlation between a patient’s self-reported health, using the Global Health Status PROMIS, and predicting their likelihood to abuse prescription pain medication, as measured through the PMQ (Pain Medication Questionnaire). Successively, clinicians can target the endorsement of poor mental health and/or poor physical health as a distinct concern in reducing pain behaviors such as prescription misuse. SUBJECTS: The final sample included data from males and females evaluated for the Interdisciplinary Pain Program at the McDermott Pain Clinic at UT Southwestern Medical center. Participants who were not chosen to participate in the IPP were still included in the data set. As the McDermott Pain Clinic does not typically provide care for children and adolescents (<18 years), children and adolescents were excluded from the present study. The test groups will consist of participants between 18 and 90 years of age as referred to the program by psychologists, Dr. Travis Whitfill and Dr. Richard Robinson of UT Southwestern and capable of providing informed consent, able to read and speak English, experiencing non-malignant pain-related problems, and willing to allow access to their electronic medical records. METHOD: Participants were administered a battery of assessments including the Pain Medication Questionnaire, Global Health Status PROMIS and other established measures of health and pain-related outcomes (e.g., SF-36, PROMIS pain-related measures) at baseline RESULTS: The results in the current study suggest that the PROMIS mental health score is a significant predictor in examining the likelihood for prescription pain medication misuse. Although the predictor variables of PROMIS physical health, age and gender improved the overall variance of the model when examined as single predictors they were shown not to be significant. The first hypothesis was not supported as shown by the weak linearity in the scatter plots of PROMIS physical and PROMIS mental health scores. Surprisingly, the strength of the relationship of physical and mental health scores was not significantly correlated despite support in the literature; however, this may be due to sampling limitations. The second hypothesis was supported through findings that suggest PROMIS mental health score is a strong predictor of participants’ PMQ score. Although PROMIS physical, age and gender improved the overall fit of the model their p values were not found to be significant when examined within the model. The latter part of hypothesis two that suggested age and gender would not be significant predictors of PMQ was supported, as their p-values found were .862 for age and .058 for gender, respectively. DISCUSSION: The current study achieved its stated goals of evaluating the predictive utility of the Global Health Status PROMIS in comparison with the PMQ. The current study offers an important contribution to understanding and evaluating chronic pain and the multifaceted nature of Biopsychosocial outcomes. It is anticipated that future clinical research will continue to expand upon the implications from this study and contribute to more effective evaluation and treatment for individuals suffering from chronic pain and lend attention to risk factors of prescription pain medication misuse. Through targeting psychological elements in addition to physiological pain reduction clinicians can help reduce risk factors of detrimental pain behaviors.