Browsing by Subject "Patient Compliance"
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Item Adherence as a Mediating Variable Between Depression and Health Outcomes in Adolescents with Type 1 Diabetes(2013-12-30) Wolfe, Kristin Linette; Wiebe, Deborah J.; Kennard, Beth D.; Germann, JulieAdolescence is often a time of diabetes mismanagement and poor metabolic control in adolescents with type 1 diabetes. Symptoms of depression are related to poor metabolic control, but the mechanism that links them is under debate. Because depression tends to be associated with poorer adherence and poor adherence has been shown to be related to poor metabolic control, it is possible that adherence serves as a mediator between the two. The present study tested this mediation pathway in a sample of adolescents with type 1 diabetes. Participants (N=252) were recruited from endocrinology clinics in Utah during their routine diabetes clinic visits. Participants fell between the ages of 10 and 14, were able to read and write in either English or Spanish, had a diagnosis of type 1 diabetes for at least one year, and did not have a condition that would interfere with measurement completion. Participants were drawn from a larger longitudinal observational study. This study analyzed the first three time points of data, which were obtained six months apart. Demographic and illness information was obtained from self-report and participant medical files. Questionnaires were used to assess depression and adherence. Metabolic control was measured through HbA1c levels retrieved from medical records. Data were analyzed to test the mediation hypotheses. Higher levels of depression were correlated with poorer metabolic control in cross-sectional analyses at study entry, and in longitudinal analyses measured one year later. Adherence was found to be a partial mediator in cross-sectional analyses, but did not mediate changes in metabolic control across time.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 Developmental Expectations and Adolescent Type 1 Diabetes Management in Latino and Caucasian Families(2013-12-30) Sundaram, Saranya Easwar; Wiebe, Deborah J.; Wetherington, Crista E.; Gross-Toalson, JamiBACKGROUND: Transfer of responsibility for diabetes management is important across adolescence. It may contribute to poorer adherence and family conflict if unmatched to adolescent development. Research has primarily studied Caucasian samples, which may have different expectations for autonomy compared to Latino samples. This study examined developmental expectations for independence in both general and diabetes-related tasks in age- and sex-matched samples of Caucasian and Latino youth with type 1 diabetes. SUBJECTS: Participants included 118 10- to 15-year-old Caucasian and Latino adolescents with type 1 diabetes [M (SD) = 13.24 (1.69) years; 54% female] and their mothers. METHOD: Participants independently completed questionnaires measuring expectations for independence, diabetes responsibility and conflict, and adherence to diabetes management. In addition, adolescents completed an inventory measuring depressive symptoms, and HbA1c levels were obtained through medical records. RESULTS: Mothers and adolescents held different expectations for the age at which adolescents should make independent decisions about general and diabetes-related activities. In the overall sample, adolescents expected independence at younger ages for prudential activities, but at older ages for diabetes activities than did parents. These mother-adolescent differences occurred in different domains across ethnicity; Caucasians displayed mother-adolescent differences in expectations for diabetes activities, while Latinos displayed differing expectations for prudential activities. In the overall sample, expectations were associated with mother-reported conflict, but were minimally correlated with parental diabetes responsibility. Younger age expectations for prudential items were associated with poorer diabetes outcomes, but age expectations for personal and diabetes items were generally unrelated to diabetes outcomes. In contrast to expectations, associations of developmental expectations with diabetes responsibility, conflict, and outcomes were similar across Caucasian and Latino youth. DISCUSSION: Findings support that there were differing age expectations between parents and adolescents in prudential and diabetes-related activities. Different factors may influence how these expectations were associated with parental responsibility, conflict, and diabetes outcomes.Item The Impact of Cognition on Treatment Adherence in Comorbid Bipolar Disorder and Cocaine Dependence(2013-01-17) Fagan, Colleen Susan; Brown, E. SherwoodAlthough bipolar disorder and substance dependence are associated with treatment nonadherence and cognitive impairment, few studies have investigated the relationship between treatment adherence and cognitive functioning. Participants in this study were 120 outpatients with bipolar disorder and cocaine dependence enrolled in a 10 week randomized, double-blind, placebo controlled trial of lamotrigine. Baseline performance on the Stroop Color and Word Test and the Rey Auditory Verbal Learning Test were examined for their effect on retention, appointment attendance, medication adherence, and return of medication bottles. Participants with decreased scores on Word condition of the Stroop Color and Word Test were more likely and those with decreased Interference scores were as likely to attend appointments. Participants with better Rey Auditory Verbal Learning Test Total Recall scores returned more medication bottles. Cognitive functioning did not impact medication adherence or study retention. The findings suggest a relationship between cognitive functioning and treatment attendance. Assessment and treatment of cognitive dysfunction may identify and help patients at-risk for treatment nonadherence. Future studies with a more comprehensive neuropsychological test battery and advanced medication adherence measures are warranted.Item [News](1984-06-20) Rutherford, SusanItem Patient Characteristics Associated With Adherence to Phototherapy(2015-03-31) Oh, Susan B.; Jacobe, HeidiBACKGROUND: The therapeutic efficacy of phototherapy is dependent on regular visits over extended time periods. There is concern among dermatologists regarding the feasibility of phototherapy in the face of increasing patient burden in terms of cost and time. However, no studies to date have examined the association between the demographic and clinical features of patients, particularly cost, and their adherence to a phototherapy regimen. Studies of this type are needed to document barriers to access and develop strategies to overcome them. OBJECTIVE: Identify patient demographic and clinical characteristics associated with adherence to prescribed phototherapy regimens (as defined by the number of treatments) and the most common reasons for discontinuation of a prescribed regimen. SETTING, DESIGN, PARTICIPANTS: Cross sectional study of 260 patients who were prescribed phototherapy at the UTSWMC Department of Dermatology Phototherapy Center between 9/1/2011 and 12/31/2013. MAIN OUTCOMES AND MEASURES: Main outcome was total number of completed phototherapy sessions (dependent variable). Independent variables included patient characteristics such as income, commuting distance to the phototherapy center, cost of phototherapy; and demographic and clinical characteristics. RESULTS: Using ordinary least-squares regression analysis, we identified specific patient characteristics associated with adherence. Males completed more treatments when compared with females (p = 0.038). Race also played a role in adherence with Hispanics, Asians and Whites being more adherent than African Americans (p = 0.025). Cost was a major factor predicting adherence (p= 0.0001). Our univariate analysis additionally showed particular diagnoses (vitiligo and mycosis fungoides) and type of phototherapy (NBUVB) were associated with greater adherence (p= .003, p= .009), but these results lost significance in our multivariate analysis. Age, distance, income, type of insurance, and type of phototherapy were not significantly associated with differences in adherence in any of our analyses. CONCLUSION AND RELEVANCE: Cost of phototherapy was the most frequent reason why patients failed to adhere to prescribed phototherapy and the major factor affecting adherence to phototherapy. Given phototherapy is less expensive than many systemic medications used in place of phototherapy, efforts should be undertaken to reduce patient cost burden for phototherapy. Also, as specific patient and disease characteristics were associated with better adherence. providers should be aware of patients at risk for poor adherence and provide counseling to improve the likelihood of successful treatment.Item Predictors of Attrition in an Interdisciplinary Pain Management Program(2019-07-08) Chong, Jeanette Lee; Robinson, Richard C.; Jarrett, Robin B.; Hynan, Linda S.; Noe, Carl; Zafereo, JasonBACKGROUND: Chronic pain is a debilitating condition that affects millions of adults in the United States. In recent years, particularly with the growing concerns about opioid use, there has been a steady increase in the use of interdisciplinary pain programs (IPP) to treat chronic pain. The effectiveness of such programs has been well-documented; however, attrition has also been identified as a neglected topic in outcome studies. OBJECTIVE: This study aimed to investigate the extent to which demographic/clinical characteristics predict attrition in an IPP. Study aims also included examining longitudinal changes in score for the completion group for a variety of clinical measures, and an exploratory analysis comparing changes between non/completion groups. METHOD: Participants included one hundred and seventy-eight patients receiving treatment for chronic pain conditions in an IPP at the Eugene McDermott Center for Pain Management at UT Southwestern Medical Center. Participants completed measures related to pain and psychosocial functioning at baseline, mid-intervention (2 weeks post-enrollment), and post-intervention (4 weeks post-enrollment). ANALYSIS: This study used logistic regression analyses to identify variables most predictive of attrition in five domains: 1) selected demographic variables, 2) number of medical diagnoses [psychiatric and non-psychiatric], 3) opioid use/risk of misuse, 4) pain-related cognition and behavior, and 5) physical, social, and mental well-being. Mixed models analyses were also conducted to examine longitudinal changes in score on a variety of clinical measures for the completion group. RESULTS: Participants who were of younger age, unemployed, and not on opioids pre-intervention had higher odds of dropping out. The completion group demonstrated improvement pre- to post-intervention on each of the measures assessed in the 1) pain-related cognition and behavior domain and 2) physical, social, and mental well-being domain, except for one measure. DISCUSSION: Mean age of non-completers was 48.72 years (SD = 13.44); these patients may have had difficulty with program compliance due to more outside stressors (e.g., younger children, demanding jobs). Participants may have been unemployed due to a number of potential contributing factors (e.g., lack of transportation, lower motivation, physical mobility), which would create barriers to program completion. Previous findings suggest opioid dependency contributes to higher odds of dropout; however, results from the current study suggest pre-intervention opioid use--not dependency--does not contribute to higher odds of attrition.