BackgroundNon-Compliance with Long term medication is reported as high 60% (1). Health belief model suggests four elements contribute to this problem. The Beliefs About Medicines Questionnaire (BMQ) is a tool for evaluating people's beliefs about medicines (1).ObjectivesA Service Evaluation of compliance with prescribed medication for Long Term Rheumatologic Conditions at Central Middlesex Hospital. This was conducted to assess any possible relationship between compliance with medicines and beliefs or concerns or patient's ethnicity.MethodsThe design was a voluntary self-reported, cross-sectional paper based questionnaire survey of people with Rheumatic Conditions. Twelve questions were grouped within three categories (healthcare utilisation, necessity beliefs and concern beliefs) to capture compliance behaviour for later analysis and comparison.The Beliefs about Medicines Questionnaire was adapted from ref (1) to distinguish patients beliefs of 'necessity' or 'concerns'. In line with principles of PPP, the questionnaire was discussed prior to the audit with a sample focus group of 5 patients who contributed to the wording and the simplification of the questions re: ethnicity.Questionnaires were offered to all patients attending the CMH Rheumatology Unit. The evaluation was discontinued when a target of 100 was reached ( n=102). No questionnaires were excluded. And upto 5% of questions were unanswered. Data was analysed on SPSS.ResultsThe Number of questionnaires returned for this service evaluation was 102. Most respondents (94%) showed compliance with rheumatic medication as prescribed.More than half the respondents (66%) agreed or strongly agreed that their arthritis medications are necessary for their health.54% were concerned about potential adverse consequences.The overall necessity score (19.32 S.D. 3.17) was higher than the concerns score (13.48; S.D. 3.35; t =61.57, P<0.001).Concerns about the long term effect of rheumatic conditions correlate positively with perceptions of health in the future P<0.01 level (2-tailed Pearson).No significant correlation was found between compliance and patient's ethnicity/individuals demographics. ConclusionsMost people with Rheumatic conditions have positive beliefs about the necessity of their medication. However, levels of concern are high, especially towards the long-term effects of the medication. This concurs with asimilar study in Rheumatoid Arthritis.(2). The service evaluation using the Beliefs about Medicines Questionnaire has helped to identify people at risk of poor compliance long term. This illustrates a need to discuss patients beliefs and concerns in targeted drug counseling sessions with specialist nurses. A post study patient focus group recognised the high level of compliance yet recommended a fixed weekly walk in session with a nurse and pharmacist to sustain this high quality outcome. Further methods of continued patient re-education will be explored.References Horne R, Weinman J, Hankins M. The Beliefs about Medicines Questionnaire: the development an...
BackgroundRheumatoid Arthritis (RA) is associated with mood disorders and poor quality of life (QOL) Chorus et al., 2003 Yoga therapy (Y-T) has been used in several Long Term Conditions. Khalsa et al, 2016.ObjectivesThis study investigated: a) impact of a 16 week Y-T intervention on functional outcomes and QOL in 10 adult-onset RA patients, b) acceptability and experiences of the intervention.MethodsTen adult RA patients (Ages: 29–71 Y; RA duration: 1–15 years) consented to 10 individual Y-T sessions (weekly ×4; biweekly ×6) with a yoga therapist in a standard consulting room. The intervention was tailored to the needs and abilities of each patient and included: breath-centred physical yoga postures, breathing and visualisation techniques, mantras and meditation, and Lifestyle/behavioural strategies. All participants completed measures to assess changes in health pre- and post-intervention (EQ-5D and HADS) and took part in a semi-structured interview in a mixed methods design. Thematic analysis was applied to interview data.Results98/100 sessions were attended by participants.Abstract AB1440HPR – Table 1Pre-Post 10 sessions Y-T metricsPre-Post Y-T Change:PREPOSTCHANGE Mean Depression6.702.30- 65%Mean Anxiety9.404.80- 48%Mean HAQ1.100.85*−23%Mean Pain Score (HAQ)5.662.40−58%Mean Health Score (HAQ)5.101.72−66.3%Mean health Utility (EQ-5D)6.018.40**+39.6%*8/10 HAQ reduced >0.35 =/>MID (minimal important difference);**6/10 participants achieved EQ5D maximum score=1Qualitative findings indicated that considerable value was placed on the therapeutic function of the consultation, of being listened to and receiving advice on concerns. Therapeutic mechanisms appeared to reflect tailored physical practices alongside psychosocial techniques which promoted psychological wellbeing and increased perceptions of control and self-efficacy. Several reported reductions in their medication and broader benefits such as improved sleep, mood and energy. All but one participant reported positive changes to their RA symptoms, including pain reduction, greater mobility and joint flexibility.ConclusionsThis novel pilot YT intervention was positively received by patients with RA, with high levels of adherence to both the course of treatments and the tailored home practice. The results suggest that yoga therapy has potential as an adjunct therapy to improve RA symptoms, increase self-care behaviours and address negative mood. Whilst promising, a larger multi-centre study is required to evaluate the therapeutic and cost-effectiveness of Y-T.References[1] Chorus AM, Miedema HS, Boonen A, Van Der Linden S. (2003). Quality of life and work in patients with rheumatoid arthritis and ankylosing spondylitis of working age. Ann Rheum Dis. 62(12):1178–1184.[2] Khalsa, SB, Cohen, L, McCall, T & Telles, S (2016) (Eds). The Principles and Practice of Yoga in Health Care. Handspring Publishing.AcknowledgementsLNWH Trust Fund, CMH Rheumatology Patient Support Group,University of Westminster Department of Health Psychology.Disclosure of InterestV. Sadana Gra...
Background:Psoriatic Arthritis and Psoriasis have a major impact on QOL with associated mood disorders and Cardiovascular disease and Cancer as inter-related co-morbidities1. Yoga therapy (Y-T) has been used in several Long Term Conditions2and we have reported Rapid improvement in Proms in RA (RCP 2018) and so compared results of a PsA cohort offered the same Y-T intervention.Objectives:This first in UK PsA study investigated: a) impact of a 16 week Y-T intervention on functional outcomes and QOL in 10 PsA patients, b) acceptability and experiences of the intervention. We present results in comparison to a previously reported RA cohort n=10.Methods:Ten adult PsA patients (2 M 8 F Age 32-67 Avg: 53.7 Y; PsA diagnosis: 6.45 yrs:1 Juvenile onset) consented to 10 individual Y-T sessions (weekly x 4; biweekly x 6) with a yoga therapist in a standard consulting room. The intervention was tailored to the needs and abilities of each patient and included: breath-centered physical yoga postures, breathing and visualization techniques, mantras and meditation, with supportive Lifestyle/behavioural strategies. All participants completed measures pre- and post-intervention (EQ-5D HAQ HADS PGIC) to assess change in health status.Results:A 10 session course of Y-T over 16 weeks was completed with 92/100 PsA YT sessions. Note 1 patient had unrelated Trauma and withdrew after 2 sessions. This confirms acceptability of delivery in a clinic setting and all participants reported strong adherence to practices (0-1) and strong belief (0-2) in impact of yoga. (Likert 5 point 0-4 scale).Further data on only 9 PsA participants will be presented in comparison to the previous RA cohort of 10.PsA patients n=9: Pain reduced 25 % HADs Depression reduced 39% Anxiety reduced 25%HAQ health score improvement was significant at P<0.04 (ANOVA).EQol 5d(3L) improved 24% but overall QOL remained below 50% max calculated TTO.RA patients had recorded stable overall TTO at a higher level 0.63 pre and post Y-T.PGIC record of positive change is recorded as a reduction on VAS from 5/5 to 2.4/5.We will add 12 month FU data set in PsA to compare with 24 month data in the RA cohort.Conclusion:Yoga-Therapy is deliverable and acceptable in a NHS clinic setting for PsA. Improved PROMS begs further larger studies of mechanisms of bio-psychosocial intervention in long term inflammatory conditions. The outcomes support the Poly Vagal Theory3as an effector model, via the bio-mechanistic neuro-inflammatory reflex4.We propose further Health Economic analysis of this 2500 yr old Yoga model for long term conditions to examine any long term cost benefit to the NHS.References:[1]Coates LC et al Rheumatology 2018;57:1321-1331 Remission in psoriatic arthritis-where are we now?[2]Khalsa, SB, Cohen, L, McCall, T & Telles, S (2016) (Eds). The Principles and Practice of Yoga in Health Care. Handspring Publishing.[3]Sullivan M B Porges SW et alFront. Hum. Neurosci., 2018 Yoga Therapy and Polyvagal Theory: The Convergence of Traditional Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience[4]Pavlov V Tracey K Nat Rev Endocrinol. 2012 Dec; 8(12): 743–754. The vagus nerve and the inflammatory reflex—linking immunity and metabolismTable 1.PsA vs RA post Yoga Therapy PROMs at 4 mth.PsA n=9 prePsA 4 mPsA 4 m %RA n=10 PreRA4m FURA 4m %HADS m Depression6.333.88-396.72.3- 65HADS m Anxiety8.566.44-259.44.8- 48Mean HAQ0.790.75- 20.780.48- 26M Pain Score (HAQ)6045.00-255724- 58M Health Score (HAQ)6042.7-29 p<0.045117.2- 66M H Utility TTO (EQol5d)0.410.5+240.630.630PGIC52.4Acknowledgments:CMH Rheumatology Support GroupDisclosure of Interests:C Bernard Colaco Grant/research support from: Travel Support for Conference attendance, Speakers bureau: Menarini, Vidhi Sadana: None declared, Kofi Anie: None declared
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