A621 the effect of perceived financial burden of the co-payment on antihypertensive adherence in patients within the GMS. We recruited community dwelling older adults (N= 1592) from 106 community pharmacies in the Republic of Ireland between March and May 2014, administering a structured telephone interview and following up at 12 months. Dispensing records from the pharmacy were linked to each patient interview. Perceived financial burden was assessed at baseline using a single questionnaire item. Adherence was assessed at 12 months using an 8-item self-report questionnaire and by calculating the proportion of days covered (PDC) from linked dispensing records. Results: At baseline 75.1% (n= 1152) of participants were GMS eligible and 30.1% of GMS participants reported feeling financially burdened by medication costs. In linear regression models adjusted for socio-demographics, medical history, and medication use, financially burdened GMS participants had significantly lower self-reported adherence (β =-0.32, 95% CI-0.51 to-0.14), although this was not evident with refill adherence (β =-0.03, 95% CI-0.08 to 0.02). ConClusions: Further work on the financial barrier to antihypertensive adherence within the GMS is warranted and its potential impact on long-term patient outcomes.
were discussed, including day of the week and day between Monday and Friday. It was agreed that 'weekdays' could be translated as 'working days', and 'weekends' as 'Saturdays and Sundays' while several languages preferred to use the English word.(3) 94% of languages struggled to find an equivalent for 'skipping'. Many English back translations showed 'hopping' or 'jumping'. The motion of skipping was discussed with translators as moving along lightly, stepping from one foot to the other with a hop or bounce. Many decided, on the absence of a similar word in their language, to replace this concept with 'skipping with a rope' which would work equally well as a 'very active' pastime. ConClusions: Similar issues often affect a number of languages. For such items, it may not be appropriate to produce literal translations and alternative solutions must be sought, taking into account linguistic features and cultural considerations, in order to achieve conceptual equivalence.
first case study compares three hypothetical antidepressants and placebo for the treatment of severe depression on four criteria. The second case study compares eight highly active antiretroviral therapies (HAART) for HIV-positive persons on four criteria. Preferences from patients and/or clinicians were derived from previous preference studies and clinical evidence was obtained from clinical trials. Univariate and multivariate probability distributions for the preferences and clinical evidence were combined using Monte Carlo simulation methods. The main model outcomes were treatment value distributions. Decision uncertainty was estimated with the probability of rank reversals for the first rank. Results: In the antidepressants case, there seemed to be more decision uncertainty for clinicians (49%) than for patients (27%), and the decision uncertainty depended more on uncertainty in the clinical evidence (difference 23%). The decision uncertainty among patients in the HAART case was higher (64%) and depended slightly more on uncertainty in preferences (difference 3%). ConClusions: This study shows how elicited patient preferences can be formally used to weigh clinical evidence in a framework that explicitly considers uncertainty. The model can help increase insight into the decision and point to critical uncertainties in the evidence. Further work is required on integrating heterogeneity in preferences and clinical evidence, on quantifying decision uncertainty with value of information metrics, and on homogenizing evidence collection methods for the use in integration models.
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