Objectives
Medication adherence is the end result of a complex set of interwoven factors. Non‐adherence with medication in heart failure patients is associated with excess mortality and morbidity. Studies describing interventions to improve adherence in heart failure are limited by a lack of robust methods and inconsistent outcomes. The aim of this evaluation was to explore the barriers to medication adherence in Scottish heart failure patients in order to inform the development of complex interventions.
Methods
Qualitative patient interviews. Participants were aged ≥18 years with current or previous signs or symptoms of clinical heart failure, reduced left ventricular ejection fraction ≤45% and confirmed adherence of <80% in tablet counts of heart failure therapy. Thematic analysis was employed.
Key findings
Eleven patients were recruited. The median age was 79 years old, and participants were typically from socially deprived communities. Participants were prescribed a mean 9.9 different medications per day. Seven distinct themes emerged around barriers to medication adherence: co‐morbidity; treatment burden; health literacy; trust in NHS; socioeconomic factors; autonomy and health expectations.
Conclusions
The factors affecting medication adherence in heart failure are multi‐factorial and are unlikely to be improved by one single‐faceted intervention. Future interventions need to treat patients holistically, build their trust as partners, simplify complex treatment regimens where possible and involve educational and social elements. The skill set and opportunities afforded to pharmacists may be well placed to deliver many of these aspects but this would need tested in the context of the development of complex interventions.
Background
Obese patients display differences in vancomycin drug disposition, which may complicate attainment of appropriate serum vancomycin concentrations (SVCs). This study was conducted to determine if obesity leads to trough SVCs above the therapeutic range.
Methods
This retrospective cohort study sought to determine the rate and predictors of high (i.e. > 20 mg/L) serum trough levels according to level of obesity.
Results
Increasing BMI predicted SVCs > 20 mg/L after controlling for dose, age, and serum creatinine. Obese patients had significantly higher mean trough SVCs compared to non-obese patients (16.5 mg/L vs 12.1 mg/L, p=0.004) and a significantly higher proportion of obese patients had trough SVCs > 20 mg/L (18.9% vs 4.2%, p=0.03).
Conclusion
Increasing obesity predicted higher probabilities of SVCs > 20 mg/L. Development of alternative dosing and management strategies for vancomycin may be necessary to account for pharmacokinetic changes associated with obesity.
This chapter reports on a study conducted in seven countries in which young children's (aged under 8) digital practices in the home were examined. The study explored family practices with regard to access to and use of technologies, tracing the ways in which families managed risks and opportunities. Seventy families participated in the study and interviews were undertaken with both parents and children, separately and together, in order to address the research aims. This chapter focuses on the data relating to parental mediation of young children's digital practices. Findings indicate that parents used a narrow range of strategies in comparison to parents of older children, primarily because they considered their children too young to be at risk when using technologies. However, children's own reports suggested that some were able to access online sites independently from a young age and would have benefitted from more support and intervention. The implications of the study for future research and practice are considered.
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