BackgroundWe developed and tested the effectiveness of a tailored health information technology driven intervention: “Talking Prescriptions” (Talking Rx) to improve medication adherence in a resource challenged environment.MethodsWe conducted a parallel, randomized, controlled, assessor-blinded trial at the Aga Khan University (AKU), Karachi, Pakistan. Adults with diagnosis of cerebrovascular accident (CVA) or coronary artery disease (CAD) diagnosed least one month before enrollment, on anti-platelets and statins, with access to a mobile phone were enrolled. The intervention group received a) Daily Interactive Voice Response (IVR) call services regarding specific statin and antiplatelet b) Daily tailored medication reminders for statin and antiplatelet and c) Weekly lifestyle modification messages for a period of 3 months. We assessed Medication adherence to statin and antiplatelets by a validated version of the 8-item Morisky Medication Adherence scale 8 (MMAS-8) at 3 months by a blinded assessment officer. Analysis was conducted by intention-to-treat principle (ITT).ResultsBetween April 2015 and December 2015, 197 participants (99 in intervention and 98 in the usual care group) enrolled in the Talking Rx Study. The dropout rate was 9.6%. Baseline group characteristics were similar. At baseline, the mean MMAS-8 was 6.68 (SD = 1.28) in the intervention group and 6.77 (SD = 1.36) in usual care group. At end of follow-up, the mean MMAS-8 increased to 7.41(0.78) in the intervention group compared with 7.38 (0.99) in usual care group with mean difference of 0.03 (S.D 0.13) (95% C.I [-0.23, 0.29]), which was not statistically significant. (P-Value = 0.40) CVA patients showed a relatively greater magnitude of adherence via the MMAS-8 at the end of follow up where the mean MMAS-8 increased to 7.29 (S.D 0.82) in the intervention group as compared to 7.07(S.D 1.24) in usual care group with mean difference of 0.22 (SD = 0.22) 95% C.I (-0.20, 0.65) with (P-value = 0.15). Around 84% of those on intervention arm used the service, calling at least 3 times and listening to their prescriptions for an average of 8 minutes. No user was excluded due to technologic reasons.ConclusionThe use of a phone based medication adherence program was feasible in LMIC settings with high volume clinics and low patient literacy. In this early study, with limited follow up, the program did not achieve any statistically significant differences in adherence behavior as self—reported by the MMAS-8 Scale.Trial registrationClinical Trials.gov NCT02354040.
The circular economy in the construction sector in emerging economies is one of the most promising concepts that aims to keep the value of the construction materials and structures as long as possible. The construction industry is rapidly developing in Kazakhstan with a yearly increase in projects. This research paper investigates the construction sector in Kazakhstan in terms of the potential application of circular economy principles by local stakeholders—clients, contractors, designers, and manufacturers. As limited research has been conducted on the circularity within the construction environment, including construction parties, this paper aims to fill this research gap. It seeks to identify the construction trends and perform a barrier and opportunity analysis to develop circular economy principles in the construction sector. As a research method, PEST is used for the study of local construction trends. At the same time, stakeholders are interviewed using semi-structured surveys organized according to the ReSOLVE framework (regenerate, share, optimize, loop, virtualize, and exchange) to identify the barriers and opportunities for circular economy in the construction sector. As an outcome of this study, the most common barriers and opportunities were associated with the economic benefit factor, as this was the main motivation for the stakeholders to save construction materials for reuse or to refuse more eco-friendly technologies. Additionally, policy recommendations for companies involved in the construction ecosystem were provided according to the assessment of found barriers and opportunities in the context of the ReSOLVE framework. This analysis has shown that for most stakeholders of the Kazakhstani construction sector, virtualization is of the highest priority; therefore, opportunities for its development are recommended. Future research could focus on the development of economically feasible solutions for the circular economy in construction with the inclusion of virtualization technologies.
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