Background Medication nonadherence contributes to hospitalizations in recently discharged patients with heart failure (HF). We aimed to test the feasibility of telemonitoring medication adherence in patients with HF. Methods and Results We randomized 40 patients (1:1) hospitalized for HF to 30 days of loop diuretic adherence monitoring with telephonic support for nonadherence or to passive adherence monitoring alone. Eighty-three percent of eligible patients agreed to participate. The median age of patients was 64 years, 25% were female, and 45% were Hispanic. Overall, 67% of patients were nonadherent (percent of days correct number of doses taken <88%). There were no differences between intervention and passive monitoring group patients, respectively, in adherence (median correct dosing adherence 82% versus 73%; p = 0.41) or in the proportion readmitted within 30 days (30% versus 20%; p = 0.72). Eighty-eight percent of patients rated the wireless electronic adherence device as somewhat or very easy to use, and 88% agreed to use it again. Conclusions Adherence telemonitoring was acceptable to most patients with HF. Diuretic nonadherence was common even when patients knew they were being monitored. Future studies should assess whether adherence telemonitoring can improve adherence and reduce readmissions among patients with HF.
Post-traumatic stress disorder (PTSD) induced by life-threatening medical events has been associated with adverse physical and mental health outcomes, but it is unclear whether early interventions to prevent the onset of PTSD after these events are efficacious. We conducted a systematic review to address this need. We searched six biomedical electronic databases from database inception to October 2018. Eligible studies used randomized designs, evaluated interventions initiated within 3 months of potentially traumatic medical events, included adult participants, and did not have high risk of bias. The 21 included studies (N = 4,486) assessed a heterogeneous set of interventions after critical illness (9), cancer diagnosis (8), heart disease (2), and cardiopulmonary surgery (2). Fourteen psychological, 2 pharmacological, and 5 other-type interventions were assessed. Four of the psychological interventions emphasizing cognitive behavioral therapy or meaning-making, 1 other-type palliative care intervention, and 1 pharmacological-only intervention (hydrocortisone administration) were efficacious at reducing PTSD symptoms relative to control. One early, in-hospital counseling intervention was less efficacious at lowering PTSD symptoms than an active control. Clinical and methodological heterogeneity prevented quantitative pooling of data. While several promising interventions were identified, strong evidence of efficacy for any specific early PTSD intervention after medical events is currently lacking.
Objective: Medical events such as myocardial infarction and cancer diagnosis can induce symptoms of posttraumatic stress disorder (PTSD). The optimal treatment of PTSD symptoms in this context is unknown.Methods: A literature search of 6 biomedical electronic databases was conducted from database inception to November 2018. Studies were eligible if they used a randomized design and evaluated the effect of treatments on medical event-induced PTSD symptoms in adults. A random effects model was used to pool data when two or more comparable studies were available.Results: Six trials met full inclusion criteria. Studies ranged in size from 21 to 81 patients, and included patients with PTSD induced by cardiac events, cancer, HIV, multiple sclerosis, and stem *
Objective Depression may adversely affect health outcomes by influencing doctor-patient communication. We aimed to determine the association between depressive symptoms and doctor-patient communication among patients presenting to the emergency department (ED) with a suspected acute coronary syndrome (ACS). Method We enrolled a consecutive sample of 500 patients evaluated for ACS symptoms from the ED of an urban medical center. Depressive symptoms (8-item Patient Health Questionnaire, PHQ-8) and doctor-patient communication in the ED (Interpersonal Processes of Care) were assessed during hospitalization. Logistic regression was used to determine the association between depressive symptoms and doctor-patient communication, adjusting for age, sex, race, ethnicity, education, language, health insurance status, and comorbidities. Results Compared to non-depressed patients, depressed patients (PHQ-8 ≥10) were more likely (p<.05) to report suboptimal communication on 5 of 7 communication domains: clarity, elicitation of concerns, explanations, patient-centered decision-making, and discrimination. A greater proportion of depressed versus nondepressed patients reported suboptimal overall communication (39.8% versus 22.9%, p<0.001). In adjusted analyses, depressed patients remained more likely to report suboptimal doctor-patient communication (adjusted OR 2.42, 95%CI 1.52–3.87; p<0.001). Conclusions Depressed patients with ACS symptoms reported less optimal doctor-patient communication in the ED than non-depressed patients. Research is needed to determine whether subjectively rated differences in communication are accompanied by observable differences.
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