Eficacia de una intervención para mejorar el cumplimiento terapéutico en las dislipemias

Contreras, E. Márquez; Martínez, J.J. Casado; Albalat, Y. Corchado; González, Rosa Chaves; Grandío, A; Velasco, Cuaspud; Obando, Julián Andrés Ríos; Eugenio, Javier; Barrera, J.M.

doi:10.1016/s0212-6567(04)79430-5

Cited by 19 publications

(6 citation statements)

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“…Systematic reviews on interventions for chronic conditions have shown that dosage simplification and repeated assessment of medication use with feedback were by far the most effective interventions [15]. The behavioral intervention of 3 telephone calls to assess adherence, provide feedback and give recommendations in patients with dyslipidemia, provided the largest effect size [16]. It is imperative that novel strategies that combine dosage simplification, such as development of single pill combinations, and educational interventions tailored to patients with end-stage liver disease are designed and tested in this more acutely sick patient population.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Medication Non-adherence in Patients with End-Stage Liver Disease

2016

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Background Low medication adherence is known to contribute to worse health outcomes in the general population. Aim We aimed to evaluate the medication regimen and determine the adherence levels among patients with end-stage liver disease. Methods We measured adherence in patients awaiting liver transplantation at a single center using the 8-item Morisky Medication Adherence Scale (MMAS-8), with a score <8 classified as low-adherence. Medication regimen complexity was assessed using the Medication Complexity Regimen tool (MRCI). Factors associated with low-adherence were identified by logistic regression. Results Of 181 patients, 33% were female, median age was 62, and Model for end-stage liver disease (MELD) score was 13. The median (IQR) number of medications was 10 (7–13) and the MRCI was 19 (13–27). 54 (30%) were high adherers, and 127 (70%) were low-adherers. 42% reported sometimes forgetting to take their medication and 22% reported intermittent adherence within the past 2 weeks. The most common reasons for low-adherence were: forgetfulness (27%), and side effects (14%). Compared to high adherence, low-adherence was associated with higher number of medications, medication complexity, and diabetes, but lower rates of hepatocellular carcinoma and self-perceived health. In univariable logistic regression, total medication number (OR 1.08), MRCI (OR 1.04), diabetes (OR 2.38), HCC (OR 0.38) and lower self-perceived health (OR 1.37), were statistically significant factors associated with non-adherence. In multivariate analysis, only medication number without supplements (OR 1.14) remained significantly associated with medication non-adherence. Conclusion A majority of patients awaiting liver transplantation demonstrate low medication adherence. Total number of medications and regimen complexity were strong correlates of adherence. Our data underscore the need for chronic liver disease management programs to improve medication adherence in this vulnerable population.

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Section: Discussionmentioning

confidence: 99%

Factors Associated with Medication Non-adherence in Patients with End-Stage Liver Disease

2016

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“…Basing on the results reported in previous studies [ 9 , 21 ], assuming a 40 mg/dl variance in cholesterol levels, a SD = 15 mg/dl for total cholesterol, for an alpha error = 0.05 and a beta error = 15 %, 256 patients had to be recruited.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of motivational interviewing in patients with dyslipidemia: a randomized cluster trial

et al. 2015

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BackgroundIt is known that making people change their habits is challenging. It is crucial to identify the most effective approach that general practitioners (GPs) should use to help their patients change unhealthy habits. The objective this study was to assess the efficacy of a multifactorial intervention based on Motivational Interviewing performed by general practitioners to enhance lipid levels in patients with dyslipidemia, as compared to standard care.MethodsA multicenter, controlled, randomized, cluster, two-parallel arm trial with a 12-month follow-up conducted in 25 community health centers of the Spanish. 38 GPs and 227 primary care patients with uncontrolled dyslipidemia were included in the trial. GPs performed an intervention based either on Motivational Interviewing (MI) or standard practice. Lipid levels were measured, and the control degree was analyzed based on the criteria of clinical guidelines.Results107 were assigned to the Experimental Group (EG) and 120 to the Control Group (CG). An overall improvement was achieved in total cholesterol levels (Mean Difference –MD- = −19.60; 95 % CI: −15.33 at −23.87 mg/dl; p < 0.001), LDL-cholesterol levels (MD = −13.78; 95 % CI: −9.77 at −17.79 mg/dl; p < 0.001) and triglycerides (MD = −19.14; CI 95 %: −11.29 at −26.99 mg/dl; p < 0.001). No differences were found between the two groups. However, when we assessed the degree of lipid control by combining cholesterol <200 mg/dl and LDL-cholesterol < 130 mg/dl parameters, it was observed that a higher percentage of patients achieved target figures in the EG versus CG (13.1 % vs. 5.0 %; adjusted OR = 5.77, 95 % CI: 1.67-19.91).ConclusionA Motivational Interviewing-based approach conducted by Primary Care physicians aimed at patients with dyslipidemia, achieved a significant reduction in all lipid parameters, cardiovascular risk, weight reduction and the adherence to the Mediterranean diet, similar to that obtained with the usual intervention and superior in the proportion of patients achieving combined lipid control goals and the level of physical exercise.Trial registrationthe trial is registered in ClinicalTrials.gov (NCT01282190; January 21, 2011).Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0370-2) contains supplementary material, which is available to authorized users.

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“…Basing on the results and on preliminary estimates [ 22 - 24 ], 256 patients should be recruited for an individual randomized study, to reach a variation coefficient of 40 mg/dl in total cholesterol levels, a difference of 15 mg/dl in the mean value of total cholesterol level among patients of the Intervention Group -IG- and the Control Group -CG-, and a deviation alpha = 0.05, beta = 15%.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of Motivational Interviewing in improving lipid level in patients with dyslipidemia assisted by general practitioners: Dislip-EM study protocol

et al. 2011

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BackgroundThe non-pharmacological approach to cholesterol control in patients with hyperlipidemia is based on the promotion of a healthy diet and physical activity. Thus, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns, and that include brief advice and counseling services. Within this context, Motivational Interviewing has proven to be effective in changing health behaviors in specific cases. However, more robust evidence is needed on the effectiveness of Motivational Interviewing in treating chronic pathologies -such as dyslipidemia- in patients assisted by general practitioners. This article describes a protocol to assess the effectiveness of MI as compared with general practice (brief advice), with the aim of improving lipid level control in patients with dyslipidemia assisted by a general practitioner.Methods/DesignAn open, two-arm parallel, multicentre, cluster, controlled, randomized, clinical trial will be performed. A total of 48-50 general practitioners from 35 public primary care centers in Spain will be randomized and will recruit 436 patients with dyslipidemia. They will perform an intervention based either on Motivational Interviewing or on the usual brief advice. After an initial assessment, follow-ups will be performed at 2, 4, 8 and 12 months. Primary outcomes are lipid levels (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides) and cardiovascular risk. The study will assess the degree of dietary and physical activity improvement, weight loss in overweight patients, and adherence to treatment guidelines.DiscussionMotivational interview skills constitute the primary strategies GPs use to treat their patients. Having economical, simple, effective and applicable techniques is essential for primary care professionals to help their patients change their lifestyle and improve their health. This study will provide scientific evidence on the effectiveness of Motivational interviewing, and will be performed under strict control over the data collected, ensuring the maintenance of therapeutic integrity.Trials RegistrationClinicalTrials.gov (NCT01282190).

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Eficacia de una intervención para mejorar el cumplimiento terapéutico en las dislipemias

Abstract: The telephone intervention is an efficacious way of improving the percentage of patients complying with lipaemia treatment.

Cited by 19 publications

References 9 publications

Factors Associated with Medication Non-adherence in Patients with End-Stage Liver Disease

Factors Associated with Medication Non-adherence in Patients with End-Stage Liver Disease

Effectiveness of motivational interviewing in patients with dyslipidemia: a randomized cluster trial

Effectiveness of Motivational Interviewing in improving lipid level in patients with dyslipidemia assisted by general practitioners: Dislip-EM study protocol

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