Audrey Lehmann

Comparison between Two Generic Questionnaires to Assess Satisfaction with Medication in Chronic Diseases

Objective The objective of this work was to compare two generic questionnaires assessing patients’ satisfaction with medication. In addition we tested whether satisfaction can predict adherence to medication regimens in patients with chronic diseases, and which dimensions of satisfaction are most involved. Methods This prospective, observational study was conducted over one year in a heterogeneous population of patients with various chronic diseases. Satisfaction with medication was assessed by using the TSQM® vII and the SatMed-Q® questionnaires, and adherence to treatment was assessed with the Morisky-Green questionnaire. Clinical pharmacists interviewed patients to collect clinical, demographic and therapeutic data. Results 190 patients were enrolled. Both questionnaires showed excellent reliability and correlation was high (R = 0.70; p<0.001). Adherence was correlated with satisfaction with medication whether assessed with the SatMed-Q® (R = 0.23; p = 0.002) or the TSQM® (R = 0.17; p = 0.02). Among different dimensions of satisfaction, convenience of use and side effects are prominent predictors of adherence. Conclusion Adherence is related to the patient’s satisfaction with medication whether assessed with the TSQM® vII or the SatMed-Q®. Therefore, these simple questionnaires could be used as predictive tools to identify patients whos’ adherence needs to be improved.

Influence of intention to adhere, beliefs and satisfaction about medicines on adherence in solid organ transplant recipients.

Introduction Nonadherence to immunosuppressive (IS) therapy is associated with poor outcomes. Identifying factors predicting poor adherence is therefore essential. The primary objective of this study was to test whether parameters of a model adapted from the theory of planned behavior, and more specifically attitudes that are influenced by beliefs and satisfaction with medication, could predict adherence in solid organ transplant patients. Methods Adherence was assessed with a self-reported medication adherence scale and IS blood trough concentrations over 6 months, in four transplant units. Satisfaction and beliefs were assessed using the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) and Beliefs about Medicines Questionnaire (BMQ), respectively. Theory of planned behavior was assessed with a specific questionnaire exploring intentions, subjective norms, attitudes and perceived behavioral control. Treatment characteristics and socioeconomic data were also collected. Results One hundred and fifty-three solid organ transplant patients were enrolled, including lung (n=33), heart (n=43), liver (n=42), and kidney (n=44) patients. Satisfaction and positive beliefs about medication were higher in adherent than those in nonadherent patients. Factors independently associated with an increased risk of nonadherence were negative general beliefs about medications (odds ratio [OR]=0.89 [0.83–0.97]), living alone (OR=2.78 [1.09–7.09]), heart transplantation (OR=3.49 [1.34–9.09]), and being on everolimus (OR=5.02 [1.21–20.8]). Conclusion Negative beliefs toward medications were shown to be an independent risk factor of poor adherence. Therefore, the BMQ could be an effective, easy to implement tool, for use in everyday practice, to identify patients needing interventions to improve adherence to IS.

Why Do Patients with Chronic Inflammatory Rheumatic Diseases Discontinue Their Biologics? An Assessment of Patients' Adherence Using a Self-report Questionnaire.

Objective. Concerns have been raised about nonadherence behavior among patients with chronic inflammatory rheumatic diseases (CIRD) receiving biologics. This nonadherence may be caused by various factors. The main objective was to explain why patients discontinue their biologics of their own accord. Methods. A quantitative and descriptive study was performed using a self-report questionnaire that was sent through the Internet to members of different patient associations. Sociodemographic data, medical and therapeutic history, management of biologic administration, previous experiences, and patients’ beliefs and perceptions about treatment efficacy and side effects were studied to explain self-discontinuation (SD). Results. A total of 581 patients answered the questionnaire between June 16, 2012, and July 4, 2012, including patients with ankylosing spondylitis (351/581, 60.4%), rheumatoid arthritis (196/581, 33.7%), psoriatic arthritis (30/581, 5.2%), and other CIRD (4/581, 0.7%). More than 1000 different biologics were described by the 581 patients, with a median of 2 lines per patient. Eighty-six patients discontinued their biologics of their own accord (14.8%). In a multivariate analysis, factors that were significantly related to SD were low level of pain, more than 1 line of biologics tried, self-administration of biologics, negative beliefs about the treatment, and a lack of medical and social support. Conclusion. Five predictive factors of this SD were identified, which should be assessed in routine with patients with CIRD receiving biologic treatment: pain, treatment history, self-administration of injections, negative beliefs about treatment, and a lack of perceived medical and social support.

Traitements des angiœdèmes héréditaires : recommandations du centre de référence national des angiœdèmes (consensus 2014 de Bordeaux)

INTRODUCTION Treatment of hereditary angiœdema (HAE), associated or not with C1Inh deficiency, has dramatically changed these last five years. Four new therapeutic options are now available in France. The French Reference Centre for Angioedema has a consensus meeting to give recommendations about their use. METHODS The proposals were based on a CREAK survey and a comprehensive review of the literature done by 4 experts. These proposals were submitted to a vote at a national CREAK meeting (Bordeaux, March 2014). Fifty-one participants, 15 experts and one expert-patient have participated. The consensus concerned HAE patients with or without C1Inh deficiency. Were excluded children, patients with acquired AE and with drug induced AE. RESULTS Proposals were done for 4 cases: acute attack treatment, short-term prophylaxis, long-term prophylaxis and pregnant women. The drugs cited were: C1Inh concentrate, icatibant, tranexamic acid, danazol and chlormadinone acetate. CONCLUSION Consensual proposals were obtained during this meeting. They will be now widely diffused.

RecommandationsTraitements des angiœdèmes héréditaires : recommandations du centre de référence national des angiœdèmes (consensus 2014 de Bordeaux)Hereditary angiœdema treatments: Recommendations from the French national center for angiœdema (Bordeaux consensus 2014)

INTRODUCTION Treatment of hereditary angiœdema (HAE), associated or not with C1Inh deficiency, has dramatically changed these last five years. Four new therapeutic options are now available in France. The French Reference Centre for Angioedema has a consensus meeting to give recommendations about their use. METHODS The proposals were based on a CREAK survey and a comprehensive review of the literature done by 4 experts. These proposals were submitted to a vote at a national CREAK meeting (Bordeaux, March 2014). Fifty-one participants, 15 experts and one expert-patient have participated. The consensus concerned HAE patients with or without C1Inh deficiency. Were excluded children, patients with acquired AE and with drug induced AE. RESULTS Proposals were done for 4 cases: acute attack treatment, short-term prophylaxis, long-term prophylaxis and pregnant women. The drugs cited were: C1Inh concentrate, icatibant, tranexamic acid, danazol and chlormadinone acetate. CONCLUSION Consensual proposals were obtained during this meeting. They will be now widely diffused.