Eimear C. Morrissey

Medication adherence among patients with apparent treatment-resistant hypertension: systematic review and meta-analysis.

Objectives: Medication nonadherence is a known behavioural contributor to poor blood pressure (BP) control that puts patients with hypertension at elevated cardiovascular risk. Studies of medication adherence for apparent treatment-resistant hypertension (aTRH) vary significantly with respect to design, methods, and setting, and, as a result, have produced highly variable figures describing the prevalence of nonadherence. This review aimed to describe the prevalence and potential moderators of medication nonadherence estimates for aTRH. Methods: Systematic review and random effects meta-analysis. Results: From an initial discovery of 921 studies, we identified 24 studies that measured medication adherence for patients with uncontrolled BP despite being prescribed three or more antihypertensive medications of different classes. By using a random effects model, the pooled prevalence of nonadherence was 31.2% (95% confidence interval = 20.2–44.7, I2 = 99.50) with nonadherence rates ranging from 3.3 to 86.1%. The strongest contributor to variance in nonadherence rates was the method of adherence assessment used. Studies that relied on self-report measures of adherence and/or pharmacy data reported lower levels of nonadherence than studies using more objective methods, such as liquid chromatography–mass spectrometry in single time-point bioassays or directly observed therapy. Conclusion: Findings indicate that medication nonadherence is a significant problem among aTRH patients. Identifying the most accurate and clinically feasible adherence assessment methods is necessary to reduce BP and cardiovascular morbidity, facilitate early behavioural intervention, prevent unnecessary diagnostic testing, and limit sometimes unnecessary and expensive BP lowering procedures. Registration number: CRD42016028121.

Effectiveness and content analysis of interventions to enhance medication adherence and blood pressure control in hypertension: A systematic review and meta-analysis

Objective: The objective of this systematic review is to evaluate the effectiveness of medication adherence interventions on blood pressure control in hypertensive patients. In addition, we aim to explore what barriers and facilitators in the interventions may have been targeted and how these might be related to the effect size on blood pressure (BP). Design: This review is a hypertension-specific update to the previous Cochrane Review by Nieuwlaat et al. (2014) on interventions to enhance medication adherence. A systematic literature search was carried out and two authors independently screened titles and abstracts for their eligibility for inclusion and independently extracted data from the selected studies and assessed the methodological quality using the Cochrane Collaboration Risk of Bias Tool. A meta-analysis was conducted and additionally, theoretical factors in interventions were identified using the Theoretical Domains Framework. Results: The meta-analysis found a modest main effect of adherence interventions on SBP (MD −2.71 mm Hg, 95% CI −4.17 to −1.26) and DBP (MD −1.25 mm Hg, 95% CI −1.72 to −.79). However, there was substantial significant heterogeneity across both outcomes. A narrative review on adherence outcomes was conducted. In terms of the theoretical analysis, the relationship between the total number of times the domains were coded within an intervention and change of SBP (r  =  −.234, p = .335) and DBP was not significant (r  =  −.080, p = .732). Similarly, the relationship between the total number of times different domains were coded within an intervention and change of SBP (r  =  .080, p = .746) and DBP was not significant (r  =  −.188, p = .415). Discussion: This review and meta-analysis of interventions documented significant but modest post-intervention improvements in BP outcomes among hypertensive patients. However, this is a tentative finding as substantial heterogeneity and potential biases were present. One of the greatest challenges of this review was assessing risk of bias, extracting sufficient data to calculate effect size and coding interventions with the amount of information provided in papers. It is imperative that future adherence research comprehensively reports methodology.

A short simple tool to measure the impact of food allergy on patients in routine clinical practice; the Food Allergy Quality of Life Questionnaire, Parent Form 10 (FAQLQ-PF10)

Aim Food Allergy is suboptimally managed, and the future risk for patients with regard to health status and quality of life is rarely evaluated in clinical contexts. Existing assessments do not meet physicians’ needs for a short simple tool to measure the impact of food allergy on patients health related quality of life (HRQL) in routine clinical practice. We aimed to modify the well-validated Parent Form of Food Allergy Quality of Life Questionnaire (FAQLQ-PF) to develop a short, reliable, valid, one scale measure.

Smartphone apps for improving medication adherence in hypertension: patients’ perspectives

Purpose Digital interventions, such as smartphone applications (apps), are becoming an increasingly common way to support medication adherence and self-management in chronic conditions. It is important to investigate how patients feel about and engage with these technologies. The aim of this study was to explore patients’ perspectives on smartphone apps to improve medication adherence in hypertension. Methods This was a qualitative study based in the West of Ireland. Twenty-four patients with hypertension were purposively sampled and engaged in focus groups. Thematic analysis on the data was carried out. Results Participants ranged in age from 50 to 83 years (M=65 years) with an equal split between men and women. Three major themes were identified in relation to patients’ perspectives on smartphone apps to improve medication adherence in hypertension: “development of digital competence,” “rules of engagement,” and “sustainability” of these technologies. Conclusion These data showed that patients can identify the benefits of a medication reminder and recognize that self-monitoring their blood pressure could be empowering in terms of their understanding of the condition and interactions with their general practitioners. However, the data also revealed that there are concerns about increasing health-related anxiety and doubts about the sustainability of this technology over time. This suggests that the current patient perspective of smartphone apps might be best characterized by “ambivalence.”

Cancer-Related Fatigue in Post-Treatment Cancer Survivors: Theory-Based Development of a Web-Based Intervention

Background Cancer-related fatigue (CrF) is the most common and disruptive symptom experienced by cancer survivors. We aimed to develop a theory-based, interactive Web-based intervention designed to facilitate self-management and enhance coping with CrF following cancer treatment. Objective The aim of our study was to outline the rationale, decision-making processes, methods, and findings which led to the development of a Web-based intervention to be tested in a feasibility trial. This paper outlines the process and method of development of the intervention. Methods An extensive review of the literature and qualitative research was conducted to establish a therapeutic approach for this intervention, based on theory. The psychological principles used in the development process are outlined, and we also clarify hypothesized causal mechanisms. We describe decision-making processes involved in the development of the content of the intervention, input from the target patient group and stakeholders, the design of the website features, and the initial user testing of the website. Results The cocreation of the intervention with the experts and service users allowed the design team to ensure that an acceptable intervention was developed. This evidence-based Web-based program is the first intervention of its kind based on self-regulation model theory, with the primary aim of targeting the representations of fatigue and enhancing self-management of CrF, specifically. Conclusions This research sought to integrate psychological theory, existing evidence of effective interventions, empirically derived principles of Web design, and the views of potential users into the systematic planning and design of the intervention of an easy-to-use website for cancer survivors.

The effectiveness of information and communication technology-based psychological interventions for paediatric chronic pain: protocol for a systematic review, meta-analysis and intervention content analysis

BackgroundResource and geographic barriers are the commonly cited constraints preventing the uptake of psychological treatment for chronic pain management. For adults, there is some evidence to support the use of information and communication technology (ICT) as a mode of treatment delivery. However, mixed findings have been reported for the effectiveness and acceptability of psychological interventions delivered using information and communication technology for children and adolescents. This is a protocol for a review that aims to (i) evaluate the effectiveness of psychological interventions delivered using information and communication technology for children and adolescents with chronic pain and (ii) identify the intervention components and usability factors in technology-based treatments associated with behaviour change.Methods/designWe will conduct a systematic review to evaluate the effectiveness of psychological interventions for paediatric chronic pain delivered using ICT. We plan to directly compare ICT-based, psychological interventions with active control, treatment as usual or waiting list control conditions. This systematic review will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Published and unpublished randomised controlled trials will be included and the literature search will comprise Ovid MEDLINE, Ovid Embase, PsycINFO and the Cochrane Library on Wiley, including CENTRAL and Cochrane Database of Systematic Reviews. Grey literature including theses, dissertations, technical and research reports will also be examined. Two review authors will independently conduct study selection, relevant data extraction and assessment of methodological quality. Risk of bias in included studies will be assessed using the Cochrane Collaboration risk of bias tool criteria. Two qualified coders will independently code behaviour change techniques according to the behaviour change taxonomy (v1) of 93 hierarchically clustered techniques and a novel coding scheme for mode of delivery and usability factors. A quantitative synthesis will be conducted if appropriate.DiscussionThe findings of this review may offer insight for healthcare professionals working in chronic pain services and to researchers involved in designing and evaluating information and communication technology-based interventions.Systematic review registrationPROSPERO CRD42016017657

A new assessment tool to measure the socio-economic impact of food allergy on patients and parents: the Food Allergy Socio-Economic Questionnaire Short-Form (FASEQ-SF)

Aim Food Allergy may have an impact on socioeconomic (SE) aspects of life. The Europrevall study (EU FP6, 2005-2009) developed and validated a SE questionnaire to measure the direct, indirect and intangible costs of food allergy. This measure takes up to 1 hour to complete as participants are required to respond to 70 to 170 questions, depending on response choice. We aimed to develop a brief, reliable, standardized measure of the socio-economic impact of food allergy on patients’ everyday lives.