Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of...
Transcript of Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of...
![Page 1: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/1.jpg)
![Page 2: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/2.jpg)
Michelle Croston RN, RHV
Bmed Sci (hons), BA Science (hons), Grad Dip Aesth Medicine. Professional Docturate Student
How well do we sell the adherence message?
![Page 3: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/3.jpg)
Overview
• Overview of adherence in HIV care • The nurses role in relation to adherence • Existing research on adherence • What interventions can be useful • Experiences from practice
![Page 4: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/4.jpg)
![Page 5: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/5.jpg)
Is adherence a problem in your clinical practice?
Data from the UK suggests adherence to ART remains a substantial problem with those who accepted treatment, with over 30% having low adherence within 6 months of treatment initiation and with 13% failing to achieve virological suppression by 1 year follow up post treatment initiation. Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence. J Acquir Immune Defic Syndr. 2007; 45(3):334-41. Lima V, Harrigan R, Bangsberg D, Hogg R, Gross R, Yip B, et al. The Combined Effect of Modern Highly Active Antiretroviral Therapy Regimens and Adherence on Mortality Over Time. J Acquir Immune Defic Syndr. 2006;50(5):529-36. Deloria-Knoll M, Chmiel JS, Moorman AC, Wood KC, Holmberg SD, Palella FJ. Factors related to and consequences of adherence to antiretroviral therapy in an ambulatory HIV-infected patient cohort. AIDS Patient Care STDS. 2004 Dec;18(12):721-7. Weidle PJ, Ganera CE, Irwin KL, McGowan JP, Ernst JA, Olivo N, et al. Adherence to antiretroviral medications in an inner-city population. J Acquir Immune Defic Syndr. 1999 15;22(5):498-502. Harte D, Dosekun O, Sethi G, Chadborn T, de Ruiter A, Copas A, et al. Immunosuppression among HIV-1-positive patients attending for care: experience from two large HIV centres in the United Kingdom. HIV Med. 2010 Feb;11(2):114-20.
![Page 6: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/6.jpg)
Why is this a problem ? Patient v’s Public health
• Low CD4 counts are associated with poorer outcomes on therapy
• Once ART is commenced , continuous tx is necessary to ensure efficacy and prevent emergence of viral resistance and exhaustion of tx options
• Public health perspective , a delay in achieving a detectable viral load increases the likelihood of onward transmission of a resistant virus
• There are cost implication as a result of second line treatments
• Increase demands on healthcare system due to opportunistic infections
![Page 7: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/7.jpg)
• All patients should be given the opportunity to be involved in making decisions about their treatment
• Treatment support should include, in-house, independent, community and peer support
• Good trusting relationship and good communications skills increase adherence
![Page 8: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/8.jpg)
• Focusing on assessing resistance for starting treatment – motivational interviewing style (WEMS)
• Screen for adherence problems
• Strategies based on Health Belief Model
• Practical approaches to support, medication training (MEMS), DOT, pill boxes
• Empowerment
![Page 9: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/9.jpg)
• Look at predictors of non-adherence
• No gold standard tool for assessing adherence, a variety of approaches may be helpful to identify the problem
• Identify a variety of approaches to help - also provide a link to CDC’s good evidence medication adherence (research around adherence)
![Page 10: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/10.jpg)
NICE guidance of medicines adherence
Medicines Adherence: involving patients in decisions about prescribed medicines and supporting adherence. January 2009. http://www.nice.org.uk/nicemedia/live/11766/42971/42971.pdf. Accessed July 2010.
� Assessing readiness
� Patient involvement in decisions about medicine
� Communication
� Increasing patient involvement
� Understanding the patient's knowledge, beliefs and concerns about medicines
� Providing information
� Supporting adherence
� Assessing adherence
� Interventions to increase adherence
� Reviewing medicine
� Communication between healthcare professionals
![Page 11: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/11.jpg)
![Page 12: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/12.jpg)
Determinants of adherence
What makes it easier to do?
![Page 13: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/13.jpg)
Horne, R. Concordance, Adherence and Compliance in Medicine-‐Taking. Report for the National Co-‐ordinating Centre for NHS Service and Delivery Organisation R&D (NCCSDO) (2005), pp 139.
Map of determinants of adherence
![Page 14: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/14.jpg)
What theories can help explain non- adherence?
• Various social cognition models such as Health Belief Model (HBM) , the Theory of Reasoned Action and (TRA) and the revised Theory of Planned Behavior (TPB) have been used to explain a variety of non adherence behavior.
For example , beliefs that failure to take treatment could result in adverse consequences and the person is personally susceptible to these effects tends to be associated with higher levels of adherence.
![Page 15: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/15.jpg)
• Leventhal’s self regulatory model of illness (SRM)
Adherence will be more likely if the paBent perceives the advice to take treatment makes ‘common-‐sense’ in the light of their experiences and their personal beliefs about adherence.
![Page 16: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/16.jpg)
Perspectives on adherence and simplicity
Stone V et al. J Acquir Immune Defic Syndr 2004;36:808–16
• The top three most helpful predictors of adherence: – Pill count – Dosing frequency
(qd, with pills taken at the same time each day)
– Adverse events
![Page 17: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/17.jpg)
Existing research
• In 2006 two meta analysis found some intervenBons improved ART adherence but effecBve sizes were typically low (odds raBo (OR)= 1.50 95% confidence interval (CI)1.16 to 1.94) • Cogni&ve behavior therapy (CBT) Safren et al 2009 highlighted the effecBveness of CBT to non-‐adherence and depression for PLHV in their RCT. Amico KR, Harman JJ, Johnson BT. Efficacy of anBretroviral therapy adherence intervenBons: a research synthesis of trials, 1996 to 2004. J Acquir Immune Defic Syndr. 2006 Mar;41(3):285-‐9 Simoni JM, Pearson CR, Pantalone DW, Marks G, Crepaz N. Efficacy of intervenBons in improving highly acBve anBretroviral therapy adherence and HIV-‐1 RNA viral load. A meta-‐analyBc review of randomized controlled trials. J Acquir Immune Defic Syndr. 2006 Dec 1;43 Suppl 1:S23-‐35. Safren SA, O’Cleirigh C et al A randomized control trial of CogniBve behaviour therapy for adherence and depression (CBT-‐AD) in HIV infected individuals. Health Psychol 2009, Jan , 28 , (1): 1-‐10
![Page 18: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/18.jpg)
• Mo&va&onal Interviewing (MI)is well cited as being effecBve when providing adherence support ( Hill et al 2012). Golin et al 2006 RCT explores the use of MI in relaBon to adherence support.
• Counseling and alarm advice Griffiths et al 2007 highlights the role of counselling and adherence support delivered by nurses/pharmacist showing a posiBve correlaBon as did Lester et al 2010 RCT and Chung et al 2011 exploratory research.
Hill, Seth and Kavookkjian (2012)MoBvaBonal interviewing as a behavioral intervenBon to increase ART adherence in paBents who are HIV posiBve . A systemaBc review of the literature. AIDS care , 24 (5) 583-‐592
Golin CE , Earp J et al 2 arm , randomised , controlled trial of a moBvaBonal interviewing based intervenBon to improve adherence to anBretroviral therapy (ART) among paBents failing or iniBaBng ART. J Acquir Immune Defic Syndr 2006 May , 1, 42-‐51
Griffiths , C et al 2007 A nurse and pharmacist –led treatment advice clinic for paBents alending an HIV outpaBents clinic , Journal of advance nursing , 58, 4, 320-‐326 Lester, Richard T et al ( 2010) Effects of a mobile phone short message service on anBviral treatment adherence in Kenya A randomised control trial. Lancet, 376 ( 9755) 1838-‐1845 Chung , MH, Richardson , BA et al (2011) A randomised controlled trial comparing the effects of counselling and alarm device on HAART adherence and virologic outcome. Plos medicine , 3,
e1000422
![Page 19: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/19.jpg)
How well do we sell adherence as nurses ?
Pre treatment • Preparing patients for ARV’s • Assessing acceptance of HIV • Checking patients mood • Passing on knowledge of HIV and treatment • Preparing to manage side effects • Assessing motivation/ Self efficacy
• Exploring Strategies to help patients remember treatment
de Bruin M, Hospers HJ, van den Borne HW, Kok G, Prins JM. Theory- and evidence-based intervention to improve adherence to antiretroviral therapy among HIV-infected patients in the Netherlands: a pilot study. AIDS Patient Care STDS. 2005 Jun;19(6):384-94
![Page 20: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/20.jpg)
Strategies during the treatment phase • Discussing non-
adherence • Discussion solutions to
the demands of ARV • Discussing motivation
to change • Evaluating and
assessing side effects
• Evaluating
ambivalence • Explaining lab results
• Changing treatment
• Discussing forgotten treatment
• Passing on knowledge
• Evaluating support
Bruin M, Hospers HJ, van den Borne HW, Kok G, Prins JM. Theory- and evidence-based intervention to improve adherence to antiretroviral therapy among HIV-infected patients in the Netherlands: a pilot study. AIDS Patient Care STDS. 2005 Jun;19(6):384-94
![Page 21: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/21.jpg)
Strategies used in all phases of the patients journey • Offering support • Assessing for
psychological distress • Building relationships • Providing ongoing
education/support • Onwards referral to
services
Bruin M, Hospers HJ, van den Borne HW, Kok G, Prins JM. Theory- and evidence-based intervention to improve adherence to antiretroviral therapy among HIV-infected patients in the Netherlands: a pilot study. AIDS Patient Care STDS. 2005 Jun;19(6):384-94
![Page 22: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/22.jpg)
Adherence support
![Page 23: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/23.jpg)
Creating a trusting relationship
• Holistic assessment • Cue based
communication • Motivational Interview • Goal setting and
negotiation • Promotion of self
efficacy and self care • Development of
decision making skills
� Assessing readiness to start treatment
� Education and empowerment
� Use of affirmation
� Side effect management
� Referrals – MDT approach essential
� Unconditional support
� Peer support
![Page 24: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/24.jpg)
Medication boxes
![Page 25: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/25.jpg)
Alternative beliefs
![Page 26: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/26.jpg)
![Page 27: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/27.jpg)
![Page 28: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/28.jpg)
![Page 29: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/29.jpg)
Submit an article
• Original research
• Nursing innovations
• Audit
![Page 30: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/30.jpg)
![Page 31: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/31.jpg)
![Page 32: Michelle Croston...Horne R, Cooper V, Gellaitry G, Leake-Date H, Fisher M. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence.](https://reader036.fdocuments.net/reader036/viewer/2022071218/604e55fa804e6a0be048a760/html5/thumbnails/32.jpg)