The Effects of Feedback on Adherence to Treatment: A Systematic Review and Meta-analysis of RCTs

Seewoodharry, Mansha; Maconachie, Gail; Gillies, Clare; Gottlob, Irène; McLean, Rebecca J.

doi:10.1016/j.amepre.2017.03.005

Cited by 11 publications

(10 citation statements)

References 32 publications

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“…Repeated educational messages (spaced learning) have been shown to be an effective strategy for memories that “stick” [ 75 ] This implies the benefit to having periodic “refresher” sessions with gout patients to remind them of the rationale for their long-term use of ULT and other key self-management points. Feedback, where patients receive individualized information based on their knowledge deficits or specific questions, has been shown to improve adherence to medications [ 76 ]. This supports potential benefit of interactive knowledge questionnaires with feedback on responses, and online programs which provide education informed by individual details entered by the patient.…”

Section: Opportunities and Timing Of Educationmentioning

confidence: 99%

How Can We Improve Disease Education in People with Gout?

Fields

Batterman

2018

Curr Rheumatol Rep

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Purpose of ReviewGout management is currently suboptimal despite excellent available therapy. Gout patient education has been shown to enhance medication adherence and self-management, but needs improvement. We explored the literature on gout patient education including gaps in gout patient knowledge; use of written materials; in-person individual and group sessions; education via nurses, pharmacists, or multi-disciplinary groups; and use of phone, web-based, mobile health app, and text messaging educational efforts.Recent FindingsNurse-led interventions have shown significant improvement in reaching urate goals. Pharmacist-led programs have likewise succeeded, but to a lesser degree. A multi-disciplinary approach has shown feasibility. Needs-assessments, patient questionnaires, and psychosocial evaluations can enhance targeted education.SummaryAn interactive and patient-centered approach can enhance gout educational interventions. Optimal programs will assess for and address educational needs related to knowledge gaps, health literacy, race, gender, socio-economic status, and level of social support.

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Section: Opportunities and Timing Of Educationmentioning

confidence: 99%

How Can We Improve Disease Education in People with Gout?

Fields

Batterman

2018

Curr Rheumatol Rep

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“…After completion of the VOICE trial, a subset of women on the active arms received retrospective feedback about their drug levels during the trial, which they reported to be useful and suggested that real-time drug level monitoring and feedback would promote honest discussions about PrEP use [ 11 ]. A recent systematic review and meta-analysis of randomized controlled trials reported that feedback, based on subjective or objective measures of adherence, increased adherence by 10% [ 12 ]. Plasma tenofovir monitoring among men who have sex with men (MSM) in a United States demonstration project was used to trigger more intensive counseling support among those who had undetectable plasma tenofovir levels, reflecting no PrEP use in the prior week, and was associated with sustained improved PrEP adherence in 50% [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

PrEP uptake, persistence, adherence, and effect of retrospective drug level feedback on PrEP adherence among young women in southern Africa: Results from HPTN 082, a randomized controlled trial

et al. 2021

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Background Pre-exposure prophylaxis (PrEP) is highly effective and an important prevention tool for African adolescent girls and young women (AGYW), but adherence and persistence are challenging. PrEP adherence support strategies for African AGYW were studied in an implementation study. Methods and findings HIV Prevention Trials Network (HPTN) 082 was conducted in Cape Town, Johannesburg (South Africa) and Harare (Zimbabwe) from October 2016 to October 2018 to evaluate PrEP uptake, persistence, and the effect of drug level feedback on adherence. Sexually active HIV–negative women ages 16–25 were offered PrEP and followed for 12 months; women who accepted were randomized to standard adherence support (counseling, 2-way SMS, and adherence clubs) or enhanced adherence support with adherence feedback from intracellular tenofovir-diphosphate (TFV-DP) levels in dried blood spots (DBS). PrEP uptake, persistence through 12 months (no PrEP hold or missed visits), and adherence were assessed. The primary outcome was high adherence (TFV-DP ≥700 fmol/punch) at 6 months, compared by study arm. Of 451 women enrolled, median age was 21 years, and 39% had curable sexually transmitted infections (STIs). Most (95%) started PrEP, of whom 55% had uninterrupted PrEP refills through 12 months. Of those with DBS, 84% had detectable TFV-DP levels at month 3, 57% at month 6, and 31% at month 12. At 6 months, 36/179 (21%) of AGYW in the enhanced arm had high adherence and 40/184 (22%) in the standard adherence support arm (adjusted odds ratio [OR] of 0.92; 95% confidence interval [CI] 0.55, 1.34; p = 0.76). Four women acquired HIV (incidence 1.0/100 person-years), with low or undetectable TFV-DP levels at or prior to seroconversion, and none of whom had tenofovir or emtricitabine resistance mutations. The study had limited power to detect a modest effect of incentives on adherence, and there was limited awareness of PrEP at the time the study was conducted. Conclusions In this study, PrEP initiation was high, over half of study participants persisted with PrEP through month 12, and the majority of young African women had detectable TFV-DP levels through month 6 with one-fifth having high adherence. Drug level feedback in the first 3 months of PrEP use did not increase the proportion with high adherence at month 6. HIV incidence was 1% in this cohort with 39% prevalence of curable STIs and moderate PrEP adherence. Strategies to support PrEP use and less adherence-dependent formulations are needed for this population. Trial registration ClinicalTrials.gov NCT02732730.

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“…McLean et al [125], argue identifying new strategies to enhance adherence needs to be improved through a greater understanding of the patient and professional and organisational factors responsible for poor adherence. The systematic review by Seawoodharry et al [127], determining the effect of feedback on adherence aligns with McLean et al [125], concluding the need to understand the patient's view of their need for treatment, their expectations and concerns was key in addressing adherence. They concede there is no intervention capable of addressing non-adherence in all patients raising challenges for tackling non-attendance in my service [127].…”

Section: Key Fi Ndingsmentioning

confidence: 73%

“…The systematic review by Seawoodharry et al [127], determining the effect of feedback on adherence aligns with McLean et al [125], concluding the need to understand the patient's view of their need for treatment, their expectations and concerns was key in addressing adherence. They concede there is no intervention capable of addressing non-adherence in all patients raising challenges for tackling non-attendance in my service [127]. shows adherence strategies to be problematic these components may have been benefi cial in improving treatment outcomes and attendance [118,128].…”

Section: Key Fi Ndingsmentioning

confidence: 73%

Does A Group Supervised Shoulder Impingement Class Improve Shoulder Pain, Disability and Generic Health Outcomes? A Summative Service Evaluation

Abramson¹

2018

J Nov Physiother Phys Rehabil

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Background: Patients with shoulder impingement syndrome (SIS) suffer pain and disability and present enormous health and fi nancial challenges to the NHS. There is limited evidence for many of the commonly used physiotherapy treatment interventions. Research suggests deprivation, age, gender and attendance are possible predictors of poor treatment outcome in common MSK conditions. The present author set up and ran a physiotherapy led group based SIS class to improve generic health outcomes and reduce shoulder pain and disability.Method: 236 SIS patients were referred over a 22 month period. 154 completed the once weekly six week course. 82 failed to complete the class. Generic health outcomes were measured with the Euroqol EQ-5D-5L with condition specifi c outcome measured using the Shoulder Pain and Disability Index (SPADI). Covariates possibly predictive of poor treatment outcome were analysed using linear regression and included Townsend Deprivation Score (TDS), age and gender. Class completers and non-completers were compared to determine any association with TDS, age and gender.Results: Statistically signifi cant improvements in generic health (t -7.77, df 153, p < 0.001) and shoulder pain and disability (t -9.36, df 153, p < 0.001) were found post intervention. No association for the predictive utility of TDS, age and gender on EQ-5D-5L and SPADI outcome was found. Statistically signifi cant differences between class completers and non-completers for TDS t (181.17)=-3.62, p < 0.001) and age (t (134.72)=2.41, p = 0.017) were found. Younger patients and those from more deprived areas attended fewer classes. No association was found between gender and non-attendance. TDS, age and gender have no association with class non-completion type be it never attended or attended then did not attend (DNA). Conclusion:Physiotherapists play a key role in managing the third most common MSK pathology. This evaluation suggests positive outcomes for those completing a group based SIS class on both health and shoulder pain and disability. SIS patients meeting inclusion criteria should be routinely fed into group based classes. Younger patients and those from more deprived areas may benefi t from a more individualised management approach.

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The Effects of Feedback on Adherence to Treatment: A Systematic Review and Meta-analysis of RCTs

Cited by 11 publications

References 32 publications

How Can We Improve Disease Education in People with Gout?

How Can We Improve Disease Education in People with Gout?

PrEP uptake, persistence, adherence, and effect of retrospective drug level feedback on PrEP adherence among young women in southern Africa: Results from HPTN 082, a randomized controlled trial

Does A Group Supervised Shoulder Impingement Class Improve Shoulder Pain, Disability and Generic Health Outcomes? A Summative Service Evaluation

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