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      Management of patient adherence to medications: protocol for an online survey of doctors, pharmacists and nurses in Europe

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          Abstract

          Introduction

          It is widely recognised that many patients do not take prescribed medicines as advised. Research in this field has commonly focused on the role of the patient in non-adherence; however, healthcare professionals can also have a major influence on patient behaviour in taking medicines. This study examines the perceptions, beliefs and behaviours of healthcare professionals—doctors, pharmacists and nurses—about patient medication adherence.

          Methods and analysis

          This paper describes the study protocol and online questionnaire used in a cross-sectional survey of healthcare professionals in Europe. The participating countries include Austria, Belgium, France, Greece, The Netherlands, Germany, Poland, Portugal, Switzerland, Hungary, Italy and England. The study population comprises primary care and community-based doctors, pharmacists and nurses involved in the care of adult patients taking prescribed medicines for chronic and acute illnesses.

          Discussion

          Knowledge of the nature, extent and variability of the practices of healthcare professionals to support medication adherence could inform future service design, healthcare professional education, policy and research.

          Article summary

          Article focus
          • A protocol for a cross-sectional survey of healthcare professionals in Europe to examine the perceptions, beliefs and behaviours of healthcare professionals—doctors, pharmacists and nurses—about patient medication adherence.

          • The questionnaire used in the survey of healthcare professionals is described in detail.

          Key messages
          • There is an acute need for evidence regarding healthcare professionals' beliefs, perceptions and behaviour with regard to patient non-adherence to medicines.

          • This protocol describes a study to address this need.

          • The results of this study could guide healthcare professionals as they support patients with taking medicine in their day-to-day clinical practice.

          Strengths and limitations of this study
          • The survey is the largest cross-national survey of healthcare professionals' approach to medication adherence.

          • Reliance on self-report data may raise concerns regarding the validity of the findings.

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          Most cited references6

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          Response Audit of an Internet Survey of Health Care Providers and Administrators: Implications for Determination of Response Rates

          Background Internet survey modalities often compare unfavorably with traditional survey modalities, particularly with respect to response rates. Response to Internet surveys can be affected by the distribution options and response/collection features employed as well as the existence of automated (out-of-office) replies, automated forwarding, server rejection, and organizational or personal spam filters. However, Internet surveys also provide unparalleled opportunities to track study subjects and examine many of the factors influencing the determination of response rates. Tracking data available for Internet surveys provide detailed information and immediate feedback on a significant component of response that other survey modalities cannot match. This paper presents a response audit of a large Internet survey of more than 5000 cancer care providers and administrators in Ontario, Canada. Objective Building upon the CHEcklist for Reporting Results of Internet E-Surveys (CHERRIES), the main objectives of the paper are to (a) assess the impact of a range of factors on the determination of response rates for Internet surveys and (b) recommend steps for improving published descriptions of Internet survey methods. Methods We audited the survey response data, analyzing the factors that affected the numerator and denominator in the ultimate determination of response. We also conducted a sensitivity analysis to account for the inherent uncertainty associated with the impact of some of the factors on the response rates. Results The survey was initially sent out to 5636 health care providers and administrators. The determination of the numerator was influenced by duplicate/unattached responses and response completeness. The numerator varied from a maximum of 2031 crude (unadjusted) responses to 1849 unique views, 1769 participants, and 1616 complete responses. The determination of the denominator was influenced by forwarding of the invitation email to unknown individuals, server rejections, automated replies, spam filters, and ‘opt out’ options. Based on these factors, the denominator varied from a minimum of 5106 to a maximum of 5922. Considering the different assumptions for the numerator and the denominator, the sensitivity analysis resulted in a 12.5% variation in the response rate (from minimum of 27.3% to maximum of 39.8%) with a best estimate of 32.8%. Conclusions Depending on how the numerator and denominator are chosen, the resulting response rates can vary widely. The CHERRIES statement was an important advance in identifying key characteristics of Internet surveys that can influence response rates. This response audit suggests the need to further clarify some of these factors when reporting on Internet surveys for health care providers and administrators, particularly when using commercially available Internet survey packages for specified, rather than convenience, samples.
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            Patient compliance and medical research: issues in methodology.

            Compliance with medication and medical appointments is presumed to have a critical influence on outcomes of medical interventions. However, compliance may not always be easily defined or accurately measured. No single method of measuring compliance with appointments or medication is applicable in all settings. The apparent effects of compliance on outcome may be both direct and indirect; research is needed to define more clearly how these effects may be mediated. Identifying effective methods of enhancing compliance requires accurate methods of measuring compliance. In addition, the effectiveness of interventions may decay over time, and differences in effectiveness in acute versus long-term settings have not been well studied. Researchers conducting clinical trials of medical interventions must evaluate compliance in the population studied and consider the potential impact of noncompliance on trial results and their generalizability. In some trial designs, data may best be analyzed by considering compliance a dependent or an outcome variable. Under appropriate circumstances, compliance may be considered an independent variable. Readers of the medical literature should consider how compliance was measured and analyzed when interpreting the results of clinical trials. Table 4 suggests criteria for critical appraisal of compliance-related issues in reports of clinical trials.
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              A review of the literature on the economics of noncompliance. Room for methodological improvement.

              Therapeutic noncompliance is a major issue in health care, having important negative consequences for clinical outcome as well as for health-care costs. This paper reviews the literature on the economics of therapeutic noncompliance, identifies methodological shortcomings and formulates recommendations for future economic research in this area. Medication noncompliance was explored more extensively, as the majority of articles dealt exclusively with this aspect of therapy. Eighteen studies were assessed according to their definition and measurement of medication noncompliance, study design, and identification and valuation of costs and outcomes. Very diverse designs and often invalid methods for calculating costs were found. Medication noncompliance is often ill-defined and measured in an inaccurate way. The economic consequences of therapeutic noncompliance have rarely been investigated according to the standard principles of good economic evaluation. Six studies examined both costs and consequences of noncompliance in a cost-outcome description or a cost-benefits, cost-effectiveness or cost-utility analysis. Eight studies dealt with the economic value of compliance-enhancing interventions. In general, studies on the economic consequences of noncompliance lack methodological rigour and fail to meet qualitative standards. There is a clear need for more and better research on the impact of noncompliance, on the cost-effectiveness of interventions and the potential of compliance-enhancing interventions to improve patient outcomes and/or reduce health-care costs.
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                Author and article information

                Journal
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2011
                3 November 2011
                3 November 2011
                : 1
                : 1
                : e000355
                Affiliations
                [1 ]NPC Plus, Keele University, Keele, UK
                [2 ]Division of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
                [3 ]School of Computing and Mathematics, Keele University, Keele, UK
                [4 ]Center for Health Services and Nursing Research, Katholieke Universiteit, Leuven, Belgium
                [5 ]Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA
                [6 ]School of Psychology, Bangor University, Bangor, UK
                [7 ]First Department of Family Medicine, Medical University of Lodz, Lodz, Poland
                Author notes
                Correspondence to Dr Wendy Clyne; w.clyne@ 123456mema.keele.ac.uk
                Article
                bmjopen-2011-000355
                10.1136/bmjopen-2011-000355
                3276023
                22080529
                7c27be32-739a-433a-8d7d-fcd1a39dfde7
                © 2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

                History
                : 26 August 2011
                : 15 September 2011
                Categories
                Drugs and Medicines
                Protocol
                1506
                1709
                1704

                Medicine
                Medicine

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