BACKGROUND: The efficacy of antiretroviral therapy (ART) has improved, and the adverse effects of antiretroviral drugs have been reduced. However, these adverse effects still significantly influence patient compliance, increasing the risk of tolerability failure. Therefore, we investigated the adverse effects and tolerability failure causing changes in the first ART regimen, and identified the regimens that were most vulnerable to switching. MATERIALS AND METHODS: We enrolled patients with human immunodeficiency virus (HIV) who commenced their first ART between January 1, 2011 and July 30, 2014. Patients who started their first ART regimen at the Kyungpook National University Hospital were included in the study if they were aged > or =18 years and were followed-up for > or =12 weeks. The primary dependent variable was the duration of treatment on the same ART regimen. We analyzed the maintenance rate of the first ART regimen based on the treatment duration between these groups using survival analysis and log rank test. The frequency of the adverse effects of ART regimens was analyzed by multiple response data analysis. RESULTS: During the investigation period, 137 patients were enrolled. Eighty-one patients were maintained on the initial treatment regimen (59.1%). In protease inhibitor (PI)-based regimen group, 54 patients were maintained on the initial treatment regimen (54/98, 55.1%). In non-nucleoside reverse transcriptase inhibitor (NNRTI)-and integrase inhibitor (II)-based regimen group, 15 (15/26, 57.7%) and 12 (12/13, 92.3%) patients were maintained on the initial treatment regimen, respectively. Adverse effects that induced ART switching included rash (16/35, 45.7%), gastrointestinal discomfort or pain (7/35, 20%), diarrhea (7/35, 20%), hyperbilirubinemia (6/35, 17.1%), headache or dizziness (3/35, 8.5%). Among the treatment regimens, the group receiving an II-based regimen showed the least switching. The group receiving PI-and NRTI-based regimens were most likely to switch due to adverse effects during the early treatment period. However, after about 18 months, switching was rarely observed in these groups. Among the PI drugs, darunavir/ritonavir showed fewer drug changes than atazanavir/ritonavir (P = 0.004, log rank test) and lopinavir/ritonavir (P = 0.010). Among the NNRTI drugs, rilpivirne produced less switching than efavirenz (P = 0.045). CONCLUSION: Adverse effects to ART resulted in about a quarter of patients switching drugs during the early treatment period. II-based regimens were advantageous because they were less likely to induce switching within 18 months of treatment commencement. These findings indicated the importance of considering and monitoring the adverse effects of ART in order to improve adherence.
Diarrhea ; Dizziness ; Exanthema ; Gyeongsangbuk-do ; Headache ; HIV ; Humans ; Hyperbilirubinemia ; Integrases ; Patient Compliance ; Protease Inhibitors ; RNA-Directed DNA Polymerase ; Statistics as Topic

OBJECTIVE: To explore the compliance of extramural hospital treatment and the long-term survival status in patients with acute myocardial infarction (AMI) in Chongqing.
 METHODS: A total of 636 patients with AMI, from grade 3 and first-class hospitals in Chongqing during Jan 2005 and Jan 2009, were enrolled for this study. The patients were followed-up for 5 years to investigate the extramural hospital treatment and influential factors.
 RESULTS: A total of 574 patients finished a five-year follow-up, and 180 cases died from cardiac death. The mortality was 31.4%. The poor compliance was a major feature in the pass away patients.
 CONCLUSION The low treatment compliance is the independent risky factor for 5-year prognosis.
Acute Disease ; Hospitals ; Humans ; Myocardial Infarction ; mortality ; therapy ; Patient Compliance ; statistics & numerical data ; Prognosis ; Risk Factors ; Survival Analysis

OBJECTIVETo evaluate the effectiveness of directly observed treatment (DOT) implementation in tuberculosis (TB) control in China.

METHODSSystematic literature review was carried out for published and unpublished articles regarding DOT, and meta analysis was used to compile results from selected papers. Also, sensitive analysis was carried out to explore the potential factors influencing the effectiveness of DOT.

RESULTSTwo hundred and four articles were identified from China National Knowledge Infrastructure, Wanfang and Medline databases during 1994 - 2004 in which 120 articles were eligible according to our selection criteria. (1) Regarding TB case management: TB patients managed under DOT was compared to cases managed under the whole course treatment management (WCM). The combined RD of cure rate was 0.14 (95% CI: 0.06 - 0.22) and the two case management methods were significantly different (P < 0.00001). Data from stratified analysis showed that strict implementation of WMC had similar effectiveness with DOT (P = 0.06), and with RD 0.02 (95% CI: 0.00 - 0.03). However, the cure rate of DOT management was significantly better than that under un-strict WCM management (P < 0.05) with RD 0.16 (95% CI: 0.07 - 0.24). The cure rate of DOT was significantly better than those patients under self-administration (RD was 0.24 with 95% CI: 0.10 - 0.38 and P = 0.002). (2) Chemotherapeutics: when short-course and long course-treatments were compared, the combined RD became 0.04 (95% CI: 0.01 - 0.07) and P = 0.003.

CONCLUSIONSIf the implementation was under strict management, the different models of patient management showed similar adherence rates. However, the effect of adherence would depend on the regimen, pattern of intake of the drugs and the methods of supervision being used.

China ; Directly Observed Therapy ; methods ; Humans ; Patient Care Management ; methods ; Patient Compliance ; statistics & numerical data ; Treatment Outcome ; Tuberculosis ; drug therapy ; prevention & control

INTRODUCTIONThe aim of this study was to find out the effects of group psychoeducation (GPE) on the scheduled clinic appointments of patients admitted for psychosis and depression after discharge from hospital.

MATERIALS AND METHODSA randomised controlled trial (RCT) of 4 sessions of GPE delivered while the patients were admitted was conducted and compared to no session of GPE with the usual care. This RCT was conducted in a 60-bed state reference neuropsychiatric hospital in Southwest of Nigeria. The study population consisted of 48 admitted patients for psychotic disorders, including schizophrenia and depression. Twenty-five patients admitted were randomly selected to undergo 4 sessions of GPE before discharge from hospital, and 23 patients were randomly selected to receive regular medication and care without undergoing GPE. Both groups were then followed for 9 months on clinic days to measure compliance with scheduled appointments. Main outcome was measured by the number of clinic appointments kept within the period of study after discharge from hospital.

RESULTSPatients in the treatment group were consistently more compliant with scheduled clinic appointments than those in the experimental group (P = 0.0009, DF = 34; t-test at 95% CI). There was also no significant difference in compliance with visits among patients with different diagnoses (treatment group; P = 0.90, DF = 12, experimental group; P = 0.33, DF = 11).

CONCLUSIONGPE is effective in improving patients' compliance with scheduled clinic appointments after discharge for a period of 9 months. GPE can be used as part of treatment package for all psychiatric diagnoses and it has no age bias.

Adult ; Aftercare ; methods ; psychology ; utilization ; Appointments and Schedules ; Depressive Disorder ; therapy ; Female ; Hospitals, Psychiatric ; utilization ; Humans ; Male ; Nigeria ; Patient Acceptance of Health Care ; statistics & numerical data ; Patient Compliance ; statistics & numerical data ; Patient Education as Topic ; methods ; Program Evaluation ; Psychotherapy, Group ; Psychotic Disorders ; therapy

OBJECTIVETo describe the characteristics and factors associated with long-term retention for methadone maintenance treatment (MMT) patients.

METHODSThis study was conducted in eight MMT clinics located in Sichuan, Yunnan, Guangxi, Guizhou and Zhejiang provinces. Five hundred and thirty-nine MMT patients who enrolled in MMT clinics in 2004 and retained in treatment by June 2010 were selected as study subjects. Chi-square tests were used to compare the demographics and drug abuse history at enrollment and treatment characteristics during the follow-up period between continuous treatment patients and discontinuous treatment patients.

RESULTSOf the 539 patients, 110 (20.4%) were continuous treatment patients whereas 429 (79.6%) were discontinuous treatment patients. Of these 429 discontinuous treatment patients, 84.1% (361/429) had 2-4 treatment episodes whereas 15.9% (68/429) had 5 or more episodes during follow-up period. When continuous treatment patients were compared with discontinuous treatment patients, living with family members or friends (88.2% (97/110), 78.5% (337/429)), age of first drug use under 25 (61.8% (68/110), 71.3% (306/429)), low urine morphine positive test results (67.3% (74/110), 38.2% (164/429)) and living within 5 kilometers of the MMT clinic (72.7% (80/110), 61.3% (263/429)) were positively associated with higher possibility of continuous treat retention (P < 0.05). Demographics and drug abuse characteristics at enrollment, including gender, age, employment status, family relationship, injection, needle sharing, criminal behavior, contacts with drug users, MMT daily dosage and family members receiving MMT were not significantly associated with treatment retention (P > 0.05).

CONCLUSIONIllicit drug use during the treatment and longer distance travelling to MMT clinic might have negative impact on patients' continuous treatment retention. Mobile MMT vehicles and expanded MMT service sites could be introduced to improve compliance of treatment retention of MMT patients.

Adult ; Female ; Humans ; Longitudinal Studies ; Male ; Methadone ; administration & dosage ; therapeutic use ; Patient Compliance ; statistics & numerical data ; Substance-Related Disorders ; drug therapy ; Treatment Outcome

OBJECTIVE: To investigate the treatment compliance and basic health needs of rural patients with gastric ulcer. METHODS: One hundred and sixteen patients with gastric ulcer were measured with treatment compliance questionnaire. The questionnaire contained 3 aspects: chemical therapy, regular callback, and improvement in life style, and had another part of questions which were designed to investigate the basic health needs of the patients. RESULTS: The patient compliance rate in the aspect of improvement in life style was 4.3% (n=5). Both of the counterparts in the other 2 aspects were 7.8% (n=9). The main correlative factor with treatment compliance of the investigated patients was economic income. There were 105 patients (90.5%) needing health consultation, 98 patients (84.5%) needing diet instruction and 93 patients (80.2%) needing regular physical examination among the 116 patients investigated. CONCLUSION The treatment compliance rate of rural patients with gastric ulcer was very low. It is necessary to emphasize health education.
Adolescent ; Adult ; Aged ; Female ; Health Services Needs and Demand ; Humans ; Male ; Middle Aged ; Patient Compliance ; statistics & numerical data ; Peptic Ulcer ; Rural Health Services ; Surveys and Questionnaires ; Young Adult

OBJECTIVETo evaluate the colorectal cancer incidence among compliers and non-compliers in the population of colorectal cancer screening area, and to provide scientific basis for health economic evaluation of cancer screening.

METHODSBy screening different years build queue, to retrospectively compare the data of colorectal cancer screening from January 1, 2008 to December 31, 2013 and the data of cancer registration, and to analyze the colorectal cancer incidence rates among screening compliers and non-compliers, and to compare the average intervals between the end of screening and clinical cancer diagnosis using SPSS 19 statistical software. Mantel-Haenszel test was performed with a statistical significance level of α = 0.05.

RESULTSThe non-compliance rate was 38.24% among males and 28.49% among females (P < 0.001). The non-compliance rate was highest in the 40-44 and 70-74 years age groups and lowest in the 50-59 years age group. The compliers of the screening were followed up for 476,049 person-years, and there were 51 cases of colorectal cancer, with an incidence rate of 10.71/100,000. The non-compliers of the screening were followed up for 259 183 person-years, and there were 66 cases of colorectal cancer, with an incidence rate of 25.46/100,000, which was 1.38 times higher than that of the compliance group (χ2 = 21.699, P < 0.001). The incidence rate of colorectal cancer among subjects who were positive in initial screening but refused to receive an electronic colonoscopy was as high as 164.40/100,000, and the average delay time was 20.8 ± 16.8 months.

CONCLUSIONSThe colorectal cancer screening adherence among women is better than among men, and that of 50-54 years and 55-59 years age groups is better than in other age groups. The subsequent incidence rate of colorectal cancer in the non-compliance group is significantly higher than that of the compliance population.

Adult ; Age Factors ; Aged ; China ; epidemiology ; Cohort Studies ; Colonoscopy ; Colorectal Neoplasms ; diagnosis ; epidemiology ; Early Detection of Cancer ; Female ; Humans ; Incidence ; Male ; Mass Screening ; statistics & numerical data ; Middle Aged ; Patient Compliance ; statistics & numerical data ; Retrospective Studies ; Sex Factors

OBJECTIVETo explore the factors associated with retention in a community-based methadone maintenance treatment(MMT) among drug users in Urumqi.

METHODSWith national MMT guideline( drift) for heroine addicted drug users, local heroine-dependent people were admitted to community-based MMT program affiliated to Xinjiang Uigur Autonomous Region Center for Mental Health. Data on outpatients' social-demo characteristics, baseline behaviors on drug use and daily stabilized dose of drugs were entered to MMT database.

RESULTSUp to 10, Feb. , 2006,353 persons withdrew MMT treatment among 709 heroin dependant drug users. Between 11, Aug., 2005 and 10, Feb., 2006, with median duration as 77 days, cumulative drop-out rate of 90 days and 180 days after first dose of MMT were 73.8% among 455 and 99.4% among 355 drug users, respectively. The incidence of drop-outs was 29.8 per 100 person-month. The median length of stay (days) in MMT was 68.0 (95% CI: 59.0- 78.0). Correlates of retention were found as: Being Uigur(HR = 1.35;95% CI :1.09-1.67), duration of drug use (HR =0.74; 95% CI:0.55-0.99) and stabilized dose(HR = 0.60;95% CI: 0.48-0.74) was found in multiple Cox proportional hazard regression model.

CONCLUSIONRetention of MMT among drug users in Urumqi was low. Uigur people should be given individual counseling to help them increase the compliance rate. Within the ranges of clinic dosage, adjustment of the methadone dose on an individual base might serve as an appropriate approach to increase the effectiveness of the program.

Adult ; Aged ; China ; Drug Users ; psychology ; statistics & numerical data ; Female ; Heroin Dependence ; psychology ; rehabilitation ; Humans ; Male ; Middle Aged ; Patient Compliance ; Substance Abuse Treatment Centers ; statistics & numerical data ; Young Adult

The purpose of this study was to investigate postpartum glucose testing rates in patients with gestational diabetes mellitus (GDM) and to determine factors affecting testing non-compliance in the Korean population. This was a retrospective study of 1,686 patients with GDM from 4 tertiary centers in Korea and data were obtained from medical records. Postpartum glucose testing was conducted using a 2-hr 75-g oral glucose tolerance, fasting glucose, or hemoglobin A1C test. Test results were categorized as normal, prediabetic, and diabetic. The postpartum glucose testing rate was 44.9% (757/1,686 patients); and of 757 patients, 44.1% and 18.4% had pre-diabetes and diabetes, respectively. According to the multivariate analysis, patients with a high parity, larger weight gain during pregnancy, and referral from private clinics due to reasons other than GDM treatment were less likely to receive postpartum glucose testing. However, patients who had pharmacotherapy for GDM were more likely to be screened. In this study, 55.1% of patients with GDM failed to complete postpartum glucose testing. Considering the high prevalence of diabetes (18.4%) at postpartum, clinicians should emphasize the importance of postpartum diabetes screening to patients with factors affecting testing noncompliance.
Blood Glucose/*metabolism ; Diabetes, Gestational/*blood ; Fasting ; Female ; *Glucose Tolerance Test ; Hemoglobin A, Glycosylated/metabolism ; Humans ; Mass Screening/statistics & numerical data ; Patient Compliance/statistics & numerical data ; Postpartum Period/*blood ; Pregnancy ; Republic of Korea ; Retrospective Studies ; Tertiary Care Centers

Adult ; Anti-Bacterial Agents ; administration & dosage ; Female ; Humans ; Male ; Nursing Staff ; statistics & numerical data ; Patient Compliance ; statistics & numerical data ; Retrospective Studies ; Shock, Septic ; drug therapy ; Time Factors ; Young Adult