Dataset Information

Adherence to drug therapy for hypertensive disorders of pregnancy: a cross-sectional survey.

ABSTRACT: Background:Hypertensive disorders of pregnancy (HDPs) are a major contributor to maternal mortality worldwide, and drug therapy for HDPs is complicated and special. Clinical guidelines help physicians optimize the care for HDPs, but little is known about whether physicians adhere to drug therapy guidelins well, especially in China. This study aims to evaluate adherence to the drug therapy guidelines of the Chinese Obstetricians and Gynecologists Association (COGA) for HDPs and to explore the corresponding associations with recommendation evidence. Methods:A cross-sectional design was executed for 306 women with HDPs hospitalized in a maternity ward of a tertiary hospital from August 2014 to July 2015 in Hubei, China. Adherence to the COGA guidelines was evaluated according to six items: the time of use and route of administration and dosage of antihypertensive drugs, MgSO4, and corticosteroids. Binary logistic regression was adopted to explore the associations between adherence to clinical decisions and recommendation evidence. Results:The average adherence rate for drug therapy for HDPs was 48.22%. The adherence rate for the time of antihypertensive drug and corticosteroid use scored 95.65 and 86.75%, whereas the other four items of the time of MgSO4 use and the routes of administration and dosages of antihypertensive drugs, MgSO4, and corticosteroids scored

SUBMITTER: Chen H

PROVIDER: S-EPMC7206801 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Adherence to drug therapy for hypertensive disorders of pregnancy: a cross-sectional survey.

Chen Haihong H Tang Yuqing Y Liu Chenxi C Liu Junjie J Wang Kang K Zhang Xinping X

Archives of public health = Archives belges de sante publique 20200508

<h4>Background</h4>Hypertensive disorders of pregnancy (HDPs) are a major contributor to maternal mortality worldwide, and drug therapy for HDPs is complicated and special. Clinical guidelines help physicians optimize the care for HDPs, but little is known about whether physicians adhere to drug therapy guidelins well, especially in China. This study aims to evaluate adherence to the drug therapy guidelines of the Chinese Obstetricians and Gynecologists Association (COGA) for HDPs and to explore ...[more]

PMID: 32419946

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Project description:BackgroundNigeria has one of the highest rates of maternal mortality in the world (576/100,000 births), with a significant proportion of death attributed to hypertensive disorders in pregnancy (HDPs). High quality antenatal care (ANC) plays a crucial role in early detection and management of HDPs. We conducted an assessment of quality of antenatal care, and its capacity to detect and manage HDPs, in two tiers of Nigerian facilities, with the aim of describing the state of service delivery and identifying the most urgent gaps.MethodsQuality of antenatal care was assessed and compared between primary healthcare centers (PHCs) (n = 56) and hospitals (secondary + tertiary facilities, n = 39) in seven states of Nigeria. A cross-sectional design captured quality of care using facility inventory checklists, semi-structured interviews with healthcare providers and clients, and observations of ANC consultations. A quality of care framework and scoring system was established based on aspects of structure, process, and outcome. Average scores were compared using independent sample t-tests and measures of effect were assessed by multivariate linear regression.ResultsAll domains of quality except provider interpersonal skills scored below 55%. The lowest overall scores were observed in provider knowledge (49.9%) and provider technical skill (47.7%). PHCs performed significantly worse than hospitals in all elements of quality except for provider interpersonal skills. Provider knowledge was significantly associated with their level of designation (i.e., obstetrician vs. other providers).ConclusionsIn order to provide high quality care, ANC in Nigeria must experience massive improvements to inventory, infrastructure and provider knowledge and training. In particular, ANC programs in PHCs must be revitalized to minimize the disparity in quality of care provided between PHCs and hospitals. The relatively low quality of care observed may be contributing to Nigeria's high rate of maternal mortality and burden of disease attributed to HDPs.

Project description:IntroductionLimited data are available to explain nonadherence to methotrexate (MTX) therapy in patients with rheumatoid arthritis (RA). Better understanding of patterns of MTX use and reasons for nonadherence may help identify patients who would benefit from alternative RA treatments and potentially aid in developing strategies to increase overall adherence. The purpose of this study was to assess patients' self-reported adherence to MTX and to identify reasons for nonadherence.MethodsPatient panel members in the US self-reporting a diagnosis of RA of ?3 months' and current MTX use of ?4 weeks' duration, with or without concomitant use of another RA prescription medication, participated in this cross-sectional, web-based survey.ResultsThe sample population (251 MTX monotherapy, 250 MTX combination therapy) was predominantly female, white, non-Hispanic, and educated; 48% were 18-44 years-old, 47% had medical comorbidities, 66% were first diagnosed with RA ?5 years earlier, 51% reported MTX use of <1 year, and 83% reported oral MTX use. Forty-two percent reported not taking MTX exactly as prescribed. Reasons for nonadherence included forgetting to take it (33%), not needing it when feeling well (24%), and concern about long-term safety (24%). Among nonadherent patients, 53% took smaller doses, 52% skipped doses, and 6% reported other nonprescribed ways of taking MTX. Younger age, male sex, and shorter duration of MTX use were associated with poorer self-reported adherence. Compared with monotherapy patients, combination therapy patients, particularly those taking ?2 other RA prescriptions, were less likely to report high adherence.ConclusionNearly half the sample reported poor MTX adherence because they forgot to take it, thought it was not needed when they felt well, or had long-term safety concerns. Patients taking ?2 other RA prescription medications were less likely to report good adherence. Reducing treatment burden without sacrificing efficacy may be a strategy worth evaluating.

Project description:OBJECTIVES:To report the situation of maternal micronutrient supplementation before and during pregnancy in Northwest China and to examine the rates of and factors related to the adherence to micronutrient supplementation among pregnant women in this region, where dietary micronutrient intake is commonly insufficient. DESIGN:A large-scale population-based cross-sectional survey. SETTING:Twenty counties and ten districts of Shaanxi Province. PARTICIPANTS:A sample of 30 027 women were selected using a stratified multistage random sampling method. A total of 28 678 women were chosen for the final analysis after excluding those who did not provide clear information about nutritional supplementation before and during pregnancy. MAIN OUTCOME MEASURES:Maternal adherence to micronutrient supplementation (high and low) were the outcomes. They were determined by the start time and duration of use according to Chinese guidelines (for folic acid (FA) supplements) and WHO recommendations (for iron, calcium and multiple-micronutrient (MMN) supplements). RESULTS:In total, 83.9% of women took at least one kind of micronutrient supplement before or during pregnancy. FA (67.6%) and calcium (57.5%) were the primarily used micronutrient supplements; few participants used MMN (14.0%) or iron (5.4%). Adherence to supplementation of all micronutrients was low (7.4% for FA, 0.6% for iron, 11.7% for calcium and 2.7% for MMN). Higher educational levels, higher income levels, urban residence and better antenatal care (including pregnancy consultation and a higher frequency of antenatal visits) were associated with high adherence to micronutrient supplementation. CONCLUSION:Maternal micronutrient supplementation before and during pregnancy in Northwest China was way below standards recommended by the Chinese guidelines or WHO. Targeted health education and future nutritional guidelines are suggested to improve this situation, especially in pregnant women with disadvantaged sociodemographic conditions.

Dataset Information

Adherence to drug therapy for hypertensive disorders of pregnancy: a cross-sectional survey.

Publications

Adherence to drug therapy for hypertensive disorders of pregnancy: a cross-sectional survey.

Similar Datasets

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