Impact of antiretroviral regimen switches on adherence.

Purpose: An understanding of the situations in which adherence lapses occur is critical to the design of effective interventions to enhance adherence. We investigated whether a switch in antiretroviral medications affected adherence by examining a prospective observational cohort of 128 patients who began a new antiretroviral regimen.

Method: Adherence was measured using electronic devices, pill counts, and self-reports, which were combined into a composite adherence measure and expressed as the proportion of prescribed medication taken.

A prospective study of predictors of adherence to combination antiretroviral medication.

Objective: Adherence to complex antiretroviral therapy (ART) is critical for HIV treatment but difficult to achieve. The development of interventions to improve adherence requires detailed information regarding barriers to adherence. However, short follow-up and inadequate adherence measures have hampered such determinations.

The alcohol-related problems survey: identifying hazardous and harmful drinking in older primary care patients.

Objectives: Older adults can incur problems at low levels of alcohol consumption because of age-related physiological changes, declining health and functional status, and medication use. We have developed and tested a screening measure specifically for older people, the Alcohol-Related Problems Survey (ARPS), to identify older adults with these risks.

Design: Survey.

Effects of CAHPS health plan performance information on plan choices by New Jersey Medicaid beneficiaries.

Objective: To assess the effects of CAHPS health plan performance information on plan choices and decision processes by New Jersey Medicaid beneficiaries.

Data Sources/study Setting: The study sample was a statewide sample of all new Medicaid cases that chose Medicaid health plans during April 1998. The study used state data on health maintenance organization (HMO) enrollments and survey data for a subset of these cases.

Patient preferences regarding antiretroviral therapy.

Antiretroviral medications for HIV infection can be combined into dozens of recommended regimens. However, little is known about patient preferences regarding antiretroviral therapy. We assessed the impact of clinician-mutable adherence barriers by conducting four patient focus groups (two English and two Spanish) consisting of 30 patients that focused discussion on antiretroviral treatment preferences.

Effect of CAHPS performance information on health plan choices by Iowa Medicaid beneficiaries.

This evaluation tested if Consumer Assessment of Health Plans Study (CAHPS) information on plan performance affected health plan choices by new beneficiaries in Iowa Medicaid. New cases entering Medicaid in selected counties during February through May 2000 were assigned randomly to experimental or control groups. The control group received standard Medicaid enrollment materials, and the experimental group received these materials plus a CAHPS report.

Development, reliability, and validity of the expectations regarding aging (ERA-38) survey.

Purpose: To develop a reliable and valid instrument to measure older adults' expectations regarding aging.

Design And Methods: Using focus groups, cognitive interviews, and multitrait scaling analysis, we developed a 38-item survey to measure expectations regarding aging (ERA-38). The survey consisted of 10 scales, each representing a domain of expectations.

Beyond alcoholism: identifying older, at-risk drinkers in primary care.

Objective: To evaluate the validity and reliability of two self-report instruments: the Alcohol-Related Problems Survey (ARPS) and its shorter version the Short ARPS (shARPS) that identify older persons whose use of alcohol alone or with their comorbidities may be placing them at risk for or causing them harm.

Method: We compared the two measures against a "LEAD" (longitudinal evaluation done by experts employing all available data) standard among a sample of 166 drinkers aged 60 years and older in 10 internal medicine clinics. The LEAD standard included a medical record review, a clinical interview and a telephone interview with a collateral informant.

Seizure reduction and quality of life improvements in people with epilepsy.

Purpose: Previous research suggests that seizure freedom may be necessary to improve health-related quality of life (HRQOL) for epilepsy surgery patients, but little is known regarding the seizure-frequency reduction needed to improve HRQOL among medically treated individuals.

Methods: With data from 134 adults with refractory complex partial seizures participating in a randomized controlled antiepileptic drug (AED) trial, we compared the change in HRQOL across groups having different levels of change in seizure frequency: 100%, 75-99%, 50-74% reduction, and 0-50% increase or decrease. Changes over time within each seizure-reduction group also were assessed.

Patient, clinician, and population perspectives on determining the clinical significance of quality-of-life scores.

Despite the success of screening and treatment of major cancers in the United States, cancer remains a chronic condition dominated by symptoms and treatment-related adverse effects. Because of these often taxing symptoms and adverse effects, numerous studies have been conducted to document the effects of cancer diagnosis and treatment on the quality of life (QOL) of patients. But there has been limited investigation of the clinical significance of QOL scores.

CAHPS in practice: the Iowa demonstration.

This article evaluates the usefulness of the Consumer Assessment of Health Plan Study (CAHPS) surveys and reports in a demonstration and evaluation with three health care purchasers in Iowa. The CAHPS survey detected significant differences between health plans in several domains of health care. Both paper- and Web-based consumer reports were developed and distributed to consumers and stakeholders.

How well do clinicians estimate patients' adherence to combination antiretroviral therapy?

Objective: Adherence to combination antiretroviral therapy is critical for clinical and virologic success in HIV-infected patients. To combat poor adherence, clinicians must identify nonadherent patients so they can implement interventions. However, little is known about the accuracy of these assessments.