Alzheimer’s disease treatment: Assessing caregiver preferences for mode of treatment delivery Adjunctive treatment with high frequency repetitive transcranial magnetic stimulation for the behavioral and psychological symptoms of patients with Alzheimer's disease: a randomized, double-blind, sham-controlled study Medication adherence survey of drugs useful in prevention of dementia of Alzheimer's type among Indian patients. The Global Adherence Project (GAP): a multicenter observational study on adherence to disease-modifying therapies in patients with relapsing-remitting multiple sclerosis. Tailored Information and Automated Reminding to Improve Medication Adherence in Spanish- and English-Speaking Elders Treated for Memory Impairment Predictors of adherence to a skill-building intervention in dementia caregivers. Improving medication adherence in stroke survivors: mediators and moderators of treatment effects. Electronic monitoring-based counseling to enhance adherence among HIV-infected patients: a randomized controlled trial. Verbal repetition in patients with Alzheimer's disease who receive donepezil. A multifaceted prospective memory intervention to improve medication adherence: design of a randomized control trial. A randomized controlled multimodal behavioral intervention trial for improving antiepileptic drug adherence Adherence therapy versus routine psychiatric care for people with schizophrenia spectrum disorders: a randomised controlled trial Treatment Patterns, Adherence, and Persistence in ADHD: A Canadian Perspective Effects of an educational compliance enhancement programme and therapeutic drug monitoring on treatment adherence in depressed patients managed by general practitioners Cognitive Function and Treatment Adherence in Older Adults With Heart Failure The effect of reminder systems on patients’ adherence to treatment An intervention that delays institutionalization of Alzheimer's disease patients: treatment of spouse-caregivers.
Introduction Management of patients with Alzheimer ’s Disease ( AD ) can exert a substantial burden upon caregivers . As new modes of treatment administration are developed , it is important to assess caregiver satisfaction and preference in a st and ardized manner . This study describes the development of the Alzheimer ’s Disease Caregiver Preference Question naire ( ADCPQ ) to assess AD caregivers ’ satisfaction with and preference for patch or capsule treatments in AD patients . Methods Twenty-five published articles ( 1987 - 2002 ) were review ed to identify potential ADCPQ domains . Three caregiver focus groups ( n=24 ) were conducted to develop a first draft of the question naire . After evaluating the acceptance of ADCPQ to caregivers through in-depth interviews ( n=10 ) , its psychometric properties were assessed using data from 986 patients enrolled in a multicenter , r and omized , double-blind , four-arm , placebo- and active-controlled , 24-week trial . Results Focus groups indicated that caregivers expressed dissatisfaction with current AD treatment routines including limitations related to : efficacy , administration schedule , number of pills , adherence to treatment , side effects , and taking pills . In-depth interviews with caregivers found the ADCPQ to be comprehensible with an acceptable layout . The result ant ADCPQ comprises three modules : A ) baseline , 11 items assessing treatment expectations ; B ) week 8 , 33 items on satisfaction and preferences with treatment options ; C ) week 24 , 10 items assessing overall opinions of treatment options . Missing data per item was low ( ≤0.3 % ) and domain internal consistency reliability was good ( 0.71–0.91 ) . Preference items were also valid when evaluating concordance and discordance between convenience and satisfaction patch and capsule domain scores . Conclusion AD treatment puts a significant strain on caregivers . New modes of treatment delivery may be less burdensome to caregivers , thereby increasing satisfaction and potential treatment adherence . The ADCPQ was well accepted by AD caregivers and its domains demonstrated satisfactory psychometric properties . The ADCPQ is a useful tool to underst and caregiver preferences for patch versus oral therapies in AD Background Behavioral and psychological symptoms of dementia ( BPSD ) occur in 70 - 90 % of patients at different stages of Alzheimer ’s Disease ( AD ) , but the available methods for managing these problems are of limited effectiveness . Aim Assess the effects of high-frequency repetitive transcranial magnetic stimulation ( rTMS ) , applied over the left dorsolateral prefrontal cortex ( DLPFC ) , on BPSD and cognitive function in persons with AD . Methods Fifty-four patients with AD and accompanying BPSD were r and omly divided into an intervention group ( n=27 ) and a control group ( n=27 ) . In addition to st and ard antipsychotic treatment , the intervention group was treated with 20Hz rTMS five days a week for four weeks , while the control group was treated with sham rTMS.The  Behavioral Pathology in Alzheimer 's Disease Rating Scale ( BEHAVE-AD ) , the Alzheimer 's Disease Assessment Scale-Cognitive ( ADAS-Cog ) , and the Treatment Emergent Symptom Scale ( TESS ) were administered by raters who were blind to the group assignment of patients before and after four weeks of treatment . Results Twenty-six subjects from each group completed the study . After four weeks of antipsychotic treatment with adjunctive real or sham rTMS treatment , the mean ( sd ) total BEHAVE-AD scores and mean total ADAS-Cog scores of both groups significantly decreased from baseline . After adjusting for baseline values , the intervention group had significantly lower scores ( i.e. , greater improvement ) than the control group on the BEHAVE-AD total score , on five of the seven BEHAVE-AD factor scores ( activity disturbances , diurnal rhythm , aggressiveness , affective disturbances , anxieties and phobias ) , on the ADAS-Cog total score , and on all four ADAS-Cog factor scores ( memory , language , constructional praxis , and attention ) . The proportion of individuals whose behavioral symptoms met a predetermined level of improvement ( i.e. , a drop in BEHAVE-AD total score of > 30 % from baseline ) in the intervention group was greater than that in the control group ( 73.1 % vs.42.3 % , X2=5.04 , p=0.025 ) . Conclusion Compared to treatment of AD with low-dose antipsychotic medications alone , the combination of low-dose antipsychotic medication with adjunctive treatment with high frequency rTMS can significantly improve both cognitive functioning and the behavioral and psychological symptoms that often accompany AD BACKGROUND Good medication adherence is the cornerstone of therapeutic success . Alzheimer 's disease ( AD ) is the most common type of dementia and most patients are old and on multiple drugs , and good compliance therefore is even more important in this population . Dementia of Alzheimer 's type ( DAT ) at present is yet to find a cure . Anticholinesterases and N-methyl-D-aspartate blockers are specific anti-AD therapies available . Hypertension , diabetes , and dyslipidemia can contribute to cognitive worsening . Keeping hypertension , diabetes , and dyslipidemia in control can therefore possibly prevent further cognitive decline . METHODS Patients with subjective memory complaints ( n = 75 ) were chosen r and omly . Upon thorough neurological diagnostic work up for dementia , those with mild cognitive impairment/ question able dementia ( Clinical Dementia Rating = 0.5 ) or those with AD were recruited in this study ( n = 67 ) . Those with hypertension , diabetes , and deranged lipid profile were further interviewed if they were able to take medicines regularly or not . An attempt was made to know causes of non-compliance . RESULTS Forty-one percent of patients were not taking the drugs that have potential to prevent cardiovascular complications or ability to slow down cognitive decline in AD on regular basis . The lack of awareness , ignorance , medicines being " too expensive , " and the pressure of taking medicines regularly were cited as the reasons for non-compliance . Being illiterate and having low education contributed majorly to poor compliance in this study . CONCLUSION Compliance to drugs that have potential or real ability to slow down cognitive decline is low in elderly people with DAT BACKGROUND most disease-modifying therapies ( DMTs ) for multiple sclerosis ( MS ) are self-injectable medications that must be taken on an ongoing basis to reduce disease activity . Thus , adherence to therapy becomes an important challenge that must be addressed to maximize benefits of therapy . This study evaluated rates of adherence to prescribed treatment and explored factors affecting adherence amongst patients with relapsing-remitting MS . METHODS this was an observational , multicenter , multinational , phase 4 study . Patients and physicians received paper question naires regarding adherence to DMTs approved at the time of the study , including intramuscular interferon beta-1a ( IFNβ-1a ) , subcutaneous IFNβ-1a , IFNβ-1b , and glatiramer acetate . Quality of life and cognition data also were collected . Multivariate analysis was conducted to identify factors associated with adherence to long-term DMTs . RESULTS two thous and six hundred and forty-eight patients were studied , revealing an average treatment duration of 31 months . Seventy-five percent of patients ( n = 1923 ) were adherent to therapy . The most common reasons for non-adherence were forgetting to administer the injection ( 50.2 % ) and other injection-related reasons ( 32.0 % ) . Adherent patients reported better quality of life ( P < 0.05 ) and fewer neuropsychological issues ( P < 0.001 ) than non-adherent patients . Adherent patients had significantly shorter duration of disease ( P < 0.001 ) and shorter duration of therapy ( P = 0.005 ) than non-adherent patients . Women were more likely than men to adhere to treatment . CONCLUSION identifying factors that affect adherence to prescribed treatments is the first step in improving adherence of patients with MS to therapy , thereby helping maximize the benefits of long-term DMTs Medication adherence is recognized as an issue of critical importance within health care , as many patients do not take their medications as prescribed . This study evaluated two interventions targeted at improving adherence in elderly patients being treated for memory impairments . Twenty-seven participants were r and omly assigned to control ( n = 11 ) , automated reminding ( n = 8) , or tailored information conditions ( n = 8) . Medication adherence  was evaluated with an electronic pill bottle . Generalized estimating equation ( GEE ) models assessed the effects of the interventions on electronically monitored medication adherence after controlling for covariates . Results showed that individuals in both intervention groups had higher levels of medication adherence than those in the control group . The presence of a caregiver was associated with substantially higher levels of adherence . Verbal memory , but not general cognitive status , predicted better adherence . Mood , health literacy , and executive functions were not associated with adherence . Results thus suggest that both automated reminding and tailored information interventions may improve medication adherence in elders , even among those with memory impairments BACKGROUND Treatment adherence is a widely recognized problem in health services but understudied in caregiver intervention research . This study examines caregiver sociodemographic and psychological characteristics , patient illness severity , and treatment implementation factors as predictors of caregiver adherence to a skills training intervention to help families manage dementia care problems at home . METHODS The sample consisted of 105 caregivers r and omized to the Home Environmental Skill-Building Program at the Philadelphia site of the National Institutes of Health ( NIH ) Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH I ) . The intervention , implemented by occupational therapists , consisted of education , problem solving , communication , environmental and task simplification techniques , and home modifications . Adherence was measured by a proportion score representing the percentage of strategies used by participants compared to the total number of strategies prescribed during intervention ( Strategy Use ) . RESULTS Regression analysis with intraclass correlation adjustment for interventionist effects revealed that caregivers with better physical health ( p < .001 ) , greater treatment exposure ( p < .001 ) , more problem areas addressed ( p = .012 ) , and for whom more active therapeutic techniques ( role play ) were used ( p = .004 ) demonstrated greater adherence . Other caregiver characteristics , patient cognitive impairment , and troublesome behaviors were not significantly related to caregiver adherence . CONCLUSIONS Modifiable caregiver and treatment implementation factors , including active engagement of caregivers , were associated with adherence , whereas patient characteristics were not . Caregivers with poor health may be at risk for not benefiting from intervention , suggesting that efforts , including instruction in preventive care and allocating time to attend to their own health care needs , be directed towards improving their health OBJECTIVE The purpose of the current study was to test theory-based predictions of mediators and moderators of treatment effects of a pilot r and omized controlled trial , which aim ed to increase adherence to preventive medication in stroke survivors via addressing both automatic ( i.e. , habitual responses ) and reflective ( i.e. , beliefs and value systems ) aspects of medication-taking behavior . METHOD Sixty-two stroke survivors were r and omly allocated to either an intervention or control group . Intervention participants received a brief 2-session intervention aim ed at increasing adherence via ( a ) helping patients establish better medication-taking routines using implementation intentions plans ( automatic ) , and ( b ) eliciting and modifying any mistaken patient beliefs regarding medication and /or stroke ( reflective ) . The control group received similar levels of non-medication-related contact . Primary outcome was adherence to antihypertensive medicine  measured objective ly over 3 months using an electronic pill bottle . Secondary outcome measures included self-reported adherence ( including forgetting ) and beliefs about medication . RESULTS Intervention participants had 10 % greater adherence on doses taken on schedule ( intervention , 97 % ; control , 87 % ; 95 % CI [ 0.2 , 16.2 ] , p = .048 ) , as well as significantly greater increases in self-reported adherence and reductions in concerns about medication . Treatment effects were mediated by reductions in both forgetting and concerns about medication , and moderated by the presence of preexisting medication-taking routines . CONCLUSIONS Addressing both automatic and reflective aspects of behavior via helping stroke survivors develop planned regular routines for medication-taking , and addressing any concerns or misconceptions about their medication , can improve adherence and thus potentially patient outcomes OBJECTIVE To investigated the effectiveness of an adherence intervention ( AIMS ) design ed to fit HIV-clinics ' routine care procedures . DESIGN Through block r and omization , patients were allocated to the intervention or control group . The study included 2 months baseline measurement , 3 months intervention , and 4 months follow-up .  HIV-nurses  delivered a minimal intervention ( " adherence sustaining " ) to patients scoring > 95 % adherence at baseline , and an intensive intervention ( " adherence improving " ) to patients with < 95 % adherence . Control participants  received high- quality usual care . MAIN OUTCOME MEASURES Electronically monitored adherence and viral load . RESULTS 133 patients were included ( 67 control , 66 intervention ) , 60 % had < 95 % adherence at baseline , and 87 % ( 116/133 ) completed the trial . Intent-to-treat analyses showed that adherence improved significantly in the complete intervention sample . Subgroup analyses showed that this effect was caused by participants scoring < 95 % at baseline ( mean difference = 15.20 % ; p < .001 ) . These effects remained stable during follow-up . The number of patients with an undetectable viral load increased in the intervention group compared to the control group ( OR = 2.96 , p < .05 ) . Treatments effects on viral load were mediated by the improvements in adherence . CONCLUSIONS The AIMS -intervention was effective and can be integrated in routine clinical care for HIV-infected patients . Future research should study its (cost)effectiveness among more heterogeneous sample s and in setting s with variable levels of st and ard care BACKGROUND Current outcome measures for Alzheimer 's disease ( AD ) drugs have been criticized as insufficiently patient-centred . One commonly unmeasured goal of patients and caregivers is verbal repetition . OBJECTIVES We examined how often reducing repetition ( of questions , statements or stories ) was set as treatment goal , whether and when it responded , and how change in repetition correlated with change in other domains . METHODS This is a secondary analysis of the open-label Atlantic Canada Alzheimer 's Disease Investigation of Expectations study of donepezil for mild-moderate AD in 100 community-dwelling people .  Goal Attainment Scaling , an individualized account of the goals of treatment , was the primary outcome measure . RESULTS Reducing repetition was a treatment goal in 46 % , who were not systematic ally different from others . Of 18 patients in whom repetition improved for 9 months , 83 % ( 15 ) showed a response at 3 months . Early ( 3-month ) response correlated best with the overall level of goal attainment ( r = 0.74 ) and changes in leisure activities ( r = 0.69 ) and social interactions ( r = 0.68 ) compared with changes in cognition ( r = 0.44 ) or behaviour ( r = 0.11 ) . Correlations with the ADAS-Cog and MMSE change scores remained only modest ( at 12 months = -0.25 and 0.19 , respectively ) . Correlations with the CIBIC-Plus were higher ( -0.47 at 3 months and -0.43 at 12 months ) . CONCLUSION Diminution of repetition is common , and appears to mark response to cholinesterase inhibition in some patients . Responders generally also show improved cognition and function , perhaps as an aspect of improved executive function Adherence to prescribed antihypertensive agents is critical because control of elevated blood pressure is the single most important way to prevent stroke and other end organ damage . Unfortunately , nonadherence remains a significant problem . Previous interventions design ed to improve adherence have demonstrated only small benefits of strategies that target single facets such as underst and ing medication directions . The intervention described here is informed by prospect i ve memory theory and performance of older adults in laboratory-based paradigms and uses a comprehensive , multifaceted approach to improve adherence . It incorporates multiple strategies design ed to support key components of prospect i ve remembering involved in taking medication . The intervention is delivered by  nurses in the home with an education control group  for comparison . Differences between groups in overall adherence following the intervention and 6 months later will be tested . Systolic and diastolic blood pressure levels also will be examined between groups and as they relate to adherence . Intra-individual regression is planned to examine change in adherence over time and its predictors . Finally , we will examine the association between executive function/working memory and adherence , predicting that adherence will be related to executive/working memory in the control group but not in the intervention group PURPOSE Medication nonadherence is one of the most important reasons for treatment failure in patients with epilepsy . The present study investigated the effectiveness of a multicomponent intervention to improve adherence to antiepileptic drug ( AED ) medication in patients with epilepsy . METHODS In a prospect i ve , r and omized multicenter trial , three sessions of face-to-face motivational interviewing ( MI ) in combination with complementary behavior change techniques were compared with st and ard care . Motivational interviewing prompted change talk and self-motivated statements from the patients , planning their own medication intake regimen and also identifying and overcoming barriers that may prevent adherence . Participants were provided with calendars to self-monitor their medication taking behavior . A family member and the health-care team were invited to attend the last session of MI in order to improve the collaboration and communication between patients , their caregiver or family member , and their health-care provider . At baseline and 6-month follow-up , psychosocial variables and medical adherence were assessed . RESULTS In total , 275 participants were included in the study . Compared with the active control group , patients in the intervention group reported significantly higher medication adherence , as well as stronger intention and perceptions of control for taking medication regularly . The intervention group also reported higher levels of action planning , coping planning , self-monitoring , and lower medication concerns . CONCLUSIONS This study shows that MI can be effective in clinical practice to improve medication adherence in patients with epilepsy . It also provides evidence that combining volitional interventions , including action planning , coping planning , and self-monitoring with motivational interviewing can promote the effectiveness of the medical treatments for epilepsy by improving adherence Background Current practice guidelines for schizophrenia care recommend that antipsychotic medication is essential for patients ’ long-term maintenance treatment but their non-adherence to this medication is still a main obstacle to relapse prevention . This study evaluated the effects of a motivational-interviewing-based adherence therapy for people with schizophrenia spectrum disorders . Methods This r and omised controlled trial was conducted with 134 out patients with schizophrenia spectrum disorders ; 67 of them received a six-session adherence therapy ( in addition to usual care ) and 67 received usual psychiatric care alone .  Participants ’ outcome measures included symptom severity , medication adherence , hospitalisation rates , insight into illness/treatment , and functioning . Results The adherence therapy group reported significantly greater improvements in symptom severity ( p < 0.003 ) , insight into illness/treatment ( p < 0.001 ) , functioning ( p < 0.005 ) , duration of re-hospitalisations ( p < 0.005 ) , and medication adherence ( p < 0.005 ) over 18 months follow-up , when compared with usual care alone . Conclusions Motivational-interviewing-based adherence therapy can be an effective approach to treatment for people with early stage of schizophrenia who poorly adhere to medication regimen . Trial registration Clinical Trials.gov NCT01780116 , registration date January 29 , 2013 Abstract Objective : To underst and attention – deficit/hyperactivity disorder ( ADHD ) treatment patterns and estimate adherence and persistence in Quebec , Canada . Design : This cross – sectional , retrospective prescription cl aims analysis used a r and om sample of 15 838 patients with ADHD from a Quebec data base ( Régie de l'assurance maladie du Québec [ RAMQ ] ) to assess treatment patterns , adherence ( 1–year medication possession ratio in new users ) , and persistence ( proportion persistent at 3 , 6 , and 12 months after index prescription ) . Results : The mean patient age was 14 years ; 72.6 % were male . During the 5–year study period ( 2004–2009 ) , 416 646 ADHD prescriptions were flled .  Short – acting ( SA ) medications declined from 72.8 % to 26.4 % of all cl aims , while stimulant and nonstimulant long – acting ( LA ) medications increased from 27.2 % to 73.6 % . Approximately half of the patients used both  SA and LA medications ( either concomitantly or subsequently ) , and the others used only SA ( 30 % ) or LA ( 19 % ) drugs . Among patients using both , switching from SA to LA was the most frequent ( 27.9 % ) treatment pattern . More patients on LA methylpheni date s ( 6.4 % ) compared with LA amphetamines ( 1.9 % ; P < 0.01 ) required augmentation with an SA drug . Fewer patients on SA stimulants ( 39.4 % ) were ≥ 80 % adherent compared with LA stimulants ( 63 % ; P < 0.001 ) and LA nonstimulants ( 60.2 % ; P < 0.001 ) . More patients on LA stimulants ( 81.1 % ) were persistent at 12 months compared with LA nonstimulants ( 61.7 % ; P < 0.001 ) and SA stimulants ( 59.6 % ; P < 0.001 ) . Similar trends were observed at all time points measured . Conclusions : Switching from SA to LA medications and treatment augmentation are common in ADHD management , with implication s for patient care and health care re source use . This analysis found poor adherence in ADHD treatment , although adherence and persistence were improved with LA stimulant formulations Medication non-adherence is a major obstacle in the treatment of affective disorders . The primary objective of this study was to evaluate two different interventions to improve adherence to antidepressant drugs .  Secondary objectives included response to treatment , relation between adherence and response , patient satisfaction and tolerability . A r and omized controlled design was used to assess the effect of a patient educational compliance enhancing programme ( CP ) and therapeutic drug monitoring in 1031 major depressed patients treated with sertraline for 24 weeks and managed by their general practitioner .  Adherence was measured by question ing , measurable serum levels of sertraline and desmethylsertraline , appointments kept and a composite index including all three methods . Treatment adherence was found in 37–70 % of patients , depending on the method used . Neither of the interventions result ed in a significant increase in adherence rate . However , significantly more patients in the CP group had responded at week 24 compared to patients in the control group . Overall , significantly more adherent patients responded to treatment compared to non-adherent patients , regardless of method used to determine adherence . This large study demonstrates that treatment response increases when using an educational compliance programme and that a strong relationship between treatment adherence and response exists Objective Treatment recommendation and guidelines for patients with heart failure ( HF ) can be complex , and past work has shown that patients with HF demonstrate low rates of adherence to recommended health behaviors . Although previous work has identified several medical , demographic , and psychosocial predictors of the capacity to adhere to treatment recommendations of persons with HF , little is known about the contribution of cognitive impairment to reported treatment adherence in this population . Methods A total of 149 persons with HF ( mean [ st and ard deviation ] = 68.08 [ 10.74 ] years ) completed a brief fitness assessment and neuropsychological testing . Treatment adherence was assessed using the  Heart Failure Compliance Question naire , a brief measure that asks participants to report their adherence to a variety of recommended health behaviors ( i.e. , medication management , diet , and exercise , among others ) . Results The percentage of participants who reported poor overall adherence was 16.1 % , with particularly high rates of nonadherence to dietary and exercise recommendations . Hierarchical regression analyses adjusting for possible confounds revealed that reduced performance on attention ( & bgr ; = .26 , p = .01 ) , executive function ( & bgr ; = .18 , p = .04 ) , and language ( & bgr ; = .22 , p = .01 ) was associated with poorer overall adherence . Follow-up analyses showed that these cognitive domains were associated with behaviors such as keeping doctor appointments , medication management , and dietary recommendations ( p < .05 for all ) . Conclusions The current findings demonstrate that cognitive function is an independent contributor to adherence in older adults with HF . Prospect i ve studies that objective ly measure treatment adherence are needed to clarify these findings and identify possible strategies to improve outcomes in this population . Trial Registration : clinical trials.gov Identifier : NCT00871897 Background Patient adherence is an important component of the treatment of chronic disease . An underst and ing of patient adherence and its modulating factors is necessary to correctly interpret treatment efficacy and barriers to therapeutic success . Purpose This meta- analysis aims to systematic ally review published r and omized controlled trials of reminder interventions to assist patient adherence to prescribed medications . Methods A Medline search was performed for r and omized controlled trials published between 1968 and June 2011 , which studied the effect of reminder-based interventions on adherence to self-administered daily medications . Results Eleven published r and omized controlled trials were found between 1999 and 2009 which measured adherence to a daily medication  in a group receiving reminder interventions compared to controls receiving no reminders .  Medication adherence was measured as the number of doses taken compared to the number prescribed within a set period of time . Meta- analysis showed a statistically significant increase in adherence in groups receiving a reminder intervention compared to controls ( 66.61 % versus 54.71 % , 95 % CI for mean : 0.8 % to 22.4 % ) . Self-reported and electronically monitored adherence rates did not significantly differ ( 68.04 % versus 63.67 % , P = 1.0 ) . Eight of eleven studies showed a statistically significant increase in adherence for at least one of the reminder group arms compared to the control groups receiving no reminder intervention . Limitations The data are limited by imperfect measures of adherence due to variability in data collection methods . It is also likely that concomitant educational efforts in the study population s , such as instructions regarding proper administration and importance of correct dosing schedules , contributed to improved patient adherence , both in reminder and control arms . The search strategy could have missed relevant studies which were categorized by disease rather than adherence . Conclusions Reminder-based interventions may improve adherence to daily medications . However , the interventions used in these studies , which included reminder phone calls , text messages , pagers , interactive voice response systems , videotelephone calls , and programmed electronic audiovisual reminder devices , are impractical for widespread implementation , and their efficacy may be optimized when combined with alternative adherence-modifying strategies . More practical reminder-based interventions should be assessed to determine their value in improving patient adherence and treatment outcomes Spouse-caregivers of Alzheimer 's disease patients were r and omly assigned to either a treatment group ( individual and family counseling , support group participation , and ad hoc consultation ) or a control group ( only routine support ) . In the first year after intake , the treatment group had less than half as many nursing home placements as the control group . This suggests that a comprehensive counseling program can reduce the socioeconomic impact of Alzheimer 's disease . Nursing home placement also was affected by the patient 's need for assistance with activities of daily living , patient income , and the age of the patients and caregivers
Results : Intentional factors affecting adherence include patient , caregiver and prescriber beliefs about therapies and the disease itself .
Conclusion : Due to the high level of caregiver involvement in the care of patients with AD , strategies that address caregiver concerns may improve adherence
Background / Aims : Treatment adherence is a major problem in numerous medical conditions , and is a particular challenge in patients with Alzheimer 's disease ( AD ) .