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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 224 Research Studies Displayed
Nguyen JK, Sanghavi P
A national assessment of legacy versus new generation Medicaid data.
The purpose of the study was to review Medicaid legacy, Medicaid new generation, and Medicare claims across multiple states and compare performance on data analytic tasks. The researchers targeted the series of events that begins with a non-hospital-related medical emergency and ends with survival to discharge or death. Six data quality indicators were developed to evaluate the following: ambulance variables; code reporting for external cause of injury; linkage between claims; and death reporting on hospital discharge status codes. For death reporting on hospital discharge status codes the researchers estimated the severity of injuries and developed a model of its correlation with death in the Medicare population. The resulting model was utilized to compare reported versus expected deaths by level of injury severity in the Medicaid population. The study found that new generation Medicare claims had high performance across states and indicators, Medicaid legacy claims underperformed on multiple indicators in most states, and while new generation Medicaid claims outperformed Medicaid legacy claims on several indicators, conducting high-level analysis with that data will require substantial improvements.
Citation: Nguyen JK, Sanghavi P . A national assessment of legacy versus new generation Medicaid data. Health Serv Res 2022 Aug;57(4):944-56. doi: 10.1111/1475-6773.13937..
Keywords: Medicaid, Medicare, Care Management
Singh AN, Sanchez V, Kenzie ES
Improving screening, treatment, and intervention for unhealthy alcohol use in primary care through clinic, practice-based research network, and health plan partnerships: protocol of the ANTECEDENT study.
This study evaluates tailored implementation support to increase screening, brief intervention, referral to treatment (SBIRT) and medication-assisted treatment for alcohol use disorder (MAUD) in primary care. It will explore how primary care clinics implement SBIRT and MAUD in routine practice and how practice facilitators vary implementation support across diverse clinic settings. It is anticipated that findings will inform how effectively to align implementation support to context, advance understanding of practice facilitator skill development over time, and ultimately improve detection and treatment of unhealthy alcohol use across diverse primary care clinics.
Citation: Singh AN, Sanchez V, Kenzie ES . Improving screening, treatment, and intervention for unhealthy alcohol use in primary care through clinic, practice-based research network, and health plan partnerships: protocol of the ANTECEDENT study. PLoS One 2022 Jun 28;17(6):e0269635. doi: 10.1371/journal.pone.0269635..
Keywords: Alcohol Use, Substance Abuse, Behavioral Health, Primary Care, Care Management
Meiselbach MK, Drake C, Saloner B
Medicaid managed care: access to primary care providers who prescribe buprenorphine.
This study examined variation in access to in-network buprenorphine-prescribing primary care providers that can treat opioid use disorder among Medicaid managed care enrollees. Approximately 32.2% of Medicaid enrollees had fewer than one in-network network buprenorphine-prescribing primary care providers per 100,000 county residents. There was on average a greater number of in-network buprenorphine-prescribing primary care providers in states with higher compared with lower overdose death rates, but most enrollees lived in areas with a shortage of these providers. The authors found that a 25 percent higher network participation rate by prescribers compared with nonprescribers could improve the probability that enrollees see a prescriber by approximately 25 percent.
Citation: Meiselbach MK, Drake C, Saloner B . Medicaid managed care: access to primary care providers who prescribe buprenorphine. Health Aff 2022 Jun;41(6):901-10. doi: 10.1377/hlthaff.2021.01719..
Keywords: Medicaid, Primary Care, Access to Care, Medication, Care Management, Opioids, Substance Abuse, Behavioral Health
Hollowell M, Hudmon KS, Perkins SM
Evaluation of a modified and abbreviated scale for assessing chronic illness care for medication therapy management practice.
The purpose of the study was to evaluate the validity and internal consistency of the Assessment of Chronic Illness Care (ACIC) abbreviated, 12-item scale as a novel instrument for measuring Medication Therapy Management (MTM) care delivery. Researchers administered the instrument to pharmacists employed at 27,560 community pharmacies. The study concluded that when applied to the measurement of chronic illness care within the MTM setting, the abbreviated ACIC showed acceptable validity and internal consistency, and could serve as a valuable tool.
Citation: Hollowell M, Hudmon KS, Perkins SM . Evaluation of a modified and abbreviated scale for assessing chronic illness care for medication therapy management practice. Res Social Adm Pharm 2022 May;18(5):2804-10. doi: 10.1016/j.sapharm.2021.06.006..
Keywords: Chronic Conditions, Medication, Provider: Pharmacist, Care Management
Brajcich BC, Shallcross ML, Johnson JK
Barriers to post-discharge monitoring and patient-clinician communication: a qualitative study.
This study used semi-structured interviews and focus groups to identify barriers to post-discharge monitoring and patient-clinician communication. Participants were gastrointestinal surgery patients and clinicians, with a total of 15 patients and 17 clinicians. Four themes and four barriers were identified from patient and clinician interviews and focus groups. Patient-identified barriers included education and expectation setting, technology access and literacy, availability of resources and support, and misalignment of communication preferences. Clinician-identified barriers included health education, access to clinical team, healthcare practitioner time constraints, and care team experience and consistency.
Citation: Brajcich BC, Shallcross ML, Johnson JK . Barriers to post-discharge monitoring and patient-clinician communication: a qualitative study. J Surg Res 2021 Dec;268:1-8. doi: 10.1016/j.jss.2021.06.032..
Keywords: Hospital Discharge, Clinician-Patient Communication, Care Management, Transitions of Care
Gupta AR, Brajcich BC, Yang AD
Necessity of posttreatment surveillance for low-grade appendiceal mucinous neoplasms.
This study’s objectives were to characterize posttreatment surveillance and determine the risk of recurrence following surgical resection of low-grade appendiceal mucinous neoplasms (LAMNs). Patients who underwent surgical rection of localized LAMNs in an 11-hospital regional healthcare system from 2000 to 2019 were included. A total of 114 patients with LAMNs were identified with various tumor grades, most of them pTis (80.7%). Patients were followed up with posttreatment surveillance (n = 39). No patients experienced tumor recurrence after a mean follow-up duration of 4.7 years, suggesting that routine surveillance may be unnecessary.
Citation: Gupta AR, Brajcich BC, Yang AD . Necessity of posttreatment surveillance for low-grade appendiceal mucinous neoplasms. J Surg Oncol 2021 Dec;124(7):1115-20. doi: 10.1002/jso.26621..
Keywords: Cancer, Surgery, Care Management
Barreto EF, Schreier DJ, May HP
Incidence of serum creatinine monitoring and outpatient visit follow-up among acute kidney injury survivors after discharge: a population-based cohort study.
This study evaluated the frequency of follow-up after hospital discharge among acute kidney injury (AKI) survivors. This population-based cohort study included adult residents of Olmsted County hospitalized from an episode of stage II or II AK between 2006 and 2014. Follow-up visits at 30-days, 90 days, and 1 year were included. In the 627 included AKI survivors, the cumulative incidence of a follow-up serum creatinine (SCr) level was 80%, a healthcare visit 82%, or both was 70%. At 90 days and 1 year after discharge, cumulative incidents of meeting both follow-up criteria rose to 82 and 91% respectively. Independent predictors of receiving both were not related to demographic or socioeconomic factors but to lower estimated glomerular filtration rate at discharge, higher comorbidity burden, longer length of hospitalization, and greater maximum AKI severity.
Citation: Barreto EF, Schreier DJ, May HP . Incidence of serum creatinine monitoring and outpatient visit follow-up among acute kidney injury survivors after discharge: a population-based cohort study. Am J Nephrol 2021;52(10-11):817-26. doi: 10.1159/000519375..
Keywords: Kidney Disease and Health, Hospital Discharge, Care Management, Healthcare Utilization
Pestka DL, Brummel AR, Wong MT
Characterizing the reach of comprehensive medication management in a population health primary care model.
As care teams adopt team-based models of care, it is important to examine the reach of interdisciplinary services, such as pharmacists providing comprehensive medication management (CMM). This study examined the reach of pharmacist-delivered CMM in the first 10 months of a population health-focused primary care transformation (PCT). This study illustrated that pharmacists providing CMM see complex patients with a high propensity for medication therapy problems.
Citation: Pestka DL, Brummel AR, Wong MT . Characterizing the reach of comprehensive medication management in a population health primary care model. J Am Coll Clin Pharm 2021 Nov;4(11):1410-19. doi: 10.1002/jac5.1525..
Keywords: Medication, Care Management, Provider: Pharmacist, Implementation
Baughman KR, Ludwick R, Jarjoura D
Multi-site study of provider self-efficacy and beliefs in explaining judgments about need and responsibility for advance care planning.
This study’s objective was to examine the impact of advance care planning (ACP) self-efficacy and beliefs in explaining skilled nursing facility (SNF) provider judgements about resident need and provider responsibility for initiating ACP conversations. This observational multi-site study anonymously surveyed 348 registered nurses, LPNs, and social workers within 29 SNFs. Providers who had more negative beliefs about ACP were less likely to judge residents in need of ACP and less likely to feel responsible for ensuring that ACP occurred. Providers with higher self-efficacy for ACP were more likely to feel responsible for ensuring ACP conversations.
Citation: Baughman KR, Ludwick R, Jarjoura D . Multi-site study of provider self-efficacy and beliefs in explaining judgments about need and responsibility for advance care planning. Am J Hosp Palliat Care 2021 Nov;38(11):1276-81. doi: 10.1177/1049909120979977..
Keywords: Care Management, Decision Making
Fraze TK, Beidler LB, Fichtenberg C
Resource brokering: efforts to assist patients with housing, transportation, and economic needs in primary care settings.
This study reviewed how 29 diverse health care organizations assisted patients with housing, transportation, and economic needs in primary care settings. Semistructured interviews were conducted with leaders and frontline staff. Organizations used case management programs to assist patients with social needs through referrals to community-based organizations (CBOs) and regular follow-up. About one-half incorporated care into established case management programs, and the remaining described standalone programs. While all organizations referred patients to CBOs, some also provided more intense services such as assistance in completing patients’ applications for services or conducting home visits. Challenges described by the organizations include: 1) effectively engaging CBOs; 2) obtaining buy-in from clinical staff; 3) considering patients' perspectives; and 4) ensuring program sustainability.
Citation: Fraze TK, Beidler LB, Fichtenberg C . Resource brokering: efforts to assist patients with housing, transportation, and economic needs in primary care settings. Ann Fam Med 2021 Nov-Dec;19(6):507-14. doi: 10.1370/afm.2739..
Keywords: Social Determinants of Health, Primary Care, Care Management
MacDonald J, Doyle L, Moore
Sustainment of proactive physical therapy for individuals with early-stage Parkinson's disease: a quality improvement study over 4 years.
The purpose of this study is to describe the process of sustaining a proactive physical therapy (PAPT) program in practice for 4 years for patients with early-stage Parkinson’s disease. Sustainability was measured using RE-AIM, NHS Sustainability Model, and the Clinical Sustainability Assessment Tool. Reach increased from 28 to 110 total patients per year. The program sustained its effect to help participants increase or maintain self-reported exercise. Upon evaluation, PAPT users in year 3 had longer time since symptom onset and worse UPDRS motor scores compared to year 1 PAPT users.
Citation: MacDonald J, Doyle L, Moore . Sustainment of proactive physical therapy for individuals with early-stage Parkinson's disease: a quality improvement study over 4 years. Implement Sci Commun 2021 Sep 27;2(1):111. doi: 10.1186/s43058-021-00205-x..
Keywords: Neurological Disorders, Quality Improvement, Quality of Care, Care Management
Jeffery AD, Werthman JA, Danesh V
Assess, prevent, and manage pain; both spontaneous awakening and breathing trials; choice of analgesia/sedation; delirium: assess, prevent, and manage; early mobility; family engagement and empowerment bundle implementation: quantifying the association of
This paper discusses a multicenter, exploratory, cross-sectional study to describe the physical environment factors of bundle-enhancing items and the association of physical environment with bundle adherence. The study included 10 medical and surgical ICUs in 6 academic medical centers. The cohort included adults with qualifying respiratory failure and/or septic shock. The interventions used were the Awakening, and Breathing trial Coordination, Delirium assessment/management, and Early mobility bundle as the recommended standard of care for randomized controlled trial patients. Primary outcome was adherence to the full bundle and the early mobility bundle component as identified from daily adherence documentation of 751 patient observations. Both unit- and patient-level factors such as unit size, a standard walker, and age were associated with increased or decreased adherence. Mechanical ventilation was always associated with decreased bundle adherence.
Citation: Jeffery AD, Werthman JA, Danesh V . Assess, prevent, and manage pain; both spontaneous awakening and breathing trials; choice of analgesia/sedation; delirium: assess, prevent, and manage; early mobility; family engagement and empowerment bundle implementation: quantifying the association of Crit Care Explor 2021 Sep 14;3(9):e0525. doi: 10.1097/cce.0000000000000525..
Keywords: Critical Care, Intensive Care Unit (ICU), Care Management, Evidence-Based Practice
Siddique SM, Tipton K, Leas B
Interventions to reduce hospital length of stay in high-risk populations: a systematic review.
Many strategies to reduce hospital length of stay (LOS) have been implemented, but few studies have evaluated hospital-led interventions focused on high-risk populations. The Agency for Healthcare Research and Quality (AHRQ) Learning Health System panel commissioned this study to further evaluate system-level interventions for LOS reduction. The objective of this study was to identify and synthesize evidence regarding potential systems-level strategies to reduce LOS for patients at high risk for prolonged LOS.
Citation: Siddique SM, Tipton K, Leas B . Interventions to reduce hospital length of stay in high-risk populations: a systematic review. JAMA Netw Open 2021 Sep;4(9):e2125846. doi: 10.1001/jamanetworkopen.2021.25846..
Keywords: Learning Health Systems, Health Systems, Evidence-Based Practice, Hospital Discharge, Risk, Inpatient Care, Care Management
Wegier P, Belden JL, Canfield SM
Home blood pressure data visualization for the management of hypertension: using human factors and design principles.
Home blood pressure measurements have equal or even greater predictive value than clinic blood pressure measurements regarding cardiovascular outcomes. With advances in home blood pressure monitors, there is an imminent flood of home measurements, but current electronic health record systems lack the functionality to allow us to use this data to its fullest. In this study, the investigators designed a data visualization display for blood pressure measurements to be used for shared decision making around hypertension.
Citation: Wegier P, Belden JL, Canfield SM . Home blood pressure data visualization for the management of hypertension: using human factors and design principles. BMC Med Inform Decis Mak 2021 Aug 5;21(1):235. doi: 10.1186/s12911-021-01598-4..
Keywords: Hypertension, Blood Pressure, Cardiovascular Conditions, Care Management
Hoffmann JA, Pergjika A, Konicek CE
Pharmacologic management of acute agitation in youth in the emergency department.
In this article, the authors reviewed the definition of agitation and pharmacologic management for youth with acute agitation, including common classes of medications, indications for use, and adverse effects. They also discussed the need to integrate the use of medications into a comprehensive strategy for agitation management that begins with proactive prevention of aggressive behavior, creation of a therapeutic treatment environment, and verbal de-escalation strategies.
Citation: Hoffmann JA, Pergjika A, Konicek CE . Pharmacologic management of acute agitation in youth in the emergency department. Pediatr Emerg Care 2021 Aug;37(8):417-22. doi: 10.1097/pec.0000000000002510..
Keywords: Children/Adolescents, Emergency Department, Medication, Care Management
Nguyen KH, Fields JD JD, Cemballi AG
The role of community-based organizations in improving chronic care for safety-net populations.
Researchers conducted a multi-stakeholder qualitative study to capture the multi-level influences on health for those living in socio-economically deprived contexts. Participants were patients with chronic illnesses in San Francisco neighborhoods with high chronic disease rates, community leaders serving the same neighborhoods, or providers from San Francisco's public health care delivery system. The researchers identified several key themes. They concluded that their results contributed new evidence toward the community domain of the Chronic Care Model, and health care systems must intentionally partner with community-based organizations to address social determinants of health and improve community resources for chronic care management.
Citation: Nguyen KH, Fields JD JD, Cemballi AG . The role of community-based organizations in improving chronic care for safety-net populations. J Am Board Fam Med 2021 Jul-Aug;34(4):698-708. doi: 10.3122/jabfm.2021.04.200591..
Keywords: Community Partnerships, Safety Net, Chronic Conditions, Social Determinants of Health, Care Management
Manges KA, Wallace AS, Groves PS
Ready to go home? Assessment of shared mental models of the patient and discharging team regarding readiness for hospital discharge.
A critical task of the inpatient interprofessional team is readying patients for discharge. Assessment of shared mental model (SMM) convergence can determine how much team members agree about patient discharge readiness and how their mental models align with the patient's self-assessment. The objective of this study was to determine the convergence of interprofessional team SMMs of hospital discharge readiness and identify factors associated with these assessments.
Citation: Manges KA, Wallace AS, Groves PS . Ready to go home? Assessment of shared mental models of the patient and discharging team regarding readiness for hospital discharge. J Hosp Med 2021 Jun;16(6):326-32. doi: 10.12788/jhm.3464..
Keywords: Hospital Discharge, Teams, Care Management, Decision Making, Hospitals
McNeil JC, Joseph M, Sommer LM
The contemporary epidemiology, microbiology and management of chronic osteomyelitis in US children.
While the majority of pediatric osteomyelitis cases are acute in nature, a significant subset present with prolonged symptoms often associated with substantial morbidity. Little data exist to guide clinicians in the management of these infections. In this study, the investigators sought to describe the epidemiology, clinical features and management of chronic osteomyelitis (CO) in children. The investigators concluded that children with CO represented a diverse group both in terms of pathogenesis and microbiology. Prolonged intravenous therapy did not appear to improve outcomes in CO.
Citation: McNeil JC, Joseph M, Sommer LM . The contemporary epidemiology, microbiology and management of chronic osteomyelitis in US children. Pediatr Infect Dis J 2021 Jun;40(6):518-24. doi: 10.1097/inf.0000000000003067..
Keywords: Children/Adolescents, Chronic Conditions, Care Management
Campbell JI, Sandora TJ, Haberer JE
A scoping review of paediatric latent tuberculosis infection care cascades: initial steps are lacking.
This literature review looked at current studies on the diagnosis and treatment of pediatric latent tuberculosis infection (TB infection), commonly known as the TB infection care cascade. The authors conducted a systematic search of several medical databases and included articles and meeting abstracts that studied children and adolescents 21 years or younger who were screened for or diagnosed with TB infection. They identified 146 studies examining steps in the pediatric TB infection care cascade, including 31 in children living in low- and middle-income countries. Most literature described the final cascade step, which is treatment initiation to completion. Strengths and gaps were identified and future research in examining cascade steps upstream of treatment initiation was recommended.
Citation: Campbell JI, Sandora TJ, Haberer JE . A scoping review of paediatric latent tuberculosis infection care cascades: initial steps are lacking. BMJ Glob Health 2021 May;6(5). doi: 10.1136/bmjgh-2020-004836..
Keywords: Children/Adolescents, Respiratory Conditions, Diagnostic Safety and Quality, Treatments, Care Management, Evidence-Based Practice
Larsen EP, Haskins Lisle A, Law B
Identification of design criteria to improve patient care in electronic health record downtime.
Researchers identified design criteria specifications for continuing safe and efficient patient care activities during downtime by examining interview transcripts from medical personnel who had experience with downtime incidents, using phenomenological analysis. They found that workload distribution and communication were significant issues in patient care during downtime. There may not be an equal work distribution, leading to an increased workload for some personnel during downtime. Some criteria were identified as potential guidelines for the development of better downtime contingency plans.
Citation: Larsen EP, Haskins Lisle A, Law B . Identification of design criteria to improve patient care in electronic health record downtime. J Patient Saf 2021 Mar 1;17(2):90-94. doi: 10.1097/pts.0000000000000580..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery, Care Management
Ozkaynak M, Valdez R, Hannah K
Understanding gaps between daily living and clinical settings in chronic disease management: qualitative study.
This study’s objective was to characterize gaps from the patient’s perspective between health-related activities across home-based and clinical settings in the management of chronic conditions. Patients were recruited from an anticoagulation clinic of an urban, western mountain system and primary interviews were conducted with 39 patients and 4 providers. The causes of gaps included clinician recommendations not fitting into patients’ daily routines; recommendations not fitting into a patients’ living contexts; and no information transfer across settings. Consequences of these gaps included increased cognitive and physical workload on the patient, poor patient satisfaction, and compromised adherence to the therapy plan.
Citation: Ozkaynak M, Valdez R, Hannah K . Understanding gaps between daily living and clinical settings in chronic disease management: qualitative study. J Med Internet Res 2021 Feb 25;23(2):e17590. doi: 10.2196/17590..
Keywords: Chronic Conditions, Care Management, Care Coordination, Patient Self-Management, Health Information Technology (HIT)
Kohn R, Harhay MO, Bayes B
Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study.
The objective of this cohort study was to assess the association of bedspacing with patient-centered outcomes among United States patients admitted to general medicine services. The study compared internal medicine, family medicine and geriatric service patients who were bedspaced versus cohorted for the entirety of their hospital stay within three large, urban hospitals. Findings showed that bedspacing was associated with adverse patient-centered outcomes. Recommendations for future work included a need to confirm these findings, to understand mechanisms contributing to adverse outcomes, and to identify factors that mitigate these adverse effects in order to provide high-value, patient-centered care to hospitalized patients.
Citation: Kohn R, Harhay MO, Bayes B . Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study. BMJ Qual Saf 2021 Feb;30(2):116-22. doi: 10.1136/bmjqs-2019-010675..
Keywords: Patient-Centered Outcomes Research, Outcomes, Inpatient Care, Hospitals, Healthcare Delivery, Care Management, Adverse Events
Wang G, Wignall J, Kinard D
An implementation model for managing cloud-based longitudinal care plans for children with medical complexity.
In this study, the investigators aimed to iteratively refine an implementation model for managing cloud-based longitudinal care plans (LCPs) for children with medical complexity (CMC). They conducted iterative 1-on-1 design sessions with CMC caregivers (ie, parents/legal guardians) and providers between August 2017 and March 2019. The investigators concluded that utilizing the management strategies, described in the article, when implementing cloud-based LCPs had the potential to improve team-based care across settings.
Citation: Wang G, Wignall J, Kinard D . An implementation model for managing cloud-based longitudinal care plans for children with medical complexity. J Am Med Inform Assoc 2021 Jan 15;28(1):23-32. doi: 10.1093/jamia/ocaa207..
Keywords: Children/Adolescents, Implementation, Chronic Conditions, Care Management, Care Coordination, Health Information Exchange (HIE), Health Information Technology (HIT), Teams
Stephens KA, Ike B, Baldwin LM
Challenges and approaches to population management of long-term opioid therapy patients.
Primary care is challenged with safely prescribing opioids for patients with chronic noncancer pain (CNCP), specifically to address risks for overdose, opioid use disorder, and death. In this study, the investigators identified sociotechnical challenges, approaches, and recommendations in primary care to effectively track and monitor patients on long-term opioid therapy, a key component for supporting adoption of opioid prescribing guidelines.
Citation: Stephens KA, Ike B, Baldwin LM . Challenges and approaches to population management of long-term opioid therapy patients. J Am Board Fam Med 2021 Jan-Feb;34(1):89-98. doi: 10.3122/jabfm.2021.01.190100..
Keywords: Opioids, Pain, Chronic Conditions, Care Management, Medication, Primary Care, Ambulatory Care and Surgery
Oikonomidi T, Ravaud P, Cosson E
AHRQ Author: Montori V
Evaluation of patient willingness to adopt remote digital monitoring for diabetes management.
Investigators sought to identify the minimum effectiveness patients report they require to adopt 36 different remote digital monitoring (RDM) scenarios. Adults with type 1 or type 2 diabetes living in 30 countries assessed three randomly selected scenarios from a total of 36 that described different combinations of digital monitoring tools. The investigators found that patients required greater health benefits to adopt more intrusive RDM modalities, food monitoring, and real-time feedback by a health care professional. They recommended that patient monitoring devices be designed to be minimally intrusive.
Citation: Oikonomidi T, Ravaud P, Cosson E . Evaluation of patient willingness to adopt remote digital monitoring for diabetes management. JAMA Netw Open 2021 Jan;4(1):e2033115. doi: 10.1001/jamanetworkopen.2020.33115..
Keywords: Telehealth, Health Information Technology (HIT), Diabetes, Chronic Conditions, Care Management, Patient Self-Management, Patient Adherence/Compliance