WorldWideScience

Sample records for medication adherence issues

  1. Placebo HAART Regimen as a Method for Teaching Medication Adherence Issues to Students

    OpenAIRE

    Sutton, Eliza L; Transue, Emily R; Comes E, Susan; Paauw, Douglas S

    2005-01-01

    Placebo medication regimens may help educate students about adherence issues. In this randomized trial, 23 third-year medical students took a 2-week placebo regimen mimicking highly active antiretroviral therapy (HAART) during their medicine clerkship; 15 students served as controls. Although no effect was demonstrated from this intervention on an evaluation instrument examining attitudes and beliefs about medication nonadherence, all 23 student-subjects agreed in postintervention interviews ...

  2. HIV Medication Adherence

    Science.gov (United States)

    ... AIDS Drugs Clinical Trials Apps skip to content HIV Treatment Home Understanding HIV/AIDS Fact Sheets HIV ... 4 p.m. ET) Send us an email HIV Medication Adherence Last Reviewed: January 17, 2018 Key ...

  3. Current Situation of Medication Adherence in Hypertension.

    Science.gov (United States)

    Vrijens, Bernard; Antoniou, Sotiris; Burnier, Michel; de la Sierra, Alejandro; Volpe, Massimo

    2017-01-01

    Despite increased awareness, poor adherence to treatments for chronic diseases remains a global problem. Adherence issues are common in patients taking antihypertensive therapy and associated with increased risks of coronary and cerebrovascular events. Whilst there has been a gradual trend toward improved control of hypertension, the number of patients with blood pressure values above goal has remained constant. This has both personal and economic consequences. Medication adherence is a multifaceted issue and consists of three components: initiation, implementation, and persistence. A combination of methods is recommended to measure adherence, with electronic monitoring and drug measurement being the most accurate. Pill burden, resulting from free combinations of blood pressure lowering treatments, makes the daily routine of medication taking complex, which can be a barrier to optimal adherence. Single-pill fixed-dose combinations simplify the habit of medication taking and improve medication adherence. Re-packing of medication is also being utilized as a method of improving adherence. This paper presents the outcomes of discussions by a European group of experts on the current situation of medication adherence in hypertension.

  4. Antihypertensive Medications Adherence Among Nigerian ...

    African Journals Online (AJOL)

    Hospital, Ogbomosho, 2Goshen Heart Clinic, Osogbo, 3Department of Economics, Osun State University, Osogbo, Nigeria ... significant impact of antihypertensive medication adherence.[13]. The level of information provided to patients may also impact ..... Muntner P. New medication adherence scale versus pharmacy.

  5. Antidiabetic medication adherence and associated factors among ...

    African Journals Online (AJOL)

    Godfrey Mutashambara Rwegerera

    2017-03-06

    Mar 6, 2017 ... tive of the study was to determine current antidiabetic medication adherence in ...... A systematic review of adherence with medications for diabetes. .... Pascal IGU, Ofoedu JN, Uchenna NP, Nkwa AA, Uchamma GUE.

  6. Adherence with Preventive Medication in Childhood Asthma

    Directory of Open Access Journals (Sweden)

    Scott Burgess

    2011-01-01

    Full Text Available Suboptimal adherence with preventive medication is common and often unrecognised as a cause of poor asthma control. A number of risk factors for nonadherence have emerged from well-conducted studies. Unfortunately, patient report a physician's estimation of adherence and knowledge of these risk factors may not assist in determining whether non-adherence is a significant factor. Electronic monitoring devices are likely to be more frequently used to remind patients to take medication, as a strategy to motivate patients to maintain adherence, and a tool to evaluate adherence in subjects with poor disease control. The aim of this paper is to review non-adherence with preventive medication in childhood asthma, its impact on asthma control, methods of evaluating non-adherence, risk factors for suboptimal adherence, and strategies to enhance adherence.

  7. Medication adherence monitoring: implications for patients and providers.

    Science.gov (United States)

    Gheorghiu, Bobby; Nayani, Seema

    2018-05-01

    Non-adherence to medication is a key worldwide issue and can lead to adverse patient outcomes and increased health system costs. Would a process facilitating notification of non-adherence infringe upon the autonomy of individuals or breach expectations of privacy? In contrast, patients who are not taking their medication could unknowingly be putting themselves at risk and all the while prescribers are unaware and without the opportunity to intervene. With the advent of electronic methods of medication adherence monitoring, this ethical dilemma now involves a new layer of complexity. We present two scenarios encountered in clinical practice that reflect issues occurring regularly in the Canadian healthcare system.

  8. Patient Medication Knowledge Governing Adherence to Asthma ...

    African Journals Online (AJOL)

    Samuel Olaleye

    disturbing levels of patients adherence with management recommendations. Asthma education strategies need to be modified to engage ... and quick procedure. ... Participants' medication adherence and skills at using .... In this study 17 of the 67 patients studied .... adherence: changing behaviour to promote better self-.

  9. Medication adherence among adult patients on hemodialysis

    Directory of Open Access Journals (Sweden)

    Abdulmalik M Alkatheri

    2014-01-01

    Full Text Available Medication adherence was assessed in 89 patients on hemodialysis (HD at the King Abdul Aziz Medical City using an Arabic version of the Morisky Medication Adherence Scale (MASS-8. The results of the study revealed that 31.46% and 40.45% of the participants showed low and medium adherence, respectively, while 28.09% showed high medication adherence. Accordingly, 71.91% of the patients visiting the dialysis unit were considered medication non-adherent. While being of older age (P = 0.012, being married (P = 0.012 increased the level of adherence, being of medium level of education (P = 0.024 decreased adherence levels. On the other hand, gender, presence of a care-giver, number of members in the household and employment status seems to have no effect on the level of medication adherence. These results call upon the practitioners in HD units to develop intervention programs that can increase the level of medication adherence.

  10. Determinants of Patient's Adherence to Hypertension Medications ...

    African Journals Online (AJOL)

    Medications: Application of Health Belief Model .... Logistic regression was used to estimate odds ratios expressing the ... costs.[15]. Adherence to medication is always a matter of concern, especially in chronic diseases and identification of the ...

  11. Medication adherence in inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Webber Chan

    2017-10-01

    Full Text Available Inflammatory bowel disease (IBD is a chronic idiopathic inflammatory condition with intestinal and extraintestinal manifestations. Medications are the cornerstone of treatment of IBD. However, patients often adhere to medication poorly. Adherence to medications is defined as the process by which patients take their medications as prescribed. Treatment non-adherence is a common problem among chronic diseases, averaging 50% in developed countries and is even poorer in developing countries. In this review, we will examine the adherence data in IBD which vary greatly depending on the study population, route of administration, and methods of adherence measurement used. We will also discuss the adverse clinical outcomes related to non-adherence to medical treatment including increased disease activity, flares, loss of response to anti-tumor necrosis factor therapy, and so forth. There are many methods to measure medication adherence namely direct and indirect methods, each with their advantages and drawbacks. Finally, we will explore different intervention strategies to improve adherence to medications.

  12. Immunosuppressive medication adherence in kidney transplant patients.

    Science.gov (United States)

    Lalić, Jelena; Veličković-Radovanović, Radmila; Mitić, Branka; Paunović, Goran; Cvetković, Tatjana

    2014-01-01

    To assess the degree of immunosuppressive medication adherence in kidney transplant patients (KTPs) and to determine if there is a difference in the rate of adherence to tacrolimus (Tac), cyclosporine (CsA) and sirolimus (Sir). From a total of 63 KTPs treated at the Clinic of Nephrology, Clinical Centre Niš, Serbia, 60 participated in the study by responding to questionnaires. They were divided into the adherence group (n = 43) and the nonadherence group (n = 17) according to their degree of adherence which was measured using a validated survey form, the simplified medication adherence questionnaire. The KTP adherence to the different immunosuppressive regimens (Tac, CsA and Sir) was compared. Statistical analysis was performed using the Student t test. Adherence was observed in 43 (71.7%) patients, and only 17 (28.3%) did not follow the prescribed therapy. The estimated glomerular filtration rate was significantly lower in the nonadherence group (38.52 ± 18.22 ml/min) than in the adherence group (52.43 ± 16.91 ml/min, p adherers and the nonadherers (6.30 ± 2.06 vs. 5.0 ± 1.52 ng/ml, p adherence. Nonadherence was associated with worse graft function and a lower Tac level. Knowledge about the degree of adherence could help the early identification of nonadherent patients and the development of strategies to improve this. © 2014 S. Karger AG, Basel

  13. Medical Issues: Orthopedics

    Science.gov (United States)

    ... Information Packets Equipment Pool Living With SMA Medical Issues Palliative Breathing Orthopedics Nutrition Equipment Daily Life At ... curesma.org > support & care > living with sma > medical issues > orthopedics Orthopedics In SMA, muscle weakness can cause ...

  14. Medical Issues: Equipment

    Science.gov (United States)

    ... Information Packets Equipment Pool Living With SMA Medical Issues Palliative Breathing Orthopedics Nutrition Equipment Daily Life At ... curesma.org > support & care > living with sma > medical issues > equipment Equipment Individuals with SMA often require a ...

  15. Medical Issues: Breathing

    Science.gov (United States)

    ... Information Packets Equipment Pool Living With SMA Medical Issues Palliative Breathing Orthopedics Nutrition Equipment Daily Life At ... curesma.org > support & care > living with sma > medical issues > breathing Breathing Breathing problems are the most common ...

  16. Oral anticancer agent medication adherence by outpatients.

    Science.gov (United States)

    Kimura, Michio; Usami, Eiseki; Iwai, Mina; Nakao, Toshiya; Yoshimura, Tomoaki; Mori, Hiromi; Sugiyama, Tadashi; Teramachi, Hitomi

    2014-11-01

    In the present study, medication adherence and factors affecting adherence were examined in patients taking oral anticancer agents. In June 2013, 172 outpatients who had been prescribed oral anticancer agents by Ogaki Municipal Hospital (Ogaki, Gifu, Japan) completed a questionnaire survey, with answers rated on a five-point Likert scale. The factors that affect medication adherence were evaluated using a customer satisfaction (CS) analysis. For patients with good and insufficient adherence to medication, the median ages were 66 years (range, 21-85 years) and 73 years (range, 30-90 years), respectively (P=0.0004), while the median dosing time was 131 days (range, 3-3,585 days) and 219 days (24-3,465 days), respectively (P=0.0447). In 36.0% (62 out of 172) of the cases, there was insufficient medication adherence; 64.5% of those cases (40 out of 62) showed good medication compliance (4-5 point rating score). However, these patients did not fully understand the effects or side-effects of the drugs, giving a score of three points or less. The percentage of patients with good medication compliance was 87.2% (150 out of 172). Through the CS analysis, three items, the interest in the drug, the desire to consult about the drug and the condition of the patient, were extracted as items for improvement. Overall, the medication compliance of the patients taking the oral anticancer agents was good, but the medication adherence was insufficient. To improve medication adherence, a better understanding of the effectiveness and necessity of drugs and their side-effects is required. In addition, the interest of patients in their medication should be encouraged and intervention should be tailored to the condition of the patient. These steps should lead to improved medication adherence.

  17. Medication adherence in patients with juvenile idiopathic arthritis

    Directory of Open Access Journals (Sweden)

    Liana Silveira Adriano

    Full Text Available ABSTRACT Objective: The aim of this study was to investigate pharmacological treatment adherence of patients with juvenile idiopathic arthritis, attended in an outpatient pharmacy at a tertiary hospital in northeastern Brazil. Methods: The analysis of adherence was performed along with caregivers, through a structured questionnaire based on Morisky, Green and Levine, which enabled the categorization of adherence in “highest”, “moderate” or “low” grades, and through evaluating medication dispensing registers, which classified the act of getting medications at the pharmacy as “regular” or “irregular”. Drug Related Problems (DRP were identified through the narrative of caregivers and classified according to the Second Granada Consensus. Then, a pharmaceutical orientation chart with information about the therapeutic regimen was applied, in order to function as a guide for issues that influenced adherence. Results: A total of 43 patients was included, with a mean age of 11.12 years, and 65.1% (n = 28 were female. Applying the questionnaire, it was found “highest” adherence in 46.5% (n = 20 patients, “moderate” adherence in 48.8% (n = 21, and “low” adherence in 4.7% (n = 2. Through an analysis of the medication dispensing registers, a lower level of adherence was observed: only 25.6% (n = 11 of the participants received “regularly” the medications. Twenty-six DRP was identified, and 84.6% (n = 22 were classified as real. There were no significant associations between socio-demographic variables and adherence, although some caregivers have reported difficulty in accessing the medicines and in understanding the treatment. Conclusion: Our findings showed problems in the adherence process related to inattention, forgetfulness and irregularity in getting medicines, reinforcing the need for the development of strategies to facilitate a better understanding of treatment and to ensure adherence.

  18. Medication adherence beliefs of U.S community pharmacists.

    Science.gov (United States)

    Witry, Matthew J

    2018-05-01

    There is increasing attention on the role of community pharmacists in improving medication adherence. There is a need to better understand pharmacist attitudes and experiences related to this role. To assess community pharmacist perceptions of patient reasons for non-adherence, characterize the adherence beliefs of community pharmacists, and test if there are demographic predictors of pharmacists' self-efficacy, outcome expectations, and role beliefs related to intervening on medication non-adherence. A cross-sectional survey was mailed using a 4-contact approach to 1000 pharmacists practicing in 5 Midwestern U.S. States. The survey included seven domains to address the study objectives. Descriptive statistics were calculated for demographic items, coefficient alphas tested the internal consistency of scales, and multiple regression was used to test the relationship between demographics and scale means. There were 261 usable responses giving a 29% response rate. Pharmacists perceived forgetting and instructions changing without a new prescription to be the most common reasons for late refills. A minority of pharmacists agreed that non-adherence involves a deliberate decision or that negative medication beliefs were common reasons for late refills. Pharmacists were confident, had positive outcome expectations, and positive role beliefs related to interacting with patients who have adherence issues. Barriers to adherence intervention included difficulties with follow-up and documentation. Also, over half of the pharmacists reported that discussing adherence makes patients defensive. Pharmacists had positive attitudes toward intervening on medication non-adherence although barriers to intervention are present. Pharmacists perceived non-intentional reasons for late refills to be more prevalent than intentional reasons. Pharmacists may benefit from additional non-adherence communication training and support targeted at identifying a broader range of non-adherence

  19. Explanatory models of depression and treatment adherence to antidepressant medication

    DEFF Research Database (Denmark)

    Buus, Niels; Johannessen, Helle; Stage, Kurt Bjerregaard

    2012-01-01

    and medicine were not central. However, taking antidepressant medication was a meaningful part of being admitted to hospital, and the adoption of the rhetoric and practices of biomedicine strengthened patients' sense of control and hope for recovery. If medicine was ineffective, the explanatory models...... legitimised alternative strategies towards recovery, including non-adherence. CONCLUSIONS: The patients' reasons for adhering to antidepressants included a range of diverse psychosocial issues, and could be regarded as a central part of their common sense illness management....

  20. Improving medication adherence in patients with hypertension

    DEFF Research Database (Denmark)

    Hedegaard, Ulla; Kjeldsen, Lene Juel; Pottegård, Anton

    2015-01-01

    BACKGROUND: and Purpose: In patients with hypertension, medication adherence is often suboptimal, thereby increasing the risk of ischemic heart disease and stroke. In a randomized trial, we investigated the effectiveness of a multifaceted pharmacist intervention in a hospital setting to improve...... medication adherence in hypertensive patients. Motivational interviewing was a key element of the intervention. METHODS: Patients (N=532) were recruited from 3 hospital outpatient clinics and randomized to usual care or a 6-month pharmacist intervention comprising collaborative care, medication review...... for persistence, blood pressure or hospital admission. CONCLUSIONS: A multifaceted pharmacist intervention in a hospital setting led to a sustained improvement in medication adherence for patients with hypertension. The intervention had no significant impact on blood pressure and secondary clinical outcomes....

  1. Factors affecting medication adherence in elderly people

    Directory of Open Access Journals (Sweden)

    Jin HK

    2016-10-01

    Full Text Available Hyekyung Jin,1 Yeonhee Kim,2 Sandy Jeong Rhie1,3 1College of Pharmacy, 2Center for Excellence in Teaching & Learning, 3Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea Background: Little is known about the functional health literacy (FHL associated with medication adherence in elderly patients. The aim of this study was to examine the FHL among older adults and identify influencing factors that can predict medication adherence. Methods: This was a cross-sectional survey. Participants (n=160 aged 65 years and older were selected from outpatient clinics of 3 tertiary care hospitals, 6 community pharmacies, and 2 senior centers between November 1 and 30, 2014. The participants’ FHL was measured using the Korean Functional Health Literacy Test, which consists of 15 items including 8 numeracy and 7 reading comprehension items. Medication adherence was measured by the Adherence to Refills and Medication Scale. Descriptive statistics, chi-square or Fisher’s exact test, and multiple regression analyses were used to analyze the data. Results: The mean score of the total FHL was 7.72±3.51 (range 0–15. The percentage of the total number of correct answers for the reading comprehension subtest and numeracy subtest were 48.1% and 54.4%, respectively. Among 160 participants, 52.5% showed low adherence to medication. The factors affecting medication adherence included the patient’s degree of satisfaction with the service (β=-0.215, P=0.022, sufficient explanation of medication counseling (β=-0.335, P=0.000, education level (β=-0.153, P=0.045, health-related problems (β=-0.239, P=0.004, and dosing frequency (β=0.189, P=0.018. Conclusion: In this study, we found medication adherence of elderly patients was associated with education level, health-related problems, dosing frequency, satisfaction with patient counseling, and explanation of medication, but no association was found with FHL. Pharmacists

  2. Identification of barriers to medication adherence in a Latino population.

    Science.gov (United States)

    Compton, Sheryl; Haack, Sally; Phillips, Charles R

    2010-12-01

    Barriers to medication adherence may present differently in diverse patient populations. Because of changing U.S. demographics, health care providers will be required to identify alternative strategies for managing increasingly diverse patient populations. This pilot project identified barriers that may hinder medication adherence in a Latino population. The results of the survey may identify trends in barriers allowing for the development of interventions aimed at improving medication adherence. The study used a convenience sample of Spanish-labeled prescriptions that had not been picked up from a community pharmacy after a 2-week period to identify study subjects. Patients were contacted by phone and surveyed regarding reasons for not picking up their prescription medication. The 24-item survey instrument consisted of demographic and medication-related questions, reasons for, and associated barriers with failure to pick up medications. The most common classes of medications patients failed to pick up were chronic medications. More than 90% of the patients thought that the medication in question was helpful to them, and nearly 80% thought that the medicine was still needed. Patients cited communication issues (ie, content matter, such as when the prescription was ready), logistics, and limited hours of pharmacy operation as the primary barriers in picking up their medications, whereas nearly 40% failed to identify any barriers. Barriers identified by patients that could be improved included confusion regarding when their prescription was ready and limited hours of pharmacy operation. Most of the patients were comfortable using the American health care system. The barriers to medication adherence identified did not appear to be the result of cultural influences. This could be because the community pharmacy had bilingual staff and interpreters available for patient education and prescription processing. Alternative methods are needed to further identify reasons for

  3. Medication Adherence Apps: Review and Content Analysis.

    Science.gov (United States)

    Ahmed, Imran; Ahmad, Niall Safir; Ali, Shahnaz; Ali, Shair; George, Anju; Saleem Danish, Hiba; Uppal, Encarl; Soo, James; Mobasheri, Mohammad H; King, Dominic; Cox, Benita; Darzi, Ara

    2018-03-16

    Medication adherence is an expensive and damaging problem for patients and health care providers. Patients adhere to only 50% of drugs prescribed for chronic diseases in developed nations. Digital health has paved the way for innovative smartphone solutions to tackle this challenge. However, despite numerous apps available claiming to improve adherence, a thorough review of adherence apps has not been carried out to date. The aims of this study were to (1) review medication adherence apps available in app repositories in terms of their evidence base, medical professional involvement in development, and strategies used to facilitate behavior change and improve adherence and (2) provide a system of classification for these apps. In April 2015, relevant medication adherence apps were identified by searching the Apple App Store and the Google Play Store using a combination of relevant search terms. Data extracted included app store source, app price, documentation of health care professional (HCP) involvement during app development, and evidence base for each respective app. Free apps were downloaded to explore the strategies used to promote medication adherence. Testing involved a standardized medication regimen of three reminders over a 4-hour period. Nonadherence features designed to enhance user experience were also documented. The app repository search identified a total of 5881 apps. Of these, 805 fulfilled the inclusion criteria initially and were tested. Furthermore, 681 apps were further analyzed for data extraction. Of these, 420 apps were free for testing, 58 were inaccessible and 203 required payment. Of the 420 free apps, 57 apps were developed with HCP involvement and an evidence base was identified in only 4 apps. Of the paid apps, 9 apps had HCP involvement, 1 app had a documented evidence base, and 1 app had both. In addition, 18 inaccessible apps were produced with HCP involvement, whereas 2 apps had a documented evidence base. The 420 free apps were

  4. Medical Issues: Nutrition

    Science.gov (United States)

    ... support & care > living with sma > medical issues > nutrition Nutrition Good nutrition is essential to health and growth. ... must make decisions based on their own needs. Nutrition Considerations Since we are still waiting for clinical ...

  5. Improving diabetes medication adherence: successful, scalable interventions

    Directory of Open Access Journals (Sweden)

    Zullig LL

    2015-01-01

    Full Text Available Leah L Zullig,1,2 Walid F Gellad,3,4 Jivan Moaddeb,2,5 Matthew J Crowley,1,2 William Shrank,6 Bradi B Granger,7 Christopher B Granger,8 Troy Trygstad,9 Larry Z Liu,10 Hayden B Bosworth1,2,7,11 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 2Department of Medicine, Duke University, Durham, NC, USA; 3Center for Health Equity Research and Promotion, Pittsburgh Veterans Affairs Medical Center, Pittsburgh, PA, USA; 4Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA; 5Institute for Genome Sciences and Policy, Duke University, Durham, NC, USA; 6CVS Caremark Corporation; 7School of Nursing, Duke University, Durham, NC, USA; 8Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA; 9North Carolina Community Care Networks, Raleigh, NC, USA; 10Pfizer, Inc., and Weill Medical College of Cornell University, New York, NY, USA; 11Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA Abstract: Effective medications are a cornerstone of prevention and disease treatment, yet only about half of patients take their medications as prescribed, resulting in a common and costly public health challenge for the US healthcare system. Since poor medication adherence is a complex problem with many contributing causes, there is no one universal solution. This paper describes interventions that were not only effective in improving medication adherence among patients with diabetes, but were also potentially scalable (ie, easy to implement to a large population. We identify key characteristics that make these interventions effective and scalable. This information is intended to inform healthcare systems seeking proven, low resource, cost-effective solutions to improve medication adherence. Keywords: medication adherence, diabetes mellitus, chronic disease, dissemination research

  6. Medication adherence among transgender women living with HIV

    OpenAIRE

    Baguso, Glenda N.; Gay, Caryl L.; Lee, Kathryn A.

    2016-01-01

    Medication adherence is linked to health outcomes among adults with HIV infection. Transgender women living with HIV (TWLWH) in the U.S. report suboptimal adherence to medications and are found to have difficulty integrating HIV medication into their daily routine, but few studies explore factors associated with medication adherence among transgender women. Thus, the purpose of this paper is to examine demographic and clinical factors related to self-reported medication adherence among transg...

  7. Medical adherence in young adolescents with spina bifida: longitudinal associations with family functioning.

    Science.gov (United States)

    Stepansky, Mona A; Roache, Caitlin R; Holmbeck, Grayson N; Schultz, Karen

    2010-03-01

    The purpose of this study was 2-fold: (1) to explore the transfer of responsibility of medical tasks from parent to child during the transition to adolescence, and (2) to examine the associations between family functioning and medical adherence in youth with spina bifida. Seventy families of children with spina bifida participated in this study. Data were collected during family interaction sessions by using questionnaires completed by mothers, fathers, youth, teachers and health professionals. Findings suggest that responsibility for medical regimens transfers gradually from parent to child over time. Additionally, family conflict and cohesion were correlated with medical adherence. Finally, family conflict over medical issues was related to a decrease in medical adherence over time. Results suggest that as youth take more responsibility over their medical regimens, family conflict regarding medical issues becomes a contributor to their adherence behaviors. Interventions that target family conflict may facilitate adherence behaviors.

  8. Measurement complexity of adherence to medication

    Directory of Open Access Journals (Sweden)

    Galato D

    2012-04-01

    Full Text Available Dayani Galato, Fabiana Schuelter-Trevisol, Anna Paula PiovezanMaster Program in Health Sciences, University of Southern Santa Catarina (Unisul Tubarão, Santa Catarina, BrazilAdherence to pharmacologic therapy is a major challenge for the rational use of medicines, particularly when it comes to antiretroviral drugs that require adherence to at least 95% of prescribed doses.1 Studies in this area are always important and contribute to medication adherence understanding, even though there is no reference test for measuring this. Recently, an article was published in this journal that proposes the determination of lamivudine plasma concentration to validate patient self-reported adherence to antiretroviral treatment.2 In that study, serum levels obtained after 3 hours of ingestion of the last dose of the drug were compared with patient reports that were classified into different levels of adherence, based on their recall of missed doses in the previous 7 days.It was hypothesized by the authors that the use of a biological marker for drug adherence was extremely important, given the relevance of the topic. However, we would like to draw attention to some points that may determine the success of the use of similar methods for this purpose. The formation of groups with similar anthropometric characteristics is relevant since the dose of lamivudine may have to be changed, depending, for example, on sex, weight, and age.3 Even information considered important by the authors of that study was not provided. There is a need for greater clarity on the eligibility criteria, especially with regard to the clinical stage of the disease, CD4 counts and viral load, associated diseases, and comorbidity, as well as the evaluation of kidney function and other medications used that can affect lamivudine pharmacokinetics.3View original paper by Minzi and colleagues

  9. Medication adherence in type 2 diabetes patients: study of patients ...

    African Journals Online (AJOL)

    Medication adherence in type 2 diabetes patients: study of patients in ... impact of medication adherence on the clinical outcomes of type 2 diabetes patients at ... the review of case notes of one-hundred and fifty two randomly selected patients.

  10. Evaluating the Impact of Sample Medication on Subsequent Patient Adherence.

    Science.gov (United States)

    Pringle, Janice L; Aldridge, Arnie; Kearney, Shannon M; Grasso, Kim; Radack, John; Hogue, Susan; Manolis, Chronis

    2016-11-01

    Medication nonadherence is problematic throughout health care practice. Patient nonadherence is a result of several factors, such as financial issues, confusion about the medication, or concerns about possible side effects. Efforts to improve adherence have been implemented, but new strategies are needed to ensure that patients fill their medication prescriptions and adhere to their prescribed use. To investigate whether providing patients with a free 30-day supply of medication at the point of care via a dispensing kiosk-a secure, computerized cabinet placed in the prescriber's office-that provides sample medication and educational materials had a measurable impact on adherence and health care cost. The study sample consisted of patients drawn from the electronic health records of a large health care provider who were prescribed medications to treat diabetes, hypertension, and dyslipidemia. The comparison groups included a treatment group of patients who each received a 30-day generic sample of medication and a control group of patients who did not receive a sample. The study outcome was primary medication non-adherence (PMN), defined as whether a patient filled a prescription within 90, 180, or 365 days of prescribing. Only patients receiving a prescription for the first time were considered; patients on a medication before receipt of the sample were dropped. Postprescription medication adherence (PPMA), measured as proportion of days covered (PDC) and proportion of days covered ≥ 80% (PDC80), was also examined. Propensity score methods and multivariate regression models were used to examine the outcomes and group differences. Costs to the patient before and after the prescription were also analyzed. Key informant interviews were conducted with physicians, and qualitative analyses were performed. Patients who received a 30-day generic medication sample had a higher probability of filling a first prescription within 90 days (72.2% for treatment patients vs. 37

  11. Gamification of Medication Adherence in Epilepsy.

    Science.gov (United States)

    Abdul Rahim, Mohammad Izzat; Thomas, Rhys Huw

    2017-11-01

    Adherence to medication regimens is a crucial factor in seizure-freedom and well-being for people with epilepsy. In contrast, taking medication inconsistently increases the risk of not only seizures and their adverse effects, but drug side-effects and unnecessary modifications to treatment plans. Epilepsy is prevalent across all age groups and we have been slow to utilise both the technologies and psychologies derived from computer gaming. Gaming has broken through to the mainstream and is no longer the preserve of younger males, mirroring the adoption of smart-phones. 'Gamification' motivates users into engaging in an activity with a higher intensity and duration. Introducing gaming elements into a non-gaming context has the potential to transform routine tasks into more enjoyable and motivating experiences. This has been exploited by marketing executives, but also has clear uses in a healthcare setting too. We discuss how previously published frameworks could be employed to help people with epilepsy adhere to medication regimens to create a patient-focussed, modifiable and fun experience. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  12. Emotional functioning, barriers, and medication adherence in pediatric transplant recipients.

    Science.gov (United States)

    McCormick King, Megan L; Mee, Laura L; Gutiérrez-Colina, Ana M; Eaton, Cyd K; Lee, Jennifer L; Blount, Ronald L

    2014-04-01

    This study assessed relationships among internalizing symptoms, barriers to medication adherence, and medication adherence in adolescents with solid organ transplants. The sample included 72 adolescents who had received solid organ transplants. Multiple mediator models were tested via bootstrapping methods. Bivariate correlations revealed significant relationships between barriers and internalizing symptoms of depression, anxiety, and posttraumatic stress, as well as between internalizing symptoms and medication adherence. Barriers indicative of adaptation to the medication regimen (e.g., forgetting, lack of organization) were related to medication adherence and mediated the relationship between internalizing symptoms and medication adherence. These findings indicate that barriers may serve as a more specific factor in the relationship between more general, pervasive internalizing symptoms and medication adherence. Results may help guide areas for clinical assessment, and the focus of interventions for adolescent transplant recipients who are experiencing internalizing symptoms and/or who are nonadherent to their medication regimen.

  13. Role for automated communication strategies in medication adherence management.

    Science.gov (United States)

    Ross, S Michael

    2008-11-01

    Lack of medication adherence is a prevalent problem that causes a broad range of health-and health-economics-related issues. Adherence management is therefore an important strategy, but it also presents its own set of challenges. Interventional communication from care support teams at managed care organizations and disease management and wellness programs has proved effective at modifying patients' medication adherence and reporting behaviors. However, these communications do not work well from an economic standpoint. It is not economically feasible to scale call centers and the numbers of clinical and professional staff to communicate with the increasing number of patients with chronic diseases who require ongoing medication use. Using communication automation to augment traditional call center outreach can help to mediate patient medication-taking behaviors. Specific design criteria for the automation of this interaction are discussed in this article, offering supporting data from a recent trial of 304 elderly patients with hypertension, and showing the benefits of using such a system for effective blood pressure monitoring, at reduced costs.

  14. Medical and Dental Patient Issues

    Science.gov (United States)

    ... A RadiationAnswers.org Ask the Experts Medical and Dental Patient Issues What's My Risk? The risks of ... developed by our topic editors for this category: Dental-Patient Issues Medical CT Reference Books and Articles ...

  15. Primary non-adherence to prescribed medication in general practice

    DEFF Research Database (Denmark)

    Linnet, Kristján; Halldórsson, Matthías; Thengilsdóttir, Gudrún

    2013-01-01

    Primary non-adherence refers to the patient not redeeming a prescribed medication at some point during drug therapy. Research has mainly focused on secondary non-adherence. Prior to this study, the overall rate of primary non-adherence in general practice in Iceland was not known....

  16. Beliefs about medications predict adherence to antidepressants in older adults.

    Science.gov (United States)

    Fawzi, Waleed; Abdel Mohsen, Mohamed Yousry; Hashem, Abdel Hamid; Moussa, Suaad; Coker, Elizabeth; Wilson, Kenneth C M

    2012-01-01

    Adherence to treatment is a complex and poorly understood phenomenon. This study investigates the relationship between older depressed patients' adherence to antidepressants and their beliefs about and knowledge of the medication. Assessment was undertaken of 108 outpatients over the age of 55 years diagnosed with depressive disorder and treated for at least four weeks with antidepressants. Adherence was assessed using two self-report measures: the Medication Adherence Rating Scale (MARS) and a Global Adherence Measure (GAM). Potential predictors of adherence investigated included sociodemographic, medication and illness variables. In addition, 33 carers were interviewed regarding general medication beliefs. 56% of patients reported 80% or higher adherence on the GAM. Sociodemographic variables were not associated with adherence on the MARS. Specific beliefs about medicines, such as "my health depends on antidepressants" (necessity) and being less worried about becoming dependant on antidepressants (concern) were highly correlated with adherence. General beliefs about medicines causing harm or being overprescribed, experiencing medication side-effects and severity of depression also correlated with poor adherence. Linear regression with the MARS as the dependent variable explained 44.3% of the variance and showed adherence to be higher in subjects with healthy specific beliefs who received more information about antidepressants and worse with depression severity and autonomic side-effects. Our findings strongly support a role for specific beliefs about medicines in adherence. Challenging patients' beliefs, providing information about treatment and discussing side-effects could improve adherence. Poor response to treatment and medication side-effects can indicate poor adherence and should be considered before switching medications.

  17. Family strategies for achieving medication adherence in pediatric kidney transplantation.

    Science.gov (United States)

    Ingerski, Lisa; Perrazo, Lauren; Goebel, Jens; Pai, Ahna L H

    2011-01-01

    Although nonadherence is well documented and strategies for adherence have been shown to be critical to overcoming barriers and improving overall adherence rates, it is unknown how family strategy use is related to adherence in the pediatric renal transplant population. The aims of this study were to assess (a) the strategies used by adolescents with kidney transplants and their caregivers to adhere to the posttransplant oral medication regimen and (b) the relationship of these strategies to objective adherence rates. Semistructured interviews to assess self-management were administered to 17 adolescents (14-18 years) and 17 caregivers. Adherence to oral immunosuppressant medication, measured via electronic monitors, was determined also for a subset of 13 dyads. Common strategies endorsed by families included the following: making it part of the routine (88.2%), verbal reminders by caregiver (82.4%), caregiver verifying medication was taken (76.5%), placing medication in a convenient location (76.5%), and using a pillbox (70.6%). A greater number of family-endorsed strategies were correlated with higher levels of adherence. Of those strategies spontaneously endorsed, only caregiver reminders to take medication and caregiver verification that medications were taken were related significantly to higher adherence rates. The findings highlight the importance of identification and use of specific strategies to improve adherence rates of pediatric renal transplant recipients and emphasize the need for continued caregiver involvement in the promotion of adherence to the treatment regimen.

  18. [Concept analysis of medication adherence in patients with chronic disease].

    Science.gov (United States)

    Huang, Jen-Ying; Chen, Hsing-Mei

    2014-06-01

    Pharmacotherapy plays an important role in the management of chronic diseases. However, many patients with chronic disease do not adhere to their medication regimen. This results in worsening symptoms and frequent re-hospitalizations. As a result, healthcare providers may view these patients as bad. Medication adherence is a complex concept. Analyzing this concept may assist nurses to improve patient-centered care. This paper uses Walker & Avant's method to conduct a concept analysis of medication adherence. Results show the defining attributes of medication adherence as: (1) knowing and agreeing to the medication; (2) communicating and negotiating the regimen; and (3) active, continuous involvement in and appraisal of the treatment effect. Identified antecedents of medication adherence included the patient having: (1) a prescribed medication regimen; (2) cognitive and action abilities in her / his role as a patient; and (3) level of preparation for medication treatment. Identified consequences of medication adherence include: (1) improving symptom control; (2) decreasing re-hospitalizations and mortality; (3) reducing medical care costs; (4) restoring self-esteem; and (5) diminishing depression. It is hoped that this concept analysis provides a reference for nurses to achieve a better understanding of medication adherence and further improve nursing practice.

  19. Self-reported Medication Adherence and CKD Progression

    Directory of Open Access Journals (Sweden)

    Esteban A. Cedillo-Couvert

    2018-05-01

    Full Text Available Introduction: In the general population, medication nonadherence contributes to poorer outcomes. However, little is known about medication adherence among adults with chronic kidney disease (CKD. We evaluated the association of self-reported medication adherence with CKD progression and all-cause death in patients with CKD. Methods: In this prospective observational study of 3305 adults with mild-to-moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC Study, the baseline self-reported medication adherence was assessed by responses to 3 questions and categorized as high, medium, and low. CKD progression (50% decline in eGFR or incident end-stage renal disease and all-cause death were measured using multivariable Cox proportional hazards. Results: Of the patients, 68% were categorized as high adherence, 17% medium adherence, and 15% low adherence. Over a median follow-up of 6 years, there were 969 CKD progression events and 675 deaths. Compared with the high-adherence group, the low-adherence group experienced increased risk for CKD progression (hazard ratio = 1.27, 95% confidence interval = 1.05, 1.54 after adjustment for sociodemographic and clinical factors, cardiovascular medications, number of medication types, and depressive symptoms. A similar association existed between low adherence and all-cause death, but did not reach standard statistical significance (hazard ratio = 1.14 95% confidence interval = 0.88, 1.47. Conclusion: Baseline self-reported low medication adherence was associated with an increased risk for CKD progression. Future work is needed to better understand the mechanisms underlying this association and to develop interventions to improve adherence. Keywords: CKD, death, medication adherence, progression

  20. Health Information Technology: Meaningful Use and Next Steps to Improving Electronic Facilitation of Medication Adherence.

    Science.gov (United States)

    Bosworth, Hayden B; Zullig, Leah L; Mendys, Phil; Ho, Michael; Trygstad, Troy; Granger, Christopher; Oakes, Megan M; Granger, Bradi B

    2016-03-15

    The use of health information technology (HIT) may improve medication adherence, but challenges for implementation remain. The aim of this paper is to review the current state of HIT as it relates to medication adherence programs, acknowledge the potential barriers in light of current legislation, and provide recommendations to improve ongoing medication adherence strategies through the use of HIT. We describe four potential HIT barriers that may impact interoperability and subsequent medication adherence. Legislation in the United States has incentivized the use of HIT to facilitate and enhance medication adherence. The Health Information Technology for Economic and Clinical Health (HITECH) was recently adopted and establishes federal standards for the so-called "meaningful use" of certified electronic health record (EHR) technology that can directly impact medication adherence. The four persistent HIT barriers to medication adherence include (1) underdevelopment of data reciprocity across clinical, community, and home settings, limiting the capture of data necessary for clinical care; (2) inconsistent data definitions and lack of harmonization of patient-focused data standards, making existing data difficult to use for patient-centered outcomes research; (3) inability to effectively use the national drug code information from the various electronic health record and claims datasets for adherence purposes; and (4) lack of data capture for medication management interventions, such as medication management therapy (MTM) in the EHR. Potential recommendations to address these issues are discussed. To make meaningful, high quality data accessible, and subsequently improve medication adherence, these challenges will need to be addressed to fully reach the potential of HIT in impacting one of our largest public health issues.

  1. Predictors of medication non-adherence for vasculitis patients

    Science.gov (United States)

    Hogan, Susan L.; DeVellis, Robert F.

    2013-01-01

    The primary purpose of this article is to document whether demographic, clinical, regimen-related, intrapersonal, and interpersonal factors predict medication non-adherence for vasculitis patients. A secondary purpose is to explore whether adherence varies by medication type and whether patients experienced drug-related side effects. Vasculitis patients (n=228) completed online baseline and 3-month follow-up surveys. Demographic (age, gender, education, race, marital status, and insurance status), clinical (perceived vasculitis severity, disease duration, vasculitis type, and relapse/remission status), regimen-related (experience of side effects), intrapersonal (depressive symptoms), and interpersonal (adherence-related support from family and friends) factors were measured at baseline. Medication non-adherence was assessed at follow-up using the Vasculitis Self-Management Survey medication adherence sub-scale (α=0.89). Variables that significantly correlated (pvasculitis medication types, patients who experienced side effects were less adherent than patients who did not experience side effects. Multiple factors are associated with medication non-adherence for vasculitis patients. Providers should discuss medication adherence and drug-related side effects with vasculitis patients. Providers may want to particularly target younger patients and patients with clinical signs of depression. PMID:23314654

  2. Transient improvement of urticaria induces poor adherence as assessed by Morisky Medication Adherence Scale-8.

    Science.gov (United States)

    Kaneko, Sakae; Masuda, Koji; Hiragun, Takaaki; Inomata, Naoko; Furue, Masutaka; Onozuka, Daisuke; Takeuchi, Satoshi; Murota, Hiroyuki; Sugaya, Makoto; Saeki, Hidehisa; Shintani, Yoichi; Tsunemi, Yuichiro; Abe, Shinya; Kobayashi, Miwa; Kitami, Yuki; Tanioka, Miki; Imafuku, Shinichi; Abe, Masatoshi; Hagihara, Akihito; Morisky, Donald E; Katoh, Norito

    2015-11-01

    Poor adherence to medication is a major public health challenge. Here, we aimed to determine the adherence to oral and topical medications and to analyze underlying associated factors using the translated Japanese version of Morisky Medication Adherence Scale-8 regarding urticaria treatment. Web-based questionnaires were performed for 3096 registered dermatological patients, along with a subanalysis of 751 registered urticaria patients in this study. The adherence to oral medication was significantly associated with the frequency of hospital visits. Variables that affected the adherence to topical medication included age and experience of drug effectiveness. The rate of responses that "It felt like the symptoms had improved" varied significantly among the dermatological diseases treated with oral medications. Dermatologists should be aware that adherence to the treatment of urticaria is quite low. Regular visits and active education for patients with urticaria are mandatory in order to achieve a good therapeutic outcome by increasing the adherence. © 2015 The Authors. The Journal of Dermatology published by Wiley Publishing Asia Pty Ltd on behalf of Japanese Dermatological Association.

  3. Discrepancies between beliefs and behavior: a prospective study into immunosuppressive medication adherence after kidney transplantation.

    Science.gov (United States)

    Massey, Emma K; Tielen, Mirjam; Laging, Mirjam; Timman, Reinier; Beck, Denise K; Khemai, Roshni; van Gelder, Teun; Weimar, Willem

    2015-02-01

    Nonadherence to immunosuppressive medication after kidney transplantation is a behavioral issue and as such it is important to understand the psychological factors that influence this behavior. The aim of this study was to investigate the extent to which goal cognitions, illness perceptions, and treatment beliefs were related to changes in self-reported immunosuppressive medication adherence up to 18 months after transplantation. Interviews were conducted with patients in the outpatient clinic 6 weeks (T1; n=113), 6 months (T2; n=106), and 18 months (T3; n=84) after transplantation. Self-reported adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale Interview. Psychological concepts were measured using the Brief Illness Perceptions Questionnaire, Beliefs about Medicines Questionnaire, and questions on the importance of adherence as a personal goal, conflict with other goals, and self-efficacy for goal attainment. Nonadherence significantly increased over time to 31% at T3. Perceived necessity of medication, perceived impact of transplant on life (consequences) and emotional response to transplantation significantly decreased over time. Participants who reported low importance of medication adherence as a personal goal were more likely to become nonadherent over time. Illness perceptions can be described as functional and supportive of adherence which is inconsistent with the pervasive and increasing nonadherence observed. There appears therefore to be a discrepancy between beliefs about adherence and actual behavior. Promoting (intrinsic) motivation for adherence goals and exploring the relative importance in comparison to other personal goals is a potential target for interventions.

  4. Medication adherence as a learning process: insights from cognitive psychology.

    Science.gov (United States)

    Rottman, Benjamin Margolin; Marcum, Zachary A; Thorpe, Carolyn T; Gellad, Walid F

    2017-03-01

    Non-adherence to medications is one of the largest contributors to sub-optimal health outcomes. Many theories of adherence include a 'value-expectancy' component in which a patient decides to take a medication partly based on expectations about whether it is effective, necessary, and tolerable. We propose reconceptualising this common theme as a kind of 'causal learning' - the patient learns whether a medication is effective, necessary, and tolerable, from experience with the medication. We apply cognitive psychology theories of how people learn cause-effect relations to elaborate this causal-learning challenge. First, expectations and impressions about a medication and beliefs about how a medication works, such as delay of onset, can shape a patient's perceived experience with the medication. Second, beliefs about medications propagate both 'top-down' and 'bottom-up', from experiences with specific medications to general beliefs about medications and vice versa. Third, non-adherence can interfere with learning about a medication, because beliefs, adherence, and experience with a medication are connected in a cyclic learning problem. We propose that by conceptualising non-adherence as a causal-learning process, clinicians can more effectively address a patient's misconceptions and biases, helping the patient develop more accurate impressions of the medication.

  5. Medical adherence to topical corticosteroid preparations prescribed for psoriasis

    DEFF Research Database (Denmark)

    Svendsen, Mathias Tiedemann; Andersen, Flemming; Hansen, Jakob

    2017-01-01

    OBJECTIVE: Topical corticosteroids and corticosteroid combinations are the principal treatments in psoriasis. The aim of this study was to investigate published literature dealing with medical adherence to topical corticosteroid or corticosteroid combinations in patients with psoriasis. MATERIALS...... health outcome in topical treatment of psoriasis, further studies should be conducted addressing determinants of nonadherence and test interventions to improve adherence. Validated measurements of medical nonadherence, prescription registers, or medication-weight are needed....

  6. Identification of documented medication non-adherence in physician notes.

    Science.gov (United States)

    Turchin, Alexander; Wheeler, Holly I; Labreche, Matthew; Chu, Julia T; Pendergrass, Merri L; Einbinder, Jonathan S; Einbinder, Jonathan Seth

    2008-11-06

    Medication non-adherence is common and the physicians awareness of it may be an important factor in clinical decision making. Few sources of data on physician awareness of medication non-adherence are available. We have designed an algorithm to identify documentation of medication non-adherence in the text of physician notes. The algorithm recognizes eight semantic classes of documentation of medication non-adherence. We evaluated the algorithm against manual ratings of 200 randomly selected notes of hypertensive patients. The algorithm detected 89% of the notes with documented medication non-adherence with specificity of 84.7% and positive predictive value of 80.2%. In a larger dataset of 1,000 documents, notes that documented medication non-adherence were more likely to report significantly elevated systolic (15.3% vs. 9.0%; p = 0.002) and diastolic (4.1% vs. 1.9%; p = 0.03) blood pressure. This novel clinically validated tool expands the range of information on medication non-adherence available to researchers.

  7. Benefits of adherence to psychotropic medications on depressive symptoms and antiretroviral medication adherence among men and women living with HIV/AIDS.

    Science.gov (United States)

    Cruess, Dean G; Kalichman, Seth C; Amaral, Christine; Swetzes, Connie; Cherry, Chauncey; Kalichman, Moira O

    2012-04-01

    Psychotropic medications are commonly used for depressive symptoms among people living with HIV/AIDS. We examined the relationships between adherence to psychotropic medications, depressive symptoms, and antiretroviral adherence. We assessed depressive symptoms among 324 people living with HIV/AIDS across a 3-month period (70% men; mean age 45 years; 90% African-American). Psychotropic and antiretroviral adherence was assessed using monthly, unannounced telephone pill counts. Multiple-regression and mediation analyses were utilized to examine associations under investigation. Greater depressive symptoms were associated with lower antiretroviral and psychotropic medication adherence. Greater adherence to psychotropic medications regardless of medication class was positively related to higher antiretroviral adherence. Greater adherence to psychotropic medications also significantly mediated the association between depressive symptoms and antiretroviral adherence. This study demonstrates the benefits of adherence to psychotropic medications on both depressive symptoms and antiretroviral adherence. Future work examining psychotropic medication adherence on disease outcomes in people living with HIV/AIDS is warranted.

  8. Does good medication adherence really save payers money?

    Science.gov (United States)

    Stuart, Bruce C; Dai, Mingliang; Xu, Jing; Loh, Feng-Hua E; S Dougherty, Julia

    2015-06-01

    Despite a growing consensus that better adherence with evidence-based medications can save payers money, assertions of cost offsets may be incomplete if they fail to consider additional drug costs and/or are biased by healthy adherer behaviors unobserved in typical medical claims-based analyses. The objective of this study was to determine whether controlling for healthy adherer bias (HAB) materially affected estimated medical cost offsets and additional drug spending associated with higher adherence. A total of 1273 Medicare beneficiaries with diabetes enrolled in Part D plans between 2006 and 2009. Using survey and claims data from the Medicare Current Beneficiary Survey, we measured medical and drug costs associated with good and poor adherence (proportion of days covered ≥ 80% and <80%, respectively) to oral antidiabetic drugs, ACE inhibitors/ARBs, and statins over 2 years. To test for HAB, we estimated pairs of regression models, one set containing variables typically controlled for in conventional claims analysis and a second set with survey-based variables selected to capture HAB effects. We found consistent evidence that controlling for HAB reduces estimated savings in medical costs from better adherence, and likewise, reduces estimates of additional adherence-related drug spending. For ACE inhibitors/ARBs we estimate that controlling for HAB reduced adherence-related medical cost offsets from $6389 to $4920 per person (P<0.05). Estimates of additional adherence-related drug costs were 26% and 14% lower in HAB-controlled models (P < 0.05). These results buttress the economic case for action by health care payers to improve medication adherence among insured persons with chronic disease. However, given the limitations of our research design, further research on larger samples with other disease states is clearly warranted.

  9. Medical Issues in Adoption

    Science.gov (United States)

    ... any medical tests the child has had the child's development in relation to standard age milestones, such as ... You may also want to arrange for the child to bring along some personal belongings. The touch and smell of a favorite toy or an old piece of clothing can help ...

  10. A wearable sensor system for medication adherence prediction.

    Science.gov (United States)

    Kalantarian, Haik; Motamed, Babak; Alshurafa, Nabil; Sarrafzadeh, Majid

    2016-05-01

    Studies have revealed that non-adherence to prescribed medication can lead to hospital readmissions, clinical complications, and other negative patient outcomes. Though many techniques have been proposed to improve patient adherence rates, they suffer from low accuracy. Our objective is to develop and test a novel system for assessment of medication adherence. Recently, several smart pill bottle technologies have been proposed, which can detect when the bottle has been opened, and even when a pill has been retrieved. However, very few systems can determine if the pill is subsequently ingested or discarded. We propose a system for detecting user adherence to medication using a smart necklace, capable of determining if the medication has been ingested based on the skin movement in the lower part of the neck during a swallow. This, coupled with existing medication adherence systems that detect when medicine is removed from the bottle, can detect a broader range of use-cases with respect to medication adherence. Using Bayesian networks, we were able to correctly classify between chewable vitamins, saliva swallows, medication capsules, speaking, and drinking water, with average precision and recall of 90.17% and 88.9%, respectively. A total of 135 instances were classified from a total of 20 subjects. Our experimental evaluations confirm the accuracy of the piezoelectric necklace for detecting medicine swallows and disambiguating them from related actions. Further studies in real-world conditions are necessary to evaluate the efficacy of the proposed scheme. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Adherence to oral contraception in women on Category X medications.

    Science.gov (United States)

    Steinkellner, Amy; Chen, William; Denison, Shannon E

    2010-10-01

    Over 6% of women become pregnant when taking teratogenic medications, and contraceptive counseling appears to occur at suboptimal rates. Adherence to contraception is an important component in preventing unwanted pregnancy and has not been evaluated in this population. We undertook a pharmacy claims-based analysis to evaluate the degree to which women of childbearing age who receive Category X medications adhere to their oral contraception. We evaluated the prescription medication claims for over 6 million women, age 18-44 years, with prescription benefits administered by a pharmacy benefits manager. Women with 2 or more claims for a Category X medication and 2 or more claims for oral contraception were evaluated in further detail. Adherence to oral contraception was measured by analyzing pharmacy claims. Multivariable logistic regression was performed to identify factors associated with adherence. There were 146,758 women of childbearing age who received Category X medications, of which 26,136 also took oral contraceptive medication. Women who received Category X medications were prescribed oral contraception (18%) at rates similar to others of childbearing age (17%). Women prescribed both Category X and oral contraception demonstrated adherence similar to the overall population. Age, class of Category X medication, number of medications, prescriber's specialty, and ethnicity correlated with lower adherence rates. Despite added risk associated with unintended pregnancy, many women who receive Category X medications have refill patterns suggesting nonadherence to oral contraception. Compared with all women age 18-44 years, women receiving teratogenic medications do not have better adherence to oral contraception. Copyright © 2010 Elsevier Inc. All rights reserved.

  12. Adherence to Medical Cannabis Among Licensed Patients in Israel

    OpenAIRE

    Zolotov, Yuval; Baruch, Yehuda; Reuveni, Haim; Magnezi, Racheli

    2016-01-01

    Abstract Objectives: To evaluate adherence among Israeli patients who are licensed to use medical cannabis and to identify factors associated with adherence to medical cannabis. Methods: Ninety-five novice licensed patients were interviewed for this cross-sectional study. The questionnaire measured demographics, the perceived patient?physician relationship, and the level of patients' active involvement in their healthcare. In addition, patients were queried about adverse effect(s) and about t...

  13. Adherence to Medical Cannabis Among Licensed Patients in Israel.

    Science.gov (United States)

    Zolotov, Yuval; Baruch, Yehuda; Reuveni, Haim; Magnezi, Racheli

    2016-01-01

    Objectives: To evaluate adherence among Israeli patients who are licensed to use medical cannabis and to identify factors associated with adherence to medical cannabis. Methods: Ninety-five novice licensed patients were interviewed for this cross-sectional study. The questionnaire measured demographics, the perceived patient-physician relationship, and the level of patients' active involvement in their healthcare. In addition, patients were queried about adverse effect(s) and about their overall satisfaction from this medical treatment. Results: Eighty percent ( n =76) has been identified as adherent to medical cannabis use. Variables found associated with adherence were "country of origin" (immigrant status), "type of illness" (cancer vs. non-cancer), and "experiencing adverse effect(s)." Three predictors of adherence were found significant in a logistic regression model: "type of illness" (odds ratio [OR] 0.101), patient-physician relationship (OR 1.406), and level of patient activation (OR 1.132). 71.5% rated themselves being "completely satisfied" or "satisfied" from medical cannabis use. Conclusions: Our findings show a relatively high adherence rate for medical cannabis, as well as relative safety and high satisfaction among licensed patients. Additionally indicated is the need to develop and implement standardized education about this evolving field-to both patients and physicians.

  14. Factors relevant to medication non-adherence in kidney transplant: a systematic review.

    Science.gov (United States)

    Belaiche, Stephanie; Décaudin, Bertrand; Dharancy, Sébastien; Noel, Christian; Odou, Pascal; Hazzan, Marc

    2017-06-01

    Background Medication non-adherence is a major issue after transplant that can lead to misdiagnosis, rejection, poor health affecting quality of life, graft loss or death. Several estimations of adherence and related factors have previously been described but conclusions leave doubt as to the most accurate assessment method. Aim of the review To identify the factors most relevant to medication non-adherence in kidney transplant in current clinical practice. Method This systematic review is registered in the PROSPERO data base and follows the Prisma checklist. Articles in English in three databases from January 2009 to December 2014 were analysed. A synthesis was made to target adherence assessment methods, their prevalence and significance. Results Thirty-seven studies were analysed rates of non-adherence fluctuating from 1.6 to 96%. Assessment methods varied from one study to another, although self-reports were mainly used. It appears that youth (≤50 years old), male, low social support, unemployment, low education, ≥3 months post graft, living donor, ≥6 comorbidities, ≥5 drugs/d, ≥2 intakes/d, negative beliefs, negative behavior, depression and anxiety were the factors significantly related to non-adherence. Conclusion As there are no established guidelines, consideration should be given to more than one approach to identify medication non-adherence although self-reports should remain the cornerstone of adherence assessment.

  15. Patient Medication Knowledge Governing Adherence to Asthma ...

    African Journals Online (AJOL)

    Asthma is a chronic disease and often requires complex management. This study was undertaken in four pharmacies–V-Ninat Pharmacy, Videc Chemists, Tomabel Pharmacy and Josbet Chemists, all in Isolo, Lagos, to determine the level of adherence to the anti-asthmatic drugs by asthmatic patients who participated in the ...

  16. Antipsychotic medication non-adherence among schizophrenia ...

    African Journals Online (AJOL)

    2018-03-05

    Mar 5, 2018 ... Non-adherence can cause high rates of relapse within 5 years of recovery from the first episode.7. Thus, lack of .... schizophrenia patients at Amanuel Mental Specialized Hospital, Addis Ababa,. Ethiopia, June 2014 (n = 412). 0. No substance use. Alcohol. Cigarre e. Chat. Alcohol/Cigarete/Chat. Cigarrete/ ...

  17. Social network approaches to recruitment, HIV prevention, medical care, and medication adherence.

    Science.gov (United States)

    Latkin, Carl A; Davey-Rothwell, Melissa A; Knowlton, Amy R; Alexander, Kamila A; Williams, Chyvette T; Boodram, Basmattee

    2013-06-01

    This article reviews the current issues and advancements in social network approaches to HIV prevention and care. Social network analysis can provide a method to understand health disparities in HIV rates, treatment access, and outcomes. Social network analysis is a valuable tool to link social structural factors to individual behaviors. Social networks provide an avenue for low-cost and sustainable HIV prevention interventions that can be adapted and translated into diverse populations. Social networks can be utilized as a viable approach to recruitment for HIV testing and counseling, HIV prevention interventions, optimizing HIV medical care, and medication adherence. Social network interventions may be face-to-face or through social media. Key issues in designing social network interventions are contamination due to social diffusion, network stability, density, and the choice and training of network members. There are also ethical issues involved in the development and implementation of social network interventions. Social network analyses can also be used to understand HIV transmission dynamics.

  18. Predictive patterns of early medication adherence in renal transplantation.

    Science.gov (United States)

    Nevins, Thomas E; Robiner, William N; Thomas, William

    2014-10-27

    Patients' adherence with posttransplant immunosuppression is known to affect renal transplant outcomes. Prospectively, individual medication adherence patterns in 195 kidney transplant recipients were quantified with electronic medication monitors. Monitored drugs were mycophenolate mofetil, sirolimus, or azathioprine. Monitoring began at hospital discharge and continued an average of 15±8 months. Patient follow-up for clinical outcomes averaged 8±3 years. Each month's adherence percentage was calculated as the sum of daily adherence percents, divided by the number of evaluable days. During the first 3 months after transplantation, patients (n=44) with declining medication adherence, defined as dropping by 7% or higher (equal to missing 2 days) between months 1 and 2, later experienced lower mean medication adherence for months 6 to 12, 73% versus 92% respectively (Padherence, they also had more frequent (P=0.034) and earlier (P=0.065) acute rejection episodes. This was additionally associated with more frequent (P=0.017) and earlier (P=0.046) death-censored graft loss.In addition, daily medication adherence, expressed as the percentage of doses taken, decreased as the number of prescribed daily doses increased. During the first 3 months after transplantation, adherence with four doses per day averaged 84%, compared to 91% for patients on twice-daily dosing (P=0.024) and 93.5% for patients on once-daily dosing (P=0.008). Early declining medication nonadherence is associated with adverse clinical outcomes. This pattern is detectable during the first 2 months after transplantation. Early detection of nonadherence provides opportunities to target interventions toward patients at the highest risk for adverse behaviors and events.

  19. Appointment length, psychiatrists' communication behaviors, and medication management appointment adherence.

    Science.gov (United States)

    Cruz, Mario; Roter, Debra L; Cruz, Robyn F; Wieland, Melissa; Larson, Susan; Cooper, Lisa A; Pincus, Harold Alan

    2013-09-01

    The authors explored the relationship between critical elements of medication management appointments (appointment length, patient-centered talk, and positive nonverbal affect among providers) and patient appointment adherence. The authors used an exploratory, cross-sectional design employing quantitative analysis of 83 unique audio recordings of split treatment medication management appointments for 46 African-American and 37 white patients with 24 psychiatrists at four ambulatory mental health clinics. All patients had a diagnosis of depression. Data collected included demographic information; Patient Health Questionnaire-9 scores for depression severity; psychiatrist verbal and nonverbal communication behaviors during medication management appointments, identified by the Roter Interaction Analysis System during analysis of audio recordings; and appointment adherence. Bivariate analyses were employed to identify covariates that might influence appointment adherence. Generalized estimating equations (GEEs) were employed to assess the relationship between appointment length, psychiatrist patient-centered talk, and positive voice tone ratings and patient appointment adherence, while adjusting for covariates and the clustering of observations within psychiatrists. Wald chi square analyses were used to test whether all or some variables significantly influenced appointment adherence. GEE revealed a significant relationship between positive voice tone ratings and appointment adherence (p=.03). Chi square analyses confirmed the hypothesis of a positive and significant relationship between appointment adherence and positive voice tone ratings (p=.03) but not longer visit length and more patient-centered communication. The nonverbal conveyance of positive affect was associated with greater adherence to medication management appointments by depressed patients. These findings potentially have important implications for communication skills training and adherence research.

  20. Medication non-adherence and uncertainty

    DEFF Research Database (Denmark)

    Kriegbaum, Margit; Lau, Sofie Rosenlund

    2017-01-01

    BACKGROUND: Statins are widely prescribed to lower cardiovascular morbidity and mortality. However, statin non-adherence is very high. PURPOSE: The aim of this paper was to investigate reasons for stopping statin treatment in the general population and to study how aspects of information-seeking ......BACKGROUND: Statins are widely prescribed to lower cardiovascular morbidity and mortality. However, statin non-adherence is very high. PURPOSE: The aim of this paper was to investigate reasons for stopping statin treatment in the general population and to study how aspects of information......-seeking and processing is associated with statin non-adherence. METHODS: This study used a population survey on 3050 Danish residents aged 45-65 years. Reasons for statin discontinuation was studied among those who were previous statin users. The association between information seeking and processing and statin...... from information disseminated by media outlets. Side effects and fear of side effects should be addressed in clinical practice. Health care professionals should pay attention to emotional aspects of how information is disseminated and perceived by statin users....

  1. Association between adherence to medications for COPD and medications for other chronic conditions in COPD patients

    Directory of Open Access Journals (Sweden)

    Dhamane AD

    2016-12-01

    Full Text Available Amol D Dhamane,1 Phil Schwab,2 Sari Hopson,2 Chad Moretz,2 Srinivas Annavarapu,2 Kate Burslem,1 Andrew Renda,3 Shuchita Kaila1 1Health Economics and Outcomes Research, Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT, 2Comprehensive Health Insights Inc, Louisville, 3Humana Inc, Louisville, KY, USA Background: Patients with COPD often have multiple comorbidities requiring use of multiple medications, and adherence rates for maintenance COPD (mCOPD medications are already known to be suboptimal. Presence of comorbidities in COPD patients, and use of medications used to treat those comorbidities (non-COPD medications, may have an adverse impact on adherence to mCOPD medications. Objective: The objective of the study was to evaluate the association between non-adherence to mCOPD medications and non-COPD medications in COPD patients. Methods: COPD patients were identified using a large administrative claims database. Selected patients were 40–89 years old and continuously enrolled for 12 months prior to and 24 months after the first identified COPD diagnosis (index date during January 1, 2009 to December 31, 2010. Patients were required to have ≥1 prescription for a mCOPD medication within 365 days of the index date and ≥1 prescription for one of 12 non-COPD medication classes within ±30 days of the first COPD prescription. Adherence (proportion of days covered [PDC] was measured during 365 days following the first COPD prescription. The association between non-adherence (PDC <0.8 to mCOPD and non-adherence to non-COPD medications was determined using logistic regression, controlling for baseline patient characteristics. Results: A total of 14,117 patients, with a mean age of 69.9 years, met study criteria. Of these, 40.9% were males and 79.2% were non-adherent to mCOPD medications with a mean PDC of 0.47. Non-adherence to mCOPD medications was associated with non-adherence to 10 of 12 non-COPD medication classes (odds ratio 1.38–1

  2. Adherence to medications by patients after acute coronary syndromes.

    Science.gov (United States)

    Sud, Anchal; Kline-Rogers, Eva M; Eagle, Kim A; Fang, Jianming; Armstrong, David F; Rangarajan, Krishna; Otten, Richard F; Stafkey-Mailey, Dana R; Taylor, Stephanie D; Erickson, Steven R

    2005-11-01

    Nonadherence to medication may lead to poor medical outcomes. To describe medication-taking behavior of patients with a history of acute coronary syndromes (ACS) for 4 classes of drugs and determine the relationship between self-reported adherence and patient characteristics. Consenting patients with the diagnosis of ACS were interviewed by telephone approximately 10 months after discharge. The survey elicited data characterizing the patient, current medication regimens, beliefs about drug therapy, reasons for discontinuing medications, and adherence. The survey included the Beliefs About Medicine Questionnaire providing 4 scales: Specific Necessity, Specific Concerns, General Harm, and General Overuse, and the Medication Adherence Scale (MAS). Multivariate regression was used to determine the independent variables with the strongest association to the MAS. A p value or =1 other person, and 42% indicating excellent or very good health. The percentage of patients continuing on medication at the time of the survey category ranged from 87.4% (aspirin) to 66.0% (angiotensin-converting enzyme inhibitors). Reasons for stopping medication included physician discontinuation or adverse effects. Of patients still on drug therapy, the mean MAS was 1.3 +/- 0.4, with 53.8% indicating nonadherence (score >1). The final regression model showed R(2) = 0.132 and included heart-related health status and Specific Necessity as significant predictor variables. After ACS, not all patients continue their drugs or take them exactly as prescribed. Determining beliefs about illness and medication may be helpful in developing interventions aimed at improving adherence.

  3. Ethno-Cultural Considerations in Cardiac Patients' Medication Adherence.

    Science.gov (United States)

    King-Shier, K M; Singh, S; Khan, N A; LeBlanc, P; Lowe, J C; Mather, C M; Chong, E; Quan, H

    2017-10-01

    We aimed to develop an in-depth understanding about factors that influence cardiac medication adherence among South Asian, Chinese, and European White cardiac patients. Sixty-four patients were purposively sampled from an ongoing study cohort. Interviews were audio-recorded and transcribed for analyses. Physicians' culturally sensitive communication and patients' motivation to live a symptom-free and longer life enhanced adherence. European Whites were motivated to enhance personal well-being and enjoy family life. South Asians' medication adherence was influenced by the desire to fulfill the will of God and family responsibilities. The Chinese were motivated to avoid pain, illness, and death, and to obey a health care provider. The South Asians and Chinese wanted to ultimately reduce medication use. Previous positive experiences, family support, and establishing a routine also influenced medication adherence. Deterrents to adherence were essentially the reverse of the motivators/facilitators. This analysis represents an essential first step forward in developing ethno-culturally tailored interventions to optimize adherence.

  4. Concordance of Adherence Measurement Using Self-Reported Adherence Questionnaires and Medication Monitoring Devices: An Updated Review.

    Science.gov (United States)

    Monnette, Alisha; Zhang, Yichen; Shao, Hui; Shi, Lizheng

    2018-01-01

    As medication adherence continues to be a prevalent issue in today's society, the methods used to monitor medication-taking behaviors are constantly being re-evaluated and compared in search of the 'gold standard' measure. Our review aimed to assess the current literature surrounding the correlation between self-reported questionnaires (SRQs) and electronic monitoring devices to determine if these measures produce similar results. We performed a literature search from 2009 to 2017 using PubMed, PubMed In-Process and Non-Indexed, EMBASE, Ovid MEDLINE, and Ovid MEDLINE In-Process. A keyword search using the terms 'patient compliance', 'treatment compliance', 'medication adherence', 'drug monitoring', 'drug therapy', 'electronic', 'digital', 'computer', 'monitor', 'monitoring', 'drug', 'pharmaceutical preparations', 'compliance', and 'medications' was done to capture all articles. We included articles measuring adherence using both monitoring devices and SRQs. Thirty-five articles were included in this review. The average difference in measured adherence rates between the two measures was 9.2% (range -66.3 to 61.5). A majority (62.7%) of articles reported moderate (n = 12; 27.9%), high (n = 5, 11.6%), or significant (n = 10, 23.3%) correlations between SRQs and monitoring devices. Results from our review are consistent with previous studies, as we found that many of our studies produced moderate to high correlation between both SRQs and monitoring devices [Farmer, Clin Ther 21(6):1074-90 (1999), IMS Institute for Healthcare Informatics. Avoidable costs in US health care (2012), Patel et al., Respirology 18(3):546-52 (2013), Siracusa et al., J Cyst Fibros 14(5):621-6 (2015), Smith et al., Int J Cardiol 145(1):122-3 (2010)]. Our findings demonstrate that self-reported adherence produces comparable results to electronic monitoring devices. As there is not yet a 'gold standard' measure for monitoring patient adherence, SRQs and Medication Event Monitoring Systems

  5. Medication adherence and Medicare expenditure among beneficiaries with heart failure.

    Science.gov (United States)

    Lopert, Ruth; Shoemaker, J Samantha; Davidoff, Amy; Shaffer, Thomas; Abdulhalim, Abdulla M; Lloyd, Jennifer; Stuart, Bruce

    2012-09-01

    To (1) measure utilization of and adherence to heart failure medications and (2) assess whether better adherence is associated with lower Medicare spending. Pooled cross-sectional design using six 3-year cohorts of Medicare beneficiaries with congestive heart failure (CHF) from 1997 through 2005 (N = 2204). Adherence to treatment was measured using average daily pill counts. Bivariate and multivariate methods were used to examine the relationship between medication adherence and Medicare spending. Multivariate analyses included extensive variables to control for confounding, including healthy adherer bias. Approximately 58% of the cohort were taking an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), 72% a diuretic, 37% a beta-blocker, and 34% a cardiac glycoside. Unadjusted results showed that a 10% increase in average daily pill count for ACE inhibitors or ARBs, beta-blockers, diuretics, or cardiac glycosides was associated with reductions in Medicare spending of $508 (not significant [NS]), $608 (NS), $250 (NS), and $1244 (P <.05), respectively. Estimated adjusted marginal effects of a 10% increase in daily pill counts for beta-blockers and cardiac glycosides were reductions in cumulative 3-year Medicare spending of $510 to $561 and $750 to $923, respectively (P <.05). Higher levels of medication adherence among Medicare beneficiaries with CHF were associated with lower cumulative Medicare spending over 3 years, with savings generally exceeding the costs of the drugs in question.

  6. 76 FR 12969 - Campaign To Improve Poor Medication Adherence (U18)

    Science.gov (United States)

    2011-03-09

    ... the root causes for inadequate medication adherence, and effecting changes in knowledge and behaviors... adherence, a vital first step toward improved adherence behavior and better public health outcomes. DATES... adherence behavior and better health outcomes. Relevance Inadequate medication adherence is a $290 billion...

  7. Adherence to anti-depressant medication

    DEFF Research Database (Denmark)

    Buus, Niels

    2014-01-01

    The study of medicine taking is controversial as it often reveals a discrepancy between healthcare professionals' advice and patients' actual behaviour. Qualitative researchers have examined depressed people's adherence to prescriptions of antidepressants by exploring the meaning they impute...... to the medicine and their use of the medicine in the wider context of their everyday lives. This paper contributes to this area of research by means of a prospective research study focussing on depressed patients' perspectives on taking medicine and how they change through time. The study included consecutive...... semi-structured interviews with 16 people four times during the year following an admission to hospital for depression. Data were collected in 2008-2009 in the Region of Southern Denmark. The study was based on an interactionist conception of social career and data were analysed thematically. Findings...

  8. Tackling medication non-adherence in severe mental illness: where are we going wrong?

    Science.gov (United States)

    Brown, E; Gray, R

    2015-04-01

    Although people with schizophrenia require medication to manage symptoms such as hearing voices, most do not take it as prescribed (they are non-adherent). We talked to psychiatrists, nurses and pharmacists about how they work with patients to help them be better at sticking with their medication. Although the professionals that we talked to recognized that treatment adherence was a major issue in their clinical work, they did not make best use of evidence-based interventions to address the problem. Often their practice was based on what they believed would work (e.g. patient education) even when the research shows that way of working to be ineffective. As far as we can determine, this is the first study to examine what interventions different mental health professionals report that they use in clinical practice to address patient's medication non-adherence. Non-adherence with medication is common in patients with schizophrenia. Addressing adherence to treatment may enhance clinical outcomes. Our aim was to explore mental health professionals experience and practise managing medication adherence in patients with schizophrenia. In this qualitative study, we interviewed mental health professionals from three key groups involved in promoting adherence: pharmacists, psychiatrists and nurses. Interviews were transcribed and analysed using a thematic approach. Thirty-five health professionals participated. From these interviews, we identified five main themes: my beliefs inform my practice; withholding information; adherence is important; who is responsible for promoting adherence?; and is it ok to pay people to take medication? Our overarching meta-theme was that practice with regard to promoting adherence was informed by beliefs and not by evidence. To the best of our knowledge, this is the first study to explore different mental health professionals' approaches to working with patients who do not want to take medication. The significance of participants' personal

  9. Medication Days Supply, Adherence, Wastage, and Cost

    Data.gov (United States)

    U.S. Department of Health & Human Services — In an attempt to contain Medicaid pharmacy costs, nearly all states impose dispensing limits on medication days supply. Although longer days supply appears to...

  10. Medication Adherence Survey: A First Year Pharmacy Immersion Students’ Perspective

    Directory of Open Access Journals (Sweden)

    Claudia F Ortiz Lopez

    2016-09-01

    Full Text Available First year pharmacy Immersion students from University of North Carolina Eshelman School of Pharmacy used a three question survey during their rotation at Moses H. Cone Hospital that analyzed patients’ medication adherence. Data collection revealed common trends that have been shown in the literature and areas for improvement. This method of evaluation was used by Phase I Immersion students to gain perspective on the problems we continue to have with medication adherence. Conflict of Interest We do not have any potential conflicts of interest with respect to the research, authorship, and/or publication of this article.   Type: Student Project

  11. Expert Involvement and Adherence to Medical Evidence in Medical Mobile Phone Apps: A Systematic Review.

    Science.gov (United States)

    Subhi, Yousif; Bube, Sarah Hjartbro; Rolskov Bojsen, Signe; Skou Thomsen, Ann Sofia; Konge, Lars

    2015-07-27

    Both clinicians and patients use medical mobile phone apps. Anyone can publish medical apps, which leads to contents with variable quality that may have a serious impact on human lives. We herein provide an overview of the prevalence of expert involvement in app development and whether or not app contents adhere to current medical evidence. To systematically review studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. We systematically searched 3 databases (PubMed, The Cochrane Library, and EMBASE), and included studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. Two authors performed data extraction independently. Qualitative analysis of the included studies was performed. Based on inclusion criteria, 52 studies were included in this review. These studies assessed a total of 6520 apps. Studies dealt with a variety of medical specialties and topics. As much as 28 studies assessed expert involvement, which was found in 9-67% of the assessed apps. Thirty studies (including 6 studies that also assessed expert involvement) assessed adherence of app content to current medical evidence. Thirteen studies found that 10-87% of the assessed apps adhered fully to the compared evidence (published studies, recommendations, and guidelines). Seventeen studies found that none of the assessed apps (n=2237) adhered fully to the compared evidence. Most medical mobile phone apps lack expert involvement and do not adhere to relevant medical evidence.

  12. The therapeutic relationship and adherence to antipsychotic medication in schizophrenia.

    Directory of Open Access Journals (Sweden)

    Rosemarie McCabe

    Full Text Available OBJECTIVE: Previous research has shown that a better therapeutic relationship (TR predicts more positive attitudes towards antipsychotic medication, but did not address whether it is also linked with actual adherence. This study investigated whether the TR is associated with adherence to antipsychotics in patients with schizophrenia. METHODS: 134 clinicians and 507 of their patients with schizophrenia or a related psychotic disorder participated in a European multi-centre study. A logistic regression model examined how the TR as rated by patients and by clinicians is associated with medication adherence, adjusting for clinician clustering and symptom severity. RESULTS: Patient and clinician ratings of the TR were weakly inter-correlated (r(s = 0.13, p = 0.004, but each was independently linked with better adherence. After adjusting for patient rated TR and symptom severity, each unit increase in clinician rated TR was associated with an increase of the odds ratio of good compliance by 65.9% (95% CI: 34.6% to 104.5%. After adjusting for clinician rated TR and symptom severity, for each unit increase in patient rated TR the odds ratio of good compliance was increased by 20.8% (95% CI: 4.4% to 39.8%. CONCLUSIONS: A better TR is associated with better adherence to medication among patients with schizophrenia. Patients' and clinicians' perspectives of the TR are both important, but may reflect distinct aspects.

  13. Effects of coverage gap reform on adherence to diabetes medications.

    Science.gov (United States)

    Zeng, Feng; Patel, Bimal V; Brunetti, Louis

    2013-04-01

    To investigate the impact of Part D coverage gap reform on diabetes medication adherence. Retrospective data analysis based on pharmacy claims data from a national pharmacy benefit manager. We used a difference-in-difference-indifference method to evaluate the impact of coverage gap reform on adherence to diabetes medications. Two cohorts (2010 and 2011) were constructed to represent the last year before Affordable Care Act (ACA) reform and the first year after reform, respectively. Each patient had 2 observations: 1 before and 1 after entering the coverage gap. Patients in each cohort were divided into groups based on type of gap coverage: no coverage, partial coverage (generics only), and full coverage. Following ACA reform, patients with no gap coverage and patients with partial gap coverage experienced substantial drops in copayments in the coverage gap in 2011. Their adherence to diabetes medications in the gap, measured by percentage of days covered, improved correspondingly (2.99 percentage points, 95% confidence interval [CI] 0.49-5.48, P = .019 for patients with no coverage; 6.46 percentage points, 95% CI 3.34-9.58, P gap in 2011. However, their adherence did not increase (-0.13 percentage point, P = .8011). In the first year of ACA coverage gap reform, copayments in the gap decreased substantially for all patients. Patients with no coverage and patients with partial coverage in the gap had better adherence in the gap in 2011.

  14. Medical prescription adherence among patient visiting gynecology department

    International Nuclear Information System (INIS)

    Rafique, M.; Arshad, H.; Tabassum, H.; Khan, N. U. S.; Qamar, K.

    2017-01-01

    Objective: The aim of this study was to explore the level of Medical prescription adherence among gynecological patients of Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: The study was conducted in Punjab province and data were collected from June 2015 to April 2016. Material and Methods: This cross-sectional study was carried out in main cities of Punjab province of Pakistan; Lahore, Gujranwala, Faisalabad and Sheikhupura. The survey data was collected from different location of cities. Patients visiting the gynecological and going to chemists for getting the prescribed medicine were selected through probability based random sampling for this study. The questionnaire consisted on the extent to which they adhere to time, dose, frequency and procedure prescribed from their doctors. The questions were asked in native language (Urdu). The data analysis was performed by using SPSS software (Ver.21). Results: Results of this study, based on sample from four big cities of Punjab province of Pakistan, showed that the level of medical prescription was associated with the age, qualification and background of the patients. Adherence level of patients reporting with rural background was observed higher than the adherence level of patients from urban areas. Conclusion: Over all the patient require counseling regarding adherence to medical prescription irrespective of the nature of the disease. (author)

  15. Multifaceted Prospective Memory Intervention to Improve Medication Adherence.

    Science.gov (United States)

    Insel, Kathie C; Einstein, Gilles O; Morrow, Daniel G; Koerner, Kari M; Hepworth, Joseph T

    2016-03-01

    To test whether a multifaceted prospective memory intervention improved adherence to antihypertensive medications and to assess whether executive function and working memory processes moderated the intervention effects. Two-group longitudinal randomized control trial. Community. Individuals aged 65 and older without signs of dementia or symptoms of severe depression who were self-managing prescribed medication. After 4 weeks of initial adherence monitoring using a medication event monitoring system, individuals with 90% or less adherence were randomly assigned to groups. The prospective memory intervention was designed to provide strategies that switch older adults from relying on executive function and working memory processes (that show effects of cognitive aging) to mostly automatic associative processes (that are relatively spared with normal aging) for remembering to take medications. Strategies included establishing a routine, establishing cues strongly associated with medication taking actions, performing the action immediately upon thinking about it, using a medication organizer, and imagining medication taking to enhance encoding and improve cuing. There was significant improvement in adherence in the intervention group (57% at baseline to 78% after the intervention), but most of these gains were lost after 5 months. The control condition started at 68% and was stable during the intervention, but dropped to 62%. Executive function and working memory moderated the intervention effect, with the intervention producing greater benefit for those with lower executive function and working memory. The intervention improved adherence, but the benefits were not sustained. Further research is needed to determine how to sustain the substantial initial benefits. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  16. Providing physicians with feedback on medication adherence for people with chronic diseases taking long-term medication.

    Science.gov (United States)

    Zaugg, Vincent; Korb-Savoldelli, Virginie; Durieux, Pierre; Sabatier, Brigitte

    2018-01-10

    information about patient adherence to medication. Only studies in which feedback to the physician was the sole intervention or the essential component of a multifaceted intervention were eligible. In the comparison groups, the physicians should not have had access to information about their patients' adherence to medication. We considered the following outcomes: medication adherence, patient outcomes, health resource use, processes of care, and adverse events. Two independent review authors extracted and analysed all data using standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care group. Due to heterogeneity in study methodology, comparison groups, intervention settings, and measurements of outcomes, we did not carry out meta-analysis. We describe the impact of interventions on outcomes in tabular form and make a qualitative assessment of the effects of studies. We included nine studies (23,255 patient participants): eight randomised trials and one interrupted time series analysis. The studies took place in primary care and other outpatient settings in the USA and Canada. Seven interventions involved the systematic provision of feedback to physicians concerning all their patients' adherence to medication, and two interventions involved issuing an alert for non-adherent patients only. Seven studies used pharmacy refill data to assess medication adherence, and two used an electronic device or self-reporting. The definition of adherence differed across studies, making comparisons difficult. Eight studies were at high risk of bias, and one study was at unclear risk of bias. The most frequent source of bias was lack of protection against contamination.Providing physicians with feedback may lead to little or no difference in medication adherence (seven studies, 22,924 patients), patient outcomes (two studies, 1292 patients), or health resource use (two studies, 4181 patients). Providing physicians with feedback on medication

  17. Retrospective Analysis of Medication Adherence and Cost Following Medication Therapy Management

    Directory of Open Access Journals (Sweden)

    Ashley Branham, PharmD

    2010-01-01

    Full Text Available Objective: To determine if pharmacist-provided medication therapy management (MTM improves medication adherence in Medicare patients. A secondary objective is to compare the total monthly cost of a patient’s prescription medication regimen 6 months before and 6 months following a comprehensive medication review (CMR. Design: Retrospective analysis of medication adherence, pre-post comparison. Setting: Three independent pharmacies in North Carolina. Patients: 97 Medicare Part D beneficiaries with one or more chronic disease states who participated in a comprehensive medication review (CMR. Intervention: MTM services provided by community pharmacists. Main outcome measure: Change in adherence as measured by the proportion of days covered (PDC and change in medication costs for patients and third party payers. Results: Patients were adherent to chronic disease-state medications before and after MTM (PDC≥ 0.8. Overall, change in mean adherence before and after MTM did not change significantly (0.87 and 0.88, respectively; p = 0.43. However, patients taking medications for cholesterol management, GERD, thyroid and BPH demonstrated improved adherence following a CMR. No change in adherence was noted for patients using antihypertensives and antidiabetic agents. Average total chronic disease-state medication costs for participants were reduced from $210.74 to $193.63 (p=0.08 following the comprehensive medication review. Total costs for patient and third party payers decreased from patients prescribed antilipemics, antihypertensives, GERD and thyroid disorders following a CMR. Conclusions: Pharmacist-provided MTM services were effective at improving medication adherence for some patients managed with chronic medications. Pharmacist-provided MTM services also were effective in decreasing total medication costs.

  18. Assessing Medication Adherence in Patients with Rheumatoid Arthritis (RA)

    Science.gov (United States)

    2017-04-26

    35.4) 53 (64.6) Vrrywtilk Weak Moder; lte Strona VerySlronl • Fisher’. 1txllC1 test • MMAS8 and CQR19 taking and dosing group assignments were...eported meaSlle 01 medICation adherence Med Care 1966.2467_74 Morl6ky DE. OJMalteo MR Improving the measurement of ult.,epor1ed medICation nonadherence

  19. Adherence to oral and topical medication in 445 patients with tinea pedis as assessed by the Morisky Medication Adherence Scale-8.

    Science.gov (United States)

    Tsunemi, Yuichiro; Abe, Shinya; Kobayashi, Miwa; Kitami, Yuki; Onozuka, Daisuke; Hagihara, Akihito; Takeuchi, Satoshi; Murota, Hiroyuki; Sugaya, Makoto; Masuda, Koji; Hiragun, Takaaki; Kaneko, Sakae; Saeki, Hidehisa; Shintani, Yoichi; Tanioka, Miki; Imafuku, Shinichi; Abe, Masatoshi; Inomata, Naoko; Morisky, Donald E; Furue, Masutaka; Katoh, Norito

    2015-01-01

    Adherence is defined as the extent to which a person's behavior corresponds with recommendations from health care providers. Adherence to treatment is an important factor for a good therapeutic outcome. This study aimed to examine the adherence of patients with tinea pedis and to clarify the factors related to it. We assessed medication adherence for oral and topical drugs using a translated version of the Morisky Medication Adherence Scale-8 (MMAS-8) together with other background factors in 445 Japanese patients with tinea pedis, using a questionnaire in a web-based monitoring system. Overall, high, medium and low adherence rates as assessed by MMAS-8 were 8.7%, 31.7% and 59.6% for oral medication, and 8.6%, 17.4% and 74.0% for topical medication, respectively. The adherence level was significantly higher for oral medication than for topical medication. Subgroup analyses showed that the adherence level for topical medication was significantly higher when topical and oral medications were used in combination than when topical medication was used alone. A low adherence level was shown in employed patients, those for whom their oral medication had not been effective and those with topical medication who had visited their hospital less often than once every six months. Patient adherence to therapy can be effectively improved by selecting highly effective medication while considering the prescription of topical and oral antifungal medications concomitantly, by carefully selecting a therapy plan for employed patients and by encouraging patients to visit their doctor regularly.

  20. HYPERTENSION IN THE ELDERLY: AN APPROACH TO MEDICATION ADHERENCE

    Directory of Open Access Journals (Sweden)

    A. N. Cunha

    2018-04-01

    Full Text Available Systemic arterial hypertension is a chronic disease of high prevalence in Brazil, considered a public health problem. The purpose of this study was to analyze medication adherence by the elderly, for this, a quantitative study was carried out with hypertensive patients enrolled in the Hiperdia program and attended in a Basic Health Unit at Sinop, Mato Grosso. Individual interviews were conducted with the elderly in the Family Health Strategy, at prescheduled time and place according to the patient's availability. The interview script was structured with simple, direct and easy-to-understand questions, involving three aspects: socio-demographic variables (gender, age and income, guided questions about the pathology in question (eating habits, physical exercises, drug therapy and assessment of adherence to antihypertensive treatment. The data were analyzed by means of descriptive statistics and the prevalence coefficients were calculated. Fifteen elderly (50% adherents to the drug treatment were identified, of whom 13 were female and only two were male, thus making evident that women seek more the public health service and adhere better to the treatment. Given this, it is necessary to seek strategies that allow greater adherence to treatment and that encourage the male gender to seek health services for constant monitoring and not only in extreme cases.

  1. Adherence to Principles of Medical Ethics Among Physicians in Mazandaran Province, Iran.

    Science.gov (United States)

    Ghaderi, Ahmad; Malek, Farhad; Mohammadi, Mohammad; Rostami Maskopaii, Somayeh; Hamta, Amir; Madani, Seyyed Abdollah

    2018-01-01

    Considering that medical ethics is an applied subject providing systematic solutions to help physicians with moral issues, this research aimed to evaluate adherence to the principles of medical ethics among physicians on the basis of attitude of physicians of Mazandaran province. This cross-sectional study was conducted in Mazandaran province, Iran during 2015. A researcher-made questionnaire was used for data collection. The questionnaire was first completed by 40 physicians and its reliability was confirmed by obtaining a Cronbach's alpha coefficient equal to 0.818. Its validity was confirmed by medical ethics experts. Therefore, the questionnaire was reliable and valid. Analytical and descriptive analysis were performed. According to our findings, there is a significant correlation between some of variables of medical ethics principles. The results show that adherence to indicators of beneficence, non-maleficence and justice has been almost good; however, physicians' ethical behaviors which pertain towards the principle of autonomy have not been acceptable. There was not any significant difference in adherence to the principles of autonomy, beneficence and non-maleficence, and justice on the basis of sex, residency, education and occupation. According to the present study, more training is required to improve physicians' adherence to the principles of medical ethics . 2018 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  2. Effects of First Diagnosed Diabetes Mellitus on Medical Visits and Medication Adherence in Korea

    Science.gov (United States)

    Hyeongsu, KIM; Soon-Ae, SHIN; Kunsei, LEE; Jong-Heon, PARK; Tae Hwa, HAN; Minsu, PARK; Eunyoung, Minsu; Hyoseon, JEONG; Jung-Hyun, LEE; Hyemi, AHN; Vitna, KIM

    2018-01-01

    Background: The National Health Insurance Service (NHIS) conducted a screening test to detect chronic diseases such as hypertension and diabetes in Korea. This study evaluated the effects of health screening for DM on pharmacological treatment. Methods: The data from qualification and the General Health Screening in 2012, the insurance claims of medical institutions from Jan 2009 to Dec 2014, and the diabetic case management program extracted from the NHIS administrative system were used. Total 16068 subjects were included. Visiting rate to medical institution, medication possession ratio and the rate of medication adherence of study subjects were used as the indices. Results: The visiting rates to medical institutions were 39.7%. The percentage who received a prescription for a diabetes mellitus medication from a doctor was 80.9%, the medication possession ratio was 70.8%, and the rate of medication adherence was 57.8%. Conclusion: The visiting rate, medication possession ratio and rate of medication adherence for DM medication were not high. In order to increase the visiting rate, medication possession ratio and rate of medication adherence, NHIS should support environment in which medical institutions and DM patients can do the role of each part. PMID:29445630

  3. Expert Involvement and Adherence to Medical Evidence in Medical Mobile Phone Apps

    DEFF Research Database (Denmark)

    Subhi, Yousif; Bube, Sarah Hjartbro; Rolskov Bojsen, Signe

    2015-01-01

    BACKGROUND: Both clinicians and patients use medical mobile phone apps. Anyone can publish medical apps, which leads to contents with variable quality that may have a serious impact on human lives. We herein provide an overview of the prevalence of expert involvement in app development and whether...... or not app contents adhere to current medical evidence. OBJECTIVE: To systematically review studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. METHODS: We systematically searched 3 databases (PubMed, The Cochrane Library, and EMBASE......), and included studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. Two authors performed data extraction independently. Qualitative analysis of the included studies was performed. RESULTS: Based on inclusion criteria, 52 studies were included...

  4. Training general practitioners in behavior change counseling to improve asthma medication adherence

    NARCIS (Netherlands)

    Broers, Sandra; Smets, Ellen; Bindels, Patrick; Bennebroek Evertsz', Floor; Calff, Mart; de Haes, Hanneke

    2005-01-01

    Objective: Adherence to asthma medication regimens is problematic in general practice. We developed and evaluated a communication training for general practitioners (GPs) to help them address medication adherence during routine consultations. This paper describes the development of the training and

  5. Factors related to medication non-adherence for patients with hypertension in Taiwan.

    Science.gov (United States)

    Li, Wen-Wen; Kuo, Chi-Tai; Hwang, Shiow-Li; Hsu, Hsin-Tien

    2012-07-01

    To characterise a Taiwanese population and to examine the prevalence of antihypertensive medication non-adherence and how the cultural/clinical factors were associated with non-adherence in Taiwan. Antihypertensive medication non-adherence is a significant clinical issue in the United States. However, little is known about hypertension (HTN) control and cultural/clinical factors related to non-adherence in Taiwan. A convenience sample survey design was used. Data were gathered from a convenience sample of 200 subjects recruited from a large teaching hospital. Medication non-adherence and cultural/clinical factors were recorded using various self-administered questionnaires, and blood pressure was taken twice for each participant. The mean age of the participants was 60.4 (SD 11.5 years) including 62% men. Two-thirds had less than a high school education (64.5%), and the majority of them were married (86·0%) and lived with family or close friends (93.5%). The average length of HTN diagnosis was 8.6 years (SD 9.0 years). Medication non-adherence rate was 47·5%, and uncontrolled HTN rate was 49.0%. Some participants (17.0%) used Chinese herbs for treating their disease (e.g. cough) and promoting health in addition to their regular antihypertensive medications. Two factors were found to be statistically significant for predicting medication non-adherence: Lower Perceived Susceptibility to Specific Diseases [OR = 1.15 (95%CI, 1.01-1.31)] and Longer Length of HTN Diagnosis [OR = 1.06 (95%CI, 1.01-1.12)]. Taiwanese at risk of non-adherence included those who perceived lower susceptibility to specific diseases and had been diagnosed with HTN for a longer time. Those using herbs need to be studied for an impact of herbs on their adherence behaviour. These findings can help guide the development of culturally sensitive and clinically appropriate nursing interventions for HTN management in Taiwan. © 2012 Blackwell Publishing Ltd.

  6. Challenges and strategies of medication adherence in Parkinson's disease: A qualitative study.

    Science.gov (United States)

    Shin, Ju Young; Habermann, Barbara; Pretzer-Aboff, Ingrid

    2015-01-01

    Little is known about strategies used by people with Parkinson's disease (PD) to facilitate medication adherence in the U.S. The purpose of this study was to describe challenges in adherence to medication regimens and to identify strategies used to facilitate adherence to medication regimens. A qualitative research design was used to interview sixteen community-dwelling people with PD and five caregivers. Data analysis was performed using content analysis. The majority of the participants (81.3%) reported decreased adherence to medication regimens. Seven themes emerged from the data. The main challenges of medication adherence included medication responses, cost of medications, and forgetfulness. Strategies used to facilitate adherence to medication regimens included seeking knowledge about antiparkinsonian medications, seeking advice from family and friends, use of devices, and use of reminders. These findings may be important in formulating interventions to improve adherence to medication regimens for people living with PD. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Medication Adherence After Renal Transplantation-a Review of the Literature.

    Science.gov (United States)

    Rebafka, Anne

    2016-12-01

    Whether or not patients follow the advice given by their healthcare professional is commonly referred to as adherence. In the case of kidney transplantation, transplant recipients need to take immunosuppressive drugs on a regular basis to prevent rejection of their transplant. However, medication adherence can be problematic for many patients. This critical appraisal of evidence aimed to gain insights into factors contributing to adherence and non-adherence in recipients of kidney transplants, and to explore patients' perceptions regarding adherence to immunosuppression. A comprehensive literature search was performed using Medline, PsycInfo, the Joanna Briggs Institute, CINAHL and the Cochrane Library. Included were primary research studies or reviews of primary research, independent of their research paradigms, on adult kidney or kidney/pancreas transplant recipients published in English or German. Children or adolescents were not considered. No time-frame was applied RESULTS: Fifty-two papers were included in the review. All extracted findings of included papers were organised according to the five factors influencing medication-taking behaviour as defined by the World Health Organisation: social and economic factors; therapy-related factors; patient-related factors; condition-related factors; healthcare team and system-related factors. Reasons for non-adherence after kidney transplantations are diverse. Attention is attracted by the fact that potentially modifiable factors such as social support, experiences on dialysis, side effects, features of the treatment regimen, intentions and beliefs, forgetfulness and mental health issues play a greater role than other factors in the development of medication non-adherence. Factors not related to patient characteristics seem to be under researched. © 2016 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  8. A systematic review of medication non-adherence in persons with dementia or cognitive impairment.

    Directory of Open Access Journals (Sweden)

    Daisy Smith

    Full Text Available Adherence to medication is vital for disease management while simultaneously reducing healthcare expenditure. Older persons with cognitive impairment (CI are at risk for non-adherence as cognitive processes are needed to manage medications. This systematic review focuses on the relationship between medication non-adherence and specific cognitive domains in persons with CI, and explores determinants of medication non-adherence. When available, relationships and factors are compared with cognitively intact populations.A seven database systematic search of studies published between 1 January 1949-31 December 2015 examining medication non-adherence in community dwelling persons with CI or dementia was conducted. Articles reporting medication non-adherence in people with CI or dementia in the community, with or without caregiver supports were eligible for inclusion. Papers reporting adherence to treatments in cognitively intact populations, populations from hospital or institutional settings, for non-prescribed medication or those describing dementia as a factor predicting medication non-adherence were excluded. Data on study and population characteristics, research design, data sources and analysis, specific cognitive domains, non-adherence prevalence, measurement of adherence, salient findings, factors associated with adherence and strategies to improve medication adherence were extracted. Study limitations included inconsistencies between data sources and definitions, resulting in a loss of fidelity in the value and comprehensiveness of data, as well as exclusion of non-pharmacological treatments and regimens.Fifteen studies met inclusion criteria. Adherence among CI subjects ranged from 10.7%-38% with better rates of adherence in non-CI individuals. Medication non-adherence definitions varied considerably. New-learning, memory and executive functioning were associated with improved adherence and formed the focus of most studies. Multiple factors

  9. Barriers to medication adherence in asthma: the importance of culture and context.

    Science.gov (United States)

    McQuaid, Elizabeth L

    2018-03-23

    Significant disparities exist in asthma outcomes. Racial and ethnic minorities have lower controller medication adherence, which may contribute to differences in asthma morbidity between minority and non-minority groups. The objective of this review is to identify individual, patient-provider communication, and systems issues that contribute to this pattern of medication underuse and to discuss potential strategies for intervention. Data were gathered from numerous sources, including reports of pharmacy and medical records, observational studies, and trials. Studies analyzed factors contributing to patterns of asthma medication adherence that differ by race and ethnicity. There is clear evidence of underuse of asthma controller medications among racial and ethnic minorities in prescription receipt, prescription initiation, and medication use once obtained. Individual factors such as medication beliefs and depressive symptoms play a role. Provider communication is also relevant, including limited discussion of Complementary and Alternative Medicine (CAM) use, difficulties communicating with patients and caregivers with limited English proficiency (LEP), and implicit biases regarding cultural differences. Systems issues (e.g., insurance status, cost) and social context factors (e.g. exposure to violence) also present challenges. Culturally-informed strategies that capitalize on patient strengths and training providers in culturally-informed communication strategies hold promise as intervention approaches. Disparities in controller medication use are pervasive. Identifying the sources of these disparities is a critical step toward generating intervention approaches to enhance disease management among the groups that bear the greatest asthma burden. Copyright © 2018. Published by Elsevier Inc.

  10. Attitudes towards medication non-adherence in elderly kidney transplant patients: A Q methodology study

    OpenAIRE

    Moors-Tielen, Mirjam; Exel, Job; Buren, M.C.; Maasdam, L.; Weimar, Willem

    2011-01-01

    textabstractBackground. Non-adherence to the post-transplant regime is a common problem in kidney transplant patients and may lead to rejection or even graft failure. This study investigated attitudes towards the post-transplant regime of immunosuppressive medication among the ever growing population of elderly kidney recipients.Methods. Q methodology was used to explore attitude profiles. Participants (> 65 years) were asked to rank-order opinion statements on issues associated with (non-)ad...

  11. Type D Personality Predicts Poor Medication Adherence in Patients with Heart Failure in the USA

    Science.gov (United States)

    Wu, Jia-Rong; Moser, Debra K.

    2015-01-01

    Background Type D (distressed) personality and medication nonadherence have been associated with poor health outcomes. Type D personality is associated with poor medication adherence in patients with coronary artery disease. However, the relationship between type D personality and medication adherence in patients with heart failure (HF) remains unknown. Purpose Therefore, the goal of this study was to examine the association between type D personality and medication adherence in patients with HF. Method This was a sub-analysis of baseline data from a randomized controlled trial with 84 patients with HF in the USA. Demographic, clinical, and psychological data were collected at baseline by interview, questionnaires, and medical record review. Type D personality was assessed using the Type D Personality Scale (DS14). Medication adherence was measured using both objective (Medication Event Monitoring System, MEMS) and self-reported (Morisky Medication Adherence Scale, MMAS-4) measures. Patients started medication adherence monitoring with the MEMS bottle at baseline and is used continuously for a month. Multiple regressions were used to explore the relationships between type D personality and medication adherence while adjusting for demographic, clinical, and psychological factors. Results Patients with type D personality were more likely to have poor medication adherence. Type D personality was associated with medication adherence before and after adjusting for covariates when it was analyzed as a categorical variable. However, type D personality was not associated with medication adherence when analyzed as a dimensional construct. Negative affectivity, a component of type D personality, was associated with medication adherence. Conclusion As a dimensional construct, type D personality may not reflect the components of the personality associated with poor outcomes. Negative affectivity was associated with medication adherence in patients with HF. Interventions aiming

  12. Health locus of control: Its relationship with medication adherence and medication wastage.

    Science.gov (United States)

    West, Lorna Marie; Borg Theuma, Ruth; Cordina, Maria

    2017-12-09

    Non-adherence is a significant factor contributing to medication wastage. Whilst there is some evidence on the influence of patients' health locus of control in relation to adherence, there has been little inquiry into its relationship with mediation wastage. To determine the relationship between medication adherence and health locus of control as well as medication wastage and health locus of control in patients with chronic conditions. Outpatients having a diagnosis of asthma, cardiovascular conditions, or diabetes participated in a cross-sectional study employing a self-administered questionnaire. The questionnaire determined presence of unused medication (wastage), adherence using 'Tool for Adherence Behaviour Screening' (TABS), and health locus of control using 'Multidimensional Health Locus of Control' (MHLC) scale Form C. Logistic regression was performed to ascertain the effects of MHLC and demographics in relation to adherence and wastage. MHLC beliefs were divided into 8 types of health locus of control. One-Way ANOVA was used to assess differences between conditions and belief types. P-values ≤ .05 were considered significant. There were 330 patients recruited (58% male; age, mean±(SD): 61 ± 15 years; 110 asthma, 110 cardiovascular, 110 diabetes). In terms of health locus of control, females had higher 'doctors' beliefs (p = .054) and significantly lower 'other people' beliefs (p = control. 'Yea-sayers' had the least presence of unused medication, followed by 'pure internal' believers. 'Pure powerful others external' had the highest presence of unused medication. Healthcare professionals should take into account patients' health locus of control beliefs whilst conducting an intervention with patients; this can impact positively medication adherence and minimisation of medication wastage. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. The Adherence Estimator: a brief, proximal screener for patient propensity to adhere to prescription medications for chronic disease.

    Science.gov (United States)

    McHorney, Colleen A

    2009-01-01

    To conceptualize, develop, and provide preliminary psychometric evidence for the Adherence Estimator--a brief, three-item proximal screener for the likelihood of non-adherence to prescription medications (medication non-fulfillment and non-persistence) for chronic disease. Qualitative focus groups with 140 healthcare consumers and two internet-based surveys of adults with chronic disease, comprising a total of 1772 respondents, who were self-reported medication adherers, non-persisters, and non-fulfillers. Psychometric tests were performed on over 150 items assessing 14 patient beliefs and skills hypothesized to be related to medication non-adherence along a proximal-distal continuum. Psychometric tests included, but were not limited to, known-groups discriminant validity at the scale and item level. The psychometric analyses sought to identify: (1) the specific multi-item scales that best differentiated self-reported adherers from self-reported non-adherers (non-fulfillers and non-persisters) and, (2) the single best item within each prioritized multi-item scale that best differentiated self-reported adherers from self-reported non-adherers (non-fulfillers and non-persisters). The two rounds of psychometric testing identified and cross-validated three proximal drivers of self-reported adherence: perceived concerns about medications, perceived need for medications, and perceived affordability of medications. One item from each domain was selected to include in the Adherence Estimator using a synthesis of psychometric results gleaned from classical and modern psychometric test theory. By simple summation of the weights assigned to the category responses of the three items, a total score is obtained that is immediately interpretable and completely transparent. Patients can be placed into one of three segments based on the total score--low, medium, and high risk for non-adherence. Sensitivity was 88%--of the non-adherers, 88% would be accurately classified as medium

  14. Nurses' perceptions of medication adherence in schizophrenia: results of the ADHES cross-sectional questionnaire survey.

    Science.gov (United States)

    Emsley, Robin; Alptekin, Koksal; Azorin, Jean-Michel; Cañas, Fernando; Dubois, Vincent; Gorwood, Philip; Haddad, Peter M; Naber, Dieter; Olivares, José Manuel; Papageorgiou, Georgios; Roca, Miguel; Thomas, Pierre; Hargarter, Ludger; Schreiner, Andreas

    2015-12-01

    Poor adherence to antipsychotic treatment is a widespread problem within schizophrenia therapy with serious consequences including increased risks of relapse and rehospitalization. Mounting evidence supports the key roles that nurses play in monitoring patient progress and facilitating long-term treatment adherence. The Adherencia Terapéutica en la Esquizofrenia (ADHES) nurses' survey was designed to assess the opinions of nurses on the causes and management of partial/nonadherence to antipsychotic medication. A questionnaire-based cross-sectional survey of 4120 nurses from Europe, the Middle East and Africa. Interpretation of results was based on a descriptive comparison of responses. Nurses perceived 54% of patients seen in the preceding month to be partially/nonadherent to treatment. Most nurses (90%) reported some level of experience with administration of long-acting injectable (LAI) antipsychotics, with 24% of nurses administering >10 injections per month. The majority (85%) of nurses surveyed believed that improving adherence would improve patient outcomes. Nearly half (49%) reported that most of their patients depend on a family member or other nonprofessional carer to remind them to take their medication as prescribed. A similar proportion of nurses (43%) reported that most of their patients relied on a professional to remind them to take medication. Most nurses (92%) felt that ensuring continuous medication with LAI antipsychotics would yield long-term benefits for patients, but their opinion was that over a third of patients were unaware of LAI antipsychotic treatments. In a series of forced options, the strategy used most often by respondents (89%) to promote medication adherence was to build trusting relationships with patients while listening to and interpreting their needs and concerns. Respondents also rated this as the most effective strategy that they used (48%). Nurses are highly aware of adherence issues faced by their patients; further patient

  15. Nurses’ perceptions of medication adherence in schizophrenia: results of the ADHES cross-sectional questionnaire survey

    Science.gov (United States)

    Emsley, Robin; Alptekin, Koksal; Azorin, Jean-Michel; Cañas, Fernando; Dubois, Vincent; Gorwood, Philip; Haddad, Peter M.; Naber, Dieter; Olivares, José Manuel; Papageorgiou, Georgios; Roca, Miguel; Thomas, Pierre; Hargarter, Ludger; Schreiner, Andreas

    2015-01-01

    Objectives: Poor adherence to antipsychotic treatment is a widespread problem within schizophrenia therapy with serious consequences including increased risks of relapse and rehospitalization. Mounting evidence supports the key roles that nurses play in monitoring patient progress and facilitating long-term treatment adherence. The Adherencia Terapéutica en la Esquizofrenia (ADHES) nurses’ survey was designed to assess the opinions of nurses on the causes and management of partial/nonadherence to antipsychotic medication. Methods: A questionnaire-based cross-sectional survey of 4120 nurses from Europe, the Middle East and Africa. Interpretation of results was based on a descriptive comparison of responses. Results: Nurses perceived 54% of patients seen in the preceding month to be partially/nonadherent to treatment. Most nurses (90%) reported some level of experience with administration of long-acting injectable (LAI) antipsychotics, with 24% of nurses administering >10 injections per month. The majority (85%) of nurses surveyed believed that improving adherence would improve patient outcomes. Nearly half (49%) reported that most of their patients depend on a family member or other nonprofessional carer to remind them to take their medication as prescribed. A similar proportion of nurses (43%) reported that most of their patients relied on a professional to remind them to take medication. Most nurses (92%) felt that ensuring continuous medication with LAI antipsychotics would yield long-term benefits for patients, but their opinion was that over a third of patients were unaware of LAI antipsychotic treatments. In a series of forced options, the strategy used most often by respondents (89%) to promote medication adherence was to build trusting relationships with patients while listening to and interpreting their needs and concerns. Respondents also rated this as the most effective strategy that they used (48%). Conclusion: Nurses are highly aware of adherence

  16. Physicians' communication with patients about adherence to HIV medication in San Francisco and Copenhagen: a qualitative study using Grounded Theory

    Directory of Open Access Journals (Sweden)

    Rubow Cecilie

    2006-12-01

    Full Text Available Abstract Background Poor adherence is the main barrier to the effectiveness of HIV medication. The objective of this study was to explore and conceptualize patterns and difficulties in physicians' work with patients' adherence to HIV medication. No previous studies on this subject have directly observed physicians' behavior. Methods This is a qualitative, cross-sectional study. We used a Grounded Theory approach to let the main issues in physicians' work with patients' adherence emerge without preconceiving the focus of the study. We included physicians from HIV clinics in San Francisco, U.S.A. as well as from Copenhagen, Denmark. Physicians were observed during their clinical work and subsequently interviewed with a semi-structured interview guide. Notes on observations and transcribed interviews were analyzed with NVivo software. Results We enrolled 16 physicians from San Francisco and 18 from Copenhagen. When we discovered that physicians and patients seldom discussed adherence issues in depth, we made adherence communication and its barriers the focus of the study. The main patterns in physicians' communication with patients about adherence were similar in both settings. An important barrier to in-depth adherence communication was that some physicians felt it was awkward to explore the possibility of non-adherence if there were no objective signs of treatment failure, because patients could feel "accused." To overcome this awkwardness, some physicians consciously tried to "de-shame" patients regarding non-adherence. However, a recurring theme was that physicians often suspected non-adherence even when patients did not admit to have missed any doses, and physicians had difficulties handling this low believability of patient statements. We here develop a simple four-step, three-factor model of physicians' adherence communication. The four steps are: deciding whether to ask about adherence or not, pre-questioning preparations, phrasing the

  17. Physicians' communication with patients about adherence to HIV medication in San Francisco and Copenhagen: a qualitative study using Grounded Theory.

    Science.gov (United States)

    Barfod, Toke S; Hecht, Frederick M; Rubow, Cecilie; Gerstoft, Jan

    2006-12-04

    Poor adherence is the main barrier to the effectiveness of HIV medication. The objective of this study was to explore and conceptualize patterns and difficulties in physicians' work with patients' adherence to HIV medication. No previous studies on this subject have directly observed physicians' behavior. This is a qualitative, cross-sectional study. We used a Grounded Theory approach to let the main issues in physicians' work with patients' adherence emerge without preconceiving the focus of the study. We included physicians from HIV clinics in San Francisco, U.S.A. as well as from Copenhagen, Denmark. Physicians were observed during their clinical work and subsequently interviewed with a semi-structured interview guide. Notes on observations and transcribed interviews were analyzed with NVivo software. We enrolled 16 physicians from San Francisco and 18 from Copenhagen. When we discovered that physicians and patients seldom discussed adherence issues in depth, we made adherence communication and its barriers the focus of the study. The main patterns in physicians' communication with patients about adherence were similar in both settings. An important barrier to in-depth adherence communication was that some physicians felt it was awkward to explore the possibility of non-adherence if there were no objective signs of treatment failure, because patients could feel "accused." To overcome this awkwardness, some physicians consciously tried to "de-shame" patients regarding non-adherence. However, a recurring theme was that physicians often suspected non-adherence even when patients did not admit to have missed any doses, and physicians had difficulties handling this low believability of patient statements. We here develop a simple four-step, three-factor model of physicians' adherence communication. The four steps are: deciding whether to ask about adherence or not, pre-questioning preparations, phrasing the question, and responding to the patient's answer. The three

  18. Association between medication adherence and clinical outcomes in patients with chronic kidney disease: a prospective cohort study.

    Science.gov (United States)

    Tangkiatkumjai, Mayuree; Walker, Dawn-Marie; Praditpornsilpa, Kearkiat; Boardman, Helen

    2017-06-01

    There is limited evidence of medication adherence related to progression of chronic kidney disease (CKD) worldwide. The aim of this study was to determine associations between medication adherence and the progression of CKD in outpatients with CKD. This cohort study recruited 339 Thai patients with stages 3-5 CKD. Patients with a glomerular disease or receiving renal replacement therapy before recruitment were excluded. 295 were followed up regarding their serum creatinine, blood pressure, glycated hemoglobin, and low-density lipoprotein cholesterol over 12 months. Medication adherence was measured at baseline using the Thai version of the 8-Item Morisky Medication Adherence Scale ® . The primary outcome was the progression of CKD. The progression of CKD was defined as either a decline in estimated glomerular filtration rate of at least 3 ml/min/1.73 m 2 /year or initiation of renal replacement therapy. Univariate and multivariate analyses were performed using Chi-squared tests and multiple logistic regressions. Twenty-one percent had poor adherence. Younger patients were more likely to have poor adherence (adjusted OR 2.81, 95 % CI 1.45-5.43). Anti-hypertensive agents were the most frequently reported as not being taken (52 %). Patients with poor adherence were associated with the progression of CKD (adjusted OR 1.96, 95 % CI 1.02-3.76). Those with poor adherence were less likely to control their blood pressure, than moderate-to-high adherence group (p < 0.01). The findings suggest that CKD patients with poor medication adherence are more likely to have progression of CKD. Health care providers should acknowledge these findings and provide effective strategies to deal with this issue.

  19. Objective confirmation of asthma diagnosis improves medication adherence

    DEFF Research Database (Denmark)

    Backer, V; Stensen, L; Sverrild, A

    2017-01-01

    OBJECTIVE: The impact of diagnostic work-up in asthma management on medication redemption and probably also drug adherence is largely unknown, but we hypothesized that a confirmed diagnosis of asthma in a hospital-based out-patient clinic increases the willingness to subsequent medication...... redemption in a real life setting. METHODS: In a retrospective register-based study, 300 medical records of patients referred with possible asthma during one year were examined, of whom 171 had asthma (57%). One-year data on dispensed medicine was collected using the Danish Registry of Medicinal Product...... more frequently prescribed new therapy compared to those with unverified asthma (88.9% vs. 65.0%, respectively, p time redemption of prescriptions (72% vs. 64%, respectively, p = 0.3), whereas the second (52% vs. 27%, p = 0.001) and third or more asthma...

  20. Medication Adherence in Patients with Rheumatoid Arthritis: The Effect of Patient Education, Health Literacy, and Musculoskeletal Ultrasound

    Directory of Open Access Journals (Sweden)

    Samantha Joplin

    2015-01-01

    Full Text Available Background. Rheumatoid arthritis (RA is a chronic systemic inflammatory disease affecting <1% of the population. Incompletely controlled RA results in fatigue, joint and soft tissue pain, progressive joint damage, reduced quality of life, and increased cardiovascular mortality. Despite an increasing range of disease modifying agents which halt disease progression, poor patient adherence with medication is a significant barrier to management. Objective. The goal of this review was to examine the effectiveness of measures to improve patient medication adherence. Methods. Studies addressing treatment adherence in patients with RA were identified by trawling PsycINFO, Medline, Cochrane, Pubmed, and ProQuest for studies published between January 2000 and October 2014. Articles were independently reviewed to identify relevant studies. Results. Current strategies were of limited efficacy in improving patient adherence with medications used to treat RA. Conclusion. Poor medication adherence is a complex issue. Low educational levels and limited health literacy are contributory factors. Psychological models may assist in explaining medication nonadherence. Increasing patient knowledge of their disease seems sensible. Existing educational interventions appear ineffective at improving medication adherence, probably due to an overemphasis on provision of biomedical information. A novel approach to patient education using musculoskeletal ultrasound is proposed.

  1. Can Mindfulness Training Improve Medication Adherence? Integrative Review of the Current Evidence and Proposed Conceptual Model.

    Science.gov (United States)

    Salmoirago-Blotcher, Elena; Carey, Michael P

    Medication adherence is a complex, multi-determined behavior that is often influenced by system- (e.g., cost), drug- (e.g., regimen complexity), and patient-related (e.g., depression) factors. System-level approaches (e.g., making medications more affordable) are critically important but do not address patient-level factors that can undermine adherence. In this paper, we identify patient-level determinants of non-adherence and discuss whether mindfulness-training approaches that target these determinants can help to improve adherence to medical treatment. We highlight two chronic medical conditions (viz., heart failure and HIV) where poor adherence is a significant concern, and examine the evidence regarding the use of mindfulness interventions to improve medication adherence in these two conditions. We also discuss the theoretical underpinnings of mindfulness training with respect to medication adherence, and conclude by suggesting directions for future research. Copyright © 2018 Elsevier Inc. All rights reserved.

  2. Stress, coping and adherence to immunosuppressive medications in kidney transplantation: a comparative study

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    Daniela Cristina Sampaio de Brito

    Full Text Available ABSTRACT CONTEXT AND OBJECTIVE : Adherence to medication is a key issue relating to outcomes from transplantation and it is influenced by several factors, such as stress and coping strategies. However, these factors have been poorly explored. We aimed to compare stress and coping strategies between adherent and nonadherent renal transplant recipients who were receiving immunosuppression. DESIGN AND SETTING : We conducted a comparative, cross-sectional and observational study at a university-based transplantation clinic in Juiz de Fora, Brazil. METHODS :Fifty patients were recruited and classified as adherent or nonadherent following administration of the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Stress was evaluated using the Lipp Stress Symptom Inventory for Adults and coping strategies were assessed using the Ways of Coping Scale. RESULTS : The study included 25 nonadherent patients and 25 controls with a mean age of 44.1 ± 12.8 years and median post-transplantation time of 71.8 months. Stress was present in 50% of the patients. Through simple logistic regression, nonadherence was correlated with palliative coping (OR 3.4; CI: 1.02-11.47; P < 0.05 and had a marginal trend toward significance with more advanced phases of stress (OR 4.7; CI: 0.99-22.51; P = 0.053. CONCLUSION :Stress and coping strategies may have implications for understanding and managing nonadherent behavior among transplantation patients and should be considered among the strategies for reducing nonadherence.

  3. Stress, coping and adherence to immunosuppressive medications in kidney transplantation: a comparative study.

    Science.gov (United States)

    Brito, Daniela Cristina Sampaio de; Marsicano, Elisa Oliveira; Grincenkov, Fabiane Rossi Dos Santos; Colugnati, Fernando Antônio Basile; Lucchetti, Giancarlo; Sanders-Pinheiro, Helady

    2016-01-01

    : Adherence to medication is a key issue relating to outcomes from transplantation and it is influenced by several factors, such as stress and coping strategies. However, these factors have been poorly explored. We aimed to compare stress and coping strategies between adherent and nonadherent renal transplant recipients who were receiving immunosuppression. : We conducted a comparative, cross-sectional and observational study at a university-based transplantation clinic in Juiz de Fora, Brazil. :Fifty patients were recruited and classified as adherent or nonadherent following administration of the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Stress was evaluated using the Lipp Stress Symptom Inventory for Adults and coping strategies were assessed using the Ways of Coping Scale. : The study included 25 nonadherent patients and 25 controls with a mean age of 44.1 ± 12.8 years and median post-transplantation time of 71.8 months. Stress was present in 50% of the patients. Through simple logistic regression, nonadherence was correlated with palliative coping (OR 3.4; CI: 1.02-11.47; P transplantation patients and should be considered among the strategies for reducing nonadherence.

  4. AI empowered context-aware smart system for medication adherence

    Directory of Open Access Journals (Sweden)

    Qiong Wu

    2017-06-01

    Full Text Available Purpose – Poor medication adherence leads to high hospital admission rate and heavy amount of health-care cost. To cope with this problem, various electronic pillboxes have been proposed to improve the medication adherence rate. However, most of the existing electronic pillboxes use time-based reminders which may often lead to ineffective reminding if the reminders are triggered at inopportune moments, e.g. user is sleeping or eating. Design/methodology/approach – In this paper, the authors propose an AI-empowered context-aware smart pillbox system. The pillbox system collects real-time sensor data from a smart home environment and analyzes the user’s contextual information through a computational abstract argumentation-based activity classifier. Findings – Based on user’s different contextual states, the smart pillbox will generate reminders at appropriate time and on appropriate devices. Originality/value – This paper presents a novel context-aware smart pillbox system that uses argumentation-based activity recognition and reminder generation.

  5. Validating the Modified Drug Adherence Work-Up (M-DRAW) Tool to Identify and Address Barriers to Medication Adherence.

    Science.gov (United States)

    Lee, Sun; Bae, Yuna H; Worley, Marcia; Law, Anandi

    2017-09-08

    Barriers to medication adherence stem from multiple factors. An effective and convenient tool is needed to identify these barriers so that clinicians can provide a tailored, patient-centered consultation with patients. The Modified Drug Adherence Work-up Tool (M-DRAW) was developed as a 13-item checklist questionnaire to identify barriers to medication adherence. The response scale was a 4-point Likert scale of frequency of occurrence (1 = never to 4 = often). The checklist was accompanied by a GUIDE that provided corresponding motivational interview-based intervention strategies for each identified barrier. The current pilot study examined the psychometric properties of the M-DRAW checklist (reliability, responsiveness and discriminant validity) in patients taking one or more prescription medication(s) for chronic conditions. A cross-sectional sample of 26 patients was recruited between December 2015 and March 2016 at an academic medical center pharmacy in Southern California. A priming question that assessed self-reported adherence was used to separate participants into the control group of 17 "adherers" (65.4%), and into the intervention group of nine "unintentional and intentional non-adherers" (34.6%). Comparable baseline characteristics were observed between the two groups. The M-DRAW checklist showed acceptable reliability (13 item; alpha = 0.74) for identifying factors and barriers leading to medication non-adherence. Discriminant validity of the tool and the priming question was established by the four-fold number of barriers to adherence identified within the self-selected intervention group compared to the control group (4.4 versus 1.2 barriers, p tool will include construct validation.

  6. A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity.

    Science.gov (United States)

    Gellad, Walid F; Grenard, Jerry L; Marcum, Zachary A

    2011-02-01

    effects and polypharmacy; and other factors including the patient-provider relationship and various logistical barriers to obtaining medications. None of the reviewed studies examined primary nonadherence or nonpersistence. Medication nonadherence in the elderly is not well described in the literature, despite being a major cause of morbidity, and thus it is difficult to draw a systematic conclusion on potential barriers based on the current literature. Future research should focus on standardizing medication adherence measurements among the elderly to gain a better understanding of this important issue. Published by EM Inc USA.

  7. Caregivers' beliefs associated with medication adherence among children and adolescents with epilepsy.

    Science.gov (United States)

    Miner, Patricia Johnson; Alexander, Jeffrey; Ewing, Helen; Gerace, Laina

    2013-08-01

    The purpose of this study was to determine the association between adherence to prescribed antiepileptic medication in a convenience sample of caregivers (n = 100) of children diagnosed with epilepsy, ages 2-14 years, and caregivers' beliefs about the medication. Using the Beliefs about Medication Questionnaire and Medication Adherence Report Scale, caregivers were questioned about beliefs of necessity and concerns associated with medication adherence. Using bivariate linear regression, no significant correlation was found between necessity for antiepileptic drug treatment or caregiver's concerns and medication adherence. Nevertheless, although only 28% of the respondents reported complete adherence, the majority of caregivers perceived their child's medication was necessary to maintain good health. Educational aspects and social desirability in this setting may have contributed to the discordance between adherence and caregivers' beliefs.

  8. The Relationship Between Treatment Adherence and Non-picked Up Medications in Community Pharmacies

    Directory of Open Access Journals (Sweden)

    Vu Phan Hoang Nguyen

    2016-10-01

    Full Text Available Medication adherence is one of the major factors that determine an outcome of a treatment. Despite the effort of healthcare providers to improve the adherence rate, it still remains a serious issue in our health care system today. Many patients do not take their medications as directed or just simply do not want to fill or refill their prescriptions. A small survey performed by pharmacy students at Temple School of Pharmacy showed that there is a significant number of patients did not pick up their medications. Cardiovascular medications are the most common non-picked up drugs. There are various reasons that patients use to justify for this non-adherence behavior. However, they are unaware that their actions create a tremendous negative effect not only on the treatment itself but also on the entire health care system. The consequences include expensive therapies, inaccurate research data, and poor treatment outcomes. Many solutions have been utilized to solve this problem, but it is still the major problem for healthcare providers to keep in mind when planning a drug regimen. Although many people believed that pharmacists are responsible for solving this problem, it should be a multidisciplinary effort of all healthcare providers to improve the medication adherence. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received, employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.   Type: Student Project

  9. Medication adherence in kidney transplant recipients in an urban Indian setting

    Directory of Open Access Journals (Sweden)

    U R Adhikari

    2017-01-01

    Full Text Available Medication nonadherence is a known problem after renal transplantation and can vary from one setting to another. Since it can lead to negative outcomes, it is important to develop intervention strategies to enhance adherence in a given setting using determinants identified through exploratory studies. We explored nonadherence in renal transplant recipients. A longitudinal survey was done with adult renal transplant recipients at a tertiary care public and two private hospitals of Kolkata. Subjects were followed-up for 1 year. After screening for medication adherence status by the four-item Morisky Medication Adherence Scale, those admitting to potential nonadherence were probed further. A patient was deemed to be nonadherent if failing to take medicines on appointed time (doses missed or delayed by more than 2 h more than three times in any month during the observation period. A pretested questionnaire was used to explore potential determinants of nonadherence. Data of 153 patients recruited over a 2-year were analyzed. The extent of nonadherence with immunosuppressant regimens was about 31% overall; 44% in the public sector and 19% in the private sector (P < 0.001. Nonadherence with other medication was around 19% in both the sectors. Several potential demographic, socioeconomic and psychosocial determinants of nonadherence were identified on univariate analysis. However, logistic regression analysis singled out only the economic status. This study had updated the issue of nonadherence in renal transplant recipients in the Indian setting. Strategies to improve medication adherence can be planned by relevant stakeholders on the basis of these findings.

  10. Adherence therapy improves medication adherence and quality of life in people with Parkinson's disease: a randomised controlled trial.

    Science.gov (United States)

    Daley, D J; Deane, K H O; Gray, R J; Clark, A B; Pfeil, M; Sabanathan, K; Worth, P F; Myint, P K

    2014-08-01

    Many factors are associated with medication non-adherence in Parkinson's disease (PD), including complex treatment regimens, mood disorders and impaired cognition. However, interventions to improve adherence which acknowledge such factors are lacking. A phase II randomised controlled trial was conducted investigating whether Adherence Therapy (AT) improves medication adherence and quality of life (QoL) compared with routine care (RC) in PD. Eligible PD patients and their spouse/carers were randomised to intervention (RC plus AT) or control (RC alone). Primary outcomes were change in adherence (Morisky Medication Adherence Scale) and QoL (Parkinson's Disease Questionnaire-39) from baseline to week-12 follow up. Secondary outcomes were MDS-UPDRS (part I, II, IV), Beliefs about Medication Questionnaire (BMQ), EuroQol (EQ-5D) and the Caregiving Distress Scale. Blinded data were analysed using logistic and linear regression models based on the intention-to-treat principle. Seventy-six patients and 46 spouse/carers completed the study (intervention: n = 38 patients, n = 24 spouse/carers). At week-12 AT significantly improved adherence compared with RC (OR 8.2; 95% CI: 2.8, 24.3). Numbers needed to treat (NNT) were 2.2 (CI: 1.6, 3.9). Compared with RC, AT significantly improved PDQ-39 (-9.0 CI: -12.2, -5.8), BMQ general harm (-1.0 CI: -1.9, -0.2) and MDS-UPDRS part II (-4.8 CI: -8.1, -1.4). No significant interaction was observed between the presence of a spouse/carer and the effect of AT. Adherence Therapy improved self-reported adherence and QoL in a PD sample. The small NNT suggests AT may be cost-effective. A larger pragmatic trial to test the efficacy and cost-effectiveness of AT by multiple therapists is required. © 2014 John Wiley & Sons Ltd.

  11. Integrative Review of Mobile Phone Contacts and Medication Adherence in Severe Mental Illness.

    Science.gov (United States)

    Bright, Cordellia E

    Poor medication adherence is a significant problem in individuals with severe mental illness (SMI). About 50% of people with SMI become nonadherent to treatment in the first month following discharge from the hospital. This study examined literature in the past decade (2006-2016) on the use of mobile phone contacts in individuals with SMI to improve medication adherence post hospital discharge. This integrative review used the search terms texting, text messaging, SMS, cell/mobile phone, medication adherence, medication compliance, and mental illness. Databases (CINAHL, PubMed, PsycINFO, and Scopus) and manual searching of reference lists were done. The main inclusion criteria were the use of mobile phone contacts on medication adherence in individuals with SMI. Adults 18 years and older, studies conducted from 2006 to 2016, and studies conducted in English were also criteria for inclusion. Only five studies met criteria for inclusion. Outcomes from the review showed that mobile phone contacts have been used to improve medication adherence in individuals with SMI and able to provide the four types of social support (instrumental, informational, emotional, and, appraisal). When phone contacts especially text messaging was used as an adjunct to other interventions, it yielded better medication adherence than when used alone. However, results on medication adherence rates were mixed in participants on both psychiatric and nonpsychiatric medications. Although mobile phone contacts are a promising tool to enhance medication adherence after hospital discharge, its effectiveness to increase medication adherence in this population remains inconclusive.

  12. Patient-oncologist cost communication, financial distress, and medication adherence.

    Science.gov (United States)

    Bestvina, Christine M; Zullig, Leah L; Rushing, Christel; Chino, Fumiko; Samsa, Gregory P; Altomare, Ivy; Tulsky, James; Ubel, Peter; Schrag, Deborah; Nicolla, Jon; Abernethy, Amy P; Peppercorn, Jeffrey; Zafar, S Yousuf

    2014-05-01

    Little is known about the association between patient-oncologist discussion of cancer treatment out-of-pocket (OOP) cost and medication adherence, a critical component of quality cancer care. We surveyed insured adults receiving anticancer therapy. Patients were asked if they had discussed OOP cost with their oncologist. Medication nonadherence was defined as skipping doses or taking less medication than prescribed to make prescriptions last longer, or not filling prescriptions because of cost. Multivariable analysis assessed the association between nonadherence and cost discussions. Among 300 respondents (86% response), 16% (n = 49) reported high or overwhelming financial distress. Nineteen percent (n = 56) reported talking to their oncologist about cost. Twenty-seven percent (n = 77) reported medication nonadherence. To make a prescription last longer, 14% (n = 42) skipped medication doses, and 11% (n = 33) took less medication than prescribed; 22% (n = 66) did not fill a prescription because of cost. Five percent (n = 14) reported chemotherapy nonadherence. To make a prescription last longer, 1% (n = 3) skipped chemotherapy doses, and 2% (n = 5) took less chemotherapy; 3% (n = 10) did not fill a chemotherapy prescription because of cost. In adjusted analyses, cost discussion (odds ratio [OR] = 2.58; 95% CI, 1.14 to 5.85; P = .02), financial distress (OR = 1.64, 95% CI, 1.38 to 1.96; P financial burden than expected (OR = 2.89; 95% CI, 1.41 to 5.89; P financial distress were associated with medication nonadherence, suggesting that cost discussions are important for patients forced to make cost-related behavior alterations. Future research should examine the timing, content, and quality of cost-discussions. Copyright © 2014 by American Society of Clinical Oncology.

  13. Improving adherence to medication in adults with diabetes in the United Arab Emirates.

    Science.gov (United States)

    Al-Haj Mohd, Mohammed M M; Phung, Hai; Sun, Jing; Morisky, Donald E

    2016-08-24

    Diabetes is a chronic medical condition and adherence to medication in diabetes is important. Improving medication adherence in adults with diabetes would help prevent the chronic complications associated with diabetes. A case control trial was used to study the effects of an educational session on medication adherence among adults with diabetes as measured by the Morisky Medication adherence scale (MMAS-8©). The study took place at the Dubai Police Health Centre between February 2015 and November 2015. Questionnaires were used to collect socio-demographic, clinical and disease related variables and the primary measure of outcome was adherence levels as measured by the Morisky Medication Adherence Scale (MMAS-8©). The intervention group involved a standardized thirty minute educational session focusing on the importance of adherence to medication. The change in MMAS-8© was measured at 6 months. Four hundred and forty six patients were enrolled. Mean age 61 year +/- 11. 48.4 % were male. The mean time since diagnosis of diabetes was 3.2 years (Range 1-15 years). At baseline two hundred and eighty eight (64.6 %) patients were considered non-adherent (MMAS-8© adherence score strategies should focus on wider educational strategies targeting medication adherence in diabetic patients in the UAE.

  14. Factors associated with adherence to medication among depressed patients from Saudi Arabia: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Al Jumah K

    2014-10-01

    Full Text Available Khalaf Al Jumah,1 Mohamed Azmi Hassali,2 Dalal Al Qhatani,1 Kamal El Tahir3 1Department of Pharmacy, Al Amal Psychiatric Hospital, Riyadh, Saudi Arabia; 2School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; 3College of Pharmacy, King Saud University, Riyadh, Saudi Arabia Background: Several studies have investigated the factors associated with adherence to antidepressants, with inconsistent conclusions. However, no similar study has investigated this issue among patients diagnosed with major depressive disorder in Saudi Arabia. The aim of this study is to explore patients’ adherence to antidepressant medications, and the factors associated with adherence.Methods: A non-experimental cross-sectional design was used to measure adherence to antidepressants among major depressive disorder patients, and the factors associated with adherence. The patients were recruited from the outpatient clinic at the Al-Amal Complex for Mental Health in Riyadh, Saudi Arabia, between August 2013 and January 2014. Eligible participants met with one of the research coordinators for assessment of their adherence. Adherence was investigated indirectly by use of the Morisky Medication Adherence Scale, and patients’ beliefs were assessed through the Beliefs about Medicine Questionnaire. Information about the severity of their depression, demographics, and other study variables were collected.Results: A total of 403 patients met the inclusion criteria and participated in the study. Of those, 203 (50.37% were females, while the remaining 200 (49.6% were males. There was an average age of 39 years (standard deviation, ±11 years. Half of the patients (52.9% reported low adherence to their antidepressant medication, with statistically significant differences between the low adherence and high adherence scores relating to sex, age, and duration of illness. Conclusion: Low medication adherence is a common problem among major depressive disorder

  15. Psychotropic Medication Adherence among Community-Based Individuals with Developmental Disabilities and Mental Illness

    Science.gov (United States)

    Tan, Xi; Marshall, Vincent D.; Balkrishnan, Rajesh; Patel, Isha; Chang, Jongwha; Erickson, Steven R.

    2015-01-01

    Psychotropic medications are a common treatment for mental illness in people with developmental disabilities. Medication adherence is a critical determinant of the effectiveness of psychotropic drugs, but psychotropic medication adherence research specific to this population remains limited. This retrospective study analyzed Marketscan®…

  16. Improving adherence to medication in adults with diabetes in the United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Mohammed M. M. Al-Haj Mohd

    2016-08-01

    Full Text Available Abstract Background Diabetes is a chronic medical condition and adherence to medication in diabetes is important. Improving medication adherence in adults with diabetes would help prevent the chronic complications associated with diabetes. A case control trial was used to study the effects of an educational session on medication adherence among adults with diabetes as measured by the Morisky Medication adherence scale (MMAS-8©. Methods The study took place at the Dubai Police Health Centre between February 2015 and November 2015. Questionnaires were used to collect socio-demographic, clinical and disease related variables and the primary measure of outcome was adherence levels as measured by the Morisky Medication Adherence Scale (MMAS-8©. The intervention group involved a standardized thirty minute educational session focusing on the importance of adherence to medication. The change in MMAS-8© was measured at 6 months. Results Four hundred and forty six patients were enrolled. Mean age 61 year +/− 11. 48.4 % were male. The mean time since diagnosis of diabetes was 3.2 years (Range 1–15 years. At baseline two hundred and eighty eight (64.6 % patients were considered non-adherent (MMAS-8© adherence score < 6 while 118 (26.5 % and 40 (9.0 % had low adherence (MMAS-8© adherence score < 6 and medium adherence (MMAS-8© adherence scores of 6 to 7 to their medication respectively. The percentage of patients scoring low adherence MMAS-8 scores in the interventional group dropped from 64.60 % at baseline to 44.80 % at 6-months (p = 0.01. There was no obvious change in the adherence scores at baseline and at 6-months in the control group. Based on the study data, the Wilcoxon signed-rank test showed that at 6 months, the educational 30-min session on diabetes and adherence to medication did elicit a statistically significant change in adherence levels in adults with diabetes enrolled in the intervention arm (Z = −6

  17. Patient adherence to prescribed medication instructions for dyspepsia: the DIAMOND-study

    NARCIS (Netherlands)

    Fransen, G.A.J.; Mesters, I.; Muris, J.W.M.; Marrewijk, C.J. van; Mujakovic, S.; Laheij, R.J.F.; Numans, M.E.; de Wit, N.J.; Samsom, M.; Jansen, J.B.M.J.; Knottnerus, J.A.

    2012-01-01

    BACKGROUND: Insight into patient adherence is needed to enable an effect evaluation of medication for dyspepsia. OBJECTIVES: Adherence was explored by investigating two adherence outcome measures (completeness and intake fidelity) using data from the DIAMOND-study. METHODS: The DIAMOND-study is a

  18. Poor adherence to medication as assessed by the Morisky Medication Adherence Scale-8 and low satisfaction with treatment in 237 psoriasis patients.

    Science.gov (United States)

    Saeki, Hidehisa; Imafuku, Shinichi; Abe, Masatoshi; Shintani, Yoichi; Onozuka, Daisuke; Hagihara, Akihito; Katoh, Norito; Murota, Hiroyuki; Takeuchi, Satoshi; Sugaya, Makoto; Tanioka, Miki; Kaneko, Sakae; Masuda, Koji; Hiragun, Takaaki; Inomata, Naoko; Kitami, Yuki; Tsunemi, Yuichiro; Abe, Shinya; Kobayashi, Miwa; Morisky, Donald E; Furue, Masutaka

    2015-04-01

    Previously we assessed the medication adherence for oral and topical remedies by a translated Japanese version of the Morisky Medication Adherence Scale-8 (MMAS-8) together with socioeconomic backgrounds in 3096 Japanese dermatological patients, and found the medication adherence, especially to topical drugs, was poor in these patients. In order to elucidate the disease-specific sociomedical factors, we further sub-analyzed the medication adherence in 237 psoriasis patients and compared it with that in other dermatological diseases such as atopic dermatitis, urticaria or tinea. This study was conducted among patients registered in monitoring system and 3096 eligible patients were enrolled. Our web-based questionnaire included the following items such as age, sex, annual income, main health-care institution, experience of effectiveness by oral or topical medication, overall satisfaction with treatment, and MMAS-8 for oral or topical medication. Mean adherence score by MMAS-8 was 5.2 for oral and 4.3 for topical medication. More patients with psoriasis used a university hospital and fewer used a private clinic compared with those with the other skin disease patients. Experience of drug effectiveness by oral medication and overall satisfaction with treatment was lower in psoriasis patients than in other patients. In oral medication, significantly better adherence was observed in those of higher age and with higher annual income. The adherence to medication, especially to topical drugs, was poor in 237 psoriasis patients. We speculated that some severe psoriasis patients were not sufficiently treated systemically and were resistant to topical therapy, leading to poor adherence. © 2015 Japanese Dermatological Association.

  19. Pharmacist's Role in Improving Medication Adherence in Transplant Recipients With Comorbid Psychiatric Disorders.

    Science.gov (United States)

    Khorassani, Farah; Tellier, Shannon; Tsapepas, Demetra

    2018-01-01

    Medication nonadherence rates are high in both the transplant and psychiatric populations. The consequence of medication nonadherence posttransplant is graft rejection and psychiatric decompensation, highlighting the importance of optimizing adherence to medication regimens. Pharmacists may work with transplant patients with psychiatric comorbidity to improve medication adherence through identifying patient-specific barriers and recommending an appropriate intervention. Multiple evidence-based practices for improving nonadherence have been detailed in the transplant and psychiatric population. Medication adherence aids, medication management, patient education, and motivational interviewing are all strategies that may be used to improve adherence. Selecting which interventions to make will be based on the reasons for a patient's nonadherence. Most patients benefit from medication management, patient education, and medication adherence aids. Selection of medication adherence aids may be based on patient demographics, technology literacy, and preference. Motivational interviewing may be considered in patients with intentional nonadherence relating to a lack of insight into their illness or the importance of taking medication. Pharmacists may promote adherence and potentially improve patient outcomes in transplant recipients with comorbid psychiatric disorders through assisting patients with designing a tailored medication adherence plan.

  20. Modeling the economic impact of medication adherence in type 2 diabetes: a theoretical approach.

    Science.gov (United States)

    Cobden, David S; Niessen, Louis W; Rutten, Frans Fh; Redekop, W Ken

    2010-09-07

    While strong correlations exist between medication adherence and health economic outcomes in type 2 diabetes, current economic analyses do not adequately consider them. We propose a new approach to incorporate adherence in cost-effectiveness analysis. We describe a theoretical approach to incorporating the effect of adherence when estimating the long-term costs and effectiveness of an antidiabetic medication. This approach was applied in a Markov model which includes common diabetic health states. We compared two treatments using hypothetical patient cohorts: injectable insulin (IDM) and oral (OAD) medications. Two analyses were performed, one which ignored adherence (analysis 1) and one which incorporated it (analysis 2). Results from the two analyses were then compared to explore the extent to which adherence may impact incremental cost-effectiveness ratios. In both analyses, IDM was more costly and more effective than OAD. When adherence was ignored, IDM generated an incremental cost-effectiveness of $12,097 per quality-adjusted life-year (QALY) gained versus OAD. Incorporation of adherence resulted in a slightly higher ratio ($16,241/QALY). This increase was primarily due to better adherence with OAD than with IDM, and the higher direct medical costs for IDM. Incorporating medication adherence into economic analyses can meaningfully influence the estimated cost-effectiveness of type 2 diabetes treatments, and should therefore be considered in health care decision-making. Future work on the impact of adherence on health economic outcomes, and validation of different approaches to modeling adherence, is warranted.

  1. Medication Adherence in People Dually Treated for HIV Infection and Mental Health Conditions: Test of the Medications Beliefs Framework

    OpenAIRE

    Kalichman, Seth C.; Pellowski, Jennifer; Kegler, Christopher; Cherry, Chauncey; Kalichman, Moira O.

    2015-01-01

    Beliefs about medication necessity and concerns predict treatment adherence in people with a wide-array of medical conditions, including HIV infection. However, medication beliefs have not been examined in people dually treated with psychotropic medications and antiretroviral therapy. In the current study, we used a prospective design to investigate the factors associated with adherence to psychotropic medications and antiretrovirals among 123 dually treated persons living with HIV. We used u...

  2. A performance improvement plan to increase nurse adherence to use of medication safety software.

    Science.gov (United States)

    Gavriloff, Carrie

    2012-08-01

    Nurses can protect patients receiving intravenous (IV) medication by using medication safety software to program "smart" pumps to administer IV medications. After a patient safety event identified inconsistent use of medication safety software by nurses, a performance improvement team implemented the Deming Cycle performance improvement methodology. The combined use of improved direct care nurse communication, programming strategies, staff education, medication safety champions, adherence monitoring, and technology acquisition resulted in a statistically significant (p < .001) increase in nurse adherence to using medication safety software from 28% to above 85%, exceeding national benchmark adherence rates (Cohen, Cooke, Husch & Woodley, 2007; Carefusion, 2011). Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Pediatric psychotropic medication initiation and adherence: a literature review based on social exchange theory.

    Science.gov (United States)

    Hamrin, Vanya; McCarthy, Erin M; Tyson, Veda

    2010-08-01

    Psychotropic medication initiation and adherence is an identified problem. This literature review explores factors that determine families' decisions to initiate, sustain, or discontinue use of psychotropic medication in children and adolescents. Social exchange theory is used as a framework to explore decisions to initiate and adhere to psychotropic medications. Contributing factors related to psychotropic medication initiation, adherence, and discontinuation are explored. Themes in the literature encompassing costs and benefits of psychotropic medication adherence include family experiences with adverse effects, previous psychotropic medication experience, medication psychoeducation, stigma, societal views about psychotropic medication, particular diagnosis, the effect of comorbid diagnosis on adherence, attitudes and beliefs about medication by both children and parents, and relationships with the provider. The impact of family demographics including parent gender, age of the child, ethnicity, and parent educational level on psychotropic medication adherence is evaluated. International and U.S. studies from Medline, Cumulative Index for Nursing and Allied Health Literature and PsychInfo evaluating medication initiation and adherence in the pediatric psychiatric population and social exchange theory was incorporated from relevant textbook resources. Rewards experienced from medication treatment include improvement in symptoms, school performance and family relationships, and reduced level of parenting stress. Identified costs include impact of adverse side effects, social stigma, lack of response, fears of addiction, and changing the child's personality. Acceptance of the diagnosis influences adherence while medication education has varying effects. Families' attitudes, beliefs and perceptions about psychiatric illness and treatment play a large role in medication treatment decisions. A trusting provider relationship has a positive effect on adherence

  4. Validating the Modified Drug Adherence Work-Up (M-DRAW Tool to Identify and Address Barriers to Medication Adherence

    Directory of Open Access Journals (Sweden)

    Sun Lee

    2017-09-01

    Full Text Available Barriers to medication adherence stem from multiple factors. An effective and convenient tool is needed to identify these barriers so that clinicians can provide a tailored, patient-centered consultation with patients. The Modified Drug Adherence Work-up Tool (M-DRAW was developed as a 13-item checklist questionnaire to identify barriers to medication adherence. The response scale was a 4-point Likert scale of frequency of occurrence (1 = never to 4 = often. The checklist was accompanied by a GUIDE that provided corresponding motivational interview-based intervention strategies for each identified barrier. The current pilot study examined the psychometric properties of the M-DRAW checklist (reliability, responsiveness and discriminant validity in patients taking one or more prescription medication(s for chronic conditions. A cross-sectional sample of 26 patients was recruited between December 2015 and March 2016 at an academic medical center pharmacy in Southern California. A priming question that assessed self-reported adherence was used to separate participants into the control group of 17 “adherers” (65.4%, and into the intervention group of nine “unintentional and intentional non-adherers” (34.6%. Comparable baseline characteristics were observed between the two groups. The M-DRAW checklist showed acceptable reliability (13 item; alpha = 0.74 for identifying factors and barriers leading to medication non-adherence. Discriminant validity of the tool and the priming question was established by the four-fold number of barriers to adherence identified within the self-selected intervention group compared to the control group (4.4 versus 1.2 barriers, p < 0.05. The current study did not investigate construct validity due to small sample size and challenges on follow-up with patients. Future testing of the tool will include construct validation.

  5. Medication non-adherence in the homeless population in an Intermountain West city

    Directory of Open Access Journals (Sweden)

    Elizabeth J. Unni

    2014-01-01

    Full Text Available Background: Homelessness happens when people or household are unable to acquire and/or maintain housing they can afford. Approximately 17% of homeless individuals are also chronically ill. Studies have often not objectively measured medication non- adherence among the homeless population, probably due to lack of consistent pharmacy records. This study proposed to objectively estimate medication non-adherence to chronic medications among the homeless population in Salt Lake City, Utah. Methods: A retrospective study design was used based on the pharmacy records from the Fourth Street Pharmacy based on four classes of chronic medications - asthma, diabetes, statins, and psychiatric medications. Data was collected between November 1, 2010 and February 28, 2011 on the variables: date of original prescription, number of refills on the original prescription, date of 1st, 2nd, 3rd, and 4th fills, age, gender, and race. Primary non-adherence and medication refill non-adherence based on Continuous Measure of Medication Gaps were calculated. Results: The medication refill non-adherence rate was 38.8% with asthma medications, 38.5% with diabetic medications, 27.2% with statins, and 47.1% with psychiatric medications. The primary non-adherence rate varied from zero percent to 20%. Conclusion: The study concluded that this population has comparable non-adherence rates with asthma, diabetes, cholesterol lowering, and certain psychiatric medications than the general population.   Type: Original Research

  6. Measuring medication adherence in patients with incident hypertension: a retrospective cohort study.

    Science.gov (United States)

    Tang, Karen L; Quan, Hude; Rabi, Doreen M

    2017-02-13

    Though pharmacy claims data are commonly used to study medication adherence, there remains no standard operational definition for adherence especially for patients on multiple medications. Even when studies use the same terminology, the actual methods of calculating adherence can differ drastically. It is unclear whether the use of different definitions results in different conclusions regarding adherence and associated outcomes. The objective of our study was to compare adherence rates and associations with mortality using different operational definitions of adherence, and using various methods of handling concurrent medication use. We conducted a cohort study of patients aged ≥65 years from Manitoba, Canada, with incident hypertension diagnosed in 2004 and followed to 2009. We calculated adherence rates to anti-hypertensive medications using different operational definitions of medication adherence (including interval and prescription based medication possession ratios [MPR] and proportion of days covered [PDC]). For those on concurrent medications, we calculated adherence rates using the different methods of handling concurrent medication use, for each definition. We used logistic regression to determine the association between adherence and mortality for each operational definition. Among 2199 patients, 24.1% to 90.5% and 71.2% to 92.7% were considered adherent when using fixed interval and prescription-based interval medication possession ratios [MPRi and MPRp] respectively, depending on how concurrent medications were handled. Adherence was inversely associated with death, with the strongest association for MPRp measures. This association was significant only when considering adherence to any anti-hypertensive [aOR 0.70, 95% CI 0.51, 0.97], or when the mean of the class-specific MPRp's [adjusted OR 0.71, 95% CI 0.53, 0.95] was used. No significant association existed when the highest or lowest class-specific MPRp was used as the adherence estimate. The

  7. Are carer attitudes toward medications related to self-reported medication adherence amongst people with mental illness?

    Science.gov (United States)

    Deane, Frank P; McAlpine, Elizabeth; Byrne, Mitchell K; Davis, Esther L; Mortimer, Christine

    2017-11-22

    Medication nonadherence among consumers with psychiatric disorders can significantly affect the health and wellbeing of the consumer and their family. Previous research has suggested that carers have an impact on consumer attitudes toward medication and adherence. Yet, how carer attitudes toward medication may be related to consumer attitudes and adherence has received little investigation. This exploratory study aimed to investigate the relationships between carer and consumer attitudes toward medication and consumer adherence behaviour. A cross-sectional survey assessing consumer and carer attitudes toward medication and consumer adherence was conducted amongst 42 consumer-carer dyads. Correlation analyses showed a positive association between consumer and carer attitudes toward medication and between consumer and carer attitudes with adherence. There was a general indication that the greater the difference between consumer and carer attitudes, the lower the level of adherence. Regression analyses revealed that while neither consumer nor carer attitudes were significant predictors of adherence, carer attitudes appeared to have a stronger role in adherence than consumer attitudes. These preliminary results highlight the importance of carer attitudes in relation to patient perceptions and behaviours toward medication, and thus the potential benefits of addressing both consumer and carer attitudes in any intervention for improving adherence. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Association of Social Support and Medication Adherence in Chinese Patients with Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Gu, Linni; Wu, Shaomin; Zhao, Shuliang; Zhou, Huixuan; Zhang, Shengfa; Gao, Min; Qu, Zhiyong; Zhang, Weijun; Tian, Donghua

    2017-12-06

    The prevalence of diabetes is steadily increasing in China. When diabetes is uncontrolled, it generates dire consequences for health and well-being. Numerous studies have shown that health outcomes were associated with social support and medication adherence. Previous study confirmed that social support was associated with medication adherence in patients with heart failure, HIV diseases, and first-episode psychosis. However, the relationship between social support and medication adherence in patients with type 2 diabetes mellitus (T2DM) is remains unclear. This study aims to examine whether social support is associated with medication adherence in patients with T2DM. This study was conducted in the First Affiliated Hospital of the General Hospital of the People's Liberation Army (PLA). In Beijing, a systematic random sample of 412 patients with T2DM over 18 years was recruited at baseline, and demographic characteristics, clinical data and their assessment of social support were collected from medical records and self-reported questionnaires. 330 of these patients completed a self-report measure of medication adherence at the sixth month after baseline data collection. Regression analysis showed that social support presented a positive effect on medication adherence, additionally, support utilization and the subscale of social support exhibited a significantly strong influence on medication adherence in patients with T2DM. Although medication adherence was influenced by multiple factors, this finding confirmed that social support must be recognized as a core element in interventions aimed at improving in the management of patients with T2DM.

  9. An observational study of health literacy and medication adherence in adult kidney transplant recipients

    OpenAIRE

    Demian, Maryam N.; Shapiro, R. Jean; Thornton, Wendy Loken

    2016-01-01

    Background There is a high prevalence of non-adherence to immunosuppressants in kidney transplant recipients. Although limited health literacy is common in kidney recipients and is linked to adverse outcomes in other medical populations, its effect on medication adherence in kidney transplant recipients remains poorly understood. The objective was to investigate the effect of lower health literacy on immunosuppressant adherence. Methods Kidney recipients who were at least 6 months post-transp...

  10. Attitudes towards medication non-adherence in elderly kidney transplant patients: a Q methodology study.

    Science.gov (United States)

    Tielen, Mirjam; van Exel, N Job A; van Buren, Marleen C; Maasdam, Louise; Weimar, Willem

    2011-05-01

    Non-adherence to the post-transplant regime is a common problem in kidney transplant patients and may lead to rejection or even graft failure. This study investigated attitudes towards the post-transplant regime of immunosuppressive medication among the ever growing population of elderly kidney recipients. Q methodology was used to explore attitude profiles. Participants (> 65 years) were asked to rank-order opinion statements on issues associated with (non-)adherence. The rankings were subject to by-person factor analysis, and the resulting factors were interpreted and described as attitudes. Twenty-six elderly renal transplant recipients participated in the study. All passed the Mini-Mental State Examination. Two attitude profiles were found: (i) satisfied and easy-going (attitude A), and (ii) reserved and concerned (attitude B). Elderly patients with attitude A want to enjoy the new life following their kidney transplant, are not very concerned about having to recommence dialysis, now and then even forget their regime, and do not really worry about it. Elderly patients with attitude B feel more insecure about their kidney transplant, are fairly concerned over issues like rejection or going back on dialysis, and try to adapt their way of life to the regime. One-third of these elderly patients forget their medication at least once a month, but there was no difference between attitude groups. Attitudes about the post-transplant regime differ among elderly patients, implying different needs for assistance, monitoring and risk of non-adherence to the regime. The proportion of elderly patients who forget their medication is considerable, but may be much higher among those with mild and severe cognitive limitations.

  11. Medical issues in synchronized skating.

    Science.gov (United States)

    Abbott, Kristin; Hecht, Suzanne

    2013-01-01

    Synchronized skating is a unique sport of team skating and currently represents the largest competitive discipline in U.S. Figure Skating. Synchronized skating allows skaters to compete as part of a team with opportunities to represent their country in international competitions. As the popularity of the sport continues to grow, more of these athletes will present to sports medicine clinics with injuries and illnesses related to participation in synchronized skating. The purpose of this article is to review the common injuries and medical conditions affecting synchronized skaters.

  12. Medical issues and research activity

    International Nuclear Information System (INIS)

    Orecchia, R.; Solcia, E.; Fossati, P.

    2006-01-01

    We want to report on the CNAO Centro Nazionale di Adroterapia Oncologica (National Centre for Oncological Hadrontherapy) Foundation activity aiming to create the clinical conditions that will enable CNAO to work in the most advantageous way. CNAO Foundation is taking care to inform the population, patients and medical community on the existence, potentiality and limits of hadrontherapy. To achieve this goal it has created a website that gives general information on hadrontherapy and a medical service that advises on specific clinical cases; it has moreover promoted seminars and courses for residents and specialists. Disease specific working groups have been created to define protocols on patients selection criteria, indications, dose and fractionation and to design clinical trials that will be carried out at CNAO. These protocols and trials are a working tool that will permit a more rational clinical activity. CNAO Foundation is promoting training of personnel that will work at CNAO and in the next few months physicians and physicists will be send abroad to learn the practical aspects of hadrontherapy in foreign facilities where hadrons are already in clinical use. CNAO Foundation is sponsoring research activity in the fields of precision patient positioning, organ motion management, in vivo dosimetry with in room positron emission tomography (PET) scan and radiobiology. These activities will help to take full advantage of the facility under construction and to better define the role of hadrontherapy in cancer care. (author)

  13. Schizophrenia: Impact of psychopathology, faith healers and psycho-education on adherence to medications.

    Science.gov (United States)

    Abdel Aziz, Karim; Elamin, Mohammed H; El-Saadouni, Nisrin M; El-Gabry, Dina Aly; Barakat, Mahmoud; Alhayyas, Fatima; Moselhy, Hamdy F

    2016-12-01

    Many patients suffering from psychosis are nonadherent to their medications. Nonadherence can range from treatment refusal to irregular use or partial change in daily medication doses. To investigate whether symptom dimensions, post-discharge care plans and being involved with faith healer affect the adherence to treatment in patients with schizophrenia. A total of 121 patients with schizophrenia were examined 6 weeks post-discharge from the inpatient unit and assessed for full, partial or nonadherence to medication. There was a significant association between family involvement and partial adherence and between community team involvement post-discharge and full adherence to medications. Psycho-education was a predictor for adherence to medications, persecutory delusions and lack of insight predicted partial adherence, while being involved with faith healers predicted nonadherence. Adherence to medications and socio-demographic variables are independent. This study demonstrated that nonadherence or partial adherence to medications is associated with lack of insight and persecutory delusions. Psycho-education could improve the adherence to medication compliances. © The Author(s) 2016.

  14. The ADHOC study of older adults' adherence to medication in 11 countries.

    NARCIS (Netherlands)

    Cooper, C.; Carpenter, I.; Katona, C.; Schroll, M.; Wagner, C.; Fialova, D.; Livingston, G.

    2005-01-01

    OBJECTIVE: Authors investigated, cross-nationally, the factors, including demographic, psychiatric (including cognitive), physical, and behavioral, determining whether older people take their prescribed medication. Older adults are prescribed more medication than any other group, and poor adherence

  15. Stressors may compromise medication adherence among adults with diabetes and low socioeconomic status.

    Science.gov (United States)

    Osborn, Chandra Y; Mayberry, Lindsay Satterwhite; Wagner, Julie A; Welch, Garry W

    2014-10-01

    Studies examining the impact of stressors on diabetes self-care have focused on a single stressor or have been largely qualitative. Therefore, we assessed the stressors experienced by a high-risk population with type 2 diabetes, and tested whether having more stressors was associated with less adherence to multiple self-care behaviors. Participants were recruited from a Federally Qualified Health Center and 192 completed a stressors checklist. Experiencing more stressors was associated with less adherence to diet recommendations and medications among participants who were trying to be adherent, but was not associated with adherence to other self-care behaviors. Because having more stressors was also associated with more depressive symptoms, we further adjusted for depressive symptoms. Stressors remained associated with less adherence to medications, but not to diet recommendations. For adults engaged in adherence, experiencing an accumulation of stressors presents barriers to adherence that are distinct from associated depressive symptoms. © The Author(s) 2014.

  16. Stressors May Compromise Medication Adherence among Adults with Diabetes and Low Socioeconomic Status

    Science.gov (United States)

    Osborn, Chandra Y.; Mayberry, Lindsay S.; Wagner, Julie A.; Welch, Garry W.

    2014-01-01

    Studies examining the impact of stressors on diabetes self-care have been limited by focusing on a single stressor or have been largely qualitative. Therefore, we assessed the stressors experienced by a high-risk population with type 2 diabetes, and tested whether having more stressors was associated with less adherence to multiple self-care behaviors. Participants were recruited from a Federally Qualified Health Center and 192 completed a stressors checklist. Experiencing more stressors was associated with less adherence to diet recommendations and medications among participants who were trying to be adherent, but was not associated with adherence to other self-care behaviors. Because having more stressors was also associated with more depressive symptoms, we further adjusted for depressive symptoms; stressors remained associated with less adherence to medications, but not to diet recommendations. For adults engaged in adherence, experiencing numerous chronic stressors presents barriers to adherence that are distinct from associated depressive symptoms. PMID:24569697

  17. A Comparison of Self-reported Medication Adherence to Concordance Between Part D Claims and Medication Possession.

    Science.gov (United States)

    Savitz, Samuel T; Stearns, Sally C; Zhou, Lei; Thudium, Emily; Alburikan, Khalid A; Tran, Richard; Rodgers, Jo E

    2017-05-01

    Medicare Part D claims indicate medication purchased, but people who are not fully adherent may extend prescription use beyond the interval prescribed. This study assessed concordance between Part D claims and medication possession at a study visit in relation to self-reported medication adherence. We matched Part D claims for 6 common medications to medications brought to a study visit in 2011-2013 for the Atherosclerosis Risk in Communities study. The combined data consisted of 3027 medication events (claims, medications possessed, or both) for 2099 Atherosclerosis Risk in Communities study participants. Multinomial logistic regression estimated the association of concordance (visit only, Part D only, or both) with self-reported medication adherence while controlling for sociodemographic characteristics, veteran status, and availability under Generic Drug Discount Programs. Relative to participants with high adherence, medication events for participants with low adherence were approximately 25 percentage points less likely to match and more likely to be visit only (PDiscount Programs were 3 percentage points more likely to be visit only. Part D claims were substantially less likely to be concordant with medications possessed at study visit for participants with low self-reported adherence. This result supports the construction of adherence proxies such as proportion days covered using Part D claims.

  18. Improving medication adherence: a framework for community pharmacy-based interventions

    Directory of Open Access Journals (Sweden)

    Pringle J

    2015-11-01

    Full Text Available Janice Pringle,1 Kim C Coley2 1Program Evaluation and Research Unit, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA; 2Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA Abstract: Evidence supports that patient medication adherence is suboptimal with patients typically taking less than half of their prescribed doses. Medication nonadherence is associated with poor health outcomes and higher downstream health care costs. Results of studies evaluating pharmacist-led models in a community pharmacy setting and their impact on medication adherence have been mixed. Community pharmacists are ideally situated to provide medication adherence interventions, and effective strategies for how they can consistently improve patient medication adherence are necessary. This article suggests a framework to use in the community pharmacy setting that will significantly improve patient adherence and provides a strategy for how to apply this framework to develop and test new medication adherence innovations. The proposed framework is composed of the following elements: 1 defining the program's pharmacy service vision, 2 using evidence-based, patient-centered communication and intervention strategies, 3 using specific implementation approaches that ensure fidelity, and 4 applying continuous evaluation strategies. Within this framework, pharmacist interventions should include those services that capitalize on their specific skill sets. It is also essential that the organization's leadership effectively communicates the pharmacy service vision. Medication adherence strategies that are evidence-based and individualized to each patient's adherence problems are most desirable. Ideally, interventions would be delivered repeatedly over time and adjusted when patient's adherence circumstances change. Motivational interviewing principles are particularly well

  19. Improving medication adherence of patients with chronic heart failure: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Shah D

    2015-07-01

    Full Text Available Deval Shah,1 Kim Simms,2 Debra J Barksdale,3 Jia-Rong Wu3 1Internal Medicine, Wake Forest Baptist Hospital, Winston-Salem, 2Duke University Hospital, Durham, 3School of Nursing, University of North Carolina, Chapel Hill, NC, USA Abstract: Heart failure is a chronic debilitating illness that affects 5.7 million Americans. The financial burden of heart failure in the US toppled $31 billion in 2012, which is one of the highest among all chronic medical conditions. Medication adherence is a major component of heart failure self-care behaviors. Therefore, medication non-adherence is associated with more emergency department visits, frequent rehospitalizations, and higher medical cost. Medication adherence rates have varied from 10% to 98% depending on the definition and measurement used to assess and analyze adherence. Many factors contribute to medication non-adherence such as lack of support, finances, absent of symptoms, cognitive decline, adverse reactions, depression, poor attention span, poor knowledge about medication, multiple medications, difficulty swallowing large pills, and inconveniences of urinary frequency with diuretics. Researchers have explored various strategies such as the use of pharmacists, nurses, telemedicine, and interdisciplinary teams to provide interventions to improve medication adherence in heart failure. Health care providers should continue to provide education, constantly reinforce the importance of taking medication as prescribed, and when feasible, utilize one of the successful evidence-based strategies to increase adherence. Keywords: pharmacy, tele-health, interdisciplinary, registered nurse, interventions

  20. Trials and tribulations with electronic medication adherence monitoring in kidney transplantation.

    Science.gov (United States)

    Williams, Allison; Low, Jac Kee; Manias, Elizabeth; Dooley, Michael; Crawford, Kimberley

    2016-01-01

    Medication adherence in kidney transplantation is critical to prevent graft rejection. Testing interventions designed to support patients to take their prescribed medications following a kidney transplant require an accurate measure of medication adherence. In research, the available methods for measuring medication adherence include self-report, pill counts, prescription refill records, surrogate measures of medication adherence and medication bottles with a microchip-embedded cap to record bottle openings. Medication bottles with a microchip-embedded cap are currently regarded as the gold standard measure. This commentary outlines the challenges in measuring medication adherence using electronic medication monitoring of kidney transplant patients recruited from five sites. The challenges included obtaining unanimous stakeholder support for using this method, agreement on an index medication to measure, adequate preparation of the patient and training of pharmacy staff, and how to analyze data when periods of time were not recorded using the electronic adherence measure. Provision of this information will enable hospital and community pharmacists to implement approaches that promote the effective use of this adherence measure for optimal patient outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Modeling the economic impact of medication adherence in type 2 diabetes: a theoretical approach

    Directory of Open Access Journals (Sweden)

    David S Cobden

    2010-08-01

    Full Text Available David S Cobden1, Louis W Niessen2, Frans FH Rutten1, W Ken Redekop11Department of Health Policy and Management, Section of Health Economics – Medical Technology Assessment (HE-MTA, Erasmus MC, Erasmus University Rotterdam, The Netherlands; 2Department of International Health, Johns Hopkins University School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD, USAAims: While strong correlations exist between medication adherence and health economic outcomes in type 2 diabetes, current economic analyses do not adequately consider them. We propose a new approach to incorporate adherence in cost-effectiveness analysis.Methods: We describe a theoretical approach to incorporating the effect of adherence when estimating the long-term costs and effectiveness of an antidiabetic medication. This approach was applied in a Markov model which includes common diabetic health states. We compared two treatments using hypothetical patient cohorts: injectable insulin (IDM and oral (OAD medications. Two analyses were performed, one which ignored adherence (analysis 1 and one which incorporated it (analysis 2. Results from the two analyses were then compared to explore the extent to which adherence may impact incremental cost-effectiveness ratios.Results: In both analyses, IDM was more costly and more effective than OAD. When adherence was ignored, IDM generated an incremental cost-effectiveness of $12,097 per quality-adjusted life-year (QALY gained versus OAD. Incorporation of adherence resulted in a slightly higher ratio ($16,241/QALY. This increase was primarily due to better adherence with OAD than with IDM, and the higher direct medical costs for IDM.Conclusions: Incorporating medication adherence into economic analyses can meaningfully influence the estimated cost-effectiveness of type 2 diabetes treatments, and should therefore be ­considered in health care decision-making. Future work on the impact of adherence on health

  2. Implementation and adherence issues in a workplace treadmill desk intervention.

    Science.gov (United States)

    Tudor-Locke, Catrine; Hendrick, Chelsea A; Duet, Megan T; Swift, Damon L; Schuna, John M; Martin, Corby K; Johnson, William D; Church, Timothy S

    2014-10-01

    We report experiences, observations, and general lessons learned, specifically with regards to participant recruitment and adherence, while implementing a 6-month randomized controlled treadmill desk intervention (the WorkStation Pilot Study) in a real-world office-based health insurance workplace. Despite support from the company's upper administration, relatively few employees responded to the company-generated e-mail to participate in the study. Ultimately only 41 overweight/obese participants were deemed eligible and enrolled from a recruitment pool of 728 workers. Participants allocated to the Treadmill Desk Group found the treadmill desk difficult to use for 45 min twice a day as scheduled. Overall attendance averaged 45%-50% of all possible scheduled sessions. The most frequently reported reasons for missing sessions included work conflict (35%), out of office (30%), and illness/injury/drop-out (20%). Although focus groups indicated consistently positive comments about treadmill desks, an apparent challenge was fitting a rigid schedule of shared use to an equally rigid and demanding work schedule punctuated with numerous tasks and obligations that could not easily be interrupted. Regardless, we documented that sedentary office workers average ∼43 min of light-intensity (∼2 METs) treadmill walking daily in response to a scheduled, facilitated, and shared access workplace intervention. Workstation alternatives that combine computer-based work with light-intensity physical activity are a potential solution to health problems associated with excessive sedentary behavior; however, there are numerous administrative, capital, and human resource challenges confronting employers considering providing treadmill desks to workers in a cost-effective and equitable manner.

  3. Prevalence, predictors, and clinical consequences of medical adherence in IBD: how to improve it?

    Science.gov (United States)

    Lakatos, Peter Laszlo

    2009-09-14

    Inflammatory bowel diseases (IBD) are chronic diseases with a relapsing-remitting disease course necessitating lifelong treatment. However, non-adherence has been reported in over 40% of patients, especially those in remission taking maintenance therapies for IBD. The economical impact of non-adherence to medical therapy including absenteeism, hospitalization risk, and the health care costs in chronic conditions, is enormous. The causes of medication non-adherence are complex, where the patient-doctor relationship, treatment regimen, and other disease-related factors play key roles. Moreover, subjective assessment might underestimate adherence. Poor adherence may result in more frequent relapses, a disabling disease course, in ulcerative colitis, and an increased risk for colorectal cancer. Improving medication adherence in patients is an important challenge for physicians. Understanding the different patient types, the reasons given by patients for non-adherence, simpler and more convenient dosage regimens, dynamic communication within the health care team, a self-management package incorporating enhanced patient education and physician-patient interaction, and identifying the predictors of non-adherence will help devise suitable plans to optimize patient adherence. This editorial summarizes the available literature on frequency, predictors, clinical consequences, and strategies for improving medical adherence in patients with IBD.

  4. Interventions to Improve Medication Adherence among Older Adults: Meta-Analysis of Adherence Outcomes among Randomized Controlled Trials

    Science.gov (United States)

    Conn, Vicki S.; Hafdahl, Adam R.; Cooper, Pamela S.; Ruppar, Todd M.; Mehr, David R.; Russell, Cynthia L.

    2009-01-01

    Purpose: This study investigated the effectiveness of interventions to improve medication adherence (MA) in older adults. Design and Methods: Meta-analysis was used to synthesize results of 33 published and unpublished randomized controlled trials. Random-effects models were used to estimate overall mean effect sizes (ESs) for MA, knowledge,…

  5. Geriatric syndromes are potential determinants of the medication adherence status in prevalent dialysis patients

    Directory of Open Access Journals (Sweden)

    Chia-Ter Chao

    2016-06-01

    Full Text Available Background. Geriatric syndromes (GS exhibit high prevalence in patients with end-stage renal disease (ESRD under chronic dialysis irrespective of age. We sought to determine whether GS influences medication adherence in ESRD patients. Methods. A prospective cohort of chronic dialysis patients was assembled. The presence of GS components, including frailty/prefrailty, polypharmacy, and malnutrition, were ascertained through a validated questionnaire, electronic records and chart abstraction, and laboratory tests. The severity of medication non-adherence was defined using the eight-item Morisky Medication Adherence Scale (MMAS. Multiple logistic regression analysis was performed targeting MMAS results and incorporating relevant clinical features and GS. Results. The prevalence of frailty/pre-frailty, polypharmacy, and hypoalbuminemia/ malnutrition among the enrolled participants was 66.7%, 94%, and 14%, respectively. The average MMAS scores in these dialysis patients were 2 ± 1.7 (range, 0–6, with only 15.7% exhibiting high medication adherence. Multiple regression analyses showed that the absence of frailty/pre-frailty (P = 0.01 were significantly associated with poorer medication adherence, while the presence of polypharmacy (P = 0.02 and lower serum albumin, a potential sign of malnutrition (P = 0.03, were associated with poor adherence in another model. Conclusion. This study is among the very few reports addressing GS and medication adherence, especially in ESRD patients. Interventions targeting frailty, polypharmacy, and malnutrition might potentially improve the medication non-adherence and symptom control in these pill-burdened patients.

  6. Analysis of medication adherence-related notes from a service-oriented community pharmacy.

    Science.gov (United States)

    Witry, Matthew; Parry, Rachel; McDonough, Randal; Deninger, Michael

    2017-07-15

    nonadherence in practice. This study descriptively coded community pharmacist notes related to medication nonadherence. Most notes were prompted by automatic calculations by the documentation software of the proportion of days covered. This prompted regular conversations about non-adherence issues and clarifications on how medications are being used at home. Documentation suggested most adherence problems were technical in nature rather than stemming from patient factors like medication beliefs. Pharmacists could be more intentional and descriptive when documenting nonadherence issues so that more targeted follow up can be made, including a greater investigation of medication beliefs. Copyright © 2017. Published by Elsevier Inc.

  7. Personality and medication non-adherence among older adults enrolled in a six-year trial

    Science.gov (United States)

    Jerant, Anthony; Chapman, Benjamin; Duberstein, Paul; Robbins, John; Franks, Peter

    2011-01-01

    Objectives Personality factors parsimoniously capture the variation in dispositional characteristics that affect behaviours, but their value in predicting medication non-adherence is unclear. We investigated the relationship between five-factor model personality factors (Conscientiousness, Neuroticism, Agreeableness, Extraversion, and Openness) and medication non-adherence among older participants during a six-year randomized placebo-controlled trial (RCT). Design Observational cohort data from 771 subjects aged ≥72 years enrolled in the Ginkgo Evaluation of Memory study, a RCT of Ginkgo biloba for prevention of dementia. Methods Random effects logistic regression analyses examined effects of NEO Five-Factor Inventory scores on medication non-adherence, determined via pill counts every 6 months (median follow-up 6.1 years) and defined as taking personality factor associated with non-adherence: a 1 SD increase was associated with a 3.8% increase in the probability of non-adherence (95% CI [0.4, 7.2]). Lower cognitive function was also associated with non-adherence: a 1 SD decrease in mental status exam score was associated with a 3.0% increase in the probability of non-adherence (95% CI [0.2, 5.9]). Conclusions Neuroticism was associated with medication non-adherence over 6 years of follow-up in a large sample of older RCT participants. Personality measurement in clinical and research settings might help to identify and guide interventions for older adults at risk for medication non-adherence. PMID:21226789

  8. Self-transcendence and medication adherence in older adults with hypertension.

    Science.gov (United States)

    Thomas, Nezbile F; Dunn, Karen S

    2014-12-01

    The purpose of this study was to examine the relationship between self-transcendence and medication adherence among older adults prescribed antihypertensive medication. Descriptive, correlational research design. Forty-six older adults who were prescribed antihypertensive medications from an independent living facility participated in this study. Participants were given a survey that included a demographic questionnaire, the Morisky Medication Adherence Scale, and Reed's Self-Transcendence Scale. No significant relationship was found between medication adherence and self-transcendence (r = -.20, p = .18). Ninety percent of the participants however, admitted to cutting back or stopping their medication without notifying their providers. Continued investigation is needed to identify reasons why older adults fail to adhere to taking prescribed hypertension medications in order to improve health outcomes in this population. © The Author(s) 2014.

  9. Non-adherence to immunosuppressive medications in kidney transplantation: intent vs. forgetfulness and clinical markers of medication intake.

    Science.gov (United States)

    Griva, Konstadina; Davenport, Andrew; Harrison, Michael; Newman, Stanton P

    2012-08-01

    Although adherence to immunosupressive medication after transplantation is important to maximize good clinical outcomes it remains suboptimal and not well-understood. The purpose of this study was to examine intentional and unintentional non-adherence to immunosuppression medication in kidney transplant patients. A cross-sectional sample of N=218 patients [49.6 ± 12.3 years] recruited in London, UK (1999-2002) completed measures of medication beliefs, quality-of-life, depression, and transplantation-specific emotions. Adherence was measured with self-report and serial immunosuppressive assays. Intentional non-adherence was low (13.8 %) yet 62.4 % admitted unintentional non-adherence and 25.4 % had sub-target immunosuppressive levels. The risk of sub-target serum immunosuppressive levels was greater for patients admitting unintentional non-adherence (OR=8.4; p=0.004). Dialysis vintage, doubts about necessity, and lower worry about viability of graft explained R(2)=16.1 to 36 % of self-report non-adherence. Depression was related only to intentional non-adherence. Non-adherence is common in kidney transplantation. Efforts to increase adherence should be implemented by targeting necessity beliefs, monitoring depression, and promoting strategies to decrease forgetfulness.

  10. Cognitive-Behavioral Therapy for HIV Medication Adherence and Depression

    Science.gov (United States)

    Safren, Steven A.; Hendriksen, Ellen S.; Mayer, Kenneth H.; Mimiaga, Matthew J.; Pickard, Robert; Otto, Michael W.

    2004-01-01

    For patients with HIV, depression is a common, distressing condition that can interfere with a critical self-care behavior--adherence to antiretroviral therapy. The present study describes a cognitive-behavioral treatment designed to integrate cognitive-behavioral therapy for depression with our previously tested approach to improving adherence to…

  11. Assessment of medication adherence among type 2 diabetic patients in Quetta city, Pakistan.

    Science.gov (United States)

    Iqbal, Qaiser; Bashir, Sajid; Iqbal, Javeid; Iftikhar, Shehla; Godman, Brian

    2017-08-01

    Type 2 diabetes (T2DM) is a growing burden among all countries including Pakistan, with medication adherence very important to improve care. However, little is known about medication adherence in Pakistan and potential predictors among T2DM patients to provide future guidance. This needs to be addressed. Consequently, the present study sought to assess medication adherence among type 2 diabetic patients in Quetta city, Pakistan. Questionnaire based, descriptive study among 300 Pakistani patients attending public and private hospitals aged 18 years and above, having a confirmed diagnosis of T2DM, without additional co-morbidities were targeted. Descriptive statistics were used to describe demographic and disease characteristics. The association between socio-demographic data and study variables was compared through the Mann Whitney/Kruskal Wallis test (where applicable). The factors that were significantly associated with medication adherence were further assessed by logistic regression analysis. 55.6% of patients had high adherence although overall patients reported moderate adherence. Age, gender, education, diabetes-related knowledge and treatment satisfaction were significantly associated with medication adherence. Older males with only primary education and with poor diabetes-related knowledge had the lowest adherence. This study presents a model that is associated with medication adherence among T2DM patients, with disease-related knowledge as a significant predictor of likely adherence. Results of the current study revealed that improved diabetes related knowledge plays a significant role in improving medication adherence. Healthcare practitioners and the system should formalize and acknowledge patient education as a key component to treat patients with T2DM. This should include a greater role for pharmacists and other professionals.

  12. Electronically-measured adherence to immunosuppressive medications and kidney function after deceased donor kidney transplantation*

    Science.gov (United States)

    Israni, Ajay K.; Weng, Francis L.; Cen, Ye-Ying; Joffe, Marshall; Kamoun, Malek; Feldman, Harold I.

    2013-01-01

    Background Non-adherence with immunosuppressive medications can result in allograft rejection and eventually allograft loss. Methods In a racially diverse population, we utilized microelectronic cap monitors to determine the association of adherence with a single immunosuppressive medication and kidney allograft outcomes post-transplantation. This prospective cohort study enrolled 243 patients from eight transplant centers to provide adherence and kidney allograft outcomes data. To determine the association of adherence with change in estimated glomerular filtration rate (eGFR), we fit mixed effects models with the outcome being change in eGFR over time. We also fit Cox proportional hazards models to determine the association of adherence with time to persistent 25% and 50% decline in eGFR. Results The distribution of adherence post-transplant was as follows: 164 (68%), 49 (20%) and 30 (12%) had >85–100%, 50–85% and adherence, respectively. 79 (33%) and 36 (15%) of the subjects experienced a persistent 25% decline in eGFR or allograft loss and 50% decline in eGFR or allograft loss during follow-up. Adherence was not associated with acute rejection or 25% decline or 50% decline in eGFR. In the adjusted and unadjusted model, adherence and black race were not associated with change in eGFR over time. Conclusions Non-adherence with a single immunosuppressive medication, was not associated with kidney allograft outcomes. PMID:20977496

  13. Electronically measured adherence to immunosuppressive medications and kidney function after deceased donor kidney transplantation.

    Science.gov (United States)

    Israni, Ajay K; Weng, Francis L; Cen, Ye-Ying; Joffe, Marshall; Kamoun, Malek; Feldman, Harold I

    2011-01-01

    Non-adherence with immunosuppressive medications can result in allograft rejection and eventually allograft loss. In a racially diverse population, we utilized microelectronic cap monitors to determine the association of adherence with a single immunosuppressive medication and kidney allograft outcomes post-transplantation. This prospective cohort study enrolled 243 patients from eight transplant centers to provide adherence and kidney allograft outcomes data. To determine the association of adherence with change in estimated glomerular filtration rate (eGFR), we fit mixed effects models with the outcome being change in eGFR over time. We also fit Cox proportional hazards models to determine the association of adherence with time to persistent 25% and 50% decline in eGFR. The distribution of adherence post-transplant was as follows: 164 (68%), 49 (20%), and 30 (12%) had >85-100%, 50-85%, and adherence, respectively. Seventy-nine (33%) and 36 (15%) of the subjects experienced a persistent 25% decline in eGFR or allograft loss and 50% decline in eGFR or allograft loss during follow-up. Adherence was not associated with acute rejection or 25% decline or 50% decline in eGFR. In the adjusted and unadjusted model, adherence and black race were not associated with change in eGFR over time. Non-adherence with a single immunosuppressive medication was not associated with kidney allograft outcomes. © 2010 John Wiley & Sons A/S.

  14. Medication adherence levels and differential use of mental-health services in the treatment of schizophrenia

    Directory of Open Access Journals (Sweden)

    Furiak Nicolas M

    2009-01-01

    Full Text Available Abstract Background Adherence to antipsychotics for schizophrenia is associated with favorable clinical outcomes. This study compared annual mental-health service utilization by recent medication adherence levels for patients treated for schizophrenia, and assessed whether adherence levels change from pre- to post-psychiatric hospitalization. Methods We analyzed data from a large prospective, non-interventional study of patients treated for schizophrenia in the United States, conducted between 7/1997 and 9/2003. Detailed mental-health resource utilization was systematically abstracted from medical records and augmented with patients' self report. Medication possession ratio (MPR with any antipsychotic in the 6 months prior to enrollment was used to categorize patients as: adherent (MPR ≥ 80%, N = 1758, partially adherent (MPR ≥ 60% Results Adherent patients had a lower rate of psychiatric hospitalization compared with partially adherent and non-adherent patients (p Conclusion Adherence is associated with lower utilization of acute care services and greater engagement in outpatient mental-health treatment. Adherence is a potentially dynamic phenomenon, which may improve, at least temporarily, following patients' psychiatric hospitalizations.

  15. Time perspective and medication adherence among individuals with hypertension or diabetes mellitus.

    Science.gov (United States)

    Sansbury, Brittany; Dasgupta, Abhijit; Guthrie, Lori; Ward, Michael

    2014-04-01

    The study determined if time perspective was associated with medication adherence among people with hypertension and diabetes. Using the Health Beliefs Model, we used path analysis to test direct and indirect effects of time perspective and health beliefs on adherence among 178 people who participated in a community-based survey near Washington, D.C. We measured three time perspectives (future, present fatalistic, and present hedonistic) with the Zimbardo Time Perspective Inventory and medication adherence by self-report. The total model demonstrated a good fit (RMSEA=0.17, 90% CI [0.10, 0.28], p=0.003; comparative fit index=0.91). Future time perspective and age showed direct effects on increased medication adherence; an increase by a single unit in future time perspective was associated with a 0.32 standard deviation increase in reported adherence. There were no significant indirect effects of time perspective with reported medication adherence through health beliefs. The findings provide the first evidence that time perspective plays an under-recognized role as a psychological motivator in medication adherence. Patient counseling for medication adherence may be enhanced if clinicians incorporate consideration of the patient's time perspective. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  16. Predictors of medication adherence and smoking cessation among smokers under community corrections supervision.

    Science.gov (United States)

    Cropsey, Karen L; Clark, C Brendan; Stevens, Erin N; Schiavon, Samantha; Lahti, Adrienne C; Hendricks, Peter S

    2017-02-01

    Individuals in the U.S. criminal justice system now represent over 12% of all current U.S. smokers. With smoking banned in most U.S. jails and prisons, the cessation focus for this population has shifted to individuals who are under community correction supervision (e.g., probation, parole). The aim of this study was to examine predictors of successful smoking cessation among criminal justice individuals supervised in the community. Five hundred participants under community corrections supervision were randomized to receive either four sessions of smoking cessation counseling or no counseling in conjunction with 12weeks of bupropion treatment plus brief physician advice to quit. Logistic regression analyses examined associations of smoking variables with medication adherence and successful abstinence. Mediation analysis evaluated the indirect effects of medication adherence on smoking abstinence. The strongest associate of medication adherence was previous use of bupropion, while the strongest associate of smoking abstinence was medication adherence. Mediation analysis indicated that previous use of bupropion indirectly increased cessation rates through the pathway of increased medication adherence. These results highlight the importance of medication adherence for smoking cessation among community corrections smokers. Providing exposure to medication may be a promising intervention to increase medication adherence and subsequent cessation rates in this population. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Depression and medication adherence among older Korean patients with hypertension: Mediating role of self-efficacy.

    Science.gov (United States)

    Son, Youn-Jung; Won, Mi Hwa

    2017-06-01

    Many studies have reported the negative effects of depression on adherence to antihypertensive medication. However, little is known about the mechanism underlying this relationship in elderly patients with hypertension. The aim of this cross-sectional study is to examine the mediating role of self-efficacy in the relationship between depression and medication adherence among older patients with hypertension. The data were collected from October to December 2014. A total of 255 older patients with hypertension were assessed using the Geriatric Depression Scale, the Self-efficacy for Appropriate Medication Use Scale, and the Morisky Medication Adherence Scale. Hierarchical linear regression analysis and the Sobel test were used to examine the mediating role of self-efficacy in the relationship between depression and medication adherence. Depression and self-efficacy were statistically significant predictors of medication adherence in older patients with hypertension. Self-efficacy partially mediated the relationship between depression and medication adherence. Interventions targeting self-efficacy could increase the confidence of patients in their ability to actively take their medicines. Moreover, health care providers should be aware of the importance of early detection of depression in older patients with hypertension. Future studies with longitudinal data are warranted to clarify the multidirectional relationships between depression, self-efficacy, and medication adherence. © 2017 John Wiley & Sons Australia, Ltd.

  18. Implementation of smart technology to improve medication adherence in patients with cardiovascular disease: is it effective?

    Science.gov (United States)

    Treskes, Roderick W; Van der Velde, Enno T; Schoones, Jan W; Schalij, Martin J

    2018-02-01

    Medication adherence is of key importance in the treatment of cardiovascular disease. Studies consistently show that a substantial proportion of patients is non-adherent. Areas covered: For this review, telemedicine solutions that can potentially improve medication adherence in patients with cardiovascular disease were reviewed. A total of 475 PubMed papers were reviewed, of which 74 were assessed. Expert commentary: Papers showed that evidence regarding telemedicine solutions is mostly conflictive. Simple SMS reminders might work for patients who do not take their medication because of forgetfulness. Educational interventions and coaching interventions, primarily delivered by telephone or via a web-based platform can be effective tools to enhance medication adherence. Finally, it should be noted that current developments in software engineering may dramatically change the way non-adherence is addressed in the nearby future.

  19. MEDICATION ADHERENCE IN ELDERLY WITH POLYPHARMACY LIVING AT HOME: A SYSTEMATIC REVIEW OF EXISTING STUDIES.

    Science.gov (United States)

    Zelko, Erika; Klemenc-Ketis, Zalika; Tusek-Bunc, Ksenija

    2016-04-01

    We wanted to systematically review the available evidence to evaluate the drug adherence in elderly with polypharmacy living at home. We performed a literature search using MEDLINE, ISI Web of Science, ProQuest, EMBASE, SCOPUS, Springer Link, Sage Journals and CINAHL. We used the following terms: Medication Adherence, Medication Compliance, Polypharmacy, and Elderly. The search was limited to English-language articles. We included only clinical trials, systematic reviews, meta-analysis and cross-sectional studies. A total of seven articles were included in this systematic review after applying the search strategy. Six studies dealt with the prevalence of medication adherence and its correlates in patients aged 65 years or more with polypharmacy. Two studies dealt with the effect of various interventions on medication adherence in patients aged 65 years or more with polypharmacy. The available literature on the polypharmacy and drug adherence in elderly living at home is scarce and further studies are needed.

  20. Does Health Information in Mass Media Help or Hurt Patients? Investigation of Potential Negative Influence of Mass Media Health Information on Patients' Beliefs and Medication Regimen Adherence.

    Science.gov (United States)

    Im, Heewon; Huh, Jisu

    2017-03-01

    As an important public health issue, patient medication non-adherence has drawn much attention, but research on the impact of mass media as an information source on patient medication adherence has been scant. Given that mass media often provide confusing and contradicting information regarding health/medical issues, this study examined the potential negative influence of exposure to health information in mass media on patients' beliefs about their illnesses and medications, and medication adherence, in comparison with the effects of exposure to another primary medication information source, physicians. Survey data obtained from patients on blood thinner regimens revealed that the frequency of exposure to health information in mass media was negatively related to accuracy of patients' beliefs about their medication benefits and patient medication adherence. On the other hand, frequency of visits with physicians was positively associated with patients' beliefs about their medication benefits but had no significant relation to medication regimen adherence. The implications of the study findings are discussed, and methodological limitations and suggestion for future research are presented.

  1. Improving Post-Discharge Medication Adherence in Patients with CVD: A Pilot Randomized Trial

    Directory of Open Access Journals (Sweden)

    Alfredo D. Oliveira-Filho

    2014-12-01

    Full Text Available Background: Effective interventions to improve medication adherence are usually complex and expensive. Objective: To assess the impact of a low-cost intervention designed to improve medication adherence and clinical outcomes in post-discharge patients with CVD. Method: A pilot RCT was conducted at a teaching hospital. Intervention was based on the four-item Morisky Medication Adherence Scale (MMAS-4. The primary outcome measure was medication adherence assessed using the eight-item MMAS at baseline, at 1 month post hospital discharge and re-assessed 1 year after hospital discharge. Other outcomes included readmission and mortality rates. Results: 61 patients were randomized to intervention (n = 30 and control (n = 31 groups. The mean age of the patients was 61 years (SD 12.73, 52.5% were males, and 57.4% were married or living with a partner. Mean number of prescribed medications per patient was 4.5 (SD 3.3. Medication adherence was correlated to intervention (p = 0.04 and after 1 month, 48.4% of patients in the control group and 83.3% in the intervention group were considered adherent. However, this difference decreased after 1 year, when adherence was 34.8% and 60.9%, respectively. Readmission and mortality rates were related to low adherence in both groups. Conclusion: The intervention based on a validated patient self-report instrument for assessing adherence is a potentially effective method to improve adherent behavior and can be successfully used as a tool to guide adherence counseling in the clinical visit. However, a larger study is required to assess the real impact of intervention on these outcomes.

  2. A renewed Medication Adherence Alliance call to action: harnessing momentum to address medication nonadherence in the United States

    Directory of Open Access Journals (Sweden)

    Zullig LL

    2016-07-01

    Full Text Available Leah L Zullig,1,2 Bradi B Granger,3 Hayden B Bosworth,1–4 On behalf of the Medication Adherence Alliance 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 2Division of General Internal Medicine, Department of Medicine, Duke University, 3Duke Heart Center Nursing Research Program, School of Nursing, Duke University, 4Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA The problem: Nonadherence to prescription medications is a common and costly problem with multiple contributing factors, spanning the dimensions of individual behavior change, psychology, medicine, and health policy, among others. Addressing the problem of medication nonadherence requires strategic input from key experts in a number of fields.Meeting of experts: The Medication Adherence Alliance is a group of key experts, predominately from the US, in the field of medication nonadherence. Members include representatives from consumer advocacy groups, community health providers, nonprofit groups, the academic community, decision-making government officials, and industry. In 2015, the Medication Adherence Alliance convened to review the current landscape of medication adherence. The group then established three working groups that will develop recommendations for shifting toward solutions-oriented science.Commentary of expert opinion: From the perspective of the Medication Adherence Alliance, the objective of this commentary is to describe changes in the US landscape of medication adherence, framing the evolving field in the context of a recent think tank meeting of experts in the field of medication adherence. Keywords: medication adherence, health planning recommendations, chronic disease

  3. The Effects of a Problem Solving-Based Intervention on Depressive Symptoms and HIV Medication Adherence Are Independent

    NARCIS (Netherlands)

    Gross, Robert; Bellamy, Scarlett L.; Chapman, Jennifer; Han, Xiaoyan; O'Duor, Jacqueline; Strom, Brian L.; Houts, Peter S.; Palmer, Steven C.; Coyne, James C.

    2014-01-01

    Depression and depressive symptoms predict poor adherence to medical therapy, but the association is complex, nonspecific, and difficult to interpret. Understanding this association may help to identify the mechanism explaining the results of interventions that improve both medical therapy adherence

  4. Predictors of medication adherence in high risk youth of color living with HIV.

    Science.gov (United States)

    Macdonell, Karen E; Naar-King, Sylvie; Murphy, Debra A; Parsons, Jeffrey T; Harper, Gary W

    2010-07-01

    To test predictors of medication adherence in high-risk racial or ethnic minority youth living with HIV (YLH) using a conceptual model of social cognitive predictors including a continuous measure of motivational readiness. Youth were participants in a multi-site clinical trial examining the efficacy of a motivational intervention. Racial-minority YLH (primarily African American) who were prescribed antiretroviral medication were included (N = 104). Data were collected using computer-assisted personal interviewing method via an Internet-based application and questionnaires. Using path analysis with bootstrapping, most youth reported suboptimal adherence, which predicted higher viral load. Higher motivational readiness predicted optimal adherence, and higher social support predicted readiness. Decisional balance was indirectly related to adherence. The model provided a plausible framework for understanding adherence in this population. Culturally competent interventions focused on readiness and social support may be helpful for improving adherence in YLH.

  5. Differences in medication adherence are associated with beliefs about medicines in asthma and COPD

    OpenAIRE

    Brandstetter, Susanne; Finger, Tamara; Fischer, Wiebke; Brandl, Magdalena; Böhmer, Merle; Pfeifer, Michael; Apfelbacher, Christian

    2017-01-01

    Adherence to medication is crucial for achieving treatment control in chronic obstructive lung diseases. This study refers to the “necessity-concerns framework” and examines the associations between beliefs about medicines and self-reported medication adherence in people with chronic obstructive lung disease. 402 patients (196 with asthma, 206 with COPD) participated in the study and completed a questionnaire comprising the “Beliefs about Medicines-Questionnaire” (BMQ) and the “Medication Adh...

  6. A risk stratification model for antihypertensive medication non-adherence among Chinese immigrants

    Directory of Open Access Journals (Sweden)

    Wen-Wen Li

    2016-12-01

    Full Text Available The purpose of this study was to establish a risk stratification model for identifying Chinese immigrants at risk for non-adherence to antihypertensive medications. Questionnaires were self-administered to 200 Chinese immigrants in San Francisco, USA. Questionnaires included demographics, culture factors (e.g., Perceived Susceptibility in General, Perceived Benefits of Western Medication, Perceived Benefits of Chinese Herbs, and Health-Related Social Support, and medications adherence. Participants' mean age was 70.6 (±10.3 years. Three stratification factors were identified for non-adherence: Lower Perceived Susceptibility in General, lower Perceived Benefit of Western Medications, and longer Length of Stay in the United States. The probability of non-adherence was 77%, 62%, and 57% for lower perceived susceptibility, longer stay in the United States, and lower perceived benefits of Western medications, respectively. A combination of lower perceived susceptibility and lower perceived benefits of medication predicted 81% non-adherence and lower perceived susceptibility with longer stay in the United States predicted at 84%. All three factors combined predicted nearly 90%. Patients with all three factors had the highest risk for non-adherence. The second priority groups are patients with lower perceived susceptibility and those with lower perceived susceptibility combined with any of the other two factors. In the clinical setting, these three groups are a high priority for education on the importance of medication adherence.

  7. A quantitative systematic review of the efficacy of mobile phone interventions to improve medication adherence.

    Science.gov (United States)

    Park, Linda G; Howie-Esquivel, Jill; Dracup, Kathleen

    2014-09-01

    To evaluate the characteristics and efficacy of mobile phone interventions to improve medication adherence. Secondary aims are to explore participants' acceptability and satisfaction with mobile phone interventions and to evaluate the selected studies in terms of study rigour, impact, cost and resource feasibility, generalizability and implications for nursing practice and research. Medication non-adherence is a major global challenge. Mobile phones are the most commonly used form of technology worldwide and have the potential to promote medication adherence. Guidelines from the Centre for Reviews and Dissemination were followed for this systematic review. A comprehensive search of databases (PubMed, Web of Science, CINAHL, PsycInfo, Google Chrome and Cochrane) and bibliographies from related articles was performed from January 2002-January 2013 to identify the included studies. A quantitative systematic review without meta-analysis was conducted and the selected studies were critically evaluated to extract and summarize pertinent characteristics and outcomes. The literature search produced 29 quantitative research studies related to mobile phones and medication adherence. The studies were conducted for prevention purposes as well as management of acute and chronic illnesses. All of the studies used text messaging. Eighteen studies found significant improvement in medication adherence. While the majority of investigators found improvement in medication adherence, long-term studies characterized by rigorous research methodologies, appropriate statistical and economic analyses and the test of theory-based interventions are needed to determine the efficacy of mobile phones to influence medication adherence. © 2014 John Wiley & Sons Ltd.

  8. Medication adherence in patients with hypertension: Does satisfaction with doctor-patient relationship work?

    Science.gov (United States)

    Mahmoudian, Ahmad; Zamani, Ahmadreza; Tavakoli, Neda; Farajzadegan, Ziba; Fathollahi-Dehkordi, Fariba

    2017-01-01

    It is assumed that doctor-patient relationship plays an effective role in patients' satisfaction, medication adherence, and health outcomes since exploring different aspects of this relationship, such as addressing medication adherence, has rarely been investigated. Therefore, the main aim of the present study was to assess the impact of patients' satisfaction derived from communicating with doctors on medication adherence in hypertensive patients. This cross-sectional survey was conducted on three hundred patients with hypertension, using multistage sampling technique in health care centers in Isfahan, Iran. Data were collected by two questionnaires comprised (1) patients' satisfaction derived from the relationship with doctors and (2) medication adherence named "Morisky Medication Adherence Scale" with 8 items. Multivariate logistic regression model was applied to test the odds ratio (OR) of patients' satisfaction resulting from the relationship with physicians in numerous aspects in two groups: appropriate and inappropriate medication adherence. A lower level of satisfaction derived from building the relationship (confidence interval [CI] =0.95, 0.06-0.71 and OR = 0.20) and empathy subscales (CI = 0.95, 13-0.80 and OR = 0.33) was associated with nonadherence to treatment after controlling the physicians' gender and patients' age, gender, education, and duration of disease. Patients' satisfaction resulting from building the relationship and empathy with physicians appeared to be associated with medication adherence among hypertensive patients.

  9. Medication adherence in patients with hypertension: Does satisfaction with doctor-patient relationship work?

    Directory of Open Access Journals (Sweden)

    Ahmad Mahmoudian

    2017-01-01

    Full Text Available Background: It is assumed that doctor-patient relationship plays an effective role in patients' satisfaction, medication adherence, and health outcomes since exploring different aspects of this relationship, such as addressing medication adherence, has rarely been investigated. Therefore, the main aim of the present study was to assess the impact of patients' satisfaction derived from communicating with doctors on medication adherence in hypertensive patients. Materials and Methods: This cross-sectional survey was conducted on three hundred patients with hypertension, using multistage sampling technique in health care centers in Isfahan, Iran. Data were collected by two questionnaires comprised (1 patients' satisfaction derived from the relationship with doctors and (2 medication adherence named “Morisky Medication Adherence Scale” with 8 items. Multivariate logistic regression model was applied to test the odds ratio (OR of patients' satisfaction resulting from the relationship with physicians in numerous aspects in two groups: appropriate and inappropriate medication adherence. Results: A lower level of satisfaction derived from building the relationship (confidence interval [CI] =0.95, 0.06–0.71 and OR = 0.20 and empathy subscales (CI = 0.95, 13–0.80 and OR = 0.33 was associated with nonadherence to treatment after controlling the physicians' gender and patients' age, gender, education, and duration of disease. Conclusion: Patients' satisfaction resulting from building the relationship and empathy with physicians appeared to be associated with medication adherence among hypertensive patients.

  10. Standardizing terminology and definitions of medication adherence and persistence in research employing electronic databases.

    Science.gov (United States)

    Raebel, Marsha A; Schmittdiel, Julie; Karter, Andrew J; Konieczny, Jennifer L; Steiner, John F

    2013-08-01

    To propose a unifying set of definitions for prescription adherence research utilizing electronic health record prescribing databases, prescription dispensing databases, and pharmacy claims databases and to provide a conceptual framework to operationalize these definitions consistently across studies. We reviewed recent literature to identify definitions in electronic database studies of prescription-filling patterns for chronic oral medications. We then develop a conceptual model and propose standardized terminology and definitions to describe prescription-filling behavior from electronic databases. The conceptual model we propose defines 2 separate constructs: medication adherence and persistence. We define primary and secondary adherence as distinct subtypes of adherence. Metrics for estimating secondary adherence are discussed and critiqued, including a newer metric (New Prescription Medication Gap measure) that enables estimation of both primary and secondary adherence. Terminology currently used in prescription adherence research employing electronic databases lacks consistency. We propose a clear, consistent, broadly applicable conceptual model and terminology for such studies. The model and definitions facilitate research utilizing electronic medication prescribing, dispensing, and/or claims databases and encompasses the entire continuum of prescription-filling behavior. Employing conceptually clear and consistent terminology to define medication adherence and persistence will facilitate future comparative effectiveness research and meta-analytic studies that utilize electronic prescription and dispensing records.

  11. A renewed Medication Adherence Alliance call to action: harnessing momentum to address medication nonadherence in the United States.

    Science.gov (United States)

    Zullig, Leah L; Granger, Bradi B; Bosworth, Hayden B

    2016-01-01

    Nonadherence to prescription medications is a common and costly problem with multiple contributing factors, spanning the dimensions of individual behavior change, psychology, medicine, and health policy, among others. Addressing the problem of medication nonadherence requires strategic input from key experts in a number of fields. The Medication Adherence Alliance is a group of key experts, predominately from the US, in the field of medication nonadherence. Members include representatives from consumer advocacy groups, community health providers, nonprofit groups, the academic community, decision-making government officials, and industry. In 2015, the Medication Adherence Alliance convened to review the current landscape of medication adherence. The group then established three working groups that will develop recommendations for shifting toward solutions-oriented science. From the perspective of the Medication Adherence Alliance, the objective of this commentary is to describe changes in the US landscape of medication adherence, framing the evolving field in the context of a recent think tank meeting of experts in the field of medication adherence.

  12. Risk factors for antipsychotic medication non-adherence behaviors and attitudes in adult-onset psychosis.

    Science.gov (United States)

    Hui, Christy Lai Ming; Poon, Venessa Wing Yan; Ko, Wai Tung; Miao, Ho Yee; Chang, Wing Chung; Lee, Edwin Ho Ming; Chan, Sherry Kit Wa; Lin, Jingxia; Chen, Eric Yu Hai

    2016-07-01

    Research on antipsychotic medication non-adherence in first-episode psychosis patients tends to examine non-adherence behaviors and attitudes together. Nonetheless, attitudes do not always directly translate into behaviors. We examined the baseline predictors for antipsychotics non-adherence behaviors and attitudes separately in a first-episode psychosis cohort. We also included cognitive impairments as one of the predictor variables as this domain is rarely explored in adherence studies. Participants were 313 adult-onset psychosis patients recruited from the Jockey Club Early Psychosis project in Hong Kong. Demographic, premorbid, clinical, and cognitive characteristics were first assessed at baseline. Six months later, participants completed a 14-item Medication Compliance Questionnaire, which was a modified and Cantonese-translated version of the Medication Adherence Rating Scale that includes items pertaining to both adherence behaviors and attitudes. Rates of poor adherence behaviors and negative adherence attitudes were 17.6% and 27.8%, respectively. Determinants of poor adherence behavior included more severe positive symptoms, hospitalization at onset of illness, and poorer engagement in extended social network. As for negative adherence attitude, determinants included more severe general psychopathology, poorer insight, more psychic medication side-effects, and poorer performance on backward digit span test and WAIS-R information test. The risk factors for non-adherence behaviors and attitudes are different and they should all be taken into careful consideration while formulating appropriate intervention programs to tackle the adherence problem in adult onset psychosis. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. An observational study of health literacy and medication adherence in adult kidney transplant recipients.

    Science.gov (United States)

    Demian, Maryam N; Shapiro, R Jean; Thornton, Wendy Loken

    2016-12-01

    There is a high prevalence of non-adherence to immunosuppressants in kidney transplant recipients. Although limited health literacy is common in kidney recipients and is linked to adverse outcomes in other medical populations, its effect on medication adherence in kidney transplant recipients remains poorly understood. The objective was to investigate the effect of lower health literacy on immunosuppressant adherence. Kidney recipients who were at least 6 months post-transplant and outpatients of Vancouver General Hospital in B.C., Canada were recruited through invitation letters. A total of 96 recipients completed the Health Literacy Questionnaire, which provides a multifactorial profile of self-reported health literacy and the Transplant Effects Questionnaire-Adherence subscale measuring self-reported immunosuppressant adherence. Hierarchical linear regression was used to analyze the association between health literacy and adherence after controlling for identified risk factors of non-adherence. Our sample was on average 53 years old, 56% male and 9 years post-transplant. Kidney recipients reported low levels of health literacy on scales measuring active health management and critical appraisal of information and 75% reported non-perfect adherence. Worse adherence was associated with poorer overall health literacy (Δ R 2 = 0.08, P = 0.004) and lower scores on six of nine of the health literacy factors. Poorer health literacy is associated with lower immunosuppressant adherence in adult kidney transplant recipients suggesting the importance of considering a recipient's level of health literacy in research and clinical contexts. Medication adherence interventions can target the six factors of health literacy identified as being risk factors for lower medication adherence.

  14. The mediatory role of medication adherence in improving patients’ medication experience through patient–physician communication among older hypertensive patients

    Directory of Open Access Journals (Sweden)

    Lee W

    2017-07-01

    Full Text Available Woojung Lee, Youran Noh, Hyeonjin Kang, Song Hee Hong Research Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, Korea Background: Understanding how patient–physician communication affects patients’ medication experience would help hypertensive patients maintain their regular long-term medication therapy. This study aimed to examine whether patient–physician communication (information and interpersonal treatment affects patients’ medication experience directly or indirectly through changing medication adherence for each of the two communication domains.Methods: A self-administered cross-sectional survey was conducted for older patients who had visited a community senior center as a member. Two communication domains were assessed using two subscales of the Primary Care Assessment Survey. Medication adherence and experience were measured using the Morisky Medication Adherence Scale and a five-point Likert scale, respectively. Mediatory effects were assessed via Baron and Kenny’s procedure and a Sobel test. Results: Patient–physician communication had a positive prediction on patients’ medication experience (β=0.25, P=0.03, and this was fully mediated by medication adherence (z=3.62, P<0.001. Of the two components of patient–physician communication, only informative communication showed a mediatory effect (z=2.21, P=0.03. Conclusion: Patient–physician communication, specifically informative communication, had the potential to improve patients’ medication experience via changes in medication adherence. This finding can inform health care stakeholders of the mediatory role of medication adherence in ensuring favorable medication experience for older hypertensive patients by fostering informative patient–physician communication. Keywords: patient medication experience, medication adherence, patient–physician communication, patient-centered practice, patient-reported outcome, mediation

  15. Financial incentives to improve adherence to antipsychotic maintenance medication in non-adherent patients: a cluster randomised controlled trial.

    Science.gov (United States)

    Priebe, Stefan; Bremner, Stephen A; Lauber, Christoph; Henderson, Catherine; Burns, Tom

    2016-09-01

    Poor adherence to long-term antipsychotic injectable (LAI) medication in patients with psychotic disorders is associated with a range of negative outcomes. No psychosocial intervention has been found to be consistently effective in improving adherence. To test whether or not offering financial incentives is effective and cost-effective in improving adherence and to explore patient and clinician experiences with such incentives. A cluster randomised controlled trial with economic and nested qualitative evaluation. The intervention period lasted for 12 months with 24 months' follow-up. The unit of randomisation was mental health teams in the community. Community teams in secondary mental health care. Patients with a diagnosis of schizophrenia, schizoaffective psychosis or bipolar illness, receiving ≤ 75% of their prescribed LAI medication. In total, 73 teams with 141 patients (intervention n = 78 and control n = 63) were included. Participants in the intervention group received £15 for each LAI medication. Patients in the control group received treatment as usual. adherence to LAI medication (the percentage of received out of those prescribed). percentage of patients with at least 95% adherence; clinical global improvement; subjective quality of life; satisfaction with medication; hospitalisation; adverse events; and costs. Qualitative evaluation: semistructured interviews with patients in the intervention group and their clinicians. outcome data were available for 131 patients. Baseline adherence was 69% in the intervention group and 67% in the control group. During the intervention period, adherence was significantly higher in the intervention group than in the control group (85% vs. 71%) [adjusted mean difference 11.5%, 95% confidence interval (CI) 3.9% to 19.0%; p = 0.003]. Secondary outcome: patients in the intervention group showed statistically significant improvement in adherence of at least 95% (adjusted odds ratio 8.21, 95% CI 2.00 to 33

  16. Medication adherence in type 2 diabetes patients: study of patients ...

    African Journals Online (AJOL)

    diabetes mellitus over the years, diabetes places an immense burden on the individuals living ... Key words: Diabetes type 2, adherence, glycemic level, health education and counselling. ... modifying dietary choices, implementing exercise re-.

  17. medication non-adherence among adult psychiatric out patients in

    African Journals Online (AJOL)

    GB

    2013-11-03

    Nov 3, 2013 ... KEYWORDS: mental illness, non-adherence, Jimma University Specialized Hospital, Ethiopia .... first time, individuals who were so seriously ill that they could not respond to the ..... don't work when they are not taken. Aus. J.

  18. Acceptance-based behavior therapy to promote HIV medication adherence.

    Science.gov (United States)

    Moitra, Ethan; Herbert, James D; Forman, Evan M

    2011-12-01

    A significant number of adults with HIV in the USA do not maintain adherence to highly active antiretroviral therapy (HAART) at adequate levels. Although traditional cognitive behavioral interventions have shown promise in promoting HAART adherence, acceptance-based behavior therapy (ABBT) may be particularly useful in this population. ABBT has the potential to overcome common avoidance-based barriers associated with poor adherence, including denial of various illness-related factors and avoidance of stigmatization. We describe the rationale for promoting psychological and behavioral acceptance in HIV-positive populations; outline an ABBT to promote HAART adherence targeting primary care patients from urban, minority, low socioeconomic backgrounds; and report preliminary qualitative observations of treatment feasibility and acceptability.

  19. Medication adherence and direct treatment cost among diabetes ...

    African Journals Online (AJOL)

    Department of Pharmacology, Ekiti State University, Ado-Ekiti,. Nigeria. 2. ... According to the International. Diabetic ... 53% non-adherence among diabetics in Malaysia; similar .... Necessary adjustments were made in the contents and.

  20. Type D personality, self-efficacy, and medication adherence in patients with heart failure-A mediation analysis.

    Science.gov (United States)

    Wu, Jia-Rong; Song, Eun Kyeung; Moser, Debra K

    2015-01-01

    Type D personality is associated with medication non-adherence. Both Type D personality and non-adherence are predictors of poor outcomes. Self-efficacy, which is modifiable, is also associated with medication adherence. To determine the relationships among Type D personality, self-efficacy, and medication adherence in 84 heart failure patients. Self-efficacy, Type D personality, medication adherence, demographic and clinical data were collected. Hierarchical linear regression was used. Type D patients were more likely to have lower self-efficacy (p = .023) and medication non-adherence (p = .027) than non-Type D patients. Low self-efficacy was associated with medication non-adherence (p mediation. Self-efficacy mediates the relationship between Type D personality and medication adherence. Developing and applying interventions to enhance self-efficacy may help to sever the link between Type D personality and poor outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Mobile technology for medication adherence in people with mood disorders: A systematic review.

    Science.gov (United States)

    Rootes-Murdy, Kelly; Glazer, Kara L; Van Wert, Michael J; Mondimore, Francis M; Zandi, Peter P

    2018-02-01

    Medication non-adherence is a critical challenge for many patients diagnosed with mood disorders (Goodwin and Jamison, 1990). There is a need for alternative strategies that improve adherence among patients with mood disorders that are cost-effective, able to reach large patient populations, easy to implement, and that allow for communication with patients outside of in-person visits. Technology-based approaches to promote medication adherence are increasingly being explored to address this need. The aim of this paper is to provide a systematic review of the use of mobile technologies to improve medication adherence in patients with mood disorders. A total of nine articles were identified as describing mobile technology targeting medication adherence in mood disorder populations. Results showed overall satisfaction and feasibility of mobile technology, and reduction in mood symptoms; however, few examined effectiveness of mobile technology improving medication adherence through randomized control trials. Given the limited number of studies, further research is needed to determine long term effectiveness. Mobile technologies has the potential to improve medication adherence and can be further utilized for symptom tracking, side effects tracking, direct links to prescription refills, and provide patients with greater ownership over their treatment progress. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Discrepancies in mother and child perceptions of spina bifida medical responsibilities during the transition to adolescence: associations with family conflict and medical adherence.

    Science.gov (United States)

    Psihogios, Alexandra M; Holmbeck, Grayson N

    2013-09-01

    This study investigated mother-child discrepancies over perceptions of who is responsible for spina bifida (SB) medical tasks in relation to family conflict and medical adherence. 140 youth with SB and their mothers completed questionnaires regarding who is responsible for specific SB medical tasks, family conflict, and medical adherence. An observational measure was also used to assess family conflict. Although children viewed themselves as more responsible for medical management than mothers did, mother-child discrepancies were not associated with family conflict or medical adherence. Interaction effects revealed that adherence was better when family conflict was low and when parents were responsible for medical tasks. Parental involvement in SB medical care is essential for optimal medical adherence during adolescence. The presence of family conflict also plays an influential role on SB medical adherence. Future research should evaluate the relations between discrepancies, family conflict, and medical adherence across time.

  3. Post-traumatic stress disorder and medication adherence: results from the Mind Your Heart study.

    Science.gov (United States)

    Kronish, Ian M; Edmondson, Donald; Li, Yongmei; Cohen, Beth E

    2012-12-01

    Patients with post-traumatic stress disorder (PTSD) are at increased risk for adverse outcomes from comorbid medical conditions. Medication non-adherence is a potential mechanism explaining this increased risk. We examined the association between PTSD and medication adherence in a cross-sectional study of 724 patients recruited from two Department of Veterans Affairs Medical Centers between 2008 and 2010. PTSD was assessed using the Clinician Administered PTSD Scale. Medication adherence was assessed using a standardized questionnaire. Ordinal logistic regression models were used to calculate the odds ratios (ORs) for medication non-adherence in patients with versus without PTSD, adjusting for potential confounders. A total of 252 patients (35%) had PTSD. Twelve percent of patients with PTSD reported not taking their medications as prescribed compared to 9% of patients without PTSD (unadjusted OR 1.85, 95% CI 1.37-2.50, Pversus 13%; unadjusted OR 2.01, 95% CI 1.44-2.82, P<0.001). The association between PTSD and non-adherence remained significant after adjusting for demographics, depression, alcohol use, social support, and medical comorbidities (adjusted OR 1.47, 95% CI 1.03-2.10, P=0.04 for not taking medications as prescribed and 1.95, 95% CI 1.31-2.91, P=0.001 for skipping medications). PTSD was associated with medication non-adherence independent of psychiatric and medical comorbidities. Medication non-adherence may contribute to the increased morbidity and mortality observed in patients with PTSD. Copyright © 2012 Elsevier Ltd. All rights reserved.

  4. Determinants of medication adherence in older people with dementia from the caregivers' perspective.

    Science.gov (United States)

    El-Saifi, Najwan; Moyle, Wendy; Jones, Cindy; Alston-Knox, Clair

    2018-05-11

    ABSTRACTBackground:Adherence to treatment is a primary determinant of treatment success. Caregiver support can influence medication adherence in people with cognitive impairment. This study sought to characterize medication adherence in older people with dementia from the caregivers' perspective, and to identify influencing factors. Caregivers caring for a person with dementia and living in the community were eligible to complete the survey. Bayesian profile regression was applied to identify determinants of medication adherence measured using the Adherence to Refills and Medication Scale. Out of the 320 caregivers who participated in the survey, Bayesian profile regression on 221 participants identified two groups: Profile 1 (55 caregivers) with a mean adherence rate of 0.69 (80% Credible Interval (CrI): 0.61-0.77), and Profile 2 (166 caregivers) with a mean adherence rate of 0.80 (80% CrI: 0.77-0.84). Caregivers in Profile 1 were characterized with below data average scores for the following: cognitive functioning, commitment or intention, self-efficacy, and health knowledge, which were all above the data average in Profile 2, except for health knowledge. Caregivers in Profile 1 had a greater proportion of care recipients taking more than five medications and with late-stage dementia. Trade, technical, or vocational training was more common among the caregivers in Profile 1. Profile 2 caregivers had a better patient-provider relationship and less medical problems. Bayesian profile regression was useful in understanding caregiver factors that influence medication adherence. Tailored interventions to the determinants of medication adherence can guide the development of evidence-based interventions.

  5. Interventions combining motivational interviewing and cognitive behaviour to promote medication adherence: a literature review.

    Science.gov (United States)

    Spoelstra, Sandra L; Schueller, Monica; Hilton, Melissa; Ridenour, Kimberly

    2015-05-01

    This article presents an integrative review of the evidence for combined motivational interviewing and cognitive behavioural interventions that promote medication adherence. We undertook this review to establish a scientific foundation for development of interventions to promote medication adherence and to guide clinical practice. The World Health Organization has designated medication adherence as a global problem. Motivational interviewing and cognitive behaviour interventions have been found to individually promote medication adherence. However, there is a gap in the literature on the effect of combined motivational interviewing and cognitive behavioural approaches to promote medication adherence. Integrative review. COCHRANE, PubMed and CINAHL were searched to access relevant studies between 2004-2014. Inclusion criteria were interventions combining motivational interviewing and cognitive behavioural therapy with medication adherence as the outcome. Articles were assessed for measures of adherence and methodological rigour. Analysis was performed using an integrative review process. Six articles met the inclusion criteria. A randomised controlled trial reported pretreatment missed doses of 5·58 and post-treatment of 0·92 and trended towards significance. Four cohort studies had effect sizes of 0·19-0·35 (p motivational interviewing and cognitive behavioural interventions, five out of six were effective at improving medication adherence. Future studies with large rigorous randomised trials are needed. This review provides clinicians with the state of the science in relation to combined motivational interviewing and cognitive behavioural therapy interventions that promote medication adherence. A summary of intervention components and talking points are provided to aid nurses in informing decision-making and translating evidence into practice. © 2014 John Wiley & Sons Ltd.

  6. The clinical and economic burden of poor adherence and persistence with osteoporosis medications in ireland.

    LENUS (Irish Health Repository)

    Hiligsmann, Mickaël

    2012-07-01

    Medication nonadherence is common for osteoporosis, but its consequences have not been well described. This study aimed to quantify the clinical and economic impacts of poor adherence and to evaluate the potential cost-effectiveness of improving patient adherence by using hypothetical behavioral interventions.

  7. Non-adherence to antipsychotic medication, relapse and rehospitalisation in recent-onset schizophrenia

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    Widen Jan H

    2008-04-01

    Full Text Available Abstract Background The aims of this study were to describe outcome with respect to persistent psychotic symptoms, relapse of positive symptoms, hospital admissions, and application of treatment by coercion among patients with recent onset schizophrenia being adherent and non-adherent to anti-psychotic medication. Materials and methods The study included 50 patients with recent onset schizophrenia, schizoaffective or schizophreniform disorders. The patients were clinically stable at study entry and had less than 2 years duration of psychotic symptoms. Good adherence to antipsychotic medication was defined as less than one month without medication. Outcomes for poor and good adherence were compared over a 24-month follow-up period. Results The Odds Ratio (OR of having a psychotic relapse was 10.27 and the OR of being admitted to hospital was 4.00 among non-adherent patients. Use of depot-antipsychotics were associated with relapses (OR = 6.44. Conclusion Non-adherence was associated with relapse, hospital admission and having persistent psychotic symptoms. Interventions to increase adherence are needed. Trial registration Current Controlled Trials NCT00184509. Key words: Adherence, schizophrenia, antipsychotic medication, admittances, relapse.

  8. Medication adherence among Nigerians with schizophrenia: correlation between clinico-demographic factors and quality of life

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    Oluseun P. Ogunnubi

    2017-03-01

    Full Text Available Medication adherence contributes significantly to symptom remission, recovery and wellbeing in mental illnesses. We evaluated how medication adherence correlates with clinico-demographic factors and quality of life (QoL in a sample of Nigerians with schizophrenia. This descriptive crosssectional study involved 160 randomly selected participants with confirmed diagnosis of schizophrenia based on MINI International Neuropsychiatric Interview. Data on socio-demographic and clinical characteristics of participants were collected with a questionnaire. Medication adherence was assessed with Morisky Medication Adherence Questionnaire, and participants completed the World Health Organization Quality of Life Scale-BREF. The mean age of participants was 38.54 (±11.30 years, and all the participants were on antipsychotics, but only 45% were adherent to their medication. Out of all the participants, 45 (28.2% considered their overall QoL to be good, 97 (60.6% considered theirs to be fair, while 18 (11.2% reported poor QoL. Medication non-adherence correlated negatively with good QoL across multiple dimensions including overall QoL (r=- 0.175, health satisfaction (r=-0.161, physical (r=-0.186 and psychological domain (r=-0.175. Again, participant’s age (r=- 0.190 and age of onset of illness (r=-0.172 correlated negatively with medication nonadherence, and a trend towards relapse delay with medication adherence was also observed (r=-0.155. The effect size of these correlations were however small. Our findings suggest a link between medication adherence and QoL in schizophrenia, such that strategy that addresses medication nonadherence and its determinants may have potential benefits on wellbeing. Further hypotheses-driven studies are desirable.

  9. Association between patients' beliefs and oral antidiabetic medication adherence in a Chinese type 2 diabetic population

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    Wu P

    2016-06-01

    Full Text Available Ping Wu,1 Naifeng Liu2 1Department of Clinical Pharmacy, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, 2Institute of Cardiovascular Disease, Southeast University Medical School, Nanjing, People’s Republic of China Purpose: The objective of this study was to identify, using the theory of planned behavior (TPB, patients’ beliefs about taking oral antidiabetic drugs (OADs as prescribed, and to measure the correlations between beliefs and medication adherence.Patients and methods: We performed a cross-sectional study of type 2 diabetic patients using structured questionnaires in a Chinese tertiary hospital. A total of 130 patients were enrolled to be interviewed about TPB variables (behavioral, normative, and control beliefs relevant to medication adherence. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8. Spearman’s rank correlation was used to assess the association between TPB and MMAS-8. Logistic regression analysis was performed to examine the relationship between different variables and MMAS-8, with statistical significance determined at P<0.05.Results: From 130 eligible Chinese patients with an average age of 60.6 years and a male proportion of 50.8%, a nonsignificant relationship between behavioral, normative, and the most facilitating control beliefs and OAD adherence was found in our study. Having the OADs on hand (P=0.037 was the only facilitating control belief associated with adherence behavior. Being away from home or eating out (P=0.000, not accepting the disease (P=0.000, ignorance of life-long drug adherence (P=0.038, being busy (P=0.001, or poor memory (P=0.008 were control belief barriers found to be correlated with poor adherence. TPB is the only important determinant influencing OAD adherence among all the factors (P=0.011.Conclusion: The results indicate that the TPB model could be used to examine adherence to OADs. One

  10. Adherence to ARV medication in Romanian young adults: self-reported behaviour and psychological barriers

    NARCIS (Netherlands)

    Dima, A.L.; Schweitzer, A.M.; Diaconiţă, R.; Remor, E.; Wanless, R.S.

    2013-01-01

    Adherence to antiretroviral (ARV) treatment during adolescence and young adulthood is a significant clinical issue for the current management of the HIV/AIDS epidemic in Romania. Understanding patients' own perceptions of their adherence behaviours and related psychological barriers is instrumental

  11. The utility of an electronic adherence assessment device in type 2 diabetes mellitus: a pilot study of single medication

    Directory of Open Access Journals (Sweden)

    Nadir Kheir

    2010-07-01

    Full Text Available Nadir Kheir1, William Greer2, Adil Yousif3, Hajer Al-Geed1, Randa Al Okkah1, Mahmoud Zirie4, Amy Sandridge5, Manal Zaidan61College of Pharmacy, 2Sidra Medical and Research Centre, 3Department of Statistics, College of Arts and Sciences, Qatar University, 4Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; 5Private Research Consultant, 6Al Amal Cancer Centre, Hamad Medical Corporation, Doha, QatarObjectives: The primary objective of this pilot study was to determine if the Medication Event Monitoring System (MEMS is capable of providing meaningful estimates of compliance within the indigenous Qatari population. The secondary objective was to highlight any specific problems which might be associated with the use of MEMS within this population.Method: A sample of adult diabetic Qatari patients attending an outpatient diabetic clinic were administered a Knowledge, Attitude, and Practices (KAP questionnaire and then dispensed one of their regular medications in a MEMS®-fitted bottle. Data contained in the MEMS® were downloaded after the patients returned for a refill and adherence was estimated using 2 methods: pill count and MEMS® data.Results: A total of 54 patients agreed to participate in this pilot study. Adherence to daily doses was 67.7% and with regimen 13.7%. No correlation was found between adherence assessed by pill count and MEMS®. The association between KAP and adherence was generally poor. A number of other issues and challenges in the use of MEMS® that could affect its utility were noted and will be discussed.Conclusions: Our results revealed problems associated with the use of MEMS® that could affect its usefulness in assessing adherence in this part of the world. Some issues identified in this pilot study included retrieving the MEMS®, registering extra opening of MEMS®, desire to hoard medicine by taking doses at different frequency than recorded in MEMS®. All these issues could be closely associated with the

  12. Empirical validation of the information-motivation-behavioral skills model of diabetes medication adherence: a framework for intervention.

    Science.gov (United States)

    Mayberry, Lindsay S; Osborn, Chandra Y

    2014-01-01

    Suboptimal adherence to diabetes medications is prevalent and associated with unfavorable health outcomes, but it remains unclear what intervention content is necessary to effectively promote medication adherence in diabetes. In other disease contexts, the Information-Motivation-Behavioral skills (IMB) model has effectively explained and promoted medication adherence and thus may have utility in explaining and promoting adherence to diabetes medications. We tested the IMB model's hypotheses in a sample of adults with type 2 diabetes. Participants (N = 314) completed an interviewer-administered survey and A1C test. Structural equation models tested the effects of diabetes medication adherence-related information, motivation, and behavioral skills on medication adherence and the effect of medication adherence on A1C. The IMB elements explained 41% of the variance in adherence, and adherence explained 9% of the variance in A1C. As predicted, behavioral skills had a direct effect on adherence (β = 0.59; P information (indirect effect 0.08 [0.01-0.15]) and motivation (indirect effect 0.12 [0.05-0.20]) on adherence. Medication adherence significantly predicted glycemic control (β = -0.30; P information, motivation, and behavioral skills and assessing the degree to which change in these determinants leads to changes in medication adherence behavior.

  13. Empirical Validation of the Information–Motivation–Behavioral Skills Model of Diabetes Medication Adherence: A Framework for Intervention

    Science.gov (United States)

    Mayberry, Lindsay S.; Osborn, Chandra Y.

    2014-01-01

    OBJECTIVE Suboptimal adherence to diabetes medications is prevalent and associated with unfavorable health outcomes, but it remains unclear what intervention content is necessary to effectively promote medication adherence in diabetes. In other disease contexts, the Information–Motivation–Behavioral skills (IMB) model has effectively explained and promoted medication adherence and thus may have utility in explaining and promoting adherence to diabetes medications. We tested the IMB model’s hypotheses in a sample of adults with type 2 diabetes. RESEARCH DESIGN AND METHODS Participants (N = 314) completed an interviewer-administered survey and A1C test. Structural equation models tested the effects of diabetes medication adherence-related information, motivation, and behavioral skills on medication adherence and the effect of medication adherence on A1C. RESULTS The IMB elements explained 41% of the variance in adherence, and adherence explained 9% of the variance in A1C. As predicted, behavioral skills had a direct effect on adherence (β = 0.59; P motivation (indirect effect 0.12 [0.05–0.20]) on adherence. Medication adherence significantly predicted glycemic control (β = −0.30; P motivation, and behavioral skills and assessing the degree to which change in these determinants leads to changes in medication adherence behavior. PMID:24598245

  14. Renal Transplant Recipients: The Factors Related to Immunosuppressive Medication Adherence Based on the Health Belief Model.

    Science.gov (United States)

    Kung, Pen-Chen; Yeh, Mei Chang; Lai, Ming-Kuen; Liu, Hsueh-Erh

    2017-10-01

    Kidney transplant failures are caused primarily by lack of adherence to immunosuppressive medication regimens by patients after transplantation. A number of studies have indicated that health-related beliefs are an effective predictor of health-related behavior. The aim of this study is to understand the influence of the personal characteristics and health-related beliefs of patients on adherence to treatment with immunosuppressive medication based on the Health Belief Model. This cross-sectional study distributed questionnaires to patients who had been recruited via purposive sampling at one medical center in Taipei. All of the potential participants had undergone kidney transplantation at least 6 months previously. The self-developed questionnaire collected data in three areas: personal characteristics, health-related beliefs regarding transplant rejection, and adherence to the immunosuppressive medication regimen. One hundred twenty-two valid questionnaires were received. The collected data were analyzed using descriptive statistics, independent t test, one-way analysis of variance, Pearson's correlation, and multiple regression. Participants who had received dialysis treatment or had experienced rejection perceived susceptibility to rejection more strongly than those who had not. Participants who had undergone transplantation in Taiwan, had experienced more drug-related symptoms, or had contracted severe to extremely severe infections in the past showed lower rates of adherence to treatment with immunosuppressive medication. Adherence to medication regimens correlated negatively with length of time since transplantation. Length of time since transplantation, drug-related symptoms, perceived susceptibility to rejection, and perceived benefits of treatment were identified as major predictors of adherence to immunosuppressive medication regimens. The results partially conformed to the concepts of the Health Belief Model. Perceived susceptibility to rejection and

  15. Assessment of patient knowledge of diabetic goals, self-reported medication adherence, and goal attainment

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    Whitley HP

    2006-12-01

    Full Text Available Background: Medication adherence is an integral aspect of disease state management for patients with chronic illnesses, including diabetes mellitus. It has been hypothesized that patients with diabetes who have poor medication adherence may have less knowledge of overall therapeutic goals and may be less likely to attain these goals. Objective: The purpose of this study was to assess self-reported medication adherence, knowledge of therapeutic goals (hemoglobin A1C [A1C], low density lipoprotein cholesterol [LDL-C] and blood pressure [BP], and goal attainment in adult patients with diabetes. Methods: A survey was created to assess medication adherence, knowledge of therapeutic goals, and goal attainment for adult patients with diabetes followed at an internal medicine or a family medicine clinic. Surveys were self-administered prior to office visits. Additional data were collected from the electronic medical record. Statistical analysis was performed. Results: A total of 149 patients were enrolled. Knowledge of therapeutic goals was reported by 14%, 34%, and 18% of survived patients for LDL-C, BP, and A1C, respectively. Forty-six percent, 37%, and 40% of patients achieved LDL-C, BP, and A1C goals, respectively. Low prescribing of cholesterol-lowering medications was an interesting secondary finding; 36% of patients not at LDL-C goal had not been prescribed a medication targeted to lower cholesterol. Forty-eight percent of patients were medication non-adherent; most frequently reported reasons for non-adherence were forgot (34% and too expensive (14%. Patients at A1C goal were more adherent than patients not at goal (p=0.025. Conclusion: The majority did not reach goals and were unknowledgeable of goals; however, most were provided prescriptions to treat these parameters. Goal parameters should be revisited often amongst multidisciplinary team members with frequent and open communications. Additionally, it is imperative that practitioners discuss

  16. Factors influencing adherence to psychopharmacological medications in psychiatric patients: a structural equation modeling approach.

    Science.gov (United States)

    De Las Cuevas, Carlos; de Leon, Jose; Peñate, Wenceslao; Betancort, Moisés

    2017-01-01

    To evaluate pathways through which sociodemographic, clinical, attitudinal, and perceived health control variables impact psychiatric patients' adherence to psychopharmacological medications. A sample of 966 consecutive psychiatric outpatients was studied. The variables were sociodemographic (age, gender, and education), clinical (diagnoses, drug treatment, and treatment duration), attitudinal (attitudes toward psychopharmacological medication and preferences regarding participation in decision-making), perception of control over health (health locus of control, self-efficacy, and psychological reactance), and level of adherence to psychopharmacological medications. Structural equation modeling was applied to examine the nonstraightforward relationships and the interactive effects among the analyzed variables. Structural equation modeling demonstrated that psychiatric patients' treatment adherence was associated: 1) negatively with cognitive psychological reactance (adherence decreased as cognitive psychological reactance increased), 2) positively with patients' trust in their psychiatrists (doctors' subscale), 3) negatively with patients' belief that they are in control of their mental health and that their mental health depends on their own actions (internal subscale), and 4) positively (although weakly) with age. Self-efficacy indirectly influenced treatment adherence through internal health locus of control. This study provides support for the hypothesis that perceived health control variables play a relevant role in psychiatric patients' adherence to psychopharmacological medications. The findings highlight the importance of considering prospective studies of patients' psychological reactance and health locus of control as they may be clinically relevant factors contributing to adherence to psychopharmacological medications.

  17. Improving medication adherence among community-dwelling seniors with cognitive impairment: a systematic review of interventions.

    Science.gov (United States)

    Kröger, Edeltraut; Tatar, Ovidiu; Vedel, Isabelle; Giguère, Anik M C; Voyer, Philippe; Guillaumie, Laurence; Grégoire, Jean-Pierre; Guénette, Line

    2017-08-01

    Background Medication non-adherence may lead to poor therapeutic outcomes. Cognitive functions deteriorate with age, contributing to decreased adherence. Interventions have been tested to improve adherence in seniors with cognitive impairment or Alzheimer disease (AD), but high-quality systematic reviews are lacking. It remains unclear which interventions are promising. Objectives We conducted a systematic review to identify, describe, and evaluate interventions aimed at improving medication adherence among seniors with any type of cognitive impairment. Methods Following NICE guidance, databases and websites were searched using combinations of controlled and free vocabulary. All adherence-enhancing interventions and study designs were considered. Studies had to include community dwelling seniors, aged 65 years or older, with cognitive impairment, receiving at least one medication for a chronic condition, and an adherence measure. Study characteristics and methodological quality were assessed. Results We identified 13 interventions, including six RCTs. Two studies were of poor, nine of low/medium and two of high quality. Seven studies had sample sizes below 50 and six interventions focused on adherence to AD medication. Six interventions tested a behavioral, four a medication oriented, two an educational and one a multi-faceted approach. Studies rarely assessed therapeutic outcomes. All but one intervention showed improved adherence. Conclusion Three medium quality studies showed better adherence with patches than with pills for AD treatment. Promising interventions used educational or reminding strategies, including one high quality RCT. Nine studies were of low/moderate quality. High quality RCTs using a theoretical framework for intervention selection are needed to identify strategies for improved adherence in these seniors.

  18. Stigma, disclosure, coping, and medication adherence among people living with HIV/AIDS in Northern Tanzania

    NARCIS (Netherlands)

    Lyimo, R.A.; Stutterheim, S.E.; Hospers, H.J.; de Glee, T.; van der Ven, A.; de Bruin, M.

    2014-01-01

    This study examines a proposed theoretical model examining the interrelationships between stigma, disclosure, coping, and medication adherence among 158 HIV-infected patients on antiretroviral therapy (ART) in northern Tanzania. Perceived and self-stigma, voluntary and involuntary disclosure,

  19. Methods for measuring, enhancing, and accounting for medication adherence in clinical trials.

    Science.gov (United States)

    Vrijens, B; Urquhart, J

    2014-06-01

    Adherence to rationally prescribed medications is essential for effective pharmacotherapy. However, widely variable adherence to protocol-specified dosing regimens is prevalent among participants in ambulatory drug trials, mostly manifested in the form of underdosing. Drug actions are inherently dose and time dependent, and as a result, variable underdosing diminishes the actions of trial medications by various degrees. The ensuing combination of increased variability and decreased magnitude of trial drug actions reduces statistical power to discern between-group differences in drug actions. Variable underdosing has many adverse consequences, some of which can be mitigated by the combination of reliable measurements of ambulatory patients' adherence to trial and nontrial medications, measurement-guided management of adherence, statistically and pharmacometrically sound analyses, and modifications in trial design. Although nonadherence is prevalent across all therapeutic areas in which the patients are responsible for treatment administration, the significance of the adverse consequences depends on the characteristics of both the disease and the medications.

  20. Concomitant medication polypharmacy, interactions and imperfect adherence are common in Australian adults on suppressive antiretroviral therapy

    NARCIS (Netherlands)

    Siefried, Krista J; Mao, Limin; Cysique, Lucette A; Rule, John; Giles, Michelle L; Smith, Don E; McMahon, James E.; Read, Tim R; Ooi, Catriona; Tee, Ban K; Bloch, Mark; de Wit, John; Carr, Andrew

    2018-01-01

    OBJECTIVES: We quantified concomitant medication polypharmacy, pharmacokinetic and pharmacodynamic interactions, adverse effects and adherence in Australian adults on effective antiretroviral therapy. DESIGN: Cross-sectional. METHODS: Patients recruited into a nationwide cohort and assessed for

  1. The Effectiveness of a Comprehensive Wellness Assessment on Medication Adherence in a Medicare Advantage Plan Diabetic Population.

    Science.gov (United States)

    Guerard, Barbara; Omachonu, Vincent; Perez, Blake; Sen, Bisakha

    2018-01-01

    The issue of medication nonadherence has generated significant interest because of its complexity from both cost and outcomes perspectives. Of the 3.2 billion prescriptions written annually in the United States, estimates indicate that half are not taken as prescribed, especially among patients with asymptomatic chronic conditions. The objective of this study was to assess whether a comprehensive wellness assessment (CWA) program helps improve medication adherence for oral diabetic medications, statins, and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACE/ARBs) in a Medicare Advantage (MA) plan diabetic population. The Centers for Medicare & Medicaid Services includes these medications among its triple-weighted measures.The researchers used a retrospective panel study employing administrative claims data and member month-level enrollment data for members who were newly diagnosed with diabetes since 2010, allowing for up to 5 years of follow-up. The treatment variable of interest was whether the enrollee had undergone a CWA in the 12 months prior to the study. Results for the full sample show that a CWA visit in the prior 12 months is significantly associated with increased adherence to statin medication (incidence rate ratio [IRR]: 1.022, t-test: 2.51) and oral diabetes medication (IRR: 1.032, t-test: 3.00), but it is not significantly associated with adherence to ACE/ARB medication (IRR: 1.009, t-test: 1.09). Results vary considerably in subsamples stratified by dual Medicare and Medicaid eligibility status, presence of certain chronic conditions, and age. CWAs are most beneficial when targeted toward dual-eligible members or members younger than 65. On the basis of these findings, improving medication adherence by targeting CWA visits to certain MA member subcategories may be more cost-effective than using CWAs for the full MA membership.

  2. Does cognitive impairment impact adherence? A systematic review and meta-analysis of the association between cognitive impairment and medication non-adherence in stroke.

    LENUS (Irish Health Repository)

    Rohde, Daniela

    2017-12-08

    While medication adherence is essential for the secondary prevention of stroke, it is often sub-optimal, and can be compromised by cognitive impairment. This study aimed to systematically review and meta-analyse the association between cognitive impairment and medication non-adherence in stroke.

  3. Adherence to Cardiovascular Disease Medications: Does Patient-Provider Race/Ethnicity and Language Concordance Matter?

    OpenAIRE

    Traylor, Ana H.; Schmittdiel, Julie A.; Uratsu, Connie S.; Mangione, Carol M.; Subramanian, Usha

    2010-01-01

    BACKGROUND: Patient-physician race/ethnicity and language concordance may improve medication adherence and reduce disparities in cardiovascular disease (CVD) by fostering trust and improved patient-physician communication. OBJECTIVE: To examine the association of patient race/ethnicity and language and patient-physician race/ethnicity and language concordance on medication adherence rates for a large cohort of diabetes patients in an integrated delivery system. DESIGN: We studied 131,277 adul...

  4. Adherence to Follow-Up Recommendations by Triathlon Competitors Receiving Event Medical Care

    OpenAIRE

    Joslin, Jeremy D.; Lloyd, Jarem B.; Copeli, Nikoli; Cooney, Derek R.

    2017-01-01

    Introduction. We sought to investigate triathlete adherence to recommendations for follow-up for participants who received event medical care. Methods. Participants of the 2011 Ironman Syracuse 70.3 (Syracuse, NY) who sought evaluation and care at the designated finish line medical tent were contacted by telephone approximately 3 months after the initial encounter to measure adherence with the recommendation to seek follow-up care after event. Results. Out of 750 race participants, 35 (4.6%) ...

  5. Allopurinol Medication Adherence as a Mediator of Optimal Outcomes in Gout Management.

    Science.gov (United States)

    Coburn, Brian W; Bendlin, Kayli A; Sayles, Harlan; Meza, Jane; Russell, Cynthia L; Mikuls, Ted R

    2017-09-01

    Patient and provider factors, including allopurinol medication adherence, affect gout treatment outcomes. The aim of this study was to examine associations of patient and provider factors with optimal gout management. Linking longitudinal health and pharmacy dispensing records to questionnaire data, we assessed patient and provider factors among 612 patients with gout receiving allopurinol during a recent 1-year period. Associations of patient (medication adherence and patient activation) and provider factors (dose escalation, low-dose initiation, and anti-inflammatory prophylaxis) with serum urate (SU) goal achievement of less than 6.0 mg/dL were examined using multivariable logistic regression. Medication adherence was assessed as a mediator of these factors with goal achievement. A majority of patients (63%) were adherent, whereas a minority received dose escalation (31%). Medication adherence was associated with initiation of daily allopurinol doses of 100 mg/d or less (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.20-2.76). In adjusted models, adherence (OR, 2.35; 95% CI, 1.50-3.68) and dose escalation (OR, 2.48; 95% CI, 2.48-4.25) were strongly associated with SU goal attainment. Low starting allopurinol dose was positively associated with SU goal attainment (OR, 1.11; 95% CI, 1.02-1.20) indirectly through early adherence, but also had a negative direct association with SU goal attainment (OR, 0.21; 95% CI, 0.12-0.37). Medication adherence and low starting dose combined with dose escalation represent promising targets for future gout quality improvement efforts. Low starting dose is associated with better SU goal attainment through increased medication adherence, but may be beneficial only in settings where appropriate dose escalation is implemented.

  6. Barriers to and determinants of medication adherence among hypertensive patients attended National Health Service Hospital, Sunderland

    Directory of Open Access Journals (Sweden)

    Muhammad Umair Khan

    2014-01-01

    Full Text Available Background: Hypertension is a silent killer, a time bomb in both the developed and developing nations of the world. It is one of the most significant risk factors for cardiovascular morbidity and mortality resulting from target-organ damage to blood vessels in the heart, brain, kidney and eyes. Adherence to long-term therapy for chronic illnesses like hypertension is an important tool to enhance the effectiveness of pharmacotherapy. Objective: The two objectives of this study were to evaluate the extent and reasons of non-adherence in patients attended National Health Service (NHS Hospital, Sunderland. Materials and Methods: The study was conducted for 4 months in the out-patient department of NHS Hospital. A total of 200 patients were selected randomly for this study. Morisky′s Medication Adherence Scale was used to assess the adherence rate and the reason of non-adherence. Data were entered and analyzed using Microsoft Excel 2010. Results: The overall adherence rate was found to be 79% (n = 158. Adherence rate in females were low was compared with their male counterparts (74.7% vs. 85.7%. The higher rate of adherence was found in age group of 30-40 years (82%, n = 64. The major intentional and non-intentional reason of non-adherence was side-effects and forgetfulness respectively. Conclusion: Overall, more than three-fourth of the hypertensive participants were found to be adherent to their treatment. On the basis of factors associated with non-adherence, it is analyzed that suitable therapy must be designed for patients individually to increase medication adherence and its effectiveness.

  7. Use of a computerized medication shared decision making tool in community mental health settings: impact on psychotropic medication adherence.

    Science.gov (United States)

    Stein, Bradley D; Kogan, Jane N; Mihalyo, Mark J; Schuster, James; Deegan, Patricia E; Sorbero, Mark J; Drake, Robert E

    2013-04-01

    Healthcare reform emphasizes patient-centered care and shared decision-making. This study examined the impact on psychotropic adherence of a decision support center and computerized tool designed to empower and activate consumers prior to an outpatient medication management visit. Administrative data were used to identify 1,122 Medicaid-enrolled adults receiving psychotropic medication from community mental health centers over a two-year period from community mental health centers. Multivariate linear regression models were used to examine if tool users had higher rates of 180-day medication adherence than non-users. Older clients, Caucasian clients, those without recent hospitalizations, and those who were Medicaid-eligible due to disability had higher rates of 180-day medication adherence. After controlling for sociodemographics, clinical characteristics, baseline adherence, and secular changes over time, using the computerized tool did not affect adherence to psychotropic medications. The computerized decision tool did not affect medication adherence among clients in outpatient mental health clinics. Additional research should clarify the impact of decision-making tools on other important outcomes such as engagement, patient-prescriber communication, quality of care, self-management, and long-term clinical and functional outcomes.

  8. Medication Adherence and its Related Factors in Patients with Type II Diabetes

    Directory of Open Access Journals (Sweden)

    Behzad Gholamaliei

    2016-03-01

    Full Text Available Background and Objectives: Low levels of medication adherence in patients with type 2 diabetes is one of the greatest challenges in the treatment and control of diabetes. This study was designed to determine medication adherence and its related factors in patients with type II diabetes. Materials and Methods: In this cross-sectional study, a total of 300patients with type 2diabetes records in the health centers of Tuyserkan city were randomly selected in 2015. Data collection instrument was a self-made questionnaire, which consisted of factors related to the medication adherence. Questionnaires were completed after confirmation of validity and reliability, by interviews. To analyze the data, descriptive and inferential statistics (T-test, AnOVA, Simple and multiple linear regression were applied, using SPSS software, version 19. Results: Overall, %26.3 of patients were male and %73.7 were female. Also, %65 of patients were illiterate, %24 had some degree of symptoms, and %59.4 had poor medication adherence. There was a significant relationship between age, education, patient care and treatment expenditure, health care team and health system, therapy-related factors and condition-related factors, beliefs about illness, efficacy, and concerns about drugs and medication adherence (P < 0.05. Conclusions: This study showed that medication adherence in patients with diabetes was not suitable and individual, economical and social factors were influential.Therefore, the role of these factors must be considered when designing intervention programs.

  9. The relationship between the theory of planned behavior and medication adherence in patients with epilepsy.

    Science.gov (United States)

    Lin, Chung-Ying; Updegraff, John A; Pakpour, Amir H

    2016-08-01

    The aim of this study was to apply the theory of planned behavior (TPB) with two other factors (action planning and coping planning) to the medication adherence of adults with epilepsy. We measured the elements of the theory of planned behavior (attitude, subjective norm, perceived behavioral control, and behavioral intention), action planning, and coping planning at baseline among adults with epilepsy (n=567, mean±SD age=38.37±6.71years, male=48.5%). Medication adherence was measured using the Medication Adherence Report Scale (MARS) and antiepileptic serum level at the 24-month follow-up. Structural equation modeling (SEM) examined three models relating TPB elements to medication adherence. Three SEM models all had satisfactory fit indices. Moreover, attitude, subjective norms, perceived behavioral control, and intention together explained more than 50% of the variance for medication adherence measured using MARS. The explained variance increased to 61.8% when coping planning and action planning were included in the model, with coping planning having greater association than action planning. In addition, MARS explained 3 to 5% of the objective serum level. The theory of planned behavior is useful in understanding medication adherence in adults with epilepsy, and future interventions may benefit by improving such beliefs as well as beliefs about coping planning. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Differences in medication adherence are associated with beliefs about medicines in asthma and COPD.

    Science.gov (United States)

    Brandstetter, Susanne; Finger, Tamara; Fischer, Wiebke; Brandl, Magdalena; Böhmer, Merle; Pfeifer, Michael; Apfelbacher, Christian

    2017-01-01

    Adherence to medication is crucial for achieving treatment control in chronic obstructive lung diseases. This study refers to the "necessity-concerns framework" and examines the associations between beliefs about medicines and self-reported medication adherence in people with chronic obstructive lung disease. 402 patients (196 with asthma, 206 with COPD) participated in the study and completed a questionnaire comprising the "Beliefs about Medicines-Questionnaire" (BMQ) and the "Medication Adherence Report Scale" (MARS). Multivariable logistic regression analyses with the BMQ-subscales as explanatory and the dichotomized MARS-score as dependent variable were computed for the asthma and the COPD sample, respectively, and adjusted for potentially confounding variables. 19% of asthma patients and 34% of COPD patients were completely adherent to their prescribed medication. While specific beliefs about the necessity of medicines were positively associated with medication adherence both in patients with asthma and with COPD, general beliefs about harm and overuse of medicines by doctors were negatively associated with medication adherence only among patients with asthma. The findings of this study suggest that patients' specific beliefs about the necessity of medicines represent an important modifiable target for improving patient-doctor consultations when prescribing medicines.

  11. The Danish version of the Medication Adherence Report Scale: preliminary validation in cancer pain patients

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Møldrup, Claus; Christrup, Lona Louring

    2009-01-01

    into Danish following the repeated back-translation procedure. Cancer patients for the study were recruited from specialized pain management facilities. Thirty-three patients responded to the DMARS-4, the Danish Barriers Questionnaire II, The Danish version of Patient Perceived Involvement in Care Scale......OBJECTIVE: To examine the psychometric properties of the Danish version of the Medication Adherence Report Scale (DMARS-4) adapted to measure adherence to analgesic regimen among cancer patients. METHODS: The validated English version of the Medication Adherence Report Scale was translated...

  12. Patient knowledge and pulmonary medication adherence in adult patients with cystic fibrosis

    Directory of Open Access Journals (Sweden)

    Lin AH

    2017-03-01

    Full Text Available Ann Hsu-An Lin,1 Jennifer G Kendrick,2,3 Pearce G Wilcox,4,5 Bradley S Quon4,51Faculty of Medicine, 2Faculty of Pharmaceutical Sciences, University of British Columbia, 3Department of Pharmacy, Children’s and Women’s Health Centre of British Columbia, 4Department of Medicine, Division of Respiratory Medicine, University of British Columbia, 5Centre for Heart Lung Innovation, St Paul’s Hospital, Vancouver, BC, CanadaBackground and objectives: Patient knowledge of lung function (ie, forced expiratory volume in 1 s [FEV1]% predicted and the intended benefits of their prescribed pulmonary medications might play an important role in medication adherence, but this relationship has not been examined previously in patients with cystic fibrosis (CF.Methods: All patients diagnosed with CF and without prior lung transplantation were invited to complete knowledge and self-reported medication adherence questionnaires during routine outpatient visits to the Adult CF Clinic, St Paul’s Hospital, Vancouver, Canada from June 2013 to August 2014.Results: A total of 142 out of 167 (85% consecutive adults attending CF clinic completed patient knowledge and medication adherence survey questionnaires. Sixty-four percent of the patients recalled their last FEV1% predicted value within 5%, and 70% knew the intended benefits of all their prescribed medications. Self-reported adherence rates were highest for inhaled antibiotics (81%, azithromycin (87%, and dornase alpha (76% and lowest for hypertonic saline (47%. Individuals who knew their FEV1% predicted value within 5% were more likely to self-report adherence to dornase alpha (84% vs 62%, P=0.06 and inhaled antibiotics (88% vs 64%, P=0.06 compared to those who did not, but these associations were not statistically significant. There were no significant associations observed between patient knowledge of intended medication benefits and self-reported medication adherence.Conclusion: Contrary to our hypothesis

  13. [Medication adherence of 65 patients in hemodialysis in Togo].

    Science.gov (United States)

    Sabi, K A; Noto-Kadou-Kaza, B; Amekoudi, Y E; Tsevi, M C; Sylla, F; Kossidze, K; Gnionsahe, D A

    2014-01-01

    The aim of this study was to assess adherence in people on hemodialysis and determine the factors of poor adherence. This cross-sectional study took place throughout the month of September, 2012, in the hemodialysis center of the Sylvanus Olympio University Hospital, the only such center in Togo. The study included 65 patients, with a mean age of 49.5 years (range: 22 to 77 years), more often men (sex ratio: 1.82) and married (74 %). More than half (58%) had completed secondary education, while 73% belonged to the least advantaged socioeconomic class; 61 (94%) had health insurance, and 57% had been on dialysis for 1 to 4 years. The compliance rate was 11%. The main factors associated with good adherence were marital status (p = 0.0339) and the patient's general health status (p = 0.001). Treatment fatigue (p = 0.0347), forgetfulness (p = 0.0001), dosage forms and drug characteristics (p = 0.0198) were all factors of noncompliance. Therapeutic non-compliance was proportional to the number of drugs prescribed (p = 0.4263). Adherence in hemodialysis patients in Togo is very poor.

  14. Medical Adherence in Diabetes Hypertension Comorbidity: A Reply ...

    African Journals Online (AJOL)

    2018-01-01

    Jan 1, 2018 ... supplied to the patients through the health facility while also considering the potential for acquiring refills through out of pocket purchases. Furthermore, adherence is a dynamic behaviour which is subject to variation over time due to interaction of diverse patient and health factors (like acute sickness in ...

  15. Subjective reasons for adherence to psychotropic medication and associated factors among older adults with schizophrenia.

    Science.gov (United States)

    Sapra, Mamta; Vahia, Ipsit V; Reyes, Pia N; Ramirez, Paul; Cohen, Carl I

    2008-12-01

    There are limited data examining subjective influences on medication adherence among older persons with schizophrenia. The subjective reasons for adherence to antipsychotic medication and associated clinical and psychosocial factors in this population are examined. The sample consisted of 198 community dwelling persons aged >or=55 who developed schizophrenia before age 45. Using the Rating of Medication Influences Scale (ROMI), a principal component factor analysis with varimax rotation yielded three subscales: Medication Affinity and Prevention, Influence of Others, and Impact of Authority. These subscales were dichotomized into high and low based on a median split. We also created an ordinal High Adherence measure based on the summed scores of each person's three dichotomized ROMI subscales. A modified Health Belief Model was used to examine the association between 18 predictor variables and the ROMI subscales and the adherence scale. The mean subscale rankings were Medication Affinity and Prevention > Impact of Authority > Influence of Others. In logistic regression, lower education, more side effects, higher depression scores, and more mental health services were associated with higher scores on Influence of Others subscale. More side effects and more entitlements were associated with higher scores on the Medication Affinity and Prevention subscale. The Impact of Authority subscale had no significant associations. More side effects and higher depression scores were associated with higher scores on High Adherence measure. We identified a three-dimensional model for explaining the subjective reasons for medication adherence in older persons with schizophrenia. Our findings suggest that cognitive approaches and use of authority figures may be useful for promoting adherence in older adults. Independent variables associated with these subscales may provide guidance for improving adherence in this population.

  16. Differences between patient and physician opinions on adherence to medication for hypertension and diabetes mellitus.

    Science.gov (United States)

    Liguori, Yuji; Murase, Katsuhito; Hamamura, Misako

    2016-09-01

    Non-adherence to prescribed medication presents a barrier to effective treatment. In order to find improved ways of tackling non-adherence, it is important to understand the perspective of both patients and physicians. A web-based survey study was performed to obtain the views and opinions of patients receiving medical treatment for hypertension or diabetes mellitus in Japan, and physicians treating such patients, on adherence to medication. Forty-four percent of both physicians and patients placed great importance on medication adherence, but 11% of patients considered it of low importance. Overall, 85% of patients reported taking their medication correctly. Patients missed a mean of 4.8 or 5.4 daily doses per 30 day prescription based on patient and physician estimates, respectively. Both patients (64%) and physicians (23%) considered the main reason patients forgot to take their medication was that they "inadvertently forgot". Only 1% of physicians said they do not specifically check for residual drugs, but 46% of patients said they do not report missed doses to their doctor. Measures taken by physicians to reduce residual drugs included use of single packs (64%) and reductions in administration frequency (55%); 63% adjusted prescriptions to take account of any remaining drugs. Only 4% of physicians were satisfied with the effectiveness of measures to reduce non-adherence, whereas 59% of patients felt they managed to successfully perform measures to avoid forgetting to take drugs. The study questionnaires were newly developed and did not incorporate validated instruments to assess adherence. Similar proportions of physicians and patients consider medication adherence to be important, but their opinions about measures used to improve adherence differ to some extent. Importantly, almost half of patients do not tell their doctor about missed doses.

  17. Psychosocial Variables Associated with Immunosuppressive Medication Non-Adherence after Renal Transplantation

    Directory of Open Access Journals (Sweden)

    Jennifer Felicia Scheel

    2018-02-01

    Full Text Available IntroductionNon-adherence to immunosuppressive medication is regarded as an important factor for graft rejection and loss after successful renal transplantation. Yet, results on prevalence and relationship with psychosocial parameters are heterogeneous. The main aim of this study was to investigate the association of immunosuppressive medication non-adherence and psychosocial factors.MethodsIn 330 adult renal transplant recipients (≥12 months posttransplantation, health-related quality of life, depression, anxiety, social support, and subjective medication experiences were assessed, and their associations with patient-reported non-adherence was evaluated.Results33.6% of the patients admitted to be partially non-adherent. Non-adherence was associated with younger age, poorer social support, lower mental, but higher physical health-related quality of life. There was no association with depression and anxiety. However, high proportions of clinically relevant depression and anxiety symptoms were apparent in both adherent and non-adherent patients.ConclusionIn the posttransplant follow-up, kidney recipients with lower perceived social support, lower mental and higher physical health-related quality of life, and younger age can be regarded as a risk group for immunosuppressive medication non-adherence. In follow-up contacts with kidney transplant patients, physicians may pay attention to these factors. Furthermore, psychosocial interventions to optimize immunosuppressive medication adherence can be designed on the basis of this information, especially including subjectively perceived physical health-related quality of life and fostering social support seems to be of importance.

  18. Medical tourism in Iran: Issues and challenges.

    Science.gov (United States)

    Jabbari, Alireza; Delgoshaei, Bahram; Mardani, Raja; Tabibi, Seid Jamaledin

    2012-01-01

    Medical tourism is rapidly becoming a worldwide, multibillion-dollar industry. Iran has a high potential for this industry. The purpose of this study was to examine the medical tourism cluster, using Diamond Analysis tool. This study is a descriptive, analytical and qualitative one. Thirty professionals and researchers in this field were interviewed and official documents belonging to the Health ministry as well as tourism organization and finally related literature were examined. The data was analyzed using content analysis method. Positive and negative parts of the medical tourism industry of Iran were determined according to diamond of advantage. The strategic issues were identified and a number of possible solutions for addressing them were recommended. More and effective public-private participations, aggressive marketing, improving infrastructures, and international accreditation of health care facilities and human resources development could improve medical tourism industry in the country.

  19. Medical tourism in Iran: Issues and challenges

    Science.gov (United States)

    Jabbari, Alireza; Delgoshaei, Bahram; Mardani, Raja; Tabibi, Seid Jamaledin

    2012-01-01

    Introduction: Medical tourism is rapidly becoming a worldwide, multibillion-dollar industry. Iran has a high potential for this industry. The purpose of this study was to examine the medical tourism cluster, using Diamond Analysis tool. Materials and Methods: This study is a descriptive, analytical and qualitative one. Thirty professionals and researchers in this field were interviewed and official documents belonging to the Health ministry as well as tourism organization and finally related literature were examined. The data was analyzed using content analysis method. Results: Positive and negative parts of the medical tourism industry of Iran were determined according to diamond of advantage. Conclusion: The strategic issues were identified and a number of possible solutions for addressing them were recommended. More and effective public-private participations, aggressive marketing, improving infrastructures, and international accreditation of health care facilities and human resources development could improve medical tourism industry in the country. PMID:23555142

  20. Adherence to anti-Parkinson drug therapy in the "REASON" sample of Italian patients with Parkinson's disease: the linguistic validation of the Italian version of the "Morisky Medical Adherence Scale-8 items".

    Science.gov (United States)

    Fabbrini, G; Abbruzzese, G; Barone, P; Antonini, A; Tinazzi, M; Castegnaro, G; Rizzoli, S; Morisky, D E; Lessi, P; Ceravolo, R

    2013-11-01

    Information about patients' adherence to therapy represents a primary issue in Parkinson's disease (PD) management. To perform the linguistic validation of the Italian version of the self-rated 8-Item Morisky Medical Adherence Scale (MMAS-8) and to describe in a sample of Italian patients affected by PD the adherence to anti-Parkinson drug therapy and the association between adherence and some socio-demographic and clinical features. MMAS-8 was translated into Italian language by two independent Italian mother-tongue translators. The consensus version was then back-translated by an English mother-tongue translator. This translation process was followed by a consensus meeting between the authors of translation and investigators and then by two comprehension tests. The translated version of the MMAS-8 scale was then administered at the baseline visit of the "REASON" study (Italian Study on the Therapy Management in Parkinson's disease: Motor, Non-Motor, Adherence and Quality Of Life Factors) in a large sample of PD patients. The final version of the MMAS-8 was easily understood. Mean ± SD MMAS-8 score was 6.1 ± 1.2. There were no differences in adherence to therapy in relationship to disease severity, gender, educational level or decision to change therapy. The Italian version of MMAS-8, the key tool of the REASON study to assess the adherence to therapy, has shown to be understandable to patients with PD. Patients enrolled in the REASON study showed medium therapy adherence.

  1. Motivational interviewing: a tool for increasing psychotropic medication adherence for youth.

    Science.gov (United States)

    Hamrin, Vanya; McGuinness, Teena M

    2013-06-01

    There are serious outcomes to nonadherence to psychotropic medications in children and adolescents, including poor school performance, prolonged duration of illness, increased psychopathology, poor interpersonal relationships, increased psychiatric episodes, and suicide attempts. Medication treatment has demonstrated improved psychiatric functioning and a 50% reduction in suicidal behavior. more than 50% of youth with mental health problems are nonadherent with psychiatric medications. A review of literature examining motivational interviewing (MI) for the problem of treatment adherence in children and adolescents is discussed. MI has great potential to improve psychiatric medication adherence in adolescents. An example of how to implement MI with youth is provided.

  2. Strategies to improve medication adherence in patients with schizophrenia: the role of support services

    Directory of Open Access Journals (Sweden)

    El-Mallakh P

    2015-04-01

    Full Text Available Peggy El-Mallakh, Jan FindlayCollege of Nursing, University of Kentucky, Lexington, KY, USAAbstract: The purpose of this review is to describe research over the past 10 years on the role of support services in promoting medication adherence in mental health consumers diagnosed with schizophrenia. A literature search was conducted using the terms “medication adherence,” “schizophrenia,” and “support services,” using Medline, PubMed, and CINAHL. Reference lists from published studies were also reviewed to identify additional research studies. Twenty-two articles focused on support-service intervention studies, and these were selected for review. Available support-service interventions include adherence therapy, electronic reminders via text messages and telephones, cognitive–behavioral and motivational strategies, and financial incentives. Support-service intervention strategies need to be tailored to the specific needs of mental health consumers with schizophrenia. More research is needed to investigate effective support services to enhance long-term adherence and adherence to medications for medical illnesses in this population.Keywords: schizophrenia, medication adherence, support services, therapy, interventions

  3. Cost of medication adherence and persistence in type 2 diabetes mellitus: a literature review

    Directory of Open Access Journals (Sweden)

    Kennedy-Martin T

    2017-06-01

    Full Text Available Tessa Kennedy-Martin,1 Kristina S Boye,2 Xiaomei Peng2 1Kennedy-Martin Health Outcomes Ltd, Brighton, UK; 2Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA Purpose: To explore published evidence on health care costs associated with adherence or persistence to antidiabetes medications in adults with type 2 diabetes mellitus (T2DM.Methods: Primary research studies published between January 2006 and December 2015 on compliance, adherence, or persistence and treatment in patients with T2DM that document a link with health care costs were identified through literature searches in bibliographic databases and 2015 abstract books for relevant DM congresses. Results were assessed for relevance by two reviewers. The review was part of a larger overview evaluating the impact of adherence and persistence on a range of clinical and economic outcomes; only findings from the cost element are reported herein.Results: A total of 4,662 de-duplicated abstracts were identified and 110 studies included in the wider review. Of these, 19 reported an association between adherence (n=13, persistence (n=5, or adherence and persistence (n=1, and health care costs. All studies were retrospective, with sample sizes ranging from 301 to 740,195. Medication possession ratio was the most commonly employed adherence measure (n=11. The majority of adherence studies (n=9 reported that medication adherence was associated with lower total health care costs. Pharmacy costs were often increased in adherent patients but this was offset by beneficial effects on other costs. Findings were more variable in persistence studies; three reported that higher pharmacy costs in persistent patients were not sufficiently offset by savings in other areas to result in a reduction in total health care costs.Conclusions: Few studies have evaluated the relationship between adherence, persistence, and health care costs in T2DM. However, it has been consistently shown that medication

  4. Medical records and issues in negligence

    Directory of Open Access Journals (Sweden)

    Joseph Thomas

    2009-01-01

    Full Text Available It is very important for the treating doctor to properly document the management of a patient under his care. Medical record keeping has evolved into a science of itself. This will be the only way for the doctor to prove that the treatment was carried out properly. Moreover, it will also be of immense help in the scientific evaluation and review of patient management issues. Medical records form an important part of the management of a patient. It is important for the doctors and medical establishments to properly maintain the records of patients for two important reasons. The first one is that it will help them in the scientific evaluation of their patient profile, helping in analyzing the treatment results, and to plan treatment protocols. It also helps in planning governmental strategies for future medical care. But of equal importance in the present setting is in the issue of alleged medical negligence. The legal system relies mainly on documentary evidence in a situation where medical negligence is alleged by the patient or the relatives. In an accusation of negligence, this is very often the most important evidence deciding on the sentencing or acquittal of the doctor. With the increasing use of medical insurance for treatment, the insurance companies also require proper record keeping to prove the patient′s demand for medical expenses. Improper record keeping can result in declining medical claims. It is disheartening to note that inspite of knowing the importance of proper record keeping it is still in a nascent stage in India. It is wise to remember that "Poor records mean poor defense, no records mean no defense". Medical records include a variety of documentation of patient′s history, clinical findings, diagnostic test results, preoperative care, operation notes, post operative care, and daily notes of a patient′s progress and medications. A properly obtained consent will go a long way in proving that the procedures were

  5. Perceived need to take medication is associated with medication non-adherence in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Zwikker HE

    2014-11-01

    Full Text Available Hanneke E Zwikker,1,2 Sandra van Dulmen,3–5 Alfons A den Broeder,1,2 Bart J van den Bemt,1,2,6 Cornelia H van den Ende1,2 1Department of Rheumatology, 2Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands; 3Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands; 4NIVEL (Netherlands Institute for Health Services Research, Utrecht, the Netherlands; 5Department of Health Science, Buskerud and Vestfold University College, Drammen, Norway; 6Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands Background: This is the first cross-sectional study that aims to examine associations between beliefs about medication and non-adherence in patients with rheumatoid arthritis (RA using disease-modifying antirheumatic drugs, taking potential psychological confounders into account.Methods: Eligible patients (diagnosed with RA for ≥1 year or ≥18 years, using greater than or equal to one disease-modifying antirheumatic drug were included by their rheumatologist during regular outpatient visits between September 2009 and September 2010. Included patients received questionnaires. The Beliefs about Medicines Questionnaire was used to measure the perceived need to take medication (necessity beliefs, the concerns about taking medication (concern beliefs, general medication beliefs, and attitudes toward taking medication. Medication non-adherence (no/yes was measured using the Compliance Questionnaire Rheumatology (CQR. Associations between beliefs and non-adherence, and the influence of demographical, clinical, and psychological factors (symptoms of anxiety/depression, illness cognitions, self-efficacy were assessed using logistic regression.Results: A total of 580 of the 820 eligible patients willing to participate were included in the analyses (68% female, mean age 63 years, 30% non-adherent to their medication. Weaker necessity beliefs (OR [odds ratio]: 0.8, 95% CI

  6. Medication adherence in the transition of adolescent kidney transplant recipients to the adult care.

    Science.gov (United States)

    Akchurin, Oleh M; Melamed, Michal L; Hashim, Becky L; Kaskel, Frederick J; Del Rio, Marcela

    2014-08-01

    Non-adherence is common in adolescent and young adult kidney transplant recipients, leading to adverse graft outcomes. The aim of this study was to determine whether adherence to immunosuppressant medications changes during transition from a pediatric to an adult program within the same transplant center. Adherence was assessed for a period of two yr before and two yr after the transfer. Subtherapeutic trough levels of serum tacrolimus and level variability were used as measures of adherence. Twenty-five patients were transitioned between 1996 and 2011 at the median age of 22.3 [IQR 21.6-23.0] yr. Young adults 21-25 yr of age (n = 26) and non-transitioned adolescents 17-21 yr of age (currently followed in the program, n = 24 and those that lost their grafts prior to the transfer, 22) formed the comparison groups. In the transitioned group, adherence prior to the transfer was not significantly different from the adherence after the transfer (p = 0.53). The rate of non-adherence in the group of non-transitioned adolescents who lost their grafts (68%) was significantly higher than in the transitioned group (32%, p = 0.01). In the group of young adults, adherence was not significantly different from the transitioned group (p = 0.27). Thus, transition was not associated with differences in medication adherence in this single-center study. Large-scale studies are needed to evaluate the national data on medication adherence after transfer. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. [Relationship between exercise adherence and personality characteristics in persons experienced in the Medical Fitness program].

    Science.gov (United States)

    Yamashita, Yuko; Seki, Nao; Umeda, Kimie; Tanabe, Naohito; Shinoda, Kunihiko; Konishi, Isamu; Sekiya, Akiyoshi; Sekii, Akiko; Ohta, Tamaki

    2017-01-01

    Objective We examined effective exercise adherence support methods for persons experienced in the Medical Fitness (MF) program to clarify the relation of personality traits with exercise adherence and the factors that improve exercise adherence.Methods Subjects were 283 adults who had registered as members in the MF program at an affiliate of Hospital A. We implemented an anonymous self-administered questionnaire by postal mail. Using the Japanese version of the Ten Item Personality Inventory (which contains 10 items that measure the Big Five personality traits), we evaluated the following characteristics: "Extraversion", "Agreeableness", "Conscientiousness", "Neuroticism", and "Openness". The subjects who reported exercising regularly at the time of survey were considered persons with subjective exercise adherence.Results In persons with subjective exercise adherence, "Conscientiousness" was significantly lower (P=0.003) among men and "Neuroticism" was significantly higher (P=0.018) among women when compared to persons with subjective exercise adherence. There was no correlation between the things that emphasize exercise adherence and "Conscientiousness" among men. There was a negative correlation between "can achieve goal" and "Neuroticism" among women.Conclusions It is essential to consider personality and gender differences when devising exercise adherence support measures for the MF program. Our results suggest that women with high neuroticism do not need "can achieve goal" to maintain their exercise habits; therefore, it is necessary to examine teaching methods that do not focus on only goal achievement as part of exercise adherence support for MF.

  8. ROLE OF COUNSELING ON MEDICAL ADHERENCE AND GLYCEMIC CONTROL IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

    Directory of Open Access Journals (Sweden)

    Anoop Kumar

    2015-11-01

    Full Text Available BACKGROUND: Diabetes Mellitus (DM refers to a group of common metabolic disorders that share the phenotype of hyperglycemia. It is the leading cause of of end stage renal disease, non-traumatic limb amputation and adult blindness. The studies have shown that complications of DM can be prevented by the proper control of blood glucose, which is dependent on the patient’s adherence to medication, life style modification, frequent monitoring of blood glucose etc. and can be influenced by proper education and counseling of the patient. The patients with DM should receive education about exercise, care of DM during illness and medications to lower plasma glucose1 . This study aims to assess the impact of patients counseling on the medication adherence in type 2DM. METHOD: This is a prospective randomized study that includes 100 patients with type 2 DM in the out-patient department of internal medicine in a tertiary care teaching hospital, north Kerala. After getting informed consent, they were kept in two groups by simple randomization technique and were assessed and followed at 4 weeks interval. Data related to the medication adherence was collected using Morisky Medication Adherence Scale questionnaire (MMAS-8. RESULTS: Out of 100 patients 33% were male and 67% female. Both baseline and 1st follow up showed a low adherence value (<6 both in control and intervention group. In the second follow up most of the patients in intervention group showed a moderate adherence (6-8, whereas control group did not show any improvement. CONCLUSION: It can be concluded that there is a stastically significant improvement in the adherence level after patient counseling and education. Knowledge about the disease and treatment has improved the patient’s adherence to medication.

  9. Medication adherence, comorbidities, and health risk impacts on workforce absence and job performance.

    Science.gov (United States)

    Loeppke, Ronald; Haufle, Vince; Jinnett, Kim; Parry, Thomas; Zhu, Jianping; Hymel, Pamela; Konicki, Doris

    2011-06-01

    To understand impacts of medication adherence, comorbidities, and health risks on workforce absence and job performance. Retrospective observational study using employees' medical/pharmacy claims and self-reported health risk appraisals. Statin medication adherence in individuals with Coronary Artery Disease was significant predictor (P absenteeism. Insulin, oral hypoglycemic, or metformin medication adherence in type 2 diabetics was significant (P performance. Number of comorbidities was found as significant (P absenteeism in five of nine subsamples. Significant links (P performance were found across all nine subsamples. Results suggest integrated health and productivity management strategies should include an emphasis on primary and secondary prevention to reduce health risks in addition to tertiary prevention efforts of disease management and medication management.

  10. Identifying configurations of behavior change techniques in effective medication adherence interventions: a qualitative comparative analysis.

    Science.gov (United States)

    Kahwati, Leila; Viswanathan, Meera; Golin, Carol E; Kane, Heather; Lewis, Megan; Jacobs, Sara

    2016-05-04

    Interventions to improve medication adherence are diverse and complex. Consequently, synthesizing this evidence is challenging. We aimed to extend the results from an existing systematic review of interventions to improve medication adherence by using qualitative comparative analysis (QCA) to identify necessary or sufficient configurations of behavior change techniques among effective interventions. We used data from 60 studies in a completed systematic review to examine the combinations of nine behavior change techniques (increasing knowledge, increasing awareness, changing attitude, increasing self-efficacy, increasing intention formation, increasing action control, facilitation, increasing maintenance support, and motivational interviewing) among studies demonstrating improvements in adherence. Among the 60 studies, 34 demonstrated improved medication adherence. Among effective studies, increasing patient knowledge was a necessary but not sufficient technique. We identified seven configurations of behavior change techniques sufficient for improving adherence, which together accounted for 26 (76 %) of the effective studies. The intervention configuration that included increasing knowledge and self-efficacy was the most empirically relevant, accounting for 17 studies (50 %) and uniquely accounting for 15 (44 %). This analysis extends the completed review findings by identifying multiple combinations of behavior change techniques that improve adherence. Our findings offer direction for policy makers, practitioners, and future comparative effectiveness research on improving adherence.

  11. A New Lebanese Medication Adherence Scale: Validation in Lebanese Hypertensive Adults.

    Science.gov (United States)

    Bou Serhal, R; Salameh, P; Wakim, N; Issa, C; Kassem, B; Abou Jaoude, L; Saleh, N

    2018-01-01

    A new Lebanese scale measuring medication adherence considered socioeconomic and cultural factors not taken into account by the eight-item Morisky Medication Adherence Scale (MMAS-8). Objectives were to validate the new adherence scale and its prediction of hypertension control, compared to MMAS-8, and to assess adherence rates and factors. A cross-sectional study, including 405 patients, was performed in outpatient cardiology clinics of three hospitals in Beirut. Blood pressure was measured, a questionnaire filled, and sodium intake estimated by a urine test. Logistic regression defined predictors of hypertension control and adherence. 54.9% had controlled hypertension. 82.4% were adherent by the new scale, which showed good internal consistency, adequate questions (KMO coefficient = 0.743), and four factors. It predicted hypertension control (OR = 1.217; p value = 0.003), unlike MMAS-8, but the scores were correlated (ICC average measure = 0.651; p value < 0.001). Stress and smoking predicted nonadherence. This study elaborated a validated, practical, and useful tool measuring adherence to medications in Lebanese hypertensive patients.

  12. A New Lebanese Medication Adherence Scale: Validation in Lebanese Hypertensive Adults

    Directory of Open Access Journals (Sweden)

    R. Bou Serhal

    2018-01-01

    Full Text Available Background. A new Lebanese scale measuring medication adherence considered socioeconomic and cultural factors not taken into account by the eight-item Morisky Medication Adherence Scale (MMAS-8. Objectives were to validate the new adherence scale and its prediction of hypertension control, compared to MMAS-8, and to assess adherence rates and factors. Methodology. A cross-sectional study, including 405 patients, was performed in outpatient cardiology clinics of three hospitals in Beirut. Blood pressure was measured, a questionnaire filled, and sodium intake estimated by a urine test. Logistic regression defined predictors of hypertension control and adherence. Results. 54.9% had controlled hypertension. 82.4% were adherent by the new scale, which showed good internal consistency, adequate questions (KMO coefficient = 0.743, and four factors. It predicted hypertension control (OR = 1.217; p value = 0.003, unlike MMAS-8, but the scores were correlated (ICC average measure = 0.651; p value < 0.001. Stress and smoking predicted nonadherence. Conclusion. This study elaborated a validated, practical, and useful tool measuring adherence to medications in Lebanese hypertensive patients.

  13. A Practice-Based Evaluation of Distress Screening Protocol Adherence and Medical Service Utilization.

    Science.gov (United States)

    Zebrack, Brad; Kayser, Karen; Bybee, Deborah; Padgett, Lynne; Sundstrom, Laura; Jobin, Chad; Oktay, Julianne

    2017-07-01

    Background: This study examined the extent to which cancer programs demonstrated adherence to their own prescribed screening protocol, and whether adherence to that protocol was associated with medical service utilization. The hypothesis is that higher rates of service utilization are associated with lower rates of adherence to screening protocols. Methods: Oncology social workers at Commission on Cancer-accredited cancer programs reviewed electronic health records (EHRs) in their respective cancer programs during a 2-month period in 2014. Rates of overall adherence to a prescribed distress screening protocol were calculated based on documentation in the EHR that screening adherence and an appropriate clinical response had occurred. We examined documentation of emergency department (ED) use and hospitalization within 2 months after the screening visit. Results: Review of 8,409 EHRs across 55 cancer centers indicated that the overall adherence rate to screening protocols was 62.7%. The highest rates of adherence were observed in Community Cancer Programs (76.3%) and the lowest rates were in NCI-designated Cancer Centers (43.3%). Rates of medical service utilization were significantly higher than expected when overall protocol adherence was lacking. After controlling for patient and institutional characteristics, risk ratios for ED use (0.82) and hospitalization (0.81) suggest that when overall protocol adherence was documented, 18% to 19% fewer patients used these medical services. Conclusions: The observed associations between a mandated psychosocial care protocol and medical service utilization suggest opportunities for operational efficiencies and costs savings. Further investigations of protocol integrity, as well as the clinical care models by which psychosocial care is delivered, are warranted. Copyright © 2017 by the National Comprehensive Cancer Network.

  14. Episodic medication adherence in adolescents and young adults with perinatally acquired HIV: a within-participants approach.

    Science.gov (United States)

    Hawkins, Amy; Evangeli, Michael; Sturgeon, Kate; Le Prevost, Marthe; Judd, Ali

    2016-01-01

    Due to the success of antiretroviral (ART) medications, young people living with perinatally acquired HIV (PHIV+) are now surviving into adolescence and young adulthood. Understanding factors influencing ART non-adherence in this group is important in developing effective adherence interventions. Most studies of ART adherence in HIV-positive populations assess differences in adherence levels and adherence predictors between participants, over a period of time (global adherence). Many individuals living with HIV, however, including PHIV+ young people, take medication inconsistently. To investigate this pattern of adherence, a within-participants design, focussing on specific episodes of adherence and non-adherence, is suitable (episodic adherence). A within-participants design was used with 29 PHIV+ young people (17 female, median age 17 years, range 14-22 years), enrolled in the UK Adolescents and Adults Living with Perinatal HIV cohort study. Participants were eligible if they could identify one dose of medication taken and one dose they had missed in the previous two months. For each of the two episodes (one adherent, one non-adherent), behavioural factors (whom they were with, location, routine, day, reminders) and psychological factors at the time of the episode (information about medication, adherence motivation, perceived behavioural skills to adhere to medication - derived from the Information-Motivation-Behavioural Skills (IMB) Model - and affect) were assessed in a questionnaire. Non-adherence was significantly associated with weekend days (Friday to Sunday versus Monday to Thursday, p = .001), lack of routine (p = .004), and being out of the home (p = .003), but not with whom the young person was with or whether they were reminded to take medication. Non-adherence was associated with lower levels of behavioural skills (p ART, or ART motivation. The use of situationally specific strategies to enhance adherence in young people who take their

  15. Bioethics and Medical Issues in Literature

    OpenAIRE

    Stripling, Mahala Yates

    2013-01-01

    Many of the bioethical and medical issues challenging society today have been anticipated and addressed in literature ranging from Mary Shelley's Frankenstein, Albert Camus’s The Plague, to Margaret Edson's Wit. The ten works of fiction explored in this book stimulate lively dialogue on topics like bioterrorism, cloning, organ transplants, obesity and heart disease, sexually transmitted diseases, and civil and human rights. This interdisciplinary and multicultural approach introducing literat...

  16. Lacunae in noncommunicable disease control program: Need to focus on adherence issues!

    Directory of Open Access Journals (Sweden)

    Tarundeep Singh

    2017-01-01

    Full Text Available Introduction: Chronic non communicable diseases in India have increased in magnitude with earlier onset and more likelihood of complications. Much emphasis is given to early diagnosis and timely treatment. Additionally, tertiary prevention through medication adherence is needed to limit disability and prevent early onset of complications. This study was aimed to assess the magnitude of medication and lifestyle adherence among elderly patients suffering from diabetes and hypertension in rural areas of Punjab. Methodology: This was a clinic based study in district Fatehgarh Sahib, Punjab. Patients were subjected to regular blood pressure and blood glucose monitoring. Thereafter they were offered free medications through weekly clinic held at Community Health Center, Bassi Pathana. Along with treatment, Public Health Nurse conducted counselling on diet and lifestyle. Frequency and process of taking medications was explained in local language and records duly maintained during visits. Results: Nearly 70% of study subjects were more than 50 years old. Males constituted 26% of the sample and 60% of subjects were illiterate. Large majority of study subjects did not consumed tobacco (98.08% or alcohol (89.42% in past thirty days. In-sufficient physical activity and poor compliance to diet was reported by 10.5% (Males: 7.4%, Females: 11.7% and 23.5% (Males: 31.5%, Females: 20.8% subjects. Nearly 46.15% of study subjects reported missing prescribed medications. Nearly 61.54% of study subjects were very sure that they will be able to take medicines as directed by physician. Conclusion: National Program for Control of Diabetes, Cardio-vascular Disease and Stroke relies on early diagnosis and treatment non- communicable diseases. However, with reported levels of adherence to medication and lifestyle interventions, there is an urgent need of exploring innovative ways to ensure compliance and improve treatment outcomes.

  17. Asthma medication adherence: the role of God and other health locus of control factors.

    Science.gov (United States)

    Ahmedani, Brian K; Peterson, Edward L; Wells, Karen E; Rand, Cynthia S; Williams, L Keoki

    2013-02-01

    Medication adherence is an important determinant of disease outcomes, yet medication use on average tends to be low among patients with chronic conditions, including asthma. Although several predictors of non-adherence have been assessed, more research is needed on patients' beliefs about God and how these relate to medication use. To examine the relationship between perceptions about "God's" role in health and other locus of control factors with inhaled corticosteroid (ICS) adherence among asthma patients. Participants were from a clinical trial to improve ICS adherence and were 5-56 years old, had a diagnosis of asthma, and were receiving ICS medication. Baseline adherence was estimated from electronic prescription and pharmacy fill records. Patients were considered to be adherent if ICS use was ≥80% of prescribed. A baseline survey with the Multidimensional Health Locus of Control scale was used to assess five sources (God, doctors, other people, chance, and internal). Medication adherence was low (36%). Patients' who had a stronger belief that God determined asthma control were less likely to be adherent (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.70-0.96). This relationship was stronger among African American (OR 0.68, 95% CI0.47-0.99) compared to white patients (OR 0.89, 95% CI 0.75-1.04), and among adults (OR 0.81, 95% CI 0.69-0.96) compared to children (OR 0.84, 95% CI 0.58-1.22). Patients' belief in God's control of health appears to be a factor in asthma controller use, and therefore should be considered in physician-patient discussions concerning course of treatment. ClinicalTrials.gov: NCT00459368. Copyright © 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  18. Medication Adherence Among Elderly Patients with High Blood Pressure in Gweru, Zimbabwe.

    Science.gov (United States)

    Wariva, Elizabeth; January, James; Maradzika, Julita

    2014-02-04

    High blood pressure is a global health concern which is mainly managed by taking anti-hypertensive medications. Although medication is available to control high blood pressure, adhering to treatment is a major problem among hypertensive patients. The purpose of the study was to assess the predisposing, enabling and reinforcing factors to medication adherence among hypertensive patients in Gweru urban aged 40-70 years. A descriptive cross sectional study was used with a sample size of 110 conveniently sampled hypertensive patients. We used an interviewer administered questionnaire designed using phase 4 of the PRECEDE model. The modal age was 70 years and mean age was 58 years (SD=10.29). There were 61.8% females and 38.2% males. Variables associated with medication adherence were: age (P=0.0059), marital status (P=0.015), average monthly income (P=0.0002), support group (P=0.027) and knowledge (P=0.0058). Providing information to patients with high blood pressure and having a good patient-provider relationship improves medication adherence. There is need to focus on the predisposing, enabling and reinforcing factors of medication adherence since demographic and socio-economic factors may be more difficult to change.

  19. A Digital Language Divide? The Relationship between Internet Medication Refills and Medication Adherence among Limited English Proficient (LEP) Patients.

    Science.gov (United States)

    Casillas, Alejandra; Moreno, Gerardo; Grotts, Jonathan; Tseng, Chi-Hong; Morales, Leo S

    2018-03-29

    Use of an Internet portal to refill medicines positively affects medication adherence among English-speakers. No prior studies, however, have specifically examined the relationship between Internet refills and medication adherence among patients who are limited English proficient (LEP). (1) Examine the relationship between Internet medication refill system use and medication adherence among linguistically diverse patients with chronic conditions and (2) compare this relationship between LEP and English-proficient (EP) patients. We analyzed 2013-2014 cross-sectional data from 509 surveyed adults in the Group Health Cooperative. Surveys were merged with plan enrollment, claims data, and electronic medical records. Medication adherence was calculated by the "Continuous Measure of Medication Gaps" (CMG) method. For Internet refill system use, patients were asked, "Have you used the health systems Internet site to refill any medications in the last 12 months?" LEP status was captured in the electronic medical record by a non-English primary language and a claims record of interpreter use in at least one clinical encounter between 2005 and 2012. We used multivariate linear regression models to examine Internet refill system use and medication adherence and compared the association between LEP and EP patients. Three hundred eighty-four patients (75%) had a calculable CMG: 134 EP and 250 LEP in the adherence analyses. In unadjusted analyses, LEP patients had lower use of the Internet refill system (p < .001) and lower adherence versus the EP group (p < .001). In multivariate analyses, LEP status (β = - 0.022, p = .047) was negatively associated with adherence, while use of the Internet refill system (β = 0.030, p = .002) was positively associated. In stratified models, use of Internet refills was positively associated with adherence, even when examining LEP (β = 0.029, p = .003) and EP patients (β = 0.027, p = .049) separately

  20. Self-care and adherence to medication: a survey in the hypertension outpatient clinic

    Directory of Open Access Journals (Sweden)

    Lip Gregory YH

    2008-02-01

    Full Text Available Abstract Background Self-care practices for patients with hypertension include adherence to medication, use of blood pressure self-monitoring and use of complementary and alternative therapies (CAM The prevalence of CAM use and blood pressure self-monitoring have not been described in a UK secondary care population of patients with hypertension and their impact on adherence to medication has not been described. Adherence to medication is important for blood pressure control, but poor adherence is common. The study aimed to determine the prevalence of self-care behaviours in patients attending a secondary care hypertension clinic. Methods Cross-sectional questionnaire survey. 196 patients attending a secondary care hypertension clinic in a teaching hospital serving a multiethnic population, Birmingham, UK. Main outcome measures: Prevalence of use of CAM, home monitors, adherence to anti-hypertensive medication. Results CAM use in previous 12 months was reported by 66 (43.1% respondents. CAM users did not differ statistically from non-CAM users by age, gender, marital status or education. Vitamins, prayer a dietary supplements were the most commonly used CAM. Nine (12.7% women reported using herbal CAM compared to one man (1.2%, (p = 0.006. Ten (6.7% respondents reported ever being asked by a doctor about CAM use. Perfect adherence to anti-hypertensive medication was reported by 26 (44.8% CAM-users and 46 (60.5% non-CAM users (p = 0.07. Being female and a CAM user was significantly associated with imperfect adherence to anti-hypertensive medication. Older and white British respondents were significantly more likely to report perfect adherence. Blood pressure monitors were used by 67 (43.8% respondents, which was not associated with gender, CAM use or adherence to medication. Conclusion Hypertensive patients use a variety of self-care methods, including CAM, home blood pressure monitors, and adherence to prescribed medication. This study found the

  1. The influence of frailty syndrome on medication adherence among elderly patients with hypertension

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    Jankowska-Polańska B

    2016-12-01

    Full Text Available Beata Jankowska-Polańska,1 Krzysztof Dudek,2 Anna Szymanska-Chabowska,3 Izabella Uchmanowicz1 1Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 2Department of Logistic and Transport Systems, Faculty of Mechanical Engineering, Wroclaw University of Technology, 3Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland Background: Hypertension affects about 80% of people older than 80 years; however, diagnosis and treatment are difficult because about 55% of them do not adhere to treatment recommendations due to low socioeconomic status, comorbidities, age, physical limitations, and frailty syndrome.Aims: The purposes of this study were to evaluate the influence of frailty on medication adherence among elderly hypertensive patients and to assess whether other factors influence adherence in this group of patients.Methods and results: The study included 296 patients (mean age 68.8±8.0 divided into frail (n=198 and non-frail (n=98 groups. The Polish versions of the Tilburg Frailty Indicator (TFI for frailty assessment and 8-item Morisky Medication Adherence Scale for adherence assessment were used. The frail patients had lower medication adherence in comparison to the non-frail subjects (6.60±1.89 vs 7.11±1.42; P=0.028. Spearman’s rank correlation coefficients showed that significant determinants with negative influence on the level of adherence were physical (rho =-0.117, psychological (rho =-0.183, and social domain (rho =-0.163 of TFI as well as the total score of the questionnaire (rho =-0.183. However, multiple regression analysis revealed that only knowledge about complications of untreated hypertension (β=0.395 and satisfaction with the home environment (β=0.897 were found to be independent stimulants of adherence level.Conclusion: Frailty is highly prevalent among elderly hypertensive patients. Higher level of frailty

  2. Factors influencing medication knowledge and beliefs on warfarin adherence among patients with atrial fibrillation in China

    Science.gov (United States)

    Zhao, Shujuan; Zhao, Hongwei; Wang, Xianpei; Gao, Chuanyu; Qin, Yuhua; Cai, Haixia; Chen, Boya; Cao, Jingjing

    2017-01-01

    Objectives Warfarin is often used for ischemic stroke prevention in patients with atrial fibrillation (AF), but the factors affecting patient adherence to warfarin therapy have not been fully understood. Methods A cross-sectional survey was conducted in AF patients undergoing warfarin therapy at least 6 months prior to the study. The clinical data collected using questionnaires by phone interviews included the following: 1) self-reported adherence measured by the Morisky Medication Adherence Scale-8©; 2) beliefs about medicines surveyed by Beliefs about Medicines Questionnaire (BMQ); and 3) drug knowledge as measured by the Warfarin Related Knowledge Test (WRKT). Demographic and clinical factors associated with warfarin adherence were identified using a logistic regression model. Results Two hundred eighty-eight patients completed the survey and 93 (32.3%) of them were classified as nonadherent (Morisky Medication Adherence Scale-8 score <6). Major factors predicting warfarin adherence included age, cardiovascular disorders, WRKT, and BMQ; WRKT and BMQ were independently correlated with adherence to warfarin therapy by multivariate logistic regression analysis. Adherents were more likely to have greater knowledge scores and stronger beliefs in the necessity of their specific medications ([odds ratio {OR} =1.81, 95% confidence interval {CI} =1.51–2.15] and [OR =1.17, 95% CI =1.06–1.29], respectively). Patients with greater concerns about adverse reactions and more negative views of general harm were more likely to be nonadherent ([OR =0.76, 95% CI =0.69–0.84] and [OR =0.82, 95% CI =0.73–0.92], respectively). Conclusion BMK and WRKT are related with patient behavior toward warfarin adherence. BMQ can be applied to identify patients at increased risk of nonadherence. PMID:28223782

  3. Feasibility of mHealth and Near Field Communication technology based medication adherence monitoring.

    Science.gov (United States)

    Morak, Juergen; Schwarz, Mark; Hayn, Dieter; Schreier, Guenter

    2012-01-01

    Poor patients' adherence to intake of prescribed medication has been identified as a serious problem in the treatment of chronically ill patients. Technical solutions are needed to measure and - if necessary - to increase the patients' adherence. A telemonitoring solution was developed to record a patient's medication intake based on smart blisters and mobile phones with NFC functionality. The components allowed recording of drug type, timestamp, and dosage of pills taken. The system's usability and technical feasibility was evaluated in the course of an application study. Over a period of 13 months 59 patients suffering from diabetes were monitored. 1,760 blisters were handed out to these patients and 14,843 takeout events were recorded and transmitted via mobile phone. Results indicate the feasibility of this concept to monitor adherence. Although the system still needs to be optimized for routine use it shows the potential for targeting the problem of poor patient adherence by NFC enabled devices.

  4. Medication Adherence Improvements in Employees Participating in a Pharmacist-Run Risk Reduction Program

    Directory of Open Access Journals (Sweden)

    Mallory C. McKenzie

    2012-01-01

    Full Text Available Objective: To evaluate the medication adherence of individuals participating in a pharmacist-run employee health Cardiovascular and Diabetes Risk Reduction Program. Design: Retrospective analysis of medication adherence using pharmacy refill data. Setting: A medium sized university located in the Midwest United States and the organization's outpatient pharmacy. Participants: 38 participants ≥ 18 years of age, employed and receiving their health insurance through the organization, and have a diagnosis of hypertension, hyperlipidemia, diabetes mellitus, or a combination thereof. Intervention: Participation in the risk reduction program that emphasizes medication therapy management (MTM, lifestyle medicine and care coordination. Main Outcome Measures: The Proportion of Days Covered (PDC and the Medication Possession Ratio (MPR. Results: PDC and MPR analysis showed a statistically significant improvement in medication adherence for 180 days and 360 days post enrollment versus the 180 days prior to enrollment (P<0.01. The PDC analysis demonstrated a statistically significant improvement in the number of medications that achieved a PDC ≥ 80% (high adherence for the 180 days post enrollment versus the 180 days prior to enrollment (+30%, P<0.01. The MPR analysis showed a non-statistically significant improvement in the number of medications that achieved an MPR ≥ 80% (high adherence pre enrollment versus post enrollment (+10%, P=0.086. The percentage of participants in the program that reached a PDC and MPR adherence rate ≥ 80% at 180 days post enrollment was 78.9% and 94.4%, respectively which exceeds that of a matched cohort that reached a PDC and MPR adherence rate ≥ 80% of 66.4% and 82.8%, respectively. Conclusion: Pharmacists can improve medication adherence as measured by PDC and MPR when working with employees enrolled in a novel pharmacist-run employee health risk reduction program. Medication adherence was shown to be sustainable for

  5. Machine learning classification of medication adherence in patients with movement disorders using non-wearable sensors.

    Science.gov (United States)

    Tucker, Conrad S; Behoora, Ishan; Nembhard, Harriet Black; Lewis, Mechelle; Sterling, Nicholas W; Huang, Xuemei

    2015-11-01

    Medication non-adherence is a major concern in the healthcare industry and has led to increases in health risks and medical costs. For many neurological diseases, adherence to medication regimens can be assessed by observing movement patterns. However, physician observations are typically assessed based on visual inspection of movement and are limited to clinical testing procedures. Consequently, medication adherence is difficult to measure when patients are away from the clinical setting. The authors propose a data mining driven methodology that uses low cost, non-wearable multimodal sensors to model and predict patients' adherence to medication protocols, based on variations in their gait. The authors conduct a study involving Parkinson's disease patients that are "on" and "off" their medication in order to determine the statistical validity of the methodology. The data acquired can then be used to quantify patients' adherence while away from the clinic. Accordingly, this data-driven system may allow for early warnings regarding patient safety. Using whole-body movement data readings from the patients, the authors were able to discriminate between PD patients on and off medication, with accuracies greater than 97% for some patients using an individually customized model and accuracies of 78% for a generalized model containing multiple patient gait data. The proposed methodology and study demonstrate the potential and effectiveness of using low cost, non-wearable hardware and data mining models to monitor medication adherence outside of the traditional healthcare facility. These innovations may allow for cost effective, remote monitoring of treatment of neurological diseases. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. A Structural Equation Model of HIV-related Symptoms, Depressive Symptoms, and Medication Adherence

    OpenAIRE

    Yoo-Jeong, Moka; Waldrop-Valverde, Drenna; McCoy, Katryna; Ownby, Raymond L

    2016-01-01

    Adherence to combined antiretroviral therapy (cART) remains critical in management of HIV infection. This study evaluated depression as a potential mechanism by which HIV-related symptoms affect medication adherence and explored if particular clusters of HIV symptoms are susceptible to this mechanism. Baseline data from a multi-visit intervention study were analyzed among 124 persons living with HIV (PLWH). A bifactor model showed two clusters of HIV-related symptom distress: general HIV-rela...

  7. The influence of traditional and complementary and alternative medicine on medication adherence in Honduras.

    Science.gov (United States)

    Catalino, Michael Paul; Durón, Reyna Maria; Bailey, Julia Nancy; Holden, Kenton Roy

    2015-01-01

    Adherence to medication is a worldwide problem and deserves country-specific attention. Honduras, like many other countries, has allopathic providers, traditional medicine (TM), and complementary and alternative medicine (CAM). Understanding a population's health behaviors is essential to satisfactory integration of these systems and successful patient care. The objective was to identify factors that influence medication adherence in Honduras. The research team administered a cross-sectional, 25-item questionnaire to various neighborhoods based on national demographic statistics in order to obtain a quota sample. Setting • The survey took place in Tegucigalpa, Honduras, Central America. The research team surveyed 614 Hondurans, aged ≥ 18 y, within the general population of Tegucigalpa, the largest and capital city of Honduras, in neighborhoods representing areas where primarily the lower and middle classes lived. The primary outcome measure was a modified Medication Adherence Report Scale (MARS). Results • The research team collected 610 surveys that had complete answers to questions about adherence (610/614, 99.3%) total complete responses to other items varied. The prevalence of use of TM was 62.8% (381/607). Nearly one-half, 47.3% (287/607), of all the respondents had used herbs or teas for health in the prior year, and 26.1% (159/607) of all respondents had received a sobada (therapeutic rubbing). Respondents with daily private spiritual devotions (OR = 0.610, P = .018) and diabetes (OR = 0.154, P = .004) were less likely to report low adherence. Receiving a sobada and a history of fever were independently associated with low adherence (OR = 1.718, P = .017 and OR = 2.226, P < .001, respectively). Hondurans use both allopathic and TM. Although private spiritual devotion may help improve adherence to medication, only use of traditional massage therapy, the sobada, was associated with decreased adherence. Effective integration of alternative therapies in

  8. Sustainability of professionals’ adherence to clinical practice guidelines in medical care: a systematic review

    Science.gov (United States)

    Ament, Stephanie M C; de Groot, Jeanny J A; Maessen, José M C; Dirksen, Carmen D; van der Weijden, Trudy; Kleijnen, Jos

    2015-01-01

    Objectives To evaluate (1) the state of the art in sustainability research and (2) the outcomes of professionals’ adherence to guideline recommendations in medical practice. Design Systematic review. Data sources Searches were conducted until August 2015 in MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and the Guidelines International Network (GIN) library. A snowball strategy, in which reference sections of other reviews and of included papers were searched, was used to identify additional papers. Eligibility criteria Studies needed to be focused on sustainability and on professionals’ adherence to clinical practice guidelines in medical care. Studies had to include at least 2 measurements: 1 before (PRE) or immediately after implementation (EARLY POST) and 1 measurement longer than 1 year after active implementation (LATE POST). Results The search retrieved 4219 items, of which 14 studies met the inclusion criteria, involving 18 sustainability evaluations. The mean timeframe between the end of active implementation and the sustainability evaluation was 2.6 years (minimum 1.5–maximum 7.0). The studies were heterogeneous with respect to their methodology. Sustainability was considered to be successful if performance in terms of professionals’ adherence was fully maintained in the late postimplementation phase. Long-term sustainability of professionals’ adherence was reported in 7 out of 18 evaluations, adherence was not sustained in 6 evaluations, 4 evaluations showed mixed sustainability results and in 1 evaluation it was unclear whether the professional adherence was sustained. Conclusions (2) Professionals’ adherence to a clinical practice guideline in medical care decreased after more than 1 year after implementation in about half of the cases. (1) Owing to the limited number of studies, the absence of a uniform definition, the high risk of bias, and the mixed results of studies, no firm conclusion about the

  9. Sustainability of professionals' adherence to clinical practice guidelines in medical care: a systematic review.

    Science.gov (United States)

    Ament, Stephanie M C; de Groot, Jeanny J A; Maessen, José M C; Dirksen, Carmen D; van der Weijden, Trudy; Kleijnen, Jos

    2015-12-29

    To evaluate (1) the state of the art in sustainability research and (2) the outcomes of professionals' adherence to guideline recommendations in medical practice. Systematic review. Searches were conducted until August 2015 in MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and the Guidelines International Network (GIN) library. A snowball strategy, in which reference sections of other reviews and of included papers were searched, was used to identify additional papers. Studies needed to be focused on sustainability and on professionals' adherence to clinical practice guidelines in medical care. Studies had to include at least 2 measurements: 1 before (PRE) or immediately after implementation (EARLY POST) and 1 measurement longer than 1 year after active implementation (LATE POST). The search retrieved 4219 items, of which 14 studies met the inclusion criteria, involving 18 sustainability evaluations. The mean timeframe between the end of active implementation and the sustainability evaluation was 2.6 years (minimum 1.5-maximum 7.0). The studies were heterogeneous with respect to their methodology. Sustainability was considered to be successful if performance in terms of professionals' adherence was fully maintained in the late postimplementation phase. Long-term sustainability of professionals' adherence was reported in 7 out of 18 evaluations, adherence was not sustained in 6 evaluations, 4 evaluations showed mixed sustainability results and in 1 evaluation it was unclear whether the professional adherence was sustained. (2) Professionals' adherence to a clinical practice guideline in medical care decreased after more than 1 year after implementation in about half of the cases. (1) Owing to the limited number of studies, the absence of a uniform definition, the high risk of bias, and the mixed results of studies, no firm conclusion about the sustainability of professionals' adherence to guidelines in medical practice can be drawn

  10. The effect of electronic monitoring feedback on medication adherence and clinical outcomes: A systematic review.

    Science.gov (United States)

    van Heuckelum, Milou; van den Ende, Cornelia H M; Houterman, Anne E J; Heemskerk, Charlotte P M; van Dulmen, Sandra; van den Bemt, Bart J F

    2017-01-01

    This study aims to assess the efficacy of Electronic Monitoring Feedback (EMF) as an intervention to improve medication adherence (i.e. dose- or full adherence) and clinical outcomes in adult patients. A systematic search was performed in Medline, EMBASE, PsycINFO and Web of Science and reported according to the PRISMA guidelines. Randomised controlled trials (RCTs) comparing EMF with usual care were identified to systematically summarise the evidence for use of EMF in improving medication adherence and clinical outcomes. The GRADE approach was used to assess the quality of the body of evidence. Of 9,993 initially-identified studies, ten studies (four of high-quality and six of low-quality) were included. The sample size of the studies included varied from 18 to 205 patients. Four of the six studies (66.7%) reported a significant positive effect of EMF on mean dose adherence levels, whereas a significant positive effect of EMF on mean full adherence levels was found in all of the included studies (100%, five out of five of the studies included). A significant positive effect of EMF on clinical outcomes was reported in one of the seven studies included. The overall effect of EMF on mean dose- and full adherence was positive and the overall effect of EMF on clinical outcomes was inconclusive. Considering the positive effect of EMF on medication adherence, EMF might be a promising intervention to enhance medication adherence. However, the effect of EMF on clinical outcomes was inconclusive. Prior to implementing EMF in clinical practice, future research with high-quality studies (e.g. adequate sample sizes, follow-up periods and no interfering co-interventions) is required to examine the (long-term) efficacy of EMF.

  11. Depression, patient characteristics, and attachment style: correlates and mediators of medication treatment adherence in a racially diverse primary care sample.

    Science.gov (United States)

    Hooper, Lisa M; Tomek, Sara; Roter, Debra; Carson, Kathryn A; Mugoya, George; Cooper, Lisa A

    2016-03-01

    The depth and breadth of problems related to depressive symptomatology and optimal treatment outcomes, including medication treatment adherence, have long been documented in the literature. Missing are clear explanations as to what factors and patient characteristics may account for lack of medication treatment adherence. The two objectives of the current study were to examine the predictive strength of depression, patient characteristics, and patient attachment style regarding medication treatment adherence and to consider the extent to which attachment styles mediate the relation between depression and medication treatment adherence. Participants in the present study were 237 racially diverse American primary care patients with a diagnosis of hypertension who were participants in a clinical trial. Depression, patient characteristics, attachment style, and medication treatment adherence were assessed. Partly consistent with our four hypotheses, the following results were found: (a) Black American, younger, never married, and poorer patients had lower medication treatment adherence (b) depression was significantly associated with lower self-reported medication adherence; (c) insecure-dismissing attachment style was related to lower medication adherence; and (d) insecure-dismissing attachment style mediates the relation between depression and medication treatment adherence by exacerbating the negative association. Physicians and other primary care providers should consider how depressive symptomatology, patient characteristics, and attachment style may inform the treatment plans they put forward and the extent to which patients may adhere to those treatment plans.

  12. Medication adherence and its associated factors among diabetic patients at Zewditu Memorial Hospital, Addis Ababa, Ethiopia.

    Science.gov (United States)

    Ali, Muhammed; Alemu, Tigestu; Sada, Oumer

    2017-12-04

    Diabetes is a global problem with devastating human, social and economic impact. Anti-diabetic medications play a major role in the glycemic control of patients with diabetes. However, inadequate adherence compromises safety and treatment effectiveness, leading to increased mortality and morbidity. The aim of this study was to assess adherence to anti-diabetic medications and associated factors among patient with diabetes mellitus receiving care at Zewditu Memorial Hospital. Among the total of 146 diabetic patients (mean age 46.5 ± 14.7), the level of adherence to anti diabetic medication was 54.8% (80) whilst 45.2% (66) of the participants were non adherent. Multiple logistic regression showed that knowledge of medication (AOR = 4.905, 95% CI 1.64-14.62, medication availability (AOR = 0.175, 95% CI 0.031-0.987) and education level (AOR = 13.65, 95% CI 1.45-128.456) were reasons for non-adherence.

  13. Cannabis Use, Medication Management and Adherence Among Persons Living with HIV.

    Science.gov (United States)

    Vidot, Denise C; Lerner, Brenda; Gonzalez, Raul

    2017-07-01

    Cannabis is used to relieve nausea, trigger weight gain, and reduce pain among adults living with HIV; however, the relationship between its use and medication adherence and management is unclear. Participants (N = 107) were from an ongoing cohort study of community-dwelling HIV+ adults, stratified by cannabis (CB) use: HIV+/CB+ (n = 41) and HIV+/CB- (n = 66). CB+ participants either tested positive in a urine toxicology screen for THC or had a self-reported history of regular and recent use. HIV-status was provided by physician results and/or biomarker assessment. Adherence was measured via the Morisky scale and medication management was assessed via the Medication Management Test-Revised. After adjusting for gender, we found no association between cannabis use group and adherence nor medication management. The amount of cannabis used was also not associated with measures of adherence and management. Preliminary findings suggest that cannabis use may not adversely influence medication adherence/management among adults living with HIV.

  14. What puts heart failure patients at risk for poor medication adherence?

    Directory of Open Access Journals (Sweden)

    Knafl GJ

    2014-07-01

    Full Text Available George J Knafl,1 Barbara Riegel2,31School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 2School of Nursing, University of Pennsylvania, Philadelphia, PA, USA; 3Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, USABackground: Medication nonadherence is a major cause of hospitalization in patients with heart failure (HF, which contributes enormously to health care costs. We previously found, using the World Health Organization adherence dimensions, that condition and patient level factors predicted nonadherence in HF. In this study, we assessed a wider variety of condition and patient factors and interactions to improve our ability to identify those at risk for hospitalization. Materials and methods: Medication adherence was measured electronically over the course of 6 months, using the Medication Event Monitoring System (MEMS. A total of 242 HF patients completed the study, and usable MEMS data were available for 218 (90.1%. Participants were primarily white (68.3%, male (64.2%, and retired (44.5%. Education ranged from 8–29 years (mean, 14.0 years; standard deviation, 2.9 years. Ages ranged from 30–89 years (mean, 62.8 years; standard deviation, 11.6 years. Analyses used adaptive methods based on heuristic searches controlled by cross-validation scores. First, individual patient adherence patterns over time were used to categorize patients in poor versus better adherence types. Then, risk factors for poor adherence were identified. Finally, an effective model for predicting poor adherence was identified based on identified risk factors and possible pairwise interactions between them. Results: A total of 63 (28.9% patients had poor adherence. Three interaction risk factors for poor adherence were identified: a higher number of comorbid conditions with a higher total number of daily medicines, older age with poorer global sleep quality, and fewer months since diagnosis of HF with poorer

  15. Medication Adherence and Health Insurance/Health Benefit in Adult Diabetics in Kingston, Jamaica.

    Science.gov (United States)

    Bridgelal-Nagassar, R J; James, K; Nagassar, R P; Maharaj, S

    2015-05-15

    To determine the association between health insurance/health benefit and medication adherence amongst adult diabetic patients in Kingston, Jamaica. This was a cross-sectional study. The target population was diabetics who attended the diabetic outpatient clinics in health centres in Kingston. Two health centres were selectively chosen in Kingston. All diabetic patients attending the diabetic clinics and over the age of 18 years were conveniently sampled. The sample size was 260. An interviewer-administered questionnaire was utilized which assessed health insurance/health benefit. Adherence was measured by patients' self-reports of medication usage in the previous week. The Chi-squared test was used to determine the significance of associations. Sample population was 76% female and 24% male. Type 2 diabetics comprised 93.8%. More than 95% of patients were over the age of 40 years. Approximately 32% of participants were employed. Approximately 75% of patients had health insurance/health benefit. Among those who had health insurance or health benefit, 71.5% were adherent and 28.5% were non-adherent. This difference was statistically significant (χ2 = 6.553, p = 0.01). Prevalence of medication non-adherence was 33%. AIn Kingston, diabetic patients who are adherent are more likely to have health insurance/health benefit ( p = 0.01).

  16. A Structural Equation Model of HIV-related Symptoms, Depressive Symptoms, and Medication Adherence.

    Science.gov (United States)

    Yoo-Jeong, Moka; Waldrop-Valverde, Drenna; McCoy, Katryna; Ownby, Raymond L

    2016-05-01

    Adherence to combined antiretroviral therapy (cART) remains critical in management of HIV infection. This study evaluated depression as a potential mechanism by which HIV-related symptoms affect medication adherence and explored if particular clusters of HIV symptoms are susceptible to this mechanism. Baseline data from a multi-visit intervention study were analyzed among 124 persons living with HIV (PLWH). A bifactor model showed two clusters of HIV-related symptom distress: general HIV-related symptoms and gastrointestinal (GI) symptoms. Structural equation modeling showed that both general HIV-related symptoms and GI symptoms were related to higher levels of depressive symptoms, and higher levels of depressive symptoms were related to lower levels of medication adherence. Although general HIV-related symptoms and GI symptoms were not directly related to adherence, they were indirectly associated with adherence via depression. The findings highlight the importance of early recognition and evaluation of symptoms of depression, as well as the underlying physical symptoms that might cause depression, to improve medication adherence.

  17. Caregiver's Health Locus of Control and Medication Adherence in Sickle Cell Disease.

    Science.gov (United States)

    Viswanathan, Kusum; Swaminathan, Neeraja; Viswanathan, Ramaswamy; Lakkaraja, Madhavi

    2015-03-01

    The authors would like to thank Dr. Morisky for giving us permission to use the Morisky Medication Adherence Scale To explore caregivers' Health Locus of Control's relationship to self-reported adherence to penicillin prophylaxis or hydroxyurea in children with sickle cell disease (SCD). A questionnaire-based study was conducted of caregivers of children with SCD who visited a comprehensive sickle cell center in an inner city hospital, who were either on penicillin prophylaxis or hydroxyurea or both. Multidimensional Health Locus of Control Scale (MHLC) and the Morisky Medication Adherence Scale (MMAS-8) questionnaires were used for the study. Caregivers of 43 children (27 on penicillin prophylaxis, 13 on hydroxyurea, and 3 on both) completed the MHLC and the MMAS-8. There was no significant difference in adherence between the penicillin and the hydroxyurea groups. The mean Powerful Others score of caregivers of the hydroxyurea only group (25.5+5.6) was higher than that of the penicillin only group (21.2+6.1, p=0.043). Regression analysis revealed an inverse relationship of Chance Locus of Control to adherence in the entire group (Beta = -0.306, R2=0.093, F[1,40]=4.12, p=0.049). Chance Locus of control may identify caregivers of children with SCD at risk for non-adherence to treatment. © 2015 National Medical Association. Published by Elsevier Inc. All rights reserved.

  18. Factors influencing medication knowledge and beliefs on warfarin adherence among patients with atrial fibrillation in China.

    Science.gov (United States)

    Zhao, Shujuan; Zhao, Hongwei; Wang, Xianpei; Gao, Chuanyu; Qin, Yuhua; Cai, Haixia; Chen, Boya; Cao, Jingjing

    2017-01-01

    Warfarin is often used for ischemic stroke prevention in patients with atrial fibrillation (AF), but the factors affecting patient adherence to warfarin therapy have not been fully understood. A cross-sectional survey was conducted in AF patients undergoing warfarin therapy at least 6 months prior to the study. The clinical data collected using questionnaires by phone interviews included the following: 1) self-reported adherence measured by the Morisky Medication Adherence Scale-8 © ; 2) beliefs about medicines surveyed by Beliefs about Medicines Questionnaire (BMQ); and 3) drug knowledge as measured by the Warfarin Related Knowledge Test (WRKT). Demographic and clinical factors associated with warfarin adherence were identified using a logistic regression model. Two hundred eighty-eight patients completed the survey and 93 (32.3%) of them were classified as nonadherent (Morisky Medication Adherence Scale-8 score beliefs in the necessity of their specific medications ([odds ratio {OR} =1.81, 95% confidence interval {CI} =1.51-2.15] and [OR =1.17, 95% CI =1.06-1.29], respectively). Patients with greater concerns about adverse reactions and more negative views of general harm were more likely to be nonadherent ([OR =0.76, 95% CI =0.69-0.84] and [OR =0.82, 95% CI =0.73-0.92], respectively). BMK and WRKT are related with patient behavior toward warfarin adherence. BMQ can be applied to identify patients at increased risk of nonadherence.

  19. Use of automated medication adherence monitoring in bipolar disorder research: pitfalls, pragmatics, and possibilities.

    Science.gov (United States)

    Levin, Jennifer B; Sams, Johnny; Tatsuoka, Curtis; Cassidy, Kristin A; Sajatovic, Martha

    2015-04-01

    Medication nonadherence occurs in 20-60% of persons with bipolar disorder (BD) and is associated with serious negative outcomes, including relapse, hospitalization, incarceration, suicide and high healthcare costs. Various strategies have been developed to measure adherence in BD. This descriptive paper summarizes challenges and workable strategies using electronic medication monitoring in a randomized clinical trial (RCT) in patients with BD. Descriptive data from 57 nonadherent individuals with BD enrolled in a prospective RCT evaluating a novel customized adherence intervention versus control were analyzed. Analyses focused on whole group data and did not assess intervention effects. Adherence was assessed with the self-reported Tablets Routine Questionnaire and the Medication Event Monitoring System (MEMS). The majority of participants were women (74%), African American (69%), with type I BD (77%). Practical limitations of MEMS included misuse in conjunction with pill minders, polypharmacy, cost, failure to bring to research visits, losing the device, and the device impacting baseline measurement. The advantages were more precise measurement, less biased recall, and collecting data from past time periods for missed interim visits. Automated devices such as MEMS can assist investigators in evaluating adherence in patients with BD. Knowing the anticipated pitfalls allows study teams to implement preemptive procedures for successful implementation in BD adherence studies and can help pave the way for future refinements as automated adherence assessment technologies become more sophisticated and readily available.

  20. Perception Towards the Use of Smartphone Application (Apps to Enhance Medication Adherence Among Saudi Pediatrics

    Directory of Open Access Journals (Sweden)

    Renad Alsalamah

    2018-03-01

    Full Text Available Objectives: The aim of this study was to measure the importance of smartphone applications (Apps in medication adherence in children to help parents and caregivers in giving medication to children to maintain a good health and quality of life, and to improve current clinical practices in adherence to medications among Saudi pediatrics. Methodology: Cross sectional survey to Saudi Arabia population was conducted from March to April 2017(n=405. Data were collected, tabulated and analyzed using Survey Monkey. We present design requirements for building medication reminders that support the routine aspect of medication-taking by linking children’s concerns, (such as games on taking medications at time. Results: Of the 405 survey participants, the majority of participants 72.5% were not aware by applications of smart device that make easier to take medicines regularly. Eighty percent of participants preferred a mobile app to help their children take the medicine easily and regularly, and 39.8% of them thought that the child will interact with this game, the majority of them 88.6% don’t have any obstacle hinders the use of these updated applications. Fifty percent of them will encourage young patients, to use such applications (App to help them in their medication adherence. Conclusion: Nonadherence to medication is still represents a fundamental health care challenge. The presence of an application makes it easier for parents to give medication to their sick children. Most children love playing games, there is a high probability of their attachment to this application (App and it will promote children’s medication adherence. Key words: Patient adherence, Pediatric, Smartphone, Applications, Apps.

  1. Effects of breast cancer on chronic disease medication adherence among older women.

    Science.gov (United States)

    Santorelli, Melissa L; Steinberg, Michael B; Hirshfield, Kim M; Rhoads, George G; Bandera, Elisa V; Lin, Yong; Demissie, Kitaw

    2016-08-01

    The purpose of this study was to determine the effects of breast cancer on chronic disease medication adherence among older women. The Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked data and a 5% random sample of Medicare enrollees were used. Stage I-III breast cancer patients diagnosed in 2008 and women without cancer were eligible. Three cohorts of medication users 66+ years were identified using diagnosis codes and prescription fill records: diabetes, hypertension, and lipid disorders. For each cohort, breast cancer patients were frequency matched to comparison women by age and geographic area. Medication adherence was measured by the proportion of days covered and medication persistence. During the post-baseline period, the percentage of breast cancer patients who were non-adherent was 26.2% for diabetes medication, 28.9% for lipid-lowering medication, and 14.2% for hypertension medication. Breast cancer patients experienced an increased odds of diabetes medication non-adherence [odds ratio (OR) = 1.44; 95% confidence interval (CI) = 1.07 to 1.95] and were more likely to be non-persistent with diabetes medication (hazard ratio = 1.31; 95%CI: 1.04 to 1.66) relative to women without cancer. The study failed to show a difference between breast cancer and comparison women in the odds of non-adherence to hypertensive (OR = 0.87; 95%CI: 0.71 to 1.05) or lipid-lowering medication (OR = 0. 91; 95%CI: 0.73 to 1.13) with a proportion of days covered threshold of 80%. Special attention should be given to the coordination of primary care for older breast cancer patients with diabetes. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  2. A holistic conceptual framework model to describe medication adherence in and guide interventions in diabetes mellitus.

    Science.gov (United States)

    Jaam, Myriam; Awaisu, Ahmed; Mohamed Ibrahim, Mohamed Izham; Kheir, Nadir

    2018-04-01

    Nonadherence to medications in patients with diabetes, which results in poor treatment outcomes and increased healthcare costs, is commonly reported globally. Factors associated with medication adherence have also been widely studied. However, a clear and comprehensive, disease-specific conceptual framework model that captures all possible factors has not been established. This study aimed to develop a conceptual framework that addresses the complex network of barriers to medication adherence in patients with diabetes. Fourteen databases and grey literature sources were systematically searched for systematic reviews reporting barriers to medication adherence in patients with diabetes. A thematic approach was used to categorize all identified barriers from the reviews and to create a matrix representing the complex network and relations of the different barriers. Eighteen systematic reviews were identified and used for the development of the conceptual framework. Overall, six major themes emerged: patient-, medication-, disease-, provider-, system-, and societal-related factors. Each of these themes was further classified into different sub-categories. It was noted that most interactions were identified to be within the patient-related factors, which not only interact with other themes but also within the same theme. Patient's demographics as well as cultural beliefs were the most notable factors in terms of interactions with other categories and themes. The intricate network and interaction of factors identified between different themes and within individual themes indicate the complexity of the problem of adherence. This framework will potentially enhance the understanding of the complex relation between different barriers for medication adherence in diabetes and will facilitate design of more effective interventions. Future interventions for enhancing medication adherence should look at the overall factors and target multiple themes of barriers to improve patient

  3. Medical pluralism: global perspectives on equity issues.

    Science.gov (United States)

    Marian, Florica

    2007-12-01

    Over the last decades, awareness has increased about the phenomenon of medical pluralism and the importance to integrate biomedicine and other forms of health care. The broad variety of healing cultures existing alongside biomedicine is called complementary or alternative medicine (CAM) in industrialized countries and traditional medicine (TM) in developing countries. Considerable debate has arisen about ethical problems related to the growing use of CAM in industrialized countries. This article focuses on equity issues and aims to consider them from a global perspective of medical pluralism. Several dimensions of equity are explored and their interrelatedness discussed: access to care, research (paradigm and founding) and recognition. This so-called 'equity circle' is then related to Iris Marion Young's justice theory and particularly to the concepts of cultural imperialism, powerlessness and marginalisation.

  4. Design and Evaluation of a Medication Adherence Application with Communication for Seniors in Independent Living Communities.

    Science.gov (United States)

    Dasgupta, Dipanwita; Johnson, Reid A; Chaudhry, Beenish; Reeves, Kimberly G; Willaert, Patty; Chawla, Nitesh V

    2016-01-01

    Medication non-adherence is a pressing concern among seniors, leading to a lower quality of life and higher healthcare costs. While mobile applications provide a viable medium for medication management, their utility can be limited without tackling the specific needs of seniors and facilitating the active involvement of care providers. To address these limitations, we are developing a tablet-based application designed specifically for seniors to track their medications and a web portal for their care providers to track medication adherence. In collaboration with a local Aging in Place program, we conducted a three-month study with sixteen participants from an independent living facility. Our study found that the application helped participants to effectively track their medications and improved their sense of wellbeing. Our findings highlight the importance of catering to the needs of seniors and of involving care providers in this process, with specific recommendations for the development of future medication management applications.

  5. Adherence of pharmaceutical advertisements in medical journals to FDA guidelines and content for safe prescribing.

    Science.gov (United States)

    Korenstein, Deborah; Keyhani, Salomeh; Mendelson, Ali; Ross, Joseph S

    2011-01-01

    Physician-directed pharmaceutical advertising is regulated in the United States by the Food and Drug Administration (FDA); adherence to current FDA guidelines is unknown. Our objective was to determine adherence rates of physician-directed print advertisements in biomedical journals to FDA guidelines and describe content important for safe prescribing. Cross-sectional analysis of November 2008 pharmaceutical advertisements within top U.S.-based biomedical journals publishing original research. We excluded advertisements for devices, over the counter medications, and disease awareness. We utilized FDA guideline items identifying unique forms of advertisement bias to categorize advertisements as adherent to FDA guidelines, possibly non-adherent to at least 1 item, or non-adherent to at least 1 item. We also evaluated advertisement content important for safe prescribing, including benefit quantification, risk information and verifiable references. All advertisements were evaluated by 2 or more investigators, with differences resolved by discussion. Twelve journals met inclusion criteria. Nine contained pharmaceutical advertisements, including 192 advertisements for 82 unique products; median 2 per product (range 1-14). Six "teaser" advertisements presented only drug names, leaving 83 full unique advertisements. Fifteen advertisements (18.1%) adhered to all FDA guidelines, 41 (49.4%) were non-adherent with at least one form of FDA-described bias, and 27 (32.5%) were possibly non-adherent due to incomplete information. Content important for safe prescribing was often incomplete; 57.8% of advertisements did not quantify serious risks, 48.2% lacked verifiable references and 28.9% failed to present adequate efficacy quantification. Study limitations included its focus on advertisements from a single month, the subjectivity of FDA guidelines themselves, and the necessary subjectivity of determinations of adherence. Few physician-directed print pharmaceutical advertisements

  6. Adherence of pharmaceutical advertisements in medical journals to FDA guidelines and content for safe prescribing.

    Directory of Open Access Journals (Sweden)

    Deborah Korenstein

    Full Text Available Physician-directed pharmaceutical advertising is regulated in the United States by the Food and Drug Administration (FDA; adherence to current FDA guidelines is unknown. Our objective was to determine adherence rates of physician-directed print advertisements in biomedical journals to FDA guidelines and describe content important for safe prescribing.Cross-sectional analysis of November 2008 pharmaceutical advertisements within top U.S.-based biomedical journals publishing original research. We excluded advertisements for devices, over the counter medications, and disease awareness. We utilized FDA guideline items identifying unique forms of advertisement bias to categorize advertisements as adherent to FDA guidelines, possibly non-adherent to at least 1 item, or non-adherent to at least 1 item. We also evaluated advertisement content important for safe prescribing, including benefit quantification, risk information and verifiable references. All advertisements were evaluated by 2 or more investigators, with differences resolved by discussion. Twelve journals met inclusion criteria. Nine contained pharmaceutical advertisements, including 192 advertisements for 82 unique products; median 2 per product (range 1-14. Six "teaser" advertisements presented only drug names, leaving 83 full unique advertisements. Fifteen advertisements (18.1% adhered to all FDA guidelines, 41 (49.4% were non-adherent with at least one form of FDA-described bias, and 27 (32.5% were possibly non-adherent due to incomplete information. Content important for safe prescribing was often incomplete; 57.8% of advertisements did not quantify serious risks, 48.2% lacked verifiable references and 28.9% failed to present adequate efficacy quantification. Study limitations included its focus on advertisements from a single month, the subjectivity of FDA guidelines themselves, and the necessary subjectivity of determinations of adherence.Few physician-directed print pharmaceutical

  7. Characterization of socioeconomic status of Japanese patients with atopic dermatitis showing poor medical adherence and reasons for drug discontinuation.

    Science.gov (United States)

    Murota, Hiroyuki; Takeuchi, Satoshi; Sugaya, Makoto; Tanioka, Miki; Onozuka, Daisuke; Hagihara, Akihito; Saeki, Hidehisa; Imafuku, Shinichi; Abe, Masatoshi; Shintani, Yoichi; Kaneko, Sakae; Masuda, Koji; Hiragun, Takaaki; Inomata, Naoko; Kitami, Yuki; Tsunemi, Yuichiro; Abe, Shinya; Kobayashi, Miwa; Morisky, Donald E; Furue, Masutaka; Katoh, Norihito

    2015-09-01

    Patients' high adherence to medication is indispensable for the management of skin diseases including atopic dermatitis. We previously showed poor medication adherence in Japanese dermatological patients. This study was conducted to determine the level of adherence to oral or topical medication in Japanese patients with atopic dermatitis, attempting to characterize the socioeconomic status of those patients with poor adherence. A web questionnaire survey on demographic data as well as adherence level was conducted on patients registered in the monitoring system. Adherence level was assessed with Morisky Medication Adherence Scale-8 (MMAS-8). Among a total of 3096 respondents with dermatological disorders, data of 1327 subjects with atopic dermatitis were extracted and analyzed. More than 80% of subjects felt that both oral and topical medications were safe and efficacious, while less than 60% of them were satisfied with their treatment. Levels of adherence to oral and topical treatments were evaluated with MMAS-8, giving scores of 4.6 and 4.2, respectively. Demographic factors such as gender, marital status, state of employment, alcohol consumption, frequency of hospital visits, and experience of drug effectiveness had a significant impact on the degree of adherence to treatment. Medication adherence level in Japanese subjects with atopic dermatitis was relatively low compared with that of other chronic diseases. Our survey has characterized patients with poor adherence, who are good targets for interventions to maximize potentially limited healthcare resources. Copyright © 2015 Z. Published by Elsevier Ireland Ltd.. All rights reserved.

  8. Medication adherence to oral iron therapy in patients with iron deficiency anemia

    Science.gov (United States)

    Gereklioglu, Cigdem; Asma, Suheyl; Korur, Asli; Erdogan, Ferit; Kut, Altug

    2016-01-01

    Objective: This study aimed at investigating the factors affecting medication adherence in patients who use oral iron therapy due to iron deficiency anemia. Methods: A total of 96 female patients in fertile age with mean age of 30±10.1 years (range 18-53) who were admitted to Family Medicine Clinic between 01 January and 31 March 2015 and who had received iron therapy within the recent three years were enrolled in the study. Data were collected through a questionnaire form. Results: Of the patients, 39 (40,6%) were detected not to use the medication regularly or during the recommended period. A statistically significant relationship was found between non-adherence to therapy and gastrointestinal side effects and weight gain (p<0.05). Conclusion: Medication adherence is deficient in patients with iron deficiency anemia. The most important reason for this seems gastrointestinal side effects, in addition to weight gain under treatment. PMID:27375698

  9. Interdisciplinary Medication Adherence Program: The Example of a University Community Pharmacy in Switzerland

    Directory of Open Access Journals (Sweden)

    Mélanie Lelubre

    2015-01-01

    Full Text Available The Community Pharmacy of the Department of Ambulatory Care and Community Medicine (Policlinique Médicale Universitaire, PMU, University of Lausanne, developed and implemented an interdisciplinary medication adherence program. The program aims to support and reinforce medication adherence through a multifactorial and interdisciplinary intervention. Motivational interviewing is combined with medication adherence electronic monitors (MEMS, Aardex MWV and a report to patient, physician, nurse, and other pharmacists. This program has become a routine activity and was extended for use with all chronic diseases. From 2004 to 2014, there were 819 patient inclusions, and 268 patients were in follow-up in 2014. This paper aims to present the organization and program’s context, statistical data, published research, and future perspectives.

  10. Perspectives of patients on factors relating to adherence to post-acute coronary syndrome medical regimens

    Directory of Open Access Journals (Sweden)

    Lambert-Kerzner A

    2015-07-01

    Full Text Available Anne Lambert-Kerzner,1,2 Edward P Havranek,2,3 Mary E Plomondon,1,2 Katherine M Fagan,1 Marina S McCreight,1 Kelty B Fehling,1 David J Williams,2 Alison B Hamilton,4 Karen Albright,2 Patrick J Blatchford,2 Renee Mihalko-Corbitt,5 Chris L Bryson,6 Hayden B Bosworth,7 Miriam A Kirshner,7 Eric J Del Giacco,5 P Michael Ho1,2 1Department of Cardiology, Veterans Health Administration (VA Eastern Colorado Health Care System, Denver, CO, 2School of Public Health or School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, 3Cardiology, Denver Health Medical Center, Denver, CO, 4Health Services Research, Veterans Health Administration (VA Greater Los Angeles Healthcare System, Los Angeles, CA, 5Internal Medicine, John L. McClellan Memorial Veterans Hospital, Little Rock, AR, 6Health Services Research, Veterans Health Administration (VA Puget Sound Health Care System, Seattle, WA, 7Health Services Research, Durham Veterans Affairs Medical Center, Durham, NC, USA Purpose: Poor adherence to cardioprotective medications after acute coronary syndrome (ACS hospitalization is associated with increased risk of rehospitalization and mortality. Clinical trials of multifaceted interventions have improved medication adherence with varying results. Patients’ perspectives on interventions could help researchers interpret inconsistent outcomes. Identifying factors that patients believe would improve adherence might inform the design of future interventions and make them more parsimonious and sustainable. The objective of this study was to obtain patients’ perspectives on adherence to medical regimens after experiencing an ACS event and their participation in a medication adherence randomized control trial following their hospitalization. Patients and methods: Sixty-four in-depth interviews were conducted with ACS patients who participated in an efficacious, multifaceted, medication adherence randomized control trial. Interview transcripts were

  11. Interdisciplinary Medication Adherence Program: The Example of a University Community Pharmacy in Switzerland.

    Science.gov (United States)

    Lelubre, Mélanie; Kamal, Susan; Genre, Noëllie; Celio, Jennifer; Gorgerat, Séverine; Hugentobler Hampai, Denise; Bourdin, Aline; Berger, Jerôme; Bugnon, Olivier; Schneider, Marie

    2015-01-01

    The Community Pharmacy of the Department of Ambulatory Care and Community Medicine (Policlinique Médicale Universitaire, PMU), University of Lausanne, developed and implemented an interdisciplinary medication adherence program. The program aims to support and reinforce medication adherence through a multifactorial and interdisciplinary intervention. Motivational interviewing is combined with medication adherence electronic monitors (MEMS, Aardex MWV) and a report to patient, physician, nurse, and other pharmacists. This program has become a routine activity and was extended for use with all chronic diseases. From 2004 to 2014, there were 819 patient inclusions, and 268 patients were in follow-up in 2014. This paper aims to present the organization and program's context, statistical data, published research, and future perspectives.

  12. Qualitative Comparison of Barriers to Antiretroviral Medication Adherence Among Perinatally and Behaviorally HIV-Infected Youth.

    Science.gov (United States)

    Fields, Errol L; Bogart, Laura M; Thurston, Idia B; Hu, Caroline H; Skeer, Margie R; Safren, Steven A; Mimiaga, Matthew J

    2017-07-01

    Medication adherence among youth living with HIV (28%-69%) is often insufficient for viral suppression. The psychosocial context of adherence barriers is complex. We sought to qualitatively understand adherence barriers among behaviorally infected and perinatally infected youth and develop an intervention specific to their needs. We conducted in-depth interviews with 30 youth living with HIV (aged 14-24 years) and analyzed transcripts using the constant comparative method. Barriers were influenced by clinical and psychosocial factors. Perinatally infected youth barriers included reactance, complicated regimens, HIV fatigue, and difficulty transitioning to autonomous care. Behaviorally infected youth barriers included HIV-related shame and difficulty initiating medication. Both groups reported low risk perception, medication as a reminder of HIV, and nondisclosure, but described different contexts to these common barriers. Common and unique barriers emerged for behaviorally infected and perinatally infected youth reflecting varying HIV experiences and psychosocial contexts. We developed a customizable intervention addressing identified barriers and their psychosocial antecedents.

  13. Medication adherence to oral iron therapy in patients with iron deficiency anemia.

    Science.gov (United States)

    Gereklioglu, Cigdem; Asma, Suheyl; Korur, Asli; Erdogan, Ferit; Kut, Altug

    2016-01-01

    This study aimed at investigating the factors affecting medication adherence in patients who use oral iron therapy due to iron deficiency anemia. A total of 96 female patients in fertile age with mean age of 30±10.1 years (range 18-53) who were admitted to Family Medicine Clinic between 01 January and 31 March 2015 and who had received iron therapy within the recent three years were enrolled in the study. Data were collected through a questionnaire form. Of the patients, 39 (40,6%) were detected not to use the medication regularly or during the recommended period. A statistically significant relationship was found between non-adherence to therapy and gastrointestinal side effects and weight gain (p<0.05). Medication adherence is deficient in patients with iron deficiency anemia. The most important reason for this seems gastrointestinal side effects, in addition to weight gain under treatment.

  14. The Effectiveness of Mobile Phone Text Messaging in Improving Medication Adherence for Patients with Chronic Diseases: A Systematic Review

    OpenAIRE

    Ershad Sarabi, Roghayeh; Sadoughi, Farahnaz; Jamshidi Orak, Roohangiz; Bahaadinbeigy, Kambiz

    2016-01-01

    Context Medication non-adherence is a commonly observed problem in the self-administration of treatment, regardless of the disease type. Text messaging reminders, as electronic reminders, provide an opportunity to improve medication adherence. In this study, we aimed to provide evidence addressing the question of whether text message reminders were effective in improving patients? adherence to medication. Evidence Acquisition We carried out a systematic literature search, using the five elect...

  15. EpxMedTracking: Feasibility Evaluation of an SMS-Based Medication Adherence Tracking System in Community Practice

    OpenAIRE

    Tricarico, Christopher; Peters, Robert; Som, Avik; Javaherian, Kavon; Ross, Will

    2017-01-01

    Background Medication adherence remains a difficult problem to both assess and improve in patients. It is a multifactorial problem that goes beyond the commonly cited reason of forgetfulness. To date, eHealth (also known as mHealth and telehealth) interventions to improve medication adherence have largely been successful in improving adherence. However, interventions to date have used time- and cost-intensive strategies or focused solely on medication reminding, leaving much room for improvem...

  16. Breast cancer oral anti-cancer medication adherence: a systematic review of psychosocial motivators and barriers.

    Science.gov (United States)

    Lin, Cheryl; Clark, Rachel; Tu, Pikuei; Bosworth, Hayden B; Zullig, Leah L

    2017-09-01

    In the past decade, there has been an increase in the development and use of oral anti-cancer medications (OAMs), especially for breast cancer-the most prevalent cancer in women. However, adherence rates for OAMs are often suboptimal, leading to lower survival rate, increased risk of recurrence, and higher healthcare costs. Our goal was to identify potentially modifiable psychosocial facilitators and barriers that may be targeted to increase OAM adherence for breast cancer patients. We systematically searched PubMed for studies published in the U.S. by June 15, 2016 that addressed the following: (1) OAMs for breast cancer; (2) medication adherence; and (3) at least one psychosocial aspect of adherence. Of the 1752 papers screened, 21 articles were included and analyzed. The most commonly reported motivators for adherence are patient-provider relationships (n = 11 studied, 82% reported significant association) and positive views and beliefs of medication (n = 9 studied, 89% reported significant association). We also identified consistent evidence of the impact of depression and emotions, perception of illness, concern of side effects, self-efficacy in medication management and decision making, knowledge of medication, and social support on OAM adherence. Compared to traditional demographic, system, and clinical-related factors that have been well documented in the literature but are not easily changed, these cognitive, psychological, and interpersonal factors are more amendable via intervention and therefore could generate greater benefit in improving patient compliance and health outcomes. As OAMs shift treatment administration responsibility onto patients, continuous provider communication and education on illness and regimen are the keys to supporting patients' medication behavior.

  17. A Randomized Trial of a Multicomponent Intervention to Promote Medication Adherence: The Teen Adherence in Kidney Transplant Effectiveness of Intervention Trial (TAKE-IT).

    Science.gov (United States)

    Foster, Bethany J; Pai, Ahna L H; Zelikovsky, Nataliya; Amaral, Sandra; Bell, Lorraine; Dharnidharka, Vikas R; Hebert, Diane; Holly, Crystal; Knauper, Baerbel; Matsell, Douglas; Phan, Veronique; Rogers, Rachel; Smith, Jodi M; Zhao, Huaqing; Furth, Susan L

    2018-03-15

    Poor adherence to immunosuppressive medications is a major cause of premature graft loss among children and young adults. Multicomponent interventions have shown promise but have not been fully evaluated. Unblinded parallel-arm randomized trial to assess the efficacy of a clinic-based adherence-promoting intervention. Prevalent kidney transplant recipients 11 to 24 years of age and 3 or more months posttransplantation at 8 kidney transplantation centers in Canada and the United States (February 2012 to May 2016) were included. Adherence was electronically monitored in all participants during a 3-month run-in, followed by a 12-month intervention. Participants assigned to the TAKE-IT intervention could choose to receive text message, e-mail, and/or visual cue dose reminders and met with a coach at 3-month intervals when adherence data from the prior 3 months were reviewed with the participant. "Action-Focused Problem Solving" was used to address adherence barriers selected as important by the participant. Participants assigned to the control group met with coaches at 3-month intervals but received no feedback about adherence data. The primary outcomes were electronically measured "taking" adherence (the proportion of prescribed doses of immunosuppressive medications taken) and "timing" adherence (the proportion of doses of immunosuppressive medications taken between 1 hour before and 2 hours after the prescribed time of administration) on each day of observation. Secondary outcomes included the standard deviation of tacrolimus trough concentrations, self-reported adherence, acute rejection, and graft failure. 81 patients were assigned to intervention (median age, 15.5 years; 57% male) and 88 to the control group (median age, 15.8 years; 61% male). Electronic adherence data were available for 64 intervention and 74 control participants. Participants in the intervention group had significantly greater odds of taking prescribed medications (OR, 1.66; 95% CI, 1

  18. Medication Adherence Amongst Diabetic Patients in a Tertiary ...

    African Journals Online (AJOL)

    2014-03-22

    Mar 22, 2014 ... Pharmacotherapy Group, Faculty of Pharmacy, University of Benin, Benin City, 300001 Nigeria. All rights reserved. ... ambulatory care is an important link between medical ... the outpatient clinic of the endocrine unit of the.

  19. Knowledge of and Adherence to Hygiene Guidelines among Medical Students in Austria

    Directory of Open Access Journals (Sweden)

    Verena G. Herbert

    2013-01-01

    Full Text Available Background. Adherence to hygiene guidelines is of utmost importance for healthcare professionals. The aim of this study was to evaluate the knowledge on and the adherence to hygiene guidelines among medical students in Austria. Additionally, a possible difference between female and male students was investigated. Methods. An open paper-based survey among third-year medical students at the Medical University of Graz was conducted. The questionnaire consisted of 20 single-choice questions covering compliance with basic hygiene standards, self-rated knowledge of hygiene guidelines, and satisfaction with current hygiene education, equipment, and quality standards. Results. Of 192 medical students, 70% judged their knowledge of hygiene standards as “excellent” or “good”; however, only 49% reported adherence to hygiene guidelines and only 43% performed hygienic hand disinfection according to WHO guidelines. Of the respondents, 79% voted for a mandatory course on hygiene standards in medical education. No significant gender differences were observed. Conclusion. While the knowledge on hygiene guidelines appears to be good among medical students, adherence is limited and requires improvement. The need for an optimum education in hygiene is high.

  20. Medication practice and feminist thought: a theoretical and ethical response to adherence in HIV/AIDS.

    Science.gov (United States)

    Broyles, Lauren M; Colbert, Alison M; Erlen, Judith A

    2005-08-01

    Accurate self-administration of antiretroviral medication therapy for HIV/AIDS is a significant clinical and ethical concern because of its implications for individual morbidity and mortality, the health of the public, and escalating healthcare costs. However, the traditional construction of patient medication adherence is oversimplified, myopic, and ethically problematic. Adherence relies on existing social power structures and western normative assumptions about the proper roles of patients and providers, and principally focuses on patient variables, obscuring the powerful socioeconomic and institutional influences on behaviour. Some professionals advocate for alternate approaches to adherence, but many of the available alternatives remain conceptually underdeveloped. Using HIV/AIDS as an exemplar, this paper presents medication practice as a theoretical reconstruction and explicates its conceptual and ethical evolution. We first propose that one of these alternatives, medication practice, broadens the understanding of individuals' medication-taking behaviour, speaks to the inherent power inequities in the patient-provider interaction, and addresses the ethical shortcomings in the traditional construal. We then integrate medication practice with feminist thought, further validating individuals' situated knowledge, choices, and multiple roles; more fully recognizing the individual as a multidiminsional, autonomous human being; and reducing notions of obedience and deference to authority. Blame is thus extricated from the healthcare relationship, reshaping the traditionally adversarial components of the interaction, and eliminating the view of adherence as a patient problem in need of patient-centred interventions.

  1. The association between trust in health care providers and medication adherence among Black women with hypertension

    Directory of Open Access Journals (Sweden)

    Willie M. Abel

    2013-12-01

    Full Text Available Background: Black women have the highest prevalence of hypertension in the world. Reasons for this disparity are poorly understood. The historical legacy of medical maltreatment of Blacks in the U.S. provides some insight into distrust in the medical profession, refusal of treatment, and poor adherence to treatment regimens.Methods: Black women (N=80 who were prescribed antihypertensive medications were recruited from urban communities in North Carolina. Study participants completed the Trust in Physician and Hill-Bone Compliance to High Blood Pressure Therapy questionnaires. An exact discrete-event model was used to examine the relationship between trust and medication adherence.Results: Mean age of study participants was 48 ± 9.2 years. The majority of participants (67% were actively employed and 30% had incomes at or below the federal poverty level. Increasing levels of trust in the health care provider was independently associated with greater medication adherence (PTrend=0.015.Conclusions: Black women with hypertension who trusted their health care providers were more likely to be adherent with their prescribed antihypertensive medications than those who did not trust their health care providers. Findings suggest that trusting relationships between Black women and health care providers are important to decreasing disparate rates of hypertension.

  2. Impact on medication use and adherence of Australian pharmacists' diabetes care services.

    Science.gov (United States)

    Krass, Ines; Taylor, Susan J; Smith, Carlene; Armour, Carol L

    2005-01-01

    To assess the effect of a specialized service implemented in community pharmacies for patients with type 2 diabetes on medication use and medication-related problems. Parallel group, multisite, control versus intervention, repeated measures design, with three different regions in New South Wales, Australia, used as intervention regions, then matched with control regions as much as possible. After initial training, pharmacists followed a clinical protocol for more than 9 months, with patient contact approximately monthly. Each patient received an adherence assessment at the beginning and end of the study, adherence support, and a medication review as part of the intervention. Risk of nonadherence using Brief Medication Questionnaire (BMQ) scores and changes to medication regimen. Compared with 82 control patients, 106 intervention patients with similar demographic and clinical characteristics had significantly improved self-reported nonadherence as reflected in total BMQ scores after 9 months. The mean (+/-SD) number of medications prescribed at follow-up in intervention participants decreased significantly, from 8.2+/-3.0 to 7.7+/-2.7. No reduction was observed among the control patients (7.6+/-2.4 and 7.3+/-2.4). The overall prevalence of changes to the regimen was also significantly higher in the intervention group (51%) compared with controls (40%). Community pharmacists trained in medication review and using protocols in collaboration with providers improved adherence in patients with type 2 diabetes, reduced problems patients had in accessing their medications, and recommended medication regimen changes that improved outcomes.

  3. Medication adherence among adolescent solid-organ transplant recipients: A survey of healthcare providers.

    Science.gov (United States)

    Mehta, Pooja; Steinberg, Elizabeth A; Kelly, Sarah L; Buchanan, Cindy; Rawlinson, Alana Resmini

    2017-11-01

    The aim of this study was to assess healthcare provider perspectives on barriers to medication adherence and to discover recommendations for interventions among providers of pediatric solid-organ transplant patients. An anonymous online survey was administered to a multidisciplinary pool of pediatric transplant providers from February 2015 to March 2016. It consisted of 15 questions regarding transplant providers' attitudes, clinical practice, and beliefs pertaining to medication adherence among teenage solid-organ transplant recipients. Data were analyzed using descriptive statistics. Responses to open-ended questions were coded and categorized into themes. One hundred ten surveys were completed by providers specializing in pediatric heart, kidney, liver, lung, and/or intestinal transplantation. Commonly cited reasons for poor adherence were forgetting/poor planning (94%), the desire to be normal (86%), lack of support (86%), and poor parental monitoring (79%). Suggestions to improve adherence included increasing peer and family support, providing education, and incorporating technology into adherence regimens. Barriers to adherence in transplant patients are recognized by providers and are both similar to and disparate from patient and family identified barriers published in the literature. Providers recognize the importance of education, social support, and technologically driven interventions on improving outcomes in the transplant population. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. The association of smoking with medical treatment adherence in the workforce of a large employer

    Directory of Open Access Journals (Sweden)

    Sherman BW

    2014-04-01

    Full Text Available Bruce W Sherman,1–3 Wendy D Lynch4,5 1Employers Health Coalition, Inc., Canton, OH, USA; 2Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA; 3Sherman Consulting Services, LLC, Burlington, MA, USA; 4Lynch Consulting, Ltd, Steamboat Springs, CO, USA; 5Altarum Institute, Ann Arbor, MI, USA Purpose: Prior descriptive epidemiology studies have shown that smokers have lower compliance rates with preventive care services and lower chronic medication adherence rates for preventive care services in separate studies. The goal of this study was to perform a more detailed analysis to validate both of these findings for current smokers versus nonsmokers within the benefit-covered population of a large US employer. Patients and methods: This study involved the analysis of incurred medical and pharmacy claims for employee and spouse health plan enrollees of a single US-based employer during 2010. Multivariate regression models were used to compare data by active or never-smoker status for preventive care services and medication adherence for chronic conditions. Analysis controlled for demographic variables, chronic condition prevalence, and depression. Results: Controlling for demographic variables and comorbid conditions, smokers had significantly lower cancer screening rates, with absolute reductions of 6%–13%. Adherence to chronic medication use for hypertension was also significantly lower among smokers, with nearly 7% fewer smokers having a medication possession ratio of ≥80%. Smokers were less adherent to depression medications (relative risk =0.79 than nonsmokers (P=0.10. While not statistically significant, smokers were consistently less adherent to all other medications than nonsmokers. Conclusion: Current smokers are less compliant with recommended preventive care and medication use than nonsmokers, likely contributing to smoking-related employer costs. Awareness of these care gaps among smokers and

  5. Assessing the Medication Adherence App Marketplace From the Health Professional and Consumer Vantage Points.

    Science.gov (United States)

    Dayer, Lindsey E; Shilling, Rebecca; Van Valkenburg, Madalyn; Martin, Bradley C; Gubbins, Paul O; Hadden, Kristie; Heldenbrand, Seth

    2017-04-19

    Nonadherence produces considerable health consequences and economic burden to patients and payers. One approach to improve medication nonadherence that has gained interest in recent years is the use of smartphone adherence apps. The development of smartphone adherence apps has increased rapidly since 2012; however, literature evaluating the clinical app and effectiveness of smartphone adherence apps to improve medication adherence is generally lacking. The aims of this study were to (1) provide an updated evaluation and comparison of medication adherence apps in the marketplace by assessing the features, functionality, and health literacy (HL) of the highest-ranking adherence apps and (2) indirectly measure the validity of our rating methodology by determining the relationship between our app evaluations and Web-based consumer ratings. Two independent reviewers assessed the features and functionality using a 4-domain rating tool of all adherence apps identified based on developer claims. The same reviewers downloaded and tested the 100 highest-ranking apps including an additional domain for assessment of HL. Pearson product correlations were estimated between the consumer ratings and our domain and total scores. A total of 824 adherence apps were identified; of these, 645 unique apps were evaluated after applying exclusion criteria. The median initial score based on descriptions was 14 (max of 68; range 0-60). As a result, 100 of the highest-scoring unique apps underwent user testing. The median overall user-tested score was 31.5 (max of 73; range 0-60). The majority of the user tested the adherence apps that underwent user testing reported a consumer rating score in their respective online marketplace. The mean consumer rating was 3.93 (SD 0.84). The total user-tested score was positively correlated with consumer ratings (r=.1969, P=.04). More adherence apps are available in the Web-based marketplace, and the quality of these apps varies considerably. Consumer

  6. Beliefs About GI Medications and Adherence to Pharmacotherapy in Functional GI Disorder Outpatients

    Science.gov (United States)

    Cassell, Benjamin; Gyawali, C. Prakash; Kushnir, Vladimir M.; Gott, Britt M.; Nix, Billy D.; Sayuk, Gregory S.

    2016-01-01

    OBJECTIVES Pharmacotherapy is a mainstay in functional gastrointestinal (GI) disorder (FGID) management, but little is known about patient attitudes toward medication regimens. Understanding patient concerns and adherence to pharmacotherapy is particularly important for off-label medication use (e.g., anti-depressants) in FGID. METHODS Consecutive tertiary GI outpatients completed the Beliefs About Medications questionnaire (BMQ). Subjects were categorized as FGID and structural GI disease (SGID) using clinician diagnoses and Rome criteria; GI-specific medications and doses were recorded, and adherence to medication regimens was determined by patient self-report. BMQ domains (overuse, harm, necessity, and concern) were compared between FGID and SGID, with an interest in how these beliefs affected medication adherence. Psychiatric measures (depression, anxiety, and somatization) were assessed to gauge their influence on medication beliefs. RESULTS A total of 536 subjects (mean age 54.7±0.7 years, range 22–100 years; n=406, 75.7% female) were enrolled over a 5.5-year interval: 341 (63.6%) with FGID (IBS, 64.8%; functional dyspepsia, 51.0%, ≥2 FGIDs, 38.7%) and 142 (26.5%) with SGID (IBD, 28.9%; GERD, 23.2%). PPIs (n=231, 47.8%), tricyclic antidepressants (TCAs) (n=167, 34.6%), and anxiolytics (n=122, 25.3%) were common medications prescribed. FGID and SGID were similar across all BMQ domains (P>0.05 for overuse, harm, necessity, and concern). SGID subjects had higher necessity-concern framework (NCF) scores compared with FGID subjects ( P=0.043). FGID medication adherence correlated negatively with concerns about medication harm (r=−0.24, P<0.001) and overuse (r=−0.15, P=0.001), whereas higher NCF differences predicted medication compliance (P=0.006). Medication concern and overuse scores correlated with psychiatric comorbidity among FGID subjects (P<0.03 for each). FGID patients prescribed TCAs (n=142, 41.6%) expressed a greater medication necessity (17.4

  7. Patient-Centered Tablet Application for Improving Medication Adherence after a Drug-Eluting Stent.

    Science.gov (United States)

    Shah, Vicki; Dileep, Anandu; Dickens, Carolyn; Groo, Vicki; Welland, Betty; Field, Jerry; Baumann, Matthew; Flores, Jose D; Shroff, Adhir; Zhao, Zhongsheng; Yao, Yingwei; Wilkie, Diana J; Boyd, Andrew D

    2016-01-01

    This study's objective was to evaluate a patient-centered educational electronic tablet application, "My Interventional Drug-Eluting Stent Educational App" (MyIDEA) to see if there was an increase in patient knowledge about dual antiplatelet therapy (DAPT) and medication possession ratio (MPR) compared to treatment as usual. In a pilot project, 24 elderly (≥50 years old) research participants were recruited after a drug-eluting stent. Eleven were randomized to the control arm and 13 to the interventional arm. All the participants completed psychological and knowledge questionnaires. Adherence was assessed through MPR, which was calculated at 3 months for all participants who were scheduled for second and third follow-up visits. Relative to control, the interventional group had a 10% average increase in MPR. As compared to the interventional group, more patients in the control group had poor adherence (<80% MPR). The psychological data revealed a single imbalance in anxiety between the control and interventional groups. On average, interventional participants spent 21 min using MyIDEA. Consumer health informatics has enabled us to engage patients with their health data using novel methods. Consumer health technology needs to focus more on patient knowledge and engagement to improve long-term health. MyIDEA takes a unique approach in targeting DAPT from the onset. MyIDEA leverages patient-centered information with clinical care and the electronic health record highlighting the patients' role as a team member in their own health care. The patients think critically about adverse events and how to solve issues before leaving the hospital.

  8. Patient Centered Tablet Application for improving medication adherence after a Drug Eluting Stent

    Directory of Open Access Journals (Sweden)

    Vicki Shah

    2016-12-01

    Full Text Available Background/Aims: This study’s objective was to evaluate a patient-centered educational electronic tablet application, My Interventional Drug-Eluting Stent Educational App (MyIDEA to see if there was an increase in patient knowledge about dual antiplatelet therapy (DAPT and medication possession ratio (MPR compared to treatment as usual. Methods: In a pilot project, 24 elderly (≥50 years-old research participants were recruited after a Drug Eluting Stent. 11 were randomized to the control arm and 13 to the interventional arm. All participants completed psychological and knowledge questionnaires. Adherence was assessed through MPR, which was calculated at three months for all participants who were scheduled for a second and third follow-up visit.Results: Relative to control, the interventional group had a 10% average increase in MPR. As compared to the interventional group, more patients in the control group had poor adherence (<80% MPR. The psychological data revealed a single imbalance in anxiety between the control and interventional groups. On average interventional participants spent 21 minutes using MyIDEA. Discussion: Consumer health informatics has enabled us to engage patients with their health data using novel methods. Consumer health technology needs to focus more on patient knowledge and engagement to improve long term health. MyIDEA takes a unique approach in targeting DAPT from the onset.Conclusion: MyIDEA leverages patient centered information with clinical care and the electronic health record highlighting the patients’ role as a team member in their own healthcare. The patients think critically about adverse events and how to solve issues before leaving the hospital.

  9. Medication Adherence using Non-intrusive Wearable Sensors

    Directory of Open Access Journals (Sweden)

    T. H. Lim

    2017-12-01

    Full Text Available Activity recognition approaches have been applied in home ambient systems to monitor the status and well- being of occupant especially for home care systems. With the advancement of embedded wireless sensing devices, various applications have been proposed to monitor user´s activities and maintain a healthy lifestyle. In this paper, we propose and evaluate a Smart Medication Alert and Treatment Electronic Systems (SmartMATES using a non-intrusive wearable activity recognition sensing system to monitor and alert an user for missing medication prescription. Two sensors are used to collect data from the accelerometer and radio transceiver. Based on the data collected, SmartMATES processes the data and generate a model for the various actions including taking medication. We have evaluated the SmartMATES on 9 participants. The results show that the SmartMATES can identify and prevent missing dosage in a less intrusive way than existing mobile application and traditional approaches.

  10. Correlation between the use of 'over-the-counter' medicines and adherence in elderly patients on multiple medications

    DEFF Research Database (Denmark)

    Olesen, Charlotte; Harbig, Philipp; Barat, Ishay

    2014-01-01

    (herbal medicines, dietary supplements, or non-prescribed drugs) was elicited during home visit interviews. Prescription drug adherence was determined by pill counts. A patient was categorised as non-adherent if the mean adherence rate for all drugs consumed was ... to be adherent than were non-users (odds ratio 0.41; 95 % confidence interval 0.18–0.91). Sensitivity analyses where adherence was defined different show no relationship between adherence and use of OTC medicine. Furthermore, separate analyses of herbal medicines, dietary supplements, or non-prescribed drugs did...... not correlate with adherence to prescriptions. Conclusion Amongst elderly patients on multiple medications a positive relationship was found between the overall use of OTC medicines and adherence to prescription drugs, in contrast to none when adherence were defined different or herbal medicines, dietary...

  11. The economics of improving medication adherence in osteoporosis: validation and application of a simulation model.

    Science.gov (United States)

    Patrick, Amanda R; Schousboe, John T; Losina, Elena; Solomon, Daniel H

    2011-09-01

    Adherence to osteoporosis treatment is low. Although new therapies and behavioral interventions may improve medication adherence, questions are likely to arise regarding their cost-effectiveness. Our objectives were to develop and validate a model to simulate the clinical outcomes and costs arising from various osteoporosis medication adherence patterns among women initiating bisphosphonate treatment and to estimate the cost-effectiveness of a hypothetical intervention to improve medication adherence. We constructed a computer simulation using estimates of fracture rates, bisphosphonate treatment effects, costs, and utilities for health states drawn from the published literature. Probabilities of transitioning on and off treatment were estimated from administrative claims data. Patients were women initiating bisphosphonate therapy from the general community. We evaluated a hypothetical behavioral intervention to improve medication adherence. Changes in 10-yr fracture rates and incremental cost-effectiveness ratios were evaluated. A hypothetical intervention with a one-time cost of $250 and reducing bisphosphonate discontinuation by 30% had an incremental cost-effectiveness ratio (ICER) of $29,571 per quality-adjusted life year in 65-yr-old women initiating bisphosphonates. Although the ICER depended on patient age, intervention effectiveness, and intervention cost, the ICERs were less than $50,000 per quality-adjusted life year for the majority of intervention cost and effectiveness scenarios evaluated. Results were sensitive to bisphosphonate cost and effectiveness and assumptions about the rate at which intervention and treatment effects decline over time. Our results suggests that behavioral interventions to improve osteoporosis medication adherence will likely have favorable ICERs if their efficacy can be sustained.

  12. Defining the minimal detectable change in scores on the eight-item Morisky Medication Adherence Scale.

    Science.gov (United States)

    Muntner, Paul; Joyce, Cara; Holt, Elizabeth; He, Jiang; Morisky, Donald; Webber, Larry S; Krousel-Wood, Marie

    2011-05-01

    Self-report scales are used to assess medication adherence. Data on how to discriminate change in self-reported adherence over time from random variability are limited. To determine the minimal detectable change for scores on the 8-item Morisky Medication Adherence Scale (MMAS-8). The MMAS-8 was administered twice, using a standard telephone script, with administration separated by 14-22 days, to 210 participants taking antihypertensive medication in the CoSMO (Cohort Study of Medication Adherence among Older Adults). MMAS-8 scores were calculated and participants were grouped into previously defined categories (<6, 6 to <8, and 8 for low, medium, and high adherence). The mean (SD) age of participants was 78.1 (5.8) years, 43.8% were black, and 68.1% were women. Overall, 8.1% (17/210), 16.2% (34/210), and 51.0% (107/210) of participants had low, medium, and high MMAS-8 scores, respectively, at both survey administrations (overall agreement 75.2%; 158/210). The weighted κ statistic was 0.63 (95% CI 0.53 to 0.72). The intraclass correlation coefficient was 0.78. The within-person standard error of the mean for change in MMAS-8 scores was 0.81, which equated to a minimal detectable change of 1.98 points. Only 4.3% (9/210) of the participants had a change in MMAS-8 of 2 or more points between survey administrations. Within-person changes in MMAS-8 scores of 2 or more points over time may represent a real change in antihypertensive medication adherence.

  13. African Americans’ Perceptions of Adherence to Medications and Lifestyle Changes Prescribed to Treat Hypertension

    Directory of Open Access Journals (Sweden)

    Christina M. Pettey

    2016-01-01

    Full Text Available More than 80 million Americans have hypertension (HTN, and African Americans (AAs are disproportionately affected. AAs also have lower rates of adherence to HTN treatment. It is important to understand AAs’ perceptions of adherence to develop effective interventions. The aim of this study is to examine AAs’ perceptions of adherence to medications and lifestyle changes prescribed to treat HTN. In this qualitative study, we used purposive sampling to recruit Southern AAs with HTN aged 21 and older from a free, faith-based clinic. We recorded individual, in-person interviews about perceptions related to adherence to treatment of HTN and analyzed verbatim transcripts using content analysis and constant comparison. We also conducted medical record audits. Twenty-nine AAs participated (52% female, 38% were <50 years of age, 52% had taken anti-HTN medications for ≥5 years. Audits indicated that 65% had uncontrolled HTN during the previous year. Two main themes included causes of HTN and ways to improve blood pressure. Perceived causes of HTN included diet, stress, unhealthy actions, genes, and obesity. Ways to improve HTN included using cultural treatments “passed down,” increasing exercise, reducing stress, and losing weight. Many reported using home remedies to control HTN, including drinking pickle juice. More than half of this sample had uncontrolled HTN. They identified influences of culture on perceptions of adherence including causes and treatment of HTN, and possibly detrimental home remedies. It is imperative that clinicians identify culturally appropriate interventions for this high-risk group.

  14. Personality Makes a Difference: Attachment Orientation Moderates Theory of Planned Behavior Prediction of Cardiac Medication Adherence.

    Science.gov (United States)

    Peleg, Shira; Vilchinsky, Noa; Fisher, William A; Khaskia, Abed; Mosseri, Morris

    2017-12-01

    To achieve a comprehensive understanding of patients' adherence to medication following acute coronary syndrome (ACS), we assessed the possible moderating role played by attachment orientation on the effects of attitudes, subjective norms, and perceived behavioral control (PBC), as derived from the Theory of Planned Behavior (TPB; Ajzen, 1991), on intention and reported adherence. A prospective longitudinal design was employed. During hospitalization, ACS male patients (N = 106) completed a set of self-report questionnaires including sociodemographic variables, attachment orientation, and measures of TPB constructs. Six months post-discharge, 90 participants completed a questionnaire measuring adherence to medication. Attachment orientations moderated some of the predictions of the TPB model. PBC predicted intention and reported adherence, but these associations were found to be significant only among individuals with lower, as opposed to higher, attachment anxiety. The association between attitudes and intention was stronger among individuals with higher, as opposed to lower, attachment anxiety. Only among individuals with higher attachment avoidance, subjective norms were negatively associated with intention to take medication. Cognitive variables appear to explain both adherence intention and behavior, but differently, depending on individuals' attachment orientations. Integrating personality and cognitive models may prove effective in understanding patients' health behaviors. © 2016 Wiley Periodicals, Inc.

  15. Assessing medication adherence in inflammatory bowel diseases. A comparison between a self-administered scale and a pharmacy refill index.

    Science.gov (United States)

    de Castro, María Luisa; Sanromán, Luciano; Martín, Alicia; Figueira, Montserrat; Martínez, Noemi; Hernández, Vicent; Del Campo, Victor; Pineda, Juan R; Martínez-Cadilla, Jesús; Pereira, Santos; Rodríguez Prada, José Ignacio

    2017-08-01

    Medication non-adherence in inflammatory bowel disease (IBD) has a negative impact on disease outcome. Different tools have been proposed to assess non-adherence. We aimed to compare a self-administered scale and a pharmacy refill index as a reliable measure of medication adherence and to determine what factors are related to adherence. Consecutive non-active IBD outpatients were asked to fill in the self-reported Morisky Medication Adherence Scale (MMAS-8) and the Beliefs about Medication Questionnaire (BMQ). Pharmacy refill data were reviewed from the previous three or six months and the medication possession ratio (MPR) was calculated. Non-adherence was defined as MMAS-8 scores harm of medication were significantly associated with MPR non-adherence (p = 0.01). The accuracy of MMAS-8 to identify medication non-adherence in inactive IBD outpatients in our setting is poor due to a low specificity and a negative predictive value. Psychosocial factors such as beliefs about medication seem to be related to IBD non-adherence.

  16. Development of a Patient-Centered Antipsychotic Medication Adherence Intervention

    Science.gov (United States)

    Pyne, Jeffrey M.; Fischer, Ellen P.; Gilmore, LaNissa; McSweeney, Jean C.; Stewart, Katharine E.; Mittal, Dinesh; Bost, James E.; Valenstein, Marcia

    2014-01-01

    Objective: A substantial gap exists between patients and their mental health providers about patient's perceived barriers, facilitators, and motivators (BFMs) for taking antipsychotic medications. This article describes how we used an intervention mapping (IM) framework coupled with qualitative and quantitative item-selection methods to…

  17. Patients' Perception of App-based Educational and Behavioural Interventions for Enhancing Oral Anticancer Medication Adherence.

    Science.gov (United States)

    Ali, Eskinder Eshetu; Leow, Jo Lene; Chew, Lita; Yap, Kevin Yi-Lwern

    2017-07-14

    Well-designed smartphone apps can potentially help in enhancing adherence to oral anticancer medications (OAMs). The objective of this study was to evaluate patients' perception on inclusion of various adherence-enhancing strategies as features of an app and their interest in using such app. A cross-sectional survey was conducted at the National Cancer Centre Singapore. A structured self-administered questionnaire was used to collect data from patients taking OAMs. Final analysis was based on 409 surveys and most of the respondents were female (291, 71.1%), Chinese (332, 81.2%), married (296, 72.4%) and breast cancer patients (211, 51.6%). Close to two-thirds of respondents rated medication information (65.0%), disease information (60.2%) and side effect self-management (60.2%) features as having the highest level of importance in an adherence app. Three hundred thirty-two (81.2%) of the respondents owned a smartphone, among which 92 (27.7%) reported using health-related apps. From respondents with smartphones, 219 (66.0%) were interested in using an app for OAM adherence. Age 65 and older compared to 21-54 years old (adjusted OR = 0.34; 95% CI = 0.15-0.76) and current use of a health app (adjusted OR = 1.91; 95% CI = 1.07-3.41) were significant predictors of interest to adopt an adherence app. In conclusion, patients value the inclusion of educational and behavioural interventions in adherence apps. Developers of adherence apps should consider including tools for side effect self-management and provision of information to educate patients on their medications and disease condition.

  18. Identifying determinants of medication adherence following myocardial infarction using the Theoretical Domains Framework and the Health Action Process Approach.

    Science.gov (United States)

    Presseau, Justin; Schwalm, J D; Grimshaw, Jeremy M; Witteman, Holly O; Natarajan, Madhu K; Linklater, Stefanie; Sullivan, Katrina; Ivers, Noah M

    2017-10-01

    Despite evidence-based recommendations, adherence with secondary prevention medications post-myocardial infarction (MI) remains low. Taking medication requires behaviour change, and using behavioural theories to identify what factors determine adherence could help to develop novel adherence interventions. Compare the utility of different behaviour theory-based approaches for identifying modifiable determinants of medication adherence post-MI that could be targeted by interventions. Two studies were conducted with patients 0-2, 3-12, 13-24 or 25-36 weeks post-MI. Study 1: 24 patients were interviewed about barriers and facilitators to medication adherence. Interviews were conducted and coded using the Theoretical Domains Framework. Study 2: 201 patients answered a telephone questionnaire assessing Health Action Process Approach constructs to predict intention and medication adherence (MMAS-8). Study 1: domains identified: Beliefs about Consequences, Memory/Attention/Decision Processes, Behavioural Regulation, Social Influences and Social Identity. Study 2: 64, 59, 42 and 58% reported high adherence at 0-2, 3-12, 13-24 and 25-36 weeks. Social Support and Action Planning predicted adherence at all time points, though the relationship between Action Planning and adherence decreased over time. Using two behaviour theory-based approaches provided complimentary findings and identified modifiable factors that could be targeted to help translate Intention into action to improve medication adherence post-MI.

  19. Importance of doctor-patient relationship for patient adherence with medication regimes

    DEFF Research Database (Denmark)

    Sokolowski, Ineta; Vedsted, Peter

    Aim: It has been supposed that the relation between the doctor and the patient has implications for the adherence to medication. This study explores the effect of patient reported doctor-patient relationship on patient adherence with medication regiments. Methods: Design: Prospective cohort study...... practices. Doctor-patient relationship was measured from The Danish version of the 23-item EUROPEP questionnaire measuring patient evaluation of general practice. From the register data on prescriptions we drew all subsidised drugs redeemed at pharmacies for each patient in 2002-2005. Patients, who did...... was measured as secondary non-compliance and as persistence. The incidence rate ratio of non-adherence was calculated for different levels of the patient evaluated doctor-patient-relationship. Results: A total of 482 patients started new treatment of which 98 were non-compliant and 7 were censored. This study...

  20. Variation in medication adherence across patient behavioral segments: a multi-country study in hypertension

    Directory of Open Access Journals (Sweden)

    Sandy R

    2015-10-01

    Full Text Available Robert Sandy, Ulla Connor CoMac Analytics, Inc, Providence, RI, USA Objectives: This study determines the following for a hypertensive patient population: 1 the prevalence of patient worldview clusters; 2 differences in medication adherence across these clusters; and 3 the adherence predictive power of the clusters relative to measures of patients’ concerns over their medication’s cost, side effects, and efficacy. Methods: Members from patient panels in the UK, Germany, Italy, and Spain were invited to participate in an online survey that included the Medication Adherence Report Scale-5 (MARS-5 adherence instrument and a patient segmentation instrument developed by CoMac Analytics, Inc, based on a linguistic analysis of patient talk. Subjects were screened to have a diagnosis of hypertension and treatment with at least one antihypertensive agent. Results: A total of 353 patients completed the online survey in August/September 2011 and were categorized against three different behavioral domains: 1 control orientation (n=176 respondents [50%] for I, internal; n=177 respondents [50%] for E, external; 2 emotion (n=100 respondents [28%] for P, positive; n=253 respondents [72%] for N, negative; and 3 agency or ability to act on choices (n=227 respondents [64%] for H, high agency; n=126 [36%] for L, low agency. Domains were grouped into eight different clusters with EPH and IPH being the most prevalent (88 respondents [25%] in each cluster. The prevalence of other behavior clusters ranged from 6% (22 respondents, INH to 12% (41 respondents, IPL. The proportion of patients defined as perfectly adherent (scored 25 on MARS-5 varied sharply across the segments: 51% adherent (45 of 88 respondents for the IPH vs 8% adherent (2 of 25 respondents classified as INL. Side effects, being employed, and stopping medicine because the patient got better were all significant determinants of adherence in a probit regression model. Conclusion: By categorizing

  1. Medication adherence following coronary artery bypass graft surgery: assessment of beliefs and attitudes.

    Science.gov (United States)

    Khanderia, Ujjaini; Townsend, Kevin A; Erickson, Steven R; Vlasnik, Jon; Prager, Richard L; Eagle, Kim A

    2008-02-01

    The medication management of patients following coronary artery bypass graft (CABG) surgery may include antiplatelet agents, beta-blockers, angiotensin-converting enzyme inhibitors, and statins. However, poor adherence is common, and patient attitudes and beliefs play a role in adherence. To evaluate the association between self-reported adherence and the beliefs patients have about cardiovascular medicines used after CABG. Adults were surveyed 6-24 months following CABG. The validated Beliefs about Medicines Questionnaire (BMQ) assessed attitudes concerning the Specific Necessity, Specific Concerns, General Harm, and General Overuse of medicines. The validated medication adherence scale assessed self-reported adherence. Analysis included univariate comparison (BMQ scales) and multivariate logistic regression (identification of adherence predictor variables). Of 387 patients surveyed, 132 (34%) completed the questionnaire. Nonparticipants were more likely to be female and have undergone 1- or 2-vessel CABG procedures compared with 3- or 4-vessel procedures. Subjects were primarily English-speaking, white, and male. Adherent behavior was reported in 73 of 132 patients (55%). The average period between CABG and the survey was 16 months. Nonadherent patients were in stronger agreement on the General Overuse (p = 0.01) and General Harm (p = 0.04) scales. The adjusted odds of adherent behavior were significantly lower, with an increasing General Overuse score (OR 0.83; 95% CI 0.72 to 0.95; p = 0.007); an annual income of $50,000 to $100,000 relative to less than $20,000 (OR 0.36; 95% CI 0.14 to 0.91; p = 0.031), and a living status of "alone" compared with "with adults and no children" (OR 0.20; 95% CI 0.06 to 0.65; p = 0.007). The odds ratio of self-reported adherence was higher with increasing age (OR 1.05; 95% CI 1.01 to 1.09; p = 0.023). In summary, patient beliefs and attitudes regarding medications, along with other social, economic, and demographic factors, help

  2. The Chinese Life-Steps Program: A Cultural Adaptation of a Cognitive-Behavioral Intervention to Enhance HIV Medication Adherence.

    Science.gov (United States)

    Shiu, Cheng-Shi; Chen, Wei-Ti; Simoni, Jane; Fredriksen-Goldsen, Karen; Zhang, Fujie; Zhou, Hongxin

    2013-05-01

    China is considered to be the new frontier of the global AIDS pandemic. Although effective treatment for HIV is becoming widely available in China, adherence to treatment remains a challenge. This study aimed to adapt an intervention promoting HIV-medication adherence-favorably evaluated in the West-for Chinese HIV-positive patients. The adaptation process was theory-driven and covered several key issues of cultural adaptation. We considered the importance of interpersonal relationships and family in China and cultural notions of health. Using an evidence-based treatment protocol originally designed for Western HIV-positive patients, we developed an 11-step Chinese Life-Steps program with an additional culture-specific intervention option. We describe in detail how the cultural elements were incorporated into the intervention and put into practice at each stage. Clinical considerations are also outlined and followed by two case examples that are provided to illustrate our application of the intervention. Finally, we discuss practical and research issues and limitations emerging from our field experiments in a HIV clinic in Beijing. The intervention was tailored to address both universal and culturally specific barriers to adherence and is readily applicable to generalized clinical settings. This evidence-based intervention provides a case example of the process of adapting behavioral interventions to culturally diverse communities with limited resources.

  3. Factors influencing adherence to psychopharmacological medications in psychiatric patients: a structural equation modeling approach

    Directory of Open Access Journals (Sweden)

    De las Cuevas C

    2017-03-01

    Full Text Available Carlos De las Cuevas,1 Jose de Leon,2–4 Wenceslao Peñate,5 Moisés Betancort5 1Departamento de Medicina Interna, Dermatología y Psiquiatría, Universidad de La Laguna, Canary Islands, Spain; 2Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA; 3Psychiatry and Neurosciences Research Group (CTS-549, Institute of Neurosciences, University of Granada, Granada, Spain; 4Biomedical Research Center in Mental Health Net (CIBERSAM, Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain; 5Departamento de Psicología Clínica, Psicobiología y Metodología, Universidad de La Laguna, Canary Islands, Spain Purpose: To evaluate pathways through which sociodemographic, clinical, attitudinal, and perceived health control variables impact psychiatric patients’ adherence to psychopharmacological medications.Method: A sample of 966 consecutive psychiatric outpatients was studied. The variables were sociodemographic (age, gender, and education, clinical (diagnoses, drug treatment, and treatment duration, attitudinal (attitudes toward psychopharmacological medication and preferences regarding participation in decision-making, perception of control over health (health locus of control, self-efficacy, and psychological reactance, and level of adherence to psychopharmacological medications. Structural equation modeling was applied to examine the nonstraightforward relationships and the interactive effects among the analyzed variables.Results: Structural equation modeling demonstrated that psychiatric patients’ treatment adherence was associated: 1 negatively with cognitive psychological reactance (adherence decreased as cognitive psychological reactance increased, 2 positively with patients’ trust in their psychiatrists (doctors’ subscale, 3 negatively with patients’ belief that they are in control of their mental health and that their mental health depends on their own actions (internal subscale, and 4

  4. Study to Measure the impact of Pharmacists and Pharmacy Services (STOMPP on Medication Non-Adherence: Medication Adherence and Clinical Outcomes

    Directory of Open Access Journals (Sweden)

    Sharrel Pinto, BS Pharm, DMM, MS, PhD

    2018-02-01

    Full Text Available Objective: To compare the impact of various pharmacy-based services on medication adherence and clinical outcomes. Design: Prospective, randomized control trial Setting: A local endocrinology group (clinic setting and community pharmacies belonging to a regional integrated delivery network (IDN in Toledo, OH Population: Subjects included within this study had type 2 diabetes, were prescribed a minimum of five medications, at least 18 years of age, having the ability to self-administer medications as prescribed, and be able to speak and understand English. Subjects were required to have Paramount health insurance, must be willing and able to provide informed consent, actively participate in the assigned MTM sessions, and have adequate transportation to attend the sessions at a participating pharmacy.  Methods: Patients were recruited through flyers at practice sites, referrals from physicians and pharmacists, and direct mailers. Members of the research team would screen patients to assess their eligibility to participate in the study. Patients who fit the inclusion criteria were randomized into one of the following four different groups: Pill Bottle (PB, Blister Pack (BP, Pill Bottle + Medication Therapy Management (PB+MTM, and Adherence Pharmacy (BP+MTM. Patients enrolled in the BP groups had their medications synchronized. Patients in the AP group were given the option to have their medications delivered, if needed. Practice innovation: We partnered with a regional integrated delivery network (IDN with multiple community pharmacy practice sites and a practice group of endocrinologists. A new practice model called Adherence Pharmacy was conceptualized and implemented within the community setting and was accessible to patients. Main Outcomes Measures: Medication adherence, measured using proportions of days covered (PDC and pill count scores at baseline, 3 months, 6 months, 9 months, and 12 months; Hemoglobin A1c (HbA1c, body mass index (BMI

  5. Antiprogestin drugs: ethical, legal and medical issues.

    Science.gov (United States)

    Cook, R J; Grimes, D A

    1992-01-01

    RU 486 allows women the choice of a medical rather than a surgical abortion, and, for most women, the choice is one of procedure, not of whether to have an abortion. Issues surrounding RU 486 were explored in an American Society of Law and Medicine conference in December 1991 entitled "Antiprogestin Drugs: Ethical, Legal and Medical Issues." An introduction to 14 conference papers provides an overview of the proceedings. Baulieu, the father of RU 486, described updated developments in its use and the medically supervised method of abortion. Bygdeman and Swahn presented their work in Sweden on combining RU 486 with a prostaglandin to make abortion more effective. They suggested that the drug may be an attractive postovulation contraceptive. Greenslad et al. discussed service delivery aspects of the use of RU 486. Holt considered the implications of use of the drug in low-resource settings. A survey of obstetricians and gynecologists, presented by Heilig, indicates that 22% more physicians would perform a medical abortion. Patient perspectives were addressed by David, who stated that measuring acceptability of an abortion technique is difficult; women have historically used whatever method is available. A collaborative research project in India and Cuba on why women chose certain methods was reported by Winikoff et al. (90% of women would choose medical abortion if faced with the choice again). Berer analyzed French data on women's perspectives on medical vs. surgical abortion. The question of adolescent use of the drug was considered by Senderowitz, who lamented the lack of data on the subject and described what is known about adolescent pregnancy. Macklin proposed a framework for ethical analysis and used facts to address ethical questions. Weinstein provided another ethical framework, to analyze whether pharmacists have a right to refuse to provide abortifacient drugs. Buc approached the subject from a legal point of view and concluded that, whereas legal problems

  6. Interventions to improve medication adherence in adult kidney transplant recipients: a systematic review.

    Science.gov (United States)

    Low, Jac Kee; Williams, Allison; Manias, Elizabeth; Crawford, Kimberley

    2015-05-01

    In kidney transplantation, adherence to immunosuppressive therapy is paramount for long-term graft survival. This systematic review aimed to assess the effectiveness of interventions to improve medication adherence in adult kidney transplantation. Eight electronic databases were searched from inception to November 2013. Only primary intervention studies, which reported measurement of adherence to immunosuppressive medications after kidney transplantation, were included. The quality of all studies was assessed using the Consolidated Standards of Reporting Trials and Transparent Reporting of Evaluations with Non-randomized Designs checklists. A synthesis was undertaken to tease out the domains targeted by interventions: (i) educational/cognitive, (ii) counselling/behavioural, (iii) psychologic/affective and (iv) financial support. For each study, key information, such as population, location, methods of measurements, comparison group, type of intervention and outcomes, were extracted and tabulated. Twelve intervention studies were identified. Quality of studies ranged from 16.0 to 80.5%. Effective interventions were implemented for 3, 6 and 12 months. Medication adherence rates were greatly enhanced when multidimensional interventions were implemented whereas one-off feedback from a nurse and financial assistance programmes offered little improvement. Dose administration aids when used in conjunction with self-monitoring also improved adherence. The number of patients who had a drug holiday (at least 1-day interval without a dose) was higher in a once-daily regimen than a twice-daily regimen. The findings of this review suggest an intervention targeting behavioural risk factors or a combination of behavioural, educational and emotional changes is effective in enhancing medication adherence. Effectiveness of an intervention may be further enhanced if patients are encouraged to participate in the development process. © The Author 2014. Published by Oxford University

  7. The importance of cholesterol medication adherence: the need for behavioral change intervention programs

    Directory of Open Access Journals (Sweden)

    Bosworth HB

    2018-03-01

    Full Text Available Hayden B Bosworth,1–5 Barbara Ngouyombo,6 Jan Liska,7 Leah L Zullig,1,2 Caroline Atlani,8 Anne C Beal7 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA; 2Department of Population Health Sciences, Duke University, Durham, NC, USA; 3School of Nursing, Duke University, Durham, NC, USA; 4Department of Psychiatry, Duke University, Durham, NC, USA; 5Department of Behavioral Sciences, Duke University, Durham, NC, USA; 6Value & Access Team, Sanofi Pasteur, Lyon, France; 7Center of Excellence for Patient Centricity, Sanofi, Paris, France; 8Patient Strategy, Diabetes & Cardiovascular Unit, Sanofi, Paris, France Abstract: Lipid-lowering medications have been shown to be efficacious, but adherence is suboptimal. This is a narrative, perspective review of recently published literature in the field of medication adherence research for lipid-lowering medications. We provide an overview of the impact of suboptimal adherence and use a World Health Organization framework (patient, condition, therapy, socioeconomic, and health system-related systems to discuss factors that influence hyperlipidemia treatment adherence. Further, the review involves an evaluation of intervention strategies to increase hyperlipidemia treatment adherence with a special focus on mHealth interventions, patient reminders on packaging labels, nurse- and pharmacist-led interventions, and health teams. It also highlights opportunities for pharmaceutical companies to support and scale such behavioral interventions. Medication adherence remains a challenge for the long-term management of chronic conditions, especially those involving asymptomatic disease such as hyperlipidemia. To engage patients and enhance motivation over time, hyperlipidemia interventions must be targeted to individual patients’ needs, with sequencing and frequency of contact tailored to the various stages of behavioral change. Keywords: cardiovascular

  8. Socioeconomic disadvantage and primary non-adherence with medication in Sweden.

    Science.gov (United States)

    Wamala, Sarah; Merlo, Juan; Bostrom, Gunnel; Hogstedt, Christer; Agren, Gunner

    2007-06-01

    Lack of adherence with pharmacological therapy is a public health concern that compels tremendous costs for the health care system and the community. To analyse the association between socioeconomic disadvantage and primary non-adherence with medication, and to explore possible mediating effects of trust in health care and lifestyle profile. Cross-sectional population-based study based on data from the Swedish national public health surveys 2004-2005. The study comprised 13603 men and 18292 women aged 21-84 years who had any contact with a physician at a hospital or primary care centre. Measures Primary non-adherence with medication based on whether respondents reported that they refrained from purchasing at the pharmacy prescribed medication. Socioeconomic Disadvantage Index was based on four different indicators of economic deprivation. Socioeconomic disadvantage was associated with primary non-adherence with medication independent of long-term illness, risky lifestyle, low education, living alone and low trust for health care. This association increased with older age, particularly among women. Among individuals aged 21-34 years, severe compared with no socioeconomic disadvantage, was associated with two-fold increased odds for non-adherence with medication. The corresponding odds among individuals aged 65-84 years were three-fold increase among elderly men (OR=3.3, 95% CI: 1.4-7.8) and six-fold increase among elderly women (OR=6.2, 95% CI: 2.5-15.3). Yet every seventh elderly woman aged 65-84 years suffered from long-term illness. Results indicate that health policies for 'care on equal terms' in Sweden have been less successful in relation to equitable access to prescribed medication, especially among the elderly.

  9. eHealth in the future of medications management: personalisation, monitoring and adherence.

    Science.gov (United States)

    Car, Josip; Tan, Woan Shin; Huang, Zhilian; Sloot, Peter; Franklin, Bryony Dean

    2017-04-05

    Globally, healthcare systems face major challenges with medicines management and medication adherence. Medication adherence determines medication effectiveness and can be the single most effective intervention for improving health outcomes. In anticipation of growth in eHealth interventions worldwide, we explore the role of eHealth in the patients' medicines management journey in primary care, focusing on personalisation and intelligent monitoring for greater adherence. eHealth offers opportunities to transform every step of the patient's medicines management journey. From booking appointments, consultation with a healthcare professional, decision-making, medication dispensing, carer support, information acquisition and monitoring, to learning about medicines and their management in daily life. It has the potential to support personalisation and monitoring and thus lead to better adherence. For some of these dimensions, such as supporting decision-making and providing reminders and prompts, evidence is stronger, but for many others more rigorous research is urgently needed. Given the potential benefits and barriers to eHealth in medicines management, a fine balance needs to be established between evidence-based integration of technologies and constructive experimentation that could lead to a game-changing breakthrough. A concerted, transdisciplinary approach adapted to different contexts, including low- and middle-income contries is required to realise the benefits of eHealth at scale.

  10. Effectiveness of a medication-adherence tool : Study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Hilbink, Mirrian; Lacroix, Joyca; Bremer-van der Heiden, Linda; van Halteren, Aart; Teichert, Martina; van Lieshout, Jan

    2016-01-01

    Background: Research shows that more than half of the people taking medication for a chronic condition are non-adherent. Nonadherence hinders disease control with a burden on patient quality of life and healthcare systems. We developed a tool that provides insight into nonadherence risks and

  11. A theoretical approach to medication adherence for children and youth with psychiatric disorders.

    Science.gov (United States)

    Charach, Alice; Volpe, Tiziana; Boydell, Katherine M; Gearing, Robin E

    2008-01-01

    This article provides a theoretical review of treatment adherence for children and youth with psychiatric disorders where pharmacological agents are first-line interventions. Four empirically based models of health behavior are reviewed and applied to the sparse literature about medication adherence for children with attention-deficit/hyperactivity disorder and young people with first-episode psychosis. Three qualitative studies of medication use are summarized, and details from the first-person narratives are used to illustrate the theoretical models. These studies indicate, when taken together, that the clinical approach to addressing poor medication adherence in children and youth with psychiatric disorders should be guided by more than one theoretical model. Mental health experts should clarify beliefs, address misconceptions, and support exploration of alternative treatment options unless contraindicated. Recognizing the larger context of the family, allowing time for parents and children to change their attitudes, and offering opportunities for easy access to medication in the future are important ways of respecting patient preferences, while steering them toward best-evidence interventions. Future research using qualitative methods of inquiry to investigate parent, child, and youth experiences of mental health interventions should identify effective ways to improve treatment adherence.

  12. Meta-analyses of Theory use in Medication Adherence Intervention Research

    Science.gov (United States)

    Conn, Vicki S.; Enriquez, Maithe; Ruppar, Todd M.; Chan, Keith C.

    2016-01-01

    Objective This systematic review applied meta-analytic procedures to integrate primary research that examined theory- or model-linked medication adherence interventions. Methods Extensive literature searching strategies were used to locate trials testing interventions with medication adherence behavior outcomes measured by electronic event monitoring, pharmacy refills, pill counts, and self-reports. Random-effects model analysis was used to calculate standardized mean difference effect sizes for medication adherence outcomes. Results Codable data were extracted from 146 comparisons with 19,348 participants. The most common theories and models were social cognitive theory and motivational interviewing. The overall weighted effect size for all interventions comparing treatment and control participants was 0.294. The effect size for interventions based on single-theories was 0.323 and for multiple-theory interventions was 0.214. Effect sizes for individual theories and models ranged from 0.041 to 0.447. The largest effect sizes were for interventions based on the health belief model (0.477) and adult learning theory (0.443). The smallest effect sizes were for interventions based on PRECEDE (0.041) and self-regulation (0.118). Conclusion These findings suggest that theory- and model-linked interventions have a significant but modest effect on medication adherence outcomes. PMID:26931748

  13. Predicting adherence to prophylactic medication in adolescents with asthma: an application of the ASE-model

    NARCIS (Netherlands)

    van Es, S.M.; Kaptein, A.A.; Bezemer, P.D.; Nagelkerke, A.F.; Colland, V.T.; Bouter, L.M.

    2002-01-01

    An explanatory framework, referred to as the attitude/social influence/self-efficacy-model (ASE-model), was utilised to explain future self-reported adherence of adolescents to daily inhaled prophylactic asthma medication. The objective was to investigate the long-term influence of these earlier

  14. Predicting adherence to prophylactic medication in adolescents with asthma : an application of the ASE-model

    NARCIS (Netherlands)

    van Es, Saskia M; Kaptein, Adrian A; Bezemer, P Dick; Nagelkerke, Ad F; Colland, Vivian T; Bouter, Lex M

    An explanatory framework, referred to as the attitude/social influence/self-efficacy-model (ASE-model), was utilised to explain future self-reported adherence of adolescents to daily inhaled prophylactic asthma medication. The objective was to investigate the long-term influence of these earlier

  15. Effectiveness of a medication-adherence tool: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Hilbink-Smolders, M.; Lacroix, J.; Bremer-van der Heiden, L.; Halteren, A. van; Teichert, M.; Lieshout, J. van

    2016-01-01

    BACKGROUND: Research shows that more than half of the people taking medication for a chronic condition are non-adherent. Nonadherence hinders disease control with a burden on patient quality of life and healthcare systems. We developed a tool that provides insight into nonadherence risks and

  16. Medication Adherence in Kidney Transplant Recipients in an Urban Indian Setting.

    Science.gov (United States)

    Adhikari, U R; Taraphder, A; Hazra, A; Das, T

    2017-01-01

    Medication nonadherence is a known problem after renal transplantation and can vary from one setting to another. Since it can lead to negative outcomes, it is important to develop intervention strategies to enhance adherence in a given setting using determinants identified through exploratory studies. We explored nonadherence in renal transplant recipients. A longitudinal survey was done with adult renal transplant recipients at a tertiary care public and two private hospitals of Kolkata. Subjects were followed-up for 1 year. After screening for medication adherence status by the four-item Morisky Medication Adherence Scale, those admitting to potential nonadherence were probed further. A patient was deemed to be nonadherent if failing to take medicines on appointed time (doses missed or delayed by more than 2 h) more than three times in any month during the observation period. A pretested questionnaire was used to explore potential determinants of nonadherence. Data of 153 patients recruited over a 2-year were analyzed. The extent of nonadherence with immunosuppressant regimens was about 31% overall; 44% in the public sector and 19% in the private sector ( P transplant recipients in the Indian setting. Strategies to improve medication adherence can be planned by relevant stakeholders on the basis of these findings.

  17. Attitudes towards medication non-adherence in elderly kidney transplant patients: A Q methodology study

    NARCIS (Netherlands)

    M. Moors-Tielen (Mirjam); N.J.A. van Exel (Job); M.C. Buren; L. Maasdam; W. Weimar (Willem)

    2011-01-01

    textabstractBackground. Non-adherence to the post-transplant regime is a common problem in kidney transplant patients and may lead to rejection or even graft failure. This study investigated attitudes towards the post-transplant regime of immunosuppressive medication among the ever growing

  18. A Mobile Phone HIV Medication Adherence Intervention: Care4Today™ Mobile Health Manager

    Science.gov (United States)

    Martin, C. Andrew

    2016-01-01

    This paper presents the findings of a qualitative study designed to describe the experience of HIV medication adherence using a mobile phone application. For the purpose of this qualitative study, nine semi-structured focus group discussions were conducted over a three-month period at an AIDS service organization in Central Texas. The data were…

  19. Comparison of various measures for assessing medication refill adherence using prescription data

    NARCIS (Netherlands)

    Vink, N. M.; Klungel, O. H.; Stolk, R. P.; Denig, P.

    Background Several measures using prescription data have been developed for estimating medication refill adherence. Few Studies have made direct comparisons, and little is known about the accuracy of these measures in patients oil a multiple-drug regimen. Purpose To compare different calculation

  20. Interplay between Oral Hypoglycemic Medication Adherence and Quality of Life among Elderly Type 2 Diabetes Mellitus Patients.

    Science.gov (United States)

    Manan, Mohamed Mansor; Husin, Akhma Radzuanna; Alkhoshaiban, Ali Saleh; Al-Worafi, Yaser Mohammed Ali; Ming, Long Chiau

    2014-12-01

    Adherence to medications is an important factor that contributes to therapeutic success. With the current increase in the elderly population, information relating to adherence to treatment and quality of life (QoL) of diabetic elderly patients will help the healthcare provider to improve their treatment. Thus, this study aims to determine the factors affecting adherence to medications and the consequence of non adherence to QoL. This was a cross-sectional study using validated Morisky Medication Adherence Scale (MMAS) Questionnaire. This study was conducted to assess the level of adherence on oral hypoglycemic medications (OHM) and quality of life of the Type 2 diabetes mellitus (T2DM) elderly patients in an urban health centre in Malaysia. A retrospective medication record review was also conducted to collect and confirm data on patients' demographics, diagnosis, treatments, and outcomes. One hundred and seventy nine patients were recruited in this study. Median adherence score was 7.75 (IQR 6.50- 8.00). Good adherer was observed in 48.00% of the participants. A Chi-square test indicated significant correlation between adherence and HbA1c (p= 0.010). The mean elderly diabetes mellitus Problem Areas in Diabetes (PAID) score was 6.30 ±SD 8.50. A significant inversed association was observed between PAID score and the level of adherence (r = - 0.175, pwestern countries.

  1. Differences in Medication Adherence between Living and Deceased Donor Kidney Transplant Patients.

    Science.gov (United States)

    Denhaerynck, K; Schmid-Mohler, G; Kiss, A; Steiger, J; Wüthrich, R P; Bock, A; De Geest, S

    2014-01-01

    Literature review suggests that adherence to immunosuppressive drugs may be lower in recipients of living than of deceased donor kidney grafts, possibly because of profile differences. To compare the level of immunosuppressive adherence levels between patients with deceased and living (-related; -unrelated) donor grafts in Switzerland. Using data from two similar cross-sectional studies at two transplant centers in Switzerland, the level of adherence between the two groups was compared. Medication adherence was assessed by self-report or electronic monitoring. Possible explanatory factors included age, beliefs regarding immunosuppressive drugs, depressive symptomatology, pre-emptive transplantation, and the number of transplants received, were also considered. Data were analyzed using logistic regression analysis. Unadjusted non-adherence odds were 2 to 3 times higher in living-related than deceased donor transplantation (ORs: 2.09-3.05; padherence in recipients of living-related donor kidneys, possibly owing to differences in patient profile (ie, health beliefs regarding their immunosuppressive needs), knowledge of which may enhance adherence if addressed.

  2. Recent mobile health interventions to support medication adherence among HIV-positive MSM.

    Science.gov (United States)

    Muessig, Kathryn E; LeGrand, Sara; Horvath, Keith J; Bauermeister, José A; Hightow-Weidman, Lisa B

    2017-09-01

    We describe recent mobile health (mHealth) interventions supporting antiretroviral therapy (ART) medication adherence among HIV-positive MSM. Keyword searches (1 January 2016-13 May 2017) identified 721 citations. Seven publications reporting on six studies met inclusion criteria. Five studies focused on MSM. Interventions primarily employed text messaging (n = 4), whereas two focused on smartphone apps and one on social media. Three studies measured intervention impact on adherence and found increased ART use intentions (n = 1), self-reported adherence (n = 1), and viral suppression (n = 1, no control group). Other mHealth interventions for HIV-positive MSM focused on status disclosure and reducing sexual risk. mHealth interventions to support ART adherence among MSM show acceptability, feasibility, and preliminary efficacy. No recent mHealth interventions for MSM measured impact on viral suppression compared with a control condition despite earlier (pre-2015) evidence for efficacy. Studies are underway that include multiple features designed to improve adherence within complex smartphone or internet-based platforms. Areas for future growth include overcoming measurement and engagement challenges, developing tools for coordinating patient and provider adherence data, testing combination interventions, and adapting efficacious interventions for new languages and geographic settings.

  3. Electronic monitoring of patient adherence to oral antihypertensive medical treatment: a systematic review.

    Science.gov (United States)

    Christensen, Arne; Osterberg, Lars G; Hansen, Ebba Holme

    2009-08-01

    Poor patient adherence is often the reason for suboptimal blood pressure control. Electronic monitoring is one method of assessing adherence. The aim was to systematically review the literature on electronic monitoring of patient adherence to self-administered oral antihypertensive medications. We searched the Pubmed, Embase, Cinahl and Psychinfo databases and websites of suppliers of electronic monitoring devices. The quality of the studies was assessed according to the quality criteria proposed by Haynes et al. Sixty-two articles were included; three met the criteria proposed by Haynes et al. and nine reported the use of electronic adherence monitoring for feedback interventions. Adherence rates were generally high, whereas average study quality was low with a recent tendency towards improved quality. One study detected investigator fraud based on electronic monitoring data. Use of electronic monitoring of patient adherence according to the quality criteria proposed by Haynes et al. has been rather limited during the past two decades. Electronic monitoring has mainly been used as a measurement tool, but it seems to have the potential to significantly improve blood pressure control as well and should be used more widely.

  4. The safety issues of medical robotics

    Energy Technology Data Exchange (ETDEWEB)

    Fei Baowei; Ng, W.S.; Chauhan, Sunita; Kwoh, Chee Keong

    2001-08-01

    In this paper, we put forward a systematic method to analyze, control and evaluate the safety issues of medical robotics. We created a safety model that consists of three axes to analyze safety factors. Software and hardware are the two material axes. The third axis is the policy that controls all phases of design, production, testing and application of the robot system. The policy was defined as hazard identification and safety insurance control (HISIC) that includes seven principles: definitions and requirements, hazard identification, safety insurance control, safety critical limits, monitoring and control, verification and validation, system log and documentation. HISIC was implemented in the development of a robot for urological applications that was known as URObot. The URObot is a universal robot with different modules adaptable for 3D ultrasound image-guided interstitial laser coagulation, radiation seed implantation, laser resection, and electrical resection of the prostate. Safety was always the key issue in the building of the robot. The HISIC strategies were adopted for safety enhancement in mechanical, electrical and software design. The initial test on URObot showed that HISIC had the potential ability to improve the safety of the system. Further safety experiments are being conducted in our laboratory.

  5. The safety issues of medical robotics

    International Nuclear Information System (INIS)

    Fei Baowei; Ng, W.S.; Chauhan, Sunita; Kwoh, Chee Keong

    2001-01-01

    In this paper, we put forward a systematic method to analyze, control and evaluate the safety issues of medical robotics. We created a safety model that consists of three axes to analyze safety factors. Software and hardware are the two material axes. The third axis is the policy that controls all phases of design, production, testing and application of the robot system. The policy was defined as hazard identification and safety insurance control (HISIC) that includes seven principles: definitions and requirements, hazard identification, safety insurance control, safety critical limits, monitoring and control, verification and validation, system log and documentation. HISIC was implemented in the development of a robot for urological applications that was known as URObot. The URObot is a universal robot with different modules adaptable for 3D ultrasound image-guided interstitial laser coagulation, radiation seed implantation, laser resection, and electrical resection of the prostate. Safety was always the key issue in the building of the robot. The HISIC strategies were adopted for safety enhancement in mechanical, electrical and software design. The initial test on URObot showed that HISIC had the potential ability to improve the safety of the system. Further safety experiments are being conducted in our laboratory

  6. Poor medication adherence to bisphosphonates and high self-perception of aging in elderly female patients with osteoporosis.

    Science.gov (United States)

    Wu, X; Wei, D; Sun, B; Wu, X N

    2016-10-01

    Non-adherence to bisphosphonates exposes the elderly female osteoporosis patients to an increased risk of fracture. This was one of the first studies to explore the relationship between medication adherence and self-perception of aging. Feelings of lacking control and expectations for negative events, beliefs of illness's chronic duration nature, and its linkage with aging were associated with of poor medication adherence. To examine the relationship between medication adherence to bisphosphonates and self-perception of aging in elderly female patients with osteoporosis. This was a cross-sectional survey. A convenience sample of 245 elderly female patients with osteoporosis prescribed regular oral bisphosphonate therapy was recruited from three tertiary hospitals in China. Sociodemographic and osteoporosis-related data, Morisky Medication Adherence Scale-8 (MMAS-8) and Aging Perceptions Questionnaire (APQ) data were collected. Mean adherence score measured by MMAS-8 was 4.46(SD = 1.91; range, 0.25-7.00). Percentages of good and poor adherence were 28.6 and 71.4 %, which showed a poor medication adherence. Six domains of APQ statistically significantly associated with medication adherence. Interestingly, with control of age, educational status, marital status, and symptoms accompanying osteoporosis as covariates in the multivariate linear regression model, the effects of three domains disappeared. Significantly, worse adherence was observed in those patients who had higher feelings of lack of control, more expectations for negative events, more beliefs of osteoporosis's chronic duration nature and its linkage with aging. We conclude that feelings of lacking control, expectations for negative events, beliefs of illness's chronic duration nature, and its linkage with aging were associated with poor medication adherence in elderly female patients with osteoporosis. Concerns about self-perception of aging need to be addressed in order to improve medication adherence.

  7. Interventions to Improve Medication Adherence in Hypertensive Patients: Systematic Review and Meta-analysis.

    Science.gov (United States)

    Conn, Vicki S; Ruppar, Todd M; Chase, Jo-Ana D; Enriquez, Maithe; Cooper, Pamela S

    2015-12-01

    This systematic review applied meta-analytic procedures to synthesize medication adherence interventions that focus on adults with hypertension. Comprehensive searching located trials with medication adherence behavior outcomes. Study sample, design, intervention characteristics, and outcomes were coded. Random-effects models were used in calculating standardized mean difference effect sizes. Moderator analyses were conducted using meta-analytic analogues of ANOVA and regression to explore associations between effect sizes and sample, design, and intervention characteristics. Effect sizes were calculated for 112 eligible treatment-vs.-control group outcome comparisons of 34,272 subjects. The overall standardized mean difference effect size between treatment and control subjects was 0.300. Exploratory moderator analyses revealed interventions were most effective among female, older, and moderate- or high-income participants. The most promising intervention components were those linking adherence behavior with habits, giving adherence feedback to patients, self-monitoring of blood pressure, using pill boxes and other special packaging, and motivational interviewing. The most effective interventions employed multiple components and were delivered over many days. Future research should strive for minimizing risks of bias common in this literature, especially avoiding self-report adherence measures.

  8. Video chat technology to remotely quantify dietary, supplement and medication adherence in clinical trials.

    Science.gov (United States)

    Peterson, Courtney M; Apolzan, John W; Wright, Courtney; Martin, Corby K

    2016-11-01

    We conducted two studies to test the validity, reliability, feasibility and acceptability of using video chat technology to quantify dietary and pill-taking (i.e. supplement and medication) adherence. In study 1, we investigated whether video chat technology can accurately quantify adherence to dietary and pill-taking interventions. Mock study participants ate food items and swallowed pills, while performing randomised scripted 'cheating' behaviours to mimic non-adherence. Monitoring was conducted in a cross-over design, with two monitors watching in-person and two watching remotely by Skype on a smartphone. For study 2, a twenty-two-item online survey was sent to a listserv with more than 20 000 unique email addresses of past and present study participants to assess the feasibility and acceptability of the technology. For the dietary adherence tests, monitors detected 86 % of non-adherent events (sensitivity) in-person v. 78 % of events via video chat monitoring (P=0·12), with comparable inter-rater agreement (0·88 v. 0·85; P=0·62). However, for pill-taking, non-adherence trended towards being more easily detected in-person than by video chat (77 v. 60 %; P=0·08), with non-significantly higher inter-rater agreement (0·85 v. 0·69; P=0·21). Survey results from study 2 (n 1076 respondents; ≥5 % response rate) indicated that 86·4 % of study participants had video chatting hardware, 73·3 % were comfortable using the technology and 79·8 % were willing to use it for clinical research. Given the capability of video chat technology to reduce participant burden and outperform other adherence monitoring methods such as dietary self-report and pill counts, video chatting is a novel and promising platform to quantify dietary and pill-taking adherence.

  9. Rethinking agency and medical adherence technology: applying Actor Network Theory to the case study of Digital Pills.

    Science.gov (United States)

    Hurtado-de-Mendoza, Alejandra; Cabling, Mark L; Sheppard, Vanessa B

    2015-12-01

    Much literature surrounding medical technology and adherence posits that technology is a mechanism for social control. This assumes that the medical establishment can take away patients' agency. Although power relationships and social control can play a key role, medical technology can also serve as an agentive tool to be utilized. We (1) offer the alternative framework of Actor Network Theory to view medical technology, (2) discuss the literature on medication adherence and technology, (3) delve into the ramifications of looking at adherence as a network and (4) use Digital Pills as a case study of dispersed agency. © 2015 John Wiley & Sons Ltd.

  10. Healthcare provider-led interventions to support medication adherence following ACS: a meta-analysis.

    Science.gov (United States)

    Crawshaw, Jacob; Auyeung, Vivian; Ashworth, Lucy; Norton, Sam; Weinman, John

    2017-01-01

    We conducted a systematic review and meta-analysis to determine the effectiveness of healthcare provider-led (HCPs) interventions to support medication adherence in patients with acute coronary syndrome (ACS). A systematic search of Cochrane Library, Medline, EMBASE, PsycINFO, Web of Science, IPA, CINAHL, ASSIA, OpenGrey, EthOS, WorldCat and PQDT was undertaken. Interventions were deemed eligible if they included adult ACS patients, were HCP-led, measured medication adherence and randomised participants to parallel groups. Intervention content was coded using the Behaviour Change Technique (BCT) Taxonomy and data were pooled for analysis using random-effects models. Our search identified 8870 records, of which 27 were eligible (23 primary studies). A meta-analysis (n=9735) revealed HCP-led interventions increased the odds of medication adherence by 54% compared to control interventions (k=23, OR 1.54, 95% CI 1.26 to 1.88, I 2 =57.5%). After removing outliers, there was a 41% increase in the odds of medication adherence with moderate heterogeneity (k=21, OR 1.41, 95% CI 1.21 to 1.65, I 2 =35.3%). Interventions that included phone contact yielded (k=12, OR 1.63, 95% CI 1.25 to 2.12, I 2 =32.0%) a larger effect compared to those delivered exclusively in person. A total of 32/93 BCTs were identified across interventions (mean=4.7, SD=2.2) with 'information about health consequences' (BCT 5.1) (19/23) the most common. HCP-led interventions for ACS patients appear to have a small positive impact on medication adherence. While we were able to identify BCTs among interventions, data were insufficient to determine the impact of particular BCTs on study effectiveness. CRD42016037706.

  11. Medication adherence in schizophrenia: The role of insight, therapeutic alliance and perceived trauma associated with psychiatric care.

    Science.gov (United States)

    Tessier, Arnaud; Boyer, Laurent; Husky, Mathilde; Baylé, Franck; Llorca, Pierre-Michel; Misdrahi, David

    2017-11-01

    Medication non adherence in schizophrenia is a major cause of relapse and hospitalization and remains for clinicians an important challenge. This study investigates the associations between insight, therapeutic alliance, perceived trauma related to psychiatric treatment and medication adherence in patients with schizophrenia. In this multicenter study, 72 patients were assessed regarding symptomatology, self-reported adherence with medication, insight, medication side-effects, therapeutic alliance and perceived trauma related to psychiatric treatment. Structural Equation Modeling (SEM) was used to test predicted paths among these variables. The data fit a model in which medication adherence was directly predicted by insight, therapeutic alliance and perceived trauma related to psychiatric treatment. Perceived trauma moderates the role of insight on medication adherence. The final model showed good fit, based on four reliable indices. Greater adherence was correlated with higher insight, higher therapeutic alliance and lower perceived trauma. These three variables appear to be important determinants of patient's medication adherence. Medication adherence could be enhanced by reducing perceived trauma and by increasing insight. The need for mental health providers to acknowledge patients' potentially traumatic experience with psychiatric treatment and the need to encourage greater involvement in care are discussed. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Factors influencing medication knowledge and beliefs on warfarin adherence among patients with atrial fibrillation in China

    Directory of Open Access Journals (Sweden)

    Zhao S

    2017-02-01

    Full Text Available Shujuan Zhao,1 Hongwei Zhao,1 Xianpei Wang,2 Chuanyu Gao,2 Yuhua Qin,1 Haixia Cai,1 Boya Chen,1 Jingjing Cao1 1Department of Pharmacy, 2Department of Cardiovascular Medicine, People’s Hospital of Henan Province, Zhengzhou, Henan, People’s Republic of China Objectives: Warfarin is often used for ischemic stroke prevention in patients with atrial fibrillation (AF, but the factors affecting patient adherence to warfarin therapy have not been fully understood. Methods: A cross-sectional survey was conducted in AF patients undergoing warfarin therapy at least 6 months prior to the study. The clinical data collected using questionnaires by phone interviews included the following: 1 self-reported adherence measured by the Morisky Medication Adherence Scale-8©; 2 beliefs about medicines surveyed by Beliefs about Medicines Questionnaire (BMQ; and 3 drug knowledge as measured by the Warfarin Related Knowledge Test (WRKT. Demographic and clinical factors associated with warfarin adherence were identified using a logistic regression model. Results: Two hundred eighty-eight patients completed the survey and 93 (32.3% of them were classified as nonadherent (Morisky Medication Adherence Scale-8 score <6. Major factors predicting warfarin adherence included age, cardiovascular disorders, WRKT, and BMQ; WRKT and BMQ were independently correlated with adherence to warfarin therapy by multivariate logistic regression analysis. Adherents were more likely to have greater knowledge scores and stronger beliefs in the necessity of their specific medications ([odds ratio {OR} =1.81, 95% confidence interval {CI} =1.51–2.15] and [OR =1.17, 95% CI =1.06–1.29], respectively. Patients with greater concerns about adverse reactions and more negative views of general harm were more likely to be nonadherent ([OR =0.76, 95% CI =0.69–0.84] and [OR =0.82, 95% CI =0.73–0.92], respectively. Conclusion: BMK and WRKT are related with patient behavior toward warfarin

  13. Assessing medication adherence in inflammatory bowel diseases: a comparison between a self-administered scale and a pharmacy refill index

    Directory of Open Access Journals (Sweden)

    María-Luisa de-Castro

    Full Text Available Background: Medication non-adherence in inflammatory bowel disease (IBD has a negative impact on disease outcome. Different tools have been proposed to assess non-adherence. We aimed to compare a self-administered scale and a pharmacy refill index as a reliable measure of medication adherence and to determine what factors are related to adherence. Methods: Consecutive non-active IBD outpatients were asked to fill in the self-reported Morisky Medication Adherence Scale (MMAS-8 and the Beliefs about Medication Questionnaire (BMQ. Pharmacy refill data were reviewed from the previous three or six months and the medication possession ratio (MPR was calculated. Non-adherence was defined as MMAS-8 scores < 6 or MPR < 0.8. Results: Two-hundred and three patients were enrolled (60% ulcerative colitis, 40% Crohn's disease; 51% were men, and the mean age was 46.3 (14 years. Seventy-four per cent of patients were on monotherapy and 26% on combination therapy; altogether, 65% received mesalazine, 46% thiopurines and 16% anti-tumor necrosis factor alfa. Non-adherence rate assessed by MPR was 37% and 22.4% by MMAS-8. Receiver operator curve analysis using a MMAS-8 cut-off of six gave an area under the curve of 0.6 (95% CI 0.5-0.7, p = 0.001. This score had an 85% sensitivity and 34% specificity to predict medication non-adherence, with negative and positive predictive values of 57% and 70% respectively. High scores in the BMQ potential for harm of medication were significantly associated with MPR non-adherence (p = 0.01. Conclusion: The accuracy of MMAS-8 to identify medication non-adherence in inactive IBD outpatients in our setting is poor due to a low specificity and a negative predictive value. Psychosocial factors such as beliefs about medication seem to be related to IBD non-adherence.

  14. Antihypertensive medication adherence in chronic type B aortic dissection is an important consideration in the management debate.

    Science.gov (United States)

    Martin, Guy; Patel, Nandesh; Grant, Yasmin; Jenkins, Michael; Gibbs, Richard; Bicknell, Colin

    2018-03-31

    Early aortic stenting in chronic type B aortic dissection (TBAD) may lead to long-term benefit, although the optimal treatment strategy is hotly debated. A robust comparison to outcomes seen in medically managed patients is challenging as the rate of antihypertensive medication adherence is unknown. The aims of this study were therefore to identify the rate of antihypertensive medication adherence and predictors of adherence in TBAD. This was a cross-sectional mixed methods study of patients with TBAD. Medication adherence was assessed by the eight-item Morisky Medication Adherence Scale together with an assessment of demographic, behavioral, and psychological variables and disease-specific knowledge. There were 47 patients (mean age, 59 years; 81% male) who were recruited from a tertiary vascular unit. The mean total number of medications taken was 5.8 (2-14), and the mean number of antihypertensive medications was 1.9 (1-6). Of the 47 patients, 20 (43%) reported high levels of medication adherence, 17 (36%) reported moderate adherence, and 10 (21%) reported low adherence. Previous aortic surgery was associated with higher levels of adherence (β = 0.332; P = .03), as was taking a greater number of medications (β = 0.332; P = .026), perceived benefit from treatment (β = 0.486; P debate; one cannot robustly compare two strategies when half of a treatment group may not be receiving the stated intervention. To develop an evidence-based treatment strategy for TBAD, we must take into account the direct and indirect effects of medical therapy and thoracic endovascular aortic repair. Further work to improve medication adherence and to understand its impact on disease progression is vital to inform the debate and to deliver the best outcomes for patients. Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  15. Clinic Attendance for Medication Refills and Medication Adherence amongst an Antiretroviral Treatment Cohort in Uganda: A Prospective Study

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    Setor Kunutsor

    2010-01-01

    Full Text Available Background. Regular clinic attendance for antiretroviral (ARV drug refills is important for successful clinical outcomes in HIV management. Methods. Clinic attendance for ARV drug refills and medication adherence using a clinic-based pill count in 392 adult patients receiving antiretroviral therapy (ART in a district hospital in Uganda were prospectively monitored over a 28-week period. Results. Of the 2267 total scheduled clinic visits, 40 (1.8% were missed visits. Among the 392 clients, 361 (92% attended all appointments for their refills (regular attendance. Clinic attendance for refills was statistically significantly associated with medication adherence with regular attendant clients having about fourfold greater odds of achieving optimal (≥95% medication adherence [odds ratio (OR=3.89, 95% CI: 1.48 to 10.25, exact P=.013]. In multivariate analysis, clients in age category 35 years and below were less likely to achieve regular clinic attendance. Conclusion. Monitoring of clinic attendance may be an objective and effective measure and could be a useful adjunct to an adherence measure such as pill counting in resource-constrained settings. Where human resource constraints do not allow pill counts or other time-consuming measures, then monitoring clinic attendance and acting on missed appointments may be an effective proxy measure.

  16. Adherence to Follow-Up Recommendations by Triathlon Competitors Receiving Event Medical Care.

    Science.gov (United States)

    Joslin, Jeremy D; Lloyd, Jarem B; Copeli, Nikoli; Cooney, Derek R

    2017-01-01

    Introduction . We sought to investigate triathlete adherence to recommendations for follow-up for participants who received event medical care. Methods . Participants of the 2011 Ironman Syracuse 70.3 (Syracuse, NY) who sought evaluation and care at the designated finish line medical tent were contacted by telephone approximately 3 months after the initial encounter to measure adherence with the recommendation to seek follow-up care after event. Results . Out of 750 race participants, 35 (4.6%) athletes received event medical care. Of these 35, twenty-eight (28/35; 80%) consented to participate in the study and 17 (61%) were available on telephone follow-up. Of these 17 athletes, 11 (11/17; 65%) of participants reported that they had not followed up with a medical professional since the race. Only 5 (5/17; 29%) confirmed that they had seen a medical provider in some fashion since the race; of these, only 2 (2/17; 12%) sought formal medical follow-up resulting from the recommendation whereas the remaining athletes merely saw their medical providers coincidentally or as part of routine care. Conclusion . Only 2 (2/17; 12%) of athletes who received event medical care obtained postrace follow-up within a one-month time period following the race. Event medical care providers must be aware of potential nonadherence to follow-up recommendations.

  17. Adherence to Follow-Up Recommendations by Triathlon Competitors Receiving Event Medical Care

    Directory of Open Access Journals (Sweden)

    Jeremy D. Joslin

    2017-01-01

    Full Text Available Introduction. We sought to investigate triathlete adherence to recommendations for follow-up for participants who received event medical care. Methods. Participants of the 2011 Ironman Syracuse 70.3 (Syracuse, NY who sought evaluation and care at the designated finish line medical tent were contacted by telephone approximately 3 months after the initial encounter to measure adherence with the recommendation to seek follow-up care after event. Results. Out of 750 race participants, 35 (4.6% athletes received event medical care. Of these 35, twenty-eight (28/35; 80% consented to participate in the study and 17 (61% were available on telephone follow-up. Of these 17 athletes, 11 (11/17; 65% of participants reported that they had not followed up with a medical professional since the race. Only 5 (5/17; 29% confirmed that they had seen a medical provider in some fashion since the race; of these, only 2 (2/17; 12% sought formal medical follow-up resulting from the recommendation whereas the remaining athletes merely saw their medical providers coincidentally or as part of routine care. Conclusion. Only 2 (2/17; 12% of athletes who received event medical care obtained postrace follow-up within a one-month time period following the race. Event medical care providers must be aware of potential nonadherence to follow-up recommendations.

  18. Medication adherence and its determinants among psychiatric patients in an Ethiopian referral hospital

    Directory of Open Access Journals (Sweden)

    Demoz Z

    2014-09-01

    Full Text Available Zaid Demoz,1 Befikadu Legesse,1 Gebrehiwot Teklay,1 Birhanu Demeke,1 Tewodros Eyob,2 Zewdneh Shewamene,3 Mubarek Abera4 1Department of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, 2Department of Pharmacy, College of Public Health and Medical Sciences, Jimma University, Jimma, 3Department of Pharmacology, School of Pharmacy, University of Gondar, Gondar, 4Department of Psychiatry, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia Background: The degree to which an individual follows medical advice is a major concern in every medical specialty. Non-adherence to psychiatric treatment regimens has a pro­found impact on the disease course, relapse, future recovery, cost of health care, and the outcome for the patient. The aim of this study was to assess medication adherence and its correlates among psychiatric patients at Ayder Referral Hospital, Northern Ethiopia.Methods: A cross-sectional study was conducted from June to September 2013 at Ayder Referral Hospital, where 423 patients were selected by a systematic random sampling technique from all patients attending the psychiatric clinic at the hospital. Data were collected by trained data collectors through interview of the patients using a structured questionnaire. The collected data were entered into Epi Info version 7 and analyzed by Statistical Package for the Social Sciences version 16 software. Logistic regression was used to assess independent predictors of adherence. Results: A total of 387 patients completed the interview. Two hundred and sixteen (55.8% and 113 (29.2% were patients with a diagnosis of schizophrenia and mood disorder, respectively, while 35 (9% and 23 (5.9% had a diagnosis of drug addiction and autistic disorder. Two hundred and seven (71.6% patients were found to be adherent to their medication. When adherence rates were observed according to type of disorder, 60 (53.1%, 24 (68.6%, 149 (69%, and 18 (78.3% of patients

  19. Mobile phone text messaging to improve medication adherence in secondary prevention of cardiovascular disease.

    Science.gov (United States)

    Adler, Alma J; Martin, Nicole; Mariani, Javier; Tajer, Carlos D; Owolabi, Onikepe O; Free, Caroline; Serrano, Norma C; Casas, Juan P; Perel, Pablo

    2017-04-29

    Worldwide at least 100 million people are thought to have prevalent cardiovascular disease (CVD). This population has a five times greater chance of suffering a recurrent cardiovascular event than people without known CVD. Secondary CVD prevention is defined as action aimed to reduce the probability of recurrence of such events. Drug interventions have been shown to be cost-effective in reducing this risk and are recommended in international guidelines. However, adherence to recommended treatments remains sub-optimal. In order to influence non-adherence, there is a need to develop scalable and cost-effective behaviour-change interventions. To assess the effects of mobile phone text messaging in patients with established arterial occlusive events on adherence to treatment, fatal and non-fatal cardiovascular events, and adverse effects. We searched CENTRAL, MEDLINE, Embase, the Conference Proceedings Citation Index - Science on Web of Science on 7 November 2016, and two clinical trial registers on 12 November 2016. We contacted authors of included studies for missing information and searched reference lists of relevant papers. We applied no language or date restrictions. We included randomised trials with at least 50% of the participants with established arterial occlusive events. We included trials investigating interventions using short message service (SMS) or multimedia messaging service (MMS) with the aim to improve adherence to medication for the secondary prevention of cardiovascular events. Eligible comparators were no intervention or other modes of communication. We used standard methodological procedures expected by Cochrane. In addition, we attempted to contact all authors on how the SMS were developed. We included seven trials (reported in 13 reports) with 1310 participants randomised. Follow-up ranged from one month to 12 months. Due to heterogeneity in the methods, population and outcome measures, we were unable to conduct meta-analysis on these studies

  20. MAGIC Study: Aims, Design and Methods using SystemCHANGE™ to Improve Immunosuppressive Medication Adherence in Adult Kidney Transplant Recipients.

    Science.gov (United States)

    Russell, Cynthia L; Moore, Shirley; Hathaway, Donna; Cheng, An-Lin; Chen, Guoqing; Goggin, Kathy

    2016-07-16

    Among adult kidney transplant recipients, non-adherence to immunosuppressive medications is the leading predictor of poor outcomes, including rejection, kidney loss, and death. An alarming one-third of kidney transplant patients experience medication non-adherence even though the problem is preventable. Existing adherence interventions have proven marginally effective for those with acute and chronic illnesses and ineffective for adult kidney transplant recipients. Our purpose is to describe the design and methods of the MAGIC (Medication Adherence Given Individual SystemCHANGE™) trial We report the design of a randomized controlled trial with an attention-control group to test an innovative 6-month SystemCHANGE™ intervention designed to enhance immunosuppressive medication adherence in adult non-adherent kidney transplant recipients from two transplant centers. Grounded in the Socio-Ecological Model, SystemCHANGE™ seeks to systematically improve medication adherence behaviors by identifying and shaping routines, involving supportive others in routines, and using medication taking feedback through small patient-led experiments to change and maintain behavior. After a 3-month screening phase of 190 eligible adult kidney transplant recipients, those who are adherent as measured by electronic monitoring, will be randomized into a 6-month SystemCHANGE™ intervention or attention-control phase, followed by a 6-month maintenance phase without intervention or attention. Differences in adherence between the two groups will be assessed at baseline, 6 months (intervention phase) and 12 months (maintenance phase). Adherence mediators (social support, systems-thinking) and moderators (ethnicity, perceived health) are examined. Patient outcomes (creatinine/blood urea nitrogen, infection, acute/chronic rejection, graft loss, death) and cost effectiveness are to be examined. Based on the large effect size of 1.4 found in our pilot study, intervention shows great promise

  1. A Mobile Phone HIV Medication Adherence Intervention: Acceptability and Feasibility Study.

    Science.gov (United States)

    Martin, C Andrew; Upvall, Michele J

    We present the findings of a qualitative pilot study designed to describe the experience of HIV medication adherence using a mobile phone application. Nine semi-structured focus group discussions were conducted over a 3-month period at an AIDS Services Organization in Central Texas. The data were analyzed following the principles of thematic analysis. During analysis, four themes were identified, and relations between these themes were delineated to reflect the experiences of the 23 participants. The mobile phone application, Care4Today™ Mobile Health Manager, was the intervention tool. Collection of focus group discussion outcomes over a 3-month period with baseline versus end-of-study data determined the feasibility and acceptability of this medication adherence intervention. The findings suggest that when individuals are offered the necessary resources, such as a mobile phone medication reminder application, they may have greater success in performing the behavior. Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

  2. Systematic procedures to promote U.S. HIV medication adherence via Photovoice.

    Science.gov (United States)

    Teti, Michelle; Shaffer, Victoria; Majee, Wilson; Farnan, Rose; Gerkovich, Mary

    2017-06-21

    Medication adherence is essential to promote the health of people living with HIV (PL-HIV) and prevent HIV transmission in the U.S. Novel medication health promotion interventions are needed that address patient-centeredness, understandability, and communication with providers. The aims of this article are to define the systematic stages we used to develop an effective health promotion intervention via the products (e.g. images and stories) of Photovoice. We designed an intervention to improve HIV adherence knowledge, attitudes, and communication with providers through Photovoice. 16 PL-HIV used Photovoice strategies to describe their experiences with medication via images and captions and create an intervention (10 adherence promotion posters) that integrated photo-stories of their adherence motivators, journeys from sickness to health, and how they manage and counter HIV stigma. We outline the systematic process we used to adapt Photovoice to create the effective intervention for replication. The process included six stages: (i) identify scope of the project; (ii) create collaborative project team; (iii) design project materials; (iv) review and revise materials with team members; (v) disseminate materials; and (vi) evaluate materials. Photovoice is used traditionally as a social action research method. In this project, it was adapted to create patient-driven images and stories for health promotion posters. Poster viewers experienced improved self-efficacy for HIV medication adherence. Describing the adaptation of the Photovoice process in a deliberate and transparent way can support fidelity to the essence of the participant-driven method, while also allowing researchers and practitioners to replicate Photovoice as a successful health promotion intervention. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  3. Workplace social capital and adherence to antihypertensive medication: a cohort study.

    Directory of Open Access Journals (Sweden)

    Tuula Oksanen

    Full Text Available While hypertension is a common and treatable health problem, adherence to antihypertensive medication remains a challenge. This study examines the hypothesis that workplace social capital may influence adherence to antihypertensive medication among hypertensive employees.We linked survey responses to nationwide pharmacy records for a cohort of 3515 hypertensive employees (mean age 53.9 years, 76% women who required continuous antihypertensive drug therapy (the Finnish Public Sector study. A standard scale was used to measure workplace social capital from co-workers' assessments and self-reports in 2000-2004. Non-adherence to antihypertensive medication was determined based on the number of days-not-treated at the year following the survey using comprehensive prescription records. Negative binomial regression models were conducted adjusting for socio-demographic characteristics, duration of hypertension, behaviour-related risk factors, and co-morbid conditions. The overall rate of days-not-treated was 20.7 per person-year (78% had no days-not-treated. Higher age, obesity, and presence of somatic co-morbidities were all associated with better adherence, but this was not the case for co-worker-assessed or self-reported workplace social capital. The rate of days-not-treated was 19.7 per person-year in the bottom fourth of co-worker-assessed workplace social capital, compared to 20.4 in the top fourth. The corresponding rate ratio from the fully-adjusted model was 0.95 (95% confidence interval (CI 0.58-1.56. In a subgroup of 907 new users of antihypertensive medication this rate ratio was 0.98 (95% CI 0.42-2.29.We found no consistent evidence to support the hypothesized effect of workplace social capital on adherence to drug therapy among employees with chronic hypertension.

  4. Medication understanding, non-adherence, and clinical outcomes among adult kidney transplant recipients.

    Science.gov (United States)

    Patzer, Rachel E; Serper, Marina; Reese, Peter P; Przytula, Kamila; Koval, Rachel; Ladner, Daniela P; Levitsky, Josh M; Abecassis, Michael M; Wolf, Michael S

    2016-10-01

    We sought to evaluate the prevalence of medication understanding and non-adherence of entire drug regimens among kidney transplantation (KT) recipients and to examine associations of these exposures with clinical outcomes. Structured, in-person interviews were conducted with 99 adult KT recipients between 2011 and 2012 at two transplant centers in Chicago, IL; and Atlanta, GA. Nearly, one-quarter (24%) of participants had limited literacy as measured by the Rapid Estimate of Adult Literacy in Medicine test; patients took a mean of 10 (SD=4) medications and 32% had a medication change within the last month. On average, patients knew what 91% of their medications were for (self-report) and demonstrated proper dosing (via observed demonstration) for 83% of medications. Overall, 35% were non-adherent based on either self-report or tacrolimus level. In multivariable analyses, fewer months since transplant and limited literacy were associated with non-adherence (all Padherence, and hospitalization could help target appropriate self-care interventions. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Perspectives on medicine adherence in service users and carers with experience of legally sanctioned detention and medication: a qualitative study.

    Science.gov (United States)

    Gault, Iris; Gallagher, Ann; Chambers, Mary

    2013-01-01

    To explore and analyze perceptions of service users and caregivers on adherence and nonadherence to medication in a mental health care context. Mental health medication adherence is considered problematic and legal coercion exists in many countries. This was a qualitative study aiming to explore perceptions of medication adherence from the perspective of the service user (and their caregiver, where possible). Eighteen mental health service users (and six caregivers) with histories of medication nonadherence and repeated compulsory admission were recruited from voluntary sector support groups in England. Data were collected between 2008 and 2010. Using qualitative coding techniques, the study analyzed interview and focus group data from service users, previously subjected to compulsory medication under mental health law, or their caregivers. The process of medication adherence or nonadherence is encapsulated in an explanatory narrative. This narrative constitutes participants' struggle to negotiate acceptable and effective routes through variable quality of care. Results indicated that service users and caregivers eventually accepted the reality of their own mental illness and their need for safety and treatment. They perceived the behavior of professionals as key in their recovery process. Professionals could be enabling or disabling with regard to adherence to medication. This study investigated service user and caregiver perceptions of medication adherence and compulsory treatment. Participants described a process perceived as variable and potentially doubly faceted. The behavior of professionals was seen as crucial in collaborative decision making on medication adherence.

  6. Feasibility of motivational interviewing delivered by a glaucoma educator to improve medication adherence.

    Science.gov (United States)

    Cook, Paul F; Bremer, Robert W; Ayala, A J; Kahook, Malik Y

    2010-10-05

    Adherence to glaucoma treatment is poor, potentially reducing therapeutic effects. A glaucoma educator was trained to use motivational interviewing (MI), a patient-centered counseling style, to improve adherence. This study was designed to evaluate whether MI was feasible in a busy ophthalmology practice. Feasibility was assessed using five criteria from the National Institutes of Health Behavior Change consortium: fidelity of intervention components to MI theory; success of the training process; delivery of MI-consistent interventions by the glaucoma educator; patient receipt of the intervention based on enrollment, attrition, and satisfaction; and patient enactment of changes in motivation and adherence over the course of the intervention. A treatment manual was designed by a multidisciplinary team with expertise in health psychology, public health, and ophthalmology. The glaucoma educator received 6 hours of training including role-play exercises, self-study, and individual supervision. His MI-related knowledge and skills increased following training, and he delivered exclusively MI-consistent interventions in 66% of patient encounters. 86% (12/14) of eligible patients agreed to be randomized into glaucoma educator support or a control condition. All 8 patients assigned to the glaucoma educator completed at least 2 of 6 planned contacts, and 50% (4/8) completed all 6 contacts. Patients assigned to the glaucoma educator improved over time in both motivation and adherence. The introduction of a glaucoma educator was feasible in a busy ophthalmology practice. Patients improved their adherence while participating in the glaucoma educator program, although this study was not designed to show a causal effect. The use of a glaucoma educator to improve glaucoma patients' medication adherence may be feasible at other ophthalmology clinics, and can be implemented with a standardized training approach. Pilot data show the intervention can be implemented with fidelity, is

  7. Self-reported non-adherence and beliefs about medication in a Swedish kidney transplant population.

    Science.gov (United States)

    Lennerling, Annette; Forsberg, Anna

    2012-01-01

    Patients' non-adherence to immunosuppressant treatment after organ transplantation may lead to organ failure, graft loss and death. Non-adherence among Swedish kidney transplant recipients has not previously been studied. Hence the aim of this study was to explore non-adherence among Swedish kidney transplant recipients by using self-report instruments as well as testing the hypothesis that there is a difference in self-reported symptoms, beliefs about medicine and social support between respondents with or without self reported non-adherence. In the present cross sectional study 250 renal transplant recipients participated by replying to a questionnaire. Two validated instruments were included, one on beliefs about medicine (the BMQ©), the other on nonadherence (the BAASIS©). Only 46 % never failed to follow the medical treatment with respect to taking the drugs, dosage or timing (>2 hrs from prescribed time). Timing was the most frequently reported deviation (48 %). Forty-seven patients (16 %) had failed taking at least one dose of the prescribed immunosuppressants during the past four weeks. Four individuals had reduced the prescribed doses. Only one reported taking a 'drug holiday'. Nine participants reported stronger concerns than necessities for immunosuppressive medication. For the BMQ the necessity scores were extremely high while the scores for concern were low. Risk behaviour identified by the BAASIS had no association in risk attitudes as identified in the BMQ. The only factor relating to non-adherence was lack of social support (p=0.022). In general adherence was high. Identification of the exceptions remains a challenge.

  8. Understanding barriers to medication adherence in the hypertensive population by evaluating responses to a telephone survey

    Directory of Open Access Journals (Sweden)

    Nair KV

    2011-04-01

    Full Text Available Kavita V Nair1, Daniel A Belletti3, Joseph J Doyle3, Richard R Allen4, Robert B McQueen1, Joseph J Saseen1, Joseph Vande Griend1, Jay V Patel5, Angela McQueen2, Saira Jan21School of Pharmacy, University of Colorado, Aurora, CO, USA; 2Horizon Blue Cross Blue Shield of New Jersey, Newark, NJ, USA; 3Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, 4Peakstat Statistical Services, Evergreen, CO, USA; 5Care Management International, Marlborough, MA, USABackground: Although hypertension is a major risk factor for cardiovascular disease, adherence to hypertensive medications is low. Previous research identifying factors influencing adherence has focused primarily on broad, population-based approaches. Identifying specific barriers for an individual is more useful in designing meaningful targeted interventions. Using customized telephonic outreach, we examined specific patient-reported barriers influencing hypertensive patients' nonadherence to medication in order to identify targeted interventions.Methods: A telephone survey of 8692 nonadherent hypertensive patients was conducted. The patient sample comprised health plan members with at least two prescriptions for antihypertensive medications in 2008. The telephone script was based on the "target" drug associated with greatest nonadherence (medication possession ratio [MPR] <80% during the four-month period preceding the survey.Results: The response rate was 28.2% of the total sample, representing 63.8% of commercial members and 37.2% of Medicare members. Mean age was 63.4 years. Mean MPR was 61.0% for the target drug. Only 58.2% of Medicare respondents and 60.4% of commercial respondents reported "missing a dose of medication". The primary reason given was "forgetfulness" (61.8% Medicare, 60.8% commercial, followed by "being too busy" (2.7% Medicare, 18.5% commercial and "other reasons" (21.9% Medicare, 8.1% commercial including travel, hospitalization/sickness, disruption of daily events

  9. A New Electronic Monitoring Device to Measure Medication Adherence: Usability of the Helping Hand™

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    Sabina De Geest

    2010-03-01

    Full Text Available The aim of this study was to test the user performance, satisfaction and acceptability of the Helping Hand™ (B&O Medicom electronic medication adherence monitor. Using a mixed-method design, we studied 11 kidney transplant patients and 10 healthy volunteers during three weeks. Although testing showed positive usability aspects, several areas requiring technical improvement were identified: the most important obstacles to usability and acceptability were the weak sound signal, problems loading the medication, and the fact that only one medication could be used at a time.

  10. Effectiveness of a group-based intervention to change medication beliefs and improve medication adherence in patients with rheumatoid arthritis: a randomized controlled trial.

    NARCIS (Netherlands)

    Zwikker, H.E.; Ende, C.H. van den; Lankveld, W.G. van; Broeder, A.A. den; Hoogen, F.H. van den; Mosselaar, B. van de; Dulmen, S. van; Bemt, B.J. van den

    2014-01-01

    Objective: To assess the effect of a group-based intervention on the balance between necessity beliefs and concern beliefs about medication and on medication non-adherence in patients with rheumatoid arthritis (RA). Methods: Non-adherent RA patients using disease-modifying anti-rheumatic drugs

  11. Hemodialysis knowledge and medical adherence in African Americans diagnosed with end stage renal disease: results of an educational intervention.

    Science.gov (United States)

    Wells, Janie R

    2011-01-01

    The purpose of this three-group quasi-experimental research study was to describe the relationship between hemodialysis knowledge and perceived medical adherence to a prescribed treatment regimen in African Americans diagnosed with end stage renal disease and to determine if an educational intervention improved hemodialysis knowledge and medical adherence. Eighty-five African Americans participated in this study using the Life Options Hemodialysis Knowledge Test and the Medical Outcomes Study Measures of Patient Adherence tools. No significant correlation was found between hemodialysis knowledge and medical adherence. Paired sample t-tests revealed significantly higher hemodialysis knowledge scores in the post-test group compared to the pre-test group, t(26) = -3.79, p adherence. This study suggests that more education is needed to improve the knowledge level of African-American patients on hemodialysis.

  12. Non-adherence to Psychotropic Medication Among Adolescents - A Systematic Review of the Literature.

    Science.gov (United States)

    Häge, Alexander; Weymann, Lisa; Bliznak, Lucia; Märker, Viktoria; Mechler, Konstantin; Dittmann, Ralf W

    2018-01-01

    Whether patients take their medication as prescribed is of increasing importance in adolescent psychiatry since both the number of efficacious pharmaceutical treatments and the rate of prescriptions of psychotropic compounds are on the rise. Previous research showed high rates of medication nonadherence among both adolescents with medical disorders and adult patients with psychiatric disorders. The present review was performed according to PRISMA guidelines and evaluates existing scientific literature concerning adherence to psychotropic medication among adolescents. The goal was to determine rates of nonadherence in this age group as well as the factors associated with it. Therefore, we conducted a comprehensive literature search of PubMed from its inception until 15 September 2015 using the keywords "adherence," "compliance," "adolescent," and "psychotropic medication." A total of 607 pertinent articles were collected and screened; 15 publications were selected for detailed review. The studies differed, among other things, regarding sample characteristics, medication type, and indications. Furthermore, the definitions of what constitutes nonadherence and the methods used to assess it varied widely. Nonadherence rates ranged from 6 % to 62 % (median 33 %). Nonadherence to psychotropic medication is a clinically relevant problem among adolescents. Because of the methodological heterogeneity across studies and partially contradictory results, no conclusions could be drawn concerning the influence of factors such as psychopathology, medication type, side effects, the effectiveness of treatment, or family-related factors. Well-designed long-term studies of large patient samples and a consensus regarding definitions are therefore warranted. Such research would facilitate the design of tailored strategies to improve adherence in these patients.

  13. Improving maintenance medication adherence in adult inflammatory bowel disease patients: a pilot study

    Directory of Open Access Journals (Sweden)

    Michelle L. Matteson-Kome

    2014-01-01

    Full Text Available Medication nonadherence in inflammatory bowel disease (IBD may lead to suboptimal control of the disease, decreased quality of life, and poor outcomes. This pilot study evaluated the feasibility, intervention mechanism, and potential effectiveness of a three-month continuous self-improvement (CSI intervention to enhance medication adherence (MA in adult nonadherent IBD patients. Adult IBD patients taking a daily or twice-daily dosed maintenance medication were screened electronically for two months to determine baseline MA levels. Nonadherent IBD participants were randomized to the CSI or the attention control (AC intervention and monitored for three months. The CSI intervention consisted of a data evaluation and system refinement process in which system changes were identified and implemented. The AC group was given educational information regarding IBD disease process, extra-intestinal manifestations of IBD, and medical therapy. Demographic statistics, change scores for within and between- group differences, and effect size estimates were calculated. Nine nonadherent participants (medication adherence score <0.85 were eligible for randomization. The intervention was found feasible and acceptable. Although no statistically significant improvement in MA was found (P=0.14, adherence improved in 3 of 4 of the CSI group and 1 of 2 in the attention control group. The effect size calculation of 1.9 will determine the sample size for future study. The results of this pilot study showed the intervention was feasible and had a positive effect on MA change score and adherence levels. A larger fully powered study is needed to test of the effectiveness of this innovative intervention.

  14. Relationship between medication beliefs, self-reported and refill adherence, and symptoms in patients with asthma using inhaled corticosteroids

    Directory of Open Access Journals (Sweden)

    Van Steenis MNA

    2014-01-01

    Full Text Available MNA Van Steenis,1 JA Driesenaar,2 JM Bensing,2,3 R Van Hulten,4 PC Souverein,4 L Van Dijk,2,4 PAGM De Smet,5 AM Van Dulmen2,6,71Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; 2NIVEL (Netherlands institute for health services research, Utrecht, The Netherlands; 3Department of Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands; 4Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands; 5IQ Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; 6Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; 7Department of Health Sciences, Buskerud University College, Drammen, NorwayBackground: Beliefs play a crucial role in medication adherence. Interestingly, the relationship between beliefs and adherence varies when different adherence measures are used. How adherence, in turn, is related to asthma symptoms is still unclear. Our aim was to investigate the relationship between beliefs (ie, necessities and concerns about inhaled corticosteroids (ICS and subjectively as well as objectively measure adherence and the agreement between these measures. Further, the relationship between adherence and asthma symptoms was examined.Methods: A total of 280 patients aged 18–80 years who filled at least two ICS prescriptions in the preceding year were recruited to complete a questionnaire. The questionnaire included the Beliefs about Medicines Questionnaire to assess necessity beliefs and concerns about ICS, four questions about ICS use to measure self-reported adherence, and the Asthma Control Questionnaire to assess asthma symptoms. Proportion of days covered was used to determine pharmacy refill adherence.Results: Data from 93 patients with asthma were analyzed. Necessities were positively related to self-reported adherence (P = 0.01. No other

  15. Value-Based Benefit Design to Improve Medication Adherence for Employees with Anxiety or Depression.

    Science.gov (United States)

    Reid, Kimberly J; Aguilar, Kathleen M; Thompson, Eric; Miller, Ross M

    2015-01-01

    Through reduced out-of-pocket costs and wellness offerings, value-based benefit design (VBBD) is a promising strategy to improve medication adherence and other health-related outcomes across populations. There is limited evidence, however, of the effectiveness of these policy-level changes among individuals with anxiety or depression. To assess the impact of a multifaceted VBBD policy that incorporates waived copayments, wellness offerings, and on-site services on medication adherence among plan members with anxiety or depression, and to explore how this intervention and its resulting improved adherence affects other health-related outcomes. A retrospective longitudinal pre/post design was utilized to measure outcomes before and after the VBBD policy change. Repeated measures statistical regression models with correlated error terms were utilized to evaluate outcomes among employees of a self-insured global health company and their spouses (N = 529) who had anxiety or depression after the VBBD policy change. A multivariable linear regression model was chosen as the best fit to evaluate a change in medication possession ratio (MPR) after comparing parameters for several distributions. The repeated measures multivariable regression models were adjusted for baseline MPR and potential confounders, including continuous age, sex, continuous modified Charlson Comorbidity Index, and the continuous number of prescriptions filled that year. The outcomes were assessed for the 1 year before the policy change (January 1, 2011, through December 31, 2011) and for 2 years after the change (January 1, 2012, through December 31, 2013). The primary outcome was a change in MPR. The secondary outcomes included healthcare utilization, medical or pharmacy costs, the initiation of medication, generic medication use, and employee absenteeism (the total number of sick days). The implementation of the VBBD strategy was associated with a significant increase in average MPR (0.65 vs 0.61 in

  16. A Nursing Management Model to Increase Medication Adherence and Nutritional Status of Patients with Pulmonary TB

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    Eka Mishbahatul Mar’ah Has

    2015-04-01

    Full Text Available Introduction: High dropout rate, inadequate treatment, and resistance to medication, still become an obstacle in the treatment of pulmonary TB. Pulmonary TB patient care management at home can be done actively through telenursing. N-SMSI (Ners-Short Message Service Intervention is one of community nursing intervention, in which community nurses send short messages to remind patients to take medication and nutrition. The aim of this study was to analyze the effect of nursing management model N-SMSI to increased medication adherence and nutritional status of patients with pulmonary TB. Method: This study was used prospective design. The populations were new pulmonary TB patient at intensive phase, at Puskesmas Pegirian Surabaya. Samples were taken by purposive sampling technique; consist of 30 people, divided into treatment and control groups. The independent variable was N-SMSI. The dependent variables were medication adherence collected by using questionnaire and nutritional status by using measurement of body weight (kg. The data were then analyzed by using Wilcoxon Signed Rank Test, Mann Whitney, and Independent t-test with α ≤ 0.05 Result: The results of wilcoxon signed rank test had showed difference in the nutritional status of the treatment group before and after intervention, with p = 0.001. It’s similar with the control group, with p = 0.002. Mann whitney test results had showed no signifi cant difference in nutritional status between treatment and control group, as indicated by the value of p=0.589. While independent t-test had showed difference in compliance between treatment and control group, with p=0.031. Conslusion: N-SMSI can improve medication adherence of patient with Pulmonary TB. This model can be developed by nurse as alternative methods to improve medication adherence in patients with Pulmonary TB. Further research should modify nursing management model which can improve the nutritional status of patient with Pulmonary

  17. Curing the disobedient patient: medication adherence programs as pharmaceutical marketing tools.

    Science.gov (United States)

    Lamkin, Matt; Elliott, Carl

    2014-01-01

    Pharmaceutical companies have long focused their marketing strategies on getting doctors to write more prescriptions. But they lose billions in potential sales when patients do not take their prescribed drugs. Getting patients to "adhere" to drug therapies that have unpleasant side effects and questionable efficacy requires more than mere ad campaigns urging patients to talk to their doctors. It requires changing patients' beliefs and attitudes about their medications through repeated contact from people patients trust. Since patients do not trust drug companies, these companies are delivering their marketing messages through nurses, pharmacists, and even other patients--leveraging patients' trust in these intermediaries to persuade them to consume more brand name drugs. Armed with the premise that better adherence improves patients' health, drug companies justify manipulating patients by reframing reasonable decisions to decline therapy as pathological, and promote brand loyalty in the guise of offering medical care. © 2014 American Society of Law, Medicine & Ethics, Inc.

  18. CDC Grand Rounds: Improving Medication Adherence for Chronic Disease Management - Innovations and Opportunities.

    Science.gov (United States)

    Neiman, Andrea B; Ruppar, Todd; Ho, Michael; Garber, Larry; Weidle, Paul J; Hong, Yuling; George, Mary G; Thorpe, Phoebe G

    2017-11-17

    Adherence to prescribed medications is associated with improved clinical outcomes for chronic disease management and reduced mortality from chronic conditions (1). Conversely, nonadherence is associated with higher rates of hospital admissions, suboptimal health outcomes, increased morbidity and mortality, and increased health care costs (2). In the United States, 3.8 billion prescriptions are written annually (3). Approximately one in five new prescriptions are never filled, and among those filled, approximately 50% are taken incorrectly, particularly with regard to timing, dosage, frequency, and duration (4). Whereas rates of nonadherence across the United States have remained relatively stable, direct health care costs associated with nonadherence have grown to approximately $100-$300 billion of U.S. health care dollars spent annually (5,6). Improving medication adherence is a public health priority and could reduce the economic and health burdens of many diseases and chronic conditions (7).

  19. Modeling determinants of medication attitudes and poor adherence in early nonaffective psychosis: implications for intervention.

    Science.gov (United States)

    Drake, Richard J; Nordentoft, Merete; Haddock, Gillian; Arango, Celso; Fleischhacker, W Wolfgang; Glenthøj, Birte; Leboyer, Marion; Leucht, Stefan; Leweke, Markus; McGuire, Phillip; Meyer-Lindenberg, Andreas; Rujescu, Dan; Sommer, Iris E; Kahn, René S; Lewis, Shon W

    2015-05-01

    We aimed to design a multimodal intervention to improve adherence following first episode psychosis, consistent with current evidence. Existing literature identified medication attitudes, insight, and characteristics of support as important determinants of adherence to medication: we examined medication attitudes, self-esteem, and insight in an early psychosis cohort better to understand their relationships. Existing longitudinal data from 309 patients with early Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, nonaffective psychosis (83% first episode) were analyzed to test the hypothesis that medication attitudes, while meaningfully different from "insight," correlated with insight and self-esteem, and change in each influenced the others. Rosenberg Self-Esteem Scale, Birchwood Insight Scale, and Positive and Negative Syndrome Scale insight were assessed at presentation, after 6 weeks and 3 and 18 months. Drug Attitudes Inventory (DAI) and treatment satisfaction were rated from 6 weeks onward. Structural equation models of their relationships were compared. Insight measures' and DAI's predictive validity were compared against relapse, readmission, and remission. Analysis found five latent constructs best fitted the data: medication attitudes, self-esteem, accepting need for treatment, self-rated insight, and objective insight. All were related and each affected the others as it changed, except self-esteem and medication attitudes. Low self-reported insight at presentation predicted readmission. Good 6-week insight (unlike drug attitudes) predicted remission. Literature review and data modeling indicated that a multimodal intervention using motivational interviewing, online psychoeducation, and SMS text medication reminders to enhance adherence without damaging self-concept was feasible and appropriate. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For

  20. The differences between medical trust and mistrust and their respective influences on medication beliefs and ART adherence among African-Americans living with HIV.

    Science.gov (United States)

    Pellowski, Jennifer A; Price, Devon M; Allen, Aerielle M; Eaton, Lisa A; Kalichman, Seth C

    2017-09-01

    The purpose of this study was to examine the relationships between medical mistrust and trust and to determine if these measures differentially predict antiretroviral therapy (ART) medication adherence for African-American adults living with HIV. A total of 458 HIV positive African-Americans completed a cross-sectional survey. Self-reported ART adherence was collected using the visual-analog scale. The Beliefs About Medicines Questionnaire was used to assess medication necessity and concern beliefs. All measures of medical mistrust and trust were significantly negatively correlated, ranging from r = -.339 to -.504. Race-based medical mistrust significantly predicted medication necessity and concern beliefs, whereas general medical mistrust only significantly predicted medication concerns. Both measures of trust significantly predicted medication necessity beliefs and medication concerns. Higher levels of race-based medical mistrust predicted lower medication adherence, whereas, neither trust in own physician nor trust in health care provider significantly predicted medication adherence. However, trust in own physician significantly predicted medication necessity beliefs, which predicted medication adherence. Trust and mistrust are not simply opposites of one another. These findings provide evidence for the complexity of understanding the relationship between health care trust, mistrust and patient-related health beliefs and behaviours.

  1. An innovative and comprehensive technique to evaluate different measures of medication adherence: The network meta-analysis.

    Science.gov (United States)

    Tonin, Fernanda S; Wiecek, Elyssa; Torres-Robles, Andrea; Pontarolo, Roberto; Benrimoj, Shalom Charlie I; Fernandez-Llimos, Fernando; Garcia-Cardenas, Victoria

    2018-05-19

    Poor medication adherence is associated with adverse health outcomes and higher costs of care. However, inconsistencies in the assessment of adherence are found in the literature. To evaluate the effect of different measures of adherence in the comparative effectiveness of complex interventions to enhance patients' adherence to prescribed medications. A systematic review with network meta-analysis was performed. Electronic searches for relevant pairwise meta-analysis including trials of interventions that aimed to improve medication adherence were performed in PubMed. Data extraction was conducted with eligible trials evaluating short-period adherence follow-up (until 3 months) using any measure of adherence: self-report, pill count, or MEMS (medication event monitoring system). To standardize the results obtained with these different measures, an overall composite measure and an objective composite measure were also calculated. Network meta-analyses for each measure of adherence were built. Rank order and surface under the cumulative ranking curve analyses (SUCRA) were performed. Ninety-one trials were included in the network meta-analyses. The five network meta-analyses demonstrated robustness and reliability. Results obtained for all measures of adherence were similar across them and to both composite measures. For both composite measures, interventions comprising economic + technical components were the best option (90% of probability in SUCRA analysis) with statistical superiority against almost all other interventions and against standard care (odds ratio with 95% credibility interval ranging from 0.09 to 0.25 [0.02, 0.98]). The use of network meta-analysis was reliable to compare different measures of adherence of complex interventions in short-periods follow-up. Analyses with longer follow-up periods are needed to confirm these results. Different measures of adherence produced similar results. The use of composite measures revealed reliable alternatives

  2. The effect of patient satisfaction with pharmacist consultation on medication adherence: an instrumental variable approach

    Directory of Open Access Journals (Sweden)

    Gu NY

    2008-12-01

    Full Text Available There are limited studies on quantifying the impact of patient satisfaction with pharmacist consultation on patient medication adherence. Objectives: The objective of this study is to evaluate the effect of patient satisfaction with pharmacist consultation services on medication adherence in a large managed care organization. Methods: We analyzed data from a patient satisfaction survey of 6,916 patients who had used pharmacist consultation services in Kaiser Permanente Southern California from 1993 to 1996. We compared treating patient satisfaction as exogenous, in a single-equation probit model, with a bivariate probit model where patient satisfaction was treated as endogenous. Different sets of instrumental variables were employed, including measures of patients' emotional well-being and patients' propensity to fill their prescriptions at a non-Kaiser Permanente (KP pharmacy. The Smith-Blundell test was used to test whether patient satisfaction was endogenous. Over-identification tests were used to test the validity of the instrumental variables. The Staiger-Stock weak instrument test was used to evaluate the explanatory power of the instrumental variables. Results: All tests indicated that the instrumental variables method was valid and the instrumental variables used have significant explanatory power. The single equation probit model indicated that the effect of patient satisfaction with pharmacist consultation was significant (p<0.010. However, the bivariate probit models revealed that the marginal effect of pharmacist consultation on medication adherence was significantly greater than the single equation probit. The effect increased from 7% to 30% (p<0.010 after controlling for endogeneity bias. Conclusion: After appropriate adjustment for endogeneity bias, patients satisfied with their pharmacy services are substantially more likely to adhere to their medication. The results have important policy implications given the increasing focus

  3. The function of medication beliefs as mediators between personality traits and adherence behavior in people with asthma

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    Axelsson M

    2013-10-01

    Full Text Available Malin Axelsson,1,2 Christina Cliffordson,2 Bo Lundbäck,1 Jan Lötvall11Krefting Research Centre, Institute of Medicine, Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 2Department of Nursing, Health and Culture, University West, Trollhättan, SwedenBackground: There is evidence that both personality traits and personal beliefs about medications affect adherence behavior. However, limited research exists on how personality and beliefs about asthma medication interact in influencing adherence behavior in people with asthma. To extend our knowledge in this area of adherence research, we aimed to determine the mediating effects of beliefs about asthma medication between personality traits and adherence behavior.Methods: Asthmatics (n=516 selected from a population-based study called West Sweden Asthma Study completed the Neuroticism, Extraversion and Openness to Experience Five-Factor Inventory, the Medication Adherence Report Scale, and the Beliefs about Medicines Questionnaire. Data were analyzed using confirmatory factor analysis and structural equation modeling.Results: Three of the five investigated personality traits – agreeableness, conscientiousness, and neuroticism – were associated with both concerns about asthma medication and adherence behavior. Concerns functioned as a partial mediator for the influencing effects of agreeableness, conscientiousness, and neuroticism on adherence behavior.Conclusion: The findings suggest that personality traits could be used to identify individuals with asthma who need support with their adherence behavior. Additionally, targeting concerns about asthma medication in asthmatics with low levels of agreeableness or conscientiousness or high levels of neuroticism could have a favorable effect on their adherence behavior.Keywords: adherence, individual differences, medication concerns, health behavior

  4. Exploring risk factors of non-adherence to immunosuppressive medication in kidney transplant recipients : improving methodology & reorienting research goals

    OpenAIRE

    Denhaerynck, Kris

    2006-01-01

    8.1. Background and aim of the research program Non-adherence to the immunosuppressive therapy is an important issue in kidney transplant patients. About 20% of the kidney transplant patients are non-adherent to the immunosuppressive regimen. Non-adherence contributes to 20% of late acute rejection episodes and 16% of the graft losses, and results in a decreased number of quality adjusted life years. A strategy to increase long-term successful outcome after transplantation i...

  5. Walking a fine line: managing the tensions associated with medication non-adherence in an acute inpatient psychiatric setting.

    Science.gov (United States)

    Wijnveld, Anne-Marie; Crowe, Marie

    2010-05-01

    The aim of this study was to use a phenomenological methodology to examine mental health nurses' experiences of administering medications to patients who were non-adherent in an acute inpatient service. There is a large body of literature focused on exploring the issue of non-adherence to prescribed medication, but there is very little examining this from mental health nurses' perspectives. Many of the medications prescribed for patients diagnosed with a psychiatric disorder have serious side effects and limited efficacy. Mental health nurses in acute inpatient environments are regularly confronted with the difficulties inherent in the conflicting roles associated with the need to maintain therapeutic relationships and the expectation that they ensure patients take their medications. This is a qualitative study exploring mental health nurses' descriptions of managing medication adherence in an acute inpatient unit. The interpretive phenomenological methodology of Van Manen (Researching Lived Experience: Human Science for an Action Sensitive Pedagogy, 1990) was used in this study to capture the experiences of a group of nurses. This research process involves a dynamic interplay between the following six research activities: (1) turning to the nature of the lived experience; (2) investigating the experience as we live it; (3) reflecting on essential themes; (4) a description of the phenomenon through the art of writing and rewriting; (5) maintaining a strong and oriented pedagogical relation to the phenomenon; and (6) balancing the research context by considering parts and whole. Four themes emerged from the existential analysis that described the mental health nurses' experiences: doing the job for doctors (relationality); stopping and listening (temporality); stepping in (corporeality); and walking a fine line (spatiality). It is proposed that models of therapeutic interventions offering alternative or conjunctive treatment to medications could be incorporated into

  6. Spiritual care may impact mental health and medication adherence in HIV+ populations

    Directory of Open Access Journals (Sweden)

    Oji VU

    2017-04-01

    Full Text Available Valerie U Oji,1–3 Leslie C Hung,3 Reza Abbasgholizadeh,1,4 Flora Terrell Hamilton,5 E James Essien,6 Evaristus Nwulia7 1Lifefountain Center Ministries Inc, Houston, TX, USA; 2Feik School of Pharmacy, University of the Incarnate Word, San Antonio, TX, USA; 3University of Texas, College of Pharmacy, Austin, TX, USA; 4University of Houston, Houston, TX, USA; 5Administration, Family & Medical Counseling Service, Inc. (FMCS, Washington, DC, USA; 6University of Houston Institute for Community Health, Houston, TX, USA; 7Psychiatry, Howard University Translational Neuroscience Laboratory, Washington, DC, USA Objective: To explore a potential role for spirituality in medication-related needs assessment for integrated care in chronically ill populations. Method: A systematic literature review was conducted to explore the impact of faith beliefs on health and/or medication adherence in individuals with depression and/or HIV+/AIDS. Retrospective electronic medical record review of adult HIV+ patients of an urban primary care clinic with integrated mental health services was conducted, with Substance Abuse and Mental Illness Symptoms Screener (SAMISS, major depressive disorder (MDD incidence over the preceding year, and history of contact with a spiritual advisor. A convenience sample was interviewed to qualitatively assess potential medication therapy management needs and medication-related problems. Another sample was examined utilizing the Daily Spiritual Experience Scale. Results: The literature reports positive influence on health behaviors, coping and outcomes; and poor medication adherence and treatment decisions due to patient passivity or resistance. Spiritual advisor contact (not limited to a specific religion was significantly associated with MDD absence (1.7% vs. 15.3%, P<0.005 and inversely related to SAMISS, depression, and poor health behaviors. Patient interviews reflected significance of faith in terms of insight and acceptance of

  7. A modified version of the Greek Simplified Medication Adherence Questionnaire for hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Victoria Alikari

    2017-05-01

    Full Text Available Non-adherence to the therapeutic regimen is an increasingly growing problem especially among patients undergoing hemodialysis. The aim of this study was to modify the Greek version of Simplified Medication Adherence Questionnaire (GR-SMAQ for patients undergoing hemodialysis (GR-SMAQ-HD and explore its validity and reliability. Between June 2016 and November 2016 a group of patients undergoing hemodialysis (N=107 completed the Greek version of SMAQ. The study was carried out in three Dialysis Units of Hospitals of Athens and Peloponnese region, Greece. The form of GR-SMAQ was modified specifically for renal patients while four additional items were added so as the tool study all aspects of adherence to hemodialysis regimen. Construct validity was checked through exploratory factor analysis with principal Component Analysis with the Equamax method. Test-retest reliability and internal consistency were tested. Statistical analysis was performed using the IBM SPSS Statistics version 21. The significance level was set up at 5%. The Greek version of SMAQ for patients undergoing hemodialysis includes eight questions. Three factors emerged from factor analysis. Cronbach’s α coefficient was 0.742 for the whole scale and for each subscale was for Medication Adherence 0.75, for Attendance at hemodialysis session 0.856 and for Diet/Fluid restriction was 0.717. The total mean score was 6.29 (±1.82. GR-SMAQ-HD is a reliable and valuable tool that can be used by hemodialysis nurses and students of nursing for detection of adherence levels in clinical practice.

  8. Acute migraine medication adherence, migraine disability and patient satisfaction: A naturalistic daily diary study.

    Science.gov (United States)

    Seng, Elizabeth K; Robbins, Matthew S; Nicholson, Robert A

    2017-09-01

    Objective To examine the influence of acute migraine medication adherence on migraine disability and acute medication satisfaction. Methods Adults with migraine completed three months of daily electronic diaries assessing headache symptoms, acute medication taken, acute medication satisfaction, and daily migraine disability. Repeated measures mixed-effects models examined the effect of initial medication type [migraine-specific medication (MSM) vs. over-the-counter analgesic (OTC) vs. an opiate/barbiturate], the severity of pain at dosing, and their interaction with daily migraine disability and satisfaction with acute medication. Results Participants (N = 337; 92.5% female; 91.1% Caucasian, non-Hispanic; 84.0% with episodic migraine) recorded 29,722 diary days. Participants took acute medication on 96.5% of 8090 migraine days. MSM was most frequently taken first (58%), followed by OTC (29.9%) and an opiate/barbiturate (12.1%). Acute medication was most frequently taken when pain was mild (41.2%), followed by moderate (37.7%) and severe pain (11.4%). Initially dosing with MSM while pain was mild was associated with the lowest daily disability [medication × pain at dosing F (4, 6336.12) = 58.73, p migraine disability and highest acute medication satisfaction.

  9. The Effectiveness of Mobile Phone Text Messaging in Improving Medication Adherence for Patients with Chronic Diseases: A Systematic Review.

    Science.gov (United States)

    Ershad Sarabi, Roghayeh; Sadoughi, Farahnaz; Jamshidi Orak, Roohangiz; Bahaadinbeigy, Kambiz

    2016-05-01

    Medication non-adherence is a commonly observed problem in the self-administration of treatment, regardless of the disease type. Text messaging reminders, as electronic reminders, provide an opportunity to improve medication adherence. In this study, we aimed to provide evidence addressing the question of whether text message reminders were effective in improving patients' adherence to medication. We carried out a systematic literature search, using the five electronic bibliographic databases: PubMed, Embase, PsycINFO, CINAHL, and the Cochrane central register of controlled trials. Studies were included on the basis of whether they examined the benefits and effects of short-message service (SMS) interventions on medication adherence. The results of this systematic review indicated that text messaging interventions have improved patients' medication adherence rate (85%, 29.34). Included in the review, those who had problems with adherence, or those whom text messaging was most helpful had HIV, asthma, diabetes, schizophrenia and heart disease (73.5%). The period of intervention varied from 1 week to 14 months. The most common study design was randomized controlled trials (RCTs) (66%) carried out in the developed countries. This study demonstrated the potential of mobile phone text messaging for medication non-adherence problem solving.

  10. Impact of Polypharmacy on Adherence to Evidence-Based Medication in Patients who Underwent Percutaneous Coronary Intervention.

    Science.gov (United States)

    Mohammed, Shaban; Arabi, Abdulrahaman; El-Menyar, Ayman; Abdulkarim, Sabir; AlJundi, Amer; Alqahtani, Awad; Arafa, Salah; Al Suwaidi, Jassim

    2016-01-01

    The primary objective of this study was to evaluate the impact of polypharmacy on primary and secondary adherence to evidence-based medication (EBM) and to measure factors associated with non-adherence among patients who underwent percutaneous coronary intervention (PCI). We conducted a retrospective analysis for patients who underwent PCI at a tertiary cardiac care hospital in Qatar. Patients who had polypharmacy (defined as ≥6 medications) were compared with those who had no polypharmacy at hospital discharge in terms of primary and secondary adherence to dual antiplatelet therapy (DAPT), beta-blockers (BB), angiotensin converting enzyme inhibitors (ACEIs) and statins. A total of 557 patients (mean age: 53±10 years; 85%; males) who underwent PCI were included. The majority of patients (84.6%) received ≥6 medications (polypharmacy group) while only 15.4% patients received ≥5 medications (nonpolypharmacy group). The two groups were comparable in term of gender, nationality, socioeconomic status and medical insurance. The non-polypharmacy patients had significantly higher adherence to first refill of DAPT compared with patients in the polypharmacy group (100 vs. 76.9%; p=0.001). Similarly, the non-polypharmacy patients were significantly more adherent to secondary preventive medications (BB, ACEI and statins) than the polypharmacy group. In patients who underwent PCI, polypharmacy at discharge could play a negative role in the adherence to the first refill of EBM. Further studies should investigate other parameters that contribute to long term non-adherence.

  11. Complex antithrombotic therapy: determinants of patient preference and impact on medication adherence

    Directory of Open Access Journals (Sweden)

    Abraham NS

    2015-11-01

    Full Text Available Neena S Abraham,1,2 Aanand D Naik,3,4 Richard L Street Jr,3–5 Diana L Castillo,3 Anita Deswal,6 Peter A Richardson,3,4 Christine M Hartman,3 George Shelton Jr,3,4 Liana Fraenkel7,8 1Division of Gastroenterology, Mayo Clinic, Scottsdale, AZ, USA; 2Divison of Healthcare Policy and Research, Department of Health Services Research, Rochester, MN, USA; 3Center for Innovations in Quality, Effectiveness, and Safety at the Michael E DeBakey VA Medical Center, Houston, TX, USA; 4Department of Medicine, Baylor College of Medicine, Houston, TX, USA; 5Department of Communication, Texas A&M University, College Station, TX, USA; 6Cardiology, Michael E DeBakey VAMC, Houston, TX, USA; 7Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA; 8Department of Medicine, Yale University, New Haven, CT, USA Purpose: For years, older patients have been prescribed multiple blood-thinning medications (complex antithrombotic therapy [CAT] to decrease their risk of cardiovascular events. These therapies, however, increase risk of adverse bleeding events. We assessed patient-reported trade-offs between cardioprotective benefit, gastrointestinal bleeding risk, and burden of self-management using adaptive conjoint analysis (ACA. As ACA could be a clinically useful tool to obtain patient preferences and guide future patient-centered care, we examined the clinical application of ACA to obtain patient preferences and the impact of ACA on medication adherence.Patients and methods: An electronic ACA survey led 201 respondents through medication risk–benefit trade-offs, revealing patients’ preferences for the CAT risk/benefit profile they valued most. The post-ACA prescription regimen was categorized as concordant or discordant with elicited preferences. Adherence was measured using VA pharmacy refill data to measure persistence of use prior to and 1 year following preference-elicitation. Additionally, we analyzed qualitative interviews of 56 respondents

  12. Adherence to hydroxyurea medication by children with sickle cell disease (SCD) using an electronic device: a feasibility study.

    Science.gov (United States)

    Inoue, Susumu; Kodjebacheva, Gergana; Scherrer, Tammy; Rice, Gary; Grigorian, Matthew; Blankenship, Jeremy; Onwuzurike, Nkechi

    2016-08-01

    Adherence to hydroxyurea (HU) is a significant modifying factor in sickle cell vaso-occlusive pain. We conducted a study using an electronic medication container-monitor-reminder device (GlowCap™) to track adherence and determine whether use of this device affected rates of HU adherence. Subjects were regular attendees to our clinic. They were given a 37-item questionnaire and were asked to use a GlowCap containing HU. When the device cap is opened, it makes a remote "medication taken" record. The device also provides usage reminder in the form of lights and alarm sounds if the cap opening is delayed. Nineteen subjects participated in the survey, and 17 in the intervention phase. Of the 17, 12 had reliable adherence data. Seventeen caregivers of patients and two patients completed the survey. Two most common barriers to adherence identified were lack of reminders and absence of medicine home delivery. The intervention component of this study, which used both the electronic (GlowCap) method and medication possession ratio showed that the median adherence rate for the 12 patients evaluated was 85 %. The GlowCap device accurately kept a record of adherence rates. This device may be an effective tool for increasing HU medication adherence.

  13. The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature

    NARCIS (Netherlands)

    Vervloet, M.; Linn, A.J.; van Weert, J.C.M.; de Bakker, D.H.; Bouvy, M.L.; van Dijk, L.

    2012-01-01

    Background: Many patients experience difficulties in adhering to long-term treatment. Although patients' reasons for not being adherent are diverse, one of the most commonly reported barriers is forgetfulness. Reminding patients to take their medication may provide a solution. Electronic reminders

  14. The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature.

    NARCIS (Netherlands)

    Vervloet, M.; Linn, A.J.; Weert, J.C.M. van; Bakker, D.H. de; Bouvy, M.L.; Dijk, L. van

    2012-01-01

    Background: Many patients experience difficulties in adhering to long-term treatment. Although patients’ reasons for not being adherent are diverse, one of the most commonly reported barriers is forgetfulness. Reminding patients to take their medication may provide a solution. Electronic reminders

  15. Current Issues and the Veterinary Medical Library

    Science.gov (United States)

    Nault, Andre J.

    2010-01-01

    Veterinary medical libraries and librarians are unique. There are now 33 veterinary colleges in North America, and in accordance with American Veterinary Medical Association accreditation, each has a library managed by an accredited librarian. Colleges with veterinary programs often maintain specialized branch libraries to support the degree,…

  16. Investigating the association between medication adherence and health-related quality of life in COPD : Methodological challenges when using a proxy measure of adherence

    NARCIS (Netherlands)

    Boland, Melinde R. S.; van Boven, Job F. M.; Kruis, Annemarije L.; Chavannes, Niels H.; van der Molen, Thys; Goossens, Lucas M. A.; Rutten-van Molken, Maureen P. M. H.

    Background: The association between non-adherence to medication and health-related quality-of-life (HRQoL) in Chronic Obstructive Pulmonary Disease (COPD) remains poorly understood. Different ways to deal with methodological challenges to estimate this association have probably contributed to

  17. Examination of the Link Between Medication Adherence and Use of Mail-Order Pharmacies in Chronic Disease States.

    Science.gov (United States)

    Fernandez, Elena V; McDaniel, Jennifer A; Carroll, Norman V

    2016-11-01

    Higher medication adherence is associated with positive health outcomes, including reduction in hospitalizations and costs, and many interventions have been implemented to increase patient adherence. To determine whether patients experience higher medication adherence by using mail-order or retail pharmacies. Articles pertaining to retail and mail-order pharmacies and medication adherence were collected from 3 literature databases: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and International Pharmaceutical Abstracts (IPA). Searches were created for each database and articles were compiled. Articles were screened for exclusion factors, and final articles (n=15) comparing medication adherence in patients utilizing mail and retail pharmacies were analyzed. For each study, various factors were identified including days supply, patients' out-of-pocket costs, prior adherence behavior, therapeutic class, measure of adherence, limitations, and results. Studies were then categorized by disease state, and relevant information from each study was compared and contrasted. The majority of studies-14 out of the 15 reviewed-supported higher adherence through the mail-order dispensing channel rather than through retail pharmacies. There are a number of reasons for the differences in adherence between the channels. Study patients who used mail-order pharmacies were more likely to have substantially higher prior adherence behavior, socioeconomic status, and days supply of medicines received and were likely to be offered financial incentives to use mail-order. The few studies that attempted to statistically control for these factors also found that patients using mail-order services were more adherent but the size of the differences was smaller. The extent to which these results indicate an inherent adherence advantage of mail-order pharmacy (as distinct from adherence benefits due to greater days supply, lower copays, or more adherent patients

  18. Conceptualisations of masculinity and self-reported medication adherence among HIV-positive Latino men in Los Angeles, California, USA.

    Science.gov (United States)

    Galvan, Frank H; Bogart, Laura M; Wagner, Glenn J; Klein, David J; Chen, Ying-Tung

    2014-06-01

    HIV-positive Latino men have been found to have poorer medication adherence compared to Whites. This study sought to identify how cultural conceptualisations of masculinity are associated with self-reported medication adherence among Latino men. A total of 208 HIV-positive men reported the number of doses of antiretroviral medication missed in the previous seven days (dichotomised at 100% adherence versus less). Conceptualisations of masculinity consisted of traditional machismo (e.g., power and aggressive attitudes, which are normally associated with negative stereotypes of machismo) and caballerismo (e.g., fairness, respect for elders and the importance of family). Multivariate logistic regression was used to identify factors associated with adherence. The mean adherence was 97% (SD = 6.5%; range = 57-100%). In all, 77% of the participants reported 100% adherence in the previous seven days. Caballerismo was associated with a greater likelihood (OR = 1.77; 95% CI: 1.08-2.92; p = 0.03) and machismo with a lower likelihood (OR = 0.60; 95% CI: 0.38-0.95; p = 0.03) of medication adherence. In addition, higher medication side-effects were found to be associated with a lower likelihood (OR = 0.59; 95% CI: 0.43-0.81; p = 0.001) of medication adherence. These findings reinforce the importance of identifying cultural factors that may affect medication adherence among HIV-positive Latino men resident in the USA.

  19. A randomized trial comparing in person and electronic interventions for improving adherence to oral medications in schizophrenia.

    Science.gov (United States)

    Velligan, Dawn; Mintz, Jim; Maples, Natalie; Xueying, Li; Gajewski, Stephanie; Carr, Heather; Sierra, Cynthia

    2013-09-01

    Poor adherence to medication leads to symptom exacerbation and interferes with the recovery process for patients with schizophrenia. Following baseline assessment, 142 patients in medication maintenance at a community mental health center were randomized to one of 3 treatments for 9 months: (1) PharmCAT, supports including pill containers, signs, alarms, checklists and the organization of belongings established in weekly home visits from a PharmCAT therapist; (2) Med-eMonitor (MM), an electronic medication monitor that prompts use of medication, cues the taking of medication, warns patients when they are taking the wrong medication or taking it at the wrong time, record complaints, and, through modem hookup, alerts treatment staff of failures to take medication as prescribed; (3) Treatment as Usual (TAU). All patients received the Med-eMonitor device to record medication adherence. The device was programmed for intervention only in the MM group. Data on symptoms, global functioning, and contact with emergency services and police were obtained every 3 months. Repeated measures analyses of variance for mixed models indicated that adherence to medication was significantly better in both active conditions than in TAU (both p<0.0001). Adherence in active treatments ranged from 90-92% compared to 73% in TAU based on electronic monitoring. In-person and electronic interventions significantly improved adherence to medication, but that did not translate to improved clinical outcomes. Implications for treatment and health care costs are discussed.

  20. A single-item self-report medication adherence question predicts hospitalisation and death in patients with heart failure.

    Science.gov (United States)

    Wu, Jia-Rong; DeWalt, Darren A; Baker, David W; Schillinger, Dean; Ruo, Bernice; Bibbins-Domingo, Kristen; Macabasco-O'Connell, Aurelia; Holmes, George M; Broucksou, Kimberly A; Erman, Brian; Hawk, Victoria; Cene, Crystal W; Jones, Christine DeLong; Pignone, Michael

    2014-09-01

    To determine whether a single-item self-report medication adherence question predicts hospitalisation and death in patients with heart failure. Poor medication adherence is associated with increased morbidity and mortality. Having a simple means of identifying suboptimal medication adherence could help identify at-risk patients for interventions. We performed a prospective cohort study in 592 participants with heart failure within a four-site randomised trial. Self-report medication adherence was assessed at baseline using a single-item question: 'Over the past seven days, how many times did you miss a dose of any of your heart medication?' Participants who reported no missing doses were defined as fully adherent, and those missing more than one dose were considered less than fully adherent. The primary outcome was combined all-cause hospitalisation or death over one year and the secondary endpoint was heart failure hospitalisation. Outcomes were assessed with blinded chart reviews, and heart failure outcomes were determined by a blinded adjudication committee. We used negative binomial regression to examine the relationship between medication adherence and outcomes. Fifty-two percent of participants were 52% male, mean age was 61 years, and 31% were of New York Heart Association class III/IV at enrolment; 72% of participants reported full adherence to their heart medicine at baseline. Participants with full medication adherence had a lower rate of all-cause hospitalisation and death (0·71 events/year) compared with those with any nonadherence (0·86 events/year): adjusted-for-site incidence rate ratio was 0·83, fully adjusted incidence rate ratio 0·68. Incidence rate ratios were similar for heart failure hospitalisations. A single medication adherence question at baseline predicts hospitalisation and death over one year in heart failure patients. Medication adherence is associated with all-cause and heart failure-related hospitalisation and death in heart

  1. Assessment of medication errors and adherence to WHO prescription writing guidelines in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Dilnasheen Sheikh

    2017-06-01

    Full Text Available The objective of the study is to assess the medication errors and adherence to WHO prescription writing guidelines in a tertiary care hospital. A prospective observational study was carried out for a period of 8 months from June 2015 to February 2016 at tertiary care hospital. At inpatient department regular chart review of patient case records was carried out to assess the medication errors. The observed medication errors were assessed for level of harm by using NCCMERP index. The outpatient prescriptions were screened for adherence to WHO prescription writing guidelines. Out of 200 patients, 40 patients developed medication errors. Most of the medication errors were observed in the age group above 61 years (40%. Majority of the medication errors were observed with drug class of antibiotics 9 (22.5% and bronchodilators 9 (22.5%. Most of the errors were under the NCCMERP index category C. Out of 545 outpatient prescriptions, 51 (9.37% prescriptions did not have prescriber’s name and all of the prescriptions lack prescriber’s personal contact number. Eighteen prescriptions did not have patient’s name and 426 (78.2% prescriptions did not have patient’s age. The prevalence of medication errors in this study was relatively low (20% without any fatal outcome. Omission error was the most frequently observed medication errors 31 (77.5%. In the present study, the patient’s age was missing in 78.2% of the prescriptions and none of the prescriptions had patient’s address and the drug names were not mentioned by their generic names.

  2. Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

    DEFF Research Database (Denmark)

    Ingebrigtsen, Truls S; Marott, Jacob L; Nordestgaard, Børge G

    2015-01-01

    OBJECTIVE: We tested the hypothesis that use of and adherence to maintenance medication is low among individuals in the general population who have chronic obstructive pulmonary disease (COPD) , even in cases of severe and very severe COPD. DESIGN AND PARTICIPANTS: We identified 5,812 individuals...... with COPD from the Copenhagen General Population Study, and classified them according to the Global Initiative for Obstructive Lung Disease (GOLD) airflow limitation grades 1-4. Dispensing of fixed-dose combinations of inhaled corticosteroids with long-acting beta2-agonists, long-acting anti...... for COPD in the general population was associated with the severity of COPD as defined by GOLD, but even in severe and very severe COPD, use and adherence was low....

  3. The effect of posthypnotic suggestion, hypnotic suggestibility, and goal intentions on adherence to medical instructions.

    Science.gov (United States)

    Carvalho, Claudia; Mazzoni, Giuliana; Kirsch, Irving; Meo, Maria; Santandrea, Maura

    2008-04-01

    The effects of implementation intentions and posthypnotic suggestion were investigated in 2 studies. In Experiment 1, participants with high levels of hypnotic suggestibility were instructed to take placebo pills as part of an investigation of how to best enhance compliance with medical instruction. In Experiment 2, participants with high, medium, and low levels of hypnotic suggestibility were asked to run in place, take their pulse rate before, and send an e-mail report to the experimenter each day. Experiment 1 revealed enhanced adherence as a function of both implementation intentions and posthypnotic suggestion. Experiment 2 failed to find any significant main effects but found a significant interaction between suggestibility and the effects of posthypnotic suggestion. Posthypnotic suggestion enhanced adherence among high suggestible participants but lowered it among low suggestibles.

  4. The Malaysian Medication Adherence Scale (MALMAS): Concurrent Validity Using a Clinical Measure among People with Type 2 Diabetes in Malaysia

    OpenAIRE

    Chung, Wen Wei; Chua, Siew Siang; Lai, Pauline Siew Mei; Morisky, Donald E.

    2015-01-01

    Medication non-adherence is a prevalent problem worldwide but up to today, no gold standard is available to assess such behavior. This study was to evaluate the psychometric properties, particularly the concurrent validity of the English version of the Malaysian Medication Adherence Scale (MALMAS) among people with type 2 diabetes in Malaysia. Individuals with type 2 diabetes, aged 21 years and above, using at least one anti-diabetes agent and could communicate in English were recruited. The ...

  5. Sharing Physician Notes Through an Electronic Portal is Associated With Improved Medication Adherence: Quasi-Experimental Study

    OpenAIRE

    Wright, Eric; Darer, Jonathan; Tang, Xiaoqin; Thompson, Jason; Tusing, Lorraine; Fossa, Alan; Delbanco, Tom; Ngo, Long; Walker, Jan

    2015-01-01

    Background In surveys, interviews, and focus groups, patients taking medications and offered Web portal access to their primary care physicians? (PCPs) notes report improved adherence to their regimens. However, objective confirmation has yet to be reported. Objective To evaluate the association between patient Internet portal access to primary care physician visit notes and medication adherence. Methods This study is a retrospective comparative analysis at one site of the OpenNotes quasi-exp...

  6. Medication adherence, work performance and self-esteem among psychiatric patients attending psychosocial rehabilitation services at Bangalore, India

    OpenAIRE

    Sailaxmi Gandhi; Rajitha Pavalur; Sivakumar Thanapal; Nirmala B Parathasarathy; Geetha Desai; Poornima Bhola; Mariamma Philip; Santosh K Chaturvedi

    2014-01-01

    Context: Work benefits mental health in innumerable ways. Vocational rehabilitation can enhance self-esteem. Medication adherence can improve work performance and thereby the individuals’ self-esteem. Aim: To test the hypothesis that there would be a significant correlation between medication adherence, work performance and self-esteem. Setting and Design: A quantitative, descriptive correlational research design was adopted to invite patients attending psychiatric rehabilitation services to ...

  7. Barriers to Prescription Medication Adherence Among Homeless and Vulnerably Housed Adults in Three Canadian Cities.

    Science.gov (United States)

    Hunter, Charlotte E; Palepu, Anita; Farrell, Susan; Gogosis, Evie; O'Brien, Kristen; Hwang, Stephen W

    2015-07-01

    Medication adherence is an important determinant of successful medical treatment. Marginalized populations, such as homeless and vulnerably housed individuals, may face substantial barriers to medication adherence. This study aimed to determine the prevalence of, reasons for, and factors associated with medication nonadherence among homeless and vulnerably housed individuals. Additionally, we examined the association between medication nonadherence and subsequent emergency department utilization during a 1-year follow-up period. Data were collected as part of the Health and Housing in Transition study, a prospective cohort study tracking the health and housing status of 595 homeless and 596 vulnerably housed individuals in 3 Canadian cities. Logistic regression was used to identify factors associated with medication nonadherence, as well as the association between medication nonadherence at baseline and subsequent emergency department utilization. Among 716 participants who had been prescribed a medication, 189 (26%) reported nonadherence. Being ≥40 years old was associated with decreased likelihood of nonadherence (adjusted odds ratio [AOR] = 0.59; 95% confidence interval [CI] = 0.41-0.84), as was having a primary care provider (AOR = 0.49; 95% CI = 0.34-0.71). Having a positive screen on the AUDIT (Alcohol Use Disorders Identification Test; an indication of harmful or hazardous drinking) was associated with increased likelihood of nonadherence (AOR = 1.86; 95% CI = 1.31-2.63). Common reasons for nonadherence included side effects, cost, and lack of access to a physician. Self-reported nonadherence at baseline was significantly associated with frequent emergency department use (≥3 visits) over the follow-up period at the bivariate level (OR = 1.55; 95% CI = 1.02-2.35) but was not significant in a multivariate model (AOR = 1.49; 95% CI = 0.96-2.32). Homeless and vulnerably housed individuals face significant barriers to medication adherence. Health care

  8. Process- and patient-reported outcomes of a multifaceted medication adherence intervention for hypertensive patients in secondary care

    DEFF Research Database (Denmark)

    Hedegaard, Ulla; Hallas, Jesper; Ravn-Nielsen, Lene Vestergaard

    2016-01-01

    BACKGROUND: Adherence to antihypertensive medications is suboptimal. Hospital pharmacist interventions including motivational interviewing (MI) might assist in improving adherence in patients with hypertension. For an intervention to be useful, it is important to have tools that can easily identify...... potential adherence problems. OBJECTIVES: To evaluate process outcomes and patient- and pharmacist-reported outcomes of a pharmacist adherence intervention for hypertensive patients treated in hospital outpatient clinics. Secondly, to determine the agreement between two different adherence metrics......-39% reported increased knowledge, confidence and skills in relation to their medication as well as better quality of life. The pharmacists found that the intervention elements were meaningful pharmacist tasks, and that the DRAW tool was easy to use and helped them focus on addressing reasons for non...

  9. A counselor in your pocket: feasibility of mobile health tailored messages to support HIV medication adherence

    Directory of Open Access Journals (Sweden)

    Cook PF

    2015-09-01

    Full Text Available Paul F Cook,1 Jane M Carrington,2 Sarah J Schmiege,1 Whitney Starr,3 Blaine Reeder11University of Colorado College of Nursing, Aurora, CO, USA; 2University of Arizona College of Nursing, Tucson, AZ, USA; 3University of Colorado School of Medicine, Aurora, CO, USAPurpose: Medication adherence is a major challenge in HIV treatment. New mobile technologies such as smartphones facilitate the delivery of brief tailored messages to promote adherence. However, the best approach for tailoring messages is unknown. Persons living with HIV (PLWH might be more receptive to some messages than others based on their current psychological state.Methods: We recruited 37 PLWH from a parent study of motivational states and adherence. Participants completed smartphone-based surveys at a random time every day for 2 weeks, then immediately received intervention or control tailored messages, depending on random assignment. After 2 weeks in the initial condition, participants received the other condition in a crossover design. Intervention messages were tailored to match PLWH’s current psychological state based on five variables – control beliefs, mood, stress, coping, and social support. Control messages were tailored to create a mismatch between message framing and participants’ current psychological state. We evaluated intervention feasibility based on acceptance, ease of use, and usefulness measures. We also used pilot randomized controlled trial methods to test the intervention’s effect on adherence, which was measured using electronic caps that recorded pill-bottle openings.Results: Acceptance was high based on 76% enrollment and 85% satisfaction. Participants found the hardware and software easy to use. However, attrition was high at 59%, and usefulness ratings were slightly lower. The most common complaint was boredom. Unexpectedly, there was no difference between mismatched and matched messages’ effects, but each group showed a 10%–15% improvement

  10. Multi-dose drug dispensing as a tool to improve medication adherence: A study in patients using vitamin K antagonists.

    Science.gov (United States)

    van Rein, Nienke; de Geus, Kristel S; Cannegieter, Suzanne C; Reitsma, Pieter H; van der Meer, Felix J M; Lijfering, Willem M

    2018-01-01

    Multi-dose drug dispensing (MDD) is a dosing aid that provides patients with disposable bags containing all drugs intended for 1 dosing moment. MDD is believed to increase medication adherence, but studies are based on self-reported data, and results may depend on socially desirable answers. Therefore, our purpose was to determine the effect of MDD on medication adherence in non-adherent patients taking vitamin K antagonists (VKAs), and to compare with instructing patients on medication use. We conducted a before-after study in non-adherent patients where MDD was the exposure and change in adherence after MDD initiation was the outcome (within patient comparison). Time in therapeutic range (TTR) was selected as a measure for adherence, as this reflects stability of VKA treatment. To analyze whether MDD improved adherence as compared with standard care (ie, letters or calls from nurses of the anticoagulation clinic), non-adherent patients without MDD were also followed to estimate their TTR change over time (between patient comparison). Eighty-three non-adherent VKA patients started using MDD. The median TTR was 63% before MDD and 73% 6 months after MDD. The within patient TTR increased on average by 13% (95%CI 6% to 21%) within 1 month after starting MDD and remained stable during the next 5 months. The TTR of MDD-patients increased 10% (95%CI 2% to 19%) higher as compared with non-MDD patients within 1 month but was similar after 4 months (TTR difference 3%, 95%CI -2% to 9%). Adherence improved after initiation of MDD. Compared with instructing patients, MDD was associated with better adherence within 1 month but was associated with similar improvement after 4 months. Copyright © 2017 John Wiley & Sons, Ltd.

  11. Medication adherence among ambulatory patients with type 2 diabetes in a tertiary healthcare setting in Southwestern Nigeria

    Directory of Open Access Journals (Sweden)

    Adisa R

    2011-06-01

    Full Text Available Objective: To assess adherence to medication among ambulatory patients with type 2 diabetes, ascertain the level of glycemic control, and evaluate patients’ opinions on probable reasons for non-adherence with a view to identify areas of intervention to improve adherence.Methods: A prospective cross-sectional study was carried out at a 900-bed tertiary teaching hospital in Ibadan, Southwestern Nigeria between June and August, 2009. Out of 140 consented patients, 114 (81.4% properly responded to the validated and pre-tested data collection tool and these were subsequently considered for analysis. Descriptive statistics were used to summarize the data. Means and proportions were compared using student t-test and chi-square or Kruskal-Wallis test as appropriate, with p<0.05 considered statistical significant.Results: Approximately sixty percent of the patients were adjudged adherent with prescribed medication. Out of 58.8% of the cohort who gave their recent fasting plasma glucose (FPG values, 59.7% had FPG above 110mg/dL. The mean FPG for patients was 139.05 (SD=70.5mg/dL, males and females significantly differed in their mean FPG, 146.55 (SD=85.0mg/dL versus 133.33 (SD=57.6mg/dL respectively (p=0.032. Also, the mean FPG values for adherent patients, 137.09 (SD=59.3mg/dL was lower than their non-adherent counterparts, 143.92 (SD=87.6 mg/dL, but the difference was not statistically significant (p=0.095. Financial constraint (34.4% was the major barrier to optimal adherence with medication. A significant association exist between genders and opinions on physician’s mode of approach during patient-physician interaction as a contributory factor for non-adherence (p=0.038.Conclusion: Medication adherence of ambulatory type 2 diabetes patients is considerable. However, the relatively high level of adherence did not appear to have significantly impacted on patients’ glycemic status due to a substantial number who had plasma glucose above the

  12. Facilitators and barriers of medication adherence in pediatric liver and kidney transplant recipients: a mixed-methods study.

    Science.gov (United States)

    Claes, Anouck; Decorte, Anneloes; Levtchenko, Elena; Knops, Noel; Dobbels, Fabienne

    2014-12-01

    Many young transplant patients (≤11 years old) struggle to take their immunosuppressive and co-medications correctly, yet it remains unclear which factors positively or negatively affect medication adherence. Research studies on determinants in this age group are scarce, have methodological flaws, and focus exclusively on immunosuppressants or on barriers rather than on facilitators. This study used a consecutive mixed-methods (qualitative + quantitative) design. Semistructured interviews with parents of 10 pediatric liver or kidney transplant recipients 2 to 11 years old on adherence facilitators and barriers were conducted, complemented by quantification of adherence to the immunosuppressants and co-medications, and completion of the "immunosuppressive medication adherence barriers" self-report instrument. A median of 19 (range, 10-29) barriers was reported: the most commonly encountered were forgetfulness (70%), vomiting (70%), bad taste (60%), and interruptions in routine (60%). Parents reported a median of 15 facilitators (range, 6-26), including using practical aids (100%), having medication with you at all times (100%), having to take fewer medications (80%), and experiencing fewer regimen changes over time (80%). No clear distinction between immunosuppressants or co-medications was made. This study provides several new insights based on peer experience to support future patients and their parents in medication adherence.

  13. Identifying psychosocial predictors of medication non-adherence following acute coronary syndrome: A systematic review and meta-analysis.

    Science.gov (United States)

    Crawshaw, Jacob; Auyeung, Vivian; Norton, Sam; Weinman, John

    2016-11-01

    Medication non-adherence following acute coronary syndrome (ACS) is associated with poor clinical outcomes. A systematic review and meta-analysis were undertaken to identify psychosocial factors associated with medication adherence in patients with ACS. A search of electronic databases (Cochrane Library, Medline, EMBASE, PsycINFO, Web of Science, International Pharmaceutical Abstracts, CINAHL, ASSIA, OpenGrey, EthOS and WorldCat) was undertaken to identify relevant articles published in English between 2000 and 2014. Articles were screened against our inclusion criteria and data on study design, sample characteristics, predictors, outcomes, analyses, key findings and study limitations were abstracted. Our search identified 3609 records, of which 17 articles met our inclusion criteria (15 independent studies). Eight out of ten studies found an association between depression and non-adherence. A meta-analysis revealed that depressed patients were twice as likely to be non-adherent compared to patients without depression (OR=2.00, 95% CI 1.57-3.33, p=0.015). Type D personality was found to predict non-adherence in both studies in which it was measured. Three out of three studies reported that treatment beliefs based on the Necessity-Concerns Framework predicted medication non-adherence and there was some evidence that social support was associated with better adherence. There was insufficient data to meta-analyse all other psychosocial factors identified. There was some evidence that psychosocial factors, particularly depression, were associated with medication adherence following ACS. Targeting depressive symptoms, screening for Type D personality, challenging maladaptive treatment beliefs, and providing better social support for patients may be useful strategies to improve medication adherence. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  14. Barriers to medication adherence for the secondary prevention of stroke: a qualitative interview study in primary care.

    Science.gov (United States)

    Jamison, James; Graffy, Jonathan; Mullis, Ricky; Mant, Jonathan; Sutton, Stephen

    2016-08-01

    Medications are highly effective at reducing risk of recurrent stroke, but success is influenced by adherence to treatment. Among survivors of stroke and transient ischaemic attack (TIA), adherence to medication is known to be suboptimal. To identify and report barriers to medication adherence for the secondary prevention of stroke/TIA. A qualitative interview study was conducted within general practice surgeries in the East of England, UK. Patients were approached by letter and invited to take part in a qualitative research study. Semi-structured interviews were undertaken with survivors of stroke, caregivers, and GPs to explore their perspectives and views around secondary prevention and perceived barriers to medication adherence. Key themes were identified using a grounded theory approach. Verbatim quotes describing the themes are presented here. In total, 28 survivors of stroke, including 14 accompanying caregivers and five GPs, were interviewed. Two key themes were identified. Patient level barriers included ability to self-care, the importance people attach to a stroke event, and knowledge of stroke and medication. Medication level barriers included beliefs about medication and beliefs about how pills work, medication routines, changing medications, and regimen complexity and burden of treatment. Patients who have had a stroke are faced with multiple barriers to taking secondary prevention medications in UK general practice. This research suggests that a collaborative approach between caregivers, survivors, and healthcare professionals is needed to address these barriers and facilitate medication-taking behaviour. © British Journal of General Practice 2016.

  15. Assessing the Multidimensional Relationship Between Medication Beliefs and Adherence in Older Adults With Hypertension Using Polynomial Regression.

    Science.gov (United States)

    Dillon, Paul; Phillips, L Alison; Gallagher, Paul; Smith, Susan M; Stewart, Derek; Cousins, Gráinne

    2018-02-05

    The Necessity-Concerns Framework (NCF) is a multidimensional theory describing the relationship between patients' positive and negative evaluations of their medication which interplay to influence adherence. Most studies evaluating the NCF have failed to account for the multidimensional nature of the theory, placing the separate dimensions of medication "necessity beliefs" and "concerns" onto a single dimension (e.g., the Beliefs about Medicines Questionnaire-difference score model). To assess the multidimensional effect of patient medication beliefs (concerns and necessity beliefs) on medication adherence using polynomial regression with response surface analysis. Community-dwelling older adults >65 years (n = 1,211) presenting their own prescription for antihypertensive medication to 106 community pharmacies in the Republic of Ireland rated their concerns and necessity beliefs to antihypertensive medications at baseline and their adherence to antihypertensive medication at 12 months via structured telephone interview. Confirmatory polynomial regression found the difference-score model to be inaccurate; subsequent exploratory analysis identified a quadratic model to be the best-fitting polynomial model. Adherence was lowest among those with strong medication concerns and weak necessity beliefs, and adherence was greatest for those with weak concerns and strong necessity beliefs (slope β = -0.77, pnecessity beliefs had lower adherence than those with simultaneously low concerns and necessity beliefs (slope β = -0.36, p = .004; curvature β = -0.25, p = .003). The difference-score model fails to account for the potential nonreciprocal effects. Results extend evidence supporting the use of polynomial regression to assess the multidimensional effect of medication beliefs on adherence.

  16. NEA activities on medical isotope supply issues

    International Nuclear Information System (INIS)

    Westmacott, C.; Vance, R.

    2009-01-01

    Medical radioisotopes play a vital role in modern medical practices. One of their principal uses is for nuclear diagnostic imaging techniques. These techniques are powerful and non-invasive, allowing the identification of common diseases such as heart conditions and cancer at an early stage, tracking disease progression and providing predictive information about likely success of a therapy. Such techniques enable precise and accurate management of the disease and may significantly assist in the medical decision-making process, for example removing the need for surgical intervention to obtain diagnostic information. Every year, 46 million people are estimated to benefit globally from such nuclear medicine testing. However, over the last few years there have been a number of supply shortages of Molybdenum-99 (Mo-99) and its decay product, Technetium-99m (Tc-99m), the most widely used medical radioisotope. These isotopes decay within a matter of days; therefore they must be produced continually in order to meet demand. Most recently, the unexpected extended shutdown of Canada's NRU research reactor - which produces approximately 35 percent of world Mo-99 supply - has compounded existing concerns regarding the supply reliability of these medical radioisotopes. Currently, five reactors between 42 and 52 years old produce over 95 percent of the world's supply of Mo-99 and face challenges in maintaining a continuous supply to the health community. As outlined above, disruptions in this supply chain have affected the availability of vital medical testing for millions of patients around the world. On 29-30 January 2009, the NEA hosted a workshop on Security of Supply of Medical Radioisotopes at the request of the Government of Canada. The workshop assembled an international group of experts to identify challenges faced in providing a reliable supply of Mo-99 and Tc-99m and measures that should be taken to ensure such reliability. Workshop participants discussed a wide

  17. Adherence to systemic therapies for immune-mediated inflammatory diseases in Lebanon: a physicians' survey from three medical specialties.

    Science.gov (United States)

    Ammoury, Alfred; Okais, Jad; Hobeika, Mireille; Sayegh, Raymond B; Shayto, Rani H; Sharara, Ala I

    2017-01-01

    Immune-mediated inflammatory diseases (IMIDs) are chronic conditions that may cause tissue damage and disability, reduced quality of life and increased mortality. Various treatments have been developed for IMIDs, including immune modulators and targeted biologic agents. However, adherence remains suboptimal. An adherence survey was used to evaluate physicians' beliefs about adherence to medication in IMID and to evaluate if and how they manage adherence. The survey was distributed to 100 randomly selected physicians from three different specialties. Results were analyzed by four academic experts commissioned to develop an action plan to address practical and perceptual barriers to adherence, integrating it into treatment goals to maximize outcomes in IMID, thereby elevating local standards of care. Eighty-two physicians participated in this study and completed the questionnaire. Most defined adherence as compliance with prescribed treatment. Although the majority of surveyed physicians (74%) did not systematically measure adherence in their practice, 54% identified adherence as a treatment goal of equal or greater importance to therapeutic endpoints. Lack of time and specialized nursing support was reported as an important barrier to measuring adherence. The expert panel identified four key areas for action: 360° education (patient-nurse-physician), patient-physician communication, patient perception and concerns, and market access/cost. An action plan was developed centered on education and awareness, enhanced benefit-risk communication, development of adherence assessment tools and promotion of patient support programs. Nonadherence to medication is a commonly underestimated problem with important consequences. A customized target-based strategy to address the root causes of non-adherence is essential in the management of chronic immune-mediated diseases.

  18. Adherence to clinical practice guidelines for the treatment of candidemia at a Veterans Affairs Medical Center

    Science.gov (United States)

    Ashong, Chester N.; Hunter, Andrew S.; Mansouri, M. David; Cadle, Richard M.; Hamill, Richard J.; Musher, Daniel M.

    2017-01-01

    Objectives: The primary objective of this study was to examine the appropriateness of candidemia management at a Veterans Affairs Medical Center as recommended by the 2009 Infectious Diseases Society of America (IDSA) guidelines for treatment of Candida infections. Methods: A retrospective analysis of 94 adult patients with blood cultures positive for Candida spp. was performed. Patients were stratified by severity of disease into two groups: non-neutropenic, mild-moderate disease (Group 1, n = 54, 56%) and non-neutropenic, moderate-severe disease (Group 2, n = 40, 42%). Results: Adherence to the IDSA recommendations for recommended antifungal drug, dose, and duration of therapy was low in both groups (16.7% in Group 1 and 17.5% in Group 2). Although adherence was not associated with higher clinical resolution of infection (P = 0.111), it was associated with a significantly lower mortality rate (P = 0.001) when compared to variance from the guidelines at 6 weeks. Conclusion: Although adherence to published guidelines for treating patients with candidemia was suboptimal at our institution, patients that were managed based on the guidelines had a statistically lower mortality rate. PMID:28936146

  19. Medication non-adherence and uncertainty: Information-seeking and processing in the Danish LIFESTAT survey.

    Science.gov (United States)

    Kriegbaum, Margit; Lau, Sofie Rosenlund

    2017-09-23

    Statins are widely prescribed to lower cardiovascular morbidity and mortality. However, statin non-adherence is very high. The aim of this paper was to investigate reasons for stopping statin treatment in the general population and to study how aspects of information-seeking and processing is associated with statin non-adherence. This study used a population survey on 3050 Danish residents aged 45-65 years. Reasons for statin discontinuation was studied among those who were previous statin users. The association between information seeking and processing and statin discontinuation were analysed using multivariate logistical regression models. Experience of side effects and fear of side effects played an important role in the discontinuation of statin treatment. Feelings of uncertainty and confusion regarding information on statins predicted statin discontinuation. This applied to information from both mass media and from general practitioners. There was no clear pattern of information seeking and statin non-adherence. The article point to the impact of information-seeking on the decision to take cholesterol-lowering medication. This included contributions from information disseminated by media outlets. Side effects and fear of side effects should be addressed in clinical practice. Health care professionals should pay attention to emotional aspects of how information is disseminated and perceived by statin users. Copyright © 2017. Published by Elsevier Inc.

  20. The Malaysian Medication Adherence Scale (MALMAS: Concurrent Validity Using a Clinical Measure among People with Type 2 Diabetes in Malaysia.

    Directory of Open Access Journals (Sweden)

    Wen Wei Chung

    Full Text Available Medication non-adherence is a prevalent problem worldwide but up to today, no gold standard is available to assess such behavior. This study was to evaluate the psychometric properties, particularly the concurrent validity of the English version of the Malaysian Medication Adherence Scale (MALMAS among people with type 2 diabetes in Malaysia. Individuals with type 2 diabetes, aged 21 years and above, using at least one anti-diabetes agent and could communicate in English were recruited. The MALMAS was compared with the 8-item Morisky Medication Adherence Scale (MMAS-8 to assess its convergent validity while concurrent validity was evaluated based on the levels of glycated hemoglobin (HbA1C. Participants answered the MALMAS twice: at baseline and 4 weeks later. The study involved 136 participants. The MALMAS achieved acceptable internal consistency (Cronbach's alpha=0.565 and stable reliability as the test-retest scores showed fair correlation (Spearman's rho=0.412. The MALMAS has good correlation with the MMAS-8 (Spearman's rho=0.715. Participants who were adherent to their anti-diabetes medications had significantly lower median HbA1C values than those who were non-adherence (7.90 versus 8.55%, p=0.032. The odds of participants who were adherent to their medications achieving good glycemic control was 3.36 times (95% confidence interval: 1.09-10.37 of those who were non-adherence. This confirms the concurrent validity of the MALMAS. The sensitivity of the MALMAS was 88.9% while its specificity was 29.6%. The findings of this study further substantiates the reliability and validity of the MALMAS, in particular its concurrent validity and sensitivity for assessing medication adherence of people with type 2 diabetes in Malaysia.

  1. Adherence to medical treatment in relation to pregnancy, birth outcome & breastfeeding behavior among women with Crohn's disease.

    Science.gov (United States)

    Julsgaard, Mette

    2016-07-01

    Crohn's disease (CD) is common among women of fertile age, and it often requires maintenance medical treatment. Adherence to medical treatment among women with CD prior to, during, and after pregnancy has, however, never been examined. Although CD women have increased risk of adverse pregnancy outcomes, little is known about predictors for these outcomes in women with CD. In addition, the impact of breastfeeding on disease activity remains controversial. The aims of this PhD thesis were to determine adherence to treatment and to investigate predictors for and prevalence rates of non-adherence to maintenance medical treatment among women with CD prior to, during, and after pregnancy; to assess pregnancy outcomes among women with CD, taking medical treatment, smoking status, and disease activity into account; to assess breastfeeding rates and the impact of breastfeeding on the risk of relapse. We conducted a population-based prevalence study including 154 women with CD who had given birth within a six-year period. We combined questionnaire data, data from medical records, and medical register data. Among 105 (80%) respondents, more than half reported taking medication with an overall high adherence rate of 69.8%. Counselling, previous pregnancy, and planned pregnancy seemed to decrease the likelihood of non-adherence, whereas smoking seemed to predict non-adherence prior to pregnancy, although our sample size prevented any firm conclusions. During pregnancy, the vast majority (95%) of CD women were in remission. The children's birth weight did not differ in relation to maternal medical treatment, but mean birth weight in children of smokers in medical treatment was 274 g lower than that of children of non-smokers in medical treatment. In our relatively small study CD women in medical treatment were not at increased risk of adverse pregnancy outcomes compared with untreated women with CD. In total, 87.6% of CD women were breastfeeding, and rates did not vary by

  2. Medication Adherence, Work Performance and Self-Esteem among Psychiatric Patients Attending Psychosocial Rehabilitation Services at Bangalore, India.

    Science.gov (United States)

    Gandhi, Sailaxmi; Pavalur, Rajitha; Thanapal, Sivakumar; Parathasarathy, Nirmala B; Desai, Geetha; Bhola, Poornima; Philip, Mariamma; Chaturvedi, Santosh K

    2014-10-01

    Work benefits mental health in innumerable ways. Vocational rehabilitation can enhance self-esteem. Medication adherence can improve work performance and thereby the individuals' self-esteem. To test the hypothesis that there would be a significant correlation between medication adherence, work performance and self-esteem. A quantitative, descriptive correlational research design was adopted to invite patients attending psychiatric rehabilitation services to participate in the research. Data was collected from a convenience sample of 60 subjects using the 'Medication Adherence Rating scale', 'Griffiths work behaviour scale' and the 'Rosenberg's Self-esteem scale'. Analysis was done using spss18 with descriptive statistics, Pearsons correlation coefficient and multiple regression analysis. There were 36 males and 24 females who participated in this study. The subjects had good mean medication adherence of 8.4 ± 1.5 with median of 9.00, high mean self-esteem of 17.65 ± 2.97 with median of 18.0 and good mean work performance of 88.62 ± 22.56 with median of 93.0. Although weak and not significant, there was a positive correlation (r = 0.22, P = 0.103) between medication adherence and work performance; positive correlation between (r = 0.25, P = 0.067) medication adherence and self-esteem; positive correlation between (r = 0.136, P = 0.299) work performance and self-esteem. Multiple regression analysis showed no significant predictors for medication adherence, work performance and self-esteem among patients with psychiatric illness. Medication monitoring and strengthening of work habit can improve self-esteem thereby, strengthening hope of recovery from illness.

  3. A randomized controlled trial with a Canadian electronic pill dispenser used to measure and improve medication adherence in patients with schizophrenia

    OpenAIRE

    Stip, Emmanuel; Vincent, Philippe D.; Sablier, Juliette; Guevremont, Catherine; Zhornitsky, Simon; Tranulis, Constantin

    2013-01-01

    Objective: Medication adherence is extremely important in preventing relapse and lowering symptoms in schizophrenic patients. However, estimates show that nearly half of these patients have poor adherence. The Brief Adherence Rating Scale (BARS) seems to be the most reliable tool assessing adherence in schizophrenia and shows that the antipsychotic adherence ratio (AAR) is about 49.5% in schizophrenia. The aim of the study was to test if an electronic pill dispenser named DoPill® improved AAR...

  4. A randomized-controlled trial with a Canadian electronic pill dispenser used to measure and improve medication adherence in patients with schizophrenia

    OpenAIRE

    Emmanuel eStip; Emmanuel eStip; Emmanuel eStip; Philippe D. Vincent; Philippe D. Vincent; Philippe D. Vincent; Catherine eGuevremont; Simon eZhornitsky; Constantin eTranulis; Constantin eTranulis; Constantin eTranulis; Juliette eSablier; Juliette eSablier

    2013-01-01

    Objective: Medication adherence is extremely important in preventing relapse and lowering symptoms in schizophrenic patients. However, estimates show that nearly half of these patients have poor adherence. The Brief Adherence Rating Scale (BARS) seems to be the most reliable tool assessing adherence in schizophrenia and shows that the antipsychotic adherence ratio (AAR) is about 49.5 % in schizophrenia. The aim of the study was to test if an electronic pill dispenser named DoPill® improv...

  5. Patient medical costs for tuberculosis treatment and impact on adherence in China: a systematic review

    Directory of Open Access Journals (Sweden)

    Zhang Tuohong

    2011-05-01

    Full Text Available Abstract Background Charging for tuberculosis (TB treatment could reduce completion rates, particularly in the poor. We identified and synthesised studies that measure costs of TB treatment, estimates of adherence and the potential impact of charging on treatment completion in China. Methods Inclusion criteria were primary research studies, including surveys and studies using qualitative methods, conducted in mainland China. We searched MEDLINE, PUBMED, EMBASE, Science Direct, HEED, CNKI to June 2010; and web pages of relevant Chinese and international organisations. Cost estimates were extracted, transformed, and expressed in absolute values and as a percentage of household income. Results Low income patients, defined at household or district level, pay a total of US$ 149 to 724 (RMB 1241 to 5228 for medical costs for a treatment course; as a percentage of annual household income, estimates range from 42% to 119%. One national survey showed 73% of TB patients at the time of the survey had interrupted or suspended treatment, and estimates from 9 smaller more recent studies showed that the proportion of patients at the time of the survey who had run out of drugs or were not taking them ranged from 3 to 25%. Synthesis of surveys and qualitative research indicate that cost is the most cited reason for default. Conclusions Despite a policy of free drug treatment for TB in China, health services charge all income groups, and costs are high. Adherence measured in cross sectional surveys is often low, and the cumulative failure to adhere is likely to be much higher. These findings may be relevant to those concerned with the development and spread of multi-drug resistant TB. New strategies need to take this into account and ensure patient adherence.

  6. Scalable decision support at the point of care: a substitutable electronic health record app for monitoring medication adherence.

    Science.gov (United States)

    Bosl, William; Mandel, Joshua; Jonikas, Magdalena; Ramoni, Rachel Badovinac; Kohane, Isaac S; Mandl, Kenneth D

    2013-07-22

    Non-adherence to prescribed medications is a serious health problem in the United States, costing an estimated $100 billion per year. While poor adherence should be addressable with point of care health information technology, integrating new solutions with existing electronic health records (EHR) systems require customization within each organization, which is difficult because of the monolithic software design of most EHR products. The objective of this study was to create a published algorithm for predicting medication adherence problems easily accessible at the point of care through a Web application that runs on the Substitutable Medical Apps, Reusuable Technologies (SMART) platform. The SMART platform is an emerging framework that enables EHR systems to behave as "iPhone like platforms" by exhibiting an application programming interface for easy addition and deletion of third party apps. The app is presented as a point of care solution to monitoring medication adherence as well as a sufficiently general, modular application that may serve as an example and template for other SMART apps. The widely used, open source Django framework was used together with the SMART platform to create the interoperable components of this app. Django uses Python as its core programming language. This allows statistical and mathematical modules to be created from a large array of Python numerical libraries and assembled together with the core app to create flexible and sophisticated EHR functionality. Algorithms that predict individual adherence are derived from a retrospective study of dispensed medication claims from a large private insurance plan. Patients' prescription fill information is accessed through the SMART framework and the embedded algorithms compute adherence information, including predicted adherence one year after the first prescription fill. Open source graphing software is used to display patient medication information and the results of statistical prediction

  7. A qualitative study exploring issues related to medication management in residential aged care facilities

    Directory of Open Access Journals (Sweden)

    Ahmad Nizaruddin M

    2017-11-01

    Full Text Available Mariani Ahmad Nizaruddin, Marhanis-Salihah Omar, Adliah Mhd-Ali, Mohd Makmor-Bakry Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia Background: Globally, the population of older people is on the rise. As families are burdened with the high cost of care for aging members, demand is increasing for medical care and nursing homes. Thus, medication management is crucial to ensure that residents in a care center benefit and assist the management of the care center in reducing the burden of health care. This study is aimed to qualitatively explore issues related to medication management in residential aged care facilities (RACFs.Participants and methods: A total of 11 stakeholders comprising health care providers, administrators, caretakers and residents were recruited from a list of registered government, nongovernmental organization and private RACFs in Malaysia from September 2016 to April 2017. An exploratory qualitative study adhering to Consolidated Criteria for Reporting Qualitative Studies was conducted. In-depth interview was conducted with consent of all participants, and the interviews were audio recorded for later verbatim transcription. Observational analysis was also conducted in a noninterfering manner.Results and discussion: Three themes, namely medication use process, personnel handling medications and culture, emerged in this study. Medication use process highlighted an unclaimed liability for residents’ medication by the RACFs, whereas personnel handling medications were found to lack sufficient training in medication management. Culture of the organization did affect the medication safety and quality improvement. The empowerment of the residents in their medication management was limited. There were unclear roles and responsibility of who manages the medication in the nongovernment-funded RACFs, although they were well structured in the private nursing homes.Conclusion: There are important issues

  8. A qualitative study exploring issues related to medication management in residential aged care facilities.

    Science.gov (United States)

    Ahmad Nizaruddin, Mariani; Omar, Marhanis-Salihah; Mhd-Ali, Adliah; Makmor-Bakry, Mohd

    2017-01-01

    Globally, the population of older people is on the rise. As families are burdened with the high cost of care for aging members, demand is increasing for medical care and nursing homes. Thus, medication management is crucial to ensure that residents in a care center benefit and assist the management of the care center in reducing the burden of health care. This study is aimed to qualitatively explore issues related to medication management in residential aged care facilities (RACFs). A total of 11 stakeholders comprising health care providers, administrators, caretakers and residents were recruited from a list of registered government, nongovernmental organization and private RACFs in Malaysia from September 2016 to April 2017. An exploratory qualitative study adhering to Consolidated Criteria for Reporting Qualitative Studies was conducted. In-depth interview was conducted with consent of all participants, and the interviews were audio recorded for later verbatim transcription. Observational analysis was also conducted in a noninterfering manner. Three themes, namely medication use process, personnel handling medications and culture, emerged in this study. Medication use process highlighted an unclaimed liability for residents' medication by the RACFs, whereas personnel handling medications were found to lack sufficient training in medication management. Culture of the organization did affect the medication safety and quality improvement. The empowerment of the residents in their medication management was limited. There were unclear roles and responsibility of who manages the medication in the nongovernment-funded RACFs, although they were well structured in the private nursing homes. There are important issues related to medication management in RACFs which require a need to establish policy and guidelines.

  9. Missing signposts on the roadmap to quality: a call to improve medication adherence indicators in data collection for population research

    Directory of Open Access Journals (Sweden)

    Bradi B. Granger

    2013-11-01

    Full Text Available Purpose: Poor adherence to prescribed medicines is associated with increased rates of poor outcomes, including hospitalization, serious adverse events, and death, and is also associated with increased healthcare costs. However, current approaches to evaluation of medication adherence using real-world electronic health records (EHRs or claims data may miss critical opportunities for data capture and fall short in modeling and representing the full complexity of the healthcare environment. We sought to explore a framework for understanding and improving data capture for medication adherence in a population-based intervention in four U.S. counties.Approach: We posited that application of a data model and a process matrix when designing data collection for medication adherence would improve identification of variables and data accessibility, and could support future research on medication-taking behaviors. We then constructed a use case in which data related to medication adherence would be leveraged to support improved healthcare quality, clinical outcomes, and efficiency of healthcare delivery in a population-based intervention for persons with diabetes. Because EHRs in use at participating sites were deemed incapable of supplying the needed data, we applied a taxonomic approach to identify and define variables of interest. We then applied a process matrix methodology, in which we identified key research goals and chose optimal data domains and their respective data elements, to instantiate the resulting data model.Conclusions: Combining a taxonomic approach with a process matrix methodology may afford significant benefits when designing data collection for clinical and population-based research in the arena of medication adherence. Such an approach can effectively depict complex real-world concepts and domains by mapping the relationships between disparate contributors to medication adherence and describing their relative contributions to

  10. A compilation of consumers' stories: the development of a video to enhance medication adherence in newly transplanted kidney recipients.

    Science.gov (United States)

    Low, Jac Kee; Crawford, Kimberley; Manias, Elizabeth; Williams, Allison

    2016-04-01

    To describe the design, development and evaluation of a consumer-centred video, which was underpinned by the Theory of Planned Behaviour and it was created to educate newly transplanted kidney recipients about the importance of medication adherence. Kidney transplantation is a treatment whereby medication adherence is critical to ensure long-term kidney graft success. To date, many interventions aimed to improve medication adherence in kidney transplantation have been conducted but consumers remain largely uninvolved in the interventional design. Qualitative sequential design. Twenty-two participants who had maintained their kidney transplant for at least 8 months and three participants who had experienced a kidney graft loss due to non-adherence were interviewed from March-May 2014 in Victoria, Australia. These interviews were independently reviewed by two researchers and were used to guide the design of the story plot and to identify storytellers for the video. The first draft of the video was evaluated by a panel of seven experts in the field, one independent educational expert and two consumers using Lynn's content validity questionnaire. The content of the video was regarded as highly relevant and comprehensive, which achieved a score of >3·7 out of a possible 4. The final 18-minute video comprised 15 sections. Topics included medication management, the factors affecting medication adherence and the absolute necessity of adherence to immunosuppressive medications for graft survival. This paper has demonstrated the feasibility of creating a consumer-driven video that supports medication adherence in an engaging way. © 2015 John Wiley & Sons Ltd.

  11. Obedience and motivation as mechanisms for adherence to medication: a study in obese type 2 diabetic patients

    Directory of Open Access Journals (Sweden)

    Reach G

    2011-10-01

    Full Text Available Gérard Reach Department of Endocrinology, Diabetes, and Metabolic Diseases, Avicenne Hospital APHP, and EA 3412, CRNH-IdF, Paris 13 University, Bobigny, France Objective: To clarify the mechanisms of adherence. Methods: A cross-sectional, multicenter French study using a self-questionnaire administered by 116 general practitioners to 782 obese type 2 diabetic patients. Results: The analysis of 670 completed questionnaires revealed a strong association between the adherence to medication and the behavior of fastening the seatbelt when seated in the rear of a car. Multivariate analysis indicated that this behavior was an independent determinant of adherence to medication (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.4–3.6, P < 0.001 with the same OR as the motivation to adhere to medical prescriptions (OR 2.2, 95% CI 1.3–3.6, P = 0.003 in a model with good accuracy (area under the receiver operating characteristic curve 0.774. A multiple correspondence analysis suggested that adherence to medication and seatbelt behavior are “homologous” behaviors, with homology between phenomena defined by the fact that they share a common etiology. Conclusion: Adherence may have two dimensions: passive (obedience, the main determinant of seatbelt behavior and active (motivation. This conclusion has theoretical and practical implications. Firstly, empowerment through patient education can be defined as a process that replaces the passive mechanism of adherence in patients’ minds with an active, conscious choice. Secondly, recognizing these two dimensions may help to establish a tailored patient-physician relationship to prevent nonadherence. Keywords: adherence, compliance, motivation, obedience, reactance, patience, seatbelt, medication

  12. A Motivational Interviewing Intervention by Pharmacy Students to Improve Medication Adherence.

    Science.gov (United States)

    Abughosh, Susan; Wang, Xin; Serna, Omar; Esse, Tara; Mann, Amanda; Masilamani, Santhi; Holstad, Marcia McDonnell; Essien, Ekere James; Fleming, Marc

    2017-05-01

    Diabetes mellitus (DM) patients with comorbid hypertension (HTN) are at a higher risk of developing microvascular and macrovascular DM complications. Through guideline-driven recommendations, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are highly recommended for these patients. Unfortunately, medication adherence to these products, though crucial to achieving therapeutic benefit, is frequently suboptimal. Motivational interviewing (MI) is a patient-centered collaborative communication style that is used to strengthen internal motivation for change that may prove effective in enhancing adherence. To examine the effect of an MI telephone intervention conducted by pharmacy students in improving adherence to ACEIs/ARBs among Medicare Advantage Plan (MAP) patients with both DM and HTN. A prospective study was conducted among patients enrolled in a Texas MAP. Medical claims data were used to identify patients with DM and HTN, and pharmacy claims were observed to recognize those who filled either an ACEI or an ARB during June 2014. Patients with a 6-month proportion of days covered (PDC) sustainability of the intervention effect for longer time periods and its influence on associated clinical outcomes. This project was supported by the Pharmaceutical Research and Manufacturers of America Foundation (PhRMA). The content is solely the responsibility of the authors and does not necessarily represent the official views of PhRMA. The funding agency was not involved in research design, analysis, or reporting results. Funding was obtained by Abughosh. Holstad provided a consultation regarding the MI guide and provided the MI training. Study concept and design were contributed by Abughosh and Fleming, along with Serna, Esse, and Holstad. Serna, Esse, Mann, Holstad, and Masilamani collected the data, and data interpretation was performed by Abughosh, Wong, and Esse. The manuscript was written by Abughosh, Wong, and Esse and revised

  13. Improving medication adherence among kidney transplant recipients: Findings from other industries, patient engagement, and behavioral economics—A scoping review

    Science.gov (United States)

    Oberlin, Shelley R; Parente, Stephen T; Pruett, Timothy L

    2016-01-01

    The immune system is a powerful barrier to successful organ transplantation, but one that has been routinely thwarted through modern pharmacotherapeutics. Despite the benefits of immunosuppressive therapy, medication non-adherence leads to an increased risk of graft rejection, higher hospital utilization and costs, and poor outcomes. We conduct a scoping review following Arksey and O’Malley’s five-stage framework methodology to identify established or novel interventions that could be applied to kidney transplant recipients to improve medication adherence. As the desired outcome is a behavior (taking a pill), we assess three areas: behavioral-focused interventions in other industries, patient engagement theories, and behavioral economic principles. Search strategies included mining business, social sciences, and medical literature with additional guidance from six consultative interviews. Our review suggests that no intervention stands out as superior or likely to be more effective than any other intervention; yet promising strategies and interventions were identified across all three areas examined. Based on our findings, we believe there are five strategies that transplant centers and other organizations can implement to improve medication adherence: (1) Build a foundation of trust; (2) Employ multiple interventions; (3) Stratify the population; (4) Develop collaborative partnerships; and (5) Embed medication adherence into the organization’s culture. The effectiveness of these interventions will need to be investigated further, but we believe they are a step in the right direction for organizations to consider in their efforts to improve medication adherence. PMID:26835016

  14. Improving medication adherence among kidney transplant recipients: Findings from other industries, patient engagement, and behavioral economics—A scoping review

    Directory of Open Access Journals (Sweden)

    Shelley R Oberlin

    2016-01-01

    Full Text Available The immune system is a powerful barrier to successful organ transplantation, but one that has been routinely thwarted through modern pharmacotherapeutics. Despite the benefits of immunosuppressive therapy, medication non-adherence leads to an increased risk of graft rejection, higher hospital utilization and costs, and poor outcomes. We conduct a scoping review following Arksey and O’Malley’s five-stage framework methodology to identify established or novel interventions that could be applied to kidney transplant recipients to improve medication adherence. As the desired outcome is a behavior (taking a pill, we assess three areas: behavioral-focused interventions in other industries, patient engagement theories, and behavioral economic principles. Search strategies included mining business, social sciences, and medical literature with additional guidance from six consultative interviews. Our review suggests that no intervention stands out as superior or likely to be more effective than any other intervention; yet promising strategies and interventions were identified across all three areas examined. Based on our findings, we believe there are five strategies that transplant centers and other organizations can implement to improve medication adherence: (1 Build a foundation of trust; (2 Employ multiple interventions; (3 Stratify the population; (4 Develop collaborative partnerships; and (5 Embed medication adherence into the organization’s culture. The effectiveness of these interventions will need to be investigated further, but we believe they are a step in the right direction for organizations to consider in their efforts to improve medication adherence.

  15. Improving medication adherence among kidney transplant recipients: Findings from other industries, patient engagement, and behavioral economics-A scoping review.

    Science.gov (United States)

    Oberlin, Shelley R; Parente, Stephen T; Pruett, Timothy L

    2016-01-01

    The immune system is a powerful barrier to successful organ transplantation, but one that has been routinely thwarted through modern pharmacotherapeutics. Despite the benefits of immunosuppressive therapy, medication non-adherence leads to an increased risk of graft rejection, higher hospital utilization and costs, and poor outcomes. We conduct a scoping review following Arksey and O'Malley's five-stage framework methodology to identify established or novel interventions that could be applied to kidney transplant recipients to improve medication adherence. As the desired outcome is a behavior (taking a pill), we assess three areas: behavioral-focused interventions in other industries, patient engagement theories, and behavioral economic principles. Search strategies included mining business, social sciences, and medical literature with additional guidance from six consultative interviews. Our review suggests that no intervention stands out as superior or likely to be more effective than any other intervention; yet promising strategies and interventions were identified across all three areas examined. Based on our findings, we believe there are five strategies that transplant centers and other organizations can implement to improve medication adherence: (1) Build a foundation of trust; (2) Employ multiple interventions; (3) Stratify the population; (4) Develop collaborative partnerships; and (5) Embed medication adherence into the organization's culture. The effectiveness of these interventions will need to be investigated further, but we believe they are a step in the right direction for organizations to consider in their efforts to improve medication adherence.

  16. Prevalence and correlates of medication non-adherence among kidney transplant recipients more than 6 months post-transplant: a cross-sectional study

    OpenAIRE

    Weng, Francis L; Chandwani, Sheenu; Kurtyka, Karen M; Zacker, Christopher; Chisholm-Burns, Marie A; Demissie, Kitaw

    2013-01-01

    Background Among kidney transplant recipients, non-adherence with immunosuppressive medications frequently precedes allograft loss. We sought to determine the prevalence and correlates of medication non-adherence among kidney transplant recipients. Methods We performed a single-center, cross-sectional study of kidney transplant recipients who were at least 6 months post-transplant. We measured self-reported adherence using the Immunosuppressive Therapy Adherence Scale (ITAS, which is scored f...

  17. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors

    Directory of Open Access Journals (Sweden)

    Polonsky WH

    2016-07-01

    Full Text Available William H Polonsky,1,2 Robert R Henry2,3 1Behavioral Diabetes Institute, San Diego, 2University of California, San Diego, 3Center for Metabolic Research, VA San Diego Healthcare System, San Diego, CA, USA Abstract: At least 45% of patients with type 2 diabetes (T2D fail to achieve adequate glycemic control (HbA1c <7%. One of the major contributing factors is poor medication adherence. Poor medication adherence in T2D is well documented to be very common and is associated with inadequate glycemic control; increased morbidity and mortality; and increased costs of outpatient care, emergency room visits, hospitalization, and managing complications of diabetes. Poor medication adherence is linked to key nonpatient factors (eg, lack of integrated care in many health care systems and clinical inertia among health care professionals, patient demographic factors (eg, young age, low education level, and low income level, critical patient beliefs about their medications (eg, perceived treatment inefficacy, and perceived patient burden regarding obtaining and taking their medications (eg, treatment complexity, out-of-pocket costs, and hypoglycemia. Specific barriers to medication adherence in T2D, especially those that are potentially modifiable, need to be more clearly identified; strategies that target poor adherence should focus on reducing medication burden and addressing negative medication beliefs of patients. Solutions to these problems would require behavioral innovations as well as new methods and modes of drug delivery. Keywords: glycemic control, HbA1c, hypoglycemia, medication adherence, psychosocial, type 2 diabetes

  18. Functional health literacy and adherence to the medication in older adults: integrative review.

    Science.gov (United States)

    Martins, Nidia Farias Fernandes; Abreu, Daiane Porto Gautério; Silva, Bárbara Tarouco da; Semedo, Deisa Salyse Dos Reis Cabral; Pelzer, Marlene Teda; Ienczak, Fabiana Souza

    2017-01-01

    to characterize the national and international scientific production on the relationship of Functional Health Literacy and the adherence to the medication in older adults. integrative review of literature, searching the following online databases: Scientific Electronic Library Online (SCIELO); Latin American and Caribbean Health Sciences Literature (LILACS); Medical Literature Analysis and Retrieval System Online (MEDLINE); and Cumulative Index to Nursing & Allied Health Literature (CINAHL), in June 2016. We selected 7 articles that obeyed the inclusion criteria. all articles are from the USA. The inappropriate Functional Health Literacy affects the non-adherence to medication; however, there are several strategies and interventions that can be practiced to change this relationship. nursing needs to explorefurther this theme, since it can exert a differentiated care for adherence to medication in older adults, considering the literacy. caracterizar a produção científica nacional e internacional sobre a relação do Letramento Funcional em Saúde e a adesão à medicação em idosos. revisão integrativa da literatura, com busca nas bases de dados on-line: Scientific Electronic Library Online (SCIELO); Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS); Medical Literature Analysis and Retrieval System Online (MEDLINE); e Cumulative Index to Nursing & Allied Health Literature (CINAHL), no mês de junho de 2016. Foram selecionados 7 artigos que obedeceram aos critérios de inclusão. todos os artigos são internacionais e originários dos EUA. O Letramento Funcional em Saúde inadequado influencia para a não adesão à medicação, porém há diversas estratégias e intervenções que podem ser realizadas na prática para modificar essa relação. a enfermagem precisa explorar mais essa temática, visto que pode exercer um cuidado diferenciado para a adesão à medicação em idosos, levando em conta o letramento.

  19. Self-efficacy beliefs, locus of control, religiosity and non-adherence to immunosuppressive medications in kidney transplant patients.

    Science.gov (United States)

    Silva, Andresa Nascimento; Moratelli, Lucas; Tavares, Paula Liziero; Marsicano, Elisa De Oliveira; Pinhati, Renata Romanholi; Colugnati, Fernando Antonio Basile; Lucchetti, Giancarlo; Sanders-Pinheiro, Helady

    2016-11-01

    Adherence to immunosuppressive medication is essential for favourable kidney transplant outcomes. The present study aims to investigate how self-efficacy beliefs, health locus of control and religiosity are associated with adherence to immunosuppressives in post kidney transplant recipients. This is a cross-sectional study with 88 recipients with more than 1 year after transplantation. Three methods were used to classify patients as adherent or non-adherent: Basel Assessment of Adherence Scale for Immunosuppressives - BAASIS, the collateral report and blood levels of immunosuppressive medications. Self-efficacy, health locus of control, and religiosity were evaluated applying General Perceived Self-Efficacy Scale, Multidimensional Health Locus of Control Scale and Duke University Religion Index, respectively. Non-adherence was modelled by uni- and multivariated analysis. Sixty-three percent of the patients were male, age 47.2 ± 12.9 years, and median post-transplant time 108.71 (49.0-266.0) months. We found 70.5% of patients were non-adherent through at least one method. Adherent patients presented higher self-efficacy scores (45.1 ± 4.9 vs 38.3 ± 8.6; P locus of control (OR 1.23, IC 1.04-1.45, P = 0.016) and lower intrinsic religiosity (OR 0.56, IC 0.38-0.84, P = 0.006). Our study showed that self-efficacy, chance locus of control, and intrinsic religiosity were associated with non-adherence to immunosuppressives. A broader perception of the kidney transplant patient´s integrality can help health professionals to design strategies to promote adherence in this population. © 2015 Asian Pacific Society of Nephrology.

  20. Perspectives on medicine adherence in service users and carers with experience of legally sanctioned detention and medication: a qualitative study

    Directory of Open Access Journals (Sweden)

    Chambers M

    2013-08-01

    Full Text Available Iris Gault,1 Ann Gallagher,2 Mary Chambers31Faculty of Health and Social Care Sciences, Kingston University and St George's University of London, Kingston, Surrey, UK; 2International Centre for Nursing Ethics, School of Health and Social Care, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK; 3Faculty of Health and Social Care Sciences, Kingston University and St George's University of London, St George's University of London, Tooting, London, UKAim: To explore and analyze perceptions of service users and caregivers on adherence and nonadherence to medication in a mental health care context.Background: Mental health medication adherence is considered problematic and legal coercion exists in many countries.Design: This was a qualitative study aiming to explore perceptions of medication adherence from the perspective of the service user (and their caregiver, where possible.Participants: Eighteen mental health service users (and six caregivers with histories of medication nonadherence and repeated compulsory admission were recruited from voluntary sector support groups in England.Methods: Data were collected between 2008 and 2010. Using qualitative coding techniques, the study analyzed interview and focus group data from service users, previously subjected to compulsory medication under mental health law, or their caregivers.Results: The process of medication adherence or nonadherence is encapsulated in an explanatory narrative. This narrative constitutes participants' struggle to negotiate acceptable and effective routes through variable quality of care. Results indicated that service users and caregivers eventually accepted the reality of their own mental illness and their need for safety and treatment. They perceived the behavior of professionals as key in their recovery process. Professionals could be enabling or disabling with regard to adherence to medication.Conclusion: This study investigated service user

  1. Long-term patterns of adherence to medication therapy among patients with type 2 diabetes mellitus in Denmark

    DEFF Research Database (Denmark)

    Jensen, Majken Linnemann; Jørgensen, Marit Eika; Hansen, Ebba Holme

    2017-01-01

    : Adherence to six medicine groups (metformin, sulfonylureas, acetylsalicylic acid, thiazide diuretics, renin angiotensin system inhibitors, and statins) were analysed among 5,232 patients with type 2 diabetes at a tertiary referral hospital during 1998-2009. Rate-ratios of initiation of treatment, recurrent......AIMS: Poor adherence to medication therapy among type 2 diabetes patients is a clinical challenge. We aimed to determine which factors are associated with the three phases of long-term adherence to medication: initiation, implementation and discontinuation in a register-based study. METHODS...... gaps in supply of medication, and discontinuation of treatment were analysed using Poisson regression. RESULTS: Poor initiation rather than poor implementation or discontinuation was the main contributor to medication nonadherence. Polypharmacy was a risk factor for slower initiation of treatment...

  2. Impact of one-dose package dispensing with patient counseling on medication adherence in geriatrics suffering from chronic disorders

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    Narayana Goruntla

    2018-01-01

    Full Text Available Introduction: Medication nonadherence in elderly patients could result in a waste of medical expenses in a long-time span as well as deterioration of the patient's medical condition. Aim: The aim of this study is to evaluate the impact of one-dose package dispensing with patient counseling on medication adherence among elderly patients suffering from chronic disorders. Settings and Design: This is prospective, open-labeled, randomized trial carried out at dispensing pharmacy of the secondary care referral hospital, located in resource-limited settings of Anantapur District, Andhra Pradesh, India. Subjects and Methods: A total of 330 (aged ≥60 years patients were randomly assigned to one of three study groups: Group A (n = 110, no change in dosing and packing; Group B (n = 110, one-dose package dispensing; Group C (n = 110, One-dose package dispensing with patient counseling. Medication adherence levels were measured using a pill count and visual analog scal