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Branham, Ashley, Joseph Moose, and Stefanie Ferreri. "Retrospective Analysis of Medication Adherence and Cost Following Medication Therapy Management." INNOVATIONS in pharmacy 1, no. 1 (June 1, 2010): 12. http://dx.doi.org/10.24926/iip.v1i1.195.
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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.
Type: Original Research
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Badi, Safaa, Ali Abdalla, Lina Altayeb, Mounkaila Noma, and Mohamed H. Ahmed. "Adherence to Antidiabetic Medications Among Sudanese Individuals With Type 2 Diabetes Mellitus: A Cross-Sectional Survey." Journal of Patient Experience 7, no. 2 (March 13, 2019): 163–68. http://dx.doi.org/10.1177/2374373519831073.
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Background: Adherence to antidiabetic medications is crucial for optimum glycemic control and decreasing complications. This study aimed to assess adherence to antidiabetic medications and the associated factors among individuals with type 2 diabetes attending Jabir Abu Eliz Diabetes Centre in Khartoum state, Sudan. Methods: This was a descriptive cross-sectional study, recruited 213 individuals with type 2 diabetes, and used a pretested questionnaire. Data were analyzed using the Statistical Package of Social Sciences version 21. Logistic regression analysis was used to check for factors that linked to poor adherence to diabetes medication. Results: The median duration of antidiabetic medications use was 8 years; 15.0% were highly adherent to diabetes medications, 44.6% were medium adherent, and 40.4% showed low adherence. Main factors and barriers were medication side effects (18.3%), use of herbal medicine (12.3%), and unavailability of medication (7%). Predictors to nonadherence were gender, and housing status (0.043 and 0.042, respectively). Conclusion: Level of adherence to diabetes medication was unsatisfactory as only 15% showed high adherence. Predictors of nonadherence were gender, and housing status. Effective interventions should be implemented to improve medication adherence, like appropriate patient education and involvement in the treatment plan.
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Zyryanov, Sergey K., Sergey B. Fitilev, Alexander V. Vozzhaev, Irina I. Shkrebniova, Natalya N. Shindryaeva, Dmitry A. Klyuev, Liusine N. Stepanyan, Nikolay N. Landyshev, and Yana G. Voronko. "Medication adherence in patients with stable coronary artery disease in primary care." Research Results in Pharmacology 6, no. 2 (June 30, 2020): 97–103. http://dx.doi.org/10.3897/rrpharmacology.6.54130.
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Introduction: Lack of research targeting non-adherence to cardiovascular medications in Russia prevents from developing effective interventions to improve adherence. The aim was to study medication adherence in patients with stable coronary artery disease in primary care. Material and methods: The study was conducted in a primary care setting of Moscow. Demography, medical history, pharmacotherapy data were obtained retrospectively from 386 coronary patients’ medical records. Medication adherence was measured by 8-item Morisky Medication Adherence Scale (MMAS-8). A statistical analysis was performed using SPSS Statistics V16.0. Results and discussion: According to the results from MMAS-8, 188 (48.7%) coronary patients had high medication adherence, 135 (35.0%) – moderate, and 63 (16.3%) – low. By the dichotomous interpretation: 48.7% (n = 188) – were adherent, 51.3% (n = 198) – were non-adherent. These groups were similar in gender distribution, age, and medical history profile (p > 0.1 for all variables). Smokers prevailed in the non-adherent group (13.6 vs. 5.3%; p = 0.009). Both groups were equally prescribed beta-blockers, antiplatelets, and statins (p > 0.1 for all). Use of fixed dose combinations (11.7 vs. 5.6%; p = 0.048) and the number of pills taken (mean 5.64 ± 1.52 vs. 5.99 ± 1.62; p = 0.029) were associated with better adherence. Higher values of total cholesterol (mean 5.2 ± 1.4 vs. 4.7 ± 1.2 mmol/L; p < 0.001) and low-density lipoprotein cholesterol (mean 2.9 ± 1.2 vs. 2.4 ± 0.9 mmol/L; p < 0.001) were revealed in non-adherents. Subjects with suboptimal adherence visited general practitioners more frequently (median 5 vs. 3 visits; p = 0,003). Conclusion: Medication non-adherence in coronary outpatients exceeded 50%. High adherence was associated with more frequent use of fixed dose combinations and fewer pills taken by patient. Smoking and poorer control of blood lipids prevailed in non-adherents, who also caused higher load on general practitioners.
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González-Bueno, Javier, Daniel Sevilla-Sánchez, Emma Puigoriol-Juvanteny, Núria Molist-Brunet, Carles Codina-Jané, and Joan Espaulella-Panicot. "Factors Associated with Medication Non-Adherence among Patients with Multimorbidity and Polypharmacy Admitted to an Intermediate Care Center." International Journal of Environmental Research and Public Health 18, no. 18 (September 12, 2021): 9606. http://dx.doi.org/10.3390/ijerph18189606.
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Identifying determinants of medication non-adherence in patients with multimorbidity would provide a step forward in developing patient-centered strategies to optimize their care. Medication appropriateness has been proposed to play a major role in medication non-adherence, reinforcing the importance of interdisciplinary medication review. This study examines factors associated with medication non-adherence among older patients with multimorbidity and polypharmacy. A cross-sectional study of non-institutionalized patients aged ≥65 years with ≥2 chronic conditions and ≥5 long-term medications admitted to an intermediate care center was performed. Ninety-three patients were included (mean age 83.0 ± 6.1 years). The prevalence of non-adherence based on patients’ multiple discretized proportion of days covered was 79.6% (n = 74). According to multivariable analyses, individuals with a suboptimal self-report adherence (by using the Spanish-version Adherence to Refills and Medications Scale) were more likely to be non-adherent to medications (OR = 8.99, 95% CI 2.80–28.84, p < 0.001). Having ≥3 potentially inappropriate prescribing (OR = 3.90, 95% CI 0.95–15.99, p = 0.059) was barely below the level of significance. These two factors seem to capture most of the non-adherence determinants identified in bivariate analyses, including medication burden, medication appropriateness and patients’ experiences related to medication management. Thus, the relationship between patients’ self-reported adherence and medication appropriateness provides a basis to implement targeted strategies to improve effective prescribing in patients with multimorbidity.
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Varshney, Upkar, and Neetu Singh. "A Framework for Studying Patterns of Effective Medication Adherence." International Journal of Interdisciplinary Telecommunications and Networking 5, no. 4 (October 2013): 1–12. http://dx.doi.org/10.4018/ijitn.2013100101.
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Medication adherence has been studied extensively in the healthcare literature. Most of the studies focus on improving medication adherence using interventions, including those based on wireless and mobile technologies, and measure average medication adherence level. This is useful in differentiating between patients with high and low levels of adherence. In practice, the same average medication adherence could be achieved by patients with widely different adherence patterns. In this paper, the authors propose that in addition to average medication adherence level, the patterns of adherence should also be studied. The patterns of adherence can be obtained using wireless medication systems and set of actions/decisions can be communicated to these systems or mobile applications for medication management. The authors present a framework, some metrics including Effective Medication Adherence, and results related to the patterns of adherence. Their results show that pattern of adherence has significant impact on the effective medication adherence. Also, higher levels of effective adherence can be achieved for more flexible medication regimen, such as those with higher values of maximum inter-dose time. It is also possible for a patient with lower average adherence but a desirable pattern of adherence to have higher effective medication adherence than a patient with higher average adherence with less desirable pattern.
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El-Rachidi, Sarah, Joseph M. Larochelle, and Jill A. Morgan. "Pharmacists and Pediatric Medication Adherence: Bridging the Gap." Hospital Pharmacy 52, no. 2 (February 2017): 124–31. http://dx.doi.org/10.1310/hpj5202-124.
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Pediatric medication nonadherence is a major problem in the United States health care system. Age of the child, lack of understanding about the disease or treatment, culture, socioeconomic status, family structure, schedule of medications, and taste can all contribute to this problem. Strategies that target interventions to the individual patient and family can be most effective. Pharmacists are at the forefront of patient care and can help children become more adherent to their medications through counseling and building a trusting relationship with the family. This article highlights some common problems to adherence and some solutions to increase adherence.
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Oh, Seung-Won. "Medication Adherence and Effective Management of Hypertension." Korean Journal of Family Medicine 42, no. 2 (March 20, 2021): 89–90. http://dx.doi.org/10.4082/kjfm.42.2e.
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Claassen, Dirk, Walid K. Fakhoury, Richard Ford, and Stefan Priebe. "Money for medication: financial incentives to improve medication adherence in assertive outreach." Psychiatric Bulletin 31, no. 1 (January 2007): 4–7. http://dx.doi.org/10.1192/pb.31.1.4.
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Aims and MethodAlthough financial incentives to improve treatment adherence have been found effective in various medical specialties, there are few systematic data on their use, ethical background and effectiveness in psychiatry. We explored the practice of and possible ethical problems associated with direct financial incentives to improve adherence in assertive outreach teams in England. We also report clinical observations of a money for medication scheme with five assertive outreach patients in East London.ResultsNone of the assertive outreach teams that responded to the survey (response rate 47%) uses financial incentives. Attitudes of team managers towards the practice were mostly negative, often regarding it as unethical. Specific concerns were related to possible coercion and a negative impact on the therapeutic relationship. Out of five patients studied, four accepted the offer of money and had improved adherence; three remained without hospital admission since entering the scheme.Clinical ImplicationsMoney for medication might be a non-coercive and effective option to achieve medication adherence in otherwise non-adherent assertive outreach patients. However, ethical issues need further exploration and controlled trials are required to establish the effectiveness.
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Aishwaria Jyothi Bhasu, Mangala Susmitha, Rhea Climies, Asmita Clara Baral, Divya Mol E. C., and Nandini Swamy. "Assessment of Health Related Quality of Life and Medication Adherence in the Elderly Population." International Journal of Research in Pharmaceutical Sciences 12, no. 3 (July 5, 2021): 2233–38. http://dx.doi.org/10.26452/ijrps.v12i3.4839.
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The elderly population, aged above 60 years, are prone to various chronic and concurrent diseases. This requires prolonging medication usage, often with complex regimens which affect their medication-taking behavior, compliance, adherence, and overall prognosis of the disease. Thereby, an accurate assessment of adherence behavior and its complimentary factors, prescription analysis are necessary for effective and efficient treatment planning and an overall improvement in the Health Related Quality of Life (HRQOL) of the elderly population. Our study was aimed to comprehend the HRQOL and medication adherence pattern of the elderly. One hundred and thirty-three subjects with a mean age of 66.68 ± 5.49 years were recruited for the study and were assessed for their HRQOL, medication adherence, and the factors influencing medication adherence. Relevant data were collected, questionnaires were administered, and appropriate descriptive and inferential statistics were performed. Our findings demonstrated that there is a noticeable change in the HRQOL of the elderly population. It was also found that subjects were highly adherent to their medications, but certain factors played a major role in influencing medication non-adherence. This implies the importance of determining factors affecting HRQOL, medication adherence, adequate prescription analysis, and promoting and practicing rational use of drugs that can significantly optimize therapy and provide a good prognosis of disease for the elderly population.
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Xu, Shuyin, Bangshan Liu, and Yan Zhang. "Effectiveness of mental therapy for poor medication adherence in depression: A review." Tropical Journal of Pharmaceutical Research 19, no. 8 (November 20, 2020): 1785–92. http://dx.doi.org/10.4314/tjpr.v19i8.30.
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Purpose: To review the effectiveness and underlying mechanism of different types of psychotherapy to improve medication adherence (MA).Methods: In this review, the status and possible factors influencing medication adherence in patients with depression patients based on information obtained from various literature.Results: Although the focus of psychologists' analysis of the causes and solutions of mental illness is different, several of these therapies can improve patient compliance with their medications. An effective psychotherapy can change patients’ attitudes towards disease and help them reduce the disease recurrence rate.Conclusion: Psychotherapy has an irreplaceable role in dealing with the major depressive disorder. This review aimed to provide effective instructions for improving medication adherence and reducing disease relapse and recurrence in the future.
Keywords: Depression, Medication adherence, Psychotherapy
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Ni, Zhao, Latefa Dardas, Bei Wu, and Ryan Shaw. "Cardioprotective medication adherence among patients with coronary heart disease in China: a systematic review." Heart Asia 11, no. 2 (June 2019): e011173. http://dx.doi.org/10.1136/heartasia-2018-011173.
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In China, poor cardioprotective medication adherence is a key reason for the high mortality rate of coronary heart disease (CHD). The aims of this systematic review are to (1) describe and synthesise factors that influence medication adherence among Chinese people with CHD, (2) evaluate the current status of intervention studies, and (3) discuss directions of future research to improve medication adherence. A comprehensive search using PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, Global Health and PsycINFO was undertaken to describe poor adherence in China. Thirty-three eligible articles were included in the study. The review shows that there are multiple contributing factors to poor medication adherence, including patients’ sociodemographic characteristics, health status and medication characteristics. In addition, from patients’ perspective, lack of medication-related knowledge, such as the name, function, dosage and frequency, contributes to poor adherence. From physicians’ perspective, a gap exists between CHD secondary prevention guidelines and clinical practice in China. Follow-up phone calls, educational lectures, booklets and reminder cards were common methods found to be effective in improving medication adherence. This systematic review indicates that cardioprotective medications were commonly prescribed as secondary prevention medication to patients with CHD in China, but adherence to these medications gradually decreased during a follow-up period. Therefore, more research should be conducted on how to establish high-quality health educational programmes aimed at increasing patients’ medication adherence.
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Toelle, Brett G., Guy B. Marks, and Stewart M. Dunn. "Psychological and Medical Characteristics Associated with Non-Adherence to Prescribed Daily Inhaled Corticosteroid." Journal of Personalized Medicine 10, no. 3 (September 14, 2020): 126. http://dx.doi.org/10.3390/jpm10030126.
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Medication non-adherence is associated with sub-optimal asthma control. Identification of medical and psychological characteristics associated with non-adherence is important to enable a targeted and personalized approach when working with patients and for the development of interventions to improve patient outcomes by improving medication adherence. We enrolled adults who had diagnosed asthma and who were prescribed daily inhaled corticosteroid medication. We used published and validated instruments to measure medical characteristics including asthma features, practical asthma knowledge and perceived involvement in care and psychological characteristics including anxiety, depression, optimism, and personality traits, to assess the relationship with medication non-adherence. A total of 126 participants provided data, with 64 (50.8%) of the participants identified as non-adherent. Multivariate analyses showed that younger age, high neuroticism scores and a previous asthma hospital admission were associated with non-adherence. Interestingly, depression was associated with a lower risk of non-adherence. This study showed that a personalized medicine approach would include interventions targeting those who are younger, who have been in hospital for asthma and who rate high on the neuroticism personality trait. Given the availability of effective medications for asthma, better understanding of the characteristics associated with non-adherence is important to enhance optimal self-management.
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Lee, Won Kyung, and Joongyub Lee. "Evaluation and improvement of adherence to medication." Journal of the Korean Medical Association 64, no. 2 (February 10, 2021): 130–36. http://dx.doi.org/10.5124/jkma.2021.64.2.130.
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Medication adherence refers to the extent to which a patient takes medication according to prescription. In many cases, adherence to medication is defined as the proportion of prescribed drugs taken as prescribed over a certain period. However, there is no satisfactory level of adherence that can be applied uniformly to all diseases and medications. Patients with poor adherence experience worsening of conditions, complications, and increased risk for death, which increases medical expenses. Therefore, to improve medication adherence, healthcare providers should try to identify poor adherence, adjust prescriptions to optimize treatment according to the patient’s lifestyle, and educate patients to help them understand the value of medical treatment and the effects of adherence. The most practical way to identify poor adherence during clinical visits is by asking patients about their medication adherence in a non-judgmental manner. Reducing the number of doses is more effective than reducing the number of tablets to increase compliance. It is necessary to adopt innovative methods based on information technology in our healthcare system because of the labor-intensive nature of educational intervention to improve adherence.
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Blocker, Kenneth A., and Wendy A. Rogers. "Exploring Older Adults’ Internalizations And Misconceptions Regarding Antihypertensive Medication Management." Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care 10, no. 1 (June 2021): 304–8. http://dx.doi.org/10.1177/2327857921101221.
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Hypertension, or high blood pressure, is an asymptomatic cardiovascular condition common with increasing age that must be controlled with proper management behaviors, such as adherence to prescribed antihypertensive medications. Unfortunately, older adults may struggle with consistent and effective management of this medication specifically and the disease generally, which can lead to poorer health outcomes. The goal of the study was to investigate older adults’ antihypertensive medication management using the Illness Representation Model as a lens to identify potential misconceptions that may contribute to medication management. We conducted semi-structured interviews with 40 older adults regarding management routines, hypertension knowledge, perceived nonadherence contributors, and perspectives related to their illness. We identified numerous misconceptions regarding hypertension knowledge, disease severity, as well as perceived adherence performance that may contribute to challenges older adults face with maintaining antihypertensive medication adherence. Moreover, these findings inform the need for and design of effective educational tools for improving antihypertensive medication adherence.
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Dhippayom, Teerapon, and Ines Krass. "Medication-taking behaviour in New South Wales patients with type 2 diabetes: an observational study." Australian Journal of Primary Health 21, no. 4 (2015): 429. http://dx.doi.org/10.1071/py14062.
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This study aimed to (1) determine adherence to diabetes medication in type 2 diabetes (T2D) patients; (2) describe respondents’ attitudes and beliefs about medications, and barriers to adherence; and (3) to model predictors of non-adherence. Data were collected using online and postal surveys. Diabetes patients aged ≥18 years who were members of the Australian Diabetes Council were invited to participate. Main outcome measures were adherence to diabetes medication using 8-item Morisky Medication Adherence Score (MMAS-8) and beliefs about medication using the Beliefs about Medicines Questionnaire. A total of 543 T2D patients responded to the survey. The median (interquartile range) MMAS-8 score was 6.8 (5.0–7.0). The prevalence of adherence (MMAS-8 score ≥6) was 64.6%. The proportion of respondents who expressed concern about taking medications was 53.6%. Potential predictors of adherence included age (OR, 1.83; 95% CI, 1.19–2.82), concern about medication (OR, 0.91; 95% CI, 0.87–0.96), knowledge of diabetes (OR, 0.85, 95% CI, 0.73–0.99), having difficulty in paying for medication (OR, 0.51; 95% CI ,0.33–0.79), having more than one regular pharmacy (OR, 0.59; 95% CI, 0.36–0.95), and using insulin (OR, 0.49; 95% CI, 0.30–0.81). Adherence to taking diabetes medication in a sample of the Australian T2D patient population was suboptimal. An understanding of medication-taking behaviour will assist health-care professionals to deliver appropriate and effective interventions to enhance adherence and optimise diabetes control in T2D patients.
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Dhippayom, Teerapon, and Ines Krass. "Corrigendum to: Medication-taking behaviour in New South Wales patients with type 2 diabetes: an observational study." Australian Journal of Primary Health 22, no. 6 (2016): 576. http://dx.doi.org/10.1071/py14062_co.
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This study aimed to (1) determine adherence to diabetes medication in type 2 diabetes (T2D) patients; (2) describe respondents' attitudes and beliefs about medications, and barriers to adherence; and (3) to model predictors of non-adherence. Data were collected using online and postal surveys. Diabetes patients aged ?18 years who were members of the Australian Diabetes Council were invited to participate. Main outcome measures were adherence to diabetes medication using 8-item Morisky Medication Adherence Score (MMAS-8) and beliefs about medication using the Beliefs about Medicines Questionnaire. A total of 543 T2D patients responded to the survey. The median (interquartile range) MMAS-8 score was 6.8 (5.0–7.0). The prevalence of adherence (MMAS-8 score ?6) was 64.6%. The proportion of respondents who expressed concern about taking medications was 53.6%. Potential predictors of adherence included age (OR, 1.83; 95% CI, 1.19–2.82), concern about medication (OR, 0.91; 95% CI, 0.87–0.96), knowledge of diabetes (OR, 0.85, 95% CI, 0.73–0.99), having difficulty in paying for medication (OR, 0.51; 95% CI ,0.33–0.79), having more than one regular pharmacy (OR, 0.59; 95% CI, 0.36–0.95), and using insulin (OR, 0.49; 95% CI, 0.30–0.81). Adherence to taking diabetes medication in a sample of the Australian T2D patient population was suboptimal. An understanding of medication-taking behaviour will assist health-care professionals to deliver appropriate and effective interventions to enhance adherence and optimise diabetes control in T2D patients.
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Billingsley, Luanne, and Ann Carruth. "Use of Technology to Promote Effective Medication Adherence." Journal of Continuing Education in Nursing 46, no. 8 (August 1, 2015): 340–42. http://dx.doi.org/10.3928/00220124-20150721-12.
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Mulhem, Elie, David Lick, Jobin Varughese, Eithne Barton, Trevor Ripley, and Joanna Haveman. "Adherence to Medications after Hospital Discharge in the Elderly." International Journal of Family Medicine 2013 (March 26, 2013): 1–6. http://dx.doi.org/10.1155/2013/901845.
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Objectives. To evaluate the adherence rate to prescribed medications in elderly patients 24–48 hours after being discharged from the hospital. Methods. Family medicine residents visited patients over the age of 65 years at their homes one to two days after being discharged from the hospital and documented all the medications that they were taking since coming home from the hospital. The list of medications was later compared to the medications recorded in hospital discharge instructions. Results. Complete data was available for 46 participants. The average patient age was 76 years; 54.4% were women. Only three patients (6.5%) adhered completely to the discharge medication list found in the medical record. Thirty-six patients (78.2%) reported taking at least one additional prescription medication, twenty patients (43.4%) missed at least one prescription medication, twenty patients (43.4%) reported taking the wrong dose of at least one medication, and nineteen patients (41.3%) reported taking medications at an incorrect frequency. Conclusion. The vast majority of elderly patients in our study did not adhere to the medication regimen in the first two days after hospital discharge. Cost-effective improvements to hospital discharge processes are needed to improve adherence and reduce preventable posthospitalization complications.
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Gangadharan, Aswathi, Diya Sheela Thomas, ,. Harshida, Cyril Tom, and Prabhakar Adake. "The Role of Clinical Pharmacist in Enhancement of Medication Adherence and Quality of Life in Bronchial Asthma and Chronic Obstructive Pulmonary Disease." Journal of Drug Delivery and Therapeutics 11, no. 4-S (August 15, 2021): 48–53. http://dx.doi.org/10.22270/jddt.v11i4-s.4952.
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Asthma and Chronic Obstructive Pulmonary Disease (COPD) are two of the leading causes of morbidity, mortality and economic burden worldwide. The burden of chronic respiratory disease has major adverse effects on the quality of life and ability of affected individuals. A variety of effective treatment options exist for patients with Asthma and COPD but long-term adherence to medications is required for treatment success. Aim of the study was to assess the adherence to medication and quality of life in Asthma and COPD patients using questionnaires, and to enhance adherence and quality of life using the strategies of counselling and education. The observational study was conducted for a period of 6 months, assessed medication adherence by Morisky self-reported questionnaires and quality of life by St. George’s Respiratory questionnaire (SGRQ) and 36 item short form health survey (SF-36). The study shows there was statistically significant improvement in medication adherence score (p<0.05) and quality of life (p<0.05) after pharmacist’s counselling regarding disease, medication and lifestyle. Comparison between various demographic factors like age, gender, co-morbidities, smoking index showed equal impact of pharmacist’s counselling on improvement of overall medication adherence and quality of life in Asthma and COPD patients. Overall medication adherence and quality of life improvement was found to be statistically significant in Asthma and COPD patients after counselling by clinical pharmacists. Clinical pharmacists must be considered as an integral element of healthcare system. Patient counselling is effective to resolve the problems associated with medication non-adherence and quality of life.
Keywords: Asthma, COPD, Medication adherence, Quality of life
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TING, TRACY V., DEEPA KUDALKAR, SHANNEN NELSON, SANDRA CORTINA, JOSHUA PENDL, SHAAISTA BUDHANI, JENNIFER NEVILLE, et al. "Usefulness of Cellular Text Messaging for Improving Adherence Among Adolescents and Young Adults with Systemic Lupus Erythematosus." Journal of Rheumatology 39, no. 1 (November 15, 2011): 174–79. http://dx.doi.org/10.3899/jrheum.110771.
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Objective.In a cohort of 70 patients with childhood-onset systemic lupus erythematosus (cSLE): to determine the baseline adherence to medications and visits; to investigate the effects of cellular text messaging reminders (CTMR) on adherence to clinic visits; and to study the influence of CTMR on adherence to use of hydroxychloroquine (HCQ).Methods.CTMR were sent to 70 patients prior to clinic visits for 14 months. A subgroup of patients were evaluated for medication adherence to HCQ: 19 patients receiving CTMR prior to each scheduled HCQ dose were compared to 22 patients randomized to standard of care education about HCQ. Visit adherence was measured using administrative databases. Pharmacy refill information, self-report of adherence, and HCQ blood levels were utilized to monitor medication adherence to HCQ. Sufficient adherence to visits or HCQ was defined as estimates > 80%. Disease activity was primarily monitored with the Systemic Lupus Erythematosus Disease Activity Index.Results.At baseline, 32% of patients were sufficiently adherent to HCQ, and 81% to clinic visits. Visit adherence improved significantly by > 80% among those who were nonadherent to clinic visits at the baseline CTMR (p = 0.01). CTMR did not influence adherence to HCQ over time.Conclusion.Patients with cSLE were only modestly adherent to HCQ and clinic visits. CTMR may be effective for improving visit adherence among adolescents and young adults with cSLE, but it does not improve adherence to HCQ.
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Berben, Lut, Fabienne Dobbels, Christiane Kugler, Cynthia L. Russell, and Sabina De Geest. "Interventions Used by Health Care Professionals to Enhance Medication Adherence in Transplant Patients: A Survey of Current Clinical Practice." Progress in Transplantation 21, no. 4 (December 2011): 322–31. http://dx.doi.org/10.1177/152692481102100412.
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Context Although medication nonadherence is associated with severe complications including graft rejection and loss, its prevalence remains high among organ transplant recipients. Still, little information exists on clinical use of interventions to improve medication adherence. Objective To identify transplant health care professionals' methods of assessing medication adherence, classify the used interventions, and measure those interventions' perceived effectiveness. Design, Setting and Participants A 46-item questionnaire on adherence assessment and interventions was distributed at the 2010 International Transplant Nurses Society symposium in Germany. Data were analyzed by using descriptive statistics. Results Of 141 distributed questionnaires, 94 (67%) were returned. Respondents with no direct patient contact (9%, n = 8) were excluded. The most frequently used assessment strategy was patient self-reporting (60%, n = 52). On average, participants reported using 47% of the educational/cognitive, 44% of the counseling/behavioral, and 42% of the psychological/affective interventions listed. Training patients to self-administer medications and providing printed adherence information were the most frequently used interventions (79% each, n = 68), followed by providing printed medication instructions (69%, n = 59). Most respondents (90%, n = 77) reported combining interventions. The intervention perceived as most effective was medication self-administration training. Conclusion Although available alternatives are demonstrably more effective for enhancing medication adherence, this sample relied more on educational interventions.
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Amin, Zulfiquer Ahmed, MI Kabir, JH Karami, and N. Nahar. "Doctor-Patient Communication to Improve Adherence to Anti- Hypertensive Treatment." Bangladesh Medical Research Council Bulletin 44, no. 3 (January 23, 2019): 145–51. http://dx.doi.org/10.3329/bmrcb.v44i3.39938.
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Background: Non-adherence to medication increases patient’s risk of morbidity, mortality and economic wastage of scare medical resources. This study was conducted to assess the role of doctor-patient communication and duration of consultation, as tools to improve adherence to hypertension treatment.
Methods: Data of this cross-sectional study were collected by face to face interview and document review at Combined Military Hospital (CMH), Dhaka among 253 conveniently recruited hypertensive patients attending outpatient department during July 2016 to June 2017. Mean-age of the respondents was 49.2 (±10.4) years, mostly married male (54.9% male, 95.3% married). Mean consultation duration experienced by the respondents was 5.3 (± 1.3) minutes. Among the participants, 63.64% experienced effective communication, 66% were adherent and 34% were non-adherent to medication. Among the respondents with effective communication, 92.5% were adherent to medication. On the contrary, among the respondents with ineffective communication, 80.4% were non-adherent.
Results: Duration of consultation had significant association with adherence to hypertension treatment (p<0.001). Association between communication and adherence to medication was highly significant (p<0.001). Binary logistic regression revealed that respondents were 3.23 times more adherent to medication with favorable response to the item- ‘Doctor gave me as much information as I wanted’ (p = 0.041); and 10.24 times with favorable response to the item- ‘Doctor checked to be sure that I understood everything’(p=0.006). Patients’ faithfulness in carrying out prescription and proscriptions correctly, depends on the adequacy and accuracy of patient’s knowledge of what they were supposed to do and on their motivation.
Conclusion: Thus, it is necessary to formulate interventions to scale up communication skill of the physicians, and devise effective ways to educate patients on medication of chronic diseases. Further studies on characteristics of consultation to make it motivating and more effective may be conducted.
Bangladesh Med Res Counc Bull 2018; 44: 145-151
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Ismail, Lamia Mohamed Nabil, Mohga Abed-AlAziz Selim, and Sahar Omar Yehia Elkhashab. "Factors affecting medication adherence among patients with rheumatic disorders." Journal of Nursing Education and Practice 7, no. 8 (March 6, 2017): 7. http://dx.doi.org/10.5430/jnep.v7n8p7.
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Background and objective: Patient's adherence is an important factor affecting the successful maintenance of treatment, slow progression of the disease; reduce costs of health care especially in the presence of multiple chronic conditions as rheumatic disorders. While, medication non-adherence is a significant problem leads to increased mortality and morbidity. So, identification of the factors affecting non-adherence to medication regimens is beneficial for healthcare providers to improve patient’s health condition. The aim of the study was to determine factors affecting medication adherence among sample of Egyptian patients with rheumatic disorders.Methods: Design: An exploratory descriptive research design. Subjects: Purposive sampling of patients with history of rheumatic disorders. Setting: The study was carried out in rheumatology department and medical wards at Al-Kaser Al-Aini hospital. Tool: Patient Preliminary Informational Variables, Morisky Medication Adherence Scale 8-Items and Factors affecting drug adherence checklist were used to collect pertinent data.Results: The study showed 59.2% of study group had low adherence, followed by medium adherence and high adherence (28%, 12.7%) to prescribed medications respectively. Findings also; revealed that the highest percent of these factors that may combine to render patients to be less able to adhere to prescribed medication ranked as complexity of medication regimen; chronic conditions, restricted formularies, changing medications covered on formularies; fear of possible adverse effects, fear of dependence; lack of continuity of care, treatment interferes with lifestyle or requires significant behavioral changes; patient information materials written at too high literacy level; severity of symptoms; lack of knowledge on adherence and the effective interventions for improving it; as well the medication cost; long wait times; burdensome schedule; poor access or missed appointments; actual or perceived unpleasant side effects; duration of therapy; medication negative effect on liver and kidney; in addition, psychosocial stress, anxiety and anger.Conclusions: Due to the diversity of causes of non-adherence, the health care professionals must understand factors affecting medication adherence when dealing with problems of medication adherence especially with chronic conditions as rheumatic disorders. Recommendation: Interventions for overcoming factors affecting adherence must become a central component of efforts to improve patients’ health worldwide. This could be done by proper determination for factors affecting medication adherence, also to consider patient condition individually and modify the treatment approach accordingly.
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Alptekin, K. "The Reality of Taking Antipsychotic Medication." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70363-3.
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Antipsychotic medication provides effective treatment for patients with schizophrenia and bipolar disorder. Patient satisfaction with antipsychotics is positively associated with improvement in psychotic symptoms and treatment adherence. However, some patients, whilst recognising their need for effective intervention, have specific concerns over their management. If these concerns are not adequately addressed the patients remain unsatisfied and may become non-adherent.Health-related attitudes and beliefs of the patients and insights about their illness may affect patients’ decisions on taking medications in the short and long term. Therefore, it is essential for physicians to communicate with their patients about their beliefs regarding their mental and physical health. Careful assessment of the environmental characteristics of the patient relevant to health may also decrease the risk of non-adherence. Improvement of a patient's treatment adherence using specific motivational interview techniques should also be discussed.At the outset patients are often concerned over the possibility of treatment-related adverse events (AEs) such as headache, somnolence and weight gain with antipsychotic treatment. If such AEs do occur, patients have to develop coping strategies and may be tempted to self-manage, which can lead to treatment discontinuation and/or selective adherence.A joint decision-making process between patient and clinician will allow a rational approach to treatment selection and adherence, and the provision of supportive networks will ensure that there is an opportunity for patients to learn about the effects of their medication.
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Angadi, Netravathi Basavaraj, Avinash Kavi, and Shashikant Shankreppa Torgal. "Therapeutic Adherence among Elderly with Chronic Diseases Residing in Urban Area of South India – A Descriptive Cross Sectional Study." Biomedical and Pharmacology Journal 13, no. 4 (December 30, 2020): 2109–16. http://dx.doi.org/10.13005/bpj/2092.
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Non-communicable diseases (NCDs) are no longer confined to urban and rich persons. They impose a great risk in the low-income nations due to epidemiological and demographic transition. Adherence to medication is key factor in improving the quality of life and preventing complications of NCDs. This study was carried out to study the prevalence of medication adherence and factors determining non-adherence in elderly population with chronic diseases. A community based cross sectional study was conducted with 400 elderly aged 60 years and above. Data was collected by using a pretested questionnaire, which included socio-demographic variables, co-morbidities and details of their medication. Therapeutic adherence was assessed by modified Morisky-Green test, level of cognitive impairment by Pfeiffer’s short portable mental status questionnaire and functional dependence in activities of daily living by Katz Index. Statistical analysis was done using chi-square test. In our study, out of 400 participants, male participants were 184 (48%) and female participants were 216 (52%). 58.5% of them were adherent to their respective treatment medication. Male gender, low level of education, lower socio-economic status and cognitive impairment were the factors associated with therapeutic non-adherence. Therapeutic non-adherence is highly prevalent among elderly persons and is multi-factorial in origin. Interventions to increase adherence among elderly might effective if they are provided with proper guidance and education on the indications of individual treatments, their adverse effects, importance of adherence to medications and various consequences of non-adherence to the therapy.
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Gesinde, B., and S. Harry. "The use of motivational interviewing in improving medication adherence for individuals with asthma: a systematic review." Perspectives in Public Health 138, no. 6 (July 6, 2018): 329–35. http://dx.doi.org/10.1177/1757913918786528.
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Objective: This review was conducted to examine current literature on the use of motivational interviewing (MI) as a strategy to promote individuals with asthma to make behavioral changes and improve health outcomes. This article systematically reviews empirical MI studies which were used to promote asthma medication adherence in children, adolescents, and adults. Methods: Studies were obtained from several databases. We searched CINAHL, MEDLINE, PyscINFO, PubMed, and Cochrane database for articles on the use of MI to improve asthma medication adherence in individuals diagnosed with moderate to severe asthma. Various combinations of the following search terms were used: motivational interviewing, asthma, medication adherence, medication non-adherence, and MI. Results: MI intervention showed evidence of improved self-efficacy, asthma, self-management, and positive behavior change for individuals diagnosed with asthma. The results suggest that MI is a feasible and promising approach to improve attitudes toward asthma medication adherence. Conclusion: The generally favorable results indicate MI merged with other interventions and support is effective in improving medication adherence and is also more sustainable than MI as a stand-alone intervention. Additional research is necessary to assess the effectiveness of MI in ensuring individuals fill their prescriptions and use their medications as recommended.
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Hui, Christy L. M., Eric Y. H. Chen, C. S. Kan, K. C. Yip, C. W. Law, and Cindy P. Y. Chiu. "Detection of Non-Adherent Behaviour in Early Psychosis." Australian & New Zealand Journal of Psychiatry 40, no. 5 (May 2006): 446–51. http://dx.doi.org/10.1080/j.1440-1614.2006.01821.x.
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Objective: Adherence to antipsychotic treatment is an important aspect of the long-term management of schizophrenia. The evaluation of adherence is often dif?cult in the clinical setting. This study compared patient self-reporting and clinician judgment of adherence behaviour in patients with early and chronic schizophrenia. Method: Clinician-rated questionnaires and parallel patient self-rated questionnaires were administered to 229 patients with early schizophrenia (illness duration < 5 years) and 255 patients with chronic schizophrenia. Items in the questionnaires addressed two forms of adherence behaviour (forgetting to take medication and deciding to stop medication) as well as attitudes toward medication. Results: Signi?cant non-adherent behaviour was reported by patients, particularly in the early schizophrenia group. Non-adherent behaviour was related to feelings of embarrassment about taking medication. Both non-adherence and embarrassment were under-recognized by clinicians. Starting from a prior probability of 0.24, knowledge of the patients' attitudes increased the posterior probability to 0.33, whereas clinicians' detection of non-adherence (deciding to stop medication) improved the posterior probability to 0.65. When both clinicians' evaluations and patients' attitudes were known, the posterior probability improved to 0.68. Conclusion: Non-adherence is a widespread phenomenon in early schizophrenia. Increasing clinicians' sensitivity to patients' feelings of embarrassment may be an important factor in the detection of non-adherence. When taking a base rate of nonadherence into consideration, clinicians' evaluations appeared to be more effective in detecting non-adherence than simple information obtained from patients on their attitudes toward medication. Pragmatic real-life estimation of non-adherence has important implications for the possibility of intervention.
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Getenet, Atsede, Mulugeta Tesfa, Aster Ferede, and Yalew Molla. "Determinants of adherence to anti-hypertensive medications among adult hypertensive patients on follow-up in Hawassa Referral Hospital: A case–control study." JRSM Cardiovascular Disease 8 (January 2019): 204800401989275. http://dx.doi.org/10.1177/2048004019892758.
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Introduction Hypertension is a global challenge which accounts for high morbidity and mortality rates in the world. The availability of effective anti-hypertensive medications does not result in a good outcome in controlling blood pressure which points towards poor adherence. Thus, this study was conducted to assess the determinants of adherence to anti-hypertensive medication among hypertensive patients on follow-up in Hawassa Referral Hospital. Methods Institution-based case–control study was conducted on a sample of 289 clients from February to May 2018. Census was conducted on 1600 clients to select cases and controls. Then, systematic random sampling was used to select study subjects, and adherence was measured by Morisky medication adherence scale. The associations of variables were analyzed using bivariable followed by multivariable logistic regression analyses. Results The respondent’s adherence to medication was found to be 67% as measured by Morisky medication adherence scale. The multivariate logistic regression analysis showed that medication adherence was found to be better in younger age (<45) (AOR = 3.8), clients living in urban areas (AOR = 6.84), those clients who had good knowledge (AOR = 3.13), those with no co-morbidities (AOR = 3.14) and patients who controlled their blood pressure (<140/90) (AOR = 2.35). Conclusions The rate of medication adherence was found to be low, and hence educational interventions focusing on factors promoting adherence and patients’ health support should be implemented.
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Riley, Bobbie, Anton Berisha, and Brian Eidex. "Data as an effective tool to boost medication adherence." Research in Social and Administrative Pharmacy 14, no. 5 (May 2018): e8. http://dx.doi.org/10.1016/j.sapharm.2018.03.034.
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Siddiqui, Mohammed, Eric K. Judd, Tanja Dudenbostel, Pankaj Gupta, Maciej Tomaszewski, Prashanth Patel, Suzanne Oparil, and David A. Calhoun. "Antihypertensive Medication Adherence and Confirmation of True Refractory Hypertension." Hypertension 75, no. 2 (February 2020): 510–15. http://dx.doi.org/10.1161/hypertensionaha.119.14137.
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Refractory hypertension (RfHTN) is a phenotype of antihypertensive treatment failure defined as uncontrolled BP despite the use of effective doses of ≥5 antihypertensive medications including a long-acting thiazide-like diuretic (chlorthalidone) and a mineralocorticoid receptor antagonist. The degree of medication nonadherence is unknown among patients with RfHTN. In this prospective evaluation, 54 patients with apparent RfHTN were recruited from the University of Alabama at Birmingham Hypertension Clinic after having uncontrolled BP at 3 or more clinic visits. All patients’ BP was evaluated by automated office BP and 24-hour ambulatory BP monitoring (n=49). Antihypertensive medication adherence was determined by measuring 24-hour urine specimens for antihypertensive medications and their metabolites by high-performance liquid chromatography-tandem mass spectrometry (n=45). Of the 45 patients who completed 24-hour ambulatory BP monitoring, 40 (88.9%) had confirmed RfHTN based on an elevated automated office BP (≥130/80 mm Hg), mean 24-hour ABP (≥125/75 mm Hg), and mean awake (day-time) ABP (≥130/80 mm Hg). Out of the 40 fully evaluated patients with RfHTN, 16 (40.0%) were fully adherent with all prescribed medications. Eighteen (45.0%) patients were partially adherent and 6 (15.0%) had none of the prescribed agents detected in their urine. Of 18 patients who were partially adherent, 5 (12.5%) were adherent with at least 5 medications, including chlorthalidone and the mineralocorticoid receptor antagonist, consistent with true RfHTN. Of patients identified as having apparent RfHTN, 52.5% were adherent with at least 5 antihypertensive medications, including chlorthalidone and a mineralocorticoid receptor antagonist, confirming true RfTHN. These findings validate RfHTN as a rare, but true phenotype of antihypertensive treatment failure.
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Zambo, Dikai, Dumisani Moyo, Gobe Tanthuma, Jennifer Chapman, Vincent Lo Re, Amelia Graziani, Elizabeth Lowenthal, et al. "Development and Usability of a Smartphone Application for Tracking Antiretroviral Medication Refill Data for Human Immunodeficiency Virus." Methods of Information in Medicine 56, no. 05 (2017): 351–59. http://dx.doi.org/10.3414/me17-01-0045.
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Summary Background: Adherence to antiretroviral medication leads to HIV suppression and decreased morbidity and mortality. In resource- limited settings, the dependence on paper medical charts and unstable electronic health records creates a challenge to monitoring medication adherence. A pharmacy-based strategy that utilizes existing cellular phone infrastructure may lead to a more stable system to monitor adherence. Objectives: To develop and evaluate the usability of a smartphone-based software application (app) for tracking antiretroviral medication refill data in a resource-limited setting. Methods: A pharmacy-based smartphone app for tracking HIV medication adherence was developed through a multi-step rapid prototyping process. The usability of the app was assessed during the daily activities of pharmacy dispensers at HIV clinics in and around Gaborone, Botswana using a validated computer usability survey. Results: The study demonstrated the effective development of and favorable end-user responses to a pharmacy-based HIV medication adherence app. End users had suggestions for minor changes to improve the app’s functionality. Conclusions: In resource-limited settings where electronic health record support is limited, such a system was feasible and appealing. In the future, this system may allow for improved HIV medication adherence tracking and be applied to medications beyond antiretrovirals.
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Stuck, Rachel E., Amy W. Chong, L. Mitzner Tracy, and Wendy A. Rogers. "Medication Management Apps: Usable by Older Adults?" Proceedings of the Human Factors and Ergonomics Society Annual Meeting 61, no. 1 (September 2017): 1141–44. http://dx.doi.org/10.1177/1541931213601769.
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For older adults, managing medications can be a burden and could lead to medication non-adherence. To decrease risks associated with medication non-adherence, healthcare providers may recommend medication reminder apps as an assistive tool. However, these apps are often not designed with consideration of older adults’ needs, capabilities, and limitations. To identify whether available apps are suitable for older adults, we conducted an in-depth cognitive walkthrough and a heuristic evaluation of the most commonly downloaded medication reminder app. Findings revealed three main issues: 1) difficulty in navigation, 2) poor visibility, and 3) a lack of transparency. We also selected the top five downloaded medication reminder apps and categorized user reviews to assess app functionality and usability problems. The results of our analysis provide guidance for app design for older adult users to provide effective tools for managing medications and supporting patient/user health.
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Kvarnström, Kirsi, Aleksi Westerholm, Marja Airaksinen, and Helena Liira. "Factors Contributing to Medication Adherence in Patients with a Chronic Condition: A Scoping Review of Qualitative Research." Pharmaceutics 13, no. 7 (July 20, 2021): 1100. http://dx.doi.org/10.3390/pharmaceutics13071100.
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Introduction: Medication adherence continues to be a significant challenge in healthcare, and there is a shortage of effective interventions in this area. This scoping review studied the patient-related factors of medication adherence. Methods: We searched Medline Ovid, Scopus, and Cochrane Library from January 2009 to June 2021 to find the most recent original qualitative studies or systematic reviews that addressed the patient-related factors of medication adherence in treating chronic conditions. We used the PRISMA-ScR checklist to ensure the quality of the study. Results: The initial search revealed 4404 studies, of which we included 89 qualitative studies in the scoping review. We inductively organized the patient-related factors causing barriers, as well as the facilitators to medication adherence. The studies more often dealt with barriers than facilitators. We classified the factors as patient-specific, illness-specific, medication-related, healthcare and system-related, sociocultural, as well as logistical and financial factors. Information and knowledge of diseases and their treatment, communication, trust in patient-provider relationships, support, and adequate resources appeared to be the critical facilitators in medication adherence from the patient perspective. Discussion and conclusions: Patients are willing to discuss their concerns about medications. Better communication and better information on medicines appear to be among the critical factors for patients. The findings of this scoping review may help those who plan further interventions to improve medication adherence.
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Gearing, R., L. Townsend, M. Mackenzie, and A. Charach. "Reconceptualizing medication adherence: six phases of dynamic adherence." European Psychiatry 26, S2 (March 2011): 1242. http://dx.doi.org/10.1016/s0924-9338(11)72947-9.
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IntroductionNonadherence is the Achilles heel of effective psychiatric treatment. The meaning of the term “adherence” has evolved over time and is now associated with a variety of definitions and measurement methods. This has resulted in a poorly operationalized and non-standardized term that is often interpreted differently by providers and patients.Objectives/AimsThis abstract aims to: 1) describe changes in the concept of adherence; 2) present a more comprehensive definition of adherence which recognizes the influence of patient-provider transactions; 3) introduce dynamic adherence, a six-phase model, which incorporates the influence of transactional processes and econometrics on patients’ adherence decisions; and 4) provide recommendations for providers to improve their relationships with patients and in turn, medication adherence.MethodsA review of the scientific mental health literature.ResultsDespite the prevalence, seriousness, and costs associated with medication nonadherence, the construct of adherence remains poorly operationalized and lacks cogent standardization. Drawing from psychiatric research, a dynamic model of medication adherence across six phases is presented.ConclusionsThis model of adherence highlights the importance of the patient-provider relationship and the transactional processes that comprise what is a dynamic developmental system. Dynamic adherence is intended to foster movement toward a more coherent and unified set of definitions and clinical strategies that will provide the potential to more fully elucidate the risk and protective mechanisms impacting adherence, and the subsequent development and refinement of best practices in increasing the odds of stable medication adherence.
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Foronda, Cynthia L., Sadandaula Rose Muheriwa, Margo Fernandez-Burgos, Susan Prather, and Paula Nersesian. "Medication Adherence of Latino Children and Caregivers: An Integrative Review." Hispanic Health Care International 18, no. 4 (December 30, 2019): 207–13. http://dx.doi.org/10.1177/1540415319896623.
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Introduction: There are significant disparities in medication adherence among underserved minority groups such as Latinos. Adherence to medication is a primary determinant of treatment success. Little is known about medication adherence among Latino children. This integrated review aims to describe what is known about medication adherence among Latino children and explore barriers and facilitators to medication adherence. Method: This review was guided by Whittemore and Knafl’s method of integrative review and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Results: Of the 20 articles reviewed about medication adherence among Latino children, the analysis of these articles revealed four major themes: (1) low adherence, (2) low adherence associations, (3) child outcomes, and (4) effective interventions. Conclusion: Health practitioners should consider medication adherence associations and interventions when collaborating with the family caregiver to improve child outcomes.
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Allison, Kristen. "Adherence through education: A call to clinicians to educate all patients on medication use." Mental Health Clinician 2, no. 4 (October 1, 2012): 83–85. http://dx.doi.org/10.9740/mhc.n117761.
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Medication nonadherence contributes to lack of achievement of desired therapeutic outcomes. This article reviews the evidence supporting patient education as a one of the tools to promote medication adherence. Patient education and provision of tools to help patients overcome adherence barriers are effective ways to improve medication adherence.
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Mathew, Ritu A., Samuel Johnson, Shalumol Jose, Shampa Chakraborty, Kenneth N, and Veeranna Gowda. "A comparative study of monotherapy versus combination therapy in patients with stage-1 hypertension in terms of efficacy and cost effectiveness and to assess the medication adherence." International Journal of Research in Pharmaceutical Sciences 9, no. 1 (March 12, 2018): 147. http://dx.doi.org/10.26452/ijrps.v9i1.1216.
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Hypertension has multiple pathogenesis and majority of patients require two or more antihypertensive drugs to provide optimum control of blood pressure. The aim is to compare the effectiveness of mono therapy versus combination therapy in patients with stage-1 hypertension, to assess the medication adherence and to compare the cost incurred per day for the different therapies. Patient’s demographical details and history was recorded in a data entry form. Outcome of the treatment was measured in terms of reduction in systolic and diastolic blood pressure. Patient’s medication adherence was assessed using modified Medication Adherence Scale. Economic outcomes were measured in terms of cost of individual therapy. The data was entered into the excel sheet and statistically analysed using ANOVA. Results showed that dual therapy is the most effective in reducing the mean systolic (28.75 mm Hg) and diastolic (8.875) blood pressure with the combination of Amlodipine + Telmisartan being the most effective. Here, 66 patients (33%) were found to be adherent and 134 patients (67%) were found to be non- adherent. It was found that AMLOKIND 2.5, LOSAKIND and ATEN 50 were the most cost effective brands of drug from the classes of calcium channel blockers, angiotensin receptor blockers and beta blockers respectively. Comparison of effectiveness of various antihypertensive therapies showed that dual therapy shows maximum reduction in mean systolic BP and thus it can be prescribed more often in Stage I hypertensive patients. The poor adherence scores indicate that a multidisciplinary approach with a greater involvement of the patient is required to increase the compliance of the patient. Also cost effective drugs need to be prescribed more in order to decrease the financial burden on the patients.
Keywords: Blood pressure; Monotherapy; Dual therapy; Triple therapy; Medication adherence
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Zukin, Mauro, Marcos Coelho Simões Travassos Soares, Nathalia Fonseca Gamboa, Fabiano Hosken Pombo, and Lucyana Carvalho. "Oral chemotherapy follow up on a Brazilian private health care unit." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e18311-e18311. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18311.
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e18311 Background: Oral antineoplastic therapy is a growing reality, and ensures greater comfort and better quality of life for patients. However, this modality of treatment requires greater attention of the professionals to avoid dispensing errors and to guarantee adherence to the treatment. The goal of this study is to present a method to follow up cancer patients to reduce percentage of problems related to medication and improve oral antineoplastic adherence. Methods: The study was conducted at a private oncology clinic in Rio de Janeiro during the year 2018. In the first dispensation, patients received verbal and written pharmaceutical advice on posology, proper storage, safe handling requirements and strategies to avoid adverse side effects and food and drugs interactions. There were also given nutrition, sexuality, rights and duties guidelines. To improve adherence and to avoid forgetfulness or duplicity of dosing, patients received a medication calendar. Pharmacist made dispensing, managed adverse side effects and assessed adherence of patient using a model based on Morisky Medication Adherence Scale. Patients that answered "yes" to any questions were considered non-adherents. All information was registered in medical record. Non-compliances were considered: wrong medicine, incorrect dose and delays of any administrative reason. Results: In 2018, on average 1487 dispensings were made and 1053 patients’ adherence behavior were measured. 94.37% were considered adherent. Monthly percentage of non-compliance was 1.5% of dispensings. Conclusions: The present study demonstrates that with education and pharmaceutical follow-up since the first dispensation, it is possible to guarantee a safer and more effective treatment for patients using oral cancer medication. It is imperative to maintain the objective of developing better techniques for dispensing, guiding and guaranteeing high adherence.
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Bahall, Mandreker U. "Medication non-adherence related to patients’ attitudes and knowledge rather than socio-cultural factors: a study of cardiac clinic attendees at a public healthcare institute." International Journal Of Community Medicine And Public Health 6, no. 2 (January 24, 2019): 480. http://dx.doi.org/10.18203/2394-6040.ijcmph20190167.
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Background: Medication non-adherence contributes significantly to sub-optimum care, for reasons that could be unique to specific localities. The study sought to identify reasons for non-adherence and associated factors in cardiac clinic attendees at a leading tertiary health institution in Trinidad and Tobago.Methods: This cross-sectional study included a convenience sample of cardiac clinic attendees. The data collection instrument was a questionnaire comprising items regarding socio-demographic characteristics, medical history, social support and reasons for medication non-adherence. Data were collected between March and July, 2016. Non-adherence was identified with total scores of >1 using selected similar questions to that used in the Morisky four-item adherence instrument. Data analyses involved both descriptive and inferential methods.Results: Non-adherent patients represented the largest proportion of participants (n=270, 78.3%). Participants were predominantly women, aged >50 years, of Indo-Trinidadian descent, married, and unemployed. Carelessness (n=251, 93.0%), ceasing medication use when feeling well (n=217, 80.4%), forgetfulness (n=187, 69.3%), and ceasing medication use when feeling worse (n=151, 50.6%) were the leading reasons for non-adherence, followed by unpleasant effects of medication and cost (n=144, 53.3%). Associated factors included feeling that one would become more ill upon ceasing medication use (p=0.003), the importance of understanding the reasons for taking medication (p=0.017), the importance of following physicians’ instructions (p=0.023), and educational level (p=0.040).Conclusions: Effective communication regarding patients’ concerns and potential adverse medication effects between patients and healthcare providers could promote greater adherence.
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Park, Linda G., Fion Ng, Janet K Shim, Abdelaziz Elnaggar, and Ofelia Villero. "Perceptions and experiences of using mobile technology for medication adherence among older adults with coronary heart disease: A qualitative study." DIGITAL HEALTH 6 (January 2020): 205520762092684. http://dx.doi.org/10.1177/2055207620926844.
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Objective Medication non-adherence is linked to adverse clinical outcomes (i.e. rehospitalization, mortality) among patients with coronary heart disease. Given its global adoption and growing popularity among older adults, mobile technology may be an effective strategy to improve medication adherence. The aim of this article is to present the perceptions, attitudes, and beliefs of individuals with coronary heart disease about using text messaging and mobile phone applications for medication adherence. Methods We recruited 28 participants (veterans and non-veterans) with a history of coronary heart disease and antiplatelet medication use in Northern California. We formed six focus groups of individuals who participated in three sessions (total 18 sessions). We analyzed our data using grounded theory. Results The median age was 69.5 ± 10.8 years for non-veterans (50% male) and 70 ± 8.6 years for veterans (100% male). In the first session, we found that participants perceived text message reminders as a convenient, easy, and flexible tool to establish a routine for taking medications. In the second session, participants were eager to use applications for their greater interactivity, individualized health monitoring, and personalized medication information. The third session, participants shared preferred features (i.e. drug interactions, tracking symptoms) after using two applications at home for 2 weeks. Conclusions Older adults are engaged and can be proficient mobile technology users. Text messaging and mobile phone applications are perceived as helpful tools for medication adherence. Future research should include rigorous clinical trials to test the efficacy of mobile health technology to promote medication adherence in populations that require strict medication adherence.
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Aston, Jeff, Keith Wilson, and David Terry. "P016 Parent/carer intended non- adherence to their child’s medication regimen." Archives of Disease in Childhood 104, no. 7 (June 19, 2019): e2.19-e2. http://dx.doi.org/10.1136/archdischild-2019-nppc.26.
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AimTo identify intended non-adherence reported by parents/carers of children/young people taking long-term medication.MethodsA 10 question postal survey was sent to 180 parents of patients receiving medication via homecare at a tertiary paediatric hospital with a single repeat mailing. Demographic details collected were age, current prescribed medication and duration. Participants were asked about changes that they had made to their child’s medication without consulting a healthcare professional. They were asked about delaying/not starting new medication, compliance with medication instructions, with-holding medication, altering the dose of medication, altering medication taking to fit in with daily life and strategies to aid administering medication. The data were analysed using SPSS version 23 and NVivo version 11.ResultsThe response rate was 32/180 (17.8%). The mean age of respondents was 8.4 years (range 0.83 to 17 years). One hundred and fifty-eight medications were prescribed with a mean of 5 medications per patient (range 1 to 15). In total, 16/32 (50%) respondents had made changes to their child’s medication. The most common change (9/32, 28.1%) was adjusting the medication regimen to fit around daily life followed by delaying initiating a new medication (7/32, 20.6%). No respondents indicated that they had not started a new prescribed medication. Six (17.6%) respondents indicated that they had not followed the medication instructions. Four (11.8%) respondents advised that they had withheld their child’s medication. Four (11.8%) respondents communicated that they had given a higher than prescribed dose and four (11.8%) a lower dose. Three (8.8%) respondents adjusted how they gave their child’s medication to aid administration.ConclusionHalf of respondents made changes to their child’s medication without consultation with a healthcare professional. Commonly changes were made to fit around daily life. The decision to prescribe medication should be undertaken in partnership with patients.1 Adherence to medication in long-term paediatric conditions is particularly complex requiring parents to balance the daily needs of their child taking medication with everyday life.2 Strategies to support medication adherence include self-management programmes, simplified dosing regimens and pharmacist led medication reviews.3 Parents/carers may benefit from a structured medication review for their child although further research is required to determine the effectiveness of such an intervention. This study has identified parent practices that could be included in such a review.ReferencesNational Institute for Health and Care Excellence. Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. London: NICE. 2015.Santer M, Ring N, Yardley L, et al. Treatment non-adherence in paediatric long-term medical conditions: systematic review and synthesis of qualitative studies of caregivers’ views. BMC Pediatrics 2014;14:63.Ryan R, Santesso N, Lowe D, et al. Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD007768.
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Rajiah, Kingston, Shreeta Sivarasa, and Mari Kannan Maharajan. "Impact of Pharmacists’ Interventions and Patients’ Decision on Health Outcomes in Terms of Medication Adherence and Quality Use of Medicines among Patients Attending Community Pharmacies: A Systematic Review." International Journal of Environmental Research and Public Health 18, no. 9 (April 21, 2021): 4392. http://dx.doi.org/10.3390/ijerph18094392.
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Community pharmacists are responsible for providing the appropriate information on the use of medications to patients, which may enhance their medication adherence. The extent of control that patients have on their health care preferences creates many challenges for community pharmacists. This study aimed to determine the impact of pharmacist interventions and patient decisions on health outcomes concerning medication adherence and the quality use of medicines among patients attending community pharmacies. Appropriate studies were identified in a systematic search using the databases of Medline, Scopus, Google Scholar, and PubMed. The search included literature published between 2004 and 2019. The database searches yielded 683 titles, of which 19 studies were included after the full-text analysis with a total of 9313 participants. Metaprop command in Stata software version 14 was used for the analysis. This study was undertaken based on the general principles of the Cochrane Handbook for Systematic Reviews of Interventions and subsequently reported according to the Preferred Reporting Items for Systematic Reviews (PRISMA) extension. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was directly used to rate the quality of evidence (high, moderate, low, or very low). The results revealed the effective interaction between patients and community pharmacists, the importance of pharmacist intervention on medication adherence and quality use of medicine, and the role of community pharmacists in counselling patients. Decision/choice of patients in self-care and self-medication is a factor contributing to health outcomes. Effective interaction of community pharmacists with patients in terms of medication adherence and quality use of medicines provided a better health outcome among patients. The community pharmacists influenced the decision/choice of patients in self-care and self-medications.
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Santo, Karla, Clara K. Chow, Aravinda Thiagalingam, Kris Rogers, John Chalmers, and Julie Redfern. "MEDication reminder APPs to improve medication adherence in Coronary Heart Disease (MedApp-CHD) Study: a randomised controlled trial protocol." BMJ Open 7, no. 10 (October 2017): e017540. http://dx.doi.org/10.1136/bmjopen-2017-017540.
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IntroductionThe growing number of smartphone health applications available in the app stores makes these apps a promising tool to help reduce the global problem of non-adherence to long-term medications. However, to date, there is limited evidence that available medication reminder apps are effective. This study aims to determine the impact of medication reminder apps on adherence to cardiovascular medication when compared with usual care for people with coronary heart disease (CHD) and to determine whether an advanced app compared with a basic app is associated with higher adherence.Methods and analysisRandomised controlled trial with follow-up at 3 months to evaluate the feasibility and effectiveness of medication reminder apps on medication adherence compared with usual care. An estimated sample size of 156 patients with CHD will be randomised to one of three groups (usual care group, basic medication reminder app group and advanced medication reminder app group). The usual care group will receive standard care for CHD with no access to a medication reminder app. The basic medication reminder app group will have access to a medication reminder app with a basic feature of providing simple daily reminders with no interactivity. The advanced medication reminder app group will have access to a medication reminder app with additional interactive and customisable features. The primary outcome is medication adherence measured by the eight-item Morisky Medication Adherence Scale at 3 months. Secondary outcomes include clinical measurements of blood pressure and cholesterol levels, and medication knowledge. A process evaluation will also be performed to assess the feasibility of the intervention by evaluating the acceptability, utility and engagement with the apps.Ethics and disseminationEthical approval has been obtained from the Western Sydney Local Health Network Human Research Ethics Committee (AU/RED/HREC/1/WMEAD/3). Study findings will be disseminated via usual scientific forums.Trial registration numberACTRN12616000661471; Pre-results
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Wolf, John E. "Medication adherence: A key factor in effective management of rosacea." Advances in Therapy 18, no. 6 (November 2001): 272–81. http://dx.doi.org/10.1007/bf02850197.
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Mistry, Niraj, Arun Keepanasseril, Nancy L. Wilczynski, Robby Nieuwlaat, Manthan Ravall, and R. Brian Haynes. "Technology-mediated interventions for enhancing medication adherence." Journal of the American Medical Informatics Association 22, e1 (February 28, 2015): e177-e193. http://dx.doi.org/10.1093/jamia/ocu047.
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Abstract Background Despite effective therapies for many conditions, patients find it difficult to adhere to prescribed treatments. Technology-mediated interventions (TMIs) are increasingly being used with the hope of improving adherence. Objective To assess the effects of TMI, intended to enhance patient adherence to prescribed medications, on both medication adherence and clinical outcomes. Methods A secondary in-depth analysis was conducted of the subset of studies that utilized technology in at least one component of the intervention from an updated Cochrane review on all interventions for enhancing medication adherence. We included studies that clearly described an information and communication technology or medical device as the sole or major component of the adherence intervention. Results Thirty-eight studies were eligible for in-depth review. Only seven had a low risk of bias for study design features, primary adherence, and clinical outcomes. Eighteen studies used a TMI for education and/or counseling, 11 studies used a TMI for self-monitoring and/or feedback, and nine studies used electronic reminders. Studies used a variety of TMIs, with telephone the most common technology in use. Studies targeted a wide distribution of diseases and used a variety of adherence and clinical outcome measures. A minority targeted children and adolescents. Fourteen studies reported significant effects in both adherence and clinical outcome measures. Conclusions This review provides evidence for the inconsistent effectiveness of TMI for medication adherence and clinical outcomes. These results must be interpreted with caution due to a lack of high-quality studies.
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Pouls, Bart P. H., Johanna E. Vriezekolk, Charlotte L. Bekker, Annemiek J. Linn, Hein A. W. van Onzenoort, Marcia Vervloet, Sandra van Dulmen, and Bart J. F. van den Bemt. "Effect of Interactive eHealth Interventions on Improving Medication Adherence in Adults With Long-Term Medication: Systematic Review." Journal of Medical Internet Research 23, no. 1 (January 8, 2021): e18901. http://dx.doi.org/10.2196/18901.
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Background Medication nonadherence leads to suboptimal treatment outcomes, making it a major priority in health care. eHealth provides an opportunity to offer medication adherence interventions with minimal effort from health care providers whose time and resources are limited. Objective The aim of this systematic review is twofold: (1) to evaluate effectiveness of recently developed and tested interactive eHealth (including mHealth) interventions on medication adherence in adult patients using long-term medication and (2) to describe strategies among effective interventions. Methods MEDLINE, EMBASE, Cochrane Library, PsycINFO, and Web of Science were systematically searched from January 2014 to July 2019 as well as reference lists and citations of included articles. Eligible studies fulfilled the following inclusion criteria: (1) randomized controlled trial with a usual care control group; (2) a total sample size of at least 50 adult patients using long-term medication; (3) applying an interactive eHealth intervention aimed at the patient or patient’s caregiver; and (4) medication adherence as primary outcome. Methodologic quality was assessed using the Cochrane risk of bias tool. Selection and quality assessment of studies were performed by 2 researchers (BP and BvdB or JV) independently. A best evidence synthesis was performed according to the Cochrane Back Review Group. Results Of the 9047 records screened, 22 randomized clinical trials were included reporting on 29 interventions. Most (21/29, 72%) interventions specified using a (mobile) phone for calling, SMS text messaging, or mobile apps. A majority of all interactive interventions (17/29) had a statistically significant effect on medication adherence (P<.05). Of these interventions, 9 had at least a small effect size (Cohen d ≥ 0.2) and 3 showed strong odds for becoming adherent in the intervention group (odds ratio > 2.0). Our best evidence synthesis provided strong evidence for a positive effect of interventions using SMS text messages or interactive voice response, mobile app, and calls as mode of providing adherence tele-feedback. Intervention strategies “to teach medication management skills,” “to improve health care quality by coordinating medication adherence care between professionals,” and “to facilitate communication or decision making between patients and health care providers” also showed strong evidence for a positive effect. Conclusions Overall, this review supports the hypothesis that interactive eHealth interventions can be effective in improving medication adherence. Intervention strategies that improve patients’ treatment involvement and their medication management skills are most promising and should be considered for implementation in practice.
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Pouls, Bart P. H., Johanna E. Vriezekolk, Charlotte L. Bekker, Annemiek J. Linn, Hein A. W. van Onzenoort, Marcia Vervloet, Sandra van Dulmen, and Bart J. F. van den Bemt. "Effect of Interactive eHealth Interventions on Improving Medication Adherence in Adults With Long-Term Medication: Systematic Review." Journal of Medical Internet Research 23, no. 1 (January 8, 2021): e18901. http://dx.doi.org/10.2196/18901.
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Background Medication nonadherence leads to suboptimal treatment outcomes, making it a major priority in health care. eHealth provides an opportunity to offer medication adherence interventions with minimal effort from health care providers whose time and resources are limited. Objective The aim of this systematic review is twofold: (1) to evaluate effectiveness of recently developed and tested interactive eHealth (including mHealth) interventions on medication adherence in adult patients using long-term medication and (2) to describe strategies among effective interventions. Methods MEDLINE, EMBASE, Cochrane Library, PsycINFO, and Web of Science were systematically searched from January 2014 to July 2019 as well as reference lists and citations of included articles. Eligible studies fulfilled the following inclusion criteria: (1) randomized controlled trial with a usual care control group; (2) a total sample size of at least 50 adult patients using long-term medication; (3) applying an interactive eHealth intervention aimed at the patient or patient’s caregiver; and (4) medication adherence as primary outcome. Methodologic quality was assessed using the Cochrane risk of bias tool. Selection and quality assessment of studies were performed by 2 researchers (BP and BvdB or JV) independently. A best evidence synthesis was performed according to the Cochrane Back Review Group. Results Of the 9047 records screened, 22 randomized clinical trials were included reporting on 29 interventions. Most (21/29, 72%) interventions specified using a (mobile) phone for calling, SMS text messaging, or mobile apps. A majority of all interactive interventions (17/29) had a statistically significant effect on medication adherence (P<.05). Of these interventions, 9 had at least a small effect size (Cohen d ≥ 0.2) and 3 showed strong odds for becoming adherent in the intervention group (odds ratio > 2.0). Our best evidence synthesis provided strong evidence for a positive effect of interventions using SMS text messages or interactive voice response, mobile app, and calls as mode of providing adherence tele-feedback. Intervention strategies “to teach medication management skills,” “to improve health care quality by coordinating medication adherence care between professionals,” and “to facilitate communication or decision making between patients and health care providers” also showed strong evidence for a positive effect. Conclusions Overall, this review supports the hypothesis that interactive eHealth interventions can be effective in improving medication adherence. Intervention strategies that improve patients’ treatment involvement and their medication management skills are most promising and should be considered for implementation in practice.
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Selak, Vanessa, and Ruth Webster. "Polypills for the secondary prevention of cardiovascular disease: effective in improving adherence but are they safe?" Therapeutic Advances in Drug Safety 9, no. 2 (December 20, 2017): 157–62. http://dx.doi.org/10.1177/2042098617747836.
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International guidelines recommend blood pressure-lowering therapy, statins and aspirin for people who have had a cardiovascular event but use of these medications is low, particularly for lower income countries. Clinical trials have demonstrated that combining these medications into a single pill or capsule (a ‘polypill’) improves adherence, systolic blood pressure and low density lipoprotein cholesterol compared with usual care in secondary prevention. Uptake of polypill-based care has been underwhelming, possibly due to safety concerns. Overall, results from the clinical trials of polypill use among people who have had a cardiovascular event show no immediate safety concerns. Increased use and adherence to medications will always be associated with side effects however use within a combination medication has not been shown to be any less safe than individual component medications. Research investigating the relative consequences of nonadherence to a polypill compared with individual components would be useful.
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Meece, Jerry. "Improving Medication Adherence Among Patients With Type 2 Diabetes." Journal of Pharmacy Practice 27, no. 2 (December 27, 2013): 187–94. http://dx.doi.org/10.1177/0897190013513803.
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Type 2 diabetes mellitus (T2DM) accounts for the vast majority of diagnosed diabetes cases and is a considerable burden to the US health care system. However, patients with T2DM often fail to adhere to treatment for numerous reasons including concerns about administration, mode, timing, convenience, adverse events, and cost. As the prevalence of T2DM and the complexity of therapeutic regimens increases, the role of pharmacists in educating patients about treatment benefits, administration techniques, dosage flexibility, and avoiding side effects is critical and may optimize care by increasing the likelihood of treatment adherence. In addition, pharmacists are in a unique position to assess which patients are not taking medications as they are prescribed and can therefore determine the most effective methods to promote adherence. This article will examine the causes of nonadherence in T2DM and the integral role that pharmacists can play in improving medication adherence and persistence. Strategies for improving adherence, such as patient education, motivational interviewing, medication therapy management programs, and collaborative management, will also be considered.
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BURNIER, M. "Medication Adherence and Persistence as the Cornerstone of Effective Antihypertensive Therapy." American Journal of Hypertension 19, no. 11 (November 2006): 1190–96. http://dx.doi.org/10.1016/j.amjhyper.2006.04.006.
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