Medication Compliance in COPD Patients

Sleep Quality and Medication Adherence in Older Adults: A Systematic Review

Sleep quality significantly impacts individuals' overall health, especially in older adults. Older adults often face comorbid conditions, polypharmacy (the intake of five or more medications per day), and medication non-adherence, which are common among those with sleep disorders. The purpose of this systematic review is to examine the relationship between sleep quality and medication adherence in older adults and to describe the measuring instruments used. A systematic review was performed following the PRISMA guidelines. The PubMed, Scopus, Cochrane Library, and CINAHL databases were screened from January 2024 to March 2024. Nine articles were included in the final synthesis based on the inclusion and exclusion criteria. The review found that poor sleep quality is significantly associated with reduced medication adherence in older adults. The key sleep determinants linked to medication non-adherence include sleep disorders, sleep efficiency, sleep duration, and daytime dysfunctions. Inappropriate medication prescriptions have been associated with reduced sleep efficiency. The tools for assessing sleep quality and medication adherence are predominantly subjective and varied. To address these challenges, a comprehensive geriatric assessment should include investigations into sleep disorders and comorbidity factors. Additionally, nursing educational interventions could be pivotal in improving medication adherence among older adults.

Inhaler Adherence in COPD: A Crucial Step Towards the Correct Treatment

COPD is a typical example of chronic disease. As such, treatment adherence tends to be as low as between 30% and 50%, with specific issues in COPD due to the use of inhaled therapies. Decreased adherence in COPD is associated with worse outcomes, with increased risk for exacerbations and long-term mortality. Factors that impact adherence are multiple, some related to patient, some related to clinicians and finally some related to healthcare system. Among clinician factors, prescription of simplified treatment regimens delivered by an inhaler adapted to the patient's characteristics is crucial. Although it has been observed a huge improvement in the design and usability of inhaler devices for COPD in the last two centuries, there is still a clear gap in this field. Smart inhalers as well as simplified treatment regimens could improve adherence and therefore improve long-term outcomes in COPD.

Relationships between beliefs about statins and non-adherence in inpatients from Northwestern China: a cross-sectional survey

Background: Studies have identified patients' beliefs about medicines as an important determinant of non-adherence. However, scant data are available on the possible association between patients' beliefs and statin non-adherence among adult patients in China. The objectives of this study are to assess the prevalence of statin non-adherence, and to identify the factors associated with statin non-adherence, especially the association between inpatients' beliefs about statins and non-adherence in a tertiary hospital in the Northwestern China. Methods: A cross-sectional questionnaire-based survey was carried out in the department of cardiology and neurology between February and June 2022. The Beliefs about Medicine Questionnaire (BMQ) was used to assess patients' beliefs about statins. The Adherence to Refills and Medications Scale (ARMS) was used to assess statin adherence. Logistic regression analyses were performed to identify the factors associated with statin non-adherence. Receiver operator characteristic (ROC) was conducted to assess the performance of the logistic regression model in predicting statin non-adherence. Results: A total of 524 inpatients participated and finished the questionnaire, 426 (81.3%) inpatients were non-adherent to statin, and 229 (43.7%) inpatients expressed strong beliefs about the stain treatment necessity, while 246 (47.0%) inpatients expressed strong concerns about the potential negative effects. We found that the low necessity beliefs about statin (adjusted odds ratio [OR] and 95% confidence interval [CI], 1.607 [1.019, 2.532]; p = 0.041), prescribed rosuvastatin (adjusted OR 1.820 [1.124, 2.948]; p = 0.015) and ex-drinker (adjusted OR 0.254 [0.104, 0.620]; p = 0.003) were independent determinants of statin non-adherence. Conclusion: Statin adherence was poor in this study. The findings indicated a significant association between inpatients' lower necessity beliefs and statin non-adherence. More attention should be focused on statin non-adherence in China. Nurses and pharmacists could play an important role in patient education and patient counseling in order to improve medication adherence.

Treatment Adherence in Patients with Obstructive Pulmonary Diseases

COPD is the third most common cause of death globally. Adherence rates in patients with obstructive pulmonary diseases usually range between 10% and 40%. The aim of the study was to evaluate the level of treatment adherence to inhaled therapy in patients with obstructive pulmonary diseases. A total of 325 patients, of mean age 63.04 ± 11.29, with COPD or asthma, were included into the study between 2020 and 2021. The following questionnaires were used: Beliefs about Medicines Questionnaire, Test of Adherence to Inhalers and Adherence to Refills and Medications Scale. The respondents tended to be convinced of the necessity of their medication (3.87 points per question). The patients reported moderate levels of overall adherence (21.15 ± 6.23). A total of 74% of patients demonstrated sporadic non-compliance. We conclude that patients with obstructive pulmonary diseases are moderately adherent to their medication. Beliefs about medicines have a significant impact on adherence to medications. Being unemployed, being a non-smoker and belief in the necessity of medication are independent determinants of better medication adherence. The number of hospital admissions due to exacerbations of the disease over the last year and belief that medicines are harmful are independent determinants of poorer medication adherence.

How the cost-effectiveness results change in the China health policy environment: an economic evaluation of glycopyrrolate/formoterol for the treatment of COPD

OBJECTIVE

To investigate the cost-effectiveness of glycopyrrolate/formoterol compared with tiotropium bromide for the treatment of moderate-to-severe COPD in China and discuss the influence of healthcare policies on the economic evaluation.

METHODS

A Markov model with seven disease states was built to evaluate the lifetime cost-effectiveness of glycopyrrolate/formoterol from the perspective of the Chinese healthcare sector. Drug prices both before and after the negotiation were applied to discuss the influence on the economic evaluation results. Exacerbation and adverse event were included in each cycle. The improvement of forced expiratory volume in 1 second (FEV₁) and incidence rate of exacerbation were derived from pooled PINNACLE analysis. Mortality rates from Chinese life tables were adjusted using hazard ratios. Direct medical costs were modeled in accordance with the perspective chosen. Health resource utilization were derived from previous studies and expert's opinions. Life-years gained, quality-adjusted life years (QALYs), and incidence of exacerbation were simulated as the health outcomes. One-way sensitivity analysis and probability analysis were conducted to explore the robustness of the base case results. Several scenario analyses were also designed.

RESULTS

Glycopyrrolate/formoterol generated an additional 0.0063 LYs and 0.0032 QALYs with lower lifetime costs compared with tiotropium (CNY 27,854 vs. CNY 33,189) and was proved to be the dominant strategy in the base case analysis. The one-way sensitivity analysis confirmed the robustness of the base case results. The probabilities of glycopyrrolate/formoterol being cost-effective were 96.5, 95.7, and 93.0% when CNY 72,000 (1 time GDP per capital), CNY 108,000, and CNY 216,000 were used as thresholds, respectively. Compared with the scenario where price before negotiation was used, the cost-effectiveness based on current price was significantly increased.

CONCLUSION

Glycopyrrolate/formoterol was demonstrated to be a clinically and cost-effective treatment for moderate-to-severe COPD in China using the latest price. The negotiation policy could increase the cost-effectiveness and benefit the patients.

Cognitive appraisal of the disease and stress level in lung cancer patients. The mediating role of coping styles

PURPOSE

The aim of the study was to provide support for the hypothesis that there was a correlation between the subjective appraisal of one's disease and the level of stress, as well as the hypothesis that coping styles may have a mediating role on the relationship between the perception of the disease and stress level in patients diagnosed with lung cancer.

METHODS

The study involved 97 respondents diagnosed with lung cancer, including 50 men and 47 women. The following methods were used for the study: the Disease-Related Appraisals Scale, the Coping Inventory for Stressful Situations, and the Perceived Stress Scale. Socio-demographic data were also collected.

RESULTS

The results show that emotion-oriented coping (EOC) acts as a mediator on the relationship between the appraisal of the disease and stress level in patients diagnosed with lung cancer. A total of 4 multiple mediation models were tested.

CONCLUSION

The research findings provide support for the hypothesis that coping style is crucial for the way patients appraise their disease and for their stress level. It is important to diagnose individual specific needs of lung cancer patients. The research results are an important source of information for those responsible for training medical staff on how to support cancer patients in their illness.