The prevalence and associated factors of nonadherence to antihypertensive medication in secondary healthcare

The cost-effectiveness of peer education on medication adherence in the elderly with hypertension: a randomized controlled trial

BACKGROUND

Peer education is an effective approach for promoting medication adherence in hypertensive patients, but there is limited evidence on its cost-effectiveness analysis. This study aimed to evaluate the cost -effectiveness of peer education for improving medication adherence in the elderly with hypertension.

METHODS

This randomized clinical trial involved 74 elderly individuals with hypertension who were referred to health centers affiliated to Mashhad University of Medical Sciences in 2019. Educational content was presented over six sessions across six weeks by a peer in the intervention group, and a health center nurse in the control group. Data was collected before the intervention, immediately after intervention, and at 3 and 6 weeks post-intervention using the Morisky Medication Adherence Scale. Data analysis was performed by SPSS (Ver. 23) with both descriptive and statistical test. Cost-effectiveness analysis of the educational methods measured the impact on medication adherence scores for each group.

RESULTS

The medication adherence score was 7.33 ± 0.41 and 6.37 ± 0.76 at 6 weeks post educational sessions in the intervention and control groups, respectively. There was a significant difference in mean score of medication adherence at the end of the intervention, as well as at 3 and 6 weeks post-intervention between the groups (p < 0.001). Additionally, the results indicated that peer education approach was more cost-effective than routine education.

CONCLUSIONS

Peer education programs promote medication adherence in elderly with hypertension and are more cost-effective than routine education in health centers. Healthcare managers can improve medication adherence and reduce costs with employing peers to educate older individuals with hypertension.

TRIAL REGISTRATION

This study was registered in the Iranian Registry of Clinical Trials (registration number: IRCT20180519039710N1). Registration date: July 29, 2018.

Medication Adherence of Older Adults with Hypertension: A Systematic Review

Objective

Hypertension (HTN) significantly increases the risk of stroke and heart disease, which are the leading causes of death and disability globally, particularly among older adults. Antihypertensive medication is a proven treatment for blood pressure control and preventing complications. However, medication adherence rates in older adults with HTN are low. In this review, we systematically identified factors influencing medication adherence in older adults with HTN.

Methods

We applied the PRISMA guidelines and conducted systematic searches on PubMed, MEDLINE, and Google Scholar in July 2022 to identify preliminary studies reporting factors influencing medication adherence among older adults with HTN. The convergent integrated analysis framework suggested by the Joanna Briggs Institute for systematic reviews was adopted for data synthesis.

Results

Initially, 448 articles were identified, and after title and abstract screening, 16 articles qualified for full-text review. During this phase, three articles were excluded for reporting on irrelevant populations or focusing on issues beyond the review's aim, leaving thirteen studies in the final review. After data synthesis, fifteen themes were extracted from the key findings of the included studies. The most prevalent themes included the number of medications used (53.9%, n=7 studies), financial status (38.5%, n=5), sex (38.5%, n=5), age (30.1%, n=4), duration of disease (23.1%, n=3), comorbidities (23.1%, n=3), and health compliance (23.1%, n=3). Other themes, such as education, health literacy, health belief, medication belief, perception of illness, patient-physician relationship, self-efficacy, and social support, were also identified.

Conclusion

The findings of this review highlight critical areas for developing innovative, evidence-based programs to improve medication adherence in hypertensive older adults. Insights from this review can contribute to improving medication adherence and preventing future health complications.

Assessment Tools for Measuring Health Literacy and Digital Health Literacy in a Hospital Setting: A Scoping Review

Assessment of (digital) health literacy in the hospital can raise staff awareness and facilitate tailored communication, leading to improved health outcomes. Assessment tools should ideally address multiple domains of health literacy, fit to the complex hospital context and have a short administration time, to enable routine assessment. This review aims to create an overview of tools for measuring (digital) health literacy in hospitals. A search in Scopus, PubMed, WoS and CINAHL, following PRISMA guidelines, generated 7252 hits; 251 studies were included in which 44 assessment tools were used. Most tools (57%) were self-reported and 27% reported an administration time of <5 min. Almost all tools addressed the domain 'understanding' (98%), followed by 'access' (52%), 'apply' (50%), 'appraise' (32%), 'numeracy' (18%), and 'digital' (18%). Only four tools were frequently used: the Newest Vital Sign (NVS), the Short Test of Functional Health Literacy for Adults ((S)TOFHLA), the Brief Health Literacy Screener (BHLS), and the Health Literacy Questionnaire (HLQ). While the NVS and BHLS have a low administration time, they cover only two domains. HLQ covers the most domains: access, understanding, appraise, and apply. None of these four most frequently used tools measured digital skills. This review can guide health professionals in choosing an instrument that is feasible in their daily practice, and measures the required domains.

Utilizing Social Determinants of Health Model to Understand Barriers to Medication Adherence in Patients with Ischemic Stroke: A Systematic Review

Introduction

Ischemic strokes and their recurrence create an immense disease burden globally. Therefore, preventing recurrent strokes by promoting medication adherence is crucial to reduce morbidity and mortality. In addition, understanding the barriers to medication adherence related to the social determinants of health (SDoH) could promote equity among persons with ischemic stroke.

Objective

To explore the barriers to medication adherence among patients with ischemic stroke through the SDoH.

Methods

This systematic review included studies published between January 2018 and December 2022 identified through PubMed, MEDLINE, Web of Science, and CINAHL Plus Full Text. The descriptions of the studies were systematically summarized and discussed based on the SDoH from the US Healthy People 2030 initiative.

Results

Eight studies met the inclusion criteria and were included in this review. The most common barrier to adherence was inappropriate medication beliefs, medication side effects, and patient-physician relationship, which relate to the dimensions of healthcare access and quality. Health literacy and health perception, dependent on education access and quality, frequently influenced adherence. Other social determinants, such as financial strain and social and community context, were found to alter adherence behaviors. No study addressed the neighborhood and built environment domain. We found that cognitive impairment is another factor that impacts adherence outcomes among stroke patients.

Conclusion

Multifaceted approaches are needed to address the SDoH to improve medication adherence among patients with ischemic stroke. This review emphasized strategies, including patient education, provider-patient communication, social support, health literacy, technology, and policy advocacy to enhance adherence.

Impact of a pharmacist-led, primary medication nonadherence intervention program on prescription fills in underserved patient populations

BACKGROUND

Poor medication adherence is a critical barrier to improving patient health. Patients who are medically underserved are prone to a chronic disease state diagnosis and experience different social determinants of health.

OBJECTIVE

This study aimed to determine the impact of a primary medication nonadherence (PMN) intervention on prescription fills in underserved patient populations.

METHODS

This randomized control trial included 8 pharmacies that were chosen based on current poverty demographic data for each region in a metropolitan area as reported by the U.S. Census Bureau. Randomization was completed by a random number generator into (1) an intervention group or (2) a control group: (1) initiation of a PMN intervention and (2) no intervention offered on PMN. The intervention consists of a pharmacist addressing and resolving patient-specific barriers. Patients were enrolled in a PMN intervention at day 7 of a newly prescribed medication or a medication that has not been used in the previous 180 days, not being obtained for therapy. Data were collected to determine the number of eligible medications or therapeutic alternatives that were obtained after a PMN intervention was initiated and if that medication was refilled.

RESULTS

The intervention group consisted of 98 patients and the control group had 103. Rate of PMN was higher (P = 0.037) in the control group (71.15%) than the intervention group (47.96%). Cost and forgetfulness encompassed 53% of the barriers experienced by patients in the interventional group. The most commonly prescribed medication classes associated with PMN included statins (32.98%), renin angiotensin system antagonists (26.18%), oral diabetes medications (25.65%), and chronic obstructive pulmonary disease and corticosteroid inhalers (10.47%).

CONCLUSION

The rate of PMN had a statistically significant decrease when a pharmacist-led, evidence-based intervention was conducted with the patient. Although this study depicted a statistically significant decrease in PMN rates, larger studies are needed to strengthen the correlation between the decrease in PMN and a pharmacist-led, PMN intervention program.

Salt taste threshold and contributory factors of chronic kidney disease patients: a cross-sectional study

PROPOSE

High salt intake, correlated with high salt taste threshold, may accelerate renal injury in chronic kidney disease (CKD) patients. However, few studies have focused on factors that influence salt taste threshold. Therefore, we aimed to identify factors that influence the salt taste threshold of CKD patients, to provide more precise salt restriction recommendations in dietary therapy.

METHODS

Between April 2016 and March 2019, we measured the salt taste threshold of 1019 CKD patients, aged 22-78 years, from 52 hospitals across southwestern China, and then we performed a cross-sectional study.

RESULTS

The mean salt taste threshold was 0.37 ± 0.16% NaCl. There were 115 (11.3%), 670 (65.7%), and 234 (23.0%), respectively, patients who had low (≤ 0.1% NaCl), medium (0.1-0.4% NaCl), and high (> 0.4% NaCl) salt taste thresholds. One-way ANOVA and regression results revealed that sex (male), age, decreased estimated glomerular filtration rate, and absence of salt restriction were factors that influenced CKD groups with high salt taste threshold.

CONCLUSION

We found an independent correlation between contributory factors including sex, age, eGFR, and salt restriction behavior of subjects with the salt taste threshold of CKD patients. Our findings also offer insights on salt taste thresholds that could be useful for clinicians advising salt restriction to impair the salt taste sensitivity of the corresponding populations.