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Bulo B, Woldu M, Beyene A, Mekonnen D, Engidawork E. The Impact of a Medication Therapy Management Service on the Outcomes of Hypertension Treatment Follow-Up Care in an Ethiopian Tertiary Hospital: A Pre-Post Interventional Study. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2024; 18:11795468241274720. [PMID: 39314870 PMCID: PMC11418338 DOI: 10.1177/11795468241274720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 07/23/2024] [Indexed: 09/25/2024]
Abstract
Background According to a report from the WHO, an estimated 1.13 billion people worldwide have hypertension. Medication therapy management (MTM) service is a clinical service based on the theoretical and methodological framework of pharmaceutical care practice, which aims to ensure the best therapeutic outcomes for the patient by identifying, preventing, and resolving drug therapy problems (DTPs). Purpose The goal of this study was to determine the impact of MTM on hypertension management in Ethiopia. Methods A pre-post interventional study design was used. Descriptive statistics, linear regression, and logistic regressions were employed to present and analyze data. Results The final analysis included 279 patients out of 304, with a 7.8% attrition rate. The prevalence of drug therapy problems (DTPs) reduced from 63.4% at baseline to 31.5% during the post-intervention phase. Polypharmacy (AOR = 2.46; 95% CI: 1.27-4.77) and complications (AOR = 0.52; 95% CI: 0.27-0.99) were substantially associated with DTPs at the start of the study. The MTM resulted in a significant reduction in mean systolic blood pressure (SBP) (AOR = 5.31, 95% CI (3.50-7.11), P < .001), as well as a significant increase (P < .001) in the number of study patients who reached a target BP. At the end of the MTM intervention, non-adherence was linked with DTP (AOR = 2.40; 95% CI: 1.33-4.334) and living outside Addis Ababa (AOR = 1.73; 95% CI: 1.38-1.88). On average, treatment satisfaction was 86.55% (+SD) 10.34. Conclusion To resolve DTPs and improve clinical outcomes, the MTM service was critical. The majority of patients were found to be compliant with a high treatment satisfaction score.
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Affiliation(s)
- Belachew Bulo
- Tirunesh Beijing General Hospital, Addis Ababa, Ethiopia
| | - Minyahil Woldu
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemseged Beyene
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Desalew Mekonnen
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Hartch CE, Dietrich MS, Lancaster BJ, Stolldorf DP, Mulvaney SA. Effects of a medication adherence app among medically underserved adults with chronic illness: a randomized controlled trial. J Behav Med 2024; 47:389-404. [PMID: 38127174 PMCID: PMC11026187 DOI: 10.1007/s10865-023-00446-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/16/2023] [Indexed: 12/23/2023]
Abstract
For individuals living with a chronic illness who require use of long-term medications, adherence is a vital aspect of successful symptom management and outcomes. This study investigated the effect of a smartphone app on adherence, self-efficacy, knowledge, and medication social support in a medically underserved adult population with various chronic illnesses. Participants were randomized to a group who used the app for one month or a control group provided with a printed medication list. Compared to the control group, participants receiving the intervention had significantly greater medication adherence (Cohen's d = -0.52, p = .014) and medication self-efficacy (Cohen's d = 0.43, p = .035). No significant effects were observed related to knowledge or social support. The findings suggest use of the app could positively impact chronic disease management in a medically underserved population in the United States.
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Affiliation(s)
- Christa E Hartch
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN, 37240, USA.
- School of Nursing and Health Sciences, Manhattanville College, 2900 Purchase Street, Purchase, NY, 10577, USA.
| | - Mary S Dietrich
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN, 37240, USA
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1100, Nashville, TN, 37203, USA
| | - B Jeanette Lancaster
- Sadie Heath Cabiness Professor and Dean Emerita, School of Nursing, University of Virginia, 225 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA
| | - Deonni P Stolldorf
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN, 37240, USA
| | - Shelagh A Mulvaney
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN, 37240, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Avenue, #1475, Nashville, TN, 37203, USA
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Mwita JC, Joubert A, Saidu H, Sani MU, Damasceno A, Mocumbi AO, Sinxadi P, Viljoen CA, Hoevelmann J, Gebreyesus MS, Denti P, Wasmann R, Maartens G, Wiesner L, Stewart S, Davison B, Cotter G, Sliwa K. Objectively measured medication adherence using assays for carvedilol and enalaprilat in patients with heart failure in Mozambique and Nigeria. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 19:200213. [PMID: 37811486 PMCID: PMC10556761 DOI: 10.1016/j.ijcrp.2023.200213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/22/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023]
Abstract
Background Poor medication adherence leads to poor health outcomes and increased healthcare costs among patients with heart failure (HF). This study aimed to objectively assess medication adherence by measuring carvedilol and enalaprilat plasma concentrations among patients with HF. Methods The present sub-study of the Safety, Tolerability, and Efficacy of Rapid Optimization, helped by NT-proBNP testing, of Heart Failure therapies (STRONG-HF) study involved adult patients with acute HF admitted in two Mozambican and two Nigerian hospitals who were not optimally treated with oral enalapril and carvedilol. Patients in the high-intensity arm of the STRONG-HF study, and those not meeting the biomarker criteria for persistent congestion, were included in the "frequent visit" (FV) arm. In the FV arm, blood for bioanalysis of plasma enalaprilat or/and carvedilol was drawn at the 2,6,12th week post-discharge. Patients in the usual care arm of STRONG-HF were included in the "standard visit" (SV) arm, which followed the usual local practice with blood sampling in week 12. Results The study involved 113 (79 FV and 34 SV) participants with a mean age of 48.6 years and a mean left ventricular (LV) ejection fraction of 33.1%. Theenalaprilat below the lower level of quantification (LLOQ) was documented in 7.7%, 11.9%, and 15.6% of participants in FV during the 2,6 and 12th weeks. Carvedilol concentration below LLOQ was documented in 37%, 30%, and 44.4% of participants in the FV arm during the 2,6 and 12th weeks, respectively. For the SV arm, enalaprilat and carvedilol concentrations below LLOQ in the twelfth week were documented in 37.3% and 42.9% of patients, respectively. Conclusion Up to a third of patients using enalapril and carvedilol did not take any medication during the 12 weeks of follow-up. Non adherence was more common in patients who had less follow up, emphasizing the importance of close follow up to adherence. No adherence was also more common in medications know to have more side effects such as carvedilol.
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Affiliation(s)
- Julius Chacha Mwita
- Department of Internal Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana
| | - Andre Joubert
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Hadiza Saidu
- Department of Medicine Bayero University Kano & Murtala Muhammed Specialist Hospital, Kano, Nigeria
| | - Mahmoud Umar Sani
- Department of Medicine, Bayero University Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Research Unit, Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - Ana Olga Mocumbi
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Instituto Nacional de Saúde, Vila de Marracuene, Mozambique
| | - Phumla Sinxadi
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- SAMRC/UCT Platform for Pharmacogenomics Research and Translation, South African Medical Research Council, Cape Town, South Africa
| | - Charle Andre Viljoen
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Julian Hoevelmann
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Internal Medicine III - Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Manna Semere Gebreyesus
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Roeland Wasmann
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Simon Stewart
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Beth Davison
- Momentum Research, Inc., Chapel Hill, NC, USA
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France
| | - Gad Cotter
- Momentum Research, Inc., Chapel Hill, NC, USA
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France
| | - Karen Sliwa
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Chapman-Goetz J, Packham N, Yu K, Gabb G, Potts C, Prosser A, Arstall MA, Burdeniuk C, Chan A, Wilson T, Hotham E, Suppiah V. NPS MedicineWise application in supporting medication adherence in chronic heart failure: an acceptability and feasibility pilot study. Front Digit Health 2023; 5:1274355. [PMID: 38034908 PMCID: PMC10684918 DOI: 10.3389/fdgth.2023.1274355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Heart failure (HF) is an increasing global concern. Despite evidence-based pharmacotherapy, associated morbidity and mortality remain high. This study aimed to assess the acceptability, feasibility, and value of the NPS MedicineWise dose reminder app in a tiered, pharmacist-led intervention to address medication non-adherence in patients with HF. Methods This prospective, single-blinded, randomised controlled trial recruited 55 patients with HF between September 2019 and October 2020. Participants were randomly assigned to either the intervention or control arms. Intervention participants used the app which prompted medication administration at each dosing interval. Control participants received standard care and remained blinded to the app throughout the study. Treatment non-adherence prompted a tiered, pharmacist-led intervention. Comparison of the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) at baseline and 6-months measured the app's value in supporting medication adherence. Secondary outcome measures included self-reported medication knowledge, health-related quality of life, psychological wellbeing, and signs and symptoms of HF. Data were analysed using standard statistical tests with significance set at α 0.05. Results Approximately half of respondents reported managing HF and medications better by using the MedicineWise app (Tier 1). Most respondents expressed satisfaction with the in-app messages (Tier 2) and pharmacists' phone calls (Tier 3). The intervention participants demonstrated a significant improvement in the SEAMS between baseline and 6-months follow-up. Discussion It is feasible and potentially of value to use the MedicineWise app with a tiered, pharmacist-led intervention to support medication adherence in patients with HF. Our findings provide clinicians with "real-world" information on the practicality and potential value of using mobile health to support treatment adherence in patients with HF. Trial registration number Australian New Zealand Clinical Trials Registry Clinical trial registration number: ACTRN12619000289112p (http://www.ANZCTR.org.au/ACTRN12619000289112p.aspx).
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Affiliation(s)
- Jessica Chapman-Goetz
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Nerida Packham
- Consumer Medicines Information Services, NPS MedicineWise, Surry Hills, NSW, Australia
| | - Kitty Yu
- e-Health, NPS MedicineWise, Melbourne, VIC, Australia
| | - Genevieve Gabb
- Department of Cardiology, Noarlunga GP Plus Super Clinic, Adelaide, SA, Australia
| | - Cassandra Potts
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Adaire Prosser
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Margaret A. Arstall
- Department of Cardiology, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Christine Burdeniuk
- Department of Cardiology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Alicia Chan
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Teena Wilson
- Integrated Cardiovascular Clinical Network, Country Health South Australia, Adelaide, SA, Australia
| | - Elizabeth Hotham
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Vijayaprakash Suppiah
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
- Australian Centre for Precision Health, University of South Australia, Adelaide, SA, Australia
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Tolley A, Grewal K, Weiler A, Papameletiou AM, Hassan R, Basu S. Factors influencing adherence to non-communicable disease medication in India: secondary analysis of cross-sectional data from WHO - SAGE2. Front Pharmacol 2023; 14:1183818. [PMID: 37900158 PMCID: PMC10603298 DOI: 10.3389/fphar.2023.1183818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Background: Non-communicable diseases (NCDs) are a leading cause of death globally and disproportionately affect those in low- and middle-income countries lower-middle-income countries. Poor medication adherence among patients with NCDs is prevalent in India due to lack of initiation, missed dosing or cessation of treatment, and represents a growing healthcare and financial burden. Objective: This study aimed to identify factors influencing medication adherence in adults with NCDs in India. Methods: We performed a cross-sectional study, conducting secondary data analysis on the second wave of the World Health Organisation's 'Study on global AGEing and adult health (SAGE)', a survey that collected data from predominantly older adults across India. Bivariate analysis and multivariate logistic regression modelling were conducted to specifically interrogate the reasons for lack of initiation and cessation of treatment. Reporting of this study was informed by the STROBE guidelines. Results: The average medication adherence rate was 51% across 2,840 patients with one or more NCDs, reflecting non-initiation and lack of persistence of treatment. The strongest factor significantly predicting non-adherence to medication across these components was multimorbidity (odds ratio 0.47, 95% CI 0.40-0.56). Tobacco use (OR = 0.76, CI 0.59-0.98) and never having attended school (OR = 0.75, CI 0.62-0.92) were significantly associated with poor medication adherence (p < 0.05) while rural living (OR = 0.70, CI 0.48-1.02), feelings of anxiety (OR = 0.84, CI 0.66-1.08) and feelings of depression (OR = 0.90, CI 0.70-1.16) were factors lacking statistically significant association with medication adherence on multivariate analysis. Older age (OR = 2.02, CI 1.51-2.71) was significantly associated with improved medication adherence whilst there was a weak association between increased wealth and improved medication use. Limitations: The SAGE2 survey did not capture whether patients were taking their medication doses according to prescribed instructions-as a result our findings may under-estimate the true prevalence of medication non-adherence. Conclusion: Our analysis provides evidence that poor medication adherence in India is multifactorial, with distinct socioeconomic and health-system factors interacting to influence patient decision making. Future large-scale surveys interrogating adherence should assess all components of adherence specifically, whilst public health interventions to improve medication adherence should focus on barriers that may exist due to multimorbidity, comorbid depression and anxiety, and low educational status.
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Affiliation(s)
- Abraham Tolley
- School of Clinical Medicine, University of Cambridge, Cambridge, England
| | - Kirpal Grewal
- Faculty of Natural Science, University of Cambridge, Cambridge, England
| | - Alessa Weiler
- Faculty of Natural Science, University of Cambridge, Cambridge, England
| | | | - Refaat Hassan
- School of Clinical Medicine, University of Cambridge, Cambridge, England
| | - Saurav Basu
- Indian Institute of Public Health, Public Health Foundation of India, New Delhi, India
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6
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Tolley A, Hassan R, Sanghera R, Grewal K, Kong R, Sodhi B, Basu S. Interventions to promote medication adherence for chronic diseases in India: a systematic review. Front Public Health 2023; 11:1194919. [PMID: 37397765 PMCID: PMC10311913 DOI: 10.3389/fpubh.2023.1194919] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Cost-effective interventions that improve medication adherence are urgently needed to address the epidemic of non-communicable diseases (NCDs) in India. However, in low- and middle-income countries like India, there is a lack of analysis evaluating the effectiveness of adherence improving strategies. We conducted the first systematic review evaluating interventions aimed at improving medication adherence for chronic diseases in India. Methods A systematic search on MEDLINE, Web of Science, Scopus, and Google Scholar was conducted. Based on a PRISMA-compliant, pre-defined methodology, randomized control trials were included which: involved subjects with NCDs; were located in India; used any intervention with the aim of improving medication adherence; and measured adherence as a primary or secondary outcome. Results The search strategy yielded 1,552 unique articles of which 22 met inclusion criteria. Interventions assessed by these studies included education-based interventions (n = 12), combinations of education-based interventions with regular follow up (n = 4), and technology-based interventions (n = 2). Non-communicable diseases evaluated commonly were respiratory disease (n = 3), type 2 diabetes (n = 6), cardiovascular disease (n = 8) and depression (n = 2). Conclusions Although the vast majority of primary studies supporting the conclusions were of mixed methodological quality, patient education by CHWs and pharmacists represent promising interventions to improve medication adherence, with further benefits from regular follow-up. There is need for systematic evaluation of these interventions with high quality RCTs and their implementation as part of wider health policy. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022345636, identifier: CRD42022345636.
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Affiliation(s)
| | | | | | | | - Ruige Kong
- University of Cambridge, Cambridge, United Kingdom
| | - Baani Sodhi
- Indian Institute of Public Health-Delhi, Gurugram, India
| | - Saurav Basu
- Indian Institute of Public Health-Delhi, Gurugram, India
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7
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Baryakova TH, Pogostin BH, Langer R, McHugh KJ. Overcoming barriers to patient adherence: the case for developing innovative drug delivery systems. Nat Rev Drug Discov 2023; 22:387-409. [PMID: 36973491 PMCID: PMC10041531 DOI: 10.1038/s41573-023-00670-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 03/29/2023]
Abstract
Poor medication adherence is a pervasive issue with considerable health and socioeconomic consequences. Although the underlying reasons are generally understood, traditional intervention strategies rooted in patient-centric education and empowerment have proved to be prohibitively complex and/or ineffective. Formulating a pharmaceutical in a drug delivery system (DDS) is a promising alternative that can directly mitigate many common impediments to adherence, including frequent dosing, adverse effects and a delayed onset of action. Existing DDSs have already positively influenced patient acceptability and improved rates of adherence across various disease and intervention types. The next generation of systems have the potential to instate an even more radical paradigm shift by, for example, permitting oral delivery of biomacromolecules, allowing for autonomous dose regulation and enabling several doses to be mimicked with a single administration. Their success, however, is contingent on their ability to address the problems that have made DDSs unsuccessful in the past.
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Affiliation(s)
| | | | - Robert Langer
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Kevin J McHugh
- Department of Bioengineering, Rice University, Houston, TX, USA.
- Department of Chemistry, Rice University, Houston, TX, USA.
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Z Malak M, J Al-Thbetat A, M Al-Amer R. Psychosocial factors correlate with adherence to medications among cardiovascular outpatient clinics in Jordan. J Public Health (Oxf) 2023; 45:206-213. [PMID: 34693450 DOI: 10.1093/pubmed/fdab356] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 04/25/2021] [Accepted: 08/19/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Adherence to medications is a significant element of self-care behaviors for patients with cardiovascular diseases (CVDs). Non-adherence to cardiovascular medications is the major risk for poor outcomes following any cardiac event. However, there is a lack of studies that addressed medication adherence among patients with CVDs attending outpatient clinics in Arabic countries, including Jordan. Thus, this study purposed to assess the psychosocial factors (e.g. depression, anxiety, stress, social support and self-esteem) and their correlation with adherence to medications among patients with CVDs attending outpatient clinics in Jordan. METHODS A total of 395 Jordanian patients attending CVDs outpatient clinics at government, military and private healthcare facilities were recruited. RESULTS Our study findings showed that 31.4% of the patients reported complete adherence to their medications. The proportion of psychological reactions reported by the participants was 72.1% for depressive symptoms, 62.6% for anxiety and 50.1% for stress; 79.7% had moderate and normal social support, and 44% had low self-esteem. Depression, anxiety and stress had a significant negative correlation with adherence to medications; however, self-esteem had a significant positive relationship with adherence to medications. In addition, depression, anxiety and stress were the main predictors of adherence to medications. CONCLUSION Our findings might aid in paving the road for designing and developing strategies and interventions to increase adherence to medications and minimize these psychosocial problems among CVD patients in outpatient clinics.
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Affiliation(s)
- Malakeh Z Malak
- Community Health Nursing, Faculty of Nursing, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Ahlam J Al-Thbetat
- Adult Health Nursing, Ministry of Health, Amman, Jordan.,Adult Health Nursing, Faculty of Nursing, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Rasmieh M Al-Amer
- Mental Health Nursing, Faculty of Nursing, Isra University, Amman, Jordan.,School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
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A Comparative Study of Lymphatic Filariasis-Related Perceptions among Treated and Non-Treated Individuals in the Ahanta West Municipality of Ghana. Trop Med Infect Dis 2022; 7:tropicalmed7100273. [DOI: 10.3390/tropicalmed7100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/14/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Ghana joined the Global Programme to Eliminate Lymphatic Filariasis (GPELF), established in the year 2000, with the aim of eliminating the disease as a public health problem through annual mass treatment of entire endemic populations. Since 2001, the country has implemented mass drug administration (MDA) in endemic districts, with great reductions in the population at risk for infection. However, in many districts, the elimination programme is faced with the presence of hotspots, which may be due in part to individuals not taking part in MDA (either intentionally or unintentionally) who may serve as reservoirs to sustain transmission. This paper compares the LF-related perceptions among individuals who regularly take the MDA drugs and those who seldom or never take part in the MDA in the Ahanta West Municipality of Ghana to determine community acceptable ways to implement an intervention aimed to track, engage, and treat individuals who regularly miss MDA or to test individuals who intentionally refuse MDA and treat them if positive for LF. Methods: This was a mixed method study employing questionnaire surveys and focus group discussions (FDG) for data collection. Survey participants were randomly selected from the 2019 treatment register to stratify respondents into treated and non-treated groups. FGD participants were selected purposively such that there are at least two non-treated persons in each discussion session. Results: Over 90% of the respondents were aware of the disease. Poor hygiene/dirty environment was wrongly reported by most respondents (76.8%) as the causes. MDA awareness was very high among both treated (96.9%) and non-treated (98.6%) groups. A low sense of vulnerability to LF infection was evident by a reduction in the number of people presenting clinical manifestations of the disease in communities. Slightly more, 65 (29.0%) of the non-treated group compared to the 42 (19.4%) treated group reported ever experiencing adverse effects of the MDA drugs. Barriers to MDA uptake reported in both groups were poor planning and implementation of the MDA, lack of commitments on the part of drug distributors, and adverse drug reactions. About 51% of the non-treated group reported never taking the drugs even once in the last five years, while 61% among the treated group took the MDA drug consistently in the past five years. Respondents in both groups believed that, when engaged properly, most non-treated persons will accept to take the drug but insisted community drug distributors (CDDs) must be trained to effectively engage people and have time for those they will be engaging in dialogue. The chiefs emerged as the most influential people who can influence people to take MDA drugs. Conclusions: The reduction in risk perception among respondents, adverse reactions and the timing of MDA activities may be influencing MDA non-participation in the study area; however, respondents think that non-treated individuals will accept the interventions when engaged properly by the CDDs. This has been corrected and it now read “Respondents in both groups believed that, when community drug distributors (CDDs) are trained on how to engage the non-treated persons in effective dialogue, most of them will accept to take the drugs”.
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10
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Gil-Guillen VF, Balsa A, Bernárdez B, Valdés y Llorca C, Márquez-Contreras E, de la Haba-Rodríguez J, Castellano JM, Gómez-Martínez J. Medication Non-Adherence in Rheumatology, Oncology and Cardiology: A Review of the Literature of Risk Factors and Potential Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12036. [PMID: 36231341 PMCID: PMC9564665 DOI: 10.3390/ijerph191912036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
Medication adherence is directly associated with health outcomes. Adherence has been reviewed extensively; however, most studies provide a narrow scope of the problem, covering a specific disease or treatment. This project's objective was to identify risk factors for non-adherence in the fields of rheumatology, oncology, and cardiology as well as potential interventions to improve adherence and their association with the risk factors. The project was developed in three phases and carried out by a Steering Committee made up of experts from the fields of rheumatology, oncology, cardiology, general medicine, and hospital and community pharmacy. In phase 1, a bibliographic review was performed, and the articles/reviews were classified according to the authors' level of confidence in the results and their clinical relevance. In phase 2, 20 risk factors for non-adherence were identified from these articles/reviews and agreed upon in Steering Committee meetings. In phase 3, potential interventions for improving adherence were also identified and agreed upon. The results obtained show that adherence is a dynamic concept that can change throughout the course of the disease, the treatments, and other factors. Educational interventions are the most studied ones and have the highest level of confidence in the authors' opinion. Information and education are essential to improve adherence in all patients.
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Affiliation(s)
- Vicente F. Gil-Guillen
- Department of Clinical Medicine, Miguel Hernandez University, 03550 San Juan, Spain
- Research Unit, Hospital General Universitario de Elda, 30600 Elda, Spain
| | - Alejandro Balsa
- Rheumatology Department, La Paz University Hospital, 28046 Madrid, Spain
- Institute for Health Research Hospital La Paz (IdiPaz), 28046 Madrid, Spain
| | - Beatriz Bernárdez
- Department of Oncologic Pharmacy, Santiago de Compostela University Hospital, 15706 Santiago de Compostela, Spain
- Medicine Department, Santiago de Compostela University, 15706 Santiago de Compostela, Spain
- Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15782 Santiago de Compostela, Spain
- Adherence Group of the Sociedad Española de Farmacia Hospitalaria (ADHEFAR-SEFH), 28001 Madrid, Spain
| | - Carmen Valdés y Llorca
- Fuencarral Health Center, 28034 Madrid, Spain
- Observatorio de Adherencia al Tratamiento (OAT), 28231 Madrid, Spain
- Treatment Adherence Chair, San Juan de Alicante University, 03550 Alicante, Spain
| | | | | | - Jose M. Castellano
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- Centro Integral de Enfermedades Cardiovasculares, Monteprincipe University Hospital, 28660 Madrid, Spain
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Chapman-Goetz J, Packham N, Gabb G, Potts C, Yu K, Prosser A, Hotham E, Suppiah V. Acceptability and feasibility of the NPS MedicineWise mobile phone application in supporting medication adherence in patients with chronic heart failure: Protocol for a pilot study. PLoS One 2022; 17:e0263284. [PMID: 35120174 PMCID: PMC8815969 DOI: 10.1371/journal.pone.0263284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/21/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Heart failure (HF) is an increasing global concern. Despite evidence-based pharmacotherapy, morbidity and mortality remain high in HF. Medication non-adherence is a crucial factor in optimising clinical outcomes. A growing number of smartphone applications (apps) assist management. While evidence support their use to promote treatment adherence, apps alone may not be the solution. The objective of this pilot study is to assess the acceptability and feasibility of a tiered intervention added to the NPS MedicineWise dose reminder app (MedicineWise app) in supporting medication adherence in HF. METHODS AND ANALYSIS This prospective, single-blinded, randomised controlled trial will recruit 55 Australian patients with HF to be randomly assigned to either intervention (MedicineWise app + usual care) or control (usual care alone) arm. Control participants will remain unaware of the intervention throughout the study. At baseline, intervention participants will be instructed in the MedicineWise app. A reminder will then prompt medication administration at each dosing interval. If non-adherence is suggested from 24 hourly reports (critical medications) or 72 hours (non-critical medications), the individual/s will be escalated through a tiered, pharmacist-led intervention. The primary outcome will be the acceptability and feasibility of this approach in supporting adherence. Between-group comparison of the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) at baseline, 3 and 6 months will be used to measure the app's value in supporting adherence. Secondary outcome measures include self-reported medication adherence and knowledge, health-related quality of life, psychological wellbeing, signs and symptoms of HF, and medication and HF knowledge. ETHICS AND DISSEMINATION The protocol received ethics approval from Central Adelaide Clinical Human Research Ethics Committee (Protocol number R20190302) and University of South Australia Human Research Ethics Committee (Protocol number 202450). Findings will be disseminated through peer-reviewed journals. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry Clinical trial number: ACTRN12619000289112p (http://www.ANZCTR.org.au/ACTRN12619000289112p.aspx).
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Affiliation(s)
| | - Nerida Packham
- Consumer Medicines Information Services, NPS Medicine Wise, Sydney, Australia
| | - Genevieve Gabb
- Department of Cardiology, Noarlunga GP Plus Super Clinic, Adelaide, Australia
| | | | - Kitty Yu
- e-Health, NPS Medicine Wise, Melbourne, Australia
| | - Adaire Prosser
- SA Pharmacy, Flinders Medical Centre, Adelaide, Australia
| | - Elizabeth Hotham
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Vijayaprakash Suppiah
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
- Australian Centre for Precision Health, University of South Australia, Adelaide, Australia
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12
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Takahashi E, Vilay P, Chanthakoummane K, Pongvongsa T, Kounnavong S, Kano S, Kobayashi J, Nonaka D. Adherence to antihypertensive medications in rural Lao PDR: a prospective observational study. Trop Med Health 2021; 49:88. [PMID: 34715938 PMCID: PMC8556995 DOI: 10.1186/s41182-021-00374-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background Although hypertension is becoming more prevalent among the adult population of the Lao People’s Democratic Republic (PDR), with a prevalence of approximately 20% in 2013, treatment adherence of patients with hypertension, especially those in rural areas, remains poorly understood. The objective of the present study was to examine the rate of medication adherence to antihypertensive medicines among outpatients with hypertension in rural districts of the Savannakhet. Methods A prospective observational study was conducted in Xepon, Phin, and Nong districts. The study population was outpatients aged 18 years or older who were prescribed antihypertensive medicines at three district hospitals between February and August 2017. Data were collected on the first day of treatment (day 0) and the day of follow-up (around day 7) through interviews with the patients and outpatient registration books. The medication adherence rate was determined using the four-item Morisky Medication Adherence Scale. The level of adherence was evaluated by the sum of the scale, with scores ranging from 0 to 4 points. The adherent group, namely those with a score of 0, and the non-adherent group, namely those with scores of 1 to 4 points, were compared. Fisher’s exact test was used to identify factors associated with medication adherence. Results Of the 68 patients examined, 38.2% newly began treatment. Half of the patients (n = 34, 50.0%, 95% CI 0.38 to 0.62) adhered to medication instructions. The adherent group was more likely to have received written instructions when prescribed medication, compared to the non-adherent group (79.4% vs 55.9%, p = 0.068). Those who perceived that hypertension needs lifelong treatment were significantly more likely to adhere to the medication regimen (p = 0.028). Conclusions Medication adherence was present among 50% of outpatients with hypertension who visited a district hospital. Therefore, providing written instructions to patients would be effective for improving medication adherence.
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Affiliation(s)
- Emiri Takahashi
- Faculty of Pharmacy, Takasaki University of Health and Welfare, Takasaki, Gunma, Japan.
| | - Phoutnalong Vilay
- Center of Malariology, Parasitology and Entomology, Ministry of Health, Vientiane, Lao PDR
| | | | - Tiengkham Pongvongsa
- Savannakhet Provincial Health Department, Savannakhet, Lao PDR.,Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao PDR
| | - Shigeyuki Kano
- Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Jun Kobayashi
- Department of Global Health, Graduate School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Daisuke Nonaka
- Department of Global Health, Graduate School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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13
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Development and Validation of a Questionnaire to Measure Medication Adherence to Direct-Acting Agents in Patients with Hepatitis C. Pharmaceutics 2021; 13:pharmaceutics13101683. [PMID: 34683976 PMCID: PMC8540644 DOI: 10.3390/pharmaceutics13101683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 01/21/2023] Open
Abstract
This study aims to develop a new self-report tool (HCV-AD) measuring adherence factors, intentional or unintentional, during Hepatitis C Virus (HCV) treatment with direct-acting antivirals (DAA) aiming to achieve high efficacy, otherwise resulting in drug resistance and treatment failure. Two phases were conducted: in the first phase, items were generated based on an extensive literature review, and, in the second phase, a prospective cohort study was conducted using HCV patients from Gastroenterology Department from University County Hospital of Craiova, Romania (n = 222), to evaluate the validity and reliability of the questionnaire. A number of 19 items were generated following a systematic review and through expert opinion. The internal consistency reliability was evaluated using Cronbach’s alpha. The construct validity was assessed using correlations with two other instruments: visual analog scale (VAS) and medication possession ratio (MPR). The final questionnaire (HCV-AD10) was derived through exploratory factor analysis, with 82% of total variance explained. This instrument appeared as a reliable and valid measure for medication adherence, with Cronbach’s alpha (0.867) and significant high positive correlations between adherence scores calculated with HCV-AD10 and VAS (ρ = 0.61, p < 0.001) or with HCV-AD10 and MPR (ρ = 0.75, p < 0.001). This research would make a worthwhile contribution to HCV management.
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14
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Santos RD, Pereira C, Cesena F, Laurinavicius AG, Tabone V, Bittencourt MS. Cardiovascular Risk Misperception and Low Awareness of Familial Hypercholesterolemia in Individuals with Severe Hypercholesterolemia. Arq Bras Cardiol 2021; 116:706-712. [PMID: 33566934 PMCID: PMC8121404 DOI: 10.36660/abc.20190516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 02/03/2020] [Indexed: 12/17/2022] Open
Abstract
Fundamento Indivíduos com hipercolesterolemia grave apresentam alto risco de desenvolver doença cardiovascular aterosclerótica (DCVA). Muitos deles apresentam hipercolesterolemia familiar (HF). Objetivos Avaliar, a partir da perspectiva dos pacientes, o nível de conhecimento sobre a hipercolesterolemia grave, especialmente em relação a HF, DCVA, percepção de risco, desempenho do rastreamento em cascata e tratamento de indivíduos participantes de um programa de avaliação periódica de saúde. Métodos De um banco de dados de 70.000 brasileiros avaliados entre 2006 e 2016, 1.987 (2,8%) atenderam aos critérios de inclusão (idade ≥ 18 anos e LDL-C ≥ 190 mg/dL ou ≥ 160 mg/dL se sem uso de estatinas ou em terapia com estatinas, respectivamente). Desses, 200 foram aleatoriamente convidados a preencher um questionário extenso. A HF foi diagnosticada em caso de suspeita pelo médico responsável. Resultados Embora 97% da amostra (48±9 anos; 16% do sexo feminino; 95% com ensino superior; 88% em prevenção primária; LDL-C 209±47 mg/dL) tenha apresentado hipercolesterolemia grave, apenas 18% e 29,5% se consideravam de alto risco para desenvolver DCVA e relataram saber sua meta recomendada de LDL-C, respectivamente. Em relação à possibilidade de o colesterol alto ser uma doença hereditária, 58% relataram conhecimento sobre o fato; 24,5% (n = 49) já tinham ouvido falar em HF; e apenas 14% (n = 20) foram previamente identificados com suspeita de HF (idade ao diagnóstico de HF: 35±12 anos; 79% e 31% foram diagnosticados com > 30 e > 40 anos, respectivamente). Apenas 2,5% foram submetidos a testes genéticos; 17%, à rastreamento em cascata; e 17% não faziam uso de tratamento farmacológico. Conclusões Identificou-se uma importante lacuna na percepção de risco, no controle do colesterol e em aspectos relacionados à HF em indivíduos com hipercolesterolemia grave. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)
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Affiliation(s)
- Raul D Santos
- Hospital Israelita Albert Einstein , São Paulo , SP - Brasil.,Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo , São Paulo , SP - Brasil
| | - Carolina Pereira
- Escola de Enfermagem Anna Nery , Universidade Federal do Rio de Janeiro , Rio de Janeiro , RJ - Brasil
| | - Fernando Cesena
- Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
| | | | - Viviane Tabone
- Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
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Pirasath S, Sundaresan T. Descriptive cross-sectional study on knowledge, awareness and adherence to medication among hypertensive patients in a tertiary care center, Eastern Sri Lanka. SAGE Open Med 2021; 9:20503121211012497. [PMID: 34017590 PMCID: PMC8114314 DOI: 10.1177/20503121211012497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/01/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction: Hypertension is one of the common non-communicable diseases and public health problem among developed and developing countries. The lack of knowledge and awareness on hypertension and poor adherence of medication are a major challenge to control hypertension and prevent its complications. Our study aimed to assess the knowledge, awareness of hypertension and adherence to medication among hypertensive patients attending the medical clinics of a tertiary care center, Eastern Province of Sri Lanka. Methods: A descriptive cross-sectional study was conducted among hypertensive patients to assess knowledge, awareness of hypertension and adherence to medication in medical clinics in a tertiary care for 6 months duration. Data were collected by using pretested and validated Hypertension Facts Questionnaire. Their medication adherence and the reasons for nonadherence were studied using Medication Adherence Scale. Data were analyzed using SPSS (version 18) analytical package and the chi-square test was performed. The scoring system was used to categorize the level of knowledge and awareness of hypertension among patients. Results: The majority of patients had moderate-to-high knowledge (101, 65.8%) about hypertension and had moderate-to-high awareness (111, 73.2%) on hypertension. Even though, 134 (87.6%) patients knew that they have hypertension, and 108 (70.6%) patients did not know their blood pressure value at the time of diagnosis. Most of the patients (90, 58.8%) had good drug adherence, and most of them (141, 92.1%) thought that taking medicine plays a key role to control their blood pressure. The main reasons for nonadherence of medication were forgetfulness (39, 32%) and expenses (46, 35.4%). The knowledge and awareness about hypertension among respondents were significantly associated with educational level (p < 0.05) Conclusion: Most of the patients had adequate knowledge on the risk factors and complications of hypertension. But they were unaware about their disease status, and their diagnosis, target organ damage and recent blood pressure values. The drug adherence was reasonably adequate. The main reasons for nonadherence of medication were forgetfulness and expenses.
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Persaud N, Bedard M, Boozary A, Glazier RH, Gomes T, Hwang SW, Juni P, Law MR, Mamdani M, Manns B, Martin D, Morgan SG, Oh P, Pinto AD, Shah BR, Sullivan F, Umali N, Thorpe KE, Tu K, Laupacis A. Adherence at 2 years with distribution of essential medicines at no charge: The CLEAN Meds randomized clinical trial. PLoS Med 2021; 18:e1003590. [PMID: 34019540 PMCID: PMC8139488 DOI: 10.1371/journal.pmed.1003590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 03/19/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Adherence to medicines is low for a variety of reasons, including the cost borne by patients. Some jurisdictions publicly fund medicines for the general population, but many jurisdictions do not, and such policies are contentious. To our knowledge, no trials studying free access to a wide range of medicines have been conducted. METHODS AND FINDINGS We randomly assigned 786 primary care patients who reported not taking medicines due to cost between June 1, 2016 and April 28, 2017 to either free distribution of essential medicines (n = 395) or to usual medicine access (n = 391). The trial was conducted in Ontario, Canada, where hospital care and physician services are publicly funded for the general population but medicines are not. The trial population was mostly female (56%), younger than 65 years (83%), white (66%), and had a low income from wages as the primary source (56%). The primary outcome was medicine adherence after 2 years. Secondary outcomes included control of diabetes, blood pressure, and low-density lipoprotein (LDL) cholesterol in patients taking relevant treatments and healthcare costs over 2 years. Adherence to all appropriate prescribed medicines was 38.7% in the free distribution group and 28.6% in the usual access group after 2 years (absolute difference 10.1%; 95% confidence interval (CI) 3.3 to 16.9, p = 0.004). There were no statistically significant differences in control of diabetes (hemoglobin A1c 0.27; 95% CI -0.25 to 0.79, p = 0.302), systolic blood pressure (-3.9; 95% CI -9.9 to 2.2, p = 0.210), or LDL cholesterol (0.26; 95% CI -0.08 to 0.60, p = 0.130) based on available data. Total healthcare costs over 2 years were lower with free distribution (difference in median CAN$1,117; 95% CI CAN$445 to CAN$1,778, p = 0.006). In the free distribution group, 51 participants experienced a serious adverse event, while 68 participants in the usual access group experienced a serious adverse event (p = 0.091). Participants were not blinded, and some outcomes depended on participant reports. CONCLUSIONS In this study, we observed that free distribution of essential medicines to patients with cost-related nonadherence substantially increased adherence, did not affect surrogate health outcomes, and reduced total healthcare costs over 2 years. TRIAL REGISTRATION ClinicalTrials.gov NCT02744963.
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Affiliation(s)
- Nav Persaud
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael Bedard
- Department of Family Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Andrew Boozary
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Richard H Glazier
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Tara Gomes
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Stephen W Hwang
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Juni
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Healthcare Analytics Research and Training at St Michael's Hospital and Vector Institute, Toronto, Ontario, Canada
| | - Braden Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danielle Martin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Steven G Morgan
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Oh
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Andrew D Pinto
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Frank Sullivan
- Department of Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
- Division of Population and Behavioral Science, University of St Andrews, Scotland
| | - Norman Umali
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Andreas Laupacis
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Moucheraud C, Phiri K, Hoffman RM. Health behaviours and beliefs among Malawian adults taking antihypertensive medication and antiretroviral therapy: A qualitative study. Glob Public Health 2021; 17:688-699. [PMID: 33471610 PMCID: PMC8289928 DOI: 10.1080/17441692.2021.1874468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In order to understand HIV-positive Malawian adults' experiences with hypertension management, we conducted qualitative interviews with 30 hypertensive adults who were also taking antiretroviral therapy. These interviews regarding hypertension management behaviours and beliefs were audio-recorded, transcribed, translated into English, and coded in Atlas.ti. Despite acknowledging the dangers of hypertension and the benefits of medication, many respondents missed their antihypertensive medication. Primary reasons included feeling healthy, health workers' advice to stop taking medicine when blood pressure normalised, side effects, and using herbs or non-prescription medicines to manage hypertension. Women highlighted difficulties with dietary modifications, and changes in their social relationships. Both men and women spoke about hypertension-related challenges with employment and household economics. These results suggest numerous challenges among adults managing hypertension and HIV in Malawi, and frequent suboptimal adherence to medication. We identified new key themes - the quality of adherence counselling for antihypertensive medication, the effects of hypertension on financial stability, and the role of social relationships in self-care - and encourage further investigation into these topics in low-income, high-burden countries.
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Affiliation(s)
- Corrina Moucheraud
- Department of Health Policy and Management, University of California Fielding School of Public Health, Los Angeles, CA, USA
| | | | - Risa M Hoffman
- Division of Infectious Diseases, University of California Geffen School of Medicine, Los Angeles, CA, USA
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Scherman J, Zilla P. Poorly suited heart valve prostheses heighten the plight of patients with rheumatic heart disease. Int J Cardiol 2020; 318:104-114. [DOI: 10.1016/j.ijcard.2020.05.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/13/2020] [Accepted: 05/22/2020] [Indexed: 12/12/2022]
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Petersohn S, Pouwels X, Ramaekers B, ten Cate-Hoek A, Joore M. Rivaroxaban plus aspirin for the prevention of ischaemic events in patients with cardiovascular disease: a cost-effectiveness study. Eur J Prev Cardiol 2020; 27:1354-1365. [PMID: 32223323 PMCID: PMC7457457 DOI: 10.1177/2047487320913380] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/26/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Dual pathway inhibition with 2.5 mg rivaroxaban twice daily plus 100 mg aspirin once daily may be a promising alternative to 100 mg aspirin antiplatelet therapy for the prevention of cardiovascular events in patients with coronary artery disease and/or peripheral arterial disease. However, treatment costs and bleeding risks are higher, and there is another treatment option for peripheral arterial disease, 75 mg clopidogrel. A comprehensive assessment of benefits, risks and costs of dual pathway inhibition versus standard of care is needed. METHODS We used a state transition model including cardiovascular, ischaemic limb and bleeding events to compare dual pathway inhibition to aspirin antiplatelet therapy in coronary artery disease, and additionally to clopidogrel antiplatelet therapy in peripheral arterial disease patients. We calculated the incremental cost-effectiveness ratio from costs and quality-adjusted life-years of lifelong treatment, and the cost-effectiveness probability at a €50,000/quality-adjusted life-year threshold. RESULTS Quality-adjusted life-years and costs of dual pathway inhibition were highest, the incremental cost-effectiveness ratios versus aspirin were €32,109 in coronary artery disease and €26,381 in peripheral arterial disease patients, with 92% and 56% cost-effectiveness probability, respectively (clopidogrel was extendedly dominated). Incremental cost-effectiveness ratios were below €20,000 in comorbid peripheral arterial disease patients and coronary artery disease patients younger than 65 years, incremental cost-effectiveness ratios were above €50,000 in carotid artery disease patients and coronary artery disease patients older than 75 years. CONCLUSION Lifelong preventive treatment of coronary artery disease and peripheral arterial disease patients at risk of cardiovascular events with dual pathway inhibition improves health outcomes and seems overall cost-effective relative to aspirin antiplatelet therapy and also to clopidogrel antiplatelet therapy for peripheral arterial disease, particularly in comorbid patients, but not in older patients and in carotid artery disease patients. These findings may warrant a targeted approach.
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Affiliation(s)
- Svenja Petersohn
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, The Netherlands
| | - Xavier Pouwels
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, The Netherlands
| | - Bram Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, The Netherlands
| | - Arina ten Cate-Hoek
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, The Netherlands
| | - Manuela Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, The Netherlands
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Bhandari B, Narasimhan P, Vaidya A, Jayasuriya R. Theory-based mobile phone text messaging intervention for blood pressure control (TEXT4BP) among hypertensive patients in Nepal: study protocol for a feasibility randomised controlled trial. BMJ Open 2020; 10:e040799. [PMID: 32873686 PMCID: PMC7467528 DOI: 10.1136/bmjopen-2020-040799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/17/2020] [Accepted: 07/31/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Uncontrolled blood pressure is one of the main risk factors for cardiovascular disease and death in Low-income and middle-income countries. Improvements to medication adherence and lifestyle changes can be assisted by using mobile phone text messaging interventions. This study aims to test the feasibility and acceptability of a text messaging intervention for blood pressure control '(TEXT4BP)', developed based on behavioural change theory to improve treatment adherence and lifestyle change among hypertensive patients in Nepal. METHODS AND ANALYSIS The TEXT4BP intervention will be tested using a two-arm parallel-group, unblinded, individually randomised controlled trial. This feasibility study would recruit 200 clinically diagnosed hypertensive patients aged 18-69 years, currently receiving blood pressure-lowering medication for more than 3 months, visiting a tertiary healthcare facility in Kathmandu, Nepal. A nested qualitative study will assess the acceptability of the short message service intervention. The intervention group will receive text messages containing information on hypertension, diet, medication and physical activity three times a week for 3 months. The control group will receive standard care. At baseline and 3 months, measures of medication adherence, salt intake, physical activity and blood pressure will be collected. Feasibility measures, such as differential rates of recruitment and attrition rates, will be calculated. Acceptability of text message interventions will be studied using usability measures and in-depth interviews among intervention group participants. This pilot study is not funded. ETHICS AND DISSEMINATION This study has received ethics approval from the University of New South Wales Human Research Ethics Committee B (HC190357), Nepal Health Research Council (302/2019) and Institutional Review Committee of Kathmandu Medical College and Teaching Hospital Kathmandu, Nepal (030520192). The findings of the study will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12619001213134.
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Affiliation(s)
- Buna Bhandari
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Central Department of Public Health, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Padmanesan Narasimhan
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Abhinav Vaidya
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Rohan Jayasuriya
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Piña IL, Di Palo KE, Brown MT, Choudhry NK, Cvengros J, Whalen D, Whitsel LP, Johnson J. Medication adherence: Importance, issues and policy: A policy statement from the American Heart Association. Prog Cardiovasc Dis 2020; 64:111-120. [PMID: 32800791 DOI: 10.1016/j.pcad.2020.08.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023]
Abstract
Medications do not work in patients who do not take them. This true statement highlights the importance of medication adherence. Providers are often frustrated by the lack of consistent medication adherence in the patients they care for. Today with the time constraints that providers face, it becomes difficult to discover the extent of non-adherence. There are certainly many challenges in medication adherence not only at the patient-provider level but also within a healthy system and finally in insurers and payment systems. In a cross-sectional survey of unintentional nonadherence in over 24,000 adults with chronic illness, including hypertension, diabetes and hyperlipidemia, 62% forgot to take medications and 37% had run out of their medications within a year. These sobering data necessitate immediate policy and systems solutions to support patients in adherence. Medication adherence for cardiovascular diseases (CVD) has the potential to change outcomes, such as blood pressure control and subsequent events. The American Heart Association (AHA)/American Stroke Association (ASA) has a goal of improving medication adherence in CVD and stroke prevention and treatment. This paper will explore medication adherence with all its inherent issues and suggest policy and structural changes that must happen in order to transform medication adherence levels in the U.S. and achieve the AHA/ASA's health impact goals.
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Affiliation(s)
- Ileana L Piña
- Wayne State University, Central Michigan University, Detroit, MI, United States of America.
| | | | - Marie T Brown
- Rush University Medical Center, Chicago, IL, United States of America
| | - Niteesh K Choudhry
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Jamie Cvengros
- Rush University Medical Center, Chicago, IL, United States of America
| | - Deborah Whalen
- Boston University School of Medicine, Boston, MA, United States of America
| | - Laurie P Whitsel
- American Heart Association, Washington, DC, United States of America
| | - Janay Johnson
- American Heart Association, Washington, DC, United States of America
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Khonsari S, Chandler C, Parker R, Holloway A. Increasing cardiovascular medication adherence: A medical research council complex mhealth intervention mixed-methods feasibility study to inform global practice. J Adv Nurs 2020; 76:2670-2684. [PMID: 32761638 DOI: 10.1111/jan.14465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/11/2020] [Accepted: 06/08/2020] [Indexed: 12/07/2022]
Abstract
AIMS To evaluate a mHealth intervention to increase medication adherence among Iranian coronary heart disease patients. DESIGN Quantitative-dominant mixed-methods study. DATA SOURCE Iranian coronary heart disease patients' responses and most recent clinical documents as well as responses from Iranian cardiac nurses who participated in this study. METHODS The study was conducted between September 2015-April 2016 drawing on the Medical Research Council's Framework. Phase one comprised of a patients' survey and focus groups with cardiac nurses. The automated short message service reminder was piloted in phase two. We recruited 78 patients and randomized to receive either 12-week daily reminders or usual care. The primary outcome was the effect on medication adherence; secondary outcomes were self-efficacy, ejection fraction, functional capacity, readmission rate and quality of life. RESULTS Feasibility was evidenced by high ownership of mobile phones and high interest in receiving reminders. Participants in the intervention group showed significantly higher medication adherence compared with the control group. CONCLUSION The mHealth intervention was well accepted and feasible with early evidence of effectiveness that needs to be confirmed in a fully powered future randomized clinical trial.
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Affiliation(s)
- Sahar Khonsari
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Colin Chandler
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Richard Parker
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Aisha Holloway
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
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Descriptive Cross-Sectional Study on Knowledge, Awareness, and Adherence to Medication among Hypertensive Patients at a Tertiary Care Centre in Colombo District, Sri Lanka. Int J Hypertens 2020; 2020:1320109. [PMID: 32832144 PMCID: PMC7422006 DOI: 10.1155/2020/1320109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/10/2020] [Accepted: 06/23/2020] [Indexed: 12/03/2022] Open
Abstract
Objective This study was aimed to assess the patient's knowledge and awareness about hypertension and adherence to antihypertensive medication among hypertensive patients. Methods The descriptive cross-sectional study was conducted in three medical clinics of Colombo South Teaching hospital, Kalubowila, Sri Lanka, from April 2019 to September 2019. Total of 384 hypertensive patients were recruited by systematic randomized controlled sampling and interviewed with validated questionnaires to assess their knowledge about hypertension and adherence to antihypertensive medication. Data were analyzed using SPSS (version 21) analytical package, and the chi-squared test was performed. Results The total sample consisted of 384 hypertensive patients with a mean age of 59.32 (±12.34SD). This included 180 (46.9%) males and 204 (53.1%) females. The male : female ratio was approximately 9 : 10. Most of patients were with primary and ordinary educational status (65.9%), normal body mass index (54.9%), mild elevation of LDL cholesterol (76.3%), and coexistent ischemic heart disease (39.6%). The knowledge about hypertension among majority of patients was reasonable. However, they were unaware about normal values of blood pressure (69%, 95% of CI 1.92–2.09) and diagnostic values of hypertension (90.1%, 95% of CI 2.26–2.40). Moreover, they were unaware of their blood pressure values at time of diagnosis (75.3%, 95% of CI 2.09–2.25), at recent clinic visit (71.3%, 95% of CI 2.0-2.17), and target level (81.8%, 95% of CI 2.25-2.41). Most patients had adequate knowledge about the risk factors and complications of hypertension and were aware of their target organ damage (70.3%). Most patients believed that medication alone is not sufficient to control blood pressure (41.7%, 95% of CI 1.40-1.51) and adequate control of their blood pressure reduces complications (68.2%, 95% of CI 1.37-1.51). Most of the patients (71.8%) had reasonable good drug compliance. The forgetfulness was commonly attributed for nonadherence (69%, 95% of CI 1.26-1.36). Conclusions The knowledge about hypertension among majority of patients was reasonable. But, they were unaware about their disease status and their diagnosis, target, and recent blood pressure values. Most of patients had adequate knowledge about the risk factors and complications of hypertension. However, they were unaware about their target organ damage due to hypertension. The drug compliance was reasonable among them. The forgetfulness was common reason for nonadherence. Therefore, healthcare professionals should implement individualized educational programmes to increase the awareness of disease status, appropriate blood pressure levels, and adherence of treatment to improve the outcome of patients.
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Connor S, Forrister D, Karir V, Kauffman Y, Sochacki M. Improving equitable access to essential medicines: Learning from the experience of pharmacists within Médecins Sans Frontières (Doctors Without Borders). JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Sharon Connor
- University of Pittsburgh School of Pharmacy Pittsburgh PA
| | - Daniel Forrister
- Social Solutions International (USAID Institutional Contractor), Office of U.S. Foreign Disaster Assistance, Preparation, Strategic Planning, and Mitigation Division Washington DC
| | - Veena Karir
- Doctors Without Borders (Médecins Sans Frontières), Operational Center Amsterdam (OCA) Amsterdam Netherlands
| | - Yardlee Kauffman
- Doctors Without Borders (Médecins Sans Frontières) Operational Center Brussels (OCB) Brussels Belgium
| | - Marisa Sochacki
- Doctors Without Borders (Médecins Sans Frontières) Operational Center Paris (OCP) Paris France
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Factors that influence adherence to treatment plans amongst people living with cardiovascular disease: A review of published qualitative research studies. Int J Nurs Stud 2020; 110:103727. [PMID: 32823026 DOI: 10.1016/j.ijnurstu.2020.103727] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Treatment plan adherence is recognized as a worldwide health issue, particularly important in the management of cardiovascular patients. Healthcare professionals are the primary sources of information and support for people diagnosed with CVD and those who have experienced a cardiac event, yet we know little about how healthcare professionals contribute to the process of adherence to treatment plans that aim to prevent and/or reduce disease and adverse events. Qualitative evidence that explores factors that influence adherence to treatment plans is limited. OBJECTIVE This systematic review identified and synthesised the best available evidence on factors that influence adherence to treatment plans amongst people living with cardiovascular disease. DESIGN Systematic review and qualitative synthesis. METHODS Data were collected from Medline, Web of Science, CINAHL, PsychINFO, Embase- Non-Medline, Scopus, Cochrane Library, ProQuest Central (Grey Literature). Pre-defined keywords and MeSH terms were used to identify qualitative methods English-language studies published between 2001 and 2018. Quality appraisal of each paper was completed using the JBI Critical Appraisal Checklist and two reviewers extracted the data independently. RESULTS Twenty-two articles were included. Eight key themes were identified that related to facilitators and barriers to adherence to treatment plans. Facilitators were identified as engaging in exercise, having support and mentorship, lifestyle modification, and the perceived value of taking medication. Barriers were identified as a perceived lack of support, concerns about taking medication, and lack of engagement in exercise and lifestyle changes. CONCLUSIONS The findings highlight the factors that support adherence and healthcare professionals can build on also the areas that can be targeted to support and improve adherence to treatment plans. Nurses can play an important role in enhancing the provision of information pre hospital discharge and support in the community on taking medication, the value of physical activity and dietary changes.
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Burnier M, Polychronopoulou E, Wuerzner G. Hypertension and Drug Adherence in the Elderly. Front Cardiovasc Med 2020; 7:49. [PMID: 32318584 PMCID: PMC7154079 DOI: 10.3389/fcvm.2020.00049] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/13/2020] [Indexed: 12/20/2022] Open
Abstract
Hypertension is highly prevalent after the age of 65 years affecting more than 60% of individuals in developed countries. Today, there is sufficient evidence from clinical trials that treating elderly subjects with hypertension with antihypertensive medications has a positive benefit/risk ratio even in very elderly patients (>80 years). In recent years, partial or total non-adherence has been recognized as major issues in the long-term management of hypertension in all age categories. However, whether non-adherence is more frequent in hypertensive patients older than 65 years or not is still a matter of debate and the common belief is that adherence is lower in older than in younger patients. Are clinical data supporting this belief? In this brief review, we discuss the topic of drug adherence in elderly in the context of the medical treatment of hypertension. Studies show that drug adherence is actually better in patients aged 65 to 80 years when compared to younger hypertensive patients (<50 years). However, in very old patients (>80 years) the prevalence of non-adherence does increase. In this patients' group, there are specific risk factors for non-adherence such as cognitive ability, depression, and health believes, in addition to classical risk factors for non-adherence. One important aspect in the elderly is the prescription of potentially inappropriate medications that will interfere with the adherence to necessary treatments. In this context, an interesting new concept was developed few years ago, i.e., the process of deprescribing. Thus, today, in addition to conventional guidelines recommendations (use of single pill combinations, individualization of treatments), the evaluation of cognitive abilities, the regular assessment of potentially inappropriate medications, and the process of deprescribing appear to be three new additional steps to improve drug adherence in the elderly and thereby ameliorate the global management of hypertension.
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Affiliation(s)
- Michel Burnier
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Hypertension Research Foundation, St-Légier, Switzerland
| | - Erietta Polychronopoulou
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gregoire Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Hypertension Research Foundation, St-Légier, Switzerland
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Zilla P, Bolman RM, Boateng P, Sliwa K. A glimpse of hope: cardiac surgery in low- and middle-income countries (LMICs). Cardiovasc Diagn Ther 2020; 10:336-349. [PMID: 32420116 PMCID: PMC7225428 DOI: 10.21037/cdt.2019.11.03] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/04/2019] [Indexed: 12/17/2022]
Abstract
Currently, more than five times more people live in low- and middle-income countries (LMICs) than in high-income countries (HICs). As such, the downward trend in cardiac surgical needs in HICs reflects only the situation of one sixth of the world population while the vast majority living in LMICs has still no or limited access to life saving heart operations. In these countries, rheumatic heart disease (RHD) still accounts for a significant proportion of cardiac surgical needs. In low- and lower-middle income countries it remains the single most common cardiovascular disease in young adult and adolescent patients in need of heart surgery outweighing other indications such as congenital cardiac defects almost 4-fold. Compared to HICs with their predominance of calcific aortic stenosis in the elderly mitral valve surgery is required in >90% of the largely young patients with RHD in low-income countries (LICs) and still in 70% of the often middle aged patients in middle-income countries (MICs). Although recent government initiatives in LICs led to the establishment of local, independent cardiac surgical services gradually replacing fly-in missions, these centers still only cover less than 2% of the needs of their populations. In MICs, cardiac surgical needs continually grow with the emergence of degenerative diseases. As such, in spite of the concomitant growth of cardiac surgical capacity, significantly less than half the estimated patients in need have access. Capacities in LICs range from 0.5 to 7 cardiac operations/million population; 100-481/million in MICs and >1,200/million in HICs such as the USA and Germany. While a new level of awareness of the scope and magnitude of the problem has begun to emerge in LICs and the establishment of local cardiac surgical capacity has given rise to a glimpse of hope, the challenges of expanding these fledgling services to a significant proportion of the population still seem insurmountable. Challenges in MICs are on the other hand the widening gap between private cardiac medicine for the affluent few and overwhelmed public services for the many and the rural urban divide with the underappreciation of the ongoing dominance of RHD in the rural and indigent population on the other. Overshadowing all LMICs is the low level of valve-repair skills associated with insufficient cardiac surgical capacity and the unavailability of suitable replacement valves which address the young age of the patients and the difficulties of anticoagulation in a socioeconomic environment distinctly different from the elderly patients of HICs.
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Affiliation(s)
- Peter Zilla
- Christian Barnard Department for Cardiothoracic Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - R. Morton Bolman
- Anschutz Medical Campus, University of Colorado Denver, Aurora and University of Colorado, Denver, CO, USA
| | - Percy Boateng
- Department of Cardiovascular Surgery, Icahn School of Medicine, Mount Sinai (ISMMS) Medical Center, New York, NY, USA
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Persaud N, Bedard M, Boozary AS, Glazier RH, Gomes T, Hwang SW, Jüni P, Law MR, Mamdani MM, Manns BJ, Martin D, Morgan SG, Oh PI, Pinto AD, Shah BR, Sullivan F, Umali N, Thorpe KE, Tu K, Laupacis A. Effect on Treatment Adherence of Distributing Essential Medicines at No Charge: The CLEAN Meds Randomized Clinical Trial. JAMA Intern Med 2020; 180:27-34. [PMID: 31589276 PMCID: PMC6784757 DOI: 10.1001/jamainternmed.2019.4472] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/12/2019] [Indexed: 11/14/2022]
Abstract
Importance Nonadherence to treatment with medicines is common globally, even for life-saving treatments. Cost is one important barrier to access, and only some jurisdictions provide medicines at no charge to patients. Objective To determine whether providing essential medicines at no charge to outpatients who reported not being able to afford medicines improves adherence. Design, Setting, and Participants A multicenter, unblinded, parallel, 2-group, superiority, outcomes assessor-blinded, individually randomized clinical trial conducted at 9 primary care sites in Ontario, Canada, enrolled 786 patients between June 1, 2016, and April 28, 2017, who reported cost-related nonadherence. Follow-up occurred at 12 months. The primary analysis was performed using an intention-to-treat principle. Interventions Patients were randomly allocated to receive free medicines on a list of essential medicines in addition to otherwise usual care (n = 395) or usual medicine access and usual care (n = 391). Main Outcomes and Measures The primary outcome was adherence to treatment with all medicines that were appropriately prescribed for 1 year. Secondary outcomes were hemoglobin A1c level, blood pressure, and low-density lipoprotein cholesterol levels 1 year after randomization in participants taking corresponding medicines. Results Among the 786 participants analyzed (439 women and 347 men; mean [SD] age, 51.7 [14.3] years), 764 completed the trial. Adherence to treatment with all medicines was higher in those randomized to receive free distribution (151 of 395 [38.2%]) compared with usual access (104 of 391 [26.6%]; difference, 11.6%; 95% CI, 4.9%-18.4%). Control of type 1 and 2 diabetes was not significantly improved by free distribution (hemoglobin A1c, -0.38%; 95% CI, -0.76% to 0.00%), systolic blood pressure was reduced (-7.2 mm Hg; 95% CI, -11.7 to -2.8 mm Hg), and low-density lipoprotein cholesterol levels were not affected (-2.3 mg/dL; 95% CI, -14.7 to 10.0 mg/dL). Conclusions and Relevance The distribution of essential medicines at no charge for 1 year increased adherence to treatment with medicines and improved some, but not other, disease-specific surrogate health outcomes. These findings could help inform changes to medicine access policies such as publicly funding essential medicines. Trial Registration ClinicalTrials.gov identifier: NCT02744963.
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Affiliation(s)
- Navindra Persaud
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael Bedard
- Department of Family Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Andrew S. Boozary
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
| | - Richard H. Glazier
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Stephen W. Hwang
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Jüni
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael R. Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Muhammad M. Mamdani
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Healthcare Analytics Research and Training, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Braden J. Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danielle Martin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
| | - Steven G. Morgan
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul I. Oh
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Andrew D. Pinto
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- The Upstream Lab, MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Baiju R. Shah
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Frank Sullivan
- Department of Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
- Division of Population and Behavioral Science, University of St Andrews, St Andrews, Scotland
| | - Norman Umali
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Kevin E. Thorpe
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Applied Health Research Centre, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andreas Laupacis
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Yaphe H, Adekoya I, Steiner L, Maraj D, O'Campo P, Persaud N. Exploring the experiences of people in Ontario, Canada who have trouble affording medicines: a qualitative concept mapping study. BMJ Open 2019; 9:e033933. [PMID: 31888944 PMCID: PMC6937130 DOI: 10.1136/bmjopen-2019-033933] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The experiences of people who report cost-related medicine non-adherence are not well documented. We aimed to present experiences relating to accessing medicines reported by the participants in a randomised controlled trial of free medicine distribution. METHODS The trial consisted of primary care patients from a large urban family practice and three rural family practices who reported cost-related medicine non-adherence. Participants were randomly allocated to continue their poor access (control) or to receive free and easily accessible medicines (intervention). As part of data collection for the first year of the trial, participants were asked closed and open-ended questions to assess their adherence to medication, health outcomes and their experiences in relation to medicine accessibility. We conducted a qualitative concept mapping study in which we analysed and summarised participants' responses to the open-ended question on a concept map to visually present their experiences relating to accessing medicines. RESULTS Of the 524 trial participants contacted, 198 (38%) responded to the open-ended question. The concept map contains clusters that represent eight types of experiences of participants related to medicine access including stress, relationship with doctor, health impact, quality of life, sacrificing other essentials, medicines are expensive, financial impact and adherence. These experiences fall under two major themes, experiences relating to personal finances and experiences relating to well-being, which are bridged by a central cluster of adherence. CONCLUSIONS The experiences shared by the participants demonstrate that access to medicines impacts people's finances and well-being as well as their adherence to prescribed medicines. These results indicate that effects on personal finances and general well-being should be measured for interventions and policy changes aimed at improving medicine access. TRIAL REGISTRATION NUMBER This article is linked to the Carefully Selected and Easily Accessible at No Charge Medicines (CLEAN Meds) randomised controlled trial (trial registration number: NCT02744963).
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Affiliation(s)
- Hannah Yaphe
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Itunuoluwa Adekoya
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Liane Steiner
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Darshanand Maraj
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Patricia O'Campo
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nav Persaud
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
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Chalachew T, Yadeta D, Tefera E. Factors associated with sub-optimal control of anticoagulation in patients with prosthetic heart valves taking oral anticoagulants in a sub-Saharan African setting. Cardiovasc J Afr 2019; 30:316-320. [PMID: 31140545 PMCID: PMC8802369 DOI: 10.5830/cvja-2019-024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/27/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Replacement of diseased valves reduces the morbidity and mortality rate associated with native valvular disease but comes at the expense of risking complications related to the implanted prosthetic device. Establishing the desired anticoagulation level in a sub-Saharan African setting may be a challenge. OBJECTIVES This study was conducted to determine the challenges of maintaining a desired level of anticoagulation and factors associated with sub-optimal anticoagulation in patients with prosthetic heart valves on chronic anticoagulation. METHODS We reviewed 73 patients who had undergone prosthetic valve replacement for chronic rheumatic valvular heart disease and were taking warfarin. The follow up ranged from one to 13 years. We studied international normalised ratio (INR) profiles of the patients for the six months preceding the study and defined optimal control as an INR of 2.5-3.5. We aimed to determine if there were factors associated with sub-optimal control of INR. RESULTS Forty-two patients (57.5%) were female. Mean age of the participants was 21.5 ± 3.1 years (range 14-25 years). Warfarin was the anticoagulant in 55 (75.3%) of the patients and 18 (24.7%) were on combined warfarin and aspirin anticoagulation. Thirty-five (47.9%) patients had optimal control of their INR. Educational level of primary school or less, distance from follow-up medical facility of more than 300 km, quarterly or less-frequent check-up visit, and public health institution as a source of free warfarin supply were found to be significantly associated with sub-optimal control of INR. CONCLUSIONS Educational level, distance from follow-up facility, number of follow-up visits and source of warfarin supply were found to be significantly associated with sub-optimal control of INR.
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Affiliation(s)
- Tigist Chalachew
- Department of Pediatrics and Child Health, School of Medicine, Hawassa University, Hawassa, Ethiopia
| | - Dejuma Yadeta
- Department of Internal Medicine, Division of Cardiology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Endale Tefera
- Department of Pediatrics and Adolescent Health, Division of Cardiology, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
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Fetensa G, Yadecha B, Tolossa T, Bekuma TT. Medication Adherence and Associated Factors among Chronic Heart Failure Clients on Follow Up Oromia Region, West Ethiopia. Cardiovasc Hematol Agents Med Chem 2019; 17:104-114. [PMID: 31629399 DOI: 10.2174/1871525717666191019162254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic heart failure is a complex clinical syndrome with typical symptoms that can occur at rest or on effort. It requires patients to manage their lifestyle with their disease and when to notify their healthcare provider. The study was aimed to identify medication adherence and associated factors among chronic heart failure clients on follow up Oromia region, West Ethiopia, 2017. METHODS Institutional based cross-sectional study design was employed, after selecting three hospitals by lottery method and allocating respondents to the three hospitals proportionally. A total of 424 patients were admitted to the medical ward and/or chronic follow up of Nekemte referral, Gimbi, and Shambu hospitals. The data was collected using a structured questionnaire. The data was entered into Epi-data version 3.1, cleared, explored, and then exported to SPSS windows version 24.0 for further analysis. Variable having a p-value less than 0.05 in the bivariate analysis was a candidate for multivariable analysis and the effect of confounding variables was observed. Variables having a p-value less than 0.05 in the multivariable analysis were assumed significant. RESULTS A total of 424 respondents were included in the final analysis giving a 95.3% response rate. The result indicated that more than half of the study participants have adhered to prescribed medication. Respondents with good medication adherence were more likely to adhere to good self-care behavior [AOR (95% CI of OR) = 3.5(2.044, 5.96)]. Respondents whose limited fluid intake was one or half-liter per day were more likely to adhere to the medication [AOR (95% CI of OR) = 2.5(1.43, 4.49)]. It was also found that those patients who avoided spices, sauces and others in food are more likely to adhere to the medication [AOR (95% CI of OR) = 2.2 (1.152, 4.039)]. CONCLUSION AND RECOMMENDATION Even if more than half of the study respondents have good medication and self-care adherence, still it needs great attention in health education over their visit. Health institutions are strongly recommended to give health education for clients and researchers to use advanced study design for measuring medication adherence and self-care behaviors.
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Affiliation(s)
- Getahun Fetensa
- School of Nursing and Midwifery, health science Wollega University, Nekemte, Ethiopia
| | - Birhanu Yadecha
- School of Nursing and Midwifery, health science Wollega University, Nekemte, Ethiopia
| | - Tadesse Tolossa
- School of Nursing and Midwifery, health science Wollega University, Nekemte, Ethiopia
| | - Tariku Tesfaye Bekuma
- School of Nursing and Midwifery, health science Wollega University, Nekemte, Ethiopia
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Singh K, Choudhry NK, Krumme AA, McKay C, McElwee NE, Kimura J, Franklin JM. A concept-wide association study to identify potential risk factors for nonadherence among prevalent users of antihypertensives. Pharmacoepidemiol Drug Saf 2019; 28:1299-1308. [PMID: 31313427 PMCID: PMC11293841 DOI: 10.1002/pds.4850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 06/04/2019] [Accepted: 06/07/2019] [Indexed: 11/07/2022]
Abstract
PURPOSE We sought to determine whether an association study using information contained in clinical notes could identify known and potentially novel risk factors for nonadherence to antihypertensive medications. METHODS We conducted a retrospective concept-wide association study (CWAS) using clinical notes to identify potential risk factors for medication nonadherence, adjusting for age, sex, race, baseline blood pressure, estimated glomerular filtration rate, and a combined comorbidity score. Participants included Medicare beneficiaries 65 years and older receiving care at the Harvard Vanguard Medical Associates network from 2010-2012 and enrolled in a Medicare Advantage program. Concepts were extracted from clinical notes in the year prior to the index prescription date for each patient. We tested associations with the outcome for 5013 concepts extracted from clinical notes in a derivation cohort (4382 patients) and accounted for multiple hypothesis testing by using a false discovery rate threshold of less than 5% (q < .05). We then confirmed the associations in a validation cohort (3836 patients). Medication nonadherence was defined using a proportion of days covered (PDC) threshold less than 0.8 using pharmacy claims data. RESULTS We found 415 concepts associated with nonadherence, which we organized into 11 clusters using a hierarchical clustering approach. Volume depletion and overload, assessment of needs at the point of discharge, mood disorders, neurological disorders, complex coordination of care, and documentation of noncompliance were some of the factors associated with nonadherence. CONCLUSIONS This approach was successful in identifying previously described and potentially new risk factors for antihypertensive nonadherence using the clinical narrative.
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Affiliation(s)
- Karandeep Singh
- Departments of Learning Health Sciences and Internal Medicine, University of Michigan Medical School and University of Michigan School of Information, Ann Arbor, MI
| | - Niteesh K. Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Alexis A. Krumme
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | | | | | - Joe Kimura
- Atrius Health and Harvard Medical School, Boston, MA
| | - Jessica M. Franklin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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Lin JK, Moran AE, Bibbins-Domingo K, Falase B, Pedroza Tobias A, Mandke CN, Kazi DS. Cost-effectiveness of a fixed-dose combination pill for secondary prevention of cardiovascular disease in China, India, Mexico, Nigeria, and South Africa: a modelling study. LANCET GLOBAL HEALTH 2019; 7:e1346-e1358. [PMID: 31477544 DOI: 10.1016/s2214-109x(19)30339-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/28/2019] [Accepted: 07/22/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Fewer than 25% of patients with atherosclerotic cardiovascular disease in countries of low and middle income (LMICs) use guideline-directed drugs for secondary prevention. A fixed-dose combination polypill might improve cardiovascular outcomes by increasing prescription rates and adherence, but the cost-effectiveness of this approach is uncertain. METHODS We developed microsimulation models to assess the cost-effectiveness of a polypill containing aspirin, lisinopril, atenolol, and simvastatin for secondary prevention of atherosclerotic cardiovascular disease compared with current care in China, India, Mexico, Nigeria, and South Africa. We modelled baseline use of secondary prevention drugs on the Prospective Urban Rural Epidemiological study. In the intervention arm, we assumed that patients currently prescribed any prevention drug for atherosclerotic cardiovascular disease would receive the polypill instead, which would improve adherence by 32% (from a meta-analysis of two randomised trials in LMICs). We assessed the cost-effectiveness of the polypill at prices in the public sector and on the retail market. Key outcomes were major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) over a 5-year period and the incremental cost-effectiveness ratio (ICER) from the perspective of the health-care sector and a lifetime analytical horizon. We assumed a cost-effectiveness threshold equal to each country's per capita gross domestic product (GDP) per disability-adjusted life-year (DALY) averted. In sensitivity analyses, we examined the population health effect achievable by increasing the uptake of the polypill in the eligible population. FINDINGS Among adults aged 30-84 years with established atherosclerotic cardiovascular disease, adoption of the polypill for secondary prevention compared with current care was projected to avert 40-54 major adverse cardiovascular events for every 1000 patients treated for 5 years and produce between three and ten additional serious adverse events. Assuming public-sector pharmaceutical prices, the ICER of the polypill compared with current care over a lifetime analytical horizon was Int$168 (95% UI 55 to 337) per DALY averted in China, $154 (57 to 289) in India, $88 (15 to 193) in Mexico, $364 (147 to 692) in Nigeria, and $64 (cost-saving to 203) in South Africa, amounting to 0·4-6·2% of the per capita GDP in these countries. The ICER of the polypill compared with current care increased to 3·3-14·6% of the per capita GDP at retail market pharmaceutical prices. Use of the polypill at current rates of prescription of secondary prevention drugs would produce modest health benefits, reducing DALYs from atherosclerotic cardiovascular disease among patients with established disease by 3·1-10·1% over 10 years. Increasing use to 50% or 75% of the eligible population would produce substantially larger health gains (up to 24·3% atherosclerotic cardiovascular disease DALYs averted). INTERPRETATION The polypill is projected to be cost-effective compared with current care for secondary prevention of atherosclerotic cardiovascular disease in China, India, Mexico, Nigeria, and South Africa, particularly if it is made available at public-sector pricing. However, achieving meaningful improvements in cardiovascular health will require simultaneous investments in health infrastructure to increase the uptake of the polypill among patients with established atherosclerotic cardiovascular disease. FUNDING Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Hellman Family Foundation, Department of Veterans Affairs, and University of California at San Francisco.
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Affiliation(s)
- John K Lin
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Primary Care Outcomes Research, Stanford University, Stanford, CA, USA
| | - Andrew E Moran
- Division of General Medicine, Columbia University Medical Center and College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA; Center for Vulnerable Populations, University of California at San Francisco, San Francisco, CA, USA
| | - Bode Falase
- Cardiothoracic Division, Department of Surgery, Lagos State University College of Medicine, Lagos, Nigeria
| | - Andrea Pedroza Tobias
- Global Health Sciences, University of California at San Francisco, San Francisco, CA, USA; Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Charuta N Mandke
- H B T Medical College, and Dr R N Cooper Hospital, Mumbai, India
| | - Dhruv S Kazi
- Richard A and Susan F Smith Center for Outcomes Research in Cardiology, and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Desai R, Thakkar S, Fong HK, Varma Y, Ali Khan MZ, Itare VB, Raina JS, Savani S, Damarlapally N, Doshi RP, Gangani K, Sitammagari K. Rising Trends in Medication Non-compliance and Associated Worsening Cardiovascular and Cerebrovascular Outcomes Among Hospitalized Adults Across the United States. Cureus 2019; 11:e5389. [PMID: 31482043 PMCID: PMC6701890 DOI: 10.7759/cureus.5389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction Small-scale studies have described concerning rates of non-compliance/nonadherence towards groups of medications for primary and secondary prevention. Trends in cardiovascular and cerebrovascular events (CCE) among hospitalized patients with a non-compliant behavior towards medication, on the whole, remains unexplored on a large scale. Methods Using the National Inpatient Sample databases (2007-2014), we sought to assess the prevalence and trends in all-cause mortality and CCE in adult patients hospitalized with medication non-compliance. We compared baseline characteristics and comorbidities in the non-compliant patients with and without concomitant in-hospital CCE. Results We identified 7,453,831 adult hospitalizations with medication non-compliance from 2007 to 2014, of which 867,997 (11.6%) patients demonstrated in-hospital CCE. Non-compliant patients with CCE consisted of a higher number of older, white, male patients having greater comorbid risk factors. Non-compliant patients with CCE had higher all-cause in-hospital mortality (3% vs. 0.7%), frequent transfers [4.4% vs. 1.8% transfers to short-term hospitals, and 17.6% vs. 11.6% other transfers (skilled nursing or intermediate care facilities)], lower routine discharges (59.4% vs. 71.1%), and higher mean hospital charges ($52,740 vs. $30,748) compared to non-compliant patients without CCE. Remarkably, this study demonstrates the rising trend in medication non-compliance across all age, sex, and race groups, and related in-hospital mortality, CCE, transfers to other facilities, and the health care cost from 2007 to 2014. Conclusions We observed rising trends in the prevalence of medication non-compliance and subsequent in-hospital mortality in hospitalizations among adults from 2007 to 2014. Non-compliant patients with inpatient CCE demonstrated rising trends in all-cause mortality, complications, health care utilization, and cost from 2007 to 2014.
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Affiliation(s)
- Rupak Desai
- Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, USA
| | | | - Hee Kong Fong
- Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, USA
| | - Yash Varma
- Internal Medicine, Government Medical College, Bhavnagar, IND
| | - Mir Z Ali Khan
- Internal Medicine, Saint Peters University Hospital, New Brunswick, USA
| | - Vikram B Itare
- Internal Medicine, Smolensk State Medical University, Smolensk, RUS
| | - Jilmil S Raina
- Internal Medicine, Smolensk State Medical University, Smolensk, RUS
| | - Sejal Savani
- Public Health, New York University, New York, USA
| | | | - Rajkumar P Doshi
- Internal Medicine, University of Nevada, Reno School of Medicine, Reno, USA
| | - Kishorbhai Gangani
- Internal Medicine, Texas Health Arlington Memorial Hospital, Arlington, USA
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Boulle P, Sibourd-Baudry A, Ansbro É, Prieto Merino D, Saleh N, Zeidan RK, Perel P. Cardiovascular Disease among Syrian refugees: a descriptive study of patients in two Médecins Sans Frontières clinics in northern Lebanon. Confl Health 2019; 13:37. [PMID: 31413727 PMCID: PMC6688221 DOI: 10.1186/s13031-019-0217-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/09/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Literature on the burden and management of atherosclerotic cardiovascular disease (ASCVD) in humanitarian settings is limited. This study aimed to describe patient characteristics and explore both service use and use of recommended secondary prevention drugs in Syrian refugee patients with ASCVD attending two Médecins Sans Frontières (MSF) clinics in Lebanon. METHODS This study comprised a cross-sectional survey of ASCVD patients attending either MSF clinic over a four-week period in early 2017. Using descriptive statistics, we explored patient demographic characteristics, cardiovascular risk factors and assessed ASCVD secondary prevention medication prescription and patient adherence with a 7-day self-report scale. A retrospective study of routine clinical data explored workload and trends in patient loss to follow-up. We performed logistic regression modelling to explore risk factors for loss to follow-up. RESULTS We included 514 patients with ASCVD in the cross-sectional study, performed in 2017. Most (61.9%) were male and mean age was 60.4 years (95% CI, 59.6-61.3). Over half (58.8%) underwent revascularization and 26.1% had known cerebrovascular disease. ASCVD risk factors included 51.8% with diabetes and 72.2% with hypertension. While prescription (75.7 to 98.2%) and self-reported adherence rates (78.4 to 93.9%) for individual ASCVD secondary prevention drugs (ACE-inhibitor, statin and antiplatelet) were high, the use of all three was low at 41.3% (CI95%: 37.0-45.6). The 5-year retrospective cohort study (ending April 2017) identified 1286 patients with ASCVD and 16,618 related consultations (comprising 24% of all NCD consultations). Over one third (39.7%) of patients were lost to follow-up, with lower risk among men. CONCLUSIONS The burden of ASCVD within MSF clinics in Lebanon is substantial. Although prescription and adherence of individual secondary prevention drugs is acceptable, overall use of the three recommended drugs is suboptimal. Loss to follow-up rates were high. Further studies are needed to evaluate innovative strategies to increase the use of the multiple recommended drugs, and to increase the retention of patients with ASCVD in the care system.
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Affiliation(s)
| | | | - Éimhín Ansbro
- Department of Noncommunicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - David Prieto Merino
- Department of Noncommunicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Nadine Saleh
- Epidemiology and Biostatistics Department, Faculty of Public Health II, Lebanese University, Beirut, Lebanon
| | - Rouba Karen Zeidan
- Doctoral School of Science and Technology, Lebanese University, Beirut, Lebanon
| | - Pablo Perel
- Department of Noncommunicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Sanders CJ, Lindenmeyer A, Marriott J. A meta-ethnography of adult smokers' exploring the meanings of tobacco dependency medications adherence behaviours during smoking cessation. J Adv Nurs 2019; 75:3286-3298. [PMID: 31287166 DOI: 10.1111/jan.14146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 03/27/2019] [Accepted: 04/30/2019] [Indexed: 12/01/2022]
Abstract
AIMS To synthesize the experiences and adherence of adult smokers' with tobacco dependence medications. DESIGN Meta-ethnography. DATA SOURCES Seven bibliographic databases were systematically searched until April 2016. REVIEW METHODS A standardized appraisal tool evaluated the quality of the selected studies. RESULTS Seven studies met the eligibility criteria. Three major themes described the experiences and adherence of adult smokers' with tobacco dependence medications; the psychosocial context, predilection for willpower and "natural" methods and a tendency to resist medications. CONCLUSION The findings of this meta-ethnography are important to future clinical practice guideline development so health professionals contribute effectively to further reduction in smoking prevalence. Further research is needed to understand resistance to tobacco dependence medications and to inform the design of person-tailored interventions to improve tobacco dependence medication adherence that can be incorporated into smoking cessation interventions. IMPACT Smoking causes more death and disability in the world than any other avoidable factor. Research on smoker perspectives on tobacco dependence medications is sparse. Tobacco dependency is a unique treatment context with specific adherence issues. Smokers are active decision-makers regarding tobacco dependence medications. Inconsistent adherence to tobacco dependency medication regimens was apparent. Implications for health professionals, healthcare policy and clinical practice guidelines regard the structure of consultations with smoking patients. It is critical for all health professionals to assess the person seeking to stop smoking and foresee the possible causes of non-adherence behaviour. Addressing non-adherence will to lead to more effective health communications and positively contribute to quality of smoking cessation care.
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Affiliation(s)
- Carol Jane Sanders
- College of Medical and Dental Sciences, School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Antje Lindenmeyer
- Murray Learning Centre, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - John Marriott
- College of Medical and Dental Sciences, School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Massy ZA, Ferrières J, Bruckert E, Lange C, Liabeuf S, Velkovski-Rouyer M, Stengel B. Achievement of Low-Density Lipoprotein Cholesterol Targets in CKD. Kidney Int Rep 2019; 4:1546-1554. [PMID: 31890996 PMCID: PMC6933478 DOI: 10.1016/j.ekir.2019.07.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/14/2019] [Accepted: 07/22/2019] [Indexed: 01/22/2023] Open
Abstract
Introduction We describe the characteristics of patients with moderate/advanced chronic kidney disease (CKD) according to receipt of lipid-lowering therapy (LLT), and whether they achieved low-density lipoprotein cholesterol (LDL-C) targets for high- and very high-risk patients. Methods CKD-REIN (NCT03381950), a prospective cohort study conducted in 40 nephrology clinics in France, enrolled 3033 patients with moderate (stage G3) or advanced (stage G4/G5) CKD (2013-2016) who had not been on chronic dialysis or undergone kidney transplantation. Data were collected from patients' interviews and medical records. Patients were followed up at 1 year. Results Among 2542 patients (mean [SD] age 67 [13] years, 34% women) with LDL-C measurements at baseline (mean [SD] LDL-C 2.7 [1.1] mmol/l; cholesterol 4.8 [1.3] mmol/l), 63% were on LLT; 24% were at high (CKD stage G3, no cardiovascular disease [CVD] or diabetes) and 74% at very high (CKD stage G3 with diabetes or CVD, or CKD stage G4/5) cardiovascular risk. Among high-risk patients, 45% of those on statin and/or ezetimibe achieved the LDL-C treatment target (<2.6 mmol/l). Among very high-risk patients, the percentage at goal (<1.8 mmol/l) was 38% for CKD stage G3 and 29% for stage G4/5. There was a trend toward higher achievement of LDL-C targets with increasing LLT intensity (adjusted odds ratios for moderate vs. low intensity 1.20; 95% confidence interval 0.92-1.56; high vs. low intensity 1.46; 1.02-2.09; P trend = 0.036). Conclusion Many patients with CKD stage G3-G5 who are eligible for LLT are not treated, and those on LLT rarely achieve LDL-C targets.
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Affiliation(s)
- Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), Inserm UMRS 1018, Villejuif, France.,University of Versailles-Saint Quentin, Univ Paris-Saclay, Villejuif, France.,Department of Nephrology, CHU Ambroise Paré, APHP, Boulogne, France
| | - Jean Ferrières
- Department of Cardiology, Toulouse Rangueil University Hospital (CHU), Toulouse, France.,Department of Epidemiology and Public Health, UMR INSERM 1027, INSERM - Université de Toulouse, Toulouse, France
| | - Eric Bruckert
- Service d'Endocrinologie métabolisme et prévention cardiovasculaire, Unité fonctionnelle d'Aphérèse, Institut E3M et IHU cardiométabolique, Hôpital Pitié Salpêtrière, Paris, France
| | - Céline Lange
- Agence de Biomédecine, La Plaine-Saint Denis, France
| | - Sophie Liabeuf
- Pharmacology Department, Amiens University Hospital, Amiens, France
| | | | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health (CESP), Inserm UMRS 1018, Villejuif, France.,Univ Paris-Sud, Univ Paris-Saclay, Villejuif, France
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Macquart de Terline D, Kane A, Kramoh KE, Ali Toure I, Mipinda JB, Diop IB, Nhavoto C, Balde DM, Ferreira B, Dèdonougbo Houenassi M, Ikama MS, Kingue S, Kouam Kouam C, Takombe JL, Limbole E, Mfeukeu Kuate L, N’guetta R, Damorou JM, Sesso Z, Sidy Ali A, Perier MC, Azizi M, Empana JP, Jouven X, Antignac M. Factors associated with poor adherence to medication among hypertensive patients in twelve low and middle income Sub-Saharan countries. PLoS One 2019; 14:e0219266. [PMID: 31291293 PMCID: PMC6619761 DOI: 10.1371/journal.pone.0219266] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/19/2019] [Indexed: 01/04/2023] Open
Abstract
Introduction Over the past few decades, the prevalence of hypertension has dramatically increased in Sub-Saharan Africa. Poor adherence has been identified as a major cause of failure to control hypertension. Scarce data are available in Africa. Aims We assessed adherence to medication and identified socioeconomics, clinical and treatment factors associated with low adherence among hypertensive patients in 12 sub-Saharan African countries. Method We conducted a cross-sectional survey in urban clinics of both low and middle income countries. Data were collected by physicians on demographics, treatment and clinical data among hypertensive patients attending the clinics. Adherence was assessed by questionnaires completed by the patients. Factors associated with low adherence were investigated using logistic regression with a random effect on countries. Results There were 2198 individuals from 12 countries enrolled in the study. Overall, 678 (30.8%), 738 (33.6%), 782 (35.6%) participants had respectively low, medium and high adherence to antihypertensive medication. Multivariate analysis showed that the use of traditional medicine (OR: 2.28, 95%CI [1.79–2.90]) and individual wealth index (low vs. high wealth: OR: 1.86, 95%CI [1.35–2.56] and middle vs. high wealth: OR: 1.42, 95%CI [1.11–1.81]) were significantly and independently associated with poor adherence to medication. In stratified analysis, these differences in adherence to medication according to individual wealth index were observed in low-income countries (p<0.001) but not in middle-income countries (p = 0.17). In addition, 26.5% of the patients admitted having stopped their treatment due to financial reasons and this proportion was 4 fold higher in the lowest than highest wealth group (47.8% vs 11.4%) (p<0.001). Conclusion This study revealed the high frequency of poor adherence in African patients and the associated factors. These findings should be useful for tailoring future programs to tackle hypertension in low income countries that are better adapted to patients, with a potential associated enhancement of their effectiveness.
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Affiliation(s)
- Diane Macquart de Terline
- Department of Pharmacy, Saint Antoine hospital, HUEP, AP-HP, Paris, France
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
- Paris Descartes University, Paris, France
- * E-mail:
| | - Adama Kane
- Cardiology Department, University Hospital of Aristide Le Dantec, Dakar, Senegal
| | | | - Ibrahim Ali Toure
- Internal Medicine and Cardiology Department, University Hospital of Lamorde, Niamey, Niger
| | | | | | | | - Dadhi M. Balde
- Department of Cardiology, University Hospital of Conakry, Conakry, Guinea
| | | | | | - Méo Stéphane Ikama
- Cardiology Department, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville, Congo
| | - Samuel Kingue
- University of Yaoundé, Ministry of Public Health, Yaoundé, Cameroon
| | | | | | - Emmanuel Limbole
- Department of Internal Medicine of la Gombe (CMCG), Department of Internal Medicine, Ngaliema Hospital, Kinshasa; Democratic Republic of the Congo
| | | | | | | | | | | | - Marie-Cécile Perier
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
| | - Michel Azizi
- Paris Descartes University, Paris, France
- Hypertension Unit, Assistance-Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
- Institut National de la Santé et de la Recherche Médicale, Centre d’Investigation Clinique, Paris, France
| | - Jean Philippe Empana
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
| | - Xavier Jouven
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
- Paris Descartes University, Paris, France
- Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - Marie Antignac
- Department of Pharmacy, Saint Antoine hospital, HUEP, AP-HP, Paris, France
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
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Santo K, Singleton A, Chow CK, Redfern J. Evaluating Reach, Acceptability, Utility, and Engagement with An App-Based Intervention to Improve Medication Adherence in Patients with Coronary Heart Disease in the MedApp-CHD Study: A Mixed-Methods Evaluation. Med Sci (Basel) 2019; 7:medsci7060068. [PMID: 31167489 PMCID: PMC6631463 DOI: 10.3390/medsci7060068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/27/2019] [Accepted: 05/31/2019] [Indexed: 12/03/2022] Open
Abstract
Objective: The aim of this study was to assess the reach, acceptability, utility, and engagement with the apps that were used in the MEDication reminder APPlications (apps) to improve medication adherence in Coronary Heart Disease (MedApp-CHD) study, a randomised clinical trial to improve medication adherence, using a mixed-methods approach. Methods: The MedApp-CHD study randomised 163 patients with coronary heart disease (CHD) to one of three groups: (i) usual care (n = 56), (ii) a basic medication reminder app (n = 54), or (iii) an advanced medication reminder app (n = 53). For this mixed-methods evaluation, the data sources included patient screening logs, feedback questionnaires collected at three-month follow-up, focus groups discussions, and analytical data from the app software. Results: Ninety-four percent (98/104) of participants who received a medication reminder app completed the three-month feedback questionnaire and 15 participated in the focus group discussions. The themes that were identified included that participants (i) found the medication reminders useful in reminding them to take the medications on the correct time every day, (ii) liked having the medication list as an easily-accessible record of medications’ names and dosages, (iii) reported being likely to continue to use the apps after the study completion, (iv) would be likely to recommend the apps to their family and friends, and (v) those who used the clinical measurements feature found it useful as a tool to track and graph the blood pressure and glucose levels over time (especially those with diabetes and/or hypertension). In addition, analytical data from the app software demonstrated that the participants used the medication-related features more than the clinical measurements feature. Furthermore, data from the patient screening logs showed that the main reason for exclusion, other than not meeting the CHD criteria, was not having a suitable smartphone, and those that were excluded for this reason were older and had a higher proportion of females than those enrolled in the study. Conclusion: This study provides important insights regarding the features that are most useful in apps that aim to improve medication adherence. This mixed-methods evaluation suggests that, currently, young male patients with CHD are more likely to use such apps, that the apps were well-accepted and useful in reminding the patients to take the medications, and that the patients were engaged in regularly using the apps.
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Affiliation(s)
- Karla Santo
- Westmead Applied Research Centre, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2145, Australia.
- The George Institute for Global Health, Sydney, NSW 2050, Australia.
| | - Anna Singleton
- Westmead Applied Research Centre, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2145, Australia.
| | - Clara K Chow
- Westmead Applied Research Centre, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2145, Australia.
- The George Institute for Global Health, Sydney, NSW 2050, Australia.
- Westmead Hospital, Cardiology Department, Sydney, NSW 2145, Australia.
| | - Julie Redfern
- Westmead Applied Research Centre, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2145, Australia.
- The George Institute for Global Health, Sydney, NSW 2050, Australia.
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Al-Ganmi AHA, Al-Fayyadh S, Abd Ali MBH, Alotaibi AM, Gholizadeh L, Perry L. Medication adherence and predictive factors in patients with cardiovascular disease: A comparison study between Australia and Iraq. Collegian 2019. [DOI: 10.1016/j.colegn.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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41
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Cardoso PC, Gussatschenko Caballero L, Brasil Ruschel K, Pereira de Moraes MA, Rabelo da Silva ER. Profile of the nursing diagnoses in stable heart disease patients. INVESTIGACION Y EDUCACION EN ENFERMERIA 2019; 37:e08. [PMID: 31487445 PMCID: PMC7871490 DOI: 10.17533/udea.iee.v37n2e08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 06/04/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To identify the nursing diagnoses through reports in the medical records of patients monitored in a specialized ischemic heart disease outpatient clinic. METHODS Cross-sectional study with retrospective data collection in the medical records. From the data collected, the nursing diagnoses were proposed by the researchers and submitted for validation by specialist cardiology nurses. RESULTS A total of 13 nursing diagnoses were evaluated from the medical records of 50 outpatients with the following validation agreements among the specialists: Ineffective health management (100%), Noncompliance (100%), Sedentary lifestyle (100%), Activity intolerance (100%), Decreased cardiac output (88%), Risk of decreased cardiac tissue perfusion (65%), Risk of intolerance to activity (65%), Acute pain (76%), Ineffective health maintenance (65%), Risk-prone health behavior (65%), Risk for decreased cardiac output (65%), Risk for intolerance to activity (65%), Ineffective respiratory pattern (53%), Impaired memory (29%). CONCLUSIONS In this study, the nursing diagnoses validated for stable heart disease patients were linked to adherence to treatment and to the cardiovascular responses of the patients, reinforcing the importance of early intervention. These results allow the multidisciplinary team to individualize the goals and interventions proposed for ischemic heart disease patients.
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Affiliation(s)
| | | | - Karen Brasil Ruschel
- Institute for Health Technology Assessment, Federal University of Rio Grande do Sul, Brazil,
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The dynamics of patients’ attendance at outpatient clinics after acute coronary syndrome: The data of LISS-3 registry. ADVANCES IN INTEGRATIVE MEDICINE 2019. [DOI: 10.1016/j.aimed.2018.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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43
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Leslie KH, McCowan C, Pell JP. Adherence to cardiovascular medication: a review of systematic reviews. J Public Health (Oxf) 2019; 41:e84-e94. [PMID: 29850883 PMCID: PMC6459362 DOI: 10.1093/pubmed/fdy088] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/21/2018] [Accepted: 05/03/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Use of cardiovascular medication has increased over time, especially for primary and secondary prevention, with polypharmacy common. METHODS Review of published systematic reviews of the factors and outcomes associated with adherence to cardiovascular medication using MEDLINE, Embase, CINAHL and PsycINFO databases. Quality was assessed using the AMSTAR tool. RESULTS Of 789 systematic reviews identified, 45 met the inclusion criteria and passed the quality assessment; 34 focused on factors associated with adherence, and 11 on outcomes. High heterogeneity, both between and within reviews, precluded meta-analysis and so a pooled estimate of adherence levels could not be derived. Adherence was associated with disease factors, therapy factors, healthcare factors, patient factors and social factors, though with some inconsistencies. In total, 91% of reviews addressing outcomes reported that low adherence was associated with poorer clinical and economic endpoints. CONCLUSIONS Factors from across five key domains relate to non-adherence to cardiovascular medications, and may contribute to poorer clinical outcomes. Interventions to improve adherence should be developed to address modifiable factors and targeted at those at highest risk of non-adherence. Adherence research is highly heterogeneous to-date and efforts to standardize this should be implemented to improve comparability.
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Affiliation(s)
- K H Leslie
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, UK
| | - C McCowan
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, Glasgow, UK
| | - J P Pell
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, UK
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Santo K, Singleton A, Rogers K, Thiagalingam A, Chalmers J, Chow CK, Redfern J. Medication reminder applications to improve adherence in coronary heart disease: a randomised clinical trial. Heart 2018; 105:323-329. [PMID: 30150326 DOI: 10.1136/heartjnl-2018-313479] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 08/01/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The aim of the MEDication reminder APPs to improve medication adherence in Coronary Heart Disease Study was to evaluate the effectiveness and feasibility of using publicly available high-quality medication reminder applications (apps) to improve medication adherence compared with usual care in patients with coronary heart disease (CHD). An additional aim was to examine whether an app with additional features improved adherence further. METHODS Patients with CHD (n=163) were randomised to one of three groups: (1) usual care, (2) a basic app or (3) an advanced app with interactive/customisable features. The primary analysis compared usual care versus app use on the primary outcome of the 8-item Morisky Medication Adherence Scale (MMAS-8) at 3 months. Secondary outcomes included blood pressure and cholesterol levels. RESULTS The mean age was 57.9 years and 87.7% were male. At 3 months, patients using an app had higher adherence (mean MMAS-8 score 7.11) compared with the usual care group (mean MMAS-8 score 6.63) with a mean difference between groups of 0.47 (95% CI 0.12 to 0.82, p=0.008). There was no significant difference in patients using the basic app versus the advanced app (mean difference -0.16, 95% CI -0.56 to 0.24, p=0.428). There were no significant differences in secondary clinical outcome measures. CONCLUSION Patients with CHD who used medication reminder apps had better medication adherence compared with usual care, and using apps with additional features did not improve this outcome further. These data suggest medication apps are likely to help patients with chronic health conditions adhere to medicines, but further examination of whether such benefits are sustained is warranted. CLINICAL TRIAL REGISTRATION NUMBER ACTRN12616000661471; Results.
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Affiliation(s)
- Karla Santo
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia.,Westmead Applied Research Centre, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Anna Singleton
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Westmead Applied Research Centre, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kris Rogers
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Aravinda Thiagalingam
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Westmead Applied Research Centre, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Cardiology Department, Westmead Hospital, Sydney, New South Wales, Australia.,Cardio-respiratory Division, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - John Chalmers
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Clara K Chow
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Cardiology Department, Westmead Hospital, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia.,Westmead Applied Research Centre, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Julie Redfern
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia.,Westmead Applied Research Centre, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Qanitha A, Uiterwaal CSPM, Henriques JPS, Mappangara I, Idris I, Amir M, de Mol BAJM. Predictors of medium-term mortality in patients hospitalised with coronary artery disease in a resource-limited South-East Asian setting. Open Heart 2018; 5:e000801. [PMID: 30057767 PMCID: PMC6059341 DOI: 10.1136/openhrt-2018-000801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/24/2018] [Accepted: 06/13/2018] [Indexed: 01/30/2023] Open
Abstract
Objective To measure medium-term outcomes and determine the predictors of mortality in patients with coronary artery disease (CAD) both during and after hospitalisation in a resource-limited South-East Asian setting. Methods From February 2013 to December 2014, we conducted a prospective observational cohort study of 477 patients admitted to Makassar Cardiac Center, Indonesia, with acute coronary syndrome and stable CAD. We actively obtained data on clinical outcomes and after-discharge management until April 2017. Multivariable Cox proportional hazard analysis was performed to examine predictors for our primary outcome, all-cause mortality. Results From hospital admission, patients were followed over a median of 18 (IQR 6-36) months; in total 154 (32.3%) patients died. More patients with acute myocardial infarction died in the hospital compared with patients with unstable and stable angina (p=0.002). Over the total follow-up, there was a difference in mortality between non-ST-segment elevation myocardial infarction (n=41, 48.2%), ST-segment elevation myocardial infarction (n=65, 30.8%), unstable angina (n=18, 26.5%) and stable coronary artery disease (n=30, 26.5%) groups (p=0.007). The independent predictors of all-cause mortality were hyperglycaemia on admission (HR 1.55 (95% CI 1.12 to 2.14), p=0.008), heart failure/Killip class ≥2 (HR 2.50 (95% CI 1.76 to 3.56), p<0.001), estimated glomerular filtration rate <60 mL/min (HR 1.77 (95% CI 1.26 to 2.50), p=0.001), no revascularisation (percutaneous coronary intervention/coronary artery bypass grafting) (HR 2.38 (95% CI 1.31 to 4.33), p=0.005) and poor adherence to after-discharge medications (HR 10.28 (95% CI 5.52 to 19.16), p<0.001). Poor medication adherence predicted postdischarge mortality and did so irrespective of underlying CAD diagnosis (p interaction=0.88). Conclusions Patients with CAD in a poor South-East Asian setting experience high in-hospital and medium-term mortality. The initial severity of the disease, lack of access to guidelines-recommended therapy and poor adherence to after-discharge medications are the main drivers for excess mortality. Improved access to early and late hospital care and patient education should be prioritised for better survival.
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Affiliation(s)
- Andriany Qanitha
- Department of Cardio-thoracic Surgery, AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Physiology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Jose P S Henriques
- Department of Cardiology, AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Idar Mappangara
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Irfan Idris
- Department of Physiology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Muzakkir Amir
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Bastianus A J M de Mol
- Department of Cardio-thoracic Surgery, AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Nguyen T, Nguyen TH, Nguyen PT, Tran HT, Nguyen NV, Nguyen HQ, Ha BN, Pham TT, Taxis K. Pharmacist-Led Intervention to Enhance Medication Adherence in Patients With Acute Coronary Syndrome in Vietnam: A Randomized Controlled Trial. Front Pharmacol 2018; 9:656. [PMID: 29977205 PMCID: PMC6021484 DOI: 10.3389/fphar.2018.00656] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/31/2018] [Indexed: 11/21/2022] Open
Abstract
Background: Patient adherence to cardioprotective medications improves outcomes of acute coronary syndrome (ACS), but few adherence-enhancing interventions have been tested in low-income and middle-income countries. Objectives: We aimed to assess whether a pharmacist-led intervention enhances medication adherence in patients with ACS and reduces mortality and hospital readmission. Methods: We conducted a randomized controlled trial in Vietnam. Patients with ACS were recruited, randomized to the intervention or usual care prior to discharge, and followed 3 months after discharge. Intervention patients received educational and behavioral interventions by a pharmacist. Primary outcome was the proportion of adherent patients 1 month after discharge. Adherence was a combined measure of self-reported adherence (the 8–item Morisky Medication Adherence Scale) and obtaining repeat prescriptions on time. Secondary outcomes were (1) the proportion of patients adherent to medication; (2) rates of mortality and hospital readmission; and (3) change in quality of life from baseline assessed with the European Quality of Life Questionnaire – 5 Dimensions – 3 Levels at 3 months after discharge. Logistic regression was used to analyze data. Registration: ClinicalTrials.gov (NCT02787941). Results: Overall, 166 patients (87 control, 79 intervention) were included (mean age 61.2 years, 73% male). In the analysis excluding patients from the intervention group who did not receive the intervention and excluding all patients who withdrew, were lost to follow-up, died or were readmitted to hospital, a greater proportion of patients were adherent in the intervention compared with the control at 1 month (90.0% vs. 76.5%; adjusted OR = 2.77; 95% CI, 1.01–7.62) and at 3 months after discharge (90.2% vs. 77.0%; adjusted OR = 3.68; 95% CI, 1.14–11.88). There was no significant difference in median change of EQ-5D-3L index values between intervention and control [0.000 (0.000; 0.275) vs. 0.234 (0.000; 0.379); p = 0.081]. Rates of mortality, readmission, or both were 0.8, 10.3, or 11.1%, respectively; with no significant differences between the 2 groups. Conclusion: Pharmacist-led interventions increased patient adherence to medication regimens by over 13% in the first 3 months after ACS hospital discharge, but not quality of life, mortality and readmission. These results are promising but should be tested in other settings prior to broader dissemination.
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Affiliation(s)
- Thang Nguyen
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Thao H Nguyen
- Department of Clinical Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Phu T Nguyen
- Department of Clinical Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Ha T Tran
- Department of Clinical Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Ngoc V Nguyen
- Department of Clinical Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Hoa Q Nguyen
- Department of Clinical Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Ban N Ha
- Heart Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tam T Pham
- Faculty of Public Health, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Katja Taxis
- Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
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Mongkhon P, Ashcroft DM, Scholfield CN, Kongkaew C. Hospital admissions associated with medication non-adherence: a systematic review of prospective observational studies. BMJ Qual Saf 2018; 27:902-914. [DOI: 10.1136/bmjqs-2017-007453] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 03/19/2018] [Accepted: 03/24/2018] [Indexed: 11/04/2022]
Abstract
BackgroundMedication non-adherence in ambulatory care has received substantial attention in the literature, but less so as it affects acute care. Accordingly, we aimed to estimate the frequency with which non-adherence to medication contributes to hospital admissions.MethodsWe searched the Cochrane Library, EMBASE, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts and PubMed (until December 2017) to identify prospective observational studies that examined prevalence rates of hospital admissions associated with medication non-adherence. A quality assessment was performed using an expanded Crombie checklist. Data extraction covered patterns, circumstances, and patient and other key characteristics of non-adherence. Pooled estimates were obtained using a random-effect model.ResultsOf 24 included studies, 8 were undertaken in North America, 7 from Europe, 6 from Asia and 3 from Australia. Most studies (79%) were rated as low risk of bias. All but three studies used combination measures to detect non-adherence, but approaches to assess preventability varied considerably. Across the studies, there was high heterogeneity among prevalence estimates (χ2=548, df 23, p<0.001, I2=95.8%). The median prevalence rate of hospital admissions associated with non-adherence was 4.29% (IQR 3.22%–7.49%), with prevalence rates ranging from 0.72% to 10.79%. By definition, almost all of these admissions were considered preventable. The underlying causes contributing to these admissions included medication cost and side effects, and non-adherence most often involved cardiovascular medicines.ConclusionsHospital admissions associated with non-adherence to medication are a common problem. This systematic review highlights important targets for intervention. Greater attention could be focused on adherence to medication during the hospital stay as part of an enhanced medication reconciliation process. Standardisation in study methods and definitions is needed to allow future comparisons among settings; future studies should also encompass emerging economies.
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Saglam-Aydinatay B, Uysal S, Taner T. Facilitators and barriers to referral compliance among dental patients with increased risk of obstructive sleep apnea. Acta Odontol Scand 2018; 76:86-91. [PMID: 28984173 DOI: 10.1080/00016357.2017.1386797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Our aims were to determine the adherence rate to dentist referrals for sleep apnea evaluation and the barriers and facilitators to referral compliance. MATERIAL AND METHODS A sample of 1099 patients was screened with the STOP-Bang questionnaire. Those with elevated risk were referred for a sleep evaluation. An interview was conducted over the phone to determine compliance to referral and the barriers and facilitators to compliance. RESULTS Of the 1099 patients (mean age: 45.1 ± 10 years) screened, 224 (20.4%) patients were determined to be at-risk for obstructive sleep apnea (OSA). Only 41 (18.3%) patients with increased risk adhered to referral recommendation. Demographic and health characteristics did not show significant differences between the compliant and non-compliant patients. The most common facilitators to compliance were increased awareness about OSA (N = 25, 65%) and dentist recommendation (N = 14, 34.1%), whereas the most common barriers to referral compliance were misconceptions about OSA (N = 69, 37.7%) and work responsibilities (N = 44, 24%). CONCLUSIONS Only a small percentage of patients adhered to the recommendation of their dentist to see a sleep specialist. Increased awareness about OSA and dentist recommendation were the most common factors that facilitated compliance, whereas misconceptions about OSA and work responsibilities were the most common barriers to patient compliance.
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Affiliation(s)
- Banu Saglam-Aydinatay
- Department of Orthodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Serdar Uysal
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Tülin Taner
- Department of Orthodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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Murphy A, Palafox B, O'Donnell O, Stuckler D, Perel P, AlHabib KF, Avezum A, Bai X, Chifamba J, Chow CK, Corsi DJ, Dagenais GR, Dans AL, Diaz R, Erbakan AN, Ismail N, Iqbal R, Kelishadi R, Khatib R, Lanas F, Lear SA, Li W, Liu J, Lopez-Jaramillo P, Mohan V, Monsef N, Mony PK, Puoane T, Rangarajan S, Rosengren A, Schutte AE, Sintaha M, Teo KK, Wielgosz A, Yeates K, Yin L, Yusoff K, Zatońska K, Yusuf S, McKee M. Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study. Lancet Glob Health 2018; 6:e292-e301. [PMID: 29433667 PMCID: PMC5905400 DOI: 10.1016/s2214-109x(18)30031-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 11/30/2017] [Accepted: 01/16/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development. METHODS We assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE) study. Defining one or more drugs as a minimal level of secondary prevention, wealth-related inequality was measured using the Wagstaff concentration index, scaled from -1 (pro-poor) to 1 (pro-rich), standardised by age and sex. Correlations between inequalities and national health-related indicators were estimated. FINDINGS The proportion of patients with cardiovascular disease on three medications ranged from 0% in South Africa (95% CI 0-1·7), Tanzania (0-3·6), and Zimbabwe (0-5·1), to 49·3% in Canada (44·4-54·3). Proportions receiving at least one drug varied from 2·0% (95% CI 0·5-6·9) in Tanzania to 91·4% (86·6-94·6) in Sweden. There was significant (p<0·05) pro-rich inequality in Saudi Arabia, China, Colombia, India, Pakistan, and Zimbabwe. Pro-poor distributions were observed in Sweden, Brazil, Chile, Poland, and the occupied Palestinian territory. The strongest predictors of inequality were public expenditure on health and overall use of secondary prevention medicines. INTERPRETATION Use of medication for secondary prevention of cardiovascular disease is alarmingly low. In many countries with the lowest use, pro-rich inequality is greatest. Policies associated with an equal or pro-poor distribution include free medications and community health programmes to support adherence to medications. FUNDING Full funding sources listed at the end of the paper (see Acknowledgments).
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Affiliation(s)
- Adrianna Murphy
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK.
| | - Benjamin Palafox
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK
| | - Owen O'Donnell
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, Netherlands; Faculty of Economics and Business, University of Lausanne, Lausanne, Switzerland
| | - David Stuckler
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Pablo Perel
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alvaro Avezum
- Institute of Cardiology, University of Santo Amaro, Sao Paulo, Brazil
| | - Xiulin Bai
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jephat Chifamba
- Department of Physiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Clara K Chow
- The University of Sydney and The George Institute for Global Health, Camperdown, NSW, Australia
| | - Daniel J Corsi
- Ottawa Hospital Research Institute, OMNI Research Group, Clinical Epidemiology Program, Ottawa, ON, Canada
| | - Gilles R Dagenais
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec City, QC, Canada
| | - Antonio L Dans
- University of the Philippines-Manila, Manila, Philippines
| | - Rafael Diaz
- Estudios Clínicos Latinoamérica (ECLA) International, Rosario, Santa Fe, Argentina
| | | | - Noorhassim Ismail
- Department of Community Health, UKM Medical Centre, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Romaina Iqbal
- Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Chamran Hospital, Isfahan, Iran
| | - Rasha Khatib
- Department of Public Health Sciences, Loyola Medical Center, Maywood, IL, USA
| | | | | | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Patricio Lopez-Jaramillo
- Fundación Oftalmológica de Santander-FOSCAL-FOSCAL Internacional, Floridablanca, Santander, Colombia
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and DrMohan's Diabetes Specialities Centre, Gopalapuram, Chennai, India
| | - Nahed Monsef
- Dubai Health Authority, Dubai, United Arab Emirates
| | - Prem K Mony
- St John's Medical College and Research Insitute, Bangalore, India
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Cape Town, Western Cape Province, South Africa
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, C2-106 DBCVSRI Hamilton General Hospital, Hamilton, ON, Canada
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital/Östra, Göteborg, Sweden
| | - Aletta E Schutte
- South African Medical Research Council Unit for Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Mariz Sintaha
- Independent University, Bangladesh, Dhaka, Bangladesh
| | - Koon K Teo
- Population Health Research Institute, McMaster University, C2-106 DBCVSRI Hamilton General Hospital, Hamilton, ON, Canada
| | | | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Lu Yin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Khalid Yusoff
- Universiti Teknologi MARA, Selyang Campus, Selayang, Selangor and UCSI University, Cheras, Malaysia
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University, C2-106 DBCVSRI Hamilton General Hospital, Hamilton, ON, Canada
| | - Martin McKee
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK
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Ahorlu CSK, Koka E, Adu-Amankwah S, Otchere J, de Souza DK. Community perspectives on persistent transmission of lymphatic filariasis in three hotspot districts in Ghana after 15 rounds of mass drug administration: a qualitative assessment. BMC Public Health 2018; 18:238. [PMID: 29433461 PMCID: PMC5809858 DOI: 10.1186/s12889-018-5157-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 02/06/2018] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The Global Program for the Elimination of Lymphatic Filariasis (GPELF) started operation in 2000 and aimed at eliminating the disease by the year 2020, following 5-6 rounds of effective annual Mass Drug Administration (MDA). The MDA programme took off in Ghana in 2001 and has interrupted transmission in many areas while it has persisted in some areas after 10 or more rounds of MDA. This study was to appreciate community members' perspectives on MDA after over 15 years of implementation. Findings will inform strategies to mobilise community members to participate fully in MDA to enhance the disease elimination process. METHODS This was a qualitative study, employing key-informant in-depth-interviews. Respondents were selected based on their recognition by community members as opinion leaders and persons who were knowledgeable about the topic of interest in the community. A snowball sampling technique was used to select respondents. RESULTS Respondents were well informed about the MDA with most of them saying, it has been implemented for over 12 years. They were aware that the MDA was for the treatment/control of LF (elephantiasis). It came to light that MDA compliance was affected by five related barriers. These are; Medication, Personal, Health system, Disease and Social structure related barriers. Adverse effects of the drugs and the fact that many people perceived that they were not susceptibility to the infection have grossly affected the ingestion of the drugs. CONCLUSION There is a need for community mobilization and promotional activities to explain the expected adverse reactions associated with the drugs to the people. Also the importance of why every qualified person in the community must comply with MDA must be emphasized.
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Affiliation(s)
- Collins S K Ahorlu
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, P.O Box LG 581, Legon-Accra, Ghana.
| | - Eric Koka
- Department of Sociology and Anthropology, University of Cape Coast, Cape Coast, Ghana
| | - Susan Adu-Amankwah
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, P.O Box LG 581, Legon-Accra, Ghana
| | - Joseph Otchere
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, P.O Box LG 581, Legon-Accra, Ghana
| | - Dziedzom Komi de Souza
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, P.O Box LG 581, Legon-Accra, Ghana
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