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Nelson AJ, Pagidipati NJ, Bosworth HB. Improving medication adherence in cardiovascular disease. Nat Rev Cardiol 2024; 21:417-429. [PMID: 38172243 DOI: 10.1038/s41569-023-00972-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
Non-adherence to medication is a global health problem with far-reaching individual-level and population-level consequences but remains unappreciated and under-addressed in the clinical setting. With increasing comorbidity and polypharmacy as well as an ageing population, cardiovascular disease and medication non-adherence are likely to become increasingly prevalent. Multiple methods for detecting non-adherence exist but are imperfect, and, despite emerging technology, a gold standard remains elusive. Non-adherence to medication is dynamic and often has multiple causes, particularly in the context of cardiovascular disease, which tends to require lifelong medication to control symptoms and risk factors in order to prevent disease progression. In this Review, we identify the causes of medication non-adherence and summarize interventions that have been proven in randomized clinical trials to be effective in improving adherence. Practical solutions and areas for future research are also proposed.
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Affiliation(s)
- Adam J Nelson
- Victorian Heart Institute, Melbourne, Victoria, Australia
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | | | - Hayden B Bosworth
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.
- Population Health Sciences, Duke University, Durham, NC, USA.
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Hoonakker JD, Adeline-Duflot F, Orcel V, Grudzinski ML, Cognet M, Renard V. Use of visual aids in general practice consultations: A questionnaire-based survey. PEC INNOVATION 2023; 2:100159. [PMID: 37384162 PMCID: PMC10294083 DOI: 10.1016/j.pecinn.2023.100159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 06/30/2023]
Abstract
Objectives Visual aids (VAs) seem effective to improve doctor-patient communication. The objective was to describe how VAs are used in consultation and what French general practitioners (GPs) expect of them. Methods Cross-sectional study using a self-administered questionnaire among French GPs in 2019. Descriptive and multinominal logistic regression analyses were performed. Results Of the 376 respondents, 70% used VAs at least weekly and 34% daily; 94% considered VAs useful/very useful; 77% felt they did not use VAs enough. Sketches were the most used VAs and considered the most useful. Younger age was significantly associated with a higher rate of use of simple digital images. VAs were mainly used to describe anatomy and facilitate patient comprehension. Main reasons for not using VAs more often were time spent searching, lack of habit and poor quality of available VAs. Many GPs requested a database of good quality VAs. Conclusions GPs use VAs regularly in consultations but would like to use them more often. Informing GPs of the usefulness of VAs, training them to draw adapted sketches and creating a good quality databank are some possible strategies to increase the use of VAs. Innovation This study described in detail the use of VAs as tool for doctor-patient communication.
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Affiliation(s)
- Jean-Denis Hoonakker
- Department of General Practice, Faculty of Health, University Paris-Est Créteil, Créteil, France
- Multidisciplinary Health Centre of Pays de Nemours, Nemours, France
| | | | - Véronique Orcel
- Department of General Practice, Faculty of Health, University Paris-Est Créteil, Créteil, France
| | - Marie-Louise Grudzinski
- Department of General Practice, Faculty of Health, University Paris-Est Créteil, Créteil, France
| | - Mathilde Cognet
- Department of General Practice, Faculty of Health, University Paris-Est Créteil, Créteil, France
- University Multidisciplinary Health Centre of Sucy-en-Brie, Sucy-en-Brie, France
| | - Vincent Renard
- Department of General Practice, Faculty of Health, University Paris-Est Créteil, Créteil, France
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Maleki G, Norian R, Moeini B, Barati M, Maleki S, Afshari M. Factors related to medication adherence in patients with hypertension in Iran: a systematic review study. Blood Press Monit 2023; 28:221-235. [PMID: 37661726 DOI: 10.1097/mbp.0000000000000665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIVES This study aimed to review the available studies of the factors in Iranian hypertensive patients' adherence to drug treatment. METHODS Four Persian databases and seven English databases were searched. The articles, which were published from 2000 to 2022 in Persian and English and examined the adherence to drug treatment in the Iranian population of adults with high blood pressure, were reviewed. Based on the primary examination, 31 of the initial 1062 articles met the inclusion criteria and were included in the analysis. The evidence, which was provided by the examined articles, was summarized and discussed using the 5-dimensional framework of adherence to long-term treatments, which was developed by WHO. RESULTS The factors that significantly correlated with adherence to drug treatment in the examined studies were: (1) factors that were related to the health team or the health system: patients' satisfaction with their doctor-patient relationship; (2) factors that were related to the conditions: the number of concomitant diseases, high quality of life and the implementation of effective interventions; (3) factors which were related to the treatment: long duration of illness, short intervals between the visits, duration of treatment, lower numbers of drugs, and the patient's blood pressure control; and (4) factors that were related to the patient: self-efficacy, health literacy, social support, locus of control, illness perception, beliefs, attitude, knowledge, and cues to action. CONCLUSION It is possible to draw definite conclusions about the factors which affect adherence to drug treatment in patients with high blood pressure because most of the relevant studies have been cross-sectional. Therefore, in the future, valuable results can be obtained by conducting more studies that preferably use objective instruments for assessing adherence to drug treatment.
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Affiliation(s)
- Golara Maleki
- Department of Psychology, Sari Branch, Islamic Azad University, Sari
| | - Rohollah Norian
- Workplace Health Promotion Research Center, Shahid Beheshti University of Medical Sciences, Tehran
| | | | | | | | - Maryam Afshari
- Social Determinants of Health Research Center
- Department of Public Health, School of Health
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
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Huy LD, Truong NLT, Hoang NY, Nguyen NTH, Nguyen TTP, Dang LT, Hsu YHE, Huang CC, Chang YM, Shih CL, Carbone ET, Yang SH, Duong TV. Insight into global research on health literacy and heart diseases: A bibliometric analysis. Front Cardiovasc Med 2022; 9:1012531. [PMID: 36505390 PMCID: PMC9729531 DOI: 10.3389/fcvm.2022.1012531] [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: 08/05/2022] [Accepted: 11/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Health literacy (HL) has shown its important role on reducing the burden of heart diseases. However, no study has provided a comprehensive worldwide view of the data regarding HL and heart diseases. The study aimed to provide insight into: (1) the intellectual structure, (2) research trends, and (3) research gaps on HL and heart diseases; and (4) to explore HL scales commonly utilized in heart studies. Materials and methods Studies related to HL and heart diseases were retrieved from Web of Science, Scopus, and PubMed. All publications published between 2000 and 2021 were included after conducting keyword searches on "heart diseases" in general or on specific types of heart diseases (e.g., "heart failure") and "health literacy". Bibliometric analyses were carried out using the Bibliometrix R package and VOSviewer 1.6.14. Findings A total of 388 original research articles and reviews on HL and heart diseases were included in our study. The studies were primarily conducted in the United States and developed countries. A total of 337 studies (86.9%) focused on heart failure (200 studies, 51.5%) and ischemic heart diseases (137 studies, 35.3%). Sixty-two studies (16.0%) focused on other heart diseases (e.g., valvular diseases and rheumatic heart diseases). The number of interventional studies was limited (52 studies, 13.4%) and fluctuated from 2000 to 2021. The most common questionnaires measuring health literacy among patients with heart diseases were the Test of Functional Health Literacy in Adults (TOFHLA), Short Test of Functional Health Literacy in Adults (STOFHLA), and Brief Health Literacy Screen (BHLS). Use of the eHealth Literacy Scale (eHEALS) has become the latest trend among patients with heart diseases. Conclusion Health literacy and heart diseases were most often studied in the United States and developed countries. Several HL tools were used; eHEALS has been lately used in this field. These findings suggest the need to conduct more empirical studies on HL and heart diseases in different settings (e.g., developing or poor countries) and with different types of heart diseases (e.g., valvular and rheumatic disorders). Additionally, it is necessary to develop heart disease-specified HL scales for research and practice.
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Affiliation(s)
- Le Duc Huy
- Health Personnel Training Institute, University of Medicine and Pharmacy, Hue University, Hue, Thua Thien Hue, Vietnam
| | - Nguyen L. T. Truong
- School of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam,Pharmacy Department, Thong Nhat Hospital, Ho Chi Minh City, Vietnam
| | - Nhi Y. Hoang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Nhi Thi Hong Nguyen
- Health Personnel Training Institute, University of Medicine and Pharmacy, Hue University, Hue, Thua Thien Hue, Vietnam,School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Thao T. P. Nguyen
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Loan T. Dang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan,Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam
| | - Yi-Hsin Elsa Hsu
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan,Executive Master Program of Business Administration in Biotechnology, College of Management, Taipei Medical University, Taipei, Taiwan,International Ph.D. Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Chung-Chien Huang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan,International Ph.D. Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan,Department of Long-Term Care and School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan,School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Yao-Mao Chang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan,Research Center of Health and Welfare Policy, Taipei Medical University, Taipei, Taiwan
| | | | - Elena T. Carbone
- Department of Nutrition, University of Massachusetts, Amherst, MA, United States
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan,Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan,Research Center of Geriatric Nutrition, Taipei Medical University, Taipei, Taiwan,*Correspondence: Shwu-Huey Yang,
| | - Tuyen V. Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan,International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan,Tuyen V. Duong,
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Nazu NA, Wikström K, Lamidi ML, Lindström J, Tirkkonen H, Rautiainen P, Laatikainen T. Mode of treatments and achievement of treatment targets among type 2 diabetes patients with different comorbidities - a register-based retrospective cohort study in Finland. BMC PRIMARY CARE 2022; 23:278. [PMID: 36352358 PMCID: PMC9644526 DOI: 10.1186/s12875-022-01889-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
AIMS Type 2 diabetes (T2D) is a progressive disease often associated with comorbidities that complicate the management of T2D and affect the achievement of treatment targets. However, adherence to guidelines and individualized treatments can potentially improve treatment outcomes. This study assessed the association between different glucose lowering and lipid lowering medication lines and the achievement of treatment targets with different comorbidities among a T2D cohort in North Karelia, Finland (2011-12 to 2015-16). METHODS The data on all diagnosed T2D patients (n = 10,190) in North Karelia were collated retrospectively from regional electronic health records (EHRs). Analyses were performed considering the age, sex, and comorbidities such as cardiovascular diseases (CVD) and any mental disorders (AMD). We analyzed the trends in using glucose lowering and lipid lowering medications and the effect of changes in medication on the achievement of treatment targets among different patient groups. RESULTS Metformin was the most common treatment in all patient groups. The use of only metformin declined and the use of metformin and/or other non-insulin medications increased during the follow-up. A Combination of insulin and non-insulin medication was mostly used by T2D patients with both cardiovascular diseases and mental disorders (T2D + CVD + AMD), and the use of insulin increased among this group in follow-up. Achievement of the glucose treatment target deteriorated even after the intensification of medication among all patient groups during the follow-up. A considerably higher number of patients with T2D + AMD and T2D + CVD + AMD did not use lipid lowering medication when compared to the T2D + CVD patients both at baseline and follow-up. However, the achievement of the LDL treatment target improved during the follow-up. CONCLUSION Achievement of the glucose target deteriorated even after the intensification of treatment, and especially among patients with multiple diseases. Many T2D patients with AMD and CVD remained without lipid lowering medication, which needs further attention.
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Affiliation(s)
- Nazma Akter Nazu
- Department of Public Health, University of Helsinki,, PO BOX 63, 00014, Helsinki, Finland.
| | - Katja Wikström
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO BOX 1627, 70211, Kuopio, Finland
- Department of Public Health and Social welfare, Finnish Institute for Health and Welfare, PO BOX 30, 00271, Helsinki, Finland
| | - Marja-Leena Lamidi
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO BOX 1627, 70211, Kuopio, Finland
| | - Jaana Lindström
- Department of Public Health, University of Helsinki,, PO BOX 63, 00014, Helsinki, Finland
- Department of Public Health and Social welfare, Finnish Institute for Health and Welfare, PO BOX 30, 00271, Helsinki, Finland
| | - Hilkka Tirkkonen
- Joint municipal authority for North Karelia Social and Health Services (Siun sote), Tikkamäentie 16, 70210, Joensuu, Finland
| | - Päivi Rautiainen
- Joint municipal authority for North Karelia Social and Health Services (Siun sote), Tikkamäentie 16, 70210, Joensuu, Finland
| | - Tiina Laatikainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO BOX 1627, 70211, Kuopio, Finland
- Department of Public Health and Social welfare, Finnish Institute for Health and Welfare, PO BOX 30, 00271, Helsinki, Finland
- Joint municipal authority for North Karelia Social and Health Services (Siun sote), Tikkamäentie 16, 70210, Joensuu, Finland
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Sedeh FB, Arvid Simon Henning M, Mortensen OS, Jemec GBE, Ibler KS. Communicating with patients through pictograms and pictures - a scoping review. J DERMATOL TREAT 2022; 33:2730-2737. [PMID: 35440279 DOI: 10.1080/09546634.2022.2068790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BackgroundCommunication between patients and Health Care Workers (HCW) may on occasion be challenged by disparities in cultural background, age and educational level. Written educational material is commonly used to reduce the risk of miscommunication. However, literacy among patients may also differ and it is therefore speculated that the use of pictograms may improve patients' understanding and adherence.ObjectiveTo evaluate the scientific literature and investigate the effect and practical utility of pictograms in medical settings with focus on dermatological patients.Materials and methodsPubmed, EMBASE, and Cochrane Library were searched July 2021 for studies regarding use of pictograms in medical settings and dermatology.ResultsThe use of pictograms in dermatology is not well characterized, but studies in other fields of medicine report a positive effect of using pictograms in communication. Pictograms have a significant positive effect when presented alongside verbal or written explanations.ConclusionThe quality of the development process is important to ensure the utility of any pictogram. Involving the target population in the design and validation of the pictograms may be critical. In the validation process, testing of transparency and translucency may benefit from international recommendations.
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Affiliation(s)
| | | | - Ole Steen Mortensen
- Department of Occupational and Social Medicine, Holbaek University Hospital, Holbaek, Denmark.,Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
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van Herpen-Meeuwissen LJM, van Onzenoort HAW, van den Bemt PMLA, Maat B, van den Bemt BJF. The Effect of Self-Administration of Medication During Hospitalization on Patient's Self-Efficacy and Medication Adherence After Discharge. Patient Prefer Adherence 2022; 16:2683-2693. [PMID: 36196066 PMCID: PMC9527028 DOI: 10.2147/ppa.s375295] [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: 06/13/2022] [Accepted: 08/19/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The effect of self-administration of medication (SAM), in which capable hospitalized patients administer medication themselves on medication self-efficacy is inconclusive. The aim of this study was to evaluate the effect of SAM on medication self-efficacy, adherence and patient satisfaction. PATIENTS AND METHODS A prospective pre-post intervention study on the orthopedic ward of the Sint Maartenskliniek (Nijmegen) was conducted from January 2020 to July 2021. All adults admitted to this ward were eligible for participation. The primary outcome was the level of medication self-efficacy measured by the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) one week after discharge. Secondary outcomes were SEAMS-score three months after hospitalization, medication adherence measured by the Medication Adherence Rating Scale (MARS) one week and three months after hospitalization and patient satisfaction expressed on a five-point Likert scale in patients who experienced SAM. The differences in median SEAMS-scores and non-adherence pre- versus post-implementation of SAM were statistically analyzed. Patients' agreement regarding satisfaction with SAM was calculated as proportion per Likert scale answer. RESULTS Of the 197 patients participating in the study, 96 were included pre- and 101 post-implementation of SAM. Median SEAMS-scores one week after discharge were 35 [IQR 31-38] and 34 [IQR 30-36] pre- and post-intervention respectively (p = 0.08). There was no difference in the proportion of non-adherent patients at one week and three months after discharge pre- and post-intervention, 52.4%, 53.2%, 57.9% and 64.4% respectively. Of the patients that experienced SAM 32% agreed and 49% strongly agreed that they would like to self-manage medication again during a future hospitalization. CONCLUSION In this orthopedic population with high medication self-efficacy scores at discharge, SAM did not affect patients' medication self-efficacy nor medication adherence after hospitalization. Most patients preferred SAM. Additional studies should focus on the effect of SAM in other patient populations.
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Affiliation(s)
- Loes J M van Herpen-Meeuwissen
- Department of Pharmacy, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Department of Pharmacy, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
- Correspondence: Loes JM van Herpen-Meeuwissen, Department of Pharmacy, Radboud University Medical Centre, PO Box 9101, Nijmegen, the Netherlands, Tel +31 624 3617744, Email
| | - Hein A W van Onzenoort
- Department of Pharmacy, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Patricia M L A van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Barbara Maat
- Department of Pharmacy, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
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Improving Medication Adherence in Isolated Patients With Cognitive Impairment Using Automated Telephone Reminders. Dement Neurocogn Disord 2022; 21:117-125. [DOI: 10.12779/dnd.2022.21.4.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/05/2022] [Accepted: 09/01/2022] [Indexed: 11/09/2022] Open
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Saleem A, Woodruff G, Steadman K, La Caze A. Investigating the impact of patient-centred labels on comprehension of medication dosing: a randomised controlled trial. BMJ Open 2021; 11:e053969. [PMID: 34794998 PMCID: PMC8603299 DOI: 10.1136/bmjopen-2021-053969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study aims to implement a version of patient-centred labels (PCL) consistent with current labelling practice in Australia; assess the effectiveness of PCL in relation to the proportion of participants that correctly comprehend dosing instructions, and explore the proportion of correct comprehension of PCL in participants with both low and high health literacy. DESIGN Randomised controlled trial. SETTING A large tertiary care hospital in Brisbane, Queensland, Australia. PARTICIPANTS 121 participants with a majority born in Australia (65.3%), New Zealand (14.0%), the UK (6.6%) and Ireland (2.5%). INTERVENTION Participants were randomly assigned to either a panel of three PCL (n=61) or three standard labels (n=60) and asked to comprehend their assigned panel of labels. OUTCOME MEASURES Difference in the proportion of participants that correctly comprehend dosing instructions provided on PCL compared with standard labels. The two-proportion test was used to measure the impact of PCL on the proportion of participants correctly comprehending dosing instructions. RESULTS A greater proportion of participants were able to accurately comprehend PCL compared with standard labels. The proportion of participants who were able to correctly comprehend dose instructions provided on all three labels was significantly higher in the group that received PCL; 23.3% standard vs 83.6% PCL, p<0.001. The effect was observed in both low and high health literacy participants. The proportion of participants with accurate label comprehension was higher in participants with low Newest Vital Signs scores (8.3% standard vs 85.7% PCL, p<0.001) and low Rapid Estimate of Adult Literacy in Medicine scores (10.5% standard vs 96.0% PCL, p<0.001) who received PCL. CONCLUSION This study supports the use of PCL in Australian pharmacy practice. PCL provide simple, clear and explicit dosing instructions to patients. Implementing PCL may reduce the risk of misinterpreting dosing instructions by patients and improve quality use of medicines. TRIAL REGISTRATION NUMBER ACTRN12621000083897; Results.
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Affiliation(s)
- Ahsan Saleem
- School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Gemma Woodruff
- Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Kathryn Steadman
- School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Adam La Caze
- School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
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The effect of visual interventions on illness beliefs and medication adherence for chronic conditions: A scoping review of the literature and mapping to behaviour change techniques (BCTs). Res Social Adm Pharm 2021; 18:3239-3262. [PMID: 34815181 DOI: 10.1016/j.sapharm.2021.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 11/04/2021] [Accepted: 11/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Maintaining health with chronic conditions often involves taking multiple medications; however, approximately 50% of patients with chronic conditions are non-adherent to medication. Patients' illness beliefs inform health behaviour, including medication-taking. Research has shown that visuals accompanying health information increased patient comprehension and the accuracy of illness perceptions. To date, the influence of visuals on illness beliefs and medication adherence has not been comprehensively reviewed. OBJECTIVES The review aimed to collate available literature on visualisation interventions for illness beliefs and medication adherence in chronic conditions and identify key intervention characteristics. METHODS A scoping review was conducted according to recommended guidelines and the PRISMA-ScR statement. Searches used keywords relating to 'illness', 'visual', 'adherence', 'illness perception', 'intervention', and 'medication'. Six databases were searched from inception to 2019; reference-list searching provided additional articles. Articles were included if the study population had a chronic health condition, the intervention included a visual element, had a measure of illness beliefs or medication adherence. Data regarding intervention characteristics and outcomes were extracted. Behaviour change techniques (BCTs) were identified to provide further insight into intervention characteristics. RESULTS Initially, 18,012 articles were identified. Screening led to 293 full-text articles, ultimately resulting in 45 studies for final analysis. Forty-four were quantitative studies, 1 was qualitative. Studies were grouped into those using visuals to conceptualise a condition, medication reminders and educational interventions. Almost two-thirds of visual interventions were effective post-intervention, 3 sustained post-1-year, although many studies only assessed impact immediately post-intervention. BCTs from 'Natural consequences', 'Socialsupport' and 'Feedback and monitoring' categories were prevalent in effective interventions for both outcomes, particularly the 'Salience of consequences' BCT. CONCLUSIONS This comprehensive scoping review found that visual interventions can positively influence illness beliefs and medication adherence. These findings highlight the need to further evaluate the impact and sustainability of visual interventions.
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Merks P, Cameron J, Bilmin K, Świeczkowski D, Chmielewska-Ignatowicz T, Harężlak T, Białoszewska K, Sola KF, Jaguszewski MJ, Vaillancourt R. Medication Adherence and the Role of Pictograms in Medication Counselling of Chronic Patients: a Review. Front Pharmacol 2021; 12:582200. [PMID: 34489688 PMCID: PMC8417421 DOI: 10.3389/fphar.2021.582200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
Pharmaceutical care requires a patient-centered approach, focusing on the ability of patients to understand drug-related information and follow the instructions delivered by pharmacists as well as other health-care providers included in the circle of care. With the goal of ensuring the prescribed use of medications, called medication adherence, health-care providers have to consider many risk factors such as geography (culture), social economic status, age, and low literacy that may predispose patients to non-adherence, and considerations have to be made for chronic patients living with life-long disease states. The aim of this review is to provide a balanced and comprehensive review outlining a number of different medication counselling and education approaches that have been used to try to improve medication adherence and health outcomes with the use of clear and concise graphic illustrations—called pictograms. By highlighting the current landscape of the general use and efficacy of pharmaceutical pictograms to aid in the knowledge and recall of drug-related information, as well as outlining specific medication adherence outcomes with pharmaceutical pictograms in chronic patients, the current review describes the need for health-care providers to move beyond the traditional didactic methods of oral and verbal communication with patients regarding medication-taking behavior.
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Affiliation(s)
- Piotr Merks
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland.,Department of Pharmaceutical Technology, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | - Jameason Cameron
- Department of Pharmacy, Children's Hospital of Eastern Ontario, Centre Hospitalier pour Enfants de L'est de L'Ontario, Ottawa, ON, Canada
| | - Krzysztof Bilmin
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Damian Świeczkowski
- First Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland
| | | | - Tomasz Harężlak
- Department of Pharmaceutical Technology, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | | | | | | | - Regis Vaillancourt
- Department of Pharmacy, Children's Hospital of Eastern Ontario, Centre Hospitalier pour Enfants de L'est de L'Ontario, Ottawa, ON, Canada
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Abstract
Cardiovascular disease is the leading cause of death globally. While pharmacological advancements have improved the morbidity and mortality associated with cardiovascular disease, non-adherence to prescribed treatment remains a significant barrier to improved patient outcomes. A variety of strategies to improve medication adherence have been tested in clinical trials, and include the following categories: improving patient education, implementing medication reminders, testing cognitive behavioral interventions, reducing medication costs, utilizing healthcare team members, and streamlining medication dosing regimens. In this review, we describe specific trials within each of these categories and highlight the impact of each on medication adherence. We also examine ongoing trials and future lines of inquiry for improving medication adherence in patients with cardiovascular diseases.
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Affiliation(s)
- Steven T Simon
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Vinay Kini
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew E Levy
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Cardiology, Denver Health Medical Center, Denver, CO, USA
| | - P Michael Ho
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Cardiology Section, VA Eastern Colorado Health Care System, Aurora, CO, USA
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Bastani P, Bikineh P, Mehralian G, Sadeghkhani O, Rezaee R, Kavosi Z, Ravangard R. Medication adherence among the elderly: applying grounded theory approach in a developing country. J Pharm Policy Pract 2021; 14:55. [PMID: 34193278 PMCID: PMC8243431 DOI: 10.1186/s40545-021-00340-9] [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: 06/09/2021] [Accepted: 06/24/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Medication adherence is an important concept particularly among the elderly that can, directly and indirectly, affect the health system's costs and the elderly's health, quality of life, and functional abilities. This study aimed to determine the model of medication adherence among the Iranian elderly using the grounded theory approach. METHODS The concept of medication adherence and the determination of its process among the elderly is a multidisciplinary social issue that can be affected by many contextual factors. Grounded theory with the approach of Strauss and Corbin (2004) was applied to determine the customized model. Data triangulation occurred through semi-structured interviews, observation, field notes, and memoing. Open coding, selective coding, and axial coding were applied to analyze the data. RESULTS Delinquency in the medication use among the elderly was caused by factors such as doubtfulness, fear of complications, not following the patients by the physicians, and negative others and medical staff's impacts. During the process of medication adherence, the patient's lack of knowledge, lack of sufficient education, inappropriate and restricted lifestyle, difficult living conditions, and social pressures imposed on individuals could exacerbate and worsen the delinquency in medication adherence. It should not be neglected that some other factors such as lack of an effective supervision system, lack of supportive organizations, stakeholders' market-based behaviors, consumption inconvenience, consumption stress, hopelessness, and misunderstanding could also aggravate the delinquency. CONCLUSIONS Although the proposed theory and model were customized and context-based for the Iranian elderly, in general, making positive changes in the process of adherence to the medication use among the elderly requires scientific and basic management and planning of its factors. It should be noted that making these changes requires some interventions in and cooperation of all levels of the country's health system, from the Ministry of Health and Medical Education to the individual level of the elderly.
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Affiliation(s)
- Peivand Bastani
- Health Human Resources Research Center, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parisa Bikineh
- Student Research Committee, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamhossein Mehralian
- Pharmacoeconomics and Pharma Management Department, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Sadeghkhani
- Student Research Committee, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rita Rezaee
- Health Human Resources Research Center, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Kavosi
- Health Human Resources Research Center, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Ravangard
- Health Human Resources Research Center, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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Stormacq C, Wosinski J, Boillat E, Van den Broucke S. Effects of health literacy interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: a systematic review. JBI Evid Synth 2021; 18:1389-1469. [PMID: 32813388 DOI: 10.11124/jbisrir-d-18-00023] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The objectives of this review were: i) to identify and synthesize the best available evidence on the effectiveness on health-related outcomes of health literacy interventions for enabling socioeconomically disadvantaged people living in the community to access, understand, appraise and apply health information; and ii) to identify components of health literacy interventions associated with improved health-related outcomes. INTRODUCTION Health literacy is defined as a person's competence in accessing, understanding, appraising and applying health information in order to make sound health decisions. A high level of health literacy is positively related to better health outcomes. However, nearly half of the American and European populations have low health literacy levels. Socioeconomically disadvantaged groups in particular present with the weakest health literacy levels, suggesting that differences in health literacy levels contribute to health disparities. Therefore, there is a need to understand the conditions under which health literacy interventions aiming at improving health-related outcomes among socioeconomically disadvantaged people can be implemented. INCLUSION CRITERIA This review considered studies on socioeconomically disadvantaged adults living in the community identified using the socially stratifying PROGRESS factors (Place of residence, Race/ethnicity, Occupation, Gender, Religion, Education, Socioeconomic status, Social capital).This review considered studies evaluating the following interventions: i) targeting health literacy based on either a clinical and/or a public health approach, ii) delivered at the individual, interpersonal, community or societal level, iii) delivered by any healthcare/social work professional, and iv) using a single or multicomponent strategy. The comparator was no treatment, standard care or a variation of the intervention. All randomized and non-randomized controlled trials as well as quasi-experimental designs were included. Outcomes considered were: i) health-related quality of life and health-related outcomes, ii) health behavior outcomes, and iii) outcomes related to the access and use of healthcare services. METHODS A three-step strategy was conducted for primary research published up to May 2018 across seven databases without any language restriction. A search for gray literature was also conducted. Titles and abstracts were screened for assessment against the inclusion criteria. Studies that met the inclusion criteria were retrieved in full and then assessed in detail against the inclusion criteria. Critical appraisal was undertaken using the standardized critical appraisal instruments from JBI. Data were extracted from included studies using standardized data extraction tools from JBI. A meta-analysis was not possible; findings have been presented in a narrative form. RESULTS Twenty-one studies were included in the review. Three studies addressed the health literacy competency of understanding health information, and 18 addressed the competency of applying health information. Thirteen studies were found as effective based on a variety of health-related outcomes (mainly clinical outcomes), preventive health practices and behaviors, and health-promoting behaviors. Results enabled identification of some effective intervention operational components, including cultural appropriateness, tailoring, skills building, goal setting and active discussions. Multi-faceted interventions, combining both an information transfer medium and contact with an interventionist, appear to be more effective than single modality interventions. The use of an appropriate theoretical foundation is also an important factor for successful interventions. CONCLUSION To improve health-related outcomes among socioeconomically disadvantaged people, health literacy interventions are more likely to be successful if they are theory-based, are multi-faceted and use person-centered operational components such as cultural appropriateness, tailoring, skills building, goal setting and active discussions.
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Affiliation(s)
- Coraline Stormacq
- 1Université Catholique de Louvain, Faculté de Santé Publique, Woluwé-Saint-Lambert, Belgium 2La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland 3Bureau d'Echanges des Savoirs pour des praTiques exemplaires de soins (BEST): a Joanna Briggs Centre of Excellence 4Ngoma School of Nursing, Adventist University of Central Africa, Kigali, Rwanda 5Université Catholique de Louvain, Faculté de Psychologie et des Sciences de l'Éducation, Louvain-la-Neuve, Belgium
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Shah G, Erickson JL, Luxenburg J, Hu B, Reali-Sorrell M, Lovelace R, Pfoh E, Kobaivanova N, Brateanu A. Impact on patients' compliance with medication using prepacked blisters for multidrug medical therapy: I-COMPLY Study. Am J Health Syst Pharm 2021; 78:1713-1719. [PMID: 33950184 DOI: 10.1093/ajhp/zxab193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Studies have supported the use of packaging interventions such as pillboxes or blister packs to improve medication adherence but have not evaluated the efficacy of these interventions in a population of low socioeconomic status. The aim of this study was to assess the effect of home-delivered pill packs on medication adherence in a low-income Black American population with Medicaid insurance. METHODS This study was an open-label, randomized, controlled trial. The patient population studied included 80 patients followed by primary care physicians at the Cleveland Clinic. Patients were randomized to a study group who received delivery of their multidrug medical therapy, defined as a minimum of 4 medications daily, in prepackaged blisters or a control group who obtained their prescriptions from their routine pharmacy. RESULTS The primary analysis compared the mean percentage of missed pills between the 2 groups using t-test analysis. The percentage of missed pills in the study group was significantly lower than in the control group (mean [SD]: 3.7% [6.0%] vs 17.4% [16.6%] missed daily pills; P < 0.001). The number of daily missed doses was also significantly lower in the study group (0.3 [0.5] vs 0.7 [0.6]; P = 0.002). Patients were on a mean of 8.1 (SD, 2.3) and 8.1 (SD, 2.6) medications in the study and control groups, respectively (P = 0.96). CONCLUSION Delivery of prepackaged medications in a low-income Black American community was demonstrated to improve medication adherence. The use of prepackaged blisters for medication home delivery is a model that can be utilized on a larger scale for patients on multidrug medical therapy.
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Affiliation(s)
- Gautam Shah
- Regional Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Bo Hu
- Department of Quantitative Health Science, Cleveland Clinic, Cleveland, OH, USA
| | | | - Rita Lovelace
- Department of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Elizabeth Pfoh
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA
| | | | - Andrei Brateanu
- Department of Medicine, Cleveland Clinic, Cleveland, OH, USA
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Mbanda N, Dada S, Bastable K, Ingalill GB, Ralf W S. A scoping review of the use of visual aids in health education materials for persons with low-literacy levels. PATIENT EDUCATION AND COUNSELING 2021; 104:998-1017. [PMID: 33339657 DOI: 10.1016/j.pec.2020.11.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 11/14/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To conduct a scoping review on the literature on visual aids in health education for persons with low-literacy. METHODS A scoping review methodology was employed. Pre-defined selection criteria identified 47 studies for inclusion. Data were extracted in relation to: (a) definitions of low-literacy and health literacy, (b) population studied, (c) research country, (d) consent procedures, (e) visual aids used, (f) development of visual aids, and (g) targeted outcomes. RESULTS Visual aids developed with persons with low-literacy demonstrated statistically significant improvements in health literacy outcomes, with benefits in medication adherence and comprehension also reported. Pictograms and videos were the most effective visual aids. Only one study adapted consent procedures for low-literacy participants. DISCUSSION Visual aids in health education materials may benefit persons with low-literacy levels, but large gaps in the research base are evident. Experimental research in low- and middle-income countries, with a particular focus on consent for participants with low-literacy is needed. PRACTICE IMPLICATIONS Visual aid design needs to include stakeholders. Consent procedures and decision-making need to be specifically adapted for participants with low-literacy.
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Affiliation(s)
- Njabulo Mbanda
- Centre for Augmentative and Alternative Communication, University of Pretoria, South Africa
| | - Shakila Dada
- Centre for Augmentative and Alternative Communication, University of Pretoria, South Africa.
| | - Kirsty Bastable
- Centre for Augmentative and Alternative Communication, University of Pretoria, South Africa
| | | | - Schlosser Ralf W
- Centre for Augmentative and Alternative Communication, University of Pretoria, South Africa; Department of Communication Sciences and Disorders, Northeastern University, USA
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Bastani P, Bikineh P, Ravangard R, Rezaee R, Kavosi Z. Determinants affecting medication adherence in the elderly: A qualitative study. Aging Med (Milton) 2021; 4:35-41. [PMID: 33738378 PMCID: PMC7954825 DOI: 10.1002/agm2.12132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Due to high rates of irrational use of medicines and low rates of medication adherence among older Iranian patients, this study aimed to explore the determinants of medication adherence in the elderly. METHODS This qualitative study was conducted in 2019 via 20 semi-structured interviews with a purposeful sample of elderly people and health-care personnel. Transcript data were analyzed applying thematic analysis. MAXQDA10 was used for thematic analysis and presenting a thematic map. RESULTS Two main themes appeared as the main determinants of medication adherence: individual determinants and external determinants. Other results show that there were six sub-themes and 23 main categories in this regard. The sub-themes were as follows: consumption disorder, consumption acceptance, delinquency, forgetfulness, sociocultural factors, and others' impacts. CONCLUSIONS Different individual and external factors can affect elderly people's medication adherence. Considering the significance of this issue for the health of elderly people and the whole community, positive changes are needed to manage the medication-adherence process. Basic and scientific planning, appropriate interventions, and comprehensive collaboration among all health-system levels are required for implementing such changes.
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Affiliation(s)
- Peivand Bastani
- Health Human Resources Research CenterSchool of Management and Medical InformaticsShiraz University of Medical SciencesShirazIran
| | - Parisa Bikineh
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Ramin Ravangard
- Health Human Resources Research CenterSchool of Management and Medical InformaticsShiraz University of Medical SciencesShirazIran
| | - Rita Rezaee
- Health Human Resources Research CenterSchool of Management and Medical InformaticsShiraz University of Medical SciencesShirazIran
| | - Zahra Kavosi
- Health Human Resources Research CenterSchool of Management and Medical InformaticsShiraz University of Medical SciencesShirazIran
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Azami M, Pilevarzadeh M, Sharifi N. The Effect of Information Therapy on Treatment Adherence among Patients Referred to Addiction Treatment Centers. ADDICTION & HEALTH 2020; 12:1-10. [PMID: 32582409 PMCID: PMC7291900 DOI: 10.22122/ahj.v12i1.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The low level of drug adherence in addicts who are quitting is one of the biggest challenges in the treatment and management of this disease. Therefore, this study aimed to evaluate the effect of information therapy on adherence to treatment among the patients in addiction treatment centers. Methods The present quasi-experimental study was performed on 60 patients referred to addiction treatment centers in Jiroft City, Iran. The control and experimental groups were selected using simple random sampling method. The 8-item Morisky Medication Adherence Scale was used for data collection. The level of adherence to treatment was assessed before and after the intervention, which consisted of 6 one-hour training sessions per week. Findings The adherence to medication was low in both experimental and control groups before the notification. However, the chi-square value obtained by comparing the frequencies of the experimental and control groups in three variables of adherence level (high, moderate, and low) was 9.84 which was statistically significant (P = 0.007). Therefore, there was a significant difference between the experimental and control groups after information therapy. In fact, the information in the experimental group had a significant and positive effect. Conclusion Because of the low level of adherence to treatment, it is recommended to use information therapy to give information on timely and correct use of drugs as well as its importance in the treatment of addiction; so that the level of adherence would improve.
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Affiliation(s)
- Mohammad Azami
- Medical Informatics Research Center, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Neda Sharifi
- Modeling in Health Research Center, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Sletvold H, Sagmo LAB, Torheim EA. Impact of pictograms on medication adherence: A systematic literature review. PATIENT EDUCATION AND COUNSELING 2020; 103:1095-1103. [PMID: 31924384 DOI: 10.1016/j.pec.2019.12.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/17/2019] [Accepted: 12/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of this systematic review was to investigate the potential effect of pictograms on patient adherence to medication therapies. METHOD PubMed, MEDLINE, Embase, CINAHL, and CENTRAL were searched for relevant articles. Experimental studies testing the use of pictograms in patient counselling regarding medication therapy, which quantitatively measured adherence, were included. RESULTS Seventeen studies were identified that fulfilled our inclusion criteria. These were heterogeneous with respect to study setting, population size, and the medication regimen tested. All the studies had methodological quality limitations. The pictogram interventions differed with respect to complexity, intervention length, and the measured adherence outcome. Ten studies (58.8 %) reported a statistically significant effect, of the pictogram intervention in question, on patient adherence to medication therapies. Of these, 80 % involved populations at elevated risk for non-adherence. CONCLUSION AND PRACTICE IMPLICATIONS Pictograms used in combination with written and/or oral information can have a positive impact on patient populations that are highly at risk for non-adherence when counselled on the proper use of medicines.
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Affiliation(s)
- Hege Sletvold
- Faculty of Nursing and Health Sciences, Nord University, Norway.
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Cross AJ, Elliott RA, Petrie K, Kuruvilla L, George J. Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications. Cochrane Database Syst Rev 2020; 5:CD012419. [PMID: 32383493 PMCID: PMC7207012 DOI: 10.1002/14651858.cd012419.pub2] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Older people taking multiple medications represent a large and growing proportion of the population. Managing multiple medications can be challenging, and this is especially the case for older people, who have higher rates of comorbidity and physical and cognitive impairment than younger adults. Good medication-taking ability and medication adherence are necessary to ensure safe and effective use of medications. OBJECTIVES To evaluate the effectiveness of interventions designed to improve medication-taking ability and/or medication adherence in older community-dwelling adults prescribed multiple long-term medications. SEARCH METHODS We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, CINAHL Plus, and International Pharmaceutical Abstracts from inception until June 2019. We also searched grey literature, online trial registries, and reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs. Eligible studies tested interventions aimed at improving medication-taking ability and/or medication adherence among people aged ≥ 65 years (or of mean/median age > 65 years), living in the community or being discharged from hospital back into the community, and taking four or more regular prescription medications (or with group mean/median of more than four medications). Interventions targeting carers of older people who met these criteria were also included. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed abstracts and full texts of eligible studies, extracted data, and assessed risk of bias of included studies. We conducted meta-analyses when possible and used a random-effects model to yield summary estimates of effect, risk ratios (RRs) for dichotomous outcomes, and mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes, along with 95% confidence intervals (CIs). Narrative synthesis was performed when meta-analysis was not possible. We assessed overall certainty of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Primary outcomes were medication-taking ability and medication adherence. Secondary outcomes included health-related quality of life (HRQoL), emergency department (ED)/hospital admissions, and mortality. MAIN RESULTS We identified 50 studies (14,269 participants) comprising 40 RCTs, six cluster-RCTs, and four quasi-RCTs. All included studies evaluated interventions versus usual care; six studies also reported a comparison between two interventions as part of a three-arm RCT design. Interventions were grouped on the basis of their educational and/or behavioural components: 14 involved educational components only, 7 used behavioural strategies only, and 29 provided mixed educational and behavioural interventions. Overall, our confidence in results regarding the effectiveness of interventions was low to very low due to a high degree of heterogeneity of included studies and high or unclear risk of bias across multiple domains in most studies. Five studies evaluated interventions for improving medication-taking ability, and 48 evaluated interventions for improving medication adherence (three studies evaluated both outcomes). No studies involved educational or behavioural interventions alone for improving medication-taking ability. Low-quality evidence from five studies, each using a different measure of medication-taking ability, meant that we were unable to determine the effects of mixed interventions on medication-taking ability. Low-quality evidence suggests that behavioural only interventions (RR 1.22, 95% CI 1.07 to 1.38; 4 studies) and mixed interventions (RR 1.22, 95% CI 1.08 to 1.37; 12 studies) may increase the proportions of people who are adherent compared with usual care. We could not include in the meta-analysis results from two studies involving mixed interventions: one had a positive effect on adherence, and the other had little or no effect. Very low-quality evidence means that we are uncertain of the effects of educational only interventions (5 studies) on the proportions of people who are adherent. Low-quality evidence suggests that educational only interventions (SMD 0.16, 95% CI -0.12 to 0.43; 5 studies) and mixed interventions (SMD 0.47, 95% CI -0.08 to 1.02; 7 studies) may have little or no impact on medication adherence assessed through continuous measures of adherence. We excluded 10 studies (4 educational only and 6 mixed interventions) from the meta-analysis including four studies with unclear or no available results. Very low-quality evidence means that we are uncertain of the effects of behavioural only interventions (3 studies) on medication adherence when assessed through continuous outcomes. Low-quality evidence suggests that mixed interventions may reduce the number of ED/hospital admissions (RR 0.67, 95% CI 0.50 to 0.90; 11 studies) compared with usual care, although results from six further studies that we were unable to include in meta-analyses indicate that the intervention may have a smaller, or even no, effect on these outcomes. Similarly, low-quality evidence suggests that mixed interventions may lead to little or no change in HRQoL (7 studies), and very low-quality evidence means that we are uncertain of the effects on mortality (RR 0.93, 95% CI 0.67 to 1.30; 7 studies). Moderate-quality evidence shows that educational interventions alone probably have little or no effect on HRQoL (6 studies) or on ED/hospital admissions (4 studies) when compared with usual care. Very low-quality evidence means that we are uncertain of the effects of behavioural interventions on HRQoL (1 study) or on ED/hospital admissions (2 studies). We identified no studies evaluating effects of educational or behavioural interventions alone on mortality. Six studies reported a comparison between two interventions; however due to the limited number of studies assessing the same types of interventions and comparisons, we are unable to draw firm conclusions for any outcomes. AUTHORS' CONCLUSIONS Behavioural only or mixed educational and behavioural interventions may improve the proportion of people who satisfactorily adhere to their prescribed medications, but we are uncertain of the effects of educational only interventions. No type of intervention was found to improve adherence when it was measured as a continuous variable, with educational only and mixed interventions having little or no impact and evidence of insufficient quality to determine the effects of behavioural only interventions. We were unable to determine the impact of interventions on medication-taking ability. The quality of evidence for these findings is low due to heterogeneity and methodological limitations of studies included in the review. Further well-designed RCTs are needed to investigate the effects of interventions for improving medication-taking ability and medication adherence in older adults prescribed multiple medications.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Rohan A Elliott
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
- Pharmacy Department, Austin Health, Heidelberg, Australia
| | - Kate Petrie
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Lisha Kuruvilla
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
- Pharmacy Department, Barwon Health, North Geelong, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
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Kripalani S. Structured prescription instructions and medication adherence. Am J Health Syst Pharm 2020; 77:157-158. [PMID: 31974559 DOI: 10.1093/ajhp/zxz303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sunil Kripalani
- Center for Clinical Quality and Implementation Research Department of Medicine Vanderbilt University Medical Center Nashville, TN
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Zhao YY, Dang FP, Zhai TT, Li HJ, Wang RJ, Ren JJ. The effect of text message reminders on medication adherence among patients with coronary heart disease: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e18353. [PMID: 31876709 PMCID: PMC6946488 DOI: 10.1097/md.0000000000018353] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To determine the effectiveness of text message reminders (TMR) on medication adherence (MA) and to investigate the effects of TMR on clinical outcomes. METHODS The PubMed, Cochrane library, EMbase, and China Biology Medicine databases were searched for randomized-controlled trials with TMR as the intervention for patients with coronary heart disease. Two reviewers independently extracted data and assessed the risk of bias. Meta-analysis was conducted using Stata 15.0 software. RESULTS In total, 1678 patients in 6 trials were included. Compared with the control group, the MA was 2.85 times greater among the intervention group (RR [relative risk] 2.85; 95% confidence interval [CI] 1.07-7.58). TMR reduced systolic blood pressure (BP) (weighted mean difference) = -6.51; 95% CI -9.79 to -3.23), cholesterol (standard mean difference = -0.26; 95% CI -0.4 to -0.12) and increased the number of patients with BP <140/90 mm Hg (RR 1.39; 95% CI 1.26-1.54). CONCLUSION TMR significantly promoted MA and reduced systolic BP, cholesterol level, and body mass index, but had no effect on mortality, diastolic BP, or lipoproteins. However, substantial heterogeneity existed in our analyses.
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Affiliation(s)
| | - Fang-Ping Dang
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
| | - Tian-Tian Zhai
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
| | - Hui-Ju Li
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
| | - Rui-Juan Wang
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
| | - Jing-Jie Ren
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
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Gao Y, Peterson E, Pagidipati N. Opportunities for improving use of evidence-based therapy in patients with type 2 diabetes and cardiovascular disease. Clin Cardiol 2019; 42:1063-1070. [PMID: 31448852 PMCID: PMC6837027 DOI: 10.1002/clc.23252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 08/20/2019] [Indexed: 12/30/2022] Open
Abstract
Evidence‐based therapy that target hyperlipidemia, hypertension, smoking cessation, and weight loss have demonstrated significant benefits in reducing cardiovascular risks and related events. Although the benefit of intensively lowering blood glucose is unclear, newer antidiabetic drugs (glucagon‐like peptide‐1 receptor agonists and sodium‐glucose cotransporter‐2 inhibitors) have shown cardiovascular benefits in addition to their antihyperglycemic effect. Yet, studies suggest that recent use of evidence‐based therapy and management of cardiovascular risk among individuals with type 2 diabetes (T2D) and cardiovascular disease (CVD) remains largely suboptimal. The following narrative review first identifies barriers to translating research evidence to clinical practice at the levels of provider, health system, patient, and cost. Then it synthesizes previous implementation strategies that addressed multifaceted barriers and attempted to improve care for patients with T2D and CVD. In conclusion, team‐based care coordination, reminding systems in combination to pharmacist consultation and patient education, provider education compatible with clinical workflow, and coupled incentives between providers and patients appeared to be effective in reducing cardiovascular risks for patients with T2D and CVD, though the scalability and long‐term clinical effect of these strategies as well as the possibility of interventions involving payers and health systems remain uncertain.
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Affiliation(s)
- Yumin Gao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric Peterson
- Department of Medicine, Duke Clinical Research Institute, Center for Preventive Medicine, Duke University, Durham, North Carolina
| | - Neha Pagidipati
- Department of Medicine, Duke Clinical Research Institute, Center for Preventive Medicine, Duke University, Durham, North Carolina
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Dehghan Nayeri N, Yadegary MA, Seylani K, Navab E. Development and Psychometric Evaluation of Coronary Artery Disease Treatment Adherence Scale. Cardiol Ther 2019; 8:103-115. [PMID: 30972558 PMCID: PMC6525209 DOI: 10.1007/s40119-019-0135-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Poor treatment adherence reduces treatment effectiveness and increases healthcare costs. The promotion of treatment adherence necessitates valid and reliable tools to assess the effectiveness of adherence promotion strategies. This study was undertaken to develop and evaluate the psychometric properties of the Coronary Artery Disease Treatment Adherence Scale. METHODS This methodological study was conducted in two phases. In the first phase, a literature review was done and a 62-item scale was developed. In the second phase, different methods were used to assess the psychometric properties of the scale, namely its face validity, content validity, construct validity, internal consistency, and test-retest stability. RESULTS During face and content validity assessments, the number of items was reduced from 62 to 53. Moreover, in construct validity assessment via exploratory factor analysis, 18 items were deleted because their factor loading values were less than 0.3. The remaining 35 items were loaded on four factors, namely medication adherence, dietary adherence, exercise adherence, and healthy lifestyle adherence. The Cronbach's alpha values of the scale before and after factor analysis were 0.850 and 0.862, respectively. Its test-retest intraclass correlation coefficient was also 0.85. CONCLUSIONS The Coronary Artery Disease Treatment Adherence Scale is a valid and reliable tool and can be used in different healthcare settings for the assessment of treatment adherence among patients' with coronary artery disease. TRIAL REGISTRATION Tehran University of Medical Sciences, identifier, 35456.
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Affiliation(s)
- Nahid Dehghan Nayeri
- Nursing Management Department, Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Yadegary
- Critical Care Nursing Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Khatereh Seylani
- Critical Care Nursing Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Navab
- Critical Care Nursing Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Kubica A, Kosobucka A, Fabiszak T, Gorog DA, Siller-Matula JM. Assessment of adherence to medication in patients after myocardial infarction treated with percutaneous coronary intervention. Is there a place for newself-reported questionnaires? Curr Med Res Opin 2019; 35:341-349. [PMID: 30091642 DOI: 10.1080/03007995.2018.1510385] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Non-adherence to medication regimen after myocardial infarction (MI) leads to increased morbidity and mortality and generates additional cost to the healthcare system. OBJECTIVES The aim of this systematic review was to critically discuss assessment methods of adherence to medication in patients after myocardial infarction treated with percutaneous coronary intervention and the possible application of a new self-reported questionnaire. METHODS A systematic investigation of all published literature was conducted to minimize the risk of bias. A database search (PubMed, CENTRAL and Google Scholar databases) from January 1998 through December 2017. RESULTS Adequate assessment of patient adherence to treatment is necessary to understand the potential for adverse outcomes. Methods developed for adherence evaluation are classified as subjective and objective or as direct and indirect. Direct, objective measures reflect pharmacokinetics and include measurement of the drug or its metabolite concentration, evaluation of the presence of biological markers given with the drug and direct observation of patients' medication-taking behavior. Several indirect, objective methods are based on evaluation of the availability of prescribed medications assuming that medication is taken exactly as prescribed. Assessment of the effectiveness of treatment, both at the pharmacodynamic and clinical level, indirectly but objectively reflects adherence to treatment. Subjective methods, including patient-kept diaries, patient interviews and self-reported questionnaires, due to their simplicity, real-time feedback and low cost, are often used for adherence evaluation in clinical practice. CONCLUSIONS In spite of the availability, convenience and variety of methods, measuring adherence still remains a real challenge. Using a well designed questionnaire provides an opportunity to identify patients at increased risk of non-adherence and the obstacles impeding implementation of the treatment plan, allowing implementation of tailored interventions in order to improve patient medication-taking behavior.
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Affiliation(s)
- Aldona Kubica
- a Department of Health Promotion , Collegium Medicum, Nicolaus Copernicus University , Bydgoszcz , Poland
| | - Agata Kosobucka
- a Department of Health Promotion , Collegium Medicum, Nicolaus Copernicus University , Bydgoszcz , Poland
| | - Tomasz Fabiszak
- b Department of Cardiology and Internal Diseases , Collegium Medicum, Nicolaus Copernicus University , Bydgoszcz , Poland
| | - Diana A Gorog
- c National Heart & Lung Institute, Imperial College , London , UK
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Elbashir M, Awaisu A, El Hajj MS, Rainkie DC. Measurement of health literacy in patients with cardiovascular diseases: A systematic review. Res Social Adm Pharm 2019; 15:1395-1405. [PMID: 30709731 DOI: 10.1016/j.sapharm.2019.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 01/10/2019] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND While many instruments have been developed, validated, and used to assess health literacy skills, their use and appropriateness among patients with cardiovascular diseases (CVDs) are not widely studied. OBJECTIVE To identify, appraise, and synthesize available health literacy assessment instruments used in patients with CVDs. METHODS Electronic databases were searched for studies that used validated measures to assess health literacy in patients with CVDs. Included studies were assessed for risk of bias and the identified instruments were evaluated based on their psychometric properties. Data were synthesized using a narrative approach. RESULTS Forty-three studies were included in the review, of which 20 were cross-sectional studies and 12 were randomized controlled trials. Eleven health literacy assessment instruments were identified, of which only one was disease-specific. The Abbreviated version of the Test of Functional Health Literacy in Adults (S-TOFHLA) (n = 19) and the Rapid Estimate of Adult Literacy in Medicine (REALM) (n = 13) were found to be the most commonly used instruments to assess health literacy in CVDs. CONCLUSIONS The S-TOFHLA and the REALM are the most widely used instruments to evaluate health literacy in CVD population. More CVD-specific health literacy screening instruments are warranted. Assessment of health literacy should be a standard of care in patients with CVDs and effective interventions should be developed to improve the impact of limited health literacy on health outcomes in this population.
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Affiliation(s)
| | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, Qatar.
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Abstract
IMPORTANCE Among adults with chronic illness, 30% to 50% of medications are not taken as prescribed. In the United States, it is estimated that medication nonadherence is associated with 125 000 deaths, 10% of hospitalizations, and $100 billion in health care services annually. OBSERVATIONS PubMed was searched from January 1, 2000, to September 6, 2018, for English-language randomized clinical trials of interventions to improve medication adherence. Trials of patients younger than 18 years, trials that used self-report as the primary adherence outcome, and trials with follow-up periods less than 6 months were excluded; 49 trials were included. The most common methods of identifying patients at risk for nonadherence were patient self-report, electronic drug monitors (pill bottles), or pharmacy claims data to measure gaps in supply. Patient self-report is the most practical method of identifying nonadherent patients in the context of clinical care but may overestimate adherence compared with objective methods such as electronic drug monitors and pharmacy claims data. Six categories of interventions, and characteristics of successful interventions within each category, were identified: patient education (eg, recurrent and personalized telephone counseling sessions with health educators); medication regimen management (using combination pills to reduce the number of pills patients take daily); clinical pharmacist consultation for chronic disease co-management (including education, increased frequency of disease monitoring via telephone or in-person follow-up visits, and refill reminders); cognitive behavioral therapies (such as motivational interviewing by trained counselors); medication-taking reminders (such as refill reminder calls or use of electronic drug monitors for real-time monitoring and reminding); and incentives to promote adherence (such as reducing co-payments and paying patients and clinicians for achieving disease management goals). The choice of intervention to promote adherence will depend on feasibility and availability within a practice or health system. Successful interventions that are also clinically practical include using combination pills to reduce daily pill burden, clinical pharmacist consultation for disease co-management, and medication-taking reminders such as telephone calls to prompt refills (maximum observed absolute improvements in adherence of 10%, 15%, and 33%, respectively). CONCLUSIONS AND RELEVANCE Adherence can be assessed and improved within the context of usual clinical care, but more intensive and costly interventions that have demonstrated success will require additional investments by health systems.
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Affiliation(s)
- Vinay Kini
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora
| | - P Michael Ho
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora
- Cardiology Section, VA Eastern Colorado Health Care System, Aurora
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Mullen RJ, Duhig J, Russell A, Scarazzini L, Lievano F, Wolf MS. Best-practices for the design and development of prescription medication information: A systematic review. PATIENT EDUCATION AND COUNSELING 2018; 101:1351-1367. [PMID: 29548600 DOI: 10.1016/j.pec.2018.03.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 02/10/2018] [Accepted: 03/07/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To present evidence supporting best-practices for prescription drug labeling and educational materials. METHODS Articles were selected from three online databases (PubMed, Embase, CINAHL). Eligible manuscripts were: 1) English-language, 2) randomized, controlled trials, and 3) focused on improving prescription drug labeling practices. RESULTS Forty-nine articles were reviewed, and included both regulated label materials and pharmacy or health systems-generated tools. Best-practices included use of plain language principles, typographic cues, quantitative descriptors, and standardized formats, when applicable. Common outcomes included preference and comprehension, while few studies examined actual medication use (e.g. adherence, harms) or clinical health outcomes. Approximately half of studies directly engaged patients' perspectives in intervention development, which may have helped increase tool effectiveness. CONCLUSIONS Several best practices were apparent in the literature, particularly for written materials and pharmacy-generated container labeling. Design principles for supplemental instructions and multimedia tools were less cohesive, albeit less researched. The impact of patient involvement in tool design is promising, though requiring further study. PRACTICE IMPLICATIONS Definitive studies to inform practice standards on how to best communicate medication information to consumers are needed, especially as communication modalities continue to evolve. Increased research on if and how to incorporate patient-centered decision-making into the development process should be considered.
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Affiliation(s)
- Rebecca J Mullen
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States.
| | - James Duhig
- Pharmacovigilance and Patient Safety, AbbVie, Inc., 1 N. Waukegan Rd., GM60, AP51-2, North Chicago, IL, 60064, United States.
| | - Andrea Russell
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States.
| | - Linda Scarazzini
- Pharmacovigilance and Patient Safety, AbbVie, Inc., 1 N. Waukegan Rd., GM60, AP51-2, North Chicago, IL, 60064, United States.
| | - Fabio Lievano
- Safety Sciences, AbbVie, Inc., 1 N. Waukegan Rd., GM60, AP51-2, North Chicago, IL, 60064, United States.
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States.
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Magnani JW, Mujahid MS, Aronow HD, Cené CW, Dickson VV, Havranek E, Morgenstern LB, Paasche-Orlow MK, Pollak A, Willey JZ. Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention: A Scientific Statement From the American Heart Association. Circulation 2018; 138:e48-e74. [PMID: 29866648 PMCID: PMC6380187 DOI: 10.1161/cir.0000000000000579] [Citation(s) in RCA: 237] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Health literacy is the degree to which individuals are able to access and process basic health information and services and thereby participate in health-related decisions. Limited health literacy is highly prevalent in the United States and is strongly associated with patient morbidity, mortality, healthcare use, and costs. The objectives of this American Heart Association scientific statement are (1) to summarize the relevance of health literacy to cardiovascular health; (2) to present the adverse associations of health literacy with cardiovascular risk factors, conditions, and treatments; (3) to suggest strategies that address barriers imposed by limited health literacy on the management and prevention of cardiovascular disease; (4) to demonstrate the contributions of health literacy to health disparities, given its association with social determinants of health; and (5) to propose future directions for how health literacy can be integrated into the American Heart Association's mandate to advance cardiovascular treatment and research, thereby improving patient care and public health. Inadequate health literacy is a barrier to the American Heart Association meeting its 2020 Impact Goals, and this statement articulates the rationale to anticipate and address the adverse cardiovascular effects associated with health literacy.
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Schaffler J, Leung K, Tremblay S, Merdsoy L, Belzile E, Lambrou A, Lambert SD. The Effectiveness of Self-Management Interventions for Individuals with Low Health Literacy and/or Low Income: A Descriptive Systematic Review. J Gen Intern Med 2018; 33:510-523. [PMID: 29427178 PMCID: PMC5880764 DOI: 10.1007/s11606-017-4265-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 11/20/2017] [Accepted: 12/04/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND With the burden of chronic illness increasing globally, self-management is a crucial strategy in reducing healthcare costs and increasing patient quality of life. Low income and low health literacy are both associated with poorer health outcomes and higher rates of chronic disease. Thus, self-management represents an important healthcare strategy for these populations. The purpose of this study is to review self-management interventions in populations with low income or low health literacy and synthesize the efficacy of these interventions. METHODS A systematic review of trials evaluating the efficacy of self-management interventions in populations with low income or low health literacy diagnosed with a chronic illness was conducted. Electronic databases were primarily searched to identify eligible studies. Data were extracted and efficacy summarized by self-management skills, outcomes, and content tailoring. RESULTS 23 studies were reviewed, with ten reporting an overall positive effect on at least one primary outcome. Effective interventions most often included problem-solving as well as taking action and/or resource utilization. A wide range of health-related outcomes were considered, were efficacious empowerment and disease-specific quality of life were found to be significant. The efficacy of interventions did not seem to vary by duration, format, or mode of delivery or whether these included individuals with low health literacy and/or low income. Tailoring did not seem to impact on efficacy. DISCUSSION Findings suggest that self-management interventions in populations with low income or low health literacy are most effective when three to four self-management skills are utilized, particularly when problem-solving is targeted. Healthcare providers and researchers can use these findings to develop education strategies and tools for populations with low income or low health literacy to improve chronic illness self-management.
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Affiliation(s)
- Jamie Schaffler
- Ingram School of Nursing, McGill University, Quebec, Montreal, Canada
| | - Katerina Leung
- Ingram School of Nursing, McGill University, Quebec, Montreal, Canada
| | - Sarah Tremblay
- Ingram School of Nursing, McGill University, Quebec, Montreal, Canada
| | - Laura Merdsoy
- Ingram School of Nursing, McGill University, Quebec, Montreal, Canada
| | - Eric Belzile
- St. Mary's Research Centre, Quebec, Montreal, Canada
| | - Angella Lambrou
- Schulich Library of Science and Engineering, McGill University, Quebec, Montreal, Canada
| | - Sylvie D Lambert
- Ingram School of Nursing, McGill University, Quebec, Montreal, Canada. .,St. Mary's Research Centre, Quebec, Montreal, Canada.
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Levy AE, Huang C, Huang A, Michael Ho P. Recent Approaches to Improve Medication Adherence in Patients with Coronary Heart Disease: Progress Towards a Learning Healthcare System. Curr Atheroscler Rep 2018; 20:5. [PMID: 29368179 DOI: 10.1007/s11883-018-0707-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Non-adherence to medications for the secondary prevention of myocardial infarction (MI) is a major contributor to morbidity and mortality in these patients. This review describes recent advances in promoting adherence to therapies for coronary artery disease (CAD). RECENT FINDINGS Two large randomized controlled trials to "incentivize" adherence were somewhat disappointing; neither financial incentives nor "peer pressure" successfully increased rates of adherence in the post-MI population. Patient education and provider engagement appear to be critical aspects of improving adherence to CAD therapies, where the provider is a physician, pharmacist, or nurse and follow-up is performed in person or by telephone. Fixed-dose combinations of CAD medications, formulated as a so-called "polypill," have shown some early efficacy in increasing adherence. Technological advances that automate monitoring and/or encouragement of adherence are promising but seem universally dependent on patient engagement. For example, medication reminders via text message perform better if patients are required to respond. Multifaceted interventions, in which these and other interventions are combined together, appear to be most effective. There are several available types of proven interventions through which providers, and the health system at large, can advance patient adherence to CAD therapies. No single intervention to promote adherence will be successful in all patients. Further study of multifaceted interventions and the interactions between different interventions will be important to advancing the field. The goal is a learning healthcare system in which a network of interventions responds and adapts to patients' needs over time.
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Affiliation(s)
| | - Carrie Huang
- University of Southern California, Los Angeles, California, USA
| | - Allen Huang
- University of Southern California, Los Angeles, California, USA
| | - P Michael Ho
- Department of Medicine, Denver VA Medical Center, Denver, CO, 80220, USA
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Ancker JS, Send A, Hafeez B, Osorio SN, Abramson E. Health IT Usability Focus Section: Adapting EHR-Based Medication Instructions to Comply with Plain Language Guidance-A Randomized Experiment. Appl Clin Inform 2017; 8:1127-1143. [PMID: 29241250 DOI: 10.4338/aci-2017-06-ra-0111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Patient instructions are generally written by clinicians. However, clinician-centered language is challenging for patients to understand; in the case of pediatric medication instructions, consequences can be serious. Using examples of clinician-written medication instructions from an electronic health record, we conducted an experiment to determine whether parental misinterpretations would be reduced by instructions that followed best practices for plain language.
Methods We selected examples of dosing instructions from after-visit summaries in a commercial electronic health record. A demographically diverse sample of parents and adult caregivers was recruited from an online panel to participate in an English-language experiment, in which they received a comprehension questionnaire with either original after-visit summary instructions or instructions revised to comply with federal and other sources of plain-language guidance.
Results Nine-hundred and fifty-one respondents completed the experiment; 50% were women, the mean age was 36 years, and 38% had less than a 4-year college education. The revisions were associated with an 8 percentage point increase in correct answers overall (from 55% to 63%, p < 0.001), although revisions were not equally effective for all instructions. Health literacy and health numeracy were strong and independent predictors of comprehension. Overall, mistakes on comprehension questions were common, with respondents missing an average of 41% (6.1 of 15) of questions.
Conclusion In this experimental study, a relatively simple intervention of revising text was associated with a modest reduction in frequency of misinterpretations of medication instructions. As a supplement to more intensive high-touch interventions, revising electronic health record output to replace complex language with patient-centered language in an automated fashion is a potentially scalable solution that could reduce medication administration errors by parents.
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Affiliation(s)
- Jessica S Ancker
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, United States
| | - Alexander Send
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, United States
| | - Baria Hafeez
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, United States
| | - Snezana N Osorio
- Department of Pediatrics, Weill Cornell Medicine, New York, New York, United States
| | - Erika Abramson
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, United States.,Department of Pediatrics, Weill Cornell Medicine, New York, New York, United States
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Leong C, Sareen J, Leslie WD, Enns MW, Bolton J, Alessi-Severini S, Katz LY, Logsetty S, Snider C, Berry J, Prior HJ, Chateau D. Validity of the days supply field in pharmacy administrative claims data for the identification of blister packaging of medications. Pharmacoepidemiol Drug Saf 2017; 26:1540-1545. [PMID: 28856756 DOI: 10.1002/pds.4288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 04/17/2017] [Accepted: 07/14/2017] [Indexed: 11/10/2022]
Abstract
PURPOSE Pharmacy claims data is often used in pharmacoepidemiology studies, but no studies to date have examined whether it was possible to identify the use of blister packs in these databases. We aimed to determine whether medications dispensed in days divisible by 7 are more likely to be blister packed than medications dispensed in other quantities. METHODS Community pharmacies in Manitoba were invited to participate in a mail-out survey to identify the use of blister packaging for up to 25 patients who had a solid oral medication dispensed from April 1, 2012 to March 31, 2014. Eligible medications were identified using the population-based province-wide retail pharmacy network. Algorithms for identifying the use of blister packaging were determined by comparing the proportion of fills that confirmed blister pack use between different days supply quantities. RESULTS Twenty-seven out of 32 pharmacies that agreed to participate completed the survey. The total number of prescriptions in the analysis was 2045 of which 131 (6.4%) were dispensed in blister packaging. Overall, prescriptions dispensed in days divisible by 7 yielded a 72.5% sensitivity, 86.6% specificity, 30.3% PPV, and 97.9% NPV compared with prescriptions dispensed in other quantities. A 28-day to 30-day comparison yielded an 87.9% sensitivity, 96.1% specificity, 64.6% PPV, and 99.0% NPV. CONCLUSION While the NPV was high, the PPV for identifying blister packaging using the days supply field in pharmacy claims data was modest given the low prevalence in blister pack use. The best predictor occurred when 28 days was compared with 30 days. KEY POINTS Blister packs are arranged in 4 × 7 compartments and are often used to improve adherence, but no studies have examined whether it was possible to identify the use of blister packs using the days supply field in pharmacy claims data. Findings show that a 28-day supply yielded a high sensitivity and specificity for identifying the use of blister packaging compared with a 30-day supply, but there is potential for misclassification. Future studies directed at examining subgroups that are more likely to use blister packs and replication of findings using other data sources in other jurisdictions are encouraged.
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Affiliation(s)
- Christine Leong
- College of Pharmacy, Rady Faculty of Health Sciences, Apotex Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - William D Leslie
- Department of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Murray W Enns
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Silvia Alessi-Severini
- College of Pharmacy, Rady Faculty of Health Sciences, Apotex Centre, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laurence Y Katz
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarvesh Logsetty
- Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carolyn Snider
- Department of Emergency Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jason Berry
- Information Management and Analytics, Manitoba Health, Seniors and Active Living, Winnipeg, Manitoba, Canada
| | - Heather J Prior
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dan Chateau
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Monroe AK, Pena JS, Moore RD, Riekert KA, Eakin MN, Kripalani S, Chander G. Randomized controlled trial of a pictorial aid intervention for medication adherence among HIV-positive patients with comorbid diabetes or hypertension. AIDS Care 2017; 30:199-206. [PMID: 28793785 DOI: 10.1080/09540121.2017.1360993] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
As the HIV-infected population ages and the burden of chronic comorbidities increases, adherence to medications for HIV and diabetes and hypertension is crucial to improve outcomes. We pilot-tested a pictorial aid intervention to improve medication adherence for both HIV and common chronic conditions. Adult patients with HIV and diabetes (DM) and/or hypertension (HTN) attending a clinic for underserved patients and at risk for poor health outcomes were enrolled. Patients were randomized to receive either a pictorial aid intervention (a photographic representation of their medications, the indications, and the dosing schedule) or a standard clinic visit discharge medication list. Adherence to antiretroviral therapy (ART) for HIV and therapy for DM or HTN was compared. Predictors of ART adherence at baseline were determined using logistic regression. Medication adherence was assessed using medication possession ratio (MPR) for the 6-month interval before and after the intervention. Change in adherence by treatment group was compared by ANOVA. Among the 46 participants, there was a trend towards higher adherence to medications for HIV compared with medications for hypertension/diabetes (baseline median MPR for ART 0.92; baseline median MPR for the medication for the comorbid condition 0.79, p = 0.07). The intervention was feasible to implement and satisfaction with the intervention was high. With a small sample size, the intervention did not demonstrate significant improvement in adherence to medications for HIV or comorbid conditions. Patients with HIV are often medically complex and may have multiple barriers to medication adherence. Medication adherence is a multifaceted process and adherence promotion interventions require an approach that targets patient-specific barriers.
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Affiliation(s)
- A K Monroe
- a Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - J S Pena
- a Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - R D Moore
- a Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - K A Riekert
- b Division of Pulmonary and Critical Care Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - M N Eakin
- b Division of Pulmonary and Critical Care Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - S Kripalani
- c Division of General Internal Medicine and Public Health , Vanderbilt University Medical Center , Nashville , TN , USA
| | - G Chander
- a Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Kröger E, Tatar O, Vedel I, Giguère AMC, Voyer P, Guillaumie L, Grégoire JP, Guénette L. Improving medication adherence among community-dwelling seniors with cognitive impairment: a systematic review of interventions. Int J Clin Pharm 2017; 39:641-656. [PMID: 28555421 DOI: 10.1007/s11096-017-0487-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/13/2017] [Indexed: 11/24/2022]
Abstract
Background Medication non-adherence may lead to poor therapeutic outcomes. Cognitive functions deteriorate with age, contributing to decreased adherence. Interventions have been tested to improve adherence in seniors with cognitive impairment or Alzheimer disease (AD), but high-quality systematic reviews are lacking. It remains unclear which interventions are promising. Objectives We conducted a systematic review to identify, describe, and evaluate interventions aimed at improving medication adherence among seniors with any type of cognitive impairment. Methods Following NICE guidance, databases and websites were searched using combinations of controlled and free vocabulary. All adherence-enhancing interventions and study designs were considered. Studies had to include community dwelling seniors, aged 65 years or older, with cognitive impairment, receiving at least one medication for a chronic condition, and an adherence measure. Study characteristics and methodological quality were assessed. Results We identified 13 interventions, including six RCTs. Two studies were of poor, nine of low/medium and two of high quality. Seven studies had sample sizes below 50 and six interventions focused on adherence to AD medication. Six interventions tested a behavioral, four a medication oriented, two an educational and one a multi-faceted approach. Studies rarely assessed therapeutic outcomes. All but one intervention showed improved adherence. Conclusion Three medium quality studies showed better adherence with patches than with pills for AD treatment. Promising interventions used educational or reminding strategies, including one high quality RCT. Nine studies were of low/moderate quality. High quality RCTs using a theoretical framework for intervention selection are needed to identify strategies for improved adherence in these seniors.
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Affiliation(s)
- Edeltraut Kröger
- Centre d'excellence sur le vieillissement de Québec, Axe Santé des populations et pratiques optimales en santé, Centre intégré universitaire des soins et services de santé de la Capitale nationale, Hôpital St-Sacrement, 1050 Chemin Ste-Foy, Room L2-30, Quebec City, QC, G1S 4L8, Canada. .,Faculty of Pharmacy, Université Laval, Quebec City, QC, Canada. .,Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Center, Quebec City, Canada.
| | - Ovidiu Tatar
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Anik M C Giguère
- Centre d'excellence sur le vieillissement de Québec, Axe Santé des populations et pratiques optimales en santé, Centre intégré universitaire des soins et services de santé de la Capitale nationale, Hôpital St-Sacrement, 1050 Chemin Ste-Foy, Room L2-30, Quebec City, QC, G1S 4L8, Canada.,Département de médecine de famille et de médecine d'urgence, Université Laval, Quebec City, QC, Canada.,Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Center, Quebec City, Canada
| | - Philippe Voyer
- Centre d'excellence sur le vieillissement de Québec, Axe Santé des populations et pratiques optimales en santé, Centre intégré universitaire des soins et services de santé de la Capitale nationale, Hôpital St-Sacrement, 1050 Chemin Ste-Foy, Room L2-30, Quebec City, QC, G1S 4L8, Canada.,Faculté des sciences infirmières, Université Laval, Quebec City, QC, Canada.,Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Center, Quebec City, Canada
| | - Laurence Guillaumie
- Faculté des sciences infirmières, Université Laval, Quebec City, QC, Canada.,Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Center, Quebec City, Canada.,Chair on Adherence to Treatment, Université Laval, Quebec City, QC, Canada
| | - Jean-Pierre Grégoire
- Faculty of Pharmacy, Université Laval, Quebec City, QC, Canada.,Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Center, Quebec City, Canada.,Chair on Adherence to Treatment, Université Laval, Quebec City, QC, Canada
| | - Line Guénette
- Faculty of Pharmacy, Université Laval, Quebec City, QC, Canada.,Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Center, Quebec City, Canada.,Chair on Adherence to Treatment, Université Laval, Quebec City, QC, Canada
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Spoelstra SL, Sansoucie H. Putting evidence into practice: evidence-based interventions for oral agents for cancer. Clin J Oncol Nurs 2017; 19:60-72. [PMID: 26030394 DOI: 10.1188/15.s1.cjon.60-72] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The limited evidence available suggests that adherence to oral agents for cancer is a significant clinical problem and may have a substantial impact on treatment success or failure. Adherence is a difficult issue among patients who are very sick with a life-threatening disease who often must adhere to complex treatment protocols independently at home. OBJECTIVES This article aims to identify effective interventions for the promotion, treatment, and management of adherence to oral agents for cancer and to synthesize the literature for use in clinical practice. METHODS As part of the Oncology Nursing Society (ONS) Putting Evidence Into Practice (PEP) initiative, a comprehensive examination of the current literature was conducted to identify effective interventions for patients prescribed oral agents for cancer. The ONS PEP weight-of-evidence classification schema levels of evidence were used to categorize interventions to assist nurses in identifying strategies that are effective at improving adherence. FINDINGS The majority of evidence found was conducted in conditions other than cancer; therefore, research is needed to identify whether these interventions are effective at promoting adherence in patients with cancer.
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Mitchell B, Chong C, Lim WK. Medication adherence 1 month after hospital discharge in medical inpatients. Intern Med J 2016; 46:185-92. [PMID: 26602319 DOI: 10.1111/imj.12965] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/28/2015] [Accepted: 11/06/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND The rate of medication non-adherence has been consistently reported to be between 20 and 50%. The majority of available data comes from international studies, and we hypothesised that a similar rate of adherence may be observed in Australian patients. AIMS To determine the rate of adherence to medications after discharge from acute general hospital admission and identify factors that may be associated with non-adherence. METHODS A prospective cohort study of 68 patients, comparing admission and discharge medication regimens to self-reported regimens 30-40 days after discharge from hospital. Patients were followed up via telephone call and univariate and multivariate binary logistic regression used to determine patient factors associated with non-adherence. RESULTS In all, 27 of 68 patients (39.7%) were non-adherent to one or more regular medications at follow up. Intentional and unintentional non-adherence contributed equally to non-adherence. Using multivariate analysis, presence of a carer responsible for medications was associated with significantly lower non-adherence (odds ratio (OR) 0.20 (0.05-0.83), P = 0.027) when adjusted for age, co-morbidities, chemist blister pack and total number of discharge medications. CONCLUSIONS Non-adherence to prescription medications is suboptimal and consistent with previous overseas studies. Having a carer responsible for medications is associated with significantly lower rates of non-adherence. Understanding patients' preferences and involving them in their healthcare may reduce intentional non-adherence.
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Affiliation(s)
- B Mitchell
- Department of Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - C Chong
- Department of Aged Care, Northern Hospital, Melbourne, Victoria, Australia
| | - W K Lim
- Department of Aged Care, Northern Hospital, Melbourne, Victoria, Australia
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Chinn D, Homeyard C. Easy read and accessible information for people with intellectual disabilities: Is it worth it? A meta-narrative literature review. Health Expect 2016; 20:1189-1200. [PMID: 27862757 PMCID: PMC5689240 DOI: 10.1111/hex.12520] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2016] [Indexed: 11/28/2022] Open
Abstract
Background The proliferation of “accessible information” for people with intellectual disabilities in UK health care has accelerated in recent years, underpinned by policy guidance alongside the recent introduction of mandatory standards. However, questions have been raised as to the impact of such resources as a means of enhancing involvement in health care and addressing health inequalities. Objective To review and synthesize the evidence from different approaches used to evaluate the impact of accessible information for people with intellectual disabilities using a meta‐narrative approach. Search strategy Literature searches were iterative and incorporated formal databases, grey literature and hand searches alongside more intuitive and opportunistic methods. Inclusion criteria Included English language papers published before December 2015 described the design and evaluation of written information adapted for adults with intellectual disabilities. Data extraction and synthesis We organized the papers into five groups according to similarity in authors’ writing styles and presentation, epistemology and theoretical foundations, aims and methodologies, professional and organizational identities. Main results The 42 included papers in the five groupings occupied diverse positions on (i) public communication vs individualized materials, (ii) literacy as decontextualized skills vs social practices and (iii) the expertise of patients vs professionals. There was limited evidence for the impact of accessible health information, notwithstanding the potential benefits associated with their creation. Conclusions Individually tailored information is more likely to meet personalized health information needs for people with intellectual disabilities. The emergence of different social formations in the creation of accessible information has potential for advancing engagement of diverse groups.
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Affiliation(s)
- Deborah Chinn
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Claire Homeyard
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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Wali H, Hudani Z, Wali S, Mercer K, Grindrod K. A systematic review of interventions to improve medication information for low health literate populations. Res Social Adm Pharm 2016; 12:830-864. [DOI: 10.1016/j.sapharm.2015.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 12/02/2015] [Accepted: 12/04/2015] [Indexed: 01/18/2023]
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Al-Ganmi AH, Perry L, Gholizadeh L, Alotaibi AM. Cardiovascular medication adherence among patients with cardiac disease: a systematic review. J Adv Nurs 2016; 72:3001-3014. [PMID: 27377689 DOI: 10.1111/jan.13062] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2016] [Indexed: 12/20/2022]
Abstract
AIMS The aim of this study was to critically appraise and synthesize the best available evidence on the effectiveness of interventions suitable for delivery by nurses, designed to enhance cardiac patients' adherence to their prescribed medications. BACKGROUND Cardiac medications have statistically significant health benefits for patients with heart disease, but patients' adherence to prescribed medications remains suboptimal. DESIGN A systematic quantitative review of intervention effects. DATA SOURCES We conducted systematic searches for English-language, peer-reviewed randomized controlled trial publications via Medline, EMBASE, CINAHL, the Cochrane Library, ProQuest, Web of Science and Google Scholar published between January 2004-December 2014. REVIEW METHODS According to pre-determined inclusion and exclusion criteria, eligible studies were identified and data extracted using a predefined form. Of 1962 identified papers; 14 studies met the study inclusion criteria, were assessed for risk of bias using the Cochrane Collaboration tool; and included in the review. RESULTS Study findings were presented descriptively; due to the heterogeneity of studies meta-analysis was not possible. Included papers described interventions categorized as: (1) multifaceted; and (2) behavioural and educational, comprising: (a) text message and mail message; (b) telephone calls; (c) motivational interviewing and (d) nurse-led counselling and education. CONCLUSIONS Substantial heterogeneity limited the robustness of conclusions, but this review indicated that motivational interviewing, education and phone or text messaging appeared promising as means to enhance cardiac medication adherence. Future research should integrate multifaceted interventions that target individual behaviour change to enhance adherence to cardiovascular medications, to build on the beneficial outcomes indicated by this review.
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Affiliation(s)
- Ali Hussein Al-Ganmi
- University of Technology Sydney, Faculty of Nursing, Midwifery and Health, Sydney, New South Wales, Australia.,University of Baghdad, College of Nursing, Iraq
| | - Lin Perry
- University of Technology Sydney, Faculty of Nursing, Midwifery and Health, Sydney, New South Wales, Australia.,Health Services and Practice Research Strength, South Eastern Sydney Local Health District, Randwick, New South Wales, Australia.,Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Leila Gholizadeh
- Faculty University of Technology Sydney, Faculty of Nursing, Midwifery and Health, Sydney, New South Wales, Australia
| | - Abdulellah Modhi Alotaibi
- University of Technology Sydney, Faculty of Nursing, Midwifery and Health, Sydney, New South Wales, Australia.,Shqra University, Faculty of Applied Health Sciences, Saudi Arabia
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42
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Chase JAD, Bogener JL, Ruppar TM, Conn VS. The Effectiveness of Medication Adherence Interventions Among Patients With Coronary Artery Disease: A Meta-analysis. J Cardiovasc Nurs 2016; 31:357-66. [PMID: 27057598 PMCID: PMC4826853 DOI: 10.1097/jcn.0000000000000259] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Despite the known benefits of medication therapy for secondary prevention of coronary artery disease (CAD), many patients do not adhere to prescribed medication regimens. Medication nonadherence is associated with poor health outcomes and higher healthcare cost. OBJECTIVE The purpose of this meta-analysis was to determine the overall effectiveness of interventions designed to improve medication adherence (MA) among adults with CAD. In addition, sample, study design, and intervention characteristics were explored as potential moderators to intervention effectiveness. METHODS Comprehensive search strategies helped in facilitating the identification of 2-group, treatment-versus-control-design studies testing MA interventions among patients with CAD. Data were independently extracted by 2 trained research specialists. Standardized mean difference effect sizes were calculated for eligible primary studies, adjusted for bias, and then synthesized under a random-effects model. Homogeneity of variance was explored using a conventional heterogeneity statistic. Exploratory moderator analyses were conducted using meta-analytic analogs for analysis of variance and regression for dichotomous and continuous moderators, respectively. RESULTS Twenty-four primary studies were included in this meta-analysis. The overall effect size of MA interventions, calculated from 18,839 participants, was 0.229 (P < .001). The most effective interventions used nurses as interventionists, initiated interventions in the inpatient setting, and informed providers of patients' MA behaviors. Medication adherence interventions tested among older patients were more effective than those among younger patients. The interventions were equally effective regardless of number of intervention sessions, targeting MA behavior alone or with other behaviors, and the use of written instructions only. CONCLUSIONS Interventions to increase MA among patients with CAD were modestly effective. Nurses can be instrumental in improving MA among these patients. Future research is needed to investigate nurse-delivered MA interventions across varied clinical settings. In addition, more research testing MA interventions among younger populations and more racially diverse groups is needed.
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Affiliation(s)
- Jo-Ana D. Chase
- S343 School of Nursing, University of Missouri, Columbia, MO 65211
| | - Jennifer L. Bogener
- University of Missouri, School of Nursing, School of Health Professions, 100 E. Green Meadows Rd. Ste. 10, Columbia, MO 65203
| | - Todd M. Ruppar
- S423 School of Nursing, University of Missouri, Columbia, MO 65211
| | - Vicki S. Conn
- S317 School of Nursing, University of Missouri, Columbia, MO 65211
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Pedrosa RBDS, Rodrigues RCM. Adaptation and evaluation of the measurement properties of the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale. Rev Lat Am Enfermagem 2016; 24:e2692. [PMID: 27192417 PMCID: PMC4877142 DOI: 10.1590/1518-8345.0167.2692] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 07/25/2015] [Indexed: 12/20/2022] Open
Abstract
Objectives: to undertake the cultural adaptation of, and to evaluate the measurement
properties of, the Brazilian version of the Self-efficacy for Appropriate
Medication Adherence Scale in coronary heart disease (CHD) patients, with
outpatient monitoring at a teaching hospital. Method: the process of cultural adaptation was undertaken in accordance with the
international literature. The data were obtained from 147 CHD patients, through
the application of the sociodemographic/clinical characterization instrument, and
of the Brazilian versions of the Morisky Self-Reported Measure of Medication
Adherence Scale, the General Perceived Self-Efficacy Scale, and the Self-efficacy
for Appropriate Medication Adherence Scale. Results: the Brazilian version of the Self-efficacy for Appropriate Medication Adherence
Scale presented evidence of semantic-idiomatic, conceptual and cultural
equivalencies, with high acceptability and practicality. The floor effect was
evidenced for the total score and for the domains of the scale studied. The
findings evidenced the measure's reliability. The domains of the Brazilian version
of the Self-efficacy for Appropriate Medication Adherence Scale presented
significant inverse correlations of moderate to strong magnitude between the
scores of the Morisky scale, indicating convergent validity, although correlations
with the measure of general self-efficacy were not evidenced. The validity of
known groups was supported, as the scale discriminated between "adherents" and
"non-adherents" to the medications, as well as to "sufficient dose" and
"insufficient dose". Conclusion: the Brazilian version of the Self-efficacy for Appropriate Medication Adherence
Scale presented evidence of reliability and validity in coronary heart disease
outpatients.
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Choi J, Jacelon CS, Kalmakis KA. Web-Based, Pictograph-Formatted Discharge Instructions for Low-Literacy Older Adults After Hip Replacement Surgery: Findings of End-User Evaluation of the Website. Rehabil Nurs 2016; 42:254-261. [PMID: 27061209 DOI: 10.1002/rnj.274] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this study was to develop web-based, pictograph-formatted discharge instructions and evaluate the website with intended users to maximize the relevance and clarity of the website. DESIGN A descriptive study. METHODS Low-literacy text and 45 sets of pictographs were implemented in web-based instructions. The content, design, function, and navigation of the website were reviewed by 15 low-literate older adults following hip replacement surgery. FINDINGS Participants observed that the simple line drawings with clear background were well suited to web pages and helped to convey the points made. They also suggested changes such as adding an additional alphabetical index menu to enhance easy navigation and removing hypertext links to avoid distraction. CONCLUSIONS Web-based, pictograph-formatted discharge instructions were well received by low-literate older adults, who perceived the website easy to use and understand. CLINICAL RELEVANCE A pictograph-formatted approach may provide effective strategies to promote understanding of lengthy, complex action-based discharge instructions in rehabilitation facilities.
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Affiliation(s)
- Jeungok Choi
- College of Nursing, University of Massachusetts Amherst, Amherst, MA, USA
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45
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Santo K, Kirkendall S, Laba TL, Thakkar J, Webster R, Chalmers J, Chow CK, Redfern J. Interventions to improve medication adherence in coronary disease patients: A systematic review and meta-analysis of randomised controlled trials. Eur J Prev Cardiol 2016; 23:1065-76. [DOI: 10.1177/2047487316638501] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 02/22/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Karla Santo
- The George Institute for Global Health, University of Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
| | | | - Tracey-Lea Laba
- The George Institute for Global Health, University of Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
| | - Jay Thakkar
- The George Institute for Global Health, University of Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
- Cardiology Department, Westmead Hospital, Australia
| | - Ruth Webster
- The George Institute for Global Health, University of Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
| | - John Chalmers
- The George Institute for Global Health, University of Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
| | - Clara K Chow
- The George Institute for Global Health, University of Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
- Cardiology Department, Westmead Hospital, Australia
| | - Julie Redfern
- The George Institute for Global Health, University of Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
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46
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Glynn L, Fahey T. Cardiovascular medication: improving adherence using prompting mechanisms. BMJ CLINICAL EVIDENCE 2015; 2015:0220. [PMID: 26389860 PMCID: PMC4577014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Adherence to medication is generally defined as the extent to which people take medications as prescribed by their healthcare providers. It can be assessed in many ways (e.g., by self-reporting, pill counting, direct observation, electronic monitoring, or by pharmacy records). This overview reports effects of prompting mechanisms on adherence to cardiovascular medications, however adherence has been measured. METHODS AND OUTCOMES We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of prompting mechanisms to improve adherence to long-term medication for cardiovascular disease in adults? We searched Medline, Embase, The Cochrane Library, and other important databases up to May 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). RESULTS At this update, searching of electronic databases retrieved 174 studies. After deduplication and removal of conference abstracts, 80 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 45 studies and the further review of 35 full publications. Of the 35 full articles evaluated, one RCT was added at this update. We performed a GRADE evaluation of seven PICO combinations. CONCLUSIONS In this systematic overview, we categorised the efficacy for seven comparisons based on information relating to the effectiveness and safety of prompting mechanisms, alone and in combination with reminder packaging or patient education.
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Affiliation(s)
- Liam Glynn
- National University of Ireland, Galway, Ireland
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47
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Bailey SC, Navaratnam P, Black H, Russell AL, Wolf MS. Advancing Best Practices for Prescription Drug Labeling. Ann Pharmacother 2015; 49:1222-36. [DOI: 10.1177/1060028015602272] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Problematic prescription drug labeling has been cited as a root cause of patient misunderstanding, medication errors, and nonadherence. Although numerous studies have recently been conducted to identify and test labeling best practices, the last systematic review on this topic was conducted a decade ago. The objective of this review was, therefore, to examine, summarize, and update best practices for conveying written prescription medication information and instructions to patients. Data Sources: English-language articles published from June 2005 to June 2015 were identified in MEDLINE and CINAHL by searching the following text words: ‘ medication OR prescription OR drug’ AND ‘label OR leaflet OR brochure OR pamphlet OR medication guide OR medication insert OR drug insert OR medication information OR drug information OR instructions’ AND ‘ patient OR consumer.’ Reference mining and secondary searches were also performed. Study Selection and Data Extraction: A total of 31 articles providing evidence on how to improve written, prescription drug labeling for patient use were selected. Two reviewers independently screened articles, rated their quality, and abstracted data. Data Synthesis: Identified best practices included the use of plain language, improved formatting and organization, and more explicit instructions to improve patient comprehension. The use of icons had conflicting findings, and few studies tested whether practices improved knowledge or behaviors with patients’ actual prescribed regimens. Conclusions: Future studies are needed to determine how specific modifications and improvements in drug labeling can enhance patient knowledge and behavior in actual use. Synthesizing best practices across all patient materials will create a more useful, coordinated system of prescription information.
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Affiliation(s)
- Stacy Cooper Bailey
- Eshelman School of Pharmacy at The University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Allison L. Russell
- Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Michael S. Wolf
- Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
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Conn VS, Enriquez M, Ruppar TM, Chan KC. Cultural relevance in medication adherence interventions with underrepresented adults: systematic review and meta-analysis of outcomes. Prev Med 2014; 69:239-47. [PMID: 25450495 PMCID: PMC4312199 DOI: 10.1016/j.ypmed.2014.10.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 10/14/2014] [Accepted: 10/19/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This meta-analysis systematically compiles intervention research designed to increase medication adherence among underrepresented adults. METHOD Comprehensive searching located published and unpublished studies with medication adherence behavior outcomes. Studies were included if samples were adults living in North America who had any of the following backgrounds or identities: African American, Native American, Latino, Latino American, Asian, Asian American, Pacific Islander, Native Alaskan, or Native Hawaiian. Random-effect analyses synthesized data to calculate effect sizes as a standardized mean difference and variability measures. Exploratory moderator analyses examined the association between specific efforts to increase the cultural relevance of medication adherence studies and behavior outcomes. RESULTS Data were synthesized across 5559 subjects in 55 eligible samples. Interventions significantly improved medication adherence behavior of treatment subjects compared to control subjects (standardized mean difference=0.211). Primary studies infrequently reported strategies to enhance cultural relevance. Exploratory moderator analyses found no evidence that associated cultural relevance strategies with better medication adherence outcomes. CONCLUSION The modest magnitude of improvements in medication adherence behavior documents the need for further research with clear testing of cultural relevance features.
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Affiliation(s)
- Vicki S Conn
- Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA.
| | - Maithe Enriquez
- Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA.
| | - Todd M Ruppar
- Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA.
| | - Keith C Chan
- Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA.
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McNaughton CD, Jacobson TA, Kripalani S. Low literacy is associated with uncontrolled blood pressure in primary care patients with hypertension and heart disease. PATIENT EDUCATION AND COUNSELING 2014; 96:165-170. [PMID: 24882088 PMCID: PMC4102336 DOI: 10.1016/j.pec.2014.05.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 04/28/2014] [Accepted: 05/04/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To evaluate the association between low literacy and uncontrolled blood pressure (BP) and their associations with medication adherence. METHODS Cross-sectional study of 423 urban, primary care patients with hypertension and coronary disease. The relationship between low literacy (Rapid Estimate of Adult Literacy in Medicine ≤ 44) and uncontrolled BP (≥140/90 mmHg, ≥130/80 mmHg for patients with diabetes) was evaluated by crude and adjusted logistic regression. Relationships with self-reported adherence and refill adherence were explored using adjusted linear and logistic regression. RESULTS Overall, 192 (45%) subjects had low literacy and 227 (52.9%) had uncontrolled BP. Adjusting for age, gender, race, employment, education, mental status, and self-reported adherence, low literacy was associated with uncontrolled BP (OR 1.75, 95% CI 1.06-2.87). Lower self-reported adherence was associated with uncontrolled BP; the relationship between refill adherence and uncontrolled BP was not statistically significant. CONCLUSION Low literacy is independently associated with uncontrolled BP. PRACTICE IMPLICATIONS Awareness of the relationships among patient literacy, BP control, and medication adherence may guide healthcare providers as they communicate with patients.
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Affiliation(s)
- Candace D McNaughton
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA.
| | - Terry A Jacobson
- Division of General Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, USA
| | - Sunil Kripalani
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, USA; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, USA
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Testing a novel pictorial medication sheet to improve adherence in veterans with heart failure and cognitive impairment. Heart Lung 2014; 43:486-93. [PMID: 24928185 DOI: 10.1016/j.hrtlng.2014.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 05/02/2014] [Accepted: 05/03/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES (a) To evaluate efficacy of a pictorial medication sheet to improve adherence in veterans with heart failure (HF) and cognitive impairment (CI); (b) to describe acceptance of the intervention. BACKGROUND CI is prevalent in HF and is associated with worsened medication adherence. The Veteran's Administration has developed a medication image library; however, use of images to improve adherence has not been tested. METHODS Thirty-six veterans with HF and CI were enrolled and provided pictorial medication sheets and an optional alarmed pillbox. Adherence pre-and post-intervention was determined by 30-day pill counts. Acceptance was assessed from interviews. RESULTS Twenty-seven veterans (75%) completed the study. Overall medication adherence was poor, however there was significant improvement from pre-intervention (M = 79.74, SD = ±16.98) to post-intervention (M = 84.74, SD = ±10.00) adherence (t(26) = 2.16, p < .05, Cohen's d = .42). CONCLUSIONS This pilot study provides preliminary evidence that medication images improve adherence with complex medication regimens. The intervention was well received by patients.
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