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Folkvord F, Würth AR, van Houten K, Liefveld AR, Carlson JI, Bol N, Krahmer E, Beets G, Ollerton RD, Turk E, Hrubos‐Strøm H, Nahoui H, Einvik G, Schirmer H, Moen A, Barrio‐Cortes J, Merino‐Barbancho B, Arroyo P, Fico G, Midão L, Sampaio R, Fonseca JA, Geipel K, Scheckenbach K, de Ruiter LE, Lupiáñez‐Villanueva F. A systematic review on experimental studies about patient adherence to treatment. Pharmacol Res Perspect 2024; 12:e1166. [PMID: 38204399 PMCID: PMC10782217 DOI: 10.1002/prp2.1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/23/2023] [Accepted: 12/03/2023] [Indexed: 01/12/2024] Open
Abstract
A better understanding of patients' adherence to treatment is a prerequisite to maximize the benefit of healthcare provision for patients, reduce treatment costs, and is a key factor in a variety of subsequent health outcomes. We aim to understand the state of the art of scientific evidence about which factors influence patients' adherence to treatment. A systematic literature review was conducted using PRISMA guidelines in five separate electronic databases of scientific publications: PubMed, PsycINFO (ProQuest), Cochrane library (Ovid), Google Scholar, and Web of Science. The search focused on literature reporting the significance of factors in adherence to treatment between 2011 and 2021, including only experimental studies (e.g., randomized controlled trials [RCT], clinical trials, etc.). We included 47 experimental studies. The results of the systematic review (SR) are grouped according to predetermined categories of the World Health Organization (WHO): socioeconomic, treatment, condition, personal, and healthcare-related factors. This review gives an actual overview of evidence-based studies on adherence and analyzed the significance of factors defined by the WHO classification. By showing the strength of certain factors in several independent studies and concomitantly uncovering gaps in research, these insights could serve as a basis for the design of future adherence studies and models.
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Affiliation(s)
- Frans Folkvord
- PredictByBarcelonaSpain
- Tilburg Center for Cognition and Communication (TiCC), Department of Communication and CognitionTilburg UniversityTilburgThe Netherlands
| | | | | | | | | | - Nadine Bol
- Tilburg Center for Cognition and Communication (TiCC), Department of Communication and CognitionTilburg UniversityTilburgThe Netherlands
| | - Emiel Krahmer
- Tilburg Center for Cognition and Communication (TiCC), Department of Communication and CognitionTilburg UniversityTilburgThe Netherlands
| | - Gwenn Beets
- Tilburg Center for Cognition and Communication (TiCC), Department of Communication and CognitionTilburg UniversityTilburgThe Netherlands
| | - Rachel Drbohlav Ollerton
- Tilburg Center for Cognition and Communication (TiCC), Department of Communication and CognitionTilburg UniversityTilburgThe Netherlands
| | - Eva Turk
- Institute for Health and SocietyUniversity of OsloOsloNorway
| | - Harald Hrubos‐Strøm
- Akershus University HospitalLørenskogNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | | | | | | | - Anne Moen
- Institute for Health and SocietyUniversity of OsloOsloNorway
| | - Jaime Barrio‐Cortes
- Foundation for Biosanitary Research and Innovation in Primary CareMadridSpain
- Research Unit, Primary Healthcare Management, Madrid Health ServiceMadridSpain
- University Camilo José CelaMadridSpain
| | | | - Peña Arroyo
- Universidad Politécnica de Madrid, Life Supporting Technologies Research GroupMadridSpain
| | - Giuseppe Fico
- Universidad Politécnica de Madrid, Life Supporting Technologies Research GroupMadridSpain
| | - Luís Midão
- Associate Laboratory i4HB – Institute for Health and Bioeconomy, UCIBIO – Applied Molecular Biosciences Unit, Porto4Ageing – Competence Centre on Active and Healthy Ageing, Faculty of Pharmacy of the University of PortoPortoPortugal
| | - Rute Sampaio
- CINTESIS@RISE, Department of BiomedicineFaculty of Medicine of the University of PortoPortoPortugal
| | - João A. Fonseca
- MEDIDA, Medicina, EDucação, I&D e Avaliação LdaPortugal
- MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of MedicineUniversity of PortoPortoPortugal
| | - Katja Geipel
- Department of OtorhinolaryngologyHeinrich‐Heine‐UniversityDüsseldorfGermany
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Akamine A, Nagasaki Y, Tomizawa A, Otori K. Risk Factors for Non-Adherence to Pharmacist or Non-Pharmacist Explanations on Preoperative Medication Discontinuation: A Retrospective Japanese Study. Patient Prefer Adherence 2024; 18:255-266. [PMID: 38313826 PMCID: PMC10838503 DOI: 10.2147/ppa.s445474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/20/2024] [Indexed: 02/06/2024] Open
Abstract
Purpose The risk factors for non-adherence to pharmacist or non-pharmacist explanations of preoperative medication discontinuation are unknown. The primary outcome of this study was to determine whether the final explainer's occupation was a risk factor for non-adherence. The secondary outcomes were to determine the risk factors for non-adherence after limiting the departments or adjusting for age. Patients and Methods We retrospectively examined the data (including patient age, sex, prescription medications, comorbidities, presence of roommate, and number of days between receiving explanation and surgery) of 1132 patients on medications that could affect surgery at a Japanese university hospital between April 1, 2017, and March 31, 2020. The primary endpoint was whether the occupation of the last person explaining medication discontinuation to the patient was an independent risk factor for non-adherence (age ≥65 years vs <65 years). Secondary endpoints included subgroup analyses in urological, gastrointestinal, and otolaryngological areas, as well as a sensitivity analysis (age as a continuous variable) to confirm the validity of the primary endpoint results. A multivariate binary logistic regression identified independent non-adherence risk factors. Results The main analysis showed that discontinuing two or more medications was a risk factor for non-adherence (adjusted odds ratio (AOR): 1.67; 95% confidence interval (CI): 1.13-2.47; p = 0.01). However, in analyses coordinated by department (urological, gastrointestinal, and otolaryngological), ≥65 (versus <65) years of age was determined as a risk factor for increased nonadherence (AOR: 2.27, 95% CI: 1.11-4.63; p=0.024). Age-adjusted analysis (continuous variables) showed similar results to the primary endpoint (AOR: 1.68, 95% CI: 1.14-2.49, p = 0.009). Conclusion Two or more medications, and not the final explainer's occupation, were associated with pre-surgery medication non-adherence. To prevent non-adherence, pharmacists and non-pharmacists should educate patients about preoperative medication discontinuation. These findings could help identify high-risk non-adherence patients.
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Affiliation(s)
| | - Yuya Nagasaki
- Department of Pharmacy, Kitasato University Hospital, Kanagawa, Japan
| | - Atsushi Tomizawa
- Department of Pharmacy, Kitasato University Hospital, Kanagawa, Japan
| | - Katsuya Otori
- Department of Pharmacy, Kitasato University Hospital, Kanagawa, Japan
- Research and Education Center for Clinical Pharmacy, Division of Clinical Pharmacy, Laboratory of Pharmacy Practice and Science 1, Kitasato University School of Pharmacy, Tokyo, Japan
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Al Daccache M, Al-Shaar L, Sibai AM, Ismaeel H, Badr K, Nasreddine L. Psychosocial characteristics are associated with adherence to dietary, drugs and physical activity recommendations amongst cardiovascular disease patients in Lebanon. PLoS One 2023; 18:e0287844. [PMID: 37874832 PMCID: PMC10597531 DOI: 10.1371/journal.pone.0287844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/13/2023] [Indexed: 10/26/2023] Open
Abstract
Cardiovascular diseases are increasing at an alarming rate worldwide, reaching epidemic proportions in countries of the Eastern Mediterranean Region, including Lebanon. Despite the growing number of patients suffering from cardiovascular diseases in Lebanon, there is scarce data on whether cardiac patients adhere to therapeutic dietary guidelines, drug prescriptions, and physical activity recommendations and whether such adherence differs according to sociodemographic, lifestyle, or psychosocial characteristics. A cross-sectional study was conducted among 367 Lebanese adult cardiovascular disease patients admitted for hospitalization at various hospital sites in Lebanon. Electronic medical records and a multi-component questionnaire were used to collect information on patients' characteristics. Dietary assessment was performed using a culture-specific validated food frequency questionnaire, and physical activity levels were assessed using the international physical activity questionnaire (IPAQ). Mental well-being was assessed based on the validated five-item well-being index (WHO-5), and drug adherence was evaluated using the Morisky medication adherence scale (MMAS-8). The majority of the patients were males (67.8%), overweight or obese (74%), smokers (62.1%), and unemployed or retired (54.5%). Almost 35% of the patients were lonely, and nearly one fourth were at a high risk of poor mental health. Approximately 43%, 70%, and 52% of the patients were found to have poor adherence to diet, drug, and physical activity recommendations, respectively. A lower sense of mental well-being was a significant predictor of low dietary and drug adherence. Surprisingly, overweight and obesity were associated with higher odds of dietary adherence. Male gender was positively associated with physical activity while loneliness was inversely associated with physical activity. This study showed that adherence to diet, drug, and physical activity recommendations was low in this patient population and identified several non-clinical characteristics that may affect adherence. These findings highlighted the need for considering patients' psychosocial characteristics in the treatment of patients with cardiovascular diseases.
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Affiliation(s)
- Melodie Al Daccache
- Faculty of Agricultural and Food Sciences, Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
- Faculty of Health Sciences, Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Laila Al-Shaar
- Faculty of Medicine, Department of Public Health Sciences, Pennsylvania State University, State College, Pennsylvania, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Abla Mehio Sibai
- Faculty of Health Sciences, Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
| | - Hussain Ismaeel
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
- Medical Services, Aman Hospital, Doha, Qatar
| | - Kamal Badr
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
- Department of Internal Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Lara Nasreddine
- Faculty of Agricultural and Food Sciences, Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
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Horne CE, Abel WM, Crane PB. Fatigue, Stress, and Blood Pressure Medication Adherence by Race After Myocardial Infarction. J Nurse Pract 2023; 19:104757. [PMID: 37810177 PMCID: PMC10552602 DOI: 10.1016/j.nurpra.2023.104757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Fatigue and stress may affect medication adherence. This study explored fatigue, stress, and blood pressure (BP) medication adherence in Black and White adults (N= 152) who had experienced a myocardial infarction. Over half of the sample (55%) reported fatigue as moderate to severe. The regression model explained up to 40% of the variance (p < .001) with fatigue and race significantly predicting adherence. Black participants reported fatigue causing distress (r =.40), and White participants reported greater association of fatigue severity-related BP medication adherence (r =.49). Our findings support considering racial differences when evaluating fatigue associated with BP medication adherence.
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Affiliation(s)
- Carolyn E Horne
- School of Nursing, The University of North Carolina, Charlotte, NC
| | - Willie M Abel
- School of Nursing, The University of North Carolina, Charlotte, NC
| | - Patricia B Crane
- School of Nursing, The University of North Carolina, Charlotte, NC
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Vitale K, Powell WR, Krekeler BN, Yee J, Rogus-Pulia N. Stratifying Risk of Nonadherence in Lingual Strengthening Dysphagia Rehabilitation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2111-2127. [PMID: 37566883 PMCID: PMC10569446 DOI: 10.1044/2023_ajslp-22-00338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/14/2023] [Accepted: 04/27/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE Exercise-based treatments may improve swallowing safety and efficiency; yet, it is not clearly understood which factors predict nonadherence to recommended treatment protocols. The aim of this study was to construct an algorithm for stratifying risk of nonadherence to a lingual strengthening dysphagia treatment program. METHOD Using recursive partitioning, we created a classification tree built from a pool of sociodemographic, clinical, and functional status indicators to identify risk groups for nonadherence to an intensive lingual strengthening treatment program. Nonadherence, or noncompletion, was defined as not completing two or more follow-up sessions or a final session within 84 days. RESULTS The study cohort consisted of 243 Veterans enrolled in the Intensive Dysphagia Treatment program across six sites from January 2012 to August 2019. The overall rate of nonadherence in this cohort was 38%. The classification tree demonstrated good discriminate validity (C-statistic = 0.74) and contained eight groups from five variables: primary diagnosis, marital status, Penetration-Aspiration Scale (PAS) severity score, race/ethnicity, and age. Nonadherence risk was categorized as high (range: 69%-77%), intermediate (27%-33%), and low risk (≤ 13%-22%). CONCLUSIONS This study identified distinct risk groups for nonadherence to lingual strengthening dysphagia rehabilitation. Additional research is necessary to understand how these factors may drive nonadherence. With external validation and refinement through prospective studies, a clinically relevant risk stratification tool can be developed to identify patients who may be at high risk for nonadherence and provide targeted patient support to mitigate risk and provide for unmet needs.
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Affiliation(s)
- Kailey Vitale
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
- Department of Otolaryngology, Boston Medical Center, MA
- Department of Otolaryngology-Head and Neck Surgery, Boston University Chobanian & Avedisian School of Medicine, MA
| | - W. Ryan Powell
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison
| | - Brittany N. Krekeler
- Department of Surgery-Otolaryngology, University of Wisconsin–Madison
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, OH
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati College of Medicine, OH
| | - Joanne Yee
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Nicole Rogus-Pulia
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
- Department of Surgery-Otolaryngology, University of Wisconsin–Madison
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
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Gao L, Han Y, Jia Z, Wang P, Zhang M, Ma T, Yan S, Liu H. Impact of continuous pharmaceutical care led by clinical pharmacists during transitions of care on medication adherence and clinical outcomes for patients with coronary heart disease: a prospective cohort study. Front Pharmacol 2023; 14:1249636. [PMID: 37693909 PMCID: PMC10484794 DOI: 10.3389/fphar.2023.1249636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/04/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives: The study aimed to explore the impact of a continuous pharmaceutical care (CPC) program during care transitions on medication adherence and clinical outcomes for patients with coronary heart disease (CHD). Methods: A prospective cohort study was conducted from April 2020 to February 2021. Patients diagnosed with CHD were selected and divided into intervention (CPC) and usual care (UC) groups by nurses at equal intervals based on admission time. The intervention group received CPC services provided by clinical pharmacists (including medication reconciliation, disease education, medication guidance, lifestyle counseling, and follow-up services) and usual care. The UC group received only routine medical care. The study compared medication adherence, clinical indicators (low-density lipoprotein cholesterol [LDL-C], blood pressure [BP], glycated hemoglobin [HbA1c] control rates), the incidence of adverse drug reactions (ADRs), and readmission rates (overall, major adverse cardiovascular events [MACEs]-related, and CHD risk factors-related) at admission and 1, 3, and 6 months after discharge between the two groups. Results: A total of 228 patients with CHD completed the study, including 113 patients in the CPC group and 115 patients in the UC group. There were no significant differences (p > 0.05) in both groups in demographic and clinical characteristics at baseline. A total of 101 drug-related problems were identified in the CPC group (an average of 0.89 per person). The CPC group showed significantly higher medication adherence at 1, 3, and 6 months after discharge than the UC group (p < 0.05). At 3 and 6 months after discharge, the intervention group had significantly higher control rates of LDL-C (61.11% vs. 44.64% at 3 months, 78.18% vs. 51.43% at 6 months), and BP (91.15% vs. 77.39% at 3 months, 88.50% vs. 77.19% at 6 months). The CPC group had higher HbA1c control rates (53.85% vs. 34.21% at 3 months, 54.05% vs. 38.46% at 6 months) than the UC group. However, the differences were not statistically significant. The incidence of ADRs 6 months after discharge was significantly lower in the CPC group than in the UC group (5.13% vs. 12.17%, p < 0.05). The CPC group had a lower overall readmission rate (13.27% vs. 20.00%), MACE-related readmission rate (5.31% vs. 12.17%), and readmission rate related to CHD risk factors (0.88% vs. 2.61%) 6 months after discharge compared to the UC group. However, these differences were not statistically significant (p > 0.05). Conclusion: CPC led by clinical pharmacists during care transitions effectively improved medication adherence, safety, and risk factor control in patients with CHD.
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Affiliation(s)
- Lingyan Gao
- Department of Pharmacy, Aerospace Center Hospital, Beijing, China
| | - Yalei Han
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
| | - Zhankun Jia
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
| | - Pengfei Wang
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
| | - Meijing Zhang
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
| | - Teng Ma
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
| | - Suying Yan
- Department of Pharmacy, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Hua Liu
- Department of Pharmacy, Aerospace Center Hospital, Beijing, China
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Rymer JA, Wegermann ZK, Kaltenbach LA, Webb LE, Peterson ED, Wang TY. Challenge in Predicting Persistence to P2Y12 Inhibitors: A Perspective From the ARTEMIS Trial. J Am Heart Assoc 2023:e029063. [PMID: 37301758 DOI: 10.1161/jaha.122.029063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/04/2023] [Indexed: 06/12/2023]
Abstract
Background Premature discontinuation of P2Y12 inhibitor therapy has been associated with adverse cardiac events, which might be preventable by improving medication persistence. Current risk models have limited ability to predict patients at risk of P2Y12 inhibitor nonpersistence. Methods and Results ARTEMIS (Affordability and Real-World Antiplatelet Treatment Effectiveness after Myocardial Infarction Study) was a randomized, controlled trial testing the impact of a copayment assistance intervention on P2Y12 inhibitor persistence and outcomes. Among 6212 patients post myocardial infarction with a planned 1-year course of P2Y12 inhibitor therapy, nonpersistence was defined as a gap in P2Y12 inhibitor filled >30 days by pharmacy fill data. We developed a predictive model for 1-year P2Y12 inhibitor nonpersistence among patients randomized to usual care. P2Y12 inhibitor nonpersistence rates were 23.8% (95% CI, 22.7%-24.8%) at 30 days and 47.9% (46.6%-49.1%) at 1 year; the majority of these patients had in-hospital percutaneous coronary intervention. Patients who received the copayment assistance intervention had nonpersistence rates of 22.0% (20.7%-23.3%) at 30 days and 45.3% (43.8%-46.9%) at 1 year. A 53-variable multivariable model predicting 1-year persistence had a C-index of 0.63 (optimism-corrected C-index 0.58). Model discrimination did not improve with inclusion of patient-reported perceptions about disease, medication-taking beliefs, and prior medication-filling behavior in addition to demographic and medical history data (C-index 0.62). Conclusions Despite addition of patient-reported variables, models predicting persistence with P2Y12 inhibitor therapy performed poorly, thereby suggesting the need for continued patient and clinician education on the importance of P2Y12 inhibitor therapy after acute myocardial infarction. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02406677.
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Affiliation(s)
| | | | | | - Laura E Webb
- Duke University School of Medicine Durham NC USA
| | - Eric D Peterson
- University of Texas Southwestern Medical Center Dallas TX USA
| | - Tracy Y Wang
- Duke University School of Medicine Durham NC USA
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Kalaydzhyan EP, Kutishenko NP, Lukina YV, Sichinava DP, Martsevich SY, Drapkina OM. The Study of Adherence to Drug Therapy at the Stage of Outpatient Follow-up in Patients with Acute Myocardial Infarction (Data from the PROFIL-IM Registry). RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2023. [DOI: 10.20996/1819-6446-2023-02-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Aim. To assess adherence to the recommended therapy at the stage of outpatient follow-up and its impact on long-term outcomes in patients after acute myocardial infarction based on the materials of the prospective PROFILE-IM registry.Material and methods. The PROFILE-IM register included 160 patients who applied to one of the polyclinics in Moscow after a myocardial infarction. The combined endpoint (CE) included death from any cause, cardiovascular events (nonfatal myocardial infarction, nonfatal cerebral stroke), emergency hospitalizations for cardiovascular diseases, significant cardiac arrhythmias. Patients' adherence to therapy was assessed using the original questionnaire "Scale of Adherence of the National Society of Evidence-based Pharmacotherapy" (NODF) and a direct standardized patient survey by a doctor about taking medications. Visits to the doctor were carried out every two months, data from the first year of patient follow-up are presented.Results. In a personal interview with a doctor, the ratio of the proportion of committed, partially committed and non-committed patients did not change significantly over the entire follow-up period, while the proportion of committed patients was 81-85%. The "NODF Adherence Scale" showed that the proportion of non-committed patients was about 10 times higher than with direct patient responses to the doctor, and the proportion of non-committed and partially committed patients remained high at all stages of follow-up (respectively 28% and 10% at the beginning of the study, 18% and 10% at the end of the study). Among the main factors of non-commitment, there was a decrease in the importance of forgetfulness and an increase in factors such as fear of side effects of medications, doubt about the need for long-term use of medications and well-being. A direct relationship of adherence with the male sex, the presence of hypertension, a feedback relationship with alcohol consumption was revealed. The risk of CE in non-committed patients was higher compared to the group of committed and partially committed patients (p<0.01).Conclusion. The proportion of non-committed and partially committed patients remained high at all stages of follow-up. There was a direct relationship between adherence to therapy with the male sex, the presence of hypertension in the anamnesis, and a feedback relationship with alcohol consumption. Low adherence to therapy significantly increased the risk of cardiovascular events.
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Affiliation(s)
| | - N. P. Kutishenko
- National Medical Research Center for Therapy and Preventive Medicine
| | - Yu. V. Lukina
- National Medical Research Center for Therapy and Preventive Medicine
| | | | - S. Yu. Martsevich
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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Mansi ET, Banks S, Littman AJ, Weiss NS. Association between sociodemographic factors and cholesterol-lowering medication use in U.S. adults post-myocardial infarction. PLoS One 2023; 18:e0281607. [PMID: 36758062 PMCID: PMC9910652 DOI: 10.1371/journal.pone.0281607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 01/26/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Cholesterol-lowering medications offer effective secondary prevention after myocardial infarction (MI). Our objective was to evaluate the association between sociodemographic factors and cholesterol-lowering medication use in high-risk adults. METHODS We conducted an analysis using weighted data from 31,408 participants in the 2017 and 2019 Behavioral Risk Factor Surveillance Systems cross-sectional surveys, who had a self-reported history of MI and high blood cholesterol. The sociodemographic factors evaluated were sex, age, race and ethnicity, annual household income, education level, relationship status, and reported healthcare coverage. We estimated the weighted prevalence of medication use, and weighted prevalence differences (with 95% confidence intervals) across categories, adjusting for sex, age group, healthcare coverage, smoking status, hypertension, and diabetes. RESULTS AND DISCUSSION Overall, 83% of survey participants with a self-reported history of both MI and high blood cholesterol reported currently using a cholesterol-lowering medication. The prevalence of use was only 61% in those without self-reported healthcare coverage, compared to 85% of those with healthcare coverage (adjusted prevalence difference of -20%; 95% CI: -25% to -14%). Use of cholesterol-lowering medication was relatively low in younger adults and higher in older adults, leveling off after age 65 years. The proportion of Native Hawaiian or Pacific Islanders who were using a cholesterol-lowering medication was relatively low, but otherwise there was little variation by race and ethnicity. Household income, education level, and relationship status were weakly or not associated with medication use. CONCLUSIONS Knowledge of characteristics of persons who are relatively less likely to be adherent with cholesterol-lowering medications for secondary prevention may be useful to policymakers and healthcare providers involved in the long-term treatment of MI patients. Policy makers might consider a reduced cost prescription coverage for persons without current healthcare coverage who have sustained an MI to reduce future cardiovascular morbidity and mortality.
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Affiliation(s)
- Elizabeth T. Mansi
- School of Public Health, University of Washington, Seattle, Washington, United States of America
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
| | - Samantha Banks
- School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Alyson J. Littman
- School of Public Health, University of Washington, Seattle, Washington, United States of America
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services, Seattle, Washington, United States of America
| | - Noel S. Weiss
- School of Public Health, University of Washington, Seattle, Washington, United States of America
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Parsons EM, Hiserodt M, Otto MW. Initial assessment of the feasibility and efficacy of a scalable digital CBT for generalized anxiety and associated health behaviors in a cardiovascular disease population. Contemp Clin Trials 2023; 124:107018. [PMID: 36414206 PMCID: PMC10132350 DOI: 10.1016/j.cct.2022.107018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
Generalized anxiety disorder (GAD) is a significant yet modifiable risk factor for worse cardiovascular disease (CVD) outcomes. The treatment of GAD in an accessible manner represents an unmet need in CVD, given that patients with CVD experience numerous barriers to in-person treatment engagement. This paper presents the rationale and design for an investigation of a strategy to enhance care for patients with CVD by introducing a scalable, affordable, and system-friendly digital intervention that targets a prominent modifiable risk factor (generalized anxiety and associated worry) for negative health behaviors in CVD. In the context of a randomized clinical trial design, we describe an experimental medicine approach for evaluating the degree to which a digital cognitive behavior therapy (dCBT), relative to a waitlist control group, engages anxiety and worry outcomes in a sample of 90 adults who have experienced an acute CVD event and who have comorbid GAD symptoms. We also investigate the degree to which dCBT leads to greater changes in GAD symptoms compared to the control condition and whether reductions in these symptoms are associated with corresponding reductions in cardiac anxiety and cardiac health behaviors (including smoking, physical activity, heart-healthy diet, and medication adherence). We propose that by targeting GAD symptoms in CVD in a way that does not tax ongoing medical care provision, we have the potential to improve the uptake of effective care and address both GAD and associated health behaviors.
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Affiliation(s)
- E Marie Parsons
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
| | - Michele Hiserodt
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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11
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Socioeconomic inequity in incidence, outcomes and care for acute coronary syndrome: A systematic review. Int J Cardiol 2022; 356:19-29. [DOI: 10.1016/j.ijcard.2022.03.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/17/2022] [Accepted: 03/24/2022] [Indexed: 12/17/2022]
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12
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Greco A, Brugnera A, D’Addario M, Compare A, Franzelli C, Maloberti A, Giannattasio C, Fattirolli F, Steca P. A three-year longitudinal study of healthy lifestyle behaviors and adherence to pharmacological treatments in newly diagnosed patients with acute coronary syndrome: hierarchical linear modeling analyses. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01369-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Abstract
Aim
Healthy lifestyle behaviors and a good adherence to pharmacological treatments are important predictors of lower recurrence rates and better overall outcomes among patients with an established acute coronary syndrome (ACS). The present study sought to investigate the longitudinal trajectories of these behaviors years after the onset of an ACS.
Subject and methods
We recruited a sample of 275 newly diagnosed consecutive patients at their first ACS event (mean age: 57.1 ± 7.87 years; 84% males) admitted to a cardiac rehabilitation program from three large public hospitals in Northern Italy. Patients completed a battery of sociodemographic questionnaires, which evaluated healthy lifestyles (smoking status, alcohol intake, diet, and physical activity) and adherence to pharmacological treatments, at five time-points (pre-event, 6-, 12-, 24-, and 36-month follow-ups). Longitudinal trajectories were examined through hierarchical (generalized) linear models, controlling for several demographic and clinical variables.
Results
We found significant changes in all healthy lifestyles from pre-event to the 6-month follow-up, suggesting the adoption of healthier behaviors soon after the cardiac event. However, from the 6-month up to the 3-year follow-up, patients experienced small but significant declines in their self-reported levels of healthy dietary behaviors and physical activity. Further, we found that the odds of being at medium risk of non-adherence to the pharmacological treatments significantly increased over the course of 3 years.
Conclusion
Given the negative long-term trajectories in specific lifestyles and adherence to pharmacological treatments, cardiac rehabilitation programs are suggested to provide repeated psychological interventions aimed at fostering patients’ capabilities to self-regulate their habitual behaviors.
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13
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Obrova J, Sovova E, Ivanova K, Furstova J, Taborsky M. Let It Beat: How Lifestyle and Psychosocial Factors Affect the Risk of Sudden Cardiac Death-A 10-Year Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052627. [PMID: 35270315 PMCID: PMC8909732 DOI: 10.3390/ijerph19052627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022]
Abstract
(1) Background: The aim of this study was to evaluate the lifestyle and occurrence of psychosocial factors in patients with a high risk of sudden cardiac death (SCD) and to explore their effect on the occurrence of the adequate therapy of an Implantable Cardioverter Defibrillator (ICD). (2) Methods: In this retro-prospective single-centre study, a group of patients aged 18-65 years old, who underwent the first ICD implantation for primary (PP) or secondary (SP) prevention between 2010-2014, was studied. The control group consisted of pair-matched (age ± 5 years, gender) respondents without a high risk of SCD. Information was obtained using a self-reported questionnaire and hospital electronic health records. The adequacy of ICD therapy was evaluated regularly until 31 January 2020. Multivariate logistic regression models were employed to assess the risk of SCD. (3) Results: A family history of SCD, coronary artery disease, diabetes mellitus and depression significantly aggravated the odds of being at a high risk of SCD. The occurrence of an appropriate ICD therapy was significantly associated with being in the SP group, BMI, education level and TV/PC screen time. (4) Conclusions: Lifestyle and psychosocial factors have been confirmed to affect the risk of SCD. Early identification and treatment of coronary artery disease and its risk factors remain the cornerstones of preventive effort. Further research is needed to evaluate the complex nature of psychosocial determinants of cardiac health.
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Affiliation(s)
- Jana Obrova
- Department of Internal Medicine I—Cardiology, University Hospital Olomouc, 779 00 Olomouc, Czech Republic;
- Correspondence: ; Tel.: +420-588-44-5429
| | - Eliska Sovova
- Department of Exercise Medicine and Cardiovascular Rehabilitation, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, 779 00 Olomouc, Czech Republic;
| | - Katerina Ivanova
- Department of Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic;
| | - Jana Furstova
- Olomouc University Social Health Institute, Palacký University Olomouc, 779 00 Olomouc, Czech Republic;
| | - Milos Taborsky
- Department of Internal Medicine I—Cardiology, University Hospital Olomouc, 779 00 Olomouc, Czech Republic;
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14
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Panahi S, Rathi N, Hurley J, Sundrud J, Lucero M, Kamimura A. Patient Adherence to Health Care Provider Recommendations and Medication among Free Clinic Patients. J Patient Exp 2022; 9:23743735221077523. [PMID: 35155751 PMCID: PMC8832560 DOI: 10.1177/23743735221077523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patient adherence is vital for the quality of health care outcomes and treatment efficacy, and reduces the economic burden on the healthcare system. The purpose of this study was to examine factors associated with levels of general adherence among uninsured free clinic patients. This was a cross-sectional study using a convenience sample of free clinic patients aged 18 years and older who spoke English and/or Spanish. Descriptive statistics and multiple regression were performed to understand sociodemographic characteristics and factors associated with higher levels of general adherence. A higher level of general adherence were significantly associated with younger age (P < .01), levels of adherence to lifestyle recommendations (P < .01), and medication (P < .01). Having attended health education classes and having a primary care provider were not associated with levels of general adherence.This study suggested that a lower level of general adherence exists among elderly patients of the free clinic. In this light, providers need to consider unique strategies to enhance the provider-patient relationship by understanding patient's characteristics and providing sufficient information and explanation for treatment and medication.
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Affiliation(s)
- Samin Panahi
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Naveen Rathi
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | | | - Justine Sundrud
- Maliheh Free Clinic, University of Utah, Salt Lake City, UT, USA
| | - Mary Lucero
- Maliheh Free Clinic, University of Utah, Salt Lake City, UT, USA
| | - Akiko Kamimura
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
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15
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Wang Y, Veltkamp DMJ, van der Boog PJM, Hemmelder MH, Dekker FW, de Vries APJ, Meuleman Y. Illness Perceptions and Medication Nonadherence to Immunosuppressants After Successful Kidney Transplantation: A Cross-Sectional Study. Transpl Int 2022; 35:10073. [PMID: 35185376 PMCID: PMC8842226 DOI: 10.3389/ti.2022.10073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/10/2022] [Indexed: 11/17/2022]
Abstract
Background: Medication nonadherence to immunosuppressants is a well-known risk factor for suboptimal health outcomes in kidney transplant recipients (KTRs). This study examined the relationship between illness perceptions and medication nonadherence in prevalent Dutch KTRs and whether this relationship depended on post-transplant time. Methods: Eligible KTRs transplanted in Leiden University Medical Center were invited for this cross-sectional study. The illness perceptions and medication nonadherence were measured via validated questionnaires. Associations between illness perceptions and medication nonadherence were investigated using multivariable logistic regression models. Results: For the study, 627 participating KTRs were analyzed. 203 (32.4%) KTRs were considered nonadherent to their immunosuppressants with “taking medication more than 2 h from the prescribed dosing time” as the most prevalent nonadherent behaviour (n = 171; 27.3%). Three illness perceptions were significantly associated with medication nonadherence: illness identity (adjusted odds ratio [ORadj] = 1.07; 95% confidence interval [CI], 1.00–1.14), concern (ORadj = 1.07; 95%CI,1.00–1.14), and illness coherence (ORadj = 1.11; 95%CI,1.01–1.22). The relationships between illness perceptions and medication nonadherence did not differ depending on post-transplant time (p-values ranged from 0.48 to 0.96). Conclusion: Stronger negative illness perceptions are associated with medication nonadherence to immunosuppressants. Targeting negative illness perceptions by means of psychoeducational interventions could optimize medication adherence and consequently improve health outcomes in KTRs.
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Affiliation(s)
- Yiman Wang
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
- *Correspondence: Yiman Wang,
| | - Denise M. J. Veltkamp
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, Netherlands
| | - Paul J. M. van der Boog
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, Netherlands
- Transplant Center, Leiden University Medical Center, Leiden, Netherlands
| | - Marc H. Hemmelder
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, Netherlands
- CARIM School for Cardiovascular Research, University Maastricht, Maastricht, Netherlands
| | - Friedo W. Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Aiko P. J. de Vries
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, Netherlands
- Transplant Center, Leiden University Medical Center, Leiden, Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
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16
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Zorina O, Fatkulina N, Saduyeva F, Omarkulov B, Serikova S. Patient Adherence to Therapy After Myocardial Infarction: A Scoping Review. Patient Prefer Adherence 2022; 16:1613-1622. [PMID: 35812765 PMCID: PMC9268220 DOI: 10.2147/ppa.s356653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with myocardial infarction have low adherence to secondary prevention. Patients with acute coronary syndromes usually decide not to take cardiac drugs for 7 days after discharge for various reasons and adherence rates are usually very low. The aim of this scoping review was to identify factors influencing treatment adherence after myocardial infarction and the role of interventions to improve treatment adherence. METHODS Two electronic databases (PubMed and Web of Science) were systematically searched for relevant published reviews of interventions for adherence after myocardial infarction. Inclusion criteria were study design: randomized control trial, systematic reviews; published in English; sample age ≥18 years. The methodological framework proposed by Arksey & O'Malley was used to guide the review process of the study. RESULTS Thirteen articles met the inclusion/exclusion criteria. Four of the thirteen studies assessed factors influencing patient adherence to therapy after myocardial infarction, the remaining studies examined various interventions increasing adherence to treatment after myocardial infarction. CONCLUSION There is a need to improve adherence of patients to treatment after myocardial infarction. Studies show that the use of modern technologies and communication with the patients by phone improve adherence to treatment.
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Affiliation(s)
- Olga Zorina
- Research School, Karaganda Medical University, Karaganda, Kazakhstan
- Correspondence: Olga Zorina; Natalja Fatkulina, Email ;
| | - Natalja Fatkulina
- Institute of Health Sciences, Vilnius University, Vilnius, Lithuania
| | - Feruza Saduyeva
- Research School, Karaganda Medical University, Karaganda, Kazakhstan
| | - Bauyrzhan Omarkulov
- Institute of Public Health and Professional Health, Karaganda Medical University, Karaganda, Kazakhstan
| | - Saltanat Serikova
- Research School, Karaganda Medical University, Karaganda, Kazakhstan
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17
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Bonsu KO, Young S, Lee T, Nguyen H, Chitsike RS. Adherence to Antithrombotic Therapy for Patients Attending a Multidisciplinary Thrombosis Service in Canada - A Cross-Sectional Survey. Patient Prefer Adherence 2022; 16:1771-1780. [PMID: 35923661 PMCID: PMC9339664 DOI: 10.2147/ppa.s367105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Poor medication adherence puts patients who require antithrombotic therapy at greater risk of complications. We started a multidisciplinary Adult Outpatient Thrombosis Service in 2017 in a Canadian health authority and were interested in the level of medication adherence in the population attending. AIMS The aim of this study is to assess adherence to antithrombotic medications for patients attending a multidisciplinary Thrombosis Service. METHODS We conducted a cross-sectional survey of outpatients seen at the Thrombosis Service between 2017 and 2019 using the 12-item validated Adherence to Refills and Medications Scale (ARMS) to assess adherence to antithrombotic (anticoagulants and antiplatelet) therapy. Linear regression analysis examined the factors associated with adherence to antithrombotic therapy. RESULTS Of 1058 eligible patients, 53.2% responded to the survey. Seventeen were excluded from the analysis for missing more than 6 responses to the 12 items on the ARMS. About 55% (n = 297) were on direct oral anticoagulants (DOACs), 19% (n = 102) on warfarin, 5.0% (n = 27) on low molecular weight heparin, 3.3% (n = 18) on antiplatelet therapy and 18% (n = 96) were no longer on antithrombotic therapy. Nearly half (47%, n = 253) had taken antithrombotic therapy for 1-5 years while 28% (n = 150) and 25% (n = 137) had taken antithrombotic treatments for <1 and >5 years, respectively. Most patients (87%, n = 475) were ≥50 years and half (51%, n = 277) were male. The mean adherence score was 13.9 (SD±2.2) and 88% (n = 481) of participants were adherent to antithrombotic treatment (ARMS = 12-16). Multivariable linear regression showed that patients with post-graduate education had 0.4% lower adherence to antithrombotic therapy as compared with elementary education (β = 0.0039, p = 0.048). Patients with prior antithrombotic agent use >5 years had 0.5% lower adherence to antithrombotic treatment compared to patients with <1 year (β = 0.0047, p = 0.0244). CONCLUSION Self-reported adherence to antithrombotic therapy was high (88%) within a multidisciplinary Thrombosis Service. Patients with advanced education and prolong duration of antithrombotic therapy were more likely to have lower self-reported adherence to antithrombotic treatment.
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Affiliation(s)
- Kwadwo Osei Bonsu
- School of Pharmacy, Memorial University of Newfoundland and Labrador, St John’s, NL, A1B 3V6, Canada
- Correspondence: Kwadwo Osei Bonsu, School of Pharmacy, Memorial University of Newfoundland and Labrador, 300 Prince Philip Drive, St John’s, NL, A1B 3V6, Canada, Email
| | - Stephanie Young
- School of Pharmacy, Memorial University of Newfoundland and Labrador, St John’s, NL, A1B 3V6, Canada
- Pharmacy Program, Eastern Region Health Authority, St John’s, NL, A1B 3V6, Canada
| | - Tiffany Lee
- School of Pharmacy, Memorial University of Newfoundland and Labrador, St John’s, NL, A1B 3V6, Canada
- Pharmacy Program, Eastern Region Health Authority, St John’s, NL, A1B 3V6, Canada
| | - Hai Nguyen
- School of Pharmacy, Memorial University of Newfoundland and Labrador, St John’s, NL, A1B 3V6, Canada
| | - Rufaro S Chitsike
- Division of Medicine (Hematology), Memorial University of Newfoundland and Labrador, St John’s, NL, A1B 3V6, Canada
- Division of Hematology, Eastern Region Health Authority, St John’s, NL, A1B 3V6, Canada
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Sotorra-Figuerola G, Ouchi D, García-Sangenís A, Giner-Soriano M, Morros R. Pharmacological treatment after acute coronary syndrome: Baseline clinical characteristics and gender differences in a population-based cohort study. Aten Primaria 2022; 54:102157. [PMID: 34717156 PMCID: PMC8566964 DOI: 10.1016/j.aprim.2021.102157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe baseline socio-demographic and clinical characteristics and drugs prescribed for secondary prevention after a first episode of ACS and to assess differences between men and women. SETTING PHC in Catalonia. DATA SOURCE SIDIAP (Information System for Research in Primary Care). PARTICIPANTS Patients who suffered an ACS during 2009-2016 and followed-up in PHC centres of the Catalan Health Institute in Catalonia. INTERVENTIONS Not applicable. MAIN MEASURES Socio-demographic and clinical characteristics at baseline: sex, age, socioeconomic index, toxic habits, comorbidities, study drugs (prescribed for cardiovascular secondary prevention: antiplatelets, betablockers, statins, drugs acting on the renin-angiotensin system) and comedications. RESULTS 8071 patients included, 71.3% of them were men and 80.2% had an acute myocardial infarction. Their mean age was 65.3 and women were older than men. The most frequent comorbidities were hypertension, dyslipidaemia and diabetes and they were more common in women. Antiplatelets (91.3%) and statins (85.7%) were the study drugs most prescribed. The uses of all comedications were significantly higher in women, except for nitrates. The combination of four study groups was initially prescribed in 47.7% of patients and combination of beta-blockers, statins and antiplatelets was prescribed in 18.4%. More men than women received all recommended pharmacological groups. CONCLUSION Women were older, had more comorbidities and received more comedications. Most patients were treated with a combination of four or three study drugs for secondary prevention. Men initiated more drug treatments for secondary prevention and dual antiplatelet therapy than women. EUPAS REGISTER EUPAS19017.
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Affiliation(s)
- Gerard Sotorra-Figuerola
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Dan Ouchi
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Ana García-Sangenís
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Maria Giner-Soriano
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.
| | - Rosa Morros
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Institut Català de la Salut, Barcelona, Spain; Universitat Autònoma de Barcelona, Departament de Farmacologia, Terapèutica i Toxicologia, Bellaterra (Cerdanyola del Vallès), Spain; Plataforma SCReN, UICEC IDIAP Jordi Gol, Barcelona, Spain
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19
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Foley L, Larkin J, Lombard-Vance R, Murphy AW, Hynes L, Galvin E, Molloy GJ. Prevalence and predictors of medication non-adherence among people living with multimorbidity: a systematic review and meta-analysis. BMJ Open 2021; 11:e044987. [PMID: 34475141 PMCID: PMC8413882 DOI: 10.1136/bmjopen-2020-044987] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This systematic review aimed to describe medication non-adherence among people living with multimorbidity according to the current literature, and synthesise predictors of non-adherence in this population. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. PubMed, EMBASE, CINAHL and PsycINFO were searched for relevant articles published in English language between January 2009 and April 2019. Quantitative studies reporting medication non-adherence and/or predictors of non-adherence among people with two or more chronic conditions were included in the review. A meta-analysis was conducted with a subgroup of studies that used an inclusive definition of multimorbidity to recruit participants, rather than seeking people with specific conditions. Remaining studies reporting prevalence and predictors of non-adherence were narratively synthesised. RESULTS The database search produced 10 998 records and a further 75 were identified through other sources. Following full-text screening, 178 studies were included in the review. The range of reported non-adherence differed by measurement method, at 76.5% for self-report, 69.4% for pharmacy data, and 44.1% for electronic monitoring. A meta-analysis was conducted with eight studies (n=8949) that used an inclusive definition of multimorbidity to recruit participants. The pooled prevalence of non-adherence was 42.6% (95% CI: 34.0 - 51.3%, k=8, I2=97%, p<0.01). The overall range of non-adherence was 7.0%-83.5%. Frequently reported correlates of non-adherence included previous non-adherence and treatment-related beliefs. CONCLUSIONS The review identified a heterogeneous literature in terms of conditions studied, and definitions and measures of non-adherence used. Results suggest that future attempts to improve adherence among people with multimorbidity should determine for which conditions individuals require most support. The variable levels of medication non-adherence highlight the need for more attention to be paid by healthcare providers to the impact of multimorbidity on chronic disease self-management. PROSPERO REGISTRATION NUMBER CRD42019133849.
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Affiliation(s)
- Louise Foley
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - James Larkin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Richard Lombard-Vance
- Department of Psychology, National University of Ireland Maynooth, Maynooth, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
- HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Lisa Hynes
- Health Programmes, Croí Heart & Stroke Centre, Galway, Ireland
| | - Emer Galvin
- School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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Sotorra-Figuerola G, Ouchi D, Giner-Soriano M, Morros R. Impact of adherence to drugs for secondary prevention on mortality and cardiovascular morbidity: A population-based cohort study. IMPACT study. Pharmacoepidemiol Drug Saf 2021; 30:1250-1257. [PMID: 33938603 DOI: 10.1002/pds.5261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/28/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE Adherence to pharmacological therapy for secondary prevention after an acute coronary syndrome (ACS) reduces the risk of new cardiovascular events. However, several studies showed poor adherence. Our study aim was to assess the risk of a composite endpoint of major cardiovascular events (MACE) and all-cause mortality according to the adherence to these drugs in patients after an ACS in a primary health care cohort. METHODS Population-based observational cohort study of patients with a first episode of ACS during 2009-2016. DATA SOURCE Information System for Research in Primary Care (SIDIAP) database. Drug adherence was evaluated through proportion of days covered (PDC). RESULTS We included 7152 patients and 5692 (79.6%) were adherent (PDC ≥ 75%) to the study drugs during the first year after the event. Adherents to any combination showed a significant reduction of the composite endpoint risk (HR 0.80 [0.73-0.88]), and a significant lower probability of the composite endpoint than nonadherents for all drugs, except beta-blockers. Adherents to 2 (HR 1.2; 95% CI 1.0-1.3) and 1 drug (HR 1.5; 95% CI 1.2-1.8) had higher composite endpoint risk compared to adherents to 4-3 drugs. CONCLUSION Adherence to any combination of recommended drugs reduced the composite endpoint risk, regardless the number of drugs prescribed. Adherence to a combination of 4-3 drugs was significantly associated with a reduced mortality risk compared with adherents to 2 or 1, but it was not significant for MACE.
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Affiliation(s)
- Gerard Sotorra-Figuerola
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Dan Ouchi
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Maria Giner-Soriano
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Rosa Morros
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Institut Català de la Salut, Barcelona, Spain.,Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Plataforma SCReN, UICEC IDIAP Jordi Gol, Barcelona, Spain
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21
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Per-Treatment Post Hoc Analysis of Clinical Trial Outcomes With Tolvaptan in ADPKD. Kidney Int Rep 2021; 6:1032-1040. [PMID: 33912753 PMCID: PMC8071614 DOI: 10.1016/j.ekir.2021.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/07/2020] [Accepted: 01/12/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction In pivotal trials of patients with autosomal dominant polycystic kidney disease at risk of rapid progression, tolvaptan slowed estimated glomerular filtration rate (eGFR) decline in early-to-moderate (TEMPO 3:4 [NCT00428948]) and moderate- to late-stage (REPRISE [NCT02160145]) chronic kidney disease (CKD). Discontinuation was less frequent in REPRISE (15.0%) than TEMPO 3:4 (23.0%), given that in REPRISE, only subjects who tolerated tolvaptan 60/30 mg daily initiated the double-blind phase. We evaluated whether the greater treatment effect in REPRISE was attributable to different completion rates. Methods We conducted post hoc analyses of TEMPO 3:4 and REPRISE completers, defined as subjects who took trial drug to the end of the treatment period in TEMPO 3:4 (3 years) or REPRISE (1 year). Efficacy (rate of change in eGFR for tolvaptan vs. placebo) was analyzed as in each trial. Subjects from TEMPO 3:4 and REPRISE were also matched by propensity score for age, gender, and baseline eGFR to explore potential additional determinants of treatment effect. Results The annualized tolvaptan treatment effect in TEMPO 3:4 completers (difference vs. placebo of 0.98 ml/min per 1.73 m2/y) and REPRISE completers (difference of 1.23) was similar to that of the respective total trial populations (TEMPO 3:4: 0.94; REPRISE: 1.27). The treatment effect of tolvaptan was also similar between matched subjects. Conclusion Greater treatment completion rate did not drive greater treatment effect in REPRISE. The more advanced CKD of REPRISE subjects may be more relevant. More rapid decline in kidney function in later-stage CKD enabled the effects of tolvaptan to be more easily discerned.
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Oura K, Itabashi R, Omoto T, Yamaguchi Oura M, Kiyokawa T, Hirai E, Maeda T. Impact of Introducing the Pletaal Assist System on Drug Adherence in Outpatients with Ischaemic Stroke: A Pilot Study. Patient Prefer Adherence 2021; 15:835-841. [PMID: 33907385 PMCID: PMC8064721 DOI: 10.2147/ppa.s297045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The effectiveness of Electronic Medication Packaging devices for monitoring drug adherence has been widely reported. However, conventional devices are expensive for routine use and cannot confirm whether the medication was administered. We aimed to determine, in a pilot and feasibility study, the impact of introducing a new medication support device, the Pletaal Assist System®, to monitor and improve cilostazol adherence for stroke prevention at an outpatient clinic. PATIENTS AND METHODS We assessed consecutive patients treated with cilostazol for >3 months at our stroke outpatient clinic from January 2018 to March 2020. The adherence rate was assessed as follows: (the number of pills prescribed minus the number of remaining pills)/the number of pills prescribed. We compared the adherence rates before, during, and after Pletaal Assist System® usage, respectively. RESULTS Overall, 25 patients (median age, 68.5 years; range, 51-86 years; male, 64%) were enrolled. All participants were prescribed cilostazol (100 mg) twice a day. There was no significant difference in the adherence rate among the three periods. However, in 10 patients with adherence rate below 100%, the adherence rate during Pletaal Assist System® usage was higher than before usage (99.5% vs 95%, p=0.04), and the rate after using the Pletaal Assist System® tended to be lower compared to the rate during usage (99.5% vs 96%, p=0.05). CONCLUSION Our preliminary evidence suggest that the Pletaal Assist System® could further improve cilostazol adherence in outpatients with poor drug adherence and may reduce the risk of recurrent strokes by improving adherence of patients with a history of stroke.
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Affiliation(s)
- Kazumasa Oura
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
- Correspondence: Kazumasa Oura Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba-Cho, Shiwa-Gun, Iwate, 028-3695, JapanTel +81-19-613-7111Fax +81-19-907-6933 Email
| | - Ryo Itabashi
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Takashi Omoto
- Department of Pharmacy, Iwate Medical University Hospital, Iwate, Japan
| | - Mao Yamaguchi Oura
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Tetsuro Kiyokawa
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Eisuke Hirai
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Tetsuya Maeda
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
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Parra DI, Trapero Gimeno I, Sánchez Rodríguez JM, Rodríguez Corredor LC, Hernández Vargas JA, López Romero LA, García López FJ, Escudero-Gómez C, Trujillo-Cáceres SJ, Serrano-Gallardo P, Vera-Cala LM. Individual interventions to improve adherence to pharmaceutical treatment, diet and physical activity among adults with primary hypertension. A systematic review protocol. BMJ Open 2020; 10:e037920. [PMID: 33371014 PMCID: PMC7757507 DOI: 10.1136/bmjopen-2020-037920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hypertension is a chronic disease with 31% worldwide prevalence in adults. It has been associated with non-adherence to therapeutic regime with a negative impact on the prognosis of the disease and healthcare-associated costs. So, it is necessary to identify effective interventions to improve adherence among the afflicted population. The objective of this protocol is to describe the methods for a systematic review that will evaluate the effect of individual interventions so as to improve adherence to the prescribed pharmacological treatment, as well as to prescribed diet and physical activity in adults with primary hypertension. METHODS AND ANALYSIS A systematic search of studies will be conducted in PubMed/MEDLINE, BVS, CINAHL, Embase, Cochrane and Scopus databases. Randomised and non-randomised clinical studies conducted in human beings, published from 1 January 2009 to 13 December 2019, are to be included, in any language. Adherence to pharmacological treatment, diet and physical activity, measured by direct and indirect methods, will be the primary outcome. Two independent reviewers will select relevant studies and will extract the data following the Cochrane's Handbook for Systematic Reviews of Approach and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. Methodological quality will be evaluated using the risk-of-bias (RoB) 2 and Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tools. Risk of bias will also be evaluated, and if the criteria are met, a meta-analysis will be finally performed. ETHICS AND DISSEMINATION Information to be analysed is of a grouped nature, and given that its sources are published studies, no ethics committee approval is required. Results will be published in scientific journals, and in conferences, seminars and symposiums. Copyrights will be addressed by giving due credit through bibliographic references. PROSPERO REGISTRATION NUMBER CRD42020147655.
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Affiliation(s)
- Dora Inés Parra
- Nursing School, Universidad Industrial de Santander, Bucaramanga, Colombia
- Clinical and Community Nursing Doctoral student, Universitat de València, Valencia, Spain
| | | | | | - Lizeth Catherine Rodríguez Corredor
- Research Division, Instituto Neumológico del Oriente, Bucaramanga, Colombia
- Public Health Department, Universidad Industrial de Santander, Bucaramanga, Colombia
| | | | | | | | | | | | - Pilar Serrano-Gallardo
- Department of Nursing, School of Medicine, Universidad Autónoma de Madrid/IDIPHIM / INAECU, Madrid, Spain
| | - Lina M Vera-Cala
- Public Health Department, Universidad Industrial de Santander, Bucaramanga, Colombia
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Pietrzykowski Ł, Kasprzak M, Michalski P, Kosobucka A, Fabiszak T, Kubica A. Therapy Discontinuation after Myocardial Infarction. J Clin Med 2020; 9:jcm9124109. [PMID: 33352811 PMCID: PMC7766090 DOI: 10.3390/jcm9124109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 01/08/2023] Open
Abstract
The discontinuation of recommended therapy after myocardial infarction predisposes patients to serious thrombotic complications. The aim of this study was a comprehensive analysis of permanent as well as short- and long-term discontinuation of pharmacotherapy, taking into consideration the basic groups of medications and nonadherence determinants in a one-year follow-up in post-myocardial infarction (MI) patients. Material and methods: The study was a single center cohort clinical trial with a one-year follow-up including 225 patients (73.3% men, 26.7% women) aged 62.9 ± 11.9 years. In eight cases (3.6%), the follow-up duration was less than one year due to premature death. The following factors were analyzed: lack of post-discharge therapy initiation; short-term therapy discontinuation (<30 days); long-term therapy discontinuation (≥30 days); and permanent cessation of therapy. The analysis of therapy discontinuation was performed based on prescription filling data. Results: Occupational activity (Odds Ratio (OR) 5.15; 95% Confidence interval (CI) 1.42–18.65; p = 0.013) and prior MI (OR 5.02; 95% CI 1.45–16.89; p = 0.009) were found to be independent predictors of a lack of post-discharge therapy initiation with P2Y12 receptor inhibitors. We found no independent predictors of lack of post-discharge therapy initiation with other medications, whether analyzed separately or together. Age above 65 years (Hazard Ratio (HR)—1.59; 95% CI 1.15–2.19; p = 0.0049) and prior revascularization (HR—1.44; 95% CI 1.04–2.19; p = 0.0273) were identified as independent predictors of therapy discontinuation. Multilogistic regression analysis showed no independent predictors of the cessation of any of the medications as well as the permanent or temporary simultaneous discontinuation of all medications. Conclusions: The vast majority of post-MI patients discontinue, either temporarily or permanently, one of the essential medications within one year following myocardial infarction. The most likely medication class to be discontinued are statins. Older age and prior cardiac revascularization are independent determinants of therapy discontinuation.
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Affiliation(s)
- Łukasz Pietrzykowski
- Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland; (P.M.); (A.K.); (A.K.)
- Correspondence: ; Tel.: +48-52-585-58-35
| | - Michał Kasprzak
- Department of Cardiology, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland; (M.K.); (T.F.)
| | - Piotr Michalski
- Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland; (P.M.); (A.K.); (A.K.)
| | - Agata Kosobucka
- Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland; (P.M.); (A.K.); (A.K.)
| | - Tomasz Fabiszak
- Department of Cardiology, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland; (M.K.); (T.F.)
| | - Aldona Kubica
- Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland; (P.M.); (A.K.); (A.K.)
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Almeida TDCF, Sousa MMD, Gouveia BDLA, Olinda RAD, Lamas JLT, Oliveira SHDS. Psychosocial Determinants of the Intention to Take Oral Antihypertensive Drugs: A Cross-sectional Study. AQUICHAN 2020. [DOI: 10.5294/aqui.2020.20.4.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To identify the psychosocial predictors that influence the behavioral intention to take oral antihypertensive drugs.
Materials and methods: A cross-sectional study, based on the theory of planned behavior. A questionnaire constructed and validated was applied to 220 individuals with systemic arterial hypertension in outpatient follow-up at a public hospital. The chi-square and Fisher’s exact tests, Spearman’s correlation and multiple logistic regression were used for data analysis.
Results: The participants presented a high intention of taking antihypertensive drugs. The behavioral beliefs (ß = 0.0432; p = 0.0364), subjective norm (ß = -1.5708; p < 0.01) and perceived behavioral control (ß = 2.2809; p = 0.0028) explained the behavioral intention in 33 %.
Conclusions: The behavioral beliefs, the subjective norm, and the perceived behavioral control are significant psychosocial predictors of taking antihypertensive drugs and must be valued, individually and jointly, in the health actions targeted at this population.
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Jones SMW, Henrikson NB, Panattoni L, Syrjala KL, Shankaran V. A theoretical model of financial burden after cancer diagnosis. Future Oncol 2020; 16:3095-3105. [PMID: 32976048 PMCID: PMC7787147 DOI: 10.2217/fon-2020-0547] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/10/2020] [Indexed: 11/21/2022] Open
Abstract
Current models of financial burden after cancer do not adequately define types of financial burden, moderators or causes. We propose a new theoretical model to address these gaps. This model delineates the components of financial burden as material and psychological as well as healthcare-specific (affording treatment) versus general (affording necessities). Psychological financial burden is further divided into worry about future costs and rumination about past and current financial burden. The model hypothesizes costs and employment changes as causes, and moderators include precancer socioeconomic status and post-diagnosis factors. The model outlines outcomes affected by financial burden, including depression and mortality. Theoretically derived measures of financial burden, interventions and policy changes to address the causes of financial burden in cancer are needed.
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Affiliation(s)
- Salene MW Jones
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, King County, Washington 98101, USA
| | - Laura Panattoni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
| | - Karen L Syrjala
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
| | - Veena Shankaran
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
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Medication adherence and its determinants in patients after myocardial infarction. Sci Rep 2020; 10:12028. [PMID: 32694522 PMCID: PMC7374107 DOI: 10.1038/s41598-020-68915-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 06/22/2020] [Indexed: 11/08/2022] Open
Abstract
Non-adherence to prescribed medication is a serious limitation of long-term treatment in patients after myocardial infarction (MI), which can be associated with medical, social and economical consequences. Improvement of medication adherence has been shown to be a challenge for healthcare providers. The aim of this study was to evaluate changes in medication adherence and variability of adherence determinants during follow-up in patients after MI. A single-center, cohort observational study was conducted in 225 post-MI patients treated with primary coronary intervention (PCI) (27% women and 73% men) aged 30–91 years. Adherence was defined as availability of evaluated drugs within 1-year after discharge from hospital, based on completed prescriptions data obtained from the National Health Fund. The analysis of therapeutic plan realization (adherence to medication prescribed at discharge from hospital) embraced only reimbursed drugs: ACEIs (ramipril, perindopril), P2Y12 receptor inhibitors (clopidogrel) and statins (atorvastatin, simvastatin, rosuvastatin). Sufficient adherence was defined as ≥ 80%. During 1-year follow-up, adherence for all three drug classes was 64 ± 25%, with 67 ± 32% for ACEIs, 62 ± 34% for P2Y12 receptor inhibitor and 64 ± 32% for statins. A gradual decline in adherence was observed from 65% ± 26% in the first quarter of follow-up to 51% ± 34% in the last quarter of follow-up (p < 0.00001). Sufficient adherence for all drugs classes was found only in 29% of patients throughout the whole follow-up period (44% for ACEI, 36% for P2Y12 receptor inhibitor and 41% for statins). According to a multivariate analysis, age, prior CABG, level of education, place of residence, economic status and marital status were independent predictors of drug adherence. Whereas patients > 65 years and having a history of prior CABG more often had an insufficient adherence to drugs, married and hypertensive patients, city inhabitants and patients with higher education tended to have a sufficient drug adherence. Adherence to pharmacotherapy after myocardial infarction decreases over time in a similar manner for all pivotal groups of drugs prescribed after MI. A number of socioeconomic and clinical factors have been identified to affect medication adherence over time.
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Ma G, Luo A, Shen Z, Duan Y, Shi S, Zhong Z. The status of medication literacy and associated factors of hypertensive patients in China: a cross-sectional study. Intern Emerg Med 2020; 15:409-419. [PMID: 31650433 PMCID: PMC7165129 DOI: 10.1007/s11739-019-02187-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/28/2019] [Indexed: 12/23/2022]
Abstract
The adverse consequence of low medication literacy is a major problem that threatens patients' health. The number of people with hypertension is increasing in China. We described the current situation of medication literacy of patients with hypertension in China and its related influencing factor. We conducted a cross-sectional study, which contains 590 hypertensive patients. Stratified sampling was adopted according to the hospital level in China. To determine the factors related to medication literacy, multiple linear regression analysis was used to determine associations between medication literacy of hypertensive patients and other factors. Among 590 respondents, results showed that they have poor medication literacy. Multiple linear regression analysis showed that level of education, annual income, occupation status, and type of medical insurance were significantly associated with medication literacy level of hypertensive patients. In addition, our study also demonstrates that we can identify the medication literacy level of hypertensive patients using the Chinese version Medication Literacy Scale for Hypertensive Patients. High medication literacy is an important factor for hypertensive patients to improve medication adherence, so as to better control blood pressure. We should pay attention to the improvement of medication literacy and take corresponding measures.
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Affiliation(s)
- Guiyue Ma
- grid.216417.70000 0001 0379 7164Third Xiangya Hospital, Central South University, Changsha, 410013 China
- grid.216417.70000 0001 0379 7164Xiangya School of Nursing, Central South University, Changsha, 410013 China
| | - Aijing Luo
- grid.216417.70000 0001 0379 7164Key Laboratory of Medical Information Research, Central South University, College of Hunan Province, Changsha, 410013 China
| | - Zhiying Shen
- grid.216417.70000 0001 0379 7164Third Xiangya Hospital, Central South University, Changsha, 410013 China
| | - Yinglong Duan
- grid.216417.70000 0001 0379 7164Third Xiangya Hospital, Central South University, Changsha, 410013 China
| | - Shuangjiao Shi
- grid.216417.70000 0001 0379 7164Third Xiangya Hospital, Central South University, Changsha, 410013 China
- grid.216417.70000 0001 0379 7164Xiangya School of Nursing, Central South University, Changsha, 410013 China
| | - Zhuqing Zhong
- grid.216417.70000 0001 0379 7164Third Xiangya Hospital, Central South University, Changsha, 410013 China
- grid.216417.70000 0001 0379 7164Xiangya School of Nursing, Central South University, Changsha, 410013 China
- grid.216417.70000 0001 0379 7164Key Laboratory of Medical Information Research, Central South University, College of Hunan Province, Changsha, 410013 China
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Adherence to Cardiac Medications in Patients With Atrial Fibrillation: A Pilot Study. Heart Lung Circ 2020; 29:e131-e139. [PMID: 32089489 DOI: 10.1016/j.hlc.2019.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 11/13/2019] [Accepted: 11/24/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Non-adherence to medications is common in patients with atrial fibrillation (AF), increasing the risk of stroke, co-morbidities, and AF symptoms. Understanding factors influencing medication adherence is important in providing holistic care to patients with AF. This study aimed to explore medication adherence in patients with AF, and explore associations with health literacy, cognition, or AF knowledge. METHODS A single-centre pilot study, using survey questionnaires and open questions. Patients with a primary cardiac diagnosis, with AF as primary or secondary diagnosis, were eligible for recruitment. During hospitalisation, adherence to cardiac medications was assessed using the Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS). Health literacy, cognition, and AF knowledge were assessed through validated questionnaires. Facilitators and barriers for medication adherence were obtained through open-ended question and coded using a content analysis approach. RESULTS Fifty-four (54) patients were recruited (61% male, mean age 71±11). Twenty-two (22) participants (41%) were classified as non-adherent using the BAASIS; with a corresponding self-reported adherence of 87.7% in non-adherent participants compared to 97.8% in adherent participants. No associations were identified between medication adherence and cognition, health literacy, or AF knowledge. Facilitators for adherence included external assistance, routines, and medication knowledge, and these were reported by both adherent and non-adherent participants. Non-adherent participants reported more barriers including medication concerns, forgetfulness, and lifestyle factors. CONCLUSIONS Large numbers of AF patients are likely to be non-adherent to medications. Medication adherence is influenced by multiple factors, individual to each patient. Diverse strategies are required to ensure adherence to cardiac medications.
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Takada S, Ettner SL, Harawa NT, Garland WH, Shoptaw SJ, Cunningham WE. Life Chaos is Associated with Reduced HIV Testing, Engagement in Care, and ART Adherence Among Cisgender Men and Transgender Women upon Entry into Jail. AIDS Behav 2020; 24:491-505. [PMID: 31396766 PMCID: PMC6994355 DOI: 10.1007/s10461-019-02570-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Life chaos, the perceived inability to plan for and anticipate the future, may be a barrier to the HIV care continuum for people living with HIV who experience incarceration. Between December 2012 and June 2015, we interviewed 356 adult cisgender men and transgender women living with HIV in Los Angeles County Jail. We assessed life chaos using the Confusion, Hubbub, and Order Scale (CHAOS) and conducted regression analyses to estimate the association between life chaos and care continuum. Forty-eight percent were diagnosed with HIV while incarcerated, 14% were engaged in care 12 months prior to incarceration, mean antiretroviral adherence was 65%, and 68% were virologically suppressed. Adjusting for sociodemographics, HIV-related stigma, and social support, higher life chaos was associated with greater likelihood of diagnosis while incarcerated, lower likelihood of engagement in care, and lower adherence. There was no statistically significant association between life chaos and virologic suppression. Identifying life chaos in criminal-justice involved populations and intervening on it may improve continuum outcomes.
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Affiliation(s)
- Sae Takada
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
- Veterans Affairs Health Services Research and Development Service, Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA.
| | - Susan L Ettner
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Nina T Harawa
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- College of Medicine, Charles R. Drew University, Los Angeles, CA, USA
| | - Wendy H Garland
- Los Angeles County Department of Public Health, Division of HIV and STD Programs, Los Angeles, CA, USA
| | - Steve J Shoptaw
- Department of Family Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - William E Cunningham
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
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Hanna A, Yael EM, Hadassa L, Iris E, Eugenia N, Lior G, Carmit S, Liora O. ``It's up to me with a little support'' – Adherence after myocardial infarction: A qualitative study. Int J Nurs Stud 2020; 101:103416. [DOI: 10.1016/j.ijnurstu.2019.103416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 08/25/2019] [Accepted: 08/29/2019] [Indexed: 11/27/2022]
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Cho H, Jeong S, Kang C, Kang HJ, Jang S, Jang S. Risk Factors and the Usual Source of Care on Non-Adherence to Antihypertensive Drugs in Immigrants with Hypertension. Patient Prefer Adherence 2020; 14:2123-2133. [PMID: 33173281 PMCID: PMC7648264 DOI: 10.2147/ppa.s269008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/15/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Immigrants are vulnerable to suboptimal health care utilization including non-adherence of medication use. Thus, we aimed to identify the potential risk factors of non-adherence and evaluate whether utilizing a usual source of care was associated with medication adherence in immigrants. METHODS We utilized the Korea National Health Insurance Claims Database between 2012 and 2015. Cases were immigrants who had antihypertensive prescriptions at the time of hypertension diagnosis in 2012. Controls were native-born Koreans with hypertension who were 1:1 matched to immigrants by age, sex, and Charlson comorbidity index. We used the medication possession ratio for three years to assess the adherence to antihypertensive drugs. The likelihood of non-adherence was evaluated between cases and controls by multivariate linear regression models stratified by age, sex, and number of clinic visits. We assessed the potential risk factors of non-adherence in immigrants by multivariate linear regression and logistic regression models, respectively. RESULTS In total, 4114 immigrants and 4114 matched native-born Koreans with hypertension were included. The mean MPR was significantly lower in immigrants (56% vs 70%, p<0.0001). Immigrants showed almost two times the level of non-adherence as native-born Koreans (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.83-2.21). Stratified analyses on non-adherence presented the highest non-adherence (2.28 times) in immigrants in the younger group (30-49 years old) and the lowest non-adherence in immigrants in 65 and old group where the risk was 1.69 times higher than native Korean with the same age. The absence of a usual source of care significantly increased medication non-adherence by 1.31 to 1.58 times among immigrants. CONCLUSION When the number of visited clinics increased, the degree of non-adherence increased consistently. Therefore, the systematization of registering with primary care (a usual source of care) might be a modifiable health care strategy to improve health care outcomes in immigrants.
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Affiliation(s)
- Hyemin Cho
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Sohyun Jeong
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Cinoo Kang
- Department of Biostatics and Epidemiology, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Hee-Jin Kang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Suhyun Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
- Correspondence: Sunmee Jang College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, 191 Hambakmoero, Yeonsu-Gu, Incheon21936, South KoreaTel +82-32-820-4941Fax +82-32-820-4829 Email
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Predictors of in-laboratory polysomnography attendance in a cohort of patients with stroke or TIA. Sleep Med 2019; 66:159-164. [PMID: 31877507 DOI: 10.1016/j.sleep.2019.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVES After cerebrovascular events, obstructive sleep apnea (OSA) is associated with poor functional outcomes, an increased risk of recurrent stroke, and mortality. Although the significant under-diagnosis of OSA is likely multifactorial in nature, factors associated with attendance at in-laboratory polysomnography (iPSG) are poorly understood. We evaluated demographic, lifestyle, and clinical variables that predicted attendance at iPSG in a cohort of patients with stroke and transient ischemic attack (TIA) enrolled in a clinical research study. METHODS Demographic, lifestyle, and clinical variables were summarized for the patients who did and did not attend iPSG. Multivariable binary logistic regression analyses were performed to examine four models that thematically aggregated predictors expected to relate to attendance. Further, t-tests for continuous variables, and chi-squared tests for categorical variables, were performed to uncover differences between the two groups. RESULTS In the 122 participants included in our analyses, mean age was 66.6 ± 15.7 (64.8% males) with only 59.0% of participants attending iPSG. Only Model 1, which investigated the impact of demographic, lifestyle, and cognitive status, was significant (χ2 = 35.31, p < 0.001). Among our variables, (1) younger age, (2) better cognition, (3) higher level of education, and (4) never-smoking status significantly predicted attendance at iPSG. CONCLUSION By understanding the relationship between variables that significantly predict attendance, we hope our results will translate into practices that promote iPSG attendance, which may help improve outcomes in the stroke/TIA population. CLINICAL TRIALS SLEep APnea Screening Using Mobile Ambulatory Recorders After TIA/Stroke (SLEAP SMART) (NCT02454023); https://clinicaltrials.gov/ct2/show/NCT02454023.
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Jones SMW, Du Y, Panattoni L, Henrikson NB. Assessing Worry About Affording Healthcare in a General Population Sample. Front Psychol 2019; 10:2622. [PMID: 31824388 PMCID: PMC6883904 DOI: 10.3389/fpsyg.2019.02622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/06/2019] [Indexed: 11/20/2022] Open
Abstract
This study adapted a measure on worry about affording healthcare. The financial costs of healthcare are increasingly being shifted to patients. Financial burden from healthcare costs can be material (such as bankruptcy) or psychological. Psychological distress can be either worry about affording future care or distress due to material consequences and, despite evidence from clinical psychology that differentiates these types of emotional symptoms, this distinction has largely been ignored for financial burden in healthcare. We adapted a worry about affording healthcare scale for use in the general population (n = 398) to facilitate comparisons between disease groups and across countries. Participants completed a survey through an online platform. The worry about affording healthcare measure showed good reliability and validity through associations with quality of life (QOL) and measures of other types of financial burden. Worry about affording healthcare was also associated with cost-related non-adherence to medical care. Future research on patient QOL should consider worry about affording healthcare.
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Affiliation(s)
- Salene M W Jones
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Yuxian Du
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,Bayer Healthcare U.S. LLC, Whippany, NJ, United States
| | - Laura Panattoni
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
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Determinants of Hepatitis C Treatment Adherence and Treatment Completion Among Veterans in the Direct Acting Antiviral Era. Dig Dis Sci 2019; 64:3001-3012. [PMID: 30903364 DOI: 10.1007/s10620-019-05590-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 03/12/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite the availability of direct acting antiviral medications (DAAs), there are ongoing concerns about adherence to hepatitis C virus (HCV) treatment. We sought to understand the barriers to and facilitators of DAA adherence in the Veteran population. METHODS Patients completed semi-structured interviews focused on barriers to and facilitators of HCV treatment adherence both pre- and post-DAA treatment. Adherence was assessed via provider pill count and self-report. Thematic analyses were conducted in the qualitative software program Atlas.ti in order to understand anticipated barriers to and facilitators of treatment adherence and completion. Charts were reviewed for clinical data and sustained virologic response (SVR12). RESULTS Of 40 patients, 15 had cirrhosis and 10 had prior interferon-based treatment. Pre-treatment interviews revealed anticipated barriers to adherence such as side effects (n = 21) and forgetting pills (n = 11). Most patients (n = 27) reported following provider advice, and others had unique reasons not to (e.g., feeling like a "guinea pig"). Post-treatment interviews uncovered facilitators of treatment including wanting to cure HCV (n = 17), positive results (n = 18), and minimal side effects (n = 15). Three patients (8%) did not complete therapy (whom we further elaborate on) and 6 (15%) missed doses but completed treatment. SVR12 was achieved by all participants who completed therapy (93%). Patients who did not complete therapy or missed doses were all treatment naïve, mostly non-cirrhotic (8 of 9), and often anticipated concerns with forgetting their medications. CONCLUSIONS This qualitative study uncovered several unanticipated determinants of HCV treatment completion and provides rationale for several targeted interventions such as incorporating structured positive reinforcement.
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O'Conor R, Benavente JY, Kwasny MJ, Eldeirawi K, Hasnain-Wynia R, Federman AD, Hebert-Beirne J, Wolf MS. Daily Routine: Associations With Health Status and Urgent Health Care Utilization Among Older Adults. THE GERONTOLOGIST 2019; 59:947-955. [PMID: 30247549 DOI: 10.1093/geront/gny117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Chronically ill older adults must integrate self-care behaviors into their daily routine to promote health and reduce urgent health care utilization. Individuals of lower socioeconomic position (SEP) experience a disproportionate burden of stressors that challenge the formation of regular routines. We examined associations between the presence of a daily routine and older adults' health status and urgent health care utilization, to determine whether higher levels of daily routine mediates associations between SEP and health outcomes. RESEARCH DESIGN AND METHODS We used data from a cohort of older adult primary care patients in Chicago. Daily routine was measured using a brief, validated scale. A single factor score of SEP was created with measures of education, income, homeownership, and insurance status. Health status was assessed by Patient Reported Outcomes Measurement Information Service physical function, depression, and anxiety. Urgent health care utilization was patient reported. Multivariable models were used to assess the effect of routine and SEP on health status and urgent health care utilization. RESULTS Individuals reporting low levels of daily routine reported worse physical function (β = -2.34; 95% CI -4.18, -0.50), more anxiety (β = 2.73; 95% CI 0.68, 4.78) and depressive symptoms (β = 2.83; 95% CI 0.94, 4.74) than those with greater daily routine. No differences in urgent health care utilization were observed by daily routine. Daily routine varied by SEP (p < .001); routine partially mediated the relationship between SEP and physical function and anxiety symptoms (ps < .05). DISCUSSION AND IMPLICATIONS A daily routine may be an under recognized modifiable factor that could promote health outcomes among older adults.
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Affiliation(s)
- Rachel O'Conor
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL
| | | | - Mary J Kwasny
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kamal Eldeirawi
- College of Nursing, University of Illinois at Chicago, Chicago, IL
| | | | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York
| | - Jennifer Hebert-Beirne
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL
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Al-Ganmi AHA, Al-Fayyadh S, Abd Ali MBH, Alotaibi AM, Gholizadeh L, Perry L. Medication adherence and predictive factors in patients with cardiovascular disease: A comparison study between Australia and Iraq. Collegian 2019. [DOI: 10.1016/j.colegn.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Quantifying Social Reinforcement Among Family Members on Adherence to Medications for Chronic Conditions: a US-Based Retrospective Cohort Study. J Gen Intern Med 2019; 34:855-861. [PMID: 30406566 PMCID: PMC6544705 DOI: 10.1007/s11606-018-4654-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/20/2018] [Accepted: 08/17/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND More than 50% of patients are non-adherent to medications, often without an easily identifiable reason to clinicians. No study has quantified the extent to which health behaviors like medication-taking are correlated within families using national or routinely collected data for a range of conditions. OBJECTIVE To examine how an individual's health behaviors are influenced by those of their family members, particularly in adherence to medications for chronic conditions. DESIGN Retrospective cohort study. PATIENTS Using claims from a large nationwide insurer, we identified patients initiating medications for one of five chronic conditions with a family member who also recently filled one of these medications. MAIN MEASURES The primary exposure was whether family members were fully adherent (defined as a proportion of days covered ≥ 80%) before the patient's date of initiation. The outcome of interest was whether patients were fully adherent in the 12 months after initiation. Baseline demographic and clinical characteristics were also measured before initiation. We used multivariable modified Poisson regression to examine the association between prior family adherence and subsequent patient adherence. KEY RESULTS Among 254,144 patients, rates of full adherence among patients whose family members were and were not fully adherent were 37.3% and 26.9%, respectively (adjusted relative risk [aRR] 1.29, 95%CI 1.28-1.31). The association was stronger when both used cardiometabolic medications (aRR 1.35, 95%CI 1.32-1.37). Similarly, patients were also 38% more likely to be adherent if they and their family members used a medication for the same condition (aRR 1.38, 95%CI 1.35-1.40). CONCLUSIONS Adherence among family members appeared to be highly correlated, suggesting positive reinforcement by family or the sharing of unmeasured behaviors or characteristics associated with better adherence. Regardless, information about prior adherence among family members from routinely collected data could potentially inform adherence prediction or intervention efforts.
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Lowres N, Giskes K, Hespe C, Freedman B. Reducing Stroke Risk in Atrial Fibrillation: Adherence to Guidelines Has Improved, but Patient Persistence with Anticoagulant Therapy Remains Suboptimal. Korean Circ J 2019; 49:883-907. [PMID: 31535493 PMCID: PMC6753021 DOI: 10.4070/kcj.2019.0234] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/24/2022] Open
Abstract
Atrial fibrillation (AF) is a significant risk factor for avoidable stroke. Among high-risk patients with AF, stroke risk can be mitigated using oral anticoagulants (OACs), however reduction is largely contingent on physician prescription and patient persistence with OAC therapy. Over the past decade significant advances have occurred, with revisions to clinical practice guidelines relating to management of stroke risk in AF in several countries, and the introduction of non-vitamin K antagonist OACs (NOACs). This paper summarises the evolving body of research examining guideline-based clinician prescription over the past decade, and patient-level factors associated with OAC persistence. The review shows clinicians' management over the past decade has increasingly reflected guideline recommendations, with an increasing proportion of high-risk patients receiving OACs, driven by an upswing in NOACs. However, a treatment gap remains, as 25–35% of high-risk patients still do not receive OAC treatment, with great variation between countries. Reduction in stroke risk directly relates to level of OAC prescription and therapy persistence. Persistence and adherence to OAC thromboprophylaxis remains an ongoing issue, with 2-year persistence as low as 50%, again with wide variation between countries and practice settings. Multiple patient-level factors contribute to poor persistence, in addition to concerns about bleeding. Considered review of individual patient's factors and circumstances will assist clinicians to implement appropriate strategies to address poor persistence. This review highlights the interplay of both clinician's awareness of guideline recommendations and understanding of individual patient-level factors which impact adherence and persistence, which are required to reduce the incidence of preventable stroke attributable to AF.
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Affiliation(s)
- Nicole Lowres
- Heart Research Institute, Charles Perkins Centre, Camperdown, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Katrina Giskes
- Heart Research Institute, Charles Perkins Centre, Camperdown, Australia.,School of Medicine, The University of Notre Dame, Sydney, Australia
| | - Charlotte Hespe
- School of Medicine, The University of Notre Dame, Sydney, Australia
| | - Ben Freedman
- Heart Research Institute, Charles Perkins Centre, Camperdown, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Cardiology, Concord Hospital, The University of Sydney Concord Clinical School, Concord, Australia
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Factors Associated with Perceived Life Chaos among Post-Myocardial Infarction Survivors in a Malaysian Cardiac Care Facility. ACTA ACUST UNITED AC 2018; 54:medicina54050079. [PMID: 30400590 PMCID: PMC6262329 DOI: 10.3390/medicina54050079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/22/2018] [Accepted: 10/31/2018] [Indexed: 01/20/2023]
Abstract
Background and objectives: Survivors of chronic life-threatening conditions like myocardial infarction (MI) are often confronted with multiple physical and psychological stressors as a consequence of elevated demands of lifestyle adjustments and modifications. Such stressors, collectively known as “life chaos”, cause disruption to one’s lifestyle equilibrium of having organized, calm, and regular routines. The objective of the current study was to determine the level of life chaos and its associated correlates among post-myocardial infarction (post-MI) survivors in Malaysia. Materials and Methods: An analytical cross-sectional study was conducted among 242 post-MI survivors in a Malaysian cardiac health facility from July to September 2016. A self-administered questionnaire in Malay that consisted of items on socio-demographics, health attributes, validated OSLO-3 Social Support Scale (OSS-3), and the Modified Confusion, Hubbub, and Order Scale (CHAOS-6) was utilized in this study. Descriptive, bivariate, and multivariate analyses were conducted. Results: The sample constituted of 208 (86%) men and 34 (14%) women. The average age was 55 years (SD = 11), and the age ranged between 24 and 96 years. Overall, 128 (52.9%) of the total post-MI survivors had highly chaotic lives. In multivariate analysis, younger age, lower household income, perceived financial insecurity, poor health status, and multiple comorbidities were related to the high chaos score, and these associations were statistically significant (p < 0.05). Conclusions: Highly chaotic lifestyles were prevalent in post-MI survivors. Demographic, health attributes, and socio-economic factors were important correlates of life chaos.
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Jamison J, Ayerbe L, Di Tanna GL, Sutton S, Mant J, De Simoni A. Evaluating practical support stroke survivors get with medicines and unmet needs in primary care: a survey. BMJ Open 2018; 8:e019874. [PMID: 29526835 PMCID: PMC5855212 DOI: 10.1136/bmjopen-2017-019874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To design a questionnaire and use it to explore unmet needs with practical aspects of medicine taking after stroke, predictors of medicine taking and to estimate the proportion of survivors who get support with daily medication taking. DESIGN Four workshops with stroke survivors and caregivers to design the questionnaire.A cross-sectional postal questionnaire in primary care. SETTING 18 general practitioner practices in the East of England and London. Questionnaires posted between September 2016 and February 2017. PARTICIPANTS 1687 stroke survivors living in the community outside institutional long-term care. PRIMARY OUTCOME MEASURES The proportion of community stroke survivors receiving support from caregivers for practical aspects of medicine taking; the proportion with unmet needs in this respect; the predictors of experiencing unmet needs and missing taking medications. RESULTS A five-item questionnaire was developed to cover the different aspects of medicine taking. 596/1687 (35%) questionnaires were returned. 56% reported getting help in at least one aspect of taking medication and 11% needing more help. 35% reported missing taking their medicines. Unmet needs were associated with receiving help with medications (OR 5.9, P<0.001), being on a higher number of medications (OR 1.2, P<0.001) and being dependent for activities of daily living (OR 4.9, P=0.001). Missing medication was associated with having unmet needs (OR 5.3, P<0.001), receiving help with medications (OR 2.1, P<0.001), being on a higher number of medicines (OR 1.1, P=0.008) and being older than 70 years (OR 0.6, P=0.006). CONCLUSIONS More than half of patients who replied needed help with taking medication, and 1 in 10 had unmet needs in this regard. Stroke survivors dependent on others have more unmet needs, are more likely to miss medicines and might benefit from focused clinical and research attention. Novel primary care interventions focusing on the practicalities of taking medicines are warranted.
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Affiliation(s)
- James Jamison
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Luis Ayerbe
- Centre for Primary Care and Public Health, Barts, The London School of Medicine and Dentistry, London, UK
| | - Gian Luca Di Tanna
- Centre for Primary Care and Public Health, Barts, The London School of Medicine and Dentistry, London, UK
| | - Stephen Sutton
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Anna De Simoni
- Centre for Primary Care and Public Health, Barts, The London School of Medicine and Dentistry, London, UK
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Giner-Soriano M, Sotorra Figuerola G, Cortés J, Pera Pujadas H, Garcia-Sangenis A, Morros R. Impact of Medication Adherence on Mortality and Cardiovascular Morbidity: Protocol for a Population-Based Cohort Study. JMIR Res Protoc 2018; 7:e73. [PMID: 29523501 PMCID: PMC5866299 DOI: 10.2196/resprot.8121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 01/11/2018] [Accepted: 01/28/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a group of disorders of the heart and blood vessels, such as coronary heart disease (CHD), cerebrovascular disease, and peripheral artery disease. CVD is the leading threat to global health, whether measured by mortality, morbidity, or economic cost. Long-term administration of aspirin, statins, beta-blockers, and angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers improves survival in patients with stablished coronary heart disease. Nevertheless, adherence to prescribed medication is poor for long-term drug treatment. OBJECTIVE We aim to assess the relationship between adherences to the four pharmacological groups recommended for secondary prevention and the clinical outcomes of cardiovascular morbidity and mortality in patients with established CHD according to the level of adherence to these drugs in a population of incident cases of acute coronary syndrome (ACS). METHODS Population-based cohort study of patients with a first episode of ACS during 2006-2015 in the Information System for Research in Primary Care (SIDIAP) database. We will estimate adherence to these drugs. The primary endpoint is a composite of all-cause mortality, ACS, and ischaemic stroke. Bivariate analyses will be performed estimating odds ratios for categorical variables and mean differences for continuous variables. Hazard ratios for adherences will be calculated for outcome events using Cox proportional hazard regression models, and proportionality of hazards assumption will be tested. RESULTS We expect to estimate adherence to all four study treatments, the incidence of MACE, and to analyze if this incidence is associated with the level of drug adherence. CONCLUSIONS We expect to find that adherent patients have a lower risk of the primary endpoints compared with nonadherent patients. TRIAL REGISTRATION This study protocol was classified as EPA-OD by the AEMPS (IJG-EST-2017-01-2017-01, 07/04/2017) and registered in the EU PAS register (EUPAS19017, 09/05/2017).
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Affiliation(s)
- Maria Giner-Soriano
- Medicines Research Unit, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
- Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Institut Català de la Salut, Barcelona, Spain
| | - Gerard Sotorra Figuerola
- Medicines Research Unit, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jordi Cortés
- Medicines Research Unit, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Departament d'Estadística i Investigació Operativa, Universitat Politècnica de Catalunya, Barcelona, Spain
- Spanish Clinical Research Network, Unidad de Investigación Clínica y Ensayos Clínicos, Institut Universitari d'Investigació en Atenció Primària, Barcelona, Spain
| | - Helena Pera Pujadas
- Medicines Research Unit, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Spanish Clinical Research Network, Unidad de Investigación Clínica y Ensayos Clínicos, Institut Universitari d'Investigació en Atenció Primària, Barcelona, Spain
| | - Ana Garcia-Sangenis
- Medicines Research Unit, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Rosa Morros
- Medicines Research Unit, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
- Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Institut Català de la Salut, Barcelona, Spain
- Spanish Clinical Research Network, Unidad de Investigación Clínica y Ensayos Clínicos, Institut Universitari d'Investigació en Atenció Primària, Barcelona, Spain
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Zullig LL, Diamantidis CJ, Bosworth HB, Bhapkar MV, Barnhart H, Oakes MM, Pendergast JF, Miller JJ, Patel UD. Racial differences in nocturnal dipping status in diabetic kidney disease: Results from the STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) study. J Clin Hypertens (Greenwich) 2017; 19:1327-1335. [PMID: 28834119 PMCID: PMC5722697 DOI: 10.1111/jch.13088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/30/2017] [Accepted: 06/04/2017] [Indexed: 11/29/2022]
Abstract
While racial variation in ambulatory blood pressure (BP) is known, patterns of diurnal dipping in the context of diabetic kidney disease have not been well defined. The authors sought to determine the association of race with nocturnal dipping status among participants with diabetic kidney disease enrolled in the STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) trial. The primary outcome was nocturnal dipping-percent decrease in average systolic BP from wake to sleep-with categories defined as reverse dippers (decrease <0%), nondippers (0%-<10%), and dippers (≥10%). Twenty-four-hour ambulatory BP monitoring was completed by 108 participants (54% were nondippers, 24% were dippers, and 22% were reverse dippers). In adjusted models, the common odds of reverse dippers vs nondippers/dippers and reverse dippers/nondippers vs dippers was 2.6 (95% confidence interval, 1.2-5.8) times higher in blacks than in whites. Without ambulatory BP monitoring data, interventions that target BP in black patients may be unable to improve outcomes in this high-risk group.
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Affiliation(s)
- Leah L. Zullig
- Center of Excellence for Health Services Research in Primary CareDurham Veterans Affairs Health Care CenterDurhamNCUSA
- Division of General Internal MedicineDuke UniversityDurhamNCUSA
| | | | - Hayden B. Bosworth
- Center of Excellence for Health Services Research in Primary CareDurham Veterans Affairs Health Care CenterDurhamNCUSA
- Division of General Internal MedicineDuke UniversityDurhamNCUSA
- Department of Psychiatry and School of NursingDuke UniversityDurhamNCUSA
| | | | - Huiman Barnhart
- Department of Biostatistics and BioinformaticsDuke UniversityDurhamNCUSA
| | - Megan M. Oakes
- Division of General Internal MedicineDuke UniversityDurhamNCUSA
| | - Jane F. Pendergast
- Department of Biostatistics and BioinformaticsDuke UniversityDurhamNCUSA
| | - Julie J. Miller
- Division of General Internal MedicineDuke UniversityDurhamNCUSA
| | - Uptal D. Patel
- Division of NephrologyDuke UniversityDurhamNCUSA
- Gilead SciencesSan FranciscoCAUSA
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Ganasegeran K, Selvaraj K, Rashid A. Confirmatory Factor Analysis of the Malay Version of the Confusion, Hubbub and Order Scale (CHAOS-6) among Myocardial Infarction Survivors in a Malaysian Cardiac Healthcare Facility. Malays J Med Sci 2017; 24:39-46. [PMID: 28951688 DOI: 10.21315/mjms2017.24.4.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/12/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The six item Confusion, Hubbub and Order Scale (CHAOS-6) has been validated as a reliable tool to measure levels of household disorder. We aimed to investigate the goodness of fit and reliability of a new Malay version of the CHAOS-6. METHODS The original English version of the CHAOS-6 underwent forward-backward translation into the Malay language. The finalised Malay version was administered to 105 myocardial infarction survivors in a Malaysian cardiac health facility. We performed confirmatory factor analyses (CFAs) using structural equation modelling. A path diagram and fit statistics were yielded to determine the Malay version's validity. Composite reliability was tested to determine the scale's reliability. RESULTS All 105 myocardial infarction survivors participated in the study. The CFA yielded a six-item, one-factor model with excellent fit statistics. Composite reliability for the single factor CHAOS-6 was 0.65, confirming that the scale is reliable for Malay speakers. CONCLUSION The Malay version of the CHAOS-6 was reliable and showed the best fit statistics for our study sample. We thus offer a simple, brief, validated, reliable and novel instrument to measure chaos, the Skala Kecelaruan, Keriuhan & Tertib Terubahsuai (CHAOS-6), for the Malaysian population.
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Affiliation(s)
- Kurubaran Ganasegeran
- Department of Public Health Medicine, Penang Medical College, 10450 George Town, Pulau Pinang, Malaysia.,Ministry of Health Malaysia, Parcel E, Putrajaya, Malaysia
| | - Kamaraj Selvaraj
- Cardiology Department, Hospital Serdang, 43000 Kajang, Selangor, Malaysia
| | - Abdul Rashid
- Department of Public Health Medicine, Penang Medical College, 10450 George Town, Pulau Pinang, Malaysia
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Ferdinand KC, Yadav K, Nasser SA, Clayton-Jeter HD, Lewin J, Cryer DR, Senatore FF. Disparities in hypertension and cardiovascular disease in blacks: The critical role of medication adherence. J Clin Hypertens (Greenwich) 2017; 19:1015-1024. [PMID: 28856834 DOI: 10.1111/jch.13089] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/21/2017] [Accepted: 05/22/2017] [Indexed: 12/21/2022]
Abstract
Blacks are two to three times as likely as whites to die of preventable heart disease and stroke. Declines in mortality from heart disease have not eliminated racial disparities. Control and effective treatment of hypertension, a leading cause of cardiovascular disease, among blacks is less than in whites and remains a challenge. One of the driving forces behind this racial/ethnic disparity is medication nonadherence whose cause is embedded in social determinants. Eight practical approaches to addressing medication adherence with the potential to attenuate disparities were identified and include: (1) patient engagement strategies, (2) consumer-directed health care, (3) patient portals, (4) smart apps and text messages, (5) digital pillboxes, (6) pharmacist-led engagement, (7) cardiac rehabilitation, and (8) cognitive-based behavior. However, while data suggest that these strategies may improve medication adherence, the effect on ameliorating racial/ethnic disparities is not certain. This review describes the relationship between disparities and medication adherence, which likely plays a role in persistent disparities in cardiovascular morbidity and mortality.
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Affiliation(s)
- Keith C Ferdinand
- Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA
| | - Kapil Yadav
- Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA
| | - Samar A Nasser
- Department of Clinical Research & Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Helene D Clayton-Jeter
- Cardiovascular and Endocrine Liaison Program, Office of the Commissioner/External Affairs/Health & Constituent Affairs, Food and Drug Administration, Silver Springs, MD, USA
| | - John Lewin
- Lewin and Associates LLC, National Coalition on Health Care, Washington, DC, USA
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Ganasegeran K, Rashid A. The prevalence of medication nonadherence in post-myocardial infarction survivors and its perceived barriers and psychological correlates: a cross-sectional study in a cardiac health facility in Malaysia. Patient Prefer Adherence 2017; 11:1975-1985. [PMID: 29263654 PMCID: PMC5726356 DOI: 10.2147/ppa.s151053] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Although evidence-based practice has shown the benefits of prescribed cardioprotective drugs in post-myocardial infarction (MI) survivors, adherence rates remain suboptimal. The aim of this study was to determine the prevalence and factors associated with medication nonadherence among post-MI survivors in Malaysia. MATERIALS AND METHODS This cross-sectional study was conducted from February to September 2016 among 242 post-MI survivors aged 24-96 years at the cardiology outpatient clinic in a Malaysian cardiac specialist center. The study utilized an interviewer-administered questionnaire that consisted of items adapted and modified from the validated Simplified Medication Adherence Questionnaire, sociodemographics, health factors, perceived barriers, and novel psychological attributes, which employed the modified Confusion, Hubbub, and Order Scale and the Verbal Denial in Myocardial Infarction questionnaire. RESULTS The prevalence of medication nonadherence was 74%. In the multivariable model, denial of illness (AOR 1.2, 95% CI 0.9-1.8; P=0.032), preference to traditional medicine (AOR 8.7, 95% CI 1.1-31.7; P=0.044), lack of information about illness (AOR 3.3, 95% CI 1.1-10.6; P=0.045), fear of side effects (AOR 6.4, 95% CI 2.5-16.6; P<0.001), and complex regimen (AOR 5.2, 95% CI 1.9-14.2; P=0.001) were statistically significant variables associated with medication nonadherence. CONCLUSION The relatively higher medication-nonadherence rate in this study was associated with patient-, provider-, and therapy-related factors and the novel psychological attribute denial of illness. Future research should explore these factors using robust methodological techniques to determine temporality among these factors.
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Affiliation(s)
- Kurubaran Ganasegeran
- Department of Public Health Medicine, Penang Medical College, George Town, Malaysia
- Correspondence: Kurubaran Ganasegeran, Department of Public Health Medicine, Penang Medical College, Sepoy Lines, George Town, Penang 10450, Malaysia, Tel +60 19 371 1268, Email
| | - Abdul Rashid
- Department of Public Health Medicine, Penang Medical College, George Town, Malaysia
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Lauffenburger JC, Gagne JJ, Song Z, Brill G, Choudhry NK. Potentially disruptive life events: what are the immediate impacts on chronic disease management? A case-crossover analysis. BMJ Open 2016; 6:e010958. [PMID: 27491664 PMCID: PMC4985837 DOI: 10.1136/bmjopen-2015-010958] [Citation(s) in RCA: 2] [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: 02/03/2023] Open
Abstract
OBJECTIVE To explore the association between unexpected potentially disruptive life events in a patient or family member that may challenge an individual's ability to take medications as prescribed and the discontinuation of evidence-based medications for common, chronic conditions. Understanding the relationship between medication adherence and life stressors, especially those that can be identified using administrative data, may help identify patients at risk of non-adherence. DESIGN Observational self-controlled case-crossover design. SETTING Individuals in a nationally representative US commercial health insurance database. PARTICIPANTS Adult individuals who initiated an oral hypoglycaemic, antihypertensive and/or statin and subsequently stopped the medication for ≥90 days. MAIN OUTCOME MEASURE Potentially disruptive life events among patients and their family members measured in the 30 days just before the medication was discontinued ('hazard period') compared with the 30 days before this period ('control period'). These events included personal injury, hospitalisation, emergency room visits, changes in insurance coverage, acute stress or acute anxiety. RESULTS Among the 326 519 patients meeting study criteria who discontinued their chronic disease medications, 88 896 (27.2%) experienced at least one potentially disruptive life event. Newly experiencing an injury (OR: 1.26, 95% CI 1.12 to 1.42), an emergency room visit (OR: 1.19, 95% CI 1.13 to 1.26) and acute stress (OR: 1.19, 95% CI 1.08 to 1.31) were associated with discontinuation. Life events among patients' family members did not appear to be associated with medication discontinuation or occurred less frequently just prior to discontinuation. CONCLUSIONS Potentially disruptive life events among individuals identified using routinely collected claims data are associated with discontinuation of chronic disease medications. Awareness of these events may help providers or payers identify patients at risk of non-adherence to maximise patient outcomes.
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Affiliation(s)
- Julie C Lauffenburger
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Center for Healthcare Delivery Sciences, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joshua J Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Zirui Song
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gregory Brill
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Niteesh K Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Center for Healthcare Delivery Sciences, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Hamood H, Hamood R, Green MS, Almog R. Determinants of adherence to evidence-based therapy after acute myocardial infarction. Eur J Prev Cardiol 2015. [DOI: 10.1177/2047487315597209] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hatem Hamood
- Department of Cardiology, Bnai-Zion Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Leumit Health Services, Karmiel, Israel
| | - Rola Hamood
- School of Public Health, University of Haifa, Israel
| | | | - Ronit Almog
- School of Public Health, University of Haifa, Israel
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Marzec LN, Carey EP, Lambert-Kerzner AC, Del Giacco EJ, Melnyk SD, Bryson CL, Fahdi IE, Bosworth HB, Fiocchi F, Ho PM. Cognitive dysfunction and poor health literacy are common in veterans presenting with acute coronary syndrome: insights from the MEDICATION study. Patient Prefer Adherence 2015; 9:745-51. [PMID: 26089651 PMCID: PMC4467742 DOI: 10.2147/ppa.s75110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient nonadherence to cardiac medications following acute coronary syndrome (ACS) is associated with increased risk of recurrent events. However, the prevalence of cognitive dysfunction and poor health literacy among ACS patients and their association with medication nonadherence are poorly understood. METHODS We assessed rates of cognitive dysfunction and poor health literacy among participants of a clinical trial that tested the effectiveness of an intervention to improve medication adherence in patients hospitalized with ACS. Of 254 patients, 249 completed the Rapid Estimate of Adult Literacy in Medicine, Revised (REALM-R) survey, an assessment of risk for poor literacy, and the St Louis University Mental Status (SLUMS) exam, a tool assessing for neurocognitive deficits, during ACS hospitalization. We assessed if SLUMS or REALM-R scores were associated with medication adherence. RESULTS Based on SLUMS score, 14% of patients were categorized as having dementia, and 52% with mild neurocognitive disorder (MNCD). Based on REALM-R score of ≤6, 34% of patients were categorized as at risk for poor health literacy. There was no association between poor health literacy and medication nonadherence. Of those with MNCD, 35.5% were nonadherent, compared to 17.5% with normal cognitive function and 6.7% with dementia. In multivariable analysis, cognitive dysfunction was associated with medication nonadherence (P=0.007), mainly due to an association between MNCD and nonadherence (odds ratio =12.2, 95% confidence interval =1.9 to 243; P=0.007). Cognitive status was not associated with adherence in patients randomized to the intervention. CONCLUSION Cognitive dysfunction and risk for poor health literacy are common in patients hospitalized with ACS. We found an association between MNCD and medication nonadherence in the usual care group but not in the intervention group. These findings suggest efforts to screen for MNCD are needed during ACS hospitalization to identify patients at risk for nonadherence and who may benefit from an adherence intervention.
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Affiliation(s)
- Lucas N Marzec
- Division of Cardiology, Denver VA Medical Center, Denver, CO, USA
- Correspondence: Lucas N Marzec, Academic Office 1, Room #7104, 12631 E 17th Avenue, Campus Box B-130, Aurora, CO 80045, USA, Tel +1 303 724 2105, Fax +1 303 724 2094, Email
| | - Evan P Carey
- Division of Cardiology, Denver VA Medical Center, Denver, CO, USA
| | | | - Eric J Del Giacco
- Department of Medicine, Little Rock VA Medical Center, Little Rock, AR, USA
| | | | - Chris L Bryson
- Department of Medicine, Puget Sound VA Medical Center, Seattle, WA, USA
| | - Ibrahim E Fahdi
- Department of Medicine, Little Rock VA Medical Center, Little Rock, AR, USA
| | | | - Fran Fiocchi
- American College of Cardiology, Washington, DC, USA
| | - P Michael Ho
- Division of Cardiology, Denver VA Medical Center, Denver, CO, USA
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