Factors affecting medication adherence in patients with hypertension

Barriers and facilitators of habit building for long-term adherence to antihypertensive therapy among people with hypertensive disorders in Los Angeles, California: a qualitative study

OBJECTIVES

The aim of this study was to a) explore barriers and facilitators associated with medication-taking habit formation, and b) elicit feedback on the components of an intervention designed to help form strong habits for long-term medication adherence.

DESIGN

The study design was qualitative; we conducted semistructured interviews between September 2021 and February 2022.

SETTING

The interviews were conducted online, with 27 participants recruited at the Cedars-Sinai Medical Center in Los Angeles, California.

PARTICIPANTS

A purposive sample of 20 patients who were over 18 years of age, had been diagnosed with hypertensive disorder (or reported high blood pressure; >140/90 mm Hg) and who were prescribed antihypertensive therapy at the time of recruitment, along with seven providers were interviewed.

RESULTS

Contextual factors included frequent changes to prescription for regimen adjustment, and polypharmacy. Forgetfulness, perceived need for medication, and routine disruptions were identified as possible barriers to habit formation. Facilitators of habit formation included identification of stable routines for anchoring, planning, use of external reminders (including visual reminders) and pillboxes for prescription management, and extrinsic motivation for forming habits. Interestingly, experiencing medication side effects was identified as a possible barrier and a possible facilitator of habit formation. Feedback on study components included increasing text size, and visual appeal of the habit leaflet; and imparting variation in text message content and adjusting their frequency to once a day. Patients generally favoured the use of conditional financial incentives to support habit formation.

CONCLUSION

The study sheds light on some key considerations concerning the contextual factors for habit formation among people with hypertension. As such, future studies may evaluate the generalisability of our findings, consider the role of visual reminders in habit formation and sustenance, and explore possible disruptions to habits.

TRIAL REGISTRATION NUMBER

NCT04029883.

Self-reported medication adherence instruments and their applicability in low-middle income countries: a scoping review

Introduction

Medication non-adherence is an important public health issue, associated with poor clinical and economic outcomes. Globally, self-reported instruments are the most widely used method to assess medication adherence. However, the majority of these were developed in high-income countries (HICs) with a well-established health care system. Their applicability in low- and middle-income countries (LMICs) remains unclear. The objective of this study is to systematically review the applicability of content and use of self-reported adherence instruments in LMICs.

Method

A scoping review informed by a literature search in Pubmed, EBSCO, and Cochrane databases was conducted to identify studies assessing medication adherence using self-reported instruments for patients with five common chronic diseases [hypertension, diabetes, dyslipidemia, asthma, or Chronic Obstructive Pulmonary Disease (COPD)] in LMICs up to January 2022 with no constraints on publication year. Two reviewers performed the study selection process, data extraction and outcomes assessment independently. Outcomes focused on LMIC applicability of the self-reported adherence instruments assessed by (i) containing LMIC relevant adherence content; (ii) methodological quality and (iii) fees for use.

Findings

We identified 181 studies that used self-reported instruments for assessing medication adherence in LMICs. A total of 32 distinct types of self-reported instruments to assess medication adherence were identified. Of these, 14 self-reported instruments were developed in LMICs, while the remaining ones were adapted from self-reported instruments originally developed in HICs. All self-reported adherence instruments in studies included presented diverse potential challenges regarding their applicability in LMICs, included an underrepresentation of LMIC relevant non-adherence reasons, such as financial issues, use of traditional medicines, religious beliefs, lack of communication with healthcare provider, running out of medicine, and access to care. Almost half of included studies showed that the existing self-reported adherence instruments lack sufficient evidence regarding cross cultural validation and internal consistency. In 70% of the studies, fees applied for using the self-reported instruments in LMICs.

Conclusion

There seems insufficient emphasis on applicability and methodological rigor of self-reported medication adherence instruments used in LMICs. This presents an opportunity for developing a self-reported adherence instrument that is suitable to health systems and resources in LMICs.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier: CRD42022302215.

Individual-related factors associated with treatment adherence among hypertensive patients

Background

Currently, some of the most prevalent illnesses are attributable to external sources, such as chronic disorders that threaten people's health. The goal of the study was to investigate the differences in individual characteristics associated with treatment adherence among hypertension patients.

Materials and Methods

In this descriptive cross-sectional study, 176 hypertensive patients who reviewed primary healthcare facilities in Babylon Province were included. Experts were used to ensure the study questionnaire's validity, and a pilot study was used to ensure its reliability. Using a standardized questionnaire and interviewing methods, data were collected and analyzed.

Results

According to the study's findings, participants' average ages were 59 (10.86), 67% of them were over 60, 55.1% and 65.3% of them were men and married respectively, nearly half of them had moderate monthly income, the unemployed percentage was 61.9%, and 36.4% had completed their secondary education. Two-thirds, or 70.5%, of hypertension patients, reported poor treatment adherence. Ages 30-59, male patients, married, highincome, and college-educated patients showed significantly better treatment compliance (P<0.05).

Conclusions

Every individual characteristic of patients with high blood pressure is regarded as a predictor of therapy adherence. The current study is one of the few in Iraq to evaluate treatment adherence and look into the various elements that may influence it using the survey approach. Future research on the subject of antihypertensive treatment adherence in the hypertensive population in Iraq employing a representative sample, a qualitative methodology, and more factor exploration may offer additional insights.

Knowledge on hypertension in Myanmar: levels and groups at risk

Background: Non-communicable diseases, specifically the burden of hypertension, have become a major public health threat to low- and middle-income countries, such as Myanmar. Inadequate knowledge of hypertension and its management among people may hinder its effective prevention and treatment with some groups at particular increased risks, but evidence on this is lacking for Myanmar. The aims of this study were therefore to assess the level of knowledge of risk factors, symptoms and complications of hypertension, by hypertension treatment status, community group-membership, and sociodemographic and socioeconomic factors in Myanmar. Methods: Data was collected through structured questionnaires in 2020 on a random sample of 660 participants, stratified by region and existence of community groups. Knowledge of hypertension was measured with the 'Knowledge' part of a validated 'Knowledge, Attitude and Practice' survey questionnaire and categorised into ill-informed and reasonably to well-informed about hypertension. Results: The majority of respondents seem reasonably to well-informed about risk factors, symptoms and complications of hypertension. This did not vary by hypertension treatment status and community group membership. People with jobs (B=0.96; 95%-confidence interval 0.343 to 1.572) and higher education (B=1.96; 0.060 to 3.868) had more hypertension knowledge than people without jobs or low education. Adherence to treatment among hypertensive people was low. Conclusion: This study shows a majority of participants in this study in Myanmar seem reasonably to well-informed, with no differences by hypertension status, treatment status, and community group-membership. People without jobs and low education have less hypertension knowledge, making them priority groups for tailored education on health care level as well as community level, lowering the burden of hypertension. Almost half of the hypertensive patients did not take their medicines and therefore, adherence to treatment of hypertension should be an important element for future health education.

Psychosocial and behavioral correlates of self-efficacy in treatment adherence in older patients with comorbid hypertension and type 2 diabetes

Background

Adhering to clinical prescriptions is known to protect against the effects of uncontrolled hypertension and of acute and chronic cardiovascular diseases, including diabetes. Contextually, positive associations between self-care behaviors and psychological constructs, such as self-efficacy, are widely acknowledged in the literature. However, still little is known about the psychological factors underlying the patient’s self-efficacy. This study aimed to investigate the psychosocial and behavioral correlates of self-efficacy related to treatment adherence in older patients with comorbid hypertension and type 2 diabetes mellitus.

Participants and procedure

Italian and Polish patients (≥ 65 years; N = 180) consecutively responded to self-report questionnaires measuring psycho-social (i.e., beliefs about medicines, perceived physician’s communication effectiveness, medication-specific social sup-port, self-efficacy) and behavioral factors (i.e., pharmacological adherence, medications refill adherence, intentional non-adherence) related to treatment adherence. Between-group comparisons and regression analyses were performed.

Results

Fisher’s least significant difference (LSD) test showed significant differences between the Italian and Polish groups in all questionnaires (p < .01) with the Italian patients reporting more satisfactory scores. Younger age (β = .08, p = .045), female gender (β = 1.03, p = .042), higher medication refills adherence (β = –.07, p = .024), lower intentional non-adherence (β = –.03, p = .009), positive beliefs about medications (β = .13, p < .001), better quality of communication with the physician (β = .09, p < .001), and stronger perceived medication-specific social support (β = .06, p = .001) were significantly associat-ed with self-efficacy related to treatment adherence.

Conclusions

Future research and interventions should leverage psychosocial and behavioral factors to address self-efficacy contributing to enhancing adherence to clinical prescriptions.

Management of epilepsy in Lebanon: medication reviews and drug-related problems

PURPOSE

The goal of epilepsy treatment is to control seizures without drug related problems (DRPs). The evaluation of anti-seizure drugs (ASD) strategies and identification of DRPs are rarely studied. This study aimed primarily to evaluate the choice of ASD according to international guidelines and secondarily to identify and describe anti-seizure drug-related problems.

METHODS

A cross-sectional study was conducted during one year among Lebanese adults with epilepsy attending neurology clinics. The choice of ASD was compared to National Institute for Health and Care Excellence guidelines. Drug-drug interactions were evaluated by the Lexicomp database, and the DRP classification was performed using the Pharmaceutical Care Network Europe classification.

RESULTS

Four hundred and four patients with epilepsy were included. The prescription for an ASD was in accordance with the indication set in guidelines in 75.0% of population, and 1078 DRPs were identified. The main DRPs detected were adverse drug reactions (51.0%), inappropriate combinations of drugs (50.0%), and suboptimal drug regimens (46.3%). Single and divorced patients, who living in Mount Lebanon, and who took the old with the new generation had a less risk to have an inadequate prescription to guidelines. However, female gender, controlled epilepsy, multiple ASDs, and living in a rural region increased DRPs.

CONCLUSIONS

This study showed that quarter of the population used ASDs contraindicated according to international guidelines. Since DRPs were related to the number and type of ASD prescribed, it is important to assess the case of each patient by a clinical pharmacist to prevent drug-drug interactions and iatrogenic issues.

Interventions Incorporating Therapeutic Alliance to Improve Medication Adherence in Black Patients with Diabetes, Hypertension and Kidney Disease: A Systematic Review

BACKGROUND

Black Americans have a disproportionately increased risk of diabetes, hypertension, and kidney disease, and higher associated morbidity, mortality, and hospitalization rates than their White peers. Structural racism amplifies these disparities, and negatively impacts self-care including medication adherence, critical to chronic disease management. Systematic evidence of successful interventions to improve medication adherence in Black patients with diabetes, hypertension, and kidney disease is lacking. Knowledge of the impact of therapeutic alliance, ie, the unique relationship between patients and providers, which optimizes outcomes especially for minority populations, is unclear. The role and application of behavioral theories in successful development of medication adherence interventions specific to this context also remains unclear.

OBJECTIVE

To evaluate the existing evidence on the salience of a therapeutic alliance in effective interventions to improve medication adherence in Black patients with diabetes, hypertension, or kidney disease.

DATA SOURCES

Medline (via PubMed), EMBASE (OvidSP), Cumulative Index of Nursing and Allied Health Literature (CINAHL) (EBSCOhost), and PsycINFO (ProQuest) databases.

REVIEW METHODS

Only randomized clinical trials and pre/post intervention studies published in English between 2009 and 2022 with a proportion of Black patients greater than 25% were included. Narrative synthesis was done.

RESULTS

Eleven intervention studies met the study criteria and eight of those studies had all-Black samples. Medication adherence outcome measures were heterogenous. Five out of six studies which effectively improved medication adherence, incorporated therapeutic alliance. Seven studies informed by behavioral theories led to significant improvement in medication adherence.

DISCUSSION/CONCLUSION

Study findings suggest that therapeutic alliance-based interventions are effective in improving medication adherence in Black patients with diabetes and hypertension. Further research to test the efficacy of therapeutic alliance-based interventions to improve medication adherence in Black patients should ideally incorporate cultural adaptation, theoretical framework, face-to-face delivery mode, and convenient locations.

Clinicians' prescribing pattern, rate of patients' medication adherence and its determinants among adult hypertensive patients at Jimma University Medical Center: Prospective cohort study

BACKGROUND

Many studies conducted in the past focused on patients' sociodemographic factors and medical profiles to identify the determinants of suboptimal blood pressure control. However, prescribing patterns and clinicians' adherence to guidelines are also important factors affecting the rate of blood pressure control. Therefore, this study aimed to determine clinicians' prescribing patterns, patients' medication adherence, and its determinants among hypertensive patients at Jimma University Medical Center.

METHODS

A general prospective cohort study was conducted among hypertensive patients who had regular follow-up at Jimma university ambulatory cardiac clinic from March 20, 2018, to June 20, 2018. Patients' specific data was collected with a face-to-face interview and from their medical charts. Clinicians' related data were collected through a self-administered questionnaire. Data were analyzed using SPSS version 21.0. Bivariate and multivariable logistic regression analyses were done to identify key independent variables influencing patients' adherence. P-Values of less than 0.05 were considered statically significant.

RESULTS

From the total of 416 patients, 237(57.0%) of them were males with a mean age of 56.50 ± 11.96 years. Angiotensin-converting enzyme inhibitors were the most frequently prescribed class of antihypertensives, accounting for 261(63.7%) prescriptions. Combination therapy was used by the majority of patients, with 275 (66.1%) patients receiving two or more antihypertensive drugs. Patients' medication adherence was 46.6%, while clinicians' guideline adherence was 44.2%. Patients with merchant occupation (P = 0.020), physical inactivity (P = 0.033), and diabetes mellitus co-morbidity (P = 0.008) were significantly associated with a higher rate of medication non-adherence.

CONCLUSION

The rate of medication adherence was poor among hypertensive patients. Physicians were not-adherent to standard treatment guideline. The most commonly prescribed class of drugs were angiotensin-converting enzyme inhibitors. Effective education should be given to patients to improve medication adherence. Prescribers should be trained on treatment guidelines regularly to keep them up-to-date with current trends of hypertension treatment and for better treatment outcomes.

Psychometric Properties of the Arabic Version of Medication Adherence Self-Efficacy Scale-Revised in Hypertension

BACKGROUND AND PURPOSE

Cultural adaptation of Medication Adherence Self-Efficacy Scale-Revised is lacking in the Arabs population. This study tested the psychometric properties of the Arabic version of the Medication Adherence Self-Efficacy Scale-Revised.

METHODS

The study included 199 Omani hypertensive patients. The scale was translated into Arabic. Reliability and construct and convergent validity were examined.

RESULTS

Scale's reliability was α = .93. One factor was identified and explained about 57.5% of the variance. A new modified model with covariance suggested a better model fit. A significant relationship between the scale and Morisky medication adherence scale was found (r = .53, p < .001).

CONCLUSIONS

The Arabic version scale is reliable, valid, and could be applied in the clinical settings to improve medication adherence.

Assessing forgetfulness and polypharmacy and their impact on health-related quality of life among patients with hypertension and dyslipidemia in Greece during the COVID-19 pandemic

Purpose

We estimate the association between forgetfulness to take medications as prescribed and polypharmacy and health-related quality of life (HRQoL) among a cohort of patients with hypertension, dyslipidemia or both in Greece during the COVID-19 pandemic.

Methods

A telephone survey of 1018 randomly selected adults was conducted in Greece in June 2020. Participants were included in the survey, if they (a) had a diagnosis of hypertension, dyslipidemia or both and (b) were on prescription treatment for these conditions. HRQoL was calculated using the short form (SF) -12 Patient Questionnaire. A multivariable generalized linear regression model (GLM) was used to estimate the association between forgetfulness and polypharmacy and HRQoL, controlling for sociodemographic and health-related covariates.

Results

Overall, 351 respondents met the inclusion criteria, of whom 28 did not fully complete the questionnaire (response rate: 92%, n = 323). Of those, 37% were diagnosed with hypertension only, 28% with dyslipidemia only, and 35% with both. Most reported good to average physical (64.1%) and mental health (48.6%). Overall, 25% indicated that they sometimes forget to take their prescribed medications, and 12% took two or more pills multiple times daily. Total HRQoL score was 68.9% (s.d. = 18.0%). About 10% of participants reported paying less attention to their healthcare condition during the pandemic. Estimates of multivariable analyses indicated a negative association between forgetfulness (− 9%, adjusted β: − 0.047, 95% confidence interval − 0.089 to − 0.005, p = 0.029), taking two or more pills multiple times daily compared to one pill once a day (− 16%, adjusted β: − 0.068, 95% confidence interval − 0.129 to − 0.008, p = 0.028) and total HRQoL.

Conclusion

Our results suggest that among adult patients with hypertension, dyslipidemia or both in Greece, those who forget to take their medications and those with more complex treatment regimens had lower HRQoL. Such patients merit special attention and require targeted approaches by healthcare providers to improve treatment compliance and health outcomes.

Improving Medication Adherence Through Adaptive Digital Interventions (iMedA) in Patients With Hypertension: Protocol for an Interrupted Time Series Study

BACKGROUND

There is a strong need to improve medication adherence (MA) for individuals with hypertension in order to reduce long-term hospitalization costs. We believe this can be achieved through an artificial intelligence agent that helps the patient in understanding key individual adherence risk factors and designing an appropriate intervention plan. The incidence of hypertension in Sweden is estimated at approximately 27%. Although blood pressure control has increased in Sweden, barely half of the treated patients achieved adequate blood pressure levels. It is a major risk factor for coronary heart disease and stroke as well as heart failure. MA is a key factor for good clinical outcomes in persons with hypertension.

OBJECTIVE

The overall aim of this study is to design, develop, test, and evaluate an adaptive digital intervention called iMedA, delivered via a mobile app to improve MA, self-care management, and blood pressure control for persons with hypertension.

METHODS

The study design is an interrupted time series. We will collect data on a daily basis, 14 days before, during 6 months of delivering digital interventions through the mobile app, and 14 days after. The effect will be analyzed using segmented regression analysis. The participants will be recruited in Region Halland, Sweden. The design of the digital interventions follows the just-in-time adaptive intervention framework. The primary (distal) outcome is MA, and the secondary outcome is blood pressure. The design of the digital intervention is developed based on a needs assessment process including a systematic review, focus group interviews, and a pilot study, before conducting the longitudinal interrupted time series study.

RESULTS

The focus groups of persons with hypertension have been conducted to perform the needs assessment in a Swedish context. The design and development of digital interventions are in progress, and the interventions are planned to be ready in November 2020. Then, the 2-week pilot study for usability evaluation will start, and the interrupted time series study, which we plan to start in February 2021, will follow it.

CONCLUSIONS

We hypothesize that iMedA will improve medication adherence and self-care management. This study could illustrate how self-care management tools can be an additional (digital) treatment support to a clinical one without increasing burden on health care staff.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04413500; https://clinicaltrials.gov/ct2/show/NCT04413500.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/24494.

Barriers to Access to Treatment for Hypertensive Patients in Primary Health Care of Less Developed Northwest China: A Predictive Nomogram

Background

This study aims to evaluate the risk factors associated with untreated hypertension and develop and internally validate untreated risk nomograms in patients with hypertension among primary health care of less developed Northwest China.

Methods

A total of 895 eligible patients with hypertension in primary health care of less developed Northwest China were divided into a training set (n = 626) and a validation set (n = 269). Untreated hypertension was defined as not taking antihypertensive medication during the past two weeks. Using least absolute shrinkage and selection operator (LASSO) regression model, we identified the optimized risk factors of nontreatment, followed by establishment of a prediction nomogram. The discriminative ability, calibration, and clinical usefulness were determined using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision analysis. The results were assessed by internal validation in the validation set.

Results

Five independent risk factors were derived from LASSO regression model and entered into the nomogram: age, herdsman, family income per member, altitude of habitation, and comorbidity. The nomogram displayed a robust discrimination with an AUC of 0.859 (95% confidence interval: 0.812–0.906) and good calibration. The nomogram was clinically useful when the intervention was decided at the untreated possibility threshold of 7% to 91% in the decision curve analysis. Results were confirmed by internal validation.

Conclusions

Our nomogram showed favorable predictive accuracy for untreated hypertension in primary health care of less developed Northwest China and might help primary health care assess the risk of nontreatment in patients with hypertension.

Adherence to antihypertensive therapy and its determinants among patients attending primary care hospitals of Kashmir, India

Background:

Adherence to antihypertensive therapy is an important factor in determining the clinical course of hypertension. This study was planned to estimate adherence to antihypertensive therapy and its determinants among OPD patients attending two primary care hospitals in Kashmir valley.

Methods:

This study employed a cross-sectional study design. All subjects who reported to OPD between October and December 2020 and had been prescribed antihypertensive medications for at least 1 year were included. Sociodemographic information was collected on a pretested schedule and adherence to medications was assessed by using the-14 item Hill-Bone HBP Compliance to High Blood Pressure Therapy Scale (HB-HBP). Mann–Whitney test and Spearman’s rank correlation coefficient were used.

Results:

A total of 406 subjects were included in the final analysis with a mean age of 58 years for women and 56 years for men. The sample comprised 54% women. More than 60% of subjects were currently married, urban area residents, and belonged to middle strata of social class. The mean score obtained in the HB-MAS (maximum score 56) was 19.26 (SD ± 4.3). Subjects aged 60 years and above, those belonging to lower socioeconomic class, and subjects prescribed three or more drugs with more than once-daily dosing regimen had higher odds of having poor adherence.

Conclusion:

There is suboptimal adherence among OPD patients at primary care level. There is a need for enhanced counselling regarding medication adherence particularly for elderly, poor, illiterate persons and those prescribed multiple medicines with more than once-daily dosing.

Diabetes Mellitus Versus Hypertension-Does Disease Affect Pharmacological Adherence?

The aim of the study was to answer the questions whether a chronic disease can have a significant impact on the level of adherence and whether there are differences in adherence-related predictors depending on the chronic disease. The study included 1,571 patients (mean age 64.7 ± 11.3) with chronic diseases [1,030 diabetes mellitus (DM) type 2 and 541 hypertension (HA)]. Adherence was assessed using the Adherence Refills Medication Scale (ARMS). The average adherence score for the whole group was 18.9. Fifty-five percent of patients had a low level of adherence. A comparison between DM and HA shows a statistically significant difference and a higher level of adherence with pharmacological recommendations in the group of patients with type 2 DM (17.5 ± 12.0 vs 19.2 ± 8.0). In the single factors analysis, HA diagnosis had a statistically significant negative effect on adherence (β=0.92, p ≤ 0.001). In simple linear regression analysis, independent of chronic disease, a higher level of adherence was observed among women (β=-0.40, p=0.015), people with secondary education (β=-1.26, p ≤ 0.001), and inactive patients (β=-0.48; p=0.005). However, place of residence - countryside (β =0.35, p=0.044) and higher education (β=0.90, p ≤ 0.001) had a negative influence on the level of adherence. In multiple linear regression analysis HA (B=0.99; p ≤ 0.001), female gender (B=-0.47; p=0.003) and secondary education (B=-1.16; p ≤ 0.001) were important independent determinants of adherence. (1) Hypertension is an independent, statistically significant predictor that reduces the adherence level. (2) Female gender and higher education are the most important determinants improving adherence to pharmacological therapy. (3) There is a different pattern of predictors of adherence among patients: occupational activity plays an important role in DM, while education plays a role in HA.

Patient adherence to antihypertensive medications in upper Egypt: a cross-sectional study

Background

Control of hypertension is a very difficult issue. Non-adherence to medications is a well-recognized factor contributing to uncontrolled hypertension. It is required to detect factors that affect adherence of patients to antihypertensive medications at different societies and good planning with the collaboration of governments, universities, media, pharmaceutical companies, and civil society to create intervention programs ensuring good adherence to medications. In our study, we aimed to determine different factors affecting adherence to antihypertensive medications in Upper Egypt societies.

Results

From September 2015 to September 2019, we conducted a large cross-sectional multi-center study among 2420 hypertensive patients attending the out-patient cardiac clinics at three different university hospitals. Data was collected through a personal interview with the patients using a questionnaire to cover a variety of items.

In the total of 2420 patients, we found that 1116 (46.12%) patients were adherent to medications and 1304 (53.88%) were non-adherent. From the final regression analysis of the results, we found that age > 65 years, illiterate patients, low income, associated comorbidities, using three or more antihypertensive pills, and living in rural areas were statistically significant socio-demographic factors associated with non-adherence to treatment. Also, missing doses of medication and lack of complying with dietary regimen were statistically significant behavioral causes associated with non-adherence.

Conclusion

Many factors are predictors of good adherence to antihypertensive drugs, including young age, urban residence, a smaller number of pills, absence of comorbid conditions, high income, and high education level. Also missed doses of drugs and absence of complies with dietary regimen were the significant causes of non-adherence. Health institutions and governmental efforts should be directed toward improving adherence by creating effective intervention programs targeting these factors. Therefore, it might be concluded that patients who are more health ware are more adherent to medications than non-health aware patients.

Adherence to antihypertensive fixed-dose combination among Egyptian patients presenting with essential hypertension

Background

Many patients with hypertension require more than one drug to achieve blood pressure control. They are prescribed with fixed-dose combination (FDC) antihypertensive therapy rather than monotherapies. Although it is commonly admitted that the use of FDC may improve compliance to treatment, adherence rates in patients receiving FDCs have not been documented. Therefore, the aim of this study was to assess the adherence to treatment in patients receiving FDCs of antihypertensive medications in a real-world setting in Egypt.

Results

We conducted a multi-center cross-sectional study over a period of 1 year from Jan 2017 to Jan 2018. We included patients above 21 years old with essential hypertension who were already prescribed with an FDC of antihypertensive treatment for at least 3-month duration. We assessed the adherence to treatment by patient self-assessment using the Morisky 8-Item Medication Adherence Scale (MMAS 8).

This study enrolled 2000 hypertensive Egyptian patients. The mean age of enrolled patients was 55.8 ± 10.9 years. Male to female ratio was 1.08. The mean MMAS score was 6.5 ± 1.9. Our analysis showed that 825 (41.3%) patients reached high adherence score, 523 (26.2%) medium adherence, and 652 (32.6%) low adherence.

Furthermore, Male patients showed higher adherence rate than females (56.4% versus 43.6%, p < 0.001). Out of 746 patients with controlled blood pressure (< 140/90), 387 (51.9%) patients were highly adherent to treatment. Higher level of education was significantly associated with high adherence rate; 559 (67.8%) patients were university graduates, 232 (28.1%) had primary/secondary school education, and 34 (4.1%) were illiterate (p < 0.001).

Moreover, once daily (99.2%) fixed-dose combination was associated with higher adherence rate than twice regimen daily (0.8%), p = 0.03. Multivariate logistic regression analysis showed that patients with high level of education, employed patients, and patients with controlled blood pressure have high adherence rate to medication.

Conclusions

Higher adherence to medication is associated with high level of education and employment, and it can lead to better blood pressure control. Thus, patient education programs may increase patients’ adherence to their medication.

Adherence of Geriatric Patients and Their Beliefs toward Their Medicines in the United Arab Emirates

INTRODUCTION

Drug adherence is a major factor in determining health outcomes of geriatric patients and is a growing concern for health-care systems as the geriatric population shows a steep rise due to improved health-care services in the UAE.

AIM

We aimed to evaluate the adherence and beliefs of geriatric patients in the UAE toward their medicines and to explore the factors affecting them.

METHODS

A cross-sectional study was performed including 163 geriatric patients. Surveys, direct observations, and interviews were used for primary data collection. Demographic data were computed using descriptive statistics method. The Statistical Package for the Social Sciences (SPSS) program, Version 19.0, SPSS Inc., Chicago, IL, USA, was used to analyze and code the raw data, whereas chi-squared test was used to analyze the responses. Secondary data were also collected.

RESULTS

The results indicated that patient factors and medication factors are the main risk factors for medication nonadherence among geriatric patients in the UAE. The study found that drug regimen (91.4%, N = 149), forgetfulness (87.1%, N = 142), time constraints (67.5%, N = 110), and cost (55.2%, N = 90) were the main key factors affecting medication adherence. Also, poor communication (12.9%), the lack of trust (16.6%), confidence (20.2%), and patient involvement (43.6%) were shown to influence adherence behaviors to medication. The main habits, attitudes, and beliefs that were found to affect patient's adherence were follow-ups (73%), inadequate knowledge of medicine (60.1%), the lack of perceived benefits (18.4%), and limited knowledge on health conditions (19.6%). The study showed 161 patients among the total 163 participants forget taking their medications and others cease from taking their medications. To conclude, nonadherence to medications is a substantial problem among the elderly in the UAE.

CONCLUSION

The study findings confirm the need for further research to examine the perspectives of at-risk population with a focus on knowledge, beliefs, and attitudes on medication nonadherence.

Gender Difference in General Self-Efficacy among Young-Old Elderly Aged 60-74 in Rural Shandong China: A Cross-Sectional Survey

OBJECTIVE

This study aims to explore the determinants of general self-efficacy (GSE) among young-old elderly, with focus on examining the gender difference of general self-efficacy.

METHODS

Data were collected from the 2017 Survey of the Shandong Elderly Family Health Service, which was conducted by Shandong University. T-test was used to examine the gender difference in GSE. Univariate models and adjusted multiple linear regression model were used to explore the determinants of GSE by gender.

RESULTS

The females' GSE score was lower than that of male participants (26.1 ± 8.1 vs. 28.7 ± 7.7), and there was a significant gender difference (t = 10.877, p < 0.001). Multiple linear regression model showed that some factors are common significant determinants of GSE such as age, education level, activity of daily living (ADL), self-rated health, mental health, personality, and whether participants have intimate friends and interpersonal relationships. Hypertension and frequent communication with children were specific determinants of GSE among male young-old. Personal income was a specific determinant of female participants.

CONCLUSION

Some influencing factors of GSE in both genders are identical, the others are different. More attention should be paid for the poor young-old females, young-old males with hypertension, and disabled young-old people.

Determinants of Primary Nonadherence to Medications Prescribed by General Practitioners Among Adults in Hungary: Cross-Sectional Evaluation of Health Insurance Data

Background: Primary nonadherence to prescribed medications occurs when patients do not fill or dispense prescriptions written by healthcare providers. Although it has become an important public health issue in recent years, little is known about its frequency, causes, and consequences. Moreover, the pattern of risk factors shows remarkable variability across countries according to the published results. Our study aimed to assess primary nonadherence to medications prescribed by general practitioners (GPs) and its associated factors among adults in Hungary for the period of 2012–2015.

Methods: Data on all general medical practices (GMPs) of the country were obtained from the National Health Insurance Fund and the Central Statistical Office. The ratio of the number of dispensed medications to the number of prescriptions written by a GP for adults was used to determine the medication adherence, which was aggregated for GMPs. The effect of GMP characteristics (list size, GP vacancy, patients’ education provided by a GMP, settlement type [urban or rural], and geographical location [by county] of the center) on adherence, standardized for patients’ age, sex, and eligibility for an exemption certificate, were investigated through generalized linear regression modeling.

Results: A total of 281,315,386 prescriptions were dispensed out of 438,614,000 written by a GP. Overall, 64.1% of prescriptions were filled. According to the generalized linear regression coefficients, there was a negative association between standardized adherence and urban settlement type (b = -0.099, 95%CI = -0.103 to -0.094), higher level of education (b = -0.440, 95%CI = -0.468 to -0.413), and vacancy of the general practices (b = -0.193, 95%CI = -0.204 to -0.182). The larger GMP size proved to be a risk factor, and there was a significant geographical inequality for counties as well.

Conclusions: More than one-third of the written prescriptions of GPs for adults in Hungary were not dispensed. This high level of nonadherence had great variability across GMPs, and can be explained by structural characteristics of GMPs, the socioeconomic status of patients provided, and the quality of cooperation between patients and GPs. Moreover, our findings suggest that the use of the dispensed-to-prescribed medication ratio in routine monitoring of primary health care could effectively support the necessary interventions.

Medication Adherence In Patients With Arterial Hypertension: The Relationship With Healthcare Systems' Organizational Factors

PURPOSE

Arterial hypertension is one of the most common diseases in the world, presenting a great impact on global mortality. Despite having good medication, the best control depends on patient's adherence. Our aim is to characterize the relationship of adherence to medication in hypertensive patients with consultation length and other organizational factors of healthcare systems.

PATIENTS AND METHODS

We performed a comprehensive review of literature using the MeSH terms "hypertension" and "medication adherence". 61 articles were selected for inclusion and adherence parameters were extracted, allowing us to estimate the mean adherence for each country. The adherence was then correlated with organizational aspects of healthcare systems: consultation length, number of health providers (doctors, nurses and pharmacists), number of hospital beds, health expenditure and general government expenditure.

RESULTS

Adherence to medication ranged between 11.8% in Indonesia and 85.0% in Australia. There is much heterogeneity in methodology, but the Morisky Medication Adherence Scale was the preferred method, used in 63.6% of the cases. We found no relation with consultation length, but a significant one with the greater number of health professionals available. Some differences were observed when considering European countries or Morisky Medication Adherence Scale alone.

CONCLUSION

The better the drugs, the better the control of blood pressure, if patients take them. Rather than investing in the prescription of more drugs, it is important to address non-adherence and reduce it to promote better blood pressure control. Organizational factors are relevant constraints and depend on administrative and political decisions. Although they are not always considered, they greatly impact the adherence to medication.

Treatment adherence and blood pressure outcome among hypertensive out-patients in two tertiary hospitals in Sokoto, Northwestern Nigeria

BACKGROUND

Treatment adherence play important roles in blood pressure control leading to reduction in morbidity and mortality. This study therefore assessed adherence to pharmacological and non-pharmacological therapies among ambulatory hypertensive patients. Reasons for treatment non-adherence, and association between adherence and blood pressure were also investigated.

METHODS

Cross-sectional questionnaire-guided interview and retrospective review of medical records of 605-patients from two-tertiary healthcare institutions in Sokoto, Northwestern Nigeria. Nine-item modified Morisky adherence scale was used to assess medication adherence. Overall adherence score to lifestyle modifications was obtained from the total scores from 4-domains of non-pharmacological measures including cigarette smoking and alcohol cessation, salt-restriction and exercise. Patient-specific adherence education was provided at contact to resolve the knowledge gap(s). Clinical-parameters were retrieved at contact and subsequent 2-months appointment. Descriptive statistics, Chi-square and Student's t-test were used for analysis at p < 0.05.

RESULTS

Fifty-four (8.9%) patients were adherent to medications. Forgetfulness (404; 35.2%) was the most common reason for medication non-adherence. Use of buddy/companion reminder (605, 30.2%) top the list of adherence education. Overall adherence to lifestyle modifications was 36(6.0%). Mean systolic blood pressure (SBP) at contact was 149.6 ± 22.5 versus 134.2 ± 15.8 mmHg at 2-months with a 10% reduction. There were significant associations in baseline SBP for patients with or without adherence to medication, cigarette smoking cessation, and exercise (p < 0.05).

CONCLUSIONS

Overall adherence to antihypertensive medications and lifestyle modifications is suboptimal, underscoring the need for continuous patient-specific adherence education to ensure better therapeutic outcomes.

Qualitative exploration of the modifiable factors for medication adherence among subsidised and self-paying patients in Malaysia

BACKGROUND

Numerous studies have evaluated the related factors of medication adherence among patients with chronic disease. However, the factors influencing medication adherence and non-adherence among subsidised patients with chronic diseases-for whom medication costs may not be a constraint-remain unexplored. Thus, this study aims to identify and compare the potential factors that may influence subsidised and non-subsidised (i.e., self-paying) patients' adherence to medication.

METHODS

Subsidised and self-paying patients were identified at public and private healthcare institutions in three states of Malaysia. Patients were then purposively selected for semi-structured, face-to-face interviews according to their medication adherence status (including adherent and non-adherent patients), which was measured using the Medication Event Monitoring System (MEMS). Adherence was defined as having 80% or more for the percentage of days in which the dose regimen was executed as prescribed. The interview was conducted from January to August 2016 and during the interviews, patients were asked to provide reasons for their medication adherence or non-adherence. The patient interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis with NVivo 11 software.

RESULTS

Thirteen subsidised and 12 self-paying patients were interviewed. The themes found among subsidised and self-paying patients were similar. The factors that influenced adherence to medication include the 'perceived importance of quality of life' and 'perceived benefit or value of the medications'. A unique factor reported by patients in this study included 'perceived value of the money spent on medications'; more specifically, patients adhered to their medications because they valued the money spent to buy/receive the medications.

CONCLUSION

Medication adherence among subsidised and self-paying patients was influenced by many factors, including a unique factor relating to their perceptions of the value of money spent on medications.

Factors affecting medication adherence in community-managed patients with hypertension based on the principal component analysis: evidence from Xinjiang, China

PURPOSE

The analysis of factors affecting the nonadherence to antihypertensive medications is important in the control of blood pressure among patients with hypertension. The purpose of this study was to assess the relationship between factors and medication adherence in Xinjiang community-managed patients with hypertension based on the principal component analysis.

PATIENTS AND METHODS

A total of 1,916 community-managed patients with hypertension, selected randomly through a multi-stage sampling, participated in the survey. Self-designed questionnaires were used to classify the participants as either adherent or nonadherent to their medication regimen. A principal component analysis was used in order to eliminate the correlation between factors. Factors related to nonadherence were analyzed by using a χ2-test and a binary logistic regression model.

RESULTS

This study extracted nine common factors, with a cumulative variance contribution rate of 63.6%. Further analysis revealed that the following variables were significantly related to nonadherence: severity of disease, community management, diabetes, and taking traditional medications.

CONCLUSION

Community management plays an important role in improving the patients' medication-taking behavior. Regular medication regimen instruction and better community management services through community-level have the potential to reduce nonadherence. Mild hypertensive patients should be monitored by community health care providers.

Treatment adherence among adult hypertensive patients: a cross-sectional retrospective study in primary care in Romania

PURPOSE

This study was performed to elucidate the level of adherence to antihypertensive treatment in adult subjects attending a family medicine clinic in a city in central Romania.

PATIENTS AND METHODS

A cross-sectional, retrospective study was performed on a cohort of hypertensive adults. A total of 525 participants were selected from 1,714 adults attending a single urban family medicine practice. Assessment of adherence to therapy was performed by a chart review of prescription and clinical records over a 4-year study period.

RESULTS

The results showed that 69.8% of the patients had high adherence (>80% with therapy); 20.3% had medium adherence (20%-79%); and 9.9% had low adherence (<20%). A positive association was found (p = 0.01) between low adherence and male gender. A significant positive association (p = 0.02) was found between total cardiovascular risk and level of adherence. We found that 54.7% of the high adherence subjects had well-controlled blood pressure, and chronic kidney disease was associated with high adherence to therapy (p = 0.03). Antihypertensive regimens administered as fixed-dose combinations were positively associated with high adherence (p = 0.001). Subjects who had their antihypertensive regimen adjusted to a new drug class during the study period showed enhanced adherence compared to subjects treated with an unchanged regimen (p = 0.001).

CONCLUSION

This is the first published study assessing adherence to antihypertensive therapy in family medicine practice in Romania. It presented data derived from a primarily urban setting and targeted a geographical area where the prevalence of hypertension has increased continuously. Female gender, age, presence of cardiovascular risk factors, defined cardiovascular disease, chronic renal impairment, and good control of hypertension were positively associated with high adherence. The results provide insights to guide further strategies to improve adherence and indirect methods for blood pressure management strategies.

Hypertension and Frailty Syndrome in Old Age: Current Perspectives

Hypertension is both a health problem and a financial one globally. It affects nearly 30 % of the general population. Elderly people, aged ≥65 years, are a special group of hypertensive patients. In this group, the overall prevalence of the disease reaches 60 %, rising to 70 % in those aged ≥80 years. In the elderly population, isolated systolic hypertension is quite common. High systolic blood pressure is associated with an increased risk of cardiovascular disease, cerebrovascular disease, peripheral artery disease, cognitive impairment and kidney disease. Considering the physiological changes resulting from ageing alongside multiple comorbidities, treatment of hypertension in elderly patients poses a significant challenge to treatment teams. Progressive disability with regard to the activities of daily life, more frequent hospitalisations and low quality of life are often seen in elderly patients. There is discussion in the literature regarding frailty syndrome associated with old age. Frailty is understood to involve decreased resistance to stressors, depleted adaptive and physiological reserves of a number of organs, endocrine dysregulation and immune dysfunction. The primary dilemma concerning frailty is whether it should only be defined on the basis of physical factors, or whether psychological and social factors should also be included. Proper nutrition and motor rehabilitation should be prioritised in care for frail patients. The risk of orthostatic hypotension is a significant issue in elderly patients. It results from an autonomic nervous system dysfunction and involves maladjustment of the cardiovascular system to sudden changes in the position of the body. Other significant issues in elderly patients include polypharmacy, increased risk of falls and cognitive impairment. Chronic diseases, including hypertension, deteriorate baroreceptor function and result in irreversible changes in cerebral and coronary circulation. Concurrent frailty or other components of geriatric syndrome in elderly patients are associated with a worse perception of health, an increased number of comorbidities and social isolation of the patient. It may also interfere with treatment adherence. Identifying causes of non-adherence to pharmaceutical treatment is a key factor in planning therapeutic interventions aimed at increasing control, preventing complications, and improving long-term outcomes and any adverse effects of treatment. Diagnosis of frailty and awareness of the associated difficulties in adhering to treatment may allow targeting of those elderly patients who have a poorer prognosis or may be at risk of complications from untreated or undertreated hypertension, and for the planning of interventions to improve hypertension control.

Understanding Non-Adherence From the Inside: Hypertensive Patients' Motivations for Adhering and Not Adhering

Patients' low adherence to medical treatment in chronic illnesses is one of the biggest public health problems. Numerous studies attend to the diverse factors associated with patient adherence. However, little research has been done to explore patients' reasons for non-compliance from their own point of view. In this article, we aim to understand patient non-adherence using dialogical self-theory and qualitative research methods. We interviewed 51 hypertensive patients to explore their anti- and pro-adherence motivations. Results show that most patients adhere and non-adhere to different aspects of treatment programs (medication, exercise, diet) according to the way they construct meaning to those activities. Also, our findings support the notion that patients' non-adherent behavior aims to preserve important values such as self-esteem, autonomy, affiliation, well-being, freedom, and health (or that more adherence is not worth the extra effort). We discuss the therapeutic relevance of empathically understanding patients' worldview and implicit beliefs.

Factors Associated With Medication Adherence Among Medical-Aid Beneficiaries With Hypertension

The purpose was to examine factors associated with medication adherence among medical-aid beneficiaries with hypertension using the Expanded Behavioral Model of Health Services Utilization. A cross-sectional study was conducted with a convenient sample of 289 patients. The instruments included scales to measure medication adherence, health literacy, general self-efficacy, and pros and cons of chronic disease management. Data collection was performed between February and March 2011. A hierarchical regression analysis was performed. The study found that 25.6% to 34.6% had low motivation and low knowledge regarding medication adherence. Those with higher health literacy and higher self-efficacy scores were more likely to have higher medication adherence, whereas widowed and those who perceived more cons of chronic disease management were more likely to have lower medication adherence than their counterparts (p < .05). Interventions incorporating significant factors associated with medication adherence are required to enhance medication adherence and to prevent complications associated with medication non-adherence.

The influence of illness acceptance on the adherence to pharmacological and non-pharmacological therapy in patients with hypertension

BACKGROUND

The available publications show that 50% of patients with hypertension discontinue their medications within the first 12 months after the beginning of treatment.

AIM

The aim of the study was to analyse the relationship between the acceptance of illness and the adherence to pharmacological and non-pharmacological therapy in patients with hypertension.

METHODS

The study included 102 patients with hypertension examined with validated instruments: Acceptance of Illness Scale (AIS), Health Behavior Inventory (HBI) and Morisky Medication Adherence Scale (MMAS-8).

RESULTS

High (>30 points) and moderate (19-29 points) levels of AIS were presented respectively by 59 and 43 patients. In a univariate analysis, the level of AIS had a statistically significant, independent, positive influence on all domains of the HBI questionnaire: HBI (Spearman's coefficient of rank correlation (r_S) =+0.3997), healthy eating habits (r_S=+ 0.376), preventive behaviours (r_S=+0.242), positive mental attitude (r_S=+0.504), health practices (r_S=+0.264). In univariate analysis the level of MMAS-8 was influenced by female gender (r_S=+0.325; p=0.001), higher education level (r_S=+0.241; p=0.015), employment (r_S=+0.217; p=0.029) and short duration of illness (r_S=+0.229; p=0.022). Multiple regression analysis showed that female gender was an independent predictor of pharmacological adherence (β=+0.325; p=0.001). Illness acceptance was an independent predictor in two domains of the HBI: positive mental attitude HBI domain (β=+0.468; p<0.001) and healthy eating habits (β=+0.321; p=0.001).

CONCLUSIONS

(1) Correlation analysis shows that illness acceptance is an important factor contributing to a higher level of adherence to non-pharmacological therapy of hypertension (total index of health behaviours: healthy eating habits, preventive behaviours, positive mental attitude, health practice) but has no influence on adherence to pharmacological treatment. (2) Female gender, higher levels of education, and the short duration of the disease significantly improve patients' adherence to the prescribed pharmacological and non-pharmacological therapy of hypertension.

Psychometric properties of the Polish version of the eight-item Morisky Medication Adherence Scale in hypertensive adults

Low adherence to pharmacological treatment is often associated with poor blood pressure control, but identification of nonadherent patients in outpatient settings is difficult. The aim of the study was to translate and evaluate the psychometric properties of the Polish version of the structured self-report eight-item Morisky Medication Adherence Scale (MMAS-8) among patients with hypertension. The study was conducted in a family doctor practice between January and July 2015. After a standard "forward-backward" procedure to translate MMAS-8 into Polish, the questionnaire was administered to 160 patients with hypertension. Reliability was tested using a measure of internal consistency (Cronbach's α) and test-retest reliability. Validity was confirmed using known group validity. Three levels of adherence were considered based on the following scores: 0 to <6 (low); 6 to <8 (medium); and 8 (high). Complete questionnaires were returned by 110 respondents (mean age: 60.7 years ±12.6; 54.6% were female). The mean number of pills taken daily was 3.61±4.31. The mean adherence score was 6.42± 2.0. Moderate internal consistency was found (Cronbach's α=0.81), and test-retest reliability was satisfactory (r=0.461-0.905; P<0.001). Reproducibility expressed by Cohen's κ coefficient =0.61 was good. In high-adherent patients, the percentage of well-controlled blood pressure was higher than in low-adherent patients (33.3% vs 19.1%, χ (2)=0.87, P=0.648). Psychometric evaluation of the Polish version of the MMAS-8 indicates that it is a reliable and valid measure tool to detect nonadherent patients. The MMAS-8 may be routinely used to support communication about the medication-taking behavior in hypertensive patients.

An observational study of hypertension treatment and patient outcomes in a primary care setting

INTRODUCTION

Evaluation and treatment of high blood pressure are vital to reducing hypertension-related morbidity. There are limited data on treatment of hypertension in Lesotho. The aim of this study was to investigate hypertension treatment and control in a primary care setting in Lesotho.

METHODS

A cross-sectional study was conducted among hypertensive patients treated at Domiciliary Health Clinic in Maseru, Lesotho between April and May 2013. We reviewed medical records and evaluated hypertension treatment and blood pressure control in the past 12 months. Patients were interviewed to assess adherence to hypertension treatment. Logistic regression analysis was used to identify factors associated with poor blood pressure control.

RESULTS

70 patients were enrolled in the study; 90.0% were female, the mean age was 57.7 years, 80.0% were overweight/obese and 27.1% had diabetes mellitus. 90.0% of the patients received combination antihypertensive therapy; the most frequently prescribed drugs were hydrochlorothiazide (90.0%), captopril (67.1%) and atenolol (51.4%). The majority of the patients had chronic uncontrolled hypertension. 67.2% of the patients had continuous access to antihypertensive drugs in the past 12 months; adherence to medication, diet and exercise was 64.3%, 37.1% and 7.1% respectively. Age ≥65 was the strongest independent predictor of poor blood pressure control (AOR = 10.3, 95% CI: 1.21-88.98, p = 0.033).

CONCLUSION

There is a need for interventions to improve hypertension care and outcomes in this setting. Efforts should be made to improve assessment of hypertensive patients, optimise antihypertensive therapy and promote patient adherence to treatment.

Comparative analysis of non-adherence to medication treatment for systemic arterial hypertension in urban and rural populations

OBJECTIVE

to evaluate the indexes and the main factors associated with non-adherence to medication treatment for systemic arterial hypertension between urban and rural areas.

METHOD

analytical study based on an epidemiological survey with a sample of 247 hypertensive residents of rural and urban areas, with application of a socio-demographic and economic questionnaire, and treatment adherence assessment. The Pearson's Chi-square test was used and the odds ratio (OD) was calculated to analyze the factors related to non-adherence.

RESULTS

the prevalence of non-adherence was 61.9% and it was higher in urban areas (63.4%). Factors significantly associated with non-adherence were: male gender (OR=1.95; 95% CI 1.08-3.50), age 20-59 years old (OR=2.51; 95% CI 1.44-4.39), low economic status (OR=1.95; 95% CI 1.09-3.47), alcohol consumption (OR=5.92, 95% CI 1.73-20.21), short time of hypertension diagnosis (OR=3.07; 95% CI 1.35-6.96) and not attending the health service for routine consultations (OR=2.45; 1.35-4.42).

CONCLUSION

the socio-demographic/economic characteristics, lifestyle habits and how to relate to health services were the factors that presented association with non-adherence regardless of the place of residence.

Factors influencing adherence in long-term use of statins

PURPOSE

To assess the factors influencing adherence in long-term medication use as exemplified by statins.

METHODS

Data from an in-depth survey of Australians aged 45 years and over were linked to national prescription reimbursement data to assess medication possession ratio (MPR) for statins for the middle two years of a four-year period of statin possession. Poisson regression was used to calculate the relative risk (RR) for adherence (MPR ≥ 80%) for patient characteristics and factors related to access to and need for health care services. Separate models were fit for patients receiving healthcare concession subsidies and those who do not ('general beneficiaries').

RESULTS

In the analysis, 42 492 concessional and 16 110 general beneficiary patients were included, with 80.1% and 56.7% showing MPR ≥ 80%, respectively. In both models, RR for adherence was significantly elevated for older (age 65+) and less healthy (worse self-rated health, pre-existing heart condition or obese) individuals, and for those who had private health insurance. Significantly lower RR (i.e. more non-adherence) was found for individuals reporting speaking a language other than English at home, who were smokers, were employed, and had higher levels of education, and for those who reported psychological distress. Income had no significant relationship with adherence, and the pattern of adherence by remoteness of area of residence was inconsistent.

CONCLUSIONS

Poor adherence in long-term use of statins is commonplace, but a number of key predictors-including age, language other than English spoken at home, smoking status and psychological distress-are readily assessable by the prescribing practice.