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Pisani F, Pisani LR, Barbieri MA, de Leon J, Spina E. Optimization of Therapy in Patients with Epilepsy and Psychiatric Comorbidities: Key Points. Curr Neuropharmacol 2023; 21:1755-1766. [PMID: 35619263 PMCID: PMC10514544 DOI: 10.2174/1570159x20666220526144314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/24/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022] Open
Abstract
Psychiatric disorder comorbidity in patients with epilepsy (PWE) is very frequent with a mean percentage prevalence of up to 50% and even higher. Such a high frequency suggests that epilepsy and psychiatric disorders might share common pathological pathways. Various aspects contribute in making the matter very complex from a therapeutic point of view. Some antiseizure medications (ASMs), namely valproic acid, carbamazepine, and lamotrigine, have mood-stabilising effects and are routinely used for the treatment of bipolar disorder in patients who do not have epilepsy. Pregabalin and, to a lesser extent, gabapentin, exerts anxiolytic effects. However, several ASMs, in particular levetiracetam, topiramate, and perampanel, may contribute to psychiatric disorders, including depression, aggressive behaviour, and even psychosis. If these ASMs are prescribed, the patient should be monitored closely. A careful selection should be made also with psychotropic drugs. Although most of these can be safely used at therapeutic doses, bupropion, some tricyclic antidepressants, maprotiline, and clozapine may alter seizure threshold and facilitate epileptic seizures. Interactions between ASMs and psychotropic medication may make it difficult to predict individual response. Pharmacokinetic interactions can be assessed with drug monitoring and are consequently much better documented than pharmacodynamic interactions. Another aspect that needs a careful evaluation is patient adherence to treatment. Prevalence of non-adherence in PWE and psychiatric comorbidities is reported to reach values even higher than 70%. A careful evaluation of all these aspects contributes in optimizing therapy with a positive impact on seizure control, psychiatric wellbeing, and quality of life.
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Affiliation(s)
- Francesco Pisani
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | | | | | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA and Psychiatry and Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Italy
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What Factors Influence Treatment Effectiveness in Rheumatoid Arthritis: An Evidence-Based Approach to Multidimensional Measurement of Treatment Effectiveness. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1102242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Purpose: The aim of the study was to examine the effects of socio-demographic characteristics, disease-related characteristics and health care use related-characteristics on the treatment effectiveness of rheumatoid arthritis patients, both separately and together.
Methods: The sample of the study consisted of 440 rheumatoid arthritis patients for 99% confidence level, and this sample was reached based on the convenience sampling method. Patients who received at least one anti-TNF therapy were included in the study. Treatment effectiveness levels of rheumatoid arthritis patients were measured with a questionnaire. In the analysis of the study, four different regression models were established. In the first model, socio-demographic characteristics; in the second model, disease characteristics; in the third model, health care use characteristics: in the fourth model, the effect of all these variables on treatment effectiveness was examined.
Results: In the study, smoking status, age (socio-demographic characteristics), drug regimen complexity, comorbidity status, education about the disease, disease duration (disease characteristics), and a number of admissions (health care use characteristics), were found to have a significant effect on treatment effectiveness.
Conclusion: In the study, the factors affecting the treatment effectiveness were determined. Therefore, it is important to consider these factors revealed in this study in order to increase the treatment effectiveness in patients with rheumatoid arthritis.
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van den Berg P, Sluiter E, Oosterveld MH, van Leerdam M, Langendijk P, Schweitzer DH. Single pharmacy governed denosumab home administration: optimal adherence by means of a fracture liaison service (FLS) and home care collaboration. Osteoporos Int 2022; 33:881-887. [PMID: 34775527 DOI: 10.1007/s00198-021-06234-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Abstract
UNLABELLED Low adherence for denosumab (Dmab, Prolia®) is of major concern. Dutch pharmacies deliveries were calculated recently being 76.5% for a total of 3 injections. INTRODUCTION Comparing a model where the prescriber maintains responsibility for adherence (model HC1) (Dmab is purchased and dispensed by patient's own community pharmacy and administered through a home care service (HC)) or an all-in-one model where the pharmacist maintains responsibility for the adherence (Dmab is purchased, dispensed, and administered by a pharmacist's HC) (HC2). METHODS We counted the number of Dmab injections, follow-up appointments on time, Dmab administrations delayed to a maximum of 60 days, the number of Dmab discontinuations, and all causes legally traceable under EU privacy act (EDPR). RESULTS Home care started by 2014 (study closure in 2021) and included 711 Dmab injections to 256 unique patients: HC1: 536 and HC2: 175 orders. The whole group received on average 2.8 Dmab injections by consistent intervals of about 182 days. Average administration after the latest Dmab injection: 272.8 days (HC1: 362.0 and HC2: 124.0 days). Administration of a subsequent injection > 60 days occurred in 26.6% (HC1: 38.8% and HC2: 6.2%; OR = 9.49). After adjustment for no more than three Dmab injections administered per patient, it occurred in 27.3% (HC1: 51.8% and HC2 4.4%; OR = 23.34). CONCLUSION It was possible to achieve 94% adherence for Dmab injections treatment just by transferring the complete supply chain to one pharmacy-initiated home care provider after treatment initiation by either a physician or FLS health care professional.
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Affiliation(s)
- P van den Berg
- Department of Orthopedics and Surgery, Fracture Liaison Service, Reinier de Graaf Gasthuis, Delft, The Netherlands.
| | - E Sluiter
- Zuid-Hollandse Apotheek Service (ZHAS), The Hague, The Netherlands
| | - M H Oosterveld
- Zuid-Hollandse Apotheek Service (ZHAS), The Hague, The Netherlands
| | | | - P Langendijk
- Department of Hospital Pharmacy, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - D H Schweitzer
- Department of Internal Medicine and Endocrinology, Reinier the Graaf Gasthuis, Delft, The Netherlands
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Sieben A, A.W. van Onzenoort H, J.H.M. van Laarhoven K, Bredie SJ, van Dulmen S. Identification of Cardiovascular Patient Groups at Risk for Poor Medication Adherence: A Cluster Analysis. J Cardiovasc Nurs 2021; 36:489-497. [PMID: 32501862 PMCID: PMC8366598 DOI: 10.1097/jcn.0000000000000702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Poor medication adherence limits the secondary prevention of cardiovascular diseases (CVDs) and leads to increased morbidity, mortality, and costs. Identifying groups of patients at risk of poor adherence behavior could enable an intervention to be developed and target patients appropriately. OBJECTIVE The first aim of this study was to identify homogeneous subgroups of cardiovascular outpatients based on their cardiovascular risk factors. Subsequently, differences in medication adherence between these groups were examined. METHODS In this retrospective, observational study, patients with an established CVD were included. Well-known cardiovascular risk factors such as smoking, diet, exercise, blood lipid levels, blood pressure, and body mass index were collected. To identify patient subgroups, a 2-step cluster analytic procedure was performed. Differences between the groups on medication adherence were determined on the outcome of the Modified Morisky Scale. Data collection took place between October 2011 and January 2013. RESULTS Cardiovascular risk factors of 530 patients were included in the cluster analysis. Three groups were identified. Compared with other clusters (clusters 1 and 2), cluster 3 contained significantly fewer patients who could be classified as highly adherent and more patients classified as medium adherent (23% and 57%, respectively; P = .024). This group was characterized by a younger age (53% were <55 years old) and using a relatively low number of different medications (41% used <4 different medications). Besides, in this subgroup the most smokers (37%), unhealthy alcohol users (27%), and patients with unhealthy eating habits (14%) were present. CONCLUSION This study showed that cardiovascular patients who are relatively young and have an unhealthy lifestyle are at risk for nonadherent behavior.
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Peh KQE, Kwan YH, Goh H, Ramchandani H, Phang JK, Lim ZY, Loh DHF, Østbye T, Blalock DV, Yoon S, Bosworth HB, Low LL, Thumboo J. An Adaptable Framework for Factors Contributing to Medication Adherence: Results from a Systematic Review of 102 Conceptual Frameworks. J Gen Intern Med 2021; 36:2784-2795. [PMID: 33660211 PMCID: PMC8390603 DOI: 10.1007/s11606-021-06648-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/28/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To summarize the available conceptual models for factors contributing to medication adherence based on the World Health Organization (WHO)'s five dimensions of medication adherence via a systematic review, identify the patient groups described in available conceptual models, and present an adaptable conceptual model that describes the factors contributing to medication adherence in the identified patient groups. METHODS We searched PubMed®, Embase®, CINAHL®, and PsycINFO® for English language articles published from inception until 31 March 2020. Full-text original publications in English that presented theoretical or conceptual models for factors contributing to medication adherence were included. Studies that presented statistical models were excluded. Two authors independently extracted the data. RESULTS We identified 102 conceptual models, and classified the factors contributing to medication adherence using the WHO's five dimensions of medication adherence, namely patient-related, medication-related, condition-related, healthcare system/healthcare provider-related, and socioeconomic factors. Eight patient groups were identified based on age and disease condition. The most universally addressed factors were patient-related factors. Medication-related, condition-related, healthcare system-related, and socioeconomic factors were represented to various extents depending on the patient group. By systematically examining how the WHO's five dimensions of medication adherence were applied differently across the eight different patient groups, we present a conceptual model that can be adapted to summarize the common factors contributing to medication adherence in different patient groups. CONCLUSION Our conceptual models can be utilized as a guide for clinicians and researchers in identifying the facilitators and barriers to medication adherence and developing future interventions to improve medication adherence. PROTOCOL REGISTRATION PROSPERO Identifier: CRD42020181316.
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Affiliation(s)
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Hendra Goh
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Hasna Ramchandani
- Department of Biology, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Jie Kie Phang
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore
| | - Zhui Ying Lim
- SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore
| | - Dionne Hui Fang Loh
- SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore
| | - Truls Østbye
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Family Medicine and Community Health, Duke University, Durham, NC USA
| | - Dan V. Blalock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC USA
| | - Sungwon Yoon
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Hayden Barry Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC USA
- Departments of Population Health Sciences and Psychiatry and Behavioral Sciences, School of Medicine, School of Nursing, Duke University, Durham, NC USA
| | - Lian Leng Low
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
| | - Julian Thumboo
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
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Factors Affecting Hypertensive Treatment Adherence: Development and Preliminary Validation of a New Scale. Int J Hypertens 2021; 2021:6617980. [PMID: 33824763 PMCID: PMC8007347 DOI: 10.1155/2021/6617980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/12/2021] [Indexed: 12/03/2022] Open
Abstract
Design A sequential exploratory mixed method study was used. Methods After item generation using a qualitative study and literature review, the psychometric properties of the scale were evaluated. Face, content, and construct validity, Cronbach's alpha, and test-retest reliability were used to validate the scales. Results Data analysis showed that the scale had acceptable face and content validity. The scale had excellent stability (intraclass correlation = 0.89) and good acceptability of internal consistency (α = 0.71). The exploratory factor analysis showed that the scale consisted of five subscales which were meaningful. Conclusion Psychometric properties of the scale achieved the standard level, and it was sufficient to recommend for general use in future measures of caring in nursing.
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Schooley B, Singh A, Hikmet N, Brookshire R, Patel N. Integrated Digital Patient Education at the Bedside for Patients with Chronic Conditions: Observational Study. JMIR Mhealth Uhealth 2020; 8:e22947. [PMID: 33350961 PMCID: PMC7785403 DOI: 10.2196/22947] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/13/2020] [Accepted: 11/30/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Patient education delivered by a health care provider increases patients' understanding and adherence to medical instructions, which helps to improve patient health. Multiple challenges exist to delivering effective patient education to patients with multiple chronic conditions, including giving the necessary time, range, and types of learning materials, and assessing the level of understanding. To help overcome these challenges, it is important to study new electronic means to assist in patient education, such as the use of mobile devices, interactive media, 3-dimensional images, and multimedia educational content at the bedside. OBJECTIVE The goal of this study was to address the need for blended learning strategies combining technical and workflow integration of digital patient education systems for patients with chronic conditions within and across the regular process of care. Studies are needed to evaluate the utility and benefits of these technologies for providers and patients alike. METHODS A mixed-methods approach was employed including survey administration to 178 patients after they received digital patient education in person with a health care provider, and qualitative interviews with 16 nurse educators who used the mobile digital health education technology to deliver instruction to patients. Patient survey data were analyzed using chi-square statistical tests. Qualitative interviews were analyzed for user acceptance and perceived value themes. RESULTS Patients who were counseled using a blended digital health education approach reported improved understanding of educational content (P=.034) and chronic health conditions (P<.001), were more motivated to care for themselves at home (P<.001), were more likely to say that they felt capable of making health care decisions with their doctors (P<.001) and on their own (P=.001), and were more likely to report their intention to follow their doctor's instructions (P<.001) than were patients whose education was not computer-based. Nurse educators felt that the digital education system and content enhanced their education efforts and could be easily integrated into the outpatient clinical workflow. CONCLUSIONS Patient education for individuals with chronic conditions may be more effective than traditional formats when provided in blended digital formats supervised by a health care provider.
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Affiliation(s)
- Benjamin Schooley
- Health Information Technology Program, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
| | - Akanksha Singh
- Department of Computer Science and Engineering, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
| | - Neşet Hikmet
- Health Information Technology Program, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
| | - Robert Brookshire
- Health Information Technology Program, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
| | - Nitin Patel
- Department of Medicine, School of Medicine, University of South Carolina, Columbia, SC, United States
- Digital Health, Prisma Health, Columbia, SC, United States
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Kwan YH, Oo LJY, Loh DHF, Phang JK, Weng SD, Blalock DV, Chew EH, Yap KZ, Tan CYK, Yoon S, Fong W, Østbye T, Low LL, Bosworth HB, Thumboo J. Development of an Item Bank to Measure Medication Adherence: Systematic Review. J Med Internet Res 2020; 22:e19089. [PMID: 33030441 PMCID: PMC7582150 DOI: 10.2196/19089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023] Open
Abstract
Background Medication adherence is important in managing the progression of chronic diseases. A promising approach to reduce cognitive burden when measuring medication adherence lies in the use of computer‐adaptive tests (CATs) or in the development of shorter patient-reported outcome measures (PROMs). However, the lack of an item bank currently hampers this progress. Objective We aim to develop an item bank to measure general medication adherence. Methods Using the preferred reporting items for systematic review and meta-analysis (PRISMA), articles published before October 2019 were retrieved from PubMed, Embase, CINAHL, the Cochrane Library, and Web of Science. Items from existing PROMs were classified and selected (“binned” and “winnowed”) according to standards published by the Patient-Reported Outcomes Measurement Information System (PROMIS) Cooperative Group. Results A total of 126 unique PROMs were identified from 213 studies in 48 countries. Items from the literature review (47 PROMs with 579 items for which permission has been obtained) underwent binning and winnowing. This resulted in 421 candidate items (77 extent of adherence and 344 reasons for adherence). Conclusions We developed an item bank for measuring general medication adherence using items from validated PROMs. This will allow researchers to create new PROMs from selected items and provide the foundation to develop CATs.
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Affiliation(s)
- Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Livia Jia Yi Oo
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Dionne Hui Fang Loh
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
| | - Jie Kie Phang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Si Dun Weng
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Eng Hui Chew
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Kai Zhen Yap
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Corrinne Yong Koon Tan
- Pharmacy Transformation Office, National Healthcare Group Pharmacy, Singapore, Singapore
| | - Sungwon Yoon
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Truls Østbye
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Lian Leng Low
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore.,Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore.,Post Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
| | - Hayden Barry Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.,School of Nursing, Duke University Medical Center, Durham, NC, United States.,Department of Population Health Sciences, Duke University Medical Center, Durham, NC, United States
| | - Julian Thumboo
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Jankowska-Polańska B, Karniej P, Polański J, Seń M, Świątoniowska-Lonc N, Grochans E. Diabetes Mellitus Versus Hypertension-Does Disease Affect Pharmacological Adherence? Front Pharmacol 2020; 11:1157. [PMID: 32848766 PMCID: PMC7432322 DOI: 10.3389/fphar.2020.01157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/16/2020] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Beata Jankowska-Polańska
- Department of Clinical Nursing, Public Health Department, Wroclaw Medical University, Wrocław, Poland
| | - Piotr Karniej
- Department of Health Promotion, Public Health Department, Wroclaw Medical University, Wrocław, Poland
| | - Jacek Polański
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Mariola Seń
- Department of Health Promotion, Public Health Department, Wroclaw Medical University, Wrocław, Poland
| | | | - Elżbieta Grochans
- Department of Nursing, Pomeranian Medical University in Szczecin, Szczecin, Poland
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Cross AJ, Elliott RA, Petrie K, Kuruvilla L, George J. Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications. Cochrane Database Syst Rev 2020; 5:CD012419. [PMID: 32383493 PMCID: PMC7207012 DOI: 10.1002/14651858.cd012419.pub2] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Older people taking multiple medications represent a large and growing proportion of the population. Managing multiple medications can be challenging, and this is especially the case for older people, who have higher rates of comorbidity and physical and cognitive impairment than younger adults. Good medication-taking ability and medication adherence are necessary to ensure safe and effective use of medications. OBJECTIVES To evaluate the effectiveness of interventions designed to improve medication-taking ability and/or medication adherence in older community-dwelling adults prescribed multiple long-term medications. SEARCH METHODS We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, CINAHL Plus, and International Pharmaceutical Abstracts from inception until June 2019. We also searched grey literature, online trial registries, and reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs. Eligible studies tested interventions aimed at improving medication-taking ability and/or medication adherence among people aged ≥ 65 years (or of mean/median age > 65 years), living in the community or being discharged from hospital back into the community, and taking four or more regular prescription medications (or with group mean/median of more than four medications). Interventions targeting carers of older people who met these criteria were also included. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed abstracts and full texts of eligible studies, extracted data, and assessed risk of bias of included studies. We conducted meta-analyses when possible and used a random-effects model to yield summary estimates of effect, risk ratios (RRs) for dichotomous outcomes, and mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes, along with 95% confidence intervals (CIs). Narrative synthesis was performed when meta-analysis was not possible. We assessed overall certainty of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Primary outcomes were medication-taking ability and medication adherence. Secondary outcomes included health-related quality of life (HRQoL), emergency department (ED)/hospital admissions, and mortality. MAIN RESULTS We identified 50 studies (14,269 participants) comprising 40 RCTs, six cluster-RCTs, and four quasi-RCTs. All included studies evaluated interventions versus usual care; six studies also reported a comparison between two interventions as part of a three-arm RCT design. Interventions were grouped on the basis of their educational and/or behavioural components: 14 involved educational components only, 7 used behavioural strategies only, and 29 provided mixed educational and behavioural interventions. Overall, our confidence in results regarding the effectiveness of interventions was low to very low due to a high degree of heterogeneity of included studies and high or unclear risk of bias across multiple domains in most studies. Five studies evaluated interventions for improving medication-taking ability, and 48 evaluated interventions for improving medication adherence (three studies evaluated both outcomes). No studies involved educational or behavioural interventions alone for improving medication-taking ability. Low-quality evidence from five studies, each using a different measure of medication-taking ability, meant that we were unable to determine the effects of mixed interventions on medication-taking ability. Low-quality evidence suggests that behavioural only interventions (RR 1.22, 95% CI 1.07 to 1.38; 4 studies) and mixed interventions (RR 1.22, 95% CI 1.08 to 1.37; 12 studies) may increase the proportions of people who are adherent compared with usual care. We could not include in the meta-analysis results from two studies involving mixed interventions: one had a positive effect on adherence, and the other had little or no effect. Very low-quality evidence means that we are uncertain of the effects of educational only interventions (5 studies) on the proportions of people who are adherent. Low-quality evidence suggests that educational only interventions (SMD 0.16, 95% CI -0.12 to 0.43; 5 studies) and mixed interventions (SMD 0.47, 95% CI -0.08 to 1.02; 7 studies) may have little or no impact on medication adherence assessed through continuous measures of adherence. We excluded 10 studies (4 educational only and 6 mixed interventions) from the meta-analysis including four studies with unclear or no available results. Very low-quality evidence means that we are uncertain of the effects of behavioural only interventions (3 studies) on medication adherence when assessed through continuous outcomes. Low-quality evidence suggests that mixed interventions may reduce the number of ED/hospital admissions (RR 0.67, 95% CI 0.50 to 0.90; 11 studies) compared with usual care, although results from six further studies that we were unable to include in meta-analyses indicate that the intervention may have a smaller, or even no, effect on these outcomes. Similarly, low-quality evidence suggests that mixed interventions may lead to little or no change in HRQoL (7 studies), and very low-quality evidence means that we are uncertain of the effects on mortality (RR 0.93, 95% CI 0.67 to 1.30; 7 studies). Moderate-quality evidence shows that educational interventions alone probably have little or no effect on HRQoL (6 studies) or on ED/hospital admissions (4 studies) when compared with usual care. Very low-quality evidence means that we are uncertain of the effects of behavioural interventions on HRQoL (1 study) or on ED/hospital admissions (2 studies). We identified no studies evaluating effects of educational or behavioural interventions alone on mortality. Six studies reported a comparison between two interventions; however due to the limited number of studies assessing the same types of interventions and comparisons, we are unable to draw firm conclusions for any outcomes. AUTHORS' CONCLUSIONS Behavioural only or mixed educational and behavioural interventions may improve the proportion of people who satisfactorily adhere to their prescribed medications, but we are uncertain of the effects of educational only interventions. No type of intervention was found to improve adherence when it was measured as a continuous variable, with educational only and mixed interventions having little or no impact and evidence of insufficient quality to determine the effects of behavioural only interventions. We were unable to determine the impact of interventions on medication-taking ability. The quality of evidence for these findings is low due to heterogeneity and methodological limitations of studies included in the review. Further well-designed RCTs are needed to investigate the effects of interventions for improving medication-taking ability and medication adherence in older adults prescribed multiple medications.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Rohan A Elliott
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
- Pharmacy Department, Austin Health, Heidelberg, Australia
| | - Kate Petrie
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Lisha Kuruvilla
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
- Pharmacy Department, Barwon Health, North Geelong, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
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Fernandez-Lazaro CI, García-González JM, Adams DP, Fernandez-Lazaro D, Mielgo-Ayuso J, Caballero-Garcia A, Moreno Racionero F, Córdova A, Miron-Canelo JA. Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study. BMC FAMILY PRACTICE 2019; 20:132. [PMID: 31521114 PMCID: PMC6744672 DOI: 10.1186/s12875-019-1019-3] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/30/2019] [Indexed: 12/11/2022]
Abstract
Background Adherence to treatment, a public health issue, is of particular importance in chronic disease therapies. Primary care practices offer ideal venues for the effective care and management of these conditions. The aim of this study is to assess adherence to treatment and related-factors among patients with chronic conditions in primary care settings. Methods A cross-sectional study was conducted among 299 adult patients with ≥1 chronic condition(s) and prescribed medication in primary healthcare centers of Spain. The Morisky-Green-Levine questionnaire was used to assess medication adherence via face-to-face interviews. Crude and adjusted multivariable logistic regression models were used to analyze factors associated with adherence using the Multidimensional Model proposed by the World Health Organization — social and economic, healthcare team and system-related, condition-related, therapy-related, and patient-related factors. Results The proportion of adherent patients to treatment was 55.5%. Older age (adjusted odds ratio 1.31 per 10-year increment, 95% CI 1.01–1.70), lower number of pharmacies used for medication refills (0.65, 95% CI 0.47–0.90), having received complete treatment information (3.89, 95% CI 2.09–7.21), having adequate knowledge about medication regimen (4.17, 95% CI 2.23–7.80), and self-perception of a good quality of life (2.17, 95% CI 1.18–4.02) were independent factors associated with adherence. Conclusions Adherence to treatment for chronic conditions remained low in primary care. Optimal achievement of appropriate levels of adherence through tailored multifaceted interventions will require attention to the multidimensional factors found in this study, particularly those related to patients’ education and their information needs. Electronic supplementary material The online version of this article (10.1186/s12875-019-1019-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cesar I Fernandez-Lazaro
- Department of Biomedical and Diagnostic Sciences, School of Medicine, University of Salamanca, Calle Alfonso X el Sabio s/n, 37007, Salamanca, Spain. .,Department of Preventive Medicine and Public Health, School of Medicine, IDISNA, University of Navarra, Pamplona, Spain.
| | | | - David P Adams
- Dual Enrollment Program, Point University-Savannah Campus, Savannah, GA, USA
| | - Diego Fernandez-Lazaro
- Department of Cell Biology, Histology and Pharmacology, University of Valladolid, Soria, Spain
| | - Juan Mielgo-Ayuso
- Department of Biochemistry, Molecular Biology and Physiology, Faculty of Physical Therapy, University of Valladolid, Soria, Spain
| | | | | | - Alfredo Córdova
- Department of Biochemistry, Molecular Biology and Physiology, Faculty of Physical Therapy, University of Valladolid, Soria, Spain
| | - Jose A Miron-Canelo
- Department of Biomedical and Diagnostic Sciences, School of Medicine, University of Salamanca, Calle Alfonso X el Sabio s/n, 37007, Salamanca, Spain
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12
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Ye L, Zhang X. Visualizing the knowledge structure of medication-adherence research: A bibliometric analysis (1997-2016). Int J Health Plann Manage 2019; 34:1333-1353. [PMID: 31297912 DOI: 10.1002/hpm.2852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 11/08/2022] Open
Abstract
This study involves a bibliometric analysis of the medication-adherence research and covers publications from 1997 to 2016. A database of 19 621 publications and 335 208 references from the Web of Science was investigated using the CiteSpace software. Some interesting findings were obtained. First, the most significant developments and progress in the medication-adherence research have occurred in North America and Europe. Second, Osterberg L. and the Journal of the American Medical Association (JAMA) are the most cited author and journal, respectively, with the strongest academic influence. Third, the existing studies on medication adherence primarily focus on pharmacology/pharmacy, psychiatry, public environmental occupational health, and general internal medicine. Fourth, research hotspots showed a diversifying trend and increasingly covered chronic diseases. Moreover, the topic of integrating formal outcome evaluations into adherence interventions is one long-term research hotspot. In addition, the research frontiers mainly focus on medication adherence for HIV/AIDS patients, especially active antiretroviral therapy. Finally, the evolution of the medication-adherence research has occurred in approximately three stages: The first stage involved the introduction of the term "compliance" into medicine, then the primary focus shifted to patient adherence to HIV/AIDS medication, and the final stage has involved a diversifying trend with more diseases and methods for measuring adherence being researched in the current stage. Furthermore, because of an aging population and a disease spectrum change in the current phase, the focus of medication-adherence research has gradually shifted from infectious diseases to chronic diseases.
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Affiliation(s)
- Liping Ye
- College of Public Administration, Central China Normal University, Wuhan, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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13
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Jansà M, Bertran MJ, Vilardell J, Garcia F, Escarrabill J. Analysis of the quality of patient therapeutic education and information in a high complexity reference hospital. J Healthc Qual Res 2018; 33:343-351. [PMID: 30482647 DOI: 10.1016/j.jhqr.2018.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/13/2018] [Accepted: 08/21/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The application and monitoring of quality criteria in information and therapeutic patient education can identify areas to improve care. The objectives of this study were: (1) To analyze the characteristics of patient information materials, educational activities, and self-management programs, and (2) to determine health care provider (HCP) proposals on therapeutic patient education. MATERIALS AND METHODS Using a cross-sectional study, an online questionnaire was sent to hospital departments in a high complexity reference hospital from September to December 2013 to record: (a) information materials, (b) patient educational activities, and self-management program characteristics, (c) HCP proposals. The materials were analyzed using Health Promoting Hospitals (HPH) recommendations. RESULTS (1) An analysis was performed on 258 materials (leaflets [54%]) for chronic patients (86%), acute patients (7%), and the general population (7%). More than half (55%) lacked the authors, and 43% the year issued, and 69% followed HPH recommendations. (2) An evaluation was made of 70 educational activities and 37 self-management programs addressed to patients/relatives with diabetes/obesity, musculoskeletal disorders, COPD/asthma, pelvic-floor disorders, transplantation, bowel-inflammation/liver disease, hypertension, cancer, heart failure, acquired immune deficiency syndrome, chronic renal insufficiency, splenectomy, anticoagulation and older-patient dependence. The structure, process and outcome evaluation varied. (3) HCP proposals included: standardization of materials criteria, web accessibility, list of accredited websites, cross-sectional use, and HCP training in self-management education. CONCLUSIONS The online questionnaire showed the weaknesses and strengths of patient information and education, and can be used to monitor their quantity and quality. These results help in the definition of a useful model to improve patient information and education policies.
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Affiliation(s)
- M Jansà
- Diabetes Unit, Chronic Care Program, Hospital Clínic, 170 Villarroel Street, 08036 Barcelona, Spain; Chronic Care Program, Hospital Clínic, 170 Villarroel Street, 08036 Barcelona, Spain.
| | - M J Bertran
- Preventive Medicine and Epidemiology Department, Hospital Clínic, 170 Villarroel Street, 08036 Barcelona, Spain
| | - J Vilardell
- Communication Area, Hospital Clínic, 170 Villarroel Street, 08036 Barcelona, Spain
| | - F Garcia
- Information Technologies Systems, Hospital Clínic, 170 Villarroel Street, 08036 Barcelona, Spain
| | - J Escarrabill
- Chronic Care Program, Hospital Clínic, 170 Villarroel Street, 08036 Barcelona, Spain; REDISSEC, Health Services Research on Chronic Patients Network, Mater Plan for Respiratory Diseases & Home Respiratory Therapies Observatory ((Ministry of Health, Catalonia), Hospital Clínic, 170 Villarroel Street, 08036 Barcelona, Spain
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14
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Fernandez-Lazaro CI, Adams DP, Fernandez-Lazaro D, Garcia-González JM, Caballero-Garcia A, Miron-Canelo JA. Medication adherence and barriers among low-income, uninsured patients with multiple chronic conditions. Res Social Adm Pharm 2018; 15:744-753. [PMID: 30241872 DOI: 10.1016/j.sapharm.2018.09.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 08/30/2018] [Accepted: 09/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Poor adherence to long-term therapies is a public health concern that affects all populations. Little is known about the context of adherence in chronic diseases for the uninsured population in the United States. OBJECTIVE To evaluate medication adherence and barriers among low-income, uninsured adults recently initiating new therapy for a chronic disease. METHODS A cross-sectional study in two Community Health Centers located in Chatham County, Georgia, was performed between September and December 2015. Patients, randomly selected for inclusion in the study, were eligible if they had been prescribed medication for 2 or more chronic conditions and had recently started a new medication regimen. The Morisky-Green-Levine questionnaire was used to assess adherence. Potential barriers were analyzed using the Multidimensional Model proposed by the World Health Organization-social and economic, healthcare team and system-related, condition-related, therapy-related, and patient-related factors. Multivariate logistic regression models were used to analyze factors associated with non-adherence. RESULTS A total of 150 participants were interviewed at 6 months after treatment initiation. Non-adherence was reported by 52% of the participants. Higher adjusted odds of non-adherence were observed in participants who did not receive information about their medications (adjusted odds ratio [AOR] = 2.40, 95% confidence interval [CI] = 1.01-5.74), did not regularly visit a primary health-care provider (AOR = 2.74, 95% CI = 1.09-6.88), and had changes in their treatment (AOR = 3.75, 95% CI = 1.62-8.70). Alternatively, adjusted odds of non-adherence were lower for patients who reported using pillboxes (AOR = 0.31, 95% CI = 0.10-0.95), having help from a caregiver (AOR = 0.15, 95% CI = 0.04-0.60), and integrating medication dosing into daily routines (AOR = 0.18, 95% CI = 0.06-0.59). CONCLUSIONS Medication non-adherence was common among low-income, uninsured patients initiating therapy for chronic conditions. Several modifiable barriers highlight opportunities to address medication non-adherence through multidisciplinary interventions.
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Affiliation(s)
- Cesar I Fernandez-Lazaro
- Department of Biomedical and Diagnostic Sciences, School of Medicine, University of Salamanca, C/ Alfonso X El Sabio s/n., 37007, Salamanca, Spain; Department of Health Sciences, Armstrong State University, 11935 Abercorn St, Savannah, GA, 31419, USA.
| | - David P Adams
- Department of General Studies, Point University-Savannah Campus, 55 Al Henderson Blvd, Savannah, GA, 31419, USA
| | - Diego Fernandez-Lazaro
- Department of Biochemistry and Physiology, School of Physical Therapy, University of Valladolid, Campus Duques de Soria, 42003, Soria, Spain.
| | - Juan M Garcia-González
- Department of Sociology, Pablo de Olavide University, Ctra. de Utrera, 1, 41013, Sevilla, Spain.
| | - Alberto Caballero-Garcia
- Department of Anatomy, School of Physiotherapy, University of Valladolid, Campus Duques de Soria, 42004, Soria, Spain.
| | - Jose A Miron-Canelo
- Department of Biomedical and Diagnostic Sciences, School of Medicine, University of Salamanca, C/ Alfonso X El Sabio s/n., 37007, Salamanca, Spain.
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15
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Clemens KK, Ouédraogo A, Nash DM, Garg AX, Shariff SZ. The Health and Health Care of Adults With Type 1 And 2 Diabetes Across the Spectrum of Estimated Glomerular Filtration Rates. Can J Diabetes 2018; 43:105-114.e4. [PMID: 30287054 DOI: 10.1016/j.jcjd.2018.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/04/2018] [Accepted: 06/14/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Little is known about the health and health-care patterns of patients with diabetes according to their estimated glomerular filtration rates, especially within a publicly funded health-care system. METHODS Using linked health-care databases in Ontario, Canada, we performed a population-based study of adults 50 years of age and older (mean age, 68 years) with prevalent diabetes on January 1, 2014. We categorized patients according to their levels of kidney function (estimated glomerular filtration rate ≥90, 60 to 89, 30 to 59, 15 to 29 or <15 mL/min/1.73 m2, or the receipt of ongoing maintenance dialysis). We then followed patients for 2 years to determine: 1) their level of contact with health-care providers (i.e. visits to family doctors, specialists); 2) their use and repeated use of acute medical services (i.e. hospitalizations and emergency department encounters; 3) diabetes-related monitoring and screening (i.e. glycated hemoglobin and cholesterol tests, vision screening); 4) glycemic and lipid control; and 5) diabetes-related outcomes. RESULTS There were 569,384 patients in our study. Most had estimated glomerular filtration rates between 60 and 89 mL/min/1.73 m2. At baseline, patients with lower kidney function had longer durations of diabetes and more comorbidities. Over 2 years of follow up, they had higher burdens of medical care, excessive diabetes monitoring and were underscreened for diabetes-related complications. Although metabolic control was reasonable across groups, patients with low kidney function had more hospital encounters and more diabetes-related complications. CONCLUSIONS Patients with diabetes and low kidney function are a vulnerable population that faces health system challenges and care gaps. Suggestions for policy and practice are discussed.
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Affiliation(s)
- Kristin K Clemens
- Department of Medicine, Division of Endocrinology, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Ontario, Canada; Lawson Health Sciences Centre, London, Ontario, Canada.
| | | | | | - Amit X Garg
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Ontario, Canada; Lawson Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada
| | - Salimah Z Shariff
- Institute for Clinical Evaluative Sciences, Ontario, Canada; Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
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16
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Lambert K, Mullan J, Mansfield K. An integrative review of the methodology and findings regarding dietary adherence in end stage kidney disease. BMC Nephrol 2017; 18:318. [PMID: 29061163 PMCID: PMC5653982 DOI: 10.1186/s12882-017-0734-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 09/27/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Dietary modification is an important component of the management of end stage kidney disease (ESKD). The diet for ESKD involves modifying energy and protein intake, and altering sodium, phosphate, potassium and fluid intake. There have been no comprehensive reviews to date on this topic. The aims of this integrative review were to (i) describe the methods used to measure dietary adherence (ii) determine the rate of dietary adherence and (iii) describe factors associated with dietary adherence in ESKD. METHODS The Web of Science and Scopus databases were searched using the search terms 'adherence' and 'end stage kidney disease'. Of the 787 potentially eligible papers retrieved, 60 papers of 24,743 patients were included in this review. Of these papers, 44 reported the rate of dietary adherence and 44 papers described factors associated with adherence. RESULTS Most of the evidence regarding dietary adherence is derived from studies of hemodialysis patients (72% of patients). The most common method of measuring dietary adherence in ESKD was subjective techniques (e.g. food diaries or adherence questionnaires). This was followed by indirect methods (e.g. serum potassium, phosphate or interdialytic weight gain). The weighted mean adherence rate to ESKD dietary recommendations was 31.5% and 68.5% for fluid recommendations. Adherence to protein, sodium, phosphate, and potassium recommendations were highly variable due to differences in measurement methods used, and were often derived from a limited evidence base. Socioeconomic status, age, social support and self-efficacy were associated with dietary adherence. However, factors such as taste, the impact of the diet on social eating occasions; and dietetic staffing also appear to play a role in dietary adherence. CONCLUSION Dietary adherence rates in people with ESKD are suboptimal. Further research is required on dietary adherence in patients with ESKD from different social, educational, economic and ethnic groups. This research may identify other factors which may impact upon adherence, and could be used to inform the design of future strategies to improve dietary adherence. Future research that reports not just the rate of adherence to individual components of the nutrient prescription but also the overall quality of the diet would be useful.
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Affiliation(s)
- Kelly Lambert
- Department of Clinical Nutrition, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Level 5, Block C, Crown Street, Wollongong, NSW 2500 Australia
| | - Judy Mullan
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute, University of Wollongong, iC Enterprise 1, Innovation Campus, Wollongong, New South Wales 2522 Australia
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, New South Wales 2522 Australia
| | - Kylie Mansfield
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, New South Wales 2522 Australia
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17
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Pantuzza LL, Ceccato MDGB, Silveira MR, Junqueira LMR, Reis AMM. Association between medication regimen complexity and pharmacotherapy adherence: a systematic review. Eur J Clin Pharmacol 2017; 73:1475-1489. [PMID: 28779460 DOI: 10.1007/s00228-017-2315-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/26/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE The purpose of this study was to systematically review evidence regarding the association between regimen complexity and adherence. METHODS Articles were searched in MEDLINE, LILACS, Cochrane, CINAHL, PsycINFO and references of included studies. Search terms included medication regimen complexity, medication adherence and their synonyms. Randomized clinical trials, cross-sectional, cohort or case-control studies published until March 2016 in English, Portuguese or Spanish were eligible if quantitatively examined the association between complexity and adherence in patients of any age and sex, under any type of medication therapy. Complexity was defined according to the strategy used to assess it in the individual studies. All types of instruments used to assess complexity and adherence were considered. Data extraction was performed using an electronic spreadsheet. Quality assessment was conducted independently using standard scales. The data were qualitatively synthesized. RESULTS Fifty-four studies were included: 37 cross-sectional and 17 cohorts. Most were conducted in outpatient setting. Most frequently, studies were carried out with HIV-infected individuals or patients with chronic conditions. The most frequent methods used to assess complexity and adherence were complexity index (19) and self-report (27), respectively. Complexity was associated with adherence in 35 studies. Most of them (28) identified that participants with more complex regimens were less likely to adhere to pharmacotherapy; seven studies found a direct correlation. The others found inconclusive results or no association between complexity and adherence. The studies had low to moderate-methodological quality. CONCLUSION Although there was variability regarding the association between complexity and adherence, most studies showed that an increased regimen complexity reduces medication adherence.
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Affiliation(s)
- Laís Lessa Pantuzza
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Maria das Graças Braga Ceccato
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Micheline Rosa Silveira
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Luane Mendes Ribeiro Junqueira
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Adriano Max Moreira Reis
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
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18
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Cross AJ, Elliott RA, George J. Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Amanda J Cross
- Monash University; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences; Parkville VIC Australia 3052
| | - Rohan A Elliott
- Monash University; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences; Parkville VIC Australia 3052
- Austin Health; Pharmacy Department; Heidelberg Victoria Australia 3084
| | - Johnson George
- Monash University; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences; Parkville VIC Australia 3052
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19
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Meca-Lallana J, Mendibe M, Hernández-Clares R, Caminero AB, Mallada-Frechin J, Dávila-Gonzalez P, Garcés-Redondo M, Gómez M, Millán-Pascual J, Soriano-Hernández G, Amigo-Jorrín MDC. Predictors of burden and depression among caregivers of relapsing-remitting MS patients in Spain: MS Feeling study. Neurodegener Dis Manag 2016; 6:277-87. [PMID: 27480482 DOI: 10.2217/nmt-2016-0014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIM To assess potential predictors for burden and depression among caregivers of relapsing-remitting multiple sclerosis patients in Spain. Family functioning and social support were also assessed. PATIENTS & METHODS Multicenter and cross-sectional study in relapsing-remitting multiple sclerosis adult patients and their respective informal caregivers (n = 180). Assessment performed: Zarit Scale (Burden), Center for Epidemiologic Studies Depression-7 Scale (depression), Family APGAR (Adaptation, Partnership, Growth, Affection, Resolve) Questionnaire (family functioning) and Duke UNC-11 Functional Social Support Questionnaire (social support). Multivariate logistic regression analysis assessed burden and depression predictors among caregivers. RESULTS Caregivers suffered burden (19.4%) and depression (20.6%) and perceived poor social support (9.4%) and family dysfunction (10.6%). Burden predictors were patient's degree of disability, caregiver time and number of medications administered to patient. Depression predictors were patient's age and daily caregiving time. CONCLUSION The factors reported here could help clinicians to identify caregiver groups particularly at risk of burden and depression for timely intervention.
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Affiliation(s)
- José Meca-Lallana
- Multiple Sclerosis Unit, Department of Neurology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Cathedra of Clinical Neuroimmunology & Multiple Sclerosis, UCAM Universidad Católica San Antonio de Murcia, España
| | - Mar Mendibe
- Department of Neurology, Hospital Universitario de Cruces, Vizcaya, Spain
| | - Rocío Hernández-Clares
- Multiple Sclerosis Unit, Department of Neurology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Cathedra of Clinical Neuroimmunology & Multiple Sclerosis, UCAM Universidad Católica San Antonio de Murcia, España
| | - Ana Belén Caminero
- Department of Neurology, Hospital Nuestra Señora de Sonsoles, Complejo Asistencial de Ávila, Ávila, Spain
| | | | | | - Moisés Garcés-Redondo
- Department of Neurology, Hospital de Tortosa Vergede la Cinta, Tortosa, Tarragona, Spain
| | - Montserrat Gómez
- Department of Neurology, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Jorge Millán-Pascual
- Section of Neurology, Hospital General La Mancha-Centro, Alcázar de San Juan, Ciudad Real, Spain
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20
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Akarırmak Ü, Koçyiğit H, Eskiyurt N, Esmaeilzadeh S, Kuru Ö, Yalçinkaya EY, Peker Ö, Ekim AA, Özgirgin N, Çalış M, Rezvani A, Çevikol A, Eyigör S, Şendur ÖF, İrdesel J. Influence of patient training on persistence, compliance, and tolerability of different dosing frequency regimens of bisphosphonate therapy: An observational study in Turkish patients with postmenopausal osteoporosis. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2016; 50:415-23. [PMID: 27524671 PMCID: PMC6197458 DOI: 10.1016/j.aott.2016.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/30/2015] [Accepted: 10/05/2015] [Indexed: 11/30/2022]
Abstract
Objective In our study, we aimed to evaluate the influence of training on compliance and persistence with bisphosphonate treatment given on a weekly vs. monthly basis in postmenopausal osteoporosis patients. Methods A total of 979 patients with postmenopausal osteoporosis (mean age: 63.2 ± 7.2 years) were included in this national, multicenter, prospective non-interventional observational cohort registry study. Patients were randomized into training (n = 492, 50.3%, mean age: 63.4 ± 7.2 years) and control (n = 487, 49.7%, mean age: 63.0 ± 7.1 years) groups. Patients in each intervention group were given weekly (44.9% and 44.6% for training and control subjects, respectively) or monthly (55.1% and 55.4%, respectively) bisphosphonate regimens. After the initial visit, patients were followed up at three-month intervals throughout 12 months of treatment for evaluation of persistence, compliance and adverse events. Results On average, 79.4% of the patients were persistent with the treatment with a mean of 350.4 days of duration during the 12-month follow-up period. The mean compliance in the compliant and fully compliant group remained at an average of 86.6%. No significant difference was detected between the training and control groups in terms of compliance and persistence. Significantly longer persistence (360.0 ± 89.0 vs. 345.0 ± 108.0 days; p = 0.035), higher percentage of persistent patients (83.4% vs. 74.2%; p = 0.012) and higher compliance rates (88.8% vs. 83.3%; p = 0.002) were noted in monthly regimen patients in comparison to those given weekly regimen. Conclusion Our findings revealed remarkably high rates for persistence and compliance with bisphosphonate treatment in postmenopausal osteoporosis, with no impact of training on compliance and persistence rates. Longer persistence and better compliance rates were achieved with the monthly bisphosphonate regimen when compared to the weekly regimen.
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Affiliation(s)
- Ülkü Akarırmak
- İstanbul University, Cerrahpaşa School of Medicine, İstanbul, Turkey.
| | | | - Nurten Eskiyurt
- İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | | | - Ömer Kuru
- Ondokuz Mayıs University, Faculty of Medicine, Samsun, Turkey
| | - Ebru Yılmaz Yalçinkaya
- İstanbul Physical Therapy and Rehabilitation Training and Research Hospital, İstanbul, Turkey
| | - Özlen Peker
- Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | | | - Neşe Özgirgin
- Ankara Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Mustafa Çalış
- Erciyes University, School of Medicine, Kayseri, Turkey
| | - Aylin Rezvani
- Bezm-i Alem University, Faculty of Medicine, İstanbul, Turkey
| | - Alev Çevikol
- Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Sibel Eyigör
- Ege University, Faculty of Medicine, İzmir, Turkey
| | | | - Jale İrdesel
- Uludağ University, School of Medicine, Bursa, Turkey
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Font D, Escarrabill J, Gómez M, Ruiz R, Enfedaque B, Altimiras X. Integrated Health Care Barcelona Esquerra (Ais-Be): A Global View of Organisational Development, Re-Engineering of Processes and Improvement of the Information Systems. The Role of the Tertiary University Hospital in the Transformation. Int J Integr Care 2016; 16:8. [PMID: 27616964 PMCID: PMC5015542 DOI: 10.5334/ijic.2476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 12/18/2022] Open
Abstract
The Integrated Health Area "Barcelona Esquerra" (Área Integral de Salud de Barcelona Esquerra - AIS-BE), which covers a population of 524,000 residents in Barcelona city, is running a project to improve healthcare quality and efficiency based on co-ordination between the different suppliers in its area through the participation of their professionals. Endowed with an Organisational Model that seeks decision-taking that starts out from clinical knowledge and from Information Systems tools that facilitate this co-ordination (an interoperability platform and a website) it presents important results in its structured programmes that have been implemented such as the Reorganisation of Emergency Care, Screening for Colorectal Cancer, the Onset of type 2 Diabetes Mellitus, Teledermatology and the Development of Cross-sectional Healthcare Policies for Care in Chronicity.
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Affiliation(s)
- David Font
- Strategy and Planning Manager, Hospital Clínic, Barcelona 08036, Spain
- Standing Committee of AIS-BE, Spain
| | - Joan Escarrabill
- Chronic Care Programme Manager. Hospital Clínic – AIS-BE, Spain
- Director Master Plan for Respiratory Diseases (PDMAR) & Home Respiratory Therapies Observatory (Obs TRD) (Ministry of Health), Spain
- REDISSEC (Research Network for Health Services in Chronic Disease), Spain
| | - Mónica Gómez
- Coordinator of the AISBE Technical office, Spain
- Standing Committee of AIS-BE, Spain
| | - Rafael Ruiz
- Eixample Primary Care Consortium (CAPSE) Manager, Spain
- Standing Committee of AIS-BE, Spain
| | - Belén Enfedaque
- Primary Care Manager (SAP Esquerra – Catalan Health Institute), Spain
- Standing Committee of AIS-BE, Spain
| | - Xavier Altimiras
- Integrated Health Area “Barcelona Esquerra” (AIS-BE) Manager. Barcelona Health Consortium (CatSalut), Spain
- Standing Committee of AIS-BE, Spain
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Le Rhun A, Wastiaux HA, Moret L, Misery L, Danou N, Aujoulat I, Lagger G, Barbarot S. Fears regarding the use of topical corticosteroids in atopic dermatitis: looking at the coping strategies and the role of health care providers. A qualitative study. ACTA ACUST UNITED AC 2015. [DOI: 10.1051/tpe/2015011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Napolitano F, Napolitano P, Angelillo IF. Medication adherence among patients with chronic conditions in Italy. Eur J Public Health 2015; 26:48-52. [DOI: 10.1093/eurpub/ckv147] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rubboli A. Adherence to and persistence with non-vitamin K-antagonist oral anticoagulants: does the number of pills per day matter? Curr Med Res Opin 2015; 31:1845-7. [PMID: 26312384 DOI: 10.1185/03007995.2015.1086993] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Once daily dosing schedule is associated with increased adherence to and persistence with cardiovascular therapies. Such feature has been claimed responsible for the significantly lower (both temporary and permanent) discontinuation of oral anticoagulation with rivaroxaban (which is given once daily) compared to dabigatran (which is given twice daily) in a large, real-world dataset of patients with atrial fibrillation (AF) in the United States. While a cause-effect relationship between dosing schedule and adherence and persistence could not be established, the above finding supports nonetheless the preferential selection of the non vitamin-K-antagonists oral anticoagulant (NOAC) with the easiest and most convenient regimen. Given however, the differences in efficacy and safety observed with the various NOACs compared to warfarin in the phase III clinical trials in non-valvular AF, careful individualization of treatment should be pursued, being dosing schedule only one of the variables to be taken into account. Maximal effort instead, should be put in implementing measures to enhance patient's adherence to and persistence with treatment.
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Affiliation(s)
- Andrea Rubboli
- a Division of Cardiology , Laboratory of Interventional Cardiology, Ospedale Maggiore , Bologna , Italy
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Diaz R, Behr JG. A Simulation Framework for Evaluating the Effectiveness of Chronic Disease Management Interventions. INTERNATIONAL JOURNAL OF INFORMATION SYSTEMS IN THE SERVICE SECTOR 2014. [DOI: 10.4018/ijisss.2014100103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The treatment and management of chronic diseases currently comprise a major fraction of the United States' healthcare expenditures. These expenses are projected to increase as the US population ages. Utilization of the ambulatory healthcare system stemming from chronic conditions has been seen as contributory factor in the rising expenditures. Efforts to better manage chronic conditions ought to result in better health outcomes and, by extension, savings through lower utilization of ambulatory services. The longer-term financial consequences of such interventions, however, are more uncertain. This study offers a System Dynamics simulation framework that identifies and models the critical relationships associated with health outcomes and longer-term financial consequences. This framework is demonstrated through a comparison between groups with a similar generic chronic condition, but one group is subjected to a management intervention and the other group is not. The framework provides constructive insights into how the initial intervention cost estimates, the resulting savings, and the health status may change depending on uncertainties, feedback effects, and cost structures.
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Affiliation(s)
- Rafael Diaz
- Virginia Modeling, Analysis, and Simulation Center, Old Dominion University, Suffolk, VA, USA
| | - Joshua G. Behr
- Virginia Modeling, Analysis, and Simulation Center, Old Dominion University, Suffolk, VA, USA
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Harrow A, Dryden R, McCowan C, Radley A, Parsons M, Thompson AM, Wells M. A hard pill to swallow: a qualitative study of women's experiences of adjuvant endocrine therapy for breast cancer. BMJ Open 2014; 4:e005285. [PMID: 24928595 PMCID: PMC4067895 DOI: 10.1136/bmjopen-2014-005285] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To explore women's experiences of taking adjuvant endocrine therapy as a treatment for breast cancer and how their beliefs about the purpose of the medication, side effects experienced and interactions with health professionals might influence adherence. DESIGN Qualitative study using semistructured, one-to-one interviews. SETTING 2 hospitals from a single health board in Scotland. PARTICIPANTS 30 women who had been prescribed tamoxifen or aromatase inhibitors (anastrozole or letrozole) and had been taking this medication for 1-5 years. RESULTS Women clearly wished to take their adjuvant endocrine therapy medication as prescribed, believing that it offered them protection against breast cancer recurrence. However, some women missed tablets and did not recognise that this could reduce the efficacy of the treatment. Women did not perceive that healthcare professionals were routinely or systematically monitoring their adherence. Side effects were common and impacted greatly on the women's quality of life but did not always cause women to stop taking their medication, or to seek advice about reducing the side effects they experienced. Few were offered the opportunity to discuss the impact of side effects or the potential options available. CONCLUSIONS Although most women in this study took adjuvant endocrine therapy as prescribed, many endured a range of side effects, often without seeking help. Advice, support and monitoring for adherence are not routinely offered in conventional follow-up settings. Women deserve more opportunity to discuss the pros, cons and impact of long-term adjuvant endocrine therapy. New service models are needed to support adherence, enhance quality of life and ultimately improve survival. These should ideally be community based, in order to promote self-management in the longer term.
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Affiliation(s)
- Alison Harrow
- School of Nursing and Midwifery, University of Dundee, Dundee, UK
| | - Ruth Dryden
- Institute for Research and Innovation in Social Services, Glasgow, UK
| | - Colin McCowan
- Robertson Centre for Biostatistics, University of Glasgow Boyd Orr Building, Glasgow, UK
| | - Andrew Radley
- NHS Tayside, Directorate of Public Health, Kings Cross Hospital, Dundee, UK
| | - Mark Parsons
- NHS Tayside, Pharmacy Department, Ninewells Hospital, Dundee, UK
| | - Alastair M Thompson
- Department of Surgical Oncology, MD Anderson Cancer Center, Holcombe Boulevard, Houston, Texas, USA
| | - Mary Wells
- NMAHP Research Unit, Scion House, University of Stirling, Stirling, UK
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Abstract
BACKGROUND Medication nonadherence is a major cause of hospitalization in patients with heart failure (HF), which contributes enormously to health care costs. We previously found, using the World Health Organization adherence dimensions, that condition and patient level factors predicted nonadherence in HF. In this study, we assessed a wider variety of condition and patient factors and interactions to improve our ability to identify those at risk for hospitalization. MATERIALS AND METHODS Medication adherence was measured electronically over the course of 6 months, using the Medication Event Monitoring System (MEMS). A total of 242 HF patients completed the study, and usable MEMS data were available for 218 (90.1%). Participants were primarily white (68.3%), male (64.2%), and retired (44.5%). Education ranged from 8-29 years (mean, 14.0 years; standard deviation, 2.9 years). Ages ranged from 30-89 years (mean, 62.8 years; standard deviation, 11.6 years). Analyses used adaptive methods based on heuristic searches controlled by cross-validation scores. First, individual patient adherence patterns over time were used to categorize patients in poor versus better adherence types. Then, risk factors for poor adherence were identified. Finally, an effective model for predicting poor adherence was identified based on identified risk factors and possible pairwise interactions between them. RESULTS A total of 63 (28.9%) patients had poor adherence. Three interaction risk factors for poor adherence were identified: a higher number of comorbid conditions with a higher total number of daily medicines, older age with poorer global sleep quality, and fewer months since diagnosis of HF with poorer global sleep quality. Patients had between zero and three risk factors. The odds for poor adherence increased by 2.6 times with a unit increase in the number of risk factors (odds ratio, 2.62; 95% confidence interval, 1.78-3.86; P<0.001). CONCLUSION Newly diagnosed, older HF patients with comorbid conditions, polypharmacy, and poor sleep are at risk for poor medication adherence. Interventions addressing these specific barriers are needed.
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Affiliation(s)
- George J Knafl
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, USA
- Correspondence: Barbara Riegel, School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA, Tel +1 215 898 9927, Fax +1 240 282 7707, Email
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Tüzün Ş, Akyüz G, Eskiyurt N, Memiş A, Kuran B, İçağasıoğlu A, Sarpel T, Özdemir F, Özgirgin N, Günaydın R, Çakçı A, Yurtkuran M. Impact of the training on the compliance and persistence of weekly bisphosphonate treatment in postmenopausal osteoporosis: a randomized controlled study. Int J Med Sci 2013; 10:1880-7. [PMID: 24324365 PMCID: PMC3856379 DOI: 10.7150/ijms.5359] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 10/17/2013] [Indexed: 11/05/2022] Open
Abstract
Long-term patient adherence to osteoporosis treatment is poor despite proven efficacy. In this study, we aimed to assess the impact of active patient training on treatment compliance and persistence in patients with postmenopausal osteoporosis. In the present national, multicenter, randomized controlled study, postmenopausal osteoporosis patients (45-75 years) who were on weekly bisphosphonate treatment were randomized to active training (AT) and passive training (PT) groups and followed-up by 4 visits after the initial visit at 3 months interval during 12 months of the treatment. Both groups received a bisphosphonate usage guide and osteoporosis training booklets. Additionally, AT group received four phone calls (at 2(nd), 5(th), 8(th), and 11(th) months) and participated to four interactive social/training meetings held in groups of 10 patients (at 3(rd), 6(th), 9(th), and 12(th) months). The primary evaluation criteria were self-reported persistence and compliance to the treatment and the secondary evaluation criteria was quality life of the patients assessed by 41-item Quality of Life European Foundation for Osteoporosis (QUALEFFO-41) questionnaire. Of 448 patients (mean age 62.4±7.7 years), 226 were randomized to AT group and 222 were randomized to PT group. Among the study visits, the most common reason for not receiving treatment regularly was forgetfulness (54.9% for visit 2, 44.3% for visit 3, 51.6% for visit 4, and 43.8% for visit 5), the majority of the patients always used their drugs regularly on recommended days and dosages (63.8% for visit 2, 60.9% for visit 3, 72.1% for visit 4, and 70.8% for visit 5), and most of the patients were highly satisfied with the treatment (63.4% for visit 2, 68.9% for visit 3, 72.4% for visit 4, and 65.2% for visit 5) and wanted to continue to the treatment (96.5% for visit 2, 96.5% for visit 3, 96.9% for visit 4, and 94.4% for visit 5). QUALEFFO scores of the patients in visit 1 significantly improved in visit 5 (37.7±25.4 vs. 34.0±14.6, p<0.001); however, the difference was not significant between AT and PT groups both in visit 1 and visit 5. In conclusion, in addition to active training, passive training provided at the 1(st) visit did not improve the persistence and compliance of the patients for bisphosphonate treatment.
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Affiliation(s)
- Şansın Tüzün
- 1. Department of Physical Medicine and Rehabilitation, Istanbul University Cerrahpasa School of Medicine, Istanbul
| | - Gülseren Akyüz
- 2. Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Istanbul
| | - Nurten Eskiyurt
- 3. Department of Physical Medicine and Rehabilitation, Istanbul University Istanbul School of Medicine, Istanbul
| | - Asuman Memiş
- 4. Physical Medicine and Rehabilitation Clinic, Izmir Ataturk Training and Research Hospital, Izmir
| | - Banu Kuran
- 5. Physical Medicine and Rehabilitation Clinic, Sisli Etfal Training and Research Hospital, Istanbul
| | - Afitap İçağasıoğlu
- 6. Physical Medicine and Rehabilitation Clinic, Goztepe Training and Research Hospital, Istanbul
| | - Tunay Sarpel
- 7. Department of Physical Medicine and Rehabilitation, Cukurova University Faculty of Medicine, Adana
| | - Ferda Özdemir
- 8. Department of Physical Medicine and Rehabilitation, Trakya University Faculty of Medicine, Edirne
| | - Neşe Özgirgin
- 9. Physical Medicine and Rehabilitation Clinic, Ankara Physical Therapy Training and Research Hospital, Ankara
| | - Rezzan Günaydın
- 10. Physical Medicine and Rehabilitation Clinic, Izmir Training and Research Hospital, İzmir
| | - Aytül Çakçı
- 11. Physical Medicine and Rehabilitation Clinic, Diskapi Training and Research Hospital, Ankara
| | - Merih Yurtkuran
- 12. Department of Physical Medicine and Rehabilitation, Uludag University Faculty of Medicine, Bursa; Turkey
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Ma C, Chen S, Zhou Y, Huang C. Treatment adherence of Chinese patients with hypertension: a longitudinal study. Appl Nurs Res 2013; 26:225-31. [PMID: 24050917 DOI: 10.1016/j.apnr.2013.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 05/27/2013] [Accepted: 08/06/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is no research concerning treatment adherence and correlated factors using longitudinal design in China. AIM This article investigated the treatment adherence of patients with hypertension and examined determinants of adherence, with a focus on changes of adherence and psychosocial factors over 1 year. METHODS A longitudinal design was adopted to facilitate the survey of patients with hypertension across two time points. RESULTS The results demonstrated that treatment adherence of hypertensive patients improved over 1 year follow-up. The blood pressure values of hypertensive patients decreased at time 2. The regression analysis found that time 1 treatment adherence, social support, education and duration of diagnosis were significant predictors of treatment adherence at time 2, accounting for 26% of the total variance. Time 1 treatment adherence explained 15% of the variance, social support 7%, education 3% and duration of diagnosis 1%. CONCLUSIONS The effective strategies targeted patients at risk are suggested to be necessary and should be designed according to the factors affecting adherence.
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Affiliation(s)
- Chunhua Ma
- School of Nursing, Guangzhou Medical College, Guangzhou 510180, China.
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Paquin AM, Zimmerman KM, Kostas TR, Pelletier L, Hwang A, Simone M, Skarf LM, Rudolph JL. Complexity perplexity: a systematic review to describe the measurement of medication regimen complexity. Expert Opin Drug Saf 2013; 12:829-40. [PMID: 23984969 DOI: 10.1517/14740338.2013.823944] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Complex medication regimens are error prone and challenging for patients, which may impact medication adherence and safety. No universal method to assess the complexity of medication regimens (CMRx) exists. The authors aim to review literature for CMRx measurements to establish consistencies and, secondarily, describe CMRx impact on healthcare outcomes. AREAS COVERED A search of EMBASE and PubMed for studies analyzing at least two medications and complexity components, among those self-managing medications, was conducted. Out of 1204 abstracts, 38 studies were included in the final sample. The majority (74%) of studies used one of five validated CMRx scales; their components and scoring were compared. EXPERT OPINION Universal CMRx assessment is needed to identify and reduce complex regimens, and, thus, improve safety. The authors highlight commonalities among five scales to help build consensus. Common components (i.e., regimen factors) included dosing frequency, units per dose, and non-oral routes. Elements (e.g., twice daily) of these components (e.g., dosing frequency) and scoring varied. Patient-specific factors (e.g., dexterity, cognition) were not addressed, which is a shortcoming of current scales and a challenge for future scales. As CMRx has important outcomes, notably adherence and healthcare utilization, a standardized tool has potential for far-reaching clinical, research, and patient-safety impact.
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Affiliation(s)
- Allison M Paquin
- VA Boston Healthcare System , 150 South Huntington Avenue, Boston, MA 02130 , USA
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Brennan MJ. Update on prescription extended-release opioids and appropriate patient selection. J Multidiscip Healthc 2013; 6:265-80. [PMID: 23900563 PMCID: PMC3726523 DOI: 10.2147/jmdh.s38562] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Chronic pain is largely underdiagnosed, often undertreated, and expected to increase as the American population ages. Many patients with chronic pain require long-term treatment with analgesic medications, and pain management may involve use of prescription opioids for patients whose pain is inadequately controlled through other therapies. Yet because of the potential for abuse and addiction, many clinicians hesitate to treat their patients with pain with potentially beneficial agents. Finding the right opioid for the right patient is the first - often complicated - step. Ensuring that patients continue to properly use the medication while achieving therapeutic analgesic effects is the long-term goal. Combined with careful patient selection and ongoing monitoring, new formulations using extended-release technologies incorporating tamper-resistant features may help combat the growing risk of abuse or misuse, which will hopefully reduce individual suffering and the societal burden of chronic pain. The objective of this manuscript is to provide an update on extended-release opioids and to provide clinicians with a greater understanding of which patients might benefit from these new opioid formulations and how to integrate the recommended monitoring for abuse potential into clinical practice.
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Sigurdardottir AK, Arnadottir SA, Gunnarsdottir ED. Socioeconomic status and differences in medication use among older people according to ATC categories and urban–rural residency. Scand J Public Health 2013; 41:311-7. [DOI: 10.1177/1403494813476375] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: To study how selected indicators of socioeconomic status and urban–rural residency associate with medication use in form of number of daily medications, polypharmacy, and medication use according to Anatomic Therapeutic Classification (ATC) system. Methods: Cross-sectional, population-based study among older community-dwelling Icelanders. Criteria for participation were: age ≥65 years, community-dwelling, and able to communicate verbally and to set up a time for a face-to-face interview. Information on medication use was obtained by interviews and by examining each person’s medication record. Medications were categorised according to ATC system. A questionnaire and the physical and mental health summary scales of SF-36 Health Survey were used to assess potential influential factors associated with medication use. Results: On average, participants ( n=186) used 3.9 medications, and the prevalence of polypharmacy was 41%. No indicators of socioeconomic status had significant association to any aspects of medication use. Compared to urban residents, rural residents had more diagnosed diseases, were less likely to live alone, were less likely to report having adequate income, and had fewer years of education. Controlling for these differences, urban people were more likely to use medication from the B and C categories. Moreover, older urban men, with worse physical health, and greater number of diagnosed diseases used more medications from the B category. Conclusions: There are unexplained regional differences in medications use, from categories B and C, by older Icelanders. Further studies are needed on why urban residents used equal number of medications, or even more medications, compared to rural residents, despite better socioeconomic status and fewer diagnosed diseases.
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Affiliation(s)
| | - Solveig A Arnadottir
- University of Akureyri, Solborg, Nordurslod, Akureyri, Iceland
- Department of Physical Therapy, Faculty of Medicine,
University of Iceland, Reykjavik, Iceland
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Wang L, Wei W, Miao R, Xie L, Baser O. Real-world outcomes of US employees with type 2 diabetes mellitus treated with insulin glargine or neutral protamine Hagedorn insulin: a comparative retrospective database study. BMJ Open 2013; 3:bmjopen-2012-002348. [PMID: 23633415 PMCID: PMC3641450 DOI: 10.1136/bmjopen-2012-002348] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To compare real-world outcomes of initiating insulin glargine (GLA) versus neutral protamine Hagedorn (NPH) insulin among employees with type 2 diabetes mellitus (T2DM) who had both employer-sponsored health insurance and short-tem-disability coverages. DESIGN Retrospective cohort study. SETTING MarketScan Commercial Claims and Encounters/Health and Productivity Management Databases 2003-2009. PARTICIPANTS Adult employees with T2DM who were previously treated with oral antidiabetic drugs and/or glucagon-like-peptide 1 receptor agonists and initiated GLA or NPH were included if they were continuously enrolled in healthcare and short-term-disability coverages for 3 months before (baseline) and 1 year after (follow-up) initiation. Treatment selection bias was addressed by 2:1 propensity score matching. Sensitivity analyses were conducted using different matching ratios. PRIMARY AND SECONDARY OUTCOME MEASURES Outcomes during 1-year follow-up were measured and compared: insulin treatment persistence and adherence; hypoglycaemia rates and daily average consumption of insulin; total and diabetes-specific healthcare resource utilisation and costs and loss in productivity, as measured by short-term disability, and the associated costs. RESULTS A total of 534 patients were matched and analysed (GLA: 356; NPH 178) with no significant differences in baseline characteristics. GLA patients were more persistent and adherent (both p<0.05), had lower rates of hospitalisation (23% vs 31.4%; p=0.036) and endocrinologist visits (19.1% vs 26.9%; p=0.038), similar hypoglycaemia rates (both 4.4%; p=1.0), higher diabetes drug costs ($2031 vs $1522; p<0.001), but similar total healthcare costs ($14 550 vs $16 093; p=0.448) and total diabetes-related healthcare costs ($4686 vs $5604; p=0.416). Short-term disability days and costs were numerically lower in the GLA cohort (16.0 vs 24.5 days; p=0.086 and $2824 vs $4363; p=0.081, respectively). Sensitivity analyses yielded similar findings. CONCLUSIONS Insulin GLA results in better persistence and adherence, compared with NPH insulin, with no overall cost disadvantages. Better persistence and adherence may lead to long-term health benefits for employees with T2DM.
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Affiliation(s)
- Li Wang
- STATinMED Research, Ann Arbor, Michigan, USA
| | - Wenhui Wei
- Sanofi-aventis US, Bridgewater, New Jersey, USA
| | | | - Lin Xie
- STATinMED Research, Ann Arbor, Michigan, USA
| | - Onur Baser
- STATinMED Research, Ann Arbor, Michigan, USA
- The University of Michigan, Ann Arbor, Michigan, USA
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Jansà M, Vidal M, Giménez M, Conget I, Galindo M, Roca D, Colungo C, Esmatjes E, Salamero M. Psychometric analysis of the Spanish and Catalan versions of the Diabetes Self-Care inventory-revised version questionnaire. Patient Prefer Adherence 2013; 7:997-1005. [PMID: 24124352 PMCID: PMC3794847 DOI: 10.2147/ppa.s50271] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The purpose of this study was to validate the Spanish and Catalan versions of the Diabetes Self-Care Inventory-Revised Version (SCI-R) questionnaire to assess the degree of adherence to self-care among adults with diabetes. METHODS We validated the Spanish and Catalan translation from, and back translation to, English and cultural adaptation of the SCI-R in type 1 diabetes patients on multiple insulin doses or continuous subcutaneous insulin infusion and in type 2 diabetes patients on oral agents and/or insulin. Internal reliability, structural validity, and external validity (correlation with glycated hemoglobin) were evaluated. Responsiveness to change was assessed in patients 1 year after onset of type 1 diabetes and following a structured education program. RESULTS The SCI-R presented good internal reliability Cronbach's α: 0.75, test-retest reliability (r = 0.82) and structural validity (r > 0.40). The external validity was also good; the SCI-R correlated with HbA1c in patients with type 1 diabetes on multiple insulin doses (r = -0.50) or continuous subcutaneous insulin infusion (r = -0.66) and in patients with type 2 diabetes on multiple insulin doses (r = -0.62). However, it was not satisfactory in patients on oral agents (r = -0.20) and/or bedtime insulin (r = -0.35). Responsiveness to change was analyzed in 54 patients (age 27.3±7.4 years, 26% men, HbA1c 6.8% ±1.1%); the SCI-R score was 72.3% ±13.7% and correlated negatively with glycated hemoglobin (r = -0.42) and 3 scales of the Diabetes Quality of Life questionnaire (lower score indicating better perception): Impact (r = -0.37), Social Worry (r = -0.36) and Diabetes Worry (r = -0.38), all at P < 0.05. CONCLUSION The Spanish and Catalan versions of the SCI-R questionnaire show good psychometric properties and both could be considered as useful tools for evaluating self-care behavior in patients with type 1 or type 2 diabetes. However, there are still some subgroups of patients with type 2 diabetes in which the validity of this questionnaire needs further evaluation.
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Affiliation(s)
- Margarida Jansà
- Diabetes Unit, Endocrinology and nutrition, Hospital Clinic, Barcelona, Spain
- Correspondence: Margarida Jansà, Diabetes Unit, Endocrinology and nutrition, Institut Clinic de Malalties Digestives i Metabòliques Hospital Clinic, 170 Villarroel St, 08036 Barcelona, Spain, Tel +34 93 227 9846, Fax +34 93 451 6638, Email
| | - Mercè Vidal
- Diabetes Unit, Endocrinology and nutrition, Hospital Clinic, Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and nutrition, Hospital Clinic, Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and nutrition, Hospital Clinic, Barcelona, Spain
| | - Mercedes Galindo
- Endocrinology and nutrition Department, Hospital Clinico, Madrid, Spain
| | - Daria Roca
- Diabetes Unit, Endocrinology and nutrition, Hospital Clinic, Barcelona, Spain
| | | | - Enric Esmatjes
- Diabetes Unit, Endocrinology and nutrition, Hospital Clinic, Barcelona, Spain
| | - Manel Salamero
- Psychology Department, Hospital Clinic, Barcelona, Spain
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AlGhurair SA, Hughes CA, Simpson SH, Guirguis LM. A systematic review of patient self-reported barriers of adherence to antihypertensive medications using the world health organization multidimensional adherence model. J Clin Hypertens (Greenwich) 2012; 14:877-86. [PMID: 23205755 PMCID: PMC8108877 DOI: 10.1111/j.1751-7176.2012.00699.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 05/23/2012] [Accepted: 07/04/2012] [Indexed: 08/01/2023]
Abstract
Multiple barriers can influence adherence to antihypertensive medications. The aim of this systematic review was to determine what adherence barriers were included in each instrument and to describe the psychometric properties of the identified surveys. Barriers were characterized using the World Health Organization (WHO) Multidimensional Adherence Model with patient, condition, therapy, socioeconomic, and health care system/team-related barriers. Five databases (Medline, Embase, Health and Psychological Instruments, CINHAL, and International Pharmaceutical Abstracts [IPA]) were searched from 1980 to September 2011. Our search identified 1712 citations; 74 articles met inclusion criteria and 51 unique surveys were identified. The Morisky Medication Adherence Scale was the most commonly used survey. Only 20 surveys (39%) have established reliability and validity evidence. According to the WHO Adherence Model domains, patient-related barriers were most commonly addressed, while condition, therapy, and socioeconomic barriers were underrepresented. The complexity of adherence behavior requires robust self-report measurements and the inclusion of barriers relevant to each unique patient population and intervention.
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Affiliation(s)
- Suliman A. AlGhurair
- From the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Christine A. Hughes
- From the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Scot H. Simpson
- From the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Lisa M. Guirguis
- From the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
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Sanz G, Fuster V, Guzmán L, Guglietta A, Arnáiz JA, Martínez F, Sarria A, Roncaglioni MC, Taubert K. The fixed-dose combination drug for secondary cardiovascular prevention project: improving equitable access and adherence to secondary cardiovascular prevention with a fixed-dose combination drug. Study design and objectives. Am Heart J 2011; 162:811-817.e1. [PMID: 22093195 DOI: 10.1016/j.ahj.2011.08.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 08/19/2011] [Indexed: 01/31/2023]
Abstract
In spite of advances in prevention and treatment, the burden of cardiovascular diseases is increasing. A fixed-dose combination (FDC) pill, or "polypill," composed of evidence-based drugs has been proposed as a means of improving cardiovascular prevention by reducing cost and increasing patient adherence to treatment. The aim of the FOCUS project, funded by the 7th Framework Programme of the European Commission, is to characterize the factors that underlie inadequate secondary prevention and to test a new FDC. To achieve these goals, a 9-member consortium has been constituted, including institutions from Argentina, France, Italy, Spain, and Switzerland. FOCUS Phase-1 will examine factors potentially related to lack of adequate secondary prevention in 4,000 post-myocardial infarction (MI) patients and analyze the relationship between these factors and patient treatment adherence. Primary end points will be (1) the percentage of patients receiving aspirin, angiotensin-converting enzyme inhibitors, and statins and (2) adherence to treatment measured by the Morisky-Green test. FOCUS Phase-2 is a randomized trial that will compare adherence to treatment in 1,340 post-myocardial infarction patients either receiving an FDC comprising aspirin (100 mg), ramipril (2.5, 5, or 10 mg), and simvastatin (40 mg) or receiving the same 3 drugs separately.
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Affiliation(s)
- Ginés Sanz
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
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Ma C, Chen S, You L, Luo Z, Xing C. Development and psychometric evaluation of the Treatment Adherence Questionnaire for Patients with Hypertension. J Adv Nurs 2011; 68:1402-13. [DOI: 10.1111/j.1365-2648.2011.05835.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Eichenberger PM, Haschke M, Lampert ML, Hersberger KE. Drug-related problems in diabetes and transplant patients: an observational study with home visits. Int J Clin Pharm 2011; 33:815-23. [DOI: 10.1007/s11096-011-9542-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 07/11/2011] [Indexed: 11/30/2022]
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Sanz G, Fuster V. Polypill and Global Cardiovascular Health Strategies. Semin Thorac Cardiovasc Surg 2011; 23:24-9. [DOI: 10.1053/j.semtcvs.2011.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2011] [Indexed: 11/11/2022]
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Reach G. Obedience and motivation as mechanisms for adherence to medication: a study in obese type 2 diabetic patients. Patient Prefer Adherence 2011; 5:523-31. [PMID: 22114466 PMCID: PMC3218113 DOI: 10.2147/ppa.s24518] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [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
OBJECTIVE To clarify the mechanisms of adherence. METHODS A cross-sectional, multicenter French study using a self-questionnaire administered by 116 general practitioners to 782 obese type 2 diabetic patients. RESULTS The analysis of 670 completed questionnaires revealed a strong association between the adherence to medication and the behavior of fastening the seatbelt when seated in the rear of a car. Multivariate analysis indicated that this behavior was an independent determinant of adherence to medication (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.4-3.6, P < 0.001) with the same OR as the motivation to adhere to medical prescriptions (OR 2.2, 95% CI 1.3-3.6, P = 0.003) in a model with good accuracy (area under the receiver operating characteristic curve 0.774). A multiple correspondence analysis suggested that adherence to medication and seatbelt behavior are "homologous" behaviors, with homology between phenomena defined by the fact that they share a common etiology. CONCLUSION ADHERENCE MAY HAVE TWO DIMENSIONS: passive (obedience, the main determinant of seatbelt behavior) and active (motivation). This conclusion has theoretical and practical implications. Firstly, empowerment through patient education can be defined as a process that replaces the passive mechanism of adherence in patients' minds with an active, conscious choice. Secondly, recognizing these two dimensions may help to establish a tailored patient-physician relationship to prevent nonadherence.
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Affiliation(s)
- Gérard Reach
- Correspondence: Gérard Reach, Service d’Endocrinologie, Diabétologie, Maladies Métaboliques, Hôpital Avicenne APHP, 125 route de Stalingrad, 93000 Bobigny, France, Tel +33 1 4895 5158, Fax +33 1 4895 5560, Email
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Sanz G. Beyond Cholesterol in the Primary Prevention of Cardiovascular Disease: Is The Polypill the Answer? CURRENT CARDIOVASCULAR RISK REPORTS 2010. [DOI: 10.1007/s12170-010-0135-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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van Dulmen S. Moving forward to improve medication adherence. PATIENT EDUCATION AND COUNSELING 2010; 81:145-146. [PMID: 20850257 DOI: 10.1016/j.pec.2010.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 08/17/2010] [Indexed: 05/29/2023]
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