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Dugunchi F, Mudgal SK, Marznaki ZH, Shirafkan H, Abrotan S, Jafarian F, Pourkia R. Levels of adherence to treatment, illness perception and acceptance of illness in patients with coronary artery disease - descriptive and correlational study. BMC Cardiovasc Disord 2024; 24:171. [PMID: 38509506 PMCID: PMC10953129 DOI: 10.1186/s12872-024-03827-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/04/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Understanding the disease and its acceptance significantly influence adherence to prescribed medications, a critical aspect in managing coronary artery disease (CAD). This study is designed to explore the multifaceted factors influencing medication adherence specifically in CAD patients. Of particular interest is investigating the interconnectedness between medication adherence, the perception of illness, and the level of acceptance of the illness itself among these individuals. METHODS This cross-sectional study involved 280 confirmed CAD patients who were selected through a convenience sampling method adhering to predefined inclusion criteria. The study was conducted between March and September 2023. Three primary parameters-medication adherence, illness perception, and acceptance of illness-were evaluated using standardized tools: The Morisky Medication Adherence Scale-8, Illness Perception Questionnaire-Brief, and Acceptance of Illness Scale. Statistical analyses using SPSS (version 25) were used to analyze the data. RESULTS Patients had moderate illness perception (51.82 ± 7.58) and low acceptance to illness (16.98 ± 4.75), and 61.8 of them adhered to their medication regimen. A positive relationship between acceptance of illness and medication adherence (r = 0.435, p-value < 0.01) was found. Level of education, type of drug and marital status had significantly impact on medication adherence, and gender, level of education, intention to stop drug and marital status were associated with acceptance of illness (p < 0.05). CONCLUSION These results underscore the pivotal role of medication adherence in CAD management. Future interventions should target improving illness perception and acceptance of illness among CAD patients to enhance their overall adherence to prescribed medications and ultimately improve disease management.
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Affiliation(s)
- Farzad Dugunchi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Shiv Kumar Mudgal
- College of Nursing, All India Institute of Medical Sciences, Deoghar, India
| | - Zohreh Hosseini Marznaki
- Imam Ali Hospital, Amol, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran
| | - Hoda Shirafkan
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Saeed Abrotan
- Department of Cardiology, Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Fateme Jafarian
- Department of Cardiology, Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Roghayeh Pourkia
- Department of Cardiology, Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran.
- Department of Cardiology, School of Medicine, Babol University of Medical Sciences, Babol, Iran.
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Schäfer C. Reimagining Medication Adherence: A Novel Holistic Model for Hypertension Therapy. Patient Prefer Adherence 2024; 18:391-410. [PMID: 38370031 PMCID: PMC10870933 DOI: 10.2147/ppa.s442645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/14/2024] [Indexed: 02/20/2024] Open
Abstract
Purpose Patients' adherence to the prescribed therapy is influenced by several personal and social factors. However, existing studies have mostly focused on individual aspects. We took a holistic approach to develop a higher-level impact factor model. Patients and Methods In this independent, non-interventional, cross-sectional and anonymous study design the pharmacist recruited patients who entered the pharmacy and handed in a prescription for a blood pressure medication. The patients received a paper questionnaire with a stamped return envelope to volunteer participation. A total of 476 patients in Germany who reported having at least high normal blood pressure according to the Global Hypertension Practice Guidelines were surveyed. In this study, each patient received an average of 2.49 antihypertensive prescriptions and 7.9% of all patients received a fixed-dose combination. Partial least squares structural equation modeling was performed for model analytics since it enables robust analysis of complex relationships. Results Emotional attitude, behavioral control, and therapy satisfaction directly explained 65% of therapy adherence. The predictive power of the out-of-sample model for the Q2-statistic was significant. The patient's overall therapy satisfaction determined medication adherence. The medication scheme's complexity also influenced the adherence levels. Therapy satisfaction was significantly shaped by the complexity of the medication scheme, behavioral control, and emotional attitude. The results demonstrated the superior performance of fixed-dose combinations against combinations of mono-agents according to the adherence level. Additionally, patient-physician and patient-pharmacist relationships influenced behavioral control of medication therapy execution. According to the A14-scale to measure the level of adherence, 49.6% of patients were classified as adherent and the remainder as non-adherent. Conclusion The results enable healthcare stakeholders to target attractive variables for intervention to achieve maximum effectiveness. Moreover, the proven predictive power of the model framework enables clinicians to make predictions about the adherence levels of their hypertensive patients.
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Affiliation(s)
- Christian Schäfer
- Department of Business Administration and Health-Care, Baden-Württemberg Cooperative State University Mannheim (DHBW), Mannheim, Germany
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Sováriová Soósová M, Suchanová R, Parová V, Ulbrichtová A, Kopčová O, Rimárová K. Association Between Illness Perception and Adherence to Treatment in Slovak Patients With Hypertension: A Cross-sectional Study. J Cardiovasc Nurs 2023; 38:433-442. [PMID: 35420560 DOI: 10.1097/jcn.0000000000000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lack of adherence to treatment in patients with arterial hypertension leads to poor blood pressure control, increased morbidity and mortality, and increased costs to health and social care. Regular assessment of treatment adherence as well as factors influencing it is important to improve patient adherence and consequently increase treatment efficacy. Personal beliefs, particularly illness representations, are significant factors that influence adherence. OBJECTIVE The aim of this study was to assess the associations between adherence to treatment, illness perception, and selected sociodemographic and clinical characteristics in patients with arterial hypertension. METHODS In this cross-sectional observational study, 235 patients with arterial hypertension completed the Hill-Bone Compliance to High Blood Pressure Therapy Scale and the Brief Illness Perception Questionnaire. Associations between variables were assessed by Spearman ρ and multiple linear regression analysis. RESULTS Younger age, male gender, overall number of drugs used, and poorer beliefs related to the timeline, treatment control, and understanding were associated with higher levels of nonadherence. The final regression model significantly ( P ≤ .05) explained 19.4% of the variance in diet adherence, 5.0% in appointment keeping, and 17.8% in medication adherence. CONCLUSION Comprehensive care aimed at regular evaluation of illness perceptions with an emphasis on increasing understanding of the disease and its treatment and reducing patient worries and negative emotions seems to be a relevant strategy for improving adherence to antihypertensive treatment in everyday clinical practice.
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Baharvand P, Malekshahi F, Babakhani A. Perception of hypertension and adherence to hypertension treatment among patients attending a hospital in western Iran: A cross-sectional study. Health Sci Rep 2023; 6:e1501. [PMID: 37599662 PMCID: PMC10435721 DOI: 10.1002/hsr2.1501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023] Open
Abstract
Background and Aims Hypertension is the third leading cause of death in the world and is estimated to be increased by about 60% by 2025. Beliefs about hypertension can predict patient adherence to hypertension treatment. This study aims to investigate the perceptions of hypertension and adherence to hypertension treatment among patients in Khorramabad, Iran. Methods This is a descriptive/analytical study with a cross-sectional design. Participants were 265 patients with a history of hypertension referred to a hospital in Khorramabad, Lorestan Province in western Iran in 2020, who were selected using a convenience sampling method. A demographic form, the brief illness perception questionnaire-revised (BIPQ-R), and Morisky medication adherence scale (MMAS-8) were used for collecting data. The collected data were analyzed in SPSS v.22 software using descriptive statistics, Pearson's correlation test, independent t-test, one-way ANOVA, and regression analysis. Results The mean scores of BIPQ-R and MMAS-8 were 49.05 ± 15.45 (out of 80) and 3.69 ± 1.62 (out of 8), respectively. There was a significant relationship between the mean scores of MMAS-8 and BIPQ-R in total (p < 0.001). Perceptions of illness consequences (B = 4.59, p = 0.005), personal control (B = 0.190, p = 0.047), and symptoms (B = 1.77, p = 0.005) could significantly predict treatment adherence of patients. In illness perception, there were significant differences among patients with different places of residence (p = 0.032), educational levels (p = 0.001), and employment status (p = 0.010). In treatment adherence, there were significant differences among patients with different places of residence (p = 0.042) and educational levels (p = 0.045). Conclusion Treatment adherence of hypertensive patients in western Iran is at a low level, while their perception of hypertension is at a moderate level. Clinical physicians are recommended to pay attention to the perception of illness in these patients (especially unemployed and less educated patients living in rural areas) to improve their adherence to treatment and blood pressure control.
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Affiliation(s)
- Parastoo Baharvand
- Department of Social MedicineSocial Determinants of Health Research Center, School of Medicine, Lorestan University of Medical SciencesKhorramabadIran
| | - Farideh Malekshahi
- Department of Social MedicineSocial Determinants of Health Research Center, School of Medicine, Lorestan University of Medical SciencesKhorramabadIran
| | - Amirpourya Babakhani
- Department of Social MedicineSchool of Medicine, Lorestan University of Medical SciencesKhorramabadIran
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Kim H, Lingler JH, Bender CM, Albert SM, Sereika SM. Do Individuals Aged 50 or Older View Cognitive Conditions Differently Than Physical Conditions? Evidence From a Pooled Analysis of Illness Perceptions in Type 2 Diabetes and Mild Cognitive Impairment. Innov Aging 2023; 7:igad027. [PMID: 37128237 PMCID: PMC10148452 DOI: 10.1093/geroni/igad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Indexed: 05/03/2023] Open
Abstract
Background and Objectives Type 2 diabetes (T2DM) and mild cognitive impairment (MCI) are common late-life physical and cognitive health conditions. Illness perceptions, an individual's personal beliefs about the conditions, should be explored in the context of disease characteristics (physical or cognitive). This secondary analysis explored illness perceptions with a priori hypotheses about control (perceived controllability) and coherence (perceived understanding) dimensions among persons with T2DM and MCI, treating each as an exemplar of late-life physical and cognitive health conditions. We also explored whether age, education, and comorbid conditions moderate the relationships between T2DM or MCI condition groups and illness perceptions. Research Design and Methods This cross-sectional, descriptive study examined baseline data collected from 146 T2DM to 90 MCI participants in 2 independent studies. The 9-item Brief Illness Perception Questionnaire was used to identify the similarities and differences in illness perceptions among persons with T2DM and MCI. We performed hierarchical linear regression controlling for identified covariates. Results We found that T2DM and MCI participants had significantly different illness perceptions, including perceptions of personal control (b = -0.943, p = .009), treatment control (b = -1.619, p < .001), and coherence (b = -1.265, p = .001), after controlling for covariates. The results suggest that persons with MCI were likely to believe that their condition is less controllable (through their own strategies or medical treatment) and less understandable compared with their T2DM counterparts. Such associations remained statistically significant when the interactions were added to the models. Discussion and Implications As T2DM and MCI are prevalent late-life conditions, health care professionals should consider individuals' subjective perceptions about their conditions in the context of disease characteristics when counseling secondary prevention strategies for disease management. Further research on illness perceptions in other conditions is needed to ensure the replicability of our findings.
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Affiliation(s)
- Hyejin Kim
- Department of Adult Health and Gerontological Nursing, Rush University College of Nursing, Chicago, Illinois, USA
| | - Jennifer H Lingler
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
- Alzheimer’s Disease Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Catherine M Bender
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Susan M Sereika
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
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Adherence to Acromegaly Treatment and Analysis of the Related Factors-A Real-World Study in Bulgaria. Pharmaceutics 2023; 15:pharmaceutics15020438. [PMID: 36839760 PMCID: PMC9963513 DOI: 10.3390/pharmaceutics15020438] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
The purpose was to assess the level of medication adherence (MA) and related factors among individuals with acromegaly. The secondary goal was to assess the quality of life of patients and whether and how it correlates with the level of adherence. A prospective one-year study was conducted among patients with acromegaly diagnosed, treated, and monitored in the reference center for rare endocrine diseases in Bulgaria in 2021. Clinical data, patients reported outcomes, and health economics data were collected to define the predictors of non-adherence to medicines. Medication adherence level was assessed through a free Morisky-Green 4-item questionnaire. A total of 179 patients with acromegaly were observed. Approximately 62% were female, 50% were between 41 and 60 years, and the mean age at diagnosis was 40.4 years. The response rate to the questionnaires was 53% (n = 95; mean age 53.5 years, 73% female and 26% male). Patients with high levels of MA reported higher median values for the 36-Item Short Form Health Survey (SF-36) in comparison with those with low levels: 65.5 vs. 48.5 (p = 0.017). Similar results for EQ-5D-3L (3-level EuroQol 5D version) values and the level of MA were found: 0.656 vs. 0.796 (p = 0.0123). A low level of adherence was revealed in 34.7% of the patients, with no difference among different age groups. A significant positive determinant for adherence was years lived with acromegaly (OR = 5.625, 95% CI 1.7401-18.1832, p = 0.0039), as shorter duration was related to higher odds for high level of adherence. The current study demonstrates the importance of MA assessment for patients with acromegaly in Bulgaria. The medication adherence to the prescribed therapy among the observed group of patients with acromegaly varied as the percentage of adherent patients was around 65%. Still, there are low-adherent patients, and the responsible factors should be further investigated.
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Mobini S, Allahbakhshian A, Shabanloei R, Sarbakhsh P. Illness Perception, Self-Efficacy, and Medication Adherence in Patients With Coronary Artery Disease: A Path Analysis of Conceptual Model. SAGE Open Nurs 2023; 9:23779608231171772. [PMID: 37334063 PMCID: PMC10272659 DOI: 10.1177/23779608231171772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/02/2023] [Accepted: 04/07/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Illness perception and self-efficacy in patients with coronary artery disease (CAD) may affect medication adherence, which is one of the most important challenges in disease management in this group of patients. Objective The present study aimed to investigate the factors influencing medication adherence in CAD patients, especially the effect of illness perception and self-efficacy. Methods This study was cross-sectional and conducted from April to September 2021. A total of 259 patients with confirmed CAD were selected by convenience sampling method based on inclusion criteria. Illness perception, self-efficacy, and medication adherence were investigated using Brief IPQ, SCSES, and MARS_10 questionnaires, respectively. The data were analyzed using the STATA software (version 14) and the regression path analysis method. Results Patients had moderate illness perception and high self-efficacy, and 61.8 of them adhered to their medication regimen. Greater illness perception, better self-efficacy, and higher education had a positive effect on medication adherence, and increasing age had a negative effect on it. The final path model shows a good fit of the data in the model (χ2: 0.37, df: 274, χ2/df: 0.36, CFI: 1, IFI: 0.95, TLI: 1.07, and RMSEA: 0.00). Conclusion The results of the present study suggest that patients' illness perception can play an important role in predicting self-efficacy in disease management and the level of medication adherence in patients with CAD. To improve self-efficacy and medication adherence, future intervention studies should focus on the patient's illness perceptions and their improvement.
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Affiliation(s)
- Soheil Mobini
- Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Atefeh Allahbakhshian
- Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Reza Shabanloei
- Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Parvin Sarbakhsh
- Faculty of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
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Alfian SD, Annisa N, Perwitasari DA, Coelho A, Abdulah R. The role of illness perceptions on medication nonadherence among patients with hypertension: A multicenter study in indonesia. Front Pharmacol 2022; 13:985293. [PMID: 36225558 PMCID: PMC9549155 DOI: 10.3389/fphar.2022.985293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/29/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction: Nonadherence to antihypertensive medications is recognized as a significant cause of treatment failure. Therefore, identifying its underlying factors, particularly from the patient’s perspective, is essential for developing tailored intervention strategies. The objective of this study was to evaluate the associations between different domains of illness perception and medication nonadherence among patients with hypertension in Indonesia. Patients and methods: A multicenter cross-sectional study was conducted among patients with hypertension aged 18 years old and older who were using antihypertensive medications in the last 3 months in the community health centers in the three cities in Indonesia. The different domains of illness perception (e.g., consequences, timeline, personal control, treatment control, identity, concerns, comprehension, and emotional response) and medication nonadherence were assessed using a validated Brief Illness Perceptions Questionnaire (BIPQ) and Medication Adherence Report Scale (MARS), respectively. A logistic regression analysis was conducted to evaluate the associations between the different domains of illness perception and medication nonadherence adjusting for confounders. The odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Results: A total of 440 participants were included, whom 41.8% reported nonadherence to antihypertensive medications. The majority of the participants were females (64.3%) and aged between 60 and 69 years old (39.5%). The treatment control (OR: 0.80, 95% confidence interval: 0.7–10.90), patient’s comprehension of hypertension (OR: 0.89, 95% CI: 0.820–0.97), and patient’s emotions (OR: 0.93, 95% CI: 0.88–0.99) were significantly associated with medication nonadherence. No significant associations were observed between the other domains of illness perception and medication nonadherence. Conclusion: Different dimensions of illness perception were associated with non-adherence to antihypertensive medications. Educational interventions should be developed based on patients’ perception of their illness.
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Affiliation(s)
- Sofa D. Alfian
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
- *Correspondence: Sofa D. Alfian,
| | - Nurul Annisa
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Unit Clinical Pharmacy and Community, Faculty of Pharmacy, Universitas Mulawarman, Samarinda, Indonesia
| | - Dyah A. Perwitasari
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
| | - Andre Coelho
- Health and Technology Research Center (H&TRC), Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa (ESTeSL), Lisbon, Portugal
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
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Lee EKP, Poon P, Yip BHK, Bo Y, Zhu MT, Yu CP, Ngai ACH, Wong MCS, Wong SYS. Global Burden, Regional Differences, Trends, and Health Consequences of Medication Nonadherence for Hypertension During 2010 to 2020: A Meta-Analysis Involving 27 Million Patients. J Am Heart Assoc 2022; 11:e026582. [PMID: 36056737 PMCID: PMC9496433 DOI: 10.1161/jaha.122.026582] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Nonadherence to antihypertensive medications is the leading cause of poor blood pressure control and thereby cardiovascular diseases and mortality worldwide. Methods and Results We investigated the global epidemiology, regional differences, and trend of antihypertensive medication nonadherence via a systematic review and meta‐analyses of data from 2010 to 2020. Multiple medical databases and clinicaltrials.gov were searched for articles. Observational studies reporting the proportion of patients with anti‐hypertensive medication nonadherence were included. The proportion of nonadherence, publication year, year of first recruitment, country, and health outcomes attributable to antihypertensive medication nonadherence were extracted. Two reviewers screened abstracts and full texts, classified countries according to levels of income and locations, and extracted data. The Joanna Briggs Institute prevalence critical appraisal tool was used to rate the included studies. Prevalence meta‐analyses were conducted using a fixed‐effects model, and trends in prevalence were analyzed using meta‐regression. The certainty of evidence concerning the effect of health consequences of nonadherence was rated according to Grading of Recommendations, Assessment, Development and Evaluations. A total of 161 studies were included. Subject to different detection methods, the global prevalence of anti‐hypertensive medication nonadherence was 27% to 40%. Nonadherence was more prevalent in low‐ to middle‐income countries than in high‐income countries, and in non‐Western countries than in Western countries. No significant trend in prevalence was detected between 2010 and 2020. Patients with antihypertensive medication nonadherence had suboptimal blood pressure control, complications from hypertension, all‐cause hospitalization, and all‐cause mortality. Conclusions While high prevalence of anti‐hypertensive medication nonadherence was detected worldwide, higher prevalence was detected in low‐ to middle‐income and non‐Western countries. Interventions are urgently required, especially in these regions. Current evidence is limited by high heterogeneity. Registration URL: www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021259860.
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Affiliation(s)
- Eric K P Lee
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Paul Poon
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Benjamin H K Yip
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Yacong Bo
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Meng-Ting Zhu
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Chun-Pong Yu
- Li Ping Medical Library The Chinese University of Hong Kong Shatin Hong Kong
| | - Alfonse C H Ngai
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Martin C S Wong
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Samuel Y S Wong
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
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Alomari A, Alananzeh I, Lord H, Abdulla Al-Lenjawi B, Fernandez R. Medication Adherence Rate in Arab Patients With Cardiovascular Disease: A Systematic Review. J Transcult Nurs 2022; 33:632-641. [PMID: 35583032 DOI: 10.1177/10436596221095851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is one of the most common chronic illnesses in the Eastern Mediterranean. There have been few studies on medication adherence in Arab patients with CVD. AIM To investigate the rates and the reasons for medication adherence in Arab patients with CVD. METHODOLOGY The Joanna Briggs Institute methodology for prevalence systematic reviews was used. MEDLINE, EMCARE, CINAHL, Scopus, Science Direct, PsychINFO, and the Cochrane Central Register of Controlled Trials were searched. RESULTS Thirteen quantitative studies on medication adherence in Arab adult CVD patients were included.Pooled data from nine studies demonstrated that 53.2% (95% confidence interval = [51.2%, 55.1%]) of patients were adherent to their medications. Reasons for nonadherence to medication include personal factors, understanding, and complexity of treatment regimes, medication knowledge and structural barriers. CONCLUSION Medication adherence appears to have a social gradient, and families should be actively involved in future strategies to increase medication adherence.
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Affiliation(s)
| | | | - Heidi Lord
- South Eastern Sydney Local Health District, Kogarah, New South Wales, Australia
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Shiyanbola OO, Rao D, Kuehl S, Bolt D, Ward E, Brown C. Psychometric evaluation of a culturally adapted illness perception questionnaire for African Americans with type 2 diabetes. BMC Public Health 2022; 22:741. [PMID: 35418064 PMCID: PMC9007270 DOI: 10.1186/s12889-022-13172-2] [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: 08/14/2021] [Accepted: 03/31/2022] [Indexed: 11/29/2022] Open
Abstract
Background Diabetes is burdensome to African Americans, who are twice as likely to be diagnosed, more likely to develop complications and are at a greater risk for death and disability than non-Hispanic whites. Medication adherence interventions are sometimes ineffective for African Americans because their unique illness perceptions are not adequately addressed. The Illness Perception Questionnaire-Revised (IPQ-R) that assesses illness perceptions has shown reliability and validity problems when used with African Americans. Thus, the study objective was to adapt the IPQ-R for African Americans and assess the validity and reliability of the culturally adapted questionnaire. Methods The parent study used an exploratory sequential mixed methods design, to explore African Americans’ illness perceptions qualitatively, used the results to adapt the IPQ-R, and tested the culturally adapted IPQ-R items quantitatively. In this paper, a preliminary culturally adapted IPQ-R refined based on the qualitative study, was administered to 170 middle-aged United States-based African Americans with type 2 diabetes in a face-to-face survey. Content, construct, convergent, and predictive validity, including reliability was examined. Pearson and item-total correlations, item analysis, exploratory factor analysis, multiple linear regression analysis, and test-retest were conducted. Results A revised culturally adapted IPQ-R was identified with a 9-factor structure and was distinct from the old factor structure of the original IPQ-R. The ‘consequences’ domain from the IPQ-R occurred as two factors (external and internal consequences) while the ‘emotional representations’ domain in the IPQ-R emerged as separate ‘present’ and ‘future’ emotional representation factors. Illness coherence’ was differently conceptualized as ‘illness interpretations’ to capture additional culturally adapted items within this domain. Most items had factor loadings greater than 0.4, with moderate factor score correlations. Necessity and concern beliefs in medicines significantly correlated with domains of the culturally adapted IPQ-R. Pearson’s correlation values were not greater than 0.7, indicating good convergent validity. The culturally adapted IPQ-R significantly predicted medication adherence. None of the correlation values were higher than 0.7 for the test-retest, indicating moderate reliability. Most domains of the culturally adapted IPQ-R had Cronbach’s alpha values higher than 0.7, indicating good internal consistency. Conclusions The results provide preliminary support for the validity of the culturally adapted IPQ-R in African Americans with diabetes, showing good construct, convergent and predictive validity, as well as reliability. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13172-2.
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Affiliation(s)
- Olayinka O Shiyanbola
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, Madison, WI, 53705, USA.
| | - Deepika Rao
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, Madison, WI, 53705, USA
| | - Sierra Kuehl
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, Madison, WI, 53705, USA
| | - Daniel Bolt
- Department of Educational Psychology, University of Wisconsin-Madison, Madison, WI, USA
| | - Earlise Ward
- Department of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Carolyn Brown
- Division of Health Outcomes and Pharmacy Practice, University of Texas- Austin, Austin, TX, USA
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Thirunavukkarasu A, Naser Abdullah Alshahrani A, Mazen Abdel-Salam D, Homoud Al-Hazmi A, Farhan ALruwaili B, Awad Alsaidan A, Narapureddy BR, Muteb AL-Ruwaili A, Ghuwayli aljabri F, Khalaf Albalawi R, Alanazi KAF. Medication Adherence Among Hypertensive Patients Attending Different Primary Health Centers in Abha, Saudi Arabia: A Cross-Sectional Study. Patient Prefer Adherence 2022; 16:2835-2844. [PMID: 36303595 PMCID: PMC9592733 DOI: 10.2147/ppa.s388365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Optimal blood pressure control is achieved by medication adherence. This will reduce the risk of associated morbidities and mortalities. The present study aimed to determine medication adherence and its associated factors among hypertensive patients attending different primary health centers (PHC) in Abha, Saudi Arabia (KSA). METHODS A cross-sectional study was conducted among ten different PHCs in Abha, KSA. Simple random sampling procedure was utilized to choose 400 participants. A structured anonymous questionnaire was used in the present study. Analysis of the data was done using the SPSS program, version 23. A logistic regression statistical test was applied to identify the independent associated factors of medication adherence. Furthermore, we have applied Spearman's test to find the correlation between overall B-IPQ score and medication adherence score. RESULTS A total of 400 hypertensive patients responded in the present survey. More than one-third of the participants (36.3%) were in the high adherence category group, while the remaining participants (63.7%) were either low or medium adherence category. The binary logistic regression analysis revealed that low and medium adherence category is significantly associated with age (adjusted odds ratio [AOR] = 0.96, 95% CI =0.93-0.99, p = 0.021), married participants (AOR = 0.42, 95% CI =0.33-0.58, p = 0.001), residing at village (AOR = 1.49, 95% CI =1.14-1.73, p = 0.038), and participants with monthly family income of 5000 to 7000 SAR (AOR = 3.06, 95% CI =1.62-5.79, p = 0.001). A negligible positive correlation was revealed between illness perception and medication adherence. CONCLUSION The present study revealed that hypertensive patients poorly adhere to their antihypertensive medications. This low adherence is significantly associated with the age, monthly income, people living in rural areas, and married participants. The present study results recommend sustained efforts to implement health education programs and awareness-raising interventions targeted at hypertensive patients.
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Affiliation(s)
- Ashokkumar Thirunavukkarasu
- Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia
- Correspondence: Ashokkumar Thirunavukkarasu, Email
| | - Abdullah Naser Abdullah Alshahrani
- Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia
- Department of Public Health, Asir Health Affairs, Asir Region, Saudi Arabia
| | - Doaa Mazen Abdel-Salam
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmad Homoud Al-Hazmi
- Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia
| | - Bashayer Farhan ALruwaili
- Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia
| | - Aseel Awad Alsaidan
- Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia
| | - Bayapa Reddy Narapureddy
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Aliyah Muteb AL-Ruwaili
- Department of Public Health, Ministry of Health, Jouf Health Affairs, Sakaka, Aljouf, Saudi Arabia
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Chen H, Xu X, Peng J, Ge X, Zhang J, Dong Q, Jiang X, Li P. Warfarin Adherence Among Patients with Atrial Fibrillation in Rural Area of Dongyang, China: A Questionnaire-Based Study. Patient Prefer Adherence 2022; 16:2345-2352. [PMID: 36046498 PMCID: PMC9423105 DOI: 10.2147/ppa.s374808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Adherence to warfarin is associated with improved outcome in patients with atrial fibrillation (AF), but the adherence status of patients in rural areas of China is not known. METHODS A questionnaire-based study evaluating warfarin adherence of rural residents with AF was carried out in Dongyang, China. Potentially eligible patients were screened and contacted by telephone, and their demographic characteristics were collected. Illness perception was assessed using the Brief Illness Perception Questionnaire (BIPQ), and warfarin adherence was assessed using a Chinese-version adherence scale. Univariate and multivariate analyses were conducted to identify factors associated with unsatisfactory adherence. RESULTS A total of 201 patients (male, n=99; mean age, 70.3±8.12 years) were included, among whom 95 (47.3%) patients showed good adherence and 63 (31.3%) poor adherence. Number of co-dispensed drugs (multivariate analysis: odds ratio [OR]=3.64, 95% confidence interval [CI] 1.35-9.81, p=0.011) and BIPQ score (OR=1.25, 95% CI 1.17-1.33, p<0.001) were identified as factors associated with good adherence. CONCLUSION Medical adherence to warfarin needs to improve in rural patients with AF. Efforts that can reduce the number of co-dispensed drugs and increase illness perception may improve warfarin adherence. This study may benefit future management of warfarin administration to rural patients with AF.
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Affiliation(s)
- Huadong Chen
- Department of Pharmacy, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, People’s Republic of China
- Correspondence: Huadong Chen, Department of Pharmacy, Affiliated Dongyang Hospital of Wenzhou Medical University, 60th Wuning West Road, Dongyang, People’s Republic of China, Email
| | - Xing’e Xu
- Department of Pharmacy, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, People’s Republic of China
| | - Jiren Peng
- Department of Vasculocardiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, People’s Republic of China
| | - Xuan Ge
- Health Management Center, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, People’s Republic of China
| | - Jing’an Zhang
- Department of Pharmacy, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, People’s Republic of China
| | - Qianqian Dong
- Department of Pharmacy, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, People’s Republic of China
| | - Xiunan Jiang
- Department of Pharmacy, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, People’s Republic of China
| | - Piaopiao Li
- Department of Pharmacy, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, People’s Republic of China
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Illness Perceptions, Self-efficacy, and Self-reported Medication Adherence in Persons Aged 50 and Older With Type 2 Diabetes. J Cardiovasc Nurs 2021; 36:312-328. [PMID: 32304467 PMCID: PMC7572490 DOI: 10.1097/jcn.0000000000000675] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Illness perceptions, patients' beliefs about their health condition, may affect medication adherence as well as self-efficacy for managing the condition in type 2 diabetes (T2DM). OBJECTIVES The aims of this study were to investigate the associations between illness perceptions, self-efficacy, and self-reported medication adherence among persons (≥50 years of age) with T2DM and explore whether the number of comorbid conditions moderates these associations. METHODS This secondary analysis of cross-sectional data used baseline data from persons with T2DM. Self-administered questionnaires, including the Brief Illness Perception Questionnaire, Self-efficacy for Managing Chronic Disease, and the 4-item Morisky-Green-Levine Medication Adherence Scale, were used. We performed hierarchical multiple linear regression analyses. RESULTS Participants (N = 146) were 57.5% female, 67.1% white, and on average 64 years old. Six dimensions of illness perceptions (ie, consequences, personal control, treatment control, identity, concerns, and emotional representations) were associated with self-efficacy for managing T2DM. Five dimensions (ie, timeline, personal control, treatment control, coherence, and emotional representations) were significant predictors of self-reported medication adherence. Whereas the number of comorbid conditions was significantly associated with self-efficacy for managing T2DM in all models (P values < .001), the number of comorbid conditions was not associated with self-reported medication adherence. CONCLUSIONS This study suggests that illness perceptions and comorbid conditions may play a critical role in either self-efficacy or self-reported medication adherence in persons (≥50 years of age) with T2DM. Future research should incorporate an individual's illness perceptions and comorbid conditions into the development of interventions that may improve both self-efficacy and medication adherence in T2DM.
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Treatment Satisfaction Questionnaire for Medication (TSQM version 1.4): Ceiling and Floor Effects, Reliability, and Known-Group Validity in Brazilian Outpatients With Hypertension. Value Health Reg Issues 2020; 23:150-156. [PMID: 33158803 DOI: 10.1016/j.vhri.2020.07.578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/29/2020] [Accepted: 07/04/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Evaluate the acceptability, ceiling and floor effects, reliability, and known-group validity of the Brazilian version of the Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4 in patients with hypertension. METHODS The sample consisted of 300 hypertensive patients undergoing treatment in an outpatient department. The acceptability was evaluated from the items not answered in the TSQM. The reliability of the TSQM was estimated through Cronbach's alpha. Known-group validity tested whether the TSQM discriminates satisfaction between different stages of hypertension, diagnoses of left ventricular hypertrophy, medication adherence, and occurrence of side effects. RESULTS The TSQM had high acceptability (99% of participants answered all items). A substantial ceiling effect was found in the side effect (89%) and global satisfaction (29%) subscales. Reliability evaluated with Cronbach's alpha showed values >0.76 in all subscales. Known-group validity was supported with a statistically significant difference in patient satisfaction effectiveness between the hypertension groups and those without left ventricular hypertrophy. Regarding medication adherence, the TSQM was able to discriminate satisfaction in the side effect and global satisfaction subscales. A significantly higher satisfaction was found in all subscales of the TSQM in those patients without side effects. CONCLUSIONS The TSQM is a reliable and valid questionnaire to be used in Brazilians with hypertension.
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Biffi A, Rea F, Iannaccone T, Filippelli A, Mancia G, Corrao G. Sex differences in the adherence of antihypertensive drugs: a systematic review with meta-analyses. BMJ Open 2020; 10:e036418. [PMID: 32641331 PMCID: PMC7348648 DOI: 10.1136/bmjopen-2019-036418] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Poor worldwide rate of blood pressure control is largely due to poor adherence to antihypertensive (AHT) drug treatment. The question of whether sex affects adherence has long been debated but conflicting findings have been reported on this issue. Our objective was to evaluate sex differences in the adherence to AHT therapy. RESEARCH DESIGN AND METHODS Studies were identified through a systematic search of PubMed, CINAHL, PsycINFO, Web of Science and Google Scholar (through January 2020) and manual handsearching of relevant articles. Observational studies reporting adherence to AHT drugs measured by self-report or pharmacy refill prescription-based methods among men and women were included. Summarised estimates of ORs with 95% CIs were calculated using random-effects model and meta-regression models. RESULTS From 12 849 potentially relevant publications, 82 studies (15 517 457 men and 18 537 599 women) were included. No significant between-sex differences in adherence to AHT were observed, whether all study-specific estimates were summarised (ORs 1.04, 95% CI 1.00 to 1.09, p=0.07), nor estimates were pooled according to the method for measuring adherence. Among patients aged 65 years or older, lower self-reported adherence was observed in women (ORs 0.84, 95% CI 0.72 to 0.97, p=0.02), while the main result remained unchanged according to other subgroup analyses. CONCLUSIONS Definitive evidence of sex differences in adherence to AHT therapy cannot be drawn. Our little knowledge about factors affecting adherence, in particular of sex effect among elderly, urgently requires high-quality studies investigating these issues.
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Affiliation(s)
- Annalisa Biffi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milano, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
| | - Federico Rea
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milano, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
| | - Teresa Iannaccone
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Fisciano, Italy
| | - Amelia Filippelli
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Fisciano, Italy
| | - Giuseppe Mancia
- University of Milan-Bicocca, Milano, Italy
- Policlinico di Monza, Monza, Italy
| | - Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milano, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
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Shahin W, Kennedy GA, Cockshaw W, Stupans I. The role of refugee and migrant migration status on medication adherence: Mediation through illness perceptions. PLoS One 2020; 15:e0227326. [PMID: 31923264 PMCID: PMC6953853 DOI: 10.1371/journal.pone.0227326] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/17/2019] [Indexed: 01/20/2023] Open
Abstract
Background Illness perceptions may vary between different populations. This raises the question as to whether refugees and migrants of the same ethnic background have different perceptions. Understanding differences may have a significant impact on enhancing medication adherence in these groups. Objective The study examined the associations and differences between illness perceptions, and medication adherence in hypertensive Middle Eastern migrants and refugees. Methods Middle Eastern refugees and migrants (≥30 years old), with hypertension were recruited from Arabic community groups in Australia and asked to complete a cross-sectional survey. The survey consisted of basic socio-demographic and clinical profile, self-reported illness perceptions, and self-reported medication adherence. The outcome measure was the Medication Adherence Questionnaire. Simple mediation modelling was applied to examine the role of illness perceptions as a mediator between different migration statuses, and medication adherence. Results A total of 320 participants were recruited; 168 refugees, and 152 migrants. Educational level was found to be positively significantly associated with medication adherence in refugees, p = 0.003, while employed migrants were more likely to report higher adherence to hypertensive medication, p = 0.005. In both groups, there was a significant association between illness perceptions and medication adherence p = 0.0001. Significant differences were found between both groups regarding adherence and illness perceptions variables. Refugees had more negative illness perceptions and were less adherent than migrants. Illness perception was a mediator in the relationship between migration status and medication adherence; the unstandardized indirect effect was 0.24, and the 95% confidence interval ranged from (0.21–0.36). Conclusions To achieve better adherence to medications in vulnerable populations such as refugees, illness perceptions need to be understood, and differentiated from other populations, such as migrants from similar backgrounds. Patients’ education about illnesses and medications should be specific and targeted to each population. Interventional studies are recommended to modify refugees’ and migrants’ illness perceptions, to enhance medication adherence and wellbeing.
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Affiliation(s)
- Wejdan Shahin
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
- * E-mail:
| | - Gerard A. Kennedy
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Wendell Cockshaw
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Ieva Stupans
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
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Shakya R, Shrestha S, Gautam R, Rai L, Maharjan S, Satyal GK, KC B, Rai MK. Perceived Illness and Treatment Adherence to Hypertension Among Patients Attending a Tertiary Hospital in Kathmandu, Nepal. Patient Prefer Adherence 2020; 14:2287-2300. [PMID: 33244224 PMCID: PMC7685346 DOI: 10.2147/ppa.s270786] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/16/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Hypertension (HTN) is a silent killer, accountable for life-threatening complications. An individual's illness perception may affect adherence to treatment which is crucial to prevent complications of HTN. The objective of this study was to identify illness perception and treatment adherence among patients with HTN in a tertiary hospital in Kathmandu, Nepal. METHODS Descriptive correlational study was conducted in the out-patient department of Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu Nepal. Non-probability purposive sampling was used. A face-to-face interview was conducted from September to December 2018, using a structured questionnaire that included socio-demographic variables, illness perception questionnaire (revised) and Hill bone compliance to high blood pressure therapy scale. Data analysis was done by using descriptive and inferential statistics (chi-square test, Spearman rank correlation). RESULTS Among 204 participants, 51% were male, 77% were literate, mean ± S.D. age was 60±12. About 72% experienced headache and 88% said that headache is related to HTN. Behavioural factors and psychological factors were regarded as the leading cause of HTN. Almost 63% participants believed HTN as highly threatening illness. Higher scores in timeline (acute/chronic), personal control, and treatment control revealed that patients believed HTN as a chronic disease with a higher rate of personal and treatment control. Regarding treatment adherence, the mean score was 16.58 (SD = 2.08), and only 14.7% had perfect adherence. Participants were more adherent to medication and appointment keeping rather than reduce salt intake. Duration of HTN diagnosis (p=0.027) and duration under HTN medication (p= 0.021) were found to be significantly associated with treatment adherence. There was a significant positive correlation between illness perception and treatment adherence (ρ = 0.282, p<0.01). CONCLUSION Illness perception and treatment adherence are correlated. Hence, it is beneficial to improve illness perception to achieve perfect treatment adherence. Reinforcement is essential to maintain adherence to both medications and behaviour therapy.
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Affiliation(s)
- Rajina Shakya
- Department of Nursing, Nobel College, Pokhara University, Sinamangal, Kathmandu, Nepal
- Correspondence: Rajina Shakya Email
| | - Sunil Shrestha
- Department of Pharmacy, Nepal Cancer Hospital and Research Center, Lalitpur, Nepal
- Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Nepal
| | - Roshani Gautam
- Maharajgunj Nursing Campus, Tribhuvan University, Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | - Lalita Rai
- Maharajgunj Nursing Campus, Tribhuvan University, Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | | | - Gita Kumari Satyal
- Female Surgical Ward, Department of Nursing, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bhuvan KC
- School of Pharmacy, Monash University Malaysia, Subang Jaya47500, Selangor, Malaysia
- Bhuvan KC Email
| | - Mana Kumari Rai
- Maharajgunj Nursing Campus, Tribhuvan University, Institute of Medicine Maharajgunj, Kathmandu, Nepal
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Spikes T, Higgins M, Lewis T, Dunbar SB. The associations among illness perceptions, resilient coping, and medication adherence in young adult hypertensive black women. J Clin Hypertens (Greenwich) 2019; 21:1695-1704. [PMID: 31556484 PMCID: PMC6851441 DOI: 10.1111/jch.13712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/23/2019] [Accepted: 09/02/2019] [Indexed: 02/02/2023]
Abstract
Hypertension, a modifiable risk factor of cardiovascular disease, is largely responsible for the disproportionate morbidity and mortality in black women. Black women 20 years of age and older have a higher prevalence of HTN compared to white women (44% vs 28%). Poor adherence and non-adherence to hypertensive medications have been strongly indicated as a primary contributor to the early onset of disparity in cardiovascular disease morbidity and mortality experienced by black people. The purpose of this study was to examine medication adherence in black women relative to sociodemographic, clinical, cultural context, psychosocial, cognitive, and behavioral factors. This was a prospective, descriptive cross-sectional study of N = 85, hypertensive black women, with mean age of 39 ± 5.4 years, 18-45 years of age. Variables and measures included: sociodemographic characteristics, clinical, adverse social stressors, psychosocial, cognitive-behavioral factors, and medication adherence. Descriptive statistics, correlations, multivariate logistic regressions, and moderation analysis were tested. 81.2% (n = 69) of the sample was categorized as non-adherent. SBP was the only clinical covariate associated with HTN medication adherence. HTN illness perceptions, composite score, resilient coping, depressive symptoms, exposure to lifetime gender, and racial stressors, were not associated with HTN medication adherence. Using multivariate logistic regression, decreased SBP and lower scores on the "Consequence" dimension of the HTN illness perception scale were associated with medication adherence (χ2 = 10.53, P = .001). Adherence was associated with both the "Consequence" and "Identity" dimensions of the HTN illness perception scale indicating the need and importance for clinicians to have open and honest communication regarding HTN and its treatment in facilitating adherence.
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Affiliation(s)
- Telisa Spikes
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgia
| | - Melinda Higgins
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgia
- Rollins School of Public HealthEmory UniversityAtlantaGeorgia
| | - Tene’ Lewis
- Rollins School of Public HealthEmory UniversityAtlantaGeorgia
| | - Sandra B. Dunbar
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgia
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Shahin W, Kennedy GA, Stupans I. The impact of personal and cultural beliefs on medication adherence of patients with chronic illnesses: a systematic review. Patient Prefer Adherence 2019; 13:1019-1035. [PMID: 31303749 PMCID: PMC6611718 DOI: 10.2147/ppa.s212046] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/04/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients' adherence to therapeutic regimes may be influenced by subjective beliefs about chronic conditions. One of the challenges for health professionals in enhancing adherence is taking patients' understanding into account when giving health advice and/or providing medical treatment. PURPOSE This review aimed to evaluate the consequent effects of personal and cultural beliefs on medication adherence, in patients with chronic conditions such as hypertension, diabetes mellitus, chronic obstructive pulmonary disease and asthma. METHOD A systematic review methodology was used. PubMed, CINAHL, EMBASE and PsychINFO, databases were searched for relevant articles. The main terms analyzed were illness perceptions, health beliefs, cultural beliefs, chronic conditions and medication adherence. RESULTS From 2,646 articles, 127 were retained for further assessment, and finally 25 met the inclusion criteria. A cross-sectional questionnaire survey research design was conducted in all included articles. Of these most (n=22) targeted hypertension or diabetes mellitus. A number of personal and cultural based factors were identified as being associated with adherence to medication regimes - 40% of articles (n=10) examined perception of illness, 20% (n=5) health literacy, 16% (n=4) cultural beliefs, 12% (n=3) self-efficacy, 16% (n=4) spiritual and religious beliefs, as well as 20% (n=5) illness knowledge. Statistically significant associations between medication adherence and these personal and cultural factors were found in 80% (n=20) of the included studies. However, the direction of associations varied between studies depending on the factor that was examined. CONCLUSION This review has evaluated the impact of personal and cultural factors on medication adherence and highlighted the gaps in literature regarding adherence. Further research is required to fully identify the associations between religious beliefs, control beliefs and illness knowledge and medication adherence.
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Affiliation(s)
- Wejdan Shahin
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria3083, Australia
| | - Gerard A Kennedy
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria3083, Australia
| | - Ieva Stupans
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria3083, Australia
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Qvarnström M, Kahan T, Kieler H, Brandt L, Hasselström J, Wettermark B. Medication persistence to antihypertensive drug treatment – a cross-sectional study of attitudes towards hypertension and medication in persistent and non-persistent patients. Blood Press 2019; 28:309-316. [DOI: 10.1080/08037051.2019.1627858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Miriam Qvarnström
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lena Brandt
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hasselström
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Björn Wettermark
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Healthcare Development, Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden
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Cámara R, Venegas E, García-Arnés JA, Cordido F, Aller J, Samaniego ML, Mir N, Sánchez-Cenizo L. Treatment adherence to pegvisomant in patients with acromegaly in Spain: PEGASO study. Pituitary 2019; 22:137-145. [PMID: 30756345 DOI: 10.1007/s11102-019-00943-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE The burden of chronic daily subcutaneous administration of pegvisomant on adherence has not been previously studied. This study was aimed to determine the adherence to pegvisomant treatment in acromegaly patients in the real-world clinical practice setting in Spain. METHODS Multicenter, observational, descriptive, cross-sectional study in patients with acromegaly treated with pegvisomant for at least 12 months. Patient adherence was indirectly determined by Batalla and Haynes-Sackett questionnaires and directly by prescription record review. Additionally, treatment satisfaction was assessed by the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) and treatment convenience by an ad-hoc Pegvisomant questionnaire. Errors in reconstitution and administration process were determined by direct observation. RESULTS 108 patients were included in the analysis. Rates of adherence varied from 60.7 to 92.1% and did not correlate with disease control. Older patient age and alternative schedules other than daily pegvisomant dosing were associated with lower adherence. Treatment satisfaction and convenience was high, with a mean (SD) total SATMED-Q score of 74.6 ± 15.4 over 100 and a total ad-hoc Pegvisomant questionnaire score of 71.2 ± 15.2 over 100. 34.3% of patients made mistakes during the reconstitution /administration process. CONCLUSIONS Patient adherence to pegvisomant was high (60.7-92.1%), but more than a third of the patients in the study made mistakes during the administration process, with a potential impact on disease control. Besides dosing compliance, correct administration of medication should be carefully assessed in these patients.
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Affiliation(s)
- Rosa Cámara
- Hospital Universitario y Politécnico La Fe, Avenida de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Eva Venegas
- Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot, s/n, 41013, Sevilla, Spain
| | | | - Fernando Cordido
- Complejo Hospitalario Universitario A Coruña, As Xubias, 84, 15006, La Coruña, Spain
| | - Javier Aller
- Hospital Universitario Puerta de Hierro-Majadahonda, Calle Manuel de Falla, 1, 28222, Majadahonda, Madrid, Spain
| | - M Luz Samaniego
- TFS Statistical Services, Avda. Europa, 20B. Parque Empresarial La Moraleja, 28108, Alcobendas, Madrid, Spain
| | - Nuria Mir
- Pfizer S.L.U, Avda. Europa, 20B. Parque Empresarial La Moraleja, 28108, Alcobendas, Madrid, Spain
| | - Laura Sánchez-Cenizo
- Pfizer S.L.U, Avda. Europa, 20B. Parque Empresarial La Moraleja, 28108, Alcobendas, Madrid, Spain.
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Moreno Juste A, Gimeno Miguel A, Poblador Plou B, González Rubio F, Aza Pascual-Salcedo MM, Menditto E, Prados Torres A. Adherence to treatment of hypertension, hypercholesterolaemia and diabetes in an elderly population of a Spanish cohort. Med Clin (Barc) 2018; 153:1-5. [PMID: 30503066 DOI: 10.1016/j.medcli.2018.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/11/2018] [Accepted: 10/18/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Sub-optimal adherence to treatment in the general population has been highlighted in several studies, especially in the elderly and/or chronic patients. This study aims to describe the adherence to treatment of diabetes mellitus, dyslipidaemia and hypertension, and to identify the factors that influence adherence. MATERIAL AND METHOD Retrospective, cross-sectional observational study on 16,208 patients aged ≥65 years from the EpiChron Cohort who initiated monotherapy treatment of an antidiabetic, a lipid-lowering or an antihypertensive medication in 2010. Adherence was measured by calculating the medication possession ratio during one year, considering those cases with medication possession ratio ≥80% to be adherent. We performed a descriptive study, and a logistic regression model was used to identify the predictors of low adherence. RESULTS Adherence to antidiabetics, antihypertensive and lipid-lowering drugs was 72.4%, 50.7% and 44.3%, respectively. An increase in adherence of 3-8% was observed for each additional chronic disease suffered by the patient. The presence of mental illness did not affect adherence, and sex, age and number of prescribed drugs did not present consistent effects. CONCLUSION The results obtained show a sub-optimal adherence to treatment for the 3chronic diseases studied. Adherence increased with the number of chronic diseases, while sex, age and number of drugs did not show a consistent effect. It is necessary to investigate if there are other factors that may influence therapeutic adherence, since improving adherence may have a greater impact on health than any progress in therapies.
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Affiliation(s)
- Aida Moreno Juste
- Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, España; Servicio Aragonés de Salud (SALUD), Zaragoza, España.
| | - Antonio Gimeno Miguel
- Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, España
| | - Beatriz Poblador Plou
- Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, España
| | - Francisca González Rubio
- Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, España; Servicio Aragonés de Salud (SALUD), Zaragoza, España; Grupo de Trabajo de Utilización de Fármacos de la semFYC, España
| | - María Mercedes Aza Pascual-Salcedo
- Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, España; Servicio Aragonés de Salud (SALUD), Zaragoza, España
| | - Enrica Menditto
- CIRFF, Centro de Farmacoeconomía, Universidad de Nápoles Federico II, Nápoles, Italia
| | - Alexandra Prados Torres
- Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, España
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Miyazaki M, Nakashima A, Nakamura Y, Sakamoto Y, Matsuo K, Goto M, Uchiyama M, Okamura K, Mitsutake R, Urata H, Kamimura H, Imakyure O. Association between medication adherence and illness perceptions in atrial fibrillation patients treated with direct oral anticoagulants: An observational cross-sectional pilot study. PLoS One 2018; 13:e0204814. [PMID: 30265710 PMCID: PMC6161891 DOI: 10.1371/journal.pone.0204814] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 09/15/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the association between medication adherence and illness perceptions, and to explore the factors associated with poor medication adherence in atrial fibrillation (AF) patients receiving direct oral anticoagulants (DOACs) in a real-world clinical setting. METHODS An observational cross-sectional pilot study was conducted at a single Japanese university hospital. One hundred and twenty-nine patients who were diagnosed with AF and who were taking DOACs were recruited from outpatients between January 4th and April 25th, 2017. We evaluated medication adherence to DOACs using the Morisky Medication Adherence Scale-8 (MMAS-8) and illness perceptions using the Brief Illness Perception Questionnaire (BIPQ). The patients' characteristics and clinical data were collected from electronic medical records. RESULTS Ninety-nine (76.7%) patients (male, n = 74; mean age, 71.4±9.8 years) participated in this study. According to the MMAS-8, 21 (21.2%) of the patients were classified into the poor adherence group (MMAS-8 score of <6), and 78 (78.8%) were classified into the good adherence group (MMAS-8 score of 6-8). A multivariate logistic regression analysis revealed that age (per year, odds ratio [OR] 0.912, 95% confidence interval [CI] 0.853-0.965, p = 0.001), a history of warfarin use (OR 0.181, 95% CI 0.033-0.764, p = 0.019), duration of DOAC exposure (per 100 days, OR 1.245, 95% CI 1.084-1.460, p = 0.001), and the BIPQ emotional response score (per 1 point, OR 1.235, 95% CI 1.015-1.527, p = 0.035) were significantly associated with poor medication adherence in AF patients receiving DOACs. CONCLUSION Poor medication adherence to DOACs was strongly associated with a stronger emotional response (i.e. stronger feelings of anger, anxiety, and depression), as well as younger age, the absence of a history of warfarin treatment, and longer DOAC exposure. Further evaluation of the factors associated with medication adherence in AF patients and the development and execution of strategies for improving poor adherence are warranted in the real-world clinical setting.
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Affiliation(s)
- Motoyasu Miyazaki
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Akio Nakashima
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yoshihiko Nakamura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yuya Sakamoto
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Koichi Matsuo
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Miwa Goto
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Masanobu Uchiyama
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Keisuke Okamura
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Ryoko Mitsutake
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Hidenori Urata
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | | | - Osamu Imakyure
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
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25
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Rahmawati R, Bajorek B. Factors affecting self-reported medication adherence and hypertension knowledge: A cross-sectional study in rural villages, Yogyakarta Province, Indonesia. Chronic Illn 2018; 14:212-227. [PMID: 29119817 DOI: 10.1177/1742395317739092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives This study assessed medication adherence and hypertension knowledge, and their predictive factors, in people with hypertension, living in rural communities in Indonesia. Methods Data were acquired from 384 people living in eight rural villages via a researcher-administered questionnaire, a validated adherence scale, and a standardized hypertension knowledge survey. Multivariate analysis was used to identify the predictors of adherence and knowledge. Results Fifty-nine (15%) participants had good hypertension knowledge (score ≥ 8 out of 10). Compared to participants with poor knowledge, these participants had higher formal education (odds ratio = 2.7, 95% confidence interval = 1.5-4.7), and lived closer to a community health center (odds ratio = 1.8, 95% confidence interval = 1.0-3.3). Knowledge gaps about the need for long-term medication, hypertension complications, and the target blood pressure were identified. Good hypertension knowledge predicted good adherence to medication (odds ratio = 7.1, 95% confidence interval = 3.3-15.2). Only 42 (11%) participants were considered to have good adherence. Reasons for intentional nonadherence were beliefs that medicines should be taken only when symptoms are evident, limited access to healthcare services, and a preference using traditional medicines. Conclusion Strategies for addressing knowledge gaps and misconceptions about hypertension medication are needed, particularly for people with a low educational level and those living some distances from healthcare facilities.
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Affiliation(s)
- Riana Rahmawati
- 1 Graduate School of Health: Discipline of Pharmacy, The University of Technology Sydney, Sydney, Australia.,2 Pharmacology Department, Faculty of Medicine, Islamic University of Indonesia, Yogyakarta, Indonesia
| | - Beata Bajorek
- 1 Graduate School of Health: Discipline of Pharmacy, The University of Technology Sydney, Sydney, Australia.,3 Department of Pharmacy, Royal North Shore Hospital, Sydney, Australia
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26
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Jneid S, Jabbour H, Hajj A, Sarkis A, Licha H, Hallit S, Khabbaz LR. Quality of Life and Its Association With Treatment Satisfaction, Adherence to Medication, and Trust in Physician Among Patients With Hypertension: A Cross-Sectional Designed Study. J Cardiovasc Pharmacol Ther 2018; 23:532-542. [PMID: 29916266 DOI: 10.1177/1074248418784292] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Patients with hypertension tend to have a lower health-related quality of life (HRQOL) compared to normotensive patients. This study's main objectives are to assess (1) HRQOL and factors that might impact it and (2) association between HRQOL and adherence to treatment, trust in physician, and treatment satisfaction among patients with hypertension. METHODS A cross-sectional study enrolled 196 patients from medical-care offices in Beirut, North and South Lebanon. Eligible patients signed a consent form and were asked to complete the Trust in Physician Scale, World Health Organization Quality of Life-brief (WHOQOL-brief) questionnaire, and Treatment Satisfaction Questionnaire (TSQM 1.4) as well as questions assessing medication adherence. RESULTS Better antihypertensive medication adherence was significantly and positively correlated with better HRQOL domains except general health where significance was not reached ( P = .089). Better adherence was also significantly related to better treatment satisfaction (side effects, convenience, and global satisfaction but not to effectiveness) and an increased trust in physicians ( P < .0001). Better treatment satisfaction (TSQM domains) was significantly and positively associated with a better overall HRQOL ( P ≤ .001). Increased trust in physician scores were significantly and positively correlated with a better psychological health, environment, and overall HRQOL domains ( P = .045, .005, and .006, respectively). Finally, TSQM effectiveness, convenience, and global satisfaction were significantly higher when trust in physician was greater ( P = .017, .035, and .002, respectively). CONCLUSION The results of this study revealed an association between increased adherence to treatment, a higher global satisfaction, and an increased quality of life. An increased patient satisfaction with their antihypertensive treatment and trust in their physician were also correlated with a greater adherence to treatment.
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Affiliation(s)
- Siba Jneid
- 1 Pharmacology, Clinical Pharmacy and Quality Control Laboratory, Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon.,2 Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Hicham Jabbour
- 3 Anesthesia and Critical Care Department, Saint-Joseph University of Beirut, Beirut, Lebanon.,4 Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Aline Hajj
- 1 Pharmacology, Clinical Pharmacy and Quality Control Laboratory, Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon.,2 Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Antoine Sarkis
- 4 Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon.,5 Cardiology Department, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Hady Licha
- 6 Cardiology Department, Tennova Healthcare Hospital, Cleveland, TN, USA
| | - Souheil Hallit
- 2 Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon.,7 Faculty of Pharmacy, Lebanese University, Beirut, Lebanon.,8 Faculty of Medicine and Medical Sciences, Holy Spirit University, Kaslik, Lebanon.,9 Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,10 U1219 BPH Bordeaux Population Health Research Center Inserm, Université de Bordeaux, France.,11 INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - Lydia Rabbaa Khabbaz
- 1 Pharmacology, Clinical Pharmacy and Quality Control Laboratory, Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon.,2 Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon
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27
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Gerretsen P, Kim J, Shah P, Quilty L, Balakumar T, Caravaggio F, Plitman E, Chung JK, Iwata Y, Pollock BG, Dash S, Sockalingam S, Graff-Guerrero A. BASIS: The blood pressure awareness and insight scale. J Clin Hypertens (Greenwich) 2018. [PMID: 29524293 DOI: 10.1111/jch.13248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Impaired illness awareness or not accepting that one has hypertension (HTN) may be an important predictor of treatment adherence and optimal blood pressure control. The purpose of this study was to perform a systematic review of available instruments to evaluate HTN awareness, and subsequently present a novel scale that measures the core domains of subjective illness awareness in HTN. Based on the absence of any validated HTN specific measure identified through our review, the Blood Pressure Awareness and Insight Scale (BASIS) was developed (www.illnessawarenessscales.com). An online survey platform was used to collect data on 100 participants. BASIS showed good concurrent (r(98) = .65, P < 0.001) and discriminant validity, internal consistency (Cronbach's α = .75), and 1-month test-retest reliability (ICC = 0.77). BASIS is a comprehensive, easy-to-use instrument specifically designed to measure subjective HTN awareness. BASIS may be used in research studies and clinical practice to assess the impact of HTN awareness on treatment adherence and clinical outcomes.
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Affiliation(s)
- Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Geriatric Mental Health Division, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Lena Quilty
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Thushanthi Balakumar
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Eric Plitman
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jun Ku Chung
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Yusuke Iwata
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Bruce G Pollock
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Geriatric Mental Health Division, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Satya Dash
- Toronto General Hospital, University Health Network Toronto, Toronto, ON, Canada
| | - Sanjeev Sockalingam
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital, University Health Network Toronto, Toronto, ON, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Geriatric Mental Health Division, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
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28
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Berhe DF, Taxis K, Haaijer‐Ruskamp FM, Mulugeta A, Mengistu YT, Burgerhof JGM, Mol PGM. Impact of adverse drug events and treatment satisfaction on patient adherence with antihypertensive medication - a study in ambulatory patients. Br J Clin Pharmacol 2017; 83:2107-2117. [PMID: 28429533 PMCID: PMC5555859 DOI: 10.1111/bcp.13312] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/24/2017] [Accepted: 04/07/2017] [Indexed: 12/01/2022] Open
Abstract
AIMS The aim of the present study was to evaluate the impact of adverse drug events (ADEs) and treatment satisfaction on antihypertensive medication adherence. METHODS A cross-sectional study was conducted in six public hospitals in Ethiopia. We included adult ambulatory patients on antihypertensive medication. Adherence was measured using the eight-point Morisky Medication Adherence Scale, which categorizes as low (0-5), medium (6-7) and high (8) adherence. Treatment satisfaction was measured using the Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4, which included questions about ADEs. Data were analysed using generalized ordered logistic regression with 95% confidence intervals (CIs). RESULTS We included 925 out of 968 patients. Overall, 42% of patients scored low, 37% medium and 21% high adherence. Satisfaction with treatment was low, with a mean (standard deviation) TSQM score for global satisfaction of 51 (14). A total of 193 (21%) patients experienced 421 ADEs - mainly dyspeptic symptoms (12%), headache (11%) and cough (11). Experiencing more ADEs reduced the odds of being adherent [low vs. medium/high: odds ratio (OR) OR1 0.77 (95% CI 0.67, 0.89), and low/medium vs. high: OR2 0.55 (05% CI 0.41, 0.73)]. Being more satisfied increased the odds of being adherent [low vs. medium/high: OR1 1.02 (95% CI 1.01, 1.03)]. Taking medication >1 year [OR1 = 2 , 0.60 (95% CI 0.43, 0.83)] and taking calcium channel blockers [OR1 = 2 0.71 (95% CI 0.54, 0.92)] decreased the odds for both low vs. medium/high and low/medium vs. high adherence. CONCLUSIONS Only one in five patients reported perfect (high) adherence to their antihypertensive treatment regimen. Experiencing ADEs and being dissatisfied with treatment were associated with lower adherence. In addition to addressing treatment satisfaction and drug safety in first-world countries, these should also be addressed in resource-poor settings, within patient consultations, to enhance adherence.
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Affiliation(s)
- Derbew Fikadu Berhe
- Department of Clinical Pharmacy and Pharmacology, University of GroningenUniversity Medical Center GroningenThe Netherlands
- Department of Pharmacy, College of Health SciencesMekelle UniversityMekelleEthiopia
| | - Katja Taxis
- Department of Pharmacy, Unit Pharmacotherapy, ‐epidemiology and ‐economicsUniversity of GroningenGroningenThe Netherlands
| | - Flora M. Haaijer‐Ruskamp
- Department of Clinical Pharmacy and Pharmacology, University of GroningenUniversity Medical Center GroningenThe Netherlands
| | - Afework Mulugeta
- School of Public Health, College of Health SciencesMekelle UniversityMekelleEthiopia
| | - Yewondwossen Tadesse Mengistu
- Department of Internal Medicine, School of Medicine, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | - Johannes G. M. Burgerhof
- Department of Epidemiology, University of GroningenUniversity Medical Center GroningenThe Netherlands
| | - Peter G. M. Mol
- Department of Clinical Pharmacy and Pharmacology, University of GroningenUniversity Medical Center GroningenThe Netherlands
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29
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Assessment of patients' knowledge and practices regarding their medication use and risks in Lebanon. Int J Clin Pharm 2017; 39:1084-1094. [PMID: 28756580 DOI: 10.1007/s11096-017-0517-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
Abstract
Background Patients' knowledge of their medications play a pivotal role in their disease management. Objective Assess the knowledge and practices of Lebanese outpatients regarding their own medication use and risks. Setting Four hundred and sixty community pharmacies across Lebanon. Method It was a cross-sectional study performed from March through May 2016 among Lebanese outpatients, using a self-administered questionnaire. Descriptive statistics were used to calculate all participants' responses. The association between categorical variables were evaluated using Pearson χ2 test or Fisher's exact test. Binary logistic regressions were performed to identify factors associated with medication patients' knowledge and interest. Main outcome measure Ability of the patients to identify own medications' elements: name, strength, dosage regimen, indication, and adverse drug reactions. Results Our study comprised 921 patients, with around 16% taking ≥5 medications/day. Around 56% of our patients showed sub-optimal medication knowledge. Patients' higher educational level, number of chronic diseases, and patient physician interaction were associated with higher medication knowledge. Many patients admitted not discussing their medications each time they visit their physicians (38.7%); not reading the leaflet of each medication they take (61.2%); and not regularly asking their pharmacist about the potential interactions of OTC drugs with prescribed medications (53.9%). Conclusion This study showed suboptimal medication-related knowledge, and suboptimal patient's interactions with primary care givers. Our findings serve as a platform for healthcare providers to understand patients' needs and educate them about medication use and risks.
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30
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Yuguero O, Marsal JR, Esquerda M, Soler-González J. Occupational burnout and empathy influence blood pressure control in primary care physicians. BMC FAMILY PRACTICE 2017; 18:63. [PMID: 28499346 PMCID: PMC5429573 DOI: 10.1186/s12875-017-0634-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 05/01/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Good physician-patient communication can favor the adoption of healthy lifestyle habits, which is essential in high blood pressure (BP) management. More empathic physicians tend to have lower burnout and better communication skills. We analyzed the association between burnout and empathy among primary care physicians and nurses and investigated the influence on BP control performance. METHODS Descriptive study conducted in 2014 investigating burnout and empathy levels in 267 primary care physicians and nurses and BP control data for 301,657 patients under their care. We administered the Maslach Burnout Inventory and the Jefferson Scale of Physician Empathy and defined good BP control as a systolic BP <130 mmHg. RESULTS Low burnout and high empathy were observed in 58.8% and 33.7% of practitioners, respectively. Burnout and empathy were significantly negatively associated (p < 0.009). Practitioners with high empathy and low burnout had significantly better BP control and performance than those with low empathy and high burnout (p < 0.05). CONCLUSIONS Low burnout and high empathy were significantly associated with improved BP control and performance, possibly in relation to better physician/nurse-patient communication.
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Affiliation(s)
- Oriol Yuguero
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain. .,Regió Sanitària de Lleida. Institut Català de la Salut, Lleida, Spain.
| | - Josep Ramon Marsal
- Unitat de Suport a la Recerca Lleida. Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | | | - Jorge Soler-González
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Regió Sanitària de Lleida. Institut Català de la Salut, Lleida, Spain
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31
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Goldstein KM, Stechuchak KM, Zullig LL, Oddone EZ, Olsen MK, McCant FA, Bastian LA, Batch BC, Bosworth HB. Impact of Gender on Satisfaction and Confidence in Cholesterol Control Among Veterans at Risk for Cardiovascular Disease. J Womens Health (Larchmt) 2017; 26:806-814. [PMID: 28192012 DOI: 10.1089/jwh.2016.5739] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Compared with men, women have poorer lipid control. Although potential causes of this disparity have been explored, it is unknown whether patient-centered factors such as satisfaction and confidence contribute. We evaluated (1) whether satisfaction with lipid control and confidence in ability to improve it vary by gender and (2) whether sociodemographic characteristics modify the association. MATERIALS AND METHODS We evaluated baseline survey responses from the Cardiovascular Intervention Improvement Telemedicine Study, including self-rated satisfaction with cholesterol levels and confidence in controlling cholesterol. Participants had poorly controlled hypertension and/or hypercholesterolemia. RESULTS A total of 428 veterans (15% women) participated. Compared with men, women had higher low-density lipoprotein values at 141.2 versus 121.7 mg/dL, respectively (p < 0.05), higher health literacy, and were less likely to have someone to help track their medications (all p < 0.05). In an adjusted model, women were less satisfied with their cholesterol levels than men with estimated mean scores of 4.3 versus 5.6 on a 1-10 Likert scale (p < 0.05). There was no significant difference in confidence by gender. Participants with support for tracking medications reported higher confidence levels than those without, estimated mean 7.8 versus 7.2 (p < 0.05). CONCLUSIONS Women veterans at high risk for cardiovascular disease were less satisfied with their lipid control than men; however, confidence in ability to improve lipid levels was similar. Veterans without someone to help to track medications were less confident, and women were less likely to have this type of social support. Lack of social support for medication tracking may be a factor in lingering gender-based disparities in hyperlipidemia.
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Affiliation(s)
- Karen M Goldstein
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,2 Division of General Internal Medicine, Department of Medicine, Duke University Medical Center , Durham, North Carolina
| | - Karen M Stechuchak
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina
| | - Leah L Zullig
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,2 Division of General Internal Medicine, Department of Medicine, Duke University Medical Center , Durham, North Carolina
| | - Eugene Z Oddone
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,2 Division of General Internal Medicine, Department of Medicine, Duke University Medical Center , Durham, North Carolina
| | - Maren K Olsen
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,3 Department of Biostatistics and Bioinformatics, Duke University Medical Center , Durham, North Carolina
| | - Felicia A McCant
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina
| | - Lori A Bastian
- 4 VA Connecticut Healthcare System , West Haven, Connecticut.,5 Department of Medicine, Yale University , New Haven, Connecticut
| | - Bryan C Batch
- 6 Division of Endocrinology, Department of Medicine, Duke University Medical Center , Durham, North Carolina
| | - Hayden B Bosworth
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,2 Division of General Internal Medicine, Department of Medicine, Duke University Medical Center , Durham, North Carolina.,7 School of Nursing, Duke University School of Medicine , Durham, North Carolina.,8 Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham, North Carolina
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Shen Y, Peng X, Wang M, Zheng X, Xu G, Lü L, Xu K, Burstrom B, Burstrom K, Wang J. Family member-based supervision of patients with hypertension: a cluster randomized trial in rural China. J Hum Hypertens 2017; 31:29-36. [PMID: 26911532 PMCID: PMC5144121 DOI: 10.1038/jhh.2016.8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 01/17/2016] [Accepted: 01/21/2016] [Indexed: 02/02/2023]
Abstract
Empirical evidence has suggested that social support from family can help patients take their medicines correctly. This study aims to evaluate the role of a family member-based supervision package in the management of hypertension using a cluster randomized trial in rural China. We recruited patients with hypertension from four villages in Yangzhong and randomly allocated them to the control group (n=288) and the intervention group (n=266). A family member-based supervision package was applied to the intervention group, while the usual service was applied to the controls. Patients were followed for 12 months and completed face-to-face interviews at the end of 6 and 12 months. The primary outcomes were patients' medication adherence and frequency of blood pressure measurement. Secondary outcomes included changes in blood pressure, altered risk behaviours and occurrence of hypertension-related complications. To control for the effects of cluster randomization, multilevel mixed-effects regression models were used to compare group changes. We observed that the intervention improved patients' blood pressure measurement frequency (OR: 9.00, 95% CI: 4.52-17.91) and adherence to antihypertensive treatment (OR: 1.74, 95% CI: 0.91-3.32). Its effect on the blood pressure control rate was significant at the mid-term investigation (OR: 0.67, 95% CI: 0.40-0.93), but the long-term effect was not significant (OR: 0.89, 95% CI: 0.64-1.26). After 6 months of intervention, either systolic or diastolic blood pressure was significantly decreased in the intervention group. However, this difference was not significant at the final investigation. Findings from this study revealed that the family member-based supervised therapy may have positive effects on patients' adherence to blood monitoring and hypertensive medications.
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Affiliation(s)
- Y Shen
- Department of Gastrointestinal Surgery, Aoyoung Hospital, Zhangjiagang, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - X Peng
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - M Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - X Zheng
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - G Xu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - L Lü
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - K Xu
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - B Burstrom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - K Burstrom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - J Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
- The Innovation Center for Social Risk Governance in Health, School of Public Health, Nanjing Medical University, Nanjing, China
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Walsh CP, Prior JA, Chandratre P, Belcher J, Mallen CD, Roddy E. Illness perceptions of gout patients and the use of allopurinol in primary care: baseline findings from a prospective cohort study. BMC Musculoskelet Disord 2016; 17:394. [PMID: 27639692 PMCID: PMC5027094 DOI: 10.1186/s12891-016-1252-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/13/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Patients' perceptions of their illness are dynamic and can directly influence aspects of management. Our aim was to examine the illness perceptions of gout patients in UK primary care and associations with allopurinol use. METHODS A health questionnaire was sent to 1805 people with gout aged ≥18 years identified by a gout diagnosis or prescriptions for allopurinol or colchicine in their primary care medical records in the preceding 2 years. The questionnaire included selected items from the revised illness perception questionnaire (IPQ-R). Associations between illness perceptions and use of allopurinol were calculated using multinomial logistic regression adjusted for age, gender, deprivation status, body mass index, alcohol consumption, comorbidities and gout characteristics. RESULTS One thousand one hundred eighty-four participants responded to the baseline questionnaire (65.6 %). Approximately half of responders perceived that they were able to control (51.2 %) or affect their gout through their own actions (44.8 %). Three quarters perceived treatments to be effective (76.4 %) and agreed that gout is a serious condition (76.4 %). Patients who agreed that they could control their gout (Relative Risk Ratio, 95 % confidence interval 1.66 (1.12 to 2.45)) and that treatments were effective (2.24 (1.32 to 3.81)) were more likely to currently be using allopurinol than not using allopurinol. However, this significance was attenuated after adjustment for self-reported gout characteristics (1.39 (0.89 to 2.17) & 1.78 (0.96 to 3.29) respectively). CONCLUSIONS Patients who perceive that they can control their gout and that treatments are effective are more likely to be using allopurinol, this suggests that better information is needed for the patient from GPs and rheumatologist to reassure and support their use of ULT.
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Affiliation(s)
- Ciaran P Walsh
- Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - James A Prior
- Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.
| | - Priyanka Chandratre
- Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - John Belcher
- Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - Christian D Mallen
- Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - Edward Roddy
- Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
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Saarti S, Jabbour H, El Osta N, Hajj A, Khabbaz LR. Cross-cultural adaptation and psychometric properties of an Arabic language version of the Brief Illness Perception Questionnaire in Lebanon. Libyan J Med 2016; 11:31976. [PMID: 27282197 PMCID: PMC4901509 DOI: 10.3402/ljm.v11.31976] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/19/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Patients' positive illness perceptions (IPs) significantly contribute to treatment success. The Brief Illness Perception Questionnaire (Brief IPQ) is widely used in various diseases for assessing IPs. It was developed in English-speaking countries and studies on it in Arab countries are scarce. OBJECTIVES, SETTING AND DESIGN This observational cross-sectional study aimed to cross-culturally adapt the Brief IPQ English version into a modern Arabic language version and determine its psychometric properties in a sample of Lebanese cardiac disease patients. This study was approved by the Institutional Review Board of Saint Joseph University of Beirut, Lebanon. PARTICIPANTS A convenience sample of 30 patients with cardiac disease were recruited during routine visits to cardiologists' offices in Beirut, Lebanon. Inclusion criteria were at least one cardiac disease for at least 6 months with no acute episode or exacerbation of the disease during the 6 preceding months, age ≥ 18 years, and the ability to read and comprehend Arabic. The pre-final version of the Brief IPQ Arabic version was tested for face and content validity. The meaning, comprehensibility, and acceptability were studied by individual interviews. For discriminant validity and internal consistency of the Brief IPQ Arabic version (Brief IPQ-Ar), 100 patients were recruited in a similar manner using the same inclusion criteria. To assess reproducibility, 30 patients, selected randomly from the 100 patients, filled the questionnaire a second time, 3-4 weeks after its first administration and under the same conditions. MAIN OUTCOME MEASURES Psychometric properties of the Brief IPQ-Ar among Lebanese patients suffering from cardiac diseases. RESULTS Semantic equivalence between the Brief IPQ-Ar questions and patients' descriptions was 100%. Cronbach's alpha was 0.717, which shows good internal consistency. Reproducibility was satisfactory (ICC values>0.776). Moreover, the Brief IPQ-Ar discriminated participants according to the type of cardiac disease and treatment-related characteristics. CONCLUSIONS We confirm that the Brief IPQ-Ar is appropriate for exploring IPs in cardiac disease patients whose first language is Arabic. Further research should be conducted to test this Arabic version in other types of diseases.
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Affiliation(s)
- Stéphanie Saarti
- Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Faculty of Pharmacy, Saint Joseph University, Beirut, Lebanon
| | - Hicham Jabbour
- Department of Anesthesia and Critical Care, Hôtel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
- Department of Public Health, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Nada El Osta
- Department of Public Health, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
- Department of Prosthodontics, Faculty of Dental Medicine, Saint Joseph University, Beirut, Lebanon
| | - Aline Hajj
- Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Faculty of Pharmacy, Saint Joseph University, Beirut, Lebanon
- Faculty of Pharmacy, Saint Joseph University, Beirut, Lebanon
| | - Lydia Rabbaa Khabbaz
- Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Faculty of Pharmacy, Saint Joseph University, Beirut, Lebanon
- Faculty of Pharmacy, Saint Joseph University, Beirut, Lebanon;
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35
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Tan CSL, Teng GG, Chong KJ, Cheung PP, Lim AYN, Wee HL, Santosa A. Utility of the Morisky Medication Adherence Scale in gout: a prospective study. Patient Prefer Adherence 2016; 10:2449-2457. [PMID: 27980395 PMCID: PMC5144895 DOI: 10.2147/ppa.s119719] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The outcomes of any chronic illness often depend on patients' adherence with their treatment. A tool is lacking to assess adherence in gout that is standardized, allows real-time feedback, and is easy to understand. OBJECTIVE We set out to evaluate the utility of the 8-item Morisky Medication Adherence Scale (MMAS-8) in monitoring medication adherence in a multiethnic Asian gout cohort on urate-lowering therapy (ULT). METHODS This cohort study recruited patients with gout where baseline and 6-monthly clinical data, self-report of adherence, and health status by Gout Impact Scale (GIS) and EuroQoL-5 dimension 3 levels were collected. Those who received at least 9 months of ULT were analyzed. Convergent and construct validities of MMAS-8 were evaluated against medication possession ratio (MPR) and known groups, clinical outcomes, and patient-reported outcomes. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. RESULTS Of 91 patients, 92.3% were male, 72.5% Chinese with mean age 53.5 years. MMAS-8 (mean 6.17) and MPR (mean 96.3%) were poorly correlated (r=0.069, P=0.521). MMAS-8 did not differ between those who did or did not achieve target serum urate (SU) <360 µmol/L (P=0.852); or among those whose SU improved, stagnated, or worsened during follow-up (P=0.777). Adherence was associated with age (β=0.256, P=0.015) and education level (P=0.011) but not comorbidities, polypharmacy, or flare frequency. Concerns for medication side effects and anxiety or depression were associated with lower MMAS-8 (P<0.005). Internal consistency was acceptable (α=0.725) and test-retest reliability was satisfactory (ICC =0.70, 95% confidence interval [CI] 0.36-0.88). CONCLUSION MMAS-8 had limited construct validity in assessing medication adherence to ULT in our gout patients. Nevertheless, it identified patients bothered or worried about ULT side effects, and those with underlying anxiety or depression, for whom targeted education and coping support may be useful.
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Affiliation(s)
- CSL Tan
- University Medicine Cluster, Division of Rheumatology, National University Health System
| | - GG Teng
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
| | - KJ Chong
- Department of Medicine, Yong Loo Lin School of Medicine
| | - PP Cheung
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
| | - AYN Lim
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
| | - HL Wee
- Department of Pharmacy, Faculty of Science
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - A Santosa
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
- Correspondence: A Santosa, University Medicine Cluster, Division of Rheumatology, National University Health System, Level 10 Tower Block, 1E Lower Kent Ridge Road, Singapore 119228, Singapore, Fax +65 6872 4130, Email
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Chiolero A, Burnier M, Santschi V. Improving treatment satisfaction to increase adherence. J Hum Hypertens 2015; 30:295-6. [PMID: 26290276 DOI: 10.1038/jhh.2015.89] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- A Chiolero
- Chronic Diseases Division, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - M Burnier
- Service of Nephrology, Lausanne University Hospital, Lausanne, Switzerland
| | - V Santschi
- Service of Nephrology, Lausanne University Hospital, Lausanne, Switzerland.,La Source, School of Nursing Sciences, University of Applied Sciences Western Switzerland, Lausanne, Switzerland
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