Medication barriers and anti-hypertensive medication adherence: The moderating role of locus of control

Following Physician's Advice in Late Life: The Roles of Health Beliefs and Health Status

Objective

This study aims to explore the influence of health-related locus of control beliefs such as belief in the role of health professionals in influencing patient health, cognitive functioning, and multimorbidity on adherence to physician's recommendations among older adults.

Methods

A cross-sectional study involving older adults (N=684, age range = 71-100 years) living in Clearwater, Florida, reported their adherence to physician's recommendations, cognitive functioning, physical health, and health-related locus of control beliefs. Ordered Logistic regression was used.

Results

Older adults who believed that health professionals influence health and a person is likely to recover from illness because other people take good care of him/her had higher adherence to physician's recommendations. Older adults who believed that their own action affects their health had lower odds of reporting adherence by 27%. Additionally, those with cognitive impairment had lower odds of reporting adherence by 38%. Functional limitations, multimorbidity, and self-image of health were not associated with adherence.

Conclusion

This is one of the first studies to consider the influence of locus of control beliefs on adherence of physician's recommendations among community dwelling older adults. With the exception of one item "My good health is largely a matter of good fortune", generally individuals with external locus of control had higher adherence. Our findings also underscore the policy and clinical significance of different health-related beliefs held by older adults.

The Association of Health Locus of Control with Clinical and Psychosocial Aspects of Living with Multiple Sclerosis

Health Locus of control (LOC) refers to one's beliefs regarding control over one's health. This study aimed to determine the relationship between LOC on clinical and psychosocial aspects associated with multiple sclerosis (MS). 5059 participants with MS completed a questionnaire pack including the Multidimensional Health Locus of Control Scale. Associations between LOC and sociodemographic (age, gender, educational level) and clinical variables (duration, disability, depression, anxiety, self-efficacy, QoL) were explored. LOC was found to be significantly associated with all of the clinical variables and age, but not gender or educational level. When controlling for level of disability, Chance (CLOC) was associated with higher self-efficacy, lower anxiety and higher QoL than Powerful Others (PLOC), while Internal (ILOC) had no association. The proportion with ILOC preference was lower in increased disability. In MS, believing that health is controlled mainly by chance confers the most benefit with regard to quality of life. There is prima-facie evidence that LOC preference changes with MS progression, in a pattern that is protective against psychological distress.

Addressing Hypertension Outcomes Using Telehealth and Population Health Managers: Adaptations and Implementation Considerations

Purpose of Review

There is a growing evidence base describing population health approaches to improve blood pressure control. We reviewed emerging trends in hypertension population health management and present implementation considerations from an intervention called Team-supported, Electronic health record-leveraged, Active Management (TEAM). By doing so, we highlight the role of population health managers, practitioners who use population level data and to proactively engage at-risk patients, in improving blood pressure control.

Recent Findings

Within a population health paradigm, we discuss telehealth-delivered approaches to equitably improve hypertension care delivery. Additionally, we explore implementation considerations and complementary features of team-based, telehealth-delivered, population health management. By leveraging the unique role and expertise of a population health manager as core member of team-based telehealth, health systems can implement a cost-effective and scalable intervention that addresses multi-level barriers to hypertension care delivery.

Summary

We describe the literature of telehealth-based population health management for patients with hypertension. Using the TEAM intervention as a case study, we then present implementation considerations and intervention adaptations to integrate a population health manager within the health care team and effectively manage hypertension for a defined patient population. We emphasize practical considerations to inform implementation, scaling, and sustainability. We highlight future research directions to advance the field and support translational efforts in diverse clinical and community contexts.

An Active Inference Approach to Dissecting Reasons for Nonadherence to Antidepressants

BACKGROUND

Antidepressant medication adherence is among the most important problems in health care worldwide. Interventions designed to increase adherence have largely failed, pointing toward a critical need to better understand the underlying decision-making processes that contribute to adherence. A computational decision-making model that integrates empirical data with a fundamental action selection principle could be pragmatically useful in 1) making individual-level predictions about adherence and 2) providing an explanatory framework that improves our understanding of nonadherence.

METHODS

Here we formulated a partially observable Markov decision process model based on the active inference framework that can simulate several processes that plausibly influence adherence decisions.

RESULTS

Using model simulations of the day-to-day decisions to take a prescribed selective serotonin reuptake inhibitor, we show that several distinct parameters in the model can influence adherence decisions in predictable ways. These parameters include differences in policy depth (i.e., how far into the future one considers when deciding), decision uncertainty, beliefs about the predictability (stochasticity) of symptoms, beliefs about the magnitude and time course of symptom reductions and side effects, and strength of medication-taking habits that one has acquired.

CONCLUSIONS

Clarifying these influential factors will be an important first step toward empirically determining which factors are contributing to nonadherence to antidepressants in individual patients. The model can also be seamlessly extended to simulate adherence to other medications (by incorporating the known symptom reduction and side effect trajectories of those medications), with the potential promise of identifying which treatments may be best suited for different patients.

Health beliefs and medication adherence in patients with hypertension: A systematic review of quantitative studies

OBJECTIVE

This review synthesizes findings of quantitative studies examining the relationship between health beliefs and medication adherence in hypertension.

METHODS

This review included published studies in PubMed, CINHAL, EMBASE, and PsycINFO databases. Studies were included if they examined beliefs of patients with hypertension. Quality of the studies was evaluated using the Quality Assessment Tool for Systematic Review of Observational Studies.

RESULTS

Of the 1558 articles searched, 30 articles were included in the analysis. Most beliefs examined by studies of this review in relation to medication adherence were beliefs related to hypertension severity and susceptibility to its consequences, medication effectiveness or necessity, and barriers to medication adherence. Higher medication adherence was significantly related to fewer perceived barriers to adherence (e.g, side-effects) was fairly consistent across studies. Higher self-efficacy was related to higher medication adherence. Patients' beliefs and their relationship to medication adherence appear to vary unpredictably across and within countries.

CONCLUSION

Clinicians should assess beliefs for individual patients. When individual beliefs appear likely to undermine adherence, it may be useful to undertake educational interventions to try to modify them.

PRACTICAL IMPLICATIONS

Clinicians should explore individual patients' beliefs about hypertension and blood pressure medications, discuss their implications for medication adherence, and try to modify counterproductive beliefs.

Better understanding the influence and complexity of beliefs on medication adherence in asthma

OBJECTIVE

The aim was to better understand how beliefs influence medication adherence in asthma.

METHODS

All participants were prescribed an inhaled corticosteroid for a diagnosis of asthma. Each participant completed a survey consisting of: Beliefs about Medicines Questionnaire (BMQ), Brief-Illness Perception Questionnaire (B-IPQ) and Multi-dimensional Health Locus of Control Scale (MHLCS). Adherence to inhaled corticosteroids was elicited using the Medication Adherence Report Scale (MARS). Multiple linear regression with interaction effects was used to identify significant predictors of medication adherence and interactions between beliefs.

RESULTS

A total of 198 participants completed the survey. The mean(±SD) MARS score was 19.2(±4.5). A multivariable model (adjusted R² = 0.39) predicted adherence using: age, asthma hospitalisation, timeline (B-IPQ) subscale, necessity and concern (BMQ) subscales, doctor (MHLCS) subscale and the two interaction effects (concerns [BMQ] moderated by chance [MHLCS] and treatment control [B-IPQ] moderated by understanding [B-IPQ]).

CONCLUSION

The findings of this study contribute to a better understanding of the role of beliefs in medication adherence in asthma. Certain beliefs meaningfully interrelate and change the relationship they have with medication adherence.

PRACTICE IMPLICATIONS

If these beliefs are causally related to medication adherence and can be intervened upon, the findings are useful for providing targets to personalise adherence support.

Improving anti-platelet therapy adherence in the Veterans Health Administration: A randomized multi-site hybrid effectiveness-implementation study protocol

BACKGROUND

P2Y12 inhibitors are critical following percutaneous coronary intervention (PCI) with stent placement; they reduce the risk of stent thrombosis and myocardial infarction. Despite the importance of the therapy, non-adherence is common among Veterans.

METHODS AND RESULTS

Our main objective is to conduct a multi-site randomized stepped wedge trial to test the effectiveness of a multi-faceted intervention to improve adherence to P2Y12 inhibitors and PCI outcomes as well as formatively evaluate and refine the intervention implementation process. The primary outcomes of the study are the proportion of patients whose P2Y12 inhibitor prescription was filled at the time of hospital discharge following PCI with stent placement as well as the proportion of patients who were adherent based on the pharmacy refill data in the year after PCI hospital discharge. We will also assess the secondary outcomes such as bleeding, myocardial infarction, stroke, and mortality among these patients, and the cost-effectiveness of the intervention. The study was conducted at Veterans Health Administration (VA) PCI sites. At each site, we enrolled patients over a 6-month period and followed them for 12 months after PCI. Additionally, we collected qualitative data to identify contextual factors and to assess barriers and facilitators to the implementation and maintenance of the intervention.

CONCLUSIONS

The study will add to the current state of knowledge on improving medication adherence in patients receiving PCI with stent implantation. Moreover, the study includes an extensive examination of the implementation process and will contribute to the field of implementation science.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01609842 https://clinicaltrials.gov/ct2/show/NCT01609842?term=clopidogrel+adherence&cntry1=NA%3AUS&rank=1.

Adverse effects and non-adherence to antihypertensive medications in University of Gondar Comprehensive Specialized Hospital

Background

A considerable proportion of cardiovascular events could be attributed to poor adherence to antihypertensive medications. Adverse effects can be severe enough to affect adherence to antihypertensive medications. This study aimed to measure the contribution of adverse effects on antihypertensive medications adherence.

Methods

The study was conducted from May 1 to June 30, 2017, at the ambulatory clinic of University of Gondar Comprehensive Specialized Hospital (UOGCSH) in Gondar town. A binary logistic regression was performed to determine the significance of the association between adverse effects and adherence to antihypertensive medications. An institution-based cross-sectional study was conducted by administering a questionnaire to hypertensive patients who came for follow-up at the ambulatory clinic of UOGCSH. Level of adherence to antihypertensive medications was used as outcome measure.

Results

A total of 249 patients were included in the final analysis with a mean age of 56.51 years and a female majority (53%). The following variables were identified as predictors of poor adherence: tiredness [AOR (95% CI): 3.802 (1.723-8.391), p = 0.001], muscle pain [AOR (95% CI): 5.199 (1.407-19.214), p = 0.013], poor sleep [AOR (95% CI): 4.891 (1.578-15.160), p = 0.006] and, believing that the symptoms were caused by antihypertensive medications [AOR (95% CI): 3.249 (1.248-8.456), p = 0.016].

Conclusion

Adverse effect significantly contributes to antihypertensive medication non-adherence among hypertensive patients.

Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence

Background

Current health policies emphasize the need for an equitable doctor-patient relationship, and this requires a certain level of patient empowerment. However, a systematic review of the empirical evidence on how empowerment affects medication adherence—the extent to which patients follow the physician’s prescription of medication intake—is still missing. The goal of this systematic review is to sum up current state-of-the-art knowledge concerning the relationship between patient empowerment and medication adherence across medical conditions. As our conceptualization defines health locus of control and self-efficacy as being crucial components of empowerment, we explored the relationship between these two constructs and medication adherence.

Methods

Relevant studies were retrieved through a comprehensive search of Medline and PsychINFO databases (1967 to 2017). In total, 4903 publications were identified. After applying inclusion and exclusion criteria and quality assessment, 154 articles were deemed relevant. Peer-reviewed articles, written in English, addressing the relationship between empowerment (predictor) and medication adherence (outcome) were included.

Findings

High levels of self-efficacy and Internal Health Locus of Control are consistently found to promote medication adherence. External control dimensions were found to have mainly negative (Chance and God attributed control beliefs) or ambiguous (Powerful others attributed control beliefs) links to adherence, except for Doctor Health Locus of Control which had a positive association with medication adherence. To fully capture how health locus of control dimensions influence medication adherence, the interaction between the sub-dimensions and the attitudinal symmetry between the doctor and patient, regarding the patient’s control over the disease management, can provide promising new alternatives.

Discussion

The beneficial effect of patients’ high internal and concurrent physician-attributed control beliefs suggests that a so-called “joint empowerment” approach can be suitable in order to foster medication adherence, enabling us to address the question of control as a versatile component in the doctor-patient relationship.

Fatalism and hypertension prevalence, awareness, treatment and control in US Hispanics/Latinos: results from HCHS/SOL Sociocultural Ancillary Study

Compared with non-Hispanic whites, US Hispanics/Latinos display similar hypertension prevalence, but lower awareness, treatment, and control. Sociocultural factors may affect these patterns. Fatalism, the belief that health is predetermined by fate, relates to poorer adoption of risk reducing health behaviors. We examined the association of fatalism with hypertension prevalence, awareness, treatment, and control among 5313 Hispanics/Latinos, ages 18-74, who were enrolled from four US communities in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. After accounting for socioeconomic status and acculturation in logistic regression analyses, higher fatalism was associated with increased odds of hypertension (OR 1.14, 95 % CI 1.02, 1.28). This association was non-significant when diabetes and other health-related covariates were statistically adjusted. Fatalism was not associated with hypertension awareness, treatment, or control. Findings suggest that the association of fatalism with hypertension may be due largely to its association with SES, acculturation, or related health conditions.

Cultural Beliefs Underlying Medication Adherence in People of Chinese Descent in the United States

This article examines the meanings, practices, and cultural beliefs underlying medication adherence in people of Chinese descent living in the United States. The narratives were analyzed using interpretive phenomenology, resulting in the following themes that influenced the communication and behaviors around medication adherence of the participants: (a) cultural concepts of yin yang balance and "qi," (b) understandings of Western and Chinese medicine's efficacy profiles, (c) importance of family and social support, and (d) level of acculturation. This article discusses the influence of these themes on medication adherence and proposes that health communication campaigns, interventions, and doctor-patient communication about increasing medication adherence with people of Chinese descent should engage these understandings.

Medication adherence in Greek hemodialysis patients: the contribution of depression and health cognitions

BACKGROUND

Several studies have shown that non-adherence is a common and increasing problem among individuals with chronic illnesses, including hemodialysis patients.

PURPOSE

The present study aimed to investigate the influence of depression and health cognitions on medication adherence among patients undergoing hemodialysis.

METHOD

A sample of 168 participants was recruited from six general hospitals in the broader area of Athens, consisting of patients undergoing in-center hemodialysis. Measurements were conducted with the following instruments: the Medication Adherence Rating Scale, the Center for Epidemiologic Studies Depression Scale (CES-D), and the Multidimensional Health Locus of Control (MHLC) scale.

RESULTS

The results indicated that medication adherence was associated positively with the dimensions of internal and doctor-attributed health locus of control, measured by the MHLC. It was also related negatively to depression, measured by the CES-D.

CONCLUSIONS

The present study demonstrates the importance of depression in understanding the medication adherence of hemodialysis patients, as well as the contribution of heath cognitions.

Locus of control and anti-hypertensive medication adherence in Ghana

Introduction

Medication non-adherence is a major public health problem in Ghana. Locus of control (LoC) may influence adherence to medication. In this study we examine the association between locus orientation and adherence to hypertensive medication among adult patients. We also take into account the role of medication side effects.

Methods

We conducted a hospital-based cross-sectional study involving two tertiary hospitals in southern and northern Ghana. Data were collected from 400 hypertensive patients using a structured questionnaire. We gathered information on patient’s sociodemographic characteristics, health LoC, side effects of anti-hypertensive medication and adherence to anti-hypertensive medication.

Results

Participants exhibited features of mixed LoC (both internal and external) usually referred to as bi-local expectancy. However, orientation was skewed towards external LoC. Females were marginally more likely than males to have an internal LoC. Education was associated with a greater likelihood of internal LoC. While most patients (93.3%) poorly adhered to antihypertensive medications, logistic regression model revealed that non-adherence was significantly associated with low internal LoC, medication side effects and the combined effect of medication side effects and external LoC.

Conclusion

Medication non-adherence, experiences of medication side effects and LoC are associated. Multifaceted intervention programmes highlighting personality characteristics like LoC may improve anti-hypertensive medication adherence.

Patient and healthcare provider barriers to hypertension awareness, treatment and follow up: a systematic review and meta-analysis of qualitative and quantitative studies

Background

Although the importance of detecting, treating, and controlling hypertension has been recognized for decades, the majority of patients with hypertension remain uncontrolled. The path from evidence to practice contains many potential barriers, but their role has not been reviewed systematically. This review aimed to synthesize and identify important barriers to hypertension control as reported by patients and healthcare providers.

Methods

Electronic databases MEDLINE, EMBASE and Global Health were searched systematically up to February 2013. Two reviewers independently selected eligible studies. Two reviewers categorized barriers based on a theoretical framework of behavior change. The theoretical framework suggests that a change in behavior requires a strong commitment to change [intention], the necessary skills and abilities to adopt the behavior [capability], and an absence of health system and support constraints.

Findings

Twenty-five qualitative studies and 44 quantitative studies met the inclusion criteria. In qualitative studies, health system barriers were most commonly discussed in studies of patients and health care providers. Quantitative studies identified disagreement with clinical recommendations as the most common barrier among health care providers. Quantitative studies of patients yielded different results: lack of knowledge was the most common barrier to hypertension awareness. Stress, anxiety and depression were most commonly reported as barriers that hindered or delayed adoption of a healthier lifestyle. In terms of hypertension treatment adherence, patients mostly reported forgetting to take their medication. Finally, priority setting barriers were most commonly reported by patients in terms of following up with their health care providers.

Conclusions

This review identified a wide range of barriers facing patients and health care providers pursuing hypertension control, indicating the need for targeted multi-faceted interventions. More methodologically rigorous studies that encompass the range of barriers and that include low- and middle-income countries are required in order to inform policies to improve hypertension control.

The causal representation of outpatients with Crohn's disease: is there a link between psychological distress and clinical disease activity?

OBJECTIVES

Because of the fluctuating and occasional character of Crohn's disease (CD), patients have to cope with a changeable condition of health. Personal perceived control is known to be an important element of adaptation to their medical condition. The objectives of this work are to determine if perceived personal control is predictive of the clinical activity of the disease and of psychological distress (depression, anxiety).

METHODS

The Hospital Anxiety Depression Scale (HADS), the causal dimension scale and the Clinical Global Impression (CGI; assessing perceived severity) were administered to 160 patients affected by Crohn's disease. Indicators of inflammation (CRP), disease duration and clinical activity of the disease were also asessed.

RESULTS

Globally, CD patients perceive their disease as being personally neither controllable nor uncontrollable. Whereas psychological distress is significantly higher when the disease is active, the relationship between the variables appears complex. The feeling of personal control is explained by the clinical activity of the disease (p=.0001) and by the perception that CD is unstable (p<.00001) and globally impacts the life of patients (p=.001). Nevertheless perception of personal control does not explain the clinical activity of the disease. Finally, psychological distress is explained by the perception that the medical team is unable to control the disease (p=.00001) and by the global consequences of the disease on life (p<.005).

CONCLUSIONS

Psychological treatments should take these dimensions into account so as to improve the well-being and medical conditions of patients.

Obesity Modifies the Association of Race/Ethnicity with Medication Adherence in the CARDIA Study

OBJECTIVE

To assess associations between race/ethnicity and medication adherence, and the potential modifying effects of weight category (normal, overweight, obese) in a community-based sample.

STUDY DESIGN AND SETTING

We studied 1355 participants from the CARDIA (Coronary Artery Risk Development in Young Adults) study who were taking prescription medications in 2000-1. Medication adherence, as rated on the four-item Morisky medication adherence scale (score of 4 = maximum adherence), was reported for all participants.

RESULTS

The mean age ± SD of participants was 40 ± 3.6 years; 45% were African American and 36% were male. Overall, Whites had a higher proportion of maximum adherence than African Americans (59 vs 41%, respectively; p = 0.001). However, this difference was statistically significant only for participants within the normal weight category, of whom 54% of Whites were maximally adherent versus 35% of African Americans (p < 0.05). After adjustment for possible confounding covariates, race/ethnicity was associated with adherence only in those of normal weight: the odds ratio for maximum adherence in Whites versus African Americans of normal weight was 1.98 (95% CI 1.13, 3.47). Within race/ethnicity subgroups, weight category was associated with adherence in Whites but not in African Americans.

CONCLUSION

Weight category modifies the association of race/ethnicity with medication adherence. The high levels of non-adherence observed among African Americans and obese and overweight Whites bodes poorly for treatment of obesity-associated diseases such as cardiovascular disease or diabetes mellitus.

Association of age, health literacy, and medication management strategies with cardiovascular medication adherence

OBJECTIVE

To examine patients' use of medication management strategies (e.g., reminders, pill boxes), and to determine how their use influences the relationship between patient characteristics and medication adherence.

METHODS

Retrospective and cross-sectional study of 434 patients with coronary heart disease, examining both refill adherence and self-reported adherence.

RESULTS

The most common strategy for managing refills was seeing a near empty pill bottle (89.9%), and for managing daily medications, it was associating medications with daily events (80.4%). Age<65 (OR = 1.7), as well as marginal (OR = 2.0) or inadequate health literacy (OR = 1.9), was independently associated with low refill adherence. Patients <65 also had lower self-reported adherence (OR = 1.8). Adjustment for use of medication management strategies did not substantially change these relationships. Reliance on reminders from friends or family to take medications, or waiting to refill a medicine only when the bottle was near empty, each were associated with 3-fold greater odds of non-adherence.

CONCLUSION

Age <65 and marginal or inadequate health literacy were independently associated with medication non-adherence. Use of medication management strategies did not explain these relationships.

PRACTICE IMPLICATIONS

The strategies which patients report using to assist with managing medication refills and daily medication use may be ineffective.

[Drug compliance and health locus of control in schizophrenia]

Schizophrenia is a frequent disorder since it affects about 1% of the general population. Drug compliance, that is to say patients' adherence to their treatment, remains rather poor concerning this disease with, on an average, one patient out of two not complying with his/her medication. Among the factors influencing drug compliance, we focused on patients' beliefs in terms of health control, a concept known as health locus of control. This is a concept that originated from social psychology and derived from the Rotters' original concept of locus of control: it corresponds to the type of connexion established by an individual between subsequent events in the history of his/her disease and internal (personal abilities) or external factors (chance, powerful others). Nowadays, the tridimensional structure of this concept is commonly admitted as being in three dimensions: internality, chance externality and powerful others externality, the latter group being divided between doctors and others. We have assumed that there is a correlation between the degree of drug compliance and the internal and/or doctors' external health locus of control. For this purpose, we have determined the quality of drug compliance by using the Medical Adherence Rating Scale (MARS) and the type of health locus of control by using the Multidimensional Health Locus of Control (MHLC) scale among 65 schizophrenic patients. We have also considered it was important to evaluate patients' insight by using the Amador's scale (Scale of Unawareness of Mental Disorder) because many researchers have established a strong correlation between insight and drug compliance in schizophrenia. Associations between the four dimensions of health locus of control ("internal", "chance external", "others external" and "doctors' external") and drug compliance were assessed by estimating Spearman's rank correlation coefficient (r) and its degree of significance (p). These associations were judged significant at an alpha threshold of 5%, which corresponded to a level of p inferior to 0.05. Our results tend to confirm a statistically significant positive correlation between internal (r=0.25; p=0.043) and/or doctors' external (r=0.27; p=0.027) health locus of control and drug compliance. Conversely, there is no correlation between chance external or others' external health locus of control and drug compliance (p>0.05). This means that the more patients believe that their schizophrenia can be controlled by themselves and/or by doctors, the more they follow their prescriptions. Furthermore, the link between health locus of control and drug compliance appears to be confused by two dimensions of insight, namely awareness of the response to the treatment and perceived need for treatment. An application of these results is that, in the case of patients whose health locus of control is chance or others' external, it can be beneficial to attempt to change their beliefs in order to improve drug compliance. These results hold particular interest in the field of psycho-education and can be directly applied to cognitive therapy for beliefs among stabilized schizophrenic patients.

Antihypertensive Medication Adherence Among Elderly Chinese Americans

This study explored the level of antihypertensive medication adherence and examined certain demographic attributes and influential factors in relation to antihypertensive medication nonadherence among Chinese American elders using a descriptive cross-sectional survey design. Findings revealed that 52% of the elderly Chinese Americans adhered to their antihypertensive medications. Gender, education, years of residency in the United States, years of diagnosed hypertension, and perceived safety of taking antihypertensive medications did not contribute to the differences in medication adherence. Forgetfulness, medication adverse effects, language difficulties, and cultural barriers were the influential factors that hinder antihypertensive medication adherence. Developing effective and culturally appropriate strategies for Chinese American elders is recommended.

Low medication adherence and hypertension control among adults with CKD: data from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study

BACKGROUND

Low adherence to antihypertensive medication is an important barrier to achieving blood pressure control. Few data are available for medication adherence in adults with chronic kidney disease (CKD).

STUDY DESIGN

Cross-sectional.

SETTING & PARTICIPANTS

3,936 and 9,129 participants with and without CKD using antihypertensive medication in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study, respectively. CKD was defined as albuminuria with albumin excretion>or=30 mg/g or estimated glomerular filtration rate<60 mL/min/1.73 m2.

OUTCOMES

Medication adherence and uncontrolled hypertension.

MEASUREMENTS

Medication adherence was assessed using a validated 4-item scale. Blood pressure was measured 2 times by trained staff.

RESULTS

In REGARDS participants with and without CKD, 1,426 (36.2%) and 2,421 (26.5%) had uncontrolled hypertension with blood pressure>or=140/90 mm Hg, and 2,656 (67.5%) and 5,627 (61.6%), >or=130/80 mm Hg. Also, 27.7% of those with CKD and 27.9% of those without CKD responded "yes" to ever forgetting to take their medication and 4.4% and 4.2%, respectively, responded yes to being careless about taking their medication. Also, 5.7% and 5.3% responded yes to missing taking medication when they felt better, and 4.2% and 3.6%, to missing it when they felt sick. Overall, 23.3% and 23.7% of participants with and without CKD responded yes to 1 adherence question, whereas 7.7% and 7.2%, respectively, responded yes to 2 or more adherence questions. In those with CKD, the multivariable adjusted ORs for uncontrolled hypertension (blood pressure>or=140/90 mm Hg) for individuals answering yes to 1 and 2 or more versus 0 adherence questions were 1.26 (95% CI, 1.05-1.51) and 1.49 (95% CI, 1.12-1.98), respectively. Analogous ORs for systolic/diastolic blood pressure>or=130/80 mm Hg were 1.06 (95% CI, 0.78-1.45) and 1.20 (95% CI, 0.88-1.64).

LIMITATIONS

Pharmacy fill data were not available.

CONCLUSIONS

Individuals with CKD had similarly poor medication-taking behaviors as those without CKD.

Views on treatment necessity, harm, and benefits in patients using statins

BACKGROUND

Patients with dyslipidemia and high overall risk of ischemic heart disease are those most likely to benefit from treatment with statins. The objective of this study was to investigate patients' views of the necessity, harm, and expected benefits of their statin treatment, as well as factors associated with these treatment beliefs. One main objective was to investigate whether cardiovascular risk level and previous coronary heart disease affect the way patients view these different aspects of their medication.

METHODS

A total of 829 statin users were recruited while visiting a pharmacy to collect their statin medication (response rate, 69.4%). Patients returned a questionnaire assessing their medical history, concurrent risk status, social demographic factors, as well as their views and expectations regarding their statin treatment.

RESULTS

Previous ischemic heart disease, or high risk of such disease, was not associated with a more favorable notion on statin treatment. Having an internal health locus of control as well as being satisfied with the physician's treatment explanation were factors associated with more positive views on expected treatment effect. The views on necessity, harm, and treatment benefit were closely associated with each other.

CONCLUSION

The main findings in this study suggest that cardiovascular risk level and previous coronary heart disease are not associated with the way patients value potential benefits of statin treatment. Patients' views of the treatment's necessity, harm, and benefits do not seem to be independent dimensions of patient beliefs but rather represent one overall question: is this good for me?

Applying qualitative methods in developing a culturally tailored workbook for black patients with hypertension

OBJECTIVE

To apply qualitative research methods in developing a culturally tailored, educational workbook for hypertensive black patients.

METHODS

The workbook was developed using formative qualitative data from 60 black primary care patients with hypertension. Participants were interviewed using qualitative methods and data were analyzed through sequential steps of open coding, axial coding, and selective coding. From these analyses, themes describing patients' cultural beliefs about hypertension were derived and used to develop the workbook.

RESULTS

The workbook, "Living With Hypertension: Taking Control" is a 37-page illustrated workbook with 11 chapters based on patients' perceptions of hypertension. These chapters focus on strengthening participants' ability to take control and manage hypertension and on providing knowledge and health behavior techniques.

CONCLUSION

Qualitative research methods were used to inform the development of a culturally tailored educational workbook.

PRACTICE IMPLICATIONS

The workbook developed in this study may offer a practical and effective means of educating patients about blood pressure control in primary care settings.

Autonomous regulation and locus of control as predictors of antiretroviral medication adherence

The purpose of the current study was to examine the interrelationships between autonomous regulation (AR) and locus of control (LOC) and their prediction of Antiretroviral Therapy (ART) adherence among 189 HIV+ patients. Path analyses revealed that neither AR nor LOC directly predicted adherence although AR was indirectly related when mediated by self-efficacy. AR was positively related to internal and doctors LOC, but not related to chance or others LOC. Overall, results support Self-determination Theory's conceptualization of AR and indicate that AR may be a more robust predictor of medication adherence than LOC variables.