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Ferreira PD, Simoes JA, Velho DC. Adherence to Antihypertensive Therapy and Its Determinants: A Systematic Review. Cureus 2024; 16:e59532. [PMID: 38826951 PMCID: PMC11144025 DOI: 10.7759/cureus.59532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
Hypertension is a globally prevalent condition, and low adherence to antihypertensive therapy is considered one of the main causes of poor blood pressure (BP) control. Non-adherence to antihypertensive treatment is a complex issue that can arise from various factors; however, gaining an understanding of this provides key targets for intervention strategies. This study aimed to provide an overview of the current status and recent developments regarding our understanding of the determinants of patients' adherence to antihypertensives. A systematic review was performed using the electronic databases MEDLINE/PubMed, Web of Science, Scientific Electronic Library Online (SciELO), and "Índex das Revistas Médicas Portuguesas", which included studies published between 2017 and 2021 following the PICOS model: (P) Adult patients with the diagnosis of primary hypertension, using at least one antihypertensive agent; (I) all interventions on both pharmacological and non-pharmacological level; (C) patient's adherence against their non-adherence; (O) changes in adherence to the therapeutic plan; and (S) any study design (except review articles) written in English, French, Spanish or Portuguese. Articles were reviewed by two researchers and their quality was assessed. Subsequently, determinants were classified according to their consistent or inconsistent association with adherence or non-adherence. Only 45 of the 635 reports identified met the inclusion criteria. Adherence was consistently associated with patient satisfaction with communication, patient-provider relationship, their treatment, and use of eHealth and mHealth strategies; a patient's mental and physical health, including depression, cognitive impairment, frailty, and disability, previous hospitalization, occurrence of vital events; drug treatment type and appearance; and unwillingness due to health literacy, self-efficacy, and both implicit and explicit attitudes towards treatment. There were discrepancies regarding the association of other factors to adherence, but these inconsistent factors should also be taken into account. In conclusion, the barriers to adherence are varied and often interconnected between socioeconomic, patient, therapy, condition, and healthcare system levels. Healthcare teams should invest in studying patients' non-adherence motives and tailoring interventions to individual levels, by using a multifaceted approach to assess adherence. Further research is needed to analyze the impact of implicit attitudes, the use of new technological approaches, and the influence of factors that are inconsistently associated with non-adherence, to understand their potential in implementing adherence strategies.
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Affiliation(s)
| | - Jose A Simoes
- Department of Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilhã, PRT
| | - Denise C Velho
- Family Medicine, ULS de Leiria, USF Santiago, Leiria, PRT
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McSorley VE, Howard C, Shah RC, James BD, Boyle P, Barnes LL. The Relationship of John Henryism With Cognitive Function and Decline in Older Black Adults. Psychosom Med 2022; 84:766-772. [PMID: 35980784 PMCID: PMC9437121 DOI: 10.1097/psy.0000000000001113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE This study aimed to investigate the relationship between John Henryism, a psychological trait typified by high-effort active coping that has been associated with adverse health outcomes among Blacks, and cognitive decline. METHODS In a cohort of community-dwelling older Black adults ( N = 611), we investigated the relationship between John Henryism and cognitive decline. John Henryism was measured using the John Henryism Active Coping Scale (JHACS), a nine-item validated measure of self-reported high-effort coping (mean [standard deviation] = 16.9 [4.8]; range, 4-27). We implemented a three-step modeling process using mixed-effects models to assess the relationship between the JHACS and global cognitive function as well as five cognitive domains. We adjusted for demographics and for factors known to be associated with cognitive function and decline including vascular risk factors, discrimination, and income. RESULTS The trait of high-effort active coping was associated with lower-average cognitive function ( β = -0.07, 95% confidence interval = -0.10 to -0.03), but not with decline. The results remained after further adjustment for experiences of discrimination, income, and vascular risk factors. In domain-specific analyses, we found that the JHACS was associated with baseline levels of working memory, semantic memory, and visuospatial ability, but not decline. CONCLUSIONS These results highlight the importance of using culturally specific measures in considering the heterogeneity of cognitive health outcomes in minoritized populations. Understanding how stress responses relate to late-life cognition among older Black adults could help promote aspects of behavioral resilience along with healthful coping responses.
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Affiliation(s)
- V. Eloesa McSorley
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Christopher Howard
- Department of Psychology, Utah State Hospital
- Department Brigham Young University
| | - Raj C. Shah
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Family Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Bryan D. James
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Patricia Boyle
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
- Department Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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Orozco A, Cardoner N, Aragón CF, Ruiz-Murugarren S, Vicens M, Álvarez-Mon MÁ, Lahera G. Obsessive-compulsive symptoms in anxiety and depressive disorders: Influence of recent and/or traumatic life events. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2021; 14:218-226. [PMID: 34861930 DOI: 10.1016/j.rpsmen.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/03/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A high prevalence of obsessive-compulsive symptoms (OCSs) in anxiety-depressive disorders ranging from 30 to 67% has been described. OBJECTIVE This study aims to assess the presence and persistence of OCSs in an outpatient sample of subjects with anxiety and depressive disorders, as well as its relationship with recent life events (RLEs) and/or traumatic experiences (TEs). METHOD We conducted a prospective, observational, analytical study of 200 subjects with DSM-5 diagnoses of anxiety and/or depression. Participants were included by consecutive sampling and were evaluated at baseline and after 6-12 months (mean 8.5 months) of follow-up. The severity of the symptoms was assessed through the Hamilton Anxiety Scale (HARS) and Hamilton Scale for the evaluation of depression (HRSD-17), and comorbidity was assessed through the International Neuropsychiatric Interview (MINI). The Revised Inventory of Obsessions and Compulsions (OCI-R), the Recent Vital Changes Questionnaire (CVSV), and the Diagnostic Scale for Post-Traumatic Stress (PDS) were also administered. RESULTS 54% of the sample presented OCSs, and 30.5% presented one or more TEs throughout life. At the baseline visit, the presence of OCSs was associated with the severity of depressive symptoms (p=0.028), the presence of TEs (p<0.01), symptoms of post-traumatic stress disorder (p<0.01) and the number of RLEs (p<0.01). Response rate at follow-up was 38%, and persistence of OCSs was found in 60.5% of patients, independent of depressive or anxious symptoms, but was associated with the number of RLEs (p<0.01). CONCLUSION The presence of OCSs in patients with anxiety and depressive disorders is frequent and persistent. Anxious-depressive patients with a history of TEs and RLEs had higher OCS levels. These findings highlight the importance of early detection and the use of therapeutic strategies focused on resilience to stress and trauma.
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Affiliation(s)
- Arantxa Orozco
- Príncipe de Asturias University Hospital, Alcalá, Madrid, Spain
| | - Narcís Cardoner
- Hospital Universitario Parc Taulí Sabadell, Barcelone, Spain
| | | | | | - María Vicens
- Príncipe de Asturias University Hospital, Alcalá, Madrid, Spain
| | - Miguel Ángel Álvarez-Mon
- Faculty of Medicine, University of Alcalá, Madrid, Spain; Infanta Leonor Hospital, Madrid, Spain
| | - Guillermo Lahera
- Príncipe de Asturias University Hospital, Alcalá, Madrid, Spain; Faculty of Medicine, University of Alcalá, Madrid, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.
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Krousel-Wood M, Craig LS, Peacock E, Zlotnick E, O’Connell S, Bradford D, Shi L, Petty R. Medication Adherence: Expanding the Conceptual Framework. Am J Hypertens 2021; 34:895-909. [PMID: 33693474 DOI: 10.1093/ajh/hpab046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/22/2021] [Accepted: 03/05/2021] [Indexed: 12/21/2022] Open
Abstract
Interventions targeting traditional barriers to antihypertensive medication adherence have been developed and evaluated, with evidence of modest improvements in adherence. Translation of these interventions into population-level improvements in adherence and clinical outcomes among older adults remains suboptimal. From the Cohort Study of Medication Adherence among Older adults (CoSMO), we evaluated traditional barriers to antihypertensive medication adherence among older adults with established hypertension (N = 1,544; mean age = 76.2 years, 59.5% women, 27.9% Black, 24.1% and 38.9% low adherence by proportion of days covered (i.e., PDC <0.80) and the 4-item Krousel-Wood Medication Adherence Scale (i.e., K-Wood-MAS-4 ≥1), respectively), finding that they explained 6.4% and 14.8% of variance in pharmacy refill and self-reported adherence, respectively. Persistent low adherence rates, coupled with low explanatory power of traditional barriers, suggest that other factors warrant attention. Prior research has investigated explicit attitudes toward medications as a driver of adherence; the roles of implicit attitudes and time preferences (e.g., immediate vs. delayed gratification) as mechanisms underlying adherence behavior are emerging. Similarly, while associations of individual-level social determinants of health (SDOH) and medication adherence are well reported, there is growing evidence about structural SDOH and specific pathways of effect. Building on published conceptual models and recent evidence, we propose an expanded conceptual framework that incorporates implicit attitudes, time preferences, and structural SDOH, as emerging determinants that may explain additional variation in objectively and subjectively measured adherence. This model provides guidance for design, implementation, and assessment of interventions targeting sustained improvement in implementation medication adherence and clinical outcomes among older women and men with hypertension.
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Affiliation(s)
- Marie Krousel-Wood
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Leslie S Craig
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Erin Peacock
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Emily Zlotnick
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Samantha O’Connell
- Office of Academic Affairs, Tulane University, New Orleans, Louisiana, USA
| | - David Bradford
- Department of Public Administration and Policy, University of Georgia, Athens, Georgia, USA
| | - Lizheng Shi
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Richard Petty
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
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Hladek M, Gill JM, Lai C, Bandeen-Roche K, Xue QL, Allen J, Leyden C, Kanefsky R, Szanton SL. High Social Coping Self-Efficacy Associated With Lower Sweat Interleukin-6 in Older Adults With Chronic Illness. J Appl Gerontol 2021; 41:581-589. [PMID: 33840242 DOI: 10.1177/07334648211006518] [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: 11/15/2022] Open
Abstract
Inflammation, particularly interleukin-6 (IL-6), is associated with chronic disease in older adults, but not all older adults have the same progression of poor health outcomes. Self-efficacy may play a role in buffering the inflammatory burden in chronic disease. To evaluate associations between self-efficacy and IL-6, 159 community-dwelling older adults (N = 159, Mage = 82 years, SD = 6.3 years) with one or more chronic illnesses were recruited for this cross-sectional study. Sweat IL-6 was collected using a noninvasive sweat patch worn for 72 hrs. Multiple linear regression with bootstrapping showed a significant association between social coping self-efficacy and IL-6 (β = -0.534, p = .010) after adjustment for age, sex, race, body mass index, financial strain, chronic conditions, and social support. Although preliminary, this study creates a rationale to explore the self-efficacy inflammatory biomarker association further. Enhancing self-efficacy might be a viable nonpharmacological treatment to lower or slow the inflammatory burden in older adults.
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Affiliation(s)
| | | | - Chen Lai
- Tissue Injury Branch NIH/NINR, Bethesda, MD, USA
| | | | - Qian-Li Xue
- Johns Hopkins University, Baltimore, MD, USA
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Orozco A, Cardoner N, Aragón CF, Ruiz-Murugarren S, Vicens M, Álvarez-Mon MÁ, Lahera G. Obsessive-compulsive symptoms in anxiety and depressive disorders: Influence of recent and/or traumatic life events. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020; 14:S1888-9891(20)30129-4. [PMID: 33359119 DOI: 10.1016/j.rpsm.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION A high prevalence of obsessive-compulsive symptoms (OCSs) in anxiety-depressive disorders ranging from 30 to 67% has been described. OBJECTIVE This study aims to assess the presence and persistence of OCSs in an outpatient sample of subjects with anxiety and depressive disorders, as well as its relationship with recent life events (RLEs) and/or traumatic experiences (TEs). METHOD We conducted a prospective, observational, analytical study of 200 subjects with DSM-5 diagnoses of anxiety and/or depression. Participants were included by consecutive sampling and were evaluated at baseline and after 6-12 months (mean 8.5 months) of follow-up. The severity of the symptoms was assessed through the Hamilton Anxiety Scale (HARS) and Hamilton Scale for the evaluation of depression (HRSD-17), and comorbidity was assessed through the International Neuropsychiatric Interview (MINI). The Revised Inventory of Obsessions and Compulsions (OCI-R), the Recent Vital Changes Questionnaire (CVSV), and the Diagnostic Scale for Post-Traumatic Stress (PDS) were also administered. RESULTS 54% of the sample presented OCSs, and 30.5% presented one or more TEs throughout life. At the baseline visit, the presence of OCSs was associated with the severity of depressive symptoms (p=0.028), the presence of TEs (p<0.01), symptoms of post-traumatic stress disorder (p<0.01) and the number of RLEs (p<0.01). Response rate at follow-up was 38%, and persistence of OCSs was found in 60.5% of patients, independent of depressive or anxious symptoms, but was associated with the number of RLEs (p<0.01). CONCLUSION The presence of OCSs in patients with anxiety and depressive disorders is frequent and persistent. Anxious-depressive patients with a history of TEs and RLEs had higher OCS levels. These findings highlight the importance of early detection and the use of therapeutic strategies focused on resilience to stress and trauma.
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Affiliation(s)
- Arantxa Orozco
- Príncipe de Asturias University Hospital, Alcalá, Madrid, Spain
| | - Narcís Cardoner
- Hospital Universitario Parc Taulí Sabadell, Barcelone, Spain
| | | | | | - María Vicens
- Príncipe de Asturias University Hospital, Alcalá, Madrid, Spain
| | - Miguel Ángel Álvarez-Mon
- Faculty of Medicine, University of Alcalá, Madrid, Spain; Infanta Leonor Hospital, Madrid, Spain
| | - Guillermo Lahera
- Príncipe de Asturias University Hospital, Alcalá, Madrid, Spain; Faculty of Medicine, University of Alcalá, Madrid, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.
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Hladek MD, Gill J, Bandeen-Roche K, Walston J, Allen J, Hinkle JL, Lorig K, Szanton SL. High coping self-efficacy associated with lower odds of pre-frailty/frailty in older adults with chronic disease. Aging Ment Health 2020; 24:1956-1962. [PMID: 31290680 PMCID: PMC8098714 DOI: 10.1080/13607863.2019.1639136] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Frailty affects an estimated 15% of community dwelling older adults. Few studies look at psychosocial variables like self-efficacy (confidence to perform well at a particular task or life domain) in relation to frailty. The purpose of this study was to evaluate associations between pre-frailty/frailty and self-efficacy. METHODS This cross-sectional study enrolled community dwelling older adults 65 and older (N = 146) with at least one chronic condition. Scales included: 5-item FRAIL scale (including measures of Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight); coping self-efficacy used to measure confidence in one's ability to problem solve, emotionally regulate and ask for support when problems in life occur; illness intrusiveness; patient health questionnaire to assess depressive symptoms; financial strain; life events count; social support; heart rate; tobacco use and body mass index. Logistic regression was used for model development. RESULTS Roughly half (49.3%) of the participants were frail/pre-frail. High coping self-efficacy was associated with a 92% decreased odds of pre-frailty/frailty after adjustment for age, sex, race, co-morbidities, heart rate, a life events count, and body mass index. This relationship remained significant when illness intrusiveness and depression scores were added to the model (OR: 0.10; p-value = 0.014). Increases in age, co-morbidities, heart rate and body mass index were also significantly associated with higher adjusted odds of pre-frailty/frailty. CONCLUSIONS High coping self-efficacy was associated with greater odds of a robust state. Further consideration should be given to coping self-efficacy in frailty research and intervention development.
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Affiliation(s)
| | - Jessica Gill
- Tissue Injury Branch, NIH, NINR, Bethesda, MD, USA
| | | | - Jeremy Walston
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jerilyn Allen
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Janice L. Hinkle
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
| | - Kate Lorig
- School of Medicine, Stanford University, Stanford, CA, USA
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Cuffee YL, Hargraves L, Rosal M, Briesacher BA, Allison JJ, Hullett S. An Examination of John Henryism, Trust, and Medication Adherence Among African Americans With Hypertension. HEALTH EDUCATION & BEHAVIOR 2020; 47:162-169. [PMID: 31592686 DOI: 10.1177/1090198119878778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. John Henryism is defined as a measure of active coping in response to stressful experiences. John Henryism has been linked with health conditions such as diabetes, prostate cancer, and hypertension, but rarely with health behaviors. Aims. We hypothesized that reporting higher scores on the John Henryism Scale may be associated with poorer medication adherence, and trust in providers may mediate this relationship. Method. We tested this hypothesis using data from the TRUST study. The TRUST study included 787 African Americans with hypertension receiving care at a safety-net hospital. Ordinal logistic regression was used to examine the relationship between John Henryism and medication adherence. Results. Within our sample of African Americans with hypertension, lower John Henryism scores was associated with poorer self-reported adherence (low, 20.62; moderate, 19.19; high, 18.12; p < .001). Higher John Henryism scores were associated with lower trust scores (low John Henryism: 40.1; high John Henryism: 37.9; p < .001). In the adjusted model, each 1-point increase in the John Henryism score decreased the odds of being in a better cumulative medication adherence category by a factor of 4% (odds ratio = 0.96, p = .014, 95% confidence interval = 0.93-0.99). Twenty percent of the association between medication adherence and John Henryism was mediated by trust (standard deviation = 0.205, 95% confidence interval = 0.074-0.335). Discussion. This study provides important insights into the complex relationship between psychological responses and health behaviors. It also contributes to the body of literature examining the construct of John Henryism among African Americans with hypertension. Conclusion. The findings of this study support the need for interventions that promote healthful coping strategies and patient-provider trust.
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Affiliation(s)
| | - Lee Hargraves
- The University of Massachusetts Boston, Boston, MA, USA
| | - Milagros Rosal
- University of Massachusetts Medical School, Worcester, MA, USA
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Gathright EC, Salmoirago-Blotcher E, DeCosta J, Balletto BL, Donahue ML, Feulner MM, Cruess DG, Wing RR, Carey MP, Scott-Sheldon LAJ. The impact of transcendental meditation on depressive symptoms and blood pressure in adults with cardiovascular disease: A systematic review and meta-analysis. Complement Ther Med 2019; 46:172-179. [PMID: 31519275 PMCID: PMC7046170 DOI: 10.1016/j.ctim.2019.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Transcendental Meditation (TM) as a stress management technique may offer an adjunctive strategy to improve health and well-being in adults with cardiovascular disease (CVD). OBJECTIVES To examine the efficacy of TM to improve aspects of cardiovascular health and psychological functioning in adults with CVD. METHOD Studies (a) evaluating TM in adults with hypertension or CVD and (b) assessing a physiological or psychological outcome were retrieved and meta-analyzed. Weighted mean effect sizes were computed to assess between- and within-group changes. RESULTS Nine studies met inclusion criteria (N = 851; mean age = 60 ± 8 years; 47% women). Between-group analyses revealed no differences between TM and control groups. However, within-group (i.e., pre- to post-intervention) analyses revealed reductions in systolic (d+ = 0.31) and diastolic (d+ = 0.53) blood pressure (BP) for the TM group. There were no changes in depressive symptoms for TM or control participants. CONCLUSIONS TM was associated with within-group (but not between-groups) improvements in BP. Continued research using randomized controlled trials with larger samples, and measuring psychophysiological outcomes at longer follow-up intervals is recommended.
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Affiliation(s)
- Emily C Gathright
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.
| | - Elena Salmoirago-Blotcher
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Julie DeCosta
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Brittany L Balletto
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Marissa L Donahue
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Melissa M Feulner
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Dean G Cruess
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA; Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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Casagrande M, Boncompagni I, Mingarelli A, Favieri F, Forte G, Germanò R, Germanò G, Guarino A. Coping styles in individuals with hypertension of varying severity. Stress Health 2019; 35:560-568. [PMID: 31397061 DOI: 10.1002/smi.2889] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/22/2019] [Accepted: 08/01/2019] [Indexed: 01/01/2023]
Abstract
The strategies that people usually use to cope with stressful events, that is, their coping style, may affect blood pressure and cardiovascular functioning. Generally, hypertension is positively associated with emotion-oriented, maladaptive coping strategies and negatively related to task-focused coping styles, but no study has investigated the relationship between coping strategies and the severity of hypertension. This study aimed to assess whether the severity of cardiovascular disorders was associated with specific coping strategies. Participants were selected from the Policlinico Umberto I of the University of Rome "Sapienza." The sample was divided into five groups: (a) healthy people (n = 190); (b) people with untreated hypertension (n = 232); (c) people using antihypertensive medication (n = 158); (d) people using antihypertensive medication with uncontrolled hypertension (n = 179); and (e) people suffering from both hypertension and heart diseases (N = 192). Coping strategies were evaluated with the Coping Inventory for Stressful Situations. One-way ANCOVAs, considering Group as the independent variable and the coping strategies (task-focused, emotion-oriented and avoidance-oriented coping) as dependent variables, showed that individuals affected by both hypertension and heart diseases made less use of task-focused coping strategies than the other groups. These findings confirm the relationship between coping style and hypertension and highlight that patients with hypertension and heart diseases make less use of appropriate coping strategies.
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Affiliation(s)
- Maria Casagrande
- Dipartimento di Psicologia Dinamica e Clinica, Università di Roma "Sapienza", Rome, Italy
| | | | - Alessandro Mingarelli
- Dipartimento di Psicologia Dinamica e Clinica, Università di Roma "Sapienza", Rome, Italy
| | - Francesca Favieri
- Dipartimento di Psicologia, Università di Roma "Sapienza", Rome, Italy
| | - Giuseppe Forte
- Dipartimento di Psicologia, Università di Roma "Sapienza", Rome, Italy
| | - Rosanna Germanò
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche e Geriatriche, Università di Roma "Sapienza", Rome, Italy
| | - Giuseppe Germanò
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche e Geriatriche, Università di Roma "Sapienza", Rome, Italy
| | - Angela Guarino
- Dipartimento di Psicologia Dinamica e Clinica, Università di Roma "Sapienza", Rome, Italy
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Oori MJ, Mohammadi F, Norouzi K, Fallahi-Khoshknab M, Ebadi A. Conceptual Model of Medication Adherence in Older Adults with High Blood Pressure-An Integrative Review of the Literature. Curr Hypertens Rev 2019; 15:85-92. [PMID: 30360745 PMCID: PMC6635648 DOI: 10.2174/1573402114666181022152313] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/16/2018] [Accepted: 10/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Medication adherence (MA) is the most important controlling factor of high blood pressure (HBP). There are a few MA models, but they have not been successful in predicting MA completely. Thus, this study aimed to expand a conceptual model of MA based on an ecological approach. METHODS An integrative review of the literature based on theoretical and empirical studies was completed. Data source comprised: Medline (including PubMed and Ovid), ISI, Embase, Google scholar, and internal databases such as Magiran, Google, SID, and internal magazines. Primary English and Persian language studies were collected from 1940 to 2018. The steps of study included: (a) problem identification, (b) literature review and extracting studies, (c) appraising study quality, (d) gathering data, (e) data analysis using the directed content analysis, (f) concluding. RESULTS Thirty-six articles were finally included and analyzed. After analysis, predictors of MA in older adults with hypertension were categorized into personal, interpersonal, organizational, and social factors. Although the personal factors have the most predictors in sub-categories of behavioral, biological, psychological, knowledge, disease, and medication agents, social, organizational and interpersonal factors can have indirect and important effects on elderly MA. CONCLUSION There are many factors influencing MA of elderly with HBP. The personal factor has the most predictors. The designed model of MA because of covering all predictor factors, can be considered as a comprehensive MA model. It is suggested that future studies should select factors for study from all levels of the model.
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Affiliation(s)
| | - Farahnaz Mohammadi
- Address correspondence to this author at Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Tel: +989125003527; E-mail:
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Vargas EA, Li Y, Mahalingham R, Hui P, Liu G, Lapedis M, Liu JR. The double edge sword of John Henryism: Impact on patients' health in the People's Republic of China. J Health Psychol 2018; 25:2374-2387. [PMID: 30229675 DOI: 10.1177/1359105318800141] [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: 11/15/2022] Open
Abstract
The People's Republic of China has experienced extraordinary economic growth, which is associated with increases in chronic health stressors. We examined the impact of John Henryism-a coping mechanism-on various health indicators in a sample of patients (n = 642) in China. John Henryism significantly related to increased medical adherence (B=.03,p<.001) and health-promotional behaviors (B=.02,p<.001). John Henryism predicted several indicators of psychological health through social support. John Henryism was also related to increased alcoholism (B=.04,p<.05). The findings highlight the complexity and paradoxical implications of John Henryism on health. Implications are discussed in relation to China's epidemiological and age demographic shifts.
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Affiliation(s)
| | | | | | - Pan Hui
- Peking Union Medical College Hospital, China
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Vitaliano PP, Fitzpatrick AL, Williams LE, Montano MA, Russo JE. Demographic-Specific Rates for Life Events in the Cardiovascular Health Study and Comparisons With Other Studies. Innov Aging 2018; 2:igy005. [PMID: 30911687 DOI: 10.1093/geroni/igy005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose of the Study (1a) We use the Cardiovascular Health Study (CHS), a multi-site heterogeneous sample of Medicare enrollees (N = 5,849) to provide rates for specific life events experienced within 6 months; (1b) We present rates for 29 other studies of community-residing older adults (N = 41,308); (2) For the CHS, we provide demographic-specific rates and predicted probabilities for age [young-old (65-75) vs old-old (≥75)], gender, race, marital status, and education. Design/Methods The CHS sample is 57.6% women, 84.2% white (15.8% black), and 66.3% married. Mean age is 72.8 years (standard deviation [SD] = 5.6, range = 65-100) and education is 13.7 years (SD = 4.8). Life events were interviewer-assessed. Regressions estimated associations of life event rates with demographic groups (e.g., age), controlling for other demographic variables (e.g., gender, etc.). Results (1a) CHS rates ranged from 44.7% (death of someone close) to 1.1% (retirement/work changes). (1b) Most life event studies used total scores and only 5 that met our inclusion criteria used time intervals <1 year; longer intervals were associated with higher rates. (2) In the CHS, the life event for illnesses was related to 5 demographic variables (net the other 4 demographic variables), difficulties caregiving to 4, and worse relationships to 3 demographic variables. Race was related to 8 life events, marital status to 7, education to 6, and age to 4 events. Implications By identifying demographic groups at highest risk for life events, this research focuses on older adults at greatest risk for health problems. These data are necessary for translating research into interventions, practice, and policy.
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Affiliation(s)
- Peter P Vitaliano
- Department of Psychiatry and Behavioral Sciences, University of Washington Seattle
| | - Annette L Fitzpatrick
- Department of Family Medicine, University of Washington Seattle.,Department of Epidemiology, University of Washington Seattle
| | - Lee E Williams
- Department of Bioengineering, University of Washington Seattle
| | | | - Joan E Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington Seattle
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Andjelkovic M, Mitrovic M, Nikolic I, Jovanovic DB, Zelen I, Zaric M, Canovic P, Kovacevic A, Jankovic S. Older Hypertensive Patients’ Adherence to Healthy Lifestyle Behaviors. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2018. [DOI: 10.1515/sjecr-2016-0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Non-pharmacological treatment including diet, body weight reduction, smoking cessation and physical activity, is very important part of hypertension treatment. The objective of this study was to investigate the adherence to healthy lifestyle behavior in the representative sample of the older hypertensive patients, and to investigate factors associated with adherence in the studied older population. The study was conducted on random sample of 362 long term hypertensive (> five years) patients older than 65 years of age, at Health Care Center of Kragujevac. Adherence was assessed using the structured questionnaire for the analysis of the implementation of both hypertension and diabetes guidelines in the primary care. Both bivariate and multivariate analyses were conducted. Nearly 35% of examined patients were highly adherent; they exercised regularly, avoided smoking for at least five years and consumed special healthy diet prescribed for hypertension. Another 35.6% of the cases reported exercising regularly, 39.5% followed the recommended diet for the hypertension, while 23.4% of the patients have still consumed cigarettes. Multivariate logistic regression demonstrated that received counseling on healthy lifestyle behaviors by physicians and lack of education predicted high adherence to healthy lifestyle behavior. In order to improve adherence of elderly hypertensive patients to healthy lifestyle, strengthening patient-physician relationships through efforts to enhance communication may be a promising strategy to enhance patients’ engagement in healthy lifestyle behaviors for hypertension. Such an improvement could be achieved through the education of both the physicians and patients.
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Affiliation(s)
- Marija Andjelkovic
- Department of Laboratory Diagnostics, Clinical Center Kragujevac , Kragujevac , Serbia
- Department of Biochemistry, Faculty of medical sciences , University of Kragujevac , Kragujevac , Serbia
| | - Marina Mitrovic
- Department of Biochemistry, Faculty of medical sciences , University of Kragujevac , Kragujevac , Serbia
| | - Ivana Nikolic
- Department of Biochemistry, Faculty of medical sciences , University of Kragujevac , Kragujevac , Serbia
| | | | - Ivanka Zelen
- Department of Biochemistry, Faculty of medical sciences , University of Kragujevac , Kragujevac , Serbia
| | - Milan Zaric
- Department of Biochemistry, Faculty of medical sciences , University of Kragujevac , Kragujevac , Serbia
| | - Petar Canovic
- Department of Biochemistry, Faculty of medical sciences , University of Kragujevac , Kragujevac , Serbia
| | | | - Slobodan Jankovic
- Department of Pharmacology, Clinical Center Kragujevac, Faculty of medical sciences , University of Kragujevac , Kragujevac , Serbia
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Abstract
Adherence to antihypertensive medication remains a key modifiable factor in the management of hypertension. The multidimensional nature of adherence and blood pressure (BP) control call for multicomponent, patient-centered interventions to improve adherence. Promising strategies to improve antihypertensive medication adherence and BP control include regimen simplification, reduction of out-of-pocket costs, use of allied health professionals for intervention delivery, and self-monitoring of BP. Research to understand the effects of technology-mediated interventions, mechanisms underlying adherence behavior, and sex-race differences in determinants of low adherence and intervention effectiveness may enhance patient-specific approaches to improve adherence and disease control.
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Affiliation(s)
- Erin Peacock
- Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - Marie Krousel-Wood
- Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA; Center for Health Research, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
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Jankowska-Polanska B, Uchmanowicz I, Chudiak A, Dudek K, Morisky DE, Szymanska-Chabowska A. Psychometric properties of the Polish version of the eight-item Morisky Medication Adherence Scale in hypertensive adults. Patient Prefer Adherence 2016; 10:1759-66. [PMID: 27672314 PMCID: PMC5026177 DOI: 10.2147/ppa.s101904] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Low adherence to pharmacological treatment is often associated with poor blood pressure control, but identification of nonadherent patients in outpatient settings is difficult. The aim of the study was to translate and evaluate the psychometric properties of the Polish version of the structured self-report eight-item Morisky Medication Adherence Scale (MMAS-8) among patients with hypertension. The study was conducted in a family doctor practice between January and July 2015. After a standard "forward-backward" procedure to translate MMAS-8 into Polish, the questionnaire was administered to 160 patients with hypertension. Reliability was tested using a measure of internal consistency (Cronbach's α) and test-retest reliability. Validity was confirmed using known group validity. Three levels of adherence were considered based on the following scores: 0 to <6 (low); 6 to <8 (medium); and 8 (high). Complete questionnaires were returned by 110 respondents (mean age: 60.7 years ±12.6; 54.6% were female). The mean number of pills taken daily was 3.61±4.31. The mean adherence score was 6.42± 2.0. Moderate internal consistency was found (Cronbach's α=0.81), and test-retest reliability was satisfactory (r=0.461-0.905; P<0.001). Reproducibility expressed by Cohen's κ coefficient =0.61 was good. In high-adherent patients, the percentage of well-controlled blood pressure was higher than in low-adherent patients (33.3% vs 19.1%, χ (2)=0.87, P=0.648). Psychometric evaluation of the Polish version of the MMAS-8 indicates that it is a reliable and valid measure tool to detect nonadherent patients. The MMAS-8 may be routinely used to support communication about the medication-taking behavior in hypertensive patients.
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Affiliation(s)
- Beata Jankowska-Polanska
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
- Correspondence: Beata Jankowska-Polanska, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, Wroclaw, 51-618, Poland, Tel +48 71 784 1824, Fax +48 71 345 9324, Email
| | - Izabella Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Chudiak
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Dudek
- Department of Logistic and Transport Systems, Faculty of Mechanical Engineering, Wroclaw University of Technology, Wroclaw, Poland
| | - Donald E Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Anna Szymanska-Chabowska
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland
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Bhatt H, Safford M, Stephen G. Coronary heart disease risk factors and outcomes in the twenty-first century: findings from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Curr Hypertens Rep 2015; 17:541. [PMID: 25794955 PMCID: PMC4443695 DOI: 10.1007/s11906-015-0541-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
REasons for Geographic and Racial Differences in Stroke (REGARDS) is a longitudinal study supported by the National Institutes of Health to determine the disparities in stroke-related mortality across USA. REGARDS has published a body of work designed to understand the disparities in prevalence, awareness, treatment, and control of coronary heart disease (CHD) and its risk factors in a biracial national cohort. REGARDS has focused on racial and geographical disparities in the quality and access to health care, the influence of lack of medical insurance, and has attempted to contrast current guidelines in lipid lowering for secondary prevention in a nationwide cohort. It has described CHD risk from nontraditional risk factors such as chronic kidney disease, atrial fibrillation, and inflammation (i.e., high-sensitivity C-reactive protein) and has also assessed the role of depression, psychosocial, environmental, and lifestyle factors in CHD risk with emphasis on risk factor modification and ideal lifestyle factors. REGARDS has examined the utility of various methodologies, e.g., the process of medical record adjudication, proxy-based cause of death, and use of claim-based algorithms to determine CHD risk. Some valuable insight into less well-studied concepts such as the reliability of current troponin assays to identify "microsize infarcts," caregiving stress, and CHD, heart failure, and cognitive decline have also emerged. In this review, we discuss some of the most important findings from REGARDS in the context of the existing literature in an effort to identify gaps and directions for further research.
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Affiliation(s)
- Hemal Bhatt
- Division of Cardiovascular Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0113, USA
| | - Monika Safford
- Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0113, USA
| | - Glasser Stephen
- Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0113, USA
- 1717 11th Avenue South, MT 634, Birmingham, AL 35205, USA
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Salgado TM, Ramos SB, Sobreira C, Canas R, Cunha I, Benrimoj SI, Fernandez-Llimos F. Newest Vital Sign as a proxy for medication adherence in older adults. J Am Pharm Assoc (2003) 2014; 53:611-7. [PMID: 24091561 DOI: 10.1331/japha.2013.12249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the utility of the Newest Vital Sign (NVS) as a proxy for medication adherence in community-dwelling older adults. DESIGN Descriptive cross-sectional study. SETTING 12 adult day care centers in the Lisbon metropolitan area, Portugal, between March and May 2009. PARTICIPANTS 100 white community-dwelling older adults. INTERVENTION Participants were administered the NVS, Single Item Literacy Screener (SILS), and self-reported Measure of Adherence to Therapy (MAT). MAIN OUTCOME MEASURES Health literacy and medication adherence. RESULTS The mean (±SD) age of the respondents was 73.3 ± 7.8 years and 71% were women. The NVS score was 0.81 ± 0.10 (of 6 possible points), and 95% of the respondents scored in the three lowest possible scores, indicating a notable floor effect. Age was found to be inversely correlated with NVS score (P = 0.003). The MAT score was 36.2 ± 4.7 (range 17-42). No statistically significant association between the NVS and level of education (P = 0.059 [Kruskal-Wallis]), gender (P = 0.700 [Mann-Whitney]), SILS (P = 0.167), or MAT (P = 0.379) was identified. CONCLUSION The utility of the NVS as a proxy for medication adherence in community-dwelling older adults is limited because of a floor effect that hinders its predictive power for medication adherence.
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Kronish IM, Rieckmann N, Burg MM, Alcántara C, Davidson KW. The psychosocial context impacts medication adherence after acute coronary syndrome. Ann Behav Med 2014; 47:158-64. [PMID: 24163188 PMCID: PMC3967002 DOI: 10.1007/s12160-013-9544-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Depression is associated with poor adherence to medications and worse prognosis in patients with acute coronary syndrome (ACS). PURPOSE To determine whether cognitive, behavioral, and/or psychosocial vulnerabilities for depression explain the association between depression and medication adherence among ACS patients. METHODS One hundred sixty-nine ACS patients who agreed to have their aspirin adherence measured using an electronic pill bottle for 3 months were enrolled within 1 week of hospitalization. Linear regression was used to determine whether depression vulnerabilities predicted aspirin adherence after adjustment for depressive symptoms, demographics, and comorbidity. RESULTS Of the depression vulnerabilities, only role transitions (beta = -3.32; P = 0.02) and interpersonal conflict (beta -3.78; P = 0.03) predicted poor adherence. Depression vulnerabilities did not mediate the association between depressive symptoms and medication adherence. CONCLUSIONS Key elements of the psychosocial context preceding the ACS including major role transitions and conflict with close contacts place ACS patients at increased risk for poor medication adherence independent of depressive symptoms.
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Affiliation(s)
- Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, PH9-311, 622 W168th Street, New York, NY, 10032, USA,
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de Vries ST, Keers JC, Visser R, de Zeeuw D, Haaijer-Ruskamp FM, Voorham J, Denig P. Medication beliefs, treatment complexity, and non-adherence to different drug classes in patients with type 2 diabetes. J Psychosom Res 2014; 76:134-8. [PMID: 24439689 DOI: 10.1016/j.jpsychores.2013.11.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/01/2013] [Accepted: 11/05/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the relationship of patients' medication beliefs and treatment complexity with unintentional and intentional non-adherence for three therapeutic groups commonly used by patients with type 2 diabetes. METHODS Survey data about adherence (Medication Adherence Report Scale) and beliefs about medicines (Beliefs about Medicines Questionnaire) were combined with prescription data from the Groningen Initiative to ANalyse Type 2 diabetes Treatment (GIANTT) database. Patients were classified as being adherent, mainly unintentional non-adherent, or partly intentional non-adherent per therapeutic group (glucose-, blood pressure-, and lipid-lowering drugs). Treatment complexity was measured using the Medication Regimen Complexity Index, which includes the dosage form, dosing frequency and additional directions of taking the drug. Analyses were performed using Kruskal-Wallis and Mann-Whitney U-tests. RESULTS Of 257 contacted patients, 133 (52%) returned the questionnaire. The patients had a mean age of 66years and 50% were females. Necessity beliefs were not significantly different between the adherers, mainly unintentional non-adherers, and partly intentional non-adherers (differences smaller than 5 points on a scale from 5 to 25). For blood pressure-lowering drugs, patients reporting intentional non-adherence had higher concern beliefs than adherers (8 point difference, P=0.01). Treatment complexity scores were lower for adherers but similar for mainly unintentional and partly intentional non-adherers to glucose- and blood pressure-lowering drugs. CONCLUSION Treatment complexity was related to non-adherence in general. Beliefs about necessity were not strongly associated with non-adherence, while patients' concern beliefs may be associated with intentional non-adherence. However, the role of these determinants differs per therapeutic group.
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Affiliation(s)
- Sieta T de Vries
- Department of Clinical Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Joost C Keers
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Van Swieten Research Institute, Martini Hospital, Groningen, The Netherlands.
| | - Rosalie Visser
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, The LifeLines Cohort Study, Groningen, The Netherlands.
| | - Dick de Zeeuw
- Department of Clinical Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Flora M Haaijer-Ruskamp
- Department of Clinical Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Jaco Voorham
- Department of Clinical Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Petra Denig
- Department of Clinical Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Zwikker HE, van den Bemt BJ, Vriezekolk JE, van den Ende CH, van Dulmen S. Psychosocial predictors of non-adherence to chronic medication: systematic review of longitudinal studies. Patient Prefer Adherence 2014; 8:519-63. [PMID: 24851043 PMCID: PMC4011900 DOI: 10.2147/ppa.s47290] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Several cross-sectional studies suggest that psychosocial factors are associated with non-adherence to chronic preventive maintenance medication (CPMM); however, results from longitudinal associations have not yet been systematically summarized. Therefore, the objective of this study was to systematically synthesize evidence of longitudinal associations between psychosocial predictors and CPMM non-adherence. MATERIALS AND METHODS PUBMED, EMBASE, CINAHL, and PsychINFO databases were searched for studies meeting our inclusion criteria. The reference lists and the ISI Web of Knowledge of the included studies were checked. Studies were included if they had an English abstract, involved adult populations using CPMM living in Western countries, and if they investigated associations between psychosocial predictors and medication non-adherence using longitudinal designs. Data were extracted according to a literature-based extraction form. Study quality was independently judged by two researchers using a framework comprising six bias domains. Studies were considered to be of high quality if ≥four domains were free of bias. Psychosocial predictors for non-adherence were categorized into five pre-defined categories: beliefs/cognitions; coping styles; social influences and social support; personality traits; and psychosocial well-being. A qualitative best evidence synthesis was performed to synthesize evidence of longitudinal associations between psychosocial predictors and CPMM non-adherence. RESULTS Of 4,732 initially-identified studies, 30 (low-quality) studies were included in the systematic review. The qualitative best evidence synthesis demonstrated limited evidence for absence of a longitudinal association between CPMM non-adherence and the psychosocial categories. The strength of evidence for the review's findings is limited by the low quality of included studies. CONCLUSION The results do not provide psychosocial targets for the development of new interventions in clinical practice. This review clearly demonstrates the need for high-quality, longitudinal research to identify psychosocial predictors of medication non-adherence.
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Affiliation(s)
- Hanneke E Zwikker
- Departments of Rheumatology and Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Bart J van den Bemt
- Departments of Rheumatology and Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands
- Correspondence: Bart van den Bemt, Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, PO Box 9011, 6500 GM Nijmegen, the Netherlands, Tel +31 24 365 8213, Email
| | - Johanna E Vriezekolk
- Departments of Rheumatology and Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Cornelia H van den Ende
- Departments of Rheumatology and Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Sandra van Dulmen
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands
- Netherlands Institute for Health Services Research, the Netherlands
- Department of Health Science, Buskerud University College, Drammen, Norway
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Kivimäki M, Batty GD, Hamer M, Nabi H, Korhonen M, Huupponen R, Pentti J, Oksanen T, Kawachi I, Virtanen M, Westerlund H, Vahtera J. Influence of retirement on nonadherence to medication for hypertension and diabetes. CMAJ 2013; 185:E784-90. [PMID: 24082018 DOI: 10.1503/cmaj.122010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The extent to which common life transitions influence medication adherence among patients remains unknown. We examined whether retirement is associated with a change in adherence to medication in patients with hypertension or type 2 diabetes. METHODS Participants in the Finnish Public Sector study were linked to national registers. We included data for the years 1994-2011. We identified and followed 3468 adult patients with hypertension and 412 adult patients with type 2 diabetes for medication adherence for the 3 years before their retirement and the 4 years after their retirement (mean follow-up 6.8 yr). Our primary outcome was proportion of patients with poor adherence to medication, which we defined as less than 40% of days covered by treatment. We determined these proportions before and after retirement using data from filled prescriptions. RESULTS The preretirement prevalence of poor adherence to medication was 6% in men and women with hypertension, 2% in men with diabetes and 4% in women with diabetes. Among men, retirement was associated with an increased risk of poor adherence to both antihypertensive agents (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.03-1.68) and antidiabetic drugs (OR 2.40, 95% CI 1.37-4.20). Among women, an increased risk of poor adherence was seen only for antihypertensive agents (OR 1.25, 95% CI 1.07-1.46). Similar results were apparent for alternative definitions of poor adherence. Our results did not differ across strata of age, socioeconomic status or comorbidity. INTERPRETATION We found a decline in adherence to medication after retirement among men and women with hypertension and men with type 2 diabetes. If these findings can be confirmed, we need randomized controlled trials to determine whether interventions to reduce poor adherence after retirement could improve clinical outcomes of treatments for hypertension and diabetes.
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Kronish IM, Diefenbach MA, Edmondson DE, Phillips LA, Fei K, Horowitz CR. Key barriers to medication adherence in survivors of strokes and transient ischemic attacks. J Gen Intern Med 2013; 28:675-82. [PMID: 23288379 PMCID: PMC3631079 DOI: 10.1007/s11606-012-2308-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 10/23/2012] [Accepted: 12/03/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Even though medications can greatly reduce the risk of recurrent stroke, medication adherence is suboptimal in stroke survivors. OBJECTIVE To identify key barriers to medication adherence in a predominantly low-income, minority group of stroke and transient ischemic attack (TIA) survivors. DESIGN Cross-sectional study. PARTICIPANTS Six hundred stroke or TIA survivors, age ≥ 40 years old, recruited from underserved communities in New York City. MAIN MEASURES Medication adherence was measured using the 8-item Morisky Medication Adherence Questionnaire. Potential barriers to adherence were assessed using validated instruments. Logistic regression was used to test which barriers were independently associated with adherence. Models were additionally controlled for age, race/ethnicity, income, and comorbidity. KEY RESULTS Forty percent of participants had poor self-reported medication adherence. In unadjusted analyses, compared to adherent participants, non-adherent participants had increased concerns about medications (26 % versus 7 %, p < 0.001), low trust in their personal doctor (42 % versus 29 %, p = 0.001), problems communicating with their doctor due to language (19 % versus 12 %, p = 0.02), perceived discrimination from the health system (42 % versus 22 %, p < 0.001), difficulty accessing health care (16 % versus 8 %, p = 0.002), and inadequate continuity of care (27 % versus 20 %, p = 0.05). In the fully adjusted model, only increased concerns about medications [OR 5.02 (95 % CI 2.76, 9.11); p < 0.001] and perceived discrimination [OR 1.85 (95 % CI 1.18, 2.90); p = 0.008] remained significant barriers. CONCLUSIONS Increased concerns about medications (related to worry, disruption, long-term effects, and medication dependence) and perceived discrimination were the most important barriers to medication adherence in this group. Interventions that reduce medication concerns have the greatest potential to improve medication adherence in low-income stroke/TIA survivors.
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Affiliation(s)
- Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA.
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Recent publications by ochsner authors. Ochsner J 2013; 13:278-83. [PMID: 23789020 PMCID: PMC3684343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
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