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Barbati S, Baumgartner PC, Dietrich F, Allemann SS, Arnet I. Concordance between pharmacy dispensing and electronic monitoring data of direct oral anticoagulants - A secondary analysis of the MAAESTRO study. Res Social Adm Pharm 2024:S1551-7411(24)00332-2. [PMID: 39209562 DOI: 10.1016/j.sapharm.2024.08.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/22/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Direct oral anticoagulants are the preferred treatment for stroke patients with atrial fibrillation. Pharmacy dispensing data represent a practical method to identify suboptimal medication adherence. OBJECTIVE This study investigates whether pharmacy dispensing data are indicative of real-life adherence behavior, using data from 130 patients in the MAAESTRO study (2018-2022) in Basel, Switzerland. METHODS This secondary data analysis of the MAAESTRO study (Dietrich, 2024) included patients with electronic monitoring (EM) and dispensing data for 12 months. Patients with at least two refills were included in the analysis. We categorized refill series into three adherence patterns using the Delta T method (Baumgartner, 2022): all refills on time, erratic refills, end-gaps ≥10 days. EM-adherence was assessed through "taking adherence" and "missing days" (24h without intake). We analyzed: i) all dispensing data ("all refills"); ii) all data independently of the MAAESTRO phase ("all phases"); iii) the last two dispensing data ("last"), and iv) EM data from the MAAESTRO phase that match the date of the last refill ("matched"). Associations between refill patterns and adherence were examined using Spearman correlation and Fisher's exact test. RESULTS Data analyzed from 50 patients (mean age 76.4 ± 9.1 years, 56.0 % male) included 252 refills with a median of 4 refills per patient. Refill patterns were: all refills on time (40.0 %), erratic refills (36.0 %), and end-gaps >10 days (24.0 %). Mean taking adherence was 89.3 ± 13.7 %. EM data revealed missing days in 82.0 % of patients, with 61.0 % having irregular refill patterns. Matched taking adherence was moderately associated with Delta T over all refills (p = 0.034) and the last refill (p = 0.013). CONCLUSIONS Dispensing data processed with the Delta T method correlate moderately with EM data. The Delta T value for the last two refills shows promise for estimating irregular adherence, suggesting potential for targeted interventions in pharmacy practice.
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Affiliation(s)
- Selina Barbati
- University of Basel, Department of Pharmaceutical Sciences, Klingelbergstrasse 50, 4056, Basel, Switzerland.
| | | | - Fine Dietrich
- Leipzig University, Clinical Trial Center, Härtelstrasse 16-18, 04107, Leipzig, Germany
| | - Samuel S Allemann
- University of Basel, Department of Pharmaceutical Sciences, Klingelbergstrasse 50, 4056, Basel, Switzerland
| | - Isabelle Arnet
- University of Basel, Department of Pharmaceutical Sciences, Klingelbergstrasse 50, 4056, Basel, Switzerland
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2
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Veale EL. Pharmacy-Led Management of Atrial Fibrillation: Improving Treatment Adherence and Patient Outcomes. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2024; 13:101-114. [PMID: 39101005 PMCID: PMC11297543 DOI: 10.2147/iprp.s397844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 07/13/2024] [Indexed: 08/06/2024] Open
Abstract
The world's population is ageing, with the number of those over 60 years expected to represent a fifth of the total population by 2050. Increases in chronic long-term health conditions (LTCs) associated with ageing, and requiring regular but often avoidable medical intervention, are pressurising already overloaded, health and social care systems. Atrial fibrillation (AF) is an LTC, which is most frequently diagnosed in the elderly. An often, asymptomatic condition, AF is associated with a 3- to 5-fold increased risk of severe ischemic stroke. Stroke prevention, with risk-stratified oral anticoagulants (OACs) is the standard recommended care for patients with AF. Stroke avoidance is, however, dependent on persistent adherence to OAC medication, with an adherence rate of >80% considered necessary to achieve optimal health outcomes. Suboptimal adherence to OACs is common, with a third of all AF patients not taking their medication as prescribed. This combined with the short half-life of OACs can result in poor clinical outcomes for patients. Policy makers now consider improving adherence to prescribed medicines for LTCs, a public health priority, to ensure better health outcomes for patients, whilst minimising unnecessary health system costs. Prescribing medicines to treat LTCs, such as AF, is not enough, particularly when the patient may not experience any measurable benefit to the treatment and may instead, experience medication-associated adverse events, including a risk of bleeding. Pharmacists who are experts in medicines management are ideally placed to support medication adherence, to educate, and to improve health outcomes for patients with AF. In this review, I will consider the evidence for poor medication adherence in LTCs and in particular adherence to OACs in patients with AF and highlight the role that pharmacists can play in ensuring optimal adherence and showcase pharmacist-led interventions that effectively address this problem.
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Affiliation(s)
- Emma L Veale
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, Kent, UK
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3
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Sagara K, Goto K, Maeda M, Murata F, Fukuda H. Medication adherence and associated factors in newly diagnosed hypertensive patients in Japan: the LIFE study. J Hypertens 2024; 42:718-726. [PMID: 38230627 DOI: 10.1097/hjh.0000000000003661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Hypertension is the leading cardiovascular risk factor worldwide. However, in Japan, only 30% of patients have their blood pressure controlled under 140/90 mmHg, and nonadherence to antihypertensives is thought to be a reason for the poor control of hypertension. We therefore sought to assess the adherence to hypertension treatment and to evaluate factors influencing patients' adherence in a large, representative sample of the Japanese population. To this end, we analyzed claims data from the LIFE Study database, which includes 112 506 Japanese adults with newly diagnosed hypertension. Medication adherence was measured for a year postdiagnosis using the proportion of days covered (PDC) method. Factors associated with adherence to antihypertensives were also assessed. Among the total 112 506 hypertensive patients, the nonadherence rate (PDC ≤ 80%) for antihypertensives during the first year after initiation of the treatment was 26.2%. Younger age [31-35 years: odds ratio (OR), 0.15; 95% confidence interval (95% CI), 0.12-0.19 compared with 71-74-year-old patients], male gender, monotherapy, and diuretics use [OR, 0.87; 95% CI, 0.82-0.91 compared with angiotensin II receptor blockers (ARBs)] were associated with poor adherence in the present study. Cancer comorbidity (OR, 0.84; 95% CI, 0.79-0.91 compared with no comorbidity), prescription at a hospital, and living in a medium-sized to regional city were also associated with poor adherence. Our present findings showing the current status of adherence to antihypertensive medications and its associated factors using claims data in Japan should help to improve adherence to antihypertensives and blood pressure control.
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Affiliation(s)
- Kumi Sagara
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka City
| | - Kenichi Goto
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka City
| | - Megumi Maeda
- Department of Healthcare Administration and Management, Graduate School of Medical Sciences, Kyushu University Fukuoka City, Fukuoka, Japan
| | - Fumiko Murata
- Department of Healthcare Administration and Management, Graduate School of Medical Sciences, Kyushu University Fukuoka City, Fukuoka, Japan
| | - Haruhisa Fukuda
- Department of Healthcare Administration and Management, Graduate School of Medical Sciences, Kyushu University Fukuoka City, Fukuoka, Japan
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Hall YN, Anderson ML, McClure JB, Ehrlich K, Hansell LD, Hsu CW, Margolis KL, Munson SA, Thompson MJ, Green BB. Relationship of Blood Pressure, Health Behaviors, and New Diagnosis and Control of Hypertension in the BP-CHECK Study. Circ Cardiovasc Qual Outcomes 2024; 17:e010119. [PMID: 38328915 DOI: 10.1161/circoutcomes.123.010119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 09/27/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Undiagnosed hypertension and uncontrolled blood pressure (BP) are common and contribute to excess cardiovascular morbidity and mortality. We examined whether BP control, changes in BP, and patient behaviors and attitudes were associated with a new hypertension diagnosis. METHODS We performed a post hoc analysis of 323 participants from BP-CHECK (Blood Pressure Checks for Diagnosing Hypertension), a randomized diagnostic study of BP measuring methods in adults without diagnosed hypertension with elevated BP recruited from 12 primary care clinics of an integrated health care system in Washington State during 2017 to 2019. All 323 participants returned a positive diagnostic test for hypertension based on 24-hour ambulatory BP monitoring and were followed for 6 months. We used linear regression to examine the relationships between a new hypertension diagnosis (primary independent variable) and differences in the change in study outcomes from baseline to 6-month. RESULTS Mean age of study participants was 58.3 years (SD, 13.1), 147 (45%) were women, and 253 (80%) were of non-Hispanic White race. At 6 months, 154 of 323 (48%) participants had a new hypertension diagnosis of whom 88 achieved target BP control. Participants with a new hypertension diagnosis experienced significantly larger declines from baseline in BP (adjusted mean difference: systolic BP, -7.6 mm Hg [95% CI, -10.3 to -4.8]; diastolic BP, -3.8 mm Hg [95% CI, -5.6 to -2.0]) compared with undiagnosed peers. They were also significantly more likely to achieve BP control by 6 months compared with undiagnosed participants (adjusted relative risk, 1.5 [95% CI, 1.1 to 2.0]). At 6 months, 101 of 323 participants (31%) with a positive ambulatory BP monitoring diagnostic test remained with undiagnosed hypertension, uncontrolled BP, and no antihypertensive medications. CONCLUSIONS Approximately one-third of participants with high BP on screening and ambulatory BP monitoring diagnostic testing remained with undiagnosed hypertension, uncontrolled BP, and no antihypertensive medications after 6 months. New strategies are needed to enhance integration of BP diagnostic testing into clinical practice. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03130257.
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Affiliation(s)
- Yoshio N Hall
- Kidney Research Institute (Y.N.H.), University of Washington, Seattle
- Nephrology Section, VA Puget Sound HCS, Seattle, WA (Y.N.H.)
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA (M.L.A., J.B.M., K.E., L.H., C.H., B.B.G.)
| | - Jennifer B McClure
- Kaiser Permanente Washington Health Research Institute, Seattle, WA (M.L.A., J.B.M., K.E., L.H., C.H., B.B.G.)
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA (J.B.M., B.B.G.)
| | - Kelly Ehrlich
- Kaiser Permanente Washington Health Research Institute, Seattle, WA (M.L.A., J.B.M., K.E., L.H., C.H., B.B.G.)
| | - Laurel D Hansell
- Kaiser Permanente Washington Health Research Institute, Seattle, WA (M.L.A., J.B.M., K.E., L.H., C.H., B.B.G.)
| | - Clarissa W Hsu
- Kaiser Permanente Washington Health Research Institute, Seattle, WA (M.L.A., J.B.M., K.E., L.H., C.H., B.B.G.)
| | | | - Sean A Munson
- Department of Human Centered Design and Engineering (S.A.M.), University of Washington, Seattle
| | - Matthew J Thompson
- Clinical Research Scientist, Digital Health Center of Excellence, Google, Seattle, WA (M.J.T.)
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, WA (M.L.A., J.B.M., K.E., L.H., C.H., B.B.G.)
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA (J.B.M., B.B.G.)
- Washington Permanente Medical Group, Seattle (B.B.G.)
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Jacquelet E, Poujois A, Pheulpin MC, Demain A, Tinant N, Gastellier N, Woimant F. Adherence to treatment, a challenge even in treatable metabolic rare diseases: A cross sectional study of Wilson's disease. J Inherit Metab Dis 2021; 44:1481-1488. [PMID: 34480375 DOI: 10.1002/jimd.12430] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/26/2021] [Accepted: 09/01/2021] [Indexed: 11/09/2022]
Abstract
Wilson's disease (WD), a rare genetic disorder responsible for copper accumulation in the body, is fatal if left untreated. Although there are effective treatments, adherence to treatment tends to be low. We evaluated the medication adherence of 139 patients using the Morisky scale. Adherence was correlated with age at diagnosis and at inclusion in the study, the form of the disease, the treatment, the duration of treatment, delivery and storage problems, depression, anxiety, the level of education, and the biological data. 32.4% of the patients had low adherence; their levels of exchangeable copper were significantly higher than those of the patients with high or medium adherence (P = .049). The average age of the patients at the time of the study was significantly higher in those with high adherence than in those with medium or low adherence (P = .043). 75.9% of the patients with high adherence had a neurological form and 26.7% of the patients with low adherence were asymptomatic (P = .0090). The duration of treatment was significantly longer in the patients with high adherence than in those with medium or low adherence (P = .0192). The type of treatment (chelators or zinc) had no impact on the level of adherence. Forty-four percent of the patients experienced problems dispensing and storing medications. Despite the availability of effective treatments for this rare disease, adherence problems occur with Wilson's disease in particular in asymptomatic patients. Although different factors are involved, sustained multidisciplinary management on a case-by-case basis is necessary.
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Affiliation(s)
- Elodie Jacquelet
- Department of Neurology, Lariboisière University Hospital, AP-HP, Paris, France
- Department of Neurology, National Reference Centre for Wilson's Disease, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Aurelia Poujois
- Department of Neurology, National Reference Centre for Wilson's Disease, Hôpital Fondation Adolphe de Rothschild, Paris, France
- Department of Neurology, Rothschild Foundation Hospital, Paris, France
| | | | - Adèle Demain
- Department of Neurology, Lariboisière University Hospital, AP-HP, Paris, France
- Department of Neurology, National Reference Centre for Wilson's Disease, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Nadège Tinant
- Department of Neurology, Lariboisière University Hospital, AP-HP, Paris, France
- Department of Neurology, National Reference Centre for Wilson's Disease, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Nathalie Gastellier
- Department of Neurology, Lariboisière University Hospital, AP-HP, Paris, France
| | - France Woimant
- Department of Neurology, Lariboisière University Hospital, AP-HP, Paris, France
- Department of Neurology, National Reference Centre for Wilson's Disease, Hôpital Fondation Adolphe de Rothschild, Paris, France
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Effect of number of medications and complexity of regimens on medication adherence and blood pressure management in hospitalized patients with hypertension. PLoS One 2021; 16:e0252944. [PMID: 34111189 PMCID: PMC8191947 DOI: 10.1371/journal.pone.0252944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/25/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Good adherence of antihypertensives is recommended for the accomplishment of hypertension therapy. The number of medications and characteristics contributing to medication regimen complexity, such as dosage forms and dosing frequency, are known to influence medication adherence. However, the effect of medication regimen complexity on the therapeutic efficacy of medicines remains to be clarified. In the present study, we retrospectively investigated the effect of number of medications and medication regimen complexity on medication adherence and therapeutic efficacy in patients with hypertension. METHODS According to the inclusion and exclusion criteria, 1,057 patients, who were on medications including antihypertensives on admission at the Mie University Hospital between July 2018 and December 2018, were enrolled in this study. Poor blood pressure management was defined if the systolic or diastolic blood pressure were ≥140 mmHg or ≥ 90 mmHg. Medication regimen complexity was quantified using the medication regimen complexity index (MRCI) score. RESULTS Among 1,057 patients, 164 and 893 patients were categorized into poor and good adherence groups, respectively. The multivariate analyses revealed that age ≥ 71 years and oral MRCI score ≥ 19.5 but not number of oral medications were extracted as risk factors for poor medication adherence. Medication adherence and blood pressure management were poor in the group with oral MRCI score ≥ 19.5, regardless of the age. The rate of readmission was similar. CONCLUSION Our study is the first to demonstrate that medication regimen complexity rather than number of medications is closely related to medication adherence and blood pressure management. Hence, physicians and/or pharmacists should consider the complexity of medication regimens while modifying them.
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7
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Lauder L, Ewen S, Glasmacher J, Lammert F, Reith W, Schreiber N, Kaddu-Mulindwa D, Ukena C, Böhm M, Meyer MR, Mahfoud F. Drug adherence and psychosocial characteristics of patients presenting with hypertensive urgency at the emergency department. J Hypertens 2021; 39:1697-1704. [PMID: 33734143 DOI: 10.1097/hjh.0000000000002842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify potentially targetable psychosocial factors associated with nonadherence to prescribed antihypertensive medications in patients presenting with hypertensive urgencies at an emergency department. METHODS This prospective study included patients treated with antihypertensive drugs who presented with hypertensive urgencies (SBP ≥180 mmHg and/or DBP ≥110 mmHg) at the emergency department of a tertiary referral clinic between April 2018 and April 2019. Health literacy was assessed using the Newest Vital Sign test. The Hospital Anxiety and Depression Scale (HADS) was used to quantify symptoms of anxiety and depression. Patients were classified nonadherent if less than 80% of the prescribed antihypertensive drugs were detectable in urine or plasma using liquid chromatography-high-resolution mass spectrometry. RESULTS A total of 104 patients (62% women) presenting with hypertensive urgencies with a median SBP of 200 mmHg (IQR 190-212) and DBP of 97.5 mmHg (IQR 87-104) were included. Twenty-five patients (24%) were nonadherent to their antihypertensive medication. Nonadherent patients were more often men (66 versus 23%, P = 0.039), prescribed higher numbers of antihypertensive drugs (median 3, IQR 3-4 versus 2, IQR 1-3; P < 0.001), and more often treated with calcium channel blockers (76 versus 25%; P < 0.001) and/or diuretics (64 versus 40%; P = 0.030). There was no difference in health literacy (P = 0.904) or the scores on the HADS subscales for depression (P = 0.319) and anxiety (P = 0.529) between adherent and nonadherent patients. CONCLUSION Male sex, higher numbers of antihypertensive drugs, and treatment with diuretics and/or calcium channel blockers were associated with nonadherence. We did not identify a specific psychosocial characteristic associated with nonadherence.
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Affiliation(s)
- Lucas Lauder
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University.,Emergency Department, Universitätsklinikum des Saarlandes
| | - Julius Glasmacher
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University
| | | | | | - Naemi Schreiber
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University
| | - Dominic Kaddu-Mulindwa
- Department of Hematology, Oncology, Clinical Immunology, Rheumatology, Saarland University Medical Center
| | - Christian Ukena
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University
| | - Markus R Meyer
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS), Saarland University, Homburg/Saar, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University.,Institute for Medical Engineering and Science, MIT, Cambridge, Massachusetts, USA
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8
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Alfian SD, van Boven JFM, Abdulah R, Sukandar H, Denig P, Hak E. Effectiveness of a targeted and tailored pharmacist-led intervention to improve adherence to antihypertensive drugs among patients with type 2 diabetes in Indonesia: A cluster randomised controlled trial. Br J Clin Pharmacol 2020; 87:2032-2042. [PMID: 33085801 PMCID: PMC8056734 DOI: 10.1111/bcp.14610] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/26/2020] [Accepted: 09/25/2020] [Indexed: 01/31/2023] Open
Abstract
Aim To assess the effects of a targeted and tailored pharmacist‐led intervention among patients with type 2 diabetes (T2DM) who are nonadherent to antihypertensive drugs. Methods A cluster‐randomised controlled trial was conducted in 10 community health centres (CHCs) in Indonesia among T2DM patients aged ≥18 years who reported nonadherence to antihypertensive drugs according to the Medication Adherence Report Scale (MARS‐5). Patients in CHCs randomised to the intervention group received a tailored intervention based on their adherence barriers (eg, forgetfulness, lack of knowledge, lack of motivation and/or other drug‐related problems) using a simple question‐based flowchart at baseline and 1‐month follow‐up. Patients in control CHCs received usual care. Primary outcome was the between‐group difference in change in MARS‐5 score from baseline to 3‐month follow‐up. Secondary outcomes included changes in patients' blood pressure and their medication beliefs. Differences in difference in primary and secondary outcomes between groups were assessed using general linear models. Results In total, 201 patients were screened for eligibility, 113 met the inclusion criteria and participated, and 89 (79%) patients had complete follow‐up. Forgetfulness (42%) and lack of knowledge (18%) were the most common adherence barriers identified at baseline. The intervention improved medication adherence by 4.62 points on the MARS‐5 scale (95% CI 0.93 to 8.34, P value = 0.008). There were no significant changes in blood pressure levels and beliefs about antihypertensive drugs. Conclusion A tailored low‐cost pharmacist‐led intervention aimed at nonadherent T2DM patients resulted in an improvement in medication adherence to antihypertensive drugs. There were no significant changes in secondary outcomes.
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Affiliation(s)
- Sofa D Alfian
- University of Groningen, Groningen Research Institute of Pharmacy, Unit Pharmaco-Therapy, -Epidemiology & -Economics, Groningen, the Netherlands.,Universitas Padjadjaran, Faculty of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Jatinangor, Indonesia.,Universitas Padjadjaran, Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Jatinangor, Indonesia
| | - Job F M van Boven
- University of Groningen, University Medical Centre Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, the Netherlands.,Medication Adherence Expertise Centre Of the northern Netherlands (MAECON), Groningen, the Netherlands
| | - Rizky Abdulah
- Universitas Padjadjaran, Faculty of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Jatinangor, Indonesia.,Universitas Padjadjaran, Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Jatinangor, Indonesia
| | - Hadyana Sukandar
- Universitas Padjadjaran, Faculty of Medicine, Department of Public Health, Bandung, Indonesia
| | - Petra Denig
- University of Groningen, University Medical Centre Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, the Netherlands.,Medication Adherence Expertise Centre Of the northern Netherlands (MAECON), Groningen, the Netherlands
| | - Eelko Hak
- University of Groningen, Groningen Research Institute of Pharmacy, Unit Pharmaco-Therapy, -Epidemiology & -Economics, Groningen, the Netherlands.,Medication Adherence Expertise Centre Of the northern Netherlands (MAECON), Groningen, the Netherlands
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9
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A Gap in Post-Stroke Blood Pressure Target Attainment at Entry to Cardiac Rehabilitation. Can J Neurol Sci 2020; 48:487-495. [PMID: 33059775 DOI: 10.1017/cjn.2020.231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Recurrent events account for approximately one-third of all strokes and are associated with greater disability and mortality than first-time strokes. Blood pressure (BP) is the most important modifiable risk factor. Objectives were to determine the proportion of post-stroke patients enrolled in cardiac rehabilitation (CR) meeting systolic and diastolic BP (SBP/DBP) targets and to determine correlates of meeting these targets. METHODS A retrospective study of 1,804 consecutively enrolled post-stroke patients in a CR program was conducted. Baseline data (database records 2006-2017) included demographics, anthropometrics, clinical/medication history, and resting BP. Multivariate analyses determined predictors of achieving BP targets. RESULTS Mean age was 64.1 ± 12.7 years, median days from stroke 210 (IQR 392), with most patients being male (70.6%; n = 1273), overweight (66.8%; n = 1196), and 64.2% diagnosed with hypertension (n = 1159), and 11.8% (n = 213) with sleep apnea. A mean of 1.69 ± 1.2 antihypertensives were prescribed, with 26% (n = 469) of patients prescribed 3-4 antihypertensives. SBP target was met by 71% (n = 1281) of patients, 83.3% (n = 1502) met DBP target, and 64.3% (n = 1160) met both targets. Correlates of meeting SBP target were not having diabetes, younger age, fewer prescribed antihypertensives, and more recent program entry. Correlates of meeting DBP target were not having diabetes, older age, fewer prescribed antihypertensives, and more recent stroke. CONCLUSIONS Up to one-third of patients were not meeting BP targets. Patients with diabetes, and those prescribed multiple antihypertensives are at greater risk for poorly controlled SBP and DBP. Reasons for poor BP control such as untreated sleep apnea and medication non-adherence need to be investigated.
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10
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Margolis KL, Crain AL, Bergdall AR, Beran M, Anderson JP, Solberg LI, O'Connor PJ, Sperl-Hillen JM, Pawloski PA, Ziegenfuss JY, Rehrauer D, Norton C, Haugen P, Green BB, McKinney Z, Kodet A, Appana D, Sharma R, Trower NK, Williams R, Crabtree BF. Design of a pragmatic cluster-randomized trial comparing telehealth care and best practice clinic-based care for uncontrolled high blood pressure. Contemp Clin Trials 2020; 92:105939. [PMID: 31981712 DOI: 10.1016/j.cct.2020.105939] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Uncontrolled hypertension is the largest single contributor to all-cause and cardiovascular mortality in the U.S. POPULATION Nurse- and pharmacist-led team-based care and telehealth care interventions have been shown to result in large and lasting improvements in blood pressure (BP); however, it is unclear how successfully these can be implemented at scale in real-world settings. It is also uncertain how telehealth interventions impact patient experience compared to traditional clinic-based care. AIMS/OBJECTIVES To compare the effects of two evidence-based blood pressure care strategies in the primary care setting: (1) best-practice clinic-based care and (2) telehealth care with home BP telemonitoring and management by a clinical pharmacist. To evaluate implementation using mixed-methods supported by the RE-AIM framework and Consolidated Framework for Implementation Research. METHODS The design is a cluster-randomized comparative effectiveness pragmatic trial in 21 primary care clinics (9 clinic-based care, 12 telehealth care). Adult patients (age 18-85) with hypertension are enrolled via automated electronic health record (EHR) tools during primary care encounters if BP is elevated to ≥150/95 mmHg at two consecutive visits. The primary outcome is change in systolic BP over 12 months as extracted from the EHR. Secondary outcomes are change in key patient-reported outcomes over 6 months as measured by surveys. Qualitative data are collected at various time points to investigate implementation barriers and help explain intervention effects. CONCLUSION This pragmatic trial aims to inform health systems about the benefits, strengths, and limitations of implementing home BP telemonitoring with pharmacist management for uncontrolled hypertension in real-world primary care settings.
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Affiliation(s)
- Karen L Margolis
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America.
| | - A Lauren Crain
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Anna R Bergdall
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - MarySue Beran
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Jeffrey P Anderson
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Leif I Solberg
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Patrick J O'Connor
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - JoAnn M Sperl-Hillen
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Pamala A Pawloski
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Jeanette Y Ziegenfuss
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Dan Rehrauer
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Christine Norton
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Patricia Haugen
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Av, Seattle, WA 98101, United States of America
| | - Zeke McKinney
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Amy Kodet
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Deepika Appana
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Rashmi Sharma
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Nicole K Trower
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - RaeAnn Williams
- HealthPartners, Mailstop 31100A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Benjamin F Crabtree
- Rutgers Robert Wood Johnson Medical School, Department of Family Medicine and Community Health, New Brunswick, NJ 08901, United States of America
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Schoenthaler A, de la Calle F, Pitaro M, Lum A, Chaplin W, Mogavero J, Rosal MC. A Systems-Level Approach to Improving Medication Adherence in Hypertensive Latinos: a Randomized Control Trial. J Gen Intern Med 2020; 35:182-189. [PMID: 31625041 PMCID: PMC6957668 DOI: 10.1007/s11606-019-05419-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 07/08/2019] [Accepted: 08/21/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite numerous interventions targeting medication adherence in patients with uncontrolled hypertension, practice-based trials in Latino patients are scant. OBJECTIVE To evaluate the effect of a systems-level adherence intervention, delivered by medical assistants (MAs), versus a comparison condition on medication adherence and blood pressure (BP) in 119 hypertensive Latino patients who were initially non-adherent to their antihypertensive medications. STUDY DESIGN Randomized control trial. PARTICIPANTS Patients (50% women; mean age, 61 years) were recruited from April 2013 to August 2015 in a community-based practice in New York. INTERVENTION Systems-level approach that included an office system component built into the electronic health record and a provider support component consisting of nine MA-delivered health coaching sessions for improving medication adherence. The comparison group received the standard health coaching procedures followed at the clinic. MAIN OUTCOME MEASURES The primary outcome was rate of medication adherence measured by an electronic monitoring device (EMD) across 6 months. The secondary outcomes were self-reported medication adherence measured by the eight-item Morisky Medication Adherence Scale (MMAS-8) and BP reduction from baseline to 6 months. KEY RESULTS Adherence as measure by EMD worsened for both groups (p = 0.04) with no between-group difference (- 9.6% intervention and - 6.6% control, p = 0.66). While systolic BP improved in both groups, the difference between groups was not significant (- 6 mmHg in intervention vs. - 2.7 mmHg in control, p = 0.34). In contrast, the intervention group had a greater improvement in self-reported adherence (mean change 1.98 vs. 1.26, p = 0.03) when measured using the MMAS-8. CONCLUSIONS Among Latinos with poorly controlled BP who were non-adherent to their antihypertensive medications, a systems-level intervention did not improve adherence as measured by EMD nor blood pressure. However, many patients reported challenges to using the EMD. Improvements in self-reported adherence suggest that this measure captures different aspects of adherence behavior than EMD. CLINICAL TRIAL REGISTRATION NCT03560596.
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Affiliation(s)
- Antoinette Schoenthaler
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA.
| | - Franzenith de la Calle
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA
| | | | | | - William Chaplin
- Department of Psychology, St. Johns University, Jamaica, NY, USA
| | - Jazmin Mogavero
- Department of Psychology, St. Johns University, Jamaica, NY, USA
| | - Milagros C Rosal
- Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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12
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Sieben A, van Onzenoort HAW, van Dulmen S, van Laarhoven CJHM, Bredie SJH. A nurse-based intervention for improving medication adherence in cardiovascular patients: an evaluation of a randomized controlled trial. Patient Prefer Adherence 2019; 13:837-852. [PMID: 31213778 PMCID: PMC6537037 DOI: 10.2147/ppa.s197481] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 03/21/2019] [Indexed: 01/13/2023] Open
Abstract
Background: Poor medication adherence is a limitation in the secondary prevention of cardiovascular diseases (CVDs) and leads to increased morbidity, mortality, and costs. Purpose: To examine the process and effect of a nurse-led, web-based intervention based on behavioral change strategies to improve medication adherence in patients with CVD. Patients and methods: In this single-center, prospective, controlled clinical trial, cardiovascular patients were assigned to usual care, usual care plus a personalized website, or usual care plus a personalized website and personal consultations. Primary outcome was the level of adherence to cardiovascular medication. Data collection occurred between October 2011 and January 2015. Results: In total, 419 patients were randomized. Just 77 patients logged on the website and half of the invited patients attended the group consultation. Due to the limited use of the website, we combined the results of usual care and the usual care plus website group in one group (usual care) and compared these with the results of the group which received the nurse intervention (intervention group). No significant difference in adherence between the usual care group and the intervention group was observed. The adherence level in the usual care group was 93%, compared to 89% in the intervention group (p=0.08). 29% (usual care) and 31% (intervention group) of the patients showed a low adherence according to the Modified Morisky Scale® (p-value=0.94). The mean necessity concern differential was 3.8 with no differences between the two studied groups (mean 3.8 vs mean 3.9, p-value =0.86). Conclusion: Our intervention program did not show an effect. This could indicate that structured usual care provided to all cardiovascular patients already results in high medication adherence or that shortly after a cardiovascular event adherence is high. It could also indicate that the program did not have enough impact because there was not enough compliance with the intervention protocol. Trial registration: ID number NCT01449695, approved May 2011.
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Affiliation(s)
- Angelien Sieben
- Department of Surgery, Division of Vascular Surgery, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Hein AW van Onzenoort
- Department of Clinical Pharmacy, Amphia Hospital, Breda, the Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Sandra van Dulmen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
- NIVEL (Netherlands institute for health services research), Utrecht, the Netherlands
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - CJHM van Laarhoven
- Department of General Surgery, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Sebastian JH Bredie
- Department of General Internal Medicine, Division of Vascular Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
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13
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Prior medication adherence of participants and non participants of a randomized controlled trial to improve patient adherence in cardiovascular risk management. BMC Med Res Methodol 2019; 19:95. [PMID: 31072304 PMCID: PMC6506957 DOI: 10.1186/s12874-019-0743-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/29/2019] [Indexed: 02/07/2023] Open
Abstract
Background Poor medication adherence is a major factor in the secondary prevention of cardiovascular diseases (CVD) and contributes to increased morbidity, mortality, and costs. Interventions for improving medication adherence may have limited effects as a consequence of self selection of already highly adherent participants into clinical trials. Methods In this retrospective cohort study, existing levels of medication adherence were examined in self-decided participants and non-participants prior to inclusion in a randomized controlled study (RCT), evaluating the effect of an intervention to improve adherence. In addition, the non-participants were further divided into ‘responders’ and ‘non responders’. All individuals had manifest cardiovascular disease and completed a questionnaire with baseline characteristics, the Beliefs about Medicines Questionnaire (BMQ) and the Modified Morisky Scale® (MMS®) as part of a regular screening program. A logistic regression was conducted to examine the relationship between study participation willingness, adherence level and the beliefs about medication. Results According to the MMS® the adherence level was comparable in all groups. In both (non)-participants groups, 36% was classified as high adherent; 46% participants versus 44% non-participants were classified as medium adherent and 19% of the participants versus 20% of the non-participants were low adherent (p = 0.91. The necessity concern differential (NCD) from the BMQ was 3.8 for participants and 3.4 for non-participants (p = 0.32). Conclusion This study shows that adherence to medication and beliefs about medication do not differ between participants and non-participants before consenting to participate in an RCT. The study design seems not to have led to greater adherence in the study group.
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Leslie KH, McCowan C, Pell JP. Adherence to cardiovascular medication: a review of systematic reviews. J Public Health (Oxf) 2019; 41:e84-e94. [PMID: 29850883 PMCID: PMC6459362 DOI: 10.1093/pubmed/fdy088] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/21/2018] [Accepted: 05/03/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Use of cardiovascular medication has increased over time, especially for primary and secondary prevention, with polypharmacy common. METHODS Review of published systematic reviews of the factors and outcomes associated with adherence to cardiovascular medication using MEDLINE, Embase, CINAHL and PsycINFO databases. Quality was assessed using the AMSTAR tool. RESULTS Of 789 systematic reviews identified, 45 met the inclusion criteria and passed the quality assessment; 34 focused on factors associated with adherence, and 11 on outcomes. High heterogeneity, both between and within reviews, precluded meta-analysis and so a pooled estimate of adherence levels could not be derived. Adherence was associated with disease factors, therapy factors, healthcare factors, patient factors and social factors, though with some inconsistencies. In total, 91% of reviews addressing outcomes reported that low adherence was associated with poorer clinical and economic endpoints. CONCLUSIONS Factors from across five key domains relate to non-adherence to cardiovascular medications, and may contribute to poorer clinical outcomes. Interventions to improve adherence should be developed to address modifiable factors and targeted at those at highest risk of non-adherence. Adherence research is highly heterogeneous to-date and efforts to standardize this should be implemented to improve comparability.
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Affiliation(s)
- K H Leslie
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, UK
| | - C McCowan
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, Glasgow, UK
| | - J P Pell
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, UK
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15
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Burnier M. Is There a Threshold for Medication Adherence? Lessons Learnt From Electronic Monitoring of Drug Adherence. Front Pharmacol 2019; 9:1540. [PMID: 30687099 PMCID: PMC6334307 DOI: 10.3389/fphar.2018.01540] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 12/17/2018] [Indexed: 12/20/2022] Open
Abstract
Medication adherence is a well-recognized problem in the management of patients with chronic diseases needing a long-term pharmacotherapy. While fighting against non-adherence, an important question frequently arises, i.e., how much adherence is enough to obtain the full treatment benefits? Most studies having attempted to answer this question have used large pharmacy records and health care databases to quantify the percentage of days covered by the prescribed treatment and hence deduce a threshold below which there appears to be fewer benefits from therapy. In the present paper, the use of data obtained using electronic monitoring of adherence is discussed as another means to assess adherence thresholds with a particular emphasis on hypertension. The data show that even with the use of electronic monitoring of adherence, which provides a comprehensive dosing history, it is extremely difficult to define an adherence threshold in hypertension. This is due to many factors that need to be taken into account, including not only the pattern of patients’ adherence and their clinical and environmental characteristics, but also the pharmacological characteristics of the prescribed drugs, the severity of the disease and many others. To determine adherence cut-offs more precisely, specific protocols should be designed to answer the question in various clinical conditions. These protocols should be conducted in well-defined patients’ groups, they should use the most reliable methods to measure adherence providing if possible a detailed dosing history perhaps combined with drugs levels in blood or urine. These studies should also choose the best methods to measure clinical endpoints, such as ambulatory blood pressure monitoring or home blood pressure in the case of hypertension. One important aspect is that datasets should be solid and large enough to be able to analyze adherence data as a continuous variable using newly developed mathematical models including new metrics catching the complexity of adherence. The rapid development of new technologies like devices, connectivity, and analytics, will probably provide new solutions to improve our ability to define valid and clinically useful adherence thresholds in various therapeutic areas.
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Affiliation(s)
- Michel Burnier
- Hypertension Research Foundation, University of Lausanne, Lausanne, Switzerland
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16
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Lee CP, Holmes T, Neri E, Kushida CA. Deception in clinical trials and its impact on recruitment and adherence of study participants. Contemp Clin Trials 2018; 72:146-157. [PMID: 30138717 DOI: 10.1016/j.cct.2018.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/27/2018] [Accepted: 08/14/2018] [Indexed: 11/27/2022]
Abstract
Deceptive practices by participants in clinical research are prevalent. It has been shown that as high as 75% of participants withheld information to avoid exclusion from studies. Self-reported adherence has been found to be largely inaccurate. Overcoming deception is a critical issue, since the safety of study participants, the integrity of research data and research resources are at risk. In this review article, we examine deception from the perspective of investigators conducting clinical trials; we describe the types (concealment, fabrication, drug holidays and collusion), prevalence, risks, and predictors of deception, and propose an approach to reduce the impact of deception, especially on adherence, in clinical trials.
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Affiliation(s)
- Chuen Peng Lee
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore.
| | - Tyson Holmes
- Stanford University Human Immune Monitoring Center, Institute for Immunity Transplantation and Infection, Stanford University School of Medicine, Stanford, United States
| | - Eric Neri
- Stanford University School of Medicine, Palo Alto, CA, United States
| | - Clete A Kushida
- Stanford Sleep Medicine Center, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 450 Broadway Street, MC 5704, Pavilion C, 2nd Floor, Redwood City, CA 94063-5704, United States
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17
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Evaluation of the antihypertensive effect of nocturnal administration of acetylsalicylic acid: a cross-over randomized clinical trial. J Hypertens 2018; 37:406-414. [PMID: 30095728 DOI: 10.1097/hjh.0000000000001887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Several studies have shown that evening intake of aspirin has antihypertensive effect in healthy adults, which has not been proven in patients with cardiovascular disease, who mostly take aspirin in the morning. We have evaluated the antihypertensive effect of bedtime administration of aspirin in patients with cardiovascular disease already treated for hypertension. METHODS This is a multicenter randomized triple-blind placebo-controlled crossover trial, with hypertensive patients treated with aspirin for secondary prevention. There was a baseline-randomized assignment to 2-month periods of bedtime aspirin (100 mg) first and morning-time aspirin later, or inversely, both periods separated by an open label 2-4 weeks period of morning-time aspirin. At the start and end of each treatment period, a 24-h ambulatory blood pressure monitoring was performed. The main outcome measure was mean 24-h blood pressure. The analyses were performed according to the intention-to-treat principle. RESULTS Overall, 225 patients were randomized. No significant differences were observed in ambulatory blood pressure by time of intake of usual low doses of aspirin. The mean SBP/DBP was 123.2/69.9 (95% CI 121.58-124.9/68.86-76.86) with bedtime administration and 122.4/68.8 (95% CI 120.76-124.01/67.85-69.83) with daytime administration (P = 0.3 and P = 0.23 for SBP and DBP, respectively). CONCLUSION Administering aspirin at bedtime rather than in the morning does not modify the 24-h ambulatory blood pressure in hypertensive patients in secondary cardiovascular prevention.The trial was registered with ClinicalTrials.gov (number NCT01741922).
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18
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Didier R, Gilard M, Denolle T. [Resistant hypertension by unadvertised non-compliance detected by psychiatric expertise and drug dosages]. Ann Cardiol Angeiol (Paris) 2018; 67:222-225. [PMID: 29753423 DOI: 10.1016/j.ancard.2018.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/24/2018] [Indexed: 11/15/2022]
Abstract
The management of patients with resistant hypertension remains a major challenge in daily clinical practice in order to limit macro and microvascular impact. However, lack of compliance often remains one of the main etiologies of resistant hypertension. Through a clinical case of complex therapeutic non-compliance, we will detail the frequency, the screening and the management of therapeutic non-compliance. Finally, we will specify the contribution of drug dosages and psychological expertise in screening non-observant patients with presumed resistant hypertension.
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Affiliation(s)
- R Didier
- Department of Cardiology, University Hospital of Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France.
| | - M Gilard
- Department of Cardiology, University Hospital of Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France
| | - T Denolle
- Hypertension center Rennes-Dinard, 35800 Dinard, France
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19
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Lomper K, Chabowski M, Chudiak A, Białoszewski A, Dudek K, Jankowska-Polańska B. Psychometric evaluation of the Polish version of the Adherence to Refills and Medications Scale (ARMS) in adults with hypertension. Patient Prefer Adherence 2018; 12:2661-2670. [PMID: 30587938 PMCID: PMC6296194 DOI: 10.2147/ppa.s185305] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Only 50%-75% of chronically ill patients take their medication as prescribed. The patient is found to adhere to treatment correctly and optimally if they accomplish 80% or more of the treatment plan. A questionnaire titled the Adherence to Refills and Medications Scale (ARMS) has been used in studies involving various populations and proved to be a simple instrument for measuring adherence, with good psychometric properties. OBJECTIVE The aim of this study was to develop a Polish version of the ARMS (ARMS-P), an instrument that identifies levels of adherence in the hypertensive population, and evaluate its psychometric properties. METHODS This cross-sectional study included 279 patients, including 166 females (mean age 66.5 years), hospitalized between September 2016 and March 2017 in the Department of Internal Medicine, Occupational Diseases, and Hypertension of Wrocław Medical University, Poland. The 12-item ARMS was translated from English into Polish. The 12 items included in the final questionnaire comprise two subscales: adherence to taking medications (eight items) and adherence to refilling prescriptions (four items). RESULTS Patients in the good-adherence group were younger (P=0.017; P=0.048), more likely to be professionally active (P=0.041), better educated (P=0.037), and more likely to have normal blood pressure (P<0.001). They also measured their blood pressure more often (P<0.001), and took fewer pills in a day (P<0.001). Adherent patients were also more likely to take their medication on their own (P=0.016) and read information leaflets on the medication (P<0.001). The study demonstrated that the ARMS-P questionnaire has good psychometric properties that enable its use for assessing adherence in chronically ill patients, including in particular, patients with hypertension. CONCLUSION The psychometric properties of the questionnaire are satisfactory (reliability measured by means of Cronbach's α). The ARMS-P questionnaire proved to be suitable for use in the Polish population. The use of this screening tool for the assessment of adherence to treatment is recommended in this population of hypertensive patients.
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Affiliation(s)
- Katarzyna Lomper
- Division of Nursing of Internal Diseases, Department of Clinical Nursing, Faculty of Health Science, Wrocław Medical University, Wrocław, Poland
| | - Mariusz Chabowski
- Division of Surgical Procedures, Department of Clinical Nursing, Faculty of Health Science, Wrocław Medical University, Wrocław, Poland,
| | - Anna Chudiak
- Division of Nursing of Internal Diseases, Department of Clinical Nursing, Faculty of Health Science, Wrocław Medical University, Wrocław, Poland
| | - Artur Białoszewski
- Department of Prevention of Environmental Hazards and Allergology, Warsaw Medical University, Warsaw, Poland
| | - Krzysztof Dudek
- Faculty of Mechanical Engineering, Wrocław University of Science and Technology, Wrocław, Poland
| | - Beata Jankowska-Polańska
- Division of Nursing of Internal Diseases, Department of Clinical Nursing, Faculty of Health Science, Wrocław Medical University, Wrocław, Poland
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20
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Jacquelet E, Beretti J, De-Tassigny A, Girardot-Tinant N, Wenisch E, Lachaux A, Pheulpin MC, Poujois A, Woimant F. [Compliance with treatment in Wilson's disease: On the interest of a multidisciplinary closer follow-up]. Rev Med Interne 2017; 39:155-160. [PMID: 29274796 DOI: 10.1016/j.revmed.2017.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 10/16/2017] [Accepted: 11/25/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Compliance with treatment is very important for patients who suffer from Wilson's disease, a rare genetic disorder. They can benefit a long-life and effective treatment. The purpose of our study is to identify the level of compliance in Wilson's disease patients and features associated with compliance as well. METHODS This is a prospective study carried out in the National Reference Center for Wilson Disease (based in Paris and Lyon) over a 8 months period. Patients were evaluated on the first (M0) and last month (M8) with a questionnaire evaluating the number of missed treatment doses, a self-questionnaire collecting the reasons for non-compliance, and analogic scales analyzing the doctor-patient relationship and their behavior towards the treatment. The severity of depression symptoms was investigated by the Beck Depression Inventory (BDI). A detailed phone call interview was conducted by a psychologist every two months to evaluate their compliance and feeling. RESULTS Thirty-nine patients were included. The mean age of patients was 34 years (±9.9). At M0, 84.6% had a poor compliance with treatment. They were diagnosed more recently (P=0.049) with a higher proportion involving neurological disorders (P=0.007). Age, the type of treatment and the quality of the doctor-patient relationship were not associated with the outcome; 38.5% suffered from depressive symptoms. At M8, 56.8% of patients were poor compliants and 21.6% presented depressive symptoms. CONCLUSION Wilsons's disease patients have important problems with compliance, without necessary being depressed. A close follow-up may help them become compliant, particularly those with neurological symptoms.
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Affiliation(s)
- E Jacquelet
- Centre national de référence de la maladie de Wilson, hôpital Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Laboratoire UTRPP, université Paris 13, 99, avenue Jean-Baptiste-Clément, 93430 Villetaneuse, France.
| | - J Beretti
- Centre national de référence de la maladie de Wilson, hôpital Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - A De-Tassigny
- Centre national de référence de la maladie de Wilson, hôpital Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - N Girardot-Tinant
- Centre national de référence de la maladie de Wilson, hôpital Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - E Wenisch
- Centre national de référence de la maladie de Wilson, hôpital Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - A Lachaux
- Service d'hépatologie-gastro-entérologie et nutrition pédiatriques, hôpital Femme-Mère-Enfant, CHU de Lyon, 39, avenue Doyen-Jean-Lépine, 69500 Bron, France
| | - M-C Pheulpin
- Université Paris 13, 99, avenue Jean-Baptiste-Clément, 93430 Villetaneuse, France
| | - A Poujois
- Centre national de référence de la maladie de Wilson, hôpital Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - F Woimant
- Centre national de référence de la maladie de Wilson, hôpital Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
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Affiliation(s)
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, The Netherlands
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22
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Affiliation(s)
- Lindsay C Strowd
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27104, USA
| | - Steven R Feldman
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27104, USA.
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24
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Velentgas P, Sheffield R, Nordstrom BL, Johnson E, Do T, Mentor SM, Seeger JD. Persistence with Medications in Glaucoma Management, Hypertension, and Dyslipidemia. J Pharm Technol 2016. [DOI: 10.1177/875512250702300406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective:To summarize pharmacy database studies of persistence with ocular hypotensives and review the literature of adherence with 2 additional classes of medication—antihypertensives and antihyperlipidemics—comparing methods used to analyze adherence in the 3 treatment areas.Data Sources:A search of MEDLINE (1990–2004) was conducted, using search terms designed to identify English-language articles describing adherence or persistence with any of the 3 drug classes of interest.Study Selection and Data Extraction:All articles identified through MEDLINE were reviewed and screened for use of an automated pharmacy database as an information source, quantitative results provided, and follow-up duration of at least 90 days. Details of methods used to estimate adherence or persistence and estimates of persistence with ocular hypotensive therapy, antihypertensives, and lipid-lowering agents were extracted.Data Synthesis:All studies describing the use of ocular hypotensives, and the majority of studies in the other treatment areas, identified inception cohorts of drug initiators. Use of survival analysis techniques to analyze adherence to medication therapy was less common in the hypertension and hyperlipidemia treatment adherence literature than in literature about glaucoma. In the treatment of hypertension, use of angiotensin II receptor antagonists or angiotensin-converting enzyme inhibitors was associated with higher levels of adherence. Statins in treatment of hyperlipidemia and topical prostaglandins as ocular hypotensive medications were also associated with higher levels of adherence.Conclusions:Findings regarding the relative superiority of specific drug classes were consistent within each therapeutic area, with less consistency in identifying other predictors of adherence. Increased use of survival analysis in future studies of persistence might improve comparability of results across studies.
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Affiliation(s)
- Priscilla Velentgas
- PRISCILLA VELENTGAS PhD, at time of writing, Director, Epidemiology, Ingenix i3 Drug Safety, Waltham, MA; now, Lecturer, Department of Ambulatory Care and Prevention, Harvard Medical School and Hard Pilgrim Health Care, Boston, MA
| | - Reinee Sheffield
- REINEE SHEFFIELD PharmD MPH, at time of writing, Manager, Pfizer US Outcomes Research, New York, NY; now, Associate Director, Baxter Bioscience Medical Outcomes Research and Economics, Westlake Village, CA
| | - Beth L Nordstrom
- BETH L NORDSTROM PhD MPH, Senior Scientist, Center for Health Economics, Epidemiology and Science Policy, United BioSource Corporation, Medford, MA
| | - Eric Johnson
- ERIC JOHNSON PhD, Affiliate Assistant Professor, Department of Pharmacy, University of Washington, Seattle, WA
| | - Thy Do
- THY DO MPH, at time of writing, Research Associate, Department of Pharmacy, University of Washington; now, Epidemiologist, Amgen, Seattle
| | - Sherry M Mentor
- SHERRY M MENTOR BA, at time of writing, Research Associate, Ingenix i3 Drug Safety; now, MPH Candidate in Community Health, New York University, New York, NY
| | - John D Seeger
- JOHN D SEEGER PharmD DrPH, Senior Scientist, Ingenix i3 Drug Safety
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Rabbia F, Fulcheri C, Di Monaco S, Covella M, Perlo E, Pappaccogli M, Veglio F. Adherence to antihypertensive therapy and therapeutic dosage of antihypertensive drugs. High Blood Press Cardiovasc Prev 2016; 23:341-345. [PMID: 27160721 DOI: 10.1007/s40292-016-0158-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022] Open
Abstract
Adherence to antihypertensive therapy is critical to achieving adequate blood pressure control. About half of hypertensive patients do not take their drugs as directed and the physicians often underestimate this issue. Non-adherence has important public health economic implications (numbers of visits, diagnostic procedures, prescribed drugs) and, moreover, it results in increased morbidity and mortality rates. Poor adherence can have several patients and therapy related causes. Currently, multiple different direct and indirect methods to measure therapeutic adherence are available, but, in clinical practice, there is no cost-effective and simple one. Therapeutic drug monitoring (TDM), characterized by drug (or metabolites) concentration measurement in body fluids (blood or urine), is a cost-effective direct method to assess therapeutic adherence. Despite some limitations, TDM may decrease health costs, by reducing the number of visits and by identifying those patients who would undergo unnecessary invasive procedures. Moreover, TDM can be a new alternative method to identify patients with true resistant hypertension, improving the achievement of blood pressure control In this minor revision, we would assess poor therapeutic adherence in hypertensive population, analyzing the different direct and direct available methods, with emphasis on TDM.
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Affiliation(s)
- Franco Rabbia
- Division of Internal Medicine, Hypertension Unit, AOU Città della Salute e della Scienza, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Chiara Fulcheri
- Division of Internal Medicine, Hypertension Unit, AOU Città della Salute e della Scienza, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy.
| | - Silvia Di Monaco
- Division of Internal Medicine, Hypertension Unit, AOU Città della Salute e della Scienza, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Michele Covella
- Division of Internal Medicine, Hypertension Unit, AOU Città della Salute e della Scienza, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Elisa Perlo
- Division of Internal Medicine, Hypertension Unit, AOU Città della Salute e della Scienza, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Marco Pappaccogli
- Division of Internal Medicine, Hypertension Unit, AOU Città della Salute e della Scienza, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Franco Veglio
- Division of Internal Medicine, Hypertension Unit, AOU Città della Salute e della Scienza, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
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Abstract
Untreated and uncontrolled hypertension (HTN) presents a major public health burden in the USA and worldwide. Despite the known risk for increased cardiovascular (CV) morbidity and mortality, blood pressure remains untreated and uncontrolled at alarming rates of between 20 and 40 % in patients with known HTN. Further, while cumulative evidence indicates that early onset of antihypertensive effect improves CV outcomes, the time to blood pressure (BP) control remains long. The objective of hypertension management cannot be simply to achieve and maintain the goal BP, but to do so quickly to improve short-term and long-term CV outcomes. In this review, we will (1) describe the magnitude of uncontrolled HTN, (2) identify the factors that contribute to uncontrolled BP in patients with the diagnosis of HTN, and (3) explore the rationale for and benefits of aggressive and immediate control of HTN.
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Kressin NR, Long JA, Glickman ME, Bokhour BG, Orner MB, Clark C, Rothendler JA, Berlowitz DR. A Brief, Multifaceted, Generic Intervention to Improve Blood Pressure Control and Reduce Disparities Had Little Effect. Ethn Dis 2016; 26:27-36. [PMID: 26843793 DOI: 10.18865/ed.26.1.27] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Poor blood pressure (BP) control and racial disparities therein may be a function of clinical inertia and ineffective communication about BP care. METHODS We compared two different interventions (electronic medical record reminder for BP care (Reminder only, [RO]), and clinician training on BP care-related communication skills plus the reminder (Reminder + Training, [R+T]) with usual care in three primary care clinics, examining BP outcomes among 8,866 patients, and provider-patient communication and medication adherence among a subsample of 793. RESULTS Clinician counseling improved most at R+T. BP improved overall; R+T had a small but significantly greater reduction in diastolic BP (DBP; -1.7 mm Hg). White patients at RO experienced greater overall improvements in BP control. Site and race disparities trends suggested that disparities decreased at R+T, either stayed the same or decreased at Control; and stayed the same or increased at RO. CONCLUSIONS More substantial or racial/ethnically tailored interventions are needed.
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Affiliation(s)
- Nancy R Kressin
- Boston VA Healthcare System; Center for Healthcare Organization and Implementation Research, Boston/Bedford VA Medical Centers; Section of General Internal Medicine, Boston University School of Medicine; Health/care Disparities Research Program
| | - Judith A Long
- Center for Health Equity Research and Promotion, Philadelphia VAMC; Department of Internal Medicine, University of Pennsylvania School of Medicine
| | - Mark E Glickman
- Center for Healthcare Organization and Implementation Research, Boston/Bedford VA Medical Centers; Health Policy and Management Department, Boston University School of Public Health
| | - Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research, Boston/Bedford VA Medical Centers; Health Policy and Management Department, Boston University School of Public Health
| | - Michelle B Orner
- Center for Healthcare Organization and Implementation Research, Boston/Bedford VA Medical Centers
| | | | - James A Rothendler
- Center for Healthcare Organization and Implementation Research, Boston/Bedford VA Medical Centers; Health Policy and Management Department, Boston University School of Public Health
| | - Dan R Berlowitz
- Center for Healthcare Organization and Implementation Research, Boston/Bedford VA Medical Centers; Health Policy and Management Department, Boston University School of Public Health
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Calderón-Larrañaga A, Diaz E, Poblador-Plou B, Gimeno-Feliu LA, Abad-Díez JM, Prados-Torres A. Non-adherence to antihypertensive medication: The role of mental and physical comorbidity. Int J Cardiol 2016; 207:310-6. [PMID: 26814635 DOI: 10.1016/j.ijcard.2016.01.069] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/15/2015] [Accepted: 01/01/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Multiple parameters influence adherence to drug treatment, including socio-economic, healthcare, condition, therapy, and patient-related factors. However, studies of the impact of patient-related factors, particularly regarding comorbid conditions, have produced conflicting results. OBJECTIVES To analyse the association between mental and physical comorbidity and non-adherence to antihypertensive medication in patients attending primary care, after including a comprehensive range of chronic comorbidities and potential confounders. METHODS Cross-sectional study of 113,397 adults with a diagnosis of hypertension in 2010 assigned to the public health service of a region in northeastern Spain. Pharmacy billing records were linked to data from electronic health records at individual level. Non-adherence was defined as an antihypertensive medication possession ratio (MPR) <80%. Multivariable logistic regression models were used to estimate the odds ratio for non-adherence. Potential predictors included mental and physical comorbidity, age, sex, blood pressure level, nationality, rurality, polypharmacy, and number of visits to the GP and to different specialties. RESULTS One fifth of the study population showed poor adherence levels. Female sex, younger age, foreign nationality, living in a rural area, low blood pressure levels, polypharmacy, and mental comorbidity were positively and significantly associated with non-adherence. Conversely, non-adherence was negatively and significantly associated with the presence of cardiovascular risk factors and higher annual rates of GP visits. CONCLUSION The majority of patient-related determinants identified here (e.g., the presence of mental comorbidity, polypharmacy, foreign nationality) underscores the need for a patient- rather than a disease-centred care approach, as well as adequate physician-patient communication.
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Affiliation(s)
- Amaia Calderón-Larrañaga
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/ Sinesio Delgado 4, 28029 Madrid, Spain
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, NO-5020 Bergen, Norway; Norwegian Centre for Minority Health Research (NAKMI), Oslo University Hospital, PO box 4956, NO-0424 Oslo, Norway
| | - Beatriz Poblador-Plou
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/ Sinesio Delgado 4, 28029 Madrid, Spain
| | - Luis Andrés Gimeno-Feliu
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/ Sinesio Delgado 4, 28029 Madrid, Spain; San Pablo Health Centre, C/ Aguadores 7, 50003 Zaragoza, Spain; University of Zaragoza-Faculty of Medicine, C/ Domingo Miral s/n, 50009 Zaragoza, Spain
| | - José María Abad-Díez
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; University of Zaragoza-Faculty of Medicine, C/ Domingo Miral s/n, 50009 Zaragoza, Spain; Dpt. of Health, Welfare and Family, DG Planning and Assurance, Government of Aragon, Vía Univérsitas 36, 50009 Zaragoza, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/ Sinesio Delgado 4, 28029 Madrid, Spain; University of Zaragoza-Faculty of Medicine, C/ Domingo Miral s/n, 50009 Zaragoza, Spain
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Land SR, Walcott FL, Liu Q, Wickerham DL, Costantino JP, Ganz PA. Symptoms and QOL as Predictors of Chemoprevention Adherence in NRG Oncology/NSABP Trial P-1. J Natl Cancer Inst 2015; 108:djv365. [PMID: 26615179 DOI: 10.1093/jnci/djv365] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 10/27/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Tamoxifen provides a 50% reduction in the incidence of breast cancer (BC) among high-risk women, yet many do not adhere to the five-year course of therapy. Using the prospective double-blind National Surgical Adjuvant Breast and Bowel Project P-1 study, we evaluated whether participant-reported outcomes were associated with drug adherence and whether baseline behavioral risk factors modified those associations. METHODS P-1 participants were randomly assigned to placebo vs tamoxifen (20mg/day). Mixed effects logistic regression was used to evaluate whether baseline or three-month SF-36 quality of life (QOL) mental and physical component summaries (MCS, PCS), and participant-reported symptoms (gynecologic, vasomotor, sexual, and other) predicted 12-month drug adherence (76-100% of assigned medication). The evaluation accounted for age, treatment, estimated breast cancer risk, education, baseline smoking, alcohol consumption, and obesity. All statistical tests were two-sided. RESULTS Participants enrolled at least three years before trial unblinding and without medically indicated discontinuation before 12 months were eligible for the present analyses (n = 10 576). At 12 months, 84.3% were adherent. Statistically significant predictors of adherence were: three-month MCS (odds ratio [OR] = 1.15 per 10 points, 95% confidence interval [CI] = 1.06 to 1.25); three-month gynecologic symptoms among moderate alcohol drinkers (OR = .79, 95% CI = 0.72 to 0.88); baseline vasomotor symptoms among participants assigned tamoxifen (OR = .88, 95% CI = 0.80 to 0.97); and three-month sexual symptoms among younger participants (OR = .89 at age 41 years, 95% CI = 0.80 to 0.99). The strongest association was with three-month other symptoms (OR = .77, 95% CI = 0.63 to 0.93). PCS was not associated with adherence. Symptom and QOL associations were not modified by smoking or obesity. CONCLUSIONS Promoting QOL and managing symptoms early in therapy may be important strategies to improve adherence.
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Affiliation(s)
- Stephanie R Land
- National Surgical Adjuvant Breast and Bowel Project (now a part of NRG Oncology), Pittsburgh, PA (SRL, DLW, PAG); Division of Cancer Control and Population Sciences (SRL) and Division of Cancer Prevention (FLW), National Cancer Institute, Rockville, MD; NRG Oncology, Pittsburgh, PA and Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (QL, JPC); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (DLW); UCLA Schools of Medicine and Public Health, and Jonsson Comprehensive Cancer Center, Division of Cancer Prevention & Control Research, Department of Health Services, Los Angeles, CA (PAG).
| | - Farzana L Walcott
- National Surgical Adjuvant Breast and Bowel Project (now a part of NRG Oncology), Pittsburgh, PA (SRL, DLW, PAG); Division of Cancer Control and Population Sciences (SRL) and Division of Cancer Prevention (FLW), National Cancer Institute, Rockville, MD; NRG Oncology, Pittsburgh, PA and Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (QL, JPC); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (DLW); UCLA Schools of Medicine and Public Health, and Jonsson Comprehensive Cancer Center, Division of Cancer Prevention & Control Research, Department of Health Services, Los Angeles, CA (PAG)
| | - Qing Liu
- National Surgical Adjuvant Breast and Bowel Project (now a part of NRG Oncology), Pittsburgh, PA (SRL, DLW, PAG); Division of Cancer Control and Population Sciences (SRL) and Division of Cancer Prevention (FLW), National Cancer Institute, Rockville, MD; NRG Oncology, Pittsburgh, PA and Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (QL, JPC); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (DLW); UCLA Schools of Medicine and Public Health, and Jonsson Comprehensive Cancer Center, Division of Cancer Prevention & Control Research, Department of Health Services, Los Angeles, CA (PAG)
| | - D Lawrence Wickerham
- National Surgical Adjuvant Breast and Bowel Project (now a part of NRG Oncology), Pittsburgh, PA (SRL, DLW, PAG); Division of Cancer Control and Population Sciences (SRL) and Division of Cancer Prevention (FLW), National Cancer Institute, Rockville, MD; NRG Oncology, Pittsburgh, PA and Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (QL, JPC); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (DLW); UCLA Schools of Medicine and Public Health, and Jonsson Comprehensive Cancer Center, Division of Cancer Prevention & Control Research, Department of Health Services, Los Angeles, CA (PAG)
| | - Joseph P Costantino
- National Surgical Adjuvant Breast and Bowel Project (now a part of NRG Oncology), Pittsburgh, PA (SRL, DLW, PAG); Division of Cancer Control and Population Sciences (SRL) and Division of Cancer Prevention (FLW), National Cancer Institute, Rockville, MD; NRG Oncology, Pittsburgh, PA and Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (QL, JPC); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (DLW); UCLA Schools of Medicine and Public Health, and Jonsson Comprehensive Cancer Center, Division of Cancer Prevention & Control Research, Department of Health Services, Los Angeles, CA (PAG)
| | - Patricia A Ganz
- National Surgical Adjuvant Breast and Bowel Project (now a part of NRG Oncology), Pittsburgh, PA (SRL, DLW, PAG); Division of Cancer Control and Population Sciences (SRL) and Division of Cancer Prevention (FLW), National Cancer Institute, Rockville, MD; NRG Oncology, Pittsburgh, PA and Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (QL, JPC); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (DLW); UCLA Schools of Medicine and Public Health, and Jonsson Comprehensive Cancer Center, Division of Cancer Prevention & Control Research, Department of Health Services, Los Angeles, CA (PAG)
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Akintunde AA, Akintunde TS. Antihypertensive Medications Adherence Among Nigerian Hypertensive Subjects in a Specialist Clinic Compared to a General Outpatient Clinic. Ann Med Health Sci Res 2015; 5:173-8. [PMID: 26097758 PMCID: PMC4455006 DOI: 10.4103/2141-9248.157492] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Poor adherence to antihypertensive medications has been linked with increased cardiovascular risk and mortality in many population. Africans have been shown to have a worse prognosis from hypertension, poorer blood pressure control, and increased risk of complications arising from hypertension compared to Caucasians. Aim: The aim was to describe the level of adherence to antihypertensive medications, its determinants and whether any difference exist between those attending specialty clinic or general outpatient department (GOPD) Clinic in a Nigerian University Teaching Hospital. Subjects and Methods: An analytical cross-sectional study. The Morisky scale was used to assess for adherence to antihypertensive medications. Clinical and demographic data were taken. Statistical analysis was performed using SPSS 17.0. (Chicago, IL, USA). P < 0.05 was taken as statistically significant. Results: A total of 114 hypertensive subjects were recruited for this study. Seventy-nine were from the cardiology clinic whereas 35 were from the GOPD. They consisted of 60 males (52.6%, 60/114) and 54 females (47.4%, 54/110). The mean age was 63.6 (14.1) years. High adherence, low adherence and medium adherence as defined by Morisky scale was found in 36.8% (42/114), 23.9% (27/114) and 39.5% (45/114), respectively. Adherence level was higher among those attending specialty clinic despite shorter duration of hypertension and use of more medications. More than four-fifth of those attending cardiology clinic had at least medium level of adherence compared to a little bit over half of those attending GOPD clinic. Those with good adherence were likely to be older, had a higher level of education and higher average monthly income than those with poor adherence. Conclusion: Poor adherence to medications is very common in the hypertensive Nigerians. Hypertensive subjects attending specialty clinic seems to have a better adherence to antihypertensive medications possibly due to the level of health education and information provided to patients. Effective health education and regular screening for compliance and adherence is a potential way to reduce cardiovascular risk associated with uncontrolled hypertension.
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Affiliation(s)
- A A Akintunde
- Department of Medicine, Ladoke Akintola University of Technology and Ladoke Akintola University of Technology Teaching Hospital, Ogbomosho, Nigeria ; Department of Medicine, Goshen Heart Clinic, Osogbo, Nigeria
| | - T S Akintunde
- Department of Economics, Osun State University, Osogbo, Nigeria
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Reach G, Guedj-Meynier D, Darné B, Herpin D. [Factors associated with medication non-adherence in uncontrolled hypertensive males and females: ODACE study]. Ann Cardiol Angeiol (Paris) 2015; 64:222-226. [PMID: 26047871 DOI: 10.1016/j.ancard.2015.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The aim of this study was (1) to measure adherence in males and females with uncontrolled hypertension, and (2) to identify factors associated with non-adherence to antihypertensive medication. PATIENTS AND METHODS Each general practitioner (GP) should include the first two male and the first two female patients with uncontrolled treated hypertension. Adherence to antihypertensive treatment was estimated by the GP and using the French League Against High blood pressure (FLAH) self-administered questionnaire. A stepwise logistic regression analysis was used to identify factors associated with non-adherence on the FLAH scale, independently in males and in females. RESULTS A total of 1630 males and 1612 females were included in the analysis. Adherence to treatment was significantly better in females or when estimated by the GP. Lack of motivation was the first factor associated with poor adherence in both sexes. Considering hypertension as a simple anomaly and not a disease that can lead to cardiac or cerebral disorders was the second common parameter in both sexes. Other common factors were: having monthly periods of financial difficulties in facing his/her needs and absence of regular screening for colon cancer. CONCLUSION Adherence to treatment is better in uncontrolled hypertensive females. Poor adherence is mainly associated with non-clinical factors. The lack of motivation is the most important element.
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Affiliation(s)
- G Reach
- Service d'endocrinologie diabétologie maladies métaboliques, hôpital Avicenne & EA 3412, université Paris 13, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 125, route de Stalingrad, 93000 Bobigny, France.
| | | | - B Darné
- Monitoring Force Group, 38, rue Jean-Mermoz, bâtiment D, 78604 Maisons-Laffitte cedex, France
| | - D Herpin
- Service de cardiologie, centre hospitalier et universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
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Solomon A, Schoenthaler A, Seixas A, Ogedegbe G, Jean-Louis G, Lai D. Medication Routines and Adherence Among Hypertensive African Americans. J Clin Hypertens (Greenwich) 2015; 17:668-72. [PMID: 25952495 DOI: 10.1111/jch.12566] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/17/2015] [Accepted: 02/19/2015] [Indexed: 01/09/2023]
Abstract
Poor adherence to prescribed medication regimens remains an important challenge preventing successful treatment of cardiovascular diseases such as hypertension. While studies have documented differences in the time of day or weekday vs weekend on medication adherence, no study has examined whether having a medication-taking routine contributes to increased medication adherence. The purpose of this study was to: (1) identify patients' sociodemographic factors associated with consistent medication-taking routine; (2) examine associations between medication-taking consistency, medication adherence, and blood pressure (BP) control. The study included black patients with hypertension (n = 190; 22 men and 168 women; age, mean±standard deviation 54 ± 12.08 years) who completed a practice-based randomized controlled trial. Findings showed that medication-taking consistency was significantly associated with better medication adherence (F = 9.54, P = .002). Associations with the consistency index were not statistically significant for diastolic BP control (odds ratio, 1.319; 95% confidence interval, 0.410-4.246; P = .642) and systolic BP control (odds ratio, 0.621; 95% confidence interval, 0.195-1.974; P = .419).
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Affiliation(s)
| | - Antoinette Schoenthaler
- Prairie View A&M University, Houston, TX.,Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, NY
| | - Azizi Seixas
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, NY
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, NY
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, NY
| | - Dejian Lai
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, NY
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Non-adherence to antihypertensive medication is very common among resistant hypertensives: results of a directly observed therapy clinic. J Hum Hypertens 2015; 30:83-9. [DOI: 10.1038/jhh.2015.38] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 03/03/2015] [Accepted: 03/25/2015] [Indexed: 12/19/2022]
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Abstract
BACKGROUND Testing for patients at risk for hepatitis C virus (HCV) infection is recommended, but it is unclear whether providers adhere to testing guidelines. We aimed to measure adherence to an HCV screening protocol during a multifaceted continuous intervention. SUBJECTS AND METHODS Prospective cohort design to examine the associations between patient-level, physician-level, and visit-level characteristics and adherence to an HCV screening protocol. Study participants included all patients with a visit to 1 of the 3 study clinics and the physicians who cared for them. Adherence to the HCV screening protocol and patient-level, physician-level, and visit-level predictors of adherence were measured. RESULTS A total of 8981 patients and 154 physicians were examined. Overall protocol adherence rate was 36.1%. In multivariate analysis, patient male sex (odds ratio [OR] = 1.18), new patient (OR = 1.23), morning visit (OR = 1.32), and patients' preferred language being non-English (OR = 0.87) were significantly associated with screening adherence. There was a wide variation in overall adherence among physicians (range, 0%-92.4%). Screening adherence continuously declined from 59.1% in week 1 of the study to 13.7% in week 15 (final week). When implementing complex clinical practice guidelines, planners should address physician attitudinal barriers as well as gaps in knowledge to maximize adherence.
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Hosseininasab M, Jahangard-Rafsanjani Z, Mohagheghi A, Sarayani A, Rashidian A, Javadi M, Ahmadvand A, Hadjibabaie M, Gholami K. Self-monitoring of blood pressure for improving adherence to antihypertensive medicines and blood pressure control: a randomized controlled trial. Am J Hypertens 2014; 27:1339-45. [PMID: 24771706 DOI: 10.1093/ajh/hpu062] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Self-monitoring is reported to have limited efficacy for hypertension management in high-income countries. In this study, we aimed to evaluate the effect of self-monitoring on blood pressure (BP) control in an Iranian population. METHODS A randomized controlled trial was conducted on 196 mild to moderate hypertensive patients in an outpatient cardiovascular clinic. Patients in the intervention group received a wrist self-monitoring device and were educated to measure and document their BP daily during the study period (24 weeks). Patients in the control group received usual care. Three follow-up visits with the physician were scheduled for all patients (weeks 4, 12, and 24), and the investigator assessed adherence to medications after each visit (pill counting). The primary outcome (BP) was compared between groups using repeated-measure analysis of variance. RESULTS One hundred ninety patients completed the study. Systolic BP (144.4±7.4 vs 145.9±6.4mm Hg) and diastolic BP (85.5±6.9 vs. 85.1±7.7mm Hg) were similar between groups at baseline. The trend of BP was not significantly different between groups during the study period. Systolic and diastolic BP decreased significantly in both groups at the first follow-up visit (systolic BP: 132.6 vs. 133.4mm Hg; diastolic BP: 77.4 vs. 77.2mm Hg). In the intervention group, we observed a small continued decrease in diastolic BP up to week 24 BP (P = 0.01). Both groups showed adherence rates >95% during the study period. CONCLUSIONS Our study could not confirm that self-monitoring can improve BP control in patients with frequent medical visits.
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Affiliation(s)
- Masumeh Hosseininasab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Jahangard-Rafsanjani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Mohagheghi
- Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Sarayani
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Javadi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Ahmadvand
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Molouk Hadjibabaie
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Kheirollah Gholami
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran;
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Parthan A, Vincze G, Morisky DE, Khan ZM. Strategies to improve adherence with medications in chronic, ‘silent’ diseases representing high cardiovascular risk. Expert Rev Pharmacoecon Outcomes Res 2014; 6:325-36. [DOI: 10.1586/14737167.6.3.325] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Matsumura K, Arima H, Tominaga M, Ohtsubo T, Sasaguri T, Fujii K, Fukuhara M, Uezono K, Morinaga Y, Ohta Y, Otonari T, Kawasaki J, Kato I, Tsuchihashi T. Impact of antihypertensive medication adherence on blood pressure control in hypertension: the COMFORT study. QJM 2013; 106:909-14. [PMID: 23696676 DOI: 10.1093/qjmed/hct121] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It has not been fully elucidated whether antihypertensive medication adherence affects blood pressure (BP) control in hypertension cases. AIM To investigate the association of adherence to antihypertensive drug regimens and BP control using data from the Combination Pill of Losartan Potassium and Hydrochlorothiazide for Improvement of Medication Compliance Trial (COMFORT) study. DESIGN An observational analysis from a randomized controlled trial. METHODS A total of 203 hypertensive subjects were randomly assigned to a daily regimen of a combination pill (losartan 50 mg/hydrochlorothiazide 12.5 mg) or two pills, an angiotensin II receptor blocker and a thiazide diuretic. Medication adherence calculated based on pill counts and BPs was evaluated at 1, 3 and 6 months after randomization. RESULTS The subjects were divided into three groups according to their adherence, i.e. relatively low-adherence (<90%; n = 19), moderate-adherence (90-99%; n = 71) and high-adherence (100%; n = 113) groups. Clinical characteristics of the subjects including BP, sex, randomized treatments and past medical history did not differ significantly among the three groups. Achieved follow-up BPs over the 6-month treatment period, which were adjusted for age, sex, baseline BP and randomized treatment, were significantly higher in the low-adherence group (135/78 mmHg) compared with the high-adherence (130/74 mmHg; P = 0.02/0.02) and the moderate-adherence (128/74 mmHg; P = 0.003/0.02) groups. CONCLUSION Low adherence to an antihypertensive-drug regimen was associated with poor BP control.
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Affiliation(s)
- K Matsumura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan.
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Alison Phillips L, Leventhal H, Leventhal EA. Assessing theoretical predictors of long-term medication adherence: Patients’ treatment-related beliefs, experiential feedback and habit development. Psychol Health 2013; 28:1135-51. [DOI: 10.1080/08870446.2013.793798] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kardas P, Lewek P, Matyjaszczyk M. Determinants of patient adherence: a review of systematic reviews. Front Pharmacol 2013; 4:91. [PMID: 23898295 PMCID: PMC3722478 DOI: 10.3389/fphar.2013.00091] [Citation(s) in RCA: 429] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 06/28/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE A number of potential determinants of medication non-adherence have been described so far. However, the heterogenic quality of existing publications poses the need for the use of a rigorous methodology in building a list of such determinants. The purpose of this study was a systematic review of current research on determinants of patient adherence on the basis of a recently agreed European consensus taxonomy and terminology. METHODS MEDLINE, EMBASE, CINAHL, Cochrane Library, IPA, and PsycINFO were systematically searched for systematic reviews published between 2000/01/01 and 2009/12/31 that provided determinants on non-adherence to medication. The searches were limited to reviews having adherence to medication prescribed by health professionals for outpatient as a major topic. RESULTS Fifty-one reviews were included in this review, covering 19 different disease categories. In these reviews, exclusively assessing non-adherence to chronic therapies, 771 individual factor items were identified, of which most were determinants of implementation, and only 47-determinants of persistence with medication. Factors with an unambiguous effect on adherence were further grouped into 8 clusters of socio-economic-related factors, 6 of healthcare team- and system-related factors, 6 of condition-related factors, 6 of therapy-related factors, and 14 of patient-related factors. The lack of standardized definitions and use of poor measurement methods resulted in many inconsistencies. CONCLUSIONS This study provides clear evidence that medication non-adherence is affected by multiple determinants. Therefore, the prediction of non-adherence of individual patients is difficult, and suitable measurement and multifaceted interventions may be the most effective answer toward unsatisfactory adherence. The limited number of publications assessing determinants of persistence with medication, and lack of those providing determinants of adherence to short-term treatment identify areas for future research.
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Affiliation(s)
- Przemyslaw Kardas
- First Department of Family Medicine, Medical University of Lodz Lodz, Poland
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Burnier M, Wuerzner G, Struijker-Boudier H, Urquhart J. Measuring, analyzing, and managing drug adherence in resistant hypertension. Hypertension 2013; 62:218-25. [PMID: 23753412 DOI: 10.1161/hypertensionaha.113.00687] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Michel Burnier
- Service of Nephrology and Hypertension, CHUV Rue du Bugnon 17, 1005 Lausanne, Switzerland.
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Lee GKY, Wang HHX, Liu KQL, Cheung Y, Morisky DE, Wong MCS. Determinants of medication adherence to antihypertensive medications among a Chinese population using Morisky Medication Adherence Scale. PLoS One 2013; 8:e62775. [PMID: 23638143 PMCID: PMC3636185 DOI: 10.1371/journal.pone.0062775] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 03/26/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Poor adherence to medications is one of the major public health challenges. Only one-third of the population reported successful control of blood pressure, mostly caused by poor drug adherence. However, there are relatively few reports studying the adherence levels and their associated factors among Chinese patients. This study aimed to study the adherence profiles and the factors associated with antihypertensive drug adherence among Chinese patients. METHODS A cross-sectional study was conducted in an outpatient clinic located in the New Territories Region of Hong Kong. Adult patients who were currently taking at least one antihypertensive drug were invited to complete a self-administered questionnaire, consisting of basic socio-demographic profile, self-perceived health status, and self-reported medication adherence. The outcome measure was the Morisky Medication Adherence Scale (MMAS-8). Good adherence was defined as MMAS scores greater than 6 points (out of a total score of 8 points). RESULTS From 1114 patients, 725 (65.1%) had good adherence to antihypertensive agents. Binary logistic regression analysis was conducted. Younger age, shorter duration of antihypertensive agents used, job status being employed, and poor or very poor self-perceived health status were negatively associated with drug adherence. CONCLUSION This study reported a high proportion of poor medication adherence among hypertensive subjects. Patients with factors associated with poor adherence should be more closely monitored to optimize their drug taking behavior.
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Affiliation(s)
- Gabrielle K. Y. Lee
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Harry H. X. Wang
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kirin Q. L. Liu
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yu Cheung
- New Territories East Cluster, Hospital Authority, Hong Kong SAR, China
| | - Donald E. Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, United States of America
| | - Martin C. S. Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
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Mukora-Mutseyekwa FNN, Chadambuka EM. Drug adherence behavior among hypertensive out-patients at a tertiary health institution in Manicaland province, Zimbabwe, 2011. Patient Prefer Adherence 2013; 7:65-70. [PMID: 23378742 PMCID: PMC3553332 DOI: 10.2147/ppa.s40295] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study investigated the level of drug adherence among hypertensive outpatients at a tertiary hospital in Zimbabwe. Specific objectives included measurement of blood pressure (BP) control achievement, estimating prevalence of drug adherence behavior, and establishing the association between drug adherence behavior and achievement of BP control. METHODS AND MATERIALS An analytic cross sectional design was applied on a convenience sample of 102 participants using an interviewer administered questionnaire. Self-reported adherence was assessed using the Morisky Medication Adherence Scale. FINDINGS The median age of participants was 68.5 years (Q(1) 61;Q(3) 76). The majority were female (n = 71;69.6%). BP control (< 140/90 mmHg) was achieved in 52% (n = 53). Self-reported drug adherence was 40.2% (n = 42). After multivariate logistic regression analysis, participants with normal BP measurements were more than three times as likely to report maximal adherence to prescribed drug schedules (odds ratio 3.37; 95% confidence interval: 1.38-.24). CONCLUSION Poor drug adherence behavior prevails among hypertensive outpatients. This contributes to poor achievement of BP control. The hospital is recommended to set up a specialized hypertension clinic in the Out-patients' Department where an intensified health education package can be introduced as well as community awareness programs on the importance of medication adherence.
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Affiliation(s)
- Fadzai NN Mukora-Mutseyekwa
- Faculty of Health Sciences, Africa University, Mutare, Zimbabwe
- Correspondence: Fadzai NN Mukora-Mutseyekwa Africa University, Box 1320, Mutare, Zimbabwe Tel +263 20 65269 Email
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Griva K, Davenport A, Harrison M, Newman SP. Non-adherence to immunosuppressive medications in kidney transplantation: intent vs. forgetfulness and clinical markers of medication intake. Ann Behav Med 2012; 44:85-93. [PMID: 22454221 DOI: 10.1007/s12160-012-9359-4] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although adherence to immunosupressive medication after transplantation is important to maximize good clinical outcomes it remains suboptimal and not well-understood. The purpose of this study was to examine intentional and unintentional non-adherence to immunosuppression medication in kidney transplant patients. METHODS A cross-sectional sample of N=218 patients [49.6 ± 12.3 years] recruited in London, UK (1999-2002) completed measures of medication beliefs, quality-of-life, depression, and transplantation-specific emotions. Adherence was measured with self-report and serial immunosuppressive assays. RESULTS Intentional non-adherence was low (13.8 %) yet 62.4 % admitted unintentional non-adherence and 25.4 % had sub-target immunosuppressive levels. The risk of sub-target serum immunosuppressive levels was greater for patients admitting unintentional non-adherence (OR=8.4; p=0.004). Dialysis vintage, doubts about necessity, and lower worry about viability of graft explained R(2)=16.1 to 36 % of self-report non-adherence. Depression was related only to intentional non-adherence. CONCLUSIONS Non-adherence is common in kidney transplantation. Efforts to increase adherence should be implemented by targeting necessity beliefs, monitoring depression, and promoting strategies to decrease forgetfulness.
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Affiliation(s)
- Konstadina Griva
- Department of Psychology, National University of Singapore, 9 Arts Link AS402/28, Singapore, Singapore.
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Li WW, Kuo CT, Hwang SL, Hsu HT. Factors related to medication non-adherence for patients with hypertension in Taiwan. J Clin Nurs 2012; 21:1816-24. [PMID: 22672451 DOI: 10.1111/j.1365-2702.2012.04088.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIMS AND OBJECTIVE To characterise a Taiwanese population and to examine the prevalence of antihypertensive medication non-adherence and how the cultural/clinical factors were associated with non-adherence in Taiwan. BACKGROUND Antihypertensive medication non-adherence is a significant clinical issue in the United States. However, little is known about hypertension (HTN) control and cultural/clinical factors related to non-adherence in Taiwan. DESIGN A convenience sample survey design was used. METHOD Data were gathered from a convenience sample of 200 subjects recruited from a large teaching hospital. Medication non-adherence and cultural/clinical factors were recorded using various self-administered questionnaires, and blood pressure was taken twice for each participant. RESULTS The mean age of the participants was 60.4 (SD 11.5 years) including 62% men. Two-thirds had less than a high school education (64.5%), and the majority of them were married (86·0%) and lived with family or close friends (93.5%). The average length of HTN diagnosis was 8.6 years (SD 9.0 years). Medication non-adherence rate was 47·5%, and uncontrolled HTN rate was 49.0%. Some participants (17.0%) used Chinese herbs for treating their disease (e.g. cough) and promoting health in addition to their regular antihypertensive medications. Two factors were found to be statistically significant for predicting medication non-adherence: Lower Perceived Susceptibility to Specific Diseases [OR = 1.15 (95%CI, 1.01-1.31)] and Longer Length of HTN Diagnosis [OR = 1.06 (95%CI, 1.01-1.12)]. CONCLUSIONS Taiwanese at risk of non-adherence included those who perceived lower susceptibility to specific diseases and had been diagnosed with HTN for a longer time. Those using herbs need to be studied for an impact of herbs on their adherence behaviour. RELEVANCE TO CLINICAL PRACTICE These findings can help guide the development of culturally sensitive and clinically appropriate nursing interventions for HTN management in Taiwan.
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Affiliation(s)
- Wen-Wen Li
- School of Nursing, San Francisco State University, San Francisco, CA, USA
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Abstract
Uncontrolled hypertension imposes a substantial global health burden, and poor patient compliance with prescribed antihypertensive medication makes a major contribution to the development of suboptimal blood pressure (BP) control. The asymptomatic nature of hypertension, side effects of medication, treatment complexity, and high pill burdens all have a negative impact on patient compliance. It is important to address the issue of poor patient compliance as studies have shown that good compliance is associated with improvement of BP control and positive health outcomes. As the majority of hypertensive patients require treatment with two or more agents to achieve goal BP, treatment guidelines have acknowledged the value of simplifying treatment through the use of fixed-dose combination (FDC) therapy. Triple FDC therapy comprising an angiotensin II type 1 receptor antagonist (angiotensin receptor blocker), calcium channel blocker, and thiazide diuretic is a novel treatment strategy for the improvement of BP control in hard-to-treat patients.
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Affiliation(s)
- Serap Erdine
- Department of Cardiology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey.
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Erdine S. How do Compliance, Convenience, and Tolerability Affect Blood Pressure Goal Rates? Am J Cardiovasc Drugs 2012. [DOI: 10.2165/11635450-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Stavropoulou C. Perceived information needs and non-adherence: evidence from Greek patients with hypertension. Health Expect 2012; 15:187-96. [PMID: 21496190 PMCID: PMC5060616 DOI: 10.1111/j.1369-7625.2011.00679.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The role of information on patients' decision to non-adhere is important, yet not well explored. OBJECTIVE To identify differences between perceived information needs for hypertension and medication to treat it, to explore the information channels used by patients and to test what type of information is more important to adhere to medication. DESIGN, SETTING AND PARTICIPANTS A questionnaire study was designed and conducted by telephone in the Centre for the Treatment of Hypertension in Athens, Greece, among 743 individuals. MAIN VARIABLES STUDIED The main variables included perceived information needs, information channels, non-adherence to medication and socio-demographic characteristics. MAIN OUTCOME MEASURES Non-adherence to medication was measured using the Morisky scale. RESULTS Patients reported feeling better informed about hypertension (90%) than medication to treat it (80%). The doctor remains the dominant information source, while the Media and magazines on health issues were reported more frequently than the family and the pharmacist. Feeling well informed about medication for hypertension was a predictor of better adherence. Other determinants of adherence were the use of the Internet and the Media. DISCUSSION The results confirm the importance of patients leaving the consultation feeling well informed about their medication as this improves adherence. They also show that the use of the Internet and the Media can be beneficial for adherence. CONCLUSIONS Given the restricted time the doctor can usually spend with the patient, it is important to know that more emphasis on the information regarding medication is important.
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Gee ME, Campbell NRC, Gwadry-Sridhar F, Nolan RP, Kaczorowski J, Bienek A, Robitaille C, Joffres M, Dai S, Walker RL. Antihypertensive medication use, adherence, stops, and starts in Canadians with hypertension. Can J Cardiol 2012; 28:383-9. [PMID: 22522073 DOI: 10.1016/j.cjca.2012.01.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 01/23/2012] [Accepted: 01/23/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Some of the greatest barriers to achieving blood pressure control are perceived to be failure to prescribe antihypertensive medication and lack of adherence to medication prescriptions. METHODS Self-reported data from 6017 Canadians with diagnosed hypertension who responded to the 2008 Canadian Community Health Survey and the 2009 Survey on Living with Chronic Diseases in Canada were examined. RESULTS The majority (82%) of individuals with diagnosed hypertension reported using antihypertensive medications. The main reasons for not taking medications were either that they were not prescribed (42%) or that blood pressure had been controlled without medications (45%). Of those not taking antihypertensive medications in 2008 (n = 963), 18% had started antihypertensive medications by 2009, and of those initially taking medications (n = 5058), 5% had stopped. Of those taking medications in 2009, 89% indicated they took the medication as prescribed, and 10% indicated they occasionally missed a dose. Participants who were recently diagnosed, not measuring blood pressure at home, not having a plan to control blood pressure, or not receiving instructions on how to take medications were less likely to be taking antihypertensive medications; similar factors tended to be associated with stopping antihypertensive medication use. CONCLUSIONS Compatible with high rates of hypertension control, most Canadians diagnosed with hypertension take antihypertensive medications and report adherence. Widespread implementation of self-management strategies for blood pressure control and standardized instructions on antihypertensive medication may further optimize drug treatment.
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Hyman DJ, Pavlik VN, Greisinger AJ, Chan W, Bayona J, Mansyur C, Simms V, Pool J. Effect of a physician uncertainty reduction intervention on blood pressure in uncontrolled hypertensives--a cluster randomized trial. J Gen Intern Med 2012; 27:413-9. [PMID: 22033742 PMCID: PMC3304039 DOI: 10.1007/s11606-011-1888-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 09/03/2011] [Accepted: 09/06/2011] [Indexed: 01/13/2023]
Abstract
BACKGROUND Clinical inertia, provider failure to appropriately intensify treatment, is a major contributor to uncontrolled blood pressure (BP). Some clinical inertia may result from physician uncertainty over the patient's usual BP, adherence, or value of continuing efforts to control BP through lifestyle changes. OBJECTIVE To test the hypothesis that providing physicians with uncertainty reduction tools, including 24-h ambulatory BP monitoring, electronic bottle cap monitoring, and lifestyle assessment and counseling, will lead to improved BP control. DESIGN Cluster randomized trial with five intervention clinics (IC) and five usual care clinics (UCC). SETTING Six public and 4 private primary care clinics. PARTICIPANTS A total of 665 patients (63 percent African American) with uncontrolled hypertension (BP ≥140 mmHg/90 mmHg or ≥130/80 mmHg if diabetic). INTERVENTIONS An order form for uncertainty reduction tools was placed in the IC participants' charts before each visit and results fed back to the provider. OUTCOME MEASURES Percent with controlled BP at last visit. Secondary outcome was BP changes from baseline. RESULTS Median follow-up time was 24 months. IC physicians intensified treatment in 81% of IC patients compared to 67% in UCC (p < 0.001); 35.0% of IC patients and 31.9% of UCC patients achieved control at the last recorded visit (p > 0.05). Multi-level mixed effects longitudinal regression modeling of SBP and DBP indicated a significant, non-linear slope difference favoring IC (p (time × group interaction) = 0.048 for SBP and p = 0.001 for DBP). The model-predicted difference attributable to intervention was -2.8 mmHg for both SBP and DBP by month 24, and -6.5 mmHg for both SBP and DBP by month 36. CONCLUSIONS The uncertainty reduction intervention did not achieve the pre-specified dichotomous outcome, but led to lower measured BP in IC patients.
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Affiliation(s)
- David J Hyman
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Houston, TX 77098, USA
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