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Zeijen VJ, Peeters LE, Asman A, Boersma E, Massey EK, van Dijk L, Daemen J, Versmissen J. Quality-of-life and beliefs about medication in relation to a therapy adherence intervention in resistant hypertension: the Resistant HYpertension: MEasure to ReaCh Targets trial. J Hypertens 2024; 42:1687-1694. [PMID: 38780122 PMCID: PMC11356742 DOI: 10.1097/hjh.0000000000003780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 04/30/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To assess the impact of personalized feedback on therapy adherence testing results on quality of life and beliefs about medication in patients with resistant hypertension, as well as to identify patient-oriented predictors of therapy adherence. METHODS This study was a prespecified post hoc analysis of the multicenter randomized controlled trial Resistant HYpertension: MEasure to ReaCh Targets (RHYME-RCT). Patients were randomized to a personalized feedback conversation on measured antihypertensive drug levels additional to standard-of-care, or standard-of-care only. The primary outcomes consisted of EuroQol EQ-5D-5L and Beliefs about Medicine Questionnaire (BMQ) scores at 12 months. RESULTS A total of 56 patients with median age 61.5 [25th-75th percentile: 55.8-69.3] years (21.4% women) were included. Mean blood pressure ±SD was 149.8/84.1 ± 14.9/13.8 mmHg while being on a median of 5.6 [4.8-7.3] defined daily dosages (DDD) of antihypertensive drugs. At 12 months, no differences were observed in EQ-5D-5L index (0.81 [0.69-0.89] vs. 0.89 [0.73-1.00]; P = 0.18) and visual analogue scale score on general patient-perceived health (70 [60-80] vs. 70 [60-82]; P = 0.53) between the intervention-arm and the standard-of-care only-arm. Likewise, individual EQ-5D-5L domain scores and BMQ scores did not differ between both arms. Irrespective of the intervention, independent positive predictors of the percentage adherence were patient age, EQ-5D-5L index score, BMQ-specific necessity score and concern score, whereas the total number of drugs prescribed was a negative predictor. CONCLUSION Within this prespecified subanalysis of the randomized RHYME-RCT trial, implementation of a personalized feedback conversation targeting therapy adherence did not improve health-related quality-of-life and beliefs about medication in patients with resistant hypertension.
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Affiliation(s)
| | - Laura E.J. Peeters
- Department of Internal Medicine
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam
| | - Azra Asman
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam
| | | | | | - Liset van Dijk
- Netherlands Institute for Health Services Research (NIVEL), Utrecht
- Department of PharmacoTherapy, Epidemiology and Economics (PTEE), Groningen Research Institute of Pharmacy, Faculty of Science and Engineering, University of Groningen, Groningen, the Netherlands
| | | | - Jorie Versmissen
- Department of Internal Medicine
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam
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Kengne AP, Brière JB, Gudiña IA, Jiang X, Kodjamanova P, Bennetts L, Khan ZM. The impact of non-pharmacological interventions on adherence to medication and persistence in dyslipidaemia and hypertension: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2024; 24:807-816. [PMID: 38366854 DOI: 10.1080/14737167.2024.2319598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Suboptimal medication adherence is common among patients with cardiovascular diseases. We sought evidence on non-pharmacological interventions used to support adherence for patients with hypertension and/or dyslipidemia. METHODS We searched MEDLINE, EMBASE, MEDLINE In-Process, ClinicalTrials.gov, EUCTR, and conference proceedings from July 2011 to July 2021 to identify trials evaluating effects of health education, phone reminders, or digital interventions on medication adherence or persistence of adult patients with hypertension and/or dyslipidemia. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool v2. RESULTS Of 64 studies, 62 used health education approaches (e.g. educational interviews, motivational meetings, advice from physicians, and mobile health content), 16 phone reminders (e.g. text reminders, electronic pill-box linked reminders, bi-directional text messaging), and 10 digital applications as interventions (e.g., various self-management applications). All studies assessed medication adherence; only two persistence. Overall, 30 studies (83%) assessing health education approaches alone and 25 (78%) combined with other strategies, 12 (75%) phone reminders and eight studies (80%) digital applications combined with other strategies reported improved medication adherence. Two studies assessing health education approaches reported improved persistence. CONCLUSIONS Our findings indicate non-pharmacological interventions may positively impact adherence. Therefore, 'beyond the pill' approaches could play a role in preventing cardiovascular diseases.
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Affiliation(s)
| | | | | | - Xiaobin Jiang
- Health Economics and Market Access, Amaris Consulting, Shanghai, China
| | - Petya Kodjamanova
- Health Economics and Market Access, Amaris Consulting, Sofia, Bulgaria
| | - Liga Bennetts
- Health Economics and Market Access, Amaris Consulting, Montréal, Canada
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Mills KT, O'Connell SS, Pan M, Obst KM, He H, He J. Role of Health Care Professionals in the Success of Blood Pressure Control Interventions in Patients With Hypertension: A Meta-Analysis. Circ Cardiovasc Qual Outcomes 2024; 17:e010396. [PMID: 39027934 PMCID: PMC11338746 DOI: 10.1161/circoutcomes.123.010396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/29/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Globally, only 13.8% of patients with hypertension have their blood pressure (BP) controlled. Trials testing interventions to overcome barriers to BP control have produced mixed results. Type of health care professional delivering the intervention may play an important role in intervention success. The goal of this meta-analysis is to determine which health care professionals are most effective at delivering BP reduction interventions. METHODS We searched Medline and Embase (until December 2023) for randomized controlled trials of interventions targeting barriers to hypertension control reporting who led intervention delivery. One hundred articles worldwide with 116 comparisons and 90 474 participants with hypertension were included. Trials were grouped by health care professional, and the effects of the intervention on systolic and diastolic BP were combined using random effects models and generalized estimating equations. RESULTS Pharmacist-led interventions , community health worker-led interventions, and health educator-led interventions resulted in the greatest systolic BP reductions of -7.3 (95% CI, -9.1 to -5.6), -7.1 (95% CI, -10.8 to -3.4), and -5.2 (95% CI, -7.8 to -2.6) mm Hg, respectively. Interventions led by multiple health care professionals, nurses, and physicians also resulted in significant systolic BP reductions of -4.2 (95% CI, -6.1 to -2.4), -3.0 (95% CI, -4.2 to -1.9), and -2.4 (95% CI, -3.4 to -1.5) mm Hg, respectively. Similarly, the greatest diastolic BP reductions were -3.9 (95% CI, -5.2 to -2.5) mm Hg for pharmacist-led and -3.7 (95% CI, -6.6 to -0.8) mm Hg for community health worker-led interventions. In pairwise comparisons, pharmacist were significantly more effective than multiple health care professionals, nurses, and physicians at delivering interventions. CONCLUSIONS Pharmacists and community health workers are most effective at leading BP intervention implementation and should be prioritized in future hypertension control efforts.
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Affiliation(s)
- Katherine T Mills
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., S.S.O., M.P., K.M.O., H.H., J.H.)
- Tulane University Translational Science Institute, New Orleans, LA (K.T.M., K.M.O., H.H., J.H.)
| | - Samantha S O'Connell
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., S.S.O., M.P., K.M.O., H.H., J.H.)
| | - Meng Pan
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., S.S.O., M.P., K.M.O., H.H., J.H.)
| | - Katherine M Obst
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., S.S.O., M.P., K.M.O., H.H., J.H.)
- Tulane University Translational Science Institute, New Orleans, LA (K.T.M., K.M.O., H.H., J.H.)
| | - Hua He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., S.S.O., M.P., K.M.O., H.H., J.H.)
- Tulane University Translational Science Institute, New Orleans, LA (K.T.M., K.M.O., H.H., J.H.)
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., S.S.O., M.P., K.M.O., H.H., J.H.)
- Tulane University Translational Science Institute, New Orleans, LA (K.T.M., K.M.O., H.H., J.H.)
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Rahman MM, Nakamura R, Islam MM, Alam MA, Azmat SK, Sato M. Effectiveness of a Community Pharmacy-Based Health Promotion Program on Hypertension in Bangladesh and Pakistan: Study Protocol for a Cluster-Randomized Controlled Trial. Healthcare (Basel) 2024; 12:1402. [PMID: 39057545 PMCID: PMC11276715 DOI: 10.3390/healthcare12141402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 07/02/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
The aim of this multi-country, cluster-randomized trial is to test the impact of pharmacy-based health promotion to reduce the blood pressure of individuals with hypertension over a 12-month period in Bangladesh and Pakistan. The trial will be implemented with two arms. In Bangladesh, the estimated sample size is around 3600 hypertensive patients. In Pakistan, we will select samples equivalent to 10% of the participants from Bangladesh, comprising 360 hypertensive patients from four pharmacies. Community pharmacies will be randomized into one of two parallel groups (allocation ratio 1:1). Pharmacy professionals in the treatment arm will provide their patients with educational training and counseling, as well as phone calls/mobile text messages and care coordination in the health sector, as part of the intervention. The study will be conducted in three phases: a baseline survey with intervention, a midline survey with intervention and follow-up, and an endline survey with impact evaluation. The primary outcome of the study will be BP. The secondary outcomes will be BP controlled to target, treatment adherence, quality of life, mortality or hospital admission rates resulting from hypertension and its related complications, incremental cost per health-related quality of life gained, knowledge on healthy lifestyle and dietary behavior, and change in the prevalence of current smoking status.
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Affiliation(s)
- Md. Mizanur Rahman
- Research Center for Health Policy and Economics, Hitotsubashi University, Tokyo 186-8601, Japan
| | - Ryota Nakamura
- Research Center for Health Policy and Economics, Hitotsubashi University, Tokyo 186-8601, Japan
- Graduate School of Economics, Hitotsubashi University, Tokyo 186-8601, Japan
| | - Md. Monirul Islam
- Global Public Health Research Foundation, Dhaka 1230, Bangladesh
- Centre for Policy Studies, University College Cork, T12 K8AF Cork, Ireland
| | - Md. Ashraful Alam
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Syed Khurram Azmat
- AAPNA-Institute of Public Health, Jinnah Sindh Medical University, Karachi 75510, Pakistan
| | - Motohiro Sato
- Research Center for Health Policy and Economics, Hitotsubashi University, Tokyo 186-8601, Japan
- Graduate School of Economics, Hitotsubashi University, Tokyo 186-8601, Japan
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Hias J, Defieuw L, Vanassche T, Verhamme P, Van der Linden L. Therapy and guideline adherence at a multidisciplinary hypertension clinic: A prospective, observational study. Vascul Pharmacol 2024; 154:107271. [PMID: 38159830 DOI: 10.1016/j.vph.2023.107271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/11/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Hypertension is highly prevalent and remains one of the most frequent and preventable causes of cardiovascular morbidity and mortality. Yet, suboptimal blood pressure control is common. Hypertension clinics might play an important role in improving target attainment, by targeting drug therapy adherence, improving guideline compliance and by involving pharmacists. OBJECTIVES We aimed to characterize patient drug therapy adherence, prescriber guideline compliance and pharmacist interventions at the hypertension clinic. METHODS A prospective observational study was performed at the hypertension clinic of a large, academic hospital. Adult Dutch-speaking patients were eligible for inclusion. Following data were collected: patient demographics, medication use, patient adherence to prescribed antihypertensive drug therapies according to the BAASIS tool and prescriber compliance to the 2018 European Society of Cardiology (ESC) hypertension guidelines. RESULTS A cohort of 108 patients was included with 51.9% male and aged 65 (IQR: 52-75) years. In total, 104 patients took at least 1 antihypertensive drug and 46 patients (44.2%) were classified as non-adherent with regard to their antihypertensive treatment; 82 patients (78.8%) had suboptimal blood pressure control. Compliance with the ESC guidelines was 66.3% prior to the consultation at the clinic and significantly increased to 77.9% thereafter (p = 0.0015). The clinical pharmacist performed a medication review for 27 patients with a total of 44 recommendations and an acceptance rate of 59.1%. CONCLUSION A visit to the multidisciplinary hypertension clinic improved prescriber guideline compliance and the use of single pill combinations. Involvement of a clinical pharmacist could be beneficial to further improve patient drug therapy adherence and guideline compliance.
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Affiliation(s)
- Julie Hias
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium; Hospital Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Lise Defieuw
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
| | - Thomas Vanassche
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Peter Verhamme
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Lorenz Van der Linden
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium; Hospital Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
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Newsome JS. Demonstrating the Benefits of Antihypertensive Nighttime Dosing and Indapamide Usage in Hypertension Management. J Pharm Technol 2024; 40:10-14. [PMID: 38318257 PMCID: PMC10838540 DOI: 10.1177/87551225231207275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
Background: Uncontrolled hypertension, specifically nocturnal hypertension, increases the risk for significant clinical outcomes. Evidence on the use of nighttime antihypertensives is scant and conflicting. In addition, hydrochlorothiazide continues to be the primary thiazide used despite being the least potent. Objective: The primary purpose of this study was to evaluate instituting nighttime dosing to control hypertension and compare the short-term effectiveness of blood pressure control with indapamide versus hydrochlorothiazide. Methods: This was a retrospective, observational study. Participant inclusion criteria consisted of patients 18 years of age or older, a current diagnosis of hypertension, and hypertension that required medical therapy. The investigator documented whether a patient was taking at least one antihypertensive at night versus all morning medications, as well as the use of indapamide versus hydrochlorothiazide. The patient's baseline and first follow-up blood pressure readings were documented. The primary outcome was to determine whether including nighttime dosing in antihypertensive regimens is more effective than all morning antihypertensive regimens. The secondary outcome was to determine whether indapamide was more effective than hydrochlorothiazide. Results: A total of 64 patients were included in the study. Twenty-eight patients were taking >1 nighttime antihypertensives versus 32 patients on all morning medications. Patients on at least one nighttime medication demonstrated greater systolic blood pressure reduction. There was no difference in blood pressure reduction between indapamide and hydrochlorothiazide. Conclusion: The study findings support the use of nighttime dosing to improve blood pressure management. The results on the effectiveness of indapamide versus hydrochlorothiazide conflict with previous research.
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Affiliation(s)
- Jonathan S. Newsome
- Clinical Sciences Department, The Ben and Maytee Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, TX, USA
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Yuan W, Zhang Y, Ma L. Comparative Different Interventions to Improve Medication Adherence in Patients with Hypertension: A Network Meta-analysis. J Cardiovasc Nurs 2023:00005082-990000000-00104. [PMID: 37406171 DOI: 10.1097/jcn.0000000000001015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
BACKGROUND Hypertension has become a major public problem. One of every 4 adults has hypertension. Medications are critical in controlling blood pressure, but patient medication adherence is low. Therefore, it is very crucial to promote medication adherence. However, the complexity and variety of interventions cause clinical decision-making difficulties for health managers and patients. OBJECTIVE The aim of this study was to compare the effectiveness of different interventions to improve medication adherence in patients with hypertension. METHODS We searched PubMed, Cochrane Library, Web of Science, EMBASE, Wan Fang, China National Knowledge Infrastructure, China Science and Technology Journal Database, and China Biology Medicine disc databases for eligible studies. Medication adherence rate and medication adherence difference were assessed as outcomes. Sensitivity analysis and inconsistency detection were performed to evaluate whether the exclusion of high-risk studies affected the validity. The risk of bias was assessed using the risk of bias table in Review Manager 5.4. The surface under the cumulative ranking curve was used to estimate the rankings among different interventions. RESULTS Twenty-seven randomized controlled trials were included, and the interventions involved were categorized into 8 different categories. The network meta-analysis showed that the health intervention was the best to promote medication compliance in patients with hypertension. CONCLUSIONS Health intervention is recommended to improve medication adherence in patients with hypertension. CLINICAL IMPLICATIONS Health managers are recommended to provide health intervention to patients with hypertension to improve their medication adherence. This approach reduces morbidity, mortality, and healthcare costs for patients with cardiovascular disease.
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Kelly WN, Ho MJ, Smith T, Bullers K, Kumar A. Association of pharmacist intervention counseling with medication adherence and quality of life: A systematic review and meta-analysis of randomized trials. J Am Pharm Assoc (2003) 2023; 63:1095-1105. [PMID: 37142053 DOI: 10.1016/j.japh.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/20/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE(S) To assess the association between pharmacist intervention counseling with medication adherence and quality of life. Also, to assess if these associations vary by the focus, structure, training, or robustness of the counseling. METHODS The initial search identified 1805 references, of which 62 randomized trials (RCTs) met inclusion criteria for the systematic review. Of the 62 RCTs, 60 (with 62 results) had extractable data for the meta-analysis. Data were pooled using a random-effects model. RESULTS Most study patients were older and taking multiple prescription drugs. The pooled results showed a statistically significant increase in the odds of medication adherence with the pharmacist counseling intervention versus no counseling (pooled odds ratio [OR] = 4.41; 95% confidence interval [CI] 2.46-7.91; P < 0.01). The results of a subgroup analysis suggest the primary disease, counseling focus, location, and robustness may modify the effect of pharmacist counseling on medication adherence. There was a statistically significant improvement in the quality of life with pharmacist counseling versus no pharmacist counseling (pooled standardized mean difference [SMD] = 0.69; 95% CI 0.41-0.96; P < 0.01). The results of a subgroup analysis suggest that counseling focus, location, training, robustness, and the measurement method, but not the disease category, may modify the effect of pharmacist counseling on quality of life. CONCLUSION The evidence supports pharmacist intervention counseling to increase mediation adherence and quality of life. The counseling location and structure may be significant factors in improving medication adherence. The overall methodological quality of evidence was very low.
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Ayogu EE, Yahaya RI, Isah A, Ubaka CM. Effectiveness of a pharmacist-led educational intervention on health outcomes in hypertension management at community pharmacies in Nigeria: A two-arm parallel single-blind randomized controlled trial. Br J Clin Pharmacol 2023; 89:649-659. [PMID: 36031952 DOI: 10.1111/bcp.15514] [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: 06/21/2022] [Revised: 08/16/2022] [Accepted: 08/23/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS This study determined the impact of a pharmacist-led educational intervention on the health outcomes of hypertensive patients in community pharmacies. METHODS A 2-arm parallel single-blind randomized trial design was adopted among hypertensive patients in 4 pharmacies in Abuja and Lokoja, Nigeria. A pharmacist-led educational intervention was provided to the patients in the intervention group. The study outcomes, namely changes in adherence to medication, quality of life and cost of medication were measured using MARS-10, SF-12 and official price list, respectively. Independent and paired-sample t-tests were conducted on the data. RESULTS A total of 128 patients participated in the study. All of them completed the study and were included in the analysis: 70 in the control arm and 58 in the intervention arm. There was a significant improvement in components of Behaviour (2.57 vs. 2.98), Attitude (2.59 vs. 3.14) and Negative attitude (1.62 vs. 1.92). There was a better improvement in adherence in the intervention arm: 8.05 ± 1.32 vs. 6.55 ± 2.24; t = -4.65, P = .0001. There were no changes in the respondents' health status after intervention in both groups (P < .05). There was a weak inverse association between the physical health component and mental health component: R = -0.2, P = .04 and a positive association with overall adherence (R = 0.26, P = .004) in the intervention group, in whom the monthly cost of treatment decreased from N2233.1 to N2068.4. CONCLUSION Community pharmacy educational intervention improves health outcomes, particularly with adherence among patients with hypertension. Health-related quality of life of the patients improved, but the physical health component was better than that of the mental health component.
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Affiliation(s)
- Ebere Emilia Ayogu
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Rahmat Isa Yahaya
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Abdulmuminu Isah
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Chukwuemeka Michael Ubaka
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Enugu State, Nigeria
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Alalawneh M, Berardi A, Nuaimi N, Basheti IA. Improving Syrian refugees' knowledge of medications and adherence following a randomized control trial assessing the effect of a medication management review service. PLoS One 2022; 17:e0276304. [PMID: 36240214 PMCID: PMC9565448 DOI: 10.1371/journal.pone.0276304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 08/23/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Syrian refugees living in Jordan have many chronic conditions and use many medications. Pharmacists delivering the Medication Management Review (MMR) service can have a role in improving this growing global refugees' problem. OBJECTIVES To assess the effect of the MMR service on adherence to treatment therapy and knowledge of chronic medications for Syrian refugees residing in Jordan. METHODS This randomized intervention control single-blinded study was conducted in Jordan. Syrian refugees were recruited and randomized into intervention and control groups. Two home visits were delivered to each participant, at baseline and three months later. All participants completed questionnaires regarding adherence and knowledge. As a part of the MMR service, treatment-related problems (TRPs) were recognized for all patients; recommendations to resolve these TRPs were only delivered to intervention group refugees' physicians; TRPs were corrected. At follow-up, TRPs assessment, adherence and medication knowledge were assessed for all refugee participants. RESULTS Participants (n = 106; intervention n = 53, control n = 53) had a number of medications and diagnosed chronic diseases of 5.8 ± 2.1 and 2.97 ± 1.16 per participant respectively. A significant improvement in the adherence and knowledge scores were noted in the intervention (P < 0.001 for both) but not the control group (P = 0.229, P = 0.07 respectively). CONCLUSION The MMR service can significantly improve refugees' TRPs, adherence to therapy and knowledge of chronic medications. If this approach was extended to the large scale, many refugees in need would be able to access a quality essential health-care service; a step towards achieving universal health coverage. TRIAL REGISTRATION Registry: ClinicalTrials.gov Identifier: NCT04554810.
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Affiliation(s)
- Majdoleen Alalawneh
- Department of Pharmaceutical Sciences, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Alberto Berardi
- Department of Pharmaceutical Sciences and Pharmaceutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Nabeel Nuaimi
- Department of Clinical Pharmacy, College of Pharmacy, AlNoor University College, Mosul, Iraq
| | - Iman A. Basheti
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Sciences Private University, Amman, Jordan
- School of Pharmacy, The University of Sydney, Sydney, Australia
- * E-mail:
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Shrestha S, Shrestha R, Ahmed A, Sapkota B, Khatiwada AP, Christopher CM, Thapa P, KC B, Blebil AQ, Khanal S, Paudyal V. Impact of pharmacist services on economic, clinical, and humanistic outcome (ECHO) of South Asian patients: a systematic review. J Pharm Policy Pract 2022; 15:37. [PMID: 35538500 PMCID: PMC9088065 DOI: 10.1186/s40545-022-00431-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/14/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Pharmacists in high-income countries routinely provide efficient pharmacy or pharmaceutical care services that are known to improve clinical, economic, and humanistic outcomes (ECHO) of patients. However, pharmacy services in low- and middle-income countries, mainly South Asia, are still evolving and limited to providing traditional pharmacy services such as dispensing prescription medicines. This systematic review aims to assess and evaluate the impact of pharmacists' services on the ECHO of patients in South Asian countries. METHODS We searched PubMed/Medline, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 20th September 2021. Original studies (only randomised controlled trials) conducted in South Asian countries (published only in the English language) and investigating the economic, clinical (therapeutic and medication safety), and humanistic impact (health-related quality of life) of pharmacists' services, from both hospital and community settings, were included. RESULTS The electronic search yielded 430 studies, of which 20 relevant ones were included in this review. Most studies were conducted in India (9/20), followed by Pakistan (6/20), Nepal (4/20) and Sri Lanka (1/20). One study showed a low risk of bias (RoB), 12 studies showed some concern, and seven studies showed a high RoB. Follow-up duration ranged from 2 to 36 months. Therapeutic outcomes such as HbA1c value and blood pressure (systolic blood pressure and diastolic blood pressure) studied in fourteen studies were found to be reduced. Seventeen studies reported humanistic outcomes such as medication adherence, knowledge and health-related quality of life, which were found to be improved. One study reported safety and economic outcomes each. Most interventions delivered by the pharmacists were related to education and counselling of patients including disease monitoring, treatment optimisation, medication adherence, diet, nutrition, and lifestyle. CONCLUSION This systematic review suggests that pharmacists have essential roles in improving patients' ECHO in South Asian countries via patient education and counselling; however, further rigorous studies with appropriate study design with proper randomisation of intervention and control groups are anticipated.
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Affiliation(s)
- Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Malaysia
| | - Rajeev Shrestha
- Department of Pharmacy, District Hospital Lamjung, Besisahar, Province Gandaki Nepal
| | - Ali Ahmed
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Malaysia
| | - Binaya Sapkota
- Department of Pharmaceutical Sciences, Nobel College, Affiliated to Pokhara University, Kathmandu, Province Bagmati Nepal
| | - Asmita Priyadarshini Khatiwada
- Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Province Bagmati Nepal
| | | | - Parbati Thapa
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Malaysia
| | - Bhuvan KC
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Malaysia
| | - Ali Qais Blebil
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Malaysia
| | - Saval Khanal
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Paulo PTC, Medeiros PADD, Azevedo PRMD, Diniz RDS, Egito ESTD, Araújo IBD. Pharmaceutical Care Practice and Consequences on Quality of Life and Satisfaction of Diabetic Patients: A Randomized Clinical Trial. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e19500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Li Y, Liu G, Liu C, Wang X, Chu Y, Li X, Yang W, Shen Y, Wu F, Zhang W. Effects of Pharmacist Intervention on Community Control of Hypertension: A Randomized Controlled Trial in Zunyi, China. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:890-904. [PMID: 34933984 PMCID: PMC8691874 DOI: 10.9745/ghsp-d-20-00505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/15/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We aimed to test the effects of pharmacist intervention on the community control of hypertension through a comparative randomized controlled trial. METHODS We recruited adult hypertensive patients with comorbidity or confusion with medication (n=636) from 2 community health centers in Zunyi, China. They were randomly and equally divided into 2 groups. Both groups received the usual care and participated in the community systematic management program of hypertension. Participants in the intervention group were given interventions from pharmacists, including a monthly review of medications, patient education, and medication adjustment advice to medical doctors over 6 months. Participants' blood pressure was assessed at baseline, 3 months, and 6 months. Participants' knowledge and medication adherence were measured using a questionnaire before and after the trial. RESULTS Compared to the control group (n=298), a significantly higher percentage of participants in the intervention group (n=290) had their blood pressure under control 3 months (46.9% vs. 38.3%, P=.034) and 6 months (60.7% vs. 40.9%, P<.001) after the interventions. Difference-in-differences analyses showed that the pharmacist intervention resulted in an increase in knowledge scores by 12.55 points (P<.001), a decrease in systolic blood pressure by 6.65 mmHg (P=.001), and a decrease in diastolic blood pressure by 7.26 mmHg (P<.001) compared to the controls after adjustment for variations in potential confounding factors. The odds of participants passing the hypertension knowledge tests in the intervention group was 4.45 times those in the control group (P<.001). Similarly, it was found that the intervention group had higher odds of not needing any medication adjustments (adjusted odds ratio [AOR]=2.75, P<.001) and having their blood pressure under control (AOR=2.18, P=.002) compared to the control group. CONCLUSION It is evident that pharmacist intervention has significant short-term effects on improving the knowledge and medication adherence of hypertensive patients, as well as timely medication adjustments from medical doctors, resulting in lowered blood pressure and an increased control rate. Further studies should explore the long-term sustainability of the effects of community pharmacist intervention.
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Affiliation(s)
- Ying Li
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
- The Second Affiliated Hospital of Zunyi Medical University, Zunyi, People's Republic of China
| | - Guoqin Liu
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China.
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne VIC 3086, Australia.
| | - Xianhong Wang
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Yalin Chu
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Xiaoqin Li
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Wenhao Yang
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Yewei Shen
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Fang Wu
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Wenzhi Zhang
- Department of Pharmacy, Affiliated Hospital of Zunyi Medical University, Zunyi, People's Republic of China
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Heine M, Lategan F, Erasmus M, Lombaard CM, Mc Carthy N, Olivier J, van Niekerk M, Hanekom S. Health education interventions to promote health literacy in adults with selected non-communicable diseases living in low-to-middle income countries: A systematic review and meta-analysis. J Eval Clin Pract 2021; 27:1417-1428. [PMID: 33749092 DOI: 10.1111/jep.13554] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/15/2021] [Accepted: 02/21/2021] [Indexed: 12/17/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Health illiteracy is an important contributor to the burden of non-communicable diseases (NCDs); in particular in settings where health illiteracy is part of a perpetuating system of risk factors. Interventions that promote health literacy may provide an important tool in the primary and secondary prevention of NCDs. The objective of this systematic review was to evaluate the effectiveness of health literacy interventions on health literacy in the management of patients with selected NCDs living in low-to-middle income countries (LMIC). METHODS Seven electronic databases were searched (October 29, 2020) for RCTs aimed at improving health literacy in adults with NCDs in LMICs. Eligible NCDs included those pertaining to cancer, cardiovascular disease (CVD), chronic respiratory disease (CRD) or Diabetes. Studies were included that explicitly focussed on improving health literacy, and reported comprehensive measures of health literacy, or components thereof (ie, knowledge, attitude or behaviour). Random-effect meta-analyses were conducted for continuous outcome measures (Hedges-g). RESULTS The completed search yielded 2573 unique results of which 53 unique studies met the inclusion criteria. Studies included patients with cancer (n = 1, 2%), CRD (n = 8, 15%), CVD (n = 11, 21%) or Diabetes (n = 33, 62%). A significant (P < .01) summary effect was found for disease knowledge (SES = 1.27 [n = 23, 95%CI = 1.05-1.49]), attitude (SES = 1.17 [n = 20, 95%CI = 0.88-1.47]), and behaviour (SES = 1.20 [n = 31, 95%CI = 0.94-1.46]). CONCLUSIONS These results support the conclusion that there is compelling evidence, in particular, for patients with Diabetes, that health-literacy interventions are effective in promoting disease knowledge, attitude and behaviour across four chronic conditions that drive the burden of NCDs.
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Affiliation(s)
- Martin Heine
- Institute of Sport and Exercise Medicine, Division of Orthopaedics, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Frandene Lategan
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Misha Erasmus
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Chris-Mari Lombaard
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nina Mc Carthy
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jeandri Olivier
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marnus van Niekerk
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan Hanekom
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Ahmed A, Saqlain M, Tanveer M, Blebil AQ, Dujaili JA, Hasan SS. The impact of clinical pharmacist services on patient health outcomes in Pakistan: a systematic review. BMC Health Serv Res 2021; 21:859. [PMID: 34425816 PMCID: PMC8381566 DOI: 10.1186/s12913-021-06897-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/17/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The pharmacist's role shifts from dispensing to bedside care, resulting in better patient health outcomes. Pharmacists in developed countries ensure rational drug use, improve clinical outcomes, and promote health status by working as part of a multidisciplinary team of healthcare professionals. However, clinical pharmacist services on healthcare utilization in low-and middle-income countries (LMICs) like Pakistan are unclear. As a result, we aim to systematically review pharmacists' clinical roles in improving Pakistani patients' therapeutic, safety, humanistic, and economic outcomes. METHODS We searched PubMed, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 28th February 2021. All authors were involved in the screening and selection of studies. Original studies investigating the therapeutic, humanistic, safety, and economic impact of clinical pharmacists in Pakistani patients (hospitalised or outpatients) were selected. Two reviewers independently assessed the risk of bias in studies, and discrepancies were resolved through mutual consensus. All of the included studies were descriptively synthesised, and PRISMA reporting guidelines were followed. RESULTS The literature search found 751 articles from which nine studies were included; seven were randomized controlled trials (RCTs), and two were observational studies. Three RCTs included were having a low risk of bias (ROB), two RCTs were having an unclear ROB, while two RCTs were having a high ROB. The nature of clinical pharmacist interventions included one or more components such as disease-related education, lifestyle changes, medication adherence counselling, medication therapy management, and discussions with physicians about prescription modification if necessary. Clinical pharmacist interventions reduce medication-related errors, improve therapeutic outcomes such as blood pressure, glycemic control, lipid control, CD4 T lymphocytes, and renal functions, and improve humanistic outcomes such as patient knowledge, adherence, and health-related quality of life. However, no study reported the economic outcomes of interventions. CONCLUSIONS The findings of the studies included in this systematic review suggest that clinical pharmacists play important roles in improving patients' health outcomes in Pakistan; however, it should be noted that the majority of the studies have a high risk of bias, and more research with appropriate study designs is needed.
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Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor Malaysia
| | - Muhammad Saqlain
- Department of Pharmacy, Quaid I Azam University, Islamabad, Pakistan
| | - Maria Tanveer
- Department of Pharmacy, Quaid I Azam University, Islamabad, Pakistan
| | - Ali Qais Blebil
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor Malaysia
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor Malaysia
| | - Syed Shahzad Hasan
- School of Applied Sciences, Department of Pharmacy, University of Huddersfield, Huddersfield, UK
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Bailey R, English J, Knee C, Keller A. Treatment Adherence in Integrative Medicine-Part One: Review of Literature. Integr Med (Encinitas) 2021; 20:48-60. [PMID: 34373679 PMCID: PMC8325505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Treatment adherence is a topic that is well studied but not well understood. Low treatment adherence is a significant issue that limits the effective management and treatment of chronic conditions, creating significant health care burden, costs, and poor patient outcomes. This report provides a review of the factors that facilitate or create barriers to treatment adherence, as well as strategies recommended to overcome adherence barriers. A total of 25 interviews were conducted with practitioners demonstrating both high (n = 16) and low (n = 9) treatment adherence rates. A total of 185 survey responses were received from high-treatment adherence rate practitioners (n = 21), low-treatment adherence rate practitioners (n = 83), and practitioners that were neither in the high- or low-treatment adherence rate range (n = 81). Practitioner prescribing behaviors and adherence statistics were determined and stratified by high-treatment adherence rate and low-treatment adherence rate practitioners. From the interviews, 78% of low-rate practitioners mentioned that establishing trust is a primary best practice for optimizing adherence, and for high-rate practitioners, 69% thought that facilitating trust was important to optimizing adherence. Both low- and high-adherence rate practitioners prioritized using a staged approach as a strategy to overcome barriers to adherence. From the total survey sample it was found that key strategies to improving adherence included the practice of booking follow-up appointments, using lab results to explain treatment plans, and using a staged approach for treatment plans. Our research sought to elicit strategies and skills that can help improve treatment adherence in integrative medicine and our findings have identified several common practices that can help to improve adherence. Research taking advantage of mobile devices and the internet for adherence has started to expand within the last 10 to 15 years. Technology has the potential to lead the development and establishment of a centralized database that acquires adherence information and provides solutions to its practitioners and patients. Further work to advance the field of integrative medicine through additional research and interventions that support treatment adherence would be valuable to the effective treatment and management of integrative medicine patients.
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Ogungbe O, Byiringiro S, Adedokun-Afolayan A, Seal SM, Dennison Himmelfarb CR, Davidson PM, Commodore-Mensah Y. Medication Adherence Interventions for Cardiovascular Disease in Low- and Middle-Income Countries: A Systematic Review. Patient Prefer Adherence 2021; 15:885-897. [PMID: 33953548 PMCID: PMC8092634 DOI: 10.2147/ppa.s296280] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/02/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The burden of cardiovascular diseases (CVD) is high in low- and middle-income countries (LMICs). Medications are integral to the management and control of CVD; however, suboptimal adherence impacts health outcomes. This systematic review aims to critically examine interventions targeted at improving medication adherence among persons with CVD in LMICs. METHODS In this systematic review, we searched online databases PubMed, Embase, and CINAHL for studies that evaluated a medication adherence intervention for CVD, reported adherence as an outcome measure, were conducted in LMICs and reported the strategy or tool used to measure adherence. We included articles published in English, available in full text, peer-reviewed, and published between 2010 and 2020. RESULTS We included 45 articles in this review. The majority of the studies implemented counseling and educational interventions led by nurses, pharmacists, or community health workers. Many of the studies delivered medication-taking reminders in the form of phone calls, text messages, short message services (SMS), and in-phone calendars. Multi-component interventions were more effective than unifocal interventions. Interventions involving technology, such as mobile phone calls, electronic pillboxes, and interactive phone SMS reminders, were more effective than generic reminders. The outcomes reported in the studies varied based on the complexity and combination of strategies. When interventions were implemented at both the patient level, such as reminders, and at the provider level, such as team-based care, the effect on medication adherence was larger. CONCLUSION In LMICs, medication adherence interventions among persons with CVD included a combination of patient education, reminders, fixed-dose combination therapy and team-based care approach were generally more effective than singular interventions. Among patients who had CVD, the medication adherence interventions were found to be moderately effective. Future studies focusing on improving medication adherence in LMICs should consider non-physician-led interventions and appropriately adapt the interventions to the local context.
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Affiliation(s)
| | | | | | - Stella M Seal
- William H. Welch Medical Library, Johns Hopkins University and Medicine, Baltimore, MD, USA
| | - Cheryl R Dennison Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Treciokiene I, Postma M, Nguyen T, Fens T, Petkevicius J, Kubilius R, Gulbinovic J, Taxis K. Healthcare professional-led interventions on lifestyle modifications for hypertensive patients - a systematic review and meta-analysis. BMC FAMILY PRACTICE 2021; 22:63. [PMID: 33820547 PMCID: PMC8022420 DOI: 10.1186/s12875-021-01421-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 03/23/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND About 0.9 billion people in the world have hypertension. The mortality due to hypertension increased dramatically over the last decades. Healthcare professionals should support patients with hypertension to modify their lifestyle to decrease blood pressure, but an overview of effective lifestyle interventions is lacking. The aim of this study was to determine whether healthcare professional-led interventions on lifestyle modifications are effective in lowering blood pressure in patients with hypertension. METHODS A systematic literature review following the PRISMA guidelines was conducted. PubMed, EMBASE and CINAHL databases were searched for randomized control trials (RCTs) of interventions on lifestyle modifications of hypertensive patients which were performed by healthcare professionals (physician, nurse, pharmacist) and which reported blood pressure measurements. Papers were reviewed by two reviewers and analysed using Cochrane software Revman 5.4. In a meta-analysis difference in systolic blood pressure (SBP), diastolic blood pressure (DBP) and the percentage of patients with controlled blood pressure (BP) was analysed. RESULTS In total, 34 clinical trials reporting on 22,419 patients (mean age 58.4 years, 49.14% female, 69.9% used antihypertensive medications) were included. The mean difference SBP was - 4.41 mmHg (95% CI, - 5.52to - 3.30) and the mean difference DBP was - 1.66 mmHg (95% CI - 2.44 to - 0.88) in favor of the intervention group vs usual care. Fifty-six percent of patients achieved BP control in the intervention group vs 44% in usual care, OR = 1.87 (95% CI, 1.51 to 2.31). CONCLUSION Healthcare professional-led interventions were effective. Patients achieved almost 5 mmHg decrease of SBP and more patients achieved BP control. The results suggest that efforts are needed for widespread implementation.
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Affiliation(s)
- Indre Treciokiene
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Groningen, Netherlands.
- Pharmacy Center, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Maarten Postma
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Groningen, Netherlands
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, Netherlands
| | - Thang Nguyen
- Pharmacology & Clinical Pharmacy Department, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
| | - Tanja Fens
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Groningen, Netherlands
| | | | | | - Jolanta Gulbinovic
- Pharmacy Center, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Katja Taxis
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Groningen, Netherlands
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Chambord J, Couzi L, Merville P, Moreau K, Xuereb F, Djabarouti S. Benefit of a pharmacist-led intervention for medication management of renal transplant patients: a controlled before-and-after study. Ther Adv Chronic Dis 2021; 12:20406223211005275. [PMID: 33868624 PMCID: PMC8024450 DOI: 10.1177/20406223211005275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/03/2021] [Indexed: 11/16/2022] Open
Abstract
Aims To assess the effect of a pharmacist-led intervention, using Barrows cards method, during the first year after renal transplantation, on patient knowledge about their treatment, medication adherence and exposure to treatment in a French cohort. Methods We conducted a before-and-after comparative study between two groups of patients: those who benefited from a complementary pharmacist-led intervention [intervention group (IG), n = 44] versus those who did not [control group (CG), n = 48]. The pharmacist-led intervention consisted of a behavioral and educational interview at the first visit (visit 1). The intervention was assessed 4 months later at the second visit (visit 2), using the following endpoints: treatment knowledge, medication adherence [proportion of days covered (PDC) by immunosuppressive therapy] and tacrolimus exposure. Results At visit 2, IG patients achieved a significantly higher knowledge score than CG patients (83.3% versus 72.2%, p = 0.001). We did not find any differences in treatment exposure or medication adherence; however, the intervention tended to reduce the proportion of non-adherent patients with low knowledge scores. Using the PDC by immunosuppressive therapy, we identified 10 non-adherent patients (10.9%) at visit 1 and six at visit 2. Conclusions Our intervention showed a positive effect on patient knowledge about their treatment. However, our results did not show any improvement in overall medication adherence, which was likely to be because of the initially high level of adherence in our study population. Nevertheless, the intervention appears to have improved adherence in non-adherent patients with low knowledge scores.
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Affiliation(s)
| | - Lionel Couzi
- Department of Nephrology and Renal Transplantation, CHU Bordeaux, Bordeaux, Aquitaine, France
| | - Pierre Merville
- Department of Nephrology and Renal Transplantation, CHU Bordeaux, Bordeaux, Aquitaine, France
| | - Karine Moreau
- Department of Nephrology and Renal Transplantation, CHU Bordeaux, Bordeaux, Aquitaine, France
| | - Fabien Xuereb
- CHU Bordeaux, Pharmacy, Bordeaux, Pessac, France Univ. Bordeaux, INSERM U1034, Bordeaux, France
| | - Sarah Djabarouti
- CHU Bordeaux, Pharmacy, Bordeaux, Pessac, France Univ. Bordeaux, INSERM U1034, Bordeaux, France
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20
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Macedo LA, de Oliveira Santos Silva R, Silvestre CC, Alcântara TDS, de Magalhães Simões S, Lyra DP. Effect of pharmacists' interventions on health outcomes of children with asthma: A systematic review. J Am Pharm Assoc (2003) 2021; 61:e28-e43. [PMID: 33608222 DOI: 10.1016/j.japh.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/10/2020] [Accepted: 01/03/2021] [Indexed: 12/12/2022]
Abstract
METHODS A literature search was performed in January 23, 2018 at the Embase, LILACS, OpenThesis, PubMed, Cochrane Library, and Web of Science databases through January 23, 2018, using keywords related to "asthma," "pharmacist," and "children." This systematic review followed the methodologic standards recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included intervention studies on the effect of pharmacists' interventions on pediatric patients with asthma, performed in hospital or ambulatory care settings, with presenting process and outcome indicators as a result of pharmacists' interventions. The methodologic quality of the included studies was assessed independently by 2 researchers. The Cohen kappa index was used to measure the degree of agreement between the 2 investigators. RESULTS The search yielded 3671 records, of which 5 were included in this review. Most of these studies were conducted in the United States (n = 2) and in outpatient clinics (n = 4). All studies described components of pharmacists' interventions. The most reported category concerning pharmacists' work process was the initial assessment of patients' conditions, with the assessment of outcomes (at baseline and follow-up) as the only category present in all studies. The most assessed outcomes at baseline were asthma control, emergency department visits, medication use and technique, and adherence to asthma therapy. At follow-up, emergency department visits were the most evaluated outcome (n = 2), and no study assessed economic outcomes. The average consultation time ranged from 20 to 45 minutes, and the number of encounters ranged from 2 to 3. CONCLUSION This study highlighted the limited number of studies, most with low quality, on the impact of the pharmacist on pediatric asthma. The most assessed outcome was the number of emergency department visits, with positive results after interventions. Heterogeneity regarding assessed outcomes and work processes was noted, which limited comparison of the results and interventions.
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Parra DI, Trapero Gimeno I, Sánchez Rodríguez JM, Rodríguez Corredor LC, Hernández Vargas JA, López Romero LA, García López FJ, Escudero-Gómez C, Trujillo-Cáceres SJ, Serrano-Gallardo P, Vera-Cala LM. Individual interventions to improve adherence to pharmaceutical treatment, diet and physical activity among adults with primary hypertension. A systematic review protocol. BMJ Open 2020; 10:e037920. [PMID: 33371014 PMCID: PMC7757507 DOI: 10.1136/bmjopen-2020-037920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hypertension is a chronic disease with 31% worldwide prevalence in adults. It has been associated with non-adherence to therapeutic regime with a negative impact on the prognosis of the disease and healthcare-associated costs. So, it is necessary to identify effective interventions to improve adherence among the afflicted population. The objective of this protocol is to describe the methods for a systematic review that will evaluate the effect of individual interventions so as to improve adherence to the prescribed pharmacological treatment, as well as to prescribed diet and physical activity in adults with primary hypertension. METHODS AND ANALYSIS A systematic search of studies will be conducted in PubMed/MEDLINE, BVS, CINAHL, Embase, Cochrane and Scopus databases. Randomised and non-randomised clinical studies conducted in human beings, published from 1 January 2009 to 13 December 2019, are to be included, in any language. Adherence to pharmacological treatment, diet and physical activity, measured by direct and indirect methods, will be the primary outcome. Two independent reviewers will select relevant studies and will extract the data following the Cochrane's Handbook for Systematic Reviews of Approach and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. Methodological quality will be evaluated using the risk-of-bias (RoB) 2 and Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tools. Risk of bias will also be evaluated, and if the criteria are met, a meta-analysis will be finally performed. ETHICS AND DISSEMINATION Information to be analysed is of a grouped nature, and given that its sources are published studies, no ethics committee approval is required. Results will be published in scientific journals, and in conferences, seminars and symposiums. Copyrights will be addressed by giving due credit through bibliographic references. PROSPERO REGISTRATION NUMBER CRD42020147655.
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Affiliation(s)
- Dora Inés Parra
- Nursing School, Universidad Industrial de Santander, Bucaramanga, Colombia
- Clinical and Community Nursing Doctoral student, Universitat de València, Valencia, Spain
| | | | | | - Lizeth Catherine Rodríguez Corredor
- Research Division, Instituto Neumológico del Oriente, Bucaramanga, Colombia
- Public Health Department, Universidad Industrial de Santander, Bucaramanga, Colombia
| | | | | | | | | | | | - Pilar Serrano-Gallardo
- Department of Nursing, School of Medicine, Universidad Autónoma de Madrid/IDIPHIM / INAECU, Madrid, Spain
| | - Lina M Vera-Cala
- Public Health Department, Universidad Industrial de Santander, Bucaramanga, Colombia
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Woit C, Yuksel N, Charrois TL. Pharmacy and medical students' competence and confidence with prescribing: A cross-sectional study. CURRENTS IN PHARMACY TEACHING & LEARNING 2020; 12:1311-1319. [PMID: 32867929 DOI: 10.1016/j.cptl.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 06/01/2020] [Accepted: 06/14/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Previous research has shown that prescribing competence is weakly correlated with prescribing confidence. This questions whether undergraduate programs adequately prepare students and junior practitioners for safe and rational prescribing. The goal of this project was to investigate whether there are differences in prescribing competence and confidence between fourth year pharmacy and medical students at the University of Alberta. METHODS A cross-sectional design measured prescribing competence using five case scenarios and prescribing confidence with a survey. All fourth-year pharmacy and medical students at the University of Alberta were eligible to participate. Answers to the cases were graded based on therapeutic appropriateness and inclusion of all legal requirements. The confidence survey assessed self-rated confidence of both assessment and prescribing skills. Chi-square tests were used to compare frequencies of prescribing errors and self-rated confidence. The Spearman correlation coefficient was used to explore the correlation between prescribing competence and confidence for both cohorts independently. RESULTS Thirty-one pharmacy students and 16 medical students (response rate 24% and 10%, respectively) completed the assessment between December 2018 and March 2019. Pharmacy students had significantly more appropriate prescriptions and fewer inappropriate prescriptions than medical students. Both rated themselves as confident or very confident with prescribing, however neither group consistently included all the legal requirements of a prescription. There were no significant correlations between competence and confidence. CONCLUSIONS There are differences in prescribing competence and confidence between pharmacy and medical students. This assessment identified deficits in prescribing skills that could be targeted by future educational initiatives.
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Affiliation(s)
- Cassandra Woit
- University of Alberta, Faculty of Pharmacy and Pharmaceutical Sciences, 3-227 Edmonton Clinic Health Academy (ECHA), 11405 - 87 Ave, Edmonton, AB T6G 1C9, Canada.
| | - Nese Yuksel
- University of Alberta, Faculty of Pharmacy and Pharmaceutical Sciences, 3-227 Edmonton Clinic Health Academy (ECHA), 11405 - 87 Ave, Edmonton, AB T6G 1C9, Canada.
| | - Theresa L Charrois
- University of Alberta, Faculty of Pharmacy and Pharmaceutical Sciences, 3-227 Edmonton Clinic Health Academy (ECHA), 11405 - 87 Ave, Edmonton, AB T6G 1C9, Canada.
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Pharmacists' viewpoint towards their professional role in healthcare system: a survey of hospital settings of Pakistan. BMC Health Serv Res 2020; 20:610. [PMID: 32615966 PMCID: PMC7330985 DOI: 10.1186/s12913-020-05459-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 06/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pharmacy service is an essential part of a healthcare system. The profession of pharmacy is well recognized and is practiced to its full potential in developed countries however, it is underutilized in developing countries such as Pakistan. The recognition of pharmacist's role as healthcare professional is limited. This study aimed to document pharmacists' attitude towards their role in Pakistan's healthcare system, their experience with doctors and their perceptions towards involvement in medicines management. METHODS A 4-month cross-sectional survey (Jan - Apr 18) was conducted targeting pharmacists practising in 26 tertiary care hospitals across Pakistan using a developed and validated questionnaire in both Urdu/English languages. Chi square (χ2) test was used to report any associations between independent variables, i.e., education, type of hospital and work experience and, dependent variables, i.e., pharmacists' attitudes, experience, and perception. A p-value of ≤0.01 with value of Cramer's V ≥ 0.3 was considered cut-off for establishing statistical significance. The study was approved by ethical committee and local hospital committees. RESULTS Three hundred ninety-six questionnaires were returned out of 500, i.e., response rate = 87.9%. Most participants (92.2%) interacted with doctors at least once daily. Most interactions were related to drug availability inquiry (72.5%). Most pharmacists (91.4%) mentioned that pharmacy duties are mostly clinical in nature. 93.4% of the respondents indicated that pharmacists are reliable source of information regarding general medicines. Furthermore, 87.4% reasoned inadequate training for not being able to discuss issues of clinical nature with doctors. CONCLUSION Pharmacists were willing to perform their duties and provide healthcare benefits to patients however, they seemed sceptical of advanced clinical pharmacy roles such as intervening in prescriptions and medication therapy, consultations and prescribing. There is a need to increase awareness regarding pharmacist's role. Therefore, it would be helpful if trainings and seminars are conducted on the importance of clinical pharmacy to improve the pharmacy services in Pakistan's healthcare system.
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Silva RCD, Vieira F, Suzuki K, Cavalcante AMRZ. EDUCATIONAL INTERVENTIONS IN IMPROVING QUALITY OF LIFE FOR HYPERTENSIVE PEOPLE: INTEGRATIVE REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2020. [DOI: 10.1590/1980-265x-tce-2018-0399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to evaluate the effectiveness of educational interventions in improving the quality of life of people with arterial hypertension. Method: an integrative literature review which included studies that conducted educational interventions aimed at the hypertensive public to improve quality of life. The search was performed in the following databases: MEDLINE, LILACS, IBECS, CUMED, BDENF, SciELO and CINAHL, without restriction of language, date and sample size. For this, the following descriptors were crossed: “hipertensão” (hypertension), “educação em saúde” (health education) and “qualidade de vida” (quality of life). 619 articles were retrieved and after the selection and analysis process, a total of 10 made up this review. Data extraction and analysis were performed with the help of validated instruments and the result summarized. Results: Most studies were developed on a quasi-experimental basis, using generic instruments to measure quality of life with significant improvement after educational interventions, with group technology being the most used educational strategy. Just one study used a specific instrument to evaluate hypertensive patients. Conclusion: these results may direct the interventions to be implemented by health professionals in managing arterial hypertension. Further investigations are needed to identify and verify the most effective interventions for hypertensive patients, considering heterogeneous profiles and aiming at improving quality of life.
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Woit C, Yuksel N, Charrois TL. Competence and confidence with prescribing in pharmacy and medicine: a scoping review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 28:312-325. [DOI: 10.1111/ijpp.12595] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 11/01/2019] [Accepted: 11/09/2019] [Indexed: 11/30/2022]
Abstract
Abstract
Objectives
Prescribing is a growing scope of practice for pharmacists. The objective of this scoping review is to explore themes within the literature related to prescribing competence and confidence in the disciplines of pharmacy and medicine.
Methods
Online databases MEDLINE, EMBASE and Global Health were used to identify articles from inception to October 2018. Articles describing either the competence or confidence of physician, pharmacist or student prescribing, including inappropriate prescribing and prescribing errors were included.
Key findings
After applying the inclusion and exclusion criteria, 33 eligible articles remained. Many studies demonstrate that medical students and junior doctors are not competent in prescribing when they enter practice, and their perceived confidence is often higher than their assessed competence. There were fewer studies about pharmacist competence and confidence with prescribing; however, they described pharmacists that felt competent to prescribe but lacked confidence. Themes from the review included self-awareness, lack of education and educational improvements, prescribing errors and resources, prescribing culture and barriers to prescribing, gender differences and benefits to prescribing.
Conclusions
There is little consensus from the outcomes of these studies related to prescribing competence or confidence. While some reflect positively on prescribing competence and confidence, others show major deficits in competence and lack of confidence. Further research needs to be done to evaluate pharmacist competence and confidence with respect to prescribing.
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Affiliation(s)
- Cassandra Woit
- University of Alberta Faculty of Pharmacy and Pharmaceutical Sciences, Edmonton Clinic Health Academy, Edmonton, Canada
| | - Nese Yuksel
- University of Alberta Faculty of Pharmacy and Pharmaceutical Sciences, Edmonton Clinic Health Academy, Edmonton, Canada
| | - Theresa L Charrois
- University of Alberta Faculty of Pharmacy and Pharmaceutical Sciences, Edmonton Clinic Health Academy, Edmonton, Canada
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Naqvi AA, Hassali MA, Naqvi SBS, Aftab MT. Impact of pharmacist educational intervention on disease knowledge, rehabilitation and medication adherence, treatment-induced direct cost, health-related quality of life and satisfaction in patients with rheumatoid arthritis: study protocol for a randomized controlled trial. Trials 2019; 20:488. [PMID: 31399128 PMCID: PMC6688212 DOI: 10.1186/s13063-019-3540-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/27/2019] [Indexed: 11/10/2022] Open
Abstract
Background The objective of this study is to evaluate the effectiveness of pharmacist intervention in improving disease knowledge, adherence to treatment, health-related quality of life (HRQoL) and direct cost of treatment. The study also documents patient satisfaction with pharmacist counselling as a quality control measure. Methods/design This is a randomized, single-blind, two-arm, controlled trial in patients with rheumatoid arthritis visiting outpatient rheumatology clinics in Karachi, Pakistan. We will enroll patients with established diagnosis of rheumatoid arthritis over 3 months. The patients would be randomized through a computer-generated list into the control group, i.e., usual care or into the intervention group, i.e., pharmaceutical care, in a ratio of 1:1, after providing signed written consent. The study will take place in two patient-visits over the course of 3 months. Patients in the intervention group would receive intervention from the pharmacist while those in the control group will receive usual care. Primary outcomes include change in mean score from baseline (week 0) and at follow up (week 12) in disease knowledge, adherence to medications and rehabilitation/physical therapy. The secondary outcomes include change in the mean direct cost of treatment, HRQoL and patient satisfaction with pharmacist counselling. Discussion This is a novel study that evaluates the role of the pharmacist in improving treatment outcomes in patients with rheumatoid arthritis. The results of this trial could set the foundation for future delivery of care for this patient population in Pakistan. The results of this trial would be published in a peer-reviewed journal. Trial registration ClinicalTrials.gov, NCT03827148. Registered on February 2019. Electronic supplementary material The online version of this article (10.1186/s13063-019-3540-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Atta Abbas Naqvi
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, 11800, Penang, Malaysia.
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, 11800, Penang, Malaysia
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Wan Puteh SE, Siwar C, Zaidi MAS, Abdul Kadir H. Health related quality of life (HRQOL) among low socioeconomic population in Malaysia. BMC Public Health 2019; 19:551. [PMID: 31196024 PMCID: PMC6565523 DOI: 10.1186/s12889-019-6853-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The rapid growth of economy and increasing cost of living in Malaysia have given significant impact especially to the lowest household income population. The main objective of this study was to determine risk factors for low quality of life (QOL) and poor health status of this population. Methods This was a cross sectional study design. A total of 347 respondents from low household income groups, including persons with disability and Orang Asli were recruited from E-kasih. A semi-guided self-administered questionnaire was used. QOL measured by EQ. 5D utility value and health status measured by visual analogue score (VAS). Descriptive statistic, bivariate Chi-square analysis and binary logistic regression were conducted to determine factors influencing low QOL and poor health status. Results Majority of the respondents were Malay, female (61%), 63% were married, 60% were employed and 46% with total household income of less than 1 thousand Ringgit Malaysia. 70% of them were not having any chronic medical problems. Factors that associated with low QOL were male, single, low household income, and present chronic medical illness, while poor health status associated with female, lower education level and present chronic medical illness. Logistic regression analysis has showed that determinants of low QOL was present chronic illness [AOR 4.15 95%CI (2.42, 7.13)], while determinants for poor health status were; female [AOR 1.94 95%CI (1.09,3.44)], lower education [AOR 3.07 95%CI (1.28,7.34)] and present chronic illness [AOR 2.53 95%CI (1.39,4.61)]. Conclusion Low socioeconomic population defined as low total household income in this study. Low QOL of this population determined by present chronic illness, while poor health status determined by gender, education level and chronic medical illness.
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Affiliation(s)
- Sharifa Ezat Wan Puteh
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Chamhuri Siwar
- Institute for Environment and Development (LESTARI), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Hazila Abdul Kadir
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
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Asgari MR, Bouraghi H, Mohammadpour A, Haghighat M, Ghadiri R. The role of psychosocial determinants in predicting adherence to treatment in patient with hypertension. Interv Med Appl Sci 2019; 11:8-16. [PMID: 32148898 PMCID: PMC7044565 DOI: 10.1556/1646.10.2018.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Non-adherence in patients with hypertension directly exacerbates clinical outcomes. The purpose of the present research is to study the recognition of the relationships between the perceived social support and self-efficacy and the satisfaction of health care agents and the interaction of the patient with therapeutic personnel and access to health care and the behaviors of adherence to treatment in the patients who suffer hypertension. MATERIALS AND METHODS This descriptive cross-sectional correlation study recruited 250 patients from a specialized hypertension clinic in Semnan, who completed the following questionnaires: Multidimensional Scale of Perceived Social Support, self-efficacy, adherence to treatment, access to and satisfaction with health care, and the patient's interaction with treatment personnel. RESULTS An overall statistical description of the sample consists of 89 (35.6%) men and 161 (64.4%) women (SD = 10.41, range = 51.98). Regression coefficient of previous variables (three steps) shows that self-efficacy share, consent form civil services, and job could demonstrate with 99% certainty in the changes of treatment conformity in a meaningful way. CONCLUSIONS High self-efficacy, satisfaction with health care, and a favorable job have a high direct effect on adherence to treatment in patients with hypertension and controlling hypertension. Social support and education do not have a significant impact on adherence to treatment.
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Affiliation(s)
- Mohammad Reza Asgari
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Hamid Bouraghi
- Department of Health Information Technology, School of Paramedical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Mohammadpour
- Department of Health Information Technology, School of Paramedical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mina Haghighat
- Unit of Psychology Consultation, Semnan University, Semnan, Iran
| | - Raheleh Ghadiri
- Jahadieh Health Center, Semnan University of Medical Sciences, Semnan, Iran
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Sheilini M, Hande HM, Prabhu MM, Pai MS, George A. Impact of multimodal interventions on medication nonadherence among elderly hypertensives: a randomized controlled study. Patient Prefer Adherence 2019; 13:549-559. [PMID: 31114169 PMCID: PMC6489579 DOI: 10.2147/ppa.s195446] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/12/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose: The study was conducted to investigate the effects of multimodal interventions on medication nonadherence, quality of life (QoL), hypertension (HTN), self-efficacy, and clinical outcome in terms of blood pressure (BP) among elderly people with HTN. Methods: An experimental design using a randomized controlled trial was adopted (N=80+80). The experimental group received multimodal interventions and the control group received routine care. Both groups were followed up at baseline and at 3 and 6 months. The data collection tools of demographic and clinical proforma, structured knowledge questionnaire on HTN (r=0.84), Revised Medication Adherence Self-Efficacy Scale (r=0.94), Morisky Medication Adherence Scale (r=0.83), World Health Organization Quality of Life-BREF scale (r=0.87), and digital BP apparatus were used. Necessary administrative permission was obtained for the study. Results: The study results proved that nurse-led multimodal interventions led to an improvement in medication adherence [F(1.75,214.30)=774.18, p<0.001], knowledge on HTN [F(2,244)=43.83, p<0.001], and self-efficacy [F(1,122)=3.99, p=0.04] of elderly people on antihypertensives over a period of 6 months. Overall QoL did not exhibit any statistically significant improvement, and no statistically significant reductions in the systolic BP (SBP) and diastolic BP (DBP) scores were obtained (p>0.05) in the experimental group over a period of 6 months. However, the clinical significance of multimodal interventions for improvements in medication adherence, QoL, knowledge on HTN, and self-efficacy was more favorable compared with the reduction in SBP and DBP scores. Conclusion: Nurses play a crucial role in improving medication adherence among elderly people with HTN. Trial details: Ethical clearance was obtained (IEC no. KH IEC 253/2012) from the Institutional Ethical Committee of Manipal University, Manipal, and the study was conducted in accordance with the Declaration of Helsinki. The study is registered under Clinical Trials Registry of India (CTRI/2017/04/008405). Informed consent was obtained from participants, and the confidentiality of information was assured.
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Affiliation(s)
- Melita Sheilini
- Department of Medical Surgical Nursing, Manipal College of Nursing Manipal, MAHE, Manipal, Udupi District, Karnataka, India
- Correspondence: Melita SheiliniDepartment of Medical Surgical Nursing, Manipal College of Nursing Manipal, MAHE, Manipal, Udupi District, Karnataka576104, IndiaTel +91 809 597 6561Fax +91 820 292 2572Email
| | - H Manjunatha Hande
- Department of Medicine, Kasturba Hospital, MAHE, Manipal, Udupi District, Karnataka, India
| | - Mukhyaprana M Prabhu
- Department of Medicine, Kasturba Hospital, MAHE, Manipal, Udupi District, Karnataka, India
| | - Mamatha Shivananda Pai
- Department of Child Health Nursing, Manipal College of Nursing Manipal, MAHE, Manipal, Udupi District, Karnataka, India
| | - Anice George
- Department of Child Health Nursing, Manipal College of Nursing Manipal, Manipal MAHE, Manipal, Udupi District, Karnataka, India
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Rêgo ADS, Radovanovic CAT. Adherence of hypertension patients in the Brazil's Family Health Strategy. Rev Bras Enferm 2018; 71:1030-1037. [PMID: 29924169 DOI: 10.1590/0034-7167-2017-0297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 05/30/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to evaluate the adherence and associate it to blood pressure control and to follow-up observation of people with hypertension in the Brazil's Family Health Strategy. METHOD cross-sectional study, conducted with 417 people in treatment of hypertension, living in a municipality located in the Northwest region of the state of Paraná, Brazil. The data were collected in the first 2016 semester, using an instrument adapted and validated for the evaluation of satisfaction with the services offered by Primary Health Care. Analysis of variance and the logistic regression model were used for the treatment of variables. RESULTS it was evidenced that people with inadequate follow-up observation evaluate the relations between professional/user and the guidance to the medications used as unsatisfactory. CONCLUSION weak guidelines and ineffective dialogue between health professionals and users might result in an inadequate follow-up observation of blood pressure control and of people with hypertension.
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de Souza ACC, Borges JWP, Moreira TMM. Quality of life and treatment adherence in hypertensive patients: systematic review with meta-analysis. Rev Saude Publica 2016; 50:71. [PMID: 28099657 PMCID: PMC5152803 DOI: 10.1590/s1518-8787.2016050006415] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/11/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To verify the effects of antihypertensive treatment (pharmacological and non-pharmacological) on the health-related quality of life of individuals with hypertension. METHODS We conducted a systematic review with meta-analysis using the following databases: IBECS, LILACS, SciELO, Medline, Cochrane, Science Direct, Scopus and the Brazilian Capes Theses and Dissertations Database. The statistical analysis was performed using Review Manager, version 5.2. The average difference was used for the summarization of meta-analytic effect by the fixed-effect model. Twenty studies were included. RESULTS The summarization of the effect showed an average increase of 2.45 points (95%CI 1.02-3.87; p < 0.0008) in the quality of life of individuals adhering to non-pharmacological treatment for arterial hypertension. Adherence to pharmacological treatment indicated an average increase of 9.24 points (95%CI 8.16-10.33; p < 0.00001) in the quality of life of individuals with arterial hypertension. CONCLUSIONS Non-pharmacological treatment improves the overall quality of life and physical domain of people with arterial hypertension. Adherence to pharmacological treatment has a positive impact on the mental and physical domains of patients, as it did on the overall quality of life score. OBJETIVO Verificar os efeitos do tratamento anti-hipertensivo (farmacológico e não-farmacológico) na qualidade de vida relacionada à saúde de pessoas com hipertensão arterial. MÉTODOS Foi conduzida revisão sistemática com metanálise utilizando as bases de dados IBECS, Lilacs, SciELO, Medline, Cochrane, Science Direct, Scopus e o banco de teses da Capes. A análise estatística foi realizada pelo Review Manager versão 5.2. Foi utilizada a diferença da média na sumarização do efeito metanalítico pelo modelo de efeito fixo. Vinte estudos foram incluídos. RESULTADOS A sumarização do efeito mostrou incremento de 2,45 pontos na média (IC95% 1,02-3,87; p < 0,0008) da qualidade de vida em pessoas com adesão ao tratamento não farmacológico para hipertensão arterial. A adesão ao tratamento farmacológico indicou aumento de 9,24 pontos na média (IC95% 8,16-10,33; p < 0,00001) da qualidade de vida em pessoas com hipertensão arterial. CONCLUSÕES O tratamento não-farmacológico melhora a qualidade de vida global e o domínio físico de pessoas com hipertensão arterial. A adesão ao tratamento farmacológico impacta positivamente nos domínios mental, físico e escore total da qualidade de vida.
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Affiliation(s)
- Ana Célia Caetano de Souza
- Unidade de Farmacologia Clínica. Núcleo de Pesquisa e Desenvolvimento de Medicamentos. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - José Wicto Pereira Borges
- Programa de Graduação em Enfermagem. Programa de Pós-Graduação em Saúde e Comunidade. Campus Amilcar Ferreira Sobral. Universidade Federal do Piauí. Floriano, PI, Brasil
| | - Thereza Maria Magalhães Moreira
- Programa de Pós-Graduação em Saúde Coletiva. Programa de Pós-Graduação em Cuidados Clínicos em Enfermagem e Saúde. Centro de Ciências da Saúde. Universidade Estadual do Ceará. Fortaleza, CE, Brasil
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Chen CM, Kuo LN, Cheng KJ, Shen WC, Bai KJ, Wang CC, Chiang YC, Chen HY. The effect of medication therapy management service combined with a national PharmaCloud system for polypharmacy patients. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 134:109-119. [PMID: 27480736 DOI: 10.1016/j.cmpb.2016.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 05/31/2016] [Accepted: 07/01/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND This study evaluated a medication therapy management service using the Taiwan National Health Insurance Administration's PharmaCloud system in a medical center in Taiwan. The new PharmaCloud System, launched in 2013, links a complete list of prescribed and dispensed medication from different hospitals, clinics, and pharmacies for all insured patients. METHOD The study included patients with polypharmacy (≥5 drugs) at a medication therapy management service from March 2013 to March 2014. A structured questionnaire was designed to collect patients' baseline data and record patients' knowledge, attitudes, and practice scores before and after the service intervention. Phone follow-ups for practice and adherence scores on medication use were performed after 3 months. RESULTS There were 152 patients recruited in the study. Scores for medication use attitudes and practice significantly increased after the service (attitudes: 40.06 ± 0.26 to 43.07 ± 0.19, p <0.001; practice: 33.42 ± 0.30 to 40.37 ± 0.30, p <0.001). The scores for medication adherence also increased from 3.02 ± 0.07 to 3.92 ± 0.02 (p <0.001). CONCLUSIONS The PharmaCloud system facilitates accurate and efficient medication reconciliation for pharmacists in the medication therapy management service. The model improved patients' attitudes and practice of the rational use of medications and adherence with medications. Further studies are warranted to evaluate human resources, executing costs, and the cost-benefit ratio of this medication therapy management service with the PharmaCloud system.
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Affiliation(s)
- Chang-Ming Chen
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan; Department of Pharmacy, Taipei Medical University-Wan Fang Medical Center, Taipei, Taiwan
| | - Li-Na Kuo
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan; Department of Pharmacy, Taipei Medical University-Wan Fang Medical Center, Taipei, Taiwan
| | - Kuei-Ju Cheng
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan; Department of Pharmacy, Taipei Medical University-Wan Fang Medical Center, Taipei, Taiwan
| | - Wan-Chen Shen
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan; Department of Pharmacy, Taipei Medical University-Wan Fang Medical Center, Taipei, Taiwan
| | - Kuan-Jen Bai
- Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Chi Wang
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan; Department of Statistics, University of Virginia, Charlottesville, Virginia, USA
| | - Yi-Chun Chiang
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan; Department of Pharmacy, Taipei Medical University-Wan Fang Medical Center, Taipei, Taiwan
| | - Hsiang-Yin Chen
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan; Department of Pharmacy, Taipei Medical University-Wan Fang Medical Center, Taipei, Taiwan.
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Patient acceptability of and readiness-to-pay for pharmacy-based health membership plans to improve hypertension outcomes in Lima, Peru. Res Social Adm Pharm 2016; 13:589-601. [PMID: 27344393 DOI: 10.1016/j.sapharm.2016.05.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/28/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Pharmacies have been used to improve population health in Peru and other countries globally, operating as a non-traditional health access point. A pharmacy-based model holds potential to improve patient management of hypertension, a leading risk factor for non-communicable diseases in low- and middle-income countries. The aim of this study was to evaluate patient acceptability of hypertension services and health membership plans, if offered through private pharmacies in the future. METHODS A cross-sectional study was conducted with 347 hypertensive individuals who purchased anti-hypertensive medications in a private pharmacy during the study period (July-October 2012). The study included a brief survey assessing patients' acceptability of and readiness-to-pay for pharmacy-based hypertension management services. Chi-square tests for differences in proportions were used to evaluate whether any demographic characteristics (e.g., binary variables for age, time since diagnosis, and type of medication usually purchased) could identify groups of hypertensive individuals that might be more or less likely to use pharmacy-based services. Multiple logistic regression was used to estimate associations between readiness-to-pay for pharmacy-based health membership plans and patient-level characteristics. RESULTS Over 80% of individuals indicated they would be interested in pharmacy-based hypertension services, particularly discounts on anti-hypertensive medications and free blood pressure screenings. Compared to individuals 65 years of age or older, individuals under 65 years were more interested in receiving at least one pharmacy-based service. Another 80% indicated they would be interested in purchasing a monthly health plan through a pharmacy that provided access to hypertension services each month. The vast majority of individuals interested in pharmacy-based services indicated they would pay ≤$3.69 US/month to participate in a monthly health membership plan. CONCLUSIONS Hypertensive patients would be interested in using and ready to pay for pharmacy-based hypertension services.
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Conn VS, Ruppar TM, Chase JAD, Enriquez M, Cooper PS. Interventions to Improve Medication Adherence in Hypertensive Patients: Systematic Review and Meta-analysis. Curr Hypertens Rep 2016; 17:94. [PMID: 26560139 DOI: 10.1007/s11906-015-0606-5] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This systematic review applied meta-analytic procedures to synthesize medication adherence interventions that focus on adults with hypertension. Comprehensive searching located trials with medication adherence behavior outcomes. Study sample, design, intervention characteristics, and outcomes were coded. Random-effects models were used in calculating standardized mean difference effect sizes. Moderator analyses were conducted using meta-analytic analogues of ANOVA and regression to explore associations between effect sizes and sample, design, and intervention characteristics. Effect sizes were calculated for 112 eligible treatment-vs.-control group outcome comparisons of 34,272 subjects. The overall standardized mean difference effect size between treatment and control subjects was 0.300. Exploratory moderator analyses revealed interventions were most effective among female, older, and moderate- or high-income participants. The most promising intervention components were those linking adherence behavior with habits, giving adherence feedback to patients, self-monitoring of blood pressure, using pill boxes and other special packaging, and motivational interviewing. The most effective interventions employed multiple components and were delivered over many days. Future research should strive for minimizing risks of bias common in this literature, especially avoiding self-report adherence measures.
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Affiliation(s)
- Vicki S Conn
- School of Nursing, University of Missouri, S317 Sinclair Building, Columbia, MO, 65211, USA.
| | - Todd M Ruppar
- School of Nursing, University of Missouri, S423 Sinclair Building, Columbia, MO, 65211, USA
| | - Jo-Ana D Chase
- School of Nursing, University of Missouri, S343 Sinclair Building, Columbia, MO, 65211, USA
| | - Maithe Enriquez
- School of Nursing, University of Missouri, S327 Sinclair Building, Columbia, MO, 65211, USA
| | - Pamela S Cooper
- School of Nursing, University of Missouri, S318 Sinclair Building, Columbia, MO, 65211, USA
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