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Andala S, Sofyan H, Hasballah K, Marthoenis. Knowledge and acceptance associated with medication adherence among hypertension individuals in Aceh province, Indonesia. Heliyon 2024; 10:e29303. [PMID: 38617921 PMCID: PMC11015454 DOI: 10.1016/j.heliyon.2024.e29303] [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: 08/30/2023] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024] Open
Abstract
Low adherence to anti-hypertensive medication is observed among individuals in Aceh, the westernmost province of Indonesia. Since uncontrolled hypertension has the potential to develop into a life-threatening disease, exploring medication adherence among this specific population is essential. Therefore, this study aimed to evaluate knowledge and acceptance associated with medication adherence among hypertensive individuals in Aceh Province. A cross-sectional study was conducted from March to July 2023 on 534 respondents diagnosed with hypertension, who were selected using the random sampling method. Demographic characteristics collected included body height and weight, age, gender, education, ethnicity, and occupation. Acceptance and knowledge were measured through a set of standardized questionnaires while the Morisky Medication Adherence Scale-8 was used for evaluating medication adherence. Logistic regression with a multinomial model was used to assess the correlations of acceptance and knowledge with medication adherence. The results showed that only 28.5 % of the respondents had high adherence to anti-hypertensive medication. Furthermore, a high level of acceptance towards hypertension significantly predicted medication adherence (p < 0.001; OR = 9.14 [95%CI: 3.49-23.94]). Knowledge about dosing frequency, the benefits of low-fat and sodium diets, and the negative impacts of drinking alcohol were correlated with high-level adherence (p < 0.01). Meanwhile, knowledge about renal complications correlated negatively with adherence level (p = 0.002; OR = 0.32 [95%CI: 0.16-0.66]). In conclusion, this study showed that acceptance and knowledge of hypertension correlated with the level of medication adherence.
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Affiliation(s)
- Sri Andala
- Graduate School of Mathematics and Applied Sciences, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia
- STIKes Muhammadiyah Lhokseumawe, Lhokseumawe, 24300, Indonesia
- Dinas Kesehatan Kota Lhokseumawe, Lhokseumawe, 24300, Indonesia
| | - Hizir Sofyan
- Department of Statistics, Faculty of Math and Science, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia
| | - Kartini Hasballah
- Department of Pharmacology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia
| | - Marthoenis
- Department of Psychiatry and Mental Health Nursing, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia
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Oliveira HC, Hayashi D, Carvalho SDL, Barros RDCLD, Neves MLDS, Andrechuk CRS, Alexandre NMC, Ribeiro PAB, Rodrigues RCM. Quality of measurement properties of medication adherence instruments in cardiovascular diseases and type 2 diabetes mellitus: a systematic review and meta-analysis. Syst Rev 2023; 12:222. [PMID: 37993931 PMCID: PMC10664314 DOI: 10.1186/s13643-023-02340-z] [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: 07/14/2022] [Accepted: 08/29/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Medication adherence has a major impact on reducing mortality and healthcare costs related to the treatment of cardiovascular diseases and diabetes mellitus. Selecting the best patient-reported outcome measure (PROM) among the many available for this kind of patient is extremely important. This study aims to critically assess, compare and synthesize the quality of the measurement properties of patient-reported outcome measures to assess medication adherence among patients with cardiovascular diseases and/or type 2 diabetes mellitus. METHODS This review followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines and was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). The searches were performed in Web of Science, SCOPUS, PubMed, CINAHL, EMBASE, LILACS, PsycINFO, and ProQuest (gray literature). RESULTS A total of 110 records encompassing 27 different PROMs were included in the review. The included records were published between 1986 and 2023, most of which reported studies conducted in the United States and were published in English. None of the PROMs were classified in the category "a", thus being recommended for use due to the quality of its measurement properties. The PROMs that should not be recommended for use (category "c") are the MTA, GMAS, DMAS-7, MALMAS, ARMS-D, and 5-item questionnaire. The remaining PROMs, e.g., MMAS-8, SMAQ, MEDS, MNPS, ARMS-12, MGT, MTA-OA, MTA-Insulin, LMAS-14, MARS-5, A-14, ARMS-10, IADMAS, MAQ, MMAS-5, ProMAS, ARMS-7, 3-item questionnaire, AS, 12-item questionnaire, and Mascard were considered as having the potential to be recommended for use (category "b"). CONCLUSION None of the included PROMs met the criteria for being classified as trusted and recommended for use for patients with cardiovascular diseases and/or type 2 diabetes mellitus. However, 21 PROMs have the potential to be recommended for use, but further studies are needed to ensure their quality based on the COSMIN guideline for systematic reviews of PROMs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019129109.
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Affiliation(s)
- Henrique Ceretta Oliveira
- CEPSchool of Nursing - University of Campinas (Unicamp), 126 Tessália Vieira de Camargo Street, Campinas, São Paulo, 13083-887, Brazil.
| | - Daisuke Hayashi
- CEPSchool of Nursing - University of Campinas (Unicamp), 126 Tessália Vieira de Camargo Street, Campinas, São Paulo, 13083-887, Brazil
| | - Samantha Dalbosco Lins Carvalho
- CEPSchool of Nursing - University of Campinas (Unicamp), 126 Tessália Vieira de Camargo Street, Campinas, São Paulo, 13083-887, Brazil
| | - Rita de Cássia Lopes de Barros
- CEPSchool of Nursing - University of Campinas (Unicamp), 126 Tessália Vieira de Camargo Street, Campinas, São Paulo, 13083-887, Brazil
| | - Mayza Luzia Dos Santos Neves
- CEPSchool of Nursing - University of Campinas (Unicamp), 126 Tessália Vieira de Camargo Street, Campinas, São Paulo, 13083-887, Brazil
| | - Carla Renata Silva Andrechuk
- CEPSchool of Nursing - University of Campinas (Unicamp), 126 Tessália Vieira de Camargo Street, Campinas, São Paulo, 13083-887, Brazil
| | - Neusa Maria Costa Alexandre
- CEPSchool of Nursing - University of Campinas (Unicamp), 126 Tessália Vieira de Camargo Street, Campinas, São Paulo, 13083-887, Brazil
| | - Paula Aver Bretanha Ribeiro
- Research Centre of the Montreal University Hospital (CRCHUM), 850 Rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Roberta Cunha Matheus Rodrigues
- CEPSchool of Nursing - University of Campinas (Unicamp), 126 Tessália Vieira de Camargo Street, Campinas, São Paulo, 13083-887, Brazil
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Al Daccache M, Al-Shaar L, Sibai AM, Ismaeel H, Badr K, Nasreddine L. Psychosocial characteristics are associated with adherence to dietary, drugs and physical activity recommendations amongst cardiovascular disease patients in Lebanon. PLoS One 2023; 18:e0287844. [PMID: 37874832 PMCID: PMC10597531 DOI: 10.1371/journal.pone.0287844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/13/2023] [Indexed: 10/26/2023] Open
Abstract
Cardiovascular diseases are increasing at an alarming rate worldwide, reaching epidemic proportions in countries of the Eastern Mediterranean Region, including Lebanon. Despite the growing number of patients suffering from cardiovascular diseases in Lebanon, there is scarce data on whether cardiac patients adhere to therapeutic dietary guidelines, drug prescriptions, and physical activity recommendations and whether such adherence differs according to sociodemographic, lifestyle, or psychosocial characteristics. A cross-sectional study was conducted among 367 Lebanese adult cardiovascular disease patients admitted for hospitalization at various hospital sites in Lebanon. Electronic medical records and a multi-component questionnaire were used to collect information on patients' characteristics. Dietary assessment was performed using a culture-specific validated food frequency questionnaire, and physical activity levels were assessed using the international physical activity questionnaire (IPAQ). Mental well-being was assessed based on the validated five-item well-being index (WHO-5), and drug adherence was evaluated using the Morisky medication adherence scale (MMAS-8). The majority of the patients were males (67.8%), overweight or obese (74%), smokers (62.1%), and unemployed or retired (54.5%). Almost 35% of the patients were lonely, and nearly one fourth were at a high risk of poor mental health. Approximately 43%, 70%, and 52% of the patients were found to have poor adherence to diet, drug, and physical activity recommendations, respectively. A lower sense of mental well-being was a significant predictor of low dietary and drug adherence. Surprisingly, overweight and obesity were associated with higher odds of dietary adherence. Male gender was positively associated with physical activity while loneliness was inversely associated with physical activity. This study showed that adherence to diet, drug, and physical activity recommendations was low in this patient population and identified several non-clinical characteristics that may affect adherence. These findings highlighted the need for considering patients' psychosocial characteristics in the treatment of patients with cardiovascular diseases.
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Affiliation(s)
- Melodie Al Daccache
- Faculty of Agricultural and Food Sciences, Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
- Faculty of Health Sciences, Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Laila Al-Shaar
- Faculty of Medicine, Department of Public Health Sciences, Pennsylvania State University, State College, Pennsylvania, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Abla Mehio Sibai
- Faculty of Health Sciences, Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
| | - Hussain Ismaeel
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
- Medical Services, Aman Hospital, Doha, Qatar
| | - Kamal Badr
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
- Department of Internal Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Lara Nasreddine
- Faculty of Agricultural and Food Sciences, Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
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Korb-Savoldelli V, Tran Y, Perrin G, Touchard J, Pastre J, Borowik A, Schwartz C, Chastel A, Thervet E, Azizi M, Amar L, Kably B, Arnoux A, Sabatier B. Psychometric Properties of a Machine Learning-Based Patient-Reported Outcome Measure on Medication Adherence: Single-Center, Cross-Sectional, Observational Study. J Med Internet Res 2023; 25:e42384. [PMID: 37843891 PMCID: PMC10616746 DOI: 10.2196/42384] [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: 09/01/2022] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Medication adherence plays a critical role in controlling the evolution of chronic disease, as low medication adherence may lead to worse health outcomes, higher mortality, and morbidity. Assessment of their patients' medication adherence by clinicians is essential for avoiding inappropriate therapeutic intensification, associated health care expenditures, and the inappropriate inclusion of patients in time- and resource-consuming educational interventions. In both research and clinical practices the most extensively used measures of medication adherence are patient-reported outcome measures (PROMs), because of their ability to capture subjective dimensions of nonadherence. Machine learning (ML), a subfield of artificial intelligence, uses computer algorithms that automatically improve through experience. In this context, ML tools could efficiently model the complexity of and interactions between multiple patient behaviors that lead to medication adherence. OBJECTIVE This study aimed to create and validate a PROM on medication adherence interpreted using an ML approach. METHODS This cross-sectional, single-center, observational study was carried out a French teaching hospital between 2021 and 2022. Eligible patients must have had at least 1 long-term treatment, medication adherence evaluation other than a questionnaire, the ability to read or understand French, an age older than 18 years, and provided their nonopposition. Included adults responded to an initial version of the PROM composed of 11 items, each item being presented using a 4-point Likert scale. The initial set of items was obtained using a Delphi consensus process. Patients were classified as poorly, moderately, or highly adherent based on the results of a medication adherence assessment standard used in the daily practice of each outpatient unit. An ML-derived decision tree was built by combining the medication adherence status and PROM responses. Sensitivity, specificity, positive and negative predictive values (NPVs), and global accuracy of the final 5-item PROM were evaluated. RESULTS We created an initial 11-item PROM with a 4-point Likert scale using the Delphi process. After item reduction, a decision tree derived from 218 patients including data obtained from the final 5-item PROM allowed patient classification into poorly, moderately, or highly adherent based on item responses. The psychometric properties were 78% (95% CI 40%-96%) sensitivity, 71% (95% CI 53%-85%) specificity, 41% (95% CI 19%-67%) positive predictive values, 93% (95% CI 74%-99%) NPV, and 70% (95% CI 55%-83%) accuracy. CONCLUSIONS We developed a medication adherence tool based on ML with an excellent NPV. This could allow prioritization processes to avoid referring highly adherent patients to time- and resource-consuming interventions. The decision tree can be easily implemented in computerized prescriber order-entry systems and digital tools in smartphones. External validation of this tool in a study including a larger number of patients with diseases associated with low medication adherence is required to confirm its use in analyzing and assessing the complexity of medication adherence.
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Affiliation(s)
- Virginie Korb-Savoldelli
- Pharmacy Department, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris Cedex 15, France
- Clinical Pharmacy Department, Faculty of Pharmacy, Paris-Saclay University, Orsay, France
| | - Yohann Tran
- Clinical Research Unit, Université Paris Cité, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
- Clinical Investigation Center (CIC) 1418 Clinical Epidemiology, Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Germain Perrin
- Pharmacy Department, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris Cedex 15, France
- Health data- and model- driven Knowledge Acquisition (HeKA) Team, Institut National de la Santé et de la Recherche Médicale (INSERM) - (Institut National de Recherche en Informatique et en Automatique (INRIA), PariSanté Campus, Paris, France
| | - Justine Touchard
- Pharmacy Department, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris Cedex 15, France
| | - Jean Pastre
- Pulmonary Medecine and Intensive Care Department, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Adrien Borowik
- Pharmacy Department, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris Cedex 15, France
| | - Corine Schwartz
- Pharmacy Department, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris Cedex 15, France
| | - Aymeric Chastel
- Pharmacy Department, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris Cedex 15, France
| | - Eric Thervet
- Nephrology Department, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) - Unité Mixte de Recherche (UMR) 970 - Team 8, Paris Cardiovascular Research Center (PARCC), Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Michel Azizi
- Clinical Investigation Center (CIC) 1418 Clinical Epidemiology, Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- Hypertension Department, Reference Centre for Rare Vascular Disease, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Laurence Amar
- Clinical Investigation Center (CIC) 1418 Clinical Epidemiology, Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- Hypertension Department, Reference Centre for Rare Vascular Disease, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Benjamin Kably
- Clinical Investigation Center (CIC) 1418 Clinical Epidemiology, Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- Pharmacology Unit, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Armelle Arnoux
- Clinical Research Unit, Université Paris Cité, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
- Clinical Investigation Center (CIC) 1418 Clinical Epidemiology, Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- Health data- and model- driven Knowledge Acquisition (HeKA) Team, Institut National de la Santé et de la Recherche Médicale (INSERM) - (Institut National de Recherche en Informatique et en Automatique (INRIA), PariSanté Campus, Paris, France
| | - Brigitte Sabatier
- Pharmacy Department, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris Cedex 15, France
- Clinical Pharmacy Department, Faculty of Pharmacy, Paris-Saclay University, Orsay, France
- Health data- and model- driven Knowledge Acquisition (HeKA) Team, Institut National de la Santé et de la Recherche Médicale (INSERM) - (Institut National de Recherche en Informatique et en Automatique (INRIA), PariSanté Campus, Paris, France
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Gernier F, Grellard JM, Dupont C, Castel H, Fernette M, Lahaye F, Charles RM, Leroux T, Ory C, Faveyrial A, Morel A, Emile G, Levy C, Segura C, Allouache D, Johnson A, Geffrelot J, Gunzer K, Lelaidier A, Girault G, Dubot-Poitelon C, San C, Lequesne J, Clarisse B. Impact of web application support versus standard management on adherence with adjuvant hormone therapy in patients treated for breast cancer: the WEBAPPAC study. BMC Cancer 2023; 23:736. [PMID: 37559004 PMCID: PMC10413707 DOI: 10.1186/s12885-023-11242-1] [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: 04/17/2023] [Accepted: 07/31/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Non-metastatic breast cancer treatment is mainly based on surgery, with or without chemotherapy, radiotherapy and/or hormone therapy. To reduce the risk of hormone receptor positive (HR+) disease recurrence, hormone therapy is prescribed for at least 5 years. It may induce adverse drug reactions (ADRs) as joint pain, sexual dysfunction, weight increase, fatigue, mood disorders and vasomotor symptoms. Around 30-40% of patients withhold hormone therapy within 5 years after initiation. Based on encouraging results of mobile health in patient follow-up, we developed a web-application addressed for breast cancer patients initiating adjuvant hormonal therapy and aimed to assess its impact on hormone therapy adherence, ADRs management, and health-related quality of life. METHODS The WEBAPPAC trial is a randomized, open-label, prospective, single-center phase 3 study aiming to assess the interest of a web-application support as compared to standard management among breast cancer patients initiating hormone therapy. The main endpoint is the proportion of patients with hormone therapy adherence failure within 18 months after treatment start, in each arm. Eligible patients will be 1:1 randomized between the WEBAPPAC web-application support (experimental arm,) or standard support (control arm), with stratification on type of hormone therapy (Aromatase inhibitor or Tamoxifen). We plan to enroll 438 patients overall. Failure to hormone therapy will be assessed using the Morisky 8-item self-questionnaire (MMSA8), patient adherence logbook, and medical consultations. Secondary outcomes include hormone therapy adherence at 6 months, pain (Visual Analogue Scale and Brief Pain Inventory), quality of life (EORTC QLQ-C30 and BR23 self-questionnaires), anxiety and depression (Hospital and Depression Scale), and return to work and/or daily activities. The user experience with the WEBAPPAC web-application will be assessed using the System Usability Scale (SUS) questionnaire. DISCUSSION Hormone therapy discontinuation or adherence failure in breast cancer patients may be indirectly related to an increased risk of recurrence. A better control of medication adherence, through the detection of side effects and some proposed actions trying to reduce them, appears therefore essential to limit the risk of disease recurrence. The WEBAPPAC web-application thus aims better monitoring and allowing higher level of responsiveness in case of ADRs, thus improving treatment adherence. TRIAL REGISTRATION NCT04554927, registered September 18, 2020. PROTOCOL VERSION Version 2.1 dated from December 21, 2021.
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Affiliation(s)
- François Gernier
- Clinical Research Department, Centre François Baclesse, 3 avenue du Général Harris, Caen, 14000, France.
- ANTICIPE (Interdisciplinary Research Unit for the Prevention and Treatment of Cancer), INSERM Unit, Caen, 1086, France.
| | - Jean-Michel Grellard
- Clinical Research Department, Centre François Baclesse, 3 avenue du Général Harris, Caen, 14000, France
| | | | - Hervé Castel
- Clinical Research Department, Centre François Baclesse, 3 avenue du Général Harris, Caen, 14000, France
| | - Marie Fernette
- Clinical Research Department, Centre François Baclesse, 3 avenue du Général Harris, Caen, 14000, France
| | - François Lahaye
- Breast pathway nurse, Centre François Baclesse, Caen, France
| | | | - Tiphaine Leroux
- Breast pathway nurse, Centre François Baclesse, Caen, France
| | - Céline Ory
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Audrey Faveyrial
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Adeline Morel
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - George Emile
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Christelle Levy
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Carine Segura
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | | | - Alison Johnson
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Julien Geffrelot
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Katharina Gunzer
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Anaïs Lelaidier
- North-West Canceropole Data Center, Centre François Baclesse, Caen, France
| | - Gilles Girault
- Comprehensive Cancer Centre F. Baclesse, Medical Library, Caen, France
| | | | - Chankannira San
- Clinical Research Department, Centre François Baclesse, 3 avenue du Général Harris, Caen, 14000, France
| | - Justine Lequesne
- Clinical Research Department, Centre François Baclesse, 3 avenue du Général Harris, Caen, 14000, France
- ANTICIPE (Interdisciplinary Research Unit for the Prevention and Treatment of Cancer), INSERM Unit, Caen, 1086, France
| | - Bénédicte Clarisse
- Clinical Research Department, Centre François Baclesse, 3 avenue du Général Harris, Caen, 14000, France.
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Rotonda C, Guillemin F, Conroy T, Alleyrat C, Lefevre B, Soudant M, Tarquinio C. Validation and optimization of the French Generic Adherence for Chronic Diseases Profile (GACID-P) using classical test and item response theory. Health Qual Life Outcomes 2023; 21:49. [PMID: 37226180 DOI: 10.1186/s12955-023-02130-0] [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: 09/13/2022] [Accepted: 05/11/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND The Generic Adherence for Chronic Diseases Profile is a French generic scale (GACID-P) developed to measure adherence in several disease areas such as cardiology, rheumatology, diabetes, cancer and infectiology. METHOD We aimed to study the measurement invariance of the Generic Adherence for Chronic Diseases Profile by an item response model, optimize the new instrument version from item response model and qualitative content analyses results, and validate the instrument. The metric properties of the optimized version were studied according to classical test theory and item response model analysis. RESULTS A sample of 397 patients consulting at two French hospitals (in diabetes, cardiology, rheumatology, cancerology and infectiology) and in four private practices was recruited; 314 (79%) patients also completed the questionnaire 15 days later. Factor analyses revealed four dimensions: "Forgetting to take medication", "Intention to comply with treatment", "Limitation of risk-related consumer habits" and "Healthy lifestyle". The item response model and content analyses optimized these four dimensions, regrouping 32 items in four dimensions of 25 items, including one item conditioned on tobacco use. The psychometric properties and scale calibration were satisfactory. One score per dimension was calculated as the sum of the items for the dimensions "Forgetting to take medication" and "Intention to comply with treatment" and as a weighted score according to the item response model analysis for the two other dimensions because of differential item functioning found for two items. CONCLUSION Four adherence profile scores were obtained. The instrument validity was documented by a theoretical approach and content analysis. The Generic Adherence for Chronic Diseases Profile is now available for research targeting adherence in a broad perspective.
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Affiliation(s)
- Christine Rotonda
- Université de Lorraine, Centre Pierre Janet, Metz, F-57000, France.
- Université de Lorraine, APEMAC, équipe EPSAM, Metz, F-57000, France.
| | - F Guillemin
- CHRU Nancy, Inserm, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, F-54000, France
- Université de Lorraine, APEMAC, équipe MICS, Nancy, F-54000, France
| | - T Conroy
- Université de Lorraine, APEMAC, équipe MICS, Nancy, F-54000, France
- Institut de Cancérologie de Lorraine, Department of Medical Oncology, Vandoeuvre- lès-Nancy, F-54519, France
| | - C Alleyrat
- CHRU Nancy, Inserm, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, F-54000, France
| | - B Lefevre
- Institut de Cancérologie de Lorraine, Department of Medical Oncology, Vandoeuvre- lès-Nancy, F-54519, France
- CHRU-Nancy, Université de Lorraine, Service des Maladies Infectieuses et Tropicales, Nancy, F-54000, France
| | - M Soudant
- CHRU Nancy, Inserm, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, F-54000, France
| | - C Tarquinio
- Université de Lorraine, Centre Pierre Janet, Metz, F-57000, France
- Université de Lorraine, APEMAC, équipe EPSAM, Metz, F-57000, France
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7
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Gulayin PE, Beratarrechea A, Poggio R, Gibbons L, Nejamis A, Santero M, Rubinstein A, Irazola V. Blood Pressure Association with the 8-Item Morisky Medication Adherence Scale in Hypertensive Adults from Low-Resource Primary Care Settings: Results from a Prospective Cohort Nested within a Randomised Controlled Trial. High Blood Press Cardiovasc Prev 2023; 30:281-288. [PMID: 37199879 DOI: 10.1007/s40292-023-00580-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION One of the self-report adherence scales most widely used is the 8-item Morisky Medication Adherence Scale (MMAS-8). AIM To evaluate construct validity and reliability of the MMAS-8 in hypertensive adults from low-resource settings within the public primary care level in Argentina. METHODS Prospective data from hypertensive adults under antihypertensive pharmacological treatment that participated in the "Hypertension Control Program in Argentina" study was analyzed. Participants were followed at baseline, 6, 12 and 18 months. Based on MMAS-8, adherence was defined as low (score < 6), medium (score 6 to < 8) and high (score of 8). RESULTS 1214 participants were included in the analysis. In comparison to low adherence, high adherence category was associated with a reduction of - 5.6 mmHg (CI 95%: - 7.2; - 4.0) in systolic blood pressure (BP) and - 3.2 mmHg (CI 95%: - 4.2; - 2.2) in diastolic BP; and with a 56% higher likelihood to have controlled BP (p < .0001). Among those participants with baseline score ≤ 6, two points increase in MMAS-8 along follow-up showed a tendency to reduce BP in almost all-time points and a 34% higher likelihood of having controlled BP at the end of the follow-up (p = 0.0039). Cronbach's alpha total-item values in all time-points were higher than 0.70. CONCLUSIONS Higher MMAS-8 categories were positively associated with BP reduction and higher likelihood of BP control over time. Internal consistency was acceptable and in line with previous studies.
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Affiliation(s)
- Pablo Elías Gulayin
- Instituto de Efectividad Clínica y Sanitaria (IECS), Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina.
- Facultad de Ciencias Médicas (UNLP), La Plata, Argentina.
| | - Andrea Beratarrechea
- Instituto de Efectividad Clínica y Sanitaria (IECS), Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina
- Comisión Nacional de Investigaciones Científico Tecnológicas (CONICET), Buenos Aires, Argentina
| | - Rosana Poggio
- Instituto de Efectividad Clínica y Sanitaria (IECS), Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina
- Comisión Nacional de Investigaciones Científico Tecnológicas (CONICET), Buenos Aires, Argentina
| | - Luz Gibbons
- Instituto de Efectividad Clínica y Sanitaria (IECS), Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina
| | - Analía Nejamis
- Instituto de Efectividad Clínica y Sanitaria (IECS), Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina
| | - Marilina Santero
- Instituto de Efectividad Clínica y Sanitaria (IECS), Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina
| | - Adolfo Rubinstein
- Instituto de Efectividad Clínica y Sanitaria (IECS), Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina
- Comisión Nacional de Investigaciones Científico Tecnológicas (CONICET), Buenos Aires, Argentina
| | - Vilma Irazola
- Instituto de Efectividad Clínica y Sanitaria (IECS), Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina
- Comisión Nacional de Investigaciones Científico Tecnológicas (CONICET), Buenos Aires, Argentina
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8
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Sharma JR, Dludla PV, Dwivedi G, Johnson R. Measurement Tools and Utility of Hair Analysis for Screening Adherence to Antihypertensive Medication. Glob Heart 2023; 18:17. [PMID: 36968302 PMCID: PMC10038111 DOI: 10.5334/gh.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/16/2023] [Indexed: 03/29/2023] Open
Abstract
Poor adherence to the prescribed antihypertensive therapy is an understated public health problem and is one of the main causes of the high prevalence of uncontrolled hypertension in sub-Saharan Africa. Medication adherence is vital for the effectiveness of antihypertensive treatment and is key to ameliorating the clinical outcomes in hypertensive patients. However, it has often been ignored because the current methods used to assess medication adherence are not reliable, limiting their utilization in clinical practice. Therefore, the identification of the most accurate and clinically feasible method for measuring medication adherence is critical for tailoring effective strategies to improve medication adherence and consequently achieve blood pressure goals. This review not only explores various available methods for estimating medication adherence but also proposes therapeutic drug monitoring in hair for the measurement of medication adherence to the antihypertensive medication period.
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Affiliation(s)
- Jyoti R. Sharma
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa
| | - Phiwayinkosi V. Dludla
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa
| | - Girish Dwivedi
- Medical School, University of Western Australia, Harry Perkins Institute of Medical Sciences, Fiona Stanley Hospital, Verdun Street, Nedlands WA, 6009, Australia
| | - Rabia Johnson
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa
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9
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Yazie TS, Yimer YS, Belete AM, Desta GT. Prescribing pattern of anti-hypertensive medications among hypertensive outpatients at selected hospitals of South Gondar Zone, Amhara, Ethiopia: a hospital based cross sectional study. BMC Pharmacol Toxicol 2022; 23:97. [PMID: 36585734 PMCID: PMC9801638 DOI: 10.1186/s40360-022-00635-w] [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] [Received: 06/15/2022] [Accepted: 11/30/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Irrational prescription has a lion share for uncontrolled blood pressure. There is no study assessing prescription pattern among hypertensive patients at the study sites. Therefore, the objective of the current study was to evaluate prescription patterns for hypertension and blood pressure (BP) control at randomly selected hospitals of South Gondar Zone. METHODS A hospital based cross sectional study was conducted from December 1, 2020 to February 30, 2021. Hypertensive patients were selected by systematic random sampling proportionally from study hospitals. Structured questionnaires were used to collect socio-demographic chacteristics and adherence. Data abstraction form was used to collect prescription patterns, BP level and other necessary information. The association of prescription patterns and other variables with blood pressure control was determined by using binary logistic regression. RESULTS All recruited 423 patients were included in data analysis. Among prescriptions for hypertension, on average 93.5% were found to be in line with WHO guideline. About 53% of prescriptions for hypertension were monotherapies. Patient level low medication regimen complexity, and monotherapy were associated with blood pressure control (Ajusted Odds Ratio [AOR] = 2.04, [1.07-3.91]; AOR = 3.83 [1.42-10.35], respectively). Patients with inappropriate drug selection, and non-adherence were less likely to have controlled BP (AOR = 0.47 [0.26-0.85]; AOR = 0.52 [0.34-0.85], respectively). Moreover, patients who didn't have health insurance and follow regular aerobic exercise were less likely to have controlled BP (AOR = 0.42 [0.26-0.68]; AOR = 0.53 [0.32-0.88], respectively). CONCLUSION Diuretics were the most frequently prescribed drug in monotherapy and in combination with calcium channel blockers (CCBs) as dual therapy. On average, more than 90% of prescription was in accordance with WHO guideline and around one-third of participants experienced at least one moderate or major drug-drug interaction. Patient level low medication regimen complexity and monotherapy were positively associated with BP control whereas, non-adherence, inappropriate drug selection, having no health insurance, and didn't follow regular aerobic exercise were negatively associated with BP control. Clinicians should be adherent to treatment guidelines and focus on modifiable factors to improve BP control.
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Affiliation(s)
- Taklo Simeneh Yazie
- grid.510430.3Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | - Yohannes Shumet Yimer
- grid.510430.3Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | - Abebe Muche Belete
- grid.464565.00000 0004 0455 7818Department of Medicine, College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Amhara, Ethiopia
| | - Getaye Tessema Desta
- grid.510430.3Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
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10
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Al-Alaili MK, Abdi AM, Basgut B. Test performance of self-report adherence tools in patients with hypertension: A systematic review and a meta-analysis. J Clin Pharm Ther 2022; 47:1932-1944. [PMID: 36401121 DOI: 10.1111/jcpt.13805] [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: 08/10/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/20/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Adherence has proved to have a positive influence on achieving plausible treatment outcomes. Self-report questionnaires are widely used in evaluating adherence, creating thus a high-powered research field. This review aims to provide an update of scales used in hypertension, which are compared and analysed against reliability and validity. METHODS PubMed, Web of Science and Cochrane Library were searched in May 2022 to identify studies. We extracted the study characteristics and evaluated their quality. A random-effects model with subgroup analysis was used to calculate estimates and heterogeneity parameters as well as regressions, funnel and forest plots. A bivariate model was selected to conduct validity analyses and draw receiver operating characteristic (ROC) curves. RESULTS AND DISCUSSION Fifty-five articles were identified and classified into 22 different reliable and validated tools. Pooled analyses predicted an overall good Cronbach's alpha of 0.76 (95%CI:0.67-0.83), a good ICC of 0.8 (95%CI:0.72-0.86) and an excellent correlation coefficient of 0.91 (95%CI:0.86-0.95), which all showed high heterogeneity and slight detection of asymmetry. Regression analyses showed that only time and the number of items/scale type influenced significantly retest and alpha, respectively. Overall validity showed acceptable sensitivity of 0.65 (95%CI:0.53-0.75) and specificity of 0.57 (95%CI:0.47-0.67) with a good Area Under Curve (AUC) of 0.637. Upon comparison, four tools showed superiority over Morisky's scale. WHAT IS NEW AND CONCLUSION Adherence is a multi-dimensional phenomenon, which deems scales to be highly variable or complex; thus, complicating the selection process. Adherence to Refills and Medications Scale (ARMS) is the most promising free non-inferior alternative to Morisky, the most used scale.
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Affiliation(s)
| | - Abdikarim Mohamed Abdi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, Mersin, Turkey.,Department of Clinical Pharmacy, Faculty of Pharmacy, Yeditepe University, Ankara, Turkey
| | - Bilgen Basgut
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, Mersin, Turkey.,Department of Pharmacology, Faculty of Pharmacy, Başkent University, Ankara, Turkey
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11
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Lee EKP, Poon P, Yip BHK, Bo Y, Zhu MT, Yu CP, Ngai ACH, Wong MCS, Wong SYS. Global Burden, Regional Differences, Trends, and Health Consequences of Medication Nonadherence for Hypertension During 2010 to 2020: A Meta-Analysis Involving 27 Million Patients. J Am Heart Assoc 2022; 11:e026582. [PMID: 36056737 PMCID: PMC9496433 DOI: 10.1161/jaha.122.026582] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Nonadherence to antihypertensive medications is the leading cause of poor blood pressure control and thereby cardiovascular diseases and mortality worldwide. Methods and Results We investigated the global epidemiology, regional differences, and trend of antihypertensive medication nonadherence via a systematic review and meta‐analyses of data from 2010 to 2020. Multiple medical databases and clinicaltrials.gov were searched for articles. Observational studies reporting the proportion of patients with anti‐hypertensive medication nonadherence were included. The proportion of nonadherence, publication year, year of first recruitment, country, and health outcomes attributable to antihypertensive medication nonadherence were extracted. Two reviewers screened abstracts and full texts, classified countries according to levels of income and locations, and extracted data. The Joanna Briggs Institute prevalence critical appraisal tool was used to rate the included studies. Prevalence meta‐analyses were conducted using a fixed‐effects model, and trends in prevalence were analyzed using meta‐regression. The certainty of evidence concerning the effect of health consequences of nonadherence was rated according to Grading of Recommendations, Assessment, Development and Evaluations. A total of 161 studies were included. Subject to different detection methods, the global prevalence of anti‐hypertensive medication nonadherence was 27% to 40%. Nonadherence was more prevalent in low‐ to middle‐income countries than in high‐income countries, and in non‐Western countries than in Western countries. No significant trend in prevalence was detected between 2010 and 2020. Patients with antihypertensive medication nonadherence had suboptimal blood pressure control, complications from hypertension, all‐cause hospitalization, and all‐cause mortality. Conclusions While high prevalence of anti‐hypertensive medication nonadherence was detected worldwide, higher prevalence was detected in low‐ to middle‐income and non‐Western countries. Interventions are urgently required, especially in these regions. Current evidence is limited by high heterogeneity. Registration URL: www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021259860.
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Affiliation(s)
- Eric K P Lee
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Paul Poon
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Benjamin H K Yip
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Yacong Bo
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Meng-Ting Zhu
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Chun-Pong Yu
- Li Ping Medical Library The Chinese University of Hong Kong Shatin Hong Kong
| | - Alfonse C H Ngai
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Martin C S Wong
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Samuel Y S Wong
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
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12
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The Mediating Role of Spiritual Health in Adherence to Treatment in Patients with Cancer. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm-127820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Adherence to the treatment regimen is among the behaviors, which predict the successful control of the disease and decrease its intensity and negative consequences, which is influenced by several factors. The patient's beliefs and attitudes toward the disease are effective factors in disease management and adherence to treatment, and spiritual health is one of these influential variables. Objectives: The aim of this study was to determine the mediating role of spiritual health in adherence to treatment in patients with cancer. Methods: In this descriptive correlational study, the participants were 234 Iranian patients with cancer, who were selected through convenience sampling, admitted to the oncology wards of 9 selected teaching hospitals in the northern, southern, eastern, and western provinces of the country, as well as the capital in 2021. The research instruments included the Demographic and Clinical Information Questionnaire, Spiritual Well-Being Scale, and Morisky Medication Adherence Scale-8. The path analysis was done to determine the factors related to the degree of adherence to treatment, taking into account the mediating role of spiritual health. Results: The mean age of the participants in the study was 47.27 ± 15.36. The mean scores for spiritual health and adherence to treatment were 76.70 ± 13.75 and 6.47 ± 2.1, respectively. A positive and significant relationship was found between spiritual health and adherence to treatment (P-value < 0.05). The variables of marital status, the time of diagnosis, and being a religious person had a direct effect on spiritual health, and the time of diagnosis indirectly affected treatment adherence. Conclusions: According to the results, the level of spiritual health and adherence to the treatment in patients with cancer was moderate. In addition, the variable of diagnostic time affected adherence to treatment indirectly. Besides, in examining the factors affecting spiritual health, the findings indicated the effect of the variables “being religious”, “marital status”, and “the time of diagnosis”. In addition to strengthening spiritual health, it is necessary to highlight the need to follow therapeutic diets in these patients. Therefore, it is suggested to consider a program to meet the patients with cancer spiritual needs along with the physical care program.
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Barriers to up-titrated antihypertensive strategies in 12 sub-Saharan African countries: the Multination Evaluation of hypertension in Sub-Saharan Africa Study. J Hypertens 2022; 40:1411-1420. [PMID: 35762480 DOI: 10.1097/hjh.0000000000003169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sub-Saharan Africa (SSA) faces the highest rate of hypertension worldwide. The high burden of elevated blood pressure (BP) in black people has been emphasized. Guidelines recommend two or more antihypertensive medications to achieve a BP control. We aimed to identify factors associated with prescription of up-titrated antihypertensive strategies in Africa. METHODS We conducted a cross-sectional study on outpatient consultations for hypertension across 12 SSA countries. Collected data included socioeconomic status, antihypertensive drugs classes, BP measures, cardiovascular risk factors and complication of hypertension. We used ordinal logistic regression to assess factors associated with prescription of up-titrated strategies. RESULTS The study involved 2123 treated patients with hypertension. Patients received monotherapy in 36.3 vs. 25.9%, two-drug in 42.2 vs. 45% and three and more drugs strategies in 21.5 vs. 29.1% in low (LIC) and middle (MIC) income countries, respectively. Patients with sedentary lifestyle [OR 1.4 (1.11-1.77)], complication of hypertension [OR 2.4 (1.89-3.03)], former hypertension [OR 3.12 (2.3-4.26)], good adherence [OR 1.98 (1.47-2.66)], from MIC [OR 1.38 (1.10-1.74)] and living in urban areas [OR 1.52 (1.16-1.99)] were more likely to be treated with up-titrated strategies. Stratified analysis shows that in LIC, up-titrated strategies were less frequent in rural than in urban patients (P for trend <0.01) whereas such difference was not observed in MIC. CONCLUSION In this African setting, in addition to expected factors, up-titrated drug strategies were associated with country-level income, patient location and finally, the interplay between both in LIC. These results highlight the importance of developing policies that seek to make multiple drug classes accessible particularly in rural and LIC.
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14
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Lassale C, Gaye B, Diop IB, Mipinda JB, Kramoh KE, Kouam Kouam C, Ikama MS, Takombe JL, Damorou JM, Toure IA, Balde DM, Dzudie A, Houenassi M, Kane A, Kimbally-Kaki SG, Kingue S, Limbole E, Mfeukeu Kuate L, Ferreira B, Nhavoto C, Sidy Ali A, Azizi M, N'Guetta R, Antignac M, Jouven X. Use of traditional medicine and control of hypertension in 12 African countries. BMJ Glob Health 2022; 7:bmjgh-2021-008138. [PMID: 35654446 PMCID: PMC9163537 DOI: 10.1136/bmjgh-2021-008138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/14/2022] [Indexed: 11/26/2022] Open
Abstract
Background Use of traditional medicine (TM) is widespread in sub-Saharan Africa as a treatment option for a wide range of disease. We aimed to describe main characteristics of TM users and estimate the association of TM use with control of hypertension. Methods We used data on 2128 hypertensive patients of a cross-sectional study (convenience sampling), who attended cardiology departments of 12 sub-Saharan African countries (Benin, Cameroon, Congo, Democratic Republic of the Congo, Gabon, Guinea, Côte d’Ivoire, Mauritania, Mozambique, Niger, Senegal, Togo). To model association of TM use with odds of uncontrolled, severe and complicated hypertension, we used multivariable mixed logistic regressions, and to model the association with blood pressure (systolic (SBP) and diastolic (DBP)) we used mixed linear models. All models were adjusted for age, sex, wealth, adherence to hypertension conventional treatment and country (random effect). Results A total of 512 (24%) participants reported using TM, varying across countries from 10% in the Congo to 48% in Guinea. TM users were more likely to be men, living in rural area, poorly adhere to prescribed medication (frequently due to its cost). Use of TM was associated with a 3.87 (95% CI 1.52 to 6.22)/1.75 (0.34 to 3.16) mm Hg higher SBP/DBP compared with no use; and with greater odds of severe hypertension (OR=1.34; 95% CI 1.04 to 1.74) and of any hypertension complication (OR=1.27; 95% CI 1.01 to 1.60), mainly driven by renal complication (OR=1.57; 95% CI 1.07 to 2.29) after adjustment for measured confounders. Conclusions The use of TM was associated with higher blood pressure, more severe hypertension and more complications in Sub-Saharan African countries. The widespread use of TM needs to be acknowledged and worked out to integrate TM safely within the conventional healthcare.
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Affiliation(s)
- Camille Lassale
- Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute IMIM, Barcelona, Spain
- CIBER of Pathophysiology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Bamba Gaye
- Paris Cardiovascular Research Centre, INSERM U970, Université de Paris, Paris, France
- Cardiology department, University Hospital of Fann, Dakar, Senegal
- African Research Network, Dakar, Senegal
- Laboratoire de Physiologie et Explorations Fonctionnelles, Université Cheikh Anta Diop, Dakar, Senegal
| | | | - Jean Bruno Mipinda
- Cardiology department, Libreville University Hospital Center, Libreville, Komo-Mondah, Gabon
| | | | | | - Méo Stéphane Ikama
- Cardiology Department, National University Hospital of Brazzaville, Marien NGouabi University, Brazzaville, Congo
| | - Jean Laurent Takombe
- Department of Internal Medicine of la Gombe, Ngaliema Hospital, Kinshasa, Congo (the Democratic Republic of the)
| | | | - Ibrahim Ali Toure
- Internal Medicine and Cardiology Department, University Hospital of Lamorde Niamey University, Niamey, Niger
| | - Dadhi M Balde
- Department of Cardiology, University Hospital of Conakry, Conakry, Guinea
| | - Anastase Dzudie
- Cardiac Intensive Car & Cardiac Pacing Unit, Douala General Hospital, Douala, Cameroon
| | | | - Abdoul Kane
- Cardiology Department, University Hospital of Aristide Le Dantec, Dakar, Senegal
| | - Suzy Gisèle Kimbally-Kaki
- Cardiology Department, National University Hospital of Brazzaville, Marien NGouabi University, Brazzaville, Congo
| | - Samuel Kingue
- University of Yaoundé, Ministry of Public Health, Yaoundé, Cameroon
| | - Emmanuel Limbole
- Department of Internal Medicine of la Gombe, Ngaliema Hospital, Kinshasa, Congo (the Democratic Republic of the)
- Cardiology Department, University of Kinshasa Faculty of Medicine, Kinshasa, Congo (the Democratic Republic of the)
| | - Liliane Mfeukeu Kuate
- Internal Medecine Department, Regional Hospital, Bafoussam, Cameroon
- Cardiology Department, Central Hospital of Yaounde, Yaounde, Cameroon
| | | | | | | | - Michel Azizi
- Hypertension unit, Georges Pompidou European Hospital, AP-HP Centre, Paris, France
- INSERM, Centre d'Investigation Clinique 1418, Paris, France
- Cardiovascular Epidemiology Department, Université de Paris, Paris, France
| | | | - Marie Antignac
- Paris Cardiovascular Research Centre, INSERM U970, Université de Paris, Paris, France
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
| | - Xavier Jouven
- Paris Cardiovascular Research Centre, INSERM U970, Université de Paris, Paris, France
- Cardiovascular Epidemiology Department, Université de Paris, Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, Paris, France
- Paris-Sudden Death Expertise Center, Paris, France
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15
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Iranpour A, Sarmadi V, Alian Mofrad A, Mousavinezhad SA, Mousavinezhad SM, Mohammad Alizadeh F, Neshat S. The Persian version of the 8-item Morisky Medication Adherence Scale (MMAS-8): can we trust it? J Diabetes Metab Disord 2022; 21:835-840. [PMID: 35673439 DOI: 10.1007/s40200-022-01047-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/03/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022]
Abstract
Background Diabetes mellitus (DM) is a common serious health problem. Medication adherence is a crucial determinant of therapeutic success in patients with diabetes mellitus. This study aims to examine the 8-item Morisky Medication Adherence Scale (MMAS-8) psychometric properties among diabetic patients. Methods This study was carried out at the Internal Medicine clinic of Firooz Abadi Hospital in Tehran, Iran, from 2018 to 2020. The English version of the MMAS-8 was translated into Persian and administered to patients with diabetes mellitus. A total of 150 patients who had diabetes were included. Cronbach's alpha was calculated to assess the reliability. Results According to the recommended scoring method, the Mean ± SD of MMAS-8 scores was 4.97 ± 1.92. Good internal consistency was found in our study (Cronbach's α = 0.70). Not any significant relationship between MMAS-8 categories and occurrence of complications was found. Conclusions The findings of this validation study indicate that the Persian version of the MMAS-8 is a reliable measure of medication adherence, but it has not acceptable validity. Further studies are needed to reach a good validity.
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Affiliation(s)
- Aida Iranpour
- Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Vida Sarmadi
- Isfahan University of Medical Sciences, 81746- 73461 Isfahan, Iran
| | - Arshia Alian Mofrad
- Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Sina Neshat
- Isfahan University of Medical Sciences, 81746- 73461 Isfahan, Iran
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Shen B, Guan T, Du X, Pei C, Zhao J, Liu Y. Medication Adherence and Perceived Social Support of Hypertensive Patients in China: A Community-Based Survey Study. Patient Prefer Adherence 2022; 16:1257-1268. [PMID: 35610983 PMCID: PMC9124465 DOI: 10.2147/ppa.s363148] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/13/2022] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Previous studies suggested perceived social support has impact on medication adherence among hypertensive patients, but did not simultaneously elucidate the different contents or key providers of social support that patients perceived. This study was to identify the contents and providers of perceived social support beneficial for improving medication adherence among hypertensive patients in China, which could prove important for targeted interventions. PATIENTS AND METHODS Following a multi-stage stratified sampling framework, a total of 903 hypertensive patients from 12 primary health institutions across a middle-income city were recruited from April to June 2021. Medication adherence was measured using the Chinese version of the Morisky, Green and Levine scale; perceived social support was determined using the name generator method. A binary logistic regression model was performed to identify the association between medication adherence and perceived social support. The contents of support included informational, emotional, and instrumental support (finances and caregiving). The support providers included spouse/partner, children, parents, siblings, other relatives, and friends. RESULTS A total of 506 (56.04%) patients optimally adhered to their antihypertensive medication. Female, older, urban patients, patients with shorter duration of hypertension and antihypertensive medications used showed better adherence (P<0.05). Optimal medication adherence was positively associated with the overall score of caregiving support (adjusted odds ratio [AOR] = 1.128; 95% confidence interval [CI] = [1.013-1.257]), informational support from the spouse/partner (AOR = 1.574; 95% CI = [1.112-2.227]), emotional support from the spouse/partner (AOR = 1.430; 95% CI = [1.032-1.981]), financial support from the spouse/partner (AOR = 1.439; 95% CI = [1.069-1.937]) and caregiving support from the spouse/partner (AOR = 1.652; 95% CI = [1.130-2.414]), whereas optimal medication adherence was negatively associated with caregiving support from friends (AOR = 0.499; 95% CI = [0.286-0.872]). CONCLUSION Informational, emotional, financial and caregiving support from spouses/partners have positive impacts on optimal medication adherence of hypertensive patients of community-level. Community-based interventions designed to improve medication adherence of hypertensive patients should target both patients and their spouses/partners; spouses/partners could be encouraged to provide various support to improve the medication adherence of hypertensive patients.
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Affiliation(s)
- Bingjie Shen
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Tianjia Guan
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Xinyu Du
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Chenyang Pei
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Jinhong Zhao
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- Correspondence: Yuanli Liu, School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, 46 Xizongbu Hutong, Dongcheng District, Beijing, 100005, People’s Republic of China, Tel +86 13522592907, Fax +86 10 65105830, Email
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17
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Poinard S, Garcin T, Trone MC, Mentek M, Lambert C, Bonjean P, Renault D, Thuret G, Gain P, Gauthier AS. Objective measurement of adherence to topical steroid medication after penetrating keratoplasty using an electronic monitoring aid: A pilot study. Digit Health 2022; 8:20552076221121155. [PMID: 36133001 PMCID: PMC9483967 DOI: 10.1177/20552076221121155] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives Corneal transplantation is the most common transplant worldwide and its
success critically depends on the management of corneal graft rejection
through topical steroid therapy during the first 12 months after surgery.
There is currently no published data on adherence after keratoplasty. This
pilot study aims to explore the adherence to topical steroid after
penetrating keratoplasty using a smart electronic device. Methods Thirty patients undergoing penetrating keratoplasty were included to evaluate
the adherence to topical dexamethasone medication for 12 months after
surgery. Patients received the usual post-transplantation treatment (topical
dexamethasone) and follow-up after surgery (day 15, months 1, 2, 3, 4, 5, 6,
9, and 12). Adherence to treatment was monitored using the KaliJAR device
(Kali Care, Santa Clara, CA, USA), which recorded the number of single-dose
units (SDU) discarded. At control visits, data recorded by the device were
compared to the manually count of SDU. Adherence ratio and individual
adherence curve were explored for all patients. Results Data from 27 patients showed a high agreement between adherence ratio
calculated based on the device data and obtained from manual counting of the
discarded SDU (intraclass coefficient correlation of 0.87 [95% CI:
0.738–0.938]). Mean adherence to the treatment over the 12-month study
period was 95.2 ± 4%. Conclusions Adherence to topical dexamethasone for 12 months after corneal
transplantation was high. The connected device was able to record accurately
the discarded SDU. This approach would be a particular interest in the early
identification and personalized follow-up of poorly adherent patients.
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Affiliation(s)
- Sylvain Poinard
- Corneal Graft Biology, Engineering and Imaging Laboratory, Jean Monnet University, Saint-Etienne, France
- Ophthalmology Department, University Hospital, Saint-Etienne, France
| | - Thibaud Garcin
- Corneal Graft Biology, Engineering and Imaging Laboratory, Jean Monnet University, Saint-Etienne, France
- Ophthalmology Department, University Hospital, Saint-Etienne, France
| | - Marie-Caroline Trone
- Corneal Graft Biology, Engineering and Imaging Laboratory, Jean Monnet University, Saint-Etienne, France
- Ophthalmology Department, University Hospital, Saint-Etienne, France
| | - Marielle Mentek
- Corneal Graft Biology, Engineering and Imaging Laboratory, Jean Monnet University, Saint-Etienne, France
| | - Charles Lambert
- Ophthalmology Department, University Hospital, Saint-Etienne, France
| | - Paul Bonjean
- Ophthalmology Department, University Hospital, Saint-Etienne, France
| | - Didier Renault
- Corneal Graft Biology, Engineering and Imaging Laboratory, Jean Monnet University, Saint-Etienne, France
| | - Gilles Thuret
- Corneal Graft Biology, Engineering and Imaging Laboratory, Jean Monnet University, Saint-Etienne, France
- Ophthalmology Department, University Hospital, Saint-Etienne, France
| | - Philippe Gain
- Corneal Graft Biology, Engineering and Imaging Laboratory, Jean Monnet University, Saint-Etienne, France
- Ophthalmology Department, University Hospital, Saint-Etienne, France
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18
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Cavagna P, Takombe JL, Damorou JM, Kouam Kouam C, Diop IB, Ikama SM, Kramoh KE, Ali Toure I, Balde D, Dzudie A, Ferreira B, Houenassi M, Kane A, Kimbally-Kaki SG, Kingue S, Limbole E, Mfeukeu Kuate L, Mipinda JB, N'Guetta R, Nhavoto C, Sidy Ali A, Gaye B, Tajeu GS, Macquart De Terline D, Perier MC, Azizi M, Jouven X, Antignac M. Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT study. BMJ Open 2021; 11:e049632. [PMID: 34857562 PMCID: PMC8640662 DOI: 10.1136/bmjopen-2021-049632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE In Africa, the number of patients with hypertension is expected to reach 216.8 million by 2030. Large-scale data on antihypertensive medications used in Sub-Saharan Africa (SSA) are scarce.Here, we describe antihypertensive drug strategies and identify treatment factors associated with blood pressure (BP) control in 12 Sub-Saharan countries. SETTING Outpatient consultations for hypertension in urban tertiary cardiology centres of 29 hospitals from 17 cities across 12 SSA countries between January 2014 and November 2015. PARTICIPANTS Patients ≥18 years of age with hypertension were enrolled at any visit during outpatient consultations in the cardiology departments MAIN OUTCOME MEASURE: We collected BP levels, demographic characteristics and antihypertensive treatment use (including traditional medicine) of patients with hypertension attending outpatient visits. BP control was defined as seated office BP <140/90 mm Hg. We used logistic regression with a random effect on countries to assess factors of BP control. RESULTS Overall, 2198 hypertensive patients were included and a total of 96.6% (n=2123) were on antihypertensive medications. Among treated patients, 653 (30.8%) patients received a monotherapy by calcium channel blocker (n=324, 49.6%), renin-angiotensin system blocker (RAS) (n=126, 19.3%) or diuretic (n=122, 18.7%). Two-drug strategies were prescribed in 927 (43.6%) patients including mainly diuretics and RAS (n=327, 42% of two-drug strategies). Prescriptions of three-drugs or more were used in 543 (25.6%) patients. Overall, among treated patients, 1630 (76.7%) had uncontrolled BP, of whom 462 (28.3%) had BP levels ≥180/110 mm Hg, mainly in those on monotherapy. After adjustment for sociodemographic factors, the use of traditional medicine was the only factor significantly associated with uncontrolled BP (OR 1.72 (1.19 to 2.49) p<0.01). CONCLUSION Our study provided large-scale data on antihypertensive prescriptions in the African continent. Among patients declared adherent to drugs, poor BP control was significantly associated with the use of traditional medicine.
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Affiliation(s)
- Pauline Cavagna
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
| | - Jean Laurent Takombe
- Department of Internal Medicine, General Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Stephane Méo Ikama
- Cardiology, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville, Congo
| | - Kouadio Euloge Kramoh
- Cardiology, Institute of Cardiology of Abidjan (Côte d'Ivoire), BPV 206, abidjan, Côte d'Ivoire
| | - Ibrahim Ali Toure
- Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niamey, Niger
| | - Dadhi Balde
- Cardiology, University Hospital of Conakry, Conakry, Guinea
| | - Anastase Dzudie
- Cardiac Intensive Care & Cardiac Pacing Unit, Douala General Hospital, Douala, Cameroon
| | | | - Martin Houenassi
- National University Hospital of Hubert K. MAGA (CNHU-HKM), Cotonou, Benin
| | - Adama Kane
- Cardiology, St Louis Hospital, Dakar, Senegal
| | - Suzy Gisele Kimbally-Kaki
- Cardiology, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville, Congo
| | - Samuel Kingue
- University of Yaoundé, Ministry of Public Health, Yaoundé, Cameroon
| | - Emmanuel Limbole
- Cardiology, University of Medicine of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Department of Internal Medicine of la Gombe (CMCG), Department of Internal Medicine, Ngaliema Hospital, Kinshasa, Democratic Republic of the Congo
| | | | | | - Roland N'Guetta
- Cardiology, Institute of Cardiology of Abidjan (Côte d'Ivoire), BPV 206, abidjan, Côte d'Ivoire
| | | | | | - Bamba Gaye
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
| | - Gabriel S Tajeu
- Department of Health Services Administration Cardiology Clinics and Policy, Temple University, Philadelphia, Pennsylvania, USA
| | - Diane Macquart De Terline
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
| | | | - Michel Azizi
- Hypertension Unit, European Georges Pompidou Hospital, AP-HP Centre, Paris, France
- INSERM, Centre d'Investigation Clinique 1418, Paris, France
- Cardiovascular epidemiology department, University of Paris, Paris, France
| | - Xavier Jouven
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
- Cardiovascular epidemiology department, University of Paris, Paris, France
- Cardiology, European Georges Pompidou Hospital, AP-HP Centre, Paris, France
| | - Marie Antignac
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
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19
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Willoughby M, Weinberger AH, Shuter J, Seng EK. Pain and medication adherence in adult cigarette smokers living with HIV: a cross-sectional observational study. AIDS Care 2021; 33:1422-1429. [PMID: 33233919 PMCID: PMC8144233 DOI: 10.1080/09540121.2020.1849530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
The present study examines relationships between pain, mental health symptoms, and medication adherence in adult smokers living with HIV. Sixty-eight adult HIV-positive smokers taking antiretroviral medication completed a survey measuring medication adherence, mental health symptoms, and pain. The presence of pain, OR = 3.81, 95% CI (1.19, 12.14), higher pain severity, OR = 1.22, 95% CI (1.05, 1.41), and higher anxiety, OR = 1.09, 95% CI (1.03, 1.14) were associated with inferior medication adherence (MMAS-8 score <6). Anxiety mediated the relationships between presence of pain (ab = .56, BCa CI (0.05, 1.61)) and pain severity (ab = .09, BCa CI (0.01, 0.24)) and medication adherence. The results of this study suggest that pain and anxiety are factors that significantly contribute to medication nonadherence and thus are important areas of assessment by clinicians treating adult smokers living with HIV.
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Affiliation(s)
- Melody Willoughby
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York USA
- Counseling and Psychological Services, The College of New Jersey, Ewing, New Jersey, USA
| | - Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York USA
| | - Jonathan Shuter
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York USA
- AIDS Center and Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York USA
| | - Elizabeth K. Seng
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York USA
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York USA
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20
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Jacquelet E, Poujois A, Pheulpin MC, Demain A, Tinant N, Gastellier N, Woimant F. Adherence to treatment, a challenge even in treatable metabolic rare diseases: A cross sectional study of Wilson's disease. J Inherit Metab Dis 2021; 44:1481-1488. [PMID: 34480375 DOI: 10.1002/jimd.12430] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/26/2021] [Accepted: 09/01/2021] [Indexed: 11/09/2022]
Abstract
Wilson's disease (WD), a rare genetic disorder responsible for copper accumulation in the body, is fatal if left untreated. Although there are effective treatments, adherence to treatment tends to be low. We evaluated the medication adherence of 139 patients using the Morisky scale. Adherence was correlated with age at diagnosis and at inclusion in the study, the form of the disease, the treatment, the duration of treatment, delivery and storage problems, depression, anxiety, the level of education, and the biological data. 32.4% of the patients had low adherence; their levels of exchangeable copper were significantly higher than those of the patients with high or medium adherence (P = .049). The average age of the patients at the time of the study was significantly higher in those with high adherence than in those with medium or low adherence (P = .043). 75.9% of the patients with high adherence had a neurological form and 26.7% of the patients with low adherence were asymptomatic (P = .0090). The duration of treatment was significantly longer in the patients with high adherence than in those with medium or low adherence (P = .0192). The type of treatment (chelators or zinc) had no impact on the level of adherence. Forty-four percent of the patients experienced problems dispensing and storing medications. Despite the availability of effective treatments for this rare disease, adherence problems occur with Wilson's disease in particular in asymptomatic patients. Although different factors are involved, sustained multidisciplinary management on a case-by-case basis is necessary.
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Affiliation(s)
- Elodie Jacquelet
- Department of Neurology, Lariboisière University Hospital, AP-HP, Paris, France
- Department of Neurology, National Reference Centre for Wilson's Disease, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Aurelia Poujois
- Department of Neurology, National Reference Centre for Wilson's Disease, Hôpital Fondation Adolphe de Rothschild, Paris, France
- Department of Neurology, Rothschild Foundation Hospital, Paris, France
| | | | - Adèle Demain
- Department of Neurology, Lariboisière University Hospital, AP-HP, Paris, France
- Department of Neurology, National Reference Centre for Wilson's Disease, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Nadège Tinant
- Department of Neurology, Lariboisière University Hospital, AP-HP, Paris, France
- Department of Neurology, National Reference Centre for Wilson's Disease, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Nathalie Gastellier
- Department of Neurology, Lariboisière University Hospital, AP-HP, Paris, France
| | - France Woimant
- Department of Neurology, Lariboisière University Hospital, AP-HP, Paris, France
- Department of Neurology, National Reference Centre for Wilson's Disease, Hôpital Fondation Adolphe de Rothschild, Paris, France
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21
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Solano M, Daguindau E, Faure C, Loriod P, Pain C, Maes AC, Marguet P, Kroemer M, Rumpler A, Fontan J, Deconinck E, Limat S, Clairet AL. Oral therapy adherence and satisfaction in patients with multiple myeloma. Ann Hematol 2021; 100:1803-1813. [PMID: 33938996 DOI: 10.1007/s00277-021-04543-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
The transition to oral therapies in patients with multiple myeloma (MM) offers potential benefits to patients; however, they must self-manage their medication and adherence plays an important role in patient care. It has been shown that patient satisfaction with their medication has a strong positive correlation with adherence in chronic diseases. The aim of this study was to estimate adherence rate of oral antimyeloma therapies and to identify risk factors for medication non-adherence. This observational, prospective, and multicentre survey based on a self-report questionnaire enrolled MM patients with at least 3 months of oral therapy. The 6-item Girerd scale and the medication possession ratio (MPR) were used for measuring medication adherence and the SATMED-Q® questionnaire was used for measuring satisfaction. An analysis of risk factors for non-adherence to oral therapy was performed using univariate analysis. A total of 101 patients participated in the survey, yielding a response rate of 87%. The prevalence of adherence to oral antimyeloma therapy was estimated at 51.5% using the Girerd questionnaire. According to the MPR, adherence was evaluated at 96% (i.e. MPR ≥ 0.80). Both methods combined, adherence was estimated at 50.5%. One risk factor for medication non-adherence was identified: Eastern Cooperative Oncology Group Performance Status > 2 (p = 0.007). One predictive factor for high medication adherence was identified: high satisfaction with treatment (p = 0.01). Identifying patients at higher risk for non-adherence allows clinical pharmacists to personalise therapeutic information and education and to improve the quality of healthcare overall.
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Affiliation(s)
- Marine Solano
- Pharmacy Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France.
| | - Etienne Daguindau
- Hematology Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France.,Interaction Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR 1098, Besançon, France
| | - Cyril Faure
- Internal Medicine Department, Groupe Hospitalier de La Haute-Saône, Hospital of Haute Saone, Vesoul, France
| | - Pierre Loriod
- Hematology Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France
| | - Coline Pain
- Pharmacy Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France
| | - Anne-Cécile Maes
- Internal Medicine Department, Groupe Hospitalier de La Haute-Saône, Hospital of Haute Saone, Vesoul, France
| | - Pauline Marguet
- Pharmacy Department, Centre Hospitalier Général Louis Pasteur, Hospital of Dole, Dole, France
| | - Marie Kroemer
- Pharmacy Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France.,Interaction Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR 1098, Besançon, France
| | - Anne Rumpler
- Hematology Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France
| | - Jean Fontan
- Hematology Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France
| | - Eric Deconinck
- Hematology Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France.,Interaction Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR 1098, Besançon, France
| | - Samuel Limat
- Pharmacy Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France.,Interaction Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR 1098, Besançon, France
| | - Anne-Laure Clairet
- Pharmacy Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France.,Interaction Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR 1098, Besançon, France
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22
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Laghousi D, Rezaie F, Alizadeh M, Asghari Jafarabadi M. The eight-item Morisky Medication Adherence Scale: validation of its Persian version in diabetic adults. CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 12:77-83. [PMID: 33680402 PMCID: PMC7919181 DOI: 10.22088/cjim.12.1.77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: Adherence to treatment is an important factor in the management of diabetic patients. The aim of this study was to examine the psychometric properties of the 8-item Morisky Medication Adherence Scale (MMAS-8) among type 2 diabetes. Methods: This study carried out in Family Medicine Clinics (FMCs) in Tabriz, North West of Iran from May to September 2018. A total of 320 patients suffering from Type 2 diabetes were included. Content and face validity of the Persian version of MMAS-8 were quantitatively evaluated. The Cronbach's alpha and intra-class correlation (ICC) were calculated to assess the reliability. Exploratory factor analysis (EFA) was used to assess the construct validity of the questionnaire. Results: Content and face validity of the Persian version of MMAS-8 were confirmed. Good internal consistency (Cronbach’s a = 0.83) and test–retest reliability (ICC= 0.87, P<0.001) were found. According to the results of the EFA, Persian version of MMAS-8 among diabetic patients had two dimensions: stopping to take medication due to the forgetfulness and for reasons other than forgetfulness. Conclusion: The Persian version of the MMAS-8 is a high valid and reliable questionnaire to screen medication adherence of Persian-speaking patients with diabetes.
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Affiliation(s)
- Delara Laghousi
- Social Determinant of Health Research Center, Health Management and Safety Promotion Research institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fereshteh Rezaie
- Department of Community and Family Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahasti Alizadeh
- Social Determinant of Health Research Center, Health Management and Safety Promotion Research institute, Tabriz University of Medical Sciences, Tabriz, Iran
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23
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Suciu L, Suciu M, Voicu M, Mureșan R, Pârv FV, Buda V, Cristescu C. Factors Influencing Adherence to Treatment and Quality of Life for a Group of Patients with Essential Hypertension in Romania. Patient Prefer Adherence 2021; 15:483-491. [PMID: 33679131 PMCID: PMC7926037 DOI: 10.2147/ppa.s269119] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/19/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Romania has a high prevalence of hypertension (45.1% in 2016). Whether this is attributable to a low rate of treatment adherence-which can aggravate the pathology and reduce patients' quality of life (QoL)-is unknown. To address this point, the present study investigated the factors that influence short- and long-term adherence and QoL in patients with arterial hypertension using a specially designed questionnaire. PATIENTS AND METHODS The study enrolled 289 patients at different stages of hypertension with or without comorbidities. The diagnosis of hypertension was established by the cardiologist, and treatment regimens were communicated by patients to the clinical pharmacist who administered the questionnaire, which comprised 7 domains with variable numbers of items. RESULTS The majority of surveyed patients (57.43%) considered that their capacity for effort was decreased because of their hypertension, with 65.05% reporting that they were affected by symptoms associated with high blood pressure (eg, headache and dizziness). Most patients (71.28%) understood the consequences of discontinuing their medication and the severe complications of hypertension, and 69.55% indicated that they would not stop treatment if they experienced side effects. For 53.28% of patients, social activity was significantly affected by their condition. Only 47.05% of patients underwent regular mandatory medical examinations and 55.36% periodically monitored their blood pressure at home. A regression analysis revealed correlations between specific questionnaire items and patient characteristics. CONCLUSION Nonpharmacologic factors that were shown to influence patients' adherence to treatment and QoL included the level of health education and knowledge of disease complications, self-monitoring of hypertension, and consultation with medical and pharmaceutical healthcare providers regarding hypertension and its treatment.
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Affiliation(s)
- Liana Suciu
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, University of Medicine and Pharmacy Victor Babeș, Timisoara, Romania
| | - Maria Suciu
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, University of Medicine and Pharmacy Victor Babeș, Timisoara, Romania
| | - Mirela Voicu
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, University of Medicine and Pharmacy Victor Babeș, Timisoara, Romania
- Correspondence: Maria Suciu; Mirela Voicu Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, University of Medicine and Pharmacy Victor Babeș, Eftimie Murgu Square, No. 1-3, Timișoara, RomâniaTel +40723319050; +40745763424 Email ;
| | - Raluca Mureșan
- Department of Mathematics, Faculty of Mathematics and Informatics, West University, Timisoara, Romania
| | - Florina Viorica Pârv
- Department of Cardiology, Faculty of Medicine, University of Medicine and Pharmacy Victor Babeș, Timișoara, Romania
| | - Valentina Buda
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, University of Medicine and Pharmacy Victor Babeș, Timisoara, Romania
| | - Carmen Cristescu
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, University of Medicine and Pharmacy Victor Babeș, Timisoara, Romania
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Senbel E, Tropé S, Herman-Demars H, Zinovieva E, Courbeyrette A, Clerson P, Fardini Y, Flipo RM. Benefits of Switch from Oral to Subcutaneous Route on Adherence to Methotrexate in Patients with Rheumatoid Arthritis in Real Life Setting. Patient Prefer Adherence 2021; 15:751-760. [PMID: 33888978 PMCID: PMC8055372 DOI: 10.2147/ppa.s301010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/13/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of the APRIM study (for Adherence Polyarthrite Rhumatoïde Injection Methotrexate) was to investigate the change in treatment adherence of patients with rheumatic arthritis (RA) who switched from oral to subcutaneous methotrexate (MTX). PATIENTS AND METHODS Prospective, observational study in RA patients treated with MTX and switching from oral to subcutaneous (SC) route in real-life conditions. Data on motivations for switch, disease activity (DAS28-CRP), quality of life (AISM-2 SF), disability (HAQ-DI), and adherence to MTX were collected at inclusion (M0) and 6 months later (M6). Adherence was assessed by the 8-item Morisky Medication Adherence Scale (MMAS-8) and defined as high (MMAS-8 = 8), medium (MMAS-8 = 6 or ≤8) or low (MMAS-8 < 6). The primary evaluation criterion was the proportion of patients who maintained strong adherence or improved adherence by at least one category (from low to medium or strong or from medium to strong) between M0 and M6. RESULTS The analysis involved 207 patients (age 60.4±12.7 years, 75.2% females). 6.7% were in remission and 15.5% had low disease activity (LDA) at baseline. 58.5% reached the primary criterion and strong adherence rate increased from 42.0% to 50.7%. Change of route was combined with increased MTX dose in 34.8% of patients. Switch to SC route increased the proportion of patients with remission or LDA from 22.8% to 52.9% and increased quality of life even in patients with unchanged MTX dose. CONCLUSION Overall, change from oral to SC route improved adherence to MTX, RA control and quality of life independently of change in MTX dose.
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Affiliation(s)
| | - Sonia Tropé
- French National Patient Organization Against Rheumatoid Arthritis (ANDAR), Montpellier, France
| | | | | | | | | | - Yann Fardini
- Soladis Clinical Studies, Roubaix, France
- Correspondence: Yann Fardini Soladis Clinical Studies, 15 Boulevard Du Général Leclerc, Roubaix, 59100, FranceTel +33 6 46 32 95 85Fax +33 3 28 09 94 76 Email
| | - René-Marc Flipo
- University of Lille, Rheumatology Department, Hôpital Roger Salengro, Lille, France
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25
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Martin-Latry K, Latry P, Pucheu Y, Couffinhal T. [Hospital medication adherence scale development in cardiovascular disorders]. ANNALES PHARMACEUTIQUES FRANÇAISES 2020; 79:457-464. [PMID: 33309605 DOI: 10.1016/j.pharma.2020.11.008] [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: 02/11/2020] [Revised: 11/17/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The consequences of non-adherence to prescribed cardiovascular drugs can be serious, with cardiovascular complications having been reported in both secondary and primary prevention. The objective of this study was to develop a new scale to assess medication adherence in patients with cardiovascular diseases during their hospitalization. METHODS A cohort of 219 high risk cardiovascular patients was evaluated for this study. Data on reasons for non-adherence were collected using the newly developed Medication Adherence Scale in Cardiovascular disorders (Mascard) and compared with physician assessment during medical consultations and the control of their cardiovascular risk factors. RESULTS The Mascard consists of 5 items has good psychometric properties and validity and correlated with physician assessment and control of cardiovascular risk factors. CONCLUSIONS This rapid and easy to use scale may be useful for health care practitioners in their assessment of medication adherence in inpatients with cardiovascular disorders.
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Affiliation(s)
- K Martin-Latry
- CHU de Bordeaux, Centre d'exploration, de prévention et de traitement de l'athérosclérose, 33600 Pessac, France; Université Bordeaux, biology of cardiovascular diseases, U1034, 33600 Pessac, France; Inserm, biology of cardiovascular diseases, U1034, 33600 Pessac, France.
| | - P Latry
- Direction régionale du service médical de l'assurance maladie d'Aquitaine, CNAMTS, Bordeaux, France
| | - Y Pucheu
- CHU de Bordeaux, Centre d'exploration, de prévention et de traitement de l'athérosclérose, 33600 Pessac, France
| | - T Couffinhal
- CHU de Bordeaux, Centre d'exploration, de prévention et de traitement de l'athérosclérose, 33600 Pessac, France; Université Bordeaux, biology of cardiovascular diseases, U1034, 33600 Pessac, France; Inserm, biology of cardiovascular diseases, U1034, 33600 Pessac, France
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26
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Kably B, Billaud EM, Boutouyrie P, Azizi M. Is there any Hope for Monitoring Adherence in an Efficient and Feasible Way for Resistant Hypertension Diagnosis and Follow-Up? Curr Hypertens Rep 2020; 22:96. [PMID: 33052474 DOI: 10.1007/s11906-020-01105-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Non-adherence to antihypertensive treatment is highly prevalent and represents a major factor affecting their effectiveness in hypertensive patients, thus contributing to apparent treatment resistance. It is however often overlooked because the methods to assess non-adherence are mainly subjective, limiting their usefulness in clinical practice. Non-adherence to treatment affects daily patient management, resulting in inappropriate, costly, and potentially harmful treatments and loss of the expected benefits from antihypertensive drugs. RECENT FINDINGS Specialized centers now use a combination of objective screening tools. Firstly, snapshots of adherence levels can be provided by analytical drug detection in various biological matrixes using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and secondly electronic monitoring systems of drug delivery which provide longitudinal data on adherence. Routine utilization of those tools allows the detection of non-adherence in patients with resistant hypertension, thus enabling implementation of appropriate interventions to improve drug adherence and avoid unnecessary treatment intensification. Other complementary techniques, such as digital health feedback system with ingestible sensors, are currently evaluated. In the context of an increasing burden of uncontrolled and apparent treatment-resistant hypertension, detecting non-adherence to antihypertensive therapy is, as acknowledged by the latest guidelines, a top priority to implement in clinical practice but still faces medical conservatism and disbelief.
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Affiliation(s)
- Benjamin Kably
- Université de Paris, F-75006, Paris, France
- Pharmacology Unit, AP-HP, Hôpital Européen Georges Pompidou, F-75015, Paris, France
- Inserm U970, Paris Centre de Recherche Cardiovasculaire-PARCC, F-75015, Paris, France
| | - Eliane M Billaud
- Pharmacology Unit, AP-HP, Hôpital Européen Georges Pompidou, F-75015, Paris, France
- Inserm U970, Paris Centre de Recherche Cardiovasculaire-PARCC, F-75015, Paris, France
| | - Pierre Boutouyrie
- Université de Paris, F-75006, Paris, France
- Pharmacology Unit, AP-HP, Hôpital Européen Georges Pompidou, F-75015, Paris, France
- Inserm U970, Paris Centre de Recherche Cardiovasculaire-PARCC, F-75015, Paris, France
| | - Michel Azizi
- Université de Paris, F-75006, Paris, France.
- Hypertension Unit, DMU CARTE, AP-HP, Hôpital Européen Georges Pompidou, F-75015, Paris, France.
- Inserm, CIC 1418, F-75015, Paris, France.
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27
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Kwan YH, Weng SD, Loh DHF, Phang JK, Oo LJY, Blalock DV, Chew EH, Yap KZ, Tan CYK, Yoon S, Fong W, Østbye T, Low LL, Bosworth HB, Thumboo J. Measurement Properties of Existing Patient-Reported Outcome Measures on Medication Adherence: Systematic Review. J Med Internet Res 2020; 22:e19179. [PMID: 33034566 PMCID: PMC7584986 DOI: 10.2196/19179] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/05/2020] [Accepted: 08/08/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Medication adherence is essential for improving the health outcomes of patients. Various patient-reported outcome measures (PROMs) have been developed to measure medication adherence in patients. However, no study has summarized the psychometric properties of these PROMs to guide selection for use in clinical practice or research. OBJECTIVE This study aims to evaluate the quality of the PROMs used to measure medication adherence. METHODS This study was guided by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Relevant articles were retrieved from the EMBASE, PubMed, Cochrane Library, Web of Science, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. The PROMs were then evaluated based on the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. RESULTS A total of 121 unique medication adherence PROMs from 214 studies were identified. Hypotheses testing for construct validity and internal consistency were the most frequently assessed measurement properties. PROMs with at least a moderate level of evidence for ≥5 measurement properties include the Adherence Starts with Knowledge 20, Compliance Questionnaire-Rheumatology, General Medication Adherence Scale, Hill-Bone Scale, Immunosuppressant Therapy Barrier Scale, Medication Adherence Reasons Scale (MAR-Scale) revised, 5-item Medication Adherence Rating Scale (MARS-5), 9-item MARS (MARS-9), 4-item Morisky Medication Adherence Scale (MMAS-4), 8-item MMAS (MMAS-8), Self-efficacy for Appropriate Medication Adherence Scale, Satisfaction with Iron Chelation Therapy, Test of Adherence to Inhalers, and questionnaire by Voils. The MAR-Scale revised, MMAS-4, and MMAS-8 have been administered electronically. CONCLUSIONS This study identified 121 PROMs for medication adherence and provided synthesized evidence for the measurement properties of these PROMs. The findings from this study may assist clinicians and researchers in selecting suitable PROMs to assess medication adherence.
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Affiliation(s)
- Yu Heng Kwan
- Program in Health Services and Systems Research,, Duke-NUS Medical School, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Si Dun Weng
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Dionne Hui Fang Loh
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
| | - Jie Kie Phang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Livia Jia Yi Oo
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Eng Hui Chew
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Kai Zhen Yap
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Corrinne Yong Koon Tan
- Pharmacy Transformation Office, National Healthcare Group Pharmacy, Singapore, Singapore
| | - Sungwon Yoon
- Program in Health Services and Systems Research,, Duke-NUS Medical School, Singapore, Singapore
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Truls Østbye
- Program in Health Services and Systems Research,, Duke-NUS Medical School, Singapore, Singapore
| | - Lian Leng Low
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- Post Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
| | - Hayden Barry Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, United States
- School of Nursing, Duke University Medical Center, Durham, NC, United States
| | - Julian Thumboo
- Program in Health Services and Systems Research,, Duke-NUS Medical School, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Kwan YH, Oo LJY, Loh DHF, Phang JK, Weng SD, Blalock DV, Chew EH, Yap KZ, Tan CYK, Yoon S, Fong W, Østbye T, Low LL, Bosworth HB, Thumboo J. Development of an Item Bank to Measure Medication Adherence: Systematic Review. J Med Internet Res 2020; 22:e19089. [PMID: 33030441 PMCID: PMC7582150 DOI: 10.2196/19089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023] Open
Abstract
Background Medication adherence is important in managing the progression of chronic diseases. A promising approach to reduce cognitive burden when measuring medication adherence lies in the use of computer‐adaptive tests (CATs) or in the development of shorter patient-reported outcome measures (PROMs). However, the lack of an item bank currently hampers this progress. Objective We aim to develop an item bank to measure general medication adherence. Methods Using the preferred reporting items for systematic review and meta-analysis (PRISMA), articles published before October 2019 were retrieved from PubMed, Embase, CINAHL, the Cochrane Library, and Web of Science. Items from existing PROMs were classified and selected (“binned” and “winnowed”) according to standards published by the Patient-Reported Outcomes Measurement Information System (PROMIS) Cooperative Group. Results A total of 126 unique PROMs were identified from 213 studies in 48 countries. Items from the literature review (47 PROMs with 579 items for which permission has been obtained) underwent binning and winnowing. This resulted in 421 candidate items (77 extent of adherence and 344 reasons for adherence). Conclusions We developed an item bank for measuring general medication adherence using items from validated PROMs. This will allow researchers to create new PROMs from selected items and provide the foundation to develop CATs.
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Affiliation(s)
- Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Livia Jia Yi Oo
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Dionne Hui Fang Loh
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
| | - Jie Kie Phang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Si Dun Weng
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Eng Hui Chew
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Kai Zhen Yap
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Corrinne Yong Koon Tan
- Pharmacy Transformation Office, National Healthcare Group Pharmacy, Singapore, Singapore
| | - Sungwon Yoon
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Truls Østbye
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Lian Leng Low
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore.,Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore.,Post Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
| | - Hayden Barry Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.,School of Nursing, Duke University Medical Center, Durham, NC, United States.,Department of Population Health Sciences, Duke University Medical Center, Durham, NC, United States
| | - Julian Thumboo
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Yu C, Liu C, Du J, Liu H, Zhang H, Zhao Y, Yang L, Li X, Li J, Wang J, Wang H, Liu Z, Rao C, Zheng Z. Smartphone-based application to improve medication adherence in patients after surgical coronary revascularization. Am Heart J 2020; 228:17-26. [PMID: 32745732 DOI: 10.1016/j.ahj.2020.06.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 06/30/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Secondary preventive therapies play a key role in the prevention of adverse events after coronary artery bypass grafting (CABG). However, adherence to secondary preventive drugs after CABG is often poor. With the increasing penetration of smartphones, health-related smartphone applications might provide an opportunity to improve medication adherence. We aimed to evaluate the effectiveness and feasibility of using a smartphone-based application to improve medication adherence in patients after CABG. METHODS The Measurement and Improvement Studies of Surgical coronary revascularizatION: medication adherence (MISSION-2) study is a multicenter randomized controlled trial that planned to enroll over 1000 patients who underwent isolated CABG at one of four large teaching hospitals in China; all enrolled participants had access to a smartphone and were able to operate at least three smartphone applications. The investigators randomly assigned the participants to one of two groups: (1) the intervention group with an advanced smartphone application for 6 months which was designed specifically for this trial and did not exist before. Participants could receive medication reminders and cardiac health education by the smartphone application or (2) the control group with usual care. The primary outcome was CABG secondary preventive medication adherence as measured by the translated Chinese version of the 8-item Morisky Medication Adherence Scale (MMAS-8) at 6 months after randomization. The secondary outcomes were mortality, major adverse cardiovascular and cerebrovascular events (MACCE), cardiovascular rehospitalization, self-reported secondary preventive medication use after 6 months of follow-up, blood pressure (BP), body mass index (BMI), and self-reported smoking status. All analyses were conducted using the intention-to-treat principle. RESULTS A total of 1000 patients (mean age, 57.28 [SD, 9.09] years; 85.5% male) with coronary heart disease after CABG were enrolled between September 2015 and September 2016 and were randomly assigned to the intervention (n = 501) or control group (n = 499). At 6 months, the proportion of low-adherence participants, categorized by MMAS-8 scores, was 11.8% in the intervention group and 11.7% in the control group (RR = 1.005, 95% CI 0.682 to 1.480, P = 1.000). Similar results were found in sensitivity analyses that considered participants who withdrew from the study, or were lost to follow-up as nonadherent. There were no significant differences in the secondary clinical outcome measures, and there were no significant differences in the primary outcome across the subgroups tested. In the intervention group, the proportion of participants who used and operated the application during the first month after CABG was 88.1%; however, the use rate decreased sharply from 42.5% in the second month to 9.2% by the end of the study (6 months). CONCLUSIONS A smartphone-based application supporting secondary prevention among patients after CABG did not lead to a greater adherence to secondary preventive medications. The limited room for improvement in medication adherence and the low participants' engagement with the smartphone applications might account for these non-significant outcomes.
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Affiliation(s)
- Chunyu Yu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chongyang Liu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junzhe Du
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hanning Liu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Heng Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Zhao
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Limeng Yang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jue Wang
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huishan Wang
- Department of Cardiovascular Surgery, General Hospital of Shenyang Military Region, Shenyang, Liaoning, China
| | - Zhigang Liu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Tianjin, China
| | - Chenfei Rao
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Zhe Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Biffi A, Rea F, Iannaccone T, Filippelli A, Mancia G, Corrao G. Sex differences in the adherence of antihypertensive drugs: a systematic review with meta-analyses. BMJ Open 2020; 10:e036418. [PMID: 32641331 PMCID: PMC7348648 DOI: 10.1136/bmjopen-2019-036418] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Poor worldwide rate of blood pressure control is largely due to poor adherence to antihypertensive (AHT) drug treatment. The question of whether sex affects adherence has long been debated but conflicting findings have been reported on this issue. Our objective was to evaluate sex differences in the adherence to AHT therapy. RESEARCH DESIGN AND METHODS Studies were identified through a systematic search of PubMed, CINAHL, PsycINFO, Web of Science and Google Scholar (through January 2020) and manual handsearching of relevant articles. Observational studies reporting adherence to AHT drugs measured by self-report or pharmacy refill prescription-based methods among men and women were included. Summarised estimates of ORs with 95% CIs were calculated using random-effects model and meta-regression models. RESULTS From 12 849 potentially relevant publications, 82 studies (15 517 457 men and 18 537 599 women) were included. No significant between-sex differences in adherence to AHT were observed, whether all study-specific estimates were summarised (ORs 1.04, 95% CI 1.00 to 1.09, p=0.07), nor estimates were pooled according to the method for measuring adherence. Among patients aged 65 years or older, lower self-reported adherence was observed in women (ORs 0.84, 95% CI 0.72 to 0.97, p=0.02), while the main result remained unchanged according to other subgroup analyses. CONCLUSIONS Definitive evidence of sex differences in adherence to AHT therapy cannot be drawn. Our little knowledge about factors affecting adherence, in particular of sex effect among elderly, urgently requires high-quality studies investigating these issues.
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Affiliation(s)
- Annalisa Biffi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milano, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
| | - Federico Rea
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milano, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
| | - Teresa Iannaccone
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Fisciano, Italy
| | - Amelia Filippelli
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Fisciano, Italy
| | - Giuseppe Mancia
- University of Milan-Bicocca, Milano, Italy
- Policlinico di Monza, Monza, Italy
| | - Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milano, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
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Macquart de Terline D, Kramoh KE, Bara Diop I, Nhavoto C, Balde DM, Ferreira B, Houenassi MD, Hounsou D, Ikama MS, Kane A, Kimbally-Kaki SG, Kingue S, Koffi F, Kouam Kouam C, Limbole E, Mfeukeu Kuate L, Mipinda JB, N'goran Y, Sesso Z, Sidi Aly A, Toure IA, Plouin PF, Azizi M, Perier MC, Narayanan K, Empana JP, Jouven X, Antignac M. Poor adherence to medication and salt restriction as a barrier to reaching blood pressure control in patients with hypertension: Cross-sectional study from 12 sub-Saharan countries. Arch Cardiovasc Dis 2020; 113:433-442. [PMID: 32434710 DOI: 10.1016/j.acvd.2019.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 10/30/2019] [Accepted: 11/21/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sub-Saharan Africa is experiencing a rising burden of hypertension. Antihypertensive medications and diet are the cornerstone of effective hypertension control. AIMS To assess adherence to medication and salt restriction in 12 sub-Saharan countries, and to study the relationship between adherence and blood pressure control in patients with hypertension. METHODS We conducted a cross-sectional survey in urban clinics in twelve sub-Saharan countries. Data were collected on demographics, treatment and adequacy of blood pressure control in patients with hypertension attending the clinics. Adherence was assessed by questionnaires completed by the patients. Hypertension grades were defined according to European Society of Cardiology guidelines. Association between adherence and blood pressure control was investigated using multilevel logistic regression analysis, adjusting for age, sex and country. RESULTS Among the 2198 patients, 77.4% had uncontrolled blood pressure, 34.0% were poorly adherent to salt restriction, 64.4% were poorly adherent to medication and 24.6% were poorly adherent to both. Poor adherence to salt restriction (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.03-1.72), medication (OR 1.56, 95% CI 1.25-1.93) or both (OR 1.91 1.39-2.66) was related to uncontrolled blood pressure. Moreover, poor adherence to both medication and salt restriction was related to a 1.52-fold (95% CI 1.04-2.22), 1.8-fold (95% CI 1.22-2.65) and 3.08-fold (95% CI 2.02-4.69) increased likelihood of hypertension grade 1, 2 and 3, respectively. CONCLUSIONS High levels of poor adherence to salt restriction and medication were noted in this urban sub-Saharan study; both were significantly associated with uncontrolled blood pressure, representing major opportunities for intervention to improve hypertension control in sub-Saharan Africa.
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Affiliation(s)
- Diane Macquart de Terline
- Sorbonne Université, AP-HP, Sorbonne Université, Hôpital Saint Antoine, Service de Pharmacie, 75012 Paris, France; Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France; Université de Paris, Paris, France.
| | | | | | | | - Dadhi M Balde
- Department of Cardiology, University Hospital of Conakry, Guinea
| | | | | | - Dominique Hounsou
- National University Hospital of Hubert K. Maga (CNHU-HKM), 01 BP 386, Cotonou, Bénin
| | - Méo Stéphane Ikama
- Cardiology Department, National University Hospital of Brazzaville, Marien Ngouabi University, Brazzaville, Congo
| | - Adama Kane
- Cardiology Department, University Hospital of Aristide Le Dantec, Dakar, Senegal
| | - Suzy Gisèle Kimbally-Kaki
- Cardiology Department, National University Hospital of Brazzaville, Marien Ngouabi University, Brazzaville, Congo
| | - Samuel Kingue
- University of Yaoundé, Ministry of Public Health, Cameroon
| | - Florent Koffi
- Institute of Cardiology of Abidjan, BPV 206, Abidjan, Côte d'Ivoire
| | | | - Emmanuel Limbole
- Department of Internal Medicine of la Gombe (CMCG), Ngaliema Hospital, Kinshasa, Democratic Republic of the Congo
| | | | | | - Yves N'goran
- Institute of Cardiology of Abidjan, BPV 206, Abidjan, Côte d'Ivoire
| | | | | | - Ibrahim Ali Toure
- Internal Medicine and Cardiology Department, University Hospital of Lamordé, Niamey University, Niamey, Niger
| | - Pierre François Plouin
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France; Université de Paris, Paris, France; Department of Cardiology, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Michel Azizi
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France; Université de Paris, Paris, France; Department of Cardiology, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Marie Cécile Perier
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France
| | | | - Jean Philippe Empana
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France
| | - Xavier Jouven
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France; Université de Paris, Paris, France; Department of Cardiology, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Marie Antignac
- Sorbonne Université, AP-HP, Sorbonne Université, Hôpital Saint Antoine, Service de Pharmacie, 75012 Paris, France; Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France
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Espeche W, Salazar MR, Sabio R, Diaz A, Leiva Sisnieguez C, Olano D, Balbin E, Renna N, Grosse P, Flores RA, Lagos AC, Ferrer P, Poppe S, Risso Patron F, Sotnieczuk Stasiuk VD, Valentini E, Cardozo JR, Romano JR, Parodi R, Carbajal H. Adherence to antihypertensive drug treatment in Argentina: A multicenter study. J Clin Hypertens (Greenwich) 2020; 22:656-662. [PMID: 32065507 DOI: 10.1111/jch.13830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/15/2020] [Accepted: 01/22/2020] [Indexed: 12/14/2022]
Abstract
Adherence to antihypertensive medication is an important challenge that doctors often face in the treatment of hypertension. Good adherence is crucial to prevent cardiovascular complications. In consequence, the present study aimed at determining the prevalence of adherence to antihypertensive treatment and identifying associated clinical variables. A multicenter cross-sectional study was conducted in 12 cities of Argentina. A systematic sampling was performed in order to select patients with hypertension and under pharmacological treatment for at least 6 months. Physicians took three BP measurements, and the level of adherence was assessed using the self-administered Morisky questionnaire (MMAS-8). Participants were classified into three levels of adherence: high adherence-MMAS score of 8; medium adherence-MMAS scores of 6 to <8; and low adherence-MMAS scores of <6. A total of 1111 individuals (62 ± 12 years old, women 49.4%) were included in the present analysis; 159 (14.3%), 329 (29.6%) and 623 (56.1%) patients had low, medium, and high adherence, respectively. The prevalence of controlled hypertension increased only in high adherent patients: 42.8%, 42.2%, and 64.5% for low, medium, and high adherence groups, respectively. Similarly, systolic BP was lower only in the high adherence group. High educational level (OR 3.47, 95% CI 2.68-4.49) and diuretic treatment (OR 0.64, 95% CI 0.47-0.88) were independent predictors of high adherence. In conclusion, more than a half of treated hypertensive patients had a high level of adherence. These patients had lower BP values and higher control levels. A high educational level predicts high adherence.
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Affiliation(s)
- Walter Espeche
- Unidad de Enfermedades Cardiometabólicas, Hospital San Martin de La Plata, Buenos Aires, Argentina.,Cátedra D Clínica Médica, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Martin R Salazar
- Unidad de Enfermedades Cardiometabólicas, Hospital San Martin de La Plata, Buenos Aires, Argentina.,Cátedra D Clínica Médica, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Rodrigo Sabio
- Servicio de Medicina Interna Hospital SAMIC de Alta Complejidad, ciudad de El Calafate, Argentina
| | - Alejandro Diaz
- CCT Instituto de Investigación en Ciencias de la Salud UNICEN, CCT-CONICET, Tandil, Buenos Ires, Argentina
| | - Carlos Leiva Sisnieguez
- Unidad de Enfermedades Cardiometabólicas, Hospital San Martin de La Plata, Buenos Aires, Argentina.,Cátedra D Clínica Médica, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Daniel Olano
- Unidad de Enfermedades Cardiometabólicas, Hospital San Martin de La Plata, Buenos Aires, Argentina
| | - Eduardo Balbin
- Unidad de Enfermedades Cardiometabólicas, Hospital San Martin de La Plata, Buenos Aires, Argentina
| | | | - Pedro Grosse
- Centro privado de cardiología, Tucumán, Argentina
| | - Roberto A Flores
- Cátedra de Semiología Facultad de Ciencias Médicas, Universidad Nacional de Santiago del Estero, Santiago del Estero, Argentina
| | - Ana C Lagos
- Centro de Diagnóstico Cardiovascular, Concordia, Argentina
| | - Pablo Ferrer
- Hospital Fernandez, CABA, Buenos Aires, Argentina
| | - Silvia Poppe
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | | | | | - Elina Valentini
- Servicio de Clínica Médica, Sanatorio de La Mujer, Rosario, Argentina
| | - Jose R Cardozo
- Hospital Justo Pereyra Aristóbulo del Valle, Misiones, Argentina
| | | | - Roberto Parodi
- Primera Cátedra de Clínica Médica y Terapéutica, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Horacio Carbajal
- Cátedra D Clínica Médica, Universidad Nacional de La Plata, Buenos Aires, Argentina
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Pareja-Martínez E, Esquivel-Prados E, Martínez-Martínez F, García-Corpas JP. Questionnaires on adherence to antihypertensive treatment: a systematic review of published questionnaires and their psychometric properties. Int J Clin Pharm 2020; 42:355-365. [PMID: 32026354 DOI: 10.1007/s11096-020-00981-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 01/26/2020] [Indexed: 12/19/2022]
Abstract
Background Non-adherence to antihypertensive treatment is currently considered one of the most significant risk factors in failure to achieve controlled blood pressure values. It is therefore extremely important to measure patient adherence to antihypertensive treatment. One way to measure adherence is through questionnaires. Numerous questionnaires for measuring adherence to antihypertensive treatment have been validated, but it not easy to choose one of them as being more appropriate than all of the others. Aim of the review The aim of this study was to identify and assess questionnaires designed to measure non-adherence to antihypertensive treatment, and to discuss their psychometric properties. Method A systematic review of the literature contained in PubMed and Scopus databases was undertaken to identify validated questionnaires on adherence to antihypertensive treatment up to October 2017. PRISMA guidelines were followed to conduct and report this review. Selection of articles and data extraction were performed by two independent researchers. When there was lack of agreement, a third researcher mediated in the discussion between the first two authors so that consensus could be reached. Results 39 articles were obtained containing 17 different questionnaires for measuring adherence to antihypertensive treatment. These questionnaires were validated in 15 countries. The number of items in the questionnaires ranged from three in QAM-Q to 33 in TAQPH. Hill-Bone compliance to high blood pressure therapy scale, Morisky-Green-Levine test and an 8-item Self-Reported Medication Adherence Measurement were the most widely validated questionnaires. Validity was analyzed more than reliability. Many of the questionnaires do not provide information on content validity. Construct validity and concurrent validity are analyzed in almost all of the questionnaires, and give highly variable results. By contrast, known-groups validity was not analyzed to any great degree. As regards reliability, almost all of the questionnaires provided Cronbach's alpha information with reasonably acceptable results, but temporal stability was not analyzed to any great degree. Conclusion None of the questionnaires included in the review demonstrates fulfilling all of the validity tests (content validity, construct validity and criterion-related validity) and reliability tests (homogeneity and temporal stability) in an acceptable manner. Therefore, none of them can be considered a Gold Standard.
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Affiliation(s)
- Elisa Pareja-Martínez
- Academic Center in Pharmaceutical Care, Pharmaceutical Care Research Group, Pharmacy Faculty, University of Granada, Campus Universitario de Cartuja s/n, 18071, Granada, Spain
| | - Elisabeth Esquivel-Prados
- Academic Center in Pharmaceutical Care, Pharmaceutical Care Research Group, Pharmacy Faculty, University of Granada, Campus Universitario de Cartuja s/n, 18071, Granada, Spain
| | - Fernando Martínez-Martínez
- Academic Center in Pharmaceutical Care, Pharmaceutical Care Research Group, Pharmacy Faculty, University of Granada, Campus Universitario de Cartuja s/n, 18071, Granada, Spain
| | - José P García-Corpas
- Academic Center in Pharmaceutical Care, Pharmaceutical Care Research Group, Pharmacy Faculty, University of Granada, Campus Universitario de Cartuja s/n, 18071, Granada, Spain.
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Chen YJ, Chang J, Yang SY. Psychometric Evaluation of Chinese Version of Adherence to Refills and Medications Scale (ARMS) and Blood-Pressure Control Among Elderly with Hypertension. Patient Prefer Adherence 2020; 14:213-220. [PMID: 32103905 PMCID: PMC7020932 DOI: 10.2147/ppa.s236268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 12/25/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This study aimed to develop the ARMS-C and test its psychometric properties in hypertensive patients, to assess the level of medication adherence and to identify associated predictors for medication adherence and blood-pressure control among Chinese hypertensive patients. METHODS Hypertensive elderly who met inclusion criteria were recruited from an aged-care facility in Henan Province between January 2019 and July 2019. The patients completed the adapted ARMS-C. The scale's factor structure, internal consistency, and construct validity were tested. RESULTS Good internal consistency (Cronbach's α=0.89) and test-retest reliability (r=0.86, p<0.01) were obtained. Item-total correlation coefficients for the ten-item ARMS-C were 0.505-0.801. Factor analysis of construct validity identified two factors, explaining a total variance of 63.3%. Binary regression showed that patients with scores at level 2 (≤20 ARMS-10 scores <30) were six times as likely to have blood pressure uncontrolled as those at level 1 (ARMS-10 scores <20, OR 6.6, 95% CI 1.7-25.1; p=0.006), and patients with scores at level 3 (ARMS-10 scores >30) were 115 times as likely to have blood pressure uncontrolled as those at level 1 (ARMS-10 scores <20,OR 115, 95% CI 9-1,470; p=0). CONCLUSION The ten-item ARMS-C is a reliable and valid self-reporting screening tool for adherence to medication and refills in elderly hypertensive Chinese patients.
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Affiliation(s)
- Yi-Jing Chen
- Department of Health Care Clinic, First Affiliated Hospital of Zhengzhou University, Henan, People’s Republic of China
- Academy of Medical Science, Zhengzhou University, Henan, People’s Republic of China
| | - Jing Chang
- Department of Health Care Clinic, First Affiliated Hospital of Zhengzhou University, Henan, People’s Republic of China
- Correspondence: Jing Chang Email
| | - Si-Yu Yang
- Xiangya Medical School, Central South University, Changsha, People’s Republic of China
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35
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Thakur MKS, Talati S, Gupta AK, Bhattacharya S, Singh A. Morbidity pattern, social safety net, and drug adherence level among geriatric patients attending in a health-care facility: A cross-sectional study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2019; 8:263. [PMID: 32002435 PMCID: PMC6967230 DOI: 10.4103/jehp.jehp_319_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 12/02/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Financial support system available to geriatric populations affects their adherence level to the prescribed treatment leading to a rise in chronic disease burden. OBJECTIVE The aim of this study was to ascertain the disease pattern, health expenditure, and adherence to the prescriptions among geriatric patients reporting to a hospital in North India. METHODOLOGY This descriptive, cross-sectional study was conducted from July 2017 to June 2018. Patients who were 60 or above years in age, already diagnosed and were on treatment for more than 3 months were included in the study. A total of 310 patients were selected using convenient sampling method. Data were collected by a pretested and validated questionnaire. RESULTS The mean age of the patients was 66.16 years ± 5.37 years (54.8% males). Monthly average family income was Rs. 15202.97 ± 1134.63. Overall, 25% of the treatment cost was met through various social schemes (52% = pension scheme, 32% of patients had no such schemes and only 2% through health insurance schemes). Rest was out-of-pocket expenditure. Common diseases were hypertension (60.64%), diabetes mellitus (35.8%), cancer (28.38%), and coronary artery disease (22.58%). More than half (52.9%) of the patients had two or more illnesses; about 35.8% of them were taking treatment for 1-5 years. Moderate adherence was observed among the majority of the patients. Statistically significant (P < 0.05) difference in treatment adherence to the prescriptions was observed. CONCLUSION Geriatric patients had many chronic morbidities. They had high out-of-pocket expenditure and suboptimal financial support affecting their level of adherence to the prescriptions.
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Affiliation(s)
- Mohan Kumar Singh Thakur
- Hospital Administrator, Dr. Radhakrishnan Govt. Medical College, Hamirpur, Himachal Pradesh, India
| | - Shweta Talati
- Hospital Administrator, Dr. Radhakrishnan Govt. Medical College, Hamirpur, Himachal Pradesh, India
| | - Anil Kumar Gupta
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | - Sudip Bhattacharya
- Department of Community Medicine, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Amarjeet Singh
- Department of Community Medicine, PGIMER, Chandigarh, India
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Al-Noumani H, Wu JR, Barksdale D, Knafl G, AlKhasawneh E, Sherwood G. Health Beliefs and Medication Adherence in Omanis With Hypertension. J Cardiovasc Nurs 2019; 33:518-526. [PMID: 30130358 PMCID: PMC6179908 DOI: 10.1097/jcn.0000000000000511] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients' health beliefs are essential to improve medication adherence among patients with hypertension. OBJECTIVE Our objective was to examine the relationship between (1) patients' beliefs about hypertension, medication, and self-efficacy and medication adherence and (2) medication adherence and blood pressure control in Oman. METHODS This cross-sectional study included 215 participants with hypertension. Participants completed 4 questionnaires (Arabic version) to measure medication adherence, beliefs about hypertension severity, beliefs about medication, and self-efficacy. Bivariate and multivariate logistic regression was used to conduct the analyses. RESULTS Higher self-efficacy (odds ratio [OR], 2.59; 95% confidence interval [CI], 1.54-4.37), stronger beliefs about medication necessity (OR, 1.98; 95% CI, 1.21-3.23), increased age (OR, 1.06; 95% CI, 1.03-1.10), and fewer medication concerns (OR, 0.34; 95% CI, 0.20-0.57) were related to high medication adherence. Moreover, uncontrolled blood pressure was less likely in participants with high medication adherence (OR, 0.47; 95% CI, 0.24-0.93). CONCLUSIONS Patients' beliefs are important consideration to improve medication adherence. Clinically, patients' beliefs should be assessed, and strategies to improve medication adherence should incorporate beliefs as a key component to improve antihypertensive medication adherence. Patient education and counseling regarding hypertension and necessity and side effects of medications are important to maximize positive beliefs and improve medication adherence.
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Affiliation(s)
- Huda Al-Noumani
- Huda Al-Noumani, PhD, RN Assistant Professor, Department of Adult Health and Critical Care, College of Nursing, Sultan Qaboos University, Muscat, Oman. Jia-Rong Wu, PhD, RN Associate Professor, School of Nursing, University of North Carolina at Chapel Hill. Debra Barksdale, PhD, RN, FNP-BC, CNE, FAANP, FAAN Professor, School of Nursing, Virginia Commonwealth University, Richmond. George Knafl, PhD Professor, School of Nursing, University of North Carolina at Chapel Hill. Esra AlKhasawneh, PhD, RN, FAAN Associate Professor, College of Nursing, Sultan Qaboos University, Muscat, Oman. Gwen Sherwood, PhD, RN, FAAN Professor, School of Nursing, University of North Carolina at Chapel Hill
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Carvalho AS, Santos P. Medication Adherence In Patients With Arterial Hypertension: The Relationship With Healthcare Systems' Organizational Factors. Patient Prefer Adherence 2019; 13:1761-1774. [PMID: 31802854 PMCID: PMC6802622 DOI: 10.2147/ppa.s216091] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/01/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Arterial hypertension is one of the most common diseases in the world, presenting a great impact on global mortality. Despite having good medication, the best control depends on patient's adherence. Our aim is to characterize the relationship of adherence to medication in hypertensive patients with consultation length and other organizational factors of healthcare systems. PATIENTS AND METHODS We performed a comprehensive review of literature using the MeSH terms "hypertension" and "medication adherence". 61 articles were selected for inclusion and adherence parameters were extracted, allowing us to estimate the mean adherence for each country. The adherence was then correlated with organizational aspects of healthcare systems: consultation length, number of health providers (doctors, nurses and pharmacists), number of hospital beds, health expenditure and general government expenditure. RESULTS Adherence to medication ranged between 11.8% in Indonesia and 85.0% in Australia. There is much heterogeneity in methodology, but the Morisky Medication Adherence Scale was the preferred method, used in 63.6% of the cases. We found no relation with consultation length, but a significant one with the greater number of health professionals available. Some differences were observed when considering European countries or Morisky Medication Adherence Scale alone. CONCLUSION The better the drugs, the better the control of blood pressure, if patients take them. Rather than investing in the prescription of more drugs, it is important to address non-adherence and reduce it to promote better blood pressure control. Organizational factors are relevant constraints and depend on administrative and political decisions. Although they are not always considered, they greatly impact the adherence to medication.
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Affiliation(s)
- Ana Sofia Carvalho
- Department of Medicine of Community, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of University of Porto, Porto, Portugal
| | - Paulo Santos
- Department of Medicine of Community, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of University of Porto, Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
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Javor A, Ciumas C, Ibarrola D, Ryvlin P, Rheims S. Social cognition, behaviour and therapy adherence in frontal lobe epilepsy: a study combining neuroeconomic and neuropsychological methods. ROYAL SOCIETY OPEN SCIENCE 2019; 6:180850. [PMID: 31598216 PMCID: PMC6731699 DOI: 10.1098/rsos.180850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/23/2019] [Indexed: 05/30/2023]
Abstract
Social behaviour of healthy humans and its neural correlates have been extensively studied in social neuroscience and neuroeconomics. Whereas it is well established that several types of epilepsies, such as frontal lobe epilepsy, lead to social cognitive impairments, experimental evidence on how these translate into behavioural symptoms is scarce. Furthermore, it is unclear whether social cognitive or behavioural disturbances have an impact on therapy adherence, which is critical for effective disease management, but generally low in these patients. In order to investigate the relationship between social cognition, social behaviour, and therapy adherence in patients with frontal lobe epilepsies (FLE), we designed a study combining conventional neuropsychological with behavioural economic and functional magnetic resonance imaging (fMRI) methodology. Fifteen patients and 15 healthy controls played a prisoners' dilemma game (an established game to operationalize social behaviour) while undergoing fMRI. Additionally, social cognitive, basic neuropsychological variables, and therapy adherence were assessed. Our results implicate that social behaviour is indeed affected and can be quantified using neuroeconomic methods in patients with FLE. Impaired social behaviour in these patients might be a consequence of altered brain activation in the medial prefrontal cortex and play a role in low therapy adherence. Finally, this study serves as an example of how to integrate neuroeconomic methods in neurology.
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Affiliation(s)
- Andrija Javor
- Department of Neurology 2, Kepler University Clinic, Linz, Austria
| | - Carolina Ciumas
- Translational and Integrative Group in Epilepsy Research (TIGER), INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, University Lyon 1, Lyon, France
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland
- Epilepsy Institute (IDEE), Lyon, France
| | - Danielle Ibarrola
- CERMEP - Imagerie du vivant, MRI department and CNRS UMS3453, Lyon, France
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland
- Epilepsy Institute (IDEE), Lyon, France
| | - Sylvain Rheims
- Translational and Integrative Group in Epilepsy Research (TIGER), INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, University Lyon 1, Lyon, France
- Epilepsy Institute (IDEE), Lyon, France
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France
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Macquart de Terline D, Kane A, Kramoh KE, Ali Toure I, Mipinda JB, Diop IB, Nhavoto C, Balde DM, Ferreira B, Dèdonougbo Houenassi M, Ikama MS, Kingue S, Kouam Kouam C, Takombe JL, Limbole E, Mfeukeu Kuate L, N’guetta R, Damorou JM, Sesso Z, Sidy Ali A, Perier MC, Azizi M, Empana JP, Jouven X, Antignac M. Factors associated with poor adherence to medication among hypertensive patients in twelve low and middle income Sub-Saharan countries. PLoS One 2019; 14:e0219266. [PMID: 31291293 PMCID: PMC6619761 DOI: 10.1371/journal.pone.0219266] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/19/2019] [Indexed: 01/04/2023] Open
Abstract
Introduction Over the past few decades, the prevalence of hypertension has dramatically increased in Sub-Saharan Africa. Poor adherence has been identified as a major cause of failure to control hypertension. Scarce data are available in Africa. Aims We assessed adherence to medication and identified socioeconomics, clinical and treatment factors associated with low adherence among hypertensive patients in 12 sub-Saharan African countries. Method We conducted a cross-sectional survey in urban clinics of both low and middle income countries. Data were collected by physicians on demographics, treatment and clinical data among hypertensive patients attending the clinics. Adherence was assessed by questionnaires completed by the patients. Factors associated with low adherence were investigated using logistic regression with a random effect on countries. Results There were 2198 individuals from 12 countries enrolled in the study. Overall, 678 (30.8%), 738 (33.6%), 782 (35.6%) participants had respectively low, medium and high adherence to antihypertensive medication. Multivariate analysis showed that the use of traditional medicine (OR: 2.28, 95%CI [1.79–2.90]) and individual wealth index (low vs. high wealth: OR: 1.86, 95%CI [1.35–2.56] and middle vs. high wealth: OR: 1.42, 95%CI [1.11–1.81]) were significantly and independently associated with poor adherence to medication. In stratified analysis, these differences in adherence to medication according to individual wealth index were observed in low-income countries (p<0.001) but not in middle-income countries (p = 0.17). In addition, 26.5% of the patients admitted having stopped their treatment due to financial reasons and this proportion was 4 fold higher in the lowest than highest wealth group (47.8% vs 11.4%) (p<0.001). Conclusion This study revealed the high frequency of poor adherence in African patients and the associated factors. These findings should be useful for tailoring future programs to tackle hypertension in low income countries that are better adapted to patients, with a potential associated enhancement of their effectiveness.
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Affiliation(s)
- Diane Macquart de Terline
- Department of Pharmacy, Saint Antoine hospital, HUEP, AP-HP, Paris, France
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
- Paris Descartes University, Paris, France
- * E-mail:
| | - Adama Kane
- Cardiology Department, University Hospital of Aristide Le Dantec, Dakar, Senegal
| | | | - Ibrahim Ali Toure
- Internal Medicine and Cardiology Department, University Hospital of Lamorde, Niamey, Niger
| | | | | | | | - Dadhi M. Balde
- Department of Cardiology, University Hospital of Conakry, Conakry, Guinea
| | | | | | - Méo Stéphane Ikama
- Cardiology Department, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville, Congo
| | - Samuel Kingue
- University of Yaoundé, Ministry of Public Health, Yaoundé, Cameroon
| | | | | | - Emmanuel Limbole
- Department of Internal Medicine of la Gombe (CMCG), Department of Internal Medicine, Ngaliema Hospital, Kinshasa; Democratic Republic of the Congo
| | | | | | | | | | | | - Marie-Cécile Perier
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
| | - Michel Azizi
- Paris Descartes University, Paris, France
- Hypertension Unit, Assistance-Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
- Institut National de la Santé et de la Recherche Médicale, Centre d’Investigation Clinique, Paris, France
| | - Jean Philippe Empana
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
| | - Xavier Jouven
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
- Paris Descartes University, Paris, France
- Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - Marie Antignac
- Department of Pharmacy, Saint Antoine hospital, HUEP, AP-HP, Paris, France
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
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Prior medication adherence of participants and non participants of a randomized controlled trial to improve patient adherence in cardiovascular risk management. BMC Med Res Methodol 2019; 19:95. [PMID: 31072304 PMCID: PMC6506957 DOI: 10.1186/s12874-019-0743-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/29/2019] [Indexed: 02/07/2023] Open
Abstract
Background Poor medication adherence is a major factor in the secondary prevention of cardiovascular diseases (CVD) and contributes to increased morbidity, mortality, and costs. Interventions for improving medication adherence may have limited effects as a consequence of self selection of already highly adherent participants into clinical trials. Methods In this retrospective cohort study, existing levels of medication adherence were examined in self-decided participants and non-participants prior to inclusion in a randomized controlled study (RCT), evaluating the effect of an intervention to improve adherence. In addition, the non-participants were further divided into ‘responders’ and ‘non responders’. All individuals had manifest cardiovascular disease and completed a questionnaire with baseline characteristics, the Beliefs about Medicines Questionnaire (BMQ) and the Modified Morisky Scale® (MMS®) as part of a regular screening program. A logistic regression was conducted to examine the relationship between study participation willingness, adherence level and the beliefs about medication. Results According to the MMS® the adherence level was comparable in all groups. In both (non)-participants groups, 36% was classified as high adherent; 46% participants versus 44% non-participants were classified as medium adherent and 19% of the participants versus 20% of the non-participants were low adherent (p = 0.91. The necessity concern differential (NCD) from the BMQ was 3.8 for participants and 3.4 for non-participants (p = 0.32). Conclusion This study shows that adherence to medication and beliefs about medication do not differ between participants and non-participants before consenting to participate in an RCT. The study design seems not to have led to greater adherence in the study group.
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Kubica A, Kosobucka A, Fabiszak T, Gorog DA, Siller-Matula JM. Assessment of adherence to medication in patients after myocardial infarction treated with percutaneous coronary intervention. Is there a place for newself-reported questionnaires? Curr Med Res Opin 2019; 35:341-349. [PMID: 30091642 DOI: 10.1080/03007995.2018.1510385] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Non-adherence to medication regimen after myocardial infarction (MI) leads to increased morbidity and mortality and generates additional cost to the healthcare system. OBJECTIVES The aim of this systematic review was to critically discuss assessment methods of adherence to medication in patients after myocardial infarction treated with percutaneous coronary intervention and the possible application of a new self-reported questionnaire. METHODS A systematic investigation of all published literature was conducted to minimize the risk of bias. A database search (PubMed, CENTRAL and Google Scholar databases) from January 1998 through December 2017. RESULTS Adequate assessment of patient adherence to treatment is necessary to understand the potential for adverse outcomes. Methods developed for adherence evaluation are classified as subjective and objective or as direct and indirect. Direct, objective measures reflect pharmacokinetics and include measurement of the drug or its metabolite concentration, evaluation of the presence of biological markers given with the drug and direct observation of patients' medication-taking behavior. Several indirect, objective methods are based on evaluation of the availability of prescribed medications assuming that medication is taken exactly as prescribed. Assessment of the effectiveness of treatment, both at the pharmacodynamic and clinical level, indirectly but objectively reflects adherence to treatment. Subjective methods, including patient-kept diaries, patient interviews and self-reported questionnaires, due to their simplicity, real-time feedback and low cost, are often used for adherence evaluation in clinical practice. CONCLUSIONS In spite of the availability, convenience and variety of methods, measuring adherence still remains a real challenge. Using a well designed questionnaire provides an opportunity to identify patients at increased risk of non-adherence and the obstacles impeding implementation of the treatment plan, allowing implementation of tailored interventions in order to improve patient medication-taking behavior.
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Affiliation(s)
- Aldona Kubica
- a Department of Health Promotion , Collegium Medicum, Nicolaus Copernicus University , Bydgoszcz , Poland
| | - Agata Kosobucka
- a Department of Health Promotion , Collegium Medicum, Nicolaus Copernicus University , Bydgoszcz , Poland
| | - Tomasz Fabiszak
- b Department of Cardiology and Internal Diseases , Collegium Medicum, Nicolaus Copernicus University , Bydgoszcz , Poland
| | - Diana A Gorog
- c National Heart & Lung Institute, Imperial College , London , UK
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Impacts of Type D Personality and Depression, Alone and in Combination, on Medication Non-Adherence Following Percutaneous Coronary Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102226. [PMID: 30314347 PMCID: PMC6209952 DOI: 10.3390/ijerph15102226] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 09/29/2018] [Accepted: 09/29/2018] [Indexed: 12/14/2022]
Abstract
Background: Medication adherence after percutaneous coronary intervention (PCI) is essential to preventing the risk of restenosis. Even though Type D personality and depression have been known to affect medication non-adherence, their combined influence on PCI patients remains unclear. Aim: We aimed to identify how both Type D personality and depression were associated with medication non-adherence for 3 months after successful PCI. Methods: This prospective cohort study included 257 PCI patients, who took 3 or more cardiac medications, at a university hospital. We measured sociodemographic and clinical variables, Type D personality, depression, and medication non-adherence using face-to-face interviews and medical record reviews. Results: The total prevalence of medication non-adherence at the one- and three-month follow-ups was 14% and 16%, respectively. At one month, the prevalence of those with a combination of Type D personality and depression (23.4%) and depression alone (24%) was significantly higher than other groups. At three months, the prevalence of the Type D personality-only group (39.1%) was the highest. Type D personality increased the risk of medication non-adherence 5.089 times at three months, while depression increased it 2.6 times at one month. However, the risk of medication non-adherence was not increased in patients with combined Type D personality and depression. Conclusions: Individual assessments of Type D personality and depression are required. Therefore, psychological interventions focusing on personality and depression are crucial. Longitudinal follow-up studies must explore the interaction or individual impact of Type D personality and depression on medication non-adherence and other negative outcomes.
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Lefort M, Neufcourt L, Pannier B, Vaïsse B, Bayat S, Grimaud O, Girerd X. Sex differences in adherence to antihypertensive treatment in patients aged above 55: The French League Against Hypertension Survey (FLAHS). J Clin Hypertens (Greenwich) 2018; 20:1496-1503. [DOI: 10.1111/jch.13387] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/27/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Mathilde Lefort
- Univ Rennes, EHESP, REPERES (Recherche en Pharmaco-épidémiologie et Recours aux Soins) - EA 7449; Rennes France
| | - Lola Neufcourt
- Univ Rennes, EHESP, REPERES (Recherche en Pharmaco-épidémiologie et Recours aux Soins) - EA 7449; Rennes France
| | - Bruno Pannier
- Comité Français de Lutte Contre l’Hypertension Artérielle (CFLHTA); Paris France
| | - Bernard Vaïsse
- Comité Français de Lutte Contre l’Hypertension Artérielle (CFLHTA); Paris France
- Service de Cardiologie: Rythmologie et HTA; Marseille Cedex France
| | - Sahar Bayat
- Univ Rennes, EHESP, REPERES (Recherche en Pharmaco-épidémiologie et Recours aux Soins) - EA 7449; Rennes France
| | - Olivier Grimaud
- Univ Rennes, EHESP, REPERES (Recherche en Pharmaco-épidémiologie et Recours aux Soins) - EA 7449; Rennes France
| | - Xavier Girerd
- Comité Français de Lutte Contre l’Hypertension Artérielle (CFLHTA); Paris France
- Sorbonne Université, Assistance Publique des Hôpitaux de Paris, Unité de Prévention Cardio- Vasculaire. Hôpital de La Pitié-Salpêtrière; Paris Cedex France
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Tao L, Zhang X, Duan Z, Wang Y, Liu J, Hou H, Fang Q. Sexual dysfunction and associated factors in Chinese Han women with epilepsy. Epilepsy Behav 2018; 85:150-156. [PMID: 29940378 DOI: 10.1016/j.yebeh.2018.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/28/2018] [Accepted: 06/01/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Women with epilepsy (WWE) are believed to be at risk of sexual dysfunction (SD) and face many sexual challenges because of multiple factors. This study aimed to assess the factors associated with SD in Chinese Han WWE. METHODS This cross-sectional study examined 112 married WWE in the Affiliated Hospital of Yangzhou University with focal (FE) or generalized epilepsy (GE) on antiepileptic drugs (AEDs), and 120 healthy controls without epilepsy, all of Chinese Han nationality. Data collection tools included the Chinese version of Female Sexual Function Index (FSFI), the Chinese version of Zung Self-Rating Anxiety Scale (SAS), the Chinese version of the Zung Self-Rating Depression Scale (SDS), the Chinese version of the revised Morisky Medication Adherence Scale (MMAS-8), and the Chinese version of the National Hospital Seizure Severity Scale (NHS3). Chi-square test, t-test, one-way analysis of variance (ANOVA), and binary logistic regression were used for statistical analysis. RESULTS A high rate (70.5%) of SD was detected in WWE, with 24.2% in controls. Sexual dysfunction affected all dimensions: desire (85.7%), arousal (56.3%), lubrication (47.3%), orgasm (66.1%), satisfaction (58.9%), and pain (41.1%). Elevated rates of anxiety (40.2%) and depression (33%) and poor medication adherence (31.3%) were also found in WWE. Binary logistic regression found that poor economic status (odds ratio (OR) = 13.904, 95% confidence interval (CI): 2.025-95.472, P = 0.007 and OR = 6.350, 95% CI: 1.323-30.477, P = 0.021), anxiety (OR = 1.222, 95% CI: 1.055-1.415, P = 0.007), and poor medication adherence (OR = 0.297, 95% CI: 0.124-0.707, P = 0.006) were associated with SD. CONCLUSIONS The associated factors of SD in Chinese Han WWE are multifactorial. The WWE have higher levels of anxiety, poor family economic status, and poor medication adherence. Medical professionals should not only better control seizures but also evaluate and improve patients' sexual function so as to improve the quality of life of WWE.
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Affiliation(s)
- Lihong Tao
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu 215006, China; Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Xinjiang Zhang
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Zuowei Duan
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Yingge Wang
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Jiangbing Liu
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Hongling Hou
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu 215006, China.
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Sitruk L, Couchoud C, Hourmant M, Tuppin P, Macher MA, Legeai C. [Description of immunosuppressive maintenance treatments post kidney transplant through the National System of Health Insurance]. Nephrol Ther 2018; 14:523-530. [PMID: 29887268 DOI: 10.1016/j.nephro.2018.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/02/2018] [Accepted: 03/18/2018] [Indexed: 01/08/2023]
Abstract
The aim of this study was to describe the drug dispensing of maintenance immunosuppression treatment in 2014 for patients who received a kidney transplant in 2012, based on the data of the French national health insurance and to compare those results with the information collected in the national database for kidney recipients. For each patient, are considered all drugs dispensing with their dates of issue, the molecules and their presentations (number of pills and dosage). Among 2463 transplanted adults in 2012, 73% have received tacrolimus monohydrate, 59% mycophenolate mofetil, 54% prednisone and 20% cyclosporin in 2014. The daily doses but not the number of tablets per day declined with age. The most frequent association was tacrolimus monohydrate-mycophenolate mofetil-steroids in 34% of the cases. The use of mTOR inhibitors, rare generally (7%), is more common in patients aged 66-85 years. Associations did not differ significantly according to diabetic status, for patients with a kidney from an elderly donor or according to the number of mismatch. The daily doses estimated from the deliverance in pharmacy are respectively similar, understated and over-estimate for tacrolimus, mycophenolate mofetil and cyclosporin compared to the national database. This study confirms the difficulty of apprehending drug consumption based only on dispensing in pharmacies or punctual recording even if it allows a fairly comprehensive view of French practices.
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Affiliation(s)
- Lola Sitruk
- Agence de la biomédecine, 1, avenue du Stade-de-France, 93212 Saint-Denis-La-Plaine cedex, France
| | - Cécile Couchoud
- Agence de la biomédecine, 1, avenue du Stade-de-France, 93212 Saint-Denis-La-Plaine cedex, France
| | - Maryvonne Hourmant
- Service de néphrologie et d'immunologie clinique, CHU, 30, boulevard Jean-Monnet, immeuble Jean-Monnet, 44093 Nantes cedex 1, France
| | - Philippe Tuppin
- Caisse nationale de l'Assurance maladie des travailleurs salariés, Direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France
| | - Marie-Alice Macher
- Agence de la biomédecine, 1, avenue du Stade-de-France, 93212 Saint-Denis-La-Plaine cedex, France
| | - Camille Legeai
- Agence de la biomédecine, 1, avenue du Stade-de-France, 93212 Saint-Denis-La-Plaine cedex, France.
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Bou Serhal R, Salameh P, Wakim N, Issa C, Kassem B, Abou Jaoude L, Saleh N. A New Lebanese Medication Adherence Scale: Validation in Lebanese Hypertensive Adults. Int J Hypertens 2018; 2018:3934296. [PMID: 29887993 PMCID: PMC5985068 DOI: 10.1155/2018/3934296] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/11/2018] [Accepted: 04/16/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A new Lebanese scale measuring medication adherence considered socioeconomic and cultural factors not taken into account by the eight-item Morisky Medication Adherence Scale (MMAS-8). Objectives were to validate the new adherence scale and its prediction of hypertension control, compared to MMAS-8, and to assess adherence rates and factors. METHODOLOGY A cross-sectional study, including 405 patients, was performed in outpatient cardiology clinics of three hospitals in Beirut. Blood pressure was measured, a questionnaire filled, and sodium intake estimated by a urine test. Logistic regression defined predictors of hypertension control and adherence. RESULTS 54.9% had controlled hypertension. 82.4% were adherent by the new scale, which showed good internal consistency, adequate questions (KMO coefficient = 0.743), and four factors. It predicted hypertension control (OR = 1.217; p value = 0.003), unlike MMAS-8, but the scores were correlated (ICC average measure = 0.651; p value < 0.001). Stress and smoking predicted nonadherence. CONCLUSION This study elaborated a validated, practical, and useful tool measuring adherence to medications in Lebanese hypertensive patients.
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Affiliation(s)
- R. Bou Serhal
- Department of Epidemiology and biostatistics, Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - P. Salameh
- Faculty of Pharmacy, Lebanese University, Al Hadath, Lebanon
| | - N. Wakim
- Department of Epidemiology and biostatistics, Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - C. Issa
- Department of Nutrition and Dietetics, Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - B. Kassem
- Department of Epidemiology and biostatistics, Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - L. Abou Jaoude
- Department of Epidemiology and biostatistics, Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - N. Saleh
- Department of Epidemiology and biostatistics, Faculty of Public Health, Lebanese University, Fanar, Lebanon
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Cabral AC, Moura-Ramos M, Castel-Branco M, Fernandez-Llimos F, Figueiredo IV. Cross-cultural adaptation and validation of a European Portuguese version of the 8-item Morisky medication adherence scale. Rev Port Cardiol 2018; 37:297-303. [PMID: 29628355 DOI: 10.1016/j.repc.2017.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 07/07/2017] [Accepted: 09/24/2017] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE The 8-Item Morisky Medication Adherence Scale (MMAS-8) is one of the most widely used instruments to assess medication adherence, but a validated European Portuguese version of MMAS-8 does not exist. Our aim was to develop and validate a European Portuguese version of the MMAS-8. METHODS A process of translation and back-translation of the original MMAS-8 was performed. The questionnaire was administered in nine community pharmacies and one public hospital between March 2014 and September 2015. Adult patients taking at least one antihypertensive drug were invited to participate. A confirmatory factor analysis was performed and internal consistency, convergent validity and concurrent validity were examined. RESULTS A total of 472 patients were enrolled in the study. The mean MMAS-8 score obtained was 6.74±1.39. One hundred and thirty-two patients were classified as low adherers (28%), 181 (38.3%) as medium adherers and 159 (33.7%) as high adherers. For the factorial structure of the Portuguese version of the MMAS-8, the fit indices of the final model (chi-square [18] 48.465, p<0.001) are suggestive of very good fit, with comparative fit index 0.95, root mean square error of approximation 0.06 (90% confidence interval 0.04-0.08), and standardized root mean square residual 0.04, confirming that the construct tested was unidimensional. The Cronbach's alpha for all items was 0.60, and the translated version presents convergent validity and concurrent validity. CONCLUSION A European Portuguese version of the MMAS-8 was created that maintained a similar structure to the original MMAS-8 and good psychometric properties.
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Affiliation(s)
- Ana C Cabral
- Pharmacology and Pharmaceutical Care Laboratory, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Mariana Moura-Ramos
- Cognitive and Behavioural Center for Research and Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Margarida Castel-Branco
- Institute for Biomedical Imaging and life Sciences, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | | | - Isabel V Figueiredo
- Institute for Biomedical Imaging and life Sciences, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
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Cabral AC, Moura-Ramos M, Castel-Branco M, Fernandez-Llimos F, Figueiredo IV. Cross-cultural adaptation and validation of a European Portuguese version of the 8-item Morisky medication adherence scale. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Adjuvant hormonal therapy for early breast cancer: an epidemiologic study of medication adherence. Breast Cancer Res Treat 2018; 169:153-162. [PMID: 29362956 DOI: 10.1007/s10549-018-4676-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/16/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE The aim of this study was to determine the prevalence of adherence to adjuvant hormonal therapy (AHT) and to identify risk factors for medication non-adherence in clinical practice in patients with early-stage hormone receptor (HR)-positive breast cancer (BC) previously treated with chemotherapy. METHODS We carried out a cross-sectional, observational, prospective, and multicenter survey based on a structured self-report postal questionnaire (35 items investigating six areas). A sample of 474 patients was drawn from 676 patients potentially eligible. The structured and validated Morisky Medication Adherence Scale-4 items was used for measuring medication adherence. An analysis of risk factors for non-adherence to AHT was performed using a two-step approach: univariate, then multivariate analysis. RESULTS A total of 280 patients out of the 428 analyzed patients participated in the survey, yielding a response rate of 65.4% [60.9-69.9]. The prevalence of adherence to AHT was estimated at 68.6% [63.1-74.0], corresponding to a high level of adherence. Three risk factors for non-adherence to AHT were identified: > 2 medications to treat comorbidities (p-value = 0.003), age less than 65 years (p-value = 0.008), and patient management in a university hospital setting (p-value = 0.014). CONCLUSIONS Non-adherence is a common, complex, and multidimensional healthcare problem. This better understanding and knowledge of risk factors will allow healthcare providers (such as oncologists, general practitioners, pharmacists) to more easily identify patients at risk for non-adherence and help them provide appropriate information about AHT and its management, thus improving medication adherence in their patients.
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Schneider APH, Gaedke MÂ, Garcez A, Barcellos NT, Paniz VMV. Effect of characteristics of pharmacotherapy on non-adherence in chronic cardiovascular disease: A systematic review and meta-analysis of observational studies. Int J Clin Pract 2018; 72. [PMID: 29193650 DOI: 10.1111/ijcp.13044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/05/2017] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Cardiovascular medications are effective in prevention of cardiovascular diseases (CVD); however, medication non-adherence contributes to morbidity and mortality. OBJECTIVE This systematic review and meta-analysis aims to summarise the evidence regarding the relationship between characteristics of drug therapy (pharmacotherapy) and medication non-adherence in the CVD population. METHODS Systematic searches in PubMed, LILACS, Academic Search and CINAHL databases for observational studies that enrolled adults with CVD were performed, from January 1960 to December 2015. The meta-analysis tested the association between characteristics of pharmacotherapy and self-reported medication non-adherence outcome, using a random effects model. To investigate heterogeneity, we performed subgroup analysis and sensitivity analysis. RESULTS Twenty-four cross-sectional studies and 7 cohort studies were included in this review. Based on 31 studies including 27 441 participants, we performed meta-analyses for all the characteristics of drug therapy that at least 2 studies evaluated, with a total of fourteen meta-analyses. The pooled results showed that studies which evaluate whether participants have insurance or another program that assists with medication costs, but not full coverage (OR = 0.63; 95% CI: 0.53-0.74; P < .001; I2 = 0%, P = .938), and a dosing frequency of twice or more daily (OR = 1.38; 95% CI: 1.13-1.69; P < .001) were associated with non-adherence. CONCLUSIONS AND RELEVANCE The results of this review suggest that access to insurance or another program that assists with medication costs was a protection factor for non-adherence. On the other hand, a high frequency of dosing was a risk factor for non-adherence. Therefore, these characteristics of pharmacotherapy must be considered to improve medication adherence among CVD patients.
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Affiliation(s)
- Ana Paula Helfer Schneider
- Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brazil
- Department of Biology and Pharmacy, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
| | - Mari Ângela Gaedke
- Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brazil
- Department of Biology and Pharmacy, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
| | - Anderson Garcez
- Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brazil
| | - Nêmora Tregnago Barcellos
- Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brazil
| | - Vera Maria Vieira Paniz
- Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brazil
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