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Dean YE, Motawea KR, Shebl MA, Elawady SS, Nuhu K, Abuzuaiter B, Awayda K, Fouad AM, Tanas Y, Batista R, Elsayed A, Hassan NAIF, El‐Sakka AA, Hasan W, Husain R, Lois A, Arora A, Arora A, Ayad E, Elbahaie MA, Shah J, Shady A, Chaudhuri D, Aiash H. Adherence to antihypertensives in the United States: A comparative meta-analysis of 23 million patients. J Clin Hypertens (Greenwich) 2024; 26:303-313. [PMID: 38488773 PMCID: PMC11007819 DOI: 10.1111/jch.14788] [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: 09/22/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 04/12/2024]
Abstract
Adherence to antihypertensives is crucial for control of blood pressure. This study analyzed factors and interventions that could affect adherence to antihypertensives in the US. PubMed, Scopus, Web of Science, and Embase were searched on January 21, 2022 and December 25, 2023 for studies on the adherence to antihypertensives in the US. Nineteen studies and 23 545 747 patients were included in the analysis, which showed that adherence to antihypertensives was the highest among Whites (OR: 1.47, 95% CI 1.34-1.61 compared to African Americans). Employment status and sex were associated with insignificant differences in adherence rates. In contrast, marital status yielded a significant difference where unmarried patients demonstrated low adherence rates compared to married ones (OR: 0.8, 95% CI 0.67-0.95). On analysis of comorbidities, diabetic patients reported lower adherence to antihypertensives (OR: 0.95, 95% CI 0.92-0.97); furthermore, patients who did not have Alzheimer showed higher adherence rates. Different BMIs did not significantly affect the adherence rates. Patients without insurance reported significantly lower adherence rates than insured patients (OR: 3.93, 95% CI 3.43-4.51). Polypill users had higher adherence rates compared with the free-dose combination (OR: 1.21, 95% CI 1.2-1.21), while telepharmacy did not prove to be as effective. Lower adherence rates were seen among African Americans, uninsured, or younger patients. Accordingly, interventions such as fixed-dose combinations should be targeted at susceptible groups. Obesity and overweight did not affect the adherence to antihypertensives.
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Affiliation(s)
- Yomna E. Dean
- Faculty of MedicineAlexandria UniversityAlexandriaEgypt
| | | | | | | | | | | | | | | | - Yousef Tanas
- Faculty of MedicineAlexandria UniversityAlexandriaEgypt
| | | | - Ahmed Elsayed
- Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
| | | | | | - Walaa Hasan
- Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
| | | | - Amanda Lois
- Medical University of South CarolinaCharlestonUSA
| | | | | | | | | | | | - Amr Shady
- SUNY Upstate Medical UniversitySyracuseUSA
| | | | - Hani Aiash
- SUNY Upstate Medical UniversitySyracuseUSA
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Stamoulis T, Dragioti E, Gouva M, Mantzoukas S, Κourakos M. Unveiling the Nexus: Depressive Symptoms and Medication Adherence in Hypertensive Patients' Self-care: A Systematic Review. Mater Sociomed 2024; 36:65-72. [PMID: 38590593 PMCID: PMC10999142 DOI: 10.5455/msm.2024.36.65-72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/25/2024] [Indexed: 04/10/2024] Open
Abstract
Background Hypertension, a significant public health concern, is frequently linked to emotional disorders like depression. Research shows a reciprocal link between depression and hypertension, potentially influencing patients' adherence to self-care routines. Objective This systematic review aimed to examine the association between depressive symptoms and aspects of self-care, with a focus on medication adherence in individuals diagnosed with hypertension. Methods Following PRISMA guidelines, a systematic review was conducted by searching PubMed, PsycINFO and Scopus until March 17, 2023. The included studies involved quantitative primary research conducted in English, focusing on adults (≥18 years) diagnosed with hypertension and experiencing depressive symptoms. Observational studies were assessed using the Newcastle-Ottawa Scale, and randomized controlled trials were evaluated using the revised Cochrane Risk of Bias Tool (RoB 2.0). Due to the great diversity of these studies, a narrative synthesis of the results was undertaken. Results: A total of 18 studies involving 6,131 people with hypertension, that met our eligibility criteria were ultimately included. The reported rates of depressive symptoms ranged from 4% to 43%. Of these studies, nine reported a statistically significant association, showcasing an adverse impact of depressive symptoms on medication adherence. The remaining nine did not confirm the above. Conclusion This systematic review highlights the diverse body of research exploring depressive symptoms and medication adherence among individuals with hypertension. The review suggests a need for increased attention to self-care practices, particularly in relation to adherence to antihypertensive medication. However, it recommends the conduction of more robust longitudinal studies to comprehensively explore this relationship.
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Affiliation(s)
- Theofilos Stamoulis
- Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina
| | - Elena Dragioti
- Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina
| | - Mary Gouva
- Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina
| | - Stefanos Mantzoukas
- Research Laboratory of Integrated Health, Care and Well-being, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina
| | - Michael Κourakos
- Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina
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Phillips AZ, Kiefe CI, Lewis CE, Schreiner PJ, Tajeu GS, Carnethon MR. Alcohol Use and Blood Pressure Among Adults with Hypertension: the Mediating Roles of Health Behaviors. J Gen Intern Med 2022; 37:3388-3395. [PMID: 35212874 PMCID: PMC9551008 DOI: 10.1007/s11606-021-07375-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Alcohol use is associated with increased blood pressure among adults with hypertension, but it is unknown whether some of the observed relationship is explained by mediating behaviors related to alcohol use. OBJECTIVE We assess the potential indirect role of smoking, physical inactivity, unhealthy diet, and poor medication adherence on the association between alcohol use and blood pressure among Black and White men and women with hypertension. DESIGN Adjusted repeated-measures analyses using generalized estimating equations and mediation analyses using inverse odds ratio weighting. PARTICIPANTS 1835 participants with hypertension based on ACC/AHA 2017 guidelines in three most recent follow-up exams of the longitudinal Coronary Artery Risk Development in Young Adults cohort study (2005-2016). MAIN MEASURES Alcohol use was assessed using both self-reported average ethanol intake (drinks/day) and engagement in heavy episodic drinking (HED) in the past 30 days. Systolic and diastolic blood pressure (SBP, DBP) were measured by trained technicians (mmHg). Smoking, physical inactivity, and diet were self-reported and categorized according to American Heart Association criteria, and medication adherence was assessed using self-reported typical adherence to antihypertensive medications. KEY RESULTS At baseline (2005-2006), 57.9% of participants were Black and 51.4% were women. Mean age (standard deviation) was 45.5 (3.6) years, mean SBP was 128.7 (15.5) mmHg, and mean DBP was 83.2 (10.1) mmHg. Each additional drink per day was significantly associated with higher SBP (β = 0.713 mmHg, 95% confidence interval (CI): 0.398, 1.028) and DBP (β = 0.398 mmHg, 95% CI: 0.160, 0.555), but there was no evidence of mediation by any of the behaviors. HED was not associated with blood pressure independent of average consumption. CONCLUSIONS These findings support the direct nature of the association of alcohol use with blood pressure and the utility of advising patients with hypertension to limit consumption in addition to other behavioral and pharmacological interventions.
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Affiliation(s)
- Aryn Z Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, 1665 University Boulevard, Birmingham, AB, 35233, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Gabriel S Tajeu
- Department of Health Services Administration and Policy, Temple University College of Public Health, 1101 W. Montgomery Avenue, Philadelphia, PA, 19122, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
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Sims KD, Batty GD, Smit E, Hystad PW, McGregor JC, Odden MC. Discrimination, Mediating Psychosocial or Economic Factors, and Antihypertensive Treatment: A 4-Way Decomposition Analysis in the Health and Retirement Study. Am J Epidemiol 2022; 191:1710-1721. [PMID: 35689640 DOI: 10.1093/aje/kwac102] [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: 08/25/2021] [Revised: 04/20/2022] [Accepted: 06/07/2022] [Indexed: 01/29/2023] Open
Abstract
Untested psychosocial or economic factors mediate associations between perceived discrimination and suboptimal antihypertensive therapy. This study included 2 waves of data from Health and Retirement Study participants with self-reported hypertension (n = 8,557, 75% non-Hispanic White, 15% non-Hispanic Black, and 10% Hispanic/Latino) over 4 years (baselines of 2008 and 2010, United States). Our primary exposures were frequency of experiencing discrimination, in everyday life or across 7 lifetime circumstances. Candidate mediators were self-reported depressive symptoms, subjective social standing, and household wealth. We evaluated with causal mediation methods the interactive and mediating associations between each discrimination measure and reported antihypertensive use at the subsequent wave. In unmediated analyses, everyday (odds ratio (OR) = 0.86, 95% confidence interval (CI): 0.78, 0.95) and lifetime (OR = 0.91, 95% CI: 0.85, 0.98) discrimination were associated with a lower likelihood of antihypertensive use. Discrimination was associated with lower wealth, greater depressive symptoms, and decreased subjective social standing. Estimates for associations due to neither interaction nor mediation resembled unmediated associations for most discrimination-mediator combinations. Lifetime discrimination was indirectly associated with reduced antihypertensive use via depressive symptomatology (OR = 0.99, 95% CI: 0.98, 1.00). In conclusion, the impact of lifetime discrimination on the underuse of antihypertensive therapy appears partially mediated by depressive symptoms.
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Varadarajan V, Ibe CA, Young JH. Effect of substance use on premature mortality among severely hypertensive African Americans. J Clin Hypertens (Greenwich) 2022; 24:475-482. [PMID: 35257472 PMCID: PMC8989759 DOI: 10.1111/jch.14420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 11/29/2022]
Abstract
Low‐income African Americans residing in impoverished neighborhoods confront myriad barriers to adhering to antihypertensive regimens. Substance use may thwart medication adherence and lifestyle modification efforts, which has implications for excess cardiovascular disease mortality. The Inner‐City Hypertension and Body Organ Damage (ICHABOD) Study was a longitudinal cohort study that evaluated causes of mortality among African Americans who lived in urban areas, had severe, poorly controlled hypertension, and were admitted to a local hospital between 1999–2001 and 2002–2004. The authors employed Cox proportional hazards models to assess mortality associated with illicit substance use, including use of heroin and cocaine, as well as by use of tobacco and alcohol. Among192 participants with poorly controlled hypertension, 30% were active illicit substance users (specifically, 22.7% heroin users, 19.8% were cocaine users, and 30.7% were both cocaine and heroin users). The mean age among substance non‐users was 52.3 years versus 48.7 years among those reporting current use. Mortality over 7.6 years of follow‐up was 52.5% among substance users and 33.8% among nonusers (p‐value, 0.01). After adjusting for potential confounders, the hazard ratio (HR) for cocaine use was 2.52 (95% confidence interval (CI) 1.38–4.59), while the HR for heroin use was 2.47 (95% CI 1.42–4.28) and the HR for both was 2.75 (95% CI 1.60–4.73). Substance use was associated with increased mortality among urban black Americans with poorly controlled hypertension. These data suggest the need for targeted interventions to support African Americans who have poorly controlled hypertension and use illicit substances, as a means of reducing excess mortality.
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Affiliation(s)
- Vinithra Varadarajan
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chidinma A Ibe
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - J Hunter Young
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Medicine, Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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WILDER ME, ZHENG Z, ZEGER SL, ELMI A, KATZ RJ, LI Y, MCCARTHY ML. Relationship Between Social Determinants of Health and Antihypertensive Medication Adherence in a Medicaid Cohort. Circ Cardiovasc Qual Outcomes 2022; 15:e008150. [PMID: 35098730 PMCID: PMC8847233 DOI: 10.1161/circoutcomes.121.008150] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Little is known about the relationship between social determinants of health (SDH) and medication adherence among Medicaid beneficiaries with hypertension. METHODS We conducted a posthoc subgroup analysis of 3044 adult Medicaid beneficiaries who enrolled in a parent prospective cohort study and had a diagnosis of hypertension based on their Medicaid claims during a 24-month period before study enrollment. We calculated the proportion of days covered by at least one antihypertensive medication during the first 12 months after study enrollment using the prescription claims data. We measured numerous SDH at the time of study enrollment and we categorized our hypertension cohort into 4 social risk groups based on their response profiles to the SDH variables. We compared the mean proportion of days covered by the different levels of the SDH factors. We modeled the odds of being covered by an antihypertensive medication daily throughout the follow-up period by social risk group, adjusted for age, sex, and disease severity using a generalized linear model. RESULTS The nonrandom sample was predominately Black (93%), female (62%) and had completed high school (77%). The mean proportion of days covered varied significantly by different SDH, such as food insecurity (49%-56%), length of time living at present place (47%-57%), smoking status (50%-56%), etc. Social risk group was a significant predictor of medication adherence. Participants in the 2 groups with the most social risks were 36% (adjusted odds ratio=0.64 [95% CI, 0.53-0.78]) and 20% (adjusted odds ratio=0.80 [95% CI, 0.70-0.93]) less adherent to their hypertension therapy compared with participants in the group with the fewest social risks. CONCLUSIONS Social risks are associated with lower antihypertensive medication adherence in the Medicaid population.
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Affiliation(s)
- Marcee E. WILDER
- Department of Emergency Medicine, The George Washington University, Medical Faculty Associates, Washington, DC
| | - Zhanonian ZHENG
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Scott L. ZEGER
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Angelo ELMI
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Richard J. KATZ
- Division of Cardiology, George Washington Heart and Vascular Institute, The George Washington University, Medical Faculty Associates, Washington, DC
| | - Yixuan LI
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Melissa L. MCCARTHY
- Department of Emergency Medicine, The George Washington University, Medical Faculty Associates, Washington, DC,Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
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Spikes T, Higgins M, Clark P, Quyyumi A, Reilly C, Pemu P, Dunbar S. The Relationship Among Health Beliefs, Depressive Symptoms, Medication Adherence, and Social Support in African Americans With Hypertension. J Cardiovasc Nurs 2020; 34:44-51. [PMID: 30273259 PMCID: PMC6752722 DOI: 10.1097/jcn.0000000000000519] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND African Americans are disproportionately affected by hypertension and have lower medication adherence when compared to other racial groups. Antecedent factors such as beliefs surrounding hypertension, the presence or absence of social support, and depressive symptoms have not been extensively studied collectively in relation to hypertension medication adherence in African Americans. OBJECTIVE To determine the associations among demographic and clinical factors, depressive symptoms, hypertension beliefs, and social support with blood pressure medication adherence in middle-aged African American adults with a diagnosis of hypertension. METHODS A cross-sectional study of (N = 120) African Americans (mean age, 49 years; 22.5% men) with a current diagnosis of metabolic syndrome, including hypertension, who reported having and taking a prescribed blood pressure-lowering medication were included. Descriptive statistics, bivariate correlation analysis, and logistic regression using odds ratio were used to examine the effects of high blood pressure beliefs, social support, and depression on medication adherence. RESULTS A small but significant relationship was found between medication adherence and number of comorbidities (r = 0.19, P = .04). In a multivariate regression model, after controlling for gender, comorbidities remained associated with medication adherence (β = 0. 77, P = .04). Depressive symptoms, high blood pressure beliefs, and social support did not have a significant relationship with medication adherence. CONCLUSIONS Multiple comorbidities may have a positive impact upon medication adherence. Further study is needed in a larger sample of African Americans who have a diagnosis of hypertension in addition to other comorbidities requiring medication management.
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Affiliation(s)
- Telisa Spikes
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd. NE Atlanta, GA 30322-4027 , 404-493-1161
| | - Melinda Higgins
- Nell Hodgson Woodruff, School of Nursing, Emory University, 1520 Clifton Rd, NE Atlanta, GA 30322-4027, office# 260 ; (office): 404-727-5180
| | - Patricia Clark
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, 140 Decatur St, SE Atlanta, GA 30303, , (office): 404-413-1180 & (fax): 404-413-1205
| | - Arshed Quyyumi
- Emory Clinical Cardiovascular Research Institute, Emory University, 1462 Clifton Rd. NE, Atlanta, GA 30322-4027, Suite 507, ; (office): 404-727-3655 & (fax): 404-712-8785
| | - Carolyn Reilly
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, NE Atlanta, GA office# 366 30322-4027, ; (office): 404-727-9658
| | - Pricilla Pemu
- Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, ; (office): 404-616-8201
| | - Sandra Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, NE office 402B Atlanta, GA 30322-4027, ; (office): 404-727-6939
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McInnes DK, Shimada SL, Midboe AM, Nazi KM, Zhao S, Wu J, Garvey CM, Houston TK. Patient Use of Electronic Prescription Refill and Secure Messaging and Its Association With Undetectable HIV Viral Load: A Retrospective Cohort Study. J Med Internet Res 2017; 19:e34. [PMID: 28202428 PMCID: PMC5332835 DOI: 10.2196/jmir.6932] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Electronic personal health records (PHRs) can support patient self-management of chronic conditions. Managing human immunodeficiency virus (HIV) viral load, through taking antiretroviral therapy (ART) is crucial to long term survival of persons with HIV. Many persons with HIV have difficulty adhering to their ART over long periods of time. PHRs contribute to chronic disease self-care and may help persons with HIV remain adherent to ART. Proportionally veterans with HIV are among the most active users of the US Department of Veterans Affairs (VA) PHR, called My HealtheVet. Little is known about whether the use of the PHR is associated with improved HIV outcomes in this population. OBJECTIVE The objective of this study was to investigate whether there are associations between the use of PHR tools (electronic prescription refill and secure messaging [SM] with providers) and HIV viral load in US veterans. METHODS We conducted a retrospective cohort study using data from the VA's electronic health record (EHR) and the PHR. We identified veterans in VA care from 2009-2012 who had HIV and who used the PHR. We examined which ones had achieved the positive outcome of suppressed HIV viral load, and whether achievement of this outcome was associated with electronic prescription refill or SM. From 18,913 veterans with HIV, there were 3374 who both had a detectable viral load in 2009 and who had had a follow-up viral load test in 2012. To assess relationships between electronic prescription refill and viral control, and SM and viral control, we fit a series of multivariable generalized estimating equation models, accounting for clustering in VA facilities. We adjusted for patient demographic and clinical characteristics associated with portal use. In the initial models, the predictor variables were included in dichotomous format. Subsequently, to evaluate a potential dose-effect, the predictor variables were included as ordinal variables. RESULTS Among our sample of 3374 veterans with HIV who received VA care from 2009-2012, those who had transitioned from detectable HIV viral load in 2009 to undetectable viral load in 2012 tended to be older (P=.004), more likely to be white (P<.001), and less likely to have a substance use disorder, problem alcohol use, or psychosis (P=.006, P=.03, P=.004, respectively). There was a statistically significant positive association between use of electronic prescription refill and change in HIV viral load status from 2009-2012, from detectable to undetectable (OR 1.36, CI 1.11-1.66). There was a similar association between SM use and viral load status, but without achieving statistical significance (OR 1.28, CI 0.89-1.85). Analyses did not demonstrate a dose-response of prescription refill or SM use for change in viral load. CONCLUSIONS PHR use, specifically use of electronic prescription refill, was associated with greater control of HIV. Additional studies are needed to understand the mechanisms by which this may be occurring.
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Affiliation(s)
- D Keith McInnes
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
- Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Amanda M Midboe
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Kim M Nazi
- Veterans and Consumers Health Informatics Office, Office of Connected Care, Veterans Health Administration, Washington, DC, United States
| | - Shibei Zhao
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Justina Wu
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Casey M Garvey
- School of Nursing, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Thomas K Houston
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
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Son YJ, Won MH. Depression and medication adherence among older Korean patients with hypertension: Mediating role of self-efficacy. Int J Nurs Pract 2017; 23. [PMID: 28194846 DOI: 10.1111/ijn.12525] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/24/2016] [Accepted: 12/10/2016] [Indexed: 12/21/2022]
Abstract
Many studies have reported the negative effects of depression on adherence to antihypertensive medication. However, little is known about the mechanism underlying this relationship in elderly patients with hypertension. The aim of this cross-sectional study is to examine the mediating role of self-efficacy in the relationship between depression and medication adherence among older patients with hypertension. The data were collected from October to December 2014. A total of 255 older patients with hypertension were assessed using the Geriatric Depression Scale, the Self-efficacy for Appropriate Medication Use Scale, and the Morisky Medication Adherence Scale. Hierarchical linear regression analysis and the Sobel test were used to examine the mediating role of self-efficacy in the relationship between depression and medication adherence. Depression and self-efficacy were statistically significant predictors of medication adherence in older patients with hypertension. Self-efficacy partially mediated the relationship between depression and medication adherence. Interventions targeting self-efficacy could increase the confidence of patients in their ability to actively take their medicines. Moreover, health care providers should be aware of the importance of early detection of depression in older patients with hypertension. Future studies with longitudinal data are warranted to clarify the multidirectional relationships between depression, self-efficacy, and medication adherence.
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Affiliation(s)
- Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Mi Hwa Won
- College of Nursing, Dankook University, Cheonan, Korea
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Salinas JJ, Heyman JM, Brown LD. Financial Barriers to Health Care Among Mexican Americans With Chronic Disease and Depression or Anxiety in El Paso, Texas. J Transcult Nurs 2016; 28:488-495. [PMID: 27460753 DOI: 10.1177/1043659616660362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To determine the barriers to health care access by chronic disease and depression/anxiety diagnosis in Mexican Americans living in El Paso, TX. DESIGN A secondary analysis was conducted using data for 1,002 Hispanics from El Paso, TX (2009-2010). Logistic regression was conducted for financial barriers by number of chronic conditions and depression/anxiety diagnosis. Interaction models were conducted between number of chronic conditions and depression or anxiety. RESULTS Depressed/anxious individuals reported more financial barriers than those with chronic conditions alone. There were significant interactions between number of chronic conditions and depression/anxiety for cost, denied treatment because of an inability to pay, and an inability to pay $25 for health care. CONCLUSION Financial barriers should be considered to maintain optimal care for both mental and physical health in this population. IMPLICATIONS FOR PRACTICE There should be more focus on the impact of depression or anxiety as financial barriers to compliance.
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Affiliation(s)
- Jennifer J Salinas
- 1 University of Texas Health Science Center at Houston School of Public Health, El Paso Regional Campus., El Paso, TX, USA
| | | | - Louis D Brown
- 1 University of Texas Health Science Center at Houston School of Public Health, El Paso Regional Campus., El Paso, TX, USA
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Boutin-Foster C, Offidani E, Kanna B, Ogedegbe G, Ravenell J, Scott E, Rodriguez A, Ramos R, Michelen W, Gerber LM, Charlson M. Results from the Trial Using Motivational Interviewing, Positive Affect, and Self-Affirmation in African Americans with Hypertension (TRIUMPH). Ethn Dis 2016; 26:51-60. [PMID: 26843796 DOI: 10.18865/ed.26.1.51] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Our objective was to determine the effectiveness of combining positive affect and self-affirmation strategies with motivational interviewing in achieving blood pressure control among hypertensive African Americans (AA) compared with AA hypertensives in an education-only control group. DESIGN Randomized trial. SETTING Ambulatory practices in the South Bronx and Harlem, New York City. PARTICIPANTS African American adults with uncontrolled hypertension. INTERVENTIONS Participants were randomized to a positive affect and self-affirmation intervention or an education control group. The positive affect and self-affirmation intervention involved having participants think about things that made them happy and that reminded them of their core values on a daily basis. These strategies were reinforced every two months through motivational interviewing. The control arm received a workbook of strategies on blood pressure control. All participants were called every two months for one year. MAIN OUTCOMES Blood pressure control rate. RESULTS A total of 238 participants were randomized. The average age was 56 ± 11 years, approximately 70% were female, 80% were not married, and up to 70% had completed high school. There was no difference in control rates between the intervention and the control group. However, at one year, female participants were more likely to be controlled. Participants with high depressive symptoms or high perceived stress at baseline were less likely to be controlled. CONCLUSIONS While this study did not demonstrate an intervention effect, it does provide important insight into the psychosocial factors that may underlie blood pressure control in African Americans. Implications for future behavioral intervention trials are discussed.
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Affiliation(s)
| | | | | | | | - Joseph Ravenell
- New York University School of Medicine, Department of Population Health
| | | | | | - Rosio Ramos
- Weill Cornell Medical College, Department of Medicine
| | | | - Linda M Gerber
- Weill Cornell Medical College, Department of Healthcare Policy and Research
| | - Mary Charlson
- Weill Cornell Medical College, Department of Medicine
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Dharmarajan TS, Dharmarajan L. Tolerability of Antihypertensive Medications in Older Adults. Drugs Aging 2015; 32:773-96. [DOI: 10.1007/s40266-015-0296-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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13
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Affiliation(s)
- Paul K. Whelton
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112;
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14
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Schmittdiel JA, Dyer W, Uratsu C, Magid DJ, O'Connor PJ, Beck A, Butler M, Ho MP, Vazquez‐Benitez G, Adams AS. Initial persistence with antihypertensive therapies is associated with depression treatment persistence, but not depression. J Clin Hypertens (Greenwich) 2014; 16:412-7. [PMID: 24716533 PMCID: PMC4061252 DOI: 10.1111/jch.12300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 01/28/2014] [Accepted: 02/02/2014] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to examine the relationship between the presence of clinical depression and persistence to drug therapy treatment for depression with early nonpersistence to antihypertensive therapies in a large, diverse cohort of newly treated hypertension patients. Using a hypertension registry at Kaiser Permanente Northern California, the authors conducted a retrospective cohort study of 44,167 adults (18 years and older) with hypertension who were new users of antihypertensive therapy in 2008. We used multivariate logistic regression analysis to model the relationships between the presence of clinical depression and early nonpersistence (defined as failing to refill the first prescription within 90 days after the end of the first fill days' supply) to antihypertensive therapies, controlling for sociodemographic and clinical risk factors. Within the group of 1484 patients who had evidence of clinical depression in the 12 months prior to the initiation of antihypertensive therapy, the authors examined the relationship between drug therapy treatment for depression and 6-month persistence with antidepressant therapy with early nonpersistence with antihypertensive therapies. No association was found between the presence of clinical depression and early nonpersistence to antihypertensive therapies after adjustment for individual demographic and clinical characteristics and neighborhood-level socioeconomic status. However, among the subset of 1484 patients with documented evidence of clinical depression in the 12 months prior to the initiation of antihypertensive therapy, being prescribed and persistence with antidepressant therapy was strongly associated with lower odds of early nonpersistence to antihypertensive medications (odds ratio, 0.64; confidence interval, 0.42-0.96). In an integrated delivery system, the authors found that treatment for depression was associated with higher levels of antihypertensive persistence. Improving quality of depression care in patients with comorbid hypertension may be an important strategy in decreasing cardiovascular disease risk in these patients.
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Affiliation(s)
| | - Wendy Dyer
- Kaiser Permanente Division of ResearchOaklandCA
| | | | - David J. Magid
- Institute for ResearchKaiser PermanenteDenverCO
- University of ColoradoDenverCO
| | | | - Arne Beck
- Institute for ResearchKaiser PermanenteDenverCO
| | - Melissa Butler
- Kaiser Permanente Center for Health Research SoutheastAtlantaGA
| | - Michael P. Ho
- Institute for ResearchKaiser PermanenteDenverCO
- University of ColoradoDenverCO
- Denver VA Medical CenterDenverCO
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