1
|
Al-Noumani H, Wu JR, Barksdale D, Sherwood G, AlKhasawneh E, Knafl G. Health beliefs and medication adherence in patients with hypertension: A systematic review of quantitative studies. PATIENT EDUCATION AND COUNSELING 2019; 102:1045-1056. [PMID: 30846205 DOI: 10.1016/j.pec.2019.02.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 02/20/2019] [Accepted: 02/22/2019] [Indexed: 05/23/2023]
Abstract
OBJECTIVE This review synthesizes findings of quantitative studies examining the relationship between health beliefs and medication adherence in hypertension. METHODS This review included published studies in PubMed, CINHAL, EMBASE, and PsycINFO databases. Studies were included if they examined beliefs of patients with hypertension. Quality of the studies was evaluated using the Quality Assessment Tool for Systematic Review of Observational Studies. RESULTS Of the 1558 articles searched, 30 articles were included in the analysis. Most beliefs examined by studies of this review in relation to medication adherence were beliefs related to hypertension severity and susceptibility to its consequences, medication effectiveness or necessity, and barriers to medication adherence. Higher medication adherence was significantly related to fewer perceived barriers to adherence (e.g, side-effects) was fairly consistent across studies. Higher self-efficacy was related to higher medication adherence. Patients' beliefs and their relationship to medication adherence appear to vary unpredictably across and within countries. CONCLUSION Clinicians should assess beliefs for individual patients. When individual beliefs appear likely to undermine adherence, it may be useful to undertake educational interventions to try to modify them. PRACTICAL IMPLICATIONS Clinicians should explore individual patients' beliefs about hypertension and blood pressure medications, discuss their implications for medication adherence, and try to modify counterproductive beliefs.
Collapse
Affiliation(s)
| | - Jia-Rong Wu
- School of Nursing, University of North Carolina at Chapel Hill, NC, USA
| | - Debra Barksdale
- School of Nursing, Virginia Commonwealth University, VA, USA
| | - Gwen Sherwood
- School of Nursing, University of North Carolina at Chapel Hill, NC, USA
| | | | - George Knafl
- School of Nursing, University of North Carolina at Chapel Hill, NC, USA
| |
Collapse
|
2
|
Tola HH, Karimi M, Yekaninejad MS. Effects of sociodemographic characteristics and patients' health beliefs on tuberculosis treatment adherence in Ethiopia: a structural equation modelling approach. Infect Dis Poverty 2017; 6:167. [PMID: 29241454 PMCID: PMC5731079 DOI: 10.1186/s40249-017-0380-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 11/30/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Patients' beliefs are a major factor affecting tuberculosis (TB) treatment adherence. However, there has been little use of Health Belief Model (HBM) in determining the pathway effect of patients' sociodemographic characteristics and beliefs on TB treatment adherence. Therefore, this study was aimed at determining the effect of sociodemographic characteristics and patients' health beliefs on TB treatment adherence based on the HBM concept in Ethiopia. METHODS A cross-sectional study was conducted in Addis Ababa, Ethiopia among TB patients undertaking treatment. Thirty health centres were randomly selected and one hospital was purposely chosen. Six hundred and ninety-eight TB patients who had been on treatment for 1-2 month, were aged 18 years or above, and had the mental capability to provide consent were enrolled consecutively with non-probability sampling technique from the TB registration book until required sample size achieved. Structured questionnaires were used to collect data. Structural equation modelling was employed to assess the pathway relationship between sociodemographic characteristics, patients' beliefs, and treatment adherence. RESULTS Of the 698 enrolled participants, 401 (57.4%) were male and 490 (70.2%) were aged 35 years and below. The mean age of participants was 32 (± 11.7) and the age range was 18-90 years. Perceived barrier/benefit was shown to be a significant direct negative effect on TB treatment adherence (ß = -0.124, P = 0.032). In addition, cue to action (ß = -0.68, P ≤ 0.001) and psychological distress (ß = 0.08, P < 0.001) were shown significant indirect effects on TB treatment adherence through perceived barrier/benefit. CONCLUSIONS Interventions intended to decrease perceived barriers and maximize perceived benefits should be implemented to enhance TB treatment adherence. In addition, it is crucial that counselling is incorporated with the regular directly observed therapy program. Motivators (cue to actions) such as friends, family, healthcare workers, and the media could be used to promote TB treatment adherence.
Collapse
Affiliation(s)
- Habteyes Hailu Tola
- Department of Epidemiology and Biostatics, School of Public Health, Tehran University of Medical Sciences, International Campus, Tehran, Iran
- Tuberculosis/HIV Research Directorate, Ethiopian Public Health Institute, P.O. Box 1242, /5654 Addis Ababa, Ethiopia
| | - Mehrdad Karimi
- Department of Epidemiology and Biostatics, School of Public Health, Tehran University of Medical Sciences, International Campus, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatics, School of Public Health, Tehran University of Medical Sciences, International Campus, Tehran, Iran
| |
Collapse
|
3
|
|
4
|
McKay DL, Berkowitz JM, Blumberg JB, Goldberg JP. Communicating Cardiovascular Disease Risk Due to Elevated Homocysteine Levels: Using the EPPM to Develop Print Materials. HEALTH EDUCATION & BEHAVIOR 2016; 31:355-71. [PMID: 15155045 DOI: 10.1177/1090198104263353] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Improving the effectiveness of written information to promote compliance with therapeutic regimens is essential, particularly among older adults. Guiding their development and evaluating their effectiveness with an accepted communication theory or model may help. A preliminary test of written materials developed within the context of the Extended Parallel Process Model (EPPM) to motivate compliant behaviors among older adults at risk for cardiovascular disease is described. Participants who were not previously following the recommendations felt more confident in their ability to do so after reading a high-threat/high-efficacy message. Advanced age, lower education level, an existing chronic illness, and a higher initial homocysteine level were factors associated with lower levels of perceived threat and/or fear and may have attenuated the effectiveness of the message. This study’s results contribute to our understanding of the usefulness of theory-guided written materials in motivating compliant health behaviors. Recommendations for using this model are provided.
Collapse
Affiliation(s)
- Diane L McKay
- Antioxidants Research Laboratory, USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts 02111, USA.
| | | | | | | |
Collapse
|
5
|
Morrison VL, Holmes EAF, Parveen S, Plumpton CO, Clyne W, De Geest S, Dobbels F, Vrijens B, Kardas P, Hughes DA. Predictors of self-reported adherence to antihypertensive medicines: a multinational, cross-sectional survey. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:206-216. [PMID: 25773556 DOI: 10.1016/j.jval.2014.12.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 11/27/2014] [Accepted: 12/10/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Nonadherence to antihypertensive medicines limits their effectiveness, increases the risk of adverse health outcome, and is associated with significant health care costs. The multiple causes of nonadherence differ both within and between patients and are influenced by patients' care settings. OBJECTIVES The objective of this article was to identify determinants of patient nonadherence to antihypertensive medicines, drawing from psychosocial and economic models of behavior. METHODS Outpatients with hypertension from Austria, Belgium, England, Germany, Greece, Hungary, The Netherlands, Poland, and Wales were recruited to a cross-sectional online survey. Nonadherence to medicines was assessed using the Morisky Medication Adherence Scale (primary outcome) and the Medication Adherence Rating Scale. Associations with adherence and nonadherence were tested for demographic, clinical, and psychosocial factors. RESULTS A total of 2595 patients completed the questionnaire. The percentage of patients classed as nonadherent ranged from 24% in The Netherlands to 70% in Hungary. Low age, low self-efficacy, and respondents' perceptions of their illness and cost-related barriers were associated with nonadherence measured on the Morisky Medication Adherence Scale across several countries. In multilevel, multivariate analysis, low self-efficacy (odds ratio = 0.73; 95% confidence interval 0.70-0.77) and a high number of perceived barriers to taking medicines (odds ratio = 1.70; 95% confidence interval 1.38-2.09) were the main significant determinants of nonadherence. Country differences explained 11% of the variance in nonadherence. CONCLUSIONS Among the variables measured, patients' adherence to antihypertensive medicines is influenced primarily by their self-efficacy, illness beliefs, and perceived barriers. These should be targets for interventions for improving adherence, as should an appreciation of differences among the countries in which they are being delivered.
Collapse
Affiliation(s)
| | - Emily A F Holmes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | | | - Catrin O Plumpton
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | | | | | | | | | | | - Dyfrig A Hughes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK.
| |
Collapse
|
6
|
Holmes EAF, Hughes DA, Morrison VL. Predicting adherence to medications using health psychology theories: a systematic review of 20 years of empirical research. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:863-876. [PMID: 25498782 DOI: 10.1016/j.jval.2014.08.2671] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 05/27/2014] [Accepted: 08/01/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This review sought to identify the empirical evidence for the application of models from sociocognitive theory, self-regulation theory, and social support theory at predicting patient adherence to medications. METHODS A systematic review of the published literature (1990-2010) using MEDLINE, EMBASE, Cochrane Library, CINAHL, and PsychINFO identified studies examining the application of health psychology theory to adherence to medication in adult patients. Two independent reviewers extracted data on medication, indication, study population, adherence measure, theory, model, survey instruments, and results. Heterogeneity in theoretical model specification and empirical investigation precluded a meta-analysis of data. RESULTS Of 1756 unique records, 67 articles were included (sociocognitive = 35, self-regulation = 21, social support = 11). Adherence was most commonly measured by self-report (50 of 67). Synthesis of studies highlighted the significance (P ≤ 0.05) of self-efficacy (17 of 19), perceived barriers (11 of 17), perceived susceptibility (3 of 6), necessity beliefs (8 of 9), and medication concerns (7 of 8). CONCLUSIONS The results of this review provide a foundation for the development of theory-led adherence-enhancing interventions that could promote sustainable behavior change in clinical practice.
Collapse
|
7
|
Abstract
Uncontrolled hypertension imposes a substantial global health burden, and poor patient compliance with prescribed antihypertensive medication makes a major contribution to the development of suboptimal blood pressure (BP) control. The asymptomatic nature of hypertension, side effects of medication, treatment complexity, and high pill burdens all have a negative impact on patient compliance. It is important to address the issue of poor patient compliance as studies have shown that good compliance is associated with improvement of BP control and positive health outcomes. As the majority of hypertensive patients require treatment with two or more agents to achieve goal BP, treatment guidelines have acknowledged the value of simplifying treatment through the use of fixed-dose combination (FDC) therapy. Triple FDC therapy comprising an angiotensin II type 1 receptor antagonist (angiotensin receptor blocker), calcium channel blocker, and thiazide diuretic is a novel treatment strategy for the improvement of BP control in hard-to-treat patients.
Collapse
Affiliation(s)
- Serap Erdine
- Department of Cardiology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey.
| |
Collapse
|
8
|
Erdine S. How do Compliance, Convenience, and Tolerability Affect Blood Pressure Goal Rates? Am J Cardiovasc Drugs 2012. [DOI: 10.2165/11635450-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
9
|
Korb-Savoldelli V, Gillaizeau F, Pouchot J, Lenain E, Postel-Vinay N, Plouin PF, Durieux P, Sabatier B. Validation of a French Version of the 8-Item Morisky Medication Adherence Scale in Hypertensive Adults. J Clin Hypertens (Greenwich) 2012; 14:429-34. [DOI: 10.1111/j.1751-7176.2012.00634.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
10
|
Erdine S. Compliance with the treatment of hypertension: the potential of combination therapy. J Clin Hypertens (Greenwich) 2010; 12:40-6. [PMID: 20047629 DOI: 10.1111/j.1751-7176.2009.00200.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Patient adherence to antihypertensive medication is vital to ensure the successful treatment of hypertension. Low levels of adherence to and persistence with prescribed therapy are major factors leading to the current poor rates of blood pressure control among patients with hypertension. There are many reasons for nonadherence to therapy including patient-, physician-, and therapy-related factors. Poor tolerability has a detrimental effect on adherence, therefore reducing the apparent effectiveness of agents with dose-dependent side effects. Various effective combination therapies are recommended by current guidelines, eg, beta-blocker plus calcium channel blocker (CCB), angiotensin receptor blocker (ARB) plus thiazide diuretic, angiotensin-converting enzyme (ACE) inhibitor plus thiazide diuretic, CCB plus thiazide diuretic, ACE inhibitor plus CCB, and ARB plus CCB, and these have the potential to increase adherence to therapy by combining a favorable tolerability profile with once-daily dosing.
Collapse
Affiliation(s)
- Serap Erdine
- Department of Cardiology, Cerrahpaşa Medical School, University of Istanbul, Istanbul, Turkey.
| |
Collapse
|
11
|
Elliott JO, Lu B, Shneker BF, Moore JL, McAuley JW. The impact of 'social determinants of health' on epilepsy prevalence and reported medication use. Epilepsy Res 2009; 84:135-45. [PMID: 19233619 DOI: 10.1016/j.eplepsyres.2009.01.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 01/05/2009] [Accepted: 01/19/2009] [Indexed: 11/28/2022]
Abstract
There is a limited understanding of the complex relationship between poverty and epilepsy. To address the complex interaction of environmental and psychosocial factors in epilepsy a 'social determinants of health' model is presented where individual factors are influenced through three pathways (social environment, work and material factors). In the 2005 California Health Interview Survey, 246 of 604 (41%) persons with a history of epilepsy were in poverty, defined as <200% Federal Poverty Level (FPL). Multivariable logistic regression analyses revealed persons in poverty are not more likely to report a history of epilepsy compared to those not in poverty. However, persons with a history of epilepsy in poverty were significantly less likely than those not in poverty to report taking medication for epilepsy (OR 0.5) once material factors (annual income and living situation) and healthcare access were controlled for in the final sequential model. Healthcare practitioners must continue to recognize that connection to social services and the cost of medications are significant barriers to optimal care in persons with epilepsy. Improved connection to patient advocacy organizations and medication assistance programs may help close these gaps.
Collapse
Affiliation(s)
- John O Elliott
- The Ohio State University, Department of Neurology, 395 W 12th Avenue 7th Floor, Columbus, OH 43210, United States.
| | | | | | | | | |
Collapse
|
12
|
Wu JR, Chung M, Lennie TA, Hall LA, Moser DK. Testing the psychometric properties of the Medication Adherence Scale in patients with heart failure. Heart Lung 2009; 37:334-43. [PMID: 18790334 DOI: 10.1016/j.hrtlng.2007.10.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Many factors may contribute to medication nonadherence in heart failure (HF), but no standard measure exists to evaluate factors associated with nonadherence. To fill this gap, we developed the Medication Adherence Scale (MAS) and tested its reliability and validity in patients with HF. METHOD Questionnaire data were collected from 100 patients with HF at baseline using the MAS, and objective adherence data were collected for 3 consecutive months using the Medication Event Monitoring System. RESULTS Principal component analysis yielded three factors that explained 63% of the variance in medication adherence: knowledge, attitudes, and barriers to medication adherence. Cronbach's alphas for these subscales ranged from .75 to .94, which supported their internal consistency. The Spearman rho correlation coefficients between the Medication Event Monitoring System and Knowledge, Attitudes, and Barriers scores were .25 to .31 (P < .05), demonstrating support for construct validity. CONCLUSION These results support the reliability and validity of the MAS as a measure of knowledge, attitudes, and barriers of medication adherence.
Collapse
Affiliation(s)
- Jia-Rong Wu
- University of Kentucky, College of Nursing, Lexington, KY 40536-0232, USA
| | | | | | | | | |
Collapse
|
13
|
Al-Mehza AM, Al-Muhailije FA, Khalfan MM, Al-Yahya AA. Drug Compliance Among Hypertensive Patients; an Area Based Study. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2009. [DOI: 10.29333/ejgm/82628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
14
|
Foody JM, Joyce AT, Rudolph AE, Liu LZ, Benner JS. Persistence of atorvastatin and simvastatin among patients with and without prior cardiovascular diseases: a US managed care study. Curr Med Res Opin 2008; 24:1987-2000. [PMID: 18554430 DOI: 10.1185/03007990802203279] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In clinical practice, persistence with statin therapy is poor. While little is known about relative persistence to specific statins, previous studies have observed greater persistence in patients who achieve greater degrees of lipid lowering. Identification of statin therapies which improve patient persistence has the potential to improve the quality of patient care and clinical outcomes. Therefore, we assessed patient persistence with atorvastatin and simvastatin in primary and secondary prevention patients enrolled in managed care. METHODS New statin users aged > or =18 years, both with and without prior cardiovascular (CV) events within the 12 month pre-treatment period, were identified from a large national database of managed care patients. Patients initiated atorvastatin or simvastatin therapy from January 1, 2003 to September 30, 2005 and were continuously enrolled in a covered plan for at least 12 months before and after initiation of statin therapy. Subanalyses of patients > or =65 years were also conducted. Measures of interest included demographic and clinical characteristics of the study samples and persistence of statin utilization over the 1-year follow-up period. Persistence was defined as the number of days a patient remained on treatment in the first year following their index date, measured from the date of first fill to study end or the date of discontinuation. RESULTS A total of 129 764 atorvastatin users and 45 558 simvastatin users without prior CV events were included in the study. For those patients with prior CV events, a total of 6888 atorvastatin users and 4443 simvastatin users were included in the study. Median persistence in patients without prior CV events was 50 days longer for patients initiating therapy with atorvastatin than simvastatin (207 vs. 157 days, p<0.0001) and after adjusting for confounding factors, those treated with atorvastatin were 15% less likely to discontinue therapy during the first year than those treated with simvastatin (HR=0.85; 95% CI 0.84, 0.86; p<0.001). In secondary prevention patients median persistence was 85 days longer in atorvastatin patients than simvastatin patients (266 vs. 181 days, p<0.0001) and atorvastatin patients were 22% less likely to discontinue therapy (HR=0.78; 95% CI 0.75, 0.82; p<0.001). Persistence was worse in the elderly patients, but the relative difference between atorvastatin and simvastatin was similar to the overall patient population. CONCLUSIONS In patients with and without prior CV disease, persistence is generally poor, even worse in the elderly, but significantly better for atorvastatin patients than simvastatin patients (p<0.001). Further studies are required to determine whether this is due to differences in cost, effectiveness, side-effects, or other attributes of the statins. STUDY LIMITATIONS Differences in persistence could be, in part, due to unmeasured confounders although all available variables were adjusted in multivariate analyses. Additionally, the claims database lacks some clinical data such as lipid levels, limiting assessments of statin efficacy, and does not include any reasons for discontinuation of therapy.
Collapse
Affiliation(s)
- JoAnne M Foody
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02130, USA.
| | | | | | | | | |
Collapse
|
15
|
Wu JR, Moser DK, Chung ML, Lennie TA. Predictors of medication adherence using a multidimensional adherence model in patients with heart failure. J Card Fail 2008; 14:603-14. [PMID: 18722327 DOI: 10.1016/j.cardfail.2008.02.011] [Citation(s) in RCA: 150] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Revised: 02/12/2008] [Accepted: 02/25/2008] [Indexed: 01/19/2023]
Abstract
BACKGROUND Medication adherence in heart failure (HF) is a crucial but poorly understood phenomenon. The purpose of this study was to explore factors contributing to medication adherence in patients with HF by using the World Health Organization's multidimensional adherence model. METHODS AND RESULTS Patients (N = 134) with HF (70% were male, aged 61 +/- 12 years, 61% with New York Heart Association III/IV) were studied to determine the predictors of medication adherence derived from the multidimensional adherence model. Medication adherence was measured objectively using the medication event monitoring system for 3 months. Three indicators of adherence were assessed by the medication event monitoring system: 1) dose-count, the percentage of prescribed doses taken; 2) dose-days, the percentage of days the correct number of doses were taken; and 3) dose-time, the percentage of doses that were taken on schedule. Barriers to medication adherence, ethnicity, and perceived social support predicted dose-count (P < .001). New York Heart Association functional class, barriers to medication adherence, financial status, and perceived social support predicted dose-day (P < .001). Barriers to medication adherence and financial status predicted dose-time (P = .005). CONCLUSION A number of modifiable factors predicted medication adherence in patients with HF, providing specific targets for intervention.
Collapse
Affiliation(s)
- Jia-Rong Wu
- College of Nursing, University of Kentucky, Lexington, KY 40536-0232, USA
| | | | | | | |
Collapse
|
16
|
Albert NM. Switching to Once-Daily Evidence-Based β-Blockers in Patients With Systolic Heart Failure or Left Ventricular Dysfunction After Myocardial Infarction. Crit Care Nurse 2007. [DOI: 10.4037/ccn2007.27.6.62] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Nancy M. Albert
- Nancy M. Albert is director of nursing research and innovation in the Division of Nursing and a clinical nurse specialist in the George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, Ohio
| |
Collapse
|
17
|
Abstract
AIM To identify the health beliefs and patient characteristics associated with medication non-adherence in patients attending a heart failure outpatient clinic. METHODS A survey was administered to 350 consenting clinic patients. Questions focused on relevant demographic and clinical characteristics, the Health Belief Model, the Beliefs About Medicines Questionnaire and the Multidimensional Health Locus of Control. Multivariate logistic regression was used to identify independent predictors of refill non-adherence (<90%). RESULTS Refill non-adherence was found in 77 (22%) participants. Being a smoker [odds ratio (OR) 2.4, 95% confidence interval (CI) 1.0, 5.8, P = 0.045], two or fewer medication administration times (OR 2.4, 95% CI 1.2, 4.6, P = 0.01), and positive response to 'Have you changed your daily routine to accommodate your heart failure medication schedule' (OR 2.4, 95% CI 1.2, 4.5, P = 0.01) were the independent predictors of refill non-adherence. CONCLUSION Perceptions regarding barriers to medication taking and fewer administration times could result in medication non-adherence in congestive heart failure patients. Medication regimens should be designed after accounting for patients' existing routines.
Collapse
Affiliation(s)
- Johnson George
- School of Pharmacy, The Robert Gordon University, Aberdeen, UK.
| | | |
Collapse
|
18
|
Johnson SS, Driskell MM, Johnson JL, Prochaska JM, Zwick W, Prochaska JO. Efficacy of a Transtheoretical Model-Based Expert System For Antihypertensive Adherence. ACTA ACUST UNITED AC 2006; 9:291-301. [PMID: 17044763 DOI: 10.1089/dis.2006.9.291] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Blood pressure is not controlled in as many as 50%-75% of hypertensive patients, primarily because of inadequate adherence to treatment. This paper examines the efficacy of a Transtheoretical Model (TTM)-based expert system intervention designed to improve adherence with antihypertensives in a sample of 1,227 adults. Participants were proactively recruited and randomly assigned to receive usual care or three individualized expert system reports and a stage-matched manual over 6 months. Participants were surveyed at baseline, and 6, 12, and 18 months. Significantly more of the intervention group participants reported being in Action and Maintenance at follow-up time points (ie, 73.1% of the treatment group versus 57.6% of the control group at 12 months and 69.1% of the treatment group versus 59.2% of the control group at 18 months). Scores on a behavioral measure of nonadherence differed significantly at follow-up time points. TTM-based expert system interventions have the potential for a significant impact on entire populations of individuals who fail to adhere, regardless of their readiness to change.
Collapse
Affiliation(s)
- Sara S Johnson
- Pro-Change Behavior Systems, Inc., Kingston, Rhode Island, USA.
| | | | | | | | | | | |
Collapse
|
19
|
Lehane E, McCarthy G. Intentional and unintentional medication non-adherence: a comprehensive framework for clinical research and practice? A discussion paper. Int J Nurs Stud 2006; 44:1468-77. [PMID: 16973166 DOI: 10.1016/j.ijnurstu.2006.07.010] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 07/10/2006] [Accepted: 07/13/2006] [Indexed: 11/24/2022]
Abstract
Non-adherence to medications is a prevalent and persistent healthcare problem, particularly for patients with a chronic disorder. Researchers have endeavoured to address poor adherence for the past five decades resulting in the accumulation of a vast body of literature. Despite the enormity of research conducted, interventions to date have neither been cost-effective nor predictably clinically effective in enhancing medication adherence. Though concerning, such contemporary information serves to refocus attention on the adequacy of knowledge regarding the factors influencing medication non-adherence. Although little consensus exists regarding the optimal categorisation of these influencing factors, increasingly, the broad and 'all encompassing' categorisation of intentional and unintentional factors is being used to account for patient medication-taking behaviours and actions. An extensive review of the related literature provides the basis for a critical discussion on the value and comprehensiveness of this current classification in guiding future adherence research and consequent clinical interventions. An appraisal of this categorisation is important if decisions regarding interventions are not to be made in a vacuum of insufficient understanding, which would result in the continued ineffective use and distribution of valuable resources to combat non-adherence.
Collapse
Affiliation(s)
- Elaine Lehane
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, National University of Ireland, Cork, College Road, Cork, Ireland.
| | | |
Collapse
|
20
|
Hong TB, Oddone EZ, Dudley TK, Bosworth HB. Medication barriers and anti-hypertensive medication adherence: The moderating role of locus of control. PSYCHOL HEALTH MED 2006; 11:20-8. [PMID: 17129892 DOI: 10.1080/14786430500228580] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Locus of control as a moderator of the relationship between medication barriers (e.g., side-effects, forgetting to take medication, and keeping track of pills) and anti-hypertensive medication adherence was examined. Baseline data were obtained from 588 hypertensive veterans. In general, fewer medication barriers, higher internal locus of control and lower external locus of control was associated with better hypertensive medication adherence. Furthermore, internal locus of control served as a moderator (beta = -.74, p < .01) for the relationship between medication barriers and medication adherence; effect size was large. Decomposition of the interaction revealed that the relationship between medication barriers and medication adherence was strongest when internal control was high (b = -.24, p < .01). Higher internal locus of control was beneficial when barriers to medication adherence are low, but at high perceived barriers, locus of control plays less of a role in medication adherence. Future efforts to improve medication adherence should consider the patient's perceived level of medication barriers in conjunction with their locus of control.
Collapse
Affiliation(s)
- Tantina B Hong
- Center for Health Sciences Research in Primary Care, Durham Veterans Affairs Medial Center, North Carolina 27705, USA.
| | | | | | | |
Collapse
|
21
|
Benner JS, Pollack MF, Smith TW, Bullano MF, Willey VJ, Williams SA. Association between short-term effectiveness of statins and long-term adherence to lipid-lowering therapy. Am J Health Syst Pharm 2005; 62:1468-75. [PMID: 15998926 DOI: 10.2146/ajhp040419] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The relationship between low-density lipoprotein (LDL) cholesterol reduction in the first 3 months of statin therapy and medication adherence during a 33-month follow-up period was studied. METHODS A retrospective cohort study was conducted among enrollees in a Southeastern managed care plan who started therapy with atorvastatin, fluvastatin, lovastatin, pravastatin, or simvastatin between October 1999 and August 2001, were enrolled for > or =12 months before and > or =6 months after treatment initiation, and had at least one LDL cholesterol measurement in the year before and 4-12 weeks after the start of therapy. Patients were followed up via electronic pharmacy and medical records for up to 33 more months. The follow-up period was divided into 3-month intervals; patients were considered adherent if statin therapy was available > or =80% of the time. A generalized linear model for repeated measures quantified the association between change in LDL cholesterol at 4-12 weeks and medication adherence in subsequent intervals, adjusting for demographic, clinical, and health-service-use variables. RESULTS The final sample consisted of 9510 patients. Medication adherence decreased significantly over time: 59%, 40%, 34%, and 21% of patients were adherent at 3, 6, 12, and 36 months, respectively. Mean +/- S.D. LDL cholesterol reduction at 12 weeks was 28.9% +/- 19.9%. The relative LDL cholesterol reduction at 12 weeks was significantly and independently associated with subsequent medication adherence: Compared with subjects in the first quartile of LDL cholesterol reduction, those in quartiles 2, 3, and 4 were more likely to be adherent in any subsequent interval (adjusted odds ratio [95% confidence interval], 1.26 [1.12-1.42], 1.25 [1.11-1.40], and 1.15 [1.02-1.29], respectively). Other independent predictors of adherence in months 4-36 included adherence during the initial three months of therapy, age, and recent history of coronary revascularization. CONCLUSION Greater reduction in LDL cholesterol levels during the first three months of statin therapy was associated with greater adherence to lipid-lowering drug therapy.
Collapse
|
22
|
Seo MA, Min SK. Development of a structural model explaining medication compliance of persons with schizophrenia. Yonsei Med J 2005; 46:331-40. [PMID: 15988803 PMCID: PMC2815808 DOI: 10.3349/ymj.2005.46.3.331] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2004] [Accepted: 12/20/2004] [Indexed: 11/27/2022] Open
Abstract
The purpose of this study was to develop and test a structural model explaining medication compliance of schizophrenia. From a review of the literature, a hypothetical model was developed based on the conceptual framework of the Health Belief Model with medication knowledge, symptom severity and social support as the exogenous variables, and perceived benefits, perceived barriers, substance use and medication compliance as the endogenous variables. Data was collected at various mental health facilities, including psychiatric outpatient clinics of general hospitals and community mental health centers, between March and May, 2001. A structured questionnaire was used by one- on- one interviews to collect data on 208 schizophrenic patients. Well established measurement instruments, with confirmed reliability, were used to assess each method variable. As a result of covariance structural analysis, the hypothetical model was found not to fit the empirical data well, so a parsimonious model was adopted after modifying the model. The final model was able to explain the 33 % medication compliance. Medication knowledge, social support and perceived benefits had significant effects on medication compliance. The findings of this study address the importance of medication education and social support to promote medication compliance. It is also suggested that various education programs and support groups are needed to enhance medication compliance.
Collapse
Affiliation(s)
- Mi A Seo
- Department of Social Welfare, Seoul Cyber University, 193 Mia 3-dong, Gangbuk-gu, Seoul 142-711, Korea.
| | | |
Collapse
|
23
|
Fodor GJ, Kotrec M, Bacskai K, Dorner T, Lietava J, Sonkodi S, Rieder A, Turton P. Is interview a reliable method to verify the compliance with antihypertensive therapy? An international central-European study. J Hypertens 2005; 23:1261-6. [PMID: 15894903 DOI: 10.1097/01.hjh.0000170390.07321.ca] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Non-compliance with prescribed antihypertensive medication is an important contributor to the failure of antihypertensive therapy. OBJECTIVE To assess the validity of a short questionnaire in the identification of non-compliant patients. METHODS In three central-European countries, work-site screening for hypertension was conducted. Blood pressure was measured using an automatic electronic blood pressure measuring device (BpTRU). Respondents were interviewed by trained personnel and a short questionnaire focused on blood pressure awareness and treatment compliance was completed. RESULTS A total of 2812 persons were screened: 841(29.9%) respondents were hypertensive, and out of these the total number of treated hypertensive subjects was 359 (42.6%). Mean systolic blood pressure and diastolic blood pressure were significantly lower in the compliant group than the non-compliant group (systolic blood pressure, 139.4 and 146.2 mmHg, respectively, P = 0.002; and diastolic blood pressure, 89.2 and 92.3 mmHg, respectively, P < 0.01). The non-compliant group was younger than the compliant group (mean age, 46.7 versus 48.9 years, respectively, P = 0.01). Females, patients on combined therapy and non-smokers were more compliant than males, those on mono-therapy and smokers (P = 0.01, P = 0.004 and P = 0.005, respectively). CONCLUSION Patients reporting strict compliance with prescribed drug therapy have significantly lower systolic blood pressure and diastolic blood pressure than those who admit even an occasional lapse in taking medication. A properly formulated questionnaire can identify non-compliant patients.
Collapse
Affiliation(s)
- George J Fodor
- Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Abstract
Adherence to medication is one of the most intriguing and complex behaviours demonstrated by patients. Non-adherence to a therapeutic regimen may result in negative outcomes for patients and may be compounded in populations with multiple morbidities which require multiple drug therapy. Such a population is exemplified by the elderly. However, non-adherence may not be more prevalent in older patients and there is no consensus in the literature that age is a predictor of poor adherence. Indeed, older patients may deliberately choose not to adhere to medication (intentional non-adherence) to avoid adverse effects. Furthermore, many of the studies on adherence lack commonality in terms of how adherence is measured, the definition of an 'older' patient and the range of disease states which have been examined. Adherence may also be affected by access to medications which may be restricted by the use of formularies or insurance programmes. However, non-adherence may represent a greater risk in older people resulting in poor disease control which may be compounded with multiple morbidity and polypharmacy. A range of strategies have been implemented to try and improve adherence in this patient population. The use of forgiving drugs (those which have a prescribed dosage interval that is 50% or less the duration of drug action) may facilitate occasional lapses in drug-taking. Drug holidays (deliberate, supervised non-adherence for a fixed period of time) have been used in Parkinson's disease to reduce adverse effects. Once-daily scheduling of drug administration may offer a pragmatic approach to optimising drug therapy in some patients; this may be supplemented through the use of compliance aids. What is increasingly apparent, however, is that the role of the patient (irrespective of age) is critical in decision-making about medication, together with communication between patients and healthcare professionals. This has been articulated through the concept of concordance which has been described as a therapeutic alliance between the patient and healthcare professional. In addition, interventions employed to improve adherence must be multifaceted, and together with practical approaches (reducing unnecessary drugs and simplifying dosage regimens), the patient perspective must be considered. Good adherence should be seen as a means of achieving a satisfactory therapeutic result and not as an end in itself.
Collapse
Affiliation(s)
- Carmel M Hughes
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland.
| |
Collapse
|
25
|
Medication Adherence for Antihypertensive Therapy. Hypertension 2005. [DOI: 10.1016/b978-0-7216-0258-5.50131-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
|
26
|
Theunissen NCM, de Ridder DTD, Bensing JM, Rutten GEHM. Manipulation of patient-provider interaction: discussing illness representations or action plans concerning adherence. PATIENT EDUCATION AND COUNSELING 2003; 51:247-258. [PMID: 14630381 DOI: 10.1016/s0738-3991(02)00224-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
According to Leventhal's Self-Regulatory Model of Illness, patients have ideas and action plans related to the management of their disease. The aim of this study is to examine whether ideas and action plans relating to hypertension change as a result of general practitioner's (GP's) discussing them during consultation, and whether these changed ideas and actions plans affect adherence. The study employed an experimental design, highlighting three conditions: (0) care-as-usual consultation; (1) discussing patient's ideas about their disorder; and (2) discussing patient's action plans. Ten GP-trainees performed care-as-usual consultations, were subsequently assigned to a training in either Condition 1 or 2, and performed the trained conversations. Hundred and eight patients with hypertension were consecutively assigned to the conditions, and completed questionnaires a week before, immediately after the consultation, and 1 month later. The training resulted in two new, feasible and different types of conversations that managed to affect some of the patient's ideas and action plans. It is concluded that the study provided GPs with a tool to discuss illness representations and actions plan of patients with hypertension. Implications for the management of hypertension adherence in primary care are discussed.
Collapse
Affiliation(s)
- Nicolet C M Theunissen
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, Utrecht 3500 BN, The Netherlands
| | | | | | | |
Collapse
|
27
|
Scisney-Matlock M, Watkins KW. Validity of the Cognitive Representations of Hypertension Scales (CRHTN)1. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2003. [DOI: 10.1111/j.1559-1816.2003.tb01926.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
28
|
Abstract
The Medication Adherence Model (MAM) was developed to describe the process of medication adherence and guide health care providers in assessing medication-taking in individuals with hypertension. The MAM was structured with the idea that two types of nonadherence contribute to inconsistent medication taking, the intentional decision to miss medications, and the unintentional interruptions that cause medications not to be taken. The three core concepts identified in the model are: (a) Purposeful Action, (b) Patterned Behavior, and (c) Feedback. Patients' initiating and sustaining medication adherence are dependent on the deliberate decision to take medications based on perceived need, effectiveness, and safety (Purposeful Action). Then they establish medication-taking patterns through access, routines, and remembering (Patterned Behavior). Individuals use information, prompts, or events (Feedback) during the appraisal process to evaluate health treatment that, in return, influences individuals' levels of Purposeful Action and Patterned Behavior (Johnson, 2002; Johnson, Williams, & Marshall, 1999). The MAM depicts the dynamic process of initiating and maintaining medication adherence from the hypertensive patient's perspective. The model describes the key components of existing cognitive and self-regulatory models, and identifies an additional behavioral component. The succinct organization of the MAM may facilitate health care providers' ability to evaluate and individualize interventions for promoting medication taking.
Collapse
Affiliation(s)
- Mary Jayne Johnson
- University of New Mexico, College of Nursing, Albuquerque 87131-5688, USA.
| |
Collapse
|
29
|
Kärner A, Göransson A, Bergdahl B. Conceptions on treatment and lifestyle in patients with coronary heart disease--a phenomenographic analysis. PATIENT EDUCATION AND COUNSELING 2002; 47:137-143. [PMID: 12191537 DOI: 10.1016/s0738-3991(01)00185-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Twenty-three patients with an acute event of coronary heart disease (CHD) received routine care including information about medication and lifestyle changes. They were interviewed after 1 year about their conceptions concerning drug treatment and lifestyle changes. The interviews were taped, transcribed and analysed using the phenomenographic approach. Conceptions were hierarchically categorised with regard to level of understanding. The results showed that the patients' understanding of the effects and health benefits of their treatment was superficial as judged on an informed layman level. The knowledge was fragmentary and mechanistic. Several misconceptions were revealed. Few answers related to prognostic benefits. However, a conception about effects of stopping drug intake was risk of relapse. Some patients considered fate and heredity as the main causes of CHD. Thus, our patients had not achieved an adequate understanding of CHD treatment. The level of knowledge was lower than anticipated.
Collapse
Affiliation(s)
- Anita Kärner
- Department of Medicine and Care, Division of Cardiology, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
| | | | | |
Collapse
|
30
|
Bardage C, Isacson DG. Self-reported side-effects of antihypertensive drugs: an epidemiological study on prevalence and impact on health-state utility. Blood Press 2001; 9:328-34. [PMID: 11212061 DOI: 10.1080/080370500300000905] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The aim in this study was to assess the frequency and type of self-reported side-effects among hypertensives in a general population, and to estimate the relationship between drug use and side-effects and health utility using the Rating Scale (RS) method. The study is based on a postal questionnaire that was sent to a random sample of 8000 inhabitants aged 20-84 years (response rate 68%) in Uppsala County, Sweden, in 1995. The results showed that nearly 20% of the users of antihypertensive drugs reported side-effects. Men and women reported side-effects to nearly the same extent. In the linear regression analyses, those with hypertension, with or without medication, rated lower health utilities (-6.0 and -7.1 respectively) than did normotensives after controlling for age and sex. The lowest value, -8.7, was found among drug users who experienced side-effects. Side-effects causing impotence and emotional distress, i.e. insomnia, tiredness and depression had the strongest negative impact on health utility. To conclude, the study showed that side-effects among hypertensives are common. Both the disease and the drug treatment adversely affect the patient's well-being. However, drug treatment was of less importance than that found in prior studies. The findings here stress that side-effects should be taken into greater consideration when evaluating drug treatment.
Collapse
Affiliation(s)
- C Bardage
- Department of Pharmacy, Pharmaceutical Services Research, Uppsala University, Sweden.
| | | |
Collapse
|
31
|
Kiortsis DN, Giral P, Bruckert E, Turpin G. Factors associated with low compliance with lipid-lowering drugs in hyperlipidemic patients. J Clin Pharm Ther 2000; 25:445-51. [PMID: 11123498 DOI: 10.1046/j.1365-2710.2000.00315.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Treatment with lipid-lowering drugs decreases the risk of having a cardiovascular event by 30% according to several large intervention trials. However, both in these trials and in clinical practice the rate of discontinuation of medical treatment and the frequency of low compliance are high. OBJECTIVE The purpose of the study was to determine factors associated with poor compliance. METHODS We studied 193 hyperlipidemic subjects who had been referred to an out-patient clinic and who were treated with at least one antihyperlipidemic drug. The patients were asked to fill in a questionnaire which explored various factors that could possibly affect compliance. Compliance was evaluated by the percentage of pills missed during the previous month according to patient interview. RESULTS Younger subjects and smokers were less compliant. Perception of frequent side-effects to the current antihyperlipidemic treatment and high number of medications were inversely correlated with compliance (P=0.0237 and P=0.0311, respectively). Frequent breaking of appointments with a physician were inversely correlated with compliance (P=0.026). The patient's perception of the time that the physician spent to explain and to discuss the different aspects of cholesterol and cardiovascular disease (CVD) was correlated with a higher compliance (P=0.0125). Patients' perception of the efficacy of antihyperlipidemic therapy to prevent a CVD event in the future was also strongly associated with adherence to treatment (P<0.001). CONCLUSION Many factors affect compliance with antihyperlipidemic drug therapy. Good doctor-patient relationship, conviction of the efficacy of treatment and increased age are associated with compliance. Perceived high frequency of side-effects and prescription of numerous drugs negatively affect compliance.
Collapse
Affiliation(s)
- D N Kiortsis
- Department of Endocrinology, Pitié-Salpêtrière Hospital, Paris, France
| | | | | | | |
Collapse
|
32
|
Stroupe KT, Murray MD, Stump TE, Callahan CM. Association between medication supplies and healthcare costs in older adults from an urban healthcare system. J Am Geriatr Soc 2000; 48:760-8. [PMID: 10894314 DOI: 10.1111/j.1532-5415.2000.tb04750.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The amount of medication dispensed to older adults for the treatment of chronic disease must be balanced carefully. Insufficient medication supplies lead to inadequate treatment of chronic disease, whereas excessive supplies represent wasted resources and the potential for toxicity. We used an electronic medical record system to determine the distribution of medications supplied to older urban adults and to examine the correlations of these distributions with healthcare costs and use. DESIGN A cross-sectional study using data acquired over 3 years (1994-1996). SETTING A tax-supported urban public healthcare system consisting of a 300-bed hospital, an emergency department, and a network of community-based ambulatory care centers. PATIENTS Patients were >60 years of age and had at least one prescription refill and at least two ambulatory visits or one hospitalization during the 3-year period. MEASUREMENTS Focusing on 12 major categories of drugs used to treat chronic diseases, we determined the amounts and direct costs of these medications dispensed to older adult patients. Amounts of medications that were needed by patients to medicate themselves adequately were compared with the medication supply actually dispensed considering all sources of care (primary, emergency, and inpatient). We calculated the excess drug costs attributable to oversupply of medication (>120% of the amount needed) and the drug cost reduction caused by undersupply of medication (<80% of the amount needed). We also compared total healthcare use and costs for patients who had an oversupply, an undersupply, or an appropriate supply of their medications. RESULTS The cohort comprised 4164 patients with a mean age of 71 +/- 7 (SD) who received a mean of 3 +/- 2 (SD) drugs for chronic conditions. There were 668 patients (16%) who received <80% of the supply needed, 1556 patients (37%) who received between 80 and 120% of the supply needed, and 1940 patients (47%) who received >120% of the supply needed. The total direct cost of targeted medications for 3 years was $1.96 million or, on average, $654,000 annually. During the 3-year period, patients receiving >120% of their needed medications had excess direct medication costs of $279,084 or $144 per patient, whereas patients receiving <80% of drugs needed had reduced medication costs of $423,438 or $634 per patient. Multivariable analyses revealed that both under- and over-supplies of medication were associated with a greater likelihood of emergency department visits and hospital admissions. CONCLUSIONS More than one-half of the older adults in our study have under- or over-supplies of medications for the treatment of their chronic diseases. Such inappropriate supplies of medications are associated with healthcare utilization and costs.
Collapse
Affiliation(s)
- K T Stroupe
- Midwest Center for Health Services and Policy Research and Cooperative Studies Program Coordinating Center, Hines VA Hospital, Illinois, USA
| | | | | | | |
Collapse
|
33
|
Williams K. Accessing patient assistance programs to meet clients' medication needs. JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 2000; 12:233-5. [PMID: 11930446 DOI: 10.1111/j.1745-7599.2000.tb00187.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The high cost of medication is a barrier to patient compliance. Nurse practitioners can access patient assistance programs to assist low-income clients to obtain medications, empowering them to take action to improve their health. At Health Care Access, a primary care clinic serving low-income, uninsured persons, approximately $150,000 worth of medications were obtained through patient assistance programs in 1997, compared to the total clinic budget of $189,000. Processes for obtaining prescription drugs vary between pharmaceutical companies. An understanding of these types of programs provides nurse practitioners access to these resources for their clients.
Collapse
Affiliation(s)
- K Williams
- University of Kansas, Lawrence, KS 66045, USA.
| |
Collapse
|
34
|
Wood W, Gray J. An Integrative Review of Patient Medication Compliance from 1990-1998. Worldviews Evid Based Nurs 2000. [DOI: 10.1111/j.1524-475x.2000.00010.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
35
|
Ward HJ, Morisky DE, Lees NB, Fong R. A clinic and community-based approach to hypertension control for an underserved minority population: design and methods. Am J Hypertens 2000; 13:177-83. [PMID: 10701818 DOI: 10.1016/s0895-7061(99)00149-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This paper describes the design and methodology of the Community Hypertension Intervention Project (CHIP). CHIP is investigating the environmental and psychosocial factors related to treatment adherence and examining the effects of combining usual hypertension care with the effects of three interventions designed to improve patient compliance with treatment for high blood pressure in a high-risk, underserved minority population. Thirteen hundred and sixty-seven inner-city hypertension patients (75% black and 25% Hispanic) have agreed to participate in the 4-year longitudinal study. These participants were randomized to usual care or one of three intervention groups: individualized counseling sessions; home visits/discussion groups; or computerized appointment-tracking system. Participants are representative of the surrounding, predominantly low-income minority community and are treated in a hospital-based clinic and in a private clinic in the community. About 65% have blood pressure levels considered to be out of control. It was concluded that structural changes at the clinic site, along with the targeted interventions, would improve patient satisfaction, increase treatment adherence, and improve blood pressure control.
Collapse
Affiliation(s)
- H J Ward
- Department of Medicine, King/Drew Medical Center, Los Angeles, California 90059, USA.
| | | | | | | |
Collapse
|
36
|
Abstract
The economics of prevention supports reimbursement of nurse practitioners for patient education. The role has undergone historical change, shifting from imparting disease-oriented health education (DOPE) toward empowering patients to use their own resources to the fullest to attain health. Nurse practitioners are well suited to provide care that facilitates behavior change and health-oriented patient education (HOPE). Essentials for effective patient education include use of an open communication style, written instructions, and the address of barriers. Adult literacy and reader-friendliness must be considered when assembling written materials.
Collapse
Affiliation(s)
- I K Glanville
- College of Nursing, University of Akron, Akron, Ohio, USA
| |
Collapse
|
37
|
Abstract
Despite decades of attention to noncompliance to treatment for hypertension, the problem remains a significant factor in the inadequate control of blood pressure. Current approaches to enhancing compliance use patient demographics, medication characteristics, clinical factors, health beliefs, and the quality of patient-provider communication. Clinical researchers are just beginning to apply a new approach that views compliance as a behavior change taking place over time. In this view, patients do not simply change their behavior through a one-time decision to take their medication as directed by their physicians; they move through five stages of behavior change. Clinicians can increase compliance by assessing their patients to determine the patient's stage of behavior change, then matching their interventions to that stage.
Collapse
Affiliation(s)
- F B Garfield
- Caro Research, 336 Baker Avenue, Concord, MA 01742, USA
| | | |
Collapse
|
38
|
Johnson MJ, Williams M, Marshall ES. Adherent and nonadherent medication-taking in elderly hypertensive patients. Clin Nurs Res 1999; 8:318-35. [PMID: 10855101 DOI: 10.1177/10547739922158331] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nonadherence to medications is a significant reason why patients fail to control their blood pressure. Little work has been attempted to conceptualize medication-taking behaviors from the patient's perspective. This study examined factors that influence elderly hypertensive patients' adherence or nonadherence to prescribed medications. Using a qualitative descriptive research design, 21 hypertensive elderly people were interviewed. Two domains of adherence were identified: purposeful use of the medication for the control of patient's blood pressure and establishing and maintaining patterns of medication-taking. Two similar domains also emerged for nonadherence: purposeful and incidental. Adherence behaviors were dependent on the person's decision to take hypertension medication, access to medications, and ability to initiate treatment and maintain a medication-taking pattern. The timing and location of pills were integral parts of establishing patterns of taking medications. Inadequate access to medications or interruption of a person's pattern were associated with the incidental missing of medications.
Collapse
|
39
|
Mirotznik J, Ginzler E, Zagon G, Baptiste A. Using the health belief model to explain clinic appointment-keeping for the management of a chronic disease condition. J Community Health 1998; 23:195-210. [PMID: 9615295 DOI: 10.1023/a:1018768431574] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Broken appointments have untoward repercussions for patients' health and well-being. Although the literature on missed appointments has been largely atheoretical, several studies have tested the Health Belief Model (HBM) in this context. Those studies have found HBM dimensions are not predictive of keeping appointments for the management of a chronic condition. Given several limitations that characterize these studies, questions can be raised about the validity of this conclusion. This study investigated the utility of HBM for explaining appointment-keeping for Systemic Lupus Erythematosus (SLE), a potentially fatal chronic disease. A questionnaire, operationalizing HBM dimensions and exhibiting acceptable psychometric properties, was developed for this research and administered to 153 SLE patients enrolled at an outpatient clinic of a major teaching hospital. In addition to measuring intention to keep appointments, data were abstracted from medical records regarding actual appointment-keeping during 12 months prior to and 6 months following questionnaire completion. Regression analysis indicated that general health motivation and perceived severity of SLE were uniquely associated in the theoretically predicted direction with, respectively, intent and the percentage of scheduled appointments kept (PSAK) during the 12 month retrospective period. Perceived costs was associated in the expected direction with intent, 12 month retrospective and 6 month prospective PSAK. Typical of HBM research the effect sizes uncovered were modest in magnitude. Questions for future investigation are discussed.
Collapse
Affiliation(s)
- J Mirotznik
- Department of Health and Nutrition Sciences, Brooklyn College, CUNY 11210, USA
| | | | | | | |
Collapse
|
40
|
Bennett SJ, Milgrom LB, Champion V, Huster GA. Beliefs about medication and dietary compliance in people with heart failure: an instrument development study. Heart Lung 1997; 26:273-9. [PMID: 9257137 DOI: 10.1016/s0147-9563(97)90084-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Sodium retention is often a precursor to hospitalization in people with heart failure (HF). Lack of compliance with medications and with dietary sodium restrictions affects sodium retention. OBJECTIVES The purpose of this study was to evaluate the reliability and validity of the Beliefs about Medication Compliance Scale and the Beliefs about Dietary Compliance Scale. METHODS The Beliefs about Medication Compliance Scale and the Beliefs about Dietary Compliance Scale are instruments we developed specifically to measure beliefs about compliance with behaviors that affect sodium retention in persons with HF. The scales, based on the Health Belief Model, were designed from a review of literature and from self-reports of people with HF. A convenience sample of 101 people with HF completed the scales. RESULTS Internal consistency reliability was satisfactory. Factor analysis provided initial support for construct validity of the scales. CONCLUSIONS Future testing of the scales is needed in more diverse populations. The scales can then be used to test interventions tailored to individual subjects' beliefs about compliance.
Collapse
Affiliation(s)
- S J Bennett
- Indiana University, School of Nursing, Indianapolis 46202, USA
| | | | | | | |
Collapse
|
41
|
Abstract
OBJECTIVE To estimate the compliance rate and associated factors among a population of hypertensive subjects registered in hospitals and primary health care centres. DESIGN A prospective study carried out on a sample of hypertensive subjects. METHOD Compliance with treatment by the study sample was measured using the pill-counting method. The reasons for noncompliance are listed and the status of blood pressure control among compliant and noncompliant subjects is reported. RESULTS The compliance rate was 53.0%. It was associated positively with male sex, and negatively with older age, symptoms of illness and drug side effects. The degree of blood pressure control was worse among noncompliant subjects. Reasons for noncompliance included the asymptomatic nature of hypertension, a shortage of drugs, side effects, forgetfulness and lack of health education. CONCLUSIONS The compliance rate was low in this study and was accompanied by inadequate blood pressure control among noncompliant subjects. Disoriented behavior regarding hypertension and its medications was observed.
Collapse
Affiliation(s)
- S A Khalil
- Department of Primary Health Care, Military Hospital, Tabuk, Saudi Arabia
| | | |
Collapse
|
42
|
Miller NH, Hill M, Kottke T, Ockene IS. The multilevel compliance challenge: recommendations for a call to action. A statement for healthcare professionals. Circulation 1997; 95:1085-90. [PMID: 9054774 DOI: 10.1161/01.cir.95.4.1085] [Citation(s) in RCA: 306] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Despite the universally accepted importance of compliance, strategies known for more than two decades to be effective are not routinely incorporated into clinical practice. For the benefits of primary and secondary prevention to be realized in diverse population groups and settings, emphasis must be placed on implementing strategies at the patient, provider, and organization levels. Current knowledge of compliance strategies, if integrated into a multilevel approach, offers enormous promise for decreasing risk and improving patient outcomes.
Collapse
Affiliation(s)
- N H Miller
- American Heart Association, Dallas, TX 75231-4596, USA
| | | | | | | |
Collapse
|
43
|
Wallenius SH, Vainio KK, Korhonen MJ, Hartzema AG, Enlund HK. Self-initiated modification of hypertension treatment in response to perceived problems. Ann Pharmacother 1995; 29:1213-17. [PMID: 8672823 DOI: 10.1177/106002809502901204] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To assess the prevalence of patient-initiated modification of drug instructions and the association between different classes of problems and the modification of hypertension therapy. DESIGN AND METHODS In this cross-sectional study, all patients (n = 1215) who had been examined at a hypertension clinic during a 1-year period were surveyed. The response rate to the questionnaire was 85%. Of the 1035 respondents, 623 currently taking antihypertensive medication (self-report) were included in the study. RESULTS Of the patients taking antihypertensive drugs, 36% admitted that they had tried to manage their condition with a lower dosage and/or fewer drugs than prescribed. The percentage of patients who modified their drug regimen decreased with increasing age. One or more problems with the treatment of hypertension were reported by 79% of the respondents. The odds ratio (95% confidence interval) for modification among patients who reported 1 or more problems compared with those not reporting any problem was 3.5 (2.12 to 5.67). The prevalence of modification increased with the number of problems; this was seen in all age groups and among men and women. CONCLUSIONS Perceived problems in drug taking in the treatment of hypertension have an important impact on the prevalence of modifying drug instructions.
Collapse
Affiliation(s)
- S H Wallenius
- Department of Social Pharmacy, University of Kuopio, Finland
| | | | | | | | | |
Collapse
|
44
|
Abstract
Low compliance with antihypertensive drug regimens has been a well documented reason for inadequate control of hypertension. We assessed recent literature regarding compliance from different disciplines to clarify the nature of reported problems on low compliance to prescribed antihypertensive medication. Much research focuses on primary factors for compliance, methods to monitor and measure individual rates and patterns of compliance. From a behavioural oriented point of view, the focus is on understanding why patients act as they do. This review indicates that there is an almost complete lack of knowledge about how the decision making in the clinical practice is organized when prescribing antihypertensive medication and/or when following up treatment from patients already taking such drugs. Since the concrete communication and collaboration between patient and physician in the clinical setting are of prime significance for patient adherence to drug regimens, it is important to shed light on what happens in this critical situation.
Collapse
Affiliation(s)
- K I Kjellgren
- Department of Clinical Pharmacology, Faculty of Health Sciences, University Hospital, Linköping, Sweden
| | | | | |
Collapse
|