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Tsige AW, Kotiso TA, Ayenew KD, Ayele SG. Pharmacist intervention to improve adherence to medication among heart failure patients at North East Ethiopia hospital. Pharmacol Res Perspect 2024; 12:e1199. [PMID: 38686951 PMCID: PMC11059962 DOI: 10.1002/prp2.1199] [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: 02/03/2024] [Revised: 03/12/2024] [Accepted: 03/31/2024] [Indexed: 05/02/2024] Open
Abstract
Heart failure (HF) is a major and growing medical problem and its management is still challenging due to the coexistence of complications, co-morbidity, and medication non-adherence. HF patients who are adherent to their medication have fewer HF exacerbations, improved survival, and lower healthcare expenditure. Adherence to HF medication plays a pivotal role in attaining maximal therapeutic outcomes. The aim was to assess the medication adherence of heart failure patients at Debre Berhan Comprehensive Specialized Hospital (DBCSH). A pre-post interventional study was undertaken from July 1, 2022, to December 31, 2022, at the medical referral clinic of DBCSH. The educational interventions were provided for 6 months. Medication adherence was determined using the Morisky Green Levin Medication Adherence Scale (MGLS). The data was entered into Epidata version 4.2.0 and analyzed using SPSS version 25.0 statistical software. Descriptive statistics and binary logistic regression analysis were performed. The strength of the association between predictor variables and outcome variables was determined using a 95% confidence interval and adjusted odd ratio. In the pre-intervention phase, 54.6% of patients had medium medication adherence, while in the post-intervention phase, 36.4% of patients had high medication adherence and 61.9% of patients had medium medication adherence. Following the intervention, medication cost (120, 50%), inadequate availability of drugs (75, 31%), and forgetfulness (30, 13%) were the main reasons for medication non-adherence. The presence of co-morbidity and the number of co-morbidity (p < .05) were significantly associated with the occurrence of decreased medication adherence in the pre-intervention phase. Interventions by pharmacists to educate HF patients about the nature of their disease and providing brochures to increase awareness of their medications have been shown to improve medication adherence.
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Affiliation(s)
- Abate Wondesen Tsige
- Department of Pharmacy, College of Health SciencesDebre Berhan UniversityDebre BerhanEthiopia
| | | | - Kassahun Dires Ayenew
- Department of Pharmacy, College of Health SciencesDebre Berhan UniversityDebre BerhanEthiopia
| | - Siraye Genzeb Ayele
- Department of Midwifery, School of Nursing and Midwifery, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
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Wondmieneh A, Getie A, Bimerew M. Self-care behaviour and associated factors among heart failure patients in Ethiopia: a systematic review and meta-analysis. BMJ Open 2023; 13:e071960. [PMID: 38072478 PMCID: PMC10729130 DOI: 10.1136/bmjopen-2023-071960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE This study aimed to estimate the pooled level of self-care behaviour among heart failure patients in Ethiopia. DESIGN Systematic review and meta-analysis. DATA SOURCE PubMed/MEDLINE, HINARI, Web of Sciences, Scopus, Google Scholar, Science Direct, African journals online and University repositories were searched from 1 January 2000 to 1 November 2023. ELIGIBILITY CRITERIA We include studies that examined self-care behaviour among heart failure patients, studies that report factors associated with self-care behaviour and observational studies (cross-sectional, case-control and cohort) with full text available. DATA EXTRACTION AND SYNTHESIS The data were extracted with Microsoft Excel and analysed by using STATA V.11 software. The weighted inverse variance random-effects model at 95% CI was used to estimate the pooled level of self-care behaviour and its associated factors among heart failure patients. Tests of heterogeneity, test of publication bias and subgroup analyses were also employed. RESULTS Thirteen cross-sectional studies with 4321 study participants were included; and the pooled level of good self-care behaviour among heart failure patients in Ethiopia was found to be 38.3% (95% CI 31.46 to 45.13). Only 68.8% of heart failure patients were knowledgeable about heart failure. Knowledge about heart failure (Adjusted Odds Ratio (AOR)=3.39; 95% CI 2.42 to 4.74) and absence of comorbidity (AOR=2.69; 95% CI 1.35 to 5.37) were significantly associated with good self-care behaviour among heart failure patients in Ethiopia. CONCLUSION The majority of heart failure patients in Ethiopia did not adhere to the recommended self-care behaviours. Nearly one-third of heart failure patients were not knowledgeable about heart failure. Knowledge about heart failure and the absence of comorbidities were significantly associated with good self-care behaviour. Therefore, efforts should be devoted to increasing knowledge and preventing comorbidities among heart failure patients. PROSPERO REGISTRATION NUMBER CRD42023394373.
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Affiliation(s)
- Adam Wondmieneh
- Department of Nursing, Injibara University, Injibara, Ethiopia
| | - Addisu Getie
- Department of Nursing, Debre Markos University, Debre Markos, Ethiopia
| | - Melaku Bimerew
- Department of Nursing, Injibara University, Injibara, Ethiopia
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Ayenew B, Kumar P, Hussein A, Gashaw Y, Girma M, Ayalew A, Tadesse B. Heart failure drug classes and 30-day unplanned hospital readmission among patients with heart failure in Ethiopia. J Pharm Health Care Sci 2023; 9:49. [PMID: 38012803 PMCID: PMC10680257 DOI: 10.1186/s40780-023-00320-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Drug therapy is a crucial aspect of heart failure management and has been shown to reduce morbidity and mortality in heart failure patients. However, the comparative effects of these drug classes on readmission rates have not been well studied. Therefore, the aim of this study was to examine the association between different classes of heart failure drugs and 30-day readmission rates in patients with heart failure. METHOD A multicenter, hospital-based retrospective cohort design was employed and 572 randomly selected patients with heart failure were included. Data were entered in Epi-data version 4.6 and analyzed with STATA version 17. Kaplan-Meier and log-rank tests were used to estimate and compare survival time. A Cox proportional hazard model was utilized, employing both bi-variable and multi-variable analyses, to examine the effect of predictors on the timing of unplanned hospital readmissions. The strength of the association was assessed using an adjusted hazard ratio (aHR), and statistical significance was declared for p-values < 0.05 and a 95% confidence interval (CI). RESULTS In this study, a total of 151 (26.40%) heart failure patients were readmitted within 30 days of discharge. In the multivariate cox proportional hazards analysis being an age (> 65 year) (AHR: 2.34, 95%CI: 1.63, 3.37), rural in residency (AHR: 1.85, 95%CI: 1.07, 3.20), hospital stays > 7 Days (AHR: 3.68, 95%CI: 2.51,5.39), discharge with Diuretics (AHR: 2.37, 95%CI: 1.45, 3.86), and discharge with Beta-Blocker (AHR: 0.48, 95%CI: 0 0.34, 0.69) were identified as independent predictors of unplanned hospital readmission. CONCLUSION Elderly patients, being in rural areas, longer hospital stays, and discharges of patients on diuretics and not on beta-blockers were independent predictors of unplanned hospital readmission. Therefore, working on these factors will help to reduce the hazard of unplanned hospital readmissions, improve patient outcomes, and increase the efficiency of heart failure management.
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Affiliation(s)
- Birhanu Ayenew
- Department of Adult Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia.
| | - Prem Kumar
- Department of Adult Health Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Adem Hussein
- Department of Adult Health Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Yegoraw Gashaw
- Department of Pediatric and Child Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia
| | - Mitaw Girma
- Department of Comprehensive Health Nursing, College of Medicine & Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abdulmelik Ayalew
- Department of Adult Health Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Beza Tadesse
- Department of Adult Health Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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de Araujo Kaji P, de Lucena Ferretti-Rebustini RE, Bosco Aprile DC, de Lima Lopes J, Batista Santos V, Takao Lopes C. Control Attitudes Scale-Revised-Brazilian Version. J Cardiovasc Nurs 2023:00005082-990000000-00123. [PMID: 37661304 DOI: 10.1097/jcn.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND Heart failure demands self-care skills and behaviors that can be negatively impacted by a low level of perceived control (PC), a belief about having the necessary resources to deal with negative events. Having valid and reliable instruments to measure PC is important to support interventions that improve self-care and related outcomes. The Control Attitudes Scale-Revised (CAS-R) was developed in the United States to measure PC in cardiac conditions. In Brazil, there are no instruments available to measure this construct. OBJECTIVE The aims of this study were to translate and adapt the CAS-R to the Brazilian population and to assess the content validity of the adapted version. METHODS The CAS-R was translated, back-translated, and assessed by an expert committee for linguistic equivalences. An agreement > 80% was considered adequate. Content validity (clarity, theoretical relevance, and practical pertinence) was assessed by both an expert professional panel (n = 6-8) and a panel of patients with heart failure (n = 40). A content validity coefficient > 0.70 was considered acceptable. RESULTS The translations to Brazilian Portuguese were considered consistent with the original CAS-R. In the third round of linguistic equivalence assessment, all items achieved acceptable agreement, except for 2 items. After modifications to the instrument to achieve adequate equivalences, the adapted version had a final content validity coefficient of 0.93. Most patients were able to understand the instrument. CONCLUSIONS The CAS-R-Brazilian version is equivalent to the original CAS-R and has satisfactory evidence of content validity. Additional psychometric testing will be performed to allow for the assessment of PC in individuals with heart failure in Brazil.
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Jarrah M, Khader Y, Alkouri O, Al-Bashaireh A, Alhalaiqa F, Al Marzouqi A, Qaladi OA, Alharbi A, Alshahrani YM, Alqarni AS, Oweis A. Medication Adherence and Its Influencing Factors among Patients with Heart Failure: A Cross Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050960. [PMID: 37241192 DOI: 10.3390/medicina59050960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/26/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
Background and objectives: The chronic nature of heart failure requires long-lasting consumption of various medications. Despite the therapeutic benefits of heart failure medications, about 50% of patients with heart failure don't adequately adhere to their medications as prescribed globally. This study aimed to determine medication adherence levels among Jordanians with heart failure and its influencing factors. Materials and Methods: A cross-sectional study was conducted among 164 patients with heart failure attending cardiac clinics in the north of Jordan. The Medication Adherence Scale was used to measure medication adherence. Results: Overall, 33.5% of patients had high adherence, and 47% had partial to poor adherence. The proportion of patients with good to high adherence was significantly higher among patients younger than 60 years, having >high school level of education, being married, living with somebody, and having insurance. Conclusions: Patient-centered approach, targeting age, level of education, marital status, and health insurance coverage, should be developed using evidence-based guidelines to enhance adherence to medication and health outcomes in Jordanian patients with heart failure. The development and implementation of new and feasible strategies, particularly suited to Jordan's healthcare system capabilities, is important to improve medication adherence.
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Affiliation(s)
- Mohamad Jarrah
- Department of Internal Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Yousef Khader
- Department of Public Health, Community Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Osama Alkouri
- Faculty of Nursing, Yarmouk Univerity, P.O. Box 566, Irbid 21163, Jordan
| | - Ahmad Al-Bashaireh
- Higher Colleges of Technology, Abu Dhabi P.O. Box 25026, United Arab Emirates
| | | | - Ameena Al Marzouqi
- College of Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Omar Awadh Qaladi
- College of Nursing, King Saud University, P.O. Box 11451, Riyadh 11451, Saudi Arabia
| | - Abdulhafith Alharbi
- College of Nursing, University of Hail, P.O. Box 2440, Hail 81451, Saudi Arabia
| | | | | | - Arwa Oweis
- Faculty of Nursing, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
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Gheiasi SF, Cheraghi MA, Dastjerdi M, Navid H, Khoshavi M, Peyrovi H, Khachian A, Seylani K, Esmaeili M, Navab E. Experiences of Facilitators and Inhibitors to Treatment Adherence in Patients with Heart Failure. Clin Nurs Res 2023; 32:648-659. [PMID: 36788432 DOI: 10.1177/10547738221147402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Treatment adherence is a fundamental aspect of heart failure (HF) management. This study aimed to explore the experiences of facilitators and inhibitors of treatment adherence in patients with HF. This descriptive qualitative study was conducted from May 2020 to June 2021. Participants including people with HF, their family caregivers and physicians, and nurses were selected purposefully, with the aim of obtaining sufficient information power. Semi-structured interviews were used to collect data. Data were analyzed using thematic analysis. Two main themes "the driving forces behind treatment adherence" and "the deterrent forces behind treatment adherence" emerged from the analysis. The first theme contained the following subthemes: "supportive family," "positive personality characteristics," and "having health literacy." The second theme consisted of "negligence," "psychological problems," "cultural, social, and economic problems," "physical limitations," and "lack of self-care management knowledge." Nurses can consider facilitators and inhibitors of treatment adherence in designing educational and care programs for patients with HF.
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Zhang X, Kang J, Zhang J, Chen Y, Dai H, Hu M, Liu Y, Shang H. Effectiveness of Yiqi Fumai lyophilized injection for acute heart failure: Rationale and design of the AUGUST-AHF cohort study. Front Cardiovasc Med 2023; 9:1074406. [PMID: 36704479 PMCID: PMC9871566 DOI: 10.3389/fcvm.2022.1074406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction The effect of Yiqi Fumai lyophilized injection (YQFM) on acute heart failure (AHF) patients has been evaluated in a large sample, randomized, controlled trial (AUGUST-AHF RCT study). However, restrictive eligibility criteria from a randomized clinical trial may raise concerns about the generalizability of the results to under-represented groups or complex patients with multimorbidity. Therefore, we intend to conduct the AUGUST-AHF cohort study which aims to assess the effectiveness of YQFM in patients with AHF in a real-world setting and compare the results with AUGUST-AHF RCT study. Methods and analysis This prospective, multicenter cohort study will be conducted at 50 secondary and tertiary hospitals in China and comprise 1,200 patients with AHF. The participants will be followed for up to at least 180 days. The primary outcome is a composite of 90-day all-cause mortality or readmission for heart failure. The secondary outcomes include length of hospital stay, cardiac-specific death, MACE, NYHA cardiac function classification. Cox proportional-hazards regression models will be used to estimate the association between YQFM use and the primary outcome. The primary analysis will use propensity-score matching methods to balance the differences in baseline variables between treatment cohorts. Ethics and dissemination Approval for the study has been obtained from the Ethical Committee of Dongzhimen Hospital (approval No. 2022DZMEC-327-02) and registered at ClinicalTrials.gov (NCT05586048). The study results will be published in peer-reviewed journals and presented at scientific conferences.
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Affiliation(s)
- Xuecheng Zhang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Kang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jingjing Zhang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- College of Traditional Chinese Medicine and College of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ying Chen
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- School of Public Health, Department of Global Health, Peking University, Beijing, China
| | - Hengheng Dai
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Department of Traditional Chinese Medicine, The Sixth Medical Center of the General Hospital of the Chinese People’s Liberation Army, Beijing, China
| | - Mingzhi Hu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yan Liu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hongcai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Almeman AA, Al Mesned A, Alredaini IA, Alhumaidan RI, Alharbi SB, Alassaf FA, Alharbi SF, Alharbi SB, Alharbi HM. Assessment of Adherence to Cardiovascular Medicines in Saudi Population: An Observational Study in Patients Attending a Tertiary Care Hospital. Cardiovasc Hematol Disord Drug Targets 2023; 23:122-129. [PMID: 38093591 DOI: 10.2174/011871529x257067230927101533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 08/19/2023] [Accepted: 08/31/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Drug adherence has been extensively evaluated in many developed countries in the West using different methods of medication adherence measurement; however, there are relatively few reports studying the adherence levels among Saudi patients. Thus, this study will evaluate the adherence to cardiovascular medicines in Saudi patients visiting (PSCC) in Al-Qassim, Saudi Arabia. METHODS This cross-sectional observational study relied on self-administered questionnaires. This study used the Morisky, Green, and Levine (MGL) Adherence Scale, also known as the MAQ (Medication Adherence Questionnaire), in PSCC's pharmacy waiting room in Qassim, Saudi Arabia. RESULTS This study included 993 PSCC pharmacy waiting room patients. The patients were between 11 and 50 years old, and 52.7 percent were male. Most participants (71.2%) were above 50, while 16.3% were 41-50. Non-adherent patients cited traveling or being busy (28.6%), forgetting (18.7%), daily multi-medications (7.1%), being sleepy or sleeping (6.6%), and not repeating the prescription (6.6%). The Medicine Adherence Questionnaire indicated that 62.6 percent of patients fully adhered to their medications, and 21.6 percent usually adhered. Only drug adverse effects affected adherence (p =0.0001). CONCLUSION The current study showed that there is a good level of adherence among patients with cardiovascular diseases toward their diseases. The most common reasons for neglecting medications include traveling or being busy, forgetting multiple medications, and being tired or sleeping. Having experience with side effects was the only significant factor affecting adherence to medications.
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Affiliation(s)
- Ahmad Abdulrahman Almeman
- Clinical Pharmacology and Therapeutic Department, College of Medicine, Qassim University (QU), Buraydah, Saudi Arabia
| | - Abdulrahman Al Mesned
- Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Buraydah, Qassim, Saudi Arabia
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Clinical Parameters and Outcomes in Heart Failure Patients based on Gender Differences. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Mwabutwa ES, Kateta S, Kinley L, Ulemu T, Goodson P, Muula AS, Kumwenda J. An audit of Heart failure management among ambulatory adult patients at Queen Elizabeth Central Hospital (QECH), Malawi. Malawi Med J 2022; 34:170-175. [PMID: 36406095 PMCID: PMC9641614 DOI: 10.4314/mmj.v34i3.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background There are limited data on the clinical characteristics and use of guideline directed medical therapy among patients with heart failure in Malawi. We conducted a study to assess patient characteristics and clinical management given to heart failure patients at Queen Elizabeth Central hospital in Malawi. Methods In a cross sectional study, patients with a diagnosis of heart failure who were followed up in the adult chest clinic at QECH were recruited to ascertain their characteristics and the therapy they were receiving. Echocardiograms and electrocardiograms were performed to identify abnormalities. Results A total of 79 patients were recruited and 62% (49 out of 79) were female. The median age was 60 years (IQR 40.5-70.5). Most patients were hypertensive with NYHA (New York Heart Association) class I and II symptoms. Left ventricular(LV) systolic dysfunction was found in 55% (36 out of 65), with 68% (39 out of 65) having features of left ventricular remodeling. Most patients were on at least a single neurohormonal drug with 77% (61 out of 79) on ACEI (angiotensin converting enzyme inhibitor), 52% (42 out of 79) on a beta blocker and 34%(27 out of 79) on aldosterone antagonists. The recommended doses of medications were achieved in 14% (9 out 61), 24% (10 out 42), 22% (6 out of 27) on ACEI, beta blockers and aldosterone antagonists respectively. Conclusions Hypertension is the commonest comorbidity in patients with heart failure, who are mostly females with NYHA class I or II symptoms. Most had LV remodeling changes and are on at least one neurohormonal antagonist but most remain sub optimally treated.
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Affiliation(s)
- Emmanuel S Mwabutwa
- Department of Medicine, School of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Steve Kateta
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Louis Kinley
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Tadala Ulemu
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Patrick Goodson
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Adamson S Muula
- Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Johnstone Kumwenda
- Department of Medicine, School of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
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Emadi F, Ghanbarzadegan A, Ghahramani S, Bastani P, Baysari MT. Factors affecting medication adherence among older adults using tele-pharmacy services: a scoping review. Arch Public Health 2022; 80:199. [PMID: 36042508 PMCID: PMC9429665 DOI: 10.1186/s13690-022-00960-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background Medication adherence among older adults (aged 60 and above), particularly those with chronic conditions who take several medications, is critical, and tele-pharmacy services are a way to improve medication adherence. This study sought to determine the factors influencing medication adherence (MA) in older adults using tele-pharmacy services. Method The Joana Briggs Institute scoping review methodology was implemented. Searches were conducted in databases PubMed, Scopus, ProQuest, Web of Science, and Embase from 2000 to the present day, to identify both qualitative and quantitative studies focusing on the use of tele-pharmacy by older people. Factors impacting MA were extracted and analyzed into themes using a qualitative approach. A concept map was also designed summarising these factors. Results Of 7495 articles obtained in the initial search, 52 articles met the inclusion criteria. The analysis resulted in 5 themes and 21 sub-themes representing factors that impacted MA with tele-pharmacy. These themes are divided broadly into technology and user related factors. Technology factors included design of the tele-pharmacy intervention, commercial aspects, and adherence measurement method. User factors included user-health constraints, behaviors and perceptions. Conclusion Industry, policymakers, and stakeholders should consider using tele-pharmacy services for improving medication adherence among older adults; however, ensuring interventions facilitate communication between patients and health care teams, and are accompanied by user training and support, is essential for technology uptake and effectiveness. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00960-w.
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Pallangyo P, Komba M, Mkojera ZS, Kisenge PR, Bhalia S, Mayala H, Kifai E, Richard MK, Khanbhai K, Wibonela S, Millinga J, Yeyeye R, Njau NF, Odemary TK, Janabi M. Medication Adherence and Blood Pressure Control Among Hypertensive Outpatients Attending a Tertiary Cardiovascular Hospital in Tanzania: A Cross-Sectional Study. Integr Blood Press Control 2022; 15:97-112. [PMID: 35991354 PMCID: PMC9390787 DOI: 10.2147/ibpc.s374674] [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: 05/23/2022] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Notwithstanding the availability of effective treatments, asymptomatic nature and the interminable treatment length, adherence to medication remains a substantial challenge among patients with hypertension. Suboptimal adherence to BP-lowering agents is a growing global concern that is associated with the substantial worsening of disease, increased service utilization and health-care cost escalation. This study aimed to explore medication adherence and its associated factors among hypertension outpatients attending a tertiary-level cardiovascular hospital in Tanzania. Methods The pill count adherence ratio (PCAR) was used to compute adherence rate. In descriptive analyses, adherence was dichotomized and consumption of less than 80% of the prescribed medications was used to denote poor adherence. Logistic regression analyses was used to determine factors associated with adherence. Results A total of 849 outpatients taking antihypertensive drugs for ≥1 month prior to recruitment were randomly enrolled in this study. The mean age was 59.9 years and about two-thirds were females. Overall, a total of 653 (76.9%) participants had good adherence and 367 (43.2%) had their blood pressure controlled. Multivariate logistic regression analysis showed; lack of a health insurance (OR 0.5, 95% CI 0.3–0.7, p<0.01), last BP measurement >1 week (OR 0.6, 95% CI 0.4–0.8, p<0.01), last clinic attendance >1 month (OR 0.4, 95% CI 0.3–0.6, p<0.001), frequent unavailability of drugs (OR 0.6, 95% CI 0.3–0.9, p = 0.03), running out of medication before the next appointment (OR 0.6, 95% CI 0.4–0.9, p = 0.01) and stopping medications when asymptomatic (OR 0.6, 95% CI 0.4–0.8, p<0.001) to be independent associated factors for poor adherence. Conclusion A substantial proportion of hypertensive outpatients in this tertiary-level setting had good medication adherence. Nonetheless, observed suboptimal blood pressure control regardless of a fairly satisfactory adherence rate suggests that lifestyle modification plays a central role in hypertension management.
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Affiliation(s)
- Pedro Pallangyo
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania.,Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Makrina Komba
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Zabella S Mkojera
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Peter R Kisenge
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania.,Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Smita Bhalia
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Henry Mayala
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Engerasiya Kifai
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Mwinyipembe K Richard
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Khuzeima Khanbhai
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania.,Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Salma Wibonela
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Jalack Millinga
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Robert Yeyeye
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Nelson F Njau
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Thadei K Odemary
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
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Vargas-Escobar LM, Valle-Ballesteros R, Alemán-Parra CM, Parrado-Sarmiento AC, Cortes-Muñoz F, Sánchez-Casas C. Relationship Among Treatment Adherence, Family Functioning, and Self-Care Agency in Colombian Patients With Cardiovascular Disease. J Nurs Res 2022; 30:e224. [PMID: 35675161 DOI: 10.1097/jnr.0000000000000504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Multiple factors affect treatment adherence in individuals with cardiovascular disease. However, information on the relationships among treatment adherence, family functioning, and self-care agency in these patients and their families is limited. PURPOSE This study was developed to determine the relationships among treatment adherence, family functioning, self-care agency, and sociodemographic variables in patients with cardiovascular disease. Self-care agency, as defined by Orem, is the dynamic process patients use to engage in their own healthcare that involves discerning and addressing factors that allow their making decisions that improve self-care abilities. METHODS This cross-sectional, observational-analytical study enrolled 151 adult patients with cardiovascular diseases who had undergone pharmacological and nonpharmacological treatments and 108 family members of these patients who had consented to participate. Measurements were performed using the "Questionnaire for measuring treatment adherence in patients with cardiovascular disease," the "Family Functioning Assessment Scale," and the "Self-care Agency Scale." RESULTS Of the 151 patients, 119 (78.8%) were assessed as having a low risk of nonadherence, 60 (39.7%) as having low family functioning, and 131 (86.8%) as having high self-care agency. Treatment adherence and self-care agency showed a moderate and significant correlation ( r = .66, p < .001). Similarly, treatment adherence and family functioning showed a low but significant correlation ( r = .35, p < .001). Moreover, significant multivariate associations were found among the variables of interest. Patients with a low risk of nonadherence were found to be more likely to have a secondary or postsecondary education, not to have vision or hearing problems, and to have a contributory affiliation mode with the health system or private health insurance. In addition, participants with moderate or high levels of family functioning were less likely to be workers or to not have hearing or vision problems. Finally, significant differences were noted between patients with low self-care agency and those with high self-care agency in terms of kinship relationship with family members and affiliation mode with the health system. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The results of this research help clarify the issue of treatment adherence in patients with cardiovascular disease. Although family functioning and self-care agency were found to be low to moderately correlated with treatment adherence, relevant information regarding these variables and sociodemographic variables is presented in this study. Nurses may use these results as a reference to design nursing care plans and interventions to address the conditions of their patients more appropriately.
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Rezaei S, Vaezi F, Afzal G, Naderi N, Mehralian G. Medication Adherence and Health Literacy in Patients with Heart Failure: A Cross-Sectional Survey in Iran. Health Lit Res Pract 2022; 6:e191-e199. [PMID: 35943838 PMCID: PMC9359808 DOI: 10.3928/24748307-20220718-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Heart failure is a costly condition with high morbidity and mortality rates in low- and middle-income countries. Nonadherence to prescribed therapies can lead to severe problems such as poorer health outcomes, higher health care expenditures, increased hospitalizations, and even higher mortality rates in patients with advanced heart disease. Objective: The aim of the present study is to investigate medication adherence and the association between medication adherence and health literacy in Iranian patients with heart failure. Methods: This study was conducted in the heart failure outpatient clinic of Shahid Rajaee Cardiovascular, Medical, and Research Center in Tehran, Iran. Medical records and validated questionnaires were used to collect the necessary information on the survey variables, including sociodemographic characteristics, medication adherence, and health literacy, for a total of 250 patients with heart failure. Stepwise logistic regression analysis was performed to identify the variables that independently and significantly predicted medication nonadherence. Key Results: The results showed that most patients with heart failure had low medication adherence. Some factors, including gender, health literacy, and duration of illness, were associated with adherence. The study results showed a positive association between higher health literacy and better medication adherence. Conclusion: In view of the results, further studies on heart failure are needed to investigate other factors related to medication adherence and health literacy level to achieve better disease management and improve patients' treatment adherence. [HLRP: Health Literacy Research and Practice. 2022;6(3):e191–e199.] Plain Language Summary: This study investigated the relationship between medication adherence and health literacy in Iranian patients with heart failure. The results showed that most patients had inadequate health literacy. Moreover, it showed a significant and positive relationship between health literacy and medication adherence.
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Affiliation(s)
| | | | | | | | - Gholamhossein Mehralian
- Address correspondence to Gholamhossein Mehralian, PhD, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Hashemi Highway, Valiasr Avenue, P.O. Box 14155-6153, Tehran, Iran;
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Baymot A, Gela D, Bedada T. Adherence to self-care recommendations and associated factors among adult heart failure patients in public hospitals, Addis Ababa, Ethiopia, 2021: cross-sectional study. BMC Cardiovasc Disord 2022; 22:275. [PMID: 35715744 PMCID: PMC9206252 DOI: 10.1186/s12872-022-02717-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Adherence to self-care recommendations in heart failure (HF) patients is essential to improve the patients’ quality of life, prevent hospital admission, and reduce mortality and morbidity. Nevertheless, poor adherence to self-care recommendations remains to be an extensive problem for HF patients. Thus, the aim was to assess adherence to self-care recommendations and associated factors among HF patients in public hospitals, Addis Ababa, Ethiopia, 2021. Methods An institutional-based cross-sectional study was conducted among adult HF patients from February 15 to April 15, 2021, in five public hospitals, in Addis Ababa, Ethiopia. A total of 294 adult HF patients completed an interviewer-administered questionnaire in the Amharic language. The Revised HF Compliance Questionnaire was used to measure the adherence to self-care recommendations of HF patients. Data was collected using the Revised HF Compliance Questionnaire, the Japanese heart failure knowledge scale, the multidimensional scale of perceived social support, and the chronic diseases self-efficacy scale. Study participants were selected through a systematic random sampling technique. Data were entered into Epi-info version 7.1 and then exported to SPSS Version 25 for analysis. Descriptive and logistic regression analyses were performed and the statistical significance of associations between the variables was determined using ORs with 95% CI and p-values < 0.05. Results Adherence to self-care recommendations among adult HF patients in public hospitals, in Addis Ababa, Ethiopia was 32.70%. Being female (AOR 4.66, 95% CI 1.58–13.67), patients who had high family monthly income (AOR 10.32, 95% CI 2.00–5.13), NYHA class III (AOR: 7.01, 95% CI 2.18–22.57) and class IV (AOR: 6.30, 95% CI 1.01–39.22), who had good self-efficacy (AOR 7.63, 95% CI 2.64–21.97), and who had good knowledge about HF (AOR 3.95, 95% CI 1.56–9.95) were more likely to have good adherence to self-care recommendations, p-value < 0.05. Conclusion This study revealed that 32.70% of adult HF patients had good adherence to self-care recommendations. Factors associated with adherence to self-care recommendations of adult HF patients are sex, family monthly income, NYHA classification, self-efficacy, and knowledge about HF. Therefore, interventions focused on sex, family monthly income, NYHA classification, self-efficacy, and knowledge about HF are required to improve adherence to self-care recommendations of adult HF patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02717-3.
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Affiliation(s)
| | - Debela Gela
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Ababa, Ethiopia.
| | - Tadesse Bedada
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Ababa, Ethiopia
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Zhang X, Yao Y, Zhang Y, Jiang S, Li X, Wang X, Li Y, Yang W, Zhao Y, Zang X. Prognostic value of patient-reported outcomes in predicting 30 day all-cause readmission among older patients with heart failure. ESC Heart Fail 2022; 9:2840-2850. [PMID: 35686326 DOI: 10.1002/ehf2.13991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/05/2022] [Accepted: 05/08/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Previous prediction studies for 30 day readmission in patients with heart failure were built mainly based on electronic medical records and rarely involved patient-reported outcomes. This study aims to develop and validate a nomogram including patient-reported outcomes to predict the possibility of 30 day all-cause readmission in older patients with heart failure and to explore the value of patient-reported outcomes in prediction model. METHODS AND RESULTS This was a prospective cohort study. The nomogram was developed and internally validated by Logistic regression analysis based on 381 patients in training group from March to December 2019. The nomogram was externally validated based on 170 patients from July to October 2020. Receiver operating characteristic curves, calibration plots and decision-curve analysis were used to evaluate the performance of the nomogram. A total of 381 patients' complete data were analysed in the training group and 170 patients were enrolled in the external validation group. In the training group, 14.4% (n = 55) patients were readmitted to hospitals within 30 days of discharge and 15.9% (n = 27) patients were readmitted in the external validation group. The nomogram included six factors: history of surgery, changing the type of medicine by oneself, information acquisition ability, subjective support, depression level, quality of life, all of which were significantly associated with 30 day readmission in older patients with heart failure. The areas under the receiver operating characteristic curves of nomogram were 0.949 (95% CI: 0.925, 0.973, sensitivity: 0.873, specificity: 0.883) and 0.804 (95% CI: 0.691, 0.917, sensitivity: 0.778, specificity: 0.832) respectively in the training and external validation groups, which indicated that the nomogram had better discrimination ability. The calibration plots demonstrated favourable coordination between predictive probability of 30 day readmission and observed probability. Decision-curve analysis showed that the net benefit of the nomogram was better between threshold probabilities of 0-85%. CONCLUSIONS A novel and easy-to-use nomogram is constructed and demonstrated which emphasizes the important role of patient-reported outcomes in predicting studies. The performance of the nomogram drops in the external validation cohort and the nomogram must be validated in a wide prospective cohort of HF patients before its clinical relevance can be demonstrated. All these findings in this study can assist professionals in identifying the needs of HF patients so as to reduce 30 day readmission.
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Affiliation(s)
- Xiaonan Zhang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Ying Yao
- Department of Emergency, Tianjin Medical University General Hospital, Tianjin, China
| | - Yanwen Zhang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Sixuan Jiang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xuedong Li
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaobing Wang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yanting Li
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Weiling Yang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaoying Zang
- School of Nursing, Tianjin Medical University, Tianjin, China
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Rahpeima E, Bijani M, Karimi S, Alkamel A, Dehghan A. Effect of the Implementation of Interdisciplinary Discharge Planning on Treatment Adherence and Readmission in Patients Undergoing Coronary Artery Angioplasty. INVESTIGACION Y EDUCACION EN ENFERMERIA 2022; 40:e08. [PMID: 36264696 PMCID: PMC9714981 DOI: 10.17533/udea.iee.v40n2e08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 06/06/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To determine the effect of interdisciplinary discharge planning on treatment adherence and readmission in the patients undergoing coronary artery angioplasty in the south of Iran in 2020. METHODS This experimental study had an intervention group and a control group with pre-test and post-test. 70 patients participated in the study who were randomly divided into the groups (intervention group (n=35) and control group (n=35)). In the intervention group, discharge planning was performed based on an interdisciplinary approach. Treatment adherence before, immediately, and one month after the intervention was evaluated with a 10-question survey scored from 1 to 5 (maximum score = 50), as well as readmission three months after the discharge was examined in both groups. RESULTS Before the intervention, there was no statistically significant difference between the intervention and the control groups in the treatment adherence score (18.22 versus 17.37; p=0.84) but immediately and one month after the intervention statistically significant differences between the groups were showed (21.51 versus 46.14 and 23.28 versus 43.12, respectively; p<0.001). Within three months after discharge, the readmission rate was 11.4% in the control group, while no readmission was reported in the intervention group. Within three months after discharge, the readmission rate was 11.4% in the control group, while no readmission was reported in the intervention group. CONCLUSIONS The implementation of interdisciplinary discharge planning had positive effects on treatment adherence and readmission rate in patients undergoing coronary artery angioplasty; therefore, it is suggested that health care system managers make the necessary plans to institutionalize this new educational approach for other patients discharge planning.
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Affiliation(s)
| | | | - Shahnaz Karimi
- Department of Medical Education, Medical Education Research Center,
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Sadeghiazar S, Mobasseri K, Gholizadeh L, Sarbakhsh P, Allahbakhshian A. Illness acceptance, medication adherence and the quality of life in patients with heart failure: A path analysis of a conceptual model. Appl Nurs Res 2022; 65:151583. [DOI: 10.1016/j.apnr.2022.151583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/18/2022] [Accepted: 04/03/2022] [Indexed: 11/16/2022]
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Joho AA. Using the Health Belief Model to Explain the Patient's Compliance to Anti-hypertensive Treatment in Three District Hospitals - Dar Es Salaam, Tanzania: A Cross Section Study. East Afr Health Res J 2021; 5:50-58. [PMID: 34308245 PMCID: PMC8291213 DOI: 10.24248/eahrj.v5i1.651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 05/06/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Hypertension remains a public-health challenge globally. Its prevention, early detection, proper and adequate treatment and control should be given high consideration to prevent occurrence of cardiovascular disease and stroke. This study is guided by the Health Belief Model (HBM) to investigate the influence of treatment compliance using HBM constructs among elderly hypertensive patients in 3 regional hospitals in Dar es Salaam, Tanzania. METHODS An analytical cross-sectional study was conducted in 3 region hospitals in Dar es Salaam from April to May 2012. The study included patients who were on antihypertensive medications. Simple Random Sampling was used to enrol the study participants. Data was collected using structured questionnaire. Data was analysed using SPSS version 20. Linear Multiple Regression analysis was performed to identify variables which are strongest predictor of treatment compliance among variables of the Health belief Model. RESULTS A total of 135 participants were enrolled of whom 56% were compliant to hypertensive treatment. Multivariate analysis indicated significant model fit for the data (F=11.19 and P value <.001). The amount of variance in treatment compliance that was explained by the predictors was 30.3% (R2=0.303) with perceived barrier being the strongest predictor of treatment compliance (β=-0.477; p< .001). Other predictor variables were not statistically associated with treatment compliance. CONCLUSION The study showed that 56% of study participants had hypertensive treatment compliance and perceived barrier to treatment was the strongest predictor. Innovative strategy on improving patients' perception of barrier to treatment is recommended in order to improve treatment compliance.
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Affiliation(s)
- Angelina Alphonce Joho
- School of Nursing and Public Health, Department of Clinical Nursing, University of Dodoma, Tanzania
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Moucheraud C, Phiri K, Hoffman RM. Health behaviours and beliefs among Malawian adults taking antihypertensive medication and antiretroviral therapy: A qualitative study. Glob Public Health 2021; 17:688-699. [PMID: 33471610 PMCID: PMC8289928 DOI: 10.1080/17441692.2021.1874468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In order to understand HIV-positive Malawian adults' experiences with hypertension management, we conducted qualitative interviews with 30 hypertensive adults who were also taking antiretroviral therapy. These interviews regarding hypertension management behaviours and beliefs were audio-recorded, transcribed, translated into English, and coded in Atlas.ti. Despite acknowledging the dangers of hypertension and the benefits of medication, many respondents missed their antihypertensive medication. Primary reasons included feeling healthy, health workers' advice to stop taking medicine when blood pressure normalised, side effects, and using herbs or non-prescription medicines to manage hypertension. Women highlighted difficulties with dietary modifications, and changes in their social relationships. Both men and women spoke about hypertension-related challenges with employment and household economics. These results suggest numerous challenges among adults managing hypertension and HIV in Malawi, and frequent suboptimal adherence to medication. We identified new key themes - the quality of adherence counselling for antihypertensive medication, the effects of hypertension on financial stability, and the role of social relationships in self-care - and encourage further investigation into these topics in low-income, high-burden countries.
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Affiliation(s)
- Corrina Moucheraud
- Department of Health Policy and Management, University of California Fielding School of Public Health, Los Angeles, CA, USA
| | | | - Risa M Hoffman
- Division of Infectious Diseases, University of California Geffen School of Medicine, Los Angeles, CA, USA
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Adem A, Dukessa Gemechu T, Jarso H, Reta W. Rheumatic Heart Disease Patients' Adherence to Secondary Prophylaxis and Associated Factors at Hospitals in Jimma Zone, Southwest Ethiopia: A Multicenter Study. Patient Prefer Adherence 2020; 14:2399-2406. [PMID: 33304095 PMCID: PMC7723230 DOI: 10.2147/ppa.s281413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/12/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is a major cause of preventable premature cardiovascular-related death in developing countries. However, information regarding adherence rates and associated factors is limited and inconsistent in Ethiopia. METHODS A cross-sectional study was conducted from August to November 2019 among selected RHD patients on follow-up at four hospitals in Jimma zone. Data were collected using a structured questionnaire. Adherence of RHD patients to secondary prophylaxis in the previous consecutive 12 months was assessed based on the annual frequency of received prophylaxis (monthly injection of benzathine penicillin). Good adherence was considered the patient receiving >80% of the annual dose. The collected data were entered into Epidata 3.1 and analysed using SPSS 23. RESULTS A total of 253 RHD patients taking prophylaxis were included in the analysis, and of those 178 (70.4%) were female, giving a male:female ratio of 1:2.4. The mean age was 24±11 (6-65) years. About 63% had good adherence to benzathine penicillin prophylaxis. New York Heart Association functional class I and II, rural residence, >30 km from health facility, and duration of prophylaxis >5 years were associated with poor adherence (respectively: AOR 12.6 [95% CI 2.5-63], P=0.016; AOR 6.8 [95% CI 1.9-24.4], P=0.003; AOR 5.5 [95% CI 1.2-26.7], P=0.046; AOR 1.2 [95% CI 1.1-3.2], P=0.021). Leading barriers to good adherence were long distance from the treatment setting (56.9%), followed by lack of money (38%). CONCLUSION Patients with class I and II heart failure and those living in rural areas, especially >30 km from a hospital, were identified to be poorly adherent to secondary prophylaxis.
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Affiliation(s)
- Alinur Adem
- Department of Internal Medicine, Institute of Health Science, Jimma University, Jimma, Oromia, Ethiopia
| | - Tadesse Dukessa Gemechu
- Department of Internal Medicine, Institute of Health Science, Jimma University, Jimma, Oromia, Ethiopia
| | - Habtemu Jarso
- Department of Biostatistics and Epidemiology, Institute of Health Science, Jimma University, Jimma, Oromia, Ethiopia
| | - Wondu Reta
- Department of Biomedical Sciences, Institute of Health Science, Jimma University, Jimma, Oromia, Ethiopia
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