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Lin YW, Chen PC, Lin CH, Lin MH. Investigating medication adherence among Taiwanese patient with hypertension, hyperlipidemia, and diabetes: A pilot study using the Chinese version of a Two-Part Medication Nonadherence Scale and the NHI MediCloud system. PLoS One 2024; 19:e0304442. [PMID: 38985806 PMCID: PMC11236195 DOI: 10.1371/journal.pone.0304442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/14/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND This pilot study aimed to investigate medication nonadherence among Taiwanese patients with diabetes, hypertension, and hyperlipidemia using the Chinese version of the Two-Part Medication Nonadherence Scale (C-TPMNS) and the National Health Insurance (NHI) Medicloud system. The study revealed insights into the factors contributing to nonadherence and the implications for improving patient adherence to medications for chronic conditions. However, the small sample size limits the generalizability of the findings. Additionally, the study identified the need for further research with larger and more diverse samples to validate the preliminary findings. METHODS The study conducted surveys individuals in central Taiwan who received three-high medications and those who returned expired medications from chain pharmacies. A structured questionnaire including the C-TPMNS was administered, and additional data on medical history and HbA1c, LDL, and blood pressure levels were collected from the NHI Medicloud system. Data analysis was performed using multiple ordered logistic regression and Wald test methods. Setting interpretation cutoff point to determine medication nonadherence. RESULTS The study found that 25.8% of participants were non-adherent to prescribed medications. Non-adherent individuals had significantly higher systolic blood pressure (SBP ≥ 140 mmHg) than adherent participants. Non-adherence was also associated with factors such as lower education, single status, living alone, abnormal glucose postprandial concentration, and triglyceride levels. The C-TPMNS demonstrated good reliability (Cronbach's alpha = 0.816) and validity (area under the ROC curve = 0.72). CONCLUSION The study highlighted the complexity of medication nonadherence with diverse determinants and emphasized the importance of tailored interventions. The findings underscored the need for region-specific research to comprehensively address medication nonadherence, especially focusing on adherence to medications for hypertension, hyperlipidemia, and diabetes. The study also identified the need for larger, more diverse studies to validate and expand upon the initial findings and emphasized the importance of pharmacist interventions and patient empowerment in managing chronic conditions and improving overall health outcomes.
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Affiliation(s)
- Ya-Wen Lin
- School of Nursing, China Medical University, Taichung, Taiwan, R.O.C
| | - Pei-Chun Chen
- Department of Public Health, China Medical University, Taichung, Taiwan, R.O.C
| | - Che-Huei Lin
- Department of Pharmacy and Master Program, Tajen University, Pingtung, Taiwan, R.O.C
- Department of Business and Management, Central Taiwan University of Science and Technology, Taiwan, R.O.C
| | - Ming-Hung Lin
- Department of Pharmacy and Master Program, Tajen University, Pingtung, Taiwan, R.O.C
- College of Health, Taichung University of Science and Technology, Taiwan, R.O.C
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Kanyongo W, Ezugwu AE. Feature selection and importance of predictors of non-communicable diseases medication adherence from machine learning research perspectives. INFORMATICS IN MEDICINE UNLOCKED 2023. [DOI: 10.1016/j.imu.2023.101232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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Alsofyani MA, Aloufi AO, Al-Qhtani NS, Bamansour SO, Almathkori RS. Factors related to treatment adherence among hypertensive patients: A cross-sectional study in primary healthcare centers in Taif city. J Family Community Med 2022; 29:181-188. [PMID: 36389026 PMCID: PMC9664459 DOI: 10.4103/jfcm.jfcm_153_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/21/2022] [Accepted: 06/30/2022] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Antihypertensive medications must be taken as prescribed since noncompliance can result in the lack of hypertension (HTN) control. The aim of this study was to determine the factors that influence adherence to treatment by HTN patients in Taif city. MATERIALS AND METHODS A cross-sectional study was undertaken in basic healthcare centers in Taif city, Saudi Arabia. A simple random sampling method was used to select participants from primary healthcare centers. Data was obtained on patients' demographic characteristics, smoking habits, anti-HTN drugs and treatment characteristics, barriers to medication compliance, systolic and diastolic blood pressure (BP), anthropometric measurements, and family history of HTN and diabetes mellitus (DM). We used the 4-item Morisky Medication Adherence Scale (MMAS-4™) as a valid questionnaire to assess medication adherence. Data were analyzed using SPSS. Qualitative data was presented as numbers and percentages, and Chi-squared test was applied to test the relationship between qualitative variables. For quantitative data, mean and standard deviation was calculated. Multiple logistic regression analysis were performed to determine correlates of treatment adherence, and results were presented as Odds Ratio (OR) and 95% confidence interval (CI) for OR. RESULTS Of the 549 patients included, 36.8% did not have a regular check of their BP at home and the majority had a family history of HTN and diabetes. About 86% patients showed a high level of adherence. Income ≥5000 SAR, age ≥60 years, female gender, who were being married, having ≤10 family members, being unemployed, and never having smoked were associated with high adherence level. The most important factor that affected MMAS scores was the regular BP checks at home. CONCLUSION When patients attend routine follow-up clinics, it is critical to strengthen reminder mechanisms and provide regular counseling.
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Affiliation(s)
| | - Adel O. Aloufi
- Post Graduated Department, Public Health, Ministry of Health, Saudi Arabia
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Which domains of the theoretical domains framework should be targeted in interventions to increase adherence to antihypertensives? A systematic review. J Hypertens 2022; 40:853-859. [DOI: 10.1097/hjh.0000000000003113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cai A, Zhu Y, Clarkson SA, Feng Y. The Use of Machine Learning for the Care of Hypertension and Heart Failure. JACC. ASIA 2021; 1:162-172. [PMID: 36338169 PMCID: PMC9627876 DOI: 10.1016/j.jacasi.2021.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/22/2021] [Accepted: 07/19/2021] [Indexed: 06/12/2023]
Abstract
Machine learning (ML) is a branch of artificial intelligence that combines computer science, statistics, and decision theory to learn complex patterns from voluminous data. In the last decade, accumulating evidence has shown the utility of ML for prediction, diagnosis, and classification of hypertension and heart failure (HF). In addition, ML-enabled image analysis has potential value in assessing cardiac structure and function in an accurate, scalable, and efficient way. Considering the high burden of hypertension and HF in China and worldwide, ML may help address these challenges from different aspects. Indeed, prior studies have shown that ML can enhance each stage of patient care, from research and development, to daily clinical practice and population health. Through reviewing the published literature, the aims of the current systemic review are to summarize the utilities of ML for the care of those with hypertension and HF.
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Key Words
- ANN, artificial neural network
- AUC, area under the curve
- CNN, convolutional neural network
- HFpEF, heart failure with preserved ejection fraction
- LRM, linear or logistic regression model
- LVDD, left ventricular diastolic dysfunction
- LVH, left ventricular hypertrophy
- ML, machine learning
- RF, random forest
- SVM, support vector machine
- algorithms
- heart failure
- hypertension machine learning
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Affiliation(s)
- Anping Cai
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yicheng Zhu
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Stephen A. Clarkson
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yingqing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Mahmood S, Jalal Z, Hadi MA, Khan TM, Haque MS, Shah KU. Prevalence of non-adherence to antihypertensive medication in Asia: a systematic review and meta-analysis. Int J Clin Pharm 2021; 43:486-501. [PMID: 33515135 DOI: 10.1007/s11096-021-01236-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
Background Hypertension and its associated complications are one of the leading causes of morbidity and mortality in Asia. Racial disparities in terms of treatment outcomes among hypertension patients have been reported in literature with Asian patients resulting in poorer treatment outcomes. Non-adherence to antihypertensive therapy is frequently associated with poor treatment outcomes. Aim of the review The aim of this review was to estimate the prevalence of non-adherence to antihypertensive medications among patients with hypertension residing in Asia. Method PubMed, Google Scholar, MEDLINE, Embase, Scopus, CINHAL and Cochrane library were searched for studies published between 2000 and 2019 involving hypertensive patients. Studies investigating the prevalence of medication non-adherence in Asian countries, rated either good or fair on National Institute of Health quality assessment tool and published in English language were included in our review. Data were extracted by one author and checked by another using a structured and pilot-tested data extraction sheet. A random-effects meta-analysis was performed using STATA version 14.3®. Results Sixty-Six studies from 22 Asian countries including 2,532,582 hypertensive patients were included. Mean (± SD) age of participants was 58(± 6) years. Overall, the estimated prevalence of non-adherence to antihypertensive medication in Asia was 48% (95% CI: 41-54, P = 0.001). The rate of non-adherence was higher among females 49% (95% CI: 41-56, P = 0.001) compared to males 47% (95% CI: 40-53, P = 0.001). As per the region, the highest prevalence of non-adherence was found in South Asia 48% (95% 44-51, P = 0.877) followed by East Asia 45% (31-59, P = 0.001) and the Middle East 41 (95% 30-52, P = 0.001). Similarly, higher rate of non-adherence was observed in low and lower middle-income countries i.e. 50% (95% CI: 47-54, P = 0.220) as compare to upper-middle and high-income countries i.e. 37% (95% CI: 25-49, P = 0.001) and 44% (95% CI: 29-59, P = 0.001) respectively. Conclusion The prevalence of non-adherence to antihypertensive medication is high in Asia. This may partly explain poor treatment outcomes and incidence of higher mortality rate in Asia frequently reported in the literature. There is a need to implement appropriate policies and clinical practices to improve medication adherence.
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Affiliation(s)
- Sajid Mahmood
- Department of Pharmacy, Quaid-E-Azam University, Islamabad, 45320, Pakistan
| | - Zahraa Jalal
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Muhammad Abdul Hadi
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Science (UVAS), Lahore, Pakistan
| | - M Sayeed Haque
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Kifayat Ullah Shah
- Department of Pharmacy, Quaid-E-Azam University, Islamabad, 45320, Pakistan.
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Gao W, Liu H, Ge C, Liu X, Jia H, Wu H, Peng X. A Clinical Prediction Model of Medication Adherence in Hypertensive Patients in a Chinese Community Hospital in Beijing. Am J Hypertens 2020; 33:1038-1046. [PMID: 32710736 DOI: 10.1093/ajh/hpaa111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/20/2020] [Accepted: 07/22/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hypertension remains a global health problem. Since, there is a significant positive correlation between antihypertensive medication adherence and blood pressure control, it is therefore of great importance to elucidate the determinants of adherence to antihypertensive medications among hypertensive patients. METHODS Hereby, we retrospectively analyzed the medical records of a hypertensive cohort recruited from a community hospital in Beijing, China, to investigate the factors affecting adherence to antihypertensive medications using decision trees. In addition, all data were assigned into a training set (75%) and testing set (25%) by the random number seed method to build and validate a compliance predictive model. We identified that how many times patients became nonadherent to antihypertensive medications in the year before the first prescription, types of antihypertensive drugs used in the year before the first prescription, body weight, smoking history, total number of hospital visits in the past year, total number of days of medication use in the year before enrollment, age, total number of outpatient follow-ups in the year after the first prescription, and concurrent diabetes greatly affected the compliance to antihypertensive medications. RESULTS The compliance predictive model we built showed a 0.78 sensitivity and 0.69 specificity for the prediction of the compliance to antihypertensive medications, with an area under the representative operating characteristics curve of 0.810. CONCLUSIONS Our data provide new insights into the improvements of the compliance to antihypertensive medications, which is beneficial for the management of hypertension, and the compliance predictive model may be used in community-based hypertension management.
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Affiliation(s)
- Wenjuan Gao
- Fangzhuang Community Health Service Center of Capital Medical University, Beijing, China
| | - Hong Liu
- Capital Medical University, Beijing, China
| | - Caiying Ge
- Fangzhuang Community Health Service Center of Capital Medical University, Beijing, China
| | - Xinying Liu
- Fangzhuang Community Health Service Center of Capital Medical University, Beijing, China
| | - Hongyan Jia
- Fangzhuang Community Health Service Center of Capital Medical University, Beijing, China
| | - Hao Wu
- Fangzhuang Community Health Service Center of Capital Medical University, Beijing, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children Health, Beijing, China
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Goudarzi H, Barati M, Bashirian S, Moeini B. Determinants of medication adherence among hypertensive patients using the Pender's health promotion model. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2020; 9:89. [PMID: 32509897 PMCID: PMC7271922 DOI: 10.4103/jehp.jehp_687_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/10/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Poor adherence in treatment and medication is a global issue in curing the chronic diseases such as hypertension. The present study was conducted to identify the factors related with medication adherence among hypertensive patients referred to the health centers of Borujerd based on the Pender's Health Promotion Model (HPM). MATERIALS AND METHODS This cross-sectional study was conducted on 463 patients who were referred to the comprehensive health centers of Borujerd city by cluster sampling method in 2019. The data were collected using a questionnaire including demographic variables and Pender's HPM constructs. Data were analyzed by SPSS 18 software using Pearson correlation coefficient and linear regression. RESULTS The mean and standard deviation of the participants' age was 63.29 ± 11.2 years. The results showed that hypertensive patients had a relatively desirable level of medication adherence behavior. Perceived barriers (β = -0.169), perceived self-efficacy (β = 0.196), activity related affect (β = 0.232), and following medication regimen (β = 0.225) were the best predictors of performing the medication adherence behavior. In total, different structures of the HPM explained 42.2% of the variation of medication adherence behavior changes. CONCLUSIONS According to the findings, the design of educational programs using HPM is recommended to increase the medication adherence among hypertensive patients.
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Affiliation(s)
- Hossein Goudarzi
- Department of Public Health, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Majid Barati
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Saeed Bashirian
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Babak Moeini
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Cui B, Dong Z, Zhao M, Li S, Xiao H, Liu Z, Yan X. Analysis of Adherence to Antihypertensive Drugs in Chinese Patients with Hypertension: A Retrospective Analysis Using the China Health Insurance Association Database. Patient Prefer Adherence 2020; 14:1195-1204. [PMID: 32764892 PMCID: PMC7373416 DOI: 10.2147/ppa.s243665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/24/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To analyze the adherence to antihypertensive drugs in Chinese patients with hypertension and the factors associated with the drug adherence. METHODS The data for this analysis were obtained from the 2014 China Health Insurance Association (CHIRA) database. The study included 64,576 patients aged ≥18 years who were prescribed one of the seven antihypertensive drugs included in the study in their first prescription in 2014 and were observed for ≥180 days. The medicine possession ratio (MPR) was calculated and taken as the measure of treatment adherence. MPR values <0.3, 0.3 to <0.5, 0.5 to <0.8, and ≥0.8 were considered treatment adherence very low, low, intermediate, and high, respectively. Descriptive statistics were used to present baseline data and treatment adherence rate. Multiple regression models were used to determine independent factors which can affect the treatment adherence rate. P-value <0.05 was considered significant. RESULTS Among the study antihypertensive drugs, amlodipine (33.98%), metoprolol (25.04%), and nifedipine (17.15%) were the frequently prescribed drugs. Nifedipine controlled release tablet had the highest MPR (0.61), followed by valsartan (0.53), valsartan/amlodipine fixed-dose combination (0.50), indapamide (0.40), and amlodipine (0.39), whereas benazepril (0.27) and metoprolol (0.19) had the lowest MPR. Higher reimbursement ratio, regular tertiary hospitals visits, lower age, and lower daily medical cost positively affected treatment adherence, whereas longer duration of illness and higher daily average cost affected treatment adherence negatively. CONCLUSION Our study assessed that prescribing more cost-effective, long-acting antihypertensive drugs, and raising the reimbursement ratio were associated with a better treatment adherence in Chinese patients with hypertension.
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Affiliation(s)
- Bin Cui
- School of Public Health, Peking University, Beijing100191, People’s Republic of China
| | - Zhaohui Dong
- Human Resources and Social Security, Chinese Academy of Labour and Social Security, Beijing, 100029, People’s Republic of China
| | - Mengmeng Zhao
- School of Pharmaceutical Science and Technology, School of Pharmacy, Tianjin University, Tianjin, 300072, People’s Republic of China
| | - Shanshan Li
- Medical Affairs, Bayer Healthcare Company Limited (China), Beijing, 100020, People’s Republic of China
| | - Hua Xiao
- Medical Affairs, Bayer Healthcare Company Limited (China), Beijing, 100020, People’s Republic of China
| | - Zhitao Liu
- Medical Affairs, Bayer Healthcare Company Limited (China), Beijing, 100020, People’s Republic of China
| | - Xiaowei Yan
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China
- Correspondence: Xiaowei Yan Peking Union Medical College Hospital, Beijing100730, People’s Republic of China Email
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Shakya R, Shrestha S, Gautam R, Rai L, Maharjan S, Satyal GK, KC B, Rai MK. Perceived Illness and Treatment Adherence to Hypertension Among Patients Attending a Tertiary Hospital in Kathmandu, Nepal. Patient Prefer Adherence 2020; 14:2287-2300. [PMID: 33244224 PMCID: PMC7685346 DOI: 10.2147/ppa.s270786] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/16/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Hypertension (HTN) is a silent killer, accountable for life-threatening complications. An individual's illness perception may affect adherence to treatment which is crucial to prevent complications of HTN. The objective of this study was to identify illness perception and treatment adherence among patients with HTN in a tertiary hospital in Kathmandu, Nepal. METHODS Descriptive correlational study was conducted in the out-patient department of Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu Nepal. Non-probability purposive sampling was used. A face-to-face interview was conducted from September to December 2018, using a structured questionnaire that included socio-demographic variables, illness perception questionnaire (revised) and Hill bone compliance to high blood pressure therapy scale. Data analysis was done by using descriptive and inferential statistics (chi-square test, Spearman rank correlation). RESULTS Among 204 participants, 51% were male, 77% were literate, mean ± S.D. age was 60±12. About 72% experienced headache and 88% said that headache is related to HTN. Behavioural factors and psychological factors were regarded as the leading cause of HTN. Almost 63% participants believed HTN as highly threatening illness. Higher scores in timeline (acute/chronic), personal control, and treatment control revealed that patients believed HTN as a chronic disease with a higher rate of personal and treatment control. Regarding treatment adherence, the mean score was 16.58 (SD = 2.08), and only 14.7% had perfect adherence. Participants were more adherent to medication and appointment keeping rather than reduce salt intake. Duration of HTN diagnosis (p=0.027) and duration under HTN medication (p= 0.021) were found to be significantly associated with treatment adherence. There was a significant positive correlation between illness perception and treatment adherence (ρ = 0.282, p<0.01). CONCLUSION Illness perception and treatment adherence are correlated. Hence, it is beneficial to improve illness perception to achieve perfect treatment adherence. Reinforcement is essential to maintain adherence to both medications and behaviour therapy.
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Affiliation(s)
- Rajina Shakya
- Department of Nursing, Nobel College, Pokhara University, Sinamangal, Kathmandu, Nepal
- Correspondence: Rajina Shakya Email
| | - Sunil Shrestha
- Department of Pharmacy, Nepal Cancer Hospital and Research Center, Lalitpur, Nepal
- Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Nepal
| | - Roshani Gautam
- Maharajgunj Nursing Campus, Tribhuvan University, Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | - Lalita Rai
- Maharajgunj Nursing Campus, Tribhuvan University, Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | | | - Gita Kumari Satyal
- Female Surgical Ward, Department of Nursing, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bhuvan KC
- School of Pharmacy, Monash University Malaysia, Subang Jaya47500, Selangor, Malaysia
- Bhuvan KC Email
| | - Mana Kumari Rai
- Maharajgunj Nursing Campus, Tribhuvan University, Institute of Medicine Maharajgunj, Kathmandu, Nepal
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Song H, Zhang D, Chen Z, Wang R, Tang S, Bishwajit G, Chen S, Feng D, Wu T, Wang Y, Su Y, Feng Z. Utilisation of national community-based blood pressure monitoring service among adult Chinese and its association with hypertension treatment and blood pressure control-a mediation analysis. BMC Geriatr 2019; 19:162. [PMID: 31182039 PMCID: PMC6558874 DOI: 10.1186/s12877-019-1176-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/31/2019] [Indexed: 12/20/2022] Open
Abstract
Background Community-based blood pressure (BP) monitoring plays an important role in national hypertension management in China. However, the utilisation of this service, together with its associations on hypertension treatment and BP control has not been fully investigated. Methods The study population was from the China Health and Retirement Longitudinal Study (CHARLS) in 2015. Cross-sectional data of 2487 hypertensive persons were included as subjects. Stratified sample households were selected from 450 villages or communities of 150 counties from 28 provinces. Finally, 21,097 individuals were interviewed successfully. The main outcome was hypertension control (having average BP under 140-90 mmHg). The main independent variable was utilisation of community-based BP monitoring service (having BP examination once a season or more). The mediators were hypertension treatment (currently taking any antihypertensive medicine) and lifestyle factors (alcohol intake, physical activity, smoke). We performed chi-square and binary logistic regression to analyse associations of BP monitoring with hypertension treatment and blood pressure control. The mediation model was examined by the Sobel test. Results Mean age of the population was 64.2 (0.24). The percentage of males was 42.8%. Prevalence of community-based BP monitoring was 32.1%. Patients who used this service had higher odds of hypertension treatment (β = 1.259, P < 0.01, OR = 3.52, CI = 2.467–5.030), and BP control (β = 0.220, P < 0.05, OR = 1.246, CI = 1.035–1.499). Medication treatment played a complete mediating role between monitoring and hypertension control in this study (t = 4.51, P < 0.001). Those who underwent BP monitoring tended to be those who did not finish primary school education (χ2 = 30.300, P < 0.001), had poorer household income (χ2 = 18.298, P < 0.05), and lived in rural areas rather than in urban areas (χ2 = 40.369, P < 0.001). Conclusions Although the use of BP monitoring service had no direct effect on BP control, it had a positive effect on BP control through the full mediation effect of hypertension treatment. Termly BP monitoring by community-based health expertise among hypertensive persons, for instance, once a season, can be recommended to public health policymakers for BP control through instructions on medication treatment and health behaviours.
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Affiliation(s)
- Hongxun Song
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan, Hubei, China
| | - Donglan Zhang
- College of Public Health, University of Georgia, 305B Wright Hall, Health Sciences Campus, 100 Foster Road, Athens, Georgia
| | - Zhuo Chen
- College of Public Health, University of Georgia, 305B Wright Hall, Health Sciences Campus, 100 Foster Road, Athens, Georgia
| | - Ruoxi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan, Hubei, China
| | - Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan, Hubei, China
| | - Ghose Bishwajit
- School of International Development and Global Studies, University of Ottawa, 75 Laurier Avenue East, Ottawa, ON, Canada
| | - Shanquan Chen
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Sha Tin, N.T, Hong Kong, SAR, China
| | - Da Feng
- School of Pharmacy, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan, Hubei, China
| | - Tailai Wu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan, Hubei, China
| | - Yang Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan, Hubei, China
| | - Yanwei Su
- School of Nursing, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan, Hubei, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan, Hubei, China.
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Ma X, Zhang Y, Zhang M, Li X, Yin H, Li K, Jing M. Decomposing the effect of drug benefit program on antihypertensive medication adherence among the elderly in urban China. Patient Prefer Adherence 2019; 13:1111-1123. [PMID: 31371928 PMCID: PMC6628968 DOI: 10.2147/ppa.s201707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 06/19/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Hypertension is a rapidly growing epidemic in People's Republic of China, yet it remains inadequately controlled. This study aimed to identify the relative contributions of program effects and patients' characteristics to the differences in antihypertensive medication nonadherence between drug benefit program enrollees and non-enrollees. PATIENTS AND METHODS Data were from a cross-sectional survey of 1,969 community-dwelling elderly adults with hypertension. Self-reported adherence was measured following previous studies in People's Republic of China. The Blinder-Oaxaca nonlinear decomposition method was used to identify the relative contributions of program effects and patients' individual characteristics. RESULTS Eleven percent of the drug benefit program enrollees were nonadherent to their medication, while 17% of non-enrollees were. Blinder-Oaxaca decomposition identified that over 60% of the gap between the two groups was due to the program effects (P=0.024). The rest could be explained by differences in observable characteristics (P<0.001), such as diabetic status, duration of hypertension, and blood pressure control. CONCLUSION The study confirmed that drug benefit program enrollees were more likely to be adherent to their antihypertensive medication than non-enrollees in the context of People's Republic of China.
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Affiliation(s)
- Xiaochen Ma
- China Center for Health Development Studies, Peking University, Beijing100000, People’s Republic of China
| | - Yuji Zhang
- Department of Public Health, Shihezi University School of Medicine, Shihezi832002, Xinjiang, People’s Republic of China
| | - Mei Zhang
- Department of Public Health, Shihezi University School of Medicine, Shihezi832002, Xinjiang, People’s Republic of China
| | - Xiaoju Li
- Department of Public Health, Shihezi University School of Medicine, Shihezi832002, Xinjiang, People’s Republic of China
| | - Hongpo Yin
- Department of Public Health, Shihezi University School of Medicine, Shihezi832002, Xinjiang, People’s Republic of China
| | - Ke Li
- Department of Orthopedics, The First Affiliated Hospital of the Medical College, Shihezi University, Shihezi832002, Xinjiang, People’s Republic of China
| | - Mingxia Jing
- Department of Public Health, Shihezi University School of Medicine, Shihezi832002, Xinjiang, People’s Republic of China
- Correspondence: Mingxia JingDepartment of Public Health, Shihezi University School of Medicine, 280 N 4th Road, Shihezi, Xinjiang Uyghur Autonomous Region832002, People’s Republic of ChinaTel +1 829 937 7776Email
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Ding W, Li T, Su Q, Yuan M, Lin A. Integrating factors associated with hypertensive patients' self-management using structural equation modeling: a cross-sectional study in Guangdong, China. Patient Prefer Adherence 2018; 12:2169-2178. [PMID: 30410312 PMCID: PMC6198889 DOI: 10.2147/ppa.s180314] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Hypertension is considered a major public health issue worldwide because of its high frequency and concomitant risk of cardiovascular disease (CVD). Chronic-disease self-management has been proven to be cost-effective, but influencing factors and pathways remain complex and unclear. The purpose of this study was to integrate factors associated with hypertension self-management to provide a theoretical reference for community hypertension management. METHODS A total of 268 community-dwelling hypertensive patients were enrolled in a cross-sectional study conducted from July to September in 2017. A questionnaire on demographic-disease characteristics, disease knowledge, social support, self-efficacy, and self-management was completed by patients. Structural equation modeling was performed to verify multiple factors in self-management based on the self-efficacy theory. RESULTS The final model showed a good fit to sample data, ie, younger patients with lower CVD risk, shorter disease course, and less disease knowledge and social support predicted less self-efficacy, less hypertension self-management, and less controlled hypertension. Furthermore, social support was negatively correlated with age, CVD risk, and disease course and positively with disease knowledge. CONCLUSION Medication adherence is the lowest dimension in self-management, and self-efficacy is vital to consider in the development of self-management interventions. Self-management education and mutual-help groups may be potential solutions with the power of technology. Younger patients with lower CVD risk and shorter disease course are vulnerable and need more attention.
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Affiliation(s)
- Weiwei Ding
- Department of Epidemiology and Health Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China,
| | - Tong Li
- Department of Epidemiology and Health Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China,
| | - Qiying Su
- Department of Chronic Disease Management, Dadong Community Healthcare Center, Guangzhou, Guangdong, China
| | - Maohua Yuan
- Department of Chronic Disease Management, Dadong Community Healthcare Center, Guangzhou, Guangdong, China
| | - Aihua Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China,
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