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Garcia-Davis S, Tyagi P, Bouldin ED, Hansen J, Brintz BJ, Noel P, Rupper R, Trivedi R, Kinosian B, Intrator O, Pugh MJ, Leykum LK, Dang S. Sex differences in unmet needs between male and female older veterans. J Women Aging 2024:1-16. [PMID: 38976516 DOI: 10.1080/08952841.2024.2375480] [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: 12/21/2023] [Accepted: 06/27/2024] [Indexed: 07/10/2024]
Abstract
Aging Veterans face complex needs across multiple domains. However, the needs of older female Veterans and the degree to which unmet needs differ by sex are unknown. We analyzed responses to the HERO CARE survey from 7,955 Veterans aged 55 years and older (weighted N = 490,148), 93.9% males and 6.1% females. We evaluated needs and unmet needs across the following domains: activities of daily living (ADLs), instrumental ADLs (IADLs), health management, and social. We calculated weighted estimates and compared sex differences using age-adjusted prevalence ratios. On average, female Veterans were younger, more were Non-Hispanic Black and unmarried. Females and males reported a similar prevalence of problems across all domains. However, compared to males, female Veterans had a lesser prevalence of missed appointments due to transportation (aPR 0.49; 95% CI: 0.26-0.92), housework unmet needs (aPR: 0.44; 95% CI: 0.20-0.97), and medication management unmet needs (aPR: 0.33; 95% CI: 0.11-0.95) but a higher prevalence of healthcare communication unmet needs (aPR: 2.40; 95% CI: 1.13-5.05) and monitoring health conditions unmet needs (aPR: 2.13, 95% CI: 1.08-4.20). Female Veterans' common experience of unmet needs in communicating with their healthcare teams could result in care that is less aligned with their preferences or needs. As the number of older female Veterans grows, these data and additional work to understand sex-specific unmet needs and ways to address them are essential to providing high-quality care for female Veterans.
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Affiliation(s)
- Sandra Garcia-Davis
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Pranjal Tyagi
- South Florida Veterans Affairs Foundation for Research and Education (SFVAFRE), Miami, Florida, USA
| | - Erin D Bouldin
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
| | - Jared Hansen
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- Division of Epidemiology, University of Utah Health, Salt Lake City, Utah, USA
| | - Ben J Brintz
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah Health, Salt Lake City, Utah, USA
| | - Polly Noel
- South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Randall Rupper
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- Salt Lake City Veterans Affairs Geriatric Research Education and Clinical Center (GRECC), Salt Lake City, Utah, USA
| | - Ranak Trivedi
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
- Division of Public Mental Health and Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Bruce Kinosian
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Orna Intrator
- Canandaigua VA Medical Center Geriatrics and Extended Care Data Analysis Center (GECDAC), Canandaigua, New York, USA
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Luci K Leykum
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- South Texas Veterans Health Care System, San Antonio, Texas, USA
- Harbor Health, Austin, Texas, USA
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Stuti Dang
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- Miami Veterans Affairs Geriatric Research Education and Clinical Center (GRECC), Miami, Florida, USA
- Division of Geriatrics and Palliative Care, University of Miami Miller School of Medicine, Miami, Florida, USA
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2
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Ruksakulpiwat S, Schiltz NK, Irani E, Josephson RA, Adams J, Still CH. Medication Adherence of Older Adults with Hypertension: A Systematic Review. Patient Prefer Adherence 2024; 18:957-975. [PMID: 38737487 PMCID: PMC11088410 DOI: 10.2147/ppa.s459678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/16/2024] [Indexed: 05/14/2024] Open
Abstract
Objective Hypertension (HTN) significantly increases the risk of stroke and heart disease, which are the leading causes of death and disability globally, particularly among older adults. Antihypertensive medication is a proven treatment for blood pressure control and preventing complications. However, medication adherence rates in older adults with HTN are low. In this review, we systematically identified factors influencing medication adherence in older adults with HTN. Methods We applied the PRISMA guidelines and conducted systematic searches on PubMed, MEDLINE, and Google Scholar in July 2022 to identify preliminary studies reporting factors influencing medication adherence among older adults with HTN. The convergent integrated analysis framework suggested by the Joanna Briggs Institute for systematic reviews was adopted for data synthesis. Results Initially, 448 articles were identified, and after title and abstract screening, 16 articles qualified for full-text review. During this phase, three articles were excluded for reporting on irrelevant populations or focusing on issues beyond the review's aim, leaving thirteen studies in the final review. After data synthesis, fifteen themes were extracted from the key findings of the included studies. The most prevalent themes included the number of medications used (53.9%, n=7 studies), financial status (38.5%, n=5), sex (38.5%, n=5), age (30.1%, n=4), duration of disease (23.1%, n=3), comorbidities (23.1%, n=3), and health compliance (23.1%, n=3). Other themes, such as education, health literacy, health belief, medication belief, perception of illness, patient-physician relationship, self-efficacy, and social support, were also identified. Conclusion The findings of this review highlight critical areas for developing innovative, evidence-based programs to improve medication adherence in hypertensive older adults. Insights from this review can contribute to improving medication adherence and preventing future health complications.
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Affiliation(s)
- Suebsarn Ruksakulpiwat
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Nicholas K Schiltz
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Elliane Irani
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Jon Adams
- School of Public Health, The University of Technology Sydney, Sydney, Australia
| | - Carolyn Harmon Still
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Zhu G, Malhotra R, Xiong S, Chen X, Zhang M, Wu Y, Gong E, Wang Z, Tian X, Peng W, Østbye T, Yan LL. Community Efficacy for Non-Communicable Disease Management and Medication Adherence: The Sequential Mediating Role of Self-Efficacy and Depressive Symptoms. Patient Prefer Adherence 2023; 17:3421-3433. [PMID: 38111691 PMCID: PMC10726806 DOI: 10.2147/ppa.s436419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/02/2023] [Indexed: 12/20/2023] Open
Abstract
Purpose We assess whether the sequential mediating effects of self-efficacy and depressive symptoms on the relationship between community efficacy for non-communicable disease management (COEN) and medication adherence and whether these relationships differed by sex and age. Patients and Methods Overall, 662 individuals from 12 communities in China were interviewed twice 1 year apart. Serial mediation analysis examined whether the relationship between COEN and medication adherence was mediated by self-efficacy and depressive symptoms. Model invariance across sex and age groups was assessed using multi-group analysis. Results Serial mediation analysis indicated that self-efficacy and depressive symptoms sequentially mediated relationship between COEN and medication adherence. Multi-group analysis by sex showed that the path from self-efficacy to medication adherence was significant only for females and from depressive symptoms to medication adherence was significant only for males. Conclusion Interventions that enhance individual self-efficacy may be beneficial in decreasing depressive symptoms and improving medication adherence.
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Affiliation(s)
- Gangjiao Zhu
- School of Public Health, Wuhan University, Wuhan, People’s Republic of China
- Global Health Research Center, Duke Kunshan University, Kunshan, People’s Republic of China
| | - Rahul Malhotra
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
- Singhealth, Duke-NUS Global Health Institute Medical School, Singapore
| | - Shangzhi Xiong
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Xinyue Chen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mingyang Zhang
- Global Health Research Center, Duke Kunshan University, Kunshan, People’s Republic of China
| | - You Wu
- Global Health Research Center, Duke Kunshan University, Kunshan, People’s Republic of China
| | - Enying Gong
- School of Population Medicine and Public Health, China Academy of Medical Science & Peking Union Medical College, Beijing, People’s Republic of China
| | - Zhan Wang
- Department of Agricultural Economics, College of Agriculture, Purdue University, West Lafayette, IN, USA
| | - Xiangyang Tian
- Chinese Health Education Center, Beijing, People’s Republic of China
| | - Weixia Peng
- School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Truls Østbye
- Global Health Research Center, Duke Kunshan University, Kunshan, People’s Republic of China
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Lijing L Yan
- School of Public Health, Wuhan University, Wuhan, People’s Republic of China
- Global Health Research Center, Duke Kunshan University, Kunshan, People’s Republic of China
- Duke Global Health Institute, Duke University, Durham, NC, USA
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Fadil HA, Sammman WA, Elshafie RM. Prevalence of Nonadherence to Medications among Geriatric Patients in Al-Madinah Al-Munawara City's Hospitals, Kingdom of Saudi Arabia. Int J Clin Pract 2023; 2023:3312310. [PMID: 37942085 PMCID: PMC10630004 DOI: 10.1155/2023/3312310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Medication adherence is a major component in the treatment of chronic patients, especially the older adults. It acts as an essential part of a successful therapeutic outcome, increasing treatment benefits, and decreasing hospital admissions, health care utilization, and cost. Limited research regarding medication adherence has been conducted nationwide; however, data among the older adults is sparse due to the lack of research on this topic. Therefore, this study aimed to determine the prevalence of medication nonadherence among older adults' Saudi patients with chronic diseases living in Al-Madinah Al-Munawwarah city. Method A cross-sectional study was conducted on outpatient older patients with chronic diseases who visited clinics at different hospitals in Al-Madinah Al-Munawwarah city, from March until December 2022. The questionnaire was published in a conversational Arabic dialect. The adherence level was measured by the Adherence to Refills and Medications Scale (ARMS) and the reasons for medication nonadherence were collected by using the Cluig scale. Results 65.1% of females and 34.9% of males have participated in this study. According to the ARMS scale, 67.9% of patients had poor medication adherence and 32.1% had good medication adherence. Poor adherence was higher in females compared to males, with a p value = 0.018. For educational level, the ARMS score in graduates was higher than patients who finished middle school and illiterate patients. Based on the Cluig scale, the most common reasons for medication nonadherence were forgetfulness, feeling well, polypharmacy, and subsequent avoidance of side effects. The findings indicate the gender-based differences in the factors that associated with medication nonadherence among older adults. Conclusion Medication adherence is crucial especially among older adults to improve clinical outcomes. The current results highlight the prevalence of medication adherence among the older adult population. This result shows the gender-based differences in the factors associated with medication nonadherence among the older adult population.
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Affiliation(s)
- Haifa Abdulrahman Fadil
- Department of Clinical and Hospital Pharmacy, Faculty of Pharmacy, Taibah University, Almadinah Almunawarah 30078, Saudi Arabia
| | - Waad Abdulkareem Sammman
- Department of Pharmacology, Faculty of Pharmacy, Taibah University, Almadinah Almunawarah 30078, Saudi Arabia
| | - Riham Mohamed Elshafie
- Department of Clinical and Hospital Pharmacy, Faculty of Pharmacy, Taibah University, Almadinah Almunawarah 30078, Saudi Arabia
- Clinical Pharmacy Department, ASUSH, Ain Shams University, Cairo, Egypt
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5
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Almarwani AM, Almarwani BM. Factors predicting medication adherence among coronary artery disease patients in Saudi Arabia: A descriptive study. Saudi Med J 2023; 44:904-911. [PMID: 37717959 PMCID: PMC10505289 DOI: 10.15537/smj.2023.44.9.20230293] [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: 04/20/2023] [Accepted: 07/25/2023] [Indexed: 09/19/2023] Open
Abstract
OBJECTIVES To measure medication adherence among coronary artery disease (CAD) patients and identify sociodemographic factors that are medication adherence predictors. METHODS A cross-sectional correlation design was carried out, following the STROBE guidelines. The study was carried out in a specialized cardiac center in the western region of Saudi Arabia between March 2019 and January 2020. A total of 278 patients completed the study survey. RESULTS The majority of participants (59.4%) reported moderate medication adherence, and the remainder reported poor (30.6%) and good (10%) medication adherence. It was found that women patients, patients with higher education levels, non-smokers, patients who regularly followed-up with their cardiologist, and patients with family support showed significantly higher medication adherence. Four of the sociodemographic variables (gender, number of doctor visits, family support, and education level) predicted medication adherence. CONCLUSION Approximately 30% of the participants reported poor medication adherence. The number of cardiologist visits and the level of family support were 2 of the factors found to be associated with medication adherence.
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Affiliation(s)
- Abdulaziz M. Almarwani
- From the Department of Psychiatric Nursing (A. M. Almarwani), College of Nursing; and from the Department of Internal Medicine (B. M. Almarwani), College of Medicine, Taibah University, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
| | - Bayan M. Almarwani
- From the Department of Psychiatric Nursing (A. M. Almarwani), College of Nursing; and from the Department of Internal Medicine (B. M. Almarwani), College of Medicine, Taibah University, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
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6
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Said AH, Abd Rahim IS, Mohamad Zaini NNB, Saiful Nizam NIB. Factors Affecting Adherence to Lipid-lowering Drugs: A Scoping Review. Oman Med J 2023; 38:e523. [PMID: 37736054 PMCID: PMC10509635 DOI: 10.5001/omj.2023.67] [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: 07/06/2022] [Accepted: 10/13/2022] [Indexed: 09/02/2023] Open
Abstract
Objectives Dyslipidemia is an important risk factor for cardiovascular disease. In developed countries, only 50% of patients with chronic illness adhere to their long-term therapy. This article aimed to review the factors affecting adherence to lipid-lowering drugs (LLDs). Methods The searched articles were selected based on the available keywords in the title and abstract with the publication restricted between January 2010 and September 2020. Articles generated from the databases must fulfill both inclusion and exclusion criteria in the present systematic review. Our initial search retrieved 221 literature reviews. After excluding articles with irrelevant topics, a total of 23 articles were chosen for this current review. Results The factors were classified based on three main factors: patient-related, medication-related, and healthcare workers-related factors. For patient-related factors, gender, age, number of family members, education level, post-hospitalization, comorbidities and cardiovascular disease risk, follow-up status, occupation, socio-economy, insurance, perception, ethnicity, and health plan were among the factors affecting adherence to LLDs. As for medication-related factors, timing, polypharmacy, duration of treatment, generic medication, intensity of medication, side effects, initiating dose, packaging, drug dosing, and type of drugs were revealed as contributing factors. In the light of healthcare workers, related factors shown were counseling, medication optimization, type of provider, and location of the hospital. Conclusions Recommendations to improve adherence include educating patients on the disease itself and the importance of the treatment, modification of the dosing, timing and type of LLDs, and effective consultations by healthcare workers. Further studies need to be done in Malaysia as there is inadequate research on this topic.
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Affiliation(s)
- Abdul Hadi Said
- Department of Family Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Selangor, Malaysia
| | - Ikhlas Solehah Abd Rahim
- Department of Family Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Selangor, Malaysia
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Purić D, Petrović MB, Živanović M, Lukić P, Zupan Z, Branković M, Ninković M, Lazarević LB, Stanković S, Žeželj I. Development of a novel instrument for assessing intentional non-adherence to official medical recommendations (iNAR-12): a sequential mixed-methods study in Serbia. BMJ Open 2023; 13:e069978. [PMID: 37369402 PMCID: PMC10410978 DOI: 10.1136/bmjopen-2022-069978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES We aimed to (1) develop a novel instrument, suitable for the general population, capturing intentional non-adherence (iNAR), consisting of non-adherence to prescribed therapy, self-medication and avoidance of seeking medical treatment; (2) differentiate it from other forms of non-adherence, for example, smoking; and (3) relate iNAR to patient-related factors, such as sociodemographics, health status and endorsement of irrational beliefs (conspiratorial thinking and superstitions) and to healthcare-related beliefs and experiences ((mis)trust and negative experiences with the healthcare system, normalisation of patient passivity). DESIGN То generate iNAR items, we employed a focus group with medical doctors, supplemented it with a literature search and invited a public health expert to refine it further. We examined the internal structure and predictors of iNAR in an observational study. SETTING Data were collected online using snowball sampling and social networks. PARTICIPANTS After excluding those who failed one or more out of three attention checks, the final sample size was n=583 adult Serbian citizens, 74.4% female, mean age 39.01 years (SD=12.10). PRIMARY AND SECONDARY OUTCOME MEASURES The primary, planned outcome is the iNAR Questionnaire, while smoking was used for comparison purposes. RESULTS Factor analysis yielded a one-factor solution, and the final 12-item iNAR Questionnaire had satisfactory internal reliability (alpha=0.72). Health condition and healthcare-related variables accounted for 14% of the variance of iNAR behaviours, whereas sociodemographics and irrational beliefs did not additionally contribute. CONCLUSIONS We constructed a brief yet comprehensive measure of iNAR behaviours and related them to health and sociodemographic variables and irrational beliefs. The findings suggest that public health interventions should attempt to improve patients' experiences with the system and build trust with their healthcare practitioners rather than aim at specific demographic groups or at correcting patients' unfounded beliefs. STUDY REGISTRATION The design and confirmatory analyses plan were preregistered (https://osf.io/pnugm).
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Affiliation(s)
- D Purić
- Department of Psychology, University of Belgrade, Belgrade, Serbia
- Laboratory for Research of Individual Differences, University of Belgrade, Belgrade, Serbia
| | - M B Petrović
- Department of Psychology, University of Belgrade, Belgrade, Serbia
- Laboratory for Research of Individual Differences, University of Belgrade, Belgrade, Serbia
| | - M Živanović
- Laboratory for Research of Individual Differences, University of Belgrade, Belgrade, Serbia
- Institute for Psychology, University of Belgrade, Belgrade, Serbia
| | - P Lukić
- Department of Psychology, University of Belgrade, Belgrade, Serbia
- Laboratory for Research of Individual Differences, University of Belgrade, Belgrade, Serbia
| | - Z Zupan
- Laboratory for Research of Individual Differences, University of Belgrade, Belgrade, Serbia
- Institute for Psychology, University of Belgrade, Belgrade, Serbia
| | - M Branković
- Institute for Philosophy and Social Theory, Belgrade, Serbia
- Singidunum University, Belgrade, Serbia
| | - M Ninković
- Department of Psychology, University of Belgrade, Belgrade, Serbia
- Laboratory for Research of Individual Differences, University of Belgrade, Belgrade, Serbia
| | - L B Lazarević
- Laboratory for Research of Individual Differences, University of Belgrade, Belgrade, Serbia
- Institute for Psychology, University of Belgrade, Belgrade, Serbia
| | - S Stanković
- Laboratory for Research of Individual Differences, University of Belgrade, Belgrade, Serbia
- Institute for Psychology, University of Belgrade, Belgrade, Serbia
| | - I Žeželj
- Department of Psychology, University of Belgrade, Belgrade, Serbia
- Laboratory for Research of Individual Differences, University of Belgrade, Belgrade, Serbia
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Zhao M, Zhao J, Chen J, Li M, Zhang L, Luo X, Zhang Y, Xiong C, Guo Z, Yan J. The relationship between medication adherence and illness perception in breast cancer patients with adjuvant endocrine therapy: beliefs about medicines as mediators. Support Care Cancer 2022; 30:10009-10017. [PMID: 36261611 DOI: 10.1007/s00520-022-07411-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 10/12/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To describe medication adherence, to analyze the relationships among medication adherence, illness perception, and beliefs about medicines, and to determine the mediating effects of beliefs about medicines on the relationship in breast cancer patients with adjuvant endocrine therapy (AET) in China. METHODS A cross-sectional study was conducted on 202 breast cancer patients with AET from September 2017 to February 2019 in China. The Medication Adherence Report Scale (MARS-5), the Chinese version of the revised illness perception questionnaire for Breast Cancer (CIPQ-R-BC) and the Beliefs about Medicines Questionnaire (BMQ) were used. RESULTS The mean MARS-5 score of our participants was 23.72 (SD = 1.62), and 175 (86.6%) patients were adherent to medications. Moreover, medication adherence was negatively correlated with identity, environmental or immune factors, emotional representations, BMQ-specific concerns, BMQ-general overuse, and BMQ-general harm, as well as being positively correlated with coherence and the total BMQ scores. Furthermore, beliefs in the overuse about medicines functioned as mediators for the influencing effects of coherence and emotional representations on medication adherence. CONCLUSION Illness perception not only directly affected medication adherence, but also indirectly affected medication adherence through the beliefs about medicines. Necessary interventions that target beliefs in the overuse about medicines in breast cancer patients with AET with low levels of coherence or high levels of emotional representations could be provided to improve the level of their medication adherence.
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Affiliation(s)
- Meng Zhao
- School of Nursing, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Jing Zhao
- Tian Shui Health Commission, Tianshui, Gansu Province, China
| | - Jing Chen
- School of Nursing, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Mingfang Li
- School of Nursing, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Lijuan Zhang
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong Province, China
| | - Xia Luo
- School of Nursing, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Yue Zhang
- School of Nursing, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Chenxia Xiong
- School of Nursing, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Zijun Guo
- School of Nursing, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Jun Yan
- School of Nursing, Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
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9
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Nusair MB, Khasawneh R, Al-azzam S, Al-Shuqairat T, Khair ZM, Arabyat R. Attitudes towards adherence and deprescribing among polypharmacy patients: a cross-sectional study. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2022. [DOI: 10.1093/jphsr/rmac028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objectives
Deprescribing is the process of optimization of medication regimens through cessation of potentially inappropriate or unnecessary medications or adjustment of doses with the goal of managing polypharmacy and improving outcomes. Deprescribing potentially improves adherence by reducing polypharmacy. This study aimed to assess polypharmacy patients’ adherence attitudes and their attitudes towards deprescribing.
Methods
A cross-sectional study that targeted polypharmacy patients at outpatient clinics at King Abdullah University Hospital. The inclusion criteria were (1) patients ≥18 years old, (2) patients taking five or more medications, and (3) patients who do not require a caregiver or assistance at home. We excluded patients that showed any signs of moderate or severe cognitive impairment. Patients who met the inclusion/exclusion criteria were interviewed by a clinical pharmacist and completed two survey instruments: revised Patients’ Attitudes Toward Deprescribing (rPATD) and Adherence Attitude Inventory (AAI).
Key findings
In total, 501 patients took part in this study. Over half of the participants were not satisfied with their current medicines and over 70% of them perceived that their current medications are a burden to them and would like their prescribers to initiate deprescribing. The majority of the participants have low to medium adherence attitudes primarily due to ineffective patient–provider communication. Logistic regression analysis revealed that self-efficacy, commitment to adherence, education and age were significantly associated with participants’ willingness to stop one or more of their medications.
Conclusions
Our findings suggest that polypharmacy patients have negative attitudes towards their medication therapy and favour deprescribing. These reported attitudes had been associated with negative adherence attitudes. Study findings offer schematic direction for future investigations of the role of adherence on key health-related outcomes in patients on polypharmacy. Furthermore, research is warranted to investigate the impact of deprescribing on polypharmacy patients’ medication adherence.
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Affiliation(s)
- Mohammad B Nusair
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University , Irbid , Jordan
- Department of Sociobehavioral and Administrative Pharmacy, College of Pharmacy, Nova Southeastern University , Fort Lauderdale, FL , USA
| | - Rawand Khasawneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology , Irbid , Jordan
| | - Sayer Al-azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology , Irbid , Jordan
| | - Tala Al-Shuqairat
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology , Irbid , Jordan
| | - Zaid M Khair
- Faculty of Pharmacy, Yarmouk University , Irbid , Jordan
| | - Rasha Arabyat
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University , Irbid , Jordan
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Wyld MLR, Mata NLDL, Viecelli A, Swaminathan R, O'Sullivan KM, O'Lone E, Rowlandson M, Francis A, Wyburn K, Webster AC. Sex-Based Differences in Risk Factors and Complications of Chronic Kidney Disease. Semin Nephrol 2022; 42:153-169. [PMID: 35718363 DOI: 10.1016/j.semnephrol.2022.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Globally, females are ∼30% more likely to have pre-dialysis chronic kidney disease (CKD) than males for reasons that are not fully understood. CKD is associated with numerous adverse health outcomes which makes understanding and working to eradicating sex based disparities in CKD prevalence essential. This review maps both what is known, and what is unknown, about the way sex and gender impacts (1) the epidemiology and risk factors for CKD including age, diabetes, hypertension, obesity, smoking, and cerebrovascular disease, and (2) the complications from CKD including kidney disease progression, cardiovascular disease, CKD mineral and bone disorders, anaemia, quality-of-life, cancer and mortality. This mapping can be used to guide future research.
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Affiliation(s)
- Melanie L R Wyld
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Renal and Transplant Medicine, Westmead Hospital, Sydney, Australia.
| | - Nicole L De La Mata
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Andrea Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ramyasuda Swaminathan
- Department of Nephrology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Kim M O'Sullivan
- Department of Medicine, Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia
| | - Emma O'Lone
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Matthew Rowlandson
- Department of Renal and Transplant Medicine, Westmead Hospital, Sydney, Australia
| | - Anna Francis
- Child and Adolescent Renal Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Kate Wyburn
- Department of Renal Medicine,Royal Prince Alfred Hospital, Sydney, Australia
| | - Angela C Webster
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Renal and Transplant Medicine, Westmead Hospital, Sydney, Australia
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Sheldon RJG, Pereira M, Aldersley G, Sales T, Hewitt J, Lyon R, Whale R. Clinical outcomes following switching antipsychotic treatment due to market withdrawal: a retrospective naturalistic cohort study of pipotiazine palmitate injection (Piportil Depot) discontinuation, subsequent acute care use and effectiveness of medication to which patients switched. Ther Adv Psychopharmacol 2022; 12:20451253211067042. [PMID: 35126994 PMCID: PMC8808037 DOI: 10.1177/20451253211067042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Pipotiazine palmitate depot injection (Piportil) was withdrawn from the UK marketplace in 2015. Few studies exist on the clinical impact of such market withdrawal. Purpose: We aimed to identify a cohort of patients switching from pipotiazine following this withdrawal and explore factors associated with effectiveness of the medication switched to and subsequent acute service use. METHODS A naturalistic retrospective cohort study was conducted in Sussex, United Kingdom. Those discontinuing pipotiazine solely due to market withdrawal were identified from electronic patient database and manual searching. Multivariate logistic regression analyses and survival analyses were performed to explore associations between available baseline variables and dichotomous all-cause discontinuation of the next prescribed medication and admission to acute mental health services over the subsequent year. RESULTS Of 205 patients identified as receiving pipotiazine in October 2014, 137 switched from this due to market withdrawal. Over the subsequent year, 31.5% discontinued the medication to which they were switched and 19% required acute care. Drug class switched to (typical depot vs atypical long acting injection (LAI) vs atypical oral) had no significant association with discontinuation. Switch to atypical LAI was significantly associated with acute care in comparison to typical depot. Those with a schizophrenia diagnosis were significantly less likely to discontinue switched medication or to receive acute care in comparison to those with schizoaffective disorder. Women were significantly more likely to discontinue switched medication than men. Of those requiring acute care, only 38% had required this in the previous 2 years. CONCLUSIONS Antipsychotic market withdrawal has demonstrable negative clinical implications and requires careful clinical management. Increased acute care rates in those receiving an atypical LAI versus a typical depot following pipotiazine suggests lower effectiveness or possible withdrawal effects. No significant difference between depots, LAIs and oral medications on discontinuation supports the importance of a collaborative, fully informed approach when deciding next treatment options.
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Affiliation(s)
| | - Marco Pereira
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | | | - Tim Sales
- Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Jed Hewitt
- Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Ray Lyon
- Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Richard Whale
- Sussex Partnership NHS Foundation Trust, The Aldrington Centre, 35 New Church Road, Brighton BN3 4AG, UK
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Yu M, Wang L, Guan L, Qian M, Lv J, Deng M. Knowledge, attitudes, and barriers related to medication adherence of older patients with coronary heart disease in China. Geriatr Nurs 2021; 43:235-241. [PMID: 34952306 DOI: 10.1016/j.gerinurse.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To investigate the knowledge, attitudes, and barriers related to medication adherence in older patients with coronary heart disease (CHD). METHODS A total of 272 older patients with CHD were investigated by the Chinese version of the Medication Adherence Scale. The score ranges for the knowledge, attitudes, and barrier subscales were 0-30, 0-30, and 0-110, respectively. Higher scores indicate more knowledge, positive attitudes, and more barriers related to medication adherence. RESULTS The median scores of knowledge, attitudes and barriers were 25.5, 28, and 8, respectively. Having stents, living alone, good financial status and fewer chronic diseases were related to more knowledge. Younger age, having no stent, and more chronic diseases were associated with more barriers. Patients with good financial status and higher age had more positive attitudes. CONCLUSIONS Understanding older patients' knowledge, attitudes, and barriers related to medication adherence and their associated factors can help develop tailored interventions in medication adherence studies.
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Affiliation(s)
- Mingming Yu
- School of Nursing, Peking University, Beijing, China.
| | - Li Wang
- Nursing Department, Fangzhuang Community Healthcare Service Center, Fengtai District, Beijing, China
| | - Lanzhu Guan
- Nursing Department, Anzhen Community Healthcare Service Center, Chaoyang District, Beijing, China
| | - Min Qian
- School of Nursing, Peking University, Beijing, China
| | - Jinghong Lv
- School of Nursing, Peking University, Beijing, China
| | - Mengying Deng
- School of Nursing, Peking University, Beijing, China
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13
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Santhagunam SN, Li EPH, Buschert K, Davis JC. A theoretical framework to improve adherence among older adults to recommendations received at a falls prevention clinic: A narrative review. Appl Nurs Res 2021; 62:151493. [PMID: 34814997 DOI: 10.1016/j.apnr.2021.151493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/27/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Falls impose a prominent public health problem among older adults. Falls are preventable through multi-factorial interventions offered by a Falls Prevention Clinic. Yet, adherence to recommendations is often average or low, particularly for lifestyle recommendations. To achieve full health benefits from such a multifactorial intervention, improving adherence is critical. PURPOSE Our primary objective was to conduct a narrative review to develop a theoretical framework, categorized by intrinsic and extrinsic factors that impact adherence to falls prevention interventions, considering a Falls Prevention Clinic setting. MATERIALS AND METHODS We conducted a comprehensive literature review of all peer-reviewed manuscripts published between 1998 through August 2020 among older adults (i.e., aged 60 years and older) who fall. We used the following search engines: Pubmed, CINAHL, Embase, MedLine, Cochrane and Google Scholar. RESULTS The theoretical framework categorizes two dominate factors (comprised of specific domains) that affect adherence among older adults who fall. Intrinsic factors comprised of three domains included: demographics (age, gender, ethnicity), individual factors (participation, control, behavioural habits) and health factors (physical health, mental state, perceived severity). Extrinsic factors comprised of four domains included: caregiver factors (family dynamics, miscarried helping) medication factors (availability, accessibility, drug handling, reliability), health system (costs, communication, relationship with doctors, attention) and environmental factors (public health policy interventions). Intrinsic factors such as high socioeconomic status, high health literacy, being married and extrinsic factors such as low healthcare cost, better communication and useful policy interventions were associated with greater adherence. CONCLUSION This theoretical model elucidates priority factors to target for promoting adherence to reduce falls, decrease mortality and, lower fall-related healthcare costs.
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Affiliation(s)
- Shree Nithi Santhagunam
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, British Columbia, Canada
| | - Eric P H Li
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, British Columbia, Canada
| | - Kim Buschert
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, British Columbia, Canada
| | - Jennifer C Davis
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, British Columbia, Canada; Centre for Hip Health & Mobility, Vancouver, British Columbia, Canada. https://twitter.com/DrJenniferDav1
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Lopes A, Roque F, Morgado S, Dinis C, Herdeiro MT, Morgado M. Behavioral Sciences in the Optimization of Pharmacological and Non-Pharmacological Therapy for Type 2 Diabetes. Behav Sci (Basel) 2021; 11:bs11110153. [PMID: 34821614 PMCID: PMC8614941 DOI: 10.3390/bs11110153] [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: 08/02/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022] Open
Abstract
Type 2 diabetes mellitus is one of the main chronic diseases worldwide, with a significant impact on public health. Behavioral changes are an important step in disease prevention and management, so the way in which individuals adapt their lifestyle to new circumstances will undoubtedly be a predictor of the success of the treatments instituted, contributing to a reduction in the morbidity and mortality that may be associated with them. It is essential to prepare and educate all diabetic patients on the importance of changing behavioral patterns in relation to the disease, with health professionals assuming an extremely important role in this area, both from a pharmacological and non-pharmacological point of view, and also ensuring the monitoring of the progress of these measures. Diabetes is a chronic disease that requires a high self-management capacity on the part of patients in order to achieve success in treating the disease, and non-adherence to therapy or non-compliance with the previously defined plan, together with an erratic lifestyle, will contribute to failure in controlling the disease. The lower adherence to pharmacological and non-pharmacological treatment in diabetes is mainly correlated to socio-economic aspects, lower health literacy, the side effects associated with the use of antidiabetic therapy or even the concomitant use of several drugs. This article consists of a narrative review that aims to synthesize the findings published in the literature, retrieved by searching databases, manuals, previously published scientific articles and official texts, following the methodology of the Scale for Assessment of Narrative Review Articles (SANRA). We aim to address the importance of behavioral sciences in the treatment of diabetes, in order to assess behavior factors and barriers for behavior changes that have an impact on the therapeutic and non-therapeutic optimization in patients with type 2 diabetes mellitus control.
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Affiliation(s)
- António Lopes
- Pharmaceutical Services of Unity Local of Health of Guarda (ULS da Guarda), 6300-035 Guarda, Portugal; (A.L.); (C.D.)
- Health Sciences Faculty, University of Beira Interior (FCS-UBI), 6200-506 Covilhã, Portugal;
| | - Fátima Roque
- Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI-IPG), 6300-559 Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal
- Correspondence:
| | - Sandra Morgado
- Pharmaceutical Services of University Hospital Center of Cova da Beira, 6200-251 Covilhã, Portugal;
| | - Cristina Dinis
- Pharmaceutical Services of Unity Local of Health of Guarda (ULS da Guarda), 6300-035 Guarda, Portugal; (A.L.); (C.D.)
| | - Maria Teresa Herdeiro
- Institute of Biomedicine, Department of Medical Sciences (iBiMED-UA), University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Manuel Morgado
- Health Sciences Faculty, University of Beira Interior (FCS-UBI), 6200-506 Covilhã, Portugal;
- Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI-IPG), 6300-559 Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal
- Pharmaceutical Services of University Hospital Center of Cova da Beira, 6200-251 Covilhã, Portugal;
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Banerjee D. Loneliness in older people: Spiritual practices as an alternative pathway to action, a treatise from India. JOURNAL OF GERIATRIC MENTAL HEALTH 2021. [DOI: 10.4103/jgmh.jgmh_37_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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