Interventions to promote medication adherence for chronic diseases in India: a systematic review

Interprofessional collaboration between pharmacists and community health workers: a scoping review

INTRODUCTION

Community health workers (CHWs) help bridge the cultural gap between health services and the communities they serve. CHWs work with physicians, nurses and social workers, but little is known about their collaboration with pharmacists. This scoping review aims to describe the interprofessional collaboration between CHWs and pharmacists, the types of interventions they deliver and CHWs' and pharmacists' specific roles within these interventions.

METHOD

The scientific literature published in PubMed, Embase, MEDLINE, Scopus, Web of Science, PsycInfo, CINAHL and the grey literature were searched. Inclusion criteria were that the research (i) involved pharmacists and CHWs working collaboratively and (ii) included an intervention, service or program. One researcher screened all articles, and two reviewers screened 6% of articles (20/340) assessed for eligibility, using the software Covidence. After the discrepancies were resolved, data from the included articles were extracted using a customized template for data extraction and synthesized narratively.

RESULTS

Eighteen studies met the inclusion criteria. Most were conducted in the USA (14/18) and were published since 2020 (12/18). Most interventions involved medication reviews, support for medication adherence, disease prevention or addressing the social determinants of health. Pharmacists had primarily clinical roles (i.e., medication reconciliation and patient education), while the CHWs' roles consisted of collecting patient information, supporting patient self-management, bridging the cultural gap by translating information in the patient's language and ensuring patient follow-up. The collaborative practice occurred via interprofessional referral, ranging from the CHW facilitating the link between the patient and the pharmacist, and information sharing between the CHW and the pharmacist, to an interprofessional collaborative practice where CHWs and pharmacists delivered the intervention together.

CONCLUSION

While CHWs and pharmacists had independent roles as part of the interventions, they also collaborated at various levels to deliver services to patients. CHWs have an important role to play in bridging the cultural gap between the patient and the pharmacist, in improving patient referral so that more patients can benefit from pharmaceutical services, and in identifying patients' social determinants of health. CHWs and pharmacists can work synergistically and collaboratively to tailor an intervention to the patient's needs, which can improve and optimize pharmaceutical services, and may ultimately positively impact health outcomes.

A Mixed Methods Study of Medication Adherence in Adults with Neurofibromatosis Type 1 (NF1) on a Clinical Trial of Selumetinib

BACKGROUND

Oral therapeutic options for plexiform neurofibromas (PNs) in individuals with neurofibromatosis type 1 (NF1) are receiving attention in clinical research. The MEK inhibitor (MEKi) Selumetinib is FDA-approved in children ages 2+ years with inoperable PNs, and shows activity in adults. Prolonged therapy with selumetinib is necessary to maintain tumor reduction. Therefore, investigating long-term adherence is vital to understand patterns of adherence over time and its impact on clinical outcomes. Mixed methods research offers rich information about adherence that can inform future intervention trials, and can assist practitioners in addressing medication adherence concerns.

METHODS

This mixed-method pilot study is the first examination of the feasibility of a technology-based adherence assessment method, the medication events monitoring system (MEMSTM), among individuals with NF1-PN. Adherence was monitored in a small sample of patients (N = 12; mean age = 34.36 years; 58% male) with NF1 and PN across eighteen 28-day treatment cycles. Qualitative data were obtained from individual interviews using inductive and deductive techniques for thematic analysis.

RESULTS

The predetermined criterion was met, suggesting that using MEMSTM is feasible despite some challenges with the caps. Depression and overall stress were significantly related to reduced adherence, although these results should be considered hypothesis-generating. Barriers to medication adherence included forgetting and the timing of doses related to eating. Facilitators included consistency, reminders, and social support.

CONCLUSIONS

This study highlights patient characteristics that may be related to increased risk for nonadherence, as well as challenges with electronic pill caps that should be considered in future clinical trials for NF1-related PN. Results can inform future adherence interventions for adults with NF1 and PNs. Future research with larger samples is needed to fully explore factors related to long-term medication adherence among individuals with NF1.

A scoping review of interventions to optimize medication adherence in hypertension comorbidity

BACKGROUND

Patients with hypertension and other comorbidities have difficulties adhering to their medications which have negative impacts on clinical outcomes. Although some studies have identified strategies to improve medication adherence, a thorough analysis of these interventions will provide synthesized evidence for clinical decision-making and improved health outcomes for patients with hypertension comorbidities.

AIM

To conduct a scoping review on interventions that have been utilised to improve medication adherence in patients with hypertension and other co-morbid conditions.

METHODS

A systematic literature search was conducted in the following databases: CINAHL, COCHRANE TRIALS, MEDLINE, and SCOPUS. One (1) search engine, GOOGLE SCHOLAR was included. This was done between September 2023 to February 2024. The PRISMA-SCR guidelines were followed for this review. A total of 456 unique studies were identified after duplicates were removed. Following screening and eligibility assessments, 26 papers were selected for review with a focus on the study aim and purpose, study population, interventions used and adherence measures.

RESULTS

Most of the interventions were delivered by pharmacists, with 25 studies utilising the multimodal intervention approach. A total of 22 studies (80 % of the total) found that the interventions significantly improved medication adherence. Results from 16 studies showed a significant improvement in blood pressure. Improvements in medication adherence were a common outcome of interventions that focused on patient education.

CONCLUSION

Interventions such as patient education, simplified treatment regimens, and multidisciplinary care can improve medication adherence and clinical outcomes in patients with hypertension and comorbidities, but further research is needed to understand long-term effects.

Family Self-management Program for Hypertension Management and Sodium Consumption Adherence: A Parallel Randomized Control Trial Among Family Caregivers and People With Hypertension

BACKGROUND

Hypertension (HTN) has become a serious health problem in developing countries. The family has an important role in maintaining blood pressure (BP) at home, and sodium diet compliance in people with HTN needs to be developed. Therefore, this research aimed to evaluate the effectiveness of a family self-management program (FSMP) in HTN management and compliance with sodium consumption in rural areas of Indonesia. Study Design: A parallel-group, single-blind randomized controlled trial.

METHODS

One hundred twenty-six eligible participants were randomly allocated to an intervention (n=63) and a control group (n=63). Participants in the intervention group received a 24-week (6-month) FSMP intervention. The primary outcome measures included the systolic and diastolic BP, the Score Sodium Questionnaire (SSQ), and the Morisky Medication Adherence Scale 8 (MMAS-8). The Knowledge of Health Care for HTN questionnaire and the Efficacy and Behavior Toward Health Care for Patients with HTN questionnaire were used to assess the secondary outcome.

RESULTS

The final results were analyzed from 121 participants (n=61 intervention and n=60 control group). The repeated analysis of variance (ANOVA) test results demonstrated significant effects on the management of HTN and adherence to sodium consumption as indicated by systolic (P=0.004) and diastolic BP (P=0.006), SSQ (P<0.001), MMAS 8 (P<0.001), caregivers' knowledge (P<0.001), caregivers' self-efficacy (P<0.001), and caregivers' behaviors (P=0.005).

CONCLUSION

The FMSP emerges as a promising strategy for managing BP and adherence to sodium consumption in people with HTN through the support of family caregivers and selfmanagement activities.

Determination of SRPA and adiposity measures and its association with glycemic status in type 2 diabetics having high mean HbA1c in a private clinic of a city in west India

Introduction

Indian type 2 diabetics (T2D) is known for poor disease control on which self-reported physical activity (SRPA) and optimum body composition have positive impact. We determined prevalence of SRPA and general/visceral obesity and its impact on HbA1c-based glycemia.

Methodology

By a cross-sectional study conducted on 200 T2Ds in a private clinic, HbA1c-based glycemic status, WHO questionnaire-based SRPA, BMI-based general obesity, and bipolar bioelectrical impedance-based visceral obesity were evaluated. SRPA and obesity were compared and associated with glycaemic status keeping mean HbA1c as cutoff.

Result

Mean age, male%, mean duration of T2D, mean BMI, mean HbA1c, and SRPA prevalence were 54 years, 42.5%, 4.82 years, 25.49, 8.69%, and 61.5%, respectively. Comparison of groups based on either SRPA or BMI (cutoff 25) showed better HbA1c with the presence of SRPA and BMI <25. Physical inactivity imposed odds risk of 3.44 for visceral fat (VF) ≥10% and odds risk of 2.6 for more than mean HbA1c with statistical significances. VF ≥10% imposed odds risk of 4 for higher than mean HbA1c. Physical inactivity and visceral obesity together imposed ⅓rd prevalence of better glycaemic value, while physical activity and controlled visceral obesity yielded ¾th prevalence of good glycaemic value.

Conclusion

In T2D with poor glycaemic status and moderately prevalent physical activity, we found strongly significant association of SRPA and controlled body adiposity with HbA1c-based glycaemic status. It reaffirms physical activity and control of central obesity as forerunners of better glycaemic status and calls for further studies having vertical follow-up.

Medication Adherence among Patients with Non-Communicable Diseases in a Tertiary Hospital: A Descriptive Cross-sectional Study

INTRODUCTION

Non-communicable diseases (NCDs) are a leading cause of mortality, with a projected rise from 38 million in 2012 to 52 million by 2030. Among NCDs, hypertension, diabetes and Chronic Obstructive Pulmonary Disease are the major burdens in healthcare today, requiring long-term therapies and a significant effort in maintaining treatment adherence.

METHODS

A descriptive cross-sectional study design was adopted to determine medication adherence among patients with non-communicable diseases using non-probability, consecutive sampling techniques after ethical approval from same institute (Reference number: 524). Medication adherence was assessed on 322 patients attending the outpatient department, using a structured interview schedule, after getting Ethical approval from the Institution Review Committee. Morisky medication adherence scale (MMAS-4), Culig adherence Scale, and Beliefs about Medications (BMQ) tool were used to determine the adherence level, causes of non-adherence and belief in medication respectively. Data was coded and analysed using SPSS version 16. Descriptive statistics were used to summarise the data.

RESULTS

The study population exhibited a mean age of 58 ± 12.80 years, with male participants 190 (59.01%). The present study revealed that 148 (45.96%) of the participants have a high adherence level to prescribed medication, and 246 (76.40%) strongly believed that without medication they would be very sick and life would be impossible.

CONCLUSIONS

The study found that less than half of participants fully adhered to prescribed medicine, with forgetfulness identified as a primary cause of non-compliance.

Barriers to Medication Adherence Among Patients with Non-Communicable Disease in North Wollo Zone Public Hospitals: Socio-Ecologic Perspective, 2023

Background

The practice of taking medication as directed by a healthcare provider is known as medication adherence. Therefore, the application of a socio-ecological model to this study identifies multilevel factors on barriers of medication adherence on chronic non-communicable disease and provides information to develop scientific health communication interventional strategies to improve medication adherence.

Objective

This study aimed to explore barriers of medication adherence on non-communicable disease prevention and care among patients in North Wollo Zone public hospitals, northeast Ethiopia.

Methods

A phenomenological study design was carried out between February 5 and February 30, 2023. The study participants were chosen using a heterogeneous purposive sampling technique. In-depth interviews and targeted focus groups were used to gather data. The focus group discussions and in-depth interviews were captured on audio, accurately transcribed, and translated into English. Atlas TI-7 was utilized to do the thematic analysis.

Results

Four main themes, intrapersonal, interpersonal, community level, and health care related, as well as seven subthemes, financial problems, lack of family support, poor communication with healthcare providers, effects of social ceremonies, remote healthcare facility, and drug scarcity, were identified by this study. In this study participants reported that lack of knowledge about the disease and drugs were the main barrier for medication adherence. The study revealed that financial problems for medication and transportation cost were the main factor for medication adherence for non-communicable disease patients.

Conclusion

This study explored that lack of knowledge, financial problem, lack of family support, poor communication with healthcare providers, social ceremony effects, remote healthcare facility, and scarcity of drugs were barriers of medication adherence among non-communicable disease patients. In order to reduce morbidity and mortality from non-communicable diseases, it is advised that all relevant bodies look for ways to reduce medication adherence barriers for patients at every level of influence.

Drug-Related Problems Detected in Complex Chronic Patients by Community Pharmacists of Catalonia: Perception of the Person-Centred Approach Necessity

Community pharmacies are healthcare settings in which pharmacists are in an ideal position to carry out pharmaceutical care. The aim of this study was to analyse the number, type and groups of drugs that caused drug-related problems (DRPs) detected in complex chronic patients who are outpatients, the interventions and actions of community pharmacists and their impact on patient medication adherence. The study was designed as a secondary analysis of a multicentre study in the field of primary healthcare and community pharmacies in Catalonia (Spain). The patients who took part were divided into two groups by the primary care physician depending on whether or not they were considered likely to receive their medication through a monitored dosage system (MDS) based on pre-established criteria. Patients underwent 12 months of follow-up by community pharmacists. The prevalence of DRPs among the studied complex chronic patients was high (n = 689). The most identified DRP was nonadherence (31.20%). In the MDS group, results showed a statistically significant increase of 21% in the number of adherent patients with respect to the baseline visit (p-value = 0.0008). Community pharmacists can have an important role in addressing DRPs and optimizing the safety and effectiveness of medications for these patients and in involving them in their own health conditions.

Factors influencing adherence to non-communicable disease medication in India: secondary analysis of cross-sectional data from WHO - SAGE2

Background: Non-communicable diseases (NCDs) are a leading cause of death globally and disproportionately affect those in low- and middle-income countries lower-middle-income countries. Poor medication adherence among patients with NCDs is prevalent in India due to lack of initiation, missed dosing or cessation of treatment, and represents a growing healthcare and financial burden. Objective: This study aimed to identify factors influencing medication adherence in adults with NCDs in India. Methods: We performed a cross-sectional study, conducting secondary data analysis on the second wave of the World Health Organisation's 'Study on global AGEing and adult health (SAGE)', a survey that collected data from predominantly older adults across India. Bivariate analysis and multivariate logistic regression modelling were conducted to specifically interrogate the reasons for lack of initiation and cessation of treatment. Reporting of this study was informed by the STROBE guidelines. Results: The average medication adherence rate was 51% across 2,840 patients with one or more NCDs, reflecting non-initiation and lack of persistence of treatment. The strongest factor significantly predicting non-adherence to medication across these components was multimorbidity (odds ratio 0.47, 95% CI 0.40-0.56). Tobacco use (OR = 0.76, CI 0.59-0.98) and never having attended school (OR = 0.75, CI 0.62-0.92) were significantly associated with poor medication adherence (p < 0.05) while rural living (OR = 0.70, CI 0.48-1.02), feelings of anxiety (OR = 0.84, CI 0.66-1.08) and feelings of depression (OR = 0.90, CI 0.70-1.16) were factors lacking statistically significant association with medication adherence on multivariate analysis. Older age (OR = 2.02, CI 1.51-2.71) was significantly associated with improved medication adherence whilst there was a weak association between increased wealth and improved medication use. Limitations: The SAGE2 survey did not capture whether patients were taking their medication doses according to prescribed instructions-as a result our findings may under-estimate the true prevalence of medication non-adherence. Conclusion: Our analysis provides evidence that poor medication adherence in India is multifactorial, with distinct socioeconomic and health-system factors interacting to influence patient decision making. Future large-scale surveys interrogating adherence should assess all components of adherence specifically, whilst public health interventions to improve medication adherence should focus on barriers that may exist due to multimorbidity, comorbid depression and anxiety, and low educational status.

Effectiveness of educational interventions on hypertensive patients' self-management behaviours: an umbrella review protocol

BACKGROUND

Although different educational interventions have been widely used to manage and treat hypertension, alone or in combination with other interventions, there is a significant variation in their claimed effectiveness.

REVIEW QUESTION/OBJECTIVE

The objective of this umbrella review is to determine the effectiveness of educational interventions, alone or in combination with other interventions, for improving blood pressure control and self-management practices among hypertensive patients. The review question is: Do educational interventions, alone or in combination with other interventions, improve self-management practices among patients with hypertension?

METHODS

We will conduct a review of systematic reviews involving studies that implemented educational interventions, alone or in combination with other interventions, designed to change self-care practices among hypertensive patients who are 18 years and above, regardless of their sex and ethnicity. Following the guidelines set forth in the Preferred Reporting Items for Systematic Review and Meta-Analysis statement, a comprehensive literature search will be conducted from September to December 2023 on six electronic databases: MEDLINE, Embase, PsycINFO, CINAHL, Web of Science Core Collection and Google Scholar. Search terms will be developed using database-specific indexed terms and text words derived from the review aim. We will present the effects of the educational interventions, alone or in combination with other interventions, on hypertension self-management practices. We will report the outcome data with 95% CIs for each study. Relative risk, mean differences or ORs will be used, depending on the measuring indices in each study.

ETHICS AND DISSEMINATION

Ethical approval is not required as this study will use aggregated data from previously published systematic reviews. However, we have registered the protocol in PROSPERO. We confirm that all methods will be performed following the guidelines of the Declaration of Helsinki. The findings from this study will be disseminated through presentations at academic conferences and publication in peer-reviewed international journals.

PROSPERO REGISTRATION NUMBER

CRD42022375581.