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Fadl Elmula FEM, Mariampillai JE, Heimark S, Kjeldsen SE, Burnier M. Medical Measures in Hypertensives Considered Resistant. Am J Hypertens 2024; 37:307-317. [PMID: 38124494 PMCID: PMC11016838 DOI: 10.1093/ajh/hpad118] [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: 11/05/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Patients with resistant hypertension are the group of hypertensive patients with the highest cardiovascular risk. METHODS All rules and guidelines for treatment of hypertension should be followed strictly to obtain blood pressure (BP) control in resistant hypertension. The mainstay of treatment of hypertension, also for resistant hypertension, is pharmacological treatment, which should be tailored to each patient's specific phenotype. Therefore, it is pivotal to assess nonadherence to pharmacological treatment as this remains the most challenging problem to investigate and manage in the setting of resistant hypertension. RESULTS Once adherence has been confirmed, patients must be thoroughly worked-up for secondary causes of hypertension. Until such possible specific causes have been clarified, the diagnosis is apparent treatment-resistant hypertension (TRH). Surprisingly few patients remain with true TRH when the various secondary causes and adherence problems have been detected and resolved. Refractory hypertension is a term used to characterize the treatment resistance in hypertensive patients using ≥5 antihypertensive drugs. All pressor mechanisms may then need blockage before their BPs are reasonably controlled. CONCLUSIONS Patients with resistant hypertension need careful and sustained follow-up and review of their medications and dosages at each term since medication adherence is a very dynamic process.
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Affiliation(s)
- Fadl Elmula M Fadl Elmula
- Division of Medicine, Ullevaal University Hospital, Cardiorenal Research Centre, Oslo, Norway
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, KSA
| | | | - Sondre Heimark
- Division of Medicine, Ullevaal University Hospital, Cardiorenal Research Centre, Oslo, Norway
- Medical Faculty, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Nephrology, Ullevaal University Hospital, Oslo, Norway
| | - Sverre E Kjeldsen
- Division of Medicine, Ullevaal University Hospital, Cardiorenal Research Centre, Oslo, Norway
- Medical Faculty, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Ullevaal University Hospital, Oslo, Norway
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Soares SM, Diniz MQDA, Davino DMBMC, Albieri FB, Santos AS, Jesus EMS, Lyra-Junior DP, Neves SJ, Oliveira-Filho AD. The Simplified Medication Adherence Questionnaire: validation of a Brazilian-Portuguese version in hypertensive adults. Front Pharmacol 2024; 15:1348917. [PMID: 38666030 PMCID: PMC11043597 DOI: 10.3389/fphar.2024.1348917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/06/2024] [Indexed: 04/28/2024] Open
Abstract
Background Self-reported adherence scales are widely used in research and practice because they are low in cost and easy to apply. A free version in Brazilian-Portuguese of the Simplified Medication Adherence Questionnaire (SMAQ) can be a useful alternative for determining the adherent behavior of hypertensive patients. Purpose To translate and evaluate the psychometric properties of the Brazilian-Portuguese version of the SMAQ therapeutic adherence scale for patients with arterial hypertension. Patients and methods A multicenter, cross-sectional study was conducted in five outpatient units in Maceió-AL and Aracaju-SE between January and July 2019. A total of 117 patients aged over 18 years using antihypertensive drugs were recruited. The cross-cultural adaptation followed international methodological recommendations. Internal consistency (Cronbach's alpha) was tested as a reliability parameter. Criterion and construct validity were verified by concurrent validation, exploratory factor analysis (EFA), and validation by known groups. Results The participants had a mean age of 56.6 years (SD = 10.7 years); most were female (72.6%). The mean number of antihypertensives prescribed per patient was 1.87 (SD = 0.87). There were 79.5% (n = 86) of patients considered non-adherent. Internal consistency was satisfactory (Cronbach's alpha = 0.63). A satisfactory correlation coefficient was verified with the Morisky-Green-Levine test as an external criterion (r = 0.56, p < 0.001). The scale's sensitivity measured through known group validity was 75.3%, specificity 29.5%, positive predictive value 63.9%, and negative predictive value 41.9%. We identified two factors of the instrument's construct from EFA: specific medication-taking behaviors and barriers to adherence. The initial KMO measure of sampling adequacy was 0.691, and Bartlett's test of sphericity was significant (χ2 = 118.342, p < 0.001). Conclusion The Brazilian-Portuguese version of the SMAQ scale proved valid and reliable for determining adherence to the pharmacotherapy in hypertensive patients. It showed more ability to detect non-adherent patients but with low specificity, possibly influenced by high social desirability.
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Affiliation(s)
- Simony M. Soares
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Brazil
| | - Mirela Q. de Almeida Diniz
- Pharmacotherapy Research Group, Institute of Pharmaceutical Sciences, Federal University of Alagos, Maceió, Brazil
| | | | - Fernanda B. Albieri
- Pharmacotherapy Research Group, Institute of Pharmaceutical Sciences, Federal University of Alagos, Maceió, Brazil
| | - Adriano S. Santos
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Brazil
| | - Elisdete M. S. Jesus
- Faculty of Pharmaceutical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
| | - Divaldo P. Lyra-Junior
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Brazil
| | - Sabrina J. Neves
- Pharmacotherapy Research Group, Institute of Pharmaceutical Sciences, Federal University of Alagos, Maceió, Brazil
| | - Alfredo D. Oliveira-Filho
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Brazil
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Marston MT, Berben L, Dobbels F, Russell CL, de Geest S. Prevalence and Patient-Level Correlates of Intentional Non-Adherence to Immunosuppressive Medication After Heart-Transplantation-Findings From the International BRIGHT Study. Transpl Int 2023; 36:11308. [PMID: 37492859 PMCID: PMC10363605 DOI: 10.3389/ti.2023.11308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/15/2023] [Indexed: 07/27/2023]
Abstract
After heart transplantation (HTx), non-adherence to immunosuppressants (IS) is associated with poor outcomes; however, intentional non-adherence (INA) is poorly understood regarding its international variability in prevalence, contributing factors and impact on outcomes. We investigated (1) the prevalence and international variability of INA, (2) patient-level correlates of INA, and (3) relation of INA with clinical outcomes. Secondary analysis of data from the BRIGHT study-an international multi-center, cross-sectional survey examining multi-level factors of adherence in 1,397 adult HTx recipients. INA during the implementation phase, i.e., drug holiday and dose alteration, was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale© (BAASIS©). Descriptive and inferential analysis was performed with data retrieved through patient interview, patient self-report and in clinical records. INA prevalence was 3.3% (n = 46/1,397)-drug holidays: 1.7% (n = 24); dose alteration: 1.4% (n = 20); both: 0.1% (n = 2). University-level education (OR = 2.46, CI = 1.04-5.83), insurance not covering IS costs (OR = 2.21, CI = 1.01-4.87) and barriers (OR = 4.90, CI = 2.73-8.80) were significantly associated with INA; however, clinical outcomes were not. Compared to other single-center studies, this sample's INA prevalence was low. More than accessibility or financial concerns, our analyses identified patient-level barriers as INA drivers. Addressing patients' IS-related barriers, should decrease INA.
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Affiliation(s)
- Mark T. Marston
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
- Pediatric Intensive Care Unit, University Children’s Hospital Basel, Basel, Switzerland
| | - Lut Berben
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
- Pediatric Intensive Care Unit, University Children’s Hospital Basel, Basel, Switzerland
| | - Fabienne Dobbels
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Cynthia L. Russell
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Sabina de Geest
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Koo LW, Baur C, Horowitz AM, Wang MQ. Parental Health Literacy, Empowerment, and Advocacy for Food Allergy Safety in Schools: A Cross-Sectional Study. Health Lit Res Pract 2023; 7:e165-e175. [PMID: 37698847 PMCID: PMC10495122 DOI: 10.3928/24748307-20230823-01] [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: 07/14/2022] [Accepted: 02/10/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Approximately 8% of elementary school-aged children in the United States have food allergies, a complicated health management situation that requires parents to use many types of health literacy, empowerment, and advocacy skills to work with school staff to protect their children. OBJECTIVE This cross-sectional study examined (a) whether the highest versus lowest levels of functional, communicative, and critical health literacy are associated with higher perceived effectiveness of parental advocacy behaviors for safe food allergy management in schools [parental advocacy]; and (b) whether communicative and critical health literacy are more strongly associated with parental advocacy than functional health literacy. METHODS A sample of parents of elementary school-aged children was recruited through 26 food allergy organizations and a research patient registry. Participants completed an anonymous online survey. Self-reported measurements of parental health literacy, empowerment, and advocacy were adapted and refined through pre-testing and pilot-testing. General linear model analyses were conducted to predict parental advocacy. KEY RESULTS Participants (N = 313) were predominantly White, college-educated mothers with moderately high levels of food allergy knowledge, health literacy, empowerment, and parental advocacy skills. Parents who scored at the highest levels in the three dimensions of health literacy reported they engaged in more effective advocacy behaviors than parents who scored at the lowest levels. Parental advocacy was predicted largely by parental empowerment and the quality of the relationship with the school (B = .41 and B = .40, respectively). Functional health literacy and the child's diagnosis of asthma were smaller predictors. While accounting for covariates, functional health literacy was significantly associated with parental advocacy whereas communicative and critical health literacy were not. CONCLUSIONS Interventions to impact parental empowerment and parent-school relationships, including a health-literate universal precautions approach of communicating food allergy school policies, may influence parental advocacy for food allergy safety in schools. Further research could use a performance-based multidimensional measure of health literacy. [HLRP: Health Literacy Research and Practice. 2023;7(3):e165-e175.].
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Affiliation(s)
- Laura W. Koo
- Address correspondence to Laura W. Koo, PhD, MS, FNP-BC, University of Maryland School of Nursing, 655 West Lombard Street, Suite 375D, Baltimore, MD 21201;
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Psychosocial and behavioral correlates of self-efficacy in treatment adherence
in older patients with comorbid hypertension and type 2 diabetes. HEALTH PSYCHOLOGY REPORT 2023. [DOI: 10.5114/hpr/159284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
BackgroundAdhering to clinical prescriptions is known to protect against the effects of uncontrolled hypertension and of acute and chronic cardiovascular diseases, including diabetes. Contextually, positive associations between self-care behaviors and psychological constructs, such as self-efficacy, are widely acknowledged in the literature. However, still little is known about the psychological factors underlying the patient’s self-efficacy. This study aimed to investigate the psychosocial and behavioral correlates of self-efficacy related to treatment adherence in older patients with comorbid hypertension and type 2 diabetes mellitus.Participants and procedureItalian and Polish patients (≥ 65 years; N = 180) consecutively responded to self-report questionnaires measuring psycho-social (i.e., beliefs about medicines, perceived physician’s communication effectiveness, medication-specific social sup-port, self-efficacy) and behavioral factors (i.e., pharmacological adherence, medications refill adherence, intentional non-adherence) related to treatment adherence. Between-group comparisons and regression analyses were performed.ResultsFisher’s least significant difference (LSD) test showed significant differences between the Italian and Polish groups in all questionnaires (p < .01) with the Italian patients reporting more satisfactory scores. Younger age (β = .08, p = .045), female gender (β = 1.03, p = .042), higher medication refills adherence (β = –.07, p = .024), lower intentional non-adherence (β = –.03, p = .009), positive beliefs about medications (β = .13, p < .001), better quality of communication with the physician (β = .09, p < .001), and stronger perceived medication-specific social support (β = .06, p = .001) were significantly associat-ed with self-efficacy related to treatment adherence.ConclusionsFuture research and interventions should leverage psychosocial and behavioral factors to address self-efficacy contributing to enhancing adherence to clinical prescriptions.
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Khalifeh AH, Alhalaiqa FN, Hamaideh SH, Horne R, Hamdan-Mansour AM. The effect of adherence therapy on medication adherence, health beliefs, self-efficacy, and depressive symptoms among patients diagnosed with major depressive disorder. Int J Ment Health Nurs 2023; 32:778-790. [PMID: 36628477 DOI: 10.1111/inm.13113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 01/12/2023]
Abstract
Medication adherence is a crucial health issue in major depressive disorder (MDD) that requires regular monitoring and attention. Hence, there are multiple reasons for medication non-adherence among them. This study aimed to examine the effect of adherence therapy (AT) on medication adherence, health beliefs, self-efficacy, and depressive symptoms among patients diagnosed with MDD. One group pretest-posttest, repeated measures time-series design was conducted. A sample of 32 patients was recruited conveniently; they received eight weekly sessions of AT. A self-reported questionnaire was used to measure variables. The analysis showed that the mean scores of the baseline indicated non-adherence, moderate general benefits beliefs about the medication, high beliefs that medication is harmful, high beliefs that doctors overuse medication, high beliefs about potential adverse effects from medication, low perception of MDD severity, and high threatening perception regarding MDD, a moderate degree of confidence in the ability to taking medications, and patients had moderately severe depressive symptoms (M = 16, 3.2, 3.1, 4.1, 3.8, 50, 3, 16 respectively). Over four measurement points, adherence therapy enhanced positive beliefs towards taking medication and illness, increased medication adherence self-efficacy, improved medication adherence, and decreased depressive symptoms (F = 68.57-379.2, P < 0.001). These improvements were clinically significant in all variables immediately post-AT but declined minimally over time. The study indicated that integrating AT as part of the pre-discharge protocol is one core component to sustaining positive healthcare outcomes. Continuous efforts should be paid in terms of the long-term sustainability of an intervention to enhance adherence and clinical outcomes.
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Affiliation(s)
| | | | - Shaher Hamad Hamaideh
- Community and Mental Health Nursing Department, Faculty of Nursing-The Hashemite University, Zarqa, Jordan
| | - Robert Horne
- Department of Practice and Policy, Centre for Behavioural Medicine, School of Pharmacy, University College London, London, UK
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da Silva IC, Nogueira MRDN, Cavalcante TF, Felipe GF, Morais HCC, Moreira RP, de Oliveira ASS. Health literacy and adherence to the pharmacological treatment by people with arterial hypertension. Rev Bras Enferm 2022; 75:e20220008. [PMID: 35946621 PMCID: PMC9749777 DOI: 10.1590/0034-7167-2022-0008] [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: 01/27/2022] [Accepted: 04/05/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the association between health literacy and the adherence to the pharmacological treatment of Brazilians with arterial hypertension. METHODS Cross-sectional study with 234 participants who responded an on-line sociodemographic and clinical characterization questionnaire, in addition to evaluation of health literacy and of the adherence to their pharmacological treatment. Data were analyzed using descriptive statistics and difference and correlation tests. RESULTS People with post-graduation, who were actively working and did not smoke, had better health literacy results. Elders and those who were retired or lived on government subsidies adhered better to the medication treatment. There was a correlation between the numerical dimension (rs=0.189; p=0.004) and the global health literacy result (r2=0.170; p=0.009) with the adherence. CONCLUSIONS A better numerical and global understanding of health literacy was associated with better adherence to arterial hypertension medication treatment.
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Affiliation(s)
- Iorana Candido da Silva
- Universidade da Integração Internacional da Lusofonia Afro-Brazileira. Redenção, Ceará, Brazil
| | | | | | - Gilvan Ferreira Felipe
- Universidade da Integração Internacional da Lusofonia Afro-Brazileira. Redenção, Ceará, Brazil
| | | | - Rafaella Pessoa Moreira
- Universidade da Integração Internacional da Lusofonia Afro-Brazileira. Redenção, Ceará, Brazil
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Silva ICD, Nogueira MRDN, Cavalcante TF, Felipe GF, Morais HCC, Moreira RP, Oliveira ASSD. Letramento em saúde e adesão ao tratamento farmacológico de pessoas com hipertensão arterial. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2022-0008pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: Analisar a associação entre o letramento em saúde e a adesão ao tratamento farmacológico de brasileiros com hipertensão arterial. Métodos: Estudo transversal, desenvolvido com 234 participantes, que responderam um questionário on-line de caracterização sociodemográfica, clínica, avaliação do letramento em saúde e da adesão ao tratamento farmacológico.Os dados foram analisados com estatística descritiva e testes de diferença e correlação. Resultados: Pessoas com pós-graduação, que trabalhavam e não tabagistas obtiveram melhores resultados de letramento em saúde. Idosos e aposentados/pensionistas apresentaram melhor adesão ao tratamento medicamentoso. Houve correlação entre a dimensão numérica (rs=0,189; p=0,004) e o resultado global de letramento em saúde (rs = 0,170; p=0,009) com a adesão. Conclusões: Melhor compreensão numérica e global de letramento em saúde estiveram associados a melhores resultados de adesão ao tratamento medicamentoso da hipertensão arterial.
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Nassar RI, Basheti IA, Saini B. Exploring Validated Self-Reported Instruments to Assess Adherence to Medications Used: A Review Comparing Existing Instruments. Patient Prefer Adherence 2022; 16:503-513. [PMID: 35237029 PMCID: PMC8885149 DOI: 10.2147/ppa.s352161] [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: 12/02/2021] [Accepted: 02/16/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To provide an overview of instruments that measure adherence to medications to facilitate selection of an instrument and to provide a summary of some published adherence assessment tools tailored to be used by the healthcare team, especially the pharmacists. DATA SOURCES Studies were identified via PubMed, Medline, Embase, and Google Scholar using the search terms medication adherence, compliance, persistence, combined with the terms questionnaire, scale, survey, self-report, and instrument. STUDY SELECTION Articles written in English, describing questionnaire instruments that were psychometrically evaluated (reporting a good coefficient of internal consistency, reliability assessed through Cronbach's alpha, and had been validated against a subjective or objective measure), and containing 30 or fewer items were included. DATA SYNTHESIS Twelve instruments were identified and included in this review. Instruments were reviewed by evaluating specific characteristics (number of items, sample size, reliability, sensitivity, specificity, questionnaire completion time, criterion validity, and component analysis). CONCLUSION Various instruments are used to assess patient adherence to medications; however, no single one performs well on all criteria. Every instrument has different advantages and unique properties. A particular instrument can be chosen after considering certain factors, such as the specific requirements, population, the needed time to complete the questionnaire, the sensitivity, and the specificity of the questionnaire. Moreover, there is a recognized need to provide primary care medication adherence services customized to patient's needs. A link for teamwork between healthcare providers such as pharmacists and patients is needed. This link can be a validated instrument to assess patient's adherence to medication.
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Affiliation(s)
- Razan Izzat Nassar
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Iman Amin Basheti
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
- Correspondence: Iman Amin Basheti, Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, 11931, Jordan, P. O. Box 166, Email
| | - Bandana Saini
- College of Pharmacy, The University of Sydney, Sydney, NSW, Australia
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Ng R, Carter SR, El-Den S. The impact of mobile applications on medication adherence: a systematic review. Transl Behav Med 2021; 10:1419-1435. [PMID: 31384950 DOI: 10.1093/tbm/ibz125] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In 2008, Apple and Android launched their Application or "App" stores. Since then, there has been a growing interest in using mobile apps for improving medication adherence. However, research on the efficacy of apps, in terms of improved medication adherence and clinical outcome and/or patient-related outcome measures (PROMs) is scarce. The objective of this research was to systematically review the impact of apps on consumers' medication adherence and to determine the effect on clinical outcome and/or PROM(s). A systematic literature search was conducted to identify publications aimed at improving medication adherence published from January 2008 to April 2018. All studies were assessed for risk of bias using either the Risk Of Bias In Non-randomized Studies-of Interventions or the revised tool for Risk of Bias in randomized trials tool, depending on study design. Eleven randomized controlled trials (RCTs) and 10 non-RCTs were included. All 11 RCTs showed improvements in adherence; however, only seven reported statistically significant improvements in at least one adherence measure. Nine RCTs also demonstrated improvements in clinical outcome/PROM(s), of which five were statistically significant, whereas two RCTs did not report on clinical outcome/PROM(s). Only two studies using non-RCT study designs showed statistically significant improvements in all measures of adherence and clinical outcome/PROM(s). The risk of bias was moderate or serious for all included studies. Even though the use of an app may improve adherence, it is difficult to draw conclusions regarding the impact of apps on medication adherence due to the high degree of heterogeneity across studies, from the methodological design to the features of the app and the measure of adherence.
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Affiliation(s)
- Ricki Ng
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Stephen R Carter
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Sarira El-Den
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia
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Habib B, Buckeridge D, Bustillo M, Marquez SN, Thakur M, Tran T, Weir DL, Tamblyn R. Smart About Meds (SAM): a pilot randomized controlled trial of a mobile application to improve medication adherence following hospital discharge. JAMIA Open 2021; 4:ooab050. [PMID: 34345805 PMCID: PMC8325487 DOI: 10.1093/jamiaopen/ooab050] [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: 01/08/2021] [Revised: 05/10/2021] [Accepted: 06/17/2021] [Indexed: 11/14/2022] Open
Abstract
Objective The objectives of this pilot study were (1) to assess the feasibility of a larger evaluation of Smart About Meds (SAM), a patient-centered medication management mobile application, and (2) to evaluate SAM’s potential to improve outcomes of interest, including adherence to medication changes made at hospital discharge and the occurrence of adverse events. Materials and Methods We conducted a pilot randomized controlled trial among patients discharged from internal medicine units of an academic health center between June 2019 and March 2020. Block randomization was used to randomize patients to intervention (received access to SAM at discharge) or control (received usual care). Patients were followed for 30 days post-discharge, during which app use was recorded. Pharmacy claims data were used to measure adherence to medication changes made at discharge, and physician billing data were used to identify emergency department visits and hospital readmissions during follow-up. Results Forty-nine patients were eligible for inclusion in the study at hospital discharge (23 intervention, 26 control). In the 30 days of post-discharge, 15 (65.2%) intervention patients used the SAM app. During this period, intervention patients adhered to a larger proportion of medication changes (83.7%) than control patients (77.8%), including newly prescribed medications (72.7% vs 61.7%) and dose changes (90.9% vs 81.8%). A smaller proportion of intervention patients (8.7%) were readmitted to hospital during follow-up than control patients (15.4%). Conclusion The high uptake of SAM among intervention patients supports the feasibility of a larger trial. Results also suggest that SAM has the potential to enhance adherence to medication changes and reduce the risk of downstream adverse events. This hypothesis needs to be tested in a larger trial. Trial registration Clinicaltrials.gov, registration number NCT04676165.
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Affiliation(s)
- Bettina Habib
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
| | - David Buckeridge
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Melissa Bustillo
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
| | | | - Manish Thakur
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
| | - Thai Tran
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
| | - Daniala L Weir
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Robyn Tamblyn
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Department of Medicine, McGill University Health Center, Montreal, Canada
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12
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Helou A, Stewart K, George J. Adherence to anti-hypertensive medication in pregnancy. Pregnancy Hypertens 2021; 25:230-234. [PMID: 34273672 DOI: 10.1016/j.preghy.2021.06.002] [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: 09/06/2020] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess adherence to anti-hypertensive medication by pregnant women and to identify the factors associated with adherence or lack thereof. STUDY DESIGN Observational study in 100 pregnant women with either chronic hypertension or gestational hypertension who were being treated with at least one anti-hypertensive medication and attending antenatal clinics at one of two maternity hospitals. In-depth interviews were conducted with a subset of 27 women from the same group. Quotes from interview transcripts were used to illustrate the quantitative results. MAIN OUTCOME MEASURES BP control, self-reported adherence, complexity of medication regimen. RESULTS Participants (mean age 33 [±4.9] years; mean gestation 29 (±7) weeks) had a median blood pressure (BP) of 130/80 mmHg (IQR: 16/15). Sixty-five women had chronic hypertension, of whom 13 were diagnosed during pregnancy, before 20 weeks gestation. Thirty-five women had gestational hypertension. Ninety-two per cent of participants had sub-optimal adherence. There were no significant differences in adherence scores between participants with chronic hypertension and their counterparts. The main contributors to sub-optimal adherence were intentionally putting up with medical problems before taking any action, confusion about the medication, and making changes to the recommended medication regimen to suit lifestyle. CONCLUSIONS Nine out of ten pregnant women using anti-hypertensives self-reported some degree of suboptimal adherence, intentionally and/or unintentionally. Health professionals, including pharmacists, general practitioners and obstetricians, have a role in promoting optimal medication adherence.
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Affiliation(s)
- Amyna Helou
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kay Stewart
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.
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Factors Associated with Medication Non-Adherence among Patients with Lifestyle-Related Non-Communicable Diseases. PHARMACY 2021; 9:pharmacy9020090. [PMID: 33922240 PMCID: PMC8167756 DOI: 10.3390/pharmacy9020090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 01/17/2023] Open
Abstract
This cross-sectional study explored the association between medication non-adherence and its factors in patients with non-communicable diseases (NCDs) using an online structured questionnaire emailed to 30,000 people (aged over 20 years who lived in Japan at the time of the survey). The questions concerned respondents’ characteristics, medication non-adherence, health beliefs, lifestyles, and trouble taking medication. Factors related to non-adherence were analyzed among patients with lifestyle-related NCDs categorized into two age groups: 20–59, and >60 years. Unintentional (p < 0.001) and intentional (p < 0.001) non-adherence were more common among patients aged 20–59 than in older adults. NCD patients aged 20–59 experienced significantly more trouble taking medication than older adults. Multiple regression analysis showed that for patients aged 20–59 with NCDs, unintentional non-adherence was significantly and positively associated with current smoking habits (β = 0.280, p < 0.001), while intentional non-adherence was significantly and positively associated with alcohol consumption (β = 0.147, p = 0.020) and current smoking habits (β = 0.172, p = 0.007). In patients aged 20–59, unhealthy eating habits (β = −0.136, p = 0.034) and lack of exercise (β = −0.151, p = 0.020) were negatively associated with intentional non-adherence. In conclusion, factors affecting medication non-adherence in patients with lifestyle-related diseases are related to health awareness, lifestyle, and medication barriers.
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Shirvani T, Javadivala Z, Azimi S, Shaghaghi A, Fathifar Z, Devender Bhalla HDR, Abdekhoda M, Nadrian H. Community-based educational interventions for prevention of type II diabetes: a global systematic review and meta-analysis. Syst Rev 2021; 10:81. [PMID: 33743839 PMCID: PMC7980624 DOI: 10.1186/s13643-021-01619-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/23/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Our objective was to estimate the change in community-based education interventions throughout the world that may effectuate in risk parameters of type II diabetes (T2D), including the diabetes incidence rate, fasting blood glucose, hemoglobin A1C, body mass index, waist circumference, and systolic and diastolic blood pressure. METHODS A comprehensive search for globally eligible studies was conducted on PubMed, Embase, ProQuest, CINAHL nursing & allied health source, Cochrane Library, Google Scholar, conference proceedings, and reference lists. Data were extracted using JBI standardized data extraction tool. The primary outcome variables were diabetes incidence rate, fasting blood sugar (FBS), hemoglobin A1c (HbAlc), body mass index (BMI), waist circumference (WC), systolic/diastolic blood pressure (s/d BP). Random-effects meta-analysis and sub-group analyses were conducted. RESULTS Nineteen interventional studies were included in the review, and ten studies were pooled in the meta-analysis (n = 16,106, mean age = 41.5 years). The incidence rate of T2D was reported in three trials, within which the risk of developing T2D was reduced by 54.0% in favor of community-based educational interventions, (RR = 0.54, 95% CI = 0.38-0.75; p < 0.001). In eleven (n = 11,587) and six (n = 6416) studies, the pooled mean differences were - 0.33 (95% CI: - 0.45 to - 0.20, p < 0.0001) and - 0.15 (95% CI: - 0.28 to - 0.03, p < 0.0001) for FBS and HbA1c levels, respectively. Positive significant effects were observed on reducing BMI [pooled mean difference = - 0.47 (95% CI: - 0.66 to - 0.28), I2 = 95.7%, p < 0.0001] and WC [pooled mean difference = - 0.66 (95% CI: - 0.89 to - 0.43), I2 = 97.3%, p < 0.0001]. The use of theoretical frameworks was found to provide a 48.0% change in fasting blood sugar. CONCLUSIONS Based on a comprehensive data collection of about 16,106 participants and reasonable analyses, we conclude that educational interventions may reduce diabetes incidence by 54.0%, particularly through reductions in fasting blood glucose, body mass index, and waist circumference. The diabetes risk parameters may favorably improve irrespective of the duration of intervention, at as low as 6 months. The application of theoretical frameworks while designing educational interventions is also encouraged. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018115877.
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Affiliation(s)
- Tayebeh Shirvani
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Javadivala
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Somayeh Azimi
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolreza Shaghaghi
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Fathifar
- Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - H D R Devender Bhalla
- Iranian Epilepsy Association, Tehran, Iran.,Pôle Universitaire Euclide Intergovernmental UN Treaty 49006/49007, Bangui, Central African Republic
| | - Mohammadhiwa Abdekhoda
- Department of Health Informatics, Faculty of Health Informatics and Management, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Haidar Nadrian
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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15
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Świątoniowska-Lonc N, Polański J, Mazur G, Jankowska-Polańska B. Impact of Beliefs about Medicines on the Level of Intentional Non-Adherence to the Recommendations of Elderly Patients with Hypertension. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062825. [PMID: 33802136 PMCID: PMC7998243 DOI: 10.3390/ijerph18062825] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 11/24/2022]
Abstract
Background: Non-adherence to pharmaceutical treatment is one of the most common causes of uncontrolled hypertension. Non-adherence may be intentional or unintentional. In the case of intentional non-adherence, it is crucial to understand the reasons behind it. The literature increasingly addresses the issue of beliefs and concerns about medication, but studies on this subject performed in a Polish population of hypertensive patients are still lacking. The aim of the study was to assess the level of intentional non-adherence among patients with hypertension, and to determine the relationship between beliefs about medication and the level of intentional non-adherence to treatment in elderly patients with hypertension. Material and methods: The study included 300 patients (106 of whom were male, mean age (SD) 71.71 (8.12) years) with hypertension, treated at a hypertension clinic. The following instruments were used: the Intentional Non-Adherence Scale (INAS) for evaluating intentional non-adherence, and the Beliefs about Medicines Questionnaire (BMQ) for evaluating patients’ beliefs and opinions regarding medication. Socio-demographic and clinical data were obtained from patients’ medical records. Results: The mean (SD) INAS score in the study was 47.28 (19.12). Patients were most concerned about the harm caused by medication, and least concerned about the necessity to take medication (mean score per item 3.49 vs. 2.14). Correlation analysis demonstrated weak correlations between BMQ and INAS: higher scores for necessity were associated with more intentional non-adherence (r = 0.174, p = 0.003), while higher scores for overuse, harm, and concerns were associated with less intentional non-adherence (respectively: r = −0.253, p < 0.001 vs. r = −0.336, p < 0.001 vs. r = −0.351, p < 0.001). In multiple-factor analysis, factors increasing the level of intentional non-adherence were elderly age (β = −0.352, p = 0.009), multimorbidity (β = −2.374, p = 0.035), and a higher BMQ concerns score (β = −1.376, p < 0.001), while being single was an independent predictor decreasing intentional non-adherence (β = 5.646, p = 0.013). Conclusions: The overall level of intentional non-adherence among patients with hypertension is moderate, but approximately one third of patients with hypertension demonstrate a high level of non-adherence. Independent determinants of intentional non-adherence include concerns, elderly age, multimorbidity, and being single.
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Affiliation(s)
| | - Jacek Polański
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wrocław, Poland; (J.P.); (G.M.)
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wrocław, Poland; (J.P.); (G.M.)
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16
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The effect of acculturation and harm beliefs on medication adherence on Middle Eastern hypertensive refugees and migrants in Australia. Int J Clin Pharm 2021; 43:1283-1292. [PMID: 33660193 DOI: 10.1007/s11096-021-01248-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
Background Different populations have different levels of acculturation, and beliefs about medications. Little is known about the differences between refugees and migrants regarding these various beliefs. Adherence to medications is influenced by many factors, including individuals' characteristics, acculturation, and their perceptions about medications. Having a thorough understanding of these beliefs contributes to understanding medication adherence in refugee and migrant populations. Objectives To evaluate the differences between Middle Eastern refugees and migrants in Australia regarding acculturation, beliefs about medications, and medication adherence, and to evaluate the association of acculturation and beliefs about medications and natural remedies with medication adherence. Setting Participants were recruited from various community groups and English language learning centres in Australia. Arabic Facebook community groups were also used to recruit participants for this study. Method A total of 320 Middle Eastern refugees and migrants with hypertension completed Arabic or English versions of the general Beliefs about Medicine Questionnaire (BMQ)-harm scale, a question about beliefs in natural remedies, six items about acculturation and the Medication Adherence Questionnaire. Two models of multiple mediation were applied. The first model examined the role of acculturation, length of residency, beliefs about natural remedies, and harm beliefs as mediators between migration status and medication adherence. The second model identified the role of acculturation, and beliefs about natural remedies as mediators between migration status and medication harm beliefs. Main outcome measure Medication adherence, harm beliefs about medication, acculturation, and beliefs about natural remedies. In addition, the differences between refugees and migrants regarding these beliefs and medication adherence. Results Differences were found between refugees and migrants for medication adherence and medication beliefs. Refugees were likely to have more harm beliefs towards medicine and were less acculturated than migrants (p = 0.0001). They were also less likely to adhere to medications (p = 0.0001), and perceived natural remedies to be safer than Western medications (p = 0.0001). Perceiving medications as harmful substances, and beliefs in natural remedies were mediators in the relationship between migration status and medication adherence. Beliefs in natural remedies and acculturation were mediators in the relationship between migration status and harm beliefs. Conclusion Beliefs about medications and natural remedies, and acculturation in refugees and migrants need to be better understood to enhance medication adherence and potentially overall health outcomes.
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17
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Tan FCJH, Oka P, Dambha-Miller H, Tan NC. The association between self-efficacy and self-care in essential hypertension: a systematic review. BMC FAMILY PRACTICE 2021; 22:44. [PMID: 33618661 PMCID: PMC7901221 DOI: 10.1186/s12875-021-01391-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The successful management of hypertension requires sustained engagement in self-care behaviour such as adhering to medication regimens and diet. Bandura's Social Cognitive Theory suggests that self-efficacy is a major determinant of engagement in self-care behaviour. Self-efficacy refers to an individual's belief in their capacity to execute behaviours necessary to produce specific performance attainments. This systematic review of observational studies aims to summarise and evaluate the quality of evidence available to support the association between self-efficacy and engagement in self-care behaviour in hypertension. METHODS Searches were performed of the Pubmed, MEDLINE, CINAHL and OpenSIGLE databases from database inception to January 2020. Reference lists and individual journals were also hand searched. Observational studies in English quantifying self-efficacy and self-care behaviour in hypertensive adults were included. The quality of included articles was assessed with the National Institute of Health Quality Assessment Tool for observational studies. RESULTS The literature search identified 102 studies, of which 22 met the inclusion criteria for full-text review. There were 21 studies which reported that higher self-efficacy was associated with engagement in self-care behaviours including medication adherence (n = 9), physical activity (n = 2) and dietary changes (n = 1). Of these, 12 studies were rated as 'good' on the quality assessment tool and 10 were 'fair'. A common limitation in these studies was a lack of objectivity due to their reliance on self-reporting of engagement in self-care behaviour. CONCLUSION Our review suggests an association between self-efficacy and self-care. However, the evidence supporting this association is of low to medium quality and is limited by heterogeneity. Our findings suggest the need for further well-designed interventional studies to investigate this association.
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Affiliation(s)
- Felicia Clara Jun Hui Tan
- Ministry of Health Holdings, 1 Maritime Square, #11-25 HarbourFront Centre, Singapore, 099253, Singapore.,SingHealth Polyclinics, 167 Jalan Bukit Merah Connection One (Tower 5), #15-10, Singapore, 150167, Singapore
| | - Prawira Oka
- Ministry of Health Holdings, 1 Maritime Square, #11-25 HarbourFront Centre, Singapore, 099253, Singapore.,SingHealth Polyclinics, 167 Jalan Bukit Merah Connection One (Tower 5), #15-10, Singapore, 150167, Singapore
| | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, 167 Jalan Bukit Merah Connection One (Tower 5), #15-10, Singapore, 150167, Singapore. .,SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore.
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18
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Medication Beliefs and Adherence to Antiseizure Medications. Neurol Res Int 2020; 2020:6718915. [PMID: 33163231 PMCID: PMC7604606 DOI: 10.1155/2020/6718915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/01/2020] [Accepted: 09/30/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction The primary objective of our study was to determine the nature of medication beliefs and their association with adherence to antiseizure medications (ASMs) among elderly epilepsy patients. Our secondary objective was to enhance the psychometric properties and factor structure parameters of the Beliefs about Medications Questionnaire (BMQ) adapted to epilepsy and affected aged subjects. Methods A population-based survey was performed in which older adults (≥60 years of age) were invited for a free face-to-face consultation with the specialists as well as for the collection of necessary data. The eligible subjects were those who are affected with epilepsy and having epileptic seizures of any type. In addition, the participants were required to be of any sex, currently under treatment with ASMs, resident of Tehran, and able and interested to participate independently. All were carefully examined with a reasonably detailed case-history examination. Two Persian questionnaires used were Medication Adherence Rating Scale (MARS) and BMQ. Those with a MARS score of ≥6 were considered as adherent to ASMs. All data were described in descriptive terms. We did a group comparison of means and proportions for all possible independent variables between adherents and nonadherents. Then, we did a hierarchical multiple linear regression. For this, independent variables were categorized into three different blocks: (a) sociodemographic block (Block-1), (b) treatment side-effect block (Block-2), and (c) BMQ block that included ten items of the BMQ scale (Block-3). We also did a forward step-wise linear regression by beginning with an empty model. We also estimated the psychometric properties and factor structure parameters of BMQ and its two subdomains. Results Of all (N = 123, mean age: 63.3 years, 74.0% males), 78.0% were adherent (mean score: 7.0, 95% CI 6.2–7.8) to ASMs. The MARS scores were not different between males and females. The mean BMQ score was 23.4 (95% CI 19.8–27.0) with the mean need score of 20.0 (95% CI 18.0–22.0) and mean concern score of 16.5 (95% CI 14.3–18.7). A positive need-concern differential was 20.4%. Upon hierarchical regression, the adjusted R2 for Block-1 was 33.8%, and it was 53.8% for Block-2 and 92.2% for Block-3. Upon forward step-wise linear regression, we found that “ASMs disrupt my life” (ß −1.9, ES = −1.1, p=0.008) as the only belief associated with adherence. The alpha coefficient of BMQ was 0.81. Conclusions Ours is one of the very few studies that evaluated medication beliefs and their association with adherence to ASMs among elderly epilepsy patients in a non-western context. In our context, medication beliefs are likely to have an independent role in effecting adherence to ASMs, particularly the concern that “ASMs disrupt life.” Treating physicians should cultivate good conscience about ASMs and evaluate the patient's medication beliefs early-on to identify those who might be at the risk of becoming nonadherent.
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19
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Lim JH, Chinna K, Khosla P, Karupaiah T, Daud ZAM. Understanding How Nutrition Literacy Links to Dietary Adherence in Patients Undergoing Maintenance Hemodialysis: A Theoretical Exploration Using Partial Least Squares Structural Equation Modeling. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207479. [PMID: 33066603 PMCID: PMC7602379 DOI: 10.3390/ijerph17207479] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/29/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022]
Abstract
Dietary non-adherence is pervasive in the hemodialysis (HD) population. Health literacy is a plausible predictor of dietary adherence in HD patients, but its putative mechanism is scarcely studied. Thus, this study aimed to establish the causal model linking nutrition literacy to dietary adherence in the HD population. This was a multi-centre, cross-sectional study, involving 218 randomly selected multi-ethnic HD patients from nine dialysis centres in Klang Valley, Malaysia. Dietary adherence and self-management skills were assessed using validated End-Stage Renal Disease Adherence Questionnaire and Perceived Kidney/Dialysis Self-Management Scale, respectively. Validated self-developed scales were used to gauge nutrition literacy, dietary knowledge and Health Belief Model constructs. Relationships between variables were examined by multiple linear regressions and partial least squares structural equation modeling. Limited nutrition literacy was evident in 46.3% of the HD patients, associated with older age, lower education level, and shorter dialysis vintage. Dietary adherence rate was at 34.9%. Nutrition literacy (β = 0.390, p < 0.001) was an independent predictor of dietary adherence, mediated by self-efficacy (SIE = 0.186, BC 95% CI 0.110-0.280) and self-management skills (SIE = 0.192, BC 95% CI 0.103-0.304). Thus, nutrition literacy-enhancing strategies targeting self-efficacy and self-management skills should be considered to enhance dietary adherence in the HD population.
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Affiliation(s)
- Jun-Hao Lim
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang 43400, Malaysia;
| | - Karuthan Chinna
- School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya 47500, Malaysia;
| | - Pramod Khosla
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202-0340, USA;
| | - Tilakavati Karupaiah
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya 47500, Malaysia;
| | - Zulfitri Azuan Mat Daud
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang 43400, Malaysia;
- Research Center of Excellent (RCoE) Nutrition and Non-communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia
- Correspondence: ; Tel.: +60-397-692-431
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20
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Coskun S, Bagcivan G. Associated factors with treatment adherence of patients diagnosed with chronic disease: Relationship with health literacy. Appl Nurs Res 2020; 57:151368. [PMID: 33092934 DOI: 10.1016/j.apnr.2020.151368] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 08/01/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
AIM This study aimed to examine the relationship between the health literacy level and treatment adherence in patients with chronic disease. BACKGROUND Nonadherence to treatment and insufficient health literacy can cause a decrease in understanding treatment methods, an increase in medication errors, and an increase in morbidity and mortality rates. MATERIALS AND METHODS This cross-sectional study comprised a total of 200 patients who were taking medication for a chronic disease. Data were collected using an 18-item questionnaire for sociodemographic and medical characteristics, the Adult Health Literacy Scale (AHLS), and the Morisky Medication Adherence Scale (MMAS). RESULTS Of the patients, 42.5% reported that they took three or more medications per day, and 32.0% reported that they did not know the side effects of these medications. Of the patients, 39.0% had low adherence to treatment. The mean score of the AHLS was 12.8 ± 4.74 (min = 2; max = 21). A statistically significant positive correlation was found between the AHLS scores and MMAS scores (r = 0.604; p = 0.001). CONCLUSIONS This study revealed that patients' adherence to treatment increased as their health literacy increased. Thus, it is recommended that health literacy levels of the patients be raised through effective interventions to ensure better adherence to treatment.
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Affiliation(s)
- Sabahat Coskun
- Şeyh Edebali University, Faculty of Health Sciences, Bilecik, Turkey.
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21
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Kelly BJ, Rupert DJ, Aikin KJ, Sullivan HW, Johnson M, Bann CM, Mack N, Southwell BG, West S, Parvanta S, Rabre A, Peinado S. Development and validation of prescription drug risk, efficacy, and benefit perception measures in the context of direct-to-consumer prescription drug advertising. Res Social Adm Pharm 2020; 17:942-955. [PMID: 32883618 DOI: 10.1016/j.sapharm.2020.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 06/22/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Understanding patient perceptions of prescription drug risks and benefits is an important component of determining risk-benefit tradeoffs and helping patients make informed medication decisions. However, few validated measures exist for capturing such perceptions. The purpose of this study was to develop and validate measures of perception of prescription drug risk, efficacy, and benefit. METHODS We conducted a mixed-methods study to develop and validate the measures, including three waves of quantitative testing (item nonresponse, criterion-related validity, and convergent validity). We conducted quantitative testing with a probability-based online consumer panel of U.S. adults (n = 7635), eliminating weaker items after each testing wave. RESULTS Upon completion of all testing, we identified 21 validated measures that represent 11 distinct risk/benefit constructs. The final measures demonstrated face validity, convergent validity, criterion-related validity, and scale reliability in both illness and general population samples, among patients with both symptomatic and asymptomatic health conditions, and in response to both television and print direct-to-consumer prescription drug advertisements. CONCLUSIONS Our study produced a set of items that researchers and practitioners can use to assess patient perceptions of prescription drug risk, benefit, and efficacy and to ensure greater future comparability between studies.
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Affiliation(s)
- Bridget J Kelly
- RTI International, 3040 E. Cornwallis Road, PO Box 19104 Research Triangle Park, NC, 27709-2194, United States.
| | - Douglas J Rupert
- RTI International, 3040 E. Cornwallis Road, PO Box 19104 Research Triangle Park, NC, 27709-2194, United States
| | - Kathryn J Aikin
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue Silver Spring, MD, 20993, United States
| | - Helen W Sullivan
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue Silver Spring, MD, 20993, United States
| | - Mihaela Johnson
- RTI International, 3040 E. Cornwallis Road, PO Box 19104 Research Triangle Park, NC, 27709-2194, United States
| | - Carla M Bann
- RTI International, 3040 E. Cornwallis Road, PO Box 19104 Research Triangle Park, NC, 27709-2194, United States
| | - Nicole Mack
- RTI International, 3040 E. Cornwallis Road, PO Box 19104 Research Triangle Park, NC, 27709-2194, United States
| | - Brian G Southwell
- RTI International, 3040 E. Cornwallis Road, PO Box 19104 Research Triangle Park, NC, 27709-2194, United States
| | - Sue West
- RTI International, 3040 E. Cornwallis Road, PO Box 19104 Research Triangle Park, NC, 27709-2194, United States
| | - Sarah Parvanta
- RTI International, 3040 E. Cornwallis Road, PO Box 19104 Research Triangle Park, NC, 27709-2194, United States
| | - Alexander Rabre
- RTI International, 3040 E. Cornwallis Road, PO Box 19104 Research Triangle Park, NC, 27709-2194, United States
| | - Susana Peinado
- RTI International, 3040 E. Cornwallis Road, PO Box 19104 Research Triangle Park, NC, 27709-2194, United States
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Bekker CL, Mohsenian Naghani S, Natsch S, Wartenberg NS, van den Bemt BJF. Information needs and patient perceptions of the quality of medication information available in hospitals: a mixed method study. Int J Clin Pharm 2020; 42:1396-1404. [PMID: 32857256 PMCID: PMC7603457 DOI: 10.1007/s11096-020-01125-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022]
Abstract
Background Providing appropriate medication information to patients is of utmost importance for optimal pharmacotherapy. (Un)intentional miscommunication and information gaps resulting in unmet needs could negatively affect patient’s ability to use their medication properly. Objective To identify the information needs and patient perceptions of the quality of medication information available in hospitals in the Netherlands. Setting Cardiology, oncology, or rheumatology department of five hospitals. Methods Adult cardiology, oncology, and rheumatology patients participated in this mixed-method study. Focus groups and individual interviews were held to identify patients’ views on the medication information and their information needs. Outcomes were used to construct a questionnaire that was used in a survey among patients to compare existing medication information with patients’ needs, and to judge the quality of the provided information. Main outcome measure Patients needs with medication information. Results Four themes derived from interviews with 44 patients: (1) Content; almost all patients acknowledged to receive insufficient information not meeting their personal needs. (2) Moment of delivery; patients were dissatisfied with the timing. (3) Method of delivery; patients highly preferred verbal and written information. (4) Contextual quality prerequisites that should be met according to patients; medication information should be accessible, comprehensive, reliable and understandable. A total of 352 patients completed the questionnaire. Almost all patients reported all items as important, whereas up to 74.6% patients were not informed. Up to half of the patients perceived verbal information from healthcare providers, written information of leaflets and folders of insufficient quality. Conclusion Patients attending Dutch hospitals have needs for extensive medication information, which should be tailored to their individual needs. According to patients the quality of medication information available in hospitals can be improved.
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Affiliation(s)
- Charlotte L Bekker
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Shaghayegh Mohsenian Naghani
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Stephanie Natsch
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Naomi S Wartenberg
- Department of Pharmacy, Sint Maartenskliniek, Hengstdal 3, 6574 NA, Nijmegen, The Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Department of Pharmacy, Sint Maartenskliniek, Hengstdal 3, 6574 NA, Nijmegen, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
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Plowman RS, Peters SR, Brady BM, Osterberg LG. Revealing Novel IDEAS: A Fiduciary Framework for Team-Based Prescribing. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1186-1190. [PMID: 31789844 DOI: 10.1097/acm.0000000000003100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The importance of safe, effective, and cost-effective prescribing habits can hardly be overstated in the current pay-for-value environment. The prescribing process taught in most medical curricula focuses primarily on accurate medical indications. While this may be of utmost importance from the clinician's perspective, it falls short of addressing the other key elements of highly effective prescribing. These other elements are often paramount in the minds of patients. A patient-centric framework that associates and incorporates the necessary components of optimal prescribing is overdue. Building this framework into medical curricula will foster increased teamwork among providers and enhance shared decision making between patients and clinicians. In addition to establishing accurate medical indications, prescribing teams need to assure every prescribed medication is desired, effective, affordable, and safe for patients who receive them. Prescription writing is an honorable prerogative, and doing so safely, effectively, and cost-effectively requires both teamwork and technology. Highly effective prescribing teams can implement the IDEAS (Indicated, Desired, Effective, Affordable, Safe) framework through appropriate and deliberate delegation. By empowering members of the care team to support and educate patients, this framework will allow physicians to focus on ensuring appropriate indications and real-world effectiveness. This novel IDEAS framework serves as an important mental model for medical trainees and reinforces sound prescribing habits among seasoned clinicians. High-touch and high-tech partnerships have the potential to maximize the triple aim (i.e., improving the patient's experience of care, improving the health of populations, and reducing the per capita cost of health care). In an era when costs overwhelm quality, providing a fiduciary framework to instill responsibility for optimal prescribing, especially among young physician-leaders, is invaluable.
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Affiliation(s)
- R Scooter Plowman
- R.S. Plowman is senior medical director, Proteus Digital Health, Redwood City, California; ORCID: https://orcid.org/0000-0002-1517-8245
| | - Stephanie R Peters
- S.R. Peters is behavioral medicine director, Carium, Petaluma, California
| | - Brian M Brady
- B.M. Brady is clinical assistant professor of medicine, Nephrology Division, Stanford University, Stanford, California
| | - Lars G Osterberg
- L.G. Osterberg is associate professor of medicine, Division of Primary Care and Population Health, Stanford University, Stanford, California; ORCID: https://orcid.org/0000-0002-4694-837X
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Heizomi H, Iraji Z, Vaezi R, Bhalla D, Morisky DE, Nadrian H. Gender Differences in the Associations Between Health Literacy and Medication Adherence in Hypertension: A Population-Based Survey in Heris County, Iran. Vasc Health Risk Manag 2020; 16:157-166. [PMID: 32368074 PMCID: PMC7186197 DOI: 10.2147/vhrm.s245052] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/19/2020] [Indexed: 12/27/2022] Open
Abstract
Objective We examined the gender-based associations of health literacy (HL) with self-reported medication adherence (MEDA) among patients with primary hypertension (pHTN). Patients and Methods The subjects were recruited from the general population through all health centers of the Heris county, east Azarbaijan. They were to be adults (30+ years age), with pHTN of any stage, of any gender, and without comorbid illness. All underwent detailed face-to-face interview. We used valid questionnaires for HL and MEDA. Hierarchical regression was done to establish the association between MEDA, socio-demographic variables, and nine HL domains by gender. Other statistical procedures were also done. Results A total of 300 (48.6% males, mean age: 56.7±9.3) subjects participated; 43.0% were uneducated, 73.0% had moderate socioeconomic status, 68.0% had poor HL, and 7.0% maintained high adherence. Men were better in reading skills (p=0.002), and accessing (p=0.01) and using (p=0.02) health information, but women were better in health knowledge (p=0.004). The average regression estimate (±standard deviation) between HL and MEDA was 0.37±0.09, lower among men (0.361±0.11) than women (0.396±0.08), p=0.003. Upon hierarchical regression, the association between HL and MEDA was significant for communication and decision-making skills alone among both men (34.5%) and women (40.6%), individually. Conclusion HL had substantial association with MEDA among those with HTN, for both men and women, particularly the communication and decision-making. With considerations on gender differences, this association should be confirmed through interventional studies to help make HL a formal mitigating strategy for MEDA and other public health goals.
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Affiliation(s)
- Haleh Heizomi
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeynab Iraji
- Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rogayeh Vaezi
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Devender Bhalla
- Pôle Universitaire Euclide, Intergovernmental UN Treaty 49006/49007®, Bangui, Central African Republic.,Iranian Epilepsy Association®, Tehran, Iran.,Nepal Interest Group of Epilepsy and Neurology (NiGEN), Kathmandu, Nepal
| | - Donald E Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Haidar Nadrian
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran.,Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Makris E, Hu L, Jones GB, Wright JM. Moving the Dial on Heart Failure Patient Adherence Rates. Patient Prefer Adherence 2020; 14:2407-2418. [PMID: 33324042 PMCID: PMC7733338 DOI: 10.2147/ppa.s283277] [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: 09/22/2020] [Accepted: 11/20/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Heart failure remains a substantive contributor to patient morbidity and mortality rates worldwide and represents a significant burden on the healthcare ecosystem. Faced with persistent physical symptoms and debilitating social consequences, patients follow complex treatment regimens and often have difficulty adhering to them. PURPOSE In this manuscript, we review factors which contribute to low adherence rates and advance potential single- and multi-factor-based interventions. It is hoped that these observations can lead to improvements in managed care of this vulnerable population of patients. METHODS A narrative review of the primary literature was performed on contributing factors with primary focus on the period 2015-2020 using available databases and search engines. Adherence pain points identified were mapped against a series of potential solutions which are presented. RESULTS Enhancement of treatment adherence relies on two approaches viz. single-factor and multi-factor solutions. Single factors identified include electronic reminders, enhanced health education, financial incentives, gamification strategies, community drivers, persona-based modeling, and burden relief of poly pharmacy. Multi-factor solutions combine two or more of the seven approaches offering the potential for flexible interventions tailored to the individual. DISCUSSION AND CONCLUSION Heart failure patients with poor adherence have increased mortality, hospitalization needs, and healthcare costs. This review highlights current single-factor and multi-factor adherence methods. Against a backdrop of diversity of approaches, multi-factor solutions cast the widest net for positively influencing adherent behaviors. A key enabler lies in the development and leveraging of patient personas in the synthesis of successful intervention methods. Deployable solutions can also be envisioned in clinical trials where adherence tracking represents an essential component.
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Affiliation(s)
- Eleanna Makris
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
| | - Lucy Hu
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
| | - Graham B Jones
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
- Clinical and Translational Science Institute, Tufts University Medical Center, Boston, MA02111, USA
- Correspondence: Graham B Jones Email
| | - Justin M Wright
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
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Zanatta F, Nissanova E, Świątoniowska-Lonc N, Pierobon A, Callegari G, Olmetti F, Felicetti G, Karniej P, Polański J, Giardini A, Jankowska-Polańska B. Psychosocial Predictors of Self-Efficacy Related to Self-Reported Adherence in Older Chronic Patients Dealing with Hypertension: A European Study. Patient Prefer Adherence 2020; 14:1709-1718. [PMID: 33061314 PMCID: PMC7524841 DOI: 10.2147/ppa.s258999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/04/2020] [Indexed: 12/04/2022] Open
Abstract
PURPOSE Non-adherence to clinical prescriptions is widely recognized as the most common cause of uncontrolled hypertension, contributing to develop acute and chronic cardiovascular diseases. Specifically, patients' unintentional non-adherence is related to psychosocial factors as beliefs about medications, perceived physician's communication effectiveness and medication-specific social support. The aim of this study was to observe the impact of these factors on self-efficacy in relation to pharmacological and non-pharmacological self-reported adherence among older chronic patients with hypertension. PATIENTS AND METHODS This research had a cross-sectional, observational and multicentre study design. Italian inpatients under rehabilitation, and Polish inpatients/outpatients were recruited. Following a cognitive screening, socio-demographic and clinical characteristics were obtained. Data on clinical and behavioral adherence (i.e., pharmacological adherence, adherence to refill medicines, intentional non-adherence) and psychosocial factors related to treatment adherence (i.e., beliefs about medicines, physician's communication skills, medication-specific social support, psychological antecedents and self-efficacy) were collected with self-report questionnaires. RESULTS A total of 458 patients were recruited. Fischer's LSD post hoc test revealed significant differences between Italian and Polish samples in all measures (p<0.001). Multiple linear regression analysis showed low self-reported intentional non-adherence (β = -.02, p=0.031), high self-reported adherence to refill medications (β=-.05, p=0.017), high levels of perceived physician's communication effectiveness (β=0.11, p<0.001), positive beliefs about medications (β=0.13, p<0.001), and high perceived medication-specific social support (β=0.05, p<0.001) to predict significantly high patients' self-efficacy in relation to pharmacological and non-pharmacological self-reported adherence. CONCLUSION The observed psychosocial and behavioral factors revealed to positively impact on self-efficacy in relation to treatment adherence among older chronic patients dealing with hypertension. In a prevention framework, future studies and clinical practice may consider these factors in order to improve assessment and intervention on adherence in this population.
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Affiliation(s)
- Francesco Zanatta
- Psychology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy
| | - Ekaterina Nissanova
- Psychology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy
| | | | - Antonia Pierobon
- Psychology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy
- Correspondence: Antonia Pierobon Istituti Clinici Scientifici Maugeri IRCCS, Via S. Maugeri, 4, Pavia27100, ItalyTel +39 385 247255Fax +39 385 61386 Email
| | - Giovanna Callegari
- Respiratory Rehabilitation Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy
| | - Francesca Olmetti
- Cardiological Rehabilitation Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy
| | - Guido Felicetti
- Neuromotor Rehabilitation Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy
| | - Piotr Karniej
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek Polański
- Department of Internal Diseases, Occupational Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Giardini
- Information Technology Department, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Beata Jankowska-Polańska
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
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Zand A, Nguyen A, Stokes Z, van Deen W, Reynolds C, Dimitrova M, Khandadash A, Dvorsky M, Sauk J, Esrailian E, Hommes D. The Development of a Screening Tool to Identify and Classify Nonadherence in Inflammatory Bowel Disease. CROHN'S & COLITIS 360 2019. [DOI: 10.1093/crocol/otz035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Medication nonadherence is a challenge in chronic disease management. Tools that can both determine adherence levels and analyze patient-specific reasons for nonadherence are lacking.
Methods
Our tool was developed using 23 patient-reported items and its predictive performance was compared with the most widely used instrument in the literature.
Results
One hundred thirty-three IBD patients were included, 44 (33%) were nonadherent and 89 (67%) were adherent. Our screening question, with 87% sensitivity and 64% specificity, was followed by a 9-item survey for patients qualified as nonadherent.
Conclusions
Quantifying reasons for nonadherence can lead to more effective and personalized interventions for nonadherent patients.
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Affiliation(s)
- Aria Zand
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
- Department of Digestive Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Audrey Nguyen
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
| | - Zack Stokes
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
| | - Welmoed van Deen
- Cedars-Sinai Center for Outcomes Research and Education, Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Courtney Reynolds
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
| | - Magdalena Dimitrova
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
| | - Ariela Khandadash
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
| | - Miriam Dvorsky
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
| | - Jenny Sauk
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
| | - Eric Esrailian
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
| | - Daniel Hommes
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
- Department of Digestive Diseases, Leiden University Medical Center, Leiden, the Netherlands
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28
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Shi S, Shen Z, Duan Y, Ding S, Zhong Z. Association Between Medication Literacy and Medication Adherence Among Patients With Hypertension. Front Pharmacol 2019; 10:822. [PMID: 31396088 PMCID: PMC6664237 DOI: 10.3389/fphar.2019.00822] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/25/2019] [Indexed: 01/08/2023] Open
Abstract
Background: Few studies have investigated the association between medication literacy and medication adherence as well as the influence of medication literacy on medication adherence in hypertensive patients. Thus, the goal of the present study was to determine the association between medication literacy and medication adherence in hypertensive patients. Methods: A cross-sectional survey was conducted between August 2016 and December 2016. Self-administered questionnaires were completed, including a self-developed and structured socio-demographic questionnaire; a self-developed, validated, and self-reported Medication Literacy Scale for Hypertensive Patients (C-MLSHP) used for medication literacy measurement; and the Chinese Version of the Morisky Medication Adherence Scale-8 (C-MMAS-8), an eight-item validated, self-report scale for adherence measurement with a total score range of 0-8. A cut-off of 6 was applied to differentiate adherence levels, including patients with an MMAS score <6 (low adherence), MMAS score = 8 (high adherence), and MMAS score ≥6 and <8 (moderate adherence). In this study, hypertensive patients' medication literacy levels and adherence to antihypertensive agents were identified. Pearson correlation analysis was carried out to identify the correlation between medication literacy and adherence. Binary logistic regression analysis was performed with medication adherence as the outcome variable in order to confirm factors associated with medication adherence. Results: A total of 420 hypertensive patients, including 198 women and 222 men with a mean age of 60.6 years (SD = 12.4), were recruited. The mean score of hypertensive patients on the medication literacy scale was 24.03 (SD = 5.13). The mean scores of the four dimensions of knowledge, attitude, skill, and behavior on the medication literacy scale of this study were 6.22 ± 2.22, 5.04 ± 1.16, 4.50 ± 2.21, and 8.27 ± 1.90, respectively. Regarding medication adherence, the mean score of the C-MMAS-8 in this study was 4.82 (SD = 2.11). A total of 63.6% of patients presented with low adherence, 29.5% presented with moderate adherence, and 7.6% presented with high adherence. The Pearson correlation results showed that medication literacy (r = 0.342, P < 0.01) as a whole variable and the three dimensions of knowledge (r = 0.284, P < 0.01), attitude (r = 0.405, P < 0.01), and behavior (r = 0.237, P < 0.01) were significantly associated with medication adherence. Binary logistic regression analysis indicated that annual income [OR 1.199 (95% CI: 1.011-1.421); P = 0.037] and two dimensions of attitude [OR 2.174 (95% CI: 1.748-2.706); P = 0.000] and behavior [OR 1.139 (95% CI: 1.002-1.294); P = 0.046] in medication literacy were found to be independent predictors of medication adherence. Individuals with better attitudes and behavior literacy in medication literacy were more likely to adhere to the use of antihypertensive agents. Those who had higher annual incomes were more likely to adhere to the use of antihypertensive agents. Conclusion: The levels of medication literacy and medication adherence of hypertensive patients are suboptimal and need to be improved in China. The level of medication literacy in patients with hypertension could affect their adherence to antihypertensive drugs. It was suggested that hypertensive patients' medication adherence could be improved and driven by increasing the medication literacy level, especially in the attitude and behavior domains. Pertinent strategies that are specific to several dimensions of medication literacy should be developed and implemented in order to promote full medication literacy among hypertensive patients, thus facilitating optimal adherence and blood pressure control.
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Affiliation(s)
- Shuangjiao Shi
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Zhiying Shen
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
| | - Yinglong Duan
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
| | - Siqing Ding
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Zhuqing Zhong
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
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Naghavi S, Mehrolhassani MH, Nakhaee N, Yazdi-Feyzabadi V. Effective factors in non-compliance with therapeutic orders of specialists in outpatient clinics in Iran: a qualitative study. BMC Health Serv Res 2019; 19:413. [PMID: 31234854 PMCID: PMC6591863 DOI: 10.1186/s12913-019-4229-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/07/2019] [Indexed: 12/11/2022] Open
Abstract
Background Non-compliance with prescribed treatment is an important cause of preventable mortality and economic burden. Recognition of the factors for non-compliance with the therapeutic orders of specialists from the perspective of patients and health care providers sheds more light on the issue for policymakers and stakeholders. The current study aimed at determining the factors for non-compliance with therapeutic orders in outpatient clinics in Kerman, Iran. Methods The current qualitative study was conducted using the phenomenological method and semi-structured interviews with 10 patients, five specialists, and four health care managers and treatment officials in outpatient clinics in Kerman. The interviewees were selected by purposive sampling. The codes extracted from the interviews were transcribed using conventional content analysis to identify the viewpoints. The MAXQDA 10 software was used to analyze the data. Results The reasons for non-compliance with specialists’ orders were categorized into five themes including patient-related (patient-centered), disease-related, therapy-related, the healthcare provider related (healthcare system), and socioeconomic factors. Themes were composed of fifteen categories and forty-one sub-categories. The dominant sub-categories extracted from interviews were health literacy and knowledge of the patient, communication and patients’ trust in physicians and direct costs of treatment. Conclusion This study identified a wide range of different individual, disease, treatment, health care provider, and socio-economic factors and the interactions between them which may result into non-compliance with therapeutic orders prescribed by specialists. Therefore, specific attention should be paid to integrate the service provision system into the collaborative approach of the patient and his/her family in order to promote the level of compliance with therapy and care in planning and policy-making to improve the health service provision system. Electronic supplementary material The online version of this article (10.1186/s12913-019-4229-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Soheila Naghavi
- Msc Student in Health Services Management, Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Hossein Mehrolhassani
- PhD in Health Services Management, Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nouzar Nakhaee
- PhD in community Medicine, Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Yazdi-Feyzabadi
- PhD in Health Policy, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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30
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Chan RWY, Kisa A. A Scoping Review of Health Literacy Measurement Tools in the Context of Cardiovascular Health. HEALTH EDUCATION & BEHAVIOR 2019; 46:677-688. [PMID: 30829066 DOI: 10.1177/1090198119831754] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Despite the strong link between health literacy and cardiovascular health outcomes, health literacy measurements remain flawed and fragmented. There exists a gap in the knowledge when formulating a valid measurement to capture the broad concept of health literacy. The existence of various tools for health literacy measurement also hampers the availability of health literacy data. Additionally, little research is available on a valid measurement tool for cardiovascular health literacy. Objective. This study aims to provide an overview of the health literacy measurement tools used in the context of cardiovascular health. Method. A scoping review was conducted. Two electronic databases, Medline and Embase, were searched to identify studies that described a tool for the measurement of health literacy in the context of cardiovascular health. Results. After reviewing the available studies, 53 studies met the inclusion criteria. A total of 26 health literacy measurement tools were identified in the studies. Among the 26 tools, 16 used an objective measurement approach, 9 adopted a subjective approach, and 1 employed a mixed approach. Additionally, 28 studies used tools to measure print literacy, 15 studies measured print literacy and numeracy, and 5 studies measured print literacy, oral literacy, and numeracy. Conclusions. STOFHLA, TOFHLA, and REALM were the mostly commonly used tools in the selected studies. The majority of tools were based heavily on reading skills and word recognition. Researchers should focus on the development of more comprehensive and reliable health literacy measurement tool(s) specific to cardiovascular health to assist health care providers to more efficiently and accurately identify people with cardiovascular problems who have inadequate health literacy.
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Affiliation(s)
| | - Adnan Kisa
- University of Oslo, Oslo, Norway
- Kristiania University College, Oslo, Norway
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31
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Magnani JW, Mujahid MS, Aronow HD, Cené CW, Dickson VV, Havranek E, Morgenstern LB, Paasche-Orlow MK, Pollak A, Willey JZ. Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention: A Scientific Statement From the American Heart Association. Circulation 2018; 138:e48-e74. [PMID: 29866648 PMCID: PMC6380187 DOI: 10.1161/cir.0000000000000579] [Citation(s) in RCA: 226] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Health literacy is the degree to which individuals are able to access and process basic health information and services and thereby participate in health-related decisions. Limited health literacy is highly prevalent in the United States and is strongly associated with patient morbidity, mortality, healthcare use, and costs. The objectives of this American Heart Association scientific statement are (1) to summarize the relevance of health literacy to cardiovascular health; (2) to present the adverse associations of health literacy with cardiovascular risk factors, conditions, and treatments; (3) to suggest strategies that address barriers imposed by limited health literacy on the management and prevention of cardiovascular disease; (4) to demonstrate the contributions of health literacy to health disparities, given its association with social determinants of health; and (5) to propose future directions for how health literacy can be integrated into the American Heart Association's mandate to advance cardiovascular treatment and research, thereby improving patient care and public health. Inadequate health literacy is a barrier to the American Heart Association meeting its 2020 Impact Goals, and this statement articulates the rationale to anticipate and address the adverse cardiovascular effects associated with health literacy.
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Mentz RJ, Greiner MA, Muntner P, Shimbo D, Sims M, Spruill TM, Banahan BF, Wang W, Mwasongwe S, Winters K, Correa A, Curtis LH, O'Brien EC. Intentional and unintentional medication non-adherence in African Americans: Insights from the Jackson Heart Study. Am Heart J 2018; 200:51-59. [PMID: 29898849 PMCID: PMC6005189 DOI: 10.1016/j.ahj.2018.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 03/03/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Non-adherence to medications is common and leads to suboptimal outcomes. Non-adherence can be intentional (e.g., deciding to skip dosages) or unintentional (e.g., forgetting), yet few studies have distinguished these reasons. An improved understanding of the reasons for non-adherence could inform the development of effective interventions. METHODS AND RESULTS We analyzed data from African Americans in the Jackson Heart Study who were prescribed medications for one or more chronic conditions. Participants were grouped by patient-reported adherence with non-adherence categorized as being intentional, unintentional or both. We used modified Poisson regression models to examine the factors associated with types of non-adherence. Of 2933 participants taking medication, 2138 (72.9%) reported non-adherence with 754 (35.3%) reporting only unintentional non-adherence, 263 (12.3%) only intentional non-adherence, and 1121 (52.4%) both. Factors independently associated with intentional non-adherence included female sex and depressive symptoms while factors associated with unintentional non-adherence included younger age and separated relationship status. Unintentional and intentional non-adherence was more common among participants taking anti-arrhythmic and anti-asthmatic medications, respectively. Higher levels of global perceived stress was associated with both types of non-adherence. The adjusted models for intentional and unintentional non-adherence had c-statistics of 0.65 and 0.66, respectively, indicating modest discrimination. CONCLUSION Specific patient factors and individual medication classes were associated with distinct patterns of intentional and unintentional non-adherence, yet the overall modest discrimination of the models suggests contributions from other unmeasured factors. These findings provide a construct for understanding reasons for non-adherence and provide rationale to assess whether personalized interventions can improve adherence.
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Affiliation(s)
- Robert J Mentz
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
| | - Melissa A Greiner
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Paul Muntner
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL
| | - Daichi Shimbo
- Department of Medicine, Columbia University Medical Center, NY, New York
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Tanya M Spruill
- Department of Population Health, NYU School of Medicine, New York, NY
| | - Benjamin F Banahan
- Center for Pharmaceutical Marketing and Management, University of Mississippi, Jackson, MS
| | - Wei Wang
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Stanford Mwasongwe
- Field Center, Jackson Heart Study, Jackson State University, Jackson, MS
| | - Karen Winters
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Lesley H Curtis
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Emily C O'Brien
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Sak G, Schulz PJ. Exploring Health Information-Seeking Preferences of Older Adults With Hypertension: Quasi-Experimental Design. JMIR Cardio 2018; 2:e12. [PMID: 31758784 PMCID: PMC6834236 DOI: 10.2196/cardio.8903] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 04/10/2018] [Accepted: 04/29/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients' engagement in health care decision making is constituted by at least two behaviors: health information seeking and active involvement in medical decisions. Previous research reported that older adults desire a lot of information, but want to participate in decision making to a lesser degree. However, there is only limited evidence on the effect of desire for health information on seniors' perceived confidence in making an informed choice (ie, decision self-efficacy). OBJECTIVE The goal of this study was to investigate the role desire for health information has for older patients. More specifically, it tested whether decision self-efficacy increases as a function of an assisted computer-based information search. Additionally, the study allowed insights into the sources seniors with hypertension prefer to consult. METHODS A sample of 101 senior citizens (aged ≥60 years) with high blood pressure in the Italian-speaking part of Switzerland answered a questionnaire before and after an informational intervention was applied. The intervention consisted of offering additional information on hypertension from five different sources and of providing the information the participant desired. Preference for receiving this information was the major independent variable. The main outcome measure was decision self-efficacy (assessed at baseline and posttest). Analyses of covariance were conducted to detect differences between and within who desired additional hypertension-related content (intervention group) and "information avoiders" (control group). RESULTS Health care professionals firmly remain the preferred and most trusted source of health information for senior patients. The second most consulted source was the internet (intervention group only). However, among the total sample, the internet obtained the lowest credibility score. A significant increase in decision self-efficacy occurred in seniors consulting additional information compared to information avoiders (F1,93=28.25, P<.001). CONCLUSIONS Consulting health information on a computer screen, and assistance by a computer-savvy person, may be a helpful activity to increase perceived confidence in making treatment decisions in seniors with hypertension.
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Affiliation(s)
- Gabriele Sak
- Institute of Communication & Health, Faculty of Communication Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Peter Johannes Schulz
- Institute of Communication & Health, Faculty of Communication Sciences, Università della Svizzera italiana, Lugano, Switzerland
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Gerard M, Chimowitz H, Fossa A, Bourgeois F, Fernandez L, Bell SK. The Importance of Visit Notes on Patient Portals for Engaging Less Educated or Nonwhite Patients: Survey Study. J Med Internet Res 2018; 20:e191. [PMID: 29793900 PMCID: PMC5992450 DOI: 10.2196/jmir.9196] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/25/2018] [Accepted: 03/11/2018] [Indexed: 02/06/2023] Open
Abstract
Background OpenNotes, a national initiative to share clinicians’ visit notes with patients, can improve patient engagement, but effects on vulnerable populations are not known very well. Objective Our aim is to examine the importance of visit notes to nonwhite and less educated patients. Methods Patients at an urban academic medical center with an active patient portal account and ≥1 available ambulatory visit note over the prior year were surveyed during June 2016 until September 2016. The survey was designed with patients and families and assessed importance of reading notes (scale 0-10) for (1) understanding health conditions, (2) feeling informed about care, (3) understanding the provider’s thought process, (4) remembering the plan of care, and (5) making decisions about care. We compared the proportion of patients reporting 9-10 (extremely important) for each item stratified by education level, race/ethnicity, and self-reported health. Principal component analysis and correlation measures supported a summary score for the 5 items (Cronbach alpha=.93). We examined factors associated with rating notes as extremely important to engage in care using logistic regression. Results Of 24,722 patients, 6913 (27.96%) completed the survey. The majority (6736/6913, 97.44%) read at least one note. Among note readers, 74.0% (727/982) of patients with ≤high school education, 70.7% (130/184) of black patients, and 69.9% (153/219) of Hispanic/Latino patients reported that notes are extremely important to feel informed about their care. The majority of less educated and nonwhite patients reported notes as extremely important to remember the care plan (62.4%, 613/982 ≤high school education; 62.0%, 114/184 black patients; and 61.6%, 135/219 Hispanic/Latino patients) and to make care decisions (62.3%, 612/982; 59.8%, 110/184; and 58.5%, 128/219, respectively, and P<.003 for all comparisons to more educated and white patients, respectively). Among patients with the poorest self-reported health, 65.9% (499/757) found notes extremely important to be informed and to understand the provider. On multivariable modeling, less educated patients were nearly three times as likely to report notes were extremely important to engage in care compared with the most educated patients (odds ratio [OR] 2.9, 95% CI 2.4-3.3). Nonwhite patients were twice as likely to report the same compared with white patients (OR 2.0, 95% CI 1.5-2.7 [black] and OR 2.2, 95% CI 1.6-2.9 [Hispanic/Latino and Asian], P<.001 for each comparison). Healthier patients, women, older patients, and those who read more notes were more likely to find notes extremely important to engage in care. Conclusions Less educated and nonwhite patients using the portal each assigned higher importance to reading notes for several health behaviors than highly educated and white patients, and may find transparent notes especially valuable for understanding their health and engaging in their care. Facilitating access to notes may improve engagement in health care for some vulnerable populations who have historically been more challenging to reach.
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Affiliation(s)
- Macda Gerard
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Hannah Chimowitz
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Alan Fossa
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Fabienne Bourgeois
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Leonor Fernandez
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
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Náfrádi L, Nakamoto K, Csabai M, Papp-Zipernovszky O, Schulz PJ. An empirical test of the Health Empowerment Model: Does patient empowerment moderate the effect of health literacy on health status? PATIENT EDUCATION AND COUNSELING 2018; 101:511-517. [PMID: 28899712 DOI: 10.1016/j.pec.2017.09.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The Health Empowerment Model (Schulz & Nakamoto, 2013) advocates that the effects of health literacy and empowerment are intertwined on health outcomes. This study aims to test this assumption in the context of health status as a patient outcome. METHODS A cross-sectional study was conducted with a sample of 302 participants between June and December 2015. The participants' health literacy (using the NVS and S-TOFHLA tests), empowerment and self-reported health status were assessed. RESULTS The participants having a high level of patient empowerment and concurrent adequate health literacy (the so-called 'effective self-managers') reported better health status compared to patients who had either lower health literacy and/or lower empowerment scores (P<0.05). Moreover, the meaningfulness (b=0.053, t(297)=2.29, P=0.02) and competence (b=0.07, t(297)=2.47, P=0.01) sub-dimensions of patient empowerment moderated the effect of the NVS on current health status. CONCLUSION The study provides evidence for the independence of health literacy and empowerment and partial evidence for their interaction predicting health status. PRACTICE IMPLICATIONS Our findings highlight that health literacy and patient empowerment (in particular its competence and meaningfulness sub-facets) are crucial patient-related variables, to be taken into consideration simultaneously, during screening and health promotion campaigns fostering health status in the general population.
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Affiliation(s)
- Lilla Náfrádi
- Institute of Communication and Health, Università della Svizzera italiana, Lugano, Switzerland.
| | - Kent Nakamoto
- Institute of Communication and Health, Università della Svizzera italiana, Lugano, Switzerland
| | - Márta Csabai
- Institute of Psychology, University of Szeged, Szeged, Hungary
| | | | - Peter J Schulz
- Institute of Communication and Health, Università della Svizzera italiana, Lugano, Switzerland
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Kusch MK, Haefeli WE, Seidling HM. How to meet patients' individual needs for drug information - a scoping review. Patient Prefer Adherence 2018; 12:2339-2355. [PMID: 30464421 PMCID: PMC6229142 DOI: 10.2147/ppa.s173651] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The aim of this study was to 1) describe drug information desired by patients and 2) analyze how such information could be customized to be presented to patients according to their individual information needs. MATERIALS AND METHODS We performed a scoping literature search and identified relevant drug information topics by assessing and clustering 1) studies analyzing patients' enquiries to drug information hotlines and services, and 2) qualitative studies evaluating patient drug information needs. For the two most frequently mentioned topics, we further analyzed which components (ie, information domains) the topics contained and examined patients' and health care professionals' (HCPs) views on these components. RESULTS Of 27 identified drug information topics in the literature search, patients most frequently requested information on adverse drug reactions (ADRs) and drug-drug interactions (DDIs). Hypothetically, those topics are composed of seven distinct information domains each (eg, ADR and DDI classification by frequency, severity, or onset; information on management strategies, monitoring, and prevention strategies). Patients' and HCPs' appraisal concerning the information content of these domains varies greatly and is even lacking sometimes. CONCLUSION Patients particularly request information on ADRs and DDIs. Approaches to customize such information are sparse. The identified information domains of each topic could be used to structure corresponding drug information and to thus facilitate customization to individual information needs.
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Affiliation(s)
- Marcel Kp Kusch
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, 69120 Heidelberg, Baden-Wurttemberg, Germany,
- Cooperation Unit Clinical Pharmacy, University of Heidelberg, 69120 Heidelberg, Baden-Wurttemberg, Germany,
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, 69120 Heidelberg, Baden-Wurttemberg, Germany,
- Cooperation Unit Clinical Pharmacy, University of Heidelberg, 69120 Heidelberg, Baden-Wurttemberg, Germany,
| | - Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, 69120 Heidelberg, Baden-Wurttemberg, Germany,
- Cooperation Unit Clinical Pharmacy, University of Heidelberg, 69120 Heidelberg, Baden-Wurttemberg, Germany,
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Sikorskii A, Given CW, Given BA, Vachon E, Marshall V, Krauss JC, Banik A, Majumder A. Do treatment patterns alter beliefs cancer patients hold regarding oral oncolytic agents? Psychooncology 2017; 27:1005-1012. [PMID: 29232502 DOI: 10.1002/pon.4606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 11/09/2017] [Accepted: 11/30/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Cancer patients, particularly those prescribed with oral oncolytic medications, face treatment side effects and temporary and permanent stoppages of treatment. This research examines how events during treatment affect patients' beliefs regarding oral oncolytic medications. METHODS A total of 272 cancer patients initiating 1 of 28 oral oncolytic agents were followed for 12 weeks. Assessments of Beliefs About Medications Questionnaire, symptoms, physical function, and depression measures were performed during telephone interviews at intake (medication start) and 4, 8, and 12 weeks. Electronic medical record audits identified dates of temporary and permanent medication stoppages. Linear mixed-effects models were used for longitudinal analyses of the Beliefs About Medications Questionnaire scores in relation to patient characteristics, symptom severity, and medication stoppages. RESULTS Over the initial 12 weeks, beliefs about the necessity of oral medications have increased, concerns have decreased, and interference of medications with daily lives has increased. Permanent stoppage of a medication predicted significant declines in beliefs about its necessity over time. Male patients, those less educated, those reporting higher symptom severity, and those experiencing temporary stoppages had greater concerns. Interference of medications with daily life was higher for males, increased with higher symptom severity, and differed by drug category. CONCLUSIONS Patients' beliefs in the necessity of their oral medication were affected only by a permanent drug stoppage. Symptom severity, education, and patient sex affected patients' beliefs about their concerns with their medications and the interference medications posed for their daily lives. Interventions may need to target the distinct dimensions of beliefs during treatment with oral oncolytic agents.
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Affiliation(s)
| | | | | | - Eric Vachon
- Michigan State University, East Lansing, MI, USA
| | | | | | - Asish Banik
- Michigan State University, East Lansing, MI, USA
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Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PLoS One 2017; 12:e0186458. [PMID: 29040335 PMCID: PMC5645121 DOI: 10.1371/journal.pone.0186458] [Citation(s) in RCA: 282] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/02/2017] [Indexed: 01/17/2023] Open
Abstract
Background Current health policies emphasize the need for an equitable doctor-patient relationship, and this requires a certain level of patient empowerment. However, a systematic review of the empirical evidence on how empowerment affects medication adherence—the extent to which patients follow the physician’s prescription of medication intake—is still missing. The goal of this systematic review is to sum up current state-of-the-art knowledge concerning the relationship between patient empowerment and medication adherence across medical conditions. As our conceptualization defines health locus of control and self-efficacy as being crucial components of empowerment, we explored the relationship between these two constructs and medication adherence. Methods Relevant studies were retrieved through a comprehensive search of Medline and PsychINFO databases (1967 to 2017). In total, 4903 publications were identified. After applying inclusion and exclusion criteria and quality assessment, 154 articles were deemed relevant. Peer-reviewed articles, written in English, addressing the relationship between empowerment (predictor) and medication adherence (outcome) were included. Findings High levels of self-efficacy and Internal Health Locus of Control are consistently found to promote medication adherence. External control dimensions were found to have mainly negative (Chance and God attributed control beliefs) or ambiguous (Powerful others attributed control beliefs) links to adherence, except for Doctor Health Locus of Control which had a positive association with medication adherence. To fully capture how health locus of control dimensions influence medication adherence, the interaction between the sub-dimensions and the attitudinal symmetry between the doctor and patient, regarding the patient’s control over the disease management, can provide promising new alternatives. Discussion The beneficial effect of patients’ high internal and concurrent physician-attributed control beliefs suggests that a so-called “joint empowerment” approach can be suitable in order to foster medication adherence, enabling us to address the question of control as a versatile component in the doctor-patient relationship.
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