Medication concordance in modern medicine - A critical appraisal from an Indian perspective

Concordance in the healthcare context: A concept analysis

Background

The concept of concordance and its usage are indicative of patient-centered healthcare, which encourages an equitable collaboration between patients and clinicians. However, there is a lack of clarity in understanding concordance, and an analysis of this concept is warranted.

Objective

This paper seeks to explore the essence of the concordance concept in the healthcare context.

Methods

Walker and Avant's eight-step method of concept analysis was applied. A literature search was conducted using concordance AND concord as keywords on CINAHL, MEDLINE, PubMed, ProQuest, Cochrane database, and ScienceDirect databases, published between 2006 and 2022.

Results

The attributes of concordance include communication process, therapeutic partnership, and agreement on treatment regimens. Antecedents of concordance comprise provider-patient relationship, patients' beliefs, healthcare providers' characteristics, and complexity of treatment plans. Consequences are improved adherence and compliance, improved clinical outcomes, and better quality of life.

Conclusion

This paper offers clarification of concordance by presenting its antecedents, attributes, and consequences. The findings serve as a basis for developing assessments and nursing interventions to promote patient concordance. Nurses can use the findings to encourage concordance by establishing a trusty relationship during health encounters that respects patients' beliefs and effectively communicating to improve patients' understanding in dealing with complex treatment plans.

Views of children with diabetes from underserved communities, and their families on diabetes, glycaemic control and healthcare provision: A qualitative evidence synthesis

AIMS

Children and young people with diabetes (CYPD) from socio-economically deprived and/or ethnic minority groups tend to have poorer glucose control and greater risk of diabetes-related complications. In this systematic review of qualitative evidence (qualitative evidence synthesis, QES), we aimed to explore the experiences and views of clinical encounters in diabetes care from the perspectives of CYPD and their family/carers from underserved communities and healthcare professionals in diabetes care.

METHODS

We searched 6 databases to March 2022 with extensive search terms, and used a thematic synthesis following methods of Thomas and Harden.

RESULTS

We identified 7 studies and described 11 descriptive themes based on primary and secondary constructs. From these, three "analytical themes" were developed. (1) "Alienation of CYPD" relates to their social identity and interaction with peers, family and health service practitioners in the context of diabetes self- and family/carer management and is impacted by communication in the clinical encounter. (2) "Empowerment of CYPD and family/carers" explores families' understanding of risks and consequences of diabetes and taking responsibility for self- and family/carer management in the context of their socio-cultural background. (3) "Integration of diabetes (into self and family)" focuses on the ability to integrate diabetes self-management into the daily lives of CYPD and family/carers beyond the clinical consultation.

CONCLUSIONS

The analytical themes are interdependent and provide a conceptual framework from which to explore and strengthen the therapeutic alliance in clinical encounters and to foster greater concordance with treatment plans. Communicating the biomedical aspects of managing diabetes in the clinical encounter is important, but should be balanced with addressing socio-emotional factors important to CYPD and family/carers.

Navigating Health Literacy and Practices: A Cross-Sectional Study on Nursing Undergraduates in Riyadh, Saudi Arabia

BACKGROUND This study aimed to assess the health literacy (HL) and health practices (HP) among nursing undergraduates at King Saud University in Riyadh, Saudi Arabia. MATERIAL AND METHODS A cross-sectional survey-based study was conducted in 2023 to assess how nursing students perceive HL and HP. HL is the ability of individuals to acquire, interpret, assess, and act on information to promote and maintain good health, while HP involves the application of knowledge and skills. HL was assessed using a total of 16 items, subdivided into 4 domains (understanding, evaluating, accessing, and utilizing health information) while HP was assessed using 11 items on a 5-point Likert scale. RESULTS In this study, 53.9% of the students were found to have poor HP, while 40.9% (n=166) reported moderate HP, and 5.2% (n=21) reported good HP. With regards to HL, 38.9% (n=158) of students were found to have good HL while 52.2% (n=212) reported moderate HL, and 8.9% (n=36) reported poor HL. The findings indicated that there was a relationship between age and HP, indicating that age is a major predictor of HP (P=0.001). Other comparisons, including year of study, income source, marital status, and the prevalence of chronic conditions, were discovered to have a significant relationship (P=0.001) with HP levels. CONCLUSIONS According to these findings, most students reported poor HP, while one-third claimed good HL. Therefore, there is a need to address the factors related to poor HP while also recommending methods to support good HP among students.

Willingness of the Jordanian Population to Receive a COVID-19 Booster Dose: A Cross-Sectional Study

SARS-CoV-2 (COVID-19) vaccines are critical for containing serious infections. However, as COVID-19 evolves toward more transmissible varieties and serum antibody levels in vaccinated persons steadily decline over time, the likelihood of breakthrough infections increases. This is a cross-sectional study based on an online questionnaire for Jordanian adults (n = 915) to determine how individuals who have finished the current vaccination regimen feel about a prospective COVID-19 booster shot and what factors might influence their decision. Almost half of the participants (44.6%) intended to get the booster dose of the COVID-19 vaccine. The most frequently mentioned reasons for participants’ reluctance to get the COVID-19 vaccine booster dose were “The benefits of booster dose have not been scientifically proven” (39.8%), followed by “I took the last dose a short time ago, and there will be no need to take the booster dose for at least a year” (24.6%). In turn, “I was infected with COVID-19; thus, I do not require the booster dose” was the least reported reason (13.1%). These findings highlight the considerable hesitancy toward COVID-19 booster immunization among Jordanians, as well as the variables associated with vaccine hesitancy and the most frequently mentioned reasons for hesitancy, which will aid in creating excellent campaigns regarding booster doses.

Knowledge, Attitudes, and Practices of Adult Iraqi Population Towards COVID-19 Booster Dose: A Cross-Sectional Study

PURPOSE

COVID-19 vaccines are critical for containing the pandemic and preventing serious SARS-CoV-2 infections. In addition to the two main doses, a booster dose has been utilized to improve immunity. The aim of current study is to evaluate Iraqi adult population knowledge, attitudes, and practices towards COVID-19 booster dose.

SUBJECTS AND METHODS

This online cross-sectional survey of adult Iraqis (n = 754) assessed the attitudes of people who have had both immunizations regarding a potential COVID-19 vaccine booster dosage and to identify potential factors that might impact these attitudes. Factors evaluated in the current study included previously received vaccine type in the first two doses, socioeconomic characteristics, health status, knowledge about COVID-19 and its vaccines and adherence to protective practices.

RESULTS

Overall, 61.1% of participants expressed willingness to receive a COVID-19 booster dose, with a high median score of knowledge and practice toward COVID-19. Participants who did not perceive COVID-19 to be serious, p-value <0.001), participants who believed they would not be infected with COVID-19 in the next 6 months (p-value <0.001), low knowledge score group (p-value <0.001), lower education (p-value <0.001), participants who received the COVID-19 vaccine because of imposed laws (p-value <0.001), participants who received AstraZeneca vaccine (p-value <0.001), younger participants (p-value=0.003), low level of practice (p-value <0.001), participants who did not know someone who had died due to COVID-19 (p-value=0.01), low risk of developing serious side effects if infected with COVID-19 and participants in the low side effects score were significantly less frequently willing to receive a booster COVID-19 dose (p-value <0.001). The main reasons for booster dose hesitancy/refusal were the perceived lack of need for a booster shot, the uselessness of a booster shot and the conspiracy theory of boosting corporate profits through booster shots.

CONCLUSION

There is high hesitancy towards COVID-19 booster dose acceptance among the Iraqi population. The study identified several factors associated with vaccine hesitancy including low socioeconomic status and low knowledge about COVID-19 and its vaccines.

Medication adherence, recall periods and factors affecting it: A community-based assessment on patients with chronic diseases in urban slums

OBJECTIVE

To evaluate medication adherence, the effect of recall periods on self-reported adherence and factors influencing medication adherence among patients of chronic diseases, such as hypertension and diabetes, particularly in the community.

METHODS

A cross-sectional cohort study was conducted among individuals with hypertension and/or diabetes coming as outpatients in community camps organised in a cluster of urban slums. Responses towards questions regarding self-reported quantitative and qualitative adherence for one week and one month along with information on pill burden, socio-demographic and other factors were recorded using a mobile application.

RESULTS

Among 379 participants living in urban slum communities, who were prescribed anti-hypertensive or oral anti-diabetic medications previously, mean medication adherence over previous one week was 67.99% (standard deviation (SD) ± 38.32) and 6.87 (SD ± 3.62) on a ten-point numeric scale. The medication adherence for one month showed a strong significantly positive correlation with that of 1 week for both percentage-based (r = +0.910, 95% CI = 0.864 to 0.950, P < .0001) and Likert (ρ = +0.836, 95% CI = 0.803 to 0.863, P < .0001) scales. Age (r = 0.219, 95% CI = 0.120 to 0.313, P = .043) and pill burden (r = -0.231, 95% CI = -0.145 to -0.322, P < .0001) were found to significantly affect medication adherence. The odds of random blood sugar reduction were found to be significant (OR 1.98, 95% CI = 1.30 to 3.00, P = .001) with adequate adherence. A linear regression equation was developed to predict medication adherence percentage for a patient which was found to have 61.8% predictive power using multilayer perceptron modelling.

CONCLUSION

Overall, medication adherence was sub-optimal. Adherence assessments can be reliably performed using either one week or one month recall periods. With further refinement and validation, the regression equation could prove to be a useful tool for physicians.

A Cost Variation Analysis of Drugs Available in the Indian Market for the Management of Thromboembolic Disorders

Introduction

Cardiovascular diseases (CVDs) have become one of the major causes of mortality among the Indian population. The costs of anticoagulant, antiplatelet, and fibrinolytic drugs that are used to treat various thromboembolic disorders and used as prophylactics for individuals at high risk of CVDs vary widely in the Indian pharmaceutical market. The aim of this study was to evaluate the cost variation of different brands of drug formulations and to compare the branded prices of the formulations with their corresponding generic and ceiling prices.

Materials and methods

This study followed an analytical method. Costs of various drugs were obtained from the October - December 2019 edition of the Current Index of Medical Specialities (CIMS) and December 2019 edition of the Monthly Index of Medical Specialities (MIMS) India. Cost ratio and percentage variation in cost per tablet/capsule/injection of different drugs available in the Indian market and manufactured by different pharmaceutical companies were calculated. Comparison of the branded prices with generic and ceiling prices was also performed for different drugs by using information available from official websites.

Results

Percentage variation in cost among the commonly prescribed drugs for the management of thromboembolic disorders was found to be highest for prasugrel 10 mg tablet (1,408.44%) while it was lowest for fondaparinux 2.5 mg / 0.5 ml injection (20%). Among the commonly prescribed drugs that are under Drugs Prices Control Order (DPCO) price control, streptokinase 1.5 MIU injection had the highest cost variation (132.02%) while enoxaparin 60 mg / 0.6 ml injection had the lowest (4.99%). Among some of the important formulations under the Jan Aushadhi scheme (JAS), acenocoumarol 2 mg tablet had the highest cost variation (680.09%) and cilostazol 50 mg tablet had the lowest (55.46%).

Conclusions

Wide differences exist in the costs of various anticoagulants, antiplatelets, and fibrinolytics available in the Indian market. The prescribing physician should be aware of theses variations and prescribe medicines accordingly, keeping in mind the financial status of the patients.