Rising Trends in Medication Non-compliance and Associated Worsening Cardiovascular and Cerebrovascular Outcomes Among Hospitalized Adults Across the United States

Patient compliance: A concept analysis

Background

Patient compliance with regimens is one of the most researched and least-understood behavioral concerns in the healthcare profession due to the many meanings employed in multidiscipline over time. Thus, a thorough examination of the idea of patient compliance is necessary.

Objective

This paper aims to explore and identify the essence of the term patient compliance to achieve an operational definition of the concept.

Method

Walker and Avant's eight-step approach was used. A literature search was conducted using keywords of patient compliance AND healthcare profession from five databases: PubMed, Medline, CINAHL, ProQuest, ScienceDirect, and Cochrane database, published from 1995 to 2022.

Results

The attributes of patient compliance include 1) self-care behavior, 2) following health recommendations, and 3) willing collaboration with health professionals. Antecedents of patient compliance were characteristics of therapeutic regimens, communication of health advice, and patients' attitudes toward professional recommendations. Consequences include improved clinical outcomes, quality of life, and lifestyle or behavior modification.

Conclusion

This concept analysis offers a valuable perspective on patient compliance that guides the nursing practice in providing better interventions to promote compliance among patients.

Patient Adherence to Therapy After Myocardial Infarction: A Scoping Review

Background

Patients with myocardial infarction have low adherence to secondary prevention. Patients with acute coronary syndromes usually decide not to take cardiac drugs for 7 days after discharge for various reasons and adherence rates are usually very low. The aim of this scoping review was to identify factors influencing treatment adherence after myocardial infarction and the role of interventions to improve treatment adherence.

Methods

Two electronic databases (PubMed and Web of Science) were systematically searched for relevant published reviews of interventions for adherence after myocardial infarction. Inclusion criteria were study design: randomized control trial, systematic reviews; published in English; sample age ≥18 years. The methodological framework proposed by Arksey & O'Malley was used to guide the review process of the study.

Results

Thirteen articles met the inclusion/exclusion criteria. Four of the thirteen studies assessed factors influencing patient adherence to therapy after myocardial infarction, the remaining studies examined various interventions increasing adherence to treatment after myocardial infarction.

Conclusion

There is a need to improve adherence of patients to treatment after myocardial infarction. Studies show that the use of modern technologies and communication with the patients by phone improve adherence to treatment.

Trends in Mail-Order Pharmacy Use in the U.S. From 1996 to 2018: An Analysis of the Medical Expenditure Panel Survey

INTRODUCTION

The use of mail-order pharmacies is generally associated with lower healthcare costs and improved medication adherence. To promote the use of mail-order pharmacies, it is important to understand the time trends in their use and whether these trends vary by population subgroups.

METHODS

This study used the 1996-2018 Medical Expenditure Panel Survey to determine the annual prevalence of mail-order pharmacy use (defined as purchasing ≥1 prescription from a mail-order or online pharmacy) among U.S. adult prescription users and its variation by population characteristics. Logistic regression was used to determine the correlates of mail-order pharmacy use. Results were presented for medications and therapeutic classes most commonly purchased by mail-order pharmacy exclusive users. Analyses were conducted in December 2020.

RESULTS

The annual prevalence of mail-order pharmacy use among U.S. adult prescription users increased from 10.2% (95% CI=9.3, 11.1) in 1996 to 17.0% (95% CI=15.9, 18.1) in 2005 and then declined to 15.7% (95% CI=14.9, 16.6) by 2018. Absolute differences in the prevalence of use by race/ethnicity, education, and health insurance coverage widened over time, whereas they remained stable when stratifying by sex, age, marital status, region, limitations in daily activities, pain interference, health status, number of chronic conditions, and access to medical care. Among mail-order pharmacy exclusive users, the 3 most commonly purchased medications were atorvastatin (16.7%), levothyroxine (13.6%), and lisinopril (13.1%); the 3 most commonly purchased therapeutic classes were cardiovascular agents (57.9%), metabolic agents (52.1%), and central nervous system agents (29.6%).

CONCLUSIONS

The prevalence of mail-order pharmacy use has declined in recent years and has shown significant variation across population subgroups. Future research should examine whether the declining trends and variation in use may influence the management of chronic conditions and the disparities in health and healthcare costs.