Factors Influencing Medication Adherence in Patients with Type 2 Diabetes Mellitus in Japan

BackgroundType D personality and medication nonadherence have been shown to be associated with poor health outcomes. Type D personality is associated with poor medication adherence in patients with coronary artery disease, myocardial infarction, and heart failure. However, the relationship between type D personality and medication adherence in patients with Type 2 Diabetes Mellitus (T2DM) remains unknown. This study aims to examine whether type D personality was associated with medication adherence in patients with T2DM.Design and SettingsA follow-up study was conducted in general hospital of the People's Liberation Army in Beijing.Methods412 T2DM patients (205 females), who were recruited by circular systematic random sampling, provided demographic and baseline data about medical information and completed measures of Type D personality. Then, 330 patients went on to complete a self-report measure of medication adherence at the sixth month after baseline data collection. Chi-square test, t tests, and hierarchical multiple regression analyses were conducted, as needed.ResultsPatients with type D personality were significantly more likely to have poor medication adherence (p<0.001). Type D personality predicts poor medication adherence before and after controlling for covariates when it was analyzed as a categorical variable. However, the dimensional construct of type D personality was not associated with medication adherence when analyzed as a continuous variable.ConclusionAlthough, as a dimensional construct, type D personality may not reflect the components of the personality associated with poor medication adherence in patients with T2DM, screening for type D personality may help to identify those who are at higher risk of poor medication adherence. Interventions, aiming to improve medication adherence, should be launched for these high-risk patients.

The prevalence of diabetes is steadily increasing in China. When diabetes is uncontrolled, it generates dire consequences for health and well-being. Numerous studies have shown that health outcomes were associated with social support and medication adherence. Previous study confirmed that social support was associated with medication adherence in patients with heart failure, HIV diseases, and first-episode psychosis. However, the relationship between social support and medication adherence in patients with type 2 diabetes mellitus (T2DM) is remains unclear. This study aims to examine whether social support is associated with medication adherence in patients with T2DM. This study was conducted in the First Affiliated Hospital of the General Hospital of the People’s Liberation Army (PLA). In Beijing, a systematic random sample of 412 patients with T2DM over 18 years was recruited at baseline, and demographic characteristics, clinical data and their assessment of social support were collected from medical records and self-reported questionnaires. 330 of these patients completed a self-report measure of medication adherence at the sixth month after baseline data collection. Regression analysis showed that social support presented a positive effect on medication adherence, additionally, support utilization and the subscale of social support exhibited a significantly strong influence on medication adherence in patients with T2DM. Although medication adherence was influenced by multiple factors, this finding confirmed that social support must be recognized as a core element in interventions aimed at improving in the management of patients with T2DM.

Effects of Depression and Anxiety Improvement on Adherence to Medication and Health Behaviors in Recently Hospitalized Cardiac Patients

Medication adherence is a critical aspect of managing type 2 diabetes mellitus (T2DM) and achieving optimal clinical outcomes. Mobile app-based interventions have emerged as a promising tool to enhance adherence and glycemic control in T2DM patients. This systematic review aims to evaluate the effectiveness of mobile app interventions in improving medication adherence and glycated hemoglobin among T2DM patients. A comprehensive search was conducted in PubMed, Cochrane Library, and Google Scholar for studies published between September 2018 and September 2023. Studies were included if they were published in English and investigated the effectiveness of mobile apps in enhancing medication adherence among patients with T2DM. Studies were excluded if they included additional interventions, such as electronic pillboxes, phone calls, or SMS text messages, or if they focused on populations with chronic illnesses other than T2DM. Five studies involving 527 participants from diverse geographic locations were included in the review. The findings from the included studies show that mobile-based app interventions can significantly improve medication adherence in patients with T2DM. From the included studies, the mean HbA1c change for the intervention group was -0.664 (95%CI -0.823 to -0.506), while the mean change in HbA1c for the control group was -0.103 (95%CI -0.305 to 0.099). Studies have demonstrated the potential of mobile app-based interventions to enhance medication adherence and improve glycemic control in T2DM; further research is needed to determine the long-term effects of these interventions.

Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients

PurposeDiabetes mellitus is a growing global health problem that affects patients of all ages. Even though diabetes mellitus is recognized as a major chronic illness, adherence to antidiabetic medicines has often been found to be unsatisfactory. This study was conducted to assess adherence to medications and to identify factors that are associated with nonadherence in type 2 diabetes mellitus (T2DM) patients at Primary Health Clinics of the Ministry of Health in Malaysia.Materials and methodsThe cross-sectional survey was carried out among T2DM patients to assess adherence to medication in primary health clinics. Adherence was measured by using the Medication Compliance Questionnaire that consists of a total of seven questions. Other data, such as patient demographics, treatment, outcome, and comorbidities were also collected from patient medical records.ResultsA total of 557 patients were recruited in the study. Approximately 53% of patients in the study population were nonadherent. Logistic regression analysis was performed to predict the factors associated with nonadherence. Variables associated with nonadherence were age, odds ratio 0.967 (95% confidence interval [CI]: 0.948–0.986); medication knowledge, odds ratio 0.965 (95% CI: 0.946–0.984); and comorbidities, odds ratio 1.781 (95% CI: 1.064–2.981).ConclusionAdherence to medication in T2DM patients in the primary health clinics was found to be poor. This is a cause of concern, because nonadherence could lead to a worsening of disease. Improving medication knowledge by paying particular attention to different age groups and patients with comorbidities could help improve adherence.

Background: Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis. Tuberculosis treatment programs are long and cause some side effects that make patients not adherent to treatment so that family support is needed. Purpose: This study aims to discuss family support with medication adherence in patients with pulmonary tuberculosis. Methods: The type of research that studies the literature using the PRISMA ( Preferred Reporting Items for Systematic Reviews and Meta-analyses ) method. This literature study took 17 electronic journals from 112 international and national electronic journals namely pubmed, google scholar, and one search published between 2014 and 2019 with research inclusion criteria, namely articles containing family support and medication adherence in patients with pulmonary tuberculosis. Results: Most of the literature states that family support is in the good category and has high medication adherence. The most extended family support given to pulmonary tuberculosis patients is informational support and emotional support, while the least support provided is instrumental support. The most dominant adherence factors are the patient's desire to recover or good patient motivation, the role of the family or good family support, and the role of the health worker as a PMO. The relationship of family support with medication adherence in patients with pulmonary tuberculosis showed a significant relationship. Conclusion: The literature states that the better the family support given to patients with pulmonary tuberculosis, the higher the compliance to take medication for these patients. Family support can improve treatment success in patients with pulmonary TB.

BackgroundMedication adherence in patients with rheumatoid arthritis (RA) is suboptimal, with adherence rates between 30% to 80%. Existing interventions to improve medication adherence are mostly complex and have small effect...

Objective: Non-adherence to treatment is an important and often unrecognized risk factor that contributes to reduced control of blood sugar hence this study aims at assessing the level of medication adherence in diabetic patients. It also determines to investigate beliefs about medications held by people with diabetes, and whether these beliefs influence adherence. Methods: This is a cohort study done for six months in which a sample size of 160 members was included. This study was conducted in a tertiary care teaching hospital in south India. The study included participants with at least one cholesterol level measured, one clinic visit in the previous 6 months, prescribed with at least 2 drugs. Out of 160, 125 (78.1%) patients agreed to participate and agreed to be interviewed, 35 (21.8%) refused for adherence assessment and beliefs about medicines interview. The patients were interviewed by using Morisky 8 item medication adherence and beliefs about medicines questionnaire. Results and Discussion: There is no association between the adherence score and the sociodemographic variables like age, gender, level of education, duration of diabetes. Patients with normal weight have high adherence and is statistically significant with a p value of 0.0004. Patients with co morbidities have high morisky medication adherence score when compared to those who don’t have co morbidities (p=0.0001). Greater the no. of medicines taken higher the concerns score (p=0.038). Necessity, concerns, and differential necessity-concerns score of adherers and non adherers are not significant. Conclusion: In this sample, patients reported very high medication adherence rates regardless of number of medicines prescribed. Most people with diabetes have positive beliefs about the necessity of their medication. However, levels of concern are also high. Physicians should not feel deterred from prescribing multiple agents in order to achieve adequate control of hyperglycemia, hypertension, and hyperlipidemia.

Shared decision making and inhaled medication adherence in patients with COPD, asthma and cystic fibrosis: a systematic review.

Introduction Medication adherence rates of preventative medication for cardiovascular disease (CVD) have been reported as 57% (1). Interventions to tackle nonadherence are important for improving health-related outcomes. Pharmacist-led interventions may have the potential to improve medication adherence and clinical outcomes in patients with CVD. Aim This study aimed to assess the impact of community pharmacist-led interventions on improving medication adherence and clinical outcomes in patients with CVD. This review also explores the characteristics of the interventions and the actual content of the interventions. Methods This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (2). The protocol was registered in the PROSPERO database (CRD42021250361). Four electronic databases (MEDLINE (Ovid), PubMed Central, PsycINFO (Ovid), and Cochrane library) were systematically searched for randomised controlled trials (RCTs), assessing the impact of pharmacist-led interventions on medication adherence in patients in CVD. RCTs were filtered for English language from inception to April 2021 and duplicate removed. Screening and selection of titles, abstracts, and full text was followed by data extraction and risk of bias assessed using the Cochrane Risk of Bias tool. A narrative synthesis was performed. Ethical approval was not required. Results Searches yielded 564 citations, of which 145 duplicates were removed. The title and abstract screening resulted in 16 full-text review studies. Of these, 8 studies were excluded. Therefore, this study included 8 RCTs, published between 2007 and 2019, conducted in different countries. The sample sizes were small for most RCTs (ranged from 225 to 1906). The range of CVD targeted was diverse: 3 included patients with dyslipidaemia, 2 with heart failure, 3 with hypertension. The most frequent pharmacist-led interventions (7 out of 8 RCTs) were multifaceted context and included medication reviews and adherence counselling; the intervention duration ranged from 2 to 12 months. The interventions were conducted in a primary care setting: 6 in pharmacies, one in a clinic, and one within a home visit. A total of five RCTs reported medication adherence as the primary outcome, and three reported clinical outcomes. RCTs used different measurements to assess adherence, 3 used self-reported and 5 used pharmacy refill records. Seven of the RCTs reported that interventions enhanced medication adherence, with 3 showed statistically significant improvements at 6 months and 12 months of the intervention. Five RCTs assessed the effect of the interventions on the clinical outcomes and reported a trend toward improvement in blood pressure and low-density lipoprotein cholesterol level in the intervention arm. Regarding the quality of evidence, most RCTs were classified as having poor quality because of the high risk of bias or insufficient reporting of information. Conclusion Pharmacist-led interventions tend to improve medication adherence and clinical outcomes, but interventions varied in terms of content and delivery. The precise design of the interventions with essential characteristics tailored to patients’ needs could increase the effectiveness of these interventions. Further large RCTs are required. Limitations of this review include the exclusion of non-English language studies. Further, the clinical and methodological heterogeneity of included studies made clear a quantitative comparison difficult, thus, the findings are based on narrative analysis. References (1) Naderi SH, Bestwick JP, Wald DS. Adherence to drugs that prevent cardiovascular disease: meta-analysis on 376,162 patients. Am J Med. 2012;125(9):882-7.e1. (2) Yepes-Nuñez JJ, Urrútia G, Romero-García M, Alonso-Fernández S. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Rev Esp Cardiol (Engl Ed). 2021;74(9):790-9.

Medication adherence in cardiovascular disease (CVD) is reported to be suboptimal. Therefore, an intervention to tackle non-adherence is important. Pharmacists' intervention may have the potential to enhance medication adherence, leading to improvements in clinical outcomes in patients with CVD. This study assesses the impact of a community pharmacist intervention on improving medication adherence and clinical outcomes in patients with CVD. This study also describes the characteristics and actual contents of the interventions. Electronic databases (MEDLINE (Ovid), PsycINFO (Ovid), Cochrane library and PubMed Central) were systematically searched for randomised controlled trials (RCTs), assessing the impact of community pharmacists' interventions on medication adherence in patients with CVD. Eligible RCTs were those published in English from database inception to April 2021. A narrative analysis was performed. The RCTs included were assessed using the Cochrane Risk of Bias. This review included eight RCTs. The majority included a multifaceted intervention with medication reviews and adherence counselling. Sample sizes varied from 225 to 1906, and intervention duration ranged from 2 to 12 months. Seven of the RCTs reported that interventions enhanced medication adherence. Five RCTs assessed the effect of the interventions on the clinical outcomes and reported a trend towards improvement in blood pressure and low-density lipoprotein cholesterol level in the intervention arm. Regarding the quality of evidence, most RCTs were classified as poor, due to the high risk of bias or insufficient reporting of information. Community pharmacist-led interventions show improvements in medication adherence and clinical outcomes, but the content and delivery of the interventions vary. Future research should focus on identifying the most effective components that contribute to enhancing medication adherence and clinical outcomes for patients with CVD.

Objective : To assess the extent of medication adherence in patients suffering from type 2 diabetes mellitus. Methodology : The study protocol was approved by the hospital human ethical committee. The patients (in-patients and out-patients) suffering from Type-2 DM of either sex who were aged 35 years and above and patient diagnosed with Type 2 DM for more than one year who were either on parenteral or oral anti diabetic medication treatment were prospectively enrolled for six months. The patient, clinical, medication and socioeconomic data were collected into specialized patient profile form. Different levels education considered were: Post-gradates, graduates, schooling and illiterate. The patient medication adherence was assessed using Morisky Medication adherence scale. Each answer was dichotomously scored. Accordingly, each correct answer is awarded a score of zero while every incorrect or unsure answer was awarded a score of one. The scores were totalled and categorized as: Score 0 = High adherence, Score 1-3 = Moderate adherence and Score > 3 = Poor adherence. Result and Discussion : Totally 450 patients (Males 61%, Females 39%) suffering from Type-2 DM were enrolled. Mean age of the patients was 61years. Majority of the enrolled patients were graduates (198) 50% followed by the patients with basic level of school education( 116) 29% , and (69) 17% were illiterate and least number of patients were post graduates (17) 4 %. Among the patients who were assessed for their medication adherence, majority (219) (54.75%) had poor adherence followed by 31.5% patients who had moderate adherence. However, (13.75%) patients had high adherence. This indicates that majority of patients were not adherent to their medications. Research has shown that patients with diabetes mellitus have one of the lowest medication adherence rates at 65% to 85%.Factors that could influence the patients adherence were assessed and were able to find with four clear causes included forgetfulness (64.25%),feeling better (75%),feeling worse(79.25%) and inconvenience (61.75%). Conclusion: Majority of the patients suffering from Type-2 diabetes mellitus have poor medication adherence.

To summarise the currently developed risk prediction models for medication adherence in patients with chronic diseases and evaluate their performance and applicability. Ensuring medication adherence is crucial in effectively managing chronic diseases. Although numerous studies have endeavoured to construct risk prediction models for predicting medication adherence in patients with chronic illnesses, the reliability and practicality of these models remain uncertain. Systematic review. We conducted searches on PubMed, Web of Science, Cochrane, CINAHL, Embase and Medline from inception until 16 July 2023. Two authors independently screened risk prediction models for medication adherence that met the predefined inclusion criteria. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was employed to evaluate both the risk of bias and clinical applicability of the included studies. This systematic review adhered to the 2020 PRISMA checklist. The study included a total of 11 risk prediction models from 11 studies. Medication regimen and age were the most common predictors. The use of PROBAST revealed that some essential methodological details were not thoroughly reported in these models. Due to limitations in methodology, all models were rated as having a high-risk for bias. According to PROBAST, the current models for predicting medication adherence in patients with chronic diseases exhibit a high risk of bias. Future research should prioritise enhancing the methodological quality of model development and conducting external validations on existing models. Based on the review findings, recommendations have been provided to refine the construction methodology of prediction models with an aim of identifying high-risk individuals and key factors associated with low medication adherence in chronic diseases. This systematic review was conducted without patient or public participation.

Myotonic dystrophy (DM) and facioscapulohumeral muscular dystrophy (FSHD) are the two most common adult muscular dystrophies and have progressive and often disabling manifestations. Higher levels of medication adherence lead to better health outcomes, especially important to patients with DM and FSHD because of their multisystem manifestations and complexity of care. However, medication adherence has not previously been studied in a large cohort of DM type 1 (DM1), DM type 2 (DM2), and FSHD patients. The purpose of our study was to survey medication adherence and disease manifestations in patients enrolled in the NIH-supported National DM and FSHD Registry. The study was completed by 110 DM1, 49 DM2, and 193 FSHD patients. Notable comorbidities were hypertension in FSHD (44%) and DM2 (37%), gastroesophageal reflux disease in DM1 (24%) and DM2 (31%) and arrhythmias (29%) and thyroid disease (20%) in DM1. Each group reported high levels of adherence based on regimen complexity, medication costs, health literacy, side effect profile, and their beliefs about treatment. Only dysphagia in DM1 was reported to significantly impact medication adherence. Approximately 35% of study patients reported polypharmacy (taking 6 or more medications). Of the patients with polypharmacy, the DM1 cohort was significantly younger (mean 55.0years) compared to DM2 (59.0years) and FSHD (63.2years), and had shorter disease duration (mean 26years) compared to FSHD (26.8years) and DM2 (34.8years). Future research is needed to assess techniques to ease pill swallowing in DM1 and to monitor polypharmacy and potential drug interactions in DM and FSHD.