Affect Medication Adherence Research Articles

Comparison of clopidogrel vs. ticagrelor medication adherence in patients with acute coronary syndrome.

Medication nonadherence to dual antiplatelet therapy increases major cardiovascular events. In this study, we investigated patients' post-acute coronary syndrome (ACS) medication adherence to clopidogrel and ticagrelor over a 12-month period. Furthermore, we also examined the factors that may affect medication adherence in this patient population. This study included 509 patients who were scheduled for dual antiplatelet therapy for one year following ACS (October 2018-December 2019). A proportion of days covered (PDC) method, based on a pharmacy database system, was used to determine their medication adherence. Medication adherence was defined as > 80% PDC. No difference was found between clopidogrel and ticagrelor in terms of medication adherence (68.3% vs. 64.6%, p = 0.39). Moreover, higher education levels (B = 3.24, CI: 1.17-8.9, p = 0.023) and percutaneous coronary intervention (PCI) as a revascularization option (B = 0.35, CI: 0.17-0.71, p = 0.004) predicted medication adherence independently. In this research, medication adherence was found to be similar between the clopidogrel and ticagrelor groups. It was also predicted by higher education levels and revascularization with PCI.

The Mediating Effect of Self-Efficacy on the Relationship Between Medication Literacy and Medication Adherence Among Patients with Type 2 Diabetes.

Patients with type 2 diabetes have poor medication adherence. Medication literacy is one of the influencing factors of medication adherence among patients with type 2 diabetes. However, the mechanism by which medication literacy affects medication adherence among patients with type 2 diabetes is unclear. The aim of this study was to verify the mediating role of self-efficacy in the relationship between medication literacy and medication adherence. A total of 402 patients with type 2 diabetes were enrolled in this study. The Chinese versions of the Medication Literacy Scale, the Self-Efficacy for Appropriate Medication Use Scale and the Morisky Medication Adherence Scale-8 were used in the survey. Pearson correlation analysis was used to find correlations among medication literacy, self-efficacy and medication adherence. The PROCESS macro (Version 4.1) with Model 4 for SPSS was used to verify the mediating role of self-efficacy. Twenty-four percent of the participants had poor medication adherence. Self-efficacy and medication literacy (r=0.499, p < 0.01) and medication adherence (r=0.499, p < 0.01) were significantly and positively correlated. Self-efficacy partially mediated the relationship between medication knowledge and medication adherence among patients with type 2 diabetes, accounting for 36.7% of the total effect. Self-efficacy had a partial mediating effect on the relationship between medication literacy and medication adherence among patients with type 2 diabetes. Self-efficacy should be improved through effective measures to increase patients' confidence in adherence to antihyperglycemic drugs.

Assessment of medication adherence among Lebanese adult patients with non-communicable diseases during COVID-19 lockdown: a cross-sectional study.

Medical treatment is considered a cornerstone in non-communicable diseases (NCDs) management, lack of adherence remains the main challenge that may compromise optimal therapeutic outcome achievement. This study aimed to evaluate treatment adherence levels and associated factors among Lebanese adult patients with non-communicable diseases. A cross-sectional survey conducted during the COVID-19 lockdown imposed by the Lebanese Government (between September 2020 and January 2021) enrolled 263 adult patients through an anonymous online questionnaire to assess adherence to medications using the Lebanese Medication Adherence Scale (LMAS-14). Of the total sample, 50.2% showed low adherence with a total mean adherence score of 4.41 ± 3.94. The results showed that depression (β = 1.351) and peptic ulcer (β = 1.279) were significantly associated with higher LMAS scores (lower adherence). However, age between 50 and 70 (β = -1.591, p = 0.011), practicing physical exercise (β = -1.397, p = 0.006), having kidney disease (β = -1.701, p = 0.032), and an intermediate (β = -1.336, p = 0.006) to high income (β = -3.207, p < 0.001) were significantly associated with lower LMAS scores (higher adherence). Our study shed light on the factors affecting medication adherence in patients with non-communicable diseases. It showed that depression and peptic ulcer were associated with lower adherence, contrary to older age, exercising, having chronic kidney disease, and a higher socioeconomic status.

Association between medication literacy and medication adherence and the mediating effect of self-efficacy in older people with multimorbidity

BackgroundMultimorbidity has a significant impact on public health and primary care. Medication adherence is recognized as the most effective measure for managing and preventing multimorbidity. Studies have shown that medication literacy has a positive effect on medication adherence in patients with multimorbidity. However, limited knowledge exists regarding the underlying mechanisms of this relationship in older adults with multimorbidity. Therefore, the aim of this study was to investigate the mediating role of self-efficacy in the association between medication literacy and medication adherence in this population.MethodsThis study employed a cross-sectional design and convenience sampling method to survey older patients with multimorbidity in six communities in Zhengzhou, China, from July 12, 2021, to December 15, 2021. Participants were assessed using a demographic questionnaire, the Chinese Version of the Medication Literacy Scale (C-MLS), the Self-Efficacy for Appropriate Medication Use Scale (SEAMS), and the Chinese Version of the Morisky Medication Adherence Scale-8 (C-MMAS-8). Data were analyzed using descriptive statistics, t-tests, one-way analysis of variance, Pearson correlation analysis, and mediation analysis.ResultsA total of 350 elderly patients met the inclusion criteria, and 328 valid questionnaires were collected. The mean age of the participants was 74.90 ± 7.37 years, with a slightly higher proportion of males (55.8%) than females (44.2%). The mean score for medication adherence was 4.85 ± 1.57, indicating poor medication adherence among the participants. Medication adherence scores varied significantly among participants of different ages, education levels, employment statuses and kinds of medication (p < 0.01). Scores for medication literacy and self-efficacy showed a significant positive correlation with medication adherence scores (all p < 0.001). The standardized coefficient for the total effect and direct effect of medication literacy on medication adherence was 0.268 (95% CI: 0.201, 0.335) and 0.187 (95% CI: 0.123, 0.252), respectively. After introducing self-efficacy into the model, the standardized coefficient for the indirect effect was 0.081 (95% CI: 0.049, 0.120), indicating that self-efficacy partially mediated the relationship between medication literacy and medication adherence, accounting for 30.22% of the total effect.ConclusionThis study might suggest that medication literacy indirectly affected medication adherence in older people with multimorbidity through self-efficacy. Health care providers should be aware of the importance of improving medication literacy and implement strategies aimed at increasing self-efficacy to achieve the goal of improving medication adherence in older adults with multimorbidity.

Determinant factors of treatment adherence of hypertensive patients in a rural area of Indonesia

Background: The surging prevalence of hypertension due to lifestyle brought forth an increase in degenerative diseases. Adherence is important in achieving the effectiveness of therapy. This study aims to analyze the factors affecting medication adherence in patients with hypertension. Methods: A cross-sectional study was conducted between 20-24 February 2023 at Turirejo Village, Lawang District, Malang, Indonesia. Participants were hypertensive patients currently receiving treatment. The MMAS-8 questionnaire was used to classify adherence to medication for hypertension. Analysis with binary logistic regression test was performed on variables to display odds ratio values was conducted at a significance level of p&lt;0.05. Results: A total of 37 adults diagnosed with hypertension participated in this study. Patients were dominantly consisting of elderly (≥ 56 years old; 73.0%) and females (86.0%). Seventy-six percent of patients have low adherence, twenty-four percent of patients have moderate adherence, and no patient has high adherence. Duration of illness, knowledge, and attitude variables significantly affect adherence (low and moderate) to medication for hypertension. Multivariate analysis showed that patients with a duration of illness above 10 years (Adjusted OR 18.27; 95% CI 1.72-194.47; p-value 0.016) and positive attitude towards treatment (Adjusted OR 12.76; 95% CI 1.25-130.40; p-value 0.032, respectively) increase the possibility of moderate adherence towards the medication of hypertension. Conclusion: Improvements in factors that affect adherence to hypertension treatment are needed to increase the success of the Non-Communicable Disease Prevention Program. Further research in identifying factors of economic capacity and access to health service providers is needed to validate the results of this study.

Using the integrated theory of health behavior change to assess factors affecting diabetes medication adherence among black adults during COVID-19: an explanatory sequential mixed methods design

ABSTRACT Objectives (1) Evaluate changes in medication adherence and the role of psychosocial and interpersonal factors on adherence. (2) Explain the changes in medication adherence based on patient perceptions of adherence behaviors. Design We used an explanatory sequential mixed methods design for surveys at baseline and 1-year follow-up, followed by interviews. The Integrated Theory of Health Behavior Change guided the design of a questionnaire including self-reported measures of medication adherence, psychosocial factors such as illness and medication beliefs, self-efficacy, and depressive symptoms, interpersonal factors including social support and patient-provider communication, and socio-demographic and clinical factors. A convenience sample (n = 228) of adult patients with type 2 diabetes who self-identified as Black/African American completed the mail/telephone surveys. Nine semi-structured interviews were conducted with respondents of both surveys who had changes in medication adherence. Descriptive, mean differential, bivariate correlational analyses, and content analysis was conducted. Data integration merged quantitative and qualitative results as a joint display. Results Response rates for the baseline and follow-up survey were 28% and 47% respectively. Medication adherence scores were significantly correlated with illness perceptions (r = .30) and depression (r = .25) at baseline, and self-efficacy (r = −.51) and depression (r = .37) at follow-up. Qualitative themes included patient perceptions of adherence behaviors, impact of the COVID-19 pandemic, health literacy and self-efficacy. Mixed methods integration showed contrasting perceptions of the same themes including adherence behaviors, medication beliefs, social support, and patient-provider communication among participants whose medication adherence increased and decreased overtime. Conclusion Self-efficacy, diabetes beliefs, and depressive symptoms were key psychosocial factors that affected medication adherence among Blacks/African Americans. Contrasting perceptions of beliefs in medicines, social support, provider relationships and communication among increased and decreased adherence participant groups explained the changes in adherence, which can be used to adapt existing interventions.

Factors Affecting Immunosuppressive Medication Adherence in Liver Transplant Recipients with Poor Adherence: A Qualitative Study.

Preserving graft functions and preventing rejection is closely related to immunosuppressive medication adherence in liver transplant recipients. Therefore, it is essential to determine factors affecting immunosuppressive medication use positively or negatively in liver transplant recipients. This study aimed to explore the use of immunosuppressive medication experience in liver transplant recipients with poor adherence and reveal the factors affecting the medication adherence. The study was conducted as a qualitative study with phenomenological approach. Seven adult liver transplant recipients were included in this study, who had poor adherence to immunosuppressive medication. Data was collected via in-depth personal interviews. Data analysis was conducted through inductive content analysis with three steps of preparation, organization, and reporting phases. Content analysis revealed four main categories, nine categories and 31 sub-categories. Four main categories emerged from the interview data: medication adherence perception, types of medication non-adherence, factors affecting medication adherence negatively and factors affecting medication adherence positively. This study explored that there are several factors affecting immunosuppressive medication adherence among liver transplant recipients, both positively and negatively. In order to achieve liver transplant recipients' total adherence to immunosuppressive medication, the factors affecting medication adherence positively and negatively should be understood. The study results are expected to contribute developing strategies to improve immunosuppressive medication adherence in liver transplant recipients.

Concomitant use of allopathic medicine and herbal products for weight-loss among people with overweight or obesity from Central Mexico

This study evaluated the prevalence of concomitant use of herbal products for weight loss (HPWL) and allopathic medicine. Factors associated with the prevalence, adverse reactions, and the alteration of medication adherence with the concomitant use of HPWL alone and in combination with allopathic medicine, were assessed. The study was descriptive and cross-sectional using a questionnaire conducted among people with overweight or obesity (n=662) from five cities of Central Mexico. Adherence to medications was measured using the Morisky Medication Adherence Scale. The prevalence of adverse reactions induced by the concomitant use of HPWL, and allopathic medicine was 25.3%. The use of HPWL affected medication adherence by 68%. There is a high prevalence (45.2%) of concomitant use of HPWL and allopathic medicine in people with overweight or obesity in Central Mexico. The concomitant use of HPWL and allopathic medicine induces adverse reactions, mainly gastrointestinal, and thus, medication adherence is affected.

Substance use and solid organ transplantation in adolescents and young adults: Current findings and implications.

Understanding the role of substance use is important in the equitable allocation of solid organs and may present an opportunity for improving outcomes among substance users who receive transplants. This scoping review presents findings related to substance use among pediatric and young adult transplant populations and suggests future directions. A scoping review was conducted seeking studies related to substance use in pediatric and young adult transplant populations under the age of 39 years. Studies were deemed eligible if they collected data or addressed policy concerns and participants' mean age was below 39 years. Twenty-nine studies were identified as eligible for this review. Overall, policies around substance use are largely inconsistent throughout both pediatric and adult transplant centers. Findings indicated that substance use among pediatric and young adult transplant recipients is similar to or lower than healthy peers. Few studies addressed marijuana use and opioid misuse, among other substances. There is a general dearth of research on substance use in this population. The current findings suggest that substance use, although relatively less common, affects eligibility for transplant, may lead to poor outcomes, and affects medication adherence. Inconsistent substance use policies in transplant centers have the potential to result in bias. However, more research is needed on the effects of substance use among pediatric and young adult transplant candidates and recipients as well as on equitable policies for organ allocation for individuals who use substances.

Factors influencing medication adherence in multi-ethnic Asian patients with chronic diseases in Singapore: A qualitative study.

Background: Poor medication adherence can lead to adverse health outcomes and increased healthcare costs. Although reasons for medication adherence have been widely studied, less is explored about factors affecting medication adherence for patients in non-Western healthcare setting and from Asian cultures. This study aimed to explore cultural perspectives on factors influencing medication adherence among patients with chronic diseases in a multi-ethnic Asian healthcare setting. Methods: We conducted a qualitative study involving in-depth interviews with patients with chronic conditions purposively recruited from a community hospital in Singapore until data saturation was achieved. A total of 25 patients participated in this study. Interviews were transcribed and thematically analyzed. Themes were subsequently mapped into the World Health Organization (WHO) Framework of Medication Adherence. Results: Participants commonly perceived that sides effects (therapy-related dimension), poor understanding of medication (patient-related dimension), limited knowledge of condition (patient-related dimension), forgetfulness (patient-related dimension) and language issues within a multi-ethnic healthcare context (healthcare team and system-related dimension) as the main factors contributing to medication adherence. Importantly, medication adherence was influenced by cultural beliefs such as the notion of modern medicines as harms and fatalistic orientations towards escalation of doses and polypharmacy (patient-related dimension). Participants made various suggestions to foster adherence, including improved patient-physician communication, enhanced care coordination across providers, use of language familiar to patients, patient education and empowerment on the benefits of medication and medication adjustment. Conclusion: A wide range of factors influenced medication adherence, with therapy- and patient-related dimensions more pronounced compared to other dimensions. Findings demonstrated the importance of cultural beliefs that may influence medication adherence. Future efforts to improve medication adherence should consider a person-centered approach to foster more positive health expectations and self-efficacy on medication adherence, supplemented with routine reviews, development of pictograms and cultural competence training for healthcare professionals.

Factors Associated with Medication Adherence in Elderly Individuals with Tuberculosis: A Qualitative Study.

This qualitative study was conducted in two phases, using an integrative literature review and individual interviews. Studies were gathered without time restriction from MEDLINE databases, Institute for Scientific Information (ISI), Google Scholar, Scopus, and EMBASE, as well as national databases, including Scientific Information Database and Magiran. The findings of 38 studies that met the inclusion criteria were analyzed through the conventional content analysis method based on the ecological approach. After reviewing and forming the data matrix, purposive sampling was performed among healthcare professionals, elderly tuberculosis patients aged 60 and over, and family caregivers of elderly patients to conduct individual interviews. Data obtained from 20 interviews were analyzed using the directed content analysis method. After coding, the data from individual interviews were entered based on similarity and difference in the categories of data matrix obtained from the literature review. In general, the aforementioned codes were placed in four main categories, including individual factors (i.e., biological factors, affective-emotional factors, behavioral factors, cognitive factors, tuberculosis-related factors, and economic factors), interpersonal factors (i.e., patient's relationship with treatment team and family-related factors), factors related to healthcare service provider centers (i.e., medical centers' facilities and capacity building in healthcare service provider), and extraorganizational factors (i.e., social factors and health policymaking). The results of this study showed that medication adherence in elderly patients with tuberculosis was a complex and multidimensional phenomenon. Therefore, society, policymakers, and healthcare providers should scrutinize the factors affecting medication adherence in this group of patients to plan and implement more effective interventions.

Prevalence and risk factors of non-adherence to antipsychotic medications in Saudi Arabia.

To evaluate the rate and determinants of non-adherence to antipsychotic medications in Saudi Arabia. This was a cross-sectional study that included a questionnaire, interview, and data extraction from medical records of adult patients on antipsychotic medications. The study was conducted at outpatient clinics at the psychological care department at King Fahad Medical City, Riyadh, Saudi Arabia, between October 25 and November 26, 2020. Data collection included three parts: patients' sociodemographic characteristics; antipsychotic medications used and patients' clinical characteristics; and adherence to antipsychotic medications measured by the Medication Adherence Rating Scale (MARS). Out of 220 patients, 122 (55.5%) were considered non-adherent (MARS scores 6 or less). The MARS items contributing most to non-adherence were "the medication makes me feel tired and sluggish" and "forget to take the medication", 55 and 40.9%, respectively. Additionally, adverse drug effect significantly increased the risk of poor adherence in regression analysis (odds ratio=1.97, p=0.028). The model also showed that female sex, low income, cigarette smoking, substance abuse, uncontrolled disease, comorbidity, and use of Ruqyah religious therapy were associated with increased risk of poor adherence, but were however not statistically significant (p < 0.05). This study showed high non-adherence rate to antipsychotic medications. Adverse drug effects and forgetting to take medications were the main patient-reported barriers to adherence. Likewise, sociodemographic, clinical, and spiritual factors affected medication adherence. Knowing these predictors helps in early identification of patients who are predisposed to medication non-adherence and allows personalized interventions that improve adherence and treatment outcomes.

Treatment Adherence in Dermatology During the COVID-19 Pandemic: A Review.

The coronavirus disease 2019 (COVID-19) pandemic raised many challenges for dermatology. Safety is a principal concern for many patients, particularly those on medications that affect the immune system. Understanding how the pandemic affects patients' treatment adherence may be informative for counseling or other interventions to assure that treatment plans are not inappropriately interrupted, or for future pandemics. The purpose of this review was to investigate the extent to which the COVID-19 pandemic affected medication adherence in dermatology. A literature search of PubMed was performed using the search terms: adherence, compliance, dermatology, COVID-19, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), and pandemic. Eleven primary research studies met the inclusion criteria and were included in the review. During the COVID-19 pandemic, non-adherence in dermatology patients was primarily linked to concern about the risk of COVID-19 infection with long-term use of immunomodulatory and immunosuppressive medications. In some cases, non-adherence was associated with feelings of depression, anxiety, or perceived stress. High adherence was attributed to regular and convenient communication between patients and dermatology providers through the effective use of telemedicine and electronic messaging. Frequent communication with providers to address patient concerns and provide continuity of care improved adherence. An integrated virtual approach to patient care facilitated this, particularly through the use of telemedicine. Implementation of routine virtual questionnaires was, to some extent, effective in replacing limited in-person patient-provider interactions during the pandemic. Finally, the added threat of the pandemic presented an additional mental health component to consider for patients, supporting the need for a multidisciplinary approach to patient care.

Illness Perception, Self-Efficacy, and Medication Adherence in Patients With Coronary Artery Disease: A Path Analysis of Conceptual Model.

Illness perception and self-efficacy in patients with coronary artery disease (CAD) may affect medication adherence, which is one of the most important challenges in disease management in this group of patients. The present study aimed to investigate the factors influencing medication adherence in CAD patients, especially the effect of illness perception and self-efficacy. This study was cross-sectional and conducted from April to September 2021. A total of 259 patients with confirmed CAD were selected by convenience sampling method based on inclusion criteria. Illness perception, self-efficacy, and medication adherence were investigated using Brief IPQ, SCSES, and MARS_10 questionnaires, respectively. The data were analyzed using the STATA software (version 14) and the regression path analysis method. Patients had moderate illness perception and high self-efficacy, and 61.8 of them adhered to their medication regimen. Greater illness perception, better self-efficacy, and higher education had a positive effect on medication adherence, and increasing age had a negative effect on it. The final path model shows a good fit of the data in the model (χ2: 0.37, df: 274, χ2/df: 0.36, CFI: 1, IFI: 0.95, TLI: 1.07, and RMSEA: 0.00). The results of the present study suggest that patients' illness perception can play an important role in predicting self-efficacy in disease management and the level of medication adherence in patients with CAD. To improve self-efficacy and medication adherence, future intervention studies should focus on the patient's illness perceptions and their improvement.

HIV-Related Stigma Shapes Research Participation for Youth Living With HIV in Kenya.

Introduction: HIV stigma affects medication adherence, psychosocial outcomes, and clinical management for youth living with HIV (YLWH). We explored the impact of HIV stigma on research participation, to inform the ethical engagement of this vulnerable group. Methods: We interviewed 40 YLWH, 20 caregivers, and 39 subject matter experts (SMEs); transcripts were analyzed by HK and EG, with emerging themes confirmed by JA and AC. Results: All categories of participants identified the impacts of stigma on YLWH research participation, suggesting implementing privacy protections, considering recruitment locations carefully, and developing supportive relationships with YLWH. SMEs suggested that YLWH experience uniquely high risks from stigma due to the compounding effects of developmental challenges and transitionary life period. Accidental HIV disclosure and subsequent stigma were identified as a risk of research participation; some viewed the creation of community through research as a benefit. Conclusion: Participants provided insights into stigma-related considerations for research with YLWH, which may guide engagement protocols.

Medication regimen complexity and its impact on medication adherence and asthma control among patients with asthma in Ethiopian referral hospitals

BackgroundVarious studies have found that medication adherence is generally low among patients with asthma, and that the complexity of the regimen may be a potential factor. However, there is no information on the complexity of the regimen and its relationship to adherence and asthma outcomes in Ethiopian asthma patients. Therefore, this study assessed how complex medication regimens affected medication adherence and asthma control in patients with asthma.MethodFrom February 1 to May 30, 2022, a multicenter cross-sectional study was conducted in three public referral hospitals in northwestern Ethiopia. The Medication Complexity Index (MRCI), a 65-item validated instrument, was used to represent the complexity of medication regimens The Medication Adherence Rating Scale for Asthma (MARS-A) was used to assess medication adherence, and the ACT was used to measure the level of asthma control. The association between predictor and outcome variables was determined using multivariable logistic regression analysis. P-values of < 0.05 were declared as a significant association.ResultPatients with asthma (n = 396) who met the inclusion criteria were included in the final analysis. About 21.2% and 24.5% of the participants had high asthma-specific MRCI and patient-level MRCI, respectively. The majority (84.4%) of the participants did not adhere to their medication, and 71% of the participants were classified as having uncontrolled asthma. According to the result of the multivariable analysis, moving from a high asthma-specific MRCI to a moderate asthma MRCI enhances the likelihood of medication adherence by 2.51 times (AOR = 2.51, 95%CI: (1.27, 7.71). Likewise, patients who have low asthma MRCI were four times more likely to adhere to the medication compared with high asthma MRCI (AOR = 3.80, 95%CI: (2.0, 11.1). Similarly, patients having low patient-level MRCI were eight times more likely their asthma level had been controlled (AOR = 7.84, 95%CI: 1.46 to 21.3) and patients who had moderate patient-level MRCI were three times (AOR = 2.83, 95%CI: 1.05 to 8.25) more controlled asthma compared with patients who had high patient level MRCI.ConclusionThe majority of asthma patients had low and moderate complexity of MRCI. Patients with low and moderate regimen complexity demonstrated high adherence and had well-controlled asthma. Therefore, future researchers should consider MRCI as one factor for adherence and asthma control levels.

The Influence of Feeling Lonely and Received Social Support on Medication Adherence in Elderly with Hypertension

Background: Hypertension is currently a non-contagious disease that primarily affects the elderly population in Indonesia. Medication adherence is critical in managing hypertension and reducing the risk of morbidity and mortality. Previous research has found that loneliness and support received by older adults with hypertension influence medication adherence. Objective: This study aimed to examine the impact of feeling lonely and receiving social support on medication adherence in the elderly with hypertension at the Community Health Center in Surabaya. Methods: The study design of this research was a descriptive cross-sectional study from December 2021 to March 2022. A total of 235 eligible subjects fulfilled the inclusion criteria. The instruments used in the data collection were the patient's information form, UCLA-Loneliness Scale, MOS-Social Support Survey, and the ARMS (Adherence to Refill and Medication Scale). Results: The results revealed that the correlation between loneliness and social support was significantly associated with medication adherence in the elderly with hypertension (p &lt; 0.05). In addition, other factors, such as occupation status, living status, comorbidity, the number of drugs taken, and antihypertensive drug therapy, showed a significant correlation with medication adherence (p &lt; 0,05). The most influential factor on medication adherence was loneliness (35.5%), followed by social support (24.4%), the number of drugs taken (7.1%), antihypertensive drug therapy (monotherapy or combination therapy (2.5%), occupation status (2.4%), comorbidity (1.6%), and living status (0.2%). Conclusion: This study confirms that feeling lonely and receiving social support affect medication adherence in the elderly with hypertension at the Community Health Center in Surabaya.

The Effect of Insulin Administration on Medication Adherence in Type 2 Diabetes Mellitus Patients with Neurological Complications

Background: Medication adherence is essential to achieving controlled blood sugar in diabetic patients. Insulin generally provides better glycemic control but is considered painful and requires special techniques. Insulin administration in patients with neurological complications requires particular consideration because these complications can cause physical and cognitive barriers. Objective: This study analyses the effect of insulin administration on medication adherence in diabetic patients with neurological complications and the influence of various confounding variables (baseline characteristics, medical and medication history). Methods: This observational study was conducted with a cross-sectional design at a government hospital in East Jakarta from September 2021 to January 2022. The sample was type 2 diabetes mellitus patients with neurological complications who received antidiabetics for at least six months. The neurological complications include central nervous disorders (such as stroke) and peripheral nervous disorders (such as neuropathy). The independent variable was insulin administration, while the dependent variable was adherence, measured using subjective methods [Adherence to Refills and Medications Scale (ARMS)] and objective methods (Medication Refill Adherence (MRA) and HbA1c]. Results: Of 175 respondents, based on the three methods (MRA, ARMS, HbA1c), 13 respondents (7.4%) were adherent, namely one respondent (1.8%) in the insulin group and 12 respondents (10.1%) in the non-insulin group. Insulin administration affects adherence to antidiabetics by 0.123 times (95% CI: 0.015 - 1.024), or patients who use insulin have 87.7% lower adherence controlled by antidiabetic changes and the total number of medicines used. Conclusion: Insulin administration significantly affects medication adherence in diabetes mellitus patients with neurological complications.

Factors affecting self-reported bleeding acceptance in acute ischemic stroke survivors on various types of antithrombotic therapy

ObjectivesPrior ischemic cerebrovascular event and younger age have been shown to increase bleeding acceptance among anticoagulated outpatients with atrial fibrillation (AF). We sought to determine factors affecting bleeding acceptance in acute ischemic stroke (AIS) survivors on various types of antithrombotic therapy. Materials and MethodsWe enrolled 173 consecutive patients hospitalized for AIS (aged 68.2±11.7 years, 54.9% male), including 54 (31.2%) with AF, who had favorable functional outcome. On discharge, the Bleeding ratio, defined as the declared maximum number of major bleedings that a patient is willing to accept to prevent one major stroke, was evaluated. We assessed the predicted bleeding risk in non-cardioembolic and cardioembolic stroke survivors using S2TOP-BLEED and HAS-BLED scores, respectively. ResultsPatients with the low Bleeding ratio, defined as 5 (median) or less accepted bleeds (n=92; 53.2%), were older and more likely to receive thrombolysis and/or thrombectomy, with no impact of previous stroke. Prior major bleed (odds ratio [OR] 4.67; 95% confidence interval [CI] 0.92-23.72), AF with use of oral anticoagulants (OR 2.35, 95% CI 1.12-4.93), reperfusion treatment (OR 1.95, 95% CI 1.02-3.76), and hospitalization ≤10 days (OR 4.56; 95% CI 1.50-13.87) were associated with the low Bleeding Ratio. Prior use of anticoagulants or aspirin as well as HAS-BLED and S2TOP-BLEED scores did not affect the bleeding acceptance. ConclusionsLower bleeding acceptance declared on discharge by AIS survivors is determined by prior bleeding, anticoagulation in AF, reperfusion treatment, and duration of hospitalization, which might affect medication adherence. The results might help optimize post-discharge management and educational efforts in patients on antithrombotic therapy.

The Quality of Life and Medication Adherence in Patients with Multiple Sclerosis-Cross-Sectional Study.

Multiple sclerosis (MS) is a chronic, degenerative autoimmune inflammatory disease of the central nervous system. MS is characterized by a wide range of symptoms and unpredictable prognosis, which can severely affect patient quality of life (QOL). The treatment strategy includes acute relapse treatment, disease-modifying treatment (DMT), and symptomatic therapy. Adherence to long-term DMTs is essential in order to maximize the therapeutic effects for MS and is crucial to health-related quality of life (HRQOL). This study aimed to evaluate the relationship between QOL and adherence to DMTs in MS patients. A group of 344 patients (73% females) aged 39.1 years with relapsing-reemitting MS were included. The Multiple Sclerosis International Quality of Life (MusiQOL) and the Multiple Sclerosis Treatment Adherence Questionnaire (MS-TAQ) were used. An injection of interferon (IFN)-β1b was used in 107 patients, IFN-β1a in 94 patients, and glatiramer acetate in 34 patients. The oral treatment includes teriflunomide in 14 patients, dimethyl fumarate in 86 patients, and fingolimod in nine patients. No statistically significant differences (p > 0.05) were observed in adherent (ADH) vs. non-adherent patients (non-ADH) in MusiQOL. The total adherence rate was 72% (MS-TAQ). An analysis of the univariate logistic regression model showed an effect of only the activities of daily living (ADL) and relationship with the healthcare system (RHCS) domains on the level of adherence to treatment recommendations. The other variables studied do not affect the level of adherence. Higher QOL levels in the ADL and RHCS domains affect medication adherence in MS patients. Our findings could help manage MS patients, promoting interventions on ADLs and good relationships with healthcare providers to improve their adherence to therapy and result in better QOL.