Average Adherence Level Research Articles

Improving adherence in African American women with uncontrolled hypertension.

African American women are disproportionately affected with hypertension (HTN). The aim of this randomized controlled trial was to evaluate the effectiveness of a 6-week culturally tailored educational intervention for 60 African American women with HTN. Sixty African American women, 29 to 86 years old (mean ± SD, 57.98 ± 12.37 years), with primary HTN were recruited from 4 rural locations and randomized to intervention (n = 30) and control (n = 30) groups to determine the effectiveness of the intervention on knowledge, attitudes, beliefs, social support, adherence to an HTN regimen, and blood pressure control. Culturally tailored educational classes were provided for 90 minutes once a week for 6 weeks. The control group received usual care. A significant favorable overall main effect (time) was found for systolic blood pressure (F3,174 = 11.104, P = .000) and diastolic blood pressure (F3,174 = 4.781, P = .003) for both groups. Also for diastolic blood pressure, older age was a significant covariate (F1,56 = 6.798, P = .012). Older participants tended to have increased diastolic blood pressures. There were no significant differences between groups on knowledge, adherence, or attitudes. The culturally tailored program used the African American church as a basis for recruitment and implementation of the program that retained all participants over a 6-month period. African American women living in rural Texas who participated in a 6-week intervention program demonstrated a significant decrease in blood pressure over a 6-month period regardless of whether they were in the intervention or control group. In general, they had a relatively good knowledge of HTN and reported an average level of adherence. Future studies using a culturally tailored program with a larger sample size are warranted to decrease the high level of HTN-related complications in African American women.

Medication Adherence among Community-Dwelling Older Adults: Current Practices and Potential Technology Solution

Lack of medication adherence among elderly has severe health-related and financial consequences, including being the likely cause of 10% of hospital admissions and 23% of nursing home admissions in the U.S. Older adults living independently in their houses and independent living facilities can benefit from assistance with the management of their medications especially as their cognitive abilities diminish. To understand medication adherence practices and barriers among older adults and their potential attitudes and potential acceptance of a technology intervention to improve adherence, we surveyed 65 individuals between the ages of 67 and 96 in an independent living facility. The average age of the sample was 83 and participants reported taking six prescription medications on average per day. Our results indicated an average adherence level of 63% among this population, with daily memorized routines being the most common practice to maintain adherence. Participants had positive attitudes regarding a poten...

Cost-effectiveness of enhancing adherence to therapy with statins in the setting of primary cardiovascular prevention. Evidence from an empirical approach based on administrative databases

Aim To estimate the cost-effectiveness of enhancing adherence to statin therapy across a large population without signs of pre-existing cardiovascular disease. Methods and results The cohort of 84,262 patients aged 40–79 years, resident in the Italian Lombardia Region, who were newly treated with statins during 2002–2003, was followed from index prescription until 2007. During follow-up the 1397 patients who experienced a hospitalization for ischemic heart disease (IHD) were identified (outcome). Adherence from index prescription until the date of hospitalization or censoring was measured by the proportion of days covered by the therapy with statins (PDC). Cost-effectiveness of enhancing adherence was measured through the incremental cost-effectiveness ratio (ICER). The robustness of findings was tested in a sensitivity analysis. Interventions to increase the average level of adherence from 45% (baseline) to 50% (“soft” intervention) or to 90% (“hard” intervention) reduced the number of patients who experience IHD (from 38.9 to 38.4 or 35.8 events every 10,000 person-year, respectively), and increased the cost for drug therapy (from 1326 to 1452 or 2626 thousand euros every 10,000 person-year, respectively). ICER ranged from 243 (95% CI: 230–259) to 413 (391–439) thousand euros every 10,000 person-year for the soft and hard interventions, respectively. Conclusions Interventions aimed at enhancing adherence to statin therapy in the setting of primary cardiovascular prevention might offer important benefits in reducing the risk of cardiovascular outcome, but at a substantial cost.

Self-reported adherence to HAART in South-Eastern Nigeria is related to patients' use of pill box

The aim of this study was to assess levels of adherence and predictors of adherence to HAART in South-Eastern Nigeria. Selfreported adherence to HAART was assessed at 4-week intervals for a period of 3 months. A 10-item questionnaire was used to assess hypothesised factors in adherence to HAART. The average adherence score for the 3 months of follow-up was correlated with 10-item hypothesised factors and patient demographic variables. Linear regression was used to model the relationship between self-reported adherence and factors found to be correlated with adherence. The average adherence level of subjects that took part in the study was 86.1% ± 30.1%. Use of an adherence aid (pill box) was correlated with adherence (r=0.22, p<0.001, ß=8.3%). The study revealed a slightly higher adherence level compared with most reports in Africa. Use of a pill box could help adherence to HAART, particularly in South-Eastern Nigeria.

Evaluating Nurses' Implementation of an Infant-Feeding Counseling Protocol for HIV-Infected Mothers: The Ban Study in Lilongwe, Malawi

A process evaluation of nurses' implementation of an infant-feeding counseling protocol was conducted for the Breastfeeding, Antiretroviral and Nutrition (BAN) Study, a prevention of mother-to-child transmission of HIV clinical trial in Lilongwe, Malawi. Six trained nurses counseled HIV-infected mothers to exclusively breastfeed for 24 weeks postpartum and to stop breastfeeding within an additional four weeks. Implementation data were collected via direct observations of 123 infant feeding counseling sessions (30 antenatal and 93 postnatal) and interviews with each nurse. Analysis included calculating a percent adherence to checklists and conducting a content analysis for the observation and interview data. Nurses were implementing the protocol at an average adherence level of 90% or above. Although not detailed in the protocol, nurses appropriately counseled mothers on their actual or intended formula milk usage after weaning. Results indicate that nurses implemented the protocol as designed. Results will help to interpret the BAN Study's outcomes.

Adherence to highly active antiretroviral treatment and related factors in drug users with HIV/AIDS

Objective To explore adherence to highly active antiretroviral treatment(HAART)and related factors in dnlg users with HIV/AIDS.Methods From July to September 2007,111 HIV-infected drug users who received national free HAART were investigated in the HAART clinics in Hengyang,Yueyang,and Chenzhou districts of Hunan Province.A questionnaire of Community Programs for Clinical Research on AIDS(CPCRA)Antiretroviral Medication Self-Report Was used to assess adherence to HAART,and Zung Depression Scale and Adaptation Partnership Growth Affection Resolve Scale were used to assess patients'depression and family function respectively.ResllIts The average level of adherence to HAART was 83%.Among 111 patients.28.8%of patients reported poor adherence and took medication less than 90%.The mean score of depression was 60.8 1±13.03.There were 83.9%patients demonstrating depressive symptom and only 30.6%patients' family had good function.Logistic regression analysis showed that the degree of depression(β=-0.48,P=0.024)and treatment time(β=-1.11,P=0.036)were significantly associated with adherence negatively,while family function (β=0.65,P=0.043)and the time of being free from drug(β=0.55,P=0.040)were positively associated with adherence.Conclusion The level of adherence to HAART is low in the drug users with HIV/AIDS.Comprehensive interventions are needed to improve adherence to HAART,including managing depression,encouraging drug rehabilitation,improving family function,and evaluating adherence periodically. Key words: HIV/AIDS ; Drug abuse ; Hish active antiretroviral treatment ; Adherence ;

Desafios da adesão ao tratamento de pessoas vivendo com HIV/Aids no Brasil

To analyze the difficulties related to treatment adherence by patients living with HIV/AIDS in highly active antiretroviral therapy. Qualitative research based on 34 interviews with patients under treatment in several outpatient services in the state of São Paulo, in 1998-1999. The group was comprised of people from different socioeconomic levels, gender, length of treatment and varied adherence levels, according to healthcare staff perception. The interviews focused on the patient's narrative about his/her disease. The content analysis classified the difficulties as follows: related to social factors and life styles, including the stigma; related to beliefs about the use of medication; and directly related to the use of medication. All the interviewees reported having difficulties concerning the stigma of living with HIV/AIDS. The difficulties related to the use of medication were the most important among patients with the best adherence level. Patients with average adherence level presented all three types of difficulties. Social and cultural factors are more difficult to be overcome in order to achieve treatment adherence than those related to taking medication, thus making the role played by the health sector important, supported by clear public social policies. These dimensions must be faced not only in the health sector, but also on social and political levels.