Causes Of Poor Adherence Research Articles

Poor Acceptance of the Revised Classification of Premalignant Anal Lesions Following the LAST Standardized Project.

The Lower Anogenital Squamous Terminology (LAST) Project recommended unified classification for HPV-associated squamous lesions of the lower anogenital tract, using a 2-tiered nomenclature in 2013. Adherence to the new nomenclature worldwide is unknown. This study aims to assess the trend of the use of the two-tiered High Squamous Intraepithelial Lesion and Low Squamous Intraepithelial Lesion (HSIL/LSIL) as opposed to the traditional three-tiered Anal Intraepithelial Neoplasia (AIN I/II/III) classification as suggested by the LAST Project. A literature search on full-text English language studies of premalignant anal lesion was performed on PubMed from 2002-2022. The studies were categorized by continent, and the prevalence of HSIL/LSIL classification vs AIN I/II/III was calculated. 546 studies and 251 studies were identified using the AIN I/II/II and the HSIL/LSIL classification respectively. Global trend suggested a statistically significant downward trend in the use of the two-tiered nomenclature system in publications globally. Regional trend including North America, Europe, and other (Asia and Latin America) showed variance in adoption of the two-tiered nomenclature system. Despite multidisciplinary collaborative effort, adherence to the recommendations to use the two-tiered system for HPV-associated premalignant anal lesions continues to be suboptimal. Further efforts are needed to identify the cause of poor adherence to be able to create strategies that reinforces unification of terminology and integration of LAST the recommendations.

An overview on the role of epiglottis in obstructive sleep apnoea

Obstructive sleep apnoea (OSA) is common sleep disorder with its multimodal effect on health. OSA, if untreated can lead to various cardiovascular, cerebrovascular, psychological, cognitive as well as sexual morbidities. Continuous positive airway pressure (CPAP) device is considered as the gold standard in the treatment of OSA. Epiglottic collapse (EC) in OSA has evolved an important factor in the management of OSA as the CPAP may worsen the sleep apnoea. EC in itself is classified into primary or secondary, partial or complete, anteroposterior or lateral. Epiglottic collapse is considered as one of the causes for poor adherence to CPAP devices. There are newer diagnostic modalities to diagnose and distinguish primary and secondary epiglottic collapse of which interventional drug induced sleep endoscopy plays a viable and important role. CPAP still serves as a primary treatment modality for multilevel OSA with EC. Surgical treatment modalities for EC is aimed at improving the compliance of CPAP as well as for relieving the obstruction. Surgical options primarily include epiglottectomy, glossoepiglottopexy, epiglottis stiffening operations.

Incidence and Predictors of Major Adverse Drug Reactions Among Human Immunodeficiency Virus–infected Children on Antiretroviral Treatment in West Amhara Comprehensive Specialized Hospitals, Northwest Ethiopia: A Multicenter Retrospective Follow-up Study

PurposeMajor adverse drug reactions (ADRs) are the leading causes of poor adherence, switching of drugs, morbidity, and mortality. A limited studies was conducted to investigate major ADR in developing countries including Ethiopia, and the purpose of this study was to assess the incidence and predictors of major ADRs among HIV-infected children receiving antiretroviral therapy (ART) in West Amhara Comprehensive Specialized Hospitals, Northwest Ethiopia. MethodsAn institutional-based retrospective follow-up study was conducted among 460 children receiving ART from January 1, 2014 to December 31, 2021. A simple random sampling technique was employed, and data were collected using Kobo Toolbox software and then deployed to STATA 14 for analysis. The Kaplan-Meier survival curve and the log-rank test were used to estimate and compare survival times. Both bivariable and multivariable Weibull regression models were fitted to identify predictors. Finally, an adjusted hazards ratio (AHR) with a 95% CI was computed, and variables with P < 0.05 were considered statistically significant predictors of major ADR. FindingsThe overall incidence rate of major ADRs was 5.8 (95% CI, 4.6–7.3) per 1000 child months. Being female (AHR, 2.71; 95% CI, 1.52–4.84), tuberculosis (TB)–HIV co-infection (AHR, 2.49; 95% CI, 1.32–4.68), World Health Organization stage (III and IV) (AHR, 2.52; 95% CI, 1.39–4.56), zidovudine-based (AHR, 2.84; 95% CI, 1.11–7.31), and stavudine-based (AHR, 5.96; 95% CI, 1.63–21.84) regimens were found to be significant predictors of major ADRs. ImplicationsThe major ADR incidence rate was high. Health professionals should employ early screening and close follow-up for children with advanced World Health Organization clinical staging, females, those with TB-HIV co-infection, and those receiving stavudine- and zidovudine-based initial regimens to reduce the incidence of major ADRs.

Incidence of Adverse Drug Reactions (ADRs) and their Determinants among Sputum-Positive Pulmonary TB Patients in A Metropolitan Area, Bengaluru: A Prospective Study

Background: India accounts for 2.42 million new Tuberculosis cases in 2022. Treatment adherence is major challenge, ADRs being one of the main causes of poor adherence. Early identification and addressing of ADRs can improve adherence, reducing associated morbidity and drug resistance. With introduction of daily FDC regimen in India, we intend to study incidence of ADRs and their determinants among Pulmonary TB patients who are on FDC daily regimen. Methodology: Newly diagnosed drug-sensitive PTB patients aged 18 years and above were recruited. A pretested questionnaire was administered and patients were followed up to document ADRs. Causality and severity were assessed using the WHO-UMC scale and Hartwig’s severity assessment scale respectively. Results: Among the study participants’, 95 (78.5%) developed any ADRs. Incidence rate was 13.2 (6.98–19.22) per 100-person month follow-up with GI symptoms being most common. Increasing age [OR=4.7(1.6–14.8)] and weight [OR=5.1(1.3–16.2)] were found to be significantly associated with ADRs. All ADRs were classified as ‘probable’ and ‘mild’ in nature according to WHO scale and Hartwig’s severity assessment scale respectively. Conclusion: Occurrence of ADRs is common, most of them are mild, and occurring in intensive phase. Hence, early identification and appropriate counselling during intensive phase is critical.

Clinicians’ adherence to guidelines for the preoperative management of direct oral anticoagulants in a tertiary hospital: a retrospective study

IntroductionDespite clear, relatively easy-to-use guidance, many clinicians find the preoperative management of direct oral anticoagulants (DOACs) challenging. Inappropriate management can delay procedures and lead to haemorrhagic or thromboembolic complications. We aimed to describe preoperative management practices regarding DOACs in a tertiary hospital and clinicians’ adherence to in-house recommendations.MethodWe included all patients being treated with DOACs who underwent elective surgery in 2019 and 2020 (n = 337). In-house recommendations for perioperative management were largely comparable to the 2022 American College of Chest Physicians guidelines.ResultsTypical patients were older adults with multiple comorbidities and high thrombotic risk stratification scores, and 65.6% (n = 221) had not undergone recommended preoperative anticoagulation management protocols. Patients operated on using local anaesthesia (adjusted OR = 0.30, 95%CI 0.14–0.66; p < 0.01) were less likely to have been treated following institutional recommendations, but no association between their procedure’s bleeding risk and adherence was found. Clinicians’ failures to adhere to recommendations mostly involved late or non-indicated interruptions of anticoagulation treatment (n = 89, 26.4%) or inappropriate heparin bridging (n = 54, 16.0%). Forty-five (13.3%) procedures had to be postponed. Incorrect preoperative anticoagulation management was directly responsible for 12/45 postponements (26.7% of postponements).ConclusionThis study highlights clinicians’ low adherence rates to institutional recommendations for patients treated with DOACs scheduled for elective surgery in a tertiary hospital centre. To the best of our knowledge, this is the first clinical study addressing the issue of clinicians’ adherence to guidelines for the preoperative management of DOACs. Going beyond the issue of whether clinicians are knowledgeable about guidelines or have them available, this study questions how generalisable guidelines are in a tertiary hospital managing many highly polymorbid patients.Further studies should identify the causes of poor adherence.

Strategies of improving adherence to lipid-lowering therapy in patients with atherosclerotic cardiovascular disease.

Lowering LDL-C has been shown to reduce ASCVD events, yet many ASCVD patients do not achieve their guideline-directed LDL-C goals leaving patients at increased risk of another ASCVD event. This review discusses implementation strategies to improve guideline-directed lipid management in patients with ASCVD focusing on the provider, patient, and system level. At a provider level, under-prescribing of statin intensity due most often to statin intolerance, clinical inertia, insufficient monitoring of LDL-C levels, and the difficulty and cost of prescribing other lipid-lowering therapies such as the PCSK9 inhibitors leads to suboptimal cholesterol management in ASCVD patients. Patients concerns about medication side effects and lack of understanding of their ASCVD risk are causes of poor adherence to their lipid-lowering therapy as are barriers at a system level. To improve cholesterol management in ASCVD patients will require an integrated approach targeting the provider, the patient and the system. There is a need for further education of clinicians on the importance of intensive LDL-C lowering in ASCVD patients and greater use of nonstatin LDL-C-lowering therapies for those patients on a maximally tolerated statin who have not achieved their guideline-directed LDL-C goal. This will require shared decision-making with a focus on patient education and patient-clinician communication so that the clinician's goals and aims align with that of the patient.

0531 Excessive mask leak and its association with poor PAP compliance in women. A secondary analysis of the AWARE study

Abstract Introduction Studied have shown that continuous positive airway pressure(CPAP) adherence is lower in women. However, understanding of the specific challenges faced by woman when starting therapy remains poor. Specifically, is there any relationship between leak and women’s characteristics that could influence adherence? Methods The AWARE-study is a longitudinal pilot-study with the objective to identify in women modifiable barriers to initiating/adhering to treatment over 3-months. Adherence was considered when using CPAP for a minimum 4-hours 70% of the nights. But, is there any association between leak, mask type and other patient’s characteristics that could influence adherence in women? This is a secondary analysis looking at leak as a consequence of poor adherence in women within the AWARE-study. We gathered data directly from the PAP-data-base and evaluated adherence within the first 3-months after starting therapy and usage at-present-time. We investigated leakage (&amp;gt;25 L/min) and gathered information about severity of OSA, age, BMI, and race. Our aims: to evaluate for leak as a cause of poor adherence and to identify characteristics that could potentiate leak in women. Results Data from 49 women from the AWARE-study between the ages of 28-85, with a recent diagnosis of OSA who started CPAP was analyzed. Adherence, leakage, age, OSA severity, and mask type was gathered. Chi-squared test of independence suggests a relationship between leakage and present adherence, Chi2(1)=11.34, p=0.001. Of those women experiencing high leakage, 83% were non-adherent to therapy. Logistic regression was run to compute an odds ratio with 95% CI. Those experiencing high leakage have about 92% times lower odds to still be compliant than those not experiencing high leakage [OR=0.08, 95% CI: 0.007, 0.478]. Overall, mask type relates to adherence, 72% of nasal mask wearers were still being adherent versus 38% when using facial masks. The prediction of adherence from leakage does not significantly differ across mask type. Age was found to be related to adherence; 57% of women under 50-years were not adherent to CPAP versus 26% in women over 50-years. Conclusion This information could guide us in suggesting strategies for better mask choosing and possibly to implement more specific strategies that can increase adherence in women. Support (if any)

Adherence to r-hGH Therapy in Pediatric Growth Hormone Deficiency: Current Perspectives on How Patient-Generated Data Will Transform r-hGH Treatment Towards Integrated Care.

Pediatric growth hormone (GH) deficiency is a licensed indication for replacement therapy with recombinant human growth hormone (r-hGH). Treatment, consisting of daily subcutaneous injections, extends from the time of diagnosis until cessation of linear growth at completion of puberty. Suboptimal adherence to r-hGH therapy is common and has been well documented to substantially impair the growth response and achievement of the optimal goal which is attainment of adult height within the genetic target range. The causes of poor adherence are complex and include disease-, patient-, doctor-, and treatment-related factors. Interventions for suboptimal adherence are important for a long-term successful outcome and can include both face-to-face and digital strategies. Face-to-face interventions include behavioral change approaches such as motivational interviewing and non-judgmental assessment. Medical and nursing staff require training in these techniques. Digital solutions are rapidly advancing as evidenced by the electronic digital auto-injector device, easypod® (Merck Healthcare KGaA, Darmstadt, Germany), which uses the web-based easypod® connect platform allowing adherence data to be transmitted electronically to healthcare professionals (HCPs), who can then access GH treatment history, enhancing clinical decisions. Over the past 10 years, the multi-national Easypod® Connect Observational Study has reported high levels of adherence (>85%) from up to 40 countries. The easypod® connect system can be supported by a smartphone app, growlink™, which facilitates the interactions between the patients, their care team, and patient support services. HCPs are empowered by new digital techniques, however, the human–digital partnership remains essential for optimal growth management. The pediatric patient on r-hGH therapy will benefit from these innovations to enhance adherence and optimize long-term response.

Improving Medication Adherence in Asthma.

In little over a generation, the ingenuity of scientists and clinician researchers has developed inhaled medications and pathway-specific biological agents that control the inflammation and physiology of asthma. Unfortunately, whether it is because of cost or difficulty understanding why or how to use inhaled medications, patients often do not take these medications. The consequences of poor treatment adherence, loss of control and exacerbations, are the same as if the condition remained untreated. Furthermore, poor adherence is difficult to detect without direct measurement. Together this means that poor treatment adherence is easily overlooked and, instead of addressing the cause of poor adherence, additional medicines may be prescribed. In other words, poor treatment adherence is a risk for the patient and adds cost to healthcare systems. In this article, we discuss the rationale for and the delivery of successful interventions to improve medication adherence in asthma. We contextualize these interventions by describing the causes of poor treatment adherence and how adherence is assessed. Finally, future perspectives on the design of new interventions are described.

Impact of the COVID19 pandemic on patients followed in psychiatry

IntroductionIn the literature, some studies consider psychiatric patients to be vulnerable to COVID-19, in contrast to other studies that find them rather protected.ObjectivesTo determine the impact of the COVID 19 pandemic on patients undergoing psychiatric care.MethodsThis is a descriptive and cross-sectional study that took place in the psychiatry department A at Razi hospital in Tunisia. We conducted a comparison of patient follow-up between the period of March 2018-2019 and March 2020-2021. For this we used a form including socio demographic data, data concerning the COVID-19 situation, clinical data while comparing the follow-up of patients (hospitalizations, mode of relapses, consultations in the emergency room…)Results100 patients were included, 60% were men, mean age 44 years (+/- 11 years) [19-65 years]. Ninety-seven percent of patients had no personal history of COVID-19 infection. Comparing the pre-pandemic year (2018-2019) and the pandemic year (2020-2021), we note an increase in the rate of emergency room visits of (17.5%) as well as a relapse rate requiring hospitalization in our department in 48%, this figure was 30% in 2019. A statistically significant increase was noted for depressive and anxiety relapses (p=0.04; r=0.7). Fear of catching the virus while attending hospital facilities (17.6%), geographical isolation (17.6%), unavailability of treatment (17%) and poor insight (41.2%) were the primary causes of poor adherence.ConclusionsThe patients followed in our department have presented during this COVID-19 pandemic several relapses of their psychiatric pathologies compared to the previous year.DisclosureNo significant relationships.

A CROSS-SECTIONAL STUDY TO ASSESS THE PHARMACOTHERAPEUTIC ADHERENCE IN PATIENTS ATTENDING THE OUTPATIENT DEPARTMENT OF RESPIRATORY MEDICINE IN A TERTIARY CARE HOSPITAL

Objective: Nonadherence to anti-TB treatment may result in the emergence of multidrug-resistant TB, prolonged infectiousness, and poor tuberculosis treatment outcomes. Underuse, overuse, and improper use continue to be the most common causes of poor adherence to Bronchial Asthma therapy. The objective of the study was to determine respiratory disease medication adherence in India. Methods: Hospital-based cross-sectional study design was conducted from Feb 2020 to July 2021. The data was collected by interviewing respiratory patients receiving Tuberculosis and Bronchial Asthma medications using Morisky’s four-item scale questionnaire. The data were analyzed with a chi-square test. Results: From the total 203 patients of respiratory diseases, of which 180 tuberculosis patients, when asked about adherence to their medications: 128 (71.11%) of them did not forget to take the drugs, 130 (72.22%) of patients reported that they had been being careful in taking their medications, 140 (77.77%), 130 (72.22%) patients did not stop medications when they felt better and when they felt worse while taking medications respectively while in 23 patients of bronchial asthma, when asked about adherence to their medications: 14 (60.86%) of them did not forget to take the drugs, 9 (39.13%) of patients reported that they had been being careful in taking their medications, 8 (34.78%), 11(47.82%) patients did not stop medications when they felt better and when they felt worse while taking medications respectively. Conclusion: This study revealed that 77.83% of patients were adherent while 22.16% of patients were non-adherent to the medication, of which total adherence in Tuberculosis patients was 85.52% while in Bronchial asthma patients, it was 34.78%.

Analgesic abuse headache: risk factors and causes of poor adherence in the detox process

This is a letter to the editor to criticize the use of the term abuse for the condition Medication Overuse Headache. The terms overuse and abuse cannot be applied synonymously.

Machine learning-based prediction of adherence to continuous positive airway pressure (CPAP) in obstructive sleep apnea (OSA)

ABSTRACT Continuous positive airway pressure (CPAP) is the “gold-standard” therapy for obstructive sleep apnea (OSA), but the main problem is the poor adherence. Therefore, we have searched for the causes of poor adherence to CPAP therapy by applying predictive machine learning (ML) methods. The study was conducted on OSAs in nighttime therapy with CPAP. An outpatient follow-up was planned at 3, 6, 12 months. We collected several parameters at the baseline visit and after dividing all patients into two groups (Adherent and Non-adherent) according to therapy adherence, we compared them. Statistical differences between the two groups were not found according to baseline characteristics, except gender (P< .01). Therefore, we applied ML to predict CPAP adherence, and these predictive models showed an accuracy and sensitivity of 68.6% and an AUC (area under the curve) of 72.9% through the SVM (support vector machine) classification method. The identification of factors predictive of long-term CPAP adherence is complex, but our proof of concept seems to demonstrate the utility of ML to identify subjects poorly adherent to therapy. Therefore, application of these models to larger samples could aid in the careful identification of these subjects and result in important savings in healthcare spending.

Analgesic abuse headache: risk factors and causes of poor adherence in the detox process

BackgroundMedication overuse headache (MOH) is characterized by a pre-existing primary or secondary headache associated with medication overuse.AimsTo identify the clinical, epidemiological, and therapeutic profiles associated with MOH and poor adherence to treatment.MethodsA cross-sectional, comparative, descriptive, analytical study was carried out to assess the characteristics of patients with MOH treated at the Hospital Geral de Fortaleza (HGF).Results103 patients participated, 95 (92.2%) women and 8 (7.8%) men. Of these, 55 (53.4%) patients answered that had already been instructed about the MOH, however they continue to abuse medication for many reasons i.e.: difficulty in bearing pain, and fear of worsening the pain. When asked about what could be done to improve adherence to treatment, in a general way, 28 (27.2%) were unable to inform, 37 (35.9%) answered that most frequent consultations could help. Furthermore, 19 (18.4%) believe that psychological counseling wound bring benefits.ConclusionThe lack of guidance or interest in the guidelines provided are real and important obstacles to treat MOH. Changes in the care model that include effective communication, more frequent return, family and psychotherapy support and close monitoring by the physician or nurses are factors that should be considered in headache clinics.

Imatinib Mesylate Adherence in Chronic Myeloid Leukemia Patients: Data from Middle Euphrates Region of Iraq

Background: Chronic myeloid leukemia (CML) represents about one quarter of leukemia cases in our region making it a great challenge to the health system. Aims: Since adherence to imatinib contributes to optimal cytogenetic and molecular responses in CML patients, ours. study tries to evaluate imatinib adherence in Middle Euphrates region of Iraq. Materials & Methods: This study was conducted in Al- Hussein cancer center in Karbala province of Iraq between November 2011 and August 2019. There were 67 CML patients treated with imatinib, their adherence was assessed by using the 9-items Morisky Medication Adherence Scale, while response was evaluated by measuring BCR-ABL1 transcription level in peripheral blood. Results: Only 26.87% of our patients were adherent. Unavailability of drug was the most common cause of poor adherence in 73.13% of patients. Patients with good adherence were more likely to achieve an optimum response (P value =0.007). Conclusion: Our results showed that adherence to imatinib was very low in our region. Economic factor (Unaffordable drug prices) was the main cause leading to suboptimal response. Therefore, efforts should be made to provide drugs to our patients. That will help in improve adherence and treatment outcomes.

'What the herbal medicine can do for me in a week, the orthodox does in a year': Perceived efficacy of local alternative therapies influences medication adherence in patients with atherosclerotic cardiovascular disease.

BackgroundThere is strong evidence that anti‐platelet therapy, ACE inhibitors, beta‐blockers and statins are cost‐effective in reducing subsequent cardiovascular disease (CVD) events in patients with atherosclerotic cardiovascular disease (ACVD). In some settings, only a low proportion of people have access to these medications, and even lower adhere to them. The current study explored and presents data on the causes of poor adherence to orthodox medication and motivations for alternative therapies in patients with established atherosclerotic cardiovascular disease (ACVD).MethodsThe study was conducted among city‐dwelling adults with ACVD in Accra – Ghana's capital city. Eighteen interviews were conducted with patients with established ACVD. A follow‐up focus group discussion was conducted with some of them. The protocol was approved by two ethics review committees based in Ghana and in the United Kingdom. All participants were interviewed after informed consent. Analysis was done with the Nvivo qualitative data analysis software.ResultsWe identified motivations for use of alternatives to orthodox therapies. These cover the five dimensions of adherence: social and economic, health‐care system, condition‐related, therapy‐related, and patient‐related dimensions. Perceived inability of an orthodox medication to provide immediate benefit is an important motivator for use of alternative forms of medication.ConclusionsA multiplicity of factors precipitate non‐adherence to orthodox therapies. Perceived efficacy and easy access to local alternative therapies such as herbal and faith‐based therapies are important motivators.

Disease Progression in Multiple Sclerosis: A Literature Review Exploring Patient Perspectives.

PurposeMultiple sclerosis (MS) prognosis is often uncertain. This literature review considers patients’ understanding of, and perspectives on, MS progression to better comprehend the unmet needs of people with MS (PwMS), in order to improve treatment adherence and quality of life (QoL).MethodsLiterature searches for peer-reviewed papers concerning patient perspectives on the progression of MS and comparable conditions, published between January 2000 and January 2020, were conducted.ResultsLittle qualitative evidence exists that examines PwMS’ perspectives on MS progression. The understanding and meaning ascribed to terms such as “disease progression” vary. Some PwMS find disease labels stigmatizing, confusing, and disconnected from reality. The lack of a clear definition of progression and discrepancies between PwMS and healthcare professional (HCP) perspectives may contribute to misunderstanding and poor communication. Patient descriptions of progression and relapses include symptoms in addition to those evaluated by standard severity and disability measures. Compared with HCPs, PwMS are still focused on relapse prevention but place higher priority on QoL and ascribe different relative importance to the causes of poor adherence to treatment plans. PwMS want to discuss progression and likely prognosis. Such communication needs to be personalized and delivered with sensitivity, at an appropriate time. Poor treatment adherence may arise from a lack of understanding and poor communication, particularly around treatment goals. The few studies that directly considered patient perspectives on the progression of comparable conditions supported and extended the perspectives of PwMS. Lack of adequate communication by HCPs was the most common theme.ConclusionPatient perspectives on disease progression in MS and other chronic progressive conditions are under-investigated and under-reported. The limited evidence available highlights the importance of providing adequate information and effective HCP communication. While further studies are needed, the current evidence base offers information and insights that may help HCPs to enhance patient care, well-being, and treatment adherence.

Self-reported reasons for treatment nonadherence in chronic obstructive pulmonary disease (COPD) patients: a 24-week prospective cohort study in China

Adherence to medication plays an important role in the control of disease progression and treatment costs for patients with chronic obstructive pulmonary disease (COPD). Existing studies are mostly retrospective studies based on local medical insurance databases and prescription records and therefore cannot analyze or determine the causes of poor adherence in COPD patients. This is a prospective study that enrolled 1,223 COPD patients, including 929 newly diagnosed patients and 294 previously diagnosed patients. Telephone follow-up was conducted to administer a questionnaire on treatment adherence and collect detailed information on the prescriptions and the actual use of medications for COPD. The follow-up period was 24 weeks. COPD patients had adherence rates of 74.65%, 49.63%, and 33.61% at 4-, 12-, and 24-week telephone follow-ups, respectively. Cox regression showed that women, newly diagnosed patients, patients with a mild Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, and patients with fewer routes of administration had poorer adherence. According to the subgroup analysis of the diagnostic status, the overall adherence of the newly diagnosed patients was poorer than that of the previously diagnosed patients. Among the causes of nonadherence, drug stoppage after remission (27.2%) was the most common cause, followed by economic factors (21.5%) and poor efficacy (21.1%). This is the first study focusing on the adherence behavior of newly diagnosed COPD patients and the first large-scale clinical study on the Chinese population. Overall, sex, diagnostic status (newly diagnosed and previously diagnosed), GOLD stage, and routes of administration were the four major factors that affected the adherence of COPD patients.

P04 Barriers and facilitators to medicines adherence in children: a systematic review

AimImproving adherence to medicines in children with chronic conditions may lead to significant economic and health benefits.1 To improve adherence, the multifactorial causes of poor adherence should be understood.1 A systematic review for barriers and facilitators to medicines adherence in children was conducted seven years ago.2 We updated this to identify barriers and facilitators to medicines adherence in children reported in the last ten years.MethodA systematic literature search was performed using PubMed, EMBASE, Medline, CINAHL, IPA and Cochrane library databases covering the period November 2008 to March 2019. Inclusion criteria were original research studies identifying barriers and/or facilitators of medicines adherence in children (aged 0–18 years) and included all countries and languages. Exclusion criteria included review articles, editorials, conference papers, reports and studies in adults only. As a reliability measure, 5% of titles and abstracts were assessed independently by a second researcher. Quality assessment was performed on all included studies using the STROBE checklist for observational studies and Cochrane collaboration tools for randomised controlled studies and was checked by a second researcher.ResultsOf 9,360 papers identified by the search, only 172 articles met the inclusion criteria. Most studies were conducted in the US (76), with 11 in the UK, six in Canada and the remaining 79 studies in various countries. Diseases studied included: HIV/AIDS (60), asthma (25), kidney or liver diseases and transplants (18), psychiatric disorders (12), inflammatory bowel disease (10), epilepsy (9) and others (38). Various tools were used to identify barriers and facilitators to medicines adherence. These included 131 studies which used individually designed questionnaires, 32 studies used validated questionnaires and the remaining 9 studies used patients’ medical data. Forgetfulness and fear of side effects were the most common reported barriers to medicines adherence. Others reported barriers to adherence included family conflict, weak patient-provider relationships, stigma and discrimination, drug regimen complexity and lack of support from families. Factors reported to facilitate high rates of adherence included the linking of medicine taking with daily life routines, using reminders to avoid forgetfulness, a higher level of caregivers and parental education and good communication between healthcare professionals, patients and parents.ConclusionThe main findings of this systematic review show that children faced many and varied barriers to medicines adherence with different diseases. Using reminders to avoid forgetfulness and good communication between healthcare professionals, patients and parents were the most common facilitators. To achieve optimal adherence, healthcare providers need to be aware of these barriers and to consider the most appropriate facilitators to encourage patients to take their medicines as prescribed.ReferencesBrown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc 2011;86:304–14.Elliott RA, Watmough DE, Gray NJ, Conroy S, Lakhanpaul M, Pandya H, et al. Talking about medicines (TABS): a multi-method study to understand reasons for medicines non-adherence in children and young people with chronic illness, and to improve their contribution to managing their medicines. Natl Inst Heal Res 2012; 1–423.

Arterial Stiffness, Cognitive Dysfunction and Adherence to Antihypertensive Agents. Is there a Link to Hypertensive Patients?

The incidence of hypertension (HTN) and its cardiovascular (CV) complications are increasing throughout the world. Blood pressure (BP) control remains unsatisfactory worldwide. Medical inertia and poor adherence to treatment are among the factors that can partially explain, why BP control rate remains low. The introduction of a method for measuring the degree of adherence to a given medication is now a prerequisite. Complex treatment regimes, inadequate tolerance and frequent replacements of pharmaceutical formulations are the most common causes of poor adherence. In contrast, the use of stable combinations of antihypertensive drugs leads to improved patient adherence. We aim to review the relationships between arterial stiffness, cognitive function and adherence to medication in patients with HTN. Large artery stiffening can lead to HTN. In turn, arterial stiffness induced by HTN is associated with an increased CV and stroke risk. In addition, HTN can induce disorders of brain microcirculation resulting in cognitive dysfunction. Interestingly, memory cognitive dysfunction leads to a reduced adherence to drug treatment. Compliance with antihypertensive treatment improves BP control and arterial stiffness indices. Early treatment of arterial stiffness is strongly recommended for enhanced cognitive function and increased adherence.