Decreased Medication Adherence Research Articles

Perceived Stress and Health Outcomes Among Latinx and Non-Latinx White Adult People With HIV in East Harlem, New York: A Cross-Sectional Study.

Stress and HIV disproportionately affect Latinx adults in the United States, contributing to numerous health inequities. Among people living with HIV (PLWH), increased stress is associated with decreased medication adherence, effectiveness, and higher rates of immunosuppression and comorbidities. Our study (N = 126) examined the relationship between perceived stress and HIV-related health among Latinx (n = 83) and non-Latinx White (n = 43) PLWH. Latinx PLWH reported better HIV-related health outcomes than non-Latinx White PLWH, despite higher viral load (all p's < .05). An interaction effect showed that higher perceived distress was associated with worse health outcomes and lower CD4+ T cell count only in Latinx PLWH (p's < .05). Our findings highlight the consequences of stress on HIV-related health. Notably, higher stress may be especially detrimental among Latinx PLWH, underscoring the need for more culturally tailored interventions in HIV-related care. Future research should include additional sociocultural factors and longitudinal assessment in a larger sample.

Reconsidering the usefulness of long-term high-dose buprenorphine.

Buprenorphine has been successfully used for decades in the treatment of opioid use disorder, yet there are complexities to its use that warrant attention to maximize its utility. While the package insert of the combination product buprenorphine\naloxone continues to recommend a maximum dose of 16 mg daily for maintenance, the emergence of fentanyl and synthetic analogs in the current drug supply may be limiting the effectiveness of this standard dose. Many practitioners have embraced and appropriately implemented novel practices to mitigate the sequelae of our current crisis. It has become common clinical practice to stabilize patients with 24 - 32 mg of buprenorphine daily at treatment initiation. Many of these patients, however, are maintained on these high doses (>16 mg/d) indefinitely, even after prolonged stability. Although this may be a necessary strategy in the short term, there is little evidence to support its safety and efficacy, and these high doses may be exposing patients to more complications and side effects than standard doses. Commonly known side effects of buprenorphine that are likely dose-related include hyperhidrosis, sedation, decreased libido, constipation, and hypogonadism. There are also complications related to the active metabolite of buprenorphine (norbuprenorphine) which is a full agonist at the mu opioid receptor and does not have a ceiling on respiratory suppression. Such side effects can lead to medical morbidity as well as decreased medication adherence, and we, therefore, recommend that after a period of stabilization, practitioners consider a trial of decreasing the dose of buprenorphine toward standard dose recommendations. Some patients' path of recovery may never reach this stabilization phase (i.e., several months of adherence to medications, opioid abstinence, and other clinical indicators of stability). Side effects of buprenorphine may not have much salience when patients are struggling for survival and safety, but for those who are fortunate enough to advance in their recovery, the side effects become more problematic and can limit quality of life and adherence.

Deprescribing in an outpatient medical clinic at a tertiary care hospital in Sri Lanka

Introduction: Use of multiple concomitant medications or ‘polypharmacy’ is linked to decreased medication adherence, adverse drug reactions and increased financial burden on patients and the economy. Deprescribing by experienced healthcare personnel can ensure safe and effective use of medications. Many medications, prescribed during hospital stay or at clinic level are continued for unnecessarily long periods, highlighting the necessity for deprescribing. The objectives of this audit were to identify and deprescribe inappropriate medications in patients, identify their comorbidities and explore reasons for the inappropriate medication use.Methods: This deprescribing audit was conducted by systematic sampling in selected adult patients &gt;18 years, attending a medical clinic at National Hospital, Kandy over one month. The audit standard was the American Academy of Family Physicians (AAFP) ‘5-step process in deprescribing’. Our study was based only on the first 3 steps of the AAFP deprescribing process.Results: Out of a total of 402 patients, deprescribing was carried out in 135 (33.58%). In this deprescribed group, 59.3% of patients were female and the mean age was 62.3 (±10.9) years. Furthermore, of the deprescribed patients, 52.6% had hypertension, 44.4% had ischaemic heart disease, and 34.1% had diabetes mellitus. The most deprescribed medication was antiplatelets (37.8%), followed by analgesics (24.4%) and diuretics (20%). A clear indication for using the drug was lacking in 68.9%, while 31.1% of patients continued taking the medication for longer than recommended. Conclusions: In this audit, over one third of patients underwent deprescribing. It provides just a glimpse of the broader issue of inappropriate polypharmacy and the necessity of deprescribing. Future research involving multiple centres is recommended to enhance understanding of medication patterns necessitating deprescribing.

Medication non-adherence among outpatients with myocardial infarction: A hospital-based study

BackgroundDespite the availability of effective medications for the treatment of myocardial infarction (MI), treatment outcomes are suboptimal due to medication non-adherence. The aim of this study was to assess medication adherence and its associated factors among patients with MI. MethodsThis cross-sectional study was conducted on outpatients with MI in the cardiology clinic at a major hospital in Jordan. Medication adherence was assessed using the validated Arabic version of the 4-item Medication Adherence Scale. Ordinal regression was conducted to identify the variables associated with medication non-adherence. ResultsA total of 333 patients participated in the study. The median age was 58 years (57–60). Medication non-adherence was expressed by 54.6 % of the participants. Having less than college/university education (Coefficient = −0.625, 95%Cl (−1.191 to −0.06), P = 0.03) and increased medication-related concerns (Coefficient = −0.065, 95 % Cl (−0.126 to −0.003), P = 0.04) were associated with decreased medication adherence. Other factors, including having no family history of cardiovascular disease (CVD) (Coefficient = 0.757, 95%Cl (0.218–1.295), P = 0.006) and increased medication necessity (Coefficient = 0.186, 95%Cl (0.133–0.239), P < 0.001) were associated with high medication adherence. ConclusionThe current study demonstrated a high rate of medication non-adherence in MI patients, necessitating the need to develop tailored pharmaceutical care interventions that address patients' medication-related beliefs, focusing on their perceptions of medication necessity and concerns, particularly in patients with low education level and those with a positive family history of CVD.

Pharmacist intervention to improve adherence to medication among heart failure patients at North East Ethiopia hospital.

Heart failure (HF) is a major and growing medical problem and its management is still challenging due to the coexistence of complications, co-morbidity, and medication non-adherence. HF patients who are adherent to their medication have fewer HF exacerbations, improved survival, and lower healthcare expenditure. Adherence to HF medication plays a pivotal role in attaining maximal therapeutic outcomes. The aim was to assess the medication adherence of heart failure patients at Debre Berhan Comprehensive Specialized Hospital (DBCSH). A pre-post interventional study was undertaken from July 1, 2022, to December 31, 2022, at the medical referral clinic of DBCSH. The educational interventions were provided for 6 months. Medication adherence was determined using the Morisky Green Levin Medication Adherence Scale (MGLS). The data was entered into Epidata version 4.2.0 and analyzed using SPSS version 25.0 statistical software. Descriptive statistics and binary logistic regression analysis were performed. The strength of the association between predictor variables and outcome variables was determined using a 95% confidence interval and adjusted odd ratio. In the pre-intervention phase, 54.6% of patients had medium medication adherence, while in the post-intervention phase, 36.4% of patients had high medication adherence and 61.9% of patients had medium medication adherence. Following the intervention, medication cost (120, 50%), inadequate availability of drugs (75, 31%), and forgetfulness (30, 13%) were the main reasons for medication non-adherence. The presence of co-morbidity and the number of co-morbidity (p < .05) were significantly associated with the occurrence of decreased medication adherence in the pre-intervention phase. Interventions by pharmacists to educate HF patients about the nature of their disease and providing brochures to increase awareness of their medications have been shown to improve medication adherence.

Depression mediates the relationship between exposure to stigma and medication adherence among people living with HIV in low-resource setting: a structural equation modeling approach.

This study hypothesizes that depression mediates the association between exposure to stigma and medication non-adherence in people living with HIV (PLHIV). We recruited 372 PLHIV from the Stigma, health-related Quality of life, antiretroviral Adherence, and Depression among people living with HIV (SQuAD-HIV) project, a multicenter cross-sectional study conducted between October 2021 and February 2022 among PLHIV attending six ART clinics in two geopolitical regions of northern Nigeria. A structural equation modeling (SEM) framework, utilizing the full information maximum likelihood estimator, was used to elucidate the pathways linking stigma, depression, and ART medication adherence, adjusting for sociodemographic characteristics. The total number of eligible participants analyzed (353) included 32.7% male PLHIV with a mean age (SD) of 39.42 (10.14). Being female was positively associated with adherence (β, 95% CI 0.335, 0.163-0.523, p-value < 0.001) but negatively associated with stigma (β, 95% CI - 0.334, - 0.561 to - 0.142, p-value = 0.001), while urban residence was negatively associated with stigma (β, 95% CI - 0.564, - 0.804 to - 0.340, p-value < 0.001). Our analysis also indicated that a higher level of experienced stigma was associated with decreased medication adherence. This association was partially mediated by depression (indirect effect = (0.256) (- 0.541) = - 0.139; p-value < 0.01). The proportion of the association between stigma and medication adherence explained through mediation by depression was 35.6%. These findings underscore the need for targeted interventions aimed at lowering exposure to stigma among PLHIV to improve medication adherence.

Perception and barriers to access Pre-exposure Prophylaxis for HIV/AIDS (PrEP) among the MSM (men who have sex with men) Brazilian Amazon: A qualitative study.

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy that consists in the use of antiretroviral drugs by seronegative people at risk of HIV. Negative perceptions, inadequate understanding, and access barriers have been associated with decreased medication adherence. Manaus is the largest city in the Brazilian Amazon, where the incidence of HIV/AIDS is high, and the rates of adherence to the antiretroviral treatment for HIV and PrEP are low. In this qualitative study among PrEP users, mostly MSM, we explored perceptions, knowledge, and access barriers. We conducted 21 in-depth interviews with an intentionally sampled group of participants who had used PrEP at least once in their lifetime, selected through the snowball technique, between April and July 2022. A thematic analysis was conducted with a predominantly inductive approach. We highlight three relevant themes: (i) access to information about PrEP and its influences on users, (ii) access, monitoring, and barriers encountered, and (iii) facilitators for PrEP adherence and sexual behaviors. One of the negative perceptions identified in the study involves a misunderstanding of the association between PrEP users and the HIV/AIDS status. Participants revealed that some non-PrEP users suspect that individuals claiming PrEP usage are concealing an HIV-positive status to engage in unprotected sex. Lack of information by health professionals regarding HIV prevention methods poses significant barriers to PrEP access and adherence. Participants emphasized social media's crucial role in PrEP awareness. The results suggest a need to increase digital outreach regarding PrEP, decentralize PrEP services, and provide comprehensive healthcare training to improve the effectiveness of the preventive measure.

Association of Personality Traits and Self-Care Behaviors in People With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

Diabetes self-care is critical for individuals with type 2 diabetes mellitus (T2DM), and exploring the impact of personality traits on this domain remains pivotal. This study aimed to investigate the association between personality traits and various dimensions of self-care in people with T2DM. A Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA)-guided systematic review with meta-analysis was conducted. Two reviewers independently screened articles, extracted data, and assessed the risk of bias. Estimates were pooled using random-effects meta-analysis. Twenty-three studies, that met our inclusion criteria, revealed distinct associations between certain personality traits and various aspects of self-care. Notably, traits such as openness, conscientiousness, and agreeableness showed associations with improved foot care compliance (odds ratio (OR) = 2.53, 95% CI = 1.49-4.28; OR = 1.84, 95% CI = 1.10-3.08; and OR = 2.07, 95% CI = 1.23-3.48, respectively). Openness was also linked to better overall self-care behaviors (OR = 2.00, 95% CI = 1.17-3.41), while conscientiousness correlated with reduced smoking (OR = 0.96, 95% CI = 0.93-0.99), and agreeableness was associated with improved medication adherence (OR = 1.68, 95% CI = 1.34-2.31). Conversely, traits like extraversion and neuroticism showed associations with decreased medication adherence (OR = 0.77, 95% CI = 0.61-0.96 and OR = 0.51, 95% CI = 0.40-0.65, respectively), with neuroticism additionally linked to lower overall self-care behaviors (OR = 0.67, 95% CI: 0.55-0.81). This study emphasizes the intricate role of personality traits in shaping self-care practices in individuals with T2DM, underscoring the significance of factoring these traits into tailoring and improving diabetes self-care strategies. Nevertheless, establishing definitive causal relationships mandates further in-depth longitudinal investigations and broader meta-analyses to achieve a more conclusive understanding.

PRESCRIPTION OF SINGLE-PILL ANTIHYPERTENSIVE COMBINATION THERAPY

Objective: The need for polytherapy is common among people affected by arterial hypertension (AH). A single-pill combination is a response to decreased medication adherence, especially in elderly people often suffering from more than one disease, which tends to improve blood pressure control and cardiovascular outcomes. The aim of our study was to determine the frequency of use of a single-pill antihypertensive combination (SPC) therapy and possible differences in presence of comorbidities. Design and method: 324 hypertensive participants on pharmacological treatment were included in this research, of which 51.2% were men, and with an overall median age of 64 years (IQR = 17). For each participant undergoing 24-hour ambulatory blood pressure measurement, data about pharmacological therapy, weight, height and comorbidities such as chronic kidney disease (CKD) and diabetes mellitus (DM) were obtained from their most recent medical records combined with self reports. Body mass index (BMI) was calculated. Results: 148 (45.7%) participants were prescribed a SPC. Participants taking a SPC had lower presence of CKD (23.7% with CKD vs. 76.3% without CKD, p&lt;0.001). No significant difference was found in the presence of DM (p = 0.496). Another interesting finding was more frequent use of SPC therapy among patients with higher BMI (p = 0.029). Conclusions: The results show that less than half of the participants in our study were prescribed an SPC. From this we can conclude that more attention should be paid to educating people about the options for antihypertensive treatment and simplifying therapy regimen. Another point we should highlight is the limited availability of SPCs in the treatment of hypertension in patients suffering from CKD.

Medication adherence and associated factors among psychiatry patients at Asella Referral and Teaching Hospital in Oromia, Ethiopia: Institution based cross sectional study.

Medication adherence is the first and main determinant of treatment success. It is defined by world health organization as "the degree to which the person's behavior corresponds to the agreed recommendations from a health care provider". Non-adherence is a multi-factorial phenomenon that can result from five major interacting factors. These are health team and health system-related factors; patient-related factors; therapy-related factors; socio-economic factors; and condition-related factors. The prevalence of non-adherence in mental illness was found to be 40% to 60% world wide. In developing countries, the magnitude of poor adherence is expected to increase. So this study aimed to assess medication adherence status and its associated factors among psychiatric patients in Asella Referral and Teaching Hospital in Oromia, Ethiopia. An institution-based cross-sectional study was conducted from March 18, 2022 to May 25, 2022, with a total sample of 422 patients. Medication adherence was measured by a modified version of the medication adherence rating scale in the psychiatric setting to determine treatment adherence status, and unstructured questionnaires were assessed by interviewing the patient. Additional data concerning the medication-taking behavior of the patient was collected from caregivers. Bivariate logistic regression was performed to see the association between each explanatory variable and the outcome variable. The odds ratio and 95% confidence interval were used to see the association between treatment adherence and the strength of the link. A total of 395 study participants were interviewed, making a response rate of 93.6%. The prevalence of treatment adherence was 246(62.3%). Medication adherence show high association with lifetime alcohol use [AOR: 3.18, 95% CI:1.31-7.72] compared to those who had no alcohol use histroy, and perceived stigma [AOR (95% CI: 2.31 (1.01-5.31)] compared with those who had no perceived stigma, where as adherence show low association with having slight or superficial insight about illness [AOR (95% CI: 0.25 (0.12-0.53)] compared to those who reported cured off their illness and belief in medication [AOR: 0.36, 95% CI: 0.16-0.81)] compared to those who didn't belief in the medication they are taking. The prevalence of mediation adherence was found to be lower. In this study, factors such as having the slight insight or poor insight about their illness and belief in the medication decreased medication adherence, whereas having an alcohol use history in their lifetime and perceived stigma increased medication adherence. For a better health outcome, awareness creation at an insight level needs to be worked on by psychiatric professionals working on the follow-up psychiatric patients at psychiatry clinic of Assela Referral and Teaching Hospital to enable them to well adhere to their medication.

The role of medication adherence in the association between depressive symptoms and quality of life in older adults with type 2 diabetes mellitus

BackgroundAt present, the role of medication adherence in the association between depressive symptoms and quality of life (QOL) in older adults with type 2 diabetes mellitus (T2DM) was unclear. The purpose of this study was to explore the associations among depressive symptoms, medication adherence and QOL in older adults with T2DM.MethodsIn this cross-sectional study, 300 older adults with T2DM from the First Affiliated Hospital of Anhui Medical University were enrolled. Among them, 115 patients had depressive symptoms and 185 had no depressive symptoms. Univariate linear regression analysis was conducted to identify possible covariates. Univariate and multivariable linear regression analyses were performed to explore the associations between depressive symptoms and medication adherence or QOL in older adults with T2DM. Multiplicative interaction analysis was evaluated whether there was interaction effect between medication adherence and depressive symptoms on QOL of patients. Mediating effect analysis was used to analyze the medication effect of medication adherence on depressive symptoms and QOL in older adults with T2DM.ResultsDecreased medication adherence was observed in patients with depressive symptoms (β = -0.67, 95%CI: -1.10, -0.24) after adjusting for covariates. Depressive symptoms were associated with decreased QOL in older adults with T2DM (β = -5.99, 95%CI: -7.56, -4.42). The mediating analysis revealed that depressive symptoms were associated with decreased medication adherence (β = -0.67, 95%CI: -1.09, -0.25). Medication adherence was linked with increased QOL of older adults with T2DM (β = 0.65, 95%CI: 0.24, 1.06). Depressive symptoms were correlated with decreased QOL of older adults with T2DM (β = -5.56, 95%CI: -7.10, -4.01). The percentage mediated by medication adherence on depressive symptoms and QOL in older adults with T2DM was 10.61%.ConclusionMedication adherence might mediate depressive symptoms and QOL of older adults with T2DM, which might provide a reference for the improvement of QOL of these patients.

Parental Factors Affecting Pediatric Medication Management in Underserved Communities.

Medication errors and adverse drug events are common in the pediatric population. Limited English proficiency and low health literacy have been associated with decreased medication adherence, increased medication errors, and worse health outcomes. This study explores parental factors affecting medication management in underserved communities. Using qualitative methods, we identified factors believed to affect medication management among parents. We conducted focus group discussions between December 2019 and September 2020. We recruited parents and health care professionals from local community partners and a tertiary care children's hospital. Sessions were recorded and transcribed. Three investigators created the coding scheme. Two investigators independently coded each focus group and organized results into themes using thematic analysis. Eleven focus groups were held (n=45): 4 English-speaking parent groups (n=18), 3 Spanish-speaking parent groups (n=11), and 4 health care professional groups (n=16). We identified 4 main factors that could impact medication delivery: 1) limited health literacy among parents and feeling inadequate at medication administration (knowledge/skill gap), 2) poor communication between caregivers (regarding medication delivery, dosage, frequency, and purpose) and between providers (regarding what has been prescribed), 3) lack of pediatric medication education resources, and 4) personal attitudes and beliefs that influence one's medication-related decisions. The compounding effect of these factors - knowledge, communication, resource, and personal belief - may put families living in underserved communities at greater risk for medication errors and suboptimal health outcomes. These findings can be used to guide future interventions and may help optimize medication delivery for pediatric patients.

Evaluation of treatment simplification strategies in patients living with HIV with multi-drug resistance.

Patients living with HIV (PLWH) with multi-drug resistance (MDR) and prior episodes of virologic failure have few therapeutic options remaining. These patients are often prescribed 'salvage' antiretroviral therapy (ART) regimens with high pill burdens, leading to potential decreased medication adherence and increased side effects and drug-drug interactions. In this retrospective, observational cohort study, we included adult patients with a diagnosis of HIV-1 who received care at our institution's Ryan White Clinic and who received 'salvage' ART, defined as three of more antiretroviral agents from at least three different HIV drug classes. Patients were grouped into two cohorts, simplified ART cohort and non-simplified ART cohort, based on whether their ART regimen was reduced by at least one tablet daily. The primary outcome was the percentage of patients who had their viral load suppressed (HIV-1 RNA <50 copies/ml) at their most recent clinic visit. Secondary outcomes were virologic failure (HIV-1 RNA ⩾200 copies/ml), percentage of time patients were virologically suppressed over the past 2 years, and the emergence of new treatment-resistant mutations. There were 50 patients included in the final analysis, 28 in the simplified ART cohort and 22 in the non-simplified ART cohort. The percentage of patients who had their HIV-1 viral load suppressed at their most recent clinic visit was n = 24 (86%) in the simplified ART cohort and n = 16 (73%) in the non-simplified ART cohort (p = 0.302). There were no statistically significant differences between the two cohorts in terms of the secondary outcomes. Our study found that simplification of ART regimens based on HIV genotype in PLWH with a history of MDR and prior virologic failures, regardless of the presence of HIV-1 viremia at the time of simplification, resulted in similar rates of virologic suppression and virologic failure as non-simplified ART regimens.

Transitioning care in youth-onset type 1 and type 2 diabetes: a scoping review protocol using the socio-ecological model framework

IntroductionThe transition from paediatric to adult diabetes care in youth-onset diabetes (type 1 diabetes mellitus, Y-T1DM and type 2 diabetes mellitus, Y-T2DM) is associated with worsening glycaemic control, missed clinical...

Medication adherence and health beliefs among South Asian immigrants with diabetes in the United States: A qualitative study

AbstractIntroductionPeople of South Asian descent carry a high burden of cardiovascular disease (CVD) and type 2 diabetes mellitus (DM2) both globally and in the United States. Although retrospective cohort studies indicate decreased medication adherence among South Asian immigrants, data exploring contributing factors are limited.ObjectivesTo explore how cultural perspectives of South Asian immigrants in the U.S. impact adherence to medications for DM2 and CVD.MethodsThis qualitative research study recruited South Asian immigrants in the U.S. with CVD and/or DM2. Semi‐structured interviews were conducted utilizing the conceptual frameworks of the Patient Explanatory Model and HOPE questions. A modified version of the Voils DOSE‐Nonadherence measure was administered to all participants. Interviews were transcribed, coded, and analyzed through an iterative process to develop overarching themes.ResultsTwelve individuals participated: half were female, with an average age of 63 (range 49‐75), and the majority emigrated from Pakistan. The average extent of nonadherence score on the modified version of the Voils DOSE‐Nonadherence measure was 1.36 (range 1‐2.33). Five overarching themes were identified: (1) Numerical results motivated health change; (2) Open communication improved medication adherence; (3) Self‐management and autonomy valued; (4) Religious/spiritual beliefs may strengthen medication adherence; and (5) Complementary and alternative medicines (CAM) augment Western medicines.ConclusionProviders may engage in various culturally‐based strategies to optimize medication adherence in South Asian immigrants. Resources should be allocated toward facilitating disease state education, encouraging self‐monitoring, and providing training for providers on CAM. Providers should engage the patient‐family dyad and cultivate collaborative relationships with patients. Providers should be aware that patients desire autonomy in making health care decisions, and those with higher health literacy and health care providers in their social network may be more likely to self‐titrate medications.

An Audit on the Monitoring and Management of Hyperprolactinemia in Inpatient Adults on Regular Antipsychotics in 8 Acute Wards in an NHS Mental Health Trust

AimsThe aim of the audit is to ascertain how well hyperprolactinemia is being monitored and managed across all acute adult inpatient wards in a mental health NHS Trust, for patients on regular antipsychotic mediation. The objectives of the audit are to: 1) Assess whether prolactin is being monitored according to local guidelines for patients on regular antipsychotic medication, 2) Determine whether hyperprolactinemia is being identified and managed according to appropriate guidelines, 3) Assess the standard of documentation around the decisions made.MethodsData were collected retrospectively from the electronic notes and records for 78 patients, who were discharged from 8 acute wards in February 2021. For checking prolactin test results, the relevant reporting systems were accessed. Two data collection forms were used, which separated patients between those already taking antipsychotics prior to their admission and those who were newly initiated on an antipsychotic.Patients who were prescribed at least one regular antipsychotic were included. Patients with pre-existing medical conditions that cause hyperprolactinaemia, ongoing pregnancy or breastfeeding were excluded. The monitoring for and management of hyperprolactinaemia was assessed against NICE and local guidance.ResultsFrom the reviewed data, 41 patients were prescribed at least one regular antipsychotic drug during their admission. 32 patients were already established on an antipsychotic prior to their admission and 9 individuals were started on their first antipsychotic. Hyperprolactinaemia was identified in 9 patients. 19 patients had no prolactin assay performed during their whole admission.44.4% of antipsychotic naïve patients had a baseline prolactin level taken prior to starting an antipsychotic. 9.1% of patients with hyperprolactinaemia had their symptoms assessed by a clinician. 27.3% of patients with hyperprolactinaemia had actions discussed and undertaken to address this.ConclusionThis audit identified that patients are at risk of suffering from hyperprolactinaemia and are being insufficiently monitored. The symptoms of hyperprolactinaemia are not adequately screened or assessed for. This may increase the side effect burden and decrease medication adherence among patients. There is a need to increase the awareness among clinicians about the importance of regular prolactin monitoring to improve patient outcomes.

Antidepressant Drugs and Health-Related Quality of Life

Antidepressant drugs are effective against depression. They also improve subjective and functional outcomes such as disability, work functioning, social functioning, well-being, and health-related quality of life (HRQoL) in depressed patients. However, a recent large retrospective cohort study found that depressed subjects who received vs did not receive antidepressants did not differ in improvement in HRQoL, as measured using the 12-item Short Form (SF-12) Health Survey at the start and at the end of a 2-year period. The authors of the study therefore questioned the benefits of continuation of antidepressant drugs, suggesting a role for nonpharmacological interventions, instead. The study "went viral"; its findings were widely disseminated in the mass media and at medical and health care websites for physicians and for the lay public. The study, however, suffered from serious methodological shortcomings. These shortcomings are systematically explained so that readers understand how to critically read a research paper. This is important because uncritical acceptance of the findings of the study can negatively impact attitudes toward antidepressant medication among patients and health care professionals and may even result in decreased medication adherence in patients receiving antidepressant maintenance therapy.

The effect of insight, loneliness, and hope levels on medication adherence in patients with schizophrenia.

It is important to investigate the negative factors affecting medication compliance to continue the treatment of schizophrenia. In this descriptive and analytical study, the effects of insight, loneliness, and hope levels on medication adherence in 202 patients with schizophrenia were studied. The correlation was positive between medication adherence and insight, negative between medication adherence and loneliness, and no correlation between medication adherence and hope. A 1-point increase in insight scores increased medication adherence 1.226 times and a 1-point increase in loneliness scores decreased medication adherence 0.946 times. Medication adherence was 0.499 times lower in nonsmokers compared to smokers. Further studies on patients with schizophrenia should be conducted to evaluate factors affecting medication adherence and preventing smoking in schizophrenia.

Challenges in Optimizing Lipid Management in Women.

While there are physiologic differences in lipid metabolism in men and women, pharmacologic therapy is very effective in both with similar management strategies recommended in the current guidelines for the management of dyslipidemia. Despite similar guidelines for treatment, studies have shown that women have worse control of dyslipidemia than their male counterparts. This may stem from multiple contributing factors including underestimation of cardiovascular disease risk in women, decreased prescription and utilization of lipid-lowering therapies, decreased medication adherence, and higher risk of statin intolerance, all of which may contribute to lower attainment of lipid targets. Furthermore, heart disease is the leading cause of mortality in women, with heart disease noted an average of 7-10 years later than in men. This has historically led to the misperception that women are protected from heart disease and can be treated less aggressively. In fact, traditional risk factors for atherosclerotic cardiovascular disease often impact risk in women to a greater extent than they do in men. Unique risk factors such as pregnancy-related disorders also contribute to the level of risk and therefore warrant consideration in risk stratification. This review summarizes the efficacy of contemporary lipid-lowering therapies in women versus men and discusses the challenges that arise with lipid management in women along with potential ways to tackle these obstacles.

Challenges in the discontinuation of chronic hepatitis B antiviral agents.

Long-term antiviral treatment of chronic hepatitis B patients has been proven to be beneficial in reducing liver-related complications. However, lengthy periods of daily administration of medication have some inevitable drawbacks, including decreased medication adherence, increased cost of treatment, and possible long-term side effects. Currently, discontinuation of antiviral agent has become the strategy of interest to many hepatologists, as it might alleviate the aforementioned drawbacks and increase the probability of achieving functional cure. This review focuses on the current evidence of the outcomes following stopping antiviral treatment and the factors associated with subsequent hepatitis B virus relapse, hepatitis B surface antigen clearance, and unmet needs.