Describe Medication Adherence Research Articles

Adherence and persistence of HIV pre-exposure prophylaxis use in the United States.

To describe medication adherence and persistence of HIV PrEP overall and compare between sex and age groups of commercially insured individuals in the United States. We conducted a national retrospective cohort study of the Merative MarketScan Claims Database from 2011 to 2019 to describe adherence and persistence of PrEP overall and compared between sex and age groups. High adherence was defined as ≥80% of proportion of days covered and persistence was measured in days from initiation to the first day of a 60-day treatment gap. A total of 29 689 new PrEP users identified. Overall adherence was high (81.9%; 95% confidence interval [CI]: 81.5%-82.3%). Females were more adherent than males (adjusted odds ratio [aOR] 1.87; 95% CI: 1.50-2.34), while those ≥45-years were less adherent than individuals <45-years (aOR 0.87: 95% CI: 0.81-0.93). More than half of individuals discontinued therapy within the first year (median 238.0 days; interquartile range 99.0-507.0 days). Females were less persistent than males (hazard ratio [HR] 1.49; 95% CI: 1.34-1.65), and people ≥45-years old were more persistent (i.e., lower risk of discontinuation) than those <45-years (HR 0.43; 95% CI: 0.33-0.55). These findings show adherence to daily PrEP is high among commercially insured individuals but the majority still discontinue in the first year. Future research should investigate what factors influence PrEP discontinuation among this population and ways to reduce barriers to therapy maintenance to ensure the population-level benefits of PrEP treatment.

The relationship between medication adherence and illness perception in breast cancer patients with adjuvant endocrine therapy: beliefs about medicines as mediators.

To describe medication adherence, to analyze the relationships among medication adherence, illness perception, and beliefs about medicines, and to determine the mediating effects of beliefs about medicines on the relationship in breast cancer patients with adjuvant endocrine therapy (AET) in China. A cross-sectional study was conducted on 202 breast cancer patients with AET from September 2017 to February 2019 in China. The Medication Adherence Report Scale (MARS-5), the Chinese version of the revised illness perception questionnaire for Breast Cancer (CIPQ-R-BC) and the Beliefs about Medicines Questionnaire (BMQ) were used. The mean MARS-5 score of our participants was 23.72 (SD = 1.62), and 175 (86.6%) patients were adherent to medications. Moreover, medication adherence was negatively correlated with identity, environmental or immune factors, emotional representations, BMQ-specific concerns, BMQ-general overuse, and BMQ-general harm, as well as being positively correlated with coherence and the total BMQ scores. Furthermore, beliefs in the overuse about medicines functioned as mediators for the influencing effects of coherence and emotional representations on medication adherence. Illness perception not only directly affected medication adherence, but also indirectly affected medication adherence through the beliefs about medicines. Necessary interventions that target beliefs in the overuse about medicines in breast cancer patients with AET with low levels of coherence or high levels of emotional representations could be provided to improve the level of their medication adherence.

What methods are used to study the association between medication adherence trajectories, estimated with the group-based trajectory modeling (GBTM) method, and health-related outcomes?—a protocol for a systematic review

BackgroundThe group-based trajectory modeling (GBTM) method is increasingly used in pharmacoepidemiologic studies to describe medication adherence trajectories over time. However, assessing the associations between these medication adherence trajectories and health-related outcomes remains challenging. The purpose of this review is to identify and systematically review the methods used to assess the association between medication adherence trajectories, estimated from the GBTM method, and health-related outcomes.MethodsWe will conduct a systematic review according to the recommendations of the Cochrane handbook for systematic reviews of interventions 6.2. Results will be reported following PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-analyses) recommendations. We will search in the following databases: PubMed, Embase, PsycINFO, Web of Science, CINAHL, and Cochrane Library. Two reviewers will independently select articles and extract data. Discrepancies at every step will be resolved through discussion, and consensus will be reached for all disagreed articles. A third reviewer will act as a referee if needed. We will produce tables to synthesize the modalities used to estimate medication adherence trajectories with GBTM. We will also synthesize the modalities used to assess the association between these medication adherence trajectories and health-related outcomes by identifying the types of health-related outcomes studied and how they are defined, the statistical models used, and how the medication adherence trajectories were used in these models, and the effect measure yield. We will also review the limitations and biases reported by the authors and their attempts to mitigate them. We will provide a narrative synthesis.DiscussionThis review will provide a thorough exploration of the strategies and methods used in medication adherence research to estimate the associations between medication adherence trajectories, estimated with GBTM, and the different health-related outcomes. It will represent the first crucial steps toward optimizing these methods in adherence studies.Systematic review registrationProspero CRD42021213503.

Medication adherence of diabetes mellitus patients in Indonesia: A systematic review

Background: Diabetes mellitus is a chronic disease that requires long-term drug therapy. Adherence in taking medication increases the potential to obtain the optimum therapeutic target. Aim: This systematic review aimed to identify and describe medication adherence of diabetes mellitus patients in Indonesia. Methods: A systematic review was carried out on published research articles from three electronic databases (Pubmed, Scopus, and DOAJ). The eligibility criteria were that studies should be cross-sectional designs, and should display the result data of the measurement of medication adherence level of diabetes mellitus patients in Indonesia. A manual search was also carried out using Google Scholar and from the bibliography of the articles found. The risk of bias was assessed using the NIH quality assessment tool for cross-sectional studies. The synthesis of the results was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart. Results: Thirty published research articles were selected. Medication adherence of diabetes mellitus patients in Indonesia had varying levels. It was dominated by the category of low level and non-adherence. The limitations of the evidence used were: small sample size, the majority using only one method to measure adherence, and the validity and reliability tested was only used in a small number of studies. Conclusion: This finding showed that non-adherence to medication was still a problem for patients undergoing diabetes mellitus treatment in Indonesia.

Medication adherence among persons with coronary heart disease and associations with blood pressure and low-density-lipoprotein-cholesterol

PurposeTo describe medication adherence to lipid-lowering drugs (LLDs), antihypertensive drugs, and acetylsalicylic acid (ASA) among persons with coronary heart disease (CHD) and explore its association with low-density-lipoprotein (LDL)-cholesterol, and systolic and diastolic blood pressure.MethodsBased on record linkage between the seventh wave of the Tromsø Study and the Norwegian Prescription Database, medication adherence was calculated as the proportion of days covered (PDC) for persistent prevalent users in the period of 365 days before the attendance date. Multivariable linear regression models were used to assess the association between systolic and diastolic blood pressure and medication nonadherence to antihypertensive drugs, age, sex, lifestyle, body mass index (BMI), current and previous diabetes, and between LDL-cholesterol and medication nonadherence to LLDs, age, sex, lifestyle, BMI, and current and previous diabetes.ResultsMean PDC was 0.94 for LLDs and antihypertensive drugs and 0.97 for ASA. Among persons with PDC ≥ 0.80 for LLDs, 12.0% had an LDL-cholesterol < 1.8 mmol/L. Blood pressure < 140/90 mmHg (< 140/80 mmHg if diabetes patient) was reached by 55.1% of those with a PDC ≥ 0.80 for antihypertensive drugs. Adherence to LLDs was associated with lower LDL-cholesterol, while neither systolic nor diastolic blood pressure was associated with adherence to antihypertensive drugs.ConclusionAdherence to antihypertensive drugs, LLDs, and ASA among persons with CHD were high despite low achievement of treatment goals for blood pressure and LDL-cholesterol. There was a statistically significant association between adherence to LLDs and LDL-cholesterol, but not between adherence to antihypertensive drugs and blood pressure.

Medication adherence in older people with rheumatoid arthritis is lower according to electronic monitoring than according to pill count

ObjectivesSuboptimal medication adherence is a serious problem in the treatment of chronic inflammatory diseases. To measure medication adherence, electronic monitoring is regarded as superior to pill count. GLORIA is an ongoing two-year trial on the addition of low-dose (5 mg/d) prednisolone or placebo to standard care in older people (65+ years) with RA. During the entire trial, adherence is measured with electronic caps, and with pill counts. The objective is to describe medication adherence patterns, and to compare the adherence results of the two methods.MethodsThe recorded adherence patterns of patients (blinded for treatment group) were classified according to descriptive categories. The cutoff for good adherence was set at 80% of prescribed pills taken.ResultsTrial inclusion closed in 2018 at 451 patients, but trial follow-up is ongoing; the current dataset contains adherence data of 371 patients. Mean number of recorded 90-day periods per patient was 4 (range 1–8). Based on pill count over all periods, 90% of the patients had good adherence; based on cap data, only 20%. Cap data classified 30% of patients as non-user (<20% of days an opening) and 40% as irregular user (different adherence patterns, in or between periods).ConclusionIn our trial of older people with RA, the majority appeared to be adherent to medication according to pill count. Results from caps conflicted with those of pill counts, with patterns suggesting patients did not use the bottle for daily dispensing, despite specific advice to do so.Trial registrationNCT02585258. ClinicalTrials.gov (https://www.clinicaltrials.gov/)

Adherence to long-term therapies in cystic fibrosis: a French cross-sectional study linking prescribing, dispensing, and hospitalization data.

BackgroundCystic fibrosis (CF) is a life-shortening genetic condition that usually affects several organs and involves significant treatment burden. Adherence to medication is important for successful CF management.ObjectiveTo describe medication adherence according to age, therapeutic class, and pharmaceutical form in adults and children followed in four regional CF centers in France.MethodsWe conducted a cross-sectional study with non-transplanted patients followed in two adult and two pediatric centers during 2015 who were covered by the French National Health Insurance (NHI). Sociodemographic, clinical, hospitalization, and prescription data were collected from patient medical records. Medication dispensations were extracted from the regional French NHI database. Adherence was calculated over 12 months using continuous medication availability (CMA) accounting for dose adjustments and hospitalizations. Drug-specific CMA was computed in R with the AdhereR package for each medication prescribed more than 3 months, which was averaged to obtain a composite CMA score (cCMA) for all treatments and per therapeutic class as well as pharmaceutical form for each patient.ResultsA total of 228 patients were included. The number of chronic medications increased with age (r=0.50, p<0.001): a median of 7 medications per patient were prescribed. The mean±SD cCMA was significantly different between age groups (p=0.0098): it was 0.71±0.20 for the 0–5 years age group, 0.73±0.16 for 6–11 years, 0.64±0.17 for 12–17 years, 0.57±0.23 for 18–25 years, and 0.65±0.20 for the over 25 years age group. cCMA varied significantly according to pharmaceutical forms: the mean±SD cCMA was 0.70±0.21 for oral medications and 0.54±0.28 for inhaled medications (p<0.001).ConclusionThis study suggests that adherence to medication regimens in CF patients remains suboptimal and varies substantially between age groups and pharmaceutical forms. These variations in adherence should be considered when developing effective strategies to improve adherence.

A holistic conceptual framework model to describe medication adherence in and guide interventions in diabetes mellitus.

Nonadherence to medications in patients with diabetes, which results in poor treatment outcomes and increased healthcare costs, is commonly reported globally. Factors associated with medication adherence have also been widely studied. However, a clear and comprehensive, disease-specific conceptual framework model that captures all possible factors has not been established. This study aimed to develop a conceptual framework that addresses the complex network of barriers to medication adherence in patients with diabetes. Fourteen databases and grey literature sources were systematically searched for systematic reviews reporting barriers to medication adherence in patients with diabetes. A thematic approach was used to categorize all identified barriers from the reviews and to create a matrix representing the complex network and relations of the different barriers. Eighteen systematic reviews were identified and used for the development of the conceptual framework. Overall, six major themes emerged: patient-, medication-, disease-, provider-, system-, and societal-related factors. Each of these themes was further classified into different sub-categories. It was noted that most interactions were identified to be within the patient-related factors, which not only interact with other themes but also within the same theme. Patient's demographics as well as cultural beliefs were the most notable factors in terms of interactions with other categories and themes. The intricate network and interaction of factors identified between different themes and within individual themes indicate the complexity of the problem of adherence. This framework will potentially enhance the understanding of the complex relation between different barriers for medication adherence in diabetes and will facilitate design of more effective interventions. Future interventions for enhancing medication adherence should look at the overall factors and target multiple themes of barriers to improve patient outcomes.

Evaluation of a refill synchronization program in two community pharmacies

ObjectivesTo describe medication adherence by the proportion of days covered before and after enrollment in a refill synchronization program. MethodsWe conducted a retrospective analysis of medication adherence in 2 pharmacies offering a refill synchronization program. The study population consisted of individuals who received 2 or more medications from any of 15 predefined medication classes within 6 months of enrollment in the synchronization program. Medication adherence and refill consolidation were measured over 6 months before and after enrollment. Optimal adherence was defined as proportion of days covered ≥80%. ResultsAmong 109 patients who enrolled in the program between 2009 and 2014, 68 were included in a pre-post analysis of medication adherence. In the preenrollment period, optimal adherence was observed in 85% (217/254) of the medications taken by the 68 patients, increasing to 93% (237/254) in the postenrollment period (P <0.01). In addition, the percentage maintaining optimal adherence to all of their medications increased significantly from 60% (n = 41) to 83% (n = 57; P <0.01). ConclusionAmong a small group of patients who voluntarily participated in refill synchronization programs, high levels of medication adherence were observed in the preenrollment period. These results combined with previous studies suggest that voluntary participants of these programs are at a low risk for nonadherence; therefore, current estimates of benefit from refill synchronization programs may be overestimated.

DESCRIPTION OF PATIENTS' COMPLIANCE IN ASEER REGION, KINGDOM OF SAUDI ARABIA

Medication non-adherence can cause impairments that interfere with self-care activities in individuals who suffer from multiple comorbid diseases that require careful management. The objective of this study is to assess and describe medication adherence in patients of Aseer Region of Kingdom of Saudi Arabia (KSA). Samples of 416 patients in the outpatient department at Abha General Hospital and Aseer Central Hospital are selected randomly. The patients were interviewed using seven a self-administered close-ended anonymous questionnaire. Only descriptive statistics is reported in this study for analyze the compliance category. The participants in the study were 71% (295 out of 416 patients) of participants were females, while 29% (121 out of 416) were males. The participants’ age ranges between 18-60 years. The adherence level was 85%. The major reasons for non-adherence were forgetfulness and feeling good. The study revealed the appropriate level of adherence by participants. The study also revealed that pharmacists and other healthcare professional intervention will help to improve further the medication adherence with possible fruitful therapeutic outcomes of the patients. Key words : Non-adherence patient, Kingdom of Saudi Arabia Medication non-adherence can cause impairments that interfere with self-care activities in individuals who suffer from multiple comorbid diseases that require careful management. The objective of this study is to assess and describe medication adherence in patients of Aseer Region of Kingdom of Saudi Arabia (KSA). Samples of 416 patients in the outpatient department at Abha General Hospital and Aseer Central Hospital are selected randomly. The patients were interviewed using seven a self-administered close-ended anonymous questionnaire. Only descriptive statistics is reported in this study for analyze the compliance category. The participants in the study were 71% (295 out of 416 patients) of participants were females, while 29% (121 out of 416) were males. The participants’ age ranges between 18-60 years. The adherence level was 85%. The major reasons for non-adherence were forgetfulness and feeling good. The study revealed the appropriate level of adherence by participants. The study also revealed that pharmacists and other healthcare professional intervention will help to improve further the medication adherence with possible fruitful therapeutic outcomes of the patients. Key words : Non-adherence patient, Kingdom of Saudi Arabia

Pharmacist intervention for blood pressure control: medication intensification and adherence

The objective of this study was to describe medication adherence and medication intensification in a physician–pharmacist collaborative management (PPCM) model compared with usual care. This study was a prospective, cluster, randomized study in 32 primary care offices from 15 states. The primary outcomes were medication adherence and anti–hypertensive medication changes during the first 9 months of the intervention. The 9–month visit was completed by 539 patients, 345 of which received the intervention. There was no significant difference between intervention and usual care patients in regards to medication adherence at 9 months. Intervention patients received significantly more medication changes (4.9 vs.1.1; P = .0003) and had significantly increased use of diuretics and aldosterone antagonists when compared with usual care (P = .01).The PPCM model increased medication intensification; however, no significant change in medication adherence was detected. PPCM models will need to develop non–adherence identification and intervention methods to further improve the potency of the care team.

Treatment adherence and persistence in adult ADHD: Results from a twenty-four week controlled clinical trial with extended release methylphenidate

The aim of this analysis is to describe medication adherence, and treatment persistence, in adults with attention deficit/hyperactivity disorder (ADHD) treated for 24 weeks with extended release methylphenidate (MPH-ER). Additionally, patient-, disorder- and treatment-related factors associated with adherence and persistence will be identified. Post-hoc analysis of the active treatment group of a placebo-controlled, randomised, 24 week trial with MPH-ER with univariate description and multiple logistic regression models and Hosmer and Lemeshow tests. In the sample of 241 adults with ADHD (mean age of 35.2 ± 10.1 years), 9.4% of the patients were non-adherent, taking less than 80% of the dispensed medication. Factors associated with non-adherence included age<25 years, education level lower than secondary education, lacking family history of ADHD, lower ADHD baseline severity and lower self- and observer-rated medication efficacy. Lacking family history of ADHD, lower education level and lower self-rated medication efficacy, predicted non-adherence with a prediction accuracy of 16%. Seventeen percent of the patients discontinued early with most discontinuing within the first five weeks of the MPH-ER titration phase. Mean persistence in the discontinuing group was 63.4 ± 49.4 days. Factors associated with discontinuation included male gender, lower education level, lacking family history of ADHD and lower self- and observer-rated medication efficacy. Treatment non-response, male gender and lower education level predicted treatment discontinuation with a prediction accuracy of 22.7%. Male adults without relatives with ADHD, with lower educational level and lower self- and observer-rated medication efficacy, who are newly treated with MPH-ER, are at increased risk of non-adherence and treatment discontinuation. Patients are at increased risk of treatment discontinuation during the medication titration phase.

Oral antidiabetic therapy in a large Italian sample: drug supply and compliance for different therapeutic regimens

ObjectivesTo define the main features of patients treated with oral antidiabetics, evaluating monotherapy (MT), loose-dose combination therapy (LDCT) and fixed-dose combination therapy (FDCT); to describe medication adherence to the different therapies; and to evaluate the differences in compliance with the prescribed therapy regimen among prevalent and incident patient cohorts. Study designThis study was a retrospective cohort analysis based on the ARNO database, a national record that tracks reimbursable prescription claims submitted from selected pharmacies to the Italian national health system. In total, 169,375 subjects, from an overall population of 4,040,624 were included in this study. The patients represented 12 different local health units. Each patient had at least one oral antidiabetic prescription claim (A10B ATC code). MethodsPatients were divided into four groups according to their treatment regimen during the recruitment period (1 January 2008–31 December 2008): MT, FDCT, LDCT and switching therapy. A timespan of 5 years was considered, from 4 years before to 1 year after the index date (i.e. date of the prescription selected in the recruitment period). A medication possession ratio (MPR) with a cut-off value of 80% was used to measure medication adherence. Descriptive statistics and multiple logistic regression were used to define the objectives, while P < 0.05 was considered to indicate significance. ResultsThe median age of patients (n = 169,375, prevalence 4.2%) was 70 years [interquartile range (IQR) 17], and 49.1% were females. Considering the entire sample, the median MPRs for the treatment regimens were: MT, 0.73 (IQR 0.53; 43.9% compliant); FDCT, 1 (IQR 0.29, 68,5% compliant); and LDCT, 0.89 (IQR 0.33, 60.3% compliant). FDCT and LDCT were significantly correlated with MPR. Compliance was 48.9% in the prevalent patient cohort (i.e. patients prescribed oral antidiabetic therapy in both prerecruitment and recruitment periods); median MPRs for the treatment regimens were: MT, 0.73 (IQR 0.52); FDCT, 1 (IQR 0.28); and LDCT, 0.90 (IQR 0.32). Compliance was 43.0% in the incident patient cohort (i.e. patients who were first prescribed oral antidiabetic therapy in the recruitment period); median MPRs for the treatment regimens were: MT, 0.70 (IQR, 0.58); FDCT, 1 (IQR 0.34); and LDCT, 0.64 (IQR 0.39). ConclusionsCompliance was better for FDCT than the other therapeutic regimens in the study population. The same trend was observed in both the prevalent and incident patient cohorts. As type 2 diabetes is a chronic lifelong pathology, and multiple agents are often required to achieve glycaemic control, the preference for FDCT in the population, when clinically applicable, could be an effective strategy for functional administration of clinical outcome and sources. Evaluation of specific population fractions (age, sex, compliance, etc.) and specific agents or drug combinations could also be relevant in order to reach the healthcare objectives.

Medication adherence program: Adherence challenges and interventions in type 2 diabetes

ObjectivesTo describe medication adherence problems for adults with type 2 diabetes and to assess the nature and frequency of pharmacist activities in addressing them and proximate outcomes. DesignPre–post analysis. SettingFour community chain pharmacies located in Seattle, WA, from April 2008 to October 2009. Patients120 patients (mean age >60 years) with type 2 diabetes taking oral diabetes medications and who were 6 or more days late for refills. InterventionPharmacist telephone-initiated adherence support. Main outcomes measuresNature and frequency of adherence-related problems and intervention activities and impact on reduction in refill gaps. ResultsThe primary adherence challenge was difficulty taking medications (27.1%). Failure to remember doses and forgetting refills were reported by 24.6% and 26.3% of patients at baseline, respectively. Pharmacists provided support through some form of patient education (35.6% of encounters) or other adherence support (40.7%). Pharmacist time averaged slightly greater than 5 minutes per intervention and 12.6± minutes (mean ± SD) over 12 months, with 3.4± interventions per patient. Patient-specific education and adherence support by pharmacists and total intervention time were positively correlated, with a modest but significant reduction in refill gaps during 12 months of follow-up. ConclusionNot remembering to refill medications was the most commonly reported problem. Patient encounters averaged 4 to 6 minutes for the first visit and 12 to 13 minutes over 12 months. Phone calls by pharmacists to adults who were late for oral diabetes medication refills were effective in identifying adherence-related problems and developing support strategies to promote medication self-management in busy urban community chain pharmacy settings.

Medication adherence and blood pressure control amongst adults with primary hypertension attending a tertiary hospital primary care clinic in Eastern Nigeria

BackgroundAs the case detection rates of hypertension increase in adult Nigerians, achieving target blood pressure (BP) control has become an important management challenge.ObjectivesTo describe medication adherence and BP control amongst adult Nigerians with primary hypertension attending a primary care clinic of a tertiary hospital in a resource-poor environment in Eastern Nigeria.MethodsA cross-sectional study was carried out in 140 adult patients with primary hypertension who have been on treatment for at least 6 months at the primary care clinic of Federal Medical Centre, Umuahia. A patient was said to have achieved goal BP control if the BP was < 140 per 90 mmHg. Adherence was assessed in the previous 30 days using a pretested researcher-administered questionnaire on 30 days of self-reported therapy. Adherence was graded using an ordinal scoring system of 0–4; an adherent patient was one who scored 4 points in the previous 30 days. Reasons for non-adherence were documented.ResultsAdherence to medication and BP control rates were 42.9% and 35.0% respectively. BP control was significantly associated with medication adherence (p = 0.03), antihypertensive medication duration ≥3 years (p = 0.042), and taking ≥ one form of antihypertensive medication (p = 0.04). BP at the recruitment visit was significantly higher than at the end of the study (p = 0.036). The most common reason for non-adherence was forgetfulness (p = 0.046).ConclusionsThe rate of BP control amongst the study population was low, which may be connected with low medication adherence. This study urges consideration of factors relating to adherence alongside other factors driving goal BP control.

Evaluation of the Single-Item Self-Rating Adherence Scale for Use in Routine Clinical Care of People Living with HIV

The self-rating scale item (SRSI) is a single-item self-report adherence measure that uses adjectives in a 5-point Likert scale, from "very poor" to "excellent," to describe medication adherence over the past 4 weeks. This study investigated the SRSI in 2,399 HIV-infected patients in routine care at two outpatient primary HIV clinics. Correlations between the SRSI and four commonly used adherence items ranged from 0.37 to 0.64. Correlations of adherence barriers, such as depression and substance use, were comparable across all adherence items. General estimating equations suggested the SRSI is as good as or better than other adherence items (p's <0.001 vs. <0.001-0.99) at predicting adherence-related clinical outcomes, such as HIV viral load and CD4(+) cell count. These results and the SRSI's low patient burden suggest its routine use could be helpful for assessing adherence in clinical care and should be more widespread, particularly where more complex instruments may be impractical.

High Prevalence of Medication Non-Adherence in a Sample of Community-Dwelling Older Adults with Adult Protective Services-Validated Self-Neglect

Medication non-adherence can exacerbate disease severity, leading to impairments that interfere with self-care activities in older adults, and, ultimately, death. Elder self-neglect is the most common report to Adult Protective Services (APS) across the USA and is a significant risk factor for early mortality. These individuals often suffer from multiple comorbid diseases that require careful management, but for various reasons they are unwilling or unable to provide themselves with the self-care resources necessary for maintaining health and safety. No studies have assessed whether medication adherence is associated with elder self-neglect. The purpose of this study was to assess and describe medication adherence in this population, as well as evaluate associations between medication adherence and cognitive impairment, depression, physical function, and abilities to perform basic and instrumental activities of daily living (BADLs and IADLs). A cross-sectional study of 100 community-dwelling adults 65 years of age and older with APS-substantiated elder self-neglect were assessed. In-home comprehensive geriatric assessments (CGAs) were completed and included medication reviews. Information on each medication, including the amount taken from the date dispensed, was collected and used to determine adherence. The criteria for non-adherence were taking <80 or >110 % of at least one medication. The sample was also split into groups of low adherence (≤29 %), moderate adherence (29-86 %) and high adherence (≥86 %). Scores on the CGA measures Mini-Mental State Examination, Geriatric Depression Scale, Physical Performance Test (PPT) and Kohlman Evaluation of Living Skills were assessed to determine whether cognitive impairment, depression, physical function, and/or ability to perform BADLs and IADLs were associated with non-adherence or low, moderate or high levels of adherence. Twenty-five per cent of the sample was taking more than seven medications daily. The average rate of adherence was 59 %. Only eight participants (10 %) were adherent to their entire medication regimen, and thus, 90 % were considered non-adherent to at least one medication. The mean number of medications to which individuals were non-adherent was 3.4. The cognitive impairment, depression, physical function and BADL/IADL measures were not statistically associated with medication non-adherence using the cut-points of <80 or >110 %. However, when split into tertiles, the lowest medication adherence level (≤29 %) was significantly associated with a greater number of medications being consumed and lower objective physical function levels as measured by the PPT. Medication non-adherence is a very prevalent problem among older adults who are self-neglecting, and higher non-adherence levels were associated with the number of medications being consumed as well as lower physical function. Physicians who find high rates of medication non-adherence in their patients should consider barriers to adherence, including a large number of medications, lower physical function and the possibility of elder self-neglect. Future efforts should focus on studying the underlying reasons for medication non-adherence in larger samples of older adults who are self-neglecting. This would facilitate the development of interventions to reduce medication non-adherence in this population.

CC3-03: Drug Characteristics Associated with Medication Adherence Across Eight Disease States

Background/Aims Adherence to prescribed medications is a widespread problem and determinants of medication non-adherence have been previously described as health system, social/economic, therapy-related, condition-related, and patient-related factors. Medication non-adherence clearly represents a multifaceted challenge among patients and health care providers. The impact of drug characteristics on medication adherence has not been studied across disease states. The purpose of this study was to describe medication adherence by drug characteristics across multiple disease states to identify drug-specific factors that may serve as targets for future intervention to improve medication adherence.

Medication knowledge, adherence and predictors among people with heart failure and chronic obstructive pulmonary disease

gallagher r, warwick m, chenoweth l, stein‐parbury j &amp; milton‐wildey k (2011) Journal of Nursing and Healthcare of Chronic Illness 3, 30–40 Medication knowledge, adherence and predictors among people with heart failure and chronic obstructive pulmonary diseaseBackground. Although medicines are a key component in the self‐management of chronic illness, lack of adherence is a common problem.Aim. To describe medication adherence and predictors in relation to the Multidimensional Adherence Model among older adults with chronic illness.Method. During a home interview, we collected data from 118 patients with chronic illnesses (chronic obstructive pulmonary disease and heart failure), following a recent illness exacerbation, to determine self‐reported medication adherence, medication knowledge and capacity for self‐management of their illness. We used the Medication Adherence Model as an organising framework and performed multivariate analyses to determine the independent predictors. We conducted the study between April 2005–June 2006.Results. Participants had an average age of 75·54 years (SD 8·38), with marginally more men (56·8%) than women, and were prescribed an average 4·68 (SD 2·11) medications for their primary diagnosis of either chronic obstructive pulmonary disease or heart failure. Most participants (75·2%) were adherent to their prescribed medicines; however, medication knowledge was low [mean score 47·61 (SD 18·73) out of a potential 100]. Predictors of better adherence to medicines were patient‐related: female gender and higher self‐management capacity, and condition‐related: heart failure diagnosis. Socioeconomic and treatment‐related factors were not identified as independent predictors of medication adherence. Predictors of better medication knowledge were higher capacity for self‐management, more concurrent conditions, younger age and taking fewer medicines.Conclusion. Assessment of self‐management capacity, targeting interventions towards patients with chronic obstructive pulmonary disease and men, rather than relying solely on increasing medication knowledge, is essential to improve medication adherence. The Multidimensional Adherence Model requires further investigation to determine its use in patients with chronic illness in general.Relevance to clinical practice. The most effective interventions to improve medication adherence are less likely to be those focused on patient education, and more likely to be those tailored to increasing patients’ self‐management capacity. Programmes will need to involve formal and informal carers. Simple strategies designed to improve medication adherence, such as medication reminders, daily routines, and multi‐dose packs have been reported to be effective in systematic reviews and by patients’ themselves. We recommend all of these strategies to improve medication adherence in persons with chronic illnesses.

Adherence: a review of education, research, practice and policy in Spain.

To describe medication adherence education, practice, research and policy efforts carried out by pharmacists in Spain in the last decade. A literature review using Medline and Embase was conducted covering the last ten years. Additional pharmaceutical bibliographic sources in Spain were consulted to retrieve articles of interest from the last decade. Articles were included if a pharmacist was involved and if medication adherence was measured or there was any direct or indirect pharmacist intervention in monitoring and/or improving adherence. Articles focusing on the development of tools for adherence assessment were collected. Pre- and post-graduate pharmacy training programs were also reviewed through the Spanish Ministry of Education and Science website. Information regarding policy issues was gathered from the Spanish and Autonomous Communities of Education and Health Ministries websites. Pharmacists receive no specific training focused on adherence. There is no specific government policies for pharmacists in Spain related to medication adherence regardless of their practice setting. A total of 24 research studies met our inclusion criteria. Of these, 10 involved pharmacist intervention in monitoring and/or improving adherence and 14 assessed only adherence. Ten studies involved hospital pharmacists working in collaboration with another healthcare professional. At present in Spain, the investigative role of the pharmacist is not well developed in the area of medication adherence. Adherence improvement services provided to patients by pharmacists are not implemented in a systematic way. However, recent efforts to implement new initiatives in this area may provide the basis for offering new cognitive services aimed at improving patient adherence in the near future.