Drug Therapy Adherence Research Articles

Quality evaluation of medical care for breast cancer in Japan.

The purpose of this study is to measure adherence rate to the quality indicators (QI) in clinical practice to evaluate the quality of care for breast cancer patients in Japan. A retrospective record review. Two hundred twenty-four designated breast cancer care hospitals throughout Japan. A total of 15 227 patients diagnosed with breast cancer in 2005. The adherence rate of seven items that correspond to QIs of medical care, which were developed using an adaptation of RAND/UCLA (University of California, Los Angeles) appropriateness method. The lowest quality score was the drug therapy adherence to the St. Gallen consensus recommendations, for which the overall quality score 52.8%. The highest quality score was the adherence rate of hormone receptor testing, for which overall quality score was 97.8%. The greatest variations across facilities were for HER-2 testing and for radiation therapy after breast-conserving surgery. The least variation was for hormone receptor testing. There was a range of measurements for the adherence rate to each QI, suggesting that the desired standards of care had not necessarily pervaded all facilities. It is necessary to strive for widespread implementation of QIs and realization of the significance of measuring the medical care quality among physicians treating breast cancer.

Assessment of a hypertension screening and education intervention in Charlestown, Guyana: Hypertension Evaluation & Learning Program (HELP).

Hypertension is the leading cause of mortality among Guyanese between the ages of 45 and 64 years and is inversely related to wealth and education. This pilot study aims to determine 1) the feasibility of a pharmacy-based clinic, 2) the prevalence of elevated blood pressure and 3) the outcome of follow-up of those with elevated blood pressure. Participants were recruited based on a convenience sample. Adults with or without a previous diagnosis of hypertension were included. Screening, education and patient counselling were provided. Participants with elevated blood pressure readings were contacted 1 month after the initial visit for a follow-up. Twenty-two subjects between the ages of 27 and 78 years participated: 32% (7 of 22) were found to have elevated blood pressure readings, and 71% (5 of 7) of those with high blood pressure readings visited a physician within 1 month of the screening. Of those prescribed antihypertensive medications, 71% (5 of 7) reported low adherence to their medication. The methods developed in this study advanced knowledge on the effective management of hypertension in a developing country. One-third of participants were found to have elevated blood pressure. Among those with elevated blood pressure, most followed up with a physician and were diagnosed with hypertension. Pharmacists and pharmacies can play a pivotal role in providing education and improving drug therapy adherence. The need for pharmacy interventions is heightened in areas where access to physicians is scarce. This pilot study illustrates that a pharmacy-based screening and education intervention is indeed feasible.

Identifying and resolving medication nonadherence

Now that our practice has fully implemented continuous medicationmonitoring services for all of our patients during the dispensingprocess, we are always looking for new ways to improve our patients'drug therapy adherence and outcomes. Our efforts are reflected inour pharmacy performance measures through the Electronic QualityImprovement Platform for Plans and Pharmacies (EQuIPP). We wantour practice to be recognized as a high-performing pharmacy so thatwe're not only participating in performance-based networks but alsoreceiving new revenues from payers who are willing to reimburse uson the basis of how well we improve patient outcomes and help to controlhealth care spend.s

Influence of psychosocial factors on adherence to antihypertensive drug therapy: results from a Cardiovascular Health Program cohort followed in the Metropolitan Region of Santiago, Chile

Inadequate blood pressure control in hypertensive patients remains a persistent health problem in Chile and worldwide. Poor adherence to antihypertensive drug therapy is one of the frequently cited factors. To determine the influence of psychosocial factors in the adherence to drug therapy in hypertensive patients followed through a Cardiovascular Health Program (CHP) that provides free access to primary care centers located in the Metropolitan Region of Santiago, Chile. Cross sectional study. A randomized sample of 513 hypertensive patients (30 to 68 years) was obtained from a universe of 1.484 patients. Adherence to treatment was determined by the Morisky-Green-Levine test. Demographic, socioeconomic and average values of blood pressure were recorded. Validated questionnaires were utilized to assess the patient-physician relationship, awareness of being hypertensive, patient perception of social support, family cohesion, patient self-health assessment and symptoms of emotional stress and depression. The drug therapy adherence was 36.6%, higher in women (38.4% vs 28.9%; p < 0.001). After multivariate analysis, absence of adherence was associated with male gender (OR: 1.76 [95% CI 1.21-2.56]), low education (OR: 1.72 [95% CI 1.18 to 2.53]), inadequate patient-physician relationship (OR: 1.56 [95% CI 1.13 to 2.27]), and high level of emotional stress and depression (OR: 1.93 [95% CI 1.27 to 2.94]). Our study highlights the influence of inadequate patient-physician relation, high level of emotional stress and depression, low education level and income and male gender in the lack of adherence to antihypertensive drug therapy in hypertensive patients followed throughout the CHP.

O169 Psychosocial Factors and Drug Therapy Adherence in a Comprehensive Primary Care Hypertension Program Providing Free Access to Care

Introduction: Poor adherence to antihypertensive drug therapy (Rx) is a factor in uncontrolled blood pressure (BP) ( 140/90 mm/Hg). Objectives: To assess the relative influence of socio-economic status and psychosocial factors in achieving adherence to Rx in hypertensive patients followed in Chilean primary care centers. Methods: A weighted randomized sample of 513 patients (371 women) from a universe of 1,484 hypertensive patients (average age 55.7 years) was analyzed. Free medical care, Rx and life style modification counseling was provided throughout a government subsidized multidisciplinary program (Cardiovascular Health Program, CHP). Rx adherence was evaluated using a Morisky-Green-Levine test. Previously validated questionnaires for patient-physician relation, family income, education, emotional stress –depression, family cohesion and social network were utilized to assess psychosocial factors. Multiple Rx and years of awareness of hypertension were analyzed. Odds ratio (OR) were obtained after multivariable logistic regression analysis (adjusted for all variables). Results: Adherence was documented in 36.3% of the study group (women 38.4 %, men 28.9%, p<0.001). No adherence was significantly associated to male gender, low family income, low education, inadequate patient-physician relation, and high emotional stressdepression score. Multiple Rx, and years of awareness of hypertension showed no influence on Rx adherence.

Importance of labelling and patient knowledge to ensure proper care during drug dispensing: A case study from a tertiary hospital in Ethiopia

Correct drug labelling is central for ensuring proper drug dispensing and thus for patient safety. Labelling errors may result in adverse health outcomes. The objective of this study was, therefore, to assess the effect of labelling on the quality of drug dispensing and patient knowledge about dispensed drugs in Jimma University model and specialized hospital outpatient Pharmacies. Individual packages with prescribed drugs were examined using pretested questionnaire and observational check lists during the dispensing process. Patients’ knowledge about drugs dispensed to them was assessed at the exit interview using a pretested questionnaire. Out of 743 prescribed drugs, 682 (91.8%) were dispensed to 426 patients. The average labelling score (range from 0 to 6) of dispensed drugs in Model and Outpatient pharmacy was 2.00 (95% CI 1.97 to 2.04) and 1.73 (95% CI 1.6 to 1.8) respectively, with overall average labelling score of 1.90 (95% CI 1.84 to 1.91). The average patient knowledge score (range from 0 t0 5) was 3.45 (95% CI 3.31 to 3.59) and 3.5 (95% CI 3.35 to 3.64) for model and outpatient pharmacy, respectively, while the overall average knowledge score was 3.46 (95% CI 3.37 to 3.57). Major labelling problems were absence of patient’s name and dose followed by frequency of administration, duration of treatment, and the reason for prescription. Literacy status of patients had a significant effect on their knowledge (p 0.05). We recommend that corrective measures targeting both, labelling and patients’ knowledge should be implemented to improve the patients’ safety and drug therapy adherence.

Effects of health insurance on racial disparity in osteoporosis medication adherence

To explore whether racial disparity in osteoporosis drug therapy maintenance varies by health insurance coverage status. Longitudinal observation study. Cleveland Clinic Health System (Cleveland, OH) from January 2006 to December 2009. 3,901 black and white female Medicare beneficiaries starting osteoporosis drug therapy. Analysis of the health system's integrated electronic medical records. Drug therapy adherence (medication possession ratio ≥80%) for more than 12 of 15 surveillance units and occurrence of extended nonadherence gaps for at least two surveillance units in a row. Among patients with supplementary health insurance (n = 2,278), no difference was observed for drug therapy adherence ( P = 0.17) and extended nonadherence gaps ( P = 0.53) between black and white participants. When patients did not have supplementary health insurance (n = 1,623), blacks (36% [95% CI 28-47]) were less likely to adhere to drug therapy than whites (47% [38-57]; odds ratio [OR] 0.34 [95% CI 0.09-0.92], P = 0.004). Blacks (25% [19-32]) also were more likely to have an extended nonadherence gap episode than whites (18% [11-26]; OR 2.42 [1.13-3.50], P = 0.03). Similar to previous research on racial disparity in health services, racial disparity in osteoporosis drug therapy maintenance between black and white female older patients existed when supplementary health insurance was not affordable.

Abstract 19760: Factors Influencing Blood Pressure Control and Therapeutic Adherence in a Comprehensive Hypertension Management Program

Background: Lack of life style modification counseling, poor antihypertensive drug therapy (Rx) adherence, low education, poor patient-physician relation have been described among other social determinants as hurdles in achieving blood pressure (BP) control in hypertensive patients. Objectives: This study assesses these factors in a government sponsored Cardiovascular Health Program (CHP) that provides free access to antihypertensive treatment and life style modification counseling to Chilean hypertensive population. Methods: From a universe of 1,512 hypertensive patients (1,069 women) between 30 y 68 years followed throughout the CHP, a sample of 349 patients was analyzed. All patients received free Rx and life style modifying counseling. Surveys of physician-patient relationship, weekly physical activity (leisure physical activity) family income and education level were carried out. Rx adherence was determined using the Morisky-Green-Levine test. Odds ratio (OR) analysis adjusted for age and sex was performed to assess the influence of these factors in BP control (&lt;140/90 mmHg) and Rx adherence. Results: The mean age of the sample was 55.0 ± 8.2 years. BP control was achieved in 49.0% (741 of 1,512) of patients. 94,5% (1,429 of 1,512) received pharmacological treatment. Adherence to antihypertensive Rx was 34.9% (499 of 1,429). Factors related to BP control and influencing Rx adherence with their OR are shown in Table 1. Conclusions: Education, patient-physician relation, low social support and physical activity level influenced BP control. The same factors with the exception of physical activity level influenced Rx adherence that did not appear to affect decisively BP control. These results underscore the importance of social determinants and life style modification counseling implemented throughout this comprehensive hypertension management in the Chilean CHP.

Awareness of Diabetes Mellitus among Uae Non-Diabetic Population in Ajman and Ras Alkhaimah

The present study aims to assess the level of knowledge of DM among non diabetic people from Ajman and Ras Al Khaimah (UAE) regard to causes, complication, clinical manifestation, management, treatment, drug adherence and control, hypoglycemia associated with diabetic therapy, hypoglycemia management and other aspects related to diabetes. A cross-sectional study was conducted among non diabetic people who were attending GMCH (Gulf Medical College Hospital) community pharmacy in Ajman and RAK hospitals during the period between July and December 2009. A self-administered questionnaire was used as a tool for data collection. The percentage of participants aware of diabetes causes, symptoms, complications, management, drug treatment, drug therapy adherence and diabetes monitoring were 60.4%, 78.7%, 54.8%, 68.9%, 89.8%, 50.6%, and 76.6% respectively. Awareness of hypoglycemic symptoms which can complicate diabetes therapy was only low 23.8%. For the management of hypoglycemia 45.1% of the participants recommended the use of sugar, 23% of them suggested the use of oral medicine and 32% of the participants recommended the use of insulin. The proportions of participants who had correct knowledge of the recommended frequency of follow-up of eye exam, urine test, blood sugar measurement and blood pressure test in diabetic patients were 33.6%, 39.6%, 87.2% and 23.8 respectively. The study showed low awareness of the population about various aspects of diabetes and the least knowledge was noticed on hypoglycemic symptoms, hypoglycemia management and diabetes complications. We recommend education program to improve population knowledge regards diabetes which can create enthusiasm to improve diabetes care and can go a long way in the prevention and management of diabetes in the Gulf region and UAE in particular.

How the results and pattern of treatment have recently changed in patients with acute myocardial infarction (according to the data of two Saint-Petersburg hospitals)

The results and pattern of therapy were analyzed in 772 patients with acute myocardial infarction (AMI) who were treated at two Saint Petersburg hospitals in 1998 to 2007. A follow-up indicated that drug treatment quality and therapy adherence improved a year after AMI, resulting in a significant reduction in sudden cardiac death rates. At the same time, inadequate primary myocardial reperfusion and myocardial revascularization failed to significantly reduce mortality from chronic heart failure and incidence of myocardial reinfarction. Key words: acute myocardial infarction, sudden cardiac death, myocardial reinfarction, guidelines for the management of myocardial infarction, drug therapy adherence.

Vergleich der Therapietreue von zwei regional benachbarten Gedächtnissprechstunden mit unterschiedlicher Struktur

There are more than 100 memory clinics established in Germany, Austria and German-speaking Switzerland. We compared the impact of the structure of two German memory clinics (Erlangen and Nuremberg) on therapeutic outcome. 483 patients suffering from dementia with indication for antidementive therapy were included in this study. The data ascertainment included patient-related data, the mini mental score, comorbidity as well as psychiatric drug therapy. After a mean follow-up of 3.7 years, we performed a single cross-sectional survey covering over 90 % of patients to assess clinical course and adherence to therapy. The patients of the Erlangen University Memory Clinic were significantly younger (69.8 +/- 9.49 vs. 74.6 +/- 10.7 years; p = 0.01) and had a better mini mental score at their first presentation (20.9 +/- 9.4 vs. 19.5 +/- 5.9; p = 0.02). They showed a non-significantly faster disease progression (as measured by mini mental decline per year), than the patients from Nuremberg. Concerning the allocation of diagnosis, more late onset-dementias and dementias of a mixed type were treated at the Nuremberg clinic. At the university clinic, more dementias were of unclassified origin. Concomitant drug therapies, death rates and therapy adherence (53 %) were not different between the two clinics. The two memory clinics under investigation differed in patient age, disease severity and diagnostic assessment. Still, parameters of therapeutic outcome showed converging results.

Dyslipidemia Control in Indigent Patients Receiving Medication Assistance Compared with Insured Patients

To compare dyslipidemia management with statin-based therapy in insured patients versus indigent patients receiving medication assistance, and to determine drug therapy adherence rates in the two groups. Retrospective medical record review. Setting. University-based health care system. Two hundred forty patients with dyslipidemia who received statin-based therapy from the outpatient pharmacies and clinical care at an affiliated clinic. Prescription records identified 665 patients between October 1, 2004, and September 30, 2005. Forty of these patients had insurance (with a single carrier), and the remaining 625 patients received health care subsidies from the Colorado Indigent Care Program (CICP). Using a block scheme, 200 patients from the CICP were randomly extracted. The primary objective was measured by assessment of low-density lipoprotein cholesterol (LDL) goal attainment and use of a moderate-potency, lipid-lowering regimen capable of achieving an LDL level reduction of least 30%. Of a total of 240 patients who met study criteria, 26 were excluded whose records lacked LDL measurements while receiving therapy. The LDL goal was achieved in 122 (68.9%) of the 177 patients in the CICP group versus 29 (78.4%) of the 37 patients in the insured group (p=0.34). A moderate-potency, LDL-lowering regimen was used by 90.5% of 200 patients in the CICP group and 85% of 40 patients in the insured group (p=0.45). In patients classified as having moderately high, high, or very high cardiovascular risk, LDL goals were attained in 103 (67.3%) of 153 patients in the CICP group versus 16 (69.6%) of 23 patients in the insured group (p=0.83). In this higher-risk subgroup, a moderate-potency regimen was used in 162 (92.6%) of 175 patients in the CICP group versus 23 (92%) of 25 patients in the insured group (p=0.92). Among the very high-risk patients from the two groups combined, 30 (52.6%) of 57 patients achieved LDL concentrations below 70 mg/dl, and 58 (95.1%) of 61 patients were administered a moderate-potency, LDL-lowering regimen. The secondary objective, overall adherence, as assessed by the medication possession ratio, was better in the CICP group than in the insured group. Our data suggest that quality of dyslipidemia management is similar for indigent and insured populations. Overall LDL goal attainment rates were higher than those reported in the literature. Most patients with significant cardiovascular risk, including those at very high risk, were treated according to established guidelines. Adherence rates were greater for indigent patients.

Sleep disturbances in 50 children with attention-deficit hyperactivity disorder

This study assesses the relationship between sleep disturbances (SD) and attention-deficit and hyperactivity disorder (ADHD) to characterize clinical features and associated problems. The medical records of 50 children and adolescents ranging in age from 4 to 17 years with ADHD without the diagnosis of mental retardation or pervasive developmental disorders were reviewed. Significant relationships were found between SD and drug therapy (p<0.01), co-morbidity (p<0.01) and greater adherence to treatment prescribed for ADHD disorders (p<0.05). The results of this study suggest that SD are an important problem in children with ADHD and may be linked to increased symptoms.

Determinants of antipsychotic polypharmacy in psychiatric inpatients: a prospective study

A recent survey of clinicians' opinions suggested that antipsychotic polypharmacy is reserved for particularly severe cases, and that it is intended to avoid high doses of a single drug. In the present study, we tested these clinicians' reasons for antipsychotic polypharmacy in a sample of Italian psychiatric inpatients. During a 6-year recruitment period, all psychiatric patients receiving antipsychotic therapy at discharge from an inpatient facility were included. Sociodemographic and clinical data were collected, and the 18-item version of the Brief Psychiatric Rating Scale was administered on admission and before discharge. At discharge, data on length of inpatient stay, psychotropic drug therapy and treatment adherence were collected. Prescribed daily doses were converted into multiples of the defined daily doses. A total of 354 inpatients receiving antipsychotic treatment at discharge were included. Of these, 100 (28%) were discharged with two or more antipsychotic drugs. After background group differences were controlled for, positive symptoms, manic/hostility symptoms and polypharmacy on admission were predictors of polypharmacy at discharge. The risk of high-dose antipsychotics in patients receiving polypharmacy at discharge was 10-fold higher than that in patients receiving one antipsychotic (odds ratio 10.70, 95% confidence interval 4.78-23.97, P<0.001). The perception of clinicians is to reserve antipsychotic polypharmacy for severe, persistent and difficult-to-treat cases, and this was confirmed by the finding that patients discharged on two or more antipsychotic agents were more severely ill on admission. Conversely, the theoretical advantage of avoiding a high dose of a single drug is counterbalanced by the documented disadvantage of administering high total doses.

Suboptimal medication adherence in Parkinson's disease

Patients take less medication than prescribed in many disease areas but evidence for suboptimal therapy adherence in Parkinson's disease (PD) is limited. A single-center observational study of antiparkinsonian medication was undertaken using electronic monitoring (MEMS; Aardex, Zug, Switzerland) over 3 months. Of 68 patients approached, 6 declined and 8 dropped out, leaving 54 patients (taking 117 preparations) with available data. Poorer compliance was associated significantly with younger age, with taking more antiparkinsonian tablets per day, with higher depression scores, and with poorer quality of life. Of the 54 evaluable patients, 11 (20%) had average total compliance of under 80% (underusers) and 43 (80%) had average total compliance of over 80% (satisfactory adherence). Underusers had median total compliance of 65% (interquartile range, 37-74) versus 98% (interquartile range, 93-102) in the satisfactory adherence group. Timing compliance (number of doses taken in the correct time interval) was poor in both underusers (median, 11%; interquartile range, 2-20) and those with satisfactory adherence (median, 25%; interquartile range, 11-73). In conclusion, poorer compliance is associated with younger age, depression, and more tablets per day, and one-fifth of PD patients underuse medication. Consideration of drug therapy adherence has implications in the management of PD.

Patient autonomy and drug therapy adherence

Journal Article Patient autonomy and drug therapy adherence Get access C. Richard Talley C. Richard Talley Search for other works by this author on: Oxford Academic Google Scholar American Journal of Hospital Pharmacy, Volume 51, Issue 23, 1 December 1994, Page 2913, https://doi.org/10.1093/ajhp/51.23.2913 Published: 01 December 1994