Eight-item Morisky Medication Adherence Scale Research Articles

Prescribing Pattern and Medication Adherence in Patients with Epilepsy in a Tertiary Neuro-Center, Kathmandu

Abstract Background Epilepsy is a chronic condition characterized by unusual, frequent, excessive, and self-terminating neuronal firing. Adherence to medication is crucial to achieve the intended therapeutic outcome. However, not much research has been done on drug adherence in our context. Thus, the purpose of this study is to investigate the antiseizure medication prescribing pattern, medication adherence, and associated factors. Methodology A cross-sectional, analytical research was done on randomly selected epileptic patients through interview and documentary analysis using a semi-structured interview schedule and the eight-item Morisky Medication Adherence Scale (MMAS-8). The clinical and demographic characteristics were described using descriptive statistics (median, interquartile range [IQR], frequency, and percentage). The Shapiro–Wilk and chi-squared tests were used to examine the factors influencing medication adherence and the relationships between research variables. The analysis was performed using SPSS version 16. Result From a total of 104 patients, 77.3% were males, the median age was 29 years (IQR: 16), the majority (42.3%) had higher secondary education, 15.4% had secondary education and 5.8% were illiterate, 25% were job holders, 26% were laborers, 41.3% were from province 3, and 16.3% were from province 4. Two-thirds (63.5%) of the patients were highly adherent to antiseizure medication and 54.8% were seizure free for more than 2 years.The most common type of epilepsy diagnosed was generalized epilepsy (54.8%). Seizures were usually treated with monotherapy (65.4%), with sodium valproate being the most often used single antiseizure medicine (26.8%), followed by carbamazepine (16.3%) and levetiracetam (15.4%). Additionally, sodium valproate was the medication most frequently used in polytherapy for epilepsy. There was a strong association established between adherence and drug therapy type, age, adverse drug reaction, and seizure control. The study revealed that adherence was not significantly associated with factors such as gender, occupation, regional distribution, or type of epilepsy. Conclusion Low adherence was observed in 36.5% of patients. As a significant association was observed between medication adherence and seizure control, health care providers should focus on improving medication adherence. Evaluation of adherence needs to be a regular component of managing epilepsy. Further patients who do not stick to their drug regimens should receive more attention and assistance. It will support better therapy results.

Medication Adherence among Drug-Resistant Tuberculosis (DR-TB) Patients at Universitas Indonesia Hospital

Background: Drug-resistant tuberculosis (TB-DR) is a deadly disease caused by infectious agents. Indonesia is one of the countries with the highest drug-resistant tuberculosis (TB-DR) rates in the world. The prevalence of tuberculosis cases in Depok City between 2019-2022 showed an increase in cases every year. This study aims to measure the level of adherence of drug-resistant tuberculosis (TB-DR) patients to their treatment using the Eight-Item Morisky Medication Adherence Scale (MMAS-8) questionnaire.Methods: This study is an observational study using a cross-sectional study design, conducted from February 2024 to March 2024 at the University of Indonesia Hospital. Eighty-seven respondents participated in this study. Respondents completed the validated Indonesian version of the MMAS-8 questionnaire after signing informed consent forms.Results: The results of the study showed that 50.6% of respondents had low adherence levels, 47.1% had moderate adherence levels, and 2.3% had high adherence levels. The data was then statistically analyzed using the SPSS version 29 statistical package with Chi-Square analysis, which resulted in a significant correlation (P<0.05) between adherence levels and gender.Conclusion: There was a significant correlation between gender and respondent adherence. More than 50% of drug-resistant tuberculosis (TB-DR) patients at the University of Indonesia Hospital still have low adherence levels to their treatment.

Nonadherence to oral cancer chemotherapy in hepatocellular carcinoma: prevalence and predictive factors in Vietnam

PurposeStandard oral cancer chemotherapy (OCT) or targeted therapy (OTT) has expanded the treatment methods for hepatocellular carcinoma (HCC). However, its principal nonadherence causes a reduction in efficacy. We aimed to evaluate the status of nonadherence and influencing factors among outpatient patients with HCC.Patients and methodsIn 2021, a prospective observational study was conducted on 384 patients with either old or newly diagnosed HCC treated with OTT. Nonadherence to OCT was determined using the eight-item Morisky Medication Adherence Scale, with a score < 6 points. The patients were finished with a six-month follow-up investigation by questionnaires.Results54,8% of HCC outpatients were nonadherent to OCT, with a mean Morisky score of 5.19. They dropped out of the treatment mainly because of drug side effects, such as fatigue (72.4%), hand-foot syndrome (42.7%), diarrhea (38.3%), nausea (25%), insomnia (24.7%), abdominal pain (12%), and anxiety about these adverse events (65.9%). Additionally, financial difficulties and low relative copayments were significantly correlated with the noncompliant treatment of patients (OR = 2.29, 95% CI = 1.32–3.98, P = 0.003; OR = 4.36, 95% CI = 0.95–19.93, P = 0.039, respectively). Moreover, inadequate individual information about the clinical course, the art of treatment, and medication usage instructions were suggestive barriers to adherence to treatment (OR = 1.96, 95% CI = 1.08–3.55, P = 0.024; OR = 1.86, 95% CI = 1.1–3.14, P = 0.02; OR = 2.34, 95% CI = 1.29–4.26, P = 0.004, respectively). Finally, a low level of trust in doctors was an essential factor in nonadherence (Mean of the Anderson Trust in Physician Scale scores counted 38.12 vs. 43.97, respectively for non-adherence vs. adherence, P = 0.00001).ConclusionsThis study suggests a high rate of primary nonadherence to standard oral targeted therapy among HCC outpatient patients because of drug side effects, patient awareness of treatment, and lack of confidence in healthcare providers. Close supervision, proper medication instructions, appropriate dosage reductions, and comprehensive patient counseling might be necessary to control nonadherence.

Assessment of Medication Adherence Among Patients With Hypertension and Diabetes Mellitus in a Tertiary Healthcare Center: A Descriptive Study.

Introduction Effective management of diabetes and hypertension requires a comprehensive approach, including dietary adjustments, physical activity, routine screening for complications, and adherence to medication. Proper adherence to pharmacotherapy is essential for maintaining glycemic control and managing blood pressure. Non-adherence can result in increased complications, higher healthcare costs, and greater morbidity and mortality. This study aimed to evaluate the sociodemographic profile and medication adherence among adults with diabetes and hypertension, focusing on those undergoing treatment. The objective was to determine the extent of adherence and identify factors that influence adherence among patients with type 2 diabetes mellitus (T2DM) and hypertension. Methods A community-based study was conducted on patients with T2DM and/or hypertension in both rural and urban areas of Bhopal, specifically those attending JK Hospital, Bhopal, Madhya Pradesh, India. Participants were selected using a simple random sampling method. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8), a validated tool for measuring patient adherence behavior. Results The study included 300participants, of whom 68% (n=204) were maleand 32% (n=96) were female. The average age of the participants was 57.52±10.3 years. Among the 300patients, 9% (n=27) had high adherence to medication, 24.7% (n=74) had moderate adherence, and 66.3% (n=199) had low adherence. Conclusions Effective strategies must include targeted patient education on medication costs, side effects, and the long-term benefits of adherence. Integrating technological aids like smartphone apps may enhance adherence. Patients who adhere closely to their regimens are more likely to achieve better control over blood pressure and glycated hemoglobin (HbA1c) levels, underscoring the critical importance of adherence in managing chronic conditions effectively.

The Role of Pharmacist Intervention in Improvement of Patient Adherhence to Medication and in preventing Complication After Bariatric Surgery

Background: Bariatric surgery is the most successful treatment for obesity regarding the degree and duration of weight loss. Aim of the Study: Evaluate the impact of pharmacist educational intervention and training in improving patient adherence and its association with the prevention of clinical nutritional complications after bariatric surgery. Patient and Method: A randomized comparative interventional study was conducted in Najaf Governorate, Iraq. The Intervention group included 58 patients who received standard care and training educational and support programs. The standard care group included 58 patients who received standard care after Bariatric surgery. Results: In the intervention group, at 3 months of follow-up, the mean total score was 5.8 and increased to 6.7 at the 6 months. Conversely, the score decreased in the standard care group from 5.3 at 3 months to 2.2 at 6 months. In contrast to the standard care group, an inverse significant correlation was found between the number of incident complications and the total eight-item Morisky Medication Adherence Scale (MMAS-8) at 3 and 6 months in the intervention group. Conclusion: The pharmacist intervention leads to better patient adherence to guidelines after Bariatric surgery which results in decreased complications at three and six months after surgery.

IJCM_188A: Exploring Factors Influencing Medication Non-Adherence Among Urban Residents with Non-Communicable Diseases in Chengalpattu District: A Descriptive Cross-Sectional Study

Background: Medication non-adherence is a modifiable risk factor for non-communicable diseases (NCDs). WHO estimated the average rate of medication adherence to be around 50% in developed countries and to be lower in the developing countries. Objectives: To find the factors influencing medication non-adherence among patients diagnosed with NCDs in the urban areas. Methodology: A cross sectional study was conducted among 200 patients visiting Urban Health Training Centre, MAPIMS. A structured questionnaire was used to collect data on socio-demographic characteristics, risk factors, self-care practices, access to health care and family support to medication adherence. The outcome of the study was medication adherence measured using the eight-item Morisky medication adherence scale (MMAS-8). Results: Among the 200 participants with one or more non-communicable diseases (NCDs), the result found the prevalence of poor medication adherence rate to be 53.5%. Poor medication adherence was more prevalent in the older age group (39%, n=78), female patients (57.5%, n=115), with primary education (49.5%, n=99), unemployed individuals (58.5%, n=117), those without regular physical activities (63.5%, n=127) and classified as obese (43%, n=86). Conclusion: The study concluded that the prevalence of poor medication adherence was more common among NCD patients and the need to develop effective strategies to enhance medication adherence according to patient’s requirements through a holistic approach, by strengthening the primary health care system to achieve better health outcomes.

Treatment satisfaction with disease-modifying therapy is the only predictor of Adherence among multiple sclerosis patients from Upper Egypt

Despite the proven efficacy of the disease-modifying therapy (DMT) for multiple sclerosis (MS), the rates of non-adherence are frequently high. We aimed to evaluate the rate of non-adherence to the first DMT in Upper Egypt and identify different contributing factors. Out of 310 patients, ninety-seven adult patients with RRMS were recruited from three MS units located in Upper Egypt and were subjected to the following: complete clinical history, expanded disability status score (EDSS), Eight-item Morisky Medication Adherence Scale (MMAS-8), abbreviated Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9), Hamilton depression scale, Fatigue Severity Scale (FSS) and the Pittsburgh Sleep Quality Index (PSQI). According to MMAS-8 scores, 63 (64.9%) of patients were non-adherent to their first DMT. Non-adherent patients are more likely to have longer disease duration (p = 0.002), longer duration on first DMT (p = 0.030), first DMT-start date before 2019 (p = 0.040), and lower treatment satisfaction scores (p = 0.016). However, there was no significant relation with physical disability, depression, fatigue, or sleep quality. On the regression analysis model, a lower treatment satisfaction score was the only predictor of DMT non-adherence (p = 0.012). Despite expanding DMT options, non-adherence among MS patients in Upper Egypt is high. Treatment satisfaction with DMT is the only predictor of adherence among MS patients of Upper Egypt. Adherence and satisfaction with the prescribed DMT should be assessed carefully to maximize DMT benefits.

Anti-Hypertensive Medication Adherence and Associated Factors among Adult Hypertensive Patients at Dilla University Referral Hospital, South Ethiopia

Background: Hypertension is a global public health challenge that contributes to the burden of hypertensive heart disease, stroke, renal failure, premature morbidity, and mortality. The availability of effective antihypertensive medications didn’t bring expected outcomes in terms of adherence for antihypertensive medication. Objective: The aim of this study was to assess antihypertensive medication adherence and associated factors among adult hypertensive patients at Dilla university referral hospital, Southern Ethiopia, 2021. Methods: A hospital-based cross-sectional study was conducted, at Dilla University Referral Hospital from June 10, 2021, to July 10, 2021, and 205 study participants were selected from the study population using a systematic random sampling procedure. Patients in the study were interviewed while their medical records were reviewed using a data abstraction sheet. Adherence was assessed using an eight-item Morisky Medication adherence scale (MMAS-8); a MMAS-8 score of less than 6 was considered non-adherence, and a MMAS-8 score greater than or equal to 6 was considered adherence. Factors associated with adherence were identified using binary and multivariate logistic regression analyses. The crude odds ratio and adjusted odds ratio with a 95% confidence interval were calculated using SPSS version 20. Variables with a P-value &lt;0.05 in the multivariable analysis were assumed to be statistically significant factors. Results: 205 respondents were interviewed, with a response rate of 100%. More than half (57.6%) of the study participants were male. 65.3% (58.784–71.816) of the study participants were found to be adherent to their medication. Longer Duration of diagnosis of hypertension (AOR =0.280, 95% CI = 0.025–0.836), participants who can’t read and write (AOR = 0.40, 95% CI = 0.00-0840), and traditional drug users (AOR =0.15, 95% CI =0.003-0.489) were inversely significant associated with antihypertensive medication adherence. Conclusion: An adhesion level of 65.3% was found to be suboptimal. Traditional drug users, being uneducated and the duration of the diagnosis of hypertension were adversely influencing medication adherence. Therefore, routine health education and awareness creation are strongly recommended

Elderly and aged asthma have different characteristics: results of a multicenter study.

Characteristics of asthma in the elderly population is not well-known. The aim of the present study was to evaluate asthma in the elderly population, to compare disease characteristics between patients diagnosed <60 (aged asthma) and ≥60 (elderly asthma) years of age. The study was a prospective, multicenter, cross-sectional type. A questionnaire was filled out to patients 60 years of age and over, that have been followed for asthma for at least 3 months. Asthma Control Test (ACT), eight-item Morisky Medication Adherence Scale (MMAS-8) was filled out, inhaler device technique was assessed. A total of 399 patients were included from 17 tertiary care centers across the country. Mean age was 67.11 years and 331 (83%) were female. The age at asthma diagnosis was ≥60 in 146 (36.6%) patients. Patients diagnosed ≥60 years were older (p < 0.001), had higher education level (p < 0.001), more commonly had first-degree relative with asthma (p = 0.038), asthma related comorbidities (p = 0.009) and accompanying rhinitis/rhinosinusitis (p = 0.005), had better asthma control (p = 0.001), were using less controller medications (p = 0.014). Inhaler technique was correct in 37% of the patients with no difference in between the groups. Treatment compliance was better in elderly asthma patients (p < 0.001). In the multivariate logistic regression analysis, having well-controlled asthma (odds ratio = 1.61, CI = 1.04-2.51), and high medication adherence rate (odds ratio = 2.43, CI = 1.48-4.0) were associated with being in the elderly asthma group. The characteristics of asthma are different among patients aged 60 years and over which seems to be related to onset age of asthma. In our cohort, the elderly asthma patients had higher education level, and treatment adherence and asthma control was better. Patients diagnosed ≥60 years of age did not have more severe disease.

Adherence to Statin Among Diabetic Patients in Diabetic Centers in Qassim Region, Saudi Arabia.

Background Dyslipidemia affects approximately one-third of Saudi Arabia's adult population. Dyslipidemia, hypertension, diabetes mellitus (DM), smoking, and a familial predisposition to cardiovascular disease (CVD) are significant risk factors for CVD. It can be prevented effectively through lifestyle changes and lifelong statin therapy; however, poor adherence limits its effectiveness. This study is designed to assess the level of adherence to statin prescription in patients with DM in diabetic centers in the Qassim region and to assess the factors associated with neglecting to take medication. Methodology A cross-sectional study was conducted among 226 diabetic patients who were prescribed statins. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). Demographic and clinical data were collected, and multivariate logistic regression analysis was used to identify factors associated with medication adherence. Results Of the 226 patients, 29.7% had high adherence, 32.7% had medium adherence, and 37.6% had low adherence to statin medication. Patients diagnosed with diabetes for less than five years had the highest proportion of low adherence (41.2%). No significant associations were found between medication adherence and gender, nationality, or educational level. Conclusion The study found that medication adherence to statins in diabetic patients in the Al Qassim region of Saudi Arabia is suboptimal, with a significant proportion of patients having low adherence. Patients diagnosed with diabetes for less than five years had the highest proportion of low adherence, suggesting that patients with a shorter disease duration may require additional support or interventions to improve their medication adherence. Healthcare providers should emphasize the importance of medication adherence and work with patients to develop personalized treatment plans that include medication and lifestyle modifications to optimize lipid control and improve overall health outcomes in diabetic patients.

Association of Diabetes Management Self-efficacy with Adherence to Medication, Glycemic Control, and Disease Outcomes Among Type 2 Diabetes Patients

Background: Diabetes management self-efficacy (DMSE) positively affects diabetes self-care behaviors and can lead to better glycemic control and improved disease outcomes in diabetes patients. Objectives: This study aimed to evaluate DMSE level and its relationship with medication adherence, glycemic control, and diabetes complications among type 2 diabetes (T2D) patients. Methods: A cross-sectional study was carried out from November 2019 to January 2020 on T2D patients who attended the Diabetes Center of the Kerman University of Medical Sciences. Data were collected using two validated questionnaires including the diabetes management self-efficacy scale (DMSES) to evaluate DMSE level and the eight-item Morisky medication adherence scale (MMAS) to assess adherence to medication. The SPSS statistical software version 22 was employed for data analysis. Results: Of 440 T2D patients entering the study, 72% were female with a mean (SD) age of 59.60 (10.48). The mean (SD) DMSE score of the respondents was 5.76 (1.87). A significant negative correlation was observed between DMSE with HbA1c (r = -0.289, P &lt; 0.0001) and also with FBS (r = -0.229, P &lt; 0.0001), but there was a significant positive correlation between DMSE and adherence to medication (r = 0.208, P &lt; 0.0001). FBS level (β = -0.252, P &lt; 0.0001), number of visits by specialty or subspecialty physicians (β = -0.139, P = 0.002), medication adherence score (β = 0.165, P &lt; 0.0001), neuropathy (β = 0.142, P = 0.002), marital status β = 0.125, P = 0.004), household income (β = -0.126, P = 0.004), and blood glucose checks at home (β = 0.109, P = 0.013) were considered predictors of DMSE score. Conclusions: Diabetes management self-efficacy is considered suboptimal among T2D patients. Patients with higher DMSE have better adherence to medication, better blood glucose control, lower risk of neuropathy, and fewer visits by specialty and subspecialty physicians.

Family-centered empowerment approach to optimize phosphate management among hemodialysis patients: an experimental study

BackgroundThis study aimed to investigate the effect of a family-centered empowerment program on hyperphosphatemia management.MethodThis experimental study was performed on 80 randomly selected eligible patients with hyperphosphatemia undergoing hemodialysis. Patients were assigned randomly to two groups of family-centered empowerment program (FCEPG) and control group (CG) by coin toss (40 people per group). Data collection tools were the researcher-made Phosphate Control Knowledge Scale, the researcher-made Adherence to Dietary Restriction of Phosphorus Intake Scale, the eight-item Morisky Medication Adherence Scale, and serum phosphorus measurements. Data were collected before the intervention, one month, and three months after the intervention. Patients in FCEPG participated in a family-centered empowerment program. The statistical significance level was considered to be 0.05.ResultsInter-group comparisons showed no significant difference between FCEPG and CG in terms of the mean score of knowledge of phosphate control, adherence to dietary restriction of phosphorus intake, adherence to medication, and the mean serum phosphorus level before the empowerment program, but showed significant differences between them in these respects at one month after the program and three months after the program (p < 0.05). Intra-group comparisons showed a significant difference in FCEPG between the mean and standard deviation of all four variables before the empowerment program and the corresponding values one month and three months after the program (P < 0.05).ConclusionThe findings of this study can be used in various fields of healthcare in the hospital and community.

Effects of fatalism perception and attitudes towards complementary and alternative medicine on medication adherence in patients with epilepsy

: The present study was conducted to ascertain fatalism perceptions, attitudes towards complementary and alternative medicine, and medication adherence in patients with epilepsy, as well as to examine the effects of patients’ fatalism perceptions and attitudes towards complementary and alternative medicine on their medication adherence. : This descriptive and cross-sectional study was conducted with 150 people with epilepsy admitted to the Fırat University Hospital, Neurology Outpatient Clinic in Elazığ, in the eastern region of Turkey. The data were collected through face-to-face interviews using the “Patient Information Form,” “Fatalism Scale (FS),” “Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ),” and the “Eight-Item Morisky Medication Adherence Scale (MMAS-8).” : Of the participants, 45.3% had 5 or more seizures during the past year, 30% had simple partial seizures, 26.7% also had another chronic disease, 79.8% were receiving polytherapy, 86% used their medication regularly, 65.3% had been hospitalized during the past year, and 82% of them used complementary medicine both for the treatment of epilepsy and during seizures. For the FS and its subscale, the mean scores of the participants were found to be 3.39±0.71 for the overall scale, 3.26±0.71 for predetermination, 3.33±0.97 for luck, and 3.59±0.89 for pessimism. The mean scores for the HCAMQ and its subscale were 32.05±9.94 for the overall questionnaire, 12.99±6.01 for holistic medicine, and 19.07±4.75 for complementary and alternative medicine. The MMAS-8 mean score was 2.14±2.04. The FS variable was found to have a negative and significant effect on MMAS-8 scores. : Patients with epilepsy had a high level of fatalistic perception, positive attitudes toward complementary and alternative medicine, and a low level of treatment adherence. It was found that patients’ treatment adherence increased as their fatalistic perceptions decreased. It can be said that the use of CAM in patients with epilepsy is affected by fatalism.

Medication adherence in leukemia children receiving home-based treatment and its related factors

ABSTRACTObjectives:This study aimed to investigate home-based medication adherence in children with acute leukemia and its related factors.Methods:We examined 132 children with acute leukemia in a tertiary pediatric hospital in Chongqing. A general questionnaire, the MMAS-8 (the eight-item Morisky Medication Adherence Scale), SEAMS (Self-efficacy for Appropriate Medication Use Scale), and a multifactorial logistic regression model were used to analyze the factors related to drug adherence of the children.Results:54.55% of patients showed good medication adherence, while 50.76% either forgot a dose or administered an incorrect dose. The average score on the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) was 32.47.61. The logistic regression analysis revealed that a SEAMS score, the occupation of caregivers, and the patient’s age were predictors of medication adherence among pediatric leukemia patients (P < 0.05).Conclusions:The home-based medication adherence in children with acute leukemia was not favorable. Patients with low SEAMS scores, farmers serving as caregivers, and children under the age of three should arouse more attention. It is expected to strengthen the confidence of patient families in medication by emphasizing the development of their relationships with healthcare professionals. Awareness of breakthroughs in leukemia home-based medication management systems by utilizing Internet technology.

Abstract 38: A Novel Two-Question Antihypertensive Medication Adherence Scale Predicts Blood Pressure Control and Cardiovascular Disease Outcomes

Introduction: Poor medication adherence is a major contributor to uncontrolled hypertension, the leading preventable risk factor for CVD and mortality worldwide. Simple and accessible tools are needed to quantify medication adherence. We developed a novel two-question adherence scale in the Implementation of Multifaceted Patient-Centered Treatment Strategies for Intensive Blood Pressure Control (IMPACTS) trial and tested its prediction of BP control and CVD. Methods: We collected data on the IMPACTS Medication Adherence Scale (IMPACTS-MAS) and the eight-item Morisky Medication Adherence Scale (MMAS-8) in 1,206 IMPACTS participants. The IMPACTS-MAS consists of two questions, (1) “Over the last 7 days, on how many days did you not take any BP pills”, and (2) “Over the last 7 days, on how many days did you cut back on your BP pills?” and is categorized as low or high adherence. Linear and logistic mixed effects regressions examined the association between IMPACTS-MAS, MMAS-8, and uncontrolled BP. We also assessed IMPACTS-MAS in 33,995 China Rural Hypertension Control Project (CRHCP) participants studied at baseline and followed for CVD outcomes during a 36 month period. Cox regression examined the association between IMPACTS-MAS and CVD outcomes adjusting for treatment group, age, sex, education, and history of CVD. Results: The IMPACTS participants had an average age of 58 years and 56% (676/1,206) were female. Compared to high adherence, low adherence on IMPACTS-MAS and MMAS-8 was associated with 3.5 (95% CI: 1.9,5.1) and 2.6 (1.1,4.1) mmHg higher SBP , 2.5 (1.3,3.7) and 2.0 (0.87,3.1) higher DBP , and 73% [OR=1.73 (1.27,2.36)] and 68% [OR=1.68 (1.27,2.23)] higher uncontrolled BP (≥140/90 mmHg), respectively. The CRHCP participants had an average age of 63 years and 61% (20,825/33,995) were female. Compared to high adherence, low adherence on IMPACTS-MAS was associated with 3.6 mmHg (3.2,4.0) higher SBP , 0.89 mmHg (0.76,1.0) higher DBP , and with 42% [OR=1.42 (1.37,1.47)] higher uncontrolled BP , during follow-up. Further, low adherence was associated with 53% [HR=1.53 (1.30,1.81)] higher levels of CVD , 88% [HR=1.88 (1.11,3.17)] higher levels of myocardial infarction , and 54% [HR=1.54 (1.28,1.86)] higher levels of stroke during follow-up. Finally, low adherence was associated with 51% [HR=1.51 (1.31,1.75)] higher levels of CVD death and 47% [HR=1.47 (1.31,1.65)] higher levels of all-cause mortality , during follow-up. Conclusion: The novel two-question IMPACTS-MAS score is associated with BP control and predicts CVD outcomes and mortality in diverse populations. It is a simple, accessible tool that can be used in research and clinical practice to identify medication nonadherence.

Clinical Impact of Drug Adherence of Tyrosine Kinase Inhibitors in Children with Ph-Positive Acute Lymphoblastic Leukemia.

This study aimed to explore the impact of ABL1-tyrosine kinase inhibitors (TKIs) adherence on the survival of chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) children and clarify the potential predictors of patients' prognosis from TKIs intake practices. Ninety newly diagnosed Ph+ ALL patients who received TKIs were enrolled. We collected the baseline characteristics and adverse events in all children; moreover, TKIs adherence was measured by an eight-item Morisky medication adherence scale (MMAS-8). Progression-free survival (PFS) and overall survival (OS) analysis were performed, and risk factors for PFS and OS were evaluated. Among all patients, 69 cases were regarded as adherers, while 21 were non-adherers. The median duration of TKIs interruption was significantly prolonged in the non-adherence group than in the adherence group (13 [0-101] vs. 56 [11-128], p < 0.001). Additionally, dose reduction occurred in 55.2% of non-adherers versus 23.0% of adherers (p=0.002). The PFS and OS in adherers were significantly higher versus non-adherers (p=0.020 and p=0.039). MMAS-8 score was an independent risk factor for PFS (p=0.010) and OS (p=0.031). Among non-adherers, the median OS was only 23.1% (4.2%-42%) in patients aged ≤ 10 years versus 54.4% (38.8%-70%) in adolescents. Most of the patients who experienced TKIs non-adherence suffered pancytopenia. TKIs adherence during treatment significantly influenced the survival of pediatric Ph+ ALL patients, and non-adherers with age ≤ 10 years were more vulnerable to TKIs disruption. The cumulative TKIs dose should be especially emphasized to patients with age ≤ 10 years, which may result in an inferior achievement of relevant treatment milestones.

Medication Adherence of People Living with HIV in Japan-A Cross-Sectional Study.

Long-term medical care for people living with HIV (PLHIV) is critical for treatment efficacy, and various studies have examined reasons for antiretroviral therapy (ART) non-adherence. In Japan, doctors assume patients maintain high adherence. However, little is known about real-world treatment adherence. We conducted an anonymous self-administered web-based survey asking about adherence for a total of 1030 Japanese PLHIV who were currently on ART. Adherence was determined using the eight-item Morisky Medication Adherence Scale (MMAS-8), for which scoring ranged from 0 to 8 and scores < 6 points were classified as low adherence. Data were analyzed based on patient-related factors; therapy-related factors; condition-related factors, such as a comorbidity with depression (utilizing the Patient Health Questionnaire 9, PHQ-9); and healthcare/system-related factors. Among 821 PLHIV who responded to the survey, 291 responders (35%) were identified as being in the low adherence group. A statistically significant relationship was found between the number of missed anti-HIV drug doses within the previous 2 weeks and long-term adherence, per the MMAS-8 score (p < 0.001). Risk factors for low adherence included age (younger than 21 years, p = 0.001), moderate to severe depression (p = 0.002, using the PHQ-9), and drug dependence (p = 0.043). Adherence was also influenced by a shared decision-making process, including treatment selection, doctor-patient relations, and treatment satisfaction. Adherence was mainly affected by treatment decision factors. Hence, support of care providers should be considered critical for improving adherence.

Factors Associated with Medication Adherence among Patients with Type 2 Diabetes Mellitus: A Hospital-Based Cross-Sectional Study in Nepal.

As diabetes increases globally, high mortality increases due to complications of uncontrolled sugar. Medication adherence is important to control blood sugar and prevent its complications. Objective of the study was to identify factors associated with medication adherence among type 2 diabetes patients. A cross-sectional study was conducted among 343 patients visiting Dhulikhel Hospital, Nepal, for their fasting blood sugar test from September to December 2016. Inclusion criteria: patients with type 2 diabetes, under diabetes medication for past three months (minimum), age ≥ 18 years. The outcome of the study was medication adherence measured using the eight-item Morisky medication adherence scale (MMAS-8) (© 2006 Donald E. Morisky). Multivariate logistic regression was used for the analysis. Results showed that 61% of respondents had high medication adherence; adherence was positively associated with formal education [AOR: 2.43 (95% CI: 1.34, 4.39)] and attendance at diabetes counseling [AOR: 1.76 (95% CI: 1.02, 3.04)] after adjusting for age, occupation, medicine intake duration and diabetes medicine types. The study concluded that formal education and attendance at diabetes counseling positively affected patients' adherence to medicine. We encourage healthcare institutions to provide counseling services to all the patients with type 2 diabetes and focus more on those who are less educated.

Adherence to methotrexate and associated factors considering social desirability in patients with rheumatoid arthritis: a multicenter cross-sectional study

BackgroundAssessing medication adherence in rheumatoid arthritis (RA) is clinically significant as low adherence is associated with high disease activity. Self-reported medication adherence surveys have been shown to have problems with overestimation of adherence due to social desirability bias. However, no MTX adherence studies adjusted for social desirability have been conducted to date. This study aimed to evaluate adherence to MTX and perform an investigatory search for factors associated with MTX adherence including social desirability.MethodsThis cross-sectional multicenter study was conducted among adult RA patients consuming oral MTX for ≥ 3 months. We examined the distribution of MTX adherence, according to the eight-item Morisky Medication Adherence Scale (MMAS-8). Social desirability was using the Social Desirability Scale (SDS). Furthermore, an exploratory factor analysis involving social desirability was examined to identify factors associated with MTX adherence using linear regression analysis. To deal with missing values, we used multiple imputations with chained equations methods.ResultsA total of 165 RA patients were enrolled. The median age was 64 years, and 86.1% were women. Based on the MMAS-8, low, medium, and high adherences were noted in 12.1%, 60.0%, and 27.9% of participants, respectively. High social desirability (coefficient, 0.14; 95% confidence interval [CI], 0.05–0.23; p < 0.05) and high age (coefficient per 10 years, 0.16; 95% CI, 0.01–0.03; p < 0.05) were associated with high MTX adherence, whereas full-time work was negatively associated with high MTX adherence (coefficient, -0.50; 95% CI, -0.95–-0.05; p < 0.05).ConclusionsA large proportion of patients with RA do not take MTX as prescribed. High social desirability, high educational level, and non-full-time work may be associated with high MTX adherence. Physicians should confirm MTX adherence before switching or adding disease-modifying anti-rheumatic drugs in cases of uncontrolled disease activity.

Prevalence and Determinants of Medication Adherence in Patients with Multi-morbidities attending General Outpatient Clinics in Secondary Health Care Facilities in Kaduna State

Background: Multi-morbidity is a global public health issue which requires medication adherence to aid in the management. Poor adherence could lead to reduced quality of life, and mortality. This study was carried out to determine the prevalence and determinants of medication adherence among patients attending the general outpatient clinics in secondary health facilities in Kaduna State.&#x0D; Methods: This was a hospital-based cross-sectional study carried out among 119 patients attending the general outpatient clinics in secondary health facilities in Kaduna State. Respondents were selected via multistage sampling technique. Data was obtained from the respondents using a pre-tested interviewer-administered questionnaire. Medication adherence was assessed with eight-item Morisky Medication Adherence Scale (MMAS-8). Data was analysed using IBM SPSS Statistics version 23. Statistical significance was set at a p-value of &lt;0.05.&#x0D; Results: Seventy-four (62.2%) of the respondents were aged at least sixty years. The mean age of respondents was 60.3±13.6 years. Seventy-six (63.7%) of the respondents had low medication adherence. The older age (≥60 years) of the respondents (AOR=6.19, 95%CI=1.42-4.81, p=0.001), lack of education (AOR=5.74, 95%CI=1.39-3.42, p&lt;0.001), out-of-pocket spending (AOR=5.29, 95%CI=1.41-3.53, p&lt;0.001), low monthly income (AOR=3.39, 95%CI=1.53-4.81, p=0.004) and taking over 4 medications (AOR=8.25, 95%CI=1.26-5.13, p=0.002) were found to be predictors of low medication adherence.&#x0D; Conclusion: The finding of low adherence among majority of the respondents highlights the fact that achieving desired health outcomes will be a challenge. Improving this situation would require government interventions which are focused on social drivers of health as well as improving healthcare financing.