Green Levine Medication Adherence Scale Research Articles

Patient, family, and community factors associated with medication adherence among people with hypertension or diabetes: A cross-sectional analysis

BackgroundWhile suboptimal medication adherence remains an obstacle to the management of hypertension and diabetes in China, few studies have investigated associated factors with medication adherence on different dimensions simultaneously. ObjectiveTo systematically examine associated patient, family, and community factors with suboptimal medication adherence among people with hypertension and/or type 2 diabetes in China. MethodsThe study stratified a random sample of 622 adults aged 45 years or older with hypertension and/or type 2 diabetes from three southeast cities in China in 2019. Trained interviewers used the Morisky Green Levine Medication Adherence Scale, Self-Efficacy to Manage Chronic Disease (SEMCD) Scale, and the Family Adaptability, Partnership, Growth, Affection, and Resolve (APGAR) Scale to assess medication adherence, self-efficacy, and family function, respectively. Participants also reported their perceived satisfaction with community health services (quantity, quality, affordability, and overall acceptance). The study used the multivariable logistic regression to assess the association of patient, family, and community factors with suboptimal medication adherence. ResultsAmong the participants, 42.9% reported suboptimal medication adherence. In the multivariable logistic regression model, male participants (odds ratio [OR] = 0.55, p = 0.001) had higher medication adherence compared to females. Having a self-efficacy score that was lower than or equal to the sample mean was significantly associated with lower adherence (OR = 1.44, p = 0.039). Participants unsatisfied with the affordability of community health services and medicine had lower adherence (OR = 2.18, p = 0.028) than those neutral or satisfied. There were no significant associations between family function and medication adherence. ConclusionsSex, self-efficacy, and perceived affordability of community health services were important factors associated with medication adherence. Healthcare professionals are recommended to consider multiple factors and leverage services and resources in community health centers when promoting medication adherence.

Effect of motor, non-motor clinical features including sleep quality, and prescription pattern on adherence to antiparkinsonian medications in Parkinson’s disease

Objectives: Adherence to antiparkinsonian medications (APMs) may significantly influence Parkinson’s disease (PD) outcome. The present study assesses the role of motor and non-motor features, and prescription patterns on adherence. Materials and Methods: This observational and cross-sectional study included 50 PD patients taking APMs for ≥24 months. Demographic data, PD characteristics, treatment, and follow-up history were collected. Patients following up at least once in six months were considered as regular, else were labeled irregular. Montreal cognitive assessment, patient health questionnaire-4, Pittsburgh sleep quality (SQ) index, Epworth sleepiness scale, global quality of life (GQOL) scale, and Morisky Green Levine medication adherence scale (MGL-MAS) were used to evaluate cognition, depressive and anxiety features, SQ, excessive daytime sleepiness (EDS), quality of life (QOL), and APMs adherence, respectively. Results: Nearly half (46%) of the PD patients reported high adherence (MGL-MAS = 0). Most of the clinical characteristics were comparable between those with medium/low and high adherence, except for a larger proportion of patients in the medium/low adherence group belonging to Hoehn–Yahr stage >2 (P = 0.02). A comparable proportion of patients in both groups reported poor SQ (P = 0.52) and EDS (P = 0.32). In comparison to the high adherence group, a significantly lower median GQOL score was observed in the medium/low adherence group (median [interquartile range] = 65 [50–70] vs. 80 [70–85]; P < 0.001). The APMs prescription and follow-up patterns were comparable between both groups. Conclusion: More than half the PD patients reported medium-to-low adherence. While motor severity and depressive symptoms were associated with medium-to-low adherence, poor SQ was comparable in both groups. Those with medium-to-low adherence reported poor QOL.

Satisfaction With and Adherence to Off-Label Corticosteroids in Adolescents and Adults With Eosinophilic Esophagitis: Results of a Web-Based Survey in the United States.

We assessed satisfaction with and adherence to off-label corticosteroids in patients with eosinophilic esophagitis (EoE) in the United States. EoE is a chronic inflammatory disease for which there are currently no US Food and Drug Administration-approved swallowed topical corticosteroids. This noninterventional, cross-sectional, web-based survey included caregivers of adolescents (aged 11 to 17 y) and adults (aged 18 years or older) with a self-reported [or caregiver-reported (adolescents)] physician diagnosis of EoE who were receiving corticosteroids. Participants were recruited through 2 nonprofit, patient advocacy groups. The 9-item Treatment Satisfaction Questionnaire for Medication (TSQM-9) was used to assess satisfaction across effectiveness, convenience, and global satisfaction domains (scale: 1 to 100 per domain); higher scores indicated greater satisfaction. The 4-item Morisky Green Levine Medication Adherence Scale (MGL-4) was used to assess adherence; an MGL-4 score of <3 indicated adherence. Participants also reported reasons for nonadherence. Overall, 201 participants (caregivers of adolescents, n=98; adults, n=103) were included in this study. Mean TSQM-9 scores indicated low satisfaction with off-label corticosteroids across all 3 satisfaction domains in adolescents (≤61.1) and adults (≤55.7). Slightly fewer adolescents (37.1%) than adults (40.8%) were considered adherent. Forgetfulness was the most frequently reported reason for nonadherence; some patients chose not to take their medications, owing to poor palatability (adolescents), difficulty taking medications at specific times (adults), or feeling depressed/overwhelmed (adolescents and adults). Satisfaction with and adherence to off-label corticosteroids were low in this web-based survey of adolescents and adults with EoE in the United States.

A PHARMACIST INTERVENTION ON KNOWLEDGE AND ADHERENCE IN PATIENTS WITH OPEN-ANGLE GLAUCOMA

Objective: The objective of the study is to assess the pharmacist’s intervention on knowledge and adherence in patients with open-angle glaucoma therapy. Methods: The study was conducted at the glaucoma outpatient department of Shree Rana Ambika Shah Eye Hospital, Rupandehi, Nepal. Census sampling was performed among the glaucoma patients meeting the inclusion criteria from August 2018 to November 2018. Data were collected using a structured questionnaire that included questions about demography, knowledge of glaucoma, medication adherence, and factors associated with medication non-adherence to glaucoma therapy. Each patient was counseled by a pharmacist, and the relevant information was provided in the form of an information leaflet. Knowledge level and adherence level were re-assessed during the follow-up visit after 1 month. The Morisky–Green–Levine medication adherence scale was used to assess adherence. Results: A total of 103 patients were enrolled in the study, and the majority of the patients were of age ≥59 years. After intervention by the pharmacist, the knowledge level on glaucoma improved from poor to good. Before intervention, about 31% of patients were adherent to the medication therapy, but after intervention, about 73% of patients were adherence to the medication therapy. There was a significant difference in the mean of the knowledge level score and the mean of the medication adherence score before and after intervention. The common causes of non-adherence were reported to be forgetfulness, a stressful life, and difficulties with medication time. Conclusion: The study demonstrates that pharmacist intervention is effective in improving both knowledge and medication adherence to open-angle glaucoma therapy.

Adherence to subcutaneous interferon beta-1a treatment among patients with relapsing multiple sclerosis: the MAIN-MS study

Introduction and backgroundAdherence is a critical factor for optimal clinical outcomes in multiple sclerosis (MS) treatment. This study investigated the adherence and clinical outcomes of MS patients treated with subcutaneous (sc) interferon (IFN) (β)-1a, an established immunomodulatory treatment for relapsing MS. The benefits of a patient support programme (PSP) were also studied.MethodsThis phase-IV prospective, observational multicentre study enrolled patients with relapsing MS who were treated with sc IFN β-1a for 24 months was conducted at 53 centres across 17 countries. The primary endpoint was adherence to sc IFN β-1a treatment, as assessed using Morisky Green Levine Medication Adherence Scale (MGLS) scores at 24 months. The MGLS is a self-reported diagnostic tool to address medication non-adherence, with a score ranging from 0 to 4, with 0 representing high adherence, 1–2 representing medium adherence, and 3–4 representing low adherence. Other endpoints included time to study and treatment discontinuation over 24 months, the proportion of relapse-free patients, and Expanded Disability Status Scale (EDSS) progression (defined as ≥1.0 point increase sustained for 3 months) at 24 months. A subgroup analysis was performed for endpoints based on patients assigned to PSP (yes/no—PSP versus non-PSP subgroup).ResultsOf the 577 patients enrolled, 408 had evaluable MGLS scores at 24 months. A total of 336 (58.2%; 95% confidence interval [CI]: 54.1–62.3%) patients reported high adherence, 57 (9.9%; 95% CIs: 7.6–12.7%) reported medium adherence, and 15 (2.6%; 95% CI: 1.5–4.3%) reported low adherence at 24 months. The PSP subgroup reported higher adherence (n = 206; 65.8%) than the non-PSP subgroup (n = 130; 56.5%). By 24 months, 52.2% of the patients were relapse-free and 17.2% patients experienced ≥1 relapse. Expanded Disability Status Scale progression was observed in 12.3% of patients. Over the 24-month period, 30.8% of the patients discontinued treatment, and the most common reasons for treatment discontinuation were adverse events (AEs, 10.4%), being lost to followup (7.1%), and a lack of efficacy (5.5%). Overall, 39.6% patients experienced ≥1 AE, which ranged from mild to moderate.ConclusionThe study demonstrated high adherence to sc IFN β-1a treatment with an added benefit of PSP participation. More than half of the patients remained relapse-free over a 24-month period. No new safety concerns to sc IFN β-1a treatment were observed.Clinical trial registrationhttps://clinicaltrials.gov/study/NCT02921035, NCT02921035.

37 Adherence to treatment in Multiple Sclerosis. The importance of personality, executive functions, and social support

Objective:To test whether adherence to treatment in patients with MS is influenced by cognitive variables (executive functions), personality, and social support.Participants and Methods:This is a pilot observational, descriptive, cross-sectional study. 60 patients with Relapsing remitting MS ( 73.33% female; age: 41.41 ±14.00) undergoing medical treatment ( 28 dymethilfumarate, 7 ocrelizumab/ rituximab, 6 fingolimod, 5 interferon, 5 natalizumab, 4 cladribine, 3 teriflunomide, 1 alemtuzumab, 1 glatiramer acetate) underwent a comprehensive multi-component evaluation including : cognition, social support (using the self-reported record of social support scale), personality (using the NEO-FFI questionnaire) and evaluation of treatment adherence using the Morisky Green Levine Medication Adherence Scale Participants were divided into two groups according to their adherence to medical treatment, low vs. high adherence was defined using a cutoff score of 4. Differences between groups were evaluated using Student's t-test with a significance level of p&lt;0.05, the effect size was calculated with Cohen's d test.Results:Groups did not differ significantly in age, sex, type of treatment, Montreal Cognitive Assesments (MoCA) or neuropsychiatric scales of depression and anxiety. Regardless of treatment type, 63.33% of the patients had high treatment adherence. Significant differences between groups were found in the Global Index of Social Support (p=0.016, Cohen's d= 0.73) and the responsibility factor of the NEO-FFI (p=0.048, Cohen's d= 0.20). Conversely, no significant differences were found in executive functions (p=0.8), Openness (p=0.062), Extraversion (p=0.5), Neuroticism (p=0.4) and Agreeableness (p=0.8).Conclusions:Social support and the responsibility factor of personality are significantly different between MS patients with high and low adherence to medical treatment. The study of social support and personality may be a key component in improving adherence strategies.

AB1854 CORRELATION OF THE OUTCOMES MEASURED BY THE PATIENTS AND BY THE MEDICAL TEAM ACCORDING TO THE LEVEL OF ADHERENCE AND AN EDUCATIONAL TOOL FOR PATIENTS

BackgroundThe level of adherence to treatment in patients with rheumatoid arthritis (RA) is important to achieve control of the disease. In turn, educational strategies in self-care and knowledge of RA help improve adherence and promote knowledge for self-measurement of clinimetry.ObjectivesThe purpose of this work was to evaluate the correlation of the clinimetry measurements made by the doctor (MM) with those made by the patient (PM) in a group of patients with education in their disease and to compare it with another group of patients without specific education, according to the level of adherence.MethodsA cross-sectional study was carried out that included adult patients with RA. Two groups were included, Group A: Patients with educational training in RA (12-14 months, face-to-face and virtual modules developed by an expert health group), Group B: Patients without training. Both groups measured their PM by means of a digital form and after one week they were evaluated (blind MM). Both PM and MM included global VAS, Fatigue, MDHAQ, RAPID 3 and EQ5, additionally the physician evaluated the DAS28, CDAI and the Morisky Green Levine Medication Adherence Scale. Correlations were made using the Pearson coefficient. The project was approved by the ethics committee.ResultsAll the participants were women (Group A: 28, Group B: 63). Group A had a significantly higher proportion of higher than secondary schooling, erosivity, nodularity, polyautoimmunity, anti-CCP positivity, treatment with biologics, older age, and disease duration. The total group had a low level of disease activity (DAS28). A significant correlation (Table 1) was found in all the MM variables with corresponding ones PM, with the highest coefficients in group A (except in MDHAQ). There was a significantly higher proportion of adherent patients in group A (78.5%) than in group B (42.8). When analyzing the correlations in the subgroup of adherent patients, all the coefficients increased (except global VAS), maintaining the same ratio of superiority of correlation coefficients in group A compared to group B.Table 1.Impact of education in patients with RA on clinical outcomes and the level of adherenceTotal groupAdherents onlyMMMMPMGlobal VASFatigueMDHAQRAPID-3EQ5Global VASFatigueMDHAQRAPID-3EQ5Global VASGroup A0,591**0,3390,651**0,706**-0,595**0,459*0,3690,537**0,598**-0,514*Group B0,498**0,255*0,397**0,493**-0,447**0,3250,2360,432*0,345-0,517**FatigueGroup A0,3700,578**0,3630,409*-0,2530,3910,661**0,542**0,469*-0,407Group B0,483**0,457**0,327**0,451**-0,415**0,440*0,510**0,480*0,425*-0,535**MDHAQGroup A0,3300,581**0,660**0,398*-0,525**0,2680,588**0,653**0,364-0,527*Group B0,372**0,330**0,679**0,514**-0,581**0,395*0,399*0,745**0,514**-0,744**RAPID-3Group A0,581**0,477*0,736**0,693**-0,658**0,457*0,518*0,659**0,602**-0,593**Group B0,581**0,370**0,614**0,658**-0,614**0,477*0,3350,631**0,549**-0,705**EQ5Group A-,634**-,575**-0,756**-0,705**0,865**-0,644**-0,665**-0,769**-0,761**0,791**Group B-,440**-,463**-0,593**-0,543**0,662**-0,506**-0,501**-0,728**-0,617**0,742**MM: Medic measures; PM: Patient measures. Group A: Patients with educational training in RA. Group B: Patients without training.**. The correlation is significant at the 0.01 level (bilateral). *. The correlation is significant at the 0.05 level (bilateral).ConclusionMM has a higher correlation with PM in patients with educational training in RA. These correlations are even greater in the group that is adherent to the treatment, persisting higher in the group with training. The results deserve to be replicated in patients with different levels of severity to those studied here.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsPedro Santos-Moreno Speakers bureau: Abbvie, Abbott, Biopas-UCB, Bristol, Janssen, Pfizer, Roche, Sanofi, Grant/research support from: Abbvie, Abbott, Biopas-UCB, Bristol, Janssen, Pfizer, Roche, Sanofi, NORALMA PINTO-FLOREZ: None declared, Liliana Realpe: None declared, Fernando Rodriguez: None declared, Gabriel-Santiago Rodríguez-Vargas: None declared, Jaime-Andrés Rubio-Rubio: None declared, Pedro Rodríguez-Linares: None declared, Adriana Rojas-Villarraga: None declared.

Statin adherence in patients with high cardiovascular risk: a cross-sectional study

ABSTRACT Objectives Statin adherence is an essential problem although lifetime medication is recommended especially in patients with high cardiovascular risk. The importance of perceived risk as a predictor of adherence among cardiology patients has not been fully explored. This study aimed to test the importance of perceived risk as a predictor of statin adherence amongst hypercholesterolemic patients to identify predictors associated with poor adherence. Methods This cross-sectional study was conducted at cardiology outpatient clinics of the University hospital in Ankara, Turkey. A total of 327 consecutive patients with high CV risk were recruited. Self-reported Morisky Green Levine Medication Adherence Scale was used to assess statin adherence. Results Of the patients studied, 34.5% had concerns about side effects. Also, the mean age was 63.85 ± 11.29 years, 66.1% were men, 32.4% applied non-drug alternative therapies, 53.2% had a Mediterranean-style diet and 20.8% checked their lipid values irregularly. Participants reported 50.2% high, 30% moderate, and 19.9% low statin medication adherence. Low-density lipoprotein cholesterol (LDL-C), Total Cholesterol (TC), Triglyceride (TG) and high-density lipoprotein (HDL) control rates were 44.6%, 74.3%, 61.5% and 41.6%. On multiple logistic regression, concern about side effects was associated with a statistically significant quadruple elevation of odds of non-adherence. Also, being male, former smokers, not having complementary interventions, having regular visits, being educated for more than 5 years, having low depressive symptom scores, living in a rural, being never or former smokers, employee were significant predictors of high medication adherence scores. Conclusion Approximately half of the patients reported high medication adherence. Proper strategies to improve adherence would include patient education efforts focused on patients with concerns about side effects and those who are female, less educated, current smokers, interested in complementary interventions, have irregular follow-up visits, and have depressive symptoms. Brief medication adherence scales may facilitate the assessment of patients’ adherence.

Adherence to Insulin Therapy Among Children with Type 1 Diabetes: Reliability and Validity of the Arabic Version of the 4-Item Morisky Medication Adherence Scale

BackgroundInadequate adherence to insulin is a major concern, necessitating the use of reliable and valid metrics for assessing adherence. Up to date, there are no Arabic validated tools assessing adherence to insulin therapy among children with type 1 diabetes (T1DM). Thus, the aim of this study is to evaluate the psychometric properties of an Arabic version of the four-item Morisky Green Levine Medication Adherence Scale (MGLS-4) as a self-reported measure of adherence to insulin among a cohort of Egyptian children with T1DM.MethodsThe MGLS-4 was translated using forward and backward translation. The Cronbach’s alpha was used to assess reliability. Criterion validity of the scale was tested by examining the correlation coefficients between the compliance score (level of adherence) and the HbA1c levels.ResultsA total of 400 patients completed the Arabic version of MGLS-4. 26.25% of the studied cohort was found to be non-adherent to insulin therapy; non-adherent patients were significantly older (P=0.001). Decreased maternal education level, decreased frequency of blood glucose monitoring and prolonged disease duration best predicted the occurrence of non-adherence among the studied cohort. The internal consistency of the current version showed good reliability (Cronbach’s alpha = 0.857). The adherence score and adherence level showed very strong correlation with HbA1c level (rho = 0.830, P < 0.001 and rho = 0.808, P < 0.001, respectively).ConclusionThe Arabic version of MGLS-4 showed good reliability and validity as a self-administered tool for assessing adherence to insulin in pediatric patients with T1DM.

Medication non-adherence and the achievement of therapeutic goals of anemia therapy among hemodialysis patients in Jordan

ABSTRACT Objectives Anemia is prevalent in hemodialysis (HD) patients. Data about factors associated with medication non-adherence in anemic HD patients is limited. This study examined determinants of medication non-adherence and its association with achievement of therapeutic goals of anemia measures among HD patients. Methods A cross-sectional study was conducted among a representative group of HD patients in Jordan. Medication adherence was assessed using Morisky Green Levine Medication Adherence Scale (MGL). Other utilized instruments were modified Charlson Comorbidity Index (mCCI), general Health-Related Quality of Life (HRQoL) EQ-5D-5 L, and Hospital Anxiety and Depression Scale (HADS). Pharmacy claim data during the years of (2016–2017) were also retrieved from patients’ medical records. Logistic regression was conducted to identify factors associated with medication non-adherence and achieving therapeutic goals of anemia therapy. Results More than two-thirds of the participants (69.1%) were found non-adherent and the mean score of MGL scale was 2.4 ± 1.4. The non-adherence rate measured using refill data (69.6%) was comparable to that observed using self-reported MGL instrument. Education level of college or over was significantly associated with lower odds of non-adherence (OR = 0.365, p = 0.036), while complaining of a headache was associated with 2.5-fold risk of medication non-adherence (OR = 2.5, p = 0.017). A trend toward better achievement of iron indices therapeutic goals was observed with improved adherence measured using refill data. Multiple factors such as improved knowledge about prescribed medications was significantly associated with achieving anemia therapeutic goals (p < 0.05). Conclusion The findings suggest poor medication adherence among HD patients with anemia. Future interventions by health-care providers should target modifiable factors to improve medication adherence and, hence, health outcomes among HD patients with anemia.

Is the Association between Herbal Use and Blood-Pressure Control Mediated by Medication Adherence? A Cross-Sectional Study in Primary Care.

Herbs have been used worldwide for many health conditions as an alternative treatment, including hypertension. Their use might affect the use of conventional medications, as well as blood-pressure control. This study aims to determine whether the potential associations between herb use and high blood pressure in hypertensive patients was mediated by medication adherence. A cross-sectional study was conducted using questionnaires and available medical databases at a primary care clinic of a tertiary hospital in Chiang Mai, Thailand. The data were collected from 450 patients with essential hypertension. Drug adherence was assessed by the Morisky Green Levine Medication Adherence Scale. The history of herbs used in the past three months was obtained. The goal of controlled blood pressure was defined in accordance with the Thai guidelines on the treatment of hypertension. Of the total 450 patients, 42% had high adherence. Nearly 18% reported herb use in the past three months. High medication adherence was strongly associated with blood-pressure control when adjusted for age, gender, education, the presence of comorbidities, and herb use (aOR 26.73; 95% CI 8.58–83.23; p < 0.001). The association between herb use and blood-pressure control did not achieve statistical significance (p = 0.143). However, the adjusted odds ratio of the association between herb use and blood-pressure control was diluted from 0.67 to 0.83 when adding the factor of medication adherence to the model. In conclusion, herb use was associated with poor medication adherence, which was in turn associated with poor blood-pressure control. Assessing this information contributes to appropriate exploration and counseling.

Patient adherence to statin therapy within 12 months after coronary stenting depending on regular or remote monitoring

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Russian Ministry of Health Background. Low adherence to statins remains a challenge in the treatment of patients with cardiovascular diseases. Some patients who underwent coronary stenting (CS) are unavailable for regular follow-up with outpatient visits. The ability to remotely monitor patients after CS may facilitate adherence to treatment, achieve target low density lipoprotein (LDL) cholesterol levels and early detection of adverse events. We aimed to evaluate the adherence to statin therapy in patients after CS receiving remote monitoring or care with outpatient visits. Methods. We enrolled 279 consecutive stable CAD/silent myocardial ischemia patients (61.5 ± 9.5 years) who underwent CS. The patients were randomized into groups of regular outpatient visits (group 1, n = 96), remote monitoring (group 2, n = 95) and control group (group 3, n = 88). The visits (cardio exam and blood testing) and remote monitoring (videoconference, telephone care and blood tests interpretation) were performed at 1, 3, 6 and 12 months after CS for groups 1 and 2. Patients in the control group were cared by a physician at the residence place, the contact with the study coordinator was performed at baseline and 12 months after CS. Adherence to the prescribed medical therapy based on the four-item Morisky Green Levine Medication Adherence Scale was assessed at each contact with the study coordinator. Results. Patient adherence to statin therapy 12 months after CS was 53.6% for group 1, 55.8% for group 2 and 24.4% for group 3 (p &amp;lt; 0.05 for group 3 versus groups 1 and 2). In group 1 26.9/36.5/31.7/37.4*/41.3*% of patients achieved target LDL level at baseline/1mo/3mo/6mo/12mo, respectively (р&amp;lt;0.05 vs. baseline). In group 2 - 35.8/36.8/40.0/51.6*/57.9*% of patients (р&amp;lt;0.05 vs. baseline). In group 3 25.5/28.2% of patients achieved target LDL level at baseline/12mo, respectively. The significant decrease in LDL cholesterol levels between baseline and 12mo values was observed in groups 1 and 2 (p &amp;lt; 0.05). No differences were observed in group 3. Conclusion. The groups of patients receiving remote monitoring or care with outpatient visits demonstrate the same increase in the proportion of patients that achieved target LDL cholesterol levels within 12 months after CS. The remote monitoring is a safe strategy for improving and maintaining the adherence to statins in patients after CS.

Patients with heart failure with mid-range ejection fraction: role of comorbidity

Abstract Funding Acknowledgements Type of funding sources: None. Patients with mid-range ejection fraction (HFmrEF) are still a ‘grey area’ for clinical practice. The aim of this study was to investigate comorbidity, quality of life and psychological status of patients with HFmrEF. Materials and methods. One hundred and four patients patients with CHF (69 males and 35 females, mean age was 61.7 ± 9.6 years) were studied. CHF was defined according to ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, 2016. Age-adjusted Charlson Comorbidity Index (ACCI) was calculated. Comorbidity was regarded as high at index ≥ 6 scores. Psychological state, cognitive functions, quality of life and adherence to treatment were estimated using MMPI, MMSE, SF-36 Health Status Survey, Four-Item Morisky Green Levine Medication Adherence Scale. Follow-up period was 12 months. Results. Forty-six (44.2%) patients had HFmrEF, 58 (55.8%) - heart failure with preserved ejection fraction (HFpEF). The Charlson comorbidity index did not differ depending on left ventricular (LV) ejection fraction (EF) (5.4 ± 2.1 points for patients with HFmrEF and 4.8 ± 2.1 points for patients with HFpEF, resp., p = 0.1). LV mass index (LVMI) was more in patients HFmrEF with than in patients with HFpEF: 213.4 ± 57.7 and 176.6 ± 44.3 g/m2, resp., p = 0.009. Patients with HFmrEF had a higher functional class HF (the 6 Minute walk test - 307.4 ± 92.4 m for patients with HFmrEF and 339.0 ± 78.7 m for patients with HFpEF, p = 0.02). Twelve (11.5%) died during the 12-month follow-up. Mortality depending on LVEF did not differ. Patients with HFmrEF had lower indicators of quality of life on the physical scale: physical functioning (36.3 ± 14.2 and 48.1 ± 13.3 points resp. p = 0.006) and on the psychological health scale (33.4 ± 5.3 and 35.8 ± 6.7 points, resp.,p = 0.03) compared with patients with HFpEF. The full adherence to treatment for both groups of patients was low (30%) and did not differ. Patients with HFmrEF had a higher profile of depressive-hypochondriacal conditions, primitive and maladaptive psychological defense mechanisms compared with patients with HFpEF. Conclusion. Patients with HFmrEF are characterized by more severe clinical course, lower quality of life and high frequency of depressive-hypochondriacal conditions, primitive and maladaptive psychological defense mechanisms in comparison with patients with HFpEF, which should be taken into account in the development of interdisciplinary approach to this category of patients.

Use of complementary and alternative medicine in patients with ankylosing spondylitis.

Some studies have shown that the use of complementary and alternative medicine (CAM) is common in patients with chronic painful conditions, such as ankylosing spondylitis (AS). This study aimed to determine the prevalence and types of CAM usage in patients with AS and to evaluate the impact of treatment adherence and beliefs about medicines on CAM usage. This study has a descriptive design. A total of 140 patients with AS were included. The treatment adherence of the patients was evaluated using the Morisky Green Levine Medication Adherence Scale. The Beliefs about Medicines Questionnaire (BMQ-T) was used to assess patients' beliefs about medicines. Previous or current CAM usage was stated by 40% of the patients. It has been found that CAM usage was significantly high (p<0.05) in patients who were married, older, and diagnosed at older ages. The difference between patients' beliefs about medicines and CAM usage was not statistically significant (p>0.05). The BMQ-T scores were significantly different in terms of the patients' treatment adherence (p<0.05). This study showed that approximately half of the patients with AS were using 1 CAM method. Furthermore, medication adherence and patients' beliefs about medicines did not have any impact on CAM usage, but the patients' beliefs about medicines affected treatment adherence.

Assessment of adherence to anti-tuberculosis treatment and predictors for non-adherence among the caregivers of children with tuberculosis.

Information on the extent of patient medication adherence and the use of interventions to advance adherence are scarce in clinical practice. This study aimed to assess medication adherence and risk factors for non-adherence among the caregivers of children with tuberculosis (TB). This prospective study was conducted among the caregivers of 443 child TB patients registered during the study. Caregivers of children were queried using a structured questionnaire consisting of sociodemographic and socio-economic factors and the role of healthcare workers during the treatment course. Risk factors for non-adherence were estimated using a logistic regression model. In multivariate analysis, the independent variables that had a statistically significant positive association with non-adherence were male sex (adjusted odds ratio [AOR] 5.870 [95% confidence interval {CI} 1.99 to 17.29]), age ≥45y (AOR 5.627 [95% CI 1.88 to 16.82]), caregivers with no formal education (AOR 3.905 [95% CI 1.29 to 11.79]), financial barriers (AOR 30.297 [95% CI 6.13 to 149.54]), insufficient counselling by healthcare workers (AOR 5.319 [95% CI 1.62 to 17.42]), insufficient counselling by health professionals (AOR 4.117 [95% CI 1.05 to 16.05]) and unfriendly attitude and poor support from healthcare professionals (AOR 11.150 [95% CI 1.91 to 65.10]). Treatment adherence in the present study was 86% using the Morisky Green Levine Medication Adherence Scale and 90.7% using the visual analogue scale tool. Predictors of non-adherence need to be a focus and caregivers should be given complete knowledge about the importance of adherence to TB treatment.

Diabetes distress and peripheral neuropathy are associated with medication non-adherence in individuals with type 2 diabetes in primary care.

Psychosocial factors like diabetes distress and social support, as well as the presence of complications, affect an individual's self-management ability; however, their role in adherence behaviours is not yet clear. We examined the role of psychosocial factors and complications in non-adherence behaviours in individuals with diabetes in primary care. Baseline survey with nine-month follow up through medical records of patients with type 2 diabetes attending primary care. Medication adherence and diabetes distress were assessed using Morisky Green Levine Medication Adherence Scale and Problem Areas in Diabetes, respectively. Appointment adherence was assessed through medical records. Of the 448 participants studied, 59.8% had medication non-adherence and 21.7% were non-adherent to scheduled appointments. PAID score (odds ratio (OR) 1.01, 95% confidence interval 1.00-1.03, p = 0.013), peripheral neuropathy (OR 1.99, 95%CI 1.18-3.37, p = 0.01), home glucose monitoring (OR 0.46, 95%CI 0.30-0.69, p < 0.001), HbA1c (OR 1.34, 95%CI 1.13-1.61, p = 0.001), and age (OR 0.96, 95%CI 0.93-0.98, p = 0.001) were associated with medication non-adherence. Indian ethnicity (OR 2.93, 95%CI 1.59-5.39, p = 0.001), secondary or higher education (OR 1.94, 95%CI 1.14-3.27, p = 0.014), and HbA1c (OR 1.38, 95%CI 1.18-1.63, p < 0.001) were associated with appointment non-adherence. Non-adherence behaviours were prevalent and significantly associated with higher HbA1c. Medication non-adherence was more likely in younger individuals, those with higher diabetes distress or peripheral neuropathy. Appointment non-adherence was more likely in individuals of Indian ethnicity or those with higher education. Greater support for these groups may help improve adherence behaviours and outcomes.

Cross-cultural adaptation of the Morisky Green Levine medication adherence scale for use in patients with Ischaemic Heart Disease in Sri Lanka

Official journal of the Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.Interested in submitting to this journal? We recommend that you review the About the Journal page for the journal's section policies, as well as the Author Guidelines. Authors need to register with the journal prior to submitting or, if already registered, can simply log in and begin the five-step process.

The Impact of a Slow-Release Large Neutral Amino Acids Supplement on Treatment Adherence in Adult Patients with Phenylketonuria.

The gold standard treatment for phenylketonuria (PKU) is a lifelong low-phenylalanine (Phe) diet supplemented with Phe-free protein substitutes. Adherence to therapy becomes difficult after childhood. Supplementing with large neutral amino acids (LNAAs) has been proposed as an alternative medication to Phe-free protein substitutes (i.e., amino acid mixtures). The aim of this study was to evaluate adherence to therapy and quality of life (QoL) in a cohort of sub-optimally controlled adult PKU patients treated with a new LNAA formulation. Twelve patients were enrolled in a 12-month-trial of slow-release LNAAs (1g/kg/day) plus a Phe-restricted diet. Medication adherence was measured with the Morisky Green Levine Medication Adherence Scale; the QoL was measured using the phenylketonuria-quality of life (PKU-QoL) questionnaire. Phe, tyrosine (Tyr) levels, and Phe/Tyr ratios were measured fortnightly. Before treatment, 3/12 patients self-reported a ‘medium’ adherence to medication and 9/12 reported a low adherence; 60% of patients reported a full adherence over the past four weeks. After 12 months of LNAA treatment, all patients self-reported a high adherence to medication, with 96% reporting a full adherence. Phe levels remained unchanged, while Tyr levels increased in most patients. The Phy/Tyr ratio decreased. All patients had a significant improvement in the QoL. LNAAs may give patients a further opportunity to improve medication adherence and, consequently, their QoL.

Уровень контроля бронхиальной астмы и приверженность терапии у пациентов молодого возраста

Background: asthma is a highly variable disease, with changes in the severity over months and years. In addition to achieving asthma control, many patients experience challenges in the long-term maintenance of this condition. Good symptom control is a volatile entity even in mild asthma. The loss of asthma control is accounted for by poor adherence to treatment due the fears of taking hormonal therapy, contact with an allergen, respiratory viral infections, and the inconvenience of using the inhaler resulting in incorrect inhaler technique. Aim: to assess the control over asthma and adherence to treatment in young patients with mild-to-moderate asthma. Patients and Methods: 146 patients with verified mild-to-moderate asthma were examined. All patients were divided into two groups based on disease severity. Results: at the time of examination, the lack of the control over asthma symptoms was reported in 89% of the patients. In mild asthma, mean Asthma Control Test (AST) score was 17 [15; 21] and АCQ-5 (Asthma Control Questionnaire) score was 1.8 [1.4; 2.2]. Meanwhile, in moderate asthma, mean AST score was 15 [12; 21] and АCQ-5 score was 1.8 [1.4; 2.2]. Poor medication adherence measured by the Morisky Green Levine Medication Adherence Scale was revealed in 94% of the patients with mild asthma and 91% of the patients with moderate asthma. Conclusion: poor patient’s knowledge on asthma and little awareness of the long-term importance of regular basic therapy are the critical factors contributing to poor medication adherence. Therefore, novel approaches to patient education as well as optimized and personalized therapeutic strategies are currently important for achieving and maintaining the control over asthma symptoms. KEYWORDS: asthma, asthma control, stable course, young patients, adherence to treatment. FOR CITATION: Leont’eva N.M., Demko I.V., Sobko E.A., Ishchenko O.P. Level of asthma symptom control and adherence to treatment in young patients. Russian Medical Inquiry. 2020;4(4):180–185. DOI: 10.32364/2587-6821-2020-4-4-180-185.

Beliefs About Medicine and Glycemic Control Among Type 2 Diabetes Patients: A Cross-Sectional Study in West Bank, Palestine.

Introduction:To examine the mean differences between patient beliefs about medicine with reference to adherence and glycemic control.Methods:This study utilized a cross-sectional questionnaire-based approach. Adherence to medication was measured with the Morisky Green Levine Medication Adherence Scale (MGLS); glycemic control as the last HbA1c test value; and beliefs about medicine with the Beliefs about Medicines Questionnaire (BMQ).Results:According to MGLS scale, 220 (57.9%) of the diabetic patients were classified as high adherent to their medications and 160 (42.1%) were classified as low adherent. Patients had strong believes in their medication, the mean necessity score was significantly outweighed the mean concerns score (17.7 vs 14.4; P < .001). Low adherent patients had significantly more concerns about long term effect of medications (14.4 vs 13.8; P < .008). No significant mean differences were found between glycemic controlled and uncontrolled group regarding necessity or concern domains.Conclusion:Assessing beliefs about medicine is crucial for recognizing patients at risk of low adherence, which offers a way to help patients with diabetes to achieve a better glycemic control.