Importance Of Medication Adherence Research Articles

Abstract NS6: Connecting the Dots; a Pharmacist-Led Care Transition Model for Stroke Patients Post-Discharge

Background/Purpose: Stroke is a leading cause of adult disability worldwide, and one in four is due to recurrence, with the highest risk within the first 30 days post-discharge. Post-discharge follow-up is key to preventing hospital readmission and recurrent stroke. At our hospital, adult ischemic stroke (IS) patients are auto-enrolled in a pharmacist-led transitions of care program. Initially, our pharmacy team completes a medication history and reconciliation. Prior authorization and financial assistance services are offered. Patients who choose to remain enrolled are discharged with a 28-day supply of their medications, followed by all subsequent medications sent in adherence pill packs. Patients then receive a call 5-to-7 days post-discharge from a pharmacist to provide counseling on secondary stroke prevention and the importance of medication adherence. The pharmacist also ensures that the patient has scheduled follow-up appointments with both their primary care provider and the stroke clinic. Methods: In this retrospective cohort study, we included adult IS patients discharged from our center between October 2021 and July 2022. We compared those who chose to continue with our services beyond discharge with patients who opted out of our program. The primary outcome is medication adherence. The secondary outcome is the readmission rate. Results: Participation in our program resulted in an adherence rate of 98.5% compared with an adherence rate of 70.2% in those who declined to participate. Readmission was lower for participation, although not significantly so. Conclusions: Our program resulted in an improvement in medication adherence and a trend towards lower readmission rates amongst participating IS patients post-discharge. Further studies should be completed to examine the additional impacts of a pharmacist-led post-discharge program on secondary stroke prevention related to surrogate markers (Blood pressure, lipids, A1C, etc.) over time.

A TWO-YEAR RCT EXAMINING SPEED OF PROCESSING TRAINING ON EVERYDAY FUNCTIONING IN ADULTS WITH HAND IN THE US DEEP SOUTH

Abstract Approximately 44% of people living with HIV (PLWH) experience HIV-associated neurocognitive disorders (HAND). Cognitive training approaches, such as speed of processing (SOP) training, may reduce the detrimental impact of HAND on everyday functioning. In this experimental design study, 216 participants 40 and older with HAND or borderline HAND (82% Black) were randomized to one of three groups: 1) 10 hours of SOP training (n=70); 2) 20 hours of SOP training (n=73), or 3) 10 hours of Internet Navigation Control Training (a contact control group; n=73). Participants completed several everyday functioning measures at baseline, posttest, and year 1 and year 2 follow ups. Everyday functioning measures included: 1) Modified Lawton and Brody Activities of Daily Living (ADL) Questionnaire; 2) Timed Instrumental Activities of Daily Living (TIADL) Test; 3) Patient’s Assessment of Own Functioning (PAOFI); 4) Medication Adherence Questionnaire (MAQ); and 5) Medication Adherence Visual Analog Scale (VAS). Linear mixed-effect models and generalized estimating equation models were fitted to estimate between group differences at all follow-up time points. At follow-up timepoints, those in the 10-hour and 20-hour training groups performed better on medication adherence measures (MAQ and VAS) than those in the control group, with effects (Cohen’s d) ranging from 0.13 to 0.41 for MAQ and 0.02 to 0.43 for VAS. In conclusion, SOP training improved some indicators of everyday functioning, specifically medication adherence; however, the therapeutic effects diminished over time. This is an interesting finding given the importance of medication adherence in viral suppression and overall survival in PLWH.

Effect of patient education and healthcare campaigns on medication adherence in co-morbid patients

Co-morbidities are characterized by the presence of multiple chronic diseases within a single individual. They pose an escalating healthcare challenge and managing this growing burden, particularly with non-communicable diseases, has become a major concern. However, a significant impediment to effective management lies in medication nonadherence. The importance of medication adherence has long been a focus of healthcare literature, yet many comorbid patients tend to underestimate its significance, leading to health deterioration. Research studies indicate alarmingly low adherence rates in comorbid patients. To address this issue, patient education and healthcare campaigns have become essential tools in enhancing adherence. The research, which commenced on October 19, 2023, was initiated after an exhaustive review of existing academic literature. Multiple databases, such as PubMed, Web of Science, and Cochrane, were employed for this comprehensive literature review, utilizing a wide array of medical terminology combinations. The study aims to shed light on potential strategies and educational approaches to enhance medication adherence in comorbid patients. Findings from this research have the potential to influence healthcare policy, the design of tailored interventions, and overall healthcare delivery improvements for co-morbid patients, ultimately leading to enhanced health outcomes, reduced costs, and an improved quality of life.

Factors Associated with Adherence to Oral Antidiabetic Drugs among Patients with type 2 Diabetes Mellitus attending Diabetic Clinic at Jinja Regional Referral Hospital Jinja District

Diabetes Mellitus (DM) is a metabolic illness that causes excessive blood sugar levels as a result of either impaired pancreatic insulin production, insulin resistance, or both. People with diabetes mellitus die prematurely, and DM is a global burden. Adherence to drug regimens is essential in the management of diabetes mellitus, in addition to lifestyle changes. However, patients with diabetes are more likely not to take their medications as prescribed, and poor medication compliance jeopardizes patient safety and treatment efficacy, increasing mortality and morbidity. This study aimed to determine oral diabetes medication adherence and its associated factors among type two diabetes patients (T2DM) at Jinja Regional Referral Hospital. An institutional-based cross-sectional study of 136 T2DM patients was undertaken at Jinja Regional Referral Hospital in Jinja district. A convenience sampling technique was used to recruit participants, and the research was carried out from April 2022 to October 2022. The Morisky Medication Adherence Scale was used to assess medication adherence. STATA version 15.1 was used to analyze the data. To discover independent determinants of T2DM adherence, logistic regressions were used. To declare statistical significance, a P-value of less than 0.05 was employed. This study enrolled 136 type 2 diabetes patients, with a response rate of 100%. Overall, 58.33% of T2DM patients showed good medication adherence. T2DM patients who took both oraland injectable anti-diabetic medications (AOR = 1.98, 95% CI: 1.16-3.39), received the prescribedanti-diabetic medication from the hospital (AOR = 0.51, 95% CI: 0.32-0.80), had their own glucometer at home (AOR = 0.30, 95% CI: 0.16-0.54), and had good diabetes-related knowledgewere found to be more adherent to oral antidiabetic medication. At Jinja Regional Referral Hospital, there is a low prevalence of oral anti-diabetic drug adherence among patients with T2DM. Significant independent predictors of anti-diabetic treatment adherence included the type of medication that T2DM patients were taking, the ability of patients to receive their prescriptions from the hospital, having a glucometer at home for glucose monitoring, and having sound knowledge of diabetes. Patients should therefore receive more education on the importance of medication adherence, and as well be encouraged to purchase personal glucometers. Keywords: Diabetes Mellitus, Blood sugar levels, Insulin, Medication adherence, Oral antidiabetic.

The Importance of Medication Adherence in the Treatment of Actinic Keratosis: An Expert Consensus Panel

Background: Actinic keratosis (AK) is one of the most common dermatologic diagnoses. While there are several treatment options, many topical therapies have poor adherence due to duration of treatment and local skin reactions (LSRs).
 Objective: To review the available literature on the most commonly used patient-administered field-directed therapies for AK and create consensus statements on the role of medication adherence in improving AK outcomes.
 Methods: A literature search of PubMed was completed for English-language original research articles reporting efficacy, safety, and tolerability data for 5-FU, diclofenac gel, imiquimod cream, and tirbanibulin. Once the articles were selected, they were distributed to a panel consisting of seven dermatologists with extensive expertise in managing AKs. Each panelist reviewed the articles and assigned them a level of evidence based on Strength of Recommendation Taxonomy (SORT) criteria. The panelists then met to review and discuss the studies and created consensus statements on the management of AKs and the importance of medication compliance. A modified Delphi process was used to approve the adoption of each statement.
 Results: The literature search produced 1,326 articles that met search criteria. After screening these articles for relevance and applying the inclusion criteria, 17 articles were chosen to be reviewed by the panel and assigned a level of evidence based on SORT criteria. The panel then created six consensus statements that received a unanimous vote for adoption.
 Conclusion: While there are several options for the treatment of AK, there is little consensus on a standard of care. Clearance rates for the most common topical field therapies vary significantly but are also difficult to directly compare due to differences in methodology for measuring and assessing outcomes. Overall, it is clear that an efficacious, tolerable, and convenient treatment for AKs is critical to optimal adherence and management and, given the results of recent studies, tirbanibulin may be the best topical option for meeting these criteria.

Effectiveness of a structured pharmacist-delivered intervention for patients post-acute coronary syndromes on all-cause hospitalizations and cardiac-related hospital readmissions: a prospective quasi-experimental study

BackgroundAcute coronary syndrome (ACS) is a leading cause of mortality and morbidity in Qatar and globally.AimThe primary objective of the study was to evaluate the effectiveness of a structured clinical pharmacist-delivered intervention on all-cause hospitalizations and cardiac-related readmissions in patients with ACS.MethodA prospective quasi-experimental study was conducted at Heart Hospital in Qatar. Discharged ACS patients were allocated to one of three study arms: (1) an intervention group (received a structured clinical pharmacist-delivered medication reconciliation and counselling at discharge, and two follow-up sessions at 4 weeks and 8 weeks post-discharge), (2) a usual care group (received the general usual care at discharge by clinical pharmacists) or, (3) a control group (discharged during weekends or after clinical pharmacists' working hours). Follow-up sessions for the intervention group were designed to re-educate and counsel patients about their medications, remind them about the importance of medication adherence, and answer any questions they may have. At the hospital, patients were allocated into one of the three groups based on intrinsic and natural allocation procedures. Recruitment of patients took place between March 2016 and December 2017. Data were analyzed based on intention-to-treat principles.ResultsThree hundred seventy-three patients were enrolled in the study (intervention = 111, usual care = 120, control = 142). Unadjusted results showed that the odds of 6-month all-cause hospitalizations were significantly higher among the usual care (OR 2.034; 95% CI: 1.103–3.748, p = 0.023) and the control arms (OR 2.704; 95% CI: 1.456–5.022, p = 0.002) when compared to the intervention arm. Similarly, patients in the usual care arm (OR 2.304; 95% CI: 1.122–4.730, p = 0.023) and the control arm (OR 3.678; 95% CI: 1.802–7.506, p ≤ 0.001) had greater likelihood of cardiac-related readmissions at 6 months. After adjustment, these reductions were only significant for cardiac-related readmissions between control and intervention groups (OR 2.428; 95% CI: 1.116–5.282, p = 0.025).ConclusionThis study demonstrated the impact of a structured intervention by clinical pharmacists on cardiac-related readmissions at 6 months post-discharge in patients post-ACS. The impact of the intervention on all-cause hospitalization was not significant after adjustment for potential confounders. Large cost‐effective studies are required to determine the sustained impact of structured clinical pharmacist-provided interventions in ACS setting.Trial registrationClinical Trials: NCT02648243 Registration date: January 7, 2016.

Medication Nonadherence and Associated Factors among Heart Failure Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

Medication nonadherence, being one of the best predictors of hospitalization, increases the mortality rate and hospital readmission and reduces the quality of life of heart failure (HF) patients. Therefore, this study is aimed at assessing medication nonadherence and associated factors among HF patients at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. A cross-sectional study was conducted among 245 adult patients with HF from June to August 2017. The data were collected by using the medication Adherence Report Scale (MARS-5) and then entered and analyzed using SPSS® (IBM Corporation) version 24. Summary statistics were presented using frequency, proportion, and mean. Binary logistic regression analysis was done for identifying factors associated with medication nonadherence with a 95% confidence level and p value of less than 0.05. Among 245 patients with HF, about a quarter (23.7%) of them were medication nonadherent. More than one-third (37%) of HF patients had a history of at least one HF medication discontinuation. Refilling problems (48%) and getting better from the illness (27%) were the most commonly reported reasons for nonadherence. Presence of comorbidity (AOR = 2.761; 95%CI = 1.364, 5.589), taking three or more types of medication (AOR = 2.805; 95%CI = 1.404, 5.60), and being unmarried (AOR = 2.638, 95%CI = 1.279, 5.443) was significantly associated with medication nonadherence. The self-reported medication nonadherence among HF patients was considerably high. Refilling problems and getting better from the illness were the most commonly reported reasons for nonadherence. The presence of comorbid illness, taking three or more types of medication, and being unmarried was significantly associated factors of medication nonadherence. Awareness creation among patients on the importance of medication adherence and targeted efforts to assess and mitigate reasons for medication nonadherence may be helpful.

Prevalence of non-adherence to medications in people with type 2 Diabetes mellitus

Diabetes mellitus (DM) is a chronic, non-communicable disease that has an increasing incidence rate over time as well as increasing disease-related deaths. Furthermore, around half of diabetic patients are unaware actually about their disease, and more are not taking their medications. This study aimed to determine the extent of medication adherence and factors contributing to non-adherence among diabetic patients in Majmaah governance, Saudi Arabia. This is an observational cross-sectional study design conducted among patients with type 2 diabetes. A self- administered questionnaire was distributed among diabetic patients .The questionnaire consisted of socio- demographic data, HbA1c level, duration of DM, family history of DM, DM medications and 12-Item Medication Adherence Scale. 180 patients with diabetes type 2 were involved (71.7% females vs. 28.3% males). The prevalence of patients with uncontrolled HbA1c levels was 25%. Family history of DM constitutes 74.4%. The most preferred route for drug administration was oral (50.6%). High non-adherent to medication was found among 57.8%. The independent significant factor associated with high non-adherence to DM medication was uncontrolled HbA1c while being a female was the independent significant factor for low non-adherent to DM medication. The non-adherent of the diabetic patients regarding anti-diabetes medications was widely prevalent. Female patients tend to be more adherent to DM medication than their male counterparts. This study established the fact that uncontrolled glycated hemoglobin was a detrimental factor in adherence to anti-DM medications. More studies are required to raise the awareness of the diabetic population regarding the importance of medication adherence.

Demographic and Clinical Factors Associated with Re-admission in Patients Admitted to Psychiatric Hospital and Psychiatric Ward of General Hospital in 2011: A 7-Year Follow-Up after Discharge

Background: The present study aimed to investigate the relationship between patients’ demographic/clinical factors and readmission.
 Methods: This retrospective cohort study was conducted on all patients admitted to Iran psychiatric hospital and the Psychiatric Ward of Rasoul-e-Akram Hospital in Tehran in 2011. The study variable and post-discharge readmission status in a 7-years period until 2018 were collected by reviewing patients’ clinical charts, making telephone calls or studying patients’ records at Roozbeh Hospital. Thereafter, clinical factors such as Length of Hospital Stay (LOS), diagnosis, and medication compliance were evaluated by using statistical tests, including Meier-Kaplan survival analysis, Logrank test, and Cox regression analysis and SPSS software.
 Results: The present study was conducted on 1410 inpatients, 434 women (30.8%) and 976 men (62.9%), whose most common disorder was mood disorder. The diagnoses of the patients were recorded based on DSM-IV-TR. Among the patients readmitted, the mean time to readmission was 24.94 months. Among the demographic and clinical factors, the longer length of stay, more previous hospitalizations, inpatient physical restraint, lack of therapeutic compliance, and diagnosis of psychotic disorders has increased the odds of readmission (all p<0.01).
 Conclusion: To reduce the readmission rate among these patients, we need to use some methods to reduce readmission such as psychoeducation regarding nature of the disease, importance of medication adherence, and identifying warning signs that indicate the possibility of recurrence of the disease, especially more severe such as psychotic disorders. It is also recommended to avoid physical restraint, a factor of readmission risk, during hospitalization as much as possible.

Medication Compliance Analysis in Pulmonary Tuberculosis Patients at Bekasi Jaya Health Center Indonesia

Tuberculosis is an infectious disease caused by the bacterium mycobacterium tuberculosis. Compliance with taking medication is a key factor in the success of tuberculosis treatment. Medication non-adherence can increase the risk of treatment failure and relapse, and is considered one of the most important causes of drug resistance. Compliance with taking medication is the patient's actions related to patient compliance in the process of taking routine drugs and consuming routine drugs during the intensive and advanced stages of treatment as determined. Based on observations by distributing questionnaires at the Bekasi Jaya Health Center Indonesia in January to October 2021 for patient compliance, the results obtained were 62% obedient and about 38% of patients were not compliant in taking medication. The purpose of this study was to determine the analysis of drug adherence in pulmonary tuberculosis patients at the Bekasi Jaya Health Center. This study uses a descriptive quantitative research methodology with a cross sectional research design. The sample in this study is the total population of 37 people, and conducted by filling out a questionnaire by the patient. Data analysis was performed with Univariate and Bivariate analysis. The results of the univariate analysis in this study showed that the highest proportion of respondents who had higher education was 65%, respondents who did not work were 65%, good knowledge was 65%, the availability of health facilities and facilities of respondents who said complete was 65%, access to health services was 68% of respondents stated that it was not difficult, 86.5% of their family support was good, 68% of health workers' support was good. This study also found the results of bivariate analysis that there was a relationship between educational status (p = 0.039; PR = 2.46; 95% CI = 1.089-5.563), medication adherence (p = 0.039; QR = 2.46; 95% CI = 1.09-5.56), availability of health facilities and facilities (p = 0.039 ; QR = 2.46 ; 95% CI = 1.09 – 5.56), access to health services (p = 0.006 ; QR = 3.32; 95% CI = 1.46-7.85), family support (p = 0.039; QR = 2.46; 95% CI = 1.09 – 5.56), and support from health workers (p = 0.027 ; QR = 2.78 ; 95% CI = 1.24 – 6.21) with medication adherence. In addition, the study also found that there was no relationship between work status and medication adherence (p = 1,000; PR = 0.97; 95% CI = 0.42–2.3). The proportion of family support for tuberculosis patients was dominated, because of this, it is necessary to make efforts to increase public awareness of the working area of the health centerabout the importance of medication adherence in tuberculosis patients. The more active health workers and other related sectors, can increase the rate of adherence to taking medication for pulmonary tuberculosis patients in the work environment at Bekasi Jaya Health Center, Indonesia.

Abstract 217: Assessing Medication Non-Adherence In Heart Failure Patients: A Resident Driven Quality Improvement Initiative

Introduction: Non-adherence to guideline directed medical therapies (GDMT) is responsible for significant health care costs, morbidity, and mortality in heart failure (HF) patients. Assessing and improving medication adherence (MA) is challenging in this patient population given its multifactorial nature. We aimed to evaluate trainee assessment of MA in HF patients while identifying potential barriers to addressing MA during patient encounters. Methods: This was a single-institution study performed at a large safety net hospital in Atlanta. An anonymous questionnaire was used to assess MA strategies of interns, residents, and medical students for HF patients. This data was compiled and analyzed to identify the most commonly perceived barriers to medication non-adherence. Results: 100 surveys were returned. 99% (99/100) noted that addressing MA is important in HF patients. However, only 83% (83/100) reported that they discussed the specific reasons for non-adherence with their HF patients, with 9%, 12%, and 78% addressing MA in the outpatient, inpatient, and both settings, respectively; the lack of time was reported as the most common contributor in all settings. The most common reasons reported by trainees for patient non-adherence include misunderstanding of their regimen (71%), cost (62%), and polypharmacy (57%). Although, 40% (40/100) of survey responders believed that ≥50% of their HF patients were nonadherent, strikingly, only 12% (12/100) discussed these MA barriers at all HF patient visits. Conclusion: Improving outcomes in HF patients is multifactorial. Medicine teaching teams can play a crucial role in this process by recognizing and addressing the specific barriers to MA in HF patients while promoting GDMT adherence. Our study demonstrates that although trainees recognize the importance of MA, the unique patient characteristics that contribute to non-adherence are under appreciated. Our long-term goal is to not only identify these barriers, but to implement educational interventions, then re-assess trainee comfort level with discussing MA, to demonstrate that trainee driven interventions can improve MA in HF patients while simultaneously reducing HF related re-admissions and hospital costs.

Meta-Analysis: The Effect of Social Support on Medication Treatment Adherence in Tuberculosis Patients

Background: Tuberculosis is a disease that can be cured by various methods of treatment. How­ever, tuberculosis treatment is often not carried out properly and completely. The importance of medication adherence as a top priority in the effectiveness of treatment of tuberculosis patients through social support. The purpose of this study was to analyze the effect of social support on medication adherence in tuberculosis patients. Subjects and Method : This meta-analysis study used the PRISMA flowchart guideline with PICO, Population= Tuberculosis patients. Intervention= social support. Comparison= without social support. Outcome= medication adherence. The search process was carried out between 2017 and 2022 using Google Scholar, PubMed, Sci-Hub, and Science Direct databases. The keywords used were "Medication Adherence" OR "Drug Adherence" OR "Adherence" OR " treatment adhe­rence" AND "Tuberculosis" OR "multidrug resistant tuberculosis*" OR "Mycobacterium tuber­culosis Infection" AND "Social Support" OR "Social Support System" OR "Psychosocial Support System" OR "Support System". Based on the database, there are 10 articles that fulfill the inclusion criteria. Study analysis was using review manager 5.3 software. Results: There were 10 articles from the continents of Asia and Africa selected in this meta-analysis, the results showed that the presence of social support has the possibility to increase adherence to anti-tuberculosis treatment compared to without social support in tuberculosis patients and it was statistically significant (aOR= 2.10; CI 95%= 1.76 to 2.52; p< 0.001). Conclusion: Tuberculosis patients who have strong social support about tuberculosis adherence are more likely to adhere to anti-tuberculosis treatment. Keywords: tuberculosis, social support, medication adherence, meta-analysis. Correspondence: Lily Nabillah. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: lilynabillah09@gmail.com. Mobile: +62 821-1135-6435. Journal of Health Promotion and Behavior (2022), 07(03): 250-261 DOI: https://doi.org/10.26911/thejhpb.2022.07.03.07

Study on drug use pattern in the management of the cardiovascular diseases and with comorbidities

Background: Cardiovascular drugs are the number one cause of death globally; more people die annually from CVDs then from any other cause CVD. The purpose of this study to identify the rationality of drug prescribed for cardiovascular diseases with its comorbidities. Along with medication adherence and cost analysis. To assess the drug use pattern and to observe the drug related complications in patients with cardiovascular diseases.Methods: A hospital based prospective observational study was conducted at department of medicine in RMMCH. A total of 79 patients were enrolled based on inclusion criteria and the data was collected using designed data collection form.Results: Data of 79 patients were collected over 6 months mean age of patients with 19.95-60.5. Male to female ratio was 1.43:1. In cardiovascular diseases, most common disease conditions are systemic hypertension and acute coronary syndrome seen in our study population. Average drugs prescribed per patient was 4-9. Most frequently prescribed drug classes were beta blocker, antiplatelet, hypolipidemic agent. In these few minor drug interactions have been found. Study has no adverse drug reaction. The average cost of drugs was prescribed for 2500-3200 IND. Before patient counseling medication adherence and outcomes were less after counseling, medication adherence and outcomes are increased from 5% to 65%.Conclusions: The study concludes that most of the drugs were prescribed rationally according to world health organization/ESC guidelines. As behalf of this study, we could provide the information about the risk factor, leading commodities. Importance of medication adherence and cost of medications to cardiovascular drugs.

Importance of medication adherence in treatment needed diabetic retinopathy

We aim to investigate the role of medication adherence history in treatment needed diabetic retinopathy (TNDR). We conducted a retrospective nested case–control study using 3 population-based databases in Taiwan. The major one was the 2-million-sample longitudinal health and welfare population-based database from 1997 to 2017, a nationally representative random sample of National Health Insurance Administration enrolled beneficiaries in 2010 (LHID2010). The national death registry and national cancer registry were also checked to verify the information. The outcome was defined as the TNDR. The Medication possession ratio (MPR) was defined as the ratio of total days of diabetes mellitus (DM) medication supply divided by total observation days. MPR ≥ 80% was proposed as good medication adherence. The association of MPR and the TNDR was analyzed. Other potential confounders and MPR ratio were also evaluated. A total of (n = 44,628) patients were enrolled. Younger aged, male sex and patients with less chronic illness complexity or less diabetes complication severity tend to have poorer medication adherence. Those with severe comorbidity or participating pay-for-performance program (P4P) revealed better adherence. No matter what the characteristics are, patients with good MPR showed a significantly lower likelihood of leading to TNDR after adjustment with other factors. The protection effect was consistent for up to 5 years. Good medication adherence significantly prevents treatment needed diabetic retinopathy. Hence, it is important to promote DM medication adherence to prevent risks of diabetic retinopathy progression, especially those who opt to have low medication adherence.

Patients’ adherence to topical antiglaucoma medications in a tertiary care hospital

Abstract Objectives Adherence to glaucoma medications is a central factor to control intraocular pressure and manage glaucoma effectively. This study aims to assess the level of adherence of glaucoma patients to ocular hypotensive agents and determine factors contributing to non-adherence in the Aseer region. Methods This was a single-centre, prospective cross-sectional study carried out in Aseer Hospital, Saudi Arabia. Data were collected through a customized questionnaire adapted from the Morisky, Green and Levine Medication Adherence Questionnaire (MGLS). Key findings Of the 102 glaucoma patients, 63 (61.8%) were non-adherent to their glaucoma medications. About 48 (76.2%) of them reported that they have no background information about glaucoma. Older participants (37, 58.7%; >50 years) showed a low adherence level compared with the younger individuals. Contributing factors to non-adherence include forgetting the dose time (32, 50.8%), illiteracy (31, 49.2%; P = 0.313), economic problems (26, 41.3%; P = 0.286) and lack of information about prescribed medications (15, 23.8%; P = 0.188). Conclusions No significant relationship was found between medication adherence and patient’s demographic data or their background knowledge about glaucoma. Despite the need for improving the glaucoma patient’s knowledge of their disease and the importance of medication adherence, an additional strategy as alerts by smartwatches should be encouraged to improve the adherence level.

Effectiveness of educational intervention carried out by clinical pharmacists for the quality of life of patients with irritable bowel syndrome: A randomized controlled trial.

Background and AimIrritable bowel syndrome (IBS) is associated with repetitive gastrointestinal symptoms that greatly reduce the patient's quality of life (QoL). Training regarding IBS‐related knowledge, medication adherence, lifestyle, and diet adjustments has been demonstrated to strengthen patient QoL. The aim of this study was to evaluate the effectiveness of an educational intervention carried out by clinical pharmacists to improve the QoL of patients with IBS.MethodsOur research included data collected at the University Medical Center, Ho Chi Minh City, from April 2018 to December 2018, and was designed as a randomized controlled clinical trial. Patients with IBS were randomized into an intervention group (IG) and nonintervention group (NIG). The intervention program included training about IBS‐related knowledge, the importance of medication adherence, symptom recognition, lifestyle, and diet adjustments. Participants were followed up by monthly telephone calls. The outcome was the change in patient QoL scores (IBS‐QoL) 8 weeks after they took part in the research.ResultsOf 273 patients in the trial, there were 132 patients in the IG cohort and 141 in the NIG cohort. At 8 weeks, IG QoL score changes were statistically higher than those of NIG: 20.1 ± 12.1 (IG) versus 13.2 ± 13.4 (NIG). Furthermore, pharmacist intervention played an important role in increasing QoL after 8 weeks, as confirmed by multivariate regression analysis (B = 5.9; 95% confidence interval 2.4–9.4, P = 0.001).ConclusionsPatient education, lifestyle, and dietary intervention, administered by clinical pharmacists, improves IBS‐QoL compared to standard medical therapy over 8 weeks.

Importance of medication adherence and factors affecting it

Non-adherence leads to considerable morbidity, mortality and avoidable health care costs. adherence averages to only 50 % in patients suffering from chronic medical illness. Often, adherence and compliance are used interchangeably. Several determinants have been reported to influence adherence, like nature and duration of therapy, characteristics of disease, side-effects of medication, treatment cost, characteristics of health service facilities, the relation between the physician and patient, patient characteristics, patient’s perspective about the illness and therapy. The determinants of non-adherence according to World Health Organization (WHO) are categorized into five factors: socioeconomic, health system-related, therapy-related, condition-related and patient-related. Issues associated with medication non-adherence, which are diverse and complex have been extensively researched for decades and are documented well throughout the literature. In light of this, our study is focused specifically on providing an overview of factors affecting adherence and commonly used measures of medication adherence. Keywords: Adherence, Compliance, Treatment, Factors

Awareness about barriers to medication adherence in cardiovascular patients and strategies used in clinical practice by Portuguese clinicians: a nationwide study.

Although much is known about cardiovascular patients' medication adherence, the extent to which clinicians perceive non-adherence as a barrier in clinical practice is little explored. Objective To evaluate knowledge and awareness about potential barriers to medication adherence, and to evaluate strategies used in clinical practice by Portuguese clinicians on how to foster medication adherence of patients undergoing secondary cardiovascular prevention. Setting Nominal Group Technique (NGT) at the University of Lisbon; online survey addressed to physicians working in primary and secondary care in Portugal. Method A narrative literature review was conducted in Pubmed to identify studies describing interventions targeted at physicians to manage medication adherence. The NGT included 12 allied healthcare professionals with recognized expertise in medication adherence and was organised in four phases, resulting in survey development. The survey was used in a cross-sectional national study where clinicians reported their knowledge and perceptions about patients' medication adherence and their daily practice. Main outcome measures Knowledge and awareness about barriers to medication adherence; and practice patterns. Results A total of 296 papers were identified, 26 of which were included. Four main topics were selected to be used in the NGT: adherence determinants, detecting non-adherence, fostering adherence, and educating physicians. NGT resulted in a survey, reaching 451 physicians, mostly practicing in primary care. Most had specific education on medication adherence and considered patient interviews and prescription records the most useful assessment methods. Nonetheless, many recognised often using clinical judgement to evaluate adherence in practice. Barriers to medication adherence were perceived to occur often during implementation. Most perceived reasons for uncontrolled hypertension were non-adherence to lifestyle recommendations and to medication. Less than half the physicians asked their patients if medication was taken. More useful enabling strategies included reducing daily doses, reviewing therapeutic options and motivational interventions. Conclusions Clinicians seem well informed about the importance of medication adherence and aware of problems encountered in practice. Limited time during medical appointment may be a barrier for better patient support.

"She Just Told Me Not To Cry": A Qualitative Study of Experiences of HIV Testing and Counseling (HTC) Among Pregnant Women Living with HIV in Tanzania.

HIV testing and counseling (HTC) in antenatal care is extremely effective at identifying women living with HIV and linking them to HIV care. However, retention is suboptimal in this population. We completed qualitative interviews with 24 pregnant women living with HIV in Tanzania to explore perceptions of HTC. Participants described intense shock and distress upon testing positive, including concerns about HIV stigma and disclosure; however, these concerns were rarely discussed in HTC. Nurses were generally kind, but relied on educational content and brief reassurances, leaving some participants feeling unsupported and unprepared to start HIV treatment. Several participants described gaps in HIV knowledge, including the purpose of antiretroviral therapy and the importance of medication adherence. Targeted nurse training related to HIV disclosure, stigma, and counseling skills may help nurses to more effectively communicate the importance of care engagement to prevent HIV transmission and support the long-term health of mother and child.

IMPACT OF PATIENT COUNSELING ON HEALTH KNOWLEDGE AND MEDICATION ADHERENCE IN ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS

Objective: This study evaluated the impact of clinical pharmacist-led intervention in health knowledge and medication adherence of Asthma and chronic obstructive pulmonary disease (COPD) patients.
 Methods: Questionnaires were designed to assess Health knowledge for Asthma and COPD separately. Medication adherence was measured by using the Morisky Medication Adherence Scale-8. Pre-counseling patient responses were recorded. Patient counseling was given regarding the disease condition, medications, and medication use at baseline visit. Patient responses were re-measured upon follow-up visit. The data extracted were tabulated, statistically analyzed and the results were obtained.
 Results: A total of 141 patients completed the study. Before counseling, the mean (±standard deviation) of knowledge and adherence levels were found to be 8.51±3.36 and 5.01±2.11, respectively. After counseling, they increased up to 12.72±2.16 for knowledge (p<0.0001) and 6.60±1.35 (p<0.0001) for medication adherence. The majority of subjects had about 11–30% increase in knowledge as well as medication adherence. Male patients were more adherent to their medication regime than females.
 Conclusion: The study demonstrates the positive impact of education and counseling provided by a clinical pharmacist in achieving better therapeutic outcomes – through improvement in medication adherence and health knowledge. In conclusion, continuous education programs and patient counseling should be conducted for chronic diseases to reiterate the importance of medication adherence and, in turn, prevent recurrences, arrest disease progression, minimize hospitalization, and ultimately improve quality of life.