Improve Patient Medication Research Articles

Scoping review of enablers and challenges of implementing pharmacogenomics testing in the primary care settings

IntroductionPharmacogenomic testing (PGx) plays a crucial role in improving patient medication safety, yet ethical concerns and limitations impede its clinical implementation in the primary care settings.AimsTo systematically review the current...

Exploring medication self-management in polypharmacy: a qualitative systematic review of patients and healthcare providers perspectives.

Purpose: Polypharmacy presents many challenges to patient medication self-management. This study aims to explore the self-management processes of medication in polypharmacy from the perspectives of both patients and healthcare providers, which can help identify barriers and facilitators to effective management. Methods: A systematic review of qualitative studies was performed by searching seven databases: PubMed, Web of Science, Cochrane Library, Embase, CINAHL, PsycINFO, and MEDLINE, from their establishment until August 2024. The Critical Appraisal Skills Programme (CASP) tool was employed to evaluate the quality of the studies included. The extracted data were then analysed thematically and integrated into The Taxonomy of Everyday Self-management Strategies (TEDSS) framework. Results: A total of 16 studies were included, involving 403 patients and 119 healthcare providers. Patient management measures were mapped into TEDSS framework, including categories such as medical management, support-oriented domains, and emotional and role management. Conclusion: Enhancing patients' proactive health awareness, improving medication literacy, balancing lifestyle adjustments with medication therapy, dynamically reviewing and optimizing medications, strengthening patients' social support networks, and helping patients integrate medication management into their daily life are the key elements that can effectively assist patients in self-managing their medications. Future interventions to improve patient medication self-management ability should be designed for these issues. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024524742.

Pharmacist initiated interventions using RxChange message communication with prescribers for electronic prescriptions: A retrospective descriptive study

BackgroundRxChange messages improve patient medication management by enhancing pharmacist-prescriber communication, but their usage patterns in the United States are not well-documented. ObjectiveTo determine intervention characteristics by pharmacists and prescribers using RxChange messages. MethodsA retrospective analysis of electronic prescription and RxChange messages from 2022 to 2023, using data from Surescripts, LLC, was conducted. This included NewRx messages and RxChange Responses, categorized by 7 RxChange use cases and Anatomical Therapeutic Chemical level 4 medication classes. Descriptive statistics and nonparametric tests were used for statistical analysis. ResultsThe study analyzed 1,361,528 RxChange messages. Therapeutic interchange was the predominant use case (76.14%). Direct approvals accounted for 10.44% of requests, approvals with changes for 42.55%, and denials for 47.01%. Script clarification had the highest approval rate (64.21%), while prior authorization faced the most frequent denials (73.38%). The top denial reason was "Request addressed through alternate methods such as phone or fax (41.50%).” The most frequent drug classes observed in the data were selective beta-2 adrenoreceptor agonists, extended-spectrum penicillins, selective serotonin reuptake inhibitors, and glucagon-like peptide 1 analogues. Time from new e-prescription issuance to RxChange request submission was longer than from request to response, with a significant statistical difference (median 1.57 vs 0.27 days, P-value < 0.05). ConclusionThis study highlights interventions pharmacists make using RxChange with electronic prescriptions to improve patient care and medication safety. It underlined the need for improved RxChange message content and data on the effectiveness of RxChange messages in improving medication use.

Innovative Approaches to Enhance and Measure Medication Adherence in Chronic Disease Management: A Review.

Medication non-adherence is a problem that affects up to 50% of patients with chronic diseases. The result is a failure to achieve therapeutic goals and an increased burden on the healthcare system. It is, therefore, highly appropriate to develop models to assess patient adherence to prescribed therapy. To date, there are many methods for doing this. However, several tools have been developed that subjectively or objectively, directly or indirectly, assess the level of patient adherence. Electronic medication packaging devices are among the most rapidly evolving methods of measuring adherence. Other emerging technologies include the use of artificial intelligence algorithms and ingestible biosensors. The former is being used to create applications for mobile phones and laptops. The latter appears to be the least susceptible to the risk of overestimating adherence but remains very expensive. Here, we present recent developments in measuring patient adherence, and provide details of achievements in objective methods for assessing adherence, such as electronic monitoring devices, video-observed therapy, and ingestible biosensors. A dedicated section on using artificial intelligence and machine learning in adherence measurement and reviewing questionnaires and scales used in specific diseases is also included. Methods are discussed along with their advantages and potential limitations. This article aimed to review current measures and future initiatives to improve patient medication adherence.

Factors Influencing Insulin Adherence among Outpatients with Type 2 Diabetes Mellitus and the Impact of Pharmaceutical Intervention: A Randomized Clinical Trial

Aims. This study aimed to identify and analyze the factors significantly influencing long-term insulin medication adherence among outpatients and to evaluate whether pharmaceutical interventions targeting these factors can improve patient medication adherence and glycemic control. Methods. A cohort of 180 patients was recruited from a tertiary hospital in Nanjing, China. Factors potentially influencing insulin adherence were scrutinized employing the KAP (knowledge, attitude/belief, and practice) health behavior model. Baseline characteristics were extracted from the hospital information system, while patient knowledge of the disease and medication, medication adherence, medication beliefs, and management self-efficacy were assessed, respectively, using self-developed questionnaires, MMAS-8, C-DMSES, and BMQ scales. Univariate and multivariate analyses were conducted to determine the impact of these factors on insulin adherence. Following this, participants were randomly allocated to either the intervention or control group. The intervention group received three months of weekly telephone sessions and educational interventions targeting facets such as medication knowledge and beliefs, while the control group received standard care. After the intervention, insulin adherence and glycemic control conditions of both groups were collected and re-evaluated. Results. After excluding lost-to-follow-up patients, 152 individuals were analyzed (intervention: 75 and control: 77). Multivariate analyses revealed factors influencing insulin adherence, including age, diabetes duration, health insurance status, HbA1c level, disease and medication knowledge, diabetes management self-efficacy, and medication beliefs (P&lt;0.05). Before targeted pharmaceutical care, no significant differences existed in insulin adherence, HbA1c levels, management self-efficacy, knowledge, or medication beliefs between intervention and control groups (P&gt;0.05). However, subsequent pharmaceutical intervention notably improved adherence, HbA1c levels, self-efficacy, knowledge, and medication beliefs (P&lt;0.05). Conclusion. This study examines the impact of glycemic control, health insurance status, management self-efficacy, level of knowledge, and medication beliefs on improving insulin medication adherence in patients with type 2 diabetes mellitus. Targeted pharmaceutical intervention can enhance medication adherence, improve glucose control, and promote rational insulin use. This trial is registered with ChiCTR2300074444.

Telepharmacy intervention: Can it impact medication adherence among patients with chronic disease?

Background: Medication adherence among patients with chronic diseases remains challenging for healthcare professionals. The large number and types of drugs that must be taken in the long term and the lack of knowledge related to drugs and diseases are factors that affect patient compliance. Telepharmacy is expected to improve patient medication adherence by providing easy access to consult with pharmacists. Objective: To assess the effect of telepharmacy on chronic patient medication adherence. Methods: This study had a cross-sectional study design, and the study population was Lifepack application users. The data was collected through an online questionnaire distributed through the Lifepack platform. The adherence was evaluated using the Morisky Medication Adherence Scale, and the association of telepharmacy and patient medication adherence was examined using the chi-square independence test with significance at p &lt; 0.05. Results: In a study comprising of 94 respondents, a proportional ratio of respondents who used and did not use telepharmacy services was observed (45.75% and 54.25%, respectively). Analysis using the chi-square statistic (χ²) demonstrated a significant association between telepharmacy and patient adherence (χ² = 64.745, df = 1, p &lt; 0.001). Furthermore, the odds ratio (OR) revealed a substantial difference in adherence, with an OR of 122.67 (95% CI [27.58, 545.66]). Conclusion: Telepharmacy has a significant impact on medication adherence in chronic patients.

What should be done to improve the efficiency in dispensing-related tasks

Objective: To determine areas in which pharmacists believe efficiency should be improved in dispensing-related tasks and understand the needs in health care settings. Methods: A web-based survey was conducted among pharmacists in Japan to identify dispensing-related tasks that could be improved to increase pharmacists’ work efficiency. Descriptive statistics and chi-square tests were used for analysis. Results: Overall, 549 responses were analysed. Respondents included 301 (54.8%) community pharmacy pharmacists, 36 (6.6%) drugstore pharmacists, and 212 (38.6%) hospital pharmacists; 423 (77.0%) pharmacists had been working for more than 10 years. The results showed that 90.9% of pharmacists recognised the need to improve efficiency in dispensing-related tasks and to focus on interpersonal tasks. Regarding tasks that should be made more efficient, pharmaceutical inventory management, dispensing of one-dose packages, and counting dispensing were suggested by 66.8%, 46.3%, and 42.4% of respondents, respectively. If they could streamline their business, improving patient medication guidance and follow-up as well as investigating new drugs and diseases were reported by 40.8% and 38.8% of pharmacists, respectively. Conclusions: This survey research has identified dispensing-related tasks that need to be improved in terms of efficiency to meet the social needs of pharmacists.

Nurses Monitor Medication with a Schedule for Undrop-Out Program (SRAGAM) for TBC Clients

Regulation Minister of Health Republic Indonesia Number 15 of 2022 through 6 pillars of health transformation, one of which is primary service, namely medication adherence education. Ministry of Health Republic Indonesia, (2020) the 2020-2024 RPJMN policy directions and Sustainable Development Goals (SDGs) regarding six diseases, one is Tuberculosis (TBC). TBC prevalence in Southeast Asia (44%), Indonesia (8.5%), Lampung (40.2%), and South Lampung (41%). Indonesia's strategy to reduce the incidence of TBC has six plans: the 2020-2024 national tuberculosis program, optimizing promotion and prevention efforts, providing tuberculosis prevention treatment, and controlling. TBC treatment 6-24 months resulted in drop-out treatment. Nurses play a supervisory role and carry out counseling to increase patient adherence. The Schedule For Undrop-Out Program (SRAGAM) is a media innovation to improve patient medication adherence. SRAGAM makes it easier for patients, PMOs, and health workers to arrange medication-taking schedules. The purpose is to determine the effect of SRAGAM on increasing patient adherence. Research is a quantitative one-group pretest-posttest with a control group preexperimental design. Respondents were patients who were taking drugs. The number of samples was 32 respondents (16 intervention:16 control). The research was from December 2022 to May 2023 in Hajimena Health Center, South Lampung. Data analysis using t-test. The results of the study mean value intervention group (5.6875) and control group (4.1250). The P-value of 0.000 concluded that SRAGAM effectively increased the number of patients taking medication. The results will become educational media in preventing the incidence of dropping medication in patients.

An education-based telehealth group improves the management and clinical outcomes of patients with inflammatory bowel disease in China (THEIM study).

Although poor medication adherence has a negative impact on disease prognosis in patients with inflammatory bowel disease (IBD), finding proven solutions remains a challenge. In this study, we developed a telehealth management model based on education and patient-centered medical care (PCEB) using the social media platform WeChat. To investigate the effect of PCEB on adherence and clinical outcomes. In this retrospective cohort, 543 IBD patients (274 in the PCEB group and 269 in the routine group) at the IBD center of Renmin Hospital (Wuhan University, Wuhan, China) were enrolled between January 2020 and September 2022. The routine group received routine follow-up and management, while for PCEB patients, a comprehensive IBD education program and PCEB were conducted. Medication adherence and clinical outcomes were also evaluated. There were no differences between the PCEB and routine groups in terms of patient demographics and clinical characteristics, including disease classification, duration, biological treatment, and educational background at baseline. Compared with routine treatment, PCEB greatly improved patient medication adherence, as assessed by compliance with oral medication, enteral nutrition, biological infusion, and scheduled endoscopic assessment. Clinical and endoscopic remission in patients with PCEB increased during short-term (month 4) and long-term (month 12) follow-ups, along with a decrease in relapse rates for CD (13.3% vs. 31.8%) and UC (19.8% vs. 37.2%). The telehealth model applied to the PCEB group improved medication adherence and clinical outcomes in patients with IBD. This is a new and powerful solution for the long-term management of this chronic and progressive disease.

Effects of Face-to-Face Nursing Support on Optimal Adherence to Oral Titratable PAH Therapies

Background Therapies currently available to pulmonary arterial hypertension (PAH) patients do not reverse the disease; however, they improve pulmonary hemodynamics, offer symptomatic relief, and lengthen the time to clinical worsening. These therapies do not come without their challenges, which include side effects and compliance with challenging titration regimens. Health care providers, particularly nurses, play a significant role in improving patient medication adherence. In-home nurse visits offer disease state education, set medication expectations, and provide support tools for patients when experiencing adverse events that may lead to therapy discontinuation. The purpose of this study is to determine the impact that in-home, face-to-face nursing visits have on optimal adherence to oral PAH therapies. Methods We identified patients who received an oral PAH drug (riociguat, selexipag, or treprostinil) supported by a nursing program (study group) and patients who received an oral PAH drug (bosentan, ambrisentan, or macitentan) not supported by a nursing program (control group) using CVS Health pharmacy data from January 1, 2018, to June 30, 2019. A logistic regression model examined demographic and medication factors associated with adherence. Results From January 2018 to June 2019, we identified 107 patients in the study group and 213 patients in the control group. After 6 months, patients in the study group reported 0.6 more fill counts (5.1 vs 4.5; P = .002) and an 11% higher medication possession ratio (MPR) than those in the control group (86.4% vs 75.0%; P = .001). After adjusting for patient characteristics, control patients tended to be more likely to drop therapy in the first 6 months after the index fill (hazard ratio = 1.52; P = .064). After 6 months, the study group reported higher rates of therapy persistence than the control group (72.0% vs 60.6%; P &amp;lt; .05). Conclusions Patients receiving oral PAH therapies (riociguat, selexipag, or treprostinil) supported through a visiting nurse program had significantly higher rates of optimal adherence as demonstrated by a statistically significant improvement in the MPR and a higher prescription fill count than a control group. Ultimately, a multidisciplinary approach supporting the patient and providing patient education, proper motivation, and face-to-face nursing may support improved patient outcomes.

"Phardiacare" Program for Improved Medication Adherence and Clinical Outcomes of Type 2 Diabetes Mellitus Patients in Community Health Centers.

The role of pharmacists in middle-income countries such as Indonesia is still not optimal. In this study, we developed a program called "Phardiacare", a specific pharmacist-led program for Type 2 diabetes mellitus (T2DM) patients. The objective of this study is to assess the effectiveness of the application of the "Phardiacare" program in improving medication adherence and clinical outcomes in T2DM patients. The study was quasi-experimental, with a pretest-posttest design, and was conducted prospectively from July to October 2019 at the Matraman and Jatinegara District Health Center, Jakarta, Indonesia. The study comprised 33 T2DM patients in an intervention group (IG) who received the "Phardiacare" program and 33 patients in a control group (CG). Assessment was performed of HbA1c, FBG, LDL, HDL, total cholesterol, triglycerides, and blood pressure. HbA1c after intervention in the IG was lower than that of the CG (p <0.05). Intra-group mean differences showed improvement in the clinical parameters of FBG, triglycerides, and diastolic blood pressure in the IG (p <0.05), but not in the CG. Other clinical parameters did not show significant improvement. The results of the multivariate analysis showed that the "Phardiacare" program had a 16 times greater effect in reducing levels of HbA1c in the IG [95% CI 3.995:67.113, p <0.001] compared to the CG, even after controlling for confounding variables. The "Phardiacare" program was effective in improving patient medication adherence by decreasing HbA1c and FBG, but it did not have a significant effect on LDL, HDL, total cholesterol, and systolic blood pressure. Therefore, the implementation of Phardiacare program in the management of chronic diseases, especially T2DM, should be considered.

Use of Motivational Interviewing in Older Patients with Multiple Chronic Conditions and Their Informal Caregivers: A Scoping Review.

The use of motivational interviewing is relatively new in multiple chronic conditions (MCCs). A scoping review was conducted according to JBI methodology to identify, map and synthesize existing evidence on the use of motivational interviewing to support self-care behavior changes in older patients with MCCs and to support their informal caregivers in promoting patient self-care changes. Seven databases were searched, from database inception to July 2022, for studies that used motivational interviewing in interventions for older patients with MCCs and their informal caregivers. We identified 12 studies, reported in 15 articles, using qualitative, quantitative, or mixed-method designs, conducted between 2012 and 2022, describing the use of motivational interviewing for patients with MCCs. We could not locate any study regarding its application for informal caregivers. The scoping review showed that the use of motivational interviewing is still limited in MCCs. It was used mainly to improve patient medication adherence. The studies provided scant information about how the method was applied. Future studies should provide more information about the application of motivational interviewing and should address self-care behavior changes relevant to patients and healthcare providers. Informal caregivers should also be targeted in motivational interviewing interventions, as they are essential for the care of older patients with MCCs.

Therapeutic potential of microneedles based delivery systems for the management of atopic dermatitis

Atopic Dermatitis (AD) is a diverse skin condition with a range of shapes, localization, and progression of the disease. Even though its pathophysiology is multifaceted and not entirely comprehended, it appears to be the consequence of a mix of environmental and genetic variables that cause skin barrier disruption, dermal and systemic immunological imbalance, a significant hereditary influence, and skin microbiome dysbiosis. AD is now a major global health concern owing to its rising incidence over the past few decades. For topical distribution of numerous medications, nano-based formulations have been widely investigated during the past decade. Nanoparticles have been used for transdermal applications but their distribution over stratum corneum(SC), the primary skin barrier, is still difficult. Recent advancements in microneedle array (MN) technology, particularly the use of nanoparticles (NPs) that transport both lipophilic and hydrophilic medicinal drugs, have shown promise in the administration of a variety of formulations. Microneedles (MNs) are the devices that physically penetrate the stratum corneum to effectively traverse the epidermal barrier producing minor invasion and improving patient medication adherence. These are the microscale methods to significantly widen range of medications available for transdermal administration. The current work focuses on the developments associated with the use of microneedles and nanoparticles for efficient penetration of numerous drugs. The review also focuses on the significance of microneedles in treating atopic dermatitis, and various microneedles under preclinical and clinical studies have been summarised along with regulatory challenges and toxicity issues.

Assessment of medication adherence after enrollment in a health system funded medication assistance program for patients with diabetes

BackgroundHigh costs for patients’ medications decrease medication access and adherence which contributes to poor clinical outcomes. Numerous medication assistance programs exist, but many patients needing assistance, particularly insured patients, do not receive assistance due to eligibility criteria. ObjectiveTo determine if there is an association between medication adherence to antihyperglycemic therapy and patient access to Nebraska Medicine Charity Care (NMCC). Practice descriptionNMCC covers up to 100% of medication out-of-pocket costs for patients in financial need who do not qualify for other programs. Practice innovationThere is no published information about a long-term health system-led financial medication assistance program being utilized to improve patient medication adherence and clinical outcomes. Evaluation methodsA retrospective cohort analysis was conducted to assess adherence in patients who initiated NMCC between July 1, 2018 and June 30, 2020, with a focus on diabetes for feasibility. Adherence was assessed using a modified medication possession ratio (mMPR) for 6 months after initiating NMCC based on health system dispensing data. Overall population adherence analyses were conducted in all available data, while pre-post analyses were conducted in those with antihyperglycemic medication fills during the prior 6 months. ResultsOf 2758 unique patients receiving NMCC support, 656 patients with diabetes medication use were included. Of these, 71% had prescription insurance and 28% had prescription fills in the baseline period. Mean (SD) adherence to noninsulin antihyperglycemic medications in the follow-up period was 0.80 (0.25) with 63% adherent per mMPR ≥0.80. In the prepost analysis, mMPR was significantly higher during the follow-up period at 0.83 (0.23) than during the preindex period at 0.34 (0.17), as was the proportion who were adherent (66% vs. 2%) (P < 0.001). ConclusionThis practice innovation observed an improvement in adherence and A1C outcomes in patients with diabetes who received medication financial assistance through a health system.

Adherence Assessment on Hypertension Therapy Using The Pill Count Method In Lubuk Kilangan Health Center, Indonesia

Adherence is a major problem in hypertension treatment. Patients' adherence can be evaluated through pill count by counting the remaining amount of the patient's medication at the beginning and the end, using a pillbox as a tool to improve patient medication adherence. The purpose of this study was to describe the differences in adherence between patients who used the pillbox and without the pillbox. The research method used is Pretest-Posttest Control Group Design. The sample of this study is Prolanis (Chronic Disease Management Program) patients in 2021 at the Lubuk Kilangan Health Center in Padang City. They meet the inclusion and exclusion criteria that have been set. Sampling was carried out by total sample and obtained 70 subjects divided into the treatment group and the control group. The research technique used a Home Medication Review (HMR). The results of the study using the Mann-Whitney Test statistical test on adherence (p = 0.007) showed a value (p&lt;0.05). It can be concluded that there are differences in adherence before and after the intervention. This result indicates that adherence is higher in patients who use the pillbox than those without the pillbox.

Qualitative analysis of telephonic comprehensive medication review content and delivery.

Comprehensive medication reviews (CMRs) are offered to eligible Medicare beneficiaries to improve patient medication knowledge, identify, and address medication concerns, and empower medication self-management. However, the specific content of real-world CMRs is unclear. To qualitatively assess CMR content and delivery among telephonic CMR providers. This qualitative thematic analysis used transcriptions of audio-recorded patient interactions during CMRs from 3 telephonic medication therapy management provider organizations. Data were qualitatively analyzed using the inductive saturation model to code emergent themes by independent reviewers who met to agree themes through consensus. Intercoder reliability was calculated using Krippendorf alpha. Overall, 32 CMR transcripts from 3 organizations were analyzed in 13 rounds of coding. Intercoder reliability was >95%. A total of 21 themes were identified across 4 stages: call opening (4 themes), medication reconciliation (5 themes), clinical assessments and guidance (8 themes), and call closing (4 themes). The call opening stage included: service explanation; insurance coverage/cost; identity/privacy/recording; and patient's medication management. Medication reconciliation included: drug name, dose, frequency, and indication; medication deletion and addition; over-the-counter and vaccination assessment; drug efficacy assessment; and prescribing provider assessment. Clinical assessments and guidance included 4 core clinical assessments: allergy assessment; drug therapy problem assessment; drug-related adverse events; and medication modification; and 4 additional assessments: clinical/therapeutic guidance; cost savings guidance; diet/exercise/lifestyle guidance; and optional clinical and behavioral assessments. Call closing included: documentation; primary care provider confirmation; patient satisfaction; and call transfer. There were variations among organizations in the depth that CMR components were covered. These findings suggest provider organizations are including components that meet Centers for Medicare and Medicaid Services goals for CMRs. Yet, variations among organizations indicate a need for standardization and patient-centered measures to ensure appropriate CMR components are covered, while maintaining flexibility for pharmacists to provide patient-oriented CMRs that meet patients' clinical needs.

A non-randomized, controlled, interventional study to investigate the effects of community pharmacists’ cognitive behavioral therapy–based interventions on medication adherence and relevant indicators in patients with depression

BackgroundThe prevalence of depression is increasing in Japan. Pharmacists play an important role in helping patients use medicines effectively. Several studies had investigated the impact of community pharmacists on patient adherence to antidepressant therapy, and their results indicated that further study was warranted.MethodsThis study was conducted from June 2019 to May 2020 using a cluster non-randomized, open-label, parallel-group design. Four community pharmacy stores in Osaka and Hyogo Prefectures, Japan, participated in the study, and enrolled patients with unipolar depression. In the intervention group (IG), patients received cognitive behavioral therapy (CBT)-based medication support, and their medication adherence and adverse drug reactions were monitored by telephone. In the control group (CG), the pharmacists engaged in routine interactions with the study participants. Before participating in this study, the intervention-group pharmacists attended a 5-hour training session on CBT-based medication support. The primary outcome of this study was medication adherence, assessed using the Drug Attitude Inventory (DAI)-10. Secondary outcomes included the changes from baseline at 6 months in the following variables: the Patient Health Questionnaire (PHQ)-9 total score, the EQ-5D-5 L (Euro-QOL 5 dimensions 5 levels) score, patient satisfaction, and the Pharmacists’ Confidence Scale about Medication Consultation for Depressive Patients (PCMCD) score.ResultsFour pharmacies (two in IG and two in CG) completed the intervention period. Results were obtained from 19 patients in the IG and 12 patients in the CG. In the IG, the mean DAI-10 score increased from 4.941 at baseline to 6.105, the mean PHQ-9 score decreased from 9.263 to 8.625, and the mean patient satisfaction score increased from 39.947 to 42.211. In the CG, the mean DAI-10 score decreased from 6.333 to 4.167, the mean PHQ-9 score increased from 9.333 to 12.923, and the mean patient satisfaction score decreased from 38.929 to 38.167.ConclusionCBT-based medication support provided by community pharmacists may improve patient medication adherence to antidepressant therapy and symptoms. Such support can be expected to facilitate better treatment of depressed patients and may also allow the duration of treatment to be shortened.Trial registrationUMIN000037954, Date of first registration: 17/06/2019.

The Effect of Medication Adherence and Asthma Control in Asthma Patients at a Public Health Center in Padang, Indonesia

Asthma is characterized by reversible swelling or narrowing of the airways. Low adherence can negatively affect the effectiveness of therapy, increasing asthma morbidity and mortality. The long-term goal of asthma treatment is to achieve and maintain controlled asthma, but this goal is still challenging for most patients. This study examines the relationship between medication adherence and asthma control in patients. This study is observational, with a cross-sectional approach conducted on 40 asthma patients who received treatment at a Public Health Center. Patient medication adherence was measured by Medication Possession Ratio (MPR) method, and the level of control was measured by the Asthma Control Test (ACT) questionnaire. The results showed that most patients based on sociodemographic characteristics were female (80.0%), elderly group ≥60 years (45.0%), high school education (55.0%), and housewives (45.0%). The category of medication adherence was divided into 47.5% adherent patients and 52.5% non-adherent patients. The level of patient control was divided into fully controlled (2.50%), partly controlled (35.0%), and uncontrolled (62.5%). There was a significant relationship between adherence and asthma control (r=0.508; p&lt;0.05). Therefore, improving patient medication adherence can potentially improve asthma control levels.

Construction and application of tuberculosis medical and nursing integration cooperation model.

To explore the clinical effect of the tuberculosis (TB) doctor-nurse integration management model METHODS: This study is a retrospective historical cohort study. The clinical data of 180 patients with TB in our hospital from 2019 to 2020 were analyzed retrospectively. In a control group, 90 cases were treated with the traditional medical care model. An observation group of 90 cases received clinical diagnoses, treatments, and nursing under a doctor-nurse integration management model. Comparative analyses between the two groups were conducted on various aspects, including the awareness level of TB prevention and control, medication compliance and patient satisfaction. Comparisons between the two groups were evaluated using independent-sample t-tests or Chi-squared tests RESULTS: Compared with the control group, the knowledge awareness levels of TB prevention and medication compliance in the observation group were significantly higher (p <.05). The appointment waiting times and hospitalization times in the observation group were significantly lower than in the control group (p<.05). The total average satisfaction score of the patients in the observation group was significantly higher than in the control group (p<.05). Compared with the control group, the patients in the observation group were significantly more satisfied with their nursing methods, operating techniques, psychological techniques, service attitudes, and ward management (p<.05). In addition, in the observation group, medical-nursing relationships and doctor-patient communication were better than in the control group; additionally, the satisfaction of doctors with nursing work was also higher than in the control group, which was a statistically significant difference (p<.05) CONCLUSION: The implementation of an integrated medical-nursing cooperation model for TB will help increase the awareness of health knowledge in patients with TB, improve patient medication compliance and enhance patient satisfaction.

A nationwide exploratory survey assessing perception, practice, and barriers toward pharmaceutical care provision among hospital pharmacists in Nepal

Pharmaceutical care (PC) services reduce medication errors, improve the use of medicines, and optimize the cost of treatment. It can detect medication-related problems and improve patient medication adherence. However, PC services are not commonly provided in hospital pharmacies in Nepal. Therefore, the present study was done to determine the situation of PC in hospital pharmacies and explore the perception, practice, and barriers (and their determinants) encountered by hospital pharmacists while providing PC. A descriptive online cross-sectional study was conducted from 25th March to 25th October 2021 among pharmacists with a bachelor’s degree and above working in hospital pharmacies using non-probability quota sampling. The questionnaire in English addressed perception and practice regarding PC, and barriers encountered and were validated by experts and pre-tested among 23 pharmacists. Descriptive statistics were used to describe the data. Kendall’s correlation was used to explore the correlations among various perception and practice constructs. The scores were also compared among subgroups of respondents using the Mann–Whitney test for subgroups with two categories and Kruskal–Wallis test for greater than two categories. A total of 144 pharmacists participated in the study. Majority of the participants were male, between 22 and 31 years of age, and had work experience between 10 and 20 years. Over 50% had received no training in PC. The perception scores were higher among those with more work experience and the practice scores among those who had received PC training. Participants agreed that there were significant barriers to providing PC, including lack of support from other professionals, lack of demand from patients, absence of guidelines, inadequate training, lack of skills in communication, lack of compensation, problems with access to the patient medical record, lack of remuneration, and problems with accessing objective medicine information sources. A correlation was noted between certain perceptions and practice-related constructs. Hospital pharmacists who participated had a positive perception and practice providing PC. However, PC was not commonly practised in hospital pharmacies. Significant barriers were identified in providing PC. Further studies, especially in the eastern and western provinces, are required. Similar studies may be considered in community pharmacies.