Increase Medication Adherence Research Articles

A Pilot Randomized Control Trial of the Striving Towards EmPowerment and Medication Adherence (STEP-AD) Intervention for Black Women Living with HIV.

Black women living with HIV (BWLWH) face adversities associated with lower HIV medication adherence, viral non-suppression, and mental health symptoms (e.g., post-traumatic stress disorder) such as trauma/violence, racism, HIV-related discrimination/stigma, and gender-related stressors. We developed the first intervention based in cognitive behavioral therapy and culturally congruent coping for BWLWH to increase medication adherence and decrease PTSD symptoms by enhancing resilience, self-care, engagement in care, and coping for trauma, racism, HIV-related discrimination/stigma, and gender-related stressors. A pilot randomized control trial was conducted with BWLWH and histories of trauma who were at risk for their HIV viral load remaining or becoming detectable (i.e., below 80% medication adherence, detectable viral load in the past year, and/or missed HIV-related appointments). 119 BWLWH were assessed at baseline and 70 met inclusion criteria, completed one session of Life-Steps adherence counseling, and were randomized to either nine sessions of STEP-AD (Striving Towards EmPowerment and Medication Adherence) or ETAU (enhanced treatment as usual consisting of biweekly check-ins). Women completed a post intervention follow up assessment (3months post baseline) and 3-month post intervention follow-up (6months post baseline). Via STATA the difference-in-difference methodology with mixed models compared STEP-AD to ETAU on changes in outcomes over time. BWLWH in STEP-AD compared to E-TAU had significantly higher ART adherence (estimate = 9.36 p = 0.045) and lower likelihood of being clinically diagnosed with PTSD (OR = .07, estimate = - 2.66, p = 0.03) as well as borderline significance on higher CD4 count (estimate = 161.26, p = 0.05). Our findings suggest preliminary efficacy of STEP-AD in improving ART adherence, mental health, and immune function.

Interventions for increasing medication adherence in heart failure patients: A narrative review.

Heart failure is one of the critical and most costly medical challenges of the 21st century. It is a chronic debilitating condition and adherence to medication, a precondition for successful treatment is often poor. There are various interventions for improving the adherence. Depending on the goal of the intervention, these are roughly patient centric, healthcare provider centric and system centric. We provide an overview of these interventions with a focus on effectiveness and appropriateness in different clinical situations. Their use can lead to improved patient outcomes and reduced economic burden of the disease.

Evaluation of missed opportunity for clinical pharmacist practitioner impact on medication management in a traumatic brain injury population

BackgroundTraumatic brain injury (TBI) is a traumatically induced physiological disruption of normal brain function and/or structural brain injury. Patients with TBI may have impaired cognitive function, which may affect medication adherence and patients’ understanding of their medication regimen, making medication management challenging. Clinical pharmacist practitioner (CPP)–driven medication management has been shown to decrease polypharmacy, increase medication adherence, and prevent adverse drug reactions in various disease states; however, there are few interventions for patients with TBI. ObjectivesThis evaluation aimed to determine whether there are missed opportunities for CPP impact on medication management for patients with TBI at 1 Veterans Affairs medical center. MethodsThis was a single-center, retrospective, QI project. Patients were identified via a generated report of all patients with a diagnosis of TBI seen by a rehabilitation medicine provider between October 21, 2022, and January 1, 2023. Retrospective chart reviews were performed to determine the number of patients with polypharmacy, adherence concerns, duplicative therapy, and/or medications missing an indication. ResultsNinety-two rehabilitation medicine visits for 78 unique patients were identified over the 3-month time period. Twenty-four of the 78 patients were identified to have all of the following: polypharmacy, adherence concerns, duplicative therapy, and medications without an indication. Of the 78 patients, 10 (15.6%) were followed by a primary care CPP within the 6 months before their rehabilitation medicine appointment. ConclusionThis QI project identifies potential opportunities for CPP impact on medication management of patients diagnosed as having TBI.

Using AI to increase medication adherence

Although different measures have been taken to increase medication adherence, it still remains a significant challenge with research indicating that the rates of non-adherence remain as high as 40 to 50%. Increasing medication adherence because non-adherence has a direct impact on patient outcomes. non-adherence contributes significantly to treatment failure. It also increases the rates of hospitalizations, mortality, and morbidity. Non-adherence also adds to healthcare costs affecting the ability of healthcare systems to provide the needed quality of care. Despite the implementation of traditional measures to increase adherence, these measures have led to mixed results. Most of these measures are limited because they rely on patient self-reports to measure adherence. They also do not verify whether a patient takes medication or not. Without verifying or confirming a patient has taken medication, it becomes significantly challenging to measure the rate of adherence. This necessitates the need for additional technologies to increase medication adherence. Leveraging technologies such as AI can help to address the limitations of traditional approaches to ensuring medication adherence. AI can be used to both predict adherence and improve adherence. However, to gain the full benefits offered by AI, it is important to address the challenges these technologies present such as ethical issues with regard to patient privacy and confidentiality of their data. The use of AI to increase medication adherence is also limited by limited knowledge and skills on how to use these technologies effectively and the type of technologies available. Therefore, this review explores how AI-based technologies can be used to increase medication adherence. Keywords: Medication adherence, non-adherence, Artificial Intelligence, patient outcomes, machine learning

Reasons for switching oral antipsychotic medications and related patterns of care and costs in patients with schizophrenia initiating monotherapy treatment: Claims-linked chart study.

Antipsychotic switching is frequent in schizophrenia and is associated with poor clinical outcomes, increased health care resource utilization (HCRU), and increased health care costs. Research describing the reasons for antipsychotic switching in patients with schizophrenia and the associated impacts on HCRU and costs is limited. To explore the reasons for oral antipsychotic medication (OAM) switching and describe HCRU and costs associated with OAM switching, stratified by reasons for switching, in patients with commercial or Medicare Advantage insurance in the United States. This retrospective observational study used medical and pharmacy claims from the Optum Research Database linked to patient medical chart data. Adults with a diagnosis of schizophrenia who initiated OAM monotherapy between January 1, 2015, and June 30, 2021, and switched from their initial OAM monotherapy to a second one were included. Reasons for OAM switching were recorded from medical charts abstracted between 4 months preceding and 2 months following the patient's switch date. HCRU and costs incurred up to 3 months before and 3 months after the OAM switch were stratified and compared by reasons for switching among individuals who switched OAM monotherapy. Among 134 patients with valid, abstracted charts, the 2 most common reasons for switching were lack of efficacy (57.5% of switches) and at least 1 tolerability issue (41.8%). Mutually exclusive categories of switching reasons included lack of efficacy and no tolerability issues (56/134; 41.8%), tolerability and no efficacy issues (35/134; 26.1%), lack of efficacy and tolerability issues (21/134; 15.7%), and other or unknown (22/134; 16.4%). All-cause and schizophrenia-related HCRU and costs in any health services category did not appear to differ across the reason-for-switching cohorts, with costs for inpatient stays accounting for greater than half of the total costs, regardless of switching reason. These findings provide insight on patient experiences that contribute to OAM switching, with nearly half of patients switching because of lack of efficacy, more than one-fourth because of tolerability issues, and an additional one-sixth for reasons of both efficacy and tolerability. Health care providers should address patients' expectations regarding OAM effectiveness, symptom resolution, and side effect tolerability at treatment initiation to minimize switching before the medication has reached peak effectiveness. Prescribing access to a broad selection of antipsychotics with different side effect profiles may help physicians better match treatment to individual patients, fostering greater acceptance of therapy, increased medication adherence, and better long-term outcomes.

Evaluation of adherence to pharmacological treatments by undocumented migrants with chronic diseases: a 10-year retrospective cohort study

ObjectivesTo investigate the time course of medication adherence and some of the factors involved in this process in undocumented migrants with chronic diseases.DesignRetrospective cohort study.SettingA big non-governmental organisation in Milano,...

The Role of Pharmacists' Interventions in Increasing Medication Adherence of Patients With Epilepsy: A Scoping Review.

Epilepsy is a chronic disease that requires long-term treatment and intervention from health workers. Medication adherence is a factor that influences the success of therapy for patients with epilepsy. Therefore, this study aimed to analyze the role of pharmacists in improving the clinical outcomes of epilepsy patients, focusing on medication adherence. A scoping literature search was conducted through the ScienceDirect, PubMed, and Google Scholar databases. The literature search included all original articles published in English until August 2023 for which the full text was available. This scoping review was carried out by a team consisting of pharmacists and neurologists following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews and the Joanna Briggs Institute guidelines, including 5 steps: identifying research questions, finding relevant articles, selecting articles, presenting data, and compiling the results. The literature search yielded 10 studies that discussed pharmacist interventions for patients with epilepsy. Five articles described educational interventions involving drug-related counseling with pharmacists. Two articles focused on similar pharmacist interventions through patient education, both verbal and written. Three articles discussed an epilepsy review service, a multidisciplinary intervention program involving pharmacists and other health workers, and a mixed intervention combining education and training with therapy-based behavioral interventions. Pharmacist interventions have been shown to be effective in improving medication adherence in patients with epilepsy. Furthermore, these interventions play a crucial role in improving other therapeutic outcomes, including patients' knowledge of self-management, perceptions of illness, the efficacy of antiepileptic drugs in controlling seizures, and overall quality of life.

Participant perspectives on incentives for TB preventative therapy adherence and reduced alcohol use: A qualitative study.

Economic incentives to promote health behavior change are highly efficacious for substance use disorders as well as increased medication adherence. Knowledge about participants' experiences with and perceptions of incentives is needed to understand their mechanisms of action and optimize future incentive-based interventions. The Drinkers' Intervention to Prevent Tuberculosis (DIPT) trial enrolled people with HIV (PWH) in Uganda with latent tuberculosis and unhealthy alcohol use in a 2x2 factorial trial that incentivized recent alcohol abstinence and isoniazid (INH) adherence on monthly urine testing while on INH preventive therapy. We interviewed 32 DIPT study participants across trial arms to explore their perspectives on this intervention. Participants described 1) satisfaction with incentives of sufficient size that allowed them to purchase items that improved their quality of life, 2) multiple ways in which incentives were motivating, from gamification of "winning" through support of pre-existing desire to improve health to suggesting variable effects of extrinsic and intrinsic motivation, and 3) finding value in learning results of increased clinical monitoring. To build effective incentive programs to support both reduced substance use and increased antimicrobial adherence, we recommend carefully selecting incentive magnitude as well as harnessing both intrinsic motivation to improve health and extrinsic reward of target behavior. In addition to these participant-described strengths, incorporating results of clinical monitoring related to the incentive program that provide participants more information about their health may also contribute to health-related empowerment.

Exploring the Effectiveness of Pre-Exposure Prophylaxis (PrEP) Use for HIV Prevention among High-Risk Populations

Addressing the global burden of HIV requires effective preventative measures that have been shown to have high efficacy rates. PrEP is one of the preventative measures that is effective in preventing HIV. Different clinical trials and population studies have shown PrEPto have an efficacy rate of 40% to 90% when it comes to preventing HIV. Due to its high efficacy, PrEPcan reduce new HIV infections populations considered to be high risk. However, for efficacy to be high, there is a need to increase medication adherence and address the existing barriers that limit uptake. Some of these barriers are lack of knowledge, inadequate access, stigma,lack of trust in service providers, low perception of HIV risk, cost, and fear of side effects. Addressing these barriers can increase PrEP uptake and help in reducing HIV’s risk among high-risk populations. Some of the measures that can be put in place to address these barriers are providing education and training, allocating enough resources, leveraging technology, lowering PrEP costs, increasing insurance coverage, and improving communication among the targeted population.

The Impact of Pharmacist Medication Reviews on Geriatric Patients: A Scoping Review.

Medication review is an intervention with the potential to reduce drug-related problems (DRPs) in the elderly. This study aimed to determine the effect of pharmacists' medication reviews on geriatric patients. This study accessed two online databases, MEDLINE Complete and Scopus, and examined all studies published in English between 2019 and 2023, except for reviews. The studies included (1) participants over 65 years of age and (2) medication reviews conducted by pharmacists. The titles, abstracts, and full texts were reviewed for data extraction to determine whether the studies satisfied the inclusion and exclusion criteria. Forty-four of the initial 709 articles were included in this study. The articles included discussions on the incidence rates of DRPs and potentially inappropriate medications (PIMs) (n=21), hospitalization (n=14), medication adherence (n=9), quality of life (QoL) (n=8), and falls (n=7). Pharmacist medication reviews were associated with a reduced incidence of DRPs and PIMs, and improved adherence to medications. Patients' overall QoL is also increasing. However, pharmacist medication reviews were not strongly associated with decreased hospitalization or falls. A pharmacist's medication review may be a feasible intervention for reducing the incidence rates of DRPs and PIMs, regardless of whether it is performed as a sole intervention or supplemented with other interventions. The intervention was also effective in increasing medication adherence and QoL.

Integrating technology into a successful apomorphine delivery program in Thailand: a 10-year journey of achievements with a five-motto concept.

Apomorphine, a potent dopamine agonist, is a therapeutic option for patients with Parkinson's disease and motor fluctuations. However, the adoption of and adherence to this therapy have been limited by the need for complex delivery devices and specialized care as well as resource consumption, posing challenges for new physicians. Thailand is a unique example of a developing nation that has successfully implemented and continued the use of this therapy by employing cooperative technology that has dramatically enhanced apomorphine delivery services. Establishing apomorphine delivery services requires significant resources and step-by-step solutions. We began our services by implementing various strategies in three chronological stages: the initial stage (2013-2015), intermediate stage (2016-2019), and current stage (2020-present), each presenting unique challenges. Together, we also implemented a proposed set of five mottos to strengthen our apomorphine delivery service. Using additive technology, we developed a patient registry platform that combined electronic data acquisition, video and remote monitoring using wearable sensors, and in-house mobile applications to support our service. At the initial stage, we assembled a team to enhance the efficacy and confirm the safety of apomorphine treatment in our hospital. At the intermediate stage, we expanded our apomorphine delivery services beyond just the patients at our hospital. We supported other hospitals in Thailand in setting up their own apomorphine services by educating both physicians and nurses regarding apomorphine therapy. With this educational undertaking, increased apomorphine-related knowledge among medical professionals, and a greater number of hospitals providing apomorphine services, an increasing number of patients were administered apomorphine in subsequent years. Currently, we are providing effective apomorphine delivery to improve patient outcomes and are seamlessly integrating technology into clinical practice. Incorporating integrative technologies in our apomorphine delivery program yielded positive results in data collection and support throughout patient care, in tracking patients' statuses, in the long-term use of this treatment, and in increasing medication adherence rates. This perspective paper describes how technology can help provide supportive healthcare services in resource-constrained environments, such as in Thailand, offering a step-by-step approach to overcoming several limitations. The valuable insights from our 10-year journey in successfully integrating technology into apomorphine delivery services can benefit new physicians seeking to replicate our success.

Medication Adherence Barriers and Their Relationship to Health Determinants for Saudi Pediatric Dialysis Patients.

Medication adherence is critical for the treatment and improved outcomes of chronic diseases. However, there is little research on the medication adherence of pediatric dialysis patients in Saudi Arabia. This study examines medication adherence barriers and their relationship to health determinants among Saudi children on dialysis, to enhance treatment success. We conducted a hospital-based, cross-sectional survey of pediatric dialysis patients using a simple random sampling technique. There is a trend of higher medication adherence for peritoneal dialysis patients compared with hemodialysis patients (36.1 ± 12.9 vs. 34.7 ± 8.3, p = 0.07). The leading barriers to medication adherence for all patients included being tired of taking the medication (score = 3.0256), not feeling like taking the medicine sometimes (score = 2.7436), bad taste (score = 2.5513), and forgetfulness (score = 2.41). Determinants of health were associated with medication adherence. Lack of education (56.4%) (some children underage for school) and chronic disease requirements (16.7%) were common barriers. After adjusting for the common confounders, the adherence scores increased significantly with increasing patient age (β = 2.378, p < 0.001), patients with working parents (β = 8.726, p = 0.011), and those living outside Riyadh (β = 19.198, p < 0.001). Medication adherence among pediatric dialysis patients is influenced by sociodemographic factors, health systems, and access to care. Evidence-based targeted interventions can increase medication adherence in this group on frequent dialysis. Future efforts should utilize systematic frameworks and digital health technologies to provide quality alternatives to improve medication adherence.

Patient activation in advanced chronic kidney disease: a cross-sectional study

BackgroundPatient activation refers to the knowledge, confidence and skills required for the management of chronic disease and is antecedent to self-management. Greater self-management in chronic kidney disease (CKD) results in improved patient experience and patient outcomes.AimTo examine patient activation levels in people with CKD stage 5 pre-dialysis and determine associations with sociodemographic characteristics, treatment adherence and healthcare utilisation.Methods/designPeople with CKD stage 5 not receiving dialysis from one Australian kidney care service. Patient activation was measured using the 13-item Patient Activation Measure (PAM-13). Sociodemographic and clinical outcome data (emergency department visits, admissions) were collected from medical records. Morisky Medication Adherence Scale was used to determine self-report medication adherence.ResultsTwo hundred and four participants completed the study. The mean PAM-13 score was 53.4 (SD 13.8), with 73% reporting low activation levels (1 and 2). Patient activation scores significantly decreased with increased age (P < 0.001) and significantly increased with higher educational levels (P < 0.001). Higher patient activation level was associated with fewer hospital emergency department visits (P = 0.03) and increased medication adherence (P < 0.001).ConclusionPatient activation levels are low in people with CKD stage 5 not receiving dialysis suggesting limited ability for self-management and capacity for optimally informed decisions about their healthcare. Efforts to improve patient activation need to consider age and education level.Graphical abstract

The effectiveness of short mobile phone text message reminders compared to usual care on medication adherence in patients with hypertension: a systematic review protocol

BackgroundPoor adherence to long-term medication increases the risk of morbidity and mortality and decreases the quality of life of patients with hypertension. One strategy to improve treatment adherence is to use a short text message reminder. Although evidence indicates that such programs increase medication adherence, the extent of their effectiveness and translation into clinical practice needs to be better documented. Our systematic review will collect and analyze the available evidence for clinical practice implementation. This systematic review aimed to evaluate the effectiveness of short mobile phone text message reminders versus usual/standard care for medication adherence in patients with hypertension.MethodsThis review will include and summarize evidence from randomized controlled trials. Adults (age > 18 years) with hypertension. The comparator group received either the usual care or standard care. It encompasses standard medical care for patients not participating in a structured and supervised intervention program such as a telemedicine program.We will include studies that assess the effectiveness of short mobile phone text message reminders in improving medication adherence in patients with hypertension compared to usual care. We will search the following databases: PubMed, EMBASE, CINAHL, SCOPUS, Web of Science, Cochrane Library Central Register of Controlled Trials, and Cochrane Library. We will include studies published in English. Furthermore, we will consider studies published from the inception of the database until April 20, 2024. At least two reviewers will independently conduct study selection, data extraction, and quality assessment. A third reviewer will determine and resolve discrepancies. We will conduct a quality assessment using the ROBIS 2 critical appraisal checklist. At least two independent reviewers will crosscheck the data synthesis.DiscussionWe expect this review to provide current evidence for future studies and clinical practice concerning the impact of mobile phone text message reminders on medication adherence issues. We will publish our results in a peer-reviewed journal for publication.Systematic review registrationPROSPERO CRD42023391236.

KEPATUHAN MINUM OBAT BERBASIS TEORI MODEL IMOGENE KING PADA PASIEN HIPERTENSI

Hypertension is still an important problem for elderly. Most of those who suffer from hypertension are elderly, the aging process which has an impact on weakening brain function can cause mild memory problems or dementia so that most elderly people are disobedient to drinking, because they forget. The family as a companion to the elderly plays a role in reminding them through communication and function as a support system. The aim of this study was to determine adherence to taking hypertension medication based on the Imogene King model theory. The research design used is quantitative descriptive. The population in this study was 45 respondents, while the sample used was 40 respondents, using a purposive sampling technique in the UPTD Work Area of the Bendo Health Center, Pare District, Kediri Regency. Research variables on medication adherence based on Imogene King's model theory in hypertensive patients. This research instrument uses a questionnaire. Data analysis uses percentages and is interpreted quantitatively. The results of the research from 40 respondents, the majority of respondents, namely 28 (70%) were obedient to taking hypertension medication and a small portion of respondents, 12 (30%) were quite obedient in taking hypertension medication. The research results showed that the majority of respondents adhered to taking hypertension medication. It is hoped that the Imogene King model's theoretical interaction system can become a model for increasing medication adherence for families who have elderly family members who suffer from hypertension so that blood pressure is well controlled.

Empowering WHISE women: usability testing of a mobile application to enhance blood pressure control.

High blood pressure (hypertension) disproportionately affects African American/Black (Black) women. Previous research suggests that self-managing hypertension may be challenging, yet mobile applications (apps) can help to empower patients and increase medication adherence. We developed questions to test the usability of evaluating the WHISE (Wellness, Hypertension, Information Sharing, Self-Management, Education) mobile app for Black women with hypertension. Fifteen participants completed usability testing; five were potential app users (Black women with hypertension); each invited two of their peers to participate. Each testing session (n=5) included a brief overview of the app, time for participants to complete surveys and have an active discussion about the app (concurrent and retrospective think-aloud, concurrent and retrospective probing, per usability.gov), and observation of participants' body language during the session. Testing sessions were designed to familiarize participants with the app's features and examine their navigating ability. The app received overwhelmingly positive feedback, with 80% of participants finding it to be a valuable tool in hypertension management. Participants praised the app's user-friendliness and educational value, with one stating, 'It is a good educational piece for helping people manage hypertension, at least to understand its basics.' Another participant highlighted the potential for community support, saying, 'Having a community, having some people to be accountable, to check in with and see how things are going, could encourage and motivate people to be more diligent about managing their hypertension.' Some participants also provided constructive feedback, suggesting font size adjustments (73%) and color scheme changes (60%) for certain screens. Based on the feedback we received, we were able to mitigate the participants' concerns about font size and color and create tutorial videos to guide future users in using the app. We completed these changes prior to deploying the app in our randomized clinical controlled trial.

Structural Equation Modelling to Identify Psychometric Determinants of Medication Adherence in a Survey of Kidney Dialysis Patients.

Medication non-adherence in dialysis patients is associated with increased mortality and higher healthcare costs. We assessed whether medication adherence is influenced by specific psychometric constructs measuring beliefs about the necessity for medication and concerns about them. We also tested whether medication knowledge, health literacy, and illness perceptions influenced this relationship. This study is based on data from a cross-sectional in-person questionnaire, administered to a random sample of all adult dialysis patients at a teaching hospital. The main outcome was self-assessed medication adherence (8-Item Morisky Medication Adherence Scale). The predictors were: concerns about medications and necessity for medication (Beliefs About Medication Questionnaire); health literacy; medication knowledge (Medication Knowledge Evaluation Tool); cognitive, emotional, and comprehensibility Illness perceptions (Brief Illness Perception Questionnaire). Path analysis was performed using structural equations in both covariance and variance-based models. Necessity for medication increased (standardized path coefficient [β] 0.30 [95% CI 0.05, 0.54]) and concerns about medication decreased (standardized β -0.33 [-0.57, -0.09]) medication adherence, explaining most of the variance in outcome (r2=0.95). Medication knowledge and cognitive illness perceptions had no effects on medication adherence, either directly or indirectly. Higher health literacy, greater illness comprehension, and a more positive emotional view of their illness had medium-to-large sized effects in increasing medication adherence. These were indirect rather and direct effects mediated by decreases in concerns about medications (standardized β respectively -0.40 [-0.63,-0.16], -0.60 [-0.85, -0.34], -0.33 [-0.52, -0.13]). Interventions that reduce patients' concerns about their medications are likely to improve adherence, rather than interventions that increase patients' perceived necessity for medication. Improving patients' general health literacy and facilitating a better understanding and more positive perception of the illness can probably achieve this. Our study is potentially limited by a lack of generalizability outside of the population and setting in which it was conducted.

Efektivitas Mobile Health dan Supportive Education untuk Meningkatkan Kepatuhan Manajemen Perawatan Diri Pasien Hipertensi

This study aims to evaluate the effectiveness of mobile health interventions and supportive education in increasing self-care management compliance in hypertensive patients. The research method used is a literature review through databases, namely Scopus, Science Direct, Web of Science and Sage Journal. The results of 10 research articles report that interventions using mobile technology (m-health) and supportive educational interventions are very effective in increasing medication adherence in hypertensive patients. Conclusion, Interventions using mobile technology (m-health), combined with supportive educational interventions can be applied to increase self-care management compliance in hypertensive patients.&#x0D; &#x0D; Keywords: Supportive Education, Hypertension, Compliance, Mobile Health

Association between illness perception and medication adherence in patients with diabetes mellitus in North Shoa, Zone: cross-sectional study.

Although the impact of illness perception on medication adherence is well-established, its specific influence on medication adherence in Ethiopia remains unclear. Consequently, the objective of this study was to examine the association between illness perception and medication adherence among patients with diabetes mellitus in the North Shoa Zone. An institution-based cross-sectional study was conducted from 24 May to 25 June 2022 in the North Shoa zone. The study included a random sample of 552 individuals with diabetes from four public hospitals. Data was collected and entered into Epi Data V.3.1, and analysis was performed using SPSS version 22. Descriptive statistics were used to summarize continuous variables as means with standard deviations, while categorical variables were presented as percentages. The study variables were analyzed using binary logistic regression models to assess the associations between illness perception and medication adherence. In the bivariable analysis, variables with p-values less than 0.20 were entered into a multivariable logistic regression model. Associations with a p-value ≤0.05 and an odds ratio with a 95% confidence interval were considered statistically significant. The study results revealed that medication adherence was 64.4% (95% CI: 60.1, 67.9), while illness perception was 54.7% (95% CI, 41.2, 49.4). There was a significant and strong association between illness perception and medication adherence (p < 0.0001). In the adjusted model, the illness perception components of consequence showed a significant association with medication adherence (AOR = 3.10, 95% CI: 2.11, 4.55). Similarly, personal control (AOR = 1.77, 95% CI: 1.20, 2.61) and emotional representation of diabetes (AOR = 2.26, 95% CI: 1.54, 3.32) were also significantly associated with medication adherence in patients with diabetes. The findings of this study indicate a positive association between higher illness perception and increased medication adherence and practice. Therefore, when engaging in discussions about diabetic self-management, diabetes educators should employ psychoeducational approaches that take into account the illness perceptions of patients.

Effectiveness of cardiac rehabilitation programs on medication adherence in patients with cardiovascular disease: A systematic review and meta-analysis

BackgroundEducation to improve medication adherence is one of the core components of cardiac rehabilitation (CR) programs. However, the evidence on the effectiveness of CR programs on medication adherence is conflicting. Therefore, we aimed to summarize the effectiveness of CR programs versus standard care on medication adherence in patients with cardiovascular disease. MethodsA systematic review and meta-analysis was conducted. Seven databases and clinical trial registries were searched for published and unpublished articles from database inception to 09 Feb 2022. Only randomised controlled trials and quasi-experimental studies were included. Two independent reviewers conducted the screening, extraction, and appraisal. The JBI methodology for effectiveness reviews and PRISMA 2020 guidelines were followed. A statistical meta-analysis of included studies was pooled using RevMan version 5.4.1. ResultsIn total 33 studies were included with 16,677 participants. CR programs increased medication adherence by 14 % (RR = 1.14; 95 % CI: 1.07 to 1.22; p = 0.0002) with low degree of evidence certainty. CR also lowered the risk of dying by 17 % (RR = 0.83; 95 % CI: 0.69 to 1.00; p = 0.05); primary care and emergency department visit by mean difference of 0.19 (SMD = −0.19; 95 % CI: −0.30 to −0.08; p = 0.0008); and improved quality of life by 0.93 (SMD = 0.93; 95 % CI: 0.38 to 1.49; p = 0.0010). But no significant difference was observed in lipid profiles, except with total cholesterol (SMD = −0.26; 95 % CI: −0.44 to −0.07; p = 0.006) and blood pressure levels. ConclusionsCR improves medication adherence with a low degree of evidence certainty and non-significant changes in lipid and blood pressure levels. This result requires further investigation.