Main Reasons For Non-adherence Research Articles

Development of a Prediction Model for the Management of Noncommunicable Diseases Among Older Syrian Refugees Amidst the COVID-19 Pandemic in Lebanon

Older Syrian refugees have a high burden of noncommunicable diseases (NCDs) and economic vulnerability. To develop and internally validate a predictive model to estimate inability to manage NCDs in older Syrian refugees, and to describe barriers to NCD medication adherence. This nested prognostic cross-sectional study was conducted through telephone surveys between September 2020 and January 2021. All households in Lebanon with Syrian refugees aged 50 years or older and who received humanitarian assistance from a nongovernmental organization were invited to participate. Refugees who self-reported having chronic respiratory disease (CRD), diabetes, history of cardiovascular disease (CVD), or hypertension were included in the analysis. Data were analyzed from November 2021 to March 2022. The main outcome was self-reported inability to manage any NCD (including CRD, CVD, diabetes, or hypertension). Predictors of inability to manage any NCD were assessed using logistic regression models. The model was internally validated using bootstrapping techniques, which gave an estimate of optimism. The optimism-adjusted discrimination is presented using the C statistic, and calibration of the model is presented using calibration slope (C slope). Of 3322 older Syrian refugees, 1893 individuals (median [IQR] age, 59 [54-65] years; 1089 [57.5%] women) reported having at least 1 NCD, among whom 351 (10.6% overall; 18.6% of those with ≥1 NCD) had CRD, 781 (23.7% overall; 41.4% of those with ≥1 NCD) had diabetes, 794 (24.1% overall; 42.2% of those with ≥1 NCD) had history of CVD, and 1388 (42.3% overall; 73.6% of those with ≥1 NCD) had hypertension. Among individuals with NCDs, 387 participants (20.4%) were unable to manage at least 1 of their NCDs. Predictors for inability to manage NCDs were age, nonreceipt of cash assistance, household water insecurity, household food insecurity, and having multiple chronic diseases, with an adjusted C statistic of 0.650 (95% CI, 0.620-0.676) and C slope of 0.871 (95% CI, 0.729-1.023). The prevalence of nonadherence to medication was 9.2%, and the main reasons for nonadherence were unaffordability of medication (40.8%; 95% CI, 33.4%-48.5%) and the belief that they no longer required the medication after feeling better (22.4%; 95% CI, 16.4%-29.3%). In this cross-sectional study, the predictors of inability to manage NCDs among older Syrian refugees in Lebanon were mainly related to financial barriers. Context-appropriate assistance is required to overcome financial barriers and enable equitable access to medication and health care.

Adherence to Surveillance Guidelines after the Removal of Colorectal Polyps: A Multinational, Multicenter, Prospective Survey.

Background/AimsAs the number of colonoscopies and polypectomies performed continues to increase in many Asian countries, there is a great demand for surveillance colonoscopy. The aim of this study was to investigate the adherence to postpolypectomy surveillance guidelines among physicians in Asia.MethodsA survey study was performed in seven Asian countries. An email invitation with a link to the survey was sent to participants who were asked to complete the questionnaire consisting of eight clinical scenarios.ResultsOf the 137 doctors invited, 123 (89.8%) provided valid responses. Approximately 50% of the participants adhered to the guidelines regardless of the risk of adenoma, except in the case of tubulovillous adenoma ≥10 mm combined with high-grade dysplasia, in which 35% of the participants adhered to the guidelines. The participants were stratified according to the number of colonoscopies performed ≥20 colonoscopies per month (high volume group) and <20 colonoscopies per month (low volume group). Higher adherence to the postpolypectomy surveillance guidelines was evident in the high volume group (60%) than in the low volume group (25%). The reasons for nonadherence included concern of missed polyps (59%), the low cost of colonoscopy (26%), concern of incomplete resection (25%), and concern of medical liability (15%).ConclusionsA discrepancy between clinical practice and surveillance guidelines among physicians in Asia was found. Physicians in the low volume group frequently did not adhere to the guidelines, suggesting a need for continuing education and appropriate control. Concerns regarding the quality of colonoscopy and complete polypectomy were the main reasons for nonadherence.

Reasons for nonadherence to vaccination for influenza among older people in Brazil.

This study aimed to estimate the prevalence of non-vaccination and the reasons for nonadherence to the influenza vaccine among older Brazilians according to sociodemographic characteristics. A cross-sectional study was conducted with data from older people (≥ 60 years of age; n = 23,815) who participated in the 2013 National Health Survey. Frequencies of non-vaccination and the main reasons for nonadherence were calculated with respective 95% confidence intervals. The prevalence of non-vaccination was 26.9% (approximately 7,106,730 older people). The reason rarely gets the flu was the most cited among the men (28.2%), the 60-to-69-year-old age group (29.6%), individuals with higher education (41.9%), and those with health insurance (32.3%). Fear of a reaction was the most cited reason in the northeastern region (25.4%), among women (29.3%), longer-lived individuals (≥70 years; 28.7%), and those who did not know how to read/write (26.7%). A total of 12.1% reported not believing in the vaccine’s protection, and 5.5% did not know that it was necessary to take vaccine. The proportions of the main reasons for non-vaccination varied by sociodemographic characteristics. This study’s findings highlight the need to increase older people’s knowledge regarding influenza and influenza vaccines. Healthcare providers should be encouraged to counsel older people–especially those in subgroups with lower adherence, such as residents in the Northeast region, those aged 60–69 years, those who do not know how to read/write, those without a spouse/companion, and those without health insurance–regarding the different aspects of the vaccine and formally indicate it for groups at risk.

Non-adherence to anti-tubercular treatment during COVID-19 pandemic in Raipur district Central India

BackgroundNon-adherence is major factor in failure of any drug regimen. The significance of non-adherence is so much that WHO states that increasing the effectiveness of Adherence Interventions may have far greater impact on health of population than any improvement in specific medical treatments. Incidence of non-adherence to Anti Tubercular Treatment (ATT) usually ranges from 8.4% to 55.8%. This study aims to find out the reasons of Non-adherence to ATT in patients receiving anti-tubercular treatment at DIRECTLY OBSERVED TREATMENT SHORTCOURSE (DOTS) Centre at District Tuberculosis Centre (DTC), Kalibadi, Raipur during COVID-19 pandemic. MethodsA cross sectional study was conducted at Department of Pharmacology, Pt. JNM Medical College and DTC Kalibadi Raipur. 55 Patients taking ATT fulfilling inclusion and exclusion criteria were interviewed using structured questionnaire. The data obtained was analysed to know causes of non-adherence. ResultsStudy was carried out between March & April 2020. In our study, 80% subjects were male and 20% were female. The main reasons for Non-adherence were Side-effects of drug in 36% cases, missing medication intentionally in 34% cases, lack of encouragement by family members in 32% cases, patient's unawareness of consequences of skipping medication in 25% cases, unaware of treatment duration in 22%, not feeling any change, forgetting to take medication, and burden of concomitant medication besides ATT, each in 20% cases, 13% cases had difficulty in procuring medication due to lockdown, 5% cases did not go to collect their medicine due to fear of contracting COVID-19 infection. ConclusionsOur study shows reasons for Non-adherence are multi-factorial with drug side –effects & intentionally skipping medication being major factors.

Prevalence and factors associated with non-adherence to antiepileptic drugs among children with epilepsy in Jos, Nigeria

Background: Childhood epilepsy causes a tremendous burden for the child, the family, society as well as the healthcare system. Adherence toantiepileptic drugs (AEDs) is key to treatment success, one of the main causes of unsuccessful treatment for epilepsy is poor adherence to medications. Nonadherence in children with epilepsy presents a potential ongoing challenge for achieving a key therapeutic goal of seizure control.Aim: To determine the prevalence and factors associated with nonadherence to AEDs among children with epilepsy at Jos University Teaching Hospital, Jos, Nigeria.Methodology: This cross sectional study was done to assess the prevalence and factors associated with non-adherence to AEDs among children with epilepsy from November 2019 to February 2020. A structured questionnaire was used to collect relevant information on the adherence of studysubjects to AEDs based on self/ caregiver report. Part of the questionnaire was derived from Morisky Medication Adherence Scale (MMAS-8).Results: One hundred and ninety four subjects were recruited for the study. The prevalence of nonadherence to AEDs was 44.8%. Factors significantly associated with non-adherence were low socioeconomic status, multiple drug therapy and long duration of treatment. The main reasons for nonadherence were financial constraint, forgetfulness, lack of improvement and medication side effects.Conclusion: Non-adherence to medication is common among children with epilepsy and it hampers the key therapeutic goal of seizure control. Improving per capita income of families, providing universal health insurance, medication reminders and appropriate education/counseling will reduce non-adherence and improve the long term outcome of childhood epilepsy in our region.&#x0D; Key words: Epilepsy, Children, Ant i -epilept ic drugs, Nonadherence, Prevalence, Associated factors, Jos, Nigeria.

Adherence to Antiretroviral Therapy Among HIV-Positive Pregnant Women on followup at Mizan Tepi University Teaching and Tepi General Hospitals, Southwest Ethiopia.

Background: The introduction of highly active antiretroviral therapy has not only improved longevity in human immunodeficiency virus (HIV)–infected individuals but in addition has had a significant impact on the rate of mother-to-child transmission of the infection. Objective: To assess antiretroviral therapy adherence among HIV-positive pregnant women on follow-up at antiretroviral therapy clinic of Mizan Tepi University Teaching and Tepi General Hospitals. Methods: A descriptive cross-sectional study was undertaken in antiretroviral therapy clinics of Mizan Tepi University Teaching and Tepi General Hospitals from April to May 2018. Data were collected through face to face interview using structured and pretested questionnaires and analyzed using Statistical Package for Social Sciences version 20. Results: Majority of the patients had good adherence to their antiretroviral therapy, 68 (66.00%). Medication side effects, 12 (34.00%) and forgetfulness and distance of the hospital from home, each accounting 11 (31.00%) were the main reasons for nonadherence among nonadherent patients. Frequency of counseling (P = .000), CD4 count (χ2 = 37.529, P = .000), World Health Organization’s clinical stage (χ2 = 17.515, P = .000), stigma (χ2 = 70.426, P = .000), and family support (χ2 = 46.383, P = .000) were found to be associated with patients’ medication adherence. Conclusion: The overall patient adherence to antiretroviral therapy in the study facilities was good. Collaborative work among patients, health care organizations, and the public are necessary to tackle the adherence obstacles and enhance patient adherence to the prescribed medication.

Factors Affecting Level of Adherence Among People Living with HIV Attending Antiretroviral Care at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State

The effectiveness of Antiretroviral Therapy (ART) portends a viable remedy for Human Immunodeficiency Virus (HIV) infection with some context-specific factors identified to pose barriers to adherence to treatment. Consequently, non-adherence to treatment regimens impacts on desired improved health outcomes of affected individuals and socio-economic status of the nation. This study was thus conducted to elicit specific factors that may be responsible for the poor health outcomes attributed to non-adherence among people living with HIV recorded in the study area. A cross-sectional study was conducted on people living with Human Immunodeficiency Virus (HIV) and attending ART clinic at Nnamdi Azikiwe University Teaching Hospital Nnewi from February to August 2016. Adherence was defined as taking 95% of the prescribed doses in the week before the survey. Data collected using a standard interview questionnaire were analyzed on SPSS Version 21. Among the 272 study participants, the magnitude of adherence to ART in the week before interview was found to be 85%. The main reasons for nonadherence were forgetfulness (32%), being away from home (29%), and being busy doing other things (14%). Age and monthly income appeared to influence treatment adherence of clients sampled in the study. The researcher recommends a more inclusive approach to HIV care and treatment for a stronger adherence to treatment and implicates care-givers especially nurses at the center of the drive for higher adherence rates in Nigeria. A qualitative approach to the study is also recommended.

Malaria Prophylaxis Adherence Among Aircrew Members.

INTRODUCTION: Joint Base Charleston's C-17 Globemaster III mission is executed by 400 active-duty members from three operational and support wings. Aircrew and mission-essential personnel travel to locations with endemic diseases which are mostly eradicated in the United States. Recently, two members contracted malaria after missions in Africa which required advanced hospital care. Personnel were provided chemoprophylaxis, but the members who contracted malaria were among several who chose not to take it. This preliminary survey assessed aircrew malaria prophylaxis adherence and examined potential factors contributing to nonadherence.METHODS: JB Charleston aircrew members who visited the Flight and Operational Medicine Clinic between January and April 2018 were administered a retrospective, online survey. Researchers performed descriptive statistics and Chi-squared analysis.RESULTS: Most respondents were pilots under 30 yr of age and were prescribed malaria chemoprophylaxis while on a mission. More than two-thirds of respondent aircrew members did not take the medication as prescribed or did not take it at all. Of those, over half of respondents stated too many pills/too many days and medication side effects as the main reasons for nonadherence. Furthermore, almost 70% of adherent members experienced negative medication side effects such as nausea and heightened dreams. There was no statistical relationship between crew position, age, side effects, and prophylaxis adherence.DISCUSSION: Numerous factors contribute to poor prophylaxis regimen compliance among aircrew members. This study highlighted the need for risk-based policy validation, improved patient education, prophylaxis enforcement, process improvements to facilitate adherence, and evaluation of perceived vs. actual risk.Rutherford AE, Yale RS, Finn MF. Malaria prophylaxis adherence among aircrew members. Aerosp Med Hum Perform. 2019; 90(7):643-646.

Barriers to guideline adherence : Identification of barriers to guideline adherence using a survey on the AWMF S3 guideline epidemiology, diagnosis, treatment, and management of uncomplicated bacterial, community-acquired urinary tract infections in adult patients

Several studies have shown that nonadherence to guidelines is pretty common in the treatment of urinary tract infections (UTI). However, no urological study has raised the question, what are barriers or reasons for this nonadherence, yet. Consequently, we performed asurvey among German urologists with the primary endpoint identification of barriers for nonadherence to German guidelines on UTI. A19-item questionnaire was developed and transferred to the online portal "Survey Monkey®" (Private Equity, San Mateo, CA, USA) and tested for usability by our study group. The link for the survey was sent twice to the members of the German Society of Urology (DGU). Overall, 307 questionnaires were completed. The mean age of the study population was 46.7 years (standard deviation 11.5). The majority (34.9%) followed guidelines in 80% of the cases. Main reasons for nonadherence on the physicians' side were 23.4% personal experience and lacking practicality of UTI guidelines on the individual complex patient. On the open questions urologists mostly stated (11.7%) that the main reason on the physician side for nonadherence is ignorance. Therefore they, in open questions, suggest to promote guidelines more in meetings and more designed practically with shortcuts and simple layout. Patient-associated factors mentioned were mostly in 26.7%. Furthermore, German urologists stated that guidelines should also have apatient section, where the main recommendations are explained in plain language. We performed the first survey on identifying barriers for nonadherence to guidelines in urology. Despite some limitations, our results are very important for the further design of guidelines. This has the potential to improve guideline adherence.

A study on medication adherence, medication related challenges faced and coping strategies adopted by visually impaired subjects in a tertiary care hospital

Background: Visual impairment poses a significant threat to proper medication practice leading to medication related challenges and some adopted self coping strategies with substantial impact on medication adherence. Visually impaired are potentially more likely to have unsafe medicine related practice which by itself is more rampant in general population. Studies related to them are largely unexplored and can provide data to improve disease management and health related quality of life. Objectives was to study the level of medication adherence, medication related challenges and self adopted coping strategies in visually impaired people.Methods: A cross sectional descriptive study enrolling 204 subjects with VI was done. Medication adherence was assessed using MMAS. Medication related challenges and self-adopted coping strategies was assessed by using pre-validated semi-structured questionnaire.Results: Majority of the subjects showed medium medication adherence with forgetfulness to take medicine as the main reason for non adherence. Difficulty in remembering the instructions, spilling of liquid medicine, taking wrong dose, difficulty in using topical medications were the most common challenges faced by them in daily drug administration. To overcome challenges locating the drugs at different places, finger felt volume for liquid medication, textural feeling of the drug or container, time tracking were the major self adopted coping strategies by the visually impaired subjects.Conclusions: Creating awareness of the medication related problem faced by visually impaired helps to provide adequate assistance to medication use and improve proper health care services in them.

Assessment of Factors Associated with Low Adherence to Pharmacotherapy in Elderly Patients

Objective: To assess factors associated with low adherence to pharmacotherapy in elderly patients. Methods: A prospective cross sectional observational study was conducted in Bharati Hospital and Research Centre, Pune over a period of 6 months. A total of 240 Elderly patients (≥60 years), taking 4 or more medications daily for any medical illness or illnesses were enrolled in the study. The details like age, gender, educational and employment status, physical activity, social history, past medical and medication history, current medications were noted in self pre designed patient pro forma. The medication adherence was assessed by using Brief Medication Questionnaire (BMQ). Results: The assessment of the patient’s responses to the four scale BMQ showed that out of 240 patients, only 5.8% patients were adherent in regimen scale, 60% were adherent in belief scale, 15% were adherent in recall scale and 37.5% were adherent in access scale. Complexity of medication regimen (74.1%) was the main barrier to medication adherence. More than half of patients were unable to name their medications (68.3%). The main reason for non adherence would be related to patient related factors such as lack of knowledge about the disease (63.3%), inadequate knowledge regarding therapy (60%), taking so many pills at the same time (51.7%), forgetfulness (50.84%), difficulty in remembering to take all the pills (48.3%) and difficulty on refilling in time (20.0%). Conclusion: Various factors associated with medication nonadherence were complexity of medication regimen, lack of knowledge about the disease and therapy, difficulty in remembering to take medications and taking so many pills at the same time. Key words: Brief medication questionnaire, Factors associated with medication non-adherence.

English

Adjuvant hormonal therapy is crucial in the treatment of estrogen receptor-positive breast cancer. The nonadherence rate to hormonal treatment is reported to be as high as 60%. The goal of this study was to evaluate the factors evoked by the patients as well as the demographic and disease-related factors that could be associated with nonadherence to adjuvant hormonal therapy. All consecutive patients treated for an estrogen receptor-positive breast cancer who showed up for regular follow-up with a single breast specialist between November 2008 and April 2009 were included in the study. We assessed adherence to hormonal therapy (either with tamoxifen or aromatase inhibitor). Reasons for adherence and nonadherence were collected. Records were also reviewed for demographic and cancer characteristics and for treatment components. We included 161 patients in the study; 150 (93.2%) adhered to hormonal treatment. Side effects and absence of conviction were the main reasons for nonadherence. The importance of the diagnosis of cancer, fear of recurrence and regular follow-up were reported as the main reasons for adherence. Severity of disease and side effects are associated with nonadherence to treatment. Strict follow-up appears to be a necessary adjunct in the adherence to treatment. The association between demographic and cancer characteristics and treatment components needs further investigation. However, these factors may help identify patients at risk of nonadherence and help the oncology team.

Lack of Adherence to Follow-Up Visits After Bariatric Surgery: Reasons and Outcome

A substantial number of patients undergoing bariatric surgery are lost to follow-up for unknown reasons, which may cause an overestimation of the benefits of operation. The aim of this study was to identify the reasons of failure to attend controls after bariatric surgery and the relationship with poor weight loss. A retrospective analysis of a prospective database including all patients undergoing bariatric surgery from January 2004 to February 2012 was performed. Nonadherence was defined as missing any scheduled control visit for more than 6 months. Contact was attempted (mail, telephone, and e-mail), and responders were requested to complete a questionnaire. Forty-six (17.5%) out of 263 patients were considered nonadherent. Thirty-three (71.7%) of these patients completed the questionnaire. The main reasons for nonadherence were work- (36.4%) and family-related (18.2%) problems or having moved outside the city or to the country (15.2%). The percentage of nonadherent patients aged ≤45 years was greater as compared with those aged >45 years [28 (60.1%) vs 18 (42.2%), respectively, P = 0.034]. Likewise, of the 30 patients with unsuccessful weight loss (<50% EWL), seven (30.4%) were in the nonadherent group while 23 (10.6%) in the adherent group (P = 0.046). Finally, 96.9% of patients were completely satisfied with surgery and would recommend the procedure to other morbid obese patients. The nonadherence rate to follow-up visits after bariatric surgery was 17.5%, mainly associated with work-related problems. Nonadherence was greater in patients aged ≤45 years and in those with poor weight loss.

Factors Affecting Adherence to Antiretroviral Treatment in Harari National Regional State, Eastern Ethiopia

Background. The efficacy of antiretroviral treatment (ART) depends on strict adherence to the regimen, but many factors have been identified for nonadherence. Method. To identify the factors for non-adherence to ART, a cross-sectional study was conducted on people living with human immunodeficiency virus (HIV) and attending the ART service at Hiwot Fana and Jugal hospitals; it was done from October to December, 2010. Adherence was defined as taking 95% of the prescribed doses in the week before the survey. Data were collected using a standard interview questionnaire and were analyzed using SPSS Version 16. Result. Among the 239 study participants, the magnitude of adherence to ART in the week before interview was 87%. The main reasons for nonadherence were forgetting (47.2%), traveling (18.9%), and being busy doing other things (15.1%). There was not any independent predicator identified for adherence to ART. Conclusion. Compared to other similar studies in Ethiopia, in this study a high adherence rate was found. Forgetfulness was the most common reason for the nonadherence. Therefore, the ART counseling needs to give emphasis to using memory aids. In addition, a further study on adherence rate and its determinants with multiple adherence measurements is recommended.

P2-546 Age at diagnosis affects adherence to national breast cancer guidelines regarding local therapy

IntroductionIn the Netherlands, breast cancer patients are treated according to national guidelines. Despite comprising a large proportion, elderly breast cancer patients are underrepresented in clinical trials. Therefore it is questionable...

Adherence to waiting-time targets for pediatric nephrology clinic referrals

Waiting times for specialist consultation have not been adequately studied, especially in the pediatric population. The aim of this study was to determine the extent to which pediatric nephrology subspecialty clinic referral waiting times are adhered to with regard to previously determined access targets. Referrals to the pediatric nephrology clinics at Children's Hospital, London, Ontario, Canada, received between October 2007 and November 2008 were retrospectively analyzed. Appointment schedule was allotted by a nephrologist based on the patient's presenting complaint, reported in the referral, in accordance with the previously determined access targets. Adherence to access targets was assessed by the actual clinic visit. There were a total of 250 referrals during the timeframe studied. The median waiting time was 73 (range 0-193) days. Overall, 64% (159/250) of patients met their access target. The median time that patients waited over their access target was 6 (range 0-78) days. Of the patients who did not meet their access targets, 31% (28/91) exceeded their target by 20% or more. Office handling was a component for patients with access target <1 week, whereas availability of clinic space was the main reason for nonadherence to access targets.

Impact of adherence to antiretroviral therapy in HIV-1-infected patients at a university public service in Brazil.

The objective of this study was to assess if a simple evaluation, adherence to antiretroviral therapy, would correlate to clinical and laboratory outcomes. We followed an open cohort of patients from a public teaching hospital AIDS outpatient clinic. Patients were categorized according to adherence as: regular (Reg), optimal, all doses all days, tolerating only irregular timing (+/- 2 hours) of intake; quasi-regular (qReg), those missing up to four doses or 1 full day during a month; irregular (Irreg), all other irregular regimens, and ignored (Ign), those without information. The results from a simple questionnaire were compared to CD4+ cell counts and human immunodeficiency virus type 1 (HIV-1) RNA plasma viremia. One hundred eighty-two HIV-1-infected patients (126 males, 69%; 56 females, 31%) were analyzed. Information on adherence was available for 168 (90%). Reg adherence was reported by 75 (41%) patients, qReg adherence by 35 (19%), and Irreg by 53 (29%) of patients. The main reasons for nonadherence were forgetfulness, intolerance, use of alcohol, and misunderstanding of prescription. A significant increase of CD4+ T-cell counts and absolute gain were only observed among Reg and qReg users (p < 0.001). The median viral RNA load log10 decreases were -1.68, -1.45, -0.9 log, respectively, for Reg, qReg, and Irreg patients (p = 0.043, Kruskal-Wallis). Development of and death from AIDS occurred almost exclusively among those with Ign or Irreg adherence. Previous use of antiretroviral therapy may have had an impact in treatment response. Individuals who were treatment-naive were more likely to be Reg users (41%). Although more refined methods to assess adherence should be implemented when available, the inability to do so should not prevent simple, albeit subjective measurements that also correlate with favorable outcome. Mechanisms to improve adherence should be considered an integral part of antiretroviral therapy.