Medication Adherence In Persons Research Articles

Assessing the impact of telephone call intervention on medication adherence in individuals with mental health disorders: A longitudinal study in a tertiary facility in Volta Region

Medication adherence strategies that are successful, suitable and economical are vital to the treatment outcome of persons living with mental illness. Mobile-phone-based intervention is one such strategy and is particularly critical to reducing medication non-adherence, especially in mental health disorders. This study aimed to assess the impact of telephone adherence counselling on medication adherence in persons with mental health disorders. A longitudinal study was conducted on study participants who were randomly assigned to control and intervention groups over three months. Both groups received standard medication adherence counselling for the first month and then baseline adherence levels were determined using the medication adherence rating scale (MARS). The control group received standard medication adherence counselling at the psychiatric clinic whilst the intervention group received additional telephone calls made to each member of the intervention group once a week for a total of 8 times over 2 months. Of the patients who were screened for potential participation, 149 participants passed and 87 participants participated making a response rate of 58.40 %. The t-test conducted on the participants after the first (Month 2) and second (Month 3) on those with Telephone Call Intervention inferred significant statistical differences (p < 0.001). MARS Scores appreciated in the intervention group compared to the control group in Month 2 (1.64) and Month 3 (1.79). A positive impact of Telephone Call Interventions on medication adherence was achieved. This intervention can be a medication adherence strategy to supplement the standard medication adherence counselling which could improve treatment outcomes.

Abstract 14793: The Mediating Effect of Resilience on the Relationship Between Self-Care Activation, Hope, and Medication Adherence in a Diverse Sample of Adults With Heart Failure

Background: Despite decades of research and advances in treatment, medication adherence in those with heart failure remains suboptimal. Recent research suggests that self-care activation and positive psychological characteristics can enhance medication adherence, yet little is known about how these factors and medication adherence are related in persons with heart failure. Objective: The purpose of this study was to investigate whether the effects of self-care activation and hope on medication adherence are mediated by resilience in persons with heart failure. Methods: This study used a prospective, cross-sectional design. Regression and mediation analyses were used to examine if resilience mediates the effects of activation on medication adherence. A nationwide, diverse sample was recruited for this study. Results: Of the 174 participants, 51% were female, 48% were persons of color (POC) and the mean age was 62 years. Higher activation (B = -.023, p = .039) and hope (B = -.063, p = .011) were associated with better medication adherence. The effects of activation and hope on medication adherence were completely mediated by resilience. Indirect effect accounts for 17.4% of the total effect for activation and 71.4% for hope. Conclusion: Resilience could be a potential mechanism by which activation and hope could improve medication adherence in persons with heart failure. Thus, resilience may have a significant influence on medication adherence. More research is needed to understand the connection between resilience and medication adherence.

Staying The Course And Staying Engaged: The Road To Medication Adherence

<h3>Introduction</h3> Medication nonadherence in persons with heart failure (HF) is responsible for increased hospitalizations, morbidity, and mortality. Persons experiencing negative emotions, such as depression, are less motivated to take medications as prescribed, but very little is known about the influence of positive psychological characteristics (PPC), such as resilience and hope, on medication adherence in persons with HF. Activation, the degree to which individuals are motivated to engage self-management behaviors, has been identified as an important factor in chronic illness self-management. But there is little evidence about the role of activation in HF medication adherence. <h3>Aim</h3> The aim of this study was to investigate whether PPC (i.e., resilience, hope) and patient activation can explain or predict medication adherence in persons with HF. <h3>Methods</h3> A linear regression was calculated to predict medication adherence based on resilience, hope, and activation. Utilizing convenience sampling, 174 adults with HF completed the Patient Activation Measure (short-form) (PAM), 14-item Resilience Scale (short-form), Adult Hope Scale and Voils Self-Report of Medication Nonadherence Measurement (Part 1). Instruments were completed via the Qualtrics online platform. Linear regression models were used to show the relationships among the variables. <h3>Results</h3> Resilience, hope, and activation were positively correlated with medication adherence (p=.01). The model as a whole is significant <i>(F(3, 170)=7.398, p=.000, R² =.34)</i> and explains 15% of the variance in medication adherence scores. Resilience <i>(Beta= -.31, t(.02)=-3.0, p=.003)</i> and PAM <i>(Beta= -.17, t(.21)=-2.21, p=.028)</i> make a significant unique contribution to predicting medication adherence. <h3>Conclusions</h3> Resilience makes the strongest unique contribution to explaining medication adherence, followed by activation and hope. Resilient, hopeful, and activated persons with HF are more likely to take medications as prescribed. Thus, enhancing PPC and activation in persons with HF may result in improved medication adherence.

Characteristics associated with self-reported medication adherence in persons with psychosis referred to psychosocial rehabilitation centers.

The aim of the present study was to explore the characteristics of psychotropic treatment and of psychosocial functioning associated with self-reported medication adherence in persons with psychosis engaged in rehabilitation. The study was performed in the REHABase cohort including persons referred to a French network of psychosocial rehabilitation centers. Treatment adherence was assessed using the Medication Adherence Rating Scale (MARS). The associations between MARS score (categorized as "low" < 7 vs. "high" ≥ 7) and functioning or psychotropic treatment characteristics were explored using multivariate analyses in 326 participants with schizophrenia spectrum disorders. Regarding psychotropic treatment, high anticholinergic load was the only characteristic associated with poor medication adherence (adjusted OR, aOR 1.98, 95% CI 1.07-3.66). Regarding functioning measures, participants with poor medication adherence were more likely to present with lower stage of recovery (aOR 2.38, 95% CI 1.31-4.32), poor quality of life (aOR 2.17, 95% CI 1.27-3.71), mental well-being (aOR 1.68, 95% CI 1.03-2.72) and self-esteem (aOR 1.74, 95% CI 1.05-2.87), and higher internalized stigma (aOR 1.88, 95% CI 1.09-3.23). Self-reported poor medication adherence is a marker of poor functioning in persons with psychosis. The MARS is a quick and simple measure of adherence that may be helpful in clinical and rehabilitation settings to identify persons with specific rehabilitation needs.

Pharmacist-led motivational interviewing for diabetes medication adherence in a worksite wellness program

ObjectiveThe primary objective was to evaluate the impact of a pharmacist-delivered motivational interviewing (MI) intervention for diabetes medication adherence; the secondary objectives were to assess the changes in clinical outcomes and health-related quality of life (HRQoL). MethodsA quasi-experimental intervention study was conducted with baseline, postintervention, and follow-up data collections. The study duration was 6 months. Pharmacists trained in MI delivered 3 face-to-face encounters using MI-based semistructured conversation tools to address barriers or challenges to medication adherence. A diabetes worksite wellness program (WWP) at a 350-bed regional hospital in the southeastern United States was the setting, and the study participants were WWP employees or dependents (with type 1 diabetes or type 2 diabetes). The primary outcome was a change in self-reported diabetes medication adherence; the secondary outcomes included the changes in clinical indicators (glycated hemoglobin [HbA1c], blood pressure, and depressive symptoms), and HRQoL. The measures included the Medometer, Summary of Diabetes Self-Care Activities–Medication Subscale (SDSCA-MS), Audit of Diabetes-Dependent QoL (ADDQoL-19), and the Short Form–12 (SF-12) health survey. ResultsFifty-three WWP participants enrolled, and 36 completed the full intervention protocol. Medication adherence (through the Medometer) demonstrated statistically significant improvement after the intervention (P = 0.010); the SDSCA-MS score improved, but was not statistically significant. The change in diastolic blood pressure was statistically significant (P = 0.034), but the changes in HbA1c, systolic blood pressure, presence of depressive symptoms, and ADDQoL-19 were not statistically significant. The SF-12 physical component summary (PCS) and mental component summary (MCS) scores were statistically significant: PCS, P = 0.003, and MCS, P = 0.025. ConclusionThe findings from this pilot study support the effectiveness of a pharmacist-delivered, semistructured MI-based intervention for medication adherence in persons with diabetes in a hospital-based WWP. Pharmacists can support patients’ behavior change using MI communication skills to explore salient barriers to medication adherence and to facilitate goal setting to overcome these in encounters aimed at shared clinical and behavioral decision-making.

828-P: Challenges in Care Relationships in Diabetic Setting: The Diabetologists’ Perspective

Purpose: Poor medication adherence in persons with diabetes is a well documented issue, overall leading to worse glycemic control and quality of life. Previous studies have shown that the quality of the patient-provider relationship is a crucial factor for patient diabetes management and self-care. Most of research has focused on patient perspective, with poor attention to providers’ relational skills to handle interpersonal difficulties concerning care challenges. The purpose of the present study was to explore providers’ subjective perspective about care relationship so to detect some clues that may contribute to better manage patient medication adherence. Methods: A purposive sample of 18 Italian diabetologists participated in the study. Face-to-face interviews on providers’ emotional experience about care relationship were collected, digitally recorded, and transcribed. A computer-aided text analysis based on word co-occurrences was performed through T-Lab software, by using the conceptual model of Emotional Text Analysis. This allowed the identification of thematic domains pertaining to implicit sense-making processes, beyond the cognitive discourse organization. Results: Six thematic domains were identified across interviews, which respectively referred to: (1) preoccupation, in terms of separation anxiety and desire for contact; (2) control, focused on hypervigilance and conflict management; (3) fear for excessive closeness and effort to distance; (4) proud self-affirmation in opposition to care burden; (5) guilt feelings and over-involvement; (6) strive for achievement and satisfaction gain. Conclusions: The findings suggest the importance of providers’ awareness about potential defensive strategies in facing care challenges, from distancing to intrusive reactions, which may interfere patient health engagement and capacity to self-regulate in care behaviors, respectively. Disclosure V. Langher: None. A. Caputo: None. C. Giuliani: None. A. Convertino: None. A. Napoli: None.

Illness Perceptions, Self-efficacy, and Self-reported Medication Adherence in Persons Aged 50 and Older With Type 2 Diabetes.

Illness perceptions, patients' beliefs about their health condition, may affect medication adherence as well as self-efficacy for managing the condition in type 2 diabetes (T2DM). The aims of this study were to investigate the associations between illness perceptions, self-efficacy, and self-reported medication adherence among persons (≥50 years of age) with T2DM and explore whether the number of comorbid conditions moderates these associations. This secondary analysis of cross-sectional data used baseline data from persons with T2DM. Self-administered questionnaires, including the Brief Illness Perception Questionnaire, Self-efficacy for Managing Chronic Disease, and the 4-item Morisky-Green-Levine Medication Adherence Scale, were used. We performed hierarchical multiple linear regression analyses. Participants (N = 146) were 57.5% female, 67.1% white, and on average 64 years old. Six dimensions of illness perceptions (ie, consequences, personal control, treatment control, identity, concerns, and emotional representations) were associated with self-efficacy for managing T2DM. Five dimensions (ie, timeline, personal control, treatment control, coherence, and emotional representations) were significant predictors of self-reported medication adherence. Whereas the number of comorbid conditions was significantly associated with self-efficacy for managing T2DM in all models (P values < .001), the number of comorbid conditions was not associated with self-reported medication adherence. This study suggests that illness perceptions and comorbid conditions may play a critical role in either self-efficacy or self-reported medication adherence in persons (≥50 years of age) with T2DM. Future research should incorporate an individual's illness perceptions and comorbid conditions into the development of interventions that may improve both self-efficacy and medication adherence in T2DM.

Personal Approach to Treatment Choices for HIV (PATCH): Randomized Controlled Trial of a Brief Motivational Enhancement Intervention to Improve Medication Adherence in Persons with HIV.

This pilot randomized controlled trial evaluated the feasibility and efficacy of a brief motivational enhancement intervention to improve adherence to antiretroviral therapy in persons with HIV called Personal Approach to Treatment Choices for HIV (PATCH). We compared PATCH to an active control condition on self-reported adherence, clinical outcomes, and psychosocial outcomes. Participants were 34 individuals (61.8% male, Mage = 47.1) receiving HIV-related services who were suboptimally engaged in care. Participants completed baseline measures, participated in either PATCH or a stress reduction skills control intervention, and completed post-treatment and 3-month follow-up assessments. Results revealed no differences between conditions on adherence or clinical outcomes. At post-treatment, PATCH participants reported greater improvements in alcohol use, psychiatric symptoms, subjective mental functioning, and emotion-focused coping; improvements in subjective mental functioning were maintained at 3-months. Results suggest that motivational enhancement interventions can improve psychosocial outcomes for people with HIV. That some improvements were not maintained at follow-up suggests that effects wane over time and longer treatment may be indicated for lasting effects.

A Multi-step Usability Evaluation of a Self-Management App to Support Medication Adherence in Persons Living with HIV

PurposeAdherence to antiretroviral therapy is essential to HIV management and sustaining viral suppression. Despite simplified regimens, adherence remains difficult for certain persons living with HIV (PLWH). There is evidence to support the use of mHealth apps for effective self-management in PLWH; however, a medication adherence app with real-time monitoring for this population has not been developed and rigorously evaluated by PLWH. We developed a mHealth app (WiseApp) for HIV self-management to help PLWH self-manage their health. The purpose of this study was to evaluate the usability of the WiseApp. MethodsWe conducted a three-step usability evaluation using 1) a traditional think-aloud protocol with end-users, 2) a heuristic evaluation with experts in informatics, and 3) a cognitive walkthrough with end-users. During the cognitive walkthrough, we tested two devices (fitness tracker and medication tracking bottle) that were linked to the WiseApp. ResultsThe think-aloud protocol informed iterative updates to the app, specifically to make it easier to see different sections of the app. The heuristic evaluation confirmed the necessity of these design changes. The cognitive walkthrough informed additional updates and confirmed that overall, the app and the linked devices were usable for the end-users. ConclusionThe results of the cognitive walkthrough with both experts and end-users informed iterative refinements to the WiseApp and finalization of a mHealth app for PLWH to better self-manage their health.

The relationships among fear of disease progression, anxiety, depression and medication adherence in persons with HIV/AIDS

The relationships among fear of disease progression, anxiety, depression and medication adherence in persons with HIV/AIDS

The Combined Roles of Nonsomatic Depressive Symptomatology, Neurocognitive Function, and Current Substance Use in Medication Adherence in Adults Living With HIV Infection

Depression, global neurocognitive (GNC) function, and substance use disorders (SUDs) are each associated with medication adherence in persons living with HIV (PLWH). Because somatic symptoms can inflate depression scores in PLWH, the role of nonsomatic depressive symptomatology (NSDS) should be considered in adherence. However, the combined roles of NSDS, GNC function, and current SUDs in predicting combined antiretroviral therapy (cART) adherence remain poorly understood. Forty PLWH (70% Latina/o; 30% non-Hispanic White) completed psychiatric/SUD, neurocognitive, and self-report cART adherence evaluations. Higher NSDS was associated with suboptimal adherence (p<.01), but optimal and suboptimal adherers did not differ in GNC function or current SUDs. Only NSDS was associated with suboptimal adherence, after accounting for GNC function and SUDs (p=.01). NSDS uniquely predicted self-reported adherence, beyond GNC function and current SUDs among ethnically diverse PLWH. Methodological issues between present and prior studies should also be considered.

Development of a culturally appropriate computer-delivered tailored Internet-based health literacy intervention for Spanish-dominant Hispanics living with HIV.

BackgroundLow health literacy is associated with poor medication adherence in persons with human immunodeficiency virus (HIV), which can lead to poor health outcomes. As linguistic minorities, Spanish-dominant Hispanics (SDH) face challenges such as difficulties in obtaining and understanding accurate information about HIV and its treatment. Traditional health educational methods (e.g., pamphlets, talking) may not be as effective as delivering through alternate venues. Technology-based health information interventions have the potential for being readily available on desktop computers or over the Internet. The purpose of this research was to adapt a theoretically-based computer application (initially developed for English-speaking HIV-positive persons) that will provide linguistically and culturally appropriate tailored health education to Spanish-dominant Hispanics with HIV (HIV + SDH).MethodsA mixed methods approach using quantitative and qualitative interviews with 25 HIV + SDH and 5 key informants guided by the Information-Motivation-Behavioral (IMB) Skills model was used to investigate cultural factors influencing medication adherence in HIV + SDH. We used a triangulation approach to identify major themes within cultural contexts relevant to understanding factors related to motivation to adhere to treatment. From this data we adapted an automated computer-based health literacy intervention to be delivered in Spanish.ResultsCulture-specific motivational factors for treatment adherence in HIV + SDH persons that emerged from the data were stigma, familismo (family), mood, and social support. Using this data, we developed a culturally and linguistically adapted a tailored intervention that provides information about HIV infection, treatment, and medication related problem solving skills (proven effective in English-speaking populations) that can be delivered using touch-screen computers, tablets, and smartphones to be tested in a future study.ConclusionUsing a theoretically-grounded Internet-based eHealth education intervention that builds on knowledge and also targets core cultural determinants of adherence may prove a highly effective approach to improve health literacy and medication decision-making in this group.

Baseline medication adherence and response to an electronically delivered health literacy intervention targeting adherence

Medication adherence in persons treated for human immunodeficiency virus (HIV) continues to be an important focus for intervention. While high levels of adherence are required for good clinical outcomes, research shows many patients do not achieve these levels. Despite multiple interventions to improve adherence, most require multiple sessions delivered by trained clinicians. Cost and lack of trained personnel limit the availability of these interventions. Alternatives to clinician-delivered interventions are interventions provided via electronic devices (eg, personal/tablet computers and smartphones). Modern technology allows devices to provide tailoring of content to patient characteristics and learning needs, and to be excellent platforms to deliver multimedia teaching content. The intervention reported drew on research on health literacy in persons with HIV and the relation of health literacy to medication adherence in persons treated for HIV to develop an electronically delivered application. Using the Information-Motivation-Behavioral Skills model as a conceptual framework for understanding patients' information needs, a computer-delivered intervention was developed, its usability and acceptability was assessed, and medication adherence in 118 patients for 1 month before and after they completed the intervention was evaluated. Changes in participant adherence were evaluated in sequential models with progressively lower levels of baseline medication adherence. Results show that although changes in adherence in the entire sample only approached statistical significance, individuals with adherence less than 95% showed significant increases in adherence over time. Participants' self-reported knowledge and behavioral skills increased over the course of the study. Their change in information predicted their post-intervention adherence, suggesting a link between the intervention's effects and outcomes. A computer-delivered intervention targeting HIV-related health literacy may thus be a useful strategy for improving patient adherence.

Development and Validation of a Brief Computer-Administered HIV-Related Health Literacy Scale (HIV-HL)

Health literacy is related to a number of health status variables and has been associated with medication adherence in persons treated for HIV infection. Currently-available measures of health literacy require lengthy administration or have content or format limitations. In this paper we report the preliminary development and validation of a brief computer-administered health literacy test that includes content focused on medication adherence as well as questions based on a video simulation of an HIV-related clinical encounter. The measure shows significant relations with other measures of health literacy, HIV-related knowledge, and electronically-measured medication adherence. We also present receiver operating characteristic analyses that provide estimates of various scores' sensitivities and specificities so that the HIV-Related Health Literacy Scale can be used as a screening measure.

Qualitative inquiry into motivators for maintaining medication adherence among Taiwanese with schizophrenia

Medication non-adherence is associated with higher rates of relapse in persons with schizophrenia. Psychiatric nurses play a significant role in facilitating their medication adherence. The motivators which strengthen patients with schizophrenia to maintain their adherence to medication have seldom been explored. This study aims to explore what motivates persons with schizophrenia to consistently maintain their medication adherence. A qualitative approach was used to collect data from a psychiatric day-care centre at an armed forces hospital in Taiwan. Ten clients agreed to undergo an in-depth interview. The data was analyzed by a content analysis method. Four themes were identified: (i) the benefits of antipsychotic medication treatment; (ii) firm and ongoing family support; and the Chinese values of (iii) filial piety and (iv) hope for the future. These findings may provide psychiatric nurses with a better understanding of the motivators for medication adherence in persons with schizophrenia from the Chinese perspective. Nurses will then be able to adjust their practice to facilitate patients' medication adherence.

Self-Efficacy, Medication Adherence, and Quality of Life Among People Living With HIV in Hunan Province of China: A Questionnaire Survey

Self-efficacy is associated with health behavior and medication adherence in persons living with HIV infection (PLWH). This paper describes self-efficacy, medication adherence, and quality of life (QOL), and it examines the relationships among these variables in PLWH in China. A cross-sectional survey of 199 patients was completed using the HIV Self-Efficacy Questionnaire and the QOL for Chinese HIV-Infected Questionnaire. Medication adherence was measured through direct questioning of pill-taking behavior. Results showed that self-efficacy for disease management was moderate, with a mean score of 6.61. Of the 199 patients, 157 (78.9%) reported that medication adherence was higher than 90%. The scores for dimensions of QOL ranged from 33.1 to 81.4, with six dimensions lower than 60. Stepwise regression analyses showed that self-efficacy, medication adherence, and drug use were significant predictors of QOL. These results suggest a need for intervention programs to improve self-efficacy and quality of life in Chinese PLWH.

Medication knowledge, adherence and predictors among people with heart failure and chronic obstructive pulmonary disease

gallagher r, warwick m, chenoweth l, stein‐parbury j &amp; milton‐wildey k (2011) Journal of Nursing and Healthcare of Chronic Illness 3, 30–40 Medication knowledge, adherence and predictors among people with heart failure and chronic obstructive pulmonary diseaseBackground. Although medicines are a key component in the self‐management of chronic illness, lack of adherence is a common problem.Aim. To describe medication adherence and predictors in relation to the Multidimensional Adherence Model among older adults with chronic illness.Method. During a home interview, we collected data from 118 patients with chronic illnesses (chronic obstructive pulmonary disease and heart failure), following a recent illness exacerbation, to determine self‐reported medication adherence, medication knowledge and capacity for self‐management of their illness. We used the Medication Adherence Model as an organising framework and performed multivariate analyses to determine the independent predictors. We conducted the study between April 2005–June 2006.Results. Participants had an average age of 75·54 years (SD 8·38), with marginally more men (56·8%) than women, and were prescribed an average 4·68 (SD 2·11) medications for their primary diagnosis of either chronic obstructive pulmonary disease or heart failure. Most participants (75·2%) were adherent to their prescribed medicines; however, medication knowledge was low [mean score 47·61 (SD 18·73) out of a potential 100]. Predictors of better adherence to medicines were patient‐related: female gender and higher self‐management capacity, and condition‐related: heart failure diagnosis. Socioeconomic and treatment‐related factors were not identified as independent predictors of medication adherence. Predictors of better medication knowledge were higher capacity for self‐management, more concurrent conditions, younger age and taking fewer medicines.Conclusion. Assessment of self‐management capacity, targeting interventions towards patients with chronic obstructive pulmonary disease and men, rather than relying solely on increasing medication knowledge, is essential to improve medication adherence. The Multidimensional Adherence Model requires further investigation to determine its use in patients with chronic illness in general.Relevance to clinical practice. The most effective interventions to improve medication adherence are less likely to be those focused on patient education, and more likely to be those tailored to increasing patients’ self‐management capacity. Programmes will need to involve formal and informal carers. Simple strategies designed to improve medication adherence, such as medication reminders, daily routines, and multi‐dose packs have been reported to be effective in systematic reviews and by patients’ themselves. We recommend all of these strategies to improve medication adherence in persons with chronic illnesses.

The HIV Medication Taking Self‐efficacy Scale: psychometric evaluation

This paper is a report of an examination of the psychometric properties of the HIV Medication Taking Self-efficacy Scale. Self-efficacy is a critically important component of strategies to improve HIV medication-taking; however, valid and reliable tools for assessing HIV medication-taking self-efficacy are limited. We used a cross-sectional, correlational design. Between 2003 and 2007, 326 participants were recruited from sites in Pennsylvania and Ohio in the United States of America. Six self-report questionnaires administered at baseline and 12 weeks later during 'Improving Adherence to Antiretroviral Therapy' were used to examine the variables of interest. Means and variances, reliability, criterion, and construct validity of the HIV Medication Taking Self-efficacy Scale were assessed. Participants reported high self-confidence in their ability to carry out specific medication-related tasks (mean = 8·31) and in the medication's ability to effect good outcomes (mean = 8·56). The HIV Medication Taking Self-efficacy Scale and subscales showed excellent reliability (α = 0·93∼0·94). Criterion validity was well-established by examining the relationships between the HIV Medication Taking Self-efficacy Scale and selected physiological and psychological factors, and self-reported medication adherence (r = -0·20∼0·58). A two-factor model with a correlation between self-efficacy belief and outcome expectancy fitted the data well (model χ(2) = 3871·95, d.f. = 325, P < 001; CFA = 0·96; RMSEA = 0·046). The HIV Medication Taking Self-efficacy Scale is a psychometrically sound measure of medication-taking self-efficacy for use by researchers and clinicians with people with HIV. The findings offer insight into the development of interventions to promote self-efficacy and medication adherence in persons with HIV.

The Effect of Psychological Distress on Medication Adherence in Persons With HIV Infection in Nigeria

A high level of adherence to prescribed antiretroviral (ARV) regimens is required to achieve and maintain suppression of human immunodeficiency virus (HIV) replication and prevent drug resistance. This study aimed to determine the possible relationship between psychopathology and ARV medication adherence in Nigeria. Persons with HIV infection (N=182) completed various questionnaires on sociodemographic and clinical details, general psychopathology, self-esteem, and medication adherence. Low medication adherence was reported in 26.9% of the participants; significant correlates included presence of psychopathology and perceived poor social support. The success of any intervention policy for HIV-infected persons in sub-Saharan Africa must consider both low level of medication adherence and its associated factors.

Disparities in Antihypertensive Medication Adherence in Persons With Disabilities and Without Disabilities: Results of a Korean Population-Based Study

Park JH, Park JH, Lee SY, Kim SY, Shin Y, Kim SY. Disparities in antihypertensive medication adherence in persons with disabilities and without disabilities: results of a Korean population-based study. Objective To determine disparities in antihypertensive medication adherence between persons with disabilities and those without disabilities in South Korea. Design The study compared antihypertensive medication adherence between persons with disabilities and those without disabilities using medical claims data of the National Health Insurance (NHI). Setting We obtained data from claims submitted to the NHI, which covers almost the entire Korean population. Persons who were prescribed antihypertensive medication during the calendar year 2004 were identified. Participants The study comprised data from persons with disabilities (n=85,098) and persons without disabilities (n=2,368,636). Interventions Not applicable. Main Outcome Measures A cumulative medication adherence (CMA) greater than or equal to 80% was defined as an appropriate medication adherence. Multiple logistic regression was used to identify differences in antihypertensive medication adherence between persons with disabilities and without disabilities. Estimates were adjusted for demographic characteristics (sex, age), type of medical insurance, insurance contribution a month as a proxy for household income, residential area, and clinical characteristics (medication duration, comorbid conditions). Results People with disabilities had lower CMAs than those without (median CMA, 83.6% vs 85.7%; appropriate medication adherence, 54.5% vs 57.5%). Results of the multiple logistic regression adjusting other factors indicated that people with disabilities had decreased probabilities of appropriate adherence. Conclusions Medication adherence is reduced by various types of disability and impairment such as those involving mobility and communication. Much effort should be made to investigate how and why these disparities take place and develop health policies to remove these disparities if they exist.