Medication Adherence In Outpatients Research Articles

Potential barriers towards optimal medication adherence in out-patients with stable coronary artery disease

Introduction. The results from foreign and local studies demonstrate that more than a half of patients with cardiovascular diseases do not take medication in compliance with doctors’ recommendations. The search for significant barriers to optimal medication adherence might improve the development of adherence control measures in patients with stable coronary artery disease (SCAD) in routine clinical practice of primary care.Aim. To study the nature and incidence of potential barriers to optimal medication adherence and their association with social and demographic parameters in patients with SCAD.Methods. This publication describes the fragment of the study “PHARMCARE” in which 123 coronary patients were included. Data on demography, social status, medical history and pharmacotherapy were registered. The barriers to medication adherence were identified by means of validated scale (questionnaire) SEAMS (Self-Efficacy for Appropriate Medication Use Scale). Data analysis was conducted by descriptive statistics and regression modeling.Results. The analysis of incidence of barriers to medication adherence allowed to identify the list of most significant ones: “fear of side effects”, “intake of several different medicines each day”, “intake of medicines more than once a day”, “medicines look different than usual”, “normal routine gets messed up”, “busy day planned”, “no one reminds to take medicines” and “staying away from home”. More than a third of all the respondents reported at least one of barriers (37%), that was in major cases “fear of side effects” (22%). Linear one-factor modeling revealed association of number of significant barriers in patients with level of their education (р=0,009) and presence of partner or caregiver (р=0,001), that was also confirmed by the multivariate model. Less barriers were identified in coronary patients that had partner or caregiver (р=0,009) and higher education (р=0,045).Conclusion. The study results revealed that the significant barriers to optimal medication adherence in out-patients with SCAD were related either to patients’ behavior or to pharmacotherapy profile. Uncertainty in overcoming barriers was most typical for single patients without higher education. The obtained results should be taken into consideration when develop strategies for improvement of medication adherence in patients with SCAD in primary care practice.

Recommendations for Providing Medication Adherence Support After Pediatric Hematopoietic Stem Cell Transplant: Caregivers' Lived Experience.

Background. Medication adherence is challenging after pediatric hematopoietic stem cell transplant (HCT), particularly after hospital discharge. Post-HCT medication adherence is important to manage morbidity and mortality risk. Designing interventions that are effective and acceptable to caregivers is key to improving post-HCT medication adherence. This study aimed to characterize caregiver preferences about medication adherence support from their child's medical team. Methods. Twenty-nine caregivers of children who received an HCT completed semi-structured qualitative interviews about their experience with, and recommendations for improving, medication adherence support provided by the medical team. Twenty-two caregivers also completed a card sort task to clarify the content of received support and caregiver recommendations for future HCT families. Results. Thematic analysis revealed eight themes grouped into two categories: Communication Is Key and Practical Medication Adherence Support. Caregivers emphasized the importance of communication in helping them manage their child's outpatient medications and provided suggestions to further strengthen communication. The types of practical medication adherence support used varied across caregivers highlighting the importance of tailoring adherence support to each family's needs. Caregivers also identified all the domains as potentially helpful for other families. Discussion. Findings suggest that caregivers prefer that efforts to improve outpatient medication adherence post-HCT prioritize the medical team initiating frequent, clear, and open communication about medications, and provide educational materials on adherence (e.g., handouts). Results also indicate that practical medication adherence supports should be offered based on family preferences but that families may particularly appreciate tips about addressing medication challenges based on other caregivers' lived experience.

Multivariate analysis of medication adherence among outpatients with stable coronary artery disease

Introduction. The results of local studies indicated that medication adherence of coronary outpatients is low (not more than 60 %). The search for significant predictors of adherence to recommended treatment might allow tailoring specific strategies to control adherence for further optimization of the pharmacotherapy of coronary artery disease (CAD) in routine primary care practice. Aim. To determine the factors associated with medication adherence in outpatients with stable CAD. Methods. This paper describes the results of the fragment of randomized controlled study of the effects of Pharmacy Care Program on medication adherence of coronary outpatients, that was conducted in 2019-2020 in one of the primary care clinics of Moscow. 123 subjects with stable CAD were included in line with the pre-specified criteria. Demography, social status, medical history, pharmacotherapy, healthcare burden data were registered. Medication adherence was measured by validated questionnaire MMAS-8 (8-item Morisky Medication Adherence Scale). The analysis of predictors of adherence was performed by linear regression. Results. Simple regression analysis revealed the list of parameters, that showed statistically significant (or as statistical trend) association with medication adherence of coronary patients in univariate models. The level of medication adherence was associated with patient’s having a partner or caregiver (p=0,002), higher education (p=0,009), additional medicinal maintenance (p=0,006). Medication adherence did not depend on medical history and pharmacotherapy characteristics, but the association of high values of low-density lipoproteins cholesterol (LDL-C) (p=0,001) with suboptimal adherence was demonstrated. Good medication adherence was associated with more frequent visits to general practitioner (p=0,036) and (as statistical trend) to cardiologist (p=0,093). The multivariate regression analysis revealed two positive independent predictors of medication adherence - patient’s having a partner or caregiver (р=0,015) and regular visits to cardiologist (р=0,025). Also, the negative association was confirmed for high LDL-C (р=0,002). Conclusion. Patient’s having a partner or caregiver and regular visits to cardiologist were revealed as independent predictors of good medication adherence of coronary outpatients. Subjects with suboptimal adherence had higher LDL-C.

A randomised controlled trial of clinical pharmacy intervention versus standard care to improve medication adherence in outpatients with head and neck cancer receiving radiotherapy.

Patient understanding of medicines information and adherence to medication instructions are important variables for ensuring optimal cancer care. This randomised controlled trial (RCT) aimed to evaluate the impact of an outpatient clinical pharmacy service on medication adherence and symptom burden in cancer patients. In this single-centre RCT, 115 patients were randomised 1:1 to a pharmacist-led pharmaceutical care program (intervention, n = 59) versus standard of care (control, n = 56) within an outpatient multidisciplinary radiotherapy clinic. The primary endpoint was medication adherence as assessed by Medication Understanding and Use Self-Efficacy (MUSE) scale and Teach-Back assessment. Secondary endpoints were patient-reported symptom burden assessed by the Edmonton Symptom Assessment Scale (ESAS). Patients were assessed at baseline (weeks 1-2) and at discharge from radiotherapy (weeks 5-7). Polypharmacy (use of five or more medications) was observed in 26% of patients at baseline compared to 97% at discharge. Patient self-efficacy and medication adherence was higher in the intervention arm compared to the control arm, with a mean MUSE score difference of 2.70 (95% CI 1.24, 4.17) after adjustment for baseline, and a higher proportion of patients with average Teach-Back score of four or more (86% vs 14%; odds ratio (OR) 46.09, 95% CI 14.49, 146.56). The mean (SD) scores for aggregate ESAS (0-100) at discharge were 26.2 (14.0) in the intervention arm and 32.0 (15.8) in the control arm demonstrating lower overall symptom burden associated with the intervention (mean score difference adjusted for baseline - 0.52; 95% CI - 1.03, - 0.01). A structured outpatient clinic pharmacy service significantly improved medication adherence and reduced overall symptom burden in patients receiving radiotherapy.

Mind Your Heart: Exploring Feasibility, Acceptability, and Preliminary Effects of Phone-Delivered Mindfulness Training on Medication Adherence in Outpatients With Chronic Heart Failure.

Mindfulness training (MT) may promote medication adherence in outpatients with heart failure. The aims of this study were to determine the feasibility and acceptability of MT (primary outcomes) and explore effects on medication adherence, functional capacity, cognitive function, depression, and mindfulness skills (secondary outcomes). In this pre/post-design study, participants received a 30-minute phone-delivered MT session weekly for 8 weeks. We enrolled 33 outpatients (32% women; 69.7 White; mean age, 60.3 years). Retention was 100%, and session attendance was 91%. Overall, participants (97%) rated MT as enjoyable. Objectively assessed ( P < .05) adherence decreased post intervention, whereas improvements were noted in functional capacity ( P = .05), mindfulness ( P < .05), and cognitive function (reaching significance for Flanker scores). Phone-delivered MT was feasible and acceptable. Whereas no improvements were noted in medication adherence and depression, cognitive function, functional capacity, and mindfulness levels increased post intervention, suggesting MT may have beneficial effects in outpatients with heart failure.

Effects of Pharmacy Care Program on medication adherence in outpatients with stable coronary artery disease: a randomized controlled study

Aim. To assess the effects of the Pharmacy Care Program on medication adherence in outpatients with stable coronary artery disease (SCAD).Material and methods. An open randomized controlled study was conducted in primary care clinic over the period of 2019-2020. All subjects (n=126) were randomized at visit 1 into the multifaceted intervention group (n=63) or control group (n=63) and invited 12 months after to visit 2. Patients of intervention group were included into the Pharmacy Care Program, which consisted of the following components: pharmacist-led counseling, provision of education materials and 7-day pillbox, weekly SMS-reminders. Medication adherence was measured initially and at the end of the study period by means of eight-item Morisky Medication Adherence Scale (MMAS-8) and Self-Efficacy for Appropriate Medication Use Scale (SEAMS).Results. The implementation of the Pharmacy Care Program improved medication adherence in SCAD outpatients with MMAS-8 median score of 7,0-8,0 (p<0,001) and SEAMS median score of 35,0-36,0 (p=0,017). In the control group, no changes (p=0,123) in MMAS-8 score were revealed, while SEAMS score decreased from 35,0 down to 34,5 (p=0,003). The reduction in systolic blood pressure (p=0,049) and risk of urgent hospital admission (OR=0,28; 95% CI, 0,08-0,99; p=0,041) was registered in the intervention group in contrast to the control group over the 12-month period.Conclusion. The multicomponent intervention within the Pharmacy Care Program contributed to an increase in the adherence to pharmacotherapy of outpatients with stable CAD.

An Empirical Study on Factors Affecting Medication Adherence in Outpatients with Depression: From the Perspective of Medication Support for Patients Using Pharmacies

An Empirical Study on Factors Affecting Medication Adherence in Outpatients with Depression: From the Perspective of Medication Support for Patients Using Pharmacies

Effect of Pharmacist Intervention on Medication Adherence and Clinical Outcomes of Type 2 Diabetes Mellitus Outpatients in Primary Healthcare in Indonesia.

Objective:In Indonesia, the role of pharmacists in primary healthcare is still very limited or even absent. This study evaluates the effectiveness of programs delivered for type 2 diabetes mellitus (T2DM) patients by pharmacists in primary healthcare through counseling, short message service (SMS) reminders, and medication booklets.Methods:A quasi-experimental study with a pretest–posttest design was conducted from April to August 2018 at Merdeka and Dempo primary health-care centers, Palembang, South Sumatra Province, Indonesia. Counseling and medication booklets were distributed three times during the study period, while SMS reminders were sent once a week. Counseling was given for the management of diabetes mellitus (DM), including during the Ramadan fasting period, together with management for acute and chronic complications. The medication adherence level was measured using a medication adherence questionnaire (MAQ) and pill count adherence (PCA). The study sample comprised 80 T2DM patients, who were allocated into either the control group (CG) (n = 40) or intervention group (IG) (n = 40). Clinical outcomes were determined by measuring glycated hemoglobin (HbA1c), blood pressure, and lipid profiles.Findings:After the intervention, the IG showed significant improvements in most parameters, except for high-density lipoprotein cholesterol and systolic and diastolic blood pressure. HbA1c levels were reduced, while MAQ scores and PCA scores were improved. Lipid parameters were significantly reduced total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and triglyceride (TG). Compared with the CG, most parameters were significantly improved in the IG. Pharmacist counseling significantly improved almost all clinical parameters (HbA1c, TC, LDL-c, and TG). Pharmacist counseling was 7.1 times greater in lowering HbA1c compared with no counseling, after adjusted by other variables. The variable that most influenced the lowering of HbA1c was infrequent (“not often”) consumption of unhealthy foods (OR 14.9; 95% CI 3.5-63.7).Conclusion:The pharmacist primary health-care intervention program implemented in this study significantly improved HbA1c, TC, LDL-c, TG, and medication adherence in outpatients with T2DM.

A Prospective Survey of Outpatient Medication Adherence in Adult Allogeneic Hematopoietic Stem Cell Transplantation Patients.

Limited data exist regarding the prevalence and outcome of medication nonadherence in the adult allogeneic hematopoietic stem cell transplantation (allo-HSCT) population. The objective of this cross-sectional survey study is to determine the prevalence of medication nonadherence to immunosuppressant and nonimmunosuppressant medications in adult recipients of allo-HSCT. An electronic survey using previously validated medication adherence scales was distributed between December 2014 and April 2015 to 200 adult patients with at least 3 months of follow-up after allo-HSCT. Immunosuppressant serum drug levels and prescription refill records were retrospectively collected to assess correlation with survey responses. In the entire cohort, 51% of subjects (n=102) reported nonadherence to nonimmunosuppressant medications (95% confidence interval [CI], 44.07% to 57.93%) on the Morisky Medication Adherence Scale. Of the 153 patients taking oral immunosuppressant medications at the time of the survey, 58 (37.9%) reported nonadherence to immunosuppressant therapy (95% CI, 30.22% to 45.6%), as measured by the Immunosuppressant Therapy Adherence Scale. Younger age and distress were associated with medication nonadherence. Nonadherence to immunosuppressant therapy was associated with mild chronic graft-vs-host disease (cGVHD), and a similar trend was observed for moderate cGVHD. Medication nonadherence was found to be highly prevalent for both immunosuppressant and nonimmunosuppressant medications in adult allo-HSCT recipient, and further study to identify interventions to improve adherence in these patients is warranted.

Electronic Health Record-Based Strategy to Promote Medication Adherence Among Patients With Diabetes: Longitudinal Observational Study.

BackgroundPoor medication adherence is common; however, few mechanisms exist in clinical practice to monitor how patients take medications in outpatient settings.ObjectiveThis study aimed to pilot test the Electronic Medication Complete Communication (EMC2) strategy, a low-cost, sustainable approach that uses functionalities within the electronic health record to promote outpatient medication adherence and safety.MethodsThe EMC2 strategy was implemented in 2 academic practices for 14 higher-risk diabetes medications. The strategy included: (1) clinical decision support alerts to prompt provider counseling on medication risks, (2) low-literacy medication summaries for patients, (3) a portal-based questionnaire to monitor outpatient medication use, and (4) clinical outreach for identified concerns. We recruited adult patients with diabetes who were prescribed a higher-risk diabetes medication. Participants completed baseline and 2-week interviews to assess receipt of, and satisfaction with, intervention components.ResultsA total of 100 patients were enrolled; 90 completed the 2-week interview. Patients were racially diverse, 30.0% (30/100) had a high school education or less, and 40.0% (40/100) had limited literacy skills. About a quarter (28/100) did not have a portal account; socioeconomic disparities were noted in account ownership by income and education. Among patients with a portal account, 58% (42/72) completed the questionnaire; 21 of the 42 patients reported concerns warranting clinical follow-up. Of these, 17 were contacted by the clinic or had their issue resolved within 24 hours. Most patients (33/38, 89%) who completed the portal questionnaire and follow-up interview reported high levels of satisfaction (score of 8 or greater on a scale of 1-10).ConclusionsFindings suggest that the EMC2 strategy can be reliably implemented and delivered to patients, with high levels of satisfaction. Disparities in portal use may restrict intervention reach. Although the EMC2 strategy can be implemented with minimal impact on clinic workflow, future trials are needed to evaluate its effectiveness to promote adherence and safety.

Effect of an RN-Led Medication Teaching Initiative on Psychiatric Recidivism

This quality improvement (QI) project analyzed the impact of RN-led medication teaching on readmissions of adult patients discharged from a Midwest psychiatric veterans’ hospital. Data on patient participation in the initiative, outpatient medication adherence, and annual 30-day readmission rates were gathered from electronic medical records (EMR) and patient discharge logs from years 2017 and 2018. Forty-three percent of RNs engaged in the initiative. Percentages of patients, who received medication teaching throughout the year, ranged from 27% to 40%. However, self-reported medication adherence following discharge was much higher (73–85%). The RN-led medication teaching initiative did not impact recidivism, and low staff participation was reflected by the downtrend in numbers of patients who received medication teaching throughout the year. Compared to previous years, annual recidivism increased. Fifty-three percent of recidivist patients who received medication teaching reported complete outpatient medication adherence prior to readmission, possibly indicating it is not a significant factor in preventing readmissions or, alternatively, that patients tend to over-report adherence. A small group of patients (19%) accounted for the majority of readmissions annually (70%). This group appears to be most at risk for continued recidivism. Future attempts to improve unit recidivism might benefit from aligning interventional strategies to the common risk factors of chronic recidivists.

Effects of medication literacy on medication adherence in outpatients

Objective To assess medication literacy status of outpatients and analyze the effect of medication literacy on medication adherence. Methods Outpatients were investigated with Medication Literacy Assessment scale and Medication Adherence Scale in Tianjin Chest Hospital, Tianjin Huanhu Hospital and the Second Hospital of Tianjin Medical University in August 2017. Results The average score of Medication literacy scale of 200 outpatients was 7.60±2.98. There were significant differences among the scores of Medication Literacy Assessment scale of different ages (F=9.444, P<0.05) and education levels (F=26.682, P<0.05) . Logistic regression analysis showed that medication literacy had an impact on medication adherence in outpatients (P<0.05). The medication compliance of outpatients with high medication literacy was 2.336 times as high as who with medium medication literacy and 18.529 times as high as who with low medication literacy, and the medication compliance of outpatients with medium medication literacy was 7.925 times as high as who with low medication literacy. Conclusion The medication literacy of outpatients was at the middle level, and most of the outpatients were poor in adherence. The higher the medication literacy level was, the better the medication adherence was; the lower medication literacy level was, the poorer medication adherence was. The medical staff could improve the medication adherence by improving the medication literacy to ensure the health of outpatients. Key words: Outpatients; Medication literacy; Medication adherence

Correlates and Predictors of Medication Adherence in Outpatients Living with HIV/AIDS

Antiretroviral therapy (ART) is important in HIV outcomes and HIV prevention. However, ART adherence remains suboptimal in people living with HIV/AIDS (PLWH). This study examined associations among ART adherence and demographic, psychosocial, and religious factors in a sample of 292 PLWH. Average age of participants was 45.1 ± 7.8 years and they had been living with HIV for 10.8 ± 7.0 years, on average. Mean ART adherence scores differed significantly between participants based on age (F = 5.861, p = .016), depressive symptom status (F = 17.61, p < .0001), religious attendance (F = 5.901, p = .016), and prayer (F = 5.791, p = .017). Only age, social support, prayer, and negative religious coping were significant predictors of ART adherence, in a multivariate regression model. Higher ART adherence scores were significantly associated with being older than 50 years (β = .17, p = .014), greater social support satisfaction (β = .15, p = .031), praying daily or more (β = .17, p = .021) and lower negative religious coping scores (β = −.18, p = .014). Clinicians should assess/address these factors during ART treatment counseling.

PDB40 - Medication Adherence In Outpatients With Type 2 Diabetes At Hue University Hospital, Hue City, Vietnam

1) to assess medication adherence in outpatients with type 2 diabetes at Hue University Hospital and 2) to determine factors associated with medication adherence in those patients. A cross-sectional study was conducted on 294 patients diagnosed with type 2 diabetes. Medication adherence assessment was carried out with Morisky 8-item questionnaire. Factors associated with medication adherence were determined with logistic regression. 31.9% of the patients were not adherent to their medication. Barriers of low medication adherence were: difficulty in remembering medication use schedule (54.6%), forgetting to take medication (40.8%), uncomfortable feeling with long-term medication use (39.0%) and intentionnally stop of medication use in case that the disease gets worse (14.5%). Factors associated with medication adhrence were found: Education level (Illiterate vs. High school, OR= 4.74; CI 95%: 1.16 – 19.27), Medication use regimen (Injection and oral vs. Oral, OR = 0.41; CI 95%: 0.17 – 0.93), Reminder to take medication from physicians (Frequent vs. rare, OR = 1.84; CI 95%: 1.01 – 3.35) and Satistaction on healthcare services (No vs. Yes, OR = 0.33; CI 95%: 0.12 – 0.86). Medication nonadherence was still high (31.9%) in outpatients with type 2 diabetes. The factors associated with medication adherence could help to develop interventions aiming to improve medication adherence in those patients.

Identifying Barriers and Facilitators of 13 mHealth Projects in North America and Africa: Protocol for a 5-Year Implementation Science Study.

BackgroundAlthough many mHealth interventions have shown efficacy in research, few have been effectively implemented and sustained in real-world health system settings. Despite this programmatic gap, there is limited conclusive evidence identifying the factors that affect the implementation and successful integration of mHealth into a health system.ObjectiveThe aim of this study is to examine the individual, organizational, and external level factors associated with the effective implementation of WelTel, an mHealth intervention designed to support outpatient medication adherence and engagement in care in Africa and North America.MethodsWe will adopt the Consolidated Framework for Implementation Research (CFIR) constructs for evaluation of mHealth implementation including a scoring and monitoring system. We will apply the adapted tool to identify facilitators and barriers to implementation of the WelTel mHealth intervention in order to determine how the technology platform is perceived, diffused, adapted, and used by different mHealth project teams and health system actors in Africa and North America. We will use a mixed-methods approach to quantitatively test whether the factors identified in the CFIR framework are associated with the successful uptake of the mHealth intervention toward implementation goals. We will triangulate these data through interviews and focus group discussion with project stakeholders, exploring factors associated with successful implementation and sustainment of these interventions.ResultsThe development of the customized CFIR is finalized and currently is in pilot testing. The initial results of the use of the tool in those 13 implementations will be available in 2019. Continuous conference and peer- reviewed publications will be published in the coming years.ConclusionsThe results of this study will provide an in-depth understanding of individual, organizational, and external level factors that influence the successful implementation of mHealth in different health systems and geographic contexts over time. Via the tool’s unique scoring system connected to qualitative descriptors, these data will inform the most critical implementation targets and contribute to the tailoring of strategies that will assist the health system in overcoming barriers to implementation, and ultimately, improve treatment adherence and engagement in care.Registered Report IdentifierRR1-10.2196/9633

138 - A Survey of Outpatient Medication Adherence in Adult Allogeneic Hematopoietic Stem Cell Transplant Recipients

138 - A Survey of Outpatient Medication Adherence in Adult Allogeneic Hematopoietic Stem Cell Transplant Recipients

Effect of a Telephone Intervention on Measures of Psychiatric and Nonpsychiatric Medication Adherence in Outpatients With Schizophrenia Spectrum Disorders.

Telephone intervention may address the need for problem-solving interventions to improve medication adherence in patients with schizophrenia spectrum disorders (SSDs). The current randomized controlled trial examined the effect of weekly telephone intervention problem solving (TIPS) on quantitative measures of psychiatric and nonpsychiatric medication adherence over 6 months in 105 stable outpatients with SSDs. Independent samples t test revealed no significant differences in psychiatric or nonpsychiatric pill count adherence between groups at 6 months; however, 54.7% of experimental participants versus 32.7% of controls had serum antipsychotic levels within therapeutic range at 6 months (χ2 = 5.2, df = 1, p = 0.023). The current study extends the literature on adherence in patients with SSDs by describing a clinical sample of stable outpatients over 6 months and examining adherence to psychiatric and nonpsychiatric medications. [Journal of Psychosocial Nursing and Mental Health Services, 55(1), 29-36.].

Medication adherence in patients in treatment for rheumatoid arthritis and systemic lupus erythematosus in a university hospital in Brazil.

Medication adherence is essential for the control of symptoms and progression of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). The aim of the study was to investigate medication adherence in outpatients in treatment for RA and SLE in a university hospital in Brazil. This was a quantitative, cross-sectional analytical study. A total of 92 patients (55 RA patients and 37 SLE patients) were included in the study. A structured questionnaire for patients’ interview and a form for collecting data from medical records were used for data collection. Adherence to drug treatment was assessed by the Morisky scale questionnaire. Data storage and analysis were performed using Epi Info 3.5.4 and statistical analysis by Stata/SE 12.0. The Pearson’s chi-squared test and Fisher’s exact test were applied for statistical and bivariate analyses. For multivariate data analysis the Poisson regression and the Wald test were used. The prevalence of adherence to drug treatment was 16.4% in RA patients and 45.9% in SLE patients. The final model of the multivariate analysis demonstrated associations between medication adherence and the following covariates for both RA and SLE groups: duration of therapy for rheumatic disease at the institution greater than 15 years and presence of more than six chronic comorbidities. The parameter “acquisition of medication at the high-cost pharmacy” was differently associated with medication adherence by group, and for the SLE group, living outside the city of Goiânia was a protective factor associated with adherence. This study demonstrated a low prevalence of medication adherence in patients in treatment for RA and SLE treated at this institution. These findings will serve as a base for future studies to elucidate what factors may positively or negatively affect medication adherence in this population. In addition, multidisciplinary approaches are needed to enhance adherence to drug treatment in patients in treatment for rheumatic disease.

Factors Related to Medication Adherence in Outpatients with Schizophrenia under More Than 5 Years of Treatment

Objectives This study aimed to investigate the medication adherence rate and related factors in chronic schizophrenia. Methods A total of 65 (34 male and 31 female) outpatients with schizophrenia and with less than 5 years schizophrenia treatment were randomly selected to participate in the study survey. Medication adherence rate was evaluated by counting remaining tablets. The Korean version of Drug Attitude Inventory-10 (KDAI-10) was used to determine the subjective adherence rate. Adherence was defined as a patient taking more than 80% of their total prescribed medication. Positive KDAI-10 scores indicate good adherence. Results The rate of good adherence was 87.7%. Our analysis showed that an older age (r=0.323, p=0.009), longer duration of illness (r=0.296, p=0.017), employment (F=4.41, p=0.016), remaining married (F=5.26, p=0.008), and being supported by family members, especially spouse or siblings (F=3.02, p=0.025) were significantly associated with good adherence. Presence of symptoms such as delusion (p=0.033) and hallucination (p=0.032) were related to poor adherence. Conclusion The results indicate that future study should investigate patient characteristics associated with medication adherence and analyze the clinician/patient alliance and its affect on adherence. The results also show that further studies might be useful in developing and validating measures of adherence, as well as in designing and evaluating interventions to improve adherent behaviors

PCN8 - Is Depression Related to Underuse of Breast Cancer Screening?

1. National Cancer Institute, SEER Stat Fact Sheets: Breast Cancer. Available at: http://seer.cancer.gov/statfacts/html/breast.html, Accessed May 5, 2014. 2. Centers for Disease Control and Prevention, What Screening Tests Are There? Available at: http://www.cdc.gov/cancer/breast/basic_info/screening.htm, Accessed May 5, 2014. 3. Moss SM, Cuckle H, Evans A et al. Trial Management Group. E ect of mammographic screening from age 40 years on breast cancer mortality at 10 years’ follow-up: a randomized controlled trial. Lancet. 2006;368:2053-2060. 4. Kerlikowske K. E cacy of screening mammography among women aged 40 to 49 years and 50 to 69 years: comparison of relative and absolute bene t. J Natl Cancer Inst Monogr. 1997;22:79–86. 5. Pace LE, Keating NL. A systematic assessment of bene ts and risks to guide breast cancer screening decisions. JAMA. 2014;311:1327-1335. 6. Gehi A, Haas D, Pipkin S, Whooley MA. Depression and medication adherence in outpatients with coronary heart disease, Arch Intern Med. 2005;165:2508-2513. 7. Lin EH, Katon W, Von Kor M et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care; Diabetes Care. 2004;27:2154–2160. 8. Ziegelstein RC, Fauerbach JA, Stevens SS et al. Patients with depression are less likely to follow recommendations to reduce cardiac risk during recovery from a myocardial infarction; Arch Intern Med. 2000;160:1818-1823. 9. Manning M, Bettencourt BA. Depression and medication adherence among breast cancer survivors: bridging the gap with the theory of planned behaviour. Psychol Health. 2011;26:1173-1187. 10. Cohen M. First-degree relatives of breast-cancer patients: cognitive perceptions, coping, and adherence to breast self-examination. Behav Med. 2002;28:15-22. 11. Bogner HR, Wittink MN. Depression as a risk factor for underuse of mammography. J Womens Health (Larchmt). 2004;13:739-42. • Summary Depression itself was related to the underuse of mammography in the unadjusted analysis. However, after controlling for demographic and HBM characteristics, depression was not associated with the underuse of mammography. Regarding demographic characteristics, women in the higher level of education and income were more likely to adhere to the U.S. Preventive Services Task Force’s (USPSTF) mammogram guidelines. All HBM constructs were related to mammography use behaviors.