Medication Adherence Questionnaire Research Articles

Providing counseling through home pharmacy care (HPC) for hemodialysis patients with hypertension in lowering blood pressure.

Hypertension is one of the main factors in increasing the risk of cardiovascular disease with 51% reported cause of death in chronic kidney disease (CKD) patients with end-stage renal disease (ESRD). It is a comorbid that needs to be managed properly and gets special attention from various health disciplines including a pharmacist. This was a quasi experimental study with pretest-posttest intervention using home pharmacy care (HPC) counseling both on the counseling and the noncounseling group. Initial data collection and informed consent was done at the Hemodialysis Unit Aloei Saboe and Toto Kabila Hospital, Gorontalo. The parameters in the study were patients' compliance to their medication using the Medication Adherence Questionnaire (MAQ) and Pill Count Adherence (PCA) questionnaires and the patient's blood pressure. Fifty-eight patients met the inclusion criteria and were divided into two groups (the counseling group and the noncounseling group). Based on MAQ and PCA, the level of patient medication adherence increased significantly in the counseling group compared to the noncounseling group with a significance value of p<0.05. Increasing adherence was correlated with patients' outcome of lowering blood pressure. More patients in the counseling group showed decrease in systolic and diastolic blood pressure compared to the noncounseling group (86.2 vs. 17.2% for systolic BP and 69 vs. 10.3% for diastolic blood pressure (BP). Following adjusted confounding variables, counseling through HPC provided a chance of decreasing systolic blood pressure 32 times (95% CI: 7.198-144.550) and diastolic blood pressure 42 times (95% CI: 6.204-286.677). HPC affects the improvement of patient medication adherence and reduction of blood pressure in hemodialysis patients with hypertension.

The Association Between Mental Health of HIV Patients and Antiretroviral Medication Adherence

Background: Various factors, like mental disorders, may affect the desire for medication and adherence in HIV/AIDS patients. Objectives: The present study aimed to determine levels of neurotic disorders and associations of disorders level and Highly Active Antiretroviral Therapy (HAART) medication adherence in HIV/AIDS patients. Materials and Methods: Finally, 150 patients of Behavioral Disease Counseling Center of Shiraz were selected by a convenience method and were evaluated by Symptom Checklist-25 (SCL-25) and Medication Adherence Questionnaire (MAQ). Chi-square, Kruskal-Wallis, Mann-Whitney U tests were, Spearman's correlation coefficient and logistic regression were used to analyze the data by using SPSS-20 (P &lt; 0.05). Results: Seventy-eight percent of patients had normal mental health status. Also, 83% had very good medication adherence. Female gender, single or divorced, and working in temporary and low-income jobs were associated with decreased mental health status. Higher age and education were associated with increased adherence. Anxiety was the most common and effective disorder. Decreased mental health' status was shown to reduce drug adherence. Conclusions: Treatment of mental disorders, particularly anxiety, can be one of the most effective ways to increase drug compliance in HIV/AIDS patients.

Family Function and Treatment Adherence of People Infected with tuberculosis in Peru: A Multicenter Observational Study

<h3>Background</h3> Tuberculosis (TB) is a major public health problem in Peru. There is limited research about the effect of family function on treatment adherence in South America, and no published Peruvian studies. The purpose of this study was to 1) Report the treatment adherence of TB patients, and 2) Evaluate the effect of family function on treatment adherence. <h3>Methods</h3> This was a cross-sectional instrument study conducted in an integrated network of 16 primary care centers in Lima (Peru). An a priori power analysis indicated a 160 sample to detect a significant result. A three-part instrument (15-items) was used for data collection: Sociodemographic (6-items); Family APGAR (5-items) for family function; and Medication Adherence Questionnaire (4-items) for treatment adherence; all valid and reliable Spanish versions previously used in Peru. <h3>Results</h3> A total of 189 (81%) participants with drug-sensitive TB completed the survey. Very few participants (10%) reported treatment adherence. Participants in a relationship more frequently reported adherence (42.1%; p < 0.05), single participants more frequently reported nonadherence (55.3%; p < 0.05), while nonadherent participants more often reported moderate family dysfunction (38.8%; p=0.002). In multivariate analysis, family function was a risk factor for nonadherence, more pronounced with moderate dysfunction (OR=12.8; CI 95% 2.90-56.70). The risk decreased in the direction of good family function (OR=7.58; CI 95% 1.36-42.09) compared to the severe dysfunction, but not linearly. In the adjusted model, the same behavior was observed as the relation between moderate dysfunction and nonadherence remained statistical significance with an OR of 9.89 (CI95% 1.89-51.66) adjusted for the sociodemographic variables. <h3>Conclusions</h3> The participants reported very low treatment adherence in comparison to previous government estimates and other South American studies. The findings suggest treatment adherence is associated with family function. Further qualitative research may be important to explain the low treatment adherence and to further explore the relationship with family function.

MO756MANAGEMENT OF CHRONIC HIPERKALAEMIA IN CLINICAL PRACTICE IN HAEMODIALYSIS

Abstract Background and Aims Patients with chronic kidney disease (CKD) on haemodialysis (HD) have an increased risk of hyperkalaemia, a serious and potentially fatal electrolyte disorder. New effective strategies for managing hyperkalaemia have recently become available. However, as yet, there is insufficient experience in routine clinical practice in HD. The aim of our study was to report the prevalence of chronic hyperkalaemia and analyse the effects of different treatment strategies on potassium management, ratio of adherence and gastrointestinal symptoms in our HD population. Method A 12-week, prospective, single-centre study in HD patients with chronic hyperkalaemia (&amp;gt;5.5 mmol/l). Three study phases were established: Phase 1 — dietary advice (DA); Phase 2 — calcium polystyrene sulfonate resins (CPSRs); and Phase 3 — patiromer. In each phase, we analysed sociodemographic data, related biochemical data, treatment adherence and compliance (Simplified Medication Adherence Questionnaire [SMAQ]), gastrointestinal symptoms (Gastrointestinal Symptom Rating Scale [GSRS]), HD characteristics and usual medical treatment. Results 29.2% hyperkalaemia (46% mild); 13 patients (61.5% female); mean age 63.8 ± 14.1 years and 46.4 ± 41.6 months on HD. Serum K values decreased significantly (*p &amp;lt;0.05) only in phase 3 (–0.75 mmol/l), with a higher percentage of patients reaching optimal K range. Compared with CPSRs, patiromer yielded significantly better overall GSRS scores: abdominal pain (3.7 versus 2.5), constipation (7.1 versus 5.3), indigestion (6.2 versus 5.6); and also better treatment compliance. No significant changes were found in any other biocbhemical data, HD characteristics or usual medication over the course of the study. Conclusion Chronic hyperkalaemia is a highly prevalent disorder on our HD unit. Compared to dietary advice and traditional potassium binders; patiromer was effective in managing chronic hyperkalaemia, leading to improvement in gastrointestinal symptoms and treatment adherence with no associated severe adverse effects. Thus, considering our results, we shall consider patiromer a first-line treatment for chronic hyperkalaemia in our patients with HD.

Patients’ adherence to topical antiglaucoma medications in a tertiary care hospital

Abstract Objectives Adherence to glaucoma medications is a central factor to control intraocular pressure and manage glaucoma effectively. This study aims to assess the level of adherence of glaucoma patients to ocular hypotensive agents and determine factors contributing to non-adherence in the Aseer region. Methods This was a single-centre, prospective cross-sectional study carried out in Aseer Hospital, Saudi Arabia. Data were collected through a customized questionnaire adapted from the Morisky, Green and Levine Medication Adherence Questionnaire (MGLS). Key findings Of the 102 glaucoma patients, 63 (61.8%) were non-adherent to their glaucoma medications. About 48 (76.2%) of them reported that they have no background information about glaucoma. Older participants (37, 58.7%; &amp;gt;50 years) showed a low adherence level compared with the younger individuals. Contributing factors to non-adherence include forgetting the dose time (32, 50.8%), illiteracy (31, 49.2%; P = 0.313), economic problems (26, 41.3%; P = 0.286) and lack of information about prescribed medications (15, 23.8%; P = 0.188). Conclusions No significant relationship was found between medication adherence and patient’s demographic data or their background knowledge about glaucoma. Despite the need for improving the glaucoma patient’s knowledge of their disease and the importance of medication adherence, an additional strategy as alerts by smartwatches should be encouraged to improve the adherence level.

Text Messaging and Home Blood Pressure Monitoring for Patients with Uncontrolled Hypertension: Proposal for a Feasibility Pilot Randomized Controlled Trial.

BackgroundA decrease in blood pressure, even modestly (ie, 2 mmHg), lowers cardiovascular morbidity and mortality. Low patient adherence to antihypertensive medication is the most significant modifiable patient-related barrier to achieving controlled blood pressure. Preliminary studies have shown that SMS text messaging and home blood pressure monitoring (HBPM) can be effective in promoting medication adherence and blood pressure control. The best strategy to engage with older patients of low socioeconomic status who are low adopters of technology and disproportionally affected by uncontrolled hypertension is still unknown.ObjectiveThe objective of this study is to improve blood pressure control in the older, low socioeconomic status population. The study will test two aims: First, we aim to evaluate the feasibility of conducting a randomized controlled trial by using an SMS-based approach among nonadherent, older patients of low socioeconomic status who have uncontrolled hypertension. Feasibility will be assessed in terms of recruitment rates per month (primary outcome); patient acceptability will be evaluated by monitoring retention rates and SMS response rates and using the validated Systems Usability Scale (secondary outcomes). Second, we aim to estimate the effects of the SMS approach on lowering blood pressure and adherence to antihypertensive medications.MethodsWe will recruit 24 patients of low socioeconomic status with uncontrolled hypertension (systolic BP>140 mmHg or diastolic BP>90 mmHg) showing low medication adherence and taking at least two antihypertensives, who have presented to two outpatient clinics of Wake Forest Baptist Health (Winston Salem, North Carolina, USA). Participants will be randomly assigned to either SMS and HBPM (n=12) or usual care and HBPM (n=12) intervention. Clinicians adjusting the patients’ medications will be blinded to the study assignment. Text messages will be sent from a secure platform to assess medication adherence and HBPM on a weekly basis. The content and delivery frequency of the proposed SMS intervention are based on input from three focus groups conducted in Spring 2019. Participants in both study arms will receive education on HBPM and using an HBPM device. We hypothesize that we will successfully recruit 24 participants and the intervention will be acceptable to the participants. It will also improve medication adherence (assessed by question Medication Adherence Questionnaire scores) and blood pressure control.ResultsOur study was funded in July 2020. As of May 2021, we have enrolled 6 participants.ConclusionsOur findings will help design a larger efficacy trial to advance the field of eHealth delivery systems particularly for older adults of low socioeconomic status. This study addresses a highly significant topic and targets a population of high morbidity and mortality that has been traditionally underrepresented in clinical trials.Trial RegistrationClinicalTrials.gov NCT03596242; https://clinicaltrials.gov/ct2/show/NCT03596242International Registered Report Identifier (IRRID)PRR1-10.2196/18984

Facilitators and barriers to medication adherence with adjuvant endocrine therapy in women with breast cancer: a structural equation modelling approach.

To identify a structure to explain the relationship between socio-clinico factors, necessity-concerns beliefs, and perceived barriers to adherence with adjuvant endocrine therapy (AET) amongst women with breast cancer. Participants were 244 patients with early-stage breast cancer recruited from two tertiary hospitals from May 2015 to December 2018 who completed questionnaires on medication adherence (Simplified Medication Adherence Questionnaire), necessity-concerns beliefs (Beliefs about Medicine Questionnaire), and barriers to adherence (Adherence Starts with Knowledge Questionnaire). Socio-clinico variables were collected via interview and medical records review. Structural equation modelling was applied to examine the relationships between these variables and possible mediating effects of necessity-concerns beliefs on adherence to AET. The median age of the study participants was 61 (range 32-80) years and the median duration on AET was 1.6 (IQR 1.2-2.6) years. Adherence was positively associated with age (β = 0.145, 95% CI: 0.011 to 0.279, p = 0.034) and negatively associated with barriers (β = -0.381, 95% CI: -0.511 to -0.251, p < 0.001). There was no effect of Necessity (β = 0.006, 95% CI: -0.145 to 0.158, p = 0.933) or Concerns (β = 0.041, 95% CI: -0.117 to 0.199, p = 0.614) on adherence. Necessity-concerns beliefs were also not significant mediators in the relationship between socio-clinico factors and medication adherence. Older age and lower barriers to adherence were associated with higher adherence scores. Necessity-concerns beliefs did not have a significant effect on adherence as majority of the patients identified forgetfulness as a reason for non-adherence.

Selected psychological factors and medication adherence in patients with rheumatoid arthritis.

ObjectivesThe aim of the study was to determine the relationship between medication adherence (MA) and selected psychological factors in a group of patients with rheumatoid arthritis (RA).Material and methodsThe cross-sectional study was conducted in four rheumatology outpatient clinics in Silesia, Poland. The tests used were the Medication Adherence Questionnaire (MAQ), the Multidimensional Health Locus of Control Scale (MHLC), the Coping Inventory for Stressful Situations (CISS), and the Mindful Attention Awareness Scale (MAAS). The analysis involved 106 adult patients diagnosed with RA at least 6 months before, who were prescribed medication, with disease at any stage and with stable comorbidities. Software was used to perform analyses of frequency, basic descriptive statistics, including the Kolmogorov-Smirnov test, Student’s t-test for independent samples, intergroup univariate variance, Pearson’s r correlation coefficient, Spearman’s rank correlation ρ coefficient, Fisher’s exact test and stepwise linear regression.ResultsPowerful Others Health Locus of Control (PHLC), Internal Health Locus of Control (IHLC) and age of the subjects, F(3, 102) = 8.05; p < 0.001 explained 16.8% of the variation in the adherence level for the entire group. In the group of women PHLC and IHLC, F(2, 80) = 10.04; p < 0.001 were included in the model, which explained 18.1% of variation in MA. PHLC was the most significant factor in the group of women (β = 0.55; p < 0.001) and in the entire group (β = 0.48; p < 0.001). In the group of men, Social Diversion Style (SDS), F(1, 21) = 5.81; p = 0.02 was included in the model, which explained 17.9% of the variation in the MA level.ConclusionsThe study identified some psychological predictors of adherence, which explained 16.8% of the variability. Factors increasing the likelihood of medication adherence in patients with rheumatoid arthritis include a strong belief in the power of others, low level of internal health locus of control, and advanced age.

Adherence and persistence of optimal medical therapy after myocardial infarction in a low to middle income country

Abstract Funding Acknowledgements Type of funding sources: None. Background Adherence to medical therapy after myocardial infarction (MI) is a crucial part of patient care and indispensable for reaching clinical goals, however, data from low to middle income countries (LMIC) regarding adherence and persistence of optimal medical treatment (OMT) is scarce. Purpose To evaluate adherence and persistence to OMT after acute coronary syndrome (ACS) in a cohort of patients with ST elevation myocardial infarction (STEMI) in a low to middle income country. Methods We conducted a survey study evaluating adherence and persistence of OMT after 6 months of the index event in patients with STEMI. Patients were surveyed via phone call using the simplified medication adherence questionnaire (SMAQ) tool, which has been previously validated (both in English and Spanish) as a clinical tool to evaluate adherence to medication. We evaluated persistence of OMT as well. A secure electronic database was constructed to capture information, regarding adherence and persistence, and other clinically relevant variables. Study population The study included consecutive patients aged 18-99 years old with the diagnosis of STEMI form Mexico City’s STEMI Network, who received either pharmacoinvasive strategy (PIS) or Primary Percutaneous Coronary Intervention (pPCI) during the first 12 hours from symptom onset. This population is derived from the PHASE-Mx study (ClinicalTrials.gov Identifier: NCT03974581), which results have been previously published. Results A total of 602 patients were initially screened; among these, 158 patients (26.2%) were lost to contact, 5 patients (n = 0.008%) refused to answer and 65 patients (10.7%) died during follow up. The final analytic sample consisted of 375 patients; among them, 192 (51.2%) received primary PCI and 183 (48.8%) received pharmacoinvasive strategy. Mean age was 58 + 10 years old and most of the patients were male (90.1%). Hypertension (44.8%) and diabetes (32.0%) were common. Mean follow-up time after index STEMI was 650 (IQR: 416-832) days. After SMAQ evaluation, only 26.1% of the patients were considered to be adherent to their medications (&amp;gt;95% compliance), as shown in the Table 1. Persistence of OMT after STEMI included: ASA (84.6%), P2Y12i (71.5%), statin (83.6%), ACEI/ARB (77.1%) and beta blocker (63.7%) (Table 2). Conclusions In patients with STEMI in a low to middle income country, persistence and adherence to OMT were low. Actions to improve adherence to therapy after mayor cardiovascular events are needed. Risk factors associated to poor adherence included diabetes (OR 0.46), age (OR 0.76) and atrial fibrillation (OR 0.42). Abstract Figure.

Mental health of people living with hiv and adherence to antiretroviral therapy

IntroductionAdherence to antiretroviral therapy is a key factor in predicting the success or failure of treatment. Data suggest that the status of mental health and especially depression of people living with HIV can affect adherence to antiretroviral therapy.ObjectivesThe purpose of this study was to assess the mental health status of people living with HIV, to record adherence to antiretroviral therapy and to investigate whether mental health affects adherence to antiretroviral therapy.MethodsA cross-sectional mixed observational correlation study in a sample of 112 HIV-positive individuals was conducted. The Simplified Medication Adherence Questionnaire (SMAQ) was used to assess adherence to antiretroviral therapy, the Beck Depression Inventory (BDI) was used to assess depression, and the WHOQOL – BREF tool was used to assess mental health.Results The results of the study showed that 58.93% of patients were found to be non-adherent to antiretroviral therapy. Furthermore, according to the BDI scale, 10.7% of patients experienced marginal clinical depression, 10.7% experienced moderate levels of depression and 2.7% experienced severe or very severe levels of depression. Further, people living with HIV had a moderate level of mental health (M = 3.40, SD = 0.58).Conclusions Our study showed that a high percentage of people living with HIV are non-adherent to antiretroviral therapy. Factors that are possibly associated with decreased adherence are mental health and especially depression. Psychological support for people living with HIV and anti-depressant prevention programs could increase adherence to antiretroviral therapy.

Improvement of Adherence to Drug Therapy Using a Weekly Multidose Pillbox in Heart Transplant Patients. A Prospective Single-Center Study

Purpose Heart Transplant (HT) patients need complex drug treatment for life: many drugs and several daily doses (usually 5 times a day). This complexity may make it difficult to adhere to the treatment, which is key to therapeutic success. In order to facilitate medication preparation, a Weekly Multi-Dose Pillbox (WMDP-5), 5 doses/day, was designed in our HT program. The aim is to assess the improvement in adherence and satisfaction with the use of the WMDP-5 within a multifactorial intervention. Methods Prospective single-center study started in April 2019. All HT patients were invited to participate. The multilevel intervention included the provision of the WMDP-5 as well as a training session with a specific video and information leaflets. The study was approved by regional ethics committee. To evaluate adherence, the Spanish version of BAASIS (Basel Assessment of Adherence with Immunosuppressive Medication Scale) Patient Questionnaire Interview and the Simplified Medication Adherence Questionnaire (SMAQ) were used at delivery and at the follow-up visit. A Likert Scale (1-5) evaluate satisfaction at the follow-up visit (the next one to the center ≥ 1 months after using the WMDP). Patients with the follow-up visit until October 2019 were analyzed. Results A total of 214 HT patients (mean age 61,8±12,89 years, 79,4% males, with mean time after HT of 9,86±6,9 years) were included in the analysis. The highest level of education was primary school in 45,3%, 67,3% were married and 85% lived with someone. According to the SMAQ, there were 156/214 (72.89%) adherents at baseline and 193/214 (90,2%) at follow-up visit (p=0.006). Of 58 non-adherent patients at the baseline visit, 47 (81%) were adherent (improved) at the follow-up visit; while of 156 adherents at the basal visit, only 10 (6,4%) became non-adherents (worsened). The BAASIS questionnaire documented an overall improvement. Thus, the fist BAASIS question (if any pill was forgotten) at the baseline visit was 8%, while at the follow-up visit was 1,7%. Finally, according to the Likert Scale, 71,5% of the patients responded that the WMDP-5 helped them to take the treatment well. Conclusion The use of a WMDP-5 in the context of a multilevel intervention improves therapeutic adherence in HT patients. It should be noted that this improvement occurs in a cohort of HT patients with already high adherence.

The effect of acculturation and harm beliefs on medication adherence on Middle Eastern hypertensive refugees and migrants in Australia.

Background Different populations have different levels of acculturation, and beliefs about medications. Little is known about the differences between refugees and migrants regarding these various beliefs. Adherence to medications is influenced by many factors, including individuals' characteristics, acculturation, and their perceptions about medications. Having a thorough understanding of these beliefs contributes to understanding medication adherence in refugee and migrant populations. Objectives To evaluate the differences between Middle Eastern refugees and migrants in Australia regarding acculturation, beliefs about medications, and medication adherence, and to evaluate the association of acculturation and beliefs about medications and natural remedies with medication adherence. Setting Participants were recruited from various community groups and English language learning centres in Australia. Arabic Facebook community groups were also used to recruit participants for this study. Method A total of 320 Middle Eastern refugees and migrants with hypertension completed Arabic or English versions of the general Beliefs about Medicine Questionnaire (BMQ)-harm scale, a question about beliefs in natural remedies, six items about acculturation and the Medication Adherence Questionnaire. Two models of multiple mediation were applied. The first model examined the role of acculturation, length of residency, beliefs about natural remedies, and harm beliefs as mediators between migration status and medication adherence. The second model identified the role of acculturation, and beliefs about natural remedies as mediators between migration status and medication harm beliefs. Main outcome measure Medication adherence, harm beliefs about medication, acculturation, and beliefs about natural remedies. In addition, the differences between refugees and migrants regarding these beliefs and medication adherence. Results Differences were found between refugees and migrants for medication adherence and medication beliefs. Refugees were likely to have more harm beliefs towards medicine and were less acculturated than migrants (p = 0.0001). They were also less likely to adhere to medications (p = 0.0001), and perceived natural remedies to be safer than Western medications (p = 0.0001). Perceiving medications as harmful substances, and beliefs in natural remedies were mediators in the relationship between migration status and medication adherence. Beliefs in natural remedies and acculturation were mediators in the relationship between migration status and harm beliefs. Conclusion Beliefs about medications and natural remedies, and acculturation in refugees and migrants need to be better understood to enhance medication adherence and potentially overall health outcomes.

Inhibitory control is associated with medication adherence in young HIV patients without comorbidities

Objective In the present study we evaluated the incremental contribution of executive cognition (EC) subprocesses to antiretroviral medication adherence. Method A comprehensive EC test battery assessing updating/working memory, mental flexibility, and inhibitory control, along with measures assessing non-executive cognitive functions were completed by 100 individuals with HIV. Medication adherence was determined via a visual analogue self-report scale and the Medication Adherence Questionnaire. Potential predictors, including demographic and clinical characteristics and neuropsychological performances on EC and other cognitive tasks were regressed to medication adherence. Predictive variables related to executive processes were added in the final block of the hierarchical regression model in order to assess their incremental predictive ability on medication adherence. Results 23% of the variance in the visual analogue scale was explained by treatment complexity, memory and EC performance. A measure of inhibitory control, in particular, predicted self-reported medication adherence above and beyond demographic, clinical and other cognitive factors. Conclusions The contribution of EC to self-reported medication adherence in young seropositive adults was limited, but inhibitory control was associated with proper medication management above and beyond demographic, clinical and other cognitive functions.

The effect of the Take Charge intervention on mood, motivation, activation and risk factor management: Analysis of secondary data from the Taking Charge after Stroke (TaCAS) trial

Objective: To use secondary data from the Taking Charge after Stroke study to explore mechanisms for the positive effect of the Take Charge intervention on physical health, advanced activities of daily living and independence for people after acute stroke. Design: An open, parallel-group, randomised trial with two active and one control intervention and blinded outcome assessment. Setting: Community. Participants: Adults (n = 400) discharged to community, non-institutional living following acute stroke. Interventions: One, two, or zero sessions of the Take Charge intervention, a self-directed rehabilitation intervention which helps a person with stroke take charge of their own recovery. Measures: Twelve months after stroke: Mood (Patient Health Questionnaire-2, Mental Component Summary of the Short Form 36); ‘ability to Take Charge’ using a novel measure, the Autonomy-Mastery-Purpose-Connectedness (AMP-C) score; activation (Patient Activation Measure); body mass index (BMI), blood pressure (BP) and medication adherence (Medication Adherence Questionnaire). Results: Follow-up was near-complete (388/390 (99.5%)) of survivors at 12 months. Mean age (SD) was 72.0 (12.5) years. There were no significant differences in mood, activation, ‘ability to Take Charge’, medication adherence, BMI or BP by randomised group at 12 months. There was a significant positive association between baseline AMP-C scores and 12-month outcome for control participants (1.73 (95%CI 0.90 to 2.56)) but not for the Take Charge groups combined (0.34 (95%CI −0.17 to 0.85)). Conclusion: The mechanism by which Take Charge is effective remains uncertain. However, our findings support a hypothesis that baseline variability in motivation, mastery and connectedness may be modified by the Take Charge intervention.

Potentially inappropriate prescriptions and therapeutic complexity in older HIV patients with comorbidities.

The prolonged current survival of human immunodeficiency virus (HIV) patients exposes them to new problems arising from the comorbidities they face. To describe the situation of comorbidities, polypharmacy, therapeutic complexity and adherence in people living with HIV over 65years of age and to assess the presence of potentially inappropriate prescriptions (PIP) by applying deprescription criteria. Observational study including HIV people (> 65years) from a university tertiary level hospital. Demographic, clinical and pharmacotherapeutic characteristics of the patients and their treatments were studied. The prevalence of polypharmacy (> 5 medications) and the pharmacotherapy complexity, quantified by the Medication Regimen Complexity Index (MRCI), were calculated. Therapeutic adherence was assessed by the Simplified Medication Adherence Questionnaire (SMAQ) and the medication possession ratio, according to prescription dispensing records. The Screening Tool of Older People's Prescriptions (STOPP) and List of Evidence-baSed depreScribing for CHRONic patients (LESS-CHRON) criteria were applied to identify PIP. PIP in elderly people living with HIV. Thirty patients were included, 73% of whom were men, with a median age of 71years (IQR 67 - 76) and a median duration of infection of 17years (IQR, 9 - 21). Seventy percent of the patients suffered from dyslipemia, 66.7% from hypertension, 43.3% from diabetes and 26.7% from mental health disorders. Seventy percent of the patients took more than 5 medications and 30% more than 10. The MRCI of concomitant medications was higher (18.3 points) than the MRCI of antiretroviral therapy (5.1 points), 66.7% of the studied population was classified as adherent. Finally, 70% of the patients present some PIP according to the STOPP or LESS-CHRON criteria. The polypharmacy was significantly associated (p = 0.008) with meeting deprescription criteria. The elderly people living with HIV present numerous comorbidities and met the criteria for polypharmacy. Their pharmacotherapy complexity is mainly determined by the concomitant treatments. There is a high prevalence of meeting deprescription criteria in people living with HIV over the age of 65 and a clear relationship between polypharmacy and deprescription. The optimization of pharmacotherapy is necessary in this population.

1046 Assessing compliance to daily low dose aspirin for preeclampsia prevention using a validated questionnaire

Adherence is essential to the efficacy of ASA in preventing preeclampsia (PE). Our objective was to evaluate and compare the adherence of pregnant women at high risk for PE to different regimens of ASA using a validated questionnaire, the simplified medication adherence questionnaire (SMAQ). 33 pregnant women identified as high risk for developing PE using the Unites States Preventative Services Task Force (USPSF) criteria were randomized in an open-label setting to either ASA 81mg daily or ASA 162mg daily, to be initiated before 16 weeks’ gestation. The USPSF criteria include: PE in a prior pregnancy, chronic hypertension, pregestational diabetes, renal disease, autoimmune disease or multifetal gestation. Compliance to therapy was ascertained using the validated SMAQ at 20, 26 and 36 ± 2 weeks’ gestation (Table 1). Non-adherence was defined as: a positive response to any of the qualitative questions, >2 missed doses over the past week, or >2 days of non-use in the past 3 months. Compliance rates were compared across treatment groups using Chi-square with an alpha error level set at <0.05. The mean age of participants was 36.0±4.9 years, 16/33 (48.5%) were primiparous. Age and parity were similar for both treatment groups. 18/33 (54.5%) women were randomized to the ASA 81mg group and 15/33 (45.5%) to ASA 162mg. The SMAQ was completed by 93.9% of participants at 20±2 weeks, 87.9% at 26±2 weeks and 75.8% at 36±2 weeks. Table 2 outlines compliance rates with daily low dose aspirin, stratified by treatment group. Overall, medication adherence was higher in the ASA 81mg group, particularly after the mid-trimester. Reasons for non-adherence included gastrointestinal side effects (6.1%), vaginal spotting (3%) and non-intentional omission (9.1%). Aspirin compliance appears to be elevated in women at high risk for PE who are prescribed ASA 81mg daily and to be significantly lower in women on 162mg. This should be taken into consideration when prescribing and counseling women about low dose ASA for PE prevention.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Adherence to oral antineoplastic agents in pediatric oncology. A multicenter study.

To determine the adherence to oral maintenance medication among pediatric cancer patients and know their beliefs about medications. Information was obtained from parents, adolescents, and oncologists from six public children's hospitals of Argentina during 2018 and 2019. Questionnaires on adherence (Simplified Medication Adherence Questionnaire) and beliefs about medication (Beliefs About Medicines Questionnaire) were administered. Patients were considered adherent if they referred taking their medication without missing a dose and complying with fasting time. N = 203 patients. Parent-reported adherence was 75 %; adherence estimated by oncologists, 82 %; and that referred by adolescents, 45 %. The outcome measures associated with adherence were financial solvency, diagnosis, treating hospital, number of children under the care of the caregiver, cancer treatments received, and presence of barriers in compliance. Sample subjects did not perceive medications as harmful, but considered they were overused. Most subjects perceived the necessity to take antineoplastic agents to maintain or recover their health, but also expressed their concerns. The perception about medication was similar between parents and adolescents, and was not associated with the level of adherence. In this sample, parent-reported adherence was 75 %. Parents and patients perceived a necessity for medication and expressed their concerns about treatment.

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.

An Intervention Study for Impact Assessment of Health Education by Empowered Community Health Workers in Improving Treatment and Diet Adherence in Hypertension.

Context:Medication and low salt diet adherence play as an essential factor in blood pressure target achievement. Community health worker empowerment was reported to be a highly effective social intervention to medication and low salt diet adherence.Aims:This study aimed to investigate the effect of structured health education regarding hypertension on community health workers on medication and low salt diet adherence among hypertensive patients in Malang.Subjects and Methods:A quasi-experimental study was conducted in health workers and their hypertensive patients who join in the Integrated Health Service Post for the Elderly (IHSP-Elderly) program in Malang. Medication adherence was measured by the medication adherence questionnaire and low salt diet adherence was measured by dietary salt restriction questionnaire. The data were analyzed by Chi-square analysis for categorical data and independent t-test for numerical data.Results:This study showed that hypertensive patients in the intervention group had better knowledge regarding hypertension compared to those of the control group (P < 0.05). The patients' satisfaction in intervention group improved significantly after health education (P < 0.01). The proportion of patients with good medication adherence improved significantly (P < 0.01) from 20% to 70% after health education in intervention group. Moreover, the proportion of patients with good low salt diet compliance improved significantly (P < 0.01) from 39% to 85%. Conversely, the proportion of good medication and low salt diet adherence in control group relatively similar between pre- and post-test.Conclusions:This study showed that health education on community health workers improved hypertensive patients' medication and low salt diet adherence.

Patient Knowledge, Adherence to the Therapeutic Regimen, and Quality of Life in Hemodialysis : Knowledge, Adherence, and Quality of Life in Hemodialysis.

The aim of this study was to investigate the effect of patients' knowledge on adherence to the hemodialysis regimen and Quality of Life (QoL) of patients undergoing hemodialysis as well as the effect of adherence on QoL. Also, the effect of demographic and clinical characteristics on the above three variables was studied. In this cross-sectional study conducted between March and May 2017, 321 patients on hemodialysis from six hemodialysis units completed the Kidney Disease Questionnaire, the GR-Simplified Medication Adherence Questionnaire and the Missoula Vitas Quality of Life Index-15 to measure the patient knowledge, the adherence to hemodialysis regimen, and the QoL, respectively. The statistical analysis was performed via the Statistical Program SPSS 19.0. The statistical significance level was set up at 0.05. The knowledge was independently associated with the overall QoL and its dimension-transcendence-with total adherence and its dimension-diet/fluid adherence. The total adherence was independently associated with overall QoL and its dimensions-symptoms and interpersonal. The educational level, the type of vascular access, and the daily number of pills were independently associated with the total adherence and the overall QoL. Patient knowledge may have an important effect on adherence and QoL. Adherence may have an important effect on QoL. Demographic and clinical characteristics play, also, a crucial role in the above variables. The findings can help nephrology nurses to quantify the extent of non-adherence in hemodialysis and poor quality of life.