Morisky-Green Test Research Articles

Seguimento farmacoterapêutico de pacientes em tratamento com talidomida em um centro especializado em hanseníase

***Pharmacotherapeutic follow-up of patients treated with thalidomide at a specialized leprosy center*** AIMS: To evaluate the pharmacotherapeutic follow-up of patients with type 2 leprosy reaction in treatment with thalidomide in a philanthropic center of specialized care at Teresina. METHODS: The study was conducted at the Centro Maria Imaculada, for rehabilitation of patients with leprosy, in the city of Teresina, Piauí, Brazil. Patients of both sexes attended between september and november 2016 were included in the study. Pharmacotherapeutic follow-up was based on the Dáder Method, in the electronic base Drugdex System - Thomson Micromedex® - Interactions for analysis of drug interactions; in the classification of adverse drug reactions of Rawlins and Thompson; and the Morisky-Green test to evaluate the level of therapeutic adherence. RESULTS: Eleven patients were followed, of whom eight were male. Three drug interactions were identified, two of which were classified as moderate risk and one in lower risk. There were 23 negative results associated with medicines, mainly quantitative insecurity and untreated health problems. In addition, 22 drug-related problems were identified, with adverse drug reactions being the most frequent occurrence. All adverse drug reactions were classified as type A or predictable. Regarding adhesion, six patients among nine who responded to the Morisky-Green test obtained a high degree of adhesion. Health education corresponded to the preponderant pharmaceutical intervention, being applied to all patients. CONCLUSIONS: Relevant drug interactions, negative results associated with medicines, and drug-related problems were identified. Degree of adherence to thalidomide treatment was considered high. Pharmaceutical interventions were necessary, mainly focused on health education actions, which ratifies the need for constant monitoring of this group of patients.

Adherence of rheumatoid arthritis patients to biologic disease-modifying antirheumatic drugs: a cross-sectional study.

The aims of this study were to evaluate adherence of rheumatoid arthritis (RA) patients to biological disease-modifying antirheumatic drugs (bDMARDs), identify potential risk factors, and analyze the discriminative ability of the Morisky-Green test (MGT) to detect bDMARD nonadherence. One hundred and seventy-eight adult RA patients treated with bDMARDs were included. Adherence was measured using the medication possession ratio (MPR) of the previous 6months. An MPR>80% was considered good adherence. Patient demographics, clinical characteristics, and MGT scores were assessed through a standardized clinical interview at the cross-sectional date. One-hundred and twelve patients (63%) were taking subcutaneous bDMARDs, while 66 (37%) were taking intravenous drugs. One-hundred fifty-eight (88.8%) showed good adherence to bDMARDs, while 79 (61.2%) also correctly took concomitant conventional synthetic DMARDs (csDMARDs). In logistic regression models, nonadherence to bDMARDs was associated with higher disease activity [odds ratio (OR) 1.45; 95% CI, 1.03-2.03; p=0.032] and subcutaneous route (OR 3.70; 95% CI 1.02-13.48; p=0.040). MGT accurately identified an MPR>80% of bDMARDs in 76.9% of the patients. A sensitivity of 78%, specificity of 70%, positive predictive value of 95.3%, negative predictive value of 28.5%, positive likelihood ratio (LR) of 2.6, and negative LR of 0.3% were obtained. Adherence may be good for bDMARDs but is low for csDMARDs. Low adherence for bDMARDs is associated with poorer disease control during the past 6months and use of subcutaneous route. These findings should alert doctors to consider possible low adherence before declaring treatment failure.

MP40-14 COGNITIVE EFFECTS OF TRANSDERMAL OXYBUTYNIN IN ELDERLY PATIENTS WITH OVERACTIVE BLADDER SYNDROME

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I1 Apr 2017MP40-14 COGNITIVE EFFECTS OF TRANSDERMAL OXYBUTYNIN IN ELDERLY PATIENTS WITH OVERACTIVE BLADDER SYNDROME Carlos Muller-Arteaga, Jose Emilio Batista Miranda, Carmen Zubiaur, Ainara Rabade Ferreiro, Rafael El Khoury Moreno, Gonzalo Morales Solchaga, Javier Casas Nebra, Manuel Leva Vallejo, Oscar Gonzalez Garcia, Salvador Arlandis-Guzman, and Carlos Errando-Smet Carlos Muller-ArteagaCarlos Muller-Arteaga More articles by this author , Jose Emilio Batista MirandaJose Emilio Batista Miranda More articles by this author , Carmen ZubiaurCarmen Zubiaur More articles by this author , Ainara Rabade FerreiroAinara Rabade Ferreiro More articles by this author , Rafael El Khoury MorenoRafael El Khoury Moreno More articles by this author , Gonzalo Morales SolchagaGonzalo Morales Solchaga More articles by this author , Javier Casas NebraJavier Casas Nebra More articles by this author , Manuel Leva VallejoManuel Leva Vallejo More articles by this author , Oscar Gonzalez GarciaOscar Gonzalez Garcia More articles by this author , Salvador Arlandis-GuzmanSalvador Arlandis-Guzman More articles by this author , and Carlos Errando-SmetCarlos Errando-Smet More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1261AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Oxybutynin is a drug that has proven effective in the treatment of overactive bladder. With the oral presentation, a deterioration in cognitive function is described. The transdermal formulation has shown a decrease of the active metabolite of oxybutynin (N-DEO) involved in the onset of side effects. Cognitive impairment of anticholinergic drugs are related to passage through the blood brain barrier and antagonism of M1 receptors in the central nervous system being the elderly population more susceptible.Objective: To determine if there is impairment of cognitive function in elderly patients, between 65 and 80 years of age, treated with transdermal oxybutynin. As secondary objectives assessed the efficacy of the drug and adherence. METHODS Observational, retrospective, multicenter study. Patients diagnosed with overactive bladder who met the criteria for inclusion / exclusion were assessed at office and treatment was indicated with Oxybutynin transdermal according to routine clinical practice and recommendations for use according to data sheet. Specific questionnaires pathology (Bladder Self-Assestment questionnaire (BSAQ), Patient Perception Bladder Control (PPBC)), of Adherence (Morisky-Green Test) and Assessment of Cognitive function (Impaired Memory, Test, Clock Drawing test) at the start and in the follow-up visit at 4 weeks of treatment were administered. Statistical analysis: Results were treated with relative frequency measurement. For continuous variables, central tendency measures were used for comparisons Student t test, Wilcoxon and Chi-square test was used. The level of statistical significance was set at <0.05 RESULTS A total of 70 patients were evaluable with an average age of 71.37 years, 71.4% were women, 51.4% with basic education and 70% come from the urban environment with an average BMI of 28.68. Impaired Memory, Test results before and after treatment showed no significant differences in any of the areas of assessment of cognitive function. Similarly, no differences were observed in the Drawing Clock Test. Regarding adherence to treatment was 84% with improvement in symptoms and the PPBC and BSAQ questionnaires. CONCLUSIONS In our study not impaired cognitive function in elderly patients with overactive bladder syndrome treated with transdermal oxybutynin was observed © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e528 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Carlos Muller-Arteaga More articles by this author Jose Emilio Batista Miranda More articles by this author Carmen Zubiaur More articles by this author Ainara Rabade Ferreiro More articles by this author Rafael El Khoury Moreno More articles by this author Gonzalo Morales Solchaga More articles by this author Javier Casas Nebra More articles by this author Manuel Leva Vallejo More articles by this author Oscar Gonzalez Garcia More articles by this author Salvador Arlandis-Guzman More articles by this author Carlos Errando-Smet More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

COMPLIANCE TO CLINICIAN PRESCRIPTIONS IN ISCHEMIC HEART DISEASE PATIENTS (BY THE DATA FROM OUTPATIENT REGISTRY PROFILE)

Workgroup of the PROFILE registry: Voronina V. P., Dmitrieva N. A., Zakharova A. V., Zagrebelny A. V., Kutishenko N. P., Lerman O. V., Lukina Yu. V., Martsevich S. Yu., Tolpygina S. N. Aim. Based on the data of outpatient registry PROFILE, with addition of questionnaires, to analyze treatment compliance and influencing factors, in coronary heart disease (CHD) patients. Material and methods. 688 patients of the PROFILE registry who had come to a primary visit in scientific department of the investigation center at time between 1 January 2014 to 31 August 2015, were asked to complete an original compliance to clinician prescriptions (CP) questionnaire with integrated Morisky-Green test (MG). It was filled by 479 patients (70,1%). In 250 of answerers there was CCHD: 65 women (26%) and 175 men (74%). Mean age of CCHD patients was 63,6±12,5 y.o. 72,1% of them in the PROFILE registry, had higher education, 16 (6,4%) — scientific degree. Diagnosis of CHD was verified as anamnesis of myocardial infarction (MI), coronary arteriography (CAG) or exercise test in 231 (92,4%) participants. Results. As the patients charts show, 12 patients with CCHD from 250 participants did not receive any medication treatment, 15 took medications irregularly, and other 223 regularly, by CP. This data is confirmed by the results of original questionnaires: 193 patients responded that do strictly adhere all CP on medications, and 49 (among 238) — had misused some prescriptions. By the results of 4-unit MG test, only 47 from 230 of responders were completely adherent to the treatment, and other 71 made at least one positive response, being relatively adherent. In multifactorial logistic regression, it was found that stable angina and scientific degree do increase adherence 3 times (р=0,006; OR 2,9; CI 95% [1,4;6,0]) and more than 6 times, respectively (р=0,003; OR=6,3; CI 95% [1,9;21,0]). Also, it was shown that treatment adherence (by our original questionnaire) depends on the regularity of clinician follow-up, and office visits once per year and more do increase it more than 5 times (р=0,019, OR=5,1 CI 95% [1,3;19,9]). Conclusion. Clinical symptoms of CHD (stable angina), scientific degree, as well as regular clinician follow-up at least once per year, are the factors increasing overall patients adherence to CP and medication treatment compliance.

Impact of changes in pill appearance in the adherence to angiotensin receptor blockers and in the blood pressure levels: a retrospective cohort study

ObjectiveTo assess the level of adherence to angiotensin receptor blockers (ARBs) in patients regularly attending a community pharmacy and the influence of a change in patients' adherence to pharmacological treatment.DesignRetrospective...

Приверженность к инициальной и поддерживающей терапии у пациентов с гастроэзофагеальной рефлюксной болезнью

Aim of investigation. To analyze treatment compliance at initial course and maintenance treatment by proton pump inhibitors at gastroesophageal reflux disease (GERD). Material and methods. Overall 84 GERD patients with took part in prospective study: 50 (59.5%) men and 34 (40.5%) women aged from 18 to 74 years. By results of esophagogastroduodenoscopy and morphological investigation of mucosal biopsies non-erosive reflux disease (NERD) was diagnosed in 32 (38.1%) patients, reflux esophagitis was found in 52 cases (61.9%). Total period of patients monitoring was 12 months at which patients made five visits to the research center: initial, through 1.5, 3, 6 and 12 months with filling in of questionnaires of Spielberger-Khanin, Beck, SF-36 and abridged multifactorial questionnaire of the personality (AMQP). Treatment compliance was established according to duration of study participation, along with that patients self-estimated it on 2, 3, 4 and 5 visits by Morisky-Green test and 5-score analog scales of pharmaceutical treatment compliance and lifestyle verification. The first visit patients underwent 1:1 randomization to the educational program devoted to reflux disease. Results. Of all patients 17.9% missed the second visit, the logistic regression analysis revealed no factors associated to the early low compliance; 38% of patients made all five visits for 12 months. The latter differed significantly from those who dropped out of the study at different stages: they had high number of chronic diseases (р<0.01), received higher quantity of drugs on the constant basis (р<0.01), got lower scores by the paranoid trait scale of AMQP (р<0.05). Logistic regression is revealed factors associated to the low level of treatment compliance: number of chronic concomitant diseases (OR=1.64; р=0.0033), quantity of the received drugs (OR=1.63; р=0.0158), scores by paranoid trait AMQP scale (OR=0.95; р=0.042). Conclusion. Single course educational program in GERD patients increases treatment compliance for initial course while does not affect maintenance therapy compliance. Following predictors of high treatment motivation were found: existence of chronic diseases and intake of medications on the regular basis for concomitant diseases, minimal intensity of rigidity of affect personality trait. Constant maintenance therapy is optimal for GERD patients in the Russian population, at the same time in NERD patients without low compliance markers the course maintenance therapy can be applied.

Factors associated with adherence to pharmacological treatment among elderly persons using antihypertensive drugs

Abstract Objective: analyze adherence to pharmacotherapy and associated factors among elderly patients using at least one antihypertensive medication. Methods: A cross-sectional, population-based study was performed of elderly patients resident in Juiz de Fora, Minas Gerais, Brazil. Adherence to medication was assessed with the Morisky-Green Test. Socio-demographic variables and variables related to health status, the health service and drug therapy were collected. The Poisson regression model was used to assess crude and adjusted (95% confidence interval) prevalence ratios (PR). The level of significance was tested using the Wald test. Results: The prevalence of adherence to pharmacological therapy was 47% (95% CI: 41%-53%). The sample consisted of 279 elderly persons, the majority of whom were women (69%), described themselves as white (45.5%), and had up to four years of schooling (76.48%). Regarding pharmacological therapy, the subjects took 5.19 (±2.8) medications and 7.1 (±4.4) tablets per day. Conclusion: a significant association was observed between adherence to pharmacological therapy and the variables positive perception of vision, positive perception of hearing and absence of frailty.

SCORE study: quality indicators for rheumatology nursing clinics.

Nursing clinics in rheumatology (NCR) are organizational care models that provide care centred within the scope of nurses abilities. To analyse patients differences in the knowledge of the disease, adherence to the treatment, quality indicators of the Rheumatology Departments included quality perceived by the patients with and without NCR. National multicenter observational prospective cohort study 1year follow-up, comparing patients attending rheumatology services with and without NCR. NCR was defined by the presence of: (1) office itself; (2) at least one dedicated nurse; (3) its own appointment schedule, and (4) phone. Variables included were (baseline and 12months) Batalla, Haynes-Sackett, Morisky-Green and quality perceived tests. In addition, another specific questionnaire was drawn up to collect the healthcare, teaching and research activities of each Rheumatology Department. A total of 393 patients were included; 181 NCR and 212 not NCR, corresponding to 39units, 21 with NCR and 18 without NCR (age 53 ± 11.8 vs 56 ± 13.5years). Significant differences in favour of the NCR group were found in Haynes-Sackett (p = 0.033) and Morisky-Green (p = 0.03) tests in the basal visit. Significant differences were found in questions about "the courtesy and/or kindness received by the nurse", being "good or very good" in greater proportion in the NCR group. The publications from the last 5years were significantly higher in the NCR group in both, national (p = 0.04) and international (p = 0.03) journals. A higher research activity and quality perceived by the patients are observed in the Rheumatology Departments with NCR.

Low Scores in the Auto-Compliance Method and Fast Medical Care Influence the Poor Adherence in Diabetics attended in the Basic Health Unit

Objective: To evaluate the factors that influences the adherence in diabetics and correlate with the low and high Morisky Green Test (MGT) scores. Subjects and methods: A total of 301 type 1 and type 2 diabetes patients aged 18 to 90 years using insulin and oral hypoglycemic agents were evaluated with instruments MGT, MedTaKe test (MT), Pharmacotherapy Complexity Index (CPI), Complication of Diabetes Index (CDI) and Auto-Compliance Test (ACT). The patients were divided into two groups: adherent diabetics with scores >80 in MGT and non-adherent diabetics with scores ≤ 80 in MGT, and their differences were compared with the student T-test and odds ratio with their respective confidence intervals. Results: Significant differences were found in the variables: MGT (91.3 ± 8.5 vs. 59.2 ± 10, p 80 MGT scores, and schooling level (r=-0.15, p 80 MGT scores and attendance service time (p<0.01), marital status (p<0.00) and race influenced the ≤ 80 MGT group scores. Conclusions: ACT, marital status, race and attendance service time may influence the low adherence in diabetics.

ASSESSMENT OF ADHERENCE TO TREATMENT AND FACTORS AFFECTING IT IN PATIENTS WITH STABLE ISCHEMIC HEART DISEASE DURING THERAPY WITH NICORANDIL

Working Group of the NIKEA Program. Ekaterinburg: Akulina E.N.; Izhevsk: Shinkareva S. E., Grebnev S.A.; Krasnodar: Kudryashov E.A., Fendrikova A.V.; Krasnoyarsk: Nemik D.B., Pitaev R.R., Altaev V.D., Samokhvalov E.V., Stolbikov Y.Y.; Moscow: Dmitrieva N.A., Zagrebelnyy A.D., Zakharova A.V., Balashov I.S., Leonov A.S., Sladkova T.A., Zelenova T.I., Shestakova G.N., Kolganova E.V., Maksimova M.A.; Novosibirsk: Moskalenko I.V., Shurkevich A.A.; Omsk: Loginova E.N., Gudilin V.A.; Orel: Zhuravleva L.L., Lobanova G.N., Luneva M.M.; Orenburg: Kondratenko V.Y.; Rostov-on-Don: Kalacheva N.M., Kolomatskaia O.E., Dubishcheva N.F., Romadina G.V., Chugunova I.B., Skarzhinskaia N.S.; Ryazan: Bulanov A.V., Trofimova Y.M., Nikolaeva A.S.; St. Petersburg: Savinova E.B., Ievskaia E.V., Vasileva L.B.; Tula: Zubareva L.A., Berberfish L.D., Gorina G.I., Nadezhkina K.N., Iunusova K.N., Nikitina V.F., Dabizha V.G., Renko I.E., Soin I.A. Aim. To study the adherence to treatment and the factors that affect it in patients with stable coronary heart disease during the treatment with nicorandil. Material and methods . The use of nicorandil in addition to standard antianginal therapy was recommended to patients (n=590) in a prospective, observational, multicenter NIKEA study. Patients completed original questionnaires on adherence, including a Morisky-Green test at the enroll visit. The questionnaires were filled by 423 patients (73% response). The factors that influence adherence were studied. Results. All patients were divided into 3 groups, depending on the adherence to the use of nicorandil: immediately refused to take the drug (n=150; group 1); started, but stopped taking nicorandil in the first 3 months of observation (n=75; group 2); who took nicorandil for 3 months (n=327; group 3). Potentially adherents (intention to treat) were 582 out of 590 (98.6%) patients, and actually adherents – only 327 of 552 (59.2%) patients. The main reason for non-adherence to the beginning of therapy is polypharmacy; to the continuation of the treatment that had just started – adverse events; for termination of long-term therapy – polypharmacy, adverse events and insufficient effectiveness of treatment. Group 3 had initially more severe angina pectoris: more number of angina attacks (p=0.014) and the need of short-acting nitrates (p<0.0001). Patients of the group 1 compared to the patients of group 3 did not visit the doctors more often or attended them only when necessary, violated the medical prescriptions for taking medications (p<0.05). According to the results of the Morisky-Green test, 150 patients (36.2%) were not are committed to medical recommendations, 264 (63.8%) – are committed. Women were more adherent than men (p=0.47); patients with class I angina were more adherent than patients with class III angina (p=0.027), and patients who regularly attended the treating physician (more often than once a month) were more committed to medical recommendations than patients, not visiting the treating physician (p=0.004). С onclusion . The levels of overall adherence according to Morisky-Green test, the potential adherence according to the survey and the actual adherence of patients to treatment vary considerably. The leading cause of non-adherence at the beginning of therapy is polypharmacy, for the continuation of the recently started treatment – the adverse events; for long-term sustained treatment – equally polypharmacy, drug adverse events and the lack of treatment efficacy.

STUDY OF THE PARAMETERS OF TOLERABILITY AND ADHERENCE TO THERAPY IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ARTERIAL HYPERTENSION ON THE BACKGROUND OF TREATMENT WITH FIXED COMBINATION OF RAMIPRIL AND AMLODIPINE (ACCORDING TO THE RESULTS OF OBSERVATIONAL STUDY "GRANAT-2")

Working group of the “GRANAT-2” study: Tula - Trubitsyn G.I., Ivanov Yu.V., Mirenkova O.K., Eskova R.A., Simonova R.P., Milon M.E., Telegina E.V., Kuznetsov A.M., Zhukova N.A., Zainullina I.K.; Rostov-on-Don - Budanov O.V., London E.M., Minosyan L.V., Nedashkovskaya N.G., Ter-Ananyants Ye.A.; Tomsk - Proskokova I.Yu., Permyakova O.V., Politova L.V., Maneeva I.D., Ivanova S.Yu.; Nizhny Novgorod - Larina O.V., Pokrovskaya I.N., Patselt E.A.; Moscow - Sladkova T.A., Zelenova Т.V. Aim. To study the tolerability and adherence to antihypertensive therapy in patients with hypertension and chronic obstructive pulmonary disease (COPD) using the fixed combination of ramipril and amlodipine in the observational program for patients with arterial hypertension and COPD (GRANAT-2). Material and methods. Patients with hypertension and COPD (n=52) with all inclusion criteria and without exclusion criteria who signed informed consent to participate in the GRANAT-2 program were included into the study. The use of a fixed combination of ramipril and amlodipine was recommended in all patients. The doses were determined by the treating physicians in accordance with the official drug instruction. The patients had 4 visits, and the duration of the study was 5 months. The Morisky-Green test was used to assess an adherence of patients to treatment. Assessments of blood pressure, adverse events were performed at all visits. Results. 50 of 52 patients completed the study: 45 patients used the studied fixed combination in the recommended doses, and 5 patients used other antihypertensive drugs, 2 patients withdrew from the study. Systolic blood pressure after 1 month of treatment decreased by an average of 20 mm Hg from the baseline, and diastolic blood pressure – by 10 mmHg. These rates after 5 months of therapy were 29 mm Hg and 15 mm Hg, respectively. Target blood pressure level was achieved in all patients. Increase in adherence of patients to treatment (according to the Morisky-Green test from 21.1% to 65.1%) was found. 2 cases of adverse events (dry cough) were registered. The discrepancy in adherence assessment was revealed between the results from the Morisky-Green test and the data from program case report forms. Conclusion. Regular patient visits to the doctor and the rapid achievement of an antihypertensive effect with good tolerability of a fixed combination of ramipril and amlodipine contributed to the increase in adherence of patients to treatment. Undesirable effects of the drug therapy are significant, but not leading factors that have a negative impact on the patient adherence to treatment.

SELECTION OF PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION FOR RENAL DENERVATION

Aim. To develop an optimized scientifically based approach to medical and diagnostic measures before renal denervation. Methods. 91 patients with a previously diagnosed primary arterial hypertension aged 54.2 (52.0, 69.3) years history of arterial hypertension was 11.4±4.2 years. 57 (62.6%) patients had asymptomatic lesions of target or-gans. 34 (37.4%) were present with associated clinical conditions. The average number of classes of antihyper-tensive drugs taken by patients was 4±1.2. 18 patients (19.8%) received aldosterone antagonists. All patients were included in the study. The duration of the positive underwent standard clinical, laboratory and instrumental tests. The quality of life was assessed using the SF-36 questionnaire. Patients’ adherence to treatment was eval-uated using the Morisky-Green test. After therapy optimi-zation and a number of additional diagnostic procedures, true resistant arterial hypertension was detected in 19 pa-tients, of whom 9 were excluded from the study. 4 patients were excluded because of specific anatomy, and 5 patients were allergic to the contrast media. Results. Optimization of the diagnostic and medical algorithm for managing patients with arterial hy-pertension allowed identifying patients with secondary arterial hypertension, accounted to 8.8% of the study sample, as well as achieving significant reduction of blood pressure according to the 24-hour blood pressure monitoring findings: SBP by 34 ± 12 mm Hg, and DBP by 12 ± 4 mm Hg, compared to the initial values (p = 0.046). The obtained results are comparable in the groups with high and low adherence. 54 patients (77.1%) achieved blood pressure targets. The study groups demonstrated significant improvements of the quality of life and adherence to treatment. The proportion of patients with true resistant arterial hypertension has been identified. Conclusion. The presented algorithm of selecting patients for renal denervation allows to optimize the management strategy inpatients, who are suspected to suffer from resistant arterial hypertension, and to per-form targeted interventions.

Analysis of information received during treatment and adherence to tamoxifen in breast cancer patients.

This study examines whether women with breast cancer, who are adherent and non-adherent to tamoxifen, differ in their perceptions of information received during treatment. This cross-sectional study included women receiving tamoxifen as adjuvant treatment for breast cancer recruited from a teaching hospital specialised in women’s health in the state of São Paulo (Brazil). Women were interviewed and their records were reviewed for socio demographic data and clinical characteristics. We assessed tamoxifen adherence using the Morisky-Green Test, and the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire – Information module (EORTC QLQ-INFO25) was used to evaluate the information received by the women. The sample contained 31 women (mean age = 55.4; SD = 11.6 years). According to the Morisky-Green Test, 74.2% of the women had suboptimal tamoxifen adherence. The global score for women’s perceptions of information they received about the treatment and disease was 57.0 ±19.1 on a scale of 0 to 100, and no significant differences in scores were observed between adherents and non-adherents. A high prevalence of suboptimal tamoxifen adherence was observed. We found no significant differences between women with breast cancer who were adherent and non-adherent to tamoxifen.

Adherence to Therapy in the Outpatient Setting: the Ability to Identify and Assess the Effectiveness of Therapy

To assess adherence of patients to antihypertensive therapy, to determine the role of various factors affecting adherence to treatment by outpatients, and to assess clinical efficacy of a calcium antagonist felodipine. We examined 5 474 women and men aged >18 years who at visit to a local internist had office systolic arterial pressure (AP) 140-179 and diastolic AP up to 100 mm Hg both on and without hypotensive therapy. Examination included registration of risk factors and concomitant therapy. All patients self-assessed their state of heath using visual analog scale (VAS). Adherence to therapy was evaluated by the Morisky-Green test. Obtaining by a patient of antihypertensive drugs in the framework of the Programme for Supplementary Pharmaceutical Provision (SPP) was necessarily registered. Among examined ambulatory patients with arterial hypertension (AH) and ischemic heart disease (IHD) more than 60% had low adherence to prescribed medications. Such factors as complicated AH course when AH was combined with IHD or diabetes (D), use of angiotensin converting enzyme inhibitors, calcium antagonists, and angiotensin receptor blockers were associated with high adherence to treatment. Male sex, elderly age, presence of risk factors of cardiovascular complications, and long history of AH were associated with low adherence to therapy. Presence of prescribed drugs in the SSP list was associated with high adherence but multifactorial analysis with inclusion of IHD, D, availability of a tonometer at home made contribution of SSP in high adherence insignificant. The use of felodipine allowed not only to achieve pronounced hypotensive effect in patients with AH but also to improve initially low adherence. During long-term observation of outpatients, it is necessary to regularly assess possibly low adherence to therapy with the aim of its improvement.

ADESÃO À TERAPIA MEDICAMENTOSA E QUALIDADE DE VIDA DE USUÁRIOS DE UMA UNIDADE DE SAÚDE DA FAMÍLIA DE NOVO HAMBURGO - RS

Background: Medicines represent an important input for health care. The lack of adherence to drug therapy results not only in damages to the health and quality of life of the patient, but also it causes the waste of the resources of the health system. Objective: To evaluate the adherence to drug therapy and quality of life of patients at an USF in Novo Hamburgo, RS. Methods: A observational, quantitative, cross-sectional study was conducted with patients with chronic diseases who answered questionnaires regarding their sociodemographic profile, adherence to drug therapy (Morisky-Green and Brief Medication Questionnaire - BMQ) and quality of life (Whoqol-bref). The data were analyzed by the SPSS® 24.0 program, using Student’s t-test for comparison between groups and Pearson’s correlation for the relationship between variables, using a p < 0.05. Results: A total of 80 patients, aged 59 (± 12) years and a higher female prevalence were evaluated. The Morisky-Green scale revealed maximum compliance in 52.5 % of the patients. At BMQ, 70 % of the patients had a low adherence score. Negative correlations were observed between age and BMQ belief domainand positive between age and recall domain. Conclusions: There was no agreement between the Morisky-Green and BMQ tests, due to the fact of measuring different dimensions and establishing different cut-off points for non-adherence, as well as limitations of the methods themselves.

Factors for nonadherence to antihypertensive drugs among Federal Civil Servants attending health facilities − Abuja, FCT

Introduction: Hypertension affects approximately one billion people worldwide. Three hundred and forty million of these in economically developed and 340 million in economically-developing countries. The World Heart Federation reports that in the developed world, about 330 million people have hypertension, and about 640 million in the developing world. Estimates indicate that up to three quarters of the world’s hypertensive population will be in economically developing countries by the year 2025. Non-adherence to antihypertensive drugs is one of the most important causes of uncontrolled blood pressure. Materials and Methods: Between August 2013 and June 2014, we enrolled 424 hypertensive patients in a cross-sectional study using systematic sampling technique. The Morisky Green test for non-adherence was used to assess non-adherence to drugs. Information was collected regarding socio-demographic, drug related and healthcare service delivery factors to patient non-adherence using an interviewer administered questionnaire. Univariate, bivariate and multivariate analysis was conducted using Epi info software. Results: The level of non-adherence was 69.1%. Factors that were independently associated with non-adherence were; being a Junior Civil Servant (OR 2.9: 95%CI 1.1–7.7), exhaustion of drugs before the next clinic appointment (OR 5.9: 95%CI 2.8–12.5), buying drugs in private pharmacies and open market (OR 1.9: 95%CI 1.03–3.3) and total time spent counselling of less than five minutes (OR 1.8: 95%CI 1.02–3.2). Conclusion: The level of non-adherence in this study was found to be high. Creating special support groups for Junior Civil Servants, ensuring patients come back to the hospital to refill their drugs, improving counselling techniques and making prescribed antihypertensive drugs constantly available in the hospital, could improve the level of non-adherence to antihypertensive drugs among patients attending Federal Staff Hospitals and Clinics.

PATIENTS WITH COMBINATION OF CHRONIC HEART FAILURE, HYPERTENSION AND HISTORY OF MYOCARDIAL INFARCTION: CLINICAL AND ANAMNESTIC CHARACTERISTICS, ADMINISTRATION OF ACE INHIBITORS, ANGIOTENSIN RECEPTOR BLOCKERS, -BLOCKERS AND ADHERENCE TO THE DRUG THERAPY (DATA OF OUTPATIENT REGISTRY RECVASA)

Aim. To assess the clinical and anamnestic characteristics, the prescription rate of angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) and β-blockers in the outpatient practice, adherence to drug therapy in patients with a combination of chronic heart failure (CHF), hypertension (HT) and history of myocardial infarction (MI) in the frame of Cardiovascular Disease Registry (RECVASA). Material and methods. Data analysis in groups of patients with a combination of CHF, HT and the history of MI (n=406) and patients with a combination of CHF, HT and ischemic heart disease (IHD) without history of MI (n=1897) was performed in the frame of RECVASA registry. The structure of the associated cardiovascular and concomitant non-cardiac diseases, the severity of the clinical manifestations of CHF, IHD and HT, the prescription rate of the ACEI/ARB and β-blockers, the adherence to drug therapy (according to the Morisky-Green test) were studied in groups. Results. Patients with a combination of CHF, HT and IHD with or without MI history significantly differed in the proportion of men (47.8% vs 24.9%, respectively), prevalence of atrial fibrillation (25.9% vs 20.5%, respectively), diabetes mellitus (27.3% vs 15.7%, respectively) and the stroke history (17.2% vs 10.7%, respectively). The mean age (69.9±11.0 vs 70.3±11.0 years, respectively), as well as the prevalence of the history of respiratory diseases, chronic kidney disease, digestive diseases, obesity and anemia, did not differ significantly. Patients with a combination of CHF, HT and post-infarction cardiosclerosis (PICS) compared with patients without PICS significantly more often had CHF class 3-4 NYHA (62% vs 47.9%, respectively), HT of degree 3 (92.5% vs 84.2%, respectively), stable angina class 3-4 (84.4% vs 66.4%, respectively). Patients with PICS significantly (p<0.05) more often received β-blockers (56.7% vs 42.2%, respectively), a combination of ACEI/ARB plus β-blockers (44.6% vs 35.1%, respectively), but less often – monotherapy with ACEI/ARB (73.7% vs 77.6%, respectively). The proportion of patients with adherence to treatment (4 points on the Morisky-Green scale) was greater in patients with PICS (37.2% vs 30.6%, respectively; p<0.05). Conclusion. Patients with CHF in combination with HT and PICS compared with patients without PICS had more prevalence of atrial fibrillation, diabetes mellitus and stroke history, more severe course of CHF, HT and IHD, greater prescription rate of β-blockers, combinations of ACEI/ARB plus β-blockers, but less prescription rate only ACEI/ARB, higher adherence to treatment. The prescription rate of prognostically significant ACEI/ARB and β-blockers in these patients is inadequate, and only one third of patients are adherent to treatment.

Влияние повышения комплаентности на показатели суточного мониторирования артериального давления больных гипертонической болезнью, находящихся в условиях гуманитарной блокады Донбасса

The article presents the dynamics of daily monitoring of blood pressure in hypertensive patients of retirement age in situations of humanitarian blockade of Donbass. The impact of increase in patients’ compliance on circadian blood pressure was estimated. The study involved 40 participants from 114, who had declared their readiness to cooperate in the program of enhancing the pharmacotherapeutic effectiveness in hypertensive disease by improving adherence to treatment. The dynamics of changing the compliance according to Morisky-Green test was estimated, the impact of measures aimed at improving both the adherence of patients and circadian blood pressure profile in the course of the eight-week watching.

Comparison of medication adherence in diabetes mellitus patients on human versus analogue insulins

ABSTRACTObjetive: This study evaluated the results of treatment adherence scales in two cohorts of patients with diabetes mellitus treated either with human or analogue insulins.Methods: A cohort study was conducted in diabetes mellitus patients older than 18 that were being treated with human or analogue insulins. Two instruments were applied to each patient [medication possession ratio, Morisky-Green test] to evaluate treatment adherence.Results: A total of 238 patients, were included. The majority (69.4%) of the subjects had human insulin and 30.6% had insulin analogue prescriptions. Out of the total, 163 (68.5%) cases were classified as adherent to therapy, according to the type of insulin, as follows: 69.9% for conventional and 65.3% for analogues; without differences between the groups (CI95%:0.450–1.458). The adherence to treatment was more probable in patients with elementary-secondary education (OR:2.341; CI95%:1.199–4.568) and less probable for those in the age range of 31–45 years (OR:0.427; CI95%:0.187–0.971).Conclusions: The results of this study show that there are no significant statistical differences in adherence when comparing human with analogue insulin therapy. Strategies to improve treatment adherence are particularly important since they improve the clinical results.

Impacto de la adherencia a las recomendaciones de hábitos de vida cardiosaludables en la capacidad funcional a largo plazo en pacientes que han completado un programa de rehabilitación cardíaca

ObjectiveTo evaluate long-term adherence to healthy heart lifestyle habits in ischemic patients completing a cardiac rehabilitation/secondary prevention (CR/SP) programme and its impact on functional capacity DesignAnalytic historical cohort study of ischemic patients at moderate-risk who completed a CR/SP programme in a Cardiac Rehabilitation Unit from 2006-2007. Material and methodThe study variables were collected in 3periods: Before and after the programme and 6 years later. Measurement instruments included Trichopoulou's Mediterranean diet questionnaire, the Morisky Green test, the International Physical Activity Questionnaire and a stress test. Patients following 4 healthy heart recommendations were considered to be adherent. Statistical significance was set at P<.05. ResultsA total of 41 patients were evaluated at 6 years; 38 were men and the mean age was 56 years. Thirteen patients (32%) were considered adherent to healthy heart recommendations at 6 years. At the end of the programme and at 6 years, functional capacity was 10.4 and 8.3, respectively, in adherent patients and 9.8 and 8.9 in non-adherent patients. Loss of functional capacity in non-adherent patients was 20% compared with only 6% in adherent patients (P=.02). ConclusionAdherence to healthy heart recommendations made in a CP/SP programme was low (32%). Patients who adhered to all the recommendations lost only 6% of their functional capacity at 6 years compared with 20% of functional capacity in non-adherent patients.