Morisky Medication Adherence Scale Research Articles

Transitioning from pediatric to adult-oriented healthcare in rheumatology: the pediatric side of the coin.

The transition of adolescents and young adults (AYAs) from pediatric to adult-oriented healthcare may be affected by many factors, including the personal and cultural settings. We aimed to analyze the transition readiness and the factors affecting the transition success in rheumatology. Patients older than 12 years were included in this prospective study. All filled out the Transition Readiness Assessment Questionnaire (TRAQ) 5.0. AYAs were phone-interviewed after their transfer to adult-oriented healthcare. Drug adherence was evaluated with 4-item Morisky Medication Adherence Scale (MMAS-4). AYAs rated their transitional care experience with visual analogue scale (VAS 0-10; 0, the worst; 10, the best). A total of 504 TRAQs were filled out by 406 patients (F/M = 1.5). The total TRAQ score was positively correlated with age and higher in the forms filled out by girls than boys (4.2 vs 4.0, respectively; p= 0.005). The transition was successful for 78 (83.9%) out of 93 patients transferred to adult-oriented healthcare. The VAS for the transition process was lower and the post-transfer MMAS-4 score was worse (8 vs 9, p= 0.030 and 3 vs 4, p= 0.020; respectively) in patients whose transition was not successful when compared with the successfully-transitioned ones. The best-performing TRAQ cut-off value was >4.0 for predicting transfer readiness in rheumatology. A TRAQ score of > 4 could be used while deciding about the transfer readiness of AYAs in rheumatology. Improving the AYAs' experience of the transition process and closely monitoring medication adherence during transition are essential for a successful transition.

Abstract PO3-11-05: Sexual dysfunction among Brazilian women with early breast cancer on adjuvant endocrine therapy (ET)

Abstract Background: Sexual dysfunction is a common health problem in women, and it can occur during breast cancer treatment and survivorship. This study aims to determine the frequency of sexual disfunction among Brazilian women with early breast cancer on adjuvant endocrine therapy and to explore its relationships with patients’ clinical and social characteristics, adherence to ET, quality of life, return to work and healthcare insurance. Methodology: Women with history of early-stage ER+ invasive carcinoma of the breast on adjuvant endocrine therapy for at least 6 months were invited to participate of this study. Sexual dysfunction was evaluated using the Female Sexual Function Index questionnaire (FSFI). A score of < 26.55 in FSFI indicates sexual dysfunction. We evaluated sexually active patients (women should have at least one sexual intercourse in the previous four weeks). Demographic and medical information, site of treatment (private versus public), degree of education (completed high school vs not) were reviewed from medical records. Quality of life was assessed using EORTC QLQ C30 and BR-23 forms and adherence to ET was assessed by the Morisky Medication Adherence Scale (MMAS-8). Additionally, patients were interviewed about return to work. Data collection was performed using RedCap software and statistical analyzes were performed on the software R (R Core Team (2022). Qualitative variables were compared between groups using the Chi-square or exact Chi-square test and for quantitative variables the non-parametric Mann-Whitney test was used. Multivariable analysis was performed using Poisson regression. P < 0.05 was considered significant. Analyzes were performed in SAS 9.4. Results: From June 2021 to May 2023, a total of 461 women with ER+ early-stage breast cancer from 12 Brazilian institutions were included in this analysis. The mean age was 56.0 years (range 22-93 ), 47.7% were non-white and 38.7% were premenopausal. A total of 233 women (50.6%) had private insurance and the remaining were treated in public institutions. Median duration of ET use was 2.78 years (range 6 months- 9.61 years).Only 249 (54%) out of 461 patients who accepted to participate in this study declared to have sexual intercourse in the previous 4 weeks before evaluation and composes the population of this analysis. Sexual disfunction according results of FSFI questionnaire was found in 113 (53.3%) participants. Age was significantly associated with sexual dysfunction with women > 40 years-old having higher rates (95.3%) compared with versus younger patients (4.71% p=0.0069). Patients without sexual dysfunction had significantly higher EORTC QLQ C30 Global health status, Physical Functioning, Emotional Functioning, Sexual Functioning and Sexual Enjoyment scores than those with sexual dysfunction (p = 0.0060, p = 0.0242, p = 0 .0353, p = 0.0002 and p < 0.0001 respectively). ET duration between 2 and 5 years vs < 2 years, higher vs lower education level, EORTC QLQ-BR23 breast symptom and sexual functioning higher scores were significantly associated with the occurrence of sexual dysfunction in multivariated analysis (p < 0.05). Conclusion: In our study, only 54% of women evaluated had sexual intercourse in the previous four weeks and from those women 53.3% reported sexual dysfunction. Factors related to sexual dysfunction were higher education level, ET duration between 2 and 5 years, breast symptom and sexual functioning higher scores. div style=margin-top:10px; margin-bottom:20px;>Characteristic with adjusted prevalence ratios for the occurrence of sexual disfunction XX XX PR: prevalence ratio, EORTC: European Organisation for Research and Treatment of Cancer Citation Format: Daniele Assad-Suzuki, Fernanda Moura, Danielle Santos, Sulene Oliveira, Cristiano Souza, Heloísa Resende, Andrea Shimada, Anna Luiza Galvão, Bruno Souza, Amanda Castro, Monalisa Andrade, Yuri Beckedorff, Maria Cristina Magalhães, Carlos Paiva, Angelica Rodrigues, Daniela Pereira, Daniela Rosa, Romualdo Barroso-Sousa. Sexual dysfunction among Brazilian women with early breast cancer on adjuvant endocrine therapy (ET) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-11-05.

Abstract PO3-19-12: Evaluating the impact of ePRO-based follow-up system (Pink Ribbon Diary) on quality of life and treatment adherence in patients with breast cancer receiving CDK4/6 inhibitors: a single center, randomized controlled study (JPRO-B)

Abstract Background: Treatment-related toxicities (TRT) may decrease patient’s quality of life (QOL) and may result in a decrease of adherence to the therapy. Cyclin-dependent kinase 4/6 inhibitors (CDK4/6is), such as palbociclib (PAL) and abemaciclib (ABM) improved patients’ outcomes with estrogen receptor-positive (ER+) HER2 negative (HER2-) advanced breast cancer (ABC), however, majority of patients who undergo CDK4/6i therapy experience ≥ Grade 2 TRTs, such as hematological abnormalities, gastrointestinal disorders or general fatigue. While prompt management of those TRTs is mandatory to prevent patients from discontinuing the therapy, real-time monitoring of TRTs has been warranted. Recently, efforts have been made to monitor symptoms using electronic patient-reported outcome (ePRO) to detect side effects as early as possible and to provide timely support. However, the efficacy of ePRO in daily clinical practice for those receiving CDK4/6is is still unclear. In addition, the researches in the field of ePRO to date have only focused on drugs administered intravenously in hospitals, where patients’ adherence has no clinical importance. Study design and eligibility criteria: This randomized, open-label, controlled phase 2 trial is designed to assess the efficacy of a new proprietary ePRO system, the Pink Ribbon Diary (PRD), compared with placebo (usual care without the ePRO system) in breast cancer patients with ER+HER2-ABC receiving oral CDK4/6i-based therapy aged ≥ 20 years. All eligible patients who complete training on how to use ePRO system are randomly allocated to either arm A using ePRO system or arm B receiving usual care (1:1). Participants in the arm A are required to record medication taken and physical condition every day for 3 months, and report adverse events using PRO-CTCAETM once a week. Patients in the arm B are also asked to answer to questions concerning adverse events using PRO-CTCAETM at monthly hospital visit for 3 months. All participants are asked to respond to the EORTC QLQ-C30 at their monthly visit and a questionnaire survey on adherence before the study and after completion of the study. Participants in the arm A and healthcare providers, will answer the questionnaire about the feeling of using the PRD. Primary endpoint is the change in global health status/QOL (EORTC QLQ-C30) at 3 months from baseline. Secondary endpoints are RDI (relative dose intensity), other domains of EORTC QLQ-C30, number of days missed medication, PDC (proportion of days covered), survey of medication compliance awareness using MMAS-8 (Morisky Medication Adherence Scale), questionnaire on use of PRD, and comparison between two groups of occurrence of adverse events and incidence of missed medication. Study objective: To assess the clinical efficacy of PRD in patients with ER+HER2-ABC undergoing CDK4/6i-based therapy. Statistical methods: For analysis of QOL, the primary endpoint, the differences in global health status/QOL (EORTC QLQ-C30) before and after the study will be compared between the two groups using the t-test. Present accrual and target accrual: The study was approved by institutional review board in December 2022, and is open for enrollment. The target sample size is 70. The study is on-going and 22 patients have been accrued to date. Trial registration numbers: Japan Registry of Clinical Trials (jRCT) jRCT1030220626 (https://jrct.niph.go.jp/re/reports/detail/30182). Citation Format: Rie Ozeki, Hideo Shimizu, Kotaro Iijima, Misato Okazaki, Junichiro Watanabe, Mitsue Saito. Evaluating the impact of ePRO-based follow-up system (Pink Ribbon Diary) on quality of life and treatment adherence in patients with breast cancer receiving CDK4/6 inhibitors: a single center, randomized controlled study (JPRO-B) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-19-12.

Abstract PO2-12-04: Suboptimal adherence to adjuvant endocrine therapy (ET) in Brazilian women with early-stage estrogen receptor-positive (ER+) breast cancer

Abstract Background: Adjuvant ET reduces breast cancer recurrence and increases overall survival among patients with early-stage ER+ breast cancer, however a suboptimal number of patients in fact takes oral medicine as prescribed. In Brazil, there is a paucity of data about adherence to adjuvant ET. This study aims to evaluate adherence to adjuvant ET in Brazilian women with early breast cancer and to evaluate clinical and sociodemographic characteristics associated with higher or lower adherence. Methods: Women with history of early-stage ER+ invasive carcinoma of the breast on adjuvant ET for at least 6 months were invited to participate of this study. Adherence was assessed with questionnaire Morisky Medication Adherence Scale (MMAS-8) and high adherence was defined by a MMAS-8 score=8. Demographic and medical information, site of treatment (private versus public), degree of education (completed high school vs not) were reviewed from medical records. Quality of life was assessed using EORTC QLQ C30 and BR-23 forms, sexuality was evaluated with the Female Sex Function Index questionnaire. Additionally, patients were interviewed about return to work. Data collection was done with RedCap software. Qualitative variables were compared between groups using the Chi-square or exact Chi-square test and for quantitative variables the non-parametric Mann-Whitney test was used. Multivariable analysis was performed using Poisson regression. P < 0.05 was considered significant. Analyzes were performed in SAS 9.4. Results: From June 2021 to May 2023, a total of 461 women with ER+ early-stage breast cancer from 12 Brazilian institutions were included in this analysis. The mean age was 56.0 years (range 22-93), 47.7% were non-white and 38.7% were premenopausal. A total of 233 women (50.6%) had private insurance and the remaining were treated in public institutions. Median duration of ET use was 2.78 years (range 6 months- 9.61 years). High adherence to adjuvant endocrine therapy was present in 55.7% of patients. Median age of high adherent woman was higher than low adherent (p=0.005). Factors significantly associated with high adherence were no use of ovarian suppression (p=0.0095), use of anti-Her2 therapy (p=0.0462). Furthermore, higher scores for EORTC QLQ-C30 global health status (p=0.017) and in specific domains, including role functioning (p=0.007), emotional functioning (p< 0.0001), cognitive functioning (p< 0.001), social functioning (p = 0,0005), higher scores for EORTC BR23 body image (p< 0.001) and future perspective (p = 0.0198) were also associated with high adherence. Higher EORTC QLQ-C30 cognitive function score was the only variable associated with high adherence (p < 0.0001) to ET in multivariate model. Conclusion: Using the MMAS-8, only 55.7% of Brazilian women with stage I-III ER+ breast cancer reported high adherence to endocrine therapy. This suboptimal adherence rate leads to important questions such as the impact on the prognosis of this population Charactheristic with adjusted prevalence ratio for the occurrence of High adherence PR: Prevalence ratio; EORTC: European Organisation for Research and Treatment of Cancer Citation Format: Daniele Assad-Suzuki, Heloísa Resende, Danielle Santos, Fernanda Moura, Sulene Oliveira, Andrea Shimada, Anna Luiza Galvão, Bruno Souza, Amanda Castro, Monalisa Andrade, Yuri Beckedorff, Maria Cristina Magalhães, Cristiano Souza, Carlos Paiva, Daniela Pereira, Angelica Rodrigues, Daniela Rosa, Romualdo Barroso-Sousa. Suboptimal adherence to adjuvant endocrine therapy (ET) in Brazilian women with early-stage estrogen receptor-positive (ER+) breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-12-04.

Comprehensive Medication Management (CMM): Application of a new pharmaceutical practice in Onco-Hematology

The integration of a large number of drugs, such as antineoplastic agents and cancer-related supportive care drugs, into the management of cancer patients exposes them to an increased number of drug-related problems (DRP). Clinical pharmacists contribute to drug management by actively intervening in detected DRP.The aim of this study is to assess the impact of the applying a clinical pharmacist-driven Comprehensive Medication Management (CMM) service to Onco-hematology patients.This prospective interventional study was carried out over six-month duration, specifically from November 06, 2022 to April 5, 2023 in the oncology and hematology departments of the EHU Oran. The adherence to treatment was evaluated using the 8-item Morisky Medication Adherence Scale (MMAS). Whereas Data related to the patient's general condition and medication history was assessed using the Pharmaceutical Care Network Europe (PCNE) Classification for Drug-Related Problems V9.1.Among the 130 patients included in the study, a total of 879 DRP were identified, with a mean of 6.78 (±1.72) DRP/patient, half of which were related to efficacy (51%). Almost half of our sample (44.6%) did not adhere to their treatment. The most frequent cause of DRP, accounting for (19.9%) of the cases, was the inappropriate administration by a health professional. A total of 875 pharmaceuticals interventions (PI) were proposed, 67.2% of which were focused at the drug level. The PI acceptance rate was 94.1%.The integration of CMM services in Onco-Hematology played an important role in optimizing dosing regimen and treatment administration methods, as well as preventing iatropathology in the management of cancer patients.

Assessment of the Severity of Depression Symptoms, Knowledge, and Medication Adherence in Patients with Major Depressive Disorder in Sulaimaniyah, Iraq

Background: Patients' knowledge and medication adherence are crucial in managing major depressive disorders (MDD). Understanding treatment options empowers patients to make informed decisions, while adherence ensures consistent therapy efficacy. Objectives: To assess the severity of depressive symptoms, as well as patients' knowledge regarding their disease and their medication adherence, within the population diagnosed with MDD. Subjects and Methods: A cross-sectional study was conducted at the Ali-Kamal Psychiatric Clinic in Sulaimaniyah City, Iraq, on 102 individuals diagnosed with MDD. Data collection utilized questionnaires covering participant characteristics, depression assessment tools such as Beck's Depression Inventory, Patient Health Questionnaires, and Quick Inventory of Depressive Symptomatology, questions concerning participants' knowledge regarding depression, and medication adherence utilizing Morisky's Medication Adherence Scale-8. Results: The level of depression severity was mild to moderate for 42%, and it was severe for 34.3% of patients. The severity of depression symptoms was moderately severe in most patients (52.9%), followed by moderate (26.5%) and then severe (12.7%). The change in weight and appetite was most common (2.11 ± 0.84), while suicide ideation was the least common (1.15 ± 0.65). The knowledge of 65.7% was poor, and 87.3% was poorly adhered to medication. Conclusions: Nearly one-third of participants exhibited severe depression, while the majority experienced moderately severe symptoms. Additionally, many had insufficient knowledge and demonstrated low medication adherence.

The Effect of Self-Stigma on Self-Esteem and Treatment Compliance in Individuals with Type-2 Diabetes: An Example in the Southeast of Türkiye

Introduction: The aim of the study is to examine the effect of self-stigma on self-esteem and treatment compliance in individuals with Type-2 diabetes. Methods: This descriptive and correlational study was conducted with type 2 diabetes patients who applied to a hospital in southeast Turkey. The study was carried out between June and December 2022. The sample of the study consists of 172 patients who agreed to participate in the study. Participant Introductory Questionnaire, Self Stigma, Rosenberg Self-Esteem, and Morisky Medication Adherence Scale forms were used to collect data. Results: In the study, the mean scores of patients’ self-stigma, self-esteem, and treatment adherence were 51.16±15.41, 17.84±3.31, and 5.66±2.25, respectively. The results also indicated that there was a significant negative correlation between the mean scores of individuals’ self-stigma, self-esteem, and adherence to treatment (p

The Role of Pharmacist Intervention in Improvement of Patient Adherhence to Medication and in preventing Complication After Bariatric Surgery

Background: Bariatric surgery is the most successful treatment for obesity regarding the degree and duration of weight loss. Aim of the Study: Evaluate the impact of pharmacist educational intervention and training in improving patient adherence and its association with the prevention of clinical nutritional complications after bariatric surgery. Patient and Method: A randomized comparative interventional study was conducted in Najaf Governorate, Iraq. The Intervention group included 58 patients who received standard care and training educational and support programs. The standard care group included 58 patients who received standard care after Bariatric surgery. Results: In the intervention group, at 3 months of follow-up, the mean total score was 5.8 and increased to 6.7 at the 6 months. Conversely, the score decreased in the standard care group from 5.3 at 3 months to 2.2 at 6 months. In contrast to the standard care group, an inverse significant correlation was found between the number of incident complications and the total eight-item Morisky Medication Adherence Scale (MMAS-8) at 3 and 6 months in the intervention group. Conclusion: The pharmacist intervention leads to better patient adherence to guidelines after Bariatric surgery which results in decreased complications at three and six months after surgery.

Social support and medication adherence among adult myasthenia gravis patients in China: the mediating role of mental health and self-efficacy

BackgroundMyasthenia gravis (MG), a rare chronic neuromuscular disorder, is characterized by progressive physical decline and requires long-term pharmacological treatment. Due to the decline of physical and social abilities, MG patients are in great need of social support, including tangible and emotional support. This study aims to examine the association between social support and medication adherence and the possible mediating effects of mental health and self-efficacy among MG patients.MethodsA cross-sectional analysis of a nationwide MG registry was conducted on 865 patients under oral medication treatment in China between June and July 2022. Validated scales were used to measure the respondent’s mental distress (Four-item Patient Health Questionnaire), social support (Modified Medical Outcomes Study Social Support Scale), self-efficacy for medication use (Self-efficacy for Appropriate Medication Use Scale), and medication adherence (Morisky Medication Adherence Scale, MMAS).ResultsThe association between social support and medication adherence and possible mediating effects of mental distress and self-efficacy were tested by structural equation model, with significant demographic and disease-related factors adjusted. The respondents showed a very low level of medication adherence (71.2% poor adherence; 1.4% high adherence; mean MMAS = 4.65). The level of social support was positively associated with medication adherence, and such association was fully mediated by two indirect pathways: through self-efficacy (β = 0.07, proportion mediated = 63.8%); and through mental distress and then self-efficacy (β = 0.01, proportion mediated = 6.7%).ConclusionProvision of social support and interventions on mental health with emphasis on improving self-efficacy for medication use may effectively improve medication adherence among MG patients.

Preschool children's asthma medication: parental knowledge, attitudes, practices, and adherence.

Introduction: As parents or legal guardians primarily care for children with asthma, understanding their knowledge, attitudes, and practices (KAP) barriers to treatment and medication adherence is of essential importance. This study aimed to analyze the KAP toward asthma medication and adherence among preschool-aged asthmatic children's parents and explore the factors influencing adherence. Methods: This cross-sectional study was conducted between February 2023 and April 2023. Parents of preschool children with asthma were asked to complete the questionnaire containing knowledge, attitude, practice dimensions, and demographic characteristics. The Morisky Medication Adherence Scale (MMAS) was used to investigate adherence. Results: A total of 632 valid questionnaires (154 male and 478 female) were included. Parents showed moderate knowledge (9.49 ± 2.86, 63.27%, possible range: 0-15) and moderate attitudes (26.18 ± 2.51, 74.80%, possible range: 7-35) towards asthma medication, while their practices (27.46 ± 5.26, 91.53%, possible range: 6-30) were proactive; however, medication adherence was low (4.84 ± 1.78, total score: 8). The attitude scores (OR = 1.10, 95% CI: 1.01-1.19, P=0.020), practice scores (OR = 1.16, 95%CI: 1.12-1.21, p < 0.001), and smoking (OR = 1.64, 95%CI: 1.14-2.37, p = 0.008) were associated with medication adherence. Discussion: Preschool-aged asthmatic children's parents showed moderate knowledge, attitudes, and proactive practice toward asthma medication. Continuous training and education programs should be provided for parents to improve asthma medication management in preschool children.

Latent Profile Analysis of Medication Beliefs in Patients with Type 2 Diabetes in the Hospital-Home Transition and Comparison with Medication Adherence.

The treatment of Type 2 Diabetes Mellitus (T2DM) is a protracted and arduous process. Medication, being a universally crucial therapeutic measure, underscores the significance of medication adherence in managing the disease effectively. Medication beliefs have emerged as a significant predictor of adherence, attracting considerable scholarly attention in recent years. However, there remains a paucity of research utilizing individual-centered approaches to explore medication beliefs among the T2DM population during the hospital-home transition, leaving the relationship between these beliefs and medication adherence unclear. To investigate latent categories of medication beliefs among patients with T2DM during the transition from hospital to home, and to analyze variations in medication adherence across these categories of patients. Between August 2022 and September 2023, this study selected 304 patients with a pre-discharge diagnosis of T2DM as study subjects from a tertiary hospital in Dongguan City. The patients' profiles were assessed comprehensively via the Sociodemographic and Clinical Characteristics Questionnaire, alongside the Chinese version of Beliefs about Medicines Questionnaire-Specific and Morisky Medication Adherence Scale-8. The present study conducted latent profile analysis using Mplus 7.4 software and analyzed the influencing factors of different medication belief categories and their differences in medication adherence using SPSS 26.0 software. The medication beliefs of 304 patients were rated at 3.36±5.24 points, while medication adherence scored 6.23±1.56 points. The medication beliefs were classified into four categories: moderate necessity - low to moderate concern group (40.13%), high necessity - low concern group (9.54%), moderate necessity - moderate to high concern group (19.08%), and moderate necessity - high concern group (31.25%). Age, monthly per capita household income, and place of residence emerged as influential factors for the four categories. Moreover, the disparity in medication adherence among these categories demonstrated statistical significance (P < 0.001). The medication beliefs of patients were classified into four distinct categories, and variations in medication adherence were evident across these categories. The high necessity - low concern group demonstrated the highest medication adherence scores, while the moderate necessity - high concern group exhibited the lowest scores. Healthcare providers are advised to tailor personalized medication belief enhancement programs based on patients' homogeneous beliefs, addressing specific issues encountered by each category. This approach aims to ensure optimal medication adherence across diverse medical and social environments, effectively improving patient prognosis and enhancing quality of life.

IJCM_183A: Assessment of treatment adherence among type 2 diabetic patients attending a tertiary care hospital in Madurai district, Tamil Nadu – A cross-sectional study

Background: Type 2 Diabetes Mellitus (DM) is a major public health problem in India affecting around 77 million people above the age of 18 years. Poor adherence to medication regimen increases the probability of micro and macrovascular complications among them thereby increasing the mortality and morbidity. Therefore, assessing adherence is the need of the hour to tide over this crisis and hence present study was conducted Objectives: : 1. To assess the prevalence of treatment adherence among Type 2 DM patients &gt;18years attending tertiary care hospital, Madurai 2. To identify the factors associated with treatment adherence among the study population Methodology: A cross-sectional study was conducted among 208 adult Type 2 DM patients with minimum duration of 6 months attending tertiary care hospital in Madurai during October 2023 by consecutive sampling. Sample size was calculated based on a study in Delhi in 2019. After obtaining informed consent, patients were interviewed using semi-structured questionnaire containing sociodemographic details and Morisky Medication Adherence Scale (MMAS-8), a standard, validated questionnaire to assess treatment adherence. Data was analysed using SPSS version 25.0. Results: The mean age of the participants was 53±10.92 years and majority of them were males (54.8%). 50.5% received primary education and 38.9% belonged to class III Socio-Economic Status (SES). More than half (66.8%) had duration of diabetes between 6months to 3.5 years. 58.2% had good adherence while 29.8% and 12% had moderate and poor adherence respectively. Statistically significant association was not found between adherence and age, gender, SES and duration of diabetes except for the level of education (p value: 0.002). Factors associated with poor adherence were forgetfulness (92%) and being busy (64%). Conclusion: Sustained IEC activities are needed at all levels of health care to further improve the treatment adherence and also addressing the reasons for non-adherence

IJCM_16A: Calcium supplementation in pregnancy: adherence, determinants and barriers

Background: Calcium intake of 1gram/day in pregnancy reduces the risk of pre-ecclampsia and preterm birth. Universal free calcium supplementation program was started throughout India at considerable cost to the government. Although coverage is high, this program is only effective if there is good adherence among mothers, and this is unknown. Objectives: 1. To estimate the prevalence of adherence to calcium tablets among mothers attending antenatal clinic at Kundrathur PHC. 2. To identify the determinants and barriers to Calcium tablet adherence. Methodology: A cross sectional mixed methods study was conducted among mothers attending antenatal clinic at Kundrathur PHC during November 2023. Mothers with &gt;20 weeks gestation were recruited consecutively. They were interviewed using the Morisky Medication Adherence Scale (MMAS-8). Barriers to adherence was elicited by freelisting and analysed with Visual Anthropac. Results: 89 mothers completed the study. The participants had a mean age of 25.29+4.275 years. Majority of mothers were literate, and primi gravida (57.3%). Mean MMAS score was 4.98+1.79(95% CI 4.61, 5.36) out of maximum possible 8. Adherence was low among 69.7%, medium in 23.6% and high in only 6.7%. Only 3.4% mothers were aware of the role of calcium in hypertension. There was a significant association between adherence and level of education (X2 37.422, df 8, p&lt;0.001) and having a support person (OR 11.5 95%CI 2.568, 51.502). Major barriers identified were forgetfulness (S 0.462), big tablets (S 0.205), difficulty in swallowing (S 0.130), timing (S.077), and vomiting (S 0.077). Conclusion: Adherence to Calcium supplementation is low among mothers. Educating mothers regarding importance and role of calcium may ensure better results of the program. Forgetfulness is the major barrier, and having a designated support partner in pregnancy, who helps in reminding and giving supplements, can help improve the adherence.

IJCM_195A: Prevalence of Drug Adherence Among Hypertensive Patients attending Primary Health Centre - A Cross sectional Study

Background: There is an increase in prevalence of hypertension 31.5% in urban and 26.2% in rural dwellers of Tamil Nadu (ICMR-INDIAB study). Adherence to hypertension medication is very important for improving the quality of life and preventing complications. In this study we aim to estimate the drug adherence among hypertensive patients using Morisky Medication Adherence Scale. Objectives: To estimate the prevalence of drug adherence and its influencing factors among hypertensive patients in Rural Health Training Centre areas of Madras Medical College. Methodology: 180 Hypertensive patients attending Non-Communicable Disease clinic from two rural health centres 90 patients from each Padiyanallur PHC and Medavakkam PHC were recruited for the study. In this study we have used The Morisky Scale MMAS-4 to address medication adherence. Results: Study results showed that 32.62% of hypertensive patients had high adherence to antihypertensive medications,53.48% patients had medium adherence whereas 13.9% patients had low adherence. Adherence to drug is higher among females (36.9%) than males (29.1%). Patients with low to medium adherence to antihypertensive drugs are having more than 10% risk of developing cardiovascular disease (OR – 3.6, 95% CI – 1.86 to 6.75) than their counterpart. Patients with good knowledge (42%) had high adherence than people with poor knowledge (24.2%) Conclusion: The study reported only 32.62% were found to be adherent to antihypertensive medications. To ensure high level of control among hypertensive sustained and focussed interventions should be implemented at all levels of health care.

Telepharmacy intervention: Can it impact medication adherence among patients with chronic disease?

Background: Medication adherence among patients with chronic diseases remains challenging for healthcare professionals. The large number and types of drugs that must be taken in the long term and the lack of knowledge related to drugs and diseases are factors that affect patient compliance. Telepharmacy is expected to improve patient medication adherence by providing easy access to consult with pharmacists. Objective: To assess the effect of telepharmacy on chronic patient medication adherence. Methods: This study had a cross-sectional study design, and the study population was Lifepack application users. The data was collected through an online questionnaire distributed through the Lifepack platform. The adherence was evaluated using the Morisky Medication Adherence Scale, and the association of telepharmacy and patient medication adherence was examined using the chi-square independence test with significance at p &lt; 0.05. Results: In a study comprising of 94 respondents, a proportional ratio of respondents who used and did not use telepharmacy services was observed (45.75% and  54.25%, respectively). Analysis using the chi-square statistic (χ²) demonstrated a significant association between telepharmacy and patient adherence (χ² = 64.745, df = 1, p &lt; 0.001). Furthermore, the odds ratio (OR) revealed a substantial difference in adherence, with an OR of 122.67 (95% CI [27.58, 545.66]). Conclusion: Telepharmacy has a significant impact on medication adherence in chronic patients.

IJCM_188A: Exploring Factors Influencing Medication Non-Adherence Among Urban Residents with Non-Communicable Diseases in Chengalpattu District: A Descriptive Cross-Sectional Study

Background: Medication non-adherence is a modifiable risk factor for non-communicable diseases (NCDs). WHO estimated the average rate of medication adherence to be around 50% in developed countries and to be lower in the developing countries. Objectives: To find the factors influencing medication non-adherence among patients diagnosed with NCDs in the urban areas. Methodology: A cross sectional study was conducted among 200 patients visiting Urban Health Training Centre, MAPIMS. A structured questionnaire was used to collect data on socio-demographic characteristics, risk factors, self-care practices, access to health care and family support to medication adherence. The outcome of the study was medication adherence measured using the eight-item Morisky medication adherence scale (MMAS-8). Results: Among the 200 participants with one or more non-communicable diseases (NCDs), the result found the prevalence of poor medication adherence rate to be 53.5%. Poor medication adherence was more prevalent in the older age group (39%, n=78), female patients (57.5%, n=115), with primary education (49.5%, n=99), unemployed individuals (58.5%, n=117), those without regular physical activities (63.5%, n=127) and classified as obese (43%, n=86). Conclusion: The study concluded that the prevalence of poor medication adherence was more common among NCD patients and the need to develop effective strategies to enhance medication adherence according to patient’s requirements through a holistic approach, by strengthening the primary health care system to achieve better health outcomes.

Assessment of Alternative Medicine Use, Costs, and Predictors of Medication Adherence among Diabetes Mellitus Patients in Palestine.

Diabetes Mellitus (DM) is considered the fourth leading cause of death in Palestine, with a prevalence of 9.1% in patients aged 20-79 years, and is predicted to increase to 20.6% by 2020. This study aims to estimate DM costs, compare DM total health care cost among patient characteristics and DM management (e.g. Anti-diabetic medications and alternative medicine), as well as assess MA and its predictors including patient characteristics, DM management, alternative medicine use, and DM costs. A cross-sectional study was conducted for the past one year among 479 diabetic patients, selected by convenience sampling and snowball sampling methods via electronic post of an online questionnaire including a web link to the questionnaire page in a Google Form via email or public social media pages and applications. Data on patients' socio-demographic and clinical characteristics, medication profile, use of medicinal plants as alternative medicine, costs, and Medication Adherence (MA) were collected. The Statistical Package for Social Sciences (SPSS v. 25) was used to perform a descriptive, Kolmogorov-Smirnov test, univariate analysis, Mann-Whitney or Kruskal-Wallis test, multiple linear regression, binary logistic regression, and multiple logistic regression analysis. A P value < 0.05 was considered statistically significant. More than half of the participants were male and living in villages (50.7%, 59.1%, respectively). Approximately 51.4% received Oral Hypoglycemic Drugs (OHDs) and only 16.1% received insulin. The participants receiving ≤3 medications daily acquired the highest percentage (55.7%), and less than half received medicinal plants as an alternative medicine for the management of DM. The estimated total DM health care cost per 1 year incurred by patients and family members was Israeli Shekel 988,276 (US Dollar 307,590). More than half of the participants were considered adherent with the Eight-Item Morisky Medication Adherence Scale (MMAS-8) score ≥6. It is noteworthy that the use of alternative medicine was significantly associated with total health care cost and MA. Furthermore, DM duration was significantly associated with MA. These are results worth taking into consideration. This study reflects the need for strengthening the patient-health care professionals' relationship, and to enhance the role of preventive education, and the importance of awareness about MA, DSCMBs, and the use of alternative medicine based on evidence-based strategies to improve MA, glycemic control, meanwhile reducing the costs incurred by patients and family members.

HUBUNGAN TINGKAT PENGETAHUAN DAN SIKAP PETUGAS KESEHATAN DENGAN KEPATUHAN TERAPI ANTIRETROVIRAL (ARV) PADA ORANG DENGAN HIV/ AIDS DI PUSKESMAS TIKALA KOTA MANADO

Background: Human Immunodeficiency Virus (HIV) is a virus that damages the body's immune system by infecting and destroying CD4 cells so that it requires adherence in undergoing ARV therapy to maintain the patient's immune system. Aims: This study aims to identify the relationship between level of knowledge and adherence to antiretroviral therapy (ARV) in people with HIV/AIDS (PWHA) at the Tikala Community Health Center, Manado City. Methods: The research method used was cross sectional with a sample of 87 respondents who were selected using a purposive sampling technique. The ARV therapy adherence questionnaire uses a standard questionnaire, namely Morisky Medication Adherence Scale-8 (MMAS-8). Results: The results of this study indicate that most HIV/AIDS patients undergoing ARV therapy have a good level of knowledge where the attitude given by health workers can affect the level of comfort, trust, and satisfaction of PWHA during the treatment process which makes PWHA have good adherence to therapy. Conclusion: Support for health workers in serving PWHA which is very influential in building good relations between health workers and PWHA, especially in increasing adherence to undergoing ARV therapy to slow disease progression and improve quality of life.

The relationship between medication adherence and complementary medicine use in epilepsy patients

ObjectiveThe aim of this research is to examine the usage of Complementary and Integrated Medicine (CIM) in individuals with epilepsy and the impact of CIM usage on medication adherence. Materials and methodsThis descriptive and cross-sectional study was conducted in a university hospital in northern Turkey between July and October 2023, involving 101 individuals with epilepsy (PWE). Descriptive information forms and the Morisky Medication Adherence Scale-4 (MMS-4) were used as data collection tools. Descriptive statistics, t-tests, ANOVA, and post-hoc LSD analyses were employed for data evaluation. ResultsThe participants consisted of 65.3 % males, 25.7 % were not working due to epilepsy, and 61.4 % with generalized epilepsy. The average MMS-4 score was found to be 3.08 ± 0.96. MMS-4 scores showed significant differences based on epilepsy type (F = 3.998, p = 0.021; η2 = 0.07). 76.2 % (n = 21) of the participants who used at least one CIM technique preferred “having a religious person read a prayer.” ConclusionMedication adherence in PWE was at a moderate level. Individuals with focal and secondary generalized epilepsy showed better medication adherence compared to those with generalized types. Of those participant who used at least one CIM technique to improve their general health or control seizures, the most common was “having a religious person read a prayer.”

REBISTART: Adherence of Patients with Multiple Sclerosis to Treatment with Subcutaneous Interferon Beta in the Context of a Patient Support Program.

Treatment adherence is a critical success factor in the disease-modifying therapy (DMT) of multiple sclerosis (MS). The REBISTART study prospectively evaluated adherence in patients using components of a patient support program (PSP). The 12-month non-interventional multicenter study examined the real-world adherence to subcutaneously (sc) injected interferon beta-1a (Rebif®). Patient-assessed adherence was measured by a visual analog scale (VAS) and the Morisky Medication Adherence Scale (MMAS). Objective adherence data were obtained by readouts from the RebiSmart® injection device. Of 333 patients, 70.9% used the nursing service as the core component of the PSP. Self-assessed VAS-based adherence was stable over time at 94.0-96.3%. Similarly, MMAS score (maximum 4) was 3.8-3.9 at all visits, also reflecting high self-assessed adherence. In 269 patients using the RebiSmart® injection device, mean readout-based objective adherence was similarly high (93.0-98.4% throughout visits). At last available visit, VAS-based adherence was independent of participation in the PSP nursing service (93.1% with participation versus 91.7% without it). Adherence was also independent of injection method or disease-related measures, including fatigue, depression, cognition, and quality of life. The most frequent reason for the premature discontinuations (38.7% of patients) was "change of treatment" (10.0%). We suggest that subgroups that may specifically benefit from PSP include patients who live alone, use multiple comedications, and are affected by cognitive impairment, depression, and/or fatigue. Further studies should investigate the potential usefulness of PSPs in these populations. Very high adherence rates independent of the PSP nursing service over 1year of treatment indicate that IFN beta-1a sc is an easy-to-use and well-tolerated disease-modifying drug. Vfa.de: No. 892. https://www.vfa.de/de/arzneimittel-forschung/datenbanken-zu-arzneimitteln/nisdb/nis-details/_892 .