Predictors Of Adherence In Patients Research Articles

Predictors of Adherence Among Patients With Multiple Sclerosis Using the BETACONNECT® Autoinjector: A Prospective Observational Cohort Study.

Background: In patients with multiple sclerosis (MS), non-adherence to disease-modifying drug therapy is associated with an increased rate of MS relapses. Early identification of patients at risk of non-adherence would allow provision of timely and individualized support. The aim of the BETAPREDICT study was to investigate potential predictors of adherence in patients with MS in Germany treated with interferon β-1b (IFNβ-1b) using the BETACONNECT® autoinjector.Methods: BETAPREDICT was a national, multi-center, prospective, non-interventional, single-arm, 24-month cohort study of patients with relapsing–remitting MS or clinically isolated syndrome receiving IFNβ-1b via the BETACONNECT® autoinjector (ClinicalTrials.gov: NCT02486640). Injection data were captured by the autoinjector. The primary objective was to determine baseline predictors of compliance, persistence, and adherence to IFNβ-1b treatment after 12- and 24 months using multivariable-adjusted regression. Secondary objectives included evaluation of satisfaction with the autoinjector, injection site pain, vitamin and nutrient supplementation, clinical course, and patient-related outcome measures.Results: Of 165 patients enrolled, 153 were available for analysis (120 with autoinjector data). Seventy-two patients left the study prematurely. Compliance (N = 120), persistence (N = 153), and adherence (N = 120) at 24 months were 89.1, 53.6, and 41.7%, respectively. Compliance at 12- and 24 months was predicted by intake of vitamin D supplements and absence of specific injection site reactions. Positive predictors of persistence included age (at 12- and 24 months) and previous duration of treatment (at 12 months), while intake of vitamins/nutrients other than vitamin D was a negative predictor (at 12 months). Positive predictors of adherence at 24 months were age and being experienced with IFNβ-1b. Higher scores in specific SF-36 subscales were positive predictors of medication-taking behavior at 24 months. Satisfaction with the autoinjector was high at baseline and 24 months (median score: 9 out of 10).Conclusions: Compliance with IFNβ-1b treatment among participants still under observation remained high over a 24-month period, while persistence and adherence continuously declined. Multiple factors affected medication-taking behavior, including patient characteristics, treatment history, injection site reactions, patients' perception of their health and support programs. The importance of these factors may differ among patients according to their individual situation.

The relationship between medication adherence and affective temperaments in patients with congestive heart failure

Introduction: Congestive heart failure (CHF) is a serious condition and lack of medication adherence is one of the most common problems in the treatment of patients with CHF. This study aimed to determine the relationship between medication adherence and affective temperaments in patients with CHF. Material and methods: This cross-sectional study was performed on 150 patients, who were referred to the cardiology clinic of Ali Ibn Abi Talib Hospital of Zahedan, Iran in 2017–2018. Morisky Medication Adherence Scale (MMAS-8), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego auto questionnaire (TEMPS-A), and Beck Depression Inventory-II (BDI-II) were used to collect data. For statistical analysis, SPSS-18 was used. Logistic regression was done for modeling the relationship between medication adherence. Results: Generally, 54% of the patients were euthymic, while 16%, 23.33%, and 6.66% of them suffered from mild, moderate, and severe depression, respectively. The medication adherence was high, moderate, and low in 30.66%, 46%, and 23.33% of the patients, respectively. There was a significant relationship between medication adherence and depressive (P = 0.049), cyclothymic (P = 0.01), and irritable (P = 0.01) affective temperaments. Only BDI-II score (P = 0.018) was identified as predictors of drug adherence. Conclusions: Despite the statistically significant relationship between depressive, cyclothymic, and irritable temperaments and adherence, affective temperaments cannot be considered as a predictor of adherence in patients with CHF.

P199 The predictors of adherence with nasal continuous positive airway pressure treatment in Japanese

Abstract Introduction Continuous positive airway pressure (CPAP) is considered the-first line treatment for obstructive sleep apnea syndrome (OSAS). CPAP adherence, however, is suboptimal. Poor CPAP adherence could not prevent cardiovascular events. An early intervention in patients with poor adherence with CPAP may have a better likelihood of avoiding dropout from CPAP or improving adherence. Purpose To determine the predictors of CPAP adherence in patients with OSAS. Methods We studied 291（219 male 72 female）patients with OSAS with an apnea hypopnea index (AHI) ≥ 20 events per hour were enrolled in from April 2014 to march 2017 at 4 Clinical Centers. The introduction of CPAP treatment was performed in patient with OSAS in the hospital for education including neurocognitive performance or in outpatient with OSAS in their home, receiving education excluding neurocognitive performance. We assessed the relationship between apnea hypopnea index (AHI), the Epworth Sleepiness Scale score (ESS), B-type natriureic peptide (BNP), the type D personality (depressed state assessed by means of a valid and reliable 14-item questionnaire) and health-related quality of life using the Short Form (36) Health Survey (SF-36) and CPAP adherence (good; ≥4 h every night, 70% days in a month). Results 219 male were mean age 60.1 ± 13.7 years, mean BMI 26.8kg/m2, mean AHI 44.8/h, and 72 female were 63.4 ±13.8 years, 28.2 kg/m2, 50.5/h, respectively. CPAP treatment improved ESS from 7.5 ± 4.1 to 5.3 ± 3.2 after 3 months（p = 0.009）, AHI from 44.8 ± 19.4 to 6.1 ± 6.2（ p < 0.001）in the first month. CPAP adherence declined 89.8％ in 1 month、73.6 % in 6 months, 68.2 % in 12 months. There were no difference in CPAP adherence among 4 Clinical Centers (p = 0.47). There were not relationship between CPAP adherence and sex , age(≥ 40 years), AHI (≥30), ESS (≥11), BNP, type D personality. However, BMI(≥25 p = 0.01) and patients with initiating CPAP treatment in the hospital have better adherence than outpatients with initiating CPAP treatment in their home (hazard ratio 0.40 (95 % CI 0.16-0.9 p = 0.043) . Although CPAP treatment improved health-related quality of life (vitality, mental health, before CPAP vs after, 48.4 vs 51.4, 49.4 vs 52.5, p <0.05, respectively), there was no difference in relationship between CPAP adherence and improvement of vitality or mental health. Conclusions Patents with OSAS in the hospital, receiving education including neurocognitive performance, were good adherence to CPAP treatment. Severity of OSAS, Depress state, and improvement of health quality did not impact on CPAP adherence. This study showed education is important to keep CPAP good adherence in Japanese as well as Western people.

The relationship between patients\u2019 perception of type 2 diabetes and medication adherence: a cross-sectional study in Japan

BackgroundThe self-management of type 2 diabetes mellitus (T2DM), which involves adherence to medical instructions on diet and nutritional advice, physical activity, medication regimen, and weight and stress management, is necessary for the treatment of T2DM.In this study, we investigated the relationship between patients’ perceptions of their disease and their adherence to their medications. And we attempted to determine whether distinct subphenotypes of behavioral change of medication adherence can be discerned based on a patients’ perceptions.MethodA cross-sectional study using a questionnaire was conducted among 157 patients with T2DM from October 2015 to September 2017. Questionnaires were administered to assess the participants’ demographic and clinical characteristics, medication adherence, diabetes knowledge, and perception of being diabetic. Principal component analysis (PCA) and cluster analyses were performed to classify medication adherence patterns in the total cohort. Multiple regression analyses were performed to identify the determinant factors of medication adherence.ResultsPCA showed the interpretable medication adherence of patients with diabetes by using component 1 (“accessibility to medical treatment”) and component 2 (“status of taking medicines”). We identified four groups that show significantly different medication adherence by using cluster analysis on the basis of the two components. Multiple regression analysis showed that body mass index (BMI), family history of diabetes, one factor of patient’s perception (living an orderly life), and diabetes knowledge were found to be significant predictors of medication adherence in patients with T2DM.ConclusionsIn patients with T2DM, the patient’s diabetes perception of “living an orderly life” is associated with medication adherence. A poor adherence group may be able to change their adherence to diabetes treatment by developing the perception of “living an orderly life.”

Predictors of adherence to treatment by patients with coronary heart disease after percutaneous coronary intervention.

To identify the predictors of adherence in patients with coronary heart disease after a percutaneous coronary intervention. Adherence is a key factor in preventing the progression of coronary heart disease. An analytical multihospital survey study. A survey of 416 postpercutaneous coronary intervention patients was conducted in 2013, using the Adherence of People with Chronic Disease Instrument. The instrument consists of 37 items measuring adherence and 18 items comprising sociodemographic, health behavioural and disease-specific factors. Adherence consisted of two mean sum variables: adherence to medication and a healthy lifestyle. Based on earlier studies, nine mean sum variables known to explain adherence were responsibility, cooperation, support from next of kin, sense of normality, motivation, results of care, support from nurses and physicians, and fear of complications. Frequencies and percentages were used to describe the data, cross-tabulation to find statistically significant background variables and multivariate logistic regression to confirm standardised predictors of adherence. Patients reported good adherence. However, there was inconsistency between adherence to a healthy lifestyle and health behaviours. Gender, close personal relationship, length of education, physical activity, vegetable and alcohol consumption, LDL cholesterol and duration of coronary heart disease without previous percutaneous coronary intervention were predictors of adherence. The predictive factors known to explain adherence to treatment were male gender, close personal relationship, longer education, lower LDL cholesterol and longer duration of coronary heart disease without previous percutaneous coronary intervention. Because a healthy lifestyle predicted factors known to explain adherence, these issues should be emphasised particularly for female patients not in a close personal relationship, with low education and a shorter coronary heart disease duration with previous coronary intervention.

Exploratory analysis of predictors of patient adherence to subcutaneous interferon beta-1a in multiple sclerosis: TRACER study

ABSTRACTObjective: The TRACER multicenter retrospective study aimed to collect data on treatment adherence in a real-life setting, in order to identify predictors of adherence at baseline.Methods: We recruited 384 relapsing-remitting (RR) multiple sclerosis patients with at least 12 months of use of RebiSmart®. This electronic device records the performed injections and assesses adherence as the percentage of ‘not missing doses’, through the connection to the iMed database. Subjects with at least 80% of completed doses at the 12 month of therapy were defined ‘treatment adherents’.Results: After 12 months, 89.3% of patients were adherent; 93.2% of patients aged 26–40 years at baseline were adherent (vs 79% of the ≤25 and 87.5% of the ≥41 year olds; p = 0.006). Furthermore, 90.5% of patients with a baseline Expanded Disability Status Scale (EDSS) score <4 showed ≥80% adherence (vs 71.4% in those with EDSS score ≥4; p = 0.016). Fifty-four percent of the patients who were not adherent after 3 months were also not adherent after 12 months (OR 16.8; CI 95%:7.1–39.8).Conclusions: Patients aged 26–40 years and with an EDSS score <4 at baseline were the most adherent. The status of ‘treatment adherent’ in the first 3 months was predictive of higher adherence in the long term.

P154. Identifying predictors of low adherence in patients with Inflammatory Bowel Disease

P154. Identifying predictors of low adherence in patients with Inflammatory Bowel Disease

Prevalence Rates for and Predictors of Self-reported Adherence of Oncology Outpatients With Analgesic Medications

Inadequate adherence with an analgesic regimen may be a reason why oncology patients experience unrelieved pain. However, only a limited number of studies have evaluated the prevalence rates for adherence and no studies have attempted to determine predictors of adherence in patients with cancer pain. On the basis of concepts from the Health Belief Model, the purposes of this study were to describe oncology outpatients' level of adherence with an analgesic regimen and to evaluate the direct and indirect effects of selected demographic variables, pain characteristics, barriers to pain management, and self-efficacy (SE) on adherence with an analgesic regimen. A descriptive, cross-sectional study recruited outpatients from oncology clinics in a large, tertiary referral cancer hospital in Norway. A sample of 174 oncology outpatients completed a demographic questionnaire, the Brief Pain Inventory, 2 self-reported adherence measures, the Barriers Questionnaire, and a SE questionnaire. Only 41% of the patients were adherent with their analgesic regimen. In the regression analysis, 29.9% of the variance in adherence was explained. Higher adherence scores were associated with male sex, and also lower SE for physical function scores, higher average pain intensity scores, higher pain relief scores, and the use of strong opioid analgesics. Improvements in pain management may occur if clinicians routinely assessed patients' level of adherence with their analgesics regimen.

Self-Reported Adherence to Cholesterol-Lowering Medication in Patients with Familial Hypercholesterolaemia: The Role of Illness Perceptions

The objectives of this study are to describe levels of adherence to cholesterol-lowering medication and to identify predictors of adherence in patients with familial hypercholesterolaemia (FH). Descriptive questionnaire study. 336 adults patients with FH attending one of five outpatient lipid clinics in South East England underwent a clinical assessment by a nurse and completed a questionnaire. The questionnaire assessed self-reported adherence to cholesterol-lowering medication, anxiety, depression, and patient perceptions of heart disease. Overall, participants reported high levels of medication adherence, although 63% reported some level of non-adherence. Total medication adherence (never deviating from the regimen) was more likely to be reported by older participants, those with no formal educational qualifications, those with a personal history of cardiovascular disease, those with a lower total cholesterol level, and those with a greater difference between untreated cholesterol levels and current cholesterol levels. The illness perceptions associated with reported total adherence were lower perceived risk of raised cholesterol, perceiving greater control over FH, and perceiving genes and cholesterol to be important determinants of a heart attack. Emotional state was not associated with medication adherence. In logistic regression analysis, predictors of total medication adherence were having personal history of cardiovascular disease, having no formal qualifications, and perceiving genes to be important determinants of a heart attack. Both clinical factors and patients' illness perceptions were associated with self-reported cholesterol-lowering medication adherence. The association with illness perceptions was small and many of these associations may be a consequence, rather than a cause, of greater adherence. Given this, intervention strategies aimed at helping patients' to establish routines for medication taking may be more effective in increasing adherence than interventions designed to alter perceptions related to taking statins.

Health literacy predicts medication adherence

Vision and reading comprehension would seem to be important determinants of medication adherence. We assessed whether vision, reading, and health literacy predict medication adherence in 242 adults (> 18 years of age) with cardiovascular disease. Adherence was assessed as the percent of drug taken during six months to one year using electronic monitors. Vision was tested using the Snellen test (score range: 1 to 100). Ability to read was assessed using a previously validated instrument (range: 0 to 2). Health literacy was assessed using the Short Test of Functional Health Literacy in Adults (range: 0 to 36). Higher scores indicate better performance on all assessments. Patients were 60 ± 11 years of age, 73% female, 63% African-American, and had 11 ± 2 years of education Mean adherence was 68% ± 27%, vision 64 ± 18, and reading 1.6 ± 0.6. The health literacy score was 27 ± 11 with 74% of patients classified as having adequate health literacy. Univariate predictors of adherence included higher health literacy score (p = 0.005) or literacy level (adequate vs. inadequate, p = 0.001). In the multiple variable model controlling for demographic factors, health literacy score significantly (p = 0.007) predicted medication adherence. Health literacy is a predictor of adherence in patients with cardiovascular disease. Clinical Pharmacology & Therapeutics (2004) 75, P76–P76; doi: 10.1016/j.clpt.2003.11.288

Adherence with colorectal cancer screening guidelines: a review

Objective. To review screening rates and factors impacting patient utilization of colorectal cancer screening tests. Methods. We searched Medline, CancerLit, and PsycInfo for articles on colorectal cancer screening adherence. US studies on average-risk individuals were reviewed to identify: (1) utilization/adherence rates, (2) predictors of patient adherence, (3) correlation between long-term adherence and type of test selected, (4) predictors of physician recommendation of screening tests, and (5) patterns in the type of test recommended by physicians. Results. In 2000, only 34% of the US population obtained screening within recommended time frames (fecal occult blood test annually, flexible sigmoidoscopy every 5 years, or colonoscopy every 10 years). Positive attitude toward screening and physician recommendation result in high adherence while fear of finding cancer and the belief that cancer is fatal result in low adherence. Physician specialty impacts the type of test recommended, while perceived lack of patient adherence is not a consistent barrier to recommending screening tests. Matching individuals with their choice of screening test and newer technology, such as virtual colonoscopy, may help increase adherence. Conclusion. Additional studies are required on differences in adherence between tests, whether patient preferences impact adherence, and how the physician–patient relationship can be fostered to increase adherence.

Patient Adherence to the Recommendations of an Interdisciplinary Geriatric Day Hospital Program

This study aimed at identifying patterns and predictors of patient adherence to the recommendations of a geriatric day hospital program. Three-month follow-up interviews were conducted with a convenience sample of 116 patients and their caregivers. The mean patient adherence rate was 67.4% and varied across the five categories of recommendations. Using multiple regression analysis, four variables emerged as predictors of adherence. While patient relocation to a more supervised living situation and greater number of visits to the primary care physician (PCP) after discharge were predictive of higher adherence, lack of in-home support and greater number of recommendations to the PCP predicted lower adherence (p < .001). The findings guide the design of adherence enhancing intervention strategies to improve effectiveness of outpatient geriatric services.