Prevalence Of Non-adherence Research Articles

Investigating the association between medication regimen complexity, medication adherence and treatment satisfaction among Malaysian older adult patients: a cross-sectional study.

The prevalence of medication nonadherence among Malaysian older adults is approximately 60%. However, there is a lack of studies assessing the factors associated with medication nonadherence among this population. This research aims to explore the association between medication regimen complexity (MRC), treatment satisfaction and medication adherence among Malaysian older adults. A cross-sectional study was conducted in outpatient clinics of a teaching hospital in Pahang, Malaysia, between April 2023 and September 2023. MRC Index (MRCI), Treatment Satisfaction for Medication version II (TSQM v.II), and the Malaysian Medication Adherence Assessment Tool (MyMAAT) were used. Multivariate linear and logistic regression models were performed to test the factors affecting treatment satisfaction and medication adherence. Mediator analysis was implemented to assess the mediating role of treatment satisfaction. The study involved 429 Malaysian older adult patients, with a prevalence of nonadherence of 51.0% (n = 219) and an MRCI mean score of 17.37 (SD = 7.07). The mean overall treatment satisfaction score was 73.91 (SD = 15.23). Multivariate logistic regression analysis expressed four significant predictors associated with nonadherence: MRC (AOR = 1.179, p = 0.002), overall treatment satisfaction (AOR = 0.847, p < 0.001), partially self-managed medication (AOR = 2.675, p = 0.011) and fully managed medication by family members/caregivers (AOR = 8.436, p = 0.004). Multivariate linear regression shows three predictors of treatment satisfaction: MRC (β = -1.395, p < 0.001), Charlson Comorbidity Index (CCI) (β = -0.746, p = 0.009) and self-managed medication (β = 5.554, p = 0.006). Mediator analysis indicated that treatment satisfaction partially mediated the association between MRC and nonadherence. Nonadherence was quite prevalent among Malaysian older outpatients and was associated with regimen complexity, treatment satisfaction and patient dependence on others to manage their medications. Future studies should focus on interventions to control the factors that negatively affect patients' medication adherence.

Abstract PO2-11-01: Prevalence of Nonadherence to Endocrine Therapy and Cardiovascular Medications Among Breast Cancer Survivors

Abstract Background: Cardiovascular disease (CVD) and cancer are the two leading causes of death in the U.S, and breast cancer (BC) is the most common cancer among women. Most survivors of early-stage BC are prescribed adjuvant endocrine therapy (ET) to decrease their BC recurrence risk; many of them are also on statins and/or antihypertensives to manage concurrent CVD risk factors. Nonadherence to ET or CVD medications is associated with decreased survival and other poor outcomes, yet little is known about how best to identify nonadherence to multiple classes of medications in BC survivors. Methods: We reviewed pharmacy fill data from our electronic health record (EHR) for a diverse cohort of patients seen in our breast oncology clinic with prescriptions for ET and CVD medications (statin and/or antihypertensive(s)). Patients were excluded if their pharmacy data did not show both an active ET order and an active CVD order or fill. Nonadherence to any medication was defined as proportion of days covered (PDC) &amp;lt; 80% over the previous 180 days. A subset of patients also responded to a patient-reported nonadherence screener administered through our EHR at appointment registration starting in 2/2022. Descriptive statistics were used to determine the prevalence of nonadherence to all medications (defined as PDC&amp;lt; 80% for either ET and/or CVD medications) and for each class of medication separately. We also compared the PDC-based combined nonadherence to the self-reported nonadherence. Results: We identified a total of 1,015 BC survivors on ET and CVD medications last seen in clinic between 2/1/2020 and 6/6/2023 (mean age 69 yo; 23.6% non-Hispanic White, 11.3% non-Hispanic Black, and 38.9% Hispanic). Of these, 567 (55.9%) were prescribed ET and statins, and 745 (73.4%) were prescribed ET and antihypertensives. With nonadherence defined as PDC&amp;lt; 80% for any medication (ET and/or CVD medications), the nonadherence prevalence was 38.4%. The nonadherence prevalence by medication class was slightly lower for ET (20.7%) than for statins (25.9%) and antihypertensives (25.0%). Among patients on ET and statins, 10.1% were nonadherent to both medications and 24.3% were nonadherent to only 1 class of medications; the proportion of patients nonadherent to ET only was almost half that of patients nonadherent to statins only (8.5% vs 15.9%). A similar trend was observed among patients on ET and antihypertensives: 10.3% were nonadherent to both classes of medications and 26.2% were nonadherent to only 1 class of medications, with 11.5% of patients nonadherent to ET only and 14.6% nonadherent to antihypertensives only. Of the 1,015 patients, 390 (38.4%) responded to the nonadherence screener between 2/16/2022 and 6/6/2023, of which 93 (23.8%) reported any level of medication nonadherence. Among these, 57 (61.3%) had PDC≥ 80% and thus were categorized as adherent under our PDC-based adherence determination. Of the 297 patients who self-reported adherence to all medications on the screener, 32.3% had PDC&amp;lt; 80% for any medication. When combining nonadherence by PDC and self-report, the overall nonadherence rate for the 390 patients who responded to the screener was considerably higher at 48.5% (vs 33.8% by PDC only and 23.8% by self-report only). Conclusions: EHR-based screening can identify patients with or at risk for medication nonadherence for targeted interventions. Using a combined approach of pharmacy fill data and patient reports, close to 50% of patients were identified as having nonadherence to at least 1 medication. Nonadherence to statins and antihypertensives was more common than nonadherence to ET, which is concerning as early-stage BC survivors are more likely to die from CVD than BC. Interventions to improve adherence to multiple classes of medications are warranted in this population. Citation Format: Claire Sathe, David DeStephano, Shing Lee, Melissa Beauchemin, Nadia Liyanage-Don, Melissa Accordino, Katherine Crew, Ian Kronish, Dawn Hershman. Prevalence of Nonadherence to Endocrine Therapy and Cardiovascular Medications Among Breast Cancer Survivors [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 PO2-11-01.

Adherence to inhalers in patients with severe asthma treated with anti-interleukin-5 biologics

ObjectiveGiven poor medication adherence in severe asthma is difficult to evaluate in daily practice, using at least two methods concurrently is recommended. We aimed to determine the prevalence of nonadherence to inhalers using the Test of Adherence to Inhalers questionnaire and the medication possession ratio obtained from the pharmacy refill data in patients with severe asthma treated with anti-interleukin-5 biologics and to evaluate their concordance. MethodThis was a cross-sectional retrospective observational study of 53 patients with severe asthma recruited from the severe asthma unit of a tertiary hospital in Madrid from June to December 2020. We registered demographic data, comorbidities and concomitant therapy for asthma. Nonadherence was defined as pharmacy refill data < 80% and/or Test of Adherence to Inhalers questionnaire results < 50. Concordance was assessed by determining the Cohen's kappa statistic. ResultsThe median age was 61 years (interquartile range 51.8–67.0), and 33 (61%) were women. According to the pharmacy refill data lack of adherence to the primary inhaler was 58.5%. However, when using the Test of Adherence to Inhalers questionnaire, it was 22.6%. Combining both methods, 17% of patients were considered to have nonadherence to inhalers. Likewise, when identifying nonadherence by either of these methods, it reached a prevalence of 64.2%. The pharmacy refill data and Test of Adherence to Inhalers questionnaire agreed in 53.1% and disagreed in 46.9% of patients (k = 0137; 95% confidence interval -0.057 to 0.331; p = 0.318). ConclusionsWe observed a higher prevalence of non-adherence to inhalers in patients with severe asthma treated with anti-interleukin-5 biologics. The agreement between the Test of Adherence to Inhalers questionnaire and the pharmacy refill data is lower when evaluating nonadherence in patients with severe asthma treated with anti-interleukin-5 biologics. The pharmacy refill data detect a higher proportion of nonadherence compared with the Test of Adherence to Inhalers questionnaire.

Cancer Screening Prevalence and Preference among Hospitalized Women With and Without Obesity.

This study explored the prevalence of nonadherence and preferences for breast cancer (BRC) and colorectal cancer (CRC) screening among hospitalized women with and without obesity who were cancer-free at baseline. In addition, the study evaluated risk factors associated with nonadherence among hospitalized women with obesity. A prospective interventional study evaluated nonadherence prevalence and preference for cancer screening among hospitalized women aged 50 to 75 years. The intervention consisted of one-to-one bedside education via handouts about cancer screening. In addition, multivariable logistic regression models assessed associations between sociodemographic and clinical comorbidity variables believed to influence screening adherence among hospitalized women. Six months after discharge from the hospital, study participants received a follow-up telephone survey to determine adherence to BRC/CRC screening guidelines. Of 510 enrolled women, 61% were obese (body mass index ≥30 kg/m2). Women with and without obesity were equally nonadherent to BRC (34% vs 32%, P = 0.56) and CRC (26% vs 28%, P = 0.71) screening guidelines. Almost half of the study population preferred undergoing indicated BRC/CRC screening in the hospital regardless of obesity status. After adjustment for sociodemographic and clinical risk factors, not having a primary care physician (odds ratio [OR] 5.88, 95% confidence interval [CI] 2.20-15.7) and nonadherence to CRC screening (OR 3.65, 95% CI 1.94-6.54) were associated with nonadherence to BRC screening among women with obesity. After similar adjustment, having an education less than high school level (OR 2.55, 95% CI 1.21-5.39) and nonadherence to BRC screening (OR 3.64, 95% CI 1.97-6.75) were associated with nonadherence to CRC among women with obesity. Women with obesity are at risk of being underscreened for obesity-related malignancies, and hospitalizations may offer screening opportunities for BRC and CRC.

Prevalence of Nonadherence to Medications among Geriatric Patients in Al-Madinah Al-Munawara City's Hospitals, Kingdom of Saudi Arabia.

Medication adherence is a major component in the treatment of chronic patients, especially the older adults. It acts as an essential part of a successful therapeutic outcome, increasing treatment benefits, and decreasing hospital admissions, health care utilization, and cost. Limited research regarding medication adherence has been conducted nationwide; however, data among the older adults is sparse due to the lack of research on this topic. Therefore, this study aimed to determine the prevalence of medication nonadherence among older adults' Saudi patients with chronic diseases living in Al-Madinah Al-Munawwarah city. A cross-sectional study was conducted on outpatient older patients with chronic diseases who visited clinics at different hospitals in Al-Madinah Al-Munawwarah city, from March until December 2022. The questionnaire was published in a conversational Arabic dialect. The adherence level was measured by the Adherence to Refills and Medications Scale (ARMS) and the reasons for medication nonadherence were collected by using the Cluig scale. 65.1% of females and 34.9% of males have participated in this study. According to the ARMS scale, 67.9% of patients had poor medication adherence and 32.1% had good medication adherence. Poor adherence was higher in females compared to males, with a p value = 0.018. For educational level, the ARMS score in graduates was higher than patients who finished middle school and illiterate patients. Based on the Cluig scale, the most common reasons for medication nonadherence were forgetfulness, feeling well, polypharmacy, and subsequent avoidance of side effects. The findings indicate the gender-based differences in the factors that associated with medication nonadherence among older adults. Medication adherence is crucial especially among older adults to improve clinical outcomes. The current results highlight the prevalence of medication adherence among the older adult population. This result shows the gender-based differences in the factors associated with medication nonadherence among the older adult population.

Nonadherence Is Common in Patients With Apparent Resistant Hypertension: A Systematic Review and Meta-analysis.

The prevalence of medication nonadherence in the setting of resistant hypertension (RH) varies from 5% to 80% in the published literature. The aim of this systematic review was to establish the overall prevalence of nonadherence and evaluate the effect of the method of assessment on this estimate. MEDLINE, EMBASE, Cochrane, CINAHL, and Web of Science (database inception to November 2020) were searched for relevant articles. We included studies including adults with a diagnosis of RH, with some measure of adherence. Details about the method of adherence assessment were independently extracted by 2 reviewers. Pooled analysis was performed using the random effects model and heterogeneity was explored with metaregression and subgroup analyses. The main outcome measured was the pooled prevalence of nonadherence and the prevalence using direct and indirect methods of assessment. Forty-two studies comprising 71,353 patients were included. The pooled prevalence of nonadherence was 37% (95% confidence interval [CI] 27%-47%) and lower for indirect methods (20%, 95% CI 11%-35%), than for direct methods (46%, 95% CI 40%-52%). The study-level metaregression suggested younger age and recent publication year as potential factors contributing to the heterogeneity. Indirect methods (pill counts or questionnaires) are insufficient for diagnosis of nonadherence, and report less than half the rates as direct methods (direct observed therapy or urine assays). The overall prevalence of nonadherence in apparent treatment RH is extremely high and necessitates a thorough evaluation of nonadherence in this setting.

Comparación de la adhesión terapéutica según el Test de Adherencia a Inhaladores y el registro de la retirada en farmacia de los fármacos prescritos en pacientes asmáticos. Estudio REFARMA

IntroductionClinical guidelines recommend the combined use of “self-completed questionnaires such as the Test of Adherence to Inhalers (TAI)” and the pharmacy refill rate (PRR) to determine adherence, but evidence based on comparative studies to support these recommendations is limited. Our objective was to determine adherence to inhalers in asthmatic patients, using the TAI and the PRR, as well as the correlation and concordance between both methods. MethodsMulticentre cross-sectional study including the first 196 consecutive adult asthmatic patients, of whom 183 were on maintenance treatment with Inhaled Corticosteroids (ICS). Nonadherence was defined as TAI <50 or PRR <80% in the previous 12 months. ResultsA statistically significant positive correlation was observed between TAI and PRR scores (Spearman's rho coefficient=0.185; p=0.012). Prevalence of nonadherence based on TAI was 73.22%; 95%CI (66.54-79.91) and 57.92%; 95%CI (50.50-65.35) based on PRR was. In terms of agreement, a Cohen's kappa index=0.174 and an overall % agreement of 61.7% were obtained. Twenty-two of the 49 patients who scored 50 on TAI (44.9%) refilled <80% of inhalers. In contrast, 48 of the 134 patients who scored ≤49 on TAI (35.8%) refilled ≥80% at the pharmacy. ConclusionsAdherence remains suboptimal with prevalences of nonadherent patients>50%. The concordance results supports, in line with guideline recommendations, that the use of both approaches (TAI and PRR) increases the ability to identify poor adherence compared to TAI or PRR alone.

Adherence to Typical Antipsychotics among Patients with Schizophrenia in Uganda: A Cross-Sectional Study.

There has been a recent transition from typical to atypical antipsychotics in managing schizophrenia. This has been attributed to the acute side effects experienced by patients on typical antipsychotics that lead to nonadherence. However, the treatment cost with typical antipsychotics is cheaper (preferred in low-income settings), and there is no difference in the effectiveness, efficacy, discontinuation rate, or side effect symptom burden with atypical antipsychotics. This study is aimed at determining the prevalence of nonadherence and the associated factors to typical antipsychotics among patients with schizophrenia attending a psychiatric outpatient clinic at a rural tertiary facility in Uganda. A cross-sectional study among 135 patients with schizophrenia for at least six months on typical antipsychotics (mean age of 39.7 (±11.9) and 55.6% were female) from a rural tertiary facility in Uganda. Data were collected regarding sociodemographics, adherence, insight for psychosis, attitude towards typical antipsychotics, side effects, satisfaction with medications, and explanations from health workers about medications and side effects. Logistic regression was used to determine the factors associated with nonadherence. The prevalence of nonadherence was 16.3%, and the likelihood of being nonadherent was more among the poor (monthly earning below the poverty line). However, having reduced energy was associated with reducing the likelihood of having nonadherence. The prevalence of nonadherence was lower than many previously obtained prevalence and was comparable to nonadherence for atypical antipsychotics. However, to reduce nonadherence, we need all stakeholders (such as the government, insurance companies, and caregivers) to assist patients living in poverty with access to medication.

Predictors of Nonadherence to Medications among Hypertensive Patients in Ghana: An Application of the Health Belief Model.

Introduction Hypertension (HPT) is recognized as a significant public health problem worldwide from a health and economic perspective. This study determined predictors of nonadherence to HPT medications in Ghana using the health belief model. Methods A cross-sectional descriptive survey employing a quantitative approach was conducted among HPT patients who routinely attend clinics at selected hospitals in the Brong Ahafo region of Ghana. Respondents (n = 399) were recruited using a multistage sampling technique. Results The prevalence of nonadherence was 63.7% (n = 254). Nonadherence to hypertension medication was associated with lower education status (p=0.009). In logistic regression analysis, patients with high “perceived susceptibility” and “perceived severity” were more likely to forfeit their HPT medication schedules, while patients with high “perceived barriers” and “cues to action” were less likely to skip their medication. Conclusion The present study suggests a plausible path to improving medication adherence in this population. Given the high prevalence of nonadherence, policymakers need to urgently design tailor-made health promotion interventions to ensure optimal health outcomes.

Prevalence of Non-adherence to Antiepileptic Drugs in Patients With Epilepsy Presenting to Emergency With Fits.

BackgroundEpilepsy is considered when a patient has at least two unprovoked seizures that occurred more than a day apart. Seizure control depends upon several factors, including adequate treatment and its dosage, patients' daily activities, and adherence to antiepileptic medications. The study aimed to assess the rate of adherence to antiepileptic drugs (AED) in patients with epilepsy.MethodologyA cross-sectional study was conducted at the Department of Neurology, Ayub Teaching Hospital, Abbottabad, Pakistan, between November 2019 and October 2020. All participants who presented to the emergency room with complaints of seizures, had a known diagnosis of epilepsy, aged above 18 years, with no cognitive dysfunction or severe psychiatric disorders were included in the study. Patients with other neurological disabilities (brain tumors, cerebral palsy, neuromuscular disorder) or severe psychotic episodes and those with undiagnosed cases of epilepsy were excluded from the study. A predefined proforma was used to assess the level of adherence and non-adherence among patients and they were then divided into their respective groups.ResultsA total of 150 participants were included in the study. Of patients, 110 were adherent to AED treatment while 40 were non-compliant. It was found that the most frequent cause of non-adherence was that patients forgot their pills (72.5%). Of patients, 7.5% stopped taking the medication when symptoms were relieved. About 12.5% reported affordability to be the reason for non-adherence. The rate of poor seizure control was significantly higher in non-adherent patients as compared to adherent patients (77.5% vs. 49.1%, p = 0.001). It was also found that a greater number of non-adherent patients experienced convulsive seizures in the past year as compared to those who were adherent to their medications (p = 0.006).ConclusionTo enhance treatment adherence, the practice of prescribing more simpler treatment regimens among physicians can result in better seizure control, as the complexity of the regimen is found to be a major challenge for adjustment of AED regimens in this regard.

Prevalence of Non-adherence to Prescribed Medications among Hemodialysis Patients in Makkah City.

Patients with end-stage kidney disease (ESKD) are required to take multiple medications. Adherence to a complex regimen of medications is challenging and might lead to non-adherence. This study aimed to assess nonadherence to prescribed medications among patients with ESKD in Makkah City and determine the factors associated with a such behavior. A cross-sectional study was conducted at three governmental hospitals in Makkah City, Saudi Arabia. Descriptive statistics were performed to characterize participants, and a multivariable logistic regression analysis was used to determine factors associated with nonadherence to prescribed medications among patients with ESKD. In total, 358 patients have submitted completed surveys and were included in this study. A considerable number (45.25%) of participating patients were found to be nonadherent to prescribed medications. The factors: age, belief that taking medications as scheduled is important, adherence to dialysis sessions, and the number of comorbid diseases had significant and negative associations with nonadherence to prescribed medications. On the other hand, the factors: forgetfulness and having depression were significantly and positively associated with non-adherence to prescribed medications. Non-adherence to medications among patients on hemodialysis is a significant issue that leads to life-threatening complications. The factors identified as being significantly associated with nonadherence should be considered in designing future interventions to improve adherence to medications.

Association of Social Determinants of Health With Adherence to Second-generation Antipsychotics for People With Bipolar Disorders in a Medicaid Population.

About 7 million people, 2.8% of US adults, have bipolar disorder (BD). While second-generation antipsychotics (SGA) are indicated as acute and maintenance treatments for BD, therapeutic success requires medication adherence and reported nonadherence estimates to range as high as 60%. Identifying patient risk factors for nonadherence is important for reducing it. The objective of this study was to quantify the associations of risk factors, including social determinants of health, with SGA nonadherence among patients with BD. In this cross-sectional study of 2015-2017 MassHealth Medicaid data, we examined several definitions of adherence and used logistic regression to identify risk factors for nonadherence (medication possession ratio <0.8) among all adults aged 18-64 diagnosed with BD who could be followed for 12 months following SGA initiation. Among 5197 patients, the mean (±SD) age was 37.7 (±11.4) years, and 42.3% were men. Almost half (47.7%) of patients were nonadherent to SGAs when measured by medication possession ratio. The prevalence of nonadherence peaked at middle age for men and younger for women. Nonadherence was less common among Massachusetts' Department of Mental Health clients (odds ratio=0.60, 95% confidence limit: 0.48-0.74) and among those who used other psychotropic medications (odds ratios between 0.45 and 0.81); in contrast, increase in neighborhood socioeconomic stress was associated with increased odds of nonadherence. Adherence to SGA treatment is suboptimal among people with BD. Recognizing risk factors, including those related to social determinants of health, can help target interventions to improve adherence for people at high risk and has implications for adherence-based quality measures.

Abstract 14545: Prevalence of Medication Non-Adherence via Therapeutic Drug Monitoring in Patients With Uncontrolled Hypertension Treated at a Safety Net Hospital

Background: Medication nonadherence presents one of the greatest challenges to hypertension management. Previous studies from our group have shown therapeutic drug monitoring (TDM), biochemical monitoring of drug levels, is more accurate than self-report, detailed questionnaires, or prescription fill rate in detecting nonadherence. Prior studies have also shown a prevalence of nonadherence from 45% to 80% among insured patients with uncontrolled hypertension despite having been prescribed a multi-drug regimen. Previous studies have not assessed adherence to antihypertensive drugs in a safety net population by TDM. Methods: We performed a cross-sectional study in patients with uncontrolled hypertension in the primary care Internal Medicine and Cardiology Clinics at Parkland Health&amp; Hospital System (PHHS). Patients with BP of ≥130/80 mmHg, prescribed ≥2 antihypertensive medications, and self-reporting medication adherence were enrolled after informed consent. Plasma samples were obtained for measurement of 44 cardiovascular drugs using liquid chromatography mass spectrometry. Results: Among 77 patients with uncontrolled hypertension (57% female, 65% Black, 12% Hispanic), 13 (17%) were nonadherent to at least one anti-hypertensive drug by TDM. The adherent and nonadherent groups had similar systolic (146±13 vs 148±18, p=0.67) and diastolic (83±9 vs 88±10 mmHg, p=0.13) BP. All patients had either medical insurance or some form of prescription financial assistance. Sixty two patients had insurance, while 15 had prescription financial assistance. Nonadherence rates for patients on financial assistance programs did not significantly differ from patients with medical insurance (13% vs 18%, p&gt;0.999). Conclusions: We found a surprisingly low prevalence of anti-hypertensive medication nonadherence in this uncontrolled hypertension population despite many barriers to treatment. Our study suggests a lesser role of medication nonadherence in uncontrolled hypertension in the safety net population.

Abstract P133: Prevalence Of Medication Non-adherence Via Therapeutic Drug Monitoring In Patients With Uncontrolled Hypertension Treated At A Safety Net Hospital

Background: Medication nonadherence presents one of the greatest challenges to hypertension management. Previous studies from our group have shown therapeutic drug monitoring (TDM), biochemical monitoring of drug levels, is more accurate than self-report, detailed questionnaires, or prescription fill rate in detecting nonadherence. Prior studies have also shown a prevalence of nonadherence from 45% to 80% among insured patients with uncontrolled hypertension despite having been prescribed a multi-drug regimen. Previous studies have not assessed adherence to antihypertensive drugs in a safety net population by TDM. Methods: We performed a cross-sectional study in patients with uncontrolled hypertension in the primary care Internal Medicine and Cardiology Clinics at Parkland Health&amp; Hospital System (PHHS). Patients with BP of 130/80 mmHg, prescribed ≥2 antihypertensive medications, and self-reporting medication adherence were enrolled after informed consent. Plasma samples were obtained for measurement of 44 cardiovascular drugs using liquid chromatography mass spectrometry. Results: Among 77 patients with uncontrolled hypertension (57% female, 65% Black, 12% Hispanic), 13 (17%) were nonadherent to at least one anti-hypertensive drug by TDM. There was no difference in baseline characteristics between the two groups. The adherent and nonadherent groups had similar systolic (146±13 vs 148±18, p=0.67) and diastolic (83±9 vs 88±10 mmHg, p=0.13) BP. All patients had either medical insurance or some form of prescription financial assistance. 15 patients had prescription financial assistance, while 62 patients had medical insurance. Nonadherence rates for patients on financial assistance programs did not significantly differ from patients with medical insurance (13% vs 18%, p&gt;0.999). Conclusions: We found a surprisingly low prevalence of anti-hypertensive medication nonadherence in this uncontrolled hypertension population despite many barriers to treatment. Our study suggests a lesser role of medication nonadherence in uncontrolled hypertension in the safety net population.

Detection of Nonadherence to Antihypertensive Treatment by Measurements of Serum Drug Concentrations.

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Nonadherence to immunosuppressives and treatment in kidney transplant: ADHERE BRAZIL Study.

ABSTRACTOBJECTIVE To estimate the prevalence and variability of nonadherence to immunosuppressives and nonpharmacological treatment across kidney transplantation centers and two health access-disparate regions in Brazil.METHODS In a cross-sectional design, a random multistage sample of 1,105 patients was included, based on center transplantation activity (low/moderate/high) and region (R1: North/Northeast/Mid-West; and R2: South/Southeast). Nonadherence to immunosuppressives (implementation phase) was assessed using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS)©. Self-report questionnaires assessed nonadherence to physical activity, smoking cessation, alcohol intake, and appointment keeping. We compared regions using the adjusted-χ2 or t-test.RESULTS Most patients were men (58.5%), white (51.4%), and had a mean age of 47.5 (SD = 12.6) years. Regarding kidney transplantation centers, 75.9% were from R2 and 38.2% had low activity. The patients in R2 were older, white-majority, had more frequently steady partners, and received peritoneal dialysis. Nonadherence to immunosuppressives ranged from 11–65.2%; 44.5–90% to physical activity; 0–23.7% to appointment keeping; and 0–14% to smoking cessation. The total prevalence of nonadherence and by region (R1 versus R2) were: for immunosuppressives, 39.7% (44.9% versus 38.1%, p = 0.18); for smoking, 3.9% (1% versus 5%, p < 0.001); for physical activity, 69.1% (71% versus 69%, p = 0.48); for appointment keeping, 13% (12.7% versus 12%, p = 0.77); and for alcohol consumption, 0%.CONCLUSION Despite differences among centers and high variability, only the nonadherence to smoking cessation was higher in the region with greater access to kidney transplantation. We suppose that differences in healthcare access may have been overcome by other positive aspects of the post kidney transplantation treatment.

Nonadherence after hospital discharge in patients with schizophrenia or schizoaffective disorder: A six-month naturalistic follow-up study

BackgroundDespite a wealth of studies seeking to identify factors associated with nonadherence few consistent predictors have been determined, and several gaps still exist in the literature. MethodWe assessed 110 consecutively admitted patients diagnosed with schizophrenia or schizoaffective disorder according to ICD-10 criteria. Assessments were performed during hospitalization and at six-months follow-up. Evaluation included sociodemographic, clinical, psychopathologic and treatment-related variables. Prevalence of nonadherence, associated variables, reasons for nonadherence and possible subtypes were explored. Adherence was defined as the concurrence of adherence to antipsychotic treatment and adherence to outpatient follow-up, during the six-month period. ResultsNonadherence was detected in 58.2% of patients. An identifiable profile was found in nonadherent patients. After multivariate logistic regression analysis, low socio-economic level (OR = 3.68; 95% CI = 1.42–9.53), current cannabis use or abuse (OR = 2.79; 95% CI = 1.07–7.28), nonadherence as a reason for relapse and admission (OR = 5.46; 95% CI = 2.00–14.90), and greater overall severity of symptoms at six months follow-up (OR = 2.00; 95% CI = 1.02–3.95) remained independently associated with nonadherence. Believing that medication is unnecessary was the most reported reason for nonadherence. For nonadherent patients (N = 64), two distinguishable subtypes were found: intentional nonadherence (N = 32; 50%), and unintentional nonadherence (N = 32; 50%). ConclusionsA large percentage of patients with schizophrenia or schizoaffective disorder did not adhere to their treatment in the post-discharge follow-up period. The profile identified may enable better prevention of this problem. Specific reasons for nonadherence should also be explored to provide individualized strategies.

Prevalence of Non-Adherence to Immunosuppressive Medications in Kidney Transplant Recipients: Barriers and Predictors.

BackgroundNon-adherence to immunosuppressant therapy (IST) is a major risk factor for graft rejection. Limited reports are available regarding the prevalence of non-adherence to IST in kidney transplant recipients (KTRs) as well as the predictors and barriers of non-adherence.Material/MethodsThe study included ambulatory KTRs, ≥18 years of age, with a functional kidney, from January 2017 to November 2018. The primary outcome was the prevalence of non-adherence, assessed with: 1) A telephone interview to complete the Arabic-translated and validated Immunosuppressant Therapy Adherence Instrument Scale (ITAS) and 2) IST serum blood levels within therapeutic levels. The secondary outcomes were the barriers to adherence using the validated Immunosuppressant Therapy Barriers of Adherence Scale (ITBS).ResultsWe enrolled 102 of 141 patients screened. The mean±SD for age, body mass index, and the baseline of the estimated glomerular filtration rate were 45.5±15.6 years, 29.1±6 kg/m2, and 72.7±21.9 ml/min/1.73 m2, respectively. The prevalence of non-adherence was 5.9%, 95% CI (2.19–12.36%) and 14.7%, 95% CI (8.47–23.09%) using the ITAS and the average blood serum drug levels, respectively. The concordance of the 2 methods demonstrated an agreement of 81.3%, kappa of 0.01, and 95% CI (−0.16 to 0.18). The median, interquartile range (IQR) for ITBS, and uncontrollable and controllable barriers for adherence were 21, (18–25), 15, (12–18), and 6, (5–8), respectively.ConclusionsThe current study demonstrated a low to moderate prevalence of non-adherence to IST in KTRs. The barriers for adherence with IST necessitate additional targeted interventions to manage and optimize therapeutic and clinical outcomes.

Psychometric Properties of the Turkish Version of the Dietary Sodium Restriction Questionnaire.

Sodium restriction is the primary nonpharmacological treatment in heart failure (HF) to prevent rehospitalization and reduce HF symptom burden. Despite the importance of restricting sodium in the diet, the prevalence of nonadherence to a low-sodium diet has been known to be high. To reduce the high prevalence of nonadherence, we have to know the facilitating and challenging factors. The planned behavior theory shows those factors, including attitudes, social norms, and perceived behavioral control. The Dietary Sodium Restriction Questionnaire (DSRQ) was developed based on the planned behavior theory. However, in Turkey, the psychometric properties of this instrument have not been studied yet. Therefore, the aim of this study was to conduct a psychometric testing of the Turkish version of the DSRQ among patients with HF. Data were collected from 300 patients who were recommended a sodium-restricted diet because of a diagnosis of HF. Validity was tested using content validity index, Kendall W, and exploratory and confirmatory factor analyses. Reliability was tested using item-total and interitem correlations, Cronbach's α coefficient of reliability, independent-sample t test, and test-retest analysis. The exploratory factor analysis revealed that 3 factors accounted for 78.2% of the explained variance. The factor loads ranged between 0.67 and 0.96. The results of the confirmatory factor analysis showed goodness-of-fit indices greater than 0.90, with a root-mean-square error of approximation less than 0.10 and a root-mean-square residual of 0.05. The Cronbach's α coefficient for DSRQ was 0.92 and for each subscale was as follows: attitude and subjective norm, 0.97; perceived external behavior control, 0.89; and perceived internal behavior control, 0.83. The DSRQ is a valid and reliable instrument in assessing the attitudes, beliefs, and perceived behavioral control related to following a low-sodium diet of patients with HF in the Turkish population.

Inequalities in adherence to cervical cancer screening in Portugal.

Cervical cancer is the second cancer with the highest incidence and mortality in women aged 15-44 living in Europe. Screening is an effective strategy to reduce these rates, although in Portugal, as in other European countries, adherence to screening still presents significant disparities. Thus, this study aimed to assess the prevalence and factors associated with cervical cancer screening (CCS) nonadherence in Portugal. Cross-sectional data from 5929 women aged 25-64 included in the 2014 Portuguese National Health Survey (2014 NHS) were analyzed. The prevalence of CCS nonadherence was estimated. The association between multiple factors and CCS nonadherence was analyzed, using logistic regression, adjusting for age and educational level. The weighted prevalence of nonadherence was 13.2% [95% confidence interval (CI): 12.0-14.0]. Additionally, 10.5% of women had performed the last cervical cytology 3 years ago or more. Higher odds of nonadherence to screening were found for younger women, with low levels of education and income, unemployed, single, born outside Portugal, who never had a medical appointment or had over 12 months ago, who were never pregnant and who had never had a mammography. No association was found with other variables studied, including having public/private health insurance, BMI or smoking status. This study showed that inequalities in CCS adherence in Portugal persist. These findings reinforce the need for developing strategies to reduce inequalities in CCS adherence.