Risk Factors For Poor Adherence Research Articles

Long-term outcomes for pediatric heart transplant recipients transitioning to adult care teams.

There are limited data evaluating the success of a structured transition plan specifically for pediatric heart transplant (HT) recipients following their transfer of care to an adult specialist. We sought to identify risk factors for poor adherence, graft failure, and mortality following the transfer of care to adult HT care teams. We retrospectively reviewed all patients who underwent transition from the pediatric to adult HT program at our center between January 2011 and June 2021. Demographic characteristics, comorbid conditions, and psychosocial history were collected at the time of HT, the time of transition, and the most recent follow-up. Adverse events including mortality, graft rejection, infection, and renal function were also captured before and after the transition. Seventy-two patients were identified (54.1% male, 54.2% Caucasian). Mean age at the time of transition was 23 years after a median of 11.6 years in the pediatric program. The use of calcineurin inhibitors was associated with reduced mortality (HR.04, 95% CI.0-.6, p=.015), while prior psychiatric hospitalization (HR 45.3, 95% CI, 6.144-333.9, p=.0001) was associated with increased mortality following transition. Medication nonadherence and young age at the time of transition were markers for high-risk individuals prior to the transition of care. Transition of HT recipients from a pediatric program to an adult program occurs during a vulnerable time of emerging adulthood, and we have identified risk factors for mortality following transition. Development of a formalized transition plan with a large multidisciplinary team with focused attention on high-risk patients, including those with psychiatric comorbidities, may favorably influence outcomes.

Treatment adherence and the contemporary approach to treating type 2 diabetes mellitus.

The rising burden of type 2 diabetes mellitus (T2D) poses a significant healthcare challenge on a global scale. The economic impact is also substantial and continually increasing. In Serbia, even though the prevalence is officially around 12 percent, nearly 40 percent of the adult population is estimated to be living with undiagnosed diabetes and more than half the population is obese or overweight. This review comprehensively addresses the present approach to treating T2D, emphasizing the critical role of treatment adherence. We review the various components of T2D treatment, underlining the significance of lifestyle modifications. The pros and cons of medications used in treatment are discussed and factors influencing adherence are analysed. A healthy lifestyle remains the foundation of the treatment, and if not sufficient, early pharmacotherapy is initiated. Medications have been developed to lower blood sugar levels with cardiorenal protection, however, due to their still high cost, metformin remains the drug of first choice for most patients. Adherence to the treatment regimen is often poor. Factors associated with this are diverse and often multiple in a particular patient. Poor adherence is associated with poor glycaemic control, increased risk of disease complications, higher cardiovascular risk, increased mortality, hospitalizations, and healthcare costs. In addition to reducing the complexity of drug therapy and better informing the patient, improved education and motivation could lead to greater adherence. Enhanced communication between the patient and the physician and reduced treatment costs could also have a positive impact. The review concludes that addressing factors affecting adherence can significantly improve T2D outcomes and reduce costs. Further research is needed to identify region-specific risk factors for poor adherence.

Transition of Care in Children with Chronic Kidney Disease, Dialysis, and Transplantation.

Improvement in management of pediatric renal disorders has led to patient survival rates of 85-90%, increasing the number of adolescent and young adult (AYA) patients with childhood onset chronic kidney disease (CKD) transitioning to adult care settings. Pediatric CKD patients differ from adults with CKD in view of early onset of disease (sometimes with fetal onset), different disease spectrum, the potential effect of CKD on neurodevelopment, and substantial involvement of parents in medical decision making. In addition to the usual challenges of emerging adulthood (graduation from school to work, independent living, peak in impulsivity and risk-taking behaviors), young adults with pediatric CKD need to learn to manage a serious medical condition independently. In kidney transplant patients, regardless of the age at transplantation, graft failure rates are higher during adolescence and young adulthood than at any other age. All pediatric CKD patients must move from a pediatric to adult-focused settings and this transition is a longitudinal process requiring collaboration and interactions of AYA patients, their families, providers, health care environment and agencies. Consensus guidelines have provided recommendations to pediatric and adult renal teams to enable successful transition. Suboptimal transition is a risk factor for poor adherence to treatment and unfavorable health outcomes. The authors discuss the process of transition as it applies to pediatric CKD patients and review challenges faced by patients/families, pediatric and adult nephrology teams. They provide some suggestions and available tools to optimize the transition of pediatric CKD patients to adult-oriented care.

Risk factors for poor adherence to inhaled corticosteroid therapy in patients with moderate to severe asthma.

Poor adherence to inhaled corticosteroid (ICS) therapy is a common reason for worsened asthma control. We investigated the characteristics of patients with moderate to severe asthma who showed poor adherence to therapy, to identify the barriers for optimal ICS therapy in a real-world observational cohort. We enrolled patients aged ≥20 years presenting with moderate to severe asthma who were enrolled at 18 hospitals in Japan. According to the Global Initiative for Asthma 2018 steps 3-5, the patients were considered as moderate to severe asthmatic. At inclusion, clinical information was obtained using a self-completed questionnaire. Poor adherence was defined as skipping the ICS therapy for more than once a week or inability to recognize the necessity of daily ICS therapy. Adherence Starts with Knowledge 20 (ASK-20) questionnaire was used to evaluate the cause of therapy incompliance. Of the total 85 participants, 19 (22%) showed poor adherence. The median age at diagnosis in the poor adherence group was 10.0 years (interquartile range [IQR], 3.0-50.0), and that in the good adherence group was 41.0 years (18.5-51.5; P = 0.050). The scores for the ASK-20 items related to the "resistance to taking too much medicine" and "compliance with the number of dosing" demonstrated statistically significant differences between patients diagnosed with asthma during their childhood and others. Age at diagnosis is an independent risk factor to predict poor ICS adherence among adults with moderate to severe asthma.

Adherence to Antipsychotic Drugs by Medication Possession Ratio for Schizophrenia and Similar Psychotic Disorders in the Republic of Korea: A Retrospective Cohort Study.

ObjectivePharmacotherapy is considered as an essential element in the treatment of psychotic disorders including schizophrenia. Discontinuation of antipsychotic drugs increases medical use and economic burden. Therefore, maintenance of medication is essential to reduce the social burden caused by schizophrenia and schizophrenia similar psychosis (SSP), and hence, it is important to investigate the rate at which pharmacotherapy is maintained. Therefore, this study aimed to examine the current status of drug compliance using national health insurance data.MethodsThis was a retrospective cohort study, which analyzed data from the nationwide insurance claims database. A total of 343,134 patients who were newly diagnosed with schizophrenia and SSP during 2011−2015. The adherence to antipsychotic drugs was assessed by medication possession ratio (MPR) and the risk factors of poor adherence were defined as MPR < 40%.ResultsThe average of the MPRs was 45.8%, and the proportion of patients with less than 40% of MPR was 50.8%. It was found that female patients, the experience of “general hospital outpatient,” “psychiatric hospital admission,” “general hospital admission,” and patients receiving “health insurance” showed high risk of having statistically significant low MPR (< 40%).ConclusionIn this study, the drug adherence of schizophrenia and SSP patients currently under treatment, as estimated by MPR, was very low. However, it was also found that the MPR was high among patients receiving medical aid, with less medical expenses. Thus, it is possible to consider an institutional mechanism in which schizophrenia and SSP patients can be treated with less economic burden.

Hand washing hygiene, sanitation and sustainable development goals in Umuahia North Local Government Area, Abia State, Nigeria

study on practices of hand washing hygiene, sanitation and sustainable development goals (SDGs), was carried out in Umuahia North local government area of Abia state, Nigeria, to investigate the causes of outbreaks of health care-care associated infections (HCAIs). Questionnaires made up of 25 attributes were distributed to health care workers (HCWs) to elicit from them their perception of these practices in their units. Complete responses came from 63 respondents which represented 79.75% of questionnaires distributed. The 5-point Likert scale was used in measuring the relative impact indices (RIIs) of not observing health care rules. About 42 of the respondents (66.67%) fall within the low region of RII, 19 respondents (30.10%) belong to the moderate region of RII, while 2 respondents (3.33%) fall in high region of RII. Information from 96.77% of the respondents indicated that hand washing hygiene and sanitation is poorly practiced. Rank ordering of relative observance indices (ROIs) showed that of the 25 attributes used in the study, 16 fall in the principal negative variables (Type 3), 5 of the attributes fall in the moderately negative variables (Type 2), while 4 fall in the relatively acceptable variables (Type 1), evidencing that 84% of the attributes are poorly practiced by HCWs. This situation impacted on the achievement of SDG3 and SDG6. It is concluded that these are the reasons for outbreaks in the area and it is recommended that government should educate HCWs on the observed risk factors for poor adherence to recommended hand hygiene practices.

Rural residence and adherence to continuous positive airway pressure therapy: have we overcome a barrier?

Free AccessCommentaryRural residence and adherence to continuous positive airway pressure therapy: have we overcome a barrier? Lucas M. Donovan, MD, MS Lucas M. Donovan, MD, MS Address correspondence to: Lucas M. Donovan, MD, MS, Core Investigator, HSR&D Center of Innovation for Veteran-Centered and Value Driven Care, VA Puget Sound Health Care System, Division of Pulmonary, Critical Care and Sleep Medicine, 1660 South Columbian Way, Seattle, WA 98108; Email: E-mail Address: [email protected] Search for more papers by this author Published Online:April 1, 2022https://doi.org/10.5664/jcsm.9916SectionsPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutINTRODUCTIONThe management of obstructive sleep apnea (OSA) presents a major challenge to health systems due to the high prevalence of disease and complexities in service coordination.1,2 These challenges lead to widespread access limitations, which are not distributed equally. Patients in rural areas face particular access barriers due to the urban-based distribution of specialized personnel and equipment.3,4 Reflecting these barriers, patients in rural areas who have symptoms of OSA are less likely to be diagnosed, and those who are able to complete testing tend to be patients with more severe disease.3,5 While there appears to be a relationship between rurality and underdiagnosed OSA, the implications of rural residence on subsequent treatment outcomes are unclear. Specifically, there is a lack of information around the impact of rurality on adherence to continuous positive airway pressure (CPAP) treatment and other treatment outcomes.It is reasonable to suspect that rural residence could impact adherence. CPAP is often challenging to use, but there are actions that providers and health systems can take to support patients. These steps include education, behavioral interventions, and troubleshooting aimed at supporting patients’ self-efficacy and reducing side effects.6 These interventions historically relied on in-person visits with specialists,7–9 complicating access among rural patients. While virtual adherence interventions are increasingly adopted that can reach patients remotely (eg, video-based follow-up, telemonitoring),6,10,11 rural areas often lag behind urban ones in internet connectivity and access.12 Additionally, patients in rural areas also tend to have other risk factors for poor adherence to CPAP, including lower income and fewer years of education.13–16In the present issue of the Journal of Clinical Sleep Medicine, Dr. Corrigan and colleagues present analyses to assess the impact of rurality on adherence to CPAP and improvement in OSA symptoms.17 The authors established a prospective cohort of patients from rural and urban areas who were starting CPAP therapy for the first time from December 2018 to November 2020. To do so, the authors partnered with respiratory homecare providers across the province of Alberta to help identify and recruit eligible patients. Patients consenting to take part in this cohort completed surveys at baseline and after 3 months to assess sleepiness, visit satisfaction, and quality of life. The authors also had access to baseline diagnostic testing results and CPAP usage for each participant. The authors compared CPAP usage and patient-reported outcomes between those defined as rural or urban according to standards defined federally by the Canadian government.18Ultimately, the authors recruited 242 eligible patients, 100 rural and 142 urban patients. Aligning with prior observations, individuals in the rural group had a lower median household income, longer driving distance to a CPAP provider, and experienced longer delays in diagnosis and treatment. Overall, the authors did not detect a difference in adherence between rural and urban patients, and the mean difference in nightly CPAP use for rural vs urban patients was 0.17 hours (95% confidence interval: –0.62 to 0.96). The authors also did not detect differences with regard to improvements in sleepiness or satisfaction. However, the authors did observe a significantly greater improvement in quality of life among rural patients relative to urban: +5.1 EuroQOL-5D visual analog scale score (95% confidence interval: 0.2–10.0).These findings provide some reassurance that patients in rural areas can achieve comparable outcomes with CPAP. However, we must consider several factors before generalizing these results to other rural settings and populations. First, the authors’ analyses only include patients consenting to a research study. Those consenting for research studies often differ from those who do not consent.19,20 Importantly, the characteristics where research participants often differ from nonparticipants (higher income, greater education) are themselves associated with greater adherence.15 Second, the authors’ reported overall adherence appears to be lower than other cohorts,11,21 raising concerns that floor effects may have masked a true effect between urban and rural individuals. Finally, the nature of care delivery for this sample may not be generalizable to what is currently done in other settings. While all sleep testing was interpreted by sleep specialists, it is notable that only 8% of individuals in this study followed the specialist pathway. In other words, 92% of patients received OSA-related counseling and CPAP instruction from respiratory homecare providers without interacting with a specialist. Many health systems, particularly those in the United States, rely much more heavily on specialist consultation.22 As specialists are more likely to be isolated to urban areas,3,4,17 it is possible that a more specialist-dependent model could lead to worse adherence for patients in rural areas.Patients in rural areas face numerous barriers that limit access to services. However, the findings of Dr. Corrigan and colleagues provide some reassurance that these barriers do not necessarily translate to lower success with CPAP. Their results should give us some hope that barriers are not insurmountable. While causation cannot be directly inferred, it is important to contextualize these findings in the setting of modern technologies and systems of care that promote geographic reach.23 Innovations in remote care (eg, telemonitoring) emerged after decades of work and reinforce that, with concerted effort, creativity, and research, our field can adapt pathways to overcome access barriers. We should keep this in mind as we strive for equitable delivery of care in other areas, including addressing persistent racial, ethnic, and socioeconomic disparities in adherence.24,25DISCLOSURE STATEMENTDr. Donovan received support during the period of this work from VA Health Services Research & Development CDA 18-187 and IIR 20-240. The views expressed in this article are those of the author and do not necessarily represent the views of the US Department of Veterans Affairs. The author reports no conflicts of interest.REFERENCES1. Pack AI. Sleep-disordered breathing: access is the issue. Am J Respir Crit Care Med. 2004;169(6):666–667. CrossrefGoogle Scholar2. Benjafield AV, Ayas NT, Eastwood PR, et al.. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7(8):687–698. CrossrefGoogle Scholar3. Allen AJMH, Amram O, Tavakoli H, Almeida FR, Hamoda M, Ayas NT. Relationship between travel time from home to a regional sleep apnea clinic in British Columbia, Canada, and the severity of obstructive sleep. Ann Am Thorac Soc. 2016;13(5):719–723. CrossrefGoogle Scholar4. Kirsh S, Su GL, Sales A, Jain R. Access to outpatient specialty care: solutions from an integrated health care system. Am J Med Qual. 2015;30(1):88–90. CrossrefGoogle Scholar5. Spagnuolo CM, McIsaac M, Dosman J, Karunanayake C, Pahwa P, Pickett W. Distance to specialist medical care and diagnosis of obstructive sleep apnea in rural Saskatchewan. Can Respir J. 2019;2019:1683124. CrossrefGoogle Scholar6. Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2019;15(2):301–334. LinkGoogle Scholar7. Aloia MS, Di Dio L, Ilniczky N, Perlis ML, Greenblatt DW, Giles DE. Improving compliance with nasal CPAP and vigilance in older adults with OAHS. Sleep Breath. 2001;5(1):13–21. CrossrefGoogle Scholar8. Aloia MS, Arnedt JT, Strand M, Millman RP, Borrelli B. Motivational enhancement to improve adherence to positive airway pressure in patients with obstructive sleep apnea: a randomized controlled trial. Sleep. 2013;36(11):1655–1662. CrossrefGoogle Scholar9. Richards D, Bartlett DJ, Wong K, Malouff J, Grunstein RR. Increased adherence to CPAP with a group cognitive behavioral treatment intervention: a randomized trial. Sleep. 2007;30(5):635–640. CrossrefGoogle Scholar10. Hoy CJ, Vennelle M, Kingshott RN, Engleman HM, Douglas NJ. Can intensive support improve continuous positive airway pressure use in patients with the sleep apnea/hypopnea syndrome? Am J Respir Crit Care Med. 1999;159(4 Pt 1):1096–1100. CrossrefGoogle Scholar11. Hwang D, Chang JW, Benjafield AV, et al.. Effect of telemedicine education and telemonitoring on CPAP adherence: The Tele-OSA Randomized Trial. Am J Respir Crit Care Med. 2017. Google Scholar12. Pew Research Center. For 24% of rural Americans, high-speed internet is a major problem. https://www.pewresearch.org/fact-tank/2018/09/10/about-a-quarter-of-rural-americans-say-access-to-high-speed-internet-is-a-major-problem/. Accessed January 28, 2022. Google Scholar13. Semega J, Kollar M, Shrider EA, Creamer JF. Income and Poverty in the United States. 2019: 88; revised September 2021. https://www.census.gov/content/dam/Census/library/publications/2020/demo/p60-270.pdf. Accessed February 3, 2022. Google Scholar14. USDA Economic Research Service. Rural Education. https://www.ers.usda.gov/topics/rural-economy-population/employment-education/rural-education/ Accessed January 27, 2022. Google Scholar15. Palm A, Grote L, Theorell-Haglöw J, et al.. Socioeconomic factors and adherence to CPAP: the population-based course of disease in patients reported to the Swedish CPAP Oxygen and Ventilator Registry Study. Chest. 2021;160(4): 1481–1491. CrossrefGoogle Scholar16. Platt AB, Kuna ST, Field SH, et al.. Adherence to sleep apnea therapy and use of lipid-lowering drugs: a study of the healthy-user effect. Chest. 2010;137(1):102–108. CrossrefGoogle Scholar17. Corrigan J, Tsai WH, Ip-Buting A, et al.. Treatment outcomes among rural and urban patients with obstructive sleep apnea: a prospective cohort study. J Clin Sleep Med. 2022;18(4):1013–1020. LinkGoogle Scholar18. Statistics Canada. Population Centre and Rural Area Classification 2016. 2017. https://www.statcan.gc.ca/en/subjects/standard/pcrac/2016/index. Accessed January 25, 2022. Google Scholar19. Jordan S, Watkins A, Storey M, et al.. Volunteer bias in recruitment, retention, and blood sample donation in a randomised controlled trial involving mothers and their children at six months and two years: a longitudinal analysis. PLoS One. 2013;8(7):e67912. CrossrefGoogle Scholar20. Ganguli M, Lytle ME, Reynolds MD, Dodge HH. Random versus volunteer selection for a community-based study. J Gerontol A Biol Sci Med Sci. 1998;53(1):M39–M46. CrossrefGoogle Scholar21. Drager LF, Brunoni AR, Jenner R, Lorenzi-Filho G, Benseñor IM, Lotufo PA. Effects of CPAP on body weight in patients with obstructive sleep apnoea: a meta-analysis of randomised trials. Thorax. 2015;70(3):258–264. CrossrefGoogle Scholar22. Watson NF, Rosen IM, Chervin RD; Board of Directors of the American Academy of Sleep Medicine. The past is prologue: the future of sleep medicine. J Clin Sleep Med. 2017;13(1):127–135. LinkGoogle Scholar23. Shamim-Uzzaman QA, Bae CJ, Ehsan Z, et al.. The use of telemedicine for the diagnosis and treatment of sleep disorders: an American Academy of Sleep Medicine update. J Clin Sleep Med. 2021;17(5):1103–1107. LinkGoogle Scholar24. Billings ME, Cohen RT, Baldwin CM, et al.. Disparities in sleep health and potential intervention models: a focused review. Chest. 2021;159(3):1232–1240. CrossrefGoogle Scholar25. Borker PV, Carmona E, Essien UR, et al.. Neighborhoods with greater prevalence of minority residents have lower continuous positive airway pressure adherence. Am J Respir Crit Care Med. 2021;204(3):339–346. CrossrefGoogle Scholar Next article FiguresReferencesRelatedDetails Volume 18 • Issue 4 • April 1, 2022ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationJanuary 31, 2022Submitted in final revised formJanuary 31, 2022Accepted for publicationJanuary 31, 2022Published onlineApril 1, 2022 Information© 2022 American Academy of Sleep MedicinePDF download

Methodological approach to risk prediction noncompliance in patients with myocardial infarction

Aim. To develop a methodological approach in order to predict the risk of noncompliance in patients with myocardial infarction.Methods. 416 patients were questioned in the single-centered, prospective, non-randomized study using the original author's method. The patients were treated in specialized cardiological departments of the city of Kemerovo with the diagnosed myocardial infarction. The methodological approach to predicting the risk of non-compliance in patients with myocardial infarction covered 29 factors in 6 main blocks: sociodemographic and socio-economic characteristics, health status, medical and pharmaceutical culture of the patient, awareness of medical and pharmaceutical services, patient adherence to medical recommendations.Results. Patients with myocardial infarction were characterized by insufficient adherence to the therapy, low awareness of the disease, which can negatively affect the longterm disease prognosis. The identification of a large number of subjective factors limiting adherence to the therapy is the reason for the widespread use of noncompliance risk measurement among patients with myocardial infarction, which will allow determining the range of the risk group for each individual patient.Conclusion. The adherence to the treatment of patients with myocardial infarction is revealed as 80% which is indicated as low and requires the prophylactic use of educational and psychological programs that increase medical and social awareness and readiness to comply with the doctor's recommendations, and also justifies the need for complex risk measurement of non-compliance patients for personalized identification and addressing risk factors for poor adherence to therapy. 

Barriers to Completing Therapy for Hepatitis C with Direct-Acting Antivirals: A Real-Life Experience from a Single Treatment Center in Egypt.

IntroductionInterferon-based therapies against the hepatitis C virus had a poor adherence profile. On the other hand, new direct-acting antivirals (DAAs) are orally administered medications, show high efficacy against the hepatitis C virus in addition to a high safety profile. Therefore, adherence to this treatment is expected to improve. Assessment for treatment adherence is mandatory to assess the feasibility of achieving viral hepatitis elimination.AimThe study aims to assess the adherence rate and causes of non-adherence in Egyptian hepatitis C patients who received interferon-free treatment regimens.MethodsRetrospective data analysis for 668 hepatitis C patient’s records from August 2014 to October 2019 was done. Assessment of treatment adherence was done by revising the records and phone calls. However, 172 patients were excluded due to the absence of contact data. Rest of patients (n = 496) was categorized into 2 groups: Adherent (n = 432) and non-adherent (n = 64). For whom comparative analysis was done.ResultsThe adherent group (87%) achieved 100 % sustained virological response after 12 weeks (SVR 12). Non-adherence was reported in 12.9% of patients. Low awareness was the main cause of non-adherence (43.75%). BMI was the only significant risk factor for poor adherence (P = .04). Other Patient demographics, clinical, and laboratory data didn’t show any significant differences between both groups.ConclusionInterferon-free regimens are tolerable. Raising awareness is mandatory for proper treatment adherence and, subsequently, good clinical outcomes.

Psychosocial Predictors of Glaucoma Medication Adherence Among the Support, Educate, Empower (SEE) Personalized Glaucoma Coaching Pilot Study Participants

To evaluate the association between baseline psychosocial milieu and subsequent glaucoma medication adherence among participants in the Support, Educate, Empower (SEE) personalized glaucoma coaching program pilot study. Prospective cohort study. Participants (University of Michigan glaucoma patients aged ≥40 years, taking ≥1 glaucoma medication, who self-reported poor adherence) completed a baseline survey that assessed the following: (1) demographics; (2) social network; (3) perceived stress; (4) consideration of future consequences; (5) glaucoma-related distress; and (6) social support. Medication adherence was then monitored electronically for 3months and the percentage of prescribed doses taken was calculated. The relationship between baseline factors and medication adherence was assessed using univariate and multivariate analysis. Main outcome measure was median percent adherence over 3months. Of the 95 study participants, 63% had graduated from college, 55% were white, 35% were African-American, and 97% had insurance. Median adherence over 3months was 74% ± 21% (±standard deviation, SD). Higher income and more education were significantly associated with better adherence (P < .0001, P= .03). Glaucoma-related distress (mean score 5.6, SD= 3.0) was inversely associated with medication adherence on univariate (P < .0001) and multivariate analysis (P= .0002). Every 1-point increase in glaucoma-related distress score predicted a 2.4-percentage-point decrease in medication adherence. Lower income, lower educational attainment, and a higher level of glaucoma-related distress all predicted lower adherence to glaucoma medications. Additional glaucoma self-management support resources should be directed toward patients with such risk factors for poor adherence.

Medication Adherence Across the Life Span in Inflammatory Bowel Disease: Implications and Recommendations for Nurses and Other Health Providers.

This article reviews the differences and similarities in medication adherence between adolescent and adult cohorts with inflammatory bowel disease. The review covers the rates of medication adherence, as well as predictors, consequences, and related interventions. Rates of adherence were more favorable among adolescents (65%-90%) than among adults (55%-70%). Major risk factors for poor adherence in adolescents include low medication knowledge, not establishing good medication habits initially, and peer victimization with low social support. For adults, nonadherence is more frequently unintentional (e.g., forgetting) and occurs more often in the context of a poor-quality patient-physician relationship, low medication knowledge, infrequent/missed appointments, busy lifestyle, and concurrent mental health concerns. Nonadherence to medication is associated with worsening of symptoms and risk of relapse in adults and adolescents. Nurses can play a significant role in influencing adherence to medication in patients with inflammatory bowel disease. In particular, nurses can help to impart knowledge on the importance of medication and identify factors that may help or hinder an individual in terms of adherence. Based on the current review, implications for practice and recommendations for nurses to promote medication adherence across both adolescent and adult cohorts are provided. Limitations of the currently available evidence and suggestions for future research are discussed.

Compliance to the secondary prophylaxis and awareness of rheumatic heart disease: A cross-sectional study in low-income province of India.

Background:Rheumatic heart disease is a preventable problem and regular secondary prophylaxis and proper awareness about this disease among common people may reduce the burden of this disease in any region.Objectives:To find out compliance to the secondary prophylaxis of Rheumatic heart disease and awareness about this disease among common people of Bihar.Methodology:This was a questionnaire based cross sectional study to find out compliance to the secondary prophylaxis and awareness of Rheumatic heart disease, conducted at two tertiary care referral hospitals of Bihar.Result:19/41 (46%) study participants were non-compliant to regular secondary prophylaxis. Most of the participants (34/42,81%) had poor knowledge of Rheumatic heart disease. Low socioeconomic condition was not a statistically significant risk factor for poor adherence to the secondary prophylaxis (odds ratio-5.29,95% CI- 0.55-50.08, P-0.11). Low level of education was not a statistically significant risk factor for poor awareness as compared to the participants with education of 10th standard or above (odds ratio 4.0, 95% CI- 0.65-24.24, P- 0.15).Conclusion:Approximately half of the participants of this study were non-compliant to the regular secondary prophylaxis of rheumatic heart disease and most of them had poor awareness of this disease. Ensuring regular secondary prophylaxis and improving awareness to Rheumatic heart disease among common people may reduce its prevalence in regions with significant burden of Rheumatic heart disease.

What are the risk factors of poor medication adherence in the target-to-treat era?

This study aims to identify adherence rate and risk factors of poor adherence in patients with tightly controlled rheumatoid arthritis (RA) based on the treat-to-target (TTT) strategy. In this cross-sectional, observational study, a total of 103 patients (22 males, 81 females; mean age 58.6±9.5 years; range, 35 to 76 years) with tightly controlled RA between November 2016 and May 2017 were included. The patients were evaluated in terms of sociodemographic features, smoking and alcohol drinking status, body mass index (BMI), Disease Activity Score 28 (DAS28), and clinical and medication data. They filled out a series of standardized questionnaires including the Morisky 8-item Medication Adherence Scale (MMAS-8), Beck Depression Inventory (BDI), Mini-Mental State Examination (MMSE), and Health Assessment Questionnaire-Disability Index (HAQ-DI). Multiple multivariate linear regression analysis was used to identify variables which were possibly associated with the MMAS-8. Of the patients, 53 (51.5%) were non-adherent and 50 (48.5%) were adherent to medication. The DAS28-erythrocyte sedimentation rate, mean DAS28, HAQ, BDI scores, and the number of visits were higher and the MMSE scores were lower in non-adherent patients than adherent patients. In the linear multivariate analysis, significant associations were found between the MMAS-8 and MMSE, BDI, DAS28, and mean DAS28 scores. Our study results show that the medication adherence rate is significantly higher compared to previous studies and high disease activity, depression, and cognitive dysfunction significantly affect medication adherence in this patient population.

Cognitive Impairment Is Independently Associated with Non-Adherence to Antithrombotic Therapy in Older Patients with Atrial Fibrillation

Atrial Fibrillation (AF) patients could reduce their risk of stroke by using oral antithrombotic therapy. However, many older people with AF experience cognitive impairment and have limited health literacy, which can lead to non-adherence to antithrombotic treatment. This study aimed to investigate the influence of cognitive impairment and health literacy on non-adherence to antithrombotic therapy. The study performed a secondary analysis of baseline data from a cross-sectional survey of AF patients’ self-care behaviors at a tertiary university hospital in 2018. Data were collected from a total of 277 AF patients aged 65 years and older, through self-reported questionnaires administered by face-to-face interviews. Approximately 50.2% of patients were non-adherent to antithrombotic therapy. Multiple logistic regression analysis revealed that cognitive impairment independently increased the risk of non-adherence to antithrombotic therapy (odds ratio = 2.628, 95% confidence interval = 1.424–4.848) after adjustment for confounding factors. However, health literacy was not associated with non-adherence to antithrombotic therapy. Cognitive impairment is a significant risk factor for poor adherence to antithrombotic therapy. Thus, health professionals should periodically assess both cognitive function after AF diagnosis and adherence to medication in older patients. Further studies are needed to identify the factors that affect cognitive decline and non-adherence among AF patients.

ПРИВЕРЖЕННОСТЬ ЛЕЧЕНИЮ ВИЧ-ИНФИЦИРОВАННЫХ ПАЦИЕНТОВ С ЗАВИСИМОСТЬЮ ОТ ОПИОИДОВ

Background.&nbsp;Low commitment in HIV-infected patients with opioid dependence (PHOD) leads to a progression of HIV, its distribution, heavy medical and social consequences. The aim is to study risk factors for poor adherence to treatment in HIV-infected drug users. Material and methods. Study of risk factors for poor adherence to treatment among 213 PHOD. The socio-demographic data of respondents, their attitude to the problem, treatment of combined pathology, the level of awareness of the consequences of HIV infection combined with opioid dependence, the nature of social functioning, criminal activity, risk behavior and the organization of medical care for PHOD. The results. The level of medication adherence associated with the ability of PHOD to critically assess their disease state and its consequences (OR=2,5; 95% CI [1,5-4,1]; p&lt;0.05; χ2=14,7; p&lt;0.001; R=0.2), belief in treatment success (OR=2,5; 95% CI [1,5-4,0]; p&lt;0.05; χ2=14,5; p&lt;0,001; R=0.2), the nature of drug use and effectiveness of ART (OR=5,8; 95% CI [3,5-9,8]; p&lt;0.05; χ2=49,9; p&lt;0.001; R=0.5), the problematic of SF (OR=2,3; 95% CI [1,4-3,7]; p&lt;0.05; χ2=11,4; p&lt;0.001; R=0.2), criminal activity (OR=3,2; 95% CI [1,9-5,1]; p&lt;0.05; χ2=23,4; p&lt;0.001; R=0,1), risky behavior (OR=6,7; 95% CI [3,1-14,5]; p&lt;0.05; χ2=28.5; p&lt;0.001; R=0.3) and organization of medical care (OR=2.2; 95% CI [1.3-3.5]; p&lt;0.05; χ2=9.96; p&lt;0.002; R=0.2). Conclusions. The low level of adherence to treatment in PHOD is associated with a low ability to critically assess the painful condition and its consequences, lack of confidence in the success of treatment, active drug use and low efficiency of ART, problem SF, criminal activity, risky behavior and poor quality of medical care. The knowledge of PHOD about the consequences of combined pathology not so much influenced, but reflected the tendency to influence treatment adherence.

Factors Affecting Adherence to Topical Glaucoma Therapy: A Quantitative and Qualitative Pilot Study Analysis in Sydney, Australia

To assess which factors in the lives and disease of patients with glaucoma affect their adherence to topical glaucoma therapy and the quantitative significance of this effect. To assess qualitatively the most influential barriers to adherence from the perspective of the patient. Multicenter, prospective, cross-sectional pilot study. A total of 145 patients, attending outpatient metropolitan glaucoma clinics in Sydney, Australia, who were prescribed topical glaucoma medications. A structured interview-based questionnaire was conducted with 145 individuals using glaucoma eye drops that had been prescribed at least 2 weeks previously. The questionnaire involved 2 novel questions on adherence, 29 questions on factors identified or postulated in the literature as affecting adherence for quantitative analysis, and 1 open-response question on patient-identified causes of nonadherence for qualitative analysis. This questionnaire represents the broadest coverage of factors hypothesized to affect adherence in a single study in the glaucoma medication adherence literature to date. Adherence rate, risk factors for poor adherence, and patient-identified barriers to adherence. In response to the question "How many days have you missed a drop in the last 2 weeks," 69.7% of patients reported total adherence. Four factors were significantly related to an increased likelihood of reporting having missed drops in the last 2 weeks. These were difficulty applying drops (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.02-5.44; P < 0.05), a past or current diagnosis of depression (OR, 3.61; 95% CI, 1.53-8.52; P < 0.01), patient self-rating of own memory ≤ 7 of 10 (OR, 3.15; 95% CI, 1.36-7.30; P < 0.01), and self-reported motivation score ≤ 6 of 10 (OR, 10.94; 95% CI, 3.00-39.81; P < 0.01). Patient understanding of glaucoma, ethnicity, and socioeconomic status were among the 25 factors found not to have a statistically significant correlation with adherence. There is a significant proportion of patients taking their topical glaucoma medications less often than prescribed. Adherence to topical glaucoma therapies is negatively correlated to several factors: difficulty applying drops, a past or current diagnosis of depression, poor self-rating of own memory, and poor self-rating of own motivation. These may prove useful in designing interventions to improve adherence in these patients.

Polypharmacy and Psychological Distress May Be Associated in African American Adults.

Background: Compared to Whites, African Americans are at a higher risk of multiple chronic conditions, which places them at a higher risk of polypharmacy. Few national studies, however, have tested whether polypharmacy is associated with psychological distress—the net of socioeconomic status, health status, and stress—in African Americans. Aims: In a national sample of African Americans in the US, this study investigated the association between polypharmacy and psychological distress. Methods: The National Survey of American Life (NSAL, 2003) included 3570 African American adults who were 18 years or over. This number was composed of 2299 women and 1271 men. Polypharmacy (using ≥ 5 medications) and hyper-polypharmacy (using ≥ 10 medications) were the independent variables. Psychological distress was the dependent variable. Age, gender, socioeconomic status (education attainment, income, employment, and marital status), health care access (insurance status and usual place of care), and health status (multimorbidity and psychiatric disorders) were the covariates. Linear multivariable regression was applied to perform the data analysis. Results: Both polypharmacy and hyper-polypharmacy were associated with psychological distress. This association was significant after controlling for all the covariates. Conclusions: African Americans with polypharmacy, particularly those with hyper-polypharmacy, are experiencing higher levels of psychological distress, which itself is a known risk factor for poor adherence to medications. There is a need for a comprehensive evaluation of medications as well as screening for psychopathology in African Americans with multiple medical conditions.

Predictive factors of adherence to urinary self-catheterization in older adults.

The primary aim is to explore the adherence predicting factors in clean intermittent self-catheterization (CISC) in patients aged over 65 years. The secondary aim is to assess whether in this population, the non-adherence risk is greater, compared with patients under 65. All patients older than 65 that successfully learned CISC between January 2011 and January 2016 were included. A control population younger than 65 matched with sex, body mass index, and pathology was selected. One hundered and thirteen (66.9%) out of the 169 patients older than 65 included were adherent at 1 month, and 80 (47.3%) at 6-12 months. Obesity (P = 0.027), a low PP test (Pencil and Paper test) score (P = 0.037), significant urinary stress incontinence (SUI) (P = 0.048), and prescription of CISC less than three per day (P = 0.03) were the risk factors predicting stopping CISC at 1 month, but none was associated with non-adherence at 6-12 months. Compared with the younger group, age was a risk factor for poor adherence at 1 month. Obesity, low PP test score, and important SUI are factors of poor adherence to CISC at 1 month in older adults. Necessity of more than three CISC per day is in favor of treatment continuation, possibly due to absence of spontaneous voiding in these patients. Long-term adherence to CISC in older adults in this study remains close to adherence to other treatments prescribed in urinary disorders, and thus shows that CISC could be an easily purposed therapeutic option in this population, either on a long-term or transitory basis.

Poor adherence is a contributor to viral breakthrough in patients with chronic hepatitis B.

ObjectiveThe objective of this study was to explore the risk factors of poor adherence of nucleoside analogs (NUC) treatment in chronic hepatitis B (CHB) patients and the virological changes in patients with poor adherence.Subjects and methodsA total of 205 CHB patients were enrolled. The patients’ demographic data and family history were collected. NUC adherence was calculated every 12 weeks as follows: number of NUC tablets taken by the patients was divided by the number of NUC tablets prescribed. NUC adherence > 90% was defined as good adherence of NUC treatment.ResultsNUC adherence of male patients was significantly lower than that of female patients. Adherence among patients with previous NUC treatment was poorer than that of patients without previous NUC treatment. Multivariate analysis indicated that female gender (OR =0.367, P=0.013) was the protective factor for NUC adherence in CHB patients, while pretreatment with NUC was the risk factor for NUC adherence (OR =3.209, P=0.002). A total of six patients in the good adherence group experienced virological breakthroughs while 15 of 77 patients in the poor adherence group experienced virological breakthroughs (P=0.001). Similar trends were observed in NUC resistance. Four of the 128 patients with good adherence developed NUC resistance while nine of the 77 patients with poor adherence developed resistance (P=0.015). Multivariate analysis suggested that pretreatment with NUC (OR =3.133, P=0.031), NUC drugs (OR = 3.951, P=0.010), and adherence (OR =2.749, P=0.046) were independent risk factors associated with virological breakthroughs and that NUC drugs (OR =7.083, P=0.005) and poor adherence (OR =4.951, P=0.009) were independent risk factors for NUC resistance.ConclusionMale gender and pretreatment with NUC were risk factors associated with NUC adherence. Poor NUC adherence is more likely to induce virological breakthroughs and NUC resistance. For patients with poor NUC adherence, it is necessary to give timely education to improve treatment adherence.

Using a composite adherence tool to assess ART response and risk factors of poor adherence in pregnant and breastfeeding HIV-positive Cameroonian women at 6 and 12\xa0months after initiating option B+

BackgroundAntiretroviral therapy (ART) adherence in preventing HIV mother-to-child transmission in association with virological suppression and risk factors of low adherence in the Cameroon’s Option B+ programme are poorly understood. We used a composite adherence score (CAS) to determine adherence and risk factors of poor adherence in association with virological treatment response in HIV-positive pregnant and breastfeeding women who remained in care at 6 and 12 months after initiating ART.MethodsWe prospectively enrolled 268 women after ART initiation between October 2013 and December 2015 from five facilities within the Kumba health district. Adherence at 6 and 12 months were measured using a CAS comprising of a 6-month medication refill record review, a four-item self-reported questionnaires and a 30-day visual analogue scale. Adherence was defined as the sum scores of the three measures and classified as high, moderate and low. Measured adherence levels were compared to virological suppression rates at month 12 and risk factors of poor adherence were determined.ResultsAt 6 and 12 months, 217 (81.0%) and 185 (69.0%) women were available for adherence evaluation. Respectively. Of those, 128 (59.0%) and 68 (31.4%) had high or moderate adherence as per the CAS tool at month 6, and 116 (62.7%) and 48 (24.9%) at month 12, respectively. Viral loads were assessed in 165 women at months 12, and 92.7% had viral suppression (< 1000 copies/mL). Viral suppression was seen in 100% of women with high, 89.5% with moderate, and 52.9% with low adherence using the CAS tool. Virological treatment failure was significantly associated with low adherence [OR 7.6, (95%CI, 1.8–30.8)]. Risk factors for low adherence were younger age [aOR 3.8, (95%CI, 1.4–10.6)], primary as compared to higher levels of education [aOR 2.7, (95%CI, 1.4–5.2)] and employment in the informal sector compared to unemployment [aOR 1.9, (95%CI,1.0–3.6)].ConclusionsDuring the first year of Option B+ implementation in Cameroon our novel CAS adherence tool was feasible, and useful to discriminate ART adherence levels which correlated with viral suppression. Younger age, less educated and informal sector employed women may need more attention for optimal adherence to reduce the risk of virological failure.