Self-reported Adherence Questionnaire Research Articles

OA40 Clinical and psychological factors associated with adherence based on a patient self-reported questionnaire: results from the biologics in rheumatoid arthritis genetics and genomics study syndicate (BRAGGS) cohort

Abstract Background/Aims To explore the relationship of clinical and psychological factors with adherence based on a patient self-reported questionnaire from a prospective longitudinal study of patients receiving TNFi biologic treatment for rheumatoid arthritis, recruited since 2008. Methods Analysis of data collected from a prospective longitudinal UK study (Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate [BRAGGSS]) of patients with moderate to severe RA commencing TNFi biologic treatment. Clinical data including Disease Activity Score-28 (DAS28), serological status (Rheumatoid Factor positivity) and body mass index (BMI) were collected. Patients also completed self-reported questionnaires, the health assessment questionnaire (HAQ), hospital anxiety and depression scale (HAD), beliefs about medicine questionnaire (BMQ), brief illness perception score (B-IPQ) and a self-reported adherence questionnaire. Adherence was defined as any deviation from prescribed medication regime such as altering the dose, forgetting a dose, stopping treatment, missing a dose, and taking less than instructed. Associations between demographic and psychological variables and adherence were evaluated using regression models and a multivariable logistic regression model was used to further evaluate associations, controlling for BMI. Results 1,513 patients (75.7% female, age 58.1 [IQR 16.0], disease duration 9.6 ± 9.6 years and pre-treatment DAS28 scores 5.7 ± 0.8) were included. 70% of patients self-reported adherence to their medication. When comparing the different TNFi treatments, etanercept had the lowest levels of adherence at the 3 and 6 month time-points. Adherence was higher in those with older age (β = 0.03, p< 0.01), higher baseline CRP levels (β = 0.01, p= 0.03) and higher necessity beliefs (β = 0.04, p= 0.03). Adherence was lower in those with higher tender joint counts at baseline (β=-0.03, p= 0.04) and 3 months (β = 0.03, p= 0.02) (Table I). These associations persisted after controlling for the effects of BMI using a multivariable logistic model. Conclusion Self-reported adherence was 70% in this BRAGGS population. Factors associated with non-adherence included higher tender joint counts and lower necessity beliefs pre-treatment, which may allow targeting of interventions to optimise adherence in these groups. Disclosure T.K.Y. Chong: None. N. Nair: None. A.W. Morgan: None. J.D. Isaacs: None. A.G. Wilson: None. K.L. Hyrich: Honoraria; Abbvie. Grants/research support; K.H has grants from BMS and Pfizer. D. Plant: None. A. Barton: Grants/research support; A.B has received funding/speaker fees from BMS, Pfizer and Galapagos.

Implementing a self-reported immunosuppression adherence questionnaire to screen for non-adherence in routine care of kidney transplant recipients.

Self-reported measures of immunosuppression adherence have been largely examined in research settings. In this single center study of 610 kidney transplant recipients, we examined if a voluntary, non-anonymous self-report measure could identify non-adherence in a routine clinic setting and how patients perceived such a measure. Non-adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) and patient perception was elicited using a customized questionnaire. Non-responders to the survey (15%) were younger, more likely to be black, and less likely to have had a pre-emptive transplant. Among complete responders (n=485), 38% reported non-adherence with non-adherent patients being younger (54y vs. 60y; p=.01), less likely to have been on dialysis pre-transplant (59%vs. 68%; p=.04), further out from transplant (37vs. 22 months; p<.001) and had more rejections in the preceding year (8%vs. 3%; p=.02). Self-reported non-adherence was associated with higher calcineurin inhibitor intra-patient variability (27.4%vs. 24.5%; p=.02), but not with donor-specific antibody detection (27.8%vs. 21.2%, p=.15). Of patients providing feedback (n=500), the majority of patients felt comfortable reporting adherence (92%), that the survey was relevant to their visit (71%), and that the survey did not interfere with their clinic visit (88%). In summary, a self-reported questionnaire during clinic visits identified immunosuppression non-adherence in a significant proportion of patients and was well received by patients. Integrating self-report measures into routine post-transplant care may enable early identification of non-adherence.

P084 The relationship between self-reported adherence, drug levels and tumour necrosis factor inhibitor response in psoriatic arthritis

Abstract Background/Aims It is not currently possible to accurately predict tumour necrosis factor inhibitor (TNF-i) response in psoriatic arthritis (PsA). In rheumatoid arthritis, suboptimal adherence to TNF-i and reduced drug levels have been associated with decreased response. Suboptimal treatment adherence (16%-81%) has been reported in PsA although little is known about the impact on TNF-i response. Self-reported adherence may be biased, but direct drug measurements offer an objective adherence evaluation. The objective of this study is to assess the relationship between self-reported adherence, drug levels, and drug response to TNF-i in PsA. Methods Blood samples and adherence questionnaires were collected at 3, 6 and 12 months for PsA patients prescribed biologic or targeted synthetic anti-rheumatic drugs in a UK multi-centre observational study (OUTPASS). Self-reported adherence was measured using two previously validated questionnaires (MARS5 and Treatment). Adherence was classified as self-reporting never missing or delaying a dose, unless medically advised. Adalimumab (ADA) and etanercept (ETN) drug levels were measured at 3 and 6 months using commercially available ELISAs. Clinical response was assessed using PsARC and ΔDAS28 between baseline and 3, 6 and 12 months. Univariate regression and general estimating equations were used to assess associations across timepoints. Results In the OUTPASS cohort (46% ADA, 40% ETN), 42% of patients self-reported non-adherence within the first 12 months of treatment. Patients with self-reported non-adherence at 6 months using the MARS5 questionnaire were significantly less likely to achieve a PsARC response at 6 months [odds ratio (OR)=0.40, P = 0.047] in univariate regression. Non-adherence, reported using the Treatment questionnaire, was associated with decreased PsARC response over 12 months [OR = 0.52, P = 0.031]. There was no association (P &amp;gt; 0.05) between whether a patient returned a self-reported adherence questionnaire and response. Drug levels at 3 months (n = 70 (ADA), 73 (ETN)) were associated with drug levels at 6 months (n = 61 (ADA), 67 (ETN)) for both ADA [β = 0.47, P = 0.001] and ETN [β = 0.41, P = 0.018] paired samples. Higher 3-month ADA levels were associated with increased ΔDAS28 response at 3 months [β = 0.11, P = 0.036] and PsARC response at 12 months [OR = 1.39, P = 0.028]. Higher 3-month ETN levels were associated with increased PsARC response at 3 months [OR = 1.50, P = 0.026]. Increased ADA levels were associated with improved ΔDAS28 over 12 months [β = 0.07, P = 0.001] and higher ETN levels associated with enhanced PsARC response [OR = 1.17, P = 0.022] over 12 months. Levels of neither drug were associated (P &amp;gt; 0.05) with any self-reported adherence measures at any time point. Conclusion There was no association between self-reported adherence and TNF-i drug levels in ADA or ETN-treated PsA patients. Objectively measured adherence via drug level measurements were more strongly associated with drug response than self-reported measures, particularly using ΔDAS28 as the measure of response. Disclosure P.D.K. Curry: None. A.P. Morris: None. M. Jani: None. H. Chinoy: Grants/research support; HC received grant support from Eli Lilly and UCB. A. Barton: Grants/research support; AB has received fees/grant awards from Galapagos, Scipher Medicine, Roche-Chugai, Pfizer and BMS. J. Bluett: Grants/research support; JB has received a research grant award from Pfizer. Other; JB has received travel/conference fees from UCB, Pfizer and Eli Lilly.

Evaluation of antiglaucoma drug treatment awareness and patient-reported medication adherence: Determinants of glaucoma management.

Primary open angle glaucoma (POAG) treatment is characterized by long-duration therapy, prescription variability, and non-adherence. Patient awareness toward drug treatment is crucial to ensure adherence. The present study was planned to evaluate drug treatment awareness, patient-perceived drug adherence, and prescription patterns in POAG patients. This was a cross-sectional, single-center, questionnaire-based study conducted in the ophthalmology out patient department of a tertiary care hospital from April 2020 to November 2021. Patients of either gender, aged 40-70 years, with a confirmed diagnosis of POAG, who had records of POAG medications for at least last 3 months and who provided written informed consent, were included. Prescription details were recorded, and subsequently, patients were administered a pre-validated drug treatment awareness (14 items) questionnaire, a self-reported medication adherence (9-item) questionnaire, and then they performed eye drop instillation in a simulated setting. The total number of patients enrolled was 180, which yielded 200 prescriptions. The mean drug treatment awareness score was 8.18 ± 3.30, and 135 (75%) patients scored more than 50% (≥7/14). Similarly, 159 patients (83.33%) had scored >50% (i.e. >5/9), with a mean score of 6.30 ± 1.70 in the medication treatment adherence questionnaire. The mean eye drop instillation performance score was 7.18 ± 1.20. The 200 POAG prescriptions containing 306 drugs were analyzed, with beta blockers (184/200, 92%) and timolol (168/200, 84% encounters) being the highest prescribed classes/drugs. POAG patients did have adequate treatment awareness with good self-reported medication adherence and performance of eye drop instillation technique. Around 25% patients lacked awareness; hence, reinforcement education programs on medication regimens need to be implemented.

Using a generic quality of life measure to determine adherence thresholds: a cross-sectional study on older adults with neurological disorders in Germany

ObjectivesMeasuring the degree of adherence to medication is essential in healthcare However, the cut-offs provided for adherence scales are often arbitrary and disease-specific, and need to be validated against a...

1417. The Impact of Psychosocial Factors on ART Adherence is Mediated by Poverty in Older Adults Living With HIV

Abstract Background Despite decades of work evaluating multiple interventions to improve ART adherence, viral load suppression in the U.S. remains far below Ending the HIV Epidemic goals. Previous research demonstrates that income and other factors, including social well-being (SWB), resilience, and exercise, are correlated with ART adherence. However, it is unclear how these factors interact with income to impact adherence in older adults living with HIV (OALWH). Methods Self-reported outcome measures from the Aging with Dignity, Health, Optimism, and Community (ADHOC) cohort were collected from November 2017 to June 2019. Adherence was measured using the Brief Adherence Self-Report Questionnaire, depression using the Patient Health Questionnaire-2, SWB using the Functional Assessment of HIV Infection, and resilience using the Connor-Davidson Resilience Scale. Face-valid questions provided data on household income, race, sexual orientation, # of ART pills daily, and exercise. Linear regressions assessed the associations between these variables and adherence. Mediation analysis using bootstrapping assessed the significance of the mediation effects of income on these variables. Results For 1,039 ADHOC participants, average age was 59 years, 86% were male, 69% were White, and mean adherence was 96.2% (SD=11.2). In bivariate analyses, depression, SWB, exercise, resilience, White race, # ART pills daily, and sexual orientation were each significantly correlated with both ART adherence and income. Interestingly, depression, SWB, resilience, and exercise became non-significant predictors of adherence after adjusting for the effects of income. Mediation analysis with bootstrapping demonstrated significant causal mediation effects of income on depression and adherence (B=-0.14, 95% CI (-0.25 – -0.04)), SWB and adherence (B=0.03, 95% CI (0.01 – 0.05)), resilience and adherence (B=0.15, 95% CI (0.04 – 0.27)), and exercise and adherence (B=0.002, 95% CI (0.0007-0.003)). Conclusion In OALWH, household income mediates the relationship between ART adherence and depression, SWB, resilience, and exercise. Therefore, interventions to improve adherence must address the causal role of income and focus on providing low-income patients with economic support to help lift them out of poverty. Disclosures Peter J. Mazonson, MD, MBA, ViiV Healthcare: Grant/Research Support Maile Y. Karris, MD, Gilead Sciences: Grant/Research Support|Gilead Sciences: I have received honorarium to speak at conferences|ViiV Healthcare: Grant/Research Support Emily Huang, MPH, ViiV Healthcare: Grant/Research Support Jeff Berko, MPH, ViiV Healthcare: Grant/Research Support Frank Spinelli, MD, Gilead Sciences: Employee|ViiV Healthcare: former employee Andrew Zolopa, MD, ViiV Healthcare: full time employee|ViiV Healthcare: Stocks/Bonds.

The effects of continuous care model using a smartphone application on adherence to treatment and self-efficacy among patients with multiple sclerosis

BackgroundAdherence to disease-modifying therapy is important in patients with Multiple Sclerosis (MS) to increase the positive outcomes and improve the quality of life. This study aimed to determine the effects of Continuous Care Model (CCM) using a smartphone application on adherence to treatment and self-efficacy among MS patients.MethodsThis quasi-experimental study with pre/posttest design was conducted on 72 MS patients in Shiraz, Iran from June 2020 to August 2021. The samples were randomly assigned to intervention (n = 36) and control (n = 36) groups. In the intervention group, the CCM using a smartphone application was implemented during two months. However, no intervention was performed for the control group. The data were collected using the self-report Multiple Sclerosis Treatment Adherence Questionnaire (MS-TAQ) and MS Self-Efficacy Scale (MSSS) at baseline and two and four months after the intervention.ResultsThe results showed an improvement in adherence to treatment and self-efficacy in the intervention group compared to the control group after implementing the virtual CCM and at the two-month follow-up (p < 0.001).ConclusionsImplementing the CCM using a smartphone application resulted in improvements in the MS patients’ adherence to treatment and self-efficacy. It can be concluded that providing care using an interactive multimedia application can improve the outcomes as well as patients’ satisfaction, especially during the COVID-19 pandemic. Therefore, this approach is recommended to be used for nurses, healthcare providers, and clinicians.

Efficacy and safety of Efavirenz 400 mg-based regimens switching from 600 mg-based regimens in people living with HIV with virological suppression in China: a randomized, open-label, non-inferiority study

BackgroundEfavirenz (EFV) 400 mg has been recommended to replace EFV 600 mg. There are only 200 mg and 600 mg dosage forms of EFV in China. Whether switching from one-tablet EFV 600 mg to two-tablet EFV 200 mg would weaken adherence or further affect efficacy or safety is unknown. MethodsVirologically suppressed people living with HIV with a regimen composed of one-tablet tenofovir (TDF), one-tablet lamivudine (3TC), and one-tablet EFV (600 mg) were randomized to continue original regimen or switch to two-tablet EFV (200 mg). Self-reported adherence questionnaires, 12-Item Short-Form Health Survey (SF-12), Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index (PSQI) were used. Primary end point was the difference in proportions of participants with plasma HIV-RNA ≥ 50 copies/mL at week 48 with noninferiority margin of 4%. ResultsA total of 209 participants were randomized to the EFV 400 mg group and 211 to the EFV 600 mg. Primary end point result was −3.3% (95% CI −8.1–1.6). Further decrease of GGT (−3.1 vs. −0.3 U/L) and TC (−0.26 vs. 0.12 U/L) was observed in EFV 400 mg participants through 48 weeks. No significant changes in adherence, quality of life, and neuropsychologic condition were reported. ConclusionsEFV 400 mg was noninferior to EFV 600 mg and showed mild improvement of safety profile. Adherence was not weakened in patients taking EFV 400 mg. For patients taking EFV 600 mg with neuropsychologic symptoms, it would be better to switch to other drugs instead of EFV 400 mg.

461Alcohol use and anti-retroviral adherence among people living with HIV in ART centre of Nepal

Abstract Background Alcohol use is known to have higher prevalence among HIV infected individuals. Hazardous use of alcohol in many studies is negatively associated with the adherence to antiretroviral therapy. Use of alcohol and ART adherence among PLHIV is inadequately explored in Nepalese context. This study aimed at identifying the level of alcohol use and its relationship with adherence to ART among PLHIV. Methods A total of 205 PLHIV of age 18 years or more were randomly selected at a national ART centre of Nepal. Self-reported adherence questionnaire was used to get the level of adherence, Alcohol Use Disorder Identification Test (AUDIT) with five questions was adopted for screening the hazardous alcohol use. Those who took more than 95% of the prescribed doses were considered as adherent. Results About 86% of the respondents were adherent to ART in four days recall. About one third of the respondents were alcohol user and 40% of them had hazardous use of alcohol. Those having hazardous use of alcohol were four times (AOR=4.60, 95% CI 1.27,16.62) more likely to be non-adherent as compared to those who had not hazardous use of alcohol. Multivariate analyses adjusted ethnicity, Knowledge on dangers of non-adherence, subjective feeling of own health, use of memory aid, IDU background, treatment substitution and depression category. Conclusion Hazardous use of alcohol was independently associated with non-adherence with the ART. Key message Screening at the start of the treatment and intervention targeting alcohol use may improve HIV outcomes in individuals with hazardous alcohol use.

Long-term periodontal changes associated with oral appliance treatment of obstructive sleep apnea.

To characterize the mandibular anterior teeth crown height as a marker of periodontal changes and bone loss as a side effect of an oral appliance worn for a minimum of 4.5 years. This retrospective study conducted in patients with healthy baseline periodontium recruited participants among consecutive sleep apnea patients treated with an oral appliance between 2004 to 2014. Eligible participants were recalled for a follow-up visit at which a periodontal examination was performed and a lateral cephalogram and dental impressions were obtained. Clinical crown height for mandibular anterior teeth and cephalometric variables were measured and compared before and after treatment. A full periodontal evaluation was performed at the follow-up visit. Twenty-one patients enrolled with a mean treatment length of 7.9 ± 3.3 years. For the mandibular anterior teeth, clinical crown height did not change over the evaluated period. At follow-up, all the periodontal assessed variables were within normal limits, with the mean probing depth of 1.4 ± 0.5 mm, recession 0.6 ± 1.1 mm, and clinical attachment loss 0.8 ± 1.0 mm. Compared with baseline, there was a significant proclination of mandibular incisors (mean increase of 5.1 degrees) with the continued use of an oral appliance. Gingival levels were maintained with clinically insignificant changes during the observation period. Inclination of the mandibular incisors increases significantly with the use of an oral appliance in patients with obstructive sleep apnea. Positional changes in these teeth were not associated with any measured evidence of increase in clinical crown height or gingival recession. Heda P, Alalola B, Almeida FR, Kim H, Peres BU, Pliska BT. Long-term periodontal changes associated with oral appliance treatment of obstructive sleep apnea. J Clin Sleep Med. 2021;17(10):2067-2074.

Translating research into clinical practice: quality improvement to halve non-adherence to methotrexate.

ObjectiveMTX remains the cornerstone for therapy for RA, yet research shows that non-adherence is significant and correlates with response to therapy. This study aimed to halve self-reported non-adherence to MTX at the Kellgren Centre for Rheumatology.MethodsAn anonymous self-report adherence questionnaire was developed and data collected for 3 months prior to the introduction of interventions, and then regularly for the subsequent 2.5 years. A series of interventions were implemented, including motivational interviewing training, consistent information about MTX and development of a summary bookmark. Information on clinic times was collected for consultations with and without motivational interviewing. Surveys were conducted to ascertain consistency of messages about MTX. A biochemical assay was used to test MTX serum levels in patients at two time points: before and 2.8 years following introduction of the changes. Remission rates at 6 and 12 months post-MTX initiation were retrieved from patient notes and cost savings estimated by comparing actual numbers of new biologic starters compared with expected numbers based on the numbers of consultants employed at the two time points.ResultsBetween June and August 2016, self-reported non-adherence to MTX was 24.7%. Following introduction of the interventions, self-reported non-adherence rates reduced to an average of 7.4% between April 2018 and August 2019. Clinic times were not significantly increased when motivational interviewing was employed. Consistency of messages by staff across three key areas (benefits of MTX, alcohol guidance and importance of adherence) improved from 64% in September 2016 to 94% in January 2018. Biochemical non-adherence reduced from 56% (September 2016) to 17% (June 2019), whilst remission rates 6 months post-initiation of MTX improved from 13% in 2014/15 to 37% in 2017/18, resulting is estimated cost savings of £30 000 per year.ConclusionNon-adherence to MTX can be improved using simple measures including focussing on the adherence and the benefits of treatment, and providing consistent information across departments.

Psychosocial and Personal Level Circumstances Associated with Antiretroviral Therapy Non-adherence among HIV Positive Antiretroviral Therapy User Clients in Debre Birhan Referral Hospital

The purpose of the study was to examine psychosocial and personal level circumstances associated with ART non-adherence among HIV positive ART user clients in Debre Birhan referral hospital. This study used cross-sectional descriptive design. A total of 122 participants were selected through simple random and purposive sampling techniques. Adherence Attitude Inventory Scale and self-reported adherence questionnaire were administered. The result of chi square analysis revealed that social support, personal self-efficacy, age, marital status, religion, educational level and occupation had significant association with non-adherence at 95% CI, 6.371 (2, N =117) = 0.006, p&lt; 0.05), 11.873 (2,N =117) = 0.012, p&lt; 0.05), (x2) 5.630 (6,N =117) = 0.003, p&lt; 0.05), 0.017 (6, N =117) =0.014, p&lt; 0.05) and 14.497(6,=N=117) = 0.025, p&lt; 0.05. No significant sex difference was observed in attitude towards ART adherence. Besides, the result of multiple regression also showed that only single, unemployment and vocational education were accounted for non- adherence to ART (β = .228, t (113) = 2.655, P&lt; 0.05), (β = .297, t (114) = 3.451, p&lt; 0.05) and ( β = .231, t (113) = 2.652, p&lt; 0.05) respectively. Conclusively, Personal level factors; marital status (singlehood), unemployment and vocational education accounted for variance in adherence to ART. Thus, Counselors, social workers and health care providers should give adherence counseling and psycho education.

Feasibility of a musculoskeletal ultrasound intervention to improve adherence in juvenile idiopathic arthritis: a proof-of concept trial

BackgroundNon-adherence is a prevalent and modifiable issue in juvenile idiopathic arthritis (JIA) that currently lacks provider-based intervention. Education surrounding disease status is one way in which families remain engaged in their care. Musculoskeletal ultrasound is one such form of demonstrative, real-time education that may impact the way patients and caregivers self-manage their disease. The aims of this study are to 1) assess the feasibility, acceptability and perceived usefulness of musculoskeletal ultrasound as a non-adherence intervention tool and 2) to examine changes in methotrexate adherence in adolescents with JIA following the ultrasound.MethodsEight adolescents with polyarticular or extended oligoarticular JIA and their caregivers completed this 12 week study. A within subject design was used to compare baseline and post-intervention adherence, quality of life and disease activity indices. Adherence measures included electronic measurement of methotrexate in addition to self-reported adherence questionnaires. The ultrasound intervention included a one-time, rheumatologist provided, educational examination of three or more currently or historically active joints.ResultsThe ultrasound intervention was found to be both feasible and acceptable. One hundred percent of eligible participants completed the ultrasound intervention. The ultrasound was well received by patients and caregivers, with most believing this to be a helpful tool. Baseline adherence was 75.3% among participants, with half of the participants being classified as non-adherent. Electronically measured and self-reported adherence measures did not show significant changes during the post-intervention period. Two participants improved, four participants maintained, and two participants decreased adherence. On ultrasound, 18/27 (66.7%) of the examined joints displayed abnormalities, with 63% being discrepant and additive to the rheumatologist’s physical examination.ConclusionsWhile our intervention did not show any changes in adherence, quality of life or disease activity indices in this proof-of-concept trial, the intervention does show promise in acceptability measures and merits future study in a more robust trial design. An additional study benefit was that the musculoskeletal ultrasound intervention was able to demonstrate subclinical disease, leading to clinically impactful therapeutic changes in several participants.

Adherence to disease-modifying therapies in patients with multiple sclerosis.

BackgroundMultiple sclerosis (MS) is a chronic, inflammatory progressive demyelinating disease of the central nervous system. MS is one of the main causes of disability among young adults, and its management is a serious challenge for the healthcare system.PurposeThe main purpose of this study was to examine adherence to first-line disease-modifying therapy (DMT) in MS patients using the self-report Multiple Sclerosis Treatment Adherence Questionnaire (MS-TAQ).Materials and methodsThe participants consisted of 226 MS patients (166 women and 60 men) who were treated with first-line immunomodulatory DMT. This study used a questionnaire designed by the authors, which contained questions about sociodemographic data, and the Polish version of the MS-TAQ.ResultsThe overall adherence was 76.5% according to the first criterion (missed ≥1 injection or tablet). There were no statistically significant differences due to sociodemographic variables between adherent and nonadherent patients. However, patients taking Avonex® significantly more often belonged to the adherent group (P=0.042). The most frequently mentioned reasons why nonadherent patients forget to take the drug included the following: too busy in their daily activities, indisposition to take the drug, unwillingness to take the drug, interference with daily activities, and dissatisfaction with the drug. The degree of adherence among MS patients treated with immunomodulatory drugs is high; however, some patients do not take medications regularly.ConclusionDue to the utility of the MS-TAQ, the caregivers of MS patients are able to quickly and easily assess the occurrence of side effects, ways to cope with them, and the occurrence of barriers to taking medication.

Decision-Making Involvement and Prediction of Adherence in Youth With Type 1 Diabetes: A Cohort Sequential Study.

To assess developmental trajectories of decision-making involvement (DMI), defined as the ways in which parents and children engage each other in decision-making about illness management, in youth with type 1 diabetes (T1D) and examine the effects of DMI on levels of and changes in adherence with age. Participants included 117 youth with T1D, enrolled at ages 8-16 years and assessed five times over 2 years. The cohort sequential design allowed for the approximation of the longitudinal curve from age 8 to 19 from overlapping cohort segments. Children and parents completed the Decision-Making Involvement Scale, which yields subscales for different aspects of DMI, and a self-report adherence questionnaire. Mixed-effects growth curve modeling was used for analysis, with longitudinal measures nested within participant and participants nested within cohort. Most aspects of DMI (Parent Express, Parent Seek, Child Express, and Joint) increased with child age; scores on some child report subscales (Parent Express, Child Seek, and Joint) decreased after age 12-14 years. After accounting for age, Child Seek, Child Express, and Joint were associated with overall higher levels of adherence in both child (estimates = 0.08-0.13, p < .001) and parent (estimates = 0.07- 0.13, p < .01) report models, but they did not predict changes in adherence with age. These data suggest that helping children to be more proactive in T1D discussions, by encouraging them to express their opinions, share information, and solicit guidance from parents, is a potential target for interventions to enhance effective self-management.

Adherence to dietary and fluid restrictions among patients undergoing hemodialysis: An observational study

AimThe aim of the study was to assess the level of adherence to dietary and fluid restrictions among patients undergoing hemodialysis. BackgroundPatients with end-stage renal disease are non-compliant to fluid and dietary restrictions lead to undesirable effect on health. MethodsThe observational study design and 60 samples were adopted. The samples were selected by purposive sampling technique who full fill the inclusion criteria. Self-reported fluid and dietary adherence questionnaire were used to collect the data. Data were analyzed using SPSS software version 16.0. ResultsThe study revealed that there was a fair to good adherence level for fluid and dietary restrictions. ConclusionHowever the adherence level varies among hemodialysis patients, individually tailored interventions and constant motivation is needed to improve the adherence level and positive clinical outcome.

MEDICATION ADHERENCE BEHAVIOUR OF PRIVATE SECTOR PATIENTS AFFLICTED WITH CERTAIN COMMUNICABLE AND/OR NON-COMMUNICABLE DISEASES

Ponte Academic JournalJul 2018, Volume 74, Issue 7 MEDICATION ADHERENCE BEHAVIOUR OF PRIVATE SECTOR PATIENTS AFFLICTED WITH CERTAIN COMMUNICABLE AND/OR NON-COMMUNICABLE DISEASESAuthor(s): Suklal K. BPharm ,Naidoo P. BPharmJ. Ponte - Jul 2018 - Volume 74 - Issue 7 doi: 10.21506/j.ponte.2018.7.6 Abstract:Medication adherence is a significant factor contributing towards the achievement of treatment goals. This study was conducted to provide insight into the medication adherence behaviour of private sector patients afflicted with communicable and non-communicable chronic diseases.\r\nObjectives\r\nTo investigate the medication adherence behaviour of patients suffering from Non-Communicable diseases and Communicable diseases in the private health care sector of the eThekwini Metropolitan of KwaZulu-Natal. \r\nMethods \r\nA self-reported medication adherence questionnaire was used to obtain data, from 233 patients afflicted with Human Immunodeficiency Virus, Type 2 Diabetes Mellitus, Hypertension and Dyslipidaemia. The questionnaire focused on factors that influence medication adherence as well as the number of days of medication missed during the last 30 days. Data was collected and analysed using SPSS .\r\nResults \r\nMajority of participants were aged between 41-60 years (49.8%), and were of male gender (52.8%). An almost equal number of participants were afflicted with single disease (n=116) or multiple diseases (117). Hypertension was the most prevalent ailment (n=167), followed by Type 2 Diabetes (n=113), Dyslipidaemia (n=94) and HIV (n= 26). Over 62% of participants reported not missing any medication during the last 30 days. More than 21% had stated missing 1-2 days of their medication and 15.9% reported missing 3 or more days of medication during the last 30 days. With regards to single diagnosis, the highest percentage of adherence was reported in participants afflicted with Hypertension (60.6%), and Type 2 diabetes (58.3%). HIV and Dyslipidaemia had the lowest rates of adherence as 45% (n=9) of HIV only afflicted participants and 57.1% (n=4) of Dyslipidaemia only afflicted participants reported missing 1 or more days of their medication. The highest rate of non-adherence was found in the age group of participants 51-60 years old, while the highest rate of adherence was found in the group aged 70 years+. Reasons for non-adherence included cost, forgetting to take medication, running out of medication, stopping medication because it made them feel worse or gave a side effect and having difficulty with time schedules or having medication with/without food. \r\nConclusion\r\nParticipants afflicted with communicable and non-communicable diseases in the private health care sector have sub-optimal medication adherence. No significant correlations were found between having a particular disease and the rate of adherence, but participants afflicted with HIV only and Dyslipidaemia only where the least adherent. Reasons for non-adherence were the similar to other studies. Download full text:Check if you have access through your login credentials or your institution Username Password

Concordance of Adherence Measurement Using Self-Reported Adherence Questionnaires and Medication Monitoring Devices: An Updated Review.

As medication adherence continues to be a prevalent issue in today's society, the methods used to monitor medication-taking behaviors are constantly being re-evaluated and compared in search of the 'gold standard' measure. Our review aimed to assess the current literature surrounding the correlation between self-reported questionnaires (SRQs) and electronic monitoring devices to determine if these measures produce similar results. We performed a literature search from 2009 to 2017 using PubMed, PubMed In-Process and Non-Indexed, EMBASE, Ovid MEDLINE, and Ovid MEDLINE In-Process. A keyword search using the terms 'patient compliance', 'treatment compliance', 'medication adherence', 'drug monitoring', 'drug therapy', 'electronic', 'digital', 'computer', 'monitor', 'monitoring', 'drug', 'pharmaceutical preparations', 'compliance', and 'medications' was done to capture all articles. We included articles measuring adherence using both monitoring devices and SRQs. Thirty-five articles were included in this review. The average difference in measured adherence rates between the two measures was 9.2% (range -66.3 to 61.5). A majority (62.7%) of articles reported moderate (n=12; 27.9%), high (n=5, 11.6%), or significant (n=10, 23.3%) correlations between SRQs and monitoring devices. Results from our review are consistent with previous studies, as we found that many of our studies produced moderate to high correlation between both SRQs and monitoring devices [Farmer, Clin Ther 21(6):1074-90 (1999), IMS Institute for Healthcare Informatics. Avoidable costs in US health care (2012), Patel et al., Respirology 18(3):546-52 (2013), Siracusa et al., J Cyst Fibros 14(5):621-6 (2015), Smith et al., Int J Cardiol 145(1):122-3 (2010)]. Our findings demonstrate that self-reported adherence produces comparable results to electronic monitoring devices. As there is not yet a 'gold standard' measure for monitoring patient adherence, SRQs and Medication Event Monitoring Systems (MEMS) operating together continue to emerge as the preferred effective method for measuring medication adherence.

Patient knowledge and pulmonary medication adherence in adult patients with cystic fibrosis.

Background and objectivesPatient knowledge of lung function (ie, forced expiratory volume in 1 s [FEV1]% predicted) and the intended benefits of their prescribed pulmonary medications might play an important role in medication adherence, but this relationship has not been examined previously in patients with cystic fibrosis (CF).MethodsAll patients diagnosed with CF and without prior lung transplantation were invited to complete knowledge and self-reported medication adherence questionnaires during routine outpatient visits to the Adult CF Clinic, St Paul’s Hospital, Vancouver, Canada from June 2013 to August 2014.ResultsA total of 142 out of 167 (85%) consecutive adults attending CF clinic completed patient knowledge and medication adherence survey questionnaires. Sixty-four percent of the patients recalled their last FEV1% predicted value within 5%, and 70% knew the intended benefits of all their prescribed medications. Self-reported adherence rates were highest for inhaled antibiotics (81%), azithromycin (87%), and dornase alpha (76%) and lowest for hypertonic saline (47%). Individuals who knew their FEV1% predicted value within 5% were more likely to self-report adherence to dornase alpha (84% vs 62%, P=0.06) and inhaled antibiotics (88% vs 64%, P=0.06) compared to those who did not, but these associations were not statistically significant. There were no significant associations observed between patient knowledge of intended medication benefits and self-reported medication adherence.ConclusionContrary to our hypothesis, disease- and treatment-related knowledge was not associated with self-reported medication adherence. This suggests other barriers to medication adherence should be targeted in future studies aiming to improve medication adherence in adults with CF.

Use of medication reminders in patients with rheumatoid arthritis.

Patients with rheumatoid arthritis (RA) often have difficulties adhering to their medical treatment plans. We determined the characteristics of patients with RA who used reminders and the association between reminders and adherence. A total of 201 patients with RA were asked the frequency of reminders use such as pill containers, calendars, or diaries. Patients completed self-reported adherence questionnaires, and their disease activity and functional ability were measured. Sixty-eight patients (34%) reported using a reminder. Factors associated with reminder use were older age (yes-mean age 54 vs no-mean age 49, p=0.004), race (Whites-54% vs Blacks-30% vs Hispanics-26%, p=0.003), and sex (males-50% vs females 28%, p=0.005). Working patients were less likely to use reminders (employed-21% vs unemployed-43%, p=0.006). Use of calendars was associated with adherence while away from home (ρ=0.16, p=0.03), when busy (ρ=0.16, p=0.03), and use of any reminder was associated with adherence when running out of pills (ρ=0.15, p=0.04). The use of calendar reminders was associated with fewer tender joints (ρ=-0.17, p=0.02). Few patients with RA used reminders, and whites, males and patients of increasing age were most likely to use reminders. Our findings show that reminders can assist patients with RA in taking medications, particularly when they are most prone to forgetting, such as when they are away from home or busy. Providers should encourage using reminders as a low-cost aid to enhance adherence.