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Results for “Medication Adherence”

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At least 199 records · Page 11Linked to original sources

PubMed2003

Predictors of medication adherence and associated health care costs in an older population with type 2 diabetes mellitus: a longitudinal cohort study.

BACKGROUND: The cost of treating diabetes mellitus and its complications is high (91.8 billion dollars in the United States in 2002). It is important to understand predictors of adherence to therapy with different antidiabetic medications and to determine the relationships between adherence and health care service utilization in older adults (aged >or=65 years) with type 2 diabetes mellitus. OBJECTIVE: The aim of this study was to examine the relationship between self-reported health status data, subsequent antidiabetic medication adherence, and health care service utilization in older adults with type 2 diabetes mellitus in a managed care setting. METHODS: This was a longitudinal cohort study of older adults in the south-eastern United States with type 2 diabetes mellitus who completed a health status assessment, used antidiabetic medications, and were enrolled in a health maintenance organization (HMO) continuously for 1 to 5 years. The baseline assessment included questions related to demographics, health care service utilization in the year before enrollment, lifestyle, and quality of life. Demographic, clinical, and utilization-related economic variables were also retrieved from the administrative claims data of the patients' HMO. Prescription refill patterns were used to measure adherence. Associations were examined with a sequential, mixed-model, regression approach. Model appropriateness was tested via sensitivity analyses with logged and unlogged dependent variables. RESULTS: A total of 775 patients were included. Increased comorbidity severity and an emergency room visit during the year prior to enrollment in a Medicare HMO were independently associated with decreased antidiabetic medication possession ratios (MPRs) after enrollment. After controlling for type of medication therapy and other variables, increased antidiabetic MPR remained the strongest predictor of decreased total annual health care costs (8.6% to 28.9% decrease in annual costs with every 10% increase in MPR; P < 0.001). Adherence to anti-diabetic medications was a greater driver of cost reduction than other concurrent medications (eg, statins) in this population. CONCLUSIONS: This study found strong associations between decreased anti-diabetic medication adherence and increased health care service utilization in older adults with type 2 diabetes mellitus in a managed care setting. Health status assessments completed at time of enrollment had the potential to identify enrollees with higher risk for both nonadherent behaviors and poor health-related outcomes.

Aged↗

PubMed2000

Measurement of children's asthma medication adherence by self report, mother report, canister weight, and Doser CT.

BACKGROUND: Accurate assessment of medication adherence has been difficult to achieve but is essential to drug evaluation in clinical trials and improved outcomes in clinical care. OBJECTIVE: This study was conducted to compare four adherence assessment methods: child report, mother report, canister weight, and electronic measurements of metered dose inhaler (MDI) actuation. METHODS: Participants included 27 children with mild-to-moderate asthma who were followed prospectively for 6 months. All patients used an MDI equipped with an electronic Doser attached to their inhaled steroid. At each 2-month follow-up visit, Doser and canister weight data were recorded, while child and mother were interviewed separately regarding medication use. RESULTS: Children and mothers reported, on average, over 80% adherence with the prescribed inhaled steroid. Canister weight revealed, on average, adherence of 69%, significantly lower than self-report. When adherence recorded by the electronic Doser was truncated to no more than 100% of prescribed daily use, average adherence was 50%. Older children and adolescents, nonwhite children, and those from poorer functioning families were least adherent. CONCLUSIONS: Electronic adherence monitoring was significantly more accurate than self-report or canister weight measures. Such accuracy is an essential prerequisite to increasing understanding of the treatment, setting, and patient factors that influence adherence, and to the consequent design of effective intervention strategies.

Adult↗

PubMedDate not supplied

AIDES to improving medication adherence in older adults.

Medication regimens for older adults are often complex and costly. Designing, implementing, and maintaining an appropriate treatment regimen is challenging. The AIDES method is built on the principles of completing a comprehensive medication Assessment; partnering with patients to ensure Individualization of the regimen; choosing appropriate Documentation; providing accurate and ongoing Education tailored to the age group and needs of the individual; and continuing Supervision after initiation.

Aged↗

PubMed2004

HIV medication adherence programs: the importance of social support.

Since the advent of medical treatments for HIV, the promotion of adherence to these difficult treatment regimens has proven critical to disease management. Three Connecticut state-funded HIV medication adherence programs were evaluated.1 The purpose of this process evaluation was to explore and compare the goals and modality of each adherence program, assess client and staff satisfaction, and provide recommendations for the improvement of these programs. Focus group interviews with clients and individual interviews with staff were conducted at each of the programs. Interviews were transcribed, coded and analyzed with a code and retrieve method of theme identification. Focus group themes included the importance of social support on medication adherence and the "lifesaving" effect the program has had. The staff expressed that although complete adherence should be the long-term objective, more intermediate objectives should be considered (e.g., behavioral changes to increase clients' ability, self-esteem, and self-efficacy to take medications).

Anti-HIV Agents↗

PubMedDate not supplied

Medication adherence in persons with cardiovascular disease.

The purpose of this investigation was to determine medication adherence rates among 3 groups of elderly individuals 62 years of age or older, experiencing comorbid conditions including at least 1 cardiovascular disorder. Data, taken from a 3-week period, were combined across the groups to calculate the percentage of prescribed doses taken, percentage of days with correct number of doses, and percentage of expected doses with the correct timing of administration. Multiple linear regression also was performed on several sociodemographic variables to determine their ability to predict adherence. Risks for poor adherence and suggestions to increase adherence are presented.

Black or African American↗

PubMedDate not supplied

[Simplified scale for medication adherence related problems in anti-retroviral therapy].

OBJECTIVE: The purpose is to describe an own-developed scale for medication adherence evaluation of HIV patients under antiretroviral therapy, and to compare it with other previously described methods. METHODS: The six-item scale was compared with a pharmacy record about the delivery of medication. Accordance between scale and a four-item Morisky-type scale (measure 1) and a percentage of doses taken as prescribed during the past two weeks (measure 2) was computed. RESULTS: The own-scale showed 93% sensitivity, 70% specificity, a likelihood ratio of 3.08 and good agreement compared with the pharmacy record (k = 0.62, p < 0.001). Agreement between the scale and measure 1 and measure 2 was very weak (k = 0.12, p = 0.446 and k = 0.10, p = 0.273 respectively). 39.7% of patients was considered as adherent according with the own-scale and was observed correlation between adherence and clinical outcomes. CONCLUSION: The scale appears to be a valid instrument to check and detect adherence related problems compared with the pharmacy medication record. Easiness to use make feasible to consider as an adequate tool to detect non-adherent patients or patients with adherence related problems into the daily clinical practice.

Adult↗

PubMed2005

A temporal and dose-response association between alcohol consumption and medication adherence among veterans in care.

BACKGROUND: Previous studies have shown that alcohol consumption is associated with decreased medication adherence, but this association may be confounded by characteristics common among those who drink heavily and those who fail to adhere (e.g., illicit drug use). Our objective was to determine whether there are temporal and dose-response relationships between alcohol consumption and poor adherence. METHODS: We administered telephone interview surveys to participants in the Veterans Aging Cohort Study, an eight-site observational study of HIV+ and matched HIV- veterans in care, to determine whether alcohol consumption on a particular day was associated with nonadherence to prescribed medications on that same day. We used the Time Line Follow Back to measure alcohol consumption and the Time Line Follow Back Modified for Adherence to measure adherence. Individuals were categorized as abstainers (no alcohol in past 30 days), nonbinge drinkers (alcohol in past 30 days but < or =four standard drinks on each day), or binge drinkers (> or =five standard drinks on at least one day). RESULTS: Among 2702 respondents, 1582 (56.6%) were abstainers, 931 (34.5%) were nonbinge drinkers, and 239 (8.9%) were binge drinkers. Abstainers missed medication doses on 2.4% of surveyed days. Nonbinge drinkers missed doses on 3.5% of drinking days, 3.1% of postdrinking days, and 2.1% of nondrinking days (p < 0.001 for trend), and this trend was more pronounced among HIV+ individuals than HIV- individuals. Binge drinkers missed doses on 11.0% of drinking days, 7.0% of postdrinking days, and 4.1% of nondrinking days (p < 0.001 for trend), and this trend was comparably strong for HIV+ and HIV- individuals. CONCLUSIONS: Among veterans in care, self-reported alcohol consumption demonstrates a temporal and dose-response relationship to poor adherence. HIV+ individuals may be particularly sensitive to alcohol consumption.

Alcohol Drinking↗

PubMed1984

The effects of lay counseling on medication adherence and blood pressure: adjunctive treatment for hypertension.

Ten noncompliant hypertensive patients were monitored and received counseling from trained aides. Monitoring and lay counseling was associated with a reduction of -10 mmHg in systolic blood pressure and of -7 mmHg in diastolic pressure (P less than 0.05). Medication adherence increased from 69% to 84%. Counseling resulted in pressure decreases equal to those obtained by usual care for similar but compliant patients. This analysis provides a model for paraprofessional adjunctive counseling of patients thought to be adhering poorly to their medication regimen, which may improve control of hypertension.

Blood Pressure↗

PubMed2000

Congruence of three self-report measures of medication adherence among HIV patients.

OBJECTIVE: To evaluate the accordance between three measures of self-reported medication adherence. METHODS: A survey was administered to HIV patients. The three adherence measures included a four-item Morisky-type scale (Measure1) and two measures defining adherence as the percentage of doses taken as prescribed during the past two days (Measure2) or past two weeks (Measure3). RESULTS: For Measure1, 29.2% of the patients were categorized as high adherence and 61.5% as medium adherence. For Measure2 and Measure3, the mean scores were 93.6% and 96.5%, respectively. Using 90% as cutoff values, 78.5% and 95.4% of the patients were classified as adherent by Measure2 and Measure3, respectively (kappa = 0.30; p = 0.001). When 80% was used, 90.8% of the patients were classified as adherent for Measure2 and 96.9% for Measure3 (kappa = 0.48; p < 0.001). When using 90% and 80% as cutoff values to categorize Measure2 and Measure3 as three levels, there was no agreement between Measure1 and the other two measures. The accordance of Measure2 and Measure3 was significant albeit not high (kappa = 0.31; p < 0.001). CONCLUSIONS: The accordance between a Morisky-type adherence scale and measures of missed doses is unsatisfactory. However, "missed-dose" measures using two-day or two-week time periods yield fairly similar results. Researchers should be cautious when comparing adherence rates between studies that use different methods for assessing adherence.

Adolescent↗

PubMed2002

[A report on medication adherence among outpatients].

BACKGROUND: Increase in chronic disease and hospital stays of minimal length have caused a rise in the number of outpatients receiving long-term medication. The authors conducted the present study to examine their adherence to medication. METHODS: Self-administered questionnaires covering 20 items related to adherence were collected from outpatients who received medication from O university hospital on a day in October 1998. The authors examined the relationship between adherence to medication and lifestyle and then analyzed predictors of adherence using discriminant analysis. RESULTS: The rare of adherence to medication for 943 outpatients in O university hospital was 87.9%. The major reasons for non adherence were "forgetting medication", "leaving home without [one's] medication," "suspecting side effects" and "having no symptoms". The patients who made a detailed explanation displayed better understanding and adherence to medication. Although 94.8% of the patients received an explanation about their medications at least once, 76.9% expressed some anxiety about their use. Predictors of poor adherence to medication were "no support to remind the patient to take medicines correctly," "anxiety about medication," "not receiving a detailed explanation about medications," "poor knowledge of medication," and "youth (20-29 years of age)." CONCLUSION: Among outpatients in O university hospital, the medication adherence rate is 87.9%, but most patients had anxieties. The results clarified the need to consider lifestyle in medication management in the outpatient setting, since this was the main predictor of adherence to medication.

Adolescent↗

PubMed2002

Physician-patient relationships, patient satisfaction, and antiretroviral medication Adherence among HIV-infected adults attending a public health clinic.

The goal of this project was to explore the connections between human immunodeficiency virus (HIV)-positive patients adherence to antiretroviral medication treatment regimens and their beliefs about and satisfaction with their primary care physicians. In-depth interviews were conducted with 28 HIV-positive patients. Results showed that most patients were extremely satisfied with their current primary care physicians. When patients were dissatisfied with their care, it was often because there was a mismatch between the patient's expectations of care and the physician's consultation style. Results also showed that good quality physician-patient relationships tended to promote adherence while lesser quality relationships impeded it. Findings suggest that strengthening and promoting the bonds between physicians and HIV/acquired immunodeficiency syndrome (AIDS) patients should be an absolute priority, at both the interpersonal level of physician-patient interactions but also at the organizational level.

Adult↗

PubMed2006

A measurement model of medication adherence to highly active antiretroviral therapy and its relation to viral load in HIV-positive adults.

This study compared a multiple method measurement model of highly active antiretroviral therapy (HAART) adherence with single-method models to determine optimal validity in predicting HIV viral load. Repeated measures of antiretroviral adherence were collected over a 15-month period using three different measurement methods: a self-report questionnaire, an adherence interview item, and electronic medication monitoring. The participants included HIV-positive men and women (n = 323) who were currently prescribed HAART. Single-factor models composed of multiple measurements over time were developed for each adherence method and HIV viral load. The three adherence methods were then combined in a second order factor measurement model. Structural equation modeling was used to test the models. Mean adherence, defined as percent of doses taken, was 92%, 90%, and 57% by self-report, interview, and electronic monitoring, respectively. Reliability of individual measurements of adherence was low. Four or seven assessments were needed to attain acceptable stability, depending on the method. The second-order factor model of adherence fit the data and explained 45% of the variability in HIV viral load. Models including only one method of assessing adherence explained between 20% and 24% of the variability. Models that included both self-report and electronic monitoring optimized predictive validity. Using at least two different methods of adherence measurement, each assessed at multiple times is recommended to derive reliable and valid measurement of medication adherence, which is predictive of biological outcomes such as HIV viral load.

Adolescent↗

PubMed2001

Using drug claims data to assess the relationship of medication adherence with hospitalization and costs.

OBJECTIVE: This naturalistic study used claims data to examine the relationship of medication nonadherence to hospital use and costs among severely mentally ill clients in Wisconsin. METHODS: Data for 619 clients were obtained from Medicaid drug and hospital claims, county records, and case managers as part of a larger study in eight county-based mental health systems. Study participants were eligible for Medicaid, had a severe and persistent mental illness, were 18 years or older, and were receiving neuroleptics, lithium, or antidepressants. Drug claims were analyzed for a 12-month period to determine how regularly clients obtained their medications. Regression analyses were used to assess the effects of irregular medication use on any hospitalization for psychiatric problems, the number of days hospitalized, and hospital costs. The analyses controlled for several risk factors. RESULTS: Among clients with schizophrenia or schizoaffective disorder, 31 percent used medications irregularly. The rates were 33 percent among those with bipolar disorder and 41 percent among those with other severe mental illnesses. In the total sample, irregular users had significantly higher rates of hospitalization than regular users (42 percent versus 20 percent), more hospital days (16 days versus four days), and higher hospital costs ($3,992 versus $1,048). Irregular medication use was one of the strongest predictors of hospital use and costs even after the analyses controlled for diagnosis, demographic characteristics, baseline functioning, and previous hospitalizations. CONCLUSIONS: The availability of drug claims data and the ability to use them in predictive analyses make them a potentially useful data source in studies of medication adherence among persons with severe mental illness.

Adult↗

PubMed1998

Autonomous regulation and long-term medication adherence in adult outpatients.

Self-determination theory was applied to explore the motivational basis of adherence to long-term medication prescriptions. Adult outpatients with various diagnoses who had been on a medication for at least 1 month and expected to continue (a) completed questionnaires that assessed their autonomous regulation, other motivation variables, and perceptions of their physicians' support of their autonomy by hearing their concerns and offering choice; (b) provided subjective ratings of their adherence and a 2-day retrospective pill count during an interview with a clinical psychologist; and (c) provided a 14-day prospective pill count during a subsequent, brief telephone survey. LISREL analyses supported the self-determination model for adherence by confirming that patients' autonomous motivation for adherence did mediate the relation between patients' perceptions of their physicians' autonomy support and their own medication adherence.

Adult↗

PubMedDate not supplied

Self-reported medication adherence and health status in late adulthood: the role of beliefs.

In this study, we explore the role of subjective beliefs in determining self-reports of medication adherence and health status in 90 older adults (M age = 71.7 years, SD = 7.44). Self-reported adherence was predicted by personal health locus of control beliefs, but not by medical factors nor beliefs regarding one's own health care professionals. Self-reported health was predicted by medical factors, perceptions of one's health care professional, and health locus of control. These results suggest that self-reported adherence is primarily a belief-laden construct whereas self-reported health consists of both an objective assessment of health and a subjective belief-laden component. Exploratory analyses conducted on younger-old and older-old age groups indicated that medical factors may be less important to older-old adults' perceived health status than the younger-old adults.

Aged↗

PubMedDate not supplied

Predictors of medication adherence in the elderly.

As average life expectancy increases, so do the incidence of chronic diseases and the number of persons receiving long-term drug therapy. Thus elderly patients' noncompliance with medication regimens has the potential for sweeping medical and economic consequences and is likely to become increasingly important in the design of disease-management programs for this population. The author conducted a MEDLINE search of the English-language literature for the years 1962 to 1997 to identify articles concerning predictors of medication compliance in the elderly. A descriptive analysis of this literature indicated that there remains some uncertainty about the reasons for noncompliant medication-taking in the elderly. Clear associations have been established between elderly patients' medication adherence and race, drug and dosage form, number of medications, cost of medications, insurance coverage, and physician-patient communication. However, the findings are inconsistent with regard to the effects of patients' age, sex, socioeconomic status, living arrangement, comorbidities, number of physician visits, and knowledge, attitudes, and beliefs about health. Until the results of further comprehensive studies are available, the current knowledge should be considered when designing and implementing disease-management programs for the elderly.

Aged↗

PubMed2000

The relationship between insight and medication adherence in severely mentally ill clients treated in the community.

OBJECTIVE: To study the relationship between aspects of insight and medication adherence and elements of psychopathology. METHOD: Clients completed insight and adherence measures in interview; doctors and case managers independently completed ratings of adherence and psychopathology. Other client information was obtained from the clinical file. RESULTS: The subscale structure of the insight scale was well reproduced. Clients endorsed items relating to need for treatment more than items relating to relabelling of symptoms and awareness of illness. Self-reported insight was lower in those clients for whom either the treating doctor or the case manager or both thought the client was non-adherent. Insight was related positively to clinician ratings of depressed mood, and negatively to clinician ratings of personal functioning. CONCLUSION: Our data support the subscale structure of the insight questionnaire used, and previous suggestions that insight is positively related to depressive affect, and inversely related to impaired psychosocial functioning.

Adult↗

PubMed2006

Medication adherence and health care costs associated with biologics in Medicaid-enrolled patients with psoriasis.

BACKGROUND: Costs and patients' adherence related to biologics are important factors to consider while making informed decisions regarding therapy with biologics in psoriasis management. OBJECTIVE: To examine predictors of adherence related to biologics, total health care costs, and service utilization among psoriasis patients. METHODS: This was a longitudinal cohort study of psoriasis patients (<65 years old) enrolled in North Carolina Medicaid who were prescribed biologics (alefacept, efalizumab, and etanercept). Patients' medication adherence, health care costs, and service utilization patterns in the pre- and post-biologics period were examined. RESULTS: Adherence to biologics was significantly higher compared with the other psoriasis medications (0.66 vs 0.39; p<0.001). Prescription costs were significantly higher in the post-biologics period (3796.77 US dollars vs 11,706.32 US dollars; p<0.001). However, total health care costs in the post-biologics period did not differ significantly from the pre-biologics period (14,662.22 US dollars vs 16,156.10 US dollars; p>0.05). Patients' adherence and health care costs did not differ significantly across the biologics. After controlling for other variables, patients had a significantly lower number of hospitalizations in the post-biologics period (p<0.001). CONCLUSIONS: Although costs associated with prescriptions for biologics were higher, total health care costs did not differ significantly in the post-biologics period. Biologics had a better adherence rate compared with other psoriasis medications.

Adult↗