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At least 217 records · Page 12Linked to original sources
PubMed2006

A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy.

Nonadherence in the management of chronic illness is a pervasive clinical challenge. Although researchers have identified multiple correlates of adherence, the field remains relatively atheoretical. The authors propose a cognitive-affective model of medication adherence based on social support theory and research. Structural equation modeling of longitudinal survey data from 136 mainly African American and Puerto Rican men and women with HIV/AIDS provided preliminary support for a modified model. Specifically, baseline data indicated social support was associated with less negative affect and greater spirituality, which, in turn, were associated with self-efficacy to adhere. Self-efficacy to adhere at baseline predicted self-reported adherence at 3 months, which predicted chart-extracted viral load at 6 months. The findings have relevance for theory building, intervention development, and clinical practice.

Anti-Retroviral Agents↗
PubMedDate not supplied

Parental beliefs about medications and medication adherence among urban children with asthma.

BACKGROUND: Although national guidelines recommend controller medications for children with persistent asthma, adherence is poor. Prior studies have begun to explore parental beliefs regarding controller asthma medications and their effect on adherence. OBJECTIVE: To describe parental beliefs about controller medications among a community-based sample of urban children with persistent asthma and to examine the relationship between parental beliefs and adherence. DESIGN/METHODS: Parents of 150 children with asthma completed a telephone survey as part of a larger asthma intervention. Parents of children using controller asthma medications were included in this study. A previously validated Beliefs About Medications Questionnaire (BMQ) was used, which included two subscales: necessity and concern. The relationship between parental beliefs about medications and medication adherence was assessed using bivariate linear regression and multivariate statistics. RESULTS: This study included 67 children with parental report of controller medication (54% male, 61% African American, 69% Medicaid). Overall, 75% of parents strongly believed that their child's medications were necessary for their health and 34% had strong concerns about the medications. Only 22% of parents reported being completely adherent with medications. Parents with greater concern about medications were more likely to have poor adherence (P < .05). In a multivariate analysis, including both BMQ subscales and asthma severity, concern about medications significantly predicted poor medication adherence (P = .03). CONCLUSIONS: Parental concerns about controller medications were associated with poor medication adherence for this population of urban children with asthma. These findings highlight the importance of addressing parental concerns at the time of medication prescription.

Anti-Asthmatic Agents↗
PubMed2003

Symptoms of posttraumatic stress and death anxiety in persons with HIV and medication adherence difficulties.

The present study examined the frequency and correlates of self-reported symptoms of posttraumatic stress among patients with HIV and medication adherence problems. Self-report data revealed that more than half of participants met diagnostic criteria for posttraumatic stress disorder (PTSD) according to the Posttraumatic Diagnostic Scale PDS. Death anxiety was associated with overall PTSD symptom severity scores as well as severity scores for reexperiencing, avoidance, and arousal symptoms. The association between death anxiety and total PTSD severity, reexperiencing and avoidance symptom scores remained after controlling for depression and satisfaction with social support. Anxiety, as manifested by PTSD symptoms should be routinely assessed among patients with HIV, and variables such as death anxiety, social support, and depression are appropriate targets for mental health interventions.

Anti-HIV Agents↗
PubMed2005

Depression and medication adherence in outpatients with coronary heart disease: findings from the Heart and Soul Study.

BACKGROUND: Depression leads to adverse outcomes in patients with coronary heart disease (CHD). Medication nonadherence is a potential mechanism for the increased risk of CHD events associated with depression, but it is not known whether depression is associated with medication nonadherence in outpatients with stable CHD. METHODS: We examined the association between current major depression (assessed using the Diagnostic Interview Schedule) and self-reported medication adherence in a cross-sectional study of 940 outpatients with stable CHD. RESULTS: A total of 204 participants (22%) had major depression. Twenty-eight (14%) of 204 depressed participants reported not taking their medications as prescribed compared with 40 (5%) of 736 nondepressed participants (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.7-4.7; P<.001). Twice as many depressed participants as nondepressed participants (18% vs 9%) reported forgetting to take their medications (OR, 2.4; 95% CI, 1.6-3.8; P<.001). Nine percent of depressed participants and 4% of nondepressed participants reported deciding to skip their medications (OR, 2.2; 95% CI, 1.2-4.2; P = .01). The relationship between depression and nonadherence persisted after adjustment for potential confounding variables, including age, ethnicity, education, social support, and measures of cardiac disease severity (OR, 2.2; 95% CI, 1.2-3.9; P = .009 for not taking medications as prescribed). CONCLUSIONS: Depression is associated with medication nonadherence in outpatients with CHD. Medication nonadherence may contribute to adverse cardiovascular outcomes in depressed patients.

Aged↗
PubMed2006

Medication adherence after heart transplantation: adolescents and their issues.

CONTEXT: Medication nonadherence among adolescent heart transplant recipients can have overwhelming negative consequences including rejection and mortality. Because of issues specific to adolescents such as peer pressure, risk taking, independence, self-image, and self-esteem, they are a population susceptible to nonadherence. Adherence may be associated with a supportive environment, fewer physical and cosmetic side effects, and a sufficient knowledge of therapies. Adherence also may be related to regimens with fewer medications, predominantly fewer immunosuppressive drugs. OBJECTIVE: To examine the differences in motivation between adolescents who are more adherent and those who are less adherent to their medication regimen following transplant surgery. DESIGN: A descriptive design and mixed methodology, including a modified written survey, the Frazier Noncompliance Inventory; a self-report measure of overall medication adherence; and an interview designed by the investigator. Interview questions were reviewed for content validity by nurse clinicians and researchers. SETTING: A heart transplant follow-up clinic in the southeastern United States. RESULTS: Findings for 2 participants revealed striking contrasts in adolescent issues and factors affecting adherence. These findings are presented in a case comparison. Data show that a supportive environment and knowledge of medications were significant in increasing self-responsibility and adherence in adolescent transplant recipients. Also, experiencing rejection early in treatment because of less adherence led to increased adherence for fear of further rejections or death.

Adolescent↗
PubMed1991

Medication adherence patterns in chronic obstructive pulmonary disease.

While medical treatment of COPD has advanced, the failure to adhere to regimens for medication poses a significant barrier to effective management. Furthermore, no data are available regarding adherence for patients within the United States. Data from this investigation indicate that 78 outpatients from a medical center in the southeastern region of the United States were prescribed an average of 6.26 medications with both various dosing schedules and different modes of administration. Adherence was poor, with 42 patients (54 percent) underutilizing medications, 39 patients (50 percent) overutilizing medications during periods of respiratory distress, and 24 patients (31 percent) employing ineffective inhaler dosing techniques. Prescription patterns and adherence were not associated with demographic variables; however, adherence was related to classes of medication and situational variables.

Administration, Inhalation↗
PubMed2000

Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease.

New treatments for HIV can improve immune functioning and decrease mortality. However, lapses in adherence may render these complex regimens ineffective. Sixty-three men and 9 women on highly active antiretroviral therapy completed measures of medication adherence, psychological characteristics, and barriers to adherence. HIV viral load, a health outcome measure of virus amount present in blood, was also obtained. The sample was 36% African American and 56% Caucasian, with 35% reporting disability. Nearly one third of patients had missed medication doses in the past 5 days, and 18% had missed doses weekly over the past 3 months. Frequency of missed doses was strongly related to detectable HIV viral loads. Depression, side-effect severity, self-efficacy, and social support distinguished patients with good and poor adherence. Barriers also varied with adherence level. Implications for interventions promoting HIV treatment adherence are discussed.

Adult↗
PubMed2002

Enhancing medication adherence among inner-city children with asthma: results from pilot studies.

Despite the availability of effective treatments that aid in controlling asthma symptoms, inner-city children with asthma have high rates of morbidity and are frequent users of emergency department services. The goal of these studies was to pilot test an intervention that used social learning strategies (e.g., goal-setting, monitoring, feedback, reinforcement, and enhanced self-efficacy) and targeted known barriers to individualize a family-based asthma action plan. Participants were 15 children with asthma, aged 7-12 years, who had been prescribed at least one daily inhaled steroid. The children and their mothers lived in inner-city Baltimore and all were African-American. Participants received up to five visits in their home by a nurse. Electronic monitors were installed on the children's MDI to provide immediate feedback on medication adherence to the families and validate medication use. At baseline, only 28.6% of the children were using their medications as prescribed. Within four weeks, the number of children who were using their medications appropriately doubled from 28.6% at baseline to 54.1% (90% increase; p = 0.004), while underutilization decreased from 51.2% to 25.4% (100% decrease; p = 0.02). The number of children with no medication use at all dropped from 28.3% at baseline to 15.1% by week 5 (87% decrease; p = 0.009). Thus, within four weeks, more than half the children were using their inhaled steroids appropriately. In addition, the rate of underutilization decreased and that of nonutilization was cut in half. Our initial data suggest that an individualized, home-based intervention can significantly enhance adherence to the daily use of inhaled steroids in inner-city children with asthma. Nevertheless, adherence to daily inhaled steroid therapy remains a significant problem in this group.

Adult↗
PubMedDate not supplied

Medication adherence and persistence: a comprehensive review.

Estimates of adherence to long-term medication regimens range from 17% to 80%, and nonadherence (or nonpersistence) can lead to increased morbidity, mortality, and healthcare costs. Multifaceted interventions that target specific barriers to adherence are most effective, because they address the problems and reinforce positive behaviors. Providers must assess their patients' understanding of the illness and its treatment, communicate the benefits of the treatment, assess their patients' readiness to carry out the treatment plan, and discuss any barriers or obstacles to adherence that patients may have. A positive, supporting, and trusting relationship between patient and provider improves adherence. Individual patient factors also affect adherence. For example, conditions that impair cognition have a negative impact on adherence. Other factors--such as the lack of a support network, limited English proficiency, inability to obtain and pay for medications, or severe adverse effects or the fear of such effects--are all barriers to adherence. There are multiple reasons for nonadherence or nonpersistence; the solution needs to be tailored to the individual patient's needs. To have an impact on adherence, healthcare providers must understand the barriers to adherence and the methods or tools needed to overcome them. This report describes the barriers to medication adherence and persistence and interventions that have been used to address them; it also identifies interventions and compliance aids that practitioners and organizations can implement.

Drug Therapy↗
PubMed2006

Visual-feedback therapy for antipsychotic medication adherence.

This pilot study aimed to examine the effectiveness of visual-feedback therapy for individuals with psychotic disorders. Visual-feedback therapy combines structured psychodynamic therapy and visual feedback achieved via an electronic monitoring medication cap to increase insight about medication behaviours. Thirty subjects were randomly assigned either to visual feedback or to a supportive counselling group. Medication adherence was measured by both electronic monitoring and blood plasma drug concentration levels. The results showed that, at the end of the 3-month, intervention (bimonthly sessions), adherence rates of the visual-feedback group slightly increased, but declined during the course of the study for the supportive counselling control group (P=0.026).

Adult↗
PubMed2005

Methods to improve medication adherence in patients with hypertension: current status and future directions.

PURPOSE OF REVIEW: Efficacious pharmacologic treatments are available for the management of hypertension, yet only about 50% of patients treated with antihypertensive medications have their blood pressure controlled. A key factor contributing to poor blood pressure control is suboptimal adherence to prescribed therapy. Despite numerous studies conducted over the last 50 years to identify the best method for increasing patient compliance, no single intervention has emerged as superior to the others. This article reviews the effectiveness of methods to improve antihypertensive medication adherence, discusses the effect of drug benefit caps on compliance, and proposes a framework for future clinical and research directions. RECENT FINDINGS: Several recent systematic reviews and meta-analyses have attempted to quantify the effectiveness of various methods to improve adherence. As a result of the multiple factors influencing medication adherence, a patient-centered approach that tailors interventions aimed at overcoming barriers to adherence may be necessary. SUMMARY: Physicians and other health care professionals should consider nonadherence to medication when evaluating a patient with poor blood pressure control. In selecting an intervention to improve compliance to medications, clinicians should consider engaging the patient in an intervention that overcomes patient-specific barriers. Future research should target development of adherence models, which simultaneously examine the effects and interactions of social, psychological, and biologic variables on antihypertensive medication adherence.

Antihypertensive Agents↗
PubMed2000

HIV-infected adolescent and adult perceptions of tuberculosis testing, knowledge and medication adherence in the USA.

HIV-infected adolescent and adult perceptions of tuberculosis (TB) infection rates and physician TB behaviour, and patient knowledge of TB transmission and treatment adherence were assessed. HIV-infected youth (N = 199) from adolescent clinical care sites in three cities and HIV-infected adults (N = 133) in New York were interviewed. Adolescent self-report was compared to medical chart review. Adolescents reported they were significantly less likely to be tested, although testing rates were high for both samples. Approximately 9% of both samples reported infection with TB; the majority of whom reported receiving medication (97%), and consistent medication adherence (93%). The overall mean knowledge score was 66%, with significant age differences: adolescents were less knowledgeable than adults, and young males tended to be less knowledgeable than young females. Age, gender and experience with TB (self-perception of TB, testing history and clinic choice) significantly predicted accuracy of knowledge about TB. Results suggest that if HIV-infected individuals--a population at very high risk and often among the least able to afford health care resources--receive the education and support they need from their community health care sources they may substantially reduce their chances of contracting and spreading TB.

AIDS-Related Opportunistic Infections↗
PubMed2006

Perceived social support and HIV/AIDS medication adherence among African American women.

HIV/AIDS incidence is increasing more quickly among women than any other segment of the population. The typical woman with HIV/AIDS is young, in her late 20s, economically challenged, and of childbearing age. Adherence to HIV therapies is critical if patients are to achieve and maintain virologic suppression. The author recruited HIV/AIDS-infected African American women from an outpatient clinic to investigate the women's perceptions of social support and how it affected their medication adherence. She collected data through tape-recorded interviews using a semistructured guide and journaling over a 2-week period. Facilitators of adherence included supportive family members and having young children. Barriers to adherence included perceived stigma, feeling unloved or uncared for, relationship turbulence, and having a husband who was also HIV positive. Although participants reported being "fairly" satisfied with the quality of support they received, emotional support and often instrumental support were most desired and wanted.

Adult↗
PubMed2005

Lipodystrophy-associated symptoms and medication adherence in HIV/AIDS.

Lipodystrophy-associated manifestations remain a challenge for persons infected with HIV disease and their care providers. Symptomatic HIV disease and side effects of medications are implicated in antiretroviral medication nonadherence. This study examined the relationship between time since initial diagnosis with HIV, presence and type of lipodystrophic symptoms, and adherence to medication regimens in persons with HIV/AIDS. Using a cross-sectional, descriptive design, the sample was composed of 165 persons from three outpatient HIV settings in Boston, Massachusetts; Fresno, California; and Victoria, Texas. Participants completed a questionnaire comprised of sociodemographic questions, adherence scales, quality-of-life scales, and open-ended questions regarding presence and types of lipodystrophy-associated symptoms, and how these physical changes made them feel. Adherence was moderate with a mean score of 1.44 (standard deviation [SD] +/- 1.33) on the Morisky Medication Adherence Scale (MMAS). The MMAS is a Likert-type scale ranging from 0-4, with "0" indicating very adherent. This finding indicated that the participants took their medications moderately well despite self-reports of significant numbers of HIV disease and treatment-related body fat changes. Time since initial diagnosis was 8.86 +/- 5.55 years and was not related to adherence. Nor did the type of lipodystrophic symptoms affect adherence. Quality of life however, was significantly related to adherence suggesting an approach that might be taken to improve adherence.

Adult↗
PubMed2003

HIV/AIDS medication adherence factors: inner-city clinic patient's self-reports.

OBJECTIVE: To document common facilitators of, and barriers to, HIV/AIDS medication regimen adherence and to identify facilitators and barriers significantly correlated to attainment of higher vs. lower adherence. DESIGN: Data were collected using semi-structured interviews. SETTING: An outpatient clinic serving as the regional treatment center for HIV disease. PATIENTS: A purposive sample of 57 clinic patients was enrolled and completed the study. MAIN OUTCOME MEASURES: Self-reported adherence was measured using a visual analog scale and specified as higher or lower adherence at the 80% level, the approximate median. RESULTS: Many barriers to adherence were more prevalent in the lower adherence group, including complexity of the medication regimen and experiencing side effects. Lower adherence patients also had more problems with privacy and interference with social life and work or school. Patients in the higher adherence group were more concerned with forgetting as an adherence barrier. In general, social support, motivation to avoid AIDS, perceiving the health care practitioner as a facilitator, knowledge of medications, and keeping schedules were identified as factors enhancing adherence. CONCLUSIONS: The high prevalence of many barriers shows that the health care provider has an important role in patient education and support to accomplish increased adherence. Fear and avoidance behaviors in the lower adherence group contrasted with the increased concern with forgetting in the higher adherence group. Communicating treatment advances with patients may help more patients to address many barriers to higher adherence.

Adult↗
PubMed1999

Medication adherence failure in schizophrenia: a forensic review of rates, reasons, treatments, and prospects.

Forensic patients with schizophrenia who fail to adhere to prescribed antipsychotic medication risk recidivism, which continues to be a serious concern. It affects all stages of trial proceedings and impacts on the treaters' liability. Although much remains unchanged since the authors reviewed the subject in 1986, significant advances have occurred. A patient's insight can be assessed with greater precision. Risks posed by past noncompliance, substance abuse, and a dysphoric response to medication are more clearly documented. Clinical and laboratory methods for assessing compliance have improved. Major advances in the effective amelioration of adverse effects can be applied to promote adherence. New augmentation strategies enable adequate treatment at lower doses. The development of atypical antipsychotic agents makes compliance easier to achieve and maintain. Other advances apply to the containment of relapse when it does occur. This review organizes the literature documenting these trends for use in both treatment and consultation.

Antipsychotic Agents↗
PubMed2006

A randomized controlled psycho-education intervention trial: Improving psychological readiness for successful HIV medication adherence and reducing depression before initiating HAART.

The purpose of this study was to evaluate a novel psycho-educational intervention intended to increase patients' medication preparedness and treatment adherence skills before initiating highly active antiretroviral therapy (HAART). Sixty-three HIV-positive patients not currently on antiretroviral therapy participated in a randomized controlled trial of a standardized, four-session psycho-educational intervention (Supportive Therapy for Adherence to Antiretroviral Treatment; STAART). Session topics included learning techniques to increase medication adherence and learning effective strategies to cope with stress and depression. Patients completed psychological questionnaires assessing psychological readiness to initiate HAART and depressed mood. They completed both measures at study baseline and at four-weeks post-baseline. After controlling for baseline medication readiness scores, intervention patients (n = 30) reported significantly higher mean medication readiness following the STAART intervention (four-weeks post-baseline) (27.3+/-6.9) compared to controls (n = 33; 24.6+/-9.9; p < 0.05). Among depressed patients (n = 27), those receiving the intervention (n = 15) reported significantly lower mean depression scores at four-weeks post-baseline (22.5+/-12.9) compared to controls (n = 12; 27+/-9.9; p < 0.05). The STAART intervention enhanced HIV treatment readiness by better preparing patients prior to initiating HAART. It was also beneficial for reducing depressive symptoms in depressed, HIV-positive patients.

Adaptation, Psychological↗