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PubMed2005

Social support and locus of control as predictors of adherence to antidepressant medication in an elderly population.

OBJECTIVE: The authors examined whether social support and locus of control (LOC), either individually or jointly, would be associated with subsequent self-reported medication adherence and treatment barriers in a sample of depressed elderly patients. METHODS: A group of 85 elderly patients with major depression was enrolled in the Mental Health Clinical Research Center for the Study of Depression in Later Life at Duke University and treated with a standardized algorithm. During the course of the study, participants completed measures of social support and internal locus of control (LOC). A little more than 1 year later, they completed general measures of medication adherence and treatment barriers. RESULTS: Increasing subjective and instrumental social support and non-family interaction were associated with greater adherence among patients high in internal LOC but not among patients low in internal LOC. Less instrumental social support was associated with more treatment barriers among patients low in internal LOC but not among patients high in internal LOC. CONCLUSION: The relationship between social support and antidepressant medication adherence is moderated by beliefs about control over one's illness.

Aged↗

PubMed1997

Adherence to antihypertensive medications across the life span.

Although treatment for hypertension is readily available, poor control of hypertension is a major health problem frequently manifested in late life. Researchers believe that one of the major causes of uncontrolled hypertension is failure to take medication as directed. In this preliminary study, the medication-taking behaviors of 48 adults diagnosed with hypertension, ranging in age from 35 to 87, were recorded for 2 months with credit card-sized bar-code scanners. The social-cognitive model (Park, 1992) for understanding medication adherence, which proposes that medication adherence is governed by both beliefs and cognitive factors, was used as a basis for this research. Therefore, measures of health behaviors, attitudes about health and medication taking, and cognitive function were recorded, as well as blood pressure readings. The main findings were that (a) the oldest-old and groups of middle-aged adults were the most nonadherent, whereas the young-old were more likely to adhere than the other age groups; (b) high blood pressure readings predicted adherence to antihypertensive medications; and (c) medication beliefs influenced adherence in some situations.

Adult↗

PubMed2003

Adherence to medication treatment: a qualitative study of facilitators and barriers among a diverse sample of HIV+ men and women in four US cities.

Most studies examining HIV antiretroviral medication treatment adherence involve quantitative surveys. Although these studies have identified factors associated with medical adherence, no single variable or combination of variables is sufficiently consistent to apply to any individual or group of people. Using qualitative methods, an ethnically diverse sample (N=110) of HIV+ women, men who have sex with men, and male injecting drug users in four U.S. cities were interviewed in depth to elicit their experiences, perspectives, and life contexts regarding knowledge, attitudes, beliefs, and experiences with HIV medication adherence. Most described multiple influences on medication-taking behavior, describing adherence as a dynamic phenomenon that changes over time with their changing beliefs, attitudes, emotions, and daily and larger life events. Prevalent themes include ambivalence toward HIV medication and intentional nonadherence, usually to address physical side effects. Factors from different domains (e.g., cognitive, emotional, interpersonal) can have compensatory influences on behavioral outcomes. Findings are discussed in terms of social action theory, contributing to our theoretical understanding of the phenomenon of adherence.

Adaptation, Psychological↗

PubMedDate not supplied

Medication use patterns and health outcomes among patients using a subsidized prescription drug program.

OBJECTIVE: To evaluate medication adherence, medication safety, health care utilization, and health outcomes among patients enrolled in a subsidized prescription program. DESIGN: Cross-sectional study. SETTING: Conducted as part of the Prescription Access program, a subsidized prescription program serving indigent patients residing in Franklin County, Ohio. PATIENTS: Patients qualifying for enrollment in the program were uninsured and had a household income of 200% or less of federal poverty level. Approximately 5% of the 2,500 patients (mean age, 70.6 years) enrolled in the program were systematically selected from a computer-generated patient enrollment report. INTERVENTION: Telephone interviews conducted by a pharmacist or advanced student pharmacist between January and September 2002. MAIN OUTCOME MEASURES: Patterns of medication use and safety, level of health care utilization, and health outcomes. RESULTS: A total of 104 patients reported taking a mean (+/- SD) of 6.7 +/- 3.8 medications. A total of 72 (69%) patients reported taking their medications correctly, and 90 (87%) reported finishing their medication course as prescribed. Medication refills were obtained by 75 (72%) patients, but of these patients, only 55 (73%) indicated that they obtained their refills on time. Adverse effects occurred in 25 (24%) patients, and 2 patients reported an allergic reaction. A total of 51 (49%) patients made unscheduled visits to their primary care physician, another health care facility, an emergency department, and/or were admitted to a hospital. Unscheduled visits occurred more often among nonadherent patients (59%) than adherent patients (44%), but not significantly so. In addition, 82 (79%) patients reported an improvement in health-related quality of life (QOL); 90 (87%) had a means of transportation to obtain medications; and 93 (89%) indicated that they would have to skip medications or give up necessities, if they were not enrolled in a subsidized prescription program. CONCLUSION: An improvement in self-reported QOL and a high rate of medication adherence demonstrate support for the benefits of this and similar subsidized prescription drug programs. A high rate of additional health care utilization, especially among nonadherent patients, indicates an area for further analysis, program revisions, and/or patient education.

Aged↗

PubMed2002

Patient adherence to HIV medication regimens: a review of published and abstract reports.

A literature search was conducted to collect published articles reporting correlates of HIV medication adherence or interventions designed to increase HIV medication adherence. Proceedings from seven HIV/AIDS-related conferences were searched for relevant abstracts. We found 18 descriptive studies in published articles and 57 in conference proceedings producing over 200 separate variables falling into four broad areas: (1) factors related to treatment regimen; (2) social and psychological factors; (3) institutional resources; and (4) personal attributes. More complex regimens were related to decreased adherence, but were often successfully mitigated by regimen aids. Social and psychological factors reflecting emotional adjustment to HIV/AIDS and provider support were related to adherence. Access to institutional resources was associated with better adherence. Personal attributes showed a mixed relationship; gender was not consistently related to adherence, but younger age, minority status, and a history of substance abuse were often related to non-adherence. The intervention search yielded 16 interventions employing a wide range of behavioral, cognitive and affective strategies. Evidence of effectiveness was weak. We conclude the abstracts are a useful source of information as part of a systematic review, particularly when available published literature is limited, if results and study characteristics are reported in an adequate and standard manner.

Adult↗

PubMed2002

Psychiatric morbidity and adherence to antiretroviral medication in patients with HIV/AIDS.

OBJECTIVE: To determine whether psychological morbidity is associated with poor compliance with antiretroviral medication in HIV-positive subjects. METHOD: This is a cross-sectional survey of patients attending a public HIV clinic in Sydney. Volunteers completed a survey which gathered data on substance use, psychological distress, attitudes to illness and medication, and self-reported medication adherence. Psychological morbidity was assessed using the 28 question General Health Questionnaire, GHQ-28, and adherence was assessed using a combination of direct self-report and indirect questions. RESULTS: Forty-four per cent of subjects were identified as suffering psychological disorder on the GHQ. They reported significantly poorer adherence to antiretroviral medication than subjects not identified as 'cases' (odds ratio 4.5). Expressed scepticism about medication and previous use of psychotropics was also associated with poor adherence. CONCLUSIONS: Psychological morbidity is associated with poor adherence to antiretroviral medication. It is not known whether treatment of identified psychological morbidity leads to improved antiretroviral medication adherence and better medical outcome. A longitudinal study could help answer this question.

Acquired Immunodeficiency Syndrome↗

PubMed1995

The effects of medication education on adherence to medication regimens in an elderly population.

The purpose of this intervention study was to evaluate educational protocols to see which would be more effective in increasing medication compliance rates within an elderly population. Forty-two patients were randomized into four groups. Group 1 received a standard education protocol; group 2 received the standard education and 30 minutes of verbal instruction; group 3 received the standard education and a medication schedule; and group 4 received the standard education, a medication schedule, and 30 minutes of verbal instruction. The intervention was given on the day of hospital discharge. Home visits were made 2 weeks, 1 and 2 months post-hospital discharge. Results of the visits revealed that groups 1 and 2 had higher rates of errors with medications than groups 3 and 4. In conclusion, the groups with a medication schedule had higher compliance rates. Considering the sample size of 42, this study can act as a pilot study to justify further research in the effects of a medication schedule on compliance.

Aged↗

PubMedDate not supplied

Improving adherence and reducing medication discrepancies in patients with diabetes.

OBJECTIVE: To improve medication adherence by reducing self-reported adherence barriers, and to identify medication discrepancies by comparing physician-prescribed and patient-reported medical regimens. DESIGN: Prospective, randomized, controlled trial. SETTING AND PARTICIPANTS: A single academically affiliated community health center. Eligible patients had type 2 diabetes, had undergone laboratory testing in the year preceding the study, and had visited the clinic in the 6 months preceding the study. INTERVENTION: A pharmacist administered detailed questionnaires, provided tailored education regarding medication use and help with appointment referrals, and created a summary of adherence barriers and medication discrepancies that was entered into the medical record and electronically forwarded to the primary care provider. MEASUREMENTS: Changes in self-reported adherence rates and barriers were compared 3 months after the initial interview. Intervention patients with medication discrepancies at baseline were assessed for resolution of discrepancies at 3 months. RESULTS: Rates of self-reported medication adherence were very high and did not improve further at 3 months (6.9 of 7 d, with all medicines taken as prescribed; p = 0.3). Medical regimen discrepancies were identified in 44% of intervention patients, involving 45 doses of medicines. At 3-month follow-up, 60% of discrepancies were resolved by corrections in the medical record, while only 7% reflected corrections by patients. CONCLUSIONS: In this community cohort, patients reported few adherence barriers and very high medication adherence rates. Our patient-tailored intervention did not further reduce these barriers or improve self-reported adherence. The high prevalence of medication discrepancies appeared to mostly reflect inaccuracies in the medical record rather than patient errors.

Aged↗

PubMed2000

Stages of change for adherence with medication regimens for chronic disease: development and validation of a measure.

BACKGROUND: The stages-of-change (SOC) model has been used to explain and predict how behavior change occurs, but it is new as an approach to understanding why patients fail to take their medications as prescribed. OBJECTIVE: This study validated a 2-item measure of SOC for adherence with medication regimens in 2 groups of patients prescribed pharmacologic therapy for chronic conditions. METHODS: Two cross-sectional studies of attitudes toward medication adherence included the same measure of SOC for medication adherence. One was a sample of 161 HIV-positive patients in the United States, and the other was an international sample of 731 patients with hypertension. The validity of the measure of SOC for medication adherence was examined in both convenience samples using previously validated self-reported measures of adherence (the Medication Adherence Scale and a measure of adherence from the Medical Outcomes Study), and in the HIV sample using electronic monitoring of adherence behavior in 85 patients. RESULTS: Construct validity was demonstrated in both samples by associations between SOC and the previously validated measures of adherence (P < 0.001), and predictive validity was supported by significant associations between SOC for medication adherence and electronically monitored medication-taking behavior during the next 30 days (P < 0.03). CONCLUSIONS: Behavior-change theory suggests that stage-tailored communication strategies are more effective than uniform health-promotion messages. Our results provide a foundation for the development of interventions for medication adherence that are tailored to patients' readiness for change. Our validated 2-item measure of SOC for medication adherence can be used to match communication strategies to individual motivation and readiness for adherence with chronic disease medication regimens.

Anti-HIV Agents↗

PubMed2005

Motivational interviewing for improving adherence to antiretroviral medications.

Many interventions have been developed to address barriers to antiretroviral medication adherence, but few have focused on motivation, a fundamental component of behavior change. Research on other health behavior changes and a few pilot studies investigating motivational interviewing (MI) for adherence to antiretroviral medication suggests that MI may be highly beneficial by helping to motivate patients with HIV to adhere to their medications. Existing research, although limited, suggests that MI combined with other interventions is feasible and efficacious for improving adherence to antiretroviral medications. With continued development and refinement of antiretroviral adherence interventions that incorporate MI, more persons with HIV infection can be expected to choose to make the difficult changes necessary for them to benefit from antiretroviral therapy.

Adult↗

PubMed2003

Testing combined pharmacotherapies and behavioral interventions in alcohol dependence: rationale and methods.

Increasing knowledge about effective therapies for alcohol dependence calls for new research designs to examine treatment interactions between pharmacotherapies and behavioral interventions. In 1997, the National Institute on Alcohol Abuse and Alcoholism recruited 11 sites and a coordinating center for a large-scale (1,375 subjects), randomized placebo controlled trial to test 16 weeks of active treatment using naltrexone and acamprosate alone and in combination. Most participants receive 9 brief sessions delivered by medically trained providers to promote sobriety and enhance medication adherence (Medical Management, MM). Half the participants are also randomized to individualized psychotherapy (up to 20 sessions of Combined Behavioral Intervention, CBI), integrating elements of the successful behavioral interventions from Project MATCH. COMBINE seeks to evaluate the efficacy of the two most promising medications (naltrexone and acamprosate) both singly and together, when combined with different intensities of behavioral therapies. COMBINE incorporates a number of innovative design aspects, including a no-pill psychotherapy-alone condition, behavioral interventions that are both manual-guided and individualized, and pharmacotherapy dosing that is greater than in some previous trials. Two COMBINE pilot studies demonstrate the safety and acceptability of the combination pharmacotherapy dosing, and the feasibility of implementing the manualized behavioral interventions. This paper introduces COMBINE's goals, methods and analytic strategies, and their potential to improve multimodal treatment selection.

Acamprosate↗

PubMed2006

Self-reported medication treatment adherence among veterans with bipolar disorder.

OBJECTIVE: Treatment nonadherence has been identified as an understudied, yet frequent, cause of relapse among patients with bipolar disorder. This study evaluated factors related to treatment adherence. METHODS: This study was a cross-sectional analysis of patient characteristics, features of the patient-provider relationship, and barriers to care as they related to self-reported treatment adherence among veterans with bipolar disorder. Data were collected before patients were randomly assigned to treatment in a multicenter trial. Participants were enrolled in the study from 1997 to 2000. RESULTS: This analysis found that individuals with bipolar disorder who were adherent to medication (N=113) differed from those who were not (N=71) on patient characteristics and variables related to the patient-provider relationship. Individuals with bipolar disorder who were not adherent to medication were more likely than those who were adherent to have a current substance use disorder. A past substance use disorder was not associated with treatment nonadherence. Adherence to medication was not predicted by symptoms, overall health status, functional level, or gender. Individuals who were adherent to medication took a greater number of different medications than those who were nonadherent. CONCLUSIONS: Treatment adherence is a multidimensional entity and includes not only patient characteristics but also factors related to patient-provider interactions. Therapeutic approaches that address or incorporate an individual's comorbid conditions and are able to optimize intensity of treatment may have the greatest effect on treatment adherence attitudes and behaviors.

Antipsychotic Agents↗

PubMed1999

Behavior-changing methods for improving adherence to medication.

Long-term adherence to antihypertensive drug therapy is poor, and new strategies to predict and improve adherence to prescribed drug regimens are needed. The literature on behavior change is reviewed, and a new perspective on medication adherence is presented. Successfully adopting and continuing with a long-term medication regimen requires behavior change, and behavior change principles can be used to accelerate the adoption of adherence to medication- taking behavior. The efficacy of behavior-changing interventions, which are tailored to each patient's stage of change, has been demonstrated in several health behavior areas. Rewards, monitoring devices, and reminder techniques are most useful for individuals in later stages of behavior change, but individuals in earlier stages need consciousness-raising interventions that focus upon awareness of the benefits of therapy. Recent research has yielded reliable ways to measure the stage of change for medication adherence, providing the foundation for the application of behavior- changing principles to the pharmacologic management of hypertension.

Adaptation, Psychological↗

PubMed2006

Adapting electronic adherence monitors to standard packages of topical medications.

Adherence to topical medications is poorly characterized. Electronic monitors can provide objective adherence data, but these monitors are not designed to work with tubes of medications. We sought to adapt standard electronic monitors to commonly used medication tubes. An adapter was created to fit over standard medication tubes. Screw threads on the adapter were designed to fit standard electronic monitors. Adapters and monitors were tested with tubes of gel, ointment, and cream over an 8-week test period during which the adapters were opened and closed twice daily. The adapters were easily mated to both plastic and aluminum topical medication tubes. The bond between the adapter and the tube was maintained throughout the study. Electronic monitors were 100% accurate at identifying medication events over the study period. We conclude that adapting existing electronic monitors to medication tubes should facilitate a much better understanding of adherence to topical treatment.

Administration, Topical↗

PubMed2005

Researchers study use of the 'MATI' for improving AIDS drug adherence. Early data confirm tool's usefulness.

Investigators have found that an adherence tool that addresses multiple factors contributing to adherence difficulties can assist with better adherence. The Medication Adherence Training Intervention (MATI) is a newly-invented tool that prepares patients for adherence by incorporating medication adherence education, the patient's history and medication experiences, with motivation and empowerment interventions, says Shvawn McPherson Baker, PharmD, MPH, a research associate in the division of hepatology at the University of Miami School of Medicine in Miami, FL. "We developed the MATI along the context of clinical pharmacy, clinical medication, and clinical psychology, interfacing the three of them to come up with an approach to patient care," Baker says. "We looked at how to best incorporate the patient's abilities with our abilities." One aspect to the MATI that's important is how it is designed to be a nonjudgmental tool that doesn't admonish patients for their poor adherence habits, Baker notes. "The approach is 'Let's take off the white coat and work on this together,'" Baker says. "Let's see if there's a readiness for medication adherence and provide education on that."

HIV Infections↗

PubMed2003

Psychological distress and adherence to the medical regimen among adolescent renal transplant recipients.

This longitudinal pilot study of adolescent renal transplant recipients (a) describes the prevalence of psychological distress, (b) describes the prevalence of nonadherence, and (c) explores the association between the recipient's psychological distress and his/her subsequent medical adherence. Twenty-two adolescents, aged 13-18 years, completed two interviews that were separated by approximately 12 months. Psychological distress was assessed in three domains: symptoms of depression, anxiety, and anger. Adherence was assessed in three domains: medication taking, blood work, and clinic attendance. At the initial interview, 36.4% had symptoms of depression, 36.4% endorsed anxiety, and 18.2% endorsed excessive state anger. Non-adherence rates were 13.6% for medication, 22.7% for blood work, and 50% for missed clinic. At the second interview, nonadherence with medication remained the same and the other domains decreased. Our small pilot sample, however, limited our ability to detect statistically significant changes over time. Predictive analyses demonstrated that adolescents with excessive anger were at greater risk for subsequently missing medications than adolescents without excessive anger. These findings suggest that while symptoms of depression and anxiety are observed among some adolescents with renal transplants, only anger is associated with elevated risk for nonadherence with medication.

Adolescent↗

PubMed2004

Adherence to pharmacotherapy in patients with alcohol and opioid dependence.

AIMS: An important factor that has thus far limited the effectiveness of pharmacotherapies for patients with alcohol and opioid dependence is poor adherence to medication regimens. This paper presents a review of issues related to medication adherence in patients with these substance use disorders. DESIGN AND METHODS: A literature review was conducted of English language publications relating to medication adherence among patients with alcohol or opioid dependence. FINDINGS: The paper places the topic in the context of adherence difficulties among patients with a variety of chronic medical and psychiatric illnesses. Difficulties measuring adherence are discussed, and strategies to improve medication adherence are reviewed. These include specific interventions that prescribing clinicians can implement in their individual meetings with patients; the use of external reinforcers, such as positive and negative contingencies, and involvement of family members or significant others; and specific prescribing and dosing practices that may improve adherence. CONCLUSIONS: As the use of pharmacotherapy for substance-dependent patients increases, rigorous and innovative approaches to encourage medication adherence should be sought.

Alcoholism↗

PubMed2003

Patterns of adherence to antiretroviral medications: the value of electronic monitoring.

OBJECTIVE: To investigate the patterns of intra-subject (between medication) adherence to antiretroviral therapy. DESIGN: A prospective, observational, 3-month study of adherence to antiretroviral therapy at an inner-city clinic in 40 HIV-infected subjects. METHODS: Adherence was monitored monthly by the use of medication event monitoring system (Aprex) caps placed on each antiretroviral drug in a subject's regimen. Agreement between different drug classes and dosing schedules, for each subject, was quantified by estimating the mean difference in adherence, with 95% limits of agreement. An analysis of variance model was used to estimate the variance of the differences. Individual dosing calendars were examined for each subject. RESULTS: The dosing schedule was a strong predictor of intra-subject adherence. Regardless of the subject's overall adherence rate, high or low, when subjects missed a dose of one medication, they missed a dose of both medications taken at that dosing time. Conversely, when medications were scheduled to be taken together, regardless of the drug class, the medications were taken at the same times. The majority of the subjects took medications at obviously incorrect times. Problematical adherence was related to thrice-daily dosing and food restrictions. CONCLUSION: This is the first report objectively to quantify intra-subject adherence to antiretroviral therapy and report the findings in detail. We observed clear patterns of drug-taking behavior among the subjects in our study. To the extent that medication scheduling is a controllable factor, our report provides an insight into specific patterns of behavior that may be targets for adherence counseling.

Antiretroviral Therapy, Highly Active↗