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Results for “Medication Adherence”

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PubMed2004

Interdisciplinary approach to teaching medication adherence to pharmacy and osteopathic medical students.

The purpose of this project was to demonstrate to pharmacy and osteopathic medical students the value of interdisciplinary education through participation in an interdisciplinary medication adherence project. Each pharmacy student, assuming the role of a pharmacist, was paired with a medical student acting as a physician with a needlestick exposure requiring HIV prophylaxis therapy. Medical students were randomized to participate in one of three levels of pharmacist counseling. After completion of therapy, all students met to discuss adherence barriers, complete an attitudinal survey, and obtain a tablet count. Most pharmacy and medical students agreed or strongly agreed that participation in this project will help them work better within the health care team (82% and 87%, respectively) and that they should have more participation in interdisciplinary projects (83% and 76%, respectively). At the end of the project, these students reported positive attitudes concerning working on interdisciplinary health care education initiatives.

Antiviral Agents↗

PubMed2006

Factors related to medication adherence in memory disorder clinic patients.

Medication adherence is a substantial problem in the elderly. It may be even more important among elderly persons with memory problems, since other factors that lead to non-adherence may be compounded with the memory problems themselves. The objective was to determine whether a model that integrates research on medication adherence from several research domains is useful in understanding adherence in elderly patients. The methodology involved a cross-sectional observational study using a convenience sample of 63 patients drawn from a university-affiliated outpatient memory disorders clinic. The primary measure of medication adherence was caregivers' reports of patients' medication adherence. Patients and their caregivers were asked questions assessing their beliefs about the seriousness of each condition for which a medication was prescribed and the likely outcome of that condition without treatment. Additional data collected included presence of side effects, total number of medications taken, and patients' mood and cognitive status. Multilevel path analysis confirmed several model-based predictions. Caregivers' reports of adherence were predicted by estimates of disease outcome, the presence of side effects, and patients' relying on themselves to remember to take medications. Results partially confirm the integrative model in understanding medication adherence in these patients. Patients' beliefs about the likely effect of medication treatment for their condition and the presence of side effects influence reported medication adherence. Results thus suggest that efforts to educate patients about the likely response of their medical condition to treatment and to assess and deal with medication side effects might improve patient adherence.

Aged↗

PubMed2004

A pilot study of barriers to medication adherence in schizophrenia.

BACKGROUND: Interventions to improve adherence to antipsychotic medication are needed. The aims of the current study were to identify the most common barriers to medication adherence in a cohort of patients receiving outpatient and inpatient treatment for an acute exacerbation of schizophrenia, compare clinical and demographic characteristics of patients with lower versus higher numbers of barriers, and characterize patients most likely to be nonadherent to antipsychotic medication. METHOD: The present study analyzed data collected during the Schizophrenia Guidelines Project (SGP), a multisite study of strategies to implement practice guidelines that was funded by the U.S. Department of Veterans Affairs and conducted from March 1999 to October 2000. Nurse coordinators had conducted clinical assessments and performed an intervention designed to improve medication adherence by addressing barriers to adherence. Data on patient symptoms, functioning, and side effects had been obtained using the Positive and Negative Syndrome Scale (PANSS), the Schizophrenia Outcomes Module, the Medical Outcomes Study 36-item Short-Form Health Survey, and the Barnes Akathisia Scale (BAS). Administrative data were used to identify patients with an ICD-9 code for schizophrenia. A total of 153 patients who met this criterion and participated in the intervention arm of the SGP had complete data available for analysis in the current study. RESULTS: The most common patient-reported barriers were related to the stigma of taking medications, adverse drug reactions, forgetfulness, and lack of social support. Bivariate analysis showed that patients with high barriers were significantly more likely to be nonadherent (p < or =.02), to have problems with alcohol or drug use (p =.02), to have higher PANSS total scores (p =.03), and to have higher mean BAS scores (p =.02). Logistic regression showed that lower patient education level (odds ratio [OR] = 3.95, p =.02), substance abuse (OR = 3.24, p =.01), high PANSS total scores (OR = 1.02, p =.05), and high barriers (OR = 2.3, p =.05) were significantly associated with the probability of nonadherence. CONCLUSIONS: It may be possible to identify patients most likely to benefit from adherence intervention. The data presented here will help to inform future research of clinical interventions to improve medication adherence in schizophrenia and help to stimulate further work in this area.

Adult↗

PubMed2007

Stigma and social barriers to medication adherence with urban youth living with HIV.

Youth adherence to highly active anti-retroviral therapy (HAART) is poor, and little research exists that identifies the reasons youth have difficulty adhering to medications. Given that complete adherence is necessary for favourable health outcomes, it is essential to examine the obstacles youth face in adhering to HAART. The present investigation sought to identify these barriers and to systematically examine the experiences and attitudes youth have towards medications. Twenty-five adolescents and young adults presenting to a public primary care facility for treatment of HIV infection were asked to participate in focus groups which explored their attitudes and experiences around medication adherence. Participants provided richly detailed descriptions of the challenges of managing HIV stigma and their efforts to hide their status from friends, family, doctors, and even themselves. Fifty percent of respondents indicated that they skipped doses because they feared family or friends would discover their status. These results suggest that HIV stigma impacts treatment for youth on several levels, from the accuracy of communication with medical providers to medication adherence, subsequent health outcomes, and the emergence of treatment resistant strains.

Adolescent↗

PubMed2003

Development and evaluation of a medication adherence self-efficacy scale in hypertensive African-American patients.

Self-efficacy, a known predictor of a wide range of health behaviors, has not been investigated in studies of adherence to antihypertensive medications. A medication adherence self-efficacy scale was developed and evaluated in ambulatory hypertensive African-American patients in two sequential phases. For the item-generation phase, open-ended interviews with 106 patients were used to elicit their experiences with taking antihypertensive medications. Using qualitative techniques, responses were recorded verbatim, coded, and sorted into nine categories of barriers and facilitators of medication adherence. Concepts from categories were formatted into an initial 43-item self-efficacy questionnaire, which was administered to another group of 72 patients for the item analyses phase. Twenty-six items were retained for the final self-efficacy scale based on item-to-total correlation coefficient >0.5, kappa >0.4, and clinical relevance of individual items. Clinicians and researchers can use this scale to identify situations in which patients have low self-efficacy in adhering to prescribed medications.

Adult↗

PubMed2003

Impact of an antidepressant management program on medication adherence.

OBJECTIVE: To evaluate the impact of mail-based physician and member educational interventions on patient adherence to antidepressant medications. STUDY DESIGN: The randomized controlled prospective design included patients followed for 6 months after filling a new prescription for an antidepressant. A pharmacy claims database was used to identify patients and track medication adherence. PATIENTS AND METHODS: Patients receiving a new prescription for an antidepressant and their prescribers were included. Prescribers were randomly assigned to the intervention and control groups. Patient assignment was linked to their physician's assignment. The control group received no intervention. The educational intervention consisted of monthly letters to patients and prescribers regarding the Health Plan Employer Data and Information Set (HEDIS) standards or educational information regarding the importance of medication adherence. The primary outcome was adherence as measured by the medication possession ratio and measurement as specified by HEDIS. The Student's ttest, the chi2 test, and a logistic regression model were used to compare groups and the variables that affect adherence. Other secondary measurements of adherence were performed. RESULTS: A total of 9564 patients were included. Patients in the intervention group demonstrated greater adherence compared with the control group at 90 and 180 days (P < .05). After adjusting for variables, the intervention variable stood alone in its significant impact on adherence (P <.01; confidence interval, 1.003-1.197). Adherence in the total population was significantly higher for selective serotonin reuptake inhibitors than for other agents (P < .001). CONCLUSION: A monthly mail-based educational intervention program regarding antidepressant medications can positively influence patient adherence to therapy.

Adolescent↗

PubMed2003

Methamphetamine abuse as a barrier to HIV medication adherence among gay and bisexual men.

Medication adherence among persons with HIV infection is important not only because of the effect of non-adherence on an individual's health but also because non-adherence can lead to medication-resistant viral strains. However, adherence to HIV medications is difficult due to complex dosing regimens and side effects. This paper is a qualitative analysis of HIV medication adherence among gay and bisexual methamphetamine-abusing men enrolled in an outpatient drug treatment research project. As part of an open-ended, semi-structured interview, 23 HIV-infected men discussed the effects of their methamphetamine use on their medication adherence. Substance-use barriers to adherence were coded into two main themes: (1) planned non-adherence and (2) unplanned non-adherence. Planned non-adherence was a strategy for coping with demanding HIV medication schedules, or was linked to sexual behaviours while using methamphetamine or to fears of interaction effects from mixing methamphetamine with HIV medications. Participants did not define their medication regimen adjustments as non-adherence but as a way to achieve a sense of control over their lives. Unplanned non-adherence was linked to methamphetamine-related disruptions in food and sleep schedules. Findings are helpful in designing culturally specific HIV medication adherence interventions for this population.

Adult↗

PubMed1995

Major depression and medication adherence in elderly patients with coronary artery disease.

Little is known about the effects of depression on adherence to medical treatment regimens in older patients with chronic medical illnesses. Poor adherence may explain the increased risk of medical morbidity and mortality found in depressed medical patients. Ten of 55 patients over the age of 64 with coronary artery disease met the criteria for major depression from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987). All patients were prescribed a twice-per-day regimen of low dose aspirin to reduce their risk for myocardial infarction. Medication adherence was assessed for 3 weeks by an unobtrusive electronic monitoring device. Depressed patients adhered to the regimen on 45% of days, but nondepressed patients, on 69% (p < .02). Thus, major depression is associated with poor adherence to a regimen of prophylactic aspirin after the diagnosis of coronary artery disease.

Aged↗

PubMed2005

Effects of ethnicity on psychotropic medications adherence.

We compared psychotropic medication adherence rates in monolingual-Hispanics (mostly Puerto Ricans), bilingual-Hispanics, and African-Americans as compared with Caucasians in 122 subjects recruited from a community mental health center (CMHC). After controlling for possible confounding factors monolingual-Hispanics and African-Americans had lower medication adherence rates (77% and 68%, respectively) than Caucasians (90%). Older age was a significant predictor of higher adherence among monolingual-Hispanics. Depressive symptoms were associated with lower adherence and more years of past treatment with higher adherence among Caucasians. Further studies are needed to better understand and improve adherence among Hispanics and African-Americans.

Adult↗

PubMedDate not supplied

Pill count, self-report, and pharmacy claims data to measure medication adherence in the elderly.

OBJECTIVE: To compare medication adherence calculated from four different data sources including a pill count and self-report obtained during a home medication history, as well as calculations based on refill frequency derived from a provincial prescription claims database (manual and electronic). DESIGN: Baseline medication adherence was collected as part of a prospective, randomized, controlled study. Mean medication adherence results obtained from the four data sources were compared using repeated-measures ANOVA followed by a Tukey's multiple range test. SETTING: A pharmacy consultation service located at an interdisciplinary wellness center for noninstitutionalized elderly. PATIENTS: 65 years or older, noninstitutionalized, taking one or more prescribed or nonprescribed medications. Clients would either present to the wellness center or be referred by the Provincial Home Care program. RESULTS: When calculated from self-report or manual or electronic prescription claims data, mean percent adherence by drug was high and not statistically different (95.8% +/- 17.1%, 107.6% +/- 40.3%, and 94.6% +/- 24.0%, respectively), whereas the pill count adherence was significantly lower at 74.0% +/- 41.5% (p < 0.0001). CONCLUSIONS: An unexpected finding was that the pill count technique used in this study of elderly clients using chronic, repeat medications appeared to underestimate medication adherence. Numerous other limitations of pill count, self-report, and a province-wide prescription claims database in estimating medication adherence are presented. When using medication adherence as a process measure, the researcher and practitioner should be aware of the limitations unique to the data source they choose, and interpret data cautiously.

Aged↗

PubMed2001

Self-regulation predictors of medication adherence among ethnically different pediatric patients with renal transplants.

OBJECTIVE: To predict medication adherence among ethnically different pediatric patients with renal transplants between the ages of 6 and 20 years old, using self-regulation variables including motivation, perceived control and responsibility, and perceived support. METHODS: Twenty-six African American children and 42 Caucasian children were verbally administered the Self-Regulation of Medication Adherence Battery to assess their (1) motivation to be medication adherent, (2) perceived control of and responsibility for medication adherence, and (3) perceived support of medication adherence from their primary caregiver. Four measures were used to assess medication adherence: self-ratings, nephrologists' ratings, cyclosporine levels, and pill count/refill histories. RESULTS: For the African American patients, regression analyses revealed that responses to motivation and perceived control questions that focused on self-efficacy were unique predictors of medication adherence as rated by their primary nephrologist. For the Caucasian patients, one motivation question regarding how often they forget to take their medication predicted their self-reported adherence. CONCLUSIONS: Facilitating their beliefs that they can regularly take their medications may help promote medication adherence among African American children with renal transplants, whereas for Caucasian children, providing cues and reminders to take their medications may help. We discuss implications of the results for multimodal assessment of medication adherence and for ethnic group-specific medication adherence research and interventions.

Adolescent↗

PubMed2004

Enhancing medication adherence: clinician outcomes from the Medication Alliance training program.

OBJECTIVE: Patient nonadherence to psychiatric medication is a key cause of relapse but clinicians do not appear to possess specific adherence skills. We sought to demonstrate that a brief training program on medication adherence strategies could improve the adherence skills, attitudes and knowledge of mental health clinicians. METHODS: Twenty-three Tasmanian mental health workers were provided a 3 day training workshop on strategies to enhance patient adherence to medications (Medication Alliance). Pre- and post-training measures were taken of clinician knowledge about adherence strategies, ability to identify predictors of nonadherence, attitudes toward working with nonadherent patients, and optimism about treatment outcomes for patients. Videotapes of clinicians demonstrating key adherence therapy skills were also collected before and after training and blind-rated by two experienced therapists. RESULTS: A series of paired samples t-tests indicated significant improvements in skills, knowledge and attitudes. CONCLUSIONS: Compared with similar studies in the UK, Medication Alliance was found to be an effective and efficient training program. However, there is a need for further research to assess maintenance of training effects over time and patient outcomes.

Adult↗

PubMed2005

Effect of dosing frequency on bisphosphonate medication adherence in a large longitudinal cohort of women.

OBJECTIVE: To compare medication adherence with daily vs weekly bisphosphonate dosing for the treatment or prevention of osteoporosis in a broad US retail pharmacy database population. PATIENTS AND METHODS: From October 2002 through September 2003, the medication possession ratio (MPR = days of supply/365 days) was used to assess medication adherence. The MPR was calculated by use of daily and weekly bisphosphonate doses in a longitudinal cohort of patients who received prescriptions from 14,000 US retail pharmacies. Patient prescription Information was from a database accessed through NDCHealth in Atlanta, Ga. Adequate adherence was defined as sufficient medication supply to ensure antifracture efficacy (MPR, > or =80%). The effects of patients' age, method of prescription payment, and pattern of past osteoporosis medication use on medication adherence also were evaluated. RESULTS: Of 211,319 study patients, 177,552 (84%) were taking weekly bisphosphonates vs 33,767 (16%) taking the daily prescription. Although significantly more patients taking the weekly compared with the daily bisphosphonates had adequate medication adherence, only about one third of patients in the daily dosing group and fewer than one half in the weekly dosing group achieved adequate adherence. Patients new to bisphosphonates had the worst medication adherence over the year (25.2% for weekly vs 13.2% for daily dosing; P<.001). The highest proportion of adequately adherent patients was among those continuing to take their existing weekly bisphosphonates; however, even in this group, only about 48% exhibited adequate medication adherence. CONCLUSIONS: Once-weekly dosing of bisphosphonates for the treatment or prevention of osteoporosis was associated with better medication adherence than daily dosing during a 1-year observation period. However, even with weekly dosing, adherence remained inadequate in more than one half of patients. These findings indicate that ways to improve medication adherence in the treatment or prevention of osteoporosis are still needed.

Aged↗

PubMed2006

The negative association of independent personality and medication adherence.

OBJECTIVE: This investigation examines the association of personality factors and medication adherence among older adults. METHOD: The Six-Factor Personality Questionnaire was mailed to participants involved in a medication adherence investigation. Medication adherence was monitored with an electronic monitoring cap for 8 weeks for one prescribed daily medication. RESULTS: Sixty older adults, mean age 77 years (range 67 to 93 years), returned the questionnaire (69% response rate). Stepwise regression analysis demonstrates that when age and level of education are controlled, independence predicts medication adherence. This factor demonstrates a negative relationship with adherence suggesting that higher levels of independence may be related to lower adherence to prescribed medication. The facet component self-reliance is predictive of poor medication adherence. DISCUSSION: The finding that higher self-reliance is associated with lower adherence in an older population deserves further investigation and clinical consideration.

Aged↗

PubMed2006

Survey of medication adherence in patients with schizophrenia--Korean ADHES data.

BACKGROUND: This study evaluated the partial adherence to medication in schizophrenic patients in Korea. METHODS: The Adherence in Schizophrenia (ADHES) survey was conducted worldwide, including Asian countries. Through questionnaires for clinicians, caregivers and patients, information about medication adherence in patients with schizophrenia and factors affecting adherence were identified. This survey involved 131 psychiatrists from 80 psychiatry clinics and 2824 patients with schizophrenia were enrolled. RESULTS: Partial adherence in patients with schizophrenia was prevalent (over 60%) in Korea. From the psychiatrists' point of view, the most prevalent factors associated with partial adherence in their patients were poor awareness of the illness (85%) and embarrassment at having to take medication daily (80%). Psychiatrists believed that most patients (83%) needed help from someone to remind them to take the medication regularly. Of patients, 57% reported feeling upset at having to take medication daily and 76% of caregivers reported preferring long-acting medications. CONCLUSION: Based on the study results, a specific strategy to deal successfully with the prevalent partial adherence to medication in patients with schizophrenia should be developed, and long-acting medication may be one solution to improve partial adherence problems.

Antipsychotic Agents↗

PubMed2001

A comparison of medication adherence indices to assess long-term inhaled corticosteroid medication use.

This study examined associations between select hypothesized adherence predictors in claims databases and long-term inhaled corticosteroid adherence. Medication adherence was measured by using medication possession indexes and a refill regularity measure in 1595 older adults using inhaled corticosteroids for 2 years. Medication possession indices were highly correlated with each other but not with the refill regularity measure. Additionally, the hypothesized predictors explained a larger percentage of the variance in the medication possession indices compared to the refill regularity measure. Although long-term retrospective medication utilization poses many measurability issues, the use of multiple indices gives a more complete picture of usage behavior.

Administration, Inhalation↗

PubMed2006

Screening tests for intended medication adherence among the elderly.

BACKGROUND: Medication nonadherence is increasingly recognized as a cause of preventable adverse events, hospitalizations, and poor healthcare outcomes. While comprehensive medication adherence assessment for the elderly is likely to identify and prevent drug-related problems, it is time consuming for patient and healthcare providers alike. OBJECTIVE: To identify screening tools to predict elderly patients' intended medication adherence that are suitable for primary-care settings and community pharmacies. METHODS: This study evaluated 57 English-speaking persons aged 65 years and older who were from diverse socioeconomic backgrounds. Intended adherence was quantified, and the relationships to demographic, medical history, socioeconomic, and literacy variables were determined. RESULTS: In a multivariate analysis with the composite MedTake Test (a quantitative measure of each subject's intent to adhere to prescribed oral medications) as the dependent variable, independent predictors of intended adherence included: age, car ownership in the last 10 years, receipt of food assistance in the last 10 years, number of over-the-counter (OTC) medicines, and REALM (Rapid Estimate of Adult Literacy in Medicine). The strongest predictor was the REALM word-recognition pronunciation test (beta = 0.666; R2 = 0.271; p < 0.001). CONCLUSIONS: We observed that the REALM word-recognition pronunciation test, along with age, number of OTC drugs, and 2 socioeconomic questions, predicted the intent of seniors to correctly take their own prescribed oral medications.

Age Factors↗

PubMedDate not supplied

Pediatric HIV medication adherence: the views of medical providers from two primary care programs.

INTRODUCTION: The purpose of this study was to examine medical providers' views from two primary care programs regarding adherence to antiretroviral therapy among HIV-infected children. METHOD: Ten medical providers (five physicians and five registered nurses) working with perinatally HIV-infected children completed a structured questionnaire examining provider-patient/family relationship and participated in an individual qualitative interview regarding providers' views on pediatric adherence to antiretroviral therapy. RESULTS: Providers believed that the limited treatment options currently available to HIV-infected children presented families with tremendous challenges to adherence. Most children were prescribed difficult treatment regimens and needed increasingly complex regimens for possible success in the future, placing further demands on the adherence issue. Although providers were able to identify several helpful communication strategies in theory, they were not able to consistently implement them in practice. Further, many families are also struggling with poverty, mental health and substance use problems, additional HIV disease in the family, and disclosure issues. DISCUSSION: Adherence to antiretroviral therapy is a long-term, ongoing problem that is directly tied to the family life of the HIV-infected child. Providers clearly play an integral part in this struggle.

Antiviral Agents↗