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Results for “Medication Adherence”

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PubMed1995

Psychosocial factors in maternal phenylketonuria: women's adherence to medical recommendations.

OBJECTIVES: This study identified factors predicting adherence to medical recommendations in maternal phenylketonuria, which can result in severe fetal damage. METHODS: Sixty-nine women with phenylketonuria, 68 of their acquaintances, and 69 women with diabetes mellitus were interviewed annually for 5 years. A model in which each stage in the maternal phenylketonuria life cycle represented a treatment-related goal provided a means to assess adherence. RESULTS: At the stages of prevention of unplanned pregnancy, treatment initiation, and diet continuation throughout pregnancy, attitudes and social support were associated with adherence to medical recommendations. No specific variables were associated with outcome at reproductive decision making, but women with phenylketonuria were more likely to delay making a decision, resulting in unplanned and, hence, untreated or late-treated pregnancy. CONCLUSIONS: Women with phenylketonuria differed from their acquaintances and diabetic women in many respects, suggesting that special programs are needed. Greater emphasis on reproductive decision making is especially needed. Interventions that focus on improving social support networks and attitudes about treatment may increase adherence to recommendations.

Adult↗

PubMed2000

Inhaled corticosteroid use and associated outcomes in elderly patients with moderate to severe chronic pulmonary disease.

OBJECTIVE: This study was undertaken to examine the impact of select demographic, clinical, and medication-related factors on elderly patients' medication adherence to inhaled corticosteroid therapy. It also examined the impact of medication adherence on health outcomes and on health care service utilization and costs. BACKGROUND: Asthma in the elderly is a growing concern because of its increasing prevalence and the increase in asthma-related deaths. Poor medication utilization could be contributing to this trend in the elderly population and should be examined. METHODS: This retrospective, longitudinal, 2-year cohort study included 1595 patients aged > or =65 years with moderate to severe chronic pulmonary disease who were enrolled in a health maintenance organization. The study used sequential regression analyses to model (1) medication adherence and (2) health care service utilization and charges as functions of adherence. RESULTS: With other factors controlled for, this study found that clinical and medication-related variables including comorbidities, additional complications, and number of medications were predictive of adherence to prophylactic inhaled corticosteroid therapy in this population. Poorer medication adherence was associated with a 5% increase in total annual physician visits (P < 0.05). Better medication adherence was associated with a 20% decrease in annual hospitalization (P < 0.05). Additional pulmonary complications and severe comorbidities were associated with increases in health care utilization and costs. Patients with better adherence to prophylactic therapy were few, and the beneficial effects of better adherence were not significant when the population averages were considered. CONCLUSIONS: The results of this study indicated that the beneficial effects of better adherence to prophylactic inhaled corticosteroid therapy tended to diminish in a population with relatively poor medication adherence. Findings of this study support a policy of selectively targeting elderly patients at risk for morbidity and implementing monitoring, education, and management programs to increase medication-adherence behavior. This policy could lead to optimal resource utilization and management of chronic pulmonary disease.

Administration, Inhalation↗

PubMed1988

Adherence and medication instructions. Review and recommendations.

Prescription medication nonadherence among the elderly is a serious medical problem. Nonadherence is primarily caused by poor communication between health professionals and elderly patients. More specifically, nonadherence often reflects the inability of patients to understand and remember their medication instructions. Therefore, adherence can be increased by designing instructions that enable elders to easily construct a clear and simple mental model of how to take their medication. Inexpensive microcomputer-based hardware and software makes it possible for pharmacists to provide elderly patients with effective instructions.

Aged↗

PubMed2002

Predictors of medication-refill adherence in an indigent rural population.

OBJECTIVE: We evaluated the association of medication refill adherence with demographic and prescription characteristics to determine whether such factors could guide intervention strategies in an indigent rural population. METHODS: The study was conducted at a University-based internal medicine practice serving an indigent rural population. Refill data for diabetes, hypertension, and hypercholesterolemia drugs from a closed pharmacy system were used to calculate mean adherence (for all drugs taken by each patient) and minimum adherence (that of the least adhered to drug) for 1984 patients during a 9-month period. RESULTS: Mean refill adherence was <80% for 33% of the population and minimum refill adherence was <80% for 55% of the patients. Increasing age, race (white), and prescription length were associated with higher mean and minimum adherence, independent of income, prescription copay, and insurance status. Number of drugs taken had a positive mean but negative minimum adherence association. Gender, number of primary care visits, and dosage schedule were not independently associated with adherence. The model explained 6.8% of the variance in mean adherence. CONCLUSIONS: In a rural indigent population, medication refill adherence was associated with race, age, and prescription length, though these factors explained only a small amount of adherence variability. Although ingestion adherence is the goal, refill adherence is a necessary condition for ingestion adherence. To enhance adherence, physicians need better predictors to target their efforts to patients most in need of attention. Prescription claims data could serve this purpose.

Diabetes Mellitus↗

PubMed2001

Predictors of nonadherence to HIV-related medication regimens during methadone stabilization.

Nonadherence to HIV-related medication regimens among drug-abusing patients decreases therapeutic effectiveness and may limit patient access to newer, highly active antiretroviral therapies (HAART). A number of factors have been associated with medication nonadherence; however, few studies have examined predictors of nonadherence specifically in HIV-positive drug abusers. In the current study, a comprehensive assessment battery was administered to 42 HIV-positive, injection drug users beginning methadone maintenance. HIV-related medication adherence was assessed weekly by self-report during the 4-week methadone stabilization phase. Thirty-six percent of patients reported less than 80% adherence to their medication regimen at entry into methadone. Medication adherence increased significantly during the 4-week stabilization phase. Significant zero-order correlations were found between nonadherence during stabilization and viral load, low educational attainment, depression, and neuropsychological tests of problem solving ability and cognitive flexibility. Independent predictors of nonadherence were low levels of education and poor emotional functioning. Implications for early intervention are discussed.

Adult↗

PubMed2006

Interventions to improve adherence to medication in people with type 2 diabetes mellitus: a review of the literature on the role of pharmacists.

BACKGROUND AND OBJECTIVE: Pharmacists are now adopting a crucial role in the management of chronic illness in primary care, providing diabetes care and advice. This review aims to show whether a range of diabetes care interventions delivered by pharmacists is successful in improving adherence to medication. METHODS: The studies reviewed formed a subgroup of a Cochrane review on interventions to improve adherence to medication in people with type 2 diabetes. Search terms were 'type 2 diabetes mellitus' and 'compliance' or 'adherence'. Studies were included if they assessed adherence to medical treatment specifically, rather than other aspects of self-management. Out of the 21 studies selected for review, five described an intervention delivered by a pharmacist. RESULTS AND DISCUSSION: Two studies reported on attempts to improve adherence focused on the taking of medication. A system of reminders and packaging improved medication adherence, but measuring medicine taking through pill counts or Medication Event Monitoring System was not effective. Three studies evaluated pharmacist-led integrated management and education programmes designed to improve glycaemic control for under-served patient populations. They all succeeded in lowering glycated haemoglobin, but it remains unclear whether this resulted from improved patient adherence. CONCLUSION: This review indicates a potential benefit of pharmacist interventions to improve medication adherence in diabetes, especially in providing patient education.

Diabetes Mellitus, Type 2↗

PubMed2006

Intentional and non-intentional non-adherence to medication amongst breast cancer patients.

This study aimed to investigate the prevalence of and factors associated with non-adherence to medication amongst a sample of breast cancer patients. 131 women with stable disease were interviewed and completed standardised psychological measures. 55% of women reported non-adherence to medication frequently or occasionally, with younger women and those who disliked taking their medication being significantly less adherent (P = 0.015, P = 0.001). Women who deliberately omitted taking their tablets occasionally or frequently had significantly lower scores, indicative of a weaker influence, on 'internal' and 'powerful others' dimensions of health locus of control (P = 0.032, P = 0.009). Despite a life-threatening diagnosis, patients may not adhere to medication representing a potential missed opportunity for health gain and waste of resources. Furthermore, interpretation of clinical trial data may be misleading without adherence information. More research is needed to identify those at risk for non-adherence. If other routes of administration are available these options should be discussed with patients to maximise efficacy of therapy.

Adult↗

PubMed2005

The AdHOC Study of older adults' adherence to medication in 11 countries.

OBJECTIVE: Authors investigated, cross-nationally, the factors, including demographic, psychiatric (including cognitive), physical, and behavioral, determining whether older people take their prescribed medication. Older adults are prescribed more medication than any other group, and poor adherence is a common reason for non-response to medication. METHODS: Researchers interviewed 3,881 people over age 65 who receive home care services in 11 countries, administering a structured interview in participants' homes. The main outcome measure was the percentage of participants not adherent to medication. RESULTS: In all, 12.5% of people (N=456) reported that they were not fully adherent to medication. Non-adherence was predicted by problem drinking (OR=3.6), not having a doctor review their medication (OR=3.3), greater cognitive impairment (OR=1.4 for every one-point increase in impairment), good physical health (OR=1.2), resisting care (OR=2.1), being unmarried (OR=2.3), and living in the Czech Republic (OR=4.7) or Germany (OR=1.4). CONCLUSION: People who screen positive for problem drinking and who have dementia (often undiagnosed) are less likely to adhere to medication. Therefore, doctors should consider dementia and problem drinking when prescribing for older adults. Interventions to improve adherence in older adults might be more effective if targeted at these groups. It is possible that medication-review enhances adherence by improving the doctor-patient relationship or by emphasizing the need for medications.

Aged↗

PubMed2006

A prospective evaluation of adherence to medication in first episode schizophrenia.

The aim of this study was to identify the features of first episode schizophrenia that predict adherence antipsychotic medication at six-month follow-up. We used validated instruments to assess clinical and socio-demographic variables in all patients with first episode schizophrenia from a defined geographical area admitted to a Dublin psychiatric hospital over a four-year period (N=100). At six-month follow-up (N=60) we assessed adherence to medication using the Compliance Interview. One third of patients with schizophrenia were non-adherent with medication within six months of their first episode of illness. High levels of positive symptoms at baseline, lack of insight at baseline, alcohol misuse at baseline and previous drug misuse predict non-adherence. These results indicate that an identifiable subgroup of patients with first episode schizophrenia is at high risk of early non-adherence to medication. While high positive symptom scores pre-date and predict non-adherence in most patients, reduced insight is the best predictor of non-adherence in patients who do not misuse alcohol or other drugs.

Adult↗

PubMed2004

Objective assessment of compliance with psoriasis treatment.

OBJECTIVE: To assess patient compliance with psoriasis treatment. DESIGN: Open prospective study. Patients with psoriasis were examined and completed a brief medical and social history, a compliance assessment sheet, and the Dermatology Life Quality Index (DLQI). Patients were reexamined at 3 months, and their actual treatment use was assessed and compared with the expected use. Medication adherence was assessed by direct questioning. SETTING: Dermatology outpatient clinic. PATIENTS: Two hundred ninety-four patients fulfilled the inclusion criteria, and 201 completed the study. MAIN OUTCOME MEASURE: Adherence with topical and oral therapies, using objective and self-reporting methods and description of factors affecting compliance. RESULTS: The overall mean +/- SD medication adherence was 60.6% +/- 33.0% (range, 0%-169%). The mean +/- SD DLQI in the study was 17.4 +/- 8.9 (range, 0-30). There was a highly significant negative correlation (r = -0.92) between these variables. Being female, married, employed, and not paying for prescriptions were characteristics associated with increased medication adherence and a lower DLQI. Medication adherence was greater for topical or combined therapy, for once-daily treatment, and for first-time use of treatment. Adverse effects reduced compliance. The major reasons for missing treatment were drinking alcohol, being fed up, forgetfulness, and being too busy. Patients with facial disease and with more extensive disease had lower medication adherence. CONCLUSIONS: A range of disease-related and social factors may affect compliance with psoriasis treatment. The inversely proportional relationship between DLQI and medication adherence reflects the interaction of physical and psychological factors, as well as perceived treatment failure.

Administration, Oral↗

PubMedDate not supplied

Indicators of medical regimen adherence for myocardial infarction patients.

This study investigated relationships between demographic and medical variables, attitudes, perceived beliefs of others, and intentions toward medical regimen adherence and actual posthospitalization regimen adherence. During hospitalization, attitudes, perceived beliefs of others, and intentions toward prescribed medical regimen were elicited from 112 persons recovering from a first time myocardial infarction (MI). Six to 9 months posthospitalization, attitudes, perceived beliefs of others, and adherence behaviors were assessed. Multiple regression analysis indicated that, during hospitalization, attitudes and perceived beliefs of others were strong indicators of intentions to adhere to the medical regimen, but they were not indicators of actual adherence posthospitalization. Posthospitalization, attitudes and perceived beliefs of others were strong indicators of actual regimen adherence. Findings indicate rehabilitation plans for the MI patient should be individualized for hospital and home and should include data on health belief variables.

Adult↗

PubMedDate not supplied

Patient adherence improves glycemic control.

PURPOSE: The purpose of this study was to assess the influence of appointment keeping and medication adherence on HbA1c. METHODS: A retrospective evaluation was performed in 1560 patients with type 2 diabetes who presented for a new visit to the Grady Diabetes Clinic between 1991 and 2001 and returned for a follow-up visit and HbA1c after 1 year of care. Appointment keeping was assessed by the number of scheduled intervening visits that were kept, and medication adherence was assessed by the percentage of visits in which self-reported diabetes medication use was as recommended at the preceding visit. RESULTS: The patients had an average age of 55 years, body mass index (BMI) of 32 kg/m2, diabetes duration of 4.6 years, and baseline HbA1c of 9.1%. Ninety percent were African American, and 63% were female. Those who kept more intervening appointments had lower HbA1c levels after 12 months of care (7.6% with 6-7 intervening visits vs 9.7% with 0 intervening visits). Better medication adherence was also associated with lower HbA1c levels after 12 months of care (7.8% with 76%-100% adherence). After adjusting for age, gender, race, BMI, diabetes duration, and diabetes therapy in multivariate linear regression analysis, the benefits of appointment keeping and medication adherence remained significant and contributed independently; the HbA1c was 0.12% lower for every additional intervening appointment that was kept (P = .0001) and 0.34% lower for each quartile of better medication adherence (P = .0009). CONCLUSION: Keeping more appointments and taking diabetes medications as directed were associated with substantial improvements in HbA1c. Efforts to enhance glycemic outcomes should include emphasis on these simple but critically important aspects of patient adherence.

Black or African American↗

PubMed2005

Adherence to medications by patients after acute coronary syndromes.

BACKGROUND: Nonadherence to medication may lead to poor medical outcomes. OBJECTIVE: To describe medication-taking behavior of patients with a history of acute coronary syndromes (ACS) for 4 classes of drugs and determine the relationship between self-reported adherence and patient characteristics. METHODS: Consenting patients with the diagnosis of ACS were interviewed by telephone approximately 10 months after discharge. The survey elicited data characterizing the patient, current medication regimens, beliefs about drug therapy, reasons for discontinuing medications, and adherence. The survey included the Beliefs About Medicine Questionnaire providing 4 scales: Specific Necessity, Specific Concerns, General Harm, and General Overuse, and the Medication Adherence Scale (MAS). Multivariate regression was used to determine the independent variables with the strongest association to the MAS. A p value < or = 0.05 was considered significant for all analyses. RESULTS: Two hundred eight patients were interviewed. Mean +/- SD age was 64.9 +/- 13.0 years, with 60.6% male, 95.7% white, 57.3% with a college education, 87.9% living with > or =1 other person, and 42% indicating excellent or very good health. The percentage of patients continuing on medication at the time of the survey category ranged from 87.4% (aspirin) to 66.0% (angiotensin-converting enzyme inhibitors). Reasons for stopping medication included physician discontinuation or adverse effects. Of patients still on drug therapy, the mean MAS was 1.3 +/- 0.4, with 53.8% indicating nonadherence (score >1). The final regression model showed R(2) = 0.132 and included heart-related health status and Specific Necessity as significant predictor variables. CONCLUSIONS: After ACS, not all patients continue their drugs or take them exactly as prescribed. Determining beliefs about illness and medication may be helpful in developing interventions aimed at improving adherence.

Acute Disease↗

PubMed2006

Antidepressant adherence and medical resource use among managed care patients with anxiety disorders.

OBJECTIVES: This study evaluated adherence with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) among patients who newly initiated therapy for anxiety with or without comorbid depression; the study also quantified the health-related economic consequences of nonadherence. METHODS: A large managed care database was used to gather retrospective data for patients with anxiety disorders who had a prescription for an antidepressant between July 1, 2001, and December 31, 2002. The relationship between antidepressant adherence and medical resource utilization was assessed; the analysis controlled for age, gender, utilization of mental health specialty care, change in medication, whether the dosage was titrated, costs in the six months before the prescription for an antidepressant, and comorbid physical conditions. RESULTS: Of the 13,085 patients with anxiety diagnoses who met the criteria for study inclusion, 57 percent were nonadherent to antidepressant therapy at six months. Patients who received mental health specialty care were more likely than those who did not receive such care to be adherent to therapy (48.5 percent compared with 40.7 percent; p<.001). Those with dual diagnoses of anxiety and depression were more likely than those with anxiety alone to be adherent to therapy (46.8 percent compared with 40.2 percent; p<.001). Those with a coded diagnosis of posttraumatic stress disorder had the highest medical costs. Patients with anxiety and depression had significantly higher total costs than patients with anxiety alone. Adherent patients who did not have a change in medication or a titrated dosage had significantly lower medical costs than nonadherent patients; however, total costs (medical plus pharmacy) were similar. CONCLUSIONS: Nonadherence with antidepressant therapy in anxiety disorders is common, but mental health specialty care may be associated with improved adherence. Lower medical costs for adherent patients who did not have a change in medication or a titrated dosage offset the increase in pharmacy costs, resulting in total costs (medical plus pharmacy) that were similar to those of nonadherent patients.

Adult↗

PubMedDate not supplied

Persistence and adherence of medications for chronic overactive bladder/urinary incontinence in the california medicaid program.

OBJECTIVES: To investigate persistence and adherence of medication treatment in chronic overactive bladder/urinary incontinence (OAB/UI) patients, and to evaluate OAB/UI-related comorbidity events associated with persistence. METHODS: Pharmaceutical outcomes research with a health-care provider perspective was conducted on a California Medicaid (Medi-Cal) chronic OAB/UI population. The primary end point was medication possession ratio (MPR), which was used to measure refill adherence. Secondary end points measuring persistence patterns included discontinuation of OAB drug therapy (medication-uncovered interval > 30 days) and time to discontinuation (period from the index date until the first discontinuation date). Significant factors on nonpersistence were found by using a Cox Proportional Hazards model. Factors contributing to nonadherence (MPR < 0.8) and the relationship between OAB/UI comorbidity events and persistence were examined by logistic regressions. RESULTS: Of 2496 eligible patients, 36.9% had only one OAB/UI prescription. The mean MPR was 0.34 (SD 0.21) and the median was 0.3, indicating that on average only about one-third of period of time since medication initiation was covered by the therapy. Only 122 patients exhibited > 80% adherence during the 6-month follow-up-period. Significant predictors of higher persistence included: white ethnicity, previous hospitalization length, starting with tolterodine or oxybutynin extended-release, and previous use of topical drugs or antipsychotics. Nevertheless, previous depression or urinary tract infection (UTI) diagnosis, polypharmacy, significantly increased the odds of early discontinuation. Treatment discontinuation increased the risk of UTI diagnosis by 37% in the post-treatment period (P = 0.03; OR 1.37; 95% CI 1.03-1.84), but had no significant effect on other OAB/UI-related comorbidities. CONCLUSIONS: For chronic OAB/UI patients identified in this study, both persistence and adherence with medication treatment were suboptimal. These results suggest that persistence and treatment discontinuation remains problematic for the OAB/UI population.

Benzhydryl Compounds↗

PubMed2002

Patient adherence and medical treatment outcomes: a meta-analysis.

BACKGROUND: Adherence is a factor in the outcome of medical treatment, but the strength and moderators of the adherence-outcome association have not been systematically assessed. OBJECTIVES: A quantitative review using meta-analysis of three decades of empirical research correlating adherence with objective measures of treatment outcomes. METHOD: Sixty-three studies assessing patient adherence and outcomes of medical treatment were found involving medical regimens recommended by a nonpsychiatrist physician, and measuring patient adherence and health outcomes. Studies were analyzed according to disease (acute/chronic, severity), population (adult/child), type of regimen (preventive/treatment, use of medication), and type and sensitivity of adherence and outcomes measurements. RESULTS: Overall, the outcome difference between high and low adherence is 26%. According to a stringent random effects model, adherence is most strongly related to outcomes in studies of nonmedication regimens, where measures of adherence are continuous, and where the disease is chronic (particularly hypertension, hypercholesterolemia, intestinal disease, and sleep apnea). A less stringent fixed effects model shows a trend for higher adherence-outcome correlations in studies of less serious conditions, of pediatric patients, and in those studies using self-reports of adherence, multiple measures of adherence, and less specific measures of outcomes. Intercorrelations among moderator variables in multiple regression show that the best predictor of the adherence-outcome relationship is methodological-the sensitivity/quality of the adherence assessment.

Data Interpretation, Statistical↗

PubMed1999

Treatment alliance and its association with family functioning, adherence, and medical outcome in adolescents with severe, chronic asthma.

OBJECTIVE: To examine the concept of treatment alliance in the care of adolescents with asthma. METHODS: Measures of treatment alliance were obtained from 60 adolescents with severe, chronic asthma admitted to a tertiary care facility, their parents, and their asthma specialists at the referral center. Associations were examined between the alliance measures and multimeasure, multiagent data concerning family functioning and asthma treatment adherence and outcome. RESULTS: Physicians' reports of treatment alliance were associated with concurrent family functioning and asthma medication adherence, as well as with asthma treatment adherence and outcome in the year after the stay at the asthma center. CONCLUSIONS: As emphasized in the recently revised Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma (NHLBI, 1997), the ability of children with asthma, their parents, and their physician to create a positive partnership, or treatment alliance, appears to have an important role in optimal asthma management.

Adolescent↗

PubMed1993

Physicians' characteristics influence patients' adherence to medical treatment: results from the Medical Outcomes Study.

The influence of physicians' attributes and practice style on patients' adherence to treatment was examined in a 2-year longitudinal study of 186 physicians and their diabetes, hypertension, and heart disease patients. A physician-level analysis was conducted, controlling for baseline patient adherence rates and for patient characteristics predictive of adherence in previous analyses. General adherence and adherence to medication, exercise, and diet recommendations were examined. Baseline adherence rates were associated with adherence rates 2 years later. Other predictors were physician job satisfaction (general adherence), number of patients seen per week (medication), scheduling a follow-up appointment (medication), tendency to answer patients' questions (exercise), number of tests ordered (diet), seriousness of illness (diet), physician specialty (medication, diet), and patient health distress (medication, exercise).

Adult↗