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PubMedDate not supplied

Improving cardiovascular health in postmenopausal women by addressing medication adherence issues.

OBJECTIVE: To review medication adherence issues that relate to managing cardiovascular health in postmenopausal women and to explore strategies pharmacists can use to improve outcomes by identifying and resolving adherence problems. DATA SOURCES: Published articles identified through MEDLINE using the search terms adherence, compliance, cardiovascular, and menopause. Additional articles and data were identified from the bibliographies of the retrieved articles and from Web sites and reports from the National Council on Patient Information and Education, North American Menopause Society, American College of Obstetricians and Gynecologists, and American Heart Association. DATA SYNTHESIS: Cardiovascular disease is the leading killer of women, a fact many women do not recognize. Although effective pharmacologic treatments for managing risk factors for cardiovascular disease have been developed, these therapies are underprescribed, and patient adherence to them is often poor. Efforts to increase postmenopausal women's awareness of cardiovascular disease and the efficacy of therapeutic regimens can help improve such patients' adherence to these lifesaving treatments. CONCLUSION: As one of the most accessible health care professionals, pharmacists are well positioned to provide counseling about the importance of medication adherence, help measure and optimize outcomes from medication use, and help patients find objective and authoritative sources of information about their conditions. By working with postmenopausal women to enhance their adherence, pharmacists can help them improve their cardiovascular health.

Aged↗
PubMed1996

A telecommunications system for monitoring and counseling patients with hypertension. Impact on medication adherence and blood pressure control.

This study was conducted to evaluate the effect of automated telephone patient monitoring and counseling on patient adherence to antihypertensive medications and on blood pressure control. A randomized controlled trial was conducted in 29 greater Boston communities. The study subjects were 267 patients recruited from community sites who were >or= 60 years of age, on antihypertensive medication, with a systolic blood pressure (SBP) of >or= 160 mm Hg and/or a diastolic blood pressure (DBP) of >or= 90 mm Hg. The study compared subjects who received usual medical care with those who used a computer-controlled telephone system in addition to their usual medical care during a period of 6 months. Weekly, subjects in the telephone group reported self-measured blood pressures, knowledge and adherence to antihypertensive medication regimens, and medication side-effects. This information was sent to their physicians regularly. The main study outcome measures were change in antihypertensive medication adherence, SBP and DBP during 6 months, satisfaction of patient users, perceived utility for physicians, and cost-effectiveness. The mean age of the study population was 76.0 years; 77% were women; 11% were black. Mean antihypertensive medication adherence improved 17.7% for telephone system users and 11.7% for controls (P = .03). Mean DBP decreased 5.2 mm Hg in users compared to 0.8 mm Hg in controls (P = .02). Among nonadherent subjects, mean DBP decreased 6.0 mm Hg for telephone users, but increased 2.8 mm Hg for controls (P = .01). For telephone system users, mean DBP decreased more if their medication adherence improved (P = .03). The majority of telephone system users were satisfied with the system. Most physicians integrated it into their practices. The system was cost-effective, especially for nonadherent patient users. Therefore, weekly use of an automated telephone system improved medication adherence and blood pressure control in hypertension patients. This system can be used to monitor patients with hypertension or with other chronic diseases, and is likely to improve health outcomes and reduce health services utilization and costs.

Aged↗
PubMed2006

Race and medication adherence in Medicaid enrollees with type-2 diabetes.

OBJECTIVE: The association of medication adherence with race has been inadequately studied previously in type-2 diabetes patients. The study objective was to determine the association between race and medication adherence among type-2 diabetes patients. METHODS: This was a retrospective cohort study, which compared medication adherence among different races of Medicaid insured patients with type-2 diabetes newly starting oral antidiabetic medication. A total of 1,527 African-American patients newly starting antidiabetic medication between July 2001 and June 2002 were compared with 1,128 white patients and 514 patients of other race. Medication adherence was measured as medication possession ratio using prescription refill patterns. Multivariate regression analyses were used to determine the difference in adherence rates adjusting for other covariates. RESULTS: Medication adherence rate was significantly higher for whites [0.59 (0.31)] as compared to African Americans [0.54 (0.31), (p<0.05)]. In multivariate analyses, the adherence rate of African-American patients was found to be significantly lower by 12% as compared to whites after adjusting for other covariates. Metformin users were associated with a 62% decrease in adherence rate as compared with the sulfonylureas group (p<0.05). CONCLUSION: The antidiabetic medication adherence was associated with race. Future research should investigate patient-related factors affecting medication adherence in type-2 diabetes patients.

Adolescent↗
PubMed2004

Factors influencing medication adherence beliefs and self-efficacy in persons naive to antiretroviral therapy: a multicenter, cross-sectional study.

It is widely recognized that adherence to antiretroviral therapy is critical to long-term treatment success, yet rates of adherence to antiretroviral medications are frequently subtherapeutic. Beliefs about antiretroviral therapy and psychosocial characteristics of HIV-positive persons naive to therapy may influence early experience with antiretroviral medication adherence and therefore could be important when designing programs to improve adherence to antiretroviral therapy. As part of a multicenter AIDS Clinical Trial Group (ACTG 384) study, 980 antiretroviral-naive subjects (82% male, 47% White, median age 36 years, and median CD4 cell count 278 cells/mm3) completed a self-administered questionnaire prior to random treatment assignment of initial antiretroviral medications. Measures of symptom distress, general health and well-being, and personal and situational factors including demographic characteristics, social support, self-efficacy, depression, stress, and current adherence to (nonantiretroviral) medications were recorded. Associations among variables were explored using correlation and regression analyses. Beliefs about the importance of antiretroviral adherence and ability to take antiretroviral medications as directed (adherence self-efficacy) were generally positive. Fifty-six percent of the participants were "extremely sure" of their ability to take all medications as directed and 48% were "extremely sure" that antiretroviral nonadherence would cause resistance, but only 37% were as sure that antiretroviral therapy would benefit their health. Less-positive beliefs about antiretroviral therapy adherence were associated with greater stress, depression, and symptom distress. More-positive beliefs about antiretroviral therapy adherence were associated with better scores on health perception, functional health, social-emotional-cognitive function, social support, role function, younger age, and higher education (r values = 0.09-0.24, all p < .001). Among the subset of 325 participants reporting current use of medications (nonantiretrovirals) during the prior month, depression was the strongest correlate of nonadherence ( r = 0.33, p < .001). The most common reasons for nonadherence to the medications were "simply forgot" (33%), "away from home" (27%), and "busy" (26%). In conclusion, in a large, multicenter survey, personal and situational factors, such as depression, stress, and lower education, were associated with less certainty about the potential for antiretroviral therapy effectiveness and one's perceived ability to adhere to therapy. Findings from these analyses suggest a role for baseline screening for adherence predictors and focused interventions to address modifiable factors placing persons at high risk for poor adherence prior to antiretroviral treatment initiation.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Kitchen table wisdom: a Freirian approach to medication adherence.

Most interventions to promote medication adherence are based on psychological theories of individual behavior. In contrast, this article describes the theory and practice of a socially based adherence intervention that is guided by the educational principles of Paolo Freire. This approach asserts that adherence is influenced by the patient's social context and attempts to improve adherence through identifying social constraints on adherence behavior. The program builds on the traditions of patient education through home nursing visits. Using a dialectic process of dialogue and problem solving and working with a team that includes a nurse and a peer-educator, patients are encouraged to act to change their social environment to support their desire to achieve high levels of medication adherence. This strategy does not replace, but rather supplements, traditional methods of understanding individual patient behavior and allows the patient and the nurse to consider potential solutions to adherence challenges in the larger social context.

Anti-HIV Agents↗
PubMed2006

Stages of change for psychotropic medication adherence and substance cessation.

Psychotropic medication nonadherence has significant consequences for patients, more so if they abuse substances. This descriptive study examined two stages-of-change measures: one for psychotropic medication adherence and one for substance cessation. Findings for these measures are presented for a sample of 105 patients on admission, a sample of 51 patients on 30-day follow-up, and a cohort of 39 patients who had measures for both time points. Stage advancement for dual behaviors was evident. Integrated treatment programs for this population may be further enhanced by providing interventions that promote psychotropic medication adherence.

Adult↗
PubMed2005

Medication adherence before an increase in antihypertensive therapy: a cohort study using pharmacy claims data.

BACKGROUND: Less than one third of patients with hypertension achieve optimal blood pressure control. Poor medication adherence has been identified as one contributor to uncontrolled blood pressure. OBJECTIVE: This study was conducted to test the hypothesis that patients who require an increase in their antihypertensive regimen have poorer adherence with medication compared with patients who remain on a stable regimen. METHODS: Health plan enrollment and pharmacy claims data were used to perform a prospective cohort study and a nested case-control study in patients newly starting antihypertensive therapy. In the prospective cohort study, cumulative medication adherence (CMA, the percentage of days the patient had pills available, calculated as the total number of days of medication dispensed, excluding the final prescription, divided by the total number of days between the first and last antihypertensive prescriptions in the observation period) was compared between patients who required an increase in therapy and patients who remained on a stable antihypertensive regimen. In the nested case-control analysis, interval medication adherence (IMA, the ratio of the number of days of medication dispensed in a single prescription divided by the number of days until the next prescription is filled) during the prescription interval immediately before an increase in the antihypertensive regimen was compared with a similar interval in control patients without an increase matched by age, medication, number of days of medication dispensed, and months since initiation of therapy. RESULTS: The study included data from 5089 patients (mean [SD] age, 47.8 [13.0] years; 50.0% women). Over a median (interquartile range) of 23 (9-49) months of initial antihypertensive treatment, 935 patients (18.4%) had an increase in regimen. After adjusting for age, duration of treatment, number of prescribing physicians, and specific medication, patients with a regimen increase had a 12.0% higher CMA compared with patients remaining on a stable regimen (P < 0.001). IMA for the period immediately before the increase was not significantly different in patients with an increase compared with matched controls (98.3% vs 101.0%, respectively). CONCLUSIONS: Among these insured patients newly starting antihypertensive therapy, patients who required an increase in therapy had similar or slightly better medication adherence compared with patients remaining on a stable regimen. Poor adherence was not predictive of intensification of the antihypertensive regimen.

Adult↗
PubMed2000

The relationship of disease severity, health beliefs and medication adherence among HIV patients.

The objective was to investigate the relationship of disease severity, health beliefs and medication adherence among HIV/AIDS patients. A survey was administered to 72 patients in three different stages of HIV/AIDS (CDC clinical categories A, B, C). Multivariate analyses revealed that there were no significant differences in patients' perceptions of the severity of HIV/AIDS or perceptions of the benefits and barriers for the treatment across three disease stages. However, the most severely ill patients (in stage C) perceived a higher risk of complications if they did not take their medicine as prescribed compared to asymptomatic patients (stage A) (p = 0.01). Also, patients in stages B and C were more adherent to their medications compared to patients in stage A (p = 0.007). Finally, perceived susceptibility-inaction was positively related to medication adherence (p = 0.005) and difficulty in following doctors' instructions was negatively related to patients' medication adherence (p = 0.009). In conclusion, patients' illness experiences are associated with their beliefs about the chances of developing complications if they do not adhere to their medications. Patients who have experienced more complications perceive a stronger relationship between medication non-adherence and AIDS-related complications, and are also more adherent to their medication regimen when compared to patients with no prior complications.

Acquired Immunodeficiency Syndrome↗
PubMed2005

The mediating role of health beliefs in the relationship between depressive symptoms and medication adherence in persons with diabetes.

BACKGROUND: Although bivariate relationships between depressive symptoms, health beliefs, and medication adherence have been identified, the complex relationship among these 3 constructs has not been explicated. OBJECTIVE: This study examines the mediating role of patients' beliefs about diabetes and diabetes medications in relation to depressive symptoms and diabetes medication adherence. METHODS: A survey was sent to 1700 persons with type 2 diabetes who were enrolled in a managed care organization in the United States. The bivariate relationships between depressive symptoms, diabetes-related health beliefs, and diabetes medication adherence were assessed. A structural equation model was developed to determine if health beliefs mediated the relationship between depressive symptoms and medication adherence. RESULTS: Usable responses were received from 445 subjects. Greater depressive symptoms were associated with lower adherence to diabetes medications. The structural equation model indicated that the effect of depressive symptoms on medication adherence was mediated through perceived side effect barriers, perceived general barriers, and self-efficacy. Patients with severe depressive symptoms perceived more barriers to treatment adherence and were less confident in their ability to adhere to medication. In turn, reduced self-efficacy and heightened perceived barriers had a negative association with patients' adherence to diabetes medication regimens. CONCLUSIONS: Decreased adherence to diabetes medications in patients with both diabetes and depressive symptoms may be partly explained by the association of depression with patients' beliefs about diabetes medications and their self-efficacy for medication use.

Depression↗
PubMed2006

Medication barriers and anti-hypertensive medication adherence: the moderating role of locus of control.

Locus of control as a moderator of the relationship between medication barriers (e.g., side-effects, forgetting to take medication, and keeping track of pills) and anti-hypertensive medication adherence was examined. Baseline data were obtained from 588 hypertensive veterans. In general, fewer medication barriers, higher internal locus of control and lower external locus of control was associated with better hypertensive medication adherence. Furthermore, internal locus of control served as a moderator (beta = -.74, p < .01) for the relationship between medication barriers and medication adherence; effect size was large. Decomposition of the interaction revealed that the relationship between medication barriers and medication adherence was strongest when internal control was high (b = -.24, p < .01). Higher internal locus of control was beneficial when barriers to medication adherence are low, but at high perceived barriers, locus of control plays less of a role in medication adherence. Future efforts to improve medication adherence should consider the patient's perceived level of medication barriers in conjunction with their locus of control.

Antihypertensive Agents↗
PubMed2002

Associations with medication adherence among ethnically different pediatric patients with renal transplants.

This study examined perceived medication regimen characteristics as factors in levels of medication adherence among 26 African American and 42 European American pediatric renal transplant patients. Among both groups, perceived characteristics of their medication regimen, including pill size, pill taste and medication complexity, were found to have significantly low to moderate associations with medication adherence. These associations were stronger and more consistent across medication adherence measures among the African American patients. This supports the need to separately examine the factors contributing to medication adherence among ethnically different pediatric patients. Suggestions for promoting medication adherence among pediatric patients with renal transplants and implications for future research are discussed.

Adolescent↗
PubMed2004

Assessing associations between medication adherence and potentially modifiable psychosocial variables in pediatric kidney transplant recipients and their families.

Post-transplant immunosuppressant (IS) medication adherence is essential for long-term graft survival and relatively little is known about psychosocial barriers that interfere with optimum medication adherence in pediatric kidney transplant patients. The objective of this prospective observational cohort study was to assess the impact of modifiable psychosocial variables on medication adherence. Our hypothesis was that parental stress, dysfunctional parent-child interactions and child behavior problems would be associated with poorer medication adherence. Thirteen pediatric kidney transplant patients and their caregivers were enrolled. Transplant recipients who were able to read and caregivers of all the transplant recipients completed behavioral and attitudinal surveys. A subgroup of seven families dispensed their primary IS medication from an electronic monitoring vial (MEMS Smart Cap). For these patients, medication adherence was calculated by computing a ratio of the medication taken divided by the prescribed dose. In addition, for the entire group, serial IS levels were reviewed by two board certified pediatric nephrologists who categorized all 13 transplant recipient families as either 'probably adherent (PA)' or 'possibly non-adherent (PNA)'. Pearson correlation coefficients and independent samples Student t-tests were used to assess the association between medication adherence and psychosocial variables measured by standardized questionnaires. In this study, elevated parental stress, dysfunctional parent-child interactions, and child behavior problems were associated with poorer medication adherence. In addition, we found evidence to support the relationship between subjective dissatisfaction with appearance and poorer medication adherence. These findings suggest that pre-transplant recipient evaluations of risk factors for poor adherence are warranted.

Adolescent↗
PubMed2005

Relationships between insight and medication adherence in outpatients with schizophrenia and bipolar disorder: prospective study.

The aim of the present study was to explore the associations between insight and medication adherence at index interview and at 1-year follow-up interview in bipolar and schizophrenic outpatients. The Schedule for Assessment of Insight (SAI) and its expanded version (SAI-E) were used to provide a baseline insight score for 65 bipolar subjects and 74 schizophrenic subjects considered to be in remission or to have minimal psychopathology. Medication adherence of subjects was assessed at index interview and at 1-year follow-up interview, and the association between insight and medication adherence was analyzed cross-sectionally and prospectively. The results of the analysis reveal that in bipolar subjects, the index SAI scores for insight into treatment, mental-health status and psychotic experiences, and total SAI-E were positively correlated with medication adherence at both index and 1-year follow-up interviews. However, in schizophrenic subjects, insight into treatment and total SAI-E correlated positively with medication adherence at index interview but not at 1-year follow-up interview. Medication adherence at index interview could predict medication adherence 1 year later in both bipolar and schizophrenic subjects. These results indicate that the predictive value of insight for medication adherence differs between bipolar and schizophrenic patients, and building insight is an important step for establishing medication adherence in bipolar patients.

Adolescent↗
PubMed2006

Measuring strategies used by mental health providers to encourage medication adherence.

Mental health clinicians rely on a range of legal mandates and interpersonal strategies of encouragement and pressure to address nonadherence to treatment. This paper describes the development and testing of a scale to assess formal and informal strategies used by clinicians to encourage adherence to medication. The 16-item measure was administered to 271 clinicians and analyzed using Rasch measurement modeling. Subsequently, items were revised and readministered to a second sample of 44 clinicians in an urban mental health clinic. Rasch analysis of the items yielded a coherent and internally consistent unidimensional measure of strategies used to promote adherence that vary on a continuum of pressure or social control. Criterion-related validity was assessed by observing the association of the measure with clinician ratings of client adherence. The resulting measure may be employed in future studies to examine the ways in which clinician behavior relates to medication adherence and to consumer perceptions of treatment alliance, quality of care, and perceived coercion.

Adult↗
PubMed2001

The role of memory strategies in medication adherence among the elderly.

Research shows that older adults use memory strategies as a compensatory mechanism for coping with age-related memory loss. This research investigated the type of memory strategies used by older adults living independently in the community in adhering to their prescription medications. Older adults reported greater use of internal memory strategies and a preference for event-based over time-based prescription medication instructions. Depression and memory anxiety were significant predictors of type of medication adherence strategies used among the elderly. Health status and social support were not major determinants of the type of medication adherence strategy used.

Adaptation, Psychological↗
PubMed2005

Impact of medication adherence on hospitalization risk and healthcare cost.

OBJECTIVE: The objective of this study was to evaluate the impact of medication adherence on healthcare utilization and cost for 4 chronic conditions that are major drivers of drug spending: diabetes, hypertension, hypercholesterolemia, and congestive heart failure. RESEARCH DESIGN: The authors conducted a retrospective cohort observation of patients who were continuously enrolled in medical and prescription benefit plans from June 1997 through May 1999. Patients were identified for disease-specific analysis based on claims for outpatient, emergency room, or inpatient services during the first 12 months of the study. Using an integrated analysis of administrative claims data, medical and drug utilization were measured during the 12-month period after patient identification. Medication adherence was defined by days' supply of maintenance medications for each condition. PATIENTS: The study consisted of a population-based sample of 137,277 patients under age 65. MEASURES: Disease-related and all-cause medical costs, drug costs, and hospitalization risk were measured. Using regression analysis, these measures were modeled at varying levels of medication adherence. RESULTS: For diabetes and hypercholesterolemia, a high level of medication adherence was associated with lower disease-related medical costs. For these conditions, higher medication costs were more than offset by medical cost reductions, producing a net reduction in overall healthcare costs. For diabetes, hypercholesterolemia, and hypertension, cost offsets were observed for all-cause medical costs at high levels of medication adherence. For all 4 conditions, hospitalization rates were significantly lower for patients with high medication adherence. CONCLUSIONS: For some chronic conditions, increased drug utilization can provide a net economic return when it is driven by improved adherence with guidelines-based therapy.

Adolescent↗
PubMed2004

Medication adherence: a key factor in achieving blood pressure control and good clinical outcomes in hypertensive patients.

PURPOSE OF REVIEW: Patients' adherence to antihypertensive drug regimens is a complex but important factor in achieving blood pressure control and reducing adverse cardiovascular outcomes. Approximately one half of patients with hypertension adhere to prescribed medications, and fewer than one in three patients have controlled blood pressure. RECENT FINDINGS: Several recent studies have highlighted the importance of patient medication adherence and have outlined factors that affect patient compliance with prescribed therapy. SUMMARY: On the basis of published studies, a conceptual framework of factors that affect patient adherence is presented. Recognizing patient nonadherence to medical therapy as a factor leading to poor blood pressure control and adverse outcomes remains a key challenge for clinicians caring for patients with hypertension.

Antihypertensive Agents↗