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At least 649 records · Page 36Linked to original sources
PubMed2004

Adherence to oral therapies in pelvic inflammatory disease.

PURPOSE: To assess adherence to oral therapies in pelvic inflammatory disease (PID). METHODS: Medication adherence to oral doxycycline therapy (100 mg) was measured using electronic event monitoring (EEM) among adult women with PID. Subjects (n = 91), who were predominantly black and with a high school or lower educational attainment, were randomly selected from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Study, a trial in which subjects were randomized to either (1). initial inpatient then outpatient or (2). fully outpatient treatment with doxycycline and cefoxitin. Summary statistics calculated within treatment groups and in the cohort as a whole included the percentage of administrations taken, percentage of days with correct dosage, percentage of days with no drug taken, time elapsed until the first drug holiday, and percentage of optimal dosing intervals. RESULTS: Study subjects took an average of 70% of prescribed doses, took the prescribed two daily doses for less than half of their outpatient days, took an unscheduled drug holiday for almost 25% of their outpatient days, and took only 16.9% of their doses within the optimal timing interval. In general, working, not bleeding with sex, and not drinking hard liquor were positively associated with measures of adherence. Adherence estimates were similar among women in the inpatient and outpatient groups after hospital discharge. CONCLUSIONS: The disturbing rates of time interval adherence, even after hospitalization, suggest the need to determine the effectiveness of antibiotic regimens involving shorter courses and longer dosing intervals.

Adolescent↗
PubMed2003

Diagnosis and management of panic disorder in older patients.

Panic disorder occurs less frequently in the elderly than in younger adults and rarely starts for the first time in old age. Panic attacks that begin in late life should prompt the clinician to conduct a careful search for a depressive disorder, physical illness or drugs that could be contributing to their presence. When panic attacks do occur in the elderly, the symptoms are qualitatively similar to those experienced by younger people. The elderly, however, may have fewer and less severe symptoms and exhibit less avoidant behaviour. As panic disorder is typically a chronic or recurrent condition, its management requires a long-term approach. With the exception of one descriptive pilot study, there have been no randomised controlled trials of the treatment of panic disorder in later life. Therefore, recommendations regarding the management of this disorder in the elderly must be extrapolated from research pertaining to younger patients. Selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines and cognitive behavioural therapy are efficacious treatments for panic disorder. There are no consistent differences in efficacy between classes of medications or between pharmacotherapy and cognitive behavioural therapy. Furthermore, there are no reliable predictors of response to one type of treatment compared with another. Treatment selection, therefore, depends on an individual assessment of the risks and benefits of each type of treatment (taking into account comorbid psychiatric and physical conditions), patient preference, cost and the availability of therapists skilled in cognitive behavioural techniques. As a general rule, antidepressant medication is preferable to a benzodiazepine as a first-line treatment for panic disorder in the elderly, especially given the high level of comorbidity between panic disorder and depressive disorders. Of the antidepressants, an SSRI is recommended as the initial choice of treatment in older patients. Anxious patients frequently misattribute somatic symptoms of anxiety to adverse effects of medication. Adherence with treatment, therefore, can be enhanced by starting antidepressant medication at a low dosage so as to avoid initial exacerbation of anxiety (but then gradually increasing the dosage to the therapeutic range), frequent follow-up during the first few weeks of treatment, discussion about potential adverse effects and addressing any other concerns the patient may have about taking medication. Given the delayed onset of action of antidepressant medication, the short-term use of adjunctive lorazepam in the first few weeks of treatment may be helpful in selected patients.

Aged↗
PubMed2006

Cognitive behavioural therapy in addition to antispasmodic therapy for irritable bowel syndrome in primary care: randomised controlled trial.

OBJECTIVES: To determine whether cognitive behavioural therapy (CBT) in addition to antispasmodic treatment offers a cost-effective benefit to primary care patients with irritable bowel syndrome (IBS) and to identify predictors of outcome. DESIGN: This was a randomised controlled trial in primary care of the addition of CBT to standard general practice management of IBS, using the antispasmodic agent mebeverine hydrochloride. The study set out to compare the addition of a standardised package of IBS-specific CBT to treatment with mebeverine hydrochloride. SETTING: Ten general practices, serving a population of around 45,000 patients, located principally in south London, with some patients resident in north London. PARTICIPANTS: Patients identified as having IBS by their GPs, aged between 17 and 54 (mean 34) years and predominantly white; 82% were female and half had had IBS for more than 5 years. INTERVENTIONS: Practice nurses delivered CBT in a randomised trial of the addition of CBT to mebeverine in patients who had IBS of moderate or greater severity after 2 weeks of GP care and 4 weeks of mebeverine. The Symptom Severity Scale (SSS) was used to identify patients with moderate or severe IBS. Patients who continued to report moderate or severe IBS after 4 weeks of mebeverine at a dose of 270 mg three times a day were randomised to receive six sessions of CBT in addition to mebeverine (72 patients) or mebeverine alone (77 patients). These patients were followed at 3, 6 and 12 months after treatment. As part of the baseline evaluation, blood tests for antiendomysial and antigliadin antibodies were carried out on 141 patients to determine the prevalence of coeliac disease in this population. MAIN OUTCOME MEASURES: The principal outcome measure was the SSS. Others included the Hospital Anxiety and Depression Scale, psychopathology, the Work and Social Adjustment Scale (WASA, disability), a modified version of the Illness Perception Questionnaire (illness perceptions), the Beliefs about Medicine Questionnaire (attitudes to medication), the Reported Adherence to Medication Scale (adherence to prescribed medication), the Client Service Receipt Inventory (economic analysis), the Cognitive Scale for Functional Bowel Disorders (illness cognitions) and the Behaviour Scale for IBS (IBS coping behaviour). RESULTS: The addition of CBT produced a significant benefit compared with the mebeverine-only group at 3 months after treatment on all outcome measures, except for the adherence to medication scales. The difference between the groups was 107.8 points on the SSS, 24.5 points on question 4 of the SSS and 6.3 points on the WASA, representing therapeutic gains of approximately 20%, 28% and 40%, respectively. However, there was also evidence that these improvements began to wane, so that at 6 and 12 months follow-up significant therapeutic benefit of the addition of CBT could only be detected on question 4 of the SSS and on the WASA. The behaviour scale for IBS detected significant, positive changes in coping behaviours at up to 6 months after treatment. Three factors predicting a poor outcome were identified: male gender, believing that IBS had serious consequences and belief in an external aetiology, all of which were associated with greater than average disability at follow-up. The addition of CBT to mebeverine did not reduce overall treatment or social costs. The nested study on testing for coeliac disease provides cautious support for the inclusion of antiendomysial and antigliadin antibody testing in the investigation of patients thought to have IBS. CONCLUSIONS: Specially trained practice nurses can provide effective CBT to primary care patients with a clinical diagnosis of IBS, which although effective does not reduce service or social costs. Using a variety of measures the beneficial therapeutic effects of the addition of CBT to antispasmodic therapy persist for up to 6 months. Future research might include studies of the long-term follow-up of IBS patients treated with CBT, cost-benefit analyses comparing CBT with other therapeutic approaches to IBS, and evaluating means of training both non-specialist health professionals and GPs to deliver CBT.

Adolescent↗
PubMed2004

Prescription drug coverage, health, and medication acquisition among seniors with one or more chronic conditions.

BACKGROUND: The unabated rise in medication costs particularly affects older persons with chronic conditions that require long-term medication use, but how prescription benefits affect medication adherence for such persons has received limited study. OBJECTIVE: We sought to study the relationship among prescription benefit status, health, and medication acquisition in a sample of elderly HMO enrollees with 1 or more common, chronic conditions. RESEARCH DESIGN: We implemented a cross-sectional cohort study using primary survey data collected in 2000 and administrative data from the previous 2 years. SUBJECTS: Subjects were aged 67 years of age and older, continuously enrolled in a Medicare + Choice program for at least 2 years, and diagnosed with 1 or more of hypertension, diabetes, congestive heart failure, and coronary artery disease (n = 3073). MEASURES: Outcomes were the mean daily number of essential therapeutic drug classes and refill adherence. RESULTS: In multivariate models, persons without a prescription benefit acquired medications in 0.15 fewer therapeutic classes daily and experienced lower refill adherence (approximately 7 fewer days of necessary medications during the course of 2 years) than those with a prescription benefit. A significant interaction revealed that, among those without a benefit, persons in poor health acquired medications in 0.73 more therapeutic classes daily than persons in excellent health; health status did not significantly influence medication acquisition for those with a benefit. CONCLUSIONS: Coverage of prescription drugs is important for improving access to essential medications for persons with the studied chronic conditions. A Medicare drug benefit that provides unimpeded access to medications needed to treat such conditions may improve medication acquisition and, ultimately, health.

Aged↗
PubMed2003

Treatment adherence associated with conventional and atypical antipsychotics in a large state Medicaid program.

OBJECTIVES: Rates of medication adherence over a one-year period were assessed among outpatients with schizophrenia who initiated therapy with conventional or atypical antipsychotic agents. METHODS: Data were drawn from paid medical and pharmacy claims for a random sample of 10 percent of all California Medicaid ("Medi-Cal") recipients. Outpatients with schizophrenia who were aged 18 years or older and who initiated monotherapy with a conventional or atypical antipsychotic medication in the last quarter of 1997 were identified. The percentages of patients who discontinued antipsychotic therapy or who had a switch in medications over a one-year period were determined. The use of selected concomitant medications was also assessed. Data were analyzed by means of chi square tests and multivariate statistics that adjusted for demographic and clinical differences between medication groups. RESULTS: A total of 298 patients who initiated therapy with a conventional (N=93) or atypical (N=205) antipsychotic medication were identified. The groups were similar in mean age (about 42 years) and gender distribution (about 54 percent were male). Compared with patients who received conventional antipsychotics, those receiving atypical antipsychotics were significantly less likely to have a switch in medication and to use concomitant anticholinergic and anxiolytic medications. In each group, antipsychotic medication was available for about 60 percent of days over one year of follow-up. CONCLUSIONS: Compared with the use of conventional antipsychotics, the use of atypical antipsychotic medications was associated with significantly less treatment switching and less use of concomitant medications. However, undertreatment, evidenced by a lack of prescription refills, occurred among patients taking both medication classes, which highlights the need for further research on nonadherence.

Adolescent↗
PubMedDate not supplied

Effects of enhanced depression treatment on diabetes self-care.

PURPOSE: Among patients with diabetes, major depression is associated with more diabetic complications, lower medication adherence, and poorer self-care of diabetes. We reported earlier that enhanced depression care reduces depression symptoms but not hemoglobin A1c level. This study examined effects of depression interventions on self-management among depressed diabetic patients. METHODS: A total of 329 patients in 9 primary care clinics were randomized to an evidence-based collaborative depression treatment (pharmacotherapy, problem-solving treatment, or both in combination) or usual primary care (routine medical services). Outcome measures included the Summary of Diabetes Self-Care Activities (SDSCA), reported at baseline and 3, 6, and 12 months, and medication non-adherence as assessed by automated pharmacy refill data of oral hypoglycemic agents, lipid-lowering agents, and angiotensin-converting enzyme inhibitors. We used mixed regression models adjusted for baseline differences to compare the intervention with usual care groups at follow-up assessments. RESULTS: During the 12-month intervention period, enhanced depression care and outcomes were not associated with improved diabetes self-care behaviors (healthy nutrition, physical activity, or smoking cessation). Relative to the usual care group, the intervention group reported a small decrease in body mass index (mean difference = 0.70 kg/m2, 95% CI, 0.17 to 1.24 kg/m2) and a higher rate of nonadherence to oral hypoglycemic agents (mean difference = -6.3%, 95% CI, -11.91% to -0.71%). Adherence to lipid-lowering agents and to antihypertensive medicines was similar for the 2 groups. CONCLUSIONS: In general, diabetes self-management did not improve among the enhanced depression treatment group during a 12-month period, except for small between-group differences of limited clinical importance. Research needs to assess whether self-care interventions tailored for specific conditions, in addition to enhanced depression care, can achieve better diabetes and depression outcomes.

Adult↗
PubMed2003

Barriers and successful strategies to antiretroviral adherence among HIV-infected monolingual Spanish-speaking patients.

Focus groups were conducted with HIV-infected, monolingual Spanish-speaking patients (N = 81) taking antiretrovirals in order to: (1) determine what barriers impede medication adherence; (2) determine what strategies facilitate adherence; and (3) investigate the health care provider-patient relationship and whether it impacts adherence. Both quantitative and qualitative information was gathered. Participants were prescribed an average of 11 pills per day (M = 11.4, SD = 7.0, range = 1-30). Only 32% of participants were consistently adherent when self-report of medication taking (yesterday, the day before yesterday, and last Saturday) was compared to prescribed regimen. The most frequently reported strategies were: learning more about the medications (77%), accepting the need to take them (75%) and refilling prescriptions early or on time (70%). Barriers most often reported were: feeling depressed or overwhelmed (21%), simply forgetting (19%) and sleeping through a dose (17%). From the qualitative data, four main issues emerged: patient characteristics, the health care professional-patient relationship, language and cultural barriers within the health care system, and the medication regimen. Among this Latino sample, having someone to live for was extremely important in terms of patient adherence. Language barriers were reported, and the use of translators was not always seen as a sufficient remedy. Differences between monolingual Spanish-speaking patients' and English-speaking patients' strategies and barriers are discussed.

Adult↗
PubMed2005

Pharmacokinetics, pharmacodynamics and adherence to oral topotecan in myelodysplastic syndromes: a Cancer and Leukemia Group B study.

OBJECTIVE: To evaluate medication adherence, pharmacokinetics and exposure versus response relationships in patients with myelodysplastic syndromes (MDS). METHODS: Ninety adult patients with MDS received oral topotecan (1.2 mg/m2) either once a day for 10 days or twice a day for 5 days every 21 days for up to six cycles. Dosing histories were collected using electronic monitoring devices fitted to medication vials. Topotecan plasma concentrations were measured, and exposure was determined by a sparse sampling approach and Bayesian estimation methods. Relationships between exposure and clinical response and toxicity were evaluated using logistic regression. RESULTS: Overall adherence was excellent with 90% of patients taking the prescribed number of doses in cycle 1. Adherence did not differ between the two regimens. Topotecan pharmacokinetics were described using a one compartment open model with first order absorption and elimination. Pharmacokinetic parameter estimates did not differ between the once a day and twice a day dosing groups. While topotecan exposure was greater in the twice a day arm compared to the once a day arm due to drug accumulation, exposure did not correlate with clinical response. However, the probability of needing a platelet transfusion in the twice a day arm was significantly increased (by 35%) as a result of greater steady-state plasma topotecan concentrations. CONCLUSIONS: Adherence is high in patients with MDS receiving oral topotecan, whether the drug is prescribed once or twice daily. The optimal schedule cannot be determined from this study, as there was no evident relationship between any pharmacokinetic parameter and clinical response.

Administration, Oral↗
PubMed2002

Correlates and predictors of adherence to highly active antiretroviral therapy: overview of published literature.

Knowledge of factors associated with medication adherence could help HIV clinicians to target persons in need of intervention, design these interventions, and help researchers to plan studies of adherence. This review summarizes the results of 20 studies investigating the issue of barriers to optimal highly active antiretroviral therapy (HAART) adherence. Only a few determinants were consistently associated with nonadherence. Symptoms and adverse drug effects, psychologic distress, lack of social or family support, complexity of the HAART regimen, low patient self-efficacy, and inconvenience of treatment were the factors most consistently associated with nonadherence. There were inconsistent findings regarding the relationship of adherence and the following variables: sociodemographic characteristics, substance abuse, depressive symptoms, quality of life, CD4+ cell count, knowledge and beliefs about treatment, patients' satisfaction with health care, and patient-provider relationship. A synthesis of findings relating various factors to adherence to HAART is difficult to reach because of several limitations of the existing body of research. These limitations concern the measurement of adherence, the assessment of correlates and predictors of adherence, the study population, and the study design.

Antiretroviral Therapy, Highly Active↗
PubMed1997

The feasibility of automated voice messaging as an adjunct to diabetes outpatient care.

OBJECTIVE: To determine whether automated voice messaging (AVM) systems could be used as an adjunct to primary care for diabetic patients, we examined whether patients were able to respond to AVM queries for clinical information, whether sufficient numbers of problems were identified to warrant the implementation of the service, and whether patients found the system helpful. RESEARCH DESIGN AND METHODS: The AVM system we examined uses specialized computer technology to telephone patients, communicate messages, and collect information. Sixty-five diabetic patients participated. Based on a review of the literature and the input of diabetes clinician-researchers, we developed an AVM monitoring protocol to inquire about patients' symptoms, glucose monitoring, foot care, diet, and medication adherence. Patients also were given the option to listen to health promotion messages and to report their satisfaction with the calls. Patients responded by using their touch-tone telephone keypads. RESULTS: A total of 216 AVM calls were successfully completed, an average of 3.3 out of four calls per patient. Patients reported a variety of health problems that signaled the need for follow-up. Many patients reported not checking their blood glucose or their feet, and one in four reported problems with medication and diet adherence. Health and self-care problems varied across patient subgroups in ways suggesting that the AVM reports were reliable and valid. Overall, 98% of all patients reported that the calls were helpful, 98% reported that they had no difficulty responding to the calls, and 77% reported that receiving AVM calls would make them more satisfied with their health care. CONCLUSIONS: This study demonstrates that diabetic patients can respond to AVM queries and find the calls helpful. Such calls are a feasible strategy for identifying health and self-care problems that would otherwise go unnoticed by clinicians.

Aged↗
PubMed1985

Experimental analysis of adherence counseling: implications for hypertension management.

A time series "reversal" design demonstrated that behavioral counseling increased medication adherence from about 60 to 100% for a black, hypertensive patient. However, inadequate pharmacological treatment yielded no clinically important blood pressure decrease. The combination of improved compliance and minimal blood pressure reduction led the patient's physician to explore higher doses and alternate medications to achieve blood pressure control. The physician's aggressive medical treatment was initiated only after the patient's compliance had been improved. Thus, this study suggests that paraprofessional counseling can increase compliance and illustrates the need for both behavioral and physiological data in clinical management to avoid blaming patients for poorly controlled blood pressure.

Adult↗
PubMed2005

Race and electronically measured adherence to immunosuppressive medications after deceased donor renal transplantation.

Nonadherence to immunosuppressive medications may partly explain the worse allograft outcomes among black recipients of renal transplants. In a prospective cohort study of recipients of deceased donor renal transplants, microelectronic cap monitors were placed on bottles of one immunosuppressive medication to (1) measure average daily percentage adherence during the first posttransplantation year and (2) determine the factors associated with adherence. A total of 278 transplant recipients who provided sufficient microelectronic adherence data were grouped into four categories of average daily percentage adherence: 95 to 100% adherence (41.0% of patients), 80 to 95% adherence (32.4%), 50 to 80% adherence (12.9%), and 0 to 50% adherence (13.7%). In the unadjusted ordinal logistic regression model, black race was associated with decreased adherence (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.26 to 0.72; P = 0.001). Cause of renal disease, Powerful Others health locus of control, transplant center, and dosing frequency were also associated with adherence. After adjustment for transplant center and dosing frequency, the association between black race and decreased adherence was substantially attenuated (OR, 0.65; 95% CI, 0.38 to 1.14, P = 0.13). Transplant center (P = 0.003) and increased dosing frequency (OR, 0.43; 95% CI, 0.22 to 0.86, for three or four times per day dosing; OR, 2.35; 95% CI, 1.01 to 5.45, for daily dosing; versus two times per day dosing; P = 0.003) remained independently associated with adherence. Other baseline demographic, socioeconomic, medical, surgical, and psychosocial characteristics were not associated with adherence. The transplant center and dosing frequencies of immunosuppressive medications are associated with adherence and explain a substantial proportion of the race-adherence relationship.

Adult↗
PubMedDate not supplied

Randomized trial of geragogy-based medication instruction in the emergency department.

BACKGROUND: Medication adherence by older adults who are discharged from the emergency department (ED) is an essential attribute of effective treatment. Researchers have demonstrated that delivery of well-structured instructions increases the knowledge of discharge regimens and increases adherence among ED populations. OBJECTIVES: This study compared the level of medication knowledge of elderly ED patients receiving instruction by one of two teaching methods: the usual preprinted discharge instructions with handwritten medication information and individualized computer-generated discharge instructions designed within a geragogy framework. METHOD: The geragogy intervention included large-print, easily readable, specific information ordered within the elderly memory schema. This schema consists of purpose, administration, and emergency information in that order. The Knowledge of Medication Subtest by Horn and Swain (1977) was administered by telephone 48 to 72 hours after discharge. Sixty patients (38 women, 22 men) with a mean age of 76 years were randomly assigned to groups and completed the study at three rural ED sites. RESULTS: Subjects in the geragogy-based intervention group demonstrated significantly more knowledge of medications than did subjects experiencing the usual discharge teaching method (t = 2.19, p = .016). CONCLUSIONS: These findings suggest that a medication teaching intervention geared to the special needs of the elderly can be effective in increasing medication knowledge.

Aged↗
PubMedDate not supplied

The Client Adherence Profiling-Intervention Tailoring (CAP-IT) intervention for enhancing adherence to HIV/AIDS medications: a pilot study.

This article describes the Client Adherence Profiling-Intervention Tailoring (CAP-IT) intervention designed to enhance adherence to HIV/AIDS medications and reports the results of a pilot study aimed at assessing the feasibility of CAP-IT. Initially, CAP-IT was designed to be implemented by nurse case managers during regularly scheduled home visits; it is currently under revision for use in an outpatient, ambulatory care setting. CAP-IT is an innovative, structured nursing assessment and care-planning activity that allows a standardized assessment of client needs and tailored highly active antiretroviral therapy adherence intervention strategies. CAP-IT is significantly different from the current standard nursing case management practice. Pilot study results in a sample of 10 home care patients suggests that clients have knowledge and skill deficits related to adherence and in the management of the side effects of medications. In addition, the pilot study supported the acceptability of the protocol to clients and the feasibility of integrating CAP-IT into nurse case manager practice. The pilot study results also provided evidence for the efficacy of CAP-IT. The next steps include testing CAP-IT in a randomized clinical trial to determine its effectiveness.

Adult↗
PubMed1999

Promoting adherence to transplant medication regimens: a review of behavioral analysis.

Failure to adhere to complex behavioral regimens has been a significant and long-standing problem in healthcare. Transplant recipients are one patient population that needs to learn and incorporate a multidimensional regimen of behaviors into their lives. The literature indicates that not all transplant recipients adhere to their medication regimens, which can lead to graft loss and possibly death. Behavioral analysis is often used to increase adherence to health-related regimens and has been effective for a variety of health conditions. The use of behavioral analysis as a strategy to promote adherence behaviors has not been reported in the transplant literature. Transplant coordinators and clinicians should learn the principles of behavioral analysis and apply them to the care of transplant recipients to facilitate recipients' lifelong adherence behaviors.

Health Behavior↗
PubMedDate not supplied

Improving adherence and persistence: a review and assessment of interventions and description of steps toward a national adherence initiative.

OBJECTIVES: To identify the effectiveness of adherence interventions reported in the literature, to identify interventions being conducted and/or sponsored by large chain pharmacies and pharmaceutical manufacturers, and to seek input from a panel of pharmacists who address adherence issues on a daily basis as to the steps that should be taken to advance a national initiative to increase awareness of the importance of and opportunities associated with medication adherence and persistence. MAIN OUTCOME MEASURE: Effectiveness of the adherence interventions reported in the literature. METHODS: First, a literature search was conducted using MEDLINE, International Pharmaceutical Abstracts, CINAHL, and PsycINFO. Keywords were medication or drug and compliance or adherence or persistence and control group. Second, pharmaceutical manufacturers and chain pharmacies were surveyed. Third, an advisory panel reacted to the research findings and formulated a series of action steps that could support or be part of a national initiative to increase adherence. RESULTS: Reported adherence-related interventions were grouped into five categories--adherence aids, refill or follow-up reminders, regimen simplification, written and oral education, and comprehensive management. Median adherence increases ranged from 6% to 25% for these categories. Interviews with 10 chain pharmacies revealed that adherence is an important issue. Most chains have some form of adherence program in place, but current initiatives are product-focused rather than patient-focused. Interviews with 15 manufacturers revealed that they currently use a variety of adherence interventions and want to partner with pharmacies to implement and assess the initiatives. The advisory panel developed a series of action items for implementing a national adherence initiative. CONCLUSION: Comprehensive interventions can improve adherence and are mutually beneficial for patients, pharmacies, and manufacturers. Pharmacists must be able to assess patients' adherence, identify the reasons for nonadherence, and develop patient-specific interventions. Studies have shown that the most successful interventions have some follow-up component and address the underlying reason(s) for nonadherence. Pharmacies and pharmaceutical manufacturers have tried various adherence interventions, such as patient education and refill reminders. There is a growing sense that a national adherence initiative is needed to coordinate pharmacists' efforts to address this public health problem, and the American Pharmacists Association is well positioned to take a leadership role in such efforts.

Age Factors↗
PubMed2002

Factors associated with adherence to antiretroviral medication in HIV-infected patients.

The aim of the study was to assess adherence with antiretroviral medication in a sample of HIV patients in Hong Kong and identify predictors of adherence. The study used a cross-sectional correlational design. Adherence behaviour was assessed with the use of self-reports. Other scales assessed knowledge with HIV medication, coping, health locus of control, anxiety, depression and fatigue. A blood sample was also obtained to assess CD4+ counts and viral load. Sociodemographic characteristics and medical information were obtained from the medical records. A high adherence rate was found in this sample of 136 predominantly Chinese patients. There were only 13.7% of the patients being classified as non-adherent. Predictors of adherence included high self-efficacy in terms of being certain that the medication schedule will be followed all or most of the time as directed, low tension-anxiety scores, and low intensity of nausea and vomiting (R2=0.304). An expanded regression model revealed additional factors influencing adherence, including coping variables, pain and numbness in the hands and feet, age, disease stage, internal locus of control, fatigue, family support and taking medication twice daily. This model explained 49% of the variance in adherence. The results suggest that adherence is a multidimensional concept. Every effort should be made to assess in individuals those variables found to affect adherence and alter them whenever possible. Continuous support of patients and individualized medication programmes that will help patients adjust their treatment to their lifestyle are recommended.

Adaptation, Psychological↗