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Results for “Medication Adherence”

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PubMed2000

Medication adherence in psychosis: predictors and impact on outcome. A 2-year follow-up of first-admitted subjects.

OBJECTIVE: To assess the baseline characteristics predicting poor medication adherence following a first admission for psychosis, and the impact of poor medication adherence on outcome. METHOD: First-admitted subjects with psychosis (n = 65) were assessed at 6-month intervals over a 2-year follow-up. Medication adherence was assessed using multiple sources of information. RESULTS: Baseline lower occupational status, alcohol misuse and the intensity of delusional symptoms and suspiciousness predicted poor medication adherence during the 2-year follow-up. Over this period, subjects with poor medication adherence presented more frequently with an episodic course of illness and were more frequently readmitted, especially with regard to involuntary readmission. CONCLUSION: In naturalistic conditions one out of two subjects with psychosis interrupts his/her treatment in the months following his/her first discharge from hospital. Therapeutic programmes aimed at improving medication adherence should be implemented early in the course of psychosis to reduce the deleterious consequences of poor medication adherence on clinical outcome.

Adolescent↗

PubMed2002

Interventions to improve medication adherence in schizophrenia.

OBJECTIVE: Although nonadherence with the antipsychotic medication regimen is a common barrier to the effective treatment for schizophrenia, knowledge is limited about how to improve medication adherence. This systematic literature review examined psychosocial interventions for improving medication adherence, focusing on promising initiatives, reasonable standards for conducting research in this area, and implications for clinical practice. METHOD: Studies were identified by computerized searches of MEDLINE and PsychLIT for the years between 1980 and 2000 and by manual searches of relevant bibliographies and conference proceedings. Key articles were summarized. RESULTS: Thirteen (33%) of 39 identified studies reported significant intervention effects. Although interventions and family therapy programs relying on psychoeducation were common in clinical practice, they were typically ineffective. Concrete problem solving or motivational techniques were common features of successful programs. Interventions targeted specifically to problems of nonadherence were more likely to be effective (55%) than were more broadly based treatment interventions (26%). One-half (four of eight) of the successful interventions not specifically focused on nonadherence involved an array of supportive and rehabilitative community-based services. CONCLUSIONS: Psychoeducational interventions without accompanying behavioral components and supportive services are not likely to be effective in improving medication adherence in schizophrenia. Models of community care such as assertive community treatment and interventions based on principles of motivational interviewing are promising. Providing patients with concrete instructions and problem-solving strategies, such as reminders, self-monitoring tools, cues, and reinforcements, is useful. Problems in adherence are recurring, and booster sessions are needed to reinforce and consolidate gains.

Antipsychotic Agents↗

PubMed2006

Medication adherence in schizophrenia: exploring patients', carers' and professionals' views.

One of the major clinical problems in the treatment of people with schizophrenia is suboptimal medication adherence. Most research focusing on determinants of nonadherence use quantitative research methods. These studies have some important limitations in exploring the decision-making process of patients concerning medication. In this study we explore factors influencing medication adherence behavior in people with schizophrenia using concept mapping. Concept mapping is a structured qualitative method and was performed in 4 European countries. Participants were 27 patients with schizophrenia, 29 carers, and 28 professionals of patients with schizophrenia. Five clinically relevant themes were identified that affect adherence: medication efficacy, external factors (such as patient support and therapeutic alliance), insight, side effects, and attitudes toward medication. Importance ratings of these factors differed significantly between professionals and carers and patients. Professionals, carers, and patients do not have a shared understanding of which factors are important in patients' medication adherence behavior. Adherence may be positively influenced if professionals focus on the positive aspects of medication, on enhancing insight, and on fostering a positive therapeutic relationship with patients and carers.

Adult↗

PubMed2006

Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial.

CONTEXT: Poor medication adherence diminishes the health benefits of pharmacotherapies. Elderly patients with coronary risk factors frequently require treatment with multiple medications, placing them at increased risk for nonadherence. OBJECTIVE: To test the efficacy of a comprehensive pharmacy care program to improve medication adherence and its associated effects on blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C). DESIGN, SETTING, AND PATIENTS: A multiphase, prospective study with an observational phase and a randomized controlled trial conducted at the Walter Reed Army Medical Center of 200 community-based patients aged 65 years or older taking at least 4 chronic medications. The study was conducted from June 2004 to August 2006. INTERVENTION: After a 2-month run-in phase (measurement of baseline adherence, BP, and LDL-C), patients entered a 6-month intervention phase (standardized medication education, regular follow-up by pharmacists, and medications dispensed in time-specific packs). Following the intervention phase, patients were randomized to continued pharmacy care vs usual care for an additional 6 months. MAIN OUTCOME MEASURES: Primary end point of the observation phase was change in the proportion of pills taken vs baseline; secondary end points were the associated changes in BP and LDL-C. Primary end point of the randomization phase was the between-group comparison of medication persistence. RESULTS: A total of 200 elderly patients (77.1% men; mean [SD] age, 78 [8.3] years), taking a mean (SD) of 9 (3) chronic medications were enrolled. Coronary risk factors included drug-treated hypertension in 184 patients (91.5%) and drug-treated hyperlipidemia in 162 (80.6%). Mean (SD) baseline medication adherence was 61.2% (13.5%). After 6 months of intervention, medication adherence increased to 96.9% (5.2%; P<.001) and was associated with significant improvements in systolic BP (133.2 [14.9] to 129.9 [16.0] mm Hg; P = .02) and LDL-C (91.7 [26.1] to 86.8 [23.4] mg/dL; P = .001). Six months after randomization, the persistence of medication adherence decreased to 69.1% (16.4%) among those patients assigned to usual care, whereas it was sustained at 95.5% (7.7%) in pharmacy care (P<.001). This was associated with significant reductions in systolic BP in the pharmacy care group (-6.9 mm Hg; 95% CI, -10.7 to -3.1 mm Hg) vs the usual care group (-1.0 mm Hg; 95% CI, -5.9 to 3.9 mm Hg; P = .04), but no significant between-group differences in LDL-C levels or reductions. CONCLUSIONS: A pharmacy care program led to increases in medication adherence, medication persistence, and clinically meaningful reductions in BP, whereas discontinuation of the program was associated with decreased medication adherence and persistence. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00393419

Aged↗

PubMed2004

Relationship of depression and diabetes self-care, medication adherence, and preventive care.

OBJECTIVE: We assessed whether diabetes self-care, medication adherence, and use of preventive services were associated with depressive illness. RESEARCH DESIGN AND METHODS: In a large health maintenance organization, 4,463 patients with diabetes completed a questionnaire assessing self-care, diabetes monitoring, and depression. Automated diagnostic, laboratory, and pharmacy data were used to assess glycemic control, medication adherence, and preventive services. RESULTS: This predominantly type 2 diabetic population had a mean HbA(1c) level of 7.8 +/- 1.6%. Three-quarters of the patients received hypoglycemic agents (oral or insulin) and reported at least weekly self-monitoring of glucose and foot checks. The mean number of HbA(1c) tests was 2.2 +/- 1.3 per year and was only slightly higher among patients with poorly controlled diabetes. Almost one-half (48.9%) had a BMI >30 kg/m(2), and 47.8% of patients exercised once a week or less. Pharmacy refill data showed a 19.5% nonadherence rate to oral hypoglycemic medicines (mean 67.4 +/- 74.1 days) in the prior year. Major depression was associated with less physical activity, unhealthy diet, and lower adherence to oral hypoglycemic, antihypertensive, and lipid-lowering medications. In contrast, preventive care of diabetes, including home-glucose tests, foot checks, screening for microalbuminuria, and retinopathy was similar among depressed and nondepressed patients. CONCLUSIONS: In a primary care population, diabetes self-care was suboptimal across a continuum from home-based activities, such as healthy eating, exercise, and medication adherence, to use of preventive care. Major depression was mainly associated with patient-initiated behaviors that are difficult to maintain (e.g., exercise, diet, medication adherence) but not with preventive services for diabetes.

Body Mass Index↗

PubMed2005

Telemonitoring of medication adherence in patients with schizophrenia.

Nonadherence to medication is a widespread problem in schizophrenia and is associated with poor clinical outcomes and inappropriate management and utilization of resources. The aim of the current investigation was to assess the impact of telemonitoring of medication adherence on symptomatology and service use in patients with schizophrenia. A total of 108 schizophrenia patients were randomized into three equal groups according to the approaches used to assess medication adherence; self-report, pill counting, and telemonitoring. Telementoring was achieved through an innovative new platform called @HOME. This platform offers clinicians early warnings about impeding nonadherence as well as information about the pattern of medication taking. Patient's adherence was observed over an 8-week period, during which patient's clinical status and service use were recorded. In comparison to the other two groups, patients using @HOME showed improvement in the Global Clinical Impression Scale and a significant reduction in emergency visits and medical appointments. The @HOME platform was highly acceptable by patients, caregivers, and professionals, and required minimal training for implementation. The results of the study suggest that the use of telemonitoring in psychiatric settings was both feasible and acceptable and may be associated with significant clinical and service related benefits.

Adult↗

PubMed2003

Optimizing medication adherence in older persons with hypertension.

Suboptimal control of hypertension in large communities can be attributed, in part, to about 50% of patients who stop taking their antihypertensive drugs after 1 year. Older patients with many illnesses (including chronic kidney disease) are at especially high risk for discontinuing prescribed medications, but age is a weaker predictor than the number of consumed pills. Determining if medications are being taken as prescribed is difficult, but asking the patient and significant other the simple question, "Have you missed any pills in the last week?" is a good place to start. Despite all their other virtues, clinical trials seldom provide the same answers regarding medication adherence that are found in clinical practice. Observational and a few interventional trials have established that short, simple regimens that improve patients' symptoms and are well tolerated are more likely to be taken correctly. Patient (and family) education is the cornerstone of improving adherence to medication, but several other interventions have also proven useful. There appears to be no "magic bullet" that will improve medication adherence in all patients, but providing written instructions, simplifying the medication regimen to as few as necessary, once daily, well tolerated and inexpensive pills, involving family members, and prompting pill taking by certain activities of daily living all seem to help. Improving medication adherence would be a simple way to make antihypertensive therapies much more cost effective, since a medication that is not taken incurs all of cost, and provides no benefit to the patient.

Aged↗

PubMed2005

Training general practitioners in behavior change counseling to improve asthma medication adherence.

OBJECTIVE: Adherence to asthma medication regimens is problematic in general practice. We developed and evaluated a communication training for general practitioners (GPs) to help them address medication adherence during routine consultations. This paper describes the development of the training and evaluation results of a pilot study. METHODS: The training was based on behavior change counseling (BCC), a technique derived from motivational interviewing. We developed a five phases BCC consultation model. Participating GPs answered questions at baseline (T0), directly after (T1) and 4-10 months after (T2) the training that assessed their attitudes and confidence regarding adherence communication. They completed evaluation forms at T1 and T2. RESULTS: The 19 participating GPs were positive about the course and the feasibility of BCC in GP consultations. Also, after the training, their attitudes and confidence had improved (p<0.05) and all reported to use BCC skills at least sometimes 4-10 months after the training. CONCLUSION: These positive effects provide us with some hope that the training positively influenced the GP's communication behavior. PRACTICE IMPLICATIONS: If further data on physician behavior and patient outcomes justify implementation of the training, it would then be worthwhile to also involve practice nurses.

Adult↗

PubMed2001

Electronic monitoring in medication adherence measurement. Implications for dermatology.

Poor adherence with prescribed therapy often results in decreased efficacy, annoying for patient both and physician. Negative health improvement adds extensive costs to the healthcare system. Thus, physicians need to carefully examine medication adherence before investigating possible pharmacologic reasons for drug failure or initiating alternative treatments and special diagnostic tests. Documenting medication adherence can also help with the development of new drugs and establishing optimized treatment regimens. Reliable distinction between non-adherence and nonresponse is a new issue for medicine, the pharmaceutical industry and its regulators. Investigation of adherence patterns has been established on evidence-based clinical and biostatistical research agendas. Originally, the term 'compliance' was used to describe how a patient adheres to a recommended therapy plan. Subsequently, 'compliance' has been changed to the more appropriate term 'adherence'. Several approaches to studying the relationship between medication adherence and medical outcome exist. This article provides an overview on medical adherence and methods of measuring adherence, especially electronic monitoring. Traditional methods of adherence assessment (patient interview, diaries, questionnaires, pill counts, prescription refill surveys) often do not deliver reliable data. Thus, researchers have tried to approach adherence by measuring serum drug concentrations or other biologic or chemical markers to gain more objective data. However, the state of the art for analyzing adherence is the use of electronic monitoring devices, electronic event monitors. Such devices not only provide more reliable data but also more detailed data about actual patient adherence, such as dose frequency, dose time, dose interval and dose timing--details that traditional methods do not show. Electronic monitoring shows that poor adherence, especially dosage omission or changing intervals, is more prevalent than previously recognized. The detailed adherence patterns provided by electronic monitoring show the need for a new kind of drugs. These drugs should provide good therapeutic coverage despite dosage omission and are therefore called 'forgiving pharmaceuticals'. Adherence and medical outcome have been extensively studied in patients with psychiatric disorders, hypertension and other cardiovascular disorders and most recently in patients receiving HIV/AIDS therapy. But non-adherence can be found in any medical field. Regarding the lack of equivalent studies on adherence and therapeutic efficacy in treating skin diseases, this topic should be looked at more closely in dermatology. Recalcitrant atopic dermatitis, psoriasis, tinea pedis and acne would be ideal study areas.

Administration, Topical↗

PubMedDate not supplied

How do you foster medication adherence for better acne vulgaris management?

Suboptimal medication adherence is one of the major reasons for treatment failure among patients with acne vulgaris. Motivating patients to adhere to treatment, especially during the maintenance phase, remains a challenge. Although the literature on medication adherence in the acne vulgaris patient population is sparse, the available literature on patients with dermatologic and nondermatologic disorders suggests that a multifactorial approach, combining nonpharmacologic interventions and effective, well tolerated, and simplified drug regimens, appears to be associated with the greatest success. Furthermore, it is important to evaluate the patient for underlying affective disorders (e.g., depression) that can undermine adherence. The dermatologist can play a major role in enhancing patient adherence by prescribing adherence-enhancing therapeutic regimens and by forming a therapeutic alliance with patients.

Acne Vulgaris↗

PubMed2001

Living with Marfan syndrome II. Medication adherence and physical activity modification.

We investigated the perceptions of and adherence to medication and physical activity guidelines in 174 adults with Marfan syndrome. Over 80% of those prescribed beta- and Ca2+-channel blockade reportedly adhere well to their medication regimen. The presence of cardiovascular symptoms and fatigue were positively correlated with the medication use. Medication-takers reported that they are psychologically receptive to the use of medication for prophylactic treatment of their cardiovascular problems. However, all do not view their medication as essential for their health. Duration of the medication regimen, type of medication, and perception of controllability of the condition were each independently associated with respondents' perceptions of the necessity of taking beta- or Ca2+-channel blockers. Over 80% of the respondents reported that they choose their physical activities with their diagnosis in mind. Modifying exercise activities was significantly correlated with an increased perception of Marfan syndrome as having negative consequences on the respondents' lives. Genetic counseling should address beliefs about medication use and physical activity restrictions, as perceptions of these health behaviors may have significant impact on how adults with Marfan syndrome adhere to these recommendations and cope with their condition.

Adult↗

PubMed2004

Antipsychotic medication adherence, cocaine use, and recidivism among a parolee sample.

This study examined the independent and interactive associations between cocaine use and antipsychotic medication adherence in predicting 12 month criminal recidivism among a sample of mentally ill parolees (N = 200). Consistent with prior research, cocaine use (based on hair assays) was associated with more than a threefold increase (relative to non-cocaine users) in the likelihood of a parolee being returned to custody during the follow-up period. Although medication adherence (based on urine specimens) was not independently associated with a significant reduction in recidivism risk, the interaction between cocaine use and medication adherence was significant, revealing a disproportionate impact of medication adherence specific to cocaine users. Prediction models of recidivism based on self-reported measures of medication adherence and cocaine use revealed only marginally significant trends for cocaine use, no effect for adherence, and no significant interaction between these two predictors.

Adult↗

PubMed1993

The relative contributions of medication adherence and AA meeting attendance to abstinent outcome for chronic alcoholics.

Our preliminary studies of the efficacy of lithium carbonate therapy for alcoholism under double-blind, placebo-controlled conditions demonstrated that alcoholics who took their assigned medication (lithium or placebo) for the first 6 months after discharge from an inpatient rehabilitation program were more likely to abstain from any alcohol use for 18 months following discharge than were alcoholics who took their medication erratically or not at all. Attendance at Alcoholics Anonymous (AA) meetings was also associated with medication adherence. We applied a structural equation model to data on the relationships between medication adherence, AA meeting attendance and abstinent outcome to clarify whether medication adherence or AA meeting attendance better explains the positive-outcome "adherence effect" we observed. Both medication adherence and AA meeting attendance evidenced direct and independent influences on abstinent outcome: medication adherence showed a small direct influence, and AA meeting attendance showed a much larger, independent influence.

Adult↗

PubMed2003

Psychiatric and social barriers to HIV medication adherence in a triply diagnosed methadone population.

Although antiretrovirals can prolong life, medication adherence also poses a constant challenge for HIV-infected individuals because the success of antiretroviral regimens demands nearly perfect adherence to medications. This paper describes the psychiatric and social barriers to adherence in a convenience sample of HIV-positive clients in methadone treatment in the Bronx, New York. The study sample was part of a national study of HIV treatment adherence and health care utilization among triply diagnosed populations, the HIV/AIDS Treatment Adherence Health Outcomes and Cost Study. The triply diagnosed study sample is defined here as HIV-infected individuals who screened into the study with at least one psychiatric diagnosis in addition to opioid dependence on agonist therapy (methadone treatment) and at least one substance use diagnosis. Interviewers utilized modified versions of the Structured Clinical Interview for DSM-IV Disorders (SCID-I), the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), and the Addiction Severity Index (ASI-Lite), among a battery of Cost Study instruments. Results showed that within this sample, borderline personality disorder was significantly associated with nonadherence to HIV medications. A related finding showed a significant relationship between serious social/family problems and nonadherence. These findings build on previous research on the impact of psychiatric illness on HIV medication adherence and suggest that psychiatric assessment and treatment options be linked to adherence interventions.

Adult↗

PubMed2006

The caring behaviors of the home health nurse and influence on medication adherence.

The purpose of this study was to determine if the caring behaviors of the home health nurse toward the patient influence the patient's medication adherence. The study focused on what effects the verbal and nonverbal caring behaviors of the nurse toward the patient have on the patient's medication adherence. How is the patient's perception of caring by the nurse related to his or her medication adherence? The study was conducted in a Midwestern home health agency over a 4-week period. Findings indicated an improvement in the use of verbal and nonverbal caring behaviors by the nurses with their patients. The patients perceived an increased use of these caring behaviors by the nurses with them. The patients' medication adherence and barriers to adherence improved. Other significant findings indicated that the verbal and nonverbal caring behaviors of the nurses and the patients' perception of the caring behaviors influenced and improved the patients' medication adherence by week 4.

Adult↗

PubMed2000

Coping and medication adherence in bipolar disorder.

BACKGROUND: Effective treatment of bipolar disorder depends on medication adherence, yet few correlates of adherence have been identified. The pleasure experienced during some manic episodes may render some individuals reluctant to adhere to medications that reduce these 'highs'. Clinical observers identify denial of the severity or existence of illness as common to both bipolar disorder and addiction. The Alcoholics Anonymous model promotes acceptance as a pathway to abstinence adherence. This report hypothesized that acceptance coping would correlate positively and denial coping would correlate inversely with adherence to mood-stabilizing medication among individuals with bipolar disorder. METHODS: Thirty-two participants diagnosed with bipolar I disorder were administered scales from the Brief COPE and an adherence self-report measure. RESULTS: Consistent with hypotheses, curvilinear relationships between acceptance and denial with adherence were detected, suggesting that low levels of acceptance and high levels of denial undermine medication adherence. LIMITATIONS: Given the cross-sectional, naturalistic design of the study, no causal inferences can be made. CONCLUSIONS: The results uncover links between coping styles and adherence in a psychiatric population. The link between acceptance-denial coping, and mature, self-supportive behavior may point the way towards more effective psychosocial interventions.

Adaptation, Psychological↗

PubMed2003

Psychiatric nursing & medication adherence.

A survey was developed to determine whether the rapidly changing context of mental health care has significantly influenced how psychiatric nurses assess and intervene in issues related to medication adherence. A sample of 126 psychiatric nurses working in Veterans Affairs mental health treatment facilities in northern California, Hawaii, and Nevada identified the most effective methods for tracking medication adherence, as well as successful adherence interventions. Despite the challenge imposed by changing work environments, psychiatric nurses use creative and innovative approaches to improve their patients' medication adherence. Interventions for enhancing patient adherence with prescribed regimens are identified. Essential role dimensions related to medication adherence defined by the nurses in this survey included providing medication education, tracking patient adherence, assessing medication effectiveness, providing individualized, tailored adherence interventions, and collaborating with other health care providers in medication planning. Study findings support using nurses to their full potential and highlight nurses' need for more educational opportunities and consultation with experts (e.g., clinical pharmacists).

Humans↗

PubMed2007

Drug use and medication adherence among HIV-1 infected individuals.

This longitudinal study examined the impact of drug use and abuse on medication adherence among 150 HIV-infected individuals, 102 who tested urinalysis positive for recent illicit drug use. Medication adherence was tracked over a 6-month period using an electronic monitoring device (MEMS caps). Over the 6-month study drug-positive participants demonstrated significantly worse medication adherence than did drug-negative participants (63 vs. 79%, respectively). Logistic regression revealed that drug use was associated with over a fourfold greater risk of adherence failure. Stimulant users were at greatest risk for poor adherence. Based upon within-participants analyses comparing 3-day adherence rates when actively using versus not using drugs, this appears to be more a function of state rather than trait. These data suggest that it is the acute effects of intoxication, rather than stable features that may be characteristic of the drug-using populace, which leads to difficulties with medication adherence.

Adult↗