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Results for “Medication Adherence”

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PubMed2006

A review of evidence-based psychosocial interventions for bipolar disorder.

Various forms of psychosocial intervention have been found efficacious as adjunctive treatments for bipolar disorder, including family-focused therapy, interpersonal and social rhythm therapy, cognitive-behavioral therapy, and individual or group psychoeducation. When used in conjunction with pharmacotherapy, these interventions may prolong time to relapse, reduce symptom severity, and increase medication adherence. Family-focused therapy seeks to reduce the high levels of stress and conflict in the families of bipolar patients, thereby improving the patient's illness course. Interpersonal and social rhythm therapy focuses on stabilizing the daily and nightly routines of bipolar patients and resolving key interpersonal problems. Cognitive-behavioral therapy assists patients in modifying dysfunctional cognitions and behaviors that may aggravate the course of bipolar disorder. Group psychoeducation provides a supportive, interactive setting in which patients learn about their disorder and how to cope with it. This article discusses each of these interventions and summarizes the evidence for their efficacy in randomized trials. Recommendations for implementing psychosocial interventions in clinical practice are also given.

Bipolar Disorder↗

PubMed1995

Therapeutic algorithms for the management of sexually transmitted diseases at the peripheral level in Côte d'Ivoire: assessment of efficacy and cost.

In the acquired immunodeficiency syndrome (AIDS) era, adequate management of sexually transmitted diseases (STDs) is a primary concern in Africa. Assessed in this study is the clinical efficacy and feasibility of WHO-recommended therapeutic algorithms for genital discharges and ulcers, diagnosed without laboratory tests, for use at the primary health care level. Drugs were sold on a cost-recovery basis and included intramuscular ceftriaxone and oral ciprofloxacin for single-dose therapy of gonorrhoea and chancroid. During April 1993 in 10 peripheral health care centres in Abidjan, Côte d'Ivoire, a total of 207 patients were followed up, including 89 cases of male urethritis, 92 cases of vaginal discharges and 26 cases of genital ulcers; clinical success, assessed 7 days after the onset of therapy, was, respectively, 92%, 87%, and 100%. Less than 10% of the 207 patients were referred to the next care level, an acceptable rate from a public health point of view. Medical adherence to the algorithms was excellent for urethral discharges and genital ulcers but poor for vaginal discharges, partly because of intentional therapeutic modifications, without detriment to success. For drugs, the average cost per cure was 1546 francs CFA (US$ 5.60) (maximum, 2980 francs CFA (US$ 10.70). Effective and affordable treatments for STDs are necessary for their realistic case management in Africa.

Adolescent↗

PubMed1997

The education of depressed primary care patients: what do patients think of interactive booklets and a video?

BACKGROUND: Clinicians, policy makers, and health care administrators are attempting to improve depression outcomes in the primary care setting. Despite positive evidence about the efficacy of self-help materials and psychoeducational interventions, use of educational materials designed for the primary care patient are receiving little attention in present depression initiatives. The present study describes the use and evaluation of three educational materials by depressed primary care patients. METHODS: As a part of a randomized control trial, depressed primary care patients were identified by primary care physicians and randomized to a clinical trial exploring a new method of treating depression. Patients assigned to the new method of treatment received a package of educational materials at the time of the baseline interview. These materials included two brief interactive booklets (medication booklet, behavioral health booklet) and a short video. The present analysis concerns data obtained from 108 intervention patients in a telephone survey conducted 1 week after they received the package of educational materials. RESULTS: Approximately three quarters of the subjects reported that they read or viewed all of the educational products. The majority rated the products as somewhat to significantly helpful: medication booklet 81%; behavioral health booklet 82%; and video 69%. Previously reported results include findings of significantly better medication adherence and improved clinical outcomes by patients with major depression who received a primary care intervention that included the educational products discussed in this paper. CONCLUSIONS: Educational materials may play a significant role in improving depression treatment outcomes in the primary care setting.

Adaptation, Psychological↗

PubMed2005

Adherence to asthma controller medication regimens.

BACKGROUND: Improved adherence to inhaled corticosteroids (ICS) is recognized as an important factor in reduced morbidity, mortality and consumption of health care resources. The present study was designed to replicate previous reports of patient adherence with fluticasone/salmeterol in a single inhaler (FSC), fluticasone and salmeterol in separate inhalers (FP+SAL), fluticasone and montelukast (FP+MON), fluticasone alone (FP) and montelukast alone (MON). METHODS: A 24-month observational retrospective study was conducted using administrative claims data. Subjects were 12 years old with 24 months of continuous enrollment; had 1 asthma claim (ICD-9: 493), 1 short-acting beta(2)-agonist claim, and 1 FSC, FP, SAL, or MON claim. Outcomes included asthma medication refill rates and persistence measured by treatment days. This study was designed with a unique population of patients with asthma from different health plans to validate previous findings. RESULTS: A total of 3,503 subjects were identified based on their index medication: FSC (996), FP+SAL (259), FP+MON (101), FP (1254) and MON (893). Mean number of prescription refills for FSC (3.98) was significantly higher than FP (2.29) and the FP component of FP+SAL (2.36), and FP+MON (2.15), P<0.05. No significant differences were observed between FSC and MON fill rates (4.33). Mean number of treatment days was greater for FSC compared to FP, FP+SAL, and FP+MON (P<0.0001). CONCLUSION: This study confirms a previous report that adherence profiles of fluticasone and salmeterol in a single inhaler are significantly better when compared to the controller regimens of fluticasone and salmeterol in separate inhalers, fluticasone and montelukast, or fluticasone alone and similar to montelukast alone.

Acetates↗

PubMed2004

Self-reported adherence to cholesterol-lowering medication in patients with familial hypercholesterolaemia: the role of illness perceptions.

BACKGROUND: The objectives of this study are to describe levels of adherence to cholesterol-lowering medication and to identify predictors of adherence in patients with familial hypercholesterolaemia (FH). DESIGN: Descriptive questionnaire study. METHODS: 336 adults patients with FH attending one of five outpatient lipid clinics in South East England underwent a clinical assessment by a nurse and completed a questionnaire. The questionnaire assessed self-reported adherence to cholesterol-lowering medication, anxiety, depression, and patient perceptions of heart disease. RESULTS: Overall, participants reported high levels of medication adherence, although 63% reported some level of non-adherence. Total medication adherence (never deviating from the regimen) was more likely to be reported by older participants, those with no formal educational qualifications, those with a personal history of cardiovascular disease, those with a lower total cholesterol level, and those with a greater difference between untreated cholesterol levels and current cholesterol levels. The illness perceptions associated with reported total adherence were lower perceived risk of raised cholesterol, perceiving greater control over FH, and perceiving genes and cholesterol to be important determinants of a heart attack. Emotional state was not associated with medication adherence. In logistic regression analysis, predictors of total medication adherence were having personal history of cardiovascular disease, having no formal qualifications, and perceiving genes to be important determinants of a heart attack. CONCLUSIONS: Both clinical factors and patients' illness perceptions were associated with self-reported cholesterol-lowering medication adherence. The association with illness perceptions was small and many of these associations may be a consequence, rather than a cause, of greater adherence. Given this, intervention strategies aimed at helping patients' to establish routines for medication taking may be more effective in increasing adherence than interventions designed to alter perceptions related to taking statins.

Anticholesteremic Agents↗

PubMedDate not supplied

Using motivational interviewing to promote adherence to antiretroviral medications: a pilot study.

This report describes a pilot study of a nursing intervention to increase adherence to combination therapy. The intervention was based on motivational interviewing (MI). Participants completed a baseline assessment using the computer-administered self-interview with audio (ACASI) data collection method and then were randomly assigned to the MI intervention or control condition. Nurse counselors met with participants in the MI intervention group for three adherence sessions. Two months following baseline, participants completed a follow-up assessment. Mean scores on ratings of missed medications were lower for participants in the intervention group than those in the control group. Although there were no significant differences in the number of medications missed during the past 4 days, participants in the MI group reported being more likely to follow the medication regimen as prescribed by their health care provider. The pilot study provided useful information about the acceptability of ACASI and the adequacy of intervention procedures. The results of this pilot study show promise for the use of MI as an intervention to promote adherence to antiretroviral medications.

Adolescent↗

PubMed1992

Therapeutic adherence to oral medication regimens by adolescents with cancer. II. Clinical and psychologic correlates.

The focus of our study was to identify specific demographic, treatment, and psychologic factors that may differentiate patients who complied with cancer therapy from those who did not. In a companion study, bioassay techniques revealed frequent nonadherence to oral medication regimens among 50 adolescents and young adults with acute lymphoblastic leukemia or Hodgkin disease. In this sample, compliers and noncompliers did not differ with respect to either demographic variables (age, gender) or treatment variables (treatment duration, continuity, complexity, or parental involvement). Psychologic variables were assessed in 34 patients. Patients who adhered poorly to the therapeutic regimen had significantly less developed concepts of the illness (specifically, concepts of causality and prognosis), less perceived vulnerability (especially as related to subclinical disease), higher levels of denial as a psychologic defense, and less cohesive future orientation. The perceived health locus of control was not a significant factor. The results suggest that patients construct their own subjective view of the illness and its treatment, which then has implications for adherence to medication regimens.

Administration, Oral↗

PubMed2005

Adherence assessment using medication weight in a phase IIb clinical trial of difluoromethylornithine for the chemoprevention of skin cancer.

OBJECTIVE: Adherence is a common and essential measurement in clinical trials. This study evaluates the association between participant self-reported study diary records and the weight of the medication vessel at each study visit, in the setting of a phase IIb topical chemoprevention trial. METHODS: One hundred and twenty-four eligible participants were randomized to one of four arms [34 to difluoromethylornithine (DFMO) plus triamcinolone, 31 to DFMO plus placebo, 31 to placebo plus triamcinolone, and 28 to double placebo] for 6 months of treatment for actinic keratosis. Adherence was assessed at each clinic visit by weighing each tube of dispensed and returned medication and the participant's study diary. RESULTS: Self-reported adherence was consistently higher than adherence measured by returned medication weight (96.5% versus 71.3%, 94.6% versus 82.4%, 95.3% versus 69.5%, and 95.8% versus 66.8% for DFMO, DFMO placebo, triamcinolone, and triamcinolone placebo, respectively; P < 0.001). Most participants (59.2%) recorded 100% adherence on the study diary; however, using the weight adherence, only 10.2% were completely adherent to the study regimen. CONCLUSIONS: Self-reported diary measures seem to overestimate adherence when compared with weighing the returned medication vessel. It is recommended that future clinical trials involving topical applications incorporate medication weights as a primary measure of adherence because it is objective, quantitative, inexpensive, noninvasive, and easy to use.

Administration, Topical↗

PubMedDate not supplied

Impact on medication use and adherence of Australian pharmacists' diabetes care services.

OBJECTIVE: To assess the effect of a specialized service implemented in community pharmacies for patients with type 2 diabetes on medication use and medication-related problems. DESIGN: Parallel group, multisite, control versus intervention, repeated measures design, with three different regions in New South Wales, Australia, used as intervention regions, then matched with control regions as much as possible. INTERVENTION: After initial training, pharmacists followed a clinical protocol for more than 9 months, with patient contact approximately monthly. Each patient received an adherence assessment at the beginning and end of the study, adherence support, and a medication review as part of the intervention. MAIN OUTCOME MEASURES: Risk of nonadherence using Brief Medication Questionnaire (BMQ) scores and changes to medication regimen. RESULTS: Compared with 82 control patients, 106 intervention patients with similar demographic and clinical characteristics had significantly improved self-reported nonadherence as reflected in total BMQ scores after 9 months. The mean (+/-SD) number of medications prescribed at follow-up in intervention participants decreased significantly, from 8.2+/-3.0 to 7.7+/-2.7. No reduction was observed among the control patients (7.6+/-2.4 and 7.3+/-2.4). The overall prevalence of changes to the regimen was also significantly higher in the intervention group (51%) compared with controls (40%). CONCLUSION: Community pharmacists trained in medication review and using protocols in collaboration with providers improved adherence in patients with type 2 diabetes, reduced problems patients had in accessing their medications, and recommended medication regimen changes that improved outcomes.

Australia↗

PubMedDate not supplied

Factors that influence adherence to HIV medications: perceptions of women and health care providers.

The purpose of this pilot study was to explore factors that influence adherence to antiretroviral therapy (ART) in women with human immunodeficiency virus (HIV) disease. Antiretroviral medications that reduce viral count and prolong the time between a diagnosis of HIV disease and acquired immunodeficiency syndrome (AIDS) are expensive, numerous, and have multiple side effects. Common reasons for not adhering to the medication regimen include ART side effects and a dosage schedule that disrupts daily activities. Failure to take or errors in taking ART can result in an exacerbation of symptoms and disease progression or the development of drug-resistant strains of HIV. Women and providers in separate focus groups identified factors that facilitated and hindered adherence to ART. Knowledge of factors that influence adherence to ART will facilitate the development of interventions. Patient-provider relationships and side effects of weight gain are discussed as factors that influence adherence to ART.

Adult↗

PubMed2004

Concordance therapy: an intervention to help older people take antidepressants.

BACKGROUND: Older people often do not adhere fully to antidepressant medication. Compliance Therapy improves adherence with antipsychotic medication. OBJECTIVE: To adapt Compliance Therapy for use in older depressed patients, to pilot this 'Concordance Therapy' for feasibility and acceptability and to gain preliminary indications of its efficacy. METHODS: Randomised controlled trial (RCT). SETTING: Psychiatric services for older people in North London and Essex. PARTICIPANTS: A total of 19 older depressed patients. INTERVENTION: 10 patients received Concordance Therapy over 3-4 sessions. CONTROL: 9 patients received treatment as usual. MAIN OUTCOME MEASURE: medication adherence at 1 month. SECONDARY OUTCOME MEASURES: medication adherence at 3 months; depression severity, beliefs about medication, quality of life at 1 and 3 months; patient feedback about the therapy. RESULTS: The therapy was acceptable to patients. INTERVENTION patients were more likely to take antidepressants, had a higher quality of life, had less depressive symptomatology and were less likely to be cases of depression at 1 month. Beliefs around antidepressants at 1 month were more positive in the intervention group but this was not the case for medication in general. LIMITATIONS: As a pilot, patient numbers were small and the findings did not reach statistical significance. Three patients (1 intervention, 2 control) were in hospital and therefore offered medication at follow-up. CONCLUSION: Concordance Therapy for older people prescribed antidepressants is acceptable and feasible and shows sufficient promise of efficacy to justify an adequately powered RCT.

Aged↗

PubMed2004

Medication non-adherence and asthma treatment cost.

PURPOSE OF REVIEW: The purpose of this review is to describe the impact of asthma treatment non-adherence on patients and the healthcare system, and to outline areas of responsibility towards improved adherence. RECENT FINDINGS: The average cost of healthcare expenses for each person in the United States in 2002 was 5440 US dollars. In that year, there were 800 million medical encounters. However, adherence research suggests that a significant portion of the healthcare advice and prescriptions dispensed in these encounters was wasted. The annual cost to the healthcare system caused by non-adherence has been estimated at 300 billion US dollars. The responsibility for improving adherence has usually been placed on the patient and healthcare provider. However, if non-adherence is to be more effectively addressed, other components of the healthcare and pharmaceutical industries must also take responsibility. SUMMARY: Treatment non-adherence compromises treatment effectiveness and drives up the healthcare costs related to asthma and other chronic conditions. Collaborative efforts to improve adherence to treatments for chronic illness, recently promoted by the World Health Organization, must include multiple components of the healthcare system, must recognize that the costs of adherence promotion are outweighed by cost savings after improved adherence, and must support research to develop new and better strategies for improving adherence.

Asthma↗

PubMed2004

Psychosocial factors associated with adherence to antiretroviral medications in a sample of HIV-positive African American drug users.

The purpose of the study was to investigate factors affecting antiretroviral adherence among African American drug users, specifically to identify associations between self-reported adherence levels and psychosocial measures selected with guidance from the Transactional Model of Stress and Coping (TMSC). The study was conducted using data collected from 137 HIV-positive African American drug users who were receiving antiretroviral medications at the time they were interviewed. Bivariate associations were investigated using correlational analyses and variables showing a significant correlation with adherence were entered into a multivariate regression model. The multivariate model showed only perceived efficacy of antiretrovirals and one measure of perceived barriers, simply forgetting to take medications, were independently related to adherence. These preliminary findings suggest that theoretical approaches to understanding antiretroviral adherence must address a range of variables, including but not limited to behavioural practices, cognitive appraisals, affective responses and social support. Further studies using the complete TMSC are recommended.

Adult↗

PubMed2004

The role of perceived control and preference for control in adherence to a chronic medical regimen.

BACKGROUND: Poor patient adherence is a widespread problem among patients undergoing hemodialysis for end-stage renal disease. PURPOSE: The goal of this study was to examine the joint role of perceived restriction of control and individual differences in preference for control in predicting adherence to the hemodialysis regimen. METHODS: Participants were 49 patients recruited from five hemodialysis centers affiliated with the University of Iowa Hospitals and Clinics. Preference for control in the health care context was assessed using the Preference for Information and Preference for Behavioral Involvement subscales of the Krantz Health Opinion Survey, and perceived control was assessed using six items written for this study. Adherence was assessed by examining patients' interdialysis session weight gains (IWG). RESULTS: Hierarchical regression analysis indicated that the interaction between preference for information and perceived control over dialysis context explained a significant proportion of variance in IWG values, change in R2 =.09, F(1, 43) = 5.26, p <.05, standardized beta = -.32. Among patients with lower levels of perceived control in the dialysis setting, a higher preference for information concerning one's own health care was associated with increasingly poorer adherence. IWG levels in these individuals reflected clinically problematic nonadherence with fluid-intake restrictions. Among patients with a higher level of perceived control, preference for information had little effect on adherence. No main or interactive effects were found involving differences in patients' preference for behavioral involvement in their own health care or for the items reflecting perceived control outside the dialysis treatment setting. CONCLUSIONS: These data suggest that assessing and examining the interactive effects of patients' preferences for control and perceived control may, in some cases, be useful in identifying those individuals at risk for difficulty in adhering to the complex behavioral restrictions associated with chronic medical regimens.

Attitude to Health↗

PubMed1993

The overestimation of adherence to pediatric medical regimens.

We evaluated the accuracy of primary health care providers' predictions of parents' adherence to their children's short-term antibiotic regimen and a scheduled follow-up appointment. Adherence predictions were compared with objective measures of the parents' adherence. Providers were poor predictors of nonadherence, greatly overestimating the percentage of parents who would be adherent. Nonadherence is typically addressed by applying adherence improvement strategies to all patients. Recent pediatric research, however, suggests that applying contingency-based interventions for adherent patients can result in later nonadherence if the strategies are withdrawn. Inaccurate predictions of adherence will result in many nonadherent patients not receiving a needed intervention. The results indicate the need for strong behavioral predictors that result in more accurate identification of patient nonadherence to guide further applications of adherence improvement strategies.

Anti-Bacterial Agents↗

PubMed2004

Psychological and cognitive function: predictors of adherence with cholesterol lowering treatment.

BACKGROUND: Failure to adhere to medication regimes is a significant problem in clinical and research settings yet reliable, consistent identification of key psychosocial predictors remains elusive. Studies of mood and personality related to adherence show mixed results-compliance and objectively measured cognitive function are intuitively related but empirical support is lacking. PURPOSE: This study is a secondary analysis to examine the relations between adherence with a medication regime for lowering serum cholesterol and several domains of psychological and cognitive functioning. METHODS: Participants in the initial study completed a measure of personality and a battery of neuropsychological measures at baseline; anxiety and depression were measured at baseline and at 4-week intervals. Medication adherence was tracked with electronic cap monitors for 24 weeks. RESULTS: Only 23% of the sample was fully adherent to medication regimes at least 80% of the time over the 6-month study period. Conscientiousness, according to the Five Factor Theory of Personality, and estimated IQ remained robust predictors of adherence in hierarchical regression analyses. Depression and anxiety, mental flexibility, and visuospatial-constructional ability were less robust but statistically significant (p <.05) correlates of adherence. CONCLUSIONS: Although results of this analysis explain only a portion of the variance in adherence, they demonstrate the importance of trait psychological and cognitive factors in adherence research.

Adult↗

PubMed2006

A comprehensive evaluation of survey questions for adherence to antiretroviral medications and exploratory analyses for identifying optimal sets of survey questions.

Although many methods for assessing adherence have been developed, most are not feasible for busy clinical settings. Using patients from the Adherence and Efficacy of Protease inhibitor Therapy (ADEPT) study (1998-2000), we systematically evaluated the relationship between psychosocial, environmental, clinical, and other factors with adherence to create composite variables (CVs) that are efficient with high sensitivity for detecting nonadherence and great potential for busy clinics. Eligible patients were protease inhibitor naïve or started a regimen within 3 months from baseline. Of the 128 patients who responded to survey at baseline, weeks 8, 24, and/or 48, mean (standard deviation [SD]) age was 39.3 (8.2) years with 81% male. About half of the patients were Latino, followed by 28% African American and 14% Caucasian. Sixteen percent reported injection drug use, and 40% had male-male sex. Mean CD4 count was 184.8 cells/mm(3) with a range from 1 to 1130 cells/mm(3). Thirty-two variables had a significant association with adherence at one or two time points and 9 were significantly associated with adherence over time. Among these significant factors, 8 also had a relationship with a clearly monotonic trend, by which 219 CVs were formed. Among these CVs, 8 were significantly associated with adherence and had a relationship with monotonic trend. Compared to traditional self-reported adherence, CVs had much higher sensitivities (p < 0.001) for detecting nonadherence. We conclude that CVs consisting of a combination of psychological, behavior, and adherence questions may be reasonable substitutes for direct adherence questions, which are limited by problems with recall and social biases. Trust in physicians, having a child, history of substance use, CD4 count, and belief that antiretrovirals can help living longer or improve quality of life can efficiently predict nonadherence. Because these variables are readily obtainable in clinical settings, these selected questions may provide a clinically useful means of screening patients for antiretroviral medication nonadherence.

Adult↗

PubMed2005

Beliefs about antidepressant medications in primary care patients: relationship to self-reported adherence.

BACKGROUND: Adherence to medication is unacceptably low in both medical and psychiatric disorders. Explanatory models of illness beliefs and behaviors suggest that an individual's beliefs about a disorder and its treatment will influence their adherence. Given that beliefs about medications may influence adherence to antidepressants, we examined beliefs about medications in relation to antidepressant adherence in a primary care sample. OBJECTIVE: The purpose of this report is to 1) describe beliefs about medication in primary care patients prescribed antidepressants for depression; 2) examine the factor structure of the Beliefs about Medicines Questionnaire (BMQ) and compare it with the previously reported factor structure of the BMQ in medical conditions; and 3) examine the association of medication beliefs with self-reported medication adherence. RESULTS: Factor analysis indicates that the BMQ is valid in a sample of primary care patients receiving treatment for depression and has a similar factor structure to that obtained in samples of patients with chronic medical conditions. Beliefs about medications are significantly associated with self-reported adherence. Severity of depressive symptoms and specific concerns about antidepressants are significantly associated with self-reported medication-taking behavior. Findings suggest that in addition to telling patients how to take their medications, primary care physicians should also educate patients about the short- and long-term effects of the medication, how the medication works, and that antidepressants are not addictive.

Antidepressive Agents↗