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At least 973 records · Page 54Linked to original sources
PubMed1993

The role of the practice nurse in the management of depression in general practice: treatment adherence to antidepressant medication.

This pilot study demonstrated the feasibility of providing practice nurse support as an adjunct to standard general practitioner treatment to patients with depressive disorders prescribed antidepressant medication. With respect to the measures used and pilot study objectives identified, there were no statistically significant differences between the study groups in treatment adherence to the prescription of antidepressant medication or in the incidence and severity of adverse events to medication. Large-scale randomized controlled trials are in progress to assess the effectiveness of practice nurse interventions in the management of depressive illness in general practice.

Adult↗
PubMed1984

Characteristics and outcome of medical nonadherers in the Veterans Administration Cooperative Study of Coronary Artery Surgery.

During a 7-year follow-up period in the Veterans Administration Study of Bypass Surgery, 75 (24%) of 311 medically assigned patients without left main disease "crossed over" to surgical treatment. Nineteen baseline, clinical, electrocardiographic and angiographic characteristics of the 75 crossover patients were compared with those of the 236 patients who adhered to medical treatment. At entry into the study, the crossover group contained more patients with severe angina than did the medical adherers group (p less than 0.05) and fewer patients with electrocardiographic evidence of previous myocardial infarction (p less than 0.05). Other entry characteristics were similar in distribution among those in the medical-adherer and crossover groups. The 2 major reasons for crossover were persistence or progression of angina, which occurred in 43 and 37% of the 75 crossover patients, respectively. There was no relation between progression of symptoms and angiographic progression of coronary narrowing. Thus, crossover was not determined by more severe coronary narrowing, but was associated with more severe symptoms and a lower incidence of infarction. The medically randomized patients who later underwent surgery (medical "nonadherers") experienced the same relief of angina 1 year after surgery as did the surgically randomized patients who initially received surgery (surgical "adherers"); however, their overall 7-year survival was lower (77% for medical nonadherers vs 83% for surgical adherers; difference not significant).

Clinical Trials as Topic↗
PubMed1984

Behavioral aspects of the use of medical markers in clinical trials.

Nonadherence by trial participants to the study drug regimen threatens the satisfactory conduct of the best designed clinical trial. Reduced adherence confounds the interpretation of the study's results and may leave the study's primary question unanswered. Recent reports from multicenter clinical trials have reported adherence rates of 60%-90%. This presentation examines the use of a drug marker in counseling to improve participant adherence to a medication regimen. Potential benefits and problems are identified, and several recommendations are offered. Increasingly, behavioral counseling has been used by clinic staff members to improve the medication adherence of trial participants. Behavioral counseling is a data-based counseling process emphasizing patient collaboration with the clinician in identifying, diagnosing, and intervening in medication adherence problems. A valid, accurate drug marker would have direct application in both identifying and intervening on a medication adherence problem. However, a marker would not contribute substantially to the clinician's ability to diagnose accurately the nature of the medication adherence problem. A major concern is the manner in which the clinician introduces the drug marker into the counseling process. The use of data from a drug marker can have a strong positive or negative effect on the medication adherence problem. It also can significantly influence the continuing relationship between the clinician and the participant. Examples are presented. It is strongly recommended that the clinician identify the specific goals for the marker's use prior to the introduction of data from a medical marker into the participant counseling process. Further, the manner in which the marker is introduced into the interview with the participant must be considered carefully.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗
PubMed1988

Compliance in epilepsy. Strategies to enhance adherence to a medical regimen.

Treatment of medical disorders and prevention of disease are hampered by the all too frequent lack of adherence with the prescribed regimen. Delivery of health care to a broad-based population at reasonable cost and with high quality can be enhanced by use of multiple strategies to aid compliance. No single technique is best for all patients. Education, dose planning, appointment scheduling and monitoring coupled with communication between patient and physician or staff are basic strategies for development of immediate and long-term adherence behavior.

Anticonvulsants↗
PubMedDate not supplied

[Compliance in schizophrenia: predictive factors, therapeutical considerations and research implications].

Compliance has been defined as the extent to which a person's behavior coincides with the medical advice given. Medication compliance is one of the foremost problems affecting neuroleptic efficacy in psychiatric patients. Since chlorpromazine introduction in 1952, antipsychotics are the principal element of schizophrenia treatment. Actually progress links to the use of new antipsychotics are conditioned by quality of compliance. The problem of nonadherence to medication could concern 50% of prescription. The reported incidence of non-compliance with antipsychotic medication ranges from 11 to 80%. In a two thirds of case rehospitalization is the result of complete or partial noncompliance. After one year of first hospitalisation, 40% of relapse results from non adherence to medication. Medication adherence problems increase hospitalisation, morbidity and mortality. Social consequences, professional problems and family troubles linked to hospitalisations lead to low quality of life for patients and high cost for society. There are three main methods of measuring compliance. These include patient and clinical self-report, pill counts, and biological measures. Self-report methods are generally the most cost-effective and time-efficient way of obtaining an indication of compliance. In psychiatric research, the most commonly used self-report measure of compliance is the Drug Attitude Inventory (DAI) originally devised by Hogan et al. On the basis of criticism concerning DAI reliability, a new questionnaire of medication compliance was proposed: the Medication Adherence Rating scale (MARS). The main goal of compliance evaluation is to quantify this phenomenon with accuracy and to find predictive factors of medication nonadherence. Three types of factors influencing compliance are identified: factors due to medications, factors linked to patients and factors depending on the therapeutic relation with the clinician. Tolerance is considered as the principal reason explaining a bad compliance. Neurologic, endocrine and anticholinergic side-effects are the first fact of treatment stop. Medication prescription complexity is although important to take under consideration. Some psychotic's symptoms, comorbid addictive behavior, poor insight are mentioned in the case of noncompliance. Some effective actions to improve compliance are described. Information and communication with the patient, simplification of therapeutic plan, consultation planning and account of side effect are simple and effective actions. Social support is very important for improvement of compliance. The communication attitude of the clinician, therapeutic relation and prescription use are main points of compliance. Compared to a conventional care, psychoeducational programmes of compliance show their superiority. More research on compliance evaluation is needed. Information and tools must be proposed to practitioners.

Antipsychotic Agents↗
PubMed1985

Management of adherence to prescribed medication.

Nonadherence is a major problem for long-term use of drugs affecting lipid metabolism. Effective programs for comprehensive management of adherence are available. Their administration and operation can be readily integrated within the usual operations of both large and small clinical trials. The programs are subject to quality control and, hence, can be administered effectively. The cost of a comprehensive adherence program is approximately 10% of the conventional cost of clinical trials, varies according to the nature and number of adherence tests, and is probably totally recovered through resultant economies. All of the elements of the adherence program can be adapted to private practice. The relative risks of nonadherence to drugs affecting lipid metabolism are estimated from analyses of four regimen characteristics.

Clinical Trials as Topic↗
PubMed2005

Adherence and perception of medication in patients with chronic heart failure during a five-year randomised trial.

OBJECTIVE: Many patients with chronic heart failure (CHF) are thought to be non-adherent to their prescribed medications. The objective was to describe perceptions about and adherence to regular medicines and study medication at baseline and study end in CHF patients participating in a clinical trial. METHODS: In the carvedilol or metoprolol European trial (COMET), patients (N = 3029) with CHF were randomised and followed during a 58-month period. Patients at some Swedish centres answered a questionnaire at baseline and study end concerning their perception of their regular heart medication and study medication. Adherence was established through estimation of drug usage. RESULTS: In the Swedish sub-study, 302 patients responded once to the questionnaire while 107 patients responded both at baseline and at follow-up. At baseline, 94% of the patients stated that they believed that the study medication would make them feel better and 82% believed that their regular heart medication would do so. During the study, patients' belief in their regular cardiac medication significantly increased. Lack of belief in medication at the start of the study was a strong predictor of withdrawal from the trial (64% versus 6.8%; p < 0.0001). Those patients with very poor well-being and limited functional ability (classified as NYHA III-IV) at baseline significantly (p = 0.01) increased their belief in the regular cardiac medication but not in their study medication. CONCLUSION: Belief in medication may be related to how the patient experiences the medication's impact on functional ability, symptoms and well-being. PRACTICE IMPLICATIONS: Early identification of patients' beliefs about medication seem to be an important factor in counselling and information to patients with CHF.

Activities of Daily Living↗
PubMed2003

Impact of a patient education program on adherence to HIV medication: a randomized clinical trial.

Patients' knowledge of their HIV condition and its treatment, which has been recognized as a factor that influences adherence to antiretroviral therapy, can be improved through educational programs. This prospective, randomized, controlled trial compared an experimental group that participated in an educational program and a control group with standard care. The study evaluated the impact of an educational intervention on adherence to antiretroviral therapy, patients' knowledge, quality of life, and therapeutic response in patients treated with highly active antiretroviral therapy. Three hundred twenty-six patients were analyzed at inclusion. A higher level of adherence was associated with patients who were older, had higher incomes, and did not smoke. CD4 cell count and plasma viral load were correlated with adherence at entry. The educational intervention had an impact on adherence and knowledge in the experimental group at 6 months, which was maintained at 12 and 18 months. A delayed increase in adherence was observed in the control group at 12 months. No significant impact on quality of life was observed over time. The patients' health status improved in 56% of the experimental group subjects and 50% of the control subjects. However, no significant impact was shown on CD4 cell count and plasma viral load. This study shows that an educational intervention improves adherence to antiretroviral regimens and health status and suggests that it should be initiated early in therapy.

Adult↗
PubMed2005

Strategies for improving adherence to second-generation antipsychotics in patients with schizophrenia by increasing ease of use.

Despite the advances in the treatment of patients with schizophrenia that have occurred since the introduction of the second-generation (atypical) antipsychotic agents, a leading cause of suboptimal outcome is poor patient adherence to oral medication. Partial adherence can be attributed to a number of factors, including lack of insight, cognitive dysfunction, a complicated treatment regimen, drug-related side effects, patient attitude, lack of patient education, and cultural factors. A number of strategies, including psychosocial interventions, cognitive-behavioral techniques, strategies that minimize side effects, and pharmacological approaches that increase ease of medication use, can be employed to support adherence and improve long-term outcomes. This article focuses on strategies for increasing ease of use of antipsychotics in the treatment of patients with schizophrenia. These strategies include using monotherapy rather than polypharmacy, simplifying the medication regimen, and using a long-acting antipsychotic formulation. The goal of these strategies is to improve adherence and help prevent relapse by ensuring continuous antipsychotic coverage. Strategies that optimize ease of use of medication treatment for schizophrenia and thus improve adherence to treatment are likely to promote the attainment of new treatment goals and improved patient outcomes.

Antipsychotic Agents↗
PubMed1991

Medication regimen complexity and adherence among older adults.

Two studies were conducted to examine the relationship between medication regimen complexity and adherence among older adults recently discharged from hospitals (N = 178) and those not recently hospitalized (N = 98). Medication regimen complexity was measured by the Medication Complexity Index (Kelley, 1988), which measures the number, frequency, and types of actions required to enact a medication regimen. Adherence to the regimen was measured by pill count and verbal self-report. The negative correlations between regimen complexity and adherence were in the predicted direction but did not achieve statistical significance. Medication regimen complexity may have a larger impact on aspects of medication management other than adherence to the prescriptive regimen.

Aged↗
PubMedDate not supplied

Relationship of emotional intelligence and adherence to combination antiretroviral medications by individuals living with HIV disease.

Medications are an intentional and purposeful means to the successful management of many chronic diseases. In the treatment of disease caused by HIV, adherence to medication is of particular concern because any level of nonadherence, often a few missed doses, will lead eventually to the development of drug resistance. Many predictors of poor adherence to HIV medications have been identified as significant factors in adherence. Among these is the emotional aspect. The purpose of this study was to examine emotional intelligence (EI) and adherence to combination antiretroviral therapy in individuals who are infected with HIV. EI is defined as the ability to perceive and express emotions, facilitate emotions, understand and reason with emotion, and manage emotions. EI has been correlated with various aspects of success in life. In this study, EI was measured by the Mayer, Salovey, Caruso Emotional Intelligence Test. Adherence to medications was measured by self-report and defined as less than 10% missed doses of medications. Eighty-two participants were recruited from an urban hospital-based HIV clinic. Pearson's r was used to analyze the data for significance, and no correlation was reported. This data set was not large enough to prove significance, statistically, of the research question. However, an unexpected result of this study was that the overall EI scores for this particular population were markedly lower than the test norms. Further study would be warranted and recommended to explore El measurement in people at risk for HIV disease or in those who have the disease to further understand the impact of emotions and EI in this specific population.

Adult↗
PubMed2002

[Which collateral effects influence in the adherence with antipsychotic medication?].

The collateral effects of antipsychotic medication, specially the mental aspects of extrapyramidal symptoms, sexual disorders and weight gain, constitute an important cause of lack of adherence to treatment. The common characteristic to all these effects is that they produce a high subjective distress. This is more related to the capacity to generate suffering to the patient than to the objective severity of a collateral effect. In this paper these collateral effects are revised. The conclusion is that, in spite of the fact that new antipsychotics show an improvement with regard to their collateral effects profile, these drugs include a new profile of distressing effects that must be evaluated and corrected, as a way to optimize the patient's adherence to antipsychotic treatment.

Antipsychotic Agents↗
PubMed2004

Adherence with antidepressant medication.

Nonadherence with antidepressant medications is a well-documented factor in treatment failure. This article uses the literature to build a collaborative counseling model to increase antidepressant adherence. Studies may be warranted to determine whether specific antidepressants, when used as part of a collaborative strategy, can improve long-term adherence rates.

Antidepressive Agents↗
PubMed2006

Symptom perception and adherence to asthma controller medications.

PURPOSE: To explore asthma symptom perception and the relationship between asthma symptom perception and adherence to asthma treatment. DESIGN: Adult patients (N=120) of asthma/allergy specialty clinics, taking Advair as a controller medication, were enrolled in this cross-sectional descriptive study. METHODS: Ninety-seven participants completed 4 weeks of daily diaries to assess subjective symptom perception and measured peak expiratory flow rates (PEFR), both done twice daily. Individual perceptual accuracy scores (PAS) were determined by correlating the subjective symptom perception scores with the PEFRs. Measures included demographic variables, illness identity (personal control and treatment control, consequences, and timeline-cyclical subscales of the IPQ-R), asthma severity (FEV1 percentage) and a single-item indicator of perceived asthma severity. Adherence was measured by the Medication Adherence Report Scale (MARS) and by an Advair dose count (percentage of doses taken as prescribed). FINDINGS: Independent t tests comparing adherence rates of good versus poor perceivers were not significant, using either the percentage Advair dose count or the MARS. Multiple regression analyses showed that years with asthma, illness identity, and peak flow variability were all significant explanatory variables for perceptual accuracy. CONCLUSION: Peak flow variability adds complexity to the relationship between perceptual accuracy and adherence that warrants further investigation.

Adaptation, Psychological↗
PubMedDate not supplied

Non-adherence to HIV antiretroviral medications: 'The drugs are working and I'm a continuing success story'.

Non-adherence to antiretroviral (ARV) regimens has been associated with HIV drug resistance. Anecdotal evidence in our client group, people living with HIV/AIDS infection in Central Sydney Area Health Service (CSAHS), suggested that non-adherence was an issue. Eighty three participants completed an anonymous questionnaire; with a 98% response rate. The mean age of respondents was 44 years with 68% over age 40 years. 68% of respondents missed doses of ARV, 54% because they forgot. 54% stated they did not report the non-adherence to their doctor. They were more likely to miss the lunch time dosage (n=49, p<0.05). The results demonstrate that non-adherence with medications is a significant issue and further research into strategies for interventions to aid adherence is required.

Adult↗
PubMed2005

Secondary prevention of coronary heart disease: patient beliefs and health-related behaviour.

OBJECTIVE: Coronary heart disease (CHD) is a leading cause of illness and death in Western society. The present study was designed to evaluate the utility of illness perceptions and medication beliefs in predicting secondary preventive behaviour among patients with CHD. An extended version of Leventhal's self-regulatory model (SRM) was used as a theoretical framework for this study [Leventhal H, Nerenz DR, Steele DJ. Illness perceptions and coping with health threat. In: Baum A, Taylor SE, Singer JE, editors. Handbook of psychology and health, Volume IV: social psychological aspects of health. Hillsdale (NJ): Erlbaum, 1984. pp. 219-52; Horne R, Weinman J. Self-regulation and self-management in asthma: exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication. Psychol Health 2002;17(1):17-32]. METHOD: Medical and demographic data were gathered from the medical charts of 1611 patients with established CHD from 35 randomly selected general practices. Self-report data about patients' lifestyles (diet, exercise, smoking, alcohol consumption and medication adherence) and information on illness and medication beliefs were provided from postal questionnaire (1084 patients responded; 69% response rate). The relationship between patients' beliefs and their secondary preventive behaviour was examined using regression analyses. RESULTS: Illness perceptions appeared to be only weak predictors of smoking, exercise, diet, alcohol consumption and medication adherence, accounting for about 2% of the variance in these behaviours. Medication beliefs were moderately related to medication adherence, accounting for about 7% of the variance in scores. A strong belief in the necessity of one's medication and a lower level of concern about one's medication were associated with higher levels of adherence. CONCLUSIONS: An illness perception approach did not prove helpful in predicting secondary preventive behaviour among this group of patients. However, beliefs about medications appear to be reasonable predictive of medication adherence.

Aged↗
PubMed2005

Rates and predictors of adherence with atypical antipsychotic medication: a follow-up study of adolescent inpatients.

BACKGROUND: The use of atypical antipsychotics is increasing in adolescent populations, but little is known about adherence with these treatments. This study examined postdischarge adherence of adolescents treated as inpatients with either olanzapine or risperidone. METHODS: Eighty-six (86) adolescent inpatients (43 per treatment) were contacted an average of 10 months (range, 90 days to 18 months) after discharge from the hospital. A structured interview examined compliance, side effects, and subjective impressions regarding the efficacy of treatment. Clinical symptoms rated by clinicians, self-reports from patients, hospital chart diagnosis, treatment group (risperidone/olanzapine), and demographic factors were used to predict compliance, as were the occurrence of side effects and subjective impressions of the efficacy of treatment. RESULTS: Forty-five percent (45%) of the patients were adherent with their medications, while only 12% discontinued treatment on their own, and 43% stopped medication at the request of their parent or a physician. Medication status and symptom severity did not predict nonadherence, and the only diagnosis related to adherence was substance abuse. The only side effect that predicted nonadherence was rapid weight gain during the hospitalization; this was slightly more common in olanzapine-treated patients. Nonadherent patients' subjective impressions of efficacy were no different from the patients who continued their medications, but the patients who stopped medication on their own were more likely to also have failed to attend recommended psychotherapy as well. IMPLICATIONS: Failure to continue recommended treatment with atypical antipsychotics was most common in cases who did not comply with other aspects of the discharge plan. Efficacy of the medication did not predict nonadherence, as half of the noncompliant subjects stated that the medication had been helpful. Rapid weight gain also predicted nonadherence, but subjective impression of long-term weight gain was not different across adherence or treatment status. These data tentatively suggest that in adolescent patients, tendencies toward general uncooperativeness and substance abuse may be at least as important as the occurrence of common side effects in the determination of medication adherence.

Adolescent↗