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Results for “Medication Adherence”

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PubMed2005

Sleep disturbance and depression as barriers to adherence.

This study examined the relationships among subjective sleep disturbance, depressive symptoms, and adherence to medications among HIV-infected women. HIV-infected women (N = 173) were recruited through community AIDS service organizations throughout South Carolina. Participants completed the Pittsburgh Sleep Quality Index (PSQI), the Centers for Epidemiological Studies Depression Scale (CES-D), and a modified version of the Adults AIDS Clinical Trials Group Adherence Baseline Questionnaire. Women who reported greater sleep disturbance also reported a higher level of depressive symptoms and reported poor adherence to their medication regimen. Depression helped to explain the relationship between sleep quality and adherence. Results indicate that assessment and management of sleep disturbance and depressive symptoms in women with HIV disease is important to promote medication adherence.

Adolescent↗

PubMed2006

Predictors of rate and time to remission in first-episode psychosis: a two-year outcome study.

BACKGROUND: The evidence regarding the independent influence of duration of untreated psychosis (DUP) on rate and time to remission is far from unequivocal. The goal of the current study was to examine the role of predictors for rate and time to remission in first-episode psychosis (FEP). METHOD: The differential effect of age, gender, age of onset, duration of untreated psychosis (DUP), duration of untreated illness (DUI), pre-morbid adjustment, co-morbid diagnosis of substance abuse and adherence to medication on the rate of and time to remission were estimated using a logistic and Poisson regression, and survival analysis respectively, in FEP patients. RESULTS: In a sample of 107 FEP patients 82.2% achieved remission over a period of 2 years after a mean of 10.3 weeks (range 1-72). Regression analysis, based on complete data on all variables of interest (n=80), showed status of remission to be positively influenced by better pre-morbid adjustment (RR 0.57, 95% CI 0.34-0.95, p<0.05), later age of onset (RR 1.09, 95% CI 1.05-1.13, p<0.0001), higher level of adherence to medication (RR 1.96, 95% CI 1.38-2.76, p<0.001) and shorter DUI (RR 0.99, 95% CI 0.997-0.999, p<0.005). Time to remission was influenced by age of onset (HR 1.04, 95% CI 1.00-1.08, p<0.04) and adherence to medication (HR 1.58, 95% CI 1.11-2.23, p<0.01). CONCLUSIONS: Improving adherence to medication early in the course of treatment may be an important intervention to improve short-term outcome.

Adolescent↗

PubMed2003

Do clinicians understand why individuals stop taking lithium?

BACKGROUND: Previous research highlights that, over a 2-year period, up to 50% of individuals receiving lithium prophylaxis are non-adherent with medication against medical advice. The main reasons identified by clinicians only partially reflect the reasons given by patients. METHODS: Seventy-two subjects who were identified from biochemistry laboratory data as receiving lithium for an affective disorder and who gave written informed consent, completed the 'Reasons for Stopping Medication' questionnaire. Forty-one clinicians involved in treating these 72 patients also completed the same questionnaire. Ratings on the 'Reasons for Stopping Medication' questionnaire were compared between adherent and non-adherent patients and between patients and their clinicians. RESULTS: Adherent (n=39) and previously non-adherent patients (n=33) showed a high level of concordance in their rank ordering of reasons for considering stopping taking lithium (Kendall's W=0.059; P=0.001), with 'bothered by the idea that moods were controlled by medication', 'bothered by the idea of a chronic illness' and 'felt depressed' being the most commonly endorsed items. Clinicians and patients views showed low levels of concordance (Kendall's W=0.019; P=0.32). Clinicians identified 'missing highs', and 'felt well, saw no need to take medication' as the most likely reasons for non-adherence. The differences in the primary reasons for stopping lithium identified by clinicians and patients were statistically significant (chi(2)=61.1; df 40, P=0.005). CONCLUSIONS: Patients' reasons for stopping lithium appear to be influenced by concerns about what having an affective disorder and taking medication says about them. Clinicians are not fully aware of the main reasons patients would stop prophylactic treatment.

Adult↗

PubMed2002

Predictors of risk of nonadherence in outpatients with schizophrenia and other psychotic disorders.

We investigated the course of adherence to medication recommendations in 162 patients with psychotic disorders in ambulatory treatment. Data were collected using the clinic's outcome assessment program, maximizing the generalizability of the study. Patients initially adherent to their medication regimens maintained their adherence for an average of 13.3 months. Patients initially nonadherent developed adherence after an average of 5.6 months of treatment. Demographic factors and illness history were unrelated to adherence. This study replicated previous findings of the concurrent association between adherence and global functioning level, substance use, and working alliance with therapist. Cox regression analyses revealed that working alliance, global functioning, and being prescribed clozapine predicted longer maintenance of adherence. Working alliance was the most significant and consistent predictor of adherence to medication recommendations.

Adolescent↗

PubMed2002

Symptoms, cognition, treatment adherence and functional outcome in first-episode psychosis.

BACKGROUND: The differential strength of correlation between symptoms, cognition and other patient characteristics with community functioning in first-episode psychosis has not been fully investigated. METHOD: In a sample of 66 first-episode psychosis patients demographic variables, ratings of pre-morbid adjustment, positive and negative symptoms, duration of untreated psychosis (DUP) and assessment of cognitive functions at baseline, and symptoms, cognitive functions and adherence to medication 1 year, were correlated with scores on social relations and activities of daily living (ADL) (outcome) at 1 year. Hierarchical regression analysis was used to confirm the independent contribution of baseline and concurrent variables to functional outcome at 1 year. RESULTS: Scores on functioning related to social relations and ADL were both significantly correlated with pre-morbid adjustment, all dimensions of residual positive and negative symptoms and adherence to medication at 1 year. Scores on social relations were also modestly correlated with DUP and several cognitive measures at baseline and 1 year (verbal IQ, attention, visual memory, word fluency and working memory). Hierarchical regression confirmed independent contribution of pre-morbid adjustment, total residual symptoms and adherence to medication at 1 year for both dimensions of outcome, and psychomotor poverty and working memory for social relations. CONCLUSIONS: In addition to pre-morbid adjustment potentially malleable variables such as level of residual (but not acute) symptoms, adherence to medication and cognitive deficits are likely to influence outcome on aspects of community functioning in individuals treated for first episode of psychosis.

Activities of Daily Living↗

PubMed1999

Interactive risk factors for treatment adherence in a chronic psychotic disorders population.

This study identified the unique and primary contributions of several concurrent risk factors for poor adherence to treatment recommendations in a clinic population of individuals with chronic psychotic disorders, i.e. 48% had DSM-IV diagnoses of schizoaffective disorder, 38% had schizophrenia, paranoid type, 12% had schizophrenia, undifferentiated type, and 2% had affective disorder with psychotic features. The target cohort consisted of 87 consecutive admissions to a continuing day treatment program. As part of a services-oriented quality assurance program, clinical staff completed rating scales for all patients. These included the BASIS-32 rating scale, which consisted of the following five subscales: psychosis; depression/anxiety; impulsive/addictive behavior; relation to self and others; and daily living and role functioning, and the Working Alliance Inventory-short form (therapist version), which consisted of the following three subscales: goal; task; and bond. These data were used to identify risk factors that weaken a patient's adherence to medication and non-medication treatment during the first 2 weeks of treatment in the clinic. Medication treatment consisted of both typical and atypical neuroleptic medications, with most patients being on multiple medications. Correlational analyses suggested that many of the risk factor variables were significantly associated with poor treatment adherence. Regression analyses suggested that the degree of psychoticism was most strongly associated with poor adherence to medication treatment and that difficulties relating to self and others were the strongest predictor of poor adherence to non-medication treatment. A large-sample services research design such as this can begin to determine patterns of associations between previous identified risk factors and poor treatment adherence in individuals with chronic psychotic disorders.

Adult↗

PubMed2001

Self-reported symptoms and medication side effects influence adherence to highly active antiretroviral therapy in persons with HIV infection.

OBJECTIVES: To identify variables predictive of nonadherence to highly active antiretroviral therapy (HAART) and to assess whether self-reported symptoms or medication side effects are related to adherence. DESIGN: Cross-sectional multicenter study Adherence Italian Cohort Naive Antiretrovirals [AdICONA] within the Italian Cohort Naive Antiretrovirals (ICONA). METHODS: Participants receiving HAART completed a 16-item self-administered questionnaire to assess nonadherence in the last 3 days as well as the type and intensity of 24 common HIV- and HAART-related symptoms experienced during the last 4 weeks. RESULTS: From May 1999 to March 2000, 358 persons were enrolled: 22% reported nonadherence and were less likely to have HIV RNA <500 copies/ml (odds ratio = 0.51; 95% confidence interval: 0.31-0.85). Frequency of moderate/severe symptoms or medication side effects in nonadherent participants ranged from 3.6% to 30%. On univariate analysis, nausea, anxiety, confusion, vision problems, anorexia, insomnia, taste perversion, and abnormal fat distribution were significantly associated with nonadherence. Nonadherent persons had a higher mean overall symptom score (12.3 +/- 9.2 versus 8.1 +/- 6.6; p <.001) and mean medication side effect score (2.9 +/- 2.7 versus 1.9 +/- 1.9; p <.001) when compared with adherent participants. In the multivariate analysis, nausea ( p =.003); anxiety ( p =.006); younger age ( p =.007); unemployment ( p <.001); not recalling name, color, and timing of drugs ( p =.009); running out of pills between visits ( p =.002); and being too busy ( p =.03) were independently associated with nonadherence in the last 3 days. CONCLUSIONS: In addition to patient characteristics, medication-related variables, and reasons for nonadherence, patient-reported symptoms and medication side effects were significantly associated with adherence to HAART.

Adult↗

PubMed2004

The impact of psychiatric symptoms, drug use, and medication regimen on non-adherence to HIV treatment.

Identifying which mental disorders, substance use, and regimen factors influence non-adherence is a critical step in developing patient-customized interventions. In this cross-sectional study, 120 adults with HIV taking antiviral therapy completed interviews and questionnaires on their medication regimen, adherence behaviours, mental distress, and substance use patterns. They provided access to medical records for measures of immune health. Demographic characteristics, regimen factors, mental health indicators, and substance use variables were evaluated as predictors of four dichotomous non-adherent behaviours: running out of medications, not always taking medications as directed, taking below 95% of protease inhibitor doses, or having notations of non-compliance in the medical record. Non-adherence was prevalent and was related to immune health. Recent crack cocaine use was a risk factor for both taking a low proportion of PI medication and charted non-compliance notations. Heroin use and screening positive for social phobia were risk factors for running out of medication. Screening positive for any anxiety disorder reduced the risk of failing to take medications as directed. Clinicians caring for patients with HIV should screen for non-adherence using multiple behavioural indicators, and assess and treat substance use and anxiety disorders to reduce the risk of non-adherence.

Antiviral Agents↗

PubMed2006

Multifactorial approach and adherence to prescribed oral medications in patients with type 2 diabetes.

The aims of this study were to assess adherence to oral hypoglycaemic/cardiovascular drugs and determine non-adherence predictors in type 2 diabetes patients. It was designed as a population-based cross-sectional study in which 90 patients from a primary care setting were studied. Pill count and self-report methods were used to measure adherence. Logistic regression analysis was performed to predict factors related to non-adherence. Adequate adherence to all drugs was found in 29 patients (35.4%; 95% confidence interval (CI) 25.0-45.7). Variables associated with non-adherence were HbA1c odds ratio (OR) 2.32 (95% CI: 1.09-4.95), systolic blood pressure OR 1.68 (95% CI: 1.08-2.62), total cholesterol OR 1.34 (95% CI: 1.08-1.66), number of pills OR 1.80 (95% CI: 1.26-2.55) and duration of disease OR 0.44 (CI 95%: 0.24-0.83). In conclusion, one in three patients had adequate adherence. Factors associated with non-adherence were duration of disease, complexity of drug regimen and inadequate control of cardiovascular risk factors.

Administration, Oral↗

PubMed2005

Attitudes toward antipsychotic medication: the impact of clinical variables and relationships with health professionals.

CONTEXT: Nonadherence to antipsychotic medication is a major cause of psychotic relapse and is strongly influenced by attitudes toward treatment. Although patient variables such as insight and symptoms that contribute toward attitudes have been identified, the contributions of relationship and service factors have not been adequately studied. OBJECTIVE: To determine relations between clinical and service variables and attitudes toward medication in people with a diagnosis of schizophrenia and schizoaffective disorder. DESIGN: Consecutively admitted patients were approached to take part; 23 refused. Measures included symptoms, insight, drug adverse effects, self-reported adherence, attitudes toward treatment, perceived relationship with the prescriber, ward atmosphere, and admission experience. Data were analyzed by a proportional odds model and structural equation modeling to test predicted paths between experience of admission, relationship variables, attitudes toward treatment, and self-reported adherence to medication. SETTING: Twenty-eight inpatient wards at 8 hospitals in North Wales and the Northwest of England. Sites included hospitals with inner-city and rural catchment areas. Patients Two hundred twenty-eight patients meeting DSM-IV criteria for schizophrenia or schizoaffective disorder, assessed during acute admission. MAIN OUTCOME MEASURES: Attitudes toward treatment and self-reported adherence to medication. RESULTS: The data fit a model in which attitudes toward treatment were predicted by insight, relationship with staff (especially the physician-prescriber), and the patient's admission experience (maximum likelihood chi(2)(49) = 89.3, P<.001). A poor relationship with the prescriber, experience of coercion during admission, and low insight predicted a negative attitude toward treatment. CONCLUSIONS: The quality of relationships with clinicians during acute admission appears to be an important determinant of patients' attitudes toward treatment and adherence to medication. Enhancing such relationships may yield important clinical benefits.

Adolescent↗

PubMed1992

Adherence to cancer regimens: implications for treating the older patient.

Cancer presents unique challenges to the clinician who hopes to achieve patient adherence to medical recommendations. Preventive and treatment regimens, particularly those that involve lifestyle change, are often extremely difficult to carry out (eg, smoking cessation; following a low fat diet). Although research suggests that there is no clearcut relationship between a patient's age and his or her degree of adherence to medical treatment, older patients may have more difficulties than younger persons in understanding precisely the medical recommendations made to them and tend to be more passive recipients of care. The authors describe six factors that significantly affect adherence and clinical changes that are likely to be effective in enhancing the adherence behavior of older patients with cancer. Measurement of patient adherence in the Medical Outcomes Study is described. This paper also examines the difficulties and pressures faced by medical professionals in enhancing the adherence of their patients.

Adolescent↗

PubMed2004

Assessment of impact of medication counseling on patients' medication knowledge and compliance in an outpatient clinic in South India.

The primary aim of this study was to assess the impact of patient medication counseling by comparing the levels of patient's medication knowledge and adherence achieved by medication counseling in an outpatient clinic. Ninety patients were randomized in the ratio of 1:2 into either counseled or usual care group. Their medication knowledge was assessed by a questionnaire and adherence was assessed by pill count method and self-assessment by the patients. Their medication knowledge was assessed at baseline and during their subsequent appointments. The average medication knowledge score of the counseled group versus usual care group was 13.82+/-1.8064 and 11.78+/-3.5037. Compliance score of the patients during their follow-up period was 92.29+/-4.5 and 84.71+/-11.80 for the counseled and control group, respectively. Statistical analysis of medication knowledge was carried out and all the demographic characters and number of medication were individually correlated with medication knowledge score and the difference observed was statistically significant. Compliance score of the patients was 92.29+/-4.5 and 84.71+/-11.8 % for the counseled and usual care group, respectively.

Adult↗

PubMed1995

Factors associated with noncompliance of patients taking antihypertensive medications.

Poor adherence to drug therapy decreases the effectiveness of antihypertensive treatment. Patients must take more than 80% of their antihypertensive drugs to maintain adequate blood pressure control. To understand the incidence of noncompliance and contributing factors, a pilot study was conducted in which a questionnaire was devised and administered to a random sample of 243 hypertensive patients of the adult ambulatory care clinic at Methodist Hospital of Indiana. Ninety-eight patients completed the telephone survey. Demographic data were obtained through chart reviews. The results indicated that 30-46% of the patients were noncompliant with their antihypertensive drug regimens. Factors found to be associated with noncompliance were; employment (P = .0077), use of home remedies (P = .0043), age (P = .0165), experience of side effects (P = .0051), level of concern with missed doses (P = .0043), and cost (P = .014). The incidence of noncompliance in this pilot sample is lower than the estimated 50% noncompliance rate of published data. More research is needed to understand the determinants of noncompliance in order to design interventions to improve compliance.

Adult↗

PubMedDate not supplied

Haemodialysis patients' knowledge and beliefs about medication.

Patient adherence to treatment continues to concern health professionals. Non-adherence is costly to: a) the patient in terms of health, psychological well-being and quality of life, b) the health care providers in terms of individual professionalism, job satisfaction and the provision of optimum care packages, and c) the managers in terms of finance and service planning. Several factors are thought to be influential in treatment adherence.

Adult↗

PubMed2005

Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: double-blind, randomised, controlled clinical trial.

BACKGROUND: Chronic heart failure (CHF) is an important cause of hospital admission and death. Poor adherence to medication is common in some chronic illnesses and might reduce the population effectiveness of proven treatments. Because little is known about adherence in patients with CHF and about the consequences of non-adherence, we assessed the association between adherence and clinical outcome in the CHARM (Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity) programme. METHODS: CHARM was a double-blind, randomised, controlled clinical trial, comparing the effects of the angiotensin receptor blocker candesartan with placebo in 7599 patients with CHF. Median follow-up was 38 months. The proportion of time patients took more than 80% of their study medication was defined as good adherence and 80% or less as poor adherence. We used a Cox proportional hazards regression model, with adherence as a time-dependent covariate in the model, to examine the association between adherence and mortality in the candesartan and placebo groups. FINDINGS: We excluded 187 patients because of missing information on adherence. In the time-dependent Cox regression model, after adjustment for predictive factors (demographics, physiological and severity-of-illness variables, smoking history, and number of concomitant medications), good adherence was associated with lower all-cause mortality in all patients (hazard ratio [HR] 0.65, 95% CI 0.57-0.75, p<0.0001). The adjusted HR for good adherence was similar in the candesartan (0.66, 0.55-0.81, p<0.0001) and placebo (0.64, 0.53-0.78, p<0.0001) groups. INTERPRETATION: Good adherence to medication is associated with a lower risk of death than poor adherence in patients with CHF, irrespective of assigned treatment. This finding suggests that adherence is a marker for adherence to effective treatments other than study medications, or to other adherence behaviours that affect outcome. Understanding these factors could provide an opportunity for new interventions, including those aimed at improving adherence.

Aged↗

PubMed2005

Pediatric adherence: perspectives of mothers of children with HIV.

This study approached pediatric adherence practices from the perspective of mothers of children with HIV in the USA. The study aimed to articulate what is involved in the daily life experience of giving or supervising a child's HIV medication (i.e., adherence practices) in order to clarify, in more dynamic terms than is often found in adherence research, what promotes or impedes adherence. A team-based qualitative analytic approach was used to analyze the narrative responses of 71 maternal caregivers of children with HIV to interview questions regarding the activities and stresses of caring for a child with HIV. Four themes of dealing with medication on a daily basis that impacted mothers' adherence practices emerged from the analysis: (1) Mothers' attitudes and feelings related to adherence practices. (2) The impact of the medications on adherence practices. (3) Interactions of mothers and children related to adherence practices. (4) Developmental issues and responsibility for medication adherence. These themes, taken together, demonstrate the contextual and longitudinal factors that impact adherence and illustrate the complexity of influences on adherence practices. We found that adherence practices were impacted in a positive way by mothers' commitment to adherence, and in a negative way by feelings of stigma and guilt, by the effects of bereavement on children and by children adopting their mothers' attitudes about medications. The interactive process of giving medication was shaped by children's behavior, mothers' developmental expectations for children, and, for mothers with HIV, their adherence for themselves. We found that pediatric adherence often came at a cost to the caregiving mother's well-being.

Adolescent↗

PubMed2001

Medical quality assessment by scoring adherence to guideline intentions.

Quality assessment of clinician actions and patient outcomes is a central problem in guideline- or standards-based medical care. In this paper we describe an approach for evaluating and consistently scoring clinician adherence to medical guidelines using the intentions of guideline authors. We present the Quality Indicator Language (QUIL) that may be used to formally specify quality constraints on physician behavior and patient outcomes derived from medical guidelines. We present a modeling and scoring methodology for consistently evaluating multi-step and multi-choice guideline plans based on guideline intentions and their revisions.

Algorithms↗

PubMed2006

Gout medication treatment patterns and adherence to standards of care from a managed care perspective.

OBJECTIVE: To determine allopurinol treatment patterns and adherence to published standards of care for patients with gout. PATIENTS AND METHODS: This retrospective claims analysis in a managed care database included patients 18 years or older, with continuous eligibility for 1 year before and after the start date and 2 or more visits during which the gout disease code (274.xx) was assigned or 1 or more pharmacy prescriptions for a gout-specific medication between January 1, 2000, and December 31, 2002 (intake period). Factors associated with compliance with allopurinol therapy were measured based on the medication possession ratio, and adherence to 2 quality-of-care indicators for gout management was assessed using multivariable logistic regression analysis. RESULTS: A total of 64.9% of allopurinol users had a modal daily dose or the most commonly observed daily dose of 300 mg/d, median length of therapy was 3 months, and a high proportion of patients had a medication possession ratio of 10% or less. Suggested quality-of-care Indicators for gout had low performance: 53% of patients with renal impairment received a modal daily dose of 300 mg or greater, and 83% of patients who started taking allopurinol did not have their serum urate levels measured within 180 days. Patients with gout flares were less likely to be compliant with allopurinol (odds ratio, 0.50; 95% confidence interval, 0.40-0.63). Patients with renal impairment at baseline were 3.2 times more likely to undergo serum urate testing than patients without renal impairment (odds ratio, 3.20; 95% confidence Interval, 1.25-8.23). CONCLUSION: There was low compliance with allopurinol therapy for treatment of gout. Patients potentially received suboptimal quality of care as measured by serum urate testing and appropriateness of allopurinol dosing in patients with renal impairment.

Adolescent↗