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Results for “Medication Adherence”

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PubMed2004

Relationship between routinization of daily behaviors and medication adherence in HIV-positive drug users.

Although lifestyle factors and routinization of daily activities are emerging as important variables in understanding and improving medication adherence, measures of these constructs remain crude and rudimentary. This study evaluated whether a brief, yet more comprehensive measure of the routinization of daily behaviors and activities is predictive of medication adherence. Participants with HIV and histories of drug dependency completed a 2-week practice trial that mimicked highly active antiretroviral therapy (HAART) (phase 1), followed by a 2-week observation of adherence to HAART (phase 2) for those who started antiretroviral therapy during the study. Fifty-one participants completed the study. Average electronic monitored adherence rate (proportion of prescribed doses taken) in the practice trial was 67% (standard deviation [SD] = 24), which was significantly correlated (r = 0.50; p< 0.05) with adherence to HAART. A high frequency of four daily activities (eating breakfast, watching favorite television program, attending meetings, sleeping at home) was associated with higher adherence, whereas a low frequency of having friends over to visit was associated with higher adherence; the composite score that combined these five activities, and represented the extent to which a patient's daily routine incorporated these specific behaviors, was highly correlated (r = 0.63, p < 0.001) with adherence. In a stepwise multiple regression analysis with several adherence correlates included as independent variables, the composite score was the best independent predictor of adherence, accounting for over one third (36%) of the variance. These findings suggest that the extent to which one's daily life is structured and routinized is an important factor in understanding medication adherence. The individual items of this scale as well as a composite measure may be used to predict adherence and inform strategies to enhance adherence via recommended changes in the patient's daily routine.

Activities of Daily Living↗

PubMedDate not supplied

Detection and documentation of actual and potential medication adherence problems in patients receiving combination therapies.

This article identifies problems in the documentation of antiretroviral medication adherence in medical records of clients seen in community-based treatment centers. Medical record data abstraction was conducted in community-based clinics providing HIV treatment services in a major HIV epicenter. Medical records of a purposive sample of 146 clients in four clinics were reviewed. Results revealed that adherence issues, in both frequency and type, were inadequately documented. Furthermore, when documented, reasons for patient adherence problems were not given. Documentation of follow-up of adherence issues was also absent in the medical records of study participants. There may be several unique and overlapping reasons for problems in documenting adherence issues: (a) provider experience and expertise in assessing adherence problems, (b) lack of sensitivity and specificity in clinician's assessments of adherence, (c) absence of adequate clinic protocol, and (d) available time to both assess adherence and complete thorough progress notes. This article provides data for the formulation of a summary adherence measure to enhance providers' abilities to detect and monitor actual and potential adherence problems.

Antiretroviral Therapy, Highly Active↗

PubMed2003

Tales of pediatric asthma management: family-based strategies related to medical adherence and health care utilization.

OBJECTIVES: To examine how family management styles, garnered from parent interviews about the effect of asthma on family life, are related to medical adherence and health care utilization. STUDY DESIGN: Eighty parents with a child with asthma were interviewed. Computerized monitoring of medication use was collected every 2 months for 1 year. Parents and children completed measures of medical adherence and health care utilization at the time of the interview and at 1-year follow-up. Three categories of disease management were identified: reactive, coordinated care, and family partnerships. Group comparisons were made by using analysis of variance with medical adherence and health care utilization as dependent variables. RESULTS: Management strategies revealed in the interview were distinguishable by adherence rates at the time of interview and 1 year after. Interview categories were also predictive of emergency department use at 1-year follow-up. The reactive group received a diagnosis of asthma 1 year after noting symptoms, in contrast with the other groups, who received a diagnosis within 6 months. CONCLUSIONS: The use of semistructured interviews may reveal important information about how families manage asthma. Further work may help identify areas amenable to intervention and provide a better understanding of why some families delay treatment.

Adolescent↗

PubMed2004

A pilot study examining older adults' beliefs related to medication adherence: the BERMA survey.

OBJECTIVE: To establish a multifactorial measure of older adults' beliefs related to medication adherence. METHODS: Ninety-two older adults (M = 71.42 years) were asked to provide medication and health-related information, memory strategies, and complete the Beliefs Related to Medications (BERMA) Survey. RESULTS: The final version of the BERMA survey contains 53 questions with three scales. The overall reliability of the scale is excellent (Cronbach's alpha =.94), as is the reliability of the scales. Correlations show that better rated memory for medications was associated with higher reported adherence and fewer external memory strategies. Higher perceived ability to deal with health professionals was related to higher importance of medication adherence and greater perceived seriousness of one's medical condition. Finally, more positive attitudes about medications were associated with better self-rated health and fewer side effects. DISCUSSION: The results indicate that the BERMA survey is a potentially useful research tool for understanding older adults' medication adherence.

Aged↗

PubMed2004

Medication adherence for HIV positive women caring for children: in their own words.

Few studies have directly focused on adherence to highly active antiretroviral medication (HAART) in HIV positive women caring for children. These women may have unique barriers and facilitators to taking medication, and a deeper understanding of their adherence patterns could enhance intervention strategies. A total of 36 HIV positive women who care for children less than 18 years of age were interviewed regarding their patterns and decision around taking HAART. The study group was comprised of 19 Latinas, 10 Euro-Americans, five African Americans and two Cape Verdeans. The mean length of time the women knew they were HIV positive was 11.15 years. Adherence patterns shifted over the course of the women's HIV history. The participants continually discussed medication adherence within the context of events and relationships that either upset or stabilized their adherence. The following themes emerged: (1) shifting adherence patterns; (2) reasons for adherence; (3) reasons for non-adherence; (4) the relationship between distress level and medication adherence; (5) interpersonal relationship as barrier or facilitator of medication adherence; and (6) children as facilitators in adherence. Providers need to be aware of the shifting nature of adherence and its relationship to psychosocial functioning.

Adult↗

PubMed2003

Electronic monitoring of medication adherence in skin disease: results of a pilot study.

BACKGROUND: Traditional medication adherence monitoring for topical medication use in dermatology relies heavily on measures of self-reporting and ointment tube weight, which are susceptible to various biases. METHODS: We first assessed the feasibility of using medication electronic monitoring system caps with cream, ointment, and gel formulations. We then performed a pilot study using 10 patients given a diagnosis of psoriasis with a weekly follow-up visit. Topical salicylic acid 6% was supplied to patients in medication jars with caps that recorded the opening and closing of the bottles, without patient knowledge. RESULTS: Medication electronic monitoring system cap monitors accurately recorded the opening and closing of bottles of topical agents. Patients overreported adherence in patient logs, and there was greater detection of missed doses using electronic monitors than self-reporting through patient log (relative risk = 6.2, 95% confidence interval: 1.13, 34.09). CONCLUSION: Electronic monitoring shows promise as a more accurate form of measuring treatment adherence to topical medication regimens.

Administration, Topical↗

PubMed2005

Medication adherence and diabetes control in urban African Americans with type 2 diabetes.

In 181 urban African Americans with Type 2 diabetes, medication adherence was assessed using a measure designed specifically for an urban, impoverished sociodemographic population. Hemoglobin A-sub(1c), blood pressure and cholesterol levels, medication-related beliefs, and depression were assessed. Seventy-four percent of the sample reported adherence to diabetes medication. Adherence, adjusted for age, was associated with lower hemoglobin A-sub(1c). The specific behaviors associated with poorer diabetes control were forgetting to take medications and running out of medications. Knowledge of blood glucose goals differed for adherers and nonadherers. Blood pressure and cholesterol medication adherence rates were not associated with actual levels of blood pressure or lipids, respectively. These data suggest that specific medication-taking behaviors are important to diabetes control and constitute logical targets for interventions. ((c) 2005 APA, all rights reserved).

Adult↗

PubMed2006

Predictors of medication adherence and associated health care costs in an older population with overactive bladder syndrome: a longitudinal cohort study.

PURPOSE: We examined the relationship between self-reported health status data, subsequent antimuscarinic medication adherence and health care service use in older adults with OAB syndrome in a managed care setting. MATERIALS AND METHODS: This was a longitudinal cohort study of older adults in the southeastern United States with OAB who completed a health status assessment, used antimuscarinic medications and were enrolled in an HMO continuously for 1 to 3 years. Demographic, clinical and use related economic variables were also retrieved from the administrative claims data of patient HMOs. Prescription refill patterns were used to measure medication adherence. Associations were examined with a sequential, mixed model regression approach. RESULTS: A total of 275 patients were included. The severity of comorbidity (Charlson index), patient perception of quality of life (Short Form-12 scores) and total number of prescribed medications during the year prior to enrollment in a Medicare HMO were independently associated with decreased antimuscarinic MPRs after enrollment. After controlling for other variables increased antimuscarinic MPR remained the strongest predictor of decreased total annual health care costs (5.6% decrease in annual costs with every 10% increase in MPR, p < 0.001). CONCLUSIONS: We found strong associations between decreased antimuscarinic medication adherence and increased health care service use in older adults with OAB in a managed care setting. Health status assessments completed at enrollment had the potential to identify enrollees at higher risk for nonadherent behaviors and poor health related outcomes.

Adult↗

PubMedDate not supplied

The reliability of reports of medical adherence from children with HIV and their adult caregivers.

OBJECTIVE: To compare children's reports of their medication adherence to those of their adult caregivers. METHOD: Several indicators of medication adherence were assessed for 48 adult-child dyads. Kappa statistics were calculated as measures of agreement. RESULTS: Adherence problems were common, although the level of agreement between the child and the adult was quite low (kappas for adherence variables ranged from .05 to .32). Compared to adult-child dyads that agreed, dyads that disagreed tended to include older children who had more responsibility for managing their own medications. CONCLUSIONS: Both researchers and clinicians would benefit from acquiring information on children's adherence from multiple sources.

Adolescent↗

PubMed2006

Comparison of medication adherence and associated health care costs after introduction of pioglitazone treatment in African Americans versus all other races in patients with type 2 diabetes mellitus: a retrospective data analysis.

OBJECTIVE: The aim of this study was to compare treatment adherence and health care costs in African Americans versus all other races (All Others) in patients with type 2 diabetes mellitus starting treatment with pioglitazone. METHODS: In this retrospective cohort study, the North Carolina Medicaid database was used (query dates: July 1, 2000, to June 30, 2003). Using at least 1 code from the International Classification of Diseases, Ninth Revision, Clinical Modification for type 2 diabetes (250.xx) and 1 National Drug Code for antidiabetic medication, we identified a cohort of male and female patients aged > or =18 years with type 2 diabetes who maintained continuous Medicaid eligibility for the entire 36-month follow-up period. Race was categorized as African American and All Others (white, Asian, Native American, Pacific Islander, other) based on self-reported data collected at the time of Medicaid enrollment. Medication adherence was expressed as medication possession ratio (calculated as the number of days of antidiabetic prescription supply dispensed [eg, a 30-day supply] divided by the number of days between the first and last dispensation). Reimbursements made by Medicaid were used to calculate diabetes-related and total health care costs, which included medical and dental care, including costs for regular checkups, office visits, home health care, inpatient and outpatient care, long-term care facility care, and prescription drugs. To compare the differences in medication adherence and annual total and diabetes-related health care costs between African Americans and All Others, multivariate regression analysis was performed using only data from the year after (year 2) the year in which pioglitazone treatment was started (year 1). RESULTS: Among the 1073 patients treated with pioglitazone (26.1% men; mean [SD] age, 49.5 [10.6] years; 50.2% African American; mean [SD] total health care costs in year 1, US $7906 [$12,256]; year 2, $9546 [$14,861]), African Americans had significantly higher adherence (62%) to pioglitazone treatment compared with All Others (57%) (P < 0.05) on unadjusted analysis. However, no significant differences in rates of adherence to the medication were found between African Americans and All Others on multivariate regression analysis. African American race was not found to be an independent predictor of increased or decreased annual total health care costs in this population. Significant reductions in total health care costs (2% for every 10% increase in adherence; P < 0.001) and diabetes-related costs (4% for every 10% increase in adherence; P < 0.01) with increased adherence were found. CONCLUSIONS: On multivariate analysis, this study found no significant differences in treatment adherence between African Americans versus all other races in this population of diabetic patients enrolled in a Medicaid program (query dates: July 1, 2000, to June 30, 2003). A higher adherence rate was associated with significantly lower diabetes-related and total health care costs in this population.

Adult↗

PubMed2005

Supportive relationships and medication adherence in HIV-infected, low-income Latinos.

Inadequate social support and poor communications with health care providers can affect adherence to antiretroviral therapy. The magnitude of independent effects of these factors on adherence is not fully known. This study examined the relationship of perceived emotional or informational social support from family and friends, quality of physician-patient communications and relationships, and medication adherence in a sample of low-income, Spanish-speaking, HIV-positive Latino men and women receiving treatment in community-based clinics (n = 85). Results of the study indicated that, whereas emotional or informational support was significantly associated with level of dose adherence (OR, 1.04, 95% CI, 1.01-1.08; p = .03), quality of physician-patient communications or relationships was significantly associated with adherence to medication schedule,t(6, 71) = 4.45,p < .001. Quality of patient-physician relationship accounted for 22% of the variance in adherence to medication schedule. Both kinds of support were associated with better adherence in this population but may affect adherence behaviors in different ways.

Adult↗

PubMedDate not supplied

Fidelity to a 12-week structured medication adherence intervention in patients with HIV.

BACKGROUND: Researchers have been conducting efficacy and effectiveness studies on interventions that address medication-taking behavior in patients with HIV infection. However, they also must examine the fidelity to the research protocol for the delivery of the intervention. OBJECTIVES: The aims of this study were to determine the level of fidelity to each of the specified end points (number of intervention sessions, session duration, number of telephone calls per session, the length of time between sessions, sessions with multiple interventions, and attrition from the intervention protocol) in the delivery of the 12-week, nurse-delivered, structured telephone intervention designed to improve medication adherence and to determine the factors (race, gender, and socioeconomic status) related to participation in the intervention. METHODS: This descriptive correlational study was a substudy of a larger randomized clinical trial (N = 200) testing the effectiveness of a 12-week nurse-delivered intervention designed to improve medication adherence to antiretroviral medications in persons with HIV infection. The Intervention Tracking Form was used to collect data on all intervention delivery end points during the delivery of the structured intervention. A sociodemographic questionnaire was used to collect the sociodemographic characteristics of the sample. RESULTS: Two thirds of the sample (n = 66) were male, and slightly more than half were White. The average age was 39.68 (SD = 7.98) years. The average number of intervention sessions delivered was 8.1 (SD = 4.07). Participants were more likely to receive the first five intervention sessions (n = 77, 77.8%), and 21 (21.2%) dropped out of treatment before it was completed. Nearly one quarter (n = 24, 24.2%) of the sample had doubled-up interventions. Intervention sessions lasted, on average, 11.3 min. Typically, more than one telephone call was needed before the participant was reached (M = 2.2). The mean number of days between sessions was 11.5 days. Women were more likely to have doubled-up interventions (p = .036). There was a marginally significant difference (p = .075) in the number of sessions received between the Whites and non-Whites: Whites (M = 8.8, SD = 3.9) received slightly more sessions compared with non-Whites (M = 7.24, SD = 4.2). When examining the interaction effects between the demographic factors considered, a race-by-income effect was observed for the mean number of attempts to contact the participant (p = .044). DISCUSSION: These results demonstrate a lack of fidelity to the research intervention protocol. Factors beyond the researchers' control may have influenced fidelity to the intervention protocol.

Adult↗

PubMed2000

Predicting medication adherence in severe mental disorders.

OBJECTIVE: This study explored the utility of the health belief model (HBM) in explaining medication adherence in subjects with severe and disabling mental disorders. METHOD: Six well-established measuring instruments, with confirmed reliability and validity, were used to assess each component of the HBM and medication adherence in 39 hospital-treated subjects with affective disorders (n = 27) or schizophrenia (n = 12). RESULTS: Highly adherent and partially adherent subjects differed significantly in their perception of illness severity, their beliefs about themselves and their control over the disorder, and their concerns about further hospitalization. Two components of the HBM (perceived severity of illness and perceived benefits of treatment) explained 43% of the variance in adherence behaviour. CONCLUSION: Although the study has a number of methodological limitations, the results suggest that clinical assessment of components of the HBM may improve the detection of patients at risk of medication non-adherence.

Adolescent↗

PubMed2003

Medication adherence practices of HIV/AIDS case managers: a statewide survey in North Carolina.

The primary objective of this study was to examine the adherence-related practices and attitudes of HIV/AIDS case managers in North Carolina. All North Carolina HIV/AIDS case managers (n = 111) employed by agencies that were state certified to provide HIV case management were sent an adherence counseling survey. Negative binomial regression was used to examine the relationship of case managers' characteristics and attitudes with their medication adherence counseling practices. Of the 94 HIV/AIDS case managers who responded to the survey, the majority (65%) reported discussing medications with almost every client. The adherence-related behaviors that case managers most frequently provided were related to monitoring medication usage rather than providing medication instruction. Most case managers believed that medication adherence counseling is part of their role (77%); however, a substantial minority, (36%) did not believe that their adherence counseling skills were adequate. Multivariate analysis revealed that case managers who provided more adherence counseling services reported greater confidence in their adherence counseling skills, believed that adherence counseling is a HIV/AIDS case management role, and had a higher proportion of substance-abusing clients in their caseload. The adherence counseling activities of HIV/AIDS case managers can potentially supplement the counseling provided by other health professionals and promote greater adherence to medications. However, variability in perceived skills and adherence-related activities suggests that the role of case managers in medication adherence counseling needs to be better defined and appropriate training provided to meet the expectations of this role.

Adult↗

PubMed2004

The correlation between plasma concentrations of protease inhibitors, medication adherence and virological outcome in HIV-infected patients.

BACKGROUND: Although adherence clearly influences response to antiretroviral therapy (ART), accurate assessment of adherence is problematic. The objective of this analysis was to assess the independent predictive value of protease inhibitor (PI) concentrations as a supplement to self-report as markers of medication adherence. METHODS: This retrospective analysis was conducted from a prospective clinical trial designed to compare the outcomes of frequent versus infrequent HIV RNA measurement used to manage antiretroviral therapy. For 131 patients, self-reported medication adherence, HIV RNA levels, CD4 counts and PI concentrations (unannounced, random samples) were measured at baseline (when patients changed to a new regimen) and every 2 months thereafter. The change in HIV RNA from baseline to month 6 (area-based measure) was used to evaluate overall response. The proportion of measured PI concentrations below the detection limit was used as an alternative marker of adherence. An undetectable concentration would be expected after missing a single dose. RESULTS: The mean baseline CD4 count was 125 cells/mm3 and the mean HIV RNA level was 4.7 log10 copies/ml. The mean change in log10 HIV RNA was -0.73 copies/ml. The mean percentage of self-reported adherence was 91% (range: 15-100%) and the mean proportion of undetectable PI concentrations was 27% (range: 0-100%, mean 2.5 samples/patient). The correlation between the two measures was -0.23 (P=0.009). In a multivariate model, percentage of visits with undetectable PI concentrations (P=0.02), percentage of medication adherence (P=0.02), baseline HIV RNA level (P=0.005), prior PI use (P=0.0004), prior lamivudine (3TC) use (P=0.0009) and randomization to the frequent HIV RNA measurement group (P<0.0001) were all related to change in HIV RNA. After accounting for adherence, patients who always had detectable PI concentrations had an average of 0.4 log10 additional HIV RNA reduction compared with those who had no detectable concentrations. CONCLUSIONS: Repeated, random PI concentration values are independently predictive of virological response and may add to self-report of adherence in understanding the response to ART.

Adult↗

PubMed2004

Barriers and facilitators of medication adherence in hypertensive African Americans: a qualitative study.

OBJECTIVE: This study explored the perspectives of hypertensive African-American patients, in 2 primary care practices, regarding the factors they perceived as barriers or facilitators of adherence to prescribed antihypertensive medications. DESIGN: This qualitative study used a grounded theory methodology with data collection occurring through in-depth individual patient interviews. SETTING AND PARTICIPANTS: One hundred and six hypertensive African-American patients followed at 2 urban primary care practices participated in the open-ended interviews. METHODS: During interviews, patients' experiences taking antihypertensive medications and their perceptions of the challenges they face in adhering to their medications as prescribed were explored. Patients were also asked about the situations that make it easy or difficult for them to take their antihypertensive medications as prescribed and the skills they thought were necessary for patients to adhere to their medications as prescribed. All responses were recorded verbatim and analyzed using grounded theory methodology. RESULTS: Fifty-eight percent of participants were women, mean age was 56 years, and 60% had uncontrolled hypertension. Four categories of barriers and 5 categories of facilitators were identified. The barriers included patient-specific, medication-specific, logistic, and disease-specific barriers. The facilitators included use of reminders, having a routine, knowledge about hypertension, its treatment and complications, having social support and good doctor-patient communication. CONCLUSION: This study provides a framework for investigating issues of medication adherence in hypertensive African Americans by describing a taxonomy of barriers and facilitators of adherence identified by patients.

Black or African American↗

PubMed2001

Association between temperamental characteristics and medication adherence in subjects presenting with psychotic or mood disorders.

The links between temperamental characteristics and medication adherence were explored in subjects with psychotic (n=45) or mood disorders (n=58). Temperamental characteristics were measured using the Sensation-Seeking Scale (SSS), the Barratt Impulsivity Scale and the Physical Anhedonia Scale. Higher general SSS scores, and disinhibition and boredom susceptibility SSS subscores were associated with a greater risk to present with poor medication adherence.

Adolescent↗

PubMed2005

Placebo HAART regimen as a method for teaching medication adherence issues to students.

Placebo medication regimens may help educate students about adherence issues. In this randomized trial, 23 third-year medical students took a 2-week placebo regimen mimicking highly active antiretroviral therapy (HAART) during their medicine clerkship; 15 students served as controls. Although no effect was demonstrated from this intervention on an evaluation instrument examining attitudes and beliefs about medication nonadherence, all 23 student-subjects agreed in postintervention interviews that the experience was useful and had learning value. Representative comments from the 19 subjects who expanded their interview responses portray this intervention as an eye-opening and unique method for teaching students about medication adherence issues.

Antiretroviral Therapy, Highly Active↗