Abstract 3016: Spirituality and Medication Adherence in Older African American Adults Diagnosed with Hypertension: A Qualitative Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Lisa M Lewis
Keyword(s):  
African American ◽  
Medication Adherence ◽  
Qualitative Study ◽  
Antihypertensive Medication ◽  
Demographic Data ◽  
Patient Treatment ◽  
List Type ◽  
Medication Regimen ◽  
Antihypertensive Medications ◽  
The Mean

Background : Medication adherence (ADH) is key to decreasing hypertension (HTN)-related morbidity and mortality in older African-American (AA) adults. However, older AA adults have poorer ADH to prescribed antihypertensive medications when compared to their younger and Caucasian-American counterparts. Patient beliefs and cultural concepts about their medications influence their medication ADH. An important cultural concept in this regards is spirituality, which is a significant resource in the AA community. Thus, the purpose of this qualitative study was to explore the role of spirituality in ADH to antihypertensive medications for older AA adults. Methods: Older AA adults who were members of a Program of All Inclusive Care for the Elderly (PACE) and who were (a) diagnosed with HTN; (b) prescribed at least one antihypertensive medication; (c) self-identified as African-American or Black; and (d) self-identified as spiritual completed one in-depth individual face-to-face in this qualitative descriptive study informed by grounded theory. Demographic data were also collected. Results : Twenty-one PACE members completed the study. All of the participants were female. The mean age of participants was 73 years with most completing high school (67%). The mean HTN diagnosis was16.7 years and mean number of prescriptions for antihypertensives was 3.3. Participants indicated that their spirituality was used in a collaborative process with formal health care to manage their ADH to antihypertensive medications. This process was identified as Partnering with God to Manage My Medications. Partnering with God to Manage My Medications indicated that the PACE members acknowledged personal responsibility for adhering to their antihypertensive medication regimen but used their spirituality as a resource for making decisions to remain adherent; coping with medication side effects; and increasing their self-efficacy to deal with barriers to ADH . Conclusions : Spirituality played a positive role in medication adherence for the PACE members. Incorporating individual beliefs, such as spirituality, into patient treatment for HTN may capitalize on their inner resources for medication ADH and demonstrates culturally appropriate care.

Exploring Older Adults’ Internalizations And Misconceptions Regarding Antihypertensive Medication Management

2021 ◽  
Vol 10 (1) ◽  
pp. 304-308
Author(s):  
Kenneth A. Blocker ◽  
Wendy A. Rogers
Keyword(s):  
Older Adults ◽  
Medication Adherence ◽  
Antihypertensive Medication ◽  
Medication Management ◽  
Illness Representation ◽  
Effective Management ◽  
Structured Interviews ◽  
Antihypertensive Medications ◽  
Hypertension Knowledge ◽  
Management Behaviors

Hypertension, or high blood pressure, is an asymptomatic cardiovascular condition common with increasing age that must be controlled with proper management behaviors, such as adherence to prescribed antihypertensive medications. Unfortunately, older adults may struggle with consistent and effective management of this medication specifically and the disease generally, which can lead to poorer health outcomes. The goal of the study was to investigate older adults’ antihypertensive medication management using the Illness Representation Model as a lens to identify potential misconceptions that may contribute to medication management. We conducted semi-structured interviews with 40 older adults regarding management routines, hypertension knowledge, perceived nonadherence contributors, and perspectives related to their illness. We identified numerous misconceptions regarding hypertension knowledge, disease severity, as well as perceived adherence performance that may contribute to challenges older adults face with maintaining antihypertensive medication adherence. Moreover, these findings inform the need for and design of effective educational tools for improving antihypertensive medication adherence.

Abstract P50: Early Nonadherence to Antihypertensive Medications

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Emily B Schroeder ◽  
Jennifer L Ellis ◽  
Nikki M Carroll ◽  
Elizabeth A Bayliss ◽  
Marsha A Raebel
Keyword(s):  
Health Care ◽  
Medication Adherence ◽  
Antihypertensive Medication ◽  
Multivariate Model ◽  
Care Plan ◽  
Office Visits ◽  
Antihypertensive Medications ◽  
Kaiser Permanente ◽  
Pharmacy Claims ◽  
C Statistic

Background: Medication adherence is extremely important in the treatment of hypertension. Most medication adherence metrics are based on refill rates from pharmacy claims databases and require at least two drug dispensings for the calculations. Little is known about individuals who demonstrate early non-adherence to antihypertensive medications, either by never filling a prescription (primary non-adherence) or by filling a prescription only once (early non-persistence). Methods: We conducted a retrospective cohort study of 6,393 Kaiser Permanente Colorado enrollees with hypertension who received a first prescription for an antihypertensive medication between January 1, 2007 and June 30, 2008. We linked prescription orders to medication dispensings and then classified patients into primary non-adherent, early non-persistent, or ongoing dispensings groups. Multivariate logistic modeling was performed to investigate potential predictors of primary non-adherence compared to ongoing dispensings. Results: Five percent (331 of 6,393) of patients were primarily non-adherent, 26% (1,672 of 6,393) demonstrated early non-persistence, and 69% (4,390 of 6,393) received ongoing dispensings. In a multivariate model, the following characteristics were associated with a higher likelihood of exhibiting primary non-adherence compared to receiving ongoing dispensings: Hispanic (OR 1.74, 95% CI 1.20-2.52) or other racial/ethnic minority (1.48, 1.13-1.95), an enrollment period less than 10 years (1.28,1.00-1.62), more than four comorbidities compared to no comorbidities (1.76, 1.02-3.02), and fewer than five health care contacts in the six months after the medication was prescribed (1.31, 1.02-1.67). The copayment amount for office visits or medications was not associated with primary non-adherence. The c-statistic for the model containing demographic characteristics, comorbidities, and health care plan information was 0.63. Conclusions: A substantial number of individuals newly prescribed an antihypertensive medication exhibited early non-adherence. Our multivariate model had limited discrimination, indicating that further research is needed to better characterize these individuals and explore barriers to early adherence.

scholarly journals Antihypertensive Medication Adherence and Confirmation of True Refractory Hypertension

Hypertension ◽  
2020 ◽  
Vol 75 (2) ◽  
pp. 510-515 ◽  
Author(s):  
Mohammed Siddiqui ◽  
Eric K. Judd ◽  
Tanja Dudenbostel ◽  
Pankaj Gupta ◽  
Maciej Tomaszewski ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Treatment Failure ◽  
Receptor Antagonist ◽  
Mineralocorticoid Receptor ◽  
Antihypertensive Treatment ◽  
Antihypertensive Medication ◽  
Refractory Hypertension ◽  
Antihypertensive Medications ◽  
Mineralocorticoid Receptor Antagonist ◽  
Ambulatory Bp Monitoring

Refractory hypertension (RfHTN) is a phenotype of antihypertensive treatment failure defined as uncontrolled BP despite the use of effective doses of ≥5 antihypertensive medications including a long-acting thiazide-like diuretic (chlorthalidone) and a mineralocorticoid receptor antagonist. The degree of medication nonadherence is unknown among patients with RfHTN. In this prospective evaluation, 54 patients with apparent RfHTN were recruited from the University of Alabama at Birmingham Hypertension Clinic after having uncontrolled BP at 3 or more clinic visits. All patients’ BP was evaluated by automated office BP and 24-hour ambulatory BP monitoring (n=49). Antihypertensive medication adherence was determined by measuring 24-hour urine specimens for antihypertensive medications and their metabolites by high-performance liquid chromatography-tandem mass spectrometry (n=45). Of the 45 patients who completed 24-hour ambulatory BP monitoring, 40 (88.9%) had confirmed RfHTN based on an elevated automated office BP (≥130/80 mm Hg), mean 24-hour ABP (≥125/75 mm Hg), and mean awake (day-time) ABP (≥130/80 mm Hg). Out of the 40 fully evaluated patients with RfHTN, 16 (40.0%) were fully adherent with all prescribed medications. Eighteen (45.0%) patients were partially adherent and 6 (15.0%) had none of the prescribed agents detected in their urine. Of 18 patients who were partially adherent, 5 (12.5%) were adherent with at least 5 medications, including chlorthalidone and the mineralocorticoid receptor antagonist, consistent with true RfHTN. Of patients identified as having apparent RfHTN, 52.5% were adherent with at least 5 antihypertensive medications, including chlorthalidone and a mineralocorticoid receptor antagonist, confirming true RfTHN. These findings validate RfHTN as a rare, but true phenotype of antihypertensive treatment failure.

Abstract 2086: Community-Dwelling African-American Beliefs Associated with Adherence to Antihypertensive Medications: A Matter of Life and Death

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Lisa M Lewis
Keyword(s):  
African American ◽  
Medication Adherence ◽  
African Americans ◽  
Focus Group ◽  
Social Contexts ◽  
Community Dwelling ◽  
Antihypertensive Medications ◽  
Life And Death ◽  
Urban City ◽  
Study Participants

Medication adherence is low among hypertensive patients regardless of ethnic background. However, African-American prevalence is higher when compared to Caucasian-Americans. Recognizing African-American perspectives about their adherence to antihypertensive medications is necessary for the development of successful interventions aimed at improving adherence to prescribed regimens. Thus, the purpose of this qualitative study was to explore community-dwelling hypertensive African-American beliefs regarding adherence to antihypertensive medications. A community and academic partnership was formed to conduct three focus groups with 40 participants at two community centers in a Northeastern urban city. Each focus group was recorded and transcribed verbatim. We analyzed the focus group data using thematic analysis. Participants had a mean age of 57 years, were mostly female (n=27), high school graduates (n=14), unemployed (n=27), and earned an annual income of $20, 000 or less (n=18). In addition, they had a mean hypertension diagnosis of 8 years with most participants reporting adherence to their antihypertensive medication regimens (n=26). Study participants described salient beliefs regarding their adherence to antihypertensive medications. Data analysis revealed an overarching theme of “it’s a matter of life and death” in which study participants were able to articulate the health benefits associated with adhering to their medications but also described the difficulties associated with adherence in relation to their social contexts. Participants identified three major difficulties associated with the remaining adherent to their antihypertensive medications. The difficulties included: (a) negotiating their limited resources, (b) negotiating their neighborhood violence, and (c) negotiating their feelings of mistrust of doctors. Although these results cannot be generalized, they do provide significant insight into the contextual factors associated with the lives of some community-dwelling hypertensive African-Americans. These findings are important because they can be used to tailor interventions to increase medication adherence in hypertensive African-Americans.

scholarly journals The psychosocial barriers to medication adherence of patients with type 2 diabetes: a qualitative study

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Firoozeh Mostafavi ◽  
Fereshteh Zamani Alavijeh ◽  
Arash Salahshouri ◽  
Behzad Mahaki
Keyword(s):  
Medication Adherence ◽  
Qualitative Study ◽  
Care Center ◽  
Healthcare Providers ◽  
Work Conditions ◽  
Diabetic Patients ◽  
Medication Regimen ◽  
Diabetes Clinic ◽  
Health Care Center ◽  
Psychosocial Barriers

Abstract Background The adherence of diabetic patients to their medication regimen is associated with many psychosocial factors that are still unknown. Therefore, the present study aims to identify the psychosocial barriers to medication adherence of patients with type2 diabetes (T2D). Methodology This descriptive qualitative study was done in Isfahan, Iran by conducting in-depth unstructured interviews with 23 purposively selected patients with T2D and 10 healthcare providers (HCPs). The participants were interviewed face-to-face between November 2017 and June 2018 at the patient’s home, a Health Care Center, or at the diabetes clinic. Data analysis was performed using MAXQDA-10 software and the conventional content analysis. Results The analysis of the data led to six categories of perceived psychosocial barriers: 1) fear, concern and distress, 2) exhaustion and burnout, 3) the children’s issues being the priority, 4) poor financial support, 5) communication challenges, and 6) poor work conditions. Conclusions This study identified some of the psychosocial barriers to medication adherence of patients with T2D, which will be of great help to researchers and HCPs in designing and implementing effective interventions to overcome these barriers and change patient self-care behaviors and increase their medication adherence.

scholarly journals Measuring adherence to antihypertensive medication using an objective test in older adults attending primary care: cross-sectional study

2021 ◽  
Author(s):  
James P. Sheppard ◽  
Ali Albasri ◽  
Pankaj Gupta ◽  
Prashanth Patel ◽  
Kamlesh Khunti ◽  
...  
Keyword(s):  
Primary Care ◽  
Medication Adherence ◽  
Urine Sample ◽  
Antihypertensive Medication ◽  
Cross Sectional Study ◽  
Urine Samples ◽  
Sample Collection ◽  
Antihypertensive Medications ◽  
Cross Sectional ◽  
Adherence To Medication

AbstractAnalysis of urine samples using liquid chromatography-tandem mass spectrometry (LC-MS/MS) has previously revealed high rates of non-adherence to antihypertensive medication. It is unclear whether these rates represent those in the general population. This study aimed to investigate whether it is feasible to collect urine samples in a primary care setting and analyse them using LC-MS/MS to detect non-adherence to antihypertensive medication. This study used a prospective, observational cohort design. Consecutive patients were recruited opportunistically from five general practices in UK primary care. They were aged ≥65 years with hypertension and had at least one antihypertensive prescription. Participants were asked to provide a urine sample for analysis of medication adherence. Samples were sent to a laboratory via post and analysed using LC-MS/MS. Predictors of adherence to medication were explored with multivariable logistic regression. Of 349 consecutive patients approached for the study, 214 (61.3%) gave informed consent and 191 (54.7%) provided a valid urine sample for analysis. Participants were aged 76.2 ± 6.6 years and taking a median of 2 antihypertensive medications (IQR 1–3). A total of 27/191 participants (14.2%) reported not taking all of their medications on the day of urine sample collection. However, LC-MS/MS analysis of samples revealed only 4/27 (9/191 in total; 4.7%) were non-adherent to some of their medications. Patients prescribed more antihypertensive medications were less likely to be adherent (OR 0.24, 95%CI 0.09–0.65). Biochemical testing for antihypertensive medication adherence is feasible in routine primary care, although non-adherence to medication is generally low, and therefore widespread testing is not indicated.

Abstract 5961: Defining An Evidence-Based Cutpoint for Medication Adherence in Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jia-Rong Wu ◽  
Terry A Lennie ◽  
Marla J De Jong ◽  
Mary Kay Rayens ◽  
Misook L Chung ◽  
...  
Keyword(s):  
Heart Failure ◽  
Medication Adherence ◽  
Cox Regression ◽  
Enzyme Inhibitor ◽  
Roc Curves ◽  
Evidence Based ◽  
List Type ◽  
Medication Regimen ◽  
Event Free Survival ◽  
Free Survival

Patients with heart failure (HF) are required to take multiple medications. Long-term adherence to the HF medication regimen is necessary in order to achieve better patient outcomes. Despite the importance of adherence, clinically relevant cutpoints for distinguishing the level of adherence associated with outcomes are unknown. The purpose of this study was to use outcomes (i.e., event-free) as a criterion to determine the level of medication adherence required to achieve the best clinical outcomes. The specific aim was to determine the cutpoint above which there is a positive relationship between level of medication adherence and outcomes. This was a longitudinal study of 135 patients with HF. Medication adherence was measured using a valid and objective measure, the Medication Event Monitoring System (MEMS). Two indicators of adherence were assessed by the MEMS: dose-count, percentage of prescribed doses taken and dose-days, percentage of days correct number of doses taken. Patients were followed up to 3.5 years to collect data on outcomes. A series of Kaplan-Meier plots with log-rank tests, Cox-survival analyses, and receiver operating characteristic (ROC) curves were assessed comparing event-free survival in patients divided at one point incremental cutpoints. Event-free survival was significantly better when the prescribed number of doses taken [dose-count] or the correct dose [dose-day]) was ≥ 88%. This level was confirmed in a Cox regression model controlling for age, gender, ejection fraction, NYHA, comorbidity, angiotensin-converting enzyme inhibitor use, and beta-blocker use. ROC curves showed that adherence rates above 88 – 89% produced the optimal combination of sensitivity and specificity with respect to predicting better event-free survival. With this as the adherence cutpoint, patients in the nonadherent group were 2.2 times (by dose-count) to 3.2 times (by dose-day) more likely to experience a first event ( p = .021 and .002, respectively), compared to patients in the adherent group. The results of this study provide clinicians and researchers with an evidence-based recommendation about the level of adherence needed to achieve the best outcomes.

External ambient cues to mediate the involvement of family caregivers in the management of older adults’ medications: a qualitative study (Preprint)

2019 ◽  
Author(s):  
Marcela D. Rodríguez ◽  
Juan-Pablo Garcia-Vazquez ◽  
Angel G. Andrade
Keyword(s):  
Older Adults ◽  
Medication Adherence ◽  
Qualitative Study ◽  
Family Caregivers ◽  
Prospective Memory ◽  
Family Members ◽  
Lessons Learned ◽  
Qualitative Assessment ◽  
Medication Regimen ◽  
External Cues

BACKGROUND The most common reasons for the lack of adherence among older adults is the forgetfulness due to the multiple cognitive processes associated with prospective memory involved in remembering to follow a medication regimen. Problems with prospective memory increase the demands for care. Therefore, family members play an essential role in supporting patients in activities that involve: helping with medication adherence, transmitting knowledge about medications, and helping to refill their prescriptions. To address some of these medication problems, we designed a Medication Ambient Display (MAD) to support education, motivation, and measurement of medication-taking behaviors in older adults. The functionality of MAD consists of providing external cues to convey information through abstract and stylized representations of older adults’ medication adherence. Specifically, MAD is placed as a portrait in the elderly’s home. It shows a virtual birdcage to raise elders’ consciousness about their responsibility for caring for their health, in a similar way that they gladly take care of their pets OBJECTIVE This study aimed to assess the effect of MAD’s external cues on the involvement of family members in the management of medications for the elderly. METHODS We conducted a qualitative study consisting of semi-structured interviews with older adults and their relatives identified as informal caregivers. The study lasted ten (10) weeks. We visited participants weekly to collect data about: older adults’ medication problems, help received, and their perception about older adults’ medication adherence. The first five (5) weeks of the study was used to establish baseline data to understand the involvement of relatives on medication management activities. Afterward, we introduced MAD to be used for the successive five (5) weeks. RESULTS We found that new patterns of interaction among older adults and their relatives arose while using MAD. Participants perceived that MAD reinforced the care functions of family caregivers. For instance, it made them aware of older adults' medication adherence and encouraged youngest family members to help older adults. CONCLUSIONS We identified that the external cues provided through ambient displays did not overwhelm family members, but motivated their social connectedness with older adults. We conclude this paper with a set of lessons learned from this qualitative assessment, which may help designers to develop assistive technology for older adults.

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