Adherence to medication — a never-ending story

:The incidence of hypertension (HTN) and its cardiovascular (CV) complications are increasing throughout the world. Blood pressure (BP) control remains unsatisfactory worldwide. Medical inertia and poor adherence to treatment are among the factors that can partially explain, why BP control rate remains low. The introduction of a method for measuring the degree of adherence to a given medication is now a prerequisite. Complex treatment regimes, inadequate tolerance and frequent replacements of pharmaceutical formulations are the most common causes of poor adherence. In contrast, the use of stable combinations of antihypertensive drugs leads to improved patient adherence.:We aim to review the relationships between arterial stiffness, cognitive function and adherence to medication in patients with HTN.:Large artery stiffening can lead to HTN. In turn, arterial stiffness induced by HTN is associated with an increased CV and stroke risk. In addition, HTN can induce disorders of brain microcirculation resulting in cognitive dysfunction. Interestingly, memory cognitive dysfunction leads to a reduced adherence to drug treatment. Compliance with antihypertensive treatment improves BP control and arterial stiffness indices. Early treatment of arterial stiffness is strongly recommended for enhanced cognitive function and increased adherence.

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Evaluating Virtual Care Experiences for Patients with Covid-19 Chief Complaints: Best-Practices Recommendations (Preprint)

10.2196/preprints.19197 ◽

2020 ◽

Author(s):

Saif Khairat ◽

Malvika Pillai ◽

Barbara Edson ◽

Robert Gianforcaro

Keyword(s):

Patient Experience ◽

Wait Time ◽

Secondary Outcome ◽

Major Drawback ◽

Cross Sectional ◽

Average Wait Time ◽

Adherence To Medication ◽

Virtual Care ◽

Chief Complaints ◽

Virtual Visits

BACKGROUND Importance: Positive patient experiences are associated with illness recovery and adherence to medication. The shift toward virtual visits creates a need to understand the opportunities and challenges in providing a patient experience that is at least as positive as in-person visits. OBJECTIVE To evaluate the virtual care experience for patients with Covid-19 as their chief complaints. METHODS We conducted a cross-sectional study of the first cohort of patients with Covid-19 concerns in a virtual clinic. We collected data on all virtual visits between March 20-29, 2020. Outcomes: The main endpoints of this study were patient diagnosis, prescriptions received, referrals, wait time and duration, and satisfaction. The secondary outcome was the reported choice of alternative care options. RESULTS Of the 358 total virtual visits, 42 patients marked “Covid-19 Concern” as their chief complaint. Of those patients, 23 (54.8%) female patients, the average age of patients was 33.9 years, and 41 (97.7%) patients were seeking care for themselves and one (3.3%) visit was for a dependent. For all virtual visits, the average wait time (SD) was 157.2 (181.7) minutes and the average wait time (SD) for Covid-19 Concern visits was 177.4 (186.5) minutes. Covid-19 Concern phone visits had an average wait time (SD) of 180.1 (187.2), compared to 63.4 (34.4) minutes for Covid-19 Concern video visits. Thirteen (65%) patients rated their provider as “Excellent” with similar proportions among phone (64.3%) and video (66.7%). CONCLUSIONS This study evaluated the virtual experiences of patients with Covid-19 concerns. There were different experiences for patients depending on their choice of communication. Long wait times were a major drawback in the patient experience. We have learned from evaluating the experience of our first cohort of Covid-19 Concern patients.

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Relationship between medication adherence and psychosocial adjustment in patients with type 2 diabetes: A cross-sectional study

Nordic Journal of Nursing Research ◽

10.1177/2057158520937456 ◽

2020 ◽

Vol 40 (3) ◽

pp. 116-122

Author(s):

Duygu Kes ◽

Feray Gökdoğan

Keyword(s):

Type 2 Diabetes ◽

Psychosocial Adjustment ◽

Large City ◽

Psychosocial Care ◽

Self Report ◽

Cross Sectional ◽

Convenience Sample ◽

Adherence To Medication ◽

The Relationship

Adherence to drug treatment is a multidimensional concept. It is affected by many factors, such as physiological, psychological, family, environmental and social conditions. However, relatively little is known about the relationship between adherence to medication and psychosocial adjustment. The aim was to explore the relationship between adherence to antidiabetic drugs and the psychosocial adjustment of patients with type 2 diabetes mellitus. This cross-sectional descriptive correlational study was conducted between March and June 2018. A convenience sample of participants was recruited from seven internal disease outpatient clinics at a public tertiary hospital, located in a large city that serves as a gateway to nearby rural and urban areas in the north-west region of Turkey. Data were collected using the Adherence to Refills and Medications Scale (ARMS-7), and the Psychosocial Adjustment to Illness Scale–Self Report (PAIS–SR). This study is reported in accordance with STROBE. Pearson’s correlation analysis found a significant weak positive correlation between all domains of the PAIS–SR and the total scores on the ARMS‐7. The participants’ scores on medication refill were found to be significantly and positively correlated with all of the PAIS–SR domain scores except the sexual relationships domain. Psychosocial care could play a crucial role in improving drug regimen adherence among patients with diabetes. Therefore, nurses should integrate psychosocial care into daily practice.

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Lower perception of pharmacological treatment increases risk of non-adherence to medication

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.258 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

CB Graversen ◽

JB Valentin ◽

ML Larsen ◽

S Riahi ◽

T Holmberg ◽

...

Keyword(s):

Pharmacological Treatment ◽

Poisson Regression ◽

Drug Class ◽

Angiotensin Receptor Blockers ◽

Adverse Outcomes ◽

Adherence To Medication ◽

Increased Risk ◽

Patient Reported ◽

High Level

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation Background A large proportion of patients fail to reach optimal adherence to medication following incident ischemic heart disease (IHD) despite amble evidence of the beneficial effect of medication. Non-adherence to medication increases risk of disease-related adverse outcomes but none has explored how perception about pharmacological treatment detail on non-adherence using register-based follow-up data. Purpose To investigate the association between patients’ perception of pharmacological treatment and risk of non-initiation and non-adherence to medication in a population with incident IHD. Methods This cohort study followed 871 patients until 365 days after incident IHD. The study combined patient-reported survey data on perception about pharmacological treatment (categorised by ‘To a high level’, ‘To some level’, and ‘To a lesser level’) with register-based data on reimbursed prescription of cardiovascular medication (antithrombotics, statins, ACE-inhibitors/angiotensin receptor blockers, and β-blockers). Non-initiation was defined as no pick-up of medication in the first 180 days following incident IHD and analysed by Poisson regression. Two different measures evaluated non-adherence in patients initiating treatment: 1) proportion of days covered (PDC) analysed by Poisson regression, and 2) risk of discontinuation analysed by Cox proportional hazard regression. All analyses were adjusted for confounding variables (age, sex, ethnicity, income, educational level, civil status, occupation, charlson comorbidity index, supportive relatives, and individual consultation in medication) identified by directed acyclic graph and obtained from national registers and the survey. Item non-response was handled by multiple imputation and item consistency was evaluated by McDonalds omega. Results Lower perceptions about pharmacological treatment was associated with increased risk of non-initiation and non-adherence to medication irrespectively of drug class and adherence measure in the multiple adjusted analyses (please see figure illustrating results on antithrombotics). A dose-response relationship was observed both at 180- and 365-days of follow-up, but the steepest decline in adherence differed when comparing the two adherence measures (results not shown). Moderate internal consistency was found for the summed measure of perception (McDonalds omega = 0.67). Conclusion Lower perception of pharmacological treatment was associated with subsequent non-initiation and non-adherence to medication, irrespectively of measurement method and drug class. Abstract Figure. Figre: Multiple adjusted analyses

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Cardiac rehabilitation via telerehabilitation in COVID-19 pandemic situation

The Egyptian Heart Journal ◽

10.1186/s43044-021-00156-7 ◽

2021 ◽

Vol 73 (1) ◽

Author(s):

Dian M. Sari ◽

Laurentia C. G. Wijaya

Keyword(s):

Cardiac Rehabilitation ◽

Health Care Providers ◽

Rehabilitation Program ◽

Lifestyle Changes ◽

Second Phase ◽

Main Body ◽

Cardiac Rehabilitation Program ◽

Care Providers ◽

Adherence To Medication ◽

Home Based

Abstract Background Adherence to medication and lifestyle changes are very important in the secondary prevention of cardiovascular disease. One of the ways is by doing a cardiac rehabilitation program. Main body of the abstract Cardiac rehabilitation program is divided into three phases. The cardiac rehabilitation program’s implementation, especially the second phase, center-based cardiac rehabilitation (CBCR), has many barriers not to participate optimally. Therefore, the third phase, known as home-based cardiac rehabilitation (HBCR), can become a substitute or addition to CBCR. On the other hand, this phase is also an essential part of the patients’ functional capacity. During the coronavirus disease-2019 pandemic, HBCR has become the leading solution in the cardiac rehabilitation program’s sustainability. Innovation is needed in its implementation, such as telerehabilitation. So, the cardiac rehabilitation program can be implemented by patients and monitored by health care providers continuously. Short conclusion Physicians play an essential role in motivating patients and encouraging their family members to commit to a sustainable CR program with telerehabilitation to facilitate its implementation.

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Disclosure and health-related outcomes among children living with HIV and their caregivers

AIDS Research and Therapy ◽

10.1186/s12981-021-00337-z ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Margaret Amankwah-Poku ◽

Delight Abla Klutsey ◽

Kwaku Oppong Asante

Keyword(s):

Medication Adherence ◽

Psychological Health ◽

Positive Impact ◽

Well Being ◽

Demographic Variables ◽

Hiv Status ◽

African Countries ◽

Psychological Well Being ◽

Adherence To Medication ◽

Living With Hiv

Abstract Background The prevalence of disclosure of status to children living with the Human Immunodeficiency Virus (HIV) is low in most sub-Saharan African countries, leading to poor compliance and adverse psychological outcomes in these children. This study examined the influence of disclosure on health outcomes in children living with HIV and their caregivers. Methods Using a cross-sectional design, 155 HIV-positive children between age 6–15 years and their caregivers were administered standardized questionnaires measuring adherence to medication, children's psychological well-being, caregiver burden, and caregivers’ psychological health. Results Results indicated that only 33.5% of the children sampled knew their status. Disclosure of HIV status was significantly related to medication adherence, psychological wellbeing, the burden of caregiving, and the length of the disclosure. A child’s age and level of education were the only demographic variables that significantly predicted disclosure of HIV status. In a hierarchical analysis, after controlling for all demographic variables medication adherence, psychological well-being and burden of caregiving were found to be significant predictors of disclosure of status in children living with HIV. Conclusions Findings suggest the need for disclosure of status among children living with HIV for a positive impact on their medication adherence and psychological health. These findings underscore the need for the development of context-specific interventions that will guide and encourage disclosure of status by caregivers to children living with HIV.

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The 8-item Morisky medication adherence scale: validation of a Portuguese version in HIV patients

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.669 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A Aguiar ◽

C Piñeiro ◽

R Serrão ◽

R Duarte

Keyword(s):

Medication Adherence ◽

Psychometric Properties ◽

Reliability Analysis ◽

Cronbach’S Alpha ◽

Portuguese Version ◽

Cronbach's Alpha ◽

Adherence To Medication ◽

Morisky Medication Adherence Scale ◽

Adherence Scale ◽

The Mean

Abstract Background Antiretroviral therapy (ART) has the most effective treatment for people with HIV, but its effectiveness depends on the individual medication adherence. Morisky Medication Adherence Scale (MMAS-8) is one of the most widely used scales to assess patient adherence. Thus, we aimed to validate a Portuguese version of MMAS-8 and determine its psychometric properties in HIV positive patients. Methods A cross-sectional survey was conducted in Centro Hospitalar Universitário São João (Porto, northern Portugal) at the infectious diseases department. After authorization to use the scale - granted by the author - and, a standard forward-backwards procedure to translate MMAS-8 to Portuguese, the questionnaire was applied to 233 patients with HIV doing ART. Reliability was assessed using Cronbach's alpha and test-retest reliability. Three levels of adherence were considered: 0 to < 6 (low), 6 to < 8 (medium), 8 (high). Results In the studied sample, the mean age was 45.03 years (SD = 11.63), 80.3% men, 19.3% women and 1 transgender, and 53.8% had ≤9 years of education. The mean number of prescribed ART per patient was 1.76. The mean score for the medication adherence scale was 7.29 (SD = 6.74). For the reliability analysis, 12 patients were excluded due to missing data (n = 221). Regarding the level of adherence, 22.5% were low adhering, 71.6% medium and 5.9% high. Corrected item-total correlations showed that 1 item does not correlate very well with the overall scale and was dropped. Scale reliability analysis for the remaining 7 items revealed an overall Cronbach's alpha of 0.661. Women had a protective effect on adherence (OR = 0.31;95%CI:0.15-0.66). Number of years doing ART, age of participants, and type of residence didn't show to be correlated with adherence. Conclusions MMAS-8 is a reliable and valid measure to detect patients at risk of non-adherence. A satisfactory Cronbach's alfa (0.661) was obtained. In general, adherence to medication was medium or high. Key messages This scale can be applied nationwide in other different hospitals, as it could serve as a tool for measuring adherence to ART that can allow for better health care to the ones that are low adhering. A Portuguese version of the MMAS-8 was created for measuring adherence to ART that maintained a similar structure to the original MMAS-8 and good psychometric properties.

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Knowledge at palm of hand: supported self-management and audiovisual content School of Patients DF

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.010 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

E Cubas-Rolim ◽

F R Yung ◽

M R Gripp ◽

C L A Oliveira ◽

L A Marques ◽

...

Keyword(s):

Health Promotion ◽

Health Education ◽

Health Professionals ◽

Vital Role ◽

Prescription Data ◽

Graduate Studies ◽

Information Retention ◽

Online Networks ◽

Visual Model ◽

Adherence To Medication

Abstract Background The region of practice of the School of Patients DF is vulnerable at health literacy and income. Audiovisual information is strategic in primary care for its great power of reach and information retention. Objectives Since 2016 videos of health education have been produced, initially technical on the Planification for hypertension and diabetes. After the focus switched to popular health education, aiming at improving communication between health professionals and patients on chronic diseases and health promotion, including testimonials. The is potential for video exhibition in qualified waiting rooms and forwarding in social network. Results There are videos from diabetes, hypertension, obesity to dengue, pre-natal care and other APS themes, which follow printed orientation with pertinent links. There are graduate and post-graduate studies in course for optimizing audio-visual content for support and capacitation of the family caregivers, especially regarding the facilitated visual model of prescription (“Illustrated Prescription”). Data until 2020-January: YOUTUBE 3146 views, 118,6 hours of exhibition, 50 videos. FACEBOOK page with a reach of 369.248 views. INSTAGRAM 10.119 followers, 193 posts, 37.800 likes and 1003 commentaries. Conclusions Modifications in lifestyle and adherence to medication are fundamental for treatment, and videos are promising for health promotion and selfcare capacitation. There is potential for reducing the hierarchy barriers (testimonials). The shared construction of knowledge and its dissemination makes the patient active part in community diffusion of information. Key messages Health professionals have a vital role as educators, including for social online networks. Patients have a protagonist role in their treatment, as well as multipliers of knowledge at their community.

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