Hubungan Tingkat Penerimaan diri dengan Tingkat Kepatuhan Minum Obat Pasien Lupus di Yayasan Kupu Parahita Indonesia

Lupus is a chronic autoimmune disease that can become a bio-psycho-socio-economic-culture-spiritual burden for individuals because its complex treatment and management. Self-acceptance and adherence to medication are the keys in lupus management. Purpose of this study was to determine the relationship between self-acceptance level of lupus patients and their medication adherence level. The study was designed using a correlational study with a cross sectional approach. About 92 lupus patient respondents at Kupu Parahita Indonesia Foundation who went to the Saiful Anwar Hospital Malang were selected using purposive sampling according to inclusion and exclusion criteria. Respondents were asked to fill out a modified Acceptance of Illness questionnaire to measure patient self-acceptance level and the Morisky Medication Adherence Scale 8 (MMAS-8) to assess drug adherence level. From the 92 respondents, it was found that 37% had a high level of self-acceptance, 52.2% were moderate, and 10.8% were low. Adherence medication level in 92 respondents showed 51.1% high, 38.1% moderate, and 10.8% low. Spearman test results showed a significant relationship between self-acceptance level and medication adherence level (p=0.001, r=0.355). This value indicates the strength of the weak relationship and the direction of the positive correlation between self-acceptance and medication adherence. Conclusion, the higher of self-acceptance level of lupus patients, the higher medication adherence level.

Clinical Non-adherence and Its Associated Factors Among HIV Positive Pediatrics Attending Care in South Gondar Zone Public Health Facilities, Northwest Ethiopia, 2021

Background: The most important factor in the success of HIV treatment is clinical adherence. Inadequate clinical adherence is one of the factors that affect the adherence level of highly active antiretroviral treatment and its effect on suppressed viral replication. Even though data from different settings are necessary to tackle it, pieces of evidence are limited especially in the case of clinical adherence level of HIV-infected children. Hence, this study aimed to assess clinical non-adherence level and its associated factors among HIV-positive children on HAART. Methods: A multicenter cross-sectional study was conducted from July 1 to August 30, 2021, among HIV-infected children on ART in South Gondar Zone. Data were entered into Epi Data Version 4.6 and analysis was done using Statistical Package for Social Science (SPSS) Version 25. Binary logistic regression was implemented to assess the association of factors against the outcome variable and variables with p-values ≤ 0.25 in the bivariable analysis were entered into the multivariable analysis. Finally, variables with p-values less than 0.05 were considered statistically significant factors.Result-out of 384 study participants, 383 were included in this study with a response rate of 99.7%. Nearly half of the study participants 190(49.6%) were girls. The majority, 291 (76%) of caretakers were biological mothers, and 203(53%) did not have treatment supporters. One hundred seventy-nine (46.7%) of caretakers did not disclose the status of the child about the illness. The overall prevalence of non-adherence among children on ART was 31.9 %( 95% CI: 27.2-36.6). Rural residency, diagnostic status non-disclosure, no adherence supporter, having no biological caretaker and comorbid illness were significantly associated with clinical non-adherence of HIV positive children.Conclusion-clinical non-adherence among children among HIV-positive children attending care in south Gondar zone health institutes is unacceptably high. Being rural residency, diagnostic status non-disclosure, no adherence supporter, having non-biological caretaker, and having comorbid illness were significantly associated with clinical non-adherence. Thus, attention shall be given to successful clinical adherence in HIV-positive children who uses the antiretroviral drug.

Measurement of Adherence Level of Pulmonary Tuberculosis Drugs use in Patients in the Primary Health Centers in Karawang Regency, West Java, Indonesia, using MMAS Instrument

Aims: This study aims to determine the level of drug adherence in patients with pulmonary tuberculosis at the Cilamaya Kulon Primary Health Center area, Karawang Regency, West Java, Indonesia. Study Design: The measurement of adherence level was carried out using the MMAS (Morisky Medication Adherence Scale) instrument. Place and Duration of Study: This study was conducted at Cilamaya Kulon Primary Health Center area, specifically in Bayur Lor and Pasirukem Primary Health Centers, Karawang Regency, West Java, Indonesia, from July to September 2021. Methodology: A cross-sectional design with a purposive sampling data collection method was used. Furthermore, the subjects were pulmonary TB patients from the Bayur Lor and Pasirukem Primary Health Centers, Karawang Regency. The instrument used was the MMAS questionnaire sheet, and data analysis was performed using SPSS (version 22.0) and continued with statistical tests using the chi-square test. Results: The results showed there was no significant relationship (p>0.05) between age, gender, educational status, employment status, income level, smoking status, duration of treatment, drugs side effects, medication supervision, and patient motivation for drugs adherence in the Cilamaya Kulon Primary Health Center area. Furthermore, the level of medication adherence of pulmonary TB patients at this Primary Health Center area was high with a value of 84.13%. Conclusion: Adherence to medication in pulmonary TB patients was not influenced by age, gender, educational status, employment status, income level, smoking status, duration of treatment, drug side effects, medication supervision, and patient motivation. Therefore, the adherence level is included in the high category.

Better Medications Adherence Lowers Cardiovascular Events, Stroke, and All-Cause Mortality Risk: A Dose-Response Meta-Analysis

Aims: We investigated the association between vascular medication adherence, assessed by different methods, and the risk of cardio-cerebrovascular events and all-cause mortality. Methods: A meta-analysis with a systematic search of PubMed, Web of Science, EMBASE, and Cochrane databases from inception date to 21 June 2021 was used to identify relevant studies that had evaluated the association between cardiovascular medication adherence levels and cardiovascular events (CVEs), stroke, and all-cause mortality risks. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects meta-analysis. Restricted cubic splines were used to model the dose-response association. Results: We identified 46 articles in the dose-response meta-analysis. The dose-response analysis indicated that a 20% increment in cardiovascular medication, antihypertensive medication, and lipid-lowering medication adherence level were associated with 9% (RR: 0.91, 95% CI 0.88–0.94), 7% (RR 0.93, 95% CI: 0.84–1.03), and 10% (RR 0.90, 95% CI: 0.88–0.92) lowers risk of CVEs, respectively. The reduced risk of stroke respectively was 16% (RR: 0.84, 95% CI: 0.81–0.87), 17% (RR 0.83, 95% CI: 0.78–0.89), and 13% (RR 0.87, 95% CI: 0.84–0.91). The reduced risk of all-cause mortality respectively was 10% (RR: 0.90, 95% CI: 0.87–0.92), 12% (RR 0.88, 95% CI: 0.82–0.94), and 9% (RR 0.91, 95% CI: 0.89–0.94). Conclusions: A better medication adherence level was associated with a reduced risk of cardio-cerebrovascular events and all-cause mortality.

MEDICATION ADHERENCE AND DECREASED KIDNEY FUNCTION AS PREDICTORS OF HOSPITALIZATION FOR CHRONIC HEART FAILURE IN ELDERLY PATIENTS

Hospitalizations due to worsening of the clinical course of ambulatory care sensitive conditions (ACSC) are the significant and growing burden on health systems. Chronic heart failure (CHF) is one of the five leaders among chronic ACSC both in the frequency of hospitalizations and in their cost. Therefore, it is important to find predictors of the clinical course worsening which are easy to use in ambulatory settings. The aim of the research: to assess the effect of medication adherence and decreased renal function on the probability of hospitalization for CHF in the elderly during 6 months. Materials and methods. The prospective research included 111 ambulatory elderly patients aged from 60 to 74 years with CHF, stage II, arterial hypertension, stage II and chronic kidney disease, stage II-IIIA. During the first ambulatory visit a general clinical examination and ambulatory card analysis were performed. Creatinine level was checked with calculation of the glomerular filtration rate according to the formula of the Chronic Kidney Disease Epidemiology Collaboration (GFR EPI) to assess renal function. In addition, a 6-minute walk test (6MWT) was performed and a quality of life assessment was conducted according to Minnesota Living with Heart Failure Questionnaire. Adherence assessment on a Morisky Green Medication Adherence Scale as well as a collection of the information about hospitalization during the previous 6 months was done during the last visit. The variable "interaction" between decreased renal function and poor medication adherence was introduced separately into the logistic analysis. A logistic regression analysis was used to assess the influence of factors on the probability of hospitalization for CHF. Results. During the observation 21 patients were hospitalized for CHF (21/93, 23%). The analysis of the distribution of adherence level and GFR EPI ≤ 59,9 mL/min/1,73 m2 between groups of hospitalized and non-hospitalized patients revealed a predominance of non-adherent patients, as well as those with decreased renal function, in the group of hospitalized ones. Clinical characteristics and laboratory parameters, by which the differences were found between hospitalized and non-hospitalized patients, as well as categorical variables received by ROC-analysis - quality of life, GFR EPIcat, systolic blood pressure, 6MWTcat, and variable "interaction", were included in the univariate logistic analysis. According to univariate logistic analysis, the hospitalization probability increased with GFR EPI ≤ 59,9 mL/min/1,73 m2 (OR-6,73, CI 2,34-19,35) and decreased in the presence of medication adherence (OR-0,08, CI 0,02-0,37). In multivariate analysis (adjustment for lung crackles and functional class according to NYHA) or were 4,95 (CI 1,18-20,78) for GFR EPI ≤ 59,9 mL/min/1,73 m2 and 0,11 (CI 0,02-0,81) for medication adherence. During assessing the "interaction" variable it was found that in non-adherent patients with GFR EPI≤59,9 ml/min/1,73m2 the chance of inpatient treatment for CHF significantly increased by 6.82 times on average, with a maximum increase by 20 times. Conclusions. Medication adherence and decreased renal function in our research were shown to be significant predictors of hospitalization for CHF, which are simple to measure and assess and can be used in an outpatient setting. By increasing adherence level, especially in elderly patients with impaired renal function, it is possible to reduce the chance of inpatient treatment caused by CHF by 9.1 times.

Breast cancer patients therapeutic adherence during the COVID-19 pandemic in Indonesia: Knowledge level analytical study.

89 Background: Corona virus diseases 2019 (COVID-19) pandemic is a new challenge for Indonesia's cancer patient’s treatment. Patients face problems in undergoing therapy during the pandemic due to government lockdown regulations. Cancer patients, especially breast cancer, still do not understand how to deal with this problem. This study aims to determine COVID-19 knowledge’s effect on therapeutic adherence in breast cancer patients in Indonesia. Methods: This study was a cross-sectional study conducted from February to April 2021. This study involved breast cancer patients from various regions in Indonesia. The research instrument employed the UNS-CASKQ14 questionnaire (Universitas Sebelas Maret-Cancer Altitude Satisfaction Knowledge Questionnaire) to determine COVID-19 knowledge and therapeutic adherence levels in breast cancer patients. The data were then tested the Spearman Rho correlation utilizing SPSS 25. Results: There were 812 respondents in this study, with the most respondents in the age range of 50-59 years (31.8%). As many as 222 (27.3%) respondents had a low knowledge level about COVID-19, 511 (62.9%) respondents had a sufficient knowledge level, and 79 (9.8%) respondents had a good knowledge level. As many as 369 (45.4%) respondents had a low therapeutic adherence level, and 443 (54.6%) respondents had a good adherence level during the COVID-19 pandemic. Based on the Spearman Rho correlation test between COVID-19 knowledge and therapeutic adherence levels, the results obtained were p = 0.51 (p > 0.05), with the Spearman Rho coefficient value = 0.026. Conclusions: There was no significant effect between COVID-19 knowledge and therapeutic adherence levels in breast cancer patients during the COVID-19 pandemic in Indonesia.

Countering the rise of syphilis: A role for doxycycline post-exposure prophylaxis?

Doxycycline post-exposure prophylaxis (PEP) holds the potential to mitigate increasing rates of syphilis among sexual minority men (SMM) in the US yet has received limited attention. Since evaluation of this intervention in actual populations is not currently feasible, we used agent-based models (ABM) to assess the population-level impact of this strategy. We adapted ABM of HIV and HPV transmission, representing a population of 10,230 SMM in Philadelphia, Pennsylvania, US. Parameter inputs were derived from the literature, and ABM outputs during the pre-intervention period were calibrated to local surveillance data. Intervention scenarios varied doxycycline uptake by 20, 40, 60, 80 and 100%, while assuming continued condom use and syphilis screening and treatment. Under each intervention scenario, we incorporated treatment adherence at the following levels: 0, 20, 40, 60, 80 and 100%. Long-term population impact of prophylactic doxycycline was measured using the cumulative incidence over the 10-year period and the percentage of infections prevented attributable to doxycycline at year 10. An uptake scenario of 20% with an adherence level of 80% would reduce the cumulative incidence of infections by 10% over the next decade, translating to 57 fewer cases per 1000 SMM. At year 10, under the same uptake and adherence level, 22% of infections would be prevented due to doxycycline PEP in the instances where condoms were not used or failed. Findings suggest that doxycycline PEP will have a modest impact on syphilis incidence when assuming a reasonable level of uptake and adherence. Doxycycline PEP may be most appropriate as a secondary prevention measure to condoms and enhanced syphilis screening for reducing infections among SMM.

Peningkatan Pengetahuan dan Kepatuhan Diet Hipertensi melalui Pendidikan Kesehatan di Posyandu Lansia Tlogosuryo Kota Malang

Chronic hypertensive disorder in geriatry may trigger other serious cardiovasculary diseases. The aim of this study was to determine the effectivity of health education on geriatry knowledge and adherence on hypertension diet in Posyandu Lansia Tlogosuryo, Malang. Using pre-experimental within a one group pre-post test design, 30 elderly on chronic hipertensive disorder recruited as a sample of the study. At the baseline, less than a half of participant (46.7%) had good and fair knowlegde level and only 43.3% showed high adherence on hipertension diet. After a series of health education, 70% of participant showed an improvement on knowledge level and 50% showed higher adherence on hypertension diet. The results of paired t-test showed a p value of 0.003; 0.000 < 0.05 on the knowledge level and diet adherence level, respectively. Conclusion: Health education was effective to increase the knowledge and diet adherence among geriatry with chronic hipertensive disorder

Adherence Level to Arterial Hypertension Treatment: A Cross-Sectional Patient Survey and Retrospective Analysis of the NHS Prescription Database

One of the major problems in cardiology practice is poor adherence to antihypertensive medication. This study aimed to evaluate medication adherence; we also aim to investigate the predictors of intentional and unintentional non-adherence. We issued a survey containing questions about patient demographics, blood pressure control, pharmaceutical care, and adherence level to medication. Retrospective analysis of the prescription database of the National Health Service of the Republic of Latvia was performed. The prevalence of non-adherence was 45.9%. The lowest adherence rate (38.2%) was found among patients taking medication for 2–4.9 years. Even though 84.7% of respondents had a blood pressure monitor at home, only 25.3% of them reported measuring blood pressure regularly. There were differences between the groups of adherent patients in terms of the patients’ net income (p = 0.004), medication co-payments (p = 0.007), and whether the pharmacist offered to reduce the costs of drug therapy (p = 0.002). Roughly half of the prescriptions (50.4%) containing perindopril were purchased by patients from pharmacies. The medication adherence level and blood pressure control at home were assessed as low. Intentionally non-adherent respondents discontinued their medication because of fear of getting used to medicines. The pharmacists’ behaviour in terms of offering to reduce the costs of medications used was influenced by socio-economic factors.