Assessing the Role of Knowledge, Awareness, Practice in Achieving Medication Adherence among Hypertensive Patients

Medication adherence is that the degree to which the person's behaviour corresponds with the agreed recommendations from a health care provider. Knowledge and the awareness concerning the hypertension and the antihypertensive medications have an important role within the medication adherence, lack of this can have negative impact on the medication adherence. The assessment of medication adherence in the study was meted out by using morisky scale. It’s a cross sectional study conducted in 150 individuals in Kankanady, Valachil, Valencia, Jeppu, Padil of Mangalore in Karnataka. Patient data collection forms were used to collect the information. Present study reflected that patients had knowledge regarding normal BP, symptoms and complications, however majority thinks hypertension can be curable. A positive attitude and practice were observed among the patients apart from practice of normal exercise. Analysing the data using MAMS-8 scale, study showed only 11.3% of the population were found to be high adherent that shows the decrease in the adherence rates. 34% had moderate adherence and the remaining 54% were low adherent. Assessment of data suggests that majority lack complete information about hypertension and its management. The study results revealed that hypertension related knowledge, awareness and practice plays a serious role in improving medication adherence. Keywords: Medication adherence, Hypertension, Knowledge, Awareness, Morisky scale.

Effectiveness of an Awareness Programme on Drug Compliance among People with Selected Chronic Diseases

The compliance to drug treatment leads to the prevention of deaths from the disease. Nurses play a very important role in the adherence to treatment by patients. The study aims at exploring the level of drug compliance among people with chronic illness (hypertension and diabetes mellitus), factors that influence the decision of the person and evaluates an awareness programme on the identified issues. The study used a Survey and Evaluative Approach with survey and quasiexperimental design. Purposive samplingwas used to collect data from Marne, Athrady, Herebettu which are rural areas and Malpe area of Manipal which is an urban area. Among 23535 population surveyed a total of 1286 (602 urban and 684 rural) samples with the disease and undergoing treatment were identified. 328(184 urban and 144 rural) people who were not complying to drugs were given awareness programme. The tools used were Demographic performa, Morisky scale, Srivastava Socioeconomic scale, scale for Health status (SF-36) and a scale to assess factors. The study was based on the Rosentoch’s, Becker and Maiman’s Health Belief model.

Prospective Measures of Adherence by Questionnaire, Low Immunosuppression and Graft Outcome in Kidney Transplantation

Background: Non-adherence with immunosuppressant medication (MNA) fosters development of de novo donor-specific antibodies (dnDSA), rejection, and graft failure (GF) in kidney transplant recipients (KTRs). However, there is no simple tool to assess MNA, prospectively. The goal was to monitor MNA and analyze its predictive value for dnDSA generation, acute rejection and GF. Methods: We enrolled 301 KTRs in a multicentric French study. MNA was assessed prospectively at 3, 6, 12, and 24 months (M) post-KT, using the Morisky scale. We investigated the association between MNA and occurrence of dnDSA at year 2 post transplantation, using logistic regression models and the association between MNA and rejection or graft failure, using Cox multivariable models. Results: The initial percentage of MNA patients was 17.7%, increasing to 34.6% at 24 months. Nineteen patients (8.4%) developed dnDSA 2 to 3 years after KT. After adjustment for recipient age, HLA sensitization, HLA mismatches, and maintenance treatment, MNA was associated neither with dnDSA occurrence, nor acute rejection. Only cyclosporine use and calcineurin inhibitor (CNI) withdrawal were strongly associated with dnDSA and rejection. With a median follow-up of 8.9 years, GF occurred in 87 patients (29.0%). After adjustment for recipient and donor age, CNI trough level, dnDSA, and rejection, MNA was not associated with GF. The only parameters associated with GF were dnDSA occurrence, and acute rejection. Conclusions: Prospective serial monitoring of MNA using the Morisky scale does not predict dnDSA occurrence, rejection or GF in KTRs. In contrast, cyclosporine and CNI withdrawal induce dnDSA and rejection, which lead to GF.

Adherence to Medical Treatment in Elderly Patients with Coronary Artery Disease in the Settings of Primary Outpatient Care

Aim. To study medication adherence in elderly patients with coronary artery disease (CAD) in primary care practice.Material and methods. The study conducted in out-patient clinic of Moscow city. 293 elderly (≥65 years) patients with established CAD included. The following patient data obtained via electronic medical record system: demography, medical history, modifiable risk factors and prescribed pharmacotherapy. Level of medication adherence measured by Morisky scale (MMAS-8) via telephone survey.Results. According to Morisky scale high adherence was identified in 146 (49.8%) elderly patients, moderate adherence – in 99 (33.8%) patients, low adherence – in 48 (16.4%) patients. Analysis of specific questions of the scale done in non-adherent patients revealed signs of unintentional non-adherence due to forgetfulness (45.9%) and signs of intentional non-adherence due to patients feeling worse (35.8%) or better (28.4%). By means of dichotomic interpretation of Morisky scale results the population under research was divided into two groups: 147 (50.2%) non-adherent patients and 146 (49.8%) – totally adherent patients. These groups were comparable in terms of sex (female 71.2 vs 68.0%; p>0.05) and age (median 73.5 vs 73.0 years; p>0.05) distribution, and medical history: myocardial infarction (39.0% vs 38.8%), atrial fibrillation (37.0 and 41.5%), chronic heart failure (90.4% vs 91.2%), diabetes (26.7% vs 24.5%). There were fewer smokers in adherent group (0.7% vs 6.5%; p<0.05). As primary antianginal pharmacotherapy adherent and non-adherent patients were equally prescribed beta-blockers (75.3% vs 75.5%; p>0.05). Drugs that improve prognosis were also prescribed comparably: antiplatelets (66.4% vs 61.9%; p>0.05), anticoagulants (36.3% vs 44.9%; p>0.05), statins (82.2% vs 79.6%; p>0.05), renin-angiotensin system inhibitors (89.0 and 87.8%; p>0.05). Adherent patients had lower mean values of lipids: total cholesterol (4.7±1.2 vs 5.2±1.4 mmol/l; p<0.05) and low density cholesterol (2.4±0.9 vs 2.8±1.2 mmol/l; p<0.05). Non-adherent elderly patients made more visits to general practitioner (median 5 vs 3 visits; p<0.05). Share of patients receiving drugs within supplementary pharmaceutical provision program was comparable in both groups (53.7% vs 50.7%; p>0.05).Conclusion. Half of elderly patients with CAD are non-adherent to treatment in primary care setting. Medical history and structure of pharmacotherapy do not influence level of adherence in this population. Among adherent patients fewer individuals smoke and mean values of lipids are lower. Non-adherent elderly patients cause higher load on general practitioner, supplementary pharmaceutical provision program provided no better adherence in the population under research.

PENGARUH EDUKASI FARMASIS TERHADAP KEPATUHAN DAN KONTROL GLIKEMIK PASIEN DM TIPE 2 PENGGUNA INSULIN DI POLIKLINIK PENYAKIT DALAM RSUD BAYU ASIH KABUPATEN PURWAKARTA TAHUN 2013

Latar Belakang: Diabetes Melitus (DM) merupakan sekelompok kelainan heterogen yang ditandai dengan kenaikan kadar glukosa dalam darah atau hipeglikemia yang terjadi karena kelainan sekresi insulin, kerja insulin atau kedua-keduanya. Terapi obat yang aman dan efektif akan terjadi apabila pasien mempunyai pengetahuan yang cukup tentang obat-obat dan penggunaannya. Tujuan Penelitian: untuk mengetahui peran farmasis dalam edukasi pasien DM dan kaitannya dengan faktor-faktor yang mempengaruhi kontrol glikemik pasien DM tipe 2 di Poliklinik Penyakit Dalam RSUD Bayu Asih Kabupaten Purwakarta. Metode Penelitian: ini merupakan penelitian ekperimental dengan pengambilan data yang dilakukan secara prospektif. Pasien dikelompokkan menjadi 3 kelompok dengan masing-masing kelompok terdiri dari 20 orang yang mendapatkan edukasi oleh farmasis dengan frekuensi yang berbeda-beda, yaitu kelompok yang mendapatkan edukasi 2 kali, kelompok yang mendapatkan edukasi 3 kali, dan kelompok yang mendapatkan edukasi 4 kali. Tingkat pengetahuan pasien terhadap pengobatan diukur dengan menggunakan instrumen Medication Knowledge Assesment (MKA), sedangkan tingkat kepatuhan pasien diukur menggunakan instrumen Modified Morisky Scale (MMS). Data dianalisis secara deskriptif dan secara kuantitatif menggunakan uji T independen dan uji T berpasangan. Hasil penelitian: hasilnya menunjukan pasien kelompok 2 kali edukasi, kelompok 3 kali edukasi dan kelompok 4 kali edukasi, semuanya mengalami kenaikan pada tingkat pengetahuan dan kepatuhan. Selain itu pasien pada ketiga kelompok tersebut juga mengalami penurunan kadar Gula Darah Puasa (GDP) dan kadar Gula Darah dua jam PP (GD2JPP), namun ternyata perbedaan frekuensi pemberian edukasi tidak berpengaruh terhadap tingkat pengetahuan, kepatuhan dan juga kadar gula darah pasien. Penelitian menyimpulkan bahwa edukasi farmasis dapat meningkatkan pengetahuan dan kepatuhan pengobatan. Tidak ada korelasi antara kepatuhan pasien dan kontrol glikemik, namun ada korelasi positif antara frekuensi edukasi dan kadar glukose darah 2 jam post prandial. Simpulan: Dapat disimpulkan juga bahwa frekuensi edukasi mempengaruhi kepatuhan dan kontrol glikemik.

Antiretroviral therapy adherence among patients enrolled after the initiation of the Universal Test and Treat strategy in Dessie town: a cross-sectional study

Poor adherence was the major challenge in providing treatment, care, and support for people living with HIV (PLHIV). Evidence of adherence to antiretroviral therapy (ART) after initiation of the Universal Test and Treat (UTT) strategy was limited in Ethiopia. So, this study aimed to determine the proportion of ART adherence after the initiation of UTT strategy and associated factors among adult PLHIV in Dessie town using two adherence measurements. A cross-sectional study was conducted on 293 PLHIV selected using a systematic sampling technique. The data were collected by face-to face-interview using a pretested questionnaire; chart review was also used to collect the data. The proportion of ART adherence measured by using the Morisky scale and seven-day recall was 49.3% (95% CI: [43.5%, 54.8%]) and 95.9% (95% CI: [93.2%, 98.2%]), respectively. Being urban in residence (AOR = 3.72, 95% CI: [1.80, 7.68]), the absence of depression (adjusted odds ratio [AOR] = 3.72, 95% CI: [1.22, 11.35]), taking one tablet per day (AOR = 3.26, 95% CI: [1.64, 6.49]), and the absence of concomitant illness (AOR = 0.23, 95% CI: [0.09, 0.59]) were factors associated with ART adherence. The proportion of ART adherence measured by the Morisky scale was very low; however, adherence measured by seven-day recall was higher and consistent with World Health Organization recommendations. Residence, depression, and the number of tablets taken per day had a positive association with good ART adherence whereas having concomitant illness had a negative association with good ART adherence. Efforts should be made to improve adherence and interventions should be given to overcome factors linked with poor adherence.

Does Universal Test and Treat Strategy has an effect on Antiretroviral Therapy Adherence? A Comparative Cross-sectional Study

Background : Poor adherence is a critical problem in managing Human Immunodeficiency Virus (HIV ) -infected patients receiving Antiretroviral Therapy (ART). Evidence of adherence to antiretroviral therapy after initiation of Universal Test and Treat (UTT) strategy was limited in Ethiopia. Hence, this study aimed to compare adherence to antiretroviral therapy before and after the initiation of universal test and treat strategy, including factors affecting adherence among HIV positive adults in Dessie town. Methods: A comparative cross-sectional study was conducted on 594 HIV positive adults selected using consecutive sampling. Interview and patient record review were used to collect data. The data were analyzed using SPSS version 23. Bi-variable and multivariable logistic regression model were used to identify factors associated with ART adherence. Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was used as a measure of association. Statistical significance was declared at a P - value less than 0.05. Result : The overall proportion of ART adherence using Morisky scale and self-reports were 52.3%, 95% CI: (48.4%, 56.2%) and 95%, 95% CI: (93.5%, 96.8%) respectively. Absence of depression (AOR =3.87, 95% CI: (1.96, 7.64)), eating three or more meals per day (AOR =2.65, 95% CI: (1.08, 6.49)) and absence of concomitant illness (AOR =0.42, 95% CI: (0.23, 0.76)) were significantly associated with better ART adherence. Conclusion: The overall proportion of ART adherence measured by Morisky scale was very low while the proportion of ART adherence measured by self-report was high and consistent with the current World Health Organization (WHO) recommendation. Adherence to ART was not affected by the introduction of the UTT strategy in HIV treatment and care program. Depression, meal frequency and concomitant illness were factors associated with ART adherence. Efforts should be made to improve adherence through tailored interventions to overcome factors linked with poor adherence. Key words: Antiretroviral therapy, Adherence, HIV/AIDS, Ethiopia

EVALUASI TINGKAT KEPATUHAN PENGGUNAAN OBAT ANTIHIPERTENSI PADA PASIEN PENYAKIT GINJAL KRONIK LANJUT USIA

Chronic Kidney Disease (CKD) is a condition of kidney damage that occurs for 3 months or more in the form of structural or functional abnormalities of the kidney with or without decrease in Glomerular Filtration Rate which manifests as a pathological disorder. Treatment of CKD is closely related to medication adherence that determines a successful treatment, but patient treatment adherence is often low especially in regularity for drug use. This study aims to evaluate the level of adherence to the use of CKD patient drug at the General Hospital of Education Hasanuddin University. The research design is descriptive analysis with Cross Sectional. The data were collected by using questionnaires containing questions that led to patient characteristics, medication adherence, and factors affecting drug use. Measurement of adherence used is Modified Morisky Scale (MMS) which then analyzed using Case Management Adherence Guidelines (CMAG) against 45 subjects. The result of the research is the level of patient compliance based on quadrant level 1 as many as 8 patients (17,78%), quadrant level 2 as many as 8 patient (17,78%), level 3 quadrant 17 patient (37,77%), and quadrant level 4 of 12 patients (26.66%).

Predicting Adherence to Aromatase Inhibitor Therapy among Breast Cancer Survivors: An Application of the Protection Motivation Theory

The purpose of this observational study was to determine if the Protection Motivation Theory could predict and explain adherence to aromatase inhibitor (AI) therapy among breast cancer survivors. Purposive sampling was used to identify 288 survivors who had been prescribed AI therapy. A valid and reliable survey was mailed to survivors. A total of 145 survivors completed the survey. The Morisky scale was used to measure adherence to AI. The survivors reported a mean score of 6.84 (±0.66) on the scale. Nearly 4 in 10 survivors (38%) were non-adherent. Adherence differed by age, marital status, insurance status, income, and presence of co-morbid conditions. Self-efficacy (r=0.485), protection motivation (r=0.310), and Response Efficacy (r=0.206) were positively and significantly correlated with adherence. Response Cost (r=-0.235) was negatively correlated with adherence. The coping appraisal constructs were statistically significant predictors medication adherence (β=0.437) with self-efficacy being the strongest significant predictor of adherence (β = 0.429).