poor medication adherence
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2021 ◽  
Author(s):  
Ertao Jia ◽  
Shasha Hu ◽  
Zhiying Zhan ◽  
Wukai Ma ◽  
Hongling Geng ◽  
...  

Abstract Background: The treat-to-target (T2T) strategy is essential for patients with gout. However, the rate of T2T is low. This study aimed to explore doctor-led chronic disease management on the T2T of gout, survey the rate of T2T and assess the predictors associated with poor control of serum urate levels (SUA) in a large population of patients with gout receiving urate-lowering treatment (ULT). Methods: A multi-center, cross-sectional study was conducted. We surveyed the relevant information of outpatients who received ULT for more than six months using electronic questionnaires, including demographics, disease-related conditions, comorbid conditions, and management. The patients with gout were divided into the SUA > 360 µmol/L and ≤ 360 µmol/L, and the patient characteristics between the two groups were compared. We analyzed the predictors of SUA > 360 µmol/L and poor disease control.Results: We collected 425 (90.8% of the patients) valid questionnaires. There were significant differences in the gender, education level, regular visits, medication adherence, diabetes, economic burden and community doctor's help between the SUA > 360 µmol/L (n=311, 73.18%) and ≤ 360 µmol/L (n=114, 26.82%) groups. The predictors of SUA >360 µmol/L were general medication adherence (OR=2.35; 95% CI 1.17–4.77; p=0.016), poor medication adherence (OR=4.63; 95% CI 2.28–9.51; p<0.001) and community doctor’s help (OR=0.60; 95% CI 0.37–0.97; p=0.036 for full model, OR=0.58; 95% CI 0.36–0.93; p=0.023 for simplified model). There were significant differences in the gender, regular visits, medication adherence, gout popular science, established health files, and community doctor’s help between the not well controlled (n=361, 84.94%) and well controlled (n=61, 14.35%) groups. The predictors of not well controlled were Tophi (OR=2.48; 95% CI 1.17–5.61; p=0.023), general medication adherence (OR=2.78; 95% CI 1.28–6.05; p=0.009), poor medication adherence (OR=6.23; 95% CI 2.68–14.77; p<0.001) and no gout popular science (OR=4.07; 95% CI 1.41–13.91; p=0.015).Conclusion: The T2T and well controlled rates were very low. The medication adherence, the community doctor’s help and gout popular science which was the doctor-led chronic gout management should be further improved to increase the T2T and well controlled rate.Trial registration: ChiCTR, ChiCTR2000034700, Registered 15 July 2020. http://www.chictr.org.cn/showproj.aspx?proj=55778


2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Keiji Konishi ◽  
Hidenori Nakagawa ◽  
Akio Nakahira ◽  
Takahiro Okuno ◽  
Takeshi Inoue ◽  
...  

Abstract Background Disseminated Mycobacterium avium complex infection is an important indicator of acquired immunodeficiency syndrome (AIDS) in patients with advanced human immunodeficiency virus (HIV) infection. Effective antiretroviral therapy has dramatically reduced the incidence of and mortality due to HIV infection, although drug resistance and poor medication adherence continue to increase the risk of disseminated M. avium complex infection. However, gastrointestinal lesions in cases of disseminated M. avium complex infection resulting in protein-losing enteropathy have been rarely discussed. Therefore, we present a case of protein-losing enteropathy caused by disseminated M. avium complex infection in a patient undergoing antiretroviral therapy. Case presentation A 29-year-old man was diagnosed with AIDS 4 years ago and was admitted for a 10-month history of refractory diarrhea and fever. Despite receiving antiretroviral therapy, the viral load remained elevated due to poor medication adherence. The patient was diagnosed with disseminated M. avium complex infection and started on antimycobacterial drugs 2 years before admission. However, the infection remained uncontrolled. The previous hospitalization 1 year before admission was due to hypoalbuminemia and refractory diarrhea. Upper gastrointestinal endoscopy revealed a diagnosis of protein-losing enteropathy caused by intestinal lymphangiectasia, and treatment with intravenous antimycobacterial drugs did not resolve his intestinal lymphangiectasia. The patient inevitably died of sepsis. Conclusions Clinical remission is difficult to achieve in patients with AIDS and protein-losing enteropathy caused by disseminated M. avium complex infection due to limited options of parenteral antiretroviral drugs. This report highlights the importance of identifying alternative treatments (such as an injectable formulation) for patients who do not respond to antiretroviral therapy due to protein-losing enteropathy with disseminated M. avium complex infection.


2021 ◽  
Vol 49 (10) ◽  
pp. 030006052110440
Author(s):  
Azeez Oyemomi Ibrahim ◽  
Segun Mattew Agboola ◽  
Olayide Toyin Elegbede ◽  
Waheed Olalekan Ismail ◽  
Tosin Anthony Agbesanwa ◽  
...  

Objective We determined the prevalence of poor glycemic control and associations with sociodemographics, comorbid conditions, and medication adherence among patients with type 2 diabetes mellitus (T2DM) at a tertiary hospital in southwestern Nigeria. Methods We conducted a retrospective observational study among 300 patients with T2DM using systematic random sampling. We used a semi-structured questionnaire to collect information on respondents’ sociodemographic profile, lifestyle, comorbid conditions, and antidiabetic medications. Adherence was determined using the Morisky Medication Adherence Scale. Fasting blood samples were tested using a glycated hemoglobin marker. Multivariate logistic regression was used to identify factors associated with poor glycemic control. Results Respondents’ mean age was 61.9 ± 11.8 years. The prevalence of poor glycemic control was 40.0% (95% confidence interval [CI]: 34.4%–45.8%). The adjusted odds ratio (95% CI) for factors associated with poor glycemic control was 2.522 (1.402–4.647) for older age, 1.882 (1.021–3.467) for low income, 1.734 (1.013–3.401) for obesity, 2.014 (1.269–5.336) for non-initiation of insulin therapy, and 1.830 (1.045–3.206) for poor medication adherence. Conclusion Older age, lower income, obesity, non-initiation of insulin, and poor medication adherence were associated with poor glycemic control. These variables may help clinicians identify patients at high risk of poor glycemic control.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anbrasi Edward ◽  
Brady Campbell ◽  
Frank Manase ◽  
Lawrence J. Appel

Abstract Background Poor medication adherence is an extraordinarily common problem worldwide that contributes to inadequate control of many chronic diseases, including Hypertension (HT). Globally, less than 14% of the estimated 1.4 billion patients with HT achieve optimal control. A myriad of barriers, across patient, healthcare provider, and system levels, contributes to poor medication adherence. Few studies have explored the reasons for poor medication adherence in Tanzania and other African countries. Methods A qualitative study applying grounded theory principles was conducted in the catchment area of two semi-urban clinics in Dar es Salaam, Tanzania, to determine the perceived barriers to HT medication adherence. Ten key informant interviews were conducted with healthcare providers who manage HT patients. Patients diagnosed with HT (SBP ≥ 140 and DBP ≥ 90), were randomly selected from patient registers, and nine focus group discussions were conducted with a total 34 patients. Inductive codes were developed separately for the two groups, prior to analyzing key thematic ideas with smaller sub-categories. Results Affordability of antihypertensive medication and access to care emerged as the most important barriers. Fee subsidies for treatment and medication, along with health insurance, were mentioned as potential solutions to enhance access and adherence. Patient education and quality of physician counseling were mentioned by both providers and patients as major barriers to medication adherence, as most patients were unaware of their HT and often took medications only when symptomatic. Use of local herbal medicines was mentioned as an alternative to medications, as they were inexpensive, available, and culturally acceptable. Patient recommendations for improving adherence included community-based distribution of refills, SMS text reminders, and family support. Reliance on religious leaders over healthcare providers emerged as a potential means to promote adherence in some discussions. Conclusions Effective management of hypertensive patients for medication adherence will require several context-specific measures. These include policy measures addressing financial access, with medication subsidies for the poor and accessible distribution systems for medication refill; physician measures to improve health provider counseling for patient centric care; and patient-level strategies with reminders for medication adherence in low resource settings.


Biomedicines ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 958
Author(s):  
Katherine A. Kelly ◽  
Adaora Ewulu ◽  
Veronica K. Emmerich ◽  
Courtney E. Heron ◽  
Steven R. Feldman

The rates of refractory pediatric psoriasis and atopic dermatitis (AD) have steadily risen over the last few decades, demanding newer and more effective therapies. This review aims to explore the reasons for resistant disease, as well as its management; this includes the indications for, efficacy of, and safety of current therapies for refractory pediatric dermatologic disease. A PubMed search for key phrases was performed. Poor medication adherence is the most common cause of resistant disease and may be managed with techniques such as simplified treatment regimens, more follow-ups and educational workshops, as well as framing and tailoring. Once problems with adherence are ruled out, escalating treatment to stronger biologic therapy may be indicated. Development of anti-drug antibodies (ADAs) can cause patients’ disease to be refractory in the presence of potent biologics, which may be addressed with regular medication use or concomitant methotrexate. If patients with AD fail to respond to biologic therapy, a biopsy to rule out mycosis fungoides, or patch testing to rule out allergic contact dermatitis, may be indicated. A limitation of this study is the absence of more techniques for the management of poor medication adherence. Managing medication adherence, escalating treatment when appropriate, and addressing possible anti-drug antibodies will help assure control and relief for patients with resistant disease.


2021 ◽  
Author(s):  
Keiji Konishi ◽  
Hidenori Nakagawa ◽  
Akio Nakahira ◽  
Takahiro Okuno ◽  
Takeshi Inoue ◽  
...  

Abstract Background: Disseminated Mycobacterium avium complex infection is an important indicator of acquired immunodeficiency syndrome (AIDS) in patients with advanced human immunodeficiency virus (HIV) infection. Effective antiretroviral therapy has dramatically reduced the incidence and mortality of HIV, although drug resistance and poor medication adherence continue to increase the risk of disseminated M. avium complex infection. However, gastrointestinal lesions in cases of disseminated M. avium complex infection resulting in protein-losing enteropathy have been rarely discussed. Therefore, we report a case of protein-losing enteropathy caused by disseminated M. avium complex infection in a patient undergoing antiretroviral therapy.Case presentation: A 29-year-old male diagnosed with AIDS for four years and was admitted for a 10-month history of refractory diarrhea and fever. Despite receiving antiretroviral therapy, viral load remained elevated due to poor medication adherence. The patient was diagnosed with disseminated M. avium complex infection and started on antimycobacterial drugs two years prior to admission. However, it remained uncontrolled. Previous hospitalization a year before admission was due to hypoalbuminemia and refractory diarrhea. Upper gastrointestinal endoscopy revealed a diagnosis of protein-losing enteropathy caused by intestinal lymphangiectasia, and treatment with intravenous antimycobacterial drugs did not resolve his intestinal lymphangiectasia. The patient inevitably died of sepsis.Conclusions: Clinical remission is difficult to achieve in patients with AIDS and protein-losing enteropathy caused by disseminated M. avium complex infection due to its limited options for parenteral antiretroviral drugs.


2021 ◽  
pp. 174498712199350
Author(s):  
Josephine Gibson ◽  
Jacqueline Coupe ◽  
Caroline Watkins

Background Secondary prevention medication after stroke reduces risk of recurrence, but adherence is often poor. Stroke survivors’, carers’ and nurses’ perspectives of early post-stroke medication adherence are unexplored. Aim The aim of this study was to explore stroke survivors’, carers’ and nurses’ views and experiences about adhering to medication early after post-stroke hospital discharge. Methods Qualitative individual and group interviews, utilising the Perceptions and Practicalities Framework, were employed. Nine people <2 months post-stroke, three carers and 15 nurses from one UK stroke unit participated. Interviews were digitally recorded, transcribed and thematically analysed. Results There were four main themes with two sub-themes. (1) Perceptions of medication taking after stroke. Factors affecting adherence included depression, imperceptible benefits and concerns about adverse effects. (2) Perceptions about those at higher risk of poor medication adherence. Nurses suggested that poor adherence might be more likely in those living alone or with previous non-adherence. (3) Practicalities of taking medication early after stroke; these included post-stroke disabilities, cognition, polypharmacy and lack of information. (4a) Practicalities of addressing poor medication adherence during the hospital stay. Solutions included multidisciplinary co-ordination, but nurses and stroke survivors described suboptimal use of opportunities to promote adherence. (4b) Practicalities of addressing poor medication adherence post-discharge. Solutions included modifications and support from carers, but stroke survivors reported difficulties in evolving systems for taking medications. Conclusions Stroke survivors and informal carers lack knowledge and support needed to manage medication early after discharge. Nurses’ opportunities to promote medication adherence are under-exploited. Medication adherence strategies to support stroke survivors early after discharge are needed.


Author(s):  
Fuad Adem ◽  
Jemal Abdela ◽  
Dumessa Edessa ◽  
Bisrat Hagos ◽  
Abraham Nigussie ◽  
...  

AbstractBackgroundDrug-related problems (DRPs) can occur at any stages of medication use processes, and a single drug could be associated with multiple DRPs. Once happened, it adversely affects health outcomes. In Ethiopia, evaluation of the magnitude and factors associated with DRPs had not been attempted at the national level.MethodThe literature search was conducted in the following databases; PubMed, Embase, Medline, and Google Scholar. The quality of the included studies was checked using Joanna Brigg’s Institute (JBI’s) checklist, and data were analyzed using Stata software (version 14.0). The pooled estimate of DRPs was computed by a Random effect model (DerSimonian–Laird method). Cochran’s Q test (I2) statistic)), and Begg’s correlation and Egger’s regression test were assessed for heterogeneity and publication bias, respectively.ResultOverall, 32 studies with a total sample size of 7,129 were included in the review. The estimated pooled prevalence of DRPs was 70% [0.70 (95% CI 0.64—0.76;I2 = 97.6%p = 0.000)]. Polypharmacy (taking ≥ 5 drugs) [RR = 1.3], medical comorbidity [RR = 1.3], poor medication adherence [RR = 1.7], uncontrolled blood pressure [RR = 1.4], substance use [RR = 1.2], type 2 diabetes [RR = 1.8], significant drug interaction [RR = 1.33], and a negative medication belief [RR = 3.72] significantly influenced the occurrence of DRPs.ConclusionThe estimated national prevalence of DRPs in Ethiopia was high.Presence of medical comorbidity, using multiple drugs, significant drug interaction, poor medication adherence, uncontrolled blood pressure, type 2 diabetes, substance use and a negative belief about medication significantly influenced the occurrence of DRPs. Initiating and/or strengthening pharmaceutical care services at the health care facilities could lower the occurrence of DRPs. PROSPERO registration number CRD42020162329.


PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249222
Author(s):  
Tariku Shimels ◽  
Rodas Asrat Kassu ◽  
Gelila Bogale ◽  
Mahteme Bekele ◽  
Melsew Getnet ◽  
...  

Objective This study aims to assess the magnitude and associated factors of poor medication adherence among diabetic and hypertensive patients visiting public health facilities in Addis Ababa, Ethiopia during the COVID-19 pandemic. Methods A multi-site cross-sectional design was conducted from 1st through 30th of August 2020 at public health facilities of the study area. Adult outpatients with T2DM and hypertension visiting hospitals and health centers were included in the study. A proportion to size allocation method was used to determine the required sample size per facility. Data was collected using the 8-item Morisky medication adherence scale. Descriptive statistics and binary logistic regression were used to analyze data. A 95% confidence interval and p≤0.05 statistical significance was considered to determine factors associated with poor medication adherence. Results A total of 409 patients were included in the present study. About 57% of the patients reported that the COVID-19 pandemic has posed negative impacts on either of their follow-up visits, availability of medications, or affordability of prices. And, 21% have reported that they have been affected in all aspects. The overall magnitude of poor medication adherence was 72%. Patients with extreme poverty were more likely to have good medication adherence (AOR: 0.59; 95%C.I: 0.36–0.97), whereas attendance to a health center (AOR: 1.71; 95%C.I: 1.02–2.85), presence of comorbidity (AOR: 2.05; 95%C.I: 1.13–3.71), and current substance use history (AOR: 11.57; 95%C.I: 1.52–88.05) predicted high odds of poor adherence. Conclusion Over a three-fourth of the patients, in the study setting, have poor adherence to their anti-diabetic and antihypertensive medications. Health facility type, income level, comorbidity, and current substance use history showed a statistically significant association with poor adherence to medication. Stakeholders should set alternative strategies as perceived impacts of the COVID-19 pandemic on medication adherence are high in the study area.


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