Factors Contributing to Medication Adherence in Patients with a Chronic Condition: A Scoping Review of Qualitative Research

Trust in nurses and its association with medication adherence of cardiovascular patients: A descriptive correlational study

Background

Medication adherence plays an important role in managing cardiovascular diseases. Trust in nurses may be effective in enhancing medication adherence in patients with cardiovascular diseases.

Aim

This study aimed to investigate the correlation between trust in nurses among cardiac patients and their medication adherence and explore the predictors of medication adherence.

Methods

This descriptive correlational design was conducted among "302″ cardiac patients hospitalized at Amir Al-momenin Teaching Hospital affiliated with Maragheh University of Medical Sciences. Data was gathered using a demographic characteristics questionnaire, Medication Adherence Scale, and Trust in Nurses' Scale. Data was analyzed using descriptive (frequency, percentage, mean, standard deviation, median, and descriptive tables) and inferential (Kruskal-Wallis, Mann-Whitney, Spearman correlation coefficient, and quartile regression) statistics. Data was gathered from October 2023 to January 2024. The data was analyzed using SPSS software ver.21.

Findings

The mean and standard deviation of medication adherence and trust in nurses were 91.6 ± 6.9 and 10.5 ± 3.9, respectively. A significant positive correlation was found between trust in nurses and medication adherence(r = 0.61). There was a significant difference in medication adherence based on the type of disease. So that, the median medication adherence was the highest for coronary artery patients and the lowest for hypertensive patients. The results of quartile regression analysis showed that trust in nurses and type of disease are the main predictors of medication adherence (R2 =20 %.).

Discussion and conclusions

The results indicated that medication adherence among cardiovascular patients was moderate and patients' trust in nurses was less than average. Considering the type of disease as an unmodifiable variable, trust in nurses was the main modifiable factor that plays an important role in increasing medication adherence of cardiovascular patients. Therefore, appropriate strategies such as teaching communication skills to nurses, and training and attracting interested individuals with high communication skills should be taken to enhance patients' trust in nurses.

Does access to medicines differ from access to healthcare? Experiences of barriers to medicines access by people facing social disadvantage

BACKGROUND

Levesque et al.'s widely-cited five dimensional model of access to healthcare has been used in a variety of contexts, including access to medicines. However the model is based on healthcare, i.e., facilities where health professionals work. We examined whether there were other important features of access to medicines, not captured by this model.

METHODS

A longitudinal qualitative study was conducted, repeatedly interviewing 21 households about their lives and access to medicines, over the course of a year. Participants were Māori, Pacific, former refugee, or New Zealand Europeans with limited incomes. Analysis was thematic and inductive.

RESULTS

Our participants experienced a number of barriers to accessing medicine, some of which do not fit comfortably within existing models of access to healthcare. For example, communication difficulties with healthcare staff (lack of appropriateness of care), had implications for medicine-taking after participants got home. Confusion about medicines identity, purpose and possible side effects, led to poorer access or under-use of prescribed medicines. Communication problems were particularly acute for former refugee participants. For them, communication in pharmacies was impossible because of lack of interpreters, severely restricting the information they had access to, and increasing the use of other less reliable sources of information. Crime, fear of crime, and the justice system also impacted on access in a variety of ways.

CONCLUSION

Because medicines are portable, physical objects taken at home, the effects of appropriateness of healthcare are played out in the home. Aspects of the wider, non-healthcare environment also impact on access to medicines in unexpected ways.

High Burden and Trend in Nonadherence to Blood Pressure-Lowering Medications: Meta-Analysis of Data From Over 34 000 Adults With Hypertension in Sub-Saharan Africa

BACKGROUND

Nonadherence to blood pressure (BP)-lowering medication is a strong predictor of poor BP control. Sub-Saharan Africa has extremely low BP control rates (~10%), but it is unclear what the burden of medication nonadherence among Africans with hypertension is. This systematic review estimated the prevalence and determinants of nonadherence to BP-lowering medications in Sub-Saharan Africa.

METHODS AND RESULTS

Multiple databases were searched from inception to December 6, 2023. Two reviewers performed independent screening, extraction, and quality assessment of studies. We pooled the prevalence estimates using random effects meta-analyses and summarized the determinants using a narrative synthesis. From the 1307 records identified, we included 95 studies published between 1995 and 2023. The overall prevalence of nonadherence to BP-lowering medication among 34 102 people treated for hypertension in 27 countries was 43.9% (95% CI, 39.2-48.6). There was no change in the prevalence of nonadherence over time. Nonadherence varied by measurement method and by median age (39.4%, ≥57 years versus 47.9%, <57 years). Socioeconomic and patient-related factors were the most frequent factors influencing adherence. Active patient participation in management, accurate perceptions, and knowledge of hypertension and its treatment predicted good medication adherence, whereas high pill burden, medication cost, side effects, and comorbidities predicted poor adherence.

CONCLUSIONS

Two out of every 5 people are nonadherent to their BP treatment. With the African population projected to increase from 1.4 to ~2.5 billion by 2050, targeted strategies are urgently needed to optimize medication adherence in people with hypertension in Sub-Saharan Africa.

Prevalence of information- and advice-seeking by patients for newly prescribed medicines and interventions to promote these behaviours: scoping reviews

OBJECTIVES

To conduct scoping reviews to assess the prevalence of information- and advice-seeking by patients from pharmacy personnel for newly prescribed medicines, and interventions to promote these behaviours.

METHODS

Standard scoping review methods were used and reported using the PRISMA-ScR checklist. Searches were conducted of electronic databases: Medline (via Ovid), Embase (via Ovid), Cinahl (via EBSCO host), and PsycINFO. MeSH terms and keywords were used. The inclusion period was 2010-2024. Independent, duplicate screening, data extraction, and quality appraisal was undertaken. Quality assessment was undertaken using validated tools.

KEY FINDINGS

Two studies were identified: prevalence (n = 1) and intervention (n = 1). Information was most frequently sought for dosage information and drug side effects. The intervention study evaluated the feasibility and acceptability of a computer kiosk to provide counselling and medication-related advice. The methodological quality varied from low (prevalence n = 1) to moderate (n = 2).

CONCLUSIONS

There is paucity of empirical data regarding the extent to which patients engage with information- and advice-seeking and the effectiveness of interventions to promote these behaviours. Knowledge about medicine increases the likelihood of medication adherence and intended health outcomes. This research has identified a knowledge gap in terms of the prevalence of information- and advice-seeking by patients for prescription medicines and the effectiveness of interventions to promote these behaviours. Effective strategies are needed to promote these behaviours to increase adherence and therapeutic benefit, and decrease waste and iatrogenic disease.

Contextual Factors Affecting Adherence Revealed by Old Patients with Heart Failure in Hospital and Primary Care Interactions: A Descriptive Study

Introduction

Old patients with heart failure are a vulnerable patient group facing various challenges, specifically during the transition from hospital to home. Non-biomedical factors, or "contextual factors", such as patient attitudes and social support, can influence treatment adherence. However, their role in clinical interactions is not well understood. This study aimed to identify and describe how and when these factors manifest during clinical interactions in the hospital-to-home transition.

Methods

We audio-recorded 42 old patients with heart failure admitted to hospital interacting with their physicians at: 1. the first ward visit, 2. discharge visit, 3. first primary care visit after discharge. Based on an umbrella review, we developed a list of 48 factors known to affect adherence among cardiovascular patients. Patient utterances from the recordings containing information on one of these factors (contextual indicators (CI)) were extracted and categorized according to the type of factor, mentioned impact, and being a facilitator or barrier to adherence.

Results

From the 105 audio recordings, 742 CI were identified, each interaction containing an average of 7 CI (SD = 4.2; median = 6). CI considered to have a potential impact on patient's life or adherence were overall evenly split between facilitators (n = 82, 42%) and barriers (n = 115, 58%), and both types of CI appeared in most patient trajectories. The most salient barrier CI was related to patients' concerns regarding medications side effects and regimen complexity, while CI facilitators were more commonly related to patients' knowledge, motivation and social support.

Discussion

The findings from this study provide insights for clinicians to the main types of non-biomedical factors revealed by old patients with heart failure in medical interactions, which affect their treatment adherence. Clinicians should particularly consider patient concerns regarding medications' side effects and the regimen complexity as important aspects to discuss, leveraging on motivational and social resources if present.

Medication adherence and its effect on health-related quality of life in respiratory tract infection patients using the St. George's Respiratory Questionnaire and the Medication Adherence Report Scale

Respiratory tract infections (RTIs) are common and pose significant health challenges, particularly in economically disadvantaged regions. Medication adherence is believed to influence patient quality of life (QoL), but the extent of this impact remains unclear. A cross-sectional study was conducted at Vivekananda General Hospital, Hubballi, India, from August 2023 to January 2024 to assess the relationship between medication adherence and QoL in RTI patients. This study involved 200 patients from the pulmonology department. Medication adherence was evaluated using the Medication Adherence Report Scale, while QoL was assessed with the St. George's Respiratory Questionnaire (SGRQ). A two-way analysis of variance was performed to examine associations between adherence and QoL scores. No significant correlation was found between medication adherence and QoL. SGRQ total, symptoms, activity, and impact scores did not differ significantly between less adherent and highly adherent patients (p: 0.570-0.944). Medication adherence alone may not significantly affect QoL in RTI patients. Other factors, including disease severity, medication efficacy, comorbidities, and socioeconomic conditions, might have a greater influence. Further research is needed to explore these determinants and develop strategies to improve patient outcomes.

Combined action of dietary-based approaches and therapeutic agents on cholesterol metabolism and main related diseases

BACKGROUND

Dyslipidaemia is among the major causes of severe diseases and, despite being well-established, the hypocholesterolaemic therapies still face significant concerns about potential side effects (such as myopathy, myalgia, liver injury digestive problems, or mental fuzziness in some people taking statins), interaction with other drugs or specific foods. Accordingly, this review describes the latest developments in the most effective therapies to control and regulate dyslipidaemia.

SCOPE AND APPROACH

Herein, the metabolic dynamics of cholesterol and their integration with the current therapies: statins, bile acid sequestrants, fibrates, niacin, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, reconstituted high-density lipoprotein (rHDL), or anti-inflammatory and immune-modulating therapies), were compared focusing their effectiveness, patients' adhesion and typical side-effects. Likewise, the interaction of these therapies with recommended dietary habits, focusing functional foods and nutraceuticals uptake were also considered.

KEY FINDINGS AND CONCLUSIONS

Since none of the current therapeutic alternatives represent an ideal solution (mainly due to side-effects or patients' tolerance), the potential adjuvant action of selected diets (and other healthy habits) was proposed as a way to improve the cholesterol-lowering effectiveness, while reducing the adverse effects caused by dose-increase or continuous uptake of alternating therapeutic agents. In general, the relevance of well-adapted diets must be acknowledged and their potential effects must be exhorted among patients, who need to be aware of the associated multifactorial advantages.

A scoping review of interventions to optimize medication adherence in hypertension comorbidity

BACKGROUND

Patients with hypertension and other comorbidities have difficulties adhering to their medications which have negative impacts on clinical outcomes. Although some studies have identified strategies to improve medication adherence, a thorough analysis of these interventions will provide synthesized evidence for clinical decision-making and improved health outcomes for patients with hypertension comorbidities.

AIM

To conduct a scoping review on interventions that have been utilised to improve medication adherence in patients with hypertension and other co-morbid conditions.

METHODS

A systematic literature search was conducted in the following databases: CINAHL, COCHRANE TRIALS, MEDLINE, and SCOPUS. One (1) search engine, GOOGLE SCHOLAR was included. This was done between September 2023 to February 2024. The PRISMA-SCR guidelines were followed for this review. A total of 456 unique studies were identified after duplicates were removed. Following screening and eligibility assessments, 26 papers were selected for review with a focus on the study aim and purpose, study population, interventions used and adherence measures.

RESULTS

Most of the interventions were delivered by pharmacists, with 25 studies utilising the multimodal intervention approach. A total of 22 studies (80 % of the total) found that the interventions significantly improved medication adherence. Results from 16 studies showed a significant improvement in blood pressure. Improvements in medication adherence were a common outcome of interventions that focused on patient education.

CONCLUSION

Interventions such as patient education, simplified treatment regimens, and multidisciplinary care can improve medication adherence and clinical outcomes in patients with hypertension and comorbidities, but further research is needed to understand long-term effects.

Implementation of a Faith Community Nursing Transition of Care Program in the USA: A Propensity Score Matching Analysis

Faith community nursing (FCN) is a specialty nursing practice that integrates spiritual and religious practices into patient care. This study aimed to quantitatively assess the impact of the standardized FCN transition of care (TOC) program on the rate of hospital readmission and length of stay (LOS) through propensity score matching and difference-in-differences methods. Compared with those in the non-FCN group (n = 409), patients in the FCN group (n = 66) had a reduced likelihood of hospital readmission at 30, 90, and 180 days after discharge (by 8.8%, 9.0%, and 9.5%, respectively). Additionally, the FCN group exhibited a shorter LOS by 0.31, 0.53, and 0.87 days at 30, 90, and 180 days, respectively. The present study thus demonstrated the successful implementation of the FCN TOC program in a hospital setting, which reduced both the hospital readmission rate and LOS after discharge.

Long-term controlled release with reduced initial burst release utilizing calcium ion-triggering nanoaggregates of pasireotide-loaded fattigated albumin nanoparticles

The aim of this study was to investigate the long-term controlled release of peptide-loaded fattigated albumin nanoparticles via calcium ion-triggering nanoaggregation with minimal initial burst release. Fattigated albumin nanoparticles were prepared via sonication by the self-assembly of human serum albumin (HSA)-oleic acid conjugates (AOC) with three different substitution ratios of oleic acid (OA) to modulate hydrophobicity. Then, pasireotide pamoate (PAS) as a model peptide was encapsulated into the hydrophobic core of HSA-OA nanoparticles (PAS-AONs). The critical micelle concentration of AOC decreased as OA substitution ratio increased. The loading efficiency of PAS increased owing to the strong hydrophobic-hydrophobic interactions between PAS and the hydrophobic block in the AONs. The release rate was also delayed, whereas the initial burst release was minimized, as the hydrophobicity of AOC increased. Interestingly, calcium ions triggered the formation of nanoaggregates of negatively charged PAS-AONs via electrostatic interactions, resulting in a further decrease in the release rate for one month via a reduced surface area while minimizing the initial burst release in a calcium ion concentration-dependent manner. The modulation of OA substitutions and calcium ion concentration of AONs could provide the potential for long-term delivery of peptide drugs while minimizing the initial huge burst release and controlling the release rate.

Disparities in Antidiabetic Medication Discontinuation Between Non-Hispanic White and Black Beneficiaries in Medicare Across Diabetes Belt and Surrounding Area

OBJECTIVE

To assess racial and geographic disparities in antidiabetic medication discontinuation among Medicare beneficiaries with type 2 diabetes (T2D) in or around Diabetes Belt (DB) areas, with a specific focus on differences between non-Hispanic (NH) white and NH Black individuals.

STUDY DESIGN

A retrospective cohort analysis was conducted on Medicare beneficiaries who initiated metformin and used antidiabetic medications during 2011-2015, including metformin, sulfonylureas, insulin, DPP-4 inhibitors, GLP-1 receptor agonists, SGLT2 inhibitors, and thiazolidinediones. Medication discontinuation was defined as a gap of 90 days or more without any antidiabetic medications.

METHODS

Multivariable Cox regression was used to examine the influence of racial and geographic factors on medication discontinuation, controlling for demographic, socioeconomic, and contextual factors. The interaction between race and DB status was also examined.

RESULTS

Among 21,159 Medicare beneficiaries initiating metformin during the study period, 8710 (41.2%) experienced medication discontinuation. NH Black individuals had a significantly higher discontinuation risk (HR: 1.22, 95% CI: [1.162, 1.286]) compared to NH White individuals. No significant geographic difference (HR: 1.02, 95% CI: [0.973, 1.072]) was observed between DB and Non-Diabetes Belt (NDB). NH Black patients consistently showed significantly higher discontinuation risks within both DB and NDB. No significant difference was found within the same race across counties.

CONCLUSION

We found significant racial but no geographic disparities in antidiabetic medication discontinuation among Medicare beneficiaries with T2D. Further research is needed to understand the underlying factors to improve equitable diabetes care management.

Factors that determine patients considering medication for the disease of obesity: an IMI2 SOPHIA study

OBJECTIVE

Obesity-related problems can now be managed with effective nutritional therapy, pharmacotherapy, and surgeries that achieve >10% weight loss. Assessing patient preferences, treatment choices, and factors affecting patients can improve treatment compliance and efficacy. Our aim was to identify factors affecting patient preference and subsequent choice of pharmacotherapy among those seeking treatment for obesity-related disorders.

METHODS

A participatory action study using purposeful sampling recruited 33 patients with obesity complications. They were referred to specialist clinics in non-alcoholic fatty liver disease, diabetes mellitus, hypertension, and chronic kidney disease. Sixteen males and seventeen females aged 18-70 years, with BMI > 35 kg/m2 were recruited. Before the interview, participants watched a 60-minute video explaining nutritional therapy, pharmacotherapy, and surgery in equipoise. Data were collected in semi-structured interviews; Reflective thematic analysis was used. This sub study focuses only on patients who expressed specific attitudes (positive or negative) towards pharmacotherapy.

RESULTS

Ten (30%) patients expressed a view on pharmacotherapy. Eight (24%) patients chose pharmacotherapy alone, whereas two (6%) patients chose pharmacotherapy combined with nutritional therapy. In this sub study focusing on pharmacotherapy, five themes were identified related to choosing whether or not to take medication: (1) attitudes towards pharmacotherapy, (2) attitudes toward size of obesity and its complications, (3) weighing the benefits and risks of treatment, (4) knowledge and reassurance of health professionals, and (5) costs associated with drug therapy.

CONCLUSION

The primary concerns regarding pharmacotherapy for intentional weight loss were efficacy, side effects, lifelong dosing, pharmacokinetics, and cost. Providing access to information about all the pharmacotherapies and the benefits is likely to result in greater penetrance of treatment.

The Effects of Diverse Interventions on Diabetes Management Among Arabs With Diabetes: A Systematic Review

AIM

To identify, describe, and critically evaluate the effects of various interventions on diabetes management outcomes among Arabs with diabetes.

DESIGN

A systematic review.

DATA SOURCES

The search was conducted across three databases: PubMed, CINAHL and the Cochrane Collaboration in December 2023.

REVIEW METHODS

Screening involved randomised controlled trials and nonrandomised studies that focused on the effects of interventions on diabetes management among Arab with diabetes. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist guided the review process. Two researchers independently applied eligibility criteria. Data extraction captured key study details, and methodological quality was assessed using Downs and Black's checklist. This review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42024555668).

RESULTS

Thirty-five articles were reviewed, yielding 65 outcomes. Effective interventions included personalised care, patient-centred education and direct patient contact through lifestyle modifications, advice, feedback, motivational conversations and calls. These approaches improved haemoglobin A1c, fasting blood glucose, physical activity and medication adherence. Conversely, nonpersonalised remote monitoring and social media interventions showed no significant improvements. Notably, tailored nutritional and physical activity advice positively impacted body mass index and systolic blood pressure among Arab women with diabetes.

CONCLUSION

The findings underscore the effectiveness of personalised care and direct patient contact in optimising diabetes management among Arabs with diabetes.

IMPACT

This review highlights the importance of prioritising direct patient contact over remote methods such as social media in interventions on diabetes management among Arabs with diabetes. It emphasises the need for culturally sensitive approaches, particularly for women.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution, as this study constitutes a review of existing research.

Acceptability of a 250 mg levofloxacin formulation in children receiving TB preventive treatment

BACKGROUND

Recent evidence indicates that levofloxacin (LFX) is effective in preventing TB in individuals exposed to multidrug-resistant TB (MDR-TB). Despite the need for pediatric formulations, the 250 mg adult LFX formulation is affordable and widely used for TB treatment and prevention in children.

METHODS

TB-CHAMP (Tuberculosis Child Multidrug-resistant Preventive Therapy ISRCTN92634082) was a trial of MDR-TB preventive treatment, comparing levofloxacin to placebo in children with MDR-TB exposure. Acceptability questionnaires were administered to caregivers at six timepoints during the 24-week treatment phase. Likert scales were used to grade 6 domains of acceptability, and a composite acceptability (CA) outcome was generated. Factors associated with acceptability were assessed using modified Poisson regression models to estimate risk ratios (RRs).

RESULTS

Overall, 922 children were randomised, 453 to LFX and 469 to placebo. By Week 8, 25.1% of children on LFX had poor CA versus 6.2% receiving placebo (Weeks 0-24: RR 3.43, 95% CI 2.69-4.37). Acceptability in the LFX arm improved from 36.8% poor CA at baseline to 12.9% at Week 24. Only 11.7% of children swallowing tablets whole/halved had poor CA outcomes at Week 8, compared to 34.4% swallowing crushed/softened tablets.

CONCLUSION

LFX 250 mg tablets have reasonable acceptability and could be used as an alternative to dispersible formulations, especially in children able to swallow tablets.

Health beliefs mediates the association between the number of non-communicable diseases and preventive behaviors in middle-aged and older adults in southern China

BACKGROUND

The triadic relationship among the number of NCDs, preventive behaviors and health beliefs has not been fully explored, especially the role of health beliefs.

AIMS

To explore the association between the number of NCDs and preventive behaviors, as well as the mediating effect of health beliefs and its dimensions among middle-aged and older adults. Provide scientific evidence for developing targeted behavior intervention.

METHODS

Data from 2095 middle-aged and older adults who completed demographic information, health beliefs and preventive behaviors questionnaire. Mediation analysis was used to explore the association of health beliefs and its dimensions between the number of NCDs and preventive behaviors.

RESULTS

Health beliefs and self-efficacy positively impacted preventive behaviors, whereas perceived severity, while perceived barriers had negative effects. Health beliefs (β = - 0.1809, 95% CI - 0.2658 to - 0.0960) and its dimensions(Perceived barriers:β = - 0.0881, 95% CI - 0.1533 to - 0.0232, self-efficacy: β = - 0.2706, 95% CI - 0.3592 to - 0.1892) partially mediated the associations between the number of NCDs and preventive behaviors. The negative mediation effects indicates that as the number of NCDs increases, preventive behaviors decrease, partly due to a decline in health beliefs and self-efficacy, as well as an increase in perceived barriers (scored inversely, meaning higher barriers). These mediation pathways exhibited modest strength, highlighting the importance of health beliefs on behavior change.

CONCLUSIONS

An increasing number of NCDs is associated with reduced engagement in preventive behaviors. Health beliefs and its dimensions play a partial mediating role in this relationship. Effective intervention targeting health beliefs may help promote positive behavioral changes.

A narrative review on the psychosocial domains of the impact of organ transplantation

This review explores organ transplantation, spanning historical developments, psychosocial impacts, and future directions. In the pre-transplantation phase, evaluations of psychosocial factors, including substance use, mental health, and social support, are essential for successful outcomes. However, linking total psychosocial risk scores to post-transplant outcomes remains challenging despite available tools and assessments. Patient selection criteria and psychological assessments are pivotal in achieving successful transplantation outcomes. The age of donors significantly impacts transplant outcomes across various organs, highlighting the urgency of addressing organ shortages. Meticulous patient selection, including thorough psychosocial evaluations, ensures recipients possess the necessary emotional resilience and support systems for successful transplantation. Both pre- and post-transplantation psychological evaluation processes are crucial for assessing and supporting individuals throughout the transplant journey. Posttransplant evaluations continue to monitor adjustment difficulties, medication adherence, and complex emotions, enabling timely intervention and personalized support. The waiting period before transplantation presents significant challenges, including uncertainty, anxiety, and social isolation. Robust emotional support and coping mechanisms are crucial during this transitional phase, fostering resilience and hope among waitlist candidates. Psychological challenges during and after transplantation, including anxiety, depression, and sleep disturbances, are common among recipients. Coping mechanisms, such as religious/spiritual approaches, social support, and participation in support groups, play pivotal roles in patient adjustment and recovery. Ethical considerations are paramount in ensuring fair and effective transplantation practices, including organ allocation, adherence to post-transplant care, financial burdens, and the interplay between medical and psychosocial factors.

Effects of a Multimodal Program on Frailty Syndrome and Psychological Alterations in Breast Cancer Women Treated with Aromatase Inhibitors

Background/Objectives: Treatment with aromatase inhibitors can worsen frailty syndrome and psychological symptoms in women diagnosed with breast cancer (BC) receiving these drugs to prevent cancer recurrence. We analyze whether postmenopausal women with localized BC receiving aromatase inhibitors (AIs) treatment can achieve improvements in their mental health and their level of frailty through a multimodal program that includes supervised physical exercise and health education workshops. Methods: A total of 52 postmenopausal women with a prior diagnosis of BC and receiving hormonal treatment with AIs were included in the multimodal physical exercise and health education program and evaluated before and after it. The assessment included the following five frailty syndrome (FS) criteria: involuntary weight loss, weakness, low physical activity, slow gait speed, and low muscle strength. Mental health was assessed using the Goldberg scale, with its subscales for anxiety and depressive symptoms. The Athens scale was used to assess subjective sleep quality. Results: There was a significant difference in the number of robust, pre-frail and frail women after the program compared to the baseline. Six women did not fulfill any criteria for (robust) FS before the program (11.5%), and thirty-three women (63.5%) after the program did not fulfill any criteria for FS. A total of 33 (63.5%) women met one or two FS criteria (pre-frail) before the program, and 18 (34.6%) met one or two FS criteria after the program; thirteen (25%) women met three or more FS criteria (frail) before the program and one (1.9%) after it (p < 0.001). A statistically significant improvement on the Goldberg scale was observed (on both the subscales for anxiety and depressive symptoms) (p < 0.001). A statistically significant improvement was also noted on the Athens insomnia scale (p < 0.001). A multivariate regression model analysis identified marital status (being married) (p = 0.047, beta coefficient= -0.249, 95% CI -1.4844--0.14) and the percentage of attendance at training sessions (p = 0.041, beta coefficient = -0.290, 95% CI 0.104-0.002) as associated variables, with a lower score on the Goldberg depression subscale. Conclusions: Mental health and frailty, common in postmenopausal women diagnosed with BC on hormonal treatment with AI, can be improved with multimodal programs of supervised physical exercise and health education.

Prevalence of adherence and its impact on quality of life in oral anticoagulant users in Egypt: A cross-sectional study from two Egyptian university hospitals

BACKGROUND

Oral anticoagulant therapy (OAT) is critical for managing thromboembolic disorders, but adherence challenges significantly impact its effectiveness and patients' quality of life (QoL). This study explores the predictors of adherence and their effects on QoL among OAT users in Egypt.

METHODS

This multi-center cross-sectional descriptive study with an analytical component was conducted at Mansoura University Hospital and Ain Shams University Hospital. Participants were adults over 18 years old, on OAT for at least one month, who provided informed consent. Convenience sampling was used to recruit 212 participants. Data were collected using a survey that included socio-demographic details, the Arabic Version of the Adherence to Refills and Medications Scale (ARMS), and the WHOQOL-BREF questionnaire. Statistical analyses included descriptive statistics, chi-square tests, Student's t-tests, and multivariate logistic regression.

RESULTS

The study included 212 participants, with an average age of 55 years, 57% female and 43% male. Among the participants, 25.5% were adherent to their anticoagulant regimen, while 74.5% were non-adherent. Adherence was significantly higher among NOAC users (44.4%) compared to warfarin users (19.0%). Key predictors of adherence included the use of NOACs (OR = 2.7), residency in rural areas (OR = 2.4), and having first-degree relatives in medical specialties (OR = 2.4). Quality of life scores were significantly higher for NOAC users in psychological, social, and environmental domains compared to warfarin users. The overall QoL score was also higher in NOAC users. Poorer adherence was associated with lower scores in these QoL domains.

CONCLUSIONS

Our study indicates that NOACs enhance adherence and quality of life relative to VKAs. Key adherence predictors include NOAC use, rural residency, and having relatives in medical professions. Educational level, initially significant, did not persist as a predictor in multivariate analysis. Targeted strategies are needed to improve adherence and patient outcomes.

Adherence to a digital therapeutic mediates the relationship between momentary self-regulation and health risk behaviors

Introduction

Smoking, obesity, and insufficient physical activity are modifiable health risk behaviors. Self-regulation is one fundamental behavior change mechanism often incorporated within digital therapeutics as it varies momentarily across time and contexts and may play a causal role in improving these health behaviors. However, the role of momentary self-regulation in achieving behavior change has been infrequently examined. Using a novel momentary self-regulation scale, this study examined how targeting self-regulation through a digital therapeutic impacts adherence to the therapeutic and two different health risk behavioral outcomes.

Methods

This prospective interventional study included momentary data for 28 days from 50 participants with obesity and binge eating disorder and 50 participants who smoked regularly. An evidence-based digital therapeutic, called Laddr™, provided self-regulation behavior change tools. Participants reported on their momentary self-regulation via ecological momentary assessments and health risk behaviors were measured as steps taken from a physical activity tracker and breathalyzed carbon monoxide. Medical regimen adherence was assessed as daily Laddr usage. Bayesian dynamic mediation models were used to examine moment-to-moment mediation effects between momentary self-regulation subscales, medical regimen adherence, and behavioral outcomes.

Results

In the binge eating disorder sample, the perseverance [β 1 = 0.17, 95% CI = (0.06, 0.45)] and emotion regulation [β 1 = 0.12, 95% CI = (0.03, 0.27)] targets of momentary self-regulation positively predicted Laddr adherence on the following day, and higher Laddr adherence was subsequently a positive predictor of steps taken the same day for both perseverance [β 2 = 0.335, 95% CI = (0.030, 0.717)] and emotion regulation [β 2 = 0.389, 95% CI = (0.080, 0.738)]. In the smoking sample, the perseverance target of momentary self-regulation positively predicted Laddr adherence on the following day [β = 0.91, 95% CI = (0.60, 1.24)]. However, higher Laddr adherence was not a predictor of CO values on the same day [β 2 = -0.09, 95% CI = (-0.24, 0.09)].

Conclusions

This study provides evidence that a digital therapeutic targeting self-regulation can modify the relationships between momentary self-regulation, medical regimen adherence, and behavioral health outcomes. Together, this work demonstrated the ability to digitally assess the transdiagnostic mediating effect of momentary self-regulation on medical regimen adherence and pro-health behavioral outcomes.

Clinical Trial Registration

ClinicalTrials.gov, identifier (NCT03774433).

Fibromyalgia: Understanding, Diagnosis and Modern Approaches to Treatment

Fibromyalgia (FM) is a chronic condition characterized by generalized musculoskeletal pain associated with other symptoms, especially sleep and mood disorders, fatigue, and cognitive dysfunctions. The etiopathogenesis of FM is not sufficiently known, and regardless of numerous research, the clinical presentation is nonspecific, which makes it difficult to approve a timely diagnosis and, subsequently, an adequate therapeutic approach. Genetic, hormonal, immunological, and environmental factors are cited as potential factors in the development of this condition. Diagnosis is based on a clinical approach and known diagnostic criteria, while additional methods, such as radiographic, magnetic resonance, or laboratory analyses, can be useful to exclude other conditions. The heterogeneity of FM significantly impacts both diagnosis and treatment, as it presents a wide spectrum of symptoms that vary in severity, combinations, and underlying contributing factors. This variability is a challenge for clinicians and requires a holistic, comprehensive, multidisciplinary, patient-centered approach. According to The European League Against Rheumatism (EULAR) from 2016, treatment begins with patient education and involves the simultaneous application of pharmacological and nonpharmacological treatments. The application of only pharmacological or nonpharmacological treatment is most often not successful. Due to differences in pain threshold, psychological factors, and comorbidities, patients may respond differently to the same interventions. Although there is no universal treatment, this review brings up the fact that the timely recognition of symptoms and a tailored treatment with a patient-centered plan can significantly improve the quality of life of patients.

Polysaccharide-based hydrogels for atopic dermatitis management: A review

Atopic dermatitis (AD) is the most common form of eczema and the most burdensome skin disease globally, affecting nearly 223 million. A major AD predisposition is genetic susceptibility, affecting skin barrier integrity and cell-mediated immunity. Manifesting as red, dry, and itchy skin, basic treatment involves skin hydration with emollients. Despite their effectiveness, poor patient compliance remains a major drawback. In severe cases, medicated emollients are used, but carry risks, including skin thinning, and immunosuppression. Hence, hydrogels have emerged as a promising alternative for AD management based on their ability to improve skin hydration, attributed to their hydrophilicity and high water retention capacity. Moreover, researchers have loaded hydrogels with various compounds for AD management; they also hold the potential to reduce systemic side effects of commercial drugs by enhancing dermal retention. Hydrogels address the challenges of patient compliance based on their non-greasy texture and reduced application frequency. Their appeal also stems from their versatility, as they can be fabricated from varying polymers. Due to their abundance, this review focuses on polysaccharides including alginate, cellulose, chitosan, and hyaluronic acid, which are preferred for fabricating natural and modified natural hydrogels for AD. It also briefly explores hydrogel application methods and key AD models.

Pharmacoequity measurement framework: A tool to reduce health disparities

Pharmacoequity is a health system and policy goal of ensuring equitable access to high-quality medications for all individuals, regardless of factors such as race, ethnicity, socioeconomic status, or resource availability to reduce health disparities. Although measurement frameworks have been widely used in health equity contexts, a focused framework for pharmacoequity remains a critical gap. In this article, we introduce a novel pharmacoequity measurement framework anchored in the patient medication-use journey. The framework includes the following domains: (1) access to health care services, (2) prescription generation, (3) primary medication nonadherence, (4) secondary medication nonadherence, and (5) medication monitoring. For each domain, we provide examples of outcome measures and potential data sources that can be used for evaluation. We also outline an implementation workflow of the pharmacoequity measurement framework that population health stakeholders can use across various settings (eg, health systems, health plans). The framework provides a structured approach to identify existing gaps in the path toward achieving pharmacoequity and lay the foundation for targeted interventions. Additionally, it enables ongoing monitoring of progress toward achieving pharmacoequity while identifying interventions that are effective, scalable, and sustainable.

Sex Differences in Prescription Patterns and Medication Adherence to Guideline-Directed Medical Therapy Among Patients With Ischemic Stroke

BACKGROUND

Ischemic stroke is a leading cause of death and disability. Society guidelines recommend pharmacotherapies for secondary stroke prevention. However, the role of sex differences in prescription and adherence to guideline-directed medical therapies (GDMT) after ischemic stroke remains understudied. The aim of this study was to examine sex differences in prescription patterns and adherence to GDMT at 1 year after ischemic stroke in a cohort of commercially insured patients.

METHODS

Using the Truven Health MarketScan database from 2016 to 2020, we identified patients admitted with ischemic stroke. GDMT was defined as any statin, antihypertensive agents, or oral anticoagulant prescription within 30 days after discharge. Medication adherence was estimated using the proportion of days covered at 1 year. The proportion of days covered <0.80 was used to define nonadherence. A multivariable model adjusting for covariates was performed to identify the factors associated with nonadherence at 1 year. This analysis was restricted to new users of GDMT.

RESULTS

Among 155 220 patients admitted with acute ischemic stroke during the study period, 15 919 met the inclusion criteria. The mean age was 55.7 years, and 8218 (51.7%) were women. Women were less likely to be prescribed statins (58.0% versus 71.8%) and antihypertensive agents (27.7% versus 41.8%). In this subset of patients with atrial flutter/fibrillation, women were also less likely to be prescribed oral anticoagulants (41.2% versus 45.0%). Women were more likely to be nonadherent (ie, proportion of days covered <0.80) to statins (47.3% versus 41.6%; P<0.0001), antihypertensives (33.3% versus 32.2%; P=0.005), and the combination of both (49.6% versus 45.0%; P=0.003). On multivariable analysis, women were likely to be nonadherent to statins and antihypertensive agents at 1 year (odds ratio, 1.23 [95% CI, 1.08-1.41]).

CONCLUSIONS

In this real-world analysis of commercially insured patients with ischemic stroke, women were less likely initiated on GDMT within 30 days after discharge. Women were more likely to be nonadherent to statins and antihypertensive agents at 1 year. Future efforts and novel interventions are needed to understand the reasons and minimize these disparities.

The Association Between Medication Adherence and Rational Drug Use Knowledge and Health Literacy in Older Adults Residing in Nursing Homes

BACKGROUND

Medication adherence is a crucial factor in managing and treating chronic diseases in older adults. Health literacy (HL) skills and rational drug use (RDU) knowledge are important for individuals to make informed decisions about medication adherence behaviours.

AIM

This study was conducted to determine the association between medication adherence and rational drug use knowledge and health literacy in older adults residing in nursing homes.

METHODS

The cross-sectional study was conducted with 121 older adults residing in a nursing home in Turkey. The data were collected using the Participant Information Form, the Medication Adherence Report Scale (MARS-5), the Rational Drug Use Scale (RDUS), and The Turkish version of the European Health Literacy Survey Questionnaire (HLS EUEU-Q-TR).

RESULTS

The mean age of the older adults was 69.92 ± 6.45 years and 76.9% were male. The mean score of MARS-5 was 21.80 ± 3.55. Among older adults, 43.8% were found to have inadequate RDU knowledge, 28.9% had inadequate HL, and 46.3% had problematic-limited HL. The RDU knowledge was a statistically significant strong predictor of medication adherence (R2 = 0.495, p < 0.001). The HL was a statistically significant predictor of medication adherence (R2 = 0.037, p < 0.05).

CONCLUSION

The study found that medication adherence among older adults residing in nursing homes was moderate, RDU knowledge and HL levels were low, and medication adherence increased as RDU knowledge and HL levels increased.

Does drug dispensing influence patients' medication knowledge and medication adherence? A systematic review and meta-analysis

BACKGROUND

Inadequate medication knowledge and medication nonadherence by patients are considered an issue in healthcare, as they can lead to negative outcomes, such as therapeutic failures and hospitalization. Even though drug dispensing, which has pharmacist counseling as a core element, is a service traditionally performed by pharmacists, there is still no evidence about the influence of this service on these health outcomes.

OBJECTIVE

To evaluate the influence of drug dispensing on patients' medication knowledge and medication adherence.

METHODS

A systematic review was conducted in which a literature search was performed in the PubMed/Medline, Biblioteca Virtual da Saúde, Web of Science, and Embase databases, as well as in gray literature. Two reviewers read the titles, abstracts and complete texts according to the eligibility criteria and extracted the data from the included articles. Original studies-of any design-evaluating the influence of drug dispensing on patients' medication knowledge and/or adherence in community pharmacies were included. The methodological quality was assessed through the tools provided by the JBI Institute. The data was analyzed through qualitative synthesis and a meta-analysis was conducted for randomized controlled trials which used the outcome of medication adherence using the RStudio version 4.3.3 program.

RESULTS

A total of 7,590 studies were identified in the initial search, of which 11 articles met the eligibility criteria and were included in this systematic review. The studies were published in Africa, Latin America, Asia, Europe and Australia. Most of the studies were interventional (n = 7). Four studies evaluated the influence of drug dispensing on the patient's medication knowledge, and all showed that knowledge increased after dispensing. Eight studies evaluated the influence of dispensing on medication adherence. Three studies were included in the meta-analysis, which showed moderate heterogeneity (I2 = 44%, p = 0.17). The results indicated that there was no statistically significant difference in medication adherence post-dispensing (RR: 1.19; 95%CI 0.99 to 1.43, p = 0.07). Six studies met more than 70% of the quality assessment criteria.

CONCLUSION

This systematic review demonstrated that patient's medication knowledge can be increased through drug dispensing. However, the meta-analysis indicated that drug dispensing does not have an impact on medication adherence. Our findings can support evidence-based decisions, guiding the planning and development of public policies and interventions which improve drug dispensing for patients, families, and communities.

Associations between dialysis modality and adherence to immunosuppression after kidney transplantation-A single-center study

BACKGROUND

Patients with end-stage kidney disease often prefer home-based dialysis due to higher self-efficacy, which relates to improved medical treatment adherence. Kidney transplantation (KT) success depends on adhering to immunosuppressive medication post-transplant.

OBJECTIVES

To investigate whether adherence post-kidney transplantation (KT) and patients' attitudes toward immunosuppression were influenced by their prior dialysis type modality. Additionally, the study examined if adherence and patient's attitudes towards immunosuppression are associated with kidney graft survival.

METHODS

This cross-sectional single-center study included 201 KT patients. Adherence was assessed using BAASIS and the coefficient of variation of calcineurin inhibitors (COV-CNI). Patient attitudes towards medication were evaluated using the Q-method. Pill burden, comorbidity score and HRQoL and medication complexity, were scored. Cox regression was applied to determine KT survival outcomes over a 14-year follow-up period (until Dec 2021).

RESULTS

Prior dialysis modality was not associated with adherence to immunosuppression post-KT evaluated by BAASIS on average 4.7 years post-KT. Previous in-center hemodialysis patients had a higher CNI-COV (p = 0.011). The Q-sort analysis identified fully adherent patients linked to profile 1 (organized, resilient) whereas profile 2 patients were more careless. Patients linked to profile 3 (challenging, nervous) had higher education, a higher pill burden, and experienced more immunosuppression side effects. Death-censored graft loss increased by 7.6% with each additional pill, quadrupled if one dose of immunosuppression was missed, and increased by 2.9% for each point of COV-CNI rise.

CONCLUSIONS

Adherence to immunosuppression post-KT using BAASIS was not associated with prior dialysis type, despite in-center hemodialysis patients showing the highest COV-CNI. Taking COV-CNI into account, managing missed doses of immunosuppressants, and exploring patient attitudes could potentially enhance adherence and consequently improve KT survival.

Insulin therapy adherence and its associated factors among diabetic patients in a Ghanaian primary care hospital

BACKGROUND

Diabetes mellitus (DM) is a global health problem. Adherence to intensive insulin therapy is necessary to achieve better glycemic control in types 1 and 2 DM. This study aimed to evaluate the extent of adherence to insulin therapy, its predictors and to identify barriers to its adherence.

METHOD

This was a cross-sectional survey among adult (≥18 years) diabetic patients who are currently using insulin, either alone or in combination with an oral antidiabetic regimen, and seeking primary care at Kwame Nkrumah University of Science and Technology Hospital in Ghana. A total of one hundred and eight-six patients were conveniently sampled, and interviewed. Insulin adherence was determined using the Medication Adherence Reporting Scale-5. Descriptive statistics, a chi-square test of independence, and a multiple logistic regression analysis were performed using STATA version 14 (StataCorp, TX USA).

RESULTS

The majority of the patients interviewed were over 60 years (40.32%); female (61.83%); married (68.82%); and had completed secondary education (48.39%). 67.20% of the patients were adherent to insulin therapy. Adherence level was associated with age (p = 0.020), marital status (p = 0.001), employment status (p = 0.012), type of DM (p<0.001), regular follow-up (p = 0.007) and comorbidities (p = 0.002) and was only predicted by the type of DM (aOR = 14.82 C.I 1.34-163.50, p-value = 0.028).

CONCLUSION

Adherence to insulin therapy among our study population was suboptimal, which is a concern considering the associated increased risk of complications. Adherence assessment and counselling by healthcare professionals to address barriers to poor adherence must be continually undertaken to achieve optimal glycemic control.

IMPACT OF FINDINGS ON PRACTICE STATEMENTS

Continuous adherence assessment and counselling must be offered to all diabetes mellitus patients on insulin therapy as part of their ambulatory care to help improve outcomes.Using the Medication Adherence Reporting Scale-5 to determine patient adherence levels is an easy-to-use and an inexpensive method; however, it should be used with caution due to the potential for misclassification.Efforts must be made to provide appropriate strategies to deal with barriers to insulin adherence at ambulatory care clinics as part of the individualized comprehensive diabetic care to reduce diabetic complications.

Assessing Hypertension Management in Peru's Peri-Urban Community in the Wake of the COVID-19 Pandemic

BACKGROUND

Hypertension is a global health challenge, particularly in low- and middle-income countries. Peri-urban areas such as Pampas de San Juan de Miraflores, Peru, face challenges that the COVID-19 pandemic exacerbated.

OBJECTIVE

To assess the post-COVID-19 hypertension care cascade and mean systolic blood pressure (SBP) levels in Pampas de San Juan de Miraflores and to determine the proportion of individuals with hypertension who are diagnosed, treated, and have controlled blood pressure across age groups.

METHODS

A cross-sectional survey (October 2022-January 2023) including adults aged >35 years from the 2010 CRONICAS study and a geographically based sample of households nearby. Data collection included a hypertension awareness questionnaire and standardized blood pressure measurements. Descriptive analyses characterized the age-specific hypertension care cascade and calculated mean blood pressure in four groups: healthy, unaware, aware and untreated, and aware and treated.

RESULTS

Among 2,856 adults, age-specific hypertension prevalence based on self-reported medication use and current blood pressure screening was 13.3 % (35-44 years) to 54.6 % (>75 years). Awareness was 85 %; of those, 85 % were treated, and 76.8 % of them had controlled blood pressure. Mean SBP was highest in the unaware group (n = 102, 146.0 mmHg) and lowest in the healthy group (n = 1,929, 111.0 mmHg). These values were comparable among diagnosed patients, whether treated (n = 333, 126.0 mmHg) or untreated (n = 492, 128.0 mmHg).

CONCLUSIONS

Despite high awareness and relatively adequate control among untreated individuals, a substantial proportion remain undiagnosed or untreated after COVID-19. These findings underscore the need for interventions to improve early detection, treatment, and follow-up of hypertension.

A Medication Management App (Smart-Meds) for Patients After an Acute Coronary Syndrome: Pilot Pre-Post Mixed Methods Study

Background

Medication nonadherence remains a significant challenge in the management of chronic conditions, often leading to suboptimal treatment outcomes and increased health care costs. Innovative interventions that address the underlying factors contributing to nonadherence are needed. Gamified mobile apps have shown promise in promoting behavior change and engagement.

Objective

This pilot study aimed to evaluate the efficacy and usability of a gamified mobile app that used a narrative storytelling approach to enhance medication adherence among patients following acute coronary syndrome (ACS). The study aimed to assess changes in participants' beliefs about medication and self-reported adherence before and after the intervention. Additionally, user feedback regarding the narrative component of the app was gathered.

Methods

Overall, 18 patients who recently experienced ACS were recruited for a 1-month intervention using the gamified app. Participants' beliefs about medication and self-reported adherence were assessed using standardized scales pre- and postintervention. The app's usability was also evaluated through a postintervention questionnaire. Statistical analyses were performed to determine the significance of changes in belief and adherence scores.

Results

Although 33% (6/18) of the participants did not use the intervention more than once, the remaining 12 remained engaged during the 30 days of the study. The results did not indicate a significant improvement in participants' beliefs about medication following the intervention. However, self-reported adherence significantly improved (P<.05) after the intervention with a mean score going from 29.1 (SD 6.9) to 32.4 (SD 5.6), with participants demonstrating a greater self-efficacy to their prescribed medication regimen. However, the results did not indicate a significant improvement in participants' beliefs about medication. With a mean average score of 80.6, the usability evaluation indicates a good usability rating for the gamified app. However, the narrative storytelling component of the app was not favored by the participants, as indicated by their feedback.

Conclusions

This pilot study suggests that a gamified mobile app using narration may effectively enhance medication self-efficacy and positively influence patients' beliefs about medication following ACS. However, the narrative component of the app did not receive favorable feedback from participants. Future research should focus on exploring alternative methods to engage participants in the app's narrative elements while maintaining the positive impact on adherence and beliefs about medication observed in this study.

Adherence to Oral Anticancer Agents Among Adults With Gastrointestinal Tract Cancer: A Scoping Review

BACKGROUND

Patients with gastrointestinal tract cancer reported suboptimal adherence to oral anticancer agents (OAAs), reducing their therapeutic benefit and increasing mortality risk. A scoping review can comprehensively map available evidence on adherence to OAAs and inform appropriate support to improve treatment outcomes.

OBJECTIVE

The aim of this study was to comprehensively map studies on adherence to OAAs among adults with gastrointestinal tract cancer, including the adherence rate, nonadherence reasons, influential factors, management strategies, and theories that guide these studies.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews Checklist and the 5-stage methodological framework of scoping review were followed. According to the 5 research questions, 7 databases were systematically searched for peer-reviewed original studies, and a narrative synthesis was performed.

RESULTS

Fifty-two studies were included. Adherence ranged from 16.7% to 100%, giving a median rate of 68% by self-report. Seven categories of nonadherence reasons were identified, with adverse effects, cancer progression, patient refusal, and forgetfulness being most frequently reported. Furthermore, more than 40 influential factors were identified. They are related to patient, disease condition, therapy, socioeconomic, and healthcare-system dimensions. Education and follow-up care were the main components of management strategies, but the effectiveness was inconsistent. Currently, only 3 of 52 studies adopted theoretical frameworks.

CONCLUSION

Adherence to OAAs among adults with gastrointestinal tract cancer is suboptimal. Future studies with rigorous designs and theoretical frameworks are needed to develop adherence-enhancing strategies and explain theoretical mechanisms.

IMPLICATIONS FOR PRACTICE

Routine assessments and preventive actions are suggested to delay modifiable nonadherence.

Relationship Between Depression and Decreased Activity Level and Cognitive Impairment in Patients with Diabetes Mellitus Type 2 and/or Atrial Fibrillation

Background: The interdependence between type 2 diabetes mellitus (DM-2), atrial fibrillation (AF), and cognitive decline (CD)/dementia is a debated topic. In this study, we highlighted the influence of DM-2 and FA individually and in association on the severity of CD/dementia. Methods: This study comprises 248 patients with very high cardiovascular risk (VHCVR) according to Systematic Coronary Risk Evaluation (SCORE2), of whom 184 had DM-2 and/or AF, and 64 were age-matched controls (without DM-2/AF), admitted to the Municipal Hospital Timisoara. Results: Mini-Mental-State-Examination (MMSE), Montreal Cognitive Assessment (MoCA), Activities of Daily Living Score (ADL), and Instrumental Activities of Daily Living Score (IADL) were significantly decreased, and Geriatric Depression Scale (GDS-15) increased in patients with DM-2 and AF in comparison to controls (p < 0.05), with the subjects with DM-2 and AF having more severe CD compared to those with only one of these two pathologies. The logistic regression model showed that the risk of CD (MMSE < 27) or dementia (MMSE < 24) increased significantly in patients with DM-2 and/or AF depending on the SCORE2 values, ADL, and GDS-15. In DM-2 and/or AF patients, an increase of 1% in SCORE2 was associated with an elevation of 2.40% in the odds of CD and of 4.30% of dementia. In these patients, depression (GDS score) increased the risk of CD by 36.3%, and if ADL improved, the risk of CD decreased by 44.0%. Conclusions: Our findings suggest a direct association between CD, DM-2, and AF with SCORE2, cognitive parameters, ADL, and depression. In patients with DM-2 and/or AF, it is important to identify subclinical CD to prevent the evolution to dementia.

A Patient-Oriented Implementation Strategy for a Perioperative mHealth Intervention: Feasibility Cohort Study

BACKGROUND

Day surgery is being increasingly implemented across Europe, driven in part by capacity problems. Patients recovering at home could benefit from tools tailored to their new care setting to effectively manage their convalescence. The mHealth application ikHerstel is one such tool, but although it administers its functions in the home, its implementation hinges on health care professionals within the hospital.

OBJECTIVE

We conducted a feasibility study of an additional patient-oriented implementation strategy for ikHerstel. This strategy aimed to empower patients to access and use ikHerstel independently, in contrast to implementation as usual, which hinges on the health care professional acting as gatekeeper. Our research question was "How well are patients able to use ikHerstel independently of their health care professional?"

METHODS

We investigated the implementation strategy in terms of its recruitment, reach, dose delivered, dose received, and fidelity. Patients with a recent or prospective elective surgery were recruited using a wide array of materials to simulate patient-oriented dissemination of ikHerstel. Data were collected through web-based surveys. Descriptive analysis and open coding were used to analyze the data.

RESULTS

Recruitment yielded 213 registrations, with 55 patients ultimately included in the study. The sample was characterized by patients undergoing abdominal surgery, with high literacy and above average digital health literacy, and included an overrepresentation of women (48/55, 87%). The implementation strategy had a reach of 81% (63/78), with 87% (55/67) of patients creating a recovery plan. Patients were satisfied with their independent use of ikHerstel, rating it an average 7.0 (SD 1.9) of 10, and 54% (29/54) of patients explicitly reported no difficulties in using it. A major concern of the implementation strategy was conflicts in recommendations between ikHerstel and the health care professionals, as well as the resulting feelings of insecurity experienced by patients.

CONCLUSIONS

In this small feasibility study, most patients were satisfied with the patient-oriented implementation strategy. However, the lack of involvement of health care professionals due to the strategy contributed to patient concerns regarding conflicting recommendations between ikHerstel and health care professionals.

The relationship between frailty syndrome and quality of life in patients with hypertension: a multidimensional analysis

BACKGROUND

Hypertension is a common condition among the elderly and is frequently accompanied by frailty syndrome (FS). The coexistence of hypertension and FS poses significant challenges in patient management and negatively impacts the quality of life (QoL). This study aimed to analyze the relationship between FS and QoL in elderly patients with suspected hypertension.

METHODS

A cross-sectional study was conducted involving 201 patients aged 65 years or older, referred to a Hypertension Clinic for diagnostic evaluation. Frailty was assessed using the Tilburg Frailty Indicator (TFI), and QoL was evaluated with the World Health Organization Quality of Life Instrument (WHOQOL-BREF). Sociodemographic and clinical data were collected, and statistical analyses were performed to identify correlations between FS and QoL.

RESULTS

The study found that 79.60% of the patients were identified as frail (TFI ≥ 5). FS was significantly negatively correlated with all domains of QoL, including physical health (r = -0.634, p < 0.001), psychological health (r = -0.675, p < 0.001), social relationships (r = -0.528, p < 0.001), and environmental factors (r = -0.626, p < 0.001). Multivariate analysis revealed that physical (β = -0.091, p < 0.001) and psychological components of FS (β = -0.128, p = 0.016), as well as age (β = -0.022, p = 0.004), were significant predictors of lower QoL scores. Loneliness (β = -0.235, p = 0.049) was also a significant predictor of lower QoL.

CONCLUSIONS

The study demonstrated a strong association between FS and reduced QoL in elderly hypertensive patients, emphasizing the need for comprehensive assessments and personalized management strategies. Routine evaluation of frailty and the implementation of targeted interventions aimed at improving physical, psychological, and social well-being could substantially enhance QoL in this vulnerable population.

CLINICAL TRIAL NUMBER

Not applicable.

Photobiomodulation studies on diabetic wound healing: An insight into the inflammatory pathway in diabetic wound healing

Diabetes mellitus remains a global challenge to public health as it results in non-healing chronic ulcers of the lower limb. These wounds are challenging to heal, and despite the different treatments available to improve healing, there is still a high rate of failure and relapse, often necessitating amputation. Chronic diabetic ulcers do not follow an orderly progression through the wound healing process and are associated with a persistent inflammatory state characterised by the accumulation of pro-inflammatory macrophages, cytokines and proteases. Photobiomodulation has been successfully utilised in diabetic wound healing and involves illuminating wounds at specific wavelengths using predominantly light-emitting diodes or lasers. Photobiomodulation induces wound healing through diminishing inflammation and oxidative stress, among others. Research into the application of photobiomodulation for wound healing is current and ongoing and has drawn the attention of many researchers in the healthcare sector. This review focuses on the inflammatory pathway in diabetic wound healing and the influence photobiomodulation has on this pathway using different wavelengths.

Public Knowledge and Factors Associated With Familiarity of Treatments for Rhinosinusitis

Objective

Rhinosinusitis is a common otolaryngologic condition with many over-the-counter (OTC), prescription, and surgical treatment options. This study seeks to evaluate public familiarity with treatments for rhinosinusitis.

Study Design

Cross-sectional survey.

Setting

US adult (≥18 years) online survey respondents.

Methods

A cross-sectional survey was administered to US adults via ResearchMatch. Questions included a demographic questionnaire, validated nasal obstruction surveys, personal history of chronic rhinosinusitis (CRS), as well as familiarity with various treatments for rhinosinusitis (5-point Likert scale). Descriptive statistics were utilized to describe results, and multivariable ordinal regression was utilized to describe factors associated with knowledge of any treatment and over-the-counter treatments.

Results

The cohort (n = 1086) was primarily female (75.7%), white (80.3%), married (47.5%), and college educated (36.6%). Highest rates of familiarity with treatment were reported for antihistamines (80%), decongestants (80%), and nasal corticosteroids (78%). Factors associated with knowledge of any rhinosinusitis treatment included age (odds ratio [OR]: 0.99 [95% confidence interval [CI]: 0.98-0.99]), literacy score (OR: 0.76 [95% CI: 0.71-0.82]), CRS diagnosis (OR: 2.91 [95% CI: 2.25-3.75]), and symptomatic score. Factors associated with knowledge of OTC treatments included female gender (OR: 2.40 [95% CI: 1.82-3.16]), literacy score (OR: 0.77 [95% CI: 0.72-0.83]), CRS diagnosis (OR: 2.94 [95% CI: 2.25-3.83]), and symptomatic score.

Conclusion

Individuals at risk for having lower familiarity with treatment options include males, older individuals, and those with lower health literacy. Future studies should evaluate the impact that public knowledge and primary care provider knowledge of treatment options for rhinosinusitis has on outcomes of rhinosinusitis.

Surgical Recovery Through the Lens of Patients with Colorectal Disease: A Qualitative Study in an Enhanced Recovery after Surgery Setting

BACKGROUND

As perioperative care shifts to a more patient-centered model, understanding needs and experiences of patients is vital. Gaining such insight can enhance the alignment of care with patient priorities, encouraging adherence to recovery-oriented interventions. We aimed to explore patient-defined recovery and the elements that modify the recovery process for patients with colorectal disease under enhanced recovery after surgery (ERAS) care.

STUDY DESIGN

A qualitative study was conducted at an ERAS-participating hospital in Alberta, Canada, between April 2018 and June 2019. A co-design focus group set the research direction, and semistructured interviews were conducted postoperatively in-hospital or within 3 months postdischarge. Diverse patient ages and colorectal conditions were targeted through purposive sampling. Interviews were transcribed verbatim and analyzed through manifest and latent content analysis.

RESULTS

Twenty patients with mean age 62 (SD 13) years and 45% with cancer (17 interview, 2 focus group + interview, and 1 focus group only) were enrolled. Recovery was defined by patients as the return to normal routines and four themes were identified. First, phases of recovery: recovery was described as multidimensional phases distinctively as early, late or long-term, and the endpoint. Second, recovery facilitators: recovery was supported through positive mindsets, conscious recovery, and taking an active role. Third, recovery barriers: recovery was hindered by negative mindsets and treatment side effects. Finally, recovery catalysts: communication, autonomy, and expectations facilitated active or passive recovery.

CONCLUSIONS

Our patient-oriented recovery model may contribute a new dimension to the ERAS framework by capturing patients' recovery experiences. Further research is encouraged to explore its value in enhancing patient-centered care within ERAS.

Identifying the Relative Importance of Factors Influencing Medication Compliance in General Patients Using Regularized Logistic Regression and LightGBM: Web-Based Survey Analysis

BACKGROUND

Medication compliance, which refers to the extent to which patients correctly adhere to prescribed regimens, is influenced by various psychological, behavioral, and demographic factors. When analyzing these factors, challenges such as multicollinearity and variable selection often arise, complicating the interpretation of results. To address the issue of multicollinearity and better analyze the importance of each factor, machine learning methods are considered to be useful.

OBJECTIVE

This study aimed to identify key factors influencing medication compliance by applying regularized logistic regression and LightGBM.

METHODS

A questionnaire survey was conducted among 638 adult patients in Japan who had been continuously taking medications for at least 3 months. The survey collected data on demographics, medication habits, psychological adherence factors, and compliance. Logistic regression with regularization was used to handle multicollinearity, while LightGBM was used to calculate feature importance.

RESULTS

The regularized logistic regression model identified significant predictors, including "using the drug at approximately the same time each day" (coefficient 0.479; P=.02), "taking meals at approximately the same time each day" (coefficient 0.407; P=.02), and "I would like to have my medication reduced" (coefficient -0.410; P=.01). The top 5 variables with the highest feature importance scores in the LightGBM results were "Age" (feature importance 179.1), "Using the drug at approximately the same time each day" (feature importance 148.4), "Taking meals at approximately the same time each day" (feature importance 109.0), "I would like to have my medication reduced" (feature importance 77.48), and "I think I want to take my medicine" (feature importance 70.85). Additionally, the feature importance scores for the groups of medication adherence-related factors were 77.92 for lifestyle-related items, 52.04 for awareness of medication, 20.30 for relationships with health care professionals, and 5.05 for others.

CONCLUSIONS

The most significant factors for medication compliance were the consistency of medication and meal timing (mean of feature importance), followed by the number of medications and patient attitudes toward their treatment. This study is the first to use a machine learning model to calculate and compare the relative importance of factors affecting medication adherence. Our findings demonstrate that, in terms of relative importance, lifestyle habits are the most significant contributors to medication compliance among the general patient population. The findings suggest that regularization and machine learning methods, such as LightGBM, are useful for better understanding the numerous adherence factors affected by multicollinearity.

Pharmacoequity measurement framework: A tool to reduce health disparities

Pharmacoequity is a health system and policy goal of ensuring equitable access to high-quality medications for all individuals, regardless of factors such as race, ethnicity, socioeconomic status, or resource availability to reduce health disparities. Although measurement frameworks have been widely used in health equity contexts, a focused framework for pharmacoequity remains a critical gap. In this article, we introduce a novel pharmacoequity measurement framework anchored in the patient medication-use journey. The framework includes the following domains: (1) access to health care services, (2) prescription generation, (3) primary medication nonadherence, (4) secondary medication nonadherence, and (5) medication monitoring. For each domain, we provide examples of outcome measures and potential data sources that can be used for evaluation. We also outline an implementation workflow of the pharmacoequity measurement framework that population health stakeholders can use across various settings (eg, health systems, health plans). The framework provides a structured approach to identify existing gaps in the path toward achieving pharmacoequity and lay the foundation for targeted interventions. Additionally, it enables ongoing monitoring of progress toward achieving pharmacoequity while identifying interventions that are effective, scalable, and sustainable.

From Pills to Practices: Interpretative Phenomenological Analysis of Medication Experience and Self-Management in Schizophrenia

Schizophrenia, a mental disorder characterized by delayed onset, high relapse rates, and significant disability, ranks among the top 20 contributors to the global burden of disease and poses a substantial public health challenge. Effective self-management is crucial for the recovery of individuals with schizophrenia, with medication experience playing a vital role. However, the underlying mechanisms and logical relationships remain elusive, hindering the development of effective self-management and enhancement strategies from the perspective of medication experience. This research aimed to illuminate these aspects by conducting semi-structured interviews to delve into the impacts of medication experience on self-management behaviors among individuals with schizophrenia. The goal was to elucidate the role of medication in self-management and to identify potential barriers and facilitators via patient narratives. We employed interpretive phenomenological analysis to examine interview transcripts from 12 participants diagnosed with schizophrenia. This analysis yielded three superordinate themes: "Medicine isn't just medicine," "Experience is a catalyst for action," and "Action shaped by experience." We discuss these themes in the context of existing literature and theoretical frameworks and propose specific recommendations, such as motivational interviewing for clinicians, tailored psycho-educational programs, and supportive systems respecting patient autonomy. This study offers a contextual understanding of the medication experience for individuals with schizophrenia, enhancing our knowledge of self-management behaviors and how they can be promoted in this population.

Exploring the dark side of diagnostic dyes with a focus on Indocyanine green's adverse reactions

Indocyanine green (ICG) is a diagnostic dye commonly used in medical imaging and liver function monitoring. Given its widespread use, there is a need for detailed evaluations of its adverse drug reactions in real-world settings. As the comprehensive overview of its safety profile is very limited, this study aimed to analyze the adverse events (AEs) associated with ICG using data from the Food and Drug Administration Adverse Event Reporting System (FAERS). Data between 2004Q1 and 2023Q4 were extracted from the FAERS database. Signal detection was performed using various disproportionality analysis algorithms, including reporting odds ratio (ROR), proportional reporting ratio, Bayesian confidence propagation neural network, and multiitem gamma Poisson shrinker. During the study period, a total of 62 ICG-related AEs were reported in the FAERS database. Significant clinical adverse reactions included anaphylactic shock (ROR: 92.10, 95% confidence interval (CI): 37.71-224.96), procedural hypotension (ROR: 1397.27, 95% CI: 443.31-4404.08), and urticaria (ROR: 10.88, 95% CI: 4.02-29.42). This study provides valuable insights into the safety profile of ICG, highlighting the need for further monitoring to ensure its safe clinical use in clinical practice. Ongoing pharmacovigilance and large-scale studies are warranted to fully understand the potential risks associated with ICG.

Challenges and strategies for improving medication adherence among adolescent psychiatric patients: A qualitative study

Despite significant advancements in the development of psychotropic medications, increasing adherence rates remain a challenge in the treatment and management of psychiatric disorders. The purpose of this study is to qualitatively explore the challenges underlying medication adherence and strategies to improve it among adolescents with psychiatric disorders in Malaysia. This qualitative research design presents results from 17 semi-structured interviews with adolescent psychiatric patients, aged 11 to 19 years old, from public hospitals across Peninsular Malaysia. The data collected from interviews were transcribed and processed through thematic analysis using the NVivo 11 software. A total of three main themes concerning medication adherence were identified: (1) challenges; (2) coping strategies and (3) protective factors. In this study, thirteen subthemes emerge as challenges underlying medication adherence experienced by adolescent psychiatric patients. The coping strategies identified in this study fall under three broad subthemes which are problem-focused strategies, emotion-focused strategies and maladaptive strategies. This study also highlights social support and positive medicinal effects as protective factors for non-adherence issues in adolescent psychiatric patients. In conclusion, this study supports the notion that adherence is a multi-factorial phenomenon. This study can inform future development of interventions and targeted health promotion programmes in enhancing adherence.

Conventional medication adherence and self-treatment practices among South Asian immigrants: a qualitative study

Introduction Globally, cardiovascular disease (CVD) is a common cause of death. The highest CVD rate is among South Asian populations and South Asian immigrants have a higher risk of developing CVD than other ethnic groups. While treatment of established CVD risk factors is recommended, medication adherence may be poor. Aim This qualitative study aimed to explore medication adherence practices of New Zealand South Asians who are prescribed medications for type 2 diabetes, and/or hypertension, and/or dyslipidaemia, established risk factors for CVD. Method Twenty-one semi-structured telephone interviews were conducted with South Asians with type 2 diabetes, and/or hypertension, and/or dyslipidaemia. Data were transcribed, then analysed thematically using NVivo12. Codes and inductively derived themes were discussed. Results Five themes with 12 subthemes were identified. The five themes included daily routine and medication adherence practices, perceived necessity of medications and concerns about side effects, concern and hesitancy to start conventional medications, integration of herbal and alternative therapies, and the role of healthcare providers and communication. Discussion These findings highlight the importance of personalised approaches to medication management that consider patients' beliefs, daily routines, and cultural contexts to reduce CVD risk and improve health outcomes among South Asians.

Non-cost-related sources of medication nonadherence in the Medicare population

Significant research and attention to date have focused on cost-related medication nonadherence as rising prescription drug prices worsen affordability and access for many Americans. This study investigated self-reported sources of medication nonadherence, measuring both cost- and non-cost-related medication nonadherence among community-dwelling Medicare Part D beneficiaries in 2022. A total of 13.7% of beneficiaries (4 589 843) reported some type of medication nonadherence; 7.5% reported medication nonadherence related to cost and 6.2% reported for non-cost reasons. Beneficiaries reporting food insecurity, poor functional status, and lack of understanding of the Part D benefit were more likely to report both types of medication nonadherence after adjustment for sociodemographic factors. Beneficiaries receiving the Low-Income Subsidy had lower odds of reporting cost-related but greater odds of reporting non-cost-related medication nonadherence. These findings suggest that non-cost-related sources of medication nonadherence, such as beneficiary preferences or beliefs, understanding of their health situation or insurance coverage, and ability to fill a prescription, are significant contributors to overall nonadherence. Non-cost-related medication nonadherence should be considered alongside recent changes to the Part D benefit and in future Part D Centers for Medicare and Medicaid Services (CMS) Innovation Center models, such as the proposed Medicare $2 Drug List Model, in order to maximize the impact of these initiatives.

Effects of pharmacist-led home visit services and factors influencing medication adherence improvement

BACKGROUND

The use of medicines is crucial in treatment, but nonadherence poses an important challenge, particularly when managing polypharmacy and long-term conditions. Pharmacist-led home visit services offer a promising solution to enhance the outcomes associated with medication use. However, the effects and the factors contributing to this improvement remain unclear.

OBJECTIVE

This study assessed the effects of pharmacist-led home visit services on medication adherence and general medication knowledge. Additionally, we analyzed the factors associated with improved medication adherence.

METHODS

Face-to-face, pharmacist-led home visit services were conducted via opportunistic sampling in community settings. Data were collected between 2017 and 2019. The program included participants aged ≥65 years or taking ten or more medications, in need of care, and who were willing to participate. We estimated the effects of the program by improved medication adherence and general knowledge about taking medications. Medication adherence was measured using the Morisky Scale. We used McNemar's test to evaluate the statistical differences in outcomes before and after consultation. To identify factors influencing improvements in medication adherence, odds ratios (OR) with 95% confidence intervals (CI) were calculated using multivariate logistic regression with adjustments for covariates.

RESULTS

Among the 1,194 participants in the program, 874 were included in the analysis. Pharmacist-led home visit services improved both medication adherence (from 69.2% to 85.8%) and mean scores for general knowledge of taking medications (from 65.3% to 89.5%). Participants aged ≥70 years showed less improvement in overall adherence than those aged <70 years (OR = 0.51; 95% CI = 0.317-0.817). The program was significantly more effective at improving adherence for participants with higher level of medication knowledge (OR = 2.93; 95% CI = 1.78-4.81) compared to those with lower level of knowledge.

CONCLUSION

These quantitative findings highlight the importance of pharmacist-led interventions and suggest a framework for future programs about medication management.

Intention to use mobile text message reminders for medication adherence among hypertensive patients in North West Ethiopia: a cross-sectional study

BACKGROUND

Reminders via digital technology offer a novel and efficient means to address medication forgetfulness, as they are easily accessible and user-friendly for patients. In particular mobile text message reminders are more suitable for chronic patients, as they require few technical skills, can operate without internet connectivity, and are less expensive than other technologies. This study aimed to assess the intention to use mobile text message reminders for medication adherence among hypertensive patients at the Gondar City health facilities.

METHODS

A facility-based cross-sectional study was conducted. A simple random sampling method was used to select 423 hypertensive patients. Data was collected from April 1 to May 15, 2023. Data was collected using Kobo Toolbox, and the collected data was exported to MS Excel. Subsequently, the data was imported and analyzed using the SPSS version 20. Binary and multivariable logistic regression analysis was employed to assess factors associated with the outcome variable.

RESULT

The finding indicates that 64.5% of the patients have an Intention to use mobile text message reminders for medication adherence. Perceived usefulness (AOR = 2.53: 95%CI: 1.41, 4.52), perceived ease of use (AOR = 3.28: 95% CI: 1.81, 5.95), forgetting to take medication (AOR = 2.20: 95%CI: 1.38, 3.50) and patient holds their mobile phone always (AOR = 1.96: 95%CI: 1.04, 3.68) were associated factors with outcome variable.

CONCLUSION

Forget taking medication, the patient holds their mobile phone always, Perceived ease of use and Perceived usefulness were significantly associated with the outcome variable. We recommend designing and implementing user-friendly text message reminder systems and educating hypertensive patients about the system's benefits.

Medication adherence and quality of life among geriatric patients: Insights from a hospital-based cross-sectional study in India

BACKGROUND

Understanding the factors that influence medication adherence and the multidimensional aspects of quality of life in the elderly is of paramount importance in enhancing their overall well-being. Since geriatric patients usually suffer from multiple morbidities due to their declining age, the adherence towards their medications plays a very crucial role in their quality of life.

METHODOLOGY

This cross-sectional study explores the intricate relationship between medication adherence and quality of life among 310 elderly patients at a single medical college and hospital. Participants completed the Morisky Medication Adherence Scale (MMAS-8) to assess medication adherence and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, which comprises four domains (physical health, psychological health, social relationships, and environment) to evaluate quality of life. Statistical analyses, including correlations, paired t-tests, ANOVA, and Backward Multiple Linear Regression, were employed to examine the relationships and differences among variables.

RESULTS

The findings indicate varying levels of medication adherence among participants, with a significant proportion exhibiting medium adherence (47.1%) and highlighting the need for interventions to address challenges in medication adherence among the elderly population. Notably, gender emerged as a significant factor influencing quality of life, with males reporting higher satisfaction across all domains compared to females. Medication adherence exhibited a significant correlation with the social relationships domain (DOM3) of the WHOQOL-BREF, underlining the importance of adherence in fostering positive social interactions.

CONCLUSION

Our study revealed a significant association between medication adherence (MMAS- 8) and the quality of life (WHOQOL-BREF) among elderly patients. We also observed noteworthy gender differences in quality-of-life perceptions. It emphasizes the need for tailored interventions that consider medication adherence issues to enhance the overall quality of life among this vulnerable population.

Associations of stigma, loneliness, and treatment self-regulation with HIV medication adherence among individuals with substance use disorder using a mobile health application

Introduction

Medication adherence contributes to poor HIV outcomes, especially among people with HIV and Substance use disorder (SUD). Mobile health applications have been leveraged to improve behavioral health outcomes among this population. Our cross-sectional study examined the relationship between medication adherence with factors such as treatment self-regulation, isolation, and internalized stigma, among people with HIV and SUD using the Addiction Comprehensive Health Enhancement Support System (A-CHESS) mobile app.

Methods

A sample of 208 participants using A-CHESS to improve treatment adherence completed a survey. Adherence was measured using the Four-item Morisky Medication Adherence Scale and dichotomized (maximum score of 20 points considered as adherent). Positive and negative affect was measured separately using Positive Affect Negative Affect Schedule and loneliness was measured using UCLA three-item Loneliness Scale. Internalized stigma was measured using Internalized AIDS-Related Stigma Scale. Competence/Treatment self-regulation was measured using Treatment Self-regulation Questionnaire. Multivariable logistic regression was used to assess the associations of affect, treatment self-regulation, isolation, and internalized stigma, with adherence to antiretroviral therapy adjusting for age, education, and gender.

Results

Among 208 participants in this study, most were Black (n = 137; 66%), male (n = 156; 75%) and had a mean age of 46 (standard deviation = 11.3). The most reported substances associated with missing HIV medication were alcohol (27%) and cocaine/crack (20%). Logistic regression analysis revealed that internalized stigma was significantly associated with HIV medication adherence (OR = 0.82; 95% CI: 0.70-0.99; p = 0.034).

Conclusion

Internalized stigma was significantly associated with HIV medication adherence. Further research is needed to better understand this relationship and develop interventions addressing stigma in people with HIV and SUD.

The effect of cognitive emotion regulation on direct-acting antivirals adherence in patients with hepatitis C

INTRODUCTION

Adherence to direct-acting antivirals (DAAs) could be a predictor of chronic viral hepatitis C (HCV) therapeutic failure. We examined the perceptions of patients receiving DAAs to determine how cognitive factors influence their decision to maintain adherence. Also, we explored the threshold of DAAs adherence for obtaining sustained virologic response (SVR) among patients with HCV, in order to better implement a strategy that improves the DAAs adherence in the future clinical practice.

METHODS

A single-arm prospective study was performed. Patients with HCV that started and completed DAAs treatment in the County Hospital of Craiova, Dolj, Romania, were enrolled. Patients' medication adherence was assessed using the HCV-AD10 questionnaire, and the cognitive emotion regulation was measured with CERQ questionnaire (five positive/adaptive cognitive emotion-regulation domains and four negative/maladaptive domains). Spearman correlation analysis was conducted to explore the relationships between adherence and different factors. ROC-curves were used to evaluate the adherence threshold to achieve SVR. A linear regression model was performed to analyze the primary outcome (DAAs adherence) to be the target variable based on given independent variables (age, treatment duration, severity of HCV, the nine adaptive and maladaptive strategies).

RESULTS

368 patients (mean age: 61 years) with HCV diagnosed 4.05 ± 6.38 (average) years ago were enrolled. Mean (±SD) adherence via HCV-AD10 was 91.51 ± 8.34, and the proportion of the participants achieving SVR was 96%. Patients with an adherence less than 84% (5 patients, 1.36%) was considered nonadherent and they have a high probability of not achieving response (sensitivity and specificity of 83% and 80%, respectively). We obtained significantly higher values of three adaptive strategies between adherent and nonadherent patients following DAAs treatment: in positive refocusing (p-value = 0.044), refocus on planning (p-value = 0.037), and positive reappraisal (p-value = 0.047).

DISCUSSION

The interplay between the three adaptive strategies of the cognitive emotion regulation and the enhancement of DAAs adherence contributes to a more holistic comprehension of patient behavior in the context of HCV treatment. Increasing refocusing and planning using goal setting and assisting patients in establishing specific, achievable goals can be crucial strategies for clinicians aiming to improve adherence among their patients.

Barriers and Unmet Educational Needs Regarding Implementation of Medication Adherence Management Across Europe: Insights from COST Action ENABLE

BACKGROUND

Medication adherence is essential for the achievement of therapeutic goals. Yet, the World Health Organization estimates that 50% of patients are nonadherent to medication and this has been associated with 125 billion euros and 200,000 deaths in Europe annually.

OBJECTIVE

This study aimed to unravel barriers and unmet training needs regarding medication adherence management across Europe.

DESIGN

A cross-sectional study was conducted through an online survey. The final survey contained 19 close-ended questions.

PARTICIPANTS

The survey content was informed by 140 global medication adherence experts from clinical, academic, governmental, and patient associations. The final survey targeted healthcare professionals (HCPs) across 39 European countries.

MAIN MEASURES

Our measures were barriers and unmet training needs for the management of medication adherence across Europe.

KEY RESULTS

In total, 2875 HCPs (pharmacists, 40%; physicians, 37%; nurses, 17%) from 37 countries participated. The largest barriers to adequate medication adherence management were lack of patient awareness (66%), lack of HCP time (44%), lack of electronic solutions (e.g., access to integrated databases and uniformity of data available) (42%), and lack of collaboration and communication between HCPs (41%). Almost all HCPs pointed out the need for educational training on medication adherence management.

CONCLUSIONS

These findings highlight the importance of addressing medication adherence barriers at different levels, from patient awareness to health system technology and to fostering collaboration between HCPs. To optimize patient and economic outcomes from prescribed medication, prerequisites include adequate HCP training as well as further development of digital solutions and shared health data infrastructures across Europe.

Enhancing medication adherence: A family-centered co-designed mHealth app for children undergoing hematopoietic stem cell transplant

BACKGROUND

High rates of medication non-adherence (52-73 %) in pediatric hematopoietic stem cell transplant (HCT), due to complex regimens and forgetfulness, increase life-threatening risks.

PURPOSE

This mixed methods study aimed to develop and evaluate the usability of the BMT4me© mobile health application to enhance adherence to immunosuppressants in children undergoing HCT.

DESIGN AND METHODS

A mixed methods, cross-sectional, iterative approach, with caregiver-child dyads and healthcare providers, was used to create the BMT4me© app prototype. This iterative approach involved continuously refining the app based on feedback from stakeholders at each phase. The process was user-centered, engaging patients, caregivers and healthcare providers in each stage. In phase 1, caregiver/child dyads (ages 8-17, n = 14) provided feedback on wireframes via qualitative interviews, which informed prototype development. Phase 2 involved focus groups with healthcare providers including physicians (n = 3), nurses (n = 15), and advanced practice nurses (n = 3) who evaluated the prototype's usability and provided feedback via reaction cards and the System Usability Scale (SUS). The System Usability Scale (SUS) measured usability, and thematic analysis identified key themes regarding engagement, ease of use, safety, and helpfulness. Quantitative data were analyzed using descriptive statistics, while qualitative data were thematically analyzed with NVivo software.

RESULTS

The mean SUS score from healthcare providers was 84.2, notably higher than the average expected score of 68, indicating successful usability of the BMT4me app. Thematic analysis highlighted themes of engagement, ease of use, and safety among providers, and ease of use and helpfulness among children and caregivers. This feedback refined the app to better serve families, patients, and providers.

PRACTICE IMPLICATIONS

The BMT4me© app shows promise in improving medication adherence in pediatric HCT patients. Integrating such mHealth applications into clinical practice will support adherence and improve outcomes in patients with high-risk, complex regimens. This app will guide practical implications and effectiveness of digital health tools.

CONCLUSIONS

A user-centered design approach, involving multiple stakeholders, was essential in developing BMT4me app. Feedback facilitated enhancements in app features and functionality. Pilot feasibility testing with caregivers is ongoing. Future research will assess the efficacy of digital interventions on clinical outcomes in children with complex treatment regimens.