Self-reported versus 'true' adherence in heart failure patients: a study using the Medication Event Monitoring System

The Effect of Self-Care Education on Adherence to Treatment in Elderly Patients with Heart Failure: A Randomized Clinical Trial

Background

Noncompliance with treatment in the elderly with Heart Failure (HF) may result in a lack of recovery, a decrease in longevity, rehospitalization, and additional costs. Therefore, this study was conducted to determine the effect of self-care education on adherence to treatment among elderly patients with HF.

Materials and Methods

This study was a parallel clinical trial on 90 elderly people over 60 years of age who were hospitalized in cardiac wards. Data were collected using a demographic characteristics form and the adherence to treatment questionnaire. Individuals who met the study inclusion criteria were randomly allocated to the intervention and control groups. The intervention group training was performed before and after discharge. The adherence to treatment questionnaire was completed again by both groups 2 months after discharge. Data were analyzed using Chi-squared test; ex. (?2 = 3.95, df = 1, p = 0.046), paired and independent t-tests, and analysis of covariance.

Results

The mean (standard deviation) total score of adherence to treatment in the intervention group was 39.71 (4.51) and 78.72 (10.47) before and after the self-care education, respectively. Paired t-test showed a significant difference in both groups after the intervention compared to before the intervention, and independent t-test showed a significant difference between the groups after the intervention (p = 0.001).

Conclusions

Self-care education before discharge and home-based education were effective in promoting adherence to treatment among patients with HF. Therefore, self-care education before discharge may improve adherence to treatment among elderly patients with HF.

Medication Nonadherence and Associated Factors among Heart Failure Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Background

Medication nonadherence, being one of the best predictors of hospitalization, increases the mortality rate and hospital readmission and reduces the quality of life of heart failure (HF) patients. Therefore, this study is aimed at assessing medication nonadherence and associated factors among HF patients at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

Methods

A cross-sectional study was conducted among 245 adult patients with HF from June to August 2017. The data were collected by using the medication Adherence Report Scale (MARS-5) and then entered and analyzed using SPSS® (IBM Corporation) version 24. Summary statistics were presented using frequency, proportion, and mean. Binary logistic regression analysis was done for identifying factors associated with medication nonadherence with a 95% confidence level and p value of less than 0.05.

Results

Among 245 patients with HF, about a quarter (23.7%) of them were medication nonadherent. More than one-third (37%) of HF patients had a history of at least one HF medication discontinuation. Refilling problems (48%) and getting better from the illness (27%) were the most commonly reported reasons for nonadherence. Presence of comorbidity (AOR = 2.761; 95%CI = 1.364, 5.589), taking three or more types of medication (AOR = 2.805; 95%CI = 1.404, 5.60), and being unmarried (AOR = 2.638, 95%CI = 1.279, 5.443) was significantly associated with medication nonadherence.

Conclusion

The self-reported medication nonadherence among HF patients was considerably high. Refilling problems and getting better from the illness were the most commonly reported reasons for nonadherence. The presence of comorbid illness, taking three or more types of medication, and being unmarried was significantly associated factors of medication nonadherence. Awareness creation among patients on the importance of medication adherence and targeted efforts to assess and mitigate reasons for medication nonadherence may be helpful.

Medication Adherence and Its Associated Factors Among Outpatients with Heart Failure

Background

Poor adherence to heart failure (HF) medications represents a major barrier to achieve the desired health outcomes in those patients.

Objective

To assess medication adherence and to explore the factors associated with medication non-adherence among patient with HF in Jordan.

Methods

The current cross-sectional study was conducted at the outpatient cardiology clinics at two main hospitals in Jordan from August 2021 through April 2022. Variables including socio-demographics, biomedical variables, in addition to disease and medication characteristics were collected using medical records and custom-designed questionnaire. Medication adherence was assessed using the 4-item Morisky Medication Adherence Scale. Multinomial logistic regression analysis was performed to identify the factors that are significantly and independently associated with medication non-adherence.

Results

Of the 427 participating patients, 92.5% had low to moderate medication adherence. Results of the regression analysis revealed that that patients who had higher education level (OR=3.36; 95% CI 1.08-10.43; P=0.04) and were not suffering from medication-related side effects (OR=4.7; 95% CI 1.91-11.5; P=0.001) had significantly higher odds of being in the moderate adherence group. Patients who were taking statins (OR=16.59; 95% CI 1.79-153.98; P=0.01) or ACEIs/ ARBs (OR=3.95; 95% CI 1.01-15.41; P=0.04) had significantly higher odds of being in the high adherence group. Furthermore, Patients who were not taking anticoagulants had higher odds of being in the moderate (OR=2.77; 95% CI 1.2-6.46; P=0.02) and high (OR=4.11; 95% CI 1.27-13.36; P=0.02) adherence groups when compared to patients who were taking anticoagulants.

Conclusion

The poor medication adherence in the present study sheds the light on the importance of implementing intervention programs which focus on improving patients' perception about the prescribed medications particularly for patients who have low educational levels, receive an anticoagulant, and do not receive a statin or an ACEI/ ARB.

The Role of Depression on Treatment Adherence in Patients with Heart Failure-a Systematic Review of the Literature

INTRODUCTION

Although poor medication adherence is considered an impacting risk factor for worsening heart failure (HF) outcomes, adherence rates in HF patients continue to be considerably low. To improve this condition, several studies investigated the impact of many determinants on medication adherence; however, few authors explored the role of depression on it.

PURPOSE OF REVIEW

The purpose of this systematic review was to explore the association between depressive symptoms and medication adherence in HF patients. In particular, the research question was is depression a barrier to medication adherence in HF patients?

METHODS

A systematic review of quantitative analysis studies was undertaken. Six electronic databases were searched between the end of October and March 2022. Thirty-one trials were included, all of them assessed depression, adherence to medication, and their possible relationship.

RESULTS

As was intended, findings showed that the impact of a mild to moderate level of depression was significant on adherence to treatment in HF patients. However, many other risk factors emerged, like family support and health practices (es. low sodium diet).

CONCLUSION

The detection of depression in the setting of HF should be crucial to HF patients' physical health and quality of life. Future research should take depression into account, exploring this area through self-report and qualitative interview as well.

Testing of a health-related quality of life model in patients with heart failure: A cross-sectional, correlational study

Psychological symptoms, physical symptoms, and behavioral factors can affect health-related quality of life (HRQOL) through different pathways, but the relationships have not been fully tested in prior theoretical models. The purpose of this study was to examine direct and indirect relationships of demographic (age), biological/physiological (comorbidity), psychological (depressive symptoms), social (social support), physical (physical symptoms and functional status), and behavioral (dietary sodium adherence) factors to HRQOL. Data from 358 patients with heart failure were analyzed using structural equation modeling. There was a good model fit: Chi-square = 5.488, p = .241, RMSEA = .032, CFI = .998, TLI = .985, and SRMR = .018. Psychological symptoms, physical symptoms, and demographic factors were directly and indirectly associated, while behavioral and biological/physiological factors were indirectly associated with HRQOL through different pathways. Behavioral factors need to be included, and psychological factors and physical factors need to be separated in theoretical models of HRQOL.

Health-Related Quality of Life Is a Mediator of the Relationship Between Medication Adherence and Cardiac Event-Free Survival in Patients with Heart Failure

BACKGROUND

Health-related quality of life (HRQOL) is an important patient-reported outcome that is related to medication adherence, hospitalization and death. The nature of the relationships among medication adherence, HRQOL, and hospitalization and death is unknown. We sought to determine the relationships among medication adherence, HRQOL, and cardiac event-free survival in patients with heart failure.

METHODS AND RESULTS

We enrolled 218 patients with heart failure. Patients' medication adherence was measured objectively using the Medication Event Monitoring System. HRQOL was assessed using the Minnesota Living with Heart Failure Questionnaire. Patients were followed for up to 3.5 years to collect hospitalization and mortality data. Mediation analysis was used to determine the nature of the relationships among the variables. Patients with better medication adherence had better HRQOL (P = .014). Medication adherence and HRQOL were associated with cardiac event-free survival (both P < .05). Patients with medication nonadherence were 1.86 times more likely to experience a cardiac event than those with better medication adherence (P = .038). Medication adherence was not associated with cardiac event-free survival after entering HRQOL in the model (P = .118), indicating mediation by HRQOL of the relationship between medication adherence and cardiac event-free survival.

CONCLUSIONS

HRQOL mediated the relationship between medication adherence and cardiac event-free survival. It is important to assess medication adherence and HRQOL regularly and develop interventions to improve medication adherence and HRQOL to decrease hospitalization and mortality in patients with heart failure.

Urinary drug metabolite testing in chronic heart failure patients indicates high levels of adherence with life-prolonging therapies

AIMS

Despite medical therapy for heart failure (HF) having proven benefits of improving quality of life and survival, many patients remain under-treated. This may be due to a combination of under-prescription by medical professionals and poor adherence from patients. In HF, as with many other chronic diseases, adherence to medication can deteriorate over time particularly when symptoms are well controlled. Therefore, detecting and addressing non-adherence has a crucial role in the management of HF. Significant flaws and inaccuracies exist in the methods currently used to assess adherence such as patient reporting, pill counts, and pharmacy fill records. We aim to use high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS) to detect metabolites of HF medications in the urine samples of chronic HF patients.

METHODS AND RESULTS

Urine samples were collected from 35 patients in a specialist HF clinic. Patients were included if they had an ejection fraction <45% and were taking at least two disease-modifying HF medications. They were excluded if they had been admitted to hospital for HF in the 3 months preceding clinic attendance. These samples were sent for HPLC-MS and tested for all HF medications prescribed for that patient. A high rate of complete adherence of 89% was detected in these patients, with 94% being partially adherent (at least one HF medication detected) to therapy (at least one HF medication detected). This analysis also highlighted that mineralocorticoid antagonists represent both the most under-prescribed (67%) and poorly adhered (75%) medication class.

CONCLUSIONS

This analysis revealed a surprisingly high level of adherence to disease-modifying therapy in chronic HF patients and highlights that most of our 'total' under-treatment is likely to be from a failure to prescribe rather than a failure to adhere. Testing for metabolites of disease-modifying HF drugs in urine using HPLC-MS is feasible and is a useful adjunct to a specialist HF service. At present, the distinction between treatment failure and failure to take treatment is not always clear, which is important because the investigation and potential solutions are different. The former needs initiation of additional therapies and consideration of additional diagnoses, whereas the latter requires strategies to understand reasons underlying poor adherence and collaborative working to improve this: the wrong strategy will be ineffective.

Knowledge about heart failure and self-care persists following outpatient programme- a prospective cohort study from the Faroe Islands

Objectives: Longer life expectancies imply increased prevalence of heart failure. Blittle is known about the maintenance of disease specific knowledge following patient education. Our aim was to investigate if self-care and heart failure knowledge persists at 9 month follow up among patients with heart failure after an outpatient programme in the Faroe Islands.

Methods: A prospective cohort study with patients recently diagnosed with heart failure were recruited and evaluated by questionnaire at baseline, after 3 and 9 months using The European Heart Failure Self-Care Behaviour Scale and the Dutch Heart Failure Knowledge Scale. Clinical and demographic information was collected.

Results: Seven (15%) women and 40 (85%) men with heart failure and NYHA > 2 were included. There was an overall improvement in patients’ self-care from baseline 25 (8) to 3 months 15 (5) and to 9 months (16 (45); both p < 0.001). Mean knowledge score 10 (3) improved to 13 (2) at 3 months and 12 (2) at 9 months (both p < 0.001).

Conclusions: Disease specific patient education is applicable to heart failure patients, which can produce persistent improvements in self-care and knowledge after multidisciplinary outpatient programme.

Practice Implications: Multidisciplinary outpatient programmes are beneficial for patients with heart failure and alters disease specific knowledge and self-care.

Patient-Reported Compliance in older age patients with chronic heart failure

METHODS AND RESULTS

475 patients (including 222 women), mean age 69.7±7.7, with HF, hospitalized at University Hospital between January and December 2018 were included in the study. The patients were selected by a physician specializing in cardiology. A cardiac nurse assessed the non-pharmacological level of compliance using the Revised Heart Failure Compliance Questionnaire (RHFCQ). The socio-clinical data were obtained from medical records. The majority of the study group were patients in NYHA II (62.4%) and NYHA III (28.3%), the mean duration of the disease was 6.2±4.9 years, and the mean ejection fraction of the left ventricle (EF) was 48.6±12.6. The average level of compliance in the study group measured on a scale from 0 to 4 points was: median = 2.7, IQR [2.32; 3.25]. Only 6.9% of the respondents adhere to recommendations totally (all dimensions of RHFCQ). In univariate analysis, predictors negatively affecting compliance were: female gender (rho = -0.325), age below 65 years (rho = -0.014)), loneliness (rho = -0.559), number of hospitalizations (rho = -0.242), higher stage of NYHA (rho = -1.612), co-morbidities (rho = -0.729), re-hospitalizations (rho = -0.729), beta-blockers treatment (rho = -1.612) and diuretics treatment (rho = -0.276). Factors positively affecting compliance were: EF≥45% (rho = 0.020) and treatment with ACEI/ARB (rho = 0.34), whereas compliance was negatively affected by-EF<45% (β = 0.009). Independent predictors influencing the level of compliance were: loneliness (β = -1.816), number of hospitalizations (β = -0.117), NYHA III and IV and number of co-morbidities (β = -0.676).

CONCLUSIONS

Patients with HF do not adhere to therapeutic recommendations. The lowest compliance levels were found for exercise and daily weighing, and the highest for follow-up appointment-keeping and medication. Loneliness and age are the strongest predictors which influence the level of compliance.

The Relationship between Illness Perception and Self-Care Behaviors among Hemodialysis Patients

Objective: Illness perception and self-care behaviors can result in higher levels of health behavior among hemodialysis patients. The present study aimed to assess the relationship between illness perception and self-care behaviors among hemodialysis patients who referred to the hospitals affiliated to Shiraz University of Medical Sciences in 2017. Method : In this descriptive cross sectional study, 216 hemodialysis patients who referred to the hemodialysis wards of the hospitals affiliated to Shiraz University of Medical Sciences were selected via convenience sampling. The study data were collected using a demographic information form, Brief Illness Perception Questionnaire (9 items), and a 15-item Self-care Behavior of Hemodialysis Patients Questionnaire. Then, the data were analyzed using independent t test and one-way ANOVA. Also, significance level was set at P < 0.05. Results: The mean age of the study participants was 30.15+6.65 years. Also, most of the participants were female (n = 125, 58%). The results revealed a significant relationship between illness perception and self-care behaviors among hemodialysis patients. A significant relationship was observed between the following items: daily weight control and perception of consequences (r = 0.200, p = 0.001), between contacting the physician at the time of shortness of breath and consequences (r = 0.209, p = 0.001), between weight control according to the physician's order and consequences (r = 0.763, p = 0.001), and between adherence to fluids restriction and identity(r = 0.149, p < 0.05). Conclusion: Considering the relationship between illness perception and self-care, beliefs as illness perception have to be incorporated into self-care programs designed for hemodialysis patients so as to promote their self-care behaviors. These findings can be used for planning and implementing care for hemodialysis patients.

Gender differences in prognostic relevance of self-care behaviors on mortality and hospitalization in patients with heart failure - A report from the CHART-2 Study

BACKGROUND

Self-care behaviors (ScB) are associated with symptoms and outcomes in patients with heart failure (HF). However, little is known about gender differences in the prognostic relevance of ScB in HF patients.

METHODS

We examined gender differences in ScB of HF patients regarding its prognostic associations with mortality and HF hospitalization with a reference to ScB dimensions. The European Heart Failure Self-Care Behavior Scale (EHFScBS) was used to evaluate ScB in 2233 patients with Stage C/D HF in the CHART-2 Study.

RESULTS

Male patients (n=1583) were younger (71 vs. 73 yrs) and had lower ScB (median 33 vs. 31) (all p<0.001) than females (n=650). During the median follow-up of 2.57 years, patients with high ScB (score 12-32, n=1090), as compared with low ScB patients (score 33-60, n=1143), had significantly increased all-cause mortality in males [adjusted hazard ratio (aHR) 1.44, p=0.02] but not in females (aHR 0.80, p=0.40) (p for interaction 0.02), while ScB was not significantly associated with incidence of HF hospitalization in both genders. Among the 3 dimensions in EHFScBS, complying with regimen was associated with decreased mortality in females, but not in males (p for interaction 0.003), while asking for help was related with increased incidence of HF hospitalization in males (aHR 1.34, p=0.072) but not in females (aHR 0.98, p=0.931) (p for interaction 0.048).

CONCLUSIONS

There were gender differences in the prognostic relevance of self-care with mortality and incidence of HF hospitalization, suggesting that self-care should be implemented considering gender differences to improve prognosis.

Factors influencing adherence to treatment in older adults with hypertension

PURPOSE

Hypertension (HT) is considered to be the most common disorder in the general population. Demographic data indicate that older adults commonly suffer from HT. Older age is one of the key factors affecting the adherence of patients with HT. The main purpose was to identify demographic, socioeconomic, and clinical factors that affect adherence in older adults with HT.

MATERIALS AND METHODS

This cross-sectional study included 150 patients (84 women and 66 men) with mean age of 72.1 years. The Hill-Bone Compliance to High Blood Pressure Therapy Scale (Hill-Bone CHBPTS) was used to evaluate the adherence to therapeutic recommendations for HT.

RESULTS

The mean score obtained by the patients in the Hill-Bone CHBPTS was 20.19 (SD±4.05). The linear regression model showed the independent predictors of the total score (P<0.05): 1) age, each subsequent year of life raises the total score by an average of 0.2 points; 2) gender, males raise it by an average of 1.34 points compared to females; 3) education, a secondary, higher, or higher professional education lowers it by an average of 1.75 points compared to a primary education or no education; and 4) living with the family, having familial support lowers it by an average of 1.91 points compared to living alone or in an organized institution.

CONCLUSION

Our study has shown that the variables of age, education level, and living with the family were statistically significant in explaining the adherence rates. Health care professionals should pay more attention to older HT patients who have a low level of education and who experience the lack of social support. There is a need for a tailored education among this group of patients to better understand and adhere to medication treatment.

Non-pharmacological interventions for sleep and quality of life: a randomized pilot study

OBJECTIVE

to estimate the effects of non-pharmacological interventions to improve the quality of sleep and quality of life of patients with heart failure.

METHOD

pilot study of a randomized controlled trial with 32 individuals assigned to four groups. Sleep was assessed using the Pittsburgh Sleep Quality Inventory, while health-related quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire, at the baseline and at the 12th and 24th weeks. The means of the outcomes according to intervention groups were compared using analysis of covariance; effect sizes were calculated per group.

RESULTS

all groups experienced improved quality of sleep and health-related quality of life at the end of the intervention (week 12) and at follow-up (week 24), though differences were not statistically significant (p between 0.22 and 0.40). The effects of the interventions at the 12th week ranged between -2.1 and -3.8 for the quality of sleep and between -0.8 and -1.7 for quality of life, with similar values at the 24th week.

CONCLUSION

the effects found in this study provide information for sample size calculations and statistical power for confirmatory studies. Brazilian Clinical Trials Registry - RBR 7jd2mm.

Relationship of medication adherence and quality of life among heart failure patients

BACKGROUND

Little is known regarding the relationship between medication adherence and quality of life in heart failure patients. We therefore aimed to examine the nature of relationship between medication adherence and quality of life.

METHODS

A prospective, cross-sectional study of chronic heart failure patients with reduced ejection fraction was performed at a tertiary-care, university hospital in Thailand. Quality of life and medication adherence were assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and Morisky Medication Adherence Scale-8 (MMAS-8), respectively. Relationship of MLHFQ and MMAS-8 were examined using Spearman's correlation coefficient and multiple regression analysis for covariates adjustment.

RESULTS

Among 180 patients, 38.3%, 50.0% and 11.7% were found to have high, medium and poor adherence, respectively. For quality of life, the overall median score on the MLHFQ was relatively low. A positive relationship was identified between medication adherence and quality of life. After covariate adjustment, medication adherence was found to have the strongest relationship with quality of life, compared to other covariates.

CONCLUSIONS

Medication adherence has a small and positive relationship with quality of life among heart failure patients.

Deception in clinical trials and its impact on recruitment and adherence of study participants

Deceptive practices by participants in clinical research are prevalent. It has been shown that as high as 75% of participants withheld information to avoid exclusion from studies. Self-reported adherence has been found to be largely inaccurate. Overcoming deception is a critical issue, since the safety of study participants, the integrity of research data and research resources are at risk. In this review article, we examine deception from the perspective of investigators conducting clinical trials; we describe the types (concealment, fabrication, drug holidays and collusion), prevalence, risks, and predictors of deception, and propose an approach to reduce the impact of deception, especially on adherence, in clinical trials.

Frailty Syndrome: Nursing Interventions

Background

Frailty syndrome is now becoming a challenge for multidisciplinary teams. Frailty assessment in elderly patients is recommended due to the associated cascade of irreversible alterations that ultimately result in disability.

Aims

The purpose of this article is to identify interventions, which can be implemented and performed by nurses as part of a multidisciplinary plan. Nursing strategies related to nutrition, polypharmacy, adherence to treatment, falls, exercise, and mood and cognitive intervention are described.

Design

Discussion paper.

Data sources

Relevant and up-to-date literature from PubMed, MEDLINE, and Scopus databases regarding the selected issues, such as nutritional status, polypharmacy, falls, physical activity, and cognitive functions.

Conclusion

Frailty is considered preventable or even reversible with the appropriate interventions, which can help maintain or even restore physical abilities, cognitive function, or nutritional status in frail elderly patients. Hence, the nursing interventions are significant in clinical practice and should be implemented for frail patients.

Implications for nursing

Health-care providers, especially nurses, in their clinical practice should recognize not only elderly patients but also elderly patients with concurrent frailty, requiring intensified therapeutic interventions tailored to their individual needs. Frailty syndrome is undoubtedly a challenge for multidisciplinary teams providing health care for geriatric patients.

Improvement of medication adherence in adolescents and young adults with SLE using web-based education with and without a social media intervention, a pilot study

BACKGROUND

Self-management skills, including medication management, are vital to the health of adolescents and young adults with systemic lupus erythematosus (SLE). The purpose of this study was to assess the feasibility and preliminary effects of an online educational program in a cohort of adolescent and young adults with SLE with and without a social media (SM) experience.

METHODS

Adolescents and young adults with SLE participated weekly for 8 sessions on a web-based educational program about SLE created specifically for this project. Subjects were randomized to respond to questions at the end of each weekly module in a journal or on a SM forum with other SLE subjects. Patients were surveyed prior to initiating the study, (T0) and 6 weeks after completion of the sessions (T1). Medication adherence for hydroxychloroquine, utilizing the medication possession ratio (MPR), was compared for the 3 months preceding T0 and for the 3 months following T1.

RESULTS

Twenty-seven of the 37 subjects (73%) enrolled completed the study, including the two required sets of surveys. Reasons for being lost to follow up included being too busy, forgetting, and/or not seeing email reminders. Medication adherence improved in all subjects (p < 0.001). The percentage of the SM intervention group that was adherent (MPR ≥ 80%) significantly improved from 50% to 92% (p = 0.03), while the control group did not. Secondary outcome measures that improved, only in the SM group, included self-efficacy, sense of agency (SOA), sense of community (SOC), and empowerment. There was a strong correlation between empowerment with SOA and SOC and in turn a strong correlation with SOA and SOC with MPR, providing a possible explanation for why social media participation helped to improve medication adherence. Subjective reporting of medication adherence was not reliably correlated to MPR.

CONCLUSIONS

This pilot study has demonstrated feasibility for the use of an online educational SLE website, recruitment, and measurement of chosen outcome measures. This study provides evidence for a larger multi-site trial which has the potential to address an important service gap by delivering self-management education and peer interactions in a format that is accessible, and engaging to young people with SLE.

TRIAL REGISTRATION

Trial registration: NCT03218033 . Retrospectively registered 14 July 2017.

The effect of nurse-led education on hospitalisation, readmission, quality of life and cost in adults with heart failure. A systematic review

OBJECTIVE

The purpose of this systematic review was to highlight the effect of nurse-led 1:1 patient education sessions on Quality of Life (QoL), readmission rates and healthcare costs for adults with heart failure (HF) living independently in the community.

METHOD

A systematic review of randomised control trials was undertaken. Using the search terms nurse, education, heart failure, hospitalisation, readmission, rehospitalisation, economic burden, cost, expenditure and quality of life in PubMed, CINAHL and Google Scholar databases were searched. Papers pertaining to nurse-led 1:1 HF disease management of education of adults in the community with a history of HF were reviewed.

RESULT

The results of this review identified nurse-led education sessions for adults with HF contribute to reduction in hospital readmissions, reduction in hospitalisation and a cost benefit. Additionally, higher functioning and improved QoL were also identified.

CONCLUSION

These results suggest that nurse-led patient education for adults with HF improves QoL and reduces hospital admissions and readmissions.

PRACTICE IMPLICATIONS

Nurse-led education can be delivered utilising diverse methods and impact to reduce readmission as well as hospitalisation.

CARMIE

The incidence of chronic diseases is increasing and monitoring patients in a home environment is recommended. Noncompliance with prescribed medication regimens is a concern, especially among older people. Heart failure is a chronic disease that requires patients to follow strict medication plans permanently. With the objective of helping these patients managing information about their medicines and increasing adherence, the personal medication advisor CARMIE was developed as a conversational agent capable of interacting, in Portuguese, with users through spoken natural language. The system architecture is based on a language parser, a dialog manager, and a language generator, integrated with already existing tools for speech recognition and synthesis. All modules work together and interact with the user through an Android application, supporting users to manage information about their prescribed medicines. The authors also present a preliminary usability study and further considerations on CARMIE.

Relationship between depression and medication adherence in cardiovascular disease: the perfect challenge for the integrated care team

Many individuals with cardiovascular disease (CVD) experience depression that is associated with poor health outcomes, which may be because of medication nonadherence. Several factors influence medication adherence and likely influence the relationship between depression and medication adherence in CVD patients. This comprehensive study reviews the existing literature on depression and medication adherence in CVD patients, addresses the methods of and problems with measuring medication adherence, and explains why the integrated care team is uniquely situated to improve the outcomes in depressed CVD patients. This paper also explores how the team can collaboratively target depressive symptoms and medication-taking behavior in routine clinical care. Finally, it suggests the limitations to the integrated care approach, identifies targets for future research, and discusses the implications for CVD patients and their families.

Effectiveness of perindopril/amlodipine fixed dose combination in everyday clinical practice: results from the EMERALD study

OBJECTIVE

The rates of blood pressure (BP) control worldwide are discouraging. This study had the purpose of assessing the effectiveness of perindopril/amlodipine fixed dose combination on BP-lowering efficacy, and recording adherence, safety and tolerability during a 4 month treatment period.

RESEARCH DESIGN AND METHODS

In this multicenter, observational study 2269 hypertensive patients were prospectively enrolled. The data were recorded at 1 and 4 months of treatment.

MAIN OUTCOME MEASURES AND RESULTS

Between the first and third visits mean BP values (systolic/diastolic) decreased from 158.4 ± 13.6/89.9 ± 8.7 mmHg to 130.0 ± 7.9/77.7 ± 6.3 mmHg (P < 0.001). The magnitude of BP reduction depended on baseline blood pressure levels and total cardiovascular (CV) risk (P < 0.001). Patients with grade 1, 2 and 3 showed a BP reduction of 21.9/10.0 mmHg, 34.4/14.2 mmHg and 51.4/21.2 mmHg, accordingly (P < 0.001). Patients with very high, high, moderate and low added CV risk showed a BP reduction of 35.7/14.9 mmHg, 27.5/12.1 mmHg, 28.6/12.2 mmHg and 14.5/5.8 mmHg respectively (P < 0.001). Adherence to treatment was high: 98.3% of the sample was taking the treatment "every day" or "quite often", while only 15 patients (0.7% of the sample) prematurely discontinued treatment. Study interpretation may be limited by the fact that this is an observational study with no comparator and a short follow-up period.

CONCLUSIONS

A perindopril/amlodipine fixed dose combination significantly decreases BP levels. The degree of BP reduction is related to baseline BP levels and total CV risk.

Toward appropriate criteria in medication adherence assessment in older persons: Position Paper

Nonadherence to medication regimens is a worldwide challenge; adherence rates range from 38 to 57 % in older populations with an average rate of less than 45 % and nonadherence contributes to adverse drug events, increased emergency visits and hospitalisations. Accurate measurement of medication adherence is important in terms of both research and clinical practice. However, the identification of an objective approach to measure nonadherence is still an ongoing challenge. The aim of this Position Paper is to describe the advantages and disadvantages of the known medication adherence tools (self-report, pill count, medication event monitoring system (MEMS) and electronic monitoring devices, therapeutic drug monitoring, pharmacy records based on pharmacy refill and pharmacy claims databases) to provide the appropriate criteria to assess medication adherence in older persons. To the best of our knowledge, no gold standard has been identified in adherence measurement and no single method is sufficiently reliable and accurate. A combination of methods appears to be the most suitable. Secondly, adherence assessment should always consider tools enabling polypharmacy adherence assessment. Moreover, it is increasingly evident that adherence, as a process, has to be assessed over time and not just at one evaluation time point (drug discontinuation). When cognitive deficits or functional impairments may impair reliability of adherence assessment, a comprehensive geriatric assessment should be performed and the caregiver involved. Finally, studies considering the possible implementation in clinical practice of adherence assessment tools validated in research are needed.

A scoping review of studies comparing the medication event monitoring system (MEMS) with alternative methods for measuring medication adherence

Different methods are available for measuring medication adherence. In this paper, we conducted a scoping review to identify and summarize evidence of all studies comparing the Medication Event Monitoring System (MEMS) with alternative methods for measuring medication adherence. A literature search was performed using the open database www.iAdherence.org that includes all original studies reporting findings from the MEMS. Papers comparing methods for measuring adherence to solid oral formulations were included. Data was extracted using a standardized extraction table. A total of 117 articles fulfilled the inclusion criteria, including 251 comparisons. Most frequent comparisons were against self-report (n = 119) and pill count (n = 59). Similar outcome measures were used in 210 comparisons (84%), among which 78 used dichotomous variables (adherent or not) and 132 used continuous measures (adherence expressed as percentage). Furthermore, 32% of all comparisons did not estimate adherence over the same coverage period and 44% of all comparisons did not use a statistical method or used a suboptimal one. Only eighty-seven (35%) comparisons had similar coverage periods, similar outcome measures and optimal statistical methods. Compared to MEMS, median adherence was grossly overestimated by 17% using self-report, by 8% using pill count and by 6% using rating. In conclusion, among all comparisons of MEMS versus alternative methods for measuring adherence, only a few used adequate comparisons in terms of outcome measures, coverage periods and statistical method. Researchers should therefore use stronger methodological frameworks when comparing measurement methods and be aware that non-electronic measures could lead to overestimation of medication adherence.

Psychological Determinants of Heart Failure Self-Care: Systematic Review and Meta-Analysis

OBJECTIVE

Psychological distress has been associated with poor outcomes in patients with chronic heart failure (HF), which is assumed to be partly due to poor HF self-care behavior. This systematic review and meta-analysis describes the current evidence concerning psychological determinants of self-care in patients with chronic HF.

METHODS

Eligible studies were systematically identified by searching electronic databases PubMed, PsycINFO, and the Conference Proceedings Citation Index (Web of Science) for relevant literature (1980-October 17, 2014). Study quality was assessed according to the level of risk of bias. Quantitative data were pooled using random-effects models.

RESULTS

Sixty-five studies were identified for inclusion that varied considerably with respect to sample and study characteristics. Risk of bias was high in the reviewed studies and most problematic with regard to selection bias (67%). Depression (r = -0.19, p < .001), self-efficacy (r = 0.37, p < .001), and mental well-being (r = 0.14, p = .030) were significantly associated with self-reported self-care. Anxiety was not significantly associated with either self-reported (r = -0.18, p = .24) or objective self-care (r = -0.04, p = .79), neither was depression associated with objectively measured medication adherence (r = -0.05, p = .44).

CONCLUSIONS

Psychological factors (depression, self-efficacy, and mental well-being) were associated with specific self-care facets in patients with chronic HF. These associations were predominantly observed with self-reported indices of self-care and not objective indices. Methodological heterogeneity and limitations preclude definite conclusions about the association between psychological factors and self-care and should be addressed in future research.

Comparison of methods to assess psychiatric medication adherence in methadone-maintained patients with co-occurring psychiatric disorder

BACKGROUND

Adherence with psychiatric medication is a critical issue that has serious individual and public health implications. This is a secondary analysis of a large-scale clinical treatment trial of co-occurring substance use and psychiatric disorder.

METHOD

Participants (n=153) who received a clinically-indicated psychiatric medication ≥30 days during the 12-month study and provided corresponding data from Medication Event Monitoring System (MEMS) and Morisky Medication Taking Adherence Scale (MMAS) self-report adherence ratings were included in the analyses. Accuracy in MEMS caps openings was customized to each participant's unique required dosing schedule.

RESULTS

Consistent with expectations, MEMS-based adherence declined slowly over time, though MMAS scores of forgetting medication remained high and did not change over the 12-month study. MEMS caps openings were not significantly impacted by any baseline or treatment level variables, whereas MMAS scores were significantly associated with younger age and presence of an Axis I disorder and antisocial personality disorder, or any cluster B diagnoses.

CONCLUSIONS

Results suggest that MEMS caps may be a more objective method for monitoring adherence in patients with co-occurring substance use and psychiatric disorder relative to the MMAS self-report. Participants in this study were able to successfully use the MEMS caps for a 12-month period with <1% lost or broken caps, suggesting this comorbid population is able to use the MEMS successfully. Ultimately, these data suggest that an objective method for monitoring adherence in this treatment population yield more accurate outcomes relative to self-report.

Self-Care and All-Cause Mortality in Patients With Chronic Heart Failure

OBJECTIVES

This study examined the association of self-care with all-cause mortality in a cohort of patients with chronic heart failure (HF).

BACKGROUND

Although self-care is crucial to maintain health in patients with chronic HF, studies examining an association with clinical outcomes are scarce.

METHODS

Consecutive patients with chronic HF (n = 559, mean age 66.3 ± 9.5 years, 78% men) completed the 9-item European Heart Failure Self-care Behaviour scale. Our endpoint was all-cause mortality. Associations between self-care and all-cause mortality were assessed with Kaplan-Meier analyses and multivariable Cox regression accounting for standard sociodemographic and clinical covariates, psychological distress, and self-rated health.

RESULTS

After a median follow-up of 5.5 ± 2.4 years (range 16 weeks to 9.9 years), 221 deaths (40%) from any cause were recorded. There was no evidence of a mortality benefit in patients high over those low in global self-care (p = 0.71). In post hoc analyses, low self-reported sodium intake was associated with increased mortality (adjusted hazard ratio: 1.47; 95% confidence interval: 1.10 to 1.96; p = 0.01). Other significant predictors of mortality were: male sex, lack of a partner, New York Heart Association functional class III to IV, and increasing comorbid conditions.

CONCLUSIONS

Global self-care was not associated with long-term mortality whereas low self-reported sodium intake independently predicted increased all-cause mortality beyond parameters of disease severity. Replication of findings is needed as well as studies examining the correspondence of subjectively and objectively measured sodium intake and its effects on long-term prognosis in patients with chronic HF.

Effects of a Patient-Provider, Collaborative, Medication-Planning Tool: A Randomized, Controlled Trial

Among patients with various levels of health literacy, the effects of collaborative, patient-provider, medication-planning tools on outcomes relevant to self-management are uncertain. Objective. Among adult patients with type II diabetes mellitus, we tested the effectiveness of a medication-planning tool (Medtable™) implemented via an electronic medical record to improve patients' medication knowledge, adherence, and glycemic control compared to usual care. Design. A multicenter, randomized controlled trial in outpatient primary care clinics. 674 patients received either the Medtable tool or usual care and were followed up for up to 12 months. Results. Patients who received Medtable had greater knowledge about indications for medications in their regimens and were more satisfied with the information about their medications. Patients' knowledge of drug indication improved with Medtable regardless of their literacy status. However, Medtable did not improve patients' demonstrated medication use, regimen adherence, or glycemic control (HbA1c). Conclusion. The Medtable tool supported provider/patient collaboration related to medication use, as reflected in patient satisfaction with communication, but had limited impact on patient medication knowledge, adherence, and HbA1c outcomes. This trial is registered with ClinicalTrials.gov NCT01296633.

What matters to patients with heart failure? The influence of non-health-related goals on patient adherence to self-care management

OBJECTIVE

To describe the life goals of heart failure (HF) patients and to determine whether adherence is influenced by the extent to which these priorities are perceived as compatible with HF self-care regimens.

METHOD

Forty HF outpatients identified their top-five life goals and indicated the compatibility of HF self-care regimens (diet, exercise, weighing) with these priorities. HF knowledge, self-efficacy and reported adherence were also assessed.

RESULTS

Patients valued autonomy and social relationships as much as physical health. However, the rated importance of these domains did not predict adherence. Adherence positively correlated with the extent to which the regimen, specifically exercise, was considered compatible with life goals (r=.34, p<.05). Exercise adherence also correlated with illness severity and self-efficacy (rs=-.42 and .36, p<.05, respectively). The perceived compatibility of physical activity with personal goals predicted 11% of the variance in exercise adherence above and beyond that accounted for by illness severity and self-efficacy (FΔ (1, 36)=7.11, p<.05).

CONCLUSIONS

Patients' goals outside of the illness management context influence self-care practices.

PRACTICE IMPLICATIONS

Exploring patients' broad life goals may increase opportunities to resolve ambivalence and enhance motivation for self-care adherence.

Development of Motivate4Change Using the Intervention Mapping Protocol: An Interactive Technology Physical Activity and Medication Adherence Promotion Program for Hospitalized Heart Failure Patients

Background

It is important that heart failure (HF) patients adhere to their medication regimen and engage in physical activity. Evidence shows that adherence to these HF self-management behaviors can be improved with appropriate interventions.

Objective

To further promote medication adherence and physical activity among HF patients, we developed an intervention for hospitalized HF patients.

Methods

The intervention mapping protocol was applied in the development of the intervention. This entailed performing a needs assessment, defining change objectives, selecting determinants and strategies, and developing the materials.

Results

The resulting intervention, Motivate4Change, makes use of interactive technology and provides HF patients with personalized feedback and advice. Specific change objectives were defined. The relevant behavioral determinants for the physical activity program were practical knowledge on physical activity performance and self-efficacy for, and perceived benefits of, physical activity. For medication-taking, the selected determinants were practical knowledge on medication-taking, perceived barriers to medication-taking, beliefs about the necessity and harm regarding the medication prescribed, and beliefs about overprescribing and harm of medication in general. The change objectives and behavior change determinants were translated in feedback and advice strategies in an interactive technology program that included tailored feedback and advice, and role models in videos in which the behaviors and overcoming barriers were demonstrated. Relevant stakeholders were involved in the interventions development process. The intervention was pretested among HF patients and adjustments were made accordingly.

Conclusions

The interactive technology physical activity and medication adherence promotion program for hospitalized HF patients was systematically developed using the intervention mapping protocol and was based on the available theory and evidence regarding HF self-management behavior change. The intervention’s efficacy is yet to be determined in evaluation research.

Adesão ao tratamento de pacientes com insuficiência cardíaca em acompanhamento domiciliar por enfermeiros

Objetivo Verificar a adesão ao tratamento de pacientes com insuficiência cardíaca em acompanhamento domiciliar por enfermeiras após alta hospitalar. Método Estudo tipo antes-depois realizado com pacientes recentemente internados por insuficiência cardíaca descompensada. Três visitas domiciliares foram realizadas após alta em um intervalo de 45 dias. Avaliou-se a adesão na primeira e terceira visitas através de um questionário validado (10 questões, ponto de corte 18 pontos=70%=adesão satisfatória). Durante a primeira e segunda visitas, os pacientes receberam educação quanto à doença, adesão e autocuidado. Resultados Foram incluídos 32 pacientes, idade média 65±16 anos, 18(58%) masculinos. Os 32 pacientes receberam um total de 96 visitas domiciliares. Os escores de adesão foram 16±2.6 vs 20.4±2.7 na primeira e terceira visitas, respectivamente (p=0,001). Questões como peso e restrição hídrica aumentaram significativamente após a intervenção. Conclusão A intervenção de educação no domicílio melhorou significativamente a adesão ao tratamento de pacientes com insuficiência cardíaca e internação recente.

Relationship between Awareness of Disease and Adherence to Therapeutic Regimen among Cardiac Patients

BACKGROUND

Adherence to prescribed therapeutic regimen is an important element of self-care behaviors in cardiac patients. Awareness of disease may play an important role in patient adherence. Thus, this study was conducted to examine the relationship between awareness of the disease and adherence to therapeutic regimen among cardiac patients admitted to selected hospitals in Mashhad, Iran.

METHODS

Using a descriptive correlational design, 340 patients with heart disease were selected using convenience sampling from five hospitals in Mashhad during December 2009 to May 2010. Data were collected using three questionnaires including demographic information, awareness of disease and treatment adherence (including medication, diet and physical activity). Validity and reliability of the questionnaires were examined by content validity and test-retest, respectively. Also, inter-rater reliability was examined for two data raters. Data were analyzed by SPSS software, using Spearman and Kruskal-Wallis tests.

RESULTS

The results showed that only 15 percent of the study subjects had a good awareness of their disease. The majority of patients followed a good medication adherence (79 %), good diet adherence (60%), and weak physical activity adherence (61%). A significant correlation was found between knowledge and adherence to therapeutic regimen (P=0.001, rp=0.32).

CONCLUSION

This study showed that awareness of disease and adherence to physical activity was low in the majority of patients. It is recommended that studies should be conducted to explore effective educational programs and strategies to improve adherence to therapeutic regimen among cardiac patients.

Drug holidays: the most frequent type of noncompliance with calcium plus vitamin D supplementation in persistent patients with osteoporosis

PURPOSE

All current recommendations include calcium and vitamin D (Ca-D) as an integrated part of osteoporosis treatment. The purpose of this pilot study was to analyze compliance with a fixed combination of Ca-D in women persistent with the treatment.

PATIENTS AND METHODS

An observational study was carried out in three osteocenters in the Czech Republic. Women with osteoporosis ≥55 years of age concurrently treated with oral ibandronate were eligible. Compliance was evaluated in a period of 3 months by Medication Event Monitoring System (MEMS), tablet count, and self-report. Nonpersistence was defined as a MEMS-based gap in the use of Ca-D to be 30 days or more.

RESULTS

A total of 73 patients were monitored, of which 49 patients were analyzed (target population). Based on MEMS, mean overall compliance was 71%; good compliance (≥80%) was observed in 59% of the patients. As many as 71% of the patients took drug holidays (≥3 consecutive days without intake); overall compliance of these patients was 59% and was slightly lower on Fridays and weekends. Patients without drug holidays were fully compliant (did not omit individual doses). Compliance differed according to daily time at which the patients mostly used the Ca-D. Afternoon/evening takers showed a mean overall compliance of 82% while morning/night takers only 51% (P=0.049). Based on MEMS, tablet count, and self-report, compliance ≥75% was observed in 59%, 100%, and 87% of the patients, respectively. Outcomes obtained by the three methods were not associated with each other. Undesirable concurrent ingestion of Ca-D and ibandronate was present only twice.

CONCLUSION

Despite almost perfect self-reported and tablet count-based compliance, MEMS-based compliance was relatively poor. Consecutive supplementation-free days were common; more than two-thirds of the patients took at least one drug holiday. This pilot study showed drug holiday to be the most important type of noncompliance with Ca-D in those who are persistent with the treatment.

Adherence to self-care in patients with heart failure in the HeartCycle study

PURPOSE

The purpose of this study was to evaluate a novel online education and coaching program to promote self-care among patients with heart failure. In this program, education and coaching content is automatically tailored to the knowledge and behavior of the patient.

PATIENTS AND METHODS

The evaluation of the program took place within the scope of the HeartCycle study. This multi-center, observational study examined the ability of a third generation telehealth system to enhance the management of patients recently (<60 days) admitted to the hospital for worsening heart failure or outpatients with persistent New York Heart Association (NYHA) Functional Classification III/IV symptoms. Self-reported self-care behavior was assessed at baseline and study-end by means of the 9-item European Heart Failure Self-care Behavior scale. Adherence to daily weighing, blood pressure monitoring, and reporting of symptoms was determined by analyzing the system's database.

RESULTS

Of 123 patients enrolled, the mean age was 66±12 years, 66% were in NYHA III and 79% were men. Self-reported self-care behavior scores (n=101) improved during the study for daily weighing, low-salt diet, physical activity (P<0.001), and fluid restriction (P<0.05). Average adherence (n=120) to measuring weight was 90%±16%, to measuring blood pressure was 89%±17% and to symptom reporting was 66%±32%.

CONCLUSION

Self-reported self-care behavior scores improved significantly during the period of observation, and the objective evidence of adherence to daily weight and blood pressure measurements was high and remained stable over time. However, adherence to daily reporting of symptoms was lower and declined in the long-term.

Design and Usage of the HeartCycle Education and Coaching Program for Patients With Heart Failure

Background

Heart failure (HF) is common, and it is associated with high rates of hospital readmission and mortality. It is generally assumed that appropriate self-care can improve outcomes in patients with HF, but patient adherence to many self-care behaviors is poor.

Objective

The objective of our study was to develop and test an intervention to increase self-care in patients with HF using a novel, online, automated education and coaching program.

Methods

The online automated program was developed using a well-established, face-to-face, home-based cardiac rehabilitation approach. Education is tailored to the behaviors and knowledge of the individual patient, and the system supports patients in adopting self-care behaviors. Patients are guided through a goal-setting process that they conduct at their own pace through the support of the system, and they record their progress in an electronic diary such that the system can provide appropriate feedback. Only in challenging situations do HF nurses intervene to offer help. The program was evaluated in the HeartCycle study, a multicenter, observational trial with randomized components in which researchers investigated the ability of a third-generation telehealth system to enhance the management of patients with HF who had a recent (<60 days) admission to the hospital for symptoms or signs of HF (either new onset or recurrent) or were outpatients with persistent New York Heart Association (NYHA) functional class III/IV symptoms despite treatment with diuretic agents. The patients were enrolled from January 2012 through February 2013 at 3 hospital sites within the United Kingdom, Germany, and Spain.

Results

Of 123 patients enrolled (mean age 66 years (SD 12), 66% NYHA III, 79% men), 50 patients (41%) reported that they were not physically active, 56 patients (46%) did not follow a low-salt diet, 6 patients (5%) did not restrict their fluid intake, and 6 patients (5%) did not take their medication as prescribed. About 80% of the patients who started the coaching program for physical activity and low-salt diet became adherent by achieving their personal goals for 2 consecutive weeks. After becoming adherent, 61% continued physical activity coaching, but only 36% continued low-salt diet coaching.

Conclusions

The HeartCycle education and coaching program helped most nonadherent patients with HF to adopt recommended self-care behaviors. Automated coaching worked well for most patients who started the coaching program, and many patients who achieved their goals continued to use the program. For many patients who did not engage in the automated coaching program, their choice was appropriate rather than a failure of the program.

Patient adherence with postoperative restrictions after rotator cuff repair

HYPOTHESIS

This study aimed to measure self-reported patient adherence to postoperative restrictions after rotator cuff repair, to evaluate correlations between adherence and functional outcome, and to identify possible indicators of poor adherence. We believed that poor adherence would correlate with poor functional outcome.

METHODS

Fifty consecutive patients undergoing repair for rotator cuff tears were included and instructed to wear an abduction brace for 6 weeks after surgery. Functional evaluations, including American Shoulder and Elbow Surgeons score, University of California-Los Angeles shoulder score, and Simple Shoulder Test, were made preoperatively and postoperatively. Patients commented on their adherence with a medical adherence measurement questionnaire.

RESULTS

Average adherence was 88% (range, 59.2-100). There were no significant correlations between adherence and improvement in American Shoulder and Elbow Surgeons, University of California-Los Angeles, or Simple Shoulder Test scores after rotator cuff repair (P = .06245, .5891, and .7688). Of the patient demographics analyzed, only smoking status had a positive effect on adherence (P = .00432; coefficient, 9.867). All other demographics, including hand dominance, mechanism of injury, repair complexity, comorbidities, living status, employment status, and age, had no significant effect on self-measured adherence to postoperative restrictions (P = .7876, .5889, .6444, .4190, .0609, .4171, .5402).

CONCLUSIONS

Patients' self-reported adherence did not correlate with shoulder outcome as measured on any of 3 functional outcome scores.

Validity and reliability of the European Heart Failure Self-care Behavior Scale among adults from the United States with symptomatic heart failure

BACKGROUND

Heart failure (HF) self-care is an important component of disease management and the focus of many interventions.

AIM

The aim of this study was to evaluate the validity and reliability of the nine-item European HF Self-care Behavior Scale (EHFScB-9) in a sample of 200 adults from the USA with symptomatic HF.

METHODS

Psychometric tests included item and confirmatory factor analyses, convergent and discriminant validity, and internal consistency.

RESULTS

Item-total correlations ranged from 0.25 to 0.65. Many fit indices for the EHFScB-9 and the four-item consulting behaviors scale reached thresholds of acceptability. As expected, the EHFScB-9 was associated with other measures of HF self-care but not with quality-of-life. Coefficient α was 0.80 for the EHFScB-9 and 0.85 for the consulting behaviors subscale.

CONCLUSION

The EHFScB-9 was a valid and reliable measure of HF self-care among English-speaking US adults with symptomatic HF.

Medication complexity, prescription behaviour and patient adherence at the interface between ambulatory and stationary medical care

PURPOSE

A hospital stay is often accompanied by changes in medication therapy. The purpose of this study was to investigate the impact of a transfer across the interfaces on the complexity of therapeutic regimens and patient adherence as well as the attitudes of patients and general practitioners (GPs) towards pharmacotherapies.

METHODS

This was a prospective observational study that analysed the complexity of medication therapies and the adherence and attitudes of internal medicine and urology patients towards their medication(s) at three time points (hospital admission, discharge and 6 weeks after discharge). GPs of the patients recruited to the study were questioned about the follow-up medication therapy and their opinion on the medication prescribed in hospital.

RESULTS

At the time of hospital admission, 60.2 % of the study population were nonadherent. During hospitalization, the number decreased to 37.6 %, but increased to 61.2 % 6 weeks after discharge. Changes in the overall complexity of the therapy regimens were marginal and not statistically significant. Of the long-term medication regimens, 48.6 % were modified during hospital stay. The patients preferred regimens with a minimum of drug administrations. GPs stated to be willing to continue hospital prescriptions but were restricted by financial budgets.

CONCLUSION

The results of this study confirm that an increase in adherence during a hospital stay is only transient, underlining the need for interventions to ameliorate medication adherence. They also suggest that patients prefer simple regimens. Although GPs are willing to consider their patient's preferences on pharmacotherapy, they state limitations due to financial budgets. Further studies are needed that investigate the extent to which medication therapies can be simplified and the effect of simplification on adherence.