1
|
Karami M, Ashtarian H, Rajati M, Hamzeh B, Rajati F. The effect of health literacy intervention on adherence to medication of uncontrolled hypertensive patients using the M-health. BMC Med Inform Decis Mak 2023; 23:289. [PMID: 38102648 PMCID: PMC10724893 DOI: 10.1186/s12911-023-02393-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Given that patients' medication adherence is regarded as the major part of disease control and improving health literacy can be effective in promoting adherence to healthy behaviors, the present study aimed to investigate the effect of health literacy intervention based on the medication adherence among uncontrolled hypertensive patients using mobile health (M-health). METHODS An interventional study with a quasi-experimental design, was conducted on 118 uncontrolled hypertensive patients. Participants were randomly divided into the intervention (n = 59) and control (n = 59) groups using blocked randomization. In the intervention group, a mobile health (M-health) program was designed using programmed instruction to improve patients' health literacy over a period of 3 months. Data was collected by administering health literacy and medication adherence questionnaires to participants before and after the intervention. The analysis involved using the independent sample t-test to compare the variables before and after the study. RESULTS Before the intervention, the total score of health literacy was 33.34 and 33.14 in the intervention and control groups, respectively. After the intervention, it increased to 40.36 and 34.20 in the intervention and control groups, respectively, which was statistically significant in the intervention group (p = 0.01). Moreover, the medication adherence score of the intervention group significantly increased after the intervention. Both systolic and diastolic blood pressure decreased in the intervention group. However, it should be noted that the decrease in systolic blood pressure by 148.98 was statistically significant, while the decrease observed in diastolic blood pressure in the intervention group was not statistically significant (p = 0.08). CONCLUSION The application of programmed instruction through M-Health has shown a positive effect on the health literacy of uncontrolled hypertensive patients. In addition to detecting and treating patients, it is important to prioritize the improvement of health literacy in terms of medication adherence and the adoption of healthy behaviors.
Collapse
Affiliation(s)
- Maryam Karami
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hossein Ashtarian
- Department of Health Education and Health Promotion, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mojgan Rajati
- Department of Obstetrics and Gynecology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behrooz Hamzeh
- Department of Health Education and Health Promotion, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fatemeh Rajati
- Research Center for Environmental Determinants of Health, Health institute, Department of Health Education and Health Promotion, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| |
Collapse
|
2
|
Abdeslam EK, Ahmed C, Kamal K, Rachid L, Keltoum B, Soufiane E, Mohamed N, Fatiha C. Physical activity level and sedentary time determinants among Moroccan hypertensive patients. Ann Cardiol Angeiol (Paris) 2023; 72:101607. [PMID: 37269806 DOI: 10.1016/j.ancard.2023.101607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/19/2023] [Accepted: 05/10/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Hypertension is closely associated with an inactive lifestyle. Physical activity and/or exercise have been shown to delay the development of hypertension. This study aimed to assess the level of physical activity and sedentary time, and its determinants among Moroccan Hypertensive patients. PATIENTS AND METHODS A cross-sectional study was conducted between March and July 2019 including 680 hypertensive patients. We administered international physical activity questionnaire in face-to-face interview to assess the level of physical activity and sedentary time. RESULTS The results showed that only 43.4% of participants met recommended physical activity levels (≥ 600 MET min/week). Adherence to physical activity recommendations was observed more in male participants (p = 0.035), in participants aged less than 40 years (p = 0.040) and those aged between 41 and 50 years (p = 0.047). The average sedentary time was 37.19 ± 18.92 hours per week. This time was significantly longer in people aged 51 and over, in married, divorced, and widowed people, and in those with low levels of physical activity. CONCLUSIONS The level of physical inactivity and the sedentary time was high. In addition, participants with a high-level sedentary lifestyle had a low level of physical activity. Educational actions should be undertaken among this group of participants to prevent the risks associated with inactivity and sedentary behavior.
Collapse
Affiliation(s)
- El Kardoudi Abdeslam
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco.
| | - Chetoui Ahmed
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco.
| | - Kaoutar Kamal
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco.
| | - Lotfi Rachid
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco.
| | - Boutahar Keltoum
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco.
| | - Elmoussaoui Soufiane
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco; Mohamed VI Hospital University, BP 2360 Principal, Avenue Ibn Sina, Marrakesh, Morocco.
| | - Najimi Mohamed
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco.
| | - Chigr Fatiha
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco.
| |
Collapse
|
3
|
Abdisa L, Alemu A, Heluf H, Sertsu A, Dessie Y, Negash B, Ayana GM, Letta S. Factors associated with poor medication adherence during COVID-19 pandemic among hypertensive patients visiting public hospitals in Eastern Ethiopia: a cross-sectional study. BMJ Open 2022; 12:e064284. [PMID: 36202580 PMCID: PMC9539650 DOI: 10.1136/bmjopen-2022-064284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE This study aimed to assess factors associated with poor medication adherence during the COVID-19 pandemic among hypertensive patients visiting public hospitals in Eastern Ethiopia. SETTING Hospital-based cross-sectional study was conducted in Harari regional state and Dire Dawa Administration from 1 January to 30 February 2022. Both settings are found in Eastern Ethiopia. PARTICIPANTS A total of 402 adult hypertensive patients who visited the chronic diseases clinic for follow-up were included in the study. MAIN OUTCOME MEASURES The main outcome measure was poor medication adherence during the COVID-19 pandemic. RESULTS The level of poor antihypetensive medication adherence was 63% (95% CI 48.1 to 67.9). Patients who had no formal education (adjusted OR (AOR)=1.56, 95% CI 1.03 to 4.30), existing comorbid conditions (AOR=1.98, 95% CI 1.35 to 4.35), self-funded for medication cost (AOR=2.05, 95% CI 1.34 to 4.73), poor knowledge about hypertension (HTN) and its treatment (AOR=2.67, 95% CI 1.45 to 3.99), poor patient-physician relationship (AOR=1.22, 95% CI 1.02 to 4.34) and unavailability of medication (AOR=5.05, 95% CI 2.78 to 12.04) showed significant association with poor medication adherence during the pandemic of COVID-19. CONCLUSION The level of poor antihypertensive medication adherence was high in this study. No formal education, comorbidity, self-funded medication cost, poor knowledge about HTN and its treatment, poor patient-physician relationship, and unavailability of medication during the COVID-19 pandemic were factors significantly associated with poor adherence to antihypertensive medication. All stakeholders should take into account and create strategies to reduce the impact of the COVID-19 pandemic on medication adherence of chronic diseases.
Collapse
Affiliation(s)
- Lemesa Abdisa
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Addisu Alemu
- School of Public Health, Haramaya University College of Health Sciences, Harar, Ethiopia
| | - Helina Heluf
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Addisu Sertsu
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, Haramaya University College of Health Sciences, Harar, Ethiopia
| | - Belay Negash
- School of Public Health, Haramaya University College of Health Sciences, Harar, Ethiopia
| | - Galana Mamo Ayana
- Epidemiology and Biostatistics, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Shiferaw Letta
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| |
Collapse
|
4
|
Lee EKP, Poon P, Yip BHK, Bo Y, Zhu MT, Yu CP, Ngai ACH, Wong MCS, Wong SYS. Global Burden, Regional Differences, Trends, and Health Consequences of Medication Nonadherence for Hypertension During 2010 to 2020: A Meta-Analysis Involving 27 Million Patients. J Am Heart Assoc 2022; 11:e026582. [PMID: 36056737 PMCID: PMC9496433 DOI: 10.1161/jaha.122.026582] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Nonadherence to antihypertensive medications is the leading cause of poor blood pressure control and thereby cardiovascular diseases and mortality worldwide. Methods and Results We investigated the global epidemiology, regional differences, and trend of antihypertensive medication nonadherence via a systematic review and meta‐analyses of data from 2010 to 2020. Multiple medical databases and clinicaltrials.gov were searched for articles. Observational studies reporting the proportion of patients with anti‐hypertensive medication nonadherence were included. The proportion of nonadherence, publication year, year of first recruitment, country, and health outcomes attributable to antihypertensive medication nonadherence were extracted. Two reviewers screened abstracts and full texts, classified countries according to levels of income and locations, and extracted data. The Joanna Briggs Institute prevalence critical appraisal tool was used to rate the included studies. Prevalence meta‐analyses were conducted using a fixed‐effects model, and trends in prevalence were analyzed using meta‐regression. The certainty of evidence concerning the effect of health consequences of nonadherence was rated according to Grading of Recommendations, Assessment, Development and Evaluations. A total of 161 studies were included. Subject to different detection methods, the global prevalence of anti‐hypertensive medication nonadherence was 27% to 40%. Nonadherence was more prevalent in low‐ to middle‐income countries than in high‐income countries, and in non‐Western countries than in Western countries. No significant trend in prevalence was detected between 2010 and 2020. Patients with antihypertensive medication nonadherence had suboptimal blood pressure control, complications from hypertension, all‐cause hospitalization, and all‐cause mortality. Conclusions While high prevalence of anti‐hypertensive medication nonadherence was detected worldwide, higher prevalence was detected in low‐ to middle‐income and non‐Western countries. Interventions are urgently required, especially in these regions. Current evidence is limited by high heterogeneity. Registration URL: www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021259860.
Collapse
Affiliation(s)
- Eric K P Lee
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Paul Poon
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Benjamin H K Yip
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Yacong Bo
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Meng-Ting Zhu
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Chun-Pong Yu
- Li Ping Medical Library The Chinese University of Hong Kong Shatin Hong Kong
| | - Alfonse C H Ngai
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Martin C S Wong
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Samuel Y S Wong
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| |
Collapse
|
5
|
Latif AA, Lee KW, Phang K, Rashid AA, Chan NN, Peh SC, Thilaganathan T, Ooi PB. Patient-related factors associated with medication adherence behavior in patients with end-stage renal disease: A systematic review. Tzu Chi Med J 2022; 34:473-484. [PMID: 36578649 PMCID: PMC9791854 DOI: 10.4103/tcmj.tcmj_212_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/02/2021] [Accepted: 03/11/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives This systematic review aims to identify influencing factors of medication adherence behavior in patients with end-stage renal disease (ESRD), with a special interest in patient-related factors based on the World Health Organization adherence model. Materials and Methods Primary electronic databases comprising PubMed, Scopus, Web of Science, Embase and Cochrane Library, as well as ProQuest (Health and Medical), ProQuest (Psychology), and EBSCOHost (APA PsychARTICLES) were used to search for literature on patient-related factors in medication adherence, from inception till August 31, 2021. Results 479 articles were identified and six articles meeting eligibility criteria were reviewed and remained in this systematic review. The present review found that despite different tools being used to measure ESRD's perception of medication's necessity and beliefs, there was a profound association between perception and beliefs with medication adherence behavior. There is a positive relationship between knowledge, belief, educational level, ethnicity, female, and medication adherence behavior. Mixed finding was reported between perception, age, and medication adherence behavior. However, there were no studies on patients' attitudes and medication adherence behavior as suggested in the WHO adherence model. Conclusion Only a limited number of patient-related factors were available for evaluation in the current systematic review. Additional research is needed to advance the understanding of medication adherence behavior affected by patient-related factors on the medication and illness. However, the findings must be taken with caution because of the limited studies included in this review.
Collapse
Affiliation(s)
- Anis A'lliya Latif
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia
| | - Kai Wei Lee
- Department of Pre-Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | - Kelly Phang
- Faculty of Psychology and Social Sciences, University of Cyberjaya, Selangor, Malaysia
| | - Aneesa Abdul Rashid
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Nee Nee Chan
- Department of Education, Faculty of Social Sciences and Liberal Arts, UCSI University, Kuala Lumpur, Malaysia
| | - Suat Cheng Peh
- Jeffrey Sachs Center, School of Interdisciplinary Studies, Sunway University, Selangor, Malaysia
| | | | - Pei Boon Ooi
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia,Department of General Studies, School of Interdisciplinary Studies, Sunway University, Selangor, Malaysia,Address for correspondence: Dr. Pei Boon Ooi, Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, 5, Jalan Universiti, Bandar Sunway, 47500 Selangor, Malaysia. E-mail:
| |
Collapse
|
6
|
Ayele TA, Shibru H, Mequanent Sisay M, Melese T, Fentie M, Azale T, Belachew T, Shitu K, Alamneh TS. The effect of COVID-19 on poor treatment control among ambulatory Hypertensive and/or Diabetic patients in Northwest Ethiopia. PLoS One 2022; 17:e0266421. [PMID: 35588110 PMCID: PMC9119481 DOI: 10.1371/journal.pone.0266421] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/20/2022] [Indexed: 12/23/2022] Open
Abstract
Background
Diabetes and hypertension have emerged as important clinical and public health problems in Ethiopia. The need to have long-term sustainable healthcare services for patients with diabetes and hypertension is essential to enhance good treatment control among those patients and subsequently delay or prevent complications. A collective shift towards acute care for COVID-19 patients combined with different measures to contain the pandemic had disrupted ambulatory care. Hence, it is expected to have a significant impact on treatment control of hypertensive and diabetic patients. However, there is limited evidence on the effect of the pandemic on treatment control and its determinants. Therefore, this study aimed to assess the effect of COVID-19 pandemic on treatment control of ambulatory Hypertensive and Diabetic patients and identify the factors for poor treatment control in North West Ethiopia.
Methods
A retrospective chart review and cross-sectional survey design were conducted between December 2020 and February 2021. Using a stratified systematic random sampling technique, 836 diabetic and/or hypertensive patients were included in the study. Web-based data collection was done using Kobo collect. The changes in the proportion of poor treatment control among ambulatory Hypertensive and/or Diabetic patients during the COVID-19 pandemic period were assessed. A multivariable binary logistic regression mixed model was fitted to identify the determinants of poor treatment control. The odds ratios were reported in both crude and adjusted form, together with their 95% confidence intervals and p-values.
Result
Poor treatment control increased significantly from 24.81% (21.95, 27.92) prior to the COVID-19 pandemic to 30.33% (27.01, 33.88), 35.66% (32.26, 39.20), 36.69% (33.40, 40.12), and 34.18% (3102, 37.49) in the first, second, third, and fourth months following the date of the first COVID-19 case detection in Ethiopia, respectively. Marital status (AOR = 0.56, 95%CI; 0.41, 0.74), regimen of medication administration (AOR = 1.30, 95%CI; 1.02, 166), daily (AOR = 0.12, 95%CI; 0.08, 0.20), twice (AOR = 0.42, 95%CI; 0.30. 0.59), and three times (AOR = 0.31, 95%CI; 0.21, 0.47) frequency of medication, number medications taken per day (AOR = 0.79, 95%CI;0.73, 0.87), patients habits like hazardous alcohol use (AOR = 1.29, 95%CI; 1.02, 1.65) and sedentary lifestyle (AOR = 1.72,95%CI;1.46, 2.02), missed appointment during the COVID-19 pandemic (AOR = 2.09, 95%CI; 1.79, 2.45), and presence of disease related complication (AOR = 1.11, 95%CI; 0.93, 1.34) were significantly associated with poor treatment control among Diabetic and/or hypertensive patients during the COVID-19 pandemic.
Conclusion
The COVID-19 pandemic had a substantial impact on ambulatory Diabetic and/or Hypertensive patients’ treatment control. Being married, as well as the frequency and types of medicines taken per day were all found to be negatively associated with poor treatment control. During the COVID -19 pandemic, patients’ habits such as hazardous alcohol use and sedentary lifestyle, longer follow-up time, having disease-related complication (s), patients taking injectable medication, number of medications per day, and missed appointments were positively associated with poor treatment control in ambulatory diabetic and hypertensive patients. Therefore, it is better to consider the risk factors of poor treatment control while designing and implementing policies and strategies for chronic disease control.
Collapse
Affiliation(s)
- Tadesse Awoke Ayele
- Epidemiology & Biostatistics Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habtewold Shibru
- Internal Medicine Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Malede Mequanent Sisay
- Epidemiology & Biostatistics Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfahun Melese
- Health Informatics Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melkitu Fentie
- Health Informatics Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Telake Azale
- Health Education & Behavioural Sciences Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Kegnie Shitu
- Health Education & Behavioural Sciences Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfa Sewunet Alamneh
- Epidemiology & Biostatistics Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| |
Collapse
|
7
|
Ernawati I, Lubada EI, Lusiyani R, Prasetya RA. Association of adherence measured by self-reported pill count with achieved blood pressure level in hypertension patients: a cross-sectional study. Clin Hypertens 2022; 28:12. [PMID: 35422008 PMCID: PMC9011980 DOI: 10.1186/s40885-022-00195-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background Medication adherence plays an essential role in controlling blood pressure to reduce morbidity and mortality of hypertension disease. Thus, this study aimed to determine the association of medication adherence measured by self-reported pill count with blood pressure levels among patients at several community health centers in Surabaya. Methods Adherence was assessed using the pill count method by comparing the total number of antihypertension drugs taken with the prescribed drugs. The inclusion criteria involved hypertensive patients who received antihypertension drugs, specifically adults and elderly, except the pregnant woman. The patient blood pressure was measured by healthcare workers in the targeted community health centers. Descriptive and multivariable logistic regression analyses were performed to assess factors associated with medication adherence with blood pressure levels. Results A total of 264 hypertensive outpatients participating in this study, 77.65% of participants were adherent to antihypertensive drugs based on the pill count method, and 40.91% of participants had controlled blood pressure. Patients with uncontrolled blood pressure were about six times (adjusted odds ratio [AOR]: 6.15; 95% confidence interval [CI]: 2.694–14.039; P = 0.000) more likely to have non-adherent medication than patients with controlled blood pressure. Reciprocally, non-adherent participants (pill count < 80%) were about six times (AOR: 6.081; 95% CI: 2.672–13.838; P = 0.000) more likely to have uncontrolled blood pressure compared to adherent patients (pill count ≥ 80%). Age less than 40 years old (AOR: 5.814; 95% CI: 1.519–22.252; P = 0.01) and having middle school educational level (AOR: 0.387; 95% CI: 0.153–0.974; P = 0.045) were found to be independent factors associated with uncontrolled blood pressure. Conclusions The result showed that non-adherence to antihypertension drugs is associated with uncontrolled blood pressure. Then, age could be associated with uncontrolled blood pressure. Thus, pharmacists and other healthcare providers should pay attention to improving medication adherence and maintaining the controlled blood pressure. Supplementary Information The online version contains supplementary material available at 10.1186/s40885-022-00195-5.
Collapse
Affiliation(s)
- Iin Ernawati
- Department of Clinical and Community Pharmacy, Akademi Farmasi Surabaya, Surabaya, East Java, Indonesia.
| | - Eziah Ika Lubada
- Department of Clinical and Community Pharmacy, Akademi Farmasi Surabaya, Surabaya, East Java, Indonesia
| | - Ria Lusiyani
- Department of Clinical and Community Pharmacy, Akademi Farmasi Surabaya, Surabaya, East Java, Indonesia
| | - Rahmad Aji Prasetya
- Department of Clinical and Community Pharmacy, Akademi Farmasi Surabaya, Surabaya, East Java, Indonesia
| |
Collapse
|
8
|
Lu X, Liu J. Factors Influencing Public Awareness of and Attitudes Toward Palliative Care: A Cross-Sectional Analysis of the 2018 HINTS Data. Front Public Health 2022; 10:816023. [PMID: 35462828 PMCID: PMC9021382 DOI: 10.3389/fpubh.2022.816023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background The global burden of serious health-related suffering requiring palliative care has been projected to grow significantly by 2060, which indicates the imminent need for integrating palliative care into health systems globally. Moreover, research evidence has been accumulating in support of the earlier adoption of palliative care into the treatment course of serious life-threatening illnesses. However, barriers to earlier access to palliative care still remain, which might be attributable to the global lack of awareness of palliative care and the prevalence of negative perceptions and attitudes. To address this, further investigation of the influencing factors of public perceptions of palliative care is imperative to help inform and develop effective targeted public health campaigns and education messages aimed at improving views of palliative care and thereby early access. Methods We used data from the Health Information National Trends Survey (HINTS), a nationally representative cross-sectional survey routinely administrated by the National Cancer Institute from the United States. Specifically, we analyzed the latest palliative care data from HINTS 5 Cycle 2 data set. Sociodemographic characteristics, individual factors such as self-perceived health status, and interpersonal factors such as relationship quality were examined as predictors of public awareness of and attitudes toward palliative care. Survey data were analyzed using SPSS 26 with multiple hierarchical regression tests. Results Results showed that people's quality of interpersonal relationships was a significant influencing factor of their awareness of and attitudes toward palliative care. Moreover, cancer diagnosis history and perceived healthcare quality were found to jointly affect their awareness of palliative care; perceived health status and patient centeredness interacted to influence their awareness of and attitudes toward palliative care. Finally, female, non-white, and poorer people were more aware of palliative care, while female and more educated people had more favorable attitudes. Conclusions The quality of social relationships emerges as a significant predictor of people's awareness of and attitude toward palliative care, as treatment options and decisions of serious life-threatening illnesses often involve the patients' family. The results hold strong implications for public health campaigns and education messages aiming at changing people's views of palliative care, which ultimately improve end-of-life outcomes.
Collapse
Affiliation(s)
- Xinyu Lu
- School of Journalism and Communication, Shanghai International Studies University, Shanghai, China
| | - Jiawei Liu
- School of Journalism and Communication, Jinan University, Guangzhou, China
- *Correspondence: Jiawei Liu
| |
Collapse
|
9
|
Hung HHY, Chan EYY, Chow E, Leung SY, Lai FTT, Yeoh EK. Consumption of home-prepared meal at workplace as a predictor of glycated haemoglobin among people with type 2 diabetes in Hong Kong: a mixed-methods study. Nutr Diabetes 2022; 12:16. [PMID: 35379796 PMCID: PMC8979147 DOI: 10.1038/s41387-022-00188-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/18/2022] [Accepted: 02/24/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES There is increasing attention on association between eating patterns and diabetes control following global changes in eating patterns. There had been very limited research on the eating patterns of diabetic patients with employment, although working age population has seen the highest increase in diabetes incidence. This study aimed to identify workplace eating patterns in relation to glycaemic control among type 2 diabetic patients with employment. METHODS This is a sequential mixed-methods study. The exploratory qualitative study involved focus group interviews with 31 type 2 diabetic patients with employment, which guided the design of a subsequent cross-sectional investigation involving 185 patients with employment. Thematic analysis was conducted on the qualitative data to identify workplace eating patterns most relevant to glycaemic control. Hierarchical multiple linear regression was performed to examine association between workplace eating pattern and glycaemic control, proxied by HbA1c. RESULTS The focus group interviews identified frequency in the consumption of home-prepared meals (HPM) and meal hours as the major workplace eating patterns that affected glycaemic control. The cross-sectional study confirmed that regular consumption of HPM at workplace could explain variance of HbA1c, independent of socio-demographic factors, lifestyle factors and disease condition, with R2 = 0.146, F(14, 170) = 2.075, p = 0.015; adjusted R2 = 0.076. Patients who were female, in non-skilled occupation, on shift, with fixed work location and had break during work were more likely to consume HPM. CONCLUSIONS Consumption of HPM at workplace should be promoted to facilitate better glycaemic control by type 2 diabetic patients with employment, possibly through more practical dietary advice, and workplace accommodation in terms of space and facilities. In the context of COVID-19 pandemic, consumption of HPM also meant additional protection for diabetic patients through reducing close contact exposures in restaurants.
Collapse
Affiliation(s)
- Heidi H Y Hung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Emily Ying Yang Chan
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China. .,Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China. .,Nuffield Department of Medicine, University of Oxford, Oxford, UK. .,François-Xavier Bagnoud Center for Health & Human Rights, Harvard University, Boston, MA, USA.
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shuk-Yun Leung
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong SAR, China
| | - Francisco Tsz Tsun Lai
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.,Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China.,Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong SAR, China
| | - Eng-Kiong Yeoh
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
10
|
Wan J, Wu Y, Ma Y, Tao X, Wang A. Predictors of poor medication adherence of older people with hypertension. Nurs Open 2022; 9:1370-1378. [PMID: 35094495 PMCID: PMC8859025 DOI: 10.1002/nop2.1183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 12/12/2021] [Accepted: 01/09/2022] [Indexed: 11/16/2022] Open
Abstract
Aims To explore the risk factors for poor medication adherence in older people with hypertension. Design A cross‐sectional study. Methods Participants were administered with a self‐report questionnaire about their demographic characteristics; additionally, their four‐item Morisky Medication Adherence Scale scores were calculated. The STROBE checklist was applied as the reporting guideline for this study (File S1). Results Univariate analysis indicated that the following five factors were statistically significantly associated with medication adherence: education level (χ2 = 8.073, p = .045), co‐living (χ2 = 11.364, p = .010), hypertension complications (χ2 = 10.968, p = .001), admission blood pressure (χ2 = 8.876, p = .003), and falls (χ2 = 6.703, p = .010). Multivariable binary logistic regression analysis showed that there were four statistically significant predictors, such as people who lived with spouses and offspring (OR = 3.004, p = .017), and those who had high admission blood pressure (OR = 1.910, p = .003) had a greater risk of poor medication adherence, whereas those without hypertension complications (OR = 0.591, p = .026) and those without falls (OR = 0.530, p = .046) had a lower risk. Relevance to clinical practice We believe that these findings contribute to the identification of high‐risk people with poor adherence, allowing nurses to identify people with poor adherence in a timely manner, and pay attention to the people's medication.
Collapse
Affiliation(s)
- Jingjing Wan
- Department of Graduate School Wannan Medical College Wuhu China
| | - Yinyin Wu
- Department of Graduate School Wannan Medical College Wuhu China
| | - Yuan Ma
- Department of Graduate School Wannan Medical College Wuhu China
| | - Xiubin Tao
- Nursing Department at First Affiliated Hospital of Wannan Medical College Wuhu China
| | - Anshi Wang
- Department of Public Health Wannan Medical College Wuhu China
| |
Collapse
|
11
|
She R, Lau MMC, Lau JTF. Potential joint effects of perceptions related to COVID-19 and future social development on depressive symptoms: a Chinese population-based study. J Ment Health 2022; 31:534-542. [PMID: 34994290 DOI: 10.1080/09638237.2021.2022612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The COVID-19 pandemic has caused significant negative socio-political, economic, and psychological consequences. AIMS To investigate the impact of individual-level (illness representations of COVID-19) and structurally derived (anticipated social-political development in the economy, security, and social harmony in the next year) factors, and their potential moderation effects on depressive symptoms. METHODS An anonymous population-based telephone survey was conducted among the general public of Hong Kong, China during 3-10 April 2020 (n = 300, response rate 56%). Depressive symptoms were assessed by the validated Chinese version of the Patient Health Questionnaire-9. RESULTS Of the participants, 8.7% showed probable moderate-to-severe depression. Hierarchical linear regression models showed that illness representations of personal/treatment control and emotional responses and anticipated deterioration in social harmony were independently and significantly associated with depressive symptoms. Anticipated deterioration in security significantly moderated the associations between perceived consequence/treatment control of COVID-19 and depressive symptoms, such that the associations were stronger among people who anticipated a strong deterioration in security. CONCLUSIONS The findings suggested that perceptions of COVID-19 and future social-political development jointly and interactively contributed to depressive symptoms during the COVID-19 pandemic. Mental health professionals and promotions should take the multiple-level mental health determinants into account.
Collapse
Affiliation(s)
- Rui She
- Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Mason M C Lau
- Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Joseph T F Lau
- Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
12
|
Simegn BK, Chelkeba L, Alamirew BD. Clinicians' prescribing pattern, rate of patients' medication adherence and its determinants among adult hypertensive patients at Jimma University Medical Center: Prospective cohort study. PLoS One 2021; 16:e0259421. [PMID: 34780479 PMCID: PMC8592482 DOI: 10.1371/journal.pone.0259421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 10/19/2021] [Indexed: 11/29/2022] Open
Abstract
Background Many studies conducted in the past focused on patients’ sociodemographic factors and medical profiles to identify the determinants of suboptimal blood pressure control. However, prescribing patterns and clinicians’ adherence to guidelines are also important factors affecting the rate of blood pressure control. Therefore, this study aimed to determine clinicians’ prescribing patterns, patients’ medication adherence, and its determinants among hypertensive patients at Jimma University Medical Center. Methods A general prospective cohort study was conducted among hypertensive patients who had regular follow-up at Jimma university ambulatory cardiac clinic from March 20, 2018, to June 20, 2018. Patients’ specific data was collected with a face-to-face interview and from their medical charts. Clinicians’ related data were collected through a self-administered questionnaire. Data were analyzed using SPSS version 21.0. Bivariate and multivariable logistic regression analyses were done to identify key independent variables influencing patients’ adherence. P-Values of less than 0.05 were considered statically significant. Results From the total of 416 patients, 237(57.0%) of them were males with a mean age of 56.50 ± 11.96 years. Angiotensin-converting enzyme inhibitors were the most frequently prescribed class of antihypertensives, accounting for 261(63.7%) prescriptions. Combination therapy was used by the majority of patients, with 275 (66.1%) patients receiving two or more antihypertensive drugs. Patients’ medication adherence was 46.6%, while clinicians’ guideline adherence was 44.2%. Patients with merchant occupation (P = 0.020), physical inactivity (P = 0.033), and diabetes mellitus co-morbidity (P = 0.008) were significantly associated with a higher rate of medication non-adherence. Conclusion The rate of medication adherence was poor among hypertensive patients. Physicians were not-adherent to standard treatment guideline. The most commonly prescribed class of drugs were angiotensin-converting enzyme inhibitors. Effective education should be given to patients to improve medication adherence. Prescribers should be trained on treatment guidelines regularly to keep them up-to-date with current trends of hypertension treatment and for better treatment outcomes.
Collapse
Affiliation(s)
- Bekalu Kebede Simegn
- Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- * E-mail:
| | - Legese Chelkeba
- Department of Clinical Pharmacy, School of Pharmacy, College Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bekalu Dessie Alamirew
- Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| |
Collapse
|
13
|
Altamimi AF, Alqahtani ZA, Almughaiseeb FA, Alshiha KA, Alaryni A, Alotaibi A. The attitude and prevalence of patient noncompliance toward chronic disease medications in Saudi Arabia. J Family Med Prim Care 2021; 10:3064-3070. [PMID: 34660448 PMCID: PMC8483073 DOI: 10.4103/jfmpc.jfmpc_2512_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/28/2021] [Accepted: 04/04/2021] [Indexed: 11/04/2022] Open
Abstract
Background Failure of patients' adherence to medications has been a big issue for both physicians and patients; not only it does affect the patients' health but also it affects the financial status of the hospital and the patient. Objective This investigation aims to explore the prevalence and the factors affecting the compliance of patients with chronic conditions to their medications. Materials and Methods An online survey was distributed to patients who had chronic conditions and lived in the main cities of Saudi Arabia. The questionnaire included sections about the patients' general characters, type of chronic disease, the pattern of prescribed medications' usage, and factors affecting compliance of patients toward their medications. Data was collected in a predesigned excel sheet, and analysis was executed through SPSS program version 26. Results 301 patients responded to this questionnaire. The lowest incidence of missing pills was among patients with heart failure, followed by chronic kidney disease, whereas the highest frequency of missing pills was among patients with vitamin D deficiency, followed by hyperlipidemia. 38.5% of the patients used mobile applications as reminders for the administration of their medications. 50% of the patients who use reminders take more than four pills a day. 48.2% of the patients stopped medications without consulting their doctors, where 20.9% stopped one medication for less than a month. 57.5% forgot to take drug doses in a year, with a mean of 8.55 ± 26.3 forgotten doses. Females, patients aging between 31 and 45 years old, obese, married, illiterate, self-employed, those who follow with military hospitals, exercising regularly, and ex-smoker all showed a higher incidence of noncompliance to medications. The main reason for noncompliance was forgetfulness in 60% of patients. 63.2% of the patients did not have a GP to help them with medications compliance. Conclusion The compliance of Saudi patients toward their chronic medications requires improvement. Similar studies in other areas in Saudi Arabia are recommended.
Collapse
Affiliation(s)
| | | | | | | | - Abdullah Alaryni
- Internal Medicine Department, Imam Mohammed Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Azzam Alotaibi
- Internal Medicine Department, Imam Mohammed Ibn Saud Islamic University, Riyadh, Saudi Arabia
| |
Collapse
|
14
|
Kebede B, Chelkeba L, Dessie B. Rate of blood pressure control and its determinants among adult hypertensive patients at Jimma University Medical Center, Ethiopia: Prospective cohort study. SAGE Open Med 2021; 9:20503121211006000. [PMID: 34659760 PMCID: PMC8514076 DOI: 10.1177/20503121211006000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/05/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction Despite the fact that the goals for the management of hypertension are well-defined and effective therapies are available, control of hypertension remains poor in countries with low resources including Ethiopia. This study aimed to determine blood pressure control rate and its determinants among ambulatory adult hypertensive patients at Jimma University Medical Center. Methods A general prospective cohort study was conducted among adult hypertensive patients who had regular follow-up at Jimma University Cardiac Clinic from 20 March to 20 June 2018. Hypertensive patients who fulfilled the inclusion criteria were selected in the first month of the data collection period. Then, only those patients who visited the clinic at the first month were consequently followed-up for the next 3 months. The Eighth Joint National Committee guideline was used to categorize controlled and uncontrolled blood pressures. Patients' specific data were collected using a structured data collection tool. Data were analyzed using the statistical software package SPSS version 21.0. Bivariate and multivariable logistic regression analysis was used to identify independent variables influencing blood pressure control. p-values of less than 0.05 were considered statistically significant. Results From a total of 416 patients, 237 (57.0%) were male with a mean age of 56.50 ± 11.96 years. Two hundred and fifty eight (62.0%) participants had comorbid conditions and 275 (66.1%) were on combination therapy. The rate of blood pressure control was 42.8%. Age ⩾60 years was negatively associated with uncontrolled blood pressure (adjusted odd ratio = 0.52, confidence interval = 0.31-0.88, p = 0.015). Medication non-adherence (adjusted odd ratio = 1.64, confidence interval = 1.04-2.58, p = 0.034) and non-adherence to international guidelines (adjusted odd ratio = 2.33, confidence interval = 1.49-3.64, p < 0001) were positively associated with uncontrolled blood pressure. Conclusion The rate of blood pressure control among hypertensive patients was suboptimal. Age, clinicians' non-adherence to international guidelines, and patients' non-adherence to medications were independent predictors of blood pressure control. Physicians and clinical pharmacists should adhere to guidelines for better treatment and care of hypertensive patients.
Collapse
Affiliation(s)
- Bekalu Kebede
- Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Legese Chelkeba
- Department of Clinical Pharmacy, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Bekalu Dessie
- Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| |
Collapse
|
15
|
Abu-El-Noor NI, Aljeesh YI, Bottcher B, Abu-El-Noor MK. Impact of a mobile phone app on adherence to treatment regimens among hypertensive patients: A randomised clinical trial study. Eur J Cardiovasc Nurs 2021; 20:428-435. [PMID: 32631080 DOI: 10.1177/1474515120938235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hypertension is one of the most prevalent long-term diseases seen in many countries, including Palestine. Patients with poorly controlled blood pressure are more likely to develop several complications. Therefore; it is imperative to control their blood pressure by improving their adherence to the treatment regimen. AIM The objective of this study was to evaluate the impact of using a mobile phone app on the level of adherence to treatment regimens among hypertensive patients in the Gaza Strip. METHODS AND RESULTS This study used an experimental design with a pre and post-intervention assessment. Using the Hill-Bone compliance to high blood pressure therapy scale, 191 participants completed the study: 94 in the control group and 97 in the intervention group. The intervention group used a phone app which reminds participants to take their medication, reminding them about their follow-up appointments and sending educational information about hypertension management. After 3 months of intervention, the level of adherence to treatment was reassessed. Results showed that participants in both groups showed a significant improvement in adherence levels, with higher improvements in the intervention group in the total score as well as all three domain scores: adherence to medication, diet and keeping appointments. CONCLUSION The use of a mobile phone app resulted in improvements in adherence to hypertension treatment. Thus, this study confirms the potential effectiveness of mobile technology in improving treatment adherence in hypertension and an opportunity to reduce cardiovascular mortality and morbidity. However, wider adoption has to be accompanied by ongoing evaluation and integration in public health systems.
Collapse
|
16
|
Iweama CN, Agbaje OS, Umoke PCI, Igbokwe CC, Ozoemena EL, Omaka-Amari NL, Idache BM. Nonadherence to tuberculosis treatment and associated factors among patients using directly observed treatment short-course in north-west Nigeria: A cross-sectional study. SAGE Open Med 2021; 9:2050312121989497. [PMID: 33614034 PMCID: PMC7871291 DOI: 10.1177/2050312121989497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/30/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Tuberculosis is a public health problem in Nigeria. One of the most effective ways of controlling tuberculosis is the directly observed treatment short-course. However, some factors influence tuberculosis patients' treatment nonadherence via directly observed treatment short-course. The study objective was to assess medication nonadherence and associated factors among tuberculosis patients in north-west Nigeria. METHODS A cross-sectional study enrolled tuberculosis patients using directly observed treatment short-course in public health facilities in Kano and Kaduna States from January 2015 to June 2016. The sample selection was conducted via a multistage sampling procedure. Data were collected using tuberculosis patients' demographic and clinical characteristics forms, well-validated structured instruments, and medical records. SPSS version 20 was used for data analysis. Logistic and multivariable logistic regression analyses to determine factors of medication nonadherence (P < 0.05). RESULTS Complete responses from 390 patients out of the 460 patients recruited for the study were used for data analyses. The mean age was 51.5 (standard deviation = ±13.8) years. The mean tuberculosis medication adherence questionnaire score was 4.35 ± 1.12. The prevalence of nonadherence to tuberculosis medication was 30.5%. Multivariable logistic regression analysis showed that having a monthly income between #100,000 and #199, 000 (adjusted odds ratio = 0.01; 95% confidence interval: 0.00-0.13), being widowed (adjusted odds ratio = 26.74, 95% confidence interval: 2.92-232.9), being married (adjusted odds ratio = 120.49, 95% confidence interval: 5.38-271.1), having a distance <5 km to directly observed treatment short-course center from home (adjusted odds ratio = 0.06, 95% confidence interval: 0.00-0.01), having a tuberculosis/HIV co-infection (adjusted odds ratio = 0.01, 95% confidence interval: 0.12-0.35), use of antiretroviral treatment and cotrimoxazole prophylaxis therapy medications (adjusted odds ratio = 24.9, 95% confidence interval: 19.6-304.3) were associated with tuberculosis medication nonadherence. CONCLUSION Tuberculosis medication nonadherence was high among the patients. Thus, patient-specific adherence education, attenuation of potential factors for tuberculosis medication nonadherence, and continual resource support for tuberculosis patients are needed to improve treatment outcomes.
Collapse
Affiliation(s)
- Cylia Nkechi Iweama
- Department of Human Kinetics and Health
Education, Faculty of Education, University of Nigeria, Nsukka, Nigeria
| | - Olaoluwa Samson Agbaje
- Department of Human Kinetics and Health
Education, Faculty of Education, University of Nigeria, Nsukka, Nigeria
| | | | - Chima Charles Igbokwe
- Department of Human Kinetics and Health
Education, Faculty of Education, University of Nigeria, Nsukka, Nigeria
| | - Eyuche Lawretta Ozoemena
- Department of Human Kinetics and Health
Education, Faculty of Education, University of Nigeria, Nsukka, Nigeria
| | - Nnenna Lois Omaka-Amari
- Department of Human Kinetics and Health
Education, Faculty of Education, Ebonyi State University, Abakaliki, Nigeria
| | - Benjamin Mudi Idache
- Department of Health and Physical
Education, Faculty of Education, Kogi State University, Anyigba, Nigeria
| |
Collapse
|
17
|
Mahmood S, Jalal Z, Hadi MA, Khan TM, Haque MS, Shah KU. Prevalence of non-adherence to antihypertensive medication in Asia: a systematic review and meta-analysis. Int J Clin Pharm 2021; 43:486-501. [PMID: 33515135 DOI: 10.1007/s11096-021-01236-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
Background Hypertension and its associated complications are one of the leading causes of morbidity and mortality in Asia. Racial disparities in terms of treatment outcomes among hypertension patients have been reported in literature with Asian patients resulting in poorer treatment outcomes. Non-adherence to antihypertensive therapy is frequently associated with poor treatment outcomes. Aim of the review The aim of this review was to estimate the prevalence of non-adherence to antihypertensive medications among patients with hypertension residing in Asia. Method PubMed, Google Scholar, MEDLINE, Embase, Scopus, CINHAL and Cochrane library were searched for studies published between 2000 and 2019 involving hypertensive patients. Studies investigating the prevalence of medication non-adherence in Asian countries, rated either good or fair on National Institute of Health quality assessment tool and published in English language were included in our review. Data were extracted by one author and checked by another using a structured and pilot-tested data extraction sheet. A random-effects meta-analysis was performed using STATA version 14.3®. Results Sixty-Six studies from 22 Asian countries including 2,532,582 hypertensive patients were included. Mean (± SD) age of participants was 58(± 6) years. Overall, the estimated prevalence of non-adherence to antihypertensive medication in Asia was 48% (95% CI: 41-54, P = 0.001). The rate of non-adherence was higher among females 49% (95% CI: 41-56, P = 0.001) compared to males 47% (95% CI: 40-53, P = 0.001). As per the region, the highest prevalence of non-adherence was found in South Asia 48% (95% 44-51, P = 0.877) followed by East Asia 45% (31-59, P = 0.001) and the Middle East 41 (95% 30-52, P = 0.001). Similarly, higher rate of non-adherence was observed in low and lower middle-income countries i.e. 50% (95% CI: 47-54, P = 0.220) as compare to upper-middle and high-income countries i.e. 37% (95% CI: 25-49, P = 0.001) and 44% (95% CI: 29-59, P = 0.001) respectively. Conclusion The prevalence of non-adherence to antihypertensive medication is high in Asia. This may partly explain poor treatment outcomes and incidence of higher mortality rate in Asia frequently reported in the literature. There is a need to implement appropriate policies and clinical practices to improve medication adherence.
Collapse
Affiliation(s)
- Sajid Mahmood
- Department of Pharmacy, Quaid-E-Azam University, Islamabad, 45320, Pakistan
| | - Zahraa Jalal
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Muhammad Abdul Hadi
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Science (UVAS), Lahore, Pakistan
| | - M Sayeed Haque
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Kifayat Ullah Shah
- Department of Pharmacy, Quaid-E-Azam University, Islamabad, 45320, Pakistan.
| |
Collapse
|
18
|
Pietrzykowski Ł, Kasprzak M, Michalski P, Kosobucka A, Fabiszak T, Kubica A. Therapy Discontinuation after Myocardial Infarction. J Clin Med 2020; 9:jcm9124109. [PMID: 33352811 PMCID: PMC7766090 DOI: 10.3390/jcm9124109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 01/08/2023] Open
Abstract
The discontinuation of recommended therapy after myocardial infarction predisposes patients to serious thrombotic complications. The aim of this study was a comprehensive analysis of permanent as well as short- and long-term discontinuation of pharmacotherapy, taking into consideration the basic groups of medications and nonadherence determinants in a one-year follow-up in post-myocardial infarction (MI) patients. Material and methods: The study was a single center cohort clinical trial with a one-year follow-up including 225 patients (73.3% men, 26.7% women) aged 62.9 ± 11.9 years. In eight cases (3.6%), the follow-up duration was less than one year due to premature death. The following factors were analyzed: lack of post-discharge therapy initiation; short-term therapy discontinuation (<30 days); long-term therapy discontinuation (≥30 days); and permanent cessation of therapy. The analysis of therapy discontinuation was performed based on prescription filling data. Results: Occupational activity (Odds Ratio (OR) 5.15; 95% Confidence interval (CI) 1.42–18.65; p = 0.013) and prior MI (OR 5.02; 95% CI 1.45–16.89; p = 0.009) were found to be independent predictors of a lack of post-discharge therapy initiation with P2Y12 receptor inhibitors. We found no independent predictors of lack of post-discharge therapy initiation with other medications, whether analyzed separately or together. Age above 65 years (Hazard Ratio (HR)—1.59; 95% CI 1.15–2.19; p = 0.0049) and prior revascularization (HR—1.44; 95% CI 1.04–2.19; p = 0.0273) were identified as independent predictors of therapy discontinuation. Multilogistic regression analysis showed no independent predictors of the cessation of any of the medications as well as the permanent or temporary simultaneous discontinuation of all medications. Conclusions: The vast majority of post-MI patients discontinue, either temporarily or permanently, one of the essential medications within one year following myocardial infarction. The most likely medication class to be discontinued are statins. Older age and prior cardiac revascularization are independent determinants of therapy discontinuation.
Collapse
Affiliation(s)
- Łukasz Pietrzykowski
- Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland; (P.M.); (A.K.); (A.K.)
- Correspondence: ; Tel.: +48-52-585-58-35
| | - Michał Kasprzak
- Department of Cardiology, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland; (M.K.); (T.F.)
| | - Piotr Michalski
- Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland; (P.M.); (A.K.); (A.K.)
| | - Agata Kosobucka
- Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland; (P.M.); (A.K.); (A.K.)
| | - Tomasz Fabiszak
- Department of Cardiology, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland; (M.K.); (T.F.)
| | - Aldona Kubica
- Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland; (P.M.); (A.K.); (A.K.)
| |
Collapse
|
19
|
Comparison of Effects of ACEIs and ARBs on Albuminuria and Hyperkalemia in Indonesian Hypertensive Type 2 Diabetes Mellitus Patients. Int J Hypertens 2020; 2020:5342161. [PMID: 32802494 PMCID: PMC7414342 DOI: 10.1155/2020/5342161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 06/14/2020] [Accepted: 06/30/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose Due to economic consideration, Indonesia's formulary restrictions are at odds with the treatment guidelines of the American Diabetes Association (ADA) and the Eighth Joint National Committee (JNC 8). ADA and JNC 8 equally recommend the prescription of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) for hypertensive patients with type 2 diabetes mellitus (T2DM) with overt proteinuria (urine albumin to creatinine ratio (UACR) ≥ 300 mg/g creatinine). However, since 1 April 2018, Indonesian formulary restricted telmisartan and valsartan only for T2DM patients with declined renal function as shown by eGFR value. There is no compelling evidence in favor of ACEI over ARB or vice versa except for data supporting the early use of both drugs in patients with overt proteinuria. However, ARB is a choice if ACEI's side effects, that is, coughing, occurs. Therefore, it necessitates a detailed evaluation of the effects of ACEIs and ARBs on albuminuria and their side effect, hyperkalemia, specific to Indonesian T2DM patients. Methods This cross-sectional study involved 134 T2DM patients whose treatment was restricted to either ACEIs (n = 57) or ARBs (n = 77) for at least two months before the study during May–October 2018. Patients with known end-stage renal disease and those receiving dialysis were excluded. UACR and blood potassium levels were compared between the two study groups. Also, the risk factors of albuminuria and hyperkalemia were estimated using multivariate analysis. Results T2DM patients in the ACEI and ARB groups had similar characteristics except for a higher body mass index (p=0.008), lower glomerular filtration rate (p=0.04), and a longer duration of prior treatment (p < 0.001) in the ARB group. This study showed no differences between the ACEI and ARB groups in the proportion of cases with albuminuria (p=0.97) and hyperkalemia (p=0.86), even after adjustment for confounders. In addition, uncontrolled diastolic blood pressure was a significant factor associated with albuminuria (OR: 4.897, 95% CI: 1.026–23.366; p=0.046), whereas a female was 70.1% less likely to develop hyperkalemia than a male (OR: 0.299, 95% CI: 0.102–0.877; p=0.028). Conclusion This cross-sectional study demonstrated that ACEIs and ARBs have a similar effect on albuminuria and hyperkalemia in Indonesian hypertensive T2DM patients, even after correction for potentially confounding variables.
Collapse
|
20
|
Xie Z, Liu K, Or C, Chen J, Yan M, Wang H. An examination of the socio-demographic correlates of patient adherence to self-management behaviors and the mediating roles of health attitudes and self-efficacy among patients with coexisting type 2 diabetes and hypertension. BMC Public Health 2020; 20:1227. [PMID: 32787809 PMCID: PMC7424981 DOI: 10.1186/s12889-020-09274-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with coexisting type 2 diabetes and hypertension generally exhibit poor adherence to self-management, which adversely affects their disease control. Therefore, identification of the factors related to patient adherence is warranted. In this study, we aimed to examine (i) the socio-demographic correlates of patient adherence to a set of self-management behaviors relevant to type 2 diabetes and hypertension, namely, medication therapy, diet therapy, exercise, tobacco and alcohol avoidance, stress reduction, and self-monitoring/self-care, and (ii) whether health attitudes and self-efficacy in performing self-management mediated the associations between socio-demographic characteristics and adherence. METHODS We performed a secondary analysis of data collected in a randomized controlled trial. The sample comprised 148 patients with coexisting type 2 diabetes mellitus and hypertension. Data were collected by a questionnaire and analyzed using logistic regression. RESULTS Female patients were found to be less likely to exercise regularly (odds ratio [OR] = 0.49, P = 0.03) and more likely to avoid tobacco and alcohol (OR = 9.87, P < 0.001) than male patients. Older patients were found to be more likely to adhere to diet therapy (OR = 2.21, P = 0.01) and self-monitoring/self-care (OR = 2.17, P = 0.02). Patients living with family or others (e.g., caregivers) were found to be more likely to exercise regularly (OR = 3.44, P = 0.02) and less likely to avoid tobacco and alcohol (OR = 0.10, P = 0.04) than those living alone. Patients with better perceived health status were found to be more likely to adhere to medication therapy (OR = 2.02, P = 0.03). Patients with longer diabetes duration (OR = 2.33, P = 0.01) were found to be more likely to adhere to self-monitoring/self-care. Self-efficacy was found to mediate the association between older age and better adherence to diet therapy, while no significant mediating effects were found for health attitudes. CONCLUSIONS Adherence to self-management was found to be associated with socio-demographic characteristics (sex, age, living status, perceived health status, and diabetes duration). Self-efficacy was an important mediator in some of these associations, suggesting that patient adherence may be improved by increasing patients' self-management efficacy, such as by patient empowerment, collaborative care, or enhanced patient-physician interactions.
Collapse
Affiliation(s)
- Zhenzhen Xie
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Kaifeng Liu
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Calvin Or
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China.
| | - Jiayin Chen
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Mian Yan
- School of Intelligent Systems Science and Engineering, Jinan University, Zhuhai, China
| | - Hailiang Wang
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Hong Kong, China
| |
Collapse
|
21
|
Medication adherence and its determinants in patients after myocardial infarction. Sci Rep 2020; 10:12028. [PMID: 32694522 PMCID: PMC7374107 DOI: 10.1038/s41598-020-68915-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 06/22/2020] [Indexed: 11/08/2022] Open
Abstract
Non-adherence to prescribed medication is a serious limitation of long-term treatment in patients after myocardial infarction (MI), which can be associated with medical, social and economical consequences. Improvement of medication adherence has been shown to be a challenge for healthcare providers. The aim of this study was to evaluate changes in medication adherence and variability of adherence determinants during follow-up in patients after MI. A single-center, cohort observational study was conducted in 225 post-MI patients treated with primary coronary intervention (PCI) (27% women and 73% men) aged 30–91 years. Adherence was defined as availability of evaluated drugs within 1-year after discharge from hospital, based on completed prescriptions data obtained from the National Health Fund. The analysis of therapeutic plan realization (adherence to medication prescribed at discharge from hospital) embraced only reimbursed drugs: ACEIs (ramipril, perindopril), P2Y12 receptor inhibitors (clopidogrel) and statins (atorvastatin, simvastatin, rosuvastatin). Sufficient adherence was defined as ≥ 80%. During 1-year follow-up, adherence for all three drug classes was 64 ± 25%, with 67 ± 32% for ACEIs, 62 ± 34% for P2Y12 receptor inhibitor and 64 ± 32% for statins. A gradual decline in adherence was observed from 65% ± 26% in the first quarter of follow-up to 51% ± 34% in the last quarter of follow-up (p < 0.00001). Sufficient adherence for all drugs classes was found only in 29% of patients throughout the whole follow-up period (44% for ACEI, 36% for P2Y12 receptor inhibitor and 41% for statins). According to a multivariate analysis, age, prior CABG, level of education, place of residence, economic status and marital status were independent predictors of drug adherence. Whereas patients > 65 years and having a history of prior CABG more often had an insufficient adherence to drugs, married and hypertensive patients, city inhabitants and patients with higher education tended to have a sufficient drug adherence. Adherence to pharmacotherapy after myocardial infarction decreases over time in a similar manner for all pivotal groups of drugs prescribed after MI. A number of socioeconomic and clinical factors have been identified to affect medication adherence over time.
Collapse
|
22
|
Biffi A, Rea F, Iannaccone T, Filippelli A, Mancia G, Corrao G. Sex differences in the adherence of antihypertensive drugs: a systematic review with meta-analyses. BMJ Open 2020; 10:e036418. [PMID: 32641331 PMCID: PMC7348648 DOI: 10.1136/bmjopen-2019-036418] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Poor worldwide rate of blood pressure control is largely due to poor adherence to antihypertensive (AHT) drug treatment. The question of whether sex affects adherence has long been debated but conflicting findings have been reported on this issue. Our objective was to evaluate sex differences in the adherence to AHT therapy. RESEARCH DESIGN AND METHODS Studies were identified through a systematic search of PubMed, CINAHL, PsycINFO, Web of Science and Google Scholar (through January 2020) and manual handsearching of relevant articles. Observational studies reporting adherence to AHT drugs measured by self-report or pharmacy refill prescription-based methods among men and women were included. Summarised estimates of ORs with 95% CIs were calculated using random-effects model and meta-regression models. RESULTS From 12 849 potentially relevant publications, 82 studies (15 517 457 men and 18 537 599 women) were included. No significant between-sex differences in adherence to AHT were observed, whether all study-specific estimates were summarised (ORs 1.04, 95% CI 1.00 to 1.09, p=0.07), nor estimates were pooled according to the method for measuring adherence. Among patients aged 65 years or older, lower self-reported adherence was observed in women (ORs 0.84, 95% CI 0.72 to 0.97, p=0.02), while the main result remained unchanged according to other subgroup analyses. CONCLUSIONS Definitive evidence of sex differences in adherence to AHT therapy cannot be drawn. Our little knowledge about factors affecting adherence, in particular of sex effect among elderly, urgently requires high-quality studies investigating these issues.
Collapse
Affiliation(s)
- Annalisa Biffi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milano, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
| | - Federico Rea
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milano, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
| | - Teresa Iannaccone
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Fisciano, Italy
| | - Amelia Filippelli
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Fisciano, Italy
| | - Giuseppe Mancia
- University of Milan-Bicocca, Milano, Italy
- Policlinico di Monza, Monza, Italy
| | - Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milano, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
| |
Collapse
|
23
|
Hussein A, Awad MS, Mahmoud HEM. Patient adherence to antihypertensive medications in upper Egypt: a cross-sectional study. Egypt Heart J 2020; 72:29. [PMID: 32451726 PMCID: PMC7248145 DOI: 10.1186/s43044-020-00066-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/07/2020] [Indexed: 02/05/2023] Open
Abstract
Background Control of hypertension is a very difficult issue. Non-adherence to medications is a well-recognized factor contributing to uncontrolled hypertension. It is required to detect factors that affect adherence of patients to antihypertensive medications at different societies and good planning with the collaboration of governments, universities, media, pharmaceutical companies, and civil society to create intervention programs ensuring good adherence to medications. In our study, we aimed to determine different factors affecting adherence to antihypertensive medications in Upper Egypt societies. Results From September 2015 to September 2019, we conducted a large cross-sectional multi-center study among 2420 hypertensive patients attending the out-patient cardiac clinics at three different university hospitals. Data was collected through a personal interview with the patients using a questionnaire to cover a variety of items. In the total of 2420 patients, we found that 1116 (46.12%) patients were adherent to medications and 1304 (53.88%) were non-adherent. From the final regression analysis of the results, we found that age > 65 years, illiterate patients, low income, associated comorbidities, using three or more antihypertensive pills, and living in rural areas were statistically significant socio-demographic factors associated with non-adherence to treatment. Also, missing doses of medication and lack of complying with dietary regimen were statistically significant behavioral causes associated with non-adherence. Conclusion Many factors are predictors of good adherence to antihypertensive drugs, including young age, urban residence, a smaller number of pills, absence of comorbid conditions, high income, and high education level. Also missed doses of drugs and absence of complies with dietary regimen were the significant causes of non-adherence. Health institutions and governmental efforts should be directed toward improving adherence by creating effective intervention programs targeting these factors. Therefore, it might be concluded that patients who are more health ware are more adherent to medications than non-health aware patients.
Collapse
Affiliation(s)
- Ahmed Hussein
- Department of Internal Medicine, Faculty of Medicine, Sohag University, Nasser City, Sohag, 82524, Egypt.
| | - Mohammad Shafiq Awad
- Department of Cardiology, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
| | - Hossam Eldin M Mahmoud
- Department of Internal Medicine, Faculty of Medicine, South Valley University, Qena, Egypt
| |
Collapse
|
24
|
Nishimura S, Kumamaru H, Shoji S, Sawano M, Kohsaka S, Miyata H. Adherence to antihypertensive medication and its predictors among non-elderly adults in Japan. Hypertens Res 2020; 43:705-714. [DOI: 10.1038/s41440-020-0440-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/12/2019] [Accepted: 11/16/2019] [Indexed: 12/24/2022]
|
25
|
Mahmood S, Jalal Z, Hadi MA, Orooj H, Shah KU. Non-Adherence to Prescribed Antihypertensives in Primary, Secondary and Tertiary Healthcare Settings in Islamabad, Pakistan: A Cross-Sectional Study. Patient Prefer Adherence 2020; 14:73-85. [PMID: 32021119 PMCID: PMC6969702 DOI: 10.2147/ppa.s235517] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/07/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aimed to assess the prevalence and predictors of non-adherence to antihypertensive medication among patients with hypertension attending various healthcare settings in Islamabad, Pakistan. METHODS A questionnaire-based cross-sectional study was conducted in selected healthcare facilities between September 2017 and December 2018. The study was conducted in primary, secondary and tertiary healthcare settings in Islamabad, Pakistan. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). Sociodemographic and clinical data of recruited patients were collected through a structured questionnaire. Binary logistic regression analysis was performed to determine covariates significantly associated with medication adherence and blood pressure control. RESULTS A total of 776 hypertensive patients were invited and 741 (95%) completed the questionnaire. The mean ± SD age of participants was 53.6±12.6 years; 284 patients (38.3%) had high adherence, 178 (24%) had moderate adherence and 279 (37.7%) were non-adherent to the prescribed antihypertensive therapy. Binary regression analysis revealed that old age (OR 1.783 [95% CI: 1.172-2.712]; P=0.013), being educated (OR 2.018 [95% CI: 1.240-3.284]; P=0.036), entitlement to free medical care (OR 1.369 [95% CI: 1.009-1.859]; P=0.044), treatment duration (OR 2.868 [95% CI: 1.913-4.299]; P=0.001), number of medications (OR 1.973 [95% CI: 1.560-2.495]; P=0.001), presence of any comorbidity (OR 2.658 [95% CI: 1.836-3.848]; P=0.001) and blood pressure control (OR 3.103 [95% CI: 2.268-4.247]; P=0.001) were significantly associated with good adherence. Similarly, age (OR 1.998 [95% CI: 1.313-3.040]; P=0.004), entitlement to free medical care (OR 1.498 [95% CI: 1.116-2.010]; P=0.007), treatment duration (OR 1.886 [95% CI: 1.143-3.113]; P=0.013), presence of any comorbidity (OR 1.552 [95% CI: 1.123-2.147]; P=0.008) and adherence level (OR 3.103 [95% CI: 2.268-4.247]; P=0.001) had significant association with controlled blood pressure. The following were the main reasons for non-adherence to prescribed antihypertensive medication: "don't feel need for regular use" (24.7%), "Carelessness" (13.4%) and "adverse effects" (11.2%). CONCLUSION The prevalence of non-adherence to antihypertensive medications was high in the study population and poor medication adherence could potentially explain poor blood pressure control. Evidence-based targeted interventions on both medication adherence and blood pressure control should be introduced and implemented for better treatment outcomes.
Collapse
Affiliation(s)
- Sajid Mahmood
- Department of Pharmacy, Quaid-e-Azam University, Islamabad45320, Pakistan
| | - Zahraa Jalal
- School of Pharmacy, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Edgbaston, BirminghamB15 2TT, UK
| | - Muhammad Abdul Hadi
- School of Pharmacy, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Edgbaston, BirminghamB15 2TT, UK
| | - Hasan Orooj
- Directorate of Health Services, Metropolitan Corporation Islamabad, Islamabad, Pakistan
| | - Kifayat Ullah Shah
- Department of Pharmacy, Quaid-e-Azam University, Islamabad45320, Pakistan
- Correspondence: Kifayat Ullah Shah Department of Pharmacy, Quaid-e-Azam University, Islamabad45320, PakistanTel +92-3325542722 Email
| |
Collapse
|
26
|
Bagheri R, Masudi S, Salarilak S, Khademvatani K, Khalkhali HR. Adherence to Hypertension Treatment and its Determinants in Patients Referred to a Tertiary Cardiology Center in Urmia, Iran. AVICENNA JOURNAL OF CLINICAL MEDICINE 2019. [DOI: 10.29252/ajcm.26.2.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
27
|
Shi S, Shen Z, Duan Y, Ding S, Zhong Z. Association Between Medication Literacy and Medication Adherence Among Patients With Hypertension. Front Pharmacol 2019; 10:822. [PMID: 31396088 PMCID: PMC6664237 DOI: 10.3389/fphar.2019.00822] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/25/2019] [Indexed: 01/08/2023] Open
Abstract
Background: Few studies have investigated the association between medication literacy and medication adherence as well as the influence of medication literacy on medication adherence in hypertensive patients. Thus, the goal of the present study was to determine the association between medication literacy and medication adherence in hypertensive patients. Methods: A cross-sectional survey was conducted between August 2016 and December 2016. Self-administered questionnaires were completed, including a self-developed and structured socio-demographic questionnaire; a self-developed, validated, and self-reported Medication Literacy Scale for Hypertensive Patients (C-MLSHP) used for medication literacy measurement; and the Chinese Version of the Morisky Medication Adherence Scale-8 (C-MMAS-8), an eight-item validated, self-report scale for adherence measurement with a total score range of 0-8. A cut-off of 6 was applied to differentiate adherence levels, including patients with an MMAS score <6 (low adherence), MMAS score = 8 (high adherence), and MMAS score ≥6 and <8 (moderate adherence). In this study, hypertensive patients' medication literacy levels and adherence to antihypertensive agents were identified. Pearson correlation analysis was carried out to identify the correlation between medication literacy and adherence. Binary logistic regression analysis was performed with medication adherence as the outcome variable in order to confirm factors associated with medication adherence. Results: A total of 420 hypertensive patients, including 198 women and 222 men with a mean age of 60.6 years (SD = 12.4), were recruited. The mean score of hypertensive patients on the medication literacy scale was 24.03 (SD = 5.13). The mean scores of the four dimensions of knowledge, attitude, skill, and behavior on the medication literacy scale of this study were 6.22 ± 2.22, 5.04 ± 1.16, 4.50 ± 2.21, and 8.27 ± 1.90, respectively. Regarding medication adherence, the mean score of the C-MMAS-8 in this study was 4.82 (SD = 2.11). A total of 63.6% of patients presented with low adherence, 29.5% presented with moderate adherence, and 7.6% presented with high adherence. The Pearson correlation results showed that medication literacy (r = 0.342, P < 0.01) as a whole variable and the three dimensions of knowledge (r = 0.284, P < 0.01), attitude (r = 0.405, P < 0.01), and behavior (r = 0.237, P < 0.01) were significantly associated with medication adherence. Binary logistic regression analysis indicated that annual income [OR 1.199 (95% CI: 1.011-1.421); P = 0.037] and two dimensions of attitude [OR 2.174 (95% CI: 1.748-2.706); P = 0.000] and behavior [OR 1.139 (95% CI: 1.002-1.294); P = 0.046] in medication literacy were found to be independent predictors of medication adherence. Individuals with better attitudes and behavior literacy in medication literacy were more likely to adhere to the use of antihypertensive agents. Those who had higher annual incomes were more likely to adhere to the use of antihypertensive agents. Conclusion: The levels of medication literacy and medication adherence of hypertensive patients are suboptimal and need to be improved in China. The level of medication literacy in patients with hypertension could affect their adherence to antihypertensive drugs. It was suggested that hypertensive patients' medication adherence could be improved and driven by increasing the medication literacy level, especially in the attitude and behavior domains. Pertinent strategies that are specific to several dimensions of medication literacy should be developed and implemented in order to promote full medication literacy among hypertensive patients, thus facilitating optimal adherence and blood pressure control.
Collapse
Affiliation(s)
- Shuangjiao Shi
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Zhiying Shen
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
| | - Yinglong Duan
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
| | - Siqing Ding
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Zhuqing Zhong
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
| |
Collapse
|
28
|
Pan J, Wu L, Wang H, Lei T, Hu B, Xue X, Li Q. Determinants of hypertension treatment adherence among a Chinese population using the therapeutic adherence scale for hypertensive patients. Medicine (Baltimore) 2019; 98:e16116. [PMID: 31277112 PMCID: PMC6635171 DOI: 10.1097/md.0000000000016116] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To assess the adherence level of antihypertensive treatment and identify any associated risk factors in a sample of hypertensive patients from China.A cross-sectional study involving 488 Chinese hypertensive patients was conducted in a tertiary hospital in Xi'an, China. Data were collected regarding socio-demographic factors and hypertension-related clinical characteristics. The adherence to treatment was assessed using the previously validated instrument: therapeutic adherence scale for hypertensive patients.A total of 27.46% of patients were compliant with their antihypertensive treatments. Three factors were identified to be independently associated with antihypertensive treatment adherence: gender (P = .034), residence (P = .029), duration of high blood pressure (P < .001). Gender, residence, occupation, and the duration of antihypertensive drugs treatment used were found to have significant effects on treatment adherence in certain categories.Treatment adherence among hypertensive patients in China was poor. More attention and effective strategies should be designed to address factors affecting treatment adherence. Education about hypertension knowledge should be strengthened for patients. Moreover, the importance of lifestyle modification during hypertension treatment is often neglected by patients, therefore, there is an urgent need to educate hypertensive patients about the adherence to lifestyle modifications.
Collapse
Affiliation(s)
- Jingjing Pan
- Department of Pharmacy, Xi’an Fourth Hospital
- Xi’an Forth Hospital Affiliated Northwestern Polytechnical University
| | - Lian Wu
- Department of Ophthalmology, Xi’an Fourth Hospital
- Xi’an Forth Hospital Affiliated Northwestern Polytechnical University
| | | | - Tao Lei
- Department of Neurology, Xi’an Fourth Hospital, Xi’an, China
| | - Bin Hu
- Department of Pharmacy, Xi’an Fourth Hospital
| | | | - Qiongge Li
- Department of Pharmacy, Xi’an Fourth Hospital
| |
Collapse
|
29
|
Uchmanowicz B, Jankowska EA, Uchmanowicz I, Morisky DE. Self-Reported Medication Adherence Measured With Morisky Medication Adherence Scales and Its Determinants in Hypertensive Patients Aged ≥60 Years: A Systematic Review and Meta-Analysis. Front Pharmacol 2019; 10:168. [PMID: 30930769 PMCID: PMC6425867 DOI: 10.3389/fphar.2019.00168] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/11/2019] [Indexed: 12/18/2022] Open
Abstract
Background: The aim of this systematic review and meta-analysis was to estimate medication adherence in hypertensive patients aged ≥60 years and to explore potential determinants of adherence with antihypertensive treatment in this age group. Methods: A systematic search of the PubMed, Scopus, and Google Scholar using the Cochrane guidelines was performed. The analysis included articles published between 1 January 2000 and 30 June 2018. The patients were considered adherent if they scored ≥6 pts. on the Morisky Medication Adherence Scale (MMAS-8) or ≥3 pts. on the Morisky Green Levine Medication Adherence Scale (MGL). If available, also odds ratios (OR) with 95% confidence intervals (95% CI) for determinants of medication adherence were recorded. Results: Thirteen studies including a total of 5,247 patients were available for the meta-analysis. The pooled percentage of adherence was 68.86% (95% CI: 57.80–79.92%). Subgroup analysis did not demonstrate a significant difference in the adherence measured with the MMAS-8 and the MGL (68.31 vs. 70.39%, P = 0.773). The adherence of patients from Western countries (Europe, United States) turned out to be significantly higher than in other patients (83.87 vs. 54.30%, P = 0.004). The significant determinants of better adherence identified in more than one study were older age, retirement/unemployment, duration of hypertension >10 years, and a lower number of prescribed drugs. Conclusion: Medication adherence in the oldest old hypertensive patients seems to be higher than in younger persons. Adherence in older persons was associated with age, socioeconomic status, and therapy-related factors.
Collapse
Affiliation(s)
- Bartosz Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa A Jankowska
- Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Izabella Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Donald E Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States
| |
Collapse
|
30
|
The Effect of Special Medical Examination for Night Shift Workers and Follow-Up Management Against Hypertension. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050719. [PMID: 30823384 PMCID: PMC6427592 DOI: 10.3390/ijerph16050719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/24/2019] [Accepted: 02/25/2019] [Indexed: 11/17/2022]
Abstract
Background: Special health examination is a screening program introduced in 1973 in Korea to examine health problems of workers who are regularly exposed to 177 hazardous substances and physical environments specified by the Occupational Safety and Health Act. Shiftwork was added as a risk factor in 2013. The purpose of this study was to analyze changes of hypertension status after a special medical examination and subsequent follow-up management. Methods: We used the data based on the special medical examination outcomes for night shift workers, performed at seven different health examination centers under the Korea Medical Institute (KMI) between 2014 and 2016. Workers who received special medical examinations for two consecutive years (2014–2015 and 2015–2016) were selected. A final study population of 2070 was evaluated. Results: Compared with the first-year examination, 1503 subjects (72.6%) received hypertension medication or showed improvement in blood pressure in their second-year examination. Older age (≥40s), women, larger workplaces (≥300 full-time workers), long-term workers (≥12 years), improvement in smoking habits, improvements for diabetes or dyslipidemia, normal or reduced BMI, and normal waist circumference were associated with proper management of hypertension. Conclusions: An appropriate follow-up management program should be developed to provide health management for night shift workers that need to focus on the factors identified in this study.
Collapse
|
31
|
Shen Y, Wang T, Gao M, Zhu X, Zhang X, He C, Li Y, Sun X. Effectiveness of low-cost reminder package combined with case-based health education to improve hypertensive patients' medication adherence: a clustered randomized controlled trial. Patient Prefer Adherence 2019; 13:1083-1092. [PMID: 31371926 PMCID: PMC6628963 DOI: 10.2147/ppa.s194667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 05/30/2019] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Medication adherence (MA) is a key factor for hypertensive patients' blood pressure control and forgetfulness is one of the main reasons that cause medication non-adherence. If effective, low-cost reminder package (LCRP) has great potentials for large-scale promotion. Therefore, this study aims to evaluate the effectiveness of combining LCRP and health education to improve MA among hypertensive patients. PATIENTS AND METHODS A clustered randomized controlled trial was performed in Beijing. A total of 518 hypertensive patients recruited from 8 community health care centers were randomized to receive LCRP combined with case-based health education or usual care. Randomization was performed at community level. Multilevel modeling was used to evaluate the study effect. RESULTS MA scores did not differ significantly at baseline between the intervention group and the control group. The results of multilevel modeling indicated that MA scores increased more in the intervention group, and the intervention effect on MA was 0.287 (95% CI: [0.103, 0.471], P=0.002). Patients' systolic blood pressure (SBP) and diastolic blood pressure (DBP) were not improved (SBP: difference=0.536, 95% CI [-3.207, 4.278]; DBP: difference=-0.927, 95% CI [-3.283, 1.428]). CONCLUSION LCRP combined with case-based health education could significantly improve hypertensive patients' MA.
Collapse
Affiliation(s)
- Ying Shen
- School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Taotao Wang
- School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Min Gao
- School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Xiaorou Zhu
- School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Xing Zhang
- School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Chao He
- Department of Health Education, Shunyi Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Yindong Li
- Department of Health Education, Shunyi Center for Disease Control and Prevention, Beijing, People’s Republic of China
- Yindong Li Department of Health Education, Shunyi Center for Disease Control and Prevention, Beijing, People’s Republic of China Email
| | - Xinying Sun
- School of Public Health, Peking University, Beijing, People’s Republic of China
- Correspondence: Xinying Sun School of Public Health, Peking University, Beijing, People’s Republic of ChinaTel +86 1 369 121 2050Fax +86 108 280 1743 Email
| |
Collapse
|
32
|
Carvalho AS, Santos P. Medication Adherence In Patients With Arterial Hypertension: The Relationship With Healthcare Systems' Organizational Factors. Patient Prefer Adherence 2019; 13:1761-1774. [PMID: 31802854 PMCID: PMC6802622 DOI: 10.2147/ppa.s216091] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/01/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Arterial hypertension is one of the most common diseases in the world, presenting a great impact on global mortality. Despite having good medication, the best control depends on patient's adherence. Our aim is to characterize the relationship of adherence to medication in hypertensive patients with consultation length and other organizational factors of healthcare systems. PATIENTS AND METHODS We performed a comprehensive review of literature using the MeSH terms "hypertension" and "medication adherence". 61 articles were selected for inclusion and adherence parameters were extracted, allowing us to estimate the mean adherence for each country. The adherence was then correlated with organizational aspects of healthcare systems: consultation length, number of health providers (doctors, nurses and pharmacists), number of hospital beds, health expenditure and general government expenditure. RESULTS Adherence to medication ranged between 11.8% in Indonesia and 85.0% in Australia. There is much heterogeneity in methodology, but the Morisky Medication Adherence Scale was the preferred method, used in 63.6% of the cases. We found no relation with consultation length, but a significant one with the greater number of health professionals available. Some differences were observed when considering European countries or Morisky Medication Adherence Scale alone. CONCLUSION The better the drugs, the better the control of blood pressure, if patients take them. Rather than investing in the prescription of more drugs, it is important to address non-adherence and reduce it to promote better blood pressure control. Organizational factors are relevant constraints and depend on administrative and political decisions. Although they are not always considered, they greatly impact the adherence to medication.
Collapse
Affiliation(s)
- Ana Sofia Carvalho
- Department of Medicine of Community, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of University of Porto, Porto, Portugal
- Correspondence: Ana Sofia Carvalho Faculty of Medicine of University of Porto, Alameda Professor Hernâni Monteiro, Porto4200-319, PortugalTel +351 225513600Fax +351 225513601 Email
| | - Paulo Santos
- Department of Medicine of Community, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of University of Porto, Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
| |
Collapse
|
33
|
Choi HY, Oh IJ, Lee JA, Lim J, Kim YS, Jeon TH, Cheong YS, Kim DH, Kim MC, Lee SY. Factors Affecting Adherence to Antihypertensive Medication. Korean J Fam Med 2018; 39:325-332. [PMID: 30384549 PMCID: PMC6250947 DOI: 10.4082/kjfm.17.0041] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 08/18/2017] [Accepted: 08/29/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Hypertension is a major contributor to the global disease burden of cardiovascular and cerebrovascular disease. The aim of this study was to determine demographic and clinical factors associated with adherence to antihypertensive medication. METHODS From August 2012 to February 2015, we recruited 1,523 Korean patients with hypertension who visited family physicians. The study was conducted in 24 facilities located in urban and metropolitan areas. Of these facilities, two were primary care clinics and 22 were level 2 or 3 hospitals. Adherence was assessed using the pill count method; a cut-off value of 80% was used as the criterion for good adherence. Sociodemographic and lifestyle factors were compared between the adherent and nonadherent groups using the chi-square test for categorical variables and t-test for continuous variables. Binary logistic regression analysis was performed with medication adherence as the outcome variable. RESULTS Of the 1,523 patients, 1,245 (81.7%) showed good adherence to antihypertensive medication. In the multivariate logistic analysis, age ≥65 years, exercise, treatment in a metropolitan-located hospital, being on ≥2 classes of antihypertensive medication and concomitant medication for diabetes, and a family history of hypertension or cardiovascular diseases were associated with good adherence. Patients who had a habit of high salt intake were less adherent to medication. CONCLUSION Multiple classes of antihypertensive medications, concomitant medication, and exercise were associated with good adherence to antihypertensive medication, and high salt intake was associated with poor adherence to antihypertensive medication. These factors should be considered to improve hypertension control.
Collapse
Affiliation(s)
- Hyo Yoon Choi
- Department of Family Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Im Jung Oh
- Department of Family Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Ah Lee
- Department of Family Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Jisun Lim
- Department of Family Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Sik Kim
- Department of Family Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Hee Jeon
- Department of Family Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Yoo-Seock Cheong
- Department of Family Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Dae-Hyun Kim
- Department of Family Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Moon-Chan Kim
- Department of Family Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sang Yeoup Lee
- Departments of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Medical Education, Pusan National University School of Medicine, Yangsan, Korea
| |
Collapse
|
34
|
Adisa R, Ilesanmi OA, Fakeye TO. Treatment adherence and blood pressure outcome among hypertensive out-patients in two tertiary hospitals in Sokoto, Northwestern Nigeria. BMC Cardiovasc Disord 2018; 18:194. [PMID: 30340528 PMCID: PMC6194717 DOI: 10.1186/s12872-018-0934-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment adherence play important roles in blood pressure control leading to reduction in morbidity and mortality. This study therefore assessed adherence to pharmacological and non-pharmacological therapies among ambulatory hypertensive patients. Reasons for treatment non-adherence, and association between adherence and blood pressure were also investigated. METHODS Cross-sectional questionnaire-guided interview and retrospective review of medical records of 605-patients from two-tertiary healthcare institutions in Sokoto, Northwestern Nigeria. Nine-item modified Morisky adherence scale was used to assess medication adherence. Overall adherence score to lifestyle modifications was obtained from the total scores from 4-domains of non-pharmacological measures including cigarette smoking and alcohol cessation, salt-restriction and exercise. Patient-specific adherence education was provided at contact to resolve the knowledge gap(s). Clinical-parameters were retrieved at contact and subsequent 2-months appointment. Descriptive statistics, Chi-square and Student's t-test were used for analysis at p < 0.05. RESULTS Fifty-four (8.9%) patients were adherent to medications. Forgetfulness (404; 35.2%) was the most common reason for medication non-adherence. Use of buddy/companion reminder (605, 30.2%) top the list of adherence education. Overall adherence to lifestyle modifications was 36(6.0%). Mean systolic blood pressure (SBP) at contact was 149.6 ± 22.5 versus 134.2 ± 15.8 mmHg at 2-months with a 10% reduction. There were significant associations in baseline SBP for patients with or without adherence to medication, cigarette smoking cessation, and exercise (p < 0.05). CONCLUSIONS Overall adherence to antihypertensive medications and lifestyle modifications is suboptimal, underscoring the need for continuous patient-specific adherence education to ensure better therapeutic outcomes.
Collapse
Affiliation(s)
- Rasaq Adisa
- Department of Clinical Pharmacy & Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.
| | - Olumide Ayodeji Ilesanmi
- Pharmacy Department, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Sokoto state, Nigeria
| | - Titilayo Oyelola Fakeye
- Department of Clinical Pharmacy & Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
35
|
Nurse-led hypertension management was well accepted and non-inferior to physician consultation in a Chinese population: a randomized controlled trial. Sci Rep 2018; 8:10302. [PMID: 29985459 PMCID: PMC6037742 DOI: 10.1038/s41598-018-28721-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/28/2018] [Indexed: 11/29/2022] Open
Abstract
The objective of this study is to evaluate if nurse-led repeated prescription (NRP) could ensure non-inferior disease control and would be accepted in Chinese patients with controlled hypertension (HT) in primary care clinics. A 12-month follow-up non-inferiority randomized trial was conducted. The non-inferior margins for systolic and diastolic blood pressure were 6.6 mmHg and 3.7 mmHg, respectively. Eligible patients (>18 years of age) with HT were randomized to the NRP and usual care (UC) groups for their regular clinical follow-up. We used ANCOVA to study the difference-of-difference of the blood pressures between the two groups. The levels of patient acceptance and experience of NRP were assessed by the observed opt-out rate and a qualitative analysis. We found no statistically significant differences in BP blood pressure between the NRP (N = 194) and UC (N = 199) groups. Only 4 of the participants in the NRP group opted out due to a preference for assessment by a physician. The interviewed participants (N = 12) felt positive about NRP, because they experienced more relaxed communication with the nurse and believed that the eligibility to join the NRP program was an indication of optimal BP control. We observed no adverse events. The findings show that NRP was well accepted and found to be non-inferior to physician consultation for HT management.
Collapse
|
36
|
Rampamba EM, Meyer JC, Godman B, Kurdi A, Helberg E. Evaluation of antihypertensive adherence and its determinants at primary healthcare facilities in rural South Africa. J Comp Eff Res 2018; 7:661-672. [DOI: 10.2217/cer-2018-0004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim: To evaluate adherence to antihypertensive treatment in rural South Africa and identify potential determinants given concerns with adherence and its impact in this priority disease area. Patients & methods: Face-to-face interviews with hypertensive patients and rating their adherence to treatment using defined categorized responses. Associations between adherence and patient characteristics assessed and sensitivity analyses performed. Results: 54.6% of patients were adherent to treatment. Controlled blood pressure (BP; odds ratios [OR] = 2.1; 95% CI: 1.1, 3.8; p = 0.019), comorbidity (OR = 2.0; 95% CI: 1.1, 3.6; p = 0.032) and smoking (OR = 0.3; 95% CI: 0.1, 0.8; p = 0.018) were associated with adherence. Conclusion: Adherence and BP control were suboptimal, only smoking was an independent risk factor for adherence. Adherent patients were twice as likely to have controlled BP, although results were sensitive to the definition of adherence. Initiatives are in place to improve adherence, which will be monitored.
Collapse
Affiliation(s)
- Enos M Rampamba
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa
- Department of Health, Tshilidzini Hospital, Limpopo Province, South Africa
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Health Economics Centre, Liverpool University Management School, Liverpool, UK
| | - Amanj Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Elvera Helberg
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa
| |
Collapse
|
37
|
Jarab AS, Alefishat EA, Bani Nasur R, Mukattash TL. Investigation of variables associated with medication nonadherence in patients with hypertension. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2018. [DOI: 10.1111/jphs.12236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Anan S. Jarab
- Department of Clinical Pharmacy; Faculty of Pharmacy; Jordan University of Science and Technology; Irbid Jordan
| | - Eman A. Alefishat
- Department of Biopharmaceutics and Clinical Pharmacy; Faculty of Pharmacy; The University of Jordan; Amman Jordan
| | - Rasha Bani Nasur
- Department of Pharmacy; Jordanian Royal Medical Services; Amman Jordan
| | - Tareq L. Mukattash
- Department of Clinical Pharmacy; Faculty of Pharmacy; Jordan University of Science and Technology; Irbid Jordan
| |
Collapse
|
38
|
Abegaz TM, Abdela OA, Bhagavathula AS, Teni FS. Magnitude and determinants of uncontrolled blood pressure among hypertensive patients in Ethiopia: hospital-based observational study. Pharm Pract (Granada) 2018; 16:1173. [PMID: 30023028 PMCID: PMC6041209 DOI: 10.18549/pharmpract.2018.02.1173] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 06/06/2018] [Indexed: 11/14/2022] Open
Abstract
Background Hypertension is an important public health problem worldwide. There is lack of data on uncontrolled blood pressure in developing countries. Objectives To determine the magnitude and predicting factors of uncontrolled blood pressure in hypertensive patients attending Gondar university hospital, Ethiopia. Methods A hospital-based cross-sectional survey was conducted from July 2015 to March 2016. All hypertensive patients were followed and the blood pressure levels were measured. Binary logistic regression analysis was done to determine the predictors of uncontrolled blood pressure. A p-value of <0.05 was set at priori with 95% confidence interval to test the level of significance. Results Of the total 578 hypertension patients, 543 (93.9%) fulfilled the study criteria and were included in the final analysis. The mean age of the participants was 55.96±14.6 years. Nearly two-third (58.2%) of the participants were females. More than one-tenth (11.4%) of the respondents had uncontrolled blood pressure. High salt intake carried six times more risk of uncontrolled blood pressure. Elderly individuals had lower risk as compared to young age group. However, comorbidities were not related with uncontrolled blood pressure. Conclusions Blood pressure control was relatively high in the hospital studied. High salt intake was strongly linked with uncontrolled blood pressure. Individuals with high salt intake should be followed for their medication experience and disease knowledge.
Collapse
Affiliation(s)
- Tadesse M Abegaz
- Department of clinical pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar. Gondar (Ethiopia).
| | - Ousman A Abdela
- Department of Clinical pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar. Gondar, (Ethiopia).
| | - Akshaya S Bhagavathula
- Assistant professor. Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar. Gondar (Ethiopia).
| | - Fitsum S Teni
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Addis Ababa University. Addis Ababa (Ethiopia).
| |
Collapse
|
39
|
Zhang Y, Li X, Mao L, Zhang M, Li K, Zheng Y, Cui W, Yin H, He Y, Jing M. Factors affecting medication adherence in community-managed patients with hypertension based on the principal component analysis: evidence from Xinjiang, China. Patient Prefer Adherence 2018; 12:803-812. [PMID: 29785095 PMCID: PMC5955046 DOI: 10.2147/ppa.s158662] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The analysis of factors affecting the nonadherence to antihypertensive medications is important in the control of blood pressure among patients with hypertension. The purpose of this study was to assess the relationship between factors and medication adherence in Xinjiang community-managed patients with hypertension based on the principal component analysis. PATIENTS AND METHODS A total of 1,916 community-managed patients with hypertension, selected randomly through a multi-stage sampling, participated in the survey. Self-designed questionnaires were used to classify the participants as either adherent or nonadherent to their medication regimen. A principal component analysis was used in order to eliminate the correlation between factors. Factors related to nonadherence were analyzed by using a χ2-test and a binary logistic regression model. RESULTS This study extracted nine common factors, with a cumulative variance contribution rate of 63.6%. Further analysis revealed that the following variables were significantly related to nonadherence: severity of disease, community management, diabetes, and taking traditional medications. CONCLUSION Community management plays an important role in improving the patients' medication-taking behavior. Regular medication regimen instruction and better community management services through community-level have the potential to reduce nonadherence. Mild hypertensive patients should be monitored by community health care providers.
Collapse
Affiliation(s)
- Yuji Zhang
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Xiaoju Li
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Lu Mao
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Mei Zhang
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Ke Li
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Yinxia Zheng
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Wangfei Cui
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Hongpo Yin
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Yanli He
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Mingxia Jing
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| |
Collapse
|
40
|
Schneider APH, Gaedke MÂ, Garcez A, Barcellos NT, Paniz VMV. Effect of characteristics of pharmacotherapy on non-adherence in chronic cardiovascular disease: A systematic review and meta-analysis of observational studies. Int J Clin Pract 2018; 72. [PMID: 29193650 DOI: 10.1111/ijcp.13044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/05/2017] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Cardiovascular medications are effective in prevention of cardiovascular diseases (CVD); however, medication non-adherence contributes to morbidity and mortality. OBJECTIVE This systematic review and meta-analysis aims to summarise the evidence regarding the relationship between characteristics of drug therapy (pharmacotherapy) and medication non-adherence in the CVD population. METHODS Systematic searches in PubMed, LILACS, Academic Search and CINAHL databases for observational studies that enrolled adults with CVD were performed, from January 1960 to December 2015. The meta-analysis tested the association between characteristics of pharmacotherapy and self-reported medication non-adherence outcome, using a random effects model. To investigate heterogeneity, we performed subgroup analysis and sensitivity analysis. RESULTS Twenty-four cross-sectional studies and 7 cohort studies were included in this review. Based on 31 studies including 27 441 participants, we performed meta-analyses for all the characteristics of drug therapy that at least 2 studies evaluated, with a total of fourteen meta-analyses. The pooled results showed that studies which evaluate whether participants have insurance or another program that assists with medication costs, but not full coverage (OR = 0.63; 95% CI: 0.53-0.74; P < .001; I2 = 0%, P = .938), and a dosing frequency of twice or more daily (OR = 1.38; 95% CI: 1.13-1.69; P < .001) were associated with non-adherence. CONCLUSIONS AND RELEVANCE The results of this review suggest that access to insurance or another program that assists with medication costs was a protection factor for non-adherence. On the other hand, a high frequency of dosing was a risk factor for non-adherence. Therefore, these characteristics of pharmacotherapy must be considered to improve medication adherence among CVD patients.
Collapse
Affiliation(s)
- Ana Paula Helfer Schneider
- Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brazil
- Department of Biology and Pharmacy, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
| | - Mari Ângela Gaedke
- Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brazil
- Department of Biology and Pharmacy, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
| | - Anderson Garcez
- Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brazil
| | - Nêmora Tregnago Barcellos
- Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brazil
| | - Vera Maria Vieira Paniz
- Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brazil
| |
Collapse
|
41
|
Mekonnen HS, Gebrie MH, Eyasu KH, Gelagay AA. Drug adherence for antihypertensive medications and its determinants among adult hypertensive patients attending in chronic clinics of referral hospitals in Northwest Ethiopia. BMC Pharmacol Toxicol 2017; 18:27. [PMID: 28381241 PMCID: PMC5382443 DOI: 10.1186/s40360-017-0134-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 03/30/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Adherence to prescribed medication is an imperative issue which can be directly linked with the management of chronic diseases like hypertension; failure to adhere can affect the effectiveness of medication as well as the efficiency of the health care system. There is scarcity of information regarding the level of drug adherence for antihypertensive medications and its determinants in Ethiopia, particularly in the study area. Therefore, the aim of this study was to assess adherence level and its determinants for antihypertensive medications among adult hypertensive patients attending the chronic illness clinics of the referral hospitals in northwest Ethiopia. METHODS Institution based cross sectional study was conducted from March to April, 2016. The systematic random sampling technique was used to select 409 study participants from three referral hospitals. The questionnaire was prepared using the World Health Organization (WHO) conceptual model and by reviewing international literature. The data were collected using an interviewer administered questionnaire. The data were entered in to Epi - Info version 7 and then transferred to the statistical package for social science (SPSS) version 20 for data cleaning and analysis. Bivariate analysis was first done to see the association between each independent variables and dependent variable. Variables with a P-value of less than 0.2 in the bivariate analysis were entered in to the multivariate logistic regression model for final analysis. Multivariate analysis was done using Backward logistic regression method. P-value less than 0.05 was considered to determine the statistical significance of the association and odds ratio with a 95% confidence interval was used to determine the presence, strength, and direction of association between covariates (explanatory variables) and the outcome variable. The Morisky medication adherence scale was used to assess the adherence status using > = 6 as adherent or < 6 as non adherent score. RESULTS Four hundred and nine (409) study participants were interviewed with a response rate of 100%. The mean age of the respondents was 54.5 years with (Standard Deviation (SD) ± 13.58). The overall rate of good adherence was 67.2% (95% CI = 62.8, 71.6). Participants who had a favourable attitude towards antihypertensive medications (Adjusted odds ratio (AOR) = 9.88, 95% confidence interval (CI): 5.34, 18.27), having good patient- provider relationship (AOR = 4.25, 95% CI: 2.32, 7.86), having one (AOR = 4.36, 95% CI: 1.34, 14.12) or no (AOR = 3.38, 95% CI:1.01,11.31) co-morbidities, a long duration of treatment (AOR = 1.89, 95%CI: 1.07, 3.35), and a low medical cost (AOR = 2.06, 95% CI: 1.13, 3.76) had associations with good drug adherence for antihypertensive medication/s. CONCLUSIONS The prevalence of good drug adherence for anti-hypertensive medications in this study was high. Prevention of co- morbidities, making medical services accessible, and maintaining good client-provider interaction are of paramount importance for good drug adherence.
Collapse
Affiliation(s)
- Habtamu Sewunet Mekonnen
- Department of Medical Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mignote Hailu Gebrie
- Department of Medical Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Kokeb Haile Eyasu
- Department of Medical Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Abebaw Addis Gelagay
- Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
42
|
Choi YJ, Ah YM, Kong J, Choi KH, Kim B, Han N, Yu YM, Oh JM, Shin WG, Lee HY, Lee JY. Implication of different initial beta blockers on treatment persistence: atenolol vs new-generation beta blocker, a population-based study. Cardiovasc Ther 2017; 34:268-75. [PMID: 27214564 DOI: 10.1111/1755-5922.12197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIM Potential heterogeneity within the same class of drug in terms of persistence may lead to different clinical implications. Given that the increased risks of mortality and cardiovascular events are due, in part, to the lack of persistent use of antihypertensive medications, the objective of this study was to evaluate 1-year persistence of new-generation beta blockers compared to atenolol in antihypertensive treatment-naïve patients. METHODS A total of 9978 patients aged 18 years or older with hypertension newly diagnosed in 2012, without hypertension-related complication and initiated treatment with beta blocker monotherapy during 2012 were included in the analysis. Rate and duration of treatment and drug persistence were compared between atenolol and new-generation beta blockers. Hazards of discontinuation in nonatenolol compared to atenolol were evaluated using a multivariate Cox proportional model. RESULTS The rate of treatment persistence was higher in the nonatenolol group (57.35% vs 53.40%, P<.0001), and the time to treatment discontinuation was earlier in the atenolol group with a minimal difference in the average (243.2 vs 254 days, P<.0001). New-generation beta blockers demonstrated a lower risk of treatment discontinuation (HR: 0.91, 95% CI: 0.86-0.96) compared to atenolol; a notable improvement was observed with carvedilol and nebivolol (HR: 0.74, 95% CI: 0.69-0.80 and HR: 0.79, 95% CI: 0.70-0.89, respectively), whereas betaxolol showed a substantially greater hazard for discontinuation compared to atenolol. CONCLUSIONS This study demonstrated a meaningful improvement in treatment persistence with new-generation beta blockers compared to atenolol, with betaxolol as exception.
Collapse
Affiliation(s)
- Yun Jung Choi
- College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Gyeonggi, South Korea
| | - Young-Mi Ah
- College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Gyeonggi, South Korea
| | - Jisun Kong
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Kyung Hee Choi
- College of Pharmacy, Sunchon National University, Suncheon, Jeollanam-do, South Korea
| | - Baegeum Kim
- College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Gyeonggi, South Korea
| | - Nayoung Han
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Yun Mi Yu
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Jung Mi Oh
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Wan Gyoon Shin
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Hae-Young Lee
- Department of internal medicine, Seoul National University Hospital, Seoul, South Korea
| | - Ju-Yeun Lee
- College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Gyeonggi, South Korea
| |
Collapse
|
43
|
Lee YM, Yu HY, You MA, Son YJ. Impact of health literacy on medication adherence in older people with chronic diseases. Collegian 2017; 24:11-8. [DOI: 10.1016/j.colegn.2015.08.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
44
|
Associations of socioeconomic status with prevalence, awareness, treatment, and control of hypertension in a general Japanese population. J Hypertens 2017; 35:401-408. [DOI: 10.1097/hjh.0000000000001169] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
45
|
Khayyat SM, Khayyat SMS, Hyat Alhazmi RS, Mohamed MMA, Abdul Hadi M. Predictors of Medication Adherence and Blood Pressure Control among Saudi Hypertensive Patients Attending Primary Care Clinics: A Cross-Sectional Study. PLoS One 2017; 12:e0171255. [PMID: 28135324 PMCID: PMC5279800 DOI: 10.1371/journal.pone.0171255] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 01/17/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To assess the level of medication adherence and to investigate predictors of medication adherence and blood pressure control among hypertensive patients attending primary healthcare clinics in Makkah, Saudi Arabia. PATIENTS AND METHODS Hypertensive patients meeting the eligibility criteria were recruited from eight primary care clinics between January and May 2016 for this study. The patients completed Arabic version of Morisky Medication Adherence Scale (MMAS-8), an eight-item validated, self-reported measure to assess medication adherence. A structured data collection form was used to record patients' sociodemographic, medical and medication data. RESULTS Two hundred and four patients, of which 71.6% were females, participated in the study. Patients' mean age was 59.1 (SD 12.2). The mean number of medication used by patients was 4.4 (SD 1.89). More than half (110; 54%) of the patients were non-adherent to their medications (MMAS score < 6). Binary regression analysis showed that highly adherent patients (MMAS score = 8) were about five times (OR 4.91 [95%CI: 1.85-12.93; P = 0.01]) more likely to have controlled blood pressure compared to low adherent patients. Female gender (OR 0.40 [95% CI: 0.20-0.80; P = 0.01]), Age > 65 years (OR 2.0 [95% CI: 1.0-4.2; P = 0.04]), and being diabetic (OR 0.25 [95% CI: 0.1-0.6; P = 0.04]) were found to be independent predictors of medication adherence. CONCLUSION Medication adherence is alarmingly low among hypertensive patients attending primary care clinics in Saudi Arabia which may partly explain observed poor blood pressure control. There is a clear need to educate patients about the importance of medication adherence and its impact on improving clinical outcomes. Future research should identify barriers to medication adherence among Saudi hypertensive patients.
Collapse
Affiliation(s)
- Sarah M. Khayyat
- Department of Clinical Pharmacy, Faculty of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | | | - Mahmoud M. A. Mohamed
- Department of Clinical Pharmacy, Faculty of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
- Pharmaceutical Research Center, Deanship of Scientific Research, Umm Al-Qura University, Makkah, Saudi Arabia
| | | |
Collapse
|
46
|
Abegaz TM, Shehab A, Gebreyohannes EA, Bhagavathula AS, Elnour AA. Nonadherence to antihypertensive drugs: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e5641. [PMID: 28121920 PMCID: PMC5287944 DOI: 10.1097/md.0000000000005641] [Citation(s) in RCA: 260] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 11/18/2016] [Accepted: 11/21/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Hypertension drives the global burden of cardiovascular disease and its prevalence is estimated to increase by 30% by the year 2025. Nonadherence to chronic medication regimens is common; approximately 43% to 65.5% of patients who fail to adhere to prescribed regimens are hypertensive patients. Nonadherence to medications is a potential contributing factor to the occurrence of concomitant diseases. OBJECTIVE This systematic review applied a meta-analytic procedure to investigate the medication nonadherence in adult hypertensive patients. METHODS Original research studies, conducted on adult hypertensive patients, using the 8-item Morisky medication adherence scale (MMAS-8) to assess the medication adherence between January 2009 and March 2016 were included. Comprehensive search strategies of 3 databases and MeSH keywords were used to locate eligible literature. Study characteristics, participant demographics, and medication adherence outcomes were recorded. Effect sizes for outcomes were calculated as standardized mean differences using random-effect model to estimate overall mean effects. RESULTS A total of 28 studies from 15 countries were identified, in total comprising of 13,688 hypertensive patients, were reviewed. Of 25 studies included in the meta-analysis involving 12,603 subjects, a significant number (45.2%) of the hypertensive patients and one-third (31.2%) of the hypertensive patients with comorbidities were nonadherent to medications. However, a higher proportion (83.7%) of medication nonadherence was noticed in uncontrolled blood pressure (BP) patients. Although a higher percentage (54%) of nonadherence to antihypertensive medications was noticed in females (P < 0.001), the risk of nonadherence was 1.3 times higher in males, with a relative risk of 0.883. Overall, nearly two-thirds (62.5%) of the medication nonadherence was noticed in Africans and Asians (43.5%). CONCLUSION Nonadherence to antihypertensive medications was noticed in 45% of the subjects studied and a higher proportion of uncontrolled BP (83.7%) was nonadherent to medication. Intervention models aiming to improve adherence should be emphasized.
Collapse
Affiliation(s)
- Tadesse Melaku Abegaz
- Department of Clinical Pharmacy, College of Medicine and Health Sciences, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Abdulla Shehab
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University
| | - Eyob Alemayehu Gebreyohannes
- Department of Clinical Pharmacy, College of Medicine and Health Sciences, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Akshaya Srikanth Bhagavathula
- Department of Clinical Pharmacy, College of Medicine and Health Sciences, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Asim Ahmed Elnour
- Department of Clinical Pharmacy, Faculty of Pharmacy, Fathima College of Health Sciences, Al Ain, UAE
| |
Collapse
|
47
|
Pan J, Lei T, Hu B, Li Q. Post-discharge evaluation of medication adherence and knowledge of hypertension among hypertensive stroke patients in northwestern China. Patient Prefer Adherence 2017; 11:1915-1922. [PMID: 29200832 PMCID: PMC5700759 DOI: 10.2147/ppa.s147605] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The aims of this study were to assess the knowledge of hypertension (HTN) and investigate risk factors associated with medication adherence among hypertensive stroke patients after discharge in northwestern China. PATIENTS AND METHODS A cross-sectional study involving 440 Chinese hypertensive stroke patients was conducted in a tertiary hospital in Xi'an, China. Data were collected by telephone interviews and patients' medical records. RESULTS It was found that 35.23% of patients were compliant with their antihypertensive drug treatments, and 42.95%, 52.27% and 4.77% of patients had poor, moderate and adequate knowledge of HTN, respectively. Gender, blood pressure (BP) categories, BP monitoring and HTN knowledge were independently associated with antihypertensive medication adherence. CONCLUSION The medication adherence among hypertensive stroke patients in northwestern China was poor. Knowledge of HTN was suboptimal. More attention and effective strategies should be designed to the factors affecting medication adherence. As knowledge positively affects medication adherence, clinical pharmacists should play an important role in patients' medication education.
Collapse
Affiliation(s)
- Jingjing Pan
- Department of Pharmacy
- Correspondence: Jingjing Pan, Department of Pharmacy, Xi’an Fourth Hospital, 21 JieFang Road, 710004 Xi’an, People’s Republic of China, Tel +86 029 8748 0635 ext 029, Email
| | - Tao Lei
- Department of Neurology, Xi’an Fourth Hospital, Xi’an, People’s Republic of China
| | | | | |
Collapse
|
48
|
Rodríguez-Abt JC, Solís-Visscher RJ, Rogic-Valencia SJ, Román Y, Reyes-Rocha M. Asociación entre conocimiento de hipertensión arterial y adherencia al tratamiento en pacientes hipertensos del Hospital Nacional Edgardo Rebagliati Martins de Lima, Perú. 2015. REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n1.56773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. Conocer sobre hipertensión arterial podría favorecer la adherencia al tratamiento para un mejor control de la presión arterial.Objetivo. Evaluar si existe asociación entre conocimientos sobre hipertensión y adherencia al tratamiento en pacientes hipertensos del Hospital Nacional Edgardo Rebagliati Martins de Lima, Perú.Materiales y métodos. Se realizó un estudio transversal analítico. El muestreo por conveniencia incluyó 340 pacientes hipertensos de consultorios de cardiología en el periodo mayo-agosto de 2015. La variable principal de exposición fue grado de conocimiento sobre hipertensión medida con el cuestionario de conocimientos sobre la hipertensión (CSH) y la variable respuesta fue grado de adherencia al tratamiento medida con el cuestionario Martin-Bayarre-Grau (MBG). Se utilizó regresión de Poisson para calcular razones de prevalencias (RP) con intervalos de confianza del 95% y valor de p<0.05 para establecer significancia estadística.Resultados. Se encontró asociación entre bajo conocimiento de hipertensión y adherencia parcial al tratamiento (RP=1.4; IC95%: 1.2-1.8), tener más de 10 años de hipertensión (RP=0.7; IC95%: 0.6-0.9), no haber recibido información sobre hipertensión (RP=1.4; IC95%: 1.2-1.7) y tiempo de consulta mayor a 15 minutos (RP=0.5; IC95%: 0.3-0.7).Conclusión. Los pacientes con bajo conocimiento de hipertensión tienen más probabilidad de tener adherencia parcial al tratamiento.
Collapse
|
49
|
Pierin AMG, Silva SSBED, Colósimo FC, Toma GDA, Serafim TDS, Meneghin P. Chronic and asymptomatic diseases influence the control of hypertension treatment in primary care. Rev Esc Enferm USP 2016; 50:763-770. [PMID: 27982394 DOI: 10.1590/s0080-623420160000600008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/23/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To identify the association between blood pressure control and the following variables: a) bio-social and lifestyle characteristics of hypertensive patients; and b) factors related to the antihypertensive treatment. METHODS This is an exploratory study with 290 people with hypertension from primary care. We used a specific instrument, self-administered, with 21 questions on factors that can hinder treatment, divided into four dimensions: medication, socioeconomic, institutional and personal beliefs. We adopted a significance level of p <0.05. RESULTS The control of blood pressure was associated (p <0.05) with female gender, Caucasian ethnicity, primary/secondary education, not drinking alcohol, higher income and regular physical activity. Regarding the factors that can hinder treatment, there was association of hypertension control with only two questions: "feel nothing" and "have to do treatment for life". CONCLUSION Sociodemographic variables and beliefs concerning the absence of symptoms and chronicity of the disease influenced the control of hypertension and should be considered in the adherence process to the treatment. OBJETIVO Identificar a associação entre o controle da pressão arterial e as seguintes variáveis: a) características biossociais e hábitos de vida dos hipertensos; e b) fatores relacionados ao tratamento anti-hipertensivo. MÉTODOS Realizou-se estudo exploratório com 290 hipertensos da atenção primária. Utilizou-se de instrumento específico, autoaplicável, com 21 questões sobre fatores que podem dificultar o tratamento, divididas em quatro domínios: medicamentos, socioeconômico, institucional e crenças pessoais. Adotou-se nível de significância de p < 0,05. RESULTADOS O controle da pressão arterial se associou (p < 0,05) com sexo feminino, etnia branca, ensino fundamental/médio, não ingerir bebida alcoólica, maior renda e atividade física regular. Quanto aos fatores que podem dificultar o tratamento, houve associação do controle com apenas duas questões: "não sentir nada" e "ter que fazer tratamento para vida toda". CONCLUSÃO Variáveis sociodemográficas e crenças relativas à ausência de sintomatologia e cronicidade da doença influenciaram o controle dos hipertensos e devem ser consideradas no processo de adesão ao tratamento.
Collapse
Affiliation(s)
| | | | - Flávia Cortez Colósimo
- Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem na Saúde do Adulto, São Paulo, SP, Brazil
| | | | | | - Paolo Meneghin
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil
| |
Collapse
|
50
|
Yang S, He C, Zhang X, Sun K, Wu S, Sun X, Li Y. Determinants of antihypertensive adherence among patients in Beijing: Application of the health belief model. PATIENT EDUCATION AND COUNSELING 2016; 99:1894-1900. [PMID: 27378081 DOI: 10.1016/j.pec.2016.06.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 05/03/2016] [Accepted: 06/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study was aimed to determine the factors associated with antihypertensive adherence based on the Health Belief Model (HBM). METHODS A cross-sectional study was conducted in a rural area of China in 2014. The questionnaire included information about demographics, a scale based on the HBM, and the four-item Morisky Medication Adherence Scale. RESULTS 745 hypertensive patients participated in the study (345 men, 400 women). Patients' mean age was 56.4±10.8years. The prevalence of adherence was 43.5%. Structural equation modeling showed that men, older participants, and those with greater knowledge of hypertension showed better medication adherence than did other participants. Based on the HBM, higher levels of self-efficacy and perceived severity and a lower level of perceived barriers were associated with better antihypertensive adherence. Self-efficacy was one of the most important mediating variables affecting antihypertensive adherence. CONCLUSIONS Antihypertensive adherence was not optimal among patients in Beijing. Given that many factors are associated with medication adherence, individualized intervention strategies should be carried out in Beijing, China, especially in community settings. PRACTICE IMPLICATIONS Medication adherence can be improved by enhancing patients' self-efficacy because it was the most important influence and mediating variable.
Collapse
Affiliation(s)
- Shuaishuai Yang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Chao He
- Department of Health Education, Shunyi Center for Disease Prevention and Control, Beijing, China
| | - Xuxi Zhang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Kaige Sun
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Shiyan Wu
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Xinying Sun
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China.
| | - Yindong Li
- Department of Health Education, Shunyi Center for Disease Prevention and Control, Beijing, China.
| |
Collapse
|