The necessity-concerns framework predicts adherence to medication in multiple illness conditions: A meta-analysis

Decision-making in the multiphase optimization strategy: Applying decision analysis for intervention value efficiency to optimize an information leaflet to promote key antecedents of medication adherence

Advances in the multiphase optimization strategy (MOST) have suggested a new approach, decision analysis for intervention value efficiency (DAIVE), for selecting an optimized intervention based on the results of a factorial optimization trial. The new approach opens possibilities to select optimized interventions based on multiple valued outcomes. We applied DAIVE to identify an optimized information leaflet intended to support eventual adherence to adjuvant endocrine therapy for women with breast cancer. We used empirical performance data for five candidate leaflet components on three hypothesized antecedents of adherence: beliefs about the medication, objective knowledge about AET, and satisfaction with medication information. Using data from a 25 factorial trial (n = 1603), we applied the following steps: (i) We used Bayesian factorial analysis of variance to estimate main and interaction effects for the five factors on the three outcomes. (ii) We used posterior distributions for main and interaction effects to estimate expected outcomes for each leaflet version (32 total). (iii) We scaled and combined outcomes using a linear value function with predetermined weights indicating the relative importance of outcomes. (iv) We identified the leaflet that maximized the value function as the optimized leaflet, and we systematically varied outcome weights to explore robustness. The optimized leaflet included two candidate components, side-effects, and patient input, set to their higher levels. Selection was generally robust to weight variations consistent with the initial preferences for three outcomes. DAIVE enables selection of optimized interventions with the best-expected performance on multiple outcomes.

Behavioral Science: Enhancing Our Approach to the Development of Effective Additional Risk Minimization Strategies

Additional risk minimization strategies may be required to assure a positive benefit-risk balance for some therapeutic products associated with serious adverse drug reactions/risks of use, without which these products may be otherwise unavailable to patients. The goals of risk minimization strategies are often fundamentally to influence the behavior of healthcare professionals (HCPs) and/or patients and can include appropriate patient selection, provision of education and counselling, appropriate medication use, adverse drug reaction monitoring, and adoption of other elements to assure safe use, such as pregnancy prevention. Current approaches to additional risk minimization strategy development rely heavily on information provision, without full consideration of the contextual factors and multi-level influences on patient and HCP behaviors that impact adoption and long-term adherence to these interventions. Application of evidence-based behavioral science methods are urgently needed to improve the quality and effectiveness of these strategies. Evidence from the fields of adherence, health promotion, and drug utilization research underscores the value and necessity for using established behavioral science frameworks and methods if we are to achieve clinical safety goals for patients. The current paper aims to enhance additional risk minimization strategy development and effectiveness by considering how a behavioral science approach can be applied, drawing from evidence in understanding of engagement with pharmaceutical medicines as well as wider public health interventions for patients and HCPs.

Vaccine decision making in New Zealand: a discrete choice experiment

BACKGROUND

Vaccine hesitancy is a significant threat to global health. A key part of addressing hesitancy is to ensure that public health messaging prioritises information that is considered important to the public. This study aimed to examine how different vaccine characteristics affect public preferences for vaccines in New Zealand, what trade-offs they are willing to make between different vaccine characteristics, and how their preferences are affected by their vaccine-related conspiracy beliefs and COVID-19 vaccination status.

METHODS

An online discrete choice experiment (DCE) was designed to elicit individual preferences about vaccines using the 1000minds platform. Members of the general population of New Zealand aged ≥ 18 years were invited to complete the DCE. Participants were asked to indicate their preference between two options showing different combinations of vaccine characteristics. Data on sociodemographic characteristics were collected. Beliefs were measured using the vaccine conspiracy beliefs scale (VCBS) with scores ≥ 19 indicating strong vaccine-related conspiracy beliefs. The DCE was analysed using the PAPRIKA method (Potentially All Pairwise RanKings of all possible Alternatives) and preferences compared between respondents with high versus low VCBS scores and vaccinated versus unvaccinated respondents for COVID-19.

RESULTS

A total of 611 respondents from 15 regions completed the DCE. Mean (SD) age was 45.9 (14.7) years with most having had 2 or more doses of the coronavirus vaccine (86%). Mean (SD) VCBS score was 18.5 (12.4) indicating moderate vaccine-related conspiracy beliefs. Risk of severe adverse effects was the most highly valued vaccine characteristic, followed by vaccine effectiveness and duration of protection. Vaccine origin and route of administration were ranked least important. Respondents scoring high on the VCBS placed less value on the effectiveness of vaccines but greater value on development time and total number of doses (p < 0.001). COVID-19 unvaccinated respondents ranked development time and total number of doses more highly than those vaccinated respondents (p < 0.001).

CONCLUSIONS

Risk of severe adverse effects, vaccine effectiveness and duration of protection were rated by the New Zealand public as the top three most important vaccine characteristics. This information is important for informing public health messaging to promote vaccine uptake and inform vaccine decision-making.

Beliefs about medicines' association with endocrine therapy adherence in early breast cancer survivors in Croatia

This observational, cross-sectional study conducted at the University Hospital Centre Zagreb (UHC Zagreb) aimed to explore patients' beliefs about adjuvant endocrine therapy (AET) as well as their association with non-adherence and sociodemographic and clinical factors. Out of 420 early breast cancer (BC) patients included in the study, 79.5 % perceived AET necessary and important for their health, as measured by the Belief About Medicines Questionnaire (BMQ), with the mean necessity score (20.4 ± 3.68) significantly higher than the mean concerns score (13 ± 4.81) (p < 0.001). Based on the Medication Adherence Report Scale (MARS-5), 44.4 % (n = 182) of the participants were non-adherers, out of which 63.2 % (n = 115) were unintentional and 36.8 % (n = 67) intentional non-adherers. Significantly higher concern beliefs were found among patients that were younger (p < 0.001), employed (p < 0.001), intentionally non-adherent to AET (p = 0.006), had a lower body-mass index (p = 0.005) and a higher level of education (p < 0.001), were premenopausal at the time of diagnosis (p < 0.001), taking tamoxifen treatment (p = 0.05) and receiving ovarian suppression (p < 0.001). Younger patients should be recognized as being at risk of non-adherence as they hold greater concern beliefs about medicines.

Beliefs about medicines in gout patients: results from the NOR-Gout 2-year study

OBJECTIVE

Adherence to urate-lowering therapy (ULT) in gout is challenging. This longitudinal study aimed to determine 2 year changes in beliefs about medicines during intervention with ULT.

METHOD

Patients with a recent gout flare and increased serum urate received a nurse-led ULT intervention with tight control visits and a treatment target. Frequent visits at baseline and 1, 2, 3, 6, 9, 12, and 24 months included the Beliefs about Medicines Questionnaire (BMQ), and demographic and clinical variables. The BMQ subscales on necessity, concerns, overuse, harm, and the necessity-concerns differential were calculated as a measure of whether the patient perceived that necessity outweighed concerns.

RESULTS

The mean serum urate reduced from 500 mmol/L at baseline to 324 mmol/L at year 2. At years 1 and 2, 85.5% and 78.6% of patients, respectively, were at treatment target. The 2 year mean ± sd BMQ scores increased for the necessity subscale from 17.0 ± 4.4 to 18.9 ± 3.6 (p < 0.001) and decreased for the concerns subscale from 13.4 ± 4.9 to 12.5 ± 2.7 (p = 0.001). The necessity-concerns differential increased from 3.52 to 6.58 (p < 0.001), with a positive change independent of patients achieving treatment targets at 1 or 2 years. BMQ scores were not significantly related to treatment outcomes 1 or 2 years later, and achieving treatment targets did not lead to higher BMQ scores.

CONCLUSION

Patient beliefs about medicines improved gradually over 2 years, with increased beliefs in the necessity of medication and reduced concerns, but this improvement was unrelated to better outcomes.

TRIAL REGISTRATION

ACTRN12618001372279.

Optimization of an Information Leaflet to Influence Medication Beliefs in Women With Breast Cancer: A Randomized Factorial Experiment

BACKGROUND

Adherence to adjuvant endocrine therapy (AET) is low in women with breast cancer. Negative beliefs about the necessity of AET and high concerns are barriers to adherence.

PURPOSE

To use the multiphase optimization strategy to optimize the content of an information leaflet intervention, to change AET beliefs.

METHODS

We conducted an online screening experiment using a 25 factorial design to optimize the leaflet. The leaflet had five components, each with two levels: (i) diagrams about AET mechanisms (on/off); (ii) infographics displaying AET benefits (enhanced/basic); (iii) AET side effects (enhanced/basic); (iv) answers to AET concerns (on/off); (v) breast cancer survivor (patient) input: quotes and photographs (on/off). Healthy adult women (n = 1,604), recruited via a market research company, were randomized to 1 of 32 experimental conditions, which determined the levels of components received. Participants completed the Beliefs about Medicines Questionnaire before and after viewing the leaflet.

RESULTS

There was a significant main effect of patient input on beliefs about medication (β = 0.063, p < .001). There was one significant synergistic two-way interaction between diagrams and benefits (β = 0.047, p = .006), and one antagonistic two-way interaction between diagrams and side effects (β = -0.029, p = .093). There was a synergistic three-way interaction between diagrams, concerns, and patient input (β = 0.029, p = .085), and an antagonistic four-way interaction between diagrams, benefits, side effects, and concerns (β = -0.038, p = .024). In a stepped approach, we screened in four components and screened out the side effects component.

CONCLUSIONS

The optimized leaflet did not contain enhanced AET side effect information. Factorial experiments are efficient and effective for refining the content of information leaflet interventions.

Relationships between beliefs about statins and non-adherence in inpatients from Northwestern China: a cross-sectional survey

Background: Studies have identified patients' beliefs about medicines as an important determinant of non-adherence. However, scant data are available on the possible association between patients' beliefs and statin non-adherence among adult patients in China. The objectives of this study are to assess the prevalence of statin non-adherence, and to identify the factors associated with statin non-adherence, especially the association between inpatients' beliefs about statins and non-adherence in a tertiary hospital in the Northwestern China. Methods: A cross-sectional questionnaire-based survey was carried out in the department of cardiology and neurology between February and June 2022. The Beliefs about Medicine Questionnaire (BMQ) was used to assess patients' beliefs about statins. The Adherence to Refills and Medications Scale (ARMS) was used to assess statin adherence. Logistic regression analyses were performed to identify the factors associated with statin non-adherence. Receiver operator characteristic (ROC) was conducted to assess the performance of the logistic regression model in predicting statin non-adherence. Results: A total of 524 inpatients participated and finished the questionnaire, 426 (81.3%) inpatients were non-adherent to statin, and 229 (43.7%) inpatients expressed strong beliefs about the stain treatment necessity, while 246 (47.0%) inpatients expressed strong concerns about the potential negative effects. We found that the low necessity beliefs about statin (adjusted odds ratio [OR] and 95% confidence interval [CI], 1.607 [1.019, 2.532]; p = 0.041), prescribed rosuvastatin (adjusted OR 1.820 [1.124, 2.948]; p = 0.015) and ex-drinker (adjusted OR 0.254 [0.104, 0.620]; p = 0.003) were independent determinants of statin non-adherence. Conclusion: Statin adherence was poor in this study. The findings indicated a significant association between inpatients' lower necessity beliefs and statin non-adherence. More attention should be focused on statin non-adherence in China. Nurses and pharmacists could play an important role in patient education and patient counseling in order to improve medication adherence.

Medication nonadherence: health impact, prevalence, correlates and interventions

Nonadherence to medicines is a global problem compromising health and economic outcomes for individuals and society. This article outlines how adherence is defined and measured, and examines the impact, prevalence and determinants of nonadherence. It also discusses how a psychosocial perspective can inform the development of interventions to optimise adherence and presents a series of recommendations for future research to overcome common limitations associated with the medication nonadherence literature. Nonadherence is best understood in terms of the interactions between an individual and a specific disease/treatment, within a social and environmental context. Adherence is a product of motivation and ability. Motivation comprises conscious decision-making processes but also from more 'instinctive', intuitive and habitual processes. Ability comprises the physical and psychological skills needed to adhere. Both motivation and ability are influenced by environmental and social factors which influence the opportunity to adhere as well as triggers or cues to actions which may be internal (e.g. experiencing symptoms) or external (e.g. receiving a reminder). Systematic reviews of adherence interventions show that effective solutions are elusive, partly because few have a strong theoretical basis. Adherence support targeted at the level of individuals will be more effective if it is tailored to address the specific perceptions (e.g. beliefs about illness and treatment) and practicalities (e.g. capability and resources) influencing individuals' motivation and ability to adhere.

The relationship between medication adherence and illness perception in breast cancer patients with adjuvant endocrine therapy: beliefs about medicines as mediators

PURPOSE

To describe medication adherence, to analyze the relationships among medication adherence, illness perception, and beliefs about medicines, and to determine the mediating effects of beliefs about medicines on the relationship in breast cancer patients with adjuvant endocrine therapy (AET) in China.

METHODS

A cross-sectional study was conducted on 202 breast cancer patients with AET from September 2017 to February 2019 in China. The Medication Adherence Report Scale (MARS-5), the Chinese version of the revised illness perception questionnaire for Breast Cancer (CIPQ-R-BC) and the Beliefs about Medicines Questionnaire (BMQ) were used.

RESULTS

The mean MARS-5 score of our participants was 23.72 (SD = 1.62), and 175 (86.6%) patients were adherent to medications. Moreover, medication adherence was negatively correlated with identity, environmental or immune factors, emotional representations, BMQ-specific concerns, BMQ-general overuse, and BMQ-general harm, as well as being positively correlated with coherence and the total BMQ scores. Furthermore, beliefs in the overuse about medicines functioned as mediators for the influencing effects of coherence and emotional representations on medication adherence.

CONCLUSION

Illness perception not only directly affected medication adherence, but also indirectly affected medication adherence through the beliefs about medicines. Necessary interventions that target beliefs in the overuse about medicines in breast cancer patients with AET with low levels of coherence or high levels of emotional representations could be provided to improve the level of their medication adherence.

Neuroticism and Conscientiousness Moderate the Effect of Oral Medication Beliefs on Adherence of People with Mental Illness during the Pandemic

Background. After the declaration of the pandemic status in several countries, the continuity of face-to-face visits in psychiatric facilities has been delayed or even interrupted to reduce viral spread. Little is known about the personality factors associated with medication beliefs and adherence amongst individuals with mental illness during the COVID-19 pandemic. This brief report describes a preliminary naturalistic longitudinal study that explored whether the Big Five personality traits prospectively moderate the effects of medication beliefs on changes in adherence during the pandemic for a group of outpatients with psychosis or bipolar disorder. Methods. Thirteen outpatients undergoing routine face-to-face follow-up assessments during the pandemic were included (41 observations overall) and completed the Revised Italian Version of the Ten-Item Personality Inventory, the Beliefs about Medicines Questionnaire, the Morisky Medication Adherence Scale—8-item and the Beck Depression Inventory—II. Results. Participants had stronger concerns about their psychiatric medications rather than beliefs about their necessity, and adherence to medications was generally low. Participants who had more necessity beliefs than concerns had better adherence to medications. People scoring higher in Conscientiousness and Neuroticism traits and more concerned about the medication side effects had poorer adherence. Conclusions. These preliminary data suggest the importance of a careful assessment of the adherence to medications amongst people with psychosis/bipolar disorder during the pandemic. Interventions aimed to improve adherence might focus on patients’ medication beliefs and their Conscientiousness and Neuroticism personality traits.

Understanding reasons and factors for participation and non-participation to a medication adherence program for patients with diabetic kidney disease in Switzerland: a mixed methods study

BACKGROUND

An interprofessional medication adherence intervention led by pharmacists, combining motivational interviews and feedback with electronic monitor (EM) drug assessment, was offered to all consecutive patients with diabetic kidney disease (DKD) (estimated glomerular filtration rate < 60 mL/min/1.73 m²) visiting their nephrologist or endocrinologist. Approximately 73% (202/275) of eligible patients declined to participate, and the factors and reasons for refusal were investigated.

METHODS

Sociodemographic and clinical data of included patients and those who refused were collected retrospectively for those who had previously signed the general consent form. Multivariate logistic regression analysis was performed to identify independent variables associated with non-participation. Patients who refused or accepted the adherence study were invited to participate in semi-structured interviews. Verbatim transcription, thematic analysis, and inductive coding were performed.

RESULTS

Patients who refused to participate were older (n = 123, mean age 67.7 years, SD:10.4) than those who accepted (n = 57, mean age 64.0 years, SD:10.0, p = 0.027) and the proportion of women was higher among them than among patients who accepted it (30.9% vs 12.3%, p = 0.007). The time from diabetes diagnosis was longer in patients who refused than in those who accepted (median 14.2 years IQR 6.9-22.7 vs. 8.6 years, IQR 4.5-15.9, p = 0.003). Factors associated with an increased risk of non-participation were female sex (OR 3.8, 95% CI 1.4-10.0, p = 0.007) and the time from diabetes diagnosis (OR 1.05, 95% CI 1.01-1.09, p = 0.019). The included patients who were interviewed (n = 14) found the interprofessional intervention useful to improve their medication management, support medication literacy, and motivation. Patients who refused to participate and who were interviewed (n = 16) explained no perceived need, did not agree to use EM, and perceived the study as a burden and shared that the study would have been beneficial if introduced earlier in their therapeutic journey. Other barriers emerged as difficult relationships with healthcare providers, lack of awareness of the pharmacist's role, and negative perception of clinical research.

CONCLUSIONS

Investigating the factors and reasons for participation and non-participation in a study helps tailor intervention designs to the needs of polypharmacy patients. Patients who refused the adherence intervention may not be aware of the benefits of medication management and medication literacy. There is an urgent need to advocate for interprofessional outpatient collaborations to support medication adherence in patients with DKD. Trial registration Clinicaltrials.gov NCT04190251_PANDIA IRIS.

The Associations among Gender, Age, eHealth Literacy, Beliefs about Medicines and Medication Adherence among Elementary and Secondary School Teachers

Background: A lack of health literacy may negatively impact patient adherence behavior in health care delivery, leading to a major threat to individual health and wellbeing and an increasing financial burden on national healthcare systems. Therefore, how to cultivate citizens’ health literacy, especially electronic health (eHealth) literacy that is closely related to the Internet, may be seen as a way to reduce the financial burden of the national healthcare systems, which is the responsibility of every citizen. However, previous studies on medication adherence have mostly been conducted with chronic disease patient samples rather than normal samples. Teachers are not only the main body of school health efforts, but also role models for students’ healthy behavior. Therefore, understanding differences in eHealth literacy beliefs among schoolteachers would be helpful for improving the existing health promoting programs and merit specific research. Aims: The present study identified the relationships among gender, age, electronic health (eHealth) literacy, beliefs about medicines, and medication adherence among elementary and secondary school teachers. Methods: A total of 485 teachers aged 22−51 years completed a pen-and-paper questionnaire. The instruments included an eHealth literacy scale, a belief about medicines scale and a medication adherence scale. Results: The results showed a significant difference between genders in necessity beliefs about medication (t = 2.00, p < 0.05), and a significant difference between ages in functional eHealth literacy (F = 3.18, p < 0.05) and in necessity beliefs about medication (Welch = 7.63, p < 0.01). Moreover, age (β = 0.09), functional eHealth literacy (β = 0.12), and necessity beliefs about medication (β = 0.11) positively predicted medication adherence, while concerns about medication (β = −0.23) negatively predicted medication adherence. Conclusions: The results showed that male teachers had stronger concerns about medication than female teachers. Teachers aged 42−51 years had lower functional eHealth literacy and stronger necessity beliefs about medication than teachers aged 22−31 years. In addition, teachers who were older, had higher functional eHealth literacy, had stronger necessity beliefs about medication, and had fewer concerns about medication tended to take their medications as prescribed. These findings revealed that helping teachers develop high eHealth literacy and positive beliefs about medicines is an effective strategy for improving medication adherence.

Features of successful interventions to improve adherence to inhaled corticosteroids in children with asthma: A narrative systematic review

INTRODUCTION

Nonadherence to inhaled corticosteroids (ICSs) in children with asthma leads to significant morbidity and mortality. Few adherence interventions have been effective and little is known about what contributes to intervention effectiveness. This systematic review summarizes the efficacy and the characteristics of effective interventions.

METHODS

Six databases were systematically searched on October 3, 2020 for randomized control trials measuring adherence to ICS in children with asthma. A narrative synthesis was conducted focusing on intervention efficacy and study reliability. Intervention content was coded based on the National Institute for Health and Care Excellence guidelines for medicines adherence (the Perceptions and Practicalities Approach, PAPA) and behavior change techniques (BCTs), to determine the effective aspects of the intervention.

RESULTS

Of 240 studies identified, 25 were eligible for inclusion. Thirteen of the 25 studies were categorized as being highly reliable. Nine of the 13 interventions were effective at increasing adherence and 6 of those met the criteria for a PAPA intervention. Techniques targeting perceptions and practicalities in successful interventions included rewards, reminders, feedback and monitoring of adherence, pharmacological support, instruction on how to take their ICS/adhere, and information about triggers for symptoms and nonadherence.

CONCLUSION

Adherence interventions in children with asthma have mixed effectiveness. Effective intervention studies were more frequently of higher quality, were tailored to individuals' perceptual and practical adherence barriers, and used multiple BCTs. However, due to the small number of included studies and varying study design quality, conclusions drawn here are preliminary. Future research is needed to test a PAPA-based intervention with a rigorous study design.

Perceptions and Practicalities Influencing Pre-exposure Prophylaxis Adherence Among Men Who Have Sex with Men in England

PrEP is highly effective for HIV prevention but requires adequate adherence. In this paper we use the perceptions and practicalities approach (PAPA) to identify factors that influenced PrEP adherence using qualitative data from the PROUD study. From February 2014 to January 2016, we interviewed 41 gay, bisexual and other men-who-have-sex-with-men and one trans woman who were enrolled in the study. We purposively recruited participants for interview based on trial arm allocation, adherence and sexual risk behaviours. The interviews were conducted in English, audio-recorded, transcribed, coded and analysed using framework analysis. Participants in general were highly motivated to use and adhere to PrEP, and this was linked to strong perceptions of personal necessity for PrEP as they felt at risk of HIV and viewed PrEP as highly effective. On the other hand, concerns about side effects and HIV resistance did inhibit PrEP initiation and adherence although this was uncommon. Practical factors such as daily routine, existing habitual pill-taking and pill storage impacted adherence. Drug and alcohol use rarely caused participants to miss doses. These findings indicate that using the principals of PAPA to unpick influencers of PrEP use, could help tailor adherence support in PrEP programmes.

Utility and acceptability of a brief type 2 diabetes visual animation: A mixed-methods feasibility study (Preprint)

Background

Visualizations of illness and treatment processes are promising interventions for changing unhelpful perceptions and improving health outcomes. However, these are yet to be tested in patients with type 2 diabetes mellitus (T2DM).

Objective

This study assesses the cross-cultural acceptability and potential effectiveness of a brief visual animation of T2DM at changing unhelpful illness and treatment perceptions and self-efficacy among patients and family members in 2 countries, New Zealand and Saudi Arabia. Health care professionals’ views on visualization are also explored.

Methods

A total of 52 participants (n=39, 75% patients and family members and n=13, 25% health care professionals) were shown a 7-minute T2DM visual animation. Patients and family members completed a questionnaire on illness and treatment perceptions and self-efficacy before and immediately after the intervention and completed semistructured interviews. Health care professionals completed written open-ended questions. Means and 95% CIs are reported to estimate potential effectiveness. Inductive thematic analysis was conducted on qualitative data.

Results

All participants rated the visual animation as acceptable and engaging. Four main themes were identified: animation-related factors, impact of the animation, animation as an effective format for delivering information, and management-related factors. Effect sizes (ranged from 0.10 to 0.56) suggested potential effectiveness for changing illness and treatment perceptions and self-efficacy among patients and family members.

Conclusions

Visualizations are acceptable and may improve the perceptions of patients’ with diabetes in a short time frame. This brief visual animation has the potential to improve current T2DM education. A subsequent randomized controlled trial to investigate the effects on illness and treatment perceptions, adherence, glycemic control, and unplanned hospital admission is being prepared.

Methylphenidate augmentation of escitalopram to enhance adherence to antidepressant treatment: a pilot randomized controlled trial

BACKGROUND

Adherence to treatment, i.e. the extent to which a patient's therapeutic engagement coincides with the prescribed treatment, is among the most important problems in mental health care. The current study investigated the influence of pairing an acute positive reinforcing dopaminergic/noradrenergic effect (methylphenidate, MPH) with a standard antidepressant on the rates of adherence to medication treatment. The primary objective of this study was to determine whether MPH + escitalopram resulted in higher rates of medication adherence relative to placebo + escitalopram.

METHODS

Twenty participants with moderate to severe depression were 1-1 randomized to either (1) 5 mg MPH + 10 mg escitalopram or (2) placebo + 10 mg escitalopram with the possibility for a dose increase at 4 weeks. A Bayesian analysis was conducted to evaluate the outcomes.

RESULTS

First, neither percent Pill count nor Medication Electronic Monitoring System adherence showed that MPH was superior to placebo. In fact, placebo showed slightly higher adherence rates on the primary (7.82% better than MPH) and secondary (7.07% better than MPH) outcomes. There was a less than 25% chance of MPH augmentation showing at least as good or better adherence than placebo. Second, both groups showed a significant effect of treatment on the QIDS-SR with a median effect of an 8.6-point score reduction. Third, neither subjective measures of adherence attitudes nor socio-demographic covariates had a significant influence on the primary or secondary outcome variables.

CONCLUSIONS

These data do not support the use of MPH to increase adherence to antidepressant medication in individuals with moderate to severe depression. CLINICALTRIALS.

GOV IDENTIFIER

NCT03388164 , registered on 01/02/2018.

Feasibility and Acceptability of a Digital Patient-Reported Outcome Tool in Routine Outpatient Diabetes Care: Mixed Methods Formative Pilot Study

Background

Improvements in the digital capabilities of health systems provide new opportunities for the integration of patient-reported outcome (PRO) solutions in routine care, which can facilitate the delivery of person-centered diabetes care. We undertook this study as part of our development of a new digital PRO diabetes questionnaire and clinical dialog support tool for use by people with diabetes and their health care professionals (HCPs) to improve person-centered diabetes care quality and outcomes.

Objective

This study evaluates the feasibility, acceptability, and perceived benefits and impacts of using a digital PRO diabetes tool, DiaProfil, in routine outpatient diabetes care.

Methods

Overall, 12 people with diabetes scheduled for routine medical diabetes visits at the outpatient clinic were recruited. Purposive sampling was used to optimize heterogeneity regarding age, gender, duration, type of diabetes, treatment modality, and disease severity. Participants filled out a PRO diabetes questionnaire 2 to 5 days before their visit. During the visit, HCPs used a digital PRO tool to review PRO data with the person with diabetes for collaborative care planning. Participants completed evaluation forms before and after the visit and were interviewed for 30 to 45 minutes after the visit. HCPs completed the evaluation questionnaires after each visit. All visits were audio-recorded and transcribed for analysis. Data were analyzed using quantitative, qualitative, and mixed methods analyses.

Results

People with diabetes found the PRO diabetes questionnaire to be relevant, acceptable, and feasible to complete from home. People with diabetes and HCPs found the digital PRO tool to be feasible and acceptable for use during the diabetes visit and would like to continue using it. HCPs were able to use the tool in a person-centered manner, as intended. For several people with diabetes, completion of the questionnaire facilitated positive reflection and better preparation for the visit. The use of the PRO tool primarily improved the quality of the dialog by improving the identification and focus on the issues most important to the person with diabetes. People with diabetes did not report any negative aspects of the PRO tool, whereas HCPs highlighted that it was demanding when the person with diabetes had many PRO issues that required attention within the predefined time allocated for a visit.

Conclusions

The Danish PRO diabetes questionnaire and the digital tool, DiaProfil, are feasible and acceptable solutions for routine diabetes visits, and this tool may generate important benefits related to advancement of person-centered care. Further research is now required to corroborate and expand these formative insights on a larger scale and in diverse health care settings. The results of this study are therefore being used to define research hypotheses and finalize real-world PRO evaluation tools for a forthcoming large-scale multisector implementation study in Denmark.

'Just keep taking them, keep hoping they'll work': A qualitative study of adhering to medications for multimorbidity

OBJECTIVE

Compared to single diseases, health psychology reflects many areas of medical research by affording relatively less attention to the experiences of people self-managing multiple co-occurring conditions and, in particular, the experience of managing the associated complex medication regimens. This study aimed to explore the experience of self-managing multimorbidity among older adults, with a focus on medication adherence.

DESIGN

A qualitative approach was taken, using individual semi-structured interviews.

METHODS

Sixteen people with complex multimorbidity aged 65 years or older were recruited through general practice to take part in semi-structured interviews. Data were analysed following guidelines for reflexive thematic analysis.

RESULTS

Two themes were generated, with each theme comprising three subthemes. Theme one represents the amplified burden arising from multimorbidity that leads to unique challenges for self-management, such as integrating multiple medications into daily life, accumulating new symptoms and treatments, and managing evolving medication regimens. Theme two represents pathways towards relief that reduce this burden and promote medication adherence, such as prioritising certain conditions and treatments, resigning to the need for multiple medications, and identifying and utilising adherence supports.

CONCLUSIONS

We identified factors relevant to medication adherence for older adults with multimorbidity that go beyond single-disease influences and account for the amplified experience of chronic disease that multimorbidity can produce for some people. While evidence of single-disease influences remains fundamental to tailoring behavioural interventions to individuals, the impact of multimorbidity on medication adherence should be accounted for in research and practice.

Medication Adherence: Expanding the Conceptual Framework

Interventions targeting traditional barriers to antihypertensive medication adherence have been developed and evaluated, with evidence of modest improvements in adherence. Translation of these interventions into population-level improvements in adherence and clinical outcomes among older adults remains suboptimal. From the Cohort Study of Medication Adherence among Older adults (CoSMO), we evaluated traditional barriers to antihypertensive medication adherence among older adults with established hypertension (N = 1,544; mean age = 76.2 years, 59.5% women, 27.9% Black, 24.1% and 38.9% low adherence by proportion of days covered (i.e., PDC <0.80) and the 4-item Krousel-Wood Medication Adherence Scale (i.e., K-Wood-MAS-4 ≥1), respectively), finding that they explained 6.4% and 14.8% of variance in pharmacy refill and self-reported adherence, respectively. Persistent low adherence rates, coupled with low explanatory power of traditional barriers, suggest that other factors warrant attention. Prior research has investigated explicit attitudes toward medications as a driver of adherence; the roles of implicit attitudes and time preferences (e.g., immediate vs. delayed gratification) as mechanisms underlying adherence behavior are emerging. Similarly, while associations of individual-level social determinants of health (SDOH) and medication adherence are well reported, there is growing evidence about structural SDOH and specific pathways of effect. Building on published conceptual models and recent evidence, we propose an expanded conceptual framework that incorporates implicit attitudes, time preferences, and structural SDOH, as emerging determinants that may explain additional variation in objectively and subjectively measured adherence. This model provides guidance for design, implementation, and assessment of interventions targeting sustained improvement in implementation medication adherence and clinical outcomes among older women and men with hypertension.

To Get Vaccinated, or Not to Get Vaccinated, That Is the Question: Illness Representations about COVID-19 and Perceptions about COVID-19 Vaccination as Predictors of COVID-19 Vaccination Willingness among Young Adults in The Netherlands

Mass vaccination is considered necessary to reduce the spread of COVID-19; however, vaccination willingness was found to be especially low among young adults. Therefore, based on the extended Common Sense Model, the unique effects and the interplay of illness representations about COVID-19 and perceptions about COVID-19 vaccination in explaining COVID-19 vaccination willingness was investigated using a cross-sectional design. An online survey measuring the relevant variables was filled in by 584 participants (69.9% female) between 18 and 34 years. Correlation analyses showed that all illness representation dimensions except from timeline and both dimensions of vaccination perceptions were related to vaccination willingness. The mediation analysis revealed that less personal control, more prevention control, more concerns about COVID-19 as well as more perceived necessity of and fewer concerns about the vaccination were directly related to higher vaccination willingness. Additionally, prevention control was indirectly related to higher vaccination willingness through stronger perceptions of necessity of the vaccination. The extended Common Sense Model proved to be useful in the context of illness prevention. Campaigns to improve vaccination rates should aim at increasing the perception that COVID-19 is preventable through vaccination and the personal need of the vaccination as well as at decreasing concerns about the vaccination.

Examining Adherence to Medication in Patients With Atrial Fibrillation: The Role of Medication Beliefs, Attitudes, and Depression

BACKGROUND/OBJECTIVES

This study examined whether beliefs about medicines, drug attitudes, and depression independently predicted anticoagulant and antiarrhythmic adherence (focusing on the implementation phase of nonadherence) in patients with atrial fibrillation (AF).

METHODS

This cross-sectional study was part of a larger longitudinal study. Patients with AF (N = 118) completed the Patient Health Questionnaire-8. The Beliefs about Medicines Questionnaire, Drug Attitude Inventory, and Morisky-Green-Levine Medication Adherence Scale (self-report adherence measure), related to anticoagulants and antiarrhythmics, were also completed. Correlation and multiple logistic regression analyses were conducted.

RESULTS

There were no significant differences in nonadherence to anticoagulants or antiarrhythmics. Greater concerns (r = 0.23, P = .01) were significantly, positively associated with anticoagulant nonadherence only. Depression and drug attitudes were not significantly associated with anticoagulant/antiarrhythmic adherence. Predictors reliably distinguished adherers and nonadherers to anticoagulant medication in the regression model, explaining 14% of the variance, but only concern beliefs (odds ratio, 1.20) made a significant independent contribution to prediction (χ = 11.40, P = .02, with df = 4). When entered independently into a regression model, concerns (odds ratio, 1.24) significantly explained 10.3% of the variance (χ = 7.97, P = .01, with df = 1). Regressions were not significant for antiarrhythmic medication (P = .30).

CONCLUSIONS

Specifying medication type is important when examining nonadherence in chronic conditions. Concerns about anticoagulants, rather than depression, were significantly associated with nonadherence to anticoagulants but not antiarrhythmics. Anticoagulant concerns should be targeted at AF clinics, with an aim to reduce nonadherence and potentially modifiable adverse outcomes such as stroke.

Barriers to medication adherence in a rural-urban dual economy: a multi-stakeholder qualitative study

Background

One of the most cost-effective treatments for secondary prevention of stroke and other non-communicable diseases is a long-term medication regimen. However, the complexities of medication adherence extend far beyond individual behavior change, particularly in low- and middle-income countries. The purpose of this study was to examine stakeholder perspectives on barriers to medication adherence for stroke patients in Beijing, China, identifying opportunities to improve care and policy in resource-constrained settings.

Methods

We conducted a qualitative, phenomenological analysis of data obtained from 36 individuals. Participants were patients; caregivers; healthcare providers; and representatives from industry and government, purposively selected to synthesize multiple perspectives on medication management and adherence for stroke secondary prevention in Beijing, China. Data was analyzed by thematic analysis across iterative coding cycles.

Results

Four major themes characterized barriers on medication adherence, across stakeholders and geographies: limitations driven by individual patient knowledge / attitudes; lack of patient-provider interaction time; lack of coordination across the stratified health system; and lack of affordability driven by high overall costs and limited insurance policies.

Conclusions

These barriers to medication management and adherence suggest opportunities for policy reform and local practice changes, particularly for multi-tiered health systems. Findings from this study in Beijing, China could be explored for applicability in other low- and middle-income countries with urban centers serving large geographic regions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06789-3.

Effects of a pharmaceutical care intervention on clinical outcomes and patient adherence in coronary heart disease: the MIMeRiC randomized controlled trial

Background

In the treatment of coronary heart disease, secondary prevention goals are still often unmet and poor adherence to prescribed drugs has been suggested as one of the reasons. We aimed to investigate whether pharmaceutical care by a pharmacist at the cardiology clinic trained in motivational interviewing improves clinical outcomes and patient adherence.

Methods

This was a prospective, randomized, controlled, outcomes-blinded trial designed to compare pharmaceutical care follow-up with standard care. After standard follow-up at the cardiology clinic, patients in the intervention group were seen by a clinical pharmacist two to five times as required over seven months. Pharmacists were trained to use motivational interviewing in the consultations and they tailored their support to each patient’s clinical needs and beliefs about medicines. The primary study end-point was the proportion of patients who reached the treatment goal for low-density lipoprotein cholesterol by 12 months after discharge. The key secondary outcome was patient adherence to lipid-lowering therapy at 15 months after discharge, and other secondary outcomes were the effects on patient adherence to other preventive drugs, systolic blood pressure, disease-specific quality of life, and healthcare use.

Results

316 patients were included. The proportion of patients who reached the target for low-density lipoprotein cholesterol were 37.0% in the intervention group and 44.2% in the control group (P = .263). More intervention than control patients were adherent to cholesterol-lowering drugs (88 vs 77%; P = .033) and aspirin (97 vs 91%; P = .036) but not to beta-blocking agents or renin–angiotensin–aldosterone system inhibitors.

Conclusions

Our intervention had no positive effects on risk factors for CHD, but it increased patient adherence. Further investigation of the intervention process is needed to explore the difference in results between patient adherence and medication effects. Longer follow-up of healthcare use and mortality will determine if the increased adherence per se eventually will have a meaningful effect on patient health.

Trial registration: ClinicalTrials.gov NCT02102503, 03/04/2014 retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-021-02178-0.

Effect of necessity-concern framework and polypharmacy on treatment adherence in psychiatric patients. Comparing an Argentinian with a Spanish sample

OBJECTIVE

We aimed to replicate a prior Spanish study of medication adherence where logistic regression models provided highly significant odds ratios (ORs) for three continuous scores: necessity, concern and the necessity-concern differential, and a dichotomous variable: skeptical attitude. Adherence ORs in the necessity-concern framework were very strong in patients taking five or six medications.

METHODS

The sample comprised consecutive adult psychiatric outpatients in Mendoza, Argentina. The necessity-concerns framework was assessed using a subscale of the Beliefs about Medicines Questionnaire. Adherence (yes/no) to prescribed psychiatric medications was assessed by the Sidorkiewicz adherence tool.

RESULTS

When compared with the Spanish sample, the Argentinian group (508 patients with 875 medications) was characterized by: (1) significantly stronger adherence ORs with the necessity-concern framework, (2) significantly lower number of medications per patient and percentage of patients with marked psychiatric polypharmacy (≥4 medications), (3) though a higher number of medications still was significantly associated with poor adherence.

CONCLUSIONS

The Argentinian sample replicated the previous finding that patient beliefs regarding necessity and concern were associated with poor adherence to prescribed medications. Polypharmacy had an additive role decreasing adherence in both samples. In both samples, when prescribed ≥4 psychiatric medications, patients reported adherence to only two-third of the medications.

Factors Associated with Medication Non-Adherence in Patients with Dyslipidemia

Lack of medication adherence among patients with dyslipidemia negatively affects health-related outcomes. This study aims to evaluate medication adherence; we also aim to investigate the predictors of non-adherence among patients with dyslipidemia in Jordan. Medication adherence was evaluated in a total of 228 dyslipidemia patients. The Beliefs about Medicines Questionnaire was also used to assess patients' beliefs about medications. The majority of the current study participants (73.2%) reported non-adherence to the prescribed medications. There were significant negative associations between medication adherence and concerns of prescription drug use (B = -0.41, p-value < 0.01), duration of dyslipidemia (B = -0.22, p-value < 0.01), and the number of medications (B = -0.64, p-value < 0.01). Positive associations were found between medication adherence and the necessity of prescription drug use (B = 0.43, p-value < 0.01), taking statin and fibrate (B = 2.04, p-value < 0.01), and moderate-intensity statin (B = 2.34, p-value < 0.01). As for patients' beliefs about medications, the item "My medicine to lower my cholesterol disrupted my life" had the highest mean (3.50 ± 0.99). This study revealed a low adherence rate to medication among patients with dyslipidemia. It also demonstrates modifiable factors such as beliefs regarding perceived risk, medication harms, treatment duration, and the number of medications associated with poor adherence in patients with dyslipidemia.

Analysing incompliant attitudes towards antibiotic prescription completion in the UK

Objectives

To analyse demographic, social and geographic predictors of incompliant attitudes towards prescription completion in the UK.

Methods

Two waves of the Eurobarometer survey (85.1 and 90.1) were analysed, with a final sample size of 2016. Using logistic regression, the best-fitting combination of a set of identified variables was specified. The regression output and the model-averaged importance of each variable were analysed.

Results

Compared with a median prevalence region, respondents in the Nomenclature of Territorial Units for Statistics (NUTS) 1 London (OR = 2.358, 95% CI = 1.100–5.398) and Scotland (OR = 2.418, 95% CI = 1.083–5.693) regions were most likely to report an incompliant attitude. Respondents who correctly answered questions about whether unnecessary use of antibiotics could make them ineffective in future (OR = 0.353, 95% CI = 0.230–0.544), whether antibiotics kill viruses (OR = 0.644, 95% CI = 0.450–0.919) and whether antibiotics treat colds (OR = 0.412, 95% CI = 0.287–0.591) were less likely to report incompliant attitudes. Conversely, respondents who correctly responded that antibiotics can cause side effects (OR = 1.419, 95% CI = 1.014–1.999) were more likely to report incompliant attitudes. There was some evidence of associations between political orientation and level of compliance. Uncooperative survey respondents (OR = 2.001, 95% CI = 1.108–3.526) were more likely to report incompliant attitudes.

Conclusions

Incompliant attitudes towards antibiotic prescription compliance in the UK are associated with a variety of factors, including regional geographic variation in attitudes. Knowledge about antibiotics can relate to good stewardship attitudes, but concerns over side effects are associated with poor attitudes. Further research should examine the underlying attitudes and beliefs that political orientation may be a marker for in the context of antibiotic stewardship. Survey samples reliant on self-selection are likely to be biased towards good stewardship.

Medication adherence in adult Chinese patients with asthma: role of illness perceptions and medication beliefs

OBJECTIVE

This study aimed to investigate the relationship between illness perceptions, medication beliefs, and self-reported adherence to inhaled corticosteroid (ICS) therapy in adult Chinese patients with asthma.

METHODS

A cross-sectional survey was conducted in the asthma outpatient clinic of Zhongshan Hospital, Fudan University (Shanghai, China) between October 2018 and September 2019. Illness perceptions, medication beliefs, and medication adherence were assessed using validated scales, specifically the Medication Adherence Report Scale for Asthma, Beliefs about Medicines Questionnaire -Specific, and the Brief Illness Perception Questionnaire. Spearman correlation and multiple logistic regression were used to determine the relationship among these factors. Results: A total of 234 patients were included in this study. Of this group, 99 (42.3%) participants were non-adherent to their ICS medication. Medication adherence correlated negatively with 'illness identity' (perceived symptom), 'emotional response' (perceived emotional effect) and concerns about medication (r=-0.16, -0.16 and -0.15, respectively, p < 0.05). After adjusting for illness perceptions, medication beliefs and demographics, beliefs about the necessity of medication (odds ratio [OR]: 1.14, 95% confidence interval [CI]: 1.01-1.30), and emotional response to the disease (OR: 0.89, 95% CI: 0.80-0.99) were significantly associated with medication adherence in patients with asthma.

CONCLUSION

Beliefs about the necessity of medication and emotional response to the illness have a strong influence on self-reported medication adherence in adult patients with asthma in China. Interventions targeted adherence improvement among patients with asthma may be tailored to the individual's baseline perceptions and medication beliefs, and focus on modifying inaccurate illness perceptions and medication beliefs as the main targets.

Exploring Why People With Type 2 Diabetes Do or Do Not Persist With Glucagon-Like Peptide-1 Receptor Agonist Therapy: A Qualitative Study

OBJECTIVE

Despite the demonstrated benefits of glucagon-like peptide 1 (GLP-1) receptor agonist therapy, adherence and persistence with this therapy is often challenging. The purpose of this study was to expand current understanding of patients' experiences, motivations, and challenges relevant to their persistence with GLP-1 receptor agonist therapy.

DESIGN AND METHODS

This noninterventional, cross-sectional, qualitative study used face-to-face interviews with 36 adults with type 2 diabetes who had been treated with at least one GLP-1 receptor agonist medication. Inclusion criteria were: ≥18 years of age, diagnosed with type 2 diabetes, and currently treated with a GLP-1 receptor agonist for ≥1 month at the time of screening ("continuers") or discontinued use of a GLP-1 receptor agonist ≤1 year of screening but with a total ≥1 month of treatment ("discontinuers"). Interviews were conducted using a semi-structured qualitative interview guide that included open-ended questions and probes to obtain both spontaneous and prompted input from participants about their current and past treatment experiences with GLP-1 receptor agonist therapy.

RESULTS

Among continuers (n = 16), the most commonly identified facilitators supporting the decision to continue were the observations of improved glucose control (50%) and weight loss (55%). Among discontinuers (n = 20), the most commonly identified challenges leading to treatment discontinuation were side effects (55%) and high cost (50%). Continuers were more likely than discontinuers to receive clinically relevant information from their health care team, including facts about GLP-1 receptor agonist medications, likely treatment benefits, the importance of gradual dose titration, and the need to adjust diet after initiation.

CONCLUSION

Although cost is a major obstacle to treatment continuation, it can only be resolved through changes in ongoing reimbursement coverage and policies. However, many other obstacles could potentially be addressed (e.g., reducing side effects with gradual dosage titration and setting appropriate expectations regarding efficacy) through more collaborative patient-clinician interactions before initiating therapy.

Changing Patient and Public Beliefs About Antimicrobials and Antimicrobial Resistance (AMR) Using a Brief Digital Intervention

Background: A key driver of antimicrobial resistance (AMR) is patient demand for unnecessary antibiotics, which is driven by patients’ beliefs about antibiotics and AMR. Few interventions have targeted beliefs to reduce inappropriate demand.

Objective: To examine whether a brief, online algorithm-based intervention can change beliefs that may lead to inappropriate antibiotic demand (i.e. perceptions of antibiotic necessity and lack of concern about antibiotic harm).

Design: Pre- and post-intervention study.

Participants: Participants were 18 years or older, and residing in the United Kingdom, who self-selected to participate via Amazon mTurk, an online survey plaform, and via research networks.

Intervention: Participants were presented with a hypothetical situation of cold and flu symptoms, then exposed to the intervention. The online intervention comprised: 1) a profiling tool identifying individual beliefs (antibiotic necessity, concerns, and knowledge) driving inappropriate antibiotic demand; 2) messages designed to change beliefs and knowledge (i.e. reduce antibiotic necessity, and increase antibiotic concerns and knowledge), and 3) an algorithm linking specific messages to specific beliefs and knowledge.

Main measures: The profiling tool was repeated immediately after the intervention and compared with baseline scores to assess change in beliefs. A paired samples t-test was used to determine intervention effect.

Key Results: A total of 100 respondents completed the study. A significant change in beliefs relating to inappropriate demand was observed after the intervention, with a reduction in beliefs about antibiotic necessity (t = 7.254; p < 0.0001), an increase in antibiotic concerns (t = −7.214; p < 0.0001), and increases in antibiotic and AMR knowledge (t = −4.651; p < 0.0001).

Conclusion: This study is the first to demonstrate that patient beliefs about antibiotics and AMR associated with inappropriate demand can be changed by a brief, tailored online intervention. This has implications for the design of future interventions to reduce unnecessary antimicrobial use.

Impact of Beliefs about Medicines on the Level of Intentional Non-Adherence to the Recommendations of Elderly Patients with Hypertension

Background: Non-adherence to pharmaceutical treatment is one of the most common causes of uncontrolled hypertension. Non-adherence may be intentional or unintentional. In the case of intentional non-adherence, it is crucial to understand the reasons behind it. The literature increasingly addresses the issue of beliefs and concerns about medication, but studies on this subject performed in a Polish population of hypertensive patients are still lacking. The aim of the study was to assess the level of intentional non-adherence among patients with hypertension, and to determine the relationship between beliefs about medication and the level of intentional non-adherence to treatment in elderly patients with hypertension. Material and methods: The study included 300 patients (106 of whom were male, mean age (SD) 71.71 (8.12) years) with hypertension, treated at a hypertension clinic. The following instruments were used: the Intentional Non-Adherence Scale (INAS) for evaluating intentional non-adherence, and the Beliefs about Medicines Questionnaire (BMQ) for evaluating patients’ beliefs and opinions regarding medication. Socio-demographic and clinical data were obtained from patients’ medical records. Results: The mean (SD) INAS score in the study was 47.28 (19.12). Patients were most concerned about the harm caused by medication, and least concerned about the necessity to take medication (mean score per item 3.49 vs. 2.14). Correlation analysis demonstrated weak correlations between BMQ and INAS: higher scores for necessity were associated with more intentional non-adherence (r = 0.174, p = 0.003), while higher scores for overuse, harm, and concerns were associated with less intentional non-adherence (respectively: r = −0.253, p < 0.001 vs. r = −0.336, p < 0.001 vs. r = −0.351, p < 0.001). In multiple-factor analysis, factors increasing the level of intentional non-adherence were elderly age (β = −0.352, p = 0.009), multimorbidity (β = −2.374, p = 0.035), and a higher BMQ concerns score (β = −1.376, p < 0.001), while being single was an independent predictor decreasing intentional non-adherence (β = 5.646, p = 0.013). Conclusions: The overall level of intentional non-adherence among patients with hypertension is moderate, but approximately one third of patients with hypertension demonstrate a high level of non-adherence. Independent determinants of intentional non-adherence include concerns, elderly age, multimorbidity, and being single.

Association Between Regulatory Emotional Self-Efficacy and Immunosuppressive Medication Adherence in Renal Transplant Recipients:Does Medication Belief Act as a Mediator?

Background: Few studies have investigated the association between regulatory emotional self-efficacy (RESE) and immunosuppressive medication adherence or the mechanisms underlying this relationship. Considering that previous evidence of immunosuppressive medication adherence depended on the level of immunosuppressive medication beliefs, a model of multiple mediation was tested in which immunosuppressive medication beliefs acted as mediators of the relationship between RESE and immunosuppressive medication adherence. Methods: A retrospective cross-sectional study was performed in 293 renal transplant patients during outpatient follow-ups from November 2019 to February 2020 in China. All participants completed a general demographic questionnaire, the Chinese version of the RESE, the Beliefs about Medication Questionnaire, and the Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS). Spearson correlation analysis was carried out to identify the correlation between RESE and immunosuppressive medication adherence. Binary logistic regression analysis was performed to confirm factors associated with immunosuppressive medication adherence in renal transplant recipients. Mediating effect analysis was used to explore the internal interaction between RESE and immunosuppressive medication adherence. Results: A total of 293 renal transplant patients were recruited, including 111 women and 182 men with a mean age of 42.5 years (SD = 10.0). A total of 23.21% of patients exhibited immunosuppressive medication none-adherence behavior, and 12.97% reported altering the prescribed amount of immunosuppressive medication without physician permission, which was most popular behavior among patients. The mean RESE score was 45.78 ± 6.12; the positive (POS) score was the highest, and the anger-irritation (ANG) score was the lowest. The correlation analysis results showed that RESE (r = -0.642, p < 0.01) and immunosuppressive medication beliefs (r = -0.534, p < 0.01) were significantly associated with immunosuppressive medication adherence. Binary logistic regression analysis indicated that marital status, fertility status, rejection, immunosuppressive medication beliefs, and RESE were found to be independent predictors of immunosuppressive medication adherence [R 2 = 0.803, p < 0.05]. The results of the mediating effect analysis showed that immunosuppressive medication necessity had a partial mediating effect, RESE directly and indirectly affected immunosuppressive medication adherence via immunosuppressive medication necessity, and immunosuppressive medication concerns were not a mediator between RESE and immunosuppressive medication adherence. Conclusion: The levels of immunosuppressive medication adherence in renal transplant patients need to be improved in China. Marital status, fertility status, rejection, immunosuppressive medication beliefs, and RESE were major factors affecting immunosuppressive medication adherence. RESE could affect immunosuppressive medication adherence indirectly through immunosuppressive medication necessity.

Adherence to subcutaneous biological therapies in patients with inflammatory rheumatic diseases and inflammatory bowel disease: a systematic review

Aim: To assess adherence to subcutaneous biologicals in adults with inflammatory rheumatic diseases or inflammatory bowel disease and evaluate factors possibly associated with adherence. Materials & methods: Systematic searches were conducted of main databases from January 2000 to June 2019. Results: 41 articles (32 full papers and nine abstracts) were included in the review. Among studies which used a medication possession ratio threshold of ≥80% as the end point, adherence varied from 28.8 to 89.4%. Possible predictors of adherence were older age, professional or family member support, belief in medication necessity, lower concerns about medication and monthly versus weekly administration. Conclusion: Considerable variability in adherence rates across published studies reflects study heterogeneity and the absence of a 'gold standard' to measure adherence.

Beliefs about medicines and adherence in women with breast cancer on adjuvant endocrine therapy

The Beliefs about Medicines Questionnaire (BMQ) and Adherence Starts with Knowledge (ASK-12) questionnaire were originally developed and validated in Western populations to assess beliefs and barriers to medication adherence. The study aim is to validate the BMQ and ASK-12 questionnaire for use in a Singapore population with early stage breast cancer. English-speaking women on adjuvant endocrine therapy (n = 157) were recruited. The BMQ-Specific showed good internal consistency with structural validity. The internal consistency of BMQ-General and ASK-12 Behaviour scale improved with the new factor structure obtained from exploratory factor analysis. Further studies are needed to confirm these factor structures.

The Association between Medication Experiences and Beliefs and Low Medication Adherence in Patients with Chronic Disease from Two Different Societies: The USA and the Sultanate of Oman

This cross-sectional study aimed to describe the association between medication experiences and beliefs and self-reported medication adherence in patients with chronic diseases in two different samples from two different societies: the USA and the Sultanate of Oman. The Morisky Medication Adherence Score (MMAS-8) questionnaire was used to measure medication adherence. Three items (statements) were used for measuring medication experiences and beliefs variable on a four-point Likert scale adapted from the 2015 National Consumer Survey of the Medication Experience and Pharmacists’ Role (NCSME&PR). In the U.S., quantitative secondary data analysis of 13,731 participants was conducted using the 2015 NCSME&PR, a self-administered online survey coordinated by Qualtrics Panels between 28 April 2015 and 22 June 2015. The same variables were translated into Arabic, with studies conducted at the Royal Court Medical Center in Oman, and data from 714 participants were collected between 16 June 2019 and 16 August 2019. Data were analyzed using IMB/SPSS version 24.0 software. Chi-square analysis and descriptive statistics were used. The results showed that the low adherence rates for medication (MMAS-8 < 6) were 56% and 52% in Omani and U.S. groups, respectively. Approximately 90% of the U.S. and Omani participants believed that “medicines are a life-saver”; however, medication adherence was higher in Oman (30%) than in the United States (9%) for these participants. In total, 60% of the U.S. and 29% of Omani participants believed that “medicines are a burden”; however, about 60–65% of participants in both countries were in the low medication adherence group. Additionally, 63% of the U.S. and 83% of the Omani participants disagreed that “medicines do more harm than good”; however, medication adherence in the U.S. (15%) was higher than in Oman (8%). In conclusion, a decrease in low medication adherence was observed with positive medication experiences and beliefs. However, the impacts of medication experiences and beliefs on low medication adherence rates were different from one population to another. The “medication burden” statement resulted in the highest percentage of difference in terms of low medication adherence rates between those who agree and those who disagree in the U.S. group (20%), whereas the “medicines are a life-saver” statement resulted in a greater difference in the Omani group (30%). Proper communication between patients and healthcare providers based on the patient’s medication experiences and beliefs will substantially improve medication adherence.

Impact of a Patient Support Program on Patient Beliefs About Neovascular Age-Related Macular Degeneration and Persistence to Anti-Vascular Endothelial Growth Factor Therapy

PURPOSE

This study aimed to compare persistence between patients prescribed intravitreal aflibercept (IVT-AFL) for neovascular age-related macular degeneration (nAMD) in Australia enrolled on a patient support program (PSP) with that of a sample of patients from the Australian Pharmaceutical Benefits Scheme (PBS) dataset (10% PBS sample); explore predictors of persistence; describe changes in patient beliefs over the course of their enrollment in a PSP for patients treated with IVT-AFL for nAMD; and assess patient satisfaction.

PARTICIPANTS AND METHODS

Participants prescribed IVT-AFL for the treatment of nAMD were invited to participate in the PSP. The PSP provided tailored support to patients through provision of a welcome pack, structured telephone calls, and information booklets. Persistence was defined in the PSP as the time from the start date in the program, until discontinuation from the program; and as the time from initial prescription until 6-months after the date of last prescription in the 10% PBS set. Persistence on the program and risk of discontinuation were modeled using Kaplan-Meier methods and Cox proportional hazards. In addition, persistence was compared between patients on the PSP and a 10% PBS sample of patients prescribed IVT-AFL for nAMD.

RESULTS

Persistence on treatment at 24 months was significantly higher in patients enrolled on the PSP compared to the PBS cohort (88% vs 64%, p<0.05). The risk of discontinuation in patients enrolled on the PSP was higher in patients identified at screening as "high-risk", those who were younger, or those with significant distance to travel for treatment. During the PSP, patients reported significant increase in their belief that they had control over their condition (6.1 ± 3.5 to 6.8 ± 3.7; p=0.0034) and a reduction in concerns about treatment. Satisfaction with the PSP was high.

CONCLUSION

Patients provided with access to a PSP showed better persistence on treatment and improved beliefs about nAMD disease and its treatment compared to those in the PBS sample. Improved persistence rates may translate into better outcomes for the patient and the healthcare system, however, further research is required to determine which elements of the program are most beneficial, particularly to those at high risk of discontinuation.

Common sense model of self-regulation for understanding adherence and quality of life in type 2 diabetes with structural equation modeling

OBJECTIVES

The objective of the present study was to test the Common Sense Model of self-regulation (CSM) for its relevance for improving adherence and quality of life in type 2 diabetes.

METHODS

A sample of 253 patients with type 2 diabetes was recruited. They completed questionnaires about their perceptions regarding diabetes, coping strategies, therapeutic adherence and quality of life. Their HbA1c levels were also collected. Structural equation modeling (SEM) was used to check the adequacy of our theoretical model (CSM) with the patient data.

RESULTS

The final model indicated that perceptions were directly and indirectly related to health outcomes through coping strategies and adequately matched the data (χ² / df = 561/ 220 = 2.55; RMSEA = 0.08; PCFI = 0.66; PGFI = 0.70). Moreover, the model appeared to be identical for both types of treatment (oral and injectable).

CONCLUSIONS

Illness perceptions and coping strategies, or, more specifically, how patients accept disease and think they are able to manage it, significantly affect therapeutic adherence and quality of life in type 2 diabetes.

PRACTICE IMPLICATIONS

These results pave the way for developing psychological treatments aimed at improving patient acceptance and internal resources (e.g. use of autobiographical memory, Acceptance and Commitment Therapy).

2020 EULAR points to consider for the prevention, screening, assessment and management of non-adherence to treatment in people with rheumatic and musculoskeletal diseases for use in clinical practice

BACKGROUND

Non-adherence to treatment could preclude reaching an optimal outcome. Thirty to 80% of patients with rheumatic and musculoskeletal diseases (RMDs) do not adhere to the agreed treatment.

OBJECTIVES

The objective was to establish points to consider (PtCs) for the prevention, screening, assessment and management of non-adherence to (non-)pharmacological treatments in people with RMDs.

METHODS

An EULAR task force (TF) was established, and the EULAR standardised operating procedures for the development of PtCs were followed. The TF included healthcare providers (HCPs), comprising rheumatologists, nurses, pharmacists, psychologists, physiotherapists, occupational therapists and patient-representatives from 12 European countries. A review of systematic reviews was conducted in advance to support the TF in formulating the PtCs. The level of agreement among the TF was established by anonymous online voting.

RESULTS

Four overarching principles and nine PtCs were formulated. The PtCs reflect the phases of action on non-adherence. HCPs should assess and discuss adherence with patients on a regular basis and support patients to treatment adherence. As adherence is an agreed behaviour, the treatment has to be tailored to the patients' needs. The level of agreement ranged from 9.5 to 9.9 out of 10.

CONCLUSIONS

These PtCs can help HCPs to support people with RMDs to be more adherent to the agreed treatment plan. The basic scheme being prevent non-adherence by bonding with the patient and building trust, overcoming structural barriers, assessing in a blame-free environment and tailoring the solution to the problem.

The 'Necessity-Concerns Framework' as a means of understanding non-adherence by applying polynomial regression in three chronic conditions

OBJECTIVE

The 'Necessity-Concerns Framework' is an important framework which can support healthcare professionals in targeting patients' medication beliefs and decisions on adherence. Our aim was to determine how the interdependence of 'necessity' and 'concerns' beliefs for medication adherence compares across three chronic conditions.

METHODS

Patients diagnosed with asthma, cardiovascular conditions or diabetes attending out-patient clinics completed a self-administered questionnaire. The questionnaire gathered information regarding demographics, medication adherence using the 'Tool for Adherence Behaviour Screening', presence of unused medication in households and medication beliefs using the 'Beliefs about Medicines Questionnaire-Specific'. Polynomial regression was applied to determine the multidimensional interdependence of 'necessity' and 'concerns' beliefs for adherence. P-values ≤ 0.05 were taken to be significant.

RESULTS

Confirmatory polynomial regression rejected the differential score model in all three groups. For each condition, exploratory polynomial regression found that linear terms indicated the best fitting model for predicting adherence. In all groups, adherence increased as necessity beliefs increased and concerns decreased. Patients suffering from cardiovascular conditions and diabetes with low necessity and low concerns beliefs reported higher medication adherence compared to those with high necessity and high concerns beliefs.

DISCUSSION

Alleviating patients' concerns can enhance medication adherence and potentially curb the issue of medication wastage.

Tailored Interventions to Improve Medication Adherence for Cardiovascular Diseases

Over the past half-century, medical research on cardiovascular disease (CVD) has achieved a great deal; however, medication adherence is unsatisfactory. Nearly 50% of patients do not follow prescriptions when taking medications, which limits the ability to maximize their therapeutic effects and results in adverse clinical outcomes and high healthcare costs. Furthermore, the effects of medication adherence interventions are disappointing, and tailored interventions have been proposed as an appropriate way to improve medication adherence. To rethink and reconstruct methods of improving medication adherence for CVD, the literature on tailored interventions for medication adherence focusing on CVD within the last 5 years is retrieved and reviewed. Focusing on identifying nonadherent patients, detecting barriers to medication adherence, delivering clinical interventions, and constructing theories, this article reviews the present state of tailored interventions for medication adherence in CVD and also rethinks the present difficulties and suggests avenues for future development.

Medication Beliefs and Adherence to Antiseizure Medications

Introduction

The primary objective of our study was to determine the nature of medication beliefs and their association with adherence to antiseizure medications (ASMs) among elderly epilepsy patients. Our secondary objective was to enhance the psychometric properties and factor structure parameters of the Beliefs about Medications Questionnaire (BMQ) adapted to epilepsy and affected aged subjects.

Methods

A population-based survey was performed in which older adults (≥60 years of age) were invited for a free face-to-face consultation with the specialists as well as for the collection of necessary data. The eligible subjects were those who are affected with epilepsy and having epileptic seizures of any type. In addition, the participants were required to be of any sex, currently under treatment with ASMs, resident of Tehran, and able and interested to participate independently. All were carefully examined with a reasonably detailed case-history examination. Two Persian questionnaires used were Medication Adherence Rating Scale (MARS) and BMQ. Those with a MARS score of ≥6 were considered as adherent to ASMs. All data were described in descriptive terms. We did a group comparison of means and proportions for all possible independent variables between adherents and nonadherents. Then, we did a hierarchical multiple linear regression. For this, independent variables were categorized into three different blocks: (a) sociodemographic block (Block-1), (b) treatment side-effect block (Block-2), and (c) BMQ block that included ten items of the BMQ scale (Block-3). We also did a forward step-wise linear regression by beginning with an empty model. We also estimated the psychometric properties and factor structure parameters of BMQ and its two subdomains.

Results

Of all (N = 123, mean age: 63.3 years, 74.0% males), 78.0% were adherent (mean score: 7.0, 95% CI 6.2–7.8) to ASMs. The MARS scores were not different between males and females. The mean BMQ score was 23.4 (95% CI 19.8–27.0) with the mean need score of 20.0 (95% CI 18.0–22.0) and mean concern score of 16.5 (95% CI 14.3–18.7). A positive need-concern differential was 20.4%. Upon hierarchical regression, the adjusted R² for Block-1 was 33.8%, and it was 53.8% for Block-2 and 92.2% for Block-3. Upon forward step-wise linear regression, we found that “ASMs disrupt my life” (ß −1.9, ES = −1.1, p=0.008) as the only belief associated with adherence. The alpha coefficient of BMQ was 0.81.

Conclusions

Ours is one of the very few studies that evaluated medication beliefs and their association with adherence to ASMs among elderly epilepsy patients in a non-western context. In our context, medication beliefs are likely to have an independent role in effecting adherence to ASMs, particularly the concern that “ASMs disrupt life.” Treating physicians should cultivate good conscience about ASMs and evaluate the patient's medication beliefs early-on to identify those who might be at the risk of becoming nonadherent.

[Compliance of dog and cat owners in preventive health care]

Regular preventive health care is an essential part of our pets' health and quality of life. Preventive healthcare appointments can result in the prevention of disease development as well as lead to the detection and subsequent treatment of existing health problems at an early stage. In order to achieve optimal health care, the owners' compliance is of most importance in addition to the veterinary advice. However, dog and cat owners often seem to be unaware of the necessity for preventive health care appointments, often as a result of poor communication by the veterinarian. Educational conversations concerning the necessity of regular preventive health examinations are therefore essential. Communication is one of the key factors in building an owner-veterinarian relationship. Veterinarians are advised to invest sufficient time for communication, be aware of their verbal and non-verbal statements, and enable the owner to participate in treatment decisions. Older animals are presented less often for preventive health care appointments than younger animals, although the prevalence of age-related and chronic diseases increases with age. Owners should therefore be informed on the fact that early detection and treatment of these diseases increases their animals' health and survival. Cats are seen less frequently in preventive health care than dogs; many owners are not aware of the characteristics of cats tending to hide signs of disease. Another reason lies in the fact that many cats are stressed by being captured and transported in addition to the visit in the veterinary practice itself. Veterinarians therefore should educate cat owners concerning stress-reducing transportation measures and design their practice in a more cat-friendly fashion. Compliance can also be influenced positively by appropriate practice management, such as offering monthly instalment payments, establishing annual preventive care plans, as well as regular re-scheduling strategies. In addition to enhancing the animals' health, this can also result in increased owner satisfaction.

Beliefs and attitudes toward endocrine therapy in patients with hormone receptor-positive breast cancer

Patients' beliefs about medications are important predictors of medication adherence; however, the relationship between patient beliefs and adjuvant endocrine therapy (AET) adherence in patients with breast cancer remains unclear. In this study, we aimed to determine the association between patient beliefs and adherence to AET. Self-reported questionnaires covering necessity beliefs (NB), concerns beliefs (CB), and adherence were completed by 210 Korean patients with breast cancer. The rate of nonadherence was determined by calculating necessity-concern (N-C) differentials and attitudinal subgroup analysis. Multivariate logistic regression analysis was performed to determine the independent impact of patient beliefs on nonadherence. Nonadherence (Morisky Medication Adherence Scale < 8) was reported in 74.3% (n = 156) of patients and predicted by a negative balance regarding AET [odds ratio (OR) = 0.89; 95% confidence interval (CI): 0.83-0.96] and strong concerns about AET such as those in the Ambivalent (OR = 5.41; 95% CI: 1.84-15.92) and Skeptical (OR = 3.48, 95% CI: 1.14-10.65) subgroups. Patient beliefs are significantly associated with adherence to AET in Korean patients with breast cancer. NB, CB, and N-C differentials may be useful intervention targets to improve medication adherence.

The Consequences of General Medication Beliefs Measured by the Beliefs about Medicine Questionnaire on Medication Adherence: A Systematic Review

(1) Background: Medication adherence is a key determinant of patient health outcomes in chronic illnesses. However, adherence to long-term therapy remains poor. General beliefs about medicine are considered factors influencing medication adherence. It is essential to address the gap in the literature regarding understanding the impact of general beliefs about medicine on medication adherence to promote adherence in chronic illnesses. (2) Methods: PubMed, CINHAL, and EMBASE databases were searched. Studies were included if they examined medication beliefs using the Beliefs about Medicine Questionnaire in one of four chronic illnesses: hypertension, diabetes, chronic obstructive pulmonary disease, and/or asthma. (3) Results: From 1799 articles obtained by the search, only 11 met the inclusion criteria. Hypertension and diabetes represented 91% of included studies, while asthma represented 9%. Higher medication adherence was associated with negative general medication beliefs; 65% of the included studies found a negative association between harm beliefs and adherence, while 30% of studies found a negative association with overuse beliefs. (4) Conclusions: This review evaluated the impact of harm and overuse beliefs about medicines on medication adherence, highlighting the gap in literature regarding the impact of harm and overuse beliefs on adherence. Further research is needed to fully identify the association between general beliefs and medication adherence in people with different cultural backgrounds, and to explore these beliefs in patients diagnosed with chronic illnesses, particularly asthma and chronic obstructive pulmonary disease (COPD). Healthcare providers need to be aware of the impact of patients’ cultural backgrounds on general medication beliefs and adherence.

Medication non-adherence in patients with type 2 diabetes mellitus with full access to medicines

Purpose

The pharmacological treatment for Type 2 diabetes mellitus (T2DM) is continuous and adherence to medication is critical for disease control. Restricted access to medicines is one of the most important barriers to adherence to T2DM treatment. This study aimed to evaluate other factors for medication non-adherence by studying patients with full access to oral hypoglycemic agents.

Methods

Cross-sectional study with 300 patients receiving their medication without costs from a referral center for diabetes care in Crato, Ceará (Brazil). Participants were recruited from January to December 2017. Information was obtained by self-applied questionnaires, and the drugs used were confirmed in the prescription. Adherence to medication was determined by the Morisky Medication Adherence Scale (MMAS-4). Patient perceptions of drugs were assessed by the Beliefs about Medicines Questionnaire (BMQ).

Results

Only 22.7% of participants met the criterion of high adherence to medication. The most frequent characteristics in the low adherence group were married; hypertension; no regular physical activity; therapy based on the combination of two or more oral antidiabetic agents without insulin; low score in the BMQ necessity scale. Necessity score in BMQ increased with age and the number of medications used and decreased if the patient had family members with the same disease and had children.

Conclusions

Full access to medicines did not assure high adherence to pharmacological treatment of type 2 diabetes mellitus. Distinctive factors to medication non-adherence may be found and specific barriers should be considered when planning actions for improving adherence in such populations.

Physician-patient interaction and medication adherence in lupus nephritis

OBJECTIVE

The quality of physician-patient interaction can have a significant impact on medication adherence. Little is known about this relationship in patients with lupus nephritis.

METHODS

A cross-sectional, quantitative study. Data collected included demographics, current medication, systemic lupus erythematosus disease activity index, medication adherence, beliefs about medicines, shared decision-making, patient-doctor depth of relationship, patient-doctor quality of relationship, interpersonal trust in a physician and illness perceptions.

RESULTS

Ninety-eight patients with lupus nephritis completed the questionnaires. Logistic regression indicated that medication adherence was significantly predicted by (a) interpersonal trust in a physician (B = 0.85, Wald 3.94, 95% confidence interval (CI) 1.01, 5.44; P = 0.05); (b) timeline cyclical (B = -0.89, Wald 4.95, 95% CI 0.19, 0.90; P < 0.05) and beliefs about the necessity of medicines (B = 0.75, Wald 4.14, 95% CI 1.03, 4.38; P < 0.05). Mediation analysis showed that beliefs about the necessity of medicines significantly mediated the relationship between trust and medication adherence when adjusted for age (B = 0.48, 95% CI 0.06, 1.08; P < 0.01). A further mediation analysis showed that patient-doctor depth of relationship (B = 0.05, 95% CI 0.01, 0.09; P < 0.001), shared decision-making (B = 0.07, 95% CI 0.01, 0.13; P < 0.001) and patient-doctor quality of relationship (B = 0.08, 95% CI 0.01, 0.16; P < 0.001) significantly mediated the relationship between illness coherence and interpersonal trust in a physician.

CONCLUSION

The findings highlighted two key elements: (a) the importance of trust in relation to medication adherence; and (b) a good understanding of patients' illness is linked to a better relationship with their doctor and greater participation in shared decision-making which is associated with increased trust. Tailored psycho-educational interventions could contribute to improving the patient-doctor relationship quality, trust and increased shared decision-making, which, in turn, might improve medication adherence in patients with lupus nephritis.

Community pharmacy-based study of adherence to non-vitamin K antagonist oral anticoagulants

Objective

This study aimed to assess implementation adherence (how well the patient’s actual intake matches the prescribed dosing regimen) to non-vitamin K antagonist oral anticoagulants (NOACs) and to explore experiences with and beliefs about NOACs in a real-world sample of long-term NOAC users.

Methods

A cross-sectional observational study was conducted in home-dwelling adults who started taking a NOAC at least 1 year prior to inclusion. Pharmacy dispensing data were used to calculate the Medication Possession Ratio (MPR). Patients were recruited in 158 community pharmacies in Flanders, Belgium. They completed a questionnaire collecting basic characteristics and exploring self-reported adherence to NOACs (using the Medication Adherence Report Scale, MARS) and experiences with and beliefs about NOACs (using the Beliefs about Medicines Questionnaire, BMQ).

Results

A total of 766 patients (mean age 76.2±8.8 years, median CHA2DS2-VASc score 4 (IQR=3–4)) were included. The majority (93.5%) used NOAC for stroke prevention in atrial fibrillation. The median MPR was 95.2% (IQR=87.8–99.7) which corresponds with half of the study population not taking their NOAC on at least 17 cumulative days per year. Almost 21% of participants reported non-adherence on the MARS (score <25), with unintentional non-adherence (forgetfulness) most frequently reported (15.4%). Although two-thirds of NOAC users indicated to experience adverse drug reactions, the BMQ demonstrated a positive attitude towards NOAC therapy, where necessity beliefs outweigh the concerns.

Conclusions

Our data indicate that long-term NOAC users have high implementation adherence and a positive attitude towards NOAC therapy. However, taking into account patients’ thromboembolic risk and NOACs’ short half-lives, further optimisation of NOAC use seems warranted in this population.

The association between frailty and medication adherence among community-dwelling older adults with chronic diseases: Medication beliefs acting as mediators

OBJECTIVE

To explore the association between frailty and medication adherence by modeling medication beliefs (i.e., necessity and concerns) as mediators among community-dwelling older patients.

METHODS

This cross-sectional study was conducted among 780 Chinese older patients. Frailty, medication adherence and medication beliefs were assessed using the Comprehensive Frailty Assessment Instrument (CFAI), the 4-item Morisky Medication Adherence Scale (MMAS-4) and the Beliefs about Medicines Questionnaire-Specific (BMQ-Specific), respectively. The PROCESS SPSS Macro version 2.16.3, model 4 was used to test the significance of the indirect effects.

RESULTS

Frailty was associated with high medication necessity (β = 0.091, p = 0.011) and high medication concerns (β = 0.297, p < 0.001). Medication adherence was positively associated with medication necessity (β = 0.129, p = 0.001), and negatively associated with medication concerns (β = -0.203, p < 0.001). Medication necessity and medication concerns attenuated the total effect of frailty on medication adherence by -13.6% and 70.3%, respectively CONCLUSION: High medication concerns among frail older patients inhibit their medication adherence, which cannot be offset by the positive effect of their high medication necessity on medication adherence.

PRACTICE IMPLICATIONS

Interventions should target medication beliefs among frail older patients, particularly medication concerns, to efficiently improve their medication adherence.

Beliefs about immunosuppressant medication and correlates in a German kidney transplant population

OBJECTIVE

A common reason for organ rejection after transplantation is the lack of adherence regarding immunosuppressive medication (ISM). A variety of different aspects can promote non-adherent behavior, including the relationship between perceived benefits and concerns regarding ISM ("necessity-concerns-framework"). Little is known about the variables associated with this framework.

METHODS

As part of this cross-sectional study, 570 patients after kidney transplantation who participated in a structured multimodal follow-up program (KTx360°) were examined in two transplant centers in Lower Saxony. We used the Beliefs about Medicines Questionnaire (BMQ) to evaluate the patients' believes and concerns regarding their ISM.

RESULTS

The mean age of the participants was 51.9 (SD 14.17) years, 58.4% were men, and 25.8% had ≥12 years of school attendance. The mean time since transplantation was 65.9 months. In patients undergoing kidney transplantation, the perceived benefit of ISM mostly exceeded the concerns. We found an association between lower perceived benefits and greater concerns and lower adherence. Also, a higher perceived necessity was significantly associated with higher age and lower levels of depression and anxiety. Greater concerns were significantly associated with more symptoms of depression and anxiety, lower perceived social support, and lower kidney functioning (eGFR).

CONCLUSION

Even though patients after kidney transplantation usually acknowledge the importance of their ISM, they still have considerable concerns that are associated with less adherence and various psychosocial risk factors. Further longitudinal studies are needed to assess the extent to which beliefs about medication are variable and can be individually addressed to improve adherence.