Factors affecting older persons' adherence to prescription drugs in Israel

Factors Associated with Medication Adherence in Elderly Individuals with Tuberculosis: A Qualitative Study

Methods

This qualitative study was conducted in two phases, using an integrative literature review and individual interviews. Studies were gathered without time restriction from MEDLINE databases, Institute for Scientific Information (ISI), Google Scholar, Scopus, and EMBASE, as well as national databases, including Scientific Information Database and Magiran. The findings of 38 studies that met the inclusion criteria were analyzed through the conventional content analysis method based on the ecological approach. After reviewing and forming the data matrix, purposive sampling was performed among healthcare professionals, elderly tuberculosis patients aged 60 and over, and family caregivers of elderly patients to conduct individual interviews. Data obtained from 20 interviews were analyzed using the directed content analysis method. After coding, the data from individual interviews were entered based on similarity and difference in the categories of data matrix obtained from the literature review.

Results

In general, the aforementioned codes were placed in four main categories, including individual factors (i.e., biological factors, affective-emotional factors, behavioral factors, cognitive factors, tuberculosis-related factors, and economic factors), interpersonal factors (i.e., patient's relationship with treatment team and family-related factors), factors related to healthcare service provider centers (i.e., medical centers' facilities and capacity building in healthcare service provider), and extraorganizational factors (i.e., social factors and health policymaking).

Conclusion

The results of this study showed that medication adherence in elderly patients with tuberculosis was a complex and multidimensional phenomenon. Therefore, society, policymakers, and healthcare providers should scrutinize the factors affecting medication adherence in this group of patients to plan and implement more effective interventions.

Patterns of informal family care during acute hospitalization of older adults from different ethno-cultural groups in Israel

Introduction

Informal caregiving during hospitalization of older adults is significantly related to hospital processes and patient outcomes. Studies in home settings demonstrate that ethno-cultural background is related to various aspects of informal caregiving; however, this association in the hospital setting is insufficiently researched.

Objectives

Our study explore potential differences between ethno-cultural groups in the amount and kind of informal support they provide for older adults during hospitalization.

Methods

This research is a secondary data analysis of two cohort studies conducted in Israeli hospitals. Hospitalized older adults are divided into three groups: Israeli-born and veteran immigrant Jews, Arabs, and Jewish immigrants from the Former Soviet Union (FSU). Duration of caregiver visit, presence in hospital during night hours, type of support (using the Informal Caregiving for Hospitalized Older Adults scale) are assessed during hospitalization. Results are controlled by background parameters including functional Modified Barthel Index (MBI) and cognitive Short Portable Mental Status Questionnaire (SPMSQ) status, chronic morbidity (Charlson), and demographic characteristics.

Results

Informal caregivers of “FSU immigrants” stay fewer hours during the day in both cohorts, and provide less supervision of medical care in Study 2, than caregivers in the two other groups. Findings from Study 1 also suggest that informal caregivers of “Arab” older adults are more likely to stay during the night than caregivers in the two other groups.

Conclusions

Ethno-cultural groups differ in their patterns of caregiving of older adults during hospitalization. Health care professionals should be aware of these patterns and the cultural norms that are related to caregiving practices for better cooperation between informal and formal caregivers of older adults.

Determinants of Bone Mineral Screening Behavior among Three Ethno-Cultural Groups of Women in Israel

Bone mineral density (BMD) screening is one of the main means to detect and treat osteoporosis. Yet, the manner in which ethno-cultural background is associated with BMD health cognitions and screening behavior remains limited. Several ethno-cultural groups (n = 100 in each group)—Israeli-born Jews, Israeli-born Bedouin-Muslims, and Jewish immigrants from the Former Soviet Union (FSU), mean age 70 (SD = 7.1)—participated in face-to-face interviews in a cross-sectional survey, using valid and reliable questionnaires on BMD screening behavior, knowledge about osteoporosis, and theory of planned behavior (TPB) components. FSU immigrants reported the lowest BMD screening behavior. The multivariate analysis showed that higher knowledge level, positive attitudes, supportive subjective norms, and greater intentions increase the probability of BMD screening behavior. The TPB attitude component had a more pronounced effect on the probability of undergoing BMD screening among Israeli-born Bedouin-Muslims compared to Israeli-born Jews. Our findings contribute to the TPB by deepening our understanding of the associations between TPB components and BMD screening behaviors, from an ethno-cultural perspective. To assure sufficient BMD screening behavior among all ethno-cultural groups, intervention programs—suited to address the unique characteristics of each ethno-cultural group—are required.

Psychosocial determinants of adherence to oral antidiabetic medication among people with type 2 diabetes

AIMS AND OBJECTIVES

The aim of this study was to identify the psychosocial determinants of adherence to oral antidiabetic medication, according to the Theory of Planned Behaviour (TPB).

BACKGROUND

Appropriate adherence to oral antidiabetic medication contributes to long-term glycaemic control. However, glycaemic control is often poor in people with type 2 diabetes, mainly due to the poor adherence to oral antidiabetic agents.

DESIGN

Prospective study with 2 waves of data collection, based on STROBE checklist was conducted. One hundred and fifty-seven adults with type 2 diabetes, in chronic use of oral antidiabetic agents, composed the sample. At baseline, self-reported measures of medication adherence (proportion and global evaluation of adherence) and of metabolic control (glycated haemoglobin) of diabetes were obtained.

METHODS

The TPB main constructs (attitude, subjective norm and perceived control) and related beliefs were measured. Adherence and metabolic control measurements were obtained in a two-month follow-up (n = 157).

RESULTS

Attitude and subjective norm, together, explained 30% of the variability in intention; their underlying belief-based measures (behavioural and normative beliefs) explained 28% of the variability in intention. In addition, intention predicted behaviour at follow-up. However, when added to the prediction model, past behaviour was the only explanatory factor of adherence behaviour.

CONCLUSION

Adherence behaviour to oral antidiabetic medication was predicted by intention, which, in turn, was determined by attitude and subjective norm. In order to promote adherence to oral antidiabetic agents, health professionals should include motivational strategies as well as strategies targeted to attitude and subjective norm when designing interventions.

RELEVANCE TO CLINICAL PRACTICE

The nonadherence to antidiabetic medication contributes to lack of control of diabetes and ensuing complications. The comprehension of the factors explaining the variability in medication adherence can inform the design of theory-based interventions aimed at promoting this behaviour.

Conceptual Model of Medication Adherence in Older Adults with High Blood Pressure-An Integrative Review of the Literature

BACKGROUND

Medication adherence (MA) is the most important controlling factor of high blood pressure (HBP). There are a few MA models, but they have not been successful in predicting MA completely. Thus, this study aimed to expand a conceptual model of MA based on an ecological approach.

METHODS

An integrative review of the literature based on theoretical and empirical studies was completed. Data source comprised: Medline (including PubMed and Ovid), ISI, Embase, Google scholar, and internal databases such as Magiran, Google, SID, and internal magazines. Primary English and Persian language studies were collected from 1940 to 2018. The steps of study included: (a) problem identification, (b) literature review and extracting studies, (c) appraising study quality, (d) gathering data, (e) data analysis using the directed content analysis, (f) concluding.

RESULTS

Thirty-six articles were finally included and analyzed. After analysis, predictors of MA in older adults with hypertension were categorized into personal, interpersonal, organizational, and social factors. Although the personal factors have the most predictors in sub-categories of behavioral, biological, psychological, knowledge, disease, and medication agents, social, organizational and interpersonal factors can have indirect and important effects on elderly MA.

CONCLUSION

There are many factors influencing MA of elderly with HBP. The personal factor has the most predictors. The designed model of MA because of covering all predictor factors, can be considered as a comprehensive MA model. It is suggested that future studies should select factors for study from all levels of the model.

Factors influencing adherence to treatment in older adults with hypertension

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Patient-related beliefs and adherence toward their medications among the adult hypertensive outpatients in Tanzania

AIM

Hypertension is a leading global health problem requiring lifelong treatment. However, adherence to antihypertensive medicines is a problem, greater among developing countries. Consequently, there is a need to determine current adherence rates and their associations among developing countries to plan future initiatives.

MATERIALS & METHODS

Cross-sectional study among adult outpatients with essential hypertension in Tanzania. Predesigned questionnaires were used to gather information on adherence rates and patient-related beliefs. The main outcome measure was adherence.

RESULTS

A total of 180 participants were included, with females making up 65%. High-adherence rates were seen in 54% of the patients. Patients' belief about their medication and its necessity was higher in the high adherent group and concerns about their medicines and their necessity were higher in the low adherent group. Conclusion & recommendations: Adherence rates were low compared with a suggested level ≥80%. Educational initiatives are needed to address knowledge and concerns with hypertension to improve future outcomes.

Systematic review of the barriers affecting medication adherence in older adults

Medication adherence is a crucial part in the management of chronic diseases. As older adults form a greater proportion of the population with chronic diseases and multiple morbidities, understanding medication adherence in older adults becomes important. In the present article, we aimed to systematically review the literature for the factors associated with medication adherence in the geriatric population. We carried out a literature search using electronic databases and related keywords. 17 391 articles were reviewed in total. 65 articles were found to be relevant to our objective. A total of 80 factors of five different categories were found to be associated with medication adherence in older adults. The factors, the types of studies and the number of studies that agreed or disagreed were presented. A flower model for medication adherence was also presented to allow clinicians to better understand the complex nature of medication adherence in this population. The 80 factors reviewed were categorized into five main categories; namely, patient factors, medication factors, physician factors, system-based factors and other factors as factors affecting poor medication adherence in older adults. Clinicians need to be mindful of the complex nature of factors affecting medication adherence in this population to optimize therapeutic outcomes. Clinicians have to be more skillful to discover and to optimize the medication adherence factors in geriatric patients. The flower model is presented as a framework for clinicians to better understand the various factors affecting medication adherence in older adults. Geriatr Gerontol Int 2016; 16: 1093-1101.

Improving health outcomes: innovation, coverage, quality and adherence

The Israeli health system has made considerable progress in reducing deaths amenable to medical care but has more to do. This commentary describes how progress in this area results from innovation, coverage, quality, and adherence to treatment. It describes what is being done in Israel and beyond to address each of these factors but concentrates on the often poorly recognised problem of adherence to treatment, describing the growing evidence that it is often sub-optimal and reviewing evidence on what can be done to improve it.

Tailored Information and Automated Reminding to Improve Medication Adherence in Spanish- and English-Speaking Elders Treated for Memory Impairment

Medication adherence is recognized as an issue of critical importance within health care, as many patients do not take their medications as prescribed. This study evaluated two interventions targeted at improving adherence in elderly patients being treated for memory impairments. Twenty-seven participants were randomly assigned to control (n = 11), automated reminding (n = 8), or tailored information conditions (n = 8). Medication adherence was evaluated with an electronic pill bottle. Generalized estimating equation (GEE) models assessed the effects of the interventions on electronically monitored medication adherence after controlling for covariates. Results showed that individuals in both intervention groups had higher levels of medication adherence than those in the control group. The presence of a caregiver was associated with substantially higher levels of adherence. Verbal memory, but not general cognitive status, predicted better adherence. Mood, health literacy, and executive functions were not associated with adherence. Results thus suggest that both automated reminding and tailored information interventions may improve medication adherence in elders, even among those with memory impairments.