Examining the relationship between adherence and satisfaction with antidepressant treatment

Investigating the association between medication regimen complexity, medication adherence and treatment satisfaction among Malaysian older adult patients: a cross-sectional study

BACKGROUND

The prevalence of medication nonadherence among Malaysian older adults is approximately 60%. However, there is a lack of studies assessing the factors associated with medication nonadherence among this population. This research aims to explore the association between medication regimen complexity (MRC), treatment satisfaction and medication adherence among Malaysian older adults.

METHOD

A cross-sectional study was conducted in outpatient clinics of a teaching hospital in Pahang, Malaysia, between April 2023 and September 2023. MRC Index (MRCI), Treatment Satisfaction for Medication version II (TSQM v.II), and the Malaysian Medication Adherence Assessment Tool (MyMAAT) were used. Multivariate linear and logistic regression models were performed to test the factors affecting treatment satisfaction and medication adherence. Mediator analysis was implemented to assess the mediating role of treatment satisfaction.

RESULT

The study involved 429 Malaysian older adult patients, with a prevalence of nonadherence of 51.0% (n = 219) and an MRCI mean score of 17.37 (SD = 7.07). The mean overall treatment satisfaction score was 73.91 (SD = 15.23). Multivariate logistic regression analysis expressed four significant predictors associated with nonadherence: MRC (AOR = 1.179, p = 0.002), overall treatment satisfaction (AOR = 0.847, p < 0.001), partially self-managed medication (AOR = 2.675, p = 0.011) and fully managed medication by family members/caregivers (AOR = 8.436, p = 0.004). Multivariate linear regression shows three predictors of treatment satisfaction: MRC (β = -1.395, p < 0.001), Charlson Comorbidity Index (CCI) (β = -0.746, p = 0.009) and self-managed medication (β = 5.554, p = 0.006). Mediator analysis indicated that treatment satisfaction partially mediated the association between MRC and nonadherence.

CONCLUSION

Nonadherence was quite prevalent among Malaysian older outpatients and was associated with regimen complexity, treatment satisfaction and patient dependence on others to manage their medications. Future studies should focus on interventions to control the factors that negatively affect patients' medication adherence.

Examining the Use of Antidepressants for Adolescents with Depression/Anxiety Who Regularly Use Cannabis: A Narrative Review

Depression and anxiety disorders are two of the most common and growing mental health concerns in adolescents. Consequently, antidepressant medication (AD) use has increased widely during the last decades. Several classes of antidepressants are used mainly to treat depression, anxiety, and obsessive-compulsive disorders by targeting relevant brain neurochemical pathways. Almost all randomized clinical trials of antidepressants examined patients with no concomitant medications or drugs. This does not address the expected course of therapy and outcome in cannabis users. Cannabis is the most commonly used illicit substance globally. Substantial changes in its regulation are recently taking place. Many countries and US states are becoming more permissive towards its medical and recreational use. The psychological and physiological effects of cannabis (mainly of its major components, tetrahydrocannabinol (THC) and cannabidiol (CBD)) have been extensively characterized. Cannabis use can be a risk factor for depressive and anxiety symptoms, but some constituents or mixtures may have antidepressant and/or anxiolytic potential. The aim of this literature review is to explore whether simultaneous use of AD and cannabis in adolescence can affect AD treatment outcomes. Based on the current literature, it is reasonable to assume that antidepressants are less effective for adolescents with depression/anxiety who frequently use cannabis. The mechanisms of action of antidepressants and cannabis point to several similarities and conjunctions that merit future investigation regarding the potential effectiveness of antidepressants among adolescents who consume cannabis regularly.

Translation, Pilot Psychometric Validation, and Comparative Performance of the Arabic Version of the Anti-Clot Treatment Scale (ACTS)

Background

Anticoagulation management is a complex process that is managed through careful monitoring, and patient satisfaction has a significant impact. Given the lack of a valid and reliable tool in Arabic to examine patient satisfaction, the present study aimed to translate and examine some of the psychometric properties of the Anti-Clot Treatment Scale (ACTS) among Saudi patients.

Materials and Methods

This was a cross-sectional, methodological study conducted among patients receiving warfarin. The questionnaire was subjected to translation by using a multistep method. The final Arabic translated version of the ACTS underwent face and content validity assessments by independent experts to ensure its conceptual equivalence to the original English version. Subsequently, pilot testing of convergent, discriminant, and criterion validities were examined.

Results

Overall, 136 patients participated in the study. All patients were asked to complete the generic Treatment Satisfaction Questionnaire for Medication (TSQM) alongside the ACTS tool. Convergent validity analyses revealed statistically significant positive correlations (p < 0.01) between the ACTS subscales and the four TSQM subdomains, as reflected by the Spearman correlation coefficient (r). Interestingly, the strongest correlations were observed between ACTS Burdens and the TSQM convenience domain (r = 0.61) and between ACTS Benefits and the TSQM effectiveness satisfaction score (r = 0.58). Similarly, discriminant validity was evidenced by moderate to high significant loading of all 12 items on each of their corresponding ACTS subscales.

Conclusion

These findings of adequate validity support the use of the ACTS in Saudi patients receiving anticoagulant medications to measure their specific satisfaction levels with this type of therapy. However, future research addressing the clinical impact of ACTS scores in the Saudi population is needed.

Prevalence, Barriers, and Interventions Related to Medication Adherence Among Patients With Major Depressive Disorder: A Scoping Review

The current scoping review aimed to identify the prevalence, contributing factors, methods of measurement, and interventions related to medication adherence among patients with major depressive disorder (MDD). A total of 37 articles met inclusion criteria. The prevalence of medication adherence among patients with MDD ranged from 10.6% to 85.4%. Approximately 67% of studies used self-report data collection. Illness-related factors (e.g., onset of illness, duration of illness, symptoms, illness severity), medication-related factors (e.g., adverse reactions, duration of treatment, cost of treatment), and patient-related factors (e.g., beliefs, attitudes, knowledge, self-stigma) were the most reported factors associated with medication adherence. In addition, multi-faceted interventions were recommended over single-element interventions to enhance medication adherence. There is a need to integrate appropriate and effective assessment measures of medication adherence that lead to better health care outcomes, lower risk factors, and improved interventions related to medication adherence. [Journal of Psychosocial Nursing and Mental Health Services, 59(1), 39-51.].

The anti-clot treatment scale (ACTS): validation of the translated Arabic version among patients undergoing warfarin therapy in Saudi Arabia

Background

Long-term anticoagulation therapy, particularly with warfarin, is usually associated with poor adherence and low patient satisfaction. However, previous studies have highlighted the possibility that individual perceptions of warfarin differ according to cultural practices. This study validated the psychometric properties of the translated Arabic version of the Anti-Clot Treatment Scale (ACTS) for patients on warfarin therapy in Saudi Arabia.

Methods

A cross-sectional multicenter study was conducted at the three main medical centers in Riyadh. Stratified sampling was employed to recruit Arabic-speaking patients who had been taking warfarin for a minimum of 3 months for any indication. The patients completed the specific ACTS along with the generic Treatment Satisfaction Questionnaire for Medication (TSQM 1.4) at two clinic visits. The psychometric performance of the ACTS was evaluated using well-established criteria: feasibility, reliability, and validity.

Results

One hundred thirty-six patients participated in the study (mean age: 50.68 ± 14.6 years; range: 19–97). Overall, the patients reported moderate Burdens and Benefits scores (44 ± 9.9 and 11.92 ± 2.4, respectively) compared to the reference range for each subscale (12–60 and 3–15, respectively); however, they reported lower Burdens scores than other populations. Consistent with the original ACTS validation study, the criteria for acceptability (data targeting, floor/ceiling effects, and skewness) were satisfied; in fact, the Arabic version exhibited better item- and scale-level distributions of data than versions in other languages. The ACTS subscales also demonstrated satisfactory test-retest reliability with significant intraclass correlation coefficients ((ICC ≥ 0.5); p < 0.001) and good internal consistency (all Cronbach’s alpha values exceeded 0.7). Exploratory factor analysis supported the 2-factor loading model. Interestingly, the Arabic version exhibited greater convergent validity with the TSQM subdomains (r = 0.61).

Conclusions

This study provides convincing evidence that the Arabic versions of both the ACTS Burdens and ACTS Benefits scales are equivalent to other versions in terms of psychometric performance, as measured using reliability and validity criteria. These properties support the great potential of the Arabic ACTS to accurately reflect patient satisfaction, identify aspects of treatment that need improvement in clinical practice, and compare treatment satisfaction across different anticoagulant therapies or cultures in research.

Perceived Treatment Satisfaction and Effectiveness Facilitators Among Patients With Chronic Health Conditions: A Self-Reported Survey

Background

Approximately 50% of patients are nonadherent to prescribed medications. Patient perception regarding medication effectiveness has been linked to improved adherence. However, how patients perceive effectiveness is poorly understood.

Objective

The aim of this study was to elucidate factors associated with perceived treatment satisfaction and effectiveness among patients with chronic health conditions.

Methods

We conducted a descriptive study using a cross-sectional survey design. We administered a Web-based survey to participants with migraine, multiple sclerosis (MS), or rheumatoid arthritis (RA). Patients were recruited from established online communities of Health Union. Descriptive statistics, correlations, and comparison tests were used to examine outcomes.

Results

Data were collected from 1820 patients: 567 with migraine, 717 with MS, and 536 with RA. The majority of participants were female (1644/1820, 90.33%), >40 years old (1462/1820, 80.33%), and diagnosed >5 years ago (1189/1820, 65.33%). Treatment satisfaction and perceived medication effectiveness were highly correlated (r=0.90, P<.01). Overall, three temporal factors were positively correlated with satisfaction or perceived effectiveness: time on current medication (satisfaction r_s=0.22, P<.01; effectiveness r_s=0.25, P<.01), time since diagnosis (satisfaction r_s=0.07, P<.01; effectiveness r_s=0.09, P<.01), and time on treatment (effectiveness r_s=0.08, P<.01).

Conclusions

Findings validated the strong relationship between treatment satisfaction and perceived effectiveness. Understanding the (1) positive relationship between time and treatment satisfaction and effectiveness and (2) factors associated with determining medication effectiveness can help clinicians better understand the mindset of patients regarding treatment. Clinicians may be better prepared to elicit patient beliefs, which influence medication adherence, for people diagnosed with chronic health conditions.

Satisfaction With Statin Treatment Among Adult Coronary Artery Disease Patients: An Experience From a Resource-Constrained Setting

BACKGROUND

Statins are the most widely prescribed hypolipidaemic drugs for coronary artery disease (CAD) patients, but have been found to cause muscle and nerve related adverse effects which can affect patient satisfaction with treatment. Literature on treatment satisfaction among statin users, especially from resource-limited settings is inadequate. The aim of this cross-sectional study was to assess the level of satisfaction with treatment among statin users and evaluate the relationship between adverse effects experienced by patients and their satisfaction with the medication.

METHODS

This study included 300 adult CAD patients visiting the cardiology department of a tertiary care hospital in the northern region of India, who were prescribed statins for their diagnoses. An interviewer administered, validated and standardised Treatment Satisfaction Questionnaire for Medication (version 1.4) was used for data collection.

RESULTS

Around three quarters of the population reported being overall satisfied with their medication. Mean scores were calculated for Effectiveness, Convenience, Side-Effects and Global Satisfaction. The patients reported high scores (above 60%) for all domains. Those experiencing any adverse effect were found to be more likely to report lower effectiveness. Additionally, medication effectiveness showed a positive correlation with overall treatment satisfaction.

CONCLUSIONS

The study shows that treatment satisfaction is critical to gauge patient experiences with the treatment which can impact medication adherence and compliance. It's a crucial measure especially among CAD and other chronic disease patients since greater satisfaction can improve clinical outcomes. More research is warranted to better understand the relationship between medication effectiveness and treatment satisfaction.

Treatment Satisfaction Questionnaire for Medication: Validation of the Translated Arabic Version among Patients Undergoing Warfarin Therapy in Saudi Arabia

OBJECTIVES

To validate the psychometric properties of the translated Arabic version of the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4) for patients on warfarin therapy in Saudi anticoagulation clinics (ACCs).

METHODS

A cross-sectional survey was conducted at the Security Forces Hospital ACC in Riyadh, Saudi Arabia. It involved administering questionnaires related to patients' satisfaction and assessing adherence through interviews. The quality of the international normalized ratio control was assessed using the Rosendaal method. A psychometric evaluation of TSQM 1.4 was carried out, addressing internal consistency and known-groups and convergent validity.

RESULTS

A total of 101 patients completed the questionnaire with an 80% response rate. The independent Cronbach α values for the effectiveness, side effects, and global satisfaction domains were consistently higher than 0.75, demonstrating good internal consistency and suitability of these domains for application in the current patients' setting. When these domains were used together in a multivariable logistic regression model of adherence, the only domain that remained significant was TSQM effectiveness (P = 0.017). Interestingly, a higher likelihood of moderate to optimal international normalized ratio control was significantly and independently associated with increased satisfaction scores in the effectiveness and convenience domains, but not in the side effects and global satisfaction domains.

CONCLUSIONS

This study provides evidence in favor of the reliability and validity of the Arabic version of TSQM 1.4 as a useful measure of satisfaction with anticoagulant therapy in patients visiting ACCs. The TSQM subscales in this patient setting seem to detect a clinically meaningful change over time, enhancing the potential of their use in routine practice.

Comparison of claims vs patient-reported adherence measures and associated outcomes among patients with nonvalvular atrial fibrillation using oral anticoagulant therapy

OBJECTIVE

To compare oral anticoagulant (OAC) adherence among patients with nonvalvular atrial fibrillation (NVAF) using patient-reported and claims-based measures, and to evaluate the effect of OAC adherence on health care costs and patient satisfaction with OAC therapy.

METHODS

This was a hybrid US observational study consisting of a longitudinal cohort survey followed by linkage and analysis of respondents' administrative claims data. Patients with NVAF receiving warfarin, dabigatran, rivaroxaban, or apixaban completed an initial survey and follow-up surveys at 4, 8, and 12 months. Patient-reported adherence was measured at each survey by Morisky Medication Adherence Scale (MMAS-8) and pharmacy claims-determined adherence by the proportion of days covered (PDC) for the 12-month period following the initial survey date; adherence was defined as MMAS-8 score =8 and PDC ≥80%. Patient satisfaction with OAC therapy was assessed by the Duke Anticoagulation Satisfaction Scale (DASS).

RESULTS

Overall, 675 patients completed at least the initial survey (warfarin, n=271; dabigatran, n=266; rivaroxaban, n=128; apixaban, n=10). Fewer than half (47.9%) were PDC adherent, 37.2% were MMAS-8 adherent, and 19.4% were adherent by both measures. Total medical costs of PDC-adherent patients were significantly lower vs PDC-nonadherent patients (US$640 vs $993 per-patient per-month, respectively, p<0.05). MMAS-8-adherent patients reported higher treatment satisfaction; total DASS score was significantly lower among MMAS-8-adherent than MMAS-8-nonadherent patients (37.3 vs 42.9, respectively, p<0.001).

CONCLUSION

Using claims-based or patient-reported methods to measure OAC adherence may lead to different results when assessing impact on health care costs and satisfaction with anticoagulation medication. These results underscore the importance of considering both claims-based and patient-reported measures when evaluating treatment adherence in real-world settings.

Comparative effectiveness of switching paroxetine formulation for treatment of major depressive disorder: an open-label multicenter study

AIM

To assess the effectiveness and safety of switching the antidepressant formulation from immediate-release (IR) to controlled-release (CR) paroxetine in patients with major depressive disorder (MDD).

PATIENTS AND METHODS

A total of 113 outpatients with MDD diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and treated with a stable dose of IR paroxetine for at least 6 months were enrolled. Patients were then switched to CR paroxetine for 8 weeks. Effectiveness was evaluated by scores on the Himorogi Self-Rating Depression/Anxiety Scales (HSDS/HSAS) and the Clinical Global Impression - Severity (CGI-S). Safety was evaluated based on the reported adverse drug reactions (ADRs). Medication satisfaction and preference were assessed based on questionnaire responses using Likert-type scales.

RESULTS

The overall patient HSDS/HSAS scores significantly improved after switching from IR to CR paroxetine (P<0.001). Furthermore, CR paroxetine was superior to IR paroxetine (P<0.001) according to the results of the CGI-S evaluation. ADRs were experienced by 14 (12.4%) patients, including dry mouth, nausea/vomiting, somnolence/drowsiness, and wakefulness/arousal during sleep. Satisfaction and preference for paroxetine improved after switching to the CR formulation (P<0.001; chi-square test).

CONCLUSION

These results suggest that switching the treatment from IR to CR paroxetine could improve depressive symptoms and decrease ADRs. However, these results may have been caused by the psychological effect of drug switching. Hence, future studies with blinded evaluation methods are required to confirm and expand our findings.

Medication adherence, depression and disease activity among patients with systemic lupus erythematosus

Introduction Medication non-adherence is an important cause of treatment failure among patients with systemic lupus erythematosus (SLE). Depression is a common neuropsychiatric disorder associated with SLE. The aims of this study are to assess the prevalence of both medication non-adherence and depressed mood among Saudi patients with SLE by using validated tools and to explore the impact of both depressive symptoms and disease activity on medication non-adherence. Methods A cross-sectional study was conducted in outpatients with SLE. Medication non-adherence was assessed by using the Morisky Medication Adherence Scale, and the severity of depressed mood was evaluated with the Beck's Depression Inventory. Disease activity was measured using the SLE Disease Activity Index (SLEDAI). Multiple logistic regression models were used to identify the multivariate predictors of medication non-adherence. Results Out of 140 patients, 134 (95.7%) were females with a mean (±SD) age of 35.6 (±11.3) years and a disease duration of 8.8 (±6.7) years. Medication non-adherence and depressed mood were detected in 62.1% and 35% of the patients, respectively. A moderate or severe depressed mood was significantly associated with medication non-adherence ( p = 0.04). There was a significant correlation between disease activity and the severity of depressed mood ( r = 0.31, p = 0.003). Disease activity did not correlate with medication non-adherence. Logistic regression demonstrated that moderate-to-severe depressed mood increased the probability of medication non-adherence (OR 2.62; 1.02-6.71). Conclusion Medication non-adherence and depressive symptoms are highly prevalent among Saudi SLE patients. Routine screening could facilitate the early detection and management of depression and medication adherence.

Impact of Gender on Satisfaction and Confidence in Cholesterol Control Among Veterans at Risk for Cardiovascular Disease

BACKGROUND

Compared with men, women have poorer lipid control. Although potential causes of this disparity have been explored, it is unknown whether patient-centered factors such as satisfaction and confidence contribute. We evaluated (1) whether satisfaction with lipid control and confidence in ability to improve it vary by gender and (2) whether sociodemographic characteristics modify the association.

MATERIALS AND METHODS

We evaluated baseline survey responses from the Cardiovascular Intervention Improvement Telemedicine Study, including self-rated satisfaction with cholesterol levels and confidence in controlling cholesterol. Participants had poorly controlled hypertension and/or hypercholesterolemia.

RESULTS

A total of 428 veterans (15% women) participated. Compared with men, women had higher low-density lipoprotein values at 141.2 versus 121.7 mg/dL, respectively (p < 0.05), higher health literacy, and were less likely to have someone to help track their medications (all p < 0.05). In an adjusted model, women were less satisfied with their cholesterol levels than men with estimated mean scores of 4.3 versus 5.6 on a 1-10 Likert scale (p < 0.05). There was no significant difference in confidence by gender. Participants with support for tracking medications reported higher confidence levels than those without, estimated mean 7.8 versus 7.2 (p < 0.05).

CONCLUSIONS

Women veterans at high risk for cardiovascular disease were less satisfied with their lipid control than men; however, confidence in ability to improve lipid levels was similar. Veterans without someone to help to track medications were less confident, and women were less likely to have this type of social support. Lack of social support for medication tracking may be a factor in lingering gender-based disparities in hyperlipidemia.

Client satisfaction determinants in four Kenyan slums

PURPOSE

In Kenya, gaps exist in health service provision to slum residents, especially service availability and access to quality care. There is also little information on the health status of people living in slums other than in Nairobi. The purpose of this paper is to generate evidence for use in designing interventions to improve health services in four mid-sized slums in Embu, Nyeri and Thika, Kenya.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional survey of clients receiving services in health facilities was conducted in the targeted slums. Data were collected through face-to-face interviews. Factor scores were generated using the Rasch model; simple and multivariate logistic regression analyses were done using the R statistical software.

FINDINGS

Overall, 81 per cent of the 203 participants reported being satisfied with health services. Most clients (89 per cent) reported that health facility staff greeted them warmly; 82 per cent said their consultation was private. The facility type, waiting time and client experience with service providers determined their satisfaction (p<0.05).

PRACTICAL IMPLICATIONS

Healthcare managers can improve client satisfaction levels by understanding the client flow in their facilities and addressing causes of client dissatisfaction, such as long waiting times, while at the same time promoting facilitating factors.

ORIGINALITY/VALUE

The authors use latent variable modelling to compute client satisfaction scores, which were dichotomised into two categories and fitted into a logistic regression model to identify factors that influence client satisfaction. Health facility clients in the four slums are satisfied with services and have confidence the providers will serve them in a friendly and professional manner that promotes respect and quality care. The paper recommend healthcare managers in similar settings carry out client flow analysis and institute remedial measures to address long waiting times. Qualitative studies are recommended to determine the reasons behind the high satisfaction levels reported in this study.

Improving Consumer Satisfaction with Addiction Treatment: An Analysis of Alumni Preferences

Objective. The primary objective of this investigation is to determine which individual and aggregate factors of residential addiction treatment centers are most significant influencers of alumni satisfaction. Design. Survey targeted alumni of residential addiction treatment facilities. Alumni were queried through a survey, which utilized Likert-scale matrices and binary response options: 379 respondents met the completion threshold. Alumni rated amenities and individual and group counseling factors; additionally, respondents provided feedback on two satisfaction proxies: cost worthiness and future recommendations. Descriptive and relational analyses were conducted, with the latter utilizing logistic regression models. Results. Individual factors' scores of group counseling, and overall aggregate group counseling score, are most enthusiastically positive. Group counseling is also the most significant influencer of satisfaction. Other significant influencers of satisfaction are met expectations for individual counseling and psychiatric care offerings. Conclusions. While individual counseling and facility amenities should not be ignored, group counseling may be the most significant influencer of alumni satisfaction. Long-term outcomes are not single-faceted; however, treatment providers should be encouraged to invest in high-quality group counseling offerings in order to best satisfy, and thereby empower, clients.

Impact of pharmacist intervention on adherence and measurable patient outcomes among depressed patients: a randomised controlled study

BACKGROUND

Adherence to antidepressant treatment is essential for the effective management of patients with major depressive disorder. Adherence to medication is a dynamic decision-making process, and pharmacists play an important role in improving adherence to antidepressant treatment in different settings within the healthcare system. The aim of this study was to assess whether pharmacist interventions based on shared decision making improved adherence and patient-related outcomes.

METHODS

This was a randomised controlled study with a 6-month follow-up. Participants were randomly allocated to two groups: 1) intervention group (IG) (usual pharmacy services plus pharmacist interventions based on shared decision making); or 2) control group (CG) (usual pharmacy services). Recruited patients fulfilled the following inclusion criteria: aged 18 to 60 years diagnosed with a major depressive disorder, and no history of psychosis or bipolar disorders. A research assistant blinded to the group allocations collected all data.

RESULTS

Two hundred and thirty-nine patients met the inclusion criteria and were randomised to the IG (n = 119) or CG (n = 120). Nineteen patients dropped out of the study during the follow-up phase. After 6 months, patients in the IG had significantly more favorable medication adherence, treatment satisfaction, general overuse beliefs, and specific concern beliefs. However, the groups did not differ in severity of depression or health-related quality of life after 6 months.

CONCLUSIONS

Our findings emphasise the important role of pharmacists in providing direct patient care in regular pharmacy practice to improve adherence to medications and other patient-reported outcomes.

TRIAL REGISTRATION

ISRCTN34879893, Date assigned: 30/12/2014.

Association between adherence, treatment satisfaction and illness perception in hypertensive patients

The relationship between adherence to antihypertension medications, treatment satisfaction and illness perception has not been studied so far. The primary objective of this study was to examine the association between adherence to medication, treatment satisfaction and illness perception in Lebanese hypertensive patients. The relation between medication adherence and blood pressure (BP) control was also assessed. In this cross-sectional study, patients were recruited from the physician's practice offices and community pharmacies in Beirut. Patients who had been treated for hypertension for at least 3 months were invited to participate in the study; they completed three questionnaires: the 8-item Morisky Medication Adherence Scale (MMAS-8), the Treatment Satisfaction Questionnaire for Medication (TSQM-4) and the Brief Illness Perception Questionnaire (BIPQ). BP was also measured and recorded. A total of 117 subjects were included, of whom 29.1% had poor adherence to their antihypertension treatment (MMAS-8 scores<6). The odds of having well-controlled hypertension was 3.5 times higher in patients with high adherence compared with patients with poor adherence (P=0.010). Treatment satisfaction was significantly greater in patients with good adherence (P<0.001). Neither socio-demographic, disease- nor drug-related characteristics of the participants were significantly associated with medication adherence. As for illness perception, even though the mean BIPQ score of adherent participants was lower than the mean score of non-adherent participants, this difference did not reach statistical significance. In conclusion, treatment satisfaction was found to be a predictor of adherence. Studies are needed to determine whether interventions to increase satisfaction can improve adherence and BP control.

The influence of patients' knowledge on adherence to their chronic medications: a cross-sectional study in Jordan

BACKGROUND

Non-adherence to long-term therapy for chronic illnesses is considered the major reason why patients fail to reach their clinical goals, resulting in suboptimal health outcomes, death, and extra costs on the health care systems. Knowledge about the disease and prescription medications, an understanding of the reason the medication is needed, and good expectations or attitudes toward treatment, all contribute to a better medication-taking behavior and are associated with higher rates of adherence.

OBJECTIVE

This study examines the relationship between knowledge and adherence of patients receiving long-term therapy for one or more chronic illnesses in Jordan.

SETTINGS

The study was conducted in the out-patient clinics of two Jordanian hospitals (The University of Jordan Hospital and Jordan Hospital).

METHODS

This was a cross-sectional study that included 902 patients. The correlation between patients' knowledge about their chronic medications and adherence was assessed. Effects of several sociodemographic characteristics were investigated in regard to knowledge and adherence.

MAIN OUTCOME MEASURES

Knowledge was assessed by a modified version of the McPherson index, and the Morisky Medication Adherence Scale was used to assess medication adherence.

RESULTS

A significant correlation was found between patients' knowledge and their adherence to medications (r = 0.357, p < 0.001). Most of the participants had low adherence. Younger age, higher education levels, high income, fewer medications and diseases were significant predictors of higher knowledge levels. Knowledgeable patients were found to be twice as likely to have moderate-to-high adherence as their unknowledgeable counterparts. Similarly, high income and higher education were associated with higher adherence scores.

CONCLUSION

Forgetfulness and aversion toward medications were the most common barriers to medication adherence. This implicates that clinicians and health care policy makers should direct their effort toward two main strategies to improve adherence increasing awareness and education of effective ways to remind patients about their medications.

Safety and effectiveness of controlled-release paroxetine in routine clinical practice: results of a postmarketing surveillance study of patients with depression

OBJECTIVE

Selective serotonin reuptake inhibitors are commonly used in the pharmacotherapy of depression. However, adverse events can lead to their early discontinuation. This study evaluated the safety and effectiveness of paroxetine controlled-release (CR) tablets in Japanese patients with depression/depressive state (hereafter referred to as depression) in routine clinical practice in Japan.

PATIENTS AND METHODS

This was an open-label, noninterventional, prospective, postmarketing surveillance study. A total of 3,213 patients aged 12-92 years with depression were prescribed paroxetine CR for 8 weeks at the physician's discretion. Safety was evaluated on the basis of the reporting of adverse drug reactions. Effectiveness was evaluated on the basis of the physician's assessment using the Clinical Global Impression-Global Improvement (CGI-GI) and the Clinical Global Impression-Severity of Illness (CGI-SI) scales, as well as on the basis of the patients' self-reported satisfaction. The primary effectiveness outcome was the improvement rate based on the physician's assessment using the CGI-GI.

RESULTS

The incidence of adverse drug reactions was 11.2% (359/3,213; 95% confidence interval [CI]: 10.1%-12.3%). The common adverse drug reactions that accounted for 1.0% or more of the incidence were nausea (3.5%) and somnolence (2.7%). The proportion of patients who continued paroxetine CR at week 8 was 80.2% (2,577/3,213; 95% CI: 78.8%-81.6%). The improvement rate at week 8 (last observation carried forward) was 72.8% (2,132/2,927; 95% CI: 71.2%-74.4%). The proportion of patients with CGI-SI scores of moderately or severely ill decreased from 63.6% at baseline to 17.9% at week 8. The proportion of patients who were satisfied with paroxetine CR treatment was 69.8% (2,040/2,921; 95% CI: 68.1%-71.5%).

CONCLUSION

The results of this study suggest that paroxetine CR is a well-tolerated and efficacious treatment for depression in routine clinical practice.

Health resource use and costs of vilazodone and other selective serotonin re-uptake inhibitors in treating major depressive disorder

OBJECTIVE

Selective serotonin re-uptake inhibitors (SSRIs) are widely prescribed antidepressants. This claims database study compared healthcare resource use and costs among patients with major depressive disorder (MDD) treated with vilazodone vs other SSRIs.

METHODS

Adults with an MDD diagnosis and ≥ 1 prescription fill for vilazodone, citalopram, escitalopram, fluoxetine, paroxetine, or sertraline were identified from administrative claims data (2010-2012). Patients who concomitantly used adjunctive medication, either a second-generation antidepressant or antipsychotic, were excluded. All-cause and MDD-related healthcare resource use and costs (in 2012 USD) were compared between patients treated with vilazodone vs other SSRIs over a 6-month follow-up period using unadjusted and multivariable analyses.

RESULTS

The study cohort included 49 861 patients (mean age = 44.0 years; 70% female). Compared with the vilazodone cohort (n = 3527), patients in the citalopram (n = 12 187), escitalopram (n = 8275), fluoxetine (n = 10 142), paroxetine (n = 3146), and sertraline (n = 12 584) cohorts had significantly more all-cause inpatient hospital visits, longer hospital stays and more frequent emergency department visits, following the index date, after adjusting for baseline characteristics. All-cause medical service costs (inpatient + outpatient + emergency department visits) were significantly higher across all other SSRI cohorts vs vilazodone by $758-$1165 (p < 0.05). Similarly, all-cause total costs, were significantly or numerically (non-significantly) higher across all SSRI cohorts vs vilazodone by $351-$780.

LIMITATIONS

The was no clinical measurement of disease severity, partial coverage of the Medicare-eligible population, and short follow-up.

CONCLUSION

MDD treatment with vilazodone was associated with significantly lower rates of inpatient and emergency services, and with significantly lower all-cause medical service costs and numerically (non-significantly) lower total costs to payers than with the other SSRIs included in this study.