Gender-Related Factors in Medication Adherence for Metabolic and Cardiovascular Health

Medication adherence and its effect on health-related quality of life in respiratory tract infection patients using the St. George's Respiratory Questionnaire and the Medication Adherence Report Scale

Respiratory tract infections (RTIs) are common and pose significant health challenges, particularly in economically disadvantaged regions. Medication adherence is believed to influence patient quality of life (QoL), but the extent of this impact remains unclear. A cross-sectional study was conducted at Vivekananda General Hospital, Hubballi, India, from August 2023 to January 2024 to assess the relationship between medication adherence and QoL in RTI patients. This study involved 200 patients from the pulmonology department. Medication adherence was evaluated using the Medication Adherence Report Scale, while QoL was assessed with the St. George's Respiratory Questionnaire (SGRQ). A two-way analysis of variance was performed to examine associations between adherence and QoL scores. No significant correlation was found between medication adherence and QoL. SGRQ total, symptoms, activity, and impact scores did not differ significantly between less adherent and highly adherent patients (p: 0.570-0.944). Medication adherence alone may not significantly affect QoL in RTI patients. Other factors, including disease severity, medication efficacy, comorbidities, and socioeconomic conditions, might have a greater influence. Further research is needed to explore these determinants and develop strategies to improve patient outcomes.

Real-world efficacy and tolerability of CAB+RPV LA in women: addressing the gender gap in HIV treatment research

BACKGROUND

Women, particularly those of advanced age with comorbidities and polypharmacy, are often underrepresented in clinical trials evaluating long-acting (LA) antiretroviral therapy (ART) regimens like cabotegravir and rilpivirine (CAB + RPV LA). This single-center study aims to address this gap by assessing the effectiveness, tolerability, and adherence to CAB + RPV LA, focusing on women who often have complex health profiles.

METHODS

In this single-center, retrospective study, we analyzed virologic suppression rates, adherence and tolerability in our cohort of women living with HIV comparing their outcomes to men on the same regimen.

RESULTS

A total of 270 individuals (42 women and 228 men) were included. Women had a higher prevalence of comorbidities (86% versus 49%, P = 0.0001), and were more likely to have used ≥5 ART lines (69% versus 29%, P < 0.0001), and 31% were aged ≥60 years compared to 13% of men (P = 0.003). Despite higher rates of comorbidities and polypharmacy, women achieved virologic suppression and adherence levels comparable to men. CAB + RPV LA was well-tolerated in both groups, with no significant gender-based differences in treatment outcomes.

CONCLUSION

CAB + RPV LA is effective and well-tolerated in women with complex ART histories, providing a viable long-acting alternative for populations traditionally underrepresented in clinical trials. These findings underscore the importance of including women in studies of novel ART regimens to ensure equitable access and outcomes.

Improving quality of care for cancer patients through oncological second opinions in a Comprehensive Cancer Center: adherence to second-opinion therapy recommendations

PURPOSE

Receiving treatment in certified oncological centers and obtaining a second medical opinion has been proven to enhance both the quality and cost-effectiveness of care for oncological patients. Interdisciplinary care optimizes the treatment of oncological patients by validating the diagnosis and treatment recommendation, emphasizes translational research, and applies oncological therapies in a more target-oriented manner. This study aims to examine the extent of patient adherence to second medical opinions provided at the Comprehensive Cancer Center Erlangen-Metropolitan Area Nuremberg (CCC Erlangen-EMN) and investigates how specific patient characteristics such as age, gender, and type of cancer diagnosis influence the likelihood of adhering to a second opinion.

METHODS

This is a prospective, single-center observational study supported by the local statutory health-insurance body (Allgemeine Ortskrankenkasse, AOK). A total of 584 male and female patients with cancer in the fields of urology, gynecology, gastroenterology, or sarcoma, seeking a second medical opinion were assessed for their adherence to the second opinion. Levels of adherence in patient subgroups were compared using appropriate statistical tests. Correction for multiple testing was not performed, due to the exploratory nature of the study.

RESULTS

Almost 75% of the patients adhered to the second opinion recommendations and an additional 10% partially followed them. Men adhered to the second opinion recommendation slightly more often (79.1%) than women (70.7%; chi-square test, P = 0.01). At 83%, second-opinion adherence was highest among patients who had received an incomplete but guideline-compliant first opinion. If the first opinion was not guideline-compliant, about 67% adhered to the second opinion. Adherence to second opinions was not significantly influenced by whether the initial therapy recommendation adhered to guidelines (Fisher's test, P = 0.16 for all departments, P = 0.27 for the gynecology department). Most patients adhered to the second opinion after primary therapy (92.9%).

CONCLUSIONS

More than two-thirds of patients ultimately followed the recommendation provided in the second opinion. The results of this study enhance our understanding of patient adherence to medical advice and treatment regimens. This study demonstrated that the majority of patients adhere to second opinions and highlighted the feasibility of easy access to second opinions from a certified cancer center. Women adhered slightly less to second opinions than men. More detailed and comprehensive therapy recommendations could potentially enhance adherence rates in the future.

Group-based trajectory modeling to identify longitudinal patterns and predictors of adherence among older adults on concomitant triple therapy (oral antidiabetic, renin-angiotensin-system antagonists, statins)

BACKGROUND

Diabetes, hypertension, and hyperlipidemia frequently co-occur in older adults, significantly increasing their risk for cardiovascular disease, a leading cause of mortality in the United States. Managing these conditions often requires concomitant triple therapy, which includes antihypertensives, oral antidiabetics, and statins. Although medication adherence is critical for reducing cardiovascular risk, adherence to complex regimens is often suboptimal in older populations, further complicating disease management. Medicare's STAR metrics assess adherence to these medications as a measure of care quality. Traditional methods, like the proportion of days covered (PDC), provide single adherence estimates, but fail to capture the dynamic nature of adherence over time. Group-based trajectory modeling (GBTM) offers a more comprehensive approach, graphically depicting patterns of adherence behavior. This study seeks to understand longitudinal patterns and predictors of adherence of concurrent triple therapy among elderly patients under Managed Care using GBTM.

OBJECTIVE

To evaluate adherence patterns to concurrent triple therapy (antidiabetic, antihypertensive, and lipid-lowering medications) among older patients using GBTM and identify predictors associated with each adherence trajectory.

METHODS

Patients on concurrent triple therapy were identified using a Texas Medicare Advantage dataset from July 2016 to December 2016. Patients included had an overlap of 30 days of triple therapy, a second prescription of each component of triple therapy within the identification period, and a 12-month follow-up after the triple therapy. Monthly adherence was measured using PDC during follow-up. Patients were defined as adherent if they had at least 80% (24 out of the 30 days) covered for all 3 medications. The monthly PDC was incorporated into a logistic GBTM to provide distinct patterns of adherence. Two to five adherence groups were estimated using the second-order polynomial function of time. Predictors of adherence were identified using multinomial logistic regression, guided by the Anderson Behavioral Model.

RESULTS

Of the 7,847 patients included, the following 4 distinct adherence trajectories were identified: adherent (42.5%), gaps in adherence (28.9%), gradual decline (13.4%), and rapid decline (15.3%). Female patients had higher odds of being in the gaps in adherence or rapid decline groups compared with males. Low-income subsidy recipients were less likely to experience rapid decline. Prior hospitalizations increased the likelihood of rapid decline in adherence.

CONCLUSIONS

This study identified heterogeneous adherence patterns among older adults on triple therapy for cardiovascular disease risk factors. Targeted interventions tailored to specific adherence trajectories are needed to improve medication adherence and health outcomes in this high-risk population.

Flash Glucose Monitoring for Predicting Cardiogenic Shock Occurrence in Critically Ill Patients: A Retrospective Pilot Study

Background/Objectives: Continuous and flash glucose monitoring (CGM and FGM) may enhance glucose management by providing real-time glucose data. Furthermore, growing evidence is linking altered blood glucose concentrations and worse short-term outcomes in critically ill patients. While hyperglycemia is more common in these patients and is associated with an increased risk of adverse events, hypoglycemia is particularly concerning and significantly raises the risk of fatal outcomes. This exploratory study investigated the link between FGM variables and cardiogenic shock in critically ill Coronary Care Unit (CCU) patients. Methods: Twenty-eight CCU patients (1 May 2021-31 January 2022) were monitored using a Libre FreeStyle system. Analyzed data included patient demographic and laboratory data, left ventricular ejection fraction, standard glucose monitoring, APACHE IV scores, and cardiogenic shock occurrence. Analysis was performed using the χ2 test, Mann-Whitney U test, and logistic regression. Results: Among the patients, 13 (46.43%) developed cardiogenic shock. FGM detected hypoglycemia in 18 (64.29%) patients, while standard methods in 6 (21.43%) patients. FGM-detected hypoglycemia was more frequent in patients who developed cardiogenic shock (p = 0.0129, χ2 test) with a significantly higher time below range reading (p = 0.0093, Mann Withney U test), despite no differences in mean glucose values. In addition, hypoglycemia detected by FGM was an independent predictor of shock (p = 0.0390, logistic regression). Conclusions: FGM identified more hypoglycemic events compared to standard glucose monitoring in the CCU. Frequent FGM-detected hypoglycemic events were associated with cardiogenic shock, regardless of a history of diabetes. Due to a limited sample size, these results should be interpreted cautiously and further research in this area is justified.

Exploring sex-based differences in patient outcomes: A secondary analysis of Heartwatch, an Irish cardiovascular secondary prevention programme

Background

In the last two decades, sex-related differences regarding cardiovascular diagnosis, treatment, and risk factors management have been reported. The current study aims to explore differences in cardiovascular outcomes among male and female patients attending the Irish secondary cardiovascular prevention programme - Heartwatch.

Methods

This is a retrospective observational study. Anonymous data was extracted from the Heartwatch database from 2003 to 2017. Cardiovascular risk factors were analysed at sign-up and at four years follow-ups. An 8-point aggregate risk score (CCare Score) was assessed to calculate targeted outcomes. Generalized estimating equations models were applied for data analysis.

Results

In total 8893 patients (77 % male) were included. Females exhibited a higher risk profile across all cardiovascular risk factors and were more likely to be off target than males at baseline and after 4 years of programme attendance [M to F odds ratios(95 % CI); systolic blood pressure: 1.35 (1.21-1.49), waist circumference: 2.11(1.89-2.36), physical activity: 1.72 (1.53-1.95)]. CCare scores also demonstrated the gap between male and female patients at baseline [mean(sd); M: 5.1(1.2), F: 4.8(1.2)] and after 4 years of structured care [mean(sd); M: 5.3(1.2), F: 4.9(1.2)]. Female patients were less likely to be prescribed aspirin and ACE inhibitors but more likely to be prescribed AT2 inhibitors, calcium channel blockers, and diuretics compared to male patients.

Conclusions

The Heartwatch programme has demonstrably improved patient care, however, the continuous underperformance of female patients necessitates further investigation to ensure appropriate and equitable secondary CVD prevention among the Irish population.

Assessing community antibiotic usage and adherence as per standard treatment guidelines: A potential area to enhance awareness at community pharmacy settings

Background

Antibiotic nonadherence significantly contributes to poor treatment outcomes and antimicrobial resistance. In Southeast Asia, including Bangladesh, community pharmacies are crucial in primary healthcare, and are key sources of over-the-counter antibiotics. However, understanding of adherence to the full course of community-dispensed antibiotics is limited. This study measured antibiotic adherence to Bangladesh government and WHO Standard Treatment Guidelines (STGs) among patients at community pharmacies and identifies associated factors.

Methods

A cross-sectional survey was conducted via phone among 358 respondents from four urban and rural areas of Bangladesh who participated in a previous antibiotic purchasing behavior survey. Descriptive analysis identified antibiotic use patterns, and adherence to the full course of antibiotics was assessed against STGs recommendations. Poisson regression model was used to explore correlations between patients' demographic characteristics, knowledge of antibiotic dosage, dosage regimen, and type of health-symptoms and adherence to the full course of antibiotics.

Results

Adherence to antibiotic dosage per STGs was 40.5 %. Patients consulting a registered medical practitioner were significantly more likely to adhere (Adj-PR: 3.81, 95 % CI: 2.82-5.14) compared to those who did not. Males were 32.0 % less likely to adhere than females (Adj-PR: 0.68, 95 % CI: 0.54-0.86). Rural residents demonstrated 37.0 % lower adherence compared to urban (Adj- PR: 0.63, 95 % CI: 0.45-0.87). Respondents who recalled the antibiotic dosage had a higher likelihood of adherence (Adj-PR: 2.04, 95 % CI: 1.06-3.93). Patients on 12-hourly regimens had higher adherence (Adj-PR: 1.55, 95 % CI: 1.03-2.33) than 6-hourly regimens. Patients with uncomplicated skin-infections had higher adherence (Adj-PR: 1.72, 95 % CI: 1.22-2.47), while other symptoms showed no significant association.

Conclusion

Targeted interventions in diverse healthcare settings are essential, including user-centric research and enhancing patient knowledge and involvement. Strengthening patient-physician relationships and involving community pharmacies in antimicrobial stewardship programs can improve antibiotic dispensing and counselling practices among drug-sellers.

Improving Therapeutic Adherence and Reducing Therapeutic Inertia in the Management of People with Cardiometabolic Diseases: A Call-to-Action from the Middle East

Hypertension, dyslipidemia, and type 2 diabetes are highly prevalent and poorly controlled cardiometabolic diseases in the Middle East. Therapeutic non-adherence and therapeutic inertia are major contributors to this suboptimal disease control. Regardless of the cardiometabolic disease, evidence-based solutions may be used to improve therapeutic non-adherence and overcome inertia, and thereby help to alleviate the heavy burden of cardiovascular disease in the Middle East. Such solutions include the routine and early use of single-pill combinations, educational initiatives for patients, and multidisciplinary team-based care. This article highlights these and other potential solutions for therapeutic non-adherence and inertia, as discussed at the 2024 Evidence in the Cardiometabolic Environment (EVIDENT) Summit. There is now a 'call-to-action' from healthcare providers and other stakeholder groups to ensure that the solutions discussed at this meeting are implemented within health systems in the Middle East to significantly improve cardiovascular outcomes.Infographic available for this article.

Enhancing Therapy Adherence: Impact on Clinical Outcomes, Healthcare Costs, and Patient Quality of Life

Adherence to therapy, defined as the extent to which a patient follows prescribed therapeutic recommendations, is a pivotal factor in the effective management of chronic diseases such as diabetes, hypertension, and cardiovascular conditions. This review highlights the profound influence of adherence on clinical outcomes, healthcare costs, and patient quality of life. Despite its critical importance, non-adherence remains a pervasive challenge globally, contributing to suboptimal treatment results, higher rates of complications, increased hospitalizations, and substantial healthcare expenditures. This narrative review examines the multifaceted impact of adherence, focusing on its role in achieving clinical efficacy, mitigating economic burdens, and enhancing patient well-being. The findings reveal that poor adherence exacerbates the risk of disease progression, complications, and higher healthcare costs. Conversely, improved adherence promotes better disease control, fewer complications, and enhanced patient quality of life. Interventions such as patient education, streamlined treatment regimens, and the integration of digital health tools have shown promise in addressing adherence barriers. Furthermore, the role of healthcare professionals is underscored as fundamental, with their continuous support, effective communication, and efforts to build patient trust being essential to fostering better adherence. In conclusion, adherence significantly affects clinical outcomes, healthcare costs, and patient quality of life. Addressing barriers to adherence requires a comprehensive and personalized approach, considering individual patient needs and circumstances. Future research should prioritize the long-term evaluation of emerging technologies and the development of tailored strategies to improve adherence across diverse patient populations. Strengthening adherence is not only crucial for individual patient outcomes, but also for enhancing the sustainability and efficiency of healthcare systems.

Impact of an SMS intervention to support type 2 diabetes self-management: DiabeText clinical trial

BACKGROUND

Complications arising from uncontrolled type 2 diabetes mellitus (T2DM) pose a significant burden on individuals' wellbeing and healthcare resources. Digital interventions may play a key role in mitigating such complications by supporting patients to adequately self-manage their condition.

AIM

To assess the impact of DiabeText, a new theory-based, patient-centred, mobile health intervention integrated with electronic health records to send tailored short text messages to support T2DM self-management.

DESIGN AND SETTING

A pragmatic, phase-three, 12-month, two-arm randomised clinical trial involving primary care patients with T2DM in the Balearic Islands, Spain, including in urban and rural areas.

METHOD

In total, 742 participants with suboptimal glycaemic control (glycated haemoglobin [HbA1c] level >7.5) were randomly allocated to a control (usual care) or intervention (DiabeText) group. In addition to usual care, the DiabeText group received 167 messages focused on healthy lifestyle and medication adherence. The primary outcome was HbA1c level. Secondary outcomes were: medication possession ratio; health-related quality of life (measured using the EQ-5D-5L questionnaire); diabetes self-efficacy (measured using the Diabetes Self-Efficacy Scale [DSES]); and self-reported adherence to medication, Mediterranean diet (measured using the 14-Item Mediterranean Diet Adherence Screener [MEDAS-14]), and physical activity (measured using the International Physical Activity Questionnaire [IPAQ]).

RESULTS

Over the 12-month period, no statistically significant differences in HbA1c were observed between the intervention and the control groups (ß = -0.025 [95% confidence interval {CI} = -0.198 to 0.147; P = 0.772]). In comparison with the control group, the DiabeText group showed significant (P<0.05) improvements in self-reported medication adherence (odds ratio = 1.4; 95% CI = 1.0 to 1.9), DSES (Cohen's d = 0.35), and EQ-5D-5L (Cohen's d = 0.18) scores, but not for the rest of the secondary outcomes.

CONCLUSION

DiabeText successfully improved quality of life, diabetes self-management, and self-reported medication adherence in primary care patients with T2DM. Further research is needed to enhance its effects on physiological outcomes.

Cardiovascular medication adherence testing in patients living with HIV: A single-centre observational study

INTRODUCTION

People with HIV (PWH) are at an increased risk of developing cardiovascular disease (CVD) compared to HIV-negative individuals. We sought to evaluate the adherence to medications for CVD in PWH and identify factors associated with non-adherence to these medications.

METHODS

We conducted a cross-sectional study at the University Hospitals of Leicester NHS Trust between 16 April 2019 and 8 November 2022. We recruited consecutive PWH, who were attending a routine follow-up outpatient appointment and were prescribed at least one medication for CVD. In addition, we included urinary adherence results of patients with samples collected as part of routine clinical care. We used liquid chromatography-tandem mass spectrometry (LC-MS/MS) to assess if their prescribed medications (antihypertensives, diuretics, beta-blockers, lipid-lowering agents, antiplatelets, anticoagulants, antidiabetic medications) were present in the participant's urine sample. Multivariable models were used to identify demographic or clinical features that were associated with non-adherence.

RESULTS

A total of 162 PWH were included in the analysis. Median age was 55 [interquartile range (IQR): 50-61] years, 63% were male, average time living with HIV was 15 years (IQR: 11-19) and the majority (98%) had an undetectable HIV viral load. In approximately one-third of patients (59/162), at least one prescribed medication of interest was not detected in urine. Non-adherence to lipid-lowering agents was common (35/88, 40%). On multivariable logistic regression, the number of prescribed cardiovascular medications, was associated with medication non-adherence [medication non-adherence, per one medication increase: adjusted odds ratio (95% confidence interval) = 1.78 (1.34-2.36); p < 0.001].

CONCLUSION

We found sub-optimal adherence to medications for CVD in PWH. In order to maximize the clinical benefit of statin therapy in PWH, factors requiring consideration include: improved medication adherence, awareness of polypharmacy, educational interventions and quantitative assessment of sub-optimal adherence through chemical adherence testing.

Antihypertensive Medication Adherence and Medical Costs, Health Care Use, and Labor Productivity Among People With Hypertension

BACKGROUND

Hypertension affects nearly half of US adults yet remains inadequately controlled in over three-quarters of these cases. This study aimed to assess the association between adherence to antihypertensive medications and total medical costs, health care use, and productivity-related outcomes.

METHODS AND RESULTS

We conducted cross-sectional analyses using MarketScan databases, which included individuals aged 18 to 64 years with noncapitated health insurance plans in 2019. Adherence was defined as ≥80% medication possession ratio for prescribed antihypertensive medications. We used a generalized linear model to estimate total medical costs, a negative binomial model to estimate health care use (emergency department visits and inpatient admissions), an exponential hurdle model to estimate productivity-related outcomes (number of sick absences, short-term disability, long-term disability), and a 2-part model to estimate productivity-related costs in 2019 US dollars. All models were adjusted for age, sex, urbanicity, census region, and comorbidities. We reported average marginal effects for outcomes related to antihypertensive medication adherence. Among 379 503 individuals with hypertension in 2019, 54.4% adhered to antihypertensives. Per person, antihypertensive medication adherence was associated with $1441 lower total medical costs, $11 lower sick absence costs, $291 lower short-term disability costs, and $69 lower long-term disability costs. Per 1000 individuals, medication adherence was associated with lower health care use, including 200 fewer emergency department visits and 90 fewer inpatient admissions, and productivity-related outcomes, including 20 fewer sick absence days and 442 fewer short-term disability days.

CONCLUSIONS

Adherence to antihypertensives was consistently associated with lower total medical costs, reduced health care use, and improved productivity-related outcomes.

Impact of Mobile Health Literacy, Stroke-Related Health Knowledge, Health Beliefs, and Self-Efficacy on the Self-Care Behavior of Patients with Stroke

Background: The recent substantial increase in the incidence of stroke cases has resulted in high medical expenses. Stroke necessitates ongoing care, emphasizing the importance of consistent self-management. The occurrence of stroke impacts healthcare costs and has far-reaching effects on social services, encompassing disability, unemployment, and other related concerns beyond individuals and families. This study aimed to assess the impact of mobile health literacy, stroke-related health knowledge, health beliefs, and self-efficacy on self-care behaviors of patients with stroke to plan tailored self-care interventions for this patient population. Methods: This descriptive survey included 99 stroke patients from three hospitals, which provided treatment equivalent to or better than general hospitals, in City C and was conducted between 7 July 2023 and 30 May 2024. The data collected from hospitalized stroke patients were analyzed using descriptive statistics, independent t-tests, one-way ANOVA, and multiple linear regression. Results: The self-care behavior of patients with stroke who participated in the study was 73.01 ± 12.24 points. Stroke self-efficacy was identified as a significant factor influencing stroke self-care behaviors and eating habits. Mobile health literacy and stroke self-efficacy also influenced medication and self-care behavior, whereas hypertension and stroke self-efficacy affected lifestyle self-care behaviors. Conclusions: Strengthening stroke self-efficacy, improving mobile health literacy, and addressing comorbidities such as hypertension are important for promoting self-care behavior in stroke patients.

The PRAMOS Study: PRostaglandin Analogues Monotherapy-Awareness Survey on Ocular Surface Involvement

INTRODUCTION

Even though the local tolerance of prostaglandin (PG) analogues has improved drastically since the introduction of preservative-free (PF) eye drops, prescription patterns still vary widely among practitioners and between countries and could have an impact on the ocular surface of treated patients and, in consequence, their adherence. The aim of this study is to explore the prescribing patterns of PG analogues monotherapy in France and to evaluate their impact on ocular surface status.

METHODS

This was a national multicenter cross-sectional observational study that was conducted by 18 glaucoma experts in France. Patients over 18 years of age and receiving monotherapy with topical PG analogues for the treatment of ocular hypertension and/or glaucoma, with no history of prior glaucoma surgery, were consecutively selected from the glaucoma outpatient clinics of participating physicians and underwent an ocular surface examination.

RESULTS

A total of 344 eyes of 344 patients were enrolled between November 2022 and November 2023. Prescribed PG monotherapy was PF in 271 (78.7%) patients. Clinical history and ocular surface evaluation indicated that 79.4% of the study population (n = 273) presented with at least one symptom or clinical sign of dry eye and that three patients out of four had an unstable tear film. Subgroup analysis comparing preserved and PF PG analogues showed a higher prevalence of conjunctival hyperemia and corneal staining in the preserved group. Multivariate analysis identified conjunctival hyperemia as consistently associated with preservative use (odds ratio = 7.654; p = 0.003 for moderate conjunctival hyperemia).

CONCLUSIONS

This study highlights the growing trend toward PF PG analogue prescriptions by specialists in France. However, ocular surface issues remain prevalent, impacting patient adherence and treatment efficacy. Comprehensive ocular surface examinations are crucial in glaucoma management to enhance long-term tolerance, compliance, and overall treatment success.

2023 All-Russian screening for hypertension: results

Aim. To assess awareness of blood pressure (BP) level, adherence to therapy and achievement of target BP in residents of Russian regions as part of the 2023 hypertension (HTN) screening campaign.

Material and methods. During May 2023, 4613 participants from 23 cities of Russia took part in the screening. Participation was voluntary without restrictions on sex. All patients aged over 18 years. During screening, BP and pulse were measured three times using automatic or mechanical BP monitors, and a questionnaire about behavioral risk factors, concomitant diseases and therapy was filled out. HTN was diagnosed with systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg and/or taking antihypertensive therapy (AHT).

Results. The analysis included data from 4585 respondents aged 18 to 95 years with an average age of 45 [28;59] years, of which 1729 were men (37,7%). The proportion of hypertensive patients was 49,6%. Among them, 62,8% took AHT and achieved target BP in 76,6% and 45,7% with the target BP criterion <140/90 mm Hg and <130/80 mm Hg, respectively. Most patients took dual AHT (37,4%), while monotherapy and triple therapy was registered in 27,5% and 23,4%, respectively. Initiation of therapy was performed with combination AHT in 43,7% of patients with HTN and 41,4% are currently using fixed-dose combination therapy. On-demand therapy was the most common reason for skipping medications and was more common in women, while men more often cited the high drug cost and a history of adverse reactions. Among patients with HTN, home BP measurement was associated with a higher prevalence of achieving target BP as follows: 1000 (60%) vs 100 (17%), p<0,001.

Conclusion. The data obtained indicate, on the one hand, a continuing insufficient level of awareness about high BP and the use of antihypertensive drugs among the population, but there is a tendency to improve the effectiveness of the treatment of hypertension, including the use of fixed-dose combinations of antihypertensive drugs.

Factors influencing medication adherence in co-morbid hypertension and diabetes patients: A scoping review

Introduction

Interest in medication adherence has expanded significantly, especially in relation to the management of hypertension or diabetes in recent years. A scoping review that focuses on medication adherence in the co-morbidity of hypertension and diabetes provides crucial guidance for effective management of these interrelated diseases.

Aim

To conduct a scoping review of factors associated with medication adherence among individuals with co-morbid hypertension and diabetes.

Methods

The evaluation was conducted in accordance with the PRISMA-ScR guidelines to ensure the quality of the study. We searched three databases (Scopus, CINAHL, Medline) and one search engine (Google Scholar) from April 2023 to July 2023 on studies related to medication adherence in co-morbid hypertension and diabetes. Except for reviews there were no restrictions on design, location, and time of study.

Results

In total, 972 studies that were not duplicated were obtained. After eligibility and screening procedures were completed, 31 articles were ultimately included in the scoping review. Medication adherence was significantly affected by patient, condition, therapy, socio-economic and health related factors. Intervention trials revealed that education and counselling by pharmacists, nurses, physicians, diabetes educators, community health workers and the use of telephone to motivate patients significantly improved medication adherence.

Conclusion

This review shows the intricate factors influencing medication adherence in patients with co-morbid hypertension and diabetes, emphasizing the need for tailored interventions involving healthcare professionals, policymakers, and researchers.

Physical activity influences adherence to pharmacological treatments in patients with severe mental disorders: results from the multicentric, randomized controlled LIFESTYLE trial

Introduction: Poor adherence to pharmacological treatment is frequent in people with severe mental disorders and it often causes lack of effectiveness of many psychotropic drugs. Thus, efforts should be made to improve adherence to pharmacological treatments in patients with these disorders. Methods: In this paper, based on the LIFESTYLE randomized, controlled multicentric trial, we aim to: 1) assess the level of adherence in a real-world sample of patients with severe mental disorders; 2) evaluate differences in treatment adherence according to patients' socio-demographic and clinical characteristics; 3) evaluate the impact of an innovative psychosocial intervention, on patients' adherence to treatments. The Lifestyle Psychosocial Group Intervention consists of group sessions, focused on different lifestyle behaviours, including healthy diet; physical activity; smoking habits; medication adherence; risky behaviours; and regular circadian rhythms. At end of each session a 20-min moderate physical activity is performed by the whole group. Results: The sample consists of 402 patients, mainly female (57.1%, N = 229), with a mean age of 45.6 years (±11.8). Less than 40% of patients reported a good adherence to pharmacological treatments. Adherence to treatments was not influenced by gender, age, diagnosis and duration of illness. At the end of the intervention, patients receiving the experimental intervention reported a significant improvement in the levels of adherence to treatments (T0: 35.8% vs. T3: 47.6%, p < 0.005). Patients practicing moderate physical activity reported a two-point improvement in the levels of adherence [odds ratio (OR): 1,542; 95% confidence intervals (CI): 1,157-2,055; p < 0.001], even after controlling for several confounding factors. Discussion: The experimental lifestyle intervention, which can be easily implemented in the routine clinical practice of mental health centres, was effective in improving adherence to pharmacological treatments.