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Wu Yan Fei. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 161-189). / Abstracts in English and Chinese. / Chapter 1. --- BACKGROUND --- p.1 / Chapter 1.1 --- Hong Kong health care system --- p.1 / Chapter 1.2 --- Medication compliance and treatment responses --- p.2 / Chapter 1.3 --- Definition of compliance --- p.5 / Chapter 1.3.1 --- Compliance --- p.5 / Chapter 1.3.2 --- Adherence --- p.6 / Chapter 1.3.3 --- Concordance --- p.7 / Chapter 1.4 --- Definitions of satisfactory compliance --- p.9 / Chapter 1.5 --- Importance of compliance --- p.10 / Chapter 1.6 --- Non-compliance as a behavioral disease --- p.12 / Chapter 1.6.1 --- Disease manifestation (Patterns of non-compliance) --- p.12 / Chapter 1.6.2 --- Prevalence/Epidemiology (Rate of non-compliance) --- p.14 / Chapter 1.6.3 --- Diagnosis (Detecting non-compliance) --- p.15 / Chapter 1.6.3.1 --- Direct methods --- p.16 / Chapter 1.6.3.1.1 --- Use of biological fluids --- p.17 / Chapter 1.6.3.1.2 --- Biological surrogate (Drug) markers --- p.18 / Chapter 1.6.3.1.3 --- Pharmacological indicators --- p.20 / Chapter 1.6.3.2 --- Indirect methods --- p.22 / Chapter 1.6.3.2.1 --- Self-report / Direct questioning --- p.24 / Chapter 1.6.3.2.2 --- Pill counts --- p.25 / Chapter 1.6.3.2.3 --- Diaries --- p.27 / Chapter 1.6.3.2.4 --- Electronic monitoring --- p.27 / Chapter 1.6.3.2.5 --- Physician estimates --- p.31 / Chapter 1.6.3.2.6 --- Outcome measurement and clinical judgment --- p.32 / Chapter 1.6.3.2.7 --- Presence of side effects --- p.33 / Chapter 1.6.3.2.8 --- Keeping of appointments --- p.34 / Chapter 1.6.3.2.9 --- Prescription refill rates --- p.34 / Chapter 1.6.3.3 --- Direct observation --- p.35 / Chapter 1.6.3.4 --- The ideal detection method --- p.36 / Chapter 1.6.4 --- Risk factors (Related factors of non-compliance) --- p.37 / Chapter 1 .6.4.1 --- Patient related factors --- p.37 / Chapter 1.6.4.1.1 --- Understanding and comprehension --- p.37 / Chapter 1.6.4.1.2 --- Health beliefs --- p.39 / Chapter 1.6.4.1.3 --- Socio-demographic factors --- p.44 / Chapter 1.6.4.1.4 --- Forgetfulness --- p.45 / Chapter 1.6.4.2 --- Illness --- p.46 / Chapter 1.6.4.3 --- Therapeutic regimen --- p.46 / Chapter 1 .6.4.4 --- Patient-practitioner relationship --- p.48 / Chapter 1.6.5 --- Treatment (Interventions) --- p.50 / Chapter 1.6.5.1 --- Education --- p.51 / Chapter 1.6.5.2 --- Dosing regimen planning --- p.55 / Chapter 1.6.5.3 --- Clinic scheduling --- p.57 / Chapter 1.6.5.4 --- Communication --- p.57 / Chapter 1.6.6 --- Intelligent non-compliance --- p.60 / Chapter 1.6.7 --- Overview of problems with compliance studies --- p.63 / Chapter 1.6.7.1 --- Complex and not effective --- p.64 / Chapter 1.6.7.2 --- Lack theoretical framework --- p.64 / Chapter 1.6.7.3 --- Fragmented studies --- p.65 / Chapter 1.6.7.4 --- Lack high quality compliance study --- p.66 / Chapter 1.6.7.5 --- Without long term follow up --- p.67 / Chapter 1.6.7.6 --- Correlation between compliance and desired therapeutic outcomes --- p.68 / Chapter 2 --- HYPOTHESIS AND OBJECTIVES --- p.71 / Chapter 3 --- METHODS --- p.75 / Chapter 3.1 --- Study design --- p.76 / Chapter 3.2 --- Outcome measures --- p.80 / Chapter 3.3 --- Statistical analysis --- p.81 / Chapter 3.4 --- Power analysis --- p.82 / Chapter 4. --- RESULTS --- p.85 / Chapter 4.1 --- Patient demographics --- p.85 / Chapter 4.2 --- Clinic attended and drug usage --- p.85 / Chapter 4.3 --- Non-compliant rates and its patterns --- p.86 / Chapter 4.4 --- Reasons for non-compliance --- p.86 / Chapter 4.5 --- Relationship between drug class and medication compliance --- p.86 / Chapter 4.6 --- Relationship between dosage frequency and medication compliance --- p.87 / Chapter 4.7 --- Clinical characteristics of compliant and non-compliant patients --- p.87 / Chapter 4.8 --- Comparison of non-compliant patients identified at baseline during the second reassessment --- p.88 / Chapter 4.9 --- Effects of pharmacist's telephone intervention on tertiary outcomes --- p.88 / Chapter 4.9.1 --- Medication compliance --- p.88 / Chapter 4.9.2 --- Blood pressure --- p.89 / Chapter 4.10 --- Effects of pharmacist's telephone intervention on secondary outcomes --- p.90 / Chapter 4.11 --- Primary end-points of compliant versus non-compliant patients --- p.91 / Chapter 4.12 --- Best predictors of mortality rate for the studied population --- p.92 / Chapter 4.13 --- Effects of pharmacist's telephone intervention on primary outcomes --- p.92 / Chapter 4.14 --- Clinical characteristics of non-compliant patients with / without second follow up --- p.93 / Chapter 4.15 --- Clinical outcomes of defaulted patients at the second visit --- p.93 / Chapter 5. --- DISCUSSION --- p.126 / Chapter 5.1 --- Study design --- p.126 / Chapter 5.2 --- Compliance assessment method --- p.126 / Chapter 5.3 --- Patient demographics and drug prescribing pattern --- p.128 / Chapter 5.4 --- Extent and pattern of non-compliance --- p.128 / Chapter 5.5 --- Reasons for non-compliance --- p.129 / Chapter 5.5.1 --- Lack of knowledge --- p.129 / Chapter 5.5.1.1 --- Dosing instructions --- p.129 / Chapter 5.5.1.2 --- Drug identification --- p.130 / Chapter 5.5.1.3 --- Storage --- p.131 / Chapter 5.5.2 --- Forgetfulness --- p.131 / Chapter 5.5.3 --- Problems with health beliefs --- p.132 / Chapter 5.5.3.1 --- Common myths or misconceptions --- p.132 / Chapter 5.5.4 --- Presence of side effects --- p.133 / Chapter 5.6 --- Predictability of non-compliance --- p.134 / Chapter 5.6.1 --- Socio-demographics --- p.134 / Chapter 5.6.2 --- Polypharmacy --- p.135 / Chapter 5.6.3 --- Dosing frequency --- p.137 / Chapter 5.6.3.1 --- "Little difference between daily, twice daily and thrice daily dosing." --- p.137 / Chapter 5.6.3.2 --- Importance of drug property in determining the impact of usual dosages --- p.138 / Chapter 5.6.3.3 --- The impact of missed dosage on clinical condition --- p.139 / Chapter 5.6.3.4 --- Practical issues regarding dosing frequency --- p.140 / Chapter 5.6.4 --- Drug Profiles --- p.141 / Chapter 5.7 --- Outcomes measure --- p.142 / Chapter 5.8 --- The role of pharmacist in chronic care --- p.147 / Chapter 5.9 --- The role of physician in chronic care --- p.155 / Chapter 5.10 --- Possible sources of bias and limitations --- p.156 / Chapter 5.11 --- Further studies --- p.156 / Chapter 5.12 --- Concluding remarks --- p.159 / Chapter 6. --- REFERENCES --- p.161 / Chapter 7. --- APPENDICES --- p.190

The development of Type 1 diabetes has a profound impact on many aspects of everyday life, health and well-being. In this thesis the literature relevant to different aspects coping with Type 1 diabetes is reviewed. The research described in the thesis includes (i) a prospective assessment of how psychosocial factors affect diabetes-related outcomes in adults following the onset of Type 1 diabetes, (ii) qualitative analysis of interviews that were conducted to explore the patient's perspective of what it means to cope with diabetes, and (iii) the development, pilot testing, and subsequent partial validation of a diabetes-specific questionnaire. The Edinburgh Prospective Diabetes Study examines the relationships between psychosocial variables recorded at diagnosis and diabetes related outcomes recorded at four months (n = 69), 12 months (n = 65), 24 months (n = 56) and 36 months (n = 40) after diagnosis. The results showed that individuals who had a lower socio-economic status had consistently poorer glycaemic control at 24 months (p < 0.001) and at 36 months (p < 0.01) after diagnosis. Diabetes knowledge at four months after diagnosis was a significant predictor of glycaemic control at 12 months (r= 0.35, p < 0.01) and at 36 months after diagnosis (r = 0.35, p < 0.05). In adults, self-reported outcomes were significantly predicted by longstanding psychological (e.g. personality traits) and social factors (e.g. quality of life). There was some evidence to suggest that coping strategies have an intermediate position between psychosocial factors and diabetes-related outcomes. The results and their implications for future research are discussed in terms of existing theories of coping. To date there are few psychometrically sound instruments capable of assessing how well a person is coping with their diabetes. With this in mind, the present research was undertaken to develop a new diabetes self-report measure termed the Diabetes Impact, Adjustment and Lifestyle Scales (DIALS). The development, pilot testing and partial validation of the DIALS are described. Semi-structured interviews (n = 1 0) were conducted to explore the patients' descriptions of their adjustment to diabetes and the impact that diabetes has on aspects of their daily life. A grounded theory approach (Strauss, 1987) was adopted to analyse the data. Several domains were established, from which items were generated. Two studies, a small pilot study (n =57), and a large cross-sectional validation study (n = 246) were carried out to establish the underlying structure, internal consistency, partial validity, and stability of the DIALS. Principal components analysis of the DIALS identified five dimensions: Impact, Adherence, Information-seeking, Fear of complications and Diabetes-related distress. Overall, the results suggest that the DIALS is a valid, reliable and stable indicator of coping in adults with Type 1 diabetes. A hierarchal model of causal relationships between psychological constructs (i.e. personality traits and illness-related coping constructs) and the DIALS was formulated and tested formally using Structural Equation Modelling. There was considerable overlap in the constructs, with evidence for two latent variables relating to 'emotionoriented' and 'task-oriented coping'. In summary, coping variables may be important mediators in the link between antecedent variables such as longstanding character traits (e.g. personality) and self-reported outcomes of diabetes.

This study was undertaken to test the satisfaction process as it relates to the consumption of prescription medication. The disconfirmation of expectations model was used as a framework for the study. The study sought to evaluate the impact the provision of drug information has on the satisfaction/dissatisfaction process. To accomplish this, consumers recruited from two community pharmacies were provided with a scenario that described the purchase, and consequences of taking a prescription product intended for the treatment of migraine headache. Each subject received a scenario that contained one of four (4) levels of drug information. The four levels were: (1) no drug information; (2) information about side effects; (3) information about effectiveness; and (4) information about effectiveness and side effects. Each subject also received a scenario that described one of four therapeutic outcomes. They were: (1) no side effects with total elimination of headaches; (2) no side effects with partial elimination of headaches; (3) side effects with total elimination of headaches; and (4) side effects with partial elimination of headaches. The disconfirmation of expectation model was supported by the study. Using an ANOVA model, analyses revealed that the provision of drug information resulted in more positive disconfirmation and higher levels of satisfaction when the outcome of therapy was less than optimal. The measures of future intention were also affected by the provision of drug information. Further analyses revealed satisfaction was a function of expectation and disconfirmation.

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The purpose of this study was to describe family members' influence on medication adherence rates for schizophrenic clients following an educational program presented simultaneously to both client and family member. Three chronic schizophrenic clients participated in this study, two were females, and the other was male. The two family members who provided data were husbands of the two female clients. The obtained scores and responses of two questionnaires was indicative of improved medication adherence for clients and family members. The level of adherence was similarly perceived by the clients and their family members as obtained scores and responses were similar across both time periods. However, family members' attendance at the program presentation did not influence the level of reported medicated adherence behaviors of their wives as compared to the client who attended the program alone because the greatest increase in obtained scores was reported by the client who attended the program alone.

This study examined the difference among 3 patient education intervention strategies and compliance in the hypertensive elderly. The strategies were verbal instructions, written instructions and both verbal and written instructions. An ex post facto descriptive design was implemented based on a Cognitive Information Processing Theory of Learning. Forty subjects were recruited and interviewed. Data analysis revealed that compliance did not differ significantly with the type of educational strategy.

M.Sc. (Med.), Dept. of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, 2011

Background. Hypertension carries a high risk of cardiovascular complications. Patient medication non-compliance has been identified to be an major factor for suboptimal blood pressure control in clinical practice. Different strategies have been proposed to improve patient medication compliance but their effects on clinical outcomes were inconsistent. Methods . A telephone survey was conducted to examine patient medication compliance with anti-hypertensive drugs in Hong Kong. I then established a Pharmacist-managed Compliance Clinic in a public out-patient setting and provided individualized patient education to non-compliant patients identified by physicians. A telephone follow-up was arranged at 4-week after intervention followed by a more in-depth reassessment on subsequent physician clinic visit day. The immediate endpoint was patient compliance rate. Intermediate endpoint was systolic and diastolic blood pressure control. Other outcome measures were control of other cardiovascular risk factors and level of healthcare resources utilization. / Conclusion. Pharmacist-managed Compliance Clinic is effective in improving patient medication compliance and has positive impact on clinical outcomes. (Abstract shortened by UMI.) / Results. A total of 853 patients were successfully contacted and completed the patient survey. According to our definition, 80.4% of patients interviewed were considered to be compliant. Factors associated with medication compliance included multiple drug therapy, presence of drug adverse effects, patient's awareness of preventive nature of medication, rapport between patient and physician, and full-time working status. A causal model was successfully established with latent factors identified for medication non-compliance. The factors included patient's functional status, provision of health advice and concern from physician, and patient's knowledge regarding reasons for drug taking. Another two hundreds hypertensive patients were followed at the Pharmacist-managed Compliance Clinic. On average, each patient attended 1.3 pharmacist visits. The non-compliance rate fell from 100% to 20% after a single pharmacist intervention. Significant improvement was observed in patients' mean blood pressures readings as well as the diabetic and lipid control. Positive impacts on healthcare resources utilization were also observed. / Chan Man Chi Grace. / "June 2005." / Adviser: Juliana C.N. Chan. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3730. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 126-151). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

Doctor of Philosophy / Asthma can be a chronic disorder requiring regular medications if the symptoms are persistent. The regimen is often complex, involving a number of drugs and a variety or routes of administration. Although drug therapy may not alter the natural history of asthma it can improve lung function enabling those with asthma to lead as near a normal life as possible. Thus medication compliance is an important factor in the managemnt of asthma. (Note : Special enclosures (Publication reprints) at end of thesis have been removed for digital submission, with permission of author)