Heart failure is a chronic condition that increases the risk for death and disability. Beta blockers and ACE inhibitors have become standard treatments in heart failure because clinical trials have demonstrated their beneficial effect on mortality and morbidity in these patients. As not much is known about adherence to these medications, the main objectives of this project were to determine long term adherence to ACE inhibitors and beta blockers and determine how various degrees of adherence to a beta blocker can affect major health outcomes in patients with heart failure.<p> Data was obtained from Saskatchewan health from January 1, 1994 to December 31, 2003 for all heart failure patients from their first hospitalization for heart failure. Adherence was calculated using the fill frequency measure of adherence, and all survival analyses were completed using the Cox proportional hazards model.<p>Although 14, 000 patients were admitted to hospital for a first admission for heart failure, only 1143 subjects started a beta blocker and 5084 subjects started an ACE inhibitor within 3 months of the index hospitalization. Within the first year, adherence was excellent for both beta blockers (80.8 percent) and ACE inhibitors (82.5 percent). The proportion of patients remaining adherent slowly decreased to reach approximately 60 percent, for both medication classes, after 4 years. There was no significant difference in all-cause mortality between patients with high adherence and low adherence, but there appeared to be a trend towards decreased survival time in those remaining adherent throughout the study period [HR = 1.18 (95% CI: 0.98 to 1.43; p=0.07)].<p>Since the overall rate of adherence to beta blockers was excellent in most patients during the first year, it is possible that non-adherence is not responsible for a significant burden of mortality in Saskatchewan heart failure patients, and perhaps and the focus of quality improvement should be optimal prescribing of evidence-based therapies, and continued adherence over time.

Syfte: Syftet med denna studie är att beskriva patienters inställning till sin antipsykotiska medicinering och orsaker till varför läkemedelsordinationer inte följs. Metod: Enkätstudie med kvalitativ innehållsanalys. Resultat: Två teman och 13 kategorier framkom för att beskriva patienters inställning till läkemedlet. Dessa teman är Läkemedel som hjälp och Läkemedel som belastning. Antalet kategorier under temat läkemedel som hjälp är nio stycken och antalet kategorier under temat läkemedel som belastning är fyra. För att beskriva varför ordinationer inte följts framkom fyra kategorier. Slutsats: Huvudresultaten i denna studie är de två teman som framkom, Läkemedel som hjälp och Läkemedel som belastning. Deltagarna i denna studie uppgav både positiva och negativa attityder till sin antipsykotiska medicin. Medicinen förbättrade sjukdomsbilden och ökade deras välbefinnande, men den var också förknippad med biverkningar och att man var bunden till att äta ett läkemedel. Inställningen till antipsykotiska läkemedel var dock övervägande positiv i denna studie. Deltagare som någon gång valt att sluta med medicinen uppgav att de gjort det på grund av glömska, biverkningar och en önskan om att få vara frisk. / Objective: The purpose of this study is to describe patients’ attitude to their medication and reasons why they may not be compliant to the medical treatment. Method: Data was collected using questionnaires and the data was analysed using qualitative content analysis. Results: Two themes and 13 categories emerged to describepatients’ attitude to their medication. The themes are Medication as an aid and Medication as a burden. There were nine categories describing the theme Medication as an aid and four to describe Medication as a burden. For reasons why patients did not adhere to medication treatment four categories emerged. Conclusion: The main results in this study are the two themes that emerged, Medication as an aid and Medication as a burden. The participants in this study expressed both positive and negative attitudes towards their antipsychotic medication. The medicine improved the clinical picture and their well-being, but it was also associated with side effects and that they were tied to a drug. Participants who stated that they had quit taking their medication one time or another had done so because of forgetfulness, side effects and a desire to be healthy.

This study evaluated the epidemiological relationship between diabetes and incident depression, as well as antidepressant medication utilization among indigent care patients diagnosed with diabetes. Medical data for 2,886 subjects receiving care in a public indigent care provider network were utilized for this study. Diagnoses of diabetes, depression, and other comorbid medical conditions were identified from the electronic medical record. Prescription claims data from the clinic pharmacy network were used to evaluate medication-taking behaviors. Clinical laboratory data were extracted, as available, from the electronic clinic records. After controlling for the influence of age, gender, race/ethnicity, marital status classification, and Charlson score, a diagnosis of diabetes was associated with a 42 percent reduction in odds of new-onset depression (p = 0.021). In the a priori analysis of factors associated with new-onset depression among diabetic patients, none of the risk factors evaluated were associated with incident depression at a statistically significant level. Post-hoc exploratory analyses revealed that female gender and White non-Hispanic race/ethnicity were associated with increased odds of a prevalent diagnosis of depression among diabetic patients. Patients with diabetes were more likely to be prescribed selective serotonin reuptake inhibitors (SSRIs) as their initial antidepressant medication compared to non-SSRIs. Diagnosis of diabetes was not associated with antidepressant switch, discontinuation, or 6-month antidepressant adherence; however, diagnosis of diabetes was associated with a higher level of 12-month antidepressant adherence (p = 0.024). Diagnosis of diabetes was also associated with a higher level of 3-month antidepressant persistence (p = 0.004), but not 12-month persistence. There were no statistically significant relationships observed between initial class of antidepressant medication prescribed and any of the medication-taking behaviors evaluated. For subjects with available data (n = 106), glycemic control was evaluated in terms of hemoglobin A1c. Increased antidepressant medication adherence was associated with higher hemoglobin A1c values during follow-up. Results suggest that prevalent diabetes is associated with a reduced risk of diagnosis of new-onset depression in indigent care patients. Further research is necessary to evaluate the effect that chronic comorbid medical conditions such as diabetes may have on antidepressant medication-taking behaviors, and the relationship between antidepressant exposure and glycemic control. / text

Thesis (Ph. D.)--University of Missouri-Columbia, 2009. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Vita. "May 2009" Includes bibliographical references.

Background - Mobile health (mHealth) interventions to promote medication adherence have shown promise; among patients primarily diagnosed with Coronary Heart Disease (CHD), however, there is a lack of evidence for nurse-led mHealth interventions, in this particular group in Iran. Aim - To refine and evaluate a pre-developed nurse-led mHealth intervention to promote cardiovascular medication adherence in Iranian adult, male and female Cardiac Rehabilitation (CR) outpatients. Methods - A quantitative-dominant mixed methods study was conducted drawing upon the Medical Research Council’s (MRC) Framework on the development and evaluation of complex interventions. Phase 1 comprised of a self-completion CHD patients’ survey (n=123) and three focus groups with cardiac nurses (n=23) within three public university-affiliated hospitals in Tehran, which in turn informed Phase 2 (the exploratory trial phase). The automated Short Message Service (SMS) medication reminder was designed based on the dimensions of adherence suggested by the World Health Organisation (WHO) and Bandura’ Self-efficacy Theory. The intervention was refined according to the findings from Phase 1 and then piloted in an Iranian CR setting. Seventy eight CHD patients who were 18 years or older, and had mobile phone access were recruited and randomised to receive either daily SMS reminders (n=39) or usual care (n=39) for 12 weeks. The primary outcome was the effect on cardiovascular medication adherence as measured by the self-reported Morisky Medication Adherence Scale; secondary outcomes explored the feasibility of the mHealth intervention, intervention effect on medication adherence selfefficacy, cardiac ejection fraction, cardiac functional capacity, hospital readmission/ death rate and health-related quality of life. Patient acceptability was assessed through completion of a post-intervention survey. Results - Feasibility was evidenced by high ownership of mobile phones in CHD patients, high application of SMS messaging, positive patients’ perception about the intervention, suboptimal cardiovascular medication adherence and patients’ high interest in receiving SMS reminders for their medications. Participants in the intervention group showed higher self-reporting of medication adherence compared to the usual care group χ2 (2) = 23.447; P < 0.001. The Relative Risk (RR) was indicated that it was 2.19 times more likely for the control group to be less adherent to their medications than the intervention group (RR = 2.19; 95% Confidence Interval (CI) 1.5 - 3.19). All secondary outcomes improved in the intervention group at the end of the study. Acceptability was evidenced by participants who received the intervention reporting that they perceived the SMS reminders useful. Conclusion - The SMS medication reminder intervention was well accepted and feasible with significantly higher reporting of medication adherence in Iranian CHD patients. Effect sizes were established for use in future follow-up evaluations of the mHealth intervention.

Tuberculosis (TB) is an infectious disease and nonadherence to medication can lead to new cases, multi-drug resistant TB, or potential death. Additionally, healthcare professionals and individuals with TB’s knowledge of the disease and medication adherence are crucial for successful completion of medication therapy. Patient education is one of the most important aspects of care provided in healthcare settings (CDC, 1994). TB tends to disproportionally affect minority and economically disadvantaged patient populations. The purpose of this mixed method study was to explore the relationship between spirituality, knowledge, and TB medication adherence among African Americans and Haitians. The primary research question was: What is the relationship between spirituality, knowledge and TB medication adherence among African Americans and Haitians? Quantitative data were gathered from 33 questionnaires and analyzed by two ANOVAs and four chi square analyses. The null hypothesis was not rejected; there was not a statistically significant relationship between spirituality and TB medication adherence (p =.208) among the study’s African Americans and Haitians. Qualitative data concerning participants’ knowledge of TB, gathered from 16 individual interviews further informed this analysis. Secondary research questions examined the role of spirituality, knowledge of TB and medication adherence among African Americans and Haitians. Four common themes emerged across both groups to answer the secondary research questions. Interviews revealed the themes: (a) God is in control, (b) stigmatization of TB, (c) lack of knowledge, and (d) fear of death. The theme lack of knowledge about TB was found to contribute to stigmatization of TB patients. However, in this study stigma and lack of knowledge were related to initial denial of symptoms and delayed diagnosis, but not found to be related to TB medication adherence. This study could help adult educators and health educators enhance their educational interventions, develop a better understanding of adult learning, resulting in early diagnosis and treatment ultimately decreasing transmission of TB, drug resistance, and potential death. Educators should be aware that TB patients’ spirituality may be an important part of how they cope with having TB. A larger scale study, conducted at multiple locations should be conducted to extend the findings of this small scale exploratory study. Further studies should be done to better determine what patient, healthcare provider and health care system factors might mediate relationships that may exist between lack of knowledge of TB, stigma and TB medication adherence.

Class of 2009 Abstract / Objectives: This study utilized a prescription claims database to retrospectively assess the relationship between adherence rates with a mood stabilizer in bipolar type I patients for: gender, age, psychiatric hospitalization rates, cost of services, and concomitant psychotropic medications. Methods: Adult patients with bipolar type I disorder (N=149; F=92 and M=57) who received at least two prescriptions of a mood stabilizer (i.e., carbamazepine, lamotrigine, lithium, oxcarbazepine, and valproic acid) during a 3-month intake period were included. Adherence to the mood stabilizer was retrospectively analyzed using high: >75% (> 274 days) vs. low: < 75% (< 274 days) supply of a mood stabilizer during 12-months. Results: Only 35.6% of the patients (N=53) met the criteria for > 75% adherence and 11.4% (N=17) met the criteria for > 90% adherence. There was a trend toward women having more days supply of a mood stabilizer compared to men (p=0.08) and older patients having a higher adherence rate with a mood stabilizer (p=0.06). The high adherence group had greater prescription costs (p<0.001) and total cost per year (R2=0.34, p=0.064) and more concomitant medications (p=0.04) than the low adherence group. Overall, there were no significant differences between the high and low adherence groups for mean hospital days, inpatient costs, and total cost of care. Among those patients that were hospitalized there was a negative correlation between adherence and inpatient cost (R2=0.49, p=0.024). Conclusions: Our findings suggest that patients with bipolar type I disorder demonstrate poor medication adherence with a mood stabilizer and that adherence rates based on a prescription claims database using two adherence categories may not be a predictive factor for psychiatric hospitalizations or cost of care.

Class of 2006 Abstract / Background: Patients with a medication adherence rate of 80-90 % have the highest incidence of developing drug resistance Human Immunodeficiency Virus (HIV). The optimal adherence rate of 95% is believed to be necessary to prevent resistance to medication therapy in HIV infected patients. This level of adherence can be difficult to achieve because of the complications and complexity of medication regimens currently available for HIV treatment. Objectives: To determine if therapeutic goals set by the patient by having interventional meetings with a pharmacist improved their medication compliance rate and laboratory monitoring. Study Design: A retrospective chart review. Setting: One HIV clinic with two sites. Patients: The estimated population of the clinic was 150 patients. Only data from 14 patients met the criteria of the study and was available for collection. Intervention: Patients met initially with a pharmacist and made medication therapy goals. The patients then returned to the pharmacist at least once in a six-month period to evaluate if the goals were achieved. Measurements: CD4+ counts and viral loads from 6 months before the start of the intervention, at the beginning of intervention, and at least 6 months after the intervention were collected for analysis. Self-reports of achieving goals and self reported compliance were also collected. Results: The results showed there was no significant change in the CD+4 count in either the pre vs. baseline (p=0.0.967) or baseline vs. post- (p=0.551). There was also no significant change in the viral load in either the pre vs. baseline (p=0.388) or baseline vs. post (p=0.344). The mean (± SD) number of pharmacist visits was 2.93 (± 1.77). There was no significant improvement in viral loads (p=0.359) and CD4+ counts (p=0.268) between patient who reported missing medications and those who reported not missing doses. The same was true for patients who reported they met self-goals and those who reported they did not meet their goals (viral load p= 0.421 and CD4+ p=0.411). Conclusions: This study found no significant association between patients who set their own therapeutic goals and visited with a pharmacist and those who did not. However, an important limitation is that only 14 patients met the inclusion criteria for the study and had the required data available. Additional research is needed to more fully evaluate this intervention.

archives@tulane.edu / Background Few studies have examined the association between parenting quality and behavioral adjustment in children and asthma incidence. Medication non-adherence is a proposed mechanism for the association between caregiver stress and asthma morbidity, but research on the association is limited. Aims To examine the association between parent-child relationship and child’s behavioral adjustment and asthma incidence, and to explore the association between caregiver stress and medication non-adherence in children with asthma. Methods Secondary analyses were conducted in two study populations: a birth cohort study in the United Kingdom and an intervention trial of children with asthma in inner-city New Orleans. The first two analyses defined asthma by parent report and current asthma medication use at five or seven years. Mother-child relationship and child’s behavioral adjustment were measured with the Child-Parent Relationship Scale (CPRS) and the Strengths and Difficulties Questionnaire (SDQ), respectively, at three years. Caregiver stress and medication non-adherence were measured using Cohen’s Perceived Stress Scale (PSS-4) and caregiver self-report, respectively, at baseline and twelve months. Results Among families with the most major life events, children with mothers reporting poorest compared to best CPRS had an adjusted OR=2.8 (95% CI: 2.3-3.6) for asthma. Adjusted odds ratios for the association between abnormal versus normal SDQ at 3 years and asthma at 5 or 7 years was 1.2 (95% CI: 1.0-1.5). Adjusted odds ratios for non-adherence due to running out of medications were 6.8 (95% CI: 1.0-47.6) in high versus normal stress caregivers. Conclusions Increased risk of asthma was observed among those with the poorest mother-child relationships and the most major life events, and in children with abnormal behavioral adjustment. A statistically significant adjusted association between caregiver stress and overall medication non-adherence was not observed, but an association between increased caregiver stress and non-adherence due to running out of medications was suggested. / 1 / Fritha Morrison

No description available.