<p><strong>Background:</strong> Coronary heart disease kills more than 7 million people worldwide each year. High levels of blood fat, cholesterol, contributes significantly to coronary heart disease. Lifestyle changes combined with lipid-lowering drugs, statins, is an effective treatment. But adherence to statins is low, not even a myocardial infarction always contributes to adherence. Adherence requires patient education and good communication between patient and physician. There is no deeper knowledge of why coronary heart patients stops with statin treatment. <strong>Objective:</strong> To describe how coronary heart patients experience the disease and the statin treatment, and furthermore, opportunities and difficulties to adhere with statin therapy. <strong>Design:</strong> An exploratory qualitative study. <strong>Method:</strong> 10 male coronary heart patients, 55-78 years were strategically selected from a cardiology clinic in a larger Swedish hospital. Patients were interviewed individually in a semi-structured form, 2009/2010. Data processing was done according to content analysis and yielded four themes: <em>empowerment, effects, decision basis, </em>and<em> trust.</em> <strong>Results:</strong> The patients did not mentioned heredity among the factors they could not affect in association with the disease. Several patients saw the medication as a limitation, doubted its efficacy, but mostly took it anyway, at least for a limited time. Medication and illness were associated with each other. Information requirements were in most patients. Many patients wanted to discontinue the statin therapy. <strong>Conclusion:</strong> Retention of power over the own body, good reference base for decision about adherence, and trust in health care. These are crucial components of patients’ adherence to statin therapy, in connection with coronary heart disease.</p> / <p><strong>Bakgrund:</strong><strong> Kranskärlssjukdom dödar drygt 7 miljoner människor i världen per år.</strong></p><p><strong>För höga halter av blodfettet kolesterol i blodet bidrar kraftigt till kranskärlssjukdom.</strong> <strong>Livsstilsförändringar kombinerat med blodfettssänkande läkemedel, statiner, är en effektiv behandling. Följsamheten till statiner är dock låg, inte ens genomgången hjärtinfarkt ökar följsamhet. Följsamhet kräver patientutbildning och god kommunikation mellan patient och läkare. Det saknas djupare kunskap om varför kranskärlspatienter slutar med statiner. Syfte: </strong><strong>att </strong><strong>beskriva hur kranskärlspatienter upplever sjukdomen och statinbehandlingen, samt möjligheter och svårigheter att följa statinbehandlingen. Design: </strong><strong>explorativ kvalitativ studie. Metod: </strong><strong>10 manliga kranskärlspatienter, 55-78 år valdes strategiskt via en kardiologklinik på ett större svenskt sjukhus. Patienterna intervjuades personligen i semistrukturerad form, 2009/2010. Databearbetning skedde enligt innehållsanalys och gav fyra teman:</strong><em> egenmakt, effekter</em><strong>, </strong><em>beslutsgrund, tilltro. </em><strong>Resultat:</strong><strong> Patienterna nämnde inte ärftlighet bland faktorer som ansågs opåverkbara i samband med kranskärlssjukdomen.</strong> Flera patienter såg medicinen som en begränsning och tvivlade på effekten, men tog den oftast ändå, åtminstone under en begränsad tid. Likhetstecken sattes mellan medicinering och sjukdom. Informationsbehov fanns hos flertalet patienter. Många patienter ville sluta med statinbehandlingen. <strong>Slutsats: </strong>Bibehållen makt över sin egen kropp, god referensgrund för beslut om följsamhet samt förtroende för sjukvården, är avgörande förutsättningar för kranskärlspatienters följsamhet till statinbehandling.<strong></strong></p>

Heart failure (HF) is a debilitating chronic illness that afflicts millions of Americans and carries a poor prognosis, likely due to insufficient medication and low-salt diet adherence, which exacerbates HF symptoms and leads to frequent rehospitalizations. Specific reasons underlying non-adherence among HF patients are unclear. Studies investigating reasons for adherence among HF patients have shown that correlates of poor adherence include demographic (i.e., age, income), functional (i.e., NYHA), and psychosocial (i.e., social support, depression) variables. Research studies among individuals with chronic diseases suggest that an individual’s beliefs about medicines may explain adherence, but this research is limited among HF patients. The purpose of this study was to examine how psychosocial variables and beliefs about medicines are related to self-reported medication and low-salt diet adherence among individuals with HF, while controlling for demographic and physical functioning variables. This study had three aims: 1) To examine the relationships between psychosocial variables (e.g., depression, hostility, social support) and adherence; 2) To examine the relationship between beliefs about medicines and adherence; and 3) To investigate whether beliefs about medicines moderate the relationship between psychosocial variables and adherence. An ethnically-diverse sample of 105 HF patients completed several measures assessing depressive symptoms, level of hostility, perceived social support, beliefs about medicines, and medication and low-salt diet adherence. Structural equation modeling revealed that higher depression, higher hostility, and a stronger belief that medications are harmful and/or overused by doctors were significantly related to worse medication adherence. Further, participants who believed that medicines are necessary and had few concerns about them were more likely to adhere to a low-salt diet. Age, income, and number of co-morbid illness also were significantly related to low-salt diet adherence beyond contributions of beliefs about medicines scales and psychosocial variables. Thus, overall it appears that different beliefs about medicines differentially influence medication versus low-salt diet adherence, and psychological disposition may not underlie low-salt diet adherence. These results can inform interventions of health care practitioners in addressing adherence issues with HF patients.

Background: Coronary heart disease kills more than 7 million people worldwide each year. High levels of blood fat, cholesterol, contributes significantly to coronary heart disease. Lifestyle changes combined with lipid-lowering drugs, statins, is an effective treatment. But adherence to statins is low, not even a myocardial infarction always contributes to adherence. Adherence requires patient education and good communication between patient and physician. There is no deeper knowledge of why coronary heart patients stops with statin treatment. Objective: To describe how coronary heart patients experience the disease and the statin treatment, and furthermore, opportunities and difficulties to adhere with statin therapy. Design: An exploratory qualitative study. Method: 10 male coronary heart patients, 55-78 years were strategically selected from a cardiology clinic in a larger Swedish hospital. Patients were interviewed individually in a semi-structured form, 2009/2010. Data processing was done according to content analysis and yielded four themes: empowerment, effects, decision basis, and trust. Results: The patients did not mentioned heredity among the factors they could not affect in association with the disease. Several patients saw the medication as a limitation, doubted its efficacy, but mostly took it anyway, at least for a limited time. Medication and illness were associated with each other. Information requirements were in most patients. Many patients wanted to discontinue the statin therapy. Conclusion: Retention of power over the own body, good reference base for decision about adherence, and trust in health care. These are crucial components of patients’ adherence to statin therapy, in connection with coronary heart disease. / Bakgrund: Kranskärlssjukdom dödar drygt 7 miljoner människor i världen per år. För höga halter av blodfettet kolesterol i blodet bidrar kraftigt till kranskärlssjukdom. Livsstilsförändringar kombinerat med blodfettssänkande läkemedel, statiner, är en effektiv behandling. Följsamheten till statiner är dock låg, inte ens genomgången hjärtinfarkt ökar följsamhet. Följsamhet kräver patientutbildning och god kommunikation mellan patient och läkare. Det saknas djupare kunskap om varför kranskärlspatienter slutar med statiner. Syfte: att beskriva hur kranskärlspatienter upplever sjukdomen och statinbehandlingen, samt möjligheter och svårigheter att följa statinbehandlingen. Design: explorativ kvalitativ studie. Metod: 10 manliga kranskärlspatienter, 55-78 år valdes strategiskt via en kardiologklinik på ett större svenskt sjukhus. Patienterna intervjuades personligen i semistrukturerad form, 2009/2010. Databearbetning skedde enligt innehållsanalys och gav fyra teman: egenmakt, effekter, beslutsgrund, tilltro. Resultat: Patienterna nämnde inte ärftlighet bland faktorer som ansågs opåverkbara i samband med kranskärlssjukdomen. Flera patienter såg medicinen som en begränsning och tvivlade på effekten, men tog den oftast ändå, åtminstone under en begränsad tid. Likhetstecken sattes mellan medicinering och sjukdom. Informationsbehov fanns hos flertalet patienter. Många patienter ville sluta med statinbehandlingen. Slutsats: Bibehållen makt över sin egen kropp, god referensgrund för beslut om följsamhet samt förtroende för sjukvården, är avgörande förutsättningar för kranskärlspatienters följsamhet till statinbehandling.

Human immune deficiency virus (HIV) and Acquire immune deficiency syndrome (AIDS) is a worldwide epidemic that impacts individuals physically, socially, and psychologically, and the rates of HIV/AIDS in youth are rising. Antiretroviral treatments have drastically prolonged life in individuals with HIV/AIDS; however, this type of treatment requires strict medication adherence. Many psychosocial factors impacting antiretroviral adherence have been explored, yet very little has been investigated regarding body image. This study investigated the potential impact of body dissatisfaction on antiretroviral medication adherence in adolescents with HIV. Seventy five male and female youth were administered questionnaires on the constructs of body dissatisfaction and medication adherence. Results support the hypothesis that body dissatisfaction negatively impacts medication adherence; yet, its effect in this sample was small (R2 = .06; F(1,61) =3.87, p =.05). Additionally, it was predicted that gender would moderate the nature of the relation between body dissatisfaction and medication adherence, given the disparate societal presentations of ideal body types among genders. However, within the current sample, gender did not have an effect on this relation. Furthermore, this study was interested in exploring if body dissatisfaction within a population of HIV-infected youth was best explained by specific body dissatisfaction with areas of the body associated with lipodystrophy or lipoatrophy syndromes. Due to a very small presentation of these syndromes in the final sample (n = 4), it was not surprising that body dissatisfaction was not best explained through specific dissatisfaction with these body parts. However, dissatisfaction with muscularity in general, was predictive of general body dissatisfaction regardless of gender. A discussion of these findings is included. This study is one of the first of its kind to explore the potential detrimental effects of body dissatisfaction in HIV infected youth.

Inflammatory bowel disease (IBD; Crohn’s disease & ulcerative colitis) is a chronic illness in which medication and dietary adherence may determine disease natural history and severity of symptoms. We hypothesized that age, prospective memory (PM) and body satisfaction would predict medication and dietary adherence in adolescents with IBD and that gender and age would modify the relation between body satisfaction and adherence, with older girls being less adherent than younger children. Fifty-seven participants aged 10-21 (M = 16.5, SD = 2.3) with IBD and their caregivers were recruited. Informed consent, demographics and body satisfaction questionnaires were completed. PM was assessed using a naturalistic task. Adherence was measured by the 1-week completion of a medication and dietary log. A questionnaire was administered to evaluate coping strategies used for overcoming obstacles to dietary adherence. Two hierarchical regressions were conducted for medication and diet adherence respectively. As hypothesized, age had a significant effect (â = -.42, p < .01) on dietary adherence, accounting for approximately 17% of the variance (R2change = .17; Fchange (1,41) = 8.57, p = .006), with younger children being more adherent. Body satisfaction had a greater and more significant effect on dietary adherence than age (â = -.33, p < .01); i.e. participants more satisfied with their body reported better dietary adherence (R2change = .28; Fchange (2,35) = 6.97, p < .05). Findings remained consistent across multiple measures of body satisfaction and dietary adherence. None of the predictors had a significant effect on medication adherence. Health care providers who treat adolescents with IBD and parents should be made aware of factors affecting adherence in order to improve disease outcomes and patients’ quality of life.

The main purpose of this study was to evaluate medication use patterns (i.e., dose escalation, medication adherence, persistence, and switching) of rheumatoid arthritis (RA) patients on etanercept (ETN), infliximab (IFX) or adalimumab (ADA) and the associated healthcare utilization costs using Texas Medicaid data. Study participants were Medicaid beneficiaries (18-63 years) with an RA diagnosis (ICD-9-CM code 714.0x) who had no claim for a biologic agent in the 6-month pre-index period (July 1, 2003 - Dec 31, 2010). The index date was the first date when the patient had the first fill for any of the study TNF inhibitors (ETN, ADA or IFX) within the study identification period (Jan 1, 2004 – Aug 31, 2010). Data were extracted from July 1, 2003 to August 31, 2011. Prescription and medical claims were analyzed over an 18-month study period (i.e., 6-month pre-index and 12-month post-index periods). The primary study outcomes were adherence, persistence, dose escalation, switching and cost (i.e., total healthcare, RA-related and TNF inhibitor therapy cost). The study covariates were demographic factors (age, gender, race/ethnicity), pre-index use of other RA-related medications (pain, glucocorticoids and disease modifying antirheumatic drugs), total number of non-study RA-related medications used at index, pre-index RA and non-RA related visits, pre-index healthcare utilization cost and Charlson Comorbidity Index score. Conditional regression analyses, which accounts for matched samples, were used to address the study objectives. After propensity score matching, 822 patients (n=274/group) comprised the final sample. The mean age (±SD) was 48.9(±9.8) years, and the majority of the subjects were between 45 and 63 years (69.2%), Hispanic (53.7%) and female (88.0%). Compared to patients on ETN, the odds of having a dose escalation were ≈ 5 [Odds Ratio= 4.605 [95% CI= 1.605-12.677], p=0.0031] and ≈ 8 [Odds Ratio=7.520, [95% CI= 2.461-22.983], p=0.0004] times higher for IFX and ADA patients, respectively, while controlling for other variables in the model. Compared to ETN, patients on IFX (p=0.0171) were more adherent while adherence was comparable with patients on ADA (p=0.1144). Compared to patients on ETN, the odds of being adherent (MPR ≥ 80%) to IFX was ≈ 2 times higher [Odds Ratio= 2.437, [95% CI=1.592-3.731], p < 0.0001] while controlling for other variables in the model. Persistence to index TNF inhibitor therapy and likelihood to switch or discontinue index TNF inhibitor therapy were comparable among the 3 study groups. In addition, the duration of medication use (i.e., persistence) prior to switching or discontinuation of index therapy was comparable among the 3 study groups. Furthermore, for each of the cost variables (total healthcare, RA-related and TNF inhibitor therapy cost), costs incurred by patients on ETN were significantly lower (p < 0.01) than those incurred by ADA patients but significantly higher (p < 0.01) than those incurred by IFX patients. Finally, a positive and significant relationship (p < 0.0001) was found between RA-related healthcare cost, adherence and persistence to TNF inhibitor therapies. In conclusion, ETN was associated with lower rates of dose escalation compared to ADA or IFX. However, adherence was better and associated healthcare costs were lower with IFX. Clinicians should endeavor to work with each individual patient to identify patient-specific factors responsible for poor medication use behaviors with TNF-inhibitor therapies. Reducing the impact of these factors and improving adherence should be included as a major part of the treatment plan for each RA patient. RA patients need to be adequately educated on the importance of adhering and persisting to their TNF-inhibitor therapy as poor medication adherence/persistence negatively impacts the RA disease process. / text

Background: Inappropriate use of medications (IUM), in particular inappropriate prescribing and non-adherence to prescribed medications, are important causes of drug-related morbidities (DRMs). They are increasing problems with the ageing populations and the growing burden of chronic conditions. However, research is needed on the association of IUMs with DRMs in outpatient settings and in the general population. Aim: The aim of this thesis is to estimate and analyse the burden of potentially inappropriate prescriptions (PIPs) in the elderly and non-adherence to long-term medications among adults across care settings, and to investigate how IUM is associated to DRMs. Methods: A meta-analysis summarised the previous evidence on the percentage of adverse drug reactions (ADRs) associated to IUM across healthcare settings (Study I). From a cohort in the general population, using medical records and register data, the prevalence of PIPs in the elderly and its association with ADRs were estimated retrospectively (Study II). From the same cohort, the factors associated with refill non-adherence to antihypertensive therapy, considering the use of multiple medications, and the association between non-adherence and sub-therapeutic effects (STEs) were investigated (Study III). A survey assessed the refill behaviour to antihypertensive, lipid lowering and oral antidiabetic medications (undersupply, adequate supply and oversupply), and its association with perceived ADRs and STEs (Study IV). Results: IUM was the cause 52% and 45% of ADRs occurring in adult outpatients and inpatients respectively. Across healthcare settings, 46% of the elderly refilled PIPs over a 6-month period; PIPs were considered the cause of 30% of all ADRs; and the elderly who were prescribed PIPs had increased odds to experience ADRs (OR 2.47, 95% CI 1.65-3.69). In total, 35% was nonadherent to the full multidrug therapy and 13% was non-adherent to any medication (complete non-adherence).  Sociodemographic factors (working age and lower income) were associated with non-adherence to any medication, while clinical factors (use of specialised care, use of multiple medications, and being a new user) with non-adherence to the full multidrug therapy. STEs were associated with non-adherence to any medication a month prior to a healthcare visit (OR 3.27, 95% CI 1.27-8.49), but not with long-term measures of non-adherence. Among survey respondents, 22% of the medications were oversupplied and 12% were undersupplied. Inadequate refill behaviour was not associated with reporting ADRs or STEs (p&lt;0.05). Conclusions: A large proportion of ADRs occurring in hospital is caused by IUM, but more knowledge is needed in other settings. PIPs are common in the elderly general population and associated with ADRs. Therefore decreasing PIPs could contribute towards ADR prevention. Considering the use of multiple medications may help to better understand the factors associated with non-adherence to a multidrug therapy for tailoring the interventions to patient needs. Monitoring the adherence prior to a healthcare visit may facilitate interpreting STEs. Yet, the absence of an association between long-term measures of refill non-adherence with clinical and perceived DRMs suggest the need to enhance the knowledge of this association in clinical practice. In summary, this thesis shows a significant potential for improvements of medication use and outcomes.

According to the Puerto Rico Health Department as of January 2008, 258 cases of HIV, ages 10 -19 had been reported and 224 cases of AIDS, ages 13-19 (Puerto Rico Health Department, 2008). The purpose of this research was to describe the basic social processes of medication adherence in Puerto Rican youth who are HIV positive. Three research questions were proposed: 1) What are the basic social processes of medication adherence in Puerto Rican youth who are HIV- positive?; 2) What factors influence medication adherence (or nonadherence) among HIV- positive adolescents?; 3) What behaviors indicate that the HIV- positive adolescents adhere or do not adhere to their prescribed medications? The Autonomy Development of Adolescence by Steinberg provided the theoretical framework for this study. Grounded theory was used to study 13 Puerto Rican HIV-positive adolescents. Data collection included semi-structured, in-depth interviews, field notes, participant observation, and a demographic questionnaire. A substantive theory Striving to Live a Normal Life, with the core category of normal emerged from data analysis. Striving to Live a Normal Life explains how these Puerto Rican HIV-positive adolescents try to integrate their HIV status and treatment with their lives. These adolescents concentrate their lives on striving to live a normal life. A variety of ways is used to deal with HIV and has helped them visualize themselves as a normal adolescent with a normal life. Because they see themselves having a normal life, taking or not taking their medications for HIV is also seen as a normal part of their lives. This study suggests the beginning of understanding the concept and process of normalization in this population. These findings support the findings in a study done with HIV-positive adolescents from France in which the concept of normality was related to their lives. It also informs interventions to promote improved medication adherence among Puerto Rican youth who are HIV -positive.

There are approximately 22.2 million Americans’ who are living with asthma and of those 18.4 million are adults. African Americans’ are more likely to be diagnosed with asthma compared to Caucasians, and experience more asthma attacks. In this study, the Social Cognitive Theory was used to examine the relationships among personal characteristics, environmental factors, asthma self-efficacy, self-management behaviors, and quality of life (QOL) in African American adults with asthma. A correlational design was used. Data were collected from a non-random sample of adult African Americans’ with asthma (N = 39) using the following self-report questionnaires: the Knowledge, Attitude, and Self-Efficacy of Asthma Questionnaire (KASE), the short form of the Rapid Estimate of Adult Literacy in Medicine (REALM-SF), the Medical Outcomes Study (MOS) for social support, the Asthma Trigger Inventory (ATI), the Morisky Medication Adherence Questionnaire, Asthma Self-Management Questionnaire (ASMQ), the Modified Pittsburgh Sleep Quality Index (PSQI), the Asthma Control Test (ACT), and the Asthma Quality of Life Standardized (AQLQ-S). Data analyses included descriptive statistics, Pearson Product correlations, and hierarchical multiple regression. On average, participants (N = 39) were middle aged (M = 55.9 ± 7.9) years, female (65%), did not smoke (87%), did not use a peak flow meter (PEFR) to self-manage their asthma (72%), and were obese (M = 34.06, SD = 10.78). Participants reported high confidence in asthma self-management; however, had low medication adherence and scores indicating uncontrolled asthma (M = 16.10, SD = 4.29). More than half (67%) of the participants reported poor sleep quality (PSQI). BMI and sleep quality accounted for significant variance (38%) in asthma QOL (F (2, 38) = 7.08, p = .001). Social support was an independent predictor of asthma self-efficacy (F (2, 38) = 5.65, p = .02). Better control of weight and asthma symptoms may improve sleep quality. Health care providers need to address the ongoing challenges of asthma self-management and monitor sleep quality. Encouraging the use of peak flow meters, which have been shown to improve self-management and asthma control, may result in better quality of life for African Americans’ with asthma.

L'auteur n'a pas fourni de résumé en français / Individuals do not always enact their intentions into behaviours, which may lead to severe outcomes especially in health-related fields. Self-regulation strategies, like cuedependent plans interventions, have shown efficiency to help to counter the intentionbehaviour gap. Yet, no review has been realised recently to bring a qualitative and quantitative analyses of this effect.Firstly, we carried out a qualitative review to evaluate the effectiveness of cuedependent planning intervention to increase health-related behaviours. We included 329 studies with experimental and prospective designs that measured or evaluated the effect of cue-dependent plans (e.g. implementation intention, action planning, coping planning) on health-related behaviours, among general, clinical and student population. The qualitative analysis revealed for instance that implementation intentions were used in majority, even if the if-then format was not systematically adopted. However, we oticed confusion between the terminologies of the plans and the theories. A quantitative review will be realised to evaluate the effect size and the moderators that could magnify or diminish the effects of cuedependent planning interventions on health-related behaviours. Second, we presented two studies that tested the effectiveness of cue-dependent planning interventions on physical activity, which was the most represented health outcome in cue-dependent planning interventions, according to our review. Motivational (mental simulation) and volitional (implementation intention) interventions were combined to promote physical activity participation. The first study, adopting a cluster randomised controlled trial design among students, did not show any significant effect neither of the mental simulation plus implementation intention intervention, nor of the implementation intention intervention compared to the control condition. The second study adopted a more rigorous methodology with a full-factorial randomised controlled design, with a larger sample and objective measures of physical activity (attendance to gym centre). Nevertheless, the study revealed no statistically significant main or interactive effects of the mental simulation and implementation intention conditions on physical activity outcomes. Findings were not in line with previous research that showed effects of cue-dependent plans to promote physical activity. This adds to the necessity of identifying the moderators of these interventions in health behaviours.Thirdly, cue-dependent planning interventions are needed in illness behaviours. In chronic disease, non-adherence to medication is a public health problem that can lead to negative health outcomes. Even if the patients want to take their treatment, they may, for instance, forget it and fail to enact the behaviour. We tested the ability of an intervention adopting implementation intention and coping planning to promote medication adherence. In a randomized controlled trial, outpatients with cardiovascular diseases were randomly allocated to either an implementation intention and coping planning condition, or to a noplanning control condition. Findings revealed no significant effect of the intervention on medication adherence. However, post hoc moderator analyses showed that the beliefs moderated the effect of the intervention, which was effective in patients with lower necessity beliefs compared to those with higher necessity beliefs. The design used in the study did not enable to test the direct an interactive effect on medication adherence, so it would be necessary to replicate these findings with a full factorial design among patients with cardiovascular diseases.