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Many children with epilepsy face challenges in adhering to their medication, leading to inadequate seizure control. However, the most effective intervention is still unclear. This integrative review's main goal was to examine and synthesize the existing literature on interventions for promoting medication adherence in children with epilepsy. This integrative review followed Whittemore and Knafl's five-stage framework. Four electronic databases (PubMed, ScienceDirect, Scopus, and CINAHL Complete) were systematically searched from 2013 until 2024 to identify eligible studies published in the English language. The key search terms included "Children with epilepsy" AND "medication adherence" AND "intervention." Studies reporting on the implementation and evaluation of medication adherence interventions in children with epilepsy were eligible. Quality assessment and narrative synthesis were subsequently undertaken. A total of 17 studies were included in the review. Five interventions were found, including educational, behavioral, and mixed intervention types, using technology and family involvement. Promoting medication adherence is crucial, but tailored interventions for different age groups and sustained support are needed. Promoting medication adherence is of utmost importance to enhance the knowledge of children who have epilepsy and their families, and to increase medication adherence. However, there is still a need to develop interventions that are appropriate for children of different ages and their families, which should be suitable and sustainable during treatment. Pediatric nurses should consider socioeconomic factors, ethnicity, family functioning, and parental distress. Strategies include monitoring adherence, continuous communication, and technology support for children with epilepsy during treatment. • This study identified five existing interventions enhancing medication adherence among children with epilepsy. • Effective and sustainable medication adherence interventions are needed for children and their families. • Medication adherence and communication in children with epilepsy rely on family support and technology. [ABSTRACT FROM AUTHOR]

Background: Adherence to antihypertension medications has been explored in previous studies; however, these studies generally focus on individuals who reside in urban areas. Improved understanding is needed regarding rural older adults who are self-managing medications for hypertension and the motivational factors that may influence adherence. Objectives: The purpose of this study was to examine medication adherence among rural older adults with hypertension and the association with motivational factors as defined in self-determination theory, including quality of motivation (autonomous vs controlled), perceived competence, perceived autonomy support, and basic psychological needs satisfaction. Rural nursing theory was also used to explore the concept of resilience. Methods: This cross-sectional study involved 80 older adults (≥65 years old) self-managing at least 1 prescribed medication for managing their hypertension. Participants ranged in age from 65 to 89 (mean [SD], 74.04 [6.18]) years from rural areas in the northwest. Participants completed a demographic questionnaire, a measure of medication adherence, and questionnaires to assess perceived autonomy support, basic needs satisfaction, autonomous and controlled motivation, perceived competence, and resilience. Results: Correlational analysis and multiple regression were used to examine associations and predict adherence. Perceived autonomy support, resilience, cost of medication, and medication regimen complexity were the only variables significantly associated with medication adherence and predicted adherence. Resilience mediated the relationship between perceived autonomy support and medication adherence. Conclusions: Overall, findings indicate high levels of adherence. Interventions that enhance perceptions of autonomy support and resilience may be useful in managing hypertension. [ABSTRACT FROM AUTHOR]

Background: Hypertensive patients with high-risk comorbidities require medications for each condition, leading to greater burden. The number of chronic conditions can affect patients' concurrent medication adherence. Objective: We aimed to compare the characteristics of groups based on their concurrent medication adherence and investigate the association between the number of high-risk comorbidities and concurrent medication adherence for patients with hypertension and high-risk comorbidities. Methods: A secondary data analysis was performed with the 2018 Korea Health Panel Survey, including 2230 patients with hypertension and at least 1 high-risk comorbidity who were prescribed medications for at least 2 conditions. Using medication adherence for each condition, we identified 3 concurrent medication adherence groups: adherent, suboptimal, and nonadherent groups. Multinominal logistic regression was used to determine the association between the number of high-risk comorbidities and the concurrent medication adherence groups. Results: Adherent, suboptimal, and nonadherent groups included 85%, 11%, and 4% of the patients, respectively. Whereas having more high-risk comorbidities was associated with belonging to the suboptimal group compared with the adherent group (adjusted odds ratio, 1.46), having fewer high-risk comorbidities was associated with belonging to the nonadherent group compared with the adherent group (adjusted odds ratio, 0.52). Conclusions: We identified 3 groups based on their concurrent medication adherence. Our results indicated that the relationship of the number of high-risk comorbidities with the concurrent medication adherence group was inconsistent. [ABSTRACT FROM AUTHOR]

This article aims to evaluate the adherence to antihypertensive treatment prevalence in the Brazilian population based on peer-reviewed studies which used instruments exclusively designed and/or adapted for this purpose. A systematic review with meta-analysis based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was carried out in the BDENF, SciELO, Cuiden, PsycINFOe, CINAHL, Embase, LILACS, and MEDLINE databases, as well as the AgeLine, Google Scholar and ScienceDirect academic search engines. The protocol was registered with PROSPERO (CRD42021292689). Random effects models were used for a meta-analysis of the prevalence obtained from individual studies. A total of 104 studies were included in the meta-analysis on antihypertensive treatment in the Brazilian population, totaling 38,299 patients. The most used instrument was the fouritem Morisky-Green Test (49.5%). The adherence prevalence estimated by the meta-analysis was 44.4% (95%CI: 39.12%-49.94%, I2= 91.17, p < 0.001), showing high heterogeneity. The adherence to antihypertensive treatment prevalence found in national studies was unsatisfactory, demonstrating that this problem continues to be a major challenge. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is associated with an increased risk of thromboembolic events; however, many patients with AF are noncompliant with medication regimens, which increases said risk substantially. Suboptimal health literacy presents significant hurdles to compliance with medical treatment. Here we present a case of an elderly Hispanic woman with AF and several comorbidities, including a history of dementia, who presented with consecutive recurrence of acute limb ischemia in the bilateral lower extremities just 3 days apart. Both events were successfully treated with endovascular thrombectomy. This case study not only showcases the efficacy of the latest endovascular technologies, but also draws attention to the importance of strict patient medication adherence in AF and the effects that health literacy can have on said adherence. [ABSTRACT FROM AUTHOR]

Introduction: Medication nonadherence has a number of clinical consequences, including an increased risk of relapse and recurrence. By offering individualized in-person pharmaceutical care counseling, pharmacists play a significant part in encouraging medication adherence. One of the most popular forms of communication in nowadays is the smartphone. As a result, one of the measures for enhancing patients' outcomes should be a smartphone app specifically designed for depression. Objectives: To investigate whether depression-specific counseling and smartphone app could improve medication adherence in newly diagnosed MDD patients. Methods: A prospective, randomized, pilot study was conducted in newly diagnosed major depressive disorder patients. They were randomly assigned to either the intervention or usual care groups (1:1). The intervention included in-person pharmaceutical care counseling along with the introduction use of a depression-specific smartphone app, whereas the usual care group received traditional pharmaceutical care counseling and simple chatbot. The primary outcome, medication adherence was measured using the Medication Adherence Rating Scale (MARS) and the percentage of pills counted (PC) at the one-month follow-up. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms as a secondary outcome. Results: The study was completed by 36 participants (18 intervention and 18 usual care). The average age was 29.81 years, and 65.38% of the participants were female. The two groups had similar baseline characteristics, including baseline PHQ-9 scores. The intervention group had a mean MARS score of 7.0 (IQR=5) higher than the usual group, which had a mean score of 4.5 (IQR=7; p-value=0.04). The intervention group had a higher PC percentage of 81.75 (IQR=33.33) more than the usual care group, which had a mean percentage of 69.95 (IQR=78.57; p-value=0.10). The mean difference of PHQ-9 scores between two visits for the intervention and usual groups was -1.44 [-2.61 - -0.28]. (p-value=0.02). Discussion and Conclusions: This study discovered that new patients with major depression who received depression-specific pharmaceutical care counseling along with smartphone app improved their medication adherence. In addition, improvement in overall depression symptoms was discovered. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Clinical trials of pre-exposure prophylaxis (PrEP) to prevent HIV infection have established its efficacy as upwards of 99%. Despite this, the effectiveness of this medication has been shown to be diminished by individual factors, such as medication adherence. We completed a systematic review to identify and describe interventions to improve oral PrEP adherence. Overall, 16 articles were located. Two of the articles reported on results from the same trial and were collapsed for analysis, bringing the total to 15 studies. Twelve unique PrEP adherence interventions were tested, with the most common intervention being the use of mobile phone technology, which was used in 7 (46%) of the studies. Ten (67%) studies found that medication adherence improved when participants received an intervention to support adherence. Adherence intervention strategies effectively improved PrEP adherence. Further research into PrEP adherence interventions is warranted, particularly among diverse groups. [ABSTRACT FROM AUTHOR]

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To develop and validate the Mobile Adherence Satisfaction Scale (MASS) for assessing user satisfaction with mobile health applications aimed to improve medication adherence. The study involved patients over 18 with asthma, hypertension, heart failure, or diabetes, who used the CareAide® app for six months. Scale development included a literature review, expert consultations, and patient interviews, initially identifying 129 items. These were refined to 27 using a two-round Delphi technique and grouped into six dimensions: user interface, perceived usability, system quality, service quality, feature satisfaction, and general satisfaction. A pilot study with 30 participants further refined the model, which was then validated with 135 participants using exploratory and confirmatory factor analyses in SPSS 29 and SmartPLS 4. Data were collected via self-administered questionnaires. A total of 135 complete questionnaires were analysed. Respondents had an average age of 66.7 years (SD = 11.6) with 42.2 % male (n = 57) and 57.8 % female (n = 78). After removal of an item due to cross loading, exploratory factor analysis resulted six dimensions and 26 items with Kaiser-Meyer-Olkin measure of 0.837 and Bartlett's Test of Sphericity (χ2(n = 325) = 2085.673, P < 0.001). The confirmatory factor analysis confirmed high reliability and validity: Cronbach's alpha values > 0.70 for each dimension and an overall alpha of 0.89, with Composite Reliability and Average Variance Extracted both >0.70 and >0.50, respectively, for each dimension. Structural model indicated a significant positive impact of user interface (β = 0.226, P = 0.006) and feature satisfaction (β = 0.230, P = 0.002) on general satisfaction, explaining 23.1 % of the variance (R2 = 0.231). The study developed and validated the MASS, a reliable tool for assessing user satisfaction with mHealth apps. User interface design and feature satisfaction are key for long-term engagement and consistent medication adherence. [ABSTRACT FROM AUTHOR]

Background: Medication restricting behaviours are common among persons with diabetes increasing risk for poor health outcomes. Persons with diabetes are more likely to experience food insecurity than persons without diabetes. Aim: This study aimed to assess the relationship between food insecurity and medication restricting behaviour among persons with diabetes in the United States. Methods: Data from the 2019 National Health Interview Survey (NHIS) data conducted in the United States was used for this analysis. Medication restricting behaviour was assessed by questions asking whether four restricting behaviours were present (skipped medication, took less medication, delayed filling a prescription and/or took less medication due to cost). Food insecurity status was obtained through a 10-item scale and participants were categorized as either food secure, low food security, or very low food security. Poisson regression evaluated the relationship between medication restricting behaviour and food insecurity controlling for confounders. Results: Participants with very low food security had a significantly higher mean number of medication restricting behaviours than participants who were food secure (adjusted mean ratio (AMR) = 4.01; 95% confidence interval (CI) = (3.09, 5.21)). Similarly, participants with low food security had a significantly higher mean ratio than participants who were food secure (AMR = 3.76; 95% CI = (2.86. 4.94). Conclusion: Persons with diabetes who have low or very low food security are at an increased risk for engaging in medication restricting behaviours. [ABSTRACT FROM AUTHOR]

Background: Due to the addition of multiple new medicines following an acute myocardial infarction (MI), medication non-adherence occurs frequently. Medication education can improve adherence, comprehension, and health-related outcomes. There is currently limited literature about individualised pharmacist-led medication education post-hospital discharge following an MI. Aim: To assess whether individualised, pharmacist-led education increased patient adherence and comprehension of cardiovascular medicines over a 12-week period following an MI. Method: All participants completed the Morisky Medication Assessment Scale (MMAS) of self-reported adherence at 1 week and 12 weeks post-hospital discharge. Alongside this, a questionnaire was completed to quantify comprehension of their treatment plan. Participants were randomised to receive individualised pharmacist-led education directed at their medication regimen at 4–6 weeks post-discharge. Data were analysed using paired t-tests and mixed-design analysis of variance (ANOVA). Ethical approval was granted by the Monash Health Human and Research Ethics Committee (Reference no: RES-21-0000234L) and the study conforms to the Australian National Statement on Ethical Conduct in Human Research. Informed consent was obtained from all participants via project information sheets, verbal explanations by recruiting pharmacists with reassurance there would be no difference in standard treatment should patients decline involvement in the project, and written consent forms were completed by all participants. Results: Of the 29 participants, 15 (51%) received pharmacist-led education. The intervention group’s mean MMAS score increased from 6.7 (moderate adherence) at week 1 to 7.6 (moderate adherence) at week 12 post-hospital discharge (p = 0.009). At 12 weeks, the intervention group demonstrated a statistically significant and greater mean MMAS score compared to the control group (7.6 moderate adherence and 6.9 moderate adherence respectively, p = 0.003). The intervention group’s mean comprehension level increased from 58% at 1 week to 90% at 12 weeks (p < 0.05). The intervention group demonstrated a greater mean comprehension level at 12 weeks compared to the control group (90% and 48.21% respectively, p < 0.001). Conclusion: This pilot study demonstrated that individualised, pharmacist-led education may improve self-reported medication adherence and comprehension. [ABSTRACT FROM AUTHOR]

Schizophrenia is a chronic condition that requiring maintenance treatment with antipsychotic medication. Medication adherence is essential to improve the symptoms of this health problem reduce relapses and readmissions and achieve treatment goals. The rate of challenges associated with medication adherence in schizophrenia is reported to be 26.5–85.1 %. This study was conducted to determine factors associated with medication adherence in individual s diagnosed with schizophrenia. A descriptive correlational research design was used. The study was completed with a total of 162 participants diagnosed with schizophrenia, between February–June 2021, at a Community Mental Health Center. Regression analysis (Model: enter and stepwise) was used to determine associated factors. The mean medication adherence score of individual diagnosed with schizophrenia indicated that more than half of the participants (52 %) had poor medication adherence. In individual diagnosed with schizophrenia, medication attitudes, level of internalized stigma, the status of regular attendance to appointments, belief in recovery, and using medicines as prescribed were complicating factors for medication adherence (p < 0.05). Medication adherence in individuals with diagnosed schizophrenia may be multifactorial. Mental health professionals should consider associated factors and implement a personalized treatment plan in this direction for strengthening adherence to medication treatment. • Medication nonadherence poses a significant challenge for individuals diagnosed with schizophrenia. • This paper contributes to the limited literature on factors related to medication adherence in this population. • The study explores links to deviations from prescribed regimens, negative attitudes toward medication, high internalized stigma, irregular attendance at medical appointments, and lack of belief in recovery. • Findings provide valuable insights for healthcare professionals aiming to promote medication adherence in schizophrenia, guiding targeted intervention strategies. [ABSTRACT FROM AUTHOR]

Copyright of Revista Colombiana de Psiquiatria is the property of Asociacion Colombiana de Psiquiatria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: This study aimed to investigate the predictive relationship between medication adherence in light of health literacy and social support, in addition to differences in medication adherence according to different demographic characteristics. Methods: In this cross-sectional descriptive study, 450 hypertensive patients visiting primary care facilities in Babil Governorate were included.... [ABSTRACT FROM AUTHOR]

• Telephoning early after starting medication supports citizens in addressing questions and concerns. • Prioritise supporting citizens without prior prescriptions. • Communication skills are essential for nurses conducting telephone follow-up (TFU) calls and involve listening to and understanding citizens' perspectives. • Evaluation design informs methods for investigating intervention effects through mechanism and moderator analysis Screening for cardiovascular disease (CVD) followed by preventive medication is expected to reduce CVD (2,3,5). However, insufficient medication adherence may affect screening effectiveness (11-12). It remains uncertain which interventions are suitable to support citizens in their decision-making about taking CVD preventive medication. We evaluated if and how three nurse-led telephone follow-up (TFU) calls supported citizens in making informed decisions regarding CVD preventive medication and thereby potentially strengthened their medication adherence. Employing a theory-based evaluation design inspired by Dahler-Larsen (39-41), we developed and tested a programme theory describing if and how the TFU calls supported medical decision-making and potentially improved medication adherence. Data were collected via telephone. We analysed 61 TFU calls collected between May 2017 and April 2019 and found that TFU calls supported participants' reflections on preventive medication. TFU calls supported informed decision-making regarding initiating medication, allowing participants to consider personal preferences and values, including both opting for and abstaining from medication. The content of the TFU calls revolved around four crucial themes: I) understanding the purpose of taking the medicine; II) meaningfulness and joint reflection support the decision; III) relation to healthcare professionals; and IV) taking medication for the first time. TFU calls effectively supported citizens' understanding and addressed their needs. Trusted healthcare professionals' recommendations were preferred for decisional support. Initiating CVD preventive medication was particularly challenging for citizens who had not previously taken such medication. We recommend scheduling TFU calls early: the first after one week, the second after one month and the third after six months. [Display omitted] [ABSTRACT FROM AUTHOR]

Published scales measuring medication adherence are myriad. There is a need for a tool that guides towards downstream adherence interventions. To develop and validate a self-report questionnaire able to detect modifiable determinants of medication non-adherence. Workshops, surveys and meetings were used to identify items. Validation was performed in French and German (Switzerland) between March and April 2022. Face validation, content validation, construct validation, internal consistency and test-retest reliability were assessed. The questionnaire was finalized in August 2022. The first draft in English included 13 items divided into four areas. Following translation, validation was performed with 144 patients (63 German-, 81 French-speaking) who were recruited in 35 community pharmacies. Acceptability was good (<5% missing data). Psychometric properties were acceptable with good content validity and moderate construct validity. Internal consistency was acceptable for the French version (Cronbach's alpha = 0.71 [item 1–5] - 0.61 [item 6–9]) and less acceptable for the German version (Cronbach's alpha = 0.43 [item 1–5] - 0.45 [item 6–9]). Test-retest was given for all items (r = 0.52 to 1.0) except item 10 in French (r = 0.25). The final instrument is a 15-item questionnaire called the 15-STARS (Screening Tool for AdheRence to medicineS) that assesses practical difficulties with medicine use, reasons for non-adherence, doses missed, and need for further help. Our findings support the validity and clinical utility of the 15-STARS questionnaire. Reliability was inconclusive due to incoherent internal consistency, but explainable by the single-item nature of the scale. This new tool will enable the detection of patients who experience difficulties that negatively influence medication adherence. Pharmacists will be able to propose specific and tailored adherence interventions to the patients. Next steps will focus on evaluating its usefulness for developing targeted interventions that optimize medication adherence in routine care and research settings. • Many different tools exist in the literature to measure medication adherence. • Self-report questionnaires are time-efficient, easy to provide and to use. • The 15-STARS questionnaire screens for patients with difficulties in medicine use. • It focuses on patients' modifiable determinants and can be used in daily practice. • Adherence-enhancing interventions can be tailored to the patient's needs. [ABSTRACT FROM AUTHOR]

Copyright of Health Psychology is the property of American Psychological Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The disruption of biological rhythm (sleep, eating patterns, hormonal secretions, activities, and social life etc.) in individuals diagnosed with bipolar disorder makes it challenging to balance the mood of the patient and facilitates recurrence. Although social support, coping with stress, and medication adherence are known to affect prognosis, no study has been found to investigate the relationship between these factors and biological rhythm. This descriptive and correlational design study investigated the relationship between perceived social support, coping styles and medication adherence, and biological rhythm in individuals diagnosed with bipolar disorder. This study was conducted with 111 patients receiving treatment in the outpatient clinics of the psychiatry department of two public hospitals in Ankara, Turkey. Biological Rhythm Interview of Assessment in Neuropsychiatry (BRIAN), Multidimensional Scale of Perceived Social Support (MSPSS), Coping Style Inventory (CSI), and Morisky Medication Adherence Scale (MMAS) were used for data collection. The biological rhythm total and subscales scores were significantly and negatively related to perceived social support total, and subscales scores (p < 0.005). The biological rhythm total and most of its subscales scores were significantly and negatively related to medication adherence (p < 0.005). The biological rhythm total and domain scores were significantly and negatively related to seeking social support, self-confident, and optimistic subscales of CSI while significantly and positively related to helpless and submissive (p < 0.005). In this study, a positive relationship was found between increased perceived social support, effective coping with stress, and adherence to medication. This study highlights that these factors may be helpful for the regulation of biological rhythm. • Today, it is known that biological rhythm of individuals diagnosed with bipolar disorder might be disrupted. • Biological rhythm includes sleeping habit, social life, activities (such as job, housework), and chronotype of an individual. • Psychiatric nurses have a crucial role in regularity of the biological rhythm of individuals diagnosed with bipolar disorder. • Medication adherence, coping styles and social support are crucial in regulating biological rhythm in bipolar disorder. • Psychiatric nurses may consider these factors in planning interventions for regulating biological rhythm in bipolar disorder. [ABSTRACT FROM AUTHOR]

• Older adults with multimorbidity with lower education level, better health literacy, higher medication self-efficacy, more social support, and no side effects exhibit better medication adherence. • Beliefs about medication are not related to medication adherence, so further studies should explore the components of beliefs about medication in the context of multimorbidity to understand the complex patterns of perception and behaviors related to medication. • Nurses' role includes reviewing previous medication and related experiences, providing individualized education about diseases and treatment, and boosting collaboration to minimize pill burden and harmful side effects and ensure continuous medication adherence. Multimorbidity is a healthcare concern. To manage diseases, older adults with multimorbidity are expected to practice health behaviors, particularly medication adherence. Studies have examined adherence issues in older patients with multiple diseases, but it remains unclear which factors affect medication adherence. Therefore, this study aimed to identify the factors affecting medication adherence among older adults with multimorbidity. The participants were recruited from the outpatient departments of two hospitals in the Republic of Korea using convenience sampling. Data were collected using structured questionnaires and analyzed using multiple regression analysis. The results showed that those with a lower education level, no side effects, better health literacy, higher medication self-efficacy, and more social support exhibited better medication adherence. In addition, beliefs about medication were not related to medication adherence. These results suggest that providing individualized education, strengthening social support, and decreasing harmful side effects can improve medication adherence. [ABSTRACT FROM AUTHOR]

Objective: This study assessed antiretroviral adherence and treatment outcomes among outpatients with human immunodeficiency virus (HIV). Methods: A cross-sectional study was performed on patients with HIV over 18 years old receiving antiretroviral therapy for at least six months at an Indonesian clinic, from January to March 2021. The previously validated self-reported adherence questionnaire was used to recall antiretroviral use. Viral load and CD4 were indicators of treatment outcomes. Binary logistic regression was used to explore factors associated with nonadherence and poor treatment outcomes. Results: Ninety-five patients were included in the study (male 70.5%, median [interquartile range, IQR] age 35 [29-42] years, and median [IQR] treatment duration 29 [15-49] months). Adherence greater than 95% was observed in 89.5%, 88.4%, 95.8% of the patients in the past week, month, and three months, respectively. Patients with secondary education or lower were associated with low adherence (adjusted odds ratio, aOR: 7.73, 95%CI: 1.12-53.19). Viral suppression and improved CD4 were observed in 83.2% and 68.4% of the patients, respectively. Taking non-nucleoside reverse transcriptase inhibitors (NNRTIs)-based regimen was associated with viral suppression (aOR: 0.01, 95%CI: 0.00-0.14) as well as high CD4 count (aOR: 0.16, 95%CI: 0.03-0.83). Being diagnosed with stage 4 of HIV (aOR: 72.38, 95%CI: 3.11-1687.28) and having adherence of 95% or lower (aOR: 68.84, 95%CI: 4.86-974.89) were associated with non-suppressed viral load, and having HIV stage 3 (aOR: 7.81, 95%CI: 1.26-48.40) or 4 (aOR: 26.15, 95%CI: 3.42-200.10) at diagnosis was associated with low CD4. Conclusion: Rates of self-reported adherence and treatment outcomes were high. Secondary education or lower was a predictor of low adherence. Using NNRTIs-based therapy was associated with good treatment outcomes; meanwhile, stage 3 or 4 of HIV at diagnosis and low adherence were predictors of poor outcomes. Therefore, strategies to improve adherence and treatment outcomes are warranted. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Nonadherence to tuberculosis (pulmonary TB) medication poses a serious threat to the increase in new cases, prevention of transmission, and control of pulmonary TB. The health behavior of patients with pulmonary TB regarding medication adherence is an extremely important issue to investigate. This review aimed to identify the available literature on professional interventions and important determinants for improving adherence to pulmonary TB medication based on a health belief model (HBM). MATERIALS AND METHODS: To identify the determinants and professional treatment outcomes that affect adherence to pulmonary TB medication improvement, the following electronic databases were searched: MEDLINE, PROQUEST, EBSCO, SCOPUS, Web of Science, and Google Scholar. This review was carried out following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The full texts were reviewed if they met the following inclusion criteria (1) the articles were written in English, (2) relevant, and (3) the publication years of the studies ranged from 2015 to 2022. RESULTS: A total of 2,322 pieces of literature met the screening criteria: 47 articles met the full-text review criteria, 39 articles were excluded because they did not meet the inclusion criteria, and eight articles were reviewed. Perceived susceptibility, perceived severity, perceived obstacles, perceived benefits, and self-efficacy are determinants of patient health beliefs that contribute to medication adherence. Psychological counseling, pulmonary tuberculosis education, motivational interviews, and hypnosis are all effective professional interventions for improving medication adherence. CONCLUSIONS: Perceived susceptibility, perceived severity, perceived obstacles, perceived benefits, and self-efficacy were the key determinants for improving adherence to pulmonary TB medication. The finding suggests a professional intervention for patients to improve medication adherence and psychological counseling, pulmonary tuberculosis education, motivational interviews, and hypnosis to improve medication adherence. [ABSTRACT FROM AUTHOR]

• Participants adherence aligns with their attitudes before screening. • Not all the men understood the nature of the diseases for which they were examined. • Communication must be individualized to people with a variety of health literacy. • Nurse-led follow-up contacts may increase knowledge of the disease, medication adherence and clinical monitoring. This study explored Danish men's experience of participating in a screening program for cardiovascular disease (CVD) and their perceptions of preventive medication for CVD before and after participation in the screening program. An exploratory phenomenological-hermeneutical study. Fifteen men from a cardiovascular screening program for men aged 65–74 years participated. Semi-structured interviews were conducted before screening and one year later (2015–2017). The interviews were transcribed verbatim and analysed using Kvale and Brinkmann's approach to data analysis. Two main themes were identified: (i) seeking confirmation and control of health: familiarity with CVD; understanding the screening program; confirmation of health; perception of preventive medication, and (ii) sense of own health and prevention: experiences with the screening program; accept or denial of diagnosis and preventive medication. A minority of the men understood the nature of the diseases for which they were being examined. The invitation for screening and the outcome of the examinations must be communicated more skilfully. The health providers need to engage early in treatment after the screening and provide an individualised plan that addresses patients concerns and knowledge based on their needs. [ABSTRACT FROM AUTHOR]

Background: Medication adherence to prescribed medications in chronic diseases like rheumatoid arthritis (RA) is influenced by social and economic factors, health-care team/system factors, characteristic of the disease, disease therapies, and physician-related and patient-related factors. Socioeconomic factors of the patients play a major role in adherence to long-term therapies. In view of lack of consistent findings and limited studies, this study aimed to study the socioeconomic factors and quality of life (QOL) and their association with medication adherence in RA. Materials and Methods: This is a prospective observational study carried out in a tertiary care hospital from February 2021 to June 2021. The Compliance-Questionnaire-Rheumatology 19 was used to assess adherence with scores ≥80% considered adherent and others nonadherent. QOL was assessed by the WHOQOL-BREF Questionnaire, and socioeconomic factors were determined using the Modified Kuppuswamy's Socioeconomic Status scale 2020. Results: Of the 135 patients (108 females and 27 males) in the study, adherence was observed only in 19.3% (26) and the remaining 80.7% (109) were nonadherent. There was a significant difference (P = 0.013) in the number of medications used among both the groups. Among the socioeconomic factors, though there is difference in occupation of both the groups, it was found be not significant (P = 0.058). There was no association of adherence with any of the four domains of QOL. Conclusion: There was no association of medication adherence with socioeconomic factors and QOL in RA. [ABSTRACT FROM AUTHOR]

Children with comorbid Attention-Deficit/Hyperactivity Disorder (ADHD) and asthma are at an increased risk for adverse health outcomes and reduced quality of life. The objective of these analyses was to examine if self-reported ADHD symptoms in children with asthma are associated with asthma control, asthma controller medication adherence, quick relief medication use, pulmonary function, and acute healthcare utilization. We analyzed data from a larger study testing a behavioral intervention for Black and Latinx children with asthma aged 10–17 years and their caregivers. Participants completed the Conners-3AI self-report assessment for ADHD symptoms. Asthma medication usage data were collected for 3 weeks following baseline via electronic devices fitted to participants' asthma medications. Other outcome measures included the Asthma Control Test, self-reported healthcare utilization, and pulmonary function measured by spirometry testing. The study sample consisted of 302 pediatric participants with an average age of 12.8 years. Increased ADHD symptoms were directly associated with reduced adherence to controller medications, but no evidence of mediation was observed. Direct effects of ADHD symptoms on quick-relief medication use, health care utilization, asthma control, or pulmonary function were not observed. However, the effect of ADHD symptoms on emergency room visits was mediated by controller medication adherence. ADHD symptoms were associated with significantly reduced asthma controller medication adherence and indirectly with emergency room visits. There are significant potential clinical implications to these findings, including the need for the development of interventions for pediatric asthma patients with ADHD. [ABSTRACT FROM AUTHOR]

BACKGROUND: Inhaled corticosteroids (ICSs) are a fundamental pillar of most regimens for long-term control of persistent asthma. Poor adherence to ICS medication is a common problem in the asthma population that can lead to poor asthma control. We hypothesized that conducting a follow-up telephone call after general pediatric clinic visits for asthma would improve refill persistence. METHODS: We conducted a prospective cohort analysis of pediatric and young adult subjects followed in our pediatric primary care clinic for asthma on ICS medication found to have poor ICS refill persistence. This cohort received a follow-up telephone outreach call 528 weeks after the clinic visit. The primary outcome measure was refill persistence with regard to ICS therapy. RESULTS: There were 289 subjects who met the inclusion criteria and did not meet any exclusion criteria for the study (n 5 131 in the primary cohort, n 5 158 in the post- COVID cohort). The mean ICS refill persistence increased significantly for subjects in the primary cohort (39.4 6 30.8% post intervention vs 32.4 6 19.7% pre intervention) (P 5 .02) but not in the post-COVID cohort (36.4 6 25.6% post intervention vs 38.9 6 21.0% pre intervention) (P 5 .26). There was not a statistically significant change in hospitalizations after the intervention in either the primary or the post-COVID cohorts (P 5 .08 and .07, respectively). Systemic corticosteroid courses and emergency department visits decreased significantly post intervention (P 5 .01 and P 5 .004, respectively) in the primary group but not in the post-COVID group (P 5 .75 and P 5 .16, respectively). CONCLUSIONS: These results suggest that telephone outreach after out-patient clinic visits for asthma may have short-term benefit in ICS refill persistence; however, the effect size was small. [ABSTRACT FROM AUTHOR]

Parenting style plays a pivotal role in children's chronic disease control. However, the relationship and underlying mechanism between parenting style and asthma control remain unclear. This study investigated the effects of parenting style on children's general self-efficacy, medication adherence and asthma control and the mediating effects of general self-efficacy and medication adherence among school-age children with asthma. A cross-sectional study with a convenience sampling approach was conducted. This study followed the STROBE guidelines. School-age children with asthma and their parents (N = 211) from pediatric respiratory clinics in China completed the General Questionnaire, Short-Egna Minnen av. Barndoms Uppfostran-Chinese, General Self-Efficacy Scale, Medication Adherence Questionnaire and Childhood Asthma Control Test. Structural equation modeling was used to examine the mediation models. Positive parenting style was positively correlated with child general self-efficacy, medication adherence and asthma control (r = 0.602, 0.572, 0.613, p < 0.001). Negative parenting style was negatively correlated with child general self-efficacy, medication adherence and asthma control (r = −0.535, −0.598, −0.586, p < 0.001). Structure Equation Modle (SEM) results indicated that the relationships between positive parenting style, negative parenting style and child asthma control were mediated by general self-efficacy (Effect Size [ES]: 0.209, 95 %CI [0.075, 0.372]; and ES: -0.229, 95 %CI [−0.387, −0.103], respectively) and medication adherence (ES : 0.128, 95 %CI [0.032, 0.322]; and ES : -0.190, 95 %CI [−0.432, −0.071], respectively) and together in serial (ES: 0.177, 95 %CI [0.076, 0.295]; and ES: -0.118, 95 %CI [−0.235, −0.020], respectively). Parenting style may impact child asthma through both child general self-efficacy and medication adherence. The study may provide useful intervention targets for improving asthma control. Nurses should encourage parents to increase positive parenting style while decreasing negative parenting style. Family interventions focusing on general self-efficacy and medication adherence may be advantageous to improve asthma control. • Parenting directly affected child self-efficacy, adherence and asthma control. • Parenting indirectly influenced asthma control through self-efficacy and adherence. • Nurses should incorporate parenting style within family asthma management plans. • Family interventions should be focused on children's self-efficacy and adherence. [ABSTRACT FROM AUTHOR]

• Medication nonadherence is one of the most complicated health issues, with significant adverse and underestimated effects. • Health anxiety is one of the older adults' psychosocial factors that might be affect their medication adherence. • Fatalism is one of these beliefs that may impact attitudes toward medication adherence. • The study found a statistically significant negative relationship found between the studied geriatric clients' fatalism and health anxiety with their medication adherence. This study explored the relationship between health anxiety, fatalistic beliefs, and medication adherence among geriatric clients. Also, it determines the extent to which health anxiety and fatalism can predict the variance in medication adherence among the same population of geriatric clients. A cross-sectional analytical survey on 200 eligible participants using the Arabic Version of the Short Health Anxiety Inventory, Fatalism Scale, and Morisky Medication Adherence Scale-8 items. The study found a statistically significant negative relationship between the studied geriatric clients' fatalism and health anxiety and their medication adherence (r = -0.160, - 0.187, and P = 0.024, 0.008), respectively. This study highlights the importance of considering psychological factors such as health anxiety and fatalistic beliefs in addressing medication adherence among geriatric clients. By addressing these factors, healthcare providers can develop more effective strategies to improve medication adherence and ultimately improve the health outcomes of geriatric clients. [ABSTRACT FROM AUTHOR]

Hypertension remains the leading cause of cardiovascular disease and premature death globally, affecting half of US adults. A high proportion of hypertensive patients exhibit uncontrolled blood pressure (BP), associated with poor adherence, linked to pill burden and adverse effects. Novel pharmacological strategies are urgently needed to improve BP control. Dysregulation of the renin-angiotensin system increases BP through its primary effector, Ang II (angiotensin II), which results in tissue remodeling and end-organ damage. Silencing liver angiotensinogen (the sole source of Ang II) has been achieved using novel RNA therapeutics, including the antisense oligonucleotide, IONIS-AGT (angiotensinogen)-LRX and the small- interfering RNA, zilebesiran. Conjugation to N-acetylgalactosamine enables targeted delivery to hepatocytes, where endosomal storage, slow leakage, and small-interfering RNA recycling (for zilebesiran) result in knockdown over several months. Indeed, zilebesiran has an impressive and durable effect on systolic BP, reduced by up to 20 mm Hg and sustained for 6 months after a single administration, likely due to its very effective knockdown of angiotensinogen, without causing acute kidney injury or hyperkalemia. By contrast, IONIS-AGT-LRX caused less knockdown and marginal effects on BP. Future studies should evaluate any loss of efficacy relating to antidrug antibodies, safety issues associated with long-term angiotensinogen suppression, and broader benefits, especially in the context of common comorbidities such as type 2 diabetes and chronic kidney disease. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The patient's selfcare behavior encompasses various aspects, including medication adherence, which has been identified as a significant concern in the context of heart failure. To encourage patients in their medication, tele-motivational interviewing can be used. The main aim of this research is to examine the effects of tele-motivational interviewing on medication adherence in individuals who have been diagnosed with heart failure. MATERIALS AND METHODS: In this research, an experimental pretest-posttest design with a control group was chosen. The study involved the implementation of tele-motivational interviewing, which spanned a duration of two months, with interventions taking place on a weekly basis. To measure medication adherence, the Morisky Medication Adherence Scale (MMAS-8) was employed. In a randomly selected sample of 176 respondents, half were assigned to the experimental group (n=88), and the other half were assigned to the control group (n=88). RESULTS: Pre-test medication adherence levels for the experimental group indicate that 68 respondents (77.2%) fall into the low category (score >2), whereas post-test medication adherence levels for the same group indicate that 55 respondents (62.5%) fall into the highest category (score 0). The Wilcoxon Signed Rank Test demonstrates the p-value to be less than 0.001. CONCLUSIONS: Tele-motivational interviewing as a skill in education that supports the patients directly and continuously by monitoring during treatment by telephone, gradually changes and affects the patients' behavior. Hence, the utilization of tele-motivational interviewing presents a viable approach for enhancing medication adherence in individuals diagnosed with heart failure. [ABSTRACT FROM AUTHOR]

Copyright of Revista Horizonte Médico is the property of Universidad de San Martin de Porres and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The number of people with HIV/AIDS has consistently increased in Korea since the first case of HIV/AIDS infection was reported in 1985. The depressive symptoms of patients with HIV/AIDS may lead to medication non-adherence. This study sought to investigate the cross-sectional and longitudinal association between depression and antiretroviral treatment adherence in the Korean HIV/AIDS population. We included participants of the Korea HIV/AIDS cohort study between 2009 and 2017. All information was collected at the enrollment and every annual visit, including sociodemographic characteristics, health-related behaviors, HIV/AIDS infection-related factors, depression score, and frequency of skipped medication. We performed a cross-sectional analysis of 601 participants registered between 2009 and 2017. Longitudinal data were evaluated by panel regression analysis in 515 patients who registered from 2009 to 2013. In cross-sectional analysis, the HIV/AIDS patients with depressive symptoms were more likely to be non-adherent (adjusted OR = 0.52, 95 % CI 0.34, 0.79, p = 0.002). Medication adherence was significantly associated with a health-related lifestyle; the adjusted odds ratio of the non-smoking and non-drinking group was 1.75 (95 % CI 1.05, 2.90, p = 0.031). The longitudinal panel regression model revealed a significant negative impact of depression on medication adherence (adjusted OR = 0.50, 95 % CI 0.30, 0.84, p = 0.009). Non-smoking and non-drinking participants were 2.31 times more likely to adhere to antiretroviral treatment (95 % CI 1.29, 4.15, p = 0.005). Our finding of depression and lifestyle modifications being significant contributors underscore the importance of proactive interventions to optimize the treatment outcomes of PLWH. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to evaluate whether pharmacotherapeutic follow-up in patients with T2DM in primary care interferes in metabolic control, cardiovascular risk, medication adherence and quality of life. Methods: A prospective clinical study was conducted at two Primary Health Units in Vitória, Espírito Santo, Brazil with 75 patients with T2DM between 40 and 70 years old. The parameters of metabolic control evaluated included fasting blood glucose, HbA1c, triglyceride/HDL-c and total cholesterol/HDL-c ratio. The cardiovascular risk was calculated based on the Framingham risk score. Adherence to medication was measured using the Brief Medication Questionnaire and quality of life was evaluated by applying the World Health Organization Quality of Life-Bref. Results: After the follow-up, there was a significant decreasing in cardiovascular risk (p=0.048) and total cholesterol/HDL-c ratio (p=0.024) and a discrete improvement in fast glucose and HbA1c levels. The quality of life scores increased for all domains (p<0.0001) and the treatment adherence also improved with 12.00% of the patients classified as low adherence in the final time, against 41.33% before the meetings. Conclusion: These results show the proposed pharmacotherapeutic follow-up influenced positively cardiovascular risk, adherence to therapy and quality of life in all domains, and, therefore, may contribute to delay the onset of the main chronic complications of the disease. [ABSTRACT FROM AUTHOR]

Oral pre-exposure prophylaxis (PrEP) in the prevention of human immunodeficiency virus (HIV) infection is highly effective, yet the majority of sexually active adolescents and young adults (AYAs) at highest risk for HIV infection, particularly AYA males who have sex with males, have not been prescribed this medication. Provider hesitancy in prescribing PrEP to at-risk AYA patients is often associated with concerns about patient nonadherence and its effect on inducing HIV medication resistance. This case report has two aims. First, to outline the clinical course for an AYA patient prescribed PrEP for 3 months and then found to have HIV with an M184V resistance mutation and subsequently started on HIV treatment. And second, to illustrate how the benefits of PrEP initiation outweigh its risks by presenting clinical data on resistance patterns to PrEP medications. The patient eventually achieved viral suppression within 5 months of starting HIV treatment which has been sustained up to 2 years. This case illustrates that M184V resistance mutations, although rarely associated with PrEP, are unlikely to impact options for HIV treatment. Providers should recommend and prescribe oral PrEP to AYA patients at risk for HIV infection without concern for nonadherence leading to HIV medication resistance. [ABSTRACT FROM AUTHOR]

Copyright of Salud Uninorte is the property of Fundacion Universidad del Norte and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Traditionally, much of community pharmacy practice relies on patients to request their own medication refills. These refills are often not aligned, which has been shown to decrease adherence and workflow efficiencies. The appointment-based model (ABM) is designed to proactively synchronize refills and schedule patient-pharmacist appointments. To describe the characteristics of patients enrolled in the ABM; and to compare the number of distinct refill dates, number of refills, and adherence for antihypertensives, oral antihyperglycemics, and statins 6-months and 12-months pre-post ABM implementation. In September 2017, the ABM was implemented across independent community pharmacies within a pharmacy banner in Ontario, Canada. In December 2018, a convenience sample of three pharmacies was extracted. Demographic and clinical characteristics were collected on program enrollment (index) date for individual patients and their medication fill histories were used to investigate adherence measures including distinct number of refill dates, number of refills, and proportion of days covered. Descriptive statistics were analyzed using StataCorp. Analysis of 131 patients (48.9% male; mean age 70.8 years ± 10.5 SD) filled on average 5.1 ± 2.7 medications with 73 (55.7%) experiencing polypharmacy. Patients had a significant reduction in mean number of refill dates (6.8 ± 3.8 SD six-months pre-enrollment, 4.9 ± 3.1 SD six-months post-enrollment, p < 0.0001). Adherence to chronic medications remained high (PDC ≥95%). The ABM was implemented for a cohort of established users, already highly adherent to their chronic medications. Results demonstrate reduced filling complexity and fewer refill dates while also sustaining the high baseline adherence across all chronic medications studied. Future studies should investigate patient perspectives and potential clinical benefits of the ABM. • Multiple benefits for patients, including older adults, enrolled in the appointment-based model in community pharmacies. • Patients enrolled in the appointment-based model maintained high adherence to chronic oral standing medications. • Patients visited the pharmacy less often and obtained more medications through the appointment-based model. [ABSTRACT FROM AUTHOR]

Background: Lack of adherence to treatment in patients with arterial hypertension leads to poor blood pressure control, increased morbidity and mortality, and increased costs to health and social care. Regular assessment of treatment adherence as well as factors influencing it is important to improve patient adherence and consequently increase treatment efficacy. Personal beliefs, particularly illness representations, are significant factors that influence adherence. Objective: The aim of this study was to assess the associations between adherence to treatment, illness perception, and selected sociodemographic and clinical characteristics in patients with arterial hypertension. Methods: In this cross-sectional observational study, 235 patients with arterial hypertension completed the Hill-Bone Compliance to High Blood Pressure Therapy Scale and the Brief Illness Perception Questionnaire. Associations between variables were assessed by Spearman ρ andmultiple linear regression analysis. Results: Younger age,male gender, overall number of drugs used, and poorer beliefs related to the timeline, treatment control, and understanding were associated with higher levels of nonadherence. The final regression model significantly ( P ≤ .05) explained 19.4%of the variance in diet adherence, 5.0%in appointment keeping, and 17.8% in medication adherence. Conclusion: Comprehensive care aimed at regular evaluation of illness perceptions with an emphasis on increasing understanding of the disease and its treatment and reducing patient worries and negative emotions seems to be a relevant strategy for improving adherence to antihypertensive treatment in everyday clinical practice. [ABSTRACT FROM AUTHOR]

Background: Personal and psychological factors, such as depression, have a considerable influence on nonadherence to medications and self-care in those with heart failure. More evidence is needed about positive personal factors that motivate adherence tomedications and self-care in thosewith heart failure.Objective: The purpose of this studywas to investigate whether there was a relationship between the personal resources of resilience, hope, health literacy, social support, and self-care activation and adherence to HF self-care and medications and whether race impacts adherence. Methods: This study used a cross-sectional, correlational design. Stepwise regression was used to test whether resilience, hope, health literacy, self-care activation, and race significantly predictedmedication adherence and self-care. A diverse sample was recruited for this study. Results: Of the 174 participants, 51%were female, 51.7%wereWhite, and the mean age was 62 years. After adjustment for differences in age and depressive symptoms, a predictive relationship remained between resilience, health literacy, and medication adherence. Hope, activation, and race were not selected in the final regression model. A high level of perceived social support was the only predictor of better HF self-care. Conclusion: Persons with heart failure may have better medication adherence and overall self-care if sufficiently resilient, health literate, and supported regardless of their degree of hope or activation. Race and agemay be important factors to consider. More research is needed to understand the connection between resilience and medication adherence. [ABSTRACT FROM AUTHOR]

This study aimed to determine the association between the level of acceptance of illness and medication adherence, metabolic control, and risk of diabetic foot in patients with diabetes. This descriptive study was conducted with 298 patients with diabetes. The questionnaire comprised the demographic characteristics of the patients, Modified Morisky Scale and the Acceptance of Illness Scale. The study data were collected by the researchers through direct interviews using the questionnaire. Acceptance of illness in patients with diabetes was statistically significantly higher in the group with a higher level of knowledge of medication adherence (p < 0.001). Moreover, the acceptance of illness had a statistically significant negative correlation with fasting plasma glucose (r = −0.198; p < 0.001) and glycated hemoglobin (r = −0.159; p = 0.006) levels in individuals with diabetes. Levels of acceptance of illness had a statistically significant association with the risk of diabetic foot (p < 0.01). The study found that the level of acceptance of illness was associated with the level of knowledge about medication adherence, metabolic control, and risk of diabetic foot in individuals with diabetes. It may be recommended to conduct clinical trials to determine the effect of evaluating the level of acceptance of the illness on diabetes management and to increase this level. • Diabetic foot is associated with inadequate knowledge and poor practices. • Acceptance of illness is crucial in the management of diabetes. • Nurses should evaluate the acceptance of the illness in individuals with diabetes. [ABSTRACT FROM AUTHOR]

Previous studies on hospital discharge showed limited patient involvement, despite its positive outcomes. In this study, provider-patient communication used to enhance patient participation during discharge medication counselling was examined. This study comprises a qualitative descriptive observational study. Thirty-four discharge consultations were observed, audio recorded and analysed. We conducted a deductive analysis, elaborating on findings from earlier research. We selected themes and underlying codes illustrating professional-patient communication. For every theme, we identified examples to demonstrate its manifestation during discharge medication counselling. We also assessed what information healthcare professionals (HCPs) shared. HCPs used cues to increase patient participation, e.g. inquired about patient's preferences, showed empathy and support, and verified understanding of information shared. Patient participation occurred through asking questions, and expressing concerns. A central component in discharge medication counselling was the transmission of information from HCPs to patients. This resulted in HCPs taking a leading role. Several HCP cues were detected inviting patients to participate in consultations. Some patients participated in discharge medication counselling. This was influenced by timing of discharge consults, the performing HCP and presence of a relative. HCPs shared a lot of information with patients. However, this does not automatically mean that patients will be able to understand and apply this information. HCPs should understand the importance of using cues to enable patient participation. One example is using the teach-back method for verifying patient understanding. It may also be desirable to ensure that a relative is present when discharge information is offered. • In an observational study, we examined provider-patient communication used to enhance patient participation during discharge medication counselling. • Our results show that HCPs inquired about patient's preferences, showed empathy and support, and verified understanding of information shared. • Patient participation occurred through asking questions, and expressing concerns. • HCPs focused on transmitting information to patients, which resulted in HCPs taking a leading role. [ABSTRACT FROM AUTHOR]

BACKGROUND: Sub-Saharan Africa is undergoing an epidemiologic transition from infectious diseases to cardiovascular diseases. From 2014 to 2019, sociodemographic surveillance was performed in a large cohort in rural South Africa. METHODS: Disease prevalence and incidence were calculated using inverse probability weights. Poisson regression was used to identify disease predictors. The percentage of individuals with controlled (<140/90 mm Hg) versus uncontrolled hypertension was compared between 2014 and 2019. RESULTS: Compared with 2014 (n=5059), study participants in 2019 (n=4176) had similar rates of obesity (mean body mass index, 27.5±10.0 versus 27.0±6.5) but higher smoking (9.1% versus 11.5%) and diabetes (11.1% versus 13.9%). There was no significant increase in hypertension prevalence (58.4% versus 59.8%; age adjusted, 64.3% versus 63.3%), and there was a significant reduction in mean systolic blood pressure (138.0 versus 128.5 mm Hg; P <0.001). Among hypertensive individuals who reported medication use in 2014 and 2019 (n=796), the proportion with controlled hypertension on medication increased from 44.5% to 62.3%. Hypertension incidence was 6.2 per 100 person-years, and age was the only independent predictor. Among normotensive individuals in 2014 (n=2257), 15.2% developed hypertension by 2019, with the majority already controlled on medications by 2019. CONCLUSIONS: The hypertension prevalence and incidence are plateauing in this aging cohort. There was a statistically and clinically significant decline in mean blood pressure and a substantial increase in individuals with controlled hypertension on medication. The prevalence of cardiometabolic risk factors did not decrease over time, suggesting that the blood pressure decrease is likely due to increased medication access and adherence, promoted by local health systems. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Medication nonadherence to dual antiplatelet therapy increases major cardiovascular events. In this study, we investigated patients' post-acute coronary syndrome (ACS) medication adherence to clopidogrel and ticagrelor over a 12-month period. Furthermore, we also examined the factors that may affect medication adherence in this patient population. PATIENTS AND METHODS: This study included 509 patients who were scheduled for dual antiplatelet therapy for one year following ACS (October 2018-December 2019). A proportion of days covered (PDC) method, based on a pharmacy database system, was used to determine their medication adherence. Medication adherence was defined as > 80% PDC. RESULTS: No difference was found between clopidogrel and ticagrelor in terms of medication adherence (68.3% vs. 64.6%, p = 0.39). Moreover, higher education levels (B = 3.24, CI: 1.17-8.9, p = 0.023) and percutaneous coronary intervention (PCI) as a revascularization option (B = 0.35, CI: 0.17-0.71, p = 0.004) predicted medication adherence independently. CONCLUSIONS: In this research, medication adherence was found to be similar between the clopidogrel and ticagrelor groups. It was also predicted by higher education levels and revascularization with PCI. [ABSTRACT FROM AUTHOR]

Background: To prevent recurrent stroke, patients need to follow evidence-based practices following discharge; however, adherence to these practices is suboptimal. Purpose: To evaluate whether a smartphone mobile application can improve medication adherence and stroke awareness in secondary stroke prevention. Methods: A retrospective study design was used. Patients with ischemic stroke registered in a database between August 2018 and January 2019 were enrolled. Propensity score matching was used to match patients managed with the mobile application compared with regular practice in a 1:2 ratio. Results: Sixty-five patients were paired with 123 controls. Three-month medication adherence was 93.8% in the application group versus 82.9% in the control group (P =.036). Patients in the application group were more likely to know stroke warning signs (P =.003) and when to call an ambulance for stroke symptoms (87.7% vs 72.4%, P =.016). Conclusions: Using a mobile application may increase medication adherence and stroke awareness in secondary stroke prevention. [ABSTRACT FROM AUTHOR]

• Majority of the patients have uncontrolled hypertension and are not taking their medications as prescribed. • Pharmacist-led expert system intervention significantly improved patients' medication adherence and self-perceived knowledge. • Significant improvement in the medication adherence, knowledge of the patients, and BMI is needed to observe a significant impact on blood pressure control. • The other factors that significantly predict blood pressure are physical activity and age. [ABSTRACT FROM AUTHOR]

Background: Single-pill combination improves adherence and persistence to medication in hypertension. It remains unclear whether this also reduces cardiovascular outcomes and all-cause mortality. We analyzed whether single-pill combinations are superior to identical multiple pills on persistence to medication, cardiovascular outcomes, and all-cause mortality. Methods: This was a retrospective claims data (German AOK PLUS) analysis. Data from hypertensive patients ≥18 years treated with renin-angiotensin system combinations given as single pill or identical multipills covering the years 2012 to 2018 were analyzed and followed up to at least 1 year. After 1:1 propensity score matching, persistence to medication, cardiovascular events, and all-cause mortality were compared using non-parametric tests. Results were reported as incidence rate ratios and hazard ratios. Results: After propensity score matching data from 57 998 patients were analyzed: 10 801 patients received valsartan/amlodipine, 1026 candesartan/amlodipine, 15 349 ramipril/amlodipine, and 1823 amlodipine/valsartan/hydrochlorothiazide as single pill or identical multipill. No relevant differences in patient characteristics were observed within the 4 groups. In all groups, a significant lower all-cause mortality, a significant a higher persistence to medication, a significant lower event rate in 15 out of 20 comparisons, and a tendency in the remaining 5 comparisons was observed under single pills compared with multipill combinations. Conclusions: Antihypertensive combination therapy reduces all-cause mortality and cardiovascular when provided as single pill compared to identical drugs as multipills. This strongly supports the European Society of Cardiology/European Society of Hypertension and International Society of Hypertension guidelines recommending the use of a single-pill combination and thus should be more rigorously implemented into daily clinical practice. [ABSTRACT FROM AUTHOR]

Statin adherence is an essential problem although lifetime medication is recommended especially in patients with high cardiovascular risk. The importance of perceived risk as a predictor of adherence among cardiology patients has not been fully explored. This study aimed to test the importance of perceived risk as a predictor of statin adherence amongst hypercholesterolemic patients to identify predictors associated with poor adherence. This cross-sectional study was conducted at cardiology outpatient clinics of the University hospital in Ankara, Turkey. A total of 327 consecutive patients with high CV risk were recruited. Self-reported Morisky Green Levine Medication Adherence Scale was used to assess statin adherence. Of the patients studied, 34.5% had concerns about side effects. Also, the mean age was 63.85 ± 11.29 years, 66.1% were men, 32.4% applied non-drug alternative therapies, 53.2% had a Mediterranean-style diet and 20.8% checked their lipid values irregularly. Participants reported 50.2% high, 30% moderate, and 19.9% low statin medication adherence. Low-density lipoprotein cholesterol (LDL-C), Total Cholesterol (TC), Triglyceride (TG) and high-density lipoprotein (HDL) control rates were 44.6%, 74.3%, 61.5% and 41.6%. On multiple logistic regression, concern about side effects was associated with a statistically significant quadruple elevation of odds of non-adherence. Also, being male, former smokers, not having complementary interventions, having regular visits, being educated for more than 5 years, having low depressive symptom scores, living in a rural, being never or former smokers, employee were significant predictors of high medication adherence scores. Approximately half of the patients reported high medication adherence. Proper strategies to improve adherence would include patient education efforts focused on patients with concerns about side effects and those who are female, less educated, current smokers, interested in complementary interventions, have irregular follow-up visits, and have depressive symptoms. Brief medication adherence scales may facilitate the assessment of patients' adherence. [ABSTRACT FROM AUTHOR]

Objective: To quantitatively validate the preintention factors, behavioral intentions, and implementation factors and examine the relationships theorized by the Unified Theory of Behavior Change (UTBC) model among adolescents with attention-deficit/hyperactivity disorder (ADHD). Methods: We conducted longitudinal analyses of data from 40 adolescents with ADHD, aged 11 to 15 years old, and their parents, including self-report of UTBC constructs using standardized measures. We collected pharmacy dispensing records for adolescents for the 4 months that followed. We used bivariate correlations to examine relationships between medication continuity, behavioral intentions, preintention factors, and the implementation factors. We conducted paired sample t-tests to compare adolescent and parent responses on UTBC items. Results: Adolescents (mean [standard deviation {SD}] age = 13.3 [1.2] years, 75% male, 77.5% non-Hispanic Black, 90% publicly insured) reported a mean total ADHD symptom score = 29.8/54 (SD = 10.94) and mean total impairment score = 18.7/52 (SD = 10.90) and had a mean percentage of days covered with medicine over 4 months = 0.21 (range = 0 -0.97). Adolescent intention to take ADHD medicine every school day was significantly related to adolescents' subsequent medication continuity (r = 0.37, P < .05). Adolescent self-concept/image and confidence taking ADHD medicine were the most important factors related to the intention to take ADHD medicine every school day. Adolescents reported less belief and intention to take ADHD medicine and more barriers to taking ADHD medicine compared to their parents. Conclusion: The UTBC model shed light on factors related to subsequent medication use, providing a plausible mechanism for additional research to intervene to promote future medication continuity. [ABSTRACT FROM AUTHOR]

Background: Despite the availability of effective pharmacotherapy for the management of rheumatoid arthritis (RA), health outcomes are suboptimal due to poor adherence to the prescribed treatment. Limited research has been conducted to investigate medication non-adherence and its associated factors among patients with RA. Objective: This study aimed to assess medication adherence and to explore the factors associated with medication non-adherence among outpatients with RA in Jordan. Methods: The current cross-sectional study was conducted at outpatient rheumatology clinics at two teaching hospitals in Jordan. Variables including socio-demographics and biomedical variables, in addition to disease and medication characteristics, were collected using medical records and custom-designed questionnaire. Medication adherence was assessed using the validated 5-item Compliance Questionnaire for Rheumatology. Stepwise Logistic Regression analysis was performed to identify the factors that are independently and significantly associated with medication non-adherence. Results: A total of 261 patients participated in the study, from which, 43.3% were found non-adherent. Binary regression analysis results revealed that low monthly income (OR= 0.239, CI= 0.130-0.440, P<0.01), the presence of chronic respiratory disease (OR= 2.727, CI= 1.059-7.022, P<0.05), lower medication necessity scores (OR= 1.177, CI= 1.10-1.259, P<0.01) and higher concerns about RA medications (OR= 0.917, CI= 0.860-0.978, P<0.01) were significant and independent predictors of medication non-adherence in patients with RA. Conclusion: Future pharmaceutical care and clinical pharmacy service programs should emphasize medications benefits and minimizing medication-related concerns by selecting safe medications and providing guidance on mitigating side effects, particularly for RA patients who have low income and those who suffer from other comorbid diseases. [ABSTRACT FROM AUTHOR]

The Ascertaining Barriers to Compliance (ABC) taxonomy for describing medication adherence was created in 2012, aiming to standardize terms and definitions in research and practice. The taxonomy comprises seven terms and definitions. Originally developed in English, subsequently translated into French and German, is currently being translated to Portuguese, Spanish, Czech, Romanian and Italian, aiming to promote its global use and overcome cultural barriers. To cross-culturally translate the ABC taxonomy into Portuguese for Portugal and Brazil. A systematic literature search was conducted to identify published taxonomy terms and definitions in Portuguese, and to identify panelists in medication adherence. Initial mapping of terms and definitions retrieved was scrutinized by the research team to build an e-survey. The e-survey was piloted and then sent to panelists in both countries seeking consensus using a three-round Delphi method. Consensus was defined as ≥ 85% for round 1 and ≥ 75% for round 2. Terms with agreement <10% were dropped between rounds. In round 3, terms and definitions reaching agreement between 50 and 75% were classified as moderate consensus,>75–95% as consensus and >95% as strong consensus. A total of 778 studies were identified and 84 included, enabling the extraction of 154 terms and 32 definitions. In round 1, 164 panelists participated, 115 in round 2 and 99 in the round 3. Consensus was achieved in both countries for all seven terms and definitions, although with varying intensity of agreement. The term "Management of adherence" and the definition of "Discontinuation" obtained moderate consensus in both countries. A unified and unique ABC taxonomy in Portuguese was possible to develop for use in Portugal and in Brazil. Its use will harmonize and standardize the terms and definitions used in clinical practice and research. [ABSTRACT FROM AUTHOR]