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Holly Mansell,1 Nicola Rosaasen,2 Jenny Wichart,3 Patricia West-Thielke,4 David Blackburn,1 Juxin Liu,5 Rahul Mainra,6 Ahmed Shoker,6 Brianna Groot,7 Kevin Wen,8 Anita Wong,9 Bita Bateni,10 Cindy Luo,11 Paraag Trivedi12 1College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada; 2Saskatchewan Transplant Program, Saskatchewan Health Authority, Saskatoon, SK, Canada; 3Department of Pharmacy, Alberta Health Services, Calgary, AB, Canada; 4University of Illinois Health Sciences System, Chicago, IL, USA; 5Department of Mathematics and Statistics, College of Arts and Science, University of Saskatchewan, Saskatoon, SK, Canada; 6Saskatchewan Transplant Program; Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada; 7Canadian Hub for Applied and Social Research, University of Saskatchewan, Saskatoon, SK, Canada; 8Division of Nephrology and Transplant Immunology, Department of Medicine University of Alberta, Edmonton, AB, Canada; 9Department of Pharmacy, University of Alberta Hospital, Edmonton, AB, Canada; 10St. Paul’s Hospital, and University of British Columbia, Vancouver, BC, Canada; 11Vancouver General Hospital; Faculty of Pharmaceutical Sciences, the University of British Columbia, Vancouver, BC, Canada; 12Transplant Recipient/Patient Advisor, Regina, SK, CanadaCorrespondence: Holly Mansell, College of Pharmacy and Nutrition, Health Sciences Building (E3208), 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada, Email holly.mansell@usask.caAbstract: Sub-optimal adherence to immunosuppressant medications reduces graft survival for kidney transplant recipients and adherence-enhancing interventions are resource and time intensive. We performed a multi-center randomized controlled trial to investigate the impact of an electronically delivered intervention on adherence. Of 203 adult kidney transplant recipients who received a de novo kidney transplant n = 173 agreed to participate (intent-to-treat population) and were randomized to the intervention (video education plus behavior contract n = 91) or the control (standard education, n = 82). No significant differences were found between the groups for medication adherence measured by the Basel Assessment of Adherence to Immunosuppressive Medications Scale, intrapatient variability in tacrolimus levels, time in therapeutic range for any immunosuppressant, knowledge, self-efficacy, QOL, or hospitalizations. Among a subgroup of 64 participants randomized to the intervention group who completed a post-intervention questionnaire, two-thirds (67%, n = 43) reported watching at least 80% of the videos and 58% (n = 37) completed the electronic goal setting exercise and adherence contract. An autonomous goal setting exercise and electronic behavioural contract added to standard of care did not improve any outcomes. Our findings reiterate that nonadherence in transplantation is a difficult multifactorial problem that simple solutions will not solve. Trial registration number NCT03540121.Keywords: kidney transplant, solid organ transplant, medication adherence, immunosuppression

Sarah Bentley,1 Elizabeth Exall,1 Lucy Morgan,1 Nicolas Roche,2 Kamlesh Khunti,3 Rebecca Rossom,4 James Piercy,5 Rob Arbuckle,1 Victoria S Higgins5 1Patient-Centered Outcomes, Adelphi Values, Bollington, UK; 2Respiratory Medicine, Cochin Hospital, APHP Centre University of Paris, Institut Cochin (UMR1016), Paris, France; 3Diabetes Research Centre, Leicester University, Leicester, UK; 4HealthPartners Institute, University of Minnesota Medical School, Minneapolis, MN, USA; 5Adelphi Real World, Bollington, UKCorrespondence: Rob Arbuckle, Adelphi Values, Adelphi Mill, Grimshaw Lane, Bollington, SK10 5JB, UK, Tel +44 1625 576815, Fax +44 1625 577328, Email rob.arbuckle@adelphivalues.comPurpose: Medication adherence is crucial for achieving clinical goals. Medication adherence drivers and behaviors were explored across multiple conditions, countries, and medication schedules/modalities to develop a conceptual model of medication adherence, which could later be used to support development of a patient-reported outcome (PRO) measure of adherence.Patients and Methods: Targeted review of qualitative literature identified important medication adherence concepts. Fifty-seven qualitative concept elicitation interviews were conducted (USA n=21, Spain n=18, Germany n=18). Participants were prescribed medication for: hypertension (n=9), asthma (n=8), multiple myeloma (n=8), psoriasis (n=8), diabetes (n=7), depression (n=7), multiple sclerosis (n=7), and/or schizophrenia (n=6). Thematic analysis of verbatim transcripts was performed. Expert clinicians (n=3) provided input throughout.Results: Nine qualitative articles were selected for review from 2168 screened abstracts. Forty-two medication adherence concepts were reported and grouped into 10 domains. Eight forms of medication adherence were reported during interviews, along with 27 drivers of non-adherence, all of which were incorporated into a conceptual model. Participants reported skipping medication doses (n=36/57; 63.2%) or taking medication later in the day than prescribed (n=29/57; 50.9%). Common drivers of non-adherence included forgetfulness (n=35/57; 61.4%), being out of the usual routine (n=31/57; 54.4%) and being busy (n=22/57; 38.6%). US participants were more likely to report non-adherence due to low perceived efficacy (n=6/21, 28.6%) and cost (n=5/21, 23.8%) than German (n=1/18, 5.6%; n=0/18, 0.0%) or Spanish (n=2/18, 11.1%; n=1/18, 5.6%) participants.Conclusion: Findings highlight the diverse forms and drivers of medication non-adherence, informing the development of a comprehensive conceptual model of medication adherence. The conceptual model builds on and advances previous models of medication adherence and can be used by healthcare professionals to understand and interpret barriers to medication adherence and how best to support patients in taking their medication as intended.Plain Language Summary: Medication adherence is the extent to which a patient takes their medication as prescribed. This paper describes a literature review and concept elicitation interviews to identify forms and drivers of medication adherence across a diverse sample of participants. Forms of non-adherence identified included: deviating from the prescription, skipping a dose, taking a different amount, and taking medication at a different time. Behaviours and drivers can vary by condition, treatment modality, and dosing schedule.This research highlights the variation in the prevalence of medication non-adherence, and the different forms and drivers of non-adherence, based on individuals’ demographic and clinical characteristics. The conceptual model developed advances previous models of medication adherence and may support healthcare professionals in the management of patients and how they can be supported to take medication as intended. The research ultimately informed the development of the Adelphi Adherence Questionnaire (ADAQ©), a novel generic patient-reported outcome measure.Keywords: qualitative research, interviews, literature review, medication adherence

Efrat Neter,1 Efrat Esterkin-Hubner,2 Lea Glass-Marmor,2 Anat Wolkowitz,2 Idit Lavi3 ,† Ariel Miller2,4 1Ruppin Academic Center, Emeq Hefer, Israel; 2Multiple Sclerosis Center & Department of Neurology,Carmel Medical Center, Haifa, Israel; 3Department of Community Medicine & Epidemiology, Carmel Medical Center, Haifa, Israel; 4Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel†Idit Lavi passed away on 31.7.2022Correspondence: Efrat Neter, Ruppin Academic Center, 3 Bait, Emeq Hefer, 4025000, Israel, Tel +972-54-6462677, Fax +972-9-8983043, Email neter@ruppin.ac.il; neter@ruppin.ac.ilPurpose: To evaluate the acceptability, retention, and efficacy of face-to-face intervention, incorporating education and Motivational Interviewing (MI) to support persons with relapsing-remitting multiple sclerosis (PwRRMS) and increase self-reported medication adherence.Patients and Methods: PwRRMS (N = 60) prescribed Disease Modifying Treatment (DMT), who were identified as non-adherent and consented to participate in an intervention, received verbal education and counseling from their treating physician, a tailored MI counseling and a booster session via telephone with a health psychologist, and a concluding MI counseling six months later. Each PwRRMS filled a battery of patient-reported outcomes (PROs) at baseline, six and 12 months later. The design was a quasi-experimental pre-test post-test across a year.Results: Of the sixty identified persons who consented to enroll, 52 completed the intervention and 46 completed the follow-up. At six months following the baseline, adherence scores increased (median = 12.0) and were significantly different than at baseline (median=10.0, p = 0.030). Still, at 12 months follow-up there was no significant difference from baseline in reported adherence (median = 11.0, p = 0.106).Conclusion: This study demonstrated reasonable retention and initial efficacy of a combined psycho-education and MI protocol for PwRRMS to enhance medication adherence to DMT. To maintain the change, a more sustained intervention is required.Plain Language Summary: The study focused on persons with relapsing-remitting multiple sclerosis (PwRRMS) who do not adhere to their prescribed medication.Following the identification of non-adherent persons, PwRRMS were offered an intervention to increase their adherence. The study examined how many of those identified consented to enroll in the intervention, how many remained in the intervention, and whether the intervention was efficacious in terms of self-reported adherence.The intervention included verbal education and counseling from the treating physician, immediately followed by tailored counseling by a psychologist. There was a booster session via telephone with the psychologist, and a concluding counseling meeting six months later. Participants were followed for a year after the initial counseling.Two-thirds of PWMS identified as non-adherent consented to enroll (n = 60), 52 completed the intervention and 46 completed the follow-up. At six months following counseling, self-reported adherence scores significantly increased, but at 12 months follow-up there was no significant difference from baseline in reported adherence. To maintain the change, a more sustained intervention is required.Keywords: disease modifying therapy, medication adherence, medication beliefs, motivational interviewing, multiple sclerosis, participatory medicine, patient reported outcomes

Nan Jiang,1,&ast; Wei Jin,2,&ast; Zhenghui Fu,3,&ast; He Cao,1 Hong Zheng,3 Quqing Wang,1 Qiongting Zhang,3 Kang Ju,3 Jiwei Wang1 1Key Laboratory of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, People’s Republic of China; 2Department of Patriotic Public Health and Health Promotion instruction, Shanghai Municipal Center for Health Promotion, Shanghai, People’s Republic of China; 3Shanghai Changning Mental Health Center (Affiliated to East China Normal University), Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jiwei Wang, Key Laboratory of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, People’s Republic of China, Email jiweiwang@fudan.edu.cn Kang Ju, Shanghai Changning Mental Health Center (Affiliated to East China Normal University), Shanghai, People’s Republic of China, Email jukang2009@163.comPurpose: This study aims to explore the serial mediating effect of stigma and depression on the association between social support and medication adherence.Patients and Methods: A cross-sectional survey was undertaken in the Changning District of Shanghai using a five-part questionnaire from August to December 2023. A convenient sampling method was employed, and 35 patients with schizophrenia were invited from each of the 9 streets in Changning District to participate in the survey, resulting in a total of 305 valid questionnaires collected. The questionnaire measured social support, stigma, depression, medication adherence, and demographic characteristics. Data analysis involved descriptive statistics, independent samples t-tests, ANOVA, Pearson correlation analysis, and the bootstrap method.Results: There was a direct and significantly positive association between social support and medication adherence (β = 0.69, p < 0.001). Moreover, increased levels of stigma (β = - 0.45, p = 0.013) and depression (β = - 0.09, p = 0.017) were both associated with a decline in medication adherence. Bootstrapping analysis revealed that the association between social support and medication adherence operated indirectly through stigma (β = 0.11, 95% CI: 0.03, 0.18). Additionally, social support was indirectly associated with medication adherence through depression (β = 0.15, 95% CI: 0.04, 0.30). Further analysis indicated that social support had an indirect association with medication adherence through both stigma and depression (β = 0.04, 95% CI: 0.01, 0.07).Conclusion: Stigma and depression serially mediate the association between social support and medication adherence among patients with schizophrenia. This serial multiple mediation model underscores the importance of integrating social support interventions with psychological interventions aimed at reducing stigma and depression, thereby effectively enhancing medication adherence in patients with schizophrenia.Keywords: social support, stigma, depression, medication adherence, schizophrenia

Suebsarn Ruksakulpiwat,1 Nicholas K Schiltz,2 Elliane Irani,2 Richard A Josephson,3 Jon Adams,4 Carolyn Harmon Still2 1Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand; 2Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA; 3School of Medicine, Case Western Reserve University, Cleveland, OH, USA; 4School of Public Health, The University of Technology Sydney, Sydney, AustraliaCorrespondence: Suebsarn Ruksakulpiwat, Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand, Email suebsarn25@gmail.comObjective: Hypertension (HTN) significantly increases the risk of stroke and heart disease, which are the leading causes of death and disability globally, particularly among older adults. Antihypertensive medication is a proven treatment for blood pressure control and preventing complications. However, medication adherence rates in older adults with HTN are low. In this review, we systematically identified factors influencing medication adherence in older adults with HTN.Methods: We applied the PRISMA guidelines and conducted systematic searches on PubMed, MEDLINE, and Google Scholar in July 2022 to identify preliminary studies reporting factors influencing medication adherence among older adults with HTN. The convergent integrated analysis framework suggested by the Joanna Briggs Institute for systematic reviews was adopted for data synthesis.Results: Initially, 448 articles were identified, and after title and abstract screening, 16 articles qualified for full-text review. During this phase, three articles were excluded for reporting on irrelevant populations or focusing on issues beyond the review’s aim, leaving thirteen studies in the final review. After data synthesis, fifteen themes were extracted from the key findings of the included studies. The most prevalent themes included the number of medications used (53.9%, n=7 studies), financial status (38.5%, n=5), sex (38.5%, n=5), age (30.1%, n=4), duration of disease (23.1%, n=3), comorbidities (23.1%, n=3), and health compliance (23.1%, n=3). Other themes, such as education, health literacy, health belief, medication belief, perception of illness, patient-physician relationship, self-efficacy, and social support, were also identified.Conclusion: The findings of this review highlight critical areas for developing innovative, evidence-based programs to improve medication adherence in hypertensive older adults. Insights from this review can contribute to improving medication adherence and preventing future health complications.Keywords: hypertension, medication adherence, older adults, systematic review

Randa I Farah,1 Izzat Ahmad Alawwa,1 Dana Q Khateeb,2 Bayan E Hwidi,2 Karam Mohannad Albdour,2 Odai Ghassan Bani Monia,2 Rand Nizam Assaf,2 Abdulrahman Ali Aldabaibah,2 Gaith Iyad Jamil Alsaket,2 Mohammad Ali Alshrouf2 1Nephrology Division, Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan; 2School of Medicine, University of Jordan, Amman, JordanCorrespondence: Randa I Farah, Nephrology Division, Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan, Tel +962 799386016, Email r.farah@ju.edu.joBackground: The adherence to antihypertensive therapy plays a significant role in determining the clinical outcomes of hypertension. We aim to evaluate the level of adherence to antihypertensive medications among patients and to assess the effect of different sociodemographic factors on the level of adherence using the Hill-Bone scale for indirect assessment.Methodology: In this cross-sectional study, we utilized a validated, face-to-face interview questionnaire to collect data on sociodemographic characteristics, participants’ attitudes, and disease knowledge. The Hill-Bone questionnaire was employed to assess treatment adherence. The statistical analysis was conducted using SPSS version 28.0, where mean, standard deviation, and range were utilized for variability analysis.Results: A total of 390 patients were included in this study. The sample comprised 56.9% of females and 56.4% of participants aged 60 years or older. Approximately 80% of participants were currently married, and 46.7% had a higher education level. The average Hill-Bone CHBPTS score was 21.23± 4.95 and indicated good adherence in 63.8% of participants. The findings showed that several factors were significantly associated with higher adherence rates, including older age (COR = 3.41, 95% CI = 1.10– 10.54, p = 0.03), higher educational level (COR = 1.72, 95% CI = 1.05– 2.83, p = 0.03), regular blood pressure monitoring (COR = 1.90, 95% CI = 1.10– 3.30, p = 0.03), and knowledge about their medications (COR = 2.12, 95% CI = 1.14– 3.94, p = 0.02).Conclusion: The medication adherence within our population falls below the desired level. Enhanced counselling and further research are necessary to identify additional factors influencing adherence and develop effective strategies for promoting adherence to antihypertensive medications.Keywords: elderly patients, hypertension, hill-bone scale, medication adherence, socioeconomic factors

Obreniokibo Ibifubara Amiesimaka,1 Kristina Aluzaite,1 Rhiannon Braund,2 Michael Schultz1,3 1Gastroenterology Research Unit, Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; 2New Zealand Pharmacovigilance Centre, University of Otago, Dunedin, New Zealand; 3Gastroenterology Unit, Dunedin Hospital, Te Whatu Ora/Health New Zealand, Dunedin, New ZealandCorrespondence: Michael Schultz, Gastroenterology Research Unit, Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, 9054, New Zealand, Tel +64 3 479 0999, Email michael.schultz@otago.ac.nzAbstract: Inflammatory bowel disease (IBD) management is typified by a long-term medication regimen which can comprise multiple medications prescribed in different combinations, doses, frequencies, and with various administration routes. This complexity can make medication adherence (MA) – patients taking their medications per the prescription – for patients with IBD a challenge. The research corpus contains diverse interventions aimed at improving MA in patients with IBD. Therefore, to condense the evidenced strategies for ease of reference, this narrative evidence-based review broadly outlines the patient-level interventions reported. The interventions are grouped as educational, behavioural, cognitive-behavioural, and multicomponent. They, however, present mixed results as to their efficacy at improving MA, with those employing combined approaches being the most promising. This reflects the reality that MA is impacted by multiple factors encompassing those pertaining to the patient, disease, therapy, patients’ socioeconomic status, and health system. Hence, the most ideal interventions would likely be multifaceted patient-level interventions alongside policy/system-level strategies, to maximise the potential for successfully improving patients’ MA. These findings might have been impacted by the heterogeneity of the studies in terms of the method of MA assessment, duration of interventions, and more besides.Keywords: Inflammatory Bowel Disease, IBD, interventions, medication adherence

Mark R Marshall,1– 3,&ast; Samantha Curd,4,&ast; Julia Kennedy,4,&ast; Dharni Khatri,4,&ast; Sophia Lee,4,&ast; Krenare Pireva,4,&ast; Olita Taule’alo,4,&ast; Porsche Tiavale-Moore,4,&ast; Martin J Wolley,3,5,6,&ast; Tian M Ma,3,7,&ast; Angela L Kam,3,8,&ast; Jun S Suh,3,&ast; Trudi J Aspden4,&ast; 1School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; 2Department of Medicine, Tauranga Hospital, Hauora a Toi Bay of Plenty, Tauranga, New Zealand; 3Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand; 4School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; 5Endocrine Hypertension Research Centre, University of Queensland Frazer Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia; 6Department of Nephrology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia; 7Institute for Innovation + Improvement, North Shore Hospital, Auckland, New Zealand; 8Barts Health NHS Trust, London, UK&ast;These authors contributed equally to this workCorrespondence: Mark R Marshall, Tauranga Hospital, Te Whatu Ora Hauora a Toi Bay of Plenty, 29 Cameron Road, Tauranga South, Tauranga, 3112, New Zealand, Tel +6421461766, Email mark.marshall@bopdhb.govt.nzPurpose: Medication non-adherence in dialysis patients is associated with increased mortality and higher healthcare costs. We assessed whether medication adherence is influenced by specific psychometric constructs measuring beliefs about the necessity for medication and concerns about them. We also tested whether medication knowledge, health literacy, and illness perceptions influenced this relationship.Patients and Methods: This study is based on data from a cross-sectional in-person questionnaire, administered to a random sample of all adult dialysis patients at a teaching hospital. The main outcome was self-assessed medication adherence (8-Item Morisky Medication Adherence Scale). The predictors were: concerns about medications and necessity for medication (Beliefs About Medication Questionnaire); health literacy; medication knowledge (Medication Knowledge Evaluation Tool); cognitive, emotional, and comprehensibility Illness perceptions (Brief Illness Perception Questionnaire). Path analysis was performed using structural equations in both covariance and variance-based models.Results: Necessity for medication increased (standardized path coefficient [β] 0.30 [95% CI 0.05, 0.54]) and concerns about medication decreased (standardized β − 0.33 [− 0.57, − 0.09]) medication adherence, explaining most of the variance in outcome (r2=0.95). Medication knowledge and cognitive illness perceptions had no effects on medication adherence, either directly or indirectly. Higher health literacy, greater illness comprehension, and a more positive emotional view of their illness had medium-to-large sized effects in increasing medication adherence. These were indirect rather and direct effects mediated by decreases in concerns about medications (standardized β respectively − 0.40 [− 0.63,-0.16], − 0.60 [− 0.85, − 0.34], − 0.33 [− 0.52, − 0.13]).Conclusion: Interventions that reduce patients’ concerns about their medications are likely to improve adherence, rather than interventions that increase patients’ perceived necessity for medication. Improving patients’ general health literacy and facilitating a better understanding and more positive perception of the illness can probably achieve this. Our study is potentially limited by a lack of generalizability outside of the population and setting in which it was conducted.Keywords: medication adherence, surveys and questionnaires, latent class analysis, renal dialysis

Sifen Jiang,1,2,&ast; Tingyu Luo,2,&ast; Zhuoqi Zhu,3,&ast; Yanling Huang,2 Haopeng Liu,4 Bing Li,2 Suibin Feng,5 Kun Zeng1 1Science and Education Section, Dongguan Eighth People’s Hospital (Dongguan Children’s Hospital), Dongguan, People’s Republic of China; 2School of Nursing, Guangdong Pharmaceutical University, Guangzhou, People’s Republic of China; 3School of Public Health, Guangxi Medical University, Guangxi, People’s Republic of China; 4School of Public Health, Sun Yat-Sen University, Guangzhou, People’s Republic of China; 5Surgery Department, Dongguan Eighth People’s Hospital (Dongguan Children’s Hospital), Dongguan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Suibin Feng, Surgery Department, Dongguan Eighth People’s Hospital (Dongguan Children’s Hospital), No. 68 South West Lake 3 Road, Shilong Town, Dongguan City, Guangdong Province, 523321, People’s Republic of China, Tel +86 13430293807, Email 19526620667@163.com Kun Zeng, Science and Education Section, Dongguan Eighth People’s Hospital (Dongguan Children’s Hospital), No. 68 South West Lake 3 Road, Shilong Town, Dongguan City, Guangdong Province, 523321, People’s Republic of China, Tel +86 13790300213, Email Zengkun660524@163.comBackground: The treatment of Type 2 Diabetes Mellitus (T2DM) is a protracted and arduous process. Medication, being a universally crucial therapeutic measure, underscores the significance of medication adherence in managing the disease effectively. Medication beliefs have emerged as a significant predictor of adherence, attracting considerable scholarly attention in recent years. However, there remains a paucity of research utilizing individual-centered approaches to explore medication beliefs among the T2DM population during the hospital-home transition, leaving the relationship between these beliefs and medication adherence unclear.Purpose: To investigate latent categories of medication beliefs among patients with T2DM during the transition from hospital to home, and to analyze variations in medication adherence across these categories of patients.Patients and methods: Between August 2022 and September 2023, this study selected 304 patients with a pre-discharge diagnosis of T2DM as study subjects from a tertiary hospital in Dongguan City. The patients’ profiles were assessed comprehensively via the Sociodemographic and Clinical Characteristics Questionnaire, alongside the Chinese version of Beliefs about Medicines Questionnaire-Specific and Morisky Medication Adherence Scale-8. The present study conducted latent profile analysis using Mplus 7.4 software and analyzed the influencing factors of different medication belief categories and their differences in medication adherence using SPSS 26.0 software.Results: The medication beliefs of 304 patients were rated at 3.36± 5.24 points, while medication adherence scored 6.23± 1.56 points. The medication beliefs were classified into four categories: moderate necessity - low to moderate concern group (40.13%), high necessity - low concern group (9.54%), moderate necessity - moderate to high concern group (19.08%), and moderate necessity - high concern group (31.25%). Age, monthly per capita household income, and place of residence emerged as influential factors for the four categories. Moreover, the disparity in medication adherence among these categories demonstrated statistical significance (P < 0.001).Conclusion: The medication beliefs of patients were classified into four distinct categories, and variations in medication adherence were evident across these categories. The high necessity - low concern group demonstrated the highest medication adherence scores, while the moderate necessity - high concern group exhibited the lowest scores. Healthcare providers are advised to tailor personalized medication belief enhancement programs based on patients’ homogeneous beliefs, addressing specific issues encountered by each category. This approach aims to ensure optimal medication adherence across diverse medical and social environments, effectively improving patient prognosis and enhancing quality of life.Keywords: diabetes mellitus, T2DM, medication beliefs, medication adherence, latent profile analysis, influencing factors

Eneyew Talie Fenta,1 Birtukan Gizachew Ayal,2 Atitegeb Abera Kidie,2 Tadele Fentabil Anagaw,3 Tesfaye Shumet Mekonnen,2 Eyob Ketema Bogale,3 Sileshi Berihun,1 Tilahun Degu Tsega,1 Chernet Mengistie Munie,4 Tizazu Talie Fenta,5 Nigus Kassie Worku,6 Sintayehu Shiferaw Gelaw,7 Misganaw Guadie Tiruneh8 1Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia; 2Department of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia; 3Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia; 4Resource Mobilization Directorate, Amhara Regional health Bureau, Bahir Dar, Ethiopia; 5Department of Medical Laboratory Science, Gamby Medical and Business College, Bahir Dar, Ethiopia; 6Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia; 7Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia; 8Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Science University of Gondar, Gondar, EthiopiaCorrespondence: Eneyew Talie Fenta, Email eneyew89@gmail.comBackground: The practice of taking medication as directed by a healthcare provider is known as medication adherence. Therefore, the application of a socio-ecological model to this study identifies multilevel factors on barriers of medication adherence on chronic non-communicable disease and provides information to develop scientific health communication interventional strategies to improve medication adherence.Objective: This study aimed to explore barriers of medication adherence on non-communicable disease prevention and care among patients in North Wollo Zone public hospitals, northeast Ethiopia.Methods: A phenomenological study design was carried out between February 5 and February 30, 2023. The study participants were chosen using a heterogeneous purposive sampling technique. In-depth interviews and targeted focus groups were used to gather data. The focus group discussions and in-depth interviews were captured on audio, accurately transcribed, and translated into English. Atlas TI-7 was utilized to do the thematic analysis.Results: Four main themes, intrapersonal, interpersonal, community level, and health care related, as well as seven subthemes, financial problems, lack of family support, poor communication with healthcare providers, effects of social ceremonies, remote healthcare facility, and drug scarcity, were identified by this study. In this study participants reported that lack of knowledge about the disease and drugs were the main barrier for medication adherence. The study revealed that financial problems for medication and transportation cost were the main factor for medication adherence for non-communicable disease patients.Conclusion: This study explored that lack of knowledge, financial problem, lack of family support, poor communication with healthcare providers, social ceremony effects, remote healthcare facility, and scarcity of drugs were barriers of medication adherence among non-communicable disease patients. In order to reduce morbidity and mortality from non-communicable diseases, it is advised that all relevant bodies look for ways to reduce medication adherence barriers for patients at every level of influence.Keywords: medication adherence, socio-ecological model, non-communicable disease

Ting Wang,1 Hao-Cheng Kang,1 Chia-Chi Chen,1 Tai-Shuan Lai,2 Chih-Fen Huang,1,3 Chien-Chih Wu1,3 1Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; 2Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 3School of Pharmacy, College of Medicine, National Taiwan University, Taipei, TaiwanCorrespondence: Chien-Chih Wu, Department of Pharmacy, National Taiwan University Hospital, College of Medicine, National Taiwan University, 7 Chung Shan S. Road, Taipei, Taiwan, Tel/Fax +886-2-23123456 ext. 63702 ; +886-2-23310930, Email 101440@ntuh.gov.tw; r93451011@gmail.comPurpose: Patients with chronic kidney disease (CKD) are particularly vulnerable to the risks of polypharmacy, largely owing to various comorbid conditions. This vulnerability is further compounded by an escalated risk of renal function deterioration when exposed to nephrotoxic medications. As part of the national health insurance program in Taiwan, the pre-end-stage kidney disease patient care and education plan has included pharmaceutical care since October 2021. This study aims to explore the effect of pharmacist involvement in a multidisciplinary care team for patients with kidney disease in outpatient settings.Patients and Methods: This retrospective observational study was conducted at a single center. It analyzed data from May 2022 to May 2023, focusing on patients who received medication therapy management in the kidney disease pharmacist-managed clinic. The study assessed changes in patient medication adherence, non-steroidal anti-inflammatory drugs (NSAIDs) usage, CKD stage, and urine protein-to-creatinine ratio (UPCR) after pharmacist intervention. It also documented pharmacists’ medication recommendations and the rate of acceptance by physicians.Results: A total of 202 patients who had at least two clinic visits were included in the study. After pharmacist intervention, the proportion of poor medication adherence reduced significantly from 67.8% to 43.1% (p< 0.001). The proportion of NSAID users also decreased significantly from 19.8% to 8.4% (p=0.001). CKD stage showed a significant reduction (p=0.007), and the average UPCR improved from 2828.4 to 2111.0 mg/g (p< 0.001). The pharmacists provided a total of 56 medication recommendations, with an acceptance rate of 86%.Conclusion: The involvement of pharmacists in the multidisciplinary care team can effectively provide medication-related recommendations, ensuring the effectiveness and safety of patients’ medication use, and lead to better kidney function and lower proteinuria.Keywords: pharmaceutical care, medication therapy management, chronic kidney disease, medication adherence, non-steroidal anti-inflammatory drugs

Akihiko Akamine,1 Yuya Nagasaki,2 Atsushi Tomizawa,2 Katsuya Otori2,3 1Department of Pharmacy, Doujin Hospital, Okinawa, Japan; 2Department of Pharmacy, Kitasato University Hospital, Kanagawa, Japan; 3Research and Education Center for Clinical Pharmacy, Division of Clinical Pharmacy, Laboratory of Pharmacy Practice and Science 1, Kitasato University School of Pharmacy, Tokyo, JapanCorrespondence: Akihiko Akamine, Department of Pharmacy, Doujin Hospital, 1-37-12 Gusukuma, Urasoe, Okinawa, 901-2133, Japan, Tel +81-98-876-2212, Fax +81-98-874-7034, Email a-aka@kitasato-u.ac.jpPurpose: The risk factors for non-adherence to pharmacist or non-pharmacist explanations of preoperative medication discontinuation are unknown. The primary outcome of this study was to determine whether the final explainer’s occupation was a risk factor for non-adherence. The secondary outcomes were to determine the risk factors for non-adherence after limiting the departments or adjusting for age.Patients and Methods: We retrospectively examined the data (including patient age, sex, prescription medications, comorbidities, presence of roommate, and number of days between receiving explanation and surgery) of 1132 patients on medications that could affect surgery at a Japanese university hospital between April 1, 2017, and March 31, 2020. The primary endpoint was whether the occupation of the last person explaining medication discontinuation to the patient was an independent risk factor for non-adherence (age ≥ 65 years vs < 65 years). Secondary endpoints included subgroup analyses in urological, gastrointestinal, and otolaryngological areas, as well as a sensitivity analysis (age as a continuous variable) to confirm the validity of the primary endpoint results. A multivariate binary logistic regression identified independent non-adherence risk factors.Results: The main analysis showed that discontinuing two or more medications was a risk factor for non-adherence (adjusted odds ratio (AOR): 1.67; 95% confidence interval (CI): 1.13– 2.47; p = 0.01). However, in analyses coordinated by department (urological, gastrointestinal, and otolaryngological), ≥ 65 (versus < 65) years of age was determined as a risk factor for increased nonadherence (AOR: 2.27, 95% CI: 1.11– 4.63; p=0.024). Age-adjusted analysis (continuous variables) showed similar results to the primary endpoint (AOR: 1.68, 95% CI: 1.14– 2.49, p = 0.009).Conclusion: Two or more medications, and not the final explainer’s occupation, were associated with pre-surgery medication non-adherence. To prevent non-adherence, pharmacists and non-pharmacists should educate patients about preoperative medication discontinuation. These findings could help identify high-risk non-adherence patients.Plain Language Summary: At Kitasato University Hospital, pharmacists and non-pharmacists explain before surgery that patients scheduled for surgery should discontinue medications that could affect surgery. However, there are patients who fail to follow these explanations precisely, but the risk factors have not yet been identified. This study examined risk factors for patients who failed to comply with explanations from a pharmacist or non-pharmacist regarding the use of medications that could affect surgery. Risk factors were examined using a statistical method for identifying risk factors by considering patients’ age ≥ 65 (versus < 65) years, sex, the job title that explained the instructions to the patient, number of medications to be discontinued before surgery, and number of days between instructions and surgery as risk factors. Based on pharmacist/non-pharmacist explanations, the statistical analysis revealed that patients taking two or more medications that could affect surgery may be a risk factor for non-adherence to medications that should be discontinued before surgery. To improve medication adherence, pharmacists and non-pharmacists should be aware of the patient’s non-adherence risk factors, repeatedly explain them to the patient, and help the patient understand that failure to comply with the explanation increases surgical cancelation and intraoperative bleeding risks.Keywords: medication adherence, hematologic agents, pharmaceutical service

Fengyu Liu,1,2,&ast; Huajing Chang,1,&ast; Xiaojun Liu1,3 1School of Public Health, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China; 2School of Public Health, National Key Laboratory of Health Technology Assessment (National Health Commission of the People’s Republic of China), Global Health Institute, Fudan University, Shanghai, People’s Republic of China; 3School of Health Management, Provincial Research Center for Healthcare Reform and Development of Fujian, Health Research Institute, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiaojun Liu, School of Health Management, Fujian Medical University, No. 1 Xuefu North Road, University New District, Fuzhou City, Fujian Province, 350122, People’s Republic of China, Tel + 86 591-22869579, Email xiaojun_liu@fjmu.edu.cnBackground: Non-adherence or partial adherence is the main reason for poor therapeutic effect of hypertension. This paper aims to assess adherence behaviors and related factors among elderly hypertensive patients in China.Methods: Participants aged ≥ 60 years, with hypertension, and with complete data in 2018 interviews of the China Health and Retirement Longitudinal Study (CHARLS) were included. The adherence behaviors included medication, blood pressure monitoring and the combined adherence behaviors. Referring to the social-ecological theory, correlates of adherence behaviors were divided into three layers, namely demographic characteristics, health behaviors, living environment and retirement. Univariate and multivariable logistic regression models were performed to identify factors of adherence behaviors.Results: The prevalence of medication adherence (76.58%) was higher than that of blood pressure monitoring adherence (20.08%), and the full adherence rate was 18.53%. Self-rated health status, smoking status, living area, and health education status were detected to be associated with medication adherence and blood pressure monitoring adherence (all p < 0.05). Gender, sleep duration, health examination, and physical exercise were also detected to be associated with blood pressure monitoring adherence (all p < 0.05). Self-rated health status and health education status were detected to be associated with partially and fully adherence, while age, living area, and life satisfaction were detected to be associated with partially adherence, smoking status, sleep duration, health examination, and pension reliance were detected to be associated with fully adherence (all p < 0.05).Conclusion: Our study reveals the poor adherence behaviors of elderly hypertensive patients in China. This is most evident among those who were male, 60– 69 years old, living in rural areas, self-reported being healthier, those without health examination and health education. Targeting these vulnerable populations, we suggest to strengthen health education, increase the publicity of basic public health services and enhance the self-management ability of hypertensive patients.Keywords: medication adherence, blood pressure monitoring, hypertension, behavior, elderly

Salpe Malkon,1 Björn Wettermark,1 Thomas Kahan,2 Pia Bastholm-Rahmner,3 Jan Hasselström,4 Miriam Qvarnström1 1Department of Pharmacy, Uppsala University, Uppsala, Sweden; 2Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden; 3Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; 4Department of Neurobiology and Care Sciences and Society, Karolinska Institutet, Stockholm, SwedenCorrespondence: Miriam Qvarnström, Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Box 580, Uppsala, 751 23, Sweden, Email miriam.qvarnstrom@farmaci.uu.sePurpose: Few studies explored what patients initiated on blood pressure medication in primary care think about their disease and their medications. The aim of this study was to gain an understanding of hypertensive patients’ views on and experiences of hypertension and the use of antihypertensive medications.Methods: A qualitative study based on open-ended questions from a survey on medication adherence, which captured treated hypertensive patients’ perspective on their condition and treatment. Data were collected for 219 patients on antihypertensive medication, ≥ 30 years old, who consulted 25 primary health care centers in Stockholm, Sweden, during 2016. Thematic analysis with both inductive and deductive approach was applied.Results: We identified 21 codes from the data and grouped them under the World Health Organization’s five dimensions of adherence: condition-, therapy-, health care team and system-, patient-, and socioeconomic-related factors. The analyses revealed that many patients with hypertension have limited knowledge of their disease, are afraid of drug side effects and experience various issues in primary health care that may negatively impact adherence, including short doctor appointments, prescribing without communication and room for improvement in individualization of therapy and a person-centered approach.Conclusion: Many patients with hypertension have limited understanding of their hypertension and fear of adverse events from their antihypertensive medications. There is also room for improvement in how the patients are managed in primary health care. Interventions should focus on these issues to promote a better blood pressure target achievement.Plain Language Summary: Few studies have explored what patients initiated on blood pressure medication in primary care think about their disease and their medications.In this study, we analyzed free comments collected from 219 patients responding to a survey on medication adherence. Those who responded used antihypertensive medication, were ≥ 30 years old, and consulted primary health care centers in Stockholm, Sweden.The analyses revealed that many patients with hypertension have limited knowledge of their disease, are afraid of drug side effects and experience various issues in primary health care that may negatively impact adherence, including short doctor appointments, prescribing without communication and room for improvement in individualization of therapy and a person-centered approach.Interventions to promote a better blood pressure treatment would likely benefit from targeting these problems raised by patients.Keywords: hypertension, antihypertensive treatment, medication adherence, patient perspectives, primary health care, qualitative studies

Gangjiao Zhu,1,2 Rahul Malhotra,3– 5 Shangzhi Xiong,6 Xinyue Chen,7 Mingyang Zhang,2 You Wu,2 Enying Gong,8 Zhan Wang,9 Xiangyang Tian,10 Weixia Peng,11 Truls Østbye,2,3,12 Lijing L Yan1,2,12 1School of Public Health, Wuhan University, Wuhan, People’s Republic of China; 2Global Health Research Center, Duke Kunshan University, Kunshan, People’s Republic of China; 3Health Services and Systems Research, Duke-NUS Medical School, Singapore; 4Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore; 5Singhealth, Duke-NUS Global Health Institute Medical School, Singapore; 6The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; 7Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; 8School of Population Medicine and Public Health, China Academy of Medical Science & Peking Union Medical College, Beijing, People’s Republic of China; 9Department of Agricultural Economics, College of Agriculture, Purdue University, West Lafayette, IN, USA; 10Chinese Health Education Center, Beijing, People’s Republic of China; 11School of Public Health, Fudan University, Shanghai, People’s Republic of China; 12Duke Global Health Institute, Duke University, Durham, NC, USACorrespondence: Lijing L Yan, School of Public Health, Wuhan University, Wuhan, People’s Republic of China, Email lijing.yan@duke.eduPurpose: We assess whether the sequential mediating effects of self-efficacy and depressive symptoms on the relationship between community efficacy for non-communicable disease management (COEN) and medication adherence and whether these relationships differed by sex and age.Patients and Methods: Overall, 662 individuals from 12 communities in China were interviewed twice 1 year apart. Serial mediation analysis examined whether the relationship between COEN and medication adherence was mediated by self-efficacy and depressive symptoms. Model invariance across sex and age groups was assessed using multi-group analysis.Results: Serial mediation analysis indicated that self-efficacy and depressive symptoms sequentially mediated relationship between COEN and medication adherence. Multi-group analysis by sex showed that the path from self-efficacy to medication adherence was significant only for females and from depressive symptoms to medication adherence was significant only for males.Conclusion: Interventions that enhance individual self-efficacy may be beneficial in decreasing depressive symptoms and improving medication adherence.Keywords: medication adherence, neighborhood, community, self-efficacy, depressive symptoms, non-communicable chronic diseases, social cognitive theory, China

Luis Fernando Valladales-Restrepo,1– 3 María Camila Oyuela-Gutiérrez,3 Ana Camila Delgado-Araujo,1 Juliana Calvo-Salazar,1 Daniel Osorio-Bustamante,3 Cesar Eduardo Lerma-Barco,3 Jorge Enrique Machado-Alba1 1Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Risaralda, Colombia; 2Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia; 3Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, ColombiaCorrespondence: Jorge Enrique Machado-Alba, Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 &num; 14-140, Pereira, Risaralda, 660003, Colombia, Tel +57 3108326970, Fax +57 63137822, Email machado@utp.edu.coPurpose: Chronic obstructive pulmonary disease (COPD) affects millions of people around the world. Poor adherence to treatment contributes to increased severity of symptoms, morbidity, and mortality. The objective of this study was to establish the adherence of patients diagnosed with COPD by their devices for inhalation in a group of patients, Colombia.Patients and Methods: This was a cross-sectional study of patients treated in the Colombian health system. Adherence to inhalation devices was evaluated with the TAI-10 instrument (Inhaler Adherence Test). A score of 50 points was considered good adherence.Results: A total of 500 patients from 84 cities were identified, with a median age of 79.0 years, and 59.2% were women. A total of 45% had GOLD B COPD, and 56.6% had good adherence. Average adherence was 47.4± 5.3 points, and no significant differences were found according to inhalation devices (p=0.949). Training performed by specialist physicians (OR: 1.75; 95% CI: 1.17– 2.62), use of an inhaler for less than 1 year (OR: 1.59; 95% CI: 1.04– 2.43), use of short-acting β 2-adrenergic agonists (OR: 1.58; 95% CI: 1.05– 2.38) and increased satisfaction with the inhalation device (OR: 1.09; 95% CI: 1.04– 1.14) were associated with good adherence, while those from the central region (OR: 0.55; 95% CI: 0.36– 0.83), who had a COPD evolution time of less than 5 years (OR: 0.57; 95% CI: 0.37– 0.98) and had diabetes mellitus (OR: 0.60; 95% CI: 0.37– 0.98) had lower adherence.Conclusion: Adherence to treatment with inhaled bronchodilators and glucocorticoids were not very high, with no significant differences by type of inhalation device. Satisfaction and training by specialists increased adherence.Keywords: pulmonary disease, chronic obstructive, medication adherence, bronchodilator agents, devices, inhalation, pharmacoepidemiology

Charles Muiruri,1,2 Eline M van den Broek-Altenburg,3 Hayden B Bosworth,1,4 Crystal W Cené,5 Juan Marcos Gonzalez1,6 1Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; 2Duke Global Health Institute, Duke University, Durham, NC, USA; 3University of Vermont Larner College of Medicine, Burlington, VT, USA; 4Durham Veterans Affairs Medical Center, Durham, NC, USA; 5University of California San Diego Health, San Diego, CA, USA; 6Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USACorrespondence: Charles Muiruri, Department of Population Health Sciences Duke University School of Medicine, 215 Morris St., Suite 210, Durham, NC, 27701, USA, Tel +19196603212, Email charles.muiruri@duke.eduIntroduction: Medication non-adherence remains a significant challenge in healthcare, impacting treatment outcomes and the overall effectiveness of medical interventions. This article introduces a novel approach to understanding and predicting medication non-adherence by integrating patient beliefs, efficacy expectations, and perceived costs. Existing theoretical models often fall short in quantifying the impact of barrier removal on medication adherence and struggle to address cases where patients consciously choose not to follow prescribed medication regimens. In response to these limitations, this study presents an empirical framework that seeks to provide a quantifiable model for both individual and population-level prediction of non-adherence under different scenarios.Methods: We present an empirical framework that includes a health production function, specifically applied to antihypertensive medications nonadherence. Data collection involved a pilot study that utilized a double-bound contingent-belief (DBCB) questionnaire. Through this questionnaire, participants could express how efficacy and side effects were affected by controlled levels of non-adherence, allowing for the estimation of sensitivity in health outcomes and costs.Results: Parameters derived from the DBCB questionnaire revealed that on average, patients with hypertension anticipated that treatment efficacy was less sensitive to non-adherence than side effects. Our derived health production function suggests that patients may strategically manage adherence to minimize side effects, without compromising efficacy. Patients’ inclination to manage medication intake is closely linked to the relative importance they assign to treatment efficacy and side effects. Model outcomes indicate that patients opt for full adherence when efficacy outweighs side effects. Our findings also indicated an association between income and patient expectations regarding the health of antihypertensive medications.Conclusion: Our framework represents a pioneering effort to quantitatively link non-adherence to patient preferences. Preliminary results from our pilot study of patients with hypertension suggest that the framework offers a viable alternative for evaluating the potential impact of interventions on treatment adherence.Keywords: medication adherence, patient preferences, health production, behavioral model, quantitative framework, treatment efficacy, side effects

Ahmad Al-Azayzih,1 Roaa J Kanaan,1 Shoroq M Altawalbeh,1 Walid Al-Qerem,2 Saja Smadi1 1Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, JordanCorrespondence: Ahmad Al-Azayzih, Clinical Pharmacy Department, Faculty of Pharmacy-Jordan University of Science and Technology, Irbid, 22110, Jordan, Email aaazayzih@just.edu.joAims of the Study: To evaluate medication adherence level and identify predictors of poor medication adherence in elderly patients with Cardiovascular (CVS) diseases and type 2 diabetes in Jordan.Methods: This cross-sectional study was conducted on elderly patients who attended King Abdullah University Hospital (KAUH) outpatient diabetes and cardiology clinics from March 6, 2023, to July 6, 2023. Data on age, sex, socio-demographics, biological variables, medication characteristics, and chronic comorbidities were obtained from electronic patients’ medical records and a validated questionnaire. Medication adherence levels (low, moderate, and high) were assessed using the Arabic version of the 4-item Morisky, Green, and Levine Medication Adherence Scale-Medication Assessment Questionnaire.Results: Data from 506 elderly patients were analyzed. The average age of the participants was 67.93 years (SD = 6.22). 7.9% of patients showed low adherence levels, 33.6% showed moderate adherence level, and 58.5% of patients showed a high level of adherence toward their prescribed medications. Multivariable ordinal logistic regression analysis revealed that single/currently unmarried patients and patients who were living with others were more likely to have a higher adherence level; Odd Ratios (ORs) were 4.75 and 4.10, respectively. Patients who took their medications ≥ 3 and 2 times a day showed higher adherence to their medications than those who only took them once a day.; ORs were 2.15 and 2.36, respectively.Conclusion: This study indicated an inadequate level of adherence among patients with type 2 diabetes and cardiovascular comorbidities. This study revealed the necessity of implementing programs to help in raising the awareness among elderly patients with type 2 diabetes and CVDs of the importance of adherence to prescribed long-term medication regimens.Keywords: diabetes, medication adherence, elderly, cardiovascular diseases, geriatrics, Jordan

Ponglapat Klinpiboon,1,2,&ast; Kornkaew Chanthapasa2,&ast; 1Department of Pharmacy, Nakhon Ratchasima Rajanagarindra Psychiatric Hospital, Nakhon Ratchasima, Thailand; 2Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand&ast;These authors contributed equally to this workCorrespondence: Kornkaew Chanthapasa, Faculty of Pharmaceutical Science, Khon Kaen University, No. 123, Moo 16, Mittraphap Road, Nai-Muang, Muang District, Khon Kaen, 40002, Thailand, Tel +66 812 618 095, Fax +66 4320 2379, Email korcha@kku.ac.thPurpose: Patients with schizophrenia often experience mental illness exacerbations, which lead to frequent re-hospitalization. Non-adherence to medication is the main cause of relapses, despite many patients requiring lifelong treatment. Non-adherence consequences include higher re-admission and suicide rates, worse progression of mental illness, higher rates of violence by patients with mental illness, and increased use of emergency psychiatric services. This directly impacts the cost and workload of the mental healthcare system. This study aims to understand medication non-adherence among schizophrenia patients in Thailand based on the country’s specific context.Patients and Methods: This qualitative research study explored the causes of non-adherence to medication and health perceptions among patients with schizophrenia in Thailand. Five patients with schizophrenia were included in this study. Data was collected through in-depth interviews, recordings of treatments, and field notes based on the interpretive perspective of key informants with the concept of phenomenology.Results: Thematic analysis revealed two main themes associated with mental illness exacerbation: triggers of exacerbation and medication non-adherence. The triggers that emerged from the data were substance abuse and psychological stress. Medication non-adherence issues were misunderstandings about mental illness and its treatment, lack of participation in treatment, and difficulty accessing mental health services.Conclusion: This study explored the importance of medication adherence in patients with schizophrenia. Non-adherence to medication can worsen mental illness and create a vicious cycle that makes treatment more challenging. Substance abuse and psychological stress can also exacerbate this cycle. Mental health services should strive to improve medication adherence strategies and offer social support to prevent harmful behaviors and break the vicious cycle.Keywords: schizophrenia, medication adherence, mental health service, medication management

Deborah Obehi Onwusah,1 Elizabeth Bolanle Ojewole,1 Tawanda Manyangadze,2,3 Moses John Chimbari2,4 1Discipline of Pharmaceutical Sciences, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa; 2Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa; 3Geosciences, School of Geosciences, Disasters and Sustainable Development, Faculty of Science and Engineering, Bindura University of Science Education, Bindura, Mashonaland Central, Zimbabwe; 4Department of Public Health, School of Medical and Health Sciences, Great Zimbabwe University, Masvingo, ZimbabweCorrespondence: Deborah Obehi Onwusah, Discipline of Pharmaceutical Sciences, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, KwaZulu-Natal, 4000, South Africa, Email deborahobehi@gmail.comPurpose: Despite the life-saving benefits of oral anticancer medications (OAMs) to women with breast cancer (BC), adherence remains suboptimal and, in many cases, not well documented. The study examined barriers and facilitators of adherence to OAMs among women receiving BC treatment in Nigeria.Patients and Methods: The study was framed within the World Health Organization (WHO) Multidimensional Model of Adherence. We conducted qualitative in-depth interviews of 16 purposively sampled women in two tertiary hospitals in Southern Nigeria. The interviews were audio-recorded and transcribed verbatim. The interview data were analyzed using the Framework Method.Results: The key barriers to OAM adherence mentioned were socioeconomic factors (high cost of medication) and therapy-related factors (medication side effects). The key facilitating mechanisms for adherence to OAMs mentioned included; (i) patient-related psychosocial factors such as self-encouragement and self-discipline in sticking to the prescription, taking the medication at a particular time each day, receiving practical support from family members; and (ii) healthcare team/system factors such as obtaining an adequate supply of the medication at the pharmacy.Conclusion: Barriers and facilitators to OAM adherence are multidimensional. The study findings highlight the potential benefit of a multifaceted intervention (such as patient education and monitoring or strategies promoting cost-containment and side effects management) to optimize adherence. Therefore, our findings may inform the designing and evaluating of context-specific adherence measures and multifaceted intervention strategies targeting key barriers and approaches that enable adherence to enhance patient outcomes.Keywords: medication adherence, oral antineoplastic agents, breast cancer, women’s experiences

Na Wang,1 Pei Li,1 Dandan Suo,1 Hongyan Wei,1 Huanhuan Wei,2 Run Guo,2 Wen Si2 1Department of Infectious Diseases, Tangdu Hospital, Air Force Medical University, Xi’an, People’s Republic of China; 2Department of General Practice Medicine, Tangdu Hospital, Air Force Medical University, Xi’an, People’s Republic of ChinaCorrespondence: Wen Si, Department of General Practice Medicine, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, Baqiao District, Xi’an, Shaanxi Province, People’s Republic of China, Tel +86 15829643781, Email 15829643781@163.comPurpose: This study aims to identify the novel risk predictors of low medication adherence of cirrhosis patients in a large cohort and construct an applicable predictive model to provide clinicians with a simple and precise personalized prediction tool.Patients and Methods: Patients with cirrhosis were recruited from the inpatient populations at the Department of Infectious Diseases of Tangdu Hospital. Patients who did not meet the inclusion criteria were excluded. The primary outcome was medication adherence, which was analyzed by the medication possession ratio (MPR). Potential predictive factors, including demographics, the severity of cirrhosis, knowledge of disease and medical treatment, social support, self-care agency and pill burdens, were collected by questionnaires. Predictive factors were selected by univariable and multivariable logistic regression analysis. Then, a nomogram was constructed. The decision curve analysis (DCA), clinical application curve analysis, ROC curve analysis, Brier score and mean squared error (MSE) score were utilized to assess the performance of the model. In addition, the bootstrapping method was used for internal validation.Results: Among the enrolled patients (460), most had good or moderate (344, 74.78%) medical adherence. The main risk factors for non-adherence include young age (≤ 50 years), low education level, low income, short duration of disease (< 10 years), low Child-Plush class, poor knowledge of disease and medical treatment, poor social support, low self-care agency and high pill burden. The nomogram comprised these factors showed good calibration and good discrimination (AUC = 0.938, 95% CI = 0.918– 0.956; Brier score = 0.14). In addition, the MSE value was 0.03, indicating no overfitting.Conclusion: This study identified predictive factors regarding low medication adherence among patients with cirrhosis, and a predictive nomogram was constructed. This model could help clinicians identify patients with a high risk of low medication adherence and intervention measures can be taken in time.Keywords: medication adherence, cirrhosis, nomogram, prediction model

Charlotte C Poot,1,2 Jasmijn de Boer,3 Lyè Goto,3 Susanne J van de Hei,4,5 Niels H Chavannes,1,2 Valentijn T Visch,3 Eline Meijer1,2 1Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands; 2National eHealth Living Lab (NeLL), Leiden University Medical Centre, Leiden, The Netherlands; 3Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands; 4Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; 5General Practitioners Research Institute, Groningen, The NetherlandsCorrespondence: Charlotte C Poot, Leiden University Medical Centre, Hippocratespad 21, Leiden, 2333 ZD, The Netherlands, Email c.c.poot@lumc.nlObjective: This study aimed to design a persuasive game, using objective adherence data, to motivate people with asthma to adhere to their medication regimen.Methods: A participatory user-centered design approach was employed, involving end-users and other stakeholders throughout the study. The approach consisted of four phases. Semi-structured interviews and a survey were conducted to understand user needs and reasons for poor adherence (Phase 1: define). Key themes were identified, leading to the formulation of behavior change strategies and design and game requirements. Several design directions were ideated, resulting in a concept for a serious game (Phase 2: ideate). Two rounds of user-tests were performed to evaluate a prototype of the serious game in terms of usability, perceived impact on medication adherence and motivation (Phase 3: prototype and Phase 4: evaluate).Results: Findings from semi-structured interviews (n = 6) and the online survey (n = 20) revealed that people’s non-adherence was often attributed to the perception of asthma as an episodic condition, the delayed experienced effect of maintenance inhalers, and lack of knowledge regarding difference of effect between maintenance and reliever inhalers. The study used behavior change strategies to translate these insights into design requirements for the development of the narrative-based persuasive game Ademgenoot. This six-week challenge-based game combines various behavior change strategies, including personal goal setting and continuous visual feedback, as well as persuasive game design elements, such as a narrative and rewards, with the aim of enhancing motivation to adhere to their medication regimen. User-testing (n = 8; round 1 and 2) showed that Ademgenoot is feasible in clinical practice and has the potential to support people with mild asthma in adherence to their maintenance medication.Discussion: Future efforts should be directed towards a larger evaluation to assess the impact on motivation and inhaler use behaviour.Plain Language Summary: The goal of this study was to create a serious game that encourages people with asthma to take their medication regularly. During the study, we worked closely with individuals who have asthma and other stakeholders throughout the study. We conducted interviews and surveys to understand why people have difficulties using their maintenance inhaler as prescribed by their doctor. Based on the feedback we received, we developed a serious game called “Ademgenoot”. The game uses information on inhaler use automatically collected with a device attached to the inhaler. The game includes features like personal goals and visual feedback on inhaler use to motivate users to take their medication consistently. We tested a prototype of the game with users to see if it was easy to use and if it motivated them to use their maintenance inhaler. The results showed that Ademgenoot is a viable option for helping individuals with mild asthma stay on track with their medication.Key words: medication adherence, serious game design, behavior change, adherence monitoring, participatory design

Seifu M Abera,1,2 Colin O’Donnell,3 Taufiq Salahuddin,1,2 Krishna Prabhu,4 Carol E Simons,1 P Michael Ho,5,6 Stephen W Waldo,3,5,6 Jacob A Doll1– 3 1Section of Cardiology, VA Puget Sound Health Care System, Seattle, WA, USA; 2Department of Medicine, University of Washington, Seattle, WA, USA; 3Department of Veterans Affairs Clinical Assessment, Reporting, and Tracking Program, VHA Office of Quality and Patient Safety, Washington, DC, USA; 4Hennepin County Medical Center, Minneapolis, MN, USA; 5Rocky Mountain Regional VA Medical Center, Aurora, CO, USA; 6Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USACorrespondence: Jacob A Doll, VA Puget Sound Health Care System, 1660 S. Columbian Way, S111-CARDIO, Seattle, WA, 98108, USA, Tel +1 206-277-6199, Fax +1 206-764-2257, Email jdoll@uw.eduObjective: Adherence to anti-platelet medications is critical following coronary stenting, but prior studies indicate that clinician assessment and patient self-assessment of adherence are poorly correlated with future medication-taking behavior. We therefore sought to determine if integrated pharmacy data can be used to identify patients at high risk of non-adherence after percutaneous coronary interventions (PCI).Methods: Using Veteran Affairs (VA) Clinical Assessment, Reporting, and Tracking (CART) data linked with pharmacy records, we assessed adherence to cardiovascular medications from 2012 to 2018. Adherence was defined as the proportion of days covered (PDC) ≥ 0.80. We assessed the association of pre-PCI adherence with post-PCI adherence to P2Y12 inhibitors and clinical outcomes using logistic regression and Cox proportional hazard models, respectively.Results: Among 56,357 patients, 66.0% filled at least 1 cardiovascular medication within VA for the year prior to PCI and were evaluable for adherence. Pre-PCI non-adherence was 20.7%, and non-adherent patients were more likely to be younger and present non-electively. Non-adherent patients were less likely to adhere to P2Y12 inhibitor therapy after PCI (Adjusted OR 0.45 C.I. 0.41– 0.46), compared with adherent patients, and had a higher adjusted risk of mortality (HR 1.17 C.I. 1.03– 1.33).Conclusion: Adherence to cardiovascular medications prior to PCI can be assessed for most patients using pharmacy data, and past adherence is associated with future adherence and mortality after PCI. Use of integrated pharmacy data to identify high-risk patients could improve outcomes and cost-effectiveness of adherence interventions.Plain Language Summary: Why was the study done?: Non-adherence to anti-platelet medications is common following coronary stenting procedures and is associated with worse outcomes, but predicting non-adherence is challenging.What did the researchers do and find?: The researchers examined pharmacy fill-based adherence assessments before and after stenting procedures. Pharmacy data can provide adherence estimates for most patients receiving percutaneous coronary intervention, and these estimates are associated with downstream medication-taking behavior and clinical outcomes.What do the results mean?: Health systems should seek to integrate pharmacy-based adherence estimates into routine care for patients with cardiovascular disease. Identification and targeting of patients at high-risk for non-adherence may improve the impact and cost-effectiveness of future research and health policy interventions aimed at improving adherence.Keywords: percutaneous coronary intervention, medication adherence

Allison P Pack,1 Mary Clare Masters,2 Rachel O’Conor,1 Kenya Alcantara,1 Sophia Svoboda,1 Reneaki Smith,1 Fangyu Yeh,1 Guisselle Wismer,1 Amisha Wallia,2,3 Stacy C Bailey1 1Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; 2Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; 3Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USACorrespondence: Allison P Pack, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA, Email allison.pack@northwestern.eduBackground: People living with HIV (PLWH) are at higher risk of developing type 2 diabetes (T2DM). Both chronic conditions require individuals to adhere to medication regimens, yet few studies have sought to explore medication-taking behaviors among individuals with comorbid HIV and T2DM (HIV+T2DM).Objective: This qualitative study sought to: 1) identify and compare perceived determinants of medication adherence for HIV and, separately, for T2DM, and 2) explore how participants prioritize conditions.Methods: Between October 2022 and January 2023, we conducted in-depth interviews with individuals aged 50 or older, living with comorbid HIV+T2DM. Participants were prescribed oral medications to treat their conditions and had recent clinical measures indicating probable challenges with medication adherence. Interviews with consented participants from a large academic health center in the Midwest were conducted remotely. Questions largely drew from the Theoretical Domains Framework (TDF), a widely used implementation science framework. Additional questions explored the prioritization of conditions. Analysis employed the Framework Method and a side-by-side comparison of key determinants of medication adherence by condition.Results: A total of 19 interviews were audio recorded, transcribed, and analyzed. Participants were an average age of 61, mostly male (89.5%), and Non-Hispanic White (47.4%). Although results revealed many commonalities between perceived determinants of medication adherence for HIV and for T2DM, differences relating to two TDF domains were noted: nature of the behavior (taking medications as prescribed), and motivations and goals. Many participants viewed their conditions as equally important, though they suggested T2DM was more difficult to manage, largely due to lifestyle modifications.Conclusion: As individuals with HIV develop chronic conditions, such as T2DM, they may require additional medication adherence support. Attention should be paid to offering support early. Disease perceptions may differ by condition, and as such, one’s motivations to take medication as prescribed may also differ by condition.Keywords: qualitative, HIV, type 2 diabetes, medication adherence

Yvonne Commodore-Mensah,1,2,&ast; Sabianca Delva,3,&ast; Oluwabunmi Ogungbe,1,2,&ast; Lauren A Smulcer,4 Sally Rives,1 Cheryl R Dennison Himmelfarb,1,5,6 Miyong T Kim,7 Lee Bone,1,2,5 David Levine,1,2,5 Martha N Hill1,2,5 1Johns Hopkins School of Nursing, Baltimore, MD, USA; 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 3William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA; 4Elara Caring, Fort Polk North, LA, USA; 5Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; 6Department of Health, Behavior and Society, Johns Hopkins Bloombery School of Public Health, Baltimore, MD, USA; 7School of Nursing, University of Texas at Austin, Austin, TX, USA&ast;These authors contributed equally to this workCorrespondence: Yvonne Commodore-Mensah, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Room N530U, Baltimore, MD, 21205, USA, Tel +1 4106141519, Email ycommod1@jhmi.eduBackground: Poor medication adherence hampers hypertension control and increases the risk of adverse health outcomes. Medication adherence can be measured with direct and indirect methods. The Hill-Bone Compliance to High Blood Pressure Therapy (HBCHBPT) Scale, one of the most popular adherence measures, indirectly assesses adherence to hypertension therapy in three behavioral domains: appointment keeping, diet and medication adherence.Aim: To synthesize evidence on the use of the HBCHBPT Scale, including psychometric properties, utility in diverse patient populations, and directions for future clinical use and research.Methods: We searched electronic databases, specifically CINAHL, PubMed, PsychInfo, Embase, and Web of Science. We included original studies that used the HBCHBPT Scale or its subscales to measure a health outcome, or methodological studies involving translations and validations of the scale. We extracted and synthesized data following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines.Results: Fifty studies were included in this review, 44 on hypertension, two on diabetes, and others on other chronic conditions. The scale was successfully translated into numerous languages and used in descriptive and intervention studies. The scale demonstrated sound psychometric properties (Cronbach’s α coefficient 0.75) and sensitivity to capture intervention effects when used to evaluate the effectiveness of high blood pressure adherence interventions. The medication-taking subscale of HBCHBPT performs best and is widely used in diverse contexts to assess medication adherence for chronic conditions.Conclusion: The HBCHBPT Scale has high versatility globally and has been used in various settings by various healthcare worker cadres and researchers. The scale has several strengths, including high adherence phenotyping capabilities, contributing to the paradigm shift toward personalized health care.Keywords: medication adherence, treatment adherence, treatment compliance, hypertension, high blood pressure, Hill Bone Medication Adherence Scale, Hill-Bone Compliance to Blood Pressure Therapy Scale

Hangting Li,1,&ast; Xiaolian Wu,1,&ast; Jiaoni Shen,2 Shuhui Lou2 1Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, People’s Republic of China; 2School of Nursing, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Shuhui Lou, School of Nursing, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou City, Zhejiang Province, People’s Republic of China, Email loushh@zcmu.edu.cnBackground: Drug treatment is critical for patients with aplastic anemia, and medication adherence directly impacts the therapeutic effect. Poor medication adherence is common among patients with chronic diseases. However, knowledge of the perceptions and experiences of patients with aplastic anemia regarding taking prescribed medicines is limited.Objective: To gain insights into the perceptions and experiences of patients with aplastic anemia regarding taking prescribed medicines.Methods: A descriptive qualitative design was used. Fifteen patients with aplastic anemia were recruited from the hematology department. Individual semi-structured interviews were conducted. The data were analyzed using the thematic analysis method and conceptualized using the Health Belief Model.Results: Five themes emerged: the perceived threat of aplastic anemia, perceived benefits and barriers of taking prescribed medicines, cues to action, self-efficacy, and modifying factors. While patients’ knowledge was limited, they acknowledged the threat of aplastic anemia and the necessity of drug treatments, but they also encountered some barriers in practice. The desire for health and healthcare providers’ opinions were the main clues to medication adherence. The expectation of the future and the sense of self-competency made participants adopt good behavior.Discussions: This study provided new perspectives on the medication adherence of patients with aplastic anemia, which may be valuable in clinical work and research. Further interventions should be developed for intentional and unintentional non-compliance. Future research can start with developing professional assessment tools addressing the influence of cognition and emotion on compliance.Keywords: aplastic anemia, China, health belief model, medication adherence, perception, qualitative research

Irwin Goldstein,1 Tarek Hassan,2 Kelly Zou,3 Victoria Divino,4 Mitch DeKoven,4 Joseph Imperato,3 Vamshi Ruthwik Anupindi,4 Jim Li3 1Department of Sexual Medicine, Alvarado Hospital, San Diego, CA, USA; 2Department of Urology, Viatris Inc, Canonsburg, PA, USA; 3Global Medical Analytics and Real World Evidence, Viatris Inc, Canonsburg, PA, USA; 4Health Economics/Outcomes Research and Real-World Insights, IQVIA, Falls Church, VA, USACorrespondence: Tarek Hassan, Global Medical Lead, Department of Urology, Global Medical and Clinical, Viatris Inc, 1000 Mylan Blvd, Canonsburg, PA, 15317, USA, Tel +1 3474432850, Email tarek.hassan@viatris.comObjective: To compare health-care resource utilization (HCRU) outcomes in patients with erectile dysfunction (ED) and benign prostatic hyperplasia-associated lower urinary tract symptoms (BPH-LUTS) treated with tadalafil or non-phosphodiesterase-5 inhibitor (PDE5i), adherence to and persistence with tadalafil by dose in the United States (US).Methods: This was a noninterventional, real-world evidence study of men (aged ≥ 45 years) with ED and BPH-LUTS treated with tadalafil or non-PDE5i. The IQVIA US PharMetrics Plus claims database was used. Outcomes included all-cause and disease-specific HCRU over a 12-month follow-up. Persistence with and adherence to tadalafil were evaluated stratified by dose (10 or 20 mg as needed; 2.5 or 5 mg as once daily [OD]).Results: The final sample comprised 11,351 tadalafil and 48,722 non-PDE5i patients. For all-cause and disease-specific HCRU, including prescription fills, physician office visits, emergency room visits, laboratory tests, radiology examinations, outpatient surgical services, ancillary services, hospitalizations, mean number of utilizations, and proportions of patients with one or more utilizations, were lower for tadalafil compared with non-PDE5i patients. For all-cause HCRU, proportions of patients with one or more emergency room visits (18.6% vs 21.7%, p< 0.0001) and outpatient surgical visits (63.0% vs 68.8%, p< 0.0001) were significantly lower for tadalafil compared with non-PDE5i patients. For disease-specific HCRU, the proportion with one or more disease-specific physician office visits (55.1% vs 91.4%), laboratory tests (34.8% vs 58.2%), outpatient surgery (24.3% vs 38.9%), or outpatient ancillary services (18.0% vs 29.8%) were significantly lower for tadalafil compared with non-PDE5i patients (all comparisons, p< 0.0001). Mean persistence days (179.8 vs 61.2), proportion persistence (35.8% vs 6.5%), and mean adherence (0.5 vs 0.2) were higher for tadalafil OD doses than as-needed tadalafil doses.Conclusion: Patients on tadalafil demonstrated less HCRU and higher persistence and adherence (OD versus as-needed tadalafil) than non-PDE5i patients, which demonstrates its benefit in the management of ED and BPH-LUTS in the US.Plain Language Summary: Erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) conditions are more common in adult men and increase with age. These conditions affect their sexual satisfaction, create mental stress, and impact their interactions with family and associates. This study examined the patterns of health-care resource utilization (HCRU) in 11,351 patients treated with tadalafil versus 48,722 not treated with any PDE5i and compared treatment adherence to and persistence with tadalafil in patients with ED and comorbid BPH-LUTS in the US. All-cause and disease-specific HCRU were lower in patients treated with tadalafil than patients not treated with any PDE5i. The persistence with and adherence to therapy was higher with once-daily dose of tadalafil (2.5 or 5 mg) compared with as-needed dose of tadalafil (10 or 20 mg). Therefore, a lower dose of tadalafil demonstrated benefit in the management of men with ED and BPH-LUTS.Keywords: medication adherence, persistence, phosphodiesterase-5 inhibitor, real-world evidence, tadalafil

Suebsarn Ruksakulpiwat,1 Chitchanok Benjasirisan,1 Kedong Ding,2 Lalipat Phianhasin,1 Sutthinee Thorngthip,3 Anuoluwapo D Ajibade,4 Jai Thampakkul,5 Amy Y Zhang,6 Joachim G Voss6 1Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand; 2Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA; 3Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 4College of Art and Science, Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA; 5Case School of Engineering, Case Western Reserve University, Cleveland, OH, USA; 6Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USACorrespondence: Suebsarn Ruksakulpiwat, Email Suebsarn25@gmail.comIntroduction: Ischemic strokes and their recurrence create an immense disease burden globally. Therefore, preventing recurrent strokes by promoting medication adherence is crucial to reduce morbidity and mortality. In addition, understanding the barriers to medication adherence related to the social determinants of health (SDoH) could promote equity among persons with ischemic stroke.Objective: To explore the barriers to medication adherence among patients with ischemic stroke through the SDoH.Methods: This systematic review included studies published between January 2018 and December 2022 identified through PubMed, MEDLINE, Web of Science, and CINAHL Plus Full Text. The descriptions of the studies were systematically summarized and discussed based on the SDoH from the US Healthy People 2030 initiative.Results: Eight studies met the inclusion criteria and were included in this review. The most common barrier to adherence was inappropriate medication beliefs, medication side effects, and patient-physician relationship, which relate to the dimensions of healthcare access and quality. Health literacy and health perception, dependent on education access and quality, frequently influenced adherence. Other social determinants, such as financial strain and social and community context, were found to alter adherence behaviors. No study addressed the neighborhood and built environment domain. We found that cognitive impairment is another factor that impacts adherence outcomes among stroke patients.Conclusion: Multifaceted approaches are needed to address the SDoH to improve medication adherence among patients with ischemic stroke. This review emphasized strategies, including patient education, provider-patient communication, social support, health literacy, technology, and policy advocacy to enhance adherence.Keywords: ischemic stroke, medication adherence, social determinants of health, systematic review

Naruemon Sawaengsri,1 Wantana Maneesriwongul,1 Erica N Schorr,2 Supichaya Wangpitipanit1 1Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2School of Nursing, University of Minnesota, Minneapolis, MN, USACorrespondence: Wantana Maneesriwongul, Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand, Tel +662 2011600, Fax +662 2012858, Email wantana.lim@mahidol.ac.thIntroduction: Owing to the increased prevalence of type 2 diabetes mellitus (T2DM) and the high proportion of patients with uncontrolled T2DM, effective interventions for disease management are needed.Objective: The study aim was to test the effects of brief motivational interviewing (MI) on patients’ self-management, medication adherence, and glycemic control.Methods: A single-group repeated measures trial was used to examine the effects of usual care only and usual care plus telephone-based brief MI. Participants were 29 patients with uncontrolled T2DM recruited from a rural primary care setting in Nakhon Sawan, Thailand. Participants received usual care during the first 4 weeks, followed by usual care plus brief MI during weeks 4– 8. Outcomes of self-management, medication adherence, fasting blood sugar (FBS) levels, and hemoglobin A1c (HbA1c) levels were assessed at baseline, 4 weeks, and 8 weeks. Data were analyzed using descriptive statistics, one-way repeated measures analysis of variance, and Friedman test.Results: Significant changes in self-management (p < 0.001), medication adherence (p < 0.001), and FBS (p < 0.05) were observed over the 8-week study. In multiple comparisons, self-management was the only parameter significantly different across baseline, 4, and 8 weeks (p < 0.05, < 0.001, and < 0.001, respectively); medication adherence was significantly different between 4 and 8 weeks (p < 0.05), and between baseline and 8 weeks (p < 0.001); and FBS was significantly different between 4 and 8 weeks (p < 0.05). HbA1c declined over the 8-week study, but not significantly.Conclusion: An intervention combining telephone-based brief MI with usual care significantly increased self-management, medication adherence, and glycemic control (ie, FBS) after 4 weeks, whereas usual care only significantly increased self-management. Phone-based brief MI may be an effective way for healthcare providers to remotely enhance patients’ self-management and glycemic control, thus reducing barriers related to time and geographic location.Keywords: motivational interviewing, tele-intervention, stage of change, medication adherence, glycemic control, diabetes, T2DM

Sifen Jiang,1,&ast; Zhuoqi Zhu,2,&ast; Guisheng Liao,3,&ast; Yanling Huang,1 Lichang Li,4 Kun Zeng1 1School of Nursing, Guangdong Pharmaceutical University, Guangzhou, People’s Republic of China; 2School of Public Health, Guangxi Medical University, Guangxi, People’s Republic of China; 3Emergency Outpatient, Dongguan Eighth People’s Hospital, Dongguan, People’s Republic of China; 4Endocrinology Department, Dongguan Eighth People’s Hospital, Dongguan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Kun Zeng, School of Nursing, Guangdong Pharmaceutical University, No. 283, Jianghai Avenue, Haizhu District, Guangzhou City, Guangdong Province, 510310, People’s Republic of China, Tel +86 13790300213, Email Zengkun660524@163.comPurpose: To establish the relationship between medication literacy and medication beliefs among persons with type 2 diabetes mellitus (T2DM).Patients and methods: A cross-sectional survey of 246 patients with T2DM was conducted between April and November 2022 at a tertiary hospital in Dongguan City, Guangdong Province, China. Subsequently, these patients were administered the General Information Questionnaire, the Chinese version of Medication Literacy Assessment Scale, and the Chinese version of Beliefs about Medicines Questionnaire-Specific via survey.Results: The medication literacy score of patients with T2DM was 7.82± 3.007, and the medication beliefs score was 2.26± 4.011. The Pearson correlation analysis revealed a statistically significant but weakly positive correlation (r = 0.271, P < 0.001) between medication literacy and beliefs among patients diagnosed with T2DM. However, there was no significant correlation found between medication literacy and necessity (r = − 0.021, P > 0.05), while a lowly negative correlation was observed between medication literacy and concerns (r = − 0.307, P < 0.001). Moreover, the multiple linear regression analysis indicated that medication literacy, age, education level, and duration of medication usage were all significant factors influencing patients’ medication beliefs (all P < 0.05). Together, these variables accounted for 15.3% of the total variance observed in the regression equation.Conclusion: The study found a positive correlation between medication literacy and beliefs, and a negative correlation between medication literacy and concerns. These results indicate that enhancing medication literacy can improve medication adherence among individuals with T2DM by reducing concerns and strengthening medication beliefs.Keywords: type 2 diabetes mellitus, T2DM, medication literacy, medication beliefs, medication adherence, correlation

Haoqi Liu,1,2 Ziqiang Yao,1,2 Shuangjiao Shi,1 Feng Zheng,1– 3 Xia Li,1,4 Zhuqing Zhong1,2 1Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China; 2Xiangya Nursing School, Central South University, Changsha, People’s Republic of China; 3Cardiology Department, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China; 4Endocrinology Department, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of ChinaCorrespondence: Zhuqing Zhong, Email zhongzhuqing@126.comBackground: Patients with type 2 diabetes have poor medication adherence. Medication literacy is one of the influencing factors of medication adherence among patients with type 2 diabetes. However, the mechanism by which medication literacy affects medication adherence among patients with type 2 diabetes is unclear. The aim of this study was to verify the mediating role of self-efficacy in the relationship between medication literacy and medication adherence.Methods: A total of 402 patients with type 2 diabetes were enrolled in this study. The Chinese versions of the Medication Literacy Scale, the Self-Efficacy for Appropriate Medication Use Scale and the Morisky Medication Adherence Scale-8 were used in the survey. Pearson correlation analysis was used to find correlations among medication literacy, self-efficacy and medication adherence. The PROCESS macro (Version 4.1) with Model 4 for SPSS was used to verify the mediating role of self-efficacy.Results: Twenty-four percent of the participants had poor medication adherence. Self-efficacy and medication literacy (r=0.499, p < 0.01) and medication adherence (r=0.499, p < 0.01) were significantly and positively correlated. Self-efficacy partially mediated the relationship between medication knowledge and medication adherence among patients with type 2 diabetes, accounting for 36.7% of the total effect.Conclusion: Self-efficacy had a partial mediating effect on the relationship between medication literacy and medication adherence among patients with type 2 diabetes. Self-efficacy should be improved through effective measures to increase patients’ confidence in adherence to antihyperglycemic drugs.Keywords: type 2 diabetes, medication literacy, medication adherence, self-efficacy, mediating effect

Niken Nur Widyakusuma,1,2 Sri Suryawati,1 Chairun Wiedyaningsih,2 Probosuseno1 1Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; 2Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, IndonesiaCorrespondence: Niken Nur Widyakusuma, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl. Farmako Sekip Utara, Yogyakarta, 55281, Indonesia, Tel +62 274 560300, Fax +62 274 581876, Email niken.nur.w@ugm.ac.idPurpose: This qualitative study elicited beliefs about medication adherence among hypertensive seniors with polypharmacy.Methods: Twenty-one participants aged 60 or older with hypertension and other chronic conditions, with or without their family caregivers, residing surrounding Yogyakarta province, using five medicines or more routinely, were semi-structuredly interviewed by one researcher or one research assistant in January to April 2022. Behavioral, normative, and control beliefs were elicited using an interview guideline which was developed based on the Theory of Planned Behavior approach. Thematic analysis was applied.Results: The participants believed that taking medicines routinely was advantageous because the medicines kept their body in good condition and prevented disease worsening. However, there were concerns about the medications’ harmful effects on kidneys, gastric, and the whole body, and that the medicines would not be effective anymore. Prescribers, family, and friends would likely approve of medication adherence. However, non-prescriber doctors, family, and neighbors, mainly those with experience with complementary/alternative medicines, would likely disapprove of medication adherence. Good physical and cognitive function, help from family and technology, mealtime regularity, a simple regimen and easy-to-read medication labeling, and good communication with prescribers were among the facilitators of medication adherence. Physical and cognitive decline, mealtime irregularity, tablets that must be cut before taken, insurance that does not cover all medicines, change in dosage regimen, and hard-to-tear-off medication packaging were among the barriers to medication adherence.Conclusion: Understanding these beliefs yields insights into the health communication approaches to improving seniors’ medication adherence.Keywords: polypharmacy, medication adherence, theory of planned behavior

Anan S Jarab,1,2 Walid A Al-Qerem,3 Hanan Walid Hamam,1 Karem H Alzoubi,4,5 Shrouq R Abu Heshmeh,1 Tareq L Mukattash,1 Eman Alefishat6– 8 1Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan; 2College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates; 3Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, 11733, Jordan; 4Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates; 5Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan; 6Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates; 7Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, 11942, Jordan; 8Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab EmiratesCorrespondence: Eman Alefishat, Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates, Tel +971 5 07293877, Email eman.alefishat@ku.ac.aeBackground: Poor adherence to heart failure (HF) medications represents a major barrier to achieve the desired health outcomes in those patients.Objective: To assess medication adherence and to explore the factors associated with medication non-adherence among patient with HF in Jordan.Methods: The current cross-sectional study was conducted at the outpatient cardiology clinics at two main hospitals in Jordan from August 2021 through April 2022. Variables including socio-demographics, biomedical variables, in addition to disease and medication characteristics were collected using medical records and custom-designed questionnaire. Medication adherence was assessed using the 4-item Morisky Medication Adherence Scale. Multinomial logistic regression analysis was performed to identify the factors that are significantly and independently associated with medication non-adherence.Results: Of the 427 participating patients, 92.5% had low to moderate medication adherence. Results of the regression analysis revealed that that patients who had higher education level (OR=3.36; 95% CI 1.08– 10.43; P=0.04) and were not suffering from medication-related side effects (OR=4.7; 95% CI 1.91– 11.5; P=0.001) had significantly higher odds of being in the moderate adherence group. Patients who were taking statins (OR=16.59; 95% CI 1.79– 153.98; P=0.01) or ACEIs/ ARBs (OR=3.95; 95% CI 1.01– 15.41; P=0.04) had significantly higher odds of being in the high adherence group. Furthermore, Patients who were not taking anticoagulants had higher odds of being in the moderate (OR=2.77; 95% CI 1.2– 6.46; P=0.02) and high (OR=4.11; 95% CI 1.27– 13.36; P=0.02) adherence groups when compared to patients who were taking anticoagulants.Conclusion: The poor medication adherence in the present study sheds the light on the importance of implementing intervention programs which focus on improving patients’ perception about the prescribed medications particularly for patients who have low educational levels, receive an anticoagulant, and do not receive a statin or an ACEI/ ARB.Keywords: heart failure, medication adherence, medication necessity, medication concerns, intervention, Jordan

Yoon-A Choi,1 Young-Ran Kweon2 1Department of Nursing, Chonnam National University Hospital, Gwangju, South Korea; 2Department of Nursing, Chonnam National University, Gwangju, South KoreaCorrespondence: Young-Ran Kweon, Department of Nursing, Chonnam National University, P.O. Box 61469, 60 Baekseo-ro, Dong-gu, Gwangju, South Korea, Tel +82 62 530 4966, Fax +82 62 220 4544, Email yrk@jnu.ac.krPurpose: This study examined the mediating effect of medication adherence self-efficacy (MASE) on the relationship between drug attitude (DA) and medication adherence (MA) in patients with early psychosis.Patients and Methods: A total of 166 patients, aged 20 years or older, and who had received treatment within 5 years of their initial psychotic episode at a University Hospital outpatient center, participated in the study. Data were analyzed using descriptive statistics, t-tests, one-way analysis of variance, Pearson’s correlation coefficients, and multiple linear regression. Additionally, a bootstrapping test was conducted to determine the statistical significance of the mediating effect. All study procedures adhered to Strengthening the reporting of observational studies in epidemiology (STROBE) guidelines.Results: This study found a significant correlation between MA and DA (r=0.393, p< 0.001), and between MA and MASE (r=0.697, p< 0.001). MASE had a partial mediating effect on the association between DA and MA. The model that integrated both DA and MASE accounted for 53.4% of the variation in MA. Bootstrapping analysis indicated that MASE was a significant partial parameter (lower limit confidence interval [CI] 0.114; upper limit CI 0.356). Further, 64.5% of the study participants were either currently enrolled in college or had higher levels of education.Conclusion: These findings could potentially lead to a more personalized approach to medication education and adherence, considering the unique DA and MASE of each patient. By identifying the mediating effect of MASE on the relationship between DA and MA, healthcare providers could tailor interventions to enhance the ability of patients with early psychosis to adhere to prescribed medication regimens.Keywords: drug attitude, early psychosis, mediating effect, medication adherence, self-efficacy

Marie Viprey,1,2 Frédéric Mougeot,3 Alexandra Lelia Dima,2,4 Julie Haesebaert,2,5 Pauline Occelli,2,5 Isabelle Durieu,2,6 Héloïse Rouzé,2,5 Quitterie Reynaud,2,6 Sandrine Touzet2,7 1Hospices Civils de Lyon, Pôle Santé Publique, Service des Données de Santé, Lyon, France; 2Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France; 3Centre Max Weber, UMR 5283 - ENSEIS, Villeurbanne, France; 4Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; 5Hospices Civils de Lyon, Pôle Santé Publique, Service Recherche et Epidémiologie Cliniques, Lyon, France; 6Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Centre de Référence Adulte de la Mucoviscidose, Pierre Bénite, France; 7Hospices Civils de Lyon, Pôle Santé Publique, Service de Santé au Travail, Lyon, FranceCorrespondence: Marie Viprey, Hospices Civils de Lyon, Service des Données de Santé, 162 Avenue Lacassagne, Lyon, 69003, France, Tel +33 4 72 11 51 39, Fax +33 4 72 11 57 20, Email marie.viprey@chu-lyon.frPurpose: Cystic fibrosis (CF) is an inherited life-shortening disease involving a significant treatment burden. Few interventions have been proven effective in improving adherence, and of these fewer have been adopted for implementation. Patient participation in research is increasingly desired in developing relevant health care services. A participatory approach was implemented in an adult CF center to co-design an adherence-enhancing intervention toolkit. We aimed to report on the participatory process and the results regarding the co-designed intervention.Patients and Methods: Two focus group sessions and four working sessions were conducted at 4-week intervals with three healthcare professionals (HCP; physician, nurse, physiotherapist), eight patients, and two researchers (sociologist, public health pharmacist). The two initial focus group sessions were dedicated to the collection of narratives about CF treatment experiences to identify drivers of adherence. The next four working sessions were dedicated to the reflection on solutions that could alleviate the difficulties identified and be used in current clinical practice. The researchers observed during all sessions the interactions between participants, group dynamics, and process of implementation of the collective reflection.Results: The process facilitated an active participation of patients and HCP, who contributed equally to the intervention development. The co-design adherence-enhancing intervention toolkit consisted in a self-questionnaire to be completed by patients before the medical consultation and used as a communication support during the consultation, plus a toolkit of solutions to be proposed by the HCP for each barrier identified by patients, and to be followed up during the next consultation.Conclusion: This study demonstrated that a participatory approach involving CF patients and HCP lead to the development of an adherence-enhancing intervention toolkit, using a 6-session format; the benefits of the co-designed intervention on the medication adherence have yet to be tested in a multicenter, open-label study in 3 centers in France.Keywords: cystic fibrosis, chronic treatment, medication adherence, patient engagement, participatory research

Nouf M Aloudah Clinical Pharmacy Department, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Nouf M Aloudah, Clinical Pharmacy Department, King Saud University, PO BOX 50351, Riyadh, 11523, Saudi Arabia, Tel +966504410662, Fax +966118052966, Email naloudah@ksu.edu.saIntroduction: Studies have indicated that half of all patients with diabetes do not take their medication as prescribed. Patient social circles, including professionals (health care providers) and nonprofessionals (family and friends) might contribute to low medication adherence. Therefore, this study explored the point of view of healthcare providers and family members of patients with diabetes on patient medication adherence.Methods: Our study included health care providers and family members using in-depth, semi structured interviews. The theoretical domain framework (TDF) was used to explore their perspectives. TDF was used to build a topic guide and to frame the data analysis. The interviews were transcribed verbatim and thematically analyzed using the MAXQDA 2022 program.Results: The participants identified a variety of factors potentially associated with diabetes medication adherence. Most factors were related to the environmental context and resources such as the burden of polypharmacy, medication shortages, and long wait times for care. In addition, factors related to patient beliefs concerning diabetes complications and insulin injections were reported. Several factors were identified that related to knowledge and social influences.Discussion: Interventions that target the factors identified by the social circle of patients with diabetes might improve medication adherence and promote better disease management outcomes.Keywords: social support, medication adherence, qualitative analysis, theory, family members, health care providers, type 2 diabetes

Zeliha Ozdemir Koken,1 Rana Elcin Sezer Ceren,1 Sabri Karahan,2 Osman Abbasoglu3 1Surgical Nursing Department, Hacettepe University Faculty of Nursing, Ankara, Turkiye; 2Surgical Nursing Department, Harran University, Faculty of Health Science, Sanliurfa, Turkiye; 3General Surgery Department, Hacettepe University Faculty of Medicine, Ankara, TurkiyeCorrespondence: Zeliha Ozdemir Koken, Surgical Nursing Department, Hacettepe University Faculty of Nursing, Ankara, Turkiye, Email zeliha.ozdemir@hacettepe.edu.trPurpose: Preserving graft functions and preventing rejection is closely related to immunosuppressive medication adherence in liver transplant recipients. Therefore, it is essential to determine factors affecting immunosuppressive medication use positively or negatively in liver transplant recipients. This study aimed to explore the use of immunosuppressive medication experience in liver transplant recipients with poor adherence and reveal the factors affecting the medication adherence.Material and Methods: The study was conducted as a qualitative study with phenomenological approach. Seven adult liver transplant recipients were included in this study, who had poor adherence to immunosuppressive medication. Data was collected via in-depth personal interviews. Data analysis was conducted through inductive content analysis with three steps of preparation, organization, and reporting phases.Results: Content analysis revealed four main categories, nine categories and 31 sub-categories. Four main categories emerged from the interview data: medication adherence perception, types of medication non-adherence, factors affecting medication adherence negatively and factors affecting medication adherence positively.Conclusion: This study explored that there are several factors affecting immunosuppressive medication adherence among liver transplant recipients, both positively and negatively. In order to achieve liver transplant recipients’ total adherence to immunosuppressive medication, the factors affecting medication adherence positively and negatively should be understood. The study results are expected to contribute developing strategies to improve immunosuppressive medication adherence in liver transplant recipients.Keywords: immunosuppressive, liver transplant, medication adherence, medication non-adherence

Helena Norberg,1 Marcia Håkansson Lindqvist,2 Maria Gustafsson1 1Department of Integrative Medical Biology, Umeå University, Umeå, Sweden; 2Department of Education, Mid Sweden University, Sundsvall, SwedenCorrespondence: Helena Norberg, Department of Integrative Medical Biology, Umeå University, Umeå, S-901 87, Sweden, Tel +46 90 786 68 21, Email helena.norberg@umu.sePurpose: To develop an in-depth understanding of older individuals’ attitudes and perceptions of medication management and care after discharge from hospital-to-home.Patients and Methods: A qualitative study using semi-structured interviews with selected individuals 75 years and older, discharged from hospital within the last 6– 12 months, living at home, and managing their own medications. Face-to-face interviews were audio-recorded, transcribed and analyzed with thematic analysis.Results: Among the 15 respondents, mean age was 83.5 years (range 75– 95 years), 67% were women, and 60% lived alone. The majority (80%) managed their medications with a pill organizer or directly from the pill boxes, while 20% used dose dispensed medications. The analysis of the data led to six themes: Medication adherence, Personal responsibility, Transitions of care, Beliefs about medications, Participation (experience of participation, willingness to participate) and Accessibility (easier to reach hospital than primary care, navigating in the care system, continuity, personal chemistry).Conclusion: The included respondents who were older individuals, living at home and managing their own medications, expressed that they were medical adherent and self-managing. Two important aspects which were seen were difficulties to reach primary care on their own initiative and the lack of continuity with the same physician over a longer period of time.Keywords: medication adherence, qualitative research, transitional care, shared decision making, self management

Matthew P Genelin,1 Laura J Helmkamp,2 John F Steiner,1,3 Julie A Maertens,2 Rebecca Hanratty,1,4 Suma Vupputuri,5 Edward P Havranek,1,4,6 L Miriam Dickinson,1,2 Irene V Blair,7 Stacie L Daugherty1– 3,6 1University of Colorado School of Medicine, Aurora, CO, USA; 2Adult and Child Consortium for Outcomes Research and Delivery Sciences (ACCORDS), University of Colorado, Aurora, CO, USA; 3Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA; 4Department of Medicine, Denver Health and Hospital Authority, Denver, CO, USA; 5Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA; 6Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA; 7Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USACorrespondence: Matthew P Genelin, University of Colorado School of Medicine, 3500 Rockmont Drive, &num;15-209, Denver, CO, 80202, USA, Email matthew.genelin@cuanschutz.eduBackground: The strategies patients use to organize medications (eg, pill dispenser) may be reflected in adherence measured at follow-up. We studied whether medication organization strategies patients use at home are associated with adherence measured using pharmacy-fills, self-report, and pill counts.Design: Secondary analysis of data from a prospective randomized clinical trial.Setting: Eleven US safety-net and community primary care clinics.Patients: Of the 960 enrolled self-identified non-Hispanic Black and White patients prescribed antihypertensive medications, 731 patients reported pill organization strategies and were included.Variable: Patients were asked if they use any of the following medication organization strategies: finish previous refills first; use a pill dispenser; combine same prescriptions; or combine dissimilar prescriptions.Outcomes: Adherence to antihypertensive medications using pill counts (range, 0.0– 1.0% of the days covered), pharmacy-fill (proportion of days covered > 90%), and self-report (adherent/non-adherent).Results: Of the 731 participants, 38.3% were men, 51.7% were age ≥ 65, 52.9% self-identified as Black or African American. Of the strategies studied, 51.7% finished previous refills first, 46.5% used a pill dispenser, 38.2% combined same prescriptions and 6.0% combined dissimilar prescriptions. Median (IQR) pill count adherence was 0.65 (0.40– 0.87), pharmacy-fill adherence was 75.7%, and self-reported adherence was 63.2%. Those who combined same prescriptions had significantly lower measured pill count adherence than those who did not (0.56 (0.26– 0.82) vs 0.70 (0.46– 0.90), p< 0.01) with no significant difference in pharmacy-fill (78.1% vs 74%, p=0.22) or self-reported adherence (63.0% vs 63.3%, p=0.93).Conclusion: Self-reported medication organization strategies were common. Combining same prescriptions was associated with lower adherence as measured using pill counts but not pharmacy-fills or self-report. Clinicians and researchers should identify the pill organization strategies used by their patients to understand how these strategies may influence measures of patient adherence.Trial Registration: ClinicalTrials.gov NCT03028597; https://clinicaltrials.gov/ct2/show/NCT03028597 (Archived by WebCite at http://www.webcitation.org/72vcZMzAB).Keywords: hypertension, medication adherence, management strategies, organization strategies, medication management behaviors, chronic disease, pill count, pharmacy-fill, self-reported adherence

I Hsien Li, Wen Ling Hsieh, Wen I Liu School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, TaiwanCorrespondence: Wen I Liu, School of Nursing, National Taipei University of Nursing and Health Sciences, 365, Ming Te Road, Peitou, Taipei City, 112303, Taiwan, Tel +886-2-28227101 Ext 3184, Fax +886-2-28280219, Email wenyi@ntunhs.edu.twBackground: Adherence therapy (AT) is an intervention for improving medication adherence of people with schizophrenia spectrum disorders, but no systematic reviews have yet summarized the effectiveness and minimum treatment duration of AT. We here aimed to systematically examine the effectiveness of AT in improving outcomes versus treatment as usual (TAU) and its minimum effective duration for people diagnosed with schizophrenia spectrum disorders.Patients and Methods: Eligible randomized controlled trials were identified from four databases (Web of Science, PubMed, CINAHL and Cochrane Library) for the period 1 January 2006 to 1 January 2023. Of 1087 retrieved candidate studies, five studies with a total of 726 participants met the inclusion criteria. The search terms consisted of adherence therapy, compliance therapy, schizophrenia, schizoaffective disorder, schizophrenic disorder, medication adherence, and medication compliance (combined with OR and AND). Two investigators independently selected studies, extracted data, and conducted bias risk assessments. Random-effects models were used to analyze the pooled data.Results: Meta-analysis of the five selected studies showed that AT had a significantly greater positive effects than TAU on psychiatric symptoms, but no significant effects on adherence behaviors and attitudes.Conclusion: The AT had limited effects in terms of improving the attitudes and behaviors of people with schizophrenia spectrum disorders with respect to medication adherence, but did improve patients’ psychiatric symptoms. The therapy should be performed by trained staff for maximum benefit, and the recommended duration of the intervention is 12 hours.Keywords: adherence therapy, medication adherence, psychiatric symptoms, motivational interviewing

Yang Gu,1– 4,&ast; Xingrui Mu,1,3,4,&ast; Yan Zhang,1,3,4 Yunyan Tang,4,5 Ting Zhang,4,6 Fushan Tang1,3,4 1Department of Clinical Pharmacy, Key Laboratory of Basic Pharmacology of Guizhou Province and School of Pharmacy, Zunyi Medical University, Zunyi, 563006, People’s Republic of China; 2Department of Pharmacy, People’s Hospital in Hezhang County, Bijie, 553200, People’s Republic of China; 3Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, 563006, People’s Republic of China; 4The Key Laboratory of Clinical Pharmacy of Zunyi City, Zunyi Medical University, Zunyi, 563006, People’s Republic of China; 5Department of Pharmacy, Affiliated Meitan People’s Hospital of Zunyi Medical University, Zunyi, 564100, People’s Republic of China; 6Department of Pharmacy, Guiyang Hospital of Stomatology, Guiyang, 550002, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Fushan Tang, Department of Clinical Pharmacy, Key Laboratory of Basic Pharmacology of Guizhou Province and School of Pharmacy, Zunyi Medical University, Zunyi, Guizhou, People’s Republic of China, Tel +86851 28642337, Fax +86851 28642334, Email fstang@zmu.edu.cn; fstang@vip.163.comObjective: To investigate the effect of psychological contract of outpatients with hospital pharmacists on medication adherence, providing reference for improving the management of patients’ medication adherence from the perspective of pharmacist-patient relationship and psychological contract.Methods: The 8 patients who received medication dispensing service at the outpatient pharmacies at the First Affiliated Hospital of Zunyi Medical University and the Second Affiliated Hospital of Zunyi Medical University were selected for face-to-face in-depth interviews through a purposive sampling method. In order to get more potential information and adjust flexibly according to the actual situation of the interview, the interviews were set as semi-structured, and the interview content was analyzed by using Colaizzi’s seven-step method of phenomenological analysis and NVivo11.0 software.Results: The following four themes about effects of patients’ psychological contract with hospital pharmacists on medication adherence were extracted: from the perspective of patients, the relationship between pharmacists and patients is generally harmonious; pharmacists can basically fulfil their responsibilities; patients’ medication adherence needs to be improved; the status of patients’ psychological contract with hospital pharmacists may affect medication adherence.Conclusion: The psychological contract of outpatients with hospital pharmacists has a positive effect on their medication adherence. Effective management on medication adherence should involve the management on patients’ psychological contract with hospital pharmacists.Keywords: psychological contract, medication adherence, pharmaceutical care, qualitative study

Rebecca J Bartlett Ellis,1 Angela Andrews,2 Charles D Elomba,1 Laura M Remy,3 Sunny Yoo Ruggeri,4 Cynthia L Russell,4 Todd M Ruppar5 1Science of Nursing Care Department, Indiana University, Indianapolis, IN, USA; 2Primary Care and Health Systems, Southern Illinois University-Edwardsville, Edwardsville, IL, USA; 3Optum Infusion Services, Kansas City, MO, USA; 4School of Nursing and Health Studies, Kansas City, Missouri, University of Missouri-Kansas City, Kansas City, MO, USA; 5Department of Adult Health and Gerontological Nursing, Rush University, Chicago, IL, USACorrespondence: Rebecca J Bartlett Ellis, Science of Nursing Care Department, Indiana University, 600 Barnhill Drive, NU 120, Indianapolis, IN, 46202, USA, Tel +1 317 274 0047, Email rjbartle@iu.eduPurpose: Before the COVID-19 pandemic and the disruptions it brought, medication adherence was already a challenging and complex health behavior. The purpose of this study was to describe patients’ interactions in clinic, pharmacy, and home contexts and associated medication management and adherence during the early phase of the COVID-19 pandemic.Patients and Methods: A survey questionnaire was developed using the Medication Adherence Context and Outcomes framework and distributed via social media between May and July 2020 targeting adults taking a daily prescribed medication. Survey questions assessed sociodemographics, interactions with healthcare providers, clinics, pharmacies, medication management experiences, habit strength, and life chaos perceptions during the pandemic. Medication adherence was assessed by the self-report BAASIS© scale to measure implementation, discontinuation, and overall nonadherence.Results: A total of 134 adults from the United States, mean age 50.0 (SD 16.1) years were included in this analysis. Respondents took a median of 3.50 (interquartile range 4) daily medications. Delays in seeing a provider were reported by 47 (35.1%). Pharmacy encounters were impacted; 25 (18.7%) indicated their method for obtaining medication changed. Medication nonadherence was reported among 62 (46.3%) and was significantly greater among those who delayed prescription refills (p=0.032), pillbox users (p=0.047), and those who experienced greater life chaos (p=0.040) and lower habit strength (p< 0.001) in the early phase of the pandemic.Conclusion: Although the early phase of the pandemic affected access to care for nearly one-third of the sample, distance-accessible care options and strategies to obtain needed services without being in-person supported respondents medication management. Helpful strategies included provider accessibility, telehealth, home delivery/mail-order, drive-thru’s, 90-day supplies, and online/automatic refills. Methods to develop and reestablish habits are critical. Care providers in clinic and pharmacy settings can educate and remind patients about services like distance-accessible technologies and online ordering of medications and establishing routines to support medication adherence.Keywords: COVID-19, habits, medication adherence, medication non-adherence, pandemics

Jianbo Wu, Jie Shen, Zhujun Tao, Zhongjuan Song, Zhi-Long Chen Department of Pharmacy, Huadong Hospital, Fudan University, Shanghai, People’s Republic of ChinaCorrespondence: Jie Shen; Zhi-Long Chen, Email shj421@126.com; zlchen1967@qq.comPurpose: Poor antidiabetic medication adherence remains a great barrier to effective diabetes self-management among aging adults. This study investigates the mediation and moderation effects of self-efficacy on the relationship between medication beliefs and adherence in elderly patients with type 2 diabetes.Methods: This cross-sectional study evaluated a sample of 309 hospitalized elderly patients who completed the assessment of medication beliefs, self-efficacy for medication uses and medication adherence in a tertiary hospital in Shanghai, China. A bootstrapping sampling method and hierarchical moderator regression analysis were used to verify the hypothesis of mediation and moderation effects of self-efficacy on the relationship between medication beliefs and adherence.Results: Self-efficacy for medication use acted as a moderator (B=− 0.063, t=− 2.215, p=0.028) and partial mediator (CItotal effect=4.5– 16.63, p=0.001; CIindirect=1.524– 5.323, p=0.014; CIdirect=2.151– 11.817, p=0.001) on the relationship between general harm medication beliefs and medication adherence. Participants with lower general harm medication beliefs may develop higher self-efficacy, which, in turn, results in a higher level of medication adherence, and higher self-efficacy may attenuate the negative effect of high general harm medication beliefs on medication adherence.Conclusion: Self-efficacy for medication use not only mediated the relationship between general harm beliefs about medication and medication adherence, but moderated it negatively. The findings of this study indicate an opportunity to improve the prognosis of elderly Chinese patients with type 2 diabetes through improved medication adherence by strengthening factors such as self-efficacy for appropriate medication use and general harm beliefs about medication.Keywords: self-efficacy, medication adherence, medication belief, mediation effect, moderation effect, elderly patients

Mingfen Wu,1 Xiaohan Xu,2 Rongsheng Zhao,2 Xiangrong Bai,3 Bin Zhu,1 Zhigang Zhao1 1Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People’s Republic of China; 2Department of Pharmacy, Peking University Third Hospital, Beijing, 100191, People’s Republic of China; 3Department of Pharmacy, Xuanwu Hospital Capital Medical University, Beijing, 100053, People’s Republic of ChinaCorrespondence: Zhigang Zhao; Bin Zhu, Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People’s Republic of China, Tel +8601059978036 ; +8601059975444, Fax +8601059976856, Email 1022zzg@sina.com; zbtcm@163.comPurpose: Medication adherence plays an important role in glycemic control in type 2 diabetes mellitus (T2DM) self-management. To analyze the factors influencing medication adherence in T2DM patients and the effect of pharmacist-led interventions, we conducted a study in Beijing, China.Patients and Methods: T2DM patients with hypoglycemic drugs for at least 6 months were enrolled. A pharmacist-led survey was conducted followed by individualized interventions for those non-adherent patients monthly within 3 months. FPG, HbA1c, and 2hPG were measured as the comprehensive glycemic control. Medication adherence was determined according to the patient’s self-reported compliance with prescribed medication during the last 3 months.Results: A total of 763 T2DM patients were included. The average age was 63.26± 11.89 years, with 363 males. After pharmacist intervention, the patients with good adherence increased from 34.21% to 39.06%, while poor adherence decreased from 32.5% to 24.5% (p < 0.001). The average adherence score was a significant increase (p < 0.001) from 27.846± 4.185 to 29.831± 7.065. Furthermore, our study demonstrated that pharmacist-led interventions significantly increased glycemic control (FPG from 42.33% to 53.60%, p < 0.001; 2hPG from 41.68% to 48.75%, p = 0.005; HbA1c from 24.12% to 29.23%, p = 0.024). The results found that body mass index (OR 0.643, 95% CI 0.437– 0.945), use of medications empirically (occasionally (OR=3.066, 95% CI 2.069– 4.543); often (OR=2.984, 95% CI 1.107– 8.044)), following the doctor’s advice to visit (OR 2.129, 95% CI 1.079– 4.202) and lifestyle compliance (OR 2.835, 95% CI 1.094– 7.346) were the independent risk factors of non-adherence (p < 0.05), the area under the ROC curve was 0.716.Conclusion: Self-reported medication adherence and glycemic control in T2DM patients were poor which can be improved by pharmacist-led interventions. Interventions should focus on empirical medication behavior, non-adherence to lifestyle, and failure to follow the doctor’s advice. The recall bias with self-reported results needs further objective data to verify.Keywords: T2DM, medication adherence, glycemic control, current status, risk factor, pharmacist-led interventions

Griennasty Clawdya Siahaya, Joan Herly Herwawan, Fandro Armando Tasijawa Faculty of Health, Universitas Kristen Indonesia Maluku, Maluku Province, IndonesiaCorrespondence: Fandro Armando Tasijawa, Faculty of Health, Universitas Kristen Indonesia Maluku, Maluku Province, Indonesia, Email fandrotasidjawa@gmail.com

Maren Leiz,1,&ast; Nils Pfeuffer,1,&ast; Laura Rehner,2 Ulrike Stentzel,1 Neeltje van den Berg1 1Institute for Community Medicine, University Medicine, Greifswald, Germany; 2Institute for Nursing Science and Interprofessional Learning, University Medicine, Greifswald, Germany&ast;These authors contributed equally to this workCorrespondence: Nils Pfeuffer, Institute for Community Medicine, Ellernholzstr. 1– 2, Greifswald, 17487, Germany, Tel +49 3834 / 86 76 18, Email nils.pfeuffer@med.uni-greifswald.deAbstract: Affective disorders are a common psychological impairment. A major problem with respect to treatment is medication non-adherence. eHealth interventions are already widely used in the treatment of patients living with affective disorders. The aim of this systematic literature review is to obtain the current scientific evidence to eHealth as a tool to improve medication adherence in patients with affective disorders. A systematic search was performed across PubMed, Cochrane Library, Web of Science and PsycInfo. Studies in English and German published between 2007 and 2020 were included. The review followed the PRISMA guidelines and were performed with the CADIMA online tool. A total of 17 articles were included in this review. Eleven studies were randomized controlled trials, two were controlled clinical trials, and four had a pre-/post-design. Three different types of interventions could be identified: internet-based self-management programs (n=4), multi-faceted interventions addressing different dimensions of medication adherence (n=4), and single-faceted interventions (n=9) comprising four mobile interventions and five telehealth interventions. Eleven interventions addressed patients with (comorbid) depressions and six addressed patients with bipolar disorders. Six interventions showed a statistically significant positive effect on medication adherence. None of the studies showed a statistically significant negative effect. All interventions which had a statistically significant positive effect on medication adherence involved personal contacts between therapists and patients. All included eHealth interventions are at least as effective as control conditions and seems to be effective for patients with depression as well as with bipolar disorders. Personal contacts seem to improve the effectiveness of eHealth interventions. eHealth interventions are an effective way to improve medication adherence in patients with affective disorders. In rural or underserved regions, eHealth can supplement usual care interventions on medication adherence by expanding access. More analyses are needed in order to understand determinants for the effectiveness of eHealth interventions on medication adherence enhancement.Keywords: affective disorder, eHealth, medication adherence, medication nonadherence, compliance, noncompliance

Lijuan Liu,1,2,&ast; Wenzhuo Huang,1,2,&ast; Zhuoer Huang,1,3 Jiaxin Liu,1,3 Xiaoyuan Zheng,1 Jing Tang,1,2 Ying Wu,1 Xiaohui Wang,1 Yongzhen Liao,4 Li Cong1 1School of Medicine, Hunan Normal University, Changsha, People’s Republic of China; 2Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People’s Republic of China; 3Xiangya School of Nursing, Central South University, Changsha, People’s Republic of China; 4Shunde Polytechnic, Foshan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Li Cong, School of Medicine, Hunan Normal University, Changsha, People’s Republic of China, Tel/Fax +86-0731-88912446, Email congli@hunnu.edu.cnBackground: Oral anticoagulant is a necessary long-term treatment after mechanical valve replacement (MVR), and medication adherence has a great impact on patients with MVR. Although family caregiver burden is negatively correlated with medication adherence, little is known about the underlying mechanism.Purpose: To test whether family caregiver burden influences medication adherence through post-traumatic growth or medication literacy in patients with MVR.Patients and Methods: A total of 206 patients after MVR were included in this cross-sectional study from July 2021 to December 2021. Data regarding medication adherence, family caregiver burden, post-traumatic growth, and medication literacy were collected by questionnaires. Data were analyzed through SPSS, and pathway analysis was conducted by using AMOS, based on the bootstrapping method.Results: Post-traumatic growth was positively associated with medication adherence (r = 0.284, P < 0.05). Post-traumatic growth independently mediated the association of family caregiver burden on medication adherence [β = 0.32, 95% confidence intervals: (− 0.016, − 0.008)]. The mediated effect value for post-traumatic growth was 0.07, accounting for 24.14% of the total effect. The model’s fit indices were adequate.Conclusion: The mediating effect of post-traumatic growth between family caregiver burden and medication adherence existed in patients with MVR. Interventions considering post-traumatic growth may be useful to increase medication adherence and improve patient rehabilitation.Keywords: medication adherence, family caregiver burden, post-traumatic growth, medication literacy, mediation analyses, mechanical valve replacement

Corrine I Voils,1,2 Kara L Gavin,2 Carolyn T Thorpe,3,4 Samantha K Pabich,1,2 Bryce B Reeve,5 Ghazan J Mian,2 Aaron Faacks,2 Ian M Kronish6 1William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; 2University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; 3Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA; 4University of North Carolina, Eshelman School of Pharmacy, Chapel Hill, NC, USA; 5Duke University School of Medicine, Durham, NC, USA; 6Columbia University Irving Medical Center, New York, NY, USACorrespondence: Corrine I Voils, University of Wisconsin Department of Surgery, 600 Highland Ave, K6/100 CSC, Madison, WI, 53792-1690, USA, Tel +1 608 262 9636, Fax +1 608 263 2354, Email voils@surgery.wisc.eduIntroduction: Patients with diabetes may take oral and injectable medications and often have comorbid chronic diseases. It is unclear whether to assess nonadherence for oral and injectable medications separately or combined and for comorbid conditions separately or combined.Research Design and Methods: We conducted two cognitive interview studies among patients with type 2 diabetes who were prescribed medications for oral or injectable diabetes medications (Study 1) or at least one diabetes, blood pressure, and cholesterol medication (Study 2). Participants completed the two-domain DOSE-Nonadherence measure, which assesses extent of nonadherence and reasons for nonadherence. We asked about interpretation of instructions and items, recall period, ability to respond accurately with separate versus combined versions, and comprehensiveness of reasons for nonadherence to injectable medications.Results: Based on Study 1 (n=14), nonadherence to injectable and oral medications should be assessed separately. Participants believe they can respond accurately to 7-day recall period for daily medications and a one-month recall period for weekly injectable medications. New reasons for nonadherence to injectable medications were perceived as relevant. Based on Study 2 (n-12), nonadherence to medications for diabetes, blood pressure, and cholesterol should be assessed separately.Conclusion: Although separate versions increase response time, it may improve accuracy. Responses to the measure can facilitate conversations about nonadherence between providers and patients to inform clinical decision-making.Keywords: diabetes, medication adherence, cognitive interview

Russom Desta,1 Charlotte Blumrosen,2 Heather E Laferriere,3 Aades Saluja,4,5 Marino A Bruce,6 Tom A Elasy,7 Derek M Griffith,8,9 Keith C Norris,10 Kerri L Cavanaugh,4,5 Ebele M Umeukeje4,5 1Department of Medicine, University of Washington Medical Center, Seattle, WA, USA; 2Department of Medicine and Pediatrics, University of Rochester Medical Center, New York, NY, USA; 3Eskind Biomedical Library, Vanderbilt University, Nashville, TN, USA; 4Vanderbilt Center for Kidney Disease, Nashville, TN, USA; 5Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA; 6Department of Behavioral and Social Sciences, University of Houston, Tilman J. Fertitta Family College of Medicine, Houston, TX, USA; 7Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA; 8Department of Health Management & Policy, School of Health, Georgetown University, Washington, DC, USA; 9Center for Men’s Health Equity, Racial Justice Institute, Georgetown University, Washington, DC, USA; 10Division of General Internal Medicine & Health Services Research, UCLA, Los Angeles, CA, USACorrespondence: Ebele M Umeukeje, Division of Nephrology, Vanderbilt University Medical Center, 1161 21 st Avenue MCN S-3223, Nashville, TN, USA, Tel +1 615 936-3283, Fax +1 615 875-5626, Email ebele.m.umeukeje@vumc.orgBackground: Black Americans have a disproportionately increased risk of diabetes, hypertension, and kidney disease, and higher associated morbidity, mortality, and hospitalization rates than their White peers. Structural racism amplifies these disparities, and negatively impacts self-care including medication adherence, critical to chronic disease management. Systematic evidence of successful interventions to improve medication adherence in Black patients with diabetes, hypertension, and kidney disease is lacking. Knowledge of the impact of therapeutic alliance, ie, the unique relationship between patients and providers, which optimizes outcomes especially for minority populations, is unclear. The role and application of behavioral theories in successful development of medication adherence interventions specific to this context also remains unclear.Objective: To evaluate the existing evidence on the salience of a therapeutic alliance in effective interventions to improve medication adherence in Black patients with diabetes, hypertension, or kidney disease.Data Sources: Medline (via PubMed), EMBASE (OvidSP), Cumulative Index of Nursing and Allied Health Literature (CINAHL) (EBSCOhost), and PsycINFO (ProQuest) databases.Review Methods: Only randomized clinical trials and pre/post intervention studies published in English between 2009 and 2022 with a proportion of Black patients greater than 25% were included. Narrative synthesis was done.Results: Eleven intervention studies met the study criteria and eight of those studies had all-Black samples. Medication adherence outcome measures were heterogenous. Five out of six studies which effectively improved medication adherence, incorporated therapeutic alliance. Seven studies informed by behavioral theories led to significant improvement in medication adherence.Discussion/Conclusion: Study findings suggest that therapeutic alliance-based interventions are effective in improving medication adherence in Black patients with diabetes and hypertension. Further research to test the efficacy of therapeutic alliance-based interventions to improve medication adherence in Black patients should ideally incorporate cultural adaptation, theoretical framework, face-to-face delivery mode, and convenient locations.Keywords: diabetes mellitus, hypertension, medication adherence, African Americans

Seyed Mehrdad Hamrahian,1 Omar H Maarouf,1 Tibor Fülöp2 1Department of Medicine - Nephrology, Thomas Jefferson University, Philadelphia, PA, USA; 2Department of Medicine - Nephrology, Medical University of South Carolina, Charleston, SC, USACorrespondence: Seyed Mehrdad Hamrahian, Department of Medicine - Nephrology, Thomas Jefferson University, 33S 9th Street, Suite 700, Philadelphia, PA, 19107, USA, Tel +1 215-503 3000, Fax +1 215-503 4099, Email seyed.hamrahian@jefferson.eduAbstract: Hypertension is a global public health problem, and its prevalence is increasing worldwide. Impacting all human societies and socioeconomic strata, it remains the major modifiable risk factor for global burden of cardiovascular disease all-cause mortality and the leading cause of loss of disability-adjusted life years. Despite increased awareness, the rate of blood pressure control remains unsatisfactory, particularly in low- to middle-income countries. Apparent treatment-resistant hypertension is associated with worse adverse health outcomes. It includes both true resistant and pseudo-resistant hypertension, which requires out-of-office blood pressure monitoring to exclude white-coat effect and confirmation of adherence to the agreed recommended antihypertensive therapy. The depth of medication non-adherence remains poorly recognized among medical practitioners, thus presenting an underestimated modifiable risk factor. Medication non-adherence is a complex and multidimensional variable with three quantifiable phases: initiation, implementation, and discontinuation, collectively called persistence. Non-adherence can be both intentional and non-intentional and usually involves several interconnected factors. Persistence declines over time in the treatment of chronic diseases like hypertension. The risk is higher in patients with new diagnosis, poor insurance status, polypharmacy, and multiple comorbidities, particularly psychiatric disorders. The World Health Organization divides the contributing factors impacting adherence into five categories. Screening and detection for medication non-adherence are challenging due to its dynamic nature and potential white-coat effect. Easy-to-conduct screening methods have low reliability and validity, whereas more reliable and valid methods are costly and difficult to perform. Medication non-adherence is associated with poor clinical outcome and potential negative impact on health-care costs. Evaluation of adherence should become an integral part of assessment of patients treated for hypertension. Medication adherence can significantly improve with a patient-centered approach, non-judgmental communication skills, and collaborative multidisciplinary management, including engagement of the patients in their care by self-blood pressure monitoring.Keywords: blood pressure control, cardiovascular disease, hypertension, medication adherence, persistence, resistant hypertension