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Challenges for Improving Medication Adherence

JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 01/2007; 296(21):2614-6. DOI: 10.1001/jama.296.21.jed60074
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    • "The physician decision might have been motivated because of side effects or the prescription of a co-medication, which is also a frequent cause. The relevance of our findings might demonstrate a potential gap in the practice of the outpatient physicians or heterogeneity in the interpretation of guidelines [27]. Especially, there is a lack of explicit guidance on how to approach clinical-decision making for patients with multimorbidity. "
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    ABSTRACT: Background The prescription of recommended medical therapies is a key factor to improve prognosis after acute coronary syndromes (ACS). However, reasons for cardiovascular therapies discontinuation after hospital discharge are poorly reported in previous studies. Methods We enrolled 3055 consecutive patients hospitalized with a main diagnosis of ACS in four Swiss university hospitals with a prospective one-year follow-up. We assessed the self-reported use of recommended therapies and the reasons for medication discontinuation according to the patient interview performed at one-year follow-up. Results 3014 (99.3%) patients were discharged with aspirin, 2983 (98.4%) with statin, 2464 (81.2%) with beta-blocker, 2738 (90.3%) with ACE inhibitors/ARB and 2597 (100%) with P2Y12 inhibitors if treated with coronary stent. At the one-year follow-up, the discontinuation percentages were 2.9% for aspirin, 6.6% for statin, 11.6% for beta-blocker, 15.1% for ACE inhibitor/ARB and 17.8% for P2Y12 inhibitors. Most patients reported having discontinued their medication based on their physicians' decision: 64 (2.1%) for aspirin, 82 (2.7%) for statin, 212 (8.6%) for beta-blocker, 251 (9.1% for ACE inhibitor/ARB) and 293 (11.4%) for P2Y12 inhibitors, while side effect, perception that medication was unnecessary and medication costs were uncommon reported reasons (< 2%) according to the patients. Conclusions Discontinuation of recommended therapies after ACS differs according the class of medication with the lowest percentages for aspirin. According to patients, most stopped their cardiovascular medication based on their physician's decision, while spontaneous discontinuation was infrequent. © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
    European Journal of Internal Medicine 01/2015; 26(1). DOI:10.1016/j.ejim.2014.12.014 · 2.30 Impact Factor
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    • "It may well be that strategies have to be individualized to be fully effective [25]. Improving adherence to medication and modification of lifestyle factors are still challenges for physicians and other healthcare providers [26] [27]. The time constraints placed on today's primary care physician work force may be one factor that contributes to low control of BP [28]. "
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    ABSTRACT: Uncontrolled hypertension is a major primary healthcare problem. To investigate whether blood pressure (BP) control in primary care could be improved by nurses taking responsibility for managing hypertensive patients. Randomized trial with two groups: usual or intensive care. Patients diagnosed previously as hypertensive and with a systolic office BP greater than 140mmHg were randomized to an intensive care programme managed by trained nurses or to usual care. The intensive care programme included a visit every 6 weeks to the general practitioner's office, with standardized BP measurement, self-measurement training, risk factor checks and advice on BP reduction. The intervention lasted for 1 year. The primary endpoints were systolic BP obtained by 24-hour ambulatory BP monitoring after 1 year and the change compared with baseline. Two hundred patients from 19 physicians were enrolled (102 in the intensive care group). Data on ambulatory BP were available from 140 patients. Systolic BP declined from 134.4+/-14.0 to 126.3+/-10.4mmHg in the intensive care group and from 132.4+/-13.5 to 128.2+/-13.0mmHg in the usual care group. There was no statistically significant difference in values after 1 year (p=0.332). The reduction in systolic BP was significantly greater in the intensive care group (7.6 vs 3.3mmHg in the usual care group; p=0.036). Similar results were observed for diastolic BP and day- and night-time measurements. An intensive medical care programme in the office setting managed by trained nurses can improve BP control effectively. Nurses could take more responsibility for managing hypertensive patients.
    Archives of cardiovascular diseases 03/2010; 103(3):142-9. DOI:10.1016/j.acvd.2010.01.006 · 1.66 Impact Factor
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    • "Others, such as stigma, require more profound changes (Rosen et al. 2007). Adherence to therapy is an individual patient behaviour that is difficult to objectively measure, monitor and improve (Simpson 2006). Although demographic factors such as age and gender have not been found to be accurate predictors of adherence for other diseases (Friedland and Williams 1999), the impact of these factors on adherence to ART remains uncertain. "
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    ABSTRACT: The anti-retroviral (ARV) treatment programme in Nigeria is delivered through selected teaching and mission hospitals at a free/subsidized rate. The government aims to scale up ARV treatment in the country. However, non-adherence to ARV medication can lead to viral resistance, treatment failure, toxicities and waste of financial resources. This study examined the factors responsible for non-adherence to free/subsidized ARV treatment in south-east Nigeria. The study was cross-sectional and descriptive. Information was collected from 174 patients selected by simple random sampling from the register of all patients who had been on anti-retroviral therapy (ART) for at least 12 months at the beginning of the study period. Patients were identified during their clinic visits. Information on their socio-demographic profile, ARV treatment and determinants of non-adherence to ARV treatment was obtained from those who gave consent, using pre-tested interviewer-administered questionnaires. All patients clearly understood the need to take ARV drugs throughout their lives, and what the costs entailed. They understood the need for periodic testing, the probability that complications would develop, cost of transportation to treatment site and the daily treatment regimen. Seventy-five per cent of respondents were not adhering fully to their drug regimen; the mean number of days that respondents had been off drugs was 3.57 days the preceding month. Reasons for non-adherence included: physical discomfort (side effects); non-availability of drugs at treatment site; forgetting to carry drugs during the day; fear of social rejection; treatment being a reminder of HIV status; and selling of own drugs to those unable to enrol in the projects. Being female, under 35 years, single, and having higher educational status were significantly associated with non-adherence. It is important that policy makers and programme managers address the factors responsible for non-adherence when scaling up subsidized ARV treatment in Nigeria and other parts of sub-Saharan Africa.
    Health Policy and Planning 04/2009; 24(3):189-96. DOI:10.1093/heapol/czp006 · 3.00 Impact Factor
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