Challenges for Improving Medication Adherence

JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 01/2007; 296(21):2614-6. DOI: 10.1001/jama.296.21.jed60074
Source: PubMed

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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.
    Full-text · Article · Jan 2015 · European Journal of Internal Medicine
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    • "They are primarily ecologically based, focusing on both social and cognitive factors, and on factors spanning the illness and its medication/treatment regime, the person/patient himself/herself, and the interactions between the health care provider and the patient [5-9]. This means that effective interventions to increase adherence are individualized, long-term, complex multilayered matters and many meet with limited success [3,6-8,10]. Using relevant theoretical frameworks to guide us towards an understanding of the factors associated with adherence versus non adherence, is essential to enhancing our understanding of the matter and subsequently developing effective interventions to reduce the problem [11]. "
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    ABSTRACT: Medication regimes are often poorly adhered to, and the negative consequences of this are well recognised. The dynamics underlying non-adherence are less understood. This paper examines adherence to prescription medications for mental health difficulties in relation to the use of complementary and alternative medicines (CAMs). This was based on suggestions that within medical pluralism, CAMs may reduce adherence to conventional prescription medications for reasons such as their further complicating the medication regime or their being perceived as a substitute with less adverse side effects than conventional prescription medications. Data used was from the National Comorbidity Study Replication (NCS-R), specifically those 1396 individuals who reported taking a prescription drug for mental health difficulties within the last 12 months and under the supervision of a health professional. This subsample was selected due to their being the only subgroup questioned regarding their medication adherence. Other demographic and health factors were also considered. The use of complementary medicines alongside the conventional medicines bore no significant relation to odds of reporting adherence versus non adherence. Ethnicity and medication count were significant predictors of adherence versus non-adherence. The above findings are discussed from the point of both promoting the use of CAMs and increasing health professionals' understanding of the dynamics underlying adherence, or the lack thereof, and subsequently informing interventions to reduce the problems associated with this issue in terms of increased health care needs and reduced quality of life.
    Full-text · Article · Mar 2014 · BMC Complementary and Alternative Medicine
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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.
    Preview · Article · Mar 2010 · Archives of cardiovascular diseases
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