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Cross-national comparison of drug compliance and non-compliance associated factors in the elderly with polypharmacotherapy
Abstract
Population of seniors in the Czech Republic consumes more than 35 % of all prescribed medications. Currently, Czech seniors take on the average 4-5 prescribed drugs. However, our knowledge about factors influencing drug compliance is scarce particularly in seniors with polypharmacotherapy. Non-compliance can contribute to treatment failure and increases the risk of adverse drug reactions. The aim of the study is to compare drug compliance in the elderly in 11 European countries and to assess the impact of demographic and drug-related factors on non-compliance to medication.
Cross-sectional comparative study in 3881 elderly subjects living in the community receiving home-care services in 11 European countries participating in ADHOC (Aged in Home Care) study. In the sample of Czech subjects we performed in-depth analysis of causes and factors associated with non-compliance in patients with polypharmacotherapy. 12.5% (n=456) of European seniors were non-compliant with prescribed medication with significantly higher prevalence of non-compliance in the CR (33.5 %) and Germany (17.0 %). In the Czech sample following non-compliance risk factors have been identified: taking > or = 7 drugs per os (OR= 2.2), 10 single applications/day (OR= 2.5), more than twice daily dosing (OR= 2.4), problems with drug preparation (OR= 4.6), polypharmacotherapy 5 years and longer (OR= 5.5) and drug preparation without supervision or help (OR= 2.8). The highest prevalence of non-compliance was found for antidepressants (80 %), antiasthmatics (68 %), fibrates (60 %), nonsteroidal antiinflammatory drugs, vasodilatators, anticoagulants/antiplatelet drugs and nootropics (50 %). Among the most common causes, patients reported forgetting to take the drug (74.3 % patients), mistrust in drug effect (10.6%) and fear of taking "too many drugs" (8.6 %).
Non-compliance to prescribed drug regimen is a prevalent problem in one third of the Czech seniors and was found to be the highest among 11 European countries. Doctors prescribing to older people have to monitor purposefully compliance and strenghten co-operation and motivation of the patient to adhere with prescribed drug regimen. Particularly in seniors with polypharmacotherapy it seems necessary to simplify drug regimen as much as possible. In elderly patients with physical disability, cognitive impairment or depression supervision and/or help of another person with drug preparation and application may improve drug compliance.
... Non-adherence to prescriptions was the most common issue among patients. 41 Topinkova et al recommended simplifying the drug regimen as much as possible for seniors undergoing polypharmacotherapy. 41 This is relevant to our study, as the majority of patients take between four and 10 kinds of pills. ...
... Non-adherence to prescriptions was the most common issue among patients. 41 Topinkova et al recommended simplifying the drug regimen as much as possible for seniors undergoing polypharmacotherapy. 41 This is relevant to our study, as the majority of patients take between four and 10 kinds of pills. ...
To determine the role of adherence and its significance in the relationship between self-efficacy and self-management of diabetic patients undergoing coronary artery bypass graft (CABG) in Taiwan.
Descriptive and correlational survey design.
Three outpatient clinics in Taiwan.
Patients diagnosed with diabetes undergoing CABG at least 6 months before the study, 18 years of age or older, able to communicate verbally without any psychiatric problems, and with a life expectancy longer than 1 year.
Self-management assessment (self-efficacy for managing disease and adherence to guidelines and medication measured on a scale of 0-8), the higher aspects of self-management (keeping appointments, taking medication properly and keeping follow-up appointments) and the lower aspects of self-management (inability to share decisions with primary physician, inability to take correct actions when symptoms worsen and inability to adapt habits to improve health).
The mean score obtained for self-management among the 166 participants was 6.48, with 57 (34.3%) of them showing non-adherent behaviour. Self-efficacy accounts for 38% (R(2)=0.380, F(1,103)=63.124, p < 0.001), and 54% of good self-management was explained by self-efficacy and adherence in managing disease (R(2)=0.540, F(2,102)=56.937, p<0.001). Adherence accounts for 16% of better self-management, age and education combined account for 4.9% (R(2)=0.589, F(6.98)=23.399, p<0.001), and lifestyle items account for 5.2% (R(2)=0.641, F(14,90)=11.457, p<0.001). Disease-related variables contribute 3.4% (R(2)=0.674, F(17,87)=10.599, p<0.001). Thus self-efficacy, adherence, age, education, primary care provider and systolic pressure are considered significant predictors of self-management. With the exception of adherence, none of the variables had a statistically significant mediating effect.
The results confirm strong relationships between self-efficacy, adherence and self-management, with adherence having a significant mediating effect in post-CABG patients with diabetes in Taiwan.
... en 80–120% of the recommended medication. This range is thought to be adequate for expected medication effect. [59] Multiple factors influencing patient behaviour reflect the complex multifaceted nature of the adherence phenomenon. Moreover, a patient could be adherent with one medication and non-adherent with other medications taken concomitantly. [66] To get the full picture, adherence to all medications taken should be assessed. Previous studies identified a higher number of drugs, drug regimen complexity, previous ADEs, a longer length of treatment, cognitive impairment/ ...
... nonsymptomatic ) conditions, poverty, inadequate social support and a poor relationship between the patient and healthcare provider as being predictors of non-adherence. [35,59606166676869 Recently, Gellad et al., [62] in a systematic review, identified total number of drugs, higher co-morbidity, impaired cognition, ADEs, poorer health literacy and logistic barriers in obtaining medication as non-adherence risk factors. Conversely, better selfperceived health, more physicians visits, better executive functions and perceived negative outcomes without treatment were significantly associated with better medication adherence. ...
Geriatric pharmacotherapy represents one of the biggest achievements of modern medical interventions. However, geriatric pharmacotherapy is a complex process that encompasses not only drug prescribing but also age-appropriate drug development and manufacturing, appropriate drug testing in clinical trials, rational and safe prescribing, reliable administration and assessment of drug effects, including adherence measurement and age-appropriate outcomes monitoring. During this complex process, errors can occur at any stage, and intervention strategies to improve geriatric pharmacotherapy are targeted at improving the regulatory processes of drug testing, reducing inappropriate prescribing, preventing beneficial drug underuse and use of potentially harmful drugs, and preventing adverse drug interactions. The aim of this review is to provide an update on selected recent developments in geriatric pharmacotherapy, including age discrimination in drug trials, a new healthcare professional qualification and shared competence in geriatric drug therapy, the usefulness of information and communication technologies, and pharmacogenetics. We also review optimizing strategies aimed at medication adherence focusing on complex elderly patients.
Among the current information technologies, there is sufficient evidence that computerized decision-making support systems are modestly but significantly effective in reducing inappropriate prescribing and adverse drug events across healthcare settings. The majority of interventions target physicians, for whom the scientific concept of appropriate prescribing and the acceptability of the alert system used play crucial roles in the intervention’s success. For prescribing optimization, results of educational intervention strategies were inconsistent. The more promising strategies involved pharmacists or multidisciplinary teams including geriatric medicine services. However, methodological weaknesses including population and intervention heterogeneity do not allow for comprehensive meta-analyses to determine the clinical value of individual approaches.
In relation to drug adherence, a recent meta-analysis of 33 randomized clinical trials in older patients found behavioural interventions had significant effects, and these interventions were more effective than educational interventions. For patients with multiple conditions and polypharmacy, successful interventions included structured medication review, medication regimen simplification, administration aids and medication reminders, but no firm conclusion in favour of any particular intervention could be made. Interventions to optimize geriatric pharmacotherapy focused most commonly on pharmacological outcomes (drug appropriateness, adverse drug events, adherence), providing only limited information about clinical outcomes in terms of health status, morbidity, functionality and overall healthcare costs. Little attention was given to psychosocial and behavioural aspects of pharmacotherapy.
There is sufficient potential for improvements in geriatric pharmacotherapy in terms of drug safety and effectiveness. However, just as we require evidence-based, age-specific, pharmacological information for efficient clinical decision making, we need solid evidence for strategies that consistently improve the quality of pharmacological treatments at the health system level to shape ‘age-attuned’ health and drug policy.
... Studies looking at adherence to antidepressants in the elderly showed variable rates depending on the population studied and methods used. Rates varied between 80% nonadherence (Topinkova et al., 2006) in the Czech Republic and 77.6% adherence (missing no more than one dose per week) in the UK (Maidment et al., 2002). ...
Adherence to treatment is a complex and poorly understood phenomenon. This study investigates the relationship between older depressed patients' adherence to antidepressants and their beliefs about and knowledge of the medication.
Assessment was undertaken of 108 outpatients over the age of 55 years diagnosed with depressive disorder and treated for at least four weeks with antidepressants. Adherence was assessed using two self-report measures: the Medication Adherence Rating Scale (MARS) and a Global Adherence Measure (GAM). Potential predictors of adherence investigated included sociodemographic, medication and illness variables. In addition, 33 carers were interviewed regarding general medication beliefs.
56% of patients reported 80% or higher adherence on the GAM. Sociodemographic variables were not associated with adherence on the MARS. Specific beliefs about medicines, such as "my health depends on antidepressants" (necessity) and being less worried about becoming dependant on antidepressants (concern) were highly correlated with adherence. General beliefs about medicines causing harm or being overprescribed, experiencing medication side-effects and severity of depression also correlated with poor adherence. Linear regression with the MARS as the dependent variable explained 44.3% of the variance and showed adherence to be higher in subjects with healthy specific beliefs who received more information about antidepressants and worse with depression severity and autonomic side-effects.
Our findings strongly support a role for specific beliefs about medicines in adherence. Challenging patients' beliefs, providing information about treatment and discussing side-effects could improve adherence. Poor response to treatment and medication side-effects can indicate poor adherence and should be considered before switching medications.
... Overall, 13% of the subjects in the ADHOC sample reported that they did not fully adhere to medications. Non-adherence was strongly predicted by problem drinking, by not having a medication review by a physician, and by living in Nurnberg/Bayreuth or Prague [22], where the prevalence was the highest among the 11 European study sites [23]. ...
During the 1990s, use of home care sector has increased substantially in Europe. However, research on home care continues to be underreported. This article summarizes the findings from the "Aged in Home Care" (ADHOC) study - carried out from 2001 to 2004 in Europe - and women's situation in European Home Care.
The review is based on 4 book chapters as well as on 23 articles listed in PubMed and published from August 2004 to October 2008. ADHOC used a standardized data set collected with the Resident Assessment Instrument for Home Care (RAI-HC 2.0); this instrument was used to assess 4010 home care clients at 11 European sites. The included articles analyzed the sociodemographic and clinical characteristics, basic physical needs, provision of selected preventive measures, and medication data from the ADHOC sample. In addition home service provision, quality indicators, and selected outcomes of home care intervention during the course of 1 year were assessed.
The mean subject age was 82.3 years; women were on average 2 years older than men and more frequently lived alone, 74% were women. Women suffered more frequently from pain, depression, and extreme obesity. There were marked regional differences in both the functional status of the clients and the characteristics and use of home care services.
The implementation of a common assessment instrument for HC clients may help contribute the necessary wealth of data for (re)shaping home care in Europe. Policy makers and service providers may learn about best practices in the European context.
... What factors affect compliance? The extant research shows that reduced compliance is associated with overly complex routines, as over 74% of the participants in one particular study (Topinkova et al 2006) self-reported a memory lapse as the primary reason for adherence failure. Compliance is also reduced as perceived stress increases (Stetson et al 1997). ...
Extensive research on memory interventions has confirmed their success with older adults, but the individual difference factors that predict successful training outcomes remain relatively unexplored. In the current intervention, trainees were identified as active (compliant with training regimens) or inactive using trainer ratings based on attendance, homework completion, and class participation. The active group showed significantly greater training-related gains than the inactive group and the control group on most measures. Compliance was predicted by health, education, and self-efficacy. Specifically, active trainees were more likely to have advanced degrees and somewhat higher self-efficacy, and to have higher vitality and fewer functional limitations than the inactive trainees. This research may assist future investigators to target interventions to those who will show the most benefit.
Objective
To evaluate the risks of recurrent stroke and major bleeding events with clopidogrel and aspirin use among patients aged 80 years or older.
Patients and Methods
This retrospective cohort study was conducted using the Full Population Data of the Health and Welfare Database in Taiwan. Patients aged 80 years or older who received monotherapy with clopidogrel or aspirin following hospitalization for primary acute ischemic stroke between January 1, 2009, and December 31, 2018, were included. Inverse probability of treatment weighting was used to balance measured covariates between clopidogrel and aspirin users. Measured outcomes included recurrent acute ischemic stroke, acute myocardial infarction, composite cardiovascular events (recurrent stroke or acute myocardial infarction), intracranial hemorrhage, major gastrointestinal tract bleeding, and composite major bleeding events (intracranial hemorrhage or major gastrointestinal tract bleeding).
Results
A total of 15,045 patients were included in the study, 1979 of whom used clopidogrel and 13,066 who used aspirin following hospitalization for primary acute ischemic stroke. Clopidogrel use was associated with significantly lower risk of recurrent acute ischemic stroke (hazard ratio [HR], 0.89; 95% CI, 0.83 to 0.96; P=.002), composite cardiovascular events (HR, 0.88; 95% CI, 0.82 to 0.95; P<.001), intracranial hemorrhage (HR, 0.71; 95% CI, 0.56 to 0.90; P=.005), and composite major bleeding events (HR, 0.89; 95% CI, 0.80 to 0.99; P=.04) compared with aspirin use.
Conclusion
In patients aged 80 years or older with primary acute ischemic stroke, clopidogrel users had lower risks of recurrent stroke and the composite cardiovascular events compared with aspirin users. Clopidogrel users also had lower risks of intracranial hemorrhage and the composite major bleeding events compared with aspirin users.
Objective: The work investigates side effects of drugs from different aspects in hospitalized patients whose age is above 65. Firstly it investigates their occurrence, how patients are informed about side effects and it mentions problems with obeying doctor's prescribed treatment (adherence) and taking drugs by patients themselves. Methods: Research has been made by short interview in form of anonymous, structured medical questionnaire with 20 questions. All of the patients were hospitalized in National institute of rheumatic diseases in Piešt'any and the only criteria used to includes the patients was their age. All of them were 65 and older. Total number of patients included in study was 120, majority of them women. Results were then statistically evaluated. Results: The average age of patients in research was 71.2 and the average number of drugs which they took was 9.12. The research indicates that 53.3 % of patients had health problems, which were acc ording to their opinion probably caused by taking drugs, while with increasing number of drugs used, also presence of side effects arose. Subjective rate of information about adverse drug reactions was rising with grade of education. 32.5 % of the patients doesn't obey treatment prescribed by doctor. Conclusion: The use of several drugs in the patient's treatment is part of common practice, it is a consequence of the fact that patients reach higher age and treatment options are continuously expanding. It is the reason why it is necessary to know about the risks of this kind of treatment as much as possible and try with various measures to achieve the lowest occurrence of side effects, and thus improvement of the quality of life of elderly patients.
The increasing use of antipsychotics and antidepressants poses the patient to a higher risk of adverse events and drug interactions. The incidence of serious adverse events in patients treated with antidepressants is 1.4% . These patients are often directed to a pharmacist consultant. Pharmacotherapy optimization was shown to reduce the number of drug-drug interactions, to limit the risk of adverse events, and to increase patient compliance with treatment. Herein, we present a case of a patient with polypharmacy, where his psychiatric and overall drug therapy was optimized thorough a pharmacotherapy review and led to an improvement in his medical condition.
Objective: Cognitive rehabilitation is component of complex therapy in patients with mild and moderate stage of dementia of the Alzheimer's type and condition for achieving its benefits is long-term cooperation of patients and their relatives. The aim of pilot study is presentation of causes and factors premature withdrawal of cognitive rehabilitation. Method: Empirical data about patients we obtained by interview with the patient and her/his relative, patient's observation and analysis of medical record. 10 patients with mild and moderate stage of dementia of the Alzheimer's type were included in cognitive rehabilitation during period from April 2010 to December 2011. Selection of patients in pilot study was intentional according to specify criterions for inclusion. Cognitive rehabilitation was realized once a week at the same time. Results: Five patients finished cognitive rehabilitation arbitrarily. We detected several factors, as are decompensation of patient health state, progression of dementia disease, depression and decreased co-operation of relatives, which decrease patient's co-operation during cognitive rehabilitation and they cause of premature withdrawal of cognitive rehabilitation on patient's side. Conclusion: Dementia and other factors contribute to premature withdrawal of cognitive rehabilitation. Clinical guidelines present only partial interventions for improving patient's co-operation. Results of our pilot study aren't possible generalize and examine problem call for next examine in enhanced sample of patients.
Background: Coronary artery bypass surgery has an average recurrence rate of 10 to 20%, which generally results in the need for a reoperation and keeping close track of treatments and unhealthy lifestyle indicators. This situation negatively impacts the quality of life of patients and increases the costs of medical care. Purpose: This paper explores the factors related to the compliance behavior of post‐coronary‐bypass diabetes patients and develops a model to improve the healthcare and medical compliance of this population. Methods: This cross‐sectional study used convenience sampling to recruit diabetes patients who had received coronary artery bypass surgery at one of the largest medical hospitals in northern Taiwan. The 166 participants were asked to fill out a questionnaire that included questions on basic demographics, type of diabetes treatment, cardiovascular health status, and treatment compliance behavior. Results: A total of 34.9% of participants were identified with poor compliance behavior. Most non‐compliance behavior began to appear at 1 to 3 years post‐surgery. Patients with the best compliance behavior performed the best in the category of diet control followed by medication compliance. Lifestyle change was identified as the least important behavior. The results show that the longer the duration since CABG surgery treatment, the better that treatment compliance behaviors were. The findings also indicate that satisfaction with living environment, length of time since surgery, and the side effects of medication explained the variance in treatment compliance behaviors in participants (F = 4.039, p = .046). Implications for Practice: Healthcare workers should teach family dietary changes and control. Patients should receive education on regular medication and healthy habits. Furthermore, programs that improve living conditions may help patients comply with appropriate behavior therapy.
Older people receive medications for chronic diseases and therefore adherence is an important health and economic concern. The objective of the study is to determine relationships between pharmacist, patient and patient's family physician with special emphasis on the comparison of adherent and non-adherent patients.
The study was designed as a cross-sectional survey by use of a self-administered 33-item questionnaire. The study included 635 individuals collecting or buying drugs for the treatment of chronic diseases and 84 pharmacists dispensing drugs for chronic diseases to patients.
The study included 265 (41.7%) adherent and 370 (58.3%) non-adherent patients. Comparison of particular answers between patients and pharmacists revealed a discrepancy, with a significant difference in five of eight answers. The highest difference was recorded in answers to the question whether a pharmacist offered thorough advice to the patient on how to take the drug; an affirmative answer to this question was given by 90.5% of pharmacists and only 57.2% of patients. The analysis of respondents' claims about their relation with one doctor shows that in the first place, with the highest number of positive responses, is the claim of the respondents that their doctor always explains the results of laboratory tests and other specialized findings (n = 489, 77.0%).
Enhancing communication between the physician, the pharmacist and the patient is a key in boosting the patient's ability to follow a medication regimen. Pharmacist-physician-patient relationship can improve adherence to medication. It is very important to empower pharmacists to offer and allow time for patient counselling.
Objective: Older people receive medications for chronic diseases and therefore adherence is an important health and economic concern. The objective of the study is to determine relationships between pharmacist, patient and patient's family physician with special emphasis on the comparison of adherent and non-adherent patients.
Methods: The study was designed as a cross-sectional survey by use of a self-administered 33-item questionnaire. The study included 635 individuals collecting or buying drugs for the treatment of chronic diseases and 84 pharmacists dispensing drugs for chronic diseases to patients.
Results: The study included 265 (41.7%) adherent, and 370 (58.3%) non-adherent patients. Comparison of particular answers between patients and pharmacists revealed a discrepancy, with a significant difference in five of eight answers. The highest difference was recorded in answers to the question whether a pharmacist offered thorough advice to the patient on how to take the drug; an affirmative answer to this question was given by 90.5% of pharmacists and only 57.2% of patients. The analysis of respondents’ claims about their relation with one doctor shows that in the first place, with the highest number of positive responses, is the claim of the respondents that his/her doctor always explains the results of laboratory tests and other specialized findings (n=489, 77.0%).
Conclusion: Enhancing communication between the physician, the pharmacist and the patient is a key in boosting the patient's ability to follow a medication regimen. Pharmacist-physician-patient relationship can improve adherence to medication. It is very important to empower pharmacists to offer and allow time for patient counselling.
Energy detection is popularly used in the detection of idle spectrum because of its simple implement and low complexity. But, the detection performance can be observably affected due to noise uncertainty. Papers have proposed some solutions to resist the effects of noise uncertainty. However, most of these papers are assumed that the noise uncertainty interval is known to the detector, designing algorithms to detect the primary user signal. Few algorithms are designed to estimate the range of the noise uncertainty. This paper presents an algorithm for energy detection based on noise variance estimation that can be relatively accurate estimated the noise uncertainty interval. The simulation results show that in the case of the noise uncertainty interval is unknown to the detector, our proposed algorithm can detect well, which is similar to the theoretical detection, and its complexity is also very low.
Home care for older adults is a common phenomenon worldwide because it allows older adults to remain in their home environment. Research has shown that depression is frequently found in older recipients of home care services. Nonetheless, it is often poorly recognized and treated. Untreated or poorly treated depression in older home care recipients has been associated with a variety of negative outcomes, including increased morbidity and mortality, greater likelihood of nursing home institutionalization and higher caregiver distress.
The present review outlines some of the challenges associated with appropriate recognition and treatment of depression in older home care recipients.
Our review demonstrates that more aggressive management of depressive symptoms and the employment of an interdiciplinary team can result in beneficial outcomes.
Further research is needed, especially in the area of psychotherapeutic interventions as these should be flexible enough to meet the unique and evolving needs of this frail population of older adults.
The proportion of the elderly is constantly increasing and by the year 2025 20% of the population will be above 65 years of age. With advanced age, subjects will develop multiple diseases and often need to take several drugs.
This polypharmacy increases the risk for drug interactions and adverse effects. In addition, age-related physiological changes affect different biological systems and can contribute to alterations in pharmacokinetics and pharmacodynamics in older patients, which are more often seen in the frail than in the fit elderly. These features will complicate drug therapy in the elderly, and a careful dose titration is advisable. Furthermore, inappropriate drug prescription and non-adherence to medication represent common therapeutic challenges in elderly subjects. To date, there is no evidence of any effective antiageing agent.
This review summarizes present knowledge of age-related problems in drug action and their clinical implications for an increasingly important population.
The paper presents a discussion of the pitfalls of long-term treatment of depression. The acute, continuation and maintenance treatment differ in their goals. In the acute phase it is important to achieve full remission, in order to reduce the frequency of relapses and recurrences. The mean therapeutic efficacy of available antidepressants is similar, but there are differences as to their capacity to induce full remission and also as to their profile of side-effects. In long-term treatment, which is for many patients very often inevitable, other criteria for the selection of an optimal antidepressant become important, e.g. some persistent side-effects. Compliance is one of the frequently underestimated aspects.
The author present several studies which found just about the half of patients complies with prescribed medication. The further presented studies show the patients respect recommendations of physicians if they believe they can influence their health and if the recommendations fit into their health believes. Further studies show compliance is better if the patients is contend with the consultation and if he has the possibility to take part in making decision about the therapy and to be active in its course. Another obstacle of compliance is the patient can forget the recommendations. Subsequently the author presents several recommendations how to structure the medical interview to be most effective in influencing the patients compliance.
Results of empirical studies to what extent patients adhere exactly and consistently to the doctor's advice vary greatly. It may be foreseen that some 50% patients do not do exactly and consistently to what the physician advises them to do. And it is not only possible but essential to ask why the patient does not comply with the physician's (or healer's) advice. This is a problem for psychologists.
The objective of the study was to investigate patient compliance with two different dosage regimens. Ethinyloestradiol 80 micrograms daily was prescribed to 35 female outpatients to be taken as 20 micrograms four times daily or 40 micrograms twice daily for 7 days. It was given to standardise cervical mucus before a sperm cervical mucus penetration-test (SCMPT) was performed. Sixty-five patients with primary infertility (mean age 29.9 y) completed the study. Compliance was assessed by microprocessor-based compliance monitoring. Besides compliance (percentage of prescribed doses taken), the adherence of the patients to the dosage schedule was evaluated--'regimen compliance'. The latter parameter of drug intake behaviour was calculated by the number of days in which 2 (BID) or 4 openings (QID) were recorded by the electronic monitor. As a third parameter, the deviation from the prescribed dosing intervals, i.e. 12 or 6 h, was also determined. Partial compliance was the predominant finding and only 9 patients (13.8%) were over-compliant. Mean compliance was 75.7% in all 65 patients as a group, range 7.1 to 143%. The mean compliance with the QID regimen was 67% compared to 85% with the BID regimen. 'Regimen compliance', the percentage of doses taken on schedule, was 36% and 63% for the QID and BID regimens, respectively. Drug-intake behaviour was more erratic with the QID than the BID regimen, as indicated by the 55% of opening intervals recorded which exceeded the range of 3-9 h (mean: 6 h), compared to only 19% exceeding 6-18 h intervals (mean: 12 h).(ABSTRACT TRUNCATED AT 250 WORDS)
In this study we attempted to develop a profile that could be used prospectively to identify veterans over 64 years of age who might be at risk for medication noncompliance. Male veterans (N = 249) having from one to seven oral daily prescribed medications were studied. Instruments administered to determine their relationship to compliance were the Paired-Associate Test, the Mini Mental State, the Multidimensional Health Locus of Control, and the Standard Depression Scale. Compliance was determined by a pill count made at two home visits. Seventy-three percent of the subjects were noncompliant. Variables significantly related to noncompliance by bi-variate analysis were included in the stepwise logistic regression to develop a predictive model of noncompliance. Ethnicity and number of daily prescribed pills were the only significant variables in the final model. The model correctly classified the subjects as compliant/noncompliant in 77% of the cases. Discussions during home interviews revealed a number of common problems.
A study examined the extent and correlates of noncompliance in 155 predominantly elderly public housing tenants. Data were gathered through in-home interviews; only data from tenants taking prescribed medications on a regularly scheduled basis (n= 140) were analyzed. Noncompliance was significantly (p<0.05) associated with taking more than five prescribed medications, an inability to read prescription and auxiliary labels, and difficulty opening flip-off type medication container lids.
The results indicate that attempts to reduce the total number of prescription drug products used in these elderly residents by carefully scrutinizing the need for each prescription drug may enhance compliance. Pharmacists could assist in the detection of elderly patients at risk for medication noncompliance (five or more total prescription medications) by assessing the patients' ability to read labels on prescription containers for all new drug additions and refills, and by having them try to open a flip-off container lid.
To compare compliance in older adults with that of younger people, two studies investigated general practice patients taking either a short course of antibiotics or long-term medication. These studies examined the effects of age on compliance separately from other factors such as memory, domestic conditions, health beliefs, numbers of drugs being taken, etc.
The results indicate that seven variables were independently and significantly related to better compliance: accurate knowledge of regimen; belief in the importance of taking tablets exactly as prescribed; low resentment of time spent waiting to see the doctor; less fear of illness; ability to read the label on the bottle; understanding what the doctor has said; and living with a relative.
Age as such was not a factor affecting compliance. The results are discussed in terms of the potential influence of GPs in improving compliance in their patients.
A number of reviews have described medication compliance and asthma. The consensus emerging from the analyses and discussion of the topic is that compliance to treatment regimens is generally poor. The current article describes several trees overlooked in the forest of data generated about compliance and asthma. The paper focuses on neglected issues concerning determinants of compliance, assessment, and changing noncompliant behavior. Based on available data, the conclusion is that it is time for health care personnel and patients to share the blame for the lack of medication compliance in asthma.
The topic of medical errors has received substantial professional and public attention over the past few years. However, very little of this attention has focused specifically on the implications of this problem for older patients or on the healthcare professionals and settings specifically serving them. This article examines some of the most salient of those implications, with particular emphasis on the physician's ethical duty to admit and address errors. Practical obstacles, including physicians' legal anxieties, to admitting and thereby reducing and mitigating medical errors are outlined, along with potential strategies for effectively addressing and overcoming those barriers.