Preventive medication adherence in african american and caucasian headache patients

(Headache 2011;51:520‐532) Study Objectives.— To examine race‐related differences in adherence to preventive medication agents in headache patients and identify factors predictive of medication adherence in Caucasian and African American headache patients. Methods.— Using a longitudinal naturalistic study design, data from 77 Caucasian and 32 African American headache patients were collected through (1) 30‐day daily diaries that assessed medication adherence, headache frequency, and headache episode severity; (2) self‐administered surveys that assessed headache management self‐efficacy; and (3) telephone‐administered psychiatric interviews that yielded psychiatric diagnoses. Using daily diary adherence data, patients' adherence to preventive agents was dichotomized as “Inconsistent” (ie, adhered fewer than 80% of days) or “Consistent” (ie, adhered ≥80% of days during the past month). Results.— The proportion of adherent African American patients (69%) did not differ significantly from the proportion of adherent Caucasian patients (82%). Exploratory univariate logistic regression analyses found that preventive medication adherence levels of 80% or less were associated with being diagnosed with major depressive disorder and lower levels of headache management self‐efficacy. Conclusions.— Future research should test if interventions that reduce depressive symptoms and increase patients' levels of headache management self‐efficacy can produce concomitant increases in adherence to preventive headache agents.     

Impact of a self-administration of medications programme on elderly inpatients' competence to manage medications: a pilot study

What is known and objectives: Changes to medication regimens and failure to involve patients in management of their medications whilst in hospital may result in medication errors or non‐adherence at home after discharge. Self‐administration of medications programmes (SAMP) have been used to address this issue. The objective of this study was to assess the impact of a SAMP on elderly hospital inpatients’ competence to manage medications and their medication adherence behaviours. Methods: The SAMP comprised three stages: education, progressing to supervised self‐administration and finally to independent self‐administration. Decisions to progress patients to the next level, and whether they passed or failed the SAMP, were made by the ward pharmacist and nursing staff. The Drug Regimen Unassisted Grading Scale (DRUGS) was used to assess patients’ competence to manage medications at various time points. Tablet count and the Tool for Adherence Behaviour Screening (TABS) were used as adherence measures. Results and discussion: Participants (n = 24) with a mean age of 77·4 years, were mainly female and generally had a high level of functioning. They were prescribed a mean of 9·0 medications at the time of commencing the SAMP. Twenty‐two of the 24 participants successfully completed the SAMP. DRUGS scores at discharge improved significantly (P < 0·001) compared with that before commencement of medication self‐administration. Participants reported a significant decrease (P = 0·02) in non‐adherent behaviour and a trend towards improved adherent behaviour (P = 0·08) after participation in the SAMP. What is new and conclusion: An inpatient SAMP improved elderly patients’ ability to competently manage and adhere to their prescribed medications regimen. This finding needs to be confirmed in a larger controlled trial.     

Intervening at the Intersection of Medication Adherence and Health Literacy

Medications play a prominent role in the treatment of many illnesses. Failing to adhere to prescribed medication regimens contributes to an array of poor health outcomes. In addition to the cost in terms of human suffering, the financial cost of medication nonadherence is staggering. Poor health literacy has been identified as a major cause of medication nonadherence. This paper focuses on nonadherence related to health literacy in the older adult population in the United States. Eight simple interventions to aid health care personnel in working with this population to improve adherence are provided.