Impact of a telephonic outreach program on medication adherence in Medicare Advantage Prescription Drug (MAPD) plan beneficiaries

Objectives

To determine the impact of a telephone call reminder program provided by a campus-based medication therapy management call center on medication adherence in Medicare Advantage Part D (MAPD) beneficiaries with hypertension.

Do educational meetings and group detailing change adherence to drug formularies in hospitals? A cluster randomized controlled trial

Purpose

The aim of this study was to examine whether educational meetings and group detailing could increase the use of drugs from the ward lists or the drug formulary in hospitals.

Methods

Twelve medical wards from two hospitals were randomized into three groups: control, basic and extended intervention. All wards had a ward list review before interventions. Moreover, the basic intervention consisted of an educational meeting, and the extended intervention included two group detailing sessions. The proportion of drugs used from the ward list or hospital drug formulary (HDF) was the primary outcome. Data (defined daily doses [DDDs], numbers and cost [Euros]) on drugs sold to the wards were retrieved from the two hospitals from 1 July 2011 to 31 August 2012. Baseline data: from July to September 2011, and follow-up data: from June to August 2012.

Results

The proportion of formulary drugs used increased for the extended intervention group (0.04, range ?0.02 to 0.09) and basic intervention group (0.03, range ?0.03 to 0.09) in comparison with a decrease in the control group (?0.01, range ?0.03 to ?0.02). The interventions did not significantly change odds for selecting drugs from the formulary in comparison with the control group (basic intervention: OR 1.09 [95 % CI 0.81 to 1.46]; extended intervention: OR 1.00 [95 % CI 0.75 to 1.35]).

Conclusions

In this study, educational meetings and group detailing do not significantly improve adherence to ward lists or HDF. The adherence to the formularies at baseline was relatively high, which may explain why the interventions did not have a significant effect.     

Epoetin alpha improves the response to antiviral treatment in HCV-related chronic hepatitis

Background

The conventional antiviral treatment of chronic hepatitis related to hepatitis C virus (HCV) often leads to anemia. In this case, it is necessary to reduce ribavirin dose or stop treatment, thus reducing the rate of sustained virological response.

Aim

We investigated whether epoetin alpha administration improves treatment adherence and leads to higher percentage of response at the end of therapy and sustained virological response.

Methods

Two hundred and fourteen individuals with genotype 1b HCV-related chronic hepatitis underwent treatment with pegylated (peg)-interferon alpha-2A 180 μg once weekly and ribavirin 1,000–1,200 mg/day; 174 were responders. Forty individuals completed treatment with no hemoglobin reduction; 134 developed anemia during therapy. Anemic responders were distributed randomly into two groups: group 1 continued therapy with epoetin alpha addiction; group 2 continued antiviral therapy with ribavirin reduction only.

Results

Patients in group 1 achieved better control of hemoglobin levels (13.8?±?1.2 g/dl at the end of therapy) than tthose in group 2 (11.5?±?0.8 g/dl). Sustained virological response was 59.7% in group 1 compared with 34.4% in group 2 (p?<?0.01).

Conclusions

In patients with 1b HCV-related chronic hepatitis who develop anemia during antiviral treatment, administration of epoetin alpha increases hemoglobin levels and the end-of-treatment rate and sustains virological response by improving treatment adherence.     

Efficacy and safety of a medication dose reminder feature in a digital health offering with the use of sensor-enabled medicines

Objectives

Over one-half of patients with chronic diseases, such as hypertension and type 2 diabetes (DM), do not take medicines as prescribed. This study assessed the efficacy and safety of “seeing” versus “not seeing” medication dose reminders regarding medication adherence and risk for overdose.

A qualitative study to explore how patients identify and assess symptoms as adverse drug reactions

Purpose

To explore how Thai patients assess symptoms as adverse drug reactions (ADRs).

Methods

Out-patients at two hospitals in Thailand previously reporting suspected ADRs to statins were purposively selected to cover factors relevant to the accuracy of ADR reports. Semi-structured interviews explored the mechanisms participants used to work out whether their symptoms were related to their statin. All interviews were audio-recorded, transcribed and independently thematically analyzed by two researchers.

Results

One hundred interviews were suitable for analysis; 52 were male, age range was 36 to 77 years (mean?±?S.D.: 59.83?±?9.14) and most (92) were taking other medicines in addition to statins. Patient assessment of symptoms as ADRs fell into two major themes: medicine-related factors and external factors. Timing relationships were mentioned most frequently (74), followed by information received (55), seeing similar symptoms in others (7) and diagnosis through blood tests (4). Use of multiple medicines, consideration of the medicine versus diseases, symptoms occurring with more than one medicine or relieved through treatment reduced confidence in ADR attribution. Many participants proposed alternative explanations for symptoms, including old age. Lack of information and knowledge were obstacles to the assessment process.

Conclusions

Patients assessed possible ADRs most often by considering timing relationships. While they also used medicine information, Thai patients received inadequate information to help them assess their symptoms. Patients expressed uncertainty and difficulties in deciding attribution when concomitant medicines and diseases were involved. The findings could support the development of a patient-friendly systematic tool for identifying and assessing possible ADRs.     

Add-on Ezetimibe Reduces Small Dense Low-Density Lipoprotein Cholesterol Levels Without Affecting Absorption of Eicosapentaenoic Acid in Patients with Coronary Artery Disease: A Pilot Study

Background

Residual risk of cardiovascular disease from increased small dense low-density lipoprotein (sdLDL)-cholesterol levels and low n-3 polyunsaturated fatty acid (PUFA) levels is a considerable therapeutic issue. The purpose of this study was to evaluate the effect of ezetimibe as an add-on to statins and supplemental eicosapentaenoic acid (EPA) on sdLDL cholesterol and absorption of EPA in patients with coronary artery disease.

Methods

The study population consisted of ten male patients who were concurrently receiving statins and EPA 1,800 mg/day. Serum lipids and PUFAs, including EPA and arachidonic acid, were measured in blood samples collected before ezetimibe (baseline), 4 weeks after starting 10-mg/day ezetimibe, and 4 weeks after discontinuing ezetimibe.

Results

Ezetimibe significantly decreased sdLDL-cholesterol levels after 4 weeks of treatment (baseline 35 ± 13 mg/dl; treatment 27 ± 9 mg/dl), but the levels returned to baseline after discontinuation of ezetimibe (37 ± 13 mg/dl). The concentration of EPA did not significantly change during the study.

Conclusion

Ezetimibe shows great promise as an add-on therapy to statins to reduce sdLDL-cholesterol-related residual risk of cardiovascular disease without affecting absorption of supplemental EPA in patients with coronary artery disease.     

Antianginal Effects of Trimetazidine and Left Ventricular Function Improvement in Patients with Stable Angina Pectoris

Objective

To evaluate the effects of add-on treatment with trimetazidine, single dose and long-term, on clinical and objective parameters of ischemia in patients with stable angina pectoris receiving standard antianginal therapy.

Design

One-month single-blind, placebo-controlled study.

Patients

40 patients with stable angina pectoris.

Interventions

Patients received 1-month treatment with either trimetazidine 20mg (n = 20) or placebo (n = 20) 3 times daily in addition to standard antianginal therapy.

Main outcome measures

All patients underwent bicycle stress tests at baseline and at 1 month to assess exercise tolerance. Patients receiving trimetazidine also underwent a stress test 2 hours after administration of a 60mg single dose. Influence of trimetazidine on stress-induced left ventricular function was assessed in 11 patients, with dobutamine stress echocardiography performed at baseline and at 1 month. Clinical efficacy was evaluated in terms of mean weekly number of anginal episodes and weekly nitroglycerin (glyceryl trinitrate) tablet consumption during the study.

Results

Trimetazidine significantly improved most stress test parameters, after a single dose and after 1 month of treatment; the rate-pressure product remained unchanged. Dobutamine tests showed significant (p < 0.05) increases from baseline values in time to onset of anginal pain and threshold dobutamine dose (13.5 ± 0.7 versus 10.2 ± 0.8 min, and 43.6 ± 2.8 versus 35.4 ± 3.4 μg/kg/min, respectively). The severity of anginal pain and mean weekly number of anginal episodes was reduced significantly (p < 0.05) from baseline values after 1 months’ treatment with trimetazidine (1.3 ± 0.6 versus 2.3 ± 0.3, and 6.6 ± 1.4 versus 10.1 ± 1.3, respectively). After 1 month, weekly consumption of nitroglycerin tablets was decreased by 3.1 from baseline values in the trimetazidine group but increased by 0.3 in the placebo-treated group. No patient withdrew due to treatment-related adverse effects.

Conclusion

This study confirms the antianginal and anti-ischemic efficacy of single dose and long-term treatment with trimetazidine. Treatment with trimetazidine was well tolerated.     

Intensive treatment of persistent microalbuminuria: determinants of treatment resistance

Aims

Persistent microalbuminuria after treatment is a common finding. This study tried to evaluate the causes of treatment resistance.

Patients and methods

Sample: 204 patients treated with renina-angiotensin-axis (RAA) blocking drugs that showed positive microalbuminuria. Treatment was increased during three months to reach a BP < 130/80 mmHg and to obtain maximal RAA blockade. Then patient were classified as normoalbuminuric after treatment (N group) and microalbuminuric in spite of treatment (M).

Results

Mean microalbuminuria at recruitment was 48.5±25.6 mg/24h in N group and 90.0±140.3 mg/24h in M group. It was reduced to 16.1±10.0 mg/day in N group and to 83.5±138.2 mg/day in M group. At start, mean SBP and mean DBP were not different between groups. After treatment SBP and DBP pressure were reduced in both groups (differences between groups were not significant). Combined control of BP showed a slight increase in the two groups but it have only statistical significance in the N group (p = 0.031, McNemar test).

Conclusions

Persistent microalbuminuria seems to be associated to poor blood pressure control. Effective blood pressure reduction was followed by urinary albumin excretion decrease. Baseline severity of microalbuminuria was the only clear predictor of remission after treatment.     

Trends in statin therapy initiation during the period 2000–2010 in Israel

Purpose

The aim of this population-based study is to describe trends in the characteristics and treatment patterns of statin initiators over the first decade of the 21st century.

Methods

New statin use was studied retrospectively using the database of Maccabi Healthcare Services (MHS), a large Israeli health maintenance organization. Statin initiators were defined as MHS members aged ≥30 years who first purchased statins between 2000 and 2010. The starting dose was calculated in simvastatin equivalents based on the World Health Organization’s daily defined dose index. Persistence was calculated as the percentage of days covered (PDC) with statins during the first year of therapy.

Results

Statin initiation peaked in 2005 and decreased from 38.6 to 18.6 per 1,000 in the period 2005–2010. The average age at therapy initiation decreased from 58.9 (±12.0) to 54.5 (±11.7) years, and the average (SD) baseline low-density lipoprotein cholesterol (LDL-C) decreased from 4.2 (±1.1) to 4.0 (±0.9) mmol/l during the study period. Women were on average 3 years older than men at treatment initiation, with a higher baseline LDL-C. Among statin initiators, the prevalence of ischemic heart disease (IHD) decreased from 17.8 to 6.7 %, and diabetes prevalence increased from 8.6 to 15.7 %, peaking in 2008 (18.0 %). The PDC with statins ranged between 52.9 and 57.7 %. Simvastatin use at initiation increased from 27.5 % in 2000 to >90 % since 2002. Starting dose increased from 18.5 (±8.9) to 24.3 (±13.7) mg simvastatin equivalent.

Conclusions

Among the study population, statin initiators were increasingly characterized by a lower cardiovascular risk—namely, younger individuals without IHD and with a lower baseline LDL-C. These trends underscore the important shift towards statin initiation for primary prevention, as well as the need to balance between benefits and the potential side effect of statins.     

Prevalence and reasons for non-adherence to hyperlipidemia treatment

Aim

To assess the prevalence of medication non-adherence, and to assess the effect of selected patient-, doctor-, and therapyrelated factors on patient adherence to hyperlipidemia treatment.

Methods

Open-label questionnaire study in the primary care patients diagnosed with hyperlipidemia.

Results

A total of 255 outpatients aged 60.2 +/? 10.3 (mean +/? SD) were enrolled. Only 61.6% of patients claimed to be fully adherent during the last week. The major source of motivation to take medication was expectation to lower cholesterol level, and only extremely infrequently (2.7%) — to prolong life. Patients often pointed at economic constrains as a reason for low adherence. Getting information from doctor about the purpose of therapy (OR=3.04, 95%CI 1.36–6.80, P<0.01), understanding the purpose of therapy (OR=5.09, 95%CI 1.30–19,90, P<0.05), reading the patient information leaflet (OR=3.37, 95%CI 1.78–6.36, P<0.001), positive opinion about the effectiveness of the treatment (OR=2.45, 95%CI 1.24–4.81, P<0.01), and visiting primary care once a month (OR=2.22, 95%CI 1.05–4.69, P<0.05) were associated with adherence to the treatment.

Conclusions

Non-adherence to lipid-lowering medication is a frequent problem. This study suggests that effective doctor-patient communication may play an important role in rising patients’ motivation to systematic treatment. Better adherence might be also obtained with prescribing more affordable drugs.     

Social stratification in the dissemination of statins after stroke in Sweden

Purpose

Since 2005, statins have been recommended to patients with ischaemic stroke. The objective of this study was to analyse how statin treatment has been disseminated in different patient groups (age, sex, socioeconomic status and country of birth) in Sweden between 2004 and 2009.

Methods

The Swedish Stroke Register (Riks-Stroke) has been linked to the Longitudinal Integration Database for Health Insurance and Labour Market Studies. Approximately 85 % of stroke patients in Sweden are included in Riks-Stroke. Odds ratios for statin prescribing were calculated using a multivariable logistic regression model including age, sex, socioeconomic status and risk factors.

Results

During the study period, 108,950 ischaemic stroke patients were discharged alive from hospital. The proportion with statins at discharge increased from 32.9 % in 2004 to 60.1 % in 2009. Patients with secondary school or university education had slightly higher odds [odds ratio (OR) 1.07, 95 % confidence interval (CI) 1.04–1.11 and OR 1.05, 95 % CI 1.01–1.10 respectively] than patients with primary school education. Patients on a high income were prescribed more statins than those on a low income (OR 1.24, 95 % CI 1.19–1.28). Compared with patients born in Sweden, patients born in other countries were prescribed more statins (Nordic countries excepting Sweden: OR 1.07, 95 % CI 1.01–1.14; Europe: OR 1.31, 95 % CI 1.22–1.40; Outside Europe: OR 1.20, 95 % CI 1.08–1.34).

Conclusions

Statin prescribing after ischaemic stroke has increased from 2004 to 2009. Our results also show a social stratification in the dissemination of statins, with patients having a higher income and patients with higher education receiving statins more often than those with a lower income and education, and patients born in Sweden receiving statins less often than those born outside of Sweden.     

Influence of refill adherence method when comparing level of adherence for different dosing regimens

Purpose

To examine the impact of two methods when estimating refill adherence in patients using bisphosphonates with different dosing regimens.

Methods

In the Swedish Prescribed Drug Register, 18,203 new users of bisphosphonates aged 18–85 years were identified between 1 July 2006 and 30 June 2007 and followed for a maximum of 2 years. The patients were categorised based on dosing regimen: one tablet daily, one tablet weekly, switching between these regimens, and other regimens. Refill adherence was estimated with Continuous measure of Medication Acquisition (CMA, adherent if CMA?≥?80 %) and the maximum gap method (adherent if gaps <45 days). Differences in adherence between patients in the groups were assessed with logistic regression models controlling for confounding factors.

Results

The proportion of patients classified as adherent was higher using CMA compared with patients classified as adherent using the maximum gap method. Patients on one tablet weekly had significantly lower adherence compared with patients on one tablet daily in the main analyses of both methods (the maximum gap method: 73 % vs. 80 %; adjusted OR?=?0.71; 95 % CI 0.57–0.89 and CMA: 84 % vs. 88 %, adjusted OR?=?0.75; 95 % CI 0.57–0.99). Patients using the other two dosing regimens had significantly lower adherence compared with patients on one tablet daily using both methods.

Conclusion

Choice of method has an impact on the estimates of refill adherence to bisphosphonates. Patients on one tablet weekly dosing had lower adherence compared with patients on one tablet daily dosing using both methods.     

Health-related quality of life in patients after the acute myocardial infarction

Introduction

Acute myocardial infarction has a negative impact on patient’s quality of life. The aim of this paper was to evaluate the health-related quality of life in patients one month after the acute myocardial infarction.

Material and method

The study involved 160 patients of both sexes, 30 to 79 years of age. The health-related quality of life in patients was assessed at the admission at the coronary care unit, and one month after. The following questionnaires were used: EuroQuolVAS and EuroQuol 5 Dimension. Angina pectoris was ranked according to the Canadian Cardiovascular Society Classification. Results: Men and women evaluated their health condition in a similar way (60.48±11.98 vs 60.55±12.24). Patients who (have) undergone primary coronary intervention had significantly higher average scores on EuroQuolVAS than the patients who were treated with thrombolytic therapy (68.69±9.67 vs 52.31±7.87, p<0.001). Modest and severe problems were the most presented in answers to those questions: pain/discomfort, anxiety/depression and self-care. Both men (0.92±0.43 vs 3.27±0.59, p<0.001) and women (0.89±0.46 vs 3.19±0.55, p<0.001) had significiantly lower average marks of angina pectoris one month after the acute myocardial infarction than at the admission to the hospital.

Conclusion

One month after the acute myocardial infarction the quality of life in patients was very impared. Patients who undergone to the primary coronary intervention evaluated their health condition as better than the patients who were treated with thrombolytic therapy. Those patients also had the lower average marks of angina pectoris and the higher health-related quality of life.     

Effects of coincident 5-HT1A receptor stimulation and NMDA receptor antagonism on l-DOPA-induced dyskinesia and rotational behaviors in the hemi-parkinsonian rat

Rationale

Serotonin 1A receptor (5-HT1AR) agonists reduce l-DOPA-induced dyskinesia and enhance motor function in experimental and clinical investigations of Parkinson’s disease (PD). While the mechanism(s) by which these effects occur are unclear, recent research suggests that modulation of glutamate neurotransmission contributes.

Objective

To further delineate the relationship between 5-HT_1A receptors and glutamate, the current study examined the effects of the 5-HT_1AR agonist, ±8-OH-DPAT and the N-methyl-d-aspartic acid receptor (NMDAR) antagonist, MK-801, on l-DOPA-induced motor behavior.

Materials and methods

Unilateral 6-hydroxydopamine lesioned male Sprague–Dawley rats were rendered dyskinetic with 1 week of daily l-DOPA (12 mg/kg, i.p.) + benserazide (15 mg/kg, i.p.). On test days, one group of rats received pretreatments of: ±8-OH-DPAT (0, 0.03, 0.1, 0.3 mg/kg, i.p.) or MK-801 (0, 0.03, 0.1, 0.3 mg/kg, i.p.). A second group was administered combined ±8-OH-DPAT (0, 0.03 or 0.1 mg/kg, i.p.) + MK-801 (0, 0.1 mg/kg, i.p.). Pretreatments were followed by l-DOPA administration, after which, abnormal involuntary movements (AIMs) and rotations were monitored. To investigate effects on motor performance, subthreshold doses of ±8-OH-DPAT (0.03 mg/kg, i.p.) + MK-801 (0.1 mg/kg, i.p.) were administered to l-DOPA-naïve hemiparkinsonian rats before the forepaw adjusting steps test.

Results

Individually, both ±8-OH-DPAT and MK-801 dose-dependently decreased l-DOPA-induced AIMs without affecting rotations. Combined subthreshold doses of ±8-OH-DPAT+MK-801 reduced l-DOPA-induced AIMs and potently enhanced contralateral rotations without altering l-DOPA-induced motor improvements.

Conclusions

The current results indicate a functional interaction between 5-HT_1AR and NMDAR that may improve pharmacological treatment of PD patients.     

Management of Hypertension with the Fixed Combination of Perindopril and Amlodipine in Daily Clinical Practice

Background

Current clinical guidelines recognize that the use of more than one agent is necessary to achieve target BP in the majority of patients. The ASCOT-BPLA trial demonstrated that the free combination of amlodipine and perindopril effectively controlled BP and was better than a β-adrenoceptor antagonist (β-blocker)/diuretic combination in reducing total mortality and cardiovascular outcomes.

Objective

To evaluate the efficacy and tolerability of a fixed combination of perindopril and amlodipine in the clinical setting.

Study design

The STRONG (SafeTy & efficacy analysis of coveRsyl amlodipine in uncOntrolled and Newly diaGnosed hypertension) study was a prospective, observational, multicenter trial.

Setting

This was a naturalistic, real-world, clinic-based, outpatient study involving 336 general practitioners/ primary care physicians in 65 cities in India.

Patients

Adults aged 40–70 years with newly diagnosed/untreated stage 2 hypertension (BP ≥ 160/100 mmHg), hypertension uncontrolled with monotherapy (BP > 140/90 mmHg), or hypertension inadequately managed with another combination therapy.

Intervention

Fixed combination perindopril 4 mg/amlodipine 5 mg once daily for 60 days.

Main outcomes measure

The primary outcomes were the mean change in BP from baseline and the proportion of patients achieving adequate BP control (≤ 140/90 mmHg, or ≤ 130/80 mmHg in patients with diabetes mellitus) in the intent-to-treat (ITT) population. Secondary analyses included incidence of adverse events (ITT) and treatment adherence rate (completers).

Results

In total, 1250 patients comprised the ITT population: 32.6% with newly diagnosed hypertension; 40.5% with hypertension uncontrolled with monotherapy; and 26.9% with hypertension inadequately managed with another combination therapy. Mean SBP/DBP decreased significantly from baseline (167.4±15.2/101.4±9.1 mmHg) over 60 days (?41.9 ± 34.8/?23.2 ± 21.8 mmHg; p<0.0001). Target BP was achieved in 66.1% of patients in the total population, 68.3% of untreated patients, 68.4% of patients uncontrolled with monotherapy, and 59.9% of patients inadequately managed with combination therapy. In 161 patients with SBP >180 mmHg at baseline (newly diagnosed: n = 50; uncontrolled on monotherapy: n = 53; inadequately managed on combination therapy: n = 58), BP was reduced by 63.2 ± 32.5/29.0 ± 21.9 mmHg (p<0.0001) at day 60. The fixed combination was safe and well tolerated. All 1175 patients completing the 60-day study (94%) adhered to their treatment regimen.

Conclusion

Fixed combination perindopril/amlodipine was found to be an effective and well tolerated antihypertensive treatment, with an excellent rate of treatment adherence in the clinical setting. Fixed combination perindopril/amlodipine is expected to be useful in the management of hypertension in primary healthcare, with a positive impact on treatment adherence.     

Effect of treatment with pravastatin or ezetimibe on endothelial function in patients with moderate hypercholesterolemia

Background/Aim

Statin treatment improves endothelial function. It is matter of debate, however, if this effect of statins is due to their action on low-density lipoprotein cholesterol (LDL-C) or to other non-lipidic (pleiotropic) effects. The aim of this study was to evaluate whether the effect of pravastatin on endothelial function is mediated by pleiotropic effects. We therefore compared the effect of pravastatin and ezetimibe, a cholesterol absorption inhibitor, at doses yielding similar reductions in LDL-C and examined the effect of the two treatments on flow-mediated dilation (FMD) in hypercholesterolemic subjects.

Methods

A total of 33 moderately hypercholesterolemic patients were randomized into three treatment groups to receive ezetimibe 10 mg/day (n?=?10), pravastatin 10 mg/day (n?=?13) or no treatment (control, n?=?10) for 6 weeks. To assess endothelial function, we determined FMD of the brachial artery non-invasively by high-resolution ultrasound before and after treatment.

Results

Ezetimibe and pravastatin treatment reduced LDL-C (mean ± standard error) to a similar extent (?20.6 ± 4.1 vs. ?24.1 ± 4.0 %, respectively; P?=?0.4771), while no decrease was observed in the control group. FMD increased significantly after treatment with ezetimibe (from 11.4 ± 5.7 to 16.8 ± 3.6 %; P?=?0.022) and with pravastatin (from 13.7 ± 4.9 to 17.5 ± 4.4 %; P?=?0.0466), but not in the control group. There were no differences in the endothelial function changes between the two treatment groups.

Conclusions

In this study, two treatments that lower cholesterol via different mechanisms improved endothelial function to a similar extent, suggesting that the observed effect can be explained by the reduction of cholesterol levels.     

Potential risk factors for medication non-adherence in patients with chronic obstructive pulmonary disease (COPD)

Aims

To investigate the effect of a range of demographic and psychosocial variables on medication adherence in chronic obstructive pulmonary disease (COPD) patients managed in a secondary care setting.

Methods

A total of 173 patients with a confirmed diagnosis of COPD, recruited from an outpatient clinic in Northern Ireland, participated in the study. Data collection was carried out via face-to-face interviews and through review of patients’ medical charts. Social and demographic variables, co-morbidity, self-reported drug adherence (Morisky scale), Hospital Anxiety and Depression (HAD) scale, COPD knowledge, Health Belief Model (HBM) and self-efficacy scales were determined for each patient.

Results

Participants were aged 67?±?9.7 (mean ± SD) years, 56?% female and took a mean (SD) of 8.2?±?3.4 drugs. Low adherence with medications was present in 29.5?% of the patients. Demographic variables (gender, age, marital status, living arrangements and occupation) were not associated with adherence. A range of clinical and psychosocial variables, on the other hand, were found to be associated with medication adherence, i.e. beliefs regarding medication effectiveness, severity of COPD, smoking status, presence of co-morbid illness, depressed mood, self-efficacy, perceived susceptibility and perceived barriers within the HBM (p?P?Conclusions Adherence in COPD patients is influenced more by patients’ perception of their health and medication effectiveness, the presence of depressed mood and co-morbid illness than by demographic factors or disease severity.