Does adherence-related support from physicians and partners predict medication adherence for vasculitis patients?

Few studies have explored mediators between medication-related support and medication adherence for individuals with rare, systemic autoimmune conditions. Using the Information-Motivation-Behavioral Skills model, we tested whether depressive symptomatology and medication adherence self-efficacy mediated the relationship between adherence support and changes in medication adherence among vasculitis patients, and whether support from physicians and partners differentially affected medication adherence. Vasculitis patients (n = 172) completed baseline and follow-up questionnaires about their medication adherence and perceived adherence support. Bootstrapped mediation analyses tested the effects of physician and partner support on changes in medication adherence. Adherence self-efficacy mediated the relationship between physician support and changes in medication adherence (B = 0.05, SE = 0.03, 95% CI 0.01, 0.13). Neither self-efficacy nor depressive symptomatology mediated the effects of partner support. Although physicians spend little time with patients, they can increase patients’ confidence about taking medications correctly and potentially improve health outcomes by bolstering medication adherence.     

How does patient-provider communication influence adherence to asthma medications?

ObjectiveTo assess hypothesized pathways through which patient-provider communication impacts asthma medication adherence.MethodsA national sample of 452 adults with asthma reported assessments of patient-provider communication, proximal outcomes (understanding of asthma self-management, patient-provider agreement, trust in the clinician, involvement in care, motivation), and adherence to asthma medications. Structural equation modeling was used to examine hypothesized pathways.ResultsSignificantly positive direct pathways were found between patient-provider communication and all proximal outcomes. Only positive indirect pathways, operating through trust and motivation, were found between patient-provider communication and medication adherence.ConclusionPatient-provider communication influences many desirable proximal outcomes, but only influences adherence through trust and motivation.Practice implicationsTo promote better adherence to asthma medication regimens and, ultimately positive asthma outcomes, healthcare providers can focus on implementing communication strategies that strengthen patients’ trust and increase patient motivation to use asthma medications.     

Patient adoption of an internet based diabetes medication tool to improve adherence: A pilot study

ObjectiveTo investigate the effect of a video intervention, Managing Your Diabetes Medicines, on patient self-efficacy, problems with using medication, and medication adherence in a rural, mostly African American population.MethodsPatients selected their problem areas in medication use and watched one of nine 2-min videos with a research assistant at a clinic or pharmacy and were given an access code to watch all the videos at their convenience. Outcomes were measured at baseline and 3-month follow-up.ResultsFifty-one patients were enrolled; 84% were African American and 80% were female (mean age: 54 years). Seventy-three percent watched at least one module after the initial visit. Improved self-efficacy was associated with a decrease in concerns about medications (r = −0.64). Low literate patients experienced greater improvement in self-efficacy than more literate patients (t = 2.54, p = 0.02). Patients’ mean number of problems declined from 6.14 to 5.03. The number of patients with high or medium adherence rose from 33% at baseline to 43% at 3-month follow-up.ConclusionsA practical, customized video intervention may help improve patient self-efficacy, reduce problems with medication use, and improve medication adherence in diabetes patients.Practice implicationsProviders should consider implementing technology-based interventions in the clinic to address common problems that patients have with self-management.     

Effects of ethnicity on treatment attendance,stimulant response/dose,and 14-month outcome in ADHD

From the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder--a randomized clinical trial of 579 children ages 7-9 years receiving 14 months of medication management, behavioral treatment, combination, or community care--the authors matched each African American and Latino participant with randomly selected Caucasian participants of same sex, treatment group, and site. Although Caucasian children were significantly less symptomatic than African American and Latino children on some ratings, response to treatment did not differ significantly by ethnicity after controlling for public assistance. Ethnic minority families cooperated with and benefited significantly from combination (multimodal) treatment (d = 0.36, compared with medication). This incremental gain withstood statistical control for mother's education, single-parent status, and public assistance. Treatment for lower socioeconomic status minority children, especially if comorbid, should combine medication and behavioral treatment.     

Factors influencing patient decisions about the use of asthma controller medication.

BACKGROUND: Patient nonadherence with asthma controller medication is pervasive and impedes successful adoption of national treatment guidelines. OBJECTIVE: To survey adult patients with asthma about the factors influencing their decisions about when to use their asthma controller medications. METHODS: Two hundred adults with asthma were randomly selected from a national database and were surveyed by telephone about medication use, barriers to adherence, and treatment preferences. RESULTS: Adherence to daily controller medication in the group was generally well below the prescribed level despite the fact that many had relatively severe asthma and inadequately controlled symptoms. Thirty percent of the respondents indicated that they had been instructed by their physician to use their controller medication intermittently as guided by their symptoms. Most respondents expressed a desire to be more in control of their treatment and for that treatment to be more immediately effective and long-lasting but did not perceive inadequate information to be a barrier to adherence. CONCLUSION: These insights into patient perception and motivation suggest the importance of developing treatment plans that allow patients some degree of control over medication use.     

Predicting Medication Use in an Elderly Hypertensive Sample: Revisiting the Established Populations for Epidemiologic Studies of the Elderly Study

Though some research has begun to examine specific factors related to race that should be targeted in the design of interventions to improve medication adherence, there remains an underreporting of factors that contribute to the use of hypertensive medications by race.Methods:This study examined medication use reported by a sample of elderly, controlled and uncontrolled hypertensive patients from the North Carolina Established Populations for the Epidemiologic Studies of the Elderly (NC EPESE) study.Results:In the adjusted final multivariable models of medication use over time in both Caucasian and African-American women, those with higher BMI were more likely to report taking their medication over time; satisfaction with their medical care was predictive among Caucasian women and receiving treatment from a minority physician was predictive among African-American women.Conclusion:Focusing on individual-level characteristics and the different issues that may underlie specific ethnic groups, healthcare provider characteristics in particular may help to develop more precisely targeted interventions to improve a full range of healthcare services that are often needed by elderly hypertensive patients.     

Health care providers’ support of patients’ autonomy,phosphate medication adherence,race and gender in end stage renal disease

This study was designed to assess dialysis subjects’ perceived autonomy support association with phosphate binder medication adherence, race and gender. A multi-site cross-sectional study was conducted among 377 dialysis subjects. The Health Care Climate (HCC) Questionnaire assessed subjects’ perception of their providers’ autonomy support for phosphate binder use, and adherence was assessed by the self-reported Morisky Medication Adherence Scale. Serum phosphorus was obtained from the medical record. Regression models were used to examine independent factors of medication adherence, serum phosphorus, and differences by race and gender. Non-white HCC scores were consistently lower compared with white subjects’ scores. No differences were observed by gender. Reported phosphate binder adherence was associated with HCC score, and also with phosphorus control. No significant association was found between HCC score and serum phosphorus. Autonomy support, especially in non-white end stage renal disease subjects, may be an appropriate target for culturally informed strategies to optimize mineral bone health.     

Adherence to medication in stroke survivors: a qualitative comparison of low and high adherers

Objectives. The aim of this study was to investigate factors that may explain variance in adherence to medication in stroke patients. Design. A qualitative comparison of high and low adherers to medication. Methods. Thirteen participants, selected from a sample of 180 stroke survivors because they self‐reported the lowest adherence to medication regimes, were matched with 13 reporting maximal adherence. All took part in semi‐structured qualitative interviews. Results. Thematic analysis revealed that those with poor adherence to medication reported both intentional and non‐intentional non‐adherence. Two main themes emerged: the importance of stability of a medication routine and beliefs about medication and treatment. High adherers reported remembering to take their medication and seeking support from both family and health professionals. They also had a realistic understanding of the consequences of non‐adherence, and believed their medicine did them more good than harm. Low adherers reported forgetting their medication, sometimes intentionally not taking their medication and receiving poor support from medical staff. They disliked taking their medication, had limited knowledge about the medication rationale or intentions, and often disputed its benefits. Conclusions. Our findings suggest that appropriate medication and illness beliefs coupled with a stable medication routine are helpful in achieving optimal medication adherence in stroke patients. Interventions designed to target both intentional and non‐intentional adherence may help maximize medication adherence in stroke patients.     

Racial differences in adherence to cardiac medications

OBJECTIVE: To determine whether there are racial differences in adherence to cardiac medications. DESIGN: Retrospective analysis. PATIENTS: African-American and white male veterans aged 45 years or older who had received any of four groups of drugs: angiotensin-converting enzyme inhibitors (ACEIs), beta-blockers (BBs), calcium channel blockers (CCBs,) or HMG CoA (hydroxymethyl glutaryl coenzyme A) reductase inhibitors (statins). DATA: Administrative records were used to identify eligible veterans and their demographic characteristics, medical diagnoses, and medication use. We used a standard measure of adherence to medications based on whether the veteran obtained enough drug to take it as prescribed on 80% of the days. RESULTS: We identified 833 eligible African-American and 4436 eligible white veterans. In univariable analysis, African Americans were less likely to be adherent to medications than whites for ACEIs (81.4% versus 87.6%, P = 0.004), CCBs (75.3% versus 81.7%, P = 0.003), and statins (59.9% versus 74.1%, P < 0.001) but not BBs (84.8% versus 83.5%, P = 0.6). In multivariable analysis, racial differences in adherence to medications were found primarily among veterans younger than 55 years old. CONCLUSIONS: Younger African Americans were less adherent to medications than whites in a setting where financial barriers are minimized. Although the reason for this finding is unclear, it may contribute to high cardiovascular morbidity among African Americans.     

Predicting adherence to eye patching in children with amblyopia: An application of protection motivation theory

Objectives: This study reports an application of protection motivation theory (PMT) to the prediction of parental adherence to eye patching recommendations for children with amblyopia over a 2‐month period. The study also considered the role of past behaviour in PMT. Design and methods: A total of 151 parents of children with amblyopia who were attending follow‐up appointments for orthoptic treatment participated. They completed questionnaires based on PMT to assess their beliefs about amblyopia and eye patching. Of the parents, 105 were contacted again at 2‐month follow‐up to obtain a measure of adherence to the recommended treatment for their child. Results: PMT was found to be predictive of adherence intentions and behaviour at 2‐month follow‐up. Regression analyses revealed perceived vulnerability, response efficacy and self‐efficacy to be significant predictors of protection motivation, whereas perceived vulnerability and response costs were significant predictors of adherence behaviour. Past adherence behaviour was found to have a direct effect on future adherence behaviour over and above the influence of PMT. Conclusions: The results are discussed in relation to the sufficiency of PMTas a model of adherence behaviour. The practical implications for attempts to increase adherence to eye patching among children with amblyopia are outlined.     

Exploring the impact of depressive symptoms and medication beliefs on medication adherence in hypertension--a primary care study

Objective

This study aimed to assess the levels of adherence in a sample of hypertensive patients being cared for in primary care in Northern Ireland and to explore the impact of depressive symptoms and medication beliefs on medication adherence.

Methods

The study was conducted in 97 community pharmacies across Northern Ireland. A questionnaire containing measures of medication adherence, depressive symptoms and beliefs about medicines was completed by 327 patients receiving antihypertensive medications.

Results

Analysis found that 9.3% of participants were non-adherent with their antihypertensive medication (self-report adherence scale) and 37.9% had scores indicative of depressive symptoms as determined by the Center for Epidemiological Studies Depression Scale (CES-D). In the univariate analysis, concerns about medications had negative effects on both adherence and depressive symptomatology. However, logistic regression analysis revealed that patients over the age of 50 were more likely to be adherent with their medication than those younger than 50. Depressive symptomatology and medication beliefs (concerns) were not significantly related to adherence in the regression analysis.

Conclusion

Depressive symptomatology was high in the sample as measured by the CES-D. Age was the only significant predictor of medication adherence in this population.

Practice implications

Health care professionals should consider the beliefs of the patient about their hypertensive medications and counsel younger patients on adherence.     

Patterns of adherence with antiretroviral medications: an examination of between-medication differences.

OBJECTIVE: To determine whether adherence with one antiretroviral medication reliably predicts adherence with other antiretroviral medications. DESIGN: Cross-sectional repeated-measurement analysis. SETTING: Cohort study enrolling patients from Massachusetts and Rhode Island. PATIENTS: Total of 454 patients using antiretroviral medications for HIV infection. METHODS: For each antiretroviral medication, we asked patients to report how many days in the last week they had 1) missed a dose of the medication and 2) been off schedule with a dose of the medication. The reliability coefficient was used to compare between-person variance in adherence rates with total variance, which is the sum of between-person and within-person variance. RESULTS: The mean age of patients was 42 years; 28% were women and 37% were nonwhite. Sixty-six percent of patients were on three or more antiretroviral medications. Perfect adherence was reported by 42% of patients, and patients reported missing a dose on a mean of 1.5 days per week for each antiretroviral medication currently being taken. The reliability coefficient for days in the last week that the medication was missed was 0.85 (95% confidence interval [CI]: 0.83-0.87), and for days off-schedule in the last week, it was 0.88 (CI: 0.86-0.89). CONCLUSIONS: Most of the variability in antiretroviral adherence in this study was accounted for by between-patient differences in overall adherence rather than by within-patient differences in adherence patterns across medications. These data support the theory that when patients skip or are off schedule with doses, they skip or are off schedule with all the antiretroviral medications taken at that time. In the course of exploring patients' adherence issues, clinicians may find it useful to inquire about problematic dosing times. Researchers assessing adherence may not need to separately monitor adherence with each antiretroviral medication in a regimen.     

Depressive symptoms moderate the relationship between medication regimen complexity and objectively measured medication adherence in adults with heart failure

Patients with heart failure (HF) take many medications to manage their HF and comorbidities, and 20–50% experience depression. Depressed individuals with more complex medication regimens may be at greater risk for poor adherence. The aim of this study was to assess depressive symptoms as a moderator of the relationship between medication regimen complexity and medication adherence in an observational study of patients with HF. In hierarchical linear regression with the final sample of 299, the interaction of medication regimen complexity and depressive symptoms predicted medication adherence, p < .05. For individuals with higher levels of depressive symptoms [1 standard deviation (SD) above the mean], more regimen complexity was associated with lower adherence. For individuals with low (1 SD below the mean) or average levels of depressive symptoms, regimen complexity was unrelated to medication adherence. Care management strategies, including pillboxes and caregiver involvement, may be valuable in HF patients with depression.     

Motivational interviewing for improving adherence to antiretroviral medications

Many interventions have been developed to address barriers to antiretroviral medication adherence, but few have focused on motivation, a fundamental component of behavior change. Research on other health behavior changes and a few pilot studies investigating motivational interviewing (MI) for adherence to antiretroviral medication suggests that MI may be highly beneficial by helping to motivate patients with HIV to adhere to their medications. Existing research, although limited, suggests that MI combined with other interventions is feasible and efficacious for improving adherence to antiretroviral medications. With continued development and refinement of antiretroviral adherence interventions that incorporate MI, more persons with HIV infection can be expected to choose to make the difficult changes necessary for them to benefit from antiretroviral therapy.     

Health beliefs and medication adherence in patients with hypertension: A systematic review of quantitative studies

ObjectiveThis review synthesizes findings of quantitative studies examining the relationship between health beliefs and medication adherence in hypertension.MethodsThis review included published studies in PubMed, CINHAL, EMBASE, and PsycINFO databases. Studies were included if they examined beliefs of patients with hypertension. Quality of the studies was evaluated using the Quality Assessment Tool for Systematic Review of Observational Studies.ResultsOf the 1558 articles searched, 30 articles were included in the analysis. Most beliefs examined by studies of this review in relation to medication adherence were beliefs related to hypertension severity and susceptibility to its consequences, medication effectiveness or necessity, and barriers to medication adherence. Higher medication adherence was significantly related to fewer perceived barriers to adherence (e.g, side-effects) was fairly consistent across studies. Higher self-efficacy was related to higher medication adherence. Patients' beliefs and their relationship to medication adherence appear to vary unpredictably across and within countries.ConclusionClinicians should assess beliefs for individual patients. When individual beliefs appear likely to undermine adherence, it may be useful to undertake educational interventions to try to modify them.Practical implicationsClinicians should explore individual patients' beliefs about hypertension and blood pressure medications, discuss their implications for medication adherence, and try to modify counterproductive beliefs.     

Cultural issues in the treatment of young African American children diagnosed with disruptive behavior disorders

OBJECTIVE: To discuss issues relevant to treating young African American children with disruptive behavior disorders. METHOD: We treat behavior disorders, correlates of behavior disorders, and special differences between African American and Caucasian children that could lead to or explain behavior problems. DISCUSSION: The majority of the information on young children diagnosed with disruptive behavior disorders has been obtained primarily from Caucasian children and families. Unfortunately, this reliance on Caucasian data neglects the unique needs of minorities and may lessen the quality of the services that they receive. Omission of ethnic concerns becomes even more salient with the increasing ethnic diversity among children and families in the United States. CONCLUSIONS: We suggest future research and clinical directions that will ultimately assist clinicians to provide high-quality mental health services to African American children.     

Primary care clinicians’ use of deprescribing recommendations: A mixed-methods study

Objectiveto explore the effects of a deprescribing intervention on primary care clinicians’ medication-related communication.MethodsA clinical decision support tool provided clinicians in the intervention group with an individualized report regarding potentially inappropriate medications (PIMs), deintensification of diabetes and/or hypertension treatment, and poor adherence/cognition. Participants included 113 Veterans aged ≥ 65 prescribed ≥ 7 medications and their primary care clinicians. Encounters were recorded and analyzed.ResultsBetween 36% and 38% of intervention clinicians discussed PIMs and diabetes mellitus/hypertension deintensification and 94% discussed adherence. PIMs discussions referred to the report and prompted some medication changes. The diabetes mellitus/hypertension and adherence discussions were not prompted by the report but instead arose from enhanced medication reconciliation. Changes in diabetes mellitus/hypertension medications were not made out of overtreatment concerns. There was no deprescribing for nonadherence. Enhanced medication reconciliation also led to discussions about medications not in the report.ConclusionAn individualized report regarding medication appropriateness prompted clinicians to perform a more thorough medication reconciliation and discuss PIMs. It did not prompt chronic care deintensification or deprescribing to enhance adherence.Practice ImplicationsFeedback reports can promote robust medication reconciliation in primary care. Changing clinician practice to achieve deprescribing in chronic disease management will be more challenging.     

The reliability of reports of medical adherence from children with HIV and their adult caregivers

OBJECTIVE: To compare children's reports of their medication adherence to those of their adult caregivers. METHOD: Several indicators of medication adherence were assessed for 48 adult-child dyads. Kappa statistics were calculated as measures of agreement. RESULTS: Adherence problems were common, although the level of agreement between the child and the adult was quite low (kappas for adherence variables ranged from .05 to .32). Compared to adult-child dyads that agreed, dyads that disagreed tended to include older children who had more responsibility for managing their own medications. CONCLUSIONS: Both researchers and clinicians would benefit from acquiring information on children's adherence from multiple sources.