Beliefs about antidepressant medication and associated adherence among older Chinese patients with major depression: A cross‐sectional survey

Antidepressant non‐adherence among people with depressive disorder is a major, ongoing public health issue, yet few studies have focused on older adults and their medication adherence. Although treatment adherence is determined by multiple factors, one of the important and modifiable predictors are patients’ attitudes and beliefs about medication. We explored a sample of 135 older Chinese people with major depression, and the relationship between beliefs about antidepressants and medication adherence. Sociodemographic and illness variables were also examined. In all, high antidepressant adherence was reported in 37.8%, moderate adherence in 39.2%, and low adherence in 23%. Ordinal regression analysis showed perceived necessity (P < 0.01) and concern (P < 0.01) about antidepressants were significant influencing factors. Other variables with a positive association with higher adherence were lower average income (P < 0.05), fewer number of prior episodes of depression (P < 0.01), and comorbid anxiety (P < 0.05). The present study highlights low adherence in a sample of older depressed Chinese people, and highlights how beliefs about medication affect adherence. Therefore, more attention should be focused on non‐adherence in older patients, and there is a need to establish accessible and systematic education programmes to correct misconceptions to improve their adherence.     

Homoeopathy in primary care: self-reported change in health status

OBJECTIVES: In recent years numerous clinical trials have been carried out to evaluate homoeopathic therapy. Another approach to evaluating homoeopathy is to investigate its impact in primary health care, that is on outpatients to a homoeopathic centre. METHODS: 609 patients on their first visit to a homoeopathic clinic from June 1995 to May 1997 received a telephone call 1 year later in which they were asked to rate their general health compared with 1 year ago. RESULTS: 1 year after first examination 73.5% of patients reported a marked or moderate improvement in their health status. Marked improvement was significantly higher in subjects who stated they were satisfied with the care received, in females, in the 0-15-year-old age group and in patients who completed therapy. CONCLUSIONS: For conditions which are not life-threatening, homoeopathy seems to meet patients' needs in primary health care.     

Determinants of adherence to recommendations for depressed elderly patients in primary care: A multi-methods study

Objective. It is logical that tailoring implementation strategies to address identified determinants of adherence to clinical practice guidelines should improve adherence. This study aimed to identify and prioritize determinants of adherence to six recommendations for elderly patients with depression. Design and setting. Group and individual interviews and a survey were conducted in Norway. Method. Individual and group interviews with healthcare professionals and patients, and a mailed survey of healthcare professionals. A generic checklist of determinants of practice was used to categorize suggested determinants. Participants. Physicians and nurses from primary and specialist care, psychologists, researchers, and patients. Main outcome measures. Determinants of adherence to recommendations for depressed elderly patients in primary care. Results. A total of 352 determinants were identified, of which 99 were prioritized. The most frequently identified factors had to do with dissemination of guidelines, general practitioners’ time constraints, the low prioritization of elderly patients with depression, and the patients’ or relatives’ wish for medication. Approximately three-quarters of the determinants were from three of the seven domains in the generic checklist: individual healthcare professional factors, patient factors, and incentives and resources. The survey did not provide useful information due to a low response rate and a lack of responses to open-ended questions. Implications. The list of prioritized determinants can inform the design of interventions to implement recommendations for elderly patients with depression. The importance of the determinants that were identified may vary across communities, practices. and patients. Interventions that address important determinants are necessary to improve practice.Key Words: Depression, determinants of practice, elderly patients, general practice, Norway, primary care, tailored implementation

• Multiple factors might impede or facilitate general practitioners’ (GPs’) adherence to guidelines for the care of depressed elderly patients. Interviews and a survey were conducted to identify and prioritize such determinants of adherence.
• Factors related to dissemination of guidelines, GPs’ time constraints, and the lack of priority given to elderly patients with depression were the most frequently suggested barriers to adherence.
• Other determinants were individual healthcare professional factors (e.g. their knowledge and skills), patient factors (e.g. their beliefs and preferences), incentives, and the availability of necessary resources.

     

Determinants of adherence to recommendations for depressed elderly patients in primary care: A multi-methods study

Abstract

Objective. It is logical that tailoring implementation strategies to address identified determinants of adherence to clinical practice guidelines should improve adherence. This study aimed to identify and prioritize determinants of adherence to six recommendations for elderly patients with depression. Design and setting. Group and individual interviews and a survey were conducted in Norway. Method. Individual and group interviews with healthcare professionals and patients, and a mailed survey of healthcare professionals. A generic checklist of determinants of practice was used to categorize suggested determinants. Participants. Physicians and nurses from primary and specialist care, psychologists, researchers, and patients. Main outcome measures. Determinants of adherence to recommendations for depressed elderly patients in primary care. Results. A total of 352 determinants were identified, of which 99 were prioritized. The most frequently identified factors had to do with dissemination of guidelines, general practitioners’ time constraints, the low prioritization of elderly patients with depression, and the patients’ or relatives’ wish for medication. Approximately three-quarters of the determinants were from three of the seven domains in the generic checklist: individual healthcare professional factors, patient factors, and incentives and resources. The survey did not provide useful information due to a low response rate and a lack of responses to open-ended questions. Implications. The list of prioritized determinants can inform the design of interventions to implement recommendations for elderly patients with depression. The importance of the determinants that were identified may vary across communities, practices. and patients. Interventions that address important determinants are necessary to improve practice.     

Concordance with antidepressant medication in primary care

AIM: To identify how depression is managed in primary care settings and examine patients' perspectives on their care and the impact medication had on their recovery. This article specifically addresses patients' accounts of the influences on medication concordance. METHOD: A total of 60 patients from four primary care centres who had a recent episode of depression were interviewed using a semi-structured questionnaire and a framework analysis to identify recurring themes. Participants had largely recovered from their illness. FINDINGS: Many factors influenced patients' decisions to take and continue prescribed antidepressants and four broad themes were identified. These were: the role and relationship with health practitioners; factors related to the illness; beliefs about and experiences of medication for depression; and the wider context of depression. CONCLUSION: Concordance with antidepressants is multifactorial and may change over time in the same patient. Influences on concordance may be positive or negative and the combined effects are highly individual and dependent on circumstances. Nurses involved in medication management should encourage discussion of the likely impact of, and patients' attitudes toward, medication.     

Factors that influence adherence to HIV medications: perceptions of women and health care providers.

The purpose of this pilot study was to explore factors that influence adherence to antiretroviral therapy (ART) in women with human immunodeficiency virus (HIV) disease. Antiretroviral medications that reduce viral count and prolong the time between a diagnosis of HIV disease and acquired immunodeficiency syndrome (AIDS) are expensive, numerous, and have multiple side effects. Common reasons for not adhering to the medication regimen include ART side effects and a dosage schedule that disrupts daily activities. Failure to take or errors in taking ART can result in an exacerbation of symptoms and disease progression or the development of drug-resistant strains of HIV. Women and providers in separate focus groups identified factors that facilitated and hindered adherence to ART. Knowledge of factors that influence adherence to ART will facilitate the development of interventions. Patient-provider relationships and side effects of weight gain are discussed as factors that influence adherence to ART.     

Risk classification of adult primary care patients by self-reported quality of life

BACKGROUND:: Although patient-reported health-related quality of life (HRQOL) is known to predict health services utilization, most risk assessment systems use provider-reported diagnoses as predictors rather than HRQOL. OBJECTIVE:: We sought to classify adult primary care patients prospectively by utilization risk based on age, gender, and HRQOL at a single clinic visit. RESEARCH DESIGN:: Patients completed the Duke Health Profile. Providers completed the Duke Severity of Illness Checklist. Diagnoses were grouped with the Ambulatory Care Groups system. Predictive coefficients for 1-year primary care charges calculated from the age, gender, and HRQOL of 728 reference patients were used to classify 474 test patients into 4 risk classes. Comparisons were made with models that used diagnoses or severity of illness as predictors. RESULTS:: The positive likelihood ratio for predicting highest risk was 2.2 for the HRQOL model, compared with 1.8 for the diagnoses model, 1.6 for the severity model, and 1.5 for age and gender alone. One-year actual primary care visits and charges increased step-wise from lowest to highest risk class. Highest risk patients were older and more likely to be women, black, or Medicaid recipients. Although the highest-risk patients represented only 18.6% of the test group, they accounted for 26.7% of the primary care clinic visits, 31.6% of the clinic charges, 34.6% of the hospital days, 35.1% of hospital charges, and 30.8% of total charges at all healthcare sites. CONCLUSION:: The HRQOL risk classification system can identify primary care patients at risk for high future health services utilization.     

Family practice patients' adherence to statin medications

OBJECTIVE

To measure family practice patients’ adherence to statin medications and to identify factors associated with adherence to these medications.

DESIGN

Cross-sectional study using a mailed self-report survey sent to 400 patients.

SETTING

Two academic family practice clinics in Halifax, NS.

PARTICIPANTS

A total of 284 patients aged 40 or older who were prescribed statin medications by their family physicians, either for the first time or as a renewal during a 20-month period.

MAIN OUTCOME MEASURES

Level of adherence to statin medications as measured by patients’ self-report on the Morisky scale; association between high adherence on the Morisky scale and 38 patient-reported factors.

RESULTS

Response rate was 82.5%. Average age of patients was 65 years, 57% were men, 62% had been on statin medications for more than 2 years, and 97% reported that their family physicians managed their cholesterol levels. More than 63% of patients reported high adherence as measured by the Morisky scale. On multiple logistic regression, being older than 65, taking 4 to 6 other prescribed medications, and having a lifestyle that included regular exercise or a healthy diet were significant independent predictors of high adherence scores on the Morisky scale.

CONCLUSION

Almost two-thirds (63%) of patients who were prescribed statins by their family physicians reported high adherence to the medications. Strategies to improve adherence would best be directed at patients who are younger or taking fewer than 4 or more than 6 other prescribed medications. Patients should be encouraged to maintain a lifestyle of regular exercise and a healthy diet, as this was associated with better adherence to statin medications.     

Electronic pillboxes (MEMS) to assess the relationship between medication adherence and blood pressure control in primary care

OBJECTIVE: To investigate the relationship between blood pressure and medication adherence using electronic pillboxes (MEMS). SETTING: Five general practices in Bristol, UK. SUBJECTS: A total of 239 individuals with a clinical diagnosis of hypertension and being prescribed at least one blood pressure-lowering medication. Participants were asked to use the electronic pillbox as their drug bottle for at least one month. MAIN OUTCOME MEASURES: "Timing adherence" (correct inter-dose intervals) as measured through MEMS and systolic (SBP) and diastolic (DBP) office blood pressure. RESULTS: Mean (+/-SD) timing adherence was 88% (+/-17),>80% in 175 (73%), and less than 50% in 11 (5%) participants. Adherence was monitored for a mean of 33 (+/-6) days. Mean (+/-SD) SBP was 147.9+/-19.1 mmHg and DBP 82.3+/-10.1 mmHg. There was no evidence to suggest that timing adherence was associated with SBP or DBP (overall correlation coefficients -0.01 and -0.02 respectively). According to current guidelines, about one in four of all participants had controlled SBP (only 6% of diabetic patients). DBP was under control in 66% of the individuals. CONCLUSIONS: No relationship between adherence and blood pressure in patients with hypertension recruited from primary care was found. Average timing adherence measured by electronic monitors was high (88%) and blood pressure was controlled in a minority of patients. Our findings suggest that in terms of poor blood pressure control pharmacological non-response to or insufficient intensity of blood pressure-lowering medication might be more important than poor adherence to antihypertensive drug therapy.