Conceptualisations of masculinity and self-reported medication adherence among HIV-positive Latino men in Los Angeles,California, USA

HIV-positive Latino men have been found to have poorer medication adherence compared to Whites. This study sought to identify how cultural conceptualisations of masculinity are associated with self-reported medication adherence among Latino men. A total of 208 HIV-positive men reported the number of doses of antiretroviral medication missed in the previous seven days (dichotomised at 100% adherence versus less). Conceptualisations of masculinity consisted of traditional machismo (e.g., power and aggressive attitudes, which are normally associated with negative stereotypes of machismo) and caballerismo (e.g., fairness, respect for elders and the importance of family). Multivariate logistic regression was used to identify factors associated with adherence. The mean adherence was 97% (SD = 6.5%; range = 57–100%). In all, 77% of the participants reported 100% adherence in the previous seven days. Caballerismo was associated with a greater likelihood (OR = 1.77; 95% CI: 1.08–2.92; p = 0.03) and machismo with a lower likelihood (OR = 0.60; 95% CI: 0.38–0.95; p = 0.03) of medication adherence. In addition, higher medication side-effects were found to be associated with a lower likelihood (OR = 0.59; 95% CI: 0.43–0.81; p = 0.001) of medication adherence. These findings reinforce the importance of identifying cultural factors that may affect medication adherence among HIV-positive Latino men resident in the USA.     

上海市卢湾区居民安全用药知识与行为调查

目的了解上海市卢湾区居民安全用药知识与行为的现状,为下一步开展干预提供参考。方法采用横断面研究设计,通过方便抽样,在卢湾区72个居委中各抽取8人作为调查对象。采用自制的"卢湾区居民安全用药知识与行为调查问卷"进行面对面调查,调查内容包括人口学特征、安全用药知识及药物使用行为等。结果调查对象对儿童药物用量、生病了应尽量打针、吃过保健品可以减少药物的用量、抗生素的合理用法、"OTC"的含义等问题的回答正确率分别为42.2%、64.1%、75.2%、68.2%和38.1%;女性回答的正确率高于男性;文化程度较高的调查对象回答情况较好;医生的建议或推荐仍然是调查对象选择药物的主要途径;药店和医院是调查对象购买药物的主要场所,年龄较大的调查对象更容易接受医生的建议及在医院购买药物;89.6%的调查对象家中备有一些常用药物;59.6%的调查对象会遵从医嘱服用药物;44.7%的调查对象会将过期药物随意丢弃。结论卢湾区居民安全用药知识匮乏,安全意识淡漠,还存在一些不良用药行为,应加大安全用药知识的宣传,减少药物不良反应情况的发生。     

Education to Reduce Potentially Harmful Medication Use Among Residents of Assisted Living Facilities: A Randomized Controlled Trial

ObjectivesThe objectives of this study were (1) to investigate the effect of nurse training on the use of potentially harmful medications; and (2) to explore the effect of nurse training on residents' health-related quality of life (HRQoL), health service utilization, and mortality.DesignA randomized controlled trial.Setting and participantsIn total, 227 residents in 20 wards of assisted living facilities in Helsinki were recruited. The 20 wards were randomized into those in which (1) staff received two 4-hour training sessions on appropriate medication treatment (intervention group), and (2) staff received no additional training and continued to provide routine care (control group).InterventionTwo 4-hour interactive training sessions for nursing staff based on constructive learning theory to recognize potentially harmful medications and corresponding adverse drug events.MeasurementsUse of potentially harmful medications, HRQoL assessed using the 15 dimensional instrument of health-related quality of life, health service utilization, and mortality assessed at baseline, and 6 and 12 months.ResultsDuring the 12-month follow-up, the mean number of potentially harmful medications decreased in the intervention wards [−0.43, 95% confidence interval (CI) −0.71 to −0.15] but remained constant in the control wards (+0.11, 95% CI −0.09 to +0.31) (P = .004, adjusted for age, sex, and comorbidities). HRQoL declined more slowly in the intervention wards (−0.038 (95% CI −0.054 to −0.022) than in the control wards (−0.072 (95% CI −0.089 to −0.055) (P = .005, adjusted for age, sex, and comorbidities). Residents of the intervention wards had significantly less hospital days (1.4 days/person/year, 95% CI 1.2–1.6) than in the control wards (2.3 days/person/year; 95% CI 2.1–2.7) (relative risk 0.60, 95% CI 0.49–0.75, P < .001, adjusted for age, sex, and comorbidities).ConclusionsActivating learning methods directed at nurses in charge of comprehensive care can reduce the use of harmful medications, maintain HRQoL, and reduce hospitalization in residents of assisted living facilities.     

Effects of the Medicare Part D Comprehensive Medication Review on Racial and Ethnic Disparities in Medication Adherence

BackgroundSubstantial research has documented inequalities between US minorities and whites in meeting the eligibility criteria for the Medicare Part D medication therapy management (MTM) program. Even though the Centers for Medicare & Medicaid Services attempted to relax the eligibility criteria, a critical barrier to effective MTM reform is a lack of stronger evidence about the effects of MTM on minorities'' health outcomes.ObjectiveTo examine the effects of comprehensive medication review (CMR), an MTM core component, on racial and ethnic disparities in adherence to diabetes, hypertension, and hyperlipidemia medications among Medicare beneficiaries aged ≥65 years.MethodsThis study used full-year 2017 Medicare Parts A, B, and D claims data, including MTM data, linked to the Area Health Resources Files. Racial and ethnic disparities in nonadherence to diabetes, hypertension, and hyperlipidemia medications were compared between CMR recipients and nonrecipients matched by their propensity scores. To determine the changes in racial and ethnic disparities after receiving CMR, a difference-in-differences framework was applied, by including in logistic regression analyses interaction terms between dummy variables for CMR receipt and each racial or ethnic minority group.ResultsCompared with CMR nonrecipients, CMR recipients had significantly lower racial and ethnic disparities across the 3 outcome measures, with the exception of the difference between whites and blacks in nonadherence to diabetes medications. For example, compared with CMR nonrecipients, among CMR recipients the differences in the odds of nonadherence to hypertension medications were reduced, respectively, by 8% (95% confidence interval [CI], 0.88–0.96) between whites and blacks; by 18% (95% CI, 0.78–0.86) between whites and Hispanics; by 16% (95% CI, 0.77–0.91) between whites and Asians; and by 9% (95% CI, 0.85–0.98) between whites and other racial and ethnic groups.ConclusionReceiving a CMR reduced the racial and ethnic disparities in adherence to diabetes, hypertension, and hyperlipidemia medications among Medicare beneficiaries aged ≥65 years. These findings provide critical empirical evidence that may inform the future design of the Medicare Part D MTM program, which is valuable for improving pharmacotherapy outcomes and could further realize its potential when additional people from racial and ethnic minorities are enrolled.     

以静脉药物配置中心为平台的静脉用药医嘱干预

目的 以静脉药物配置中心为平台,对用药医嘱进行分析和干预,提高用药医嘱的合理性,促进临床合理用药.方法 对静脉药物配置中心服务的6个病区用药医嘱中的不合理医嘱进行统计分析.结果 不合理医嘱明显减少,用药医嘱合理性大幅度提高差异有显著性（P＜0.01）.结论 通过对用药医嘱干预,能促进临床合理用药,保证患者用药安全.     

Health Literacy and Medication Adherence in Underserved African-American Breast Cancer Survivors: A Qualitative Study

The increased survival rate of breast cancer has brought attention to women who are beyond the diagnosis and treatment phases of breast cancer. Although research has been conducted to address specific medical and psychosocial needs of breast cancer survivors, there has been little attention placed on health literacy and medication adherence among this population. The purpose of this article is to present the findings of a qualitative study conducted with two focus groups of underserved African-American breast cancer survivors. Four themes emerged from the transcribed interviews: inequality of access to health information, acquisition of medication information, medication usage and adherence, and barriers to access to medications.     

Costs of Medication Nonadherence in Patients with Diabetes Mellitus: A Systematic Review and Critical Analysis of the Literature

Objectives:  Information on the health care costs associated with nonadherence to treatments for diabetes is both limited and inconsistent. We reviewed and critically appraised the literature to identify the main methodological issues that might explain differences among reports in the relationship of nonadherence and costs in patients with diabetes.
Methods:  Two investigators reviewed Medline, EMBASE, Cochrane library and CINAHL and studies with information on costs by level of adherence in patients with diabetes published between January 1, 1997 and September 30th 2007 were included.
Results:  A total of 209 studies were identified and ten fulfilled the inclusion criteria. All included studies analyzed claims data and 70% were based on non-Medicaid and non-Medicare databases. Low medication possession ratios were associated with higher costs. Important differences were found in the ICD-9/ICD-9 CM codes used to identify patients and their diagnoses, data sources, analytic window period, definitions of adherence measures, skewness in cost data and associated statistical issues, adjustment of costs for inflation, adjustment for confounders, clinical outcomes and costs.
Conclusions:  Important variation among cost estimates was evident, even within studies of the same population. Readers should be cautious when comparing estimated coefficients from various studies because methodological issues might explain differences in the results of costs of nonadherence in diabetes. This is particularly important when estimates are used as inputs to pharmacoeconomic models.     

Impact of Interventions on Medication Adherence and Blood Pressure Control in Patients with Essential Hypertension: A Systematic Review by the ISPOR Medication Adherence and Persistence Special Interest Group

ObjectivesTo systematically review the evidence on the impact of interventions to improve medication adherence in adults prescribed antihypertensive medications.MethodsAn electronic search was undertaken of articles published between 1979 and 2009, without language restriction, that focused on interventions to improve antihypertensive medication adherence among patients (≥18 years) with essential hypertension. Studies must have measured adherence as an outcome of the intervention. We followed standard guidelines for the conduct and reporting of the review and conducted a narrative synthesis of reported data.ResultsNinety-seven articles were identified for inclusion; 35 (35 of 97, 36.1%) examined interventions to directly improve medication adherence, and the majority (58 of 97, 59.8%) were randomized controlled trials. Thirty-four (34 of 97, 35.1%) studies reported a statistically significant improvement in medication adherence.Discussion/ConclusionsInterventions aimed at improving patients’ knowledge of medications possess the greatest potential clinical value in improving adherence with antihypertensive therapy. However, we identified several limitations of these studies, and advise future researchers to focus on using validated adherence measures, well-designed randomized controlled trials with relevant adherence and clinical outcomes, and guidelines on the appropriate design and analysis of adherence research.     

Discontinuation of Antihypertensive Medication,Cognitive Complaints,and Incident Dementia

ObjectivesTo evaluate whether discontinuation of antihypertensive medication in community-dwelling older people is associated with a reduction in memory complaints and/or incident dementia.DesignProspective observational cohort study within the Prevention of Dementia by Intensive Vascular Care (preDIVA) trial.Setting and ParticipantsCommunity-dwelling participants (aged 70-78 years at baseline) who underwent 2-yearly assessments during 6-8 years of follow-up.MeasuresCox regression analyses of the relation between discontinuation of antihypertensive medication during the study and change in subjective memory complaints, incident dementia, and mortality.ResultsDementia occurred more often in participants discontinuing antihypertensive treatment (13.4% vs 6.2%, P = .02); mortality was similar (16.5% vs 13.9%, P = .52). Discontinuation of antihypertensive medication was associated with a double dementia hazard [hazard ratio (HR) (95% confidence interval) = 2.15 (1.15-4.03)], which somewhat attenuated after adjustment for sex, blood pressure, number of antihypertensives and other medications [HR = 1.92 (1.01-3.65)], and additionally for stroke, cardiovascular disease, diabetes, smoking, memory complaints, and MMSE score [HR = 1.79 (0.93-3.44)]. Antihypertensive discontinuation was associated with an approximately 50% higher hazard of dementia and/or mortality combined [HR = 1.58 (1.04-2.40); model 2: HR = 1.64 (1.07-2.51); model 3: HR = 1.49 (0.96-2.30)]. Antihypertensive discontinuation was not associated with change in memory complaints [odds ratio (95% confidence interval) = 0.96 (0.55-1.67)]. Subgroup and sensitivity analyses addressing possible sources of bias and confounding gave similar results.Conclusions/ImplicationsOur results suggest that antihypertensive withdrawal in community-dwelling older people does not preserve cognition and may in fact increase dementia risk. This is not due to reduced mortality as competing risk. Additional analyses suggest results are unlikely to be explainable by confounding, reverse causality, or observational biases. Studies with person-specific reasons for antihypertensive discontinuation may be able to exclude reverse causality completely. Given the beneficial effects of antihypertensive medication on cardiovascular risk, observational data may be the best currently obtainable on the pressing issue of when withdrawal of antihypertensives in older people is acceptable and what consequences need to be weighed.     

武汉市社区高血压患者药物依从性及其影响因素分析

目的 了解湖北省武汉市社区高血压患者药物依从性及其影响因素,为有效改善高血压药物控制策略效果提供参考依据。方法 于2014年8月采用整群随机抽样方法在武汉市35家公有制社区卫生服务中心和35家乡镇卫生院中抽取4 106例高血压患者进行问卷调查。结果 武汉市4 106例高血压患者中,有2 007例患者具有药物依从性,药物依从率为48.9%;多因素非条件logistic回归分析结果显示,参保类型为城镇居民医疗保险、新型农村合作医疗保险和其他医疗保险、单纯性收缩期高血压、高血压相关疾病对家庭经济造成负担比较重和非常重是武汉市社区高血压患者药物依从性的危险因素,女性、年龄≥61岁、文化程度小学及以上、高血压Ⅲ期是武汉市社区高血压患者药物依从性的保护因素。结论 武汉市社区高血压患者药物依从性较差,性别、年龄、文化程度、职业、家庭平均月收入、参保类型、高血压类型、高血压相关疾病对家庭经济造成负担是高血压患者药物依从性的影响因素。     

PDCA循环在住院病人口服用药安全管理中的应用

目的观察PDCA循环的质量管理方法在住院病人口服用药安全管理中的应用效果。方法运用PDCA循环管理方法进行现状调查,分析存在的问题,找出原因,制定对策并实施干预。将33875位口服用药的住院患者分为干预前组和干预后组,将前后两组口服用药发生不安全的情况进行对比。结果干预后组口服用药发生不安全的例数及发生率明显低于干预前组,有显著性差异（χ2=34.188,P〈0.05）。结论 PDCA循环的质量管理方法有效降低了住院病人口服用药不安全发生率,保证了护理安全,提升了护理质量。     

Methods for Measuring Multiple Medication Adherence: A Systematic Review–Report of the ISPOR Medication Adherence and Persistence Special Interest Group

Background

A broad literature base exists for measuring medication adherence to monotherapeutic regimens, but publications are less extensive for measuring adherence to multiple medications.

抗菌药物用药管理在患者临床合理用药中的作用

目的 分析抗菌药物用药管理在患者临床合理用药中的作用.方法 2018年5月-2020年5月该院收治200例患者为观察对象,随机分组,对照组常规实施抗菌药物治疗(100例),观察组于抗菌药物管理基础上实施治疗(100例),分析其作用.结果 观察组用药种类不合理比率0.00％、用药剂量不合理比率0.00％、用药时机不合理比...     

Narratives of Ugandan Women Adhering to HIV/AIDS Medication

Adherence to highly active antiretroviral therapy (HAART) is essential to improving the quality of life of people living with HIV/AIDS; however, it still remains a challenge especially for young African women. The purpose of the study was to explore how young women with HIV/AIDS in Uganda experience the influence of their everyday life occupations on adherence to HAART after more than 1 year on the medication. Narratives of six participants were elicited using two semistructured interviews within a period of 1 month. Narrative analysis was used to develop themes reflecting the participants' stories of coping with everyday activities. The participants described their adherence to HAART in relation to everyday life occupations as a “tug of war”, which describes the struggles they had taking medication because they were afraid of being discriminated by peers and the general society. They also expressed fear of not being included in many activities if people knew they have HIV/AIDS because there are many beliefs associated with the illness especially for young women in which they are branded promiscuous. However, in the Ugandan culture, women are considered to be home makers, which restricted their activities mostly around domestic work making it hard for them to prioritize their medication, and when they young women prioritized, it was all about fun activities that seemed to consume much time, hence contributing to the poor adherence. It is therefore important to assess the everyday occupations of young women before they start taking medication, so that HAART is scheduled in accordance with their everyday life occupation to reduce poor adherence. The implications of the study on practice is that it will enable occupational therapists working with persons with HIV/AIDS develop age‐specific activities taking into consideration HAART as an everyday life activity rather than one that needs to be incorporated into their already existing activities, hence improving their adherence and reducing on stigma associated to the medication. Copyright © 2012 John Wiley & Sons, Ltd.