Low levels of adherence with proton pump inhibitor therapy contribute to therapeutic failure in gastroesophageal reflux disease

To assess adherence to proton pump inhibitor (PPI) treatment and associated variables in patients with gastroesophageal reflux disease (GERD). Cross‐sectional and prospective comprising 240 consecutive adult patients, diagnosed with GERD for whom continuous use of standard or double dose of omeprazole had been prescribed. Patients were ranked as ne‐GERD (162: 67.5%) or e‐GERD classified according to the Los Angeles classification as A (48:20.0%), B (21:8.6%), C (1:0.5%), D (1:0.5%), and Barrett's esophagus (7:2.9%). The Morisky questionnaire was applied to assess adherence to therapy and a GERD questionnaire to assess symptoms and their impact. Adherence was correlated with demographics, cotherapies, comorbidities, treatment duration, symptoms scores, endoscopic findings, and patient awareness of their disease. 126 patients (52.5%) exhibited high level of adherence and 114 (47.5%) low level. Youngers (P= 0.002) or married (O.R. 2.41, P= 0.03 vs. widowers) patients had lower levels of adherence; symptomatic patients exhibited lower adherence (P= 0.02). All other variables studied had no influence on adherence. Patients with GERD attending a tertiary referral hospital in São Paulo exhibited a high rate of low adherence to the prescribed PPI therapy that may play a role in the therapy failure. Age <60 years, marital status and being symptomatic were risk factors for low adherence.     

Current apparent treatment‐resistant hypertension in patients undergoing peritoneal dialysis: A multi‐center cross‐sectional study

Apparent treatment‐resistant hypertension (aTRH) is the most commonly used term to report resistant hypertension (RH) and is considered as a common problem in dialysis population. However, few reports have focused on peritoneal dialysis (PD) hypertensive patients. The authors conducted a multi‐center cross‐sectional study involving 1789 PD patients from nine centers in Guangdong, China. The prevalence of aTRH was estimated by home blood pressure (BP) monitoring. Evaluating drug adherence through Eight‐item Morisky Medication Adherence Scale (MMAS‐8) and pill counting was performed to assess RH in one PD center. Related factors of aTRH were analyzed using logistic regression analysis. The prevalence of aTRH in PD patients was estimated at 42.2% (755 out of 1789 hypertensive patients) based on home BP. Of those, 91.4% patients were classified as uncontrolled RH, 2.0% as controlled RH, and 6.6% as refractory hypertension. The prevalence of RH was 40.6% and 41.9% among those with medium/high adherence based on the MMAS‐8 scores and the pill counting rate, respectively. PD patients who were younger, with higher body mass index, with lower serum albumin and poorer dialysis adequacy were significantly associated with higher aTRH incident. In conclusion, the present study demonstrates a high prevalence of aTRH in PD population, which occurs in about two in five treated hypertensive patients. Nutritional status and dialysis adequacy might tightly associate with aTRH.     

Predictors of self-reported adherence to direct oral anticoagulation in a population of elderly men and women with non-valvular atrial fibrillation

There is a general lack of studies evaluating medication adherence with self-report scales for elderly patients in treatment with direct oral anticoagulants (DOACs). The aim of the study was to assess the degree of adherence to DOAC therapy in a population of elderly outpatients aged 65 years or older affected by non-valvular atrial fibrillation (NVAF), using the 4-item Morisky Medication Adherence Scale, and to identify potential factors, including the geriatric multidimensional evaluation, which can affect adherence in the study population. A total of 103 subjects, anticoagulated with DOACs for NVAF in primary or secondary prevention, were eligible; 76 showed adequate adhesion to anticoagulant therapy, while 27 showed inadequate adherence. Participants underwent biochemical assessment and Morisky Scale, Instrumental Activities of Daily Living, CHA2DS2-VASc, HAS-BLED, mental status and nutritional evaluations were performed. 2% of subjects assumed Dabigatran at low dose, while 7.8% at standard dose, 9.7% assumed low-dose of Rivaroxaban and 30.1% at standard dose, 6.8% assumed Apixaban at low dose and 39.7% at standard dose, and finally 1% assumed Edoxaban at low dose and 2.9% at standard dose. Most subjects took the DOACs without help (80.6%), while 16 subjects were helped by a family member (15.5%) and 4 were assisted by a caregiver (3.9%). Binary logistic regression considered inappropriate adherence as a dependent variable, while age, male sex, polypharmacotherapy, cognitive decay, caregiver help for therapy assumption, duration of DOAC therapy and double daily administration were considered as independent variables. The double daily administration was an independent factor, determining inappropriate adherence with an OR of 2.88 (p?=?0.048, CI 1.003–8.286).     

Adherence to Asthma Therapy in Elderly Patients

Objectives. To assess the adherence to antiasthmatic therapy by the use of questionnaire and objective methods in elderly people, as well as to evaluate the association between cognition, depressive symptoms, functional status, and compliance. Methods. Patients aged 65 to 102 with chronic asthma under therapy were analyzed retrospectively to evaluate adherence using the Modified Morisky (MM) scale and a visual analog scale (VAS). In the second part of the study, a 1-year monitoring of asthma based on electronic diary and assessment of drug usage was performed. The MM scale and VAS as well as the estimation of cognition, depression symptoms, and functional status were carried out at the beginning and at the end of the observations. Results. Among 117 participants at the beginning of the study, only 9% and 21% had high adherence to therapy according to the MM scale and VAS, respectively. After 1 year of monitoring, the compliance assessed by the MM scale increased from 3.08 ± 0.97 to 3.85 ± 1.01 and by the VAS from 44% ± 7.8% to 90% ± 5.9%. Adherence by electronic diary and drug packages was lower than in both MM scale and VAS. Cognition status correlated with the results of MM and VAS tests but did not influence other methods of assessment. There was a statistical correlation between depression symptoms, cognition, and adherence (p >.01) in contrast to functional status. Compliance correlated with asthma control tests and PEFR. Conclusion. Low adherence to antiasthmatic treatment is common in elderly people. Proper monitoring of asthma by the use of diary or assessment of drugs packages with estimation of depression symptoms and cognition status could increase the compliance and asthma control in this group of patients.     

Perception of uncontrolled blood pressure and non-adherence to anti-hypertensive agents in diabetic hypertensive patients

We assessed the association between adherence to antihypertensive drug treatment and patient's perception of uncontrolled blood pressure (BP) in diabetic hypertensive subjects. This was a cross-sectional study that evaluated adherence to antihypertensives (Morisky questionnaire), patients' perception of abnormal BP, office BP, and ambulatory BP monitoring in diabetic hypertensive subjects. We evaluated 323 patients, 65.2% women, aged 56.5 ± 7 years, glycosylated hemoglobin (HbA1c) 8.0% (range, 6.9%–9.6%), diabetes duration of 10 years (range, 5–17 years). Adherence to drug treatment was 51.4%. Patients who reported hypertension-related symptoms (60.4%) had a lower level of adherence (P < .001). Non-adherence occurred four times more frequently in patients who reported hypertension-related symptoms (P < .001, adjusted for use of three or more anti-hypertensives, age, and duration of diabetes). Non-adherents had higher office diastolic BP (83.6 ± 11.9 vs. 79.8 ± 9.9; P = .003), but no difference between groups was observed considering systolic, diastolic, and mean BP evaluated by ambulatory BP monitoring. Low rates of adherence to antihypertensive drug treatment were observed in outpatient hypertensive diabetic subjects. Perception of uncontrolled BP levels was strongly and independently associated with non-adherence. Non-adherence determined repercussion on office BP that may have clinical implications in cardiovascular risk.     

Elucidating factors associated with non-adherence among Type 1 diabetes patients in primary care setting in Southeastern Brazil

AimsTo explore the factors associated with adherence and non-adherence to the pharmacological treatment of patients with T1DM in primary care setting southeast Brazil.MethodsWe conducted a cross-sectional study with 158 patients attending in the primary health care in the city of Franca southeast Brazil and measure adherence to antidiabetic medication. Adherence was measure using Morisky–Green Test modified.ResultsThe majority of patients was adherence to antidiabetic medication (63.2%). More than one third of patients were non-adherent treated pharmacologically and comorbidities most prevalent were hypertension (63.8%), dyslipidemia (43.1%) and depression (32.8%). Depression were strongest predictor OR = 2.8 (1.2–6.5) of non-adherence.ConclusionDepression is a factor associated with non-adherence to pharmacological treatment in patients with T1DM, and in clinical practice, screening for depression and intervention as well as pharmaceutical care may improve adherence to pharmacotherapy.     

Good adherence to imatinib therapy among patients with chronic myeloid leukemia—a single-center observational study

Previous studies have suggested that adherence to imatinib therapy can be an obstacle among patients with chronic myeloid leukemia (CML). We studied adherence to imatinib therapy among CML patients treated at the Sahlgrenska University Hospital. We identified all CML patients that were alive at the 1st of January 2010 (n = 70). Nineteen patients were excluded due to a history of allogenic hematopoietic stem cell transplantation, and nine were excluded due to treatment with other tyrosine kinase inhibitors. Thirty-eight out of 42 patients (90%) treated with imatinib accepted inclusion in the study. The patients were interviewed in a structured way, and adherence was evaluated in a standardized way using the nine-item Morisky Medication Adherence Scale that ranges from 1 to 13. A Morisky score ≤10 indicates nonadherence and ≥11 indicates adherence. In addition, predefined follow-up questions were asked to identify factors known to influence adherence to therapy. In contrast to previous studies, our patients showed good adherence to imatinib therapy with a mean Morisky score of 12.3 out of 13 (range, 9–13). The interviews revealed factors known to predict adherence to therapy, namely being well informed and having frequent contact with a single hematologist. Furthermore, the patients had easy access to the treating clinic and felt that they took part in decisions concerning their disease and treatment. We show that adherence to imatinib can be very good in CML patients, and we suggest that simple measures such as increased patient information and continuity of care will increase adherence in patients with CML.     

Impact of the Chronic Care Model on medication adherence when patients perceive cost as a barrier

AimsCost burdens represent a significant barrier to medication adherence among chronically ill patients, yet financial pressures may be mitigated by clinical or organizational factors, such as treatment aligned with the Chronic Care Model (CCM). This study examines how perceptions of chronic illness care attenuate the relationship between adherence and cost burden.MethodsSurveys were administered to patients at 40 small community-based primary care practices. Medication adherence was assessed using the 4-item Morisky scale, while five cost-related items documented recent pharmacy restrictions. CCM experiences were assessed via the 20-item Patient Assessment of Chronic Illness Care (PACIC). Nested random effects models determined if chronic care perceptions modified the association between medication adherence and cost-related burden.ResultsOf 1823 respondents reporting diabetes and other chronic diseases, one-quarter endorsed intrapersonal adherence barriers, while 23% restricted medication due of cost. Controlling for age and health status, the relationship between medication cost and CCM with adherence was significant; including PACIC scores attenuated cost-related problems patients with adequate or problematic adherence behavior.ConclusionsPatients experiencing treatment more consistent with the CCM reported better adherence and lower cost-related burden. Fostering highly activated patients and shared clinical decision making may help alleviate medication cost pressures and improve adherence.     

Evaluation of clinical pharmacist mediated education and counselling of systemic lupus erythematosus patients in tertiary care hospital

ObjectivesTo assess the knowledge of systemic lupus erythematosus (SLE) patients before and after clinical pharmacist's education and compare the same with the control group.MethodsIn this study done on patients with SLE, the test group patients were provided with education regarding SLE and its management including lifestyle modifications, via the distribution of patient information leaflets (PILs), while the control group were continued with conventional therapy. Validated knowledge assessment questionnaire was administered at baseline, first follow-up and final (second) follow-up to assess the medication knowledge of SLE patients. The Modified Morisky Scale (MMS) was used to assess the adherence at the final follow-up to study the influence of education.ResultsForty-five patients completed the 2 months follow-up study out of 50 enrolled patients. A significant (P < 0.001) improvement in the medication knowledge scores and medication adherence was seen in test group compared to the control group. The reasons for non-compliance included patients forgetfulness, high cost of medications, patients lack of access to hospital/drug store, lack of family support/motivation, fear of side effects, and fear of becoming dependent on treatment.ConclusionThe finding of this study showed that a well-structured SLE patient counselling by clinical pharmacist's intervention will result in improved medication knowledge and better medication adherence.     

Inhaler technique and asthma: feasability and acceptability of training by pharmacists

Poor inhaler technique is frequent in asthma, but its long-term consequences have been seldom assessed. Pharmacists are ideally positioned to teach inhaler technique. This prospective observational study evaluated the feasibility of inhaler training by pharmacists in patients receiving inhaled corticosteroids by pressurised metered-dose inhaler (pMDI) or breath-actuated MDI. In parallel, the relationships between inhaler technique, adherence, and asthma control, and their modulation one month after training were assessed. Of 727 patients receiving training at pharmacies (n=123), 61% were prescribed a pMDI; 35%, an Autohaler(?); and 5%, an Easi-Breathe(?) inhaler. Poor asthma control (Asthma Control Questionnaire score ≥ 1.5) at baseline was significantly (p<0.05) and independently associated with poor inhaler technique and poor self-reported adherence (Morisky score ≥ 3). The percentage of patients with optimal inhaler technique rose from 24% before to 79% after training (p<0.001). Median training session length was 6 min. At 1 month, mean (SD) ACQ score had improved from a baseline score of 1.8 (1.2) to 1.4 (1.1), (p<0.001). Importantly, greater change was observed in patients with improved inhaler technique versus those without. Similar results were observed for Morisky score. Inhaler technique is associated with adherence and influences asthma control. Inhaler training by pharmacists is feasible and seams to improve inhaler technique, asthma control and adherence.     

Multidisciplinary HIV adherence intervention: a randomized study

Maintaining greater than 95% adherence to antiretroviral medication is necessary in order to have the greatest therapeutic impact on HIV infection. Furthermore, evidence suggests that adherence rates of between 70% and 89% are significantly associated with viral rebound and the development of drug resistance. Adherence rates at and above the 95% level are difficult for patients to achieve and maintain. Our aim was to determine if an adherence intervention could improve adherence among patients attending an ambulatory care clinic at a large public hospital. The intervention was delivered by a multidisciplinary team of health care professionals and consisted of education coupled with the provision of devices designed to assist patient memory and adherence. A crucial component of the intervention consisted of the identification of patient specific barriers to adherence and the development of strategies to circumvent these problems. Adherence was assessed using patient self-report over the past 4, 7, and 28 days and by calculation of the Morisky score. The study was conducted as a randomised controlled trial using the stepped wedge design with a total of 68 subjects randomised to receive the intervention over a 20-week period. Adherence before and after the intervention formed the analysis. There was a significant decrease in the number of missed doses over the past 4 (1.9 to 1.0, p < 0.001), 7 (3.0 to 1.8, p < 0.001) and 28 (7.4 to 4.2, p < 0.001) days and a decrease in the Morisky score, indicating an improvement in medication taking behaviour (1.3 to 0.5 p < 0.001).     

Prevalence and risk factors of cognitive dysfunction in patients with type 2 diabetes mellitus receiving care in a reference hospital in Cameroon: a cross-sectional study

Diabetes mellitus has been associated with cognitive impairment but this has not been well investigated in sub-Saharan Africa. The aim of this study was to determine the prevalence and risk factors of cognitive dysfunction in patients with type 2 diabetes and to assess its influence on medication adherence. We carried out a cross-sectional study over a period of 4 months at the outpatient diabetes and endocrinology clinic of the Douala General Hospital. Consecutive patients with type 2 diabetes attending the clinic underwent cognitive assessment using the Mini Mental State Exam (MMSE). The patient Health Questionnaire-9 (PHQ-9) was used to rule out the confounding effect of depression, and the Morisky score was used to assess medication adherence. Data were analyzed using SPSS version 20 for Windows. Of the 223 participants (54.3% females) with a mean age of 56 ± 9.5 years, 33 (14.8%) had cognitive dysfunction (12.6, 1.8, and 0.4% having mild, moderate, and severe cognitive dysfunction, respectively). Level of education ≤7 years (OR = 5.314, 95% CI 2.443–11.561, p < 0.001) was the only factor significantly associated with cognitive dysfunction. No significant association was found between cognitive dysfunction and treatment adherence. In conclusion, one out of seven of our patients with type 2 diabetes have cognitive dysfunction, which is strongly associated with low level of education and does not affect treatment adherence and glycemic control. Our results suggest that screening for cognitive dysfunction in our patients should focus on patients with a low level of education.     

Adherence to HIV antiretrovirals among persons with serious mental illness

Despite the absence of empirical evidence, serious mental illness is assumed to be a high risk factor for nonadherence to HIV antiretroviral regimens. To assess antiretroviral adherence among persons with serious mental illness, we conducted a study in which adherence was observed over a 2-week period with electronic monitoring bottle caps and self-report. Forty-seven participants enrolled, with all but two (96%) completing the study. Psychiatric diagnoses included bipolar depression (n = 24), schizophrenia (n = 12), schizoaffective disorder (n = 5), and major depression with psychotic features (n = 6). Mean adherence (proportion of prescribed doses taken) was 66% (standard deviation [SD] = 34), as measured by electronic monitoring; 40% demonstrated at least 90% adherence, but 31% had less than 50% adherence. Self-reported adherence to psychotropics was moderately correlated with self-reported (r = 0.45, p < 0.05) and electronically monitored (r = 0.39, p < 0.05) antiretroviral adherence. Viral load (log(10)) was negatively correlated with electronically monitored (r = -0.28, p < 0.10) and self-reported (r = -0.39, p < 0.05) antiretroviral adherence, after controlling for the length of time on treatment. These findings suggest that many patients with serious mental illness are able to adhere very well to antiretroviral regimens, yet a substantial proportion of our sample displayed poor adherence, indicating the need for research to further assess the factors that influence adherence to antiretrovirals in this population.     

Compliance to drug therapy in inflammatory bowel diseases outpatients from a university hospital

BACKGROUND: Compliance to drug therapy is important for a successful treatment. Although many studies have assessed compliance to treatment in patients with chronic diseases, few investigations have been carried out in inflammatory bowel diseases. AIM: To assess compliance to drug therapy in patients with inflammatory bowel diseases, Crohn's disease and ulcerative colitis, followed at a university hospital, who had prescribed medication supplied by the Brazilian National Health System. METHODS: In a cross sectional study, a structured interview was applied to assess the compliance of 26 Crohn's disease patients, 26 ulcerative colitis patients and 4 cases with undetermined colitis. Patients were characterized as presenting higher or lower degree of compliance, based on the comparison of the information provided by the patient in the interview and data in the medical records. The Morisky test was also used to assess the behavioral pattern of the patient regarding the daily use of the medication. RESULTS: The interview showed that 15.4% of patients with Crohn's disease and 13.3% of those with ulcerative colitis could be regarded as less compliant. However, the Morisky test revealed lower compliance in 50% of patients with Crohn's disease and 63.3% of those with ulcerative colitis. Univariate analysis showed an association between low compliance and long disease duration, married status and colon involvement in Crohn's disease, and between low compliance and increased disease activity and greater number of medications in ulcerative colitis. However, multivariate analysis did not confirm any association between low compliance and any demographic or clinical factor. CONCLUSIONS: A high degree of noncompliance to treatment, linked to habitual behavior and hard to predict from demographic or clinical factor, was detected in inflammatory bowel disease patients, which suggests the need for investment in patient education regarding medication use.     

Adherence to antihypertensive drug treatment in Argentina: A multicenter study

Adherence to antihypertensive medication is an important challenge that doctors often face in the treatment of hypertension. Good adherence is crucial to prevent cardiovascular complications. In consequence, the present study aimed at determining the prevalence of adherence to antihypertensive treatment and identifying associated clinical variables. A multicenter cross‐sectional study was conducted in 12 cities of Argentina. A systematic sampling was performed in order to select patients with hypertension and under pharmacological treatment for at least 6 months. Physicians took three BP measurements, and the level of adherence was assessed using the self‐administered Morisky questionnaire (MMAS‐8). Participants were classified into three levels of adherence: high adherence—MMAS score of 8; medium adherence—MMAS scores of 6 to <8; and low adherence—MMAS scores of <6. A total of 1111 individuals (62 ± 12 years old, women 49.4%) were included in the present analysis; 159 (14.3%), 329 (29.6%) and 623 (56.1%) patients had low, medium, and high adherence, respectively. The prevalence of controlled hypertension increased only in high adherent patients: 42.8%, 42.2%, and 64.5% for low, medium, and high adherence groups, respectively. Similarly, systolic BP was lower only in the high adherence group. High educational level (OR 3.47, 95% CI 2.68‐4.49) and diuretic treatment (OR 0.64, 95% CI 0.47‐0.88) were independent predictors of high adherence. In conclusion, more than a half of treated hypertensive patients had a high level of adherence. These patients had lower BP values and higher control levels. A high educational level predicts high adherence.     

Patients’ beliefs and behaviors related to treatment adherence in patients with asthma requiring maintenance treatment in Asia

Objectives: To identify patients’ beliefs or behaviors related to treatment adherence and to assess association between asthma control and adherence in Asian patients with asthma. Methods: We conducted a cross-sectional observational study of adult patients with asthma from specialist clinics in six Asian countries. Patients who were deemed by their treating physicians to require a maintenance treatment with an inhaler for at least 1 year were recruited. Patients completed a 12-item questionnaire related to health beliefs and behaviors, the 8-item Morisky Medication Adherence Scale (MMAS-8), the Asthma Control Test (ACT?), and the Standardized Asthma Quality of Life Questionnaire (AQLQ-S). Results: Of the 1054 patients recruited, 99% were current users of inhaled corticosteroids. The mean ACT score was 20.0?±?4.5 and 64% had well-controlled asthma. The mean MMAS-8 score was 5.5?±?2.0 and 53% were adherent. Adherence was significantly associated with patients’ understanding of the disease and inhaler techniques, and with patients’ acceptance of inhaler medicines in terms of benefits, safety, convenience, and cost (p?p?=?0.001), “Taking medicines more than once a day is inconvenient” (p?=?0.002), and “Sometimes I skip my inhaler to use it over a longer period” (p?Conclusions: Our study showed that patients’ acceptance of the benefits, convenience and cost of inhaler medications have a significant impact on treatment adherence in the participating Asian countries.     

Intralesional Meglumine Antimoniate for Treatment of Cutaneous Leishmaniasis Patients with Contraindication to Systemic Therapy from Rio de Janeiro (2000 to 2006)

Abstract. We evaluated the effectiveness and safety of intralesional meglumine antimoniate (MA) in 24 not submitted to previous treatment patients with cutaneous leishmaniasis (CL) and with contraindication to systemic therapy. Each treatment consisted of one to four intralesional applications of MA at 15-day intervals. Patients' age ranged from 3 to 90 years; fourteen were females. Intralesional treatment in the absence of any relevant toxicity was successful in 20 (83.3%) patients. Three patients required additional treatment with amphotericin B and one required systemic MA. None of the patients developed mucosal lesions when followed up to 60 months. Intralesional MA is an effective and less toxic alternative treatment of patients with CL and contraindication to systemic therapy.     

Knowledge of the patients regarding leprosy and adherence to treatment

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It is known for its great disfiguring capacity and is considered an extremely serious disease to public health worldwide. The state of Ceará ranks 13th in number of cases of leprosy in Brazil, and fourth in Northeastern region, with an average of 2,149 new cases diagnosed every year. This study aimed to evaluate the knowledge of leprosy patients regarding treatment, and to assess the level of treatment adherence and its possible barriers. The study was conducted in the reference center for dermatology, from September 2010 to October 2010, in Fortaleza, Ceará. The study data were collected by means of a structured interview, along with the Morisky-Green test, in order to assess treatment adherence and barriers to adherence. A total of 70 patients were interviewed, out of whom 66 were new cases. The majority of patients were between 42 and 50 years old, and 37 (52.9%) were male. Most patients were clinically classified as presenting multibacillary leprosy (80%), and 78.6% of them were from Fortaleza, Brazil. The Morisky-Green test indicated that 62.9% of patients presented a low level of adherence (p < 0.005), despite claiming to aware of the disease risks. However, it was observed that 57.1% of the patients had no difficulty adhering to treatment, while 38.6% reported little difficulty. This study shows that despite the patients claiming to be familiar with leprosy and its treatment, the Morisky-Green test clearly demonstrated that they actually were not aware of the principles of therapy, which is evidenced by the low degree of treatment adherence.