Effectiveness of different medication management approaches on elders' medication adherence

This pilot study investigated the effects of three different medication management approaches on medication adherence and resource utilization. Sixty-one participants living in an independent elder community in South Florida were randomly assigned to one of the three medication management approaches: (1) a pillbox method, (2) a voice-activated method, and (3) self-administration of medications as they had in the past. One outcome was measured by recording the number of doses of medications ingested over a 1-, 3-, and 6-month period. Adherence to medications also was measured by the impact on the medical diagnosis. For example, the hypertensive group was defined adherent by a sustained normotensive pressure. Participants' medical records were examined as to the number of physician office visits, hospitalizations, and home health visits. There were significant differences in the mean number of doses missed, with the fewest in the voice-activated group to the highest in the self-administration (control) group. Additionally, the group that self-administered their own medications had more frequent physician office visits and increased hospitalizations. Because the elder population is prone to medication mismanagement for a variety of reasons, nurses are in a unique position to identify populations at risk and suggest interventions that may improve medication adherence.     

Promoting medication adherence in children

The problem of getting children to follow a treatment regimen is widespread and is frustrating for physicians. The extent to which any patient adheres to a medical regimen is an essential determinant of clinical success. Strategies to improve adherence in children include using simplified drug regimens (e.g., once-daily dosing), pleasant-tasting medicines, liquid or other nonpill formulations, regular phone contact between parents and physicians, reminders, information counseling, self-management plans, and other forms of individualized supervision or attention. Physicians also can encourage adherence by providing a dearly written explanation or patient information sheets that list generic and brand names, dosage, schedule, duration, and common side effects and practical ways of coping with them. Physicians, children, and parents should develop a mutually agreed-upon treatment plan. Having the child participate in devising the plan improves adherence.     

Everyday memory strategies for medication adherence

The need to manage chronic diseases and multiple medications increases for many older adults. Older adults are aware of memory declines and incorporate compensatory techniques. Everyday memory strategies used to support medication adherence were investigated. A survey distributed to 2000 households in the Atlanta metropolitan area yielded a 19.9% response rate including 354 older adults, aged 60–80 years. Older adults reported forgetting to take their medications, more so as their activity deviated from normal routines, such as unexpected activities. The majority of older adults endorsed at least two compensatory strategies, which they perceived to be more helpful in normal routines. Compensatory strategies were associated with higher education, more medications, having concern, and self-efficacy to take medications. As memory changes, older adults rely on multiple cues, and perceive reliance on multiple cues to be helpful. These data have implications for the design and successful implementation of medication reminder systems and interventions.     

Patient adherence to medication for HIV

It is important to identify health beliefs, barriers and priorities that may hinder adherence to a medication regimen. Explaining the rationale behind taking medication as prescribed is essential to gain optimal therapeutic benefits. The integration of medicine-taking into the patient's lifestyle is necessary for promoting adherence. This framework is transferable for use by nurses in other specialties.     

White matter hyperintensities and medication adherence

White matter hyperintensities (WMH) are associated with hypertension, age, and cognitive function, but the association between WMH and medication adherence has not been examined. The intent of this investigation was to consider the potential implications of hypertension-related brain morphological changes on medication adherence and thereby improve understanding of the self-management consequences of hypertension. The associations between WMH, blood pressure, age, cognitive function (specifically assessments of prefrontal function), and medication adherence were examined in 16 middle-aged and older adults self-managing at least one prescribed antihypertensive agent. Magnetic resonance imaging using an axial fluid attenuated inversion recovery (FLAIR) sequence was used to assess the presence of WMH. Cognitive assessments included measures of executive function, working memory, attention, and immediate recall. Adherence was monitored for 8 weeks using electronic medication monitoring. More WMH were associated with poorer adherence (rs = -.25) and with higher systolic blood pressure (rs = .46), although these relationships were not statistically significant. WMH were associated with cognitive assessments in the expected direction including Digit Span Backward (rs = -.53, p < .05). Adherence was associated with immediate memory (rs = .54, p < .05) and inversely associated with failure to maintain set on the Wisconsin Card Sorting Test (WCST; rs = -.61, p < .05). These findings provide preliminary evidence for the association between WMH, assessments of prefrontal function, and medication adherence.     

Enhancing medication adherence in people with schizophrenia: An international programme of research

This paper describes the development of an adherence therapy intervention in schizophrenia and synthesizes the results to date of a collaborative international programme of research. Sticking to treatment is essential to control symptoms and prevent relapse, but as with other long‐term conditions, medication adherence is poor. Adherence therapy seeks to facilitate a process of shared decision making, where both parties work towards agreed goals. Central is the theory that when patients make shared choices with a professional they are more likely to stick with them because they are personally owned and meaningful. The results of adherence therapy trials that seek to test this theory are mixed. Outcomes of trials might have been be affected by the point in the patient's illness cycle when therapy was delivered and by sampling bias. Authors of trials of medication management and alliance training packages that aim to equip mental health workers with adherence therapy competencies show considerable promise in improving clinical outcomes. Helping patients manage their medication is central to the work of mental health nurses. We argue that the potential benefits to patients are such that there is sufficient evidence to recommend that all mental health nurses receive medication management training.     

The effects of medication education on adherence to medication regimens in an elderly population

The purpose of this intervention study was to evaluate educational protocols to see which would be more effective in increasing medication compliance rates within an elderly population Forty-two patients were randomized into four groups Group 1 received a standard education protocol, group 2 received the standard education and 30 minutes of verbal instruction, group 3 received the standard education and a medication schedule, and group 4 received the standard education, a medication schedule, and 30 minutes of verbal instruction The intervention was given on the day of hospital discharge Home visits were made 2 weeks, 1 and 2 months post-hospital discharge Results of the visits revealed that groups 1 and 2 had higher rates of errors with medications than groups 3 and 4 In conclusion, the groups with a medication schedule had higher compliance rates Considering the sample size of 42, this study can act as a pilot study to justify further research in the effects of a medication schedule on compliance     

Individualizing memory strategies to improve medication adherence

Changes in cognitive processes are well documented among even essentially healthy community-dwelling older adults. Although these changes do not produce the level of cognitive impairment associated with dementia, they do have the capacity to influence the degree to which elderly individuals self-manage chronic conditions. This pilot investigation tested the effect of an intervention to improve remembering to take medications and tracking if medications were taken as intended. Twenty-seven older adults (age range = 67-89 years, M = 78 years) all self-managing prescribed medications had one medication electronically monitored for 8 weeks preintervention and then 8 weeks postintervention. The percentage of days the correct number of doses was taken increased from a mean of 64.5% to that of 78%. With the use of Wilcoxon's signed ranks test, this improvement in adherence is significant. When participants with dementia or mild cognitive impairment were eliminated from the analysis (n = 6), the intervention continued to improve adherence (70.6% to 86%), suggesting that many older adults have the potential to improve adherence through individualized implementation of memory strategies.     

Factors affecting medication adherence in hypertensive patients

BACKGROUND: Adherence to medication is a critical factor in the continued health and well-being of patients with hypertension. Patients' acceptance of medical advice and information may be influenced by their subjective beliefs about their health condition; therefore, it is essential that their beliefs be taken into account when giving health advice or medical treatment. OBJECTIVE: To determine whether a relationship exists between illness attribution, perceived control, and adherence to antihypertensive medications. METHODS: A prospective, cross-sectional survey of hypertensive patients was conducted at the University of Michigan Medical Centers, Hypertension Clinic, Ann Arbor, MI. One hundred two patients with a goal to reduce their blood pressure were included in the study. Written and follow-up telephone survey questions assessing patients' illness attributions, perceived control, and medication adherence were administered. Associations between these variables were analyzed using correlation analyses. RESULTS: The majority of patients (67.7%) were adherent with their hypertensive medications. Patients indicated that modifiable variables were the most common attribution believed to cause hypertension; however, there was no significant relationship to medication adherence. A significant inverse relationship was found between perceived control over hypertension and medication adherence (p < 0.01). CONCLUSIONS: The findings suggest that patients' greater perception of control over trying to reduce blood pressure may result in decreased reliance on medications and subsequent nonadherence to drug therapy. Implications of these findings on pharmacy practice are discussed.     

Testing a nurse-tailored HIV medication adherence intervention

BACKGROUND: The relationship between patient adherence and treatment outcomes has been documented across chronic health conditions, but the evidence base for effective adherence interventions in human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) requires more rigorous research and reporting. OBJECTIVES: The aims of this study were to determine whether a tailored, nurse-delivered adherence intervention program--Client Adherence Profiling and Intervention Tailoring (CAP-IT)--improved adherence to HIV medications, compared with standard care, and to identify the relationship among adherence measures. METHODS: A randomized controlled trial (RCT) with repeated measures was used to test the efficacy of CAP-IT over a 6-month period. A convenience sample of 240 participants was recruited from a freestanding public HIV/AIDS clinic in Houston, TX, that provides medical, psychological, and pharmaceutical services for over 5,000 clients. Study instruments and measures included demographics; chart audit to capture CD4 count, viral load, and prescribed medications; health literacy; and five measures of adherence (AIDS Clinical Trial Group-Revised Reasons for Missing Medications, Morisky Self-Report of Medication Non-Adherence, Pill Count, Medication Event Monitoring System [MEMS] caps, and Pharmacy Refill). RESULTS: A logistic regression using generalized estimating equations method showed no significant differences over time on the five medication-adherence measures between the experimental and control groups. Little correlation was documented among the five different adherence measures, and there was minimal correlation with clinical markers. DISCUSSION: It is unclear why the tailored adherence intervention was not efficacious in improving medication adherence. The findings suggest that these measures of medication adherence did not perform as expected and that, perhaps, they are not adequate measures of adherence. Effective and efficient adherence interventions are needed to address the barriers to medication adherence in HIV/AIDS.     

Multicultural medication adherence: a comparative study

The purpose of this study was to evaluate the effect of several interventions on improving medication adherence among White, Black, and Hispanic older women. A total of 109 women older than age 65 who were participating in a clinical osteoporosis trial were recruited for this 12-month study examining medication adherence. After baseline medication adherence was assessed, participants underwent standardized teaching. Participants were contacted monthly by telephone and were seen in a clinic setting every 3 months. All participants used a pillbox for 6 months, and the minority women used an electronic monitoring bottle for 6 months. Adherence was highest in White women. Black women showed significant improvement in adherence at 9 and 12 months, and Hispanic women demonstrated a significant increase in adherence at 12 months. The use of electronic monitors had a positive effect on adherence for the minority women.     

慢性心力衰竭患者服药依从性研究

目的 调查慢性心力衰竭患者的服药依从状况,并探讨其影响因素.方法 采用一般资料问卷、心力衰竭知识问卷、服药相关信念问卷、坚持服药的信心评分表及服药依从性问卷对200例住院和急诊留观的慢性心力衰竭患者进行调查,并采用多元有序Ordinal回归对患者服药依从性的影响因素进行分析.结果 患者服药依从性差,完全依从的仅有40....