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1.
Objective
To quantify and compare the determinants of different types of medication non-adherence in cholesterol lowering and asthma maintenance medications using a theoretical approach.Methods
Study design was online cross sectional survey. A conceptual framework was developed using Andersen's Behavioral Model and Leventhal's Common Sense Model to understand the determinants of medication non-adherence. Regression analyses were used to test the models for predicting non-adherence.Results
The models based on Andersen's Behavioral Model and Leventhal's Common Sense Model were significant. While predisposing factors such as treatment convenience and beliefs in medications were significant in cholesterol lowering medications, need factors such as illness perceptions and disease severity were significant in asthma maintenance medications. Among the enabling factors, self efficacy was a significant predictor in both cholesterol lowering and asthma maintenance medications.Conclusion
Different determinants explained different types of non-adherence and suggest the need to consider different types of non-adherence for different medications as well as different determinants for each type of non-adherence.Practice implications
Identifying determinants of different types of non-adherence can help health care professionals develop targeted interventions which can be more successful than the current model of single and generalized interventions to reduce non-adherence. 相似文献2.
Objective
To examine patients’ use of medication management strategies (e.g., reminders, pill boxes), and to determine how their use influences the relationship between patient characteristics and medication adherence.Methods
Retrospective and cross-sectional study of 434 patients with coronary heart disease, examining both refill adherence and self-reported adherence.Results
The most common strategy for managing refills was seeing a near empty pill bottle (89.9%), and for managing daily medications, it was associating medications with daily events (80.4%). Age < 65 (OR = 1.7), as well as marginal (OR = 2.0) or inadequate health literacy (OR = 1.9), was independently associated with low refill adherence. Patients <65 also had lower self-reported adherence (OR = 1.8). Adjustment for use of medication management strategies did not substantially change these relationships. Reliance on reminders from friends or family to take medications, or waiting to refill a medicine only when the bottle was near empty, each were associated with 3-fold greater odds of non-adherence.Conclusion
Age <65 and marginal or inadequate health literacy were independently associated with medication non-adherence. Use of medication management strategies did not explain these relationships.Practice implications
The strategies which patients report using to assist with managing medication refills and daily medication use may be ineffective. 相似文献3.
Objective
Adherence is challenging in episodic chronic conditions that require medication during both symptomatic and quiescent periods, such as ulcerative colitis (UC). Adherence for these conditions is under-studied. This study was a preliminary test of telephone nurse counseling to address cognitive and emotional barriers to adherence in UC.Methods
524 people taking mesalamine for UC were referred by their health care providers, and 278 (53%) enrolled. There were no demographic differences between program participants and nonparticipants. Participants reported multiple comorbidities and concomitant medications. All participants received telephone follow-up (M = 2.1 calls) from a registered nurse who used cognitive-behavioral and motivational interviewing counseling techniques. Adherence measured by structured interview was compared to a population baseline using a binomial test.Results
Attrition was 51% over 6 months but was unrelated to adherence. Participants had better adherence than the expected population rate, with a significant dose-response effect. Reasons for nonadherence were primarily psychological or efficacy-related.Conclusion
Adherence following intervention was better than typical mesalamine adherence. Self-efficacy predicted adherence, but demographic and clinical variables did not. Adherent participants reported more adverse events.Practice implications
Attention to patients’ cognitive and emotional reactions may help to improve adherence in episodic chronic diseases such as UC. 相似文献4.
van Geffen EC Philbert D van Boheemen C van Dijk L Bos MB Bouvy ML 《Patient education and counseling》2011,83(3):303-309
Objective
To assess the extent to which patients feel they have received enough information on cardiovascular drugs and experienced counseling at the pharmacy. In addition, to identify factors that are predictors for patient satisfaction with the information received.Methods
Fifteen community pharmacies participated. New and chronic users of cardiovascular medication received a questionnaire containing sociodemographic and health questions, a measure of satisfaction with information received (SIMS), beliefs about medication (BMQ), and frequency of pharmacy counseling.Results
Of the 578 respondents, 335 (58%) indicated to be unsatisfied with the information received on 3 or more SIMS items. Patients’ age, beliefs about medication, duration of cardiovascular treatment and use of antithrombotics predicted patients’ satisfaction with information received. Two-thirds of patients reported ‘never’ to have experienced 5 of 8 counseling activities at the pharmacy.Conclusions
A considerable proportion of patients are unsatisfied with the information received on cardiovascular medication. The majority of patients have only received a limited scope of medication counseling at the pharmacy.Practice implications
Information and counseling should be tailored to patients’ needs and concerns about cardiovascular medication and the experience patients already have with treatment. Pharmacists could enhance their role in supporting patients using cardiovascular medication. 相似文献5.
Charitini Stavropoulou 《Patient education and counseling》2011,83(1):7-13
Objective
Studies on the determinants of non-adherence to medication have put emphasis in understanding the role of the doctor-patient relationship in individuals’ decision to follow recommendations. Yet, evidence on general perceptions that individuals hold about doctors and their impact on their decision to non-adhere is lacking. This paper aims to explore the issue using data from the European Social Survey (ESS).Methods
The ESS was conducted in 2004/2005 and included 45,700 participants from 24 countries in Europe. A Heckman probit model with sample selection was used for the analysis.Results
The results show that perceptions about doctors constitute the model that better explains non-adherence to prescribed medication.Conclusion and practice implications
Our findings confirm that general beliefs individuals have about the doctor-patient relationship impact significantly on their decision to non-adhere to prescribed medication. Key points were shown to be involvement in the decision making process, treating patients as equals and avoiding leaving unresolved issues when prescribing. 相似文献6.
Delesha M. Carpenter Robert F. DeVellis Edwin B. Fisher Brenda M. DeVellis Susan L. Hogan Joanne M. Jordan 《Patient education and counseling》2010,81(2):169-176
Objective
This article explores the effect of conflicting information, defined as contradictory information about medication topics from different sources, on medication adherence in a sample of chronically ill patients. We specifically investigate whether conflicting information and physician support directly affect medication adherence or whether the effect is mediated by adherence self-efficacy and outcome expectations for medications.Methods
Vasculitis patients (n = 228) completed two on-line questionnaires which contained measures of conflicting information, adherence self-efficacy, outcome expectations, physician support, and medication adherence. We conducted a mediation analysis using a bootstrapping approach to generate point estimates and 95% confidence intervals to test the significance of each mediated effect.Results
A majority of patients (51.3%) received conflicting medication information. Conflicting information had a direct negative effect on medication adherence, which was not mediated by self-efficacy or outcome expectations. Alternatively, self-efficacy mediated the positive effect of physician support on medication adherence.Conclusion
Patients who encounter conflicting medication information are less adherent to their medications. The presence of a supportive physician may counteract the negative effect of conflicting medication information.Practice implications
Physicians should initiate conversations about conflicting medication information with their patients. Consensus-based guidelines that address medication discrepancies may also reduce the availability of conflicting information. 相似文献7.
Mitchell B Armour C Lee M Song YJ Stewart K Peterson G Hughes J Smith L Krass I 《Patient education and counseling》2011,83(3):288-294
Objective
To evaluate the capacity and effectiveness of trained community pharmacists in delivering the Diabetes Medication Assistance Service (DMAS) via (1) number and types of self-management support interventions (SMSIs); (2) number of goals set and attained by patients and (3) patient outcomes (glycaemic control, medication adherence and satisfaction).Methods
Pharmacists (n = 109) from 90 community pharmacies in Australia were trained and credentialed to deliver the DMAS. The training focused on developing pharmacists’ knowledge and skills in supporting patients’ diabetes self-management.Results
A total of 387 patients completed the trial. The mean number of SMSIs per patient was 35 (SD ±31) and the majority (87%) had at least one documented goal that was fully or partially attained. There were significant health benefits for patients including improved glycaemic control and a reduced risk of non-adherence to medications. Over 90% of DMAS patients reported improvements in their knowledge about diabetes self-management.Conclusion
The DMAS provides self management support in the community pharmacy for people with T2DM which may result in improved clinical outcomes.Practice implication
Given appropriate training in diabetes care and behavior change strategies, community pharmacists can offer programs which provide self-management support to their patients with T2DM and improve their health outcomes. 相似文献8.
Abdel-Tawab R James DH Fichtinger A Clatworthy J Horne R Davies G 《Patient education and counseling》2011,83(3):451-457
Objectives
To develop and test a framework for evaluating the consultation skills of practitioners undertaking medication-related consultations.Methods
Key components of medication-related consultations were identified through a literature review and compiled to form an initial consultation skills framework. This was iteratively refined through consultation with experts (n = 21) to form the Medication-Related Consultation Framework (MRCF). Psychometric testing was undertaken by analyzing pharmacists’ (n = 10) assessment of fifteen pre-recorded simulated consultations.Results
The MRCF consisted of 46 consultation behaviors, grouped into five sections. Performance was rated at individual behavior, framework section and global consultation levels. The MRCF discriminated between good, satisfactory and poor consultations at the global rating level (p < 0.01) with good test-retest reliability (rho = 0.59-0.95) and moderate inter-assessor reliability (Kendall's W = 0.67). There was also good internal consistency for the five sections (Cronbach's alphas = 0.58-0.97).Conclusions
The MRCF demonstrated good psychometric properties at the global and section rating levels. Some inconsistencies in assessors’ ratings of individual consultation behaviors were indentified, which may represent a future training need.Practice implications
The MRCF provides healthcare professionals with a patient-centered consultation structure, serving to identify medication-related needs and potentially support adherence. It also allows the quality of a practitioner's consultation to be evaluated. 相似文献9.
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Guirguis LM 《Patient education and counseling》2011,83(3):432-442
Objective
To characterize pharmacists’ experience and explore their beliefs toward an interactive communication technique, the three prime questions (3PQs),where pharmacists ask about patients’ understanding of medication's purpose, directions, and monitoring.Methods
Mixed method design. Pharmacists were briefly trained and then integrated the 3PQs into their practice for two weeks. Pharmacists recorded their perceptions of patient interactions, completed a survey addressing self-efficacy and role beliefs toward the 3PQs, and participated in a focus group.Results
Eleven pharmacists participated and the 3PQs were used with 176 patients. Most interactions were under 5 min. Pharmacists reported that questions about directions and monitoring were most effective in gathering new information with refills whereas medication purpose question was preferred for new fills. The majority of pharmacists were certain they could use the 3PQs and agreed it was their role. Five themes arose from the qualitative analysis: established communication routines, enhanced patient-pharmacist relationships, good medication history, tailoring of the 3PQs, and impact of pharmacy organization.Conclusion
The 3PQs enabled pharmacists to briefly assess patient medication experiences and tailor education while fostering patient-centered relationships in pharmacy practice.Practice implications
While the 3PQs may enhance pharmacists’ patient assessment; integration may challenge pharmacists’ work routine. 相似文献13.
Objective
We developed a semi-automated leaflet optimizer (ABOP) to improve the readability of Dutch patient information leaflets (PILs). Our aim was to assess whether or not revisions made with ABOP have an effect on traceability and comprehension of PIL information.Methods
Two leaflets (one for oxazepam and one for tetracycline) were revised with the ABOP tool and both the original versions and ABOP versions were tested for readability, according to the EC guideline.Results
The ABOP version for oxazepam (p < .0001) scored significantly better than its original counterpart in readability tests. Although the results showed that the ABOP version of the tetracycline antibiotic outperformed the original version the difference in scores was not statistically significant. Terminology improvements had the greatest effect on information retrieval and comprehension. Improvements to instructions and warnings did not affect retrieval and comprehension scores. Overall improvements did not ensure full compliance with EC requirements, but results are not far off.Conclusion
This study shows that even though ABOP does not solve all text quality issues, it does largely prepare a PIL for readability testing.Practice implications
Using ABOP as a revision tool for PILs can optimize PIL quality and hence reduce readability testing time and costs. 相似文献14.
Non-adherence with drug treatment after heart or lung transplantation in adults: A systematic review
V. Korb-Savoldelli B. Sabatier F. Gillaizeau R. Guillemain D. Bégué 《Patient education and counseling》2010,81(2):148-154
Objective
Heart or lung transplantation is a complex intervention requiring medication adherence. The objective of this systematic review is to estimate the prevalence of non-adherence (NA) with post-transplantation medication in heart or lung recipients and to assess its clinical impact. We examined in the selected studies if the authors considered the patient's perspective in their evaluations.Methods
The electronic database MEDLINE, EMBASE and The Cochrane Central Register were searched. Only studies that reported the number of non-adhere subjects were eligible. The different methods of measurement, the ways in which authors defined NA and if authors had integrated patient's perspective in their secondary objectives were also assessed.Results
The range frequency of NA was 1-42.9% for all drugs. Non-adherent patients tend to experience worse outcomes compared to adherent patients. The patient's perception of drug side-effects is the most reported patient-related factor for impairing adherence.Conclusion
NA after heart or lung transplantation is an important issue and concerns not only immunosuppressant treatments. The main striking point of the selected studies is the lack of patient perspective and the omission of patients-healthcare providers’ relationship.Practice implications
Future research must focus on patients’ motivation for the medication-taking behaviour. 相似文献15.
Shoemaker SJ Ramalho de Oliveira D Alves M Ekstrand M 《Patient education and counseling》2011,83(3):443-450
Objective
To describe medication therapy management (MTM) pharmacists’ encounters with patients’ medication experiences, to examine the utility of the medication experience in practice, and to explore the value of the medication experience in patient education and counseling on medications.Methods
A focus group of 10 MTM pharmacists, and 1 pharmacist's 9-month practice diary were analyzed to reveal patients’ medication experiences and the utility and value of the medication experience in practice.Results
MTM pharmacists commonly encountered patients’ medication experiences in their practices. The medication experience was often at the root of drug therapy problems (DTPs) the practitioners identified. The pharmacists identified several examples of drug therapy problems with an associated medication experience at the root. The medication experience was a meaningful construct to guide patient education and counseling on new chronic medications to ultimately prevent DTPs, and valuable for tailoring patient education and counseling on medications to resolve DTPs.Conclusion
Our study provides preliminary evidence of the value of the medication experience for patient education and counseling on chronic medications in practice.Practice implications
The medication experience is a valuable tool for practitioners to understand patients’ needs, identify and resolve DTPs, and tailor patient education and counseling for chronic medications. 相似文献16.
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Objective
Physicians are inaccurate in predicting non-adherence in patients, a problem that interferes with physicians’: (1) appropriate prescribing decisions and (2) effective prevention/intervention of non-adherence. The purpose of the current study is to investigate potential reasons for the poor accuracy of physicians’ adherence-predictions and conditions under which their predictions may be more accurate.Methods
After the medical encounter, predictions of patient-adherence and other ratings from primary-care physicians (n = 24) regarding patient-factors that may have influenced their predictions were collected. Patients (n = 288) rated their agreement regarding the prescribed treatment after the encounter and reported adherence 1 month later.Results
Several factors were related to physicians’ adherence-predictions, including physicians’ perceptions of patient-agreement regarding treatment. However, some factors were not related to adherence and agreement-perceptions were inaccurate overall, potentially contributing to the poor accuracy of adherence-predictions. The degree to which physicians discussed treatment-specifics with the patient moderated agreement-perception accuracy but not adherence-prediction accuracy.Conclusions
Training providers to discuss certain treatment-specifics with patients may improve their ability to perceive patient-agreement regarding treatment and may directly improve patient-adherence.Practice implications
Discussing treatment-specifics with patients may directly improve adherence, but providers should not rely on these discussions to give them accurate estimates of the patients’ likely adherence. 相似文献19.
De las Cuevas C Rivero A Perestelo-Perez L Gonzalez M Perez J Peñate W 《Patient education and counseling》2011,85(3):e245-e250
Objectives
To assess psychiatric outpatients’ attitudes towards concordance and shared decision making in a psychiatric setting and to evaluate the role that self-perceived knowledge and beliefs about psychiatric medicines play in those attitudes.Methods
The Leeds Attitude to Concordance Scale (LATCon) was tested on a sample of 435 psychiatric outpatients. Principal Component Analysis was used to assess the structure of LATCon items. Regression analysis on LATCon scores was performed with sociodemographics, Belief about Medicines Questionnaire (BMQ) subscales, self-perceived knowledge, perceived psychiatrist behaviour and current medications as predictor variables.Results
The LATCon scale showed a good factorial validity, with a monofactorial structure and high internal consistency. Psychiatric outpatients tended to be in agreement with the concept of concordance, but they did not share some relevant aspects of the construct. Cognitive representations of psychiatric medications, assessed by the BMQ subscales, significantly predicted scores on the LATCon scale.Conclusion
Psychiatric outpatients show a considerable desire to participate in decision making about their treatment. The Spanish version of the LATCon Scale seems to be a valid instrument.Practice implications
Psychiatrists must consider their patients’ desire to participate in treatment decisions and explore how patients’ views about psychiatric medications influence their attitudes towards concordance. 相似文献20.
Dorthe Nielsen Jesper Ryg Winnie Nielsen Nis Nissen Kim Brixen 《Patient education and counseling》2010,81(2):155-160