Hemodialysis patients' noncompliance with oral medications

The purpose of this study was to describe the prevalence, severity, and patterns of noncompliance with prescribed medications among hemodialysis patients; and to identify patient, disease and/or treatment characteristics associated with noncompliance. Demographic and medical history information were collected from chart reviews and patient interviews. Compliance data were collected via self-report, pill count, and a medication event monitoring system (MEMS, Product of Aprex, a division of Apria Healthcare; Costa Mesa, CA). A total of 135 hemodialysis patients from 11 dialysis facilities in a large Midwestern metropolitan area participated. Overall, medication compliance rates were very low. Of the patient, disease, and treatment characteristics considered, only race was found to be associated with patient noncompliance; African-American patients had higher rates of noncompliance with both monitored medications. The results of this study confirm that noncompliance with medication regimens continues to be an unremitting problem for hemodialysis patients and that demographic, medical history, and treatment characteristics do not adequately explain this behavior. Also, estimates of patient compliance as measured by self-report, pill count, and microelectronic monitoring are disparate enough to suggest that relying exclusively on patients' self-report of compliance might be insufficient.     

Family practice patients' use of acetylsalicylic acid for cardiovascular disease prevention

Objective

To determine the prevalence of acetylsalicylic acid (ASA) use among family practice patients and the proportions of patients using ASA for primary and secondary cardiovascular prevention.

Design

Cross-sectional, self-reported, waiting room questionnaire.

Setting

Two family medicine clinics in Alberta.

Participants

Patients 50 years of age and older.

Main outcome measures

Overall prevalence of ASA use, proportion of ASA use for primary or secondary cardiovascular prevention, ASA use by patient age and sex, the proportion of patients who initiated ASA therapy on the advice of a physician, adverse events, and patient beliefs about ASA therapy.

Results

A total of 807 patients completed the questionnaire; the response rate was 89.1%. Overall, 39.8% of patients reported taking ASA regularly. Of those who took ASA, 87.0% did so for cardiovascular prevention (53.1% for primary prevention and 46.9% for secondary prevention). Of patients taking ASA for primary prevention, 62.8% did so upon the advice of their family physicians. Patients who took ASA believed that the benefits of taking ASA outweighed the risks; those who did not take ASA were unsure of the benefit-to-risk profile.

Conclusion

Many family practice patients take ASA, and more than half of those taking ASA take it for primary cardiovascular prevention. Family physicians appear to have an influence on patients'' decisions to take ASA. Educating family physicians and patients about the potential benefits and risks of ASA therapy would help promote the use of ASA in those who might receive the greatest overall benefit.     

Decision-making models used by 'graduate nurses' managing patients' medications

Background. The ambiguities involving end‐of‐life issues, such as physician‐assisted suicide and voluntary stopping of eating and drinking, have caused a blurring of the definition of rational suicide and have prompted rich dialogue with moral deliberations that seem to be on disparate paths among bioethicists and other health care professionals. With the evolution of advanced medical technology extending life expectancy in older, disabled, and terminally ill people, rational suicide has become a critical issue of debate. Aim. The purpose of this article is to address the ethical positions supporting and opposing rational suicide and to consider whether coherence can be achieved through an ethic of care. Findings. Attitudes towards suicide have been controversial, varying from acceptance to non‐acceptance depending on social, political and religious influences. Nursing attitudes are no different from general societal attitudes and, consequently, nurses are treading on uncertain moral ground. Conclusion. Nurses who have not reflected on the moral issues involved with rational suicide may be unprepared psychologically and professionally when working with patients who may be contemplating such actions.     

Guidelines for preoperative administration of patients' home medications.

Currently, there are no agreed upon guidelines for the administration of preoperative medications. Institutional guidelines were formulated after a review of the literature, recommendations by experts, and a consensus among anesthesiologists, surgeons, pharmacists, and nursing educators. These guidelines were then provided to the preadmission staff to instruct patients regarding preoperative medications. These guidelines will have to be reassessed periodically as new medications and medical evidence emerge.     

Medication adherence among geriatric outpatients prescribed multiple medications

BackgroundPoor medication adherence (PMA) is associated with higher risks of morbidity, hospitalization, and mortality. Polypharmacy is not only a determinant of PMA but is also associated with many adverse health outcomes.ObjectiveWe aimed to determine the prevalence and correlates of PMA in an older population with polypharmacy.MethodsBaseline data from 193 older adults from the Medication Safety Review Clinic Taiwan Study were analyzed. Patients were either prescribed ≥8 long-term medications or visited ≥3 different physicians between August and October 2007. PMA was defined as taking either <80% or >120% of prescribed amounts of a medication. Patients were classified as no (0%), low level (>0 but <25%), and high level (≥25%) PMA depending on what percentage of entire medication regimen taken reached PMA.ResultsMean (SD) age was 76 (6) years, and mean number of medications was 9 (3), with a mean medication class number of 4 (1). Of the 1713 medications reviewed, 19% had PMA. However, at patient level, 34%, 32%, and 34% of patients were classified as no, low level, and high level PMA, respectively. Correlates varied by levels of PMA. Compared with patients without PMA, higher medication class number and use of alimentary tract, psychotropic, and hematologic agents were associated with both low and high level PMA. History of dizziness was associated with low level PMA, and higher Mini Mental Status Examination score was associated with high level PMA.ConclusionsTo enhance medication adherence in older adults prescribed multiple medications, medication class numbers and certain high-risk medication classes should be taken into account. Physicians should also routinely assess systemic (eg, cognition) or drug-specific characteristics (eg, side effects).     

An intervention to encourage ambulance paramedics to bring patients' own medications to the ED: Impact on medications brought in and prescribing errors

Objective: To undertake and evaluate a multifaceted intervention to encourage paramedics to bring patients' own medications (POM) to the ED. Method: Adult patients were enrolled in each of the pre‐intervention (March 2006) and post‐intervention (December 2006) periods if they were brought to ED by ambulance, taking four or more medications, admitted to hospital and were not referred to a pharmacist prior to the admission medication chart being written. ED pharmacists determined patients' regular medication and details of medications brought in by ambulance. Medication charts were assessed for discrepancies related to medications taken prior to presentation. These were recorded as errors if a change was made to the medication chart after discussion with the prescriber. The intervention, conducted in October and November 2006, involved meetings with Metropolitan Ambulance Service * team managers and dissemination of promotional material. Paramedics of the Metropolitan Ambulance Service were participants for the intervention. Main outcome measures were: percentage of regular medications incorrectly prescribed; and percentage of POM brought to ED by paramedics. Results: One hundred patients were enrolled in each of the pre‐ and post‐intervention periods. The percentage of regular medications incorrectly prescribed significantly decreased from 18.9% (151/800, 95% CI 16–22%) to 8.8% (73/834, 95% CI 7–11%) in the pre‐ and post‐intervention periods, respectively (P < 0.001). Pre‐intervention, paramedics brought some or all POM to ED in 67.0% (67/100, 95% CI 57–76%) of cases compared with 87.0% (87/100, 95% CI 78–93%) of cases, post‐intervention. Conclusion: The multifaceted intervention encouraging paramedics to bring POM to ED was effective. POM were brought into ED more frequently and prescribing errors reduced.     

Using motivational interviewing to promote adherence to antiretroviral medications: a pilot study.

This report describes a pilot study of a nursing intervention to increase adherence to combination therapy. The intervention was based on motivational interviewing (MI). Participants completed a baseline assessment using the computer-administered self-interview with audio (ACASI) data collection method and then were randomly assigned to the MI intervention or control condition. Nurse counselors met with participants in the MI intervention group for three adherence sessions. Two months following baseline, participants completed a follow-up assessment. Mean scores on ratings of missed medications were lower for participants in the intervention group than those in the control group. Although there were no significant differences in the number of medications missed during the past 4 days, participants in the MI group reported being more likely to follow the medication regimen as prescribed by their health care provider. The pilot study provided useful information about the acceptability of ACASI and the adequacy of intervention procedures. The results of this pilot study show promise for the use of MI as an intervention to promote adherence to antiretroviral medications.     

艾滋病患者抗病毒药物治疗依从性的干预现状

艾滋病患者抗病毒药物治疗依从性(简称服药依从性)是指艾滋病患者严格遵从医务人员治疗处方方案服用药物,包括在正确时间服用正确剂量的药物~([1]).     

HIV-infected patients' adherence to highly active antiretroviral therapy: a phenomenological study

Adherence to the treatment regimen is essential to the success of highly active antiretroviral therapy for patients who are infected with HIV. The evidence suggests that poor adherence to antiretroviral drug therapy is a major problem that has the potential to diminish effective viral suppression, promote viral resistance, and place patients at risk for hospitalization, opportunistic infections, and an increased risk of HIV transmission. The primary aim of this study was to understand patients' experiences regarding their adherence to antiretroviral drug therapy. Thus, 19 participants were recruited for in-depth interviews regarding their adherence to drug regimens. All the interviews were transcribed verbatim and analyzed by using Benner's phenomenological analysis approach. Four main themes emerged from the data: (i) choosing to live and the decision to start taking medications; (ii) strategies for adhering to the regimen and managing the side-effects; (iii) relationships with healthcare providers; and (iv) advantages of the medications as a motivator to continue one's adherence to the regimen. Studying and understanding the experiences of patients can provide new insights and strategies in order to enhance patients' adherence to highly active antiretroviral therapy.     

Beliefs about antidepressant medications in primary care patients: relationship to self-reported adherence

BACKGROUND: Adherence to medication is unacceptably low in both medical and psychiatric disorders. Explanatory models of illness beliefs and behaviors suggest that an individual's beliefs about a disorder and its treatment will influence their adherence. Given that beliefs about medications may influence adherence to antidepressants, we examined beliefs about medications in relation to antidepressant adherence in a primary care sample. OBJECTIVE: The purpose of this report is to 1) describe beliefs about medication in primary care patients prescribed antidepressants for depression; 2) examine the factor structure of the Beliefs about Medicines Questionnaire (BMQ) and compare it with the previously reported factor structure of the BMQ in medical conditions; and 3) examine the association of medication beliefs with self-reported medication adherence. RESULTS: Factor analysis indicates that the BMQ is valid in a sample of primary care patients receiving treatment for depression and has a similar factor structure to that obtained in samples of patients with chronic medical conditions. Beliefs about medications are significantly associated with self-reported adherence. Severity of depressive symptoms and specific concerns about antidepressants are significantly associated with self-reported medication-taking behavior. Findings suggest that in addition to telling patients how to take their medications, primary care physicians should also educate patients about the short- and long-term effects of the medication, how the medication works, and that antidepressants are not addictive.