Questionnaires on adherence to antihypertensive treatment: a systematic review of published questionnaires and their psychometric properties.

Background Non-adherence to antihypertensive treatment is currently considered one of the most significant risk factors in failure to achieve controlled blood pressure values. It is therefore extremely important to measure patient adherence to antihypertensive treatment. One way to measure adherence is through questionnaires. Numerous questionnaires for measuring adherence to antihypertensive treatment have been validated, but it not easy to choose one of them as being more appropriate than all of the others. Aim of the review The aim of this study was to identify and assess questionnaires designed to measure non-adherence to antihypertensive treatment, and to discuss their psychometric properties. Method A systematic review of the literature contained in PubMed and Scopus databases was undertaken to identify validated questionnaires on adherence to antihypertensive treatment up to October 2017. PRISMA guidelines were followed to conduct and report this review. Selection of articles and data extraction were performed by two independent researchers. When there was lack of agreement, a third researcher mediated in the discussion between the first two authors so that consensus could be reached. Results 39 articles were obtained containing 17 different questionnaires for measuring adherence to antihypertensive treatment. These questionnaires were validated in 15 countries. The number of items in the questionnaires ranged from three in QAM-Q to 33 in TAQPH. Hill-Bone compliance to high blood pressure therapy scale, Morisky-Green-Levine test and an 8-item Self-Reported Medication Adherence Measurement were the most widely validated questionnaires. Validity was analyzed more than reliability. Many of the questionnaires do not provide information on content validity. Construct validity and concurrent validity are analyzed in almost all of the questionnaires, and give highly variable results. By contrast, known-groups validity was not analyzed to any great degree. As regards reliability, almost all of the questionnaires provided Cronbach's alpha information with reasonably acceptable results, but temporal stability was not analyzed to any great degree. Conclusion None of the questionnaires included in the review demonstrates fulfilling all of the validity tests (content validity, construct validity and criterion-related validity) and reliability tests (homogeneity and temporal stability) in an acceptable manner. Therefore, none of them can be considered a Gold Standard.

Effectiveness of a protocolized dispensing service in community pharmacy for improving patient medication knowledge.

Background Sufficient patient medication knowledge is essential for appropriate use. The dispensing service provided in community pharmacies is one method that may be used to educate patients on their medications. Objective To compare the effectiveness of protocolized dispensing (following a dispensing protocol that includes standardized patient education), with the effectiveness of traditional dispensing (provision of medication without standardized patient education and information provided only if directly requested), for improving patient medication knowledge. Method Pre-post quasi-experimental study of patients or caregivers over 18 years of age requesting one or more medications for their own use or for others. The intervention consisted of using a protocolized process for dispensing medicines in a community pharmacy. The association between the dispensing effectiveness (patient medication knowledge pre and post dispensing) and predictor variables was studied using a multivariate binary logistical regression model. Results In total 661 participant medication requests were included in the study. Protocolized dispensing was more effective than traditional dispensing for improving medication knowledge (OR 2.390; 95 % CI 1.373-1.162). Conclusion As a means to improve patient medication knowledge it may be recommended that protocolized dispensing processes should be developed, evaluated and implemented with the ultimate aim of improving the appropriate use of medicines.

Development and testing of two implementation tools to measure components of professional pharmacy service fidelity.

RATIONALE, AIMS AND OBJECTIVES: There is a need to evaluate both service process and implementation outcomes as professional services are being implemented into pharmacy practice. Fidelity is an implementation outcome, which may be used for service optimization, by associating service components to patient outcomes, as well as use in process evaluation. The objective of this study was to develop tools to measure components of fidelity, specifically, an adherence index (adherence of the service provider to the elements of the service) and a patient responsiveness scale for the professional pharmacy service, medication review with follow-up. METHODS: The procedure described by DeVellis was followed to develop the tools. An expert panel was used to create items and establish content validity. Primary data were collected from 190 service provider pharmacists from 128 pharmacies across 11 provinces of Spain using Spanish version tools as part of an ongoing implementation study (English translations appended to the online version of the article as supplementary material). An initial assessment of item functionality was performed using descriptive statistics and item discrimination for both tools. The patient responsiveness scale's internal consistency was confirmed by calculating Cronbach's alpha coefficient and inter-item correlations. In addition, for the patient responsiveness scale, the number of factors to retain was based on Kaiser criterion, parallel analysis and Cattell's scree test and the number of items was optimized as guided by iterative exploratory factor analysis (EFA). RESULTS: Acceptability of both tools was high. An adherence index of 39 items was developed. After five EFA iterations, four items were removed, resulting in a reliable, 12-item, two-factor patient responsiveness scale, explaining 53.9% of total variance. CONCLUSIONS: Two tools for measuring implementation fidelity, an adherence index and a patient responsiveness scale, have been developed and tested. Future assessment, in particular to establish criterion validity, is recommended.

Identification of validated questionnaires to measure adherence to pharmacological antihypertensive treatments.

BACKGROUND: Low adherence to pharmacological treatments is one of the factors associated with poor blood pressure control. Questionnaires are an indirect measurement method that is both economic and easy to use. However, questionnaires should meet specific criteria, to minimize error and ensure reproducibility of results. Numerous studies have been conducted to design questionnaires that quantify adherence to pharmacological antihypertensive treatments. Nevertheless, it is unknown whether questionnaires fulfil the minimum requirements of validity and reliability. The aim of this study was to compile validated questionnaires measuring adherence to pharmacological antihypertensive treatments that had at least one measure of validity and one measure of reliability. METHODS: A literature search was undertaken in PubMed, the Excerpta Medica Database (EMBASE), and the Latin American and Caribbean Health Sciences Literature database (Literatura Latino-Americana e do Caribe em Ciências da Saúde [LILACS]). References from included articles were hand-searched. The included papers were all that were published in English, French, Portuguese, and Spanish from the beginning of the database's indexing until July 8, 2013, where a validation of a questionnaire (at least one demonstration of the validity and at least one of reliability) was performed to measure adherence to antihypertensive pharmacological treatments. RESULTS: A total of 234 potential papers were identified in the electronic database search; of these, 12 met the eligibility criteria. Within these 12 papers, six questionnaires were validated: the Morisky-Green-Levine; Brief Medication Questionnaire; Hill-Bone Compliance to High Blood Pressure Therapy Scale; Morisky Medication Adherence Scale; Treatment Adherence Questionnaire for Patients with Hypertension (TAQPH); and Martín-Bayarre-Grau. Questionnaire length ranged from four to 28 items. Internal consistency, assessed by Cronbach's α, varied from 0.43 to 0.889. Additional statistical techniques utilized to assess the psychometric properties of the questionnaires varied greatly across studies. CONCLUSION: At this stage, none of the six questionnaires included could be considered a gold standard. However, this revision will assist health professionals in the selection of the most appropriate tool for their individual circumstances.

Prevalencia y factores asociados al insomnio y mala calidad de sueño en pacientes con VIH/SIDA en Sevilla, España / Prevalence and associated factors to insomnia and poor sleep in patients with HIV/AIDS at Seville, Spain

Antecedentes: La mala calidad de sueño puede tener un impacto negativo sobre la calidad de vida de lapoblación en general, y en pacientes VIH+ puede influir negativamente sobre la adherencia del tratamientoantirretroviral. A pesar de ello, hay pocos trabajos que hayan estudiado la cantidad de personas con VIH/SIDA que padecen este trastorno del sueño. Objetivos: Determinar la prevalencia y factores asociadosal insomnio y mala calidad de sueño en un grupo de pacientes con VIH+ en España. Método: Estudioobservacional descriptivo trasversal. En el estudio se incluyó a pacientes mayores de 18 años diagnosticadoscon VIH/SIDA pertenecientes al programa de Atención Farmacéutica del servicio de farmaciadel Hospital Virgen de Valme de Sevilla (España). Todos los pacientes completaron el Pittsburgh SleepQuality Index para medir la calidad de sueño, y el Insomnia Severity Index para medir la gravedad delinsomnio. Los factores asociados con la calidad de sueño fueron determinados mediante una regresiónlogística multivariante. Por su parte, los factores asociados a la gravedad del insomnio fueron estudiadosmediante una regresión lineal multivariante. Resultados: Se incluyó 188 pacientes con una edad mediade 45 años (desviación estándar DE = 8,4). El 78,7% fueron hombres. El recuento medio de CD4+ fue609,3 (DE = 318,0), y de CD8+ fue 868,7 (DE = 446,7). La media del PSQI fue de 7,0 (DE = 4,6), y105 (55,9%) pacientes fueron clasificados como malos dormidores (PSQI > 5). La puntuación mediaobtenida en el ISI fue 7,3 (DE = 9,1). En los buenos dormidores la puntuación media fue de 1,3 (DE =2,3) y en los malos dormidores fue de 12,0 (DE = 9,7) (p < 0,001). En los malos dormidores, el 40,9%tuvieron insomnio moderado o grave. La correlación entre la puntuación del PSQI y el ISI fue 0,775 (p< 0,001). Variables como adherencia, género, edad, recuento de CD4 ó CD8 no estuvieron relacionadascon el trastorno del sueño...

Background:Poor sleep quality could have a negative impact on quality of life in general population, and in HIV-infected patients could have a negative influence on adherence to antiretroviral treatment. However,only a few researches have studied the amount of patients VIH-infected that have this sleep disorder.Objective: To determine the prevalence and associated factors of poor sleep quality and insomnia in HIV+ patients in Spain.Method: Cross-sectional study.Subjects aged 18 or older diagnosed with HIV/AIDS and that were participating in a pharmaceutical care program of the Virgen de Valme Hospital of Seville (Spain) were included. All patients completed the Pittsburgh Sleep Quality Index to measure sleep quality and Insomnia Severity Index to measure severity of insomnia. Associations of factors with sleep quality were determined by multivariate logistic regression. On the other hand, associations of factors with severity of insomnia were found by means of multivariate linear regression.

Predictors of the community pharmacy white-coat effect in treated hypertensive patients. The MEPAFAR study.

OBJECTIVE: To determine whether age, gender, body mass index (BMI), community pharmacy blood pressure (CPBP), daytime ambulatory BP (ABP) variability, treatment compliance, number of anti-hypertensive drugs and smoking status are factors associated with the community pharmacy white-coat effect (CPWCE) in treated hypertensive patients. SETTING: Eight community pharmacies in Gran Canaria, Spain. METHOD: A cross-sectional study was carried out from June 2008 to June 2009. The study included treated hypertensive patients older than 18 years. Patients were excluded if: systolic BP (SBP)/diastolic BP (DBP) ≥ 200/110 mmHg, not-recommended or unable to perform home BP measurements, changes in anti-hypertensive treatment <4 weeks, history of cardiovascular disease <6 months or pregnancy. Blood pressure (BP) was measured by a community pharmacist at 4 visits to the community pharmacy and using ABP monitoring (24 h). MAIN OUTCOME MEASURE: The CPWCE was calculated as the difference between the mean BP in the community pharmacy and daytime ABP. Independent predictors of the CPWCE were identified using multivariate linear regression analysis. RESULTS: Two hundred thirteen patients agreed to participate in the study. After exclusion and withdrawal, 169 patients were included in the analysis. Multiple linear regression analysis for systolic CPWCE revealed only community pharmacy SBP as an independent factor (ß = 0.35; P < 0.001). The regression analysis for diastolic CPWCE revealed female gender (ß = 4.88; P < 0.001), BMI (ß = 0.48; P < 0.001) and community pharmacy DBP (ß = 0.24; P < 0.001) as independent determinants. CONCLUSION: In this sample of treated hypertensive patients, factors such as gender, community pharmacy DBP and BMI were positively associated and may exert an important influence on the magnitude of the diastolic CPWCE. On the other hand, the CPWCE on SBP increased as the community pharmacy SBP increased.

Changes in knowledge after attending a community pharmacists' asthma workshop.

BACKGROUND: Pharmacists can play an important role in both the detection of asthma and its monitoring in patients with asthma. OBJECTIVE: To assess the change in asthma knowledge, and associated variables, of pharmacists attending the "Pharmacotherapy follow- up of Adult Bronchial Asthma" workshops run by the Pharmaceutical Care Center of Stada Laboratories. METHODS: All participants in the "Pharmacotherapy follow-up of Adult Bronchial Asthma" workshops completed a pre-test and a post-test. Those who left the workshop and those who did not complete the tests were not included in the analysis. Tests were scored from 0 to 10, and the change in scores was analyzed. RESULTS: Of the 90 participating pharmacists, 79 fulfilled the inclusion criteria. 81% (64) were female, and their average age was 38.8 years [CI95%= 36.65-40.81]. The average pre-test score was 3.65 [CI95%=3.29-4.01]; 72.2% of the pharmacists scored less than 5 points. The average post-test score was 7.33 [CI95%=7.01-7.65]. The average change in scores was 3.68 [CI95%=3.29-4.07]. No statistical significance was found between this change in scores and other variables analyzed (age, gender, previous training, or position in the pharmacy). CONCLUSION: CAF Stada "Adult Bronchial Asthma" workshops increased pharmacists' general knowledge.