Medication Adherence and its Predictors in Community Elderly Patients with Hypertension

BACKGROUND: Medication adherence is important for hypertension management but still stay low level. It is reasonable method to classify medication nonadherence into intentional nonadherence and unintentional nonadherence and manage it according to this categories. This study aimed to explore medication adherence and its predictors in community patients with hypertension, especially dividing into intentional nonadherence and unintentional nonadherence. METHODS: Study subjects included 1,988 patients who were prescribed hypertension drugs among 2012 community health survey subjects of 10 cities in Gyeongsangnamdo and we analyzed medication adherence with hypertension and its predictors. We conducted chi-square test for nominal variable and ANOVA test for continuous variable and use multinominal regression to analyze independent predictors of intentional nonadherence and unintentional nonadherence in contrast to medication adherence. RESULTS: Of the 1,988 patients, 49.7% were adherent, 26.1% were unintentionally nonadherent and 24.2% intentionally nonadherent. Independent predictors of unintentional nonadherence were depressive symptoms (odds ratio [OR]=1.696, P=0.047) and arthritis (OR=1.319, P=0.030) and independent predictors of intentional nonadherence were cardiocerebrovascular disease (OR=1.464, P=0.044), self-efficacy (OR=0.984, P=0.007), beliefs about medications questionnaire (necessity [OR=0.834, P<0.001] and concern [OR=1.236, P<0.001]). CONCLUSIONS: In order to manage hypertension in community, improvement in medication adherence is needed. Depressive symptom and self-efficacy need to be managed, but especially patients'beliefs about their medication need to be considered to improve intentional nonadherence.

Physical disability, perceived dependence and depression in women with osteoarthritis / 農村醫學 地域保健

OBJECTIVE: This study assessed whether both physical disability and perceived dependence relate to depression or whether perceived dependence in personal care activities, household activities, community mobility and recreational activities is an intermediate step in the relationship between physical disability and depressive symptoms. METHODS: Data come from a cross-sectional survey of 209 women, aged 55 or older, with osteoarthritis (OA). Mediation analyses occurred in four step and included logistic regression analyses as outlined by Baron & Kenny. RESULTS: The results from step 1 showed that greater difficulty with each domain of physical disabilities was significantly related to greater perceived dependence. In step 2, greater perceived dependence was significantly associated with greater depressive symptoms in all domains. Step 3 analyses showed that greater physical disabilities in each domain were significantly associated with depression. The final step testing mediation indicated that personal care activities, household activities and community mobility were fully mediated by perceived dependence. That was, once dependence was taken into account, the relationship between physical disabilities and depression was no longer significant. Partial mediation was found for dependence and recreational activity limitations. CONCLUSION: It is important to take into account the experience of perceived dependence as a mediator in understanding the relationship between disability and depression in the domains of personal care, household, and community mobility. To conclude, these findings point to the importance of taking into account an individual's reaction to their disability rather than just focusing on the severity of disability.