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Resumo O objetivo do artigo é avaliar a prevalência de adesão ao tratamento anti-hipertensivo na população brasileira, com base nos estudos revisados por pares, que utilizaram instrumentos elaborados e/ou adaptados exclusivamente para este fim. Revisão sistemática com meta-análise, baseada nas recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca foi realizada nas bases BDENF, SciELO, Cuiden, PsycINFOe, CINAHL, Embase, LILACS, MEDLINE, e nos buscadores acadêmicos AgeLine, Google Scholar e ScienceDirect. O protocolo foi registrado no PROSPERO (CRD42021292689). Modelos de efeitos aleatórios foram usados para meta-análise das prevalências obtidas dos estudos individuais. Incluíram-se 104 estudos na meta-análise sobre tratamento anti-hipertensivo na população brasileira, totalizando 38.299 pacientes. O instrumento mais utilizado foi o teste de Morisky-Green de quatro itens (49,5%). A prevalência de adesão estimada pela foi de 44,4% (IC95%: 39,12%-49,94%, I2 = 91,17, p < 0,001), apresentando alta heterogeneidade. A prevalência de adesão ao tratamento anti-hipertensivo encontrada nos estudos nacionais foi insatisfatória, demonstrando que essa problemática continua sendo um grande desafio.
Abstract This article aims to evaluate the adherence to antihypertensive treatment prevalence in the Brazilian population based on peer-reviewed studies which used instruments exclusively designed and/or adapted for this purpose. A systematic review with meta-analysis based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was carried out in the BDENF, SciELO, Cuiden, PsycINFOe, CINAHL, Embase, LILACS, and MEDLINE databases, as well as the AgeLine, Google Scholar and ScienceDirect academic search engines. The protocol was registered with PROSPERO (CRD42021292689). Random effects models were used for a meta-analysis of the prevalence obtained from individual studies. A total of 104 studies were included in the meta-analysis on antihypertensive treatment in the Brazilian population, totaling 38,299 patients. The most used instrument was the four-item Morisky-Green Test (49.5%). The adherence prevalence estimated by the meta-analysis was 44.4% (95%CI: 39.12%-49.94%, I2 = 91.17, p < 0.001), showing high heterogeneity. The adherence to antihypertensive treatment prevalence found in national studies was unsatisfactory, demonstrating that this problem continues to be a major challenge.
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A series of systematic, criterion-based drug evaluation known as Drug utilization review are conducted on a regular basis to ensure that medication is utilized appropriately. It’s a mean of learning more about the issues brought on by drug usage, if done properly, may help to solve the issues. Medication adherence generally refers to a patient’s ability to take prescription drugs as directed and their continued use of those drugs. The increasing body of research linking medication non adherence to unfavorable outcomes and increased healthcare cost has raised concerns among clinicians, healthcare institutions, and other stakeholders. Pharmacovigilance, in which the procedures keeping an eye on the assessing adverse medication reactions, is essential to clinical practice, public health and efficient drug regulating system. Aim of the study was wo study about the role of pharmacist in drug utilization review, medication adherence and pharmacovigilance.
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resumen Introducción: Se sabe que la falta de adherencia a los medicamentos psiquiátricos tiene consecuencias perjudiciales tanto para los pacientes como para la sociedad. Objetivo: Recopilar información sobre la incidencia de falta de adherencia, los factores y las causas que afectan a la adherencia al tratamiento psicofarmacológico de los pacientes con trastornos mentales graves y persistentes. Métodos: Revisión sistemática de artículos científicos en pacientes adultos (edad > 17 arios), publicados en los últimos 5 años (2015-2020) en bases de datos especializadas como Pub-Med, Scopus, Scielo y BioMed. Se incluyeron artículos de revistas indexadas con factor de impacto > 0,5 en inglés o español, originales, con diseño analítico, prospectivo, retrospectivo, transversal y aleatorizados. Una vez identificados los artículos, se procedió a su análisis, extrayendo la información necesaria para responder las preguntas de investigación. Resultados: Se incluyeron 15 artículos, el 40% (n = 6) publicados en 2020, el 20% (n = 3) realizados en China y el 53,3% (n = 8) de diseño observacional. Se incluyó una población total de 5.837 pacientes, varones el 50,6% (n = 2.955). Reportaron adherencia moderada 10 investigaciones (66,7%). La falta de adherencia varía desde el 7,7 al 60,6%. Los factores que afectan a la adherencia son propios del paciente (edad y sexo) o su red de apoyo familiar, relacionados con la enfermedad o el tratamiento. La principal causa de la falta de adherencia es la ausencia de insight. Conclusiones: La adherencia al tratamiento con psicofármacos es multifactorial. Se debería mejorar el acceso a los servicios de salud mental, poner énfasis en la formación del paciente y aportar mayor conocimiento de la enfermedad mental; la formación y la interacción con el psiquiatra podrían ser intervenciones beneficiosas.
abstract Introduction: It is known that non-adherence to psychiatric medications has harmful consequences for both patients and society. Objective: To collect information on the incidence of non-adherence, and the factors and causes affecting adherence to psychopharmacological treatment in patients with severe and persistent mental disorders. Methods: A systematic review of scientific articles on adult patients (>17 years) published in the last five years (2015-2020) on specialized databases such as PubMed, Scopus, Scielo and BioMed. Original articles from indexed journals with an impact factor>0.5, in English or Spanish, with an analytical, prospective, retrospective, cross-sectional and randomized design were included. Once the articles were identified, they were analyzed, extracting the information necessary to answer the research questions. Results: Fifteen articles were included. Of these, 40% (n = 6) were published in 2020, 20% (n = 3) were produced in China and 53.3% (n = 8) had an observational design. A total of 5,837 patients were included, of which 50.6% were men (n = 2,955), with moderate adherence (n = 10; 66.7%) reported in 10 investigations. Non-adherence varies from 7.7% to 60.6%. The factors that affect adherence are specific to the patient (age and sex), their family support network, and related to the disease or the treatment. The main cause of non-adherence is lack of insight. Conclusions: Adherence to treatment with psychotropic drugs is multifactorial. Access to mental health services should be improved, with an emphasis placed on patient education and providing greater knowledge of mental illness. Interventions to promote education and interaction with the psychiatrist could be beneficial.
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Objetivos: Relatar a experiência do uso do lúdico por meio do painel interativo como estratégia para adesão à terapia antirretroviral em crianças vivendo com HIV para auxiliar na gestão do cuidado. Métodos: Estudo descritivo, com abordagem qualitativa, do tipo relato de experiência, utilizando material educativo, tipo painel interativo, para educação em saúde, no período de 2019 a 2023. A experiência na aplicação da tecnologia envolveu diferentes momentos, como definição do plano terapêutico, conhecimento do público-alvo, construção do painel interativo, implantação do painel interativo. Resultados: Identificou-se que algumas crianças apresentaram resistência em ingerir medicamento diariamente, na tentativa de elaborar formas diferenciadas para estimular crianças e familiares sobre a importância da TARV, como proposta inicial, optou-se por utilizar o lúdico como ferramenta de educação em saúde, assim, ocorreu à construção do painel interativo. Desta forma, o lúdico estimula percepção do indivíduo acerca do mundo e da complexidade deste, de forma simplificada, tornando-o mais inserido em questões complexas. Conclusão: A implementação de estratégias lúdicas educacionais por meio de tecnologias, nos serviços da saúde, pode auxiliar na adesão ao tratamento medicamentoso, melhorando a assistência e a qualidade de vida de crianças com HIV. (AU)
Objectives: Report the experience of using play through the interactive panel as a strategy for adherence to antiretroviral therapy in children living with HIV to assist in care management. Methods: Descriptive study, with a qualitative approach, of the experience report type, using educational material, interactive panel type, for health education, from 2019 to 2023. The experience in applying the technology involved different moments, such as defining the therapeutic plan, knowledge of the target audience, construction of the interactive panel, implementation of the interactive panel. Results: It was identified that some children were resistant to taking medication daily, in an attempt to develop different ways to encourage children and families about the importance of ART, as an initial proposal, it was decided to use play as a health education tool, thus, the construction of the interactive panel took place.In this way, play stimulates the individual's perception of the world and its complexity, in a simplified way, making them more involved in complex issues. Conclusions: The implementation of playful educational strategies, through technology, in health services, can help with adherence to drug treatment, improving care and quality of life for children with HIV. (AU)
Objetivos: Informar la experiencia de utilizar el juego a través del panel interactivo como estrategia de adherencia a la terapia antirretroviral en niños viviendo con VIH para coadyuvar en la gestión del cuidado. Métodos: Estudio descriptivo, cualitativo, del tipo relato de experiencia, utilizándose del material educativo, tipo panel interactivo, para educación en salud, 2019-2023. La experiencia en la aplicación de la tecnología involucró diferentes momentos, como definición del plan terapéutico, conocimiento del público objetivo, construcción del panel interactivo, implementación del panel interactivo. Resultados: Se identificó que algunos niños presentaban resistencia a la toma diaria de medicamentos, en intento de desarrollar diferentes formas de incentivar a los niños y familias sobre la importancia de las TAR, como propuesta inicial se decidió utilizar el juego como herramienta de educación para salud, así se llevó a cabo la construcción del panel interactivo. De esta manera, el juego estimula la percepción que tiene el individuo del mundo y su complejidad, de forma simplificada, involucrándolo más en cuestiones complejas. Conclusiones: La implementación de estrategias educativas lúdicas, por tecnología, en los servicios de salud, puede ayudar con la adherencia al tratamiento farmacológico, mejorando la atención y calidad de vida de los niños con VIH. (AU)
Subject(s)
HIV , Pediatric Nursing , Health Education , Medication AdherenceABSTRACT
Objective: Pemphigus Vulgaris [PV] is a chronic autoimmune disease. Corticosteroids and Immunosuppressants are the main line of treatment. The aim of this study was to evaluate the prescription pattern and patient adherence behavior with therapy. We determined the association between patient adherence and quality of life in patients with pemphigus vulgaris.Methods: A prospective observational study was conducted from February 2020 to May 2021. The age and sex of patients who were diagnosed with PV within 1 mo period and confirmative histopathological findings in Biopsy were included in the study. A total of 35 patients were analyzed and patients were reviewed for medication adherence and quality of life by using MMAS-8 and WHOQOL respectively, monthly till 3 mo after initiation of therapy. Statistical analysis was done by using Epi Info version 7.1.5.Results: Out of 140 prescriptions, vitamin C and zinc were the most common drug prescribed in 129 prescriptions followed by prednisolone prescribed in 128 prescriptions. The average number of drugs per encounter was 8.67. 97.56 % of drugs were prescribed by generic names. No significant improvement was seen in the adherence behavior of patients from 1st follow-up to 3rd follow-up. It was observed that physical, psychological, and environmental domains have significant associations with medication adherence in all 3 follow-up visits.Conclusion: It was concluded that Polypharmacy and inappropriate use of medicines may decrease the adherence behavior of patients to the therapy. Low adherence to pharmacotherapy affects the quality of life in PV patients. This study is beneficial for raising awareness about treatment adherence and also encouraging the development of appropriate interventions.
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Objective: To identify the adherence to therapeutic regimens in patients with chronic kidney disease undergoing hemodialysis (HD). Method: This is a descriptive, cross-sectional study using a quantitative approach developed at an HD center in the south of Minas Gerais, Brazil. The study participants were 51 patients undergoing HD. Personal, socioeconomic, and objective data were collected, and the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ) was applied. The analysis was performed using simple descriptive statistics. Result: The average age was 56.7 years, and 58% of the patients were male. The percentages of non-adherence were diet (35.4%), hemodialysis (21.6%), fluid intake (15.7%), and medication (13.7%). Conclusion: Therapeutic adherence is a complex process that requires constant monitoring by a multidisciplinary team.
Objetivo: Identificar a adesão ao regime terapêutico de pacientes com doença renal crônica em hemodiálise. Método: Trata-se de um estudo descritivo, transversal, com abordagem quantitativa, desenvolvido em um centro de hemodiálise situado no sul de Minas Gerais. Os participantes do estudo foram 51 pacientes em tratamento hemodialítico. Foram coletados dados pessoais, socioeconômicos, objetivos aplicado o "Questionário de avaliação sobre a adesão do portador de doença renal crônica em hemodiálise". A análise foi realizada por meio de estatística descritiva simples. Resultado: A média de idade foi de 56,7 anos e 58% dos pacientes foram do sexo masculino. Os percentuais de não aderência encontrados foram dieta (35,4%), hemodiálise (21,6%), ingestão de líquidos (15,7%) e medicação (13,7%). Conclusão: A adesão terapêutica é um processo complexo, e por isso necessita de acompanhamento constante pela equipe multiprofissional.
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Humans , Male , Female , Middle Aged , Aged, 80 and over , Renal Insufficiency, Chronic , Hemodialysis Units, Hospital , Patient Care Team , Surveys and QuestionnairesABSTRACT
Background: Type 2 diabetes mellitus refers to a group of heterogeneous disorders with the common elements of chronic hyperglycemia. Diabetes medications play a crucial role in lowering blood sugar levels. The study aims to compare medication adherence in patients with type 2 diabetes mellitus from urban and rural areas during pre and post visit. Methods: This pre and post-study was conducted from March to August 2022. A total of 104 participants were enrolled. Details have been obtained through data collection form. Medication adherence was measured using Hill-Bone medication adherence scale, and patient education was provided through leaflet. Results: The study included 54 females and 50 males. The correlation between medication adherence versus disease knowledge and drug knowledge was found out using Pearson’s correlation and the result is statistically significant. The medication adherence was found to be increased by 17.3% and 21.2% in rural and urban areas respectively. Inadequate follow-up and financial barriers were most accounted for medication non-adherence. Conclusions: The majority of type 2 diabetes patients have suboptimal treatment adherence which is associated with poor blood sugar control. We clinical pharmacists can tackle this problem of adherence through quality patient education.
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@#<strong>BACKGROUND</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">There has been a growing prevalence of hypertension and its associated diseases. Medication adherence is one of the primary factors of uncontrolled blood pressure in patients and non-adherence to medication can result in morbidity and mortality for the patient and increased financial strain on the healthcare system. With the wide availability of mobile phones, using short messaging system (SMS) reminders as an intervention has shown promising results in improving medication adherence. The present study aims to see if SMS reminders can help improve medication adherence among hypertensive patients seen in the out-patient department.</p><strong>OBJECTIVE</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">To determine the effect of short messaging system reminders on the medication adherence among hypertensive patients seen in the outpatient department of Cebu South Medical Center (CSMC) in a 12-week trial period.</p><strong>METHODS</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">This was a two-arm parallel group, double blind, randomized clinical trial using short text messaging reminder to hypertensive patients conducted last October 4, 2023 to December 27, 2023 at CSMC Outpatient Clinic under Family Medicine Service. A two-part questionnaire composed of baseline clinical variables and the Hill-bone Medication Adherence Scale (HBMAS) (Kim, et al 2000) was utilized pre- and post-intervention. STATA Software was used to analyze the date with intention to treat analysis. Descriptive statistics was computed for dichotomous variables while continuous variables were expressed as means and measured before and after intervention. The mean HB-MAS scores pre intervention and post-intervention per group were compared using the Wilcoxon signed rank test, while scores between intervention and control groups pre- and post-intervention were analyzed using the Wilcoxon rank-sum test with 95% confidence intervals (CIs), with two-sided p values reported and statistical significance set up at p < 0.05.</p><strong>RESULTS</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">A total of 102 patients were enrolled in the study (51 in intervention group and 51 in control group) with no dropouts. There was no significant difference between the baseline and post intervention medication adherence scores in both the intervention and control groups, however, there was a significant difference of the scores between the intervention and control groups post intervention (p = 0.001). There was also noted improvement of the blood pressure among participants in the intervention group, with lower blood pressures post-intervention on average (120/80 mmHg) compared to baseline (130/90 mmHg), while participants in the control group still exhibited high blood pressure (130/90 mmHg) post-intervention.</p><strong>CONCLUSION</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">Given the widespread availability of mobile devices and the increased awareness generated by social media, it may be easier to put interventions in place that improve drug adherence. Through the use of easily accessible technology, this study helps patients remember to take their prescription by offering straightforward reminders that can help them overcome these obstacles to medication adherence.</p>
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Medication AdherenceABSTRACT
@#<strong>BACKGROUND</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">Hypertension is one of the top causes of death globally. Among Filipinos with hypertension, only 27% have their condition under control with treatment.</p><strong>OBJECTIVE</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">To determine the level of medication adherence of chronic hypertensive adult patients in Cebu South Medical Center.</p><strong>METHODS</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">Descriptive cross-sectional study, conducted at Cebu South Medical Center from June to September 2023, to 63 participants via complete enumeration using a validated two-part questionnaire that asked for patient demographics and the Hill-Bone Medication Adherence Scale adapted into Bisaya. Descriptive statistics were used.</p><strong>RESULTS</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">Out of the sixty-three (63) patients who participated in the study, there were only nine adherent respondents (30%), while the remaining majority (70%) were non adherent. The demographics showed that education and occupational background were likely to affect medication adherence. Gender had no significant effect on the level of medication adherence.</p><strong>CONCLUSION</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">Medication non-adherence is common and prevalent among adults with chronic hypertension seen in Cebu South Medical Center. Education and occupational background affect non-adherence. Together with Local Government Units promotion of proper education on disease process and proper implementation of medical adherence, strengthening medication assistance and guidance for income-generating activities could improve adherence.</p>
Subject(s)
Hypertension , Medication AdherenceABSTRACT
Objective:To investigate the efficacy of recombinant human interferon α-2b spray, administered under medication guidance, in the clinical treatment of herpangina.Methods:A total of 76 children with herpangina who were treated at The First People's Hospital of Yongkang between October 2020 and October 2022 were included in this study. Using the random number table method, these patients were randomly assigned to an observation group ( n = 42) and a control group ( n = 34). The control group received conventional treatment, whereas the observation group was administered recombinant human interferon α-2b spray under medication guidance. A comparative analysis was conducted between the two groups, evaluating clinical efficacy, inflammatory factor levels, treatment compliance, and the negative conversion rate of throat swab virology. Results:After treatment, the overall response rate of the observation group [95.24% (40/42)] and treatment compliance [97.62% (41/42)] were significantly higher than those of the control group [76.47% (26/34), 79.41% (27/34), χ2 = 4.27, 4.82, P = 0.040, 0.030]. The levels of C-reactive protein [(6.28 ± 1.64) mg/L], white blood cell count [(6.11 ± 1.10) × 10 9], and serum amyloid A [(3.47 ± 0.89) mg/L] in the observation group were significantly lower than those in the control group [(7.51 ± 1.16) mg/L, (7.51 ± 1.16) × 10 9, (7.82 ± 1.30) mg/L, t = 3.69, 6.46, 17.27, all P < 0.001]. The positive conversion rate of throat swab virology in the observation group [4.76% (2/42)] was lower than that in the control group [26.47% (9/34), χ2 = 5.51, P = 0.190]. Conclusion:The use of recombinant human interferon α-2b spray under medication guidance in the treatment of herpangina can improve treatment compliance, rapidly alleviate clinical symptoms, and significantly improve the prognosis.
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AIM: To evaluate medication adherence among patients taking topical intraocular pressure(IOP)lowering treatment and ascertain if there are differences in medication adherence between patients treated by a glaucoma specialist and those who are followed up by a general ophthalmologist. Furthermore, to identify multiple obstacles contributing to poor adherence.METHODS: Cross-sectional survey study was conducted among a total of 54 patients, recruited from October 2020 to February 2021, who were using topical ocular hypotensive medication. Subjects completed a personalized questionnaire which was developed to evaluate medication adherence and its barriers.RESULTS: Approximately 60% of our subject population were not completely adherent to topical treatment. Pearson's Chi-squared test demonstrated that there was no significant association between adherence and being followed up by a glaucoma specialist or not(χ2=1.2468, P=0.5361). Furthermore, 43% of participants expressed having problems with eyedrop instillation and Logistic regression analysis revealed that those subjects were significantly more likely to be low adherent to treatment(β&#xEE;=3.168, P=0.0367).CONCLUSION: The questionnaire was effective to evaluate medication adherence to topical IOP lowering treatment and its barriers. The medication adherence rate found in this study was remarkably low, so several strategies must be put into practice to deal with the most common obstacles related to poor adherence.
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OBJECTIVE To evaluate the medication adherence of patients with hypertension in medication consultation clinics， and to analyze its influencing factors. METHODS The data of 389 patients who visited the medication consultation clinics of our hospital from June 2021 to June 2023 were collected. Univariate and multivariate Logistic regression analysis were used to analyze the related factors affecting medication adherence of hypertensive patients or those receiving different types of drugs. RESULTS Among 389 patients with hypertension， 302 cases （77.63%） had good adherence. Multivariate Logistic analysis showed that higher education level [corrected OR＝2.25， 95%CI （1.29， 3.93）， P＝0.004] was positively correlated with medication adherence， average blood pressure level [corrected OR＝0.19， 95%CI （0.10， 0.37）， P＜0.001]， without complication [corrected OR＝0.47， 95%CI（0.26，0.84），P＝0.010] and antihypertensive drug regimen being free dose combination [corrected OR＝0.27，95%CI（0.15， 0.47）， P＜0.001] were negatively correlated with adherence. Results of univariate Logistic regression analysis showed that patients who used β-receptor blocking agents [OR＝1.65，95%CI（1.06，2.57），P＝0.027]， calcium channel blockers [OR＝2.13，95%CI（1.33， 3.42），P＝0.002] and agents acting on the renin-angiotensin system [OR＝2.04，95%CI（1.29，3.22），P＝0.002] had good medication adherence. CONCLUSIONS The medication adherence of hypertension patients needs to be improved. Hypertension patients with higher education level， lower average blood pressure level， complications and fixed-dose combination regimen and those who use agents acting on the renin-angiotensin system， calcium channel blockers and β-receptor blocking agents may have better medication adherence.
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Objective@#To investigate the characteristics of schizophrenic patients using long-acting antipsychotic medications, so as to provide the basis for applicable population of long-acting antipsychotic medications.@*Methods@#Data of schizophrenic patients using long-acting antipsychotic medications in Shanghai City from June 2020 to June 2022 were collected through Shanghai Mental Health Information Management System, and demographic characteristics, illness and medication use of patients were descriptively analyzed.@*Results@#A total of 2 684 schizophrenic patients using long-acting antipsychotic medications were included in the study, had a mean age of (46.92±12.39) years, with 1 246 males (46.42%) and 1 438 females (53.58%). There were 1 397 unemployed cases, accounting for 52.05%; 1 429 cases with an educational level in junior high school or below, accounting for 53.24%; 1 301 unmarried cases, accounting for 48.47%; 832 cases in poverty, accounting for 31.00%. The caregivers of patients were mainly their parents, with 1 507 cases accounting for 56.15%. The courses of illness were mainly ≤10 years and >10-20 years, with 860 cases each, both accounting for 32.04%; 1 963 cases with incomplete self-awareness, accounting for 73.14%; 1 570 cases hospitalized at least once, accounting for 58.49%. There were 2 486 cases with continuous medication, accounting for 92.62%. The main method of taking medication was given by others, with 1 947 cases accounting for 72.54%. The medication adherence was mainly taking medication on time and in the right amount, with 2 437 cases accounting for 90.80%.@*Conclusion@#The main characteristics of schizophrenic patients using long-acting antipsychotic medications are young, unmarried, and unemployed adults, with incomplete self-awareness, continuous medication and medication given by others.
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Background: Schizophrenia is a major psychiatric disorder affecting physical, psychosocial, and cognitive functioning. Treatment includes pharmacological and psychotherapeutic interventions. Adherence to prescribed medication is critical but reportedly low, because of side effects, failure to understand instructions, a lack of insight about the condition, cognitive deficits, and financial difficulties. Interventions to promote adherence to medication are required. This study introduced a treatment buddy to provide the patient with virtual support in adherence to medication. Aim: The aim of this study was to explore the participants' lived experiences of a treatment buddy support. Setting: A specialised psychiatric clinic in a resource-constrained district of KwaZulu-Natal, South Africa. Methods: A qualitative study design, using semi-structured one-on-one interviews, was used to collect in-depth data from 24 participants, suffering from schizophrenia and who had been offered virtual treatment buddy support for 6 months. Data were analysed using thematic analysis. Results: The intervention improved adherence to medication. Participants indicated that the text messages served as reminders to take their medication daily. An alleviation of associated problems such as sleeping difficulties was observed. Participants were willing to encourage other patients suffering from schizophrenia to join 'treatment buddy services'. Conclusion: The virtual treatment buddy support increased awareness of the importance to adhere to antipsychotic medications among patients suffering from schizophrenia and helped to resolve other schizophrenia-related problems experienced by the participants. Contribution: The study has provided a supportive intervention that can be utilised by mental health institutions to address poor adherence to medication by patients suffering from schizophrenia.
Subject(s)
Medication Adherence , Mental Disorders , Patients , COVID-19ABSTRACT
Abstract Background In view of the high prevalence of hypertension and the importance of adequate drug therapy in the prevention of complications, it is necessary to know the adherence to drug treatment in this population. Objective To verify adherence to antihypertensive drug treatment in Brazilian patients with hypertension using the Morisky-Green Test (MGT), relating it with demographic data. Methods Prospective, observational, multicenter, national registry study, with 2,578 hypertensive patients participating in study I, the Brazilian Cardiovascular Registry of Arterial Hypertension (I-RBH), recruited in the five regions of Brazil. The analyses carried out on the data were descriptive statistics, qui-square tests, ANOVA, and logistic regression, adopting 5% as the significance level for the tests. Results The research shows that 56.13% of patients in the sample were female; 56.71% were elderly (≥ 65 years); 55.86% were White; 52.37% were from the Southeast Region; and 59.74% were non-adherent. Logistic regression showed an independent relationship between patients' age, ethnicity, and region with medication adherence. Conclusion Adherence to treatment is the key to reducing high rates of cardiovascular complications. The study brings a successful outcome in the relationship between the factors ethnicity, age, and region of patients with hypertension and medication adherence. To this end, it is necessary to understand these factors, considering systematic evaluation in the care of patients with hypertension and other chronic non-communicable diseases. This study is a significant contribution to multidisciplinary teams, as it highlights which risk factors interfere with medication adherence, incorporating better strategies in health education.
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ABSTRACT Background: Monoclonal antibodies have proven efficacy in the management of several conditions and infliximab (IFX) is one of the most important drugs of the class. Some recent data have shown low rates of both persistence and adherence to several available biologics. Objective: The objective of this study was to describe adherence and persistence rate to IFX treatment and also persistence in the patient support program (PSP), among patients diagnosed with inflammatory bowel diseases (IBD) or rheumatic diseases (RD) enrolled in the program of a large pharmaceutical company in Brazil. Methods: Retrospective observational analysis using the PSP database. IBD or RD patients using IFX enrolled on the PSP database between September 2015 and August 2019 were retrospectively evaluated to identify the persistence rate and adherence and followed up until March 1, 2020. Patients were excluded if treatment start date was prior to program entry; first infusion prior to September 1st, 2015 or after August 31st, 2019; the patients did not started treatment; and patients with "OTHERS" in "Indication" field. Persistence was assessed considering both persistence in the program ("PSP persistence") and persistence on IFX in the PSP ("IFX persistence in the PSP"). PSP persistence was defined as the proportion of patients remaining in the program at 6, 12, 24, 36 and 48 months after initiating IFX. To determine IFX persistence in the PSP, censoring was defined at the time the patient left the program, died, or was lost to follow-up. Adherence to treatment was measured by medication possession ratio ((MPR) - All days supply / elapsed days from first prescription to last day of medication possession)). Descriptive statistics were initially used. Kaplan-Meier curve, the median time estimated by the survival function, Cox regression model, and restricted mean survival time (RMST) were used to evaluate the treatment persistence time at 24 months and the logistic regression model was performed aiming to identify variables associated with adherence (MPR ≥80%). Results: A total of 10,233 patients were analyzed, 5,826 (56.9%) with the diagnosis of RD and 4,407 (43.1%) of IBD. At the end of the follow-up (median 9.1 months from PSP entry to the last infusion), persistence in the PSP was 65.6%, 48.2%, 31.0%, 20.7% and 13.1% at 6, 12, 24, 36 and 48 months, respectively. Considering persistence on IFX in the PSP, estimates were 93.7%, 87.8%, 77.0%, 62.4% and 53.0% at 6, 12, 24, 36 and 48 months, respectively. Variables associated with the risk of non-persistence were gender, country region and diagnosis of rheumatoid arthritis and ankylosing spondylitis. Median MPR was 94.2%, while the percentage of patients with MPR ≥80% was 91.0%. Variables associated with MPR≥80% were country region and diagnosis of Crohn's disease. Conclusion: Many patients leave the program without discontinuing IFX, since the 12-month persistence were very different between program and medication estimates, while high adherence rates were observed among patients enrolled in the PSP. Data highlights the benefits of a PSP.
RESUMO Contexto: Os anticorpos monoclonais têm eficácia comprovada no manejo de diversas condições e o infliximabe (IFX) é um dos medicamentos mais importantes da classe. Alguns dados recentes demonstram baixas taxas de persistência e adesão a vários dos biológicos disponíveis. Objetivo: O objetivo deste estudo foi descrever a adesão e persistência ao tratamento com IFX e a persistência no programa de suporte ao paciente (PSP), entre pacientes diagnosticados com doenças inflamatórias intestinais (DII) ou doenças reumáticas (DR) inscritos no PSP de uma grande indústria farmacêutica no Brasil. Métodos: Análise observacional retrospectiva utilizando o banco de dados do PSP. Pacientes com DII ou DR usando IFX inscritos no banco de dados do PSP entre setembro de 2015 e agosto de 2019 foram avaliados retrospectivamente para identificar a taxa de persistência e adesão e acompanhados até 1º de março de 2020. Os pacientes foram excluídos se a data de início do tratamento fosse anterior à entrada no programa; primeira infusão antes de 1º de setembro de 2015 ou após 31 de agosto de 2019; o paciente não iniciou o tratamento; e pacientes com "OUTROS" no campo "indicação". A persistência foi avaliada considerando tanto a persistência no programa ("persistência PSP") quanto a persistência em uso de infliximabe no PSP ("persistência IFX no PSP"). A persistência no PSP foi definida como a proporção de pacientes que permaneceram no programa aos 6, 12, 24, 36 e 48 meses após o início do IFX. Para determinar a persistência do IFX no PSP, a censura foi definida quando o paciente deixou o programa, morreu ou perdeu o acompanhamento. A adesão ao tratamento foi medida pela razão de posse do medicamento (MPR)): todos os dias de fornecimento / decorridos da primeira prescrição ao último dia de posse do medicamento). A estatística descritiva foi inicialmente utilizada. A curva de Kaplan-Meier, o tempo mediano estimado pela função de sobrevida, o modelo de regressão de Cox e o tempo de sobrevida médio restrito (RMST) foram utilizados para avaliar o tempo de persistência do tratamento em 24 meses e o modelo de regressão logística foi realizado para identificar variáveis associadas à adesão (MPR ≥80%). Resultados: Foram analisados 10.233 pacientes, 5.826 (56,9%) com diagnóstico de DR e 4.407 (43,1%) de DII. Ao final do seguimento (mediana de 9,1 meses desde a entrada no PSP até a última infusão), a persistência no PSP foi de 65,6%, 48,2%, 31,0%, 20,7% e 13,1% aos 6, 12, 24, 36 e 48 meses, respectivamente. Considerando a persistência no IFX no PSP, as estimativas foram de 93,7%, 87,8%, 77,0%, 62,4% e 53,0% aos 6, 12, 24, 36 e 48 meses, respectivamente. As variáveis associadas ao risco de não persistência foram sexo, região do país e diagnóstico de artrite reumatoide e espondilite anquilosante. A mediana do MPR foi de 94,2%, enquanto o percentual de pacientes com MPR ≥80% foram de 91,0%. As variáveis associadas a MPR ≥80% foram região do país e diagnóstico de doença de Crohn. Conclusão: Muitos pacientes abandonam o programa sem interromper o IFX, pois a persistência em 12 meses foi muito diferente entre as estimativas do programa e da medicação, enquanto altas taxas de adesão foram observadas entre os pacientes inscritos no PSP. Os dados destacam os benefícios de um PSP.
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Resumo Objetivo Analisar a associação entre a adesão à terapia medicamentosa com nível de entendimento e complexidade da prescrição, bem como avaliar a concordância entre dois questionários de adesão aplicados a pessoas idosas polimedicadas. Método Trata-se de estudo transversal, com pessoas idosas atendidas no ambulatório de geriatria de um hospital universitário do Rio de Janeiro, Brasil. Nesses pacientes foi avaliado a adesão à terapia medicamentosa (Brief Medication Questionarie - BMQ e Instrumento de Avaliação da Atitude frente à tomada de remédios - IAAFTR), o conhecimento sobre os medicamentos prescritos e a complexidade da farmacoterapia. Para análise estatística foram utilizados testes qui-quadrado e exato de Fisher sendo considerado o nível de significância de p-valor ≤0,05. A concordância entre os dois métodos de adesão foi avaliada pelo índice Kappa. Resultados Dos 49 idosos entrevistados, 75,5% eram mulheres, hipertensão arterial (82%) e diabetes (37%) as doenças mais prevalentes. Observou-se pelos testes BMQ e IAAFTR que 35% e 45% dos pacientes, respectivamente, eram aderentes a terapia medicamentosa. Não houve concordância de resultado entre os métodos de adesão. Grande parte dos pacientes apresentou bom nível de informação sobre seus medicamentos, porém, a maioria deles foi considerada não aderente. Não foi observado associação estatisticamente significativa entre a complexidade da prescrição frente a adesão e ao nível de informação sobre medicamentos. Conclusão A adesão a terapia medicamentosa é um processo multifatorial e as ferramentas de avaliação de adesão e de outros fatores que a influência deve ser criteriosamente escolhida de acordo com a população de estudo, pois em nosso trabalho elas apresentaram respostas diferenciadas.
Abstract Objective To analyze the association between medication therapy adherence and level of understanding and complexity of the prescription, as well as to assess the agreement between two adherence questionnaires administered to polymedicated older adults. Method This is a cross-sectional study involving older adults attending the geriatrics outpatient clinic at a university hospital in Rio de Janeiro, Brazil. In these patients, medication therapy adherence (assessed using the Brief Medication Questionnaire - BMQ and the Instrument for Assessing Attitudes Toward Medication Taking - IAAFTR), knowledge about prescribed medications, and pharmacotherapy complexity were evaluated. Statistical analysis was conducted using Chi-square tests and Fisher's Exact test, with a significance level set at p-value ≤ 0.05. The agreement between the two adherence methods was assessed using the Kappa index. Results Of the 49 interviewed older adults, 75.5% were women, with arterial hypertension (82%) and diabetes (37%) being the most prevalent conditions. According to the BMQ and IAAFTR tests, 35% and 45% of patients, respectively, were adherent to medication therapy. There was no agreement in the results between the adherence methods. A large proportion of patients exhibited a good level of information about their medications; however, the majority of them were considered non-adherent. No statistically significant association was observed between prescription complexity and adherence, nor between the level of medication information and adherence. Conclusion Medication therapy adherence is a multifactorial process, and the assessment tools for adherence and other influencing factors should be carefully chosen according to the study population, as they exhibited different responses in our work.
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ABSTRACT Purpose: To determine the relationship of ocular surface disease, the number of glaucoma medications prescribed and its influence on treatment adherence. Methods: In this cross-sectional study, demographic data of patients with glaucoma were collected, and patients completed the ocular surface disease index questionnaire and the glaucoma treatment compliance assessment tool. Ocular surface parameters were assessed by "Keratograph 5M." Patients were stratified into two groups according to the amount of prescribed ocular hypotensive eye drops (Group 1, one or two classes of medications; Group 2, three or four classes) Results: In total, 27 eyes of 27 patients with glaucoma were included: 17 using 1 or 2 topical medications (Group 1) and 10 eyes using 3 or 4 classes (Group 2). For the Keratograph assessment, patients using ≥3 medications had significantly smaller tear meniscus height (0.27 ± 0.10 vs. 0.43 ± 0.22; p=0.037). The analysis of Ocular Surface Disease Index questionnaire showed higher scores among the groups using more hypotensive eye drops (18.67 ± 13.53 vs. 38.82 ± 19.72; p=0.004). Regarding the glaucoma treatment compliance assessment tool, Group 2 had worse scores in components of forgetfulness (p=0.027) and barriers due to lack of drops (p=0.031). Conclusion: Patients with glaucoma using more hypotensive eye drops had worse tear meniscus height and ocular surface disease index scores than those using fewer topical medications. Patients using three or four drug classes had worse predictors of glaucoma adherence. Despite worse ocular surface disease results, no significant difference in self-reported side effects was found.
RESUMO Objetivo: Determinar a relação entre doença da superfície ocular (OSD), número de medicamentos prescritos para o glaucoma, e como isso influencia na adesão ao tratamento. Métodos: Neste estudo transversal, pacientes com glaucoma foram submetidos à coleta de dados demográficos, preenchimento do questionário Ocular Surface Disease Index e do Glaucoma Treatment Compliance Assessment Tool. Os parâmetros da superfície ocular foram avaliados pelo "Keratograph 5M". Indivíduos foram estratificados em 2 grupos de acordo com a quantidade de colírios hipotensores oculares prescritos (Grupo 1: uma ou duas classes de medicamentos; Grupo 2: três ou quatro classes). Resultados: No total, 27 olhos de 27 pacientes com glaucoma foram incluídos: 17 usando 1 ou 2 medicamentos tópicos (Grupo 1) e 10 olhos usando 3 ou 4 classes (Grupo 2). Na avaliação do Keratograph, os pacientes em uso de 3 ou mais medicamentos apresentaram altura do menisco lacrimal significativamente menor (0,27 ± 0,10 vs. 0,43 ± 0,22; p=0,037). Análise do questionário OSDI mostrou escores mais altos entre o grupo que usou mais colírios hipotensores (18,67 ± 13,53 vs. 38,82 ± 19,72; p=0,004). Em relação ao Glaucoma Treatment Compliance Assessment Tool, o Grupo 2 apresentou piores escores nos componentes de esquecimento (p=0,027) e barreiras por falta de colírios (p=0,031). Conclusão: O estudo demonstrou que pacientes com glaucoma usando mais colírios hipotensivos apresentaram piores escores de altura do menisco lacrimal e Ocular Surface Disease Index, em comparação com aqueles que usaram menos medicamentos tópicos. Pacientes em uso de 3 ou 4 classes de colírios tiveram piores preditores de adesão ao glaucoma. Apesar dos piores resultados de doença da superfície ocular, não houve diferença significativa nos efeitos colaterais relatados.
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Abstract Background Therapeutic adherence is a decisive issue on chronic disease management in patients requiring long-term pharmacotherapy, such as Parkinson's disease (PD). Although it is well known that socioeconomic factor is a barrier to medication adherence in many chronic diseases, its impacts on PD still need to be investigated. Objective Explore what and how socioeconomic factors impact medication adherence in people with PD. Methods We carried out a scoping review across three databases to identify studies exploring what and how socioeconomic factors impact medication adherence in people with PD considering eight attributes: 1. educational level, 2. disease-related knowledge, 3. income, 4. cost of medication, 5. drug subsidy (meaning presence of subsidies in the cost of medication), 6. employability, and 7. ethnicity (black, indigenous, immigrants). Results Of the 399 identified studies (Embase = 294, Medline = 88, LILACS = 17), eight met inclusion criteria. We identified factors covering the eight attributes of socioeconomic impact, and all of them negatively impacted the medication adherence of people with PD. The most prevalent factor in the studies was low patient educational level (four studies), followed by costs of medications (three studies), income (three studies), and disease-related knowledge (three studies). Distinctly from most of the studies selected, one of them evidenced suboptimal adherence in individuals receiving the medication free of charge, and another one could not find correlation between suboptimal adherence and educational level. Conclusion Socioeconomic factors negatively impact medication adherence in PD patients. This review provides basis for developing patient and population-based interventions to improve adherence to treatment in PD.
Resumo Antecedentes A adesão à medicação é um componente crucial no manejo correto da doença de Parkinson (DP) e, embora esteja bem estabelecido que o fator socioeconômico é uma barreira à adesão medicamentosa em muitas doenças crônicas, seus impactos na DP ainda precisam ser investigados. Objetivo Explorar quais são e como os fatores socioeconômicos afetam a adesão à medicação em pessoas com DP. Métodos Realizamos uma revisão de escopo em três bases de dados para identificar estudos que explorassem quais e como os fatores socioeconômicos impactam na adesão à medicação em pessoas com DP, considerando oito atributos: 1. nível educacional, 2. conhecimento relacionado à doença, 3. renda, 4. custo de medicamentos, 5. subsídio de medicamentos (ou seja, presença de subsídios no custo dos medicamentos), 6. empregabilidade e 7. etnia (negra, indígena, imigrantes). Resultados Dos 399 estudos identificados (Embase = 294, Medline = 88, LILACS = 17), oito preencheram os critérios de inclusão. Identificamos fatores que abrangem os oito atributos de impacto socioeconômico e todos impactaram negativamente na adesão medicamentosa de pessoas com DP. Foram mais prevalentes o baixo nível educacional do paciente (quatro estudos), custos dos medicamentos, nível de renda e conhecimento relacionado à doença (três estudos cada). Diferentemente da maioria dos estudos selecionados, um deles evidenciou adesão subótima em indivíduos que receberam a medicação gratuitamente, e outro não encontrou correlação entre adesão subótima e nível educacional. Conclusão Fatores socioeconômicos impactam negativamente a adesão ao tratamento medicamentoso em pessoas com DP. Esta revisão fornece base para o desenvolvimento de intervenções baseadas em pacientes e populações no intuito de melhorar a adesão ao tratamento farmacológico de pessoas com DP.
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Abstract Objectives: to analyze the choice and continuation rate of contraceptive methods in women with sickle cell disease (SCD). Methods: an exploratory prospective study was conducted at a hospital enrolling 44 women with SCD aged 15-40 years old. After contraceptive counseling, the women selected one of the available contraceptive methods and separated into two groups, and were followed up at one, three, six, and 12 months. To analyze the continuation rate of contraceptive use, the two groups were: group (G1) using progestin-only contraceptives, through any route of administration and group (G2) using other contraceptive methods (combined hormonal and non-hormonal contraceptives). The continuation rate was analyzed using Kaplan-Meier survival analysis, considering a p<0.05. Results: after contraceptive counseling, most women opted for any progestin-only methods: injectable contraceptives (n=18; 40.9%), oral contraceptives (n=7; 15.9%), or intrauterine devices (n=3; 6.8%). The continuation rate decreased in both groups during the 12-months follow-up period. In the G1, the continuation rate was 60.7% (CI95%=40.4-76.0), while that in the G2 was 68.7% (CI95%= 40.5-85.6) with no significant difference between the groups (p=0.641). Conclusions: the overall continuation rates in both groups were satisfactory. No significant difference in the continuation rate of contraceptive methods was observed between the groups, although most women preferred progestin-only methods.
Resumo Objetivos: analisar a escolha e a taxa de continuação do uso de métodos contraceptivos em mulheres com doença falciforme (DF). Métodos: foi realizado um estudo prospectivo exploratório em um hospital, no qual foram incluídas 44 mulheres com DF com idade entre 15 e 40 anos. Após aconselhamento contraceptivo, as mulheres selecionaram um dos métodos contraceptivos disponíveis e foram separadas em dois grupos, sendo acompanhadas por um, três, seis e 12 meses. Para analisar a taxa de continuação do uso de métodos contraceptivos, os dois grupos foram: grupo (G1) que utilizou apenas contraceptivos de progestágeno, por qualquer via de administração e grupo (G2) que utilizou outros métodos contraceptivos (contraceptivos hormonais combinados e não hormonais). A taxa de continuação foi analisada pela análise de sobrevida de Kaplan-Meier, considerando um p<0,05. Resultados: após aconselhamento contraceptivo, a maioria das mulheres optou por algum dos métodos contendo apenas progestágeno: contraceptivos injetáveis (n=18; 40,9%), contraceptivos orais (n=7; 15,9%) ou dispositivos intrauterinos (n=3; 6,8%). A taxa de continuação diminuiu em ambos os grupos durante o período de acompanhamento de 12 meses. No G1, a taxa de continuação foi de 60,7% (IC95%= 40,4-76,0), enquanto no G2 foi de 68,7% (IC95%= 40,5-85,6) sem diferença significativa entre os grupos (p=0,641). Conclusões: as taxas gerais de continuação em ambos os grupos foram satisfatórias. Não foi observada diferença significativa na taxa de continuação dos métodos contraceptivos entre os grupos, embora a maioria das mulheres tenha preferido métodos somente com progestágeno.