Effect of SMS reminders to medication adherence among hypertensives in an outpatient clinic: A 12-week two-arm, parallel group randomized clinical trial

@#<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>

Level of medication adherence among chronic hypertensive adults seen at the outpatient clinics of Cebu South Medical Center from June to September 2023: A cross-sectional study

@#<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>

Level of medication adherence and associated factors among patients with type 2 diabetes mellitus at Cebu South Medical Center family medicine outpatient clinic: A cross-sectional study

@#<strong>BACKGROUND</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">Diabetes mellitus type 2 (T2DM) is one of the leading chronic conditions that greatly impacts Filipino families. Medication non-adherence is a significant challenge in achieving optimal treatment outcomes for individuals with this condition.</p><strong>OBJECTIVE</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">This study determined the level of medication adherence and explored the associated factors contributing to nonadherence among patients with T2DM at Cebu South Medical Center (CSMC) Family Medicine outpatient clinic.</p><strong>METHOD</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">A cross-sectional study was done in CSMC Family Medicine outpatient clinic from August to October 2023. A selfadministered questionnaire divided into three domains of non-adherence was adopted. Means, frequencies, and percentages were used to analyze level of adherence, sociodemographic and clinical factors. Logistic regression analysis was used to determine association of factors to medication non-adherence.</p><strong>RESULTS</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">There was a total of 69 participants. Overall, there was partial adherence to T2DM medications. There was a high prevalence of partial adherence (39.1%) in the cost-related non-adherence (CRNA) domain. Factors that showed non-significant increased odds of non-adherence included older age (AOR 1.363, 95% CI 0.345-5.386), female sex (AOR 1.544, 95% CI 0.386-6.176), low income (AOR 1.05, 95% CI 0.352-3.135), increased frequency of daily medication intake (AOR 1.436, 95% CI 0.44-4.664), and less than 10 years duration of T2DM (AOR 1.99, 95% CI 0.46-8.637).</p><strong>CONCLUSION</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">Adherence to diabetes medication may be affected by medication costs and financial status as reflected in the overall partial adherence, the high prevalence of partial adherence in CRNA domain, and the increased odds of non-adherence with low income. More studies should be done to investigate other possible contributing factors for non adherence to diabetes medication such as diabetes knowledge, patient’s self efficacy, and healthcare provider communication.</p>

Experiences of schizophrenia patients with treatment buddy support during the COVID-19 pandemic

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.

Estratégias educativas em saúde para pessoas vivendo com HIV: revisão de escopo / Estrategias educativas en salud para personas que viven con el VIH: revisión de alcance / Health educational strategies for people living with HIV: scoping review

Resumo Objetivo Mapear a produção científica sobre as estratégias educativas e os conteúdos abordados na educação de pessoas vivendo com HIV. Métodos Esta é uma revisão de escopo em que a seleção dos artigos foi realizada em abril de 2021 e atualizada em outubro de 2022 em dez fontes de dados; a revisão seguiu os pressupostos estabelecidos pelo Joanna Briggs Institute e o checklist dos Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Os resultados foram analisados descritivamente e sintetizados em um quadro. Resultados Foram selecionados 17 estudos com publicação predominante em 2017; Estados Unidos da América e Brasil foram os países com a maior quantidade de produções. A maioria dos estudos buscou avaliar o impacto e a eficácia das estratégias e desenvolver ou validar instrumentos de educação em saúde e atividades de prevenção. Em relação ao conteúdo abordado pelas estratégias, foram formadas cinco categorias: orientação inicial sobre HIV/AIDS, cuidados gerais, vida saudável, saúde sexual e suporte emocional. As estratégias educativas que se destacaram em relação à maior adesão dos pacientes ao tratamento estão relacionadas com o desenvolvimento de sistemas, programas e multimídia. As cartilhas promoveram empoderamento e autonomia de pessoas vivendo com HIV. Conclusão Foram mapeadas as principais estratégias educativas, com destaque para cartilhas, material impresso, recursos multimídia, sistemas, formulários e oficinas/workshops, abordando orientação inicial sobre HIV/AIDS, tratamento farmacológico, cuidados gerais, vida saudável, saúde sexual e suportes social e emocional.

Resumen Objetivo Mapear la producción científica sobre las estrategias educativas y los contenidos abordados en la educación de personas que viven con el VIH. Métodos Esta es una revisión de alcance, cuya selección de artículos se realizó en abril de 2021 y se actualizó en octubre de 2022 en diez fuentes de datos. La revisión siguió las premisas establecidas por el Joanna Briggs Institute y la checklist de los Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Los resultados fueron analizados descriptivamente y sintetizados en un cuadro. Resultados Se seleccionaron 17 estudios con publicación predominante en 2017. Estados Unidos de América y Brasil fueron los países con mayor cantidad de producciones. La mayoría de los estudios buscó evaluar el impacto y la eficacia de las estrategias y elaborar o validar instrumentos de educación para la salud y actividades de prevención. Con relación al contenido abordado por las estrategias, se formaron cinco categorías: instrucciones iniciales sobre VIH/SIDA, cuidados generales, vida saludable, salud sexual y apoyo emocional. Las estrategias educativas que se destacaron con relación a una mayor adhesión de los pacientes al tratamiento están relacionadas con el desarrollo de sistemas, programas y multimedia. Las cartillas promovieron empoderamiento y autonomía de personas que viven con el VIH. Conclusión Se mapearon las principales estrategias educativas, con énfasis en cartillas, material impreso, recursos multimedia, sistemas, formularios y talleres/workshops, que abordaron instrucciones iniciales sobre VIH/SIDA, tratamiento farmacológico, cuidados generales, vida saludable, salud sexual y apoyo social y emocional. Open Science Framework (OSF): https://osf.io/754uk/?view_only=6491865a3d12424d81af2c4099c112c3

Abstract Objective To map the scientific production on educational strategies and the content covered in the education of people living with HIV. Methods This is a scoping review in which the selection of articles was carried out in April 2021 and updated in October 2022 in ten data sources; the review followed the assumptions established by the Joanna Briggs Institute and the checklist of Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The results were descriptively analyzed and summarized in a chart. Results A total of 17 studies were selected, predominantly published in 2017; The USA and Brazil were the countries with the largest number of productions. Most studies sought to evaluate the impact and effectiveness of strategies and develop or validate health education instruments and prevention activities. Concerning the content covered by the strategies, five categories were formed: initial guidance on HIV/AIDS, general care, healthy living, sexual health, and emotional support. The educational strategies that stood out concerning greater patient adherence to treatment are related to the development of systems, programs, and multimedia. The booklets promoted empowerment and autonomy for people living with HIV. Conclusion The main educational strategies were mapped, with emphasis on booklets, printed material, multimedia resources, systems, forms, and workshops, covering initial guidance on HIV/AIDS, pharmacological treatment, general care, healthy living, sexual health, and social and emotional support. Open Science Framework (OSF): https://osf.io/754uk/?view_only=6491865a3d12424d81af2c4099c112c3

Fatores associados a adesão e barreiras a terapêutica medicamentosa: relação com o apoio social em idosos / Factors associated with medication adherence and therapeutic barriers: relationship with social support in the elderly / Factores asociados a la adherencia a la medicación y barreras terapéuticas: relación con el apoyo social en ancianos

Objetivo: associar a adesão e as barreiras da terapêutica medicamentosa com o apoio social em idosos. Método: estudo transversal e analítico, realizado em um ambulatório na cidade de São Paulo ­ SP, com 117 idosos, no período de março a novembro de 2019. Para coleta de dados foram utilizados o teste de Morisky Green (TMG) e a escala Brief Medical Questionnaire, e a Medical Outcomes Study. A correlação entre as variáveis foi realizada pelo teste de Kruskal-Wallis e o teste de Mann-Whitney. Em todas as análises comparativas foi utilizado um nível de significância de 5% e intervalo de confiança de 95%. Resultados: idosos que possuem apoio social na dimensão emocional e de informações apresentaram menores barreiras na adesão dos medicamentos (p=0,0216). Conclusões:esses resultados têm implicações importantes para a prática clínica, pois, os idosos mais vulneráveis com baixo apoio social possuem maiores barreiras ao uso da medicação

Objective: to associate adherence and barriers to medication therapy with social support in the elderly. Method: cross-sectional and analytical study, carried out in an outpatient clinic in the city of São Paulo ­ SP, with 117 elderly people, from March to November 2019. The Morisky Green test (TMG) and the Brief scale were used to collect data Medical Questionnaire, and the Medical Outcomes Study. The correlation between variables was performed using the Kruskal-Wallis test and the Mann-Whitney test. In all comparative analyzes a significance level of 5% and a confidence interval of 95% were used. Results: elderly people who have social support in the emotional and informational dimensions presented lower barriers to medication adherence (p=0.0216). Conclusions: these results have important implications for clinical practice, as the most vulnerable elderly people with low social support have greater barriers to using medication

Objetivos: asociar la adherencia y barreras a la terapia con medicamentos con el apoyo social en ancianos. Método: estudio transversal y analítico, realizado en un ambulatorio de la ciudad de São Paulo ­ SP, con 117 ancianos, de marzo a noviembre de 2019. Se utilizó la prueba de Morisky Green (TMG) y la escala Brief para recolectar datos del Cuestionario Médico y el Estudio de Resultados Médicos. La correlación entre variables se realizó mediante la prueba de Kruskal-Wallis y la prueba de Mann-Whitney. En todos los análisis comparativos se utilizó un nivel de significancia del 5% y un intervalo de confianza del 95%. Resultados: los ancianos que cuentan con apoyo social en las dimensiones emocional e informacional presentaron menores barreras para la adherencia a la medicación (p=0,0216). Conclusiones: estos resultados tienen implicaciones importantes para la práctica clínica, ya que las personas mayores más vulnerables y con bajo apoyo social tienen mayores barreras para el uso de medicamentos

Contribuições dos enfermeiros no processo de adesão ao tratamento da tuberculose / Contributions of nurses in the process of adherence to tuberculosis treatment

Objetivo: Identificar as contribuições de enfermeiros no processo de adesão ao tratamento da tuberculose. Métodos: Revisão integrativa nas bases de dados Cumulative Index toNursing and Allied Health Literature, Medline completeEbsco, PubMed Central, Science Direct,Scopuse Web of Sciencea partir da utilização dos descritores Patient Compliance, Medication adherence, Treatment adherence and compliance, Tuberculosise Nurse's Role. Resultados: A partir dos artigos que compuseram a amostra final, as contribuições de enfermeiros no processo de adesão que emergiram consistiram em aconselhamento, visitas domiciliares, uso de tecnologias e de programas, tais como o Tratamento Diretamente Observado, supervisão por vídeo e suporte social. Conclusão: O enfermeiro é um profissional que contribui na implementação desses métodos. O uso de tecnologia sem fio adicionada aos métodos eletrônicos é promissor e pode significar um grande avanço, uma vez que a supervisão direta não vem se mostrando viável e factível em diversas realidades. Descritores: Tuberculose; Cooperação do Paciente; Adesão à Medicação; Enfermagem; Saúde Pública

Objective: To identify the contributions of nurses in the process of adherence to tuberculosis treatment. Methods: Integrative review in the Cumulative Index to Nursing and Allied Health Literature, Medline complete Ebsco, PubMed Central, Science Direct, Scopus and Web of Science databases using the descriptors Patient Compliance, Medication adherence, Treatment adherence and compliance, Tuberculosis and Nurse's Role. Results: From the articles that composed the final sample, the contributions of nurses in the adherence process that emerged consisted of counseling, home visits, use of technologies and programs such as Directly Observed Treatment, video supervision and social support. Conclusion: Nurses are professionals who contribute to the implementation of these methods. The use of wireless technology added to electronic methods is promising and can mean a great advance, since direct supervision has not been economically viable and feasible in several realities.Descriptors:Tuberculosis; Patient cooperation; Adherence to medication; Nursing; Public health

Acesso a medicamentos anti-hipertensivos pelos usuários de uma unidade ambulatorial / Antihypertensive drugs access by users of ambulatory unit

Objetivo: caracterizar o acesso aos medicamentos anti-hipertensivos pelas pessoas com hipertensão arterial atendidas em uma unidade ambulatorial. Metodologia: estudo descritivo, quantitativo, desenvolvido com 103 pessoas com hipertensão arterial em uso de anti-hipertensivos. Os dados foram coletados por meio de questionário com perguntas sociodemográficas, sobre tratamento e acesso aos medicamentos anti-hipertensivos. Utilizou-se a estatística descritiva e teste qui-quadrado de Pearson ou exato de Fisher para análise dos dados. Resultados: Predominou a faixa etária de 50-69 (68,9%), sexo feminino (85,4%) e raça/cor autodeclarada preta (46,6%). Quanto ao acesso aos anti-hipertensivos, 70,9% relataram ter acesso gratuito, 60,2% os obtêm nas unidades de saúde, 65,7% não referiram dificuldades na aquisição e 86,4% que tinham acesso total. Todos os participantes que tinham dificuldade econômica também tinham dificuldade de acesso aos anti-hipertensivos. Verificou-se associação significativa entre a dificuldade de acesso aos anti-hipertensivos com forma de acesso (total ou parcial), quantidade de drogas e disponibilidade do medicamento nas farmácias (p<0,005). Conclusão: observou-se que, embora a maioria dos participantes do estudo não encontre dificuldades para obtenção dos anti-hipertensivos nas farmácias das unidades básicas de saúde, ainda assim, existe uma parcela da população sem acesso total aos anti-hipertensivos de forma gratuita, sendo essencial melhorias dos programas de fornecimento de medicamentos.

Objective: to characterize access to antihypertensive drugs by patients with arterial hypertension treated at an ambulatory unit. Methodology: descriptive, quantitative study, developed with a group of 103 people with arterial hypertension currently using antihypertensive drugs. The data were collected through a questionnaire with sociodemographic questions, with respect to treatment and access to antihypertensive drugs. Descriptive statistics and Pearson's chi-square test or Fisher's exact test were used for data analysis. Results: the age group 50-69 (68.9%), female (85.4%) and black self-declared race (46.6%) predominated. Regarding access to antihypertensive drugs, 70.9% reported having free access, 60.2% obtained them at health units, 65.7% did not mention difficulties in acquiring them and 86.4% that had full access. All participants who had economic difficulties also had difficulty accessing antihypertensive drugs. It was identified a significant association between difficulty in accessing antihypertensive drugs and the means of access (total or partial), quantity of drugs and availability of the drug in pharmacies (p<0.005). Conclusion: it was observed that, that most of the study participants did not find it difficult to obtain antihypertensive drugs in the pharmacies of basic health units, notwithstanding, there is a portion of the population without full access to antihypertensive drugs free of charge, improvements in drug supply programs are essential.

Polifarmácia e adesão medicamentosa em idosos no âmbito da atenção básica de saúde: estudo transversal / Polypharmacy and drug adherence in the elderly in the context of primary health care: cross-sectional study

OBJETIVO: Avaliar a adesão medicamentosa em idosos que fazem o uso de polifarmácia no âmbito da Atenção Básica. MÉTODO: Estudo transversal de caráter quantitativo. A amostra foi constituída por 231 idosos. RESULTADOS: Dos 231 idosos que participaram do estudo 36,4% eram do sexo masculino e 63,6% do sexo feminino. A média de idade observada foi de 73,4 (± 8,7) anos. Houve uma diferença estatisticamente significativa entre as variáveis "sexo", "quantidade de medicamentos" e "possui cuidador". Ademais, observou-se a correlação estatística positiva entre a idade e a quantidade de medicamentos utilizada pelo idoso. A prevalência de polifarmácia identificada foi de 16,0%. A maior parte dos usuários de múltiplos fármacos apresentaram adesão ao tratamento (86,5%). CONCLUSÃO: Presume-se a necessidade de uma maior investigação da relação entre o cuidador e a quantidade medicamentos utilizados pelos idosos, além da capacitação profissional para o manejo da polifarmácia.

OBJECTIVE: To evaluate drug adherence in elderly people who use polypharmacy in the context of primary care. METHOD: Cross-sectional study of quantitative character. The sample consisted of 231 elderly. RESULTS: Of the 231 elderly who participated in the study, 36.4% were male and 63.6% were female. The mean age observed was 73.4 (± 8.7) years. There was a statistically significant difference among the variables "sex", "quantity of drugs" and "has caregiver". In addition, a positive statistical correlation was observed between age and the amount of drugs used by the elderly. The prevalence of polypharmacy identified was 16.0%. Most users of multiple drugs showed adherence to treatment (86.5%). CONCLUSION: It is assumed the need for a greater investigation of the relationship between the caregiver and the amount of medicines used by the elderly, in addition to professional training for the management of polypharmacy.

Severity and factors associated with depressive symptoms among type 2 diabetic patients in Vietnam / Journal of the ASEAN Federation of Endocrine Societies

Background@#Diabetes and psychiatric disorders often co-occur. The prevalence of depression in a person with diabetes is two times higher than that of the general population. During the last decade, the prevalence of diabetes in Vietnam has nearly doubled. However, there is little data regarding depressive symptoms among people with diabetes. Therefore, this study aims to explore the level of depressive symptoms and its associated factors among patients with type 2 diabetes mellitus in Hanoi, Vietnam.@*Methodology@#A cross-sectional study was conducted among 519 patients diagnosed with type 2 diabetes at the Agricultural General Hospital, one of the largest primary care hospitals for diabetes in Hanoi, Vietnam. Patient Health Questionnaire-9 (PHQ-9) was used to assess the severity of depressive symptoms. Multivariate Tobit and logistic regression models were applied to examine factors associated with the severity of depressive symptoms and medication adherence@*Results@#Approximately 45.2% of participants were identified as having depressive symptoms at different levels. The proportion of patients with mild, moderate, moderately severe, and severe depressive symptoms is 36.0%, 7.6%, 1.4%, and 0.2% respectively. Regarding the treatment process, patients being treated for their diabetes for a longer time were more likely to have depressive symptoms. DDepression was positively linked to currently drinking alcohol (Coef = 1.04; 95% CI = 0.30-1.78), having comorbidities (Coef = 1.08; 95% CI = 0.15; 2.01) and having irregular physical activities (Coef = -1.28; 95% CI = -2.18; -0.38). Patients with severe depressive symptoms (higher PHQ-9 score) were more likely to be non-adherent to their medications in the last month (AOR = 1.30; 95% CI = 1.17; 1.46).@*Conclusion@#Our study shows that a high percentage of patients with diabetes have depressive symptoms. There is a strong association between having depressive symptoms and non-adherence to medications in the last month. To reduce the risk of developing depressive symptoms, depression should be screened at the initial treatment process and patients should be advised to avoid alcohol and to engage in physical activities regularly.

An analytical cross-sectional study on the correlation between patient-doctor relationship and medication adherence of hypertensive Filipinos aged 40-65 in greater Manila Area during the COVID-19 pandemic / The Health Sciences Journal

INTRODUCTION@#Hypertension is a key modifiable risk factor for myocardial infarction and stroke, yet medication adherence remains low. The ongoing COVID-19 pandemic has further complicated the management of chronic diseases like hypertension. This study aimed to explore the correlation between the patient-doctor relationship and medication adherence among hypertensive Filipinos aged 40-65 years in the Greater Manila Area during the pandemic.@*METHODS@#A cross-sectional study was conducted involving 131 hypertensive Filipino participants. Data were collected through an online survey, assessing participant demographic and medical profiles, medication adherence using the Hill-Bone Compliance Scale (HBCS), and the patient-doctor relationship using the Physician-Doctor Relationship Questionnaire-9 (PDRQ-9).@*RESULTS@#Approximately half of the participants demonstrated good adherence to hypertension medication. A weak but significant positive correlation was found between overall medication adherence and the patient-doctor relationship. The duration of anti-hypertensive drug intake also showed a weak positive correlation with medication adherence. Factors such as comorbidities and type of consultation did not significantly impact medication adherence.@*CONCLUSION@#This study emphasizes the significance of the patient-doctor relationship in medication adherence among hypertensive Filipinos during the COVID-19 pandemic. Enhancing communication and trust between patients and physicians can potentially improve medication adherence and overall disease management.

Medication adherence and health-related quality of life amongst HIV patients receiving care at umuebule cottage hospital, etched, Rivers State

HIV treatment is available, free, and accessible for individuals who are infected. The study is aimed at determining the levels of medication adherence and health related quality of life (HRQOL) among HIV patients receiving care at Umuebule Cottage Hospital, Etche, Rivers State.Method: This cross-sectional study recruited 430 adult clients who have been on ART for at least one year using a convenient sampling method. An average of 10 patients visits the facility on clinic days. After explaining the purpose of study and obtaining consent,patients who met the eligibility criteria were recruited on each clinic day for a period of 12 weeks, until the sample size was reached. Data was collected using semi-structured interviewer administered validated questionnaire; Morisky Medication Adherence Questionnaire (MMAS-8) and WHO-Quality of Life-BREF(WHOQOL-BREF), after a pilot study on 30 PLHIV from Okomoko general hospital, Etche. Data was analyzed with IBM-SPSS Version 25. The mean age of respondents was 35.9±10.9 years, 59.3% of the respondents' last viral load was suppressed, 19.1% had low level viremia, while (21.6%) were virally unsuppressed. Medication adherence levels were observed to be good (67.7%), poor (32.3%) respectively, while HRQOL of respondents were found to be poor (56.9%) and good (43.1%).Conclusion:A significant proportion of the respondents adhere to their medication whereas most of them had poor HRQOL. There is need for hospital management to collaborate with social welfare organizations to support PLHIV to set up means of earning to enable them to provide their basic needs for improved HRQOL

Medication Adherence, Barriers to Adherence and Treatment Satisfaction with Antiretroviral Therapy Among Adolescents Living with HIV in Lagos, Nigeria

The advent of antiretroviral therapy (ART) in controlling Human Immunodeficiency Virus (HIV) disease has been quite effective in ensuring that infected people can enjoy healthy, long, and productive lives. Medication adherence is an essential part of patient care, especially among patients with HIV, as it greatly determines the effectiveness of treatment. Few studies have explored factors influencing medication adherence and treatment satisfaction among adults, with little focus on adolescents. Objectives: To assess medication adherence, treatment satisfaction and factors influencing adherence to ART medication among adolescents living with HIV in Lagos, Nigeria. Methods: This descriptive, cross-sectional study was conducted among diagnosed and registered adolescents aged 10-19 years living with HIV and receiving treatment at eight selected antiretroviral centres in Lagos state, Nigeria. A total of 203 adolescents were recruited in stages, and data were collected using an interviewer-administered semi-structured questionnaire. Results: There was a low level of adherence as only 59/203 (29.1%) of the respondents adhered to ART. Depression, perceived stigma, being away from home, side effects of drugs, pill burden, and forgetfulness were some factors identified as barriers to adherence. The respondents were most satisfied with the effectiveness of the medication and least satisfied with the side effects. Conclusions: Medication adherence among adolescents was relatively low; the level of satisfaction with ART medication is an entity that significantly impacts adherence

Adherence to ART drugs among HIV-positive pregnant women at selected hospitals of East Ethiopia

Background: Substance abuse among Human Immune Deficiency Virus-positive patients causes depression, carelessness, and anxiety, which in common results in a decrease in adherence to antiretroviral treatment. The purpose of the study is to assess the prevalence of substance abuse and its association with adherence to ART drugs. Methods: The current study was conducted at three hospitals (Hiwot Fana Comprehensive University Hospital, Dillchora Hospital, and Jugal Hospital) located in East Ethiopia. Bivariate and multivariate logistic regression analysis was used to identify the association of independent variables with the dependent variables. Results: In this study, 119 HIV-positive pregnant patients were included. While 74.8% of the patients were adherent to their medication, the remaining 25.2% were nonadherent. The major reasons for nonadherence to ART medications prescribed were getting better (73.3%) and finishing medication (16.7%). Moreover, 96 (80.7%) respondents abused alcohol while 36 (30.3%) and 75 (35.6%) abused opioids and cigarette smoking, respectively. Mothers who abused alcohol were 38.1 times more likely to be nonadherent to ART medications for PMTCT [AOR = 38.1% CI: 21.47­56.54] compared to their counterparts. Additionally, mothers who abuse opioids were 19 times more likely to be nonadherent to ART treatment medication [AOR = 19, 95% CI: 2.46­ 19.46] than their counterparts. Furthermore, mothers who smoked cigarettes were 43.1 more likely to be nonadherent [AOR = 43.19, 95% CI: 8.42­187.84] than nonsmokers. Unemployment was also found to be associated with nonadherence to ART medication to PMTCT of HIV [AOR = 5.4, 95% CI: 2.8­5.7]. Smoking of marijuana/cannabis/hashish was not significantly associated with nonadherence to ART [AOR = 0.22, 95% CI: 0.084­0.355]. Conclusion: Abuse of alcohol, cigarette smoking, abuse of opioids, and joblessness were found to be significantly associated with nonadherence to ART medications prescribed to PMCT of HIV. Wheareas, smoking of marijuana/cannabis/hashish was not significantly associated with nonadherence to ART medications.

COVID­19 pandemic fatigue among well­educated Egyptian population: cross­sectional study

Aim: The study explores the emergence of COVID 19 pandemic fatigue among well educated Egyptians measured in terms of their level of adherence toward COVID 19 protective measures along 20 months since the beginning of the pandemic. Setting and Design: A cross sectional study was conducted in October 2021, using an online questionnaire for well educated Egyptians in different governorates. Results: A total of 888 participants completed the questionnaire, their mean age was 39 ± 7.2 years and 60% of them were females. There was a strong association between the presence of either behavioral risk factors or chronic conditions and % of infection. The main sources of COVID 19 information were social media, followed by the Egyptian Ministry of health and population and WHO websites. A pandemic fatigue was observed after nearly 7 to 10 months from the pandemic emergence. The participant's age, previous COVID 19 infection, and occupation status were significant predictors for adherence to COVID 19 protective measures. The participants claimed that difficulty in remaining at home, feeling uncomfortable with face masks, the high cost of protective supplies, absence of governmental enforcement, and forgetfulness are the most perceptive barriers hindering their adherence to COVID 19 protective measures. They suggested some strategies for better adherence and reduced pandemic fatigue that includes: the implementation of governmental enforcement measures, including penalties for nonwearing masks, educational health programs, and availability of free protective supplies at the workplace. Conclusions: Pandemic fatigue was observed after 7 to 10 months from the pandemic emergence even though the high education level of the participants

Factors affecting medication adherence of hypertension and diabetes club members in the District Health Centers in the City of Baguio

Background@#Medication adherence is important to mitigate complications of NCDs. Hypertension and diabetes clubs were intended to make essential medications accessible to club members. Despite these efforts, patients avail treatment and management in acute care with noted complications. To address this problem, it is important to identify factors that affect patients’ adherence medication.@*Objectives@#This study aimed to determine the factors affecting adherence to medications of members enrolled in the Hypertension and Diabetes Club in the district health centers in the city of Baguio.@*Methods@#This is a cross-sectional study with a total of 374 respondents from the 16 different district health centers in the City of Baguio, obtained through random sampling. A validated questionnaire was utilized for the collection of data and was presented using percentage and frequency tables. A chi-square test was used to find the association of clinic-demographic data with respondents’ medication adherence.@*Results@#Hypertension and Diabetic Club members overall reported good adherence to medication. Majority of the respondents are female and are older than 61 years old while comorbidities show significant association with level of adherence. On the other hand, lack of finances, feeling that the drug is not effective, multiple medications, taking medications for many years, interference with meal plan, feeling the dose is too high, and complexity of drug regimen are noted to be associated factors for non-adherence.@*Conclusion@#Hypertension and Diabetes Club a community-based management in the City of Baguio shows a good impact on patients’ medication adherence. Comorbidities, chronicity, good family support as well as good physician-patient relationship can positively affect adherence to medications. On the other hand, factors affecting medications non-adherence are: complexity of medications, subjective report that medication is too high, interference to meal, having medications for many years and having multiple medications. Identifying factors affecting adherence and nonadherence are important to decrease further complications of the common NCDs.

Percepções de familiares sobre uma rede de cuidados de saúde mental infantojuvenil / Family perceptions about a children's mental health network / Percepciones familiares sobre una red de atención de salud mental infantojuvenil

Este artigo pretende conhecer como a rede de cuidados em saúde tem se operacionalizado a partir da percepção de familiares de crianças com demanda de cuidado em saúde mental (SM). Foram realizados dois grupos focais, um com familiares da Atenção Básica (AB) e outro com familiares do Centro de Atenção Psicossocial Infantojuvenil (CAPSij), totalizando 15 participantes. Seguiu-se com a análise lexical do tipo classificação hierárquica descendente, com o auxílio do software R Interface, a fim de análises multidimensionais de textos e questionários (IRaMuTeQ), resultando em cinco classes: A Pílula Mágica; Forças e Fraquezas dos serviços; Procurando por ajuda; Aceitando o diagnóstico da criança e Onde procurei ajuda. Os resultados apontam para dificuldades presentes na AB em identificar e manejar situações de Saúde Mental Infantojuvenil (SMIJ), por meio de uma lógica ainda medicalizante. Ressalta-se que a escola é apresentada como lugar de destaque na produção da demanda por cuidado e a família ainda é pouco convocada à construção das ações. Conclui-se, então, que avanços ainda são necessários para operacionalização de um cuidado pautado nas diretrizes da política de SMIJ.(AU)

This article aims to know how the healthcare network has been operationalized from the perception of family members of children with demand for mental health care (MH). Two focus groups were held, one with family members from Primary Care (PC) and the other with family members from the Child Psychosocial Care Center (CAPSij), totaling 15 participants. A lexical analysis of the descending hierarchical classification type was performed with the help of the software R Interface for multidimensional analyzes of texts and questionnaires (IRAMUTEQ), resulting in five classes: The Magic Pill; Strengths and Weaknesses of services; Looking for help; Accepting the child's diagnosis; and Where did I look for help. The results point to difficulties present in PC in identifying and managing situations of mental health in children and adolescents (MHCA), with a medicalization logic. Note that the school is presented as a prominent place in producing the demand for care, and the family is still not very much involved in the actions. It is, thus, concluded that advances are still needed for operationalization of care guided by MHCA policy guidelines.(AU)

Este artículo tuvo por objetivo conocer cómo opera una red asistencial a partir de la percepción de familiares de niños con demanda de atención en salud mental (SM). Se realizaron dos grupos focales, uno con familiares de Atención Primaria (AP) y otro con familiares del Centro de Atención Psicosocial Infantojuvenil (CAPSij), totalizando 15 participantes. Se realizó análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ), lo que resultó en cinco clases: "La píldora mágica"; "Fortalezas y debilidades de los servicios"; "En busca de ayuda"; "Aceptar el diagnóstico del niño" y "¿Dónde busqué ayuda?". Los resultados apuntan las dificultades presentes en AP para identificar y manejar situaciones de salud mental infantojuvenil (SMIJ) mediante una lógica aún medicalizante. La escuela tiene un lugar destacado en la producción de la demanda de cuidados y la familia aún no está muy involucrada en la construcción de acciones. Se concluye que se necesitan avances para ofertar una atención guiada por lineamientos de la política del SMIJ.(AU)

A equipe de saúde diante do paciente não aderente ao tratamento / The health team in face of the patient not adhering to treatment / El equipo de salud ante el paciente que no se adhiere al tratamiento

O objetivo deste estudo foi refletir sobre os efeitos da não adesão ao tratamento para a equipe de saúde e sobre as ações/reações da equipe que podem causar a não adesão ao tratamento. A amostra foi composta por 10 profissionais de saúde. O instrumento de coleta de dados foi uma entrevista semiestruturada. O material coletado foi submetido à análise temática, e discussão foi baseada na psicanálise. Como resultado, verificou-se que os profissionais relacionaram a não adesão às carências percebidas nos pacientes. Também foi identificada a presença de um ciclo de encaminhamentos, o qual, por vezes, significava uma tentativa de eliminar um incômodo (a não adesão), mas, em contrapartida, o causava. Verificou-se também a presença de confusão entre cuidado e controle, produzindo relações permeadas por desconfiança, verificação e correção. Percebeu-se, ainda, relação entre não adesão e frustração, seja porque o tratamento é insuficiente para evitar o sofrimento do paciente, seja pelo desconforto advindo da não cooperação do paciente. Ao final, como efeitos para a equipe, evidenciou-se a presença de profissionais envolvidos por um discurso de frustração, desvalorização e impotência. Como efeitos da equipe, verificou-se que profissionais também podem produzir aquilo de que se queixam, pelos lugares subjetivos que delineiam e cristalizam. A partir disso, problematiza-se o sentido que a não adesão pode assumir, e é importante considerá-la como um sinal que pode revelar os percalços (e as possíveis resoluções) do contrato relacional entre paciente e equipe.(AU)

The objective of this study was to reflect about the effects of non-adherence to the treatment for the health team and about the actions/reactions of the team that may can cause the non-adherence to the treatment. The sample consisted of 10 health professionals. The data collection instrument was a semi-structured interview. The material collected was submitted to thematic analysis, and the discussion was based on psychoanalysis. As a result, it was verified that the professionals related non-adherence to needs perceived on patients. The presence of a referral cycle was also identified, which, sometimes, meant an attempt to eliminate a nuisance (the non-adherence) but, instead, caused it. It was also verified the presence of confusion between care and control, producing relations permeated by distrust, verification, and correction. The link between non-adherence and frustration was also observed, either due to the treatment being insufficient to avoid the suffering of the patient; or by the discomfort from the non-cooperation of the patient. At the end, as effects for the team, professionals involved by a discourse of frustration, devaluation, and impotence were evidenced. As effects of the team, it has been found that professionals can also produce what they complain about, by the subjective places that were delineate and crystallize. Thus, we problematize the meaning non-adherence may assume, and considering it a signal that can reveal the mishaps (and possible resolutions) of the relational contract between patient and team is important.(AU)

El objetivo de este estudio fue reflexionar sobre los efectos de la no adherencia al tratamiento para el equipo de salud y sobre las acciones/reacciones del equipo que pueden causar la no adherencia al tratamiento. La muestra estuvo conformada por diez profesionales de la salud. El instrumento de recolección de datos fue una entrevista semiestructurada. El material recolectado fue sometido a análisis temático, y se utilizó el psicoanálisis para discutir el material. El resultado constató que los profesionales entendieron la no adherencia como una carencia/necesidad de los pacientes. También se identificó la presencia de un ciclo de derivación, que a veces significó un intento de eliminar una molestia (falta de adherencia), pero que puede generar el problema. También se verificó la presencia de confusión entre cuidado y control, produciendo relaciones permeadas de desconfianza, verificación y corrección. También se observó el vínculo entre la no adherencia y la frustración, ya sea porque el tratamiento es insuficiente para evitar el sufrimiento del paciente o por la incomodidad que produce la falta de cooperación del paciente. Al final, como efectos para el equipo, se evidenciaron profesionales envueltos por la frustración, la devaluación y la impotencia. Como efectos del equipo, se constató que los profesionales también pueden producir lo que quejan desde los lugares subjetivos que fueron delineados y cristalizados. Así se discute el sentido que puede asumir la no adherencia, y es importante considerarla como señal de los percances (y posibles resoluciones) del contrato relacional entre paciente y equipo.(AU)