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Medication Adherence and Beliefs About Medication
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Medication Adherence and Beliefs About Medication

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Medication Management".

Deadline for manuscript submissions: closed (31 July 2021) | Viewed by 50371

Special Issue Editors

Dr. Sara Garfield

E-Mail Website
Guest Editor
Imperial College Healthcare NHS Trust, UCL School of Pharmacy, London, UK
Interests: patients' perceptions of medication; factors influencing patients' decisions about treatment; shared decision making; medication adherence; safety and quality of medication use
Special Issues, Collections and Topics in MDPI journals
Dr. Gaby Judah

E-Mail Website
Guest Editor
NIHR North West London Patient Safety Research Collaboration (PSRC), Institute of Global Health Innovation (IGHI), Imperial College London, London, UK
Interests: behaviour change; predictors of health-related behaviours; cancer screening; medication adherence; improving patient safety
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The scope of this Special Issue is to disseminate research evidence on patients’ and carers’ beliefs about and experiences of medicines, including barriers and facilitators to taking medication, and how these might impact medication adherence. The Issue will include research on the development and testing of interventions to increase adherence, particularly when these are grounded in the patient/carer perspective. Research relating to shared decision-making about medicines between patients and healthcare professionals is within the scope of the Issue. 

Submissions may be quantitative, qualitative, or mixed-methods research or reviews that meet established review standards, and data may be from primary or secondary sources. All types of study design will be considered. All healthcare settings, including acute care, long-term care, community and home care, mental health, and primary care will be included. All populations and medical conditions will be considered. 

Dr. Sara Garfield
Dr. Gaby Judah
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Adherence
  • Medicines
  • Shared decision-making
  • Patients
  • Carers
  • Beliefs
  • Attitudes
  • Barriers
  • Facilitators

Published Papers (17 papers)

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Research

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13 pages, 715 KiB  
Article
Validation of an Arabic Version of the Adherence to Refills and Medications Scale (ARMS)
by Ghaida Alammari, Hawazin Alhazzani, Nouf AlRajhi, Ibrahim Sales, Amr Jamal, Turky H. Almigbal, Mohammed A. Batais, Yousif A. Asiri and Yazed AlRuthia
Healthcare 2021, 9(11), 1430; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9111430 - 24 Oct 2021
Cited by 8 | Viewed by 4423
Abstract
Background: Medication non-adherence is a complex multifactorial phenomenon impacting patients with various health conditions worldwide. Therefore, its detection can improve patient outcomes and minimize the risk of adverse consequences. Even though multiple self-reported medication adherence assessment scales are available, very few of them [...] Read more.
Background: Medication non-adherence is a complex multifactorial phenomenon impacting patients with various health conditions worldwide. Therefore, its detection can improve patient outcomes and minimize the risk of adverse consequences. Even though multiple self-reported medication adherence assessment scales are available, very few of them exist in Arabic language. Therefore, the aim of this study was to validate a newly translated Arabic version of the Adherence to Refills and Medications Scale (ARMS) among patients with chronic health conditions. Methods: This is a single-center cross-sectional study that was conducted between October 10th 2018 and March 23rd 2021. ARMS was first translated to Arabic using the forward-backward translation method. The translated scale was then piloted among 21 patients with chronic health conditions (e.g., diabetes, hypertension, etc.…) to examine its reliability and comprehensibility using the test-retest method. Thereafter, the Arabic-translated ARMS was self-administered to adult patients aged ≥18 years with chronic health conditions visiting the primary care clinics of a university-affiliated tertiary care hospital in Riyadh, Saudi Arabia. Construct validity was examined using factor analysis with varimax rotation. Results: Of the 264 patients who were invited to participate, 202 (76.5%) consented and completed the questionnaire. Most of the participants were males (69.9%), married (75.2%), having a college degree or higher (50.9%), retired or unemployed (65.2%), aged ≥ 50 years (65.2%), and are diabetic (95.9%). The 12-item Arabic-translated ARMS mean score was 17.93 ± 4.90, and the scale yielded good internal consistency (Cronbach’s alpha = 0.802) and test-retest reliability (Intraclass correlation coefficient = 0.97). Two factors were extracted explaining 100% of the of the total variance (factor 1 = 52.94% and factor 2 = 47.06%). Conclusions: The 12-item Arabic version of ARMS demonstrated good validity and reliability. Therefore, it should help in the detection of medication non-adherence among Arabic-speaking patient population and minimize the risk of adverse consequences. Full article
(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication)
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9 pages, 1413 KiB  
Article
A New Tool for an Awareness Plan Concerning Critical Issues, Needs and Attitudes of Citizens on the Use of Medicines
by Barbara Pittau, Piergiorgio Palla, Francesca Pettinau and Antonio Mastino
Healthcare 2021, 9(11), 1409; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9111409 - 20 Oct 2021
Cited by 1 | Viewed by 1103
Abstract
This article describes a pilot study to test the adequacy of a newly developed tool for an awareness plan on the importance of properly using pharmaceuticals. The new tool consists of face-to-face interviews with adult citizens on their approach to the use of [...] Read more.
This article describes a pilot study to test the adequacy of a newly developed tool for an awareness plan on the importance of properly using pharmaceuticals. The new tool consists of face-to-face interviews with adult citizens on their approach to the use of medicines and of the following data analysis with a dedicated software application. The pilot study was carried out in a sample area of Sardinia, in Italy. The data from the interviews collected anonymously and analysed in aggregate actually emphasised the critical issues and needs in the use of pharmaceuticals in the sample area involved, also encouraging communication among different actors. The pilot study revealed that the designed tool could represent a novel strategy to stimulate interchanges of information on the proper use of pharmaceuticals with a potential impact on people’s health. Full article
(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication)
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15 pages, 520 KiB  
Article
Self-Efficacy, Social Activity, and Spirituality in the Care of Elderly Patients with Polypharmacy in Germany—A Multicentric Cross-Sectional Study within the HoPES3 Trial
by Noemi Sturm, Regina Stolz, Friederike Schalhorn, Jan Valentini, Johannes Krisam, Eckhard Frick, Ruth Mächler, Joachim Szecsenyi and Cornelia Straßner
Healthcare 2021, 9(10), 1312; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9101312 - 01 Oct 2021
Cited by 5 | Viewed by 3794
Abstract
About one third of Europe’s elderly population takes ≥5 drugs. Polypharmacy increases their risk of adverse drug reactions. To ensure drug safety, innovative approaches are needed. The aim of this cross-sectional study was to explore the relationship between psychosocial factors and medication-related beliefs [...] Read more.
About one third of Europe’s elderly population takes ≥5 drugs. Polypharmacy increases their risk of adverse drug reactions. To ensure drug safety, innovative approaches are needed. The aim of this cross-sectional study was to explore the relationship between psychosocial factors and medication-related beliefs and behaviors. Medication lists of 297 patients were recorded according to the ATC classification. Correlations between the dependent variables, Medication Adherence (MARS) and Beliefs about Medicines (BMQ), and independent variables, General Self-Efficacy (GSE), self-efficacy for managing chronic diseases (SES6G), spiritual needs (SpNQ), patient activity (PAM), loneliness (DJG), and social networks (LSNS), were measured. Patients with higher self-efficacy (OR: 1.113; 95% CI [1.056–1.174]; p < 0.001) or self-confidence in managing their chronic condition (OR: 1.188; 95% CI [1.048–1.346]; p < 0.007) also showed higher adherence. Lonely patients (OR: 0.420; 95% CI [0.267–0.660]; p < 0.001) and those with a need for inner peace (OR: 0.613; 95% CI [0.444–0.846], p = 0.003) were more likely nonadherent. Stronger positive beliefs about medications’ usefulness weakly correlated with higher scores on the SES6G (ρ = 0.178, p = 0.003) and GSES scale (ρ = 0.121, p = 0.042), patient activity (ρ = 0.155, p = 0.010) and functioning social networks scale (ρ = 0.159, p = 0.008). A weak positive correlation was found between loneliness and the belief that drugs were harmful (ρ = 0.194, p = 0.001). Furthermore, interesting correlations were detected regarding the number of medications and overuse beliefs. Psychosocial factors, such as self-efficacy, loneliness, and spiritual needs and medication-related beliefs and behaviors seem to interrelate. Addressing these factors may improve medication management and drug safety. Full article
(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication)
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12 pages, 606 KiB  
Article
What Are the Factors Associated with Nonadherence to Medications in Patients with Chronic Diseases?
by Abdel Qader Al Bawab, Walid Al-Qerem, Osama Abusara, Nimer Alkhatib, Maha Mansour and Robert Horne
Healthcare 2021, 9(9), 1237; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9091237 - 20 Sep 2021
Cited by 9 | Viewed by 3402
Abstract
Introduction: Adherence to medications is very crucial for an optimized clinical outcome in the management of chronic diseases. Beliefs about medications and other factors can significantly affect adherence to chronic medications. The objective of the present research was to identify the associated [...] Read more.
Introduction: Adherence to medications is very crucial for an optimized clinical outcome in the management of chronic diseases. Beliefs about medications and other factors can significantly affect adherence to chronic medications. The objective of the present research was to identify the associated factors of adherence to medication in Jordanian patients with chronic diseases utilizing a stepwise binary logistical regression model. Methods: A cross-sectional study was carried out between November 2018 and March 2020. The participants were reached from secondary and tertiary care setting clinics in Jordan. The recruited patients were asked to report their attitudes of adherence to medications and beliefs about medications via filling out the MARS-5 and BMQ-specific tools. Sociodemographic data were also collected from the recruited patients and included in the regression model. A stepwise binary logistical regression model was applied to identify the associated factors of adherence to chronic medications in the tested sample. Results: A total of 485 patients who met the inclusion criteria were recruited. The mean age of the participants was 57.14 (age ranged from 22 to 82 years). Around 39% of the participants were older than 65 years. Most of the patients were either hypertensive or diabetic (35.7% and 32.2%, respectively). The logistic regression model indicated that necessity beliefs are strongly associated with adherence (OR 4.22), while concerns beliefs, dosage frequency and having medical insurance were negatively associated with adherence (OR 0.73, 0.74 and 0.26, respectively), with a p-value ≤ 0.05. Conclusions: Both the MARS-5 and BMQ-specific questionnaires were applied successfully on the tested sample. Better attention should be paid to the logistic regression model variables that were associated with adherence in order to guarantee optimal treatment outcomes in the treatment of chronic diseases. Full article
(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication)
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15 pages, 1058 KiB  
Article
Exploring Barriers and Facilitators of Adherence to Artemisinin-Based Combination Therapies for the Treatment of Uncomplicated Malaria in Children in Freetown, Sierra Leone
by Kristin Banek, Deborah D. DiLiberto, Emily L. Webb, Samuel Juana Smith, Daniel Chandramohan and Sarah G. Staedke
Healthcare 2021, 9(9), 1233; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9091233 - 18 Sep 2021
Cited by 3 | Viewed by 2525
Abstract
Medication adherence is an essential step in the malaria treatment cascade. We conducted a qualitative study embedded within a randomized controlled trial comparing the adherence to the recommended dosing of two artemisinin-based combination therapies (ACT) to treat uncomplicated malaria in Freetown, Sierra Leone. [...] Read more.
Medication adherence is an essential step in the malaria treatment cascade. We conducted a qualitative study embedded within a randomized controlled trial comparing the adherence to the recommended dosing of two artemisinin-based combination therapies (ACT) to treat uncomplicated malaria in Freetown, Sierra Leone. This study explored the circumstances and factors that influenced caregiver adherence to the ACT prescribed for their child in the trial. In-depth interviews were conducted with 49 caregivers; all interviews were recorded, transcribed, and translated. Transcripts were coded and aggregated into themes, applying a thematic content approach. We identified four key factors that influenced optimal treatment adherence: (1) health system influences, (2) health services, (3) caregivers’ experiences with malaria illness and treatment, and (4) medication characteristics. Specifically, caregivers reported confidence in the health system as facilities were well maintained and care was free. They also felt that health workers provided quality care, leading them to trust the health workers and believe the test results. Ease of medication administration and perceived risk of side effects coupled with caregivers’ prior experience treating malaria influenced how medications were administered. To ensure ACTs achieve maximum effectiveness, consideration of these contextual factors and further development of child-friendly antimalarials are needed. Full article
(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication)
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12 pages, 312 KiB  
Article
Effects of Adherence to Pharmacological Treatment on the Recovery of Patients with Schizophrenia
by Alejandra Caqueo-Urízar, Alfonso Urzúa, Patricio Mena-Chamorro and Josefa Bravo de la Fuente
Healthcare 2021, 9(9), 1230; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9091230 - 18 Sep 2021
Cited by 6 | Viewed by 2315
Abstract
The aim of this study was to evaluate the effects of adherence to antipsychotic treatment on the recovery of patients with schizophrenia in northern Chile. One hundred and fifty-one patients diagnosed with schizophrenia completed the Drug Attitude Inventory (DAI-10), Positive and Negative Syndrome [...] Read more.
The aim of this study was to evaluate the effects of adherence to antipsychotic treatment on the recovery of patients with schizophrenia in northern Chile. One hundred and fifty-one patients diagnosed with schizophrenia completed the Drug Attitude Inventory (DAI-10), Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Recovery Assessment Scale (RAS-24), sociodemographic information, and clinical and treatment characteristics of patients with schizophrenia. Multivariate analysis with multiple linear regression was then performed to identify variables that were potentially associated with the recovery assessment (variable criterion). A significant association was found between adherence to antipsychotic medication and the Willing to Ask for Help dimension of Recovery (β = 0.239, p = 0.005). Association of clinical and socio-demographic variables with recovery were identified: negative symptoms with Personal Confidence and Hope (β = −0.341, p = 0.001) and Goal and Success Orientation (β = −0.266, p = 0.014); cognitive symptoms with Willing to Ask for Help (β = −0.305, p = 0.018) and no domination by symptoms (β = −0.351, p = 0.005); marital status with reliance on others (β = −0.181, p = 0.045); age with Personal Confidence and Hope (β = −0.217, p = 0.021), Goal and Success Orientation (β = −0.296, p = 0.003), and no domination by symptoms (β = 0.214, p = 0.025). Adherence has a positive relationship with personal recovery in this sample of Chilean patients with schizophrenia. Full article
(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication)
18 pages, 681 KiB  
Article
Beliefs about Polypharmacy among Home-Dwelling Older Adults Living with Multiple Chronic Conditions, Informal Caregivers and Healthcare Professionals: A Qualitative Study
by Marion Bieri, María del Río Carral, Marie Santiago-Delefosse, Giorgia Miano, Fanny Rosset, Henk Verloo and Filipa Pereira
Healthcare 2021, 9(9), 1204; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9091204 - 13 Sep 2021
Cited by 4 | Viewed by 2853
Abstract
Although home-dwelling older adults are frequently assisted with polypharmacy management by their informal caregivers, they can still face medication-related problems. Identifying older adults’ and their informal caregivers’ beliefs about medication is a gateway to understanding and improving medication adherence. This study aimed to [...] Read more.
Although home-dwelling older adults are frequently assisted with polypharmacy management by their informal caregivers, they can still face medication-related problems. Identifying older adults’ and their informal caregivers’ beliefs about medication is a gateway to understanding and improving medication adherence. This study aimed to analyse beliefs about polypharmacy among home-dwelling older adults with multiple chronic conditions and their informal caregivers, focusing on their daily medication practices. Semi-structured interviews were conducted with 28 older adults, 17 informal caregivers, but also 13 healthcare professionals. Based on an inductive methodological approach, data were analysed using thematic content analysis. Interviews revealed the different attitudes adopted by older adults and their informal caregivers in relation to the treatment information provided by healthcare professionals. A variety of beliefs were identified and linked to medication adherence by examining daily medication practices. Polypharmacy was experienced as a habit but also an obligation, highlighting some of the strategies and negotiations underlying medication use at home. Collecting viewpoints from multiple stakeholders is an innovative way of accessing and analysing beliefs about polypharmacy. Daily medication practices provided information about medication beliefs and may contribute to developing targeted professional interventions that improve medication adherence. Full article
(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication)
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11 pages, 839 KiB  
Article
Adherence Level to Arterial Hypertension Treatment: A Cross-Sectional Patient Survey and Retrospective Analysis of the NHS Prescription Database
by Anna Gavrilova, Dace Bandere, Konstantīns Logviss, Dins Šmits and Inga Urtāne
Healthcare 2021, 9(8), 1085; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9081085 - 23 Aug 2021
Cited by 3 | Viewed by 2962
Abstract
One of the major problems in cardiology practice is poor adherence to antihypertensive medication. This study aimed to evaluate medication adherence; we also aim to investigate the predictors of intentional and unintentional non-adherence. We issued a survey containing questions about patient demographics, blood [...] Read more.
One of the major problems in cardiology practice is poor adherence to antihypertensive medication. This study aimed to evaluate medication adherence; we also aim to investigate the predictors of intentional and unintentional non-adherence. We issued a survey containing questions about patient demographics, blood pressure control, pharmaceutical care, and adherence level to medication. Retrospective analysis of the prescription database of the National Health Service of the Republic of Latvia was performed. The prevalence of non-adherence was 45.9%. The lowest adherence rate (38.2%) was found among patients taking medication for 2–4.9 years. Even though 84.7% of respondents had a blood pressure monitor at home, only 25.3% of them reported measuring blood pressure regularly. There were differences between the groups of adherent patients in terms of the patients’ net income (p = 0.004), medication co-payments (p = 0.007), and whether the pharmacist offered to reduce the costs of drug therapy (p = 0.002). Roughly half of the prescriptions (50.4%) containing perindopril were purchased by patients from pharmacies. The medication adherence level and blood pressure control at home were assessed as low. Intentionally non-adherent respondents discontinued their medication because of fear of getting used to medicines. The pharmacists’ behaviour in terms of offering to reduce the costs of medications used was influenced by socio-economic factors. Full article
(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication)
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8 pages, 342 KiB  
Article
Resilience of Medication Adherence Practices in Response to Life Changes: Learning from Qualitative Data Obtained during the COVID-19 Pandemic
by Mushfique Ahmed, Carly Wheeler, Bryony Dean Franklin, Rabia Begum and Sara Garfield
Healthcare 2021, 9(8), 1048; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9081048 - 13 Aug 2021
Cited by 2 | Viewed by 2238
Abstract
Nonadherence to medicines is widespread and can adversely affect health outcomes. Previous research has identified that patients develop their own strategies to assist with adherence. However, such research has not focused on how the helpfulness of these strategies may change in response to [...] Read more.
Nonadherence to medicines is widespread and can adversely affect health outcomes. Previous research has identified that patients develop their own strategies to assist with adherence. However, such research has not focused on how the helpfulness of these strategies may change in response to changes in patients’ circumstances. This study aimed to explore resilience of medication adherence to life changes. It involved secondary thematic analysis of the verbatim transcripts of 50 semi-structured interviews that were conducted with adults who were advised to shield or were over the age of 70 during the first wave of the COVID-19 pandemic in the UK. Interview data suggested that resilience of medication adherence varied between participants. Participants either reported that they had not used any specific strategies to remind them to take their medicines prior to the pandemic, that the strategies that they had employed prior to the pandemic remained effective during the pandemic, that they had needed to make some adjustments to the strategies used, or that the strategies they had used were no longer effective. In addition, beliefs about medicines and motivation to take them were altered for some participants. These findings suggest that challenges associated with medication adherence do not always remain stable over time and that healthcare professionals need to continue to monitor and support medication adherence long-term. Full article
(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication)
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18 pages, 288 KiB  
Article
Optimising Medication Use along Dementia Progression: Recommendations from a Qualitative Study
by Dalal Alsaeed, Mine Orlu and Felicity Smith
Healthcare 2021, 9(8), 982; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9080982 - 02 Aug 2021
Cited by 1 | Viewed by 1673
Abstract
Medicines management is known to be an integral part of the role of family caregivers; it also contributes to the burden and stress of caregivers’ experience. As dementia progresses, new challenges arise as a consequence, which negatively affects the ability of people living [...] Read more.
Medicines management is known to be an integral part of the role of family caregivers; it also contributes to the burden and stress of caregivers’ experience. As dementia progresses, new challenges arise as a consequence, which negatively affects the ability of people living with dementia (PLWD) regarding practical decision making and may lead to a change of setting. The aim of this study is to identify and explore changes in medicines management and associated caregiver burden as dementia progresses. To examine medicines management and related issues across severities, a qualitative approach utilising face-to-face and telephone interviews with PLWD and their family caregivers in both the community and care-home setting in London was used. Follow-up interviews with family caregivers were also conducted to gain additional insight into change over time. Eleven family caregivers, ten PLWD, and eight care-home staff were interviewed in 2016. Findings identified how key changes along dementia progression affect medication use. These include changes to caregiver burden, respecting the PLWD’s autonomy and decline in capacity, scheduling and administration, choice of formulation, interactions with and between providers, and information needs. The findings assist in informing recommendations to optimise medication use and alleviate caregiver burden. Full article
(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication)
8 pages, 209 KiB  
Article
Association between Medication Non-Adherence and Increases in Hypertension and Type 2 Diabetes Medications
by Angshuman Gooptu, Michael Taitel, Neda Laiteerapong and Valerie G. Press
Healthcare 2021, 9(8), 976; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9080976 - 31 Jul 2021
Cited by 1 | Viewed by 2373
Abstract
Importance: Medication non-adherence is highly costly and leads to worse disease control and outcomes. However, knowledge about medication adherence is often disconnected from prescribing decisions, and this disconnect may lead to inappropriate increases in medications and higher risks of adverse events. Objectives: [...] Read more.
Importance: Medication non-adherence is highly costly and leads to worse disease control and outcomes. However, knowledge about medication adherence is often disconnected from prescribing decisions, and this disconnect may lead to inappropriate increases in medications and higher risks of adverse events. Objectives: To evaluate the association between medication non-adherence and the likelihood of increases in the intensity of medication regimens for two chronic conditions, hypertension and type 2 diabetes. Design: Cohort Study. Setting and Participants: This study used US national pharmacy claims data for Medicare Part D (ages ≥ 65) and commercial (ages 50–64) plans to evaluate medication adherence and its association with the likelihood of receiving an increase in medication intensity for patients with hypertension and/or oral diabetes medication fills. Patients had an index fill for hypertension (N = 2,536,638) and/or oral diabetes (N = 701,376) medications in January 2015. Medication fills in the follow-up period from August 2015 to December 2016 were assessed for increases in medication regimen intensity. Main Outcome(s) and Measure(s): The proportion of days covered (PDC) over 181 days was used as a measure for patient’s medication adherence before a medication addition, medication increase, or dosage increase. Differences in the likelihood of experiencing an escalation in medication intensity was considered between patients with a PDC < 80% vs. PDC ≥ 80%. Results: Among Medicare Part D and commercial plan patients filling hypertension and/or oral diabetes medications, non-adherent patients were significantly more likely to experience an intensification of their medication regimens (p < 0.001). Conclusions and Relevance: This study found a significant association between non-adherence to medications and a higher likelihood of patients experiencing potentially inappropriate increases in treatment intensity. Sharing of objective patient refill data between retail pharmacies and prescribers can enable prescribers to have more targeted discussions with patients about their adherence and overall treatment plan. Additionally, it can increase safe medication prescribing and plausibly reduce adverse drug events and healthcare costs while improving patient health outcomes. Full article
(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication)
17 pages, 430 KiB  
Article
Extending Adjuvant Endocrine Therapy for 10 Years: A Mixed-Methods Analysis of Women’s Decision Making in an Online Breast Cancer Forum
by Yolanda Eraso, Denes Stefler, Zoe Moon, Leda Rossi and Sidona Assefa
Healthcare 2021, 9(6), 688; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9060688 - 07 Jun 2021
Cited by 4 | Viewed by 3025
Abstract
An additional 5 years of treatment with adjuvant hormonal therapy, to complete 10 years of medication, is recommended to reduce the risk of breast cancer recurrence. Yet professionals and patients should balance this benefit against side effects and toxicities. Little is known about [...] Read more.
An additional 5 years of treatment with adjuvant hormonal therapy, to complete 10 years of medication, is recommended to reduce the risk of breast cancer recurrence. Yet professionals and patients should balance this benefit against side effects and toxicities. Little is known about women’s decision making regarding persistence with extended endocrine therapy. In this study, we collected data from a UK online breast cancer forum to analyse patterns of persistence and its associated factors. A mixed-methods exploratory sequential design was used, with a qualitative analysis of text (n = 61 individuals) informing the development of a quantitative instrument to statistically analyse the prevalence of the findings (n = 130). Our findings identified three different groups of women who had to make decisions regarding persistence with treatment: those about to complete 5 years of therapy, those who decided to extend treatment, and those who were initially prescribed 10 years. Factors affecting persistence were, lack of self-efficacy in managing side effects, lack of reassurance about individual risk of recurrence, and impact on quality of life. Interventions such as training of healthcare professionals including risk communication, medication reviews by clinical pharmacists, and re-planning of services in follow-up care, should better support women’s needs in extended hormonal therapy. Full article
(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication)
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11 pages, 821 KiB  
Article
Medication Handling and Storage among Pilgrims during the Hajj Mass Gathering
by Saber Yezli, Yara Yassin, Abdulaziz Mushi, Bander Balkhi, Andy Stergachis and Anas Khan
Healthcare 2021, 9(6), 626; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9060626 - 24 May 2021
Cited by 1 | Viewed by 2342
Abstract
We aimed to investigate the knowledge and practices of Hajj pilgrims regarding medication storage and handling during the Hajj mass gathering. In this cross-sectional study, adult pilgrims from 30 countries were interviewed using a structured questionnaire during the 2019 Hajj. The study enrolled [...] Read more.
We aimed to investigate the knowledge and practices of Hajj pilgrims regarding medication storage and handling during the Hajj mass gathering. In this cross-sectional study, adult pilgrims from 30 countries were interviewed using a structured questionnaire during the 2019 Hajj. The study enrolled 1221 participants with a mean age of 50.8 years (SD = 12.5, range = 18–98) and male:female ratio of 1.7:1. Most pilgrims were literate, 50.4% had a university or higher education, and 38% reported at least one underlying health condition. Most pilgrims reported receiving education regarding the proper way to store their medication during Hajj, mainly from physicians (73.7%) and pharmacists (39.4%). Although 68.2% of pilgrims had good knowledge regarding medication storage and the potential effect of inappropriate storage conditions on medications and health, inadequate knowledge and poor practice were identified among some. Level of education, having an underlying health condition and receiving health education on mediation storage were independently associated with good knowledge. Most pilgrims took their medications with them during Hajj, although storage and handling of their medication also varied depending on the stages of their Hajj pilgrimage journey. Improving Hajj pilgrims’ awareness and knowledge about appropriate storage and handling of their medications are beneficial in reducing the risk of associated adverse health outcomes, both during Hajj and beyond the mass gathering. Full article
(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication)
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20 pages, 2666 KiB  
Article
Mobile Health to Improve Adherence and Patient Experience in Heart Transplantation Recipients: The mHeart Trial
by Mar Gomis-Pastor, Sonia Mirabet Perez, Eulalia Roig Minguell, Vicenç Brossa Loidi, Laura Lopez Lopez, Sandra Ros Abarca, Elisabeth Galvez Tugas, Núria Mas-Malagarriga and Mª Antonia Mangues Bafalluy
Healthcare 2021, 9(4), 463; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9040463 - 14 Apr 2021
Cited by 19 | Viewed by 3819
Abstract
Non-adherence after heart transplantation (HTx) is a significant problem. The main objective of this study was to evaluate if a mHealth strategy is more effective than standard care in improving adherence and patients’ experience in heart transplant recipients. Methods: This was a single-center, [...] Read more.
Non-adherence after heart transplantation (HTx) is a significant problem. The main objective of this study was to evaluate if a mHealth strategy is more effective than standard care in improving adherence and patients’ experience in heart transplant recipients. Methods: This was a single-center, randomized controlled trial (RCT) in adult recipients >1.5 years post-HTx. Participants were randomized to standard care (control group) or to the mHeart Strategy (intervention group). For patients randomized to the mHeart strategy, multifaceted theory-based interventions were provided during the study period to optimize therapy management using the mHeart mobile application. Patient experience regarding their medication regimens were evaluated in a face-to-face interview. Medication adherence was assessed by performing self-reported questionnaires. A composite adherence score that included the SMAQ questionnaire, the coefficient of variation of drug levels and missing visits was also reported. Results: A total of 134 HTx recipients were randomized (intervention N = 71; control N = 63). Mean follow-up was 1.6 (SD 0.6) years. Improvement in adherence from baseline was significantly higher in the intervention group versus the control group according to the SMAQ questionnaire (85% vs. 46%, OR = 6.7 (2.9; 15.8), p-value < 0.001) and the composite score (51% vs. 23%, OR = 0.3 (0.1; 0.6), p-value = 0.001). Patients’ experiences with their drug therapy including knowledge of their medication timing intakes (p-value = 0.019) and the drug indications or uses that they remembered (p-value = 0.003) significantly improved in the intervention versus the control group. Conclusions: In our study, the mHealth-based strategy significantly improved adherence and patient beliefs regarding their medication regimens among the HTx population. The mHeart mobile application was used as a feasible tool for providing long-term, tailor-made interventions to HTx recipients to improve the goals assessed. Full article
(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication)
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10 pages, 588 KiB  
Article
Patterns and Facilitators for the Promotion of Glaucoma Medication Adherence—A Qualitative Study
by Stefanie Frech, Rudolf F. Guthoff, Amin Gamael, Christian Helbig, Annette Diener, Manuela Ritzke, Anja Wollny and Attila Altiner
Healthcare 2021, 9(4), 426; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9040426 - 07 Apr 2021
Cited by 8 | Viewed by 2271
Abstract
Primary open-angle glaucoma (POAG) is a chronic optic neuropathy causing irreversible nerve fiber damage. Initially asymptomatic, it progresses slowly without any notable sign of vision loss, thus early detection and treatment is essential. The standard treatment being non-invasive topical administration of eye drops [...] Read more.
Primary open-angle glaucoma (POAG) is a chronic optic neuropathy causing irreversible nerve fiber damage. Initially asymptomatic, it progresses slowly without any notable sign of vision loss, thus early detection and treatment is essential. The standard treatment being non-invasive topical administration of eye drops harbors the problem of patients not being adherent. This study aimed to explore the experiences and thoughts of glaucoma patients about their medication management to improve our knowledge on how adherence works for the individual patient. Narrative interviews were conducted with 21 glaucoma patients. Data were analyzed using inductive content analysis and the documentary method. Different patterns of adherence were identified which depended on personal biographies, living conditions, or the patient’s knowledge about the disease. Interpreting eye drop medication as a ritual, a task, or routine was helpful for some patients, whereas other patients, who were aware of the consequences of not taking the drops, were motivated by intrinsic or extrinsic factors. The patterns identified here represent strategies for managing and adhering to daily glaucoma medication at an individual level. Linking daily drop application or medication intake to these patterns may help to promote correct medication management of patients with chronic diseases who lack a regular medication regimen. Full article
(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication)
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15 pages, 242 KiB  
Article
A Qualitative Application of Temporal Self-Regulation Theory to Understand Adherence to Simple and Complex Medication Regimens
by Caitlin Liddelow, Barbara Mullan, Mark Boyes and Hannah McBride
Healthcare 2020, 8(4), 487; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare8040487 - 16 Nov 2020
Cited by 7 | Viewed by 3400
Abstract
Medication adherence is a global health concern, and variables of temporal self-regulation theory (TST) have been shown to be important in improving adherence. This qualitative study aims to explore how TST can help explain medication adherence in people’s daily lives, and whether there [...] Read more.
Medication adherence is a global health concern, and variables of temporal self-regulation theory (TST) have been shown to be important in improving adherence. This qualitative study aims to explore how TST can help explain medication adherence in people’s daily lives, and whether there are differences in the adherence to simple and complex medication regimens. Twenty-nine participants from Australia engaged in semi-structured interviews based on TST (intention, behavioural prepotency, self-regulation), and other variables important to adherence. Interviews were analysed using thematic analysis. Six themes were identified (Routines, External Supports, Cost, Sense of Agency, Adverse Outcomes, and Weighing Up Pros and Cons), with partial support for TST (specifically intention, past behaviour, cues and planning). Four themes not related to TST were also identified. Individuals with more complex medication regimens spoke of the importance of routines, planning, and knowledge-seeking, whereas those with simpler regimens spoke of the importance of visual cues. TST may be useful for identifying some variables important in medication adherence, however, additional factors were also identified. For simple regimens, future research should focus on the manipulation of visual cues. For complex regimens, health professionals should consider supporting the use of medication management apps to assist in planning and ensuring a consistent routine. Full article
(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication)

Review

Jump to: Research

25 pages, 2736 KiB  
Review
Systematic Review of RCTs Assessing the Effectiveness of mHealth Interventions to Improve Statin Medication Adherence: Using the Behaviour-Change Technique Taxonomy to Identify the Techniques That Improve Adherence
by Zoe Bond, Tanya Scanlon and Gaby Judah
Healthcare 2021, 9(10), 1282; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9101282 - 28 Sep 2021
Cited by 15 | Viewed by 2879
Abstract
Statin non-adherence is a common problem in the management of cardiovascular disease (CVD), increasing patient morbidity and mortality. Mobile health (mHealth) interventions may be a scalable way to improve medication adherence. The objectives of this review were to assess the literature testing mHealth [...] Read more.
Statin non-adherence is a common problem in the management of cardiovascular disease (CVD), increasing patient morbidity and mortality. Mobile health (mHealth) interventions may be a scalable way to improve medication adherence. The objectives of this review were to assess the literature testing mHealth interventions for statin adherence and to identify the Behaviour-Change Techniques (BCTs) employed by effective and ineffective interventions. A systematic search was conducted of randomised controlled trials (RCTs) measuring the effectiveness of mHealth interventions to improve statin adherence against standard of care in those who had been prescribed statins for the primary or secondary prevention of CVD, published in English (1 January 2000–17 July 2020). For included studies, relevant data were extracted, the BCTs used in the trial arms were coded, and a quality assessment made using the Risk of Bias 2 (RoB2) questionnaire. The search identified 17 relevant studies. Twelve studies demonstrated a significant improvement in adherence in the mHealth intervention trial arm, and five reported no impact on adherence. Automated phone messages were the mHealth delivery method most frequently used in effective interventions. Studies including more BCTs were more effective. The BCTs most frequently associated with effective interventions were “Goal setting (behaviour)”, “Instruction on how to perform a behaviour”, and “Credible source”. Other effective techniques were “Information about health consequences”, “Feedback on behaviour”, and “Social support (unspecified)”. This review found moderate, positive evidence of the effect of mHealth interventions on statin adherence. There are four primary recommendations for practitioners using mHealth interventions to improve statin adherence: use multifaceted interventions using multiple BCTs, consider automated messages as a digital delivery method from a credible source, provide instructions on taking statins, and set adherence goals with patients. Further research should assess the optimal frequency of intervention delivery and investigate the generalisability of these interventions across settings and demographics. Full article
(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication)
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