Poor Adherence to Medications May Be Associated with Falls

The aim of this study was to evaluate the relationship between oral ulcer activity and medication adherence according to gender in Behçet's disease (BD) patients. The study group included 330 BD patients (F/M: 167/163, mean age: 38.5±10.5 years). Oral ulcer activity and medication adherence were evaluated in the previous month. Medication adherence was evaluated using the 8-item Morisky Medication Adherence Scale (MMAS-8) having a score range of "0" to "8" with high scores indicating better adherence. Low adherence was defined as <6 points on MMAS-8. Over half of the group had active oral ulcers (n=219, 66.4%) within the month preceding the visit. The number of oral ulcers was significantly higher in female patients with low medication adherence (2.39±3.24) than in the rest of the female group (1.28±2.05; p=0.023). Although a similar trend was also observed in male patients (2.14±3.3 vs. 1.81±2.31), a significant relationship was not observed (p=0.89). The frequency of medication intake per day was lower in patients with high medication adherence than in the rest of the study group (p=0.04). Low medication adherence is a hidden risk factor in the management of BD. Poor adherence was associated with oral ulcer activity in female BD patients.

Introduction The impact of positive airway pressure (PAP) therapy for obstructive sleep apnea (OSA) on healthcare costs is uncertain. We explored the relationship between 3-year PAP adherence and direct healthcare cost utilizing the Tele-OSA study cohort. Methods The Tele-OSA randomized clinical trial demonstrated improved PAP adherence in patients receiving automated feedback messaging regarding their PAP use versus usual care. The study enrolled patients at Kaiser Permanente Southern California, a large integrated healthcare system, from 2014–2015. Patients with moderate-severe OSA (Apnea Hypopnea Index [AHI] ≥15) from all study arms were consolidated, then stratified into PAP adherence groups based on mean PAP hours and PAP use patterns over 3-year follow-up period: (a) high adherence (consistent ≥4 hours/night); (b) moderate adherence (2–3.9 hours/night or inconsistent ≥4 hours/night); (c) low adherence (&amp;lt;2 hours/night). Healthcare costs (2020 US dollars) were derived by assigning costs from Federal fee schedules to healthcare utilization extracted from electronic health records. The 6-month mean healthcare costs during follow-up were estimated using generalized linear models adjusting for patient demographics, comorbidities, Medicaid coverage, prior healthcare cost, and AHI. Results Of 374 patients (mean age 50 years, 63% male), 22% were categorized into high adherence, 18% moderate adherence, and 60% low adherence to PAP therapy. Mean (SD) hours of PAP use were 6.5 (1.1) hours, 3.7 (1.3) hours, and 0.3 (0.5) hours for high, moderate, and low adherence groups, respectively. The high adherence group had the lowest average (SE) adjusted 6-month healthcare costs compared with other groups (High: $2,991 [$234]; Moderate: $3,604 [$412]; Low: $3,854 [$300]). Cost savings of high vs low adherence were $862 (95% CI $1540, $185). Cost savings of moderate vs low adherence were $250 (95% CI -$694, $1,193). Conclusion Better PAP adherence was associated with significantly lower healthcare costs over 3 years in patients with moderate-severe OSA. Findings support the importance of care strategies to enhance long-term PAP adherence for OSA therapy. Support (if any) The Tele-OSA Study was supported by AASM Foundation SRA Grant #: 104-SR-13

Objectives: To assess the patient medication adherence using 8 item morisky medication adherence scale (MMAS). To categorize patients based on their adherence to antidiabetic medications into low, medium, and high adherent. To provide educational interventions such as patient counseling using teach-back method, patient medication information leaflet, and audio-visual aids and thus to improve the patient medication adherence.Methods: After obtaining informed consent from the patients, data of the patients were recorded in data collection forms. Their adherence to antidiabetic medication was evaluated using 8 item MMAS and patients were categorized into low, medium, and high adherence groups based on the score. Counseling was done based on the categorization (high, medium, and low). During review, again adherence was rechecked using 8 item MMAS.Results: Medication adherence was measured using 8 item MMAS on review and adherence was found to be improved using different patient counseling methods according to their adherence category. Improvement in score within low adherence group was found to be 83.87%; improvement of the low adherence group to medium adherence group was 16.12%. Improvement within the medium adherence group was 82.14% and from medium adherence to high adherence group was 17.85%.Conclusion: Patient counseling can improve adherence in type 2 diabetes mellitus patients, which in turn help patients in achieving optimal glycemic control.

Poor adherence to heart failure (HF) medications represents a major barrier to achieve the desired health outcomes in those patients. To assess medication adherence and to explore the factors associated with medication non-adherence among patient with HF in Jordan. The current cross-sectional study was conducted at the outpatient cardiology clinics at two main hospitals in Jordan from August 2021 through April 2022. Variables including socio-demographics, biomedical variables, in addition to disease and medication characteristics were collected using medical records and custom-designed questionnaire. Medication adherence was assessed using the 4-item Morisky Medication Adherence Scale. Multinomial logistic regression analysis was performed to identify the factors that are significantly and independently associated with medication non-adherence. Of the 427 participating patients, 92.5% had low to moderate medication adherence. Results of the regression analysis revealed that that patients who had higher education level (OR=3.36; 95% CI 1.08-10.43; P=0.04) and were not suffering from medication-related side effects (OR=4.7; 95% CI 1.91-11.5; P=0.001) had significantly higher odds of being in the moderate adherence group. Patients who were taking statins (OR=16.59; 95% CI 1.79-153.98; P=0.01) or ACEIs/ ARBs (OR=3.95; 95% CI 1.01-15.41; P=0.04) had significantly higher odds of being in the high adherence group. Furthermore, Patients who were not taking anticoagulants had higher odds of being in the moderate (OR=2.77; 95% CI 1.2-6.46; P=0.02) and high (OR=4.11; 95% CI 1.27-13.36; P=0.02) adherence groups when compared to patients who were taking anticoagulants. The poor medication adherence in the present study sheds the light on the importance of implementing intervention programs which focus on improving patients' perception about the prescribed medications particularly for patients who have low educational levels, receive an anticoagulant, and do not receive a statin or an ACEI/ ARB.

Self-reported Medication Adherence and Adverse Patient Safety Events in CKD

&lt;b&gt;Objective&lt;/b&gt; &lt;a&gt;We aimed to understand the factors associated with SGLT2i adherence and longitudinal adherence trajectories&lt;/a&gt; in older adults with type 2 diabetes. &lt;p&gt;&lt;b&gt;Research Design and Methods&lt;/b&gt; Using Medicare claims data (April 2013-December 2017), we identified 83,675 new SGLT2i users aged ≥66 years old with type 2 diabetes. We measured SGLT2i adherence as the Proportion of Days Covered (PDC) during the first year of SGLT2i therapy. We used linear regression to assess the association between baseline covariates and PDC. &lt;a&gt;Then we used group-based trajectory modeling to identify distinct longitudinal SGLT2i adherence groups and used a multivariable logistic regression model to examine the association between baseline covariates and membership in these adherence groups. &lt;br&gt; &lt;b&gt;Results &lt;/b&gt;Unadjusted mean PDC was 63%. Previous adherence to statins had the strongest positive association with PDC [regression coefficient 6.00% (95% CI, 5.50%,6.50%)], whereas female sex [-5.51% (-6.02%, -5.00%)], and Black race/ethnicity [-5.06% (-6.03%, -4.09%)] had the strongest negative association. We identified three adherence trajectory groups: low (23% of patients, mean PDC: 17%), moderate (32%, mean PDC: 50%), or high adherence (45%, mean PDC 96%). More patients in the high adherence group were previously adherent to statins [OR 1.43 (95% CI 1.39,1.48)], and more women [1.28 (1.23,1.32)] and Black patients [1.31 (1.23,1.40)] were in the low adherence group.&lt;/a&gt;&lt;/p&gt; &lt;p&gt;&lt;b&gt;Conclusions &lt;/b&gt;In a large population of older patients with type 2 diabetes, 45% were highly adherent during the first year of SGLT2i&lt;b&gt; &lt;/b&gt;treatment. Female sex and Black race/ethnicity were most strongly associated with low adherence. &lt;/p&gt;

Background Patients with coronary artery disease (CAD) and Type 2 diabetes mellitus (DM) represent a high‐risk population for recurrent cardiovascular events following acute coronary syndrome (ACS). Despite evidence‐based guidelines, adherence to secondary prevention strategies remains suboptimal. This study evaluated the impact of comprehensive guideline‐based secondary prevention adherence, including contemporary heart failure therapies, on major adverse cardiovascular events (MACE) in patients with CAD and DM post‐ACS, extending prior work that examined rehospitalization and all‐cause mortality outcomes. Methods This retrospective cohort study included 712 patients with confirmed CAD and Type 2 DM who presented with ACS between September 2019 and December 2022. Adherence to ten evidence‐based secondary prevention measures was assessed before the index ACS event and at 3‐year follow‐up, including antiplatelet therapy, high‐intensity statins, blood pressure control, ACE inhibitors/ARBs, beta‐blockers, SGLT‐2 inhibitors, mineralocorticoid receptor antagonists (MRA), angiotensin receptor‐neprilysin inhibitors (ARNI), lifestyle modifications, and other guideline‐recommended interventions. Patients were stratified into low (≤ 3), moderate (3–6), and high (&gt; 6) adherence groups. Primary outcomes were MACE, including cardiovascular death, nonfatal myocardial infarction, stroke, and urgent revascularization over 3 years. Results Mean patient age was 61.7 ± 12.1 years, with 58.4% male participants. Dramatic improvements in adherence occurred post‐ACS: high adherence increased from 12.6% to 62.1% ( p &lt; 0.001). Significant increases were observed in statin therapy (22.5%–84.7%), antiplatelet therapy (58.3%–91.2%), and blood pressure control (33.6%–87.4%). Cox regression analysis identified better adherence scores as an independent protective factor (HR 0.798, 95% CI 0.686–0.929, p = 0.004). Kaplan–Meier analysis demonstrated superior event‐free survival in high adherence patients (88% vs. 70% in the low adherence group, p &lt; 0.001). Statin therapy showed the strongest protective effect (HR 0.512, 95% CI 0.386–0.679, p &lt; 0.001). Conclusion ACS events significantly improve adherence to secondary prevention strategies in CAD patients with diabetes, with high adherence associated with substantial reductions in MACE and improved long‐term survival.

Asthma control is often suboptimal in routine care, and gaps in patient knowledge and medication adherence may contribute to poor control. Objective: This study aimed to examine the relationship between patients’ asthma knowledge level and medication adherence with asthma control among adult patients attending the Pulmonary Clinic of Pasar Minggu Regional General Hospital. Methodology: A quantitative cross-sectional design was used with consecutive sampling of 191 adult asthma patients. Data were collected using validated questionnaires: ACQ-5, AGKQ, and MMAS-8. Descriptive statistics summarized distributions, and Chi-square tests examined associations between knowledge and asthma control, and between adherence and asthma control. Findings: Most participants had uncontrolled asthma (56.0%), low asthma knowledge (55.0%), and low medication adherence (56.5%). Knowledge level was significantly associated with asthma control (p = 0.001), with uncontrolled asthma more prevalent in the low-knowledge group (70.5%) than the high-knowledge group (38.4%). Medication adherence was also significantly associated with asthma control (p = 0.001), with uncontrolled asthma more common among low adherence (67.6%) than moderate (41.4%) or high adherence (38.5%). Implications: Integrating structured education and adherence-support strategies into routine outpatient care may improve asthma control and reduce exacerbation risk. Originality: This study integrates asthma knowledge and medication adherence within the same analytic framework of asthma control in an Indonesian pulmonary-clinic population, providing context-specific evidence for targeted clinic-based interventions.

Low antihypertensive medication adherence is common. During recent years, the impact of low medication adherence on increased morbidity and healthcare costs has become more recognized, leading to interventions aimed at improving adherence. We analyzed a 5% sample of Medicare beneficiaries initiating antihypertensive medication between 2007 and 2012 to assess whether reductions occurred in discontinuation and low adherence. Discontinuation was defined as having no days of antihypertensive medication supply for the final 90 days of the 365 days after initiation. Low adherence was defined as having a proportion of days covered <80% during the 365 days after initiation among beneficiaries who did not discontinue treatment. Between 2007 and 2012, 41 135 Medicare beneficiaries in the 5% sample initiated antihypertensive medication. Discontinuation was stable during the study period (21.0% in 2007 and 21.3% in 2012; P-trend=0.451). Low adherence decreased from 37.4% in 2007 to 31.7% in 2012 (P-trend<0.001). After multivariable adjustment, the relative risk of low adherence for beneficiaries initiating treatment in 2012 versus in 2007 was 0.88 (95% confidence interval, 0.83-0.92). Low adherence was more common among racial/ethnic minorities, beneficiaries with Medicaid buy-in (an indicator of low income), and those with polypharmacy, and was less common among females, beneficiaries initiating antihypertensive medication with multiple classes or a 90-day prescription fill, with dementia, a history of stroke, and those who reached the Medicare Part D coverage gap in the previous year. In conclusion, low adherence to antihypertensive medication has decreased among Medicare beneficiaries; however, rates of discontinuation and low adherence remain high.

Background: Hypertension is the most common disease in India where 1 in 4 people suffering with it. In order to achieve the intended therapeutic outcomes, medication adherence is essential. Patients with hypertension must adhere to their disease by taking their prescriptions on time, following their diet, and making other lifestyle modifications. This study aims to assess medication adherence in Warangal population among hypertensive patients with comorbidities, social habits, medication use etc. Aims: The aim of the study is to assess the level of medication adherence and to investigate predictors of medication adherence and controlled hypertension in patients and to identify the factors enhancing medication adherence. The secondary aim is to describe the extent and type of medication used in patient population in Warangal. Study Design: An Observational, retrospective and cross - sectional study was employed to assess the predictors and level of medication adherence in hypertensive patients. Place and Duration of Study: Department of Cardiology, Sri Sri Cardiac Centre and Bhageerath Cardiac Care Centre, Hanamkonda, Warangal. The study was conducted from October 2022 to April 2023 for about a duration of 7 months. Methodology: This study includes 300 Hypertensive patients (Male - 169, Female 131) of age range between 20-90 years with various comorbidities like diabetes mellitus, coronary artery disease, hypothyroidism, dyslipidemia, COPD. We also included various sociodemographic factors like Gender, Age, Literacy, Income status, Alcohol consumption, Smoking status, Marital status, Controlled and Uncontrolled hypertension, usage of various drugs and Duration of hypertension. We observed Medication Adherence by using MMAS 8 scale. Results: Low levels of medication adherence among female patients (41%), educated patients (58%) compared to other groups because of awareness about their condition. Low adherence is noted in patients with low-income status ( 9.6% ), High adherence in nonsmokers (73.3%) and non-alcoholic (60.6%) compared to smokers (10.6%) and alcoholics (12.6%) and high adherence is reported in married (85%) category as compared to unmarried (2.6%), Patients with low comorbidities reported high adherence compared to patients with low comorbidities. High medication adherence is reported in uncontrolled blood pressure (50.3%) and in patients with \(\le\) year (24.6%) and 2-6 years (28%) of duration of hypertension. High adherence is noted with 2 combination therapy (23.6%), most of the participants are adherent to Telmisartan+ Metoprolol (25.2%) followed by Telmisartan+ hydrochlorothiazide (19.3%). According to MMAS-8 scale most of the patients reported (Q1) and (Q6), 91.3% of our study population were adherent to their medication, 7% were moderately adherent and 1.6% were low adherent to their medication. Conclusion: 91.3% of Medication adherence is noted in hypertensive patients in Warangal population. 8.6% of Medication Non-Adherence is noted and various factors for nonadherence were reported by patients. However various methods and apps should be developed to overcome the Medication Non-Adherence.

BackgroundSocial distancing during the COVID-19 pandemic affected follow-up visits and medication availability for patients with Parkinson’s disease (PD). As a promising strategy to deal with these challenges, the implementation of health management smartphone apps was accelerated. However, whether more intense use of such apps could improve the quality of life (QoL) for PD patients during the COVID-19 pandemic was unknown.MethodsUsing a PD management app, this observational study assessed changes in QoL, as determined by PD Questionnaire 8 (PDQ-8), among PD patients before (Jan 20, 2019 to Oct 6, 2019) and after the beginning of the COVID-19 lockdown (Jan 20, 2020 to Oct 6, 2020). According to adherence to use of the app, participants were divided into low adherence, moderate adherence, and high adherence groups. A total of 4979 PD patients registered in the app, and 226 PD patients were enrolled, including 57 patients with low adherence, 112 with moderate adherence and 57 with high adherence. A generalized linear model was used to evaluate the change of PDQ-8 scores across these three different adherence groups.ResultsAfter the COVID-19 lockdown (1-year follow-up), the PDQ-8 scores are reduced by 0.8 (95% CI, 0.3–1.4) in all participants (P = 0.004). After adjustment for age, gender, education, disease duration and levodopa equivalent dose, PDQ-8 scores significantly less reduced in the high adherence group (0.3; 95% CI, 0.6–1.2) compared to the low adherence (1.9; 95% CI, 0.7–3.1) (P = 0.040) and moderate adherence groups (0.6; 95% CI, 0.2–1.3) (P = 0.012).ConclusionsA health management smartphone-based app might be a way to both measure and improve QoL among PD patients, provided that sufficient adherence is achieved.

Limited information is available on medication adherence, depression levels, and quality of life (QoL) among young individuals with depression in Indonesia. This study examined factors associated with medication adherence, depression severity, and QoL in young Indonesians with depression. It also explored (1) reasons for good or poor adherence and (2) participants' perceived QoL. A mixed-methods sequential explanatory design was employed from January to June 2022. A national cross-sectional survey of 681 participants was conducted, followed by qualitative interviews with 40 participants. Low medication adherence was observed in 76.2% of participants. Higher adherence was associated with a bachelor's degree. Lower depression levels were linked to older age, female gender, longer treatment duration, and a family history of psychiatric disorders (p < 0.05). QoL significantly declined among people with higher income, the presence of family psychiatric disorders, lower adherence, and more severe depression level. Qualitative findings highlighted inadequate mental health literacy, marital status, low income, lack of support, and side effects as barriers to adherence. Financial stability and positive social support were critical for better QoL. Key factors influencing medication adherence among young Indonesians with depression included income, national health insurance coverage, mental health literacy, and social support. Strengthening communication between patients and mental health providers, particularly psychiatrist, is essential to optimize treatment plans and improve outcomes.

ObjectiveOur objective was to determine patterns and predictors of medication adherence in bipolar disorder.MethodsBetween August 2015 and December 2016, we recruited 160 patients with a diagnosis of bipolar disorder as per International Classification of Diseases-10: Clinical Descriptions and Diagnostic Guidelines. The diagnosis was further confirmed by using the MINI International Neuropsychiatric Inventory. All of them were currently in remission (confirmed by standard measures) and on stable dosing of medication for at least a year. Medication adherence was assessed using Tamil validated version of Morisky Medication Adherence Scale. Patients were dichotomized into low adherence (<6) and high adherence (≥6) groups and compared on various socio-demographic and clinical variables.ResultsMajority of the sample (n=97, 60.6%) demonstrated low adherence to treatment regimen. Being employed and having spent greater number of days in hospital were predictive of higher medication adherence (odds ratio [OR] 2.78, 95% confidence interval [CI] 1.019–7.585; and OR 1.02, 95% CI 1.003–1.037, respectively). Fewer number of lifetime depressive episodes and positive drug attitudes demonstrated trend level positive association with high medication adherence.ConclusionNon-adherence to prescribed medications is a common problem in bipolar disorder. Interventions targeting vocation, medication focused psychoeducation and promotion of positive drug attitudes are likely to enhance medication adherence in this group.

Poor adherence may have a major impact on clinical outcome, contributing to substantial worsening of disease, increased health care costs and even death. With increasing numbers of medications, low adherence is a growing concern, seriously undermining the benefits of current medical care. Little is known about medication adherence among older adults living at home and requiring complex medication regimens. The aim of this study was to describe adherence to drug prescriptions in a cohort of elderly patients receiving polypharmacy, discharged from an internal medicine ward. A sample of elderly patients (65years of age or older) discharged from an internal medicine ward in Italy throughout 2012 were enrolled. They were followed for 3months after discharge with a structured telephone interview to collect information on drug regimens and medication adherence 15-30days (first follow-up) and 3months (second follow-up) after discharge. Demographic variables including age, sex, marital status and caregiver were collected. Among 100 patients recruited, information on medication adherence was available for, respectively, 89 and 79 patients at the first and second follow-ups. Non-adherence was reported for 49 patients (55.1%) at the first follow-up and for 55 (69.6%) 3months from discharge. Voluntary withdrawal of a drug and change of dosage without medical consultation were the main reasons for non-adherence at both follow-ups. The number of drugs prescribed at discharge was related to medication non-adherence at both follow-up interviews. No association was found between age and non-adherence. Only 25 patients (28.1%) at the first follow-up and 20 (25.3%) at the second understood the reasons for their medications. Low medication adherence is a real, complex problem for older patients receiving polypharmacy. We found that the increasing number of drugs prescribed at hospital discharge is correlated to non-adherence and a high percentage of patients did not understand the purpose of their medications. Simplification of drug regimens and reduction of pill burdens as well as better explanations of the reason for the medications should be targets for intervention.

&lt;div&gt;&lt;table cellspacing="0" cellpadding="0" align="left"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" valign="top"&gt;&lt;p&gt;&lt;em&gt;Hypertension is a major global public health concern associated with increased risk of cardiovascular morbidity and mortality. Despite the availability of effective antihypertensive therapy, suboptimal blood pressure control remains prevalent, particularly in low- and middle-income countries. Poor medication adherence is a key contributing factor, often influenced by various sociodemographic and clinical characteristics. This study aimed to assess the level of medication adherence among hypertensive patients and to examine the association between sociodemographic and clinical factors and adherence behavior in an urban Indonesian population.&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;A cross-sectional study was conducted among 153 hypertensive patients attending six public health centers in Medan City, Indonesia, between August and October 2021. Participants were selected using purposive sampling. Medication adherence was assessed using the validated Indonesian version of the Eight-Item Morisky Medication Adherence Scale (MMAS-8). Data on age, education, income, family history, body mass index, comorbidities, and blood pressure were collected through interviews and direct measurements. Bivariate and multivariate logistic regression analyses were performed using SPSS version 24.0 to identify significant predictors of adherence. Among the participants, 52.3% demonstrated high medication adherence, while 47.7% had low adherence. Multivariate analysis revealed that age ≥45 years (RP = 4.29; p = 0.023), low education level (RP = 1.50; p = 0.044), and family history of hypertension (RP = 2.05; p = 0.040) were significantly associated with adherence. Other variables, including income, BMI, and comorbidities, were not significant predictors.&lt;/em&gt; &lt;em&gt;Medication adherence among hypertensive patients remains suboptimal. Targeted interventions focusing on older adults, patients with lower education, and family-centered support may enhance adherence and improve hypertension management outcomes.&lt;/em&gt;&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/div&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Keywords: Adherence, Education, Hypertension, Risk factors&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;