Browsing by Subject "Medication adherence"
- Results Per Page
- Sort Options
Item Open Access An mHealth-Based Medication Reminder Program for Patients with Coronary Heart Disease(2019) Ni, ZhaoProblem and Purpose:
Coronary heart disease (CHD) is the second leading cause of death in China. The treatment of CHD typically involves long-term pharmaceutical therapy. For patients with CHD, cardio-protective medications can prevent the enlargement of harmful clots, cardiovascular symptoms, and poor therapeutic outcomes such as uncontrolled high blood pressure, hyperlipidemia, arrhythmia, heart failure, and sudden cardiac death. However, in China, poor adherence to cardio-protective medications has been cited as a public health concern. This poor adherence to cardio-protective medications has been linked to increases in healthcare costs due to poor therapeutic outcomes typically requiring major medical interventions, such as coronary angioplasty and coronary artery bypass grafting.
In China, local primary healthcare clinics are often not the first choice for treatment. Instead, patients with serious illnesses such as CHD prefer to utilize hospitals. Consequently, many of the 100 million people diagnosed with CHD in China receive prescriptions and medication-related knowledge in hospitals only without a primary care clinician to monitor their treatment. Under this healthcare utilization model, patients are often not provided with proper treatment maintenance and knowledge regarding their medication-taking behaviors. This lack of follow-up care decreases patients’ awareness of the importance of taking medications the way they were prescribed.
Mobile health, known as mHealth, is the use of portable electronic devices with software applications to provide healthcare services and manage patient information. China has 1.3 billion mobile phone users, and 97% of Chinese netizens access the Internet by using a mobile phone. These conditions in China are ideal for implementing an mHealth intervention to improve health and practice. The purpose of this study is to develop an mHealth intervention to improve medication adherence among patients with CHD.
Methods:
First, a pilot study with two phases was conducted in the Cardiology Department of West China Hospital, located in Chengdu, China. Phase I was conducted to inform the development of an mHealth intervention by integrating two mobile applications. The content of reminders and educational materials, the frequency and timing of the intervention were developed in this phase. Based on Phase I, the mHealth intervention was refined and an exploratory randomized controlled trial was conducted in Phase II to evaluate the feasibility and acceptability of using mHealth as a tool to assist CHD patients to take their cardio-protective medications. The cohorts of participants in the two phases were mutually exclusive. Next, a larger scale study with 196 participants was conducted to assess if the mHealth intervention could improve medication adherence and relevant health outcomes (systolic blood pressure, diastolic blood pressure, and heart rate) among patients with CHD in comparison to a control group that receives general educational materials over a period of 60 days.
Results:
In the larger scale study, we recruited 230 participants and randomized 116 to the experimental group and 114 to the control group. Of the 230 participants, 34 participants did not provide their baseline data, thus they did not receive the allocated intervention; we collected baseline data from 196 participants. Of the 196 participants, six participants dropped out of the study and nine were lost during the follow-up period. Finally, 181 participants completed the study, 97 in the experiemental group, 84 in the control group. The majority of the participants were married (92.4%), male (80.1%), Han Chinese (93.9%), and living in urban China (82.1%). Participants’ average age was 61 years old, and half were retired (53.9%). Three out of five participants (61.7%) were prescribed at least five medications. The total medication non-adherence score decreased at 60 days and 90 days in both groups when compared to baseline. At 60 days, the mean of the decrease in medication non-adherence score in the experimental group (M = −1.21, SD = 2.59, N = 103) was greater than the decrease in the control group (M = −0.42, SD = 2.63, N = 93), meaning that the medication adherence improved more in the experimental group. Likewise, at 90 days, the mean of the decrease in medication non-adherence score in the experimental group (M = −1.58, SD = 2.49, N = 103) was greater than the decrease in the control group (M = −0.08, SD = 3.15, N = 93). This difference between the two groups was statistically significant at both 60 days (t = 2.04, df = 179, P = 0.04) and 90 days (t = 3.48, df = 155, P < 0.01).
Heart rate decreased at 60 days and 90 days in both groups compared to baseline, but the mean of the decrease was not statistically significant between the two groups at either 60 days (t = -0.28, df = 148, p=0.78) or 90 days (t = 0.32, df = 145, p=0.75). Systolic blood pressure and diastolic blood pressure decreased in the experimental group, but increased in the control group. The mean of the decrease in diastolic blood pressure was statistically significant at both 60 days (t = 2.07, df = 160, p=0.04) and 90 days (t = 2.21, df = 164, p=0.03). The mean of the decrease in systolic blood pressure was statistically significant at 90 days (t = 3.12, df = 165, p < 0.01), but not significant at 60 days (t = 1.92, df = 161, p=0.06). In addition to comparing the mean of the decreases in health outcomes, we also compared the proportional rates of normal systolic blood pressure, diastolic blood pressure, and heart rate between the experimental group and the control group. The proportional rates of normal systolic and diastolic blood pressures in both groups increased at 60 days and 90 days compared to baseline, but the difference between the two groups at both times was not statistically significant. The proportional rate of normal heart rate in both groups decreased at both times, but the difference between the two groups at both times was not statistically significant.
Conclusion:
In this dissertation, a mobile-phone based mHealth intervention was developed for patients with CHD through integrating two mobile applications to improve medication adherence. The intervention delivered medication-taking reminders and educational materials using two mobile applications. The results showed that the mHealth intervention can increase medication adherence, and potentially lower blood pressure among patients with CHD. These findings can serve as a reference for future research to increase medication adherence and lower blood pressure.
Item Open Access Evaluation of a self-management implementation intervention to improve hypertension control among patients in Medicaid.(Translational behavioral medicine, 2011-03) Bosworth, Hayden B; Dubard, C Annette; Ruppenkamp, Jill; Trygstad, Troy; Hewson, Denis Levis; Jackson, George LElevated blood pressure can lead to serious patient morbidity and mortality. The aim of the study was to evaluate the implementation of a tailored multifaceted program, administered by care managers in a Medicaid setting to improve hypertension medication adherence. The program enrolled 558 Medicaid patients. Patients had at least one phone call by care managers. The individually tailored program focused on improving lifestyle and medication adherence. The primary outcome was the medication possession ratio (MPR), calculated using fill history from pharmacy claims. We observed an improvement of medication possession from 55% 9-12 months prior to program enrollment to 77% 9-12 months post initiation of the program. We demonstrated 12 month sustainability and increased MPR. Personal interaction by phone allows the intervention to be tailored to participants' current concerns, health goals, and specific barriers to achieving these goals.Item Open Access How Medication Adherence Affects Disease Management in Veterans with Glaucoma: Lessons Learned from a Clinical Trial.(Ophthalmic research, 2023-01) Buehne, Kristen L; Rosdahl, Jullia A; Hein, Aaron M; Woolson, Sandra; Olsen, Maren; Kirshner, Miriam; Sexton, Malina; Bosworth, Hayden B; Muir, Kelly WIntroduction
We conducted a secondary, real-world clinical assessment of a randomized controlled trial to determine how a glaucoma medication adherence intervention impacted the clinical outcomes of participants at 12 months post-randomization. Participants included veterans at a VA eye clinic with medically treated glaucoma who reported poor adherence and their companions, if applicable.Methods
The treatment group received a glaucoma education session with drop administration instruction and virtual reminders from a "smart bottle" (AdhereTech) for their eye drops. The control group received a general eye health class and the smart bottle with the reminder function turned off. Medical chart extraction determined if participants in each group experienced visual field progression, additional glaucoma medications, or a recommendation for surgery or laser due to inadequate intraocular pressure control over the 12 months following randomization. The main outcome measure was disease progression, defined as visual field progression or escalation of glaucoma therapy, in the 12 months following randomization.Results
Thirty-six versus 32% of the intervention (n = 100) versus control (n = 100) groups, respectively, experienced disease intensification. There was no difference between the intervention and control groups in terms of intensification (intervention vs. control group odds ratio: 1.20; 95% confidence interval: [0.67, 2.15]), including when age, race, and disease severity were accounted for in the logistic regression model. Those whose study dates included time during the COVID-19 pandemic were evenly distributed between groups.Conclusions
A multifaceted intervention that improved medication adherence for glaucoma for 6 months did not affect the clinical outcomes measured at 12 months post-randomization. Twelve months may not be long enough to see the clinical effect of this intervention or more than 6 months of intervention are needed.Item Open Access Lessons learned from two randomized controlled trials: CITIES and STOP-DKD.(Contemporary clinical trials communications, 2020-09) Zullig, Leah L; Oakes, Megan M; McCant, Felicia; Bosworth, Hayden BBackground
Even well-designed, theoretically driven clinical trials can fall short of achieving the desired clinical outcomes. Our research team had an opportunity to conduct two randomized controlled trials that were enrolling patients in parallel. While both studies were targeting chronic disease management among patients with multiple comorbid conditions, the patient population and settings varied. The studies were the Cardiovascular Intervention Improvement Telemedicine Study (CITIES) and Simultaneous Risk Factor Control Using Telehealth to slow Progression of Diabetic Kidney Disease (STOP-DKD) studies. Both studies had null findings.Objectives
Our goal is to discuss common design considerations across CITIES and STOP-DKD and potential implications for the design of future randomized controlled trials.Methods
These were two 1:1 randomized controlled trials with attention control groups that recruited patients from various clinical practices in the Research Triangle area of North Carolina.Conclusions
We make three recommendations for future studies. First, we assert that it is important to allow for piloting the enrollment process to ensure that it is possible to identify and recruit a patient population that is well aligned with the clinical outcomes of the intervention. Second, analysis plans should be more targeted in their approach and should consider heterogeneity of treatment effects. Third, in order to support the transition of evidence generated from randomized controlled trials into clinical practice, it is important to consider even early stage randomized controlled trials through an implementation science lens.Trial registration
Simultaneous Risk Factor Control Using Telehealth to slow Progression of Diabetic Kidney Disease (STOP-DKD) NCT01829256; Cardiovascular Intervention Improvement Telemedicine Study NCT01142908.Item Open Access The Impact of COVID-19 on Hypertension and Hypertension Medication Adherence Among Underrepresented Racial and Ethnic Groups: A Scoping Review.(Current hypertension reports, 2023-11) Foster, Marva; Etchin, Anna; Pope, Charlene; Hartmann, Christine W; Emidio, Oluwabunmi; Bosworth, Hayden BPurpose of review
To conduct a scoping review of articles which examined the impact of COVID-19 on HTN and HTN medication adherence among underrepresented racial/ethnic minorities.Recent findings
Seven studies were included in this review and impact of COVID-19 was examined at 4 levels: patient, provider, health system and society. The results indicated that patient level factors, such as high unemployment and inequitable access to telemedicine due to society factors- lack of access to high-speed Internet and variation in the offering of telehealth by health systems, were most impactful on adherence. Additionally, provider level clinical inertia may have further impacted adherence to HTN medication. Our review showed that the COVID-19 pandemic did not introduce new barriers but exacerbated preexisting barriers. Ongoing efforts are needed to change policies at the state and local levels to dismantle inequities in underrepresented communities to ensure access to health care with telemedicine to promote health equity.Item Open Access The Relationship between Family Support and Medication Adherence among Hypertensive Patients in Kenya(2018) Xiong, ShangzhiBackground
Hypertension (HTN) is a serious public health problem causing an enormous disease burden globally. Non-adherence to medication among hypertensive patients has been identified as one of the major contributors to the poor control of blood pressure (BP). Despite the paucity of reliable, up-to-date data on hypertension in Kenya, existing literature suggests high HTN prevalence in that nation. Additionally, the control of hypertension in Kenya faces many challenges, including the low medication adherence rates among its hypertensive population.
Hypertension as a chronic disease requires long-term disease management, including taking medication daily and making important lifestyle changes. The role of family support for patients during this life-long process has been a topic of interest among many researchers.
The overarching goal of this study is to determine the quantitative and qualitative association between family support and medication adherence among hypertensive patients in Kenya.
Methods
A mixed-method cross-sectional study was conducted in three healthcare facilities in Nairobi, Kenya. A questionnaire and in-depth follow-up interview were included to achieve the quantitative and qualitative goals respectively.
The questionnaire consisted of five sections: demographic information; health and medical information; medication adherence measurements; family support and family function measurements; and BP measurements.
The in-depth follow-up interview was conducted among patients who were willing to participate after the questionnaire survey. An interview guide was designed to lead the semi-structured individual interview with a focus on exploring how family members may contribute to patients’ HTN management.
Descriptive statistics were used to describe the patient profiles; Fisher’s exact test and Chi-square test were used to compare the level of medication adherence and family support among different subgroups of patients; bivariate logistic regression was used to determine the predictors of medication adherence; and multiple logistic regression was used to examine the independent association between family support/function and medication adherence. Grounded theory was used to guide the thematic analysis of the qualitative data.
Results
A total of 104 patients participated in the study. The majority of participants were female (n = 71, 68.27%) and urban residents (n = 95, 91.35%), with a mean age of 56.61 (SD = 11.70).
The overall control rate of HTN among the patients was low, with only 33.98% of them under control. The percentage of highly adherent patients determined by the Morisky Green Scale was 55.77% and was 26.92% as determined by the Hill-Bone Scale. Based on the Perceived Social Support from Family Scale, most of the patients (82.69%) reported strong family support. The majority of patients (77.88%) were determined to have “functional” families by the Family Function APGAR Scale, and 22.12% had dysfunctional families. Both the bivariate logistic regression and multiple logistic regression generated non-significant results for the association between family support/function and medication adherence using either scale.
Three major themes were generated from the qualitative analysis: patients’ family relationship and situation, patients’ perceptions about HTN and medication, and patients’ family in HTN management. The qualitative results suggested that patients’ support from their family members is promising in improving HTN control and medication adherence. However, a low level of health knowledge among patients and their families may present substantial barriers to HTN patients’ medication adherence.
Conclusion
Despite strong family support and a good family function level, HTN patients in Kenya have low medication adherence and are in a critical situation concerning BP control. Lack of health knowledge, limited involvement in patients’ HTN care, and unavailability and unaffordability of antihypertensive medicines are important obstacles that compromise the positive effects of family support on HTN control in Kenya. Future HTN control interventions in Kenya should prioritize providing better health education to the patients and their families, raising people’s awareness for hypertension screening and treatment, and further engaging patients’ families in HTN care. Additionally, the Kenyan government should enhance its healthcare system to ensure people’s accessibility to hypertension medicines and services.