Adherence to tuberculosis treatment among patients attending national tuberculosis elimination centre in tertiary care hospital, Bangalore

Background: Annually ten million cases of tuberculosis (TB) and 1.8 million mortalities are recorded. Adherence to TB treatment not only reduces death outcomes but prevents prolonged sickness, transmission to others and development of multi drug resistant TB. This study was aimed at determining the rate of treatment adherence and possible factors influencing adherence to TB treatment in the NTEP Centre at Rajarajeswari medical college and hospital, Bangalore. Methods: It was a cross sectional study design. A validated 8 item Morisky medication adherence scale was used to obtain data from respondents. Adherence to TB treatment was assessed. Chi square test was used to determine the variables that were associated with treatment adherence. Results: Out of 60 patients, majority i.e. 18 (30%) were in the age group 25-34 years, males were more compared to females. Majority i.e. 21 (35%) were studied up to post high school diploma, 31(51.67%) were unemployed, majority i.e. 48 (80.00%) were married, 42 (70.00%) were from nuclear family. Out of 60 patients, majority 54 (90.00%) were Hindus 24 (40.00%) were from lower middle class. Conclusions: The adherence rate for TB treatment in this study was 68.33%. There was no significant association between socio demographic variables, personal habits, health status, current TB status, type of TB, and common symptom with treatment adherence. An intensified health education on the adherence of TB treatment therefore recommended.

Assessment of medication adherence among hypertensive patients in a tertiary care teaching hospital in India

Background: Hypertension is a chronic disorder and a prevalent non-communicable disease in India. With the increasing burden of hypertension, adherence to antihypertensive therapy plays a vital role to control blood pressure and preventing its complications. Therefore, this study was done in our tertiary care hospital to understand the medication adherence level in hypertension patients. Aims and Objectives: To assess adherence to antihypertensive medications in hypertensive patients using pre-tested structured questionnaire. Materials and Methods: A prospective observational study was conducted for 3 months in 100 hypertensive patients. The adherence status of patients to antihypertensive medications was assessed using an eight-item Morisky’s Medication Adherence Scale (MMAS-8). Results: Majority of the study participants in our study were >50 years (68%) and females (64%). We observed that patients taking combination therapy better adhered to medication than monotherapy. We assessed in detail the medication adherence level among study participants using MMAS-8 and analyzed the reasons for non-adherence. Conclusion: The medication adherence rate in our study was found to be moderate to high, which needs to be maintained to attain optimal clinical benefit and also to prevent hypertension-related complications.

Evaluación de riesgo de apnea obstructiva del sueño y de la adherencia al tratamiento farmacológico en pacientes con hipertensión arterial / Risk assessment of obstructive sleep apnea and adherence to pharmacological treatment in patients with arterial hypertension

Introducción:existe una sospecha sobre la relación bidireccional entre la apnea obstructiva del sueño (AOS) y la hipertensión arterial (HTA). Ambas ejercen una acción sinérgica sobre desenlaces cardiovasculares porlo quees trascendente ponderar la prevalencia de riesgo para AOS en los hipertensos. En este último grupo también hemos investigado la tasa de adherencia a los fármacos prescritos. Metodología:mediante un estudio de casos y controles y con la aplicación del cuestionario STOP-BANG se han discriminado las categorías de riesgo para apnea de sueño en las dos cohortes. Para el análisis de la adherencia a fármacos antihipertensivos se utilizó el cuestionario abreviado de Morisky. Resultados:se incluyeron a 590 individuos (295 casos y 295 controles. Se observó alto riesgo para AOS en el grupo de hipertensos (36,6%) comparado con el 14,2% del grupo control. Por otro lado, el sexo masculino OR 7,77 (IC95% 4,33-13,84), la obesidad OR 5,03 (IC95% 3,11-8,13) y la HTA OR 4,31 (IC95% 2,64-7,03) se ponderan significativos en un modelo de ajuste logístico aquí estudiado. El 61,69% de los hipertensos refería adherencia al tratamiento farmacológico prescrito. Discusión:el tamizaje de AOS es factible con un cuestionario aplicable en la práctica clínica diaria. De la probabilidad clínica pre-test hay que partir hacia métodos diagnósticos específicos para el diagnóstico de AOS, enfatizando casos de HTA resistente, HTA nocturna y HTA enmascarada. Se deberían realizar estudios locales que nos ayuden a comprender las causas de la falta de adherencia a fármacos antihipertensivos en una fracción importante de los individuos con HTA

Introduction:there is a suspicion about the bidirectional relationship between obstructive sleep apnea (OSA) and arterial hypertension (AHT). Both have a synergistic action on cardiovascular outcomes, so it is important to assess the prevalence of risk for OSA in hypertensive patients. In this last group we have also investigated the rate of adherence to prescribed drugs.Metodology:through a case-control study and with the application of the STOP-BANG questionnaire, the risk categories for sleep apnea in the two cohorts have been discriminated. For the analysis of adherence to antihypertensive drugs, the abbreviated Morisky questionnaire was used. Results:590 individuals were included (295 cases and 295 controls. A high risk for OSA was observed in the hypertensive group (36.6%) compared to 14.2% in the control group. On the other hand, the male sex OR 7.77 (95%CI 4.33-13.84), obesity OR 5.03 (95%CI 3.11-8.13) and hypertensionOR4.31(95%CI 2.64-7.03) they areweighted significant in a logistic adjustment model studied here.61.69% of hypertensive patients reported adherence to the prescribed pharmacological treatment.Discussion:OSA screening is feasible with a questionnaire applicable in daily clinical practice. From the pre-test clinical probability, specific diagnostic methods for the diagnosis of OSA must be started, emphasizing cases of resistant AHT, nocturnal AHT, andmasked AHT. Local studies should be carried out to help us understand the causes of non-adherence to antihypertensive drugs in a significant fraction of individuals with AHT

Analysis of Adherence to Fluoxetine Treatment through its Plasma Concentration

Abstract Depression plays an important role in non-adherence to medical recommendations. Fluoxetine is a first line of depression treatment. This study aimed to evaluate adherence to drug therapy in fluoxetine users by different methods. A cross-section study was conducted with 53 depressed patients on fluoxetine for at least six months. Drug therapy adherence was assessed by validated questionnaires [Brief Medication Questionnaire (BMQ) and Morisky-Green test (MG)] and by the blood concentration of fluoxetine and its active metabolite norfluoxetine. Blood samples were taken before the daily first dose of fluoxetine. The plasmatic concentration of fluoxetine and norfluoxetine indicated that 58.5% volunteers were within the recommended therapeutic range and thus considered adherent to drug therapy. However, questionnaires indicated a non-adherent majority: 41.5% patients had a high degree of adherence in MG and only 13.2% were adherent to pharmacological treatment in BMQ. Most fluoxetine users showed a plasma concentration of fluoxetine and norfluoxetine within the therapeutic range, despite the low adherence to the drug therapy evaluated by the questionnaires. Thus, we suggest that plasma levels of fluoxetine and norfluoxetine could be used as the main method to check adherence to treatment.

Adherencia terapéutica en pacientes hipertensos del consultorio de Clínica Médica del Hospital de Clínicas / Therapeutic adherence in hypertensive patients of the Internal Medicine office at the Hospital de Clínicas

Introducción: La adherencia al tratamiento de la hipertensión arterial constituye uno de los principales factores para la obtención de un buen control de la tensión arterial y la disminución de complicaciones crónicas que la misma condiciona. Objetivos: El objetivo de este estudio fue determinar la adherencia terapéutica en pacientes hipertensos que acuden al Consultorio Externo de Clínica Médica del Hospital de Clínicas de la Universidad Nacional de Asunción. Materiales y métodos: diseño observacional, descriptivo, de corte transversal. Se incluyó a pacientes adultos con diagnóstico de hipertensión arterial que acudieron al consultorio externo de Clínica Médica del Hospital de Clínicas en el mes de octubre de 2019. Se les aplicó el cuestionario de Morisky de adherencia a la medicación de ocho ítems (MMAS-8) para valorar el cumplimiento terapéutico y se recabaron datos sociodemográficos. Los datos fueron analizados mediante estadística descriptiva. Resultados: se incluyeron 80 sujetos, la media de edad fue de 56,4±12,6 años, 56 (70%) fueron mujeres. Más de la mitad presentó alta adherencia terapéutica (56,25%). Se encontró un nivel de adherencia similar en ambos sexos (57,14% en mujeres y 54,17% en varones). Pacientes en el rango de 18 a 40 años fueron los de mayor cumplimiento (62,5%). La mayoría procedía del Área Metropolitana (71%). La ocupación predominante fue el de quehaceres domésticos (51,25%). La mayor parte de la población presentaba algún grado de formación académica (85%). Se encontró mayor adherencia en pacientes con hipertensión de menos de 5 años de evolución (65%), solteros (66%) y en pacientes que recibían una dosis diaria de la medicación (68,75%). Conclusión: más de la mitad de los hipertensos tiene buen apego terapéutico. Se encontró mayor adherencia en pacientes solteros, menores de 40 años, con algún grado de formación académica, con hipertensión de menos de 5 años de evolución y tratados con monodosis de fármacos.

Introduction: Adherence to the treatment of arterial hypertension constitutes one of the main factors for obtaining a good control of blood pressure and the reduction of chronic complications that it conditions. Objectives: The objective of this study was to determine therapeutic adherence in hypertensive patients who attend the Outpatient Clinic of the Medical Clinic of the Hospital de Clínicas of the National University of Asunción. Materials and methods: observational, descriptive, cross-sectional design. Adult patients with a diagnosis of hypertension who attended the outpatient clinic of the Clínica Médica del Hospital de Clínicas in October 2019 were included. The Morisky questionnaire of adherence to medication of eight items (MMAS-8) was applied. to assess therapeutic compliance and sociodemographic data were collected. The data were analyzed using descriptive statistics. Results: 80 subjects were included, the mean age was 56.4 ± 12.6 years, 56 (70%) were women. More than half had high therapeutic adherence (56.25%). A similar level of adherence was found in both sexes (57.14% in women and 54.17% in men). Patients in the range of 18 to 40 years were those with the highest compliance (62.5%). The majority came from the Metropolitan Area (71%). The predominant occupation was that of housework (51.25%). Most of the population had some degree of academic training (85%). Greater adherence was found in patients with hypertension of less than 5 years of evolution (65%), single (66%) and in patients who received a daily dose of the medication (68.75%). Conclusion: more than half of hypertensive patients have good therapeutic adherence. Greater adherence was found in single patients, under 40 years of age, with some degree of academic training, with hypertension of less than 5 years of evolution and treated with single doses of drugs.

A cross-sectional study on the compliance to antihypertensive drugs in a rural area

Background: The burden of the non-communicable diseases (NCDs) is increasing over the years. Worldwide, the leading cause of morbidity and mortality has been due to NCDs. Although NCDs are multifactorial, hypertension plays a major role as a risk factor. Lack of treatment adherence can lead to negative health consequences. Objectives: The objectives of the study were as follows: (1) To assess patients’ compliance to antihypertensive drugs; (2) to evaluate association between treatment compliance and sociodemographic determinants; and (3) to find out the factors responsible for non-adherence. Materials and Methods: This study was carried among 350 hypertensive patients in the rural field practice area of a medical college using simple random sampling method. The study population consists of hypertensive patients belonging to 20–60 years of age. A pretested structured questionnaire containing Morisky’s scale was used to assess patient’s adherence. Data analysis was done using SPSS (Version 22). Results: Nearly 53.7% of the study participants were female. The prevalence of treatment compliance was estimated to be 24.6%. Statistically significant association was observed between age, education, and socioeconomic status with adherence to hypertensive medications (P < 0.05). Many reasons were identified for non-adherence and they include cost of treatment (21.4 %), side effects (27.5%), alternative treatment (16%), lack of knowledge (32.8%), and multiple drugs (25%). Conclusion: The prevalence of 23.6% of patient’s being adherent to hypertensive medications was observed among the study population. It is necessary to strengthen treatment adherence by various health education campaigns and implementing various health programs.

Barriers to adherence of maintenance medication intake among hypertensive and diabetic patients seen at the out-patient clinic of the Department of Family Medicine-East Avenue Medical Center

Background@#The treatment of chronic illnesses commonly includes the long-term use of pharmacotherapy. Almost half of patients do not enjoy the full benefits of treatment because of poor adherence. The Universal Health Care Act advocates actively improving the health literacy, of every Filipino, motivating them to strictly adhere to the recommended treatment@*Objective@#This study aimed to determine the barriers to adherence of maintenance medication intake among hypertensive and diabetic patients in the outpatient clinic setting@*Methods@#A cross sectional study design, using the Morisky Medication Adherence Scale (MMAS-8) consisting of 8 questions, with a Cronbach alpha of 0.83 (Highly reliable). Simple random sampling was used for sampling@*Results@#Out of 90 patients, 54 (60.0%) patients were adherent with their medications, while 36 (40.0%) were non-adherent. Collected social demographic profiles were analyzed to determine the barriers to the medication adherence@*Conclusion@#Forgetfulness, missing medication intake because they feel worse, or because they already feel fine are the identified barriers to adherence to maintenance medication intake among hypertensive and diabetic patients in the outpatient clinic setting. In this monocentric study, the focus was mainly on patient-related factors contributing to non-adherence. Future researches should assess also the Physician and the Health system related factors

Adherencia terapéutica y conocimientos sobre hipertensión arterial en una muestra de pacientes adultos / Therapeutic adherence and knowledge on hypertension in a sample of adult patients

Introducción: En países desarrollados, las tasas de adherencia a los tratamientos en enfermedades crónicas se sitúan alrededor de 50 %. Objetivo: Evaluar la adherencia terapéutica y los conocimientos sobre hipertensión arterial en pacientes adultos. Métodos: Se efectuó una investigación observacional y analítica de 54 pacientes adultos, de ambos sexos, quienes asistieron a la consulta externa del Hospital Docente Clinicoquirúrgico Joaquín Albarrán Domínguez de Ciudad de la Habana, durante el primer trimestre del 2018. Entre las variables analizadas figuraron: edad, sexo, tratamiento, grado de adherencia terapéutica y conocimientos. Resultados: Predominaron el sexo femenino (53,7 %), el grupo etario de 51-64 años (42,6 %) y el uso de fármacos antihipertensivos, tales como enalapril (50,0 %) y captopril (24,0 %); entre los diuréticos, la clortalidona (44,4 %) en tratamientos combinados (37,0 %). Las combinaciones más utilizadas fueron enalapril/clortalidona (16,7 %) y captopril/clortalidona (13,0 %). El conocimiento sobre su enfermedad fue insatisfactorio (51,9 %); la adherencia terapéutica se produjo en 48,0 % de los afectados, siendo los factores más frecuentes el descuido de la hora (50,0 %) y el olvido (42,9 %). Entre los factores relacionados con la no adherencia primó la polifarmacia (83,3 %) seguida de las dificultades en la obtención del medicamento (72,2 %). Conclusiones: La adherencia terapéutica en los pacientes con hipertensión arterial fue baja y no guardó relación estadística con el conocimiento sobre su enfermedad.

Introduction: In developed countries, the rates of adherence to treatments in chronic diseases are around 50 %. Objective: To evaluate the therapeutic adherence and the knowledge on hypertension in adult patients. Methods: An observational and analytic investigation of 54 adult patients of both sexes , who attended the out-patient service of Joaquín Albarrán Domínguez Teaching Clinical Surgical Hospital in Havana City was carried out during the first trimester of 2018. Among the analyzed variables there were: age, sex, treatment, degree of therapeutic adherence and knowledge. Results: The female sex (53.7 %), the age group 51-64 years (42.6 %) and the use of antihypertensive drugs, such as enalapril (50.0 %) and captopril (24.0 %); among the diuretics, the clortalidona (44.4 %) in treatments combined with 37.0 %, prevailed. The used combinations were enalapril/clortalidona (16.7 %) and captopril/clortalidona (13.0 %). The knowledge on their disease was not satisfactory (51.9 %); the therapeutic adherence took place in 48.0 % of those affected, being the most frequent factors the negligence on time (50.0 %) and forgetting (42.9 %). Among the factors related to the non adherence the polypharmacy prevailed (83.3 %) followed by the difficulties in obtaining of the medication (72.2 %). Conclusions: The therapeutic adherence in patients with hypertension was low and there was no statistical relation with the knowledge on their disease.

Adherence to treatment in type 2 diabetes mellitus patients receiving multiple drug therapy

Background: objective of the study was to evaluate adherence to therapy and factors associated with non-adherence in type 2 diabetes mellitus patients on multiple drug therapy.Methods: A prospective, cross-sectional, questionnaire based study conducted on 100 type 2 DM patients in a tertiary teaching hospital. They were interviewed using self-designed, semi-structured questionnaire to assess adherence to medication and diet/exercise schedule. Morisky medication adherence questionnaire was used to calculate overall adherence.Results: 71%patients had some co-morbidity and were on multiple medications. Average daily modifications taken by patients was 4.1±2.23 (mean+SD). Only 47% patients were found adherent. Illiteracy (11%), Language (10%), complicated dosages (8%), adverse drug events (6%), heavy outpatient load (6%), psychological illness (6%), and financial (4%) were common reasons for non-adherence. Surprisingly, total number of medicines prescribed did not interfere with adherence.58% patients were aware of the importance of medication, diet and exercise but 42% patients were not aware of the consequences of non-adherence. 65% patients adhered to diet control and 43% patients followed exercise schedule.Conclusions: 53% of type 2 DM patients on multi-drug therapy were not adhering to prescribed medication making it a major hurdle to its management. The most important cause of non adherence were not comprehending instructions due to various reasons like illiteracy, language issues, complicated schedules and less doctor-patient interaction due to heavy OPDs. Also 42% of the patients were not aware of the consequences of non adherence to therapy, diet and exercise. Hence, a multidimensional approach with adequate medication and emphasis on adherence to prescribed medication, diet and exercise schedule requires implemented. Health professionals can play a major role in improving adherence by increasing interaction with patients.

Medication Therapy Management Services and Pharmacovigilance Studies in Tuberculosis Patients: A Patient Care Aspect in the Pulmonology Department in a Tertiary Care Hospital

Background: Tuberculosis is fundamentally a disease of the lungs, however, it can influence any organ in the body. Objectives: Primary objective was to improve the patient compliance or medication adherence and to identify, detect, monitor ADRs induced by anti-tubercular drugs and report them. A secondary objective was to prevent the emergence of drug resistance and treatment of prolongation/failure in TB patients. Methods: A prospective, observational, cohort study was carried out for 6-months in tertiary care hospital. There were 60 patients included in the study. The data were evaluated for patients’ demographic profile, type of TB, medication adherence and occurrence of ADRs. Adverse drug reactions were observed and recorded. The causality of ADRs was assessed using WHO-causality assessment scale and Naranjo causality assessment scale. The severity of ADRs was determined using Hartwig’s severity assessment scale. Results and Discussion: Total of 60 patients were included in the study. Results showed that among 60 patients included in the study, 44 patients experienced ADRs. Among all age groups, the highest numbers of ADRs were seen in the age group 19-30 (43.1%) years. The occurrence of ADRs was noticed more in females (77.7%). The majority of ADRs occurred in patients was general (28.4%), and gastrointestinal effects (23.8%). Conclusion and Scope of the Study: Adherence to treatment is crucial for the cure of individual patients, controlling the spread of infection, minimizing the development of drug resistance and to reduce the chances of re-infection. Proper therapeutic monitoring of regimen, dose management, and pharmacovigilance activities are necessary. Such approaches will not only improve the treatment outcomes but also minimizes the chances of treatment prolongation/failure. All the health care professionals should interpret their responsibility in this domain of the health care profession.

Evaluación del cumplimiento de la farmacoterapia en pacientes crónicos atendidos en dos centros asistenciales de una zona rural de Paraguay / Evaluation of compliance with pharmacotherapy in chronic outpatients attended in two health care centers in a rural area of Paraguay

La falta de cumplimiento con la terapia farmacológica es un hecho recurrente y un problema global que impide que la morbimortalidad asociada a enfermedades crónicas pueda ser evitada. Describir el cumplimiento de la farmacoterapia en pacientes crónicos, que asisten a dos centros asistenciales de salud de la ciudad de Horqueta, una zona rural al norte de Paraguay. Es un estudio observacional, descriptivo, prospectivo y transversal de pacientes con Diabetes Mellitus tipo 2, Hipertensión y Dislipidémicos, con muestreo no probabilístico por conveniencia, utilizando el Test de Morisky-Green para determinar el cumplimiento al tratamiento farmacológico. Los principales resultados obtenidos fueron 63,2% mujeres; 70,6% con estudio primario concluido; 72,1 % con pareja estable, el 63,2% amas de casa y el 55,9% residentes en las áreas rurales, cercanas a ambos centros asistenciales. Los problemas de salud predominantes fueron, diabetes con hipertensión 38,2% y la hipertensión, 30,9 %. La media del tiempo de evolución de la enfermedad para los pacientes con diabetes e hipertensión fue de 10,4 años, y para los pacientes con hipertensión de 11,5 años. El 55,9%, demostró incumplimiento con la terapia. Los pacientes más cumplidores son los que tienen más de 20 años de tratamiento para su enfermedad, representado por el 81,8 %. El 55,9% no cumplen con la terapia. En el 71,1% de los casos la causa principal del no cumplimiento de la farmacoterapia fue el olvido.

The lack of compliance with drug therapy is a recurring fact and a global problem that prevents the morbidity and mortality associated with chronic diseases can be avoided. Describe the fulfillment of pharmacotherapy in chronic patients, who attend two health care centers in the city of Horqueta, a rural area in northern Paraguay. It is an observational, descriptive, prospective and cross-sectional study of patients with type 2 Diabetes Mellitus, Hypertension and Dyslipidemic, with non-probabilistic sampling for convenience, using the Morisky-Green Test to determine compliance with pharmacological treatment. The main results obtained were 63.2% women; 70.6% with primary study completed; 72.1% with a stable partner, 63.2% housewives and 55.9% residents in rural areas, close to both care centers. The predominant health problems were, diabetes with hypertension 38.2% and hypertension, 30.9%. The mean time to disease progression for patients with diabetes and hypertension was 10.4 years, and for patients with hypertension of 11.5 years. 55.9% showed non-compliance with the therapy. The most compliant patients are those who have more than 20 years of treatment for their disease, represented by 81.8%. 55.9% do not comply with the therapy. In 71.1% of cases, the main cause of noncompliance with pharmacotherapy was forgetfulness.

Assessment of knowledge and adherence to therapy among chronic kidney disease patients attending nephrology department of tertiary care hospital, Kurnool city, Andhra Pradesh

Background: High level of adherence to prescribed medication is very essential to obtain the desired outcomes in chronic kidney disease (CKD) patients. Non-adherence to medication has been associated with increased morbidity, mortality, and higher costs of care. Objectives: The objectives of this study were as follows: (1) To assess adherence to medications in CKD patients, (2) to know the patient’s knowledge regarding treatment, and (3) to study factors associated with nonadherence to medications in CKD patients. Materials and Methods: A cross-sectional study was conducted in the nephrology department of a tertiary care hospital. Patients (n = 206) aged >18 years, diagnosed with CKD and on treatment for >3 months were interviewed. Permission from ethical committee was taken and informed consent was obtained from the study subjects before start of the study. Morisky Medication Adherence Questionnaire (MMAQ) was used to assess overall adherence. A high score indicates poor adherence. Results: Of 206 patients, 1.46% (3) were Stage 1, 2.91% (6) were Stage 2, 11.17% (23) were Stage 3, 15.53% (32) were Stage 4, and 68.93% (142) were Stage 5 of CKD according to the National Kidney Foundation 2002 guidelines. Using the MMAQ, high, medium, and low adherence was reported in 23.30%, 42.23%, and 34.47% of patients, respectively. An average number of medicines taken in a day by each patient was 5.75 ± 0.707. Common causes of non-adherence were forgetfulness (71.51%), high cost of medicine (24.05%), and large pill burden (18.35%). Conclusions: Non-adherence remains a major obstacle in the effective management of CKD population. Periodic counseling about the importance of medication adherence to the patients and caregivers is essential to improve adherence.

A cross sectional study to assess pharmacotherapeutic adherence among diabetes mellitus patients in tertiary care hospital

Background: Diabetes mellitus (DM) refers to a group of common metabolic disorders that associated with abnormalities in carbohydrate, fat, and protein metabolism which results in chronic complications. Attainment of optimal blood sugar level is generally based on appropriate usage and proper adherence to prescribed medications. The study was, therefore, aimed to assess adherence to oral antidiabetic drugs among diabetic patients attending outpatient clinic of L. L. R. Hospital, G.S.V.M. Medical College, Kanpur, U.P.Methods: Hospital based cross-sectional study design was conducted from April 2017 to June 2018. The data was collected by interviewing T2DM patients receiving antidiabetic medications using Morisky’s four item adherence assessment questionnaire. The collected data was processed and analyzed with SPSS version 20.Results: From the 126 patients of diabetes, when asked about adherence to their medications as per the Morisky's four item method, 114 (90.47%) of them did not forget to take the drugs, 108 (85.71%) of patients reported that they had been being careful in taking their medications, 90 (71.42%) patients did not stop medications when they felt better and the other 108 (85.71%) patients reported that they did not stop medications when they felt worse while taking medications. This study shows that 54 (42.86%) respondents were adherent to their medications.Conclusions: This study revealed a moderate level of adherence among the participants and statistically significantly depended upon their socioeconomic status. Efforts are needed to increase the medication adherence of these patients’, so they can realize the full advantage of prescribed therapies.

Adherencia a tratamientos antihipertensivos farmacológicos en adultos de poblaciones Latinoamericanas del año 2015 al 2019 / Adherence to pharmacological antihypertensive treatments in adults of Latin American populations from 2015 to 2019

Propósito: analizar la evidencia disponible sobre la situación actual de la adherencia a tratamientos antihipertensivos farmacológicos en adultos de poblaciones Latinoamericanas. Materiales y Método: el tipo de diseño que se utilizó para la realización del estudio, fue cuantitativo, cuyo propósito fue el análisis de la evidencia disponible en relación con la adherencia al tratamiento antihipertensivo farmacológico, por medio de la revisión sistemática de artículos científicos relacionados con el tema, cuyo alcance es tener un documento actualizado en relación con la adherencia al tratamiento antihipertensivo farmacológico en pacientes adultos. Se incluyeron estudios de investigación originales, realizados en pacientes hipertensos adultos, utilizando la escala de adherencia a la medicación Morisky Green Levine y la de 8 ítems (MMAS-8) para evaluar la adherencia a la medicación entre 2015 y 2019. Se utilizaron estrategias de búsqueda exhaustivas de 3 bases de datos y palabras clave MeSH para localizar literatura elegible. Se registraron las características del estudio, la demografía de los participantes y los resultados de adherencia a la medicación, así como del tratamiento farmacológico y el control de la presión arterial. Resultados: características sociodemográficas, se observa que 50% de los artículos sí reportó al sexo masculino y el 80% sí reportó al sexo femenino. En cuanto a la edad, en algunos artículos se reportó más de un rango de edad. El mayor porcentaje de los que sí reportaron fue 70% para el rango de edad de 30-59 años, seguido de los de >60 años con 60%. En 7 de los 10 Artículos se encontró adherencia menor al 50%, en 2 artículos se reportó adherencia mayor que 50% y en 1 artículo no se encontró el dato; el porcentaje de adherencia promedio fue de 43.38%, con máximo de 88.6% y mínimo de 15%, los fármacos más indicados fueron los Beta bloqueadores y los que menos se indicaron fueron los Bloqueadores de los canales de calcio. Conclusiones: se cumplió con todos los criterios exigidos en la actualidad al escribir artículos científicos. Se debe profundizar en el tamaño de la muestra y el procedimiento de muestreo para la selección muestral, no en todos los artículos se trascendió de estudios descriptivos a estudios inferenciales; no se incluyó el rango de edades de los 18 a los 29 años: para 2019 se ha utilizado el test de Morisky Green MM8 que permite el tamizaje tanto de la adherencia como del cumplimiento al tratamiento; falta especificar la relación con la medición de Tensión Arterial para comunicar los resultados con estadísticos de significancia

Cross sectional study on prevalence and medication adherence of hypertension and diabetes in a tertiary care hospital in Karimnagar, India

Background: The study aimed to assess the prevalence of Hypertension (HTN), Diabetes mellitus(DM) and other diseases along with comorbid conditions, disease complications and also to assess medication adherence in a tertiary hospital in Karimnagar, Telangana, India.Methods: A Cross sectional study is performed by analysing a total of 500 patient抯 individual case safety reports (ICSR). Prevalence of Hypertension and Diabetes along with most prescribed drugs are analysed. Medication adherence is analysed by using Morisky Medication adherence questionnaire scale (MMAS-4).Results: Patients with past history of DM, HTN and other diseases which was found to be 245 (49%) patients. Patients with highest disease prevalence were found to be with HTN (56.73%), DM (31.83%) followed by other diseases like asthma (8.57%), Cerebrovascular accident (4.89%) etc., Total of 66 Patients were ruled out with comorbid diseases. Patients with HTN+DM (47) were found to be highest followed by DM+HTN+CVA (4). MMAS-4 revealed 208 patients were using medication out of 245 patients with previous history. According to MMAS-4 most of the patients were with medium adherence (76). Prevalent drug used for HTN include Amlodipine and for DM Telmisartan+Hydrochlorthiazide.Conclusions: The study revealed that almost half of the admitted patients were with HTN and DM. The patients were counselled properly to adhere strictly to the prescription. Medication adherence to HTN and DM was found to be good in this study. Since the disease complications were also ruled out, the health care professionals are recommended to spread awareness on DM and HTN and disease management in order to control disease and improve health outcomes.

A study to evaluate compliance in patients of diabetes mellitus in a North-Indian tertiary care hospital

Background: The objective of the study was to determine level of adherence and recognize various causative factors which can affect the compliance in the diabetic patients.Methods: This was an observational study. The study was conducted by enrolling patients of the outpatient department of Medicine of Rajindra Hospital, Government Medical College, Patiala, Punjab. To assess adherence, a questionnaire was administered to the patients - Morisky Medication Adherence Scale (MMAS) -8 item questionnaire. The various factors affecting compliance was determined by a researcher made questionnaire.Results: Out of a total of 100 subjects, age range extended from 18 years to 80 years. The mean age was 57.52±12.33years. 51% of patients were females and 49% was males. Analysis of MMAS- 8 item scores of patients showed that 52% of patients had low adherence, 29% had medium while 19% had high adherence to the treatment. Only 30% patients were compliant i.e. with HbA1C value of 7 or less while 70% patients were non-compliant i.e. with HbA1C value of more than 7.Conclusions: Compliance to medical treatment is influenced by a myriad of factors. In order to promote compliance, it is necessary to increase awareness about the disease, possible complications and treatment guidelines among patients as well as their family members.

An evaluation of factors affecting adherence to antiepileptic drugs in patients with epilepsy: a cross-sectional study

<p><b>INTRODUCTION</b>Adherence to antiepileptic drug (AED) therapy is important for controlling seizures in patients with epilepsy (PWE). It is vital to identify the factors influencing adherence to AED therapy using validated tools. This study aimed to evaluate the pattern and extent of AED adherence among PWE and to identify the factors that influence adherence.</p><p><b>METHODS</b>This was a cross-sectional study involving PWE who had a confirmed diagnosis. Treatment adherence was assessed using the four-item Morisky Medication Adherence Scale. Univariate analysis with chi-square test was used to observe the association between different variables and AED adherence. Binary logistic regression analysis was used to identify the predictors of adherence.</p><p><b>RESULTS</b>451 PWE (mean age 27.3 ± 8.1 years) were enrolled in the study; 251 (55.7%) were male and 198 (43.9%) were from the lower socioeconomic class. 326 (72.3%) patients had high adherence to AED therapy, while 125 (27.7%) had low adherence. AED adherence was significantly associated with socioeconomic status (p = 0.043) and type of epilepsy (p = 0.033). However, no significant difference was observed between adherence and age, gender, marital status, epilepsy duration, number and type of AEDs, and occurrence of adverse drug reactions. Patients with focal epilepsy and those from the middle/lower-middle socioeconomic classes were less likely to be nonadherent. The primary reason for nonadherence was forgetfulness.</p><p><b>CONCLUSION</b>This study found that a majority of PWE have optimal rates of AED adherence and that forgetfulness is the primary reason for nonadherence among PWE.</p>

Evaluation of the reliability and validity of the modified Morisky scale for patient's compliance with moxibustion / 针灸推拿医学（英文版）

Objective:A questionnaire for the compliance with moxibustion was designed based on the 4-item Morisky scale, and the reliability and validity of the questionnaire was investigated.Methods:A modified Morisky scale was designed based on the 4-item Morisky scale for the compliance with moxibustion, and 146 patients having received moxibustion for over 2 weeks were investigated using this scale to evaluate their compliance with moxibustion; the internal equity and the construct validity of the scale were statistically analyzed.Results:The analysis of reliability showed that in item of internal consistency, the Cronbach's α was 0.72 and the split-half coefficient was 0.71, the correlation coefficients between the 4 component scores and the total score ranged 0.67-0.80, and the between-component correlation coefficients ranged 0.24-0.56; the exploratory factor analysis (EFA) totally extracted 1 common factor, and the explicable variation was 55.02%, and the loads of the 4 items were respectively 0.82, 0.81, 0.74 and 0.58.Conclusion:The reliability and validity of the modified Morisky scale for the compliance with moxibustion are acceptable, while several items need further modification and improvement in the expression and content.

Adherencia al tratamiento antihipertensivo en pacientes ambulatorios de un hospital urbano

Introducción: la hipertensión arterial es una de las enfermedades crónicas más prevalentes en la población adulta. Su tratamiento incluye medidas higienicodietéticas y fármacos. La adherencia al tratamiento farmacológico es esencial para lograr el objetivo del control de la hipertensión arterial y minimizar las secuelas a largo plazo. Objetivos: determinar la adherencia al tratamiento antihipertensivo y factores asociados al cumplimiento terapéutico Metodología: estudio observacional, descriptivo, prospectivo realizado en pacientes que acudieron a consultorio de Clínica Médica en la Clínica Periférica Campo Vía del Instituto de Previsión Social, en la ciudad de Capiatá, en julio del 2014. Se utilizó el test de Morisky-Green-Levine y una encuesta. Resultados: sólo 39,7% se catalogaron como cumplidores. Estos se caracterizaron por menor tiempo de evolución de la hipertensión arterial, mayor grado de conocimiento sobre la enfermedad, nivel de instrucción superior al primario, menor número de comorbilidades y menor consumo de otros medicamentos. Conclusión: la adherencia al tratamiento antihipertensivo fue 39,7%.

Introduction: Arterial hypertension is one of the most prevalent chronic diseases in the adult population. Its treatment includes hygienic-dietary measures and drugs. Pharmacological treatment adherence is essential to achieve the control of arterial hypertension and minimize long-term consequences. Objective: To determine antihypertensive treatment adherence and factors associated to therapeutic compliance. Methodology: This was a prospective descriptive observational study carried out in patients attending the consultation room of Medical Clinics of the Campo Vía Peripheral Clinic of the Social Security Institute in the city of Capiatá in July, 2014. The Morisky-Green-Levine and a survey were used. Results: Only 39.7% were considered as compliers. They were characterized by having shorter evolution time of arterial hypertension, higher degree of knowledge about the disease, instruction level higher than primary, lower number of comorbidities and lower consumption of other drugs. Conclusion: Antihypertensive treatment adherence was 39.7%.

Psychometric Properties of the Persian Version of the Morisky Medication Adherence Scale-8.

Background: Hypertension is a global public health crisis. Poorly controlled high blood pressure is one of the most important factors contributed to this crisis. Lack of medication adherence is often considered as the main reason for insufficient control of high blood pressure. Difficulty in measuring medication adherence is another problem in this field. To reduce this difficulty several medication adherence scales were developed. This study was performed to test reliability and validity of Morisky Medication Adherence Scale-8. Materials and Methods: A cross-sectional study was conducted to validate the Persian version of MMAS-8. The Persian version of MMAS-8 was generated by using a modified forward/backward translation procedure. Two hundred and fifty hypertensive patients were participated in the study. Construct and known-groups validity, Cronbach’s alpha and test-retest reliability were used to assess psychometric properties of Persian scale. Results: Data analysis showed that the scale did not have an acceptable internal consistency (Cronbach’s Alpha= 0.40) but had excellent stability (p= 0.89). The confirmatory factor analysis poorly fitted with one-dimensional model. Participants with controlled blood pressure had significantly higher MMAS-8 scores than uncontrolled blood pressure group. Conclusion: Totally some of the psychometric properties of the Persian version of the MMAS-8 did not meet the requirements of the standard level so it is not recommended to use in general. More studies are needed to establish a more appropriate scale in order to be used in the mentioned population.