Antihypertension medication adherence and associated factors at tertiary care hospital, Gujarat, India

Background: According to world health organization (WHO) describes poor adherence as the identical cause of uncontrolled blood pressure and estimates that 50-70% of people do not take their antihypertensive medication as prescribed. The objectives of this study were to investigate the adherence and persistence of antihypertensive drugs in Indian rural population as well as monitoring adverse drug reactions and its relation to compliance.Methods: This cross-sectional study conducted among 300 hypertensive patients taking treatment at tertiary care hospital in Gujarat, India. Structured questionnaires consisting of open and closed ended questions on the antihypertensive drug adherence were distributed to patients for those found on the study area at time of data collection and the left-over pills of individual patient were counted to strengthen the consistency of the research.Results: Prevalence of non-adherence found in 24.3% participants. Present study found statistically significant association between socio-demographic factors (age, religion, marital status, occupation, substance abuse, education and family history of HT) with treatment adherence of hypertension among study participants. The other factor associated to non-adherence was therapy factor 32.9% (P=0.001) from the total non-adherence, in this case patients were supposed to unwanted effect of the drug and they were not able to take the medication.Conclusions: The main possible reasons for non-adherence were ‘refuse to take regular treatment’,‘cost of treatment’, ‘poor patient-doctor relation’, ‘unwanted side effect of drugs’ and other factors like age, marital status, occupation, education level, family H/O, substance abuse and religion are also playing supporting role to develop non-adherence to treatment

Antihypertension medication adherence and associated factors at Dessie Hospital, North East Ethiopia, Ethiopia.

Hypertension is an overwhelming global challenge. Despite the development of many effective anti hypertensive drugs, target to reduce morbidity and mortality due to high blood pressures are reached in only a minor of patients in clinical practice. Poor adherence is one of the biggest obstacles in therapeutic control of blood pressures. There are complaints from patients and physicians that the poor result of actual antihypertensive drug therapies. Many people with age indifference are attacked by this “silent killer” or which results in target organ damage as a complication. The aim of this study was to assess the magnitude of adherence and the factors associated with non-adherence to anti-hypertensive medication. Cross sectional exclusively convenient study was conducted by using structured questionnaires consisting of open and closed-ended questions on patients diagnosed for hypertension and have already been on anti hypertensive medications at least for three months at Dessie Referral hospital from 20/01/2012 to 29/01/2012. A total of hundred hypertensive patients were screened from hundred six cases by the exclusive criteria and the overall incidence of anti-hypertensive medication non adherence was 26%. The study identifies reasons why patients don’t adherent with the drug regiments. Among Factors associated with non adherence were health system and health care provider poor interaction with patient and therapy factors like frustration and unwanted effect of the medication in the long run. There was indication of non adherence from the study area. Great emphasis should be placed on intervention strategies such as patient counseling and increasing awareness of the physicians, all other prescribers and health care providers at large about the non adherence of anti hypertensive drugs as well as the complication what comes due to this medication non adherence.

Effect of Emotional Intelligence on Patient-Physician Interaction Scores of Clinical Performance Examination / 한국의학교육

PURPOSE: The patient-physician interaction (PPI) is a critical part of the clinical encounter. Recent studies have emphasized the importance of the emotional intelligence (EI) of physician in the PPI. Despite emphasizing the EI, previous studies offer limited evidence regarding the effect of a student's EI on the PPI. The purpose of this study is to explore the differences in EI depending on the demographics of medical students and the correlation between EI and PPI scores. METHODS: The sample was 85 fourth-grade medical students. Prior to taking a 12-station clinical performance examination, the students completed questionnaires on their own perception of the EI, which included 5 domains and 50 items. The tool that was used to assess the level of EI was Moon's modified version of the EI test for adults. We investigated differences in EI depending on the demographics of medical students by ANOVA and noted a correlation between EI and PPI scores by stepwise multiple regression analysis. RESULTS: This study found that females or graduate entry students have higher EI scores and that 25 to 30-year-old students have higher EI scores than aged under 25 years. The PPI scores correlated positively with total EI scores (r=0.32) and 2 subdomains (perception and expression of emotion, r=0.26; empathy, r=0.33). Two subdomains were the best predictors of PPI score (R2=0.171). CONCLUSION: EI correlates significantly with PPI score and affects it. We conclude that EI is a key influence of the PPI. Further research is required to explore whether this is a consistent effect.

The Change of CPX Scores according to Repeated CPXs / 한국의학교육

PURPOSE: Most medical schools have held clinical skills training programs recently. Despite these educational endeavors, few studies have attempted to address the effect of clinical skills assessments on clinical performance. This study investigated whether repeated experiences with the examination improved medical students' history-taking, physical exams, and patient-physician interactions (PPIs). METHODS: The subjects of the study were 101 4th-year medical students who participated in the clinical performance examination (CPX) 3 times. They completed their core clerkship before acquiring the first CPX scores; we tracked down the scores of three sets of CPX for 3 subdomains (history taking, physical exam, and patient-physician interaction) and investigated the changes in these scores. Additionally, we classified the research subjects into 3 groups by total CPX score-higher (upper 30%, n=30), intermediate (medium 40%, n=40), and lower (lower 30%, n=30)-and compared the curves for each group. RESULTS: Significant improvements were made on history taking and physical exam (F=130.786/237.358, p<0.01), while proficiency on the PPI declined (F=17.621, p<0.01). Additionally, scores in all levels improved continuously on history taking and physical exam, while students of the high and low levels experienced a sharp decline on the PPI (F=11.628, p<0.01). CONCLUSION: Improvement in the history-taking score reflects an accumulation of clinical knowledge and clinical exposure. Improvement on the physical exam score is affected by repeated practice on similar or identical cases and receipt of feedback. That PPI can deteriorate might be an effect of one's negative experience in a clinical clerkship.

Comparison of Patient-Physician Interaction (PPI) Evaluation between Different Grade Medical Students / 한국의학교육

PURPOSE: A proper patient-physician interaction (PPI) creates rapport between doctors and patients and improves medical outcomes. The importance of PPI evaluation items was evaluated in each medical student in grades 3 and 4, before and after their clinical clerkship. METHODS: Six PPI evaluation guidelines (SEGUE, Kalamazoo Consensus, Calgary-Cambridge Guide, Macy guideline, 2 Korean Consortium guidelines) were selected and importance of each guideline was evaluated through the structured questionnaire in 73 pre-clinical clerkship (3rd-grade) and 78 post-clinical clerkship (4th-grade) medical students. RESULTS: The importance of medical communication items among total clinical performance, students-rated PPI portion was 21+/-9.7%. In SEGUE recommendations, 'Elicit information' was evaluated to be most important items before (58.3%) and after (65.8%) clinical clerkship. In Kalamazoo Consensus, 'Gathering information' was evaluated to be most important (49.3%/42.3%), same as in Calgary-Cambridge Guide (52.1%/56.4%) and Daegu Gyeongbuk Consortium (47.9%/43.6%). In the Macy guideline, 'Listening' was evaluated to be most important (28.8%/33.3%). In the Seoul Gyeonggi Consortium, 'Buidling relationships' was evaluated to be most important (23.3%/28.2%). CONCLUSION: In the 4th-grade post-clerkship medical students after clinical clerkship, importance of 'Gathering information' was evaluated to be less important, however, 'Giving information' and 'Understanding the patient perspective' was evaluated to be more important, compared to pre-clerkship students 3rd-grade students.