ABSTRACT
Background: To compare the efficacy, safety and user satisfaction of levonorgestrel intrauterine system (LNG-IUS) with oral progestogen in medical management of heavy menstrual bleeding (HMB).Methods: This prospective study was conducted on 80 women with HMB in age group of 35-55 years. Patients were divided into two groups of 40 each and followed for six months. In Group I, LNG-IUS was inserted in post menstrual period and in Group II, patients received oral norethisterone 5 mg twice a day during 5th-25th day of cycle for 6 months. Patients were evaluated about amount and duration of blood loss by pictorial blood assessment chart (PBAC) along with haemoglobin estimation on each follow up visit. MMAS (Menorrhagia Multi-Attribute Scale) score comparison between two groups was done to measure the improvement in quality of life. The results were analysed by using Chi-square test and Student t-test.Results: Percentage reduction in PBAC score after six cycles of treatment was 89.3% in LNG IUS group as compared to 68% in norethisterone group. LNG-IUS was found to be more efficient in correcting anemia, lowering duration of bleeding and improving MMAS score as compared to norethisterone.Conclusions: Present study showed that LNG IUS was superior to oral progestogen in decreasing quantity and duration of bleeding and improving overall quality of life over time.
ABSTRACT
Background: The primary treatment for epilepsy is Antiepileptic drug (AED) therapy. Non-compliance to AEDs can result in break-through seizure, emergency department visits, hospitalizations, fractures, head injuries and increased mortality. Thus, compliance to AEDs is crucial to be studied. Objective is to study compliance and factors influencing compliance with AEDs among patients with epilepsy.Methods: This observational study was conducted in 105 patients with epilepsy on AED therapy in community in Ludhiana (Punjab) after approval from Institutional Ethics Committee. Demographic data and drug history was collected. Monthly follow up for 6 months was done by paying home visits and data regarding type, dose, frequency of administration of AED was recorded on a semi-structured performa. Pill count was done by recording number of pills dispensed and number of pills remaining with patient. Response to Morisky’s Medication Adherence Scale (MMAS) was also recorded. Results were correlated with patient demographics, type, frequency and number of AEDs.Results: Out of 105 patients, 65 were males and 40 were females. Fifty-four patients were non-compliant with both pill-count and MMAS. Non-compliance was high in first month and decreased gradually. Poly-therapy, lower socio-economic status and multiple dosing regimens were most commonly associated with non-compliance.Conclusions: Under-dosing was more common among non-compliers, which explains the high reporting of forgetfulness to take medicine in MMAS. Both pill count and MMAS are effective non-invasive tools to study compliance.
ABSTRACT
OBJECTIVE： To analyze the reliability and validity of Chinese version of MMAS-8 in evaluating the medication compliance of patients with chronic cardiovascular diseases， and to evaluate the effects of medication reconciliation on medication compliance. METHODS： Totally 97 patients with chronic cardiovascular diseases were selected as observation group. The reliability and validity of the questionnaire were analyzed and medication reconciliation was carried out. Totally 91 patients with chronic cardiovascular diseases were selected as control group， and given routine medical services. 8-item Morisk Medication Compliance Scale used to evaluate the drug compliance of the two groups at different time points. RESULTS： The F-test and t-test of the average score of 8 items in 27％ of questionnaire score ranking head and tail of the two extreme groups had statistical significance （P＜0.001）. Correlation coefficient between the 8 items and the total scores was higher than 0.400， and the 8 items were significantly correlated with total scores （P＜0.001）. Internal consistency reliability coefficient was 0.763； the structure validity KMO value was 0.742； the Bartlett’s spherical test value was 266.007； factor analysis method was adopted to extract 2 common factors， and explained total variance was 58.907％. Compared with control group， medication compliance of observation group was improved significantly at the first week after discharge and one month after discharge （P＜0.05）. CONCLUSIONS： The Chinese version of MMAS-8 has good reliability and validity in evaluating drug compliance of patients with chronic cardiovascular disease； medication reconstitution service can improve medication compliance of patients.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
OBJECTIVE:To investigate the reliability and validity of the Chinese version Morisky Medication Adherence Scales-8 in assessing medication compliance of the patients with rheumatoid arthritis.METHODS:The Chinese version of MMAS-8 was used to evaluate the compliance of 200 rheumatoid arthritis patients who responded to the WeChat public issue from the public forum of China rheumatism.Item analysis,homogeneity test,reliability analysis,and validity analysis were all conducted.RESULTS:The eight items showed significant difference between the two extreme groups as head and tail 27％ of the total score in Levene method F test (P＜0.001).t test of variance inequality was adopted,with significant difference (P＜0.001).Correlation coefficient between the 7 items and the total score was higher than 0.400,and the 8 items were significantly correlated with the total score (P＜0.001).Internal consistency reliability coefficient Cronbach's α was 0.657,and standardized Cronbach's α was 0.662.For construct validity,KMO was 0.638,Bartlett's sphericity test was 246.278,factor analysis method was adopted to extract 3 common factors,and explainable total variance was 58.846％.Pearson correlation coefficient was 0.435 between MMAS-8 total score and MA-VAS score (P＜0.001).CONCLUSIONS:Reliability and validity of the Chinese version MMAS-8 for the determination of medication compliance in patients with rheumatoid arthritis are good.
ABSTRACT
Introduction: The World Health Organization describes poor adherence as the most important cause of uncontrolled blood pressure and estimates that 50–70% of people do not take their antihypertensive medication as prescribed.Goal was to measure non-adherence to antihypertensive therapy in a representative sample of the hypertensive Mongolian population and to define the factors associated with non-adherence in the studied population.Materials and Methods:This descriptive study was a questionnaire-based cross sectional analysis. A simple random sample of 735 hypertensive patients, aged 35-64 years was selected. The questionnaire included sociodemographic characteristics and awareness about hypertension and anti-hypertensive treatment, and factors that encouraged or discouraged the patient’s drug taking behavior. Adherence was assessed using the Morisky Medication Adherence Scale (MMAS), with a 4-item questionnaire. Blood pressure was measured twice by the physicians using aneroid sphygmomanometers and stethoscopes. Results and Discussion: The study sample consisted of 265 men (36.1%) and 470 women (63.9%). The mean age of participants was 53.8 ± 8.7 years. The non adherence to medical treatment found in the our study was 68.3% of hypertensive patients. We found younger age (35-44), low family income, not having a regular doctor towards hypertension control, behaviour not taking drug regularly, monotherapy and lack of patient’s knowledge to be the significantly factors influencing on non-adherence to anti-hypertensive medication among Mongolian hypertensive population. The non adherence to antihypertensive treatment found in the current study was higher than that of 25.9%-55.8% found in the study done in Malaysia, Pakistan and Egypt and lower than what a study in the Bangladesh , India and Brazil (74.2%-90.0%)population.Conclusion: The level of adherence to treatment among the participants in this study seriously needs to be improved through well designed health promotion and education strategies in order to prevent poor treatment outcomes.