Exploring Validated Self-Reported Instruments to Assess Adherence to Medications Used: A Review Comparing Existing Instruments.

OBJECTIVE: To provide an overview of instruments that measure adherence to medications to facilitate selection of an instrument and to provide a summary of some published adherence assessment tools tailored to be used by the healthcare team, especially the pharmacists. DATA SOURCES: Studies were identified via PubMed, Medline, Embase, and Google Scholar using the search terms medication adherence, compliance, persistence, combined with the terms questionnaire, scale, survey, self-report, and instrument. STUDY SELECTION: Articles written in English, describing questionnaire instruments that were psychometrically evaluated (reporting a good coefficient of internal consistency, reliability assessed through Cronbach's alpha, and had been validated against a subjective or objective measure), and containing 30 or fewer items were included. DATA SYNTHESIS: Twelve instruments were identified and included in this review. Instruments were reviewed by evaluating specific characteristics (number of items, sample size, reliability, sensitivity, specificity, questionnaire completion time, criterion validity, and component analysis). CONCLUSION: Various instruments are used to assess patient adherence to medications; however, no single one performs well on all criteria. Every instrument has different advantages and unique properties. A particular instrument can be chosen after considering certain factors, such as the specific requirements, population, the needed time to complete the questionnaire, the sensitivity, and the specificity of the questionnaire. Moreover, there is a recognized need to provide primary care medication adherence services customized to patient's needs. A link for teamwork between healthcare providers such as pharmacists and patients is needed. This link can be a validated instrument to assess patient's adherence to medication.

Using drug chemical structures in the education of pharmacology and clinical therapeutics key concepts

Abstract Medicinal chemistry made it possible for pharmacists to propose pharmacodynamics and pharmacokinetics explanations of many existing drugs. Moreover, medicinal chemistry education provides pharmacy students with a reasonable understanding of drug physicochemical properties, mechanism of action (MOA), side effects, metabolism and structure-activity relationship (SAR). This paper highlights the importance of these medicinal chemistry key elements in understanding other pharmacy core courses, mainly pharmacology and clinical therapeutics. Such elements can be utilized as a tool for pharmacists while training or counseling their patients on the use of their treatments. Different new examples from the literature have been incorporated in this paper to show how chemical structures of existing drugs can provide essential information about main concepts in the education of pharmacology and clinical therapeutics, and the key structural elements for the discovery and development of other same class drugs.

Post-Stroke Depression in Jordan: Prevalence Correlates and Predictors.

BACKGROUND: Post-stroke depression is among the most frequent neuropsychiatric complications of stroke, and it is associated with poor prognosis and outcomes. This study aimed to assess the prevalence of depression; its correlates, and predictors among patients with stroke in Jordan. METHODS: A cross-sectional, descriptive correlation design was used among 198 patients with stroke admitted to 9 hospitals all over Jordan. Depression was assessed using the validated hospital depression subscale (HDS) of the Hospital Anxiety and Depression scale. RESULTS: Study patients (mean age 56.62 years [SD = 14.2], 53% were males) experienced high prevalence of depression (76%); of these, 51.6% were categorized as higher depression category (a case of depression; HDS = 11-21). Factors that correspondingly predicted higher depression categories were low level of education (odds ratio [OR] = 3.347, 95% confidence interval [CI] = 2.920-23.949, P < .001), having a preparatory level of education (OR = 8.363, 95% CI = 1.24-9.034, P = .017), having comorbid chronic diseases (OR = .401, 95% CI = .190-.847), being a smoker (OR = 2.488, 95% CI = 1.105-5.604, P = .028), patients who reported inability to perform daily activities by themselves (OR = 3.688, 95% CI = 1.746-7.790, P = .001), and patients with comorbid dysphasia (OR = 12.884, 95% CI = 4.846-34.25, P < .001). CONCLUSIONS: Post-stroke depression is a significant health problem among Jordanian patients with stroke and warrants serious attention. Clinicians need to consider these important predictors when assessing and managing depression among patients at risk.

Exploring the role of quantitative feedback in inhaler technique education: a cluster-randomised, two-arm, parallel-group, repeated-measures study.

BACKGROUND: Feedback is a critical component of any educational intervention. When it comes to feedback associated with inhaler technique education, there is a lack of knowledge on its role or its potential to solve the major issue of poor inhaler technique. AIMS: This study aims to explore the role of feedback in inhaler technique education and its impact on the inhaler technique of patients over time. METHODS: A parallel-group, repeated-measures study was conducted in the community pharmacy in which the effectiveness of current best practice inhaler technique education utilising qualitative visual feedback (Group 1) was compared with a combination of qualitative and quantitative visual feedback (Group 2). The impact of these two interventions on inhaler technique maintenance was evaluated. Community pharmacists were randomly allocated to recruit people with asthma who were using a dry powder inhaler. At Visit 1 their inhaler technique was evaluated and education delivered and they were followed up at Visit 2 (1 month later). RESULTS: Both educational interventions resulted in an increase in the proportion of patients with correct inhaler technique: from 4% to 51% in Group 1 and from 6% to 83% in Group 2 (Pearson's Chi-Squared, P=0.03, n=49, and Pearson's Chi-Squared, P=0.01, n=48, respectively). The magnitude of improvement was statistically significantly higher for Group 2 compared with Group 1 (n=97, P=0.02, Pearson's Chi-Square test). CONCLUSIONS: The nature of feedback has an impact on the effectiveness of inhaler technique education with regard to correct inhaler technique maintenance over time.