Psychosocial and behavioral correlates of self-efficacy in treatment adherence in older patients with comorbid hypertension and type 2 diabetes.

BACKGROUND: Adhering to clinical prescriptions is known to protect against the effects of uncontrolled hypertension and of acute and chronic cardiovascular diseases, including diabetes. Contextually, positive associations between self-care behaviors and psychological constructs, such as self-efficacy, are widely acknowledged in the literature. However, still little is known about the psychological factors underlying the patient's self-efficacy. This study aimed to investigate the psychosocial and behavioral correlates of self-efficacy related to treatment adherence in older patients with comorbid hypertension and type 2 diabetes mellitus. PARTICIPANTS AND PROCEDURE: Italian and Polish patients (≥ 65 years; N = 180) consecutively responded to self-report questionnaires measuring psychosocial (i.e., beliefs about medicines, perceived physician's communication effectiveness, medication-specific social support, self-efficacy) and behavioral factors (i.e., pharmacological adherence, medications refill adherence, intentional non-adherence) related to treatment adherence. Between-group comparisons and regression analyses were performed. RESULTS: Fisher's least significant difference (LSD) test showed significant differences between the Italian and Polish groups in all questionnaires (p < .01) with the Italian patients reporting more satisfactory scores. Younger age (ß = .08, p = .045), female gender (ß = 1.03, p = .042), higher medication refills adherence (ß = -.07, p = .024), lower intentional non-adherence (ß = -.03, p = .009), positive beliefs about medications (ß = .13, p < .001), better quality of communication with the physician (ß = .09, p < .001), and stronger perceived medication-specific social support (ß = .06, p = .001) were significantly associated with self-efficacy related to treatment adherence. CONCLUSIONS: Future research and interventions should leverage psychosocial and behavioral factors to address self-efficacy contributing to enhancing adherence to clinical prescriptions.

Diet as a Factor Supporting Lung Cancer Treatment-A Systematic Review.

The purpose of this study was to summarize the evidence from epidemiological studies concerning associations between diet and the effectiveness of treatment for lung cancer. For this review, a literature search has been conducted in the EMBASE and PubMed databases, including papers published between 1977 and June 2022. The term "lung cancer" was used in conjunction with "diet". Footnotes from the selected papers were also analyzed. The present study is in line with the recommendations included in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The review included studies involving adults, including randomized controlled trials (RCTs) and cohort and observational studies. In total, 863 papers were found, with duplicates excluded. Ultimately, 20 papers were reviewed. The present systematic review indicates that vitamin A, ascorbic acid (vitamin C), vitamin E, selenium, and zinc-as antioxidants-can strengthen the body's antioxidant barrier. Furthermore, preoperative immunonutrition may not only improve perioperative nutritional status following induction chemoradiotherapy in lung cancer surgery patients but also reduce the severity of postoperative complications. Similarly, a protein supply may exert a beneficial effect on human health by increasing average body weight and muscle mass. Omega-3 fatty acid content in the diet and the consumption of their main source, fish, may have some regulatory effect on inflammation in patients with lung cancer treated with chemotherapy and radiotherapy. In addition, n-3 fatty acids inhibit tumor cell proliferation and may reduce the toxicity of chemotherapy. Increased energy and protein intake are strongly associated with improved quality of life, functional outcomes, hand grip strength, symptoms, and performance in patients with lung cancer. The use of a supportive diet should be the standard of care, alongside pharmaceutical therapy, in treatment for patients with lung cancer.

Effect of nutritional status on psychological functioning and coping in patients with lung cancer.

OBJECTIVES: Lung cancer is the most common cancer. In patients with lung cancer, malnutrition may result in shorter overall survival, poorer treatment response, increased risk for complications and impaired physical and mental function. The aim of this study was to assess the effects of nutritional status on the psychological functioning and coping in patients with lung cancer. METHODS: The present study included 310 patients treated for lung cancer at the Lung Center between 2019 and 2020. The standardized instruments were used: Mini Nutritional Assessment (MNA) and Mental Adjustment to Cancer (MAC). Of the 310 patients, 113 (59%) were at risk for malnutrition and 58 (30%) had malnutrition. RESULTS: Patients with a satisfactory nutritional status and those at risk for malnutrition reported statistically significantly higher levels of constructive coping compared with patients with malnutrition (P = 0.040). Patients with malnutrition were more likely to have more advanced cancer: T4 tumor (60.3 versus 38.5; P = 0.007), distant metastases: M1 or M2 (43.9 versus 28.1; P = 0.043), tumor metastases (60.3 versus 39.3; P = 0.008) and brain metastases (19 versus 5.2: P = 0.005). Patients with malnutrition were more likely to have higher levels of dyspnea (75.9 versus 57.8; P = 0.022) and a performance status of ≥2 (69 versus 44.4; P = 0.003). CONCLUSIONS: Malnutrition is significantly more common in patients using negative strategies for coping with cancer. Lack of constructive coping is a statistically significant predictor of increased risk for malnutrition. Advanced cancer stage is a statistically significant independent predictor of malnutrition, increasing the risk of malnutrition by more than twofold.

Assessment of The Effect of Stress, Sociodemographic Variables and Work-Related Factors on Rationing of Nursing Care.

(1) Rationing of nursing care is withholding, limiting or not fulfilling the necessary nursing activities for patients. It may have a negative effect on patient safety and the quality of care. The aim of the present paper is the assessment of the effect of stress on the rationing of nursing care. (2) The current research has a cross-sectional, observational design. The study sample comprised 567 nurses. The following questionnaires were used in the study PIRNCA and PSS-10. (3) It was demonstrated that nurses with a high level of perceived stress rationed nursing care to a greater extent and showed lower assessment of nursing care and lower job satisfaction in comparison with nurses with average and low levels of perceived stress. (4) 1. Stress in nurses has a negative effect on rationing of nursing care and job satisfaction. It is recommended that actions aimed at developing effective stress coping skills be implemented as early as at the stage of training to become a nurse. 2. Factors such as marital status, sex, form of employment, place of employment and the level of professional burnout syndrome may have an influence on the level of experienced stress. In turn, the level of experienced stress, marital status, education, place of work as well as the place of residence may have an effect on rationing of nursing care and, consequently, affect the quality of care.

Impact of Loneliness on Functioning in Lung Cancer Patients.

Lung cancer is the leading cause of cancer death and carries a greater degree of stigma. Lung cancer stigma contributes to social isolation and increases loneliness, which has an impact on quality of life, increases depressive symptoms and hence affects all aspects of functioning. Functioning is assessed in five dimensions (physical, psychological, cognitive, social and life roles). The aim of the study was to assess the impact of loneliness on the functioning, nutritional status and quality of life of patients with lung cancer. METHODS: The survey study was conducted among 310 lung cancer patients. The patients were asked to complete the Mini-MAC, HADS-M, MNA, EORTC QoL, AIS and VAS questionnaires. RESULTS: In total, 136 patients were lonely and 174 were married or in a relationship. Lonely patients had significant difficulty accepting their illness and demonstrated higher levels of depression. The factors most strongly associated with loneliness were being unemployed, age 61 or over and a less score in the constructive coping strategies. CONCLUSIONS: Loneliness is a significant factor affecting the functioning of patients with lung cancer. It increases the risk of anxiety and depression, reduces levels of illness acceptance, reduces levels of constructive coping and increases the risk of malnutrition.

Relationship between Nutritional Status and Clinical Outcome in Patients Treated for Lung Cancer.

BACKGROUND: Between 34.5% and 69% of the patients with lung cancer are at risk of malnutrition. Quality of life (QoL) and physical status assessment provides valuable prognostic data on lung cancer patients. Malnutrition is a prognostic parameter for clinical outcome. Therefore, the identification of significant factors affecting the clinical outcome and QoL is important. The purpose of this study was to evaluate the relationship between nutritional status and outcome, i.e., overall survival, time to tumor progression, and QoL, in lung cancer patients. MATERIALS AND METHODS: We performed a systematic search of the Pubmed/MEDLINE databases per the Cochrane guidelines to conduct a meta-analysis consistent with the PRISMA statement, using the following keywords: "lung cancer," "malnutrition," "nutrition," "quality of life," "well-being," "health-related quality of life," and "outcome." Out of the 96 papers identified, 12 were included in our meta-analysis. RESULTS: Our meta-analysis shows that patients with a good nutritional status have a better QoL than malnourished patients in the following functioning domains: physical (g = 1.22, 95% CI = 1.19 to 1.46, p < 0.001), role (g = 1.45, 95% CI = 1.31 to 1.59, p < 0.001), emotional (g = 1.10, 95% CI = 0.97 to 1.24, p < 0.001), cognitive (g = 0.91, 95% CI = 0.76 to 1.06, p < 0.001), and social (g = 1.41, 95% CI = 1.27 to 1.56, p < 0.001). The risk of death was significantly higher in malnourished than in well-nourished patients (HR = 1.53, 95% CI = 1.25 to 1.86, p < 0.001). Nutritional status was significantly associated with survival, indicating that patients with a poorer nutritional status are at more risk of relapse. CONCLUSIONS: Nutritional status is a significant clinical and prognostic parameter in the assessment of lung cancer treatment. Malnutrition is associated with poorer outcome in terms of overall survival, time to tumor progression, and QoL in patients treated for lung cancer.

Psychosocial Determinants of Treatment Adherence in Patients with Type 2 Diabetes - A Review.

Less than 50% of patients with diabetes achieve the glycaemic goals recommended by the American Diabetes Association. The set of factors associated with adherence to treatment is very broad. Evidence suggests that psychosocial factors are related to medication adherence of patients with type 2 diabetes. Due to the lack of a clear statement from researchers regarding the relationship of psychosocial factors to adherence, an electronic search was conducted in PubMed, MEDLINE, Academic Search Ultimate, CINAHL Complete, Edition and Health Source: Nursing/Academic Edition using the following keywords "adherence", "diabetes", "social support", "stress", "anxiety and depression", "beliefs about medicine", "communication", "older age", "frailty", "cognitive impairment", "addiction", "acceptance of illness", "sense of coherence" obtaining 2758 results. After a narrowing of searches and reference scanning, 36 studies were qualified. The studies analysed showed negative effects of anxiety, diabetes distress, older age, poor communication with physicians, stress, concerns about medicines and cognitive impairment on levels of self-care and medication adherence. One study did not confirm the association of depression with adherence. Self-efficacy, social and family support, and acceptance of illness had a beneficial effect on medication adherence. In conclusion, the current evidence suggests that the relationship between psychosocial factors and adherence has reliable scientific support.

The Revised Self-Care of Heart Failure Index - a new tool for assessing the self-care of Polish patients with heart failure.

BACKGROUND: According to the European Society of Cardiology guidelines, self-care is a key part of treatment for patients with heart failure. A large evidence base has been accumulated regarding the direct impact of self-care on the outcome of patients with heart failure. In order to assess self-care in patients with heart failure and to evaluate the effectiveness of the interventions taken, a reliable and culturally acceptable instrument is required. The Revised Self-care of Heart Failure Index (SCHFI) is a new tool for assessing self-care in patients with heart failure. AIM: Our aim was to test the reliability of the Polish version of the Revised SCHFI. METHODS: The standard forward-backward translation procedure was used to translate the Revised SCHFI questionnaire into Polish. The reliability of the SCHFI was assessed based on Cronbach's α, item-total correlation, exploratory factor analysis, and confirmatory factor analysis. RESULTS: A total of 127 patients with heart failure (mean [SD] age, 68.5 [11.2] years) completed the questionnaire. The mean (SD) total self-care score in the study group was 51.92 (22.0). Patients scored the highest in terms of self-care confidence (mean [SD] score, 65.63 [21.0] points), and the lowest in symptom perception (mean [SD] score, 54.64 [18.28] points). The Revised SCHFI had satisfactory psychometric properties in all subscales (self-care maintenance α = 0.790, symptom perception α = 0.790, self-care management α = 0.705). CONCLUSION: The Polish version of the Revised SCHFI is a reliable and valid instrument for assessing self-care level in heart failure patients.

Impact of Beliefs about Medicines on the Level of Intentional Non-Adherence to the Recommendations of Elderly Patients with Hypertension.

BACKGROUND: Non-adherence to pharmaceutical treatment is one of the most common causes of uncontrolled hypertension. Non-adherence may be intentional or unintentional. In the case of intentional non-adherence, it is crucial to understand the reasons behind it. The literature increasingly addresses the issue of beliefs and concerns about medication, but studies on this subject performed in a Polish population of hypertensive patients are still lacking. The aim of the study was to assess the level of intentional non-adherence among patients with hypertension, and to determine the relationship between beliefs about medication and the level of intentional non-adherence to treatment in elderly patients with hypertension. MATERIAL AND METHODS: The study included 300 patients (106 of whom were male, mean age (SD) 71.71 (8.12) years) with hypertension, treated at a hypertension clinic. The following instruments were used: the Intentional Non-Adherence Scale (INAS) for evaluating intentional non-adherence, and the Beliefs about Medicines Questionnaire (BMQ) for evaluating patients' beliefs and opinions regarding medication. Socio-demographic and clinical data were obtained from patients' medical records. RESULTS: The mean (SD) INAS score in the study was 47.28 (19.12). Patients were most concerned about the harm caused by medication, and least concerned about the necessity to take medication (mean score per item 3.49 vs. 2.14). Correlation analysis demonstrated weak correlations between BMQ and INAS: higher scores for necessity were associated with more intentional non-adherence (r = 0.174, p = 0.003), while higher scores for overuse, harm, and concerns were associated with less intentional non-adherence (respectively: r = -0.253, p < 0.001 vs. r = -0.336, p < 0.001 vs. r = -0.351, p < 0.001). In multiple-factor analysis, factors increasing the level of intentional non-adherence were elderly age (ß = -0.352, p = 0.009), multimorbidity (ß = -2.374, p = 0.035), and a higher BMQ concerns score (ß = -1.376, p < 0.001), while being single was an independent predictor decreasing intentional non-adherence (ß = 5.646, p = 0.013). CONCLUSIONS: The overall level of intentional non-adherence among patients with hypertension is moderate, but approximately one third of patients with hypertension demonstrate a high level of non-adherence. Independent determinants of intentional non-adherence include concerns, elderly age, multimorbidity, and being single.

Influential factors in adherence to the therapeutic regime in patients with type 2 diabetes and hypertension.

BACKGROUND: Medication non-adherence is a global problem and the most common cause of treatment failure. Researchers warn that only one in two patients with chronic conditions adhere to their medication. Therefore, the primary objective of the study was to assess influential factors in adherence to the therapeutic regime in patients with type 2 diabetes and hypertension. The secondary objective was to evaluate medication adherence in patients with hypertension (HT) and/or diabetes (DM) and compare the level of adherence among patients with either diabetes or hypertension. METHODS: The study included 1303 patients divided into three groups according to the type of chronic condition. The Adherence to Refills and Medications Scale (ARMS) was used to assess the level of adherence with pharmacological recommendations. RESULTS: A comparison of adherence between the groups demonstrated that the level of adherence was highest in patients with diabetes alone (17 ± 5.15) and was lowest in patients with co-existing HT and diabetes (19.9 ± 7.51). A single-factor linear regression model analysis showed that the presence of hypertension alone has a positive effect on adherence to medications, while the co-existence of diabetes and hypertension has a statistically significantly negative impact on medication adherence. The sociodemographic predictors of higher adherence included female gender (ß = -0.06; p = 0.024), high school education (ß = -0.16 and p = 0.001) and being unemployed (ß = -0.08; p = 0.0100). CONCLUSION: Patients with co-existing diabetes and HT taking antihypertensive and antidiabetic drugs have the lowest adherence rates, and the co-existence of two chronic conditions is a statistically significant independent determinant of decreased adherence. Variables confirmed in the multiple-factor model as having an independent impact on the level of adherence include the type of condition suffered, female gender, education and professional status. Practical implication. The primary objective is to undertake actions whose aim is to improve adherence in order to enhance patients' functioning, reduce the number of follow-up visits and the hospitalisation rate, and thus limit the economic consequences of treating disease complications.

Relationship Between Nutritional Status and Quality of Life in Patients with Lung Cancer.

INTRODUCTION: Malnutrition is often co-occur in patients with advanced cancer and are associated with poorer response to treatment therapy and decrease significantly the quality of life (QoL). There is little evidence regarding the relationship between nutritional status and QoL in this patient group. PURPOSE OF THE STUDY: To assess the relationship between nutritional status and QoL in patients with lung cancer. METHODS: Our cross-sectional, descriptive study included 310 patients. Only standardized instruments were used to perform the study: Mini Nutritional Assessment (MNA) to assess nutritional status and The European Organization for Research and Treatment of Cancer Quality of Life Core-30 (EORTC-QLQ-C30) and Lung Cancer-13 (LC-13) to assess the QoL. RESULTS: The mean age in the study group was 63.77±9.43. 18.71% of patients were malnourished 44.19% at risk of malnutrition and 37.1% of patients had normal nutritional status. Clinical characteristics showed that 75% of respondents had been diagnosed with non-small-cell lung carcinoma, with an average duration of illness of 1-2 years. Nearly all patients received symptomatic treatment, and one in two had undergone surgery. At subsequent stages, QoL was analyzed in three groups depending on nutritional status risk. Malnourished patients had a lower quality of life and greater severity of cancer symptoms than those with a normal nutritional status (p<0.001). In regression analysis, nutritional status has a significant impact on all QLQ-C30 functional scales. Regression parameters are positive, indicating that better nutritional status is associated with better functioning in specific QLQ domains. CONCLUSION: A considerable proportion of lung cancer patients are either malnourished or at risk of malnutrition. Malnutrition correlates negatively with QoL and increases symptom severity. Malnutrition is an independent determinant of lower QoL. IMPLICATIONS FOR PRACTICE: Nutritional assessment should be accompanied by QoL evaluation, so that nutritional interventions can be optimized based on a patient's individual requirements.

Psychometric Properties of the Polish Version of the Self-care of Hypertension Inventory.

BACKGROUND: According to evidence-based guidelines, adherence to blood pressure-lowering medication and lifestyle modifications is a crucial part of hypertension management. Self-care is an effective method for secondary prevention. However, patients continue to exhibit major deficits in terms of adherence, self-control, and self-care. Standardized instruments for the effective monitoring of patients' self-care abilities are still lacking. OBJECTIVE: The objectives of this study were to produce a translation and cross-cultural adaptation of the Self-care of Hypertension Inventory (SC-HI) and to evaluate the psychometric properties of its Polish version. METHODS: The scale underwent translation and psychometric assessment using the standard methodology (forward-backward translation, review, psychometric analysis, criterion validity). The study included 250 patients, with a mean age of 61.23 ± 14.34 years, treated in a hypertension clinic. RESULTS: Mean self-care levels were evaluated in 3 domains: self-care maintenance (56.73 ± 18.57), self-care management (64.17 ± 21.18), and self-care confidence (62.47 ± 24.39). The Cronbach α for each domain showed satisfactory parameters: 0.755 for maintenance, 0.746 for management, and 0.892 for confidence. In the Polish version, the 3-factor structure of the SC-HI was not directly confirmed. Therefore, so-called modification indices were applied to obtain a standardized root mean square residual value less than 0.09 and a root mean square error of approximation value less than 0.06. CONCLUSIONS: The SC-HI has been successfully translated and adapted for Polish settings, and is suitable for application among patients with hypertension.

Impact of Cognitive Impairment on Adherence to Treatment and Self-Care in Patients with Type 2 Diabetes Mellitus.

BACKGROUND: Elderly patients with diabetes have a significantly increased prevalence of mild cognitive impairment compared with people of similar age without diabetes. Tasks related to diabetes self-management involve multiple cognitive skills and processes, such as memory, attention, planning, and calculating. Impaired cognitive function can threaten the patient's ability to perform self-monitoring. The objectives of the study were: to assess cognitive deficits and the level of self-care in elderly patients with diabetes, to identify correlations between cognitive deficits and self-care, and to determine which variables influence self-care behaviors and cognitive deficits. METHODS: The study involved 169 patients with type 2 DM. Standardized tools were used: Mini-mental State Examination (MMSE) to assess cognitive function and the Self-Care of Diabetes Inventory (SCODI) to assess the level of self-care. Socioclinical data were taken from the hospital records. RESULTS: 56.8% of patients had cognitive impairment (MMSE≤26). In the comparative analysis, patients with cognitive impairment had significantly lower results in all domains of the SCODI: self-care maintenance (72.9 vs 75), self-care monitoring (53.1 vs 56.3), self-care management (71.9 vs 84.4), self-care confidence (79.5 vs 86.4). Correlation analysis showed that the MMSE score correlates significantly and positively (p˂0.05; r˃0) with all SCODI subscales, and the higher the MMSE score the higher the level of self-care (A: r=0.252, B: r=0.244, C: r=0.019, D: r=0.28). CONCLUSION: In this elderly type 2 diabetes population, and using only one test to verify the cognitive function, self-care management was worse in terms of self-care management (blood glucose control). Cognitive function components are independent determinants of self-care in patients with type 2 diabetes. Recall is an independent predictor of self-care maintenance, and writing a predictor of self-care monitoring.

The Role of Sleep Disturbance, Depression and Anxiety in Frail Patients with AF-Gender Differences.

The aim of the study was to assess the link between anxiety and depression and frailty syndrome (FS) in patients with atrial fibrillation (AF) with regard to gender differences. MATERIAL AND METHODS: The study was conducted on 158 patients with AF (mean age 70.4 ± 7.6). The study used the hospital anxiety and depression scale (HADS-M), the Athens insomnia scale (AIS) and the Edmonton frailty scale to assess and compare anxiety, depression, and sleep disturbance between frail and non-frail patients with AF. RESULTS: FS was diagnosed in 53.2% of patients. A comparative analysis showed a statistically significantly higher severity level of anxiety (12.0 ± 2.6 vs. 8.4 ± 2.5, p < 0.001) and depression (12.5 ± 2.5 vs. 7.2 ± 3.3, p < 0.001) in frail patients compared to non-frail patients. The analysis of the level of anxiety, depression and FS did not show any significant differences between the studied women and men. However, statistically, significant differences were observed when FS occurred, regardless of gender. Anxiety disorders were observed in 75.5% of patients with FS and in 16.7% without frailty, whereas depressive disorders were observed in 73.6% of frail patients and in 4.2% without frailty. In an analysis of the impact of cumulative variables on the level of frailty, the risk of FS in patients with anxiety/depression and sleep disturbance is almost 500 times higher compared to patients without anxiety/depression and sleep disturbance. The risk of frailty in patients with sleep disturbance only is thirteen times higher than in the reference group, i.e., in patients without depression/anxiety and sleep disturbances. CONCLUSIONS: Patients with AF and FS show deeper anxiety, depression and sleep disturbances. Gender does not influence the risk of frailty in AF patients. Frailty in patients with AF is associated with a higher risk of depression, sleep disturbances and anxiety.

Impact of satisfaction with physician-patient communication on self-care and adherence in patients with hypertension: cross-sectional study.

BACKGROUND: Hypertension (HT) requires patients to continuously monitor their blood pressure, strictly adhere to therapeutic recommendations, and self-manage their illness. A few studies indicate that physician-patient communication and the patient's satisfaction with the therapeutic relationship may affect the course and outcomes of the treatment process. Research is still lacking on the association between satisfaction with physician-patient communication and adherence to treatment or self-care in chronically ill patients. The aim of the study was to evaluate the relationship between satisfaction with physician-patient communication and self-care and adherence in patients with HT undergoing chronic treatment. METHODS: The following instruments were used: the Adherence to Refills and Medication Scale (ARMS) for evaluating adherence (12-48 points), the Self-Care of Hypertension Inventory (SCHI) for self-care level (0-100 points), and the Communication Assessment Tool (CAT) for evaluating satisfaction with physician-patient communication. Socio-demographic and clinical data were obtained from patients' medical records. The research has a cross-sectional and observational study design. Inclusion criteria were as follows: age > 18 years, hypertension diagnosed per European Society of Hypertension (ESH) guidelines, treatment with at least one antihypertensive drug for the past 6 months, and informed consent. Cognitively impaired patients unable to complete the surveys without assistance were excluded (MMSE ≤18). Correlations between quantitative variables were analyzed using Pearson's or Spearman's correlation coefficient. Linear regression was performed. Variable distribution normality was verified using the Shapiro-Wilk test. RESULTS: The study included 250 patients (110 male, mean age 61.23 ± 14.34) with HT, treated at a hypertension clinic. In the CAT questionnaire individual questions pertaining to satisfaction with physician communication (on the CAT) were rated "excellent" 28.4-50.4% of the time. The best-rated aspects of communication included: letting the patient talk without interruptions (50.4% "excellent" ratings), speaking in a way the patient can understand (47.6%), and paying attention to the patient (47.2%). According to patient reports, physicians most commonly omitted such aspects as encouraging the patient to ask questions (28.4%), involving them in decisions (29.2%), and discussing the next steps (35.2%). The respondents had a low level of adherence to pharmaceutical treatment (16.63 ± 4.6). In terms of self-care, they scored highest in self-care management (64.17 ± 21.18), and lowest in self-care maintenance (56.73 ± 18.57). In correlation analysis, satisfaction with physician-patient communication (total CAT score) was positively correlated with all SCHI domains (self-care maintenance ß = 0.276, self-care management ß = 0.208, self-care confidence ß = 0.286, p < 0.05), and negatively correlated with ARMS scores (indicating better adherence). CONCLUSIONS: Satisfaction with physician-patient communication has a significant impact on self-care and pharmaceutical adherence in patients with hypertension. The more satisfied the patient is with communication, the better their adherence and self-care. TRIAL REGISTRATION: SIMPLE: RID.Z501.19.016.

Psychosocial Predictors of Self-Efficacy Related to Self-Reported Adherence in Older Chronic Patients Dealing with Hypertension: A European Study.

PURPOSE: Non-adherence to clinical prescriptions is widely recognized as the most common cause of uncontrolled hypertension, contributing to develop acute and chronic cardiovascular diseases. Specifically, patients' unintentional non-adherence is related to psychosocial factors as beliefs about medications, perceived physician's communication effectiveness and medication-specific social support. The aim of this study was to observe the impact of these factors on self-efficacy in relation to pharmacological and non-pharmacological self-reported adherence among older chronic patients with hypertension. PATIENTS AND METHODS: This research had a cross-sectional, observational and multicentre study design. Italian inpatients under rehabilitation, and Polish inpatients/outpatients were recruited. Following a cognitive screening, socio-demographic and clinical characteristics were obtained. Data on clinical and behavioral adherence (i.e., pharmacological adherence, adherence to refill medicines, intentional non-adherence) and psychosocial factors related to treatment adherence (i.e., beliefs about medicines, physician's communication skills, medication-specific social support, psychological antecedents and self-efficacy) were collected with self-report questionnaires. RESULTS: A total of 458 patients were recruited. Fischer's LSD post hoc test revealed significant differences between Italian and Polish samples in all measures (p<0.001). Multiple linear regression analysis showed low self-reported intentional non-adherence (ß = -.02, p=0.031), high self-reported adherence to refill medications (ß=-.05, p=0.017), high levels of perceived physician's communication effectiveness (ß=0.11, p<0.001), positive beliefs about medications (ß=0.13, p<0.001), and high perceived medication-specific social support (ß=0.05, p<0.001) to predict significantly high patients' self-efficacy in relation to pharmacological and non-pharmacological self-reported adherence. CONCLUSION: The observed psychosocial and behavioral factors revealed to positively impact on self-efficacy in relation to treatment adherence among older chronic patients dealing with hypertension. In a prevention framework, future studies and clinical practice may consider these factors in order to improve assessment and intervention on adherence in this population.

Diabetes Mellitus Versus Hypertension-Does Disease Affect Pharmacological Adherence?

The aim of the study was to answer the questions whether a chronic disease can have a significant impact on the level of adherence and whether there are differences in adherence-related predictors depending on the chronic disease. The study included 1,571 patients (mean age 64.7 ± 11.3) with chronic diseases [1,030 diabetes mellitus (DM) type 2 and 541 hypertension (HA)]. Adherence was assessed using the Adherence Refills Medication Scale (ARMS). The average adherence score for the whole group was 18.9. Fifty-five percent of patients had a low level of adherence. A comparison between DM and HA shows a statistically significant difference and a higher level of adherence with pharmacological recommendations in the group of patients with type 2 DM (17.5 ± 12.0 vs 19.2 ± 8.0). In the single factors analysis, HA diagnosis had a statistically significant negative effect on adherence (ß=0.92, p ≤ 0.001). In simple linear regression analysis, independent of chronic disease, a higher level of adherence was observed among women (ß=-0.40, p=0.015), people with secondary education (ß=-1.26, p ≤ 0.001), and inactive patients (ß=-0.48; p=0.005). However, place of residence - countryside (ß =0.35, p=0.044) and higher education (ß=0.90, p ≤ 0.001) had a negative influence on the level of adherence. In multiple linear regression analysis HA (B=0.99; p ≤ 0.001), female gender (B=-0.47; p=0.003) and secondary education (B=-1.16; p ≤ 0.001) were important independent determinants of adherence. (1) Hypertension is an independent, statistically significant predictor that reduces the adherence level. (2) Female gender and higher education are the most important determinants improving adherence to pharmacological therapy. (3) There is a different pattern of predictors of adherence among patients: occupational activity plays an important role in DM, while education plays a role in HA.

Medication Compliance in COPD Patients.

Chronic obstructive pulmonary disease (COPD) is one of the most severe public health problems and a leading cause of death worldwide. One of the main reasons for poor control of the disease is low patient compliance with treatment plan. The aim of the study was to investigate sociodemographic and health status factors that may have an influence on adherence to treatment. There were 106 inpatients (F/M, 42/64; mean age 70 ± 6 years) with COPD enrolled into this retrospective study. Patients completed the Adherence to Refills and Medications Scale (ARMS) to assess adherence to therapy. We found that the mean ARMS score was 23.1 ± 6.8. About 86% of patients had low adherence, and 14% had good adherence (mean score 3.2 ± 2.4). The low-adherence patients were more likely to be older (p = 0.020), female (p = 0.011), single (p = 0.019), not professionally active (p = 0.049), hospitalized more often (p = 0.005) and for a longer time (p = 0.046), feel worse (p = 0.023), experience a greater impact of the disease on sleep quality (p = 0.008) and daily activities (p = 0.001), and had a higher GOLD stage of COPD when compared to patients with good adherence patients (p = 0.012). Multiple factor analysis demonstrates that independent adverse predictors of the ARMS score included the following: being single (OR = 3.18), having had more than eight hospitalizations (OR = 1.18), and experiencing dysfunction in daily activities (OR = 1.79). Male gender (OR = 0.77) and longer than 21-day hospitalizations (OR = 0.93) were independent positive predictors of adherence. In conclusion, COPD patients demonstrate a low level of adherence to pharmacotherapy. Adherence is adversely affected by sociodemographic (older age, female gender, being single, and professionally inactive) and clinical factors (more frequent hospitalizations, perception of poor well-being, disordered sleep and daily functioning, and a higher GOLD stage).

Adherence to Therapy in Chronic Obstructive Pulmonary Disease: A Systematic Review.

Adherence to therapy plays a key role in treatment optimization and clinical outcome in patients with chronic obstructive pulmonary disease (COPD). The adherence to inhaled medications is poor, ranging from 20% to 60%. In this study we searched Medline and PubMed literature regarding factors that could have an impact on therapy adherence in COPD patients, using the key words "COPD" or "chronic obstructive pulmonary disease" and "adherence". The search was limited to the English language article published between January 2013 and December 2019. Review papers, study protocols, and meta-analyses were excluded. The final material included 25 articles. The evaluation was performed using the Cochrane Review Manager guidelines. The 25 articles represented 29 countries from 5 continents. We assessed adherence to therapy and the impact of selected factors on the adherence in 27,660 COPD patients (60.9% of whom were male, mean age 64 years). The factors affecting adherence were broken down into three categories: sociodemographic, clinical, and psychological. There were two standardized instruments used in the analyzed studies: Test of Adherence to Inhalers (TAI) and self-reported Morisky Medication Adherence Scale (MMAS-8). We found that 46.3% of patients had a moderately good level of adherence to inhaled therapy (TAI range around 50 points), while 41.6% of patients had a high level of adherence to oral therapy. The nature of non-adherence was in most cases inadvertent rather than an erratic or deliberate demeanor (48.5% vs. 38.9% vs. 42.4%, respectively). We conclude that standardized instruments enable the prediction of adherence to therapy and should be used in clinical practice. The assessment of adherence is essential for undertaking interventions to counteract plausible non-adherence. Collaboration between an educator and a psychologist is required to evaluate the patient's motivation and to ensure his comprehension of treatment prescribed.