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Medication Adherence among Hypertensive Patients with Free Access to Antihypertensive Treatment
Abstracts / Research in Social and Administrative Pharmacy 10 (2014) e1–e64 towards CAM were found to be neutral. It is suggested to integrate CAM as core curriculum subject in pharmacy discipline to equip the student with good knowledge. This will enable the students to counsel patients on common herbal medicine that they might encounter as pharmacist. Managing minor ailments: Patients’ health-seeking behaviour and the role of community pharmacy M.C. Watson, R. Holland, J. Ferguson, T. Porteous, T. Sach, J.A. Cleland, C.M. Bond, D.A. Wright on behalf of theMINA Study To describe a 2-year research programme to: Quantify demand on high cost health settings for the management of minor ailments (MAs). Evaluate evidence of the effectiveness and cost-effectiveness of pharmacy-based minor ailment schemes (MAs). Compare health and cost-related outcomes for the management of MAs across pharmacy, general practice (GP) and emergency department (ED) settings. Methods: The programme included: A systematic review. Audit of routine data with formal consensus exercises to quantify the prevalence of MAs in high cost settings (GPs, EDs) suitable for management in community pharmacies. A prospective cohort study comprising patients presenting in pharmacies (n¼10), GPs (n¼6) and EDs (n¼2) in North East Scotland and East Anglia, England with selected MAs. Data collection at baseline, post-consultation and at 2-weeks’ follow-up explored the reason for presentation and choice of setting, consultation satisfaction, and symptom resolution and health resource utilisation, respectively. Results: The systematic review comprised 26 studies which reported low rates of re-consultation rates and high symptom resolution. The audit/consensus exercise showed the prevalence of ED and GP consultations for MAs suitable for management in community pharmacy was 5.3% (95% CI, 3.4% to 7.1%) and 13.2% (95% CI 10.2% to 16.1%), respectively. The cohort study comprised 377 patients. Symptom resolution was similar across all settings: pharmacy (44.3%); GP (35.7%); and ED (37.3%). Mean overall costs were significantly lower with pharmacy consultations (£29.30 (standard deviation (SD) 37.81)) compared with GP (£82.34 (SD 104.16)) and ED (£147.09 (SD 74.96)). Conclusions: There is an urgent need to shift demand for MA management away from high cost settings. The evidence derived from this research programme confirmed the equivalence of health-related outcomes for patients presenting across all settings. The lower costs associated with health-seeking from pharmacies compared with the other settings provides evidence of the suitability of pharmacies to manage these conditions.
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Measuring Pharmacist Judgments to Ask Questions Using a Factorial Survey Experiment Design M.J. Witry, College of Pharmacy, University of Iowa, Iowa City, IA Inadequate medication monitoring contributes to more medication related problems than errors in initial prescribing, yet monitoring has received less focus in practice and research. Community pharmacists are positioned to engage in medication monitoring. The objective of this study was to identify significant contextual and pharmacist factors associated with community pharmacist self-reported likelihood to ask medication monitoring questions at the time of refill. Methods: Surveys were mailed to 599 community pharmacists using a Dillman approach. Surveys included demographics, 6-point Likert-type attitudinal items addressing monitoring roles (internal) and environment monitoring perceptions (external), and 5 unique vignettes randomly populated with values for 8 contextual variables based on the Health Collaboration Model. Respondents assigned their likelihood of asking non-adherence, safety, and effectiveness question for each vignette. Hierarchical linear modeling produced regression coefficients for pharmacistlevel and vignette level variables. Results: There were 254 (43%) returned, usable surveys. For non-adherence, female patients were more likely to be questioned. For side effect and effectiveness questioning, being short-staffed and the prescription previously being filled more times decreased question-asking. Side effect and effectiveness questioning may be seen as more discretionary than non-adherence questioning. Other persons waiting decreased, and increasing days late increased the likelihood of asking all three questions. Overall, metoprolol and fluoxetine were less question-worthy than warfarin and hydrocodone. Conclusions: Pharmacists reported variation in questionasking likelihood based on medication, patient, and environmental characteristics. Pharmacist medication monitoring attitudes contributed more to explaining pharmacist medication monitoring attitudes than setting, suggesting there are pharmacists oriented to monitoring in multiple settings. Days late was a cue to asking for all three question-types. Pharmacies should ensure late refill information is reaching pharmacists if increases in medication monitoring are desired. Factorial surveys are a novel approach to independently measuring the impact of personal and contextual variables on pharmacist judgments. Medication Adherence among Hypertensive Patients with Free Access to Antihypertensive Treatment A.D. Oliveira-Filho, S.J.F. Neves, School of Nursery and Pharmacy, Federal University of Alagoas, Brazil To assess the prevalence of medication adherence to free access antihypertensive treatment among hypertensive patients.
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Abstracts / Research in Social and Administrative Pharmacy 10 (2014) e1–e64
Method: We carried out a cross-sectional survey conducted in six Family Health Units of the Brazilian Unified Health System, in Maceio´, between November 2012 and March 2013. Data were collected through home interviews. Adherence was assessed using a validated version in Portuguese of the 8-item Morisky Medication Adherence Scale (MMAS-8). In this study, the patients were considered adherent if they had a score greater than or equal to 6 in the MMAS-8. Although the Brazilian public health system must provide free access to antihypertensive drugs to all hypertensive patients in the country, many patients prefer to pay for their medicines because of accessibility and convenience of private community pharmacies, thus in our study patients who had purchased at least one antihypertensive drug in the thirty days preceding the interview were excluded. Results: 685 of 720 eligible patients were assessed for adherence. 346 patients (50.5%) were considered adherent to antihypertensive therapy, which is a prevalence similar to other studies. The mean age of patients was 58.4 years (SD ¼ 10.9 years), with 49.5% older than 60 years, 68.0% female. Mean number of prescribed antihypertensives per patient was 1.64 (SD ¼ 0.9). These potential confounding factors (age, sex, number of prescribed medications) did not influence medication adherence (PO.05; Pearson chi-square). Conclusion: Although cost of medication is the modifiable barrier to adherence most well described in the literature, the removal of this factor did not improve* medication adherence among low-income hypertensive patients.
Medication adherence: It's not what you say but how you say it M. Battistella1,2, R.C.N. Wong1, S.V. Jassal2,3, 1Leslie Dan Faculty of Pharmacy, Toronto, Ontario Canada, 2 The University Health Network, Toronto, Ontario, Canada, 3Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada The purpose of this study was to identify and understand factors associated with non-adherence in a Canadian hemodialysis population. Methods: All in-centre hemodialysis patients at the Toronto General Hospital were approached. Patients who could not comprehend written and spoken English, medically unstable or unwilling to participate were excluded. They were asked to complete a questionnaire developed and validated at the same centre. Information collected included demographics, number of current medications, patient’s feelings towards medication, external support, medication taking behaviour and barriers to adherence. Patients were classified as adherent and non-adherent based on the answers to questions asking if they remember to take their medications. Differences in responses between the two groups of patients were examined.
Results: One hundred and fifty-six out of 183 eligible patients participated in the survey. Fifty-seven percent of patients were males, 58% aged 60 years or younger and 47% of patients had completed a college or university education. The majority of patients had been on hemodialysis for at least 1 year (86%) and more than half of the patients were taking more than 6 medications per day. Thirty-six patients (31%) were classified as non-adherent. These patients had a lower level of education and tended to be single. Pill burden and availability of healthcare team were both shown to have no significant correlation with patient’s medication adherence. On average, patients in the non-adherent group reported having more barriers to be adherent with medication regimen (1.4 barriers on average versus 0.5 barriers in the non-adherent and adherent groups respectively, p ! 0.001). Patients identified drug therapy management strategies around complex regimens to be barriers to taking their medications. Conclusions: Patient barriers to medication adherence were different from those previously identified. Novel method of education and support may be of benefit in improving adherence in some hemodialysis patients.
Medication use trajectories from age 26 to38 in a representative birth cohort from Dunedin, New Zealand P.J. Ballantyne1, P. Norris2, W.M. Thomson3, 1 Department of Sociology, Trent University, Peterborough, Ontario & Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada, 2 School of Pharmacy, University of Otago, Dunedin, New Zealand, 3School of Dentistry, University of Otago, Dunedin, New Zealand Despite frequent concerns about increasing medicalisation or pharmaceuticalisation of everyday life, there is little research investigating the level and type of medicines use in the general population over time. We used data from a NZ longitudinal cohort study to examine changes in medication use by a representative sample of young adults. Methods: Details of medications taken during the previous two weeks for cohort members at age 38 were compared to similar data collected at ages 32 and 26. Results: At each age a larger proportion of women than men took any medications. At each age, a larger proportion of women than men took prescription medications, although the proportion reporting the use of prescription medications decreased for women (from 68.0% at age 32 to 51.2% at age 38), and increased for men (from 24.8% at age 32 to 30.4% at age 38). At ages 32 and 38, women were more likely to report using OTC medications than men. Hormonal contraceptives, analgesics and nutritional supplements were the most frequently reported drug classes and each age. The use of anti-depressants, anti-ulcer medications and antihypertension medications increased as the cohort aged: most notable was the change in the proportion of each
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Measuring Pharmacist Judgments to Ask Questions Using a Factorial Survey Experiment Design M.J. Witry, College of Pharmacy, University of Iowa, Iowa City, IA Inadequate medication monitoring contributes to more medication related problems than errors in initial prescribing, yet monitoring has received less focus in practice and research. Community pharmacists are positioned to engage in medication monitoring. The objective of this study was to identify significant contextual and pharmacist factors associated with community pharmacist self-reported likelihood to ask medication monitoring questions at the time of refill. Methods: Surveys were mailed to 599 community pharmacists using a Dillman approach. Surveys included demographics, 6-point Likert-type attitudinal items addressing monitoring roles (internal) and environment monitoring perceptions (external), and 5 unique vignettes randomly populated with values for 8 contextual variables based on the Health Collaboration Model. Respondents assigned their likelihood of asking non-adherence, safety, and effectiveness question for each vignette. Hierarchical linear modeling produced regression coefficients for pharmacistlevel and vignette level variables. Results: There were 254 (43%) returned, usable surveys. For non-adherence, female patients were more likely to be questioned. For side effect and effectiveness questioning, being short-staffed and the prescription previously being filled more times decreased question-asking. Side effect and effectiveness questioning may be seen as more discretionary than non-adherence questioning. Other persons waiting decreased, and increasing days late increased the likelihood of asking all three questions. Overall, metoprolol and fluoxetine were less question-worthy than warfarin and hydrocodone. Conclusions: Pharmacists reported variation in questionasking likelihood based on medication, patient, and environmental characteristics. Pharmacist medication monitoring attitudes contributed more to explaining pharmacist medication monitoring attitudes than setting, suggesting there are pharmacists oriented to monitoring in multiple settings. Days late was a cue to asking for all three question-types. Pharmacies should ensure late refill information is reaching pharmacists if increases in medication monitoring are desired. Factorial surveys are a novel approach to independently measuring the impact of personal and contextual variables on pharmacist judgments. Medication Adherence among Hypertensive Patients with Free Access to Antihypertensive Treatment A.D. Oliveira-Filho, S.J.F. Neves, School of Nursery and Pharmacy, Federal University of Alagoas, Brazil To assess the prevalence of medication adherence to free access antihypertensive treatment among hypertensive patients.
e32
Abstracts / Research in Social and Administrative Pharmacy 10 (2014) e1–e64
Method: We carried out a cross-sectional survey conducted in six Family Health Units of the Brazilian Unified Health System, in Maceio´, between November 2012 and March 2013. Data were collected through home interviews. Adherence was assessed using a validated version in Portuguese of the 8-item Morisky Medication Adherence Scale (MMAS-8). In this study, the patients were considered adherent if they had a score greater than or equal to 6 in the MMAS-8. Although the Brazilian public health system must provide free access to antihypertensive drugs to all hypertensive patients in the country, many patients prefer to pay for their medicines because of accessibility and convenience of private community pharmacies, thus in our study patients who had purchased at least one antihypertensive drug in the thirty days preceding the interview were excluded. Results: 685 of 720 eligible patients were assessed for adherence. 346 patients (50.5%) were considered adherent to antihypertensive therapy, which is a prevalence similar to other studies. The mean age of patients was 58.4 years (SD ¼ 10.9 years), with 49.5% older than 60 years, 68.0% female. Mean number of prescribed antihypertensives per patient was 1.64 (SD ¼ 0.9). These potential confounding factors (age, sex, number of prescribed medications) did not influence medication adherence (PO.05; Pearson chi-square). Conclusion: Although cost of medication is the modifiable barrier to adherence most well described in the literature, the removal of this factor did not improve* medication adherence among low-income hypertensive patients.
Medication adherence: It's not what you say but how you say it M. Battistella1,2, R.C.N. Wong1, S.V. Jassal2,3, 1Leslie Dan Faculty of Pharmacy, Toronto, Ontario Canada, 2 The University Health Network, Toronto, Ontario, Canada, 3Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada The purpose of this study was to identify and understand factors associated with non-adherence in a Canadian hemodialysis population. Methods: All in-centre hemodialysis patients at the Toronto General Hospital were approached. Patients who could not comprehend written and spoken English, medically unstable or unwilling to participate were excluded. They were asked to complete a questionnaire developed and validated at the same centre. Information collected included demographics, number of current medications, patient’s feelings towards medication, external support, medication taking behaviour and barriers to adherence. Patients were classified as adherent and non-adherent based on the answers to questions asking if they remember to take their medications. Differences in responses between the two groups of patients were examined.
Results: One hundred and fifty-six out of 183 eligible patients participated in the survey. Fifty-seven percent of patients were males, 58% aged 60 years or younger and 47% of patients had completed a college or university education. The majority of patients had been on hemodialysis for at least 1 year (86%) and more than half of the patients were taking more than 6 medications per day. Thirty-six patients (31%) were classified as non-adherent. These patients had a lower level of education and tended to be single. Pill burden and availability of healthcare team were both shown to have no significant correlation with patient’s medication adherence. On average, patients in the non-adherent group reported having more barriers to be adherent with medication regimen (1.4 barriers on average versus 0.5 barriers in the non-adherent and adherent groups respectively, p ! 0.001). Patients identified drug therapy management strategies around complex regimens to be barriers to taking their medications. Conclusions: Patient barriers to medication adherence were different from those previously identified. Novel method of education and support may be of benefit in improving adherence in some hemodialysis patients.
Medication use trajectories from age 26 to38 in a representative birth cohort from Dunedin, New Zealand P.J. Ballantyne1, P. Norris2, W.M. Thomson3, 1 Department of Sociology, Trent University, Peterborough, Ontario & Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada, 2 School of Pharmacy, University of Otago, Dunedin, New Zealand, 3School of Dentistry, University of Otago, Dunedin, New Zealand Despite frequent concerns about increasing medicalisation or pharmaceuticalisation of everyday life, there is little research investigating the level and type of medicines use in the general population over time. We used data from a NZ longitudinal cohort study to examine changes in medication use by a representative sample of young adults. Methods: Details of medications taken during the previous two weeks for cohort members at age 38 were compared to similar data collected at ages 32 and 26. Results: At each age a larger proportion of women than men took any medications. At each age, a larger proportion of women than men took prescription medications, although the proportion reporting the use of prescription medications decreased for women (from 68.0% at age 32 to 51.2% at age 38), and increased for men (from 24.8% at age 32 to 30.4% at age 38). At ages 32 and 38, women were more likely to report using OTC medications than men. Hormonal contraceptives, analgesics and nutritional supplements were the most frequently reported drug classes and each age. The use of anti-depressants, anti-ulcer medications and antihypertension medications increased as the cohort aged: most notable was the change in the proportion of each