Measuring medication adherence in older community-dwelling patients with multimorbidity

Kim, San; Bennett, Kathleen; Wallace, Emma; Fahey, Tom; Cahir, Caitriona

doi:10.1007/s00228-017-2388-y

Cited by 44 publications

(39 citation statements)

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“…Furthermore, this study found that people predominantly constituted priorities by targeting individual conditions that impact a lot, but the potential effects of the prioritisation were not identified. (Kim, Bennett, Wallace, Fahey, & Cahir, 2018), medication beliefs (Schüz et al, 2011), fragmented care (Green, Hawley, & Rask, 2007) and synergistic effects between chronic conditions (Calderón-Larrañaga et al, 2019). Participants in this study did not report issues of managing multiple prescriptions nor adverse effects.…”

Section: Discussionmentioning

confidence: 95%

“…These explanations might indicate that people misunderstood their health regarding MCCs and an inability to participate in disease self‐management (Pages‐Puigdemont et al, ). Key reasons for nonadherence to treatments among MCCs population are varied, including differences in clinical variables (Kim, Bennett, Wallace, Fahey, & Cahir, ), medication beliefs (Schüz et al, ), fragmented care (Green, Hawley, & Rask, ) and synergistic effects between chronic conditions (Calderón‐Larrañaga et al, ). Participants in this study did not report issues of managing multiple prescriptions nor adverse effects.…”

Section: Discussionmentioning

confidence: 99%

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Patients' experiences of coping with multiple chronic conditions: A qualitative descriptive study

Cheng

Bai

Yang

et al. 2019

Journal of Clinical Nursing

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Objective To explore the experiences of how Chinese adults cope with multiple chronic conditions in everyday life. Background Having multiple chronic conditions is stressful, requiring people to make physical and mental adaptations. There is little evidence exploring how people cope with multiple chronic conditions, especially in an Asian context. Design A qualitative descriptive design was employed. The Consolidated criteria for reporting qualitative research (COREQ) was used to report this study. Methods This study was conducted in a tertiary referral and teaching hospital in Bengbu, Anhui, China, between August and October 2018. A purposive sample of 14 people with multiple chronic conditions, aged between 32 and 75 years, completed a demographic questionnaire and semi‐structured face‐to‐face interviews. The interviews were digitally recorded and transcribed verbatim. Qualitative content analysis guided data analysis. Results Four distinctive themes comprising subthemes were developed from participants' narratives pertaining to coping with multiple chronic conditions: (a) appraising multiple chronic conditions, (b) addressing multiple chronic conditions management, (c) maintaining psychological well‐being and (d) fulfilling a social role. Illustrative quotations were cited to support each theme. Conclusions This study underscores that people cope with multiple chronic conditions in everyday life by using a compendium of coping strategies. As one of the influencing factors, culture dominates the ways of coping at different levels among people with multiple chronic conditions. These findings expand the current literature on coping based on an Asian perspective and inform further cross‐culture research on this topic. Relevance to clinical practice Healthcare professionals should understand peoples' experiences of coping with multiple chronic conditions to provide more holistic and dynamic health care to address their actual needs. Healthcare professionals should be acquainted with how culture impacts individuals' coping and develops culture‐tailored supportive programmes such as family‐based interventions, to promote the health of people with multiple chronic conditions.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Patients' experiences of coping with multiple chronic conditions: A qualitative descriptive study

Cheng

Bai

Yang

et al. 2019

Journal of Clinical Nursing

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“…The most common conditions were hyperlipidemia, cerebrovascular disease, and heart disease. 28 The majority of the 15 family physician practices taking part in the study had above average deprivation in their catchment area (median deprivation score 2.95; range −1.04 to 4.86). 21…”

Section: Study Populationmentioning

confidence: 99%

Identifying Adverse Drug Events in Older Community-Dwelling Patients

et al. 2019

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PURPOSE To evaluate a patient-report instrument for identifying adverse drug events (ADEs) in older populations with multimorbidity in the community setting.METHODS This was a retrospective cohort study of 859 community-dwelling patients aged ≥70 years treated at 15 primary care practices. Patients were asked if they had experienced any of a list of 74 symptoms classified by physiologic system in the previous 6 months and if (1) they believed the symptom to be related to their medication, (2) the symptom had bothered them, (3) they had discussed it with their family physician, and (4) they required hospital care due to the symptom. Self-reported symptoms were independently reviewed by 2 clinicians who determined the likelihood that the symptom was an ADE. Family physician medical records were also reviewed for any report of an ADE. RESULTSThe ADE instrument had an accuracy of 75% (95% CI, 77%-79%), a sensitivity of 29% (95% CI, 27%-31%), and a specificity of 93% (95% CI, 92%-94%). Older people who reported a symptom had an increased likelihood of an ADE (positive likelihood ratio [LR+]: 4.22; 95% CI, 3.78-4.72). Antithrombotic agents were the drugs most commonly associated with ADEs. Patients were most bothered by muscle pain or weakness (75%), dizziness or lightheadedness (61%), cough (53%), and unsteadiness while standing (52%). On average, patients reported 39% of ADEs to their physician. Twenty-six (3%) patients attended a hospital outpatient clinic, and 32 (4%) attended an emergency department due to ADEs.CONCLUSION Older community-dwelling patients were often not correct in recognizing ADEs. The ADE instrument demonstrated good predictive value and could be used to differentiate between symptoms of ADEs and chronic disease in the community setting.To read or post commentaries in response to this article, see it online at http://www.AnnFamMed.org/content/17/2/133.

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“…There is also some evidence that not only the number of morbidities but the types of morbidities influence medication adherence. 12 Kardas et al 7 found significant variability in primary nonadherence across therapeutic areas, drug classes, and individual drugs. In recent years, there has been a rapid increase in the prevalence of multimorbidity and polypharmacy, presenting significant challenges for monitoring and supporting medication adherence.…”

Section: How To Citementioning

confidence: 99%

“…There is some evidence of a threshold effect for the relationship between number of concurrent medications and medical conditions and adherence. 12 Adherence has been shown to initially increase, followed by a decrease as the number of morbidities and/or medications increases. There is also some evidence that not only the number of morbidities but the types of morbidities influence medication adherence.…”

Section: How To Citementioning

confidence: 99%

Primary nonadherence: the forgotten component of medication adherence?

Cahir¹

2020

Polish Archives of Internal Medicine

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1to measure initiation and data that do exist, outside of a small number of integrated healthcare systems, are often insufficient to draw any valid conclusions. 5 Initiation is the first component in the taxonomy and the first step to understanding why patients do not take their prescribed medications. Measuring medication initiation provides important baseline rates of primary nonadherence in acute and chronic conditions. Reported rates of noninitiation have been shown to vary between 2.3% and 50% (weighed average [SD], 5.1% [1.3%]) across studies. 6 This large disparity in rates may reflect the multiple definitions of initiation and methods of measurement applied in studies, with different time frames used to identify prescribing and dispensing events. 5In this issue of Polish Archives of Internal Medicine (Pol Arch Intern Med), Kardas et al 7 aimed to address this lack of research on medication initiation and analyze the extent of primary nonadherence in Poland. The recent implementation of a nationwide eHealth system in Poland and the introduction of electronic prescriptions (e -prescriptions) enabled primary nonadherence (initiation) to be measured through the comparison of e -prescription rates to dispension rates for 47 drugs from 6 major therapeutic areas (diabetes, antithrombotic agents, cardiovascular system, lipid modifying agents, anti -invectives for systemic use, psychoanaleptics). In line with previous research, primary nonadherence was defined as an e -prescription not being dispensed within a period of 30 days. 6 In total, out of 119 880 e -prescriptions issued in Poland in 2018, 24 967 e -prescriptions were not dispensed, resulting in a primary nonadherence rate of 20.8%.Similar to studies on the prevalence of nonadherence, much of the research to date on the risk factors associated with poor adherence has focused on the implementation and discontinuation components of the taxonomy. 8,9 A systematic review of the psychosocial and behavioral factors Hippocrates (400 BC) was the first to note that some patients do not take their prescribed medicines and many later complain that the treatment does not help. 1 Since then the World Health Organisation (WHO) has called nonadherence to medication "a worldwide problem of striking magnitude" and "one of the 2 largest unsolved gaps in healthcare" (the other being suboptimal prescription of medication). 2 In the past few decades, new and efficacious medications with positive benefit -to -risk profiles have been developed and we have seen an increased focus on improving health outcomes for people and reducing costs (eg, reducing healthcare utilization). 1 However, we have made less progress in monitoring and improving adherence to medication.Recently, a taxonomy of adherence has been developed in an effort to standardize adherence--related terminology for clinical and research use and to enable benchmarking of existing adherence enhancing strategies at the European level. 3 The taxonomy defines medication adherence "as the process by which patients take t...

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Measuring medication adherence in older community-dwelling patients with multimorbidity

Abstract: In total, 31% of older patients with multimorbidity were non-adherent to their medication but adherence levels varied across treatment categories and chronic conditions.

Cited by 44 publications

References 36 publications

Patients' experiences of coping with multiple chronic conditions: A qualitative descriptive study

Patients' experiences of coping with multiple chronic conditions: A qualitative descriptive study

Identifying Adverse Drug Events in Older Community-Dwelling Patients

Primary nonadherence: the forgotten component of medication adherence?

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