Assessment of medication adherence in patients at high risk of cardiovascular diseases

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P. R. . Pal, R. K. Jat, and P. R. . Pal, “Assessment of medication adherence in patients at high risk of cardiovascular diseases”, ijmhs, vol. 10, no. 11, pp. 1381–1386, Nov. 2020.
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Abstract

BACKGROUND: Adherence to chronic pharmacotherapy is poor. Medication adherence is an important health issue. To better understand its relevance among vulnerable populations requires the availability of a valid, reliable and practical measurement approach. Researchers have proposed various competing methods, including pill counts and self-report measures. Medication adherence has been defined as the extent to which patients take medications as prescribed by their healthcare providers. Poor medication adherence diminishes the health benefits of pharmacotherapy. Elderly patients with coronary risk factors frequently require treatment with multiple medications, placing them at increased risk for nonadherence. OBJECTIVES: To test the efficacy of a comprehensive pharmacy care program to improve Medication adherence and its associated effects on blood pressure (BP) and low density lipoprotein cholesterol (LDL-C). METHODS: Prospective, Observational cohort study, in this study improvement in medication adherence & its associated effects on the patients before & after pharmacist involvement (intervention) was observed. Pharmacy records are reviewed, medication adherence was measured by proportion of days covered. PDC<80% was classified as poor adherence.( New York Heart Association )Group A- Hypertension (Usual group),Group B-Hyperlipidemia Intervention group (Pharmacist involvement) After a 2-month run-in phase (measurement of baseline adherence, BP, and LDL-C), patients entered a 6-month intervention phase (standardized medication education, regular follow-up by pharmacists, and medications dispensed in time specific packs). Following the intervention phase, patients were randomized to continued pharmacy care vs usual care for an additional 6 months. RESULTS: A total of 200 elderly patients with maximum lying in the age group 60-70 years, taking more than four chronic medications were enrolled. Coronary risk factors included drug-treated hypertension in102 patients (91.5%) and drug-treated hyperlipidemia in 99 patients (80.6%). Baseline medication adherence was 61.33% in usual care group and 70.44%.After 6 months of intervention, medication adherence increased to 72.22% in usual care and78.86% in pharmacy care group and was associated with significant improvements in BP and LDL-C .  Two months after randomization, the persistence of medication adherence decreased to69.1%among those patients assigned to usual care, whereas it was sustained at 85.66% in pharmacy care. This was associated with significant reductions in systolic BP in the pharmacy care group vs the usual care group, but no significant between group differences in LDL-C levels or reductions. Conclusions: A pharmacy care program led to increases in medication adherence, medication persistence, and clinically meaningful reductions in BP and LDL level whereas discontinuation of the program was associated with decreased medication adherence and persistence.

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References

1. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure .The JNC 7 Report. JAMA 2003,Page No.2560-2572. 2. Schoenberg NE. The relationship between perceptions of social support and adherence to dietary recommendations among African-American elders with hypertension. Int J Aging HUM Dev Page No.279-297. 3. Wilper AP,Woolhandler S, Lasser KE,McCormick D, Bor DH, Himmelstein DU. A national study of chronic disease prevalence and access to care in uninsured US adults. An Intern Med.2008;149(3),Page No.170-176 4. Morisky, D.E, Green, L.W.,& Levine, D.M.Concurrent and predictive vlidity of a self-reported measure of medication adherence.Medical Care 2000 Vol 24, Page No.67-74. 5. Piette,J.D, Heisler, M., Ganoz, D., McCarthy, J.F., & Valenstein, M. Differential medication adherence among patients with diabetes and hypertension.2007; Vol. 58,Page No.207-212 6. Haynes, R.B., McDonald, H., Garg,A.X., & Montgue,P.Interventions for helping patients to follow prescriptions for medications.Journal of the American Medical Association 2002; Vol 288, Page No.2880-2883 7. Pardeshi milind et al, Comparison of efficacy and safety of amlodipine and felodipine-ER in patients of essential hypertension. Nissinen A et al, Hypertension in developing countries, World Health statistics quarterly, 1998;41:141-154. 8. Kumar Praveen et al, Cardiovascular disease, Kumar and clarke’s clinical medicine, 2002, 5th edition, 818. 9. Boon N A et al, Cardiovascular disease. Davidson’s principals and Practice of medicine 2002, 19th edition, 392. 10. Hamilton R A, Bricelaand LL, use of prescription refill lrecords to Assess patient compliance, 2009; 49:1691-1696.

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References

1. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure .The JNC 7 Report. JAMA 2003,Page No.2560-2572.

2. Schoenberg NE. The relationship between perceptions of social support and adherence to dietary recommendations among African-American elders with hypertension. Int J Aging HUM Dev Page No.279-297.

3. Wilper AP,Woolhandler S, Lasser KE,McCormick D, Bor DH, Himmelstein DU. A national study of chronic disease prevalence and access to care in uninsured US adults. An Intern Med.2008;149(3),Page No.170-176


4. Morisky, D.E, Green, L.W.,& Levine, D.M.Concurrent and predictive vlidity of a self-reported measure of medication adherence.Medical Care 2000 Vol 24, Page No.67-74.


5. Piette,J.D, Heisler, M., Ganoz, D., McCarthy, J.F., & Valenstein, M. Differential medication adherence among patients with diabetes and hypertension.2007; Vol. 58,Page No.207-212


6. Haynes, R.B., McDonald, H., Garg,A.X., & Montgue,P.Interventions for helping patients to follow prescriptions for medications.Journal of the American Medical Association 2002; Vol 288, Page No.2880-2883

7. Pardeshi milind et al, Comparison of efficacy and safety of amlodipine
and felodipine-ER in patients of essential hypertension. Nissinen A et al, Hypertension in developing countries, World Health statistics quarterly, 1998;41:141-154.


8. Kumar Praveen et al, Cardiovascular disease, Kumar and clarke’s clinical medicine, 2002, 5th edition, 818.

9. Boon N A et al, Cardiovascular disease. Davidson’s principals and Practice of medicine 2002, 19th edition, 392.

10. Hamilton R A, Bricelaand LL, use of prescription refill lrecords to Assess patient compliance, 2009; 49:1691-1696.

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