AlignMap In Cites

Nurses and pharmacists at poison control centers have all the technical information they need to answer callers’ enquiries but need more training in order to improve caller adherence to their recommendations, according to a study published in the May issue of the Journal of Emergency Nursing.

Although 10 years old, this article, originally a CME offering, is still worthwhile reading for its explication of the ethical and medical problems inherent in treating a non-compliant patient when failure to maintain the regimen can result in the emergence of drug-resistant viral strains.

Riper H, et al. Curbing problem drinking with personalized-feedback interventions: A meta-analysis. Am J Prev Med 36(3), 2009.

Excerpt: In questionnaires delivered via mail or the Internet, 3,682 participants in 14 randomized controlled trials noted how much and how often they drank. They received personalized feedback and advice on whether their drinking patterns were normal for their peer group, based on their responses. Later, participants — most of them college-age — were re-surveyed to determine whether the intervention influenced their alcohol consumption.

Riper, lead author of the meta-analysis, and colleagues discovered that even a single session of personalized feedback helped problem drinkers reduce alcohol consumption.

For every eight intervention participants, one person reduced his or her alcohol consumption to normal levels because of the feedback, a result similar to that found in interventions involving brief face-to-face contact with a mental health professional, Riper said.

It’s apparently breaking news at the New York Times that employer-based health insurance is a major funding source for healthcare in the US and, consequently, loss of a job means loss of health insurance, leading to decreased healthcare. Pertinent to compliance is this excerpt: Richard D. Jackson, 53, was an oven operator at the bakery for 30 years. Mr. Jackson and his two daughters often used the Archway health plan to pay for doctor’s visits, imaging, surgery and medicines. Now that he has no insurance, he takes his Effexor antidepressant pills every other day, rather than daily, as prescribed. [emphasis mine]

Mahsa Mohammadi, Inger Ekman, Maria Schaufelberger
Vascular Health and Risk Management 2009:5 13–19

From Abstract: Objective: To investigate whether change in objective signs during up-titration of angiotensin-converting enzyme (ACE)-inhibitors in patients with chronic heart failure affect perception of information about medicines and subjective activities such as self-care.

Methods: Consecutive patients referred for up-titration of ACE-inhibitors were included. Patients were given the Satisfaction with Information about Medicines Scale and the European Heart Failure Self-Care Behaviour Scale at their first visit and when the target dose was reached. Blood pressure, pulse and s-creatinine were measured at each visit.

Results: Relationships were found between change in systolic (r = 0.224, p = 0.044) and diastolic (r = 0.361, p = 0.001) blood pressure and change in self-care scores and were also observed at baseline (r = 0.324, 0.398, p = 0.001, 0.000) and follow-up (r = 0.317, 0.253, p = 0.004, 0.022). Diastolic blood pressure correlated with the “potential problem of medication” score (r = −0.263, p = 0.007).

Conclusion: Patients with a more advanced disease usually have a lower blood pressure. Hence, the relationship between blood pressure and self-care scores might indicate that patients are more motivated to adhere to prescriptions the more advanced the stage of their disease.

Ann Intern Med 2008; 149: 795-903
Excerpt: Analysis of data from a controlled trial provides objective evidence that alcohol misuse is associated with poor adherence to medications.The authors of this study used data from a pre-existing cohort to examine the hypothesis that alcohol misuse would be associated with a dose-related effect on medication adherence. They used data from large randomised trial that looked at the effects of an audit and feedback intervention (ACQUIP). As part of the study, prospective data on alcohol use and medication adherence was obtained for a large cohort of primary care patients. At entry to the study, patients completed a questionnaire that assessed a range of health behaviours, including alcohol misuse using the AUDIT-C measure (Alcohol Use Disorder Identification Test–Consumption - score ranges from 0 to 12, 0 = no alcohol use). Data on medication use was obtained from pharmacy records, and medication adherence for medications used to treat hypertension, hyperlipidaemia, and diabetes; as in other work, having medication available for at least 80% of a study period was considered to be adherent. Outcome was the proportion of adherent patients according to AUDIT-C score.

There were 35,725 patients who participated in ACQUIP and returned questionnaires with completed AUDIT-C. Of these, 5,473 used a statin, 3,468 used an oral anti-diabetic drug, and 13,729 used an antihypertensive medication. Overall, about 20% had AUDIT-C scores of 4 or more, signifying possible alcohol misuse.

For lipid lowering and antihypertensive drugs, higher AUDIT-C scores were associated with reduced adherence: at one year, and after adjustment for confounding factors, in the statin group, 58% (95% CI, 52% to 65%) and 55% (95% CI, 47% to 63%) of those in the two highest alcohol misuse groups (scores 6-7 and 8-12) were adherent compared to 66% (95% CI, 64% to 68%) of non-drinkers. There was a similar difference for antihypertensive medications, however there was no significant difference between the groups for anti-diabetic drugs.