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      Determinants of Medication Adherence to Antihypertensive Medications among a Chinese Population Using Morisky Medication Adherence Scale

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          Abstract

          Background and Objectives

          Poor adherence to medications is one of the major public health challenges. Only one-third of the population reported successful control of blood pressure, mostly caused by poor drug adherence. However, there are relatively few reports studying the adherence levels and their associated factors among Chinese patients. This study aimed to study the adherence profiles and the factors associated with antihypertensive drug adherence among Chinese patients.

          Methods

          A cross-sectional study was conducted in an outpatient clinic located in the New Territories Region of Hong Kong. Adult patients who were currently taking at least one antihypertensive drug were invited to complete a self-administered questionnaire, consisting of basic socio-demographic profile, self-perceived health status, and self-reported medication adherence. The outcome measure was the Morisky Medication Adherence Scale (MMAS-8). Good adherence was defined as MMAS scores greater than 6 points (out of a total score of 8 points).

          Results

          From 1114 patients, 725 (65.1%) had good adherence to antihypertensive agents. Binary logistic regression analysis was conducted. Younger age, shorter duration of antihypertensive agents used, job status being employed, and poor or very poor self-perceived health status were negatively associated with drug adherence.

          Conclusion

          This study reported a high proportion of poor medication adherence among hypertensive subjects. Patients with factors associated with poor adherence should be more closely monitored to optimize their drug taking behavior.

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          Medication adherence: its importance in cardiovascular outcomes.

          P Michael Ho, Chris L Bryson, John S Rumsfeld (2009)
          Medication adherence usually refers to whether patients take their medications as prescribed (eg, twice daily), as well as whether they continue to take a prescribed medication. Medication nonadherence is a growing concern to clinicians, healthcare systems, and other stakeholders (eg, payers) because of mounting evidence that it is prevalent and associated with adverse outcomes and higher costs of care. To date, measurement of patient medication adherence and use of interventions to improve adherence are rare in routine clinical practice. The goals of the present report are to address (1) different methods of measuring adherence, (2) the prevalence of medication nonadherence, (3) the association between nonadherence and outcomes, (4) the reasons for nonadherence, and finally, (5) interventions to improve medication adherence.
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            Factors affecting therapeutic compliance: A review from the patient’s perspective

            Jing Jin, Grant Sklar, Vernon Min Sen Oh … (2008)
            Objective To explore and evaluate the most common factors causing therapeutic non-compliance. Methods A qualitative review was undertaken by a literature search of the Medline database from 1970 to 2005 to identify studies evaluating the factors contributing to therapeutic non-compliance. Results A total of 102 articles was retrieved and used in the review from the 2095 articles identified by the literature review process. From the literature review, it would appear that the definition of therapeutic compliance is adequately resolved. The preliminary evaluation revealed a number of factors that contributed to therapeutic non-compliance. These factors could be categorized to patient-centered factors, therapy-related factors, social and economic factors, healthcare system factors, and disease factors. For some of these factors, the impact on compliance was not unequivocal, but for other factors, the impact was inconsistent and contradictory. Conclusion There are numerous studies on therapeutic noncompliance over the years. The factors related to compliance may be better categorized as “soft” and “hard” factors as the approach in countering their effects may differ. The review also highlights that the interaction of the various factors has not been studied systematically. Future studies need to address this interaction issue, as this may be crucial to reducing the level of non-compliance in general, and to enhancing the possibility of achieving the desired healthcare outcomes.
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              Predictive validity of a medication adherence measure in an outpatient setting.

              Donald E. Morisky, Alfonso Ang, Marie Krousel-Wood … (2008)
              This study examines the psychometric properties and tests the concurrent and predictive validity of a structured, self-reported medication adherence measure in patients with hypertension. The authors also assessed various psychosocial determinants of adherence, such as knowledge, social support, satisfaction with care, and complexity of the medical regimen. A total of 1367 patients participated in the study; mean age was 52.5 years, 40.8% were male, 76.5% were black, 50.8% graduated from high school, 26% were married, and 54.1% had income <$5,000. The 8-item medication adherence scale was reliable (alpha=.83) and significantly associated with blood pressure control (P<.05). Using a cutpoint of <6, the sensitivity of the measure to identify patients with poor blood pressure control was estimated to be 93%, and the specificity was 53%. The medication adherence measure proved to be reliable, with good concurrent and predictive validity in primarily low-income, minority patients with hypertension and might function as a screening tool in outpatient settings with other patient groups.
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                Author and article information

                Contributors
                D. William Cameron: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2013
                Publication date (Electronic): 25 April 2013
                Volume: 8
                Issue: 4
                Electronic Location Identifier: e62775
                Affiliations
                [1 ]School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
                [2 ]New Territories East Cluster, Hospital Authority, Hong Kong SAR, China
                [3 ]Department of Community Health Sciences, UCLA Fielding School of Public Health, United States of America
                University of Ottawa, Canada
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: MCSW. Performed the experiments: MCSW GKYL HHXW KQLL. Analyzed the data: MCSW GKYL HHXW KQLL DEM. Contributed reagents/materials/analysis tools: YC DEM. Wrote the paper: MCSW GKYL DEM.

                Article
                Publisher ID: PONE-D-12-25427
                DOI: 10.1371/journal.pone.0062775
                PMC ID: 3636185
                PubMed ID: 23638143
                SO-VID: 813a950e-4913-447a-a734-a5e56b43cfad
                Copyright statement: Copyright @ 2013
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 21 August 2012
                Date accepted : 26 March 2013
                Page count
                Pages: 7
                Funding
                The funding source is the Direct Grant of the Research Committee, The Chinese University of Hong Kong. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Biology
                Subject: Population Biology
                Subject: Epidemiology
                Subject: Medicine
                Subject: Cardiovascular
                Subject: Hypertension
                Subject: Clinical Research Design
                Subject: Epidemiology
                Subject: Drugs and Devices
                Subject: Cardiovascular Pharmacology
                Subject: Pharmacoepidemiology
                Subject: Epidemiology
                Subject: Cardiovascular Disease Epidemiology
                Subject: Pharmacoepidemiology
                Subject: Global Health
                Subject: Non-Clinical Medicine
                Subject: Health Care Policy
                Subject: Health Education and Awareness
                Subject: Health Statistics
                Subject: Health Systems Strengthening
                Subject: Health Services Research
                Subject: Public Health
                Subject: Behavioral and Social Aspects of Health

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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