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      Role of attitudes and intentions in predicting adherence to oral diabetes medications

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          Abstract

          The purpose of this quantitative study was to investigate the extent to which patient attitudes and intentions predict adherence to the use of oral antihyperglycemic regimens in African Americans. This cross-sectional study of 115 participants used correlation analysis to establish relationships among patient attitudes, intentions and adherence. Data analyses showed significant correlations between the variables. Multiple regression analysis was used to establish predictions between the variables. A prediction model containing attitudes, subjective norms and perceived behavioral control (PBC) explained 37% of the variance to behavioral intention. Intentions accounted for 8.5% of the variance to adherence. Attitudes predicted behavioral intentions. The findings support the theory of planned behavior model and identify important correlations between attitudes, intentions and behaviors. In addition, the results underscore the need for promoting positive attitudes and positive intentions in effective adherence to the use of oral antihyperglycemic regimens. Achieving adequate adherence through behavioral counseling can effect positive social change by reducing the mortality and morbidity that are associated with inadequate adherence to the use of oral diabetic agents.

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          Most cited references15

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          Perceived barriers and effective strategies to diabetes self-management.

          This paper reports the perceived barriers to and effective strategies for self-management of adults with type 2 diabetes in a rural setting. Worldwide, diabetes is a major public health concern and financial burden. Research shows that, for people with diabetes, adhering to programs of self-care is often problematic. Despite the potential for improved metabolic control and quality of life, little is published on the barriers and effective strategies that people with diabetes successfully use to incorporate plans of care into their lifestyles. Twenty-four adults diagnosed with type 2 diabetes were recruited from a rural primary care practice to participate in one of three audiotaped focus groups. Content analysis was conducted on the focus group transcripts and validity was strengthened through independent rankings of barriers and strategies by an expert panel and by the nurse researchers. The data were collected 2002. The most frequently reported barriers were lack of knowledge of a specific diet plan, lack of understanding of the plan of care and helplessness and frustration from lack of glycaemic control and continued disease progression despite adherence. Effective strategies identified were developing a collaborative relationship with a provider, maintaining a positive attitude that prompts proactive learning and having a support person who provides encouragement and promotes accountability. These data highlight the importance of barrier and strategy identification in developing and implementing realistic self-management plans and the significance of collaborative alliances between patients and practitioners. Awareness of barriers, identification of strategies to overcome obstacles and the opportunity to problem solve with practitioners assists patients in managing a chronic illness that requires numerous daily decisions.
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            Oral antidiabetic medication adherence and glycemic control in managed care.

            To evaluate adherence to oral diabetes medications (ODMs) in patients with type 2 diabetes and the impact of ODM adherence on glycemic control. Retrospective observational study. Medical and pharmacy claims from a managed care plan in Oregon were used to identify adults with diabetes who newly initiated ODM therapy (n = 2741); a subset of this cohort linked to electronic health records was used to evaluate the relationship between adherence and glycemic control (n = 249). Glycemic control was assessed based on most recent glycosylated hemoglobin (A1C) measurement within the study period. Mean cohort age was 54 years; 46% initiated therapy with metformin, 39% with a sulfonylurea, and 12% with a thiazolidinedione. Mean adherence overall was 81%, and 65% of subjects had good adherence (>80%). Increasing age and comorbidity burden were associated with higher medication adherence. In the patient subset with A1C measurements, mean baseline A1C was 8%. An inverse relationship existed between ODM adherence and A1C; controlling for baseline A1C and therapy regimen, each 10% increase in ODM adherence was associated with a 0.1% A1C decrease (P = .0004). Although most patients were adherent to ODM therapy, adherent patients were more likely to achieve glycemic control than nonadherent patients. Greater efforts are needed to facilitate diabetes self-management behaviors to improve patient outcomes.
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              Cost sharing, adherence, and health outcomes in patients with diabetes.

              To assess the relationship between cost sharing and adherence to antidiabetic medications in patients with type 2 diabetes and to examine the relationship between medication adherence and outcomes, including complication rates, medical service utilization, and workplace productivity measures. A retrospective, cross-sectional study analyzing the healthcare experience of patients with type 2 diabetes on oral antidiabetic medication (OAD) with or without insulin (n = 96,734) and patients on OAD only (n = 55,356) with employer-sponsored insurance in the 2003-2006 MarketScan Database. Using a 2-stage residual inclusion model, the first stage estimated the effects of cost sharing on adherence to antidiabetic medications in an 18-month time frame (January 2003 through June 2004). Adherence was determined from the percentage of days covered. The second stage estimated the effects of adherence on complication rates (eg, retinopathy, neuropathy, peripheral vascular disease), medical service utilization rates, and measures of productivity (absence days and short-term disability days) in the subsequent 2 years (July 2004 through June 2006). A $10 increase in the patient cost-sharing index resulted in a 5.4% reduction in adherence to antidiabetic medications for patients on OAD only and a 6.2% reduction in adherence for patients on OAD with or without insulin. Adherence was associated with lower rates of complications (eg, amputation/ulcers, retinopathy) and also was associated with fewer emergency department visits and short-term disability days. Medical plans, employers, and policy makers should consider implementing interventions targeted to improve antidiabetic medication adherence, which may translate to better outcomes.

                Author and article information

                Journal
                Endocr Connect
                Endocr Connect
                EC
                Endocrine Connections
                Bioscientifica Ltd (Bristol )
                2049-3614
                February 2017
                13 January 2017
                : 6
                : 2
                : 63-70
                Affiliations
                [1 ]University of Maryland Medical Center Midtown Campus Baltimore, Maryland, USA
                [2 ]Walden University Minneapolis, Minnesota, USA
                Author notes
                Correspondence should be addressed to E K Fai; Email: efai@ 123456umm.edu
                Article
                EC160093
                10.1530/EC-16-0093
                5424778
                28087609
                a1d132c1-d132-406d-ad37-32460894f7bd
                © 2017 The authors

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 20 December 2016
                : 13 January 2017
                Categories
                Research

                adult diabetes,adherence,oral antihyperglycemic,african americans

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