Gina Gujral

The necessity-concerns framework predicts adherence to medication in multiple illness conditions: A meta-analysis.

OBJECTIVE This meta-analysis investigated whether beliefs in the necessity and concerns of medicine and the necessity-concerns differential are correlated with medication adherence on a population level and in different conditions. METHODS An electronic search of Web of Science, EMBASE, PubMed and CINAHL was conducted for manuscripts utilising the Beliefs about Medicines Questionnaire and comparing it to any measure of medication adherence. Studies were pooled using the random-effects model to produce a mean overall effect size correlation. Studies were stratified for condition, adherence measure, power and study design. RESULTS Ninety-four papers were included in the meta-analysis. The overall effect size(r) for necessity, concerns, and necessity-concerns differential was 0.17, -0.18 and 0.24 respectively and these were all significant (p<0.0001). Effect size for necessity was stronger in asthma and weaker in the cardiovascular group compared to the overall effect size. CONCLUSION Necessity and concerns beliefs and the necessity-concerns differential were correlated with medication adherence on a population level and across the majority of included conditions. The effect sizes were mostly small with a magnitude comparable to other predictors of adherence. PRACTICE IMPLICATIONS This meta-analysis suggests that necessity and concern beliefs about medicines are one important factor to consider when understanding reasons for non-adherence.

How do we better translate adherence research into improvements in patient care

Adherence to medicines in patients with chronic disease remains poor despite better recognition of the challenges of non-adherence and a concerted effort to address these challenges. Adherence research has progressed in recent years, both conceptually with the recent development of a taxonomy of adherence [1] and improved, if still flawed, evidence for the efficacy of some interventions [2]. However, a key challenge remains unmet: the translation of adherence research into clear advice for health professionals of effective strategies to better support the medication adherence of their patients. We outline some of the difficulties of improving the translation of adherence research into improvements in the care of individuals with chronic disease, and consider possible solutions. We have two suggestions for improving translation of adherence research: (1) better incorporation of what we know about adherence into interventions to improve adherence and (2) more sophisticated measurements of adherence. Implementing these suggestions has implications for research and practice.

Adherence and Beliefs

References 1. SHPA Committee of Specialty Practice in Clinical Pharmacy. SHPA standards of practice for clinical pharmacy. J Pharm Pract Res 2005; 35: 122-46. 2. Armour C, Brillant M, Krass I. Pharmacists’ views on involvement in pharmacy practice research: strategies for facilitating participation. Pharm Pract 2007; 5: 59-66. 3. Lipowski EE. Pharmacy practice-based research networks: why, what, who, and how. J Am Pharm Assoc 2008; 48: 142-52. 4. Carr MB, Divine H, Hanna C, Freeman PR, Blumenschein K. Independent community pharmacist interest in participating in community pharmacy research networks. J Am Pharm Assoc 2011; 51: 727-33. 5. Zwar NA, Weller DP, McCloughan L, Traynor VJ. Supporting research in primary care: are practice-based research networks the missing link? Med J Aust 2006; 185: 110-13.

Myalgia in Patients on High-Dose and Low-to-Moderate Dose Statin Therapy

Statin use has been associated with muscle toxicity and clinically significant muscle symptoms.