Jane Clatworthy

Factors Associated With Non-Adherence to Oral Medication for Inflammatory Bowel Disease: A Systematic Review

OBJECTIVES:Adherence is generally associated with improved treatment outcomes. Risk factors for non-adherence must be understood to improve adherence. A systematic review was undertaken to determine which variables were consistently associated with non-adherence to oral medication in inflammatory bowel disease (IBD).METHODS:The databases EMBASE, Medline, and PsycINFO were searched for titles relating to adherence, medication, and IBD (1980–2008). Primary, quantitative studies were included if they concerned adult patients with IBD, measured adherence to oral medication, and measured characteristics associated with adherence. The resulting 17 papers were independently reviewed by two researchers who also assessed their quality according to pre-defined criteria. The main outcome was the frequency with which demographic, clinical, treatment, and psychosocial variables were found to be statistically significantly associated with non-adherence.RESULTS:Non-adherence rates ranged from 7 to 72%, with most studies reporting that 30–45% of patients were non-adherent. No demographic, clinical, or treatment variables were consistently associated with non-adherence. Psychological distress and patients’ beliefs about medications were both related to non-adherence in four out of five studies, and doctor–patient discordance was associated with non-adherence in two out of three studies.CONCLUSIONS:This is the largest review of factors associated with non-adherence in IBD. Demographic, clinical, and treatment variables were not consistently associated with non-adherence. Psychological distress, patients’ beliefs about medications, and doctor–patient discordance were associated with non-adherence. These findings call into question some of the conclusions of earlier reviews that did not take into account nonsignificant findings. Practical suggestions for gastroenterologists and future research are discussed.

The value of self-report assessment of adherence, rhinitis and smoking in relation to asthma control

AIMS To explore the utility of self-report measures of inhaled corticosteroid (ICS) adherence, degree of rhinitis and smoking status and their association with asthma control. METHODS Patients prescribed ICS for asthma at 85 UK practices were sent validated questionnaire measures of control (Asthma Control Questionnaire; ACQ) and adherence (Medication Adherence Report Scale), a two-item measure of smoking status, and a single-item measure of rhinitis. RESULTS Complete anonymised questionnaires were available for 3916 participants. Poor asthma control (ACQ >1.5) was associated with reported rhinitis (OR = 4.62; 95% CI: 3.71-5.77), smoking (OR = 4.33; 95% CI: 3.58-5.23) and low adherence to ICS (OR = 1.35; 95% CI: 1.18-1.55). The degree of rhinitis was important, with those reporting severe rhinitis exhibiting the worst asthma control, followed by those reporting mild rhinitis and then those reporting no rhinitis symptoms (F(2, 3913)=128.7, p<.001). There was a relationship between the number of cigarettes smoked each day and asthma control (F(5,655)=6.08, p<.001). CONCLUSIONS Poor asthma control is associated with self-reported rhinitis, smoking and low medication adherence. These potentially modifiable predictors of poor asthma control can be identified through a brief self-report questionnaire, used routinely as part of an asthma review.

The utility of the Necessity—Concerns Framework in explaining treatment non-adherence in four chronic illness groups in Italy

Objective: To translate the Beliefs about Medicines Questionnaire (BMQ) into Italian and explore the utility of the Necessity—Concerns Framework in explaining treatment non-adherence in four chronic illness groups in Italy. Methods: 449 patients with chronic illness (depression, asthma, diabetes and cardiac disease) were approached at outpatient clinics in Turin and asked to complete Italian translations of the BMQ and the Medication Adherence Report Scale. Results: 427 patients consented to participate in the study. The BMQ demonstrated good internal consistency, with Cronbachs alphas of 0.78 (Necessity subscale) and 0.72 (Concerns subscale). Participants were divided into four attitudinal groups based on their responses to the BMQ: 59% Accepting (high Necessity, low Concerns), 29% ambivalent (high Necessity, high Concerns), 8% Indifferent (low Necessity, low Concerns) and 4% Skeptical (low Necessity, high Concerns). Those in the Accepting group reported the highest adherence to medication and those in the Skeptical group the lowest (p50.01). Discussion: The BMQ has been successfully translated and validated in Italian. This study provides support for the Necessity—Concerns Framework in explaining medication non-adherence in chronic illness. Interventions that address low perceived need for treatment and concerns about potential adverse effects of treatment are likely to facilitate optimal use of medicines.

Cluster analysis in illness perception research: A Monte Carlo study to identify the most appropriate method.

Cluster analysis may have theoretical and practical value in illness perception research. It is not clear, however, which of the many methods available is the most appropriate for use with illness perception data. A Monte Carlo study was conducted, whereby 420 artificial datasets with a predetermined cluster structure were generated to resemble Revised Illness Perception Questionnaire (IPQ-R) data. Sample size and equality in cluster size were manipulated. Average Linkage, Complete Linkage, Wards method and K-means (using the number of clusters and cluster centroids derived from Wards method) were applied to the artificial datasets and the percentage of cases correctly classified in each dataset by each method was recorded. A 4×3×2 ANOVA revealed that K-means cluster analysis was the most appropriate method for use in illness perception research. It is plausible that these results are generalisable to cluster analysis in other similar types of health psychology data.

High adherence and concordance within a clinical trial of antihypertensives

Objectives: To explore hypertensive patients’ beliefs about their condition and its treatment and their adherence within the context of a clinical trial. To assess the degree of concordance between patients’ beliefs about hypertension and the medical model of the condition. Methods: This was a questionnaire-based study, involving 230 patients participating in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), a randomized controlled trial comparing two pharmaceutical approaches to the management of hypertension. A comparison group of 106 hypertensive patients who were screened for ASCOT but did not meet the entry criteria was also recruited. Outcome measures were beliefs about hypertension and antihypertensive medication, and adherence to medication (self-report and tablet count). Results: Adherence to medication was higher than anticipated, with 45% participants reporting complete adherence over the 18-month study and a further 40% only rare non-adherence. Patients’ beliefs about their condition and treatment were generally concordant with the medical model of hypertension. High concordance was associated with high medication adherence (p<0.001). Discussion: Clinical trial volunteers may have beliefs that are unusually concordant with the medical model of hypertension and may demonstrate atypically high adherence. This has implications for the transferability of trial findings to the general hypertensive population.

Health professionals' beliefs about medication for bipolar disorder

Purpose – The purpose of this paper is to compare beliefs about medication prescribed for bipolar disorder across professional groups within Community Mental Health Teams (CMHTs) – psychiatric nurses, psychiatrists, support workers, social workers, and occupational therapists – who each receive different training.Design/methodology/approach – Participants (n=138) completed an adapted version of the Beliefs about Medicines Questionnaire. ANOVAs with Tukeys post hoc tests were used to compare beliefs across professional groups.Findings – Beliefs about medication differed across professional groups, with psychiatrists believing most strongly that medication is necessary in the treatment of bipolar disorder (p<0.05) and reporting the lowest concern about its adverse effects (p<0.05). Psychiatrists and social workers were significantly more likely to believe that patients take less than instructed than occupational therapists, nurses and support workers (p<0.05).Practical implications – The differences in per...