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On the basis of published studies, a conceptual framework of factors that affect patient adherence is presented. Recognizing patient nonadherence to medical therapy as a factor leading to poor blood pressure control and adverse outcomes remains a key challenge for clinicians caring for patients with hypertension.

Background Tens of thousands of health-related smartphone applications (apps), including hundreds of weight loss apps, are available but little is known about the effectiveness of these programs. Objective To evaluate the impact of introducing patients to a popular, free smartphone app for weight loss, MyFitnessPal, in a primary care setting. Design Randomized, controlled trial. Setting Two primary care clinics in the University of California Los Angeles Health System. Patients 212 primary care patients with body mass index greater than or equal to 25 kg/m2. Intervention 6 months of usual care (n = 107) or usual care plus research assistant help in downloading the MyFitnessPal app onto the patient’s smartphone (n = 105). Measurements Weight loss at six months (primary outcome), change in systolic blood pressure (SBP), change in behavioral mediators, satisfaction with the app, and frequency of app use (secondary outcomes). Results There was no significant difference between intervention and control groups in weight change (mean between group difference, −0.67 lb [CI, −3.3 to 2.1lb]; p = 0.63) or in SBP (mean between group difference, −1.7 mmHg [CI, −7.1 to 3.8]; p = 0.55). The intervention group exhibited increased use of a personal calorie goal compared to the control group (mean between group difference, 2.0 days per week [CI, 1.1 to 2.9]; p < .001), though changes in other self-reported behaviors did not differ between the groups. Most users reported high satisfaction with MyFitnessPal but logins dropped sharply after the first month. Limitation Despite blinding to the name of the app, fourteen control group participants (16%) used MyFitnessPal. 32% of intervention group participants and 19% of control group participants were lost to follow-up at 6 months. The app was given to patients by research assistants, not by physicians. Conclusion Smartphone apps for weight loss may be useful for individuals who are ready to self-monitor calories. For the average overweight primary care patient, however, introducing a smartphone app is unlikely to produce significant weight change.

Low adherence to antihypertensive medication remains a public health challenge. Understanding barriers to, and determinants of, adherence to antihypertensive medication adherence may help identify interventions to increase adherence and improve outcomes. The Cohort Study of Medication Adherence in Older Adults (CoSMO) is designed to assess risk factors for low antihypertensive medication adherence, explore differences across age, gender, and race subgroups, and determine the relationship of adherence with blood pressure (BP) control and cardiovascular outcomes over time. Between August 2006 and September 2007, 2194 participants, age 65 years and older, taking antihypertensive medication were recruited and enrolled in CoSMO and completed a baseline telephone survey. Antihypertensive medication adherence was assessed with the Morisky Medication Adherence Scale (MMAS) and the medication possession ratio (MPR). Low adherence was defined as a MMAS score < 6; non-persistent MPR was defined as <0.80. BP data were abstracted from outpatient electronic medical records; uncontrolled BP was defined as systolic or diastolic BP ≥140 or 90 mmHg, respectively. The mean age of participants was 75.0 ± 5.6 years, 58.8% were women, 30.7% were black, and 83.6% were taking 2 or more classes of antihypertensive medication. Overall, 14.1% of participants had low adherence, 27.0% had a non-persistent MPR, and 33.7% had uncontrolled BP. Participants with low MMAS were 2.71 (95% confidence interval (CI) 2.31-3.18) times more likely to have non-persistent MPR and 1.20 (95% CI 1.00-1.43) times more likely to have uncontrolled BP than participants with high MMAS. Low antihypertensive medication adherence and uncontrolled blood pressure are common in older, insured patients. Research identifying barriers to achieving antihypertensive medication adherence may assist in developing tailored interventions to increase medication adherence and improve outcomes.

Background and ObjectivesPoor 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.MethodsA 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).ResultsFrom 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.ConclusionThis 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.

BackgroundThe 14-item Treatment Satisfaction Questionnaire for Medication (TSQM) Version 1.4 is a reliable and valid instrument to assess patients' satisfaction with medication, providing scores on four scales – side effects, effectiveness, convenience and global satisfaction. In naturalistic studies, administering the TSQM with the side effects domain could provoke the physician to assess the presence or absence of adverse events in a way that is clinically atypical, carrying the potential to interfere with routine medical care. As a result, an abbreviated 9-item TSQM (TSQM-9), derived from the TSQM Version 1.4 but without the five items of the side effects domain was created. In this study, an interactive voice response system (IVRS)-administered TSQM-9 was psychometrically evaluated among patients taking antihypertensive medication.MethodsA total of 3,387 subjects were invited to participate in the study from an online panel who self-reported taking a prescribed antihypertensive medication. The subjects were asked to complete the IVRS-administered TSQM-9 at the start of the study, along with the modified Morisky scale, and again within 7 to 14 days. Standard psychometric analyses were conducted; including Cronbach's alpha, intraclass correlation coefficients, structural equation modeling, Spearman correlation coefficients and analysis of covariance (ANCOVA).ResultsA total of 396 subjects completed all the study procedures. Approximately 50% subjects were male with a good racial/ethnic mix: 58.3% white, 18.9% black, 17.7% Hispanic and 5.1% either Asian or other. There was evidence of construct validity of the TSQM-9 based on the structural equation modeling findings of the observed data fitting the Decisional Balance Model of Treatment Satisfaction even without the side effects domain. TSQM-9 domains had high internal consistency as evident from Cronbach's alpha values of 0.84 and greater. TSQM-9 domains also demonstrated good test-retest reliability with high intraclass correlation coefficients exceeding 0.70. As expected, the TSQM-9 domains were able to differentiate between individuals who were low, medium and high compliers of medication, with moderate to high effect sizes. There was evidence of convergent validity with significant correlations with the medication adherence scale.ConclusionThe IVRS-administered TSQM-9 was found to be a reliable and valid measure to assess treatment satisfaction in naturalistic study designs, in which there is potential that the administration of the side effects domain of the TSQM would interfere with routine clinical care.

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