Factors associated with medication adherence in patients living with cirrhosis

Polis, Suzanne; Zang, Ling; Mainali, Bhawana; Pons, Rachel; Pavendranathan, Gokulan; Zekry, Amany; Fernandez, Ritin

doi:10.1111/jocn.13083

Cited by 34 publications

(43 citation statements)

References 31 publications

(49 reference statements)

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“…Patients with cirrhosis including some with compensated cirrhosis are on multiple medications with an average between 3 and 10 medications . Volk et al showed that in patients with cirrhosis, the number of medications at discharge can predict time to readmission .…”

Section: Structural Barriers To Optimal Medication Managementmentioning

confidence: 99%

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Optimizing medication management for patients with cirrhosis: Evidence‐based strategies and their outcomes

Thomson

Lok

Tapper

2018

Liver International

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Cirrhosis is a morbid condition associated with frequent hospitalizations and high mortality. Management of cirrhosis requires complex medication regimens to treat underlying liver disease, complications of cirrhosis and comorbid conditions. This review examines the complexities of medication management in cirrhosis, barriers to optimal medication use, and potential interventions to streamline medication regimens and avoid medication errors. A literature review was performed by searching PUBMED through December 2017 and article reference lists to identify articles relevant to medication management, complications, adherence, and interventions to improve medication use in cirrhosis. The structural barriers in cirrhosis include sheer medication complexity related to the number of medications and potential for cognitive impairment in this population, faulty medication reconciliation and limited adherence. Tested interventions have included patient self-education, provider driven patient education, intensive case management including medication blister packs and smartphone applications. Initiatives are needed to improve patient, caregiver and provider education on appropriate use of medications in patients with cirrhosis. A multidisciplinary team should be established to coordinate care with close monitoring, address patient and caregiver concerns, and to provide timely access to outpatient evaluation of urgent/complex issues. Future studies evaluating the clinical outcomes and cost effectiveness of interventions are needed.

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Section: Structural Barriers To Optimal Medication Managementmentioning

confidence: 99%

“…Higher scores were not associated with adherence. Thirdly, one in three patients stated they would adjust their medications if their symptoms improved without talking to their physicians …”

Section: Structural Barriers To Optimal Medication Managementmentioning

confidence: 99%

Optimizing medication management for patients with cirrhosis: Evidence‐based strategies and their outcomes

Thomson

Lok

Tapper

2018

Liver International

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“…Illness and medication beliefs have been shown to influence patients’ confidence to self-manage alcoholic liver disease and to have impacts on health-related QoL [49]. Progression of disease is associated with decreased QoL, including increased symptoms; abdominal symptoms and fatigue have been found to worsen adherence in people with cirrhosis [50]. Investigation of the effect of these variables on medication adherence in patients with decompensated cirrhosis, in addition to the effect of a clinical pharmacist education and medication management intervention on modifying these variables, will provide valuable information for future ambulatory management of these patients.…”

Section: Discussionmentioning

confidence: 99%

Patient-oriented education and medication management intervention for people with decompensated cirrhosis: study protocol for a randomized controlled trial

Hayward

Martin

Cottrell

et al. 2017

Trials

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BackgroundPeople with decompensated cirrhosis require complex medical care and are often prescribed an intricate and frequently changing medication and lifestyle regimen. However, many patients mismanage their medications or have poor comprehension of their disease and self-management tasks. This can lead to harm, hospitalization, and death.Methods/designA patient-oriented education and medication management intervention has been developed for implementation at a tertiary hospital hepatology outpatient center in Queensland, Australia. Consenting patients with decompensated cirrhosis will be randomly allocated to education intervention or usual care treatment arms when they attend routine follow-up appointments. In the usual care arm, participants will be reviewed by their hepatologist according to the current model of care in the hepatology clinic. In the intervention arm, participants will be reviewed by a clinical pharmacist to receive the education and medication management intervention at baseline in addition to review by their hepatologist. Intervention participants will also receive three further educational contacts from the clinical pharmacist within the following 6-month period, in addition to routine hepatologist review that is scheduled within this time frame. All participants will be surveyed at baseline and follow-up (approximately 6 months post-enrollment). Validated questionnaire tools will be used to determine participant adherence, medication beliefs, illness perceptions, and quality of life. Patients’ knowledge of dietary and lifestyle modifications, their current medications, and other clinical data will be obtained from the survey, patient interview, and medical records. Patient outcome data will be collected at 52 weeks.DiscussionThe intervention described within this protocol is ready to adapt and implement in hepatology ambulatory care centers globally. Investigation of potentially modifiable variables that may impact medication management, in addition to the effect of a clinical pharmacist-driven education and medication management intervention on modifying these variables, will provide valuable information for future management of these patients.Trial registrationAustralian and New Zealand Clinical Trial Registry identifier: ACTRN12616000780459. Registered on 15 June 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2075-4) contains supplementary material, which is available to authorized users.

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“…Historically, most medication adherence studies describe patient forgetfulness as the greatest barrier to non-adherence (30)(31)(32)(33). This is considered a non-intentional factor.…”

Section: Behavior-specific Cognitions and Affectmentioning

confidence: 99%

The Health Promotion Model in HIV Care

Caires

2016

Aquichan

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Effective medical treatment with uninterrupted engagement in care is critical to improving the survival and the quality of life of patients infected with the human immunodeficiency virus (HIV). Objectives: Multiple behavioral interventions have been conducted to promote adherence behaviors. However, adherence to HIV medications and medical appointments is still an issue of global concern. Method: The Health Promotion Model (HPM) is a nursing adaption of the health belief model. The HPM focuses on individual characteristics and experiences, as well as behavior specific cognitions and outcomes. Integrating the HPM in addressing adherence behaviors could be one of the building blocks of success in changing health behavior. Results: A search of the literature turned up no studies that applied the HPM in adherence behavior studies conducted among HIV-infected populations. Conclusion: This paper presents the reader with the availability of current adherence-behavior interventions and strategies that align with the HPM model components. It further proposes the need for medical treatment team members to adopt the HPM in current clinical practice settings so as to effectively address adherence behavior issues. KEYWORDSHIV medication adherence; adherence theory; health promotion model; linkage to HIV care; nursing promotion model (Source: DeCS, BIREME). El modelo de promoción de la salud en el cuidado del VIH RESUMENUn tratamiento médico eficaz con un compromiso ininterrumpido en el cuidado es crítico para mejorar la supervivencia y la calidad de vida de los pacientes infectados con el virus de la inmunodeficiencia humana (VIH). Objetivos: se han llevado a cabo múltiples intervenciones conductuales para promover comportamientos de adherencia. Sin embargo, la adhesión a los medicamentos contra el VIH y las citas médicas siguen siendo un tema de preocupación mundial. Método: el modelo de promoción de la salud (HPM) es una adaptación de enfermería del modelo de creencias de salud. El HPM se centra en características y experiencias individuales, así como cogniciones y resultados específicos del comportamiento. La integración del HPM en el abordaje de los comportamientos de adherencia podría ser uno de los pilares del éxito en el cambio del comportamiento de la salud. Resultados: una búsqueda en la literatura no mostró ningún estudio que aplicó el HPM en los estudios de comportamiento de adherencia realizados entre las poblaciones infectadas por el VIH. Conclusión: este artículo presenta al lector la disponibilidad de las actuales intervenciones de adherencia-comportamiento y estrategias que se alinean con los componentes del modelo HPM. Además, propone la necesidad de que los miembros del equipo de tratamiento médico adopten el HPM en la práctica clínica actual con el fin de abordar eficazmente los problemas de comportamiento de adherencia. PALABRAS CLAVEAdhesión a los medicamentos para el VIH; teoría de la adherencia; modelo de promoción de la salud; vinculación a la atención del VIH; modelo de promoción de la enferm...

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Factors associated with medication adherence in patients living with cirrhosis

Cited by 34 publications

References 31 publications

Optimizing medication management for patients with cirrhosis: Evidence‐based strategies and their outcomes

Optimizing medication management for patients with cirrhosis: Evidence‐based strategies and their outcomes

Patient-oriented education and medication management intervention for people with decompensated cirrhosis: study protocol for a randomized controlled trial

The Health Promotion Model in HIV Care

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