Factors Related to Medication Adherence of Cognitively Impaired Patients in Community Pharmacies

Abstract

Objective: The objective of the study was to identify factors related to donepezil medication adherence ("adherence") of cognitively impaired patients in community pharmacies. Methods: One hundred and twenty community pharmacies in 28 regions in Japan were randomly selected. Questionnaires were mailed to these pharmacies. The pharmacists answered based on the medication profiles ("YAKUREKI") of the patients given donepezil at their pharmacies. The survey items were "adherence", "who is the key person" and ‘the key person’s understanding and awareness of donepazil and its symptoms. The χ<sup>2</sup> test and decision tree modeling analysis were performed to examine factors affecting adherence. A 5% level of statistical significance was used in the χ<sup>2</sup> test. Results: Questionnaires with data on 479 patients were returned. The most common level of adherence was “take as instructed” (81.2%), followed by “forget once or twice a week” (10.2%). The χ<sup>2</sup> test revealed that adherence was good if "key person" was professional caretaker (P = 0.004). Also, adherence was better if key person understood medication about dosage, P < 0.001; effect, P = 0.002; and general side effects,, P < 0.001. According to decision tree analysis, the key person had the strongest relationship with adherence. Conclusions: It was confirmed that the key person’s understanding of the medication and symptoms of cognitive impairment are related to adherence. In particular, it was suggested that there is a strong relationship between the key person and adherence and that factors related to adherence differ according to who the key person is. It is essential in the treatment of cognitive impairment to accurately identify the "key person", in order to provide better pharmaceutical care in community pharmacies

Factors Associated with Medication Adherence among hypertensive Patients in a Tertiary Health Center: A Cross-Sectional Study

“…Item by item analysis of Morinsky-Green scores shows that forgetfulness, travelling, worry over side effects were the most common reasons for non-adherence. Forgetfulness is a widely reported factor that causes non-adherence [1,[3][4][5][6][8][9][10][11][12]. Adherence is usually better with medications that require less frequent administration especially for frequent travelers [19].…”

“…Globally speaking, the estimated non-adherence rates of longterm medication therapies vary widely [4][5][6][7][8][9][10][11][12].…”

Effectiveness of Pharmacists' Comprehensive Assessment of Medication Profiles in Dementia Patients

“…Underlying these results is the fact that the continued use of dementia treatments depends on the extent to which main caregivers, family members, and patients understand the signiˆcance of treatment with respect to supporting the patient. 9) Therefore, it appears that pharmacists' collection of speciˆc information from key persons and provision of individualized solutions were beneˆcial.…”

“…23) In such cases, community pharmacists could not perform direct patient assessment. Therefore, key persons were a major factor in‰uencing adherence to donepezil in some pharmacies, 9) and their understanding of dementia in‰uenced medical treatment. 24) Hence, pharmacists interviewed key persons directly and provided pharmaceutical counseling at community pharmacies.…”

“…5) Moreover, adherence depends on caregiver management, 6) burden of care, 7,8) and an understanding of dementia medications. 9,10) Pharmacists are eŠectively involved in addressing dementia patients' medication-related problems. 11) Community pharmacists' speciˆc responsibilities include education of caregivers, to ensure that they understand the purpose of the medication, 10,12) and assistance in managing treatment 13) via the provision of information regarding adverse eŠects and drug interactions.…”