Improving Medication Adherence

O’Connor, Patrick J.

doi:10.1001/archinte.166.17.1802

Cited by 76 publications

(18 citation statements)

References 25 publications

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“…Hypertension has been identified as the leading risk factor for mortality and ranks as the third-leading cause of disability-adjusted life-years [1], [3]. Despite the availability of numerous antihypertensive agents, current antihypertensive treatment does not always provide sufficient BP control and cardiovascular protection [4]–[6]. The combination therapy with two or more classes of antihypertensive agents is a strategy adopted for improving BP control and cardiovascular protection, which has been suggested in recent guidelines even as an initial therapeutic option [7], [8].…”

Section: Introductionmentioning

confidence: 99%

Low-Dose Dextromethorphan, a NADPH Oxidase Inhibitor, Reduces Blood Pressure and Enhances Vascular Protection in Experimental Hypertension

Chao

Lin

et al. 2012

PLoS ONE

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BackgroundVascular oxidative stress may be increased with age and aggravate endothelial dysfunction and vascular injury in hypertension. This study aimed to investigate the effects of dextromethorphan (DM), a NADPH oxidase inhibitor, either alone or in combination treatment, on blood pressure (BP) and vascular protection in aged spontaneous hypertensive rats (SHRs).Methodology/Principal FindingsEighteen-week-old WKY rats and SHRs were housed for 2 weeks. SHRs were randomly assigned to one of the 12 groups: untreated; DM monotherapy with 1, 5 or 25 mg/kg/day; amlodipine (AM, a calcium channel blocker) monotherapy with 1 or 5 mg/kg/day; and combination therapy of DM 1, 5 or 25 mg/kg/day with AM 1 or 5 mg/kg/day individually for 4 weeks. The in vitro effects of DM were also examined. In SHRs, AM monotherapy dose-dependently reduced arterial systolic BP. DM in various doses significantly and similarly reduced arterial systolic BP. Combination of DM with AM gave additive effects on BP reduction. DM, either alone or in combination with AM, improved aortic endothelial function indicated by ex vivo acetylcholine-induced relaxation. The combination of low-dose DM with AM gave most significant inhibition on aortic wall thickness in SHRs. Plasma total antioxidant status was significantly increased by all the therapies except for the combination of high-dose DM with high-dose AM. Serum nitrite and nitrate level was significantly reduced by AM but not by DM or the combination of DM with AM. Furthermore, in vitro treatment with DM reduced angiotensin II-induced reactive oxygen species and NADPH oxidase activation in human aortic endothelial cells.Conclusions/SignificanceTreatment of DM reduced BP and enhanced vascular protection probably by inhibiting vascular NADPH oxidase in aged hypertensive animals with or without AM treatment. It provides the potential rationale to a novel combination treatment with low-dose DM and AM in clinical hypertension.

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Section: Introductionmentioning

confidence: 99%

Low-Dose Dextromethorphan, a NADPH Oxidase Inhibitor, Reduces Blood Pressure and Enhances Vascular Protection in Experimental Hypertension

Chao

Lin

et al. 2012

PLoS ONE

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“…Non-adherence is an important issue in medicine and dermatology [1, 2]. It is the core of pharmionics, the study of what patients do with prescribed medications [3].…”

Section: Introductionmentioning

confidence: 99%

Self-Reported Adherence to Treatment and Quality of Life in Mild to Moderate Acne

Jones‐Caballero

Pedrosa²,

Peñas

2008

Dermatology

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Background: Adherence to treatment is a mayor issue in dermatology, and its relationship to quality of life has barely been studied. Objective: To evaluate the relationship between scores on the Skindex-29 skin disease assessment scale and adherence to treatment in patients with acne. Methods: An observational, prospective study of 1,628 patients carried out by 252 clinicians in Spain. Results: Adherence was related to better objective and subjective severity index scores and better Skindex-29 scale scores at the end of the study. Young, male and unemployed patients had the worst adherence scores. Baseline and final Skindex-29 scale scores were significantly worse in non-adherent females, while non-adherent males scored better. Reasons for non-adherence were side effects for older patients and forgetfulness for younger ones. Conclusion: Dermatologists should explain that adherence to treatment is linked to better outcomes and better quality of life. Young females with high Skindex-29 scale scores and males with low Skindex scores are especially prone to non-adherence.

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“…Lack of persistence with adherence to prescribed treatments is a critical part of the gap. 2 A sustained high level of adherence identifies a pattern of healthy behaviors 3,4 and allows medications shown to be effective in clinical trials to improve outcomes, but this is difficult to achieve with many chronic conditions. For instance, adherence rates to cholesterol-lowering drugs or antihypertension medications are poor.…”

mentioning

confidence: 99%

Challenges for Improving Medication Adherence

Simpson¹

2006

JAMA

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OR CHRONIC MEDICAL CONDITIONS, SUCH AS HYPERcholesterolemia and hypertension, a wide and persistent separation exists between evidence-based recommendations and the actual care patients receive. 1 Reasons for this gap are not always clear, but some components are obvious, including failing to identify patients in need of treatment, not properly initiating treatment, failing to provide proper drugs at proper doses, and neglecting to involve the patient in the choices inherent in care. Lack of persistence with adherence to prescribed treatments is a critical part of the gap.2 A sustained high level of adherence identifies a pattern of healthy behaviors 3,4 and allows medications shown to be effective in clinical trials to improve outcomes, but this is difficult to achieve with many chronic conditions. For instance, adherence rates to cholesterol-lowering drugs or antihypertension medications are poor. [5][6][7][8] Despite its importance, adherence to therapy is an individual patient behavior that is difficult to objectively measure, monitor, and improve. Patient characteristics that may lead to poor adherence include advanced age, cognitive impairment, and depression as well as attitudes and beliefs about the importance of the medication, the disease being treated, and the potential for adverse effects. Barriers to target for optimal adherence include adverse effects, polypharmacy, frequent (more than once daily) dosing, and high costs. Health care systems and clinician barriers include insufficient access to physicians, lack of trust between clinician and patient, and in some cases, physicians' negative attitudes and inadequate knowledge about the disease and value of guideline-recommended care.9,10 Due to this complexity, improving adherence has been difficult to study and adherence rates have been refractory to simple interventions. Successful interventions are often labor intensive and multilayered. They often show limited efficacy 11 and generally target only one disease or risk factor.Interventions that successfully improve adherence generally involve patient education and structural support such as patient reminders, more frequent clinic visits, or telephone calls from staff or physicians. Attempts are often made to simplify the patient's drug regimen by reducing the number of pills consumed per day and by reducing medication costs. [7][8][9] Pharmacists are often involved in assessing adherence and offering advice to physicians about simplifying and improving drug regimens.12-16 Direct counseling of patients by pharmacists may be particularly promising because of pharmacists' specialized training and knowledge of medications and availability to patients.In this issue of JAMA, Lee and colleagues 17 report the results of a pharmacy care program designed to improve medication adherence for patients with multiple chronic medical conditions, including hypertension and elevated cholesterol levels. The study focused on elderly patients who were taking multiple medications and therefore were at risk for poor adhere...

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Improving Medication Adherence

Cited by 76 publications

References 25 publications

Low-Dose Dextromethorphan, a NADPH Oxidase Inhibitor, Reduces Blood Pressure and Enhances Vascular Protection in Experimental Hypertension

Low-Dose Dextromethorphan, a NADPH Oxidase Inhibitor, Reduces Blood Pressure and Enhances Vascular Protection in Experimental Hypertension

Self-Reported Adherence to Treatment and Quality of Life in Mild to Moderate Acne

Challenges for Improving Medication Adherence

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