• Korean Journal of Clinical Pharmacy
• /
• v.21 no.2
• /
• pp.81-89
• /
• 2011

Medication adherence is an important public health issue. This study is conducted to explore non-adherence of elderly with hypertension and/or diabetes mellitus and to better understand its' influencing factors. To explore non-adherence, 605 elderly patients in community were surveyed with Modified Morisky Scale (MMS), from Aug 18 to Sept 19, 2008. MMS is designed to predict medication-taking behavior and outcomes, and also to explain persistence of the patient's long-term continuation of therapy, which is a significant factor in the long-term management of chronic diseases. Also, MMS is designed to classify patients into a high/low continuum for knowledge and motivation. Patients self reported medication adherence were average 4.66 with MMS (range 0-6), only 78% of patients hold high motivation of medication adherence although 95.5% of patients hold high knowledge of medication adherence. This study explores which factors influence to high motivation of medication adherence and it proved that patients' participation in work, education level, participation in private health insurance, number of medication and medication frequency per day, pharmacists' explanation, experience of non adherence due to cost are important factors to explain high motivation of medication adherence of elderly with hypertension and/or diabetes mellitus.

• Korean Journal of Schizophrenia Research
• /
• v.23 no.2
• /
• pp.51-57
• /
• 2020

Treatment-resistant schizophrenia (TRS) has been defined as the persistence of positive symptoms despite two or more trials of antipsychotic medication of adequate dose and duration. TRS is a serious clinical problem and occurs in approximately 30% of patients with schizophrenia. It is important that patients who do not adequately respond to antipsychotics be reevaluated to exclude or address causes other than non-responsiveness to medication, that is, the possibility of pseudo-resistance. In particular, non-adherence to oral antipsychotic treatment should be monitored to rule out pseudo-resistant cases of TRS. Moreover, patients with TRS who take their medication as required may have subtherapeutic antipsychotic plasma levels, secondary to pharmacokinetic factors. In this paper, we review the concept and exclusion of pseudo-resistance, especially owing to non-adherence or pharmacokinetic factors, and present methods to enhance drug adherence.

• Health Policy and Management
• /
• v.24 no.2
• /
• pp.136-142
• /
• 2014

Background: This study is to research on how hypertension control is associated with adherence in newly diagnosed hypertension patients. Methods: The study is based on 255,916 patients who were diagnosed with hypertension in 2009 and didn't have any previous medical history of hypertension or associated complication for the past year using data collected by National Health Insurance Corporation. Newly diagnosed hypertension patients are divided into two group by visiting medical center numbers (more than 300 days was adherence group, if not non-adherence group). Patients are considered to have successfully controlled their hypertension based on blood pressure measured by health examination. Chi-square test and logistic regression, repeated measured analysis of variance was used to analyze. Results: The relations between adherence and hypertension control show that 1.12 times of patients in adherence group was able to control their hypertension. The additional analysis proves that adherence group are more decreased level of blood pressure than non-adherence group except for patients who are over 70. Comparison of the average of systolic blood pressure and diastolic blood pressure between adherence and non-adherence groups shows that the blood pressure has been significantly among the adherence group. Conclusion: The study proves that constant treatment for hypertension could control the blood pressure and encourages patients to put more effort for persistent treatment. It also shows that hypertension treatment are more effective in younger patients than the elderly and strategies of approaching are different depending on age.

• Korean Journal of Clinical Pharmacy
• /
• v.33 no.1
• /
• pp.62-69
• /
• 2023

Objective: Adherence is an important component in the treatment of various diseases, and poor adherence to antidepressants in patients with major depressive disorder is common. Non-adherence can be more prevalent in elderly patients with multiple morbidity and polypharmacy, resulting in negative treatment outcomes. The purpose of this study was to analyze adherence to antidepressants in Korean elderly patients with major depressive disorder. Method: A retrospective study was conducted using the Korean National Health Insurance claims database, and the subjects of this study were patients aged 65 or older who received at least one prescription of antidepressant monotherapy for the treatment of major depressive disorder between January 1, 2020 and June 30, 2020. Adherence was measured using the proportion of days covered at 6 months after the initial antidepressant prescription date. Logistic regression analysis was used to identify factors associated with adherence. Results: A total of 416,766 patients were finally included in the study. Over half of patients were non-adherent (52.67%) to antidepressants. According to the multivariate logistic regression analysis, national health insurance or medical aid, taking selective serotonin reuptake inhibitors or selective norepinephrine reuptake inhibitors, and having comorbidities were significantly associated with greater rates of adherence in the study subjects. The highest adherence rate was observed in patients taking vortioxetine. Conclusion: There was a considerable rate of non-adherence in Korean elderly patients with major depressive disorder. Health care professionals should try to improve adherence in elderly patients with major depressive disorder.

• Journal of Korean Society of Health-System Pharmacists
• /
• v.35 no.4
• /
• pp.418-429
• /
• 2018

Background : To improve medication adherence in elderly patients, the role of pharmacists in teambased services has been highlighted in the literature. However, not much is known about the role and the service elements involved in comprehensive geriatric programs in South Korea. This study was designed to describe the current status of medication adherence in geriatric patients based on the comprehensive geriatric assessment program and analyze the predictive factors for medication adherence in a tertiary teaching hospital. Methods : A retrospective cohort study was performed using electronic medical records of 247 patients from March 1st, 2015 to August 31st, 2015. Medication adherence and the types of non-adherence were also collected. Predictive factors for adherence were evaluated by including factors related to demographics, medications, illness, and patterns of medical usage. Results : The mean age of the study population was 81.2 years (range 65~98 years) and they were taking 9.7 drugs on an average (SD 5.0 drugs). The overall rate of non-adherence was 34%. About 48% of the patients had any forms of assistance in the medication administration. The most common type of non-adherence was "self-adjustment". The multivariate analyses revealed that age (adjusted odds ratio, 0.87 [95% CI, 0.80-0.96]; p 0.05) and the number of inappropriate medications (adjusted odds ratio, 0.59 [95% CI, 0.40-0.89]; p 0.05) were strong predictors for non-adherence. Conclusions : These results indicate that strategic considerations of the predictors of non-adherence should be improved in medication counseling services targeting elderly patients.

• Genomics & Informatics
• /
• v.12 no.3
• /
• pp.121-126
• /
• 2014

Medication adherence is generally defined as the extent of voluntary cooperation of a patient in taking medicine as prescribed. Adherence to long-term treatment with chronic disease is essential for reducing disease comorbidity and mortality. However, medication non-adherence in chronic disease averages 50%. This study was conducted a genome-wide association study to identify the genetic basis of medication adherence. A total of 235 medication non-adherents and 1,067 medication adherents with hypertension or diabetes were used from the Korean Association Resource project data according to the self-reported treatment status of each chronic disease, respectively. We identified four single nucleotide polymorphisms with suggestive genome-wide association. The most significant single nucleotide polymorphism was rs6978712 (chromosome 7, $p=4.87{\times}10^{-7}$), which is located proximal to the GCC1 gene, which was previously implicated in decision-making capability in drug abusers. Two suggestive single nucleotide polymorphisms were in strong linkage disequilibrium ($r^2$ > 0.8) with rs6978712. Thus, in the aspect of decision-making in adherence behavior, the association between medication adherence and three loci proximal to the GCC1 gene seems worthy of further research. However, to overcome a few limitations in this study, defining the standardized phenotype criteria for self-reported adherence should be performed before replicating association studies.

• The Korean Journal of Rehabilitation Nursing
• /
• v.19 no.2
• /
• pp.138-147
• /
• 2016

Purpose: The purpose of this study was to compare motivation for rehabilitation, family support and adherence to rehabilitation and identify factors predicting adherence to rehabilitation between depressive and non-depressive stroke patients. Methods: Stroke patients admitted to rehabilitation hospitals (n=159) participated in the study. Data were collected through self-reported questionnaires including general characteristics, depression, motivation for rehabilitation, family support and adherence to rehabilitation. The data were analyzed by descriptive statistics, t-test, $x^2$ test, Pearson correlation coefficients and logistic regression using the SPSS/WIN 21.0 program. Results: 62.9% of the subjects were identified as depressive patients. Motivation for rehabilitation (F=48.18, p=.020) and adherence to rehabilitation (F=9.68, p=.002) in depressive stroke patients were significantly lower than non-depressive stroke patients. Family support also in depressive group was lower than non-depressive group but there was no statistical significance (F=2.35, p=.127). Motivation for rehabilitation (OR=11.46), family support (OR=1.05) and onset period (less than 2 year)(OR=3.61) predicted the good adherence to rehabilitation in depressive stroke patients. Conclusion: The results of this study indicate that health professionals need to identify factors affecting adherence to rehabilitation and provide a nursing intervention considering the depression especially when caring for stroke patients.

• Journal of Sleep Medicine
• /
• v.15 no.2
• /
• pp.55-61
• /
• 2018

Objectives: Despite the accumulating evidence of the effectiveness of positive airway pressure (PAP) therapy in obstructive sleep apnea (OSA) syndrome, adherence to PAP therapy is not high. Several factors reportedly affect PAP adherence; however, it remains unclear whether patients' symptoms were detrimental to adherence rate. This study is aimed at investigating the relationship between insomnia symptoms and adherence. Methods: Retrospective analyses were performed in 359 patients with OSA (mean age $58.4{\pm}13.2$ years; females, n=80). Logistic regression analyses were performed between PAP adherence with clinical factors and questionnaires, such as Epworth Sleepiness Scale, Insomnia Severity Index, and Beck Depression Inventory (BDI). Results: PAP adherence was defined as the use of PAP for ${\geq}4h$ per night on 70% of nights during 30 consecutive days. The median follow-up time was 55 days (interquartile range, 30-119 days), and 54.3% showed poor adherence. Non-adherent patients showed more severe sleep onset insomnia, higher BDI, and higher nadir oxygen saturation ($SaO_2$). Patients with good adherence had higher apnea-hypopnea index, oxygen desaturation index, and respiratory arousal to total arousal ratio. Sleep onset insomnia [odds ratio (OR)=1.792, p=0.012], BDI (OR = 1.055, p=0.026), and nadir $SaO_2$ (OR=1.043, p=0.040) were independently associated with PAP non-adherence. Conclusions: Not the severity of insomnia but sleep onset insomnia was associated with PAP adherence, as well as depressive mood. It suggests that different interventions for reducing insomnia and depressive mood are needed to increase PAP adherence in patients with OSA.

• Journal of Korean Biological Nursing Science
• /
• v.19 no.1
• /
• pp.18-29
• /
• 2017

Purpose: This study investigates the status of medication use of the elderly with chronic disease taking non-opioid analgesics and attempts to identify factors influencing medication adherence. Methods: Data were collected from September 1 to October 19, 2016. A structured questionnaire was used for face-to-face interview with a convenience sample of 161, elderly people with chronic disease taking non-opioid analgesics. The survey included questions about status of medication use, medication adherence, symptom experience, depression and family function. Data were analyzed using descriptive statistics, t-tests, ANOVA, Pearson's correlation coefficients, and stepwise multiple regression with IBM SPSS 23.0 program. Results: The mean score of medication adherence of the elderly with chronic disease was $4.48{\pm}2.35$. Experiences of side effects (${\beta}=.31$, p< .001), use of over-the-counter pain medication (${\beta}=.19$, p= .009), and family function (${\beta}=.16$, p= .031) were identified as significant predictors. The final model explained 18.0% of the variation of medication adherence of the elderly with chronic disease taking non-opioid analgesics (F= 12.30, p< .001). Conclusion: Therefore, as a strategy to improve medication adherence of the elderly with chronic disease, therapeutic intervention should be developed to improve family function and to manage with personalized plans considering experiences of side effects and use of over-the-counter pain medication.

• Journal of mucopolysaccharidosis and rare diseases
• /
• v.1 no.1
• /
• pp.19-22
• /
• 2015

In Growth Hormone (GH) therapy, suboptimal adherence is a common problem, reaching up to 82%, and there is a need for interventions to improve adherence and to maximize patients' growth potential eventually. Current studies have demonstrated the association between the rate of non-adherence and reduced height velocity. In order to maximize patients' potential to grow, an auto-injecting/recording device, such as $easypod^{TM}$, may help improve adherence and optimize the treatment effects of GH therapy. The use of $easypod^{TM}$ has contributed to high adherence rates: 87.5% and 93% in Bozzola et al.'s study and the $Easypod^{TM}$ Connect Observational study (ECOS), respectively. Improvement of adherence by $easypod^{TM}$ may lead to higher growth rates of patients receiving GH therapy. Additionally, patients' positive acceptability of $easypod^{TM}$ suggests $easypod^{TM}$ is a preferred device by patients for better adherence.