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Debra K. Moser - One of the best experts on this subject based on the ideXlab platform.
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Medication Adherence mediates the relationship between heart failure symptoms and cardiac event free survival in patients with heart failure
Journal of Cardiovascular Nursing, 2017Co-Authors: Debra K. MoserAbstract:BACKGROUND Heart failure (HF) symptoms such as dyspnea are common and may precipitate hospitalization. Medication nonAdherence is presumed to be associated with symptom exacerbations, yet how HF symptoms, Medication Adherence, and hospitalization/death are related remains unclear. OBJECTIVE The aim of this study was to explore the relationships among HF symptoms, Medication Adherence, and cardiac event-free survival in patients with HF. METHODS At baseline, patient demographics, clinical data, and HF symptoms were collected in 219 patients with HF. Medication Adherence was monitored using the Medication Event Monitoring System. Patients were followed for up to 3.5 years to collect hospitalization and survival data. Logistic regression and survival analyses were used for the analyses. RESULTS Patients reporting dyspnea or ankle swelling were more likely to have poor Medication Adherence (P = .05). Poor Medication Adherence was associated with worse cardiac event-free survival (P = .006). In Cox regression, patients with HF symptoms had 2 times greater risk for a cardiac event than patients without HF symptoms (P = .042). Heart failure symptoms were not a significant predictor of cardiac event-free survival after entering Medication Adherence in the model (P = .091), indicating mediation. CONCLUSIONS Medication Adherence was associated with fewer HF symptoms and lower rates of hospitalization and death. It is important to develop interventions to improve Medication Adherence that may reduce HF symptoms and high hospitalization and mortality in patients with HF.
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type d personality self efficacy and Medication Adherence in patients with heart failure a mediation analysis
Heart & Lung, 2015Co-Authors: Eun Kyeung Song, Debra K. MoserAbstract:Abstract Background Type D personality is associated with Medication non-Adherence. Both Type D personality and non-Adherence are predictors of poor outcomes. Self-efficacy, which is modifiable, is also associated with Medication Adherence. Objectives To determine the relationships among Type D personality, self-efficacy, and Medication Adherence in 84 heart failure patients. Methods Self-efficacy, Type D personality, Medication Adherence, demographic and clinical data were collected. Hierarchical linear regression was used. Results Type D patients were more likely to have lower self-efficacy ( p = .023) and Medication non-Adherence ( p = .027) than non-Type D patients. Low self-efficacy was associated with Medication non-Adherence ( p p = .422), demonstrating mediation. Conclusions Self-efficacy mediates the relationship between Type D personality and Medication Adherence. Developing and applying interventions to enhance self-efficacy may help to sever the link between Type D personality and poor outcomes.
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type d personality predicts poor Medication Adherence in patients with heart failure in the usa
International Journal of Behavioral Medicine, 2014Co-Authors: Debra K. MoserAbstract:Background Type D (distressed) personality and Medication nonAdherence have been associated with poor health outcomes. Type D personality is associated with poor Medication Adherence in patients with coronary artery disease. However, the relationship between type D personality and Medication Adherence in patients with heart failure (HF) remains unknown.
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Medication Adherence social support and event free survival in patients with heart failure
Health Psychology, 2013Co-Authors: Susan K Frazier, Terry A. Lennie, Misook L Chung, Mary Kay Rayens, Debra K. MoserAbstract:Objectives: Medication Adherence and perceived social support (PSS) are independent predictors of mortality in patients with heart failure (HF). However, the predictive power of the combination of Medication Adherence and PSS for hospitalization and death has not been investigated in patients with HF. The purpose of the study was to explore the combined influence of Medication Adherence and PSS for prediction of cardiac event-free survival in patients with HF. Method: A total of 218 HF patients monitored Medication Adherence for 1–3 months and completed the Multidimensional Perceived Social Support Scale (MPSSS) at baseline. Medication Adherence was measured using a valid and objective measure, the Medication Event Monitoring System (MEMS). Patients were followed for up to 3.5 years to collect data about cardiac event-free survival (i.e., cardiac emergency department visits, hospitalizations, and death). To test the association of the combination of Medication Adherence and PSS with outcomes, the interaction term of Medication Adherence and PSS was first entered in a Cox regression to predict outcomes. Second, patients were grouped using an evidence-based cutpoint of 88% for Medication Adherence from the MEMS data and a median score 71 of the MPSSS. Kaplan-Meier and Cox proportional hazards models were used to compare cardiac event-free survival among groups. Result: Medication Adherence and PSS were independent predictors of cardiac event-free survival (p .006 and .021, respectively). Patients with Medication nonAdherence and lower PSS had a 3.5 times higher risk of cardiac events than those who were adherent and had higher PSS. Conclusion: Medication Adherence mediated the relationship between PSS and cardiac event-free survival in this sample. Moreover, Medication Adherence and social support independently, and in combination, predicted cardiac event-free survival in patients with HF. Interventions to improve clinical outcomes should address Medication Adherence and social support.
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Medication Adherence depressive symptoms and cardiac event free survival in patients with heart failure
Journal of Cardiac Failure, 2013Co-Authors: Terry A. Lennie, Rebecca L. Dekker, Martha J. Biddle, Debra K. MoserAbstract:Abstract Background Medication nonAdherence and depressive symptoms predict hospitalization and death in patients with heart failure (HF). Depressed patients have lower Medication Adherence than nondepressed patients. However, the predictive power of the combination of Medication Adherence and depressive symptoms for hospitalization and death has not been investigated in patients with HF. Objective The aim of this study was to explore the combined influence of Medication Adherence and depressive symptoms for prediction of cardiac event–free survival in patients with HF. Methods and Results We monitored Medication Adherence in 216 HF patients who completed the Patient Health Questionnaire–9 (PHQ-9) at baseline. Medication Adherence was measured objectively with the use of the Medication Event Monitoring System (MEMS). Patients were followed for up to 3.5 years to collect data on cardiac events. Survival analyses were used to compare cardiac event–free survival among groups. The risk of experiencing a cardiac event for patients with Medication nonAdherence and depressive symptoms was 5 times higher than those who were Medication adherent without depressive symptoms. The risk of experiencing a cardiac event for patients with only 1 risk factor was 1.2–1.3 times that of those with neither risk factor. Conclusions Medication nonAdherence and depressive symptoms had a negative synergistic effect on cardiac event–free survival in patients with HF.
Terry A. Lennie - One of the best experts on this subject based on the ideXlab platform.
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Medication Adherence social support and event free survival in patients with heart failure
Health Psychology, 2013Co-Authors: Susan K Frazier, Terry A. Lennie, Misook L Chung, Mary Kay Rayens, Debra K. MoserAbstract:Objectives: Medication Adherence and perceived social support (PSS) are independent predictors of mortality in patients with heart failure (HF). However, the predictive power of the combination of Medication Adherence and PSS for hospitalization and death has not been investigated in patients with HF. The purpose of the study was to explore the combined influence of Medication Adherence and PSS for prediction of cardiac event-free survival in patients with HF. Method: A total of 218 HF patients monitored Medication Adherence for 1–3 months and completed the Multidimensional Perceived Social Support Scale (MPSSS) at baseline. Medication Adherence was measured using a valid and objective measure, the Medication Event Monitoring System (MEMS). Patients were followed for up to 3.5 years to collect data about cardiac event-free survival (i.e., cardiac emergency department visits, hospitalizations, and death). To test the association of the combination of Medication Adherence and PSS with outcomes, the interaction term of Medication Adherence and PSS was first entered in a Cox regression to predict outcomes. Second, patients were grouped using an evidence-based cutpoint of 88% for Medication Adherence from the MEMS data and a median score 71 of the MPSSS. Kaplan-Meier and Cox proportional hazards models were used to compare cardiac event-free survival among groups. Result: Medication Adherence and PSS were independent predictors of cardiac event-free survival (p .006 and .021, respectively). Patients with Medication nonAdherence and lower PSS had a 3.5 times higher risk of cardiac events than those who were adherent and had higher PSS. Conclusion: Medication Adherence mediated the relationship between PSS and cardiac event-free survival in this sample. Moreover, Medication Adherence and social support independently, and in combination, predicted cardiac event-free survival in patients with HF. Interventions to improve clinical outcomes should address Medication Adherence and social support.
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Medication Adherence depressive symptoms and cardiac event free survival in patients with heart failure
Journal of Cardiac Failure, 2013Co-Authors: Terry A. Lennie, Rebecca L. Dekker, Martha J. Biddle, Debra K. MoserAbstract:Abstract Background Medication nonAdherence and depressive symptoms predict hospitalization and death in patients with heart failure (HF). Depressed patients have lower Medication Adherence than nondepressed patients. However, the predictive power of the combination of Medication Adherence and depressive symptoms for hospitalization and death has not been investigated in patients with HF. Objective The aim of this study was to explore the combined influence of Medication Adherence and depressive symptoms for prediction of cardiac event–free survival in patients with HF. Methods and Results We monitored Medication Adherence in 216 HF patients who completed the Patient Health Questionnaire–9 (PHQ-9) at baseline. Medication Adherence was measured objectively with the use of the Medication Event Monitoring System (MEMS). Patients were followed for up to 3.5 years to collect data on cardiac events. Survival analyses were used to compare cardiac event–free survival among groups. The risk of experiencing a cardiac event for patients with Medication nonAdherence and depressive symptoms was 5 times higher than those who were Medication adherent without depressive symptoms. The risk of experiencing a cardiac event for patients with only 1 risk factor was 1.2–1.3 times that of those with neither risk factor. Conclusions Medication nonAdherence and depressive symptoms had a negative synergistic effect on cardiac event–free survival in patients with HF.
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Medication Adherence mediates the relationship between marital status and cardiac event free survival in patients with heart failure
Heart & Lung, 2012Co-Authors: Terry A. Lennie, Rebecca L. Dekker, Martha J. Biddle, Susan K Frazier, Misook L Chung, Debra K. MoserAbstract:Abstract Objective Prognosis is worse in unmarried patients compared with married patients with heart failure (HF). The reasons for differences in outcomes are unclear, but variations in Medication Adherence may play a role, because Medication Adherence is essential to achieving better outcomes. The study objective was to determine whether Medication Adherence mediated the relationship between marital status and cardiac event-free survival in patients with HF. Methods Demographic, clinical, and psychosocial data were collected by questionnaires and medical record review for 136 patients with HF (aged 61 ± 11 years, 70% were male, 60% were in New York Heart Association class III/IV). Medication Adherence was monitored objectively for 3 months using the Medication Event Monitoring System. Cardiac event-free survival data were obtained by patient/family interview, hospital database, and death certificate review. A series of regression and Cox survival analyses were performed to determine whether Medication Adherence mediated the relationship between marital status and event-free survival. Results Cardiac event-free survival was worse in unmarried patients than in married patients. Unmarried patients were more likely to be nonadherent and 2 times more likely to experience an event than married patients (P = .017). Marital status was not a significant predictor of event-free survival after entering Medication Adherence in the model, demonstrating a mediation effect of Adherence on the relationship of marital status to survival. Conclusion Medication Adherence mediated the relationship between marital status and event-free survival. It is important to design interventions to increase Medication Adherence that take into account subgroups, such as unmarried patients, who are at higher risk for nonAdherence.
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Medication Adherence is a mediator of the relationship between ethnicity and event free survival in patients with heart failure
Journal of Cardiac Failure, 2008Co-Authors: Terry A. Lennie, Susan K Frazier, Seongkum Heo, Misook L Chung, Marla J De Jong, Debra K. MoserAbstract:Abstract Background Rehospitalization rates are higher in African American than Caucasian patients with heart failure (HF). The reasons for the disparity in outcomes between African Americans and Caucasians may relate to differences in Medication Adherence. To determine whether Medication Adherence is a mediator of the relationship between ethnicity and event-free survival in patients with HF. Methods and Results Medication Adherence was monitored longitudinally in 135 HF patients using the Medication Event Monitoring System. Events (emergency department visits for HF exacerbation, HF and cardiac rehospitalization, and all-cause mortality) were obtained by interview and hospital data base review. A series of regression models and survival analyses was conducted to determine whether Medication Adherence mediated the relationship between ethnicity and event-free survival. Event-free survival was significantly worse in African Americans than Caucasians. Ethnicity was a predictor of Medication Adherence ( P = .011). African Americans were 2.57 times more likely to experience an event than Caucasians ( P = .026). Ethnicity was not a predictor of event-free survival after entering Medication Adherence in the model ( P = .06). Conclusions Medication Adherence was a mediator of the relationship between ethnicity and event-free survival in this sample. Interventions designed to reduce barriers to Medication Adherence may decrease the disparity in outcomes.
Paula Anne Newmancasey - One of the best experts on this subject based on the ideXlab platform.
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demographic clinical and psychosocial predictors of change in Medication Adherence in the support educate empower program
Ophthalmology Glaucoma, 2021Co-Authors: David J Miller, Michele Heisler, Paul P Lee, Leslie M Niziol, Angela R Elam, Ken Resnicow, David C Musch, Deborah Darnleyfisch, Jamie A Mitchell, Paula Anne NewmancaseyAbstract:PURPOSE To investigate whether demographic, clinical, or psychosocial factors act as moderators of change in Medication Adherence in the Support, Educate, Empower (SEE) program. DESIGN Prospective, single-arm pilot study with a pre-post design. PARTICIPANTS Patients with glaucoma aged ≥ 40 years and taking ≥ 1 glaucoma Medication were recruited from the University of Michigan Kellogg Eye Center. Those who had electronically measured Adherence ≤ 80% in the 3-month eligibility monitoring period were enrolled in the SEE program. METHODS Medication Adherence was monitored electronically during the 7-month intervention and calculated as the percentage of doses taken correctly. Change in Adherence at different points in the SEE program and cumulative change in Adherence were modeled with linear regression, and baseline demographic, clinical, and psychosocial factors were investigated for significant associations. MAIN OUTCOME MEASURES Demographic, clinical, and psychosocial variables associated with change in Medication Adherence in the SEE program. RESULTS Thirty-nine participants completed the SEE program. These participants were on average 63.9 years old (standard deviation [SD], 10.7 years), 56% (n = 22) were male, 44% (n = 17) were White, and 49% (n = 19) were Black. Medication Adherence improved from an average of 59.9% (SD, 18.5%) at baseline to 83.6% (SD, 17.5%) after the final SEE session, for an increase of 23.7% (SD, 17.5%). Although participants with lower income ( $50 000) had lower baseline Adherence (48.4% and 64.1% vs. 70.4%), these individuals had greater increases in Adherence during the first month of Medication reminders (19.6% and 21.6% vs. 10.2%; P = 0.05 and P = 0.007, respectively). Participants taking fewer glaucoma Medications also had significantly greater increases in Adherence with Medication reminders (P < 0.001). Those with higher levels of glaucoma-related distress (GD) had lower baseline Adherence and greater increases in Adherence with glaucoma coaching (P = 0.06). CONCLUSIONS Patient-level factors associated with relatively greater improvements in Medication Adherence through the SEE Program included lower income, fewer glaucoma Medications, and increased GD. These findings demonstrate that the SEE program can improve glaucoma self-management even among participants with social and psychological barriers to Medication Adherence.
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increased near activities function associated with increased glaucoma Medication Adherence among support educate empower see participants
Journal of Glaucoma, 2021Co-Authors: Juno Cho, Michele Heisler, Leslie M Niziol, Paula Anne NewmancaseyAbstract:Prcis Higher levels of near-vision related quality of life were associated with higher Adherence to glaucoma Medications after adjusting for important confounding variables among participants in the SEE personalized glaucoma coaching pilot study. Purpose To investigate the association between vision-related quality of life (VRQoL) and glaucoma Medication Adherence. Materials and methods Subjects were recruited for the Support, Educate, Empower (SEE) program, a prospective non-controlled cohort study examining the impact of a personalized coaching program on glaucoma Medication Adherence. Glaucoma patients seen at the University of Michigan over 40 years old, taking ≥1 glaucoma Medication, and self-reported poor Adherence on two validated scales were recruited. Demographic details and VRQoL using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) were collected. Participants' Medication use for each prescribed glaucoma Medication was captured electronically using a Medication events monitoring system (Adheretech, New York, NY). The association between VRQoL and Medication Adherence was assessed with Pearson's correlation coefficient (r) and linear regression. Results Among the 95 eligible participants 49.5% were female, 55.3% were Caucasian, and mean age (±standard deviation) was 63.8±10.5 years. Mean Adherence to glaucoma Medication was 73.8%±21.0%. Mean NEI VFQ-25 composite score was 81.6±14.5. Better Medication Adherence was significantly and positively correlated with better functioning in domains of ocular pain (r=0.20, P=0.048), near activities (r=0.29, P=0.004), and role difficulties (r=0.22, P=0.036). Linear regression models adjusting for known correlates of Medication Adherence (age, gender, race, income), showed a 10-unit increase in self-perceived near activities function was associated with a 2.2% increase in Medication Adherence (95% confidence interval 1.0%-5.4%; P=0.0056). Conclusion Better self-perceived near activities function was associated with increased glaucoma Medication Adherence.
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the minimal clinically important difference in glaucoma Medication Adherence interviews of glaucoma experts
Ophthalmic Research, 2021Co-Authors: Ajay Kolli, Shelby Danielwayman, Paula Anne NewmancaseyAbstract:Poor Adherence to glaucoma Medications is associated with progressive vision loss. While many interventions have sought to increase glaucoma Medication Adherence, the amount by which Adherence must increase to have a clinically significant effect remains unknown. To generate a hypothesized minimal clinically important difference (MCID) for glaucoma Medication Adherence, we conducted interviews with glaucoma experts. Semi-structured interviews were conducted with members of the American Glaucoma Society. MCID was defined in 2 ways: (1) the incremental increase in the average percentage of eye drops a patient takes at roughly the correct time and (2) the incremental increase in the proportion of a patient population who attain good Adherence. Good Adherence was defined as taking more than 80% of drops at approximately the prescribed dose time. Expert opinions on the MCID for glaucoma Medication Adherence and open-ended responses were recorded through field notes. Twenty-five experts were interviewed. They estimated the MCID for average individual Adherence levels as 17.7% (95% CI: 14.6, 20.8). Experts estimated the MCID for the proportion of patients in a practice who attain good Adherence (defined as >80% of eye drops taken as prescribed) as 18.5% (95% CI: 15.6, 21.5). The most common identified themes were that the MCID should take into account the cost of the intervention and the burden to the ophthalmologist and to the practice, where experts thought that more costly interventions or those that required more physician time should have larger MCIDs. Based on expert opinion, we hypothesized that the MCID for glaucoma Medication Adherence is between 15 and 20%. However, the MCID for a given intervention must take into account several factors, including intervention cost and physician burden. This hypothesis may facilitate the design and implementation of future studies to objectively determine an MCID for glaucoma Medication Adherence.
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systematic review of educational interventions to improve glaucoma Medication Adherence an update in 2015
Expert Review of Ophthalmology, 2016Co-Authors: Paula Anne Newmancasey, Megan E Dayno, Alan L RobinAbstract:Purpose: To evaluate the current state of the research on educational interventions whose aim is to improve glaucoma Medication Adherence. Methods: A systematic review of Pubmed, Embase and CINAHL was conducted to identify research studies evaluating educational interventions to improve glaucoma Medication Adherence. Studies were included if the intervention was described, the outcomes assessed glaucoma Medication Adherence and the focus of the research was on adults with glaucoma. The search was conducted on June 2, 2015. Results: Seventeen studies were identified that met the inclusion criteria. These included nine randomized controlled trials and eight observational studies. Eight of the studies demonstrated an impact on glaucoma Medication Adherence, though their outcome measures were too heterogeneous to estimate a pooled effect size. Conclusion: The interventions that successfully improved glaucoma Medication Adherence used an adequate dose of face-to-face counseling to overcome barriers to health b...
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systematic review of educational interventions to improve glaucoma Medication Adherence
Seminars in Ophthalmology, 2013Co-Authors: Paula Anne Newmancasey, Jennifer S Weizer, Michele Heisler, Paul P Lee, Joshua D SteinAbstract:Adherence to prescribed glaucoma Medications is often poor, and proper Adherence can be challenging for patients. We systematically reviewed the literature and identified eight studies using educational interventions to improve glaucoma Medication Adherence. Overall, five of the eight studies found that educational interventions lead to a significant improvement in Medication Adherence, and two additional studies found a trend towards improvement. Using information from this systematic review and Health Behavior Theory, we constructed a conceptual framework to illustrate how counseling and education can improve glaucoma Medication Adherence. More rigorous studies grounded in Health Behavior Theory with adequately powered samples and longer follow-up are needed.
Susan K Frazier - One of the best experts on this subject based on the ideXlab platform.
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Medication Adherence social support and event free survival in patients with heart failure
Health Psychology, 2013Co-Authors: Susan K Frazier, Terry A. Lennie, Misook L Chung, Mary Kay Rayens, Debra K. MoserAbstract:Objectives: Medication Adherence and perceived social support (PSS) are independent predictors of mortality in patients with heart failure (HF). However, the predictive power of the combination of Medication Adherence and PSS for hospitalization and death has not been investigated in patients with HF. The purpose of the study was to explore the combined influence of Medication Adherence and PSS for prediction of cardiac event-free survival in patients with HF. Method: A total of 218 HF patients monitored Medication Adherence for 1–3 months and completed the Multidimensional Perceived Social Support Scale (MPSSS) at baseline. Medication Adherence was measured using a valid and objective measure, the Medication Event Monitoring System (MEMS). Patients were followed for up to 3.5 years to collect data about cardiac event-free survival (i.e., cardiac emergency department visits, hospitalizations, and death). To test the association of the combination of Medication Adherence and PSS with outcomes, the interaction term of Medication Adherence and PSS was first entered in a Cox regression to predict outcomes. Second, patients were grouped using an evidence-based cutpoint of 88% for Medication Adherence from the MEMS data and a median score 71 of the MPSSS. Kaplan-Meier and Cox proportional hazards models were used to compare cardiac event-free survival among groups. Result: Medication Adherence and PSS were independent predictors of cardiac event-free survival (p .006 and .021, respectively). Patients with Medication nonAdherence and lower PSS had a 3.5 times higher risk of cardiac events than those who were adherent and had higher PSS. Conclusion: Medication Adherence mediated the relationship between PSS and cardiac event-free survival in this sample. Moreover, Medication Adherence and social support independently, and in combination, predicted cardiac event-free survival in patients with HF. Interventions to improve clinical outcomes should address Medication Adherence and social support.
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Medication Adherence mediates the relationship between marital status and cardiac event free survival in patients with heart failure
Heart & Lung, 2012Co-Authors: Terry A. Lennie, Rebecca L. Dekker, Martha J. Biddle, Susan K Frazier, Misook L Chung, Debra K. MoserAbstract:Abstract Objective Prognosis is worse in unmarried patients compared with married patients with heart failure (HF). The reasons for differences in outcomes are unclear, but variations in Medication Adherence may play a role, because Medication Adherence is essential to achieving better outcomes. The study objective was to determine whether Medication Adherence mediated the relationship between marital status and cardiac event-free survival in patients with HF. Methods Demographic, clinical, and psychosocial data were collected by questionnaires and medical record review for 136 patients with HF (aged 61 ± 11 years, 70% were male, 60% were in New York Heart Association class III/IV). Medication Adherence was monitored objectively for 3 months using the Medication Event Monitoring System. Cardiac event-free survival data were obtained by patient/family interview, hospital database, and death certificate review. A series of regression and Cox survival analyses were performed to determine whether Medication Adherence mediated the relationship between marital status and event-free survival. Results Cardiac event-free survival was worse in unmarried patients than in married patients. Unmarried patients were more likely to be nonadherent and 2 times more likely to experience an event than married patients (P = .017). Marital status was not a significant predictor of event-free survival after entering Medication Adherence in the model, demonstrating a mediation effect of Adherence on the relationship of marital status to survival. Conclusion Medication Adherence mediated the relationship between marital status and event-free survival. It is important to design interventions to increase Medication Adherence that take into account subgroups, such as unmarried patients, who are at higher risk for nonAdherence.
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Medication Adherence is a mediator of the relationship between ethnicity and event free survival in patients with heart failure
Journal of Cardiac Failure, 2008Co-Authors: Terry A. Lennie, Susan K Frazier, Seongkum Heo, Misook L Chung, Marla J De Jong, Debra K. MoserAbstract:Abstract Background Rehospitalization rates are higher in African American than Caucasian patients with heart failure (HF). The reasons for the disparity in outcomes between African Americans and Caucasians may relate to differences in Medication Adherence. To determine whether Medication Adherence is a mediator of the relationship between ethnicity and event-free survival in patients with HF. Methods and Results Medication Adherence was monitored longitudinally in 135 HF patients using the Medication Event Monitoring System. Events (emergency department visits for HF exacerbation, HF and cardiac rehospitalization, and all-cause mortality) were obtained by interview and hospital data base review. A series of regression models and survival analyses was conducted to determine whether Medication Adherence mediated the relationship between ethnicity and event-free survival. Event-free survival was significantly worse in African Americans than Caucasians. Ethnicity was a predictor of Medication Adherence ( P = .011). African Americans were 2.57 times more likely to experience an event than Caucasians ( P = .026). Ethnicity was not a predictor of event-free survival after entering Medication Adherence in the model ( P = .06). Conclusions Medication Adherence was a mediator of the relationship between ethnicity and event-free survival in this sample. Interventions designed to reduce barriers to Medication Adherence may decrease the disparity in outcomes.
Maja Grubisic - One of the best experts on this subject based on the ideXlab platform.
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impact of interventions on Medication Adherence and blood pressure control in patients with essential hypertension a systematic review by the ispor Medication Adherence and persistence special interest group
Value in Health, 2013Co-Authors: Elizabeth Manias, Dyfrig A Hughes, M. Salas, Femida Gwadrysridhar, Lincy Lal, Alexandria Ratzkileewing, Maja GrubisicAbstract:Abstract Objectives To systematically review the evidence on the impact of interventions to improve Medication Adherence in adults prescribed antihypertensive Medications. Methods An electronic search was undertaken of articles published between 1979 and 2009, without language restriction, that focused on interventions to improve antihypertensive Medication Adherence among patients (≥18 years) with essential hypertension. Studies must have measured Adherence as an outcome of the intervention. We followed standard guidelines for the conduct and reporting of the review and conducted a narrative synthesis of reported data. Results Ninety-seven articles were identified for inclusion; 35 (35 of 97, 36.1%) examined interventions to directly improve Medication Adherence, and the majority (58 of 97, 59.8%) were randomized controlled trials. Thirty-four (34 of 97, 35.1%) studies reported a statistically significant improvement in Medication Adherence. Discussion/Conclusions Interventions aimed at improving patients' knowledge of Medications possess the greatest potential clinical value in improving Adherence with antihypertensive therapy. However, we identified several limitations of these studies, and advise future researchers to focus on using validated Adherence measures, well-designed randomized controlled trials with relevant Adherence and clinical outcomes, and guidelines on the appropriate design and analysis of Adherence research.