Factors Associated with Medication Adherence in Patients with Pulmonary Artery Hypertension and Chronic Thromboembolic Pulmonary Hypertension
Keywords:
Medication adherence, Pulmonary hypertension, Pulmonary artery hypertension (PAH), Chronic thromboembolic pulmonary hypertension (CTEPH)Abstract
Medication adherence is a crucial factor in improving treatment outcomes for patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). This correlational descriptive study aimed to investigate medication adherence and associated factors among patients with PAH and CTEPH, utilizing the World Health Organization framework. Data was collected from a questionnaire administered to 106 patients receiving treatment at a university hospital. Research instruments included questionnaires on demographic information, and disease and treatment; the Brief Illness Perception Questionnaire (Brief IPQ); the Beliefs about Medicines Questionnaire-Specific scale (BMQ-S); and the Medication Adherence Scale for Thais (MAST). All instruments underwent content validity and reliability testing prior to use. Data was analyzed using descriptive statistics and logistic regression.
The results revealed that the medication adherence rate was good (88.7%). Factors significantly associated with medication adherence included female gender (OR 4.45, 95% CI 1.23-16.14, p = .023), regular follow-up visits (OR 9.2, 95% CI 1.17-72.6, p = .035), and experiencing drug side effects (OR 0.05, 95% CI 0.01-0.23, p < .001). Multivariate analysis demonstrated that drug side effects were a significant predictor of medication adherence (Adj OR = 0.042, 95% CI 0.006-0.297, p = 0.001), with a prediction coefficient of 0.408.
This research has shown the significance of educating patients about potential drug side effects and how to manage them. It is crucial to identify support systems that encourage patients, especially males, to maintain good medication adherence.
References
Albanell-Fernández, M., Mestre, M. M., López, B., González-García, R., Planas, J., Serrano, M., Wilhelmi, E., Lizondo, T., Soy, D., & Martín-Conde, M. (2024). ‘Treatment patterns and factors associated with adherence in pulmonary arterial hypertension’. Farmacia Hospitalaria, S1130-6343(24)00055-2. https://doi.org/10.1016/j.farma.2024.04.005
Correale, M., Ferraretti, A., Monaco, I., Grazioli, D., Di Biase, M., & Brunetti, N. D. (2018). Endothelin-receptor antagonists in the management of pulmonary arterial hypertension: Where do we stand? Vascular Health and Risk Management, 14, 253–264. https://doi.org/10.2147/VHRM.S133921
Cutler, R. L., Fernandez-Llimos, F., Frommer, M., Benrimoj, C., & Garcia-Cardenas, V. (2018). Economic impact of medication non-adherence by disease groups: A systematic review. BMJ Open, 8(1), e016982. https://doi.org/10.1136/bmjopen-2017-016982
Fernandez-Lazaro, C. I., García-González, J. M., Adams, D. P., Fernandez-Lazaro, D., Mielgo-Ayuso, J., Caballero-Garcia, A., Moreno Racionero, F., Córdova, A., & Miron-Canelo, J. A. (2019). Adherence to treatment and related factors among patients with chronic conditions in primary care: A cross-sectional study. BMC Family Practice, 20(1), 132. https://doi.org/10.1186/s12875-019-1019-3
Galiè, N., Müller, K., Scalise, A. V., & Grünig, E. (2015). Patent plus: A blinded, randomised and extension study of riociguat plus sildenafil in pulmonary arterial hypertension. European Respiratory Journal, 45(5), 1314–1322. https://doi.org/10.1183/09031936.00105914
Grady, D., Weiss, M., Hernandez-Sanchez, J., & Pepke-Zaba, J. (2018). Medication and patient factors associated with adherence to pulmonary hypertension targeted therapies. Pulmonary Circulation, 8(1), 2045893217743616. https://doi.org/10.1177/2045893217743616
Hosmer, D. W., & Lemeshow, S. (2000). Model-building strategies and methods for logistic regression. In applied logistic regression (2nd ed., pp. 91–142). John Wiley & Sons. https://doi.org/10.1002/0471722146.ch4
Humbert, M., Kovacs, G., Hoeper, M. M., Badagliacca, R., Berger, R. M. F., Brida, M., Carlsen, J., Coats, A. J. S., Escribano-Subias, P., Ferrari, P., Ferreira, D. S., Ghofrani, H. A., Giannakoulas, G., Kiely, D. G., Mayer, E., Meszaros, G., Nagavci, B., Olsson, K. M., Pepke-Zaba, J., … ESC/ERS Scientific Document Group. (2022). 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: Developed by the task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). Endorsed by the International Society for Heart and Lung Transplantation (ISHLT) and the European Reference Network on rare respiratory diseases (ERN-LUNG). European Heart Journal, 43(38), 3618–3731. https://doi.org/10.1093/eurheartj/ehac237
Ivarsson, B., Hesselstrand, R., Rådegran, G., & Kjellström, B. (2018). Adherence and medication belief in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension: A nationwide population-based cohort survey. The Clinical Respiratory Journal, 12(6), 2029–2035. https://doi.org/10.1111/crj.12770
Ivarsson, B., Rådegran, G., Hesselstrand, R., & Kjellström, B. (2017). Information, social support and coping in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension-A nationwide population-based study. Patient Education and Counseling, 100(5), 936–942. https://doi.org/10.1016/j.pec.2016.12.021
Jongwilaikasem, K., & Lerkiatbundit, S. (2021). Development of the medication adherence scale for Thais (MAST). Thai Journal of Pharmaceutical Sciences, 13(1), 17-30. https://he01.tci-thaijo.org/index.php/TJPP/article/view/201434/166265 (in Thai)
Khamrag, C., Wattanakitkrilert, D., Charoenkitkarn, V., & Dejsomritrutai, W. (2016). Influences of perceived medication necessity, medication concern, side effects, and treatment-time on inhaled corticosteroids adherence in adult patients with asthma. Journal of Nursing Science, 34(Suppl. 1), 73-82. https://he02.tci-thaijo.org/index.php/ns/article/view/69313/56353 (in Thai)
Kjellström, B., Sandqvist, A., Hjalmarsson, C., Nisell, M., Näsman, P., & Ivarsson, B. (2020). Adherence to disease-specific drug treatment among patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. ERJ Open Research, 6(4), 00299–02020. https://doi.org/10.1183/23120541.00299-2020
Kolte, D., Lakshmanan, S., Jankowich, M. D., Brittain, E. L., Maron, B. A., & Choudhary, G. (2018). Mild pulmonary hypertension is associated with increased mortality: A systematic review and meta-analysis. Journal of the American Heart Association, 7(18), e009729. https://doi.org/10.1161/JAHA.118.009729
Leber, L., Beaudet, A., & Muller, A. (2021). Epidemiology of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: Identification of the most accurate estimates from a systematic literature review. Pulmonary Circulation, 11(1), 2045894020977300. https://doi.org/10.1177/2045894020977300
Le Bozec, A., Korb-Savoldelli, V., Sitbon, O., Boiteau, C., Montani, D., Jaïs, X., Guignabert, C., Humbert, M., Savale, L., & Chaumais, M. (2024). ‘Medication adherence and related factors among patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension: A systematic review and meta-analysis’. Revue Des Maladies Respiratoires, 41(3), 197. https://doi.org/10.1016/j.rmr.2024.01.033
Qadus, S., Naser, A. Y., Ofori-Asenso, R., Ademi, Z., Awawdeh, S. A., & Liew, D. (2023). Adherence and discontinuation of disease-specific therapies for pulmonary arterial hypertension: A systematic review and meta-analysis. American Journal of Cardiovascular Drugs, 23(1), 19–33. https://doi.org/10.1007/s40256-022-00553-6
Robbins, E. W., Bradley, K. V., Baird, G. L., Badesch, D. B., Burger, C. D., Chybowski, A. M., De Marco, T., Hemnes, A., Lammi, M. R., Mathai, S. C., Mcconnell, J. W., Melendres-Groves, L., Raza, F., Runo, J. R., Sager, J. S., Shlobin, O. A., Thenappan, T., Zamanian, R. T., & Ventetuolo, C. E. (2023). Medication non-adherence and health-related outcomes in patients with pulmonary arterial hypertension: The pulmonary hypertension association registry (PHAR). A26. American Journal of Respiratory and Critical Care Medicine, 207, A1186. https://doi.org/10.1164/ajrccm-conference.2023.207.1_MeetingAbstracts.A1186
Shah, N. B., Mitchell, R. E., Proctor, S. T., Choi, L., DeClercq, J., Jolly, J. A., Hemnes, A. R., & Zuckerman, A. D. (2019). High rates of medication adherence in patients with pulmonary arterial hypertension: An integrated specialty pharmacy approach. PLOS ONE, 14(6), e0217798. https://doi.org/10.1371/journal.pone.0217798
Shi, Q., Wang, Z., Yang, N., Ma, Y., Chen, Y., Wei, H., & Yao, H. (2022). Sildenafil for adult Asian patients with pulmonary arterial hypertension: A systematic review and meta-analysis. Annals of Palliative Medicine, 11(1), 339–351. https://doi.org/10.21037/apm-21-3979
Studer, S., Hull, M., Pruett, J., Elliott, C., Tsang, Y., & Drake, W. (2020). Retrospective database analysis of treatment patterns among patients with pulmonary arterial hypertension. Pulmonary Therapy, 6(1), 79–92. https://doi.org/10.1007/s41030-019-00106-4
Thepphawan, P., Watthnakitkrileart, D., Pongthavornkamol, K., & Dumavibhat, C. (2011). Cognitive representation, emotional responses and hospitalization experience in predicting decision making for receiving treatment among patients with acute coronary syndrome. Nursing Science Journal of Thailand, 29(2), 111-119. (in Thai)
Tsai, C. Y., Shen, C. W., Lai, H. L., & Chen, C. Y. (2023). Adherence and treatment patterns of disease-specific drugs among patients with pulmonary arterial hypertension: A nationwide, new-user cohort study. Frontiers in Pharmacology, 13, 1030693. https://doi.org/10.3389/fphar.2022.1030693
World Health Organization. (2003). Adherence to long-term therapies: Evidence for action. World Health Organization. https://iris.who.int/handle/10665/42682
Yamane, T. (1967) Statistics: An introductory analysis (2nd ed.). Harper and Row.
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