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- Linkage between electronic prescribing data and pharmacy claims records to determine primary adherence: the case of antihypertensive therapy in the Lisbon and Tagus Valley Region, PortugalPublication . Coelho, AndréBackground: Hypertension (HT) is highly prevalent and a major risk factor for cardiovascular disease. Over 42% of Portuguese adults have HT. Even though the benefits of antihypertensive (AHT) drugs have been demonstrated, HT control remains inadequate. One major reason is that patients often fail to take their medications as prescribed. This paper aims to determine primary adherence to AHT therapy in newly diagnosed and treated hypertensive patients in Primary Health Care (PHC) units of Lisbon and Tagus Valley Health Region. Methods: This study reports data from a population-based, retrospective, cohort study from patients diagnosed with HT in PHC units of Lisbon and Tagus Valley Region from 1 January to 31 March 2011, with no prior use of AHT drugs. The primary adherence rate was expressed as the number of claims records/total number of prescriptions records. Data were collected from SIARS for each patient during a 2-year period. Results: Overall primary adherence rate was 58.5%, increasing with age. Rates were higher for men, living in the Lisbon Metropolitan Area and diagnosed with uncomplicated HT. Drugs acting on the renin-angiotensin system had the highest rates, increasing for fixed-dose combinations and diminishing with the increase of cost for the patient. Conclusions: Overall, almost 1 out of 2 prescribed AHT drugs were not dispensed. Until this study, little was known in Portugal about primary adherence. Our findings imply that the potential benefits of AHT therapy cannot be fully realized in this population.
- Avaliação da adesão à terapêutica em doentes com diabetes tipo 2 e hipertensão arterial: adesão à medicação nas doenças crónicasPublication . Rosu, Amalia; Coelho, André; Camacho, PedroObjetivos: Avaliação da adesão à terapêutica em doentes recém-diagnosticados com Diabetes Mellitus tipo 2 e Hipertensão Arterial, nos Cuidados de Saúde Primários na Região Lisboa Vale Tejo. Metodologia: Estudo observacional de coorte retrospetivo. População composta pelos doentes recém-diagnosticados com Diabetes Mellitus tipo 2 e Hipertensão Arterial, em início de tratamento. Os dados foram extraídos do Sistema de Informação da Administração Regional de Saúde de Lisboa Vale Tejo. A adesão à terapêutica foi avaliada nas suas três componentes: se os doentes iniciaram a terapêutica prescrita (iniciação); através do Medication Possession Ratio (MPR) durante o período de seguimento (implementação) e a descontinuação da medicação, que marca o fim do tratamento (descontinuação). Resultados: A taxa de iniciação foi de 84.2% nos doentes com ambas as doenças (98% para a terapêutica antidiabética oral e 84.6% para a terapêutica anti-hipertensiva). A taxa de implementação (MPR) para ambas as doenças foi de, apenas 3.4% (4.2% foram considerados aderentes com a terapêutica antidiabética oral e 8.5% para a terapêutica anti-hipertensiva). A taxa de descontinuação foi de 3.4% (5.5% para a terapêutica antidiabética oral e 13.2% para terapêutica anti-hipertensiva). A maioria dos doentes iniciam a toma da medicação após a prescrição, mas poucos têm uma implementação suficiente para que a adesão seja considerada boa. Poucos doentes descontinuaram a medicação. Conclusão: Os doentes tiveram uma maior taxa de implementação à terapêutica anti-hipertensiva, mas, por outro lado, foram mais persistentes à terapêutica antidiabética oral. O padrão da adesão à terapêutica parece ser influenciado pelo doente e pela própria doença.
- The role of illness perceptions on medication nonadherence among patients with hypertension: a multicenter study in IndonesiaPublication . Alfian, Sofa D.; Annisa, Nurul; Perwitasari, Dyah A.; Coelho, André; Abdulah, RizkyIntroduction: Nonadherence to antihypertensive medications is recognized as a significant cause of treatment failure. Therefore, identifying its underlying factors, particularly from the patient's perspective, is essential for developing tailored intervention strategies. The objective of this study was to evaluate the associations between different domains of illness perception and medication nonadherence among patients with hypertension in Indonesia. Patients and methods: A multicenter cross-sectional study was conducted among patients with hypertension aged 18 years old and older who were using antihypertensive medications in the last 3 months in the community health centers in the three cities in Indonesia. The different domains of illness perception (e.g., consequences, timeline, personal control, treatment control, identity, concerns, comprehension, and emotional response) and medication nonadherence were assessed using a validated Brief Illness Perceptions Questionnaire (BIPQ) and Medication Adherence Report Scale (MARS), respectively. A logistic regression analysis was conducted to evaluate the associations between the different domains of illness perception and medication nonadherence adjusting for confounders. The odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Results: A total of 440 participants were included, 41.8% reported nonadherence to antihypertensive medications. The majority of the participants were females (64.3%) and aged between 60 and 69 years old (39.5%). The treatment control (OR: 0.80, 95% confidence interval: 0.7-10.90), patient's comprehension of hypertension (OR: 0.89, 95% CI: 0.820-0.97), and patient's emotions (OR: 0.93, 95% CI: 0.88-0.99) were significantly associated with medication nonadherence. No significant associations were observed between the other domains of illness perception and medication nonadherence. Conclusion: Different dimensions of illness perception were associated with non-adherence to antihypertensive medications. Educational interventions should be developed based on patient's perception of their illness.