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Wendy Clyne,1 Sarah McLachlan2 1Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry, UK; 2Primary Care and Health Sciences, Keele University, Staffordshire, UK Objectives: We describe a key informant study that invited national medicines policy leads for the European Union member states to self-assess the level of implementation of medicines adherence initiatives in their country and the adequacy of that implementation. Interviews with medicines policy leads enabled in-depth understanding of the variation in adherence support across nations and the ways in which different nations prioritize, plan, and implement medicines adherence systems and services.Methods: Ten national policy leads (Bulgaria, Denmark, Estonia, Finland, Germany, Ireland, Latvia, Lithuania, Malta, and the Netherlands) completed a self-assessment survey, and seven (Estonia, Finland, Germany, Ireland, Lithuania, Malta, and the Netherlands) engaged in a follow-up interview.Key findings: Policy leads varied in the level of implementation of medication adherence solutions that they reported in their nations; most initiatives were aimed directly at patients with few initiatives at government or health care commissioner levels of action. Policy leads reported insufficient implementation of medication adherence initiatives across all potential domains. Barriers to implementation included lack of resources, strategic planning, evidence to support action, the "hidden" nature of medication adherence within policy work, and dispersed responsibility for medication adherence as a policy and practice theme.Conclusion: This study has international significance and summarizes the emergent characteristics of nations with and without coordinated medication adherence activity. We highlight the importance of sharing good practice in policy formulation and implementation for medication adherence. Keywords: medication adherence, policy implementation, medicines policy, health care policy

2005 Summer. ; Includes bibliographical references. ; One of the greatest challenges in managing the medication therapy in any chronic disease is how to influence human behavior, such as adherence to antiretroviral therapy in the Human Immune Virus (HIV) positive patient. Although data demonstrate significant viral suppression and immunologic benefits of therapy when taking antiretroviral medication at a 95% adherence, non-adherence remains a problem in the HIV or Acquired Immune Deficiency Syndrome (AIDS) population. Past literature indicates it may relate to the quality of information given, the impact of the regimen on daily life, the physical or the incapacity of patients, or their social isolation. This is a basic qualitative research study. The purpose of this study is to have a basic interpretive qualitative understanding of the nature of non-adherence to mediation in the HIV infected patient in a family practice setting. During interviewing, each participant had their own personal story about being HIV positive and why they adhere or do not adhere to their medication regimen. It appears that adherence to any highly active antiretroviral therapy (HAART) revolves around the well being and the understanding of lifelong commitment of the HIV patient. A hypothetical model has been constructed relating the Health Belief Model to HIV medication adherence as found in this study. The educational opportunities for the HIV infected person have improved over the past 10 years. Many private and government organizations provide training and learning materials and the healthcare providers are more aware of the needs of the HIV positive person. The lifestyles of HIV positive people are no different then the non-infected person. However, the side effects of the HAART have been shown to affect the adherence. Seeing HIV in a more positive light contributes to the well being of the infected person. Patients find it easier to cope with their disease if they see it as an opportunity for personal growth or can attach some other positive meaning to it. The outlook on HIV disease has gone from a death sentence to one of guarded optimism. It is viewed as a life long commitment.

Introduction:Chronic obstructive pulmonary disease (COPD) is a progressive, life-threatening disease of the lungs, gradually causes breathlessness and predisposes to exacerbations and serious illness. The main objectives of the study are to evaluate disease knowledge, medication adherence, and health-related quality of life among COPD patients. Methodology:A Hospital-based, single-entered prospective observational study was conducted at a government general hospital, Andhra Pradesh. India after ethical committee approval. This study was conducted for 6 months with a sample size of 80 patients. Results:According to our study, the majority of the patients 36 (45%) don't have disease knowledge, where a few numbers of patients 7 (8.75%) is having disease knowledge as per BCKQ score values. 11.25% of patients have the lowest MMAS scores whereas 58.75% were found to have higher MMAS scores and 37.5% of total patients have higher CAT scores, and 12.5% of patients have lower CAT scores. Conclusion:We found that majority of the patients have poor disease knowledge, lower adherence to medication regimens, and substandard HRQOL. Keywords: COPD knowledge, medication adherence, and HRQOL.

Background: From 2017, the Stroke Health Manager Training Project was carried out by the Chinese Government to strengthen health management and follow-up intervention after ischemic stroke. The aim of this study was to investigate whether after the intervention of the stroke health manager, the control of blood pressure, low-density lipoprotein cholesterol (LDL-C), glucose level, and the use of secondary prevention medications improved 3 months after discharge from our center following ischemic stroke. Methods: The study used a history-controlled approach. Patients who received stroke health manager intervention from May 1, 2018, to March 31, 2019, were considered as the intervention group; those from May 1, 2017, to April 30, 2018, were enrolled as the control group. Stroke health manager intervention included health education, discharge advice, online WeChat public group follow-up, and clinical consultation. Results: In total, 642 patients with ischemic stroke were enrolled in this study (277 in the control group, 365 in the intervention group). At 3 months, the blood pressure, LDL-C and glucose control in the intervention group were better than in the control group (all P < 0.05). At the same time, the overall persistence for secondary prevention medications at 3 months after discharge increased from 201/277 (72.56%) to 303/365 (83.01%, P = 0.001). The persistence for patients taking antiplatelet, hypoglycemic and statins were significantly higher in the intervention group (P < 0.05). Conclusions: Stroke health manager intervention improved the control of blood pressure, LDL-C, glucose levels and the persistence for secondary prevention medications 3 months after discharge.

Background: Kenya experienced a political and humanitarian crisis following presidential elections on 27 December 2007. Over 1,200 people were killed and 300,000 displaced, with disproportionate violence in western Kenya. We sought to describe the immediate impact of this conflict on return to clinic and medication adherence for HIV-infected children cared for within the USAID-Academic Model Providing Access to Healthcare (AMPATH) in western Kenya. Methods: We conducted a mixed methods analysis that included a retrospective cohort analysis, as well as key informant interviews with pediatric healthcare providers. Eligible patients were HIV-infected children, less than 14 years of age, seen in the AMPATH HIV clinic system between 26 October 2007 and 25 December 2007. We extracted demographic and clinical data, generating descriptive statistics for pre- and post-conflict antiretroviral therapy (ART) adherence and post-election return to clinic for this cohort. ART adherence was derived from caregiver-report of taking all ART doses in past 7 days. We used multivariable logistic regression to assess factors associated with not returning to clinic. Interview dialogue from was analyzed using constant comparison, progressive coding and triangulation. Results: Between 26 October 2007 and 25 December 2007, 2,585 HIV-infected children (including 1,642 on ART) were seen. During 26 December 2007 to 15 April 2008, 93% (N = 2,398) returned to care. At their first visit after the election, 95% of children on ART (N = 1,408) reported perfect ART adherence, a significant drop from 98% pre-election (p < 0.001). Children on ART were significantly more likely to return to clinic than those not on ART. Members of tribes targeted by violence and members of minority tribes were less likely to return. In qualitative analysis of 9 key informant interviews, prominent barriers to return to clinic and adherence included concerns for personal safety, shortages of resources, hanging priorities, and hopelessness. Conclusion: During a period of humanitarian crisis, the vulnerable, HIV-infected pediatric population had disruptions in clinical care and in medication adherence, putting children at risk for viral resistance and increased morbidity. However, unique program strengths may have minimized these disruptions.

Purpose. Examine the effectiveness of a community-based, multimedia intervention on medication adherence among hypertensive adults. Design. Randomized controlled trial. Setting. Rural south Alabama. Subjects. Low-income adults (N = 434) receiving medication at no charge from a public health department or a Federally Qualified Health Center. Intervention. Both interventions were home-based and delivered via computer by a community health advisor. The adherence promotion (AP) intervention focused on theoretical variables related to adherence (e.g., barriers, decisional balance, and role models). The cancer control condition received general cancer information. Measures. Adherence was assessed by pill count. Other adherence-related variables, including barriers, self-efficacy, depression, and sociodemographic variables, were collected via a telephone survey. Analysis. Chi-square analysis tested the hypothesis that a greater proportion of participants in the AP intervention are ≥80% adherent compared to the control group. General linear modeling examined adherence as a continuous variable. Results. Participants receiving the intervention did not differ from individuals in the control group (51% vs. 49% adherent, respectively; p = .67). Clinic type predicted adherence (p < .0001), as did forgetting to take medications (p = .01) and difficulty getting to the clinic to obtain medications (p < .001). Conclusions. Multilevel interventions that focus on individual behavior and community-level targets (e.g., how health care is accessed and delivered) may be needed to improve medication adherence among low-income rural residents.