A systematic review of adherence to diabetes and cardiovascular medications in Iran: A call for patient education and reinforcement

Adherence to medications (AM) has been a major research priority for recent decades. Numerous factors including poor access to medicines have been identified to affect AM particularly in middle income countries (MIC). However, access to medicines seems to be addressed well in Iran as a MIC but little is known about the rate and the determinants of AM for Iranian patients. In the present study, we systematically reviewed the AM literature related to Iranian patients with diabetes (DM) and cardiovascular diseases (CVD). Methods We searched biomedical databases including Scopus, Web of Science, PubMed, CINAHL, and Google Scholar, Scientific Information Database, and IranMedex from inception to July 2012. Two independent researchers screened all abstracts. Studies were included if they reported rate of adherence to CVD or DM medications in Iran. We also included studies which had focused on AM determinants or AM improving interventions. Two teams of researchers reviewed full-texts of the relevant articles for quality appraisal and data extraction. We preferred qualitative synthesis of literature as the AM definitions and measurement tools were highly diverse among studies. Among 1003 citation, fourteen studies were eligible for review. Adherence rate for diabetic patients was 62.8-86.3% and for patients with CVD was 38.8-60.0%. Forgetfulness, lack of knowledge about medical condition and prescribed medications, and concerns about medications were consistently reported as barriers to AM. Patient education plus telephone or short message service follow-ups improved AM in diabetic patients. We found no high quality trials on AM improving interventions for patients with CVD. Non-adherence to medications may not be assured for accessible medicines in resource-limited settings. We strongly suggest for multidisciplinary policies and interventions on patient education and reinforcement strategies to address the issue of non-adherence to medications

Is 'self-medication' a useful term to retrieve related publications in the literature? A systematic exploration of related terms.

Self-Medication (SM), i.e. using medications to treat oneself, is a major concern for health researchers and policy makers. The terms "self medication" or "self-medication" (SM terms) have been used to explain various concepts while several terms have also been employed to define this practice. Hence, retrieving relevant publications would require exhaustive literature screening. So, we assessed the current situation of SM terms in the literature to improve the relevancy of search outcomes.In this Systematic exploration, SM terms were searched in the 6 following databases and publisher's portals till April 2012: Web of Science, Scopus, PubMed, Google scholar, ScienceDirect, and Wiley. A simple search query was used to include only publications with SM terms. We used Relative-Risk (RR) to estimate the probability of SM terms use in related compared to unrelated publications. Sensitivity and specificity of SM terms as keywords in search query were also calculated. Relevant terms to SM practice were extracted and their Likelihood Ratio positive and negative (LR+/-) were calculated to assess their effect on the probability of search outcomes relevancy in addition to previous search queries. We also evaluated the content of unrelated publications. All mentioned steps were performed in title (TI) and title or abstract (TIAB) of publications.1999 related and 1917 unrelated publications were found. SM terms RR was 4.5 in TI and 2.1 in TIAB. SM terms sensitivity and specificity respectively were 55.4% and 87.7% in TI and 84.0% and 59.5% in TIAB. "OTC" and "Over-The-Counter Medication", with LR+ 16.78 and 16.30 respectively, provided the most conclusive increase in the probability of the relevancy of publications. The most common unrelated SM themes were self-medication hypothesis, drug abuse and Zoopharmacognosy.Due to relatively low specificity or sensitivity of SM terms, relevant terms should be employed in search queries and clear definitions of SM applications should be applied to improve the relevancy of publications

Bibliographic Search of Publication Patterns in Rational Use of Drugs in Iran: A Systematic Approach

Inappropriate use of drugs is a widespread problem with serious consequences such as increased adverse drug reaction and antimicrobial resistance. Proper interventions would have important financial and public health benefits. Several studies have been performed about Rational Drug Use (RUD) in Iran. To provide a picture of researches were done about RUD and highlight the existing gaps in practice in Iran, a systematic search was conducted by reviewing all papers (English and Persian) found by searching keywords in Pubmed, Web of Science, Google Scholar, CINAHL, Proquest, International Pharmaceutical Abstract (IPA), SID, Iran Medex and MagIran. Retrieved articles were extracted in Access form and exported to Excel for further analysis. After excluding duplicate and irrelevant articles, 466 related articles were remained. Number of publications increased dramatically after 2001. About 73% of studies were cross-sectional. Evaluation of prescribing pattern (15%), self-medication (11.3%) and adverse drug reaction (9.1%) were among the top topics which were studied. Despite an increasing trend in RUD publications in Iran, still large gaps remain to be investigated. Knowing the existing gaps is crucial for policy makers to make investments to solve the problems

A comprehensive review of adherence to diabetes and cardiovascular medications in Iran; implications for practice and research

Treatment of diseases such as diabetes mellitus and cardiovascular disorders are highly dependent on medications and particularly adherence to medications to achieve optimal pharmacotherapy outcomes. Several factors can affect a patient's adherence including: knowledge and beliefs about their illness and medications, concomitant psychological disorders, type of therapeutic regimen, and lack of access to medicines. In Iran, a middle income country, essential medicines are highly available and affordable. However, adherence to medications has not been emphasized especially for patients with diabetes and cardiovascular diseases. In the present study, we reviewed the available literature on adherence to medications used to treat diabetes and cardiovascular disorders in Iran. We systematically searched Scopus, Web of Science, PubMed, CINAHL, Google Scholar, Scientific Information Database, and IranMedex using a highly sensitive protocol on July 2012. We retrieved 1003 citations; and two independent researchers screened them for relevant publications. Studies were included if they reported rate or determinants of adherence to diabetes mellitus and cardiovascular medications. Trials on improving interventions were also included. The quality of studies was assessed using appropriate guidelines. Fourteen studies were eligible for data extraction and review. The definition of adherence and the measurement tools used were unclear among studies. Methodological caveats including inappropriate sample size, sampling methods, inclusion/exclusion criteria, and high rate of loss to follow-up were also observed. Nevertheless, adherence rate was reported to be 62.8-86.3% for oral hypoglycemic medications and 38.8-60.0% for cardiovascular medicines. Forgetfulness, lack of knowledge about medical condition and prescribed medications, and concerns about medications efficacy and side effects were consistently reported as barriers to adherence. Patient education plus telephone or short message service follow-ups were reported to improve adherence to oral hypo-glycemic medications. We did not find any high quality trials on adherence to cardiovascular medicines. In conclusion, adherence to cardiovascular and diabetes medications is not assured in Iranian patients. Based on the available literature, patient education and reinforcement interventions are required to address this issue. Future studies should employ careful designs and standard tools for assessment of adherence to medications

A 3-Armed Randomized Controlled Trial of Nurses' Continuing Education Meetings on Adverse Drug Reactions

Introduction: Nurses' insufficient knowledge of adverse drug reactions is reported as a barrier to spontaneous reporting. Therefore, CE meetings could be utilized to enhance nurses' competencies. Methods: In a 3-armed randomized controlled trial, 496 nurses, working in a tertiary medical center, were randomly allocated to a didactic lecture, brainstorming workshop, or the control group (delayed education). Similar instructors (2 clinical pharmacists) prepared and delivered the educational content to all 3 groups. Outcomes were declarative/procedural knowledge (primary outcome), participation rate, and satisfaction. Knowledge was evaluated using a validated researcher-made questionnaire in 3 time points: immediately before, immediately after, and 3 months after each session. Participants' satisfaction was assessed immediately after each meeting via a standard tool. Data were analyzed using appropriate parametric and nonparametric tests. Results: Rate of participation was 37.7 for the lecture group and 47.5 for the workshop group. The workshop participants were significantly more satisfied in comparison with the lecture group (p <.05). Mean knowledge scores were similar at baseline in the 3 study groups (43-47). Immediately after the meeting, knowledge was significantly higher in the lecture group (79.1 ± 11.9 vs 73.7 ± 11.3; p =.01). At the follow-up, knowledge scores of the lecture and workshop groups were similar, while significantly higher than the control group. However, the reduction of knowledge score was significantly higher in the lecture group (-13.0 ± 15.9 vs -5.7 ± 15.1, p =.02). Discussion: Educational interventions can improve nurses' knowledge of adverse drug reactions. Short-term learning could be achieved with lecture, but the retention of knowledge will be enhanced by simple interactive techniques. © 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education