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

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

A community pharmacy-based cardiovascular risk screening service implemented in Iran

Background: Cardiovascular disease is a major health concern around the world. Objective: To assess the outcomes and feasibility of a pharmacy-based cardiovascular screening in an urban referral community pharmacy in Iran. Methods: A cross sectional study was conducted in a referral community pharmacy. Subjects aged between 30-75 years without previous diagnose of cardiovascular disease or diabetes were screened. Measurement of all major cardiovascular risk factors, exercise habits, medical conditions, medications, and family history were investigated. Framingham risk score was calculated and high risk individuals were given a clinical summary sheet signed by a clinical pharmacist and were encouraged to follow up with their physician. Subjects were contacted one month after the recruitment period and their adherence to the follow up recommendation was recorded. Results: Data from 287 participants were analyzed and 146 were referred due to at least one abnormal laboratory test. The results showed 26 patients with cardiovascular disease risk greater than 20%, 32 high systolic blood pressure, 22 high diastolic blood pressures, 50 high total cholesterol levels, 108 low HDL-C levels, and 22 abnormal blood glucose levels. Approximately half of the individuals who received a follow up recommendation had made an appointment with their physician. Overall, 15.9% of the individuals received medications and 15.9% received appropriate advice for risk factor modification. Moreover, 7.5% were under evaluation by a physician. Conclusion: A screening program in a community pharmacy has the potential to identify patients with elevated cardiovascular risk factor. A plan for increased patient adherence to follow up recommendations is required