Adherence to antidepressant medicines in people living with unipolar depression

Unipolar depression is a common mental disorder and is the leading cause of mental disability worldwide. Medication adherence is a complex process, particularly in people with unipolar depression. The signs and symptoms of depression can also contribute to non-adherence and it is a risk factor for non-adherence in other chronic conditions such as diabetes and HIV. The overall aim of the research presented in this thesis was to explore and examine issues pertaining to medication adherence in people with unipolar depression. To address the overall aim, the methods used in this research included a systematic review of published literature, semi-structured interviews with consumers, and a content validation study involving health care professionals. The ABC taxonomy which conceptualises adherence into three components—initiation, implementation, and discontinuation—was used as the framework for this research.«/p» «p style="text-align:justify"»The major outcome for this research was the development and content validation of a depression-specific medication adherence framework, based on the literature, qualitative findings, and experience of the research team. It was designed as a guide for health care professionals to better understand the adherence process from the consumer perspective and to inform tailored interventions to facilitate adherence. The framework acknowledges the different nature of potential factors influencing medication adherence at the specific phases of medication taking. Key considerations included individual perceptions, personal experience/s, and the influence of people around them. The findings also highlighted the need for valid measures to evaluate adherence across the three phases of adherence. A standout measure with strong reliability and validity was not apparent. Hence, a range of different subjective and objective measures is recommended to assess medication adherence across the different phases of medication taking. The overall findings of this thesis can be applied in everyday practice to enhance medication adherence in people with unipolar depressio

Prescribing Patterns and Drug Related Problems of Opioid Analgesics and Adjuvant Medications in Patients with End-stage Cancer Receiving Palliative Care Management at a Community Hospital

Objective: To determine prescribing pattern on opioids analgesics and adjuvant medications among patients with last-stage cancer receiving palliative care. Drug related problems (DRPs) and their causes, and factors potentially associated with the DRPs were also investigated. Methods: In this retrospective descriptive study, patients with end-stage cancer were selected. Data were collected from inpatient medical records, outpatient medical record and home visit record for 1 year. That were explored and evaluated drug related problem by The PCNE classifications v.7.0 then summarized and analyzed by descriptive statistics and Chi-square test at a significance level of P-value < 0.05. Results: There are 35 inpatients, the majority were male (21 cases or 60% of all patients) with an average age of 61.46 ± 14.98 years. The most diagnosed disease was liver cancer. DRPs during in hospitalization were found with an average of 1.17 DRPs per patient. The most common DRP the effect of drug treatment not optimal (39.02% of all DRPs). The majority cause of DRPs was Inappropriate drug according to guidelines/formulary. At out-patient visits, DRPs were found with an average of 1.30 DRPs per patient.In home visits, an average of 1.16 DRPs per patient was found with most common cause of the effect of drug treatment not optimal. Pain level was significantly associated with having DRP during hospitalization (P-value = 0.046). Conclusion: DRPs were found among patients with terminal cancer receiving palliative care. The findings emphasized optimal medication management with pharmacist involvement. To relieve DRPs, guidelines for opioid analgesics and adjuvant medications management should developed. Such improvement could lead to a rational drug use. Keywords: drug related problem, palliative care, end-stage cancer, analgesics, prescribing patter