• Korean Journal of Family Medicine
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• v.39 no.6
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• pp.325-332
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• 2018

Background: Hypertension is a major contributor to the global disease burden of cardiovascular and cerebrovascular disease. The aim of this study was to determine demographic and clinical factors associated with adherence to antihypertensive medication. Methods: From August 2012 to February 2015, we recruited 1,523 Korean patients with hypertension who visited family physicians. The study was conducted in 24 facilities located in urban and metropolitan areas. Of these facilities, two were primary care clinics and 22 were level 2 or 3 hospitals. Adherence was assessed using the pill count method; a cut-off value of 80% was used as the criterion for good adherence. Sociodemographic and lifestyle factors were compared between the adherent and nonadherent groups using the chi-square test for categorical variables and t-test for continuous variables. Binary logistic regression analysis was performed with medication adherence as the outcome variable. Results: Of the 1,523 patients, 1,245 (81.7%) showed good adherence to antihypertensive medication. In the multivariate logistic analysis, age ${\geq}65$ years, exercise, treatment in a metropolitan-located hospital, being on ${\geq}2$ classes of antihypertensive medication and concomitant medication for diabetes, and a family history of hypertension or cardiovascular diseases were associated with good adherence. Patients who had a habit of high salt intake were less adherent to medication. Conclusion: Multiple classes of antihypertensive medications, concomitant medication, and exercise were associated with good adherence to antihypertensive medication, and high salt intake was associated with poor adherence to antihypertensive medication. These factors should be considered to improve hypertension control.

• Health Policy and Management
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• v.31 no.3
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• pp.292-300
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• 2021

Background: Medication adherence in hypertension is the most important to control blood pressure and prevent major complications. The purpose of this study was to identify factors affecting medication adherence and to examine the relationship between medication adherence and blood pressure control in Korea. Methods: This study used data from the 7th Korea national health and nutrition examination survey (2016-2018) of the Korea Disease Control and Prevention Agency. We selected 4,063 hypertensive patients from the data. And we choose socio-demographic, health behavior, healthcare utilization, and severity characteristics as hypertensive patient characteristics. Results: Of the patients with hypertension, 92.3% had shown adherence to medication as of 2016-2018 and shows variation according to the characteristic of patients. The cases with male, under 50 years old, urban area, single household, unmet medical services, less than 5 years of hypertension duration, no comorbidities (diabetes mellitus, myocardial infarction) showed significantly low medication adherence. After adjusting for confounders, adherent patients tended to have lower current systolic blood pressure (β=-10.846, p<0.001) and diastolic blood pressure (β=-5.018, p<0.001) than nonadherent patients. And, adherent patients increased the control odds of blood pressure compared with nonadherent patients (odds ratio, 3.02; 95% confidence interval, 2.21-4.12). Conclusion: This study confirmed that adherence to antihypertensive drugs was effective in controlling blood pressure. In order to more actively manage hypertensive patients at the national level, it is necessary to make an effort to improve the medication compliance of nonadherent groups, such as early-diagnosis patients, young patients under 50 years of age, and patients living alone.

• Journal of Korean Biological Nursing Science
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• v.14 no.3
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• pp.193-202
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• 2012

Purpose: The purpose of this study was to explore socio-demographic, clinical and psychological factors associated with medication adherence among patients with chronic heart failure (CHF). Methods: In a cross-sectional survey, 133 patients with CHF who had visited a clinic located in Seoul participated. Medication adherence (MA) was measured using a single item visual analogue rating scale (VAS). Barriers and attitudes toward adherence, and depression were measured using a structured questionnaire. Medical records were reviewed to identify their clinical characteristics. Multivariate logistic regression was performed identify factors affecting medication adherence. Results: About one third of participants (31.1%) reported their MA as 100%. Overall attitudes on MA were highly positive and 49 (36.8%) of participants were depressive. MA was associated with significantly barriers (p<.001), attitudes (p<.001), age (p<.001), and duration of disease (p<.001). The high adherent group had significantly less barriers than other groups (OR=.389, p=0.02). Conclusion: This study indicates that barriers and attitudes toward MA were the most important factors affecting their adherence to HF medication. To improve MA for patient with CHF, the nursing strategies which can lead poor adherent patients to their optimal level should be developed.

• Journal of Korean Biological Nursing Science
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• v.14 no.1
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• pp.66-75
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• 2012

Purpose: This study was conducted to measure medication adherence and perceptions of anticoagulation therapy and its relationship to patients taking warfarin. Methods: in a cross-sectional survey, 150 patients taking warfarin who had visited an outpatient clinic of a cardiovascular center in Seoul were included as research subjects. Medication adherence was measured using a visual analogue rating scale (VAS). Barriers and attitudes toward adherence, and oral anticoagulation knowledge, were measured using a structured questionnaire. Participants' medical records also were reviewed to identify clinical characteristics. Results: About one third of the participants (30.7%) reported medication adherence as 100%. The major barriers to adherence were identified as "Forgetting the time of medication" and "Not carrying their medication". Overall attitudes toward medication adherence were high, but oral anticoagulation therapy knowledge was low. To determine the relationship of medication adherence and perceptions of anticoagulation therapy, participants were stratified into three groups, based on their medication adherence levels (high adherence, moderate adherence, low adherence). Participants in the high adherent group more likely to be older (OR: 1.04, 95% CI: 1.005-1.071) and to have positive attitudes toward medication adherence (OR: 1.12, 95% CI:1.013-1.229) compared to the other two groups. Conclusion: The results show that age and attitude exerts significant influence on medication adherence in patients taking warfarin.

• Korean Journal of Clinical Pharmacy
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• v.23 no.3
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• pp.197-205
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• 2013

Background: Many factors including drugs, dietary supplements, and food intake can affect the development and organ formation of fetuses. Because of this, subject tends to avoid consuming things like coffee, alcohol, or cigarettes due to the risks they pose during pregnancy. Therefore, analysis of drugs and favorite food consumption is needed and important to ensure safe health management for subject. Purpose: This study was conducted domestically to analyze these factors in South Korea. Method: The survey was conducted from pregnancy-related online communities for six days and the survey results were received via email for analysis. Result: A total of 127 subjects answered the questionnaire via email; the characteristics of subjects are widely varied in their ages, education levels, job statuses, and residences. The questionnaire included the intake of dietary supplements during pregnancy including vitamins and the result showed that the subjects took 2.23 different kinds of supplements on average. In order of highest frequency, 101 subjects took multivitamins; 79 subjects took an iron supplement; 30 subjects took analgesics; 20 subjects took prescribed antipyretic and medication for upper respiratory diseases; 12 subjects took antibiotics; 7 subjects took antiemetics. Their compliances were different in each medication categories. Only 8% of subjects answered that they had asked a pharmacist for medication information during pregnancy. In addition, 78% of subjects answered that they never counseled with anyone about pregnancy related medication use. Conclusion: In conclusion, many subjects took medication including dietary supplements. The role of pharmacists should be actively developed to improve subject care such as education about subject's medication uses and their food consumption behavior.

• Journal of Korean Academy of Nursing
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• v.44 no.4
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• pp.407-417
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• 2014

Purpose: The purpose of this study was to explore the subjective experience of Highly active Antiretroviral therapy (HAART) adherence in Korean patients with HIV. Methods: A phenomenological methodology was used for the study. Data were collected from March to December, 2013 using open-ended questions during in-depth interviews. Participants were taking HAART for HIV, and were contacted through purposive techniques. Results: Four men and 4 women whose average treatment period was 5.9 years participated in this study. Seven themes emerged from the analysis using Colazzi's method: (a) Seizing life in a deep sense of despair, (b) Struggling with medication, (c) Facing harsh treatment from health care providers, (d) Spoiling healthy pattern, (e) Hungering for communication and emotional support, (f) Turning to accepting HIV, (g) Becoming adherent to HIV treatment. Conclusion: Prejudice from health care providers and lack of emotional support were barriers to HAART in Korea. Intervention strategies are needed to decrease prejudices from health care providers and to increase family support.

• Journal of agricultural medicine and community health
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• v.40 no.1
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• pp.9-20
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• 2015

Objectives: This study aimed to explore the persistence and adherence to secondary preventive medication of stroke patients after discharge and to assess the reasons for persistence and nonadherence. Methods: Four hundred twenty-nine patients with stroke were surveyed to determine their behaviors from discharge. Reasons for stopping medications were ascertained. Persistence was defined as continuation of all secondary preventive medications prescribed at hospital discharge, and adherence as continuation of prescribed medications according to health care provider instructions. Results: Of the 429 patients, 86.5% were treatment persistent and 41.2%(non-intentional nonadherence=39.4%, intentional nonadherence=19.4%) were adherent. Independent predictors of persistence included having experience about health education. Independent predictors of non-intentional nonadherence were modified Rankin Scale(mRS) (Exp(B)=2.858, p=0.001) and health education experience (Exp(B)=0.472, p=0.032), and independent predictors of intentional nonadherence were mRS (Exp(B)=2.533, p=0.006), depressive symptoms (Exp(B)=1.113, p=0.016), beliefs about medications questionnaire(necessity, Exp(B)=0.879, p=0.011, concern, Exp(B)=1.098, p=0.019). Conclusions: Although up to one-ninth of stroke patients continued secondary prevention medications, nonadherence is common. Several potentially modifiable patient, provider, and system-level factors associated with persistence and adherence may be targets for future interventions. Specially, interventions to improve adherence should target patients' beliefs about their medication.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.21 no.3
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• pp.174-181
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• 2010

Objectives: To identify the factors affecting long-term adherence to methylphenidate treatment in children with attention-deficit hyperactivity disorder (ADHD). Methods: A retrospective medical record review of 239 ADHD patients (mean age $9.3{\pm}2.6$ years, range 6.0-17.4 years) who had visited the child and adolescent psychiatry clinic at a university hospital, in Seoul, Korea from March 2005 to February 2008. Subjects were diagnosed as ADHD based on the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision version (DSM-IV-TR) and underwent neuropsychological tests including the continuous performance test (CPT). Treatment discontinuation was defined as the last prescription date when the medication possession rate (MPR) became less than 0.80. Subjects were divided into three groups and labeled as Group I, non-adherence without pharmacotherapy, Group II, non-adherence with short-term pharmacotherapy, and Group III, adherence with long-term pharmacotherapy. Results: Ninety (37.7%) patients were grouped as non-adherent (Groups I+II) and 149 (62.3%) as adherent (Group III). The adherence group exhibited lower intelligence, higher symptom severity, and a higher number of comorbid psychiatric disorders than controls. The use of stimulants was significantly associated with long-term adherence to treatment. Additionally, the duration of interval between the date of the first visit and the date of the first prescription was positively associated with long-term adherence. Conclusion: About two-thirds of patients diagnosed as ADHD adhered to the treatment six months after the first visit. With respect to patient evaluation and the development of treatment strategies, factors affecting early drop-out and longer follow-up must be considered.

• Journal of Chest Surgery
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• v.19 no.2
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• pp.225-231
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• 1986

Pericardial adhesions following open heart surgery pose a special problems, increasing the risk of cardiac reoperation because of the danger of damaging the heart, coronary artery and veins, or grafts and also the fibrous tissue may obliterate the pericardial space and eventually constrict the heart. This study was undertaken to evaluate the effect of intrapericardial urokinase and dextran 40 on the formation of pericardial adhesions in an animal model. latrogenic traumas on the pericardium were surgically induced in 30 rabbits, simulating injuries possible during actual surgery. In all rabbits, blood [1 ml] was obtained from an ear vessel and injected into the pericardium. Control group of ten rabbits did not receive any further medication, urokinase group of ten received 15, 000-20, 000 IU of urokinase, and remained ten received 1 ml of 10% dextran 40. All rabbits were sacrificed at 4 weeks. At autopsy, the development of adhesions were graded as none [Grade I], minimal [Grade II], moderate [Grade III], and severe [Grade IV]. Histological studies of the parietal pericardium and epicardium were performed. The results were as follows: 1. Group 1[Control group] showed minimal adhesion in 40%, moderate in 50%, and severe in 10% of the group. Sharp dissections were necessary in 60% of adhesions. 2. Group II [Dextran group] showed no adhesions in 20%, minimal in 60%, and moderate in 20% of the group. 3. Group III [Urokinase group] showed no adhesions in 40%, minimal in 40%, and moderate in 20% of the group. Considering in this group, the adhesion activity was significantly suppressed [60% adhesions] compared to the control group [100% adhesions] [P < 0.05]. 4. Histological findings revealed mild serosal fibrosis in none adherent group, loose fibrous connections between two layers of pericardium in minimal adhesion group, tight fibrous connections in moderate adhesion group, and marked fibrous thickening and close attachment of two surfaces were noted in severe adhesion group. These data have revealed the decreased incidence of pericardial adhesions with urokinase and dextran 40.