Medication-related burden and its association with medication adherence among elderly tuberculosis patients in Guizhou, China: a cross-sectional study – ScienceOpen
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      Medication-related burden and its association with medication adherence among elderly tuberculosis patients in Guizhou, China: a cross-sectional study

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          Abstract

          Introduction

          Tuberculosis (TB) morbidity and mortality are significantly increasing in the elderly worldwide. Their optimal health outcomes are hampered by medication related burden (MRB) and poor treatment adherence. Understanding th e MRB status from patients’ perspectives and its association with adherence among elderly TB patients will help achieve the End TB targets. Thus, we aimed to identify the incidence of MRB and nonadherence among elderly TB patients in Guizhou, and determine their association.

          Methods

          A cross-sectional study was conducted in three prefectures with high TB notifications in Guizhou in 2022. The data were collected via face-to-face structured interviews. MRB was measured using the Living with Medicines Questionnaire version 3 (LMQ-3), which consists of eight domains. Nonadherence was assessed by treatment interruption, which was defined as any interruption lasting at least 1 day at any time within the last 3 months. A binary unconditional logistic regression model was used to determine the association between variables.

          Results

          Of the 405 elderly TB patients enrolled, 49.4% and 42.7% of the respondents perceived suffering from moderate and high MRB, respectively. The incidence of nonadherence among patients was 33.6%. Patients with higher scores in domain 2 (practical difficulties) [ OR adj = 1.19; 95% CI (1.11–1.28)] and domain 4 (side effects burden of prescribed medications) [ OR adj = 1.16; 95% CI (1.06–1.27)] were more likely to experience nonadherence. But, patients with higher scores in domain 8 (control/autonomy of medicine use) [ OR adj = 0.70; 95% CI (0.61, 0.81)] were more likely to occur adherence. Patients with a high education level [ OR adj = 0.29; 95% CI (0.08, 0.92)] had a decreased risk of nonadherence, but those with a living expense from a retirement salary [ OR adj = 2.55; 95% CI (1.16, 5.71)] had an increased risk of nonadherence.

          Discussion

          The incidence of MRB and medication nonadherence is high among elderly TB patients in Guizhou. The significant associations between the three domains of MRB and nonadherence highlight that measuring MRB in multiple dimensions using the LMQ-3 in elderly TB patients could assist clinicians in providing patient-centered care, and multifaceted interventions targeting the identified problems should be implemented to reduce MRB and nonadherence among elderly TB patients in Guizhou.

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          Most cited references40

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          Diagnosing Multicollinearity of Logistic Regression Model

          One of the key problems arises in binary logistic regression model is that explanatory variables being considered for the logistic regression model are highly correlated among themselves. Multicollinearity will cause unstable estimates and inaccurate variances that affects confidence intervals and hypothesis tests. Aim of this was to discuss some diagnostic measurements to detect multicollinearity namely tolerance, Variance Inflation Factor (VIF), condition index and variance proportions. The adapted diagnostics are illustrated with data based on a study of road accidents. Secondary data used from 2014 to 2016 in this study were acquired from the Traffic Police headquarters, Colombo in Sri Lanka. The response variable is accident severity that consists of two levels particularly grievous and non-grievous. Multicolinearity is identified by correlation matrix, tolerance and VIF values and confirmed by condition index and variance proportions. The range of solutions available for logistic regression such as increasing sample size, dropping one of the correlated variables and combining variables into an index. It is safely concluded that without increasing sample size, to omit one of the correlated variables can reduce multicollinearity considerably.
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            Tuberculosis in the Elderly.

            The tuberculosis (TB) epidemic is most prevalent in the elderly, and there is a progressive increase in the notification rate with age. Most cases of TB in the elderly are linked to the reactivation of lesions that have remained dormant. The awakening of these lesions is attributable to changes in the immune system related to senescence. The mortality rate from tuberculosis remains higher in elderly patients. Symptoms of active TB are nonspecific and less pronounced in the elderly. Diagnostic difficulties in the elderly are common in many diseases but it is important to use all possible techniques to make a microbiological diagnosis. Recognising frailty to prevent loss of independence is a major challenge in dealing with the therapeutic aspects of elderly patients. Several studies report contrasting data about poorer tolerance of TB drugs in this population. Adherence to antituberculosis treatment is a fundamental issue for the outcome of treatment. Decreased completeness of treatment was shown in older people as well as a higher risk of treatment failure.
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              The relationship between social support, treatment interruption and treatment outcome in patients with multidrug-resistant tuberculosis in China: a mixed-methods study.

              Multidrug-resistant tuberculosis (MDR-TB) has been a major threat for successful TB control. We examined the relationship between social support and treatment outcomes in MDR-TB patients and evaluated barriers to social support.
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                Author and article information

                Contributors
                URI : https://loop.frontiersin.org/people/2713312/overviewRole: Role: Role: Role: Role: Role: Role:
                URI : https://loop.frontiersin.org/people/2712405/overviewRole: Role: Role: Role: Role:
                Role: Role: Role:
                Role: Role: Role:
                Role: Role: Role:
                Role: Role: Role:
                Journal
                Front Pharmacol
                Front Pharmacol
                Front. Pharmacol.
                Frontiers in Pharmacology
                Frontiers Media S.A.
                1663-9812
                29 August 2024
                2024
                : 15
                : 1416005
                Affiliations
                [1] 1 Key Laboratory of Environmental Pollution Monitoring and Disease Control , Ministry of Education , School of Public Health , Guizhou Medical University , Guiyang, China
                [2] 2 Department of Tuberculosis , Guiyang Public Health Clinical Center , Guiyang, China
                [3] 3 Institute of Health Promotion and Education , Guizhou Center for Disease Prevention and Control , Guiyang, China
                [4] 4 School of Medicine and Health Management , Guizhou Medical University , Guiyang, China
                Author notes

                Edited by: Bernd Rosenkranz, Fundisa African Academy of Medicines Development, South Africa

                Reviewed by: Deepak Kumar Bandari, Charles University, Czechia

                Rohan Benecke, University of Stellenbosch, South Africa

                *Correspondence: Yun Wang, 441334899@ 123456qq.com
                [ † ]

                These authors have contributed equally to this work and share first authorship

                Article
                1416005
                10.3389/fphar.2024.1416005
                11391241
                39268464
                d397f6bc-1778-466f-9849-90d35b182c9a
                Copyright © 2024 Wang, Jian, Huang, Chen, Hu and Fang.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 11 April 2024
                : 19 August 2024
                Funding
                The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported by the National Natural Science Foundation of China (grant number 82360659 and 81860591), the Guizhou Provincial Science and Technology Projects [grant number ZK (2022)-386 general project] and the Doctor Initiation Fund of Guizhou Medical University [grant number (2020) 070]. The funding body had no role in the design of the study; collection, analysis and interpretation of the data or in the writing of the manuscript.
                Categories
                Pharmacology
                Original Research
                Custom metadata
                Drugs Outcomes Research and Policies

                Pharmacology & Pharmaceutical medicine
                tuberculosis,medication-related burden,medication adherence,elderly,lmq-3

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