Pharmacological Adherence Behavior Changes during COVID-19 Outbreak in a Portugal Patient Cohort
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Collection
2.2. Measures
- ■
- Sociodemographic: gender, age, marital status, and level of education.
- ■
- Health status: chronic diseases, medication, changes in self-perceived health status before and during the pandemic.
- ■
- Medication adherence: Medication Adherence Rating Scale (MARS-P9).
- ■
- COVID-19 impact on medication adherence: changes in self-perceived medication adherence before and during the pandemic, changes on medication adherence due to the pandemic and reasons.
- ■
- COVID-19 impact on adherence to healthy lifestyles: changes on adherence to a healthy diet and physical exercise.
- ■
- COVID-19 perceptions and impact on daily life: feeling nervous, anxious, or lonely during the pandemic; difficulties falling asleep; started taking prescribed medication for anxiety, depression, or sleep; have tested positive or knowing someone who has; and concerns about being infected.
2.3. Exposure Variable
2.4. Statistical Analysis
2.5. Ethics Approval
3. Results
3.1. Sample Characteristics
3.2. Impact of COVID-19 on Medication Adherence
3.3. Factors Associated with COVID-19 Related Adherence
3.3.1. Unilevel Analysis
3.3.2. Multilevel Analysis
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Item Category | Explanation | |
---|---|---|
Design | The study involved a convenience sample. Eligibility criteria included being 18 years of age or older and taking at least 1 prescribed medicine per day. | |
IRB | Approval: | The study has been approved by the Ethics Commission of the Faculty of Pharmacy of the University of Porto, Portugal. |
Informed consent: | Before completing the questionnaire, all participants provided electronic informed consent. | |
Data protection: | No information that allows for personal identification was collected. | |
Development and pre-testing | The survey was developed by a multidisciplinary team of adherence experts and pilot-testing was performed with a group of 5 individuals. | |
Recruitment process | Survey type: | The data was collected using an open survey. |
Contact mode: | Initial contact with participants was made on the Internet, through email or social media. | |
Advertising the survey: | A link was created and posted on social media platforms and disseminated through the general mailing list of the University of Porto, for students, alumni, teachers, and non-teaching staff | |
Survey administration | Web/E-mail: | The survey was input on an online survey platform—LimeSurvey. Data was entered automatically when participants responded to the questions. |
Context: | The survey was disseminated using the mailing lists of the University of Porto, and trough the official pages of the University of Porto. Also, it was posted on the social media pages of the University of Porto, and also on Porto4Ageing, the Competence Centro on Active and Healthy Ageing. | |
Mandatory/voluntary: | The survey was voluntary. | |
Incentives: | None. | |
Time/Date: | 1st March and 3rd April 2021 | |
Randomization of items or questionnaire: | N/A | |
Adaptive questioning: | Some questions only were displayed if certain answers were previously selected. | |
Number of items: | Maximum of 38 questions (adaptive questioning). | |
Number of screens: | 7 screens. | |
Completeness check: | All items were mandatory, and only one response could be chosen. | |
Review step: | Participants could go back, review or change their answers using a back button | |
Response rates | Unique site visitor: | N/A |
View rate: | N/A | |
Participation rate: | N/A | |
Completion rate: | N/A | |
Preventing multiple entries | Cookies used: | Not used |
IP check: | Not used | |
Log file analysis: | Not used | |
Registration: | N/A | |
Analysis | Handling of incomplete surveys: | Only completed surveys were analysed. |
Questionnaires submitted with an atypical timestamp: | N/A | |
Statistical correction: | N/A |
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Variables | Category | Frequency | % |
---|---|---|---|
Gender | Female | 372 | 78.2 |
Male | 104 | 21.8 | |
Age | 40.3 ± 17.9 years | ||
Marital status | Single | 250 | 52.5 |
Married | 175 | 36.8 | |
Divorced | 36 | 7.6 | |
Widowed | 15 | 3.2 | |
Education | High School | 129 | 27.1 |
Bachelor | 157 | 33.0 | |
Master or PhD | 190 | 39.9 | |
Type of chronic disease | Cardiovascular | 100 | 21.0 |
Pulmonary | 96 | 20.2 | |
Endocrine | 83 | 6.9 | |
Gastrointestinal | 27 | 5.7 | |
Joint, Muscle and Bone | 24 | 5.0 | |
Skin | 9 | 1.9 | |
Cancer | 11 | 0.9 | |
Kidney | 3 | 0.6 | |
Genetic | 3 | 0.6 | |
Pain | 2 | 0.4 | |
Infectious | 2 | 0.4 | |
Eye | 0 | 0.0 | |
Neurodegenerative | 0 | 0.0 | |
Psychological | 0 | 0.0 | |
Other | 3 | 0.6 | |
Number of chronic diseases | ≥2 | 153 | 32.1 |
<2 | 323 | 67.9 | |
Number of different medications taken per day | ≥5 | 50 | 10.5 |
<5 | 426 | 89.5 |
Reason | Frequency | % | |||
---|---|---|---|---|---|
COVID-19 Impacted Adherence | Yes 67 (14.1%) | Improved 39 (58.2%) | Awareness of health status | 23 | 59.0 |
Improve health status for fear of COVID-19 | 14 | 35.9 | |||
More time for personal care | 8 | 20.5 | |||
Feeling more able to take care of self | 6 | 15.4 | |||
Support from family, neighbours, or friends | 5 | 12.8 | |||
Declined 28 (41.8%) | Lack of support from family, neighbours, or friends | 11 | 39.3 | ||
Avoid taking the medications | 6 | 21.4 | |||
Fear of leaving home | 4 | 14.3 | |||
Feeling less able to take care of self | 2 | 7.1 | |||
Fear of going to the pharmacy | 1 | 3.6 | |||
Impossibility of moving by own means | 1 | 3.6 | |||
Afraid of secondary effects | 1 | 3.6 | |||
Economic reasons | 0 | 0.0 | |||
No 358 (75.2%) | |||||
Indifferent 51 (10.7%) |
n | n Low Adherers (%) | n High Adherers (%) | Unilevel Analysis | Multilevel Analysis | ||||||
---|---|---|---|---|---|---|---|---|---|---|
476 | 123 (25.8) | 353 (74.2) | OR | CI 95 | p | OR | CI 95 | p | ||
Sociodemographic | Gender | |||||||||
Female | 372 | 97 (78.9) | 275 (77.9) | 1 | - | - | - | - | - | |
Male | 104 | 26 (21.1) | 78 (22.1) | 0.945 | 0.572–1.561 | 0.825 | - | - | - | |
Age | ||||||||||
18–24 years | 152 | 39 (31.7) | 113 (32.0) | 1 | - | - | - | - | - | |
25–34 years | 57 | 11 (8.9) | 46 (13.0) | 1.443 | 0.679–3.067 | 0.339 | - | - | - | |
35–44 years | 65 | 14 (11.4) | 51 (14.4) | 1.257 | 0.627–2.522 | 0.518 | - | - | - | |
45–54 years | 78 | 23 (18.7) | 55 (15.6) | 0.825 | 0.449–1.518 | 0.536 | - | - | - | |
≥55 years | 124 | 36 (29.3) | 88 (24.9) | 0.844 | 0.495–1.438 | 0.531 | - | - | - | |
Marital Status | ||||||||||
Single | 250 | 62 (50.4) | 188 (53.3) | 1 | - | - | 1 | - | - | |
Married | 175 | 42 (34.1) | 133 (37.7) | 1.044 | 0.665–1.640 | 0.850 | 1.042 | 0.614–1.692 | 0.868 | |
Divorced | 36 | 11 (8.9) | 25 (7.1) | 0.750 | 0.348–1.614 | 0.460 | 0.719 | 0.317–1.633 | 0.430 | |
Widowed | 15 | 8 (6.5) | 7 (2.0) | 0.289 | 0.100–0.830 | 0.021 | 0.295 | 0.096–0.904 | 0.033 | |
Education | ||||||||||
Until High School | 129 | 32 (26.0) | 97 (27.5) | 1 | - | - | - | - | - | |
Degree | 157 | 51 (41.5) | 106 (30.0) | 0.686 | 0.407–1.156 | 0.156 | - | - | - | |
Master or PhD | 190 | 40 (32.5) | 150 (42.5) | 1.237 | 0.727–2.105 | 0.432 | - | - | - | |
Health status | Number of chronic diseases | |||||||||
≥2 | 153 | 52 (42.3) | 101 (28.6) | 1 | - | - | 1 | - | - | |
<2 | 323 | 71 (57.7) | 252 (71.4) | 1.827 | 1.192–2.800 | 0.006 | 0.548 | 0.347–0.865 | 0.010 | |
Polypharmacy | ||||||||||
No | 426 | 104 (84.6) | 322 (91.2) | 1 | - | - | - | - | - | |
Yes | 50 | 19 (15.4) | 31 (8.8) | 0.527 | 0.285–0.974 | 0.041 | - | - | - | |
Self-perceived health changed due to COVID-19 | ||||||||||
No | 336 | 83 (67.5) | 253 (71.7) | 1 | - | - | - | - | - | |
Negatively | 122 | 36 (29.3) | 86 (24.4) | 0.784 | 0.493–1.245 | 0.301 | - | - | - | |
Positively | 18 | 4 (3.3) | 14 (4.0) | 1.148 | 0.367–3.595 | 0.812 | - | - | - | |
COVID-19 impact on medication adherence | COVID-19 impacted adherence | |||||||||
No | 409 | 92 (74.8) | 317 (89.8) | 1 | - | - | 1 | - | - | |
Negatively | 28 | 17 (13.8) | 11 (3.1) | 0.188 | 0.085–0.416 | <0.001 | 0.179 | 0.078–0.413 | <0.001 | |
Positively | 39 | 14 (11.4) | 25 (7.1) | 0.518 | 0.258–1.039 | 0.064 | 0.514 | 0.247–1.070 | 0.075 | |
COVID-19 impact on adherence to healthy lifestyles | Changes in adherence to healthy diet | |||||||||
No changes | 290 | 68 (55.3) | 222 (62.9) | 1 | - | - | - | - | - | |
Yes, for a less healthy diet | 83 | 25 (20.3) | 58 (16.4) | 0.711 | 0.413–1.224 | 0.217 | - | - | - | |
Yes, for a healthier diet | 103 | 30 (24.4) | 73 (20.7) | 0.745 | 0.449–1.236 | 0.254 | - | - | - | |
Changes in adherence to physical exercise | ||||||||||
No changes | 168 | 38 (30.9) | 130 (36.8) | 1 | - | - | - | - | - | |
Stopped or started to exercise less | 209 | 54 (43.9) | 155 (43.9) | 0.839 | 0.521–1.352 | 0.119 | - | - | - | |
Started to practice (more) exercise | 99 | 31 (25.2) | 68 (19.3) | 0.641 | 0.367–1.122 | 0.470 | - | - | - | |
COVID-19 perceptions and impact on daily life | Felt lonely, anxious, or nervous | |||||||||
No | 135 | 25 (20.3) | 110 (31.2) | 1 | - | - | - | - | - | |
Yes | 341 | 98 (79.7) | 243 (68.8) | 0.564 | 0.344–0.924 | 0.023 | - | - | - | |
Trouble falling asleep | ||||||||||
No | 248 | 54 (43.9) | 194 (55.0) | 1 | - | - | - | - | - | |
Yes | 228 | 69 (56.1) | 159 (45.0) | 0.641 | 0.424–0.971 | 0.036 | - | - | - | |
During the context of the pandemic COVID-19 started taking medication for anxiety, depression or difficulty falling asleep by prescription | ||||||||||
No | 371 | 88 (71.5) | 283 (80.2) | 1 | - | - | - | - | - | |
Yes | 105 | 35 (28.5) | 70 (19.8) | 0.622 | 0.388–0.997 | 0.049 | - | - | - | |
Concerned being infected with COVID-19 * | ||||||||||
No | 83 | 23 (21.1) | 60 (19.0) | 1 | - | - | - | - | - | |
Yes | 342 | 86 (78.9) | 256 (81.0) | 0.876 | 0.510–1.505 | 0.632 | - | - | - |
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Midão, L.; Almada, M.; Carrilho, J.; Sampaio, R.; Costa, E. Pharmacological Adherence Behavior Changes during COVID-19 Outbreak in a Portugal Patient Cohort. Int. J. Environ. Res. Public Health 2022, 19, 1135. https://doi.org/10.3390/ijerph19031135
Midão L, Almada M, Carrilho J, Sampaio R, Costa E. Pharmacological Adherence Behavior Changes during COVID-19 Outbreak in a Portugal Patient Cohort. International Journal of Environmental Research and Public Health. 2022; 19(3):1135. https://doi.org/10.3390/ijerph19031135
Chicago/Turabian StyleMidão, Luís, Marta Almada, Joana Carrilho, Rute Sampaio, and Elísio Costa. 2022. "Pharmacological Adherence Behavior Changes during COVID-19 Outbreak in a Portugal Patient Cohort" International Journal of Environmental Research and Public Health 19, no. 3: 1135. https://doi.org/10.3390/ijerph19031135