***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Determine  treatment  adherence in patients with multiple chronic conditions ( MCC ) . METHODS A r and om patient sample ≥ 15 years , discharged from hospital with ≥1 chronic conditions ( CC ) was interviewed after 6 - 12 months . Analysis included variables in 5 dimensions ( WHO ) : socio-demographics , disease , treatment , patient and health system characteristics . Morisky-Green adherence question naire was used . High chronic treatment complexity was defined as : > 3 pills/day , > 6 inhalations/day , > 1 injection/day , pharmacological treatment plus diet or self-monitoring techniques . RESULTS 301 patients were interviewed ( 62 ± 15 years , 59 % males ) . Despite good treatment information perception ( 79 % ) , only 3 % followed the patient education programme . Poor adherents ( 82 % ) were older ( 64 ± 14 years vs. 55 ± 16 years ) , had more CC ( 3.25 ± 2.02 vs. 2.62 ± 2.72 ) , a higher frequency of hypertension ( 44 % vs. 15 % ) , ischaemic heart diseases : ( 21 % vs. 4 % ) , hyperlipidaemia ( 19 % vs. 6 % ) , more pills/day ( 5.78 ± 4.14 vs. 3.20 ± 4.70 ) and more complex treatments ( 95 % vs. 70 % ) ( p<0.05 ) . On multivariate analysis number of CC [ 3.68 ( 0.75 - 18.15 ) ] , pills/day [ 2.23 ( 1.02 - 4.84 ) ] , treatment complexity [ 4.00 ( 1.45 - 11.04 ) ] , and hypertension [ 2.57 ( 1.06 - 6.25 ) ] were predictive of poor adherence ( OR 95 % CI p<0.05 ) . CONCLUSION The WHO conceptual framework allows the construction of poor adherence risk profiles in patients with MCC after hospital discharge . PRACTICE IMPLICATION S Predictive variables of poor adherence could help clinicians detect patients with MCC most likely to present poor adherence Background The objective of this study was to develop and psychometrically evaluate a general measure of patients ' satisfaction with medication , the Treatment Satisfaction Question naire for Medication ( TSQM ) . Methods The content and format of 55 initial questions were based on a formal conceptual framework , an extensive literature review , and the input from three patient focus groups . Patient interviews were used to select the most relevant questions for further evaluation ( n = 31 ) . The psychometric performance of items and result ing TSQM scales were examined using eight diverse patient groups ( arthritis , asthma , major depression , type I diabetes , high cholesterol , hypertension , migraine , and psoriasis ) recruited from a national longitudinal panel study of chronic illness ( n = 567 ) . Participants were then r and omized to complete the test items using one of two alternate scaling methods ( Visual Analogue vs. Likert-type ) . Results A factor analysis ( principal component extraction with varimax rotation ) of specific items revealed three factors ( Eigenvalues > 1.7 ) explaining 75.6 % of the total variance ; namely Side effects ( 4 items , 28.4 % , Cronbach 's Alpha = .87 ) , Effectiveness ( 3 items , 24.1 % , Cronbach 's Alpha = .85 ) , and Convenience ( 3 items , 23.1 % , Cronbach 's Alpha = .87 ) . A second factor analysis of more generally worded items yielded a Global Satisfaction scale ( 3 items , Eigenvalue = 2.3 , 79.1 % , Cronbach 's Alpha = .85 ) . The final four scales possessed good psychometric properties , with the Likert-type scaling method performing better than the VAS approach . Significant differences were found on the TSQM by the route of medication administration ( oral , injectable , topical , inhalable ) , level of illness severity , and length of time on medication . Regression analyses using the TSQM scales accounted for 40–60 % of variation in patients ' ratings of their likelihood to persist with their current medication . Conclusion The TSQM is a psychometrically sound and valid measure of the major dimensions of patients ' satisfaction with medication . Preliminary evidence suggests that the TSQM may also be a good predictor of patients ' medication adherence across different types of medication and patient population Objectives Poor adherence is one of the biggest obstacles in therapeutic control of high blood pressure . The objectives of this study were ( i ) to measure adherence to antihypertensive therapy in a representative sample of the hypertensive Pakistani population and ( ii ) to investigate the factors associated with adherence in the studied population . Methods and Results A cross-sectional study was conducted on a simple r and om sample of 460 patients at the Aga Khan University Hospital ( AKUH ) and National Institute of Cardiovascular Diseases , Karachi , from September 2005–May 2006 .  Adherence was assessed using the  Morisky Medication Adherence Scale ( MMAS ) , with scores ranging from 0 ( non-adherent ) to 4 ( adherent ) . In addition to MMAS , patient self-reports about the number of pills taken over a prescribed period were used to estimate adherence as a percentage . AKU Anxiety and Depression Scale ( AKU-ADS ) was incorporated to find any association between depression and adherence . At a cut-off value of 80 % , 77 % of the cases were adherent . Upon univariate analyses , increasing age , better awareness and increasing number of pills prescribed significantly improved adherence , while depression showed no association . Significant associations , upon multivariate analyses , included number of drugs that a patient was taking ( P<0.02 ) and whether he/she was taking medication regularly or only for symptomatic relief ( P<0.00001 ) . Conclusions Similar to what has been reported worldwide , younger age , poor awareness , and symptomatic treatment adversely affected adherence to antihypertensive medication in our population . In contrast , monotherapy reduced adherence , whereas psychosocial factors such as depression showed no association . These findings may be used to identify the subset of population at risk of low adherence who should be targeted for interventions to achieve better blood pressure control and hence prevent complications Background Self-report scales are used to assess medication adherence . Data on how to discriminate change in self-reported adherence over time from r and om variability are limited . Objective : To determine the minimal detectable change for scores on the 8-item Morisky Medication Adherence Scale ( MMAS-8 ) . Methods : The MMAS-8 was administered twice , using a st and ard telephone script , with administration separated by 14 - 22 days , to 210 participants taking antihypertensive medication in the CoSMO ( Cohort Study of Medication Adherence among Older Adults ) .  MMAS-8 scores were calculated and participants were grouped into previously defined categories ( < 6 , 6 to < 8 , and 8 for low , medium , and high adherence ) . Results : The mean ( SD ) age of participants was 78.1 ( 5.8 ) years , 43.8 % were black , and 68.1 % were women . Overall , 8.1 % ( 17/210 ) , 16.2 % ( 34/210 ) , and 51.0 % ( 107/210 ) of participants had low , medium , and high MMAS-8 scores , respectively , at both survey administrations ( overall agreement 75.2 % ; 158/210 ) . The weighted κ statistic was 0.63 ( 95 % CI 0.53 to 0.72 ) . The intraclass correlation coefficient was 0.78 . The within-person st and ard error of the mean for change in MMAS-8 scores was 0.81 , which equated to a minimal detectable change of 1.98 points . Only 4.3 % ( 9/210 ) of the participants had a change in MMAS-8 of 2 or more points between survey administrations . Conclusions : Within-person changes in MMAS-8 scores of 2 or more points over time may represent a real change in antihypertensive medication adherence Background The majority of patients using antihypertensive medications fail to achieve their recommended target blood pressure . Poor daily adherence with medication regimens and a lack of persistence with medication use are two of the major reasons for failure to reach target blood pressure . There is no single intervention to improve adherence with antihypertensives that is consistently effective . Community pharmacists are in an ideal position to promote adherence to chronic medications . This study aims to test a specific intervention package that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and /or persistence with antihypertensive medications - Hypertension Adherence Program in Pharmacy ( HAPPY ) . Methods / Design The HAPPY trial is a multi-centre prospect i ve r and omised controlled trial . Fifty-six pharmacies have been recruited from three Australian states . To identify potential patients , a software application ( MedeMine CVD ) extracted data from a community pharmacy dispensing software system ( FRED Dispense ® ) . The pharmacies have been r and omised to either ' Pharmacist Care Group ' ( PCG ) or ' Usual Care Group ' ( UCG ) . To check for ' Hawthorne effect ' in the UCG , a third group of patients ' Hidden Control Group ' ( HCG ) will be identified in the UCG pharmacies , which will be made known to the pharmacists at the end of six months . Each study group requires 182 patients . Data will be collected at baseline , three and six months in the PCG and at baseline and six months in the UCG . Changes in patient adherence and persistence at the end of six months will be measured using the self-reported Morisky score , the Tool for Adherence Behaviour Screening and medication refill data . Discussion To our knowledge , this is the first research testing a comprehensive package of evidence -based interventions that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and /or persistence with antihypertensive medications . The unique features of the HAPPY trial include the use of MedeMine CVD to identify patients who could potentially benefit from the service , control for the ' Hawthorne effect ' in the UCG and the offer of the intervention package at the end of six months to patients in the UCG , a strategy that is expected to improve retention . Trial Registration Australian New Zeal and Clinical Trial Registry Background Disparities in  blood pressure ( BP ) control may be a function of disparities in treatment intensification ( TI ) . Objective To examine racial differences in TI , underst and modifiable factors that may mediate this relationship , and explore the relative effects of TI and race on blood pressure . Design Prospect i ve cohort study . Participants Participants were 819 black and white patients with hypertension from an urban , safety-net hospitalMain Measures We sequentially explored the effects of patient race , sociodemographic and clinical characteristics , beliefs about BP/medications , perceptions of provider/discrimination , sodium intake , medication adherence , and provider counseling on TI , performing a series of r and om effects analyses . To assess the effects of race and TI on BP , we performed linear regressions , using systolic BP ( SBP ) as the outcome .Key Results Unadjusted analyses and those including sociodemographic and clinical characteristics revealed that black patients had less TI than whites ( −0.31 vs.−0.24 , p < 0.001 ) , but adjustment for patient beliefs and experiences eliminated the effects of race ( β = −0.02 , p = 0.5 ) . Increased patient concerns about BP medications were related to lower TI , as was more provider counseling ( β = −0.06 , p = 0.02 and β = −0.01 , p = 0.001 , respectively ) . In the unadjusted analysis , black race was a significant predictor of SBP ( 134 mm/Hg for blacks vs. 131 mm/Hg for whites , p = 0.009 ) , but when both race and TI were included in the model , TI was a significant predictor of SBP ( final SBP 2.0 mm/Hg lower for each additional therapy increase per 10 visits , p < 0.001 ) , while race was not ( Blacks 1.6 mm/Hg higher than whites , p = 0.17 ) . Conclusions Improved patient – provider communication targeted towards addressing patient concerns about medications may have the potential to reduce racial disparities in TI and ultimately , BP control Background : Although hypertension is , in most cases , a controllable major risk factor in the development of cardiovascular disease , studies have demonstrated that hypertension remains poorly controlled in Portugal . Our aim was to evaluate the covariates associated with poor blood pressure ( BP ) control in a Portuguese hypertensive population . Patients and Results : We conducted a cross-sectional survey in a hospital hypertension outpatient clinic , located in the Eastern Central Region of Portugal . Patients attending the clinic from July to September 2009 were asked to participate in a structured interview including medication adherence and knowledge about hypertension .  Eligible participants were all adults aged 18 or over with an established diagnosis of arterial hypertension and had been on antihypertensive drug treatment for at least 6 months . Exclusion criteria were dementia , pregnancy , and breastfeeding . Detailed clinical information was prospect ively 
    Output:
    
According to the WHO Adherence Model domains , patient-related barriers were most commonly addressed , while condition , therapy , and socioeconomic barriers were underrepresented .