title: Factors associated with medication adherence in patients living with cirrhosis.
abstract: OBJECTIVE
  Medication adherence in people with cirrhosis is largely unknown. This study aims to determine adherence patterns and factors associated with adherence in patients with cirrhosis.
  
  
  BACKGROUND
  Prescribed medications are a pivotal component in the clinical management of cirrhosis with potential to retard disease progression and reduce complication risks. Medication adherence is necessary to optimise health outcomes. Understanding why medications are missed may help to develop strategies and inform nursing practice.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Participants (n = 29) diagnosed with cirrhosis attending a tertiary hospital consented to complete a self-reported survey. Demographic information, adherence to medications, patient knowledge and quality of life data were collected, collated, checked and analysed using SPSS version 21.
  
  
  RESULTS
  Less than half of the 28 patients who completed the adherence questionnaire (n = 13, 46%) reported that they had never missed medication. Being forgetful, being away from home and falling asleep contributed to nonadherence. Having less abdominal symptoms, less fatigue and increased emotional well-being were significantly associated with patients never missing medications.
  
  
  CONCLUSIONS
  To our knowledge this is the first published study to describe adherent behaviour and the reasons medications are missed in this population. The percentage of nonadherent participants is of concern considering the potential morbidity risk that is associated with missed medications and rebound symptoms of cirrhosis. Strategies to improve and sustain adherence levels are required including enhanced adherence counselling offered to patients who are deteriorating or experience periodic exacerbation of symptoms.
  
  
  CONCLUSIONS
  Study findings have the potential to change clinical practice especially the way nurses target motivational adherence counselling, key treatment messages, education and adherence monitoring. The results presented here provide a basis for developing adherence strategies and nursing management plans to improve adherence and health outcomes in people with cirrhosis.
authors.affiliation: Centre for Research in Nursing and Health, Kogarah, New South Wales, Australia.|The Kirby Institute, UNSW Australia, Kensington, New South Wales, Australia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Polis
authors.affiliation: Department of Gastroenterology, St George Hospital, Kogarah, New South Wales, Australia.
authors.forename: Ling
authors.initials: L
authors.lastname: Zang
authors.affiliation: Department of Gastroenterology, St George Hospital, Kogarah, New South Wales, Australia.
authors.forename: Bhawana
authors.initials: B
authors.lastname: Mainali
authors.affiliation: Department of Nutrition and Dietetics, St George Hospital, Kogarah, New South Wales, Australia.
authors.forename: Rachel
authors.initials: R
authors.lastname: Pons
authors.affiliation: Department of Gastroenterology, St George Hospital, Kogarah, New South Wales, Australia.
authors.forename: Gokulan
authors.initials: G
authors.lastname: Pavendranathan
authors.affiliation: Department of Gastroenterology, St George Hospital, Kogarah, New South Wales, Australia.|Clinical School of Medicine, St George Hospital, UNSW, Australia.
authors.forename: Amany
authors.initials: A
authors.lastname: Zekry
authors.affiliation: Centre for Research in Nursing and Health, Kogarah, New South Wales, Australia.|School of Nursing and Midwifery, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.
authors.forename: Ritin
authors.initials: R
authors.lastname: Fernandez
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000451:nursing / Q000523:psychology; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009517:New South Wales; D009736:Nursing Process; D011446:Prospective Studies; D011795:Surveys and Questionnaires
keywords: adherence; cirrhosis; medication; patient knowledge; quality of life