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Torres-Robles A, Wiecek E, Tonin FS, Benrimoj SI, Fernandez-Llimos F, Garcia-Cardenas V. Comparison of Interventions to Improve Long-Term Medication Adherence Across Different Clinical Conditions: A Systematic Review With Network Meta-Analysis. Front Pharmacol 2018; 9:1454. [PMID: 30618748 PMCID: PMC6311651 DOI: 10.3389/fphar.2018.01454] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/28/2018] [Indexed: 12/23/2022] Open
Abstract
Background: Medication non-adherence has a dynamic, temporal and multifactorial nature with a significant impact on economic and clinical outcomes. Interventions to improve adherence are complex and require adaptation to patients' needs, which may include patient's medical conditions. The aim of this study was to assess the comparative effectiveness of medication adherence interventions per type of clinical condition on adult patients. Methods: A systematic review with network meta-analysis was performed (PROSPERO registration number of CRD42018054598). An initial Pubmed search was conducted to select meta-analyses reporting results of interventions aiming to improve medication adherence. Primary studies were selected and those reporting results with a long-term follow up (≥10 months) on adult patients were included for data extraction. Study characteristics, description of interventions and adherence outcomes were extracted. Adherence interventions were classified in four groups: educational, attitudinal, technical, and rewards. Clinical conditions were classified in four groups: circulatory system and metabolic diseases, infectious diseases, musculoskeletal diseases, and mental, behavioral or neurodevelopmental disorders. Network meta-analyses with effect sizes expressed as odds ratio (OR) with a 95% credibility interval (CrI) were built. Ranking probabilities for each measure of adherence were calculated by using surface under the cumulative ranking analysis (SUCRA). Results: A total of 61 meta-analysis and 149 primary studies were included in the qualitative synthesis and 80 primary studies in the quantitative analysis. The most effective interventions were: educational + technical 79.6% [OR: 0.44 (CrI: 0.26, 0.73)] and 73.3% [OR: 0.56 (0.36, 0.84)] in circulatory system and metabolic diseases and infectious diseases respectively. Attitudinal intervention had the greatest probability for musculoskeletal diseases of 92.3% in SUCRA [OR: 0.30 (0.10, 0.86)]. Finally, educational + attitudinal interventions had the greatest effect (SUCRA 73.8%) for mental, behavioral or neurodevelopmental disorders, although this was not significant according to consistency analysis. Conclusion: Effectiveness of interventions seems to be related to the clinical condition. Educational and technical interventions resulted in a major effect on long-term management of medication adherence in patients with infectious diseases (HIV) and circulatory system and metabolic diseases whereas attitudinal components presented a higher effect on musculoskeletal and mental, behavioral or neurodevelopmental disorders.
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Affiliation(s)
- Andrea Torres-Robles
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Elyssa Wiecek
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Fernanda S Tonin
- Pharmaceutical Sciences Postgraduate Programme, Universidade Federal do Paraná, Curitiba, Brazil
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Fernando Fernandez-Llimos
- Department of Social Pharmacy, Faculty of Pharmacy, Research Institute for Medicines (iMed.Ulisboa), Universidade de Lisboa, Lisbon, Portugal
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102
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Heino MTJ, Knittle K, Haukkala A, Vasankari T, Hankonen N. Simple and rationale-providing SMS reminders to promote accelerometer use: a within-trial randomised trial comparing persuasive messages. BMC Public Health 2018; 18:1352. [PMID: 30526616 PMCID: PMC6286544 DOI: 10.1186/s12889-018-6121-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 10/15/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Literature on persuasion suggests compliance increases when requests are accompanied with a reason (i.e. the "because-heuristic"). The reliability of outcomes in physical activity research is dependent on sufficient accelerometer wear-time. This study tested whether SMS reminders-especially those that provided a rationale-are associated with increased accelerometer wear-time. METHODS We conducted a within-trial partially randomised controlled trial during baseline data collection in a school-based physical activity intervention trial. Of 375 participants (mean age = 18.1), 280 (75%) opted to receive daily SMS reminders to wear their accelerometers. These 280 participants were then randomised to receive either succinct reminders or reminders including a rationale. Data was analyzed across groups using both frequentist and Bayesian methods. RESULTS No differences in total accelerometer wear minutes were detected between the succinct reminder group (Mdn = 4909, IQR = 3429-5857) and the rationale group (Mdn = 4808, IQR = 3571-5743); W = 8860, p = 0.65, CI95 = - 280.90-447.20. Similarly, we found no differences in wear time between participants receiving SMS reminders (Mdn = 4859, IQR = 3527-5808) and those not receiving them (Mdn = 5067, IQR = 3201-5885); W = 10,642.5, p = 0.77, CI95 = - 424.20-305.30. Bayesian ANOVA favored a model of equal weartime means, over one of unequal means, by a Bayes Factor of 12.05. Accumulated days of valid accelerometer wear data did not differ either. Equivalence testing indicated rejection of effects more extreme than a Cohen's d (standardised mean difference) of ±~0.3. CONCLUSIONS This study casts doubt on the effectiveness of using the because-heuristic via SMS messaging, to promote accelerometer wear time among youth. The because-heuristic might be limited to face-to-face communication and situations where no intention for or commitment to the behavior has yet been made. Other explanations for null effects include non-reading of messages, and reminder messages undermining the self-reminding strategies which would occur naturally in the absence of reminders. TRIAL REGISTRATION DRKS DRKS00007721 . Registered 14.04.2015. Retrospectively registered.
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Affiliation(s)
- Matti T. J. Heino
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Keegan Knittle
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Ari Haukkala
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Tommi Vasankari
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Nelli Hankonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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103
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Ali EE, Leow JL, Chew L, Yap KYL. Patients' Perception of App-based Educational and Behavioural Interventions for Enhancing Oral Anticancer Medication Adherence. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:1306-1313. [PMID: 28707206 DOI: 10.1007/s13187-017-1248-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Well-designed smartphone apps can potentially help in enhancing adherence to oral anticancer medications (OAMs). The objective of this study was to evaluate patients' perception on inclusion of various adherence-enhancing strategies as features of an app and their interest in using such app. A cross-sectional survey was conducted at the National Cancer Centre Singapore. A structured self-administered questionnaire was used to collect data from patients taking OAMs. Final analysis was based on 409 surveys and most of the respondents were female (291, 71.1%), Chinese (332, 81.2%), married (296, 72.4%) and breast cancer patients (211, 51.6%). Close to two-thirds of respondents rated medication information (65.0%), disease information (60.2%) and side effect self-management (60.2%) features as having the highest level of importance in an adherence app. Three hundred thirty-two (81.2%) of the respondents owned a smartphone, among which 92 (27.7%) reported using health-related apps. From respondents with smartphones, 219 (66.0%) were interested in using an app for OAM adherence. Age 65 and older compared to 21-54 years old (adjusted OR = 0.34; 95% CI = 0.15-0.76) and current use of a health app (adjusted OR = 1.91; 95% CI = 1.07-3.41) were significant predictors of interest to adopt an adherence app. In conclusion, patients value the inclusion of educational and behavioural interventions in adherence apps. Developers of adherence apps should consider including tools for side effect self-management and provision of information to educate patients on their medications and disease condition.
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Affiliation(s)
- Eskinder Eshetu Ali
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, 18 Science Drive 4, Singapore, 117543, Republic of Singapore
| | - Jo Lene Leow
- Department of Pharmacy, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Republic of Singapore
| | - Lita Chew
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, 18 Science Drive 4, Singapore, 117543, Republic of Singapore
- Department of Pharmacy, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Republic of Singapore
| | - Kevin Yi-Lwern Yap
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, 18 Science Drive 4, Singapore, 117543, Republic of Singapore.
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Leader A, Benyamini N, Gafter-Gvili A, Dreyer J, Calvarysky B, Amitai A, Yarchovsky-Dolberg O, Sharf G, Tousset E, Caspi O, Ellis M, Levi I, De Geest S, Raanani P. Effect of Adherence-enhancing Interventions on Adherence to Tyrosine Kinase Inhibitor Treatment in Chronic Myeloid Leukemia (TAKE-IT): A Quasi-experimental Pre–Post Intervention Multicenter Pilot Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e449-e461. [DOI: 10.1016/j.clml.2018.06.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/08/2018] [Accepted: 06/19/2018] [Indexed: 01/28/2023]
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105
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Subbaraman R, de Mondesert L, Musiimenta A, Pai M, Mayer KH, Thomas BE, Haberer J. Digital adherence technologies for the management of tuberculosis therapy: mapping the landscape and research priorities. BMJ Glob Health 2018; 3:e001018. [PMID: 30364330 PMCID: PMC6195152 DOI: 10.1136/bmjgh-2018-001018] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 11/15/2022] Open
Abstract
Poor medication adherence may increase rates of loss to follow-up, disease relapse and drug resistance for individuals with active tuberculosis (TB). While TB programmes have historically used directly observed therapy (DOT) to address adherence, concerns have been raised about the patient burden, ethical limitations, effectiveness in improving treatment outcomes and long-term feasibility of DOT for health systems. Digital adherence technologies (DATs)-which include feature phone-based and smartphone-based technologies, digital pillboxes and ingestible sensors-may facilitate more patient-centric approaches for monitoring adherence, though available data are limited. Depending on the specific technology, DATs may help to remind patients to take their medications, facilitate digital observation of pill-taking, compile dosing histories and triage patients based on their level of adherence, which can facilitate provision of individualised care by TB programmes to patients with varied levels of risk. Research is needed to understand whether DATs are acceptable to patients and healthcare providers, accurate for measuring adherence, effective in improving treatment outcomes and impactful in improving health system efficiency. In this article, we describe the landscape of DATs that are being used in research or clinical practice by TB programmes and highlight priorities for research.
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Affiliation(s)
- Ramnath Subbaraman
- Department of Public Health and Community Medicine and Tufts Center for Global Public Health, Tufts University School of Medicine, Boston, Massachusetts, USA
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA
| | - Laura de Mondesert
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Angella Musiimenta
- Department of Information Technology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Madhukar Pai
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Beena E Thomas
- Department of Social and Behavioural Research, National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Jessica Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
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106
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Swift B, Jain L, White C, Chandrasekaran V, Bhandari A, Hughes DA, Jadhav PR. Innovation at the Intersection of Clinical Trials and Real-World Data Science to Advance Patient Care. Clin Transl Sci 2018; 11:450-460. [PMID: 29768712 PMCID: PMC6132367 DOI: 10.1111/cts.12559] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/29/2018] [Indexed: 02/01/2023] Open
Abstract
While efficacy and safety data collected from randomized clinical trials are the evidentiary standard for determining market authorization, this alone may no longer be sufficient to address the needs of key stakeholders (regulators, providers, and payers) and guarantee long-term success of pharmaceutical products. There is a heightened interest from stakeholders on understanding the use of real-world evidence (RWE) to substantiate benefit-risk assessment and support the value of a new drug. This review provides an overview of real-world data (RWD) and related advances in the regulatory framework, and discusses their impact on clinical research and development. A framework for linking drug development decisions with the value proposition of the drug, utilizing pharmacokinetic-pharmacodynamic-pharmacoeconomic models, is introduced. The summary presented here is based on the presentations and discussion at the symposium entitled Innovation at the Intersection of Clinical Trials and Real-World Data to Advance Patient Care at the American Society for Clinical Pharmacology and Therapeutics (ASCPT) 2017 Annual Meeting.
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Affiliation(s)
| | - Lokesh Jain
- Quantitative Pharmacology and PharmacometricsMerck & Co., Inc.RahwayNew JerseyUSA
| | - Craig White
- Harvard PhD program in Health PolicyCambridgeMassachusettsUSA
| | - Vasu Chandrasekaran
- Center for Observational and Real World EvidenceMerck & Co., Inc.BostonMassachusettsUSA
| | - Aman Bhandari
- Center for Observational and Real World EvidenceMerck & Co., Inc.BostonMassachusettsUSA
| | - Dyfrig A. Hughes
- Centre for Health Economics and Medicines EvaluationBangor UniversityBangorGwyneddUK
| | - Pravin R. Jadhav
- Corporate ProjectsResearch & Development (R&D) InnovationOtsuka Pharmaceutical Development and Commercialization (OPDC)PrincetonNew JerseyUSA
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107
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Kamal S, Nulty P, Bugnon O, Cavassini M, Schneider MP. Content analysis of antiretroviral adherence enhancing interview reports. PATIENT EDUCATION AND COUNSELING 2018; 101:1676-1682. [PMID: 29871817 DOI: 10.1016/j.pec.2018.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To identify factors associated with low or high antiretroviral (ARV) adherence through computational text analysis of an adherence enhancing programme interview reports. METHODS Using text from 8428 interviews with 522 patients, we constructed a term-frequency matrix for each patient, retaining words that occurred at least ten times overall and used in at least six interviews with six different patients. The text included both the pharmacist's and the patient's verbalizations. We investigated their association with an adherence threshold (above or below 90%) using a regularized logistic regression model. In addition to this data-driven approach, we studied the contexts of words with a focus group. RESULTS Analysis resulted in 7608 terms associated with low or high adherence. Terms associated with low adherence included disruption in daily schedule, side effects, socio-economic factors, stigma, cognitive factors and smoking. Terms associated with high adherence included fixed medication intake timing, no side effects and positive psychological state. CONCLUSION Computational text analysis helps to analyze a large corpus of adherence enhancing interviews. It confirms main known themes affecting ARV adherence and sheds light on new emerging themes. PRACTICE IMPLICATIONS Health care providers should be aware of factors that are associated with low or high adherence. This knowledge should reinforce the supporting factors and try to resolve the barriers together with the patient.
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Affiliation(s)
- Susan Kamal
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland; Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne, Geneva, Switzerland
| | - Paul Nulty
- Centre for Research in Arts, Social Science, and Humanities, University of Cambridge, Cambridge, UK
| | - Olivier Bugnon
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland; Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne, Geneva, Switzerland
| | - Matthias Cavassini
- Infectious Disease Service, Lausanne University Hospital and University of Lausanne, Geneva, Switzerland
| | - Marie P Schneider
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland; Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne, Geneva, Switzerland.
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108
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Zullig LL, Deschodt M, Liska J, Bosworth HB, De Geest S. Moving from the Trial to the Real World: Improving Medication Adherence Using Insights of Implementation Science. Annu Rev Pharmacol Toxicol 2018; 59:423-445. [PMID: 30125127 DOI: 10.1146/annurev-pharmtox-010818-021348] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Medication nonadherence is a serious public health concern. Although there are promising interventions that improve medication adherence, most interventions are developed and tested in tightly controlled research environments that are dissimilar from the real-world settings where the majority of patients receive health care. Implementation science methods have the potential to facilitate and accelerate the translation shift from the trial world to the real world. We demonstrate their potential by reviewing published, high-quality medication adherence studies that could potentially be translated into clinical practice yet lack essential implementation science building blocks. We further illustrate this point by describing an adherence study that demonstrates how implementation science creates a junction between research and real-world settings. This article is a call to action for researchers, clinicians, policy makers, pharmaceutical companies, and others involved in the delivery of care to adopt the implementation science paradigm in the scale-up of adherence (research) programs.
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Affiliation(s)
- Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, North Carolina 27701, USA.,Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina 27707, USA;
| | - Mieke Deschodt
- Institute of Nursing Science, Department of Public Health, University of Basel, 4056 Basel, Switzerland; .,Division of Gerontology and Geriatrics, Department of Chronic Diseases, Metabolism, and Ageing, KU Leuven, 3000 Leuven, Belgium
| | - Jan Liska
- Patient Solutions Unit, Medical Evidence Generation Team, Sanofi, 75008 Paris, France
| | - Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, North Carolina 27701, USA.,Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina 27707, USA;
| | - Sabina De Geest
- Institute of Nursing Science, Department of Public Health, University of Basel, 4056 Basel, Switzerland; .,Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
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109
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De Geest S, Zullig LL, Dunbar-Jacob J, Helmy R, Hughes DA, Wilson IB, Vrijens B. ESPACOMP Medication Adherence Reporting Guideline (EMERGE). Ann Intern Med 2018; 169:30-35. [PMID: 29946690 PMCID: PMC7643841 DOI: 10.7326/m18-0543] [Citation(s) in RCA: 225] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Research on assessing or managing medication adherence applies approaches from observational, interventional, and implementation science that spans many disciplines and demands coherent conceptualization, valid methods, appropriate analyses, and complete and accurate reporting. To ensure such reporting, the European Society for Patient Adherence, COMpliance, and Persistence (ESPACOMP) Medication Adherence Reporting Guideline (EMERGE) recommends standard reporting approaches based on an accepted taxonomy. This guideline is derived from a literature review, a reactive Delphi study with 26 medication adherence experts from many countries and disciplines, and feedback from ESPACOMP members. It is designed to supplement existing guidelines for health research reporting and is structured around 4 minimum reporting criteria and 17 items reflecting best reporting practice. By enhancing and harmonizing research reporting, EMERGE aims to advance research and, ultimately, patient outcomes.
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Affiliation(s)
- Sabina De Geest
- University of Basel, Basel, Switzerland, and Academic Centre for Nursing and Midwifery, Katholieke Universiteit Leuven, Leuven, Belgium (S.D.)
| | - Leah L Zullig
- Center for Health Services Research in Primary Care at Durham Veterans Affairs Health Care System and Duke University School of Medicine, Durham, North Carolina (L.L.Z.)
| | | | - Remon Helmy
- University of Basel, Basel, Switzerland (R.H.)
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Gwynedd, North Wales, United Kingdom (D.A.H.)
| | - Ira B Wilson
- Brown University School of Public Health, Providence, Rhode Island (I.B.W.)
| | - Bernard Vrijens
- University of Liège, Liège, Belgium, and AARDEX Group, Visé, Belgium (B.V.)
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110
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Ernawati I, Islamiyah WR, Sumarno. How to Improve Clinical Outcome of Epileptic Seizure Control Based on Medication Adherence? A Literature Review. Open Access Maced J Med Sci 2018; 6:1174-1179. [PMID: 29983823 PMCID: PMC6026415 DOI: 10.3889/oamjms.2018.235] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/11/2018] [Accepted: 05/19/2018] [Indexed: 11/09/2022] Open
Abstract
Anti-Epileptic Drugs (AEDs) are the main therapy for epilepsy to prevent seizures. Non-adherence situation plays an important factor in the failure of seizure control. Such a condition may generate several impacts on clinical, social, and economic aspect. Several methods are used to measure adherence in epilepsy patients, including direct and indirect measurement. The direct measure involves measurement of drug levels in hair or body fluids such as blood and saliva. Whereas, indirect measure involves the non-biological tools, for example, a self-report measure, pill counts, appointment attendance, medication refills, and seizure frequency. Numerous factors may affect adherence in epilepsy patients, such as age, sex, and seizure aetiology, seizure sites, which are categorised as irreversible factors and hardly to be improved. However, there are factors that can be influenced to improve adherence such as patient knowledge, medication, cultural, health care professionals, and national health policies, which are related to treatment and education factor which is associated with behaviour to be likely adherence.
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Affiliation(s)
- Iin Ernawati
- Faculty of Pharmacy, Airlangga University, Gubeng, Surabaya, East Java, Indonesia
| | | | - Sumarno
- Department of Clinical Pharmacy, Faculty of Pharmacy, Airlangga University, Gubeng, Surabaya, East Java, Indonesia
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111
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Tonin FS, Wiecek E, Torres-Robles A, Pontarolo R, Benrimoj SCI, Fernandez-Llimos F, Garcia-Cardenas V. An innovative and comprehensive technique to evaluate different measures of medication adherence: The network meta-analysis. Res Social Adm Pharm 2018; 15:358-365. [PMID: 29801918 DOI: 10.1016/j.sapharm.2018.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Poor medication adherence is associated with adverse health outcomes and higher costs of care. However, inconsistencies in the assessment of adherence are found in the literature. OBJECTIVE To evaluate the effect of different measures of adherence in the comparative effectiveness of complex interventions to enhance patients' adherence to prescribed medications. METHODS A systematic review with network meta-analysis was performed. Electronic searches for relevant pairwise meta-analysis including trials of interventions that aimed to improve medication adherence were performed in PubMed. Data extraction was conducted with eligible trials evaluating short-period adherence follow-up (until 3 months) using any measure of adherence: self-report, pill count, or MEMS (medication event monitoring system). To standardize the results obtained with these different measures, an overall composite measure and an objective composite measure were also calculated. Network meta-analyses for each measure of adherence were built. Rank order and surface under the cumulative ranking curve analyses (SUCRA) were performed. RESULTS Ninety-one trials were included in the network meta-analyses. The five network meta-analyses demonstrated robustness and reliability. Results obtained for all measures of adherence were similar across them and to both composite measures. For both composite measures, interventions comprising economic + technical components were the best option (90% of probability in SUCRA analysis) with statistical superiority against almost all other interventions and against standard care (odds ratio with 95% credibility interval ranging from 0.09 to 0.25 [0.02, 0.98]). CONCLUSION The use of network meta-analysis was reliable to compare different measures of adherence of complex interventions in short-periods follow-up. Analyses with longer follow-up periods are needed to confirm these results. Different measures of adherence produced similar results. The use of composite measures revealed reliable alternatives to establish a broader and more detailed picture of adherence.
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Affiliation(s)
- Fernanda S Tonin
- Pharmaceutical Sciences Postgraduate Programme, Federal University of Paraná, Curitiba, Brazil.
| | - Elyssa Wiecek
- Graduate School of Health, University of Technology Sydney, Australia.
| | | | - Roberto Pontarolo
- Department of Pharmacy, Federal University of Paraná, Curitiba, Brazil.
| | | | - Fernando Fernandez-Llimos
- Research Institute for Medicines (iMed.ULisboa), Department of Social Pharmacy, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal.
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112
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McGillicuddy JW, Taber DJ, Mueller M, Patel S, Baliga PK, Chavin KD, Sox L, Favela AP, Brunner-Jackson BM, Treiber FA. Sustainability of improvements in medication adherence through a mobile health intervention. Prog Transplant 2018; 25:217-23. [PMID: 26308780 DOI: 10.7182/pit2015975] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Context-Very few patient-centered, theory-guided programs for medication adherence and blood pressure control have been conducted in kidney transplant recipients. Objective-To evaluate preliminary indications of sustainability of improved blood pressure in kidney transplant recipients 12 months after completion of a 3-month randomized controlled trial of a mobile health pilot program to improve blood pressure and medication adherence. Participants and Design-A total of 18 of the 19 trial participants were contacted and all consented to inclusion in the retrospective analysis of their medical records showing their clinic-recorded systolic blood pressures at 3, 6, and 12 months following participation in the 3-month trial of a medical regimen self-management intervention. Results-A significant group difference in systolic blood pressure was observed longitudinally, indicating that the intervention group, as compared with the standard-care group, exhibited lower clinic-measured systolic blood pressures at the 12-month posttrial follow-up visit (P= .01). At 12-month follow-up, success in establishing and sustaining control of systolic blood pressure (<131 mm Hg) was greater in the intervention group (50%) than in the control group (11%). Conclusion-Patients in the intervention group continued to exhibit lower systolic blood pressure than did patients in the control group 12 months after the trial ended, suggesting that the intervention may have a durable impact on blood pressure control that most likely reflects sustained medication adherence. These findings will aid in the development of an adequately powered randomized controlled trial to address the sustainable impact of the intervention program on medication adherence and blood pressure control.
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Affiliation(s)
- John W McGillicuddy
- Medical University of South Carolina (JWM, DT, MM, SP, PKB, KDC, LS, AF, BB-J, FAT), College of Charleston (LS, AF), Charleston, South Carolina
| | - David J Taber
- Medical University of South Carolina (JWM, DT, MM, SP, PKB, KDC, LS, AF, BB-J, FAT), College of Charleston (LS, AF), Charleston, South Carolina
| | - Martina Mueller
- Medical University of South Carolina (JWM, DT, MM, SP, PKB, KDC, LS, AF, BB-J, FAT), College of Charleston (LS, AF), Charleston, South Carolina
| | - Sachin Patel
- Medical University of South Carolina (JWM, DT, MM, SP, PKB, KDC, LS, AF, BB-J, FAT), College of Charleston (LS, AF), Charleston, South Carolina
| | - Prabhakar K Baliga
- Medical University of South Carolina (JWM, DT, MM, SP, PKB, KDC, LS, AF, BB-J, FAT), College of Charleston (LS, AF), Charleston, South Carolina
| | - Kenneth D Chavin
- Medical University of South Carolina (JWM, DT, MM, SP, PKB, KDC, LS, AF, BB-J, FAT), College of Charleston (LS, AF), Charleston, South Carolina
| | - Luke Sox
- Medical University of South Carolina (JWM, DT, MM, SP, PKB, KDC, LS, AF, BB-J, FAT), College of Charleston (LS, AF), Charleston, South Carolina
| | - April P Favela
- Medical University of South Carolina (JWM, DT, MM, SP, PKB, KDC, LS, AF, BB-J, FAT), College of Charleston (LS, AF), Charleston, South Carolina
| | - Brenda M Brunner-Jackson
- Medical University of South Carolina (JWM, DT, MM, SP, PKB, KDC, LS, AF, BB-J, FAT), College of Charleston (LS, AF), Charleston, South Carolina
| | - Frank A Treiber
- Medical University of South Carolina (JWM, DT, MM, SP, PKB, KDC, LS, AF, BB-J, FAT), College of Charleston (LS, AF), Charleston, South Carolina
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Foster BJ, Pai ALH, Zelikovsky N, Amaral S, Bell L, Dharnidharka VR, Hebert D, Holly C, Knauper B, Matsell D, Phan V, Rogers R, Smith JM, Zhao H, Furth SL. A Randomized Trial of a Multicomponent Intervention to Promote Medication Adherence: The Teen Adherence in Kidney Transplant Effectiveness of Intervention Trial (TAKE-IT). Am J Kidney Dis 2018; 72:30-41. [PMID: 29602631 DOI: 10.1053/j.ajkd.2017.12.012] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/21/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Poor adherence to immunosuppressive medications is a major cause of premature graft loss among children and young adults. Multicomponent interventions have shown promise but have not been fully evaluated. STUDY DESIGN Unblinded parallel-arm randomized trial to assess the efficacy of a clinic-based adherence-promoting intervention. SETTING & PARTICIPANTS Prevalent kidney transplant recipients 11 to 24 years of age and 3 or more months posttransplantation at 8 kidney transplantation centers in Canada and the United States (February 2012 to May 2016) were included. INTERVENTION Adherence was electronically monitored in all participants during a 3-month run-in, followed by a 12-month intervention. Participants assigned to the TAKE-IT intervention could choose to receive text message, e-mail, and/or visual cue dose reminders and met with a coach at 3-month intervals when adherence data from the prior 3 months were reviewed with the participant. "Action-Focused Problem Solving" was used to address adherence barriers selected as important by the participant. Participants assigned to the control group met with coaches at 3-month intervals but received no feedback about adherence data. OUTCOMES The primary outcomes were electronically measured "taking" adherence (the proportion of prescribed doses of immunosuppressive medications taken) and "timing" adherence (the proportion of doses of immunosuppressive medications taken between 1 hour before and 2 hours after the prescribed time of administration) on each day of observation. Secondary outcomes included the standard deviation of tacrolimus trough concentrations, self-reported adherence, acute rejection, and graft failure. RESULTS 81 patients were assigned to intervention (median age, 15.5 years; 57% male) and 88 to the control group (median age, 15.8 years; 61% male). Electronic adherence data were available for 64 intervention and 74 control participants. Participants in the intervention group had significantly greater odds of taking prescribed medications (OR, 1.66; 95% CI, 1.15-2.39) and taking medications at or near the prescribed time (OR, 1.74; 95% CI, 1.21-2.50) than controls. LIMITATIONS Lack of electronic adherence data for some participants may have introduced bias. There was low statistical power for clinical outcomes. CONCLUSIONS The multicomponent TAKE-IT intervention resulted in significantly better medication adherence than the control condition. Better medication adherence may result in improved graft outcomes, but this will need to be demonstrated in larger studies. TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCT01356277.
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Affiliation(s)
- Bethany J Foster
- Montreal Children's Hospital, McGill University, Montreal, QC, Canada; Department of Pediatrics, McGill University, Montreal, QC, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
| | - Ahna L H Pai
- Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine Cincinnati OH
| | - Nataliya Zelikovsky
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sandra Amaral
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Lorraine Bell
- Montreal Children's Hospital, McGill University, Montreal, QC, Canada; Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Vikas R Dharnidharka
- Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
| | - Diane Hebert
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON
| | - Crystal Holly
- Department of Psychology, University of Ottawa, Ottawa, ON
| | | | - Douglas Matsell
- British Columbia Children's Hospital, University of British Columbia, Vancouver, BC
| | - Veronique Phan
- Centre Hospitalier Universitaire Ste-Justine, Montreal, QC, Canada
| | - Rachel Rogers
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Huaqing Zhao
- Department of Clinical Sciences, Temple University School of Medicine, Philadelphia, PA
| | - Susan L Furth
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
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114
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Sabin LL, Mansfield L, DeSilva MB, Vian T, Li Z, Wubin X, Gifford AL, Barnoon Y, Gill CJ. Why it Worked: Participants' Insights into an mHealth Antiretroviral Therapy Adherence Intervention in China. Open AIDS J 2018; 12:20-37. [PMID: 29576816 PMCID: PMC5850484 DOI: 10.2174/1874613601812010020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/15/2017] [Accepted: 01/15/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Few Antiretroviral Therapy (ART) adherence trials investigate the reasons for intervention success or failure among HIV-positive individuals. Objectives: To conduct qualitative research to explore the reasons for effectiveness of a 6-month mHealth (mobile health) trial that improved adherence among ART patients in China. The intervention utilized Wireless Pill Containers (WPCs) to provide, real-time SMS reminders, WPC-generated adherence reports, and report-informed counseling. Methods: We conducted in-depth interviews with 20 intervention-arm participants immediately following the trial. Sampling was purposeful to ensure inclusion of participants with varied adherence histories. Questions covered adherence barriers and facilitators, and intervention experiences. We analyzed data in nVivo using a thematic approach. Results: Of participants, 14 (70%) were male; 7 (35%) had used injectable drugs. Pre-intervention, 11 were optimal adherers and 9 were suboptimal adherers, using a 95% threshold. In the final intervention month, all but 3 (85%) attained optimal adherence. Participants identified a range of adherence barriers and facilitators, and described various mechanisms for intervention success. Optimal adherers at baseline were motivated by positive adherence reports at monthly clinic visits-similar to receiving A+ grades. For suboptimal adherers, reminders facilitated the establishment of adherence-promoting routines; data-guided counseling helped identify strategies to overcome specific barriers. Conclusion: Different behavioral mechanisms appear to explain the success of an mHealth adherence intervention among patients with varying adherence histories. Positive reinforcement was effective for optimal adherers, while struggling patients benefitted from reminders and data-informed counseling. These findings are relevant for the design and scalability of mHealth interventions and warrant further investigation.
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Affiliation(s)
- Lora L Sabin
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown, 3rd floor, Boston, MA, 02118, USA
| | - Lauren Mansfield
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown, 3rd floor, Boston, MA, 02118, USA
| | | | - Taryn Vian
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown, 3rd floor, Boston, MA, 02118, USA
| | - Zhong Li
- FHI 360, Room B110, Floor 4, Building 1, No.15, Guanghua Road, Chaoyang District, Beijing, 100026, China
| | - Xie Wubin
- Department of Global Health, Milken Institute School of Public Health, George Washington University, 2121 I St NW, Washington, D.C., 20052, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA, 02130, USA.,Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Yiyao Barnoon
- Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Christopher J Gill
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown, 3rd floor, Boston, MA, 02118, USA
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115
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Leenen LAM, Wijnen BFM, Kessels AGH, Chan H, de Kinderen RJA, Evers SMAA, van Heugten CM, Majoie MHJM. Effectiveness of a multicomponent self-management intervention for adults with epilepsy (ZMILE study): A randomized controlled trial. Epilepsy Behav 2018; 80:259-265. [PMID: 29449140 DOI: 10.1016/j.yebeh.2018.01.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The objective of the ZMILE study was to compare the effectiveness of a multicomponent self-management intervention (MCI) with care as usual (CAU) in adult patients with epilepsy (PWE) over a six-month period. METHODS Participants (PWE & relative) were randomized into intervention or CAU groups. Self-report questionnaires were used to measure disease-specific self-efficacy as the primary outcome measure and general self-efficacy, adherence, seizure severity, emotional functioning, quality of life, proactive coping, and side-effects of antiepileptic drugs (AED) as secondary outcome measures. Instruments used at baseline and during a six-month follow-up period were the following: disease-specific self-efficacy (Epilepsy Self-Efficacy Scale [ESES], General Self-Efficacy Scale [GSES]); adherence (Medication Adherence Scale [MARS] and Medication Event Monitoring System [MEMS]); seizure severity (National Hospital Seizure Severity Scale [NHS3]); emotional well-being (Hospital Anxiety and Depression Scale [HADS]); quality of life (Quality of Life in Epilepsy [QOLIE-31P]); proactive coping (Utrecht Proactive Coping Competence [UPCC]); and side-effects of antiepileptic drugs [SIDAED]. Multilevel analyses were performed, and baseline differences were corrected by inclusion of covariates in the analyses. RESULTS In total, 102 PWE were included in the study, 52 of whom were in the intervention group. On the SIDAED and on three of the quality of life subscales QOLIE-31P, a significant difference was found (p<0.05) in the intervention group. Self-efficacy, however, showed no significant differences between the MCI and the CAU groups. None of the other outcome measures showed any significant difference between the two groups. SIGNIFICANCE Although we found no statistically significant difference in the primary outcome measure, disease-specific self-efficacy, this MCI could prove promising, since we found improvement in some domains of quality of life in epilepsy scale and a decrease in AED side-effects in the MCI group compared with the CAU group.
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Affiliation(s)
- Loes A M Leenen
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands; Department of Research & Development, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands; Department of Neurology, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands.
| | - Ben F M Wijnen
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands; Department of Research & Development, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands.
| | - Alfons G H Kessels
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands.
| | - HoiYau Chan
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands.
| | - Reina J A de Kinderen
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Silvia M A A Evers
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Caroline M van Heugten
- School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands; Faculty of Psychology and Neurosciences: Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands.
| | - Marian H J M Majoie
- Department of Research & Development, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands; Department of Neurology, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands; School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands; School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
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Scheel JF, Schieber K, Reber S, Stoessel L, Waldmann E, Jank S, Eckardt KU, Grundmann F, Vitinius F, de Zwaan M, Bertram A, Erim Y. Psychosocial Variables Associated with Immunosuppressive Medication Non-Adherence after Renal Transplantation. Front Psychiatry 2018; 9:23. [PMID: 29497386 PMCID: PMC5818920 DOI: 10.3389/fpsyt.2018.00023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/22/2018] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Non-adherence to immunosuppressive medication is regarded as an important factor for graft rejection and loss after successful renal transplantation. Yet, results on prevalence and relationship with psychosocial parameters are heterogeneous. The main aim of this study was to investigate the association of immunosuppressive medication non-adherence and psychosocial factors. METHODS In 330 adult renal transplant recipients (≥12 months posttransplantation), health-related quality of life, depression, anxiety, social support, and subjective medication experiences were assessed, and their associations with patient-reported non-adherence was evaluated. RESULTS 33.6% of the patients admitted to be partially non-adherent. Non-adherence was associated with younger age, poorer social support, lower mental, but higher physical health-related quality of life. There was no association with depression and anxiety. However, high proportions of clinically relevant depression and anxiety symptoms were apparent in both adherent and non-adherent patients. CONCLUSION In the posttransplant follow-up, kidney recipients with lower perceived social support, lower mental and higher physical health-related quality of life, and younger age can be regarded as a risk group for immunosuppressive medication non-adherence. In follow-up contacts with kidney transplant patients, physicians may pay attention to these factors. Furthermore, psychosocial interventions to optimize immunosuppressive medication adherence can be designed on the basis of this information, especially including subjectively perceived physical health-related quality of life and fostering social support seems to be of importance.
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Affiliation(s)
- Jennifer Felicia Scheel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Katharina Schieber
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sandra Reber
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Lisa Stoessel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Elisabeth Waldmann
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Sabine Jank
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Franziska Grundmann
- Department II of Internal Medicine, Nephrology, Rheumatology, Diabetes and General Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Frank Vitinius
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Cologne, Cologne, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Anna Bertram
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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117
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Duncan S, Annunziato RA, Dunphy C, LaPointe Rudow D, Shneider BL, Shemesh E. A systematic review of immunosuppressant adherence interventions in transplant recipients: Decoding the streetlight effect. Pediatr Transplant 2018; 22:10.1111/petr.13086. [PMID: 29218760 PMCID: PMC5811374 DOI: 10.1111/petr.13086] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 12/23/2022]
Abstract
Non-adherence to immunosuppressant medications is an important risk factor for graft dysfunction. To evaluate the effectiveness of adherence-enhancing interventions, we reviewed adherence intervention studies in solid organ transplant recipients (all ages). Using the following databases: PsycINFO, PubMed, Scopus, and ScienceDirect, we identified 41 eligible studies. Only three non-randomized trials showed a possible positive effect on objective indicators of transplant outcomes (such as rejection, liver enzyme levels, kidney function). None of the 21 RCTs showed an improvement in transplant outcomes. Three studies showed a higher rate of adverse events in the intervention group as compared with controls, although this may be related to ascertainment bias. Improvement in adherence as measured indirectly (eg, with electronic monitoring devices) was not aligned with effects on transplant outcomes. We conclude that adherence interventions, to date, have largely been ineffective in improving transplant outcomes. To improve this track record, intervention efforts may wish to concentrate on non-adherent patients (rather than use convenience sampling, which excludes many of the patients who need the intervention), use direct measures of adherence to guide the interventions, and employ strategies that are intensive and yet engaging enough to ensure that non-adherent patients are able to participate.
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Affiliation(s)
- S Duncan
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY, USA
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - R A Annunziato
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY, USA
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - C Dunphy
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY, USA
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - D LaPointe Rudow
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY, USA
| | - B L Shneider
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - E Shemesh
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY, USA
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Neiman AB, Ruppar T, Ho M, Garber L, Weidle PJ, Hong Y, George MG, Thorpe PG. CDC Grand Rounds: Improving medication adherence for chronic disease management - Innovations and opportunities. Am J Transplant 2018; 18:514-517. [PMID: 29381269 DOI: 10.1111/ajt.14649] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Andrea B Neiman
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA
| | - Todd Ruppar
- Rush University, College of Nursing, Chicago, IL, USA
| | - Michael Ho
- Veteran's Administration Medical Center, Denver, CO, USA.,University of Colorado Denver, Denver, CO, USA
| | | | - Paul J Weidle
- U.S. Public Health Service Commissioned Corps, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, GA, USA
| | - Yuling Hong
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA
| | - Mary G George
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA
| | - Phoebe G Thorpe
- Office of the Associate Director for Science, CDC, Atlanta, GA, USA
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Atthakomol P, Manosroi W, Phanphaisarn A, Phrompaet S, Iammatavee S, Tongprasert S. Comparison of single-dose radial extracorporeal shock wave and local corticosteroid injection for treatment of carpal tunnel syndrome including mid-term efficacy: a prospective randomized controlled trial. BMC Musculoskelet Disord 2018; 19:32. [PMID: 29370788 PMCID: PMC5784684 DOI: 10.1186/s12891-018-1948-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 01/16/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recent studies have reported that radial extracorporeal shock wave therapy (rESWT) reduces pain and improves function in patients with mild to moderately severe carpal tunnel syndrome (CTS) compared to a placebo. However, most of those studies used multi-session rESWT combined with wrist support and evaluation of efficacy was limited to a maximum of 14 weeks. METHODS The prospective randomized controlled trial compared efficacy in relieving pain and improving clinical function between single-dose rESWT and local corticosteroid injection (LCsI) over the mid-term (24 weeks). Twenty-five patients with mild to moderately severe CTS were randomized to receive either single-dose rESWT (n = 13) or LCsI (n = 12). Primary outcomes were evaluated using the Boston self-assessment questionnaire (BQ), while secondary outcomes used the Visual analogue scale (VAS) and electrodiagnostic parameters. Evaluations at baseline and at 1, 4, 12 and 24 weeks after treatment were performed. RESULTS There was significantly greater improvement in symptom severity scores, functional scores and Boston questionnaire scores at weeks 12 to 24 in the rESWT group compared to the LCsI group. When compared to the baseline, there was significant reduction of VAS and functional score in the rESWT group at weeks 12 and 24. The LCsI group had no statistically significant differences in VAS reduction and functional score of the same period. CONCLUSIONS Treatment of CTS using single-dose rESWT has a carry-over effect lasting up to 24 weeks suggesting that single-dose rESWT is appropriate for treatment of mild to moderate CTS and provides longer-lasting benefits than LCsI. TRIAL REGISTRATION ( TCTR20150709001 ). Registered 9 July 2015.
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Affiliation(s)
- Pichitchai Atthakomol
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Worapaka Manosroi
- Division of Endocrinology, Department of Internal Medicine, Bangkok Chiang Mai Hospital, Chiang Mai, Thailand
| | - Areerak Phanphaisarn
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sureeporn Phrompaet
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sawan Iammatavee
- Department of Orthopaedics, Nakornping Hospital, Chiang Mai, Thailand
| | - Siam Tongprasert
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Park K, Cho YR, Park JS, Park TH, Kim MH, Kim YD. Design and Rationale for comParison Between ticagreLor and clopidogrEl on mIcrocirculation in Patients with Acute cOronary Syndrome Undergoing Percutaneous Coronary Intervention (PLEIO) Trial. J Cardiovasc Transl Res 2018; 11:42-49. [PMID: 29344840 PMCID: PMC5846973 DOI: 10.1007/s12265-017-9783-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/28/2017] [Indexed: 11/30/2022]
Abstract
It has been previously demonstrated that ticagrelor can reduce mortality compared to clopidogrel in acute coronary syndrome (ACS) patients. However, the mechanism for this mortality reduction remains uncertain. The objective of the present study is to assess the impact of chronic ticagrelor treatment on microvascular circulation. A total of 120 participants aged 20–85 years with clinical diagnosis of ACS will be randomized in a 1:1 fashion to the following two groups: ticagrelor 90 mg twice daily; clopidogrel 75 mg once daily. To evaluate the status of microcirculation, the primary end point is coronary microvascular dysfunction measured using an index of microcirculatory resistance (IMR) at 6 months after receiving the study agent. The purpose of this trial is to investigate whether ticagrelor, beyond its antiplatelet efficacy, could improve coronary microcirculation more effectively than clopidogrel for patients with ACS.
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Affiliation(s)
- Kyungil Park
- Regional Cardiocerebrovascular Center, Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea.
- Regional Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Daesingongwon 26, Seo-gu, Busan, 49201, Republic of Korea.
| | - Young-Rak Cho
- Regional Cardiocerebrovascular Center, Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Jong-Sung Park
- Regional Cardiocerebrovascular Center, Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Tae-Ho Park
- Regional Cardiocerebrovascular Center, Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Moo-Hyun Kim
- Regional Cardiocerebrovascular Center, Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Young-Dae Kim
- Regional Cardiocerebrovascular Center, Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
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Zaugg V, Korb‐Savoldelli V, Durieux P, Sabatier B. Providing physicians with feedback on medication adherence for people with chronic diseases taking long-term medication. Cochrane Database Syst Rev 2018; 1:CD012042. [PMID: 29320600 PMCID: PMC6491069 DOI: 10.1002/14651858.cd012042.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Poor medication adherence decreases treatment efficacy and worsens clinical outcomes, but average rates of adherence to long-term pharmacological treatments for chronic illnesses are only about 50%. Interventions for improving medication adherence largely focus on patients rather than on physicians; however, the strategies shown to be effective are complex and difficult to implement in clinical practice. There is a need for new care models addressing the problem of medication adherence, integrating this problem into the patient care process. Physicians tend to overestimate how well patients take their medication as prescribed. This can lead to missed opportunities to change medications, solve adverse effects, or propose the use of reminders in order to improve patients' adherence. Thus, providing physicians with feedback on medication adherence has the potential to prompt changes that improve their patients' adherence to prescribed medications. OBJECTIVES To assess the effects of providing physicians with feedback about their patients' medication adherence for improving adherence. We also assessed the effects of the intervention on patient outcomes, health resource use, and processes of care. SEARCH METHODS We conducted a systematic search of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase, all from database inception to December 2016 and without any language restriction. We also searched ISI Web of Science, two trials registers, and grey literature. SELECTION CRITERIA We included randomised trials, controlled before-after studies, and interrupted time series studies that compared the effects of providing feedback to physicians about their patients' adherence to prescribed long-term medications for chronic diseases versus usual care. We included published or unpublished studies in any language. Participants included any physician and any patient prescribed with long-term medication for chronic disease. We included interventions providing the prescribing physician with information about patient adherence to medication. Only studies in which feedback to the physician was the sole intervention or the essential component of a multifaceted intervention were eligible. In the comparison groups, the physicians should not have had access to information about their patients' adherence to medication. We considered the following outcomes: medication adherence, patient outcomes, health resource use, processes of care, and adverse events. DATA COLLECTION AND ANALYSIS Two independent review authors extracted and analysed all data using standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care group. Due to heterogeneity in study methodology, comparison groups, intervention settings, and measurements of outcomes, we did not carry out meta-analysis. We describe the impact of interventions on outcomes in tabular form and make a qualitative assessment of the effects of studies. MAIN RESULTS We included nine studies (23,255 patient participants): eight randomised trials and one interrupted time series analysis. The studies took place in primary care and other outpatient settings in the USA and Canada. Seven interventions involved the systematic provision of feedback to physicians concerning all their patients' adherence to medication, and two interventions involved issuing an alert for non-adherent patients only. Seven studies used pharmacy refill data to assess medication adherence, and two used an electronic device or self-reporting. The definition of adherence differed across studies, making comparisons difficult. Eight studies were at high risk of bias, and one study was at unclear risk of bias. The most frequent source of bias was lack of protection against contamination.Providing physicians with feedback may lead to little or no difference in medication adherence (seven studies, 22,924 patients), patient outcomes (two studies, 1292 patients), or health resource use (two studies, 4181 patients). Providing physicians with feedback on medication adherence may improve processes of care (e.g. more medication changes, dialogue with patient, management of uncontrolled hypertension) compared to usual care (four studies, 2780 patients). None of the studies reported an adverse event due to the intervention. The certainty of evidence was low for all outcomes, mainly due to high risk of bias, high heterogeneity across studies, and indirectness of evidence. AUTHORS' CONCLUSIONS Across nine studies, we observed little or no evidence that provision of feedback to physicians regarding their patients adherence to prescribed medication improved medication adherence, patient outcomes, or health resource use. Feedback about medication adherence may improve processes of care, but due to the small number of studies assessing this outcome and high risk of bias, we cannot draw firm conclusions on the effect of feedback on this outcome. Future research should use a clear, standardised definition of medication adherence and cluster-randomisation to avoid the risk of contamination.
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Affiliation(s)
- Vincent Zaugg
- Georges Pompidou European Hospital, AP‐HPClinical Pharmacy Department20 rue LeblancParisFrance75015
| | - Virginie Korb‐Savoldelli
- Georges Pompidou European Hospital, AP‐HPClinical Pharmacy Department20 rue LeblancParisFrance75015
- Paris Sud UniversityFaculty of PharmacyChatenay‐MalabryFrance
| | - Pierre Durieux
- Georges Pompidou European HospitalDepartment of Public Health and Medical Informatics20 rue LeblancParisFrance75015
- Paris Descartes UniversityParisFrance
| | - Brigitte Sabatier
- Georges Pompidou European Hospital, AP‐HPClinical Pharmacy Department20 rue LeblancParisFrance75015
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Desteghe L, Vijgen J, Koopman P, Dilling-Boer D, Schurmans J, Dendale P, Heidbuchel H. Telemonitoring-based feedback improves adherence to non-vitamin K antagonist oral anticoagulants intake in patients with atrial fibrillation. Eur Heart J 2018; 39:1394-1403. [DOI: 10.1093/eurheartj/ehx762] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 12/11/2017] [Indexed: 01/18/2023] Open
Affiliation(s)
- Lien Desteghe
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Hasselt, Belgium
- Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | - Johan Vijgen
- Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | - Pieter Koopman
- Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | | | - Joris Schurmans
- Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | - Paul Dendale
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Hasselt, Belgium
- Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | - Hein Heidbuchel
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Hasselt, Belgium
- Department of Cardiology University of Antwerp and Antwerp University Hospital, Wilrijkstraat 10, Edegem, Belgium
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Burns A, Webb M, Stynes G, O'Brien T, Rohde D, Strawbridge J, Clancy L, Doyle F. Implementation of a Quit Smoking Programme in Community Adult Mental Health Services-A Qualitative Study. Front Psychiatry 2018; 9:670. [PMID: 30622485 PMCID: PMC6308392 DOI: 10.3389/fpsyt.2018.00670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/20/2018] [Indexed: 01/01/2023] Open
Abstract
Little is known about the experiences of people with severe mental health difficulties in smoking cessation interventions. This study aimed to review the implementation of a smoking cessation programme across 16 community mental health day services. The aim was to establish the experience from both service user and facilitator perspectives and refine implementation for future groups. In-depth interviews were conducted with 20 service users and four focus groups held with 17 facilitators. Thematic analysis was used to analyse the data for emergent themes in relation to key enablers and barriers to implementation. Data from service users and facilitators revealed that implementation was enabled by an open and engaged recruitment approach; the resourcefulness of facilitators; programme materials and group-based format; combining the cessation programme with other and broader health initiatives; and participants' motivations, including health and money. Barriers included the structure of the service; the lack of a joined-up approach across the health services; literacy issues and the serial/logical process assumed by the programme. Barriers perceived as more specific to those with mental health difficulties included the use of smoking as a coping mechanism, lack of alternative activities/structure and lack of consistent determination. The tobacco free policy, implemented shortly before the programme, interestingly emerged as both a barrier and an enabler. In conclusion, although this group-based cessation programme in community mental health settings was well-received overall, a number of key barriers persist. A joined-up approach which addresses the culture of smoking in mental health settings, inconsistencies in smoking policies, and provides consistent cessation support, is needed. Care needs to be taken with the timing as overall it may not be helpful to introduce a new smoking cessation programme at the same time as a tobacco free policy.
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Affiliation(s)
- Annette Burns
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Greg Stynes
- EVE, Health Service Executive, Dublin, Ireland
| | - Tom O'Brien
- EVE, Health Service Executive, Dublin, Ireland
| | - Daniela Rohde
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Luke Clancy
- TobaccoFree Research Institute, Dublin Institute of Technology, Dublin, Ireland
| | - Frank Doyle
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Bajaj HS, Ye C, Jain E, Venn K, Stein E, Aronson R. Glycemic Improvement with a Fixed-dose combination of DPP-4 inhibitor + metformin in patients with Type 2 diabetes (GIFT study). Diabetes Obes Metab 2018. [PMID: 28640433 DOI: 10.1111/dom.13040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study investigates changes in A1C following a switch from dual therapy of metformin and DPP-4 inhibitor to a fixed-dose combination (FDC) of metformin + DPP-4 inhibitor following the introduction of the FDC in the provincial formulary. The LMC Diabetes Registry was queried retrospectively for patients with type 2 diabetes, aged between 18 and 80 years with at least one A1C recorded prior and ≥3 months post-switch. Five hundred and sixty-eight subjects with mean age 64 ± 12 years and mean A1C 7.7% ± 1.2% met study criteria. Overall, A1C was 0.3% lower post-switch to FDC (P < .01). In stratified analysis, subjects with baseline A1C between 7% and 10% had 0.4% lower A1C (P < .01), with 31% of these subjects reaching target A1C ≤7%, post-switch. A1C reduction was greater among patients with a higher baseline pill burden: 0.4% among those using ≥10 pills/day vs. 0.1% for those with <10 pills/day (P = .02). In this real-world study, switching to FDC of metformin + DPP-4 inhibitor was associated with a significant improvement in A1C. Switching to FDC, especially in patients with high pill burden, can improve A1C goal achievement in clinical practice.
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Affiliation(s)
- Harpreet S Bajaj
- LMC Diabetes & Endocrinology, Brampton, Ontario, Canada
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Chenglin Ye
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Esha Jain
- American University of Antigua College of Medicine, Osbourn, Antigua and Barbuda
| | - Karri Venn
- LMC Diabetes and Endocrinology, Toronto, Ontario, Canada
| | - Eden Stein
- LMC Diabetes and Endocrinology, Toronto, Ontario, Canada
| | - Ronnie Aronson
- LMC Diabetes and Endocrinology, Toronto, Ontario, Canada
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Senft Y, Kirsch M, Denhaerynck K, Dobbels F, Helmy R, Russell CL, Berben L, De Geest S. Practice patterns to improve pre and post-transplant medication adherence in heart transplant centres: a secondary data analysis of the international BRIGHT study. Eur J Cardiovasc Nurs 2017; 17:356-367. [PMID: 29231747 DOI: 10.1177/1474515117747577] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As medication non-adherence is a major risk factor for poor post-transplant outcomes, we explored how adherence is assessed, enhanced and integrated across the transplant continuum. AIM The aim of this study was to study practice patterns regarding pre- and post-transplant medication adherence assessment and interventions in international heart transplant centres. METHODS We used data from the Building Research Initiative Group: chronic illness management and adherence in heart transplantation (BRIGHT) study, a cross-sectional study conducted in 36 heart transplant centres in 11 countries. On a 27-item questionnaire, 100 clinicians (range one to five per centre) reported their practice patterns regarding adherence assessment and intervention strategies pre-transplant, immediately post-transplant, less than one year, and one or more year post-transplant. Educational/cognitive, counselling/behavioural and psychosocial/affective strategies were assessed. Clinicians' responses (intervention present vs. absent; or incongruence in reporting intervention) were aggregated at the centre level. RESULTS The adherence assessment method most commonly used along the transplant continuum was questioning patients (range 75-88.9%). Pre-transplant, all three categories of intervention strategy were applied. Providing reading materials (82.9%) or instructions (68.6%), involving family or support persons in education (91.4%), and establishing partnership (91.4%) were used most frequently. Post-transplant, strategies closely resembled those employed pre-transplant. Training patients (during recovery) and cueing were more often applied during hospitalisation (74.3%). After the first year post-transplant, except for motivational interviewing (25.7-28.6%), the number of strategies decreased. CONCLUSIONS Across the transplant continuum, diverse adherence interventions are implemented; however, post-transplant, the frequency of adherence interventions decreases. Therefore, increased investment is necessary in long-term adherence interventions.
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Affiliation(s)
- Yuliya Senft
- 1 Department of Haematology, University Hospital of Basel, Switzerland
| | - Monika Kirsch
- 2 Department of Anesthesiology, University Hospital of Basel, Switzerland
| | - Kris Denhaerynck
- 3 Institute of Nursing Science, University of Basel, Switzerland
| | | | - Remon Helmy
- 3 Institute of Nursing Science, University of Basel, Switzerland
| | - Cynthia L Russell
- 5 School of Nursing and Health Studies, University of Missouri-Kansas City, USA
| | - Lut Berben
- 3 Institute of Nursing Science, University of Basel, Switzerland
| | - Sabina De Geest
- 3 Institute of Nursing Science, University of Basel, Switzerland.,4 Academic Centre for Nursing and Midwifery, KU Leuven, Belgium
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Neiman AB, Ruppar T, Ho M, Garber L, Weidle PJ, Hong Y, George MG, Thorpe PG. CDC Grand Rounds: Improving Medication Adherence for Chronic Disease Management - Innovations and Opportunities. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2017; 66:1248-1251. [PMID: 29145353 PMCID: PMC5726246 DOI: 10.15585/mmwr.mm6645a2] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Forni Ogna V, Bassi I, Menetrey I, Muller O, Tousset E, Fontana P, Eeckhout E, Eap CB, Vrijens B, Burnier M, Wuerzner G. Comparative Long-Term Effect of Three Anti-P2Y12 Drugs after Percutaneous Angioplasty: An Observational Study Based on Electronic Drug Adherence Monitoring. Front Pharmacol 2017; 8:738. [PMID: 29118712 PMCID: PMC5660969 DOI: 10.3389/fphar.2017.00738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/02/2017] [Indexed: 11/13/2022] Open
Abstract
Aims: Dual platelet inhibition using anti-P2Y12 drugs and aspirin is the standard of care in patients after percutaneous coronary interventions (PCI). Prasugrel and ticagrelor have been shown to be more potent than clopidogrel with less high on-treatment platelet reactivity. Whether differences in long-term adherence to these drugs can partly explain different antiplatelet efficacy has not been studied so far. The objective was to compare the long-term P2Y12 receptor inhibition and drug adherence to different anti-P2Y12 drugs, and to assess the impact of adherence on the pharmacodynamic effect. Methods: Monocentric, prospective, observational study. Stable outpatients treated with clopidogrel 75 mg once daily, prasugrel 10 mg once daily or ticagrelor 90 mg twice daily after PCI with stent implantation were included. Drug adherence was recorded during 6 months using electronic monitoring. Platelet responsiveness was assessed with the vasodilator-stimulated phosphoprotein platelet reactivity index (VASP-PRI) at inclusion, 3 and 6 months. Results: 120 patients had VASP-PRI and adherence data available. At 6-months, mean VASP-PRI (±SD) was 17.7 ± 11.0% with ticagrelor, 29.2 ± 15.5% with prasugrel and 47.2 ± 17.6% with clopidogrel (ANOVA, P < 0.0001). Median [IQR] taking adherence was 96 [82-100]% with ticagrelor, 100 [97-101]% with prasugrel and 100 [99-101]% with clopidogrel (p = 0.0001). Median [IQR] correct dosing was 88 [73-95]% with ticagrelor, 97 [92.5-98]% with prasugrel and 98 [96-99]% with clopidogrel (p = 0.0001). Anti-P2Y12 drug (p ≤ 0.001) and diabetes (p = 0.014) emerged as predictors of poor antiplatelet response after adjusting for age, BMI, sex, and CYP2C19∗2 carriers status. Conclusion: Drug adherence to anti-P2Y12 drugs assessed with electronic monitoring was very high. However, anti-P2Y12 drugs showed significant differences in antiplatelet activity, with newer anti-P2Y12 drugs ticagrelor and prasugrel exerting a stronger P2Y12 receptor inhibition. These data suggest that pharmacokinetic-pharmacodynamic differences between oral anti-P2Y12 drugs are more important than adherence in determining antiplatelet efficacy when adherence to prescription is high. The study was registered (Current Controlled Trials ISRCTN85949729).
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Affiliation(s)
- Valentina Forni Ogna
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Isabelle Bassi
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Isabelle Menetrey
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Muller
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Pierre Fontana
- Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland.,Geneva Platelet Group of the Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Eric Eeckhout
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Chin B Eap
- Unit of Biochemistry and Clinical Psychopharmacology, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.,The Geneva-Lausanne School of Pharmacy (EPGL), University of Geneva, Geneva, Switzerland
| | | | - Michel Burnier
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Grégoire Wuerzner
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
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128
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Singleton J, Veach S, Catney C, Witry M. Analysis of a Community Pharmacy Intervention to Improve Low Adherence Rates to Oral Diabetes Medications. PHARMACY 2017; 5:pharmacy5040058. [PMID: 29048348 PMCID: PMC5748539 DOI: 10.3390/pharmacy5040058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/17/2017] [Accepted: 10/13/2017] [Indexed: 12/27/2022] Open
Abstract
For patients with diabetes, suboptimal medication adherence contributes to disease progression, complications, and increased healthcare costs. Identification of, and intervention for patient-identified reasons for nonadherence are essential to improving medication adherence. This prospective, quality improvement study was conducted at an independent community pharmacy in the Mid-West United States. Patients with a proportion of days covered (PDC) for their oral antidiabetic medications of less than 80% were contacted by telephone and interviewed by a clinical pharmacist. The interviews and corresponding adherence interventions were guided by an abbreviated version of the Drug Adherence Work-Up (DRAW©) tool that focused on oral medications for diabetes. The change in PDC 120-days post-interview was assessed to determine the change in adherence rates. Patients receiving the pharmacist-delivered adherence intervention had significantly higher 120 day PDC values which are likely to indicate more regular medication-taking at home. Almost half of study patients signed up for medication synchronization and these patients trended toward higher PDC values, although the relative difference was not statistically significant from those receiving the intervention and not opting to have their medications synchronized.
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Affiliation(s)
- Jerica Singleton
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, PGY1 Community Pharmacy Practice at Time of Study, Iowa City, IA 52242, USA.
| | - Stevie Veach
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA 52242, USA.
| | - Christine Catney
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA 52242, USA.
| | - Matthew Witry
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA 52242, USA.
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van Heuckelum M, van den Ende CHM, Houterman AEJ, Heemskerk CPM, van Dulmen S, van den Bemt BJF. The effect of electronic monitoring feedback on medication adherence and clinical outcomes: A systematic review. PLoS One 2017; 12:e0185453. [PMID: 28991903 PMCID: PMC5633170 DOI: 10.1371/journal.pone.0185453] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 09/13/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study aims to assess the efficacy of Electronic Monitoring Feedback (EMF) as an intervention to improve medication adherence (i.e. dose- or full adherence) and clinical outcomes in adult patients. METHODS A systematic search was performed in Medline, EMBASE, PsycINFO and Web of Science and reported according to the PRISMA guidelines. Randomised controlled trials (RCTs) comparing EMF with usual care were identified to systematically summarise the evidence for use of EMF in improving medication adherence and clinical outcomes. The GRADE approach was used to assess the quality of the body of evidence. RESULTS Of 9,993 initially-identified studies, ten studies (four of high-quality and six of low-quality) were included. The sample size of the studies included varied from 18 to 205 patients. Four of the six studies (66.7%) reported a significant positive effect of EMF on mean dose adherence levels, whereas a significant positive effect of EMF on mean full adherence levels was found in all of the included studies (100%, five out of five of the studies included). A significant positive effect of EMF on clinical outcomes was reported in one of the seven studies included. The overall effect of EMF on mean dose- and full adherence was positive and the overall effect of EMF on clinical outcomes was inconclusive. CONCLUSION Considering the positive effect of EMF on medication adherence, EMF might be a promising intervention to enhance medication adherence. However, the effect of EMF on clinical outcomes was inconclusive. Prior to implementing EMF in clinical practice, future research with high-quality studies (e.g. adequate sample sizes, follow-up periods and no interfering co-interventions) is required to examine the (long-term) efficacy of EMF.
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Affiliation(s)
- Milou van Heuckelum
- Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Cornelia H M van den Ende
- Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anne E J Houterman
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart J F van den Bemt
- Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
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Aymé S, Bockenhauer D, Day S, Devuyst O, Guay-Woodford LM, Ingelfinger JR, Klein JB, Knoers NVAM, Perrone RD, Roberts J, Schaefer F, Torres VE, Cheung M, Wheeler DC, Winkelmayer WC. Common Elements in Rare Kidney Diseases: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2017; 92:796-808. [PMID: 28938953 PMCID: PMC6685068 DOI: 10.1016/j.kint.2017.06.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/22/2017] [Accepted: 06/08/2017] [Indexed: 12/14/2022]
Abstract
Rare kidney diseases encompass at least 150 different conditions, most of which are inherited. Although individual rare kidney diseases raise specific issues, as a group these rare diseases can have overlapping challenges in diagnosis and treatment. These challenges include small numbers of affected patients, unidentified causes of disease, lack of biomarkers for monitoring disease progression, and need for complex care. To address common clinical and patient issues among rare kidney diseases, the KDIGO Controversies Conference entitled, Common Elements in Rare Kidney Diseases, brought together a panel of multidisciplinary clinical providers and patient advocates to address five central issues for rare kidney diseases. These issues encompassed diagnostic challenges, management of kidney functional decline and progression of chronic kidney disease, challenges in clinical study design, translation of advances in research to clinical care, and provision of practical and integrated patient support. Thus, by a process of consensus, guidance for addressing these challenges was developed and is presented here.
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Affiliation(s)
- Ségolène Aymé
- Institut du Cerveau et de la Moelle Épinière, Centre National de la Recherche Scientifique Unite Mixte de Recherche 7225, Institut National de la Santé et de la Recherche Médicale U 1127, Université Pierre et Marie Curie-P6 Unite Mixte de Recherche S 1127, Paris, France
| | - Detlef Bockenhauer
- University College of London Centre for Nephrology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - Simon Day
- Clinical Trials Consulting and Training Limited, Buckingham, UK
| | - Olivier Devuyst
- Institute of Physiology, University of Zurich, Zurich, Switzerland.
| | - Lisa M Guay-Woodford
- Center for Translational Science, Children's National Health System, Washington, DC, USA.
| | - Julie R Ingelfinger
- MassGeneral Hospital for Children at Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Jon B Klein
- Division of Nephrology and Hypertension, The University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Nine V A M Knoers
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ronald D Perrone
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Julia Roberts
- Polycystic Kidney Disease Foundation, Kansas City, Missouri, USA
| | - Franz Schaefer
- Division of Pediatric Nephrology, Centre for Pediatrics and Adolescent Medicine, Heidelberg University Medical Centre, Heidelberg, Germany
| | - Vicente E Torres
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Cheung
- Kidney Disease: Improving Global Outcomes, Brussels, Belgium
| | | | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Liu X, Blaschke T, Thomas B, De Geest S, Jiang S, Gao Y, Li X, Buono EW, Buchanan S, Zhang Z, Huan S. Usability of a Medication Event Reminder Monitor System (MERM) by Providers and Patients to Improve Adherence in the Management of Tuberculosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101115. [PMID: 28946683 PMCID: PMC5664616 DOI: 10.3390/ijerph14101115] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/11/2017] [Accepted: 09/16/2017] [Indexed: 12/27/2022]
Abstract
Poor initiation and implementation and premature discontinuation of anti-tuberculous therapy, all forms of nonadherence, are major reasons for treatment failure, the development of drug-resistant tuberculosis, and transmission to other non-infected individuals. Directly Observed Therapy (DOT) has been the worldwide standard, but implementation of DOT is burdensome for providers and patients, especially in resource-limited settings, where most of the burden of active TB is located. Among the alternatives to DOT is electronic monitoring (EM) of drug dosing histories. Here we report a usability study of a newly-designed, modular electronic monitor product, called the MERM (Medication Event and Reminder Monitor), that is compatible with TB medication formats and supply chains in resource-limited settings. This study, done in a rural setting in China, showed that the use of the MERM for EM of TB medications was associated with a high degree of user performance, acceptability, and satisfaction among both TB patients and medical staff. Based on these data, EM is becoming the standard of care for drug-susceptible TB patients in China and scaled implementations in several other countries with high TB burden have begun. In addition, the MERM is being used in MDR-TB patients and in clinical trials involving patients with TB/HIV and latent TB.
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Affiliation(s)
- Xiaoqiu Liu
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
| | - Terrence Blaschke
- Department of Medicine, Stanford University, Stanford, CA 94305, USA.
| | | | - Sabina De Geest
- Institute of Nursing Science, University of Basel, CH-4056 Basel, Switzerland.
| | - Shiwen Jiang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
| | - Yongxin Gao
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
| | - Xinxu Li
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
| | | | | | | | - Shitong Huan
- Bill and Melinda Gates Foundation, Beijing 100027, China.
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Spratt ES, Papa CE, Mueller M, Patel S, Killeen T, Maher E, Drayton C, Dixon TC, Fowler SL, Treiber F. Using Technology to Improve Adherence to HIV Medications in Transitional Age Youth: Research Reviewed, Methods Tried, Lessons Learned. JOURNAL OF GENERAL MEDICINE (DOVER, DEL.) 2017; 1:1002. [PMID: 30345429 PMCID: PMC6195351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In transitional age youth living with HIV or AIDS, non-adherence (<80%) to anti-retroviral medication is associated with viral resistance, disease progression, and an increased risk of death. This feasibility study investigated the Maya MedMinder electronic pillbox and cell phone texting with personalized motivational interviewing strategies to improve medication adherence in non-adherent youth. Twenty patients out of 30 identified as non-adherent by the Pediatric HIV team at the Medical University of South Carolina were approached, and 15 were recruited (Ages 12 to 20; 13.3% male, 86.7% female; 100% African-American). Following baseline MedMinder monitoring, subjects were randomized to intervention groups with reminder signals on or off. The time medications were taken was collected by the MedMinder, resulting in adherence scores. All were interviewed for readiness to change utilizing the Motivational Interviewing (MI) Stages of Change scores. Viral load and CD4 labs were scheduled every 6 weeks. Despite monetary incentives and personalized support, recruitment and adherence to the protocol was a challenge. Only 6/15 subjects completed the entire study scheduled for 6-months .Stages of change scores revealed that those that transitioned to making changes had higher CD4 percentages midway through the study. Challenges included missed appointments and labs despite efforts by text and phone to schedule convenient appointment times with participants. Device challenges included the large size of the MedMinder and faulty electronic signaling, especially from rural areas. The methodology was feasible with these patients. This small feasibility study highlights that technological tools to promote adherence and motivational enhancement strategies in teens and young adults who are non-adherent to HIV medication regimens can enhance biomarker outcomes associated with medication adherence.
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Affiliation(s)
- E S Spratt
- Department of Pediatrics, Medical University of South Carolina, USA
| | - C E Papa
- Department of Pediatrics, Medical University of South Carolina, USA
| | - M Mueller
- College of Nursing, Medical University of South Carolina, USA
| | - S Patel
- Technology Applications Center for Healthful Lifestyles, Medical University of South Carolina, USA
| | - T Killeen
- Department of Psychiatry, Medical University of South Carolina, USA
| | - E Maher
- Department of Medicine, University of North Carolina, USA
| | - C Drayton
- Department of Pediatrics, Medical University of South Carolina, USA
| | - T C Dixon
- Department of Pediatrics, Medical University of South Carolina, USA
| | - S L Fowler
- Department of Pediatrics, Medical University of South Carolina, USA
| | - F Treiber
- College of Nursing, Medical University of South Carolina, USA
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Oertel LB, Fogerty AE. Use of direct oral anticoagulants for stroke prevention in elderly patients with nonvalvular atrial fibrillation. J Am Assoc Nurse Pract 2017; 29:551-561. [PMID: 28805310 DOI: 10.1002/2327-6924.12494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/13/2017] [Accepted: 06/17/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Lynn B Oertel
- Anticoagulant Management Service, Department of Nursing, Massachusetts General Hospital, Boston, Massachusetts
| | - Annemarie E Fogerty
- Department of Hematology, Massachusetts General Hospital, Boston, Massachusetts
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Allemann SS, Dürsteler KM, Strasser J, Vogel M, Stoeckle M, Hersberger KE, Arnet I. Novel remote electronic medication supply model for opioid-dependent outpatients with polypharmacy--first long-term case study. Harm Reduct J 2017; 14:56. [PMID: 28814330 PMCID: PMC5559800 DOI: 10.1186/s12954-017-0182-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with substance use disorders grow older thanks to effective treatments. Together with a high prevalence of comorbidities, psychological problems, and low social support, these patients are at high risk for medication non-adherence. Established treatment facilities face challenges to accommodate these complex patients within their setting. Electronic medication management aids (e-MMAs) might be appropriate to simultaneously monitor and improve adherence for these patients. CASE PRESENTATION We report the first long-term experiences with a novel remote electronic medication supply model for two opioid-dependent patients with HIV. John (beginning dementia, 52 years, 6 tablets daily at 12 am) and Mary (frequent drug holidays, 48 years, 5-6 tablets daily at 8 pm) suffered from disease progression due to non-adherence. We electronically monitored adherence and clinical outcomes during 659 (John) and 953 (Mary) days between July 2013 and April 2016. Both patients retrieved over 90% of the pouches within 75 min of the scheduled time. Technical problems occurred in 4% (John) and 7.2% (Mary) of retrievals, but on-site support was seldom required. Viral loads fell below detection limits during the entire observation period. CONCLUSIONS Continuous medication supply and persistence with treatment of over 1.7 years, timing adherence of more than 90%, and suppressed HIV viral load are first results supporting the feasibility of the novel supply model for patients on opioid-assisted treatment and polypharmacy.
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Affiliation(s)
- Samuel S Allemann
- Pharmaceutical Care Research Group, Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
| | - Kenneth M Dürsteler
- Division of Addictive Disorders, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Johannes Strasser
- Division of Addictive Disorders, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Marc Vogel
- Division of Addictive Disorders, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Marcel Stoeckle
- Department of Infectious Diseases, University Hospital of Basel, Basel, Switzerland
| | - Kurt E Hersberger
- Pharmaceutical Care Research Group, Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Isabelle Arnet
- Pharmaceutical Care Research Group, Pharmaceutical Sciences, University of Basel, Basel, Switzerland
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Allemann SS, Nieuwlaat R, Navarro T, Haynes B, Hersberger KE, Arnet I. Congruence between patient characteristics and interventions may partly explain medication adherence intervention effectiveness: an analysis of 190 randomized controlled trials from a Cochrane systematic review. J Clin Epidemiol 2017; 91:70-79. [PMID: 28802672 DOI: 10.1016/j.jclinepi.2017.07.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/25/2017] [Accepted: 07/24/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Due to the negative outcomes of medication nonadherence, interventions to improve adherence have been the focus of countless studies. The congruence between adherence-related patient characteristics and interventions may partly explain the variability of effectiveness in medication adherence studies. In their latest update of a Cochrane review reporting inconsistent effects of adherence interventions, the authors offered access to their database for subanalysis. We aimed to use this database to assess congruence between adherence-related patient characteristics and interventions and its association with intervention effects. STUDY DESIGN AND SETTING We developed a congruence score consisting of six features related to inclusion criteria, patient characteristics at baseline, and intervention design. Two independent raters extracted and scored items from the 190 studies available in the Cochrane database. We correlated overall congruence score and individual features with intervention effects regarding adherence and clinical outcomes using Kruskal-Wallis rank sum test and Fisher's exact test. RESULTS Interrater reliability for newly extracted data was almost perfect with a Cohen's Kappa of 0.92 [95% confidence interval (CI) = 0.89-0.94; P < 0.001]. Although present in only six studies, the inclusion of nonadherent patients was the single feature significantly associated with effective adherence interventions (P = 0.003). Moreover, effective adherence interventions were significantly associated with improved clinical outcomes (odds ratio = 6.0; 95% CI = 3.1-12.0; P < 0.0001). However, neither the overall congruence score nor any other individual feature (i.e., "determinants of nonadherence as inclusion criteria," "tailoring of interventions to the inclusion criteria," "reasons for nonadherence assessed at baseline," "adjustment of intervention to individual patient needs," and "theory-based interventions") was significantly associated with intervention effects. CONCLUSION The presence of only six studies that included nonadherent patients and the interdependency of this feature with the remaining five might preclude a conclusive assessment of congruence between patient characteristics and adherence interventions. In order to obtain clinical benefits from effective adherence interventions, we encourage researchers to focus on the inclusion of nonadherent patients.
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Affiliation(s)
- Samuel S Allemann
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland.
| | - Robby Nieuwlaat
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton General Hospital Campus, 237 Barton Street, East Hamilton, ON L8L 2X2, Canada
| | - Tamara Navarro
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton General Hospital Campus, 237 Barton Street, East Hamilton, ON L8L 2X2, Canada
| | - Brian Haynes
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton General Hospital Campus, 237 Barton Street, East Hamilton, ON L8L 2X2, Canada
| | - Kurt E Hersberger
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland
| | - Isabelle Arnet
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland
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Nevins TE, Nickerson PW, Dew MA. Understanding Medication Nonadherence after Kidney Transplant. J Am Soc Nephrol 2017; 28:2290-2301. [PMID: 28630231 PMCID: PMC5533244 DOI: 10.1681/asn.2017020216] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Alloimmunity remains a barrier to long-term graft survival that necessitates lifelong immunosuppressive therapy after renal transplant. Medication nonadherence has been increasingly recognized as a major impediment to achieving effective immunosuppression. Electronic medication monitoring further reveals that nonadherence manifests early after transplant, although the effect is delayed. The etiology of nonadherence is multifactorial, with the strongest risk factors including past nonadherence and being an adolescent or young adult. Other risk factors with smaller but consistently important effects include minority race/ethnicity, poor social supports, and poor perceived health. In children, risk factors related to parental and child psychologic and behavioral functioning and parental distress and burden are also important. Qualitative systematic reviews highlight the need to tailor interventions to each transplant recipient's unique needs, motivations, and barriers rather than offer a one size fits all approach. To date, relatively few interventions have been studied, and most studies conducted were underpowered to allow definitive conclusions. If the kidney transplant community's goal of "one transplant for life" is to become a reality, then solutions for medication nonadherence must be found and implemented.
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Affiliation(s)
- Thomas E. Nevins
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Peter W. Nickerson
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; and
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania
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Desteghe L, Kluts K, Vijgen J, Koopman P, Dilling-Boer D, Schurmans J, Dendale P, Heidbuchel H. The Health Buddies App as a Novel Tool to Improve Adherence and Knowledge in Atrial Fibrillation Patients: A Pilot Study. JMIR Mhealth Uhealth 2017; 5:e98. [PMID: 28724512 PMCID: PMC5541241 DOI: 10.2196/mhealth.7420] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 05/28/2017] [Accepted: 06/13/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) constitutes an important risk for stroke, especially in an ageing population. A new app (Health Buddies) was developed as a tool to improve adherence to non-vitamin K antagonist oral anticoagulants (NOACs) in an elderly AF population by providing a virtual contract with their grandchildren, spelling out daily challenges for both. OBJECTIVE The aim of this pilot study was to assess the feasibility and usability of the Health Buddies app in AF patients. METHODS Two workshops were conducted to steer app development and to test a first prototype. The feasibility of the finalized app was investigated by assessing the number of eligible AF patients (based on current prescription of NOACs, the presence of grandchildren between 5 and 15 years old, availability of a mobile phone, computer, or tablet), and the proportion of those who were willing to participate. Participants had to use the app for 3 months. The motivation of the patients to use the app was assessed based on the number of logins to the app. Their perception of its usefulness was examined by specific questionnaires. Additionally, the effects on knowledge level about AF and its treatment, and adherence to NOAC intake were investigated. RESULTS Out of 830 screened AF patients, 410 were taking NOACs and 114 were eligible for inclusion. However, only 3.7% (15/410) of the total NOAC population or 13.2% of the eligible patients (15/114) were willing to participate. The main reasons for not participating were no interest to participate in general or in the concept in particular (29/99, 29%), not feeling comfortable using technology (22/99, 22%), no interest by the grandchildren or their parents (20/99, 20%), or too busy a lifestyle (12/99, 12%). App use significantly decreased towards the end of the study period in both patients (P=.009) and grandchildren (P<.001). NOAC adherence showed a taking adherence and regimen adherence of 88.6% (SD 15.4) and 81.8% (SD 18.7), respectively. Knowledge level increased from 64.6% (SD 14.7) to 70.4% (SD 10.4) after 3 months (P=.09). The app scored positively on clarity, novelty, stimulation, and attractiveness as measured with the user experience questionnaire. Patients evaluated the educational aspect of this app as a capital gain. CONCLUSIONS Only a small proportion of the current AF population seems eligible for the innovative Health Buddies app in its current form. Although the app was positively rated by its users, a large subset of patients was not willing to participate in this study or to use the app. Efforts have to be made to expand the target group in the future.
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Affiliation(s)
- Lien Desteghe
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Heart Center Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Kiki Kluts
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Johan Vijgen
- Heart Center Hasselt, Jessa Hospital, Hasselt, Belgium
| | | | | | | | - Paul Dendale
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Heart Center Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Hein Heidbuchel
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
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Zullig LL, Mendys P, Bosworth HB. Medication adherence: A practical measurement selection guide using case studies. PATIENT EDUCATION AND COUNSELING 2017; 100:1410-1414. [PMID: 28214168 PMCID: PMC5466489 DOI: 10.1016/j.pec.2017.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 01/31/2017] [Accepted: 02/03/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Medication adherence is a complex problem and can be evaluated using a variety of methods. There is no single or perfect strategy to assess adherence. The "best" measure depends on contextual factors. Our objective is to provide a practical, illustrative guide for selecting the most appropriate measure of medication adherence in common contexts. METHODS We present three case studies - from the perspectives of an academic researcher, health care payer, and clinical care provider - to describe common problems and processes for measuring medication adherence, as well as proposing possible solutions. RESULTS The most appropriate measure will depend on the context (tightly controlled clinical trial setting vs. clinical setting), intended purpose (research vs. clinical), available resources (data, personnel, materials, and funding), time (quick screening vs. comprehensive review), and phase of interest (initiation, implementation, or discontinuation). Framing the problem of medication non-adherence and methods for measuring adherence are discussed using three representative case studies. CONCLUSIONS A simple tool is provided that may help stakeholders interested in medication adherence make decisions regarding the appropriate selection of measures. PRACTICE IMPLICATIONS A medication adherence measure should be selected through the lens of each situation's unique objectives, resources, and needs.
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Affiliation(s)
- Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA; Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA.
| | - Phil Mendys
- Pfizer Inc. Medical Affairs, New York, NY, USA.
| | - Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA; Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA; School of Nursing, Duke University, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.
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Medication adherence outcomes of 771 intervention trials: Systematic review and meta-analysis. Prev Med 2017; 99:269-276. [PMID: 28315760 PMCID: PMC5467216 DOI: 10.1016/j.ypmed.2017.03.008] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/22/2017] [Accepted: 03/12/2017] [Indexed: 11/20/2022]
Abstract
Excellent medication adherence contributes to decreases in morbidity, mortality, and health care costs. Although researchers have tested many interventions to increase adherence, results are sometimes conflicting and often unclear. This systematic review applied meta-analytic procedures to integrate primary research that tested medication adherence interventions. Comprehensive searching completed in 2015 located 771 published and unpublished intervention studies with adherence behavior outcomes. Random-effects model analysis calculated standardized mean difference effect sizes. Meta-analytic moderator analyses examined the association between adherence effect sizes and sample, design, and intervention characteristics. Analyses were conducted in 2016. A standardized mean difference effect size of 0.290 comparing treatment and control groups was calculated. Moderator analyses revealed larger effect sizes for habit-based and behavioral-targeted (vs. cognitive-focused) interventions. The most effective interventions were delivered face-to-face, by pharmacists, and administered directly to patients. Effect sizes were smaller in studies with older and homeless participants. Risks of bias were common; effect sizes were significantly lower among studies with masked data collectors and intention-to-treat analyses. The largest effect sizes were reported by studies using medication electronic event monitoring and pill count medication adherence measures. Publication bias was present. This most comprehensive review to date documented that, although interventions can increase adherence, much room remains for improvement. Findings suggest health care providers should focus intervention content on behavioral strategies, especially habit-based interventions, more so than cognitive strategies designed to change knowledge and beliefs.
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Tappenden P, Sadler S, Wildman M. An Early Health Economic Analysis of the Potential Cost Effectiveness of an Adherence Intervention to Improve Outcomes for Patients with Cystic Fibrosis. PHARMACOECONOMICS 2017; 35:647-659. [PMID: 28337719 DOI: 10.1007/s40273-017-0500-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) negatively impacts upon health-related quality of life and survival. Adherence to nebulised treatments is low; improving adherence is hypothesised to reduce rates of exacerbation requiring intravenous antibiotics and lung function decline. OBJECTIVE A state transition model was developed to assess the cost effectiveness of an intervention aimed at increasing patient adherence to nebulised and inhaled antibiotics compared with current CF care, in advance of the forthcoming CFHealthHub randomised controlled trial (RCT). METHODS The model estimated the costs and health outcomes for each option from the perspective of the UK National Health Service and Personal Social Services over a lifetime horizon. Health gains were valued in terms of quality-adjusted life-years (QALYs) gained. Forced expiratory volume in 1 second (FEV1) trajectories were predicted over three lung function strata: (1) FEV1 ≥70%, (2) FEV1 40-69% and (3) FEV1 <40%. Additional states were included to represent 'post-lung transplantation' and 'dead'. The model was populated using CF Registry data, literature and expert opinion. Costs were presented at 2016 values. Uncertainty was assessed using deterministic and probabilistic sensitivity analyses. RESULTS If effective, the adherence intervention is expected to produce an additional 0.19 QALYs and cost savings of £64,078 per patient. Across all analyses, the intervention dominated current care. Over a 5-year period, the intervention is expected to generate cost savings of £49.5 million for the estimated 2979 patients with CF with Pseudomonas aeruginosa currently aged ≥16 years in the UK. If applied to a broader population of adult patients with CF receiving any nebulised therapy, the expected savings could be considerably greater. CONCLUSIONS If effective, the adherence intervention is expected to produce additional health gains at a lower cost than current CF care. However, the economic analysis should be revisited upon completion of the full RCT. More generally, the analysis suggests that considerable gains could be accrued through the implementation of adherence interventions that shift care from expensive hospital-based rescue to community-based prevention.
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Affiliation(s)
- Paul Tappenden
- ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, England, UK.
| | - Susannah Sadler
- ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, England, UK
| | - Martin Wildman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England, UK
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Ekman I, Wolf A, Vaughan Dickson V, Bosworth HB, Granger BB. Unmet expectations of medications and care providers among patients with heart failure assessed to be poorly adherent: results from the Chronic Heart Failure Intervention to Improve MEdication Adherence (CHIME) study. Eur J Cardiovasc Nurs 2017; 16:646-654. [DOI: 10.1177/1474515117707669] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Axel Wolf
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | | | - Hayden B Bosworth
- Center for Health Services Research in Primary Care and Research, VA Medical Center, USA
- Duke University School of Nursing, Durham, NC, USA
- Department of Medicine, Duke University, USA
| | - Bradi B Granger
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Duke University School of Nursing, Durham, NC, USA
- Duke University Health Systems, Durham, NC, USA
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Zhu Y, Zhou Y, Zhang L, Zhang J, Lin J. Efficacy of interventions for adherence to the immunosuppressive therapy in kidney transplant recipients: a meta-analysis and systematic review. J Investig Med 2017; 65:1049-1056. [PMID: 28483983 PMCID: PMC5847104 DOI: 10.1136/jim-2016-000265] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2017] [Indexed: 01/23/2023]
Abstract
Immunosuppressive treatment regimens are complex and require ongoing self-management. Medication adherence can be difficult to achieve for several reasons. The current meta-analysis and systematic review investigated whether adherence interventions improved immunosuppressive treatment adherence in kidney transplant recipients. Medline, Cochrane, EMBASE, and Google Scholar were searched until October 17, 2016 using the following search terms: kidney transplantation, compliance, adherence, and immunosuppressive therapy. Randomized controlled trials and two-arm prospective, retrospective, and cohort studies were included. The primary outcomes were adherence rate and adherence score. Eight studies were included with a total for 546 patients. Among participants receiving intervention, the adherence rate was significantly higher than the control group (pooled OR=2.366, 95% CI 1.222 to 4.578, p=0.011). Participants in the intervention group had greater adherence scores than those in the control group (pooled standardized difference in means =1.706, 95% CI 0.346 to 3.065, p=0.014). Sensitivity analysis indicated that findings for adherence rate were robust. However, for adherence score, the significance of the association disappeared after removing one of the studies indicating the findings may have been overly influenced by this one study. Intervention programs designed to increase immunosuppressive adherence in patients with kidney transplant improve treatment adherence.
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Affiliation(s)
- Yichen Zhu
- Department of Urology, Capital Medical University Beijing Friendship Hospital, Beijing, China.,Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation, Beijing, China
| | - Yifan Zhou
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Lei Zhang
- Department of Urology, Capital Medical University Beijing Friendship Hospital, Beijing, China.,Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation, Beijing, China
| | - Jian Zhang
- Department of Urology, Capital Medical University Beijing Friendship Hospital, Beijing, China.,Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation, Beijing, China
| | - Jun Lin
- Department of Urology, Capital Medical University Beijing Friendship Hospital, Beijing, China.,Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation, Beijing, China
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Treatment Adherence Intervention Studies in Dermatology and Guidance on How to Support Adherence. Am J Clin Dermatol 2017; 18:253-271. [PMID: 28188596 DOI: 10.1007/s40257-017-0253-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Adequate adherence to prescribed treatment regimens can help to break the cycle of treatment failure, disease progression and subsequent treatment escalation. Unfortunately, adherence in the treatment of skin disorders such as acne, atopic dermatitis/eczema and psoriasis is often inadequate. A review of the literature identified a number of studies that tested an intervention to improve adherence in dermatology, including the following: electronic messages and/or reminders; more frequent or 'extra' clinic visits; audio-visual and internet-based interventions; and patient support programmes and/or self-management, educational training programmes. While there is no one solution or action for improving adherence, some interventions were more successful than others. We provide practical guidance on how to support adherence based on aspects of the successful interventions identified and on our collective opinion and clinical practice experience. Holding patients accountable, providing a caring and supportive environment, raising awareness of poor adherence and helping patients build a solid medication-taking habit can help to improve adherence so that patients can experience maximal treatment benefits and desired clinical outcomes.
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Cropsey KL, Hendricks PS, Schiavon S, Sellers A, Froelich M, Shelton RC, Carpenter MJ. A pilot trial of In vivo NRT sampling to increase medication adherence in community corrections smokers. Addict Behav 2017; 67:92-99. [PMID: 28063325 DOI: 10.1016/j.addbeh.2016.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/13/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Individuals in the criminal justice system demonstrate high rates of cigarette use (70-80%) and low adherence to smoking cessation medication. Educational approaches have not been shown to promote adherence or cessation, though medication sampling has boosted both use and cessation. The objective of the present study was to determine whether In vivo nicotine replacement therapy (NRT) sampling approach increases NRT adherence among criminal justice smokers during a subsequent quit attempt. METHODS We conducted a pilot study with 43 community corrections smokers randomized to a 4-session (one 30-min session per week) precessation intervention of either In vivo NRT sampling (Session 1: patch; Session 2: gum; Session 3: combination NRT (cNRT); Session 4: review) vs. 4 time-matched sessions of standard smoking cessation with cNRT started after Session 1. Both groups received an additional 8weeks of cNRT following the four intervention sessions. RESULTS During the in vivo administration of NRT, total withdrawal and craving severity significantly decreased from pre- to post-session compared to Control participants. In vivo participants evinced greater patch use at Session 4 and greater gum use through Week 8 relative to Controls. DISCUSSION In vivo NRT sampling may increase NRT adherence relative to standard counseling sessions among criminal justice smokers. A larger trial of this novel intervention appears to be warranted.
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Jörntén-Karlsson M, Pintat S, Molloy-Bland M, Berg S, Ahlqvist M. Patient-Centered Interventions to Improve Adherence to Statins: A Narrative Synthesis of Systematically Identified Studies. Drugs 2017; 76:1447-1465. [PMID: 27677773 PMCID: PMC5047948 DOI: 10.1007/s40265-016-0640-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Poor adherence to statins increases cardiovascular disease risk. We systematically identified 32 controlled studies that assessed patient-centered interventions designed to improve statin adherence. The limited number of studies and variation in study characteristics precluded strict quality criteria or meta-analysis. Cognitive education or behavioural counselling delivered face-to-face multiple times consistently improved statin adherence compared with control groups (7/8 and 3/3 studies, respectively). None of four studies using medication reminders and/or adherence feedback alone reported significantly improved statin adherence. Single interventions that improved statin adherence but were not conducted face-to-face included cognitive education in the form of genetic test results (two studies) and cognitive education via a website (one study). Similar mean adherence measures were reported for 17 intervention arms and were thus compared in a sub-analysis: 8 showed significantly improved statin adherence, but effect sizes were modest (+7 to +22 % points). In three of these studies, statin adherence improved despite already being high in the control group (82-89 vs. 57-69 % in the other studies). These three studies were the only studies in this sub-analysis to include cognitive education delivered face-to-face multiple times (plus other interventions). In summary, the most consistently effective interventions for improving adherence to statins have modest effects and are resource-intensive. Research is needed to determine whether modern communications, particularly mobile health platforms (recently shown to improve medication adherence in other chronic diseases), can replicate or even enhance the successful elements of these interventions while using less time and fewer resources.
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Affiliation(s)
| | | | - Michael Molloy-Bland
- Research Evaluation Unit, Oxford PharmaGenesis, Oxford, UK
- School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
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147
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Haberer JE, Sabin L, Amico KR, Orrell C, Galárraga O, Tsai AC, Vreeman RC, Wilson I, Sam‐Agudu NA, Blaschke TF, Vrijens B, Mellins CA, Remien RH, Weiser SD, Lowenthal E, Stirratt MJ, Sow PS, Thomas B, Ford N, Mills E, Lester R, Nachega JB, Bwana BM, Ssewamala F, Mbuagbaw L, Munderi P, Geng E, Bangsberg DR. Improving antiretroviral therapy adherence in resource-limited settings at scale: a discussion of interventions and recommendations. J Int AIDS Soc 2017; 20:21371. [PMID: 28630651 PMCID: PMC5467606 DOI: 10.7448/ias.20.1.21371] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 02/24/2017] [Indexed: 01/01/2023] Open
Abstract
Introduction: Successful population-level antiretroviral therapy (ART) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale-up and, ultimately, the end of AIDS. Although many people living with HIV are adhering well, others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy. Despite the importance of ART adherence, supportive interventions have generally not been implemented at scale. The objective of this review is to summarize the recommendations of clinical, research, and public health experts for scalable ART adherence interventions in resource-limited settings. Methods: In July 2015, the Bill and Melinda Gates Foundation convened a meeting to discuss the most promising ART adherence interventions for use at scale in resource-limited settings. This article summarizes that discussion with recent updates. It is not a systematic review, but rather provides practical considerations for programme implementation based on evidence from individual studies, systematic reviews, meta-analyses, and the World Health Organization Consolidated Guidelines for HIV, which include evidence from randomized controlled trials in low- and middle-income countries. Interventions are categorized broadly as education and counselling; information and communication technology-enhanced solutions; healthcare delivery restructuring; and economic incentives and social protection interventions. Each category is discussed, including descriptions of interventions, current evidence for effectiveness, and what appears promising for the near future. Approaches to intervention implementation and impact assessment are then described. Results and discussion: The evidence base is promising for currently available, effective, and scalable ART adherence interventions for resource-limited settings. Numerous interventions build on existing health care infrastructure and leverage available resources. Those most widely studied and implemented to date involve peer counselling, adherence clubs, and short message service (SMS). Many additional interventions could have an important impact on ART adherence with further development, including standardized counselling through multi-media technology, electronic dose monitoring, decentralized and differentiated models of care, and livelihood interventions. Optimal targeting and tailoring of interventions will require improved adherence measurement. Conclusions: The opportunity exists today to address and resolve many of the challenges to effective ART adherence, so that they do not limit the potential of ART to help bring about the end of AIDS.
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Affiliation(s)
- Jessica E. Haberer
- Massachusetts General Hospital Global Health, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Lora Sabin
- Department of Global Health, Center for Global Health and Department, Boston University School of Public Health, Boston, MA, USA
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Catherine Orrell
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Omar Galárraga
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Alexander C. Tsai
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Rachel C. Vreeman
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ira Wilson
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Nadia A. Sam‐Agudu
- Clinical Department, Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Terrence F. Blaschke
- Department of Medicine and Clinical Pharmacology, Stanford University School of Medicine, Stanford, CA, USA
| | - Bernard Vrijens
- Department of Biostatistics, University of Liège, Liège, Wallonia, Belgium
- WestRock Healthcare, Sion, Switzerland
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, NYSPI and Department of Psychiatry, Columbia; University, New York, NY, USA
| | - Robert H. Remien
- HIV Center for Clinical and Behavioral Studies, NYSPI and Department of Psychiatry, Columbia; University, New York, NY, USA
| | - Sheri D. Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Elizabeth Lowenthal
- Departments of Pediatrics and Epidemiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Michael J. Stirratt
- Division of AIDS Research, National Institute of Mental Health, Bethesda, MD, USA
| | - Papa Salif Sow
- Bill and Melinda Gates Foundation, Seattle, WA, USA
- Department of Infectious diseases, University of Dakar, Dakar, Sénégal
| | | | - Nathan Ford
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Edward Mills
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard Lester
- Division of Infectious Diseases, Department of Medicine, University of British Columbia
| | - Jean B. Nachega
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Bosco Mwebesa Bwana
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Fred Ssewamala
- Columbia University School of Social Work & School of International and Public Affairs, New York, NY, USA
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Paula Munderi
- HIV Care Research Program, Medical Research Council, Uganda Virus Research Institute, Entebbe, Uganda
| | - Elvin Geng
- Division of HIV, Infectious Disease and Global Medicine, San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA
| | - David R. Bangsberg
- Oregon Health & Sciences University‐Portland State University School of Public Health, Portland, OR, USA
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Spoelstra SL, Sansoucie H. Putting evidence into practice: evidence-based interventions for oral agents for cancer. Clin J Oncol Nurs 2017; 19:60-72. [PMID: 26030394 DOI: 10.1188/15.s1.cjon.60-72] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The limited evidence available suggests that adherence to oral agents for cancer is a significant clinical problem and may have a substantial impact on treatment success or failure. Adherence is a difficult issue among patients who are very sick with a life-threatening disease who often must adhere to complex treatment protocols independently at home. OBJECTIVES This article aims to identify effective interventions for the promotion, treatment, and management of adherence to oral agents for cancer and to synthesize the literature for use in clinical practice. METHODS As part of the Oncology Nursing Society (ONS) Putting Evidence Into Practice (PEP) initiative, a comprehensive examination of the current literature was conducted to identify effective interventions for patients prescribed oral agents for cancer. The ONS PEP weight-of-evidence classification schema levels of evidence were used to categorize interventions to assist nurses in identifying strategies that are effective at improving adherence. FINDINGS The majority of evidence found was conducted in conditions other than cancer; therefore, research is needed to identify whether these interventions are effective at promoting adherence in patients with cancer.
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A Systematic Review of Randomized Controlled Trials of Medication Adherence Interventions in Adult Stroke Survivors. J Neurosci Nurs 2017; 49:120-133. [PMID: 28234660 DOI: 10.1097/jnn.0000000000000266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Stroke survivors are at an increased risk for recurrent stroke. Despite recommendations to avoid recurrence from the American Heart Association/American Stroke Association, medication adherence (MA) in persons with chronic conditions such as stroke is only 50%. PURPOSE The aim of this study was to synthesize randomized controlled trial intervention studies designed to increase MA in adult stroke survivors. SEARCH METHODS The Cumulative Index of Nursing and Allied Health Literature, PsycINFO, PubMed, and Excerpta Medica database from January 1, 2009, to December 31, 2015, were searched. STUDY SELECTION This study reviewed randomized controlled trials evaluating MA interventions in stroke survivors. DATA EXTRACTION Two reviewers independently assessed all full-text articles, and those not meeting the inclusion criteria by both researchers were excluded. RESULTS This review included 18 studies involving 10 292 participants. Overall, the strength of the included studies was strong. Statistically significant results were reported in 5 of the 18 (28%) studies. Of these, 3 used cognitive/behavioral interventions to increase MA, whereas 2 studies used an educational-based intervention. CONCLUSIONS Despite some isolated success, most MA interventions in stroke survivors do not show statistically significant improvement. Future MA research must address the lack of consistent use of objective measurement tools and focus on the long-term benefits of MA interventions.
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150
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Dima AL, van Ganse E, Laforest L, Texier N, de Bruin M. Measuring medication adherence in asthma: Development of a novel self-report tool. Psychol Health 2017; 32:1288-1307. [PMID: 28276742 DOI: 10.1080/08870446.2017.1290248] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE This study presents the development and validation of MIS-A (Medication Intake Survey-Asthma), a new self-report instrument measuring key adherence properties during long-term asthma treatment. DESIGN Within a longitudinal asthma cohort study in France and the United Kingdom, adult patients and caregivers of children responded to computer-assisted telephone interviews. MAIN OUTCOME MEASURES Scores for distinct adherence properties (taking adherence, correct dosing, therapeutic coverage, drug holidays, overuse) and composite measures were computed for several time intervals. We examined distributions, longitudinal variation, associations between adherence scores and concordance with adherence calculated from medication prescribing or dispensing records. RESULTS Nine hundred and two participants reported on adherence to 4481 medications on 4140 occasions. About 59.47 and 70.36% revealed < 100% taking adherence in the last week and month; 42.76% had a drug holiday of > 1 week in the last 4 months. Adherence varied within patients during the follow-up (intra-class correlation = . 41-.71). Correlations between adherence scores were moderate to strong (ρ = .51-.85, p ≤ .001), except medication overuse (ρ = .04-.19, p ≤.05). Four-month taking adherence was associated with dispensing adherence, but not with prescribing adherence (ρ = .33, p < .001; and .12, p = .26). CONCLUSION MIS-A is a promising, easy-to-use self-report tool that can capture accurately different adherence properties over a long time period.
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Affiliation(s)
- Alexandra L Dima
- a Amsterdam School of Communication Research ASCoR, University of Amsterdam , The Netherlands
| | - Eric van Ganse
- b Health Services and Performance Research (HESPER), Faculte d'Odontologie, Claude Bernard University , Lyon , France.,c Pharmacoepidemiology Lyon (PELyon) , Lyon , France.,d Respiratory Medicine, Croix-Rousse University Hospital , Lyon , France
| | - Laurent Laforest
- b Health Services and Performance Research (HESPER), Faculte d'Odontologie, Claude Bernard University , Lyon , France
| | | | - Marijn de Bruin
- a Amsterdam School of Communication Research ASCoR, University of Amsterdam , The Netherlands.,f Aberdeen Health Psychology Group, Institute of Applied Health Sciences , University of Aberdeen , Aberdeen , UK
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